Search results for: minimally invasive lumbar discectomy

Authors: Ravneet Kaur, Joydeep Acharya, Sudhanshu Gaur

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Artificial Intelligence (AI) has the potential to transform manufacturing by improving shop floor processes such as production, maintenance and quality. However, industrial datasets are notoriously difficult to extract in a real-time, streaming fashion thus, negating potential AI benefits. The main example is some specialized industrial controllers that are operated by custom software which complicates the process of connecting them to an Information Technology (IT) based data acquisition network. Security concerns may also limit direct physical access to these controllers for data acquisition. To connect the Operational Technology (OT) data stored in these controllers to an AI application in a secure, reliable and available way, we propose a novel Industrial IoT (IIoT) solution in this paper. In this solution, we demonstrate how video cameras can be installed in a factory shop floor to continuously obtain images of the controller HMIs. We propose image pre-processing to segment the HMI into regions of streaming data and regions of fixed meta-data. We then evaluate the performance of multiple Optical Character Recognition (OCR) technologies such as Tesseract and Google vision to recognize the streaming data and test it for typical factory HMIs and realistic lighting conditions. Finally, we use the meta-data to match the OCR output with the temporal, domain-dependent context of the data to improve the accuracy of the output. Our IIoT solution enables reliable and efficient data extraction which will improve the performance of subsequent AI applications.

Keywords: human machine interface, industrial internet of things, internet of things, optical character recognition, video analytics

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Authors: Sanjeewa Seneviratne, Ian Campbell, Nina Scott, Ross Lawrenson

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Introduction: Indigenous Māori women experience a 60% higher breast cancer mortality rate compared with European women in New Zealand. We explored the impact of difference in the rate of screen detected breast cancer between Māori and European women on more advanced disease at diagnosis and lower survival in Māori women. Methods: All primary in-situ and invasive breast cancers diagnosed in screening age women (as defined by the New Zealand National Breast Cancer Screening Programme) between 1999 and 2012 in the Waikato area were identified from the Waikato Breast Cancer Register and the national screening database. Association between screen versus non-screen detection and cancer stage at diagnosis and survival were compared by ethnicity and socioeconomic deprivation. Results: Māori women had 50% higher odds of being diagnosed with more advance staged cancer compared with NZ European women, a half of which was explained by the lower rate of screen detected cancer in Māori women. Significantly lower breast cancer survival rates were observed for Māori compared with NZ European and most deprived compared with most affluent socioeconomic groups for symptomatically detected breast cancer. No significant survival differences by ethnicity or socioeconomic deprivation were observed for screen detected breast cancer. Conclusions: Low rate of screen detected breast cancer appears to be a major contributor for more advanced stage disease at diagnosis and lower breast cancer survival in Māori compared with NZ European women. Increasing screening participation for Māori has the potential to substantially reduce breast cancer mortality inequity between Māori and NZ European women.

Keywords: breast cancer, screening, ethnicity, inequity

Procedia PDF Downloads 485

Authors: H. Hadjeris, R. B. Ghoul, Lekhlaf, M. Nebbal

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Introduction: Adenoid cystic carcinomas of the lacrimal gland or orbital cylindroma constitute the second cause of epithelial tumors of this gland. It is a malignant tumor usually developed at the expense of the salivary glands; its orbital location is exceptional. It is a rare clinical entity, formidable by its malignancy and local aggressiveness; the recurrence rate is high. Materials and methods: Clinical case: 63 years old woman who presents with irreducible no pulsatile painful left exophthalmos with inflammatory chemosis and a decrease in visual acuity with a moderate intracranial hypertension syndrome that has been evolving for 03 months. Antecedent; a biopsy of the tumor was made; the histological examination was in favor of an adenoid cystic carcinoma of the lacrimal gland. Lesion assessment: computed tomography and brain MRI: show an intra and extra-conical mass; with sinus (ethmoido-frontal) and cerebral (left frontal) extension strongly enhanced after injection of contrast product surrounded by edema around the lesion, associated with left frontal bone lysis extension assessment: unremarkable treatment: Patient operated by left frontotemporal approach, a total exenteration was performed with macroscopically complete excision of the frontal lesion and wide frontal craniectomy with craniofacial reconstruction, followed by complementary radiotherapy. Results: The patient was seen again after 3 months in consultation; she does not present any signs in favor of a recurrence. Conclusion: Adenoid cystic carcinomas of the lacrimal gland are rare malignant tumors; they are very infiltrating and invasive. The prognosis is strongly linked to the treatment time.

Keywords: adenoid cystic, lacrimal gland, orbital location, fronto-temporal approac

Procedia PDF Downloads 45

Authors: Marilena Ianculescu, Adriana Alexandru

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Internet of Health Things (IoHT) has already proved to be a persuasive means to support a proper assessment of the living conditions by collecting a huge variety of data. For a customized health management of a senior patient, IoHT provides the capacity to build a dynamic solution for sustaining the shift inside the patient-physician relationship by allowing a real-time and continuous remote monitoring of the health status, well-being, safety and activities of the senior, especially in a non-clinical environment. Thus, is created a win-win solution in which both the patient and the physician enhance their involvement and shared decision-making, with significant outcomes. Health monitoring systems in smart environments are becoming a viable alternative to traditional healthcare solutions. The ongoing “Non-invasive monitoring and health assessment of the elderly in a smart environment (RO-SmartAgeing)” project aims to demonstrate that the existence of complete and accurate information is critical for assessing the health condition of the seniors, improving wellbeing and quality of life in relation to health. The researches performed inside the project aim to highlight how the management of IoHT devices connected to the RO-SmartAgeing platform in a secure way by using a role-based access control system, can allow the physicians to provide health services at a high level of efficiency and accessibility, which were previously only available in hospitals. The project aims to identify deficient aspects in the provision of health services tailored to a senior patient’s specificity and to offer a more comprehensive perspective of proactive and preventive medical acts.

Keywords: health management, internet of health things, remote monitoring, senior patient

Procedia PDF Downloads 83

Authors: Dorina Rusu, Emil Ghiocel Ioanid, Marta Ursescu, Ana Maria Vlad, Mihaela Popescu

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During the last decades the cold plasma discharges made the subject of numerous studies concerning the applications in the cultural heritage field, especially concentrated on ecological and non-invasive aspect of these conservation procedures. The conservation treatment using cold plasma is based, on the one hand, on the well-known property of plasma discharges to inactivate the contaminant biological species and, on the other hand, on the surface cleaning effect. Moreover the plasma discharge produces the functionalization of the treated surface, allowing subsequent deposition of protective layers. The paper presents the behavior of printing inks on historical documents treated in cold RF plasma. Two types of printing inks were studied, namely red and black ink, used on a religious book published in 19 century. SEM-EDX analysis results in the identification of the two inks as carbon black ink (C presence in the EDX spectrum) and cinnabar based red ink (Hg and S lines in the spectrum), result confirmed by XRF analysis. The experiments have been performed on paper samples written with laboratory- made inks, of similar composition with the inks identified on historical documents. The samples were subjected to RF plasma discharge, operating in nitrogen gaseous medium, at 1.2 MHz frequency and low-pressure (0.5 mbar), performed in a self-designed equipment for the application of conservation treatments on naturally aged paper supports. The impact of plasma discharge on the inks has been evaluated by SEM, XRD and color analysis. The color analysis revealed a slight discoloration of cinnabar ink on the historical document. SEM and XRD analyses have been carried out in an attempt to elucidate the process responsable for color modification.

Keywords: RF plasma, printing inks, historical documents, surface cleaning effect

Procedia PDF Downloads 417

Authors: Henry Kuppen

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In the last decade, tree managers have faced many threats of pests and diseases and the effects of climate change. Managers will recognize that they have to put more energy and more money into tree management. By recognizing the cause behind this, the opportunity will arise to build sustainable tree populations for the future. More and more, unwanted larvae are sprayed, ash dieback infected trees are pruned or felled, and emerald ash borer is knocking at the door of West Europe. A lot of specific knowledge is needed to produce management plans and best practices. If pest and disease have a large impact, society loses complete tree species and need to start all over again building urban forest. But looking at the cause behind it, landscape design, and tree species selection, the sustainable solution does not present itself in managing these threats. Every pest or disease needs two important basic ingredients to be successful: climate and food. The changing climate is helping several invasive pathogens to survive. Food is often designed by the landscapers and managers of the urban forest. Monocultures promote the success of pathogens. By looking more closely at the basics, tree managers will realise very soon that the solution will not be the management of pathogens. The long-term solution for sustainable tree populations is a different design of our urban landscape. The use of tree species diversity can help to reduce the impact of climate change and pathogens. Therefore landscapers need to be supported. They are the specialists in designing the landscape using design values like canopy volume, ecosystem services, and seasonal experience. It’s up to the species specialist to show what the opportunities are for different species that meet the desired interpretation of the landscape. Based on landscapers' criteria, selections can be made, including tree species related requirements. Through this collaboration and formation of integral teams, sustainable plant design will be possible.

Keywords: climate change, landscape design, resilient landscape, tree species selection

Procedia PDF Downloads 91

Authors: Amel Osman, Stewart McKenna

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Aim: Fever may present as the sole sign of a serious underlying infection in young infants. Febrile Infants aged less than 90 days are at an elevated susceptibility to invasive bacterial infections, thus presenting a challenge in ensuring the appropriate management of these cases. This study aims to ensure strict adherence to NICE guidelines for the management of fever in infants between 0 and 90 days presenting to Tallaght Hospital ED. A comprehensive audit, followed by a re-audit, was conducted to enhance the quality of care delivered to these patients. In accordance with NICE guidelines, all febrile infants should undergo blood tests. Additionally, LP should be performed in all neonates under 28 days, infants displaying signs of illness, and those with WCC below 5 or above 15. Method: A retrospective case review was performed, encompassing all patients aged between 0 to 90 days who presented with fever at Tallaght ED. Data retrieval was conducted from electronic records on two separate occasions, six months apart. The evaluation encompassed the assessment of body temperature as well as both partial and full septic workups. Results: Over the study period, 150 infants presented to the ED with fever in the initial audit, and 120 in the re-audit. In the first study, 81 patients warranted a full septic workup as per NICE, but only 48 received it. Conversely, 40 patients met criteria for a partial septic workup, with 12 undergoing blood tests. In the second study, 73 patients qualified for a full septic workup, of which 52 were completed. Additionally, 27 patients were indicated for a partial workup, with 20 undergoing blood tests. Conclusion: Managing febrile infants under three months of age presenting to Tallaght ED remains a persistent challenge, underscoring the need for continuous educational initiatives to guarantee that these patients receive the requisite assessments and treatments.

Keywords: infants, fever, septic workup, tallaght

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Authors: Elizabeth Adebomi Akinlotan, Olukemi Odukoya

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INTRODUCTION: Physical Activity is defined as activity that involves bodily movement which is done as a part of daily activity in the form of working, playing, active transportation such as walking and also as a form of recreational activity. Physical inactivity has been identified as the fourth leading risk factor for global mortality and morbidity causing an estimated 3.2 million deaths globally and 5.5% of total deaths and it remains a pressing public health issue. There is a shift in the major causes of death from communicable to non-communicable diseases in many developed countries and this is fast becoming the case in developing countries. Physical activity is an important determinant of health and has been associated with lower mortality rates as it reduces the risk of developing chronic diseases such as diabetes mellitus, hypertension, stroke, cancer and osteoporosis. It improves musculoskeletal health, controls weight and reduces symptoms of depression. AIM: The aim is to study the knowledge, attitude and practices of physical activity among adults in Alimosho local government area. METHODOLOGY: This was a descriptive cross sectional survey designed to study the knowledge, attitude and practice of physical activity among adults in Alimosho Local Government Area. The study population were 250 adults aged 18-65 who were residents of the area of more than 6 months duration and had no chronic disease condition or physical disability. A multistage sampling method was used to select the respondents and data was collected using interviewer administered questionnaires. The data was analyzed with the use of EPI-info 2007 statistical software. Chi Square was thereafter used to test the association between selected variables. The level of statistical significance was set at 5% (p<0.05). RESULTS: In general, majority (61.6%) of the respondents had a good knowledge of what physical activity entails, 34.0% had fair knowledge and 4.4% had poor knowledge. There was a favorable attitude towards physical activity among the respondents with 82.4% having an overall positive attitude. Below a third of the respondents (26.4%) reported having a high physical activity (METS > 3001) while 40.0% had moderate (601-3000 METS) levels of activity and 33.6% were inactive (<600METS). There is statistical significance between the gender of the respondent and the levels of physical activity (p=0.0007); 75.2% males reached the minimum recommendations while 24.8% were inactive and 55.0% females reached the minimum recommendations while 45.0% were inactive. Results also showed that of 95 respondents who were satisfied with their levels of physical activity, 33.7% were insufficiently active while 66.3% were either minimally active or highly active and of 110 who were unsatisfied with their levels of physical activity, 72.0% were above the minimum recommendations while 38.0% were insufficiently active. CONCLUSION: In contrast to the high level of knowledge and favorable attitude towards physical activity, there was a lower level of practice of high or moderate physical activities. It is recommended that more awareness should be created on the recommended levels of physical activity especially for the vigorous intensity and moderate intensity physical activity.

Keywords: METS, physical activity, physical inactivity, public health

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Authors: Mahtab Baghaei, Seyed Mahmoud Tabatabaei

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Aim & Background: Electrical stimulation of transcranial direct current is considered one of the treatment methods for mental disorders. The aim of this study was to evaluate the effectiveness of transcranial electrical stimulation on the delta, theta, alpha, beta and systolic and diastolic blood pressure in patients with generalized anxiety disorder. Materials and Methods: The present study was a double-blind intervention with a pre-test and post-test design on people with generalized anxiety disorder in Tabriz in 1400. In this study, 30 patients with generalized anxiety disorder were selected by purposive sampling method based on the criteria specified in DSM-5 and randomly divided into an experimental group (n = 15) and a control group (n = 15). The experimental group received two sessions of 30 minutes of electrical stimulation of transcranial direct current with an intensity of 2 mA in the area of the lateral dorsal prefrontal cortex, and the control group also received artificial stimulation. Results: The results showed that transcranial electrical stimulation reduces delta and theta waves and increases beta and alpha brain waves in the experimental group. On the other hand, this method also showed a significant decrease in systolic and diastolic blood pressure in these patients (p <0.01). Conclusion: The results show that transcranial electrical stimulation has a statistically significant effect on brain waves and blood pressure, and this non-invasive method can be used as one of the treatment methods in people with generalized anxiety disorder.

Keywords: transcranial direct current electrical stimulation, brain waves, systolic blood pressure, diastolic blood pressure

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Authors: Rachel Wachtendonk, John Calambokidis, Kiirsten Flynn

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Large marine mammals can serve as an indicator of the overall state of the environment due to their long lifespan and apex position in marine food webs. Reductions in prey, driven by changes in environmental conditions can have resounding impacts on the trophic system as a whole; this can manifest in reduced fat stores that are visible on large whales. Poor health can lead to reduced survivorship and fitness, both of which can be detrimental to a recovering population. A non-invasive technique was used for monitoring blue whale health and for seeing if it changes with ocean conditions. Digital photographs of blue whales taken in the NE Pacific by Cascadia Research and collaborators from 2005-2018 (n=3,545) were scored for overall body condition based on visible vertebrae and body shape on a scale of 0-3 where a score of 0 indicated best body condition and a score of 3 indicated poorest. The data was analyzed to determine if there were patterns in the health of whales across years and whether overall poor health was related to oceanographic conditions and predictors of prey abundance on the California coast. The year was a highly significant factor in body condition (Chi-Square, p<0.001). The proportion of whales showing poor body condition (scores 2 & 3) overall was 33% but by year varied widely from a low of 18% (2008) to a high of 55% (2015). The only two years where >50% of animals had poor body condition were 2015 and 2017 (no other year was above 45%). The 2015 maximum proportion of whales in poor body condition coincide with the marine heat wave that affected the NE Pacific 2014-16 and impacted other whale populations. This indicates that the scoring method was an effective way to evaluate blue whale health and how they respond to a changing ocean.

Keywords: blue whale, body condition, environmental variability, photo-identification

Procedia PDF Downloads 182

Authors: I. Wiemann, N. Weiß, E. Schlücker, M. Wensing

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A very promising alternative to compression or cryogenics is the chemical storage of hydrogen by liquid organic hydrogen carriers (LOHC). These carriers enable high energy density and allow, at the same time, efficient and safe storage under ambient conditions without leakage losses. Another benefit of this storage medium is the possibility of transporting it using already available infrastructure for the transport of fossil fuels. Efficient use of LOHC is related to precise process control, which requires a number of sensors in order to measure all relevant process parameters, for example, to measure the level of hydrogen loading of the carrier. The degree of loading is relevant for the energy content of the storage carrier and simultaneously represents the modification in the chemical structure of the carrier molecules. This variation can be detected in different physical properties like permittivity, viscosity, or density. E.g., each degree of loading corresponds to different viscosity values. Conventional measurements currently use invasive viscosity measurements or near-line measurements to obtain quantitative information. This study investigates permittivity changes resulting from changes in hydrogenation degree (chemical structure) and temperature. Based on calibration measurements, the degree of loading and temperature of LOHC can thus be determined by comparatively simple permittivity measurements in a cavity resonator. Subsequently, viscosity and density can be calculated. An experimental setup with a heating device and flow test bench was designed. By varying temperature in the range of 293,15 K -393,15 K and flow velocity up to 140 mm/s, corresponding changes in the resonation frequency were determined in the hundredths of the GHz range. This approach allows inline process monitoring of hydrogenation of the liquid organic hydrogen carrier (LOHC).

Keywords: hydrogen loading, LOHC, measurement, permittivity, viscosity

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Authors: Sergey Kholodkevich, Tatiana Kuznetsova

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The objective assessment of ecological state of water ecosystems is impossible without the use of biological methods of the environmental monitoring capable in the integrated look to reveal negative for biota changes of quality of water as habitats. Considerable interest for the development of such methods of environmental quality control represents biomarker approach. Measuring systems, by means of which register cardiac activity characteristics, received the name of bioelectronic. Bioelectronic systems are information and measuring systems in which animals (namely, benthic invertebrates) are directly included in structure of primary converters, being an integral part of electronic system of registration of these or those physiological or behavioural biomarkers. As physiological biomarkers various characteristics of cardiac activity of selected invertebrates have been used in bioelectronic system.lChanges in cardiac activity are considered as integrative measures of the physiological condition of organisms, which reflect the state of the environment of their dwelling. Greatest successes in the development of tools of biological methods and technologies of an assessment of surface water quality in real time. Essential advantage of bioindication of water quality by such tool is a possibility of an integrated assessment of biological effects of pollution on biota and also the expressness of such method and used approaches. In the report the practical experience of authors in biomonitoring and bioindication of an ecological condition of sea, brackish- and freshwater areas is discussed. Authors note that the method of non-invasive cardiac activity monitoring of selected invertebrates can be used not only for the advancement of biomonitoring, but also is useful in decision of general problems of comparative physiology of the invertebrates.

Keywords: benthic invertebrates, physiological state, heart rate monitoring, water quality assessment

Procedia PDF Downloads 693

Authors: Lubena Achmad, Herman Kristanto, Julian Dewantiningrum

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Background: The Bishop score is a standard method used to predict the success of induction. This examination tends to be subjective with high inter and intraobserver variability, so it was presumed to have a low predictive value in terms of the outcome of labor induction. Cervical length measurement using transvaginal ultrasound is considered to be more objective to assess the cervical length. Meanwhile, this examination is not a complicated procedure and less invasive than vaginal touché. Objective: To compare transvaginal ultrasound and Bishop score in predicting successful induction. Methods: This study was a prospective cohort study. One hundred and twenty women with singleton pregnancies undergoing induction of labor at 37 – 42 weeks and met inclusion and exclusion criteria were enrolled in this study. Cervical assessment by both transvaginal ultrasound and Bishop score were conducted prior induction. The success of labor induction was defined as an ability to achieve active phase ≤ 12 hours after induction. To figure out the best cut-off point of cervical length and Bishop score, receiver operating characteristic (ROC) curves were plotted. Logistic regression analysis was used to determine which factors best-predicted induction success. Results: This study showed significant differences in terms of age, premature rupture of the membrane, the Bishop score, cervical length and funneling as significant predictors of successful induction. Using ROC curves found that the best cut-off point for prediction of successful induction was 25.45 mm for cervical length and 3 for Bishop score. Logistic regression was performed and showed only premature rupture of membranes and cervical length ≤ 25.45 that significantly predicted the success of labor induction. By excluding premature rupture of the membrane as the indication of induction, cervical length less than 25.3 mm was a better predictor of successful induction. Conclusion: Compared to Bishop score, cervical length using transvaginal ultrasound was a better predictor of successful induction.

Keywords: Bishop Score, cervical length, induction, successful induction, transvaginal sonography

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Authors: Farhan Nayyar, A. Batool

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The red palm weevil (RPW), being the most invasive insect pest of palm family, is considered as the most dangerous pest around the globe. As three out of four life stages of weevils are concealed inside the host plants, leaving only the adult stage for controlling it. The use of sex pheromone (Ferrugineol) for the management of red palm weevil is considered as the most rewarding technique of IPM. The current studies were conducted to find the relative potential of four different treatments including Sex pheromone, sex pheromone + date fruit + sugarcane pieces, sex pheromone + ethyl acetate and sex pheromone + jaggary water applied on the attraction behavior of weevils. The treatments were applied randomly at two different locations of Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan including Germ Plasm Unit (GPU) and fruit nursery farm having date palm plants of different ages of four varieties of date palm. The treatments were applied for three consecutive months, including February, March, and April 2022. The pheromone traps were installed at the height of two feet under shade on the western side of date palm plants. The results revealed that among the treatments, T4 consisting of Jaggary water and sex pheromone was found as the most effective treatment and attracted the maximum number of 127 weevils followed by T3 consisting of ethyl acetate and sex pheromone, attracting 53 weevils. In contrast to this, T2 consisting of sex pheromone and date fruit was found as the least effective treatment in attracting red palm weevil and attracted only 15 adult weevils. Among the two selected locations, the population of red palm weevil was found comparatively higher at GPU compared to the nursery farm, Dera Ismail Khan. In conclusion, T4 may be used for the effective and safer management of red palm weevil.

Keywords: red palm weevil, integrated management, sex pheromones, Jaggary water

Procedia PDF Downloads 69

Authors: Eric Sitorus, Septian Prahastudhi, Turgod Nainggolan, Erwin Riyanto

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Mining by block or panel caving is a mining method that takes advantage of fractures within an ore body, coupled with gravity, to extract material from a predetermined column of ore. The caving column is weakened from beneath through the use of undercutting, after which the ore breaks up and is extracted from below in a continuous cycle. The nature of this method induces cyclical stresses on the pillars of excavations as stress is built up and released over time, which has a detrimental effect on both the installed ground support and the rock mass itself. Ground support capacity, especially on the production where excavation void ratio is highest, is subjected to heavy loading. Strain above threshold of the elongation of support capacity can yield resulting in damage to excavations. Geotechnical engineers must evaluate not only the remnant capacity of ground support systems but also investigate depth of rock mass yield within pillars, backs and floors. Ground Penetrating Radar (GPR) is a geophysical method that has the ability to evaluate rock mass damage using electromagnetic waves. This paper illustrates a case study from the Grasberg mining complex where non-invasive information on the depth of damage and condition of the remaining rock mass was required. GPR with 100 MHz antenna resolution was used to obtain images of the subsurface to determine rehabilitation requirements prior to recommencing production activities. The GPR surveys were used to calibrate the reflection coefficient response of varying rock mass conditions to known Rock Quality Designation (RQD) parameters observed at the mine. The calibrated GPR survey allowed site engineers to map subsurface conditions and plan rehabilitation accordingly.

Keywords: block caving, ground penetrating radar, reflectivity, RQD

Procedia PDF Downloads 108

Authors: Hyun-jin Kim, Gumgyung Gu, Dae-Hyun Ko, Woochang Lee, Sail Chun, Won-Ki Min

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Background: Ovarian carcinoma is the fourth most common cause of cancer-related death in women worldwide. HE4, a novel marker for ovarian cancer could be used for monitoring recurrence or progression of disease in patients with invasive epithelial ovarian carcinoma. It is further intended to be used in conjunction with CA 125 to estimate the risk of epithelial ovarian cancer in women presenting with an adnexal mass. In this study, we aim to evaluate the analytical performance and clinical utility of HE4 assay using Architect i 2000SR(Abbott Diagnostics, USA). Methods: The precision was evaluated according to Clinical and Laboratory Standards Institute(CLSI) EP5 guideline. Three levels of control materials were analyzed twice a day in duplicate manner over 20 days. We calculated within run and total coefficient of variation (CV) at each level of control materials. The linearity was evaluated based on CLSI EP6 guideline. Five levels of calibrator were prepared by mixing high and low level of calibrators. For 43 women with adnexal masses, HE4 and CA 125 were measured and Risk of ovarian malignancy (ROMA) scores were calculated. The patients’ medical records were reviewed to determine the clinical utility of HE4 and ROMA score. Results: In a precision study, the within-run and total CV were 2.0 % and 2.3% for low level of control material, 1.9% and 2.4% for medium level and 0.5 % and 1.1% for high level, respectively. The linear range of HE4 was 14.63 to 1475.15pmol/L. Of the 43 patients, two patients in pre-menopausal group showed the ROMA score above the cut-off level (7.3%). One of them showed CA 125 level within the reference range, while the HE4 was higher than the cut-off. Conclusion: The overall analytical performance of HE4 assay using Architect showed high precision and good linearity within clinically important range. HE4 could be an useful marker for managing patients with adnexal masses.

Keywords: HE4, CA125, ROMA, evaluation, performance

Procedia PDF Downloads 316

Authors: Agata Krawczyk-Ozog, Mateusz K. Holda, Mateusz Koziej, Danuta Sorysz, Zbigniew Siudak, Wieslawa Klimek-Piotrowska, Dariusz Dudek

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Introduction: Rapid development of the surgical and less-invasive percutaneous mitral valve repair procedures greatly increase the interest of the mitral valve anatomy. The aim of this study was to characterize morphological variability of the mitral valve leaflets and to provide the size of their particular parts. Materials and Methods: In the study, we included 200 autopsied human hearts from Caucasian individuals (25% females) with mean age 47.5 (±17.9) without any valvular diseases. The morphology of the mitral valve was evaluated. The intercommissural and aorto-mural diameters of the mitral annulus were measured. All leaflets and their scallops were identified. The base and the height of the posteromedial commissure (PM-C), anterolateral commissure (AL-C), anterior leaflet (AL) and posterior leaflet (PL) with their scallops were measured. Results: The intercommissural diameter was 28.0±4.8 mm, the aorto-mural diameter 19.7±4.8 mm, circumference of the mitral annulus 89.9±12.6 mm and the area of the mitral valve 485.4±171.4 mm2. Classical mitral valves (AL+AL-C+PL(P1,P2,P3)+PM-C) were found in 141 (70.5%) specimens. In classical type, the mean AL base and height were 30.8±4.9 mm and 20.6±4.2 mm, while mean PL base and height 45.1±8.2 mm 12.9±2.8 mm respectively. The mean ratio of the AL base to PL base was 0.7±0.2. Variations in PL were found in 55 (27.5%) and in AL in 5 (2.5%) hearts. The most common variations were: valve with one accessory scallop (AcS) between P3 and PM-C (7%); AcS between P1 and AL-C (4%); connections of P2 and P3 scallops (4%); connections of P1 and P2 scallops (3%); AcS in AL (2.5%). All AcS were smaller than the main PL scallops. The mean intertrigonal distance was 21.9±3.8 mm. Conclusions: In all cases, the mitral valve is built by two main leaflets with possible variants in secondary to leaflets scallops (29.5%). The variations are largely associated with PL and are mostly related to the presence of AcS. Anatomically the AL is not divided into scallops, and it occupies 34.5% of the mitral annulus circumference. Understanding the anatomy of the mitral valve leaflets helps to planning and performing mitral valve repair procedures.

Keywords: accessory scallop, commissure, connected scallops, human heart, mitral leaflets, mitral valve

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Authors: Balaji Devanathan, Gokul G., Abilash S., Abhishek Yadav, Sudhir K. Gupta

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Background: As an alternative to the traditional autopsy, a virtual autopsy is carried out using scanning and imaging technologies, mainly post-mortem computed tomography (PMCT). This facility aims to supplement traditional autopsy results and reduce or eliminate internal dissection in subsequent autopsies. For emotional and religious reasons, the deceased's relatives have historically disapproved such interior dissection. The non-invasive, objective, and preservative PMCT is what friends and family would rather have than a traditional autopsy. Additionally, it aids in the examination of the technologies and the benefits and drawbacks of each, demonstrating the significance of contemporary imaging in the field of forensic medicine. Results: One hundred falls resulting in fatalities was analysed by the writers. Before the autopsy, each case underwent a PMCT examination using a 16-slice Multi-Slice CT spiral scanner. By using specialised software, MPR and VR reconstructions were carried out following the capture of the raw images. The accurate detection of fractures in the skull, face bones, clavicle, scapula, and vertebra was better observed in comparison to a routine autopsy. The interpretation of pneumothorax, Pneumoperitoneum, pneumocephalus, and hemosiuns are much enhanced by PMCT than traditional autopsy. Conclusion. It is useful to visualise the skeletal damage in fall from height cases using a virtual autopsy based on PMCT. So, the ideal tool in traumatising patients is a virtual autopsy based on PMCT scans. When assessing trauma victims, PMCT should be viewed as an additional helpful tool to traditional autopsy. This is because it can identify additional bone fractures in body parts that are challenging to examine during autopsy, such as posterior regions, which helps the pathologist reconstruct the victim's life and determine the cause of death.

Keywords: PMCT, fall from height, autopsy, fracture

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Authors: Marc Sebastián-Romagosa, Woosang Cho, Rupert Ortner, Christy Li, Christoph Guger

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Neurorehabilitation based on Brain-Computer Interfaces (BCIs) shows important rehabilitation effects for patients after stroke. Previous studies have shown improvements for patients that are in a chronic stage and/or have severe hemiparesis and are particularly challenging for conventional rehabilitation techniques. For this publication, seven stroke patients in the chronic phase with hemiparesis in the lower extremity were recruited. All of them participated in 25 BCI sessions about 3 times a week. The BCI system was based on the Motor Imagery (MI) of the paretic ankle dorsiflexion and healthy wrist dorsiflexion with Functional Electrical Stimulation (FES) and avatar feedback. Assessments were conducted to assess the changes in motor improvement before, after and during the rehabilitation training. Our primary measures used for the assessment were the 10-meters walking test (10MWT), Range of Motion (ROM) of the ankle dorsiflexion and Timed Up and Go (TUG). Results show a significant increase in the gait speed in the primary measure 10MWT fast velocity of 0.18 m/s IQR = [0.12 to 0.2], P = 0.016. The speed in the TUG was also significantly increased by 0.1 m/s IQR = [0.09 to 0.11], P = 0.031. The active ROM assessment increased 4.65º, and IQR = [ 1.67 - 7.4], after rehabilitation training, P = 0.029. These functional improvements persisted at least one month after the end of the therapy. These outcomes show the feasibility of this BCI approach for chronic stroke patients and further support the growing consensus that these types of tools might develop into a new paradigm for rehabilitation tools for stroke patients. However, the results are from only seven chronic stroke patients, so the authors believe that this approach should be further validated in broader randomized controlled studies involving more patients. MI and FES-based non-invasive BCIs are showing improvement in the gait rehabilitation of patients in the chronic stage after stroke. This could have an impact on the rehabilitation techniques used for these patients, especially when they are severely impaired and their mobility is limited.

Keywords: neuroscience, brain computer interfaces, rehabilitat, stroke

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Authors: Abera Hailu Degaga, Emana Getu Degaga

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Spodoptera frugiperda is an invasive insect pest that infests and feeds various crops, particularly affecting maize yields. However, nature has its own way of maintaining balance, and in this case, natural enemies play a crucial role in regulating the population of S. frugiperda. Locally available and easily prepared botanical sources, bio-pesticides, are also important. The objectives of the study were to investigate the natural enemies of S. frugiperda in the Gurage zone and to compare Neem aqueous extracts against its larvae in central Ethiopia. S. frugiperda larvae and egg masses were collected randomly from smallholder maize farms infested with pests between June and August 2023. Our findings revealed the existence of diverse types of parasitoids, predators, and entomopathogenic fungi associated with S. frugiperda. Notably, we documented three species of parasitoids, namely Exorista xanthaspis and Tachina spp. (Diptera: Tachinidae) and Charops annulipes (Hymenoptera: Ichneumonidae). All three species of parasitoids were recorded from Ethiopia for the first time. The overall parasitism rate was 5.3%, with individual rates ranging from 1.3 to 4%. Additionally, we identified ten species of predator insects from four different orders, including Hemiptera, Dermaptera, Coleoptera, and Mantodea, in the maize farms infested with S. frugiperda. Aqueous extract of Neem seed and leaf powder and green leaf exhibited similar mortality rates of S. frugiperda larvae at 72 hours even though there was a significant difference at 24 and 48 hours of the test. For effective management of S. frugiperda further research is necessary to fully exploit the potential of these natural enemies and additionally to use botanical source pesticides like Azadirachta indica.

Keywords: bio-pesticide, natural enemy, parasitoids, predators, Tachinid flies

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Authors: V. Veeraprathap, G. S. Harish, G. Narendra Kumar

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Uncontrolled growth of abnormal cells in the lung in the form of tumor can be either benign (non-cancerous) or malignant (cancerous). Patients with Lung Cancer (LC) have an average of five years life span expectancy provided diagnosis, detection and prediction, which reduces many treatment options to risk of invasive surgery increasing survival rate. Computed Tomography (CT), Positron Emission Tomography (PET), and Magnetic Resonance Imaging (MRI) for earlier detection of cancer are common. Gaussian filter along with median filter used for smoothing and noise removal, Histogram Equalization (HE) for image enhancement gives the best results without inviting further opinions. Lung cavities are extracted and the background portion other than two lung cavities is completely removed with right and left lungs segmented separately. Region properties measurements area, perimeter, diameter, centroid and eccentricity measured for the tumor segmented image, while texture is characterized by Gray-Level Co-occurrence Matrix (GLCM) functions, feature extraction provides Region of Interest (ROI) given as input to classifier. Two levels of classifications, K-Nearest Neighbor (KNN) is used for determining patient condition as normal or abnormal, while Artificial Neural Networks (ANN) is used for identifying the cancer stage is employed. Discrete Wavelet Transform (DWT) algorithm is used for the main feature extraction leading to best efficiency. The developed technology finds encouraging results for real time information and on line detection for future research.

Keywords: artificial neural networks, ANN, discrete wavelet transform, DWT, gray-level co-occurrence matrix, GLCM, k-nearest neighbor, KNN, region of interest, ROI

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Authors: Ya-Ching Fu, An-Kuo Chou, Boon-Fatt Tan, Chi-Nien Chen, Wen-Chien Yang, Pou-Leng Cheong

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Blind oro-/naso-pharyngeal suction and feeding tube placement are very common practices in neonatal intensive care unit. Though esophageal perforation is a rare complication of these instrumentations, its prevalence is highest in extremely premature neonates. Due to its association with significant morbidity (including respiratory deterioration, pneumothorax, and sepsis) and even mortality, it is an important issue to prevent this iatrogenic complication in the field of premature care. We demonstrate an esophageal perforation in an extreme-low-birth-weight neonate after oro-gastric tube placement. This female baby weighing 680 grams was delivered by caesarean section at 25 weeks of gestational age. She initially received oro-tracheal intubation with mechanical ventilation which was smoothly weaned to non-invasive positive-pressure ventilation at 7-day-old. However, after insertion of a 5-French oro-gastric tube, the baby’s condition suddenly worsened with apnea requiring mechanical ventilation. Her chest radiogram showed the oro-gastric tube in right pleural space, and thus another oro-gastric tube was replaced, and its position was radiographically confirmed. The malpositioned tube was then removed. The baby received 2-week course of intravenous antibiotics for her esophageal perforation. Feeding was then reintroduced and increased to full feeds in a smooth course. She was discharged at 107-day-old. Esophageal perforation in newborn is very rare. Sudden respiratory deterioration in a neonate after naso-/oro-gastric tube placement should alarm us to consider esophageal perforation, and further radiological investigation is required for the diagnosis. Tube materials, patient condition, and age are major risk factors of esophageal perforation. The use of softer tube material, such as silicone, in extreme premature baby might prevent this fetal complication.

Keywords: esophageal perforation, preterm, newborn, feeding tube

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Authors: Krishna Dahiya

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Introduction: Labour pain has been described as the most severe pain experienced by women in their lives. Pain management in labour is one of the most important challenges faced by the obstetrician. The opioids are the primary treatment for patients with moderate and severe pain but these drugs are not always tolerated and are associated with dose-dependent side effects. Nonsteroidal anti-inflammatory drugs, too, are associated with variable adverse effects. Considering these factors, our study compared the efficacy and side effect of intravenous tramadol and paracetamol. Objective: To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50mg of tramadol for intrapartum analgesia. Methods: In a randomized prospective study at Pt. BDS PGIMS, 200 women in active labor were allocated to received either paracetamol (n=100) or tramadol (n=100). The primary outcome was the efficacy of the drug to supply adequate analgesia as measured by a change in the visual analog scale (VAS) pain intensity score at various times after drug administration. The secondary outcomes included the need for additional rescue analgesia and the presence of adverse maternal or fetal events. Results: The mean age of cases were 25.55 ± 3.849 years and 25.60 ± 3.655 years respectively As recorded by the VAS score, there was significant pain reduction at 30 minutes, and at 1 and 2 hours in both groups (P<0.01). In comparison, between group I and II, a significantly higher rate of nausea and vomiting in tramadol group (14% vs 8%; P < 0.03) patients. Similarly, drowsiness (0% vs 11%; P<0.01), dry mouth (0% vs 8%; P<0.04) and dizziness (0% vs 9%; P<0.02) was also significant in group II. Conclusion: Due to difficulty in administering epidural analgesia to all parturients, administration of paracetamol and tramadol infusion for analgesia is simple and less invasive alternative. In the present study, both paracetamol and tramadol were equally effective for labour analgesia but paracetamol has emerged as safe alternative as compared to tramadol due to a low incidence of side effects.

Keywords: paracetamol, tramadol, labor, analgesia

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Authors: Andrew N. Saylor, James R. Peters

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Scoliosis is a complex 3D deformity of the thoracic and lumbar spines, clinically diagnosed by measurement of a Cobb angle of 10 degrees or more on a coronal X-ray. The Cobb angle is the angle made by the lines drawn along the proximal and distal endplates of the respective proximal and distal vertebrae comprising the curve. Traditionally, Cobb angles are measured manually using either a marker, straight edge, and protractor or image measurement software. The task of measuring the Cobb angle can also be represented by a function taking the spine geometry rendered using X-ray imaging as input and returning the approximate angle. Although the form of such a function may be unknown, it can be approximated using artificial neural networks (ANNs). The performance of ANNs is affected by many factors, including the choice of activation function and network architecture; however, the effects of these parameters on the accuracy of scoliotic deformity measurements are poorly understood. Therefore, the objective of this study was to systematically investigate the effect of ANN architecture and activation function on Cobb angle measurement from the coronal X-rays of scoliotic subjects. The data set for this study consisted of 609 coronal chest X-rays of scoliotic subjects divided into 481 training images and 128 test images. These data, which included labeled Cobb angle measurements, were obtained from the SpineWeb online database. In order to normalize the input data, each image was resized using bi-linear interpolation to a size of 500 × 187 pixels, and the pixel intensities were scaled to be between 0 and 1. A fully connected (dense) ANN with a fixed cost function (mean squared error), batch size (10), and learning rate (0.01) was developed using Python Version 3.7.3 and TensorFlow 1.13.1. The activation functions (sigmoid, hyperbolic tangent [tanh], or rectified linear units [ReLU]), number of hidden layers (1, 3, 5, or 10), and number of neurons per layer (10, 100, or 1000) were varied systematically to generate a total of 36 network conditions. Stochastic gradient descent with early stopping was used to train each network. Three trials were run per condition, and the final mean squared errors and mean absolute errors were averaged to quantify the network response for each condition. The network that performed the best used ReLU neurons had three hidden layers, and 100 neurons per layer. The average mean squared error of this network was 222.28 ± 30 degrees2, and the average mean absolute error was 11.96 ± 0.64 degrees. It is also notable that while most of the networks performed similarly, the networks using ReLU neurons, 10 hidden layers, and 1000 neurons per layer, and those using Tanh neurons, one hidden layer, and 10 neurons per layer performed markedly worse with average mean squared errors greater than 400 degrees2 and average mean absolute errors greater than 16 degrees. From the results of this study, it can be seen that the choice of ANN architecture and activation function has a clear impact on Cobb angle inference from coronal X-rays of scoliotic subjects.

Keywords: scoliosis, artificial neural networks, cobb angle, medical imaging

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Authors: Nino Tsamalaidze

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Cold plasma is an ionized neutral gas with a temperature of 30-40 degrees, but the impact of HP includes not only gas, but also active molecules, charged particles, heat and UV radiation of low power The main goal of the technology we describe is to launch the natural function of skin regeneration and improve the metabolism inside, which leads to a huge effect of rejuvenation. In particular: eliminate fine mimic wrinkles; get rid of wrinkles around the mouth (purse-string wrinkles); reduce the overhang of the upper eyelid; eliminate bags under the eyes; provide a lifting effect on the oval of the face; reduce stretch marks; shrink pores; even out the skin, reduce the appearance of acne, scars; remove pigmentation. A clear indication of the major findings of the study is based on the current patients practice. The method is to use combination of cold plasma and liquid threats. The advantage of cold plasma is undoubtedly its efficiency, the result of its implementation can be compared with the result of a surgical facelift, despite the fact that the procedure is non-invasive and the risks are minimized. Another advantage is that the technique can be applied on the most sensitive skin of the face - these are the eyelids and the space around the eyes. Cold plasma is one of the few techniques that eliminates bags under the eyes and overhanging eyelids, while not violating the integrity of the tissues. In addition to rejuvenation and lifting effect, among the benefits of cold plasma is also getting rid of scars, kuperoze, stretch marks and other skin defects, plasma allows to get rid of acne, seborrhea, skin fungus and even heals ulcers. The cold plasma method makes it possible to achieve a result similar to blepharoplasty. Carried out on the skin of the eyelids, the procedure allows non-surgical correction of the eyelid line in 3-4 sessions. One of the undoubted advantages of this method is a short rehabilitation and rapid healing of the skin.

Keywords: wrinkles, telangiectasia, pigmentation, pore closing

Procedia PDF Downloads 58

Authors: Shao-Huang Wu, Ai-Yun Wu, Meng-Chen Wu, Chun-Liang Wu, Kai-Ping Shaw, Hsiao-Ting Chen

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Objective: To analyze the forensic autopsy data of known passengers and compare it with the National database of the autopsy report in 2017, and obtain the special patterned injuries, which can be used as the reference for the reconstruction of hit-and-run motor vehicle accidents. Methods: Analyze the items of the Motor Vehicle Accident Report, including Date of accident, Time occurred, Day, Acc. severity, Acc. Location, Acc. Class, Collision with Vehicle, Motorcyclists Codes, Safety equipment use, etc. Analyzed the items of the Autopsy Report included, including General Description, Clothing and Valuables, External Examination, Head and Neck Trauma, Trunk Trauma, Other Injuries, Internal Examination, Associated Items, Autopsy Determinations, etc. Materials: Case 1. The process of injury formation: the car was chased forward and collided with the scooter. The passenger wearing the helmet fell to the ground. The helmet crashed under the bottom of the sedan, and the bottom of the sedan was raised. Additionally, the sedan was hit on the left by the other sedan behind, resulting in the front sedan turning 180 degrees on the spot. The passenger’s head was rotated, and the cervical spine was fractured. Injuries: 1. Fracture of atlantoaxial joint 2. Fracture of the left clavicle, scapula, and proximal humerus 3. Fracture of the 1-10 left ribs and 2-7 right ribs with lung contusion and hemothorax 4. Fracture of the transverse process of 2-5 lumbar vertebras 5. Comminuted fracture of the right femur 6. Suspected subarachnoid space and subdural hemorrhage 7. Laceration of the spleen. Case 2. The process of injury formation: The motorcyclist wearing the helmet fell to the left by himself, and his chest was crushed by the car going straight. Only his upper body was under the car and the helmet finally fell off. Injuries: 1. Dislocation of atlantoaxial joint 2. Laceration on the left posterior occipital 3. Laceration on the left frontal 4. Laceration on the left side of the chin 5. Strip bruising on the anterior neck 6. Open rib fracture of the right chest wall 7. Comminuted fracture of both 1-12 ribs 8. Fracture of the sternum 9. Rupture of the left lung 10. Rupture of the left and right atria, heart tip and several large vessels 11. The aortic root is nearly transected 12. Severe rupture of the liver. Results: The common features of the two cases were the fracture or dislocation of the atlantoaxial joint and both helmets that were crashed. There were no atlantoaxial fractures or dislocations in 27 pedestrians (without wearing a helmet) versus motor vehicle accidents in 2017 the National database of an autopsy report, but there were two atlantoaxial fracture or dislocation cases in the database, both of which were cases of falling from height. Conclusion: The cervical spine fracture injury of the motorcyclist, who was wearing a helmet, is very likely to be a patterned injury caused by his/her fall and rollover under the sedan. It could provide a reference for forensic peers.

Keywords: patterned injuries, atlantoaxial fracture or dislocation, accident reconstruction, motorcycle accident with helmet, forensic autopsy data

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Authors: Beatriz Lafuente Alcázar, Yash Wani, Amit J. Nimunkar

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Cardiovascular Diseases (CVDs) are the leading cause of death globally, and around 80% of sudden cardiac deaths are due to arrhythmias or irregular heartbeats. The majority of these pathologies are revealed by either short-term or long-term alterations in the electrocardiogram (ECG) morphology. The ECG is the main diagnostic tool in cardiology. It is a non-invasive, pain free procedure that measures the heart’s electrical activity and that allows the detecting of abnormal rhythms and underlying conditions. A cardiologist can diagnose a wide range of pathologies based on ECG’s form alterations, but the human interpretation is subjective and it is contingent to error. Moreover, ECG records can be quite prolonged in time, which can further complicate visual diagnosis, and deeply retard disease detection. In this context, deep learning methods have risen as a promising strategy to extract relevant features and eliminate individual subjectivity in ECG analysis. They facilitate the computation of large sets of data and can provide early and precise diagnoses. Therefore, the cardiology field is one of the areas that can most benefit from the implementation of deep learning algorithms. In the present study, a deep learning algorithm is trained following a novel approach, using a combination of different databases as the training set. The goal of the algorithm is to achieve the detection of R-peaks in ECG signals. Its performance is further evaluated in ECG signals with different origins and features to test the model’s ability to generalize its outcomes. Performance of the model for detection of R-peaks for clean and noisy ECGs is presented. The model is able to detect R-peaks in the presence of various types of noise, and when presented with data, it has not been trained. It is expected that this approach will increase the effectiveness and capacity of cardiologists to detect divergences in the normal cardiac activity of their patients.

Keywords: arrhythmia, deep learning, electrocardiogram, machine learning, R-peaks

Procedia PDF Downloads 147

Authors: Sally Ibrahim, Mohamed Hedia, Mohamed Taqi, Mohamed Derbala, Karima Mahmoud, Youssef Ahmed, Sayed Ismail, Mohamed El-Belely

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The identification and quantification of serum microRNA (miRNA) from mares with endometritis might serve as useful and implementable clinical biomarkers for the early diagnosis of endometiritis. Aims of the current study were (I) to study the expression pattern of eca-miR-155, eca-miR-223, eca-miR-17, eca-miR-200a, and eca-miR-205, and (II) to determine the levels of interleukin 6 (IL-6), prostaglandins (PGF₂α and PGE₂), in the serum of Arabian mares with healthy and abnormal uterine status (endometritis). This study was conducted on 80 Arabian mares (4-14 years old). Mares were divided into 48 sub-fertile mares suspected of endometritis and 32 fertile at stud farms. The criteria for mares to be enrolled in the endometritis group were that they had been bred three or more times unsuccessfully in the breeding season or had a history of more than one year of reproductive failure. In addition, two or more of the following criteria on a checklist were present: abnormal clinical findings, transrectal ultrasonographic uterine examination showed abnormal fluid in the uterus (echogenic or ≥2 cm in diameter), positive endometrial cytology; and bacterial and/or fungal growth. Serum samples were collected for measuring IL-6, PGF₂α, and PGE₂ concentrations, as well as serum miRNA isolation and quantitative real-time PCR. Serum concentrations of IL-6, PGE₂, and PGF₂α were higher (P ≤ 0.001) in mares with endometritis compared to the control healthy ones. The expression profile of eca-miR-155, eca-miR-223, eca-miR-17, eca-miR-200a, and eca-miR-205 increased (P≤0.001) in mares with endometritis compared to the control ones. To the best of our knowledge, this is the first study that revealed that serum miRNA and serum inflammatory mediators (IL-6, PGE₂, and PGF₂α) could be used as non-invasive gold standard biomarkers, and therefore might be served as an important additional diagnostic tool for endometritis in Arabian mares. Moreover, estimation of the serum concentrations of serum miRNA, IL-6, PGE₂, and PGF₂α is a promising recommended tool during the breeding soundness examination in mares.

Keywords: Arabian Mares, endometritis, inflammatory mediators, serum miRNA

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Authors: U.-B. Schaer, M. Wehr, R. Hodler

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Background: Most nursing students require more training time for necessary nursing skills than defined by nursing schools curriculum to acquire basic nursing skills. Given skills training lessons are too brief to enable effective student learning, meaning in-depth skills practice and repetition various learning steps. This increases stress levels and the pressure to succeed for a nursing student with slower learning capabilities. Another possible consequence is that nursing students are less prepared in the required skills for future clinical practice. Intervention: The Bern College of Higher Education of Nursing, Switzerland, started the independent peer practice learning program in 2012. A concept was developed which defines specific aims and content as well as student’s rights and obligations. Students enlist beforehand and order the required materials. They organize themselves and train in small groups in allocated training location in the area of Learning Training and Transfer (LTT). During the peer practice, skills and knowledge can be repeatedly trained and reflected in the peer groups without the presence of a tutor. All invasive skills are practiced only on teaching dummies. This allows students to use all their potential. The students may access learning materials as literature and their own student notes. This allows nursing students to practice their skills and to deepen their knowledge on corresponding with their own learning rate. Results: Peer group discussions during the independent peer practice learning support the students in gaining certainty and confidence in their knowledge and skills. This may improve patient safety in future daily care practice. Descriptive statics show that the number of students who take advantage of the independent peer practice learning increased continuously (2012-2018). It has to be mentioned that in 2012, solely students of the first semester attended the independent peer practice learning program, while in 2018 over one-third of the participating students were in their fifth semester and final study year. It is clearly visible that the demand for independent peer practice learning is increasing. This has to be considered in the development of future teaching curricula.

Keywords: learning program, nursing students, peer learning, skill training

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Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team

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