Search results for: patient decision aid

Authors: Charléa M. Smith, Raiden L. Schodowski, Arletty Pinel

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Due to the COVID-19 pandemic, the Faculty of Medical Sciences of The University of the West Indies (UWI) Mona in Kingston, Jamaica, had to rapidly migrate to digital and blended learning. Students in the preclinical stage of the program transitioned to full-time online learning, while students in the clinical stage experienced decreased daily patient contact and the implementation of a blend of online lectures and virtual clinical practice. Such sudden changes were coupled with the institutional pressure of the need to introduce a novel approach to education without much time for preparation, as well as additional strain endured by the faculty, who were overwhelmed by serving as frontline workers. During the period July 20 to August 23, 2021, this study surveyed preclinical and clinical students to capture their experiences with these changes and their recommendations for future use of digital modalities of learning to enhance medical education. It was conducted with a fellow student of the 2021 cohort of the MultiPod mentoring program. A questionnaire was developed and distributed digitally via WhatsApp to all medical students of the UWI Mona campus to assess students’ experiences and perceptions of the advantages, challenges, and impact on individual knowledge proficiencies brought about by the transition to predominantly digital learning environments. 108 students replied, 53.7% preclinical and 46.3% clinical. 67.6% of the total were female and 30.6 % were male; 1.8% did not identify themselves by gender. 67.2% of preclinical students preferred blended learning and 60.3% considered that the content presented did not prepare them for clinical work. Only 31% considered that the online classes were interactive and encouraged student participation. 84.5% missed socialization with classmates and friends and 79.3% missed a focused environment for learning. 80% of the clinical students felt that they had not learned all that they expected and only 34% had virtual interaction with patients, mostly by telephone and video calls. Observing direct consultations was considered the most useful, yet this was the least-used modality. 96% of the preclinical students and 100% of the clinical ones supplemented their learning with additional online tools. The main recommendations from the survey are the use of interactive teaching strategies, more discussion time with lecturers, and increased virtual interactions with patients. Universities are returning to face-to-face learning, yet it is unlikely that blended education will disappear. This study demonstrates that students’ perceptions of their experience during mobility restrictions must be taken into consideration in creating more effective, inclusive, and efficient blended learning opportunities.

Keywords: blended learning, digital learning, medical education, student perceptions

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Authors: Lillian Musila, Valerie Oundo, Daniel Erwin, Willie Sang

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Staphylococcus aureus infections are a major cause of nosocomial infections in Kenya. Methicillin resistant S. aureus (MRSA) infections are a significant burden to public health and are associated with considerable morbidity and mortality. At a hospital in Western Kenya two clusters of MRSA cases emerged within short periods of time. In this study we explored whether these clusters represented a nosocomial outbreak by characterizing the isolates using phenotypic and molecular assays and examining epidemiological data to identify possible transmission patterns. Specimens from the site of infection of the subjects were collected, cultured and S. aureus isolates identified phenotypically and confirmed by APIStaph™. MRSA were identified by cefoxitin disk screening per CLSI guidelines. MRSA were further characterized based on their antibiotic susceptibility patterns and spa gene typing. Characteristics of cases with MRSA isolates were compared with those with MSSA isolated around the same time period. Two cases of MRSA infection were identified in the two week period between 21 April and 4 May 2015. A further 2 MRSA isolates were identified on the same day on 7 September 2015. The antibiotic resistance patterns of the two MRSA isolates in the 1st cluster of cases were different suggesting that these were distinct isolates. One isolate had spa type t2029 and the other had a novel spa type. The 2 isolates were obtained from urine and an open skin wound. In the 2nd cluster of MRSA isolates, the antibiotic susceptibility patterns were similar but isolates had different spa types: one was t037 and the other a novel spa type different from the novel MRSA spa type in the first cluster. Both cases in the second cluster were admitted into the hospital but one infection was community- and the other hospital-acquired. Only one of the four MRSA cases was classified as an HAI from an infection acquired post-operatively. When compared to other S. aureus strains isolated within the same time period from the same hospital only one spa type t2029 was found in both MRSA and non-MRSA strains. None of the cases infected with MRSA in the two clusters shared any common epidemiological characteristic such as age, sex or known risk factors for MRSA such as prolonged hospitalization or institutionalization. These data suggest that the observed MRSA clusters were multi strain clusters and not an outbreak of a single strain. There was no clear relationship between the isolates by spa type suggesting that no transmission was occurring within the hospital between these cluster cases but rather that the majority of the MRSA strains were circulating in the community. There was high diversity of spa types among the MRSA strains with none of the isolates sharing spa types. Identification of disease clusters in space and time is critical for immediate infection control action and patient management. Spa gene typing is a rapid way of confirming or ruling out MRSA outbreaks so that costly interventions are applied only when necessary.

Keywords: cluster, Kenya, MRSA, spa typing

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Authors: Ibrahim Abouelkhir

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Background: Prior to this project, the number of CT aorta requests from our Emergency Department (ED) was reported by the radiology department to be high with a low positive event rate: only 1- 2% of CT aortas performed were positive for acute aortic syndrome. This trend raised concerns about the time required to process and report these scans, potentially impacting the timely reporting of other high-priority imaging, such as trauma-related scans. Other harms identified were unnecessary radiation, patients spending longer in ED contributing to overcrowding, and, most importantly, the patient not getting the right care the first time. The radiology department also raised the problem of reporting bias because they expected our CT aortas to be normal. Aim: The main aim of this project was to reduce the number of unnecessary CT aortas requested, which would be shown by 1. Number of CT aortas requested and 2. Positive event rate. Methodology: This was a quality improvement project carried out in the ED at Frimley Park Hospital, UK. Starting from 1 st January 2024, we recorded the number of days required to reach 35 CT aorta requests. We looked at all patients presenting to the ED over the age of 16 for whom a CT aorta was requested by the ED team. We looked at how many of these scans were positive for acute aortic syndrome. The intervention was a change in practice: all CT aortas should be approved by an ED consultant or ST4+ registrar (5th April 2024). We then reviewed the number of days it took to reach a total of 35 CT aorta requests following the intervention and again reviewed how many were positive. Results: Prior to the intervention, 35 CT Aorta scans were performed over a 20-day period. Following the implementation of the ED senior doctor vetting process, the same number of CT Aorta scan requests was observed over 50 days - more than twice the pre-intervention period. This indicates a significant reduction in the rate of CT Aorta scans being requested. During the pre-intervention phase, there were two positive cases of acute aortic syndrome. In the post-intervention period, there were zero. Conclusion: The mandatory review of CT Aorta scan requested by the ED consultant effectively reduced the number of scans requested. However, this intervention did not lead to an increase in positive scan results. We noted that post-intervention, approximately 50% of scans had been approved by registrar-grade doctors and, only 50% had been approved by ED consultants, and the majority were not in-person reviews. We wonder if restricting the approval to consultant grade only might improve the results, and furthermore, in person reviews should be the gold standard.

Keywords: quality improvement project, CT aorta scans, emergency department, radiology department, aortic dissection, scan request vetting, clinical outcomes, imaging efficiency

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Authors: Majid Bayatian, Mohammadreza Ashouri

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Releasing hazardous chemicals is one of the major problems for office buildings in the chemical industry and, therefore, environmental risks are inherent to these environments. The adverse health effects of the airborne concentration of benzene have been a matter of significant concern, especially in oil refineries. The chronic and acute adverse health effects caused by benzene exposure have attracted wide attention. Acute exposure to benzene through inhalation could cause headaches, dizziness, drowsiness, and irritation of the skin. Chronic exposures have reported causing aplastic anemia and leukemia at the occupational settings. Association between chronic occupational exposure to benzene and the development of aplastic anemia and leukemia were documented by several epidemiological studies. Numerous research works have investigated benzene emissions and determined benzene concentration at different locations of the refinery plant and stated considerable health risks. The high cost of industrial control measures requires justification through lifetime health risk assessment of exposed workers and the public. In the present study, a Computational Fluid Dynamics (CFD) model has been proposed to assess the exposure risk of office building around a refinery due to its release of benzene. For simulation, GAMBIT, FLUENT, and CFD Post software were used as pre-processor, processor, and post-processor, and the model was validated based on comparison with experimental results of benzene concentration and wind speed. Model validation results showed that the model is highly validated, and this model can be used for health risk assessment. The simulation and risk assessment results showed that benzene could be dispersion to an office building nearby, and the exposure risk has been unacceptable. According to the results of this study, a validated CFD model, could be very useful for decision-makers for control measures and possibly support them for emergency planning of probable accidents. Also, this model can be used to assess exposure to various types of accidents as well as other pollutants such as toluene, xylene, and ethylbenzene in different atmospheric conditions.

Keywords: health risk assessment, office building, Benzene, numerical simulation, CFD

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Authors: Zehra Aybike Kılıç, Alpin Köknel Yener

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Daylight is a powerful driver in terms of improving human health, enhancing productivity and creating sustainable solutions by minimizing energy demand. A proper daylighting system allows not only a pleasant and attractive visual and thermal environment, but also reduces lighting energy consumption and heating/cooling energy load with the optimization of aperture size, glazing type and solar control strategy, which are the major design parameters of daylighting system design. Particularly, in high-rise buildings where large openings that allow maximum daylight and view out are preferred, evaluation of daylight performance by considering the major parameters of the building envelope design becomes crucial in terms of ensuring occupants’ comfort and improving energy efficiency. Moreover, it is increasingly necessary to examine the daylighting design of high-rise residential buildings, considering the share of residential buildings in the construction sector, the duration of occupation and the changing space requirements. This study aims to identify a proper daylighting design solution considering window area, glazing type and solar control strategy for a high-residential building in terms of visual comfort and lighting energy efficiency. The dynamic simulations are carried out/conducted by DIVA for Rhino version 4.1.0.12. The results are evaluated with Daylight Autonomy (DA) to demonstrate daylight availability in the space and Daylight Glare Probability (DGP) to describe the visual comfort conditions related to glare. Furthermore, it is also analyzed that the lighting energy consumption occurred in each scenario to determine the optimum solution reducing lighting energy consumption by optimizing daylight performance. The results revealed that it is only possible that reduction in lighting energy consumption as well as providing visual comfort conditions in buildings with the proper daylighting design decision regarding glazing type, transparency ratio and solar control device.

Keywords: daylighting , glazing type, lighting energy efficiency, residential building, solar control strategy, visual comfort

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Authors: Bernard Kumi-Boateng, Issaka Yakubu

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Forest fire, which is, an uncontrolled fire occurring in nature has become a major concern for the Forestry Commission of Ghana (FCG). The forest fires in Ghana usually result in massive destruction and take a long time for the firefighting crews to gain control over the situation. In order to assess the effect of forest fire at local scale, it is important to consider the role fire plays in vegetation composition, biodiversity, soil erosion, and the hydrological cycle. The occurrence, frequency and behaviour of forest fires vary over time and space, primarily as a result of the complicated influences of changes in land use, vegetation composition, fire suppression efforts, and other indigenous factors. One of the forest zones in Ghana with a high level of vegetation stress is the Goaso forest area. The area has experienced changes in its traditional land use such as hunting, charcoal production, inefficient logging practices and rural abandonment patterns. These factors which were identified as major causes of forest fire, have recently modified the incidence of fire in the Goaso area. In spite of the incidence of forest fires in the Goaso forest area, most of the forest services do not provide a cartographic representation of the burned areas. This has resulted in significant amount of information being required by the firefighting unit of the FCG to understand fire risk factors and its spatial effects. This study uses Remote Sensing and Geographic Information System techniques to develop a fire risk hazard model using the Goaso Forest Area (GFA) as a case study. From the results of the study, natural forest, agricultural lands and plantation cover types were identified as the major fuel contributing loads. However, water bodies, roads and settlements were identified as minor fuel contributing loads. Based on the major and minor fuel contributing loads, a forest fire risk hazard model with a reasonable accuracy has been developed for the GFA to assist decision making.

Keywords: forest, GIS, remote sensing, Goaso

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Authors: M. Achemo, O. Saito

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Jefoure land use system is one of the traditional landscape human settlement patterns, and it is a cultural design and peculiar art of the people of Gurage in Ethiopia via which houses and trees flank roads left and right. Assessment of the multiple benefits of the traditional road that benefit society and development could enhance the understanding of the land use planners and decision makers to pay attention while planning and managing the land use system. Recent trend shows that the Jefoure land use is on the threshold of change as a result of flourishing road networks, overgrazing, and agricultural expansion. This study aimed to evaluate the multiple ecosystem services provided by the Jefoure land use system after characterization of the socio-ecological landscape. Information was compiled from existing data sources such as ordnance survey maps, aerial photographs, recent high resolution satellite imageries, designated questionnaires and interviews, and local authority contacts. The result generated scientific data on the characteristics, ecosystem services provision, and drivers of changes. The cultural landscape has novel characteristics and providing multiple ecosystem services to the community for long period of time. It is serving as road for humans, livestock and vehicles, habitat for plant species, regulating local temperature, climate, runoff and infiltration, and place for meeting, conducting religious and spiritual activities, holding social events such as marriage and mourning, playing station for children and court for football and other traditional games. As a result of its aesthetic quality and scenic beauty, it is considered as recreational place for improving mental and physical health. The study draws relevant land use planning and management solution in the improvement of socio-ecological resilience in the Jefoure land use system. The study suggests the landscape needs to be registrar as heritage site for recognizing the wisdom of the community and enhancing the conservation mechanisms.

Keywords: cultural landscape, ecosystem services, Gurage, Jefoure

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Authors: Riina I. Bray, Yifan Wang, Nikolas Argiropoulos, Stephanie Robins, John Molot, Kelly Tragash, Lynn M. Marshall, Margaret E. Sears, Marie-Andrée Pigeon, Michel Gaudet, Pierre Auger, Emily Bélanger, Rohini Peris

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Multiple chemical sensitivity (MCS) is a chronic medical condition characterized by intolerances to chemical substances. Since the arrival of the COVID-19 pandemic and associated health measures, people experiencing MCS (PEMCS) are at a heightened risk of environmental exposures associated with cleaners, disinfectants, and sanitizers. Little attention has been paid to the well-being of PEMCS in the context of the COVID-19 pandemic. Objective: This study assesses the lived experiences of Canadian adults with MCS in relation to their living environment, access to healthcare, and levels of perceived social support before and during the pandemic. Methods: A total of 119 PEMCS completed an online questionnaire. McNemar Chi-Squared and Wilcoxon Signed Rank tests were used to evaluate if there were statistically significant changes in participants’ perception of their living environment, access to healthcare, and levels of social support before and after March 11, 2020. Results: Both positive and negative outcomes were noted. Participants reported an increase in exposure to disinfectants/sanitizers that entered their living environment (p<.001). There was a reported decrease in access to a family doctor during the pandemic (p<0.001). Although PEMCS experienced increased social isolation (p<0.001), they also reported an increase in understanding from family (p<0.029) and a decrease in stigma for wearing personal protective equipment (p<0.001). Conclusion: PEMCS reported experiencing: increased exposure to disinfectants or sanitizers, a loss of social support, and barriers in accessing healthcare during the pandemic. However, COVID-19 provided an opportunity to normalize the living conditions of PEMCS, such as wearing masks and social isolation. These findings can guide decision-makers on the importance of implementing nontoxic alternatives for cleaning and disinfection, as well as improving accommodation measures for PEMCS.

Keywords: covid-19, multiple chemical sensitivity, MCS, quality of life, social isolation, physical environment, healthcare

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Authors: Periklis Brakatsoulas

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Recent empirical research shows a growing interest in investment decision-making under market anomalies that contradict the rational paradigm. Momentum is undoubtedly one of the most robust anomalies in the empirical asset pricing research and remains surprisingly lucrative ever since first documented. Although predominantly phenomena identified across equities, momentum premia are now evident across various asset classes. Yet few many attempts are made so far to provide traders a diversified portfolio of strategies across different assets and markets. Moreover, literature focuses on patterns from past returns rather than mechanisms to signal future price directions prior to momentum runs. The aim of this paper is to develop a diversified portfolio approach to price distortion signals using daily position data on stocks, credit derivatives, and bonds. An algorithm allocates assets periodically, and new investment tactics take over upon price momentum signals and across different ranking groups. We focus on momentum life cycles, trend reversals, and price acceleration signals. The main effort here concentrates on the density, time span and maturity of momentum phenomena to identify consistent patterns over time and measure the predictive power of buy-sell signals generated by these anomalies. To tackle this, we propose a two-stage modelling process. First, we generate forecasts on core macroeconomic drivers. Secondly, satellite models generate market risk forecasts using the core driver projections generated at the first stage as input. Moreover, using a combination of the ARFIMA and FIGARCH models, we examine the dependence of consecutive observations across time and portfolio assets since long memory behavior in volatilities of one market appears to trigger persistent volatility patterns across other markets. We believe that this is the first work that employs evidence of volatility transmissions among derivatives, equities, and bonds to identify momentum life cycle patterns.

Keywords: forecasting, long memory, momentum, returns

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Authors: Maria Sciammarella, Uttam M. Shrestha, Youngho Seo, Grant T. Gullberg, Elias H. Botvinick

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Background: Myocardial perfusion imaging (MPI) is typically performed with static imaging protocols and visually assessed for perfusion defects based on the relative intensity distribution. Dynamic cardiac SPECT, on the other hand, is a new imaging technique that is based on time varying information of radiotracer distribution, which permits quantification of myocardial blood flow (MBF). In this abstract, we report a progress and current status of dynamic cardiac SPECT using conventional gamma camera (Infinia Hawkeye 4, GE Healthcare) for estimation of myocardial blood flow and coronary flow reserve. Methods: A group of patients who had high risk of coronary artery disease was enrolled to evaluate our methodology. A low-dose/high-dose rest/pharmacologic-induced-stress protocol was implemented. A standard rest and a standard stress radionuclide dose of ⁹⁹ᵐTc-tetrofosmin (140 keV) was administered. The dynamic SPECT data for each patient were reconstructed using the standard 4-dimensional maximum likelihood expectation maximization (ML-EM) algorithm. Acquired data were used to estimate the myocardial blood flow (MBF). The correspondence between flow values in the main coronary vasculature with myocardial segments defined by the standardized myocardial segmentation and nomenclature were derived. The coronary flow reserve, CFR, was defined as the ratio of stress to rest MBF values. CFR values estimated with SPECT were also validated with dynamic PET. Results: The range of territorial MBF in LAD, RCA, and LCX was 0.44 ml/min/g to 3.81 ml/min/g. The MBF between estimated with PET and SPECT in the group of independent cohort of 7 patients showed statistically significant correlation, r = 0.71 (p < 0.001). But the corresponding CFR correlation was moderate r = 0.39 yet statistically significant (p = 0.037). The mean stress MBF value was significantly lower for angiographically abnormal than that for the normal (Normal Mean MBF = 2.49 ± 0.61, Abnormal Mean MBF = 1.43 ± 0. 0.62, P < .001). Conclusions: The visually assessed image findings in clinical SPECT are subjective, and may not reflect direct physiologic measures of coronary lesion. The MBF and CFR measured with dynamic SPECT are fully objective and available only with the data generated from the dynamic SPECT method. A quantitative approach such as measuring CFR using dynamic SPECT imaging is a better mode of diagnosing CAD than visual assessment of stress and rest images from static SPECT images Coronary Flow Reserve.

Keywords: dynamic SPECT, clinical SPECT/CT, selective coronary angiograph, ⁹⁹ᵐTc-Tetrofosmin

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Authors: A. Julio, R. Caparica, S. Costa Lima, S. Reis, J. G. Costa, P. Fonte, T. Santos De Almeida

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The Mycobacterium leprae causes a chronic and infectious disease called leprosy, which the most common symptoms are peripheral neuropathy and deformation of several parts of the body. The pharmacological treatment of leprosy is a combined therapy with three different drugs, rifampicin, clofazimine, and dapsone. However, clofazimine and dapsone have poor solubility in water and also low bioavailability. Thus, it is crucial to develop strategies to overcome such drawbacks. The use of ionic liquids (ILs) may be a strategy to overcome the low solubility since they have been used as solubility promoters. ILs are salts, liquid below 100 ºC or even at room temperature, that may be placed in water, oils or hydroalcoholic solutions. Another approach may be the encapsulation of drugs into polymeric nanoparticles, which improves their bioavailability. In this study, two different classes of ILs were used, the imidazole- and the choline-based ionic liquids, as solubility enhancers of the poorly soluble antileprotic drugs. Thus, after the solubility studies, it was developed IL-PLGA nanoparticles hybrid systems to deliver such drugs. First of all, the solubility studies of clofazimine and dapsone were performed in water and in water: IL mixtures, at ILs concentrations where cell viability is maintained, at room temperature for 72 hours. For both drugs, it was observed an improvement on the drug solubility and [Cho][Phe] showed to be the best solubility enhancer, especially for clofazimine, where it was observed a 10-fold improvement. Later, it was produced nanoparticles, with a polymeric matrix of poly(lactic-co-glycolic acid) (PLGA) 75:25, by a modified solvent-evaporation W/O/W double emulsion technique in the presence of [Cho][Phe]. Thus, the inner phase was an aqueous solution of 0.2 % (v/v) of the above IL with each drug to its maximum solubility determined on the previous study. After the production, the nanosystem hybrid was physicochemically characterized. The produced nanoparticles had a diameter of around 580 nm and 640 nm, for clofazimine and dapsone, respectively. Regarding the polydispersity index, it was in agreement of the recommended value of this parameter for drug delivery systems (around 0.3). The association efficiency (AE) of the developed hybrid nanosystems demonstrated promising AE values for both drugs, given their low solubility (64.0 ± 4.0 % for clofazimine and 58.6 ± 10.0 % for dapsone), that prospects the capacity of these delivery systems to enhance the bioavailability and loading of clofazimine and dapsone. Overall, the study achievement may signify an upgrading of the patient’s quality of life, since it may mean a change in the therapeutic scheme, not requiring doses of drug so high to obtain a therapeutic effect. The authors would like to thank Fundação para a Ciência e a Tecnologia, Portugal (FCT/MCTES (PIDDAC), UID/DTP/04567/2016-CBIOS/PRUID/BI2/2018).

Keywords: ionic liquids, ionic liquids-PLGA nanoparticles hybrid systems, leprosy treatment, solubility

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Authors: Subir S. Rao

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Existing warehouse configurations use non-traditional aisle designs with a central P/D point in their models, which is mathematically simple but less practical. Many warehouses use multiple P/D points to avoid congestion for pickers, and different warehouses have different flow policies and infrastructure for using the P/D points. Many warehouses use multiple P/D points with non-traditional aisle designs in their analytical models. Standard warehouse models introduce one-sided multiple P/D points in a flying-V warehouse and minimize pick distance for a one-way travel between an active P/D point and a pick location with P/D points, assuming uniform flow rates. A simulation of the mathematical model generally uses four fixed configurations of P/D points which are on two different sides of the warehouse. It can be easily proved that if the source and destination P/D points are both chosen randomly, in a uniform way, then minimizing the one-way travel is the same as minimizing the two-way travel. Another warehouse configuration analytically models the warehouse for multiple one-sided P/D points while keeping the angle of the cross-aisles and picking aisles as a decision variable. The minimization of the one-way pick travel distance from the P/D point to the pick location by finding the optimal position/angle of the cross-aisle and picking aisle for warehouses having different numbers of multiple P/D points with variable flow rates is also one of the objectives. Most models of warehouses with multiple P/D points are one-way travel models and we extend these analytical models to minimize the two-way pick travel distance wherein the destination P/D is chosen optimally for the return route, which is not similar to minimizing the one-way travel. In most warehouse models, the return P/D is chosen randomly, but in our research, the return route P/D point is chosen optimally. Such warehouses are common in practice, where the flow rates at the P/D points are flexible and depend totally on the position of the picks. A good warehouse management system is efficient in consolidating orders over multiple P/D points in warehouses where the P/D is flexible in function. In the latter arrangement, pickers and shrink-wrap processes are not assigned to particular P/D points, which ultimately makes the P/D points more flexible and easy to use interchangeably for picking and deposits. The number of P/D points considered in this research uniformly increases from a single-central one to a maximum of each aisle symmetrically having a P/D point below it.

Keywords: non-traditional warehouse, V cross-aisle, multiple P/D point, pick travel distance

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Authors: O. O. Aiyelokun, O. A. Agbede

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Numerical modelling of groundwater flow can be susceptible to calibration errors due to lack of adequate ground-based hydro-metrological stations in river basins. Groundwater resources management in Southwest Nigeria is currently challenged by overexploitation, lack of planning and monitoring, urbanization and climate change; hence to adopt models as decision support tools for sustainable management of groundwater; they must be adequately calibrated. Since river basins in Southwest Nigeria are characterized by missing data, and lack of adequate ground-based hydro-meteorological stations; the need for adopting satellite-based data for constructing distributed models is crucial. This study seeks to evaluate the suitability of satellite-based data as substitute for ground-based, for computing boundary conditions; by determining if ground and satellite based meteorological data fit well in Ogun and Oshun River basins. The Climate Forecast System Reanalysis (CFSR) global meteorological dataset was firstly obtained in daily form and converted to monthly form for the period of 432 months (January 1979 to June, 2014). Afterwards, ground-based meteorological data for Ikeja (1981-2010), Abeokuta (1983-2010), and Oshogbo (1981-2010) were compared with CFSR data using Goodness of Fit (GOF) statistics. The study revealed that based on mean absolute error (MEA), coefficient of correlation, (r) and coefficient of determination (R²); all meteorological variables except wind speed fit well. It was further revealed that maximum and minimum temperature, relative humidity and rainfall had high range of index of agreement (d) and ratio of standard deviation (rSD), implying that CFSR dataset could be used to compute boundary conditions such as groundwater recharge and potential evapotranspiration. The study concluded that satellite-based data such as the CFSR should be used as input when constructing groundwater flow models in river basins in Southwest Nigeria, where majority of the river basins are partially gaged and characterized with long missing hydro-metrological data.

Keywords: boundary condition, goodness of fit, groundwater, satellite-based data

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Authors: Zahid Ullah, Atlas Khan

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This abstract focuses on the advancements in mathematical modeling and optimization techniques that play a crucial role in enhancing the efficiency, reliability, and performance of these systems. In this era of rapidly evolving technology, mathematical modeling and optimization offer powerful tools to tackle the complex challenges faced by control, signal processing, and energy systems. This abstract presents the latest research and developments in mathematical methodologies, encompassing areas such as control theory, system identification, signal processing algorithms, and energy optimization. The abstract highlights the interdisciplinary nature of mathematical modeling and optimization, showcasing their applications in a wide range of domains, including power systems, communication networks, industrial automation, and renewable energy. It explores key mathematical techniques, such as linear and nonlinear programming, convex optimization, stochastic modeling, and numerical algorithms, that enable the design, analysis, and optimization of complex control and signal processing systems. Furthermore, the abstract emphasizes the importance of addressing real-world challenges in control, signal processing, and energy systems through innovative mathematical approaches. It discusses the integration of mathematical models with data-driven approaches, machine learning, and artificial intelligence to enhance system performance, adaptability, and decision-making capabilities. The abstract also underscores the significance of bridging the gap between theoretical advancements and practical applications. It recognizes the need for practical implementation of mathematical models and optimization algorithms in real-world systems, considering factors such as scalability, computational efficiency, and robustness. In summary, this abstract showcases the advancements in mathematical modeling and optimization techniques for control, signal processing, and energy systems. It highlights the interdisciplinary nature of these techniques, their applications across various domains, and their potential to address real-world challenges. The abstract emphasizes the importance of practical implementation and integration with emerging technologies to drive innovation and improve the performance of control, signal processing, and energy.

Keywords: mathematical modeling, optimization, control systems, signal processing, energy systems, interdisciplinary applications, system identification, numerical algorithms

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Authors: Ella Tyuryumina, Alexey Neznanov

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This study is an attempt to obtain reliable data on the natural history of breast cancer growth. We analyze the opportunities for using classical mathematical models (exponential and logistic tumor growth models, Gompertz and von Bertalanffy tumor growth models) to try to describe growth of the primary tumor and the secondary distant metastases of human breast cancer. The research aim is to improve predicting accuracy of breast cancer progression using an original mathematical model referred to CoMPaS and corresponding software. We are interested in: 1) modelling the whole natural history of the primary tumor and the secondary distant metastases; 2) developing adequate and precise CoMPaS which reflects relations between the primary tumor and the secondary distant metastases; 3) analyzing the CoMPaS scope of application; 4) implementing the model as a software tool. The foundation of the CoMPaS is the exponential tumor growth model, which is described by determinate nonlinear and linear equations. The CoMPaS corresponds to TNM classification. It allows to calculate different growth periods of the primary tumor and the secondary distant metastases: 1) ‘non-visible period’ for the primary tumor; 2) ‘non-visible period’ for the secondary distant metastases; 3) ‘visible period’ for the secondary distant metastases. The CoMPaS is validated on clinical data of 10-years and 15-years survival depending on the tumor stage and diameter of the primary tumor. The new predictive tool: 1) is a solid foundation to develop future studies of breast cancer growth models; 2) does not require any expensive diagnostic tests; 3) is the first predictor which makes forecast using only current patient data, the others are based on the additional statistical data. The CoMPaS model and predictive software: a) fit to clinical trials data; b) detect different growth periods of the primary tumor and the secondary distant metastases; c) make forecast of the period of the secondary distant metastases appearance; d) have higher average prediction accuracy than the other tools; e) can improve forecasts on survival of breast cancer and facilitate optimization of diagnostic tests. The following are calculated by CoMPaS: the number of doublings for ‘non-visible’ and ‘visible’ growth period of the secondary distant metastases; tumor volume doubling time (days) for ‘non-visible’ and ‘visible’ growth period of the secondary distant metastases. The CoMPaS enables, for the first time, to predict ‘whole natural history’ of the primary tumor and the secondary distant metastases growth on each stage (pT1, pT2, pT3, pT4) relying only on the primary tumor sizes. Summarizing: a) CoMPaS describes correctly the primary tumor growth of IA, IIA, IIB, IIIB (T1-4N0M0) stages without metastases in lymph nodes (N0); b) facilitates the understanding of the appearance period and inception of the secondary distant metastases.

Keywords: breast cancer, exponential growth model, mathematical model, metastases in lymph nodes, primary tumor, survival

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Authors: Merilin Ivanova Ivanova, Kalin Dimitrov Atanasov, Stefan Petrov Enchev

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Backgroud: Neuromyelitis optica spectrum disorder, also known as Devic’s disease, is a relapsing demyelinating autoimmune inflammatory disorder of the central nervous system associated with anti-aquaporin 4 (AQP4) antibodies that can manifest with devastating secondary neurological deficits. Most commonly affected are the optic nerves and the spinal cord-clinically this is often presented with optic neuritis (loss of vision), transverse myelitis(weakness or paralysis of extremities),lack of bladder and bowel control, numbness. APS is a core clinical entity of NMOSD and adds to the clinical representation the following symptoms: intractable nausea, vomiting and hiccup, it usually occurs isolated at onset, and can lead to a significant delay in the diagnosis. The condition may have features similar to multiple sclerosis (MS) but the episodes are worse in NMO and it is treated differently. It could be relapsing or monophasic. Possible complications are visual field defects and motor impairment, with potential blindness and irreversible motor deficits. In severe cases, myogenic respiratory failure ensues. The incidence of reported cases is approximately 0.3–4.4 per 100,000. Paediatric cases of NMOSD are rare but have been reported occasionally, comprising less than 5% of the reported cases. Objective: The case serves to show the difficulty when it comes to the diagnostic processes regarding a rare autoimmune disease with non- specific symptoms, taking large interval of rimes to reveal as complete clinical manifestation of the aforementioned syndrome, as well as the necessity of multidisciplinary approach in the setting of а general paediatric department in аn emergency hospital. Methods: itpatient's history, clinical presentation, and information from the used diagnostic tools(MRI with contrast of the central nervous system) lead us to the conclusion .This was later on confirmed by the positive results from the anti-aquaporin 4 (AQP4) antibody serology test. Conclusion: APS is a common symptom of NMOSD and is considered a challenge in a differential-diagnostic plan. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing thorough physical examinations are essential if we are to reduce and avoid misdiagnosis.

Keywords: neuromyelitis, devic's disease, hiccup, autoimmune, MRI

Procedia PDF Downloads 38

Authors: Fernando Antonio Bacchim Neto, Allan Felipe Fattori Alves, Maria Eugênia Dela Rosa, Regina Moura, Diana Rodrigues De Pina

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Interventional Radiology is the radiology modality that provides the highest dose values to medical staff. Recent researches show that personal dosimeters may underestimate dose values in interventional physicians, especially in extremities (hands and feet) and eye lens. The aim of this work was to study radiation exposure levels of medical staff in different interventional radiology procedures and estimate the annual maximum numbers of procedures (AMN) that each physician could perform without exceed the annual limits of dose established by normative. For this purpose LiF:Mg,Ti (TLD-100) dosimeters were positioned in different body regions of the interventional physician (eye lens, thyroid, chest, gonads, hand and foot) above the radiological protection vests as lead apron and thyroid shield. Attenuation values for lead protection vests were based on international guidelines. Based on these data were chosen as 90% attenuation of the lead vests and 60% attenuation of the protective glasses. 25 procedures were evaluated: 10 diagnostics, 10 angioplasty, and 5-aneurysm treatment. The AMN of diagnostic procedures was 641 for the primary interventional radiologist and 930 for the assisting interventional radiologist. For the angioplasty procedures, the AMN for primary interventional radiologist was 445 and for assisting interventional radiologist was 1202. As for the procedures of aneurism treatment, the AMN for the primary interventional radiologist was 113 and for the assisting interventional radiologist were 215. All AMN were limited by the eye lens doses already considering the use of protective glasses. In all categories evaluated, the higher dose values are found in gonads and in the lower regions of professionals, both for the primary interventionist and for the assisting, but the eyes lens dose limits are smaller than these regions. Additional protections as mobile barriers, which can be positioned between the interventionist and the patient, can decrease the exposures in the eye lens, providing a greater protection for the medical staff. The alternation of professionals to perform each type of procedure can reduce the dose values received by them over a period. The analysis of dose profiles proposed in this work showed that personal dosimeters positioned in chest might underestimate dose values in other body parts of the interventional physician, especially in extremities and eye lens. As each body region of the interventionist is subject to different levels of exposure, dose distribution in each region provides a better approach to what actions are necessary to ensure the radiological protection of medical staff.

Keywords: interventional radiology, radiation protection, occupationally exposed individual, hemodynamic

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Authors: Nirit Raichel, Dorit Alt

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Although university teaching is claimed to have a special task to support students in adopting ways of thinking and producing new knowledge anchored in scientific inquiry practices, it is argued that students' habits of learning are still overwhelmingly skewed toward passive acquisition of knowledge from authority sources rather than from collaborative inquiry activities. In order to overcome this critical inadequacy between current educational goals and instructional methods, the LLAF consortium is aimed at developing updated instructional practices that put a premium on adaptability to the emerging requirements of present society. LLAF has created a practical guide for teachers containing updated pedagogical strategies based on the constructivist approach for learning, arranged along Delors’ four theoretical ‘pillars’ of education: Learning to know, learning to do, learning to live together, and learning to be. This presentation will be limited to problem-based learning (PBL), as a strategy introduced in the second pillar. PBL leads not only to the acquisition of technical skills, but also allows the development of skills like problem analysis and solving, critical thinking, cooperation and teamwork, decision- making and self-regulation that can be transferred to other contexts. This educational strategy will be exemplified by a case study conducted in the pre-piloting stage of the project. The case describes a three-fold process implemented in a postgraduate course for in-service teachers, including: (1) learning about PBL (2) implementing PBL in the participants' classes, and (3) qualitatively assessing the contributions of PBL to students' outcomes. An example will be given regarding the ways by which PBL was applied and assessed in civic education for high-school students. Two 9th-grade classes have participated the study; both included several students with learning disability. PBL was applied only in one class whereas traditional instruction was used in the other. Results showed a robust contribution of PBL to students' affective and cognitive outcomes as reflected in their motivation to engage in learning activities, and to further explore the subject. However, students with learning disability were less favorable with this "active" and "annoying" environment. Implications of these findings for the LLAF project will be discussed.

Keywords: problem-based learning, higher education, pedagogical strategies

Procedia PDF Downloads 333

Authors: Rajish Shil, Mohammad Ali Houri, Mohammad Milad Ismail, Fatimah Al Kaabi

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The clinical presentation of Primary hyperparathyroidism can vary from simple asymptomatic hypercalcemia to severe life-threatening hypercalcemic crisis with multi-organ dysfunction, which can be due to parathyroid adenoma or sometimes with malignant cancer. This cascade of clinical presentation can lead to a diagnostic and therapeutic challenge for treating the disease. We are presenting a case of severe hypercalcemic crisis due to parathyroid adenoma with an emphasis on early management, diagnosis, and interventions to prevent any lifelong complications and any permanent organ dysfunction. A 30 years old female with a history of primary Infertility, admitted to Al Ain Hospital critical care unit with Acute Severe Necrotizing Pancreatitis. She initially had a 1-month history of abdominal pain on and off, for which she was treated conservatively with no much improvement, and later on, she developed life-threatening severe pancreatitis, which required her to be admitted to the critical care unit. She was transferred from a private healthcare facility, where she was found to have a very high level of calcium up to 15mmol/L. She received systemic Zoledronic Acid, which lowered her calcium level transiently and later was increased again. She went on to develop multiple end-organ damages along with multiple electrolytes disturbances. She was found to have high levels of Parathyroid hormone, which was correlated with a parathyroid mass on the neck via radiological imaging. After a long course of medical treatment to lower the calcium to a near-normal level, parathyroidectomy was done, which showed parathyroid adenoma on histology. She developed hungry bone syndrome after the surgery and pancreatic pseudocyst after resolving of pancreatitis. She required aggressive treatment with Intravenous calcium for her hypocalcemia as she received zoledronic acid at the beginning of the disease. Later on, she was discharged on long term calcium and other electrolytes supplements. In patients presenting with hypercalcemia, it is prudent to investigate and start treatment early to prevent complications and end-organ damage from hypercalcemia and also to treat the primary cause of the hypercalcemia, with conscious follow up to prevent hypocalcemic complications after treatment. It is important to follow up patients with parathyroid adenomas for a long period in order to detect any recurrence of the tumor or to make sure if the primary tumor is either benign or malignant.

Keywords: hypercalcemia, pancreatitis, hypocalcemia, hyperparathyroidism

Procedia PDF Downloads 121

Authors: Christopher Meyer, Laima Gerlitz

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European ports are facing high political pressure through the implementation of initiatives such as the European Green Deal or IMO's 2030 targets (Fit for 55). However, small and medium-sized ports face even higher challenges compared to bigger ones due to lower capacities in various fields such as investments, infra-structure, Human Resources, and funding opportunities. Small and Medium-Sized Ports (SMPs) roles in economic systems are various depending on their specific functionality in maritime ecosystems. Depending on their different situations, being an actor in multiport gateways, aligned to core ports, regional nodes in peripheries for the hinterland, specialized cluster members, or logistical nodes, different strategic business models may be applied to increase SMPs' competitiveness among other bigger ports. Additionally, SMPs are facing more challenges for future development in terms of digital and green transition of their operations. Thus, it is necessary to evaluate the own strategical position and apply management strategies alongside the regional growth and innovation strategies for diversification or specialisation of own port businesses. The research uses inductive perspectives to set up a transferable framework based on case studies to be analysed. In line with particular research and document analysis, qualitative approaches were considered. The research is based on a deep literature review on SMPs as well as theories on diversification and specialisation. Existing theories from different fields are evaluated on their application for the port sector and these specific maritime actors, paying respect to enabling innovation incorporation to enhance digital and environmental transition with fu-ture perspectives for SMPs. The paper aims to provide a decision-making matrix for the strategic positioning of SMPs in Europe, including opportunities to get access to particular EU funds for future development alongside the Regional In-novation Strategies on Smart Specialisation.

Keywords: strategic planning, sustainability transition, competitiveness portfolio, EU green deal

Procedia PDF Downloads 79

Authors: Dileep Maarisetty, Janaki Komandur, Saroj S. Baral

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In the current work, photocatalytic degradation of phenol was carried both in UV and visible light to find the slowest step that is limiting the rate of photo-degradation process. Characterization such as XRD, SEM, FT-IR, TEM, XPS, UV-DRS, PL, BET, UPS, ESR and zeta potential experiments were conducted to assess the credibility of catalysts in boosting the photocatalytic activity. To explore the synergy, TiO₂ was doped with graphene and alumina. The orbital hybridization with alumina doping (mediated by graphene) resulted in higher electron transfer from the conduction band of TiO₂ to alumina surface where oxygen reduction reactions (ORR) occur. Besides, the doping of alumina and graphene introduced defects into Ti lattice and helped in improving the adsorptive properties of modified photo-catalyst. Results showed that these defects promoted the oxygen reduction reactions (ORR) on the catalyst’s surface. ORR activity aims at producing reactive oxygen species (ROS). These ROS species oxidizes the phenol molecules which is adsorbed on the surface of photo-catalysts, thereby driving the photocatalytic reactions. Since mass transfer is considered as rate limiting step, various mathematical models were applied to the experimental data to probe the best fit. By varying the parameters, it was found that intra-particle diffusion was the slowest step in the degradation process. Lagergren model gave the best R² values indicating the nature of rate kinetics. Similarly, different adsorption isotherms were employed and realized that Langmuir isotherm suits the best with tremendous increase in uptake capacity (mg/g) of TiO₂-rGO-Al₂O₃ as compared undoped TiO₂. This further assisted in higher adsorption of phenol molecules. The results obtained from experimental, kinetic modelling and adsorption isotherms; it is concluded that apart from changes in surface, optoelectronic and morphological properties that enhanced the photocatalytic activity, the intra-particle diffusion within the catalyst’s pores serve as rate-limiting step in deciding the fate of photo-catalytic degradation of phenol.

Keywords: ORR, phenol degradation, photo-catalyst, rate kinetics

Procedia PDF Downloads 143

Authors: A. Gramza-Michałowska, J. Skręty, M. Antczak, J. Kobus-Cisowska, D. Kmiecik, J. Korczak, Kulczyński Bartosz

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Background: Modern consumer highly appreciates the correlation between eating habits and health. Intensified research showed many proofs confirming that food besides its basic nutritional function, possess also significant prophylactic and therapeutic potential. Preventive potential of selected food is commonly used as improvement factor of patients life standard. World Health Organization indicates that diabetes (Diabetes mellitus) and obesity are two of the most common and dangerous diseases. Diet therapy is an element of diabetes education program and a part of healing process, allowing maintaining and remaining the optimal metabolic state of the system. It must be remembered that diabetes treatment should be individualized to each patient. One of highly recommended vegetable for diabetes is asparagus (Asparagus officinalis L.), low calories common plant, growing in European countries. Objective: To propose the technology of unsweetened muesli production with addition of new components, we investigated the effects of selected vegetable addition on antioxidative capacity and consumer’s acceptance of muesli as representative of breakfast product. Methods: Muesli was formulated from a composition of oat flakes, flaxseed, bran, carrots, broccoli and asparagus. Basic composition of muesli was evaluated as content of protein, lipids, fatty acid composition, ash, selected minerals and caloricity. Antioxidant capacity of muesli was evaluated with use radical scavenging methods (DPPH, ABTS), ORAC value and PCL - photochemiluminescence antiradical potential. Proposed muesli as new product was also characterized with sensory analysis, which included color, scent, taste, consistency and overall acceptance of a product. Results: Results showed that addition of freeze-dried asparagus into muesli allowed to lower the fat content and caloricity of a product according to the base product. No significant loss in antioxidant potential was evaluated, also the sensory value of a product was not negative. Conclusion: Designed muesli would be an answer for obese people looking for healthy snack during the daytime. Results showed that product with asparagus addition would be accepted by the consumers and because of its antidiabetic potential could be a n important factor in prevention of diabetes or obesity. Financial support by the UE Project no PO IG 01.01.00.00-061/09

Keywords: muesli, vegetables, asparagus, antioxidant potential, lipids

Procedia PDF Downloads 316

Authors: Samhita Mummadi, Sree Divya Nagalli, Harshini Vemuri, Saketh Charan Nakka, Sumesh K. J.

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One of the most significant challenges faced by people in today’s digital era is an alarming increase in fraudulent activities on online platforms. The fascination with online shopping to avoid long queues in shopping malls, the availability of a variety of products, and home delivery of goods have paved the way for a rapid increase in vast online shopping platforms. This has had a major impact on increasing fraudulent activities as well. This loop of online shopping and transactions has paved the way for fraudulent users to commit fraud. For instance, consider a store that orders thousands of products all at once, but what’s fishy about this is the massive number of items purchased and their transactions turning out to be fraud, leading to a huge loss for the seller. Considering scenarios like these underscores the urgent need to introduce machine learning approaches to combat fraud in online shopping. By leveraging robust algorithms, namely KNN, Decision Trees, and Random Forest, which are highly effective in generating accurate results, this research endeavors to discern patterns indicative of fraudulent behavior within transactional data. Introducing a comprehensive solution to this problem in order to empower e-commerce administrators in timely fraud detection and prevention is the primary motive and the main focus. In addition to that, sentiment analysis is harnessed in the model so that the e-commerce admin can tailor to the customer’s and consumer’s concerns, feedback, and comments, allowing the admin to improve the user’s experience. The ultimate objective of this study is to ramp up online shopping platforms against fraud and ensure a safer shopping experience. This paper underscores a model accuracy of 84%. All the findings and observations that were noted during our work lay the groundwork for future advancements in the development of more resilient and adaptive fraud detection systems, which will become crucial as technologies continue to evolve.

Keywords: behavior analysis, feature selection, Fraudulent pattern recognition, imbalanced classification, transactional anomalies

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Authors: Catarina Seco Matos, Miguel Amaral

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The developed world is facing falling birth rates and rising life expectancies. As a result, the overall demographic structure of societies is becoming markedly older. This leads to an economic and political pressure towards the extension of individuals’ working lives. On the other hand, evidence shows that some older workers choose to stay in the labour force as employees, whereas others choose to pursue a more entrepreneurial occupational path. Thus, entrepreneurship or self-employment may be an option for socioeconomic participation of older individuals. Previous research on senior entrepreneurship is scarce and it focuses mainly on entrepreneurship determinants and individuals’ intentions. The fact that entrepreneurship is perceived as a voluntary or involuntary decision or as a positive or a negative outcome by older individuals is, to the best of our knowledge, still unexplored in the literature. In order to analyse the determinants of entrepreneurial satisfaction among older individuals, primary data were obtained from a unique questionnaire survey, which was sent to Portuguese senior entrepreneurs who have launched their company aged 50 and over (N=181). Portugal is one of the countries in the world with the with the largest ageing population and with a high proportion of older individuals who remain active after their official retirement age – which makes it an extremely relevant case study on senior entrepreneurship. Findings suggest that non pecuniary factors (rather than pecuniary) are the main driver for entrepreneurship at older ages. Specifically, results show that the will to remain active is the main motivation of older individuals to become entrepreneurs. This is line with the activity and continuity theories. Furthermore, senior entrepreneurs tend to have had an active working life (using their professional experience as a proxy) and, thus, want to keep the same lifestyle at an older age (in line with theory of continuity). Finally, results show that even though older individuals’ companies may not show the best financial performance that does not seem to affect their satisfaction with the company and with entrepreneurship in general. The present study aims at exploring, discussing and bring new research on senior entrepreneurship to the fore, rather than assuming purely deductive approach; hence, further confirmatory analyses with larger sets from different countries of data are required.

Keywords: active ageing, entrepreneurship, older entrepreneur, Portugal, satisfaction, senior entrepreneur

Procedia PDF Downloads 237

Authors: N. Khursheed, M. Fatima, S. Jamal, A. Raza, S. Rattani, Q. Ahsan, A. Rasheed, M. Jawed

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Introduction: Antibiotics are among the commonly prescribed medicines to treat bacterial infections. Their misuse intensifies resistance, and overuse incurs heavy losses to the healthcare system in terms of increased treatment costs and enhanced disease burden. Studies show that 40% of empirically used antibiotics are irrationally utilized. The objective of this study was to evaluate prescribing pattern of antibiotics at six public sector tertiary care hospitals across Pakistan. Methods: A multicenter cross-sectional point prevalence survey (PPS) was conducted in selected wards of six public sector tertiary care hospitals in Pakistan as part of the Clinical Engagement program by Fleming Fund Country Grant Pakistan in collaboration with Indus Hospital & Health Network (IHHN) from February to March 2021, these included Jinnah Postgraduate Medical Center and Dr. Ruth K. M. Pfau Civil Hospital from Karachi, Sheikh Zayed Hospital Lahore, Nishtar Medical University Hospital Multan, Medical Teaching Institute Hayatabad Medical Complex Peshawar, and Provincial Headquarters Hospital Gilgit. WHO PPS methodology was used for data collection (Hospital, ward, and patient level data was collected). Data was entered into the open-source Kobo Collect application and was analyzed using SPSS (version 22.0). Findings: Medical records of 837 in-patients were surveyed, of which the prevalence of antibiotics use was 78.5%. The most commonly prescribed antimicrobial was Ceftriaxone (21.7%) which is categorized in the Watch group of WHO AWaRe Classification, followed by Metronidazole (17.3%), Cefoperazone/Sulbactam (8.4%), Co-Amoxiclav (6.3%) and Piperacillin/Tazobactam (5.9%). The antibiotics were prescribed largely for surgical prophylaxis (36.7%), followed by community-acquired infections (24.7%). One antibiotic was prescribed to 46.7%, two to 39.9%, and three or more to 12.5 %. Two of six (30%) hospitals had functional drug and therapeutic committees, three (50%) had infection prevention and control committees, and one facility had an antibiotic formulary. Conclusion: Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasizes the importance of expanding the antimicrobial stewardship program. Mentoring clinical teams will help to rationalize antimicrobial use.

Keywords: antimicrobial resistance, antimicrobial stewardship, point prevalence survey, antibiotics

Procedia PDF Downloads 103

Authors: Neeti Rustagi, Naveen Dutt, Arvind Sinha, Mahaveer S. Rhodha, Pankaja R. Raghav

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Background: Pre-hospital trauma care services are in developing stage in fast-urbanizing cities of India including Jodhpur. Training of health professionals in providing necessary pre-hospital trauma care is an essential step in decreasing accident related morbidity and mortality. The current study explores the response of a medical graduate toward helping an accident victim in a pre-hospital setting before patient can be transferred to definitive trauma facility. Methodology: This study examines the perceived competence in predicting response to an accident victim by medical graduates in Jodhpur, Rajasthan. Participants completed measures of attitude, normative influence and perceived behavior control toward providing pre-hospital care to an accident victim. Likert scale was used to measure the participant responses. Preliminary and descriptive analysis were used using SPSS 21.0. Internal consistency of the responses received was measured using Cronbach’s alpha. Results: Almost all medical graduates agreed that road accidents are common in their area (male: 92%; female: 78%). More male medical graduates (28%) reported helping an accident victim as compared to female physicians (9%) in the previous three months. Majority of study participants (96%) reported that providing immediate care to an accident victim is essential to save the life of an individual. Experience of helping an accident victim was considered unpleasant by the majority of female participants (70%) as compared to male participants (36%). A large number of participants believed that their friends (80%) and colleagues (96%) would appreciate them helping an accident victim in a pre-hospital setting. A large number of participants also believed that they possess the necessary skills and competencies (80%) towards helping a roadside accident victim in the pre-hospital care environment. Perceived competence of helping a roadside accident victim until they are transferred to a health facility was reported by less than half of the participants (male: 56%; female: 43%). Conclusion: Medical graduates have necessary attitude, competencies, and intention of helping a roadside accident victim. The societal response towards helping a road side accident victim is also supportive. In spite of positive determinants, a large proportion of medical graduates have perceived lack of competence in helping a roadside accident victim. This is essential to explore further as providing pre-hospital care to a roadside accident victim is an essential step in establishing the continuum of care to an accident victim especially in countries where pre-hospital services are in developing phase.

Keywords: prehospital care, perceived behavior, perceived competence, medical graduates

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Authors: Haileyesus Tessema Alemneh, Abiyu Enyew Molla, Oluwole Daniel Makinde

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Introduction: Faba bean is one of the most important grown plants worldwide for humans and animals. Several biotic and abiotic elements have limited the output of faba beans, irrespective of their diverse significance. Many faba bean pathogens have been reported so far, of which the most important yield-limiting disease is chocolate spot disease (Botrytis fabae). The dynamics of disease transmission and decision-making processes for intervention programs for disease control are now better understood through the use of mathematical modeling. Currently, a lot of mathematical modeling researchers are interested in plant disease modeling. Objective: In this paper, a deterministic mathematical model for chocolate spot disease (CSD) on faba bean plant with an optimal control model was developed and analyzed to examine the best strategy for controlling CSD. Methodology: Three control interventions, quarantine (u2), chemical control (u3), and prevention (u1), are employed that would establish the optimal control model. The optimality system, characterization of controls, the adjoint variables, and the Hamiltonian are all generated employing Pontryagin’s maximum principle. A cost-effective approach is chosen from a set of possible integrated strategies using the incremental cost-effectiveness ratio (ICER). The forward-backward sweep iterative approach is used to run numerical simulations. Results: The Hamiltonian, the optimality system, the characterization of the controls, and the adjoint variables were established. The numerical results demonstrate that each integrated strategy can reduce the diseases within the specified period. However, due to limited resources, an integrated strategy of prevention and uprooting was found to be the best cost-effective strategy to combat CSD. Conclusion: Therefore, attention should be given to the integrated cost-effective and environmentally eco-friendly strategy by stakeholders and policymakers to control CSD and disseminate the integrated intervention to the farmers in order to fight the spread of CSD in the Faba bean population and produce the expected yield from the field.

Keywords: CSD, optimal control theory, Pontryagin’s maximum principle, numerical simulation, cost-effectiveness analysis

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Authors: Mandeep Saini

Abstract:

The rapid advancement of Artificial Intelligence (AI) is transforming various fields, including intellectual property law. This paper explores the emerging role of AI in interpreting patent claims, a critical and highly specialized area within intellectual property rights. Patent claims define the scope of legal protection granted to an invention, and their precise interpretation is crucial in determining the boundaries of the patent holder's rights. Traditionally, this interpretation has relied heavily on the expertise of patent examiners, legal professionals, and judges. However, the increasing complexity of modern inventions, especially in fields like biotechnology, software, and electronics, poses significant challenges to human interpretation. Introducing AI into patent claim interpretation raises several legal and ethical concerns. This paper addresses critical issues such as the reliability of AI-driven interpretations, the potential for algorithmic bias, and the lack of transparency in AI decision-making processes. It considers the legal implications of relying on AI, particularly regarding accountability for errors and the potential challenges to AI interpretations in court. The paper includes a comparative study of AI-driven patent claim interpretations versus human interpretations across different jurisdictions to provide a comprehensive analysis. This comparison highlights the variations in legal standards and practices, offering insights into how AI could impact the harmonization of international patent laws. The paper proposes policy recommendations for the responsible use of AI in patent law. It suggests legal frameworks that ensure AI tools complement, rather than replace, human expertise in patent claim interpretation. These recommendations aim to balance the benefits of AI with the need for maintaining trust, transparency, and fairness in the legal process. By addressing these critical issues, this research contributes to the ongoing discourse on integrating AI into the legal field, specifically within intellectual property rights. It provides a forward-looking perspective on how AI could reshape patent law, offering both opportunities for innovation and challenges that must be carefully managed to protect the integrity of the legal system.

Keywords: artificial intelligence (ai), patent claim interpretation, intellectual property rights, algorithmic bias, natural language processing, patent law harmonization, legal ethics

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

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

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

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Authors: Samantha Meyerholz

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MSKCC offers patients cutting edge cancer care with the highest quality standards. However, many patients and industry members do not realize that the operations of the Immunology Histology Lab (IHC) are the backbone for carrying out this mission. The IHC lab manufactures blocks and slides containing critical tissue samples that will be read by a Pathologist to diagnose and dictate a patient’s treatment course. The lab processes 200 requests daily, leading to the generation of approximately 2,000 slides and 1,100 blocks each day. Lab material is transported through labeling, cutting, staining and sorting manufacturing stations, while being managed by multiple techs throughout the space. The quality of the stain as well as wait times associated with processing requests, is directly associated with patients receiving rapid treatments and having a wider range of care options. This project aims to improve slide request turnaround time for rush and non-rush cases, while increasing the quality of each request filled (no missing slides or poorly stained items). Rush cases are to be filled in less than 24 hours, while standard cases are allotted a 48 hour time period. Reducing turnaround times enable patients to communicate sooner with their clinical team regarding their diagnosis, ultimately leading faster treatments and potentially better outcomes. Additional project goals included streamlining tech and material workflow, while reducing waste and increasing efficiency. This project followed a DMAIC structure with emphasis on lean and ergonomic principles that could be integrated into an evolving lab culture. Load times and batching processes were analyzed using process mapping, FMEA analysis, waste analysis, engineering observation, 5S and spaghetti diagramming. Reduction of lab technician movement as well as their body position at each workstation was of top concern to pathology leadership. With new equipment being brought into the lab to carry out workflow improvements, screen and tool placement was discussed with the techs in focus groups, to reduce variation and increase comfort throughout the workspace. 5S analysis was completed in two phases in the IHC lab, helping to drive solutions that reduced rework and tech motion. The IHC lab plans to continue utilizing these techniques to further reduce the time gap between tissue analysis and cancer care.

Keywords: engineering, ergonomics, healthcare, lean

Procedia PDF Downloads 222