Search results for: bio medical engineering

Authors: A. Al Hajeri, M. E. Minton, B. Haskins, F. H. Cummins

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The pre-hospital endotracheal intubation is fraught with difficulties; one solution offered has been video laryngoscopy (VL) which permits better visualization of the glottis than the standard method of direct laryngoscopy (DL). This method has resulted in a higher first attempt success rate and fewer failed intubations. However, VL has mainly been evaluated by experienced providers (experienced anesthetists), and as such the utility of this device for those whom infrequently intubate has not been thoroughly assessed. We sought to evaluate this equipment to determine whether in the hands of novice providers this equipment could prove an effective airway management adjunct. DL and two VL methods (C-Mac with distal screen/C-Mac with attached screen) were evaluated by simulating practice on a Laerdal airway management trainer manikin. Twenty Emergency Medical Technicians (basics) were recruited as novice practitioners. This group was used to eliminate bias, as these clinicians had no pre-hospital experience of intubation (although they did have basic airway skills). The following areas were assessed: Time taken to intubate, number of attempts required to successfully intubate, ease of use of equipment VL (attached screen) took on average longer for novice clinicians to successfully intubate and had a lower success rate and reported higher rating of difficulty compared to DL. However, VL (with distal screen) and DL were comparable on intubation times, success rate, gastric inflation rate and rating of difficulty by the user. This study highlights the routine use of VL by inexperienced clinicians would be of no added benefit over DL. Further studies are required to determine whether Emergency Medical Technicians (Paramedics) would benefit from this airway adjunct, and ascertain whether after initial mastery of VL (with a distal screen), lower intubation times and difficulty rating may be achievable.

Keywords: direct laryngoscopy, endotracheal intubation, pre-hospital, video laryngoscopy

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Authors: Sangeeta Palekar, Neeraj Rangwani, Akash Poddar, Jayu Kalambe

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The bio-medical analysis is an indispensable procedure for identifying health-related diseases like diabetes. Monitoring the glucose level in our body regularly helps us identify hyperglycemia and hypoglycemia, which can cause severe medical problems like nerve damage or kidney diseases. This paper presents a method for predicting the glucose concentration in blood samples using image processing and machine learning algorithms. The glucose solution is prepared by the glucose oxidase (GOD) and peroxidase (POD) method. An experimental database is generated based on the colorimetric technique. The image of the glucose solution is captured by the raspberry pi camera and analyzed using image processing by extracting the RGB, HSV, LUX color space values. Regression algorithms like multiple linear regression, decision tree, RandomForest, and XGBoost were used to predict the unknown glucose concentration. The multiple linear regression algorithm predicts the results with 97% accuracy. The image processing and machine learning-based approach reduce the hardware complexities of existing platforms.

Keywords: artificial intelligence glucose detection, glucose oxidase, peroxidase, image processing, machine learning

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Authors: Racheli Magnezi, Inbal Gazit, Michal Rassin, Joseph Barr, Orna Tal

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An effective process for transmitting patient critical information is essential for patient safety and for improving communication among healthcare staff. Previous studies have discussed handover tools such as SBAR (Situation, Background, Assessment, Recommendation) or SOFI (Short Observational Framework for Inspection). Yet, these formats lack flexibility, and require special training. In addition, nurses and physicians have different procedures for handing over information. The objectives of this study were to establish a universal, structured tool for handover, for both physicians and nurses, based on parameters that were defined as ‘important’ and ‘appropriate’ by the medical team, and to implement this tool in various hospital departments, with flexibility for each ward. A questionnaire, based on established procedures and on the literature, was developed to assess attitudes towards the most important information for effective handover between shifts (Cronbach's alpha 0.78). It was distributed to 150 senior physicians and nurses in 62 departments. Among senior medical staff, 12 physicians and 66 nurses responded to the questionnaire (52% response rate). Based on the responses, a handover form suitable for all hospital departments was designed and implemented. Important information for all staff included: Patient demographics (full name and age); Health information (diagnosis or patient complaint, changes in hemodynamic status, new medical treatment or equipment required); and Social Information (suspicion of violence, mental or behavioral changes, and guardianship). Additional information relevant to each unit included treatment provided, laboratory or imaging required, and change in scheduled surgery in surgical departments. ICU required information on background illnesses, Pediatrics required information on diet and food provided and Obstetrics required the number of days after cesarean section. Based on the model described, a flexible tool was developed that enables handover of both common and unique information. In addition, it includes general logistic information that must be transmitted to the next shift, such as planned disruptions in service or operations, staff training, etc. Development of a simple, clear, comprehensive, universal, yet flexible tool designed for all medical staff for transmitting critical information between shifts was challenging. Physicians and nurses found it useful and it was widely implemented. Ongoing research is needed to examine the efficiency of this tool, and whether the enthusiasm that accompanied its initial use is maintained.

Keywords: handover, nurses, hospital, critical information

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Authors: Yael Rieder, Yael Gilboa, S. O. Adva, Efrat Halevi, Ronnie Tepper

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Background: Operation of ultrasound equipment is a core skill for many clinical specialties. As part of the training program at -Simultech- a simulation center for Ob\Gyn at the Meir Medical Center, Israel, teaching how to operate ultrasound equipment requires dealing with misunderstandings of spatial and 3D orientation, failure of the operator to hold a transducer correctly, and limited ability to evaluate the data on the screen. We have developed a platform intended to endow physicians and sonographers with clinical and operational skills of obstetric ultrasound. Simultech's simulations are focused on medical knowledge, risk management, technology operations and physician-patient communication. The simulations encompass extreme work conditions. Setup: Between eight and ten of the eight hundred and fifty physicians and sonographers of the Clalit health services from seven hospitals and eight community centers across Israel, participate in individual Ob/Gyn training sessions each week. These include Ob/Gyn specialists, experts, interns, and sonographers. Innovative teaching and training methodologies: The six-hour training program includes: (1) An educational computer program that challenges trainees to deal with medical questions based upon ultrasound pictures and films. (2) Sophisticated hands-on simulators that challenge the trainees to practice correct grip of the transducer, elucidate pathology, and practice daily tasks such as biometric measurements and analysis of sonographic data. (3) Participation in a video-taped simulation which focuses on physician-patient communications. In the simulation, the physician is required to diagnose the clinical condition of a hired actress based on the data she provides and by evaluating the assigned ultrasound films accordingly. Giving ‘bad news’ to the patient may put the physician in a stressful situation that must be properly managed. (4) Feedback at the end of each phase is provided by a designated trainer, not a physician, who is specially qualified by Ob\Gyn senior specialists. (5) A group exercise in which the trainer presents a medico-legal case in order to encourage the participants to use their own experience and knowledge to conduct a productive ‘brainstorming’ session. Medical cases are presented and analyzed by the participants together with the trainer's feedback. Findings: (1) The training methods and content that Simultech provides allows trainees to review their medical and communications skills. (2) Simultech training sessions expose physicians to both basic and new, up-to-date cases, refreshing and expanding the trainee's knowledge. (3) Practicing on advanced simulators enables trainees to understand the sonographic space and to implement the basic principles of ultrasound. (4) Communications simulations were found to be beneficial for trainees who were unaware of their interpersonal skills. The trainer feedback, supported by the recorded simulation, allows the trainee to draw conclusions about his performance. Conclusion: Simultech was found to contribute to physicians at all levels of clinical expertise who deal with ultrasound. A break in daily routine together with attendance at a neutral educational center can vastly improve performance and outlook.

Keywords: medical training, simulations, ultrasound, Simultech

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Authors: Humberto Foyaca Sibat, Lourdes de Fátima Ibañez Valdés

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Background Cysticercosis (Ct) is a preventable and eradicable zoonotic parasitic disease secondary to a cestode infection by the larva form of pig tapeworm Taenia solium (Ts), mainly seen in people living in developing countries. When the cysticercus is in the brain parenchymal, intraventricular system, subarachnoid space (SAS), cerebellum, brainstem, optic nerve, or spinal cord, then it has named neurocysticercosis (NCC), and the often-clinical manifestations are headache and epileptic seizures/epilepsy among other less frequent symptoms and signs. In this study, we look for a manuscript related to the role played by oligodendrocytes in the pathogenesis of NCC. We review this issue and formulate some hypotheses regarding its role and the role played in the pathogenesis of calcified NCC and epileptic seizures, and secondary epilepsy. Method: We searched the medical literature comprehensively, looking for published medical subject heading (MeSH) terms like "neurocysticercosis", "pathogenesis of neurocysticercosis", "comorbidity in NCC"; OR "oligodendrocytes"; OR "oligodendrocyte precursor cells(OPC/NG2)"; OR "epileptic seizures(ES)/Epilepsy(Ep)/NCC" OR "oligodendrocytes(OLG)/ES/Ep”; OR "calcified NCC/OLG"; OR “OLG Ca2+.” Results: All selected manuscripts were peer-reviewed, and we did not find publications related to OLG/NCC.

Keywords: oligodendrocytes, neurocysticercosis, oligodendrocytes, oligodendrocyte precursor cell, KG2, calcified neurocysticercosis, cellular calcium influx.

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Authors: Steven J. Singer, Julianna F. Kamenakis, Allison R. Shapiro, Kimberly M. Cacciato

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Communication and language are topics frequently studied among deaf children. However, there is limited research that focuses specifically on the communication and language experiences of Deaf-Disabled children. In this ethnography, researchers investigated the language experiences of six sets of parents with Deaf-Disabled children who chose American Sign Language (ASL) as the preferred mode of communication for their child. Specifically, the researchers were interested in the factors that influenced the parents’ decisions regarding their child’s communication options, educational placements, and social experiences. Data collection in this research included 18 hours of semi-structured interviews, 20 hours of participant observations, over 150 pages of reflexive journals and field notes, and a 2-hour focus group. The team conducted constant comparison qualitative analysis using NVivo software and an inductive coding procedure. The four researchers each read the data several times until they were able to chunk it into broad categories about communication and social influences. The team compared the various categories they developed, selecting ones that were consistent among researchers and redefining categories that differed. Continuing to use open inductive coding, the research team refined the categories until they were able to develop distinct themes. Two team members developed each theme through a process of independent coding, comparison, discussion, and resolution. The research team developed three themes: 1) early medical needs provided time for the parents to explore various communication options for their Deaf-Disabled child, 2) without intervention from medical professionals or educators, ASL emerged as a prioritized mode of communication for the family, 3) atypical gender roles affected familial communication dynamics. While managing the significant health issues of their Deaf-Disabled child at birth, families and medical professionals were so fixated on tending to the medical needs of the child that the typical pressures of determining a mode of communication were deprioritized. This allowed the families to meticulously research various methods of communication, resulting in an informed, rational, and well-considered decision to use ASL as the primary mode of communication with their Deaf-Disabled child. It was evident that having a Deaf-Disabled child meant an increased amount of labor and responsibilities for parents. This led to a shift in the roles of the family members. During the child’s development, the mother transformed from fulfilling the stereotypical roles of nurturer and administrator to that of administrator and champion. The mother facilitated medical proceedings and educational arrangements while the father became the caretaker and nurturer of their Deaf-Disabled child in addition to the traditional role of earning the family’s primary income. Ultimately, this research led to a deeper understanding of the critical role that time plays in parents’ decision-making process regarding communication methods with their Deaf-Disabled child.

Keywords: American Sign Language, deaf-disabled, ethnography, sociolinguistics

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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: Reena Aggarwal

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The use of textile chemicals in the various pre and post-textile manufacturing processes has made the textile industry conscious of its negative contribution to environmental pollution. Popular environmentally friendly fibers such as recycled polyester and organic cotton have been now increasingly used by fabrics and apparel manufacturers. However, after these textiles or the finished apparel are manufactured, they have to be dyed in the same chemical dyes that are harmful and toxic to the environment. Dyeing is a major area of concern for the environment as well as for people who have chemical sensitivities as it may cause nausea, breathing difficulties, seizures, etc. Ayurvastra or herbal medical textiles are one step ahead of the organic lifestyle, which supports the core concept of holistic well-being and also eliminates the impact of harmful chemicals and pesticides. There is a wide range of herbs that can be used not only for dyeing but also for providing medicinal properties to the textiles like antibacterial, antifungal, antiseptic, antidepressant and for treating insomnia, skin diseases, etc. The concept of herbal dyeing of fabric is to manifest herbal essence in every aspect of clothing, i.e., from production to end-use, additionally to eliminate the impact of harmful chemical dyes and chemicals which are known to result in problems like skin rashes, headache, trouble concentrating, nausea, diarrhea, fatigue, muscle and joint pain, dizziness, difficulty breathing, irregular heartbeat and seizures. Herbal dyeing or finishing on textiles will give an extra edge to the textiles as it adds an extra function to the fabric. The herbal extracts can be applied to the textiles by a simple process like the pad dry cure method and mainly acts on the human body through the skin for aiding in the treatment of disease or managing the medical condition through its herbal properties. This paper, therefore, delves into producing Ayurvastra, which is a perfect amalgamation of cloth and wellness. The aim of the paper is to design and create herbal disposable and non-disposable medical textile products acting mainly topically (through the skin) for providing medicinal properties/managing medical conditions. Keeping that in mind, a range of antifungal socks and antibacterial napkins treated with turmeric and aloe vera were developed, which are recommended for the treatment of fungal and bacterial infections, respectively. Both Herbal Antifungal socks and Antibacterial napkins have proved to be efficient enough in managing and treating fungal and bacterial infections of the skin, respectively.

Keywords: ayurvastra, ayurveda, herbal, pandemic, sustainable

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Authors: Neeraj Malhotra

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Background: Bioreactors in tissue engineering are used as devices that apply mechanical means to influence biological processes. They are commonly employed for stem cell culturing, growth and expansion as well as in 3D tissue culture. Contemporarily there use is well established and is tested extensively in the medical sciences, for tissue-regeneration and tissue engineering of organs like bone, cartilage, blood vessels, skin grafts, cardiac muscle etc. Methodology: Literature search, both electronic and hand search, was done using the following MeSH and keywords: bioreactors, bioreactors and dentistry, bioreactors & dental tissue engineering, bioreactors and regenerative dentistry. Articles published only in English language were included for review. Results: Bioreactors like, spinner flask-, rotating wall-, flow perfusion-, and micro-bioreactors and in-vivo bioreactor have been employed and tested for the regeneration of dental and like-tissues. These include gingival tissue, periodontal ligament, alveolar bone, mucosa, cementum and blood vessels. Based on their working dynamics they can be customized in future for regeneration of pulp tissue and whole tooth regeneration. Apart from this, they have been successfully used in testing the clinical efficacy and biological safety of dental biomaterials. Conclusion: Bioreactors have potential use in testing dental biomaterials and tissue engineering approaches aimed at regenerative dentistry.

Keywords: bioreactors, biological process, mechanical stimulation, regenerative dentistry, stem cells

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Authors: Seyed Ziya Tabatabaei, Azimi Bin Hj Hamzah, Fatemeh Ebrahimi

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The increase in proportion of older people in Malaysia has led to a significant growth of health care demands. The aim of this study is to explore how perceived health care needs influence on quality of life among elderly Malay residents who reside in a Malaysian residential home. This study employed a method known as ethnographic research from May 2011 to January 2012. Four data collection strategies were selected as the main data-collecting tools including participant observation, field notes, in-depth interviews, and review of related documents. The nine knowledgeable participants for the present study were selected using the purposive sampling method. Two themes were identified: (1) Medical concerns: Feeling secure, lack of information, inadequate medical staff; and (2) Health promotion: Body condition, health education, physiotherapy and rehabilitation. These results could evoke the attention of policy-makers and care providers to better meet elderly residents’ health care needs.

Keywords: ethnographic study, health care needs, Malay elderly people, Malaysia, Quality of life, Residential home

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Authors: Lewis Wallace, William Dempster, David Nash, Alexandros Boukis, Craig Maclean

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This paper, through traditional test methods and close adherence to international standards, presents a characterization study of a woven Polyethylene Terephthalate (PET). Testing is undergone in the axial, shear, and out-of-plane (bend) directions, and the results are fitted to the *FABRIC material model with ABAQUS FEA. The non-linear behaviors of the fabric in the axial and shear directions and behaviors on the macro scale are explored at the meso scale level. The medical grade bio-fabric is tested in untreated and heat-treated forms, and deviations are closely analyzed at the micro, meso, and macro scales to determine the effects of the process. The heat-treatment process was found to increase the stiffness of the fabric during axial and bending stiffness testing but had a negligible effect on the shear response. The ability of *FABRIC to capture behaviors unique to fabric deformation is discussed, whereby the unique phenomenological input can accurately represent the experimentally derived inputs.

Keywords: experimental techniques, FEA modelling, materials characterization, post-processing techniques

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Authors: Rosa L. Figueroa, Joselyn A. Hernández

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During the last couple of years, the Ministry of Health have been developing new health policies in order to regulate and improve in benefit of the patient the pharmaceutical system in our country. However, there are still some deficiencies in how medicines have been accessed, distributed, and sold. Therefore, it is necessary to empower the patient by offering new instances to improve access to drug information. This work introduces ‘the bioequivalent’ a medical drug search tool created to increase both diffusion and getting information about the therapeutic equivalence of medicines for the patient. The development of the search tool started with a study on the availability of sources of drug information accessible to the patient where advantages and disadvantages were analyzed. The information obtained was used to feed the functional design of the new tool. The design of the new tool shows an external interface that includes a header, body, sidebar and footer. The header has a menu containing ‘Home,’ ‘Who we are,’ and ‘Mission and vision.’ The Body contains the medical drug search tool, and the Sidebar is for the user logging in. It could be anonym, registered user, as well as, administrator. Anonym user could only use the tool. Registered users could add some information on existing medicines in the database; however, adding information will be restricted and limited to specific items and subject to administrator approval because the information added must be endorsed by the Chilean Public Health Institute. On the other hand, the administrator will have all the privileges, including creating or deleting drugs or information about them. The Bioequivalent was tested on different mobile devices, and no fails have been found. Moreover, a small survey was answered by ten people who tested the tool, and all of them agree that the tool was useful to get information about bioequivalent drugs, and they would recommend the tool to others. Nevertheless, an 80% of people who tested the tool says it was easy to use, and a 70% indicates that additional help is not required. These results are evidence that ‘the Bioequivalent’ may contribute to the knowledge about the therapeutic bioequivalence and bioequivalent drugs existing in Chile. As future work, the tool will be developed to make it available to the public for a first testing stage in a more massive scenario.

Keywords: collaborative database, bioequivalent drugs, search tool, web platform

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Authors: Shyam lamsal

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Introduction: Karnali Academy of Health Sciences (KAHS) has been established in 2011, by an Act of parliament of Nepal, in Jumla, to provide health services in easy way in backward areas, to produce skilled health professionals & conduct research. The backward areas mentioned in act of KAHS are Humla, Jumla, Kalikot, Dolpa, Mugu districts of Karnali zone, Jajarkot district of Bheri zone & Bajura, Baghang & Achham districts of Seti zone in Nepal occupying around 25 % of the total national geography. Backward area of Nepal is specific to having worst health indicators with life expectancy (47 years), HDI (0.35), Literacy rate (58%), global acute malnutrition (13%), crude birth rate (33.6), crude death rate (9.6), Total fertility rate (4.2), infant mortality rate (61.5 per 1000 live births), under five mortality rate (59 per 1000 live births) and maternal mortality ratio (400 per 1000 live births). History of health facilities in backward region: All the nine districts of this region have a district hospital with very few grass root level health manpower. Government of Nepal regularly deploys one or two medical officers to each district who generally are not regular to their care. Jumla district itself was having one medical officer before the establishment of KAHS. Development activities: Establishment of 100 bedded specialty teaching hospital with 10 medical officers and five specialists, accredited its own nursing school for running diploma nursing programme, started “Karnali health survey” which covers 55 thousand households of backward region, started community care and school health camps, planning phase completed for 300 bedded teaching hospital construction. Future Plan: Expansion of the teaching hospital to 300 beds within 3 years, start health assistant and bachelor midwifery course in 2015 AD, start bachelor in laboratory and bachelor in public health course in 2016 AD and start MBBS course in 2018 AD. Deploy the medical officers and family physicians to all the district hospitals within 3 years. KAHS provides reservation up to 45% students from backward region with the commitment to stay for at least five years of their service period. Conclusion: This institution may be the example for the rest of the world in providing nursing care, education in remote areas as well as the best model for nursing manpower retention in remote areas of developing countries.

Keywords: backward area, nursing school

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Authors: Ahmed Al Ansari, Khalid Al Khalifa

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Objective: Multisource feedback (MSF), also called the 360-Degree evaluation is an evaluation process by which questionnaires are distributed amongst medical peers and colleagues to assess physician performance from different sources other than the attending or the supervising physicians. The aim of this study was to design, implement, and evaluate a 360-Degree process in assessing emergency physicians trainee in the Kingdom of Bahrain. Method: The study was undertaken in Bahrain Defense Force Hospital which is a military teaching hospital in the Kingdom of Bahrain. Thirty emergency physicians (who represent the total population of the emergency physicians in our hospital) were assessed in this study. We developed an instrument modified from the Physician achievement review instrument PAR which was used to assess Physician in Alberta. We focused in our instrument to assess professionalism, communication skills and collaboration only. To achieve face and content validity, table of specification was constructed and a working group was involved in constructing the instrument. Expert opinion was considered as well. The instrument consisted of 39 items; were 15 items to assess professionalism, 13 items to assess communication skills, and 11 items to assess collaboration. Each emergency physicians was evaluated with 3 groups of raters, 4 Medical colleague emergency physicians, 4 medical colleague who are considered referral physicians from different departments, and 4 Coworkers from the emergency department. Independent administrative team was formed to carry on the responsibility of distributing the instruments and collecting them in closed envelopes. Each envelope was consisted of that instrument and a guide for the implementation of the MSF and the purpose of the study. Results: A total of 30 emergency physicians 16 males and 14 females who represent the total number of the emergency physicians in our hospital were assessed. The total collected forms is 269, were 105 surveys from coworkers working in emergency department, 93 surveys from medical colleague emergency physicians, and 116 surveys from referral physicians from different departments. The total mean response rates were 71.2%. The whole instrument was found to be suitable for factor analysis (KMO = 0.967; Bartlett test significant, p<0.00). Factor analysis showed that the data on the questionnaire decomposed into three factors which counted for 72.6% of the total variance: professionalism, collaboration, and communication. Reliability analysis indicated that the instrument full scale had high internal consistency (Cronbach’s α 0.98). The generalizability coefficients (Ep2) were 0.71 for the surveys. Conclusions: Based on the present results, the current instruments and procedures have high reliability, validity, and feasibility in assessing emergency physicians trainee in the emergency room.

Keywords: MSF system, emergency, validity, generalizability

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Authors: Asaf Toker

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Matricelf developed a technology that enables the production of autologous engineered tissue composed of matrix and cells derived from patients Omentum biopsy. The platform showed remarkable pre-clinical results for several medical conditions. The company recently licensed the technology that enabled scientist at Tel Aviv university that 3D printed a human heart from human cells and matrix for the first time in human history. The company plans to conduct its first human clinical trial for Acute Spinal Cord Injury (SCI) early in 2023.

Keywords: tissue engineering, regenerative medicine, spinal Cord Injury, autologous implants, iPSC

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Authors: Seda Sahin, Emin Akata

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Obturator foramen is a specific structure in pelvic bone images and recognition of it is a new concept in medical image processing. Moreover, segmentation of bone structures such as obturator foramen plays an essential role for clinical research in orthopedics. In this paper, we present a novel method to analyze the similarity between the substructures of the imaged region and a hand drawn template, on hip radiographs to detect obturator foramen accurately with integrated usage of Marker-controlled Watershed segmentation and Zernike moment feature descriptor. Marker-controlled Watershed segmentation is applied to seperate obturator foramen from the background effectively. Zernike moment feature descriptor is used to provide matching between binary template image and the segmented binary image for obturator foramens for final extraction. The proposed method is tested on randomly selected 100 hip radiographs. The experimental results represent that our method is able to segment obturator foramens with % 96 accuracy.

Keywords: medical image analysis, segmentation of bone structures on hip radiographs, marker-controlled watershed segmentation, zernike moment feature descriptor

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Authors: T. Thulare, M. Herselman, A. Botha

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Poor system use, including inappropriate design of health information systems, causes difficulties in communication with patients and increased time spent by healthcare professionals in recording the necessary health information for medical records. System features like pop-up reminders, complex menus, and poor user interfaces can make medical records far more time consuming than paper cards as well as affect decision-making processes. Although errors associated with health information and their real and likely effect on the quality of care and patient safety have been documented for many years, more research is needed to measure the occurrence of these errors and determine the causes to implement solutions. Therefore, the purpose of this paper is to identify data integrity challenges in hospital information systems through a scoping review and based on the results provide recommendations on how to manage these. Only 34 papers were found to be most suitable out of 297 publications initially identified in the field. The results indicated that human and computerized systems are the most common challenges associated with data integrity and factors such as policy, environment, health workforce, and lack of awareness attribute to these challenges but if measures are taken the data integrity challenges can be managed.

Keywords: data integrity, data integrity challenges, hospital information systems, South Africa

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Authors: M. E. Abalaka, S. Y. Daniyan, S. O. Adeyemo, D. Damisa

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Gold nanoparticles (AuNPs) have gained increasing interest in recent times. This is greatly due to their special features, which include unusual optical and electronic properties, high stability and biological compatibility, controllable morphology and size dispersion, and easy surface functionalization. In typical synthesis, AuNPs were produced by reduction of gold salt AuCl4 in an appropriate solvent. A stabilizing agent was added to prevent the particles from aggregating. The antibacterial activity of different sizes of gold nanoparticles was investigated against Staphylococcus aureus, Salmonella typhi and Pseudomonas pneumonia using the disk diffusion method in a Müeller–Hinton Agar. The Au-NPs were effective against all bacteria tested. That the Au-NPs were successfully synthesized in suspension and were used to study the antibacterial activity of the two medicinal plants against some bacterial pathogens suggests that Au-NPs can be employed as an effective bacteria inhibitor and may be an effective tool in medical field. The study clearly showed that the Au-NPs exhibiting inhibition towards the tested pathogenic bacteria in vitro could have the same effects in vivo and thus may be useful in the medical field if well researched into.

Keywords: gold nanoparticles, Gomphrena celesioides, Prunus amygdalus, pathogens

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Authors: Ana Mafalda Silva, Rebeca Fontes, Ana Paula Vaz, Carla Carreira, Ana Corte-Real

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Decades of research on the topic of interpersonal violence against minors highlight five main conclusions: 1) it causes harmful effects on children's development and health; 2) it is prevalent; 3) it violates children's rights; 4) it can be prevented and 5) parents are the main aggressors. The child abuse scenario is identified through clinical observation, administrative data and self-reports. The most used instruments are self-reports; however, there are no valid and reliable self-report instruments for minors, which consist of a retrospective interpretation of the situation by the victim already in her adult phase and/or by her parents. Clinical observation and collection of information, namely from the orofacial region, are essential in the early identification of these situations. The management of medical data, such as personal data, must comply with the General Data Protection Regulation (GDPR), in Europe, and with the General Law of Data Protection (LGPD), in Brazil. This review aims to answer the question: In a situation of medical assistance to minors, in the suspicion of interpersonal violence, due to mistreatment, is it necessary for the guardians to provide consent in the registration and sharing of personal data, namely medical ones. A scoping review was carried out based on a search by the Web of Science and Pubmed search engines. Four papers and two documents from the grey literature were selected. As found, the process of identifying and signaling child abuse by the health professional, and the necessary early intervention in defense of the minor as a victim of abuse, comply with the guidelines expressed in the GDPR and LGPD. This way, the notification in maltreatment scenarios by health professionals should be a priority and there shouldn’t be the fear or anxiety of legal repercussions that stands in the way of collecting and treating the data necessary for the signaling procedure that safeguards and promotes the welfare of children living with abuse.

Keywords: child abuse, disease notifications, ethics, healthcare assistance

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Authors: Donna Erika E. De Jesus

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Introduction: Cardiac arrest occurs when abrupt cessation of cardiac function results in loss of effective circulation and complete cardiovascular collapse. For every minute of cardiac arrest without early intervention (cardiopulmonary resuscitation [CPR], defibrillation), chances of survival drop by 7-10%. It is crucial that CPR be initiated within 4-6 minutes to avoid brain death. Most out-of-hospital cardiac arrests (OHCA) occur in a residential setting where access to trained personnel and equipment is not readily available, resulting in poor victim outcomes. Methods: This is a descriptive study done from August to November 2021 using a prospective cohort design. Participants of the study include adult patients aged 18 years and above brought to the emergency room who suffered from out-of-hospital cardiac arrest. Out of the total 102 cases of OHCA, 63 participants were included in the study. Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Results: 43 were male patients, comprising the majority at 73.02%. Hypertension was identified as the top co-morbidity, followed by diabetes mellitus, heart failure, and chronic kidney disease (CKD). Medical causes of arrest were identified in 96.83% of the cases. 90.48% of cardiac arrests occurred at home. Only 26 patients (41.27%) received pre-hospital intervention prior to ER arrival, which comprised only hands-only CPR. Twenty-three of which were performed by individuals with background knowledge of CPR. 60.32% were brought via self-conduction, the remainder by ambulances, which were noted to have no available equipment necessary to provide proper resuscitation. The average travel time from dispatch to ER arrival is 20 minutes. Conclusion: Overall survival of OHCA in our local setting remains dismal, as a return of spontaneous circulation was not achieved in any of the patients. The small number of patients having pre-hospital CPR indicates the need for emphasis on training and community education.

Keywords: out-of-hospital cardiac arrest, cardiopulmonary resuscitation, basic life support, emergency medical services

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Authors: Asfa Hussain, Chee Tang, Mien Nguyen

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Introduction: The safe usage of medications is dependent on clear, well-documented prescribing. Medical drug charts should be regularly checked to ensure that they are fit for purpose. Aims: The purpose of this study was to evaluate whether the Isabel Hospice drug charts were effective or prone to medical errors. The aim was to create a comprehensive palliative care drug chart in line with medico-legal guidelines and to minimise drug administration and prescription errors. Methodology: 50 medical drug charts were audited from March to April 2020, to assess whether they complied with medico-legal guidelines, in a hospice within East of England. Meetings were held with the larger multi-disciplinary team (MDT), including the pharmacists, nursing staff and doctors, to raise awareness of the issue. A preliminary drug chart was created, using the input from the wider MDT. The chart was revised and trialled over 15 times, and each time feedback from the MDT was incorporated into the subsequent template. In the midst of the COVID-19 pandemic in September 2020, the finalised drug chart was trialled. 50 new palliative drug charts were re-audited, to evaluate the changes made. Results: Prescribing and administration errors were high prior to the implementation of the new chart. This improved significantly after introducing the new drug charts, therefore improving patient safety and care. The percentage of inadequately documented allergies went down from 66% to 20% and incorrect oxygen prescription from 40% to 16%. The prescription drug-drug interactions decreased by 30%. Conclusion: It is vital to have clear standardised drug charts, in line with medico-legal standards, to allow ease of prescription and administration of medications and ensure optimum patient-centred care. This closed loop audit demonstrated significant improvement in documentation and prevention of possible fatal drug errors and interactions.

Keywords: palliative care, drug chart, medication errors, drug-drug interactions, COVID-19, patient safety

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Authors: Esengül Elibol, Arzu Kader Harmancı Seren

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Individuals' reasons to choose a profession, profession image perceptions and future plans related to that profession affect their success in their future work lives. For nursing profession, this situation at the same time is important in terms of the health and safety of patients. The purpose of this study is to determine why medical vocational high school students in İstanbul choose nursing profession, their nursing image perceptions and future plans related to the profession. Descriptive and cross-sectional design are used. The study was carried out in four medical vocational high school in İstanbul. All third and fourth grade students who are attending to nursing programs and voluntary for participation were included in the study. In collecting data, two questionnaires that aim to learn about socio-demographic characteristics, profession choice reasons and future plans of nursing students and ‘Nursing Image Scale’ were used. Scale consisted of 28 items including individuals' opinions on nursing profession image and three sub-categories ‘General View,’ ‘Communication,’ and ‘Vocational-Educational Qualities.’ Analyzing profession choice reasons and future plans of participants, it is determined that majority chose nursing for easily finding a job (46.9%) and that majority had a dream profession other than nursing (65.8%). Analyzing nursing image perception of participants, it is determined that average of general view sub-category total scores was 9.75±2.27, average of communication sub-category total scores was8.68±2.86, and average of vocational-educational qualities sub-category total score was 21.18±3.96. In the perception score averages, meaningful differences were found according to independent variables. In conclusion, it was determined that majority of the participant students chose nursing for easily finding a job, perceived profession image negatively, and had a dream profession other than nursing.

Keywords: nursing image, medical vocational health school, perception, profession, student nurse

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Authors: Sneha Shankar, Orlando Buendia, Will Evans

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Alpha-1 antitrypsin deficiency (AATD) is a rare, genetic, and multisystemic condition. Underdiagnosis is common, leading to chronic pulmonary and hepatic complications, increased resource utilization, and additional costs to the healthcare system. Currently, there is limited evidence of the direct medical costs of AATD diagnosis in the UK. This study explores the economic impact of AATD patients during the 3 years before diagnosis and to identify the major cost drivers using primary and secondary care electronic health record (EHR) data. The 3 years before diagnosis time period was chosen based on the ability of our tool to identify patients earlier. The AATD algorithm was created using published disease criteria and applied to 148 known AATD patients’ EHR found in a primary care database of 936,148 patients (413,674 Biobank and 501,188 in a single primary care locality). Among 148 patients, 9 patients were flagged earlier by the tool and, on average, could save 3 (1-6) years per patient. We analysed 101 of the 148 AATD patients’ primary care journey and 20 patients’ Hospital Episode Statistics (HES) data, all of whom had at least 3 years of clinical history in their records before diagnosis. The codes related to laboratory tests, clinical visits, referrals, hospitalization days, day case, and inpatient admissions attributable to AATD were examined in this 3-year period before diagnosis. The average cost per patient was calculated, and the direct medical costs were modelled based on the mean prevalence of 100 AATD patients in a 500,000 population. A deterministic sensitivity analysis (DSA) of 20% was performed to determine the major cost drivers. Cost data was obtained from the NHS National tariff 2020/21, National Schedule of NHS Costs 2018/19, PSSRU 2018/19, and private care tariff. The total direct medical cost of one hundred AATD patients three years before diagnosis in primary and secondary care in the UK was £3,556,489, with an average direct cost per patient of £35,565. A vast majority of this total direct cost (95%) was associated with inpatient admissions (£3,378,229). The DSA determined that the costs associated with tier-2 laboratory tests and inpatient admissions were the greatest contributors to direct costs in primary and secondary care, respectively. This retrospective study shows the role of EHRs in calculating direct medical costs and the potential benefit of new technologies for the early identification of patients with AATD to reduce the economic burden in primary and secondary care in the UK.

Keywords: alpha-1 antitrypsin deficiency, costs, digital health, early diagnosis

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Authors: C. D. Chen, H. Takaoka, Z. Ya’cob, V. L. Low, K. W. Lau, M. Sofian-Azirun

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Adult black flies (Diptera: Simuliidae) are small (1.5-6.0 mm long), two-winged insects, and are well known as one of the biting flies of medical and veterinary importance. Female of certain species, when they bite and take blood, not only cause severe skin diseases to human and cattle but also play a role as vectors of viral, protozoan and filarial diseases in humans and animals. Black flies also attract environmental biologist and ecologist because their immature states breed only in clean running fresh waters, and larvae are one of the principal processors of plant debris in streams. All these researches on medical and ecological aspects of black flies could not be reliably proceeded without sufficient basic knowledge of the fauna of black flies established by traditional but still important morphotaxonomy. Previously, only 39 species of black flies were recorded from Peninsular Malaysia, all of which are classified into four subgenus (Daviesellum, Gomphostilbia, Nevermannia and Simulium) of the genus Simulium. We carried out faunal surveys and taxonomic works of black flies in Peninsular Malaysia since November 2010. A total of 17 new species and 4 newly recorded species were collected. This increased the number of the described species of black flies in Peninsular Malaysia from 39 to 60. Our results suggest that a much higher diverse nature of black flies in Peninsular Malaysia will be clarified by further extensive surveys.

Keywords: black flies, Simulium, Nevermannia, feuerborni species-group

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Authors: Yaeji Lim, Hee-Seok Oh

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The coherence analysis measures the linear time-invariant relationship between two data sets and has been studied various fields such as signal processing, engineering, and medical science. However classical coherence analysis tends to be sensitive to outliers and focuses only on mean relationship. In this paper, we generalized cross periodogram to quantile cross periodogram and provide richer inter-relationship between two data sets. This is a general version of Laplace cross periodogram. We prove its asymptotic distribution under the long range process and compare them with ordinary coherence through numerical examples. We also present real data example to confirm the usefulness of quantile coherence analysis.

Keywords: coherence, cross periodogram, spectrum, quantile

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Authors: David F. Nettleton, Christian Wasiak, Jonas Dorissen, David Gillen, Alexandr Tretyak, Elodie Bugnicourt, Alejandro Rosales

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In this work, preliminary results are given for the modeling and calibration of two inline processes, pultrusion, and laser ablation, using machine learning techniques. The end product of the processes is the core of a medical guidewire, manufactured to comply with a user specification of diameter and flexibility. An ensemble approach is followed which requires training several models. Two state of the art machine learning algorithms are benchmarked: Kernel Recursive Least Squares (KRLS) and Support Vector Regression (SVR). The final objective is to build a precise digital model of the pultrusion and laser ablation process in order to calibrate the resulting diameter and flexibility of a medical guidewire, which is the end product while taking into account the friction on the forming die. The result is an ensemble of models, whose output is within a strict required tolerance and which covers the required range of diameter and flexibility of the guidewire end product. The modeling and automatic calibration of complex in-line industrial processes is a key aspect of the Industry 4.0 movement for cyber-physical systems.

Keywords: calibration, data modeling, industrial processes, machine learning

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Authors: Hritwik Ghosh, Irfan Sadiq Rahat, Sachi Nandan Mohanty, J. V. R. Ravindra

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In the rapidly evolving landscape of medical diagnostics, the early detection and accurate classification of skin cancer remain paramount for effective treatment outcomes. This research delves into the transformative potential of Artificial Intelligence (AI), specifically Deep Learning (DL), as a tool for discerning and categorizing various skin conditions. Utilizing a diverse dataset of 3,000 images representing nine distinct skin conditions, we confront the inherent challenge of class imbalance. This imbalance, where conditions like melanomas are over-represented, is addressed by incorporating class weights during the model training phase, ensuring an equitable representation of all conditions in the learning process. Our pioneering approach introduces a hybrid model, amalgamating the strengths of two renowned Convolutional Neural Networks (CNNs), VGG16 and ResNet50. These networks, pre-trained on the ImageNet dataset, are adept at extracting intricate features from images. By synergizing these models, our research aims to capture a holistic set of features, thereby bolstering classification performance. Preliminary findings underscore the hybrid model's superiority over individual models, showcasing its prowess in feature extraction and classification. Moreover, the research emphasizes the significance of rigorous data pre-processing, including image resizing, color normalization, and segmentation, in ensuring data quality and model reliability. In essence, this study illuminates the promising role of AI and DL in revolutionizing skin cancer diagnostics, offering insights into its potential applications in broader medical domains.

Keywords: artificial intelligence, machine learning, deep learning, skin cancer, dermatology, convolutional neural networks, image classification, computer vision, healthcare technology, cancer detection, medical imaging

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Authors: M. P. Sebastian

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Health for all is considered as a sign of well-being and inclusive growth. New healthcare technologies are contributing to the quality of human lives by promoting health education and awareness, leading to the prevention, early diagnosis and treatment of the symptoms of diseases. Healthcare technologies have now migrated from the medical and institutionalized settings to the home and everyday life. This paper explores these new technologies and investigates how they contribute to health education and awareness, promoting the objective of high-value health system for all. The methodology used for the research is literature review. The paper also discusses the opportunities and challenges with futuristic healthcare technologies. The combined advances in genomics medicine, wearables and the IoT with enhanced data collection in electronic health record (EHR) systems, environmental sensors, and mobile device applications can contribute in a big way to high-value health system for all. The promise by these technologies includes reduced total cost of healthcare, reduced incidence of medical diagnosis errors, and reduced treatment variability. The major barriers to adoption include concerns with security, privacy, and integrity of healthcare data, regulation and compliance issues, service reliability, interoperability and portability of data, and user friendliness and convenience of these technologies.

Keywords: big data, education, healthcare, information communication technologies (ICT), patients, technologies

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Authors: Jillian Gardner, Hilde D. Miniggio

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The increasing prevalence of obesity has driven the pursuit of alternative weight loss strategies, such as jaw wiring (or ‘slimming wires’), a technique known in the medical community as maxillomandibular fixation, which has evolved beyond its original intention of treating temporomandibular joint disorders. Individuals have increasingly sought and utilized the procedure for weight loss purposes. Although legal in South Africa, this trend presents dentists with ethical dilemmas, as they face requests for interventions that prioritize aesthetic preferences over medical necessity. Drawing on scholarly literature and the four principles framework of Beauchamp and Childress, this ethical analysis offers guidance for dentists facing the ethical dilemma of patient requests for jaw wiring as a weight management intervention. The ethical analysis concludes that dentists who refuse autonomous requests to perform jaw wiring for purely weight loss purposes are ethically justified within the principlist framework in overriding these requests when the principles of non-maleficence and beneficence are at stake. The well-being and health of the patient, as well as societal and professional obligations, justify the refusal to perform jaw wiring purely for weight loss.

Keywords: ethics, jaw wiring, maxillomandibular fixation, principlism, weight loss

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Authors: Robin Root

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A fundamental premise of medical anthropology is that clinical phenomena are simultaneously cultural, political, and economic: none more so than the linked acronyms HIV/AIDS. For the medical researcher, HIV/AIDS signals an epidemiological pandemic and a pathophysiology. For persons diagnosed with an HIV-related condition, the acronym often conjures dread, too often marking and marginalizing the afflicted irretrievably. Critical medical anthropology is uniquely equipped to theorize the linkages that bind individual and social wellbeing to global structural and culture-specific phenomena. This paper reports findings from an anthropological study of HIV/AIDS in Swaziland, site of the highest HIV prevalence in the world. The project, initiated in 2005, has documented experiences of HIV/AIDS, religiosity, and treatment and care as well as drought and famine. Drawing on interviews with Swazi religious and traditional leaders about their experiences of leadership amidst worsening economic conditions, environmental degradation, and an ongoing global health crisis, the paper provides uncommon insights for global health practitioners whose singular paradigm for designing and delivering interventions is biomedically-based. In contrast, this paper details the role of local leaders in mediating extreme social suffering and resilience in ways that medical science cannot model but which radically impact how sickness is experienced and health services are delivered and accessed. Two concepts help to organize the paper’s argument. First, a ‘moral economy of language’ is central to showing up the implicit ‘technologies of knowledge’ that inhere in scientific and religious discourses of HIV/AIDS; people draw upon these discourses strategically to navigate highly vulnerable conditions. Second, Paulo Freire’s ethnographic focus on a culture’s 'dangerous words' opens up for examination how ‘sex’ is dangerous for religion and ‘god’ is dangerous for science. The paper interrogates hegemonic and ‘lived’ discourses, both biomedical and religious, and contributes to an important literature on the moral economies of health, a framework of explication and, importantly, action appropriate to a wide-range of contemporary global health phenomena. The paper concludes by asserting that it is imperative that global health planners reflect upon and ‘check’ their hegemonic policy platforms by, one, collaborating with local authoritative agents of ‘what sickness means and how it is best treated,’ and, two, taking account of the structural barriers to achieving good health.

Keywords: Africa, biomedicine, HIV/AIDS, qualitative research , religion

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