Search results for: operative notes
77 Disability in the Course of a Chronic Disease: The Example of People Living with Multiple Sclerosis in Poland
Authors: Milena Trojanowska
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Disability is a phenomenon for which meanings and definitions have evolved over the decades. This became the trigger to start a project to answer the question of what disability constitutes in the course of an incurable chronic disease. The chosen research group are people living with multiple sclerosis.The contextual phase of the research was participant observation at the Polish Multiple Sclerosis Society, the largest NGO in Poland supporting people living with MS and their relatives. The research techniques used in the project are (in order of implementation): group interviews with people living with MS and their relatives, narrative interviews, asynchronous technique, participant observation during events organised for people living with MS and their relatives.The researcher is currently conducting follow-up interviews, as inaccuracies in the respondents' narratives were identified during the data analysis. Interviews and supplementary research techniques were used over the four years of the research, and the researcher also benefited from experience gained from 12 years of working with NGOs (diaries, notes). The research was carried out in Poland with the participation of people living in this country only.The research has been based on grounded theory methodology in a constructivist perspectivedeveloped by Kathy Charmaz. The goal was to follow the idea that research must be reliable, original, and useful. The aim was to construct an interpretive theory that assumes temporality and the processualityof social life. TheAtlas.ti software was used to collect research material and analyse it. It is a program from the CAQDAS(Computer-Assisted Qualitative Data Analysis Software) group.Several key factors influencing the construction of a disability identity by people living with multiple sclerosis was identified:-course of interaction with significant relatives,- the expectation of identification with disability (expressed by close relatives),- economic profitability (pension, allowances),- institutional advantages (e.g. parking card),- independence and autonomy (not equated with physical condition, but access to adapted infrastructure and resources to support daily functioning),- the way a person with MS construes the meaning of disability,- physical and mental state,- medical diagnosis of illness.In addition, it has been shown that making an assumption about the experience of disability in the course of MS is a form of cognitive reductionism leading to further phenomenon such as: the expectation of the person with MS to construct a social identity as a person with a disability (e.g. giving up work), the occurrence of institutional inequalities. It can also be a determinant of the choice of a life strategy that limits social and individual functioning, even if this necessity is not influenced by the person's physical or psychological condition.The results of the research are important for the development of knowledge about the phenomenon of disability. It indicates the contextuality and complexity of the disability phenomenon, which in the light of the research is a set of different phenomenon of heterogeneous nature and multifaceted causality. This knowledge can also be useful for institutions and organisations in the non-governmental sector supporting people with disabilities and people living with multiple sclerosis.Keywords: disability, multiple sclerosis, grounded theory, poland
Procedia PDF Downloads 10676 Invisible Feminists: An Autonomist Marxist Perspective of Digital Labour and Resistance Within the Online Sex Industry
Authors: Josie West
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This paper focuses on the conflicts and utility of Marxist Feminist frames for sex work research, drawing on findings uncovered through in-depth interviews with online sex workers, alongside critical discourse analysis of media and political commentary. It brings the critical perspective of women into digital workerism and gig economy dialogue who, despite their significant presence within online work, have been overlooked. The autonomist Marxist concept of class composition is adopted to unpack the social, technical and political composition of this often-invisible segment of the service sector. Autonomism makes visible the perspective of workers engaged in processes of mobilization and demobilizaiton. This allows researchers to find everyday forms of resistance which occur within and outside trade unions. On the other hand, Marxist feminist arguments about invisibility politics can generate unhelpful allegories about sex work as domestic labour within the reproductive sphere. Nick Srnicek’s development of Marx’s notion of infrastructure rents helps theorize experiences of unpaid labour within online sex work. Moreover, debates about anti-work politics can cause conflict among sex workers fighting for the labour movement and those rejecting the capitalist work ethic. This illuminates’ tensions caused by white privilege and differing experiences of sex work. The monopolistic and competitive nature of sex work platforms within platform capitalism, and the vulnerable position of marginalised workers within stigmatized/criminalised markets, complicates anti-work politics further. This paper is situated within the feminist sex wars and the intensely divisive question of whether sex workers are victims of the patriarchy or symbols of feminist resistance. Camgirls are shown to engage in radical tactics of resistance against their technical composition on popular sex work platforms. They also engage in creative acts of resistance through performance art, in an attempt to draw attention to stigma and anti-criminalization politics. This sector offers a fascinating window onto grassroots class-action, alongside education about ‘whorephobia.’ A case study of resistance against Only Fans, and a small workers co-operative which emerged during the pandemic, showcases how workers engage in socialist and political acts without the aid of unions. Workers are victims of neoliberalism and simultaneous adopters of neoliberal strategies of survival. The complex dynamics within unions are explored, including tensions with grass-roots resistance, financial pressures and intersecting complications of class, gender and race.Keywords: autonomist marxism, digital labor, feminism, neoliberalism, sex work, platform capitalism
Procedia PDF Downloads 9075 Evaluation of Trabectedin Safety and Effectiveness at a Tertiary Cancer Center at Qatar: A Retrospective Analysis
Authors: Nabil Omar, Farah Jibril, Oraib Amjad
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Purpose: Trabecatine is a is a potent marine-derived antineoplastic drug which binds to the minor groove of the DNA, bending DNA towards the major groove resulting in a changed conformation that interferes with several DNA transcription factors, repair pathways and cell proliferation. Trabectedin was approved by the European Medicines Agency (EMA; London, UK) for the treatment of adult patients with advanced stage soft tissue sarcomas in whom treatment with anthracyclines and ifosfamide has failed, or for those who are not candidates for these therapies. The recommended dosing regimen is 1.5 mg/m2 IV over 24 hours every 3 weeks. The purpose of this study was to comprehensively review available data on the safety and efficacy of trabectedin used as indicated for patients at a Tertiary Cancer Center at Qatar. Methods: A medication administration report generated in the electronic health record identified all patients who received trabectedin between November 1, 2015 and November 1, 2017. This retrospective chart review evaluated the indication of trabectedin use, compliance to administration protocol and the recommended monitoring parameters, number of patients improved on the drug and continued treatment, number of patients discontinued treatment due to side-effects and the reported side effects. Progress and discharged notes were utilized to report experienced side effects during trabectedin therapy. A total of 3 patients were reviewed. Results: Total of 2 out of 3 patients who received trabectedin were receiving it for non-FDA and non-EMA, approved indications; metastatic rhabdomyosarcoma and ovarian cancer stage IV with poor prognosis. And only one patient received it as indicated for leiomyosarcoma of left ureter with metastases to liver, lungs and bone. None of the patients has continued the therapy due to development of serious side effects. One patient had stopped the medication after one cycle due to disease progression and transient hepatic toxicity, the other one had disease progression and developed 12 % reduction in LVEF after 12 cycles of trabectedin, and the third patient deceased, had disease progression on trabectedin after the 10th cycle that was received through peripheral line which resulted in developing extravasation and left arm cellulitis requiring debridement. Regarding monitoring parameters, at baseline the three patients had ECHO, and Creatine Phosphokinase (CPK) but it was not monitored during treatment as recommended. Conclusion: Utilizing this medication as indicated with performing the appropriate monitoring parameters as recommended can benefit patients who are receiving it. It is important to reinforce the intravenous administration via central intravenous line, the re-assessment of left ventricular ejection fraction (LVEF) by echocardiogram or multigated acquisition (MUGA) scan at 2- to 3-month intervals thereafter until therapy is discontinued, and CPK and LFTs levels prior to each administration of trabectedin.Keywords: trabectedin, drug-use evaluation, safety, effectiveness, adverse drug reaction, monitoring
Procedia PDF Downloads 14374 Causes and Consequences of Intuitive Animal Communication: A Case Study at Panthera Africa
Authors: Cathrine Scharning Cornwall-Nyquist, David Rafael Vaz Fernandes
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Since its origins, mankind has been dreaming of communicating directly with other animals. Past civilizations interacted on different levels with other species and recognized them in their rituals and daily activities. However, recent scientific developments have limited the ability of humans to consider deeper levels of interaction beyond observation and/or physical behavior. In recent years, animal caretakers and facilities such as sanctuaries or rescue centers have been introducing new techniques based on intuition. Most of those initiatives are related to specific cases, such as the incapacity to understand an animal’s behavior. Respected organizations also include intuitive animal communication (IAC) sessions to follow up on past interventions with their animals. Despite the lack of credibility of this discipline, some animal caring structures have opted to integrate IAC into their daily routines and approaches to animal welfare. At this stage, animal communication will be generally defined as the ability of humans to communicate with animals on an intuitive level. The trend in the field remains to be explored. The lack of theory and previous research urges the scientific community to improve the description of the phenomenon and its consequences. Considering the current scenario, qualitative approaches may become a suitable pathway to explore this topic. The purpose of this case study is to explore the beliefs behind and the consequences of an approach based on intuitive animal communication techniques for Panthera Africa (PA), an ethical sanctuary located in South Africa. Due to their personal experience, the Sanctuary’s founders have developed a philosophy based on IAC while respecting the world's highest standards for big cat welfare. Their dual approach is reflected in their rescues, daily activities, and healing animals’ trauma. The case study's main research questions will be: (i) Why do they choose to apply IAC in their work? (ii) What consequences to their activities do IAC bring? (iii) What effects do IAC techniques bring in their interactions with the outside world? Data collection will be gathered on-site via: (i) Complete participation (field notes); (ii) Semi-structured interviews (audio transcriptions); (iii) Document analysis (internal procedures and policies); (iv) Audio-visual material (communication with third parties). The main researcher shall become an active member of the Sanctuary during a 30-day period and have full access to the site. Access to documents and audio-visual materials will be granted on a request basis. Interviews are expected to be held with PA founders and staff members and with IAC practitioners related to the facility. The information gathered shall enable the researcher to provide an extended description of the phenomenon and explore its internal and external consequences for Panthera Africa.Keywords: animal welfare, intuitive animal communication, Panthera Africa, rescue
Procedia PDF Downloads 9273 Text Mining Past Medical History in Electrophysiological Studies
Authors: Roni Ramon-Gonen, Amir Dori, Shahar Shelly
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Background and objectives: Healthcare professionals produce abundant textual information in their daily clinical practice. The extraction of insights from all the gathered information, mainly unstructured and lacking in normalization, is one of the major challenges in computational medicine. In this respect, text mining assembles different techniques to derive valuable insights from unstructured textual data, so it has led to being especially relevant in Medicine. Neurological patient’s history allows the clinician to define the patient’s symptoms and along with the result of the nerve conduction study (NCS) and electromyography (EMG) test, assists in formulating a differential diagnosis. Past medical history (PMH) helps to direct the latter. In this study, we aimed to identify relevant PMH, understand which PMHs are common among patients in the referral cohort and documented by the medical staff, and examine the differences by sex and age in a large cohort based on textual format notes. Methods: We retrospectively identified all patients with abnormal NCS between May 2016 to February 2022. Age, gender, and all NCS attributes reports were recorded, including the summary text. All patients’ histories were extracted from the text report by a query. Basic text cleansing and data preparation were performed, as well as lemmatization. Very popular words (like ‘left’ and ‘right’) were deleted. Several words were replaced with their abbreviations. A bag of words approach was used to perform the analyses. Different visualizations which are common in text analysis, were created to easily grasp the results. Results: We identified 5282 unique patients. Three thousand and five (57%) patients had documented PMH. Of which 60.4% (n=1817) were males. The total median age was 62 years (range 0.12 – 97.2 years), and the majority of patients (83%) presented after the age of forty years. The top two documented medical histories were diabetes mellitus (DM) and surgery. DM was observed in 16.3% of the patients, and surgery at 15.4%. Other frequent patient histories (among the top 20) were fracture, cancer (ca), motor vehicle accident (MVA), leg, lumbar, discopathy, back and carpal tunnel release (CTR). When separating the data by sex, we can see that DM and MVA are more frequent among males, while cancer and CTR are less frequent. On the other hand, the top medical history in females was surgery and, after that, DM. Other frequent histories among females are breast cancer, fractures, and CTR. In the younger population (ages 18 to 26), the frequent PMH were surgery, fractures, trauma, and MVA. Discussion: By applying text mining approaches to unstructured data, we were able to better understand which medical histories are more relevant in these circumstances and, in addition, gain additional insights regarding sex and age differences. These insights might help to collect epidemiological demographical data as well as raise new hypotheses. One limitation of this work is that each clinician might use different words or abbreviations to describe the same condition, and therefore using a coding system can be beneficial.Keywords: abnormal studies, healthcare analytics, medical history, nerve conduction studies, text mining, textual analysis
Procedia PDF Downloads 9672 Nondestructive Monitoring of Atomic Reactions to Detect Precursors of Structural Failure
Authors: Volodymyr Rombakh
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This article was written to substantiate the possibility of detecting the precursors of catastrophic destruction of a structure or device and stopping operation before it. Damage to solids results from breaking the bond between atoms, which requires energy. Modern theories of strength and fracture assume that such energy is due to stress. However, in a letter to W. Thomson (Lord Kelvin) dated December 18, 1856, J.C. Maxwell provided evidence that elastic energy cannot destroy solids. He proposed an equation for estimating a deformable body's energy, equal to the sum of two energies. Due to symmetrical compression, the first term does not change, but the second term is distortion without compression. Both types of energy are represented in the equation as a quadratic function of strain, but Maxwell repeatedly wrote that it is not stress but strain. Furthermore, he notes that the nature of the energy causing the distortion is unknown to him. An article devoted to theories of elasticity was published in 1850. Maxwell tried to express mechanical properties with the help of optics, which became possible only after the creation of quantum mechanics. However, Maxwell's work on elasticity is not cited in the theories of strength and fracture. The authors of these theories and their associates are still trying to describe the phenomena they observe based on classical mechanics. The study of Faraday's experiments, Maxwell's and Rutherford's ideas, made it possible to discover a previously unknown area of electromagnetic radiation. The properties of photons emitted in this reaction are fundamentally different from those of photons emitted in nuclear reactions and are caused by the transition of electrons in an atom. The photons released during all processes in the universe, including from plants and organs in natural conditions; their penetrating power in metal is millions of times greater than that of one of the gamma rays. However, they are not non-invasive. This apparent contradiction is because the chaotic motion of protons is accompanied by the chaotic radiation of photons in time and space. Such photons are not coherent. The energy of a solitary photon is insufficient to break the bond between atoms, one of the stages of which is ionization. The photographs registered the rail deformation by 113 cars, while the Gaiger Counter did not. The author's studies show that the cause of damage to a solid is the breakage of bonds between a finite number of atoms due to the stimulated emission of metastable atoms. The guarantee of the reliability of the structure is the ratio of the energy dissipation rate to the energy accumulation rate, but not the strength, which is not a physical parameter since it cannot be measured or calculated. The possibility of continuous control of this ratio is due to the spontaneous emission of photons by metastable atoms. The article presents calculation examples of the destruction of energy and photographs due to the action of photons emitted during the atomic-proton reaction.Keywords: atomic-proton reaction, precursors of man-made disasters, strain, stress
Procedia PDF Downloads 9271 Effect of Perioperative Multimodal Analgesia on Postoperative Opioid Consumption and Complications in Elderly Traumatic Hip Fracture Patients: A Systematic Review of Randomised Controlled Trials
Authors: Raheel Shakoor Siddiqui, Shahbaz Malik, Manikandar Srinivas Cheruvu, Sanjay Narayana Murthy, Livio DiMascio
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Background: elderly traumatic hip fracture patients frequently present to trauma services globally. Rising low energy falls amongst an osteoporotic aging population is the commonest cause for injury. Hip fractures in this population are a major cause for severe pain, morbidity and mortality. The term hip fracture is interchangeable with neck of femur fracture, fractured neck of femur or proximal femur fracture. Hip fracture pain management protocols and guidelines suggest conventional analgesia, nerve block and opioid based treatment as rescue analgesia. There is a current global opioid crisis with overuse, abuse and dependence. Adverse opioid related complications in vulnerable elderly patients further adds to morbidity and mortality. Systematic reviews in literature have evidenced superiority of multimodal analgesia in osteoarthritic primary joint replacements compared to opioids however, this has not yet been conducted for elderly traumatic hip fracture patients. Aims: The primary aim of this systematic review is to provide standardised evidence following Cochrane and PRISMA guidance in determining advantages of perioperative multimodal analgesia over conventional opioid based treatments in elderly traumatic hip fractures. Methods: 5 databases were searched from January 2000-2023 which identified 8 randomised controlled trials and 446 total participants. These trials met defined PICOS eligibility criteria of patient mean age ≥ 65 years presenting with a unilateral traumatic fractured neck of femur for operative intervention. Analgesic intervention with perioperative multimodal analgesia has been compared to conventional opioid based analgesia. Outcomes of interest include, primarily, the change in postoperative opioid consumption within a 0-30 postoperative period and secondarily, the change in postoperative adverse events and complications. A qualitative synthesis has been performed due to clinical heterogenicity and variance amongst trials. Results: GRADE evidence of moderate quality supports perioperative multimodal analgesia leads to a reduction in postoperative opioid consumption however, low quality evidence supports a reduction of adverse effects and complications. Conclusion: Perioperative multimodal analgesia whether used preoperative, intraoperative and/or postoperative leads to a reduction in postoperative opioid consumption for elderly traumatic hip fracture patients. This review recommends the use of perioperative multimodal analgesia as part of hip fracture pain protocols however, caution and clinical judgement should be used as the risk of adverse effects may not be lower.Keywords: trauma, orthopaedics, hip, fracture, neck of femur fracture, analgesia, multimodal analgesia, opioid
Procedia PDF Downloads 9770 Evaluation of Anti-inflammatory Activities of Extracts Obtained from Capparis Erythrocarpos In-Vivo
Authors: Benedict Ofori, Kwabena Sarpong, Stephen Antwi
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Background: Medicinal plants are utilized all around the world and are becoming increasingly important economically. The WHO notes that ‘inappropriate use of traditional medicines or practices can have negative or dangerous effects and that future research is needed to ascertain the efficacy and safety of such practices and medicinal plants used by traditional medicine systems. The poor around the world have limited access to palliative care or pain relief. Pharmacologists have been focused on developing safe and effective anti-inflammatory drugs. Most of the issues related to their use have been linked to the fact that numerous traditional and herbal treatments are classified in different nations as meals or dietary supplements. As a result, there is no need for evidence of the quality, efficacy, or safety of these herbal formulations before they are marketed. The fact that access to drugs meant for pain relief is limited in low-income countries means advanced studies should be done on home drugs meant for inflammation to close the gap. Methods: The ethanolic extracts of the plant were screened for the presence of 10 phytochemicals. The Pierce BCA Protein Assay Kit was used for the determination of the protein concentration of the egg white. The rats were randomly selected and put in 6 groups. The egg white was sub-plantar injected into the right-hand paws of the rats to induce inflammation. The animals were treated with the three plant extracts obtained from the root bark, stem, and leaves of the plant. The control groups were treated with normal saline, while the standard groups were treated with standard drugs indomethacin and celecoxib. Plethysmometer was used to measure the change in paw volume of the animals over the course of the experiment. Results: The results of the phytochemical screening revealed the presence of reducing sugars and saponins. Alkaloids were present in only R.L.S (1:1:1), and phytosterols were found in R.L(1:1) and R.L.S (1:1:1). The estimated protein concentration was found to be 103.75 mg/ml. The control group had an observable increase in paw volume, which indicated that inflammation was induced during the 5 hours. The increase in paw volume for the control group peaked at the 1st hour and decreased gradually throughout the experiment, with minimal changes in the paw volumes. The 2nd and 3rd groups were treated with 20 mg/kg of indomethacin and celecoxib. The anti-inflammatory activities of indomethacin and celecoxib were calculated to be 21.4% and 4.28%, respectively. The remaining 3 groups were treated with 2 dose levels of 200mg/kg plant extracts. R.L.S, R.L, and S.R.L had anti-inflammatory activities of 22.3%, 8.2%, and 12.07%, respectively. Conclusions: Egg albumin-induced paw model in rats can be used to evaluate the anti-inflammatory activity of herbs that might have potential anti-inflammatory activity. Herbal medications have potential anti-inflammatory activities and can be used to manage various inflammatory conditions if their efficacy and side effects are well studied. The three extracts all possessed anti-inflammatory activity, with R.L.S having the highest anti-inflammatory activity.Keywords: inflammation, capparis erythrocarpos, anti-inflammatory activity, herbal medicine, paw volume, egg albumin
Procedia PDF Downloads 8969 Mechanical Properties and Antibiotic Release Characteristics of Poly(methyl methacrylate)-based Bone Cement Formulated with Mesoporous Silica Nanoparticles
Authors: Kumaran Letchmanan, Shou-Cang Shen, Wai Kiong Ng
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Postoperative implant-associated infections in soft tissues and bones remain a serious complication in orthopaedic surgery, which leads to impaired healing, re-implantation, prolong hospital stay and increase cost. Drug-loaded implants with sustained release of antibiotics at the local site are current research interest to reduce the risk of post-operative infections and osteomyelitis, thus, minimize the need for follow-up care and increase patient comfort. However, the improved drug release of the drug-loaded bone cements is usually accompanied by a loss in mechanical strength, which is critical for weight-bearing bone cement. Recently, more attempts have been undertaken to develop techniques to enhance the antibiotic elution as well as preserve the mechanical properties of the bone cements. The present study investigates the potential influence of addition of mesoporous silica nanoparticles (MSN) on the in vitro drug release kinetics of gentamicin (GTMC), along with the mechanical properties of bone cements. Simplex P was formulated with MSN and loaded with GTMC by direct impregnation. Meanwhile, Simplex P with water soluble poragen (xylitol) and high loading of GTMC as well as commercial bone cement CMW Smartset GHV were used as controls. MSN-formulated bone cements are able to increase the drug release of GTMC by 3-fold with a cumulative release of more than 46% as compared with other control groups. Furthermore, a sustained release could be achieved for two months. The loaded nano-sized MSN with uniform pore channels significantly build up an effective nano-network path in the bone cement facilitates the diffusion and extended release of GTMC. Compared with formulations using xylitol and high GTMC loading, incorporation of MSN shows no detrimental effect on biomechanical properties of the bone cements as no significant changes in the mechanical properties as compared with original bone cement. After drug release for two months, the bending modulus of MSN-formulated bone cements is 4.49 ± 0.75 GPa and the compression strength is 92.7 ± 2.1 MPa (similar to the compression strength of Simplex-P: 93.0 ± 1.2 MPa). The unaffected mechanical properties of MSN-formulated bone cements was due to the unchanged microstructures of bone cement, whereby more than 98% of MSN remains in the matrix and supports the bone cement structures. In contrast, the large portions of extra voids can be observed for the formulations using xylitol and high drug loading after the drug release study, thus caused compressive strength below the ASTM F541 and ISO 5833 minimum of 70 MPa. These results demonstrate the potential applicability of MSN-functionalized poly(methyl methacrylate)-based bone cement as a highly efficient, sustained and local drug delivery system with good mechanical properties.Keywords: antibiotics, biomechanical properties, bone cement, sustained release
Procedia PDF Downloads 25768 Multifunctional Janus Microbots for Intracellular Delivery of Therapeutic Agents
Authors: Shilpee Jain, Sachin Latiyan, Kaushik Suneet
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Unlike traditional robots, medical microbots are not only smaller in size, but they also possess various unique properties, for example, biocompatibility, stability in the biological fluids, navigation opposite to the bloodstream, wireless control over locomotion, etc. The idea behind their usage in the medical field was to build a minimally invasive method for addressing the post-operative complications, including longer recovery time, infection eruption and pain. Herein, the present study demonstrates the fabrication of dual nature magneto-conducting Fe3O4 magnetic nanoparticles (MNPs) and SU8 derived carbon-based Janus microbots for the efficient intracellular delivery of biomolecules. The low aspect ratio with feature size 2-5 μm microbots were fabricated by using a photolithography technique. These microbots were pyrolyzed at 900°C, which converts SU8 into amorphous carbon. The pyrolyzed microbots have dual properties, i.e., the half part is magneto-conducting and another half is only conducting for sufficing the therapeutic payloads efficiently with the application of external electric/magnetic field stimulations. For the efficient intracellular delivery of the microbots, the size and aspect ratio plays a significant role. However, on a smaller scale, the proper control over movement is difficult to achieve. The dual nature of Janus microbots allowed to control its maneuverability in the complex fluids using external electric as well as the magnetic field. Interestingly, Janus microbots move faster with the application of an external electric field (44 µm/s) as compared to the magnetic field (18 µm/s) application. Furthermore, these Janus microbots exhibit auto-fluorescence behavior that will help to track their pathway during navigation. Typically, the use of MNPs in the microdevices enhances the tendency to agglomerate. However, the incorporation of Fe₃O₄ MNPs in the pyrolyzed carbon reduces the chances of agglomeration of the microbots. The biocompatibility of the medical microbots, which is the essential property of any biosystems, was determined in vitro using HeLa cells. The microbots were found to compatible with HeLa cells. Additionally, the intracellular uptake of microbots was higher in the presence of an external electric field as compared to without electric field stimulation. In summary, the cytocompatible Janus microbots were fabricated successfully. They are stable in the biological fluids, wireless controllable navigation with the help of a few Guess external magnetic fields, their movement can be tracked because of autofluorescence behavior, they are less susceptible to agglomeration and higher cellular uptake could be achieved with the application of the external electric field. Thus, these carriers could offer a versatile platform to suffice the therapeutic payloads under wireless actuation.Keywords: amorphous carbon, electric/magnetic stimulations, Janus microbots, magnetic nanoparticles, minimally invasive procedures
Procedia PDF Downloads 12567 A Smart Sensor Network Approach Using Affordable River Water Level Sensors
Authors: Dian Zhang, Brendan Heery, Maria O’Neill, Ciprian Briciu-Burghina, Noel E. O’Connor, Fiona Regan
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Recent developments in sensors, wireless data communication and the cloud computing have brought the sensor web to a whole new generation. The introduction of the concept of ‘Internet of Thing (IoT)’ has brought the sensor research into a new level, which involves the developing of long lasting, low cost, environment friendly and smart sensors; new wireless data communication technologies; big data analytics algorithms and cloud based solutions that are tailored to large scale smart sensor network. The next generation of smart sensor network consists of several layers: physical layer, where all the smart sensors resident and data pre-processes occur, either on the sensor itself or field gateway; data transmission layer, where data and instructions exchanges happen; the data process layer, where meaningful information is extracted and organized from the pre-process data stream. There are many definitions of smart sensor, however, to summarize all these definitions, a smart sensor must be Intelligent and Adaptable. In future large scale sensor network, collected data are far too large for traditional applications to send, store or process. The sensor unit must be intelligent that pre-processes collected data locally on board (this process may occur on field gateway depends on the sensor network structure). In this case study, three smart sensing methods, corresponding to simple thresholding, statistical model and machine learning based MoPBAS method, are introduced and their strength and weakness are discussed as an introduction to the smart sensing concept. Data fusion, the integration of data and knowledge from multiple sources, are key components of the next generation smart sensor network. For example, in the water level monitoring system, weather forecast can be extracted from external sources and if a heavy rainfall is expected, the server can send instructions to the sensor notes to, for instance, increase the sampling rate or switch on the sleeping mode vice versa. In this paper, we describe the deployment of 11 affordable water level sensors in the Dublin catchment. The objective of this paper is to use the deployed river level sensor network at the Dodder catchment in Dublin, Ireland as a case study to give a vision of the next generation of a smart sensor network for flood monitoring to assist agencies in making decisions about deploying resources in the case of a severe flood event. Some of the deployed sensors are located alongside traditional water level sensors for validation purposes. Using the 11 deployed river level sensors in a network as a case study, a vision of the next generation of smart sensor network is proposed. Each key component of the smart sensor network is discussed, which hopefully inspires the researchers who are working in the sensor research domain.Keywords: smart sensing, internet of things, water level sensor, flooding
Procedia PDF Downloads 38166 Follicular Thyroid Carcinoma in a Developing Country: A Retrospective Study of 10 Years
Authors: Abdul Aziz, Muhammad Qamar Masood, Saadia Sattar, Saira Fatima, Najmul Islam
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Introduction: The most common endocrine tumor is thyroid cancer. Follicular Thyroid Carcinoma (FTC) accounts for 5%–10% of all thyroid cancers. Patients with FTC frequently present with more advanced stage diseases and a higher occurrence of distant metastases because of the propensity of vascular invasion. FTC is mainly treated with surgery, while radioactive iodine therapy is the main adjuvant therapy as per ATA guidelines. In many developing countries, surgical facilities and radioactive iodine are in short supply; therefore, understanding follicular thyroid cancer trends may help developing countries plan and use resources more effectively. Methodology: It was a retrospective observational study of FTC patients of age 18 years and above conducted at Aga Khan University Hospital, Karachi, from 1st January 2010 to 31st December 2019. Results: There were 404 patients with thyroid carcinoma, out of which forty (10.1%) were FTC. 50% of the patients were in the 41-60 years age group, and the female to male ratio was 1.5: 1. Twenty-four patients (60%) presented with complain of neck swelling followed by metastasis (20%) and compressive symptoms (20%). The most common site of metastasis was bone (87.5%), followed by lung (12.5%). The pre-operative thyroglobulin level was done in six out of eight metastatic patients (75%) in which it was elevated. This emphasizes the importance of checking thyroglobulin level in unusual presentation (bone pain, fractures) of a patient having neck swelling also to help in establishing the primary source of tumor. There was no complete documentation of ultrasound features of the thyroid gland in all the patients, which is an important investigation done in the initial evaluation of thyroid nodule. On FNAC, 50% (20 patients) had Bethesda category III-IV nodules, while 10% ( 4 patients ) had Bethesda category II. In sixteen patients, FNAC was not done as they presented with compressive symptoms or metastasis. Fifty percent had a total thyroidectomy and 50% had subtotal followed by completion thyroidectomy, plus ten patients had lymph node dissection, out of which seven had histopathological lymph node involvement. On histopathology, twenty-three patients (57.5%) had minimally invasive, while seventeen (42.5%) had widely invasive follicular thyroid carcinoma. The capsular invasion was present in thirty-three patients (82.5%); one patient had no capsular invasion, but there was a vascular invasion. Six patients' histopathology had no record of capsular invasion. In contrast, the lymphovascular invasion was present in twenty-six patients (65%). In this study, 65 % of the patients had clinical stage 1 disease, while 25% had stage 2 and 10% had clinical stage 4. Seventeen patients (42.5%) had received RAI 30-100 mCi, while ten patients (25%) received more than 100 mCi. Conclusion: FTC demographic and clinicopathological presentation are the same in Pakistan as compared to other countries. Surgery followed by RAI is the mainstay of treatment. Thus understanding the trend of FTC and proper planning and utilization of the resources will help the developing countries in effectively treating the FTC.Keywords: thyroid carcinoma, follicular thyroid carcinoma, clinicopathological features, developing countries
Procedia PDF Downloads 19165 Negotiating Communication Options for Deaf-Disabled Children
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
Procedia PDF Downloads 12064 Multilingual Students Acting as Language Brokers in Italy: Their Points of View and Feelings towards This Activity
Authors: Federica Ceccoli
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Italy is undergoing one of its largest migratory waves, and Italian schools are reporting the highest numbers of multilingual students coming from immigrant families and speaking minority languages. For these pupils, who have not perfectly acquired their mother tongue yet, learning a second language may represent a burden on their linguistic development and may have some repercussions on their school performances and relational skills. These are some of the reasons why they have turned out to be those who have the worst grades and the highest school drop-out rates. However, despite these negative outcomes, it has been demonstrated that multilingual immigrant students frequently act as translators or language brokers for their peers or family members who do not speak Italian fluently. This activity has been defined as Child Language Brokering (hereinafter CLB) and it has become a common practice especially in minority communities as immigrants’ children often learn the host language much more quickly than their parents, thus contributing to their family life by acting as language and cultural mediators. This presentation aims to analyse the data collected by a research carried out during the school year 2014-2015 in the province of Ravenna, in the Northern Italian region of Emilia-Romagna, among 126 immigrant students attending junior high schools. The purpose of the study was to analyse by means of a structured questionnaire whether multilingualism matched with language brokering experiences or not and to examine the perspectives of those students who reported having acted as translators using their linguistic knowledge to help people understand each other. The questionnaire consisted of 34 items roughly divided into 2 sections. The first section required multilingual students to provide personal details like their date and place of birth, as well as details about their families (number of siblings, parents’ jobs). In the second section, they were asked about the languages spoken in their families as well as their language brokering experience. The in-depth questionnaire sought to investigate a wide variety of brokering issues such as frequency and purpose of the activity, where, when and which documents young language brokers translate and how they feel about this practice. The results have demonstrated that CLB is a very common practice among immigrants’ children living in Ravenna and almost all students reported positive feelings when asked about their brokering experience with their families and also at school. In line with previous studies, responses to the questionnaire item regarding the people they brokered for revealed that the category ranking first is parents. Similarly, language-brokering activities tend to occur most often at home and the documents they translate the most (either orally or in writing) are notes from teachers. Such positive feelings towards this activity together with the evidence that it occurs very often in schools have laid the foundation for further projects on how this common practice may be valued and used to strengthen the linguistic skills of these multilingual immigrant students and thus their school performances.Keywords: immigration, language brokering, multilingualism, students' points of view
Procedia PDF Downloads 17963 The Role of China’s Rural Policies on the Changing the Rural Area in China: Changfu Village(China) Case
Authors: Zheng Lulin, Xiong Guoping
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In recent years, agriculture, rural development, and peasants are among the top concerns and priorities of the Chinese Government. Several related issues have been paid many attentions by academic communities, including the impacts of corresponding policies on the rural villages, the mechanisms of these impacts, and the future development of rural society. However, most of the researchers focus on single rural policy instead of integral rural policy system. Hence, this dissertation focused on the mechanisms of policies’ influence on rural changes through a case study from Changfu Village in central Guangxi Province, China, to propose the optimized suggestions for rural development. Forty-three relevant pivotal policies of significant influence on rural development are summarized from literature and documents, covering five aspects of agricultural production, rural living security, open rural markets, rural household registration systems, and farmland transferring. Besides, having been live in this area for more than 20 years, researchers obtain the basic information about changing the social connection between citizens and villagers, the habitat of villagers by years of informal interviews. Furthermore, more than 200 questionnaires are given to villagers to analyze the changing of their personal and family information. The summary of rural policies revealed that the development trend of public rural policies followed the U-shape curve and these policies are characterized by economic intentions and operative economy. Report of questionnaires and interviews show that the development of rural economy was promoted greatly by public policies. Firstly, Social communication and rural culture were affected to a certain extent. Secondly, the educational level of rural individuals was significantly enhanced, whereas the quality of population had limited progress. Finally, the freedom of occupational choice for rural individuals into cities was greater than before, but still restricted by the class solidification of social background, resulting in more obstacles for rural individuals to settle down in cities. From what we discuss about, we may reach the conclusion on several perspectives: Firstly, the impact of the rural policies has a significant role in promoting the economy development of the rural area. However, separations between rural and urban area are still a major problem since rural policy contributed little to improve the rural population quality. Therefore, in the future, providing high quality educational facilities including teachers, libraries, and opportunities of broadening their knowledge base are key issues of future rural policy. Secondly, the development of rural economy would be a lack of driving force for further improvement owning to the fact that working hard couldn’t get more improvement. In the future, public policies should support the rural development of culture, technology, and personal qualities to create favorable social environment for the free increase of rural population.Keywords: changing of rural area, rural development of China, rural policy, social environment
Procedia PDF Downloads 42862 Ankle Fracture Management: A Unique Cross Departmental Quality Improvement Project
Authors: Langhit Kurar, Loren Charles
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Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.Keywords: ankle, fracture, BOAST, radiology
Procedia PDF Downloads 18061 The Artificial Intelligence Driven Social Work
Authors: Avi Shrivastava
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Our world continues to grapple with a lot of social issues. Economic growth and scientific advancements have not completely eradicated poverty, homelessness, discrimination and bias, gender inequality, health issues, mental illness, addiction, and other social issues. So, how do we improve the human condition in a world driven by advanced technology? The answer is simple: we will have to leverage technology to address some of the most important social challenges of the day. AI, or artificial intelligence, has emerged as a critical tool in the battle against issues that deprive marginalized and disadvantaged groups of the right to enjoy benefits that a society offers. Social work professionals can transform their lives by harnessing it. The lack of reliable data is one of the reasons why a lot of social work projects fail. Social work professionals continue to rely on expensive and time-consuming primary data collection methods, such as observation, surveys, questionnaires, and interviews, instead of tapping into AI-based technology to generate useful, real-time data and necessary insights. By leveraging AI’s data-mining ability, we can gain a deeper understanding of how to solve complex social problems and change lives of people. We can do the right work for the right people and at the right time. For example, AI can enable social work professionals to focus their humanitarian efforts on some of the world’s poorest regions, where there is extreme poverty. An interdisciplinary team of Stanford scientists, Marshall Burke, Stefano Ermon, David Lobell, Michael Xie, and Neal Jean, used AI to spot global poverty zones – identifying such zones is a key step in the fight against poverty. The scientists combined daytime and nighttime satellite imagery with machine learning algorithms to predict poverty in Nigeria, Uganda, Tanzania, Rwanda, and Malawi. In an article published by Stanford News, Stanford researchers use dark of night and machine learning, Ermon explained that they provided the machine-learning system, an application of AI, with the high-resolution satellite images and asked it to predict poverty in the African region. “The system essentially learned how to solve the problem by comparing those two sets of images [daytime and nighttime].” This is one example of how AI can be used by social work professionals to reach regions that need their aid the most. It can also help identify sources of inequality and conflict, which could reduce inequalities, according to Nature’s study, titled The role of artificial intelligence in achieving the Sustainable Development Goals, published in 2020. The report also notes that AI can help achieve 79 percent of the United Nation’s (UN) Sustainable Development Goals (SDG). AI is impacting our everyday lives in multiple amazing ways, yet some people do not know much about it. If someone is not familiar with this technology, they may be reluctant to use it to solve social issues. So, before we talk more about the use of AI to accomplish social work objectives, let’s put the spotlight on how AI and social work can complement each other.Keywords: social work, artificial intelligence, AI based social work, machine learning, technology
Procedia PDF Downloads 10260 Mobile Phones, (Dis) Empowerment and Female Headed Households: Trincomalee, Sri Lanka
Authors: S. A. Abeykoon
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This study explores the empowerment potential of the mobile phone, the widely penetrated and greatly affordable communication technology in Sri Lanka, for female heads of households in Trincomalee District, Sri Lanka-an area recovering from the effects of a 30-year civil war and the 2004 Boxing Day Tsunami. It also investigates how the use of mobile phones by these women is shaped and appropriated by the gendered power relations and inequalities in their respective communities and by their socio-economic factors and demographic characteristics. This qualitative study is based on the epistemology of constructionism; interpretivist, functionalist and critical theory approaches; and the process of action research. The data collection was conducted from September 2014 to November 2014 in two Divisional Secretaries of the Trincomalee District, Sri Lanka. A total of 30 semi-structured depth interviews and six focus groups with the female heads of households of Sinhalese, Tamil and Muslim ethnicities were conducted using purposive, representative and snowball sampling methods. The Grounded theory method was used to analyze transcribed interviews, focus group discussions and field notes that were coded and categorized in accordance with the research questions and the theoretical framework of the study. The findings of the study indicated that the mobile phone has mainly enabled the participants to balance their income earning activities and family responsibilities and has been useful in maintaining their family and social relationships, occupational duties and in making decisions. Thus, it provided them a higher level of security, safety, reassurance and self-confidence in carrying out their daily activities. They also practiced innovative strategies for the effective and efficient use of their mobile expenses. Although participants whose husbands or relatives have migrated were more tended to use smart phones, mobile literacy level of the majority of the participants was at a lower level limited to making and receiving calls and using SMS (Short Message Service) services. However, their interaction with the mobile phone was significantly shaped by the gendered power relations and their multiple identities based on their ethnicity, religion, class, education, profession and age. Almost all the participants were precautious of giving their mobile numbers to and have been harassed with ‘nuisance calls’ from men. For many, ownership and use of their mobile phone was shaped and influenced by their children and migrated husbands. Although these practices limit their use of the technology, there were many instances that they challenged these gendered harassments. While man-made and natural destructions have disempowered and victimized the women in the Sri Lankan society, they have also liberated women making them stronger and transforming their agency and traditional gender roles. Therefore, their present position in society is reflected in their mobile phone use as they assist such women to be more self-reliant and liberated, yet making them disempowered at some time.Keywords: mobile phone, gender power relations, empowerment, female heads of households
Procedia PDF Downloads 33659 Gathering Space after Disaster: Understanding the Communicative and Collective Dimensions of Resilience through Field Research across Time in Hurricane Impacted Regions of the United States
Authors: Jack L. Harris, Marya L. Doerfel, Hyunsook Youn, Minkyung Kim, Kautuki Sunil Jariwala
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Organizational resilience refers to the ability to sustain business or general work functioning despite wide-scale interruptions. We focus on organization and businesses as a pillar of their communities and how they attempt to sustain work when a natural disaster impacts their surrounding regions and economies. While it may be more common to think of resilience as a trait possessed by an organization, an emerging area of research recognizes that for organizations and businesses, resilience is a set of processes that are constituted through communication, social networks, and organizing. Indeed, five processes, robustness, rapidity, resourcefulness, redundancy, and external availability through social media have been identified as critical to organizational resilience. These organizing mechanisms involve multi-level coordination, where individuals intersect with groups, organizations, and communities. Because the nature of such interactions are often networks of people and organizations coordinating material resources, information, and support, they necessarily require some way to coordinate despite being displaced. Little is known, however, if physical and digital spaces can substitute one for the other. We thus are guided by the question, is digital space sufficient when disaster creates a scarcity of physical space? This study presents a cross-case comparison based on field research from four different regions of the United States that were impacted by Hurricanes Katrina (2005), Sandy (2012), Maria (2017), and Harvey (2017). These four cases are used to extend the science of resilience by examining multi-level processes enacted by individuals, communities, and organizations that together, contribute to the resilience of disaster-struck organizations, businesses, and their communities. Using field research about organizations and businesses impacted by the four hurricanes, we code data from interviews, participant observations, field notes, and document analysis drawn from New Orleans (post-Katrina), coastal New Jersey (post-Sandy), Houston Texas (post-Harvey), and the lower keys of Florida (post-Maria). This paper identifies an additional organizing mechanism, networked gathering spaces, where citizens and organizations, alike, coordinate and facilitate information sharing, material resource distribution, and social support. Findings show that digital space, alone, is not a sufficient substitute to effectively sustain organizational resilience during a disaster. Because the data are qualitative, we expand on this finding with specific ways in which organizations and the people who lead them worked around the problem of scarce space. We propose that gatherings after disaster are a sixth mechanism that contributes to organizational resilience.Keywords: communication, coordination, disaster management, information and communication technologies, interorganizational relationships, resilience, work
Procedia PDF Downloads 17158 Giving Children with Osteogenesis Imperfecta a Voice: Overview of a Participatory Approach for the Development of an Interactive Communication Tool
Authors: M. Siedlikowski, F. Rauch, A. Tsimicalis
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Osteogenesis Imperfecta (OI) is a genetic disorder of childhood onset that causes frequent fractures after minimal physical stress. To date, OI research has focused on medically- and surgically-oriented outcomes with little attention on the perspective of the affected child. It is a challenge to elicit the child’s voice in health care, in other words, their own perspective on their symptoms, but software development offers a way forward. Sisom (Norwegian acronym derived from ‘Si det som det er’ meaning ‘Tell it as it is’) is an award-winning, rigorously tested, interactive, computerized tool that helps children with chronic illnesses express their symptoms to their clinicians. The successful Sisom software tool, that addresses the child directly, has not yet been adapted to attend to symptoms unique to children with OI. The purpose of this study was to develop a Sisom paper prototype for children with OI by seeking the perspectives of end users, particularly, children with OI and clinicians. Our descriptive qualitative study was conducted at Shriners Hospitals for Children® – Canada, which follows the largest cohort of children with OI in North America. Purposive sampling was used to recruit 12 children with OI over three cycles. Nine clinicians oversaw the development process, which involved determining the relevance of current Sisom symptoms, vignettes, and avatars, as well as generating new Sisom OI components. Data, including field notes, transcribed audio-recordings, and drawings, were deductively analyzed using content analysis techniques. Guided by the following framework, data pertaining to symptoms, vignettes, and avatars were coded into five categories: a) Relevant; b) Irrelevant; c) To modify; d) To add; e) Unsure. Overall, 70.8% of Sisom symptoms were deemed relevant for inclusion, with 49.4% directly incorporated, and 21.3% incorporated with changes to syntax, and/or vignette, and/or location. Three additions were made to the ‘Avatar’ island. This allowed children to celebrate their uniqueness: ‘Makes you feel like you’re not like everybody else.’ One new island, ‘About Me’, was added to capture children’s worldviews. One new sub-island, ‘Getting Around’, was added to reflect accessibility issues. These issues were related to the children’s independence, their social lives, as well as the perceptions of others. In being consulted as experts throughout the co-creation of the Sisom OI paper prototype, children coded the Sisom symptoms and provided sound rationales for their chosen codes. In rationalizing their codes, all children shared personal stories about themselves and their relationships, insights about their OI, and an understanding of the strengths and challenges they experience on a day-to-day basis. The child’s perspective on their health is a basic right, and allowing it to be heard is the next frontier in the care of children with genetic diseases. Sisom OI, a methodological breakthrough within OI research, will offer clinicians an innovative and child-centered approach to capture this neglected perspective. It will provide a tool for the delivery of health care in the center that established the worldwide standard of care for children with OI.Keywords: child health, interactive computerized communication tool, participatory approach, symptom management
Procedia PDF Downloads 15757 The Political Economy of Media Privatisation in Egypt: State Mechanisms and Continued Control
Authors: Mohamed Elmeshad
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During the mid-1990's Egypt had become obliged to implement the Economic Reform and Structural Adjustment Program that included broad economic liberalization, expansion of the private sector and a contraction the size of government spending. This coincided as well with attempts to appear more democratic and open to liberalizing public space and discourse. At the same time, economic pressures and the proliferation of social media access and activism had led to increased pressure to open a mediascape and remove it from the clutches of the government, which had monopolized print and broadcast mass media for over 4 decades by that point. However, the mechanisms that governed the privatization of mass media allowed for sustained government control, even through the prism of ostensibly privately owned newspapers and television stations. These mechanisms involve barriers to entry from a financial and security perspective, as well as operational capacities of distribution and access to means of production. The power dynamics between mass media establishments and the state were moulded during this period in a novel way. Power dynamics within media establishments had also formed under such circumstances. The changes in the country's political economy itself somehow mirrored these developments. This paper will examine these dynamics and shed light on the political economy of Egypt's newly privatized mass media in the early 2000's especially. Methodology: This study will rely on semi-structured interviews from individuals involved with these changes from the perspective of the media organizations. It also will map out the process of media privatization by looking at the administrative, operative and legislative institutions and contexts in order to attempt to draw conclusions on methods of control and the role of the state during the process of privatization. Finally, a brief discourse analysis will be necessary in order to aptly convey how these factors ultimately reflected on media output. Findings and conclusion: The development of Egyptian private, “independent” mirrored the trajectory of transitions in the country’s political economy. Liberalization of the economy meant that a growing class of business owners would explore opportunities that such new markets would offer. However the regime’s attempts to control access to certain forms of capital, especially in sectors such as the media affected the structure of print and broadcast media, as well as the institutions that would govern them. Like the process of liberalisation, much of the regime’s manoeuvring with regards to privatization of media had been haphazardly used to indirectly expand the regime and its ruling party’s ability to retain influence, while creating a believable façade of openness. In this paper, we will attempt to uncover these mechanisms and analyse our findings in ways that explain how the manifestations prevalent in the context of a privatizing media space in a transitional Egypt provide evidence of both the intentions of this transition, and the ways in which it was being held back.Keywords: business, mass media, political economy, power, privatisation
Procedia PDF Downloads 22756 Design, Development and Testing of Polymer-Glass Microfluidic Chips for Electrophoretic Analysis of Biological Sample
Authors: Yana Posmitnaya, Galina Rudnitskaya, Tatyana Lukashenko, Anton Bukatin, Anatoly Evstrapov
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An important area of biological and medical research is the study of genetic mutations and polymorphisms that can alter gene function and cause inherited diseases and other diseases. The following methods to analyse DNA fragments are used: capillary electrophoresis and electrophoresis on microfluidic chip (MFC), mass spectrometry with electrophoresis on MFC, hybridization assay on microarray. Electrophoresis on MFC allows to analyse small volumes of samples with high speed and throughput. A soft lithography in polydimethylsiloxane (PDMS) was chosen for operative fabrication of MFCs. A master-form from silicon and photoresist SU-8 2025 (MicroChem Corp.) was created for the formation of micro-sized structures in PDMS. A universal topology which combines T-injector and simple cross was selected for the electrophoretic separation of the sample. Glass K8 and PDMS Sylgard® 184 (Dow Corning Corp.) were used for fabrication of MFCs. Electroosmotic flow (EOF) plays an important role in the electrophoretic separation of the sample. Therefore, the estimate of the quantity of EOF and the ways of its regulation are of interest for the development of the new methods of the electrophoretic separation of biomolecules. The following methods of surface modification were chosen to change EOF: high-frequency (13.56 MHz) plasma treatment in oxygen and argon at low pressure (1 mbar); 1% aqueous solution of polyvinyl alcohol; 3% aqueous solution of Kolliphor® P 188 (Sigma-Aldrich Corp.). The electroosmotic mobility was evaluated by the method of Huang X. et al., wherein the borate buffer was used. The influence of physical and chemical methods of treatment on the wetting properties of the PDMS surface was controlled by the sessile drop method. The most effective way of surface modification of MFCs, from the standpoint of obtaining the smallest value of the contact angle and the smallest value of the EOF, was the processing with aqueous solution of Kolliphor® P 188. This method of modification has been selected for the treatment of channels of MFCs, which are used for the separation of mixture of oligonucleotides fluorescently labeled with the length of chain with 10, 20, 30, 40 and 50 nucleotides. Electrophoresis was performed on the device MFAS-01 (IAI RAS, Russia) at the separation voltage of 1500 V. 6% solution of polydimethylacrylamide with the addition of 7M carbamide was used as the separation medium. The separation time of components of the mixture was determined from electropherograms. The time for untreated MFC was ~275 s, and for the ones treated with solution of Kolliphor® P 188 – ~ 220 s. Research of physical-chemical methods of surface modification of MFCs allowed to choose the most effective way for reducing EOF – the modification with aqueous solution of Kolliphor® P 188. In this case, the separation time of the mixture of oligonucleotides decreased about 20%. The further optimization of method of modification of channels of MFCs will allow decreasing the separation time of sample and increasing the throughput of analysis.Keywords: electrophoresis, microfluidic chip, modification, nucleic acid, polydimethylsiloxane, soft lithography
Procedia PDF Downloads 41255 The Incidence of Inferior Alveolar Nerve Dysfunction Following Bilateral Sagittal Split Osteotomies: A Single Centre Retrospective Audit in the United Kingdom
Authors: Krupali Mukeshkumar, Jinesh Shah
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Background: Bilateral Sagittal Split Osteotomy (BSSO), used for the correction of mandibular deformities, is a common oral and maxillofacial surgical procedure. Inferior alveolar nerve dysfunction is commonly reported post-operatively by patients as paresthesia or anesthesia. The current literature lacks a consensus on the incidence of inferior alveolar nerve dysfunction as patients are not routinely assessed pre and post-operatively with an objective assessment. The range of incidence varies from 9% to 85% of patients, with some authors arguing that 100% of patients experience nerve dysfunction immediately post-surgery. Systematic reviews have shown a difference between incidence rates at different follow-up periods using objective and subjective methods. Aim: To identify the incidence of inferior alveolar nerve dysfunction following BSSO. Gold standard: Nerve dysfunction incidence rates similar or lower than current literature of 83% day one post-operatively and 18.4% at one year follow up. Setting: A retrospective cross-sectional audit of patients treated between 2017-2019 at the Royal Stoke University Hospital, Maxillofacial and Orthodontic departments. Sample: All patients who underwent a BSSO (with or without le fort one osteotomy) between 2017–2019 were identified from the database. Patients with pre-existing neurosensory disturbance, those who had a genioplasty at the same time and those with no follow-up were excluded. The sample consisted of 121 patients, 37 males and 84 females between the ages of 17-50 years at the time of surgery. Methods: Clinical records of 121 cases were reviewed to assess the age, sex, type of mandibular osteotomy, status of the nerve during the surgical procedure, type of bony split and incidence of nerve dysfunction at follow-up appointments. The surgical procedure was carried out by three Maxillo-facial surgeons and follow-up appointments were carried out in the Orthodontic and Oral and Maxillo-facial departments. Results: 120 patients were treated to correct the mandibular facial deformity and 1 patient was treated for sleep apnoea. Seventeen patients had a mandibular setback and 104 patients had mandibular advancement. 68 patients reported inferior alveolar nerve dysfunction at one week following their surgery. Seventy-six patients had temporary paresthesia present between 2 weeks and 12 months post-surgery. 13 patients had persistent nerve dysfunction at 12 months, of which 1 had a bad bony split during the BSSO. The incidence of nerve dysfunction postoperatively was 6.6% after 1 day, 56.1% at 1 week, 62.8% at 2 weeks, 59.5% between 3-6 weeks, 43.0% between 8-16 weeks and 10.7% at 1 year. Conclusions: The results of this audit show a similar incidence rate to the research gold standard at the one-year follow-up. Future Recommendations: No changes to surgical procedure or technique are indicated, but a need for improved documentation and a standardized approach for assessment of post-operative nerve dysfunction would be beneficial.Keywords: bilateral sagittal split osteotomy, inferior alveolar nerve, mandible, nerve dysfunction
Procedia PDF Downloads 23654 Implementation of Language Policy in a Swedish Multicultural Early Childhood School: A Development Project
Authors: Carina Hermansson
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This presentation focuses a development project aiming at developing and documenting the steps taken at a multilingual, multicultural K-5 school, with the aim to improve the achievement levels of the pupils by focusing language and literacy development across the schedule in a digital classroom, and in all units of the school. This pre-formulated aim, thus, may be said to adhere to neoliberal educational and accountability policies in terms of its focus on digital learning, learning results, and national curriculum standards. In particular the project aimed at improving the collaboration between the teachers, the leisure time unit, the librarians, the mother tongue teachers and bilingual study counselors. This is a school environment characterized by cultural, ethnic, linguistic, and professional pluralization. The overarching aims of the research project were to scrutinize and analyze the factors enabling and obstructing the implementation of the Language Policy in a digital classroom. Theoretical framework: We apply multi-level perspectives in the analyses inspired by Uljens’ ideas about interactive and interpersonal first order (teacher/students) and second order(principal/teachers and other staff) educational leadership as described within the framework of discursive institutionalism, when we try to relate the Language Policy, educational policy, and curriculum with the administrative processes. Methodology/research design: The development project is based on recurring research circles where teachers, leisure time assistants, mother tongue teachers and study counselors speaking the mother tongue of the pupils together with two researchers discuss their digital literacy practices in the classroom. The researchers have in collaboration with the principal developed guidelines for the work, expressed in a Language Policy document. In our understanding the document is, however, only a part of the concept, the actions of the personnel and their reflections on the practice constitute the major part of the development project. One and a half years out of three years have now passed and the project has met with a row of difficulties which shed light on factors of importance for the progress of the development project. Field notes and recordings from the research circles, a survey with the personnel, and recorded group interviews provide data on the progress of the project. Expected conclusions: The problems experienced deal with leadership, curriculum, interplay between aims, technology, contents and methods, the parents as customers taking their children to other schools, conflicting values, and interactional difficulties, that is, phenomena on different levels, ranging from school to a societal level, as for example teachers being substituted as a result of the marketization of schools. Also underlying assumptions from actors at different levels create obstacles. We find this study and the problems we are facing utterly important to share and discuss in an era with a steady flow of refugees arriving in the Nordic countries.Keywords: early childhood education, language policy, multicultural school, school development project
Procedia PDF Downloads 14553 Process of Production of an Artisanal Brewery in a City in the North of the State of Mato Grosso, Brazil
Authors: Ana Paula S. Horodenski, Priscila Pelegrini, Salli Baggenstoss
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The brewing industry with artisanal concepts seeks to serve a specific market, with diversified production that has been gaining ground in the national environment, also in the Amazon region. This growth is due to the more demanding consumer, with a diversified taste that wants to try new types of beer, enjoying products with new aromas, flavors, as a differential of what is so widely spread through the big industrial brands. Thus, through qualitative research methods, the study aimed to investigate how is the process of managing the production of a craft brewery in a city in the northern State of Mato Grosso (BRAZIL), providing knowledge of production processes and strategies in the industry. With the efficient use of resources, it is possible to obtain the necessary quality and provide better performance and differentiation of the company, besides analyzing the best management model. The research is descriptive with a qualitative approach through a case study. For the data collection, a semi-structured interview was elaborated, composed of the areas: microbrewery characterization, artisan beer production process, and the company supply chain management. Also, production processes were observed during technical visits. With the study, it was verified that the artisan brewery researched develops preventive maintenance strategies with the inputs, machines, and equipment, so that the quality of the product and the production process are achieved. It was observed that the distance from the supplying centers makes the management of processes and the supply chain be carried out with a longer planning time so that the delivery of the final product is satisfactory. The production process of the brewery is composed of machines and equipment that allows the control and quality of the product, which the manager states that for the productive capacity of the industry and its consumer market, the available equipment meets the demand. This study also contributes to highlight one of the challenges for the development of small breweries in front of the market giants, that is, the legislation, which fits the microbreweries as producers of alcoholic beverages. This makes the micro and small business segment to be taxed as a major, who has advantages in purchasing large batches of raw materials and tax incentives because they are large employers and tax pickers. It was possible to observe that the supply chain management system relies on spreadsheets and notes that are done manually, which could be simplified with a computer program to streamline procedures and reduce risks and failures of the manual process. In relation to the control of waste and effluents affected by the industry is outsourced and meets the needs. Finally, the results showed that the industry uses preventive maintenance as a productive strategy, which allows better conditions for the production and quality of artisanal beer. The quality is directly related to the satisfaction of the final consumer, being prized and performed throughout the production process, with the selection of better inputs, the effectiveness of the production processes and the relationship with the commercial partners.Keywords: artisanal brewery, production management, production processes, supply chain
Procedia PDF Downloads 12052 The International Legal Protection of Foreign Investment Through Bilateral Investment Treaties and Double Taxation Treaties in the Context of International Investment Law and International Tax Law
Authors: Abdulmajeed Abdullah Alqarni
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This paper is devoted a study of the current frameworks applicable to foreign investments at the levels of domestic and international law, with a particular focus on the legitimate balance to be achieved between the rights of the host state and the legal protections owed to foreign investors. At the wider level of analysis, the paper attempts to map and critically examine the relationship between foreign investment and economic development. In doing so, the paper offers a study in how current discourses and practices on investment law can reconcile the competing interests of developing and developed countries. The study draws on the growing economic imperative for developing nations to create a favorable investment climate capable of attracting private foreign investment. It notes that that over the past decades, an abundance of legal standards that establish substantive and procedural protections for legal forms of foreign investments in the host countries have evolved and crystalized. The study then goes on to offer a substantive analysis of legal reforms at the domestic level in countries such as Saudi Arabia before going on to provide an in- depth and substantive examination of the most important instruments developed at the levels of international law: bilateral investment agreements and double taxation agreements. As to its methods, the study draws on case studies and from data assessing the link between double taxation and economic development. Drawing from the extant literature and doctrinal research, and international and comparative jurisprudence, the paper excavates and critically examines contemporary definitions and norms of international investment law, many of which have been given concrete form and specificity in an ever-expanding number of bilateral and multilateral investment treaties. By reconsidering the wider challenges of conflicts of law and jurisdiction, and the competing aims of the modern investment law regime, the study reflects on how bilateral investment treaties might succeed in achieving the dual aims of rights protection and economic sovereignty. Through its examination of the double taxation phenomena, the study goes on to identify key practical challenges raised by the implementation of bilateral treaties whilst also assessing the sufficiency of the domestic and international legal solutions that are proposed in response. In its final analysis, the study aims to contribute to existing scholarship by assessing contemporary legal and economic barriers to the free flow of investment with due regard for the legitimate concerns and diversity of developing nations. It does by situating its analysis of the domestic enforcement of international investment instrument in its wider historical and normative context. By focusing on the economic and legal dimensions of foreign investment, the paper also aims to offer an interdisciplinary and holistic perspective on contemporary issues and developments in investment law while offering practical reform proposals that can be used to be achieve a more equitable balance between the rights and interests of states and private entities in an increasingly trans nationalized sphere of investment regulation and treaty arbitration.Keywords: foreign investment, bilateral investment treaties, international tax law, double taxation treaties
Procedia PDF Downloads 8851 Photonic Dual-Microcomb Ranging with Extreme Speed Resolution
Authors: R. R. Galiev, I. I. Lykov, A. E. Shitikov, I. A. Bilenko
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Dual-comb interferometry is based on the mixing of two optical frequency combs with slightly different lines spacing which results in the mapping of the optical spectrum into the radio-frequency domain for future digitizing and numerical processing. The dual-comb approach enables diverse applications, including metrology, fast high-precision spectroscopy, and distance range. Ordinary frequency-modulated continuous-wave (FMCW) laser-based Light Identification Detection and Ranging systems (LIDARs) suffer from two main disadvantages: slow and unreliable mechanical, spatial scan and a rather wide linewidth of conventional lasers, which limits speed measurement resolution. Dual-comb distance measurements with Allan deviations down to 12 nanometers at averaging times of 13 microseconds, along with ultrafast ranging at acquisition rates of 100 megahertz, allowing for an in-flight sampling of gun projectiles moving at 150 meters per second, was previously demonstrated. Nevertheless, pump lasers with EDFA amplifiers made the device bulky and expensive. An alternative approach is a direct coupling of the laser to a reference microring cavity. Backscattering can tune the laser to the eigenfrequency of the cavity via the so-called self-injection locked (SIL) effect. Moreover, the nonlinearity of the cavity allows a solitonic frequency comb generation in the very same cavity. In this work, we developed a fully integrated, power-efficient, electrically driven dual-micro comb source based on the semiconductor lasers SIL to high-quality integrated Si3N4 microresonators. We managed to obtain robust 1400-1700 nm combs generation with a 150 GHz or 1 THz lines spacing and measure less than a 1 kHz Lorentzian withs of stable, MHz spaced beat notes in a GHz band using two separated chips, each pumped by its own, self-injection locked laser. A deep investigation of the SIL dynamic allows us to find out the turn-key operation regime even for affordable Fabry-Perot multifrequency lasers used as a pump. It is important that such lasers are usually more powerful than DFB ones, which were also tested in our experiments. In order to test the advantages of the proposed techniques, we experimentally measured a minimum detectable speed of a reflective object. It has been shown that the narrow line of the laser locked to the microresonator provides markedly better velocity accuracy, showing velocity resolution down to 16 nm/s, while the no-SIL diode laser only allowed 160 nm/s with good accuracy. The results obtained are in agreement with the estimations and open up ways to develop LIDARs based on compact and cheap lasers. Our implementation uses affordable components, including semiconductor laser diodes and commercially available silicon nitride photonic circuits with microresonators.Keywords: dual-comb spectroscopy, LIDAR, optical microresonator, self-injection locking
Procedia PDF Downloads 7250 Maritime English Communication Training for Japanese VTS Operators in the Congested Area Including the Narrow Channel of Akashi Strait
Authors: Kenji Tanaka, Kazumi Sugita, Yuto Mizushima
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This paper introduces a noteworthy form of English communication training for the officers and operators of the Osaka-Bay Marine Traffic Information Service (Osaka MARTIS) of the Japan Coast Guard working in the congested area at the Akashi Strait in Hyogo Prefecture, Japan. The authors of this paper, Marine Technical College’s (MTC) English language instructors, have been holding about forty lectures and exercises in basic and normal Maritime English (ME) for several groups of MARTIS personnel at Osaka MARTIS annually since they started the training in 2005. Trainees are expected to be qualified Maritime Third-Class Radio Operators who are responsible for providing safety information to a daily average of seven to eight hundred vessels that pass through the Akashi Strait, one of Japan’s narrowest channels. As of 2022, the instructors are conducting 55 remote lessons at MARTIS. One lesson is 90 minutes long. All 26 trainees are given oral and written assessments. The trainees need to pass the examination to become qualified operators every year, requiring them to train and maintain their linguistic levels even during the pandemic of Corona Virus Disease-19 (COVID-19). The vessel traffic information provided by Osaka MARTIS in Maritime English language is essential to the work involving the use of very high frequency (VHF) communication between MARTIS and vessels in the area. ME is the common language mainly used on board merchant, fishing, and recreational vessels, normally at sea. ME was edited and recommended by the International Maritime Organization in the 1970s, was revised in 2002, and has undergone continual revision. The vessel’s circumstances are much more serious at the strait than those at the open sea, so these vessels need ME to receive guidance from the center when passing through the narrow strait. The imminent and challenging situations at the strait necessitate that textbooks’ contents include the basics of the phrase book for seafarers as well as specific and additional navigational information, pronunciation exercises, notes on keywords and phrases, explanations about collocations, sample sentences, and explanations about the differences between synonyms especially those focusing on terminologies necessary for passing through the strait. Additionally, short Japanese-English translation quizzes about these topics, as well as prescribed readings about the maritime sector, are include in the textbook. All of these exercises have been trained in the remote education system since the outbreak of COVID-19. According to the guidelines of ME edited in 2009, the lowest level necessary for seafarers is B1 (lower individual users) of The Common European Framework of Reference for Languages: Learning, Teaching, Assessment (CEFR). Therefore, this vocational ME language training at Osaka MARTIS aims for its trainees to communicate at levels higher than B1. A noteworthy proof of improvement from this training is that most of the trainees have become qualified marine radio communication officers.Keywords: akashi strait, B1 of CEFR, maritime english communication training, osaka martis
Procedia PDF Downloads 12349 Designing an Operational Control System for the Continuous Cycle of Industrial Technological Processes Using Fuzzy Logic
Authors: Teimuraz Manjapharashvili, Ketevani Manjaparashvili
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Fuzzy logic is a modeling method for complex or ill-defined systems and is a relatively new mathematical approach. Its basis is to consider overlapping cases of parameter values and define operations to manipulate these cases. Fuzzy logic can successfully create operative automatic management or appropriate advisory systems. Fuzzy logic techniques in various operational control technologies have grown rapidly in the last few years. Fuzzy logic is used in many areas of human technological activity. In recent years, fuzzy logic has proven its great potential, especially in the automation of industrial process control, where it allows to form of a control design based on the experience of experts and the results of experiments. The engineering of chemical technological processes uses fuzzy logic in optimal management, and it is also used in process control, including the operational control of continuous cycle chemical industrial, technological processes, where special features appear due to the continuous cycle and correct management acquires special importance. This paper discusses how intelligent systems can be developed, in particular, how fuzzy logic can be used to build knowledge-based expert systems in chemical process engineering. The implemented projects reveal that the use of fuzzy logic in technological process control has already given us better solutions than standard control techniques. Fuzzy logic makes it possible to develop an advisory system for decision-making based on the historical experience of the managing operator and experienced experts. The present paper deals with operational control and management systems of continuous cycle chemical technological processes, including advisory systems. Because of the continuous cycle, many features are introduced in them compared to the operational control of other chemical technological processes. Among them, there is a greater risk of transitioning to emergency mode; the return from emergency mode to normal mode must be done very quickly due to the impossibility of stopping the technological process due to the release of defective products during this period (i.e., receiving a loss), accordingly, due to the need for high qualification of the operator managing the process, etc. For these reasons, operational control systems of continuous cycle chemical technological processes have been specifically discussed, as they are different systems. Special features of such systems in control and management were brought out, which determine the characteristics of the construction of control and management systems. To verify the findings, the development of an advisory decision-making information system for operational control of a lime kiln using fuzzy logic, based on the creation of a relevant expert-targeted knowledge base, was discussed. The control system has been implemented in a real lime production plant with a lime burn kiln, which has shown that suitable and intelligent automation improves operational management, reduces the risks of releasing defective products, and, therefore, reduces costs. The special advisory system was successfully used in the said plant both for the improvement of operational management and, if necessary, for the training of new operators due to the lack of an appropriate training institution.Keywords: chemical process control systems, continuous cycle industrial technological processes, fuzzy logic, lime kiln
Procedia PDF Downloads 2848 User-Centered Design in the Development of Patient Decision Aids
Authors: Ariane Plaisance, Holly O. Witteman, Patrick Michel Archambault
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Upon admission to an intensive care unit (ICU), all patients should discuss their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. We employed user-centered design to adapt an existing decision aid (DA) about CPR to create a novel wiki-based DA adapted to the context of a single ICU and tailored to individual patient’s risk factors. During Phase 1, we conducted three weeks of ethnography of the decision-making context in our ICU to identify clinician and patient needs for a decision aid. During this time, we observed five dyads of intensivists and patients discussing their wishes concerning life-sustaining interventions. We also conducted semi-structured interviews with the attending intensivists in this ICU. During Phase 2, we conducted three rounds of rapid prototyping involving 15 patients and 11 other allied health professionals. We recorded discussions between intensivists and patients and used a standardized observation grid to collect patients’ comments and sociodemographic data. We applied content analysis to field notes, verbatim transcripts and the completed observation grids. Each round of observations and rapid prototyping iteratively informed the design of the next prototype. We also used the programming architecture of a wiki platform to embed the GO-FAR prediction rule programming code that we linked to a risk graphics software to better illustrate outcome risks calculated. During Phase I, we identified the need to add a section in our DA concerning invasive mechanical ventilation in addition to CPR because both life-sustaining interventions were often discussed together by physicians. During Phase II, we produced a context-adapted decision aid about CPR and mechanical ventilation that includes a values clarification section, questions about the patient’s functional autonomy prior to admission to the ICU and the functional decline that they would judge acceptable upon hospital discharge, risks and benefits of CPR and invasive mechanical ventilation, population-level statistics about CPR, a synthesis section to help patients come to a final decision and an online calculator based on the GO-FAR prediction rule. Even though the three rounds of rapid prototyping led to simplifying the information in our DA, 60% (n= 3/5) of the patients involved in the last cycle still did not understand the purpose of the DA. We also identified gaps in the discussion and documentation of patients’ preferences concerning life-sustaining interventions (e.g.,. CPR, invasive mechanical ventilation). The final version of our DA and our online wiki-based GO-FAR risk calculator using the IconArray.com risk graphics software are available online at www.wikidecision.org and are ready to be adapted to other contexts. Our results inform producers of decision aids on the use of wikis and user-centered design to develop DAs that are better adapted to users’ needs. Further work is needed on the creation of a video version of our DA. Physicians will also need the training to use our DA and to develop shared decision-making skills about goals of care.Keywords: ethnography, intensive care units, life-sustaining therapies, user-centered design
Procedia PDF Downloads 354