Search results for: integrated clinical environment

Authors: Ian McCulloh, Andrew Placona, Darren Stewart, Daniel Gause, Kevin Kiernan, Morgan Stuart, Christopher Zinner, Laura Cartwright

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An estimated 22-25% of viable deceased donor kidneys are discarded every year in the US, while waitlisted candidates are dying every day. As many as 85% of transplanted organs are refused at least once for a patient that scored higher on the match list. There are hundreds of clinical variables involved in making a clinical transplant decision and there is rarely an ideal match. Decision makers exhibit an optimism bias where they may refuse an organ offer assuming a better match is imminent. We propose a semi-parametric Cox proportional hazard model, augmented by an accelerated failure time model based on patient specific suitable organ supply and demand to estimate a time-to-next-offer. Performance is assessed with Cox-Snell residuals and decision curve analysis, demonstrating improved decision support for up to a 5-year outlook. Providing clinical decision makers with quantitative evidence of likely patient outcomes (e.g., time to next offer and the mortality associated with waiting) may improve decisions and reduce optimism bias, thus reducing discarded organs and matching more patients on the waitlist.

Keywords: decision science, KDPI, optimism bias, organ transplant

Procedia PDF Downloads 105

Authors: Yan-Lin Liu, Cheng-Ting Shih, Jay Wu

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Tablet devices have been introduced into the medical environment in recent years. The performance of display can be varied based on the use of different hardware specifications and types of display technologies. Therefore, the differences between tablet devices and medical diagnostic LCDs have to be verified to ensure that image quality is not jeopardized for clinical diagnosis in a picture archiving and communication system (PACS). In this study, a set of randomized object test patterns (ROTPs) were developed, which included randomly located spheres in abdominal CT images. Five radiologists were asked to independently review the CT images on different generations of iPads and a diagnostic monochrome medical LCD monitor. Receiver operating characteristic (ROC) analysis was performed by using a five-point rating scale, and the average area under curve (AUC) and average reading time (ART) were calculated. The AUC values for the second generation iPad, iPad mini, iPad Air, and monochrome medical monitor were 0.712, 0.717, 0.725, and 0.740, respectively. The differences between iPads were not significant. The ARTs were 177 min and 127 min for iPad mini and medical LCD monitor, respectively. A significant difference appeared (p = 0.04). The results show that the iPads were slightly inferior to the monochrome medical LCD monitor. However, tablet devices possess advantages in portability and versatility, which can improve the convenience of rapid diagnosis and teleradiology. With advances in display technology, the applicability of tablet devices and mobile devices may be more diversified in PACS.

Keywords: tablet devices, PACS, receiver operating characteristic, LCD monitor

Procedia PDF Downloads 480

Authors: H. K. V. Narayan

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This study was conducted at Tata Memorial Hospital (TMH), Mumbai, India. The study was to evaluate the impact of adapting Smart Card (SC) for clinical and business transactions in order to reduce Lead times and to enforce business rules of the hospital. The objective for implementing the Smart Card was to improve the patient perception of quality in terms of structures process and outcomes and also to improve the productivity of the Institution. The Smart Card was implemented in phases from 2011 and integrated with the Hospital Information System (HIS/EMR). The implementation was a learning curve for all the stake holders as software obviated the need to use hardcopies of transactions. The acceptability to the stake holders was challenge in change management. The study assessed the impact 3 years into the implementation and the observed trends have suggested that it has decreased the lead times for services and increased the no of transactions and thereby the productivity. Patients who used to complain of multiple queues and cumbersome transactions now compliment the administration for effective use of Information and Communication Technology.

Keywords: smart card, high availability of health care information, reduction in potential medical errors due to elimination of transcription errors, reduction in no of queues, increased transactions, augmentation of revenue

Procedia PDF Downloads 285

Authors: Emmanuel Ogala

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Cloud computing has been envisioned as the next-generation architecture of Information Technology (IT) enterprise. In contrast to traditional solutions where IT services are under physical, logical and personnel controls, cloud computing moves the application software and databases to the large data centres, where the management of the data and services may not be fully trustworthy. This is due to the fact that the systems are opened to the whole world and as people tries to have access into the system, many people also are there trying day-in day-out on having unauthorized access into the system. This research contributes to the improvement of cloud computing security for better operation. The work is motivated by two problems: first, the observed easy access to cloud computing resources and complexity of attacks to vital cloud computing data system NIC requires that dynamic security mechanism evolves to stay capable of preventing illegitimate access. Second; lack of good methodology for performance test and evaluation of biometric security algorithms for securing records in cloud computing environment. The aim of this research was to evaluate the performance of an integrated security system (ISS) for securing exams records in cloud computing environment. In this research, we designed and implemented an ISS consisting of three security mechanisms of biometric (fingerprint), auto-PIN and password into one stream of access control and used for securing examination records in Kogi State University, Anyigba. Conclusively, the system we built has been able to overcome guessing abilities of hackers who guesses people password or pin. We are certain about this because the added security system (fingerprint) needs the presence of the user of the software before a login access can be granted. This is based on the placement of his finger on the fingerprint biometrics scanner for capturing and verification purpose for user’s authenticity confirmation. The study adopted the conceptual of quantitative design. Object oriented and design methodology was adopted. In the analysis and design, PHP, HTML5, CSS, Visual Studio Java Script, and web 2.0 technologies were used to implement the model of ISS for cloud computing environment. Note; PHP, HTML5, CSS were used in conjunction with visual Studio front end engine design tools and MySQL + Access 7.0 were used for the backend engine and Java Script was used for object arrangement and also validation of user input for security check. Finally, the performance of the developed framework was evaluated by comparing with two other existing security systems (Auto-PIN and password) within the school and the results showed that the developed approach (fingerprint) allows overcoming the two main weaknesses of the existing systems and will work perfectly well if fully implemented.

Keywords: performance evaluation, fingerprint, auto-pin, password-based, security systems, cloud computing environment

Procedia PDF Downloads 140

Authors: Han Xiao, Zhang Lei, Huang Hai, Lv Shizeng

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Space environment simulator is a device for spacecraft test. KM8 large space environment simulator built in Tianjing Space City is the largest as well as the most advanced space environment simulator in China. Large deviation of spacecraft level will lead to abnormally work of the thermal control device in spacecraft during the thermal vacuum test. In order to avoid thermal vacuum test failure, level adjusting mechanism system is developed in the KM8 large space environment simulator as one of the most important subsystems. According to the level adjusting requirements of spacecraft’s thermal vacuum tests, the four fulcrums adjusting model is established. By means of collecting level instruments and displacement sensors data, stepping motors controlled by PLC drive four supporting legs simultaneous movement. In addition, a PID algorithm is used to control the temperature of supporting legs and level instruments which long time work under the vacuum cold and black environment in KM8 large space environment simulator during thermal vacuum tests. Based on the above methods, the data acquisition and processing, the analysis and calculation, real time adjustment and fault alarming of the level adjusting mechanism system are implemented. The level adjusting accuracy reaches 1mm/m, and carrying capacity is 20 tons. Debugging showed that the level adjusting mechanism system of KM8 large space environment simulator can meet the thermal vacuum test requirement of the new generation spacecraft. The performance and technical indicators of the level adjusting mechanism system which provides important support for the development of spacecraft in China have been ahead of similar equipment in the world.

Keywords: space environment simulator, thermal vacuum test, level adjusting, spacecraft, parallel mechanism

Procedia PDF Downloads 247

Authors: Atitallah Sofien, Bouyahia Olfa, Hadj Salah Ibrahim, Ben Saleh Foued, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir

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Introduction: Carbon monoxide (CO) poisoning is a common pathology responsible for high morbidity and mortality worldwide. Aim: The purpose of this study was to determine the epidemiological profile of CO poisoning as well as its clinical, paraclinical, therapeutic, and evolutionary aspects. Methods: Our study included observations of CO poisoning in children hospitalized in the pediatric department C of the Children's Hospital in Tunis over a period of 3 years. Results: We have collected 199 cases of CO poisoning in children. The average age was 5.43 years, with a sex ratio of 0.98. The source of CO was inside the home in 73.2% of cases, and it was the gas bath heater in 68.8% of cases. The intoxication was collective in 93.5% of the cases, and it occurred during the month of January in 35.8% of the cases. The clinical manifestations were headaches in 69.5% of cases. The rate of carboxyhemoglobin was pathological in 73.9% of cases. All patients received normobaric oxygen therapy, and only 3.6% of patients had a hyperbaric oxygen therapy session. We did not deplore any case of death in our study. Conclusion: CO poisoning remains a public health problem in Tunisia with high morbidity. The risk of secondary complications, particularly neuropsychiatric, requires clinical and possibly neuroradiological monitoring of these victims.

Keywords: poisoning, carbon monoxide, children, hyperbaric oxygenation

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Authors: Muhammad Zainuddin Arriafdi, Hamudah Hakimah Abdullah, Mohd Helmi Sani, Wan Azlina Ahmad, Muhd Nazrul Hisham Zainal Alam

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The biotechnology process development demands numerous experimental works. In laboratory environment, this is typically carried out using a shake flask platform. This paper presents the design and fabrication of a miniature bioreactor system as an alternative research tool for bioprocessing. The working volume of the reactor is 100 ml, and it is made of plastic. The main features of the reactor included stirring control, temperature control via the electrical heater, aeration strategy through a miniature air compressor, and online optical cell density (OD) sensing. All sensors and actuators integrated into the reactor was controlled using an Arduino microcontroller platform. In order to demonstrate the functionality of such miniature bioreactor concept, series of batch Saccharomyces cerevisiae fermentation experiments were performed under various glucose concentrations. Results attained from the fermentation experiments were utilized to solve the Monod equation constants, namely the saturation constant, Ks, and cells maximum growth rate, μmax as to further highlight the usefulness of the device. The mixing capacity of the reactor was also evaluated. It was found that the results attained from the miniature bioreactor prototype were comparable to results achieved using a shake flask. The unique features of the device as compared to shake flask platform is that the reactor mixing condition is much more comparable to a lab-scale bioreactor setup. The prototype is also integrated with an online OD sensor, and as such, no sampling was needed to monitor the progress of the reaction performed. Operating cost and medium consumption are also low and thus, making it much more economical to be utilized for biotechnology process development compared to lab-scale bioreactors.

Keywords: biotechnology, miniature bioreactor, research tools, Saccharomyces cerevisiae

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Authors: Athanasios Triantafyllou, Georgios Papagiannis, Vassilios Nikolaou, Panayiotis J. Papagelopoulos, George C. Babis

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In vitro measurements are widely used in order to predict THAs wear rate implementing gait kinematic and kinetic parameters. Clinical tests of materials and designs are crucial to prove the accuracy and validate such measurements. The purpose of this study is to examine the affection of THA gait kinematics and kinetics on wear during gait, the essential functional activity of humans, by comparing in vivo gait data to in vitro results. Our study hypothesis is that both implants will present the same hip joint kinematics and kinetics during gait. 127 unilateral primary cementless total hip arthroplasties were included in the research. Independent t-tests were used to identify a statistically significant difference in kinetic and kinematic data extracted from 3D gait analysis. No statistically significant differences observed at mean peak abduction, flexion and extension moments between the two groups (P.abduction= 0,125, P.flexion= 0,218, P.extension= 0,082). The kinematic measurements show no statistically significant differences too (Prom flexion-extension= 0,687, Prom abduction-adduction= 0,679). THA kinematics and kinetics during gait are important biomechanical parameters directly associated with implants wear. In vitro studies report less wear in CoC than CoXLPE when tested with the same gait cycle kinematic protocol. Our findings confirm that both implants behave identically in terms of kinematics in the clinical environment, thus strengthening in vitro results of CoC advantage. Correlated to all other significant factors that affect THA wear could address in a complete prism the wear on CoC and CoXLPE.

Keywords: total hip arthroplasty biomechanics, THA gait analysis, ceramic on ceramic kinematics, ceramic on XLPE kinetics, total hip replacement wear

Procedia PDF Downloads 155

Authors: Shi-xia Xu, Zai-wen Zhang, Ru-xue Chen, Shan Zhou, Xiang-feng Tang

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Objective: The clinical influence of HLA-DPB1 mismatches on clinical outcome of HSCT is less clear. This is the first meta-analysis to study the HLA-DPB1 matching statues on clinical outcomes after unrelated donor HSCT. Methods: We searched the CIBMTR, Cochrane Central Register of Controlled Trials (CENTRAL) and related databases (1995.01–2017.06) for all relevant articles. Comparative studies were used to investigate the HLA-DPB1 loci mismatches on clinical outcomes after unrelated donor HSCT, such as the disease-free survival (DFS), overall survival, GVHD, relapse, and transplant-related mortality (TRM). We performed meta-analysis using Review Manager 5.2 software and funnel plot to assess the bias. Results: At first, 1246 articles were retrieved, and 18 studies totaling 26368 patients analyzed. Pooled comparisons of studies found that the HLA-DPB1 mismatched group had a lower rate of DFS than the DPB1-matched group, and lower OS in non-T cell depleted transplantation. The DPB1 mismatched group has a higher incidence of aGVHD and more severe ( ≥ III degree) aGvHD, lower rate of relapse and higher TRM. Moreover, compared with 1-antigen mismatch, 2-antigen mismatched led to a higher risk of TRM and lower relapse rate. Conclusions: This meta-analysis indicated HLA-DPB1 has important influence on survival and transplant-related complications during unrelated donor HSCT and HLA-DPB1 donor selection strategies have been proposed based on a personalized algorithm.

Keywords: human leukocyte antigen, DPB1, transplant, meta-analysis, outcome

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Authors: Merrylord Harb-Azar

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Traditionally, PTSD treatment has involved trauma-focused cognitive behaviour therapy (TF CBT) to consolidate traumatic memories. A piloted integrated treatment of TF CBT and eye movement desensitisation reprocessing therapy (EMDR) of eight phases will fasten the rate memory is being consolidated and enhance cognitive functioning in patients with PTSD. Patients spend a considerable amount of time in treatment managing their traumas experienced firsthand, or from aversive details ranging from war, assaults, accidents, abuse, hostage related, riots, or natural disasters. The time spent in treatment or as inpatient affects overall quality of life, relationships, cognitive functioning, and overall sense of identity. EMDR is being offered twice a week in conjunction with the standard prolonged exposure as an inpatient in a private hospital. Prolonged exposure for up to 5 hours per day elicits the affect response required for EMDR sessions in the afternoon to unlock unprocessed memories and facilitate consolidation in the amygdala and hippocampus. Results are indicating faster consolidation of memories, reduction in symptoms in a shorter period of time, reduction in admission time, which is enhancing the quality of life and relationships, and improved cognition. The impact of events scale (IES) results demonstrate a significant reduction in symptoms, trauma symptoms inventory (TSI), and posttraumatic stressor disorder check list (PCL) that demonstrates large effect sizes to date. An integrated treatment approach for PTSD achieves a faster resolution of memories, improves cognition, and reduces the amount of time spent in therapy.

Keywords: EMDR enhances cognitive functioning, faster consolidation of trauma memory, integrated treatment of TF CBT and EMDR, reduction in inpatient admission time

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Authors: Yu Zhao, Rainer Gruenheid, Gerhard Bauch

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In the microwave and millimeter-wave transmission region, substrate-integrated waveguide (SIW) is a very promising candidate for the development of circuits and components. It facilitates the transmission at the data rates in excess of 200 Gbit/s. An SIW mimics a rectangular waveguide by approximating the closed sidewalls with a via fence. This structure suppresses the low frequency components and makes the channel of the SIW a bandpass or high pass filter. This channel characteristic impedes the conventional baseband transmission using non-return-to-zero (NRZ) pulse shaping scheme. Therefore, mixers are commonly proposed to be used as carrier modulator and demodulator in order to facilitate a passband transmission. However, carrier modulation is not an energy efficient solution, because modulation and demodulation at high frequencies consume a lot of energy. For the first time to our knowledge, this paper proposes a spectrum shaping scheme of low complexity for the channel of SIW, namely spread reshaping code. It aims at matching the spectrum of the transmit signal to the channel frequency response. It facilitates the transmission through the SIW channel while it avoids using carrier modulation. In some cases, it even does not need equalization. Simulations reveal a good performance of this scheme, such that, as a result, eye opening is achieved without any equalization or modulation for the respective transmission channels.

Keywords: bandpass channel, eye-opening, switching frequency, substrate-integrated waveguide, spectrum shaping scheme, spread reshaping code

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Authors: Liaquat Ali, Khurshid Natasha

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Low resource countries are not usually equipped with the organizational tools to implement health care for chronic diseases, and thus, providing effective diabetes care in such countries is a challenging task. Diabetic Association of Bangladesh (BADAS in Bengali acronym) has created a stimulating example to meet this challenge. Starting its journey in 1956 with 39 patients in a small tin shed clinic BADAS, and its affiliated associations now operate 90 hospitals and health centres all over the country. Together, these facilities provide integrated health care to about 1.5 million registered diabetic patients which constitute about 20% of the estimated diabetic population in the country. BADAS has also become a pioneer in health manpower generation in Bangladesh. Along with its affiliates, it now runs 3 Medical Colleges (to generate graduate physicians), 2 Nursing Institutes, and 2 Postgraduate Institutes which conduct 25 postgraduate courses (under the University of Dhaka) in various basic, clinical and public health disciplines. BADAS gives great emphasis on research, which encompasses basic, clinical as well as public health areas. BADAS is an ideal example of public-private partnership in health as most of its infrastructure has been created through government support but it is almost self-reliant in managing its revenue budget which approached approximately 40 million US dollar during 2010. BADAS raises resources by providing high-quality services to the people, both diabetic and non-diabetic. At the same time, BADAS has developed a cross financing model, to support diabetic patients in general and poor diabetic patients (identified through a social welfare network) in particular, through redistribution of the resources. Along with financial sustainability BADAS ensure organizational sustainability through a process of decentralization, community ownership, and democratic management. Presently a large scale pilot project (named as a Health Care Development Project or HCDP) is under implementation under BADAS umbrella with an objective to transform the diabetes care model to a health care model in general. It is expected to create further evidence on providing sustainable (with social safety net) health care delivery for diabetes, and other chronic illnesses as an integral part of general health care delivery in a resource constrained setting.

Keywords: Bangladesh, self sustain, health care, constrain

Procedia PDF Downloads 180

Authors: Oktia Woro Kasmini Handayani, Sri Ratna Rahayu, Efa Nugroho, Berta Kalswahermawati

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Diabetes occurs 10 years faster in the Southeast Asian region than the European region, which occurs in the most productive periods. Cultural differences as well as cultural transitions can be determinant factors of health cases in urban and rural areas. The purpose of this research is to analyze the effect of the cultural environment, behavior and the occurrence of diabetes mellitus in urban areas of Semarang, Indonesia. The research was conducted in the area of Semarang Regency, using a quantitative approach and supported by qualitative data, the population is DM type 2 patients, sample size of 200 people, with a purposive sampling technique. The independent variable consists of cultural environment, behavior, and the dependent variable is DM. The data is analyzed with regression test method. Cultural environment affects behavior positively, with t value of 4,690 and p (sig.) 0.000, this means sig <0.05, while the effect of behavior on Diabetes Mellitus obtained t value 2.950 with p-value (sig.) 0.003 this means that sig <0.05, thus it can be interpreted that the behavior has a significant effect on Diabetes Mellitus. The cultural environment directly affects the incidence of DM. It can also shape a person's behavior or lifestyle or habit, whether healthy or unhealthy one, which in turn causes symptoms of DM.

Keywords: Behavior, Cultural Environment, Diebetes Millitus, Urban

Procedia PDF Downloads 136

Authors: P. Sathyathas, H. M. I. S. W. Herath, T. Amalraj, U. J. M. A. L. Jayasinghe

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Over two thirds of medical radiation can now be attributed to Computed Tomography (CT). There is little information on amount of radiation received from multiphase CT scan of abdomen- pelvic region in clinical practice. We sought to estimate the radiation dose and associated exposure parameters in the multiphase abdomen - pelvic scan of Multideteror Computed Tomography (MDCT) studies in clinical practice. This was a retrospective cross sectional studies describing radiation dose associated with main exposure parameters in diagnostic multiphase abdomen - pelvic scans performed on 152 consecutive patients by two different sixteen slice CT scanners. Patient information, exposure parameters of CTDI (volume), DLP, kVp, mAs and pitch were recorded for every phases of abdomen- a pelvic study from dose report of MDCT scanners (MDCTs). Age of patients range from 14 years to 87 years in both MDCT scanners. Overall CTDI (volume) median was 63.8 (±10.4) mGy for a multiphase abdominal-pelvic scan with scanner A while it was 35.4 (±15.6) mGy for scanner B. Patients' effective dose for multiphase abdomen - pelvic CT scan range from 8.2 mSv to 58 mSv. Median effective dose for patients, who underwent multiphase abdomen- pelvis scan with scanner A and B were 38.5 (± 8.2) mSv and 21.3 (± 8.6) mSv respectively. Median value of exposure parameters of mAs, kVp and pitch, were 150 (±29.7), 130 (±15.3) and 1.3 (±0.1) respectively in scanner A. In scanner B; they were 60 (±14.5), 120 and 1. The median effective dose for patients between multiphase abdomen-pelvic scan of both MDCT, a significant different (P<0.05) was observed. Multiphase abdomen – pelvic scan of clinical study shows significant different of effective dose with reference level of phantom studies (8-14mSv) and it depends on the type of vendors.

Keywords: abdomen-pelvic region, computed tomography, exposure parameters, radiation dose

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Authors: Rajesh Kumar, Roopali Dogra, Puneet Aggarwal

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Based on a survey conducted for second and third year students of the electrical engineering department at Maharishi Markandeshwar University, India, it was found that around 92% of students felt that it would be better to introduce a virtual environment for laboratory experiments. Hence, a need was felt to perform modern pedagogy techniques for students which consist of a virtual environment using MATLAB/Simulink. In this paper, a virtual environment for the speed control of a DC motor is performed using MATLAB/Simulink. The various speed control methods for the DC motor include the field resistance control method and armature voltage control method. The performance analysis of the DC motor is hence analyzed.

Keywords: DC Motor, field control, pedagogy techniques, speed control, virtual environment, voltage control

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Authors: Paduri Veerabhadram, Antoinette Lombard

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In this paper a framework for hypothesizing about mobile learning to complement theories of formal and informal learning is presented. As such, activity theory will form the main theoretical lens through which the elements involved in formal and informal learning for mobile learning will be explored, specifically related to context-aware mobile learning application. The author believes that the complexity of the relationships involved can best be analysed using activity theory. Activity theory, as a social, cultural and activity theory can be used as a mobile learning framework in an academic environment, but to develop an optimal artifact, through investigation of inherent system's contradictions. As such, it serves as a powerful modelling tool to explore and understand the design of a mobile learning environment in the study’s environment. The Academic Tool Kit Framework (ATKF) as also employed for designing of a constructivism learning environment, effective in assisting universities to facilitate lecturers to effectively implement learning through utilizing mobile devices. Results indicate a positive perspective of students in the use of mobile devices for formal and informal learning, based on the context-aware learning environment developed through the use of activity theory and ATKF.

Keywords: collaborative learning, cooperative learning, context-aware learning environment, mobile learning, pedagogy

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Authors: Mosses E. Lufuke

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This paper attempted to investigate whether there is Granger-causality running from trade to environment as evidenced in the changing climatic condition and land degradation. Using Tanzania as the reference, VAR-Granger-causality test was employed to rationalize the conundrum of causal-effect relationship between trade and environment. The changing climatic condition, as the proxy of both nitrous oxide emissions (in thousand metric tons of CO₂ equivalent) and land degradation measured by the size of arable land were tested against trade using both exports and imports variables. The result indicated that neither of the trade variables Granger-cause the variability on gas emissions and arable land size. This suggests the possibility that all trade concerns in relation to environment to have been internalized in domestic policies to offset any likely negative consequence.

Keywords: environment, growth, impact, trade

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Authors: Eddy K. Mukadi

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This work is a documentary and descriptive study devoted to the epidemiological, clinical, histopathological and therapeutic profile of breast cancer deals with the department of gynecology and obstetrics of the university clinics of Kinshasa during the period from 1 January 2014 to 31 December 2014. We have identified 56 cases of breast cancer. These cancers accounted for 45.2% of gynecological mammary cancers. The youngest in our series was 18 years old while the oldest was 74 years old; And the mean age of these patients was 43.4 years and mostly multiparous (35.7%). Brides (60.7%) and bachelors (26.8%) were the most affected by breast cancer. The reasons for consultation were dominated by nodules in the breast (48.2%) followed by pain (35.7%) and nipple discharge (14.3%). In 89.2% of the cases, it was the advanced clinical stage (stage 3 and 4) and the infiltrating ductal carcinoma was the most frequent histological type (75%) The malignant tumor was mainly in the left breast (55.3%), and chemotherapy with hormone therapy and patey was the most convenient treatment (42.8%), while patey mastectomy was performed in 12.5% of patients. Because of the high incidence of breast cancer identified in our study, some preventive measures must be taken into account to address this public health problem, including breast autopalpation once a month, Early detection system development of a national breast cancer policy and the implementation of a national breast cancer control program.

Keywords: breast cancer, histopathological profile, epidemiological profile, Kinshasa

Procedia PDF Downloads 216

Authors: Aliakbar Hafezi, Jalal Taherian, Mahsa Elahi, Jamshid Abedi

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Background: Patients with breast cancer with different molecular subtypes may have different pathological responses to neoadjuvant chemotherapy (NAC). The aim of this study was to evaluate the pathological response to NAC in patients with locally advanced breast cancer based on molecular subtypes. Method: In this retrospective cohort study, 210 female patients with breast cancer candidate for NAC referred to the radiation oncology departments in southern Iran between August 2019 and September 2024 were evaluated in terms of pathologic complete response (pCR) based on immunohistochemical molecular markers (estrogen and progesterone receptors, Her-2/neu and Ki-67), overall survival (OS) and disease-free survival (DFS). Results: The mean age of the patients was 38.22 ± 10.34 years, and 68 patients (32.4%) had a positive family history of breast cancer. The pCR rate was 17.6% (37 patients), which in the subtypes of luminal A, luminal B, Her-2/neu positive and triple negative was 7.7%, 16.9%, 26.5% and 21.05%, respectively. Patients with pCR had significantly better OS (78.4% vs. 49.1%, P = 0.014) and DFS (83.8% vs. 51.4%, P = 0.020) than patients with partial/no pathological response. Conclusion: It seems that the molecular subtype plays a decisive role in the clinical outcome and the pathological response to NAC in patients with locally advanced breast cancer.

Keywords: locally advanced breast cancer, neoadjuvant chemotherapy, pathologic complete response, clinical outcomes

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Authors: Hamza Ikhlaq, Stephen Franks

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Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age. The aetiology behind PCOS is poorly understood but influencing ethnic, environmental, and genetic factors have been recognised. However, literature examining the impact of ethnicity is scarce. We hypothesised Body Mass Index (BMI) and ethnicity influence the clinical, metabolic, and biochemical presentations of PCOS, with an interaction between these factors. Methods: A database of 1081 women with PCOS and a control group of 72 women were analysed. BMIs were grouped using the World Health Organisation classification into normal weight, overweight and obese groups. Ethnicities were classified into European, South Asian, and Afro-Caribbean groups. Biochemical and clinical presentations were compared amongst these groups, and statistical analyses were performed to assess significance. Results: This study revealed ethnicity significantly influences biochemical and clinical presentations of PCOS. A greater proportion of South Asian women are impacted by menstrual cycle disturbances and hirsutism than European and Afro-Caribbean women. South Asian and Afro-Caribbean women show greater measures of insulin resistance and weight gain when compared to their European peers. Women with increased BMI are shown to have an increased prevalence of PCOS phenotypes alongside increased levels of insulin resistance and testosterone. Furthermore, significantly different relationships between the waist-hip ratio and measures of insulin and glucose control for Afro-Caribbean women were identified compared to other ethnic groups. Conclusions: The findings of this study show ethnicity significantly influence the phenotypic and biochemical presentations of PCOS, with an interaction between body habitus and ethnicity found. Furthermore, we provide further data on the influences of BMI on the manifestations of PCOS. Therefore, we highlight the need to consider these factors when reviewing diagnostic criteria and delivering clinical care for these groups.

Keywords: PCOS, ethnicity, BMI, clinical

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Authors: Swati Kishor Zode, Rahul Ambekar

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Data mining is the extraction of fascinating examples on the other hand information from enormous measure of information and choice is made as indicated by the applicable information extracted. As of late, with the dangerous advancement in internet, stockpiling of information and handling procedures, privacy preservation has been one of the major (higher) concerns in data mining. Various techniques and methods have been produced for protection saving data mining. In the situation of Clinical Decision Support System, the choice is to be made on the premise of the data separated from the remote servers by means of Internet to diagnose the patient. In this paper, the fundamental thought is to build the precision of Decision Support System for multiple diseases for different maladies and in addition protect persistent information while correspondence between Clinician side (Client side) also, the Server side. A privacy preserving protocol for clinical decision support network is proposed so that patients information dependably stay scrambled amid diagnose prepare by looking after the accuracy. To enhance the precision of Decision Support System for various malady C5.0 classifiers and to save security, a Homomorphism encryption algorithm Paillier cryptosystem is being utilized.

Keywords: classification, homomorphic encryption, clinical decision support, privacy

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Authors: Mehmet Bulent Ozdemir, Sultan Çagirici, Sahika Pinar Akyer, Fikri Turk

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Neuroanatomical appearance can be correlated with clinical or other characteristics of illness. With the introduction of diagnostic imaging machines, producing 3D images of anatomic structures, calculating the correlation between subjects and pattern of the structures have become possible. The aim of this study is to examine the 3D structure of hippocampus in cases with Alzheimer disease in different dementia severity. For this purpose, 62 female and 38 male- 68 patients’s (age range between 52 and 88) MR scanning were imported to the computer. 3D model of each right and left hippocampus were developed by a computer aided propramme-Surf Driver 3.5. Every reconstruction was taken by the same investigator. There were different apperance of hippocampus from normal to abnormal. In conclusion, These results might improve the understanding of the correlation between the morphological changes in hippocampus and clinical staging in Alzheimer disease.

Keywords: Alzheimer disease, hippocampus, computer-assisted anatomy, 3D

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Authors: Marlin Mubarak

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Background: Endometriosis is a complex disabling disease affecting young females in the reproductive period mainly. The aim of this project is to generate a diagnostic model to predict severity and stage of endometriosis prior to Laparoscopic surgery. This will help to improve the pre-operative diagnostic accuracy of stage 3 & 4 endometriosis and as a result, refer relevant women to a specialist centre for complex Laparoscopic surgery. The model is based on the British Society of Gynaecological Endoscopy (BSGE) pain questionnaire, clinical examination and ultrasound scan. Design: This is a prospective, observational, study, in which women completed the BSGE pain questionnaire, a BSGE requirement. Also, as part of the routine preoperative assessment patient had a routine ultrasound scan and when recto-vaginal and deep infiltrating endometriosis was suspected an MRI was performed. Setting: Luton & Dunstable University Hospital. Patients: Symptomatic women (n = 56) scheduled for laparoscopy due to pelvic pain. The age ranged between 17 – 52 years of age (mean 33.8 years, SD 8.7 years). Interventions: None outside the recognised and established endometriosis centre protocol set up by BSGE. Main Outcome Measure(s): Sensitivity and specificity of endometriosis diagnosis predicted by symptoms based on BSGE pain questionnaire, clinical examinations and imaging. Findings: The prevalence of diagnosed endometriosis was calculated to be 76.8% and the prevalence of advanced stage was 55.4%. Deep infiltrating endometriosis in various locations was diagnosed in 32/56 women (57.1%) and some had DIE involving several locations. Logistic regression analysis was performed on 36 clinical variables to create a simple clinical prediction model. After creating the scoring system using variables with P < 0.05, the model was applied to the whole dataset. The sensitivity was 83.87% and specificity 96%. The positive likelihood ratio was 20.97 and the negative likelihood ratio was 0.17, indicating that the model has a good predictive value and could be useful in predicting advanced stage endometriosis. Conclusions: This is a hypothesis-generating project with one operator, but future proposed research would provide validation of the model and establish its usefulness in the general setting. Predictive tools based on such model could help organise the appropriate investigation in clinical practice, reduce risks associated with surgery and improve outcome. It could be of value for future research to standardise the assessment of women presenting with pelvic pain. The model needs further testing in a general setting to assess if the initial results are reproducible.

Keywords: deep endometriosis, endometriosis, minimally invasive, MRI, ultrasound.

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Authors: Tran Duong Nguyen, Marwan Shagar, Qinghao Zeng, Aras Maqsoodi, Pardis Pishdad, Eunhwa Yang

Abstract:

Construction supply chain management (CSCM) involves the collaboration of many disciplines and actors, which generates vast amounts of data. However, inefficient, fragmented, and non-standardized data storage often hinders this data exchange. The industry has adopted building information modeling (BIM) -a digital representation of a facility's physical and functional characteristics to improve collaboration, enhance transmission security, and provide a common data exchange platform. Still, the volume and complexity of data require tailored information categorization, aligning with stakeholders' preferences and demands. To address this, artificial intelligence (AI) can be integrated to handle this data’s magnitude and complexities. This research aims to develop an integrated and efficient approach for data exchange in CSCM by utilizing AI. The paper covers five main objectives: (1) Investigate existing framework and BIM adoption; (2) Identify challenges in data exchange; (3) Propose an integrated framework; (4) Enhance data transmission security; and (5) Develop data exchange in CSCM. The proposed framework demonstrates how integrating BIM and other technologies, such as cloud computing, blockchain, and AI applications, can significantly improve the efficiency and accuracy of data exchange in CSCM.

Keywords: construction supply chain management, BIM, data exchange, artificial intelligence

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Authors: Robert E. Kenney, Efrain Antunez, Samuel Nodal, Ameer Malik, Richard B. Aguilar

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Physician burnout has gained much attention during the COVID pandemic. After-hours workload, HCC coding, HEDIS metrics, and clinical documentation negatively impact career satisfaction. These and other influences have increased the rate of physicians leaving the workforce. In addition, roughly 1% of the entire physician workforce will be retiring earlier than expected based on pre-pandemic trends. The two Medical Specialties with the highest rates of burnout are Family Medicine and Primary Care. With a predicted shortage of primary care physicians looming, the need to address physician burnout is crucial. Commonly reported issues leading to clinician burnout are clerical documentation requirements, increased time working on Electronic Health Records (EHR) after hours, and a decrease in work-life balance. Clinicians experiencing burnout with physical and emotional exhaustion are at an increased likelihood of providing lower quality and less efficient patient care. This may include a lack of suitable clinical documentation, medication reconciliation, clinical assessment, and treatment plans. While the annual baseline turnover rates of physicians hover around 6-7%, the COVID pandemic profoundly disrupted the delivery of healthcare. A report found that 43% of physicians switched jobs during the initial two years of the COVID pandemic (2020 and 2021), tripling the expected average annual rate to 21.5 %/yr. During this same time, an average of 4% and 1.5% of physicians retired or left the workforce for a non-clinical career, respectively. The report notes that 35.2% made career changes for a better work-life balance and another 35% reported the reason as being unhappy with their administration’s response to the pandemic. A physician-led primary care-focused health organization, Cano Health (CH), based out of Florida, sought to preemptively address this problem by implementing several supportive measures. Working with >120 clinics and >280 PCPs from Miami to Tampa and Orlando, managing nearly 120,000 Medicare Advantage lives, CH implemented a number of changes to assist with the clinician’s workload. Supportive services such as after hour and home visits by APRNs, in-clinic care managers, and patient educators were implemented. In 2021, assistive Artificial Intelligence Software (AIS) was integrated into the EHR platform. This AIS converts free text within PDF files into a usable (copy-paste) format facilitating documentation. The software also systematically and chronologically organizes clinical data, including labs, medical records, consultations, diagnostic images, medications, etc., into an easy-to-use organ system or chronic disease state format. This reduced the excess time and documentation burden required to meet payor and CMS guidelines. A clinician Documentation Support team was employed to improve the billing/coding performance. The effects of these newly designed workflow interventions were measured via analysis of clinician turnover from CH’s hiring and termination reporting software. CH’s annualized average clinician turnover rate in 2020 and 2021 were 17.7% and 12.6%, respectively. This represents a 30% relative reduction in turnover rate compared to the reported national average of 21.5%. Retirement rates during both years were 0.1%, demonstrating a relative reduction of >95% compared to the national average (4%). This model successfully promoted the retention of clinicians in a Value-Based Care setting.

Keywords: clinician burnout, COVID-19, value-based care, burnout, clinician retirement

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Authors: Seda Sahin, Emin Akata

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

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

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Authors: Nguyen Dang Duc, Nguyen Phuong Sinh, Lam Nguyen Hong Anh

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Superior mesenteric artery (SMA) syndrome is a rare cause of high-section intestinal obstruction. SMA syndrome is characterized by compression of the third segment of the duodenum due to the narrowing of the distance between the superior mesenteric artery and the abdominal aorta. The main clinical signs of SMA syndrome are high intestinal obstruction, such as postprandial vomiting, epigastric pain, early feeling of abdominal fullness, and indigestion. Abdominal computed tomography plays an important role in diagnosis. There are two main methods of treating SMA syndrome that are conservative and surgical treatment. We report a clinical case of an 18-year-old male patient admitted to the hospital because of a Bungarus snake bit in the second hour, to the twelfth day of treatment, the patient developed diarrhea that lasted until the twenty-fourth day of treatment. On the twenty-fifth day of treatment, the patient lost 16 kilograms (from 56 down to 40). The patient had symptoms of vomiting after eating, indigestion, and epigastric pain. On abdominal computed tomography, the angle created by the superior mesenteric artery and the abdominal aorta was 17 degrees, the distance between the two arteries was 3.8 millimeters, light dilation and stagnation of the D1 and D2 segment of the duodenum with gas and watery level inside segment D3 and D4 of the duodenum and this segment was constricted. This patient was diagnosed with superior mesenteric artery syndrome with the Bungarus snake bites. Currently, the patient was treated with feeding through a jejunal tube each other intravenous nutrition. Finally, The patient was discharged and returned to his house on the forty-fifth day of treatment. We reported this clinical case to introduce clinical and paraclinical signs, diagnose, and methods treated for patient having SMA syndrome.

Keywords: superior mesenteric artery syndrome, Bungarus snake bites, loss weight

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Authors: Michelangelo Sofo, Giuseppe Labianca

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In recent years, the scientific community's interest in the exploratory analysis of biomedical data has increased exponentially. Considering the field of research of nutritional biologists, the curative process, based on the analysis of clinical data, is a very delicate operation due to the fact that there are multiple solutions for the management of pathologies in the food sector (for example can recall intolerances and allergies, management of cholesterol metabolism, diabetic pathologies, arterial hypertension, up to obesity and breathing and sleep problems). In this regard, in this research work a system was created capable of evaluating various dietary regimes for specific patient pathologies. The system is founded on a mathematical-numerical model and has been created tailored for the real working needs of an expert in human nutrition using the human-centered design (ISO 9241-210), therefore it is in step with continuous scientific progress in the field and evolves through the experience of managed clinical cases (machine learning process). DietAdhoc® is a decision support system nutrition specialists for patients of both sexes (from 18 years of age) developed with an agile methodology. Its task consists in drawing up the biomedical and clinical profile of the specific patient by applying two algorithmic optimization approaches on nutritional data and a symbolic solution, obtained by transforming the relational database underlying the system into a deductive database. For all three solution approaches, particular emphasis has been given to the explainability of the suggested clinical decisions through flexible and customizable user interfaces. Furthermore, the system has multiple software modules based on time series and visual analytics techniques that allow to evaluate the complete picture of the situation and the evolution of the diet assigned for specific pathologies.

Keywords: medical decision support, physiological data extraction, data driven diagnosis, human centered AI, symbiotic AI paradigm

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Authors: Mahsa Ja’fari, Mohammad R. Khosravi-Nikou, Mohsen Motavassel

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A comprehensive development towards the production of ultra-clean fuels as a feed stoke is getting to raise due to the increasing use of diesel fuels and global air pollution. Production of environmental-friendly fuels can be achievable by some limited single methods and most integrated ones. Oxidative desulfurization (ODS) presents vast ranges of technologies possessing suitable characteristics with regard to the Fenton process. Using toluene as a model fuel feed with dibenzothiophene (DBT) as a sulfur compound under various operating conditions is the attempt of this study. The results showed that this oxidative process followed a pseudo-first order kinetics. Removal efficiency of 77.43% is attained under reaction time of 40 minutes with (Fe⁺²/H₂O₂) molar ratio of 0.05 in acidic pH environment. In this research, temperature of 50 °C represented the most influential role in proceeding the reaction.

Keywords: design of experiment (DOE), dibenzothiophene (DBT), optimization, oxidative desulfurization (ODS)

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Authors: Paria Baharvand, Mohammad Reza Abbasi, Soha Namazi

Abstract:

Introduction: Uremic pruritus (UP) is one of the major complaints in hemodialysis patients. The aim of this randomized clinical trial study was the evaluation of the anti-pruritus effect of Melatonin on hemodialysis patients with UP. Methods: This multi-centered double, blinded randomized clinical trial study was conducted on hemodialysis patients with UP that referred to the dialysis department of Imam Khomeini Hospital, Labbafinezhad Hospital and Ghiasi Hospital in Tehran, Iran, in 2018. Forty participants were enrolled and block randomization was performed by using a randomized list and divided into 2 groups of twenty patients. Evaluation of the 12-Item Pruritus Severity Scale (12-PSS), Visual analog scale (VAS), and Calculation of the affected body surface area for pruritus extent (BSA %) was performed every week. The Melatonin group received a 10 mg soft gel capsule, and the placebo group received a soft gel capsule placebo after dinner. For statistical analysis used by SPSS version 21(IRCT20180714040462N1). Results: 38 hemodialysis patients enrolled in this study. The mean age in the placebo group and in the Melatonin group was 55.88 ± 11.70 and 54.52 ± 13.00 years (p> 0.05). Also, 46% of all participants were female. Aspartate transaminase, alanine transaminase and C-reactive protein have significant differences between the two groups (p< 0.05). VAS score reduction in the two groups had a statistically significant (CI 95% = -1.71, P= 0.015(.The results of BSA% showed Melatonin had a significant effect on the decrease of the pruritus extent compared to placebo (CI 95% = -22.82, P= 0.001(. Conclusion: According to the results of this study and the preliminary effects of Melatonin on uremic pruritus, we suggest performing advanced clinical trials studies.

Keywords: Melatonin, Uremic Pruritus, hemodialysis, anti-pruritus

Procedia PDF Downloads 80