Search results for: clinical advice services

Authors: Jesus Salmeron, Carmen De Vega, Maria Soledad Vicente, Mireia Olabarria, Olaia Martinez

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Dysphagia or difficulty in swallowing affects mostly elder people: 56-78% of the institutionalized and 44% of the hospitalized. Liquid food thickening is a necessary measure in this situation because it reduces the risk of penetration-aspiration. Until now, and as proposed by the American Dietetic Association in 2002, possible consistencies have been categorized in three groups attending to their viscosity: nectar (50-350 mPa•s), honey (350-1750 mPa•s) and pudding (>1750 mPa•s). The adequate viscosity level should be identified for every patient, according to her/his impairment. Nevertheless, a systematic review on dysphagia diet performed recently indicated that there is no evidence to suggest that there is any transition of clinical relevance between the three levels proposed. It was also stated that other physical properties of the bolus (slipperiness, density or cohesiveness, among others) could influence swallowing in affected patients and could contribute to the amount of remaining residue. Texture parameters need to be evaluated as possible alternative to viscosity. The aim of this study was to evaluate the instrumental extrusion-compression test as a possible tool to characterize changes along time in water thickened with various products and in the three theoretical consistencies. Six commercial thickeners were used: NM® (NM), Multi-thick® (M), Nutilis Powder® (Nut), Resource® (R), Thick&Easy® (TE) and Vegenat® (V). All of them with a modified starch base. Only one of them, Nut, also had a 6,4% of gum (guar, tara and xanthan). They were prepared as indicated in the instructions of each product and dispensing the correspondent amount for nectar, honey and pudding consistencies in 300 mL of tap water at 18ºC-20ºC. The mixture was stirred for about 30 s. Once it was homogeneously spread, it was dispensed in 30 mL plastic glasses; always to the same height. Each of these glasses was used as a measuring point. Viscosity was measured using a rotational viscometer (ST-2001, Selecta, Barcelona). Extrusion-compression test was performed using a TA.XT2i texture analyzer (Stable Micro Systems, UK) with a 25 mm diameter cylindrical probe (SMSP/25). Penetration distance was set at 10 mm and a speed of 3 mm/s. Measurements were made at 1, 5, 10, 20, 30, 40, 50 and 60 minutes from the moment samples were mixed. From the force (g)–time (s) curves obtained in the instrumental assays, maximum force peak (F) was chosen a reference parameter. Viscosity (mPa•s) and F (g) showed to be highly correlated and had similar development along time, following time-dependent quadratic models. It was possible to predict viscosity using F as an independent variable, as they were linearly correlated. In conclusion, compression-extrusion test could be an alternative and a useful tool to assess physical characteristics of thickened liquids.

Keywords: compression-extrusion test, dysphagia, texture analyzer, thickener

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Authors: Gurleen Kour, Mowkshi Khullar, B. K. Chandan, Parvinder Pal Singh, Kushalava Reddy Yumpalla, Gurunadham Munagala, Ram A. Vishwakarma, Zabeer Ahmed

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New chemotherapeutic compounds against multidrug-resistant Mycobacterium tuberculosis (Mtb) are urgently needed to combat drug resistance in tuberculosis (TB). Apart from in-vitro potency against the target, physiochemical properties and pharmacokinetic properties play an imperative role in the process of drug discovery. We have identified novel nitroimidazole derivatives with potential activity against mycobacterium tuberculosis. One lead candidates, MCD-017, which showed potent activity against H37Rv strain (MIC=0.5µg/ml) and was further evaluated in the process of drug development. Methods: Basic physicochemical parameters like solubility and lipophilicity (LogP) were evaluated. Thermodynamic solubility was determined in PBS buffer (pH 7.4) using LC/MS-MS. The partition coefficient (Log P) of the compound was determined between octanol and phosphate buffered saline (PBS at pH 7.4) at 25°C by the microscale shake flask method. The compound followed Lipinski’s rule of five, which is predictive of good oral bioavailability and was further evaluated for metabolic stability. In-vitro metabolic stability was determined in rat liver microsomes. The hepatotoxicity of the compound was also determined in HepG2 cell line. In vivo pharmacokinetic profile of the compound after oral dosing was also obtained using balb/c mice. Results: The compound exhibited favorable solubility and lipophilicity. The physical and chemical properties of the compound were made use of as the first determination of drug-like properties. The compound obeyed Lipinski’s rule of five, with molecular weight < 500, number of hydrogen bond donors (HBD) < 5 and number of hydrogen bond acceptors(HBA) not more then 10. The log P of the compound was less than 5 and therefore the compound is predictive of exhibiting good absorption and permeation. Pooled rat liver microsomes were prepared from rat liver homogenate for measuring the metabolic stability. 99% of the compound was not metabolized and remained intact. The compound did not exhibit cytoxicity in hepG2 cells upto 40 µg/ml. The compound revealed good pharmacokinetic profile at a dose of 5mg/kg administered orally with a half life (t1/2) of 1.15 hours, Cmax of 642ng/ml, clearance of 4.84 ml/min/kg and a volume of distribution of 8.05 l/kg. Conclusion : The emergence of multi drug resistance (MDR) and extensively drug resistant (XDR) Tuberculosis emphasize the requirement of novel drugs active against tuberculosis. Thus, the need to evaluate physicochemical and pharmacokinetic properties in the early stages of drug discovery is required to reduce the attrition associated with poor drug exposure. In summary, it can be concluded that MCD-017 may be considered a good candidate for further preclinical and clinical evaluations.

Keywords: mycobacterium tuberculosis, pharmacokinetics, physicochemical properties, hepatotoxicity

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Authors: Hsiao-Lin Fang

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The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

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Authors: Josiah Damisa, Michelle Louise Richardson, Morenike Adewuyi

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Lower back pain is a significant cause of disability worldwide and associated with great implications in terms of the well-being of affected individuals and society as a whole due to its undeniable socio-economic impact. With its prevalence on the increase as a result of an aging global population, the need for novel forms of pain management is ever paramount. This review aims to provide further insight into current research regarding a role for the endocannabinoid signaling pathway as a target in the treatment of chronic pain, with particular emphasis on its potential use as part of the treatment of lower back pain. Potential advantages and limitations of cannabis-based medicines over other forms of analgesia currently licensed for medical use are discussed in addition to areas that require ongoing consideration and research. To evaluate the efficacy of cannabis-based medicines in chronic pain, studies pertaining to the role of medical cannabis in chronic disease were reviewed. Standard searches of PubMed, Google Scholar and Web of Science databases were undertaken with peer-reviewed journal articles reviewed based on the indication for pain management, cannabis treatment modality used and study outcomes. Multiple studies suggest an emerging role for cannabis-based medicines as therapeutic agents in the treatment of chronic back pain. A potential synergistic effect has also been purported if these medicines are co-administered with opiate analgesia due to the similarity of the opiate and endocannabinoid signaling pathways. However, whilst recent changes to legislation in the United Kingdom mean that cannabis is now licensed for medicinal use on NHS prescription for a number of chronic health conditions, concerns remain as to the efficacy and safety of cannabis-based medicines. Research is lacking into both their side effect profiles and the long-term effects of cannabis use. Legal and ethical considerations to the use of these products in standardized medical practice also persist due to the notoriety of cannabis as a drug of abuse. Despite this, cannabis is beginning to gain traction as an alternative or even complementary drug to opiates, with some preclinical studies showing opiate-sparing effects. Whilst there is a paucity of clinical trials in this field, there is scope for cannabinoids to be successful anti-nociceptive agents in managing chronic back pain. The ultimate aim would be to utilize cannabis-based medicines as alternative or complementary therapies, thereby reducing opiate over-reliance and providing hope to individuals who have exhausted all other forms of standard treatment.

Keywords: endocannabinoids, cannabis-based medicines, chronic pain, lower back pain

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Authors: Najma Najam, Rukhsana Kausar, Rabia Hussain Kanwal, Saira Batool, Anum Javed

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In Pakistan, elderly population though increasing but it has been neglected by the researchers and policy makers which resulted in compromised quality of life of the ageing population. Two regions, Punjab and Gilgit-Baltistan (GB) were selected for comparison as Lahore and Multan (Punjab) are highly urbanized, large cities whereas Gilgit and Skardu are remote and mountain bounded valleys in GB. This study focuses on psychological and emotional functioning of elderly and a series of measures translated and adapted in Urdu language was used to assess quality of life, psychological and mental well-being, actual and perceived social support, attachment patterns, forgiveness, affects, geriatric depression, and emotional disturbance patterns (depression, anxiety, and stress) in elderly. A gender-equated sample of 201 elderly participants, 93 from GB (60 from Gilgit, 33 from Skardu) and 108 from Punjab (61 from Lahore, 47 from Multan) with over 60 years age was collected from the multiethnic community of Punjab and GB through purposive convenient sampling technique. Findings revealed that elderly from Multan have better psychological and emotional functioning, higher levels of social support, tendency to forgive, better mental wellbeing and quality of life and lower levels of stress, anxiety, depression, negative affect and attachment avoidance and anxiety related to partner as compared to the elderly from Lahore. Furthermore, both elderly male of Gilgit & Skardu have adequate mental well-being including subjective well-being and psychological functioning which showed positive aspects of mental health but elderly female are more attached to their home and neighbourhood which shows their social and environmental mastery. Gilgiti elderly male reported more degree of positive affect such as enthusiasm, active, alertness, excitement and strong whereas among elderly from Skardu shows more negative affect i.e. aversive mood states, irritability, hostility, and general distress. The need of psychosocial therapy and family counseling for the elderly in urban areas has been identified, which can facilitate in reducing or preventing the depressive and stressful tendencies. The findings are expected to have implications for improving quality of life of the elderly, designing interventions, support system and rehabilitation services to help them. However, findings may attract attention of policy makers and researchers as currently this is the most neglected population in Pakistan.

Keywords: psychological, emotional, aging, elderly, quality of life

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Authors: Petra Hofmann, Dana Koniel, Jussi Luukkanen, Walter Nieminen, Lea Hannola, Ilkka Donoghue

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The Covid-19 pandemic forced people to isolate and become physically less connected. The pandemic hasnot only reshaped people’s behaviours and needs but also accelerated digital transformation (DT). DT of cities has become an imperative with the outlook of converting them into smart cities in the future. Embedding digital infrastructure and smart city initiatives as part of the normal design, construction, and operation of cities provides a unique opportunity to improve connection between people. Internet of Things (IoT) is an emerging technology and one of the drivers in DT. It has disrupted many industries by introducing different services and business models, and IoT solutions are being applied in multiple fields, including smart cities. As IoT and data are fundamentally linked together, IoT solutions can only create value if the data generated by the IoT devices is analysed properly. Extracting relevant conclusions and actionable insights by using established techniques, data analytics contributes significantly to the growth and success of IoT applications and investments. Companies must grasp DT and be prepared to redesign their offerings and business models to remain competitive in today’s marketplace. As there are many IoT solutions available today, the amount of data is tremendous. The challenge for companies is to understand what solutions to focus on and how to prioritise and which data to differentiate from the competition. This paper explains how IoT and data analytics can impact competitive advantage and how companies should approach IoT and data analytics to translate them into concrete offerings and solutions in the smart city context. The study was carried out as a qualitative, literature-based research. A case study is provided to validate the preservation of company’s competitive advantage through smart city solutions. The results of the researchcontribution provide insights into the different factors and considerations related to creating competitive advantage through IoT and data analytics deployment in the smart city context. Furthermore, this paper proposes a framework that merges the factors and considerations with examples of offerings and solutions in smart cities. The data collected through IoT devices, and the intelligent use of it, can create a competitive advantage to companies operating in smart city business. Companies should take into consideration the five forces of competition that shape industries and pay attention to the technological, organisational, and external contexts which define factors for consideration of competitive advantages in the field of IoT and data analytics. Companies that can utilise these key assets in their businesses will most likely conquer the markets and have a strong foothold in the smart city business.

Keywords: internet of things, data analytics, smart cities, competitive advantage

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Authors: D. O. Miranda, L. R. Azevedo, J. F. C. Cordeiro, A. H. Dos Santos, S. F. Lisboa, F. S. Guimarães, G. S. Bisson

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Background: The Colorectal cancer (CRC) is one of the most common cancers and the fourth leading cause of cancer death in the world. The prevalence of psychiatric-disorders among CRC patients, mainly depression, is high, resulting in impaired quality of life and side effects of primary treatment. High levels of proinflammatory cytokines at tumor microenvironment is a feature of CRC and the literature suggests that those mediators could contribute to the development of psychiatric disorders. Nevertheless, the ability of tumor-associated biological processes to affect the central nervous system (CNS) has only recently been explored in the context of symptoms of depression and is still not well understood. Therefore, the aim of the present study was to test the hypothesis that depressive-like behavior in an experimental model of CCR induced by N-methyl-N-nitro-N-nitrosoguanidine (MNNG) was correlated to proinflammatory profile in the periphery and in the brain. Methods: Colorectal carcinogenesis was induced in adult C57BL/6 mice (n=12) by administration of MNNG (5mg/kg, 0.1ml/intrarectal instillation) 2 times a week, for 2 week. Control group (n=12) received saline (0.1ml/intrarectal instillation). Eight weeks after beginning of MNNG administration animals were submitted to the forced swim test (FST) and the sucrose preference test for evaluation, respectively, of depressive- and anhedonia-like behaviors. After behavioral evaluation, the colon was collected and brain regions dissected (cortex-C, striatum-ST and hippocampus-HIP) for posterior evaluation of cytokine levels (IL-1β, IL-10, IL-17, and CX3CL1) by ELISA. Results: MNNG induced depressive-like behavior, represented by increased immobility time in the FST (Student t test, p < 0.05) and lower sucrose preference (Student t test, p < 0.05). Moreover, there were increased levels of IL-1β, IL-17 and CX3CL1 in the colonic tissue (Student t test, p < 0.05) and in the brain (IL-1 β in the ST and HIP, Student t test, p < 0.05; IL-17 and CX3CL1 in the C and HIP, p < 0.05). IL-10 levels, in contrast, were decreased in both the colon (p < 0.05) and the brain (C and HIP, p < 0.05). Conclusions: The results obtained in the present work support the notion that tumor growth induces neuroinflammation in stress-related brain regions and depressive-like behavior, which could be related to the high incidence of depression in colorectal carcinogenesis. This work have important clinical and research implications, taken into account that cytokine levels may be a marker promissory for the developing depression in CRC patients. New therapeutic strategies to assist in alleviating mental suffering in cancer patients might result from a better understanding of the role of cytokines in the pathophysiology of depression in these subjects.

Keywords: cytokines, brain, depression, colorectal cancer

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Authors: Ronald Croce, Timothy Quinn, John Miller

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Incomplete activation, or activation failure, of motor units during maximal voluntary contractions is often referred to as muscle inhibition (MI), and is defined as the inability of the central nervous system to maximally drive a muscle during a voluntary contraction. The purpose of the present study was to assess the interrelationship amongst peak torque (PT), muscle inhibition (MI; incomplete activation of motor units), and voluntary muscle activation (VMA) of the quadriceps’ muscle group as a function of knee angle and muscle length during maximal voluntary isometric contractions (MVICs). Nine young adult males (mean + standard deviation: age: 21.58 + 1.30 years; height: 180.07 + 4.99 cm; weight: 89.07 + 7.55 kg) performed MVICs in random order with the knee at 15, 55, and 95° flexion. MI was assessed using the interpolated twitch technique and was estimated by the amount of additional knee extensor PT evoked by the superimposed twitch during MVICs. Voluntary muscle activation was estimated by root mean square amplitude electromyography (EMGrms) and mechanomyography (MMGrms) of agonist (vastus medialis [VM], vastus lateralis [VL], and rectus femoris [RF]) and antagonist (biceps femoris ([BF]) muscles during MVICs. Data were analyzed using separate repeated measures analysis of variance. Results revealed a strong dependency of quadriceps’ PT (p < 0.001), MI (p < 0.001) and MA (p < 0.01) on knee joint position: PT was smallest at the most shortened muscle position (15°) and greatest at mid-position (55°); MI and MA were smallest at the most shortened muscle position (15°) and greatest at the most lengthened position (95°), with the RF showing the greatest change in MA. It is hypothesized that the ability to more fully activate the quadriceps at short compared to longer muscle lengths (96% contracted at 15°; 91% at 55°; 90% at 95°) might partly compensate for the unfavorable force-length mechanics at the more extended position and consequent declines in VMA (decreases in EMGrms and MMGrms muscle amplitude during MVICs) and force production (PT = 111-Nm at 15°, 217-NM at 55°, 199-Nm at 95°). Biceps femoris EMG and MMG data showed no statistical differences (p = 0.11 and 0.12, respectively) at joint angles tested, although there were greater values at the extended position. Increased BF muscle amplitude at this position could be a mechanism by which anterior shear and tibial rotation induced by high quadriceps’ activity are countered. Measuring and understanding the degree to which one sees MI and VMA in the QF muscle has particular clinical relevance because different knee-joint disorders, such ligament injuries or osteoarthritis, increase levels of MI observed and markedly reduced the capability of full VMA.

Keywords: electromyography, interpolated twitch technique, mechanomyography, muscle activation, muscle inhibition

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Authors: Yeliz Cakir Kocak, Hafize Ozturk Can, Sibel Icke, Ummahan Yucel, Esin Ceber Turfan

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Introduction: Midwifery organization in Turkey became official in 1954 with the foundation of Midwifery Association. Today there are two Professional organizations representing midwives: ‘Midwifery Association’ and ‘Association for Education, Research and Development in Midwifery (AERDM)’. In recent years, conjuction with the increase in the numbers of midwives, professional consciousness and professional organization conscious is increasing. The undergraduates of Midwifery Department of Ege University İzmir Ataturk School of Health have come together for their professions when they’re stil students, so they founded ‘Midwifery Community of Ege University (MCEU) (EGEBET in Turkish)’ in counseling within structors and the confirmation of the university in 2013. Objective: The aim of this presentation is to reveal the activities and grades of an undergraduate community in-three-years, founded by the undergraduates in order to raise awareness in pregraduate Professional organization. Thus it is aimed to be aware towards postgraduate Professional organization, and to reflect Professional unity and solidarity, alongside personal development to midwifery services by maintaining Professional development. In-the-presentation it is aimed to explain what dimension the organization of midwifery students in Turkey is, and to be a stimulus so that ICM can be more active on undergraduate communities. Findings: MCEU’s an activity that has launched in the scope of Social Responsibility Lecture instructed in curricula of second grade in the Midwifery Department. The community have performed lots activities to reach their objectives between the years of 2013-2016. MCEU have had 65 members in a very-soon period. Today the community that goes on its activities on social network in order to abolish the distances and reach more midwifery students’ve 444 members. MCEU aiming to make all the students of the Midwifery Department a member of this association also accepts the applications of national and international midwifery students. More over the community has published two student periodical magazine and carries out activities on Midwifery Day each year. Conclusion: In conjuction with the national introduction of MCEU in the student congress in 2013, it has received consultancy from the members of MCEU as a sample model in the student organization of midwifery department of other universities in Turkey, and stil remains receiving. Furthermore a student community has been founded under the roof of association with the demand of community’s members. Also academician has a responsibility to give direction to the future and shape the future. Therefore, it is thought that the study can be an instance for all branches of science students and academics. Acknowledgment: We thank to founder members of MCEU and all the other students remaining to perform activities because of their contributions to Professional organization.

Keywords: current situation, midwifery, organization, student

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Authors: Saradiya Mukherjee

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Background: Indian Muslims, compared to their counterparts in other religions, generally do not fare well on many yardsticks related to socio-economic progress and the same is true with maternal health care utilization. Due to low age at marriage a major percentage of child birth is ascribed to young (15-24 years) Muslim mothers in, which pose serious concerns on the maternal health care of Young Married Muslim women (YMMW). A thorough search of past literature on Muslim women’s health and health care reveals that studies in India have mainly focused on religious differences in fertility levels and contraceptive use while the research on the determinants of maternal health care utilization among Muslim women are lacking in India. Data and Methods: Retrieving data from the National Family Health Survey -3 (2005-06) this study attempts to assess the level of utilization and factors effecting three key maternal health indicators (full ANC, safe delivery and PNC) among YMMW (15-24 years) in India. The key socio-economic and demographic variables taken as independent or predictor variables in the study was guided by existing literature particularly for India. Bi-variate analysis and chi square test was applied and variables which were found to be significant were further included in binary logistic regression. Results: The findings of the study reveal abysmally low levels of utilization for all three indicators i.e. full ANC, safe delivery and PNC of maternal health care included in the study. Mother’s education, mass media exposure, women’s autonomy, birth order, economic status wanted status of child and region of residence were found to be significant variables effecting maternal health care utilization among YMMW. Multivariate analysis reveals that no mass media exposure, lower autonomy, education, poor economic background, higher birth order and unintended pregnancy are some of the reasons behind low maternal health care utilization. Conclusion: Considering the low level of safe maternal health care utilization and its proximate determinants among YMMW the study suggests educating Muslim girls, promoting family planning use, involving media and collaboration between religious leader and health care system could be some important policy level interventions to address the unmet need of maternity services among YMMW.

Keywords: young Muslim women, religion, socio-economic condition, antenatal care, delivery, post natal care

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Authors: Ramin Mehdiabadi, Neda Menbari, Mohammad Nazir Menbari

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As a pressing public health concern, breast cancer stands as the predominant oncological diagnosis and principal cause of cancer-related mortality among women globally, accounting for 11.7% of new cancer incidences and 6.9% of cancer-related deaths. The annual figures indicate that approximately 230,480 women are diagnosed with breast cancer in the United States alone, with 39,520 succumbing to the disease. While developed economies have reported a deceleration in both incidence and mortality rates across various forms of cancer, including breast cancer, emerging and low-income economies manifest a contrary escalation, largely attributable to lifestyle-mediated risk factors such as tobacco usage, physical inactivity, and high caloric intake. Breast cancer is distinctly characterized by molecular heterogeneity, manifesting in specific subtypes delineated by biomarkers—Estrogen Receptors (ER), Progesterone Receptors (PR), and Human Epidermal Growth Factor Receptor 2 (HER2). These subtypes, comprising Luminal A, Luminal B, HER2-enriched, triple-negative/basal-like, and normal-like, necessitate nuanced, subtype-specific therapeutic regimens, thereby challenging the applicability of generalized treatment protocols. Within this molecular complexity, the transcription factor Forkhead Box M1 (FoxM1) has garnered attention as a significant driver of cellular proliferation, tumorigenesis, metastatic progression, and treatment resistance in a spectrum of human malignancies, including breast cancer. Concurrently, microRNAs (miRs), specifically miR-216b-5p, have been identified as post-transcriptional gene expression regulators and potential tumor suppressors. The overarching objective of this academic investigation is to explicate the multifaceted interrelationship between FoxM1 and miR-216b-5p across the disparate molecular subtypes of breast cancer. Employing a methodologically rigorous, interdisciplinary research design that incorporates cutting-edge molecular biology techniques, sophisticated bioinformatics analytics, and exhaustive meta-analyses of extant clinical data, this scholarly endeavor aims to unveil novel biomarker-specific therapeutic pathways. By doing so, this research is positioned to make a seminal contribution to the advancement of personalized, efficacious, and minimally toxic treatment paradigms, thus profoundly impacting the global efforts to ameliorate the burden of breast cancer.

Keywords: breast cancer, fox m1, microRNAs, mir-216b-5p, gene expression

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Authors: Mohammad Afzal Khan, Fatimah Alanazi, Hala Abdalrahman Ahmed, Talal Shamma, Kilian Kelly, Mohammed A. Hammad, Abdullah O. Alawad, Abdullah Mohammed Assiri, Dieter Clemens Broering

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Lung transplantation is a life-saving surgical replacement of diseased lungs in patients with end-stage respiratory malfunctions. Despite the remarkable short-term recovery, long-term lung survival continues to face several significant challenges, including chronic rejection and severe toxic side-effects due to global immunosuppression. Stem cell-based immunotherapy has been recognized as a crucial immunoregulatory regimen in various preclinical and clinical studies. Despite initial therapeutic outcomes, conventional stem cells face key limitations. The Cymerus™ manufacturing facilitates the production of a virtually limitless supply of consistent human induced pluripotent stem cell (iPSC)-derived mesenchymal stem cells, which could play a key role in selective immunosuppression and graft repair during rejection. Here, we demonstrated the impact of iPSC-derived human MSCs on the development of immune-tolerance and long-term graft survival in mouse orthotopic airway allografts. BALB/c→C57BL/6 allografts were reconstituted with iPSC-derived MSCs (2 million/transplant/ at d0), and allografts were examined for regulatory T cells (Tregs), oxygenation, microvascular blood flow, airway epithelium and collagen deposition during rejection. We demonstrated that iPSC-derived MSC treatment leads to significant increase in tissue expression of hTSG-6 protein, followed by an upregulation of mouse Tregs and IL-5, IL-10, IL-15 cytokines, which augments graft microvascular blood flow and oxygenation, and thereby maintained a healthy airway epithelium and prevented the subepithelial deposition of collagen at d90 post-transplantation. Collectively, these data confirmed that iPSC-derived MSC-mediated immunosuppression has potential to establish immune-tolerance and rescue allograft from sustained hypoxic/ischemic phase and subsequently limits long-term airway epithelial injury and collagen progression, which therapeutically warrant a study of Cymerus iPSC-derived MSCs as a potential management option for immunosuppression in transplant recipients.

Keywords: stem cell therapy, immunotolerance, regulatory T cells, hypoxia and ischemia, microvasculature

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Authors: Ledi Neçaj

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Objectives: The target of this paper is (1) to explain objectively physical activity model throughout three chronic cardiopulmonary conditions, and (2) to study the connection among physical activity dimensions with disease severity, self-reported physical and emotional functioning, and exercise performance. Material and Methods: This is a cross-sectional study of patients in their domestic environment. Patients with cardiopulmonary diseases were: chronic obstructive pulmonary disease (COPD), (n-63), coronary heart failure (n=60), and patients with implantable cardioverter defibrillator (n=60). Main results measures: Seven ambulatory physical activity dimensions (total steps, percentage time active, percentage time ambulating at low, medium, and hard intensity, maximum cadence for 30 non-stop minutes, and peak performance) have been measured with an accelerometer. Results: Subjects with COPD had the lowest amount of ambulatory physical activity compared with topics with coronary heart failure and cardiac dysrhythmias (all 7 interest dimensions, P<.05); total step counts have been: 5319 as opposed to 7464 as opposed to 9570, respectively. Six-minute walk distance becomes correlated (r=.44-.65, P<.01) with all physical activity dimensions inside the COPD pattern, the most powerful correlations being with total steps and peak performance. In topics with cardiac impairment, maximal oxygen intake had the most effective small to slight correlations with five of the physical activity dimensions (r=.22-.40, P<.05). In contrast, correlations among 6-minute walk test distance and physical activity have been higher (r=.48-.61, P<.01) albeit in a smaller pattern of most effective patients with coronary heart failure. For all three samples, self-reported physical and mental health functioning, age, frame mass index, airflow obstruction, and ejection fraction had both exceptionally small and no significant correlations with physical activity. Conclusions: Findings from this study present a profitable benchmark of physical activity patterns in individuals with cardiopulmonary diseases for comparison with future studies. All seven dimensions of ambulatory physical activity have disfavor between subjects with COPD, heart failure, and cardiac dysrhythmias. Depending on the research or clinical goal, the use of one dimension, such as total steps, may be sufficient. Although physical activity had high correlations with performance on a six-minute walk test relative to other variables, accelerometers-based physical activity monitoring provides unique, important information about real-world behavior in patients with cardiopulmonary not already captured with existing measures.

Keywords: ambulatory physical activity, walking, monitoring, COPD, heart failure, implantable defibrillator, exercise performance

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Authors: Agumah N. B. Orji, M. U., Oru C. M., Ugbo, E. N., Onwuliri E. A Nwakaeze, E. A.,

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ERG11 gene has been reported to be one of the genes whose expression is responsible for resistance of Candida to various triazole drugs, which are first line treatment for candidiasis. This study was carried out to determine the prevalence of Triazole (Fluconazole and voriconazole) resistant Candida albicans expressing ERG11 gene from adult females in Abakaliki. Urine and vaginal swab samples were randomly collected from volunteers after obtaining their consent to participate in the study. A total of 565 adult females participated in the study. A total of 340 urine specimens and 288 vaginal swab specimens were collected. Direct wet mount technique, as well as culture in Trichomonas broth, were used to examine the urine and vaginal swab specimens for the presence of motile Trichomonads. The Trichomonas broth used was selective for both T. vaginalis and C. albicans. Broths that yielded budding yeast cells after microscopy were subcultured on to Sabouraud dextrose agar, after which Germ tube test was carried out to confirm the presence of C. albicans. Biochemical tests, including carbohydrate fermentation and urease utilization, were also performed. Antibiogram of C. albicans isolates obtained from this study was carried out using commercially available azole drugs. Fluconazole and voriconazole were selected as Triazole drugs used for this study. Nystatin was used as a tangential control. An MIC test was carried out with E-strips on some of the resistant C. albicans isolates A total of 6 isolates that resisted all the azole drugs were selected and screened for the presence of ERG11 gene using Reverse transcriptase polymerase chain reaction technique. The total prevalence recorded for C. albicans was 13.0%. Frequency was statistically higher in Pregnant (7.96%) than non pregnant (5.09%) volunteers (X2=0.94 at P=0.05). With respect to clinical samples, frequency was higher in vaginal swabs samples (7.96%) than Urine samples (5.09%) (X2=9.05 at P=0.05). Volunteers within the age group 26-30 years recorded the highest prevalence (4.46%), while those within the age group 36-40 years recorded the lowest at 1.27%(X2=4.34 at P=0.05). In pregnant female participants, the highest frequency was recorded with those in their 3rd trimester (4.14%), while lowest incidence was recorded for those in their first trimester (0.80%). Antibiogram results from this study showed that C. albicans isolates obtained from this study resisted Fluconazole (72%) more than Voriconazole (57%). Only one out of the six selected isolates yielded resistance in the MIC test. Results obtained from the RT-PCR showed that there was no expression of ERG11 gene among the fluconazole resistant isolates of C. albicans. Observed resistance may be due to other factors other than expression of ERG11 gene.

Keywords: candida, ERG11, triazole, nigeria

Procedia PDF Downloads 149

Authors: James D. Beauchemin

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Introduction: The incarceration of people with mental illness and substance use disorders is a major public health issue with social, clinical, and economic implications. Yoga participation has been associated with numerous psychological benefits; however, there is a paucity of research examining impacts of yoga with incarcerated populations. The purpose of this study was to evaluate effectiveness of a six-week yoga intervention on several mental health-related variables, including emotion regulation, body awareness, and warnings of substance relapse among incarcerated females. Methods: This study utilized a pre-post, three-arm design, with participants assigned to intervention, therapeutic community, or general population groups. A between-group analysis of covariance (ANCOVA) was conducted across groups to assess intervention effectiveness using the Difficulties in Emotion Regulation Scale (DERS), Scale of Body Connection (SBC), and Warnings of Relapse (AWARE) Questionnaire. Results: ANCOVA results for warnings of relapse (AWARE) revealed significant between-group differences F(2, 80) = 7.15, p = .001; np2 = .152), with significant pairwise comparisons between the intervention group and both the therapeutic community (p = .001) and the general population (p = .005) groups. Similarly, significant differences were found for emotional regulation (DERS) F(2, 83) = 10.521, p = .000; np2 = .278). Pairwise comparisons indicated a significant difference between the intervention and general population (p = .01). Finally, significant differences between the intervention and control groups were found for body awareness (SBC) F(2, 84) = 3.69, p = .029; np2 = .081). Between-group differences were clarified via pairwise comparisons, indicating significant differences between the intervention group and both the therapeutic community (p = .028) and general population groups (p = .020). Implications: Study results suggest that yoga may be an effective addition to integrative mental health and substance use treatment for incarcerated women and contributes to increasing evidence that holistic interventions may be an important component for treatment with this population. Specifically, given the prevalence of mental health and substance use disorders, findings revealed that changes in body awareness and emotion regulation might be particularly beneficial for incarcerated populations with substance use challenges as a result of yoga participation. From a systemic perspective, this proactive approach may have long-term implications for both physical and psychological well-being for the incarcerated population as a whole, thereby decreasing the need for traditional treatment. By integrating a more holistic, salutogenic model that emphasizes prevention, interventions like yoga may work to improve the wellness of this population while providing an alternative or complementary treatment option for those with current symptoms.

Keywords: wellness, solution-focused coaching, college students, prevention

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Authors: Ariyan S. Araghi, Guy C. Jackson, Stephen J. Bonsor

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Materials & Methods: A systematic literature search was undertaken using pre-determined inclusion and exclusion criteria. This review followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) statement. Several databases were used to search for randomised control trials and longitudinal cohort studies, which were published less than thirty years ago. A total of 54 studies met the predefined inclusion criteria. Four studies reviewed the success, survival, and failure characteristics of zirconia framework resin retained bridges, whilst two reviewed non-precious metal resin retained bridges. Results: The analysis of the studies revealed an overall survival rate of 95.9% for zirconia-based restorations compared to 90.7% for non-precious metal frameworks. Non-precious metal resin retained bridges displayed a higher overall failure rate of 11.9% compared to 4.6% for zirconia-based restorations in the analysed papers. The most frequent complications were wing debonding for the non-precious metal wing group, whereas substructure fracture and veneering ceramic fracture were more prevalent for the zirconia arm of the study. Conclusion: Both types of resin retained bridges provide effective medium to long-term survival. Zirconia-based frameworks will provide marginally increased success and survival and greatly improved aesthetics. However, catastrophic failure is more likely with zirconia-based restorations. Non-precious metal is time tested but performs worse than its zirconia counterpart with regards to longevity; it does not exhibit the same framework fractures as zirconia. Cement choice and attention to the adhesive bonding systems used appear to be paramount to restoration longevity with both restoration subtypes. Furthermore, improved longevity can be seen when air particle abrasion is incorporated into the adhesive protocol. Within the limitations of this study, it has been determined that zirconia-based resin retained bridges can be effectively used in anterior cantilever bridges. Clinical Significance: Zirconia-based resin retained bridges have been demonstrating promising results in terms of improved success and survival characteristics, together with improved aesthetics when compared to non-precious metal winged resin retained bridges. Their popularity is increasing in the age of digital dentistry as many restorations are manufactured using such technology. It is essential that clinicians understand the limitations of each material type and principles of adhesion to ensure restoration longevity.

Keywords: resin retained bridge, fixed partial denture, zirconia bridge, adhesive bridge

Procedia PDF Downloads 81

Authors: Shekoufeh Behdad, Amirhossein Yadegari, Leila Ghodrati, Saman Yadegari

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Context: Preoperative anxiety is a common psychological reaction experienced by all patients undergoing surgery. It can have negative effects on the patient's well-being and even impact surgical outcomes. Therefore, finding effective interventions to reduce preoperative anxiety is important in improving patient care. Research Aim: The aim of this study is to compare the effects of oral administration of zaleplon (5 mg) and alprazolam (0.5 mg) on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Methodology: This study is a double-blind, randomized clinical trial conducted after receiving approval from the university's ethics committee and obtaining written informed consent from the patients. The night before the surgery, patients were randomly assigned to receive either 0.5 mg of alprazolam or 5 mg of zaleplon orally. Anxiety levels, measured using a 10-cm visual analog scale, and hemodynamic variables (blood pressure and heart rate) were assessed before drug administration and on the morning of the operation after the patient entered the pre-operation room. Findings: The study found that there were no significant differences in mean anxiety levels or hemodynamic variables before and after administration of either drug in both groups (P value > 0.05). This suggests that both 0.5 mg of alprazolam and 5 mg of zaleplon effectively reduce preoperative anxiety in women undergoing abdominal surgery without serious side effects. Theoretical Importance: This study contributes to the understanding of the effectiveness of alprazolam and zaleplon in reducing preoperative anxiety. It adds to the existing literature on pharmacological interventions for anxiety management, specifically in the context of gynecological abdominal surgery. Data Collection: Data for this study were collected through the assessment of anxiety levels using a visual analog scale and measuring hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate. These measurements were taken before drug administration and on the morning of the surgery. Analysis Procedures: Statistical analysis was performed to compare the mean anxiety levels and hemodynamic variables before and after drug administration in the two groups. The significance of the differences was determined using appropriate statistical tests. Questions Addressed: This study aimed to answer the question of whether there are differences in the effects of alprazolam and zaleplon on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Conclusion: The oral administration of both 0.5 mg of alprazolam and 5 mg of zaleplon the night before surgery effectively reduces preoperative anxiety in women undergoing abdominal surgery. These findings have important implications for the management of preoperative anxiety and can contribute to improving the overall surgical experience for patients.

Keywords: zaleplon, alprazolam, premedication, abdominal surgery

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Authors: Abdelmanie Suleimat, Nagham Abu Shaqra, Sawsan Majali, Issam Adawi, Heba Abo Shindi, Anas Al Mohtaseb

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The Government of Jordan recognizes that maternal mortality constitutes a grave public health problem. Over the past two decades, there has been significant progress in improving the quality of maternal health services, resulting in improved maternal and child health outcomes. Despite these efforts, measurement and analysis of maternal mortality remained a challenge, with significant discrepancies from previous national surveys that inhibited accuracy. In response with support from USAID, the Jordan Maternal Mortality Surveillance Response (JMMSR) System was established to collect, analyze, and equip policymakers with data for decision-making guided by interdisciplinary multi-levelled advisory groups aiming to eliminate preventable maternal deaths, A 2016 Public Health Bylaw required the notification of deaths among women of reproductive age. The JMMSR system was launched in 2018 and continues annually, analyzing data received from health facilities, to guide policy to prevent avoidable deaths. To date, there have been four annual national maternal mortality reports (2018-2021). Data is collected, reviewed by advisory groups, and then consolidated in an annual report to inform and guide the Ministry of Health (MOH); JMMSR collects the necessary information to calculate an accurate maternal mortality ratio and assists in identifying leading causes and contributing factors for each maternal death. Based on this data, national response plans are created. A monitoring and evaluation plan was designed to define, track, and improve implementation through indicators. Over the past four years, one of these indicators, ‘percent of facilities notifying respective health directorates of all deaths of women of reproductive age,’ increased annually from 82.16%, 92.95%, and 92.50% to 97.02%, respectively. The Government of Jordan demonstrated commitment to the JMMSR system by designating the MOH to primarily host the system and lead the development and dissemination of policies and procedures to standardize implementation. The data was translated into practical and evidence-based recommendations. The successful impact of results deepened the understanding of maternal mortality in Jordan, which convinced the MOH to amend the Bylaw now mandating electronic reporting of all births and neonatal deaths from health facilities to empower the JMMSR system, by developing a stillbirths and neonatal mortality surveillance and response system.

Keywords: maternal health, maternal mortality, preventable maternal deaths, maternal morbidity

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Authors: Jami Wang, Brian Kao, Davin Agustines

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COVID-19 highlighted the active discrimination against the Asian American population easily seen through media, social tension, and increased crimes against the specific population. It is well known that long-term racism can also have a large impact on both emotional and psychological well-being. However, the healthcare disparity during this time also revealed how the Asian American community lacked the research data, political support, and medical infrastructure for this particular population. During a time when Asian American fear for safety with decreasing mental health, telepsychiatry is particularly promising. COVID-19 demonstrated how well psychiatry could integrate with telemedicine, with psychiatry being the second most utilized telemedicine visits. However, the Asian American community did not utilize the telepsychiatry resources as much as other groups. Because of this, we wanted to understand why the patient population who was affected the most by COVID-19 mentally did not seek out care. To do this, we decided to study the top top telepsychiatry platforms. The current top telepsychiatry companies in the United States include Teladoc and BetterHelp. In the Teladoc mental health sector, they only had 4 available languages (English, Spanish, French, and Danis,) with none of them being an Asian language. In a similar manner, Teladoc’s top competitor in the telepsychiatry space, BetterHelp, only listed a total of 3 Asian languages, including Mandarin, Japanese, and Malaysian. However, this is still a short list considering they have over 20 languages available. The shortage of available physicians that speak multiple languages is concerning, as it could be difficult for the Asian American community to relate with. There are limited mental health resources that cater to their likely cultural needs, further exacerbating the structural racism and institutional barriers to appropriate care. It is important to note that these companies do provide interpreters to comply with the nondiscrimination and language assistance federal law. However, interactions with an interpreter are not only more time-consuming but also less personal than talking directly with a physician. Psychiatry is the field that emphasizes interpersonal relationships. The trust between a physician and the patient is critical in developing patient rapport to guide in better understanding the clinical picture and treating the patient appropriately. The language barrier creates an additional barrier between the physician and patient. Because Asian Americans are one of the largest growing patient population bases, these telehealth companies have much to gain by catering to the Asian American market. Without providing adequate access to bilingual and bicultural physicians, the current system will only further exacerbate the growing disparity. The healthcare community and telehealth companies need to recognize that the Asian American population is a severely underserved population in mental health and has much to gain from telepsychiatry. The lack of language is one of many reasons why there is a disparity for Asian Americans in the mental health space.

Keywords: telemedicine, psychiatry, Asian American, disparity

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Authors: Shyam lamsal

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

Keywords: backward area, nursing school

Procedia PDF Downloads 320

Authors: Sanjeeb Kumar Mishra, Aartee Jha, Madhu Thapa, Pragati Gautam

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Introduction: High myopia has become a matter of global concern as it is a major risk factor for glaucoma. Various optic nerve head changes occur in high myopia over time. This might lead to difficulty in detecting pathologies associated with high myopia through conventional funduscopy examinations only. Bruch’s Membrane Opening (Area and Minimum Rim Width) is considered an anatomically more accurate and reliable landmark than the conventional clinical disc margin. Study Design: It was a hospital based cross-sectional and non-interventional type of study. Purpose: The purpose of our study was to measure Bruch’s Membrane Opening (area and Minimum Rim Width) in high myopic eyes and correlate it with axial length. Methods: A cross-sectional study was conducted at B.P Koirala Lions Center for Ophthalmic Studies, a tertiary-level eye center in Nepal. 80 eyes of 40 subjects (40% male and 60% female) aged 18-35 years with high myopia (Spherical Equivalent (SE) ≥ -6D) were taken as cases. Among them, RE of 39 and LE of 34 myopic subjects were included in the study. Spectral Domain-Optical Coherence Tomography of both the eyes of myopic patients was performed using Glaucoma Module Premiere Edition (GMPE) with Anatomic Positioning System (APS) to measure Bruch’s Membrane Opening (Area and Minimum Rim Width). Axial length in myopic patients was measured using Partial Coherence Interferometry (IOL Master). Results: Among 40 myopic subjects, 16 (40%) were males, whereas 24 (60%) were females. The mean age of myopic subjects was 24.64 ± 5.10 years, with minimum and maximum ages of 18 years and 35 years, respectively. The mean BMO area was 2.28 0.48 mm² in right eye and 2.15 0.59 mm² in left eye. BMO area in high myopic patient was significantly correlated with axial length. The correlation analysis of BMO area with axial length in RE and LE was found to be statistically significant at (r=0.465, p<0.003) and (r=0.374, p< 0.029), respectively. Likewise, the mean BMO-MRW was 325.69 ± 96µm in right eye and 339.20 ± 79.50µm in left eye. There was a significant correlation of BMO-MRW with axial length in both the eyes of myopic subjects. Moreover, a significant negative correlation of Inferior temporal, Nasal, and Inferior nasal quadrants (p<0.05) of BMO-MRW of right eye was found with axial length of right eye, whereas all the BMO-MRW quadrants of left eye were negatively correlated (p<0.05) with axial length in left eye. No significant differences were found between right eye and left eye on comparing means of refractive error, axial length, BMO area, and BMO-MRW. Conclusion: From this study, it can be concluded that BMO area enlarges in high myopia with an increase in axial length. Additionally, BMO-MRW thinning occurs along with the BMO enlargement and increases with axial length. There were no significant differences in refractive error, axial length, BMO area, and BMO-MRW between right eye and left eye.

Keywords: high myopia, Bruch’s membrane opening, Bruch’s membrane opening minimum rim width, spectral domain optical coherence tomography

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Authors: Venkata Buddharaju, Irene Mccarron, Hazel Alba

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Introduction: Male external catheters (MECs) are commonly used to collect and drain urine. MECs are increasingly used in acute care, long-term acute care hospitals, and nursing facilities, and in other patients as an alternative to invasive urinary catheters to reduce catheter-associated urinary tract infections (CAUTI).MECs are also used to avoid the need for incontinence pads and diapers. Most of the Male External Catheters are held in place by skin adhesive, with the exception of a few, which uses a foam strap clamp around the penile shaft. The adhesive condom catheters typically stay for 24 hours or less. It is also a common practice that extra skin adhesive tape is wrapped around the condom catheter for additional security of the device. The fixed nature of the adhesive will not allow the normal skin expansion of penile size over time. The adhesive can cause skin irritation, redness, erosion, and skin damage. Acanthus condom catheter (ACC) is a patented, specially designed, stretchable silicone catheter without adhesive, adapts to the size and contour of the penis. It is held in place with a single elastic strap that wraps around the lower back and tied to the opposite catheter ring holescriss cross. It can be reused for up to 5 days on the same patient after daily cleaning and washingpotentially reducing cost. Methods: The study was conducted from September 17th to October 8th, 2020. The nursing staff was educated and trained on how to use and reuse the catheter. After identifying five (5) appropriate patients, the catheter was placed and maintained by nursing staff. The data on the ease of use, leak, and skin damage were collected and reported by nurses to the nursing education department of the hospital for analysis. Setting: RML Chicago, long-term acute care hospital, an affiliate of Loyola University Medical Center, Chicago, IL USA. Results: The data showed that the catheter was easy to apply, remove, wash and reuse, without skin problems or urine infections. One patient had used for 16 days after wash, reuse, and replacement without any urine leak or skin issues. A minimal leak was observed on two patients. Conclusion: Acanthus condom catheter was easy to use, functioned well with minimal or no leak during use and reuse. The skin was intact in all patients studied. There were no urinary tract infections in any of the studied patients.

Keywords: CAUTI, male external catheter, reusable, skin adhesive

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Authors: I. Gupta, N. Setia

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Introduction. Buyer conduct is a progression of practices or examples that buyers pursue before making a buy. It begins when the shopper ends up mindful of a need or wish for an item, at that point finishes up with the buying exchange. Business visionaries can't generally simply shake hands with their intended interest group people and become more acquainted with them. Research is often necessary, so every organization primarily involves doing continuous research to understand and satisfy consumer needs pattern. Aims and Objectives: The aim of the present study is to examine the different behaviors of the consumer, including pre-purchase, purchase, and post-purchase behavior. Materials and Methods: In order to get results, face to face interview held with 80 people which comprise a larger part of female individuals having upper as well as middle-class status. The prime source of data collection was primary. However, the study has also used the theoretical contribution of many researchers in their respective field. Results: Majority of the respondents were females (70%) from the age group of 20-50. The collected data was analyzed through hypothesis testing statistical techniques such as correlation analysis, single regression analysis, and ANOVA which has rejected the null hypothesis that there is no relation between researching the consumer behavior at different stages and organizational performance. The real finding of this study is that simply focusing on the buying part isn't enough to gain profits and fame, however, understanding the pre, buy and post-buy behavior of consumer performs a huge role in organization success. The outcomes demonstrated that the organization, which deals with the three phases of research of purchasing conduct is able to establish a great brand image as compare to their competitors. Alongside, enterprises can observe customer conduct in a considerably more proficient manner. Conclusion: The analyses of consumer behavior presented in this study is an attempt to understand the factors affecting consumer purchasing behavior. This study has revealed that those corporations are more successful, which work on understanding buying behavior instead to just focus on the selling products. As a result, organizations perform good and grow rapidly because consumers are the one who can make or break the company. The interviews that were conducted face to face, clearly revealed that those organizations become at top-notch whom consumers are satisfied, not just with product but also with services of the company. The study is not targeting the particular class of audience; however, it brings out benefits to the masses, in particular to business organizations.

Keywords: consumer behavior, pre purchase, post purchase, consumer satisfaction

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Authors: Chukwuka Justus Iwegbu

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Background: A major concern facing the world is providing senior citizens, individuals with disabilities, and other vulnerable groups with high-quality care. This issue is more serious in Nigeria's North Eastern area, where the burden of disease and disability is heavy, and access to care is constrained. This study aims to fill this gap by exploring the roles, challenges and support needs of caregivers, care home management, funding and administration in challenged communities in North Eastern Nigeria. The study will also provide a comprehensive understanding of the current situation and identify opportunities for improving the quality of care and support for caregivers and care recipients in these communities. Methods: A mixed-methods design, including both quantitative and qualitative data collection methods, will be used, and it will be guided by the stress process model of caregiving. The qualitative stage approach will comprise a survey, In-depth interviews, observations, and focus group discussion and the quantitative analysis will be used in order to comprehend the variations between caregiver's roles and care home management. A review of relevant documents, such as care home policies and funding reports, would be used to gather quantitative data on the administrative and financial aspects of care. The data collected will be analyzed using both descriptive statistics and thematic analysis. A sample size of around 200-300 participants, including caregivers, care recipients, care home managers and administrators, policymakers and health care providers, would be recruited. Findings: The study revealed that caregivers in challenged communities in North Eastern Nigeria face significant challenges, including lack of training and support, limited access to funding and resources, and high levels of burnout. Care home management and administration were also found to be inadequate, with a lack of clear policies and procedures and limited oversight and accountability. Conclusion: There is a need for increased investment in training and support for caregivers, as well as a need for improved care home management and administration in challenged communities in North Eastern Nigeria. It also highlights the importance of involving community members in decision-making and planning processes related to care homes and services. The study would contribute to the existing body of knowledge by providing a detailed understanding of the challenges faced by caregivers, care home managers and administrators.

Keywords: caregivers, care home management, funding, administration, challenge communities, North Eastern Nigeria

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Authors: Laura Canagueral-Pellice, Antonio Munar-Frau, Adaia Valls-Ontanon, Joao Carames, Federico Hernandez-Alfaro, Jordi Caballe-Serrano

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Objective: Guided bone regeneration (GBR) aims to replace the missing bone with a new structure to achieve long-term stability of rehabilitations. The aim of the present systematic review and meta-analysis is to determine the effect of barrier membranes on histological outcomes after GBR procedures. Moreover, the effect of the grafting material and tissue gain were analyzed. Materials & methods: Two independent reviewers performed an electronic search in Pubmed and Scopus, identifying all eligible publications up to March 2020. Only randomized controlled trials (RCTs) assessing a histological analysis of augmented areas were included. Results: A total of 6 publications were included for the present systematic review. A total of 110 biopsied sites were analysed; 10 corresponded to vertical bone augmentation procedures, whereas 100 analysed horizontal regeneration procedures. A mean tissue gain of 3 ± 1.48mm was obtained for horizontal defects. Histological assessment of new bone formation, residual particle and sub-epithelial connective tissue (SCT) was reported. The four main barrier membranes used were natural collagen membranes, e-PTFE, polylactic resorbable membranes and acellular dermal matrix membranes (AMDG). The analysis demonstrated that resorbable membranes result in higher values of new bone formation and lower values of residual particles and SCT. Xenograft resulted in lower new bone formation compared to allograft; however, no statistically significant differences were observed regarding residual particle and SCT. Overall, regeneration procedures adding autogenous bone, plasma derivate or growth factors achieved in general greater new bone formation and tissue gain. Conclusions: There is limited evidence favoring the effect of a certain type of barrier membrane in GBR. Data needs to be evaluated carefully; however, resorbable membranes are correlated with greater new bone formation values, especially when combined with allograft materials and/or the addition of autogenous bone, platelet reach plasma (PRP) or growth factors in the regeneration area. More studies assessing the histological outcomes of different GBR protocols and procedures testing different biomaterials are needed to maximize the clinical and histological outcomes in bone regeneration science.

Keywords: barrier membrane, graft material, guided bone regeneration, implant surgery, histology

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Authors: Masilonyane Mokhele

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Across the world, different planning models of the so-called airport-led developments are becoming bandwagons hailed as key to the future of cities. However, in the existing knowledge, there is paucity of empirically informed description and explanation of the economic fundamentals driving the forces of attraction of airports. This void is arguably a result of the absence of an appropriate theoretical framework to guide the analyses. Given this paucity, the aim of the paper is to contribute towards a theoretical framework that could be used to describe and explain forces that drive the location and mix of airport-centric developments. Towards achieving this aim, the objectives of the paper are: one, to establish the type of economic activities that are located on and around O.R. Tambo International Airport (ORTIA), and analyse the reasons for locating there; two, to establish changes that have occurred over time in the form of the airport-centric development of ORTIA; three, to identify the propulsive economic qualities of ORTIA; four, to analyse the spatial, economic and structural linkages within the airport-centric development of ORTIA, between the airport-centric development and the airport, as well as the airport-centric development’s linkages with their metropolitan area and other regional, national and international airport-centric developments and locations. To address the objectives above, the study adopted a case study approach, centred on ORTIA in South Africa: Africa’s busiest airport in terms of passengers and airfreight handled. Using a lens of location theory, a survey was adopted as a main research method, wherein telephonic interviews were conducted with a representative number of firms on and around ORTIA. Other data collection methods encompassed in-depth qualitative interviews (to augment the information obtained through the survey) and analysis of secondary information, particularly as regards establishing changes that have occurred in the form of ORTIA and surrounds. From the empirical findings, ORTIA was discovered to have propulsive economic qualities that act as significant forces of attraction in the clustering of firms. Together with its airport-centric development, ORTIA was discovered to have growth pole properties because of the linkages that occur within the study area, and the linkages that exist between the airport-centric firms and the airport. It was noted that the transport-oriented firms (typified by couriers and freight carriers) act as anchors in some fellow airport-centric firms making use of elements of urbanisation economies, particularly as regards the use of the airport for airfreight services. The empirical findings presented in the paper (in conjunction with results from other airport-centric development case studies) could be used as contribution towards extending theory that describes and explains forces that drive the location and mix of airport-centric developments.

Keywords: airports, airport-centric development, O. R. Tambo international airport, South Africa

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Authors: Ergham Al Bachir

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This study adopts strategic leadership (Upper Echelons) as the core theory and contextual leadership theory as the research lens. This research asks how the external context impacts strategic leadership effectiveness to achieve the outcomes in pluralistic organizations (PO). The study explores how the context influences the selection of CEOs, top management teams (TMT), and their leadership effectiveness. POs are characterized by the multiple objectives of their top management teams, divergent objectives, multiple strategies, and multiple governing authorities. The research question is explored by means of a qualitative multiple-case study focusing on healthcare, real estate, and financial services organizations. The data sources are semi-structured interviews, documents, and direct observations. The data analysis strategy is inductive and deploys thematic analysis and cross-case synthesis. The findings differentiate between national and international CEOs' delegation of authority and relationship with the Board of Directors. The findings identify the elements of the dynamic context that influence TMT and PO outcomes. The emergent hybrid strategic and contextual leadership framework shows how the different contextual factors influence strategic direction, PO context, selection of CEOs and TMT, and the outcomes in four pluralistic organizations. The study offers seven theoretical contributions to Upper Echelons, strategic leadership, and contextual leadership research. (1) The integration of two theories revealed how CEO’s impact on the organization is complementary to the contextual impact. (2) Conducting this study in the Middle East contributes to strategic leadership and contextual leadership research. (3) The demonstration of the significant contextual effects on the selection of CEOs. (4 and 5) Two contributions revealed new links between the context, the Board role, internal versus external CEOs, and national versus international CEOs. (6 and 7) This study offered two definitions: what accounts for CEO leadership effectiveness and organizational outcomes. Two methodological contributions were also identified: (1) Previous strategic leadership and Upper Echelons research are mainly quantitative, while this study adopts qualitative multiple-case research with face-to-face interviews. (2) The extrication of the CEO from the TMT advanced the data analysis in strategic leadership research. Four contributions are offered to practice: (1) The CEO's leadership effectiveness inside and outside the organization. (2) Rapid turnover of predecessor CEOs signifies the need for a strategic and contextual approach to CEOs' succession. (3) TMT composition and education impact on TMT-CEO and TMT-TMT interface. (4) Multilevel strategic contextual leadership development framework.

Keywords: strategic leadership, contextual leadership, upper echelons, pluralistic organizations, cross-cultural leadership

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Authors: Naima Jannat, Ariful Islam, Sharafat Hossain

Abstract:

Due to the involvement of the large target volume, Craniospinal Irradiation makes it challenging to achieve a uniform dose, and it requires different isocenters. This isocentric junction needs to shift after every five fractions to overcome the possibility of hot and cold spots. This study aims to evaluate the Planning Target Volume coverage & sparing Organ at Risk between two techniques and shows that the Field Alignment Technique does not need replanning and resetting. Planning method for Craniospinal Irradiation by Eclipse treatment planning system Field Alignment and Extended Source to Surface Distance technique was developed where 36 Gy in 20 Fraction at the rate of 1.8 Gy was prescribed. The patient was immobilized in the prone position. In the Field Alignment technique, the plan consists of half beam blocked parallel opposed cranium and a single posterior cervicospine field was developed by sharing the same isocenter, which obviates divergence matching. Further, a single field was created to treat the remaining lumbosacral spine. Matching between the inferior diverging edge of the cervicospine field and the superior diverging edge of a lumbosacral field, the field alignment option was used, which automatically matches the field edge divergence as per the field alignment rule in Eclipse Treatment Planning System where the couch was set to 2700. In the Extended Source to Surface Distance technique, two parallel opposed fields were created for the cranium, and a single posterior cervicospine field was created where the Source to Surface Distance was from 120-140 cm. Dose Volume Histograms were obtained for each organ contoured and for each technique used. In all, the patient’s maximum dose to Planning Target Volume is higher for the Extended Source to Surface Distance technique to Field Alignment technique. The dose to all surrounding structures was increased with the use of a single Extended Source to Surface Distance when compared to the Field Alignment technique. The average mean dose to Eye, Brain Steam, Kidney, Oesophagus, Heart, Liver, Lung, and Ovaries were respectively (58% & 60 %), (103% & 98%), (13% & 15%), (10% & 63%), (12% & 16%), (33% & 30%), (14% & 18%), (69% & 61%) for Field Alignment and Extended Source to Surface Distance technique. However, the clinical target volume at the spine junction site received a less homogeneous dose with the Field Alignment technique as compared to Extended Source to Surface Distance. We conclude that, although the use of a single field Extended Source to Surface Distance delivered a more homogenous, but its maximum dose is higher than the Field Alignment technique. Also, a huge advantage of the Field Alignment technique for Craniospinal Irradiation is that it doesn’t need replanning and resetting up of patients after every five fractions and 95% prescribed dose was received by more than 95% of the Planning Target Volume in all the plane with the acceptable hot spot.

Keywords: craniospinalirradiation, cranium, cervicospine, immobilize, lumbosacral spine

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Authors: Riofrio Jonathan, Fernandez Guillermo

Abstract:

Renewable energy represented around 80% of the energy matrix for power generation in Ecuador during 2020, so the deployment of current public policies is focused on taking advantage of the high presence of renewable sources to carry out several electrification projects. These projects are part of the portfolio sent to the United Nations Framework on Climate Change (UNFCCC) as a commitment to reduce greenhouse gas emissions (GHG) in the established national determined contribution (NDC). In this sense, the Ecuadorian Organic Energy Efficiency Law (LOEE) published in 2019 promotes E-mobility as one of the main milestones. In fact, it states that the new vehicles for urban and interurban usage must be E-buses since 2025. As a result, and for a successful implementation of this technological change in a national context, it is important to deploy land surveys focused on technical and geographical areas to keep the quality of services in both the electricity and transport sectors. Therefore, this research presents a technological and energy comparison between a conventional diesel bus and its equivalent E-bus. Both vehicles fulfill all the technical requirements to ride in the study-case city, which is Ambato in the province of Tungurahua-Ecuador. In addition, the analysis includes the development of a model for the energy estimation of both technologies that are especially applied in a highland city such as Ambato. The altimetry of the most important bus routes in the city varies from 2557 to 3200 m.a.s.l., respectively, for the lowest and highest points. These operation conditions provide a grade of novelty to this paper. Complementary, the technical specifications of diesel buses are defined following the common features of buses registered in Ambato. On the other hand, the specifications for E-buses come from the most common units introduced in Latin America because there is not enough evidence in similar cities at the moment. The achieved results will be good input data for decision-makers since electric demand forecast, energy savings, costs, and greenhouse gases emissions are computed. Indeed, GHG is important because it allows reporting the transparency framework that it is part of the Paris Agreement. Finally, the presented results correspond to stage I of the called project “Analysis and Prospective of Electromobility in Ecuador and Energy Mix towards 2030” supported by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ).

Keywords: high altitude cities, energy planning, NDC, e-buses, e-mobility

Procedia PDF Downloads 151

Authors: J. Fox, J. Randhawa, M. Chan, L. Campbell, A. Weakely, D. J. Harvey, S. Tomaszewski Farias

Abstract:

Early identification of individuals at risk for conversion to dementia provides an opportunity for preventative treatment. Many older adults (30-60%) report specific subjective cognitive decline (SCD); however, previous research is inconsistent in terms of what types of complaints predict future cognitive decline. The purpose of this study is to identify which specific complaints from the Everyday Cognition Scales (ECog) scales, a measure of self-reported concerns for everyday abilities across six cognitive domains, are associated with: 1) conversion from a clinical diagnosis of normal to either MCI or dementia (categorical variable) and 2) progressive cognitive decline in memory and executive function (continuous variables). 415 cognitively normal older adults were monitored annually for an average of 5 years. Cox proportional hazards models were used to assess associations between self-reported ECog items and progression to impairment (MCI or dementia). A total of 114 individuals progressed to impairment; the mean time to progression was 4.9 years (SD=3.4 years, range=0.8-13.8). Follow-up models were run controlling for depression. A subset of individuals (n=352) underwent repeat cognitive assessments for an average of 5.3 years. For those individuals, mixed effects models with random intercepts and slopes were used to assess associations between ECog items and change in neuropsychological measures of episodic memory or executive function. Prior to controlling for depression, subjective concerns on five of the eight Everyday Memory items, three of the nine Everyday Language items, one of the seven Everyday Visuospatial items, two of the five Everyday Planning items, and one of the six Everyday Organization items were associated with subsequent diagnostic conversion (HR=1.25 to 1.59, p=0.003 to 0.03). However, after controlling for depression, only two specific complaints of remembering appointments, meetings, and engagements and understanding spoken directions and instructions were associated with subsequent diagnostic conversion. Episodic memory in individuals reporting no concern on ECog items did not significantly change over time (p>0.4). More complaints on seven of the eight Everyday Memory items, three of the nine Everyday Language items, and three of the seven Everyday Visuospatial items were associated with a decline in episodic memory (Interaction estimate=-0.055 to 0.001, p=0.003 to 0.04). Executive function in those reporting no concern on ECog items declined slightly (p <0.001 to 0.06). More complaints on three of the eight Everyday Memory items and three of the nine Everyday Language items were associated with a decline in executive function (Interaction estimate=-0.021 to -0.012, p=0.002 to 0.04). These findings suggest that specific complaints across several cognitive domains are associated with diagnostic conversion. Specific complaints in the domains of Everyday Memory and Language are associated with a decline in both episodic memory and executive function. Increased monitoring and treatment of individuals with these specific SCD may be warranted.

Keywords: alzheimer’s disease, dementia, memory complaints, mild cognitive impairment, risk factors, subjective cognitive decline

Procedia PDF Downloads 80