Search results for: clinical advice services

Authors: Morteza Ahmadifar, Sarah Bahari Derakhshan

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Leakage is one of the most important problems that water distribution networks face which first reason is high-pressure existence. There are many approaches to control this excess pressure, which using pressure reducing valves (PRVs) or reducing pipe diameter are ones. On the other hand, Pumps are using electricity or fossil fuels to supply needed pressure in distribution networks but excess pressure are made in some branches due to topology problems and water networks’ variables, therefore using pressure valves will be inevitable. Although using PRVs is inevitable but it leads to waste electricity or fuels used by pumps because PRVs just waste excess hydraulic pressure to lower it. Pumps working in reverse or Pumps as Turbine (called PAT in this article) are easily available and also effective sources of reducing the equipment cost in small hydropower plants. Urban areas of developing countries are facing increasing in area and maybe water scarcity in near future. These cities need wider water networks which make it hard to predict, control and have a better operation in the urban water cycle. Using more energy and therefore more pollution, slower repairing services, more user dissatisfaction and more leakage are these networks’ serious problems. Therefore, more effective systems are needed to monitor and act in these complicated networks than what is used now. In this article a new approach is proposed and evaluated: Using PAT to produce enough energy for remote valves and sensors in the water network. These sensors can be used to determine the discharge, pressure, water quality and other important network characteristics. With the help of remote valves pipeline discharge can be controlled so Instead of wasting excess hydraulic pressure which may be destructive in some cases, obtaining extra pressure from pipeline and producing clean electricity used by remote instruments is this articles’ goal. Furthermore, due to increasing the area of network there is unwanted high pressure in some critical points which is not destructive but lowering the pressure results to longer lifetime for pipeline networks without users’ dissatisfaction. This strategy proposed in this article, leads to use PAT widely for pressure containment and producing energy needed for remote valves and sensors like what happens in supervisory control and data acquisition (SCADA) systems which make it easy for us to monitor, receive data from urban water cycle and make any needed changes in discharge and pressure of pipelines easily and remotely. This is a clean project of energy production without significant environmental impacts and can be used in urban drinking water networks, without any problem for consumers which leads to a stable and dynamic network which lowers leakage and pollution.

Keywords: clean energies, pump as turbine, remote control, urban water distribution network

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Authors: Hui-mei Huang, Huei-Jiun Cheng

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Introduction Many patients are aware of the health benefits associated with an active lifestyle, but they are often hindered from engaging in physical activity due to the presence of pain. The majority of patients experience pain, which can fluctuate over time and is influenced by various factors, including gender. Gender differences in clinical pain and pain-related conditions are widely recognized. Existing literature strongly supports the notion that men and women exhibit distinct responses to pain. Previous studies conducted in Taiwan have highlighted gender differences in pain assessment, but only a limited number of studies have investigated the gender-related factors that influence pain during daily activities. The objective of this study was to examine gender differences in pain assessment among inpatients in Taiwan and investigate whether gender and surgical procedures are factors that impact the daily activities of pain. Method In this study, a prospective and structured questionnaire survey method was utilized, employing intentional sampling to gather data from inpatients admitted to a medical center in central Taiwan. The research period covered in this study is from October 1, 2019, to June 30, 2020. In this study, participants who were hospitalized within 48 hours were requested to self-assess their pain using the Numeric Rating Scale (NRS) and indicate the impact of pain on their activities. The data were analyzed to explore the potential influence of gender and surgical procedures on daily activities affected by pain. Result A total of 722 cases were included in the study, with the mean age of the subjects is 54.38 years old (SD=16.3), and the range varied from 18 to 93 years old. Among the subjects, 48.23% (n=348) were male, and 62.3% (n=450) of them had received more than 12 years of education., and 56.9% (n=411) underwent surgery. The results indicated that regardless of whether the participants underwent surgery or not, females experienced higher perceived severe pain intensity than males (t=2.248, P < .05). However, in surgical patients, there was no significant difference in gender (t=1.75, P > .05). Regarding the impact of pain on daily activities when pain intensity reached 7 , male subjects experienced a 5-point effect on their daily activities (AUC=0.84, 95% CI 0.79-0.89, P <0.01), while female subjects experienced a 7-point effect (AUC=0.88, 95% CI 0.80-0.87, P <0.01). Discussion Some studies suggest that women experience painful stimuli as more intense than men, this difference has been observed in various types of experimental pain, including mechanical and thermal stimuli. Our study reached the same conclusion, female patients exhibited greater intensity of pain. According to the research findings, The research findings highlight the significant impact of gender on individuals' response to intense pain (NRS>7) during their daily activities, with men showing a higher pain tolerance. The higher pain tolerance often observed in men may be attributed to societal conditioning, which encourages them to conceal outward expressions of pain. Further research in this area could help provide a more comprehensive understanding of the topic in Taiwan.

Keywords: pain assessment, gender, surgery, activities of daily living

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Authors: I. C. Orabueze, A. A. Amudalat, S. A. Adesegun, A. A. Usman

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Dental and associated oral diseases are increasingly affecting a considerable portion of the population and are considered some of the major causes of tooth loss, discomfort, mouth odor and loss of confidence. This study focused on the ethnobotanical survey of medicinal plants used in oral therapy and evaluation of the antimicrobial activities of methanolic extracts of two selected plants from the survey for their efficacy against dental microorganisms. The ethnobotanical survey was carried out in six herbal markets in Lagos State, Nigeria by oral interviewing and information obtained from an old family manually complied herbal medication book. Methanolic extracts of Olax subscorpioidea (stem bark) and Bridelia ferruginea (stem bark) were assayed for their antimicrobial activities against clinical oral isolates (Aspergillus fumigatus, Candida albicans, Streptococcus spp, Staphylococcus aureus, Lactobacillus acidophilus and Pseudomonas aeruginosa). In vitro microbial technique (agar well diffusion method and minimum inhibitory concentration (MIC) assay) were employed for the assay. Chlorhexidine gluconate was used as the reference drug for comparison with the extract results. And the preliminary phytochemical screening of the constituents of the plants were done. The ethnobotanical survey produced plants (28) of diverse family. Different parts of plants (seed, fruit, leaf, root, bark) were mentioned but 60% mentioned were either the stem or the bark. O. subscorpioidea showed considerable antifungal activity with zone of inhibition ranging from 2.650 – 2.000 cm against Aspergillus fumigatus but no such encouraging inhibitory activity was observed in the other assayed organisms. B. ferruginea showed antibacterial sensitivity against Streptococcus spp, Staphylococcus aureus, Lactobacillus acidophilus and Pseudomonas aeruginosa with zone of inhibitions ranging from 3.400 - 2.500, 2.250 - 1.600, 2.700 - 1.950, 2.225 – 1.525 cm respectively. The minimum inhibitory concentration of O. subscorpioidea against Aspergillus fumigatus was 51.2 mg ml-1 while that of B. ferruginea against Streptococcus spp was 0.1mg ml-1 and for Staphylococcus aureus, Lactobacillus acidophilus and Pseudomonas aeruginosa were 25.6 mg ml-1. A phytochemical analysis reveals the presence of alkaloids, saponins, cardiac glycoside, tannins, phenols and terpenoids in both plants, with steroids only in B. ferruginea. No toxicity was observed among mice given the two methanolic extracts (1000 mg Kg-1) after 21 days. The barks of both plants exhibited antimicrobial properties against periodontal diseases causing organisms assayed, thus up-holding their folkloric use in oral disorder management. Further research could be done viewing these extracts as combination therapy, checking for possible synergistic value in toothpaste and oral rinse formulations for reducing oral bacterial flora and fungi load.

Keywords: antimicrobial activities, Bridelia ferruginea, dental disinfection, methanolic extract, Olax subscorpioidea, ethnobotanical survey

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Authors: Lynne McCormack, Andrew Digges

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Since 2013, the Australian government has enforced mandatory detention of anyone arriving in Australia without a valid visa, including those subsequently identified as a refugee or seeking asylum. While consistent with the increased use of immigration detention internationally, Australia’s use of offshore processing facilities both during and subsequent to refugee status determination processing has until recently remained a unique feature of Australia’s program of deterrence. The commonplace detention of refugees and asylum seekers following displacement is a significant and independent source of trauma and a contributory factor in adverse psychological outcomes. Officially, these individuals have no prospect of resettlement in Australia, are barred from applying for substantive visas, and are frequently and indefinitely detained in closed facilities such as immigration detention centres, or alternative places of detention, including hotels. It is also important to note that the limited access to Australia’s immigration detention population made available to researchers often means that data available for secondary analysis may be incomplete or delayed in its release. Further, studies into the lived experience of refugees and asylum seekers are typically cross-sectional and convenience sampled, employing a variety of designs and research methodologies that limit comparability and focused on the immediacy of the individual’s experience. Consequently, how former detainees make sense of their experience, redefine their future trajectory upon release, and recover a sense of authenticity and purpose, is unknown. As such, the present study sought the positive and negative subjective interpretations of 6 participants in Australia regarding their lived experiences as refugees and asylum seekers within Australia’s immigration detention system and its impact on their future sense of self. It made use of interpretative phenomenological analysis (IPA), a qualitative research methodology that is interested in how individuals make sense of, and ascribe meaning to, their unique lived experiences of phenomena. Underpinned by phenomenology, hermeneutics, and critical realism, this idiographic study aimed to explore both positive and negative subjective interpretations of former refugees and asylum seekers held in detention in Australia. It sought to understand how they make sense of their experiences, how detention has impacted their overall journey as displaced persons, and how they have moved forward in the aftermath of protracted detention in Australia. Examining the unique lived experiences of previously detained refugees and asylum seekers may inform the future development of theoretical models of posttraumatic growth among this vulnerable population, thereby informing the delivery of future mental health and resettlement services.

Keywords: mandatory detention, refugee, asylum seeker, authenticity, Interpretative phenomenological analysis

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Authors: Neyzielle Ronnicque Cadiz

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The Philippine is a hotbed of disasters and is a locus of natural hazards. With an average of 20 typhoons entering the Philippine Area of Responsibility (PAR) each year, seven to eight (7-8) of which makes landfall. The country rather inevitably suffers from climate-related calamities. With this vulnerability to natural hazards, the relevant hazard-related issues that come along with the potential threat and occurrence of a disaster oftentimes garners lesser media attention than when a disaster actually occurred. Post-disaster news and events flood the content of news networks primarily focusing on, but not limited to, the efforts of the national government in resolving post-disaster displacement, and all the more on the community leaders’ incompetence in disaster mitigation-- even though the University of the Philippines’ NOAH Center work hand in hand with different stakeholders for disaster mitigation communication efforts. Disaster risk communication is actually a perennial dilemma. There are so many efforts to reach the grassroots level but emergency and disaster preparedness messages inevitably fall short.. The Philippines is very vulnerable to hazards risk and disasters but social media posts and communication efforts mostly go unnoticed, if not argued upon. This study illustrates the outcomes of a research focusing on the print, broadcast, and social media’s role on disaster communication involving the natural catastrophic events that took place in the Philippines from 2009 to present. Considering the country’s state of development, this study looks on the rapid and reliable communication between the government, and the relief/rescue workers in the affected regions; and how the media portrays these efforts effectively. Learning from the disasters that have occurred in the Philippines over the past decade, effective communication can ensure that any efforts to prepare and respond to disasters can make a significant difference. It can potentially either break or save lives. Recognizing the role of communications is not only in improving the coordination of vital services for post disaster; organizations gave priority in reexamining disaster preparedness mechanisms through the Communication with Communities (CwC) programs. This study, however, looks at the CwC efforts of the Philippine media platforms. CwC, if properly utilized by the media, is an essential tool in ensuring accountability and transparency which require effective exchange of information between disasters and survivors and responders. However, in this study, it shows that the perennial dilemma of the Philippine media is that the Disaster Risk Reduction and Management (DRRM) efforts of the country lie in the clouded judgment of political aims. This kind of habit is a multiplier of the country’s risk and insecurity. Sometimes the efforts in urging the public to take action seem useless because the challenge lies on how to achieve social, economic, and political unity using the tri-media platform.

Keywords: Philippines at risk, pre/post disaster communication, tri-media platform, UP NOAH

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Authors: Martin Grootveld, Benita Percival, Sarah Moumtaz, Kerry L. Grootveld

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Objectives/Hypotheses: The adverse health effect potential of dietary lipid oxidation products (LOPs) has evoked much clinical interest. Therefore, we employed a ¹H NMR-linked Principal Component Regression (PCR) chemometrics modelling strategy to explore relationships between data matrices comprising (1) aldehydic LOP concentrations generated in culinary oils/fats when exposed to laboratory-simulated shallow frying practices, and (2) the prior saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acid (PUFA) contents of such frying media (FM), together with their heating time-points at a standard frying temperature (180 ^oC). Methods: Corn, sunflower, extra virgin olive, rapeseed, linseed, canola, coconut and MUFA-rich algae frying oils, together with butter and lard, were heated according to laboratory-simulated shallow-frying episodes at 180 ^oC, and FM samples were collected at time-points of 0, 5, 10, 20, 30, 60, and 90 min. (n = 6 replicates per sample). Aldehydes were determined by ¹H NMR analysis (Bruker AV 400 MHz spectrometer). The first (dependent output variable) PCR data matrix comprised aldehyde concentration scores vectors (PC1* and PC2*), whilst the second (predictor) one incorporated those from the fatty acid content/heating time variables (PC1-PC4) and their first-order interactions. Results: Structurally complex trans,trans- and cis,trans-alka-2,4-dienals, 4,5-epxy-trans-2-alkenals and 4-hydroxy-/4-hydroperoxy-trans-2-alkenals (group I aldehydes predominantly arising from PUFA peroxidation) strongly and positively loaded on PC1*, whereas n-alkanals and trans-2-alkenals (group II aldehydes derived from both MUFA and PUFA hydroperoxides) strongly and positively loaded on PC2*. PCR analysis of these scores vectors (SVs) demonstrated that PCs 1 (positively-loaded linoleoylglycerols and [linoleoylglycerol]:[SFA] content ratio), 2 (positively-loaded oleoylglycerols and negatively-loaded SFAs), 3 (positively-loaded linolenoylglycerols and [PUFA]:[SFA] content ratios), and 4 (exclusively orthogonal sampling time-points) all powerfully contributed to aldehydic PC1* SVs (p 10^-3 to < 10^-9), as did all PC1-3 x PC4 interaction ones (p 10^-5 to < 10^-9). PC2* was also markedly dependent on all the above PC SVs (PC2 > PC1 and PC3), and the interactions of PC1 and PC2 with PC4 (p < 10^-9 in each case), but not the PC3 x PC4 contribution. Conclusions: NMR-linked PCR analysis is a valuable strategy for (1) modelling the generation of aldehydic LOPs in heated cooking oils and other FM, and (2) tracking their unsaturated fatty acid (UFA) triacylglycerol sources therein.

Keywords: frying oils, lipid oxidation products, frying episodes, chemometrics, principal component regression, NMR Analysis, cytotoxic/genotoxic aldehydes

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Authors: Susan Evans, Janna Gordon-Elliott, Katarzyna Wyka, Virginia Mutch

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During the rise of the COVID-19 pandemic, healthcare workers needed an intervention that could address their profound acute stress. Mindfulness-based stress reduction (MBSR) is a program that has long established effectiveness for mental and physical health outcomes. In recent years, MBSR has been modified such that the duration of both class time and number of sessions has been abbreviated, and its delivery has been adapted for online dissemination, thus increasing the likelihood that individuals who could most benefit from the program would do so. We sought to investigate whether a brief, online version of MBSR could be feasible and acceptable for health care workers (HCW) in acute stress in response to the COVID-19 pandemic. Participants were recruited via an email sent to all hospital employees, which spans residents, physicians, nurses, housekeeping, lab technicians, administrators, and others. Participating HCW were asked about their previous experience with mindfulness and asked to commit to a minimum of 3 sessions. They were then provided with four weekly 1-hour sessions online that included the major mindfulness exercises taught during traditional MBSR programs (i.e., body scan, sitting meditation, mindful eating, and yoga). Participants were provided with supporting slides, videos, demonstrations and asked to track their practice. Hospital staff enrolled in the program; by the end of the first day of recruitment, 40 had applied; by the start date, about 100 were enrolled, and n attended a minimum of 3 sessions, supporting feasibility. Hospital staff also participated and practiced the mindfulness exercises (n=42), thus supporting acceptability. Participants reported that the program was logical, successful, and worth recommending both before starting the program and after completing it (M= 22.02 and M=21.76, respectively, possible range 0-27). There was a slight decline in the belief in improvement in health and well-being due to the program (ES=.37, p=.021). Secondary hypotheses regarding participants’ self-reported stress and levels of mindfulness were also supported, such that participants reported improvements in perceived stress (ES=.45, p=.006), compassion satisfaction, burnout, and secondary traumatic stress (ES=.41, ES=.31, ES=.35, respectively, p<.05). Participants reported significant improvements in the describing facet of mindfulness (ES=.49, p=.004), while all other facets (observing, acting with awareness, nonjudging of inner experience, nonreactivity to inner experience) remained unchanged pre- to post-program. Results from this study suggest that an abridged, online version of MBSR is feasible and accessible to health care workers in acute stress and provides benefits expected from traditional MBSR programs. The lack of a randomized control group limits generalizability. We intend to provide a structure, framework, and lessons learned to hospital administrators and clinical staff seeking to support their employees in acute stress.

Keywords: acute stress, health care workers, mindfulness, online interventions

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Authors: Pradeep Peiris, Hasini Lecamwasam

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The fluid, ambiguous, and often elusive existence of caste among the Sinhalese in Sri Lanka has inspired many scholarly endeavours. Originally, Sinhalese caste was organized according to the occupational functions assigned to various groups in society. Hence cultivators came to be known as Goyigama, washers Dobi, drummers Berava, smiths Navandanna and so on. During pre-colonial times the specialized services of various groups were deployed to build water reservoirs, cultivate the land, and/or sustain the Buddhist order by material means. However, as to how and why caste prevails today in Sinhalese society when labour is in ideal terms free to move where it wants, or in other words, occupation is no longer strictly determined or restricted by birth, is a question worth exploring. Hence this paper explores how, and perhaps more interestingly why, when the nexus between traditional occupations and caste status is fast disappearing, caste itself has managed to survive and continues to be salient in politics in Sri Lanka. In answer to this larger question, the paper looks at caste from three perspectives: 1) Buddhism, whose ethical project provides a justification of social stratifications that transcends economic bases 2) Capitalism that has reactivated and reproduced archaic relations in a process of 'accumulation by subordination', not only by reinforcing the marginality of peripheral caste groups, but also by exploiting caste divisions to hinder any realization of class interests and 3) Democracy whose supposed equalizing effect expected through its ‘one man–one vote’ approach has been subverted precisely by itself, whereby the aggregate ultimately comes down to how many such votes each ‘group’ in society has. This study draws from field work carried out in Dedigama (in the District of Kegalle, Central Province) and Kelaniya (in the District of Colombo, Western Province) in Sri Lanka over three years. The choice of field locations was encouraged by the need to capture rural and urban dynamics related to caste since caste is more apparently manifest in rural areas whose material conditions partially warrant its prevalence, whereas in urban areas it exists mostly in the ideological terrain. In building its analysis, the study has employed a combination of objectivist and subjectivist approaches to capture the material and ideological existence of caste and caste politics in Sinhalese society. Therefore, methods such as in-depth interviews, observation, and collection of demographical and interpretive data from secondary sources were used for this study. The paper has been situated in a critical theoretical framework of social inquiry in an attempt to question dominant assumptions regarding such meta-labels as ‘Capitalism’ and ‘Democracy’, and also the supposed emancipatory function of religion (focusing on Buddhism).

Keywords: Buddhism, capitalism, caste, democracy, Sri Lanka

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Authors: Antonio Ruiz Gonzalez, Kwang-Leong Choy

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The measurement of electrolytes has a high value in the clinical routine. Ions are present in all body fluids with variable concentrations and are involved in multiple pathologies such as heart failures and chronic kidney disease. In the case of dissolved potassium, although a high concentration in the blood (hyperkalemia) is relatively uncommon in the general population, it is one of the most frequent acute electrolyte abnormalities. In recent years, the integration of thin films technologies in this field has allowed the development of highly sensitive biosensors with ultra-low limits of detection for the assessment of metals in liquid samples. However, despite the current efforts in the miniaturization of sensitive devices and their integration into portable systems, only a limited number of successful examples used commercially can be found. This fact can be attributed to a high cost involved in their production and the sustained degradation of the electrodes over time, which causes a signal drift in the measurements. Thus, there is an unmet necessity for the development of low-cost and robust sensors for the real-time monitoring of analyte concentrations in patients to allow the early detection and diagnosis of diseases. This paper reports a thin film ion-selective sensor for the evaluation of potassium ions in aqueous samples. As an alternative for this fabrication method, aerosol assisted chemical vapor deposition (AACVD), was applied due to cost-effectivity and fine control over the film deposition. Such a technique does not require vacuum and is suitable for the coating of large surface areas and structures with complex geometries. This approach allowed the fabrication of highly homogeneous surfaces with well-defined microstructures onto 50 nm thin gold layers. The degradative processes of the ubiquitously employed poly (vinyl chloride) membranes in contact with an electrolyte solution were studied, including the polymer leaching process, mechanical desorption of nanoparticles and chemical degradation over time. Rational design of a protective coating based on an organosilicon material in combination with cellulose to improve the long-term stability of the sensors was then carried out, showing an improvement in the performance after 5 weeks. The antifouling properties of such coating were assessed using a cutting-edge quartz microbalance sensor, allowing the quantification of the adsorbed proteins in the nanogram range. A correlation between the microstructural properties of the films with the surface energy and biomolecules adhesion was then found and used to optimize the protective film.

Keywords: hyperkalemia, drift, AACVD, organosilicon

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Authors: M. A. Akulov, V. O. Zaharov, A. A. Tomskij

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Introduction: Scapulohumeral periarthrosis, resulting as a reaction to mechanical injury of shoulder tendons and muscles, is associated with high incidence of temporal and permanent disability. There is a strong need for investigation of treatment of that patient group. Severe pain leads to limitation of movements range, which result in secondary alterations of joint capsule and ligamentous apparatus. Muscle tension and edema, swelling of fascial and fibrous structures result in nerve and vascular compression in intramuscular and osseo-muscular-fibrous spaces. Botulinum toxin injection leads to decrease of muscle tone, increase of movements range and associated pain alleviation. Study aim: Optimization of rehabilitation process in scapolohumeral periarthrosis using Xeomin. Patients and methods: 40 patients aged 37-56 years with scapulohumeral periarthrosis were evaluated. Patients were divided into two groups according to treatment regimen. The first (main) group included 21 patients, receiving intramuscular Xeomin 150-200 U in the area of brachio-scapular joint and trigger points (inducing motion range limitation and pain). Treatment procedures were combined with physical therapy and osteopathic procedures. The second (control) group included 19 patients, receiving conventional physical therapy and osteopathic procedures. The evaluation and efficacy comparison was carried out using McGill pain questionnaire, Clinical Global Impression scale (CGI), and patient-reported increase of brachio-scapular joint movement range and pain decrease at 1, 3 and 6 months of treatment. Results. The study demonstrated a significant improvement in the main group after one month of treatment, which persisted during months of treatment. At baseline, rank pain index on McGill pain questionnaire was 18,4±4,9 and 17,8±5,1 in the main and control group, respectively (p > 0,05). At 1 month of treatment we observed a significant decrease of pain syndrome (no pain or modest pain) and increase of movement range in angular degrees in the main group (р < 0,05). In the control group significant improvements were observed only on the 3 month of treatment (р < 0,05), but at 6 months of treatment the improvement in pain syndrome and motion range in brachio-scapular joint was significantly smaller, than in the main group. Rank pain index on McGill pain scale was 5,2±1,8 in the main group compared to 12,0±2,6 in the control group (р < 0,05). At 6 months of treatment patients in the first group reported a significant/highly significant improvement of general health on CGI, whereas in the second group most patients reported a minimal improvement. We observed a sustained and persistent improvement of motion range in brachio-scapular joint in the main group. Conclusion: Xeomin injections as a part of rehabilitation process in scapulohumeral periarthrosis lead to reduced time and increased quality of rehabilitation.

Keywords: botulinum toxin, rehabilitation, scapulohumeral periarthrosis

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Authors: Eva Filová, Jana Daňková, Věra Sovková, Matej Daniel

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Titanium alloys are biocompatible metals that are widely used in clinical practice as load bearing implants. The chemical modification may influence cell adhesion, proliferation, and differentiation as well as stiffness of the material. The aim of the study was to evaluate the adhesion, growth and differentiation of pig mesenchymal stem cells on the novel beta titanium alloy Ti36Nb6Ta compared to standard medical titanium alloy Ti6Al4V. Discs of Ti36Nb6Ta and Ti6Al4V alloy were sterilized by ethanol, put in 48-well plates, and seeded by pig mesenchymal stem cells at the density of 60×103/cm2 and cultured in Minimum essential medium (Sigma) supplemented with 10% fetal bovine serum and penicillin/streptomycin. Cell viability was evaluated using MTS assay (CellTiter 96® AQueous One Solution Cell Proliferation Assay;Promega), cell proliferation using Quant-iT™ ds DNA Assay Kit (Life Technologies). Cells were stained immunohistochemically using monoclonal antibody beta-actin, and secondary antibody conjugated with AlexaFluor®488 and subsequently the spread area of cells was measured. Cell differentiation was evaluated by alkaline phosphatase assay using p-nitrophenyl phosphate (pNPP) as a substrate; the reaction was stopped by NaOH, and the absorbance was measured at 405 nm. Osteocalcin, specific bone marker was stained immunohistochemically and subsequently visualized using confocal microscopy; the fluorescence intensity was analyzed and quantified. Moreover, gene expression of osteogenic markers osteocalcin and type I collagen was evaluated by real-time reverse transcription-PCR (qRT-PCR). For statistical evaluation, One-way ANOVA followed by Student-Newman-Keuls Method was used. For qRT-PCR, the nonparametric Kruskal-Wallis Test and Dunn's Multiple Comparison Test were used. The absorbance in MTS assay was significantly higher on titanium alloy Ti6Al4V compared to beta titanium alloy Ti36Nb6Ta on days 7 and 14. Mesenchymal stem cells were well spread on both alloys, but no difference in spread area was found. No differences in alkaline phosphatase assay, fluorescence intensity of osteocalcin as well as the expression of type I collagen, and osteocalcin genes were observed. Higher expression of type I collagen compared to osteocalcin was observed for cells on both alloys. Both beta titanium alloy Ti36Nb6Ta and titanium alloy Ti6Al4V Ti36Nb6Ta supported mesenchymal stem cellsˈ adhesion, proliferation and osteogenic differentiation. Novel beta titanium alloys Ti36Nb6Ta is a promising material for bone implantation. The project was supported by the Czech Science Foundation: grant No. 16-14758S, the Grant Agency of the Charles University, grant No. 1246314 and by the Ministry of Education, Youth and Sports NPU I: LO1309.

Keywords: beta titanium, cell growth, mesenchymal stem cells, titanium alloy, implant

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Authors: Mustafa M. Donma, Orkide Donma, Murat Aydin, Muhammet Demirkol, Burcin Nalbantoglu, Aysin Nalbantoglu, Birol Topcu

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Childhood obesity is an ever increasing global health problem, affecting both developed and developing countries. Accurate evaluation of obesity in children requires difficult and detailed investigation. In our study, obesity in children was evaluated using new body fat ratios and indices. Assessment of anthropometric measurements, as well as some ratios, is important because of the evaluation of gender differences particularly during the late periods of obesity. A total of 239 children; 168 morbid obese (MO) (81 girls and 87 boys) and 71 normal weight (NW) (40 girls and 31 boys) children, participated in the study. Informed consent forms signed by the parents were obtained. Ethics Committee approved the study protocol. Mean ages (years)±SD calculated for MO group were 10.8±2.9 years in girls and 10.1±2.4 years in boys. The corresponding values for NW group were 9.0±2.0 years in girls and 9.2±2.1 years in boys. Mean body mass index (BMI)±SD values for MO group were 29.1±5.4 kg/m² and 27.2±3.9 kg/m² in girls and boys, respectively. These values for NW group were calculated as 15.5±1.0 kg/m² in girls and 15.9±1.1 kg/m² in boys. Groups were constituted based upon BMI percentiles for age-and-sex values recommended by WHO. Children with percentiles >99 were grouped as MO and children with percentiles between 85 and 15 were considered NW. The anthropometric measurements were recorded and evaluated along with the new ratios such as trunk-to-appendicular fat ratio, as well as indices such as Index-I and Index-II. The body fat percent values were obtained by bio-electrical impedance analysis. Data were entered into a database for analysis using SPSS/PASW 18 Statistics for Windows statistical software. Increased waist-to-hip circumference (C) ratios, decreased head-to-neck C, height ‘to’ ‘two’-‘to’-waist C and height ‘to’ ‘two’-‘to’-hip C ratios were observed in parallel with the development of obesity (p≤0.001). Reference value for height ‘to’ ‘two’-‘to’-hip ratio was detected as approximately 1.0. Index-II, based upon total body fat mass, showed much more significant differences between the groups than Index-I based upon weight. There was not any difference between trunk-to-appendicular fat ratios of NW girls and NW boys (p≥0.05). However, significantly increased values for MO girls in comparison with MO boys were observed (p≤0.05). This parameter showed no difference between NW and MO states in boys (p≥0.05). However, statistically significant increase was noted in MO girls compared to their NW states (p≤0.001). Trunk-to-appendicular fat ratio was the only fat-based parameter, which showed gender difference between NW and MO groups. This study has revealed that body ratios and formula based upon body fat tissue are more valuable parameters than those based on weight and height values for the evaluation of morbid obesity in children.

Keywords: anthropometry, childhood obesity, gender, morbid obesity

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Authors: Richard Grant, Landolf Rhode-Barbarigos, Shouraseni Sen Roy, Lucas Brittan, Change Li, Aiden Rowe

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Ports are critical for the US economy, connecting farmers, manufacturers, retailers, consumers and an array of transport and storage operators. Port facilities vary widely in terms of their productivity, footprint, specializations, and governance. In this context, Port Miami is considered as one of the busiest ports providing both cargo and cruise services in connecting the wider region of the Caribbean and Mesoamerica to the global networks. It is considered as the “Cruise Capital of the World and Global Gateway of the Americas” and “leading container port in Florida.” Furthermore, it has also been ranked as one of the top container ports in the world and the second most efficient port in North America. In this regard, Port Miami has made significant investments in the strategic and capital infrastructure of about US$1 billion, including increasing the channel depth and other onshore infrastructural enhancements. Therefore, this study involves a detailed analysis of Port Miami’s network, using publicly available multiple years of data about marine vessel traffic, cargo, and connectivity and performance indices from 2015-2021. Through the analysis of cargo and cruise vessels to and from Port Miami and its relative performance at the global scale from 2015 to 2021, this study examines the port’s long-term resilience and future growth potential. The main results of the analyses indicate that the top category for both inbound and outbound cargo is manufactured products and textiles. In addition, there are a lot of fresh fruits, vegetables, and produce for inbound and processed food for outbound cargo. Furthermore, the top ten port connections for Port Miami are all located in the Caribbean region, the Gulf of Mexico, and the Southeast USA. About half of the inbound cargo comes from Savannah, Saint Thomas, and Puerto Plata, while outbound cargo is from Puerto Corte, Freeport, and Kingston. Additionally, for cruise vessels, a significantly large number of vessels originate from Nassau, followed by Freeport. The number of passenger's vessels pre-COVID was almost 1,000 per year, which dropped substantially in 2020 and 2021 to around 300 vessels. Finally, the resilience and competitiveness of Port Miami were also assessed in terms of its network connectivity by examining the inbound and outbound maritime vessel traffic. It is noteworthy that the most frequent port connections for Port Miami were Freeport and Savannah, followed by Kingston, Nassau, and New Orleans. However, several of these ports, Puerto Corte, Veracruz, Puerto Plata, and Santo Thomas, have low resilience and are highly vulnerable, which needs to be taken into consideration for the long-term resilience of Port Miami in the future.

Keywords: port, Miami, network, cargo, cruise

Procedia PDF Downloads 79

Authors: B. Petrović, L. Rutonjski, M. Baucal, M. Teodorović, O. Čudić, B. Basarić

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Purpose/Objective: Radiotherapy treatment planning requires use of CT simulator, in order to acquire CT images. The overall performance of CT simulator determines the quality of radiotherapy treatment plan, and at the end, the outcome of treatment for every single patient. Therefore, it is strongly advised by international recommendations, to set up a quality control procedures for every machine involved in radiotherapy treatment planning process, including the CT scanner/ simulator. The overall process requires number of tests, which are used on daily, weekly, monthly or yearly basis, depending on the feature tested. Materials/Methods: Two phantoms were used: a dedicated phantom CIRS 062QA, and a QA phantom obtained with the CT simulator. The examined CT simulator was Siemens Somatom Definition as Open, dedicated for radiation therapy treatment planning. The CT simulator has a built in software, which enables fast and simple evaluation of CT QA parameters, using the phantom provided with the CT simulator. On the other hand, recommendations contain additional test, which were done with the CIRS phantom. Also, legislation on ionizing radiation protection requires CT testing in defined periods of time. Taking into account the requirements of law, built in tests of a CT simulator, and international recommendations, the intitutional QC programme for CT imulator is defined, and implemented. Results: The CT simulator parameters evaluated through the study were following: CT number accuracy, field uniformity, complete CT to ED conversion curve, spatial and contrast resolution, image noise, slice thickness, and patient table stability.The following limits are established and implemented: CT number accuracy limits are +/- 5 HU of the value at the comissioning. Field uniformity: +/- 10 HU in selected ROIs. Complete CT to ED curve for each tube voltage must comply with the curve obtained at comissioning, with deviations of not more than 5%. Spatial and contrast resultion tests must comply with the tests obtained at comissioning, otherwise machine requires service. Result of image noise test must fall within the limit of 20% difference of the base value. Slice thickness must meet manufacturer specifications, and patient stability with longitudinal transfer of loaded table must not differ of more than 2mm vertical deviation. Conclusion: The implemented QA tests gave overall basic understanding of CT simulator functionality and its clinical effectiveness in radiation treatment planning. The legal requirement to the clinic is to set up it’s own QA programme, with minimum testing, but it remains user’s decision whether additional testing, as recommended by international organizations, will be implemented, so to improve the overall quality of radiation treatment planning procedure, as the CT image quality used for radiation treatment planning, influences the delineation of a tumor and calculation accuracy of treatment planning system, and finally delivery of radiation treatment to a patient.

Keywords: CT simulator, radiotherapy, quality control, QA programme

Procedia PDF Downloads 532

Authors: Ming-Chien Su, Yi-Zih Chen, Nien-Hsin Kao, Hideaki Shibata

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The major component of the atmosphere is nitrogen, yet atmospheric nitrogen has limited availability for biological use. Human activities have produced different types of nitrogen related compounds such as nitrogen oxides from combustion, nitrogen fertilizers from farming, and the nitrogen compounds from waste and wastewater, all of which have impacted the environment. Many studies have indicated the N-footprint is dominated by food, followed by housing, transportation, and goods and services sectors. To solve the impact issues from agricultural land, nitrogen cycle research is one of the key solutions. The study site is located in Hualien County, Taiwan, a major rice and food production area of Taiwan. Importantly, environmentally friendly farming has been promoted for years, and an environmental indicator system has been established by previous authors based on the concept of resilience capacity index (RCI) and environmental performance index (EPI). Nitrogen management is required for food production, as excess N causes environmental pollution. Therefore it is very important to develop a roadmap of the nitrogen footprint, and to integrate it with environmental indicators. The key focus of the study thus addresses (1) understanding the environmental impact caused by the nitrogen cycle of food products and (2) uncovering the trend of the N-footprint of agricultural products in Hualien, Taiwan. The N-footprint model was applied, which included both crops and energy consumption in the area. All data were adapted from government statistics databases and crosschecked for consistency before modeling. The actions involved with agricultural production were evaluated and analyzed for nitrogen loss to the environment, as well as measuring the impacts to humans and the environment. The results showed that rice makes up the largest share of agricultural production by weight, at 80%. The dominant meat production is pork (52%) and poultry (40%); fish and seafood were at similar levels to pork production. The average per capita food consumption in Taiwan is 2643.38 kcal capita−1 d−1, primarily from rice (430.58 kcal), meats (184.93 kcal) and wheat (ca. 356.44 kcal). The average protein uptake is 87.34 g capita−1 d−1, and 51% is mainly from meat, milk, and eggs. The preliminary results showed that the nitrogen footprint of food production is 34 kg N per capita per year, congruent with the results of Shibata et al. (2014) for Japan. These results provide a better understanding of the nitrogen demand and loss in the environment, and the roadmap can furthermore support the establishment of nitrogen policy and strategy. Additionally, the results serve to develop a roadmap of the nitrogen cycle of an environmentally friendly farming area, thus illuminating the nitrogen demand and loss of such areas.

Keywords: agriculture productions, energy consumption, environmental indicator, nitrogen footprint

Procedia PDF Downloads 302

Authors: Rebecca Johnson, Elizabeth Hoban

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Condom use among young men in Cambodia has declined between 2005 and 2014 which has public health implications such as increased risks of sexually transmitted infections, including HIV, and unplanned pregnancies. Conversations about sexual and reproductive health issues, including condom use, are not socially sanctioned in Cambodian society leaving young adults with limited knowledge of, and poor access to sexual and reproductive health services. Additionally, men play a dominant role in decision making regarding condom use within sexual partnerships. This study sought to fill a gap in knowledge by exploring young adult males’ attitudes, perceptions and behaviours regarding condom use. In February and March 2018, twenty young adult males, aged 18 to 24 years, were recruited from urban, peri urban and rural areas in Cambodia. The young adult males participated in a face-to-face semi structured interview that used an interview guide and photo elicitation method. The interview explored participants’ knowledge of sexual and reproductive health issues and efficacy, sexual behaviours, and use of condoms. Inductive thematic analysis was conducted and the following major themes emerged: understanding of reproduction, understanding of sexually transmitted infections, knowledge about condoms, condom use, access to condoms, and sexual behaviour. Participants’ knowledge of condoms and specific reasons for their use varied; most participants understood that condoms provide protection from sexually transmitted infections and prevent pregnancy. Stigma associated with condom access was consistently referred to as a problem and the main reason cited by young men for not using condoms during sexual intercourse. The perceived importance of condom use altered with partner type and relationship status, dependent upon the need for protection from sexually transmitted infections or pregnancy. Condoms were used for infection control in the context of multiple relationships, or as a contraceptive method for unmarried and some married couples. The majority of young men engaged in premarital sexual intercourse, of those men the many used condoms. The inconsistent use of condoms by young men in Cambodia is of public health concern because of the increased risk of sexually transmitted infections (including HIV), and unplanned pregnancy. Public health action is required in order to minimize long term health issues for individuals and the community. Health education is required to increase knowledge of condom use, sexually transmitted infections and HIV, and reduce the stigma associated with this topic. Sustainable health promotion programs are needed to increase ease of access to condoms for young people. Public health policy in Cambodia needs to be reviewed to improve sexual and reproductive health outcomes for young adults.

Keywords: Cambodia, condom use, sexual and reproductive health, young adult males

Procedia PDF Downloads 128

Authors: Jane E. Hill

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Quality of life is an important component for many. With that in mind, everyone will experience some type of loss within his or her lifetime. A person can experience loss due to break up, separation, divorce, estrangement, or death. An individual may experience loss of a job, loss of capacity, or loss caused by human or natural-caused disasters. An individual’s response to such a loss is unique to them, and not everyone will seek services to assist them with their grief due to loss. Counseling can promote positive outcomes for clients that are grieving by addressing the client’s personal loss and helping the client process their grief. However, a lack of understanding on the part of counselors of how people grieve may result in negative client outcomes such as poor health, psychological distress, or an increased risk of depression. Education and training in grief counseling can improve counselors’ problem recognition and skills in treatment planning. The purpose of this study was to examine whether the Council for Accreditation of Counseling and Related Educational Programs (CACREP) master’s degree counseling students view themselves as having been adequately trained in grief theories and skills. Many people deal with grief issues that prevent them from having joy or purpose in their lives and that leaves them unable to engage in positive opportunities or relationships. This study examined CACREP-accredited master’s counseling students’ self-reported competency, training, and education in providing grief counseling. The implications for positive social change arising from the research may be to incorporate and promote education and training in grief theories and skills in a majority of counseling programs and to provide motivation to incorporate professional standards for grief training and practice in the mental health counseling field. The theoretical foundation used was modern grief theory based on John Bowlby’s work on Attachment Theory. The overall research question was how competent do master’s-level counselors view themselves regarding the education or training they received in grief theories or counseling skills in their CACREP-accredited studies. The author used a non-experimental, one shot survey comparative quantitative research design. Cicchetti’s Grief Counseling Competency Scale (GCCS) was administered to CACREP master’s-level counseling students enrolled in their practicum or internship experience, which resulted in 153 participants. Using a MANCOVA, there was significance found for relationships between coursework taken and (a) perceived assessment skills (p = .029), (b) perceived treatment skills (p = .025), and (c) perceived conceptual skills and knowledge (p = .003). Results of this study provided insight for CACREP master’s-level counseling programs to explore and discuss curriculum coursework inclusion of education and training in grief theories and skills.

Keywords: counselor education and training, grief education and training, grief and loss, quality of life

Procedia PDF Downloads 191

Authors: Carine Platat, Fatima Qshadi, Ghofran Kayed, Nour Hussein, Amjad Jarrar, Habiba Ali

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Nowadays, smartphones are very popular. They are offering a variety of easy-to-use and free applications among which step counters and fitness tests. The number of users is huge making of such applications a potentially efficient new strategy to encourage people to become more active. Nonetheless, data on their reliability and validity are very scarce and when available, they are often negative and contradictory. Besides, weight status, which is likely to introduce a bias in the physical activity assessment, was not often considered. Hence, the use of these applications as motivational tool, assessment tool and in research is questionable. PACER is one of the free step counters application. Even though it is one of the best rated free application by users, it has never been tested for reliability and validity. Prior any use of PACER, this remains to be investigated. The objective of this work is to investigate the reliability and validity of the smartphone application PACER in measuring the number of steps and in assessing the cardiorespiratory fitness by the 6 minutes walking test. 20 overweight or obese students (10 male and 10 female) were recruited at the United Arab Emirate University, aged between 18 and 25 years old. Reliability and validity were tested in real life conditions and in controlled conditions by using a treadmill. Test-retest experiments were done with PACER on 2 days separated by a week in real life conditions (24 hours each time) and in controlled conditions (30 minutes on treadmill, 3km/h). Validity was tested against the pedometer OMRON in the same conditions. During treadmill test, video was recorded and steps numbers were compared between PACER, pedometer and video. The validity of PACER in estimating the cardiorespiratory fitness (VO2max) as part of the 6 minutes walking test (6MWT) was studied against the 20m shuttle running test. Reliability was studied by calculating intraclass correlation coefficients (ICC), 95% confidence interval (95%CI) and by Bland-Altman plots. Validity was studied by calculating Spearman correlation coefficient (rho) and Bland-Altman plots. PACER reliability was good in both male and female in real life conditions (p≤10-3) but only in female in controlled conditions (p=0.01). PACER was valid against OMRON pedometer in male and female in real life conditions (rho=0.94, p≤10-3 ; rho=0.64, p=0.01, in male and female respectively). In controlled conditions, PACER was not valid against pedometer. But, PACER was valid against video in female (rho=0.72, p≤10-3). PACER was valid against the shuttle run test in male and female (rho-=0.66, p=0.01 ; rho=0.51, p=0.04) to estimate VO2max. This study provides data on the reliability and viability of PACER in overweight or obese male and female young adults. Globally, PACER was shown as reliable and valid in real life conditions in overweight or obese male and female to count steps and assess fitness. This supports the use of PACER to assess and promote physical activity in clinical follow-up and community interventions.

Keywords: smartphone application, pacer, reliability, validity, steps, fitness, physical activity

Procedia PDF Downloads 452

Authors: Fatemah Al-Baroud, Sudharani Shreenivas Kshatriya

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Kuwait Oil Company (KOC) is one of the companies for gas & oil production in Kuwait. The oil and gas industry is truly global; with operations conducted in every corner of the globe, the global community will rely heavily on oil and gas supplies. KOC has made many commitments to protect all due to KOC’s operations and operational releases. As per KOC’s strategy, the substantial increase in production activities will bring many challenges in managing various environmental hazards and stresses in the company. In order to handle those environmental challenges, the need of implementing effectively the health, safety, and environmental management system (HSEMS) is significant. And by implementing the HSEMS system properly, the environmental aspects of the activities, products, and services were identified, evaluated, and controlled in order to (i) Comply with local regulatory and other obligatory requirements; (ii) Comply with company policy and business requirements; and (iii) Reduce adverse environmental impact, including adverse impact to company reputation. Assessments for the Jurassic Production Facilities are being carried out as a part of the KOC HSEMS procedural requirement and monitoring the implementation of the relevant HSEMS procedures in the facilities. The assessments have been done by conducting series of theme audits using KOC’s audit protocol at JPFs. The objectives of the audits are to evaluate the compliance of the facilities towards the implementation of environmental procedures and the status of the KEPA requirement at all JPFs. The list of the facilities that were covered during the theme audit program are the following: (1) Jurassic Production Facility (JPF) – Sabriya (2) Jurassic Production Facility (JPF) – East Raudhatian (3) Jurassic Production Facility (JPF) – West Raudhatian (4)Early Production Facility (EPF 50). The auditing process comprehensively focuses on the application of KOC HSE MS procedures at JPFs and their ability to reduce the resultant negative impacts on the environment from the operations. Number of findings and observations were noted and highlighted in the audit reports and sent to all concerned controlling teams. The results of these audits indicated that the facilities, in general view, were in line with KOC HSE Procedures, and there were commitments in documenting all the HSE issues in the right records and plans. Further, implemented several control measures at JPFs that minimized/reduced the environmental impact, such as SRU were installed for sulphur recovery. Future scope and monitoring audit after a sufficient period of time will be carried out in conjunction with the controlling teams in order to verify the current status of the recommendations and evaluate the contractors' performance towards the required actions in preserving the environment.

Keywords: assessment of the environmental compliance, environmental and social impact assessment, kuwait environment public authority regulations, health, safety and environment management procedures, jurassic production facilities

Procedia PDF Downloads 185

Authors: Ali Kassem, Yhea Kishik, Ali Hassan, Mohamed Abdelwahab

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Introduction: Accelerated coronary and peripheral vascular atherosclerosis is one of the most common and chronic complications of diabetes mellitus. A recent aspect of coronary artery disease in this condition is its silent nature. The aim of the work: Detection of the prevalence of silent myocardial ischemia (SMI) in Upper Egypt type 2 diabetic males and to select male diabetic population who should be screened for SMI. Patients and methods: 100 type 2 diabetic male patients with a negative history of angina or anginal equivalent symptoms and 30 healthy control were included. Full medical history and thorough clinical examination were done for all participants. Fasting and post prandial blood glucose level, lipid profile, (HbA1c), microalbuminuria, and C-reactive protein were done for all participants Resting ECG, trans-thoracic echocardiography, treadmill exercise ECG, myocardial perfusion imaging were done for all participants and patients positive for one or more NITs were subjected for coronary angiography. Results Twenty nine patients (29%) were positive for one or more NITs in the patients group compared to only one case (3.3%) in the controls. After coronary angiography, 20 patients were positive for significant coronary artery stenosis in the patients group, while it was refused to be done by the patient in the controls. There were statistical significant difference between the two groups regarding, hypertension, dyslipidemia and obesity, family history of DM and IHD with higher levels of microalbuminuria, C-reactive protein, total lipids in patient group versus controls According to coronary angiography, patients were subdivided into two subgroups, 20 positive for SMI (positive for coronary angiography) and 80 negative for SMI (negative for coronary angiography). No statistical difference regarding family history of DM and type of diabetic therapy was found between the two subgroups. Yet, smoking, hypertension, obesity, dyslipidemia and family history of IHD were significantly higher in diabetics positive versus those negative for SMI. 90% of patients in subgroup positive for SMI had two or more cardiac risk factors while only two patients had one cardiac risk factor (10%). Uncontrolled DM was detected more in patients positive for SMI. Diabetic complications were more prevalent in patients positive for SMI versus those negative for SMI. Most of the patients positive for SMI have DM more than 5 years duration. Resting ECG and resting Echo detected only 6 and 11 cases, respectively, of the 20 positive cases in group positive for SMI compared to treadmill exercise ECG and myocardial perfusion imaging that detected 16 and 18 cases respectively, Conclusion: Type 2 diabetic male patients should be screened for detection of SMI when aged above 50 years old, diabetes duration is more than 5 years, presence of two or more cardiac risk factors and/or patients suffering from one or more of the chronic diabetic complications. CRP, is an important parameter for selection of type 2 diabetic male patients who should be screened for SMI. Non invasive cardiac tests are reliable for screening of SMI in these patients in our locality.

Keywords: C-reactive protein, Silent myocardial ischemia, Stress tests, type 2 DM

Procedia PDF Downloads 385

Authors: Aarti M. Shetty, Estela Davoodi, Subrata Gangooly, Anita Rao-Coppisetty

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Background: Testing Patency of Fallopian Tubes is among one of the several protocols for investigating Subfertile Couples. Both, Hysterosalpingogram (HSG) and Laparoscopy and dye test have been used as Tubal patency test for several years, with well-known limitation. Hysterosalpingo Contrast Sonography (HyCoSy) can be used as an alternative tool to HSG, to screen patency of Fallopian tubes, with an advantage of being non-ionising, and also, use of transvaginal scan to diagnose pelvic pathology. Aim: To determine the indication and analyse the performance of transvaginal scan and HyCoSy in Broomfield Hospital. Methods: We retrospectively analysed fertility workup of 282 women, who attended HyCoSy clinic at our institution from January 2015 to June 2016. An Audit proforma was designed, to aid data collection. Data was collected from patient notes and electronic records, which included patient demographics; age, parity, type of subfertility (primary or secondary), duration of subfertility, past medical history and base line investigation (hormone profile and semen analysis). Findings of the transvaginal scan, HyCoSy and Laparoscopy were also noted. Results: The most common indication for referral were as a part of primary fertility workup on couples who had failure to conceive despite intercourse for a year, other indication for referral were recurrent miscarriage, history of ectopic pregnancy, post reversal of sterilization(vasectomy and tuboplasty), Post Gynaecology surgery(Loop excision, cone biopsy) and amenorrhea. Basic Fertility workup showed 34% men had abnormal semen analysis. HyCoSy was successfully completed in 270 (95%) women using ExEm foam and Transvaginal Scan. Of the 270 patients, 535 tubes were examined in total. 495/535 (93%) tubes were reported as patent, 40/535 (7.5%) tubes were reported as blocked. A total of 17 (6.3%) patients required laparoscopy and dye test after HyCoSy. In these 17 patients, 32 tubes were examined under laparoscopy, and 21 tubes had findings similar to HyCoSy, with a concordance rate of 65%. In addition to this, 41 patients had some form of pelvic pathology (endometrial polyp, fibroid, cervical polyp, fibroid, bicornuate uterus) detected during transvaginal scan, who referred to corrective surgeries after attending HyCoSy Clinic. Conclusion: Our audit shows that HyCoSy and Transvaginal scan can be a reliable screening test for low risk women. Furthermore, it has competitive diagnostic accuracy to HSG in identifying tubal patency, with an additional advantage of screening for pelvic pathology. With addition of 3D Scan, pulse Doppler and other non-invasive imaging modality, HyCoSy may potentially replace Laparoscopy and chromopertubation in near future.

Keywords: hysterosalpingo contrast sonography (HyCoSy), transvaginal scan, tubal infertility, tubal patency test

Procedia PDF Downloads 251

Authors: Tamar Makharadze, Anastasia Kitiashvili, Irine Zhvania, Tamar Abashidze

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After ratification of UN Convention on the Rights of Persons with Disabilities (UN CRPD) by the Parliament of Georgia in 2013, ensuring equal access to education and employment for people with disabilities has become one of the priorities of the government. The current research has analyzed the attitudes of people with disabilities, employers and society towards various challenges that employment of persons with disabilities faces in Georgia. The study has been carried out in the capital city and three towns in West and East Georgia. Both quantitative and qualitative research methods have been used. Employers’ attitudes have been studied by analyzing research data from six focus groups and 12 in-depth interviews. Views of persons with disabilities have been analyzed relied on data from eight focus groups and 14 in-depth interviews. The quantitative study covered 490 surveyed respondents from four cities in Georgia. The research was carried out with the employees of companies selected based on the Simple Random Sample; in each company, based on the size of the company 7–10 employees were surveyed. A survey was conducted using a specially developed structured questionnaire. Data analysis was carried out using SPSS (21.0). The research was carried out during June-August 2015. The research data shows that both qualitative and quantitative research participants view employment of persons with disabilities positively; however persons with severe intellectual disabilities and mental problems are viewed as less workable and desired at workplaces. The respondents support the idea of employment of persons with disabilities at an open labour market; at the same time idea of a development of sheltered workshops is also supported. The vast majority of research participants believe that employers should be rather encouraged to hire persons with disabilities than force them to do so. For employers it is important to have the state assistance in adjusting working place to the needs of employee with disabilities. Some tax benefits for employers having employees with disabilities also are seen as encouraging employment of persons with disabilities. Both employers and persons with disabilities believe that development of job coaching will help persons with disabilities to find and maintain a job at the open market. Majority of survey respondents think that the main reasons discouraging employment of persons with disabilities in Georgia are: poor socioeconomic background and high level of unemployment in the country, absence of related state programs and existed stigma towards persons with disabilities within the society. To conclude it can be said that both employers and persons with disabilities expect initiative from the government – development of the programs and services focusing on employment of persons with disabilities that will be rather encouraging and supporting than punishing and forcing. Relied on survey data it can be said that people have positive attitudes to see persons with disabilities at workplaces, educational institutions and public places. This creates a good background for extensive and consistent work towards social inclusion of persons with disabilities in Georgia.

Keywords: supported employment, job coaching, employment of persons with disabilities in Georgia, social inclusion

Procedia PDF Downloads 354

Authors: Subhra Chattopadhyay

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New Towns are usually built up at city-periphery with an eye to accommodate overspill population and functions of the city. ‘New towns are self-sufficient planned towns having a full range of urban economic and social activities, so it can provide employments for all of its inhabitants as well as a balanced self-content social community could be maintained’. In 3rd world countries New towns often emerge from scratch i.e on the area having no urban background and therefore, it needs a massive land conversion from rural to urban. This paper aims to study the implication of such land title transfer into rural sustainability with a case study at Jatragachi, New Town Kolkata. Broad objectives of this study are to understand 1. new changes in this area like i)changes in land use, ii) demographic changes, iii) occupational changes of the local people and 2.their view about new town planning. Major observations are stated below. The studied area was completely rural till recent years and is now at the heart of New Town Kolkata. Though this area is now under the jurisdiction of New Town Kolkata Development Authority (NKDA), it is still administrated by rural self-government.It creates administrative confusion and misuse of public capital. It is observed in this study that cultivation was the mainstay of livelihood for the majority of residents till recent past. There was a dramatic rise in irrigated area in the decade of 90’s pointing out agricultural prosperity.The area achieved the highest productivity of rice in the District. Percentage of marginal workers dropped significantly.In addition to it, ascending women’s literacy rate as found in this rural Mouza obviously indicates a constant social progress .Through land conversion, this flourishing agricultural land has been transformed into urban area with highly sophisticated uses. Such development may satisfy educated urban elite but the dwellers of the area suffer a lot. They bear the cost of new town planning through loss of their assured food and income as well as their place identity. The number of marginal workers increases abruptly. The growth of female literacy drops down. The area loses its functional linkages with its surroundings and fails to prove its actual growth potentiality. The physical linkages( like past roads and irrigation infrastructure) which had developed through time to support the economy become defunct. The ecological services which were provided by the agricultural field are denied. The historicity of this original site is demolished. Losses of the inhabitants of the area who have been evicted are also immense and cannot be materially compensated. Therefore, the ethos of such new town planning in stake of rural sustainability is under question. Need for an integrated approach for rural and urban development planning is felt in this study.

Keywords: new town, sustainable development, growth potentiality, land transfer

Procedia PDF Downloads 311

Authors: R. Christopher, C. Brandt, N. Damons

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Background: The sequence of prevention model states that by constant assessment of injury, injury mechanisms and risk factors are identified, highlighting that collecting and recording of data is a core approach for preventing injuries. Several screening tools are available for use in the clinical setting. These screening techniques only recently received research attention, hence there is a dearth of inconsistent and controversial data regarding their applicability, validity, and reliability. Several systematic reviews related to common soccer injuries have been conducted; however, none of them addressed the screening tools for common soccer injuries. Objectives: The purpose of this study was to conduct a review of screening tools and their accuracy for common injuries in soccer. Methods: A systematic scoping review was performed based on the Joanna Briggs Institute procedure for conducting systematic reviews. Databases such as SPORT Discus, Cinahl, Medline, Science Direct, PubMed, and grey literature were used to access suitable studies. Some of the key search terms included: injury screening, screening, screening tool accuracy, injury prevalence, injury prediction, accuracy, validity, specificity, reliability, sensitivity. All types of English studies dating back to the year 2000 were included. Two blind independent reviewers selected and appraised articles on a 9-point scale for inclusion as well as for the risk of bias with the ACROBAT-NRSI tool. Data were extracted and summarized in tables. Plot data analysis was done, and sensitivity and specificity were analyzed with their respective 95% confidence intervals. I² statistic was used to determine the proportion of variation across studies. Results: The initial search yielded 95 studies, of which 21 were duplicates, and 54 excluded. A total of 10 observational studies were included for the analysis: 3 studies were analysed quantitatively while the remaining 7 were analysed qualitatively. Seven studies were graded low and three studies high risk of bias. Only high methodological studies (score > 9) were included for analysis. The pooled studies investigated tools such as the Functional Movement Screening (FMS™), the Landing Error Scoring System (LESS), the Tuck Jump Assessment, the Soccer Injury Movement Screening (SIMS), and the conventional hamstrings to quadriceps ratio. The accuracy of screening tools was of high reliability, sensitivity and specificity (calculated as ICC 0.68, 95% CI: 52-0.84; and 0.64, 95% CI: 0.61-0.66 respectively; I² = 13.2%, P=0.316). Conclusion: Based on the pooled results from the included studies, the FMS™ has a good inter-rater and intra-rater reliability. FMS™ is a screening tool capable of screening for common soccer injuries, and individual FMS™ scores are a better determinant of performance in comparison with the overall FMS™ score. Although meta-analysis could not be done for all the included screening tools, qualitative analysis also indicated good sensitivity and specificity of the individual tools. Higher levels of evidence are, however, needed for implication in evidence-based practice.

Keywords: accuracy, screening tools, sensitivity, soccer injuries, specificity

Procedia PDF Downloads 178

Authors: Paula I. Buonfiglio, Carlos David Bruque, Lucia Salatino, Vanesa Lotersztein, Sebastián Menazzi, Paola Plazas, Ana Belén Elgoyhen, Viviana Dalamón

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Hearing loss (HL) is the most prevalent sensorineural disorder affecting about 10% of the global population, with more than half due to genetic causes. About 1 in 500-1000 newborns present congenital HL. Most of the patients are non-syndromic with an autosomal recessive mode of inheritance. To date, more than 100 genes are related to HL. Therefore, the Whole-exome sequencing (WES) technique has become a cost-effective alternative approach for molecular diagnosis. Nevertheless, new challenges arise from the detection of novel variants, in particular missense changes, which can lead to a spectrum of genotype-to-phenotype correlations, which is not always straightforward. In this work, we aimed to identify the genetic causes of HL in isolated and familial cases by designing a multistep approach to analyze target genes related to hearing impairment. Moreover, we performed in silico and in vivo analyses in order to further study the effect of some of the novel variants identified in the hair cell function using the zebrafish model. A total of 650 patients were studied by Sanger Sequencing and Gap-PCR in GJB2 and GJB6 genes, respectively, diagnosing 15.5% of sporadic cases and 36% of familial ones. Overall, 50 different sequence variants were detected. Fifty of the undiagnosed patients with moderate HL were tested for deletions in STRC gene by Multiplex ligation-dependent probe amplification technique (MLPA), leading to 6% of diagnosis. After this initial screening, 50 families were selected to be analyzed by WES, achieving diagnosis in 44% of them. Half of the identified variants were novel. A missense variant in MYO6 gene detected in a family with postlingual HL was selected to be further analyzed. A protein modeling with AlphaFold2 software was performed, proving its pathogenic effect. In order to functionally validate this novel variant, a knockdown phenotype rescue assay in zebrafish was carried out. Injection of wild-type MYO6 mRNA in embryos rescued the phenotype, whereas using the mutant MYO6 mRNA (carrying c.2782C>A variant) had no effect. These results strongly suggest the deleterious effect of this variant on the mobility of stereocilia in zebrafish neuromasts, and hence on the auditory system. In the present work, we demonstrated that our algorithm is suitable for the sequential multigenic approach to HL in our cohort. These results highlight the importance of a combined strategy in order to identify candidate variants as well as the in silico and in vivo studies to analyze and prove their pathogenicity and accomplish a better understanding of the mechanisms underlying the physiopathology of the hearing impairment.

Keywords: diagnosis, genetics, hearing loss, in silico analysis, in vivo analysis, WES, zebrafish

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Authors: Caroline Lavratti, Pedro Dal Lago, Gustavo Reinaldo, Gilson Dorneles, Andreia Bard, Laira Fuhr, Daniela Pochmann, Alessandra Peres, Luciane Wagner, Viviane Elsner

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Approximately 1% of the world's population is affected by schizophrenia (SZ), a chronic and debilitating neurodevelopmental disorder. Among possible factors, reduced levels of Brain-derived neurotrophic factor (BDNF) has been recognized in physiopathogenesis and course of SZ. In this context, peripheral BDNF levels have been used as a biomarker in several clinical studies, since this neurotrophin is able to cross the blood-brain barrier in a bi-directional manner and seems to present a strong correlation with the central nervous system fluid levels. The patients with SZ usually adopts a sedentary lifestyle, which has been partly associated with the increase in obesity incidence rates, metabolic syndrome, type 2 diabetes and coronary heart disease. On the other hand, exercise, a non-invasive and low cost intervention, has been considered an important additional therapeutic option for this population, promoting benefits to physical and mental health. To our knowledge, few studies have been pointed out that the positive effects of exercise in SZ patients are mediated, at least in part, to enhanced levels of BDNF after training. However, these studies are focused on evaluating the effect of single bouts of exercise of chronic interventions, data concerning the short- and long-term exercise outcomes on BDNF are scarce. Therefore, this study aimed to evaluate the effect of a concurrent exercise protocol (CEP) on plasma BDNF levels of SZ patients in different time-points. Material and Methods: This study was approved by the Research Ethics Committee of the Centro Universitário Metodista do IPA (no 1.243.680/2015). The participants (n=15) were subbmited to the CEP during 90 days, 3 times a week for 60 minutes each session. In order to evaluate the short and long-term effects of exercise, blood samples were collected pre, 30, 60 and 90 days after the intervention began. Plasma BDNF levels were determined with the ELISA method, from Sigma-Aldrich commercial kit (catalog number RAB0026) according to manufacturer's instructions. Results: A remarkable increase on plasma BDNF levels at 90 days after training compared to baseline (p=0.006) and 30 days (p=0.007) values were observed. Conclusion: Our data are in agreement with several studies that show significant enhancement on BDNF levels in response to different exercise protocols in SZ individuals. We might suggest that BDNF upregulation after training in SZ patients acts in a dose-dependent manner, being more pronounced in response to chronic exposure. Acknowledgments: This work was supported by Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS)/Brazil.

Keywords: exercise, BDNF, schizophrenia, time-points

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Authors: Tam Viet Hoang

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With a plethora of new mobility services and payment systems found in our cities and across modern public transportation systems, several cities globally have turned to common ticketing systems to help navigate this complexity. Helping to create time and space-differentiated fare structures and tariff schemes, common ticketing systems can optimize transport utilization rates, achieve cost efficiencies, and provide key incentives to specific target groups. However, not all cities and transportation systems have enjoyed a smooth journey towards the adoption, roll-out, and servicing of common ticketing systems, with both the experiences of success and failure being attributed to a wide variety of critical factors. Using case study research as a methodology and cities as the main unit of analysis, this research will seek to address the fundamental question of “what are the critical factors for the success and failure of common ticketing systems?” Using rail/train systems as the entry point for this study will start by providing a background to the evolution of transport ticketing and justify the improvements in operational efficiency that can be achieved through common ticketing systems. Examining the socio-economic benefits of common ticketing, the research will also help to articulate the value derived for different key identified stakeholder groups. By reviewing case studies of the implementation of common ticketing systems in different cities, the research will explore lessons learned from cities with the aim to elicit factors to ensure seamless connectivity integrated e-ticketing platforms. In an increasingly digital age and where cities are now coming online, this paper seeks to unpack these critical factors, undertaking case study research drawing from literature and lived experiences. Offering us a better understanding of the enabling environment and ideal mixture of ingredients to facilitate the successful roll-out of a common ticketing system, interviews will be conducted with transport operators from several selected cities to better appreciate the challenges and strategies employed to overcome those challenges in relation to common ticketing systems. Meanwhile, as we begin to see the introduction of new mobile applications and user interfaces to facilitate ticketing and payment as part of the transport journey, we take stock of numerous policy challenges ahead and implications on city-wide and system-wide urban planning. It is hoped that this study will help to identify the critical factors for the success and failure of common ticketing systems for cities set to embark on their implementation while serving to fine-tune processes in those cities where common ticketing systems are already in place. Outcomes from the study will help to facilitate an improved understanding of common pitfalls and essential milestones towards the roll-out of a common ticketing system for railway systems, especially for emerging countries where mass rapid transit transport systems are being considered or in the process of construction.

Keywords: common ticketing, public transport, urban strategies, Bangkok, Fukuoka, Sydney

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Authors: Geum Yeon Sim, Jasal Patel, Anand Kumthekar, Stanley Wainapel

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A 65-year-old right-hand dominant African-American man, formerly employed as a security guard, was referred to Rehabilitation Medicine with bilateral hand stiffness and weakness. His past medical history was only significant for myelofibrosis, diagnosed 4 years earlier, for which he was receiving scheduled blood transfusions. Approximately 2 years ago, he began to notice stiffness and swelling in his non-dominant hand that progressed to pain and decreased strength, limiting his hand function. Similar but milder symptoms developed in his right hand several months later. There was no history of prior injury or exposure to cold. Physical examination showed enlargement of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints with finger flexion contractures, Swan-neck and Boutonniere deformities, and associated joint tenderness. Changes were more prominent in the left hand. X-rays showed mild osteoarthritis of several bilateral PIP joints. Anti-nuclear antibodies, rheumatoid factor, and cyclic citrullinated peptide antibodies were negative. MRI of the hand showed no erosions or synovitis. A rheumatology consultation was obtained, and the cause of his symptoms was attributed to myelofibrosis-related arthropathy with secondary osteoarthritis. The patient was tried on diclofenac cream and received a few courses of Occupational Therapy with limited functional improvement. Primary myelofibrosis (PMF) is a rare myeloproliferative neoplasm characterized by clonal proliferation of myeloid cells with variable morphologic maturity and hematopoietic efficiency. Rheumatic manifestations of malignancies include direct invasion, paraneoplastic presentations, secondary gout, or hypertrophic osteoarthropathy. PMF causes gradual bone marrow fibrosis with extramedullary metaplastic hematopoiesis in the liver, spleen, or lymph nodes. Musculoskeletal symptoms are not common and are not well described in the literature. The first reported case of myelofibrosis related arthritis was seronegative arthritis due to synovial invasion of myeloproliferative elements. Myelofibrosis has been associated with autoimmune diseases such as systemic lupus erythematosus, progressive systemic sclerosis, and rheumatoid arthritis. Gout has been reported in patients with myelofibrosis, and the underlying mechanism is thought to be related to the high turnover of nucleic acids that is greatly augmented in this disease. X-ray findings in these patients usually include erosive arthritis with synovitis. Treatment of underlying PMF is the treatment of choice, along with anti-inflammatory medications. Physicians should be cognizant of recognizing this rare entity in patients with PMF while maintaining clinical suspicion for more common causes of joint deformities, such as rheumatic diseases.

Keywords: myelofibrosis, arthritis, arthralgia, malignancy

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Authors: Shiamaa Eltantawy, Gihan Sobhy, Alif Alaam

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Wilson disease, or hepatolenticular degeneration, is an autosomal recessive disease that results in excess copper buildup in the body. It primarily affects the liver and basal ganglia of the brain, but it can affect other organ systems. Musculoskeletal abnormalities, including premature osteoarthritis, skeletal deformity, and pathological bone fractures, can occasionally be found in WD patients with a hepatic or neurologic type. The aim was to assess the prevalence of osteoporosis and osteopenia in Wilson’s disease patients. This case-control study was conducted on ninety children recruited from the inpatient ward and outpatient clinic of the Paediatric Hepatology, Gastroenterology, and Nutrition department of the National Liver Institute at Menofia University, aged from 1 to 18 years. Males were 49, and females were 41. Children were divided into three groups: (Group I) consisted of thirty patients with WD; (Group II) consisted of thirty patients with chronic liver disease other than WD; (Group III) consisted of thirty age- and sex-matched healthy The exclusion criteria were patients with hyperparathyroidism, hyperthyroidism, renal failure, Cushing's syndrome, and patients on certain drugs such as chemotherapy, anticonvulsants, or steroids. All patients were subjected to the following: 1- Full history-taking and clinical examination. 2-Laboratory investigations: (FBC,ALT,AST,serum albumin, total protein, total serum bilirubin,direct bilirubin,alkaline phosphatase, prothrombin time, serum critine,parathyroid hormone, serum calcium, serum phosphrus). 3-Bone mineral density (BMD, gm/cm2) values were measured by dual-energy X-ray absorptiometry (DEXA). The results revealed that there was a highly statistically significant difference between the three groups regarding the DEXA scan, and there was no statistically significant difference between groups I and II, but the WD group had the lowest bone mineral density. The WD group had a large number of cases of osteopenia and osteoporosis, but there was no statistically significant difference with the group II mean, while a high statistically significant difference was found when compared to group III. In the WD group, there were 20 patients with osteopenia, 4 patients with osteoporosis, and 6 patients who were normal. The percentages were 66.7%, 13.3%, and 20%, respectively. Therefore, the largest number of cases in the WD group had osteopenia. There was no statistically significant difference found between WD patients on different treatment regimens regarding DEXA scan results (Z-Score). There was no statistically significant difference found between patients in the WD group (normal, osteopenic, or osteoporotic) regarding phosphorus (mg/dL), but there was a highly statistically significant difference found between them regarding ionised Ca (mmol/L). Therefore, there was a decrease in bone mineral density when the Ca level was decreased. In summary, Wilson disease is associated with bone demineralization. The largest number of cases in the WD group in our study had osteopenia (66.7%). Different treatment regimens (zinc monotherapy, Artamin, and zinc) as well as different laboratory parameters have no effect on bone mineralization in WD cases. Decreased ionised Ca is associated with low BMD in WD patients. Children with WD should be investigated for BMD.

Keywords: wilson disease, Bone mineral density, liver disease, osteoporosis

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Authors: Chen Yao, Wang Ke

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Small towns are the most basic administrative institutions in our country, which are connected with cities and rural areas. Small towns play an important role in promoting local urban and rural economic development, providing the main public services and maintaining social stability in social governance. With the vigorous development of small towns and the transformation of industrial structure, the changes of social structure, spatial structure, and lifestyle are lagging behind, causing that the spatial form and landscape style do not belong to both cities and rural areas, and seriously affecting the quality of people’s life space and environment. The rural economy in Zhejiang Province has started, the society and the population are also developing in relative stability. In September 2016, Zhejiang Province set out the 'Technical Guidelines for Comprehensive Environmental Remediation of Small Towns in Zhejiang Province,' so as to comprehensively implement the small town comprehensive environmental remediation with the main content of strengthening the plan and design leading, regulating environmental sanitation, urban order and town appearance. In November 2016, Huzhou City started the comprehensive environmental improvement of small towns, strived to use three years to significantly improve the 115 small towns, as well as to create a number of high quality, distinctive and beautiful towns with features of 'clean and livable, rational layout, industrial development, poetry and painting style'. This paper takes Meixi Town, Zhangwu Town and Sanchuan Village in Huzhou City as the empirical cases, analyzes the small town public space by applying the relative theory of actor-network and space syntax. This paper also analyzes the spatial composition in actor and social structure elements, as well as explores the relationship of actor’s spatial practice and public open space by combining with actor-network theory. This paper introduces the relevant theories and methods of spatial syntax, carries out research analysis and design planning analysis of small town spaces from the perspective of quantitative analysis. And then, this paper proposes the effective updating strategy for the existing problems in public space. Through the planning and design in the building level, the dissonant factors produced by various spatial combination of factors and between landscape design and urban texture during small town development will be solved, inhabitant quality of life will be promoted, and town development vitality will be increased.

Keywords: small towns, urbanization, public space, updating

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