Search results for: medical decision-making

Authors: C. Kuoh, C. Lucas, T. Lopes, I. Mechie, J. Yoong, W. Yoong

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For all surgeons, there is one preventable but still highly occurring complication – wrong site surgeries. They can have potentially catastrophic, irreversible, or even fatal consequences on patients. With the exponential development of microsurgery and the use of advanced technological tools, the consequences of operating on the wrong side, anatomical part, or even person is seen as the most visible and destructive of all surgical errors and perhaps the error that is dreaded by most clinicians as it threatens their licenses and arouses feelings of guilt. Despite the implementation of the WHO surgical safety checklist more than a decade ago, the incidence of wrong-site surgeries remains relatively high, leading to tremendous physical and psychological repercussions for the clinicians involved, as well as a financial burden for the healthcare institution. In this presentation, the authors explore various factors which can lead to wrong site surgery – a combination of environmental and human factors and evaluate their impact amongst patients, practitioners, their families, and the medical industry. Major contributing factors to these “never events” include deviations from checklists, excessive workload, and poor communication. Two real-life cases are discussed, and systems that can be implemented to prevent these errors are highlighted alongside lessons learnt from other industries. The authors suggest that reinforcing speaking-up, implementing medical professional trainings, and higher patient’s involvements can potentially improve safety in surgeries and electrosurgeries.

Keywords: wrong side surgery, never events, checklist, workload, communication

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Authors: Walid Moudani

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The healthcare environment is generally perceived as being information rich yet knowledge poor. However, there is a lack of effective analysis tools to discover hidden relationships and trends in data. In fact, valuable knowledge can be discovered from application of data mining techniques in healthcare system. In this study, a proficient methodology for the extraction of significant patterns from the coronary heart disease warehouses for heart attack prediction, which unfortunately continues to be a leading cause of mortality in the whole world, has been presented. For this purpose, we propose to enumerate dynamically the optimal subsets of the reduced features of high interest by using rough sets technique associated to dynamic programming. Therefore, we propose to validate the classification using Random Forest (RF) decision tree to identify the risky heart disease cases. This work is based on a large amount of data collected from several clinical institutions based on the medical profile of patient. Moreover, the experts’ knowledge in this field has been taken into consideration in order to define the disease, its risk factors, and to establish significant knowledge relationships among the medical factors. A computer-aided system is developed for this purpose based on a population of 525 adults. The performance of the proposed model is analyzed and evaluated based on set of benchmark techniques applied in this classification problem.

Keywords: multi-classifier decisions tree, features reduction, dynamic programming, rough sets

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Authors: Yasmine Aridi, Lara Nasreddine, Maya Khalil, Arafat Tfayli, Anas Mugharbel, Farah Naja

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Breast cancer is the most commonly diagnosed cancer site among women worldwide and the second most common cause of cancer mortality. Breast cancer rates differ vastly between geographical areas, countries, and within the same country. In Lebanon, the proportion of breast cancer to all other sites of tumor is 38.2%; these rates are still lower than those observed worldwide, but remain the highest among Arab countries. Studies and evidence based reviews show a strong association between breast cancer development and prognosis and dietary habits, specifically the Mediterranean diet (MD). As such, the aim of this study is to examine dietary patterns and adherence to the MD among a sample of 182 breast cancer female patients in Beirut, Lebanon. Subjects were recruited from two major hospitals; a private medical center and a public hospital. All subjects were administered two questionnaires: socio- demographics and Mediterranean diet adherence. Five Mediterranean scores were calculated: MS, MSDPS, PMDI, PREDIMED and DDS. The mean age of the participants was 53.78 years. The overall adherence to the Mediterranean diet (MD) was low since the sample means of 3 out of the 5 calculated scores were less than the scores’ medians. Given that 4 out of the 5 Mediterranean scores significantly varied between the recruitment sites, women in the private medical center were found to adhere more to the MD. Our results also show that the majority of the sample population’s intakes are exceeding the recommendations for total and saturated fat, while meeting the requirements for fiber, EPA, DHA and Linolenic Acid. Participants in the private medical center were consuming significantly more calories, carbohydrates, fiber, sugar, Lycopene, Calcium, Iron and Folate and less fat. After conducting multivariate linear regression analyses, the following significant results were observed: positive associations between MD (CPMDI, PREDIMED) and monthly income & current state of health, while negative associations between MD (MSDPS, PREDIMED) and age & employment status. Our findings indicated a low overall adherence to the MD and identified factors associated with it; which suggests a need to address dietary habits among BC patients in Lebanon, specifically encouraging them to adhere to their traditional Mediterranean diet.

Keywords: Adherence, Breast cancer, Dietary patterns, Mediterranean diet, Nutrition

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Authors: Hsin-Yi Lo, Huang-Ju Jiun, Yu-Chiao Chu

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Hemodynamic monitoring is an important in the intensive care unit. Advances in medical technology in recent years, more diversification of intensive care equipment, there are many kinds of instruments available for monitoring of hemodynamics, Edwards Lifesciences Hemodynamic Monitoring (FloTrac) is one of them. The recent medical safety incidents in parameters were changed, nurses have not to notify doctor in time, therefore, it is hoped to analyze the current problems and find effective improvement strategies. In August 2021, the survey found that only 74.0% of FloTrac correctness of operation, reasons include lack of education, the operation manual is difficulty read, lack of audit mechanism, nurse doesn't know those numerical changes need to notify doctor, work busy omission, unfamiliar with operation and have many nursing records then omissions. Improvement methods include planning professional nurse education, formulate the secret arts of FloTrac, enacting an audit mechanism, establish FloTrac action learning, make「follow the sun」care map, hold simulated training and establish monitoring data automatically upload nursing records. After improvement, FloTrac correctness of operation increased to 98.8%. The results are good, implement to the ICU of the hospital.

Keywords: hemodynamic monitoring, edwards lifesciences hemodynamic monitoring, multiple strategies, intensive care

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Authors: Mahnaz Khalafehnilsaz, Rozina Rahnama

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Introduction: The elderly population is growing rapidly, and with this growth comes an increased demand for healthcare services. Artificial intelligence (AI) has the potential to revolutionize the delivery of healthcare services to the elderly population. In this study, the various ways in which AI is used to create health content for elderly people and its transformative impact on the healthcare industry will be explored. Method: A systematic review of the literature was conducted to identify studies that have investigated the role of AI in creating health content specifically for elderly people. Several databases, including PubMed, Scopus, and Web of Science, were searched for relevant articles published between 2000 and 2022. The search strategy employed a combination of keywords related to AI, personalized health content, and the elderly. Studies that utilized AI to create health content for elderly individuals were included, while those that did not meet the inclusion criteria were excluded. A total of 20 articles that met the inclusion criteria were identified. Finding: The findings of this review highlight the diverse applications of AI in creating health content for elderly people. One significant application is the use of natural language processing (NLP), which involves the creation of chatbots and virtual assistants capable of providing personalized health information and advice to elderly patients. AI is also utilized in the field of medical imaging, where algorithms analyze medical images such as X-rays, CT scans, and MRIs to detect diseases and abnormalities. Additionally, AI enables the development of personalized health content for elderly patients by analyzing large amounts of patient data to identify patterns and trends that can inform healthcare providers in developing tailored treatment plans. Conclusion: AI is transforming the healthcare industry by providing a wide range of applications that can improve patient outcomes and reduce healthcare costs. From creating chatbots and virtual assistants to analyzing medical images and developing personalized treatment plans, AI is revolutionizing the way healthcare is delivered to elderly patients. Continued investment in this field is essential to ensure that elderly patients receive the best possible care.

Keywords: artificial intelligence, health content, older adult, healthcare

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Authors: Farzad Jalilian, Mehdi Mirzaei Alavijeh

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Background: E-interventions as a universal approach to prevent a high-risk behavior, such as alcohol drinking. This study was conducted to evaluate web-based alcohol drinking preventative intervention efficiency among medical university students in Iran. Methods: Overall, 150 freshman and sophomore male student’s college students participated in this study as intervention and control group. This was a longitudinal randomized pre- and post-test series control group design panel study to implement a behavior modification based intervention to alcohol drinking prevention among college students. Cross-tabulation, t-test, repeated measures, and GEE by using SPSS statistical package, version 21 was used for the statistical analysis. The participants were followed up for 6 months with data collection scheduled at baseline, 3 and 6 months. The primary outcomes are attitude, self-control, and sensation seeking. Furthermore, the secondary outcome is comparing alcohol drinking among the study groups. Results: It was found significant reduce in average response for an attitude towards alcohol drinking and sensation seeking among intervention group (P < 0.05). But after intervention not significant difference between intervention and control group of improve self-control and reduce alcohol drinking (P > 0.05). Conclusion: Our intervention has been accompanied with reducing alcohol use rate. These findings indicate that e-intervention may be effectiveness approach to address the alcohol prevention among college students.

Keywords: e-interventions, alcohol drinking, students, Iran

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Authors: Radah Yousuf, Ashraf Shebl

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Suicide is a tragic event with strong emotional repercussions for its survivors and for families of its victims. There were thousands of cases all over the world. There are many risk factors include mental disorders such as depression, and substance abuse, including alcoholism and use of benzodiazepines. Other suicides are impulsive acts due to stress such as from financial difficulties, troubles with relationships, or from bullying. The aim of work in this study is making a survey from archives of the suicidal cases, which had a medicolegal examination, in forensic medicine center in Al Madinah Almunawarah-KSA, for ten years in the period between 1428-1438h. In each case, some data are collected such as age, sex, time and place of an act, method of suicide, the presence of the witness, medical history. This study demonstrates that suicide is more common in male than female, and the 4th decade was the most period of age. The most common method of suicide was hanging followed by falling from the height. These results indicated that cultural and religious beliefs that discourage suicide and support self-preservation instinct, and suicide education programs provide information to students in high school, builds awareness, one of the most important issues in solving that problem. From the forensic view, circumstantial evidence of every forensic case must take and record, full history about the social, medical and psychological problems, attend the scene of death is a very important, complete medicolegal investigation for every case, and full autopsy with very skilled techniques and facilities can help in diagnosing what type of crimes.

Keywords: suicide, age, sex, hanging

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Authors: Jie Huo, Jonathan Wu

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Segmentation of anatomical structures in medical images is essential for scientific inquiry into the complex relationships between biological structure and clinical diagnosis, treatment and assessment. As a method of incorporating the prior knowledge and the anatomical structure similarity between a target image and atlases, multi-atlas segmentation has been successfully applied in segmenting a variety of medical images, including the brain, cardiac, and abdominal images. The basic idea of multi-atlas segmentation is to transfer the labels in atlases to the coordinate of the target image by matching the target patch to the atlas patch in the neighborhood. However, this technique is limited by the pairwise registration between target image and atlases. In this paper, a novel multi-atlas segmentation approach is proposed by introducing a dynamic energy model. First, the target is mapped to each atlas image by minimizing the dynamic energy function, then the segmentation of target image is generated by weighted fusion based on the energy. The method is tested on MICCAI 2012 Multi-Atlas Labeling Challenge dataset which includes 20 target images and 15 atlases images. The paper also analyzes the influence of different parameters of the dynamic energy model on the segmentation accuracy and measures the dice coefficient by using different feature terms with the energy model. The highest mean dice coefficient obtained with the proposed method is 0.861, which is competitive compared with the recently published method.

Keywords: brain MRI segmentation, dynamic energy model, multi-atlas segmentation, energy minimization

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Authors: Slawomir Pilip, Michal Wasilewski, Daniel Celinski, Leszek Szpakowski, Grzegorz Michalak

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The aim of the study was to evaluate the effectiveness of cardiopulmonary resuscitation taken by Medical Emergency Teams (MET) at the place of an accident including the usage of mechanical chest compression systems. In the period of January-May 2017, there were 137 cases of a sudden cardiac arrest in a chosen region of Eastern Poland with 360.000 inhabitants. Medical records and questionnaires filled by METs were analysed to prove the effectiveness of cardiopulmonary resuscitations that were considered to be effective when an early indication of spontaneous circulation was provided and the patient was taken to hospital. A chest compression system used by METs was applied in 60 cases (Lucas3 - 34 patients; Auto Pulse - 24 patients). The effectiveness of cardiopulmonary resuscitation among patients who were employed a chest compression system was much higher (43,3%) than the manual cardiac massage (36,4%). Thus, the usage of Lucas3 chest compression system resulted in 47% while Auto Pulse was 33,3%. The average ambulance arrival time could have had a significant impact on the subsequent effectiveness of cardiopulmonary resuscitation in these cases. Ambulances equipped with Lucas3 reached the destination within 8 minutes, and those with Auto Pulse needed 12,1 minutes. Moreover, taking effective basic life support (BLS) by bystanders before the ambulance arrival was much more frequent for ambulances with Lucas3 than Auto Pulse. Therefore, the percentage of BLS among the group of patients who were employed Lucas3 by METs was 26,5%, and 20,8% for Auto Pulse. The total percentage of taking BLS by bystanders before the ambulance arrival resulted in 25% of patients who were later applied a chest compression system by METs. Not only was shockable cardiac rhythm obtained in 47% of these cases, but an early indication of spontaneous circulation was also provided in all these patients. Both Lucas3 and Auto Pulse were evaluated to be significantly useful in improving the effectiveness of cardiopulmonary resuscitation by 97% of Medical Emergency Teams. Therefore, implementation of chest compression systems essentially makes the cardiopulmonary resuscitation even more effective. The ambulance arrival time, taking successful BLS by bystanders before the ambulance arrival and the presence of shockable cardiac rhythm determine an early indication of spontaneous circulation among patients after a sudden cardiac arrest.

Keywords: cardiac arrest, effectiveness, mechanical chest compression systems, resuscitation

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Authors: Lucie Cote, Sonia McFadden

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Mental health problems in the workplace are currently one of the main causes of absences. Research work has highlighted the importance of a collaborative process involving the stakeholders in the return-to-work process and has established the best management practices to ensure a successful return-to-work. However, very few studies have specifically explored the combination of various management models and determined whether they could satisfy the needs of the stakeholders. The objective of this study is to analyze two models for managing the return to work: the ‘medical-administrative’ and the ‘support of the worker’ in order to understand the actions and actors involved in these models. The study also aims to explore whether these models meet the needs of the actors involved in the management of the return to work. A qualitative case study was conducted in a Canadian federal organization. An abundant internal documentation and semi-directed interviews with six managers, six workers and four human resources professionals involved in the management of records of employees returning to work after a mental health problem resulted in a complete picture of the return to work management practices used in this organization. The triangulation of this data facilitated the examination of the benefits and limitations of each approach. The results suggest that the actions of management for employee return to work from both models of management ‘support of the worker’ and ‘medical-administrative’ are compatible and can meet the needs of the actors involved in the return to work. More research is needed to develop a structured model integrating best practices of the two approaches to ensure the success of the return to work.

Keywords: return to work, mental health, management models, organizations

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Authors: Shahrzad Yektatalab, Agrin Mohammadi, Ladan Zarshenas

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Background: Misophonia is a severe emotional response to repetitive sounds. This disorder may limit a person's communication, reduce their ability, or disrupt their social and personal life. This study aims to determine the prevalence of Misophonia and its relationship with obsessive-compulsive disorder, anxiety, and depression in undergraduate students of XXX University of Medical Sciences. Methods: The present study is an analytical descriptive study conducted in October 2020. The study samples are 390 undergraduate students of XXX University of medical sciences. A relative and systematic sampling method was used. In this study, a demographic questionnaire, misophonia questionnaire (A score of 7 or higher is considered as misophonia), Beck anxiety questionnaire, Beck depression questionnaire, and Maudsley questionnaire were used, and the data were analyzed using SPSS 24 software. Due to the non-normality of the data, the Spearman correlation coefficient was used for analyzing data. The significance level was considered less than 0.05. Results: 23.8% of students have misophonia. Of the 390 participants in the study, 93 had experienced misophonia. Among these 93 students, 37 (39.8%) had obsessive-compulsive disorder, 8 (8.6%) had anxiety and 9 (9.7%) had depression. There was a significant and direct relationship between all variables (p <0.001), which means that with the increase of each disorder, the probability of an increase in other disorders increases. Conclusion: Due to the high prevalence of misophonia in students and its direct relationship with obsessive-compulsive disorder, anxiety, and depression, It is recommended that future studies be conducted to identify ways to prevent and reduce the incidence of misophonia.

Keywords: misophonia, obsessive-compulsive disorder, anxiety, depression

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Authors: Alan S. Weber

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This contribution reviews the current biomedical and qualitative arts research on arts-in-health interventions to improve both individual and population health outcomes. Arts therapies–for example, music therapy with roots in Aristoxenus’s Ἁρμονικὰ στοιχεῖα and the Pythagorean sect–have long been employed in therapeutic contexts. However, the 20th century witnessed the increasing use of the visual and plastic arts (drawing, painting, sculpting), performing arts (drama and dance), and other expressive arts modalities into occupational therapy, well-being medicine, and psychological and psychiatric counselling, diagnosis, and treatment. A significant body of peer-reviewed evidence in the medical and neurological sciences on the role of arts-in-health has developed, and specifically, research on music and art therapy has led to their inclusion within the current biomedical paradigm of evidence-based practice. The arts cannot only aid in public and population health promotion (promoting healthy behaviors and lifestyles, preventing disease onset) but also in addressing psychological issues (regulation of emotion; stress, anxiety, and depression reduction), behavioural issues (basic life skills, coping), and physiological response (immune system function, hormonal regulation, homeostatis). Working as a cross-disciplinary researcher in the arts in an American medical college, the author has developed several successful arts-in-health programs at the national and international level.

Keywords: arts-in-health, evidence based medicine, arts for health, expressive arts therapies

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Authors: A/Prof Marjan Khajehei

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In the last century, the role of fathers in the birth has changed exponentially. Before the 1970s, the principal view was that birth was a female business and not a man’s place. Changing cultural and professional attitudes around the emotional bond between a man and a woman, family structure and the more proactive involved role of men in the family have encouraged fathers’ attendance at birth. There is evidence that fathers’ support can make birthing less traumatic for some women and can make couples closer. This has made some clinicians to believe the fathers should be more involved throughout the birth process. Some clinicians even go further and ask the fathers to watch the medical procedures, such as inserting vaginal speculum, forceps or vacuum, episiotomy and stitches. Although birth can unfold like a beautiful picture captured by birth photographers, with fathers massaging women’s backs by candle light and the miraculous moment of birth, it can be overshadowed by less attractive images of cervical mucous, emptying bowels and the invasive medical procedures. What happens in the birth room and the fathers’ reaction to the graphic experience of birthing can be unpredictable. Despite the fact that most men are absolutely thrilled to be in the delivery room, for some men, a very intimate body part can become completely desexualised, and they can experience psychological and sexual scarring. They see someone they cherish dramatically sliced open and can then associate their partners with a disturbing scene, and it can dramatically affect their relationships. While most women want the expectant fathers by their side for this life-changing event, not all of them may be happy for their partners to watch the perineum to be cut or stitched or when large blades of forceps are inserted inside the vagina. Anecdotal reports have shown that consent is not sought from the labouring women as to whether they want their partners to watch these procedures. The majority of research1, 2, 3 focuses on men’s and women’s retrospective attitudes towards their birth experience. However, the effect of witnessing invasive procedures during childbirth on a man's attraction to his partner, while she is most vulnerable, and also an increased risk of post-traumatic stress disorder in fathers have not been widely investigated. There is a lack of sufficient research investigating whether women need to be asked for their consent before inviting their partners to closely watch medical procedures during childbirth. Future research is required to provide a basis for better awareness and involve the consumers to understanding the men’s and women’s experience and their expectations for labour and birth.

Keywords: birth, childbirth, father, labour, men, women

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Authors: Aruha Khan, Brynn E. Kankel, Paraskevi Papadopoulou

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In recent years, extensive research upon ‘stress’ has provided insight into its two distinct guises, namely the short–term (fight–or–flight) response versus the long–term (chronic) response. Specifically, the long–term or chronic response is associated with the suppression or dysregulation of immune function. It is also widely noted that the occurrence of cancer is greatly correlated to the suppression of the immune system. It is thus necessary to explore the impact of long–term or chronic stress upon the prevalence and risk of cancer. To what extent can the dysregulation of immune function caused by long–term exposure to stress be controlled or minimized? This study focuses explicitly upon immunosuppression due to its ability to increase disease susceptibility, including cancer itself. Based upon an analysis of the literature relating to the fundamental structure of the immune system alongside the prospective linkage of chronic stress and the development of cancer, immunosuppression may not necessarily correlate directly to the acquisition of cancer—although it remains a contributing factor. A cross-sectional analysis of the survey data from the University of Tennessee Medical Center (UTMC) and Harvard Medical School (HMS) will provide additional supporting evidence (or otherwise) for the hypothesis of the study about whether immunosuppression (caused by the chronic stress response) notably impacts the prevalence of cancer. Finally, a multidimensional framework related to education on chronic stress and its effects is proposed.

Keywords: immune system, immunosuppression, long–term (chronic) stress, risk of cancer

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Authors: Abdulwhab Alotaibi, Abdullah Alzahrani, Ziyad Bokhari, Abdulelah Alghamdi

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First described in 1975 by Dr. Miller, Medical dressings are uncommon but possible cause of hand digital ischemia due the tourniquet-like effect. The incident of this complication has been reported across wide range of age-groups, yet it seems like that the pediatric population are specifically vulnerable. Multiple dressing types were reported to have caused ischemic injury, such as elastic wrap, tubular gauze, and self-adherent dressings. We present a case of medical dressing induced digital ischemia in patient with Congenital insensitivity to pain and anhidrosis (CIPA), which further challenge the discovery of the condition. An 8-year-old girl known case of CIPA. Brought by her mother to the ER after nail bed injury, which she managed by application of elastic wrap that was left for 24 hours. When the mother found out she immediately removed the elastic band, and noticed the fingertip was black and cold with tense bullae. The color then changed later when she arrived to the ER to dark purple with bluish discoloration on the tip. On examination there was well demarcated tense bullae on the distal right fifth finger. Neurovascular intact, pulse oximetry on distal digit 100%, capillary refill time was delayed. She was seen under Plastic surgery and conservative management recommended, and patient was discharged with safety netting. Two days later the patient came as follow-up visit at which her condition demonstrated significant improvement, the bullae has since ruptured leaving behind sloughed skin, capillary refill and pulse oximetry were both within normal limits, sensory function couldn’t be assessed but her motor function and ROM were normal, topical bacitracin and bandage dressings were applied for the eroded skin. Patient was scheduled for a follow-up in 2 weeks. Preventatively it’s advisable to avoid the commonly implicated dressings such as elastic, tubular gauze or self-adherent wraps in hand or digital injuries when possible, but in cases where the use of these dressings is of necessity the appropriate precautions must be taken, Dr. Makarewich proposed the following 5 measures to help minimize the incidence of the injury: 1-Unwrapping 12 inches of the dressing before rolling the injured finger. 2-Wrapping from distal to proximal with minimal tension to avoid vascular embarrassment. 3-The use of 5-25 inch to overlap the entire wrap. 4-Maintaining light pressure over the wrap to allow adherence of the dressing. 5-Minimization of the number of layers used to wrap the affected digit. Also assessing the capillary refill after the application can help in determining the patency of the supplying blood vessels. It’s also important to selectively determine if the patient is a candidate for conservative management, as tailored approach can help in maximizing the positive outcomes for our patients.

Keywords: congenital insensitivity to pain, digital ischemia, medical dressing, conservative management

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Authors: Florence A. Undiyaundeye, Aniashie Akpanke

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Early identification of developmental disorders in infants and toddlers is critical for the well being of children. It is also an integral function of the primary care medical provider and the early care given in the home or crèche. This paper is focused at providing information on special need infants and toddlers and strategies to support them in developmental concern to cope with the challenges in and out of the classroom and to interact with their peers without stigmatization and inferiority complex. The target children are from birth through three years of age. There is a strong recommendation for developmental surveillance to be incorporated at every well child preventive care program in training and practical stage of formal school settings. The paper posits that any concerns raised during surveillance should be promptly addressed with standardized developmental screening by appropriate health service providers. In addition screening tests should be administered regularly at age 9+, 19+ and 30 months of these infants. The paper also establishes that the early identification of these developmental challenges of the infants and toddlers should lead to further developmental and medical evaluation, diagnosis and treatment, including early developmental school intervention, control and teaching and learning integration and inclusion for proper career build up. Children diagnosed with developmental disorders should be identified as children with special needs so that management is initiated and its underlying etiology may also drive a range of treatment of the child, to parents. Conselling and school integration as applicable to the child’s specific need and care for sustenance in societal functioning.

Keywords: care, special need, support, infants and toddlers, management and developmental disorders

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Authors: Sara Iqbal

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Introduction:Renal transplant is increasingly one of the most popular transplants within the UK; with an aging population along with obesity epidemic we are witnessing increasing rates of diabetes – one of the commonest indications for renal transplant. However, the demand is far greater than supply. Many donors are provided by women of child-bearing age; however the long-term effects are still uncertain. Aim:Determine pregnancy outcomes and complications of women of child-bearing age following renal donation. Methods: A review of the current available literature was preformed using MEDLINE and EMBASE up to 2014. Search criteria included key terms such as pregnancy outcome post-renal donor, pregnancy outcomes and complications. Relevant articles were selected based on pure methodological medical research, after careful analysis, they were recorded within this review. Results: Out of 1141 women involved in transplant studies, 574 pregnancies reported having donated a single-renal donor prior to pregnancy. Of which a staggering miscarriage rate 32.4% (n=186) was reported, amongst this other complications included gestational hypertension of 10% (n=59) and gestational diabetes 2.3% (n=13). Other significantly noted complications included chronic hypertension, low-birth weights, and pregnancy-related death. Conclusions: After unilateral renal donor transplant, haemodynamics change along with pregnancy, predisposing women to developing several complications compared to pregnancies with no history any renal-donor transplant. Despite this, further investigation is required in order to accurately determine the safety of renal-donors in women of child-bearing age.

Keywords: renal transplant, pregnancy, complications, medical and health sciences

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Authors: Belgherbi Aicha, Hadjidj Ismahen, Bessaid Abdelhafid

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Interpretation of medical images benefits from anatomical and physiological priors to optimize computer-aided diagnosis applications. Segmentation of liver, spleen and kidneys is regarded as a major primary step in the computer-aided diagnosis of abdominal organ diseases. In this paper, a semi-automated method for medical image data is presented for the abdominal organ segmentation data using mathematical morphology. Our proposed method is based on hierarchical segmentation and watershed algorithm. In our approach, a powerful technique has been designed to suppress over-segmentation based on mosaic image and on the computation of the watershed transform. Our algorithm is currency in two parts. In the first, we seek to improve the quality of the gradient-mosaic image. In this step, we propose a method for improving the gradient-mosaic image by applying the anisotropic diffusion filter followed by the morphological filters. Thereafter, we proceed to the hierarchical segmentation of the liver, spleen and kidney. To validate the segmentation technique proposed, we have tested it on several images. Our segmentation approach is evaluated by comparing our results with the manual segmentation performed by an expert. The experimental results are described in the last part of this work.

Keywords: anisotropic diffusion filter, CT images, morphological filter, mosaic image, simultaneous organ segmentation, the watershed algorithm

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Authors: Michael Sonne Kristensen, Frank Loesche, James Foster, Elif Ozcan, Judy Edworthy

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Auditory alarms play an integral role in intensive care nurses’ daily work. Most medical devices in the intensive care unit (ICU) are designed to produce alarm sounds in order to make nurses aware of immediate or prospective safety risks. The utilisation of sound as a carrier of crucial patient information is highly dependent on nurses’ presence - both physically and mentally. For ICU nurses, especially the ones who work with stationary alarm devices at the patient bed space, it is a challenge to display ‘appropriate’ alarm responses at all times as they have to navigate with great flexibility in a complex work environment. While being primarily responsible for a small number of allocated patients they are often required to engage with other nurses’ patients, relatives, and colleagues at different locations inside and outside the unit. This work explores the social strategies used by a team of nurses to comprehend and react to the information conveyed by the alarms in the ICU. Two main research questions guide the study: To what extent do alarms from a patient bed space reach the relevant responsible nurse by direct auditory exposure? By which means do responsible nurses get informed about their patients’ alarms when not directly exposed to the alarms? A comprehensive video-ethnographic field study was carried out to capture and evaluate alarm-related events in an ICU. The study involved close collaboration with four nurses who wore eye-level cameras and ear-level binaural audio recorders during several work shifts. At all time the entire unit was monitored by multiple video and audio recorders. From a data set of hundreds of hours of recorded material information about the nurses’ location, social interaction, and alarm exposure at any point in time was coded in a multi-channel replay-interface. The data shows that responsible nurses’ direct exposure and awareness of the alarms of their allocated patients vary significantly depending on work load, social relationships, and the location of the patient’s bed space. Distributed listening is deliberately employed by the nursing team as a social strategy to respond adequately to alarms, but the patterns of information flow prompted by alarm-related events are not uniform. Auditory Spatiotemporal Trajectory (AST) is proposed as a methodological label to designate the integration of temporal, spatial and auditory load information. As a mixed-method metrics it provides tangible evidence of how nurses’ individual alarm-related experiences differ from one another and from stationary points in the ICU. Furthermore, it is used to demonstrate how alarm-related information reaches the individual nurse through principles of social and distributed cognition, and how that information relates to the actual alarm event. Thereby it bridges a long-standing gap in the literature on medical alarm utilisation between, on the one hand, initiatives to measure objective data of the medical sound environment without consideration for any human experience, and, on the other hand, initiatives to study subjective experiences of the medical sound environment without detailed evidence of the objective characteristics of the environment.

Keywords: auditory spatiotemporal trajectory, medical alarms, social cognition, video-ethography

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Authors: Orogun Daniel Oghenekevhwe

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Africa being an agrarian continent has an abundance of fruits that are both nutritional and medicinal. Regardless of the abundance of these healing elements, Africa leads the statistics of poor healthcare globally. Among others, there are two noticeable challenges in the healthcare system which are ‘Poor access and high cost of medical healthcare’. The effects of both the access and economic implications are (1) Low responsiveness and (2) High mortality rate. While the United Nations and the global health community continue to work towards reduced mortality rates and poor responsiveness to healthcare and wellness, this paper investigates how some Africans use the spiritual symbols of African fruits as responsive catalysts to embrace naturopathy thereby reducing the effects and impacts of poor healthcare challenges in Africa. The main argument is whether there are links between spiritual symbols and fruits that influence Africans' response to naturopathy and low-cost healthcare. Following that is the question of how medical healthcare responds to such development. Bitter Kola (Garcinia) is the case study fruit, and Sunnyside in Pretoria, South Africa, has been spotted as one of the high-traffic selling points of herbal fruits. A mixed research method is applicable with an expected 20 Quantitative data respondents among sellers and nutritionists and 50 Qualitative Data respondents among consumers. Based on the results, it should be clear how spirituality contributes to alternative healthcare and how it can be further encouraged to bridge the gap between the high demand and low supply of healthcare in Africa and beyond.

Keywords: spiritual symbols, naturopathy, African fruits, spirituality, healthcare

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Authors: Joseph Kimuli Balikuddembe

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Road traffic incidents (RTIs) continue to be a serious public health and development burden around the globe. Compared to high-income countries (HICs), the low and middle-income countries (LMICs) bear the heaviest brunt of RTIs. Like other LMICs, Uganda, a country located in Eastern Africa, has been experiencing a worryingly high burden of RTIs and their associated impacts. Over the years, the highest number of all the total registered RTIs in Uganda has taken place in the Greater Kampala Metropolitan Area (GKMA). This places a tremendous demand on the few existing emergency medical services (EMS) to adequately respond to those affected. In this regard, the overall objective of the study was to risk map RTIs in the GKMA so as to help in the better planning of EMS for the victims of RTIs. Other objectives included: (i) identifying the factors affecting the exposure, vulnerability and EMS capacity for the victims of RTIs; (ii) identifying the RTI prone-areas and estimating their associated risk factors; (iii) identifying the weaknesses and capacities which affect the EMS systems for RTIs; and (iv) determining the strategies and priority actions that can help to improve the EMS response for RTI victims in the GKMA. To achieve these objectives, a mixed methodological approach was used in four phrases for approximately 15 months. It employed a systematic review based on the preferred reporting items for systematic reviews and meta-data analysis guidelines; a Delphi panel technique; retrospective data analysis; and a cross-sectional method. With Uganda progressing forward as envisaged in its 'Vision 2040', the GKMA, which is the country’s political and socioeconomic epicenter, is experiencing significant changes in terms of population growth, urbanization, infrastructure development, rapid motorization and other factors. Unless appropriate actions are taken, these changes are likely to worsen the already alarming rate of RTIs in Uganda, and in turn also to put pressure on the few existing EMS and facilities to render care for those affected. Therefore, road safety vis-à-vis injury prevention measures, which are needed to reduce the burden of RTIs, should be multifaceted in nature so that they closely correlate with the ongoing dynamics that contribute to RTIs, particularly in the GKMA and Uganda as a whole.

Keywords: emergency medical services, Kampala, risk mapping, road traffic incidents

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Authors: Aneta Nitsch-Osuch, Beata Pawlus, Maria Pawlak

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Introduction: Recently, the number of parents who refuse to vaccinate their children or present so-called hesitant behaviors has increased in many developed countries. The study aimed to analyze the completeness and timeliness of vaccinations against hepatitis B and tuberculosis in neonates in a single maternity hospital in Warsaw (Poland). Material and Methods: We analyzed medical records of children born in the hospital between 1st January 2015 and 31st December 2016 and calculated the proportion of newborns not vaccinated on time. Results: The percentage of unvaccinated newborns was similar in the analyzed years: 7.2% in 2015 and 6.7% in 2016. Parental decisions rather than medical contraindications caused non-immunization (4.3% vs. 2.9% in 2015, and 4.7% vs. 2% in 2016). Most parents refused both vaccinations (81%-84%), whereas 7-8% refused only hep B vaccination, and 9-11% refused alone tuberculosis vaccination. The majority of hesitant parents decided to delay both vaccinations (70-80%), while 10-11% of parents chose to delay only one vaccination (hep B). In consecutive years, an increase in the percentage of parents delaying tuberculosis vaccination was reported (10 vs. 19%). Discussion: The increase in the number of newborns who are not correctly vaccinated just after birth due to their parents' decision should be considered non-gradual, both for hepatitis B and tuberculosis. It is necessary to implement effective educational and informative measures targeted at future parents to reinforce positive attitudes towards vaccinations and to dispel doubts about them among parents who are hesitant.

Keywords: hepatitis B, tuberculosis, immunization, new-borns, coverage rate

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Authors: Christopher Celozzi, Sarah Kochav

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Our research investigates the numerous challenges faced by Chinese ESL university students enrolled in the medical and related healthcare professional fields. The over-arching research question is how gender influences classroom participation and learning. The second research question addressed is 'what instructional strategies may be utilized to promote student participation and language acquisition?'. Participants’ language ability has been assessed and evaluated in order to facilitate the establishment of a statistical baseline for the subsequent intervention. This research delves deeper into each individual’s personal and academic circumstances, in an effort to reveal any held intrinsic gender beliefs and social identities that may influence learning. Also considered is the impact on learning for a homogenized student population within a uniform, highly structured learning environment. Specially, what is the influence of China’s ‘one-child policy’ on individual learning habits? The impact of their millennial identity and reliance on social media is also examined. A qualitative methodology with a case study approach is employed, with interviews conducted among the participants. Student response to the intervention and selected remediation strategies are documented, analyzed and discussed. The findings of the study may serve to inform educator instructional practice, while advancing the student learner in their pursuit of English competency in highly competitive professions.

Keywords: Chinese students, gender, English, language acquisition

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Authors: William Mahony, L. Jacqueline Hirth, Richard Rupp, Sandra Gonzalez, Roger Zoorob

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Background: The impact of the COVID-19 pandemic on physicians has been considered by many researchers, but less is known about non-physician healthcare workers. The aim of this study is to examine the association of COVID-19 safety training and communication with stress. Methods: A 91-item online survey was distributed, starting January 2, 2021, to non-physician healthcare workers, including physician assistants, nurse practitioners, and medical assistants (MAs) in the United States through email and social media. A $1 donation was made to the Red Cross for each completed survey. The survey consisted of demographics, occupational questions, and perceived stress (perceived stress scale, PSS). Items on the PSS were combined for an overall score and categorized according to the severity of perceived stress. Chi-square tests were performed for bivariate analyses of categorical variables. Results: Of the 284 participants consenting to complete the survey, 197 participants completed the full survey. MAs made up most of the sample at 79%. Among all respondents, 47% had moderate PSS scores (scored between 14 and 26), and 51% had severe PSS scores (scored between 27 and 40). Unvaccinated participants reported statistically significantly lower levels of perceived stress (p = 0.002). Performing tasks outside of typical job responsibilities was not associated with PSS scores (p = .667). Discussion: Non-physician healthcare workers demonstrated a high level of perceived stress overall. The association between vaccination status and perceived stress should be examined in order to evaluate whether vaccination levels could be improved with further education about the virus and associated risks.

Keywords: COVID-19, SARS-Cov-2, nursing, public health

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Authors: Jonathan Gong

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Purpose AI-driven solutions are at the forefront of many pathology and medical imaging methods. Using algorithms designed to better the experience of medical professionals within their respective fields, the efficiency and accuracy of diagnosis can improve. In particular, X-rays are a fast and relatively inexpensive test that can diagnose diseases. In recent years, X-rays have not been widely used to detect and diagnose COVID-19. The under use of Xrays is mainly due to the low diagnostic accuracy and confounding with pneumonia, another respiratory disease. However, research in this field has expressed a possibility that artificial neural networks can successfully diagnose COVID-19 with high accuracy. Models and Data The dataset used is the COVID-19 Radiography Database. This dataset includes images and masks of chest X-rays under the labels of COVID-19, normal, and pneumonia. The classification model developed uses an autoencoder and a pre-trained convolutional neural network (DenseNet201) to provide transfer learning to the model. The model then uses a deep neural network to finalize the feature extraction and predict the diagnosis for the input image. This model was trained on 4035 images and validated on 807 separate images from the ones used for training. The images used to train the classification model include an important feature: the pictures are cropped beforehand to eliminate distractions when training the model. The image segmentation model uses an improved U-Net architecture. This model is used to extract the lung mask from the chest X-ray image. The model is trained on 8577 images and validated on a validation split of 20%. These models are calculated using the external dataset for validation. The models’ accuracy, precision, recall, f1-score, IOU, and loss are calculated. Results The classification model achieved an accuracy of 97.65% and a loss of 0.1234 when differentiating COVID19-infected, pneumonia-infected, and normal lung X-rays. The segmentation model achieved an accuracy of 97.31% and an IOU of 0.928. Conclusion The models proposed can detect COVID-19, pneumonia, and normal lungs with high accuracy and derive the lung mask from a chest X-ray with similarly high accuracy. The hope is for these models to elevate the experience of medical professionals and provide insight into the future of the methods used.

Keywords: artificial intelligence, convolutional neural networks, deep learning, image processing, machine learning

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Authors: Pirakorn Sukonthaman, Paphitchaya Temphattharachok, Warangkana Thammasanya, Kraichart Tantrakarnarpa, Tanongson Tientavorn

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Agriculture is the main occupation in Thailand. Excessive amount of pesticides are used to increase the products but are toxic to human body. In 2009, Bureau of Epidemiology received 1,691 cases reported with pesticides toxicity (2.66:100,000) which 10.61 % of them is caused by Organophosphate. The purposes are to find factors associated with pesticides used and plasma cholinesterase level and other emerging issues that previous studies did not explain among agricultural workers in Baan Na Yao, Chachoengsao, Thailand. This research was an exploratory mixed method study. Qualitative interviews and quantitative questionnaires were used together in order to gather information from the agricultural workers (mainly cassava and rice farming) directly exposed to pesticides within 2 months simultaneously. Qualitative participants were selected by purposive sampling and a total survey for quantitative ones. The quantitative data was statistically analyzed by using multiple logistic regression model. Qualitative data was transcribed verbatim and thematically analyzed. For qualitative study, 15 participants were interviewed and 300/323 participants (92.88%) were given questionnaires, of which were 175 male and 125 female and 113 among them were spraymen. The prevalence of abnormal plasma cholinesterase level was 92.28% (Safe 7.72% Risky 49.33% and Unsafe 42.95%). Participants with inappropriate behaviors during spraying had a significant association with plasma cholinesterase level (95%CI=1.399-14.858) but other factors such as age, gender, education, attitude and knowledge had no association. They also had encountered various symptoms from pesticides such as fatigue (61%), vertigo (59.67%) and headache (58.86%), etc. Although they had high knowledge and attitude they still had poor behaviors. Moreover, our qualitative component showed that though they had worn the personal protective equipment (PPE) regularly, their PPE was not standard. Not only substandard PPE, but also there were obstacles of wearing such as the hot climate and inconvenience. They misunderstood their symptoms from using pesticides as allergy. Therefore, they did not seek for proper medical check-ups and treatment. This research revealed almost all of the participants have abnormal levels of plasma cholinesterase related especially those with poor behaviors. They also wore PPE but inadequately and misunderstood the symptoms produced by organophosphate use as allergy. Therefore, they did not seek for medical treatment. Occupation health education, modification of PPE and periodic medical checking are ways to make agricultural workers concern and know if there is any progression in a long term.

Keywords: pesticides, plasma cholinesterase level, spraymen, agricultural workers

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Authors: Margareth S. Zanchetta, Kateryna Metersky, Valerie Tan, Charissa Cordon, Stephanie Lucchese, Yana Siganevich, Prasha Sivasundaram, Truong Binh Nguyen, Imran Qureshi

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Due to a new area of practice, Canadian nurses possess knowledge gaps regarding the use of cannabis-based therapies by clients/patients. Education related to medical cannabis (MC) and recreational cannabis (RC) is required to promote nurses’ competency and confidence in supporting clients/patients using MC/RC toward the improvement of health outcomes. A team composed of nursing researchers and undergraduate/graduate students implemented a national survey to explore this theme with the population of undergraduate, graduate (MN and NP), and Post-Diploma (RN Bridging) nursing students enrolled in Canadian Universities Nursing Programs. Upon Research Ethics Board approval, survey recruitment was supported by major nursing stakeholders. The research questions were : (a) Which are the most preferred sources of information on MC/RC for nursing students? (b) Which are the factors and preferred learning modalities that could increase interest in learning about MC/RC, and (c) What are the future career plans among nursing students, and how would they consider the prospective use of cannabis in their practice? The survey was available from Sept. 2022 to Feb. 2023, hosted by a remote platform. An original questionnaire (English-French) was composed of 18 multiple choice questions and 2 open-ended questions. Sociodemographic information and closed-ended responses were compiled as descriptive statistics, while narrative accounts will be analysed through thematic analysis. Respondents (n=153) were from 7 Canadian provinces, national (99%) and international students (1%); the majority of respondents (61%) were in the age range of 21-30 years old. Results indicated that respondents perceive a gap in the undergraduate curriculum on the topics of MC/RC (91%) and that their learning needs include regulations (90%), data on effectiveness (88%), dosing best practices (86%), contraindications (83%), and clinical and medical indications (76%). Respondents reported motivation to learn more about MC/RC through online lectures/videos (65%), e-learning modules or online interactive training (61%), workshops (51%), webinars (36%), and social media (35%). Their primary career-related motivations regarding MC/RC knowledge include enhancing nursing practice (76%), learning about this growing scope of practice (61%), keeping up-to-date responding to scientific curiosity (59%), learning about evidence-based practice (59%), and utilizing alternative forms of medical treatment (37%). Respondents indicated that the integration of topics on cannabis in any course in the undergraduate and/or graduate curriculum would increase their desire to learn about MC/RC as equally as exposure within a clinical setting (75%). The emerging trend in the set of narrative responses (n=130) suggests that respondents believe educational MC/RC content should be integrated into core nursing courses. Respondents also urged educators to be well-informed about evidence-based practice related to MC/RC and to reflect upon stigma and biases surrounding its use. Future knowledge dissemination and translation activities include scholarly products and presentations to stimulate discussion amongst nursing faculty and students, as well as nurses in clinical settings. The goal is to mobilise talents and build collaboration for the development of a socially responsive curriculum on MC/RC competency to address the education-related expectations of all these social actors.

Keywords: Canada, medical cannabis, nursing education, nursing graduate student, nursing undergraduate student, online survey, recreational cannabis

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Authors: P. Bharathiraja

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Computer Aided decision making system is used to enhance diagnosis and prognosis of diseases and also to assist clinicians and junior doctors in clinical decision making. Medical Data used for decision making should be definite and consistent. Data Mining and soft computing techniques are used for cleaning the data and for incorporating human reasoning in decision making systems. Fuzzy rule based inference technique can be used for classification in order to incorporate human reasoning in the decision making process. In this work, missing values are imputed using the mean or mode of the attribute. The data are normalized using min-ma normalization to improve the design and efficiency of the fuzzy inference system. The fuzzy inference system is used to handle the uncertainties that exist in the medical data. Equal-width-partitioning is used to partition the attribute values into appropriate fuzzy intervals. Fuzzy rules are generated using Class Based Associative rule mining algorithm. The system is trained and tested using heart disease data set from the University of California at Irvine (UCI) Machine Learning Repository. The data was split using a hold out approach into training and testing data. From the experimental results it can be inferred that classification using fuzzy inference system performs better than trivial IF-THEN rule based classification approaches. Furthermore it is observed that the use of fuzzy logic and fuzzy inference mechanism handles uncertainty and also resembles human decision making. The system can be used in the absence of a clinical expert to assist junior doctors and clinicians in clinical decision making.

Keywords: decision making, data mining, normalization, fuzzy rule, classification

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Authors: Eslam Dabbish, Fortuna Ponte, Stefano Scoditti, Emilia Sicilia, Gloria Mazzone

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The medical techniques based on the use of light for activating the drug are occupying a prominent place in the cancer treatment due to their selectivity that contributes to reduce undesirable side effects of conventional chemotherapy. Among these therapeutic treatments, photodynamic therapy (PDT) and photoactivated chemotherapy (PACT) are emerging as complementary approaches for selective destruction of neoplastic tissue through direct cellular damage. Both techniques rely on the employment of a molecule, photosensitizer (PS), able to absorb within the so-called therapeutic window. Thus, the exposure to light of otherwise inert molecules promotes the population of excited states of the drug, that in PDT are able to produce the cytotoxic species, such as 1O2 and other ROS, in PACT can be responsible of the active species release or formation. Following the success of cisplatin in conventional treatments, many other transition metal complexes were explored as anticancer agents for applications in different medical approaches, including PDT and PACT, in order to improve their chemical, biological and photophysical properties. In this field, several crucial characteristics of candidate PSs can be accurately predicted from first principle calculations, especially in the framework of density functional theory and its time-dependent formulation, contributing to the understanding of the entire photochemical pathways involved which can ultimately help in improving the efficiency of a drug. A brief overview of the outcomes on some platinum and ruthenium-based PSs proposed for the application in the two phototherapies will be provided.

Keywords: TDDFT, metal complexes, PACT, PDT

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Authors: Renáta Nagy, Alexandra Csongor, Jon Marquette, Vilmos Warta

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The presentation aims at eliciting insight into the results of ongoing research regarding evolving trends and attitudes towards online assessment of English for Medical Purposes. The focus pinpointsonline as one of the most trending formsavailable during the global pandemic. The study was first initiated in 2019 in which its main target was to reveal the intriguing question of students’ and assessors’ attitudes towards online assessment. The research questions the attitudes towards the latest trends, possible online task types, their advantagesand disadvantages through an in-depth experimental process currently undergoing implementation. Material and methods include surveys, needs and wants analysis, and thorough investigations regarding candidates’ and assessors’ attitudes towards online tests in the field of Medicine. The examined test tasks include various online tests drafted in both English and Hungarian by student volunteers at the Medical School of the University of Pécs, Hungary. Over 400 respondents from more than 28 countries participated in the survey, which gives us an international and intercultural insight into how students with different cultural and educational background deal with the evolving online world. The results show the pandemic’s impact, which brought the slumbering online world of assessing roaring alive, fully operational andnowbearsphenomenalrelevancein today’s global education. Undeniably, the results can be used as a perspective in a vast array of contents. The survey hypothesized the generation of the 21st century expect everything readily available online, however, questions whether they are ready for this challenge are lurking in the background.

Keywords: assessment, changes, english, ESP, online assessment, online, trends

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