Search results for: onset of symptom

Authors: Kulin Dave, Kapil Mohan

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Earthquakes are considered to be the most destructive rapid-onset disasters human beings are exposed to. The amount of loss it brings in is sufficient to take careful considerations for designing of structures and facilities. Seismic Hazard Analysis is one such tool which can be used for earthquake resistant design. Ground Response Analysis is one of the most crucial and decisive steps for seismic hazard analysis. Rapar district of Kutch, Gujarat falls in Zone 5 of earthquake zone map of India and thus has high seismicity because of which it is selected for analysis. In total 8 bore-log data were studied at different locations in and around Rapar district. Different soil engineering properties were analyzed and relevant empirical correlations were used to calculate maximum shear modulus (Gmax) and shear wave velocity (Vs) for the soil layers. The soil was modeled using Pressure-Dependent Modified Kodner Zelasko (MKZ) model and the reference curve used for fitting was Seed and Idriss (1970) for sand and Darendeli (2001) for clay. Both Equivalent linear (EL), as well as Non-linear (NL) ground response analysis, has been carried out with Masing Hysteretic Re/Unloading formulation for comparison. Commercially available DEEPSOIL v. 7.0 software is used for this analysis. In this study an attempt is made to quantify ground response regarding generated acceleration time-history at top of the soil column, Response spectra calculation at 5 % damping and Fourier amplitude spectrum calculation. Moreover, the variation of Peak Ground Acceleration (PGA), Maximum Displacement, Maximum Strain (in %), Maximum Stress Ratio, Mobilized Shear Stress with depth is also calculated. From the study, PGA values estimated in rocky strata are nearly same as bedrock motion and marginal amplification is observed in sandy silt and silty clays by both analyses. The NL analysis gives conservative results of maximum displacement as compared to EL analysis. Maximum strain predicted by both studies is very close to each other. And overall NL analysis is more efficient and realistic because it follows the actual hyperbolic stress-strain relationship, considers stiffness degradation and mobilizes stresses generated due to pore water pressure.

Keywords: DEEPSOIL v 7.0, ground response analysis, pressure-dependent modified Kodner Zelasko model, MKZ model, response spectra, shear wave velocity

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Authors: Aljoša Šorgo

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Recent scholarship on Phrygian has begun to more closely examine the long-held belief that Greek and Phrygian are two very closely related languages. It is now clear that Graeco-Phrygian can be firmly postulated as a subclade of the Indo-European languages. The present paper will focus on the reconstruction of the phonological and phonetic segments of Proto-Graeco-Phrygian (= PGPh.) by providing relevant correspondence sets and reconstructing the classes of segments. The PGPh. basic vowel system consisted of ten phonemic oral vowels: */a e o ā ē ī ō ū/. The correspondences of the vowels are clear and leave little open to ambiguity. There were four resonants and two semi-vowels in PGPh.: */r l m n i̯ u̯/, which could appear in both a consonantal and a syllabic function, with the distribution between the two still being phonotactically predictable. Of note is the fact that the segments *m and *n seem to have merged when their phonotactic position would see them used in a syllabic function. Whether the segment resulting from this merger was a nasalized vowel (most likely *[ã]) or a syllabic nasal *[N̥] (underspecified for place of articulation) cannot be determined at this stage. There were three fricatives in PGPh.: */s h ç/. *s and *h are easily identifiable. The existence of *ç, which may seem unexpected, is postulated on the basis of the correspondence Gr. ὄς ~ Phr. yos/ιος. It is of note that Bozzone has previously proposed the existence of *ç ( < PIE *h₁i̯-) in an early stage of Greek even without taking into account Phrygian data. Finally, the system of stops in PGPh. distinguished four places of articulation (labial, dental, velar, and labiovelar) and three phonation types. The question of which three phonation types were actually present in PGPh. is one of great importance for the ongoing debate on the realization of the three series in PIE. Since the matter is still very much in dispute, we ought to, at this stage, endeavour to reconstruct the PGPh. system without recourse to the other IE languages. The three series of correspondences are: 1. Gr. T (= tenuis) ~ Phr. T; 2. Gr. D (= media) ~ Phr. T; 3. Gr. TA (= tenuis aspirata) ~ Phr. M. The first series must clearly be reconstructed as composed of voiceless stops. The second and third series are more problematic. With a bottom-up approach, neither the second nor the third series of correspondences are compatible with simple modal voicing, and the reflexes differ greatly in voice onset time. Rather, the defining feature distinguishing the two series was [±spread glottis], with ancillary vibration of the vocal cords. In PGPh. the second series was undergoing further spreading of the glottis. As the two languages split, this process would continue, but be affected by dissimilar changes in VOT, which was ultimately phonemicized in both languages as the defining feature distinguishing between their series of stops.

Keywords: bottom-up reconstruction, Proto-Graeco-Phrygian, spread glottis, syllabic resonant

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Authors: Kinneret Segal

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Background: The work of a midwife is emotionally challenging, both positively and negatively. Midwives share moments of joy when a baby is welcomed into the world and also attend difficult events of loss and trauma. The relationship that develops with the maternity is the essence of the midwife's care, and it is a fundamental source of motivation and professional satisfaction. This close relationship with the maternity may be used as a double-edged sword in cases of exposure to traumatic events at birth. Birth problems, exposure to emergencies and traumatic events, and loss can affect the professional quality of life and the Compassion satisfaction of the midwife. It seems that the issue of traumatic experiences in the work of midwives has not been sufficiently explored. Aim: The present study examined the associations between exposure to traumatic events, personal resilience and post-traumatic symptoms, professional quality of life, and organizational commitment among midwifery nurses in Israeli hospitals. Methods: 131 midwives from three hospitals in the country's center in Israel participated in this study. The data were collected during 2021 using a self-report questionnaire that examined sociodemographic characteristics, the degree of exposure to traumatic events in the delivery room, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment. Results: The three most difficult traumatic events for the midwives were death or fear of death of a newborn, death or fear of the death of a mother, and a quiet birth. The higher the frequency of exposure to traumatic events, the more numerous and intense the onset of post-trauma symptoms. The more numerous and powerful the post-trauma symptoms, the higher the level of professional burnout and/or compassion fatigue, and the lower the level of compassion satisfaction. High levels of compassion satisfaction and/or low professional burnout were expressed in a heightened sense of organizational commitment. Personal resilience, country of birth, traumatic symptoms, and organizational commitment predicted satisfaction from compassion. Conclusions: Midwives are exposed to traumatic events associated with dissatisfaction and impairment of the professional quality of life that accompanies burnout and compassion fatigue. Exposure to traumatic events leads to the appearance of traumatic symptoms, a decrease in organizational commitment, and psychological and mental well-being. The issue needs to be addressed by implementing training programs, organizational support, and policies to improving well-being and quality of care among midwives.

Keywords: organizational commitment, traumatic experiences, personal resilience, quality of life

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Authors: Marcio Freire Cruz, Naoaki Ono, Shigehiko Kanaya, Carlos Arthur Mattos Teixeira Cavalcante

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The systems that record patient care information, known as Electronic Medical Record (EMR) and those that monitor vital signs of patients, such as heart rate, body temperature, and blood pressure have been extremely valuable for the effectiveness of the patient’s treatment. Several kinds of research have been using data from EMRs and vital signs of patients to predict illnesses. Among them, we highlight those that intend to predict, classify, or, at least identify patterns, of sepsis illness in patients under vital signs monitoring. Sepsis is an organic dysfunction caused by a dysregulated patient's response to an infection that affects millions of people worldwide. Early detection of sepsis is expected to provide a significant improvement in its treatment. Preceding works usually combined medical, statistical, mathematical and computational models to develop detection methods for early prediction, getting higher accuracies, and using the smallest number of variables. Among other techniques, we could find researches using survival analysis, specialist systems, machine learning and deep learning that reached great results. In our research, patients are modeled as points moving each hour in an n-dimensional space where n is the number of vital signs (variables). These points can reach a sepsis target point after some time. For now, the sepsis target point was calculated using the median of all patients’ variables on the sepsis onset. From these points, we calculate for each hour the position vector, the first derivative (velocity vector) and the second derivative (acceleration vector) of the variables to evaluate their behavior. And we construct a prediction model based on a Long Short-Term Memory (LSTM) Network, including these derivatives as explanatory variables. The accuracy of the prediction 6 hours before the time of sepsis, considering only the vital signs reached 83.24% and by including the vectors position, speed, and acceleration, we obtained 94.96%. The data are being collected from Medical Information Mart for Intensive Care (MIMIC) Database, a public database that contains vital signs, laboratory test results, observations, notes, and so on, from more than 60.000 patients.

Keywords: dynamic analysis, long short-term memory, prediction, sepsis

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Authors: Nam Sze Cheng, P. C. Janita Chau

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Background: Eczema is a chronic inflammatory disease with high global prevalence rates in many childhood populations. It is also the most common paediatric skin problem. Although eczema education and proper skin care were effective in controlling eczema symptoms, the lack of both sufficient time for patient consultation and structured eczema education programme hindered the transferability of knowledge to patients and their parents. As a result, these young patients and their families suffer from a significant physical disability and psychological distress, which can substantially impair their quality of life. Objectives: This integrative review is to examine the effects of educational interventions for children with eczema and identify the core elements associated with an effective intervention. Methods: This integrative review targeted all articles published in 10 databases between May 2016 and February 2017 that reported the outcomes of disease interventions of any format for children and adolescents with the clinical diagnosis of eczema who were under 18 years of age. Five randomized controlled trials (RCT) and one systematic review of 10 RCTs were identified for review. All these publications had high methodological quality, except one study of web-based eczema education that was limited by selection bias and poor subject blinding. Findings: This review found that most studies adopted nurse-led or multi-disciplinary parental eczema education programme at the outpatient clinic setting. The format of these programmes included individual lectures, demonstration and group sharing, and the educational materials covered basic eczema knowledge and management as well as methods to interrupt itch-scratch cycle. The main outcome measures of these studies included severity of eczema symptoms, treatment adherence and quality of life of both patients and their families. Nine included studies reported statistically significant improvement in the primary outcome of symptom severity of these eczematous children. On the other hand, all these reviews failed to identify an effective dosage of intervention under these educational programmes that was attributed to the heterogeneity of the interventions. One study that was designed based on the social cognitive theory to guide the interventional content yielded statistically significant results. The systematic review recommended the importance of measuring parental self-efficacy. Implication: This integrative review concludes that structured educational programme can help nurses understand the theories behind different health interventions. They can then deliver eczema education to their patients in a consistent manner. These interventions also result in behavioral changes through patient education. Due to the lack of validated educational programmes in Chinese, it is imperative to conduct an RCT of eczema educational programme to investigate its effects on eczema severity, quality of life and treatment adherence in Hong Kong children as well as to promote the importance of parental self-efficacy.

Keywords: children, eczema, education, intervention

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Authors: Chia-Yi Wu, Jung-Chen Chang, Wen-Yu Hu, Ming-Been Lee

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In nearly all physical health conditions, suicide risk is increased compared to healthy people even after adjustment for age, gender, mental health, and substance use diagnoses. In order to highlight the importance of suicide risk assessment for the inpatients and early identification and engagement for inpatients’ mental health problems, a study was designed aiming at developing a comprehensive psychosomatic nursing engagement (PSNE) model with standardized operation procedures informing how nurses communicate, assess, and engage with the inpatients with emotional distress. The purpose of the study was to promote the gatekeeping role of clinical nurses in performing brief assessment and interventions to detect depression and anxiety symptoms among the inpatients, particularly in non-psychiatric wards. The study will be carried out in a 2000-bed university hospital in Northern Taiwan in 2019. We will select a ward for trial and develop feasible procedures and in-job training course for the nurses to offer mental health care, which will also be validated through professional consensus meeting. The significance of the study includes the following three points: (1) The study targets at an important but less-researched area of PSNE model in the cultural background of Taiwan, where hospital service is highly accessible, but mental health and suicide risk assessment are hardly provided by non-psychiatric healthcare personnel. (2) The issue of PSNE could be efficient and cost-effective in the identification of suicide risks at an early stage to prevent inpatient suicide or to reduce future suicide risk by early treatment of mental illnesses among the high-risk group of hospitalized patients who are more than three-times lethal to suicide. (3) Utilizing a brief tool with its established APP ('The Five-item Brief Symptom Rating Scale, BSRS-5'), we will invent the standardized procedure of PSNE and referral steps in collaboration with the medical teams across the study hospital. New technological tools nested within nursing assessment/intervention will concurrently be invented to facilitate better care quality. The major outcome measurements will include tools for early identification of common mental distress and suicide risks, i.e., the BSRS-5, revised BSRS-5, and the 9-item Concise Mental Health Checklist (CMHC-9). The main purpose of using the CMHC-9 in clinical suicide risk assessment is mainly to provide care and build-up therapeutic relationship with the client, so it will also be used to nursing training highlighting the skills of supportive care. Through early identification of the inpatients’ depressive symptoms or other mental health care needs such as insomnia, anxiety, or suicide risk, the majority of the nursing clinicians would be able to engage in critical interventions that alleviate the inpatients’ suffering from mental health problems, given a feasible nursing input.

Keywords: mental health care, clinical outcome improvement, clinical nurses, suicide prevention, psychosomatic nursing

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Authors: Minna-Maari Harmaala, Hanna Harilainen

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Estimates of the economic value of transitioning to circular economy models vary but it has been estimated to represent $1 trillion worth of new business into the global economy. In Europe alone, estimates claim that adopting circular-economy principles could not only have environmental and social benefits but also generate a net economic benefit of €1.8 trillion by 2030. Proponents of a circular economy argue that it offers a major opportunity to increase resource productivity, decrease resource dependence and waste, and increase employment and growth. A circular system could improve competitiveness and unleash innovation. Yet, most companies are not capturing these opportunities and thus the even abundant circular opportunities remain uncaptured even though they would seem inherently profitable. Service design in broad terms relates to developing an existing or a new service or service concept with emphasis and focus on the customer experience from the onset of the development process. Service design may even mean starting from scratch and co-creating the service concept entirely with the help of customer involvement. Service design methodologies provide a structured way of incorporating customer understanding and involvement in the process of designing better services with better resonance to customer needs. A business model is a depiction of how the company creates, delivers, and captures value; i.e. how it organizes its business. The process of business model development and adjustment or modification is also called business model innovation. Innovating business models has become a part of business strategy. Our hypothesis is that in addition to linear models still being easier to adopt and often with lower threshold costs, companies lack an understanding of how circular models can be adopted into their business and how customers will be willing and ready to adopt the new circular business models. In our research, we use robust service design methodology to develop circular economy solutions with two case study companies. The aim of the process is to not only develop the service concepts and portfolio, but to demonstrate the willingness to adopt circular solutions exists in the customer base. In addition to service design, we employ business model innovation methods to develop, test, and validate the new circular business models further. The results clearly indicate that amongst the customer groups there are specific customer personas that are willing to adopt and in fact are expecting the companies to take a leading role in the transition towards a circular economy. At the same time, there is a group of indifferents, to whom the idea of circularity provides no added value. In addition, the case studies clearly show what changes adoption of circular economy principles brings to the existing business model and how they can be integrated.

Keywords: business model innovation, circular economy, circular economy business models, service design

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Authors: Flavia Oliveira de A. M. Cruz, Edison Tostes Faria, Paula Elaine D. Reis

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When the breast is submitted to radiation therapy (RT), the most common effects are pain, skin changes, mobility restrictions, local sensory alteration, and fatigue. These effects, if not managed properly, may reduce the quality of life of cancer patients and may lead to the treatment discontinuation. Therefore, promoting knowledge and guidelines for symptom management remain a high priority for patients and a challenge for health professionals, due to the need to handle side effects in a population with a life-threatening disease. Printed materials are important strategies for supporting educative activities since they help the individual to assimilate and understand the amount of information transmitted. Nurses' behavior can be systematized through the use of an educative manual, which may be effective in promoting information regarding the treatment, self-care and how to control the effects of RT at home. In view of the importance of guaranteeing the validity of the material before its use, the objective of this research was to validate the content and appearance of an educative manual for breast cancer patients undergoing RT. The Theory of Psychometrics was used for the validation process in this descriptive methodological research. A minimum agreement rate (AR) of 80% was considered to guarantee the validity of the material. The data were collected from October to December 2017, by means of two assessments tools, constructed in the form of a Likert scale, with five levels of understanding. These instruments addressed different aspects of the evaluation, in view of two different groups of participants; 17 experts in the theme area of the educative manual, and 12 women that received RT previously to treat breast cancer. The manual was titled 'Orientation Manual: radiation therapy in breast', and was focused on breast cancer patients attended at the Department of Oncology of the Brasília University Hospital (UNACON/HUB). The research project was submitted to the Research Ethics Committee at the School of Health Sciences of the University of Brasília (CAAE: 24592213.1.0000.0030). Only two items of the assessment tool for the experts, one related to the manual's ability to promote behavioral and attitude changes and the other related to the extent of its use for other health services, obtained AR < 80% and were reformulated based on the participants' suggestions and in the literature. All other items were considered appropriate and/or complete appropriate in the three blocks proposed for the experts: objectives - 89%, structure and form - 93%, and relevance - 93%; and good and/or very good in the five blocks of analysis proposed for patients: objectives - 100%, organization - 100%, writing style - 100%, appearance - 100%, and motivation. The appearance and content validation of the educative manual proposed were attended to. The educative manual was considered relevant and pertinent and may contribute to the understanding of the therapeutic process by breast cancer patients during RT, as well as support clinical practice through the nursing consultation.

Keywords: oncology nursing, nursing care, validation studies, educational technology

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Authors: Ayse Gul Bilen

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Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants that are used clinically for the treatment of anxiety disorders, obsessive-compulsive disorder (OCD), panic disorders and eating disorders. The first SSRI, fluoxetine (sold under the brand names Prozac and Sarafem among others), had an adverse effect profile better than any other available antidepressant when it was introduced because of its selectivity for serotonin receptors. They have been considered almost free of side effects and have become widely prescribed, however questions about the safety and tolerability of SSRIs have emerged with their continued use. Most SSRI side effects are dose-related and can be attributed to serotonergic effects such as nausea. Continuous use might trigger adverse effects such as hyponatremia, tremor, nausea, weight gain, sleep disturbance and sexual dysfunction. Moderate toxicity can be safely observed in the hospital for 24 hours, and mild cases can be safely discharged (if asymptomatic) from the emergency department once cleared by Psychiatry in cases of intentional overdose and after 6 to 8 hours of observation. Although fluoxetine is relatively safe in terms of overdose, it might still be cardiotoxic and inhibit platelet secretion, aggregation, and plug formation. There have been reported clinical cases of seizures, cardiac conduction abnormalities, and even fatalities associated with fluoxetine ingestions. While the medical literature strongly suggests that most fluoxetine overdoses are benign, emergency physicians need to remain cognizant that intentional, high-dose fluoxetine ingestions may induce seizures and can even be fatal due to cardiac arrhythmia. Our case is a 35-year old female patient who was sent to ER with symptoms of confusion, amnesia and loss of orientation for time and location after being found wandering in the streets unconsciously by police forces that informed 112. Upon laboratory examination, no pathological symptom was found except sinus tachycardia in the EKG and high levels of aspartate transaminase (AST) and alanine transaminase (ALT). Diffusion MRI and computed tomography (CT) of the brain all looked normal. Upon physical and sexual examination, no signs of abuse or trauma were found. Test results for narcotics, stimulants and alcohol were negative as well. There was a presence of dysrhythmia which required admission to the intensive care unit (ICU). The patient gained back her conscience after 24 hours. It was discovered from her story afterward that she had been using fluoxetine due to post-traumatic stress disorder (PTSD) for 6 months and that she had attempted suicide after taking 3 boxes of fluoxetine due to the loss of a parent. She was then transferred to the psychiatric clinic. Our study aims to highlight the need to consider toxicologic drug use, in particular, the abuse of selective serotonin reuptake inhibitors (SSRIs), which have been widely prescribed due to presumed safety and tolerability, for diagnosis of patients applying to the emergency room (ER).

Keywords: abuse, amnesia, fluoxetine, intoxication, SSRI

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Authors: Tamphasana Wairokpam

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Inflammatory myopathies (IMs) have long been recognised as a heterogenous family of myopathies with acute, subacute, and sometimes chronic presentation and are potentially treatable. Necrotizing autoimmune myopathies (NAM) are a relatively new subset of myopathies. Patients generally present with subacute onset of proximal myopathy and significantly elevated creatinine kinase (CK) levels. It is being increasingly recognised that there are limitations to the independent diagnostic utility of muscle biopsy. Immunohistochemistry tests may reveal important information in these cases. The traditional classification of IMs failed to recognise NAM as a separate entity and did not adequately emphasize the diversity of IMs. This review and case report on NAM aims to highlight the heterogeneity of this entity and focus on the distinct clinical presentation, biopsy findings, specific auto-antibodies implicated, and available treatment options with prognosis. This article is a meta-analysis of literatures on NAM and a case report illustrating the clinical course, investigation and biopsy findings, antibodies implicated, and management of a patient with NAM. The main databases used for the search were Pubmed, Google Scholar, and Cochrane Library. Altogether, 67 publications have been taken as references. Two biomarkers, anti-signal recognition protein (SRP) and anti- hydroxyl methylglutaryl-coenzyme A reductase (HMGCR) Abs, have been found to have an association with NAM in about 2/3rd of cases. Interestingly, anti-SRP associated NAM appears to be more aggressive in its clinical course when compared to its anti-HMGCR associated counterpart. Biopsy shows muscle fibre necrosis without inflammation. There are reports of statin-induced NAM where progression of myopathy has been seen even after discontinuation of statins, pointing towards an underlying immune mechanism. Diagnosisng NAM is essential as it requires more aggressive immunotherapy than other types of IMs. Most cases are refractory to corticosteroid monotherapy. Immunosuppressive therapy with other immunotherapeutic agents such as IVIg, rituximab, mycophenolate mofetil, azathioprine has been explored and found to have a role in the treatment of NAM. In conclusion,given the heterogeneity of NAM, it appears that NAM is not just a single entity but consists of many different forms, despite the similarities in presentation and its classification remains an evolving field. A thorough understanding of underlying mechanism and the clinical correlation with antibodies associated with NAM is essential for efficacious management and disease prognostication.

Keywords: inflammatory myopathies, necrotising autoimmune myopathies, anti-SRP antibody, anti-HMGCR antibody, statin induced myopathy

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Authors: Ali Al Moussaoui

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An experiment was designed to assess the performance of 24 Lebanese adults (mean age 29:5 years) in a lexical decision making (LDM) task to find out how the facilitatory effect of phonological priming (PP) affects the speed of visual word recognition in Arabic as lexicality (wordhood) and phonological overlap positions (POP) vary. The experiment falls in line with previous research on phonological priming in the light of the cohort theory and in relation to visual word recognition. The experiment also departs from the research on the Arabic language in which the importance of the consonantal root as a distinct morphological unit is confirmed. Based on previous research, it is hypothesized that (1) PP has a facilitating effect in LDM with words but not with nonwords and (2) final phonological overlap between the prime and the target is more facilitatory than initial overlap. An LDM task was programmed on PsychoPy application. Participants had to decide if a target (e.g., bayn ‘between’) preceded by a prime (e.g., bayt ‘house’) is a word or not. There were 4 conditions: no PP (NP), nonwords priming nonwords (NN), nonwords priming words (NW), and words priming words (WW). The conditions were simultaneously controlled for word length, wordhood, and POP. The interstimulus interval was 700 ms. Within the PP conditions, POP was controlled for in which there were 3 overlap positions between the primes and the targets: initial (e.g., asad ‘lion’ and asaf ‘sorrow’), final (e.g., kattab ‘cause to write’ 2sg-mas and rattab ‘organize’ 2sg-mas), or two-segmented (e.g., namle ‘ant’ and naħle ‘bee’). There were 96 trials, 24 in each condition, using a within-subject design. The results show that concerning (1), the highest average reaction time (RT) is that in NN, followed firstly by NW and finally by WW. There is statistical significance only between the pairs NN-NW and NN-WW. Regarding (2), the shortest RT is that in the two-segmented overlap condition, followed by the final POP in the first place and the initial POP in the last place. The difference between the two-segmented and the initial overlap is significant, while other pairwise comparisons are not. Based on these results, PP emerges as a facilitatory phenomenon that is highly sensitive to lexicality and POP. While PP can have a facilitating effect under lexicality, it shows no facilitation in its absence, which intersects with several previous findings. Participants are found to be more sensitive to the final phonological overlap than the initial overlap, which also coincides with a body of earlier literature. The results contradict the cohort theory’s stress on the onset overlap position and, instead, give more weight to final overlap, and even heavier weight to the two-segmented one. In conclusion, this study confirms the facilitating effect of PP with words but not when stimuli (at least the primes and at most both the primes and targets) are nonwords. It also shows that the two-segmented priming is the most influential in LDM in Arabic.

Keywords: lexicality, phonological overlap positions, phonological priming, visual word recognition

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Authors: Lori Lioce, Gary Maddux, Norven Goddard, Ishella Fogle, Bernard Schroer

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This paper presents the integration of technologies into nursing education. The collaborative effort includes the College of Nursing (CoN) at the University of Alabama in Huntsville (UAH) and the UAH Systems Management and Production Center (SMAP). The faculty at the CoN conducts needs assessments to identify education and training requirements. A team of CoN faculty and SMAP engineers then prioritize these requirements and establish improvement/development teams. The development teams consist of nurses to evaluate the models and to provide feedback and of undergraduate engineering students and their senior staff mentors from SMAP. The SMAP engineering staff develops and creates the physical models using 3D printing, silicone molds and specialized molding mixtures and techniques. The collaboration has focused on developing teaching and training, or clinical, simulators. In addition, the onset of the Covid-19 pandemic has intensified this relationship, as 3D modeling shifted to supplied personal protection equipment (PPE) to local health care providers. A secondary collaboration has been introducing students to clinical benchmarking through the UAH Center for Management and Economic Research. As a result of these successful collaborations the Model Exchange & Development of Nursing & Engineering Technology (MEDNET) has been established. MEDNET seeks to extend and expand the linkage between engineering and nursing to K-12 schools, technical schools and medical facilities in the region to the resources available from the CoN and SMAP. As an example, stereolithography (STL) files of the 3D printed models, along with the specifications to fabricate models, are available on the MEDNET website. Ten 3D printed models have been developed and are currently in use by the CoN. The following additional training simulators are currently under development:1) suture pads, 2) gelatin wound models and 3) printed wound tattoos. Specification sheets have been written for these simulations that describe the use, fabrication procedures and parts list. These specifications are available for viewing and download on MEDNET. Included in this paper are 1) descriptions of CoN, SMAP and MEDNET, 2) collaborative process used in product improvement/development, 3) 3D printed models of training and teaching simulators, 4) training simulators under development with specification sheets, 5) family care practice benchmarking, 6) integrating the simulators into the nursing curriculum, 7) utilizing MEDNET as a pandemic response, and 8) conclusions and lessons learned.

Keywords: 3D printing, nursing education, simulation, trainers

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Authors: Jovina Concepcion Bachynski, Lenora Duhn, Idevania G. Costa, Pilar Camargo-Plazas

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Kidney failure is a life-limiting condition for which treatment, such as dialysis (hemodialysis and peritoneal dialysis), can exact a tremendously high physical and psychosocial symptom burden. Kidney failure can be severe enough to require a palliative approach to care. The term supportive care can be used in lieu of palliative care to avoid the misunderstanding that palliative care is synonymous with end-of-life or hospice care. Kidney supportive care, encompassing advance care planning, is an approach to care that improves the quality of life for people receiving dialysis through early identification and treatment of symptoms throughout the disease trajectory. Advanced care planning involves ongoing conversations about the values, goals, and preferences for future care between individuals and their healthcare teams. Kidney supportive care is underutilized and often initiated late in this population. There is evidence to indicate nurses are not providing the necessary elements of supportive kidney care. Dialysis nurses’ delay or lack of engagement in supportive care until close to the end of life may result in people dying without receiving optimal palliative care services. Using Charmaz’s constructivist grounded theory, the purpose of this doctoral study is to develop a substantive theory that explains the process of engagement in supportive care by nurses working in dialysis settings in Canada. Through initial purposeful and subsequent theoretical sampling, 23 nurses with current or recent work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings drawn from across Canada were recruited to participate in two intensive interviews using the Zoom© teleconferencing platform. Concurrent data collection and data analysis, constant comparative analysis of initial and focused codes until the attainment of theoretical saturation, and memo-writing, as well as researcher reflexivity, have been undertaken to aid the emergence of concepts, categories, and, ultimately, the constructed theory. At the time of abstract submission, data analysis is currently at the second level of coding (i.e., focused coding stage) of the research study. Preliminary categories include: (a) focusing on biomedical care; (b) multi-dimensional challenges to having the conversation; (c) connecting and setting boundaries with patients; (d) difficulty articulating kidney-supportive care; and (e) unwittingly practising kidney-supportive care. For the conference, the resulting theory will be presented. Nurses working in dialysis are well-positioned to ensure the delivery of quality kidney-supportive care. This study will help to determine the process and the factors enabling and impeding nurse engagement in supportive care in dialysis to effect change for normalizing advance care planning conversations in the clinical setting. This improved practice will have substantive beneficial implications for the many individuals living with kidney failure and their supporting loved ones.

Keywords: dialysis, kidney failure, nursing, supportive care

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Authors: Somayeh Khanjani, Samaneh Nabavi, Shirin Jalili

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Aluminum phosphide (ALP) is an inorganic phosphide used to control insects and is a highly effective insecticide and rodenticide used frequently to protect stored grain. Acute poisoning with this compound is common in some countries including India and Iran, and is a serious health problem. In Iran it was known as "rice tablet", for its use to preserve rice. Two kinds of rice tablets one being herbal while other containing 3g aluminum phosphide (AlP) are available for use in Iranian households to protect stored food grains from pests and rodents. The toxicity of Aluminum phosphide is attributed to the liberation of phosphine gas in contact with water or weak acid and is the major cause of poisoning and deaths. Rice tablet (Aluminum Phosphid) poisoning may be associated with serious and sometimes incurable complications. In 61.3% of patients were shown uniform ingestion. Vomiting was the most common symptoms reported by 96.4% patients. Agitation was reported in 36.9% and felling of thirsty in 27.9 %. Although many complications such as Hypotension, Adult Respiratory Distress Syndrome (ARDS), Acute Renal Failure (ARF) AND Multi Organ Failure (MOF) were the common complications observed in these patients, but the most lethal complication was Cardiac Arrhythmias occurred in 36.9% of cases. Abdominal pain in 31.4% of the patients, nausea in 79.4% of the patients and 41.1% of the patients showed metabolic acidosis. Suicidal intention was the most common cause of poisoning leading to deaths in 18.6% of the patients. Aluminum phosphide can cause either elevation, decrease or no change in electrolytes, bicarbonate and blood glucose level. The possible mechanism for changes in blood glucose levels are complex and depend on the balance of factors which increase its concentration and those which reduce it. AlP poisoning has been postulated to stimulate cortisol which leads to increasing blood level of cortisol, also it may cause stimulation of glucagon, and Adrenaline secretion; in addition, it can inhibit insulin synthesis which may lead to hyperglycemia. Another suggested mechanism of hyperglycemia is rennin activity in some cases, an increase in magnesium level of plasma and that of tissues, and high phosphate level. Although hyperglycemia is most frequent in this poisoning and also is known as a marker of poor prognostic, hypoglycemia in aluminum phosphide poisoning is a rare finding which may be so dangerous. Patients showed sever hypotension and sever acidosis in addition to sever hypoglycemia. The presenting features of AlP intoxication are rapid onset of shock, severe metabolic acidosis, cardiac dysrhythmias and adult respiratory distress syndrome (ARDS).

Keywords: aluminum phosphide (ALP), rice tablet, poisoning, phosphine gas

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Authors: Christina Van Wingerden

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This paper focuses on a sense of belonging, isolation, and the use of a learning management system as a “third space” for connection and community. Given student use of learning management systems (LMS) for courses on campuses, moderate to high use of social media and hand-held devices, the author explores the possibilities of LMS as a third space. The COVID-19 pandemic has exacerbated student experiences of isolation, and research indicates that students who experience a sense of belonging have a greater likelihood for academic retention and success. The impacts on students of an LMS designed for student employee orientation and training were examined through a mixed methods approach, including a survey, individual interviews, and focus groups. The sample involved 250-450 undergraduate student employees at a US northwestern university. The goal of the study was to find out the efficiency and effectiveness of the orientation information for a wide range of student employees from multiple student affairs departments. And unexpected finding emerged within the study in 2015 and was noted again as a finding in the 2017 study. Students reported feeling like they individually connected to the department, and further to the university because of the LMS orientation. They stated they could see themselves as part of the university community and like they belonged. The orientation, through the LMS, was designed for and occurred online (asynchronous), prior to students traveling and beginning university life for the academic year. The students indicated connection and belonging resulting from some of the design features. With the onset of COVID-19 and prolonged sheltering in place in North America, as well as other parts of the world, students have been precluded from physically gathering to educate and learn. COVID-19 essentially paused face-to-face education in 2020. Media, governments, and higher education outlets have been reporting on widespread college student stress, isolation, loneliness, and sadness. In this context, the author conducted a current mixed methods study (online survey, online interviews) of students in advanced degree programs, like Ph.D. and Ed.D. specifically investigating isolation and sense of belonging. As a part of the study a prototype of a Canvas site was experienced by student interviewees for their reaction of this Canvas site prototype as a “third” space. Some preliminary findings of this study are presented. Doctoral students in the study affirmed the potential of LMS as a third space for community and social academic connection.

Keywords: COVID-19, isolation, learning management system, sense of belonging

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Authors: Havva Tutar Kahraman, Erol Pehlivan

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In recent years, environmental pollution by wastewater rises very critically. Effluents discharged from various industries cause this challenge. Different type of pollutants such as organic compounds, oxyanions, and heavy metal ions create this threat for human bodies and all other living things. However, heavy metals are considered one of the main pollutant groups of wastewater. Therefore, this case creates a great need to apply and enhance the water treatment technologies. Among adopted treatment technologies, adsorption process is one of the methods, which is gaining more and more attention because of its easy operations, the simplicity of design and versatility. Ion exchange process is one of the preferred methods for removal of heavy metal ions from aqueous solutions. It has found widespread application in water remediation technologies, during the past several decades. Therefore, the purpose of this study is to the removal of hexavalent chromium, Cr(VI), from aqueous solutions. Cr(VI) is considered as a well-known highly toxic metal which modifies the DNA transcription process and causes important chromosomic aberrations. The treatment and removal of this heavy metal have received great attention to maintaining its allowed legal standards. The purpose of the present paper is an attempt to investigate some aspects of the use of three anion exchange resins: Eichrom 1-X4, Lewatit Monoplus M800 and Lewatit A8071. Batch adsorption experiments were carried out to evaluate the adsorption capacity of these three commercial resins in the removal of Cr(VI) from aqueous solutions. The chromium solutions used in the experiments were synthetic solutions. The parameters that affect the adsorption, solution pH, adsorbent concentration, contact time, and initial Cr(VI) concentration, were performed at room temperature. High adsorption rates of metal ions for the three resins were reported at the onset, and then plateau values were gradually reached within 60 min. The optimum pH for Cr(VI) adsorption was found as 3.0 for these three resins. The adsorption decreases with the increase in pH for three anion exchangers. The suitability of Freundlich, Langmuir and Scatchard models were investigated for Cr(VI)-resin equilibrium. Results, obtained in this study, demonstrate excellent comparability between three anion exchange resins indicating that Eichrom 1-X4 is more effective and showing highest adsorption capacity for the removal of Cr(VI) ions. Investigated anion exchange resins in this study can be used for the efficient removal of chromium from water and wastewater.

Keywords: adsorption, anion exchange resin, chromium, kinetics

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Authors: Amy Pullen, Samantha Rodrigues, David Kieser, Brian Shaw

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The aim of the study was to determine if a projectile interacting with the lungs increases the severity of injury in comparison to a projectile interacting with the ribs or intercostal muscle. This comparative study employed a 10% gelatine based model with either porcine ribs or balloons embedded to represent a lung. Four sample groups containing five samples were evaluated; these were control (plain gel), intercostal impact, rib impact, and lung impact. Two ammunition natures were evaluated at a range of 10m; these were 5.56x45mm and 7.62x51mm. Aspects of projectile behavior were quantified including exiting projectile weight, location of yawing, projectile fragmentation and distribution, location and area of the temporary cavity, permanent cavity formation, and overall energy deposition. Major findings included the cavity showing a higher percentage of the projectile weight exit the block than the intercostal and ribs, but similar to the control for the 5.56mm ammunition. However, for the 7.62mm ammunition, the lung was shown to have a higher percentage of the projectile weight exit the block than the control, intercostal and ribs. The total weight of projectile fragments as a function of penetration depth revealed large fluctuations and significant intra-group variation for both ammunition natures. Despite the lack of a clear trend, both plots show that the lung leads to greater projectile fragments exiting the model. The lung was shown to have a later center of the temporary cavity than the control, intercostal and ribs for both ammunition types. It was also shown to have a similar temporary cavity volume to the control, intercostal and ribs for the 5.56mm ammunition and a similar temporary cavity to the intercostal for the 7.62mm ammunition The lung was shown to leave a similar projectile tract than the control, intercostal and ribs for both ammunition types. It was also shown to have larger shear planes than the control and the intercostal, but similar to the ribs for the 5.56mm ammunition, whereas it was shown to have smaller shear planes than the control but similar shear planes to the intercostal and ribs for the 7.62mm ammunition. The lung was shown to have less energy deposited than the control, intercostal and ribs for both ammunition types. This comparative study provides insights into the influence of the lungs on thoracic gunshot trauma. It indicates that the lungs limits projectile deformation and causes a later onset of yawing and subsequently limits the energy deposited along the wound tract creating a deeper and smaller cavity. This suggests that lung impact creates an altered pattern of local energy deposition within the target which will affect the severity of trauma.

Keywords: ballistics, lung, trauma, wounding

Procedia PDF Downloads 161

Authors: Ghaneshree Moonsamy, Nodumo N. Zulu, Rajesh Lalloo, Suren Singh, Santosh O. Ramchuran

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The abalone industry of South Africa is under severe pressure due to illegal harvesting and poaching of this seafood delicacy. These abalones are harvested excessively; as a result, these animals do not have a chance to replace themselves in their habitats, ensuing in a drastic decrease in natural stocks of abalone. Abalone has an extremely slow growth rate and takes approximately four years to reach a size that is market acceptable; therefore, it was imperative to investigate methods to boost the overall growth rate and immunity of the animal. The University of Cape Town (UCT) began to research, which resulted in the isolation of two microorganisms, a yeast isolate Debaryomyces hansenii and a bacterial isolate Vibrio midae, from the gut of the abalone and characterised them for their probiotic abilities. This work resulted in an internationally competitive concept technology that was patented. The next stage of research was to develop a suitable bioprocess to enable commercial production. Numerous steps were taken to develop an efficient production process for V. midae, one of the isolates found by UCT. The initial stages of research involved the development of a stable and robust inoculum and the optimization of physiological growth parameters such as temperature and pH. A range of temperature and pH conditions were evaluated, and data obtained revealed an optimum growth temperature of 30ᵒC and a pH of 6.5. Once these critical growth parameters were established further media optimization studies were performed. Corn steep liquor (CSL) and high test molasses (HTM) were selected as suitable alternatives to more expensive, conventionally used growth medium additives. The optimization of CSL (6.4 g.l⁻¹) and HTM (24 g.l⁻¹) concentrations in the growth medium resulted in a 180% increase in cell concentration, a 5716-fold increase in cell productivity and a 97.2% decrease in the material cost of production in comparison to conventional growth conditions and parameters used at the onset of the study. In addition, a stable market-ready liquid probiotic product, encompassing the viable but not culturable (VBNC) state of Vibrio midae cells, was developed during the downstream processing aspect of the study. The demonstration of this technology at a full manufacturing scale has further enhanced the attractiveness and commercial feasibility of this production process.

Keywords: probiotics, abalone aquaculture, bioprocess technology, manufacturing scale technology development

Procedia PDF Downloads 147

Authors: Neringa Bagdonaite

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Study Aims: The current study aimed to systematically analyse various research done in the area of female post-traumatic stress disorder (PTSD) and alcohol abuse, and to critically review these results on the basis of theoretical models as well as answer following questions: (I) What is the reciprocal relationship between PTSD and problem alcohol use among females; (II) What are the moderating/mediating factors of this relationship? Methods: The computer bibliographic databases Ebsco, Scopus, Springer, Web of Science, Medline, Science Direct were used to search for scientific articles. Systematic analyses sample consisted of peer-reviewed, English written articles addressing mixed gender and female PTSD and alcohol abuse issues from Jan 2012 to May 2017. Results: Total of 1011 articles were found in scientific databases related to searched keywords of which 29 met the selection criteria and were analysed. The results of longitudinal studies indicate that (I) various trauma, especially interpersonal trauma exposure in childhood is linked with increased risk of revictimization in later life and problem alcohol use; (II) revictimization in adolescence or adulthood, rather than victimization in childhood has a greater impact on the onset and progression of problematic alcohol use in adulthood. Cross-sectional and epidemiological studies also support significant relationships between female PTSD and problem alcohol use. Regards to the negative impact of alcohol use on PTSD symptoms results are yet controversial; some evidence suggests that alcohol does not exacerbate symptoms of PTSD over time, while others argue that problem alcohol use worsens PTSD symptoms and is linked to chronicity of both disorders, especially among women with previous alcohol use problems. Analysis of moderating/mediating factors of PTSD and problem alcohol use revealed, that higher motives/expectancies, specifically distress coping motives for alcohol use significantly moderates the relationship between PTSD and problematic alcohol use. Whereas negative affective states mediate relationship between symptoms of PTSD and alcohol use, but only among woman with alcohol use problems already developed. Conclusions: Interpersonal trauma experience, especially in childhood and its reappearance in lifetime is linked with PTSD symptoms and problem drinking among women. Moreover, problem alcohol use can be both a cause and a consequence of trauma and PTSD, and if used for coping it, increases the likelihood of chronicity of both disorders. In order to effectively treat both disorders, it’s worthwhile taking into account this dynamic interplay of women's PTSD symptoms and problem drinking.

Keywords: female, trauma, post-traumatic stress disorder, problem alcohol use, systemic analysis

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Authors: Rasha Shoumar

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Background: Since the onset of the Syria crisis in 2011, Jordan has hosted many Syrian refugees, many of which are residing in urban and rural areas. Vulnerability of refugees has increased due to the COVID-19 pandemic, adding to their already existing challenge in access to medical services, rendering them vulnerable to the complications of untreated medical conditions and amplifying their risk for severe COVID-19 disease. To improve health outcomes and access to health care services in a COVID-19 context, IOM (The International Organization for Migration) provided health services including awareness raising, direct primary health care through mobile teams and referrals to secondary services were extended to the vulnerable populations of refugees. Method: 6 community health volunteers were trained and deployed to different governorates to provide COVID-19 and non-communicable disease awareness and collect data rated to non-communicable disease and access to medical health services. Primary health care services were extended to 7 governorates through a mobile medical team, providing medical management. The collected Data was reviewed and analyzed. Results: 2150 refugees in rural areas were reached out by community health volunteers, out of which 78 received their medications through the Ministry of Health, 121 received their medications through different non-governmental organizations, 665 patients couldn’t afford buying any medications, 1286 patients were occasionally buying their medications when they were able to afford it. 853 patients received medications and follow up through IOM mobile clinics, the most common conditions were hypertension, diabetes, hyperlipidemia, anemia, heart disease, thyroid disease, asthma, seizures, and psychiatric conditions. 709 of these patients had more than 3 of the comorbidities. Multiple cases were referred for secondary and tertiary lifesaving interventions. Conclusion: Non communicable diseases are highly prevalent among refugee population in Jordan, access to medical services have proven to be a challenge in rural areas especially during the COVID-19 era, many of the patients have multiple uncontrolled medical conditions placing them at risk for complications and risk for severe COVID-19 disease. Deployment of mobile clinics to rural areas plays an essential role in managing such medical conditions, thus improving the continuum of health care approach, physical and mental wellbeing of refugees and reducing the risk for severe COVID-19 disease among this group, taking us one step forward toward universal health access.

Keywords: COVID-19, refugees, mobile clinics, primary health care

Procedia PDF Downloads 128

Authors: Yuji Fujino, Kazu Amimoto, Kazuhiro Fukata, Masahide Inoue, Hidetoshi Takahashi, Shigeru Makita

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Aim: Pusher behavior (PB) is a disorder in which stroke patients shift their body weight toward the affected side of the body (the hemiparetic side) and push away from the non-hemiparetic side. These patients often use further pushing to resist any attempts to correct their position to upright. It is known that the subcortical white matter lesion (SWML) usually correlates of gait or balance function in stroke patients. However, it is unclear whether the SWML influences PB. The purpose of this study was to investigate if the damage of SWML affects the severity of PB on acute stroke patients. Methods: Fourteen PB patients without thalamic or cortical lesions (mean age 73.4 years, 17.5 days from onset) participated in this study. Evaluation of PB was performed according to the Scale for Contraversive Pushing (SCP) for sitting and/or standing. We used modified criteria wherein the SCP subscale scores in each section of the scale were >0. As a clinical measurement, patients were evaluated by the Stroke Impairment Assessment Set (SIAS). For the depiction of SWML, we used T2-weighted fluid-attenuated inversion-recovery imaging. The degree of damage on SWML was assessed using the Fazekas scale. Patients were divided into two groups in the presence of SWML (SWML+ group; Fazekas scale grade 1-3, SWML- group; Fazekas scale grade 0). The independent t-test was used to compare the SCP and SIAS. This retrospective study was approved by the Ethics Committee. Results: In SWML+ group, the SCP was 3.7±1.0 points (mean±SD), the SIAS was 28.0 points (median). In SWML- group, the SCP was 2.0±0.2 points, and the SIAS was 31.5 points. The SCP was significantly higher in SWML+ group than in SWML- group (p<0.05). The SIAS was not significant in both groups (p>0.05). Discussion: It has been considered that the posterior thalamus is the neural structures that process the afferent sensory signals mediating graviceptive information about upright body orientation in humans. Therefore, many studies reported that PB was typically associated with unilateral lesions of the posterior thalamus. However, the result indicates that these extra-thalamic brain areas also contribute to the network controlling upright body posture. Therefore, SMWL might induce dysfunction through malperfusion in distant thalamic or other structurally intact neural structures. This study had a small sample size. Therefore, future studies should be performed with a large number of PB patients. Conclusion: The present study suggests that SWML can be definitely associated with PB. The patients with SWML may be severely incapacitating.

Keywords: pushing behavior, subcortical white matter lesion, acute phase, stroke

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Authors: Tanya Anand, Arun Kandasamy, L. N. Suman

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Family based therapy for adolescent substance abuse has been studied to be effective in the West. Whereas, based on literature review, family therapy and interventions for adolescent substance abuse is still in its nascent stages in India. A multidimensional perspective to treatment has been indicated consistently in the Indian literature, but standardized therapy which addresses early substance abuse, from a social-ecological perspective has not been developed and studied for Indian population. While numerous researches have been conducted in India on the need of engaging the family in therapy for the purpose of symptom reduction, long-term maintenance of gains, and reducing family burnout, distress and dysfunction; a family based model in the Indian context has not been developed and tried, to the best of our knowledge. Hence, from the aim of building a model to treat adolescent substance abuse within the family context, experts in the area of mental health and deaddiction were interviewed to inform upon the clinical difficulties, challenges, uniqueness that Indian families present with. The integration of indigenous techniques that would be helpful in engaging families of young individuals with difficulties were also explored. Eight experts' who were interviewed, have 10-30 years of experience in working with families and substance users. An open-ended interview was conducted with the experts individually and audio-recorded. The interviews were then transcribed and subjected to qualitative analysis for building a framework and treatment guideline. Additionally, interviews with patients and their parents were conducted to elicit ‘felt needs’. The results of the analysis revealed culture-specific issues widely experienced within Indian families by adolescents and young adults, centering around the theme of Individuation versus collective identity and living. Substance abuse, in this framework, was found to be perceived as one of the maladaptive ways of the youth to disengage from the family and attempt at individuation and the responsibilities that are considered entitlements in the culture. On the other hand, interviews with family members revealed them to be engaging in inconsistent patterns of care and parenting. This was experienced and observed in terms of fostering interdependence within the family, sometimes within adverse socio-economic and societal conditions, where enacted and perceived stigma kept the individual and family members in a vicious loop of maladaptive coping patterns, dysfunctional family arrangements, and often leading to burnout with poor help seeking. The paper inform upon a framework that lays down the foundation for assessments, planning, case management and therapist competencies, required to address alcohol and drug issues in an Indian family context with such etiological factors at its heart. This paper will cover qualitative results of the interviews and present a model that may guide mental health professionals for treatment of adolescent substance use and family therapy.

Keywords: Indian families, family therapy, de-addiction, adolescent, youth, substance abuse, behavioral issues, felt needs, culture, etiology, model building, framework development, interviews

Procedia PDF Downloads 124

Authors: Olga I. Moskalenko, Vladislav A. Khanadeev, Anastasya D. Koloskova, Alexey A. Koronovskii, Anatoly A. Pivovarov

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Generalized synchronization is one of the most intricate phenomena in nonlinear science. It can be observed both in systems with a unidirectional and mutual type of coupling including the complex networks. Such a phenomenon has a number of practical applications, for example, for the secure information transmission through the communication channel with a high level of noise. Known methods for the secure information transmission needs in the increase of the privacy of data transmission that arises a question about the observation of such phenomenon in systems with a complex topology of chaotic attractor possessing two or more positive Lyapunov exponents. The present report is devoted to the study of such phenomenon in two unidirectionally and mutually coupled dynamical systems being in chaotic (with one positive Lyapunov exponent) and hyperchaotic (with two or more positive Lyapunov exponents) regimes, respectively. As the systems under study, we have used two mutually coupled modified Lorenz oscillators and two unidirectionally coupled time-delayed generators. We have shown that in both cases the generalized synchronization regime can be detected by means of the calculation of Lyapunov exponents and phase tube approach whereas due to the complex topology of attractor the nearest neighbor method is misleading. Moreover, the auxiliary system approaches being the standard method for the synchronous regime observation, for the mutual type of coupling results in incorrect results. To calculate the Lyapunov exponents in time-delayed systems we have proposed an approach based on the modification of Gram-Schmidt orthogonalization procedure in the context of the time-delayed system. We have studied in detail the mechanisms resulting in the generalized synchronization regime onset paying a great attention to the field where one positive Lyapunov exponent has already been become negative whereas the second one is a positive yet. We have found the intermittency here and studied its characteristics. To detect the laminar phase lengths the method based on a calculation of local Lyapunov exponents has been proposed. The efficiency of the method has been verified using the example of two unidirectionally coupled Rössler systems being in the band chaos regime. We have revealed the main characteristics of intermittency, i.e. the distribution of the laminar phase lengths and dependence of the mean length of the laminar phases on the criticality parameter, for all systems studied in the report. This work has been supported by the Russian President's Council grant for the state support of young Russian scientists (project MK-531.2018.2).

Keywords: complex topology of attractor, generalized synchronization, hyperchaos, Lyapunov exponents

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Authors: Nanteza Rachel

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Background: Worldwide, there were 36.7 million people living with Human Immunodeficiency Virus (HIV) in 2015, up from 35 million at the end of 2013. Wakiso district is one of the hotspots for the Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) infection in Uganda, with the prevalence of 8.1 %. Herbal medicine has gained popularity among Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) patients as adjuvant therapy to reduce the adverse effects of ART. Regardless of the subsidized and physical availability of the Anti-Retroviral Therapy (ART), majority of Africans living with Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) resort to adding to their ART traditional medicine. Result found out from a pilot observation made by the PI that indicate 13 out of 30 People Living with AIDS(PLWA) who are attending Human Immunodeficiency Virus (HIV) clinics in Wakiso district reported to be using herbal preparations despite the fact that they were taking Anti Retro Viral (ARVs) this prompted this study to be done. Purpose of the study: To determine the prevalence and factors associated with concurrent use of herbal medicine and anti-retroviral therapy among HIV/AIDS patients attending selected HIV clinics in Wakiso district. Methodology: This was a cross sectional study with both quantitative data collection (use of a questionnaire) and qualitative data collection (key informants’ interviews). A mixed method of sampling was used, that is, purposive and random sampling. Purposive sampling was based on the location in the district and used to select 7 health facilities basing on the 7 health sub districts from Wakiso. Simple random sampling was used to select one HIV clinic from each of the 7 health sub districts. Furthermore, the study units were enrolled in to the study as they entered into the HIV clinics, and 105 respondents were interviewed. Both manual and computer packages (SPSS) were used to analyze the data Results: The prevalence of concurrent use of herbal medicine and ART was 38 (36.2%). Commonly HIV symptom treated with herbs was fever 27(71.1%), diarrhea 3(7.9%) and cough 2(5.3%). Commonly used herbs for fever (Omululuza (Vernonica amydalina), Ekigagi (Aloe sp), Nalongo (Justicia betonica Linn) while for diarrhea was Ntwatwa. The side effects also included; too much pain, itchy pain of HIV, aneamia,felt sick, loss/gain appetite, joint pain and bad dreams. Herbs used to sooth the side effects were; for aneamia was avocado leaves Parea Americana mill The significant factors associated with concurrent use of herbal medicine were being familiar with herbs and conventional medicine for management HIV symptoms being expensive. The other significant factor was exhibiting hostility to patients by health personnel providing HIV care. Conclusion: Herbal medicine is widely used by clients in HIV/AIDS care. Patients being familiar with herbs and conventional medicine being expensive were associated with concurrent use of herbal medicine and ART. The exhibition of hostility to the HIV/AIDS patients by the health care providers was also associated with concurrent use of herbal medicine and ART among HIV/AIDS patients.

Keywords: HIV patients, herbal medicine, antiretroviral therapy, factors associated

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Authors: Rosni Lakandri

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With the development of science and technology, there has been a complete transformation in the domain of information technology. Particularly after the Second World War and Cold War period, the role of media and communication technology in shaping the political, economic, socio-cultural proceedings across the world has been tremendous. It performs as a channel between the governing bodies of the state and the general masses. As we have seen the international community constantly talking about the onset of Asian Century, India and China happens to be the major player in this. Both have the civilization history, both are neighboring countries, both are witnessing a huge economic growth and, important of all, both are considered the rising powers of Asia. Not negating the fact that both countries have gone to war with each other in 1962 and the common people and even the policy makers of both the sides view each other till now from this prism. A huge contribution to this perception of people goes to the media coverage of both sides, even if there are spaces of cooperation which they share, the negative impacts of media has tended to influence the people’s opinion and government’s perception about each other. Therefore, analysis of media’s impression in both the countries becomes important in order to know their effect on the larger implications of foreign policy towards each other. It is usually said that media not only acts as the information provider but also acts as ombudsman to the government. They provide a kind of check and balance to the governments in taking proper decisions for the people of the country but in attempting to answer this hypothesis we have to analyze does the media really helps in shaping the political landscape of any country? Therefore, this study rests on the following questions; 1.How do China and India depict each other through their respective News media? 2.How much and what influences they make on the policy making process of each country? How do they shape the public opinion in both the countries? In order to address these enquiries, the study employs both primary and secondary sources available, and in generating data and other statistical information, primary sources like reports, government documents, and cartography, agreements between the governments have been used. Secondary sources like books, articles and other writings collected from various sources and opinion from visual media sources like news clippings, videos in this topic are also included as a source of on ground information as this study is not based on field study. As the findings suggest in case of China and India, media has certainly affected people’s knowledge about the political and diplomatic issues at the same time has affected the foreign policy making of both the countries. They have considerable impact on the foreign policy formulation and we can say there is some mediatization happening in foreign policy issues in both the countries.

Keywords: China, foreign policy, India, media, public opinion

Procedia PDF Downloads 143

Authors: Rodrigo De A. Ferrazza, Henry D. M. Garcia, Viviana H. V. Aristizabal, Camilla De S. Nogueira, Cecilia J. Verissimo, Jose Roberto Sartori, Roberto Sartori, Joao Carlos P. Ferreira

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Environmental factors adversely influence sustainability in livestock production system. Dairy herds are the most affected by heat stress among livestock industries. This clearly implies in development of new strategies for mitigating heat, which should be based on physiological and metabolic adaptations of the animal. In this study, we incorporated the effect of climate variables and heat exposure time on the thermoregulatory responses in order to clarify the adaptive mechanisms for bovine heat dissipation under intense thermal stress induced experimentally in climate chamber. Non-lactating Holstein cows were contemporaneously and randomly assigned to thermoneutral (TN; n=12) or heat stress (HS; n=12) treatments during 16 days. Vaginal temperature (VT) was measured every 15 min with a microprocessor-controlled data logger (HOBO®, Onset Computer Corporation, Bourne, MA, USA) attached to a modified vaginal controlled internal drug release insert (Sincrogest®, Ourofino, Brazil). Rectal temperature (RT), respiratory rate (RR) and heart rate (HR) were measured twice a day (0700 and 1500h) and dry matter intake (DMI) was estimated daily. The ambient temperature and air relative humidity were 25.9±0.2°C and 73.0±0.8%, respectively for TN, and 36.3± 0.3°C and 60.9±0.9%, respectively for HS. Respiratory rate of HS cows increased immediately after exposure to heat and was higher (76.02±1.70bpm; P<0.001) than TN (39.70±0.71bpm), followed by rising of RT (39.87°C±0.07 for HS versus 38.56±0.03°C for TN; P<0.001) and VT (39.82±0.10°C for HS versus 38.26±0.03°C for TN; P<0.001). A diurnal pattern was detected, with higher (P<0.01) afternoon temperatures than morning and this effect was aggravated for HS cows. There was decrease (P<0.05) of HR for HS cows (62.13±0.99bpm) compared to TN (66.23±0.79bpm), but the magnitude of the differences was not the same over time. From the third day, there was a decrease of DMI for HS in attempt to maintain homeothermy, while TN cows increased DMI (8.27kg±0.33kg d-1 for HS versus 14.03±0.29kg d-1 for TN; P<0.001). By regression analysis, RT and RR better reflected the response of cows to changes in the Temperature Humidity Index and the effect of climate variables from the previous day to influence the physiological parameters and DMI was more important than the current day, with ambient temperature the most important factor. Comparison between acute (0 to 3 days) and chronic (13 to 16 days) exposure to heat stress showed decreasing of the slope of the regression equations for RR and DMI, suggesting an adaptive adjustment, however with no change for RT. In conclusion, intense heat stress exerted strong influence on the thermoregulatory mechanisms, but the acclimation process was only partial.

Keywords: acclimation, bovine, climate chamber, hyperthermia, thermoregulation

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Authors: Sanjeet Patra, Soham Roychowdhury

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In recent times, functionally graded dielectric elastomer (FGDE) has gained significant attention within the realm of soft actuation due to its dual capacity to exert highly localized stresses while maintaining its compliant characteristics on application of electro-mechanical loading. Nevertheless, the full potential of dielectric elastomer (DE) has not been fully explored due to their susceptibility to instabilities when subjected to electro-mechanical loads. As a result, study and analysis of such instabilities becomes crucial for the design and realization of dielectric actuators. Prismatic bifurcation is a type of instability that has been recognized in a DE tube. Though several studies have reported on the analysis for prismatic bifurcation in an isotropic DE tube, there is an insufficiency in studies related to prismatic bifurcation of FGDE tubes. Therefore, this paper aims to determine the onset of prismatic bifurcations on an incompressible FGDE tube when subjected to electrical loading across the thickness of the tube and internal pressurization. The analysis has been conducted by imposing two axial boundary conditions on the tube, specifically axially free ends and axially clamped ends. Additionally, the rigidity modulus of the tube has been linearly graded in the direction of thickness where the inner surface of the tube has a lower stiffness than the outer surface. The static equilibrium equations for deformation of the axisymmetric tube are derived and solved using numerical technique. The condition for prismatic bifurcation of the axisymmetric static equilibrium solutions has been obtained by using the linearized incremental constitutive equations. Two modes of bifurcations, corresponding to two different non-circular cross-sectional geometries, have been explored in this study. The outcomes reveal that the FGDE tubes experiences prismatic bifurcation before the Hessian criterion of failure is satisfied. It is observed that the lower mode of bifurcation can be triggered at a lower critical voltage as compared to the higher mode of bifurcation. Furthermore, the tubes with larger stiffness gradient require higher critical voltages for triggering the bifurcation. Moreover, with the increase in stiffness gradient, a linear variation of the critical voltage is observed with the thickness of the tube. It has been found that on applying internal pressure to a tube with low thickness, the tube becomes less susceptible to bifurcations. A thicker tube with axially free end is found to be more stable than the axially clamped end tube at higher mode of bifurcation.

Keywords: critical voltage, functionally graded dielectric elastomer, linearized incremental approach, modulus of rigidity, prismatic bifurcation

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Authors: Ramin Hosseinnezhad, Iurii Vozniak, Andrzej Galeski

Abstract:

Shear-induced crystallization, originated from orientation of chains along the flow direction, is an inevitable part of most polymer processing technologies. It plays a dominant role in determining the final product properties and is affected by many factors such as shear rate, cooling rate, total strain, etc. Investigation of the shear-induced crystallization process become of great importance for preparation of nanocomposite, which requires crystallization of nanofibrous sheared inclusions at higher temperatures. Thus, the effects of shear time, shear rate, and also thermal condition of cooling on crystallization of two aliphatic-aromatic copolyesters have been investigated. This was performed using Linkam optical shearing system (CSS450) for both Ecoflex® F Blend C1200 produced by BASF and synthesized copolyester of butylene terephthalate and a mixture of butylene esters: adipate, succinate, and glutarate, (PBASGT), containing 60% of aromatic comonomer. Crystallization kinetics of these biodegradable copolyesters was studied at two different conditions of shearing. First, sample with a thickness of 60µm was heated to 60˚C above its melting point and subsequently subjected to different shear rates (100–800 sec-1) while cooling with specific rates. Second, the same type of sample was cooled down when shearing at constant temperature was finished. The intensity of transmitted depolarized light, recorded by a camera attached to the optical microscope, was used as a measure to follow the crystallization. Temperature dependencies of conversion degree of samples during cooling were collected and used to determine the half-temperature (Th), at which 50% conversion degree was reached. Shearing ecoflex films for 45 seconds with a shear rate of 100 sec-1 resulted in significant increase of Th from 56˚C to 70˚C. Moreover, the temperature range for the transition of molten samples to crystallized state decreased from 42˚C to 20˚C. Comparatively low shift of 10˚C in Th towards higher temperature was observed for PBASGT films at shear rate of 600 sec-1 for 45 seconds. However, insufficient melt flow strength and non-laminar flow due to Taylor vortices was a hindrance to reach more elevated Th at very high shear rates (600–800 sec-1). The shift in Th was smaller for the samples sheared at a constant temperature and subsequently cooled down. This may be attributed to the longer time gap between cessation of shearing and the onset of crystallization. The longer this time gap, the more possibility for crystal nucleus to re-melt at temperatures above Tm and for polymer chains to recoil and relax. It is found that the crystallization temperature, crystallization induction time and spherulite growth of aliphatic-aromatic copolyesters are dramatically influenced by both the cooling rate and the shear imposed during the process.

Keywords: induced crystallization, shear rate, aliphatic-aromatic copolyester, ecoflex

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Authors: Bruno Biagianti, Angela Tseng, Kathy Wannaviroj, Allison Corlett, Megan DuBois, Kyu Lee, Suma Jacob

Abstract:

Background: ASD is characterized by pervasive Sensory Processing Abnormalities (SPA) and social cognitive deficits that persist throughout the course of the illness and have been linked to functional abnormalities in specific neural systems that underlie the perception, processing, and representation of sensory information. SPA and social cognitive deficits are associated with difficulties in interpersonal relationships, poor development of social skills, reduced social interactions and lower academic performance. Importantly, they can hamper the effects of established evidence-based psychological treatments—including PEERS (Program for the Education and Enrichment of Relationship Skills), a parent/caregiver-assisted, 16-weeks social skills intervention—which nonetheless requires a functional brain capable of assimilating and retaining information and skills. As a matter of fact, some adolescents benefit from PEERS more than others, calling for strategies to increase treatment response rates. Objective: We will present interim data on CICADAS (Care Improving Cognition for ADolescents on the Autism Spectrum)—a clinician-assisted, closed-loop technology mobile application for adolescents with ASD. Via ten mobile assessments, CICADAS captures data on sensory processing abnormalities and associated cognitive deficits. These data populate a machine learning algorithm that tailors the delivery of ten neuroplasticity-based social cognitive training (NB-SCT) exercises targeting sensory processing abnormalities. Methods: In collaboration with the Autism Spectrum and Neurodevelopmental Disorders Clinic at the University of Minnesota, we conducted a fully remote, three-arm, randomized crossover trial with adolescents with ASD to document the acceptability of CICADAS and evaluate its potential as a stand-alone treatment or as a treatment enhancer of PEERS. Twenty-four adolescents with ASD (ages 11-18) have been initially randomized to 16 weeks of PEERS + CICADAS (Arm A) vs. 16 weeks of PEERS + computer games vs. 16 weeks of CICADAS alone (Arm C). After 16 weeks, the full battery of assessments has been remotely administered. Results: We have evaluated the acceptability of CICADAS by examining adherence rates, engagement patterns, and exit survey data. We found that: 1) CICADAS is able to serve as a treatment enhancer for PEERS, inducing greater improvements in sensory processing, cognition, symptom reduction, social skills and behaviors, as well as the quality of life compared to computer games; 2) the concurrent delivery of PEERS and CICADAS induces greater improvements in study outcomes compared to CICADAS only. Conclusion: While preliminary, our results indicate that the individualized assessment and treatment approach designed in CICADAS seems effective in inducing adaptive long-term learning about social-emotional events. CICADAS-induced enhancement of processing and cognition facilitates the application of PEERS skills in the environment of adolescents with ASD, thus improving their real-world functioning.

Keywords: ASD, social skills, cognitive training, mobile app

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Authors: Duncan Wallace, M-Tahar Kechadi

Abstract:

In recent years, Machine Learning (ML) approaches have been successfully applied to an analysis of patient symptom data in the context of disease diagnosis, at least where such data is well codified. However, much of the data present in Electronic Health Records (EHR) are unlikely to prove suitable for classic ML approaches. Furthermore, as scores of data are widely spread across both hospitals and individuals, a decentralized, computationally scalable methodology is a priority. The focus of this paper is to develop a method to predict outliers in an out-of-hours healthcare provision center (OOHC). In particular, our research is based upon the early identification of patients who have underlying conditions which will cause them to repeatedly require medical attention. OOHC act as an ad-hoc delivery of triage and treatment, where interactions occur without recourse to a full medical history of the patient in question. Medical histories, relating to patients contacting an OOHC, may reside in several distinct EHR systems in multiple hospitals or surgeries, which are unavailable to the OOHC in question. As such, although a local solution is optimal for this problem, it follows that the data under investigation is incomplete, heterogeneous, and comprised mostly of noisy textual notes compiled during routine OOHC activities. Through the use of Deep Learning methodologies, the aim of this paper is to provide the means to identify patient cases, upon initial contact, which are likely to relate to such outliers. To this end, we compare the performance of Long Short-Term Memory, Gated Recurrent Units, and combinations of both with Convolutional Neural Networks. A further aim of this paper is to elucidate the discovery of such outliers by examining the exact terms which provide a strong indication of positive and negative case entries. While free-text is the principal data extracted from EHRs for classification, EHRs also contain normalized features. Although the specific demographical features treated within our corpus are relatively limited in scope, we examine whether it is beneficial to include such features among the inputs to our neural network, or whether these features are more successfully exploited in conjunction with a different form of a classifier. In this section, we compare the performance of randomly generated regression trees and support vector machines and determine the extent to which our classification program can be improved upon by using either of these machine learning approaches in conjunction with the output of our Recurrent Neural Network application. The output of our neural network is also used to help determine the most significant lexemes present within the corpus for determining high-risk patients. By combining the confidence of our classification program in relation to lexemes within true positive and true negative cases, with an inverse document frequency of the lexemes related to these cases, we can determine what features act as the primary indicators of frequent-attender and non-frequent-attender cases, providing a human interpretable appreciation of how our program classifies cases.

Keywords: artificial neural networks, data-mining, machine learning, medical informatics

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