Search results for: treatment outcomes

Authors: Ibrahim Abouelkhir

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Background: Prior to this project, the number of CT aorta requests from our Emergency Department (ED) was reported by the radiology department to be high with a low positive event rate: only 1- 2% of CT aortas performed were positive for acute aortic syndrome. This trend raised concerns about the time required to process and report these scans, potentially impacting the timely reporting of other high-priority imaging, such as trauma-related scans. Other harms identified were unnecessary radiation, patients spending longer in ED contributing to overcrowding, and, most importantly, the patient not getting the right care the first time. The radiology department also raised the problem of reporting bias because they expected our CT aortas to be normal. Aim: The main aim of this project was to reduce the number of unnecessary CT aortas requested, which would be shown by 1. Number of CT aortas requested and 2. Positive event rate. Methodology: This was a quality improvement project carried out in the ED at Frimley Park Hospital, UK. Starting from 1 st January 2024, we recorded the number of days required to reach 35 CT aorta requests. We looked at all patients presenting to the ED over the age of 16 for whom a CT aorta was requested by the ED team. We looked at how many of these scans were positive for acute aortic syndrome. The intervention was a change in practice: all CT aortas should be approved by an ED consultant or ST4+ registrar (5th April 2024). We then reviewed the number of days it took to reach a total of 35 CT aorta requests following the intervention and again reviewed how many were positive. Results: Prior to the intervention, 35 CT Aorta scans were performed over a 20-day period. Following the implementation of the ED senior doctor vetting process, the same number of CT Aorta scan requests was observed over 50 days - more than twice the pre-intervention period. This indicates a significant reduction in the rate of CT Aorta scans being requested. During the pre-intervention phase, there were two positive cases of acute aortic syndrome. In the post-intervention period, there were zero. Conclusion: The mandatory review of CT Aorta scan requested by the ED consultant effectively reduced the number of scans requested. However, this intervention did not lead to an increase in positive scan results. We noted that post-intervention, approximately 50% of scans had been approved by registrar-grade doctors and, only 50% had been approved by ED consultants, and the majority were not in-person reviews. We wonder if restricting the approval to consultant grade only might improve the results, and furthermore, in person reviews should be the gold standard.

Keywords: quality improvement project, CT aorta scans, emergency department, radiology department, aortic dissection, scan request vetting, clinical outcomes, imaging efficiency

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Authors: Yu-Ching Lin, Meei-Ling Gau, Ghi-Hwei Kao, Hung-Chang Lee

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Objective: To compare the pushing experiences and birth outcomes of three different pushing positions during the second stage of labor. The three positions were: semi-recumbent, squatting, and squatting with the aid of ergonomically designed ankle supports. Methods: A randomized controlled trial was conducted at a regional teaching hospital in northern Taiwan. Data were collected from 168 primiparous women in their 38th to 42nd gestational week. None of the participants received epidural analgesia during labor and all were free of pregnancy and labor-related complications. Intervention: During labor, after full cervical dilation and when the fetal head had descended to at least the +1 station and had turned to the occiput anterior position, the experimental group was asked to push in the squatting position while wearing the ergonomically designed ankle supports; comparison group A was asked to push in the squatting position without the use of these supports; and comparison group B was asked to push in a standard semi-recumbent position. Measures: The participants completed a demographic and obstetrics datasheet, the Short Form McGill Pain Questionnaire (MPQ-SF), and the Labor Pushing Experience scale within 4-hours postpartum. Conclusion: In terms of delivery time, the duration between the start of pushing to crowning for the experimental group (squatting with ankle supports) averaged 25.52 minutes less (F =6.02, p< .05) than the time for comparison group B (semi-recumbent). Furthermore, the duration between the start of pushing to infant birth averaged 25.21 minutes less for the experimental group than for comparison group B (F =6.14, p< .05). Moreover, the experimental group had a lower average VAS pain score (5.05±3.22) than comparison group B and the average McGill pain score for the experimental group was lower than both comparison groups (F=18.12, p< .001). In summary, the participants in the group that delivered from a squatting position with ankle supports had better labor pushing experiences than their peers in the comparison groups. Results: In comparison to both unsupported squatting and semi-recumbent pushing, squatting with the aid of ergonomically designed ankle supports reduced pushing times, ameliorated labor pain, and improved the pushing experience. Clinical application and suggestion: The squatting with ankle-support intervention introduced in the present study may significantly reduce tiredness and difficulties in maintaining balance as well as increase pushing efficiency. Thus, this intervention may reduce the caring needs of women during the second stage of labor. This intervention may be introduced in midwifery education programs and in clinical practice as a method to improve the care of women during the second stage of labor.

Keywords: second stage of labor, pushing, squatting with ankle supports, squatting

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Authors: W. Ling, Mohamed Saufi Bin Awang

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Introduction: Mycobacterium tuberculosis post a major health problem worldwide. Central nervous system (CNS) infection by mycobacterium tuberculosis is one of the most devastating complications of tuberculosis. Although with advancement in medical fields, we are yet to understand the pathophysiology of how mycobacterium tuberculosis was able to cross the blood-brain barrier (BBB) and infect the CNS. CNS TB may present with nonspecific clinical symptoms which can mimic other diseases/conditions; this is what makes the diagnosis relatively difficult and challenging. Public health has to be informed and educated about the spread of TB, and early identification of TB is important as it is a curable disease. Case Report: A young 21-year-old Malay gentleman was initially presented to us with symptoms of ear discharge, tinnitus, and right-sided headache for the past one year. Further history reveals that the symptoms have been mismanaged and neglected over the period of 1 year. Initial investigation reveals features of inflammation of the ear. Further imaging showed the feature of chronic inflammation of the otitis media and atypical right cerebral abscess, which has the same characteristic features and consistency. He further underwent a biopsy, and results reveal positive Mycobacterium tuberculosis of the otitis media. With the results and the available imaging, we were certain that this is likely a case of disseminated tuberculosis causing CNS TB. Conclusion: We aim to highlight the challenge and difficult face in our health care system and public health in early identification and treatment.

Keywords: central nervous system tuberculosis, intracranial tuberculosis, tuberculous encephalopathy, tuberculous meningitis

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Authors: Nino Kupatadze, Tamar Memanishvili, Natia Ochkhikidze, David Tugushi, Zaal Kokaia, Ramaz Katsarava

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Amino acid-based Biodegradable poly(ester-amide)s (PEAs) have gained considerable interest as a promising materials for numerous biomedical applications. These polymers reveal a high biocompatibility and easily form small particles suitable for delivery various biological, as well as elastic bio-erodible films serving as matrices for constructing antibacterial coatings. In the present work we have demonstrated a potential of the PEAs for two applications: 1. cell therapy for stroke as vehicles for delivery and sustained release of growth factors, 2. bactericidal coating as prevention biofilm and applicable in infected wound management. Stroke remains the main cause of adult disability with limited treatment options. Although stem cell therapy is a promising strategy, it still requires improvement of cell survival, differentiation and tissue modulation. .Recently, microspheres (MPs) made of biodegradable polymers have gained significant attention for providing necessary support of transplanted cells. To investigate this strategy in the cell therapy of stroke, MPs loaded with transcription factors Wnt3A/BMP4 were prepared. These proteins have been shown to mediate the maturation of the cortical neurons. We have suggested that implantation of these materials could create a suitable microenvironment for implanted cells. Particles with spherical shape, porous surface, and 5-40 m in size (monitored by scanning electron microscopy) were made on the basis of the original PEA composed of adipic acid, L-phenylalanine and 1,4-butanediol. After 4 months transplantation of MPs in rodent brain, no inflammation was observed. Additionally, factors were successfully released from MPs and affected neuronal cell differentiation in in vitro. The in vivo study using loaded MPs is in progress. Another severe problem in biomedicine is prevention of surgical devices from biofilm formation. Antimicrobial polymeric coatings are most effective “shields” to protect surfaces/devices from biofilm formation. Among matrices for constructing the coatings preference should be given to bio-erodible polymers. Such types of coatings will play a role of “unstable seating” that will not allow bacteria to occupy the surface. In other words, bio-erodible coatings would be discomfort shelter for bacteria that along with releasing “killers of bacteria” should prevent the formation of biofilm. For this purpose, we selected an original biodegradable PEA composed of L-leucine, 1,6-hexanediol and sebacic acid as a bio-erodible matrix, and nanosilver (AgNPs) as a bactericidal agent (“killer of bacteria”). Such nanocomposite material is also promising in treatment of superficial wound and ulcer. The solubility of the PEA in ethanol allows to reduce AgNO3 to NPs directly in the solution, where the solvent served as a reductive agent, and the PEA served as NPs stabilizer. The photochemical reduction was selected as a basic method to form NPs. The obtained AgNPs were characterized by UV-spectroscopy, transmission electron microscope (TEM), and dynamic light scattering (DLS). According to the UV-data and TEM data the photochemical reduction resulted in spherical AgNPs with wide particle size distribution with a high contribution of the particles below 10 nm that are known as responsible for bactericidal activity of AgNPs. DLS study showed that average size of nanoparticles formed after photo-reduction in ethanol solution ranged within ca. 50 nm.

Keywords: biodegradable polymers, microparticles, nanocomposites, stem cell therapy, stroke

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Authors: Wen-Yu Lin, Yi-Ching Chung, Jhao-Ren Lin, Tzyy-Rong Jinn

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It is well known that enterovirus 71(EV71) causes recurring outbreaks of hand, foot and mouth disease and encephalitis leading to complications or death in young children. And, several enterovirus 71 (EV71) of hand foot and mouth disease (HFMD) with high mortalities occurred in Asia country, such as Hong Kung (1985), Malaysia (1997), Taiwan (1998) and China (2008) that EV71 results in severe neurological complications and sudden death in infants and young children. However, there are still no effective drugs and vaccines to reduce and inhibit EV71 infection. Therefore, the development of specific and effective antiviral strategies against EV71 has become an urgent issue for the protection of children from the hazards of the HFMD. As reported, amantadine is effective in prophylaxis and treatment of the EV71 infections. Thus, the aim of this study was to further evaluate the synergistic antiviral activity of amantadine coupled with magnesium lithospermate B (MLB) against enterovirus 71 infection. In a preliminary test, it is shown that the infected RD cells were treated with amantadine after virus absorption, at concentrations of 3 and 5µM of amantadine suppressed EV71-induced CPE to 13% and 23%, respectively at MOI of 3. Alternatively, at concentrations of 5µg/ml of MLB combined with 3 and 5 µM of amantadine apparently suppressed EV71-induced CPE to 45% and 63%, respectively at MOI of 3. Thus, amantadine coupled with MLB may have the potential for further study to development as the chemopreventive reagents against EV71 infection.

Keywords: amantadine, Enterovirus 71, magnesium lithospermate B, RD cells, synergistic effects

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Authors: Livinus A. Obasi, Augustine N. Ajah

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Biotechnology in recent times has tried to develop a mechanism whereby sustainable electricity can be generated by the activity of microorganisms on waste and renewable biomass (often regarded as “negative value”) in a device called microbial fuel cell, MFC. In this paper, we established how the biocatalytic activities of bacteria on organic matter (substrates) produced some electrons with the associated removal of some water pollution parameters; Biochemical oxygen demand (BOD), chemical oxygen demand (COD) to the tune of 77.2% and 88.3% respectively from a petrochemical sanitary wastewater. The electricity generation was possible by conditioning the bacteria to operate anaerobically in one chamber referred to as the anode while the electrons are transferred to the fully aerated counter chamber containing the cathode. Power densities ranging from 12.83 mW/m² to 966.66 mW/m² were achieved using a dual-chamber starch membrane MFC experimental set-up. The maximum power density obtained in this research shows an improvement in the use of low cost MFC set up to achieve power production. Also, the level of organic matter removal from the sanitary waste water by the operation of this device clearly demonstrates its potential benefit in achieving an improved benign environment. The beauty of the MFCs is their potential utility in areas lacking electrical infrastructures like in most developing countries.

Keywords: bioelectricity, COD, microbial fuel cell, sanitary wastewater, wheat starch

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Authors: Claudia Donoso

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This study compares the restriction of mobility of migrants and asylum seekers during the COVID-19 pandemic in the United States and Ecuador. Based on the discourse analysis of anti-migrant rhetoric in press articles, migrant stories in the press, reports, and border control practices, the study examines the Ecuadorian government’s response to the migration flow of Venezuelans and the United States enforcement practices against Latin American asylum seekers. By exploring Giorgio Agamben’s concept of bare life, the article argues that this failure to protect mobility rights is due to the United States and Ecuador’s views of forced migrants as bare life and carriers of the virus, justifying xenophobia, resistance to humanitarian international law, and exceptionalism. By drawing on a feminist intersectional approach, the study adds to recent research on the securitization of forced migration and challenge the race/ethnicity, immigration status, class, and nationality-based discrimination of the measures undertaken during the pandemic. The article illustrates how the treatment of forced migrants as bare life was aggravated by their intersectional inequalities. It concludes by providing recommendations that could be enforced by the US and Ecuadorian governments to protect the right to freedom of mobility.

Keywords: bare life, intersectionality, mobility rights, COVID-19, Ecuador, United States

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Authors: Matjaž Šraml, Marko Renčelj, Tomaž Tollazzi, Chiara Gruden

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Road safety is a worldwide issue with numerous and heterogeneous factors influencing it. On the side, driver state – comprising distraction/inattention, fatigue, drowsiness, extreme emotions, and socio-cultural factors highly affect road safety. On the other side, the vehicle state has an important role in mitigating (or not) the road risk. Finally, the road environment is still one of the main determinants of road safety, defining driving task complexity. At the same time, thanks to technological development, a lot of detailed data is easily available, creating opportunities for the detection of driver state, vehicle characteristics and road conditions and, consequently, for the design of ad hoc interventions aimed at improving driver performance, increase awareness and mitigate road risks. This is the challenge faced by the i-DREAMS project. i-DREAMS, which stands for a smart Driver and Road Environment Assessment and Monitoring System, is a 3-year project funded by the European Union’s Horizon 2020 research and innovation program. It aims to set up a platform to define, develop, test and validate a ‘Safety Tolerance Zone’ to prevent drivers from getting too close to the boundaries of unsafe operation by mitigating risks in real-time and after the trip. After the definition and development of the Safety Tolerance Zone concept and the concretization of the same in an Advanced driver-assistance system (ADAS) platform, the system was tested firstly for 2 months in a driving simulator environment in 5 different countries. After that, naturalistic driving studies started for a 10-month period (comprising a 1-month pilot study, 3-month baseline study and 6 months study implementing interventions). Currently, the project team has approved a common evaluation approach, and it is developing the assessment of the usage and outcomes of the i-DREAMS system, which is turning positive insights. The i-DREAMS consortium consists of 13 partners, 7 engineering universities and research groups, 4 industry partners and 2 partners (European Transport Safety Council - ETSC - and POLIS cities and regions for transport innovation) closely linked to transport safety stakeholders, covering 8 different countries altogether.

Keywords: advanced driver assistant systems, driving simulator, safety tolerance zone, traffic safety

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Authors: Felipa de Mello-Sampayo

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The aim of this study is to undertake, from patient’s perspective, the timing and probability of using teledermatology, comparing it with a conventional referral system. The dynamic stochastic model’s main value-added consists of the concrete application to patients waiting for dermatology surgical intervention. Patients with low health level uncertainty must use teledermatology treatment as soon as possible, which is precisely when the teledermatology is least valuable. The results of the model were then tested empirically with the teledermatology network covering the area served by the Hospital Garcia da Horta, Portugal, links the primary care centers of 24 health districts with the hospital’s dermatology department via the corporate intranet of the Portuguese healthcare system. Health level volatility can be understood as the hazard of developing skin cancer and the trend of health level as the bias of developing skin lesions. The results of the survival analysis suggest that the theoretical model can explain the use of teledermatology. It depends negatively on the volatility of patients' health, and positively on the trend of health, i.e., the lower the risk of developing skin cancer and the younger the patients, the more presurgical teledermatology one expects to occur. Presurgical teledermatology also depends positively on out-of-pocket expenses and negatively on the opportunity costs of teledermatology, i.e., the lower the benefit missed by using teledermatology, the more presurgical teledermatology one expects to occur.

Keywords: teledermatology, wait time, uncertainty, opportunity cost, survival analysis

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Authors: Ya-Chu May Tsai, Ibrahim Yacoub, Eoin Casey

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The Australian and New Zealand College of Anaesthetists (ANZCA) advises that smoking should not be permitted within 12 hours of surgery. There is little information in the medical literature regarding patients awareness of perioperative smoking cessation recommendations nor their appreciation of how smoking might negatively impact their perioperative course. The aim of the study is to assess the prevalence of current smokers presenting to Werribee Mercy Hospital (WMH) and to evaluate if pre-operative provision of both written and verbal pre-operative advice was, 1: Effective in improving patient awareness of the benefits of pre-operative smoking cessation, 2: Associated with an increase in the number of elective surgical patients who stop smoking at least 12 hours pre-operatively. Methods: The initial survey included all patients who presented to WMH for elective surgical procedures from 19 – 30 September 2016 using a standardized questionnaire focused on patients’ smoking history and their awareness of smoking cessation preoperatively. The intervention consisted of a standard pre-operative phone call to all patients advising them of the increased perioperative risks associated with smoking, and advised patients to cease 12 hours prior. In addition, written information on smoking cessation strategies were sent out in mail at least 1 week prior to planned procedure date to all patients. Questionnaire-based study after the intervention was conducted on day of elective procedure from 10 – 21 October 2016 inclusive. Primary outcomes measured were patient’s awareness of smoking cessation and proportion of smokers who quit >12 hours, considered a clinically meaning duration to reduce anaesthetics complications. Comparison of pre and post intervention results were made using SPSS 21.0. Results: In the pre-intervention group (n=156), 36 (22.4%) patients were current smokers, 46 were ex-smokers (29.5%) and 74 were non-smokers (48.1%). Of the smokers, 12 (33%) reported having been informed of smoking cessation prior to operation and 8 (22%) were aware of increased intra- and perioperative adverse events associated with smoking. In the post-intervention group n= 177, 38 (21.5%) patients were current smokers, 39 were ex-smokers (22.0%) and 100 were non-smokers (56.5%). Of the smokers, 32 (88.9%) reported having been informed of smoking cessation prior to operation and 35 (97.2%) reported being aware of increased intra- and perioperative adverse events associated with smoking. The median time since last smoke in the pre-intervention group was 5.5 hours (Q1-Q3 = 2-14) compared with 13 hours (Q1-Q3 = 5-24) in post intervention group. Amongst the smokers, smoking cessation at least 12 hours prior to surgery significantly increased from 27.8% pre-intervention to 52.6% post intervention (P=0.03). Conclusion: A standard preoperative phone call and written instruction on smoking cessation guidelines at time of waitlist placement increase preoperative smoking cessation rates by almost 2-fold.

Keywords: anaesthesia, audit, perioperative medicine, smoking cessation

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Authors: Yamani Amal, Lazaae Jamila, Elachouri Mostafa

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Plants and their active agents – especially polyphenols – may have a principal role in the treatment of diseases that result from the defect of physiological antioxidant mechanisms. Bryonia dioica is well known in Moroccan traditional medicine for alleviatin pain and traiting many diseases. We have focused on plant belonging to Cucurbitaceae Family from around the world to understand their therapeutic uses and their potential antioxidant activities Although several biological activities and Chemical composition of Bryonia dioica are well characterized, no direct, in vitro study, of this natural product examined the antioxydant effect of the extract from the roots of Bryonia dioica. The aim of this study was to determine in vitro antioxidant activity of the B.dioica root, using antioxidant analysis methods based on determination of Hydroxyradical Scavenging, 1,1-diphenyl-2-picrylhydrazine (DPPH) radical scavenging, Hydrogenperoxide Scavenging and Nitric Oxide Scavenging. In this study, it was demonstrated, that, B. dioica root extract showed excellent antioxidant properties. This investigation showed that the roots of this plant contain potent natural scavengers R. It may represent an interesting source of antioxidant phenolics that may favour the extension of their cultivation as new source of natural antioxidants in addition to containing high quality proteins for human or animal nutrition. Therefore, there is need for all stakeholders on the Morocco to strive towards taking advantage of our enormous biodiversity resources to free our people from diseases, abject poverty and stagnation.

Keywords: Morocco, bryoniadioica, in vitro, antioxydant

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Authors: Jonathan Andres Pullas Navarrete, Ernesto Hale de la Torre Chauvin

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In this work, the antibacterial effect of activated carbon fibers (ACF) impregnated with ionic silver particles was studied. ACF were prepared from samples of cotton woven wastes (cotton based fabrics 5x10 cm) by applying a chemical activation procedure with H3PO4. This treatment was performed using several H3PO4: Cotton based fabrics weight ratios (1:2–2:1), temperatures (600–900 ºC) and activation times (0.5–2 h). The ACF obtained under the best activation conditions showed BET surface area of 1103 m2/g; this result along with iodine index demonstrated the microporous nature of the fibers herein obtained. Then, the obtained fibers were impregnated with ionic silver particles by immersion in 0.1 and 0.5 M AgNO3 solutions followed by drying and thermal decomposition in order to fix the silver particles in the structure of ACF. It was determined that the presence of Ag ions lowered the BET surface area of the ACF in approximately 17 % due to the obstruction of the porosities along the carbonized structure. Finally, the antibacterial effect of the ACF impregnated with silver was studied through direct counting method for coliforms. The antibacterial activity of the impregnated fibers was demonstrated, and it was attributed to the strongly inhibition of bacteria growth because of chemical properties of the particles of silver inside the ACF. This behavior was demonstrated at concentrations of silver as low as 0.035 % w/w.

Keywords: activated carbon, adsorption, antibacterial activity, coliforms, surface area

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Authors: Zhang Zhenzhen

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Valproate (VPA) is commonly used in the treatment of bipolar disorder and epilepsy. The mechanism is complicated, including its ability to inhibit histone deacetylases (HDACs). Here, we show that VPA attenuated VEGF gene expression and the morphological changes in choroidal neovascularization (CNV) induced by photocoagulation in retina. C57BL/6 mice were injected subcutaneously at 300mg/kg twice daily with VPA before insult. Vascular endothelial growth factor (VEGF)-A and VEGF-B were examined in the eyes of VPA-treated mice and in human retinal pigment epithelial cell lines (ARPE-19) exposed to VPA. In addition, CNV was induced by photocoagulation in mice injected with VPA, and the volume of CNV was compared by fluorescence-labeled choroidal flat mount. Morphological changes were analyzed on stained histological sections. Western blot analysis was used to determine protein levels of VEGF-A and VEGF-B, and acetylation of histone H3 in each group. VPA injected intraperitoneally attenuated the VEGF-A and VEGF-B expression in the retina, accompanied by the hyperacetylation of retina tissue, indicating that VPA acts directly on retina tissues through acetylation to reduce the expression of VEGF. VPA also attenuated the VEGF-A mRNA expression in the retinal pigment epithelium showed by immunohistochemistry. Moreover, the administration of VPA significantly attenuated photocoagulation-induced CNV in mice. These results demonstrate that VPA attenuated VEGF production in retina associated with choroidal neovascularization possibly via the HDAC inhibition.

Keywords: retina, acetylation, chorodial neovascularization, vascular endothelial growth factor

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Authors: Hanjun Zhao, Ke Zhang, Bojian Zheng

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Background: So far, there is no universal antiviral agent which can inhibit multiple viral infections. More and more drug-resistant viral strains emerge after the antiviral drug application for treatment. Defensins are the front line of host innate immunity and have broad spectrum antibacterial and antiviral effects. However, there is limited data to show if these defensins have good antiviral activity in vivo and what the antiviral mechanism is. Subjects: To investigate a peptide with widespread antivirus activity in vitro and in vivo and illustrate the antiviral mechanism. Methods: Antiviral peptide library designed from mouse beta defensins was synthesized by the company. Recombinant beta defensin was obtained from E. coli. Antiviral activity in vitro was assayed by plaque assay, qPCR. Antiviral activity in vivo was detected by animal challenge with 2009 pandemic H1N1 influenza A virus. The antiviral mechanism was assayed by western blot, ELISA, and qPCR. Conclusions: We identify a new peptide which has widespread effects against multiple viruses (H1N1, H5N1, H7N9, MERS-CoV) in vitro and has efficient antivirus activity in vivo. This peptide inhibits viral entry into target cells and subsequently blocks viral replication. The in vivo study of the antiviral peptide against other viral infections and the investigation of its more detail antiviral mechanism are ongoing.

Keywords: antiviral peptide, defensin, Influenza A virus, mechanism

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Authors: Mai Ali

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Advancing beyond the junior stage of a paediatrician’s career is a crucial step where they accumulate essential skills and knowledge. This process prepares them for the challenges they'll encounter throughout their profession, particularly in dealing with paediatric emergencies. This can be especially demanding for trainees specializing in fields like endocrinology, particularly in the management of Diabetic Ketoacidosis (DKA) in the UK. In different societal contexts, junior doctors, whether specializing in pediatrics or other medical fields, are generally expected to possess a fundamental level of knowledge and skills necessary for managing diabetic ketoacidosis (DKA) emergencies. These physicians consistently concurred in recognizing prevalent problems in the healthcare facilities they examined. Such issues include the lack of established guidelines for DKA treatment and the inadequate availability of comprehensive training opportunities. The abstract underscores the critical importance of junior paediatricians acquiring expertise in managing paediatric emergencies, with a specific focus on DKA. Commonly, issues like the lack of standardized protocols and training deficiencies are recurring themes across healthcare facilities. This research proposal aims to conduct a thematic analysis of the proficiency of paediatric trainees in the United Kingdom when handling DKA in various clinical contexts. The primary goal is to assess their competency and suggest effective strategies for comprehensive DKA training improvement.

Keywords: junior pediatrician, DKA, standardized protocols, level of competence

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Authors: Maria João Mimoso, Bárbara Magalhães Bravo

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This study aims to analyse the phenomenon of arbitration as a paradigm in solving emerging controversies of foreign investment. We will present their benefits and demonstrate their contribution to greater legal certainty in economic relations. This article explores the legal relevant concepts under a strictly conceptual methodology, preparing future research to be developed under more developed comparative law methodologies. The review of national and international literature and jurisprudence will reveal the importance of arbitration in the field of international economic relations, presenting it as an alternative dispute resolution. Globalization imposes new forms of investment protection and appeals to other forms of dispute settlement, primarily to prevent, among other problems, the possible bias of the recipient country's investment tribunals. Characterization of foreign investment, its regulatory sources, their characteristics and the need for intervention of an entity capable of resolving disputes between the parties involved: State investor reception; Investor (of a nationality other than the latter); State of the investor's nationality, and sometimes a ‘subsidiary’ local foreign investor. The ICSID (International Settlement of Investment Disputes) arbitration as a means of resolving investment litigations covered by bilateral treaties (BIT) and investment contracts calls for a delimitation of these two figures in order to clarify the scope of the arbitration under the aegis of the World Bank and to make it more secure in the view of the sovereign power of the States.

Keywords: arbitration, contract, foreign, investment, disputes

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Authors: Kazunari Ozaki, Mitsuru Kageyama, Kenki Miyazawa, Yoshio Nakamura

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Background: Kampo (Japanese Traditional medicine) is a medicine traditionally practiced in Japan, based on ancient Chinese medicine. Most Kampo doctors have used decoction of crude drug pieces for treatment. 93% of the Kampo drugs sold in Japan are Kampo products nowadays. Of all Kampo products, 81% of them are Kampo extract formulations for prescription, which is prepared in powdered or granulated form from medicinal crude drug extracts mixed with appropriate excipient. Physicians with medical license for Western medicine prescribe these Kampo extract formulations for prescription in Japan. Objectives: Our study aims at presenting a brief history of Kampo extract formulations for prescription in Japan. Methods: Systematic searches for relevant studies were conducted using not only printed journals but also electronic journals from the bibliographic databases, such as PubMed/Medline, Ichushi-Web, and university/institutional websites, as well as search engines, such as Google and Google Scholar. Results: The first commercialization of Kampo extract formulations for general use (or OTC (over-the-counter) Kampo extract formulation) was achieved after 1957. The number of drugs has been subsequentially increased, reaching 148 Kampo extract formulation for prescription currently. Conclusion: We provide a history of Kampo extract formulations for prescription in Japan. The originality of this research is that it analyzes the background history of Kampo in parallel with relevant transitions in the government and insurance systems.

Keywords: health insurance system, history, Kampo, Kampo extract formulation for prescription, OTC Kampo extract formulation, pattern corresponding prescription (Ho-sho-so-tai) system

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Authors: Anupuma Raina, Ajay Parkash

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In forensic investigation, DNA analysis helps in the identification of a particular individual under investigation. A set of Short Tandem Repeats loci are widely used for individualization at a molecular level in forensic testing. STRs with tetrameric repeats of DNA are highly polymorphic and widely used for forensic DNA analysis. Identification of an individual became challenging for forensic examiners after Hematopoietic Stem Cell Transplantation. HSCT is a well-accepted and life-saving treatment to treat malignant and nonmalignant diseases. It involves the administration of healthy donor stem cells to replace the patient’s own unhealthy stem cells. A successful HSCT results in complete donor-derived cells in a patient’s hematopoiesis and hence have the capability to change the genetic makeup of the patient. Although an individual who has undergone HSCT and then committed a crime is a very rare situation, but not impossible. Keeping such a situation in mind, various biological samples like blood, buccal swab, and hair follicle were collected and studied after a certain interval of time after HSCT. Blood was collected from both the patient and the donor before the transplant. The DNA profile of both was analyzed using a short tandem repeat kit for autosomal chromosomes. Among all exhibits studied, only hair follicles were found to be the most suitable biological exhibit, as no donor DNA profile was observed for up to 90 days of study.

Keywords: chimerism, HSCT, STRs analysis, forensic identification

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Authors: Md Nur Uddin

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The Rohingya people are one of the world's most oppressed and persecuted refugee populations, having been stateless for over six generations and still are. In recent years, more than half-million Rohingya Muslims have fled Myanmar (Burma) for neighboring nations. This article discusses the Status and Rights of Rohingya Migrants in Bangladesh, with a focus on the living conditions of this vulnerable population. A lot of information has been studied about Rohingya refugees states that violence in Rakhine state has sent an estimated 615,500 Rohingya across the border into Bangladesh's Cox's Bazar since August 25, 2017. In Cox's Bazar, a total of 33,131 Rohingya refugees are housed in two registered camps, with an additional 854,024 living in informal settlements nearby. The living conditions of Rohingya refugees in overcrowded camps remain dismal. Mental health is bad, cleanliness is poor, malnutrition is common, and physical and sexual abuse is endemic. A coordinated diplomatic effort involving Bangladesh and Myanmar, as well as international mediators such as the Organization of Islamic Countries and the United Nations, is essential to adequately resolve this complex matter. Bangladeshi officials must ensure the safety of the Rohingyas in the camps and use available humanitarian aid to give the refugees basic amenities such as food, shelter, sanitation, and medical treatment. UNHCR officials should keep an eye on the actual repatriation process to ensure that refugees who have expressed a desire to stay in Bangladesh are not deported against their choice.

Keywords: international refugee laws, united nations, Rohingya, stateless, humanitarian

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Authors: Rana Sawaya, Jalal Halwani, Isam Bashour, Nada Nehme

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Mismanagement of municipal solid wastes in Lebanon might lead to serious environmental problems, especially that a big portion of mixed wastes including putrescible is transferred to Naameh landfill. One of the consequences of municipal solid waste deposition is the production of landfill leachate, which if unproperly treated will threaten the main crucial matrices such as soil, water, and air. The main aim of this one of a kind study is to assess the risk posed to groundwater as a result of leachate infiltration on off-site wells especially after stoppage of Naameh landfill's operation end of the year 2016 and initiation of the capping process which is still ongoing and will be finalized in December 2019. For this purpose, nine representative points around the landfill were selected to undergo physicochemical and microbial analysis on a seasonal basis (every three months). The study extended from the year 2014 until the end of the year 2016 (closure of Naameh landfill). The preliminary data obtained are statistically analyzed using the Statistical Package for Social Sciences (SPSS) and was found in conformity with international and Lebanese norms. Thus, the study will be extended an additional year, especially after the finalization of capping and the results obtained, will enable us to propose new techniques and tools (treatment systems) in water resources management depending on the direction of its usage (domestic, irrigation, drinking).

Keywords: contamination, groundwater, leachate, Lebanon, solid waste

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Authors: Drazen Simlesa, Jelena Pudjak, Anita Tonkovic Busljeta

Abstract:

Regarding social economy (SE), Croatia is, on general level, considered as ex-communist country with good tradition, bad performance in second part of 20th Century because of political control in the business sector, which has in transition period (1990-1999) became a problem of ignorance in public administration (policy level). Today, social economy in Croatia is trying to catch up with other EU states on all important levels of SE sector: legislative and institutional framework, financial infrastructure, education and capacity building, and visibility. All four are integral parts of Strategy for the Development of Social Entrepreneurship in the Republic of Croatia for the period of 2015 – 2020. Within iPRESENT project, funded by Croatian Science Foundation, we have mapped social economy actors and after many years there is a clear and up to date social economy base. At the ICSE 2016 we will present main outcomes and results of this process. In the second year of the project we conducted a field research across Croatia carried out 19 focus groups with most influential, innovative and inspirational social economy actors. We divided interview questions in four themes: laws on social economy and public policies, definition/ideology of social economy and cooperation on SE scene, the level of democracy and working conditions, motivation and existence of intrinsic values. The data that are gathered through focus group interviews has been analysed via qualitative data analysis software (Atlas ti.). Major finding that will be presented in ICSA 2016 are: Social economy actors are mostly unsatisfied with legislative and institutional framework in Croatia and consider it as unsupportive and confusing. Social economy actors consider SE to be in the line with WISE model and as a tool for community development. The SE actors that are more active express satisfaction with cooperation amongst SE actors and other partners and stakeholders, but the ones that are in more isolated conditions (spatially) express need for more cooperation and networking. Social economy actors expressed their praise for democratic atmosphere in their organisations and fair working conditions. And finally, they expressed high motivation to continue to work in the social economy and are dedicated to the concept, including even those that were at the beginning interested just in getting a quick job. It means that we can detect intrinsic values for employees in social economy organisations. This research enabled us to describe for the first time in Croatia the view from the inside, attitudes and opinion of employees of social economy organisations.

Keywords: employees, focus groups, mapping, social economy

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Authors: Ilaria Manca, Ilaria Manca, Francesca Pettinau, Ignazia Mocci, Elisabetta M. Usai, Barbara Pittau

Abstract:

Lamotrigine is a phenyltriazine used in the treatment of epilepsy and bipolar disorder type I. The purpose of this study was to test and compare various solid forms of immediate release (IR) lamotrigine products, at different strenghts, in order to study their disaggregation and dissolution behavior. IR products are designed to release their active substance promptly after administration. Concentration of hydrochloric acid in gastric juice is about 0.1-0.001 M, so FDA (Food and Drug Administration) recommends, for lamotrigine regular tablets, dissolution tests in HCl 0.1 M.Toinvestigate the pH dependency of drug release in the entire gastrointestinal tract, we worked at two additional media with different pH values (4.5 and 6.8), that reflect conditions in it. To afford acceptable dissolution rates, tablets must disintegrate. Disaggregation of constituent particles increases the surface area and substantially increases the dissolution rate. For this reason availability of an active substance from tablets depends on its ability to disintegrate fast in dissolution media. pH of gastrointestinal fluid affects drug absorption by conditioning its solubility and dissolution, but also tablet disintegration may be influenced by it. To obtain information about the quantitative relationship between different mixture components, Nuclear Magnetic Resonance (NMR) spectroscopy was used. We also investigate tablet hardness. The investigation carried out confirms pH 1.2 as the ideal environment for the immediate availability of the active substance.

Keywords: dissolution, disaggregation, Lamotrigine, bioequivalence

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Authors: Jiajia Yao, Guanlin Wu, Fang Liu, Junshuai Xue, Yue Hao

Abstract:

As the production process of self-standing GaN substrates evolves, the commercialization of low dislocation density, large-scale, semi-insulating self-standing GaN substrates is gradually becoming a reality. This advancement has given rise to increased interest in GaN materials' homoepitaxial technology. However, at the homoepitaxial interface, there are considerable concentrations of impurity elements, including C, Si, and O, which generate parasitic leakage channels at the re-growth junction. This phenomenon results in leaked HEMTs that prove difficult to switch off, rendering them effectively non-functional. The emergence of leakage channels can also degrade the high-frequency properties and lower the power devices' breakdown voltage. In this study, the uniform epitaxy of AlGaN/GaN heterojunction with high electron mobility was accomplished through the surface treatment of the GaN substrates prior to growth and the design of the AlN isolation layer structure. By employing a procedure combining gallium atom in-situ cleaning and plasma nitridation, the C and O impurity concentrations at the homoepitaxial interface were diminished to the scale of 10¹⁷ cm-³. Additionally, the 1.5 nm nitrogen-rich AlN isolation layer successfully prevented the diffusion of Si impurities into the GaN channel layer. The result was an AlGaN/GaN heterojunction with an electron mobility of 1552 cm²/Vs and an electron density of 1.1 × 10¹³ cm-² at room temperature, obtained on a Fe-doped semi-insulating GaN substrate.

Keywords: MBE, AlGaN/GaN, homogenerous epitaxy, HEMT

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Authors: J. Marx, D. Smazna, R. Adelung, B. Fiedler

Abstract:

Aerographite is a 3D interconnected carbon foam. Its tetrapodal morphology is based on the zinc oxide (ZnO) template structure, which is replicated in the chemical vapour deposition (CVD) into a hollow carbon structure. This replication process is analyzed in ex-situ studies via interrupted synthesis and the observation of the reaction progress by using scanning electron (SEM), transmission electron microscopy (TEM) and Raman spectroscopy techniques. Based on the epitaxial growth process, with a layer-by-layer growth behaviour of the wall thickness or number of layers and the catalytical graphitization of the deposited amorphous carbon into graphitic carbon by zinc, a growth model is created. The properties of aerographite, such as the electrical conductivity is dependent on the graphitization and number of layer (wall thickness). Wall thicknesses between 3 nm and 22 nm are achieved by a controlled stepwise reduction of the synthesis time on the basis of the developed growth model, and by a further thermal treatment at 1800 °C the graphitization of the presented carbon foam is modified. The variation of the wall thickness leads to an optimum defect density (ID/IG ratio) and the graphitization to an improvement in the electrical conductivity. Furthermore, a metallic conducting behaviour of untreated and 1800 °C treated aerographite can be observed. Due to these structural and defective modifications, a fundamental structural-property equation for the description of their influences on the electrical conductivity is developed.

Keywords: electrical conductivity, electron microscopy (SEM/TEM), graphitization, wall thickness

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Authors: G. A. Adamu, M. S. Sallau, S. O. Idris, E. B. Agbaji

Abstract:

Drinking water is supplied to Danbatta, Makoda and some parts of Minjibir local government areas of Kano State from the surface water of Thomas Reservoir. The present land use in the catchment area of the reservoir indicates high agricultural activities, fishing, as well as domestic and small scale industrial activities. To study and monitor the quality of surface and drinking water of the area, water samples were collected from the reservoir, treated water at the treatment plant and potable water at the consumer end in three seasons November - February (cold season), March - June (dry season) and July - September (rainy season). The samples were analyzed for physical and chemical parameters, pH, temperature, total dissolved solids (TDS), conductivity, turbidity, total hardness, suspended solids, total solids, colour, dissolved oxygen (DO), biological oxygen demand (BOD), chloride ion (Cl^-) nitrite (NO₂^-), nitrate (NO₃^-), chemical oxygen demand (COD) and phosphate (PO₄^3-). The higher values obtained in some parameters with respect to the acceptable standard set by World Health Organization (WHO) and Nigerian Industrial Standards (NIS) indicate the pollution of both the surface and drinking water. These pollutants were observed to have a negative impact on water quality in terms of eutrophication, largely due to anthropogenic activities in the watershed.

Keywords: surface water, drinking water, water quality, pollution, Thomas reservoir, Kano

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Authors: Kshanaprava Dhalsamant, Punyadarshini P. Tripathy, Shanker L. Shrivastava

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With present high global population, the need for rising food usage by minimizing food wastage and investment is highly necessary to achieve food security. The purpose of this study is to enlighten the effect of pre-drying treatment on rehydration, color, texture, nanohardness, microstructure and surface morphology of solar dried potato samples dried in the mixed-mode solar dryer. Locally bought potatoes were cleaned and cut into cylindrical pieces and pretreated with sodium metabisulfite (0.5%) for 10 min before placing them in natural convection solar dryer designed and developed in Indian Institute of Technology Kharagpur, India. Advanced quality characteristics were studied using Atomic Force Microscope (AFM), Scanning Electron Microscopy (SEM) and nanoindentation method, along with color, texture and water activity. The rehydration indices of solar dried potatoes were significantly biased by pretreatment followed by rehydration temperature. A lower redness index (a*) with a higher value of yellowness index (b*), chroma (C*) and hue angle (h*) were obtained for pretreated samples. Also, the average nanohardness (H) of untreated samples exhibited substantial lower value (18.46%) compared to pretreated samples. Additionally, a creep displacement of 43.27 nm during 20 s dwell time under constant load of 200

Keywords: pretreatment, nanohardness, microstructure, surface morphology

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Authors: Sevinj Asgarova

Abstract:

Within the last few decades, major advances in the field of prenatal testing have transpired yet little research regarding the experiences of mothers who chose to continue their pregnancies after prenatally receiving a diagnosis of Down Syndrome (DS) has been undertaken. Using social constructionism and interpretive description, this retrospective research study explores this topic from the point of view of the mothers involved and provides insight as to how the experience could be improved. Using purposive sampling, 23 mothers were recruited from British Columbia (n=11) and Ontario (n=12) in Canada. Data retrieved through semi-structured in-depth interviews were analyzed using inductive, constant comparative analysis, the major analytical techniques of interpretive description. Four primary phases emerged from the data analysis 1) healthcare professional-mothers communications, 2) initial emotional response, 3) subsequent decision-making and 4) an adjustment and reorganization of lifestyle to the preparation for the birth of the child. This study validates the individualized and contextualized nature of mothers’ decisions as influenced by multiple factors, with moral values/spiritual beliefs being significant. The mothers’ ability to cope was affected by the information communicated to them about their unborn baby’s diagnosis and the manner in which that information was delivered to them. Mothers used emotional coping strategies, dependent upon support from partners, family, and friends, as well as from other families who have children with DS. Additionally, they employed practical coping strategies, such as engaging in healthcare planning, seeking relevant information, and reimagining and reorganizing their lifestyle. Over time many families gained a sense of control over their situation and readjusted to the preparation for the birth of the child. Many mothers expressed the importance of maintaining positivity and hopefulness with respect to positive outcomes and opportunities for their children. The comprehensive information generated through this study will also provide healthcare professionals with relevant information to assist them in understanding the informational and emotional needs of these mothers. This should lead to an improvement in their practice and enhance their ability to intervene appropriately and effectively, better offering improved support to parents dealing with a diagnosis of DS for their child.

Keywords: continuing affected pregnancy, decision making, disability, down syndrome, eugenic social attitudes, inequalities, life change events, prenatal care, prenatal testing, qualitative research, social change, social justice

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Authors: Xiang Wang, Yan Pang, Zhaomiao Liu

Abstract:

Droplet-based microfluidics have been studied extensively with the development of the Micro-Electro-Mechanical System (MEMS) which bears the advantages of high throughput, high efficiency, low cost and low polydispersity. Droplets, worked as versatile carriers, could provide isolated chambers as the internal dispersed phase is protected from the outside continuous phase. Droplets are used to add reagents to start or end bio-chemical reactions, to generate concentration gradients, to realize hydrate crystallization or protein analyses, while droplets coalescence acts as an important control technology. In this paper, deionized water is used as the dispersed phase, and several kinds of oil are used as the continuous phase to investigate the influence of the viscosity ratio of the two phases on the coalescence process. The microchannels are fabricated by coating a polydimethylsiloxane (PDMS) layer onto another PDMS flat plate after corona treatment. All newly made microchannels are rinsed with the continuous oil phase for hours before experiments to ensure the swelling fully developed. High-speed microscope system is used to document the serial videos with a maximum speed of 2000 frames per second. The critical capillary numbers (Ca*) of droplet pairs in various junctions are studied and compared. Ca* varies with different junctions or different liquids within the range of 0.002 to 0.01. However, droplets without extra control would have the problem of synchronism which reduces the coalescence efficiency.

Keywords: coalescence, concentration, critical capillary number, droplet pair, split

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Authors: Rebecca Dunne, Cormac Small, Geraldine O'Boyle, Nazir Ibrahim, Anisha

Abstract:

Prostate cancer is the most common cancer among men, excluding non-melanoma skin cancers. It is estimated that approximately 12% of men will develop prostate cancer during their lifetime. Patients with intermediate, high risk, and very-high risk prostate cancer often undergo a combination of radiation treatments. These treatments include external beam radiotherapy with a low-dose rate or high-dose rate brachytherapy boost, often with concomitant androgen deprivation therapy. The literature on follow-up of patients that receive brachytherapy is scarce, particularly follow-up of patients that undergo high-dose rate brachytherapy. This retrospective study aims to investigate the biochemical failure and toxicities associated with triple therapy and external beam radiotherapy given in combination with brachytherapy. Reported toxicities and prostate specific antigen (PSA) were retrospectively evaluated in eighty patients that previously underwent external beam radiotherapy with a low-dose rate or high dose-rate brachytherapy boost. The severity of toxicities were correlated with intra-operative dosing during brachytherapy on ultrasound and CT scan. The results of this study will provide further information for clinicians and patients when considering treatment options.

Keywords: toxicities, combination, brachytherapy, intra-operative dosing, biochemical failure

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Authors: A. Aravind, M. Vetrivel, P. Abhimanyu, C. A. Akaash Emmanuel Raj, K. Sundararaj, V. R. S. Kumar

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The choice of high-speed, low budget hatchback car with diversified options is increasing for meeting the new generation buyers trend. This paper is aimed to augment the current speed of the hatchback cars through the aerodynamic drag reduction technique. The inverted airfoils are facilitated at the bottom of the car for generating the downward force for negating the lift while increasing the current speed range for achieving a better road performance. The numerical simulations have been carried out using a 2D steady pressure-based    k-ɛ realizable model with enhanced wall treatment. In our numerical studies, Reynolds-averaged Navier-Stokes model and its code of solution are used. The code is calibrated and validated using the exact solution of the 2D boundary layer displacement thickness at the Sanal flow choking condition for adiabatic flows. We observed through the parametric analytical studies that the inverted airfoil integrated with the bottom surface at various predesigned locations of Hatchback cars can improve its overall aerodynamic efficiency through drag reduction, which obviously decreases the fuel consumption significantly and ensure an optimum road performance lucratively with maximum permissible speed within the framework of the manufactures constraints.

Keywords: aerodynamics of commercial cars, downward force, hatchback car, inverted airfoil

Procedia PDF Downloads 276