Search results for: networking protocols

Authors: Goutam Kumar Ghorai, Sandip Sadhukhan, Arpita Sarkar, Debprasad Sinha, G. Sarkar, Ashis K. Dhara

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Diabetes mellitus is one of the most common chronic diseases in all countries and continues to increase in numbers significantly. Diabetic retinopathy (DR) is damage to the retina that occurs with long-term diabetes. DR is a major cause of blindness in the Indian population. Therefore, its early diagnosis is of utmost importance towards preventing progression towards imminent irreversible loss of vision, particularly in the huge population across rural India. The barriers to eye examination of all diabetic patients are socioeconomic factors, lack of referrals, poor access to the healthcare system, lack of knowledge, insufficient number of ophthalmologists, and lack of networking between physicians, diabetologists and ophthalmologists. A few diabetic patients often visit a healthcare facility for their general checkup, but their eye condition remains largely undetected until the patient is symptomatic. This work aims to focus on the design and development of a fully automated intelligent decision system for screening retinal fundus images towards detection of the pathophysiology caused by microaneurysm in the early stage of the diseases. Automated detection of microaneurysm is a challenging problem due to the variation in color and the variation introduced by the field of view, inhomogeneous illumination, and pathological abnormalities. We have developed aconvolutional neural network for efficient detection of microaneurysm. A loss function is also developed to handle severe class imbalance due to very small size of microaneurysms compared to background. The network is able to locate the salient region containing microaneurysms in case of noisy images captured by non-mydriatic cameras. The ground truth of microaneurysms is created by expert ophthalmologists for MESSIDOR database as well as private database, collected from Indian patients. The network is trained from scratch using the fundus images of MESSIDOR database. The proposed method is evaluated on DIARETDB1 and the private database. The method is successful in detection of microaneurysms for dilated and non-dilated types of fundus images acquired from different medical centres. The proposed algorithm could be used for development of AI based affordable and accessible system, to provide service at grass root-level primary healthcare units spread across the country to cater to the need of the rural people unaware of the severe impact of DR.

Keywords: retinal fundus image, deep convolutional neural network, early detection of microaneurysms, screening of diabetic retinopathy

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Authors: Nouha Bouayed Abdelmoula, Rim Louati, Nawel Abdellaoui, Balkiss Abdelmoula, Oldez Kaabi, Walid Smaoui, Samir Aloulou

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Background and Aims: Cardiofaciocutaneous syndrome (CFC) is an autosomal dominant disorder with the vast majority of cases arising by a new mutation of BRAF, MEK1, MEK2, or rarely, KRAS genes. Here, we report a rare Tunisian case of CFC syndrome for whom we identify SOS1 mutation. Methods: Genomic DNA was obtained from peripheral blood collected in an EDTA tube and extracted from leukocytes using the phenol/chloroform method according to standard protocols. High resolution melting (HRM) analysis for screening of mutations in the entire coding sequence of PTPN11 was conducted first. Then, HRM assays to look for hot spot mutations coding regions of the other genes of the RAS-MAPK pathway (RAt Sarcoma viral oncogene homolog Mitogen-Activated Protein Kinases Pathway): SOS1, SHOC2, KRAS, RAF1, KRAS, NRAS, CBL, BRAF, MEK1, MEK2, HRAS, and RIT1, were applied. Results: Heterozygous SOS1 point mutation clustered in exon 10, which encodes for the PH domain of SOS1, was identified: c.1655 G > A. The patient was a 9-year-old female born from a consanguineous couple. She exhibited pulmonic valvular stenosis as congenital heart disease. She had facial features and other malformations of Noonan syndrome, including macrocephaly, hypertelorism, ptosis, downslanting palpebral fissures, sparse eyebrows, a short and broad nose with upturned tip, low-set ears, high forehead commonly associated with bitemporal narrowing and prominent supraorbital ridges, short and/or webbed neck and short stature. However, the phenotype is also suggestive of CFC syndrome with the presence of more severe ectodermal abnormalities, including curly hair, keloid scars, hyperkeratotic skin, deep plantar creases, and delayed permanent dentition with agenesis of the right maxillary first molar. Moreover, the familial history of the patient revealed recurrent brain malignancies in the paternal family and epileptic disease in the maternal family. Conclusions: This case report of an overlapping RASopathy associated with SOS1 mutation and familial history of brain tumorigenesis is exceptional. The evidence suggests that RASopathies are truly cancer-prone syndromes, but the magnitude of the cancer risk and the types of cancer partially overlap.

Keywords: cardiofaciocutaneous syndrome, CFC, SOS1, brain cancer, germline mutation

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Authors: Samineh Barmaki, Ville Jokinen, Esko Kankuri

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We report a microfluidic chip that can be used to modify the gaseous microenvironment of a cell-culture in ambient atmospheric conditions. The aim of the study is to show the cellular response to nitric oxide (NO) under hypoxic (oxygen < 5%) condition. Simultaneously targeting to hypoxic and nitric oxide will provide an opportunity for NO‑based therapeutics. Studies on cellular responses to lowered oxygen concentration or to gaseous mediators are usually carried out under a specific macro environment, such as hypoxia chambers, or with specific NO donor molecules that may have additional toxic effects. In our study, the chip consists of a microfluidic layer and a cell culture well, separated by a thin gas permeable polydimethylsiloxane (PDMS) membrane. The main design goal is to separate the gas oxygen scavenger and NO donor solutions, which are often toxic, from the cell media. Two different types of gas exchangers, titled 'pool' and 'meander' were tested. We find that the pool design allows us to reach a higher level of oxygen depletion than meander (24.32 ± 19.82 %vs -3.21 ± 8.81). Our microchip design can make the cells culture more simple and makes it easy to adapt existing cell culture protocols. Our first application is utilizing the chip to create hypoxic conditions on targeted areas of cell culture. In this study, oxygen scavenger sodium sulfite generates hypoxia and its effect on human embryonic kidney cells (HEK-293). The PDMS membrane was coated with fibronectin before initiating cell cultures, and the cells were grown for 48h on the chips before initiating the gas control experiments. The hypoxia experiments were performed by pumping of O₂-depleted H₂O into the microfluidic channel with a flow-rate of 0.5 ml/h. Image-iT® reagent as an oxygen level responser was mixed with HEK-293 cells. The fluorescent signal appears on cells stained with Image-iT® hypoxia reagent (after 6h of pumping oxygen-depleted H₂O through the microfluidic channel in pool area). The exposure to different levels of O₂ can be controlled by varying the thickness of the PDMS membrane. Recently, we improved the design of the microfluidic chip, which can control the microenvironment of two different gases at the same time. The hypoxic response was also improved from the new design of microchip. The cells were grown on the thin PDMS membrane for 30 hours, and with a flowrate of 0.1 ml/h; the oxygen scavenger was pumped into the microfluidic channel. We also show that by pumping sodium nitroprusside (SNP) as a nitric oxide donor activated under light and can generate nitric oxide on top of PDMS membrane. We are aiming to show cellular microenvironment response of HEK-293 cells to both nitric oxide (by pumping SNP) and hypoxia (by pumping oxygen scavenger solution) in separated channels in one microfluidic chip.

Keywords: hypoxia, nitric oxide, microenvironment, microfluidic chip, sodium nitroprusside, SNP

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Authors: Klaus Froehlich-Gildhoff, Ullrich Boettinger, Katharina Rauh, Angela Schickler

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The Prevention Network Ortenaukreis, PNO, funded by the German Ministry of Education and Research, aims to promote physical and mental health as well as the social inclusion of 3 to 10 years old children and their families in the Ortenau district. Within a period of four years starting 11/2014 a community network will be established. One regional and five local prevention representatives are building networks with stakeholders of the prevention and health promotion field bridging the health care, educational and youth welfare system in a multidisciplinary approach. The regional prevention representative implements regularly convening prevention and health conferences. On a local level, the 5 local prevention representatives implement round tables in each area as a platform for networking. In the setting approach, educational institutions are playing a vital role when gaining access to children and their families. Thus the project will offer 18 month long organizational development processes with specially trained coaches to 25 kindergarten and 25 primary schools. The process is based on a curriculum of prevention and health promotion which is adapted to the specific needs of the institutions. Also to ensure that the entire region is reached demand oriented advanced education courses are implemented at participating day care centers, kindergartens and schools. Evaluation method: The project is accompanied by an extensive research design to evaluate the outcomes of different project components such as interview data from community prevention agents, interviews and network analysis with families at risk on their support structures, data on community network development and monitoring, as well as data from kindergarten and primary schools. The latter features a waiting-list control group evaluation in kindergarten and primary schools with a mixed methods design using questionnaires and interviews with pedagogues, teachers, parents, and children. Results: By the time of the conference pre and post test data from the kindergarten samples (treatment and control group) will be presented, as well as data from the first project phase, such as qualitative interviews with the prevention coordinators as well as mixed methods data from the community needs assessment. In supporting this project, the Federal Ministry aims to gain insight into efficient components of community prevention and health promotion networks as it is implemented and evaluated. The district will serve as a model region, so that successful components can be transferred to other regions throughout Germany. Accordingly, the transferability to other regions is of high interest in this project.

Keywords: childhood research, health promotion, physical health, prevention network, psychological well-being, social inclusion

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Authors: Nicole Vlasman, Karamjeet Dhillon

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Over the past four years, the Healthy Relationships Program has been delivered in community organizations and schools across Canada. More than 240 groups have been facilitated in collaboration with 33 organizations. As a result, 2157 youth have been engaged in the programming. The purpose and scope of the Healthy Relationships Program are to offer sustainable, evidence-based skills through small group implementation to prevent violence and promote positive, healthy relationships in youth. The program development has included extensive networking at regional and national levels. The Healthy Relationships Program is currently being implemented, adapted, and researched within the Resilience and Inclusion through Strengthening and Enhancing Relationships (RISE-R) project. Alongside the project’s research objectives, the RISE-R team has worked to virtually share the ongoing findings of the project through a slow ontology approach. Slow ontology is a practice integrated into project systems and structures whereby slowing the pace and volume of outputs offers creative opportunities. Creative production reveals different layers of success and complements the project, the building blocks for sustainability. As a result of integrating a slow ontology approach, the RISE-R team has developed a Geographic Information System (GIS) that documents local landscapes through a Story Map feature, and more specifically, video installations. Video installations capture the cartography of space and place within the context of singular diverse community spaces (case studies). By documenting spaces via human connections, the project captures narratives, which further enhance the voices and faces of the community within the larger project scope. This GIS project aims to create a visual and interactive flow of information that complements the project's mixed-method research approach. Conclusively, creative project development in the form of a geographic information system can provide learning and engagement opportunities at many levels (i.e., within community organizations and educational spaces or with the general public). In each of these disconnected spaces, fragmented stories are connected through a visual display of project outputs. A slow ontology practice within the context of the RISE-R project documents activities on the fringes and within internal structures; primarily through documenting project successes as further contributions to the Centre for School Mental Health framework (philosophy, recruitment techniques, allocation of resources and time, and a shared commitment to evidence-based products).

Keywords: community programming, geographic information system, project development, project management, qualitative, slow ontology

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Authors: S. Ebadzadsahraei, H. Kazemian

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The main objective of this research was to measure particulate matter (PM₂.₅) and Volatile Organic Compound (VOCs) as two classes of air pollutants, at Prince George (PG) neighborhood in warm and cold seasons. To fulfill this objective, analytical protocols were developed for accurate sampling and measurement of the targeted air pollutants. PM₂.₅ samples were analyzed for their chemical composition (i.e., toxic trace elements) in order to assess their potential source of emission. The City of Prince George, widely known as the capital of northern British Columbia (BC), Canada, has been dealing with air pollution challenges for a long time. The city has several local industries including pulp mills, a refinery, and a couple of asphalt plants that are the primary contributors of industrial VOCs. In this research project, which is the first study of this kind in this region it measures physical and chemical properties of particulate air pollutants (PM₂.₅) at the city neighborhood. Furthermore, this study quantifies the percentage of VOCs at the city air samples. One of the outcomes of this project is updated data about PM₂.₅ and VOCs inventory in the selected neighborhoods. For examining PM₂.₅ chemical composition, an elemental analysis methodology was developed to measure major trace elements including but not limited to mercury and lead. The toxicity of inhaled particulates depends on both their physical and chemical properties; thus, an understanding of aerosol properties is essential for the evaluation of such hazards, and the treatment of such respiratory and other related diseases. Mixed cellulose ester (MCE) filters were selected for this research as a suitable filter for PM₂.₅ air sampling. Chemical analyses were conducted using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) for elemental analysis. VOCs measurement of the air samples was performed using a Gas Chromatography-Flame Ionization Detector (GC-FID) and Gas Chromatography-Mass Spectrometry (GC-MS) allowing for quantitative measurement of VOC molecules in sub-ppb levels. In this study, sorbent tube (Anasorb CSC, Coconut Charcoal), 6 x 70-mm size, 2 sections, 50/100 mg sorbent, 20/40 mesh was used for VOCs air sampling followed by using solvent extraction and solid-phase micro extraction (SPME) techniques to prepare samples for measuring by a GC-MS/FID instrument. Air sampling for both PM₂.₅ and VOC were conducted in summer and winter seasons for comparison. Average concentrations of PM₂.₅ are very different between wildfire and daily samples. At wildfire time average of concentration is 83.0 μg/m³ and daily samples are 23.7 μg/m³. Also, higher concentrations of iron, nickel and manganese found at all samples and mercury element is found in some samples. It is able to stay too high doses negative effects.

Keywords: air pollutants, chemical analysis, particulate matter (PM₂.₅), volatile organic compound, VOCs

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Authors: Nilson Rogério Da Silva, Ingrid Casagrande, Isabela Chicarelli Amaro Santos

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Introduction: People with Autism Spectrum Disorder (ASD) may face difficulties in social inclusion in different segments of society, especially in entering and staying at work. In Brazil, although there is legislation that equates it to the condition of disability, the number of people at work is still low. The United Nations estimates that more than 80 percent of adults with autism are jobless. In Brazil, the scenario is even more nebulous because there is no control and tracking of accurate data on the number of individuals with autism and how many of these are inserted in the labor market. Pereira and Goyos (2019) found that there is practically no scientific production about people with ASD in the labor market. Objective: To describe the experience of people with ASD inserted in the work, facilities and difficulties found in the professional exercise and the strategies used to maintain the job. Methodology: The research was approved by the Research Ethics Committee. As inclusion criteria for participation, the professional should accept to participate voluntarily, be over 18 years of age and have had some experience with the labor market. As exclusion criteria, being under 18 years of age and having never worked in a work activity. Participated in the research of 04 people with a diagnosis of ASD, aged 22 to 32 years. For data collection, an interview script was used that addressed: 1) General characteristics of the participants; 2) Family support; 3) School process; 4) Insertion in the labor market; 5) Exercise of professional activity; (6) Future and Autism; 7) Possible coping strategies. For the analysis of the data obtained, the full transcription of the interviews was performed and the technique of Content Analysis was performed. Results: The participants reported problems in different aspects: In the school environment: difficulty in social relationships, and Bullying. Lack of adaptation to the school curriculum and the structure of the classroom; In the Faculty: difficulty in following the activities, ealizar group work, meeting deadlines and establishing networking; At work: little adaptation in the work environment, difficulty in establishing good professional bonds, difficulty in accepting changes in routine or operational processes, difficulty in understanding veiled social rules. Discussion: The lack of knowledge about what disability is and who the disabled person is leads to misconceptions and negatives regarding their ability to work and in this context, people with disabilities need to constantly prove that they are able to work, study and develop as a human person, which can be classified as ableism. The adaptations and the use of technologies to facilitate the performance of people with ASD, although guaranteed in national legislation, are not always available, highlighting the difficulties and prejudice. Final Considerations: The entry and permanence of people with ASD at work still constitute a challenge to be overcome, involving changes in society in general, in companies, families and government agencies.

Keywords: autism spectrum disorder (ASD), work, disability, autism

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Authors: K. Mellou, G. Anastopoulos, T. Zakinthinos, C. Botsi, A. Terzidis

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‘PHILOS – Emergency health response to refugee crisis’ is a programme of the Greek Ministry of Health, implemented by the Hellenic Center for Disease Control and Prevention (HCDCP). The programme is funded by the Asylum, Migration and Integration Fund (AMIF) of EU’s DG Migration and Home Affairs. With the EU Member States accepting, the last period, accelerating migration flows, Greece inevitably occupies a prominent position in the migratory map due to this geographical location. The main objectives of the programme are a) reinforcement of the capacity of the public health system and enhancement of the epidemiological surveillance in order to cover refugees/migrant population, b) provision of on-site primary health care and psychological support services, and c) strengthening of national health care system task-force. The basic methods for achieving the aforementioned goals are: a) implementation of syndromic surveillance system at camps and enhancement of public health response with the use of mobile medical units (Sub-action A), b) enhancement of health care services inside the camps via increasing human resources and implementing standard operating procedures (Sub-action B), and c) reinforcement of the national health care system (primary healthcare units, hospitals, and emergency care spots) of affected regions with personnel (Sub-action C). As a result, 58 health professionals were recruited under sub-action 2 and 10 mobile unit teams (one or two at each health region) were formed. The main actions taken so far by the mobile units are the evaluation, of syndromic surveillance, of living conditions at camps and medical services. Also, vaccination coverage of children population was assessed, and more than 600 catch-up vaccinations were performed by the end of June 2017. Mobile units supported transportation of refugees/migrants from camps to medical services reducing the load of the National Center for Emergency Care (more than 350 transportations performed). The total number of health professionals (MD, nurses, etc.) placed at camps was 104. Common practices were implemented in the recording and collection of psychological and medical history forms at the camps. Protocols regarding maternity care, gender based violence and handling of violent incidents were produced and distributed at personnel working at camps. Finally, 290 health care professionals were placed at primary healthcare units, public hospitals and the National Center for Emergency Care at affected regions. The program has, also, supported training activities inside the camps and resulted to better coordination of offered services on site.

Keywords: migrants, refugees, public health, syndromic surveillance, national health care system, primary care, emergency health response

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Authors: Norhalim Yunus, Mohamad Husaini Dahalan, Nor Halina Ghazali

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Building technology start-ups from ground zero into world-class companies in form and substance present a rare opportunity for government-affiliated institutions in Malaysia. The challenge of building such start-ups becomes tougher when their core businesses involve commercialization of unproven technologies for the mass market. These simple truths, while difficult to execute, will go a long way in getting a business off the ground and flying high. Malaysian Technology Development Corporation (MTDC), a company founded to facilitate the commercial exploitation of R&D findings from research institutions and universities, and eventually help translate these findings of applications in the marketplace, is an excellent case in point. The purpose of this paper is to examine MTDC as an institution as it explores the concept of ‘it takes a village to raise a child’ in an effort to create and nurture start-ups into established world class Malaysian technology companies. With MTDC at the centre of Malaysia's innovative start-ups, the analysis seeks to specifically answer two questions: How has the concept been applied in MTDC? and what can we learn from this successful case? A key aim is to elucidate how MTDC's journey as a private limited company can help leverage reforms and achieve transformation, a process that might be suitable for other small, open, third world and developing countries. This paper employs a single case study, designed to acquire an in-depth understanding of how MTDC has developed and grown technology start-ups to world-class technology companies. The case study methodology is employed as the focus is on a contemporary phenomenon within a real business context. It also explains the causal links in real-life situations where a single survey or experiment is unable to unearth. The findings show that MTDC maximises the concept of it needs a village to raise a child in totality, as MTDC itself assumes the role of the innovator to 'raise' start-up companies into world-class stature. As the innovator, MTDC creates shared value and leadership, introduces innovative programmes ahead of the curve, mobilises talents for optimum results and aggregates knowledge for personnel advancement. The success of the company's effort is attributed largely to leadership, visionary, adaptability, commitment to innovate, partnership and networking, and entrepreneurial drive. The findings of this paper are however limited by the single case study of MTDC. Future research is required to study more cases of success or/and failure where the concept of it takes a village to raise a child have been explored and applied.

Keywords: start-ups, technology transfer, commercialization, technology incubator

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Authors: Aya Al Masri, Naima Oubenali, Safoin Aktaou, Thibault Julien, Malorie Martin, Fouad Maaloul

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Introduction: The increased number of performed 'Computed Tomography (CT)' examinations raise public concerns regarding associated stochastic risk to patients. In its Publication 102, the ‘International Commission on Radiological Protection (ICRP)’ emphasized the importance of managing patient dose, particularly from repeated or multiple examinations. We developed a Dose Archiving and Communication System that gives multiple dose indexes (organ dose, effective dose, and skin-dose mapping) for patients undergoing radiological imaging exams. The aim of this study is to compare the organ dose values given by our software for patients undergoing CT exams with those of another software named "VirtualDose". Materials and methods: Our software uses Monte Carlo simulations to calculate organ doses for patients undergoing computed tomography examinations. The general calculation principle consists to simulate: (1) the scanner machine with all its technical specifications and associated irradiation cases (kVp, field collimation, mAs, pitch ...) (2) detailed geometric and compositional information of dozens of well identified organs of computational hybrid phantoms that contain the necessary anatomical data. The mass as well as the elemental composition of the tissues and organs that constitute our phantoms correspond to the recommendations of the international organizations (namely the ICRP and the ICRU). Their body dimensions correspond to reference data developed in the United States. Simulated data was verified by clinical measurement. To perform the comparison, 270 adult patients and 150 pediatric patients were used, whose data corresponds to exams carried out in France hospital centers. The comparison dataset of adult patients includes adult males and females for three different scanner machines and three different acquisition protocols (Head, Chest, and Chest-Abdomen-Pelvis). The comparison sample of pediatric patients includes the exams of thirty patients for each of the following age groups: new born, 1-2 years, 3-7 years, 8-12 years, and 13-16 years. The comparison for pediatric patients were performed on the “Head” protocol. The percentage of the dose difference were calculated for organs receiving a significant dose according to the acquisition protocol (80% of the maximal dose). Results: Adult patients: for organs that are completely covered by the scan range, the maximum percentage of dose difference between the two software is 27 %. However, there are three organs situated at the edges of the scan range that show a slightly higher dose difference. Pediatric patients: the percentage of dose difference between the two software does not exceed 30%. These dose differences may be due to the use of two different generations of hybrid phantoms by the two software. Conclusion: This study shows that our software provides a reliable dosimetric information for patients undergoing Computed Tomography exams.

Keywords: adult and pediatric patients, computed tomography, organ dose calculation, software comparison

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Authors: Nicholus M. Warstadt, Andres D. Mallipudi, Oluwadamilola Idowu, Joshua Rodriguez, Madison M. Hunt, Soma Pathak, Laura P. Weber

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Endotracheal intubation is a core procedure performed by emergency physicians. This procedure is a high risk, and failure results in substantial morbidity and mortality. Fiberoptic intubation (FOI) is the standard of care in difficult airway protocols, yet no widespread practice exists for training emergency medicine (EM) residents in the technical acquisition of FOI skills. Simulation on mannequins is commonly utilized to teach advanced airway techniques. As part of a program to introduce FOI into our ED, residents received hands-on training in FOI as part of our weekly resident education conference. We hypothesized that prior to the hands-on training, residents had little experience with FOI and were uncomfortable with using fiberoptic as a modality. We further hypothesized that resident comfort with FOI would increase following the training. The education intervention consisted of two hours of focused airway teaching and skills acquisition for PGY 1-4 residents. One hour was dedicated to four case-based learning stations focusing on standard, pediatric, facial trauma, and burn airways. Direct, video, and fiberoptic airway equipment were available to use at the residents’ discretion to intubate mannequins at each station. The second hour involved direct instructor supervision and immediate feedback during deliberate practice for FOI of a mannequin. Prior to the hands-on training, a pre-survey was sent via email to all EM residents at NYU Grossman School of Medicine. The pre-survey asked how many FOI residents have performed in the ED, OR, and on a mannequin. The pre-survey and a post-survey asked residents to rate their comfort with FOI on a 5-point Likert scale ("extremely uncomfortable", "somewhat uncomfortable", "neither comfortable nor uncomfortable", "somewhat comfortable", and "extremely comfortable"). The post-survey was administered on site immediately following the training. A two-sample chi-square test of independence was calculated comparing self-reported resident comfort on the pre- and post-survey (α ≤ 0.05). Thirty-six of a total of 70 residents (51.4%) completed the pre-survey. Of pre-survey respondents, 34 residents (94.4%) had performed 0, 1 resident (2.8%) had performed 1, and 1 resident (2.8%) had performed 2 FOI in the ED. Twenty-five residents (69.4%) had performed 0, 6 residents (16.7%) had performed 1, 2 residents (5.6%) had performed 2, 1 resident (2.8%) had performed 3, and 2 residents (5.6%) had performed 4 FOI in the OR. Seven residents (19.4%) had performed 0, and 16 residents (44.4%) had performed 5 or greater FOI on a mannequin. 29 residents (41.4%) attended the hands-on training, and 27 out of 29 residents (93.1%) completed the post-survey. Self-reported resident comfort with FOI significantly increased in post-survey compared to pre-survey questionnaire responses (p = 0.00034). Twenty-one of 27 residents (77.8%) report being “somewhat comfortable” or “extremely comfortable” with FOI on the post-survey, compared to 9 of 35 residents (25.8%) on the pre-survey. We show that dedicated FOI training is associated with increased learner comfort with such techniques. Further direction includes studying technical competency, skill retention, translation to direct patient care, and optimal frequency and methodology of future FOI education.

Keywords: airway, emergency medicine, fiberoptic intubation, medical simulation, skill acquisition

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Authors: Liliana Gomez Cardona, Echo Parent-Racine, Joy Outerbridge, Arlene Laliberté, Outi Linnaranta

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Suicide rates among Inuit in Nunavik are six to eleven times larger than the Canadian average. The colonization, religious missions, residential schools as well as economic and political marginalization are factors that have challenged the well-being and mental health of these populations. In psychiatry, screening for mental illness is often done using questionnaires with which the patient is expected to respond how often he/she has certain symptoms. However, the Indigenous view of mental wellbeing may not fit well with this approach. Moreover, biomedical treatments do not always meet the needs of Indigenous peoples because they do not understand the culture and traditional healing methods that persist in many communities. Assess whether the questionnaires used to measure symptoms, commonly used in psychiatry are appropriate and culturally safe for the Inuit in Quebec. Identify the most appropriate tool to assess and promote wellbeing and follow the process necessary to improve its cultural sensitivity and safety for the Inuit population. Qualitative, collaborative, and participatory action research project which respects First Nations and Inuit protocols and the principles of ownership, control, access, and possession (OCAP). Data collection based on five focus groups with stakeholders working with these populations and members of Indigenous communities. Thematic analysis of the data collected and emerging through an advisory group that led a revision of the content, use, and cultural and conceptual relevance of the instruments. The questionnaires measuring psychiatric symptoms face significant limitations in the local indigenous context. We present the factors that make these tools not relevant among Inuit. Although the scale called Growth and Empowerment Measure (GEM) was originally developed among Indigenous in Australia, the Inuit in Quebec found that this tool comprehends critical aspects of their mental health and wellbeing more respectfully and accurately than questionnaires focused on measuring symptoms. We document the process of cultural adaptation of this tool which was supported by community members to create a culturally safe tool that helps in resilience and empowerment. The cultural adaptation of the GEM provides valuable information about the factors affecting wellbeing and contributes to mental health promotion. This process improves mental health services by giving health care providers useful information about the Inuit population and their clients. We believe that integrating this tool in interventions can help create a bridge to improve communication between the Indigenous cultural perspective of the patient and the biomedical view of health care providers. Further work is needed to confirm the clinical utility of this tool in psychological and psychiatric intervention along with social and community services.

Keywords: cultural adaptation, cultural safety, empowerment, Inuit, mental health, Nunavik, resiliency

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Authors: Eyosiyas Aga

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The development of information communication technology has transformed the paper-based mapping and land registration processes to a computerized and networked system. The computerization and networking of real property information system play a vital role in good governance and sustainable development of emerging countries through cost effective, easy and accessible service delivery for the customer. The efficient, transparent and sustainable real property system is becoming the basic infrastructure for the urban development thus improve the data management system and service delivery in the organizations. In Ethiopia, the real property administration is paper based as a result, it confronted problems of data management, illegal transactions, corruptions, and poor service delivery. In order to solve this problem and to facilitate real property market, the implementation of web-based real property updating system is crucial. A web-based real property updating is one of the automation (computerizations) methods to facilitate data sharing, reduce time and cost of the service delivery in real property administration system. In additions, it is useful for the integration of data onto different information systems and organizations. This system is designed by combining open source software which supported by open Geo-spatial consortium. The web-based system is mainly designed by using open source software with the help of open Geo-spatial Consortium. The Open Geo-spatial Consortium standards such as the Web Feature Service and Web Map Services are the most widely used standards to support and improves web-based real property updating. These features allow the integration of data from different sources, and it can be used to maintain consistency of data throughout transactions. The PostgreSQL and Geoserver are used to manage and connect a real property data to the flex viewer and user interface. The system is designed for both internal updating system (municipality); which is mainly updating of spatial and textual information, and the external system (customer) which focus on providing and interacting with the customer. This research assessed the potential of open source web applications and adopted this technology for real property updating system in Ethiopia through simple, cost effective and secured way. The system is designed by combining and customizing open source software to enhance the efficiency of the system in cost effective way. The existing workflow for real property updating is analyzed to identify the bottlenecks, and the new workflow is designed for the system. The requirement is identified through questionnaire and literature review, and the system is prototype for the study area. The research mainly aimed to integrate human resource with technology in designing of the system to reduce data inconsistency and security problems. In additions, the research reflects on the current situation of real property administration and contributions of effective data management system for efficient, transparent and sustainable urban development in Ethiopia.

Keywords: cadaster, real property, sustainable, transparency, web feature service, web map service

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Authors: David A. Ullisch, Yantree D. Sankar-Thomas, Stefan Wilke, Thomas Selge, Matthias Pump, Thomas Leibold, Kai Schütte, Gilbert Gorr

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Plants have been considered as a source of natural substances for ages. Secondary metabolites from plants are utilized especially in medical applications but are more and more interesting as cosmetical ingredients and in the field of nutraceuticals. However, supply of compounds from natural harvest can be limited by numerous factors i.e. endangered species, low product content, climate impacts and cost intensive extraction. Especially in the pharmaceutical industry the ability to provide sufficient amounts of product and high quality are additional requirements which in some cases are difficult to fulfill by plant harvest. Whereas in many cases the complexity of secondary metabolites precludes chemical synthesis on a reasonable commercial basis, plant cells contain the biosynthetic pathway – a natural chemical factory – for a given compound. A promising approach for the sustainable production of natural products can be plant cell fermentation (PCF®). A thoroughly accomplished development process comprises the identification of a high producing cell line, optimization of growth and production conditions, the development of a robust and reliable production process and its scale-up. In order to address persistent, long lasting production, development of cryopreservation protocols and generation of working cell banks is another important requirement to be considered. So far the most prominent example using a PCF® process is the production of the anticancer compound paclitaxel. To demonstrate the power of plant suspension cultures here we present three case studies: 1) For more than 17 years Phyton produces paclitaxel at industrial scale i.e. up to 75,000 L in scale. With 60 g/kg dw this fully controlled process which is applied according to GMP results in outstanding high yields. 2) Thapsigargin is another anticancer compound which is currently isolated from seeds of Thapsia garganica. Thapsigargin is a powerful cytotoxin – a SERCA inhibitor – and the precursor for the derivative ADT, the key ingredient of the investigational prodrug Mipsagargin (G-202) which is in several clinical trials. Phyton successfully generated plant cell lines capable to express this compound. Here we present data about the screening for high producing cell lines. 3) The third case study covers ingenol-3-mebutate. This compound is found in the milky sap of the intact plants of the Euphorbiacae family at very low concentrations. Ingenol-3-mebutate is used in Picato® which is approved against actinic keratosis. Generation of cell lines expressing significant amounts of ingenol-3-mebutate is another example underlining the strength of plant cell culture. The authors gratefully acknowledge Inspyr Therapeutics for funding.

Keywords: Ingenol-3-mebutate, plant cell culture, sustainability, thapsigargin

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Authors: Jaci Mastrandrea

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Background: The National Comprehensive Cancer Network (NCCN) recommends that healthcare institutions have established processes for integrating palliative care (PC) into cancer treatment and that all cancer patients be screened for PC needs upon initial diagnosis as well as throughout the entire continuum of care (National Comprehensive Cancer Network, 2021). Early PC screening is directly correlated with improved patient outcomes. The Sky Lakes Cancer Treatment Center (SLCTC) is an institution that has access to PC services yet does not have protocols in place for identifying patients with palliative needs or a standardized referral process. The aim of this quality improvement project is to improve early access to PC services by establishing a standardized screening and referral process for outpatient oncology patients. Method: The sample population included all adult patients with an oncology diagnosis who presented to the SLCTC for treatment during the project timeline from March 15th, 2022, to April 29th, 2022. The “Palliative and Supportive Needs Assessment'' (PSNA) screening tool was developed from validated and evidence-based PC referral criteria. The tool was initially implemented using paper forms and later was integrated into the Epic-Beacon EHR system. Patients were screened by registered nurses on the SLCTC treatment team. Nurses responsible for screening patients received an educational inservice prior to implementation. Patients with a PSNA score of three or higher were considered to be a positive screen. Scores of five or higher triggered a PC referral order in the patient’s EHR for the oncologist to review and approve. All patients with a positive screen received an educational handout on the topic of PC, and the EHR was flagged for follow-up. Results: Prior to implementation of the PSCNA screening tool, the SLCTC had zero referrals to PC in the past year, excluding referrals to hospice. Data was collected from the first 100 patient screenings completed within the eight-week data collection period. Seventy-three percent of patients met criteria for PC referral with a score greater than or equal to three. Of those patients who met referral criteria, 53.4% (39 patients) were referred for a palliative and supportive care consultation. Patients that were not referred to PC upon meeting the criteria were flagged in the EHR for re-screening within one to three months. Patients with lung cancer, chronic hematologic malignancies, breast cancer, and gastrointestinal malignancy most frequently met criteria for PC referral and scored highest overall on the scale of 0-12. Conclusion: The implementation of a standardized PC screening tool at the SLCTC significantly increased awareness of PC needs among cancer patients in the outpatient setting. Additionally, data derived from this quality improvement project supports the national recommendation for PC to be an integral component of cancer treatment across the entire continuum of care.

Keywords: oncology, palliative care, symptom management, symptom screening, ambulatory oncology, cancer, supportive care

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Authors: Saimir Cenameri, Arjana Tereziu, Kastriot Dallaku

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Introduction: Intra-uterine death is a common problem in obstetrical practice, and can lead to complications if left to resolve spontaneously. The cervix is unprepared, making inducing of labor difficult. Misoprostol is a synthetic prostaglandin E1 analogue, inexpensive, and is presented valid thanks to its ability to bring about changes in the cervix that lead to the induction of uterine contractions. Misoprostol is quickly absorbed when taken orally, resulting in high initial peak serum concentrations compared with the vaginal route. The vaginal misoprostol peak serum concentration is not as high and demonstrates a more gradual serum concentration decline. This is associated with many benefits for the patient; fast induction of labor; smaller doses; and fewer side effects (dose-depended). Mostly it has been used the regime of 50 μg/4 hour, with a high percentage of success and limited side effects. Objective: Evaluation of the efficiency of the use of oral and vaginal misoprostol in inducing labor, and comparing it with its use not by a previously defined protocol. Methods: Participants in this study included patients at U.H.O.G. 'Koco Gliozheni', Tirana from April 2004-July 2006, presenting with an indication for inducing labor in the third trimester for pregnancy termination. A total of 37 patients were randomly admitted for birth inducing activity, according to protocol (26), oral or vaginal protocol (10 vs. 16), and a control group (11), not subject to the protocol, was created. Oral or vaginal misoprostol was administered at a dose of 50 μg/4 h, while the fourth group participants were treated individually by the members of the medical staff. The main result of interest was the time between induction of labor to birth. Kruskal-Wallis test was used to compare the average age, parity, women weight, gestational age, Bishop's score, the size of the uterus and weight of the fetus between the four groups in the study. The Fisher exact test was used to compare day-stay and causes in the four groups. Mann-Whitney test was used to compare the time of the expulsion and the number of doses between oral and vaginal group. For all statistical tests used, the value of P ≤ 0.05 was considered statistically significant. Results: The four groups were comparable with regard to woman age and weight, parity, abortion indication, Bishop's score, fetal weight and the gestational age. There was significant difference in the percentage of deliveries within 24 hours. The average time from induction to birth per route (vaginal, oral, according to protocol and not according to the protocol) was respectively; 10.43h; 21.10h; 15.77h, 21.57h. There was no difference in maternal complications in groups. Conclusions: Use of vaginal misoprostol for inducing labor in the third trimester for termination of pregnancy appears to be more effective than the oral route, and even more to uses not according to the protocols approved before, where complications are greater and unjustified.

Keywords: inducing labor, misoprostol, pregnancy termination, third trimester

Procedia PDF Downloads 156

Authors: Raymond Chi Fai Si Tou, Jacey Ja Young Choe, Amy Siu Ian So

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Smart hotels can be defined as the hotel which has an intelligent system, through digitalization and networking which achieve hotel management and service information. In addition, smart hotels include high-end designs that integrate information and communication technology with hotel management fulfilling the guests’ needs and improving the quality, efficiency and satisfaction of hotel management. The purpose of this study is to identify appropriate factors that may influence guests’ satisfaction and intention to revisit Smart Hotels based on service quality measurement of lodging quality index and extended UTAUT theory. Unified Theory of Acceptance and Use of Technology (UTAUT) is adopted as a framework to explain technology acceptance and use. Since smart hotels are technology-based infrastructure hotels, UTATU theory could be as the theoretical background to examine the guests’ acceptance and use after staying in smart hotels. The UTAUT identifies four key drivers of the adoption of information systems: performance expectancy, effort expectancy, social influence, and facilitating conditions. The extended UTAUT modifies the definitions of the seven constructs for consideration; the four previously cited constructs of the UTAUT model together with three new additional constructs, which including hedonic motivation, price value and habit. Thus, the seven constructs from the extended UTAUT theory could be adopted to understand their intention to revisit smart hotels. The service quality model will also be adopted and integrated into the framework to understand the guests’ intention of smart hotels. There are rare studies to examine the service quality on guests’ satisfaction and intention to revisit in smart hotels. In this study, Lodging Quality Index (LQI) will be adopted to measure the service quality in smart hotels. Using integrated UTAUT theory and service quality model because technological applications and services require using more than one model to understand the complicated situation for customers’ acceptance of new technology. Moreover, an integrated model could provide more perspective insights to explain the relationships of the constructs that could not be obtained from only one model. For this research, ten in-depth interviews are planned to recruit this study. In order to confirm the applicability of the proposed framework and gain an overview of the guest experience of smart hotels from the hospitality industry, in-depth interviews with the hotel guests and industry practitioners will be accomplished. In terms of the theoretical contribution, it predicts that the integrated models from the UTAUT theory and the service quality will provide new insights to understand factors that influence the guests’ satisfaction and intention to revisit smart hotels. After this study identifies influential factors, smart hotel practitioners could understand which factors may significantly influence smart hotel guests’ satisfaction and intention to revisit. In addition, smart hotel practitioners could also provide outstanding guests experience by improving their service quality based on the identified dimensions from the service quality measurement. Thus, it will be beneficial to the sustainability of the smart hotels business.

Keywords: intention to revisit, guest satisfaction, qualitative interviews, smart hotels

Procedia PDF Downloads 180

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

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

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

Procedia PDF Downloads 219

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

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

Keywords: exercise, BDNF, schizophrenia, time-points

Procedia PDF Downloads 232

Authors: Yasmine Salehy, Yann Leroy, Francois Cluzel, Hong-Minh Hoang, Laurence Fournaison, Anthony Delahaye, Bernard Yannou

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Taking into consideration all the life cycle of a product is now an important step in the eco-design of a product or a technology. Life cycle assessment (LCA) is a standard tool to evaluate the environmental impacts of a system or a process. Despite the improvement in refrigerant regulation through protocols, the environmental damage of refrigeration systems remains important and needs to be improved. In this paper, the environmental impacts of refrigeration systems in a typical supermarket are compared using the LCA methodology under different conditions. The system is used to provide cold at two levels of temperature: medium and low temperature during a life period of 15 years. The most commonly used architectures of supermarket cold production systems are investigated: centralized direct expansion systems and indirect systems using a secondary loop to transport the cold. The variation of power needed during seasonal changes and during the daily opening/closure periods of the supermarket are considered. R134a as the primary refrigerant fluid and two types of secondary fluids are considered. The composition of each system and the leakage rate of the refrigerant through its life cycle are taken from the literature and industrial data. Twelve scenarios are examined. They are based on the variation of three parameters, 1. location: France (Paris), Spain (Toledo) and Sweden (Stockholm), 2. different sources of electric consumption: photovoltaic panels and low voltage electric network and 3. architecture: direct and indirect refrigeration systems. OpenLCA, SimaPro softwares, and different impact assessment methods were compared; CML method is used to evaluate the midpoint environmental indicators. This study highlights the significant contribution of electric consumption in environmental damages compared to the impacts of refrigerant leakage. The secondary loop allows lowering the refrigerant amount in the primary loop which results in a decrease in the climate change indicators compared to the centralized direct systems. However, an exhaustive cost evaluation (CAPEX and OPEX) of both systems shows more important costs related to the indirect systems. A significant difference between the countries has been noticed, mostly due to the difference in electric production. In Spain, using photovoltaic panels helps to reduce efficiently the environmental impacts and the related costs. This scenario is the best alternative compared to the other scenarios. Sweden is a country with less environmental impacts. For both France and Sweden, the use of photovoltaic panels does not bring a significant difference, due to a less sunlight exposition than in Spain. Alternative solutions exist to reduce the impact of refrigerating systems, and a brief introduction is presented.

Keywords: eco-design, industrial engineering, LCA, refrigeration system

Procedia PDF Downloads 150

Authors: B. B. S. Pereira, M. O. Souza, L. P. Zanetti, L. C. S. Oliveira, J. R. P. Moreno, M. P. Souza, V. R. Colturato, C. M. Machado

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Background: The introduction of prophylactic or preemptive therapies has effectively decreased the CMV mortality rates after hematopoietic stem cell transplantation (HSCT). CMV antigenemia (pp65) or quantitative PCR are methods currently approved for CMV surveillance in pre-emptive strategies. Commercial assays are preferred as cut-off levels defined by in-house assays may vary among different protocols and in general show low reproducibility. Moreover, comparison of published data among different centers is only possible if international standards of quantification are included in the assays. Recently, the World Health Organization (WHO) established the first international standard for CMV detection. The real time PCR COBAS Ampliprep/ CobasTaqMan (CAP/CTM) (Roche®) was developed using the WHO standard for CMV quantification. However, the cut-off for the introduction of antiviral has not been determined yet. Methods: We conducted a retrospective study to determine: 1) the sensitivity and specificity of the new CMV CAP/CTM test in comparison with pp65 antigenemia to detect episodes of CMV infection/reactivation, and 2) the cut-off of viral load for introduction of ganciclovir (GCV). Pp65 antigenemia was performed and the corresponding plasma samples were stored at -20°C for further CMV detection by CAP/CTM. Comparison of tests was performed by kappa index. The appearance of positive antigenemia was considered the state variable to determine the cut-off of CMV viral load by ROC curve. Statistical analysis was performed using SPSS software version 19 (SPSS, Chicago, IL, USA.). Results: Thirty-eight patients were included and followed from August 2014 through May 2015. The antigenemia test detected 53 episodes of CMV infection in 34 patients (89.5%), while CAP/CTM detected 37 episodes in 33 patients (86.8%). AG and PCR results were compared in 431 samples and Kappa index was 30.9%. The median time for first AG detection was 42 (28-140) days, while CAP/CTM detected at a median of 7 days earlier (34 days, ranging from 7 to 110 days). The optimum cut-off value of CMV DNA was 34.25 IU/mL to detect positive antigenemia with 88.2% of sensibility, 100% of specificity and AUC of 0.91. This cut-off value is below the limit of detection and quantification of the equipment which is 56 IU/mL. According to CMV recurrence definition, 16 episodes of CMV recurrence were detected by antigenemia (47.1%) and 4 (12.1%) by CAP/CTM. The duration of viremia as detected by antigenemia was shorter (60.5% of the episodes lasted ≤ 7 days) in comparison to CAP/CTM (57.9% of the episodes lasting 15 days or more). This data suggests that the use of antigenemia to define the duration of GCV therapy might prompt early interruption of antiviral, which may favor CMV reactivation. The CAP/CTM PCR could possibly provide a safer information concerning the duration of GCV therapy. As prolonged treatment may increase the risk of toxicity, this hypothesis should be confirmed in prospective trials. Conclusions: Even though CAP/CTM by ROCHE showed great qualitative correlation with the antigenemia technique, the fully automated CAP/CTM did not demonstrate increased sensitivity. The cut-off value below the limit of detection and quantification may result in delayed introduction of pre-emptive therapy.

Keywords: antigenemia, CMV COBAS/TAQMAN, cytomegalovirus, antiviral cut-off

Procedia PDF Downloads 166

Authors: Gianluca Castelnuovo, Giada Pietrabissa, Gian Mauro Manzoni, Margherita Novelli, Emanuele Maria Giusti, Roberto Cattivelli, Enrico Molinari

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Diabesity could be defined as a new global epidemic of obesity and being overweight with many complications and chronic conditions. Such conditions include not only type 2 diabetes, but also cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer, and various psychosocial and psychopathological disorders. The financial direct and indirect burden (considering also the clinical resources involved and the loss of productivity) is a real challenge in many Western health-care systems. Recently the Lancet journal defined diabetes as a 21st-century challenge. In order to promote patient compliance in diabesity treatment reducing costs, evidence-based interventions to improve weight-loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. Moreover, new technologies can provide useful solutions in this multidisciplinary approach, above all in maintaining long-term compliance and adherence in order to ensure clinical efficacy. Psychological therapies with diet and exercise plans could better help patients in achieving weight loss outcomes, both inside hospitals and clinical centers and during out-patient follow-up sessions. In the management of chronic diseases clinical psychology play a key role due to the need of working on psychological conditions of patients, their families and their caregivers. mHealth approach could overcome limitations linked with the traditional, restricted and highly expensive in-patient treatment of many chronic pathologies: one of the best up-to-date application is the management of obesity with type 2 diabetes, where mHealth solutions can provide remote opportunities for enhancing weight reduction and reducing complications from clinical, organizational and economic perspectives. A stepped care mHealth-based approach is an interesting perspective in chronic care management of obesity with type 2 diabetes. One promising future direction could be treating obesity, considered as a chronic multifactorial disease, using a stepped-care approach: -mhealth or traditional based lifestyle psychoeducational and nutritional approach. -health professionals-driven multidisciplinary protocols tailored for each patient. -inpatient approach with the inclusion of drug therapies and other multidisciplinary treatments. -bariatric surgery with psychological and medical follow-up In the chronic care management of globesity mhealth solutions cannot substitute traditional approaches, but they can supplement some steps in clinical psychology and medicine both for obesity prevention and for weight loss management.

Keywords: clinical health psychology, mhealth, obesity, type 2 diabetes, stepped care, chronic care management

Procedia PDF Downloads 318

Authors: Florence Roselle Adalin, Misha Louise Delariarte, Fabbette Laire Lagas, Sarah Emanuelle Mejia, Lika Mizukoshi, Irish Paullen Palomeno, Gibrianne Alistaire Ramos, Danica Pauline Ramos, Josefina Tuazon, Jo Leah Flores

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Pain, often a missed and undertreated symptom, affects the quality of life of individuals. Nurses are key players in providing effective pain management to decrease morbidity and mortality of patients in pain. Nurses’ knowledge and attitude on pain greatly affect their ability on assessment and management. The Pain Society of the Philippines recognized the inadequacy and inaccessibility of data on the knowledge, skills, and attitude of nurses on pain management in the country. This study may be the first of its kind in the county, giving it the potential to contribute greatly to nursing education and practice through providing valuable baseline data. Objectives: This study aims to describe the level of knowledge and attitude, and current practices of nurses on pain assessment and management; and determine the relationship of nurses’ knowledge and attitude with years of experience, training on pain management and clinical area of practice. Methodology: A survey research design was employed. Four hospitals were selected through purposive sampling. A total of 235 Medical-Surgical Unit and Intensive Care Unit (ICU) nurses participated in the study. The tool used is a combination of demographic survey, Nurses’ Knowledge and Attitude Survey Regarding Pain (NKASRP), Acute Pain Evidence Based Practice Questionnaire (APEBPQ) with self-report questions on non-pharmacologic pain management. The data obtained was analysed using descriptive statistics, two sample T-tests for clinical areas and training; and Pearson product correlation to identify relationship of level of knowledge and attitude with years of experience. Results and Analysis: The mean knowledge and attitude score of the nurses was 47.14%. Majority answered ‘most of the time’ or ‘all the time’ on 84.12% of practice items on pain assessment, implementation of non-pharmacologic interventions, evaluation and documentation. Three of 19 practice items describing morphine and opioid administration in special populations were only done ‘a little of the time’. Most utilized non-pharmacologic interventions were deep breathing exercises (79.66%), massage therapy (27.54%), and ice therapy (26.69%). There was no significant relationship between knowledge scores and years of clinical experience (p = 0.05, r= -0.09). Moreover, there was not enough evidence to show difference in nurses’ knowledge and attitude scores in relation to presence of training (p = 0.41) or areas (Medical-Surgical or ICU) of clinical practice (p = 0.53). Conclusion and Recommendations: Findings of the study showed that the level of knowledge and attitude of nurses on pain assessment and management is suboptimal; and no relationship between nurses’ knowledge and attitude and years of experience. It is recommended that further studies look into the nursing curriculum on pain education, culture-specific pain management protocols and evidence-based practices in the country.

Keywords: knowledge and attitude, nurses, pain management, practices on pain management

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Authors: C. A. Barros, Ana P. Barroso

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Any industrial company needs to determine the amount of variation that exists within its measurement process and guarantee the reliability of their data, studying the performance of their measurement system, in terms of linearity, bias, repeatability and reproducibility and stability. This issue is critical for automotive industry suppliers, who are required to be certified by the 16949:2016 standard (replaces the ISO/TS 16949) of International Automotive Task Force, defining the requirements of a quality management system for companies in the automotive industry. Measurement System Analysis (MSA) is one of the mandatory tools. Frequently, the measurement system in companies is not connected to the equipment and do not incorporate the methods proposed by the Automotive Industry Action Group (AIAG). To address these constraints, an R&D project is in progress, whose objective is to develop a web and cloud-based MSA tool. This MSA tool incorporates Industry 4.0 concepts, such as, Internet of Things (IoT) protocols to assure the connection with the measuring equipment, cloud computing, artificial intelligence, statistical tools, and advanced mathematical algorithms. This paper presents the preliminary findings of the project. The web and cloud-based MSA tool is innovative because it implements all statistical tests proposed in the MSA-4 reference manual from AIAG as well as other emerging methods and techniques. As it is integrated with the measuring devices, it reduces the manual input of data and therefore the errors. The tool ensures traceability of all performed tests and can be used in quality laboratories and in the production lines. Besides, it monitors MSAs over time, allowing both the analysis of deviations from the variation of the measurements performed and the management of measurement equipment and calibrations. To develop the MSA tool a ten-step approach was implemented. Firstly, it was performed a benchmarking analysis of the current competitors and commercial solutions linked to MSA, concerning Industry 4.0 paradigm. Next, an analysis of the size of the target market for the MSA tool was done. Afterwards, data flow and traceability requirements were analysed in order to implement an IoT data network that interconnects with the equipment, preferably via wireless. The MSA web solution was designed under UI/UX principles and an API in python language was developed to perform the algorithms and the statistical analysis. Continuous validation of the tool by companies is being performed to assure real time management of the ‘big data’. The main results of this R&D project are: MSA Tool, web and cloud-based; Python API; New Algorithms to the market; and Style Guide of UI/UX of the tool. The MSA tool proposed adds value to the state of the art as it ensures an effective response to the new challenges of measurement systems, which are increasingly critical in production processes. Although the automotive industry has triggered the development of this innovative MSA tool, other industries would also benefit from it. Currently, companies from molds and plastics, chemical and food industry are already validating it.

Keywords: automotive Industry, industry 4.0, Internet of Things, IATF 16949:2016, measurement system analysis

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Authors: Ekatereine Abashidze, Nino Nazarashvili, Dali Gaganidze, Oleg Gorgadze, Mariam Aznarashvili, Eter Gvritishvili

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Potato is one of the leading agricultural crops in Georgia. Georgia produces early and late potato varieties in almost all regions. Potato production is equal to 25,000 ha and its average yield is 20-25 t/ha. Among the plant pests that limit potato production and quality, the potato cyst nematodes (Globodera pallida (Stone) Behrens and Globodera rostochiensis (Wollenveber) Behrens) are harmful around the world. PCN is among the most difficult plant pests to control. Cysts protected by a durable wall can survive for over 30 years . Control of PCN (G. pallida and G. rostochiensis) is regulated by Council Directive 2007/33/EE C. There was no legislative regulation of these pests in Georgia before 2016. By Resolution #302 from July 1, 2016, developed within the action plan of the DCFTA (Deep and Comprehensive Free Trade Area) the Government of Georgia established control over potato cyst nematodes. The Agreement about the legal acts approximation to EU legislation concerns the approval of rules of PCN control and research of these pests. Taking into consideration the above mentioned, it is necessary to study PCN (G. pallida and G. rostochiensis) in the potato-growing areas of Georgia. The aim of this research is to conduct survey of potato cyst nematodes (Globodera rostochiensis and G. pallida) in two geographically distinct regions of Georgia - Samtskhe - Javakheti and Svanetii and to identify the species G. Rostochiensis and G. Pallida by the morphological - morphometric and molecular methods. Soil samples were taken in each village, in a zig-zag pattern on the potato fields of the private sector, using the Metlitsky method. Samples were taken also from infested potato plant roots. To extract nematode cysts from soil samples Fanwick can be used according to standard methods by EPPO. Cysts were measured under a stereoscopic microscope (Leica M50). Identification of the nematod species was carried out according to morphological and morphometric characteristics of the cysts and larvae using appropriate protocols EPPO. For molecular identification, a multiplex PCR test was performed by the universal ITS5 and cyst nematodes’ (G. pallida, G. rostochiensis) specific primers. To identify the species of potato cyst nematodes (PCN) in two regions (Samtskhe-Javakheti and Svaneti) were taken 200 samples, among them: 80 samples in Samtskhe-Javakheti region and 120 in Svaneti region. Cysts of Globiodera spp. were revealed in 50 samples obtained from Samtskhe-Javakheti and 80 samples from Svaneti regions. Morphological, morphometric and molecular analysis of two forms of PCN found in investigated regions of Georgia shows that one form of PCN belongs to G. rostoshiensi; the second form is the different species of Globodera sp.t is the subject of future research. Despite the different geographic locations, larvae and cysts of G. rostoshiensi were found in both regions. But cysts and larvae of G. pallida were not reported. Acknowledgement: The research has been supported by the Shota Rustaveli National Scientific Foundation of Georgia: Project # FR17_235.

Keywords: cyst nematode, globodera rostochiensis, globodera pallida, morphologic-morphometric measurement

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Authors: Salome Schulze

Abstract:

The delay of students in completing their dissertations is a worldwide problem. At the University of South Africa where this research was done, only about a third of the students complete their studies within the required period of time. This study explored the reasons why the students interrupted their studies, and why they resumed their research at a later stage. If this knowledge could be utilised to improve the throughput of doctoral students, it could have significant economic benefits for institutions of higher education while at the same time enhancing their academic prestige. To inform the investigation, attention was given to key theories concerning the learning of doctoral students, namely the situated learning theory, the social capital theory and the self-regulated learning theory, based on the social cognitive theory of learning. Ten students in the faculty of Education were purposefully selected on the grounds of their poor progress, or of having been in the system for too long. The collection of the data was in accordance with a Finnish study, since the two studies had the same aims, namely to investigate student engagement and disengagement. Graphic elicitation interviews, based on visualisations were considered appropriate to collect the data. This method could stimulate the reflection and recall of the participants’ ‘stories’ with very little input from the interviewer. The interviewees were requested to visualise, on paper, their journeys as doctoral students from the time when they first registered. They were to indicate the significant events that occurred and which facilitated their engagement or disengagement. In the interviews that followed, they were requested to elaborate on these motivating or challenging events by explaining when and why they occurred, and what prompted them to resume their studies. The interviews were tape-recorded and transcribed verbatim. Information-rich data were obtained containing visual metaphors. The data indicated that when the students suffered a period of disengagement, it was sometimes related to a lack of self-regulated learning, in particular, a lack of autonomy, and the inability to manage their time effectively. When the students felt isolated from the academic community of practice disengagement also occurred. This included poor guidance by their supervisors, which accordingly deprived them of significant social capital. The study also revealed that situational factors at home or at work were often the main reasons for the students’ procrastinating behaviour. The students, however, remained in the system. They were motivated towards a renewed engagement with their studies if they were self-regulated learners, and if they felt a connectedness with the academic community of practice because of positive relationships with their supervisors and of participation in the activities of the community (e.g., in workshops or conferences). In support of their learning, networking with significant others who were sources of information provided the students with the necessary social capital. Generally, institutions of higher education cannot address the students’ personal issues directly, but they can deal with key institutional factors in order to improve the throughput of doctoral students. It is also suggested that graphic elicitation interviews be used more often in social research that investigates the learning and development of the students.

Keywords: doctoral students, engaging and disengaging experiences, graphic elicitation interviews, student procrastination

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Authors: Cheila Pereira, Sara C. Cunha, Miguel A. Faria, José O. Fernandes

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The increasing world population brings several concerns, one of which is food security and sustainability. To meet this challenge, aquaculture, the farming of aquatic animals and plants, including fish, mollusks, bivalves, and algae, has experienced sustained growth and development in recent years. Recent advances in this industry have focused on reducing its economic and environmental costs, for example, the substitution of protein sources in fish feed. Plant-based proteins are now a common approach, and while it is a greener alternative to animal-based proteins, there are some disadvantages, such as their putative content and intoxicants such as mycotoxins. These are naturally occurring plant contaminants, and their exposure in fish can cause health problems, stunted growth or even death, resulting in economic losses for the producers and health concerns for the consumers. Different works have demonstrated the presence of both AFB1 (aflatoxin B1) and ENNB1 (enniatin B1) in fish feed and their capacity to be absorbed and bioaccumulate in the fish organism after digestion, further reaching humans through fish ingestion. The aim of this work was to evaluate the bioaccessibility of both mycotoxins in samples of Sparus aurata muscle using a static digestion model based on the INFOGEST protocol. The samples were subjected to different cooking procedures – raw, grilled and fried – and different seasonings – none, thyme and ginger – in order to evaluate their potential reduction effect on mycotoxins bioaccessibility, followed by the evaluation of the intestinal transport of both compounds with an in vitro cell model composed of Caco-2/HT-29 co-culture monolayers, simulating the human intestinal epithelium. The bioaccessible fractions obtained in the digestion studies were used in the transport studies for a more realistic approach to bioavailability evaluation. Results demonstrated the effect of the use of different cooking procedures and seasoning on the toxin's bioavailability. Sparus aurata was chosen in this study for its large production in aquaculture and high consumption in Europe. Also, with the continued evolution of fish farming practices and more common usage of novel feed ingredients based on plants, there is a growing concern about less studied contaminants in aquaculture and their consequences for human health. In pair with greener advances in this industry, there is a convergence towards alternative research methods, such as in vitro applications. In the case of bioavailability studies, both in vitro digestion protocols and intestinal transport assessment are excellent alternatives to in vivo studies. These methods provide fast, reliable and comparable results without ethical restraints.

Keywords: AFB1, aquaculture, bioaccessibility, ENNB1, intestinal transport.

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Authors: Matthew Yeager, Christopher Willy, John Bischoff

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The conceptualization and design phases of a system lifecycle consume a significant amount of the lifecycle budget in the form of direct tasking and capital, as well as the implicit costs associated with unforeseeable design errors that are only realized during downstream phases. Ad hoc or iterative approaches to generating system requirements oftentimes fail to consider the full array of feasible systems or product designs for a variety of reasons, including, but not limited to: initial conceptualization that oftentimes incorporates a priori or legacy features; the inability to capture, communicate and accommodate stakeholder preferences; inadequate technical designs and/or feasibility studies; and locally-, but not globally-, optimized subsystems and components. These design pitfalls can beget unanticipated developmental or system alterations with added costs, risks and support activities, heightening the risk for suboptimal system performance, premature obsolescence or forgone development. Supported by rapid advances in learning algorithms and hardware technology, sensors and sensor systems have become commonplace in both commercial and industrial products. The evolving array of hardware components (i.e. sensors, CPUs, modular / auxiliary access, etc…) as well as recognition, data fusion and communication protocols have all become increasingly complex and critical for design engineers during both concpetualization and implementation. This work seeks to develop and utilize a non-deterministic approach for sensor system design within the multi-attribute tradespace exploration (MATE) paradigm, a technique that incorporates decision theory into model-based techniques in order to explore complex design environments and discover better system designs. Developed to address the inherent design constraints in complex aerospace systems, MATE techniques enable project engineers to examine all viable system designs, assess attribute utility and system performance, and better align with stakeholder requirements. Whereas such previous work has been focused on aerospace systems and conducted in a deterministic fashion, this study addresses a wider array of system design elements by incorporating both traditional tradespace elements (e.g. hardware components) as well as popular multi-sensor data fusion models and techniques. Furthermore, statistical performance features to this model-based MATE approach will enable non-deterministic techniques for various commercial systems that range in application, complexity and system behavior, demonstrating a significant utility within the realm of formal systems decision-making.

Keywords: multi-attribute tradespace exploration, data fusion, sensors, systems engineering, system design

Procedia PDF Downloads 159

Authors: Marsha D. Loda

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College enrollment is declining and generation Z, today’s college students, are struggling. Before the pandemic, researchers characterized this generational cohort as unique. Gen Z has been called the most achievement-oriented generation, as they enjoy greater economic status, are more racially and ethnically diverse, and better educated than any other generation. However, they are also the most likely generation to suffer from depression and anxiety. Gen Z has grown up largely with usually well-intentioned but overprotective parents who inadvertently kept them from learning life skills, likely impacting their ability to cope with and to effectively manage challenges. The unprecedented challenges resulting from the pandemic up ended their world and left them emotionally reeling. One of the ramifications of this for higher education is how to reengage current Gen Z students in the classroom. This research presents qualitative findings from 24 single-spaced pages of verbatim comments from college students. Research questions concerned what helps them learn and what they abhor, as well as how to engage them with the university outside of the classroom to aid in retention. Students leave little doubt about what they want to experience in the classroom. In order of mention, students want discussion, to engage with questions, to hear how a topic relates to real life and the real world, to feel connections with the professor and fellow students, and to have an opportunity to give their opinions. They prefer a classroom that involves conversation, with interesting topics and active learning. “professor talks instead of lecturing” “professor builds a connection with the classroom” “I am engaged because it feels like a respectful conversation” Similarly, students are direct about what they dislike in a classroom. In order of frequency, students dislike teachers unenthusiastically reading word or word from notes or presentations, repeating the text without adding examples, or addressing how to apply the information. “All lecture. I can read the book myself” “Not taught how to apply the skill or lesson” “Lectures the entire time. Lesson goes in one ear and out the other.” Pertaining to engagement outside the classroom, Gen Z challenges higher education to step outside the box. They don’t want to just hear from professionals in their field, they want to meet and interact with them. Perhaps because of their dependence on technology and pandemic isolation, they seem to reach out for assistance in forming social bonds. “I believe fun and social events are the best way to connect with students and get them involved. Cookouts, raffles, socials, or networking events would all most likely appeal to many students”. “Events… even if they aren’t directly related to learning. Maybe like movie nights… doing meet ups at restaurants”. Qualitative research suggests strategy. This research is rife with strategic implications to improve learning, increase engagement and reduce drop-out rates among Generation Z higher education students. It also compliments existing research on student engagement. With college enrollment declining by some 1.3 million students over the last two years, this research is both timely and important.

Keywords: college enrollment, generation Z, higher education, pandemic, student engagement

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Authors: Liliana Gomez Cardona, Mary McComber, Kristyn Brown, Arlene Laliberté, Outi Linnaranta

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The history of colonialism and more contemporary political issues have resulted in the exposure of Kanien'kehá:ka: non (Kanien'kehá:ka of Kahnawake) to challenging and even traumatic experiences. Colonization, religious missions, residential schools as well as economic and political marginalization are the factors that have challenged the wellbeing and mental health of these populations. In psychiatry, screening for mental illness is often done using questionnaires with which the patient is expected to respond to how often he/she has certain symptoms. However, the Indigenous view of mental wellbeing may not fit well with this approach. Moreover, biomedical treatments do not always meet the needs of Indigenous people because they do not understand the culture and traditional healing methods that persist in many communities. Assess whether the questionnaires used to measure symptoms, commonly used in psychiatry are appropriate and culturally safe for the Mohawk in Quebec. Identify the most appropriate tool to assess and promote wellbeing and follow the process necessary to improve its cultural sensitivity and safety for the Mohawk population. Qualitative, collaborative, and participatory action research project which respects First Nations protocols and the principles of ownership, control, access, and possession (OCAP). Data collection based on five focus groups with stakeholders working with these populations and members of Indigenous communities. Thematic analysis of the data collected and emerging through an advisory group that led a revision of the content, use, and cultural and conceptual relevance of the instruments. The questionnaires measuring psychiatric symptoms face significant limitations in the local indigenous context. We present the factors that make these tools not relevant among Mohawks. Although the scale called Growth and Empowerment Measure (GEM) was originally developed among Indigenous in Australia, the Mohawk in Quebec found that this tool comprehends critical aspects of their mental health and wellbeing more respectfully and accurately than questionnaires focused on measuring symptoms. We document the process of cultural adaptation of this tool which was supported by community members to create a culturally safe tool that helps in growth and empowerment. The cultural adaptation of the GEM provides valuable information about the factors affecting wellbeing and contributes to mental health promotion. This process improves mental health services by giving health care providers useful information about the Mohawk population and their clients. We believe that integrating this tool in interventions can help create a bridge to improve communication between the Indigenous cultural perspective of the patient and the biomedical view of health care providers. Further work is needed to confirm the clinical utility of this tool in psychological and psychiatric intervention along with social and community services.

Keywords: cultural adaptation, cultural safety, empowerment, Mohawks, mental health, Quebec

Procedia PDF Downloads 111