Search results for: diagnostic tests
5215 Diagnostics of Subclinical Mastitis in Dairy Cows
Authors: G. Tanbayeva, Z. Myrzabekov, O. Tagayev, B. Barakhov, M. Tokayeva
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Mastitis is widely spread among dairy cows bringing large economic damage resulting in decreased milk yield, deterioration of the milk quality, gastrointestinal tract disorders among young animals, culling of breeding stock, and expenses for sick animal treatment. Up-to-date and accurate diagnostics of subclinical (latent) mastitis in dairy cows has huge practical and economical significance. The aim of the research was to develop a new optimal alternative rapid method for the diagnosis of subclinical mastitis in cows. The study was performed in the laboratory of the Hygiene and Sanitation of Kazakh National Agrarian University. The first stage was to evaluate the different percentages of “Promastit” preparation. It showed that the best diagnostics capacity had 10% dilution. The second stage was to compare “Promastit” with some of the domestic and foreign analogues “Somatic-Test” (Denmark), “MastTest” (Russia), “Mastidin” (Ukraine), “Diagmast” (Kazakhstan). The observation was carried out on 520 dairy cows with subclinical mastitis on farms of Almaty region of Kazakhstan. The effectiveness was checked by milk sedimentation test. Our research tends to show that the diagnostic test "Promastitis" revealed subclinical mastitis in 193 out of 520 lactating cows (37.1% of those examined). At the same time, in the case of using other diagnostic tests, the given index was as follows: 35.5% (mastidin), 34.4% (masttest-AF), 33.8% (somatic-test Ecotest), 30.7% (diagmast).Keywords: dairy cows, diagnostics, subclinical mastitis, test Promastit
Procedia PDF Downloads 3485214 The Analysis of Own Signals of PM Electrical Machines – Example of Eccentricity
Authors: Marcin Baranski
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This article presents a vibration diagnostic method designed for permanent magnets (PM) traction motors. Those machines are commonly used in traction drives of electrical vehicles. Specific structural properties of machines excited by permanent magnets are used in this method - electromotive force (EMF) generated due to vibrations. This work presents: field-circuit model, results of static tests, results of calculations and simulations.Keywords: electrical vehicle, permanent magnet, traction drive, vibrations, electrical machine, eccentricity
Procedia PDF Downloads 6195213 Estimation of Adult Patient Doses for Chest X-Ray Diagnostic Examinations in a Tertiary Institution Health Centre
Authors: G. E. Okungbowa, H. O. Adams, S. E. Eze
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This study is on the estimation of adult patient doses for Chest X-ray diagnostic examinations of new admitted undergraduate students attending a tertiary institution health centre as part of their routine clearance and check up on admitted into the institution. A total of 531 newly admitted undergraduate students were recruited for this survey in the first quarter of 2016 (January to March, 2016). CALDOSE_X 5.0 software was used to compute the Entrance Surface Dose (ESD) and Effective Dose (ED); while the Statistical Package for Social Sciences (SPSS) version 21.0 was used to carry out the statistical analyses. The basic patients' data and exposure parameters required for the software are age, sex, examination type, projection posture, tube potential and current-time product. The mean Entrance Surface Dose and Effective Doses of the undergraduate students were calculated using the software, and the values were compared with existing literature and internationally established diagnostic reference levels. The mean ESD calculated is 0.29 mGy, and the mean effective dose is 0.04 mSv. The values of ESD and ED obtained are below the internationally established diagnostic reference levels, which could be attributed to good radiographic techniques employed during the chest X-ray procedure for these students.Keywords: x-ray, dose, examination, chest
Procedia PDF Downloads 1795212 Interdisciplinary Evaluations of Children with Autism Spectrum Disorder in a Telehealth Arena
Authors: Janice Keener, Christine Houlihan
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Over the last several years, there has been an increase in children identified as having Autism Spectrum Disorder (ASD). Specialists across several disciplines: mental health and medical professionals have been tasked with ensuring accurate and timely evaluations for children with suspected ASD. Due to the nature of the ASD symptom presentation, an interdisciplinary assessment and treatment approach best addresses the needs of the whole child. During the unprecedented COVID-19 Pandemic, clinicians were faced with how to continue with interdisciplinary assessments in a telehealth arena. Instruments that were previously used to assess ASD in-person were no longer appropriate measures to use due to the safety restrictions. For example, The Autism Diagnostic Observation Schedule requires examiners and children to be in very close proximity of each other and if masks or face shields are worn, they render the evaluation invalid. Similar issues arose with the various cognitive measures that are used to assess children such as the Weschler Tests of Intelligence and the Differential Ability Scale. Thus the need arose to identify measures that are able to be safely and accurately administered using safety guidelines. The incidence of ASD continues to rise over time. Currently, the Center for Disease Control estimates that 1 in 59 children meet the criteria for a diagnosis of ASD. The reasons for this increase are likely multifold, including changes in diagnostic criteria, public awareness of the condition, and other environmental and genetic factors. The rise in the incidence of ASD has led to a greater need for diagnostic and treatment services across the United States. The uncertainty of the diagnostic process can lead to an increased level of stress for families of children with suspected ASD. Along with this increase, there is a need for diagnostic clarity to avoid both under and over-identification of this condition. Interdisciplinary assessment is ideal for children with suspected ASD, as it allows for an assessment of the whole child over the course of time and across multiple settings. Clinicians such as Psychologists and Developmental Pediatricians play important roles in the initial evaluation of autism spectrum disorder. An ASD assessment may consist of several types of measures such as standardized checklists, structured interviews, and direct assessments such as the ADOS-2 are just a few examples. With the advent of telehealth clinicians were asked to continue to provide meaningful interdisciplinary assessments via an electronic platform and, in a sense, going to the family home and evaluating the clinical symptom presentation remotely and confidently making an accurate diagnosis. This poster presentation will review the benefits, limitations, and interpretation of these various instruments. The role of other medical professionals will also be addressed, including medical providers, speech pathology, and occupational therapy.Keywords: Autism Spectrum Disorder Assessments, Interdisciplinary Evaluations , Tele-Assessment with Autism Spectrum Disorder, Diagnosis of Autism Spectrum Disorder
Procedia PDF Downloads 2055211 Dielectric Response Analysis Measurement for Diagnostic Oil-Paper Insulation System on Aged Inter Bus Transformer 3x10 MVA
Authors: Eki Farlen, Akas
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Condition assessment of oil-paper-insulated power transformers, particularly of water content, is becoming increasingly important for aged transformers. As insulation ages, it can produce water, which reduces its dielectric strength, accelerates the cellulose ageing process, and causes gas bubbles to form at high temperatures. This paper mainly assesses the life condition of oil-paper insulation system of Inter Bus Transformer (IBT) 30 MVA, 150/30 kV in PT PLN-Substation Jelok that has been operating for 41 years, since 1974. Valuable information about the condition of high voltage insulation may be obtained by measuring its dielectric response. This paper describes in detail the interpretation of Dielectric Response Analysis (DIRANA) measurements and the test result compared to other insulation tests to get deep information for diagnostic, such as Tan delta test, oil characteristic test and Dissolve Gas Analysis (DGA) test. This paper mainly discusses the parameter relationship between moisture content, water content, acidity, oil conductivity and dissipation factor. The result and analysis show that IBT 30 MVA Jelok phase U and W had just been ageing due to high acidity level (>0.2 mgKOH/g) which cause high moisture in cellulose/paper (%) are in wet category about 4.7% and 5% and water content in oil (ppm) about 3.13 ppm and 3.33 ppm at temperature 20°C. High acidity level can make oxidation process and produce water in paper and particle which can decrease the value of Interfacial Tension (IFT) below 22 mN/m (poor category) for both phase U and W. Even if paper insulation of transformer are in wet condition, dissipation factor and capacitance at the same frequency (50 Hz) from both measurement DIRANA test and Tangent delta test give the same result (almost), the results are 0.69% and 0.71% (<1%), it may be acceptable and should not be investigated. The DGA results show that TDCG are in level one (1) condition and there are no found a Key Gases, it means that transformers had no failure during operation like arching, partial discharge and thermal in oil or cellulose.Keywords: diagnostic, inter-bus transformer, oil-paper insulation, moisture, dissipation factor
Procedia PDF Downloads 2755210 Knowledge-Based Virtual Community System (KBVCS) for Enhancing Knowledge Sharing in Mechatronics System Diagnostic and Repair: A Case of Automobile
Authors: Adedeji W. Oyediran, Yekini N. Asafe
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Mechatronics is synergistic integration of mechanical engineering, with electronics and intelligent computer control in the design and manufacturing of industrial products and processes. Automobile (auto car, motor car or car is a wheeled motor vehicle used for transporting passengers, which also carries its own engine or motor) is a mechatronic system which served as major means of transportation around the world. Virtually all community has a need for automobile. This makes automobile issues as related to diagnostic and repair interesting to all communities. Consequent to the diversification of skill in diagnosing automobile faults and approaches in solving some problems and innovation in automobile industry. It is appropriate to say that repair and diagnostic of automobile will be better enhanced if community has opportunity of sharing knowledge and idea globally. This paper discussed the desirable elements in automobile as mechatronics system and present conceptual framework of virtual community model for automobile users.Keywords: automobile, automobile users, knowledge sharing, mechatronics system, virtual community
Procedia PDF Downloads 5015209 The Study on Life of Valves Evaluation Based on Tests Data
Authors: Binjuan Xu, Qian Zhao, Ping Jiang, Bo Guo, Zhijun Cheng, Xiaoyue Wu
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Astronautical valves are key units in engine systems of astronautical products; their reliability will influence results of rocket or missile launching, even lead to damage to staff and devices on the ground. Besides failure in engine system may influence the hitting accuracy and flight shot of missiles. Therefore high reliability is quite essential to astronautical products. There are quite a few literature doing research based on few failure test data to estimate valves’ reliability, thus this paper proposed a new method to estimate valves’ reliability, according to the corresponding tests of different failure modes, this paper takes advantage of tests data which acquired from temperature, vibration, and action tests to estimate reliability in every failure modes, then this paper has regarded these three kinds of tests as three stages in products’ process to integrate these results to acquire valves’ reliability. Through the comparison of results achieving from tests data and simulated data, the results have illustrated how to obtain valves’ reliability based on the few failure data with failure modes and prove that the results are effective and rational.Keywords: censored data, temperature tests, valves, vibration tests
Procedia PDF Downloads 3355208 Diagnosis of Logistics Processes: Bibliometric Review and Analysis
Authors: S. F. Bayona, J. Nunez, D. Paez
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The diagnostic processes have been consolidated as fundamental tools in the adequate knowledge of organizations and their processes. The diagnosis is related to the interpretation of the data, findings and the relevant information, to determine problems, causes, or the simple state and behavior of a process, without including a solution to the problems detected. The objective of this work is to identify the necessary stages to diagnose the logistic processes in a metalworking company, from the literary revision of different disciplines. A total of 62 articles were chosen to identify, through bibliometric analysis, the most cited articles, as well as the most frequent authors and journals. The results allowed to identify the two fundamental stages in the diagnostic process: a primary phase (general) based on the logical subjectivity of the knowledge of the person who evaluates, and the secondary phase (specific), related to the interpretation of the results, findings or data. Also, two phases were identified, one related to the definition of the scope of the actions to be developed and the other, as an initial description of what was observed in the process.Keywords: business, diagnostic, management, process
Procedia PDF Downloads 1525207 Comparative Diagnostic Performance of Diffusion-Weighted Imaging Combined With Microcalcifications on Mammography for Discriminating Malignant From Benign Bi-rads 4 Lesions With the Kaiser Score
Authors: Wangxu Xia
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BACKGROUND BI-RADS 4 lesions raise the possibility of malignancy that warrant further clinical and radiologic work-up. This study aimed to evaluate the predictive performance of diffusion-weighted imaging(DWI) and microcalcifications on mammography for predicting malignancy of BI-RADS 4 lesions. In addition, the predictive performance of DWI combined with microcalcifications was alsocompared with the Kaiser score. METHODS During January 2021 and June 2023, 144 patients with 178 BI-RADS 4 lesions underwent conventional MRI, DWI, and mammography were included. The lesions were dichotomized intobenign or malignant according to the pathological results from core needle biopsy or surgical mastectomy. DWI was performed with a b value of 0 and 800s/mm2 and analyzed using theapparent diffusion coefficient, and a Kaiser score > 4 was considered to suggest malignancy. Thediagnostic performances for various diagnostic tests were evaluated with the receiver-operatingcharacteristic (ROC) curve. RESULTS The area under the curve (AUC) for DWI was significantly higher than that of the of mammography (0.86 vs 0.71, P<0.001), but was comparable with that of the Kaiser score (0.86 vs 0.84, P=0.58). However, the AUC for DWI combined with mammography was significantly highthan that of the Kaiser score (0.93 vs 0.84, P=0.007). The sensitivity for discriminating malignant from benign BI-RADS 4 lesions was highest at 89% for Kaiser score, but the highest specificity of 83% can be achieved with DWI combined with mammography. CONCLUSION DWI combined with microcalcifications on mammography could discriminate malignant BI-RADS4 lesions from benign ones with a high AUC and specificity. However, Kaiser score had a better sensitivity for discrimination.Keywords: MRI, DWI, mammography, breast disease
Procedia PDF Downloads 525206 Endometrial Biopsy Curettage vs Endometrial Aspiration: Better Modality in Female Genital Tuberculosis
Authors: Rupali Bhatia, Deepthi Nair, Geetika Khanna, Seema Singhal
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Introduction: Genital tract tuberculosis is a chronic disease (caused by reactivation of organisms from systemic distribution of Mycobacterium tuberculosis) that often presents with low grade symptoms and non-specific complaints. Patients with genital tuberculosis are usually young women seeking workup and treatment for infertility. Infertility is the commonest presentation due to involvement of the fallopian tubes, endometrium and ovarian damage with poor ovarian volume and reserve. The diagnosis of genital tuberculosis is difficult because of the fact that it is a silent invader of genital tract. Since tissue cannot be obtained from fallopian tubes, the diagnosis is made by isolation of bacilli from endometrial tissue obtained by endometrial biopsy curettage and/or aspiration. Problems are associated with sampling technique as well as diagnostic modality due to lack of adequate sample volumes and the segregation of the sample for various diagnostic tests resulting in non-uniform distribution of microorganisms. Moreover, lack of an efficient sampling technique universally applicable for all specific diagnostic tests contributes to the diagnostic challenges. Endometrial sampling plays a key role in accurate diagnosis of female genital tuberculosis. It may be done by 2 methods viz. endometrial curettage and endometrial aspiration. Both endometrial curettage and aspirate have their own limitations as curettage picks up strip of the endometrium from one of the walls of the uterine cavity including tubal osteal areas whereas aspirate obtains total tissue with exfoliated cells present in the secretory fluid of the endometrial cavity. Further, sparse and uneven distribution of the bacilli remains a major factor contributing to the limitations of the techniques. The sample that is obtained by either technique is subjected to histopathological examination, AFB staining, culture and PCR. Aim: Comparison of the sampling techniques viz. endometrial biopsy curettage and endometrial aspiration using different laboratory methods of histopathology, cytology, microbiology and molecular biology. Method: In a hospital based observational study, 75 Indian females suspected of genital tuberculosis were selected on the basis of inclusion criteria. The women underwent endometrial tissue sampling using Novaks biopsy curette and Karmans cannula. One part of the specimen obtained was sent in formalin solution for histopathological testing and another part was sent in normal saline for acid fast bacilli smear, culture and polymerase chain reaction. The results so obtained were correlated using coefficient of correlation and chi square test. Result: Concordance of results showed moderate agreement between both the sampling techniques. Among HPE, AFB and PCR, maximum sensitivity was observed for PCR, though the specificity was not as high as other techniques. Conclusion: Statistically no significant difference was observed between the results obtained by the two sampling techniques. Therefore, one may use either EA or EB to obtain endometrial samples and avoid multiple sampling as both the techniques are equally efficient in diagnosing genital tuberculosis by HPE, AFB, culture or PCR.Keywords: acid fast bacilli (AFB), histopatholgy examination (HPE), polymerase chain reaction (PCR), endometrial biopsy curettage
Procedia PDF Downloads 3225205 Rapid and Cheap Test for Detection of Streptococcus pyogenes and Streptococcus pneumoniae with Antibiotic Resistance Identification
Authors: Marta Skwarecka, Patrycja Bloch, Rafal Walkusz, Oliwia Urbanowicz, Grzegorz Zielinski, Sabina Zoledowska, Dawid Nidzworski
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Upper respiratory tract infections are one of the most common reasons for visiting a general doctor. Streptococci are the most common bacterial etiological factors in these infections. There are many different types of Streptococci and infections vary in severity from mild throat infections to pneumonia. For example, S. pyogenes mainly contributes to acute pharyngitis, palatine tonsils and scarlet fever, whereas S. Streptococcus pneumoniae is responsible for several invasive diseases like sepsis, meningitis or pneumonia with high mortality and dangerous complications. There are only a few diagnostic tests designed for detection Streptococci from the infected throat of patients. However, they are mostly based on lateral flow techniques, and they are not used as a standard due to their low sensitivity. The diagnostic standard is to culture patients throat swab on semi selective media in order to multiply pure etiological agent of infection and subsequently to perform antibiogram, which takes several days from the patients visit in the clinic. Therefore, the aim of our studies is to develop and implement to the market a Point of Care device for the rapid identification of Streptococcus pyogenes and Streptococcus pneumoniae with simultaneous identification of antibiotic resistance genes. In the course of our research, we successfully selected genes for to-species identification of Streptococci and genes encoding antibiotic resistance proteins. We have developed a reaction to amplify these genes, which allows detecting the presence of S. pyogenes or S. pneumoniae followed by testing their resistance to erythromycin, chloramphenicol and tetracycline. What is more, the detection of β-lactamase-encoding genes that could protect Streptococci against antibiotics from the ampicillin group, which are widely used in the treatment of this type of infection is also developed. The test is carried out directly from the patients' swab, and the results are available after 20 to 30 minutes after sample subjection, which could be performed during the medical visit.Keywords: antibiotic resistance, Streptococci, respiratory infections, diagnostic test
Procedia PDF Downloads 1225204 Energy Absorption Characteristic of a Coupler Rubber Buffer Used in Rail Vehicles
Authors: Zhixiang Li, Shuguang Yao, Wen Ma
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Coupler rubber buffer has been widely applied on the high-speed trains and the main function of the rubber buffer is dissipating the impact energy between vehicles. The rubber buffer consists of two groups of rubbers, which are both pre-compressed and then installed into the frame body. This paper focuses on the energy absorption characteristics of the rubber buffers particularly. Firstly, the quasi-static compression tests were carried out for 1 and 3 pairs of rubber sheets and some energy absorption responses relationship, i.e. Eabn = n×Eab1, Edissn = n×Ediss1, and Ean = Ea1, were obtained. Next, a series of quasi-static tests were performed for 1 pair of rubber sheet to investigate the energy absorption performance with different compression ratio of the rubber buffers. Then the impact tests with five impact velocities were conducted and the coupler knuckle was destroyed when the impact velocity was 10.807 km/h. The impact tests results showed that with the increase of impact velocity, the Eab, Ediss and Ea of rear buffer increased a lot, but the three responses of front buffer had not much increase. Finally, the results of impact tests and quasi-static tests were contrastively analysed and the results showed that with the increase of the stroke, the values of Eab, Ediss, and Ea were all increase. However, the increasing rates of impact tests were all larger than that of quasi-static tests. The maximum value of Ea was 68.76% in impact tests, it was a relatively high value for vehicle coupler buffer. The energy capacity of the rear buffer was determined for dynamic loading, it was 22.98 kJ.Keywords: rubber buffer, coupler, energy absorption, impact tests
Procedia PDF Downloads 1895203 A Test to Express Diagnostic Cohesion of Football Team
Authors: Alexandra O. Savinkina
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We proposed to assess the cohesion of a football team by its subject-goal and subject-value unity according to the A.V. Petrovsky theory. Goal unity was measured by the degree of compliance of the priority targets for various players in the team. Values were estimated by the coincidence of the ideas about a perfect football player. On the basis of the provisional diagnosis of the six teams, we had made the lists of goals and values. The tests were piloted on 35 football teams. The results allowed not only to compare quantitatively the cohesion of the different teams, but also to identify subgroups within the team.Keywords: cohesion, football, psychodiagnostic, soccer, sports team, value-orientation unity
Procedia PDF Downloads 2745202 The Importance of Working Memory, Executive and Attention Functions in Attention Deficit Hyperactivity Disorder and Learning Disabilities Diagnostics
Authors: Dorottya Horváth, Tímea Harmath-Tánczos
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Attention deficit hyperactivity disorder (ADHD) and learning disabilities are common neurocognitive disorders that can have a significant impact on a child's academic performance. ADHD is characterized by inattention, hyperactivity, and impulsivity, while learning disabilities are characterized by difficulty with specific academic skills, such as reading, writing, or math. The aim of this study was to investigate the working memory, executive, and attention functions of neurotypical children and children with ADHD and learning disabilities in order to fill the gaps in the Hungarian mean test scores of these cognitive functions in children with neurocognitive disorders. Another aim was to specify the neuropsychological differential diagnostic toolkit in terms of the relationships and peculiarities between these cognitive functions. The research question addressed in this study was: How do the working memory, executive, and attention functions of neurotypical children compare to those of children with ADHD and learning disabilities? A self-administered test battery was used as a research tool. Working memory was measured with the Non-Word Repetition Test, the Listening Span Test, the Digit Span Test, and the Reverse Digit Span Test; executive function with the Letter Fluency, Semantic Fluency, and Verb Fluency Tests; and attentional concentration with the d2-R Test. The data for this study was collected from 115 children aged 9-14 years. The children were divided into three groups: neurotypical children (n = 44), children with ADHD without learning disabilities (n = 23), and children with ADHD with learning disabilities (n = 48). The data was analyzed using a variety of statistical methods, including t-tests, ANOVAs, and correlational analyses. The results showed that the performance of children with neurocognitive involvement in working memory, executive functions, and attention was significantly lower than the performance of neurotypical children. However, the results of children with ADHD and ADHD with learning disabilities did not show a significant difference. The findings of this study are important because they provide new insights into the cognitive profiles of children with ADHD and learning disabilities and suggest that working memory, executive functions, and attention are all impaired in children with neurocognitive involvement, regardless of whether they have ADHD or learning disabilities. This information can be used to develop more effective diagnostic and treatment strategies for these disorders.Keywords: ADHD, attention functions, executive functions, learning disabilities, working memory
Procedia PDF Downloads 855201 Iron Deficiency and Iron Deficiency Anaemia/Anaemia as a Diagnostic Indicator for Coeliac Disease: A Systematic Review With Meta-Analysis
Authors: Sahar Shams
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Coeliac disease (CD) is a widely reported disease particularly in countries with predominant Caucasian populations. It presents with many signs and symptoms including iron deficiency (ID) and iron deficiency anaemia/anaemia (IDA/A). The exact association between ID, IDA/A and CD and how accurate these signs are in diagnosing CD is not fully known. This systematic review was conducted to investigate the accuracy of both ID & IDA/A as a diagnostic indicator for CD and whether it warrants point of care testing. A systematic review was performed looking at studies published in MEDLINE, Embase, Cochrane Library, and Web of Science. QUADAS-2 tool was used to assess risk of bias in each study. ROC curve and forest plots were generated as part of the meta-analysis after data extraction. 16 studies were identified in total, 13 of which were IDA/A studies and 3 ID studies. The prevalence of CD regardless of diagnostic indicator was assumed as 1%. The QUADAS-2 tool indicated most of studies as having high risk of bias. The PPV for CD was higher in those with ID than for those with IDA/A. Meta-analysis showed the overall odds of having CD is 5 times higher in individuals with ID & IDA/A. The ROC curve showed that there is definitely an association between both diagnostic indicators and CD, the association is not a particularly strong one due to great heterogeneity between studies. Whilst an association between IDA/A & ID and coeliac disease was evident, the results were not deemed significant enough to prompt coeliac disease testing in those with IDA/A & ID.Keywords: anemia, iron deficiency anemia, coeliac disease, point of care testing
Procedia PDF Downloads 1225200 Symmetry of Performance across Lower Limb Tests between the Dominant and Non-Dominant Legs
Authors: Ghulam Hussain, Herrington Lee, Comfort Paul, Jones Richard
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Background: To determine the functional limitations of the lower limbs or readiness to return to sport, most rehabilitation programs use some form of testing; however, it is still unknown what the pass criteria is. This study aims to investigate the differences between the dominant and non-dominant leg performances across several lower limb tasks, which are hop tests, two-dimensional (2D) frontal plane projection angle (FPPA) tests, and isokinetic muscle tests. This study also provides the reference values for the limb symmetry index (LSI) for the hop and isokinetic muscle strength tests. Twenty recreationally active participants were recruited, 11 males and 9 females (age 23.65±2.79 years; height 169.9±3.74 cm; and body mass 74.72±5.81 kg. All tests were undertaken on the dominant and non-dominant legs. These tests are (1) Hop tests, which include horizontal hop for distance and crossover hop tests, (2) Frontal plane projection angle (FPPA): 2D capturing from two different tasks, which are forward hop landing and squatting, and (3) Isokinetic muscle strength tests: four different muscles were tested: quadriceps, hamstring, ankle plantar flexor, and hip extensor muscles. The main outcome measurements were, for the (1) hop tests: maximum distance was taken when undertaking single/crossover hop for distance using a standard tape measure, (2) for the FPPA: the knee valgus angle was measured from the maximum knee flexion position using a single 2D camera, and (3) for the isokinetic muscle strength tests: three different variables were measured: peak torque, peak torque to body weight, and the total work to body weight. All the muscle strength tests have been applied in both concentric and eccentric muscle actions at a speed of 60°/sec. This study revealed no differences between the dominant and non-dominant leg performance, and 85% of LSI was achieved by the majority of the subjects in both hop and isokinetic muscle tests, and; therefore, one leg’s hop performance can define the other.Keywords: 2D FPPA, hop tests, isokinetic testing, LSI
Procedia PDF Downloads 625199 Proposal for Knowledge-Based Virtual Community System (KBVCS) for Enhancing Knowledge Sharing in Mechatronics System Diagnostic and Repair
Authors: Adetoba B. Tiwalola, Adedeji W. Oyediran, Yekini N. Asafe, Akinwole A. Kikelomo
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Mechatronics is synergistic integration of mechanical engineering, with electronics and intelligent computer control in the design and manufacturing of industrial products and processes. Automobile (auto car, motor car or car is a wheeled motor vehicle used for transporting passengers, which also carries its own engine or motor) is a mechatronic system which served as major means of transportation around the world. Virtually all community has a need for automobile. This makes automobile issues as related to diagnostic and repair interesting to all communities. Consequent to the diversification of skill in diagnosing automobile faults and approaches in solving some problems and innovation in automobile industry. It is appropriate to say that repair and diagnostic of automobile will be better enhanced if community has opportunity of sharing knowledge and idea globally. This paper discussed the desirable elements in automobile as mechatronics system and present conceptual framework of virtual community model for knowledge sharing among automobile users.Keywords: automobile, automobile users, knowledge sharing, mechatronics system, virtual community
Procedia PDF Downloads 4365198 Production of Recombinant VP2 Protein of Canine Parvovirus Type 2c Using Baculovirus Expression System
Authors: Jae Young Song, In-Ohk Ouh, Seyeon Park, Byeong Sul Kang, Soo Dong Cho, In-Soo Cho
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Canine parvovirus (CPV) is a major pathogen of diarrhea disease in dogs. CPV type 2 has three of antigenic variants such as 2a, 2b, and 2c. CPV constructs a small non-enveloped, icosahedral capsid that contains single-stranded DNA. It has capsids that two largely overlapping virion proteins (VP), VP1 (82 kDa), and VP2 (65 kDa). Baculoviruses are insect pathogens that regulate insect populations in nature and are being successfully used to control insect pests. The proteins produced in the baculovirus-expression system are used for instance for functional studies, vaccine preparations, or diagnostics. The vaccines produced by baculovirus-expression system showed elicitation of antibodies. The recombinant baculovirus infected SF9 cells showed broken shape. The recombinant VP2 proteins from cell pellet or supernatant were confirmed by western blotting. The result showed that the recombinant VP2 protein bands were appeared at 65 kDa molecular weight in both cell pellet and supernatant of infected SF9 cell. These results indicated that the recombinant baculovirus infected SF9 cell express the recombinant VP2 protein successfully. In addition, the expressed recombinant VP2 protein is secreted from cell to supernatant. The baculovirus expression system can be used to produce the VP2 protein of CPV 2c. In addition, the secretion property of the expression of VP2 protein may decrease the cost of production, because it can be skipped the cell breaking step. The produced VP2 protein could be used for vaccine and the agent of diagnostic tests. This study provides the foundation of the production of CPV 2c vaccine and the diagnostic agent.Keywords: baculovirus, canine parvovirus 2c, dog, Korea
Procedia PDF Downloads 1415197 Novel Ultrasensitive Point of Care Device for Diagnosis of Human Schistosomiasis Mansoni
Authors: Ibrahim Aly, Waleed Elawamy, Hanan Taher, Amira Matar
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Schistosomiasis is infection with blood flukes of the genus Schistosoma, which are acquired trans-cutaneously by swimming or wading in contaminated freshwater. The present study was proposed to produce ultra-sensitive, field-friendly high-throughput rapid immunochromatography diagnostic device for accurate detection of asymptomatic parasite carriers in schistosomiasis pre-elimination settings.For assessing diagnostic potential of rapid device, 50 blood samples from patients with schistosomiasis mansoni, 29 other proven parasitic diseases and 25 blood samples as negative control were from healthy individuals were used. The sensitivity of Quantitative antigen-capture nano-ELISAwas 82 %, and specificity was 87.1 %, where the sensitivity of Nano Dot- ELISA was 86 % and specificity was 90.7 %. The sensitivity of diagnostic device was 78 % and specificity was 85.2 %, with PPV and NPV of 86.2 % and 83.1 %, respectively.The Point of care device resulted in a good performance for the diagnosis of low-intensity infections, it was able to identify 19 out of 25 (76 %) individuals with ⩽7 eggs, 10 out of 14 individuals (71.4 %) with 11–99 eggs and 100 % of individuals with 100–399 eggs.Keywords: schistosomiasis, immunochromatography, naon-dot-ELISa, diagnostis device
Procedia PDF Downloads 685196 Xerostomia and Caries Incidence in Relation to Metabolic Control in Children and Adolescents with Type 1 Diabetes
Authors: Eftychia Pappa, Heleni Vastardis, Christos Rahiotis, Andriani Vazaiou
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The aim of this study was to evaluate the prevalence of dry-mouth symptoms (xerostomia) and compare it with alterations in salivary characteristics of children and adolescents with type 1 diabetes (DM1), as measured with the use of chair-side saliva tests. This study also investigated the possible association between salivary dysfunction and incidence of caries, in relation to the level of metabolic control. A cross-sectional study was performed on young patients (6-18 years old) allocated among 3 groups: 40 patients poorly-controlled (DM1-A, HbA1c>8%), 40 well-controlled (DM1-B, HbA1c≤8%) and 40 age- and sex-matched healthy controls. The study was approved by the Research Ethics Committee of University of Athens and the parents signed written informed consent. All subjects were examined for dental caries, oral hygiene and salivary factors. Assessments of salivary function included self-reported xerostomia, quantification of resting and stimulated whole saliva flow rates, pH values, buffering capacity and saliva’s viscosity. Salivary characteristics were evaluated with the use of GC Saliva Check Buffer (3Μ ESPE). Data were analysed by chi-square and Kruskal-Wallis tests. Subjects with diabetes reported xerostomia more frequently than healthy controls (p<0.05). Unstimulated salivary flow rate and pH values remained significantly lower in DM1-A compared to DM1-B and controls. Low values of resting salivary flow rate were associated with a higher prevalence of dental caries in children and adolescents with poorly-controlled DM1 (p<0.05). The results suggested that diabetes-induced alterations in salivary characteristics are indicative of higher caries susceptibility of diabetics and chair-side saliva tests are a useful tool for the evaluation of caries risk assessment.Keywords: caries risk assessment, saliva diagnostic tests, type 1 diabetes, xerostomia
Procedia PDF Downloads 2795195 Fault Diagnosis of Manufacturing Systems Using AntTreeStoch with Parameter Optimization by ACO
Authors: Ouahab Kadri, Leila Hayet Mouss
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In this paper, we present three diagnostic modules for complex and dynamic systems. These modules are based on three ant colony algorithms, which are AntTreeStoch, Lumer & Faieta and Binary ant colony. We chose these algorithms for their simplicity and their wide application range. However, we cannot use these algorithms in their basement forms as they have several limitations. To use these algorithms in a diagnostic system, we have proposed three variants. We have tested these algorithms on datasets issued from two industrial systems, which are clinkering system and pasteurization system.Keywords: ant colony algorithms, complex and dynamic systems, diagnosis, classification, optimization
Procedia PDF Downloads 2945194 Evaluation of the Weight-Based and Fat-Based Indices in Relation to Basal Metabolic Rate-to-Weight Ratio
Authors: Orkide Donma, Mustafa M. Donma
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Basal metabolic rate is questioned as a risk factor for weight gain. The relations between basal metabolic rate and body composition have not been cleared yet. The impact of fat mass on basal metabolic rate is also uncertain. Within this context, indices based upon total body mass as well as total body fat mass are available. In this study, the aim is to investigate the potential clinical utility of these indices in the adult population. 287 individuals, aged from 18 to 79 years, were included into the scope of the study. Based upon body mass index values, 10 underweight, 88 normal, 88 overweight, 81 obese, and 20 morbid obese individuals participated. Anthropometric measurements including height (m), and weight (kg) were performed. Body mass index, diagnostic obesity notation model assessment index I, diagnostic obesity notation model assessment index II, basal metabolic rate-to-weight ratio were calculated. Total body fat mass (kg), fat percent (%), basal metabolic rate, metabolic age, visceral adiposity, fat mass of upper as well as lower extremities and trunk, obesity degree were measured by TANITA body composition monitor using bioelectrical impedance analysis technology. Statistical evaluations were performed by statistical package (SPSS) for Windows Version 16.0. Scatterplots of individual measurements for the parameters concerning correlations were drawn. Linear regression lines were displayed. The statistical significance degree was accepted as p < 0.05. The strong correlations between body mass index and diagnostic obesity notation model assessment index I as well as diagnostic obesity notation model assessment index II were obtained (p < 0.001). A much stronger correlation was detected between basal metabolic rate and diagnostic obesity notation model assessment index I in comparison with that calculated for basal metabolic rate and body mass index (p < 0.001). Upon consideration of the associations between basal metabolic rate-to-weight ratio and these three indices, the best association was observed between basal metabolic rate-to-weight and diagnostic obesity notation model assessment index II. In a similar manner, this index was highly correlated with fat percent (p < 0.001). Being independent of the indices, a strong correlation was found between fat percent and basal metabolic rate-to-weight ratio (p < 0.001). Visceral adiposity was much strongly correlated with metabolic age when compared to that with chronological age (p < 0.001). In conclusion, all three indices were associated with metabolic age, but not with chronological age. Diagnostic obesity notation model assessment index II values were highly correlated with body mass index values throughout all ranges starting with underweight going towards morbid obesity. This index is the best in terms of its association with basal metabolic rate-to-weight ratio, which can be interpreted as basal metabolic rate unit.Keywords: basal metabolic rate, body mass index, children, diagnostic obesity notation model assessment index, obesity
Procedia PDF Downloads 1435193 On Consolidated Predictive Model of the Natural History of Breast Cancer Considering Primary Tumor and Secondary Distant Metastases Growth in Patients with Lymph Nodes Metastases
Authors: Ella Tyuryumina, Alexey Neznanov
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This paper is devoted to mathematical modelling of the progression and stages of breast cancer. We propose Consolidated mathematical growth model of primary tumor and secondary distant metastases growth in patients with lymph nodes metastases (CoM-III) as a new research tool. We are interested in: 1) modelling the whole natural history of primary tumor and secondary distant metastases growth in patients with lymph nodes metastases; 2) developing adequate and precise CoM-III which reflects relations between primary tumor and secondary distant metastases; 3) analyzing the CoM-III scope of application; 4) implementing the model as a software tool. Firstly, the CoM-III includes exponential tumor growth model as a system of determinate nonlinear and linear equations. Secondly, mathematical model corresponds to TNM classification. It allows to calculate different growth periods of primary tumor and secondary distant metastases growth in patients with lymph nodes metastases: 1) ‘non-visible period’ for primary tumor; 2) ‘non-visible period’ for secondary distant metastases growth in patients with lymph nodes metastases; 3) ‘visible period’ for secondary distant metastases growth in patients with lymph nodes metastases. The new predictive tool: 1) is a solid foundation to develop future studies of breast cancer models; 2) does not require any expensive diagnostic tests; 3) is the first predictor which makes forecast using only current patient data, the others are based on the additional statistical data. Thus, the CoM-III model and predictive software: a) detect different growth periods of primary tumor and secondary distant metastases growth in patients with lymph nodes metastases; b) make forecast of the period of the distant metastases appearance in patients with lymph nodes metastases; c) have higher average prediction accuracy than the other tools; d) can improve forecasts on survival of breast cancer and facilitate optimization of diagnostic tests. The following are calculated by CoM-III: the number of doublings for ‘non-visible’ and ‘visible’ growth period of secondary distant metastases; tumor volume doubling time (days) for ‘non-visible’ and ‘visible’ growth period of secondary distant metastases. The CoM-III enables, for the first time, to predict the whole natural history of primary tumor and secondary distant metastases growth on each stage (pT1, pT2, pT3, pT4) relying only on primary tumor sizes. Summarizing: a) CoM-III describes correctly primary tumor and secondary distant metastases growth of IA, IIA, IIB, IIIB (T1-4N1-3M0) stages in patients with lymph nodes metastases (N1-3); b) facilitates the understanding of the appearance period and inception of secondary distant metastases.Keywords: breast cancer, exponential growth model, mathematical model, primary tumor, secondary metastases, survival
Procedia PDF Downloads 2965192 Impact Analysis of Quality Control Practices in Veterinary Diagnostic Labs in Lahore, Pakistan
Authors: Faiza Marrium, Masood Rabbani, Ali Ahmad Sheikh, Muhammad Yasin Tipu Javed Muhammad, Sohail Raza
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More than 75% diseases spreading in the past 10 years in human population globally are linked to veterinary sector. Veterinary diagnostic labs are the powerful ally for diagnosis, prevention and monitoring of animal diseases in any country. In order to avoid detrimental effects of errors in disease diagnostic and biorisk management, there is a dire need to establish quality control system. In current study, 3 private and 6 public sectors veterinary diagnostic labs were selected for survey. A questionnaire survey in biorisk management guidelines of CWA 15793 was designed to find quality control breaches in lab design, personal, equipment and consumable, quality control measures adopted in lab, waste management, environmental monitoring and customer care. The data was analyzed through frequency distribution statistically by using (SPSS) version 18.0. A non-significant difference was found in all parameters of lab design, personal, equipment and consumable, quality control measures adopted in lab, waste management, environmental monitoring and customer care with an average percentage of 46.6, 57.77, 52.7, 55.5, 54.44, 48.88 and 60, respectively. A non-significant difference among all nine labs were found, with highest average compliance percentage of all parameters are lab 2 (78.13), Lab 3 (70.56), Lab 5 (57.51), Lab 6 (56.37), Lab 4 (55.02), Lab 9 (49.58), Lab 7 (47.76), Lab 1 (41.01) and Lab 8 (36.09). This study shows that in Lahore district veterinary diagnostic labs are not giving proper attention to quality of their system and there is no significant difference between setups of private and public sector laboratories. These results show that most of parameters are between 50 and 80 percent, which needs some work and improvement as per WHO criteria.Keywords: veterinary lab, quality management system, accreditation, regulatory body, disease identification
Procedia PDF Downloads 1425191 Sensitivity and Specificity of Clinical Testing for Digital Nerve Injury
Authors: Guy Rubin, Ravit Shay, Nimrod Rozen
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The accuracy of a diagnostic test used to classify a patient as having disease or being disease-free is a valuable piece of information to be used by the physician when making treatment decisions. Finger laceration, suspected to have nerve injury is a challenging decision for the treating surgeon. The purpose of this study was to evaluate the sensitivity, specificity and predictive values of six clinical tests in the diagnosis of digital nerve injury. The six clinical tests included light touch, pin prick, static and dynamic 2-point discrimination, Semmes Weinstein monofilament and wrinkle test. Data comparing pre-surgery examination with post-surgery results of 42 patients with 52 digital nerve injury was evaluated. The subjective examinations, light touch, pin prick, static and dynamic 2-point discrimination and Semmes-Weinstein monofilament were not sensitive (57.6, 69.7, 42.4, 40 and 66.8% respectively) and specific (36.8, 36.8, 47.4, 42.1 and 31.6% respectively). Wrinkle test, the only objective examination, was the most sensitive (78.1%) and specific (55.6%). This result gives no pre-operative examination the ability to predict the result of explorative surgery.Keywords: digital nerve, injury, nerve examination, Semmes-Weinstein monofilamen, sensitivity, specificity, two point discrimination, wrinkle test
Procedia PDF Downloads 3365190 Diagnostic Accuracy of the Tuberculin Skin Test for Tuberculosis Diagnosis: Interest of Using ROC Curve and Fagan’s Nomogram
Authors: Nouira Mariem, Ben Rayana Hazem, Ennigrou Samir
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Background and aim: During the past decade, the frequency of extrapulmonary forms of tuberculosis has increased. These forms are under-diagnosed using conventional tests. The aim of this study was to evaluate the performance of the Tuberculin Skin Test (TST) for the diagnosis of tuberculosis, using the ROC curve and Fagan’s Nomogram methodology. Methods: This was a case-control, multicenter study in 11 anti-tuberculosis centers in Tunisia, during the period from June to November2014. The cases were adults aged between 18 and 55 years with confirmed tuberculosis. Controls were free from tuberculosis. A data collection sheet was filled out and a TST was performed for each participant. Diagnostic accuracy measures of TST were estimated using ROC curve and Area Under Curve to estimate sensitivity and specificity of a determined cut-off point. Fagan’s nomogram was used to estimate its predictive values. Results: Overall, 1053 patients were enrolled, composed of 339 cases (sex-ratio (M/F)=0.87) and 714 controls (sex-ratio (M/F)=0.99). The mean age was 38.3±11.8 years for cases and 33.6±11 years for controls. The mean diameter of the TST induration was significantly higher among cases than controls (13.7mm vs.6.2mm;p=10-6). Area Under Curve was 0.789 [95% CI: 0.758-0.819; p=0.01], corresponding to a moderate discriminating power for this test. The most discriminative cut-off value of the TST, which were associated with the best sensitivity (73.7%) and specificity (76.6%) couple was about 11 mm with a Youden index of 0.503. Positive and Negative predictive values were 3.11% and 99.52%, respectively. Conclusion: In view of these results, we can conclude that the TST can be used for tuberculosis diagnosis with a good sensitivity and specificity. However, the skin induration measurement and its interpretation is operator dependent and remains difficult and subjective. The combination of the TST with another test such as the Quantiferon test would be a good alternative.Keywords: tuberculosis, tuberculin skin test, ROC curve, cut-off
Procedia PDF Downloads 595189 Investigation on Scattered Dose Rate and Exposure Parameters during Diagnostic Examination Done with an Overcouch X-Ray Tube in Nigerian Teaching Hospital
Authors: Gbenga Martins, Christopher J. Olowookere, Lateef Bamidele, Kehinde O. Olatunji
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The aims of this research are to measure the scattered dose rate during an X-ray examination in an X-ray room, compare the scattered dose rate with exposure parameters based on the body region examined, and examine the X-ray examination done with an over couch tube. The research was carried out using Gamma Scout software installation on the computer system (Laptop) to record the radiation counts, pulse rate, and dose rate. The measurement was employed by placing the detector at 900 to the incident X-ray. Proforma was used for the collection of patients’ data such as age, sex, examination type, and initial diagnosis. Data such as focus skin distance (FSD), body mass index (BMI), body thickness of the patients, the beam output (kVp) were collected at Obafemi Awolowo University, Ile-Ife, Western Nigeria. Total number of 136 patients was considered during this research. Dose rate range between 14.21 and 86.78 µSv/h for the plain abdominal region, 85.70 and 2.86 µSv/h for the lumbosacral region,1.3 µSv/yr and 3.6 µSv/yr in the pelvis region, 2.71 µSv/yr and 28.88 µSv/yr for leg region, 3.06 µSv/yr and 29.98 µSv/yr in hand region. The results of this study were compared with those of other studies carried out in other countries. The findings of this study indicated that the number of exposure parameters selected for each diagnostic examination contributed to the dose rate recorded. Therefore, these results call for a quality assurance program (QAP) in diagnostic X-ray units in Nigerian hospitals.Keywords: X-radiation, exposure parameters, dose rate, pulse rate, number of counts, tube current, tube potential, diagnostic examination, scattered radiation
Procedia PDF Downloads 1065188 On Consolidated Predictive Model of the Natural History of Breast Cancer Considering Primary Tumor and Primary Distant Metastases Growth
Authors: Ella Tyuryumina, Alexey Neznanov
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Finding algorithms to predict the growth of tumors has piqued the interest of researchers ever since the early days of cancer research. A number of studies were carried out as an attempt to obtain reliable data on the natural history of breast cancer growth. Mathematical modeling can play a very important role in the prognosis of tumor process of breast cancer. However, mathematical models describe primary tumor growth and metastases growth separately. Consequently, we propose a mathematical growth model for primary tumor and primary metastases which may help to improve predicting accuracy of breast cancer progression using an original mathematical model referred to CoM-IV and corresponding software. We are interested in: 1) modelling the whole natural history of primary tumor and primary metastases; 2) developing adequate and precise CoM-IV which reflects relations between PT and MTS; 3) analyzing the CoM-IV scope of application; 4) implementing the model as a software tool. The CoM-IV is based on exponential tumor growth model and consists of a system of determinate nonlinear and linear equations; corresponds to TNM classification. It allows to calculate different growth periods of primary tumor and primary metastases: 1) ‘non-visible period’ for primary tumor; 2) ‘non-visible period’ for primary metastases; 3) ‘visible period’ for primary metastases. The new predictive tool: 1) is a solid foundation to develop future studies of breast cancer models; 2) does not require any expensive diagnostic tests; 3) is the first predictor which makes forecast using only current patient data, the others are based on the additional statistical data. Thus, the CoM-IV model and predictive software: a) detect different growth periods of primary tumor and primary metastases; b) make forecast of the period of primary metastases appearance; c) have higher average prediction accuracy than the other tools; d) can improve forecasts on survival of BC and facilitate optimization of diagnostic tests. The following are calculated by CoM-IV: the number of doublings for ‘nonvisible’ and ‘visible’ growth period of primary metastases; tumor volume doubling time (days) for ‘nonvisible’ and ‘visible’ growth period of primary metastases. The CoM-IV enables, for the first time, to predict the whole natural history of primary tumor and primary metastases growth on each stage (pT1, pT2, pT3, pT4) relying only on primary tumor sizes. Summarizing: a) CoM-IV describes correctly primary tumor and primary distant metastases growth of IV (T1-4N0-3M1) stage with (N1-3) or without regional metastases in lymph nodes (N0); b) facilitates the understanding of the appearance period and manifestation of primary metastases.Keywords: breast cancer, exponential growth model, mathematical modelling, primary metastases, primary tumor, survival
Procedia PDF Downloads 3305187 Diagnostic Value of Different Noninvasive Criteria of Latent Myocarditis in Comparison with Myocardial Biopsy
Authors: Olga Blagova, Yuliya Osipova, Evgeniya Kogan, Alexander Nedostup
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Purpose: to quantify the value of various clinical, laboratory and instrumental signs in the diagnosis of myocarditis in comparison with morphological studies of the myocardium. Methods: in 100 patients (65 men, 44.7±12.5 years) with «idiopathic» arrhythmias (n = 20) and dilated cardiomyopathy (DCM, n = 80) were performed 71 endomyocardial biopsy (EMB), 13 intraoperative biopsy, 5 study of explanted hearts, 11 autopsy with virus investigation (real-time PCR) of the blood and myocardium. Anti-heart antibodies (AHA) were also measured as well as cardiac CT (n = 45), MRI (n = 25), coronary angiography (n = 47). The comparison group included of 50 patients (25 men, 53.7±11.7 years) with non-inflammatory heart diseases who underwent open heart surgery. Results. Active/borderline myocarditis was diagnosed in 76.0% of the study group and in 21.6% of patients of the comparison group (p < 0.001). The myocardial viral genome was observed more frequently in patients of comparison group than in study group (group (65.0% and 40.2%; p < 0.01. Evaluated the diagnostic value of noninvasive markers of myocarditis. The panel of anti-heart antibodies had the greatest importance to identify myocarditis: sensitivity was 81.5%, positive and negative predictive value was 75.0 and 60.5%. It is defined diagnostic value of non-invasive markers of myocarditis and diagnostic algorithm providing an individual assessment of the likelihood of myocarditis is developed. Conclusion. The greatest significance in the diagnosis of latent myocarditis in patients with 'idiopathic' arrhythmias and DCM have AHA. The use of complex of noninvasive criteria allows estimate the probability of myocarditis and determine the indications for EMB.Keywords: myocarditis, "idiopathic" arrhythmias, dilated cardiomyopathy, endomyocardial biopsy, viral genome, anti-heart antibodies
Procedia PDF Downloads 1675186 Reducing Diagnostic Error in Australian Emergency Departments Using a Behavioural Approach
Authors: Breanna Wright, Peter Bragge
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Diagnostic error rates in healthcare are approximately 10% of cases. Diagnostic errors can cause patient harm due to inappropriate, inadequate or delayed treatment, and such errors contribute heavily to medical liability claims globally. Therefore, addressing diagnostic error is a high priority. In most cases, diagnostic errors are the result of faulty information synthesis rather than lack of knowledge. Specifically, the majority of diagnostic errors involve cognitive factors, and in particular, cognitive biases. Emergency Departments are an environment with heightened risk of diagnostic error due to time and resource pressures, a frequently chaotic environment, and patients arriving undifferentiated and with minimal context. This project aimed to develop a behavioural, evidence-informed intervention to reduce diagnostic error in Emergency Departments through co-design with emergency physicians, insurers, researchers, hospital managers, citizens and consumer representatives. The Forum Process was utilised to address this aim. This involves convening a small (4 – 6 member) expert panel to guide a focused literature and practice review; convening of a 10 – 12 person citizens panel to gather perspectives of laypeople, including those affected by misdiagnoses; and a 18 – 22 person structured stakeholder dialogue bringing together representatives of the aforementioned stakeholder groups. The process not only provides in-depth analysis of the problem and associated behaviours, but brings together expertise and insight to facilitate identification of a behaviour change intervention. Informed by the literature and practice review, the Citizens Panel focused on eliciting the values and concerns of those affected or potentially affected by diagnostic error. Citizens were comfortable with diagnostic uncertainty if doctors were honest with them. They also emphasised the importance of open communication between doctors and patients and their families. Citizens expect more consistent standards across the state and better access for both patients and their doctors to patient health information to avoid time-consuming re-taking of long patient histories and medication regimes when re-presenting at Emergency Departments and to reduce the risk of unintentional omissions. The structured Stakeholder Dialogue focused on identifying a feasible behavioural intervention to review diagnoses in Emergency Departments. This needed to consider the role of cognitive bias in medical decision-making; contextual factors (in Victoria, there is a legislated 4-hour maximum time between ED triage and discharge / hospital admission); resource availability; and the need to ensure the intervention could work in large metropolitan as well as small rural and regional ED settings across Victoria. The identified behavioural intervention will be piloted in approximately ten hospital EDs across Victoria, Australia. This presentation will detail the findings of all review and consultation activities, describe the behavioural intervention developed and present results of the pilot trial.Keywords: behavioural intervention, cognitive bias, decision-making, diagnostic error
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