Search results for: clinical simulation

Authors: Mayada Attia Ibrahim

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Evaluating and developing the electroplating production process is a key challenge in this type of process. The process is influenced by several factors such as process parameters, process costs, and production environments. Analyzing and optimizing all these factors together requires extensive analytical techniques that are not available in real-case industrial entities. This paper presents a practice-based framework for the evaluation and optimization of some of the crucial factors that affect the costs and production times associated with this type of process, energy costs, material costs, and product flow times. The proposed approach uses Design of Experiments, Discrete-Event Simulation, and Theory of Constraints were respectively used to identify the most significant factors affecting the production process and simulate a real production line to recognize the effect of these factors and assign possible bottlenecks. Several scenarios are generated as corrective strategies for improving the production line. Following that, data envelopment analysis CCR input-oriented DEA model is used to evaluate and optimize the suggested scenarios.

Keywords: electroplating process, simulation, design of experiment, performance optimization, theory of constraints, data envelopment analysis

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Authors: Edward Schwalb, Matthias Dehmer, Michael Schlenkrich, Farzaneh Taslimi, Ketron Mitchell-Wynne, Horen Kuecuekyan

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We present a generalized feature extraction approach for supporting Machine Learning (ML) algorithms which perform tasks similar to Finite-Element Analysis (FEA). We report results for estimating the Head Injury Categorization (HIC) of vehicle engine compartments across various impact scenarios. Our experiments demonstrate that models learned using features derived with a simple discretization approach provide a reasonable approximation of a full simulation. We observe that Decision Trees could be as effective as Neural Networks for the HIC task. The simplicity and performance of the learned Decision Trees could offer a trade-off of a multiple order of magnitude increase in speed and cost improvement over full simulation for a reasonable approximation. When used as a complement to full simulation, the approach enables rapid approximate feedback to engineering teams before submission for full analysis. The approach produces mesh independent features and is further agnostic of the assembly structure.

Keywords: mechanical design validation, FEA, supervised decision tree, convolutional neural network.

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Authors: P. Javid, A. Aeenmehr, J. Taghavifar

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In this paper, supply air pressure of HVAC system has been modeled with second-order transfer function plus dead-time. In HVAC system, the desired input has step changes, and the output of proposed control system should be able to follow the input reference, so the idea of using model based predictive control is proceeded and designed in this paper. The closed loop control system is implemented in MATLAB software and the simulation results are provided. The simulation results show that the model based predictive control is able to control the plant properly.

Keywords: air conditioning system, GPC, dead time, air supply control

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Authors: Wenjie Wu, Peng Cheng, Zehua Zhang, Fei Luo, Feng Wu, Min Zhong, Jianzhong Xu

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Background: There has been limited research into the therapeutic efficacy of rapid diagnosis of spinal tuberculosis complicated with pulmonary tuberculosis. We attempted to discover whether the utilization of a DNA microarray assay to detect multidrug-resistant spinal tuberculosis complicated with pulmonary tuberculosis can improve clinical outcomes. Methods: A prospective study was conducted from February 2006 to September 2015. One hundred and forty-three consecutive culture–confirmed, clinically and imaging diagnosed MDR-TB patients with spinal tuberculosis complicated by pulmonary tuberculosis were enrolled into the study. The initial time to treatment for MDR-TB, the method of infection control, radiological indicators of spinal tubercular infectious foci, culture conversion, and adverse drug reactions were compared with the standard culture methods. Results: Of the total of 143 MDR-TB patients, 68 (47.6%) were diagnosed by conventional culture methods and 75 (52.4%) following the implementation of detection using the DNA microarray. Patients in the microarray group began rational use of the second-line drugs schedule more speedily than sufferers in the culture group (17.3 vs. 74.1 days). Among patients were admitted to a general tuberculosis ward, those from the microarray group spent less time in the ward than those from the culture group (7.8 vs. 49.2 days). In those patients with six months follow-up (n=134), patients in the microarray group had a higher rate of sputum negativity conversion at six months (89% vs. 73%). In the microarray group, the rate of drug adverse reactions was significantly lower (22.2% vs. 67.7%). At the same time, they had a more obvious reduction of the area with spinal tuberculous lesions in radiological examinations (77% vs. 108%). Conclusions: The application of the CapitalBio™ DNA Microarray assay caused noteworthy clinical advances including an earlier time to begin MDR-TB treatment, increased sputum culture conversion, improved infection control measures and better radiographical results

Keywords: tuberculosis, multidrug-resistant, tuberculous spondylitis, DNA microarray, clinical outcomes

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Authors: Karoliina Nisula, Samuli Pekkola

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Business education has been criticized for being too theoretical and distant from business life. Different types of experiential learning environments ranging from manual role-play to computer simulations and enterprise resource planning (ERP) systems have been used to introduce the realistic and practical experience into business learning. Each of these learning environments approaches business learning from a different perspective. The implementations tend to be individual exercises supplementing the traditional courses. We suggest combining them into a business skills laboratory resembling an actual workplace. In this paper, we present a concrete implementation of an ERP-supported business learning environment that is used throughout the first year undergraduate business curriculum. We validate the implementation by evaluating the learning outcomes through the different domains of Bloom’s taxonomy. We use the role-play oriented practice enterprise model as a comparison group. Our findings indicate that using the ERP simulation improves the poor and average students’ lower-level cognitive learning. On the affective domain, the ERP-simulation appears to enhance motivation to learn as well as perceived acquisition of practical hands-on skills.

Keywords: business simulations, experiential learning, ERP systems, learning environments

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Authors: Thamir K. Ibrahim, M. M. Rahman, Marwah Noori Mohammed

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This study deals with modeling and performance enhancements of a gas-turbine combined cycle power plant. A clean and safe energy is the greatest challenges to meet the requirements of the green environment. These requirements have given way the long-time governing authority of steam turbine (ST) in the world power generation, and the gas turbine (GT) will replace it. Therefore, it is necessary to predict the characteristics of the GT system and optimize its operating strategy by developing a simulation system. The integrated model and simulation code for exploiting the performance of gas turbine power plant are developed utilizing MATLAB code. The performance code for heavy-duty GT and CCGT power plants are validated with the real power plant of Baiji GT and MARAFIQ CCGT plants the results have been satisfactory. A new technology of correlation was considered for all types of simulation data; whose coefficient of determination (R2) was calculated as 0.9825. Some of the latest launched correlations were checked on the Baiji GT plant and apply error analysis. The GT performance was judged by particular parameters opted from the simulation model and also utilized Adaptive Neuro-Fuzzy System (ANFIS) an advanced new optimization technology. The best thermal efficiency and power output attained were about 56% and 345MW respectively. Thus, the operation conditions and ambient temperature are strongly influenced on the overall performance of the GT. The optimum efficiency and power are found at higher turbine inlet temperatures. It can be comprehended that the developed models are powerful tools for estimating the overall performance of the GT plants.

Keywords: gas turbine, optimization, ANFIS, performance, operating conditions

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Authors: Renjith George, Preethy Mary Donald

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Use of internet sources to retrieve health care related information among health care professionals has increased tremendously as the accessibility to internet is made easier through smart phones and tablets. Though there are huge data available at a finger touch, it is doubtful whether all the sources providing health care information adhere to evidence based practice. The objective of this survey was to study the prevalence of use of internet sources to get health care information, to assess the mind-set towards the authenticity of health care information available via internet sources and to study the awareness about evidence based practice in health care among medical and dental students in Melaka-Manipal Medical College. The survey was proposed as there is limited number of studies reported in the literature and this is the first of its kind in Malaysia. A cross sectional survey was conducted among the medical and dental students of Melaka-Manipal Medical College. A total of 521 students including medical and dental students in their clinical years of undergraduate study participated in the survey. A questionnaire consisting of 14 questions were constructed based on data available from the published literature and focused group discussion and was pre-tested for validation. Data analysis was done using SPSS. The statistical analysis of the results of the survey proved that the use of internet resources for health care information are equally preferred over the conventional resources among health care students. Though majority of the participants verify the authenticity of information from internet sources, there was considerable percentage of candidates who feels that all the information from the internet can be utilised for clinical decision making or were not aware about the need of verification of authenticity of such information. 63.7 % of the participants rely on evidence based practice in health care for clinical decision making while 34.2 % were not aware about it. A minority of 2.1% did not agree with the concept of evidence based practice. The observations of the survey reveals the increasing use of internet resources for health care information among health care students. The results warrants the need to move towards evidence based practice in health care as all health care information available online may not be reliable. The health care person should be judicious while utilising the information from such resources for clinical decision making.

Keywords: authenticity, evidence based practice, health care information, internet

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Authors: Y. O’Connor, C. Heavin, S. O’ Connor, J. Gallagher, J. Wu, J. O’Donoghue

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Background: To improve the delivery of paediatric healthcare in resource-poor settings, Community Health Workers (CHW) have been provided with a paper-based set of protocols known as Community Case Management (CCM). Yet research has shown that CHW adherence to CCM guidelines is poor, ultimately impacting health service delivery. Digitising the CCM guidelines via mobile technology is argued in extant literature to improve CHW adherence. However, little research exist which outlines how (a) this process can be digitised and (b) adherence could be improved as a result. Aim: To explore how an electronic mobile version of CCM (eCCM) can overcome issues associated with the paper-based CCM protocol (poor adherence to guidelines) vis-à-vis service blueprinting. This service blueprint will outline how (a) the CCM process can be digitised using mobile Clinical Decision Support Systems software to support clinical decision-making and (b) adherence can be improved as a result. Method: Development of a single service blueprint for a standalone application which visually depicts the service processes (eCCM) when supporting the CHWs, using an application known as Supporting LIFE (Low cost Intervention For disEase control) as an exemplar. Results: A service blueprint is developed which illustrates how the eCCM solution can be utilised by CHWs to assist with the delivery of healthcare services to children. Leveraging smartphone technologies can (a) provide CHWs with just-in-time data to assist with their decision making at the point-of-care and (b) improve CHW adherence to CCM guidelines. Conclusions: The development of the eCCM opens up opportunities for the CHWs to leverage the inherent benefit of mobile devices to assist them with health service delivery in rural settings. To ensure that benefits are achieved, it is imperative to comprehend the functionality and form of the eCCM service process. By creating such a service blueprint for an eCCM approach, CHWs are provided with a clear picture regarding the role of the eCCM solution, often resulting in buy-in from the end-users.

Keywords: adherence, community health workers, developing countries, mobile clinical decision support systems, CDSS, service blueprint

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Authors: Jiri Barta

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At the present time, awareness, education, computer simulation and information systems protection are very serious and relevant topics. The article deals with perspectives and possibilities of implementation of emergence or natural hazard threats into the system which is developed for communication among members of crisis management staffs. The Czech Hydro-Meteorological Institute with its System of Integrated Warning Service resents the largest usable base of information. National information systems are connected to foreign systems, especially to flooding emergency systems of neighboring countries, systems of European Union and international organizations where the Czech Republic is a member. Use of outputs of particular information systems and computer simulations on a single communication interface of information system for communication among members of crisis management staff and setting the site interoperability in the net will lead to time savings in decision-making processes in solving extraordinary events and crisis situations. Faster managing of an extraordinary event or a crisis situation will bring positive effects and minimize the impact of negative effects on the environment.

Keywords: computer simulation, communication, continuity, critical infrastructure, information systems, safety

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Authors: Panasbodee Thachaopas, Duangdorm Gamnerdsap, Waraporn Inthip, Arissara Pungpa

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LDD’s IM Farm or Land Development Department’s Integrated Management Farm is the agricultural simulation application developed by Land Development Department relies on actual data in simulation game to grow 12 cash crops which are rice, corn, cassava, sugarcane, soybean, rubber tree, oil palm, pineapple, longan, rambutan, durian, and mangosteen. Launching in simulation game, players could select preferable areas for cropping from base map or Orthophoto map scale 1:4,000. Farm management is simulated from field preparation to harvesting. The system uses soil group, and present land use database to facilitate player to know whether what kind of crop is suitable to grow in each soil groups and integrate LDD’s data with other agencies which are soil types, soil properties, soil problems, climate, cultivation cost, fertilizer use, fertilizer price, socio-economic data, plant diseases, weed, pest, interest rate for taking on loan from Bank for Agriculture and Agricultural Cooperatives (BAAC), labor cost, market prices. These mentioned data affect the cost and yield differently to each crop. After completing, the player will know the yield, income and expense, profit/loss. The player could change to other crops that are more suitable to soil groups for optimal yields and profits.

Keywords: agricultural simulation, smart farmer, web application, factors of agricultural production

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Authors: Sarina Sahmeddini, Fahimeh Safarpour, Forough Pazhuheian

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With the concepts of minimally invasive treatment and preventive dentistry gaining more and more recognition by dentists, there are many published clinical trials comparing the use of the erbium laser with traditional drilling for caries removal. However, the efficacy of the erbium laser is still controversial. The aim of this review study is to compare the effects of tooth preparation by laser irradiation and conventional preparation by bur to identify the best means for cavity preparation and reduction of recurrent caries. Randomized controlled trials, controlled clinical trials, and prospective, and retrospective cohort studies were included in this review. The eligibility criteria included studies in humans’ permanent teeth in which cavities were conducted in their cervical third and proximal surfaces. PubMed, Google scholar, and Scopus about Er:YAG laser and bur prepared cavities were carried out. The studies’ details were organized in four tables according to the groups: (1) Microleakage; (2) Morphological changes; (3) Microhardness; and (4) Bond strength. The initial search resulted in 134 articles, 12 studies published from 2012 up to March 2020 were included in this review. According to the risk of bias evaluation, all studies were classified as high quality. Clinical implications: Er:YAG lasers with the energy levels between 250 to 300 mJ can be proper alternatives to conventional burs, as minimal invasive instruments with no significant differences or better results in microleakage, microhardness, and bond strength compared with conventional burs. In conclusion, Er:YAG laser irradiations accompanied by phosphoric acid etching can reduce the chance of recurrent carries.

Keywords: lasers, drilling, caries, micro leakage

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Authors: Emin Gundogar, Burak Erkayman, Aysegul Yilmaz, Nusret Sazak

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When considering current competition conditions on the world, satisfying customer demands on time has become an important factor that enables the firms take a step further. Therefore, production process must be completed faster to take the competitive advantage. A balanced assembly line is the one of most important factors affecting the speed of production lines. The aim of this study is to build an assembly line to balance the assembly line and to simulate it for different scenarios through a refrigerator factory. The times of the operations is analyzed and grouped by the priorities. First, a Kilbridge & Wester heuristics is put to the model then a simulation approach is implemented to the model and the differences are observed.

Keywords: assembly line design, assembly line balancing, simulation modelling, refrigeration industry

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Authors: Damou Mehdi, Nouri Keltouma, Fahem Mohammed

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In this paper, the concept of substrate integrated waveguide (SIW) technology is used to design filter for 30 GHz communication systems. SIW is created in the substrate of RT/Duroid 5880 having relative permittivity ε_r= 2.2 and loss tangent tanφ = 0.0009. Four Via are placed on the century filter the structures of SIW are modeled using and have been optimized in software HFSS (High Frequency Structure Simulator), à transition is designed for a Ka-band transceiver module with a 28.5GHz center frequency, . and then the results are verified using another simulation CST Microwave Studio (Computer Simulation Technology). The return loss are less than -18 dB, and -13 dB respectively. The insertion loss is divided equally -1.2 dB and -1.4 respectively.

Keywords: transition, microstrip, substrat integrated wave guide, filter, via

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Authors: M. J. Davidson, N. Selvaraj, L. Venugopal

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The elevated temperature forming studies on the expansion of thin walled tubes have been studied in the present work. The influence of process parameters namely the die angle, the die ratio and the operating temperatures on the expansion of tube ends at elevated temperatures is carried out. The range of operating parameters have been identified by perfoming extensive simulation studies. The hot forming parameters have been evaluated for AA2014 alloy for performing the simulation studies. Experimental matrix has been developed from the feasible range got from the simulation results. The design of experiments is used for the optimization of process parameters. Response Surface Method’s (RSM) and Box-Behenken design (BBD) is used for developing the mathematical model for expansion. Analysis of variance (ANOVA) is used to analyze the influence of process parameters on the expansion of tube ends. The effect of various process combinations of expansion are analyzed through graphical representations. The developed model is found to be appropriate as the coefficient of determination value is very high and is equal to 0.9726. The predicted values are found to coincide well with the experimental results, within acceptable error limits.

Keywords: expansion, optimization, Response Surface Method (RSM), ANOVA, bbd, residuals, regression, tube

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Authors: Georges F. Hatoum, Thomas H. Temple, Silvio Garcia, Xiaodong Wu

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Soft Tissue Sarcomas (STS) represent a diverse group of malignancies with heterogeneous clinical and pathological features. The treatment of extremity STS aims to achieve optimal local tumor control, improved survival, and preservation of limb function. The National Comprehensive Cancer Network guidelines, based on the cumulated clinical data, recommend radiation therapy (RT) in conjunction with limb-sparing surgery for large, high-grade STS measuring greater than 5 cm in size. Such treatment strategy can offer a cure for patients. However, when recurrence occurs (in nearly half of patients), the prognosis is poor, with a median survival of 12 to 15 months and with only palliative treatment options available. The spatially-fractionated-radiotherapy (SFRT), with a long history of treating bulky tumors as a non-mainstream technique, has gained new attention in recent years due to its unconventional therapeutic effects, such as bystander/abscopal effects. Combining single fraction of GRID, the original form of SFRT, with conventional RT was shown to have marginally increased the rate of pathological necrosis, which has been recognized to have a positive correlation to overall survival. In an effort to consistently increase the pathological necrosis rate over 90%, multiple fractions of Lattice RT (LRT), a newer form of 3D SFRT, interdigitated with the standard RT as neoadjuvant therapy was conducted in a preliminary clinical setting. With favorable results of over 95% of necrosis rate in a small cohort of patients, a Phase I/II clinical study was proposed to exam the safety and feasibility of this new strategy. Herein the design of the clinical study is presented. In this single-arm, two-stage phase I/II clinical trial, the primary objectives are >80% of the patients achieving >90% tumor necrosis and to evaluation the toxicity; the secondary objectives are to evaluate the local control, disease free survival and overall survival (OS), as well as the correlation between clinical response and the relevant biomarkers. The study plans to accrue patients over a span of two years. All patient will be treated with the new neoadjuvant RT regimen, in which one of every five fractions of conventional RT is replaced by a LRT fraction with vertices receiving dose ≥10Gy while keeping the tumor periphery at or close to 2 Gy per fraction. Surgical removal of the tumor is planned to occur 6 to 8 weeks following the completion of radiation therapy. The study will employ a Pocock-style early stopping boundary to ensure patient safety. The patients will be followed and monitored for a period of five years. Despite much effort, the rarity of the disease has resulted in limited novel therapeutic breakthroughs. Although a higher rate of treatment-induced tumor necrosis has been associated with improved OS, with the current techniques, only 20% of patients with large, high-grade tumors achieve a tumor necrosis rate exceeding 50%. If this new neoadjuvant strategy is proven effective, an appreciable improvement in clinical outcome without added toxicity can be anticipated. Due to the rarity of the disease, it is hoped that such study could be orchestrated in a multi-institutional setting.

Keywords: lattice RT, necrosis, SFRT, soft tissue sarcoma

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Authors: Shinta Stri Ayuda Nur Setyaningsih

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Anterior uveitis is often triggered by viral infections such as herpes simplex virus (HSV) and cytomegalovirus (CMV). This study aims to provide an overview of the demographic and clinical characteristics of patients with anterior uveitis caused by CMV and HSV infection at PMN Cicendo Eye Hospital Bandung. This study used a retrospective observational method. Data were collected from the medical records of patients who visited the PMN Infection and Immunology Polyclinic at Cicendo Eye Hospital between February and July 2023. The results showed that anterior uveitis associated with HSV and CMV viruses often occurs in the elderly and more in women. The most common clinical symptoms are red eyes and decreased visual acuity, with a gradual onset of symptoms. Complications that often arise are cataracts and glaucoma. This study provides a deeper understanding of anterior uveitis caused by infection with HSV and CMV viruses.

Keywords: uveitis anterior, cytomegavirus, herpes simplex virus type I ELISA

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Authors: Fatimazahrae Elbakri, Azeddine Ibrahimi, Meryem Lemrani, Dris Belghyti

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Leishmaniasis represents a major public health problem because of the number of cases recorded each year and the wide distribution of the disease. It is a parasitic disease of flagellated protozoa transmitted by the bite of certain species of sandfly, causing a spectrum of clinical pathology in humans ranging from disfiguring skin lesions to fatal visceral leishmaniasis. Cutaneous leishmaniasis due to Leishmania major is a polymorphic disease; in fact, the infection can be asymptomatic, localized, or disseminated. The objective of this work is to determine the genomic diversity that contributes to clinical variability by trying to identify the variation in chromosome number and to extract SNPs and SNPs and InDels; it is based on four sequences (WGS) of Leishmania major available on NCBI in Fastq form, from three countries: Tunisia, Algeria, and Israel, the analysis is set up from a pipeline to facilitate the discovery of genetic diversity, in particular SNP and chromosomal somy.

Keywords: Leshmania major, cutaneous Leishmania, NGS, genomic, somy, variant calling

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Authors: David J. Foran, Nhan Do, Samuel Ajjarapu, Wenjin Chen, Tahsin Kurc, Joel H. Saltz

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The large-scale data and computational requirements of investigators throughout the clinical and research communities demand an informatics infrastructure that supports both existing and new investigative and translational projects in a robust, secure environment. In some subspecialties of medicine and research, the capacity to generate data has outpaced the methods and technology used to aggregate, organize, access, and reliably retrieve this information. Leading health care centers now recognize the utility of establishing an enterprise-wide, clinical data warehouse. The primary benefits that can be realized through such efforts include cost savings, efficient tracking of outcomes, advanced clinical decision support, improved prognostic accuracy, and more reliable clinical trials matching. The overarching objective of the work presented here is the development and implementation of a flexible Intelligent Retrieval and Interrogation System (IRIS) that exploits the combined use of computational imaging, genomics, and data-mining capabilities to facilitate clinical assessments and translational research in oncology. The proposed System includes a multi-modal, Clinical & Research Data Warehouse (CRDW) that is tightly integrated with a suite of computational and machine-learning tools to provide insight into the underlying tumor characteristics that are not be apparent by human inspection alone. A key distinguishing feature of the System is a configurable Extract, Transform and Load (ETL) interface that enables it to adapt to different clinical and research data environments. This project is motivated by the growing emphasis on establishing Learning Health Systems in which cyclical hypothesis generation and evidence evaluation become integral to improving the quality of patient care. To facilitate iterative prototyping and optimization of the algorithms and workflows for the System, the team has already implemented a fully functional Warehouse that can reliably aggregate information originating from multiple data sources including EHR’s, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology PAC systems, Digital Pathology archives, Unstructured Clinical Documents, and Next Generation Sequencing services. The System enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information about patient tumors individually or as part of large cohorts to identify patterns that may influence treatment decisions and outcomes. The CRDW core system has facilitated peer-reviewed publications and funded projects, including an NIH-sponsored collaboration to enhance the cancer registries in Georgia, Kentucky, New Jersey, and New York, with machine-learning based classifications and quantitative pathomics, feature sets. The CRDW has also resulted in a collaboration with the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) at the U.S. Department of Veterans Affairs to develop algorithms and workflows to automate the analysis of lung adenocarcinoma. Those studies showed that combining computational nuclear signatures with traditional WHO criteria through the use of deep convolutional neural networks (CNNs) led to improved discrimination among tumor growth patterns. The team has also leveraged the Warehouse to support studies to investigate the potential of utilizing a combination of genomic and computational imaging signatures to characterize prostate cancer. The results of those studies show that integrating image biomarkers with genomic pathway scores is more strongly correlated with disease recurrence than using standard clinical markers.

Keywords: clinical data warehouse, decision support, data-mining, intelligent databases, machine-learning.

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Authors: Magdalena Chrabąszcz, Teresa Wolniewicz, Cezary Maciejewski, Joanna Czuwara

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BACKGROUND: Dermoscopy is a clinical tool known to improve the early detection of melanoma and other malignancies of the skin. Over the past few years melanoma has grown into a disease of socio-economic importance due to the increasing incidence and persistently high mortality rates. Early diagnosis remains the best method to reduce melanoma and non-melanoma skin cancer– related mortality and morbidity. Dermoscopy is a noninvasive technique that consists of viewing pigmented skin lesions through a hand-held lens. This simple procedure increases melanoma diagnostic accuracy by up to 35%. Dermoscopy is currently the standard for clinical differential diagnosis of cutaneous melanoma and for qualifying lesion for the excision biopsy. Like any clinical tool, training is required for effective use. The introduction of small and handy dermoscopes contributed significantly to the switch of dermatoscopy toward a first-level useful tool. Non-dermatologist physicians are well positioned for opportunistic melanoma detection; however, education in the skin cancer examination is limited during medical school and traditionally lecture-based. AIM: The aim of this randomized study was to determine whether the adjunct of dermoscopy to the standard fourth year medical curriculum improves the ability of medical students to distinguish between benign and malignant lesions and assess acceptability and satisfaction with the intervention. METHODS: We performed a prospective study in 2 cohorts of fourth-year medical students at Medical University of Warsaw. Groups having dermatology course, were randomly assigned to:  cohort A: with limited access to dermatoscopy from their teacher only – 1 dermatoscope for 15 people  Cohort B: with a full access to use dermatoscopy during their clinical classes:1 dermatoscope for 4 people available constantly plus 15-minute dermoscopy tutorial. Students in both study arms got an image-based test of 10 lesions to assess ability to differentiate benign from malignant lesions and postintervention survey collecting minimal background information, attitudes about the skin cancer examination and course satisfaction. RESULTS: The cohort B had higher scores than the cohort A in recognition of nonmelanocytic (P < 0.05) and melanocytic (P <0.05) lesions. Medical students who have a possibility to use dermatoscope by themselves have also a higher satisfaction rates after the dermatology course than the group with limited access to this diagnostic tool. Moreover according to our results they were more motivated to learn dermatoscopy and use it in their future everyday clinical practice. LIMITATIONS: There were limited participants. Further study of the application on clinical practice is still needed. CONCLUSION: Although the use of dermatoscope in dermatology as a specialty is widely accepted, sufficiently validated clinical tools for the examination of potentially malignant skin lesions are lacking in general practice. Introducing medical students to dermoscopy in their fourth year curricula of medical school may improve their ability to differentiate benign from malignant lesions. It can can also encourage students to use dermatoscopy in their future practice which can significantly improve early recognition of malignant lesions and thus decrease melanoma mortality.

Keywords: dermatoscopy, early detection of melanoma, medical education, skin cancer

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Authors: Emilia K. H. Danielsson-Waters, Malaz Elsaddig, Kevin Jones

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Unfortunately, it is well known that neonatal deaths are a common and potentially preventable occurrence across the world. Neonatal resuscitation is a simple and inexpensive intervention that can effectively reduce this rate, and can be taught and implemented globally. This project is a follow-on from one in 2012, which found that neonatal resuscitation simulation was valuable for education, but would be better improved by being delivered by local staff. Methods: This study involved auditing the neonatal admission and death records within a rural Ugandan hospital, alongside implementing a Train-The-Trainer teaching scheme to teach Neonatal Resuscitation. One local doctor was trained for simulating neonatal resuscitation, whom subsequently taught an additional 14 staff members in one-afternoon session. Participants were asked to complete questionnaires to assess their knowledge and confidence pre- and post-simulation, and a survey to identify barriers and drivers to simulation. Results: The results found that the neonatal mortality rate in this hospital was 25% between July 2016- July 2017, with birth asphyxia, prematurity and sepsis being the most common causes. Barriers to simulation that were identified predominantly included a lack of time, facilities and opportunity, yet all members stated simulation was beneficial for improving skills and confidence. The simulation session received incredibly positive qualitative feedback, and also a 0.58-point increase in knowledge (p=0.197) and 0.73-point increase in confidence (0.079). Conclusion: This research shows that it is possible to create a teaching scheme in a rural hospital, however, many barriers are in place for its sustainability, and a larger sample size with a more sensitive scale is required to achieve statistical significance. This is undeniably important, because teaching neonatal resuscitation can have a direct impact on neonatal mortality. Subsequently, recommendations include that efforts should be put in place to create a sustainable training scheme, for example, by employing a resuscitation officer. Moreover, neonatal resuscitation teaching should be conducted more frequently in hospitals, and conducted in a wider geographical context, including within the community, in order to achieve its full effect.

Keywords: neonatal resuscitation, sustainable medical education, train-the-trainer, Uganda

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Authors: F. Felipe

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Air Defense Systems contain high-value assets that are expected to fulfill their mission for several years - in many cases, even decades - while operating in a fast-changing, technology-driven environment. Thus, it is paramount that decision-makers can assess how effective an Air Defense System is in the face of new developing threats, as well as to identify the bottlenecks that could jeopardize the security of the airspace of a country. Given the broad extent of activities and the great variety of assets necessary to achieve the strategic objectives, a systems approach was taken in order to delineate the core requirements and the physical architecture of an Air Defense System. Then, value-focused thinking helped in the definition of the measures of effectiveness. Furthermore, analytical methods were applied to create a formal structure that preliminarily assesses such measures. To validate the proposed methodology, a powerful simulation was also used to determine the measures of effectiveness, now in more complex environments that incorporate both uncertainty and multiple interactions of the entities. The results regarding the validity of this methodology suggest that the approach can support decisions aimed at enhancing the capabilities of Air Defense Systems. In conclusion, this paper sheds some light on how consolidated approaches of Systems Engineering and Operations Research can be used as valid techniques for solving problems regarding a complex and yet vital matter.

Keywords: air defense, effectiveness, system, simulation, decision-support

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Authors: Rudy Djamaluddin, Arbain Tata, Rita Irmawaty

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The study conducted a simulation of the effect of sea water to the bonding capacity of GFRP sheet on the concrete beams using a simulation tank. As it well known that, fiber reinforced polymer (FRP) has been applied to many purposes for civil engineering structures not only for new structures but also for strengthening of the deteriorated structures. The FRP has advantages such as its corrosion resistance, as well as high tensile strength, to weight ratio. Glass composed FRP (GFRP) sheet is most commonly used due to its relatively lower cost compared to the other FRP materials. GFRP sheet is applied externally by bonding it on the concrete surface. Many studies have been done to investigate the bonding of GFRP sheet. However, it is still very rarely studies on the effect of sea water to the bonding capacity of GFRP sheet on the strengthened beams due to flexural loadings. This is important to be clarified for the wider application of GFRP sheet especially on the flexural structure that directly contact to the sea environment. To achieve the objective of the study, a series of concrete beams strengthened with GFRP sheet on extreme tension surface were prepared. The beams then were stored on the sea water tank for six months. Results indicated the bonding capacity decreased after six months exposed to the sea water.

Keywords: GFRP sheet, sea water, concrete beams, bonding

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Authors: Md, MCS, MPH Munyangi Wa Nkola Jerome

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The pandemic of COVID-19, a recently discovered contagious respiratory disease called SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus 2 Majority of people infected with SARS-CoV-2: Asymptomatic or mildly ill 14% of patients will develop severe illness requiring hospitalization and oxygen support, and 5% of these will be transferred to an intensive care unit, Urgent need for new treatments that can be used quickly to avoid transfer of patients to intensive care and death. Objective: To evaluate the clinical activity (efficacy) of ArtiCovid Hypothesis: Administration of 3 times a teaspoon per day by COVID patients (symptomatic, mild, or moderate forms) results in the disappearance of symptoms and improvement of biological parameters (including viral suppression). Clinical efficacy: the disappearance of clinical signs after seven days of treatment; reduction in the rate of patients transferred to intensive care units for mechanical ventilation and a decrease in mortality related to this infection Paraclinical efficacy: improvement of biological parameters (mainly d-dimer, CRP) Virological efficacy: suppression of the viral load after seven days of treatment (control test on the seventh day is negative) Pilot study using a standardized solution based on Artemisia annua (ARTICOVID) Obtaining authorization from the health authorities of the province of Central Kongo Recruitment of volunteer patients, mainly in the Kinkanda HospitalCarrying out tests before and after treatment as well as analyses before and after treatment. The protocol obtained the approval of the ethics committee 50 patients who completed the treatment were aged between 2 and 70 years, with an average age of 36 yearsMore half were male (56%). One in four patients was a health professional (25%) Of the 12 health professionals, 4 were physicians. For those who reported the date of onset of the disease, the average duration between the appearance of the first symptoms and the medical consultation was 5 days. The 50 patients put on ARTICOVID were discharged alive with CRP levels substantially normalizedAfter seven to eight days, the control test came back negative. This pilot study suggests that ARTICOVID may be effective against COVID-19 infection.

Keywords: artiCovid, DRC, Covid-19, SARS_COV_2

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Authors: Abdullah Saeidi, Aydin Gülses, Christan Flörke

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Skin cancer of the face region is the most common type of malignancy and surgical excision is the preferred approach. However, the clinical long term results reported in the literature are still controversial. Objectives: To describe; 1. Demographical characteristics 2. Affected site, distribution and TNM classification regarding tumor type 3. Surgical aspects • Surgical removal: excision principles, safety margins, the need for secondary resection, primary reconstruction/ defect closure, anesthesia protocol, duration of hospital stay (if any) • Secondary intervention for defect closure/reconstruction: Flap technique, anesthesia protocol, duration of hospital stay (if any), postoperative wound management etc. 4. Tumor recurrences 5. Clinical outcomes 6. Studying the possible therapy approach throw Biostatistical relation and correlation between multiple Histological, diagnostics and clinical Faktors. following surgical ablation of the skin cancer of the head and neck region. Methods: Selection and statistical analysis of medical records of patients who had admitted to the Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Campus Kiel during the period of 2015-2019 will be retrospectively evaluated. Data will be collected via ORBIS Information-Management-System (ORBIS AG, Saarbrücken, Germany).

Keywords: non melanoma skin cancer, face skin cancer, skin reconstruction, non melanoma skin cancer recurrence, non melanoma skin cancer metastases

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Authors: Peña A. Roland R., Lozano P. Jean P.

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The waterflooding process is an enhanced oil recovery (EOR) method that appears tremendously successful. This paper shows the importance of the role of the numerical modelling of waterflooding and how to provide a better description of the fluid flow during this process. The mathematical model is based on the mass conservation equations for the oil and water phases. Rock compressibility and capillary pressure equations are coupled to the mathematical model. For discretizing and linearizing the partial differential equations, we used the Finite Volume technique and the Newton-Raphson method, respectively. The results of three scenarios for waterflooding in porous media are shown. The first scenario was estimating the water saturation in the media without rock compressibility and without capillary pressure. The second scenario was estimating the front of the water considering the rock compressibility and capillary pressure. The third case is to compare different fronts of water saturation for three fluids viscosity ratios without and with rock compressibility and without and with capillary pressure. Results of the simulation indicate that the rock compressibility and the capillary pressure produce changes in the pressure profile and saturation profile during the displacement of the oil for the water.

Keywords: capillary pressure, numerical simulation, rock compressibility, two-phase flow

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Authors: Merav Ben Natan, Moran Makhoul Khuri, Haviel Hammer, Maya Yarkoni

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Background: Studies indicate that nursing students often rank hospice nursing among their least preferred career paths. Understanding factors influencing their intent to work in hospice care is essential for improving interest in this field. Aim: This study aimed to explore the relationship between nursing students' intention to pursue a career in hospice care and various factors, including their attitudes towards caring for dying patients, death anxiety, personal or professional experience with dying patients, and the type of nursing program they are enrolled in. Methods: In this cross-sectional study, 200 nursing students completed an online survey using the Frommelt Attitude Toward Care of the Dying Scale and the Turkish Death Anxiety Scale. The survey assessed students' intentions to work in hospice care and related variables. Results: Only 11% of participants expressed an interest in working in hospice care. Students in the accelerated program for non-nursing Bachelor of Arts graduates showed a higher intention to work in hospice care compared to those in the generic program (β = 0.27, P < .001). Conversely, completion of clinical experience in a medical ward was associated with a lower intention to work in hospice care (β = −0.21, P < .01). Conclusions: The findings suggest that nursing students in accelerated programs for non-nursing graduates are more likely to intend to work in hospice care. Enhanced experience and support are recommended to sustain their interest. Clinical experience in medical wards does not effectively substitute for hospice-specific clinical experience.

Keywords: hospice nursing, nursing students, death anxiety, career intentions

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Authors: Chorom Baek, Sungwon Choi

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The purpose of this study is to analyze the supervision system, and the training and continuing education of mental health professionals in USA, UK, Australia (New Zealand), Japan, and so on, and to deduce the implications of Korean mental health service system. In order to accomplish the purpose of this study, following methodologies were adopted: review on the related literatures, statistical data, the related manuals, online materials, and previous studies concerning issues in those countries for the past five years. The training program in Korea was compared with the others’ through this literature analysis. The induced matters were divided with some parts such as training program, continuing education, educational procedure, and curriculum. Based on the analysis, discussion and implications, the conclusion and further suggestion of this study are as follows: First, Korean Clinical Psychology of Association (KCPA) should become more powerful health main training agency for quality control. Second, actual authority of health main training agency should be a grant to training centers. Third, quality control of mental health professionals should be through standardization and systemization of promotion and qualification management. Fourth, education and training about work of supervisors and unification of criteria for supervision should be held. Fifth, the training program for mental health license should be offered by graduate schools. Sixth, legitimated system to protect the right of mental health trainees is needed. Seventh, regularly continuing education after licensed should be compulsory to keep the certification. Eighth, the training program in training centers should meet KCPA requirement. If not, KCPA can cancel the certification of the centers.

Keywords: clinical psychology, Korea, mental health system, training program

Procedia PDF Downloads 228

Authors: Rana Alkattan

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Aim: This study aims to identify and analyze the factors predicting the professional clinical competency among newly recruited registered nurses. In addition, it aims to explore factors significantly correlated with high and low professional clinical competency score. Method: A descriptive analytical is applied in this study, cross-sectional which conducted between June 2012 and June 2013 at King Abdulaziz University Hospital, as one of the largest governmental university tertiary Hospital in Saudi Arabia. A survey questionnaire was designed to collect data. And then, data were analyzed using the SPSS. Results: A total of the 86 nurses provided valid responses. 69 were female and 17 were male. The majority of the participants in this study were married, from the Philippines, between 20-29 years old. The majority had certified university bachelor’s degree in nursing, as well as had prior experience in nursing between 1 to 5 years. There are two categories emerged from the data, which significantly correlated with nurses' professional competence and development. The first was the newly employed registered nurses demographic characteristic (correlation coefficients 0.154 to 0.470, P < 0.05), while the second was the list of studied environmental factors except 'job rotation factor' (correlation coefficients 0.122 to 0.540, P < 0.01). However, nurses' attitude including motivation and confidence were not associated with nurse's professional competency. Conclusion: that nurses' professional competence development is a process affected by certain personal demographic and environmental factors which will enable newly graduates nurses to provide safe effective patients' care and maintain their career responsibilities.

Keywords: clinical, competence, development nurses professional, registered

Procedia PDF Downloads 356

Authors: Alexandru Achim, Tamás Szűcsborus, Viktor Sasi, Ferenc Nagy, Zoltán Jambrik, Attila Nemes, Albert Varga, Călin Homorodean, Olivier F. Bertrand, Zoltán Ruzsa

Abstract:

Aim: Our study aimed to establish the safety and the technical success of distal radial access for balloon aortic valvuloplasty (DR-BAV). The secondary objective was to determine the effectiveness and appropriate role of DR-BAV within half year follow-up. Methods: Clinical and angiographic data from 32 consecutive patients with symptomatic aortic stenosis were evaluated in a prospective pilot single-center study. Between 2020 and 2021, the patients were treated utilizing dual distal radial access with 6-10F compatible balloons. The efficacy endpoint was divided into technical success (successful valvuloplasty balloon inflation at the aortic valve and absence of intra- or periprocedural major complications), hemodynamic success (a reduction of the mean invasive gradient >30%), and clinical success (an improvement of at least one clinical category in the NYHA classification). The safety endpoints were vascular complications (major and minor Valve Academic Research Consortium (VARC)-2 bleeding, diminished or lost arterial pulse or the presence of any pseudo-aneurysm or arteriovenous fistula during the clinical follow-up) and major adverse events, MAEs (the composite of death, stroke, myocardial infarction, and urgent major aortic valve replacement or implantation during the hospital stay and or at one-month follow-up). Results: 32 patients (40 % male, mean age 80 ± 8,5) with severe aortic valve stenosis were included in the study and 4 patients were excluded. Technical success was achieved in all patients (100%). Hemodynamic success was achieved in 30 patients (93,75%). Invasive max and mean gradients were reduced from 73±22 mm Hg and 49±22 mm Hg to 49±19 mm Hg and 20±13 mm Hg, respectively (p = <.001). Clinical success was achieved in 29 patients (90,6%). In total, no major adverse cardiac or cerebrovascular event nor vascular complications (according to VARC 2 criteria) occurred during the intervention. All-cause death at 6 months was 12%. Conclusion: According to our study, dual distal radial artery access is a safe and effective option for balloon aortic valvuloplasty in patients with severe aortic valve stenosis and can be performed in all patients with sufficient lumen diameter. Future randomized studies are warranted to investigate whether this technique is superior to other approaches.

Keywords: mean invasive gradient, distal radial access for balloon aortic valvuloplasty (DR-BAV), aortic valve stenosis, pseudo-aneurysm, arteriovenous fistula, valve academic research consortium (VARC)-2

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Authors: Yosra Mefteh Rekik, Younes Boujelbene

Abstract:

We introduce in this paper a new conceptual model representing the stock market dynamics. This model is essentially based on cognitive behavior of the intelligence investors. In order to validate our model, we build an artificial stock market simulation based on agent-oriented methodologies. The proposed simulator is composed of market supervisor agent essentially responsible for executing transactions via an order book and various kinds of investor agents depending to their profile. The purpose of this simulation is to understand the influence of psychological character of an investor and its neighborhood on its decision-making and their impact on the market in terms of price fluctuations. Therefore, the difficulty of the prediction is due to several features: the complexity, the non-linearity and the dynamism of the financial market system, as well as the investor psychology. The Artificial Neural Networks learning mechanism take on the role of traders, who from their futures return expectations and place orders based on their expectations. The results of intensive analysis indicate that the existence of agents having heterogeneous beliefs and preferences has provided a better understanding of price dynamics in the financial market.

Keywords: artificial intelligence methods, artificial stock market, behavioral modeling, multi-agent based simulation

Procedia PDF Downloads 446