Search results for: Clinical test

Authors: Aliyah Dosani, Kerri Alderson

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Two different simulations using standardized patients were developed to reinforce content and foster undergraduate nursing students’ practice and development of interpersonal skills in difficult clinical situations in the classroom. The live actor simulations focused on fostering interpersonal skills, traditionally considered by students to be simple and easy. However, seemingly straightforward interactions can be very stressful, particularly in women’s complex social/emotional situations. Supporting patients in these contexts is fraught with complexity and high emotion, requiring skillful support, assessment and intervention by a registered nurse. In this presentation, the personal and professional perspectives of the development, incorporation, and execution of the live actor simulations will be discussed, as well as the inclusion of student perceptions, and the learning gained by the involved faculty.

Keywords: adult learning, interpersonal skill development, simulation learning, teaching and learning

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Authors: A. Mohammadi, S. Asghari, M. Aien, M. Rashidinejad

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After emergent of alternative current networks and their popularity, asynchronous motors became more widespread than other kinds of industrial motors. In order to control and run these motors efficiently, an accurate estimation of motor parameters is needed. There are different methods to obtain these parameters such as rotor locked test, no load test, DC test, analytical methods, and so on. The most common drawback of these methods is their inaccuracy in estimation of some motor parameters. In order to remove this concern, a novel method for parameter estimation of induction motors using particle swarm optimization (PSO) algorithm is proposed. In the proposed method, transient state of motor is used for parameter estimation. Comparison of the simulation results purtuined to the PSO algorithm with other available methods justifies the effectiveness of the proposed method.

Keywords: induction motor, motor parameter estimation, PSO algorithm, analytical method

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Authors: Maria L. G. Lourenço, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, João C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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The neonatal care of cats and dogs represents a challenge to veterinarians due to the small size of the newborns and their physiological particularities. In addition, many Veterinary Medicine colleges around the world do not include neonatology in the curriculum, which makes it less likely for the veterinarian to have basic knowledge regarding neonatal care and worsens the clinical care these patients receive. Therefore, lack of assistance and negligence have become frequent in the field, which contributes towards the high mortality rates. This study aims at describing cases and the main conditions pertaining to the neonatology clinical routine in cats and dogs, highlighting the importance of specialized care in this field of Veterinary Medicine. The study included 808 neonates admitted to the São Paulo State University (UNESP) Veterinary Hospital, Botucatu, São Paulo, Brazil, between January 2018 and November 2019. Of these, 87.3% (705/808) were dogs and 12.7% (103/808) were cats. Among the neonates admitted, 57.3% (463/808) came from emergency c-sections due to dystocia, 8.7% (71/808) cane from vaginal deliveries with obstetric maneuvers due to dystocia, and 34% (274/808) were admitted for clinical care due to neonatal conditions. Among the neonates that came from emergency c-sections and vaginal deliveries, 47.3% (253/534) was born in respiratory distress due to severe hypoxia or persistent apnea and required resuscitation procedure, such as the Jen Chung acupuncture point (VG26), oxygen therapy with mask, pulmonary expansion with resuscitator, heart massages and administration of emergency medication, such as epinephrine. On the other hand, in the neonatal clinical care, the main conditions and alterations observed in the newborns were omphalophlebitis, toxic milk syndrome, neonatal conjunctivitis, swimmer puppy syndrome, neonatal hemorrhagic syndrome, pneumonia, trauma, low weight at birth, prematurity, congenital malformations (cleft palate, cleft lip, hydrocephaly, anasarca, vascular anomalies in the heart, anal atresia, gastroschisis, omphalocele, among others), neonatal sepsis and other local and systemic bacterial infections, viral infections (feline respiratory complex, parvovirus, canine distemper, canine infectious traqueobronchitis), parasitical infections (Toxocara spp., Ancylostoma spp., Strongyloides spp., Cystoisospora spp., Babesia spp. and Giardia spp.) and fungal infections (dermatophytosis by Microsporum canis). The most common clinical presentation observed was the neonatal triad (hypothermia, hypoglycemia and dehydration), affecting 74.6% (603/808) of the patients. The mortality rate among the neonates was 10.5% (85/808). Being knowledgeable about neonatology is essential for veterinarians to provide adequate care for these patients in the clinical routine. Adding neonatology to college curriculums, improving the dissemination of information on the subject, and providing annual training in neonatology for veterinarians and employees are important to improve immediate care and reduce the mortality rates.

Keywords: neonatal care, puppies, neonatal, conditions

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Authors: Uraib Sharaha, Ahmad Salman, Eladio Rodriguez-Diaz, Elad Shufan, Klaris Riesenberg, Irving J. Bigio, Mahmoud Huleihel

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Antimicrobial drugs have played an indispensable role in controlling illness and death associated with infectious diseases in animals and humans. However, the increasing resistance of bacteria to a broad spectrum of commonly used antibiotics has become a global healthcare problem. Many antibiotics had lost their effectiveness since the beginning of the antibiotic era because many bacteria have adapted defenses against these antibiotics. Rapid determination of antimicrobial susceptibility of a clinical isolate is often crucial for the optimal antimicrobial therapy of infected patients and in many cases can save lives. The conventional methods for susceptibility testing require the isolation of the pathogen from a clinical specimen by culturing on the appropriate media (this culturing stage lasts 24 h-first culturing). Then, chosen colonies are grown on media containing antibiotic(s), using micro-diffusion discs (second culturing time is also 24 h) in order to determine its bacterial susceptibility. Other methods, genotyping methods, E-test and automated methods were also developed for testing antimicrobial susceptibility. Most of these methods are expensive and time-consuming. Fourier transform infrared (FTIR) microscopy is rapid, safe, effective and low cost method that was widely and successfully used in different studies for the identification of various biological samples including bacteria; nonetheless, its true potential in routine clinical diagnosis has not yet been established. The new modern infrared (IR) spectrometers with high spectral resolution enable measuring unprecedented biochemical information from cells at the molecular level. Moreover, the development of new bioinformatics analyses combined with IR spectroscopy becomes a powerful technique, which enables the detection of structural changes associated with resistivity. The main goal of this study is to evaluate the potential of the FTIR microscopy in tandem with machine learning algorithms for rapid and reliable identification of bacterial susceptibility to antibiotics in time span of few minutes. The UTI E.coli bacterial samples, which were identified at the species level by MALDI-TOF and examined for their susceptibility by the routine assay (micro-diffusion discs), are obtained from the bacteriology laboratories in Soroka University Medical Center (SUMC). These samples were examined by FTIR microscopy and analyzed by advanced statistical methods. Our results, based on 700 E.coli samples, were promising and showed that by using infrared spectroscopic technique together with multivariate analysis, it is possible to classify the tested bacteria into sensitive and resistant with success rate higher than 90% for eight different antibiotics. Based on these preliminary results, it is worthwhile to continue developing the FTIR microscopy technique as a rapid and reliable method for identification antibiotic susceptibility.

Keywords: antibiotics, E.coli, FTIR, multivariate analysis, susceptibility, UTI

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Authors: Kamal Tolani, Sandeep Kumar, Rohit Luthra, Ankit Dadhania, Krishnaprasad K., Ram Gupta, Deepa Joshi

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Background: Post-operative analgesia remains a clinical challenge, with central and peripheral sensitization playing a pivotal role in treatment-related complications and impaired quality of life. Centrally acting opioids offer poor risk benefit profile with increased intensity of gastrointestinal or central side effects and slow onset of clinical analgesia. The objective of this study was to assess the clinical feasibility of induction and maintenance therapy with Tapentadol Nasal Spray (NS) in moderate to severe acute post-operative pain. Methods: Phase III, randomized, active-controlled, non-inferiority clinical trial involving 294 cases who had undergone surgical procedures under general anesthesia or regional anesthesia. Post-surgery patients were randomized to receive either Tapentadol NS 45 mg or Tramadol 100mg IV as a bolus and subsequent 50 mg or 100 mg dose over 2-3 minutes. The frequency of administration of NS was at every 4-6 hours. At the end of 24 hrs, patients in the tramadol group who had a pain intensity score of ≥4 were switched to oral tramadol immediate release 100mg capsule until the pain intensity score reduced to <4. All patients who had achieved pain intensity ≤ 4 were shifted to a lower dose of either Tapentadol NS 22.5 mg or oral Tramadol immediate release 50mg capsule. The statistical analysis plan was envisaged as a non-inferiority trial involving comparison with Tramadol for Pain intensity difference at 60 minutes (PID60min), Sum of Pain intensity difference at 60 minutes (SPID60min), and Physician Global Assessment at 24 hrs (PGA24 hrs). Results: The per-protocol analyses involved 255 hospitalized cases undergoing surgical procedures. The median age of patients was 38.0 years. For the primary efficacy variables, Tapentadol NS was non-inferior to Inj/Oral Tramadol in relief of moderate to severe post-operative pain. On the basis of SPID60min, no clinically significant difference was observed between Tapentadol NS and Tramadol IV (1.73±2.24 vs. 1.64± 1.92, -0.09 [95% CI, -0.43, 0.60]). In the co-primary endpoint PGA24hrs, Tapentadol NS was non–inferior to Tramadol IV (2.12 ± 0.707 vs. 2.02 ±0.704, - 0.11[95% CI, -0.07, 0.28). However, on further assessment at 48hr, 72 hrs, and 120hrs, clinically superior pain relief was observed with the Tapentadol NS formulation that was statistically significant (p <0.05) at each of the time intervals. Secondary efficacy measures, including the onset of clinical analgesia and TOTPAR, showed non-inferiority to Tramadol. The safety profile and need for rescue medication were also similar in both the groups during the treatment period. The most common concomitant medications were anti-bacterial (98.3%). Conclusion: Tapentadol NS is a clinically feasible option for improved compliance as induction and maintenance therapy while offering a sustained and persistent patient response that is clinically meaningful in post-surgical settings.

Keywords: tapentadol nasal spray, acute pain, tramadol, post-operative pain

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Authors: F. Arıkan, Z. Karakus

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Cancer is a widespread disease in the world and is the third reason of deaths among the chronic diseases. Educating patients and caregivers has a vital role for empowering them in managing disease and treatment's symptoms. Informing of the patients about their disease and treatment process decreases patient's distress and decisional conflicts, improves wellbeing of them, increase success of the treatment and survival. In this era, technological education methods are used for patients that have different chronic disease. Many studies indicated that especially web based patient education such as chronic obstructive lung disease; heart failure is more effective than printed materials. Web based education provide easiness to patients while they are reaching health services. It also has more advantages because of it decreases health cost and requirement of staff. It is thought that web based education may be beneficial method for cancer patient's empowerment in coping with the disease's symptoms. The aim of the study is evaluate the effectiveness of web based education for cancer patients' clinical outcomes.

Keywords: cancer patients, e-learning, nursing, web based education

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Authors: Magdalena Bury-Kaminska, Aneta Szudy-Szczyrek, Aleksandra Nowaczynska, Olga Jankowska-Lecka, Marek Hus, Klaudia Kot

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Introduction: The aim of the research was to determine the changes in cognitive functioning in patients with plasma cell myeloma by comparing patients’ state before the treatment and during chemotherapy as well as to determine the biological factors that can be used to predict patients’ cognitive state. Methods: The patients underwent the research procedure twice: before chemotherapy and after 4-6 treatment cycles. A psychological test and measurement of the following biological variables were carried out: TNF-α (tumor necrosis factor), IL-6 (interleukin 6), IL-10 (interleukin 10), BDNF (brain-derived neurotrophic factor). The following research methods were implemented: the Montreal Cognitive Assessment (MoCA), Battery of Tests for Assessing Cognitive Functions PU1, experimental and clinical trials based on the Choynowski’s Memory Scale, Stroop Color-Word Interference Test (SCWT), depression measurement questionnaire. Results: The analysis of the research showed better cognitive functions of patients during chemotherapy in comparison to the phase before it. Moreover, neurotrophin BDNF allows to predict the level of selected cognitive functions (semantic fluency and execution control) already at the diagnosis stage. After 4-6 cycles, it is also possible to draw conclusions concerning the extent of working memory based on the level of BDNF. Cytokine TNF-α allows us to predict the level of letter fluency during anti-cancer treatment. Conclusions: It is possible to presume that BDNF has a protective influence on patients’ cognitive functions and working memory and that cytokine TNF-α co-occurs with a diminished execution control and better material grouping in terms of phonological fluency. Acknowledgment: This work was funded by the National Science Center in Poland [grant no. 2017/27/N/HS6/02057.

Keywords: chemobrain, cognitive impairment, non−central nervous system cancers, hematologic diseases

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Authors: Nur Fathin Alia Che Wahab, Thirumulu Ponnuraj Kannan, Zuliani Mahmood, Ismail Ab. Rahman, Hanafi Ismail

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Locally produced Biphasic Calcium Phosphate (BCP) consists of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) which is a promising material for dentin and bone regeneration as well as in tissue engineering applications. The study was carried out to investigate the mutagenic effect of locally produced BCP using Ames test. Mutagenicity was evaluated with and without the addition of metabolic activation system (S9). This study was performed on Salmonella typhimurium TA98, TA102, TA1537, and TA1538 strains using preincubation assay method. The doses tested were 5000, 2500, 1250, 625, 313 µg/plate. Negative and positive controls were also included. The bacteria were incubated for 48 hours at 37 ± 0.5 °C. Then, the revertant colonies were counted. Data obtained were evaluated using non-statistical method. The mean number of revertant colonies in strains with and without S9 mix treated with locally produced BCP was less than double when compared to negative control for all the tested concentrations. The results from this study indicate that the locally produced BCP is non-mutagenic under the present test conditions.

Keywords: ames test, biphasic calcium phosphate, dentin regeneration, mutagenicity

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Authors: Tamphasana Wairokpam

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

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

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Authors: Hee Yong Kang, Hyeon Ho Shin, Jung Cheol Yoo, Il Taek Lee, Sung Mo Yang

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Lightweight technology using composites is being developed for vehicle seat structures, and its design must meet the safety requirements. According to the Federal Motor Vehicle Safety Standard (FMVSS) 207 seating systems test procedure, the back moment load is applied to the seat back frame structure for the safety evaluation of the vehicle seat. The seat back frame using the composites is divided into three parts: upper part frame, and left- and right-side frame parts following the manufacturing process. When a rear moment load is applied to the seat back frame, the side frame receives the bending load and the torsional load at the same time. This results in the largest loaded strength. Therefore, strength test of the component unit is required. In this study, a component test method based on the FMVSS 207 seating systems test procedure was proposed for the strength analysis of bending load and torsional load of the automotive Bulk Molding Compound (BMC) Seat Back Side Frame. Moreover, strength evaluation according to the carbon band reinforcement was performed. The back-side frame parts of the seat that are applied to the test were manufactured through BMC that is composed of vinyl ester Matrix and short carbon fiber. Then, two kinds of reinforced and non-reinforced parts of carbon band were formed through a high-temperature compression molding process. In addition, the structure that is applied to the component test was constructed by referring to the FMVSS 207. Then, the bending load and the torsional load were applied through the displacement control to perform the strength test for four load conditions. The results of each test are shown through the load-displacement curves of the specimen. The failure strength of the parts caused by the reinforcement of the carbon band was analyzed. Additionally, the fracture characteristics of the parts for four strength tests were evaluated, and the weakness structure of the back-side frame of the seat structure was confirmed according to the test conditions. Through the bending and torsional strength test methods, we confirmed the strength and fracture characteristics of BMC Seat Back Side Frame according to the carbon band reinforcement. And we proposed a method of testing the part strength of a seat back frame for vehicles that can meet the FMVSS 207.

Keywords: seat back frame, bending and torsional strength, BMC (Bulk Molding Compound), FMVSS 207 seating systems

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Authors: Neeraj Vij, Amber Brennan, Jenni Winters, Hadi Salehi, Hamy Temkit, Emily Andrisevic, Mohan V. Belthur

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Idiopathic clubfoot is a common lower extremity deformity with an incidence of 1:500. The Ponseti Method is well known as the gold standard of treatment. However, there is limited functional data demonstrating correction of the clubfoot after treatment with the Ponseti method. The purpose of this study was to study the clinical and functional outcomes after the Ponseti method with the Clubfoot Disease-Specific Instrument (CDS) and pedobarography. This IRB-approved prospective study included patients aged 3-18 who were treated for idiopathic clubfoot with the Ponseti method between January 2008 and December 2018. Age-matched controls were identified through siblings of clubfoot patients and other community members. Treatment details were collected through a chart review of the included patients. Laboratory assessment included a physical exam, gait analysis, and pedobarography. The Pediatric Outcomes Data Collection Instrument and the Clubfoot Disease-Specific Instrument were also obtained on clubfoot patients (CF). The Wilcoxson rank-sum test was used to study differences between the CF patients and the typically developing (TD) patients. Statistical significance was set at p < 0.05. There were a total of 37 enrolled patients in our study. 21 were priorly treated for CF and 16 were TD. 94% of the CF patients had bilateral involvement. The age at the start of treatment was 29 days, the average total number of casts was seven to eight, and the average total number of casts after Achilles tenotomy was one. The reoccurrence rate was 25%, tenotomy was required in 94% of patients, and ≥1 tenotomy was required in 25% of patients. There were no significant differences between step length, step width, stride length, force-time integral, maximum peak pressure, foot progression angles, stance phase time, single-limb support time, double limb support time, and gait cycle time between children treated with the Ponseti method and typically developing children. The average post-treatment Pirani and Dimeglio scores were 5.50±0.58 and 15.29±1.58, respectively. The average post-treatment PODCI subscores were: Upper Extremity: 90.28, Transfers: 94.6, Sports: 86.81, Pain: 86.20, Happiness: 89.52, Global: 88.6. The average post-treatment Clubfoot Disease-Specific Instrument scores subscores were: Satisfaction: 73.93, Function: 80.32, Overall: 78.41. The Ponseti Method has a very high success rate and remains to be the gold standard in the treatment of idiopathic clubfoot. Timely management leads to good outcomes and a low need for repeated Achilles tenotomy. Children treated with the Ponseti method demonstrate good functional outcomes as measured through pedobarography. Pedobarography may have clinical utility in studying congenital foot deformities. Objective measures for hours of brace wear could represent an improvement in clubfoot care.

Keywords: functional outcomes, pediatric deformity, patient-reported outcomes, talipes equinovarus

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Authors: Inseon Ryoo, Soo Chin Kim, Hyena Jung, Sangil Suh

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Objectives: The purpose of this study is to evaluate the clinical significance of hyper-intense signal thyroid incidentalomas on the time of flight magnetic resonance angiography (TOF-MRA) using correlation study with ultrasound (US). Methods: We retrospectively reviewed 3,505 non-contrast TOF-MRA performed at an institution between September 2014 and May 2017. Two radiologists correlated the thyroid incidentalomas detected on TOF-MRA with US features which was obtained within three months interval between MRA and US examinations in consensus method. Results: The prevalence of hyper-intense signal thyroid nodules incidentally detected on TOF-MRA was 1.2% (43/3505). Among them, 35 people (81.4%) underwent US examinations, and total 45 hyper-intense signal thyroid nodules were detected on US exams. Of these 45 nodules, 35 nodules (72.9%) were categorized as benign (K-TIRADS category 2) on US exams. Fine needle aspiration was performed on 9 nodules according to the indications recommended by Korean Society of Thyroid Radiology. All except one high-suspicious thyroid nodule were confirmed as benign (Bethesda 2) on cytologic exams. One high-suspicious nodule on US showed a non-diagnostic result (Bethesda 1) on cytologic exam. However, this nodule collapsed after aspiration of thick colloid material. Conclusions: Our study showed that the most hyper-intense signal thyroid nodules detected on TOF-MRA were benign. Therefore, if a hyper-intense signal incidentaloma is found on TOF-MRA, further evaluation, especially invasive biopsy of the nodules could be suspended unless the patient had other symptoms or clinical factors suggesting the need for further evaluation.

Keywords: incidentaloma, thyroid nodule, TOF MR angiography, ultrasound

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Authors: Mahboobeh Sadeghi, Zahra Izadi Khah, Mansour Hakim Javadi, Masoud Gholamali Lavasani

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Background: Since there is a relation between psychological and physiological factors, the aim of this study was to examine the effect of Emotion Regulation training on cognitive emotion regulation problem in patients with Multiple Sclerosis(MS) Method: In a randomized clinical trial thirty patients diagnosed with Multiple Sclerosis referred to state welfare organization were selected. The sample group was randomized into either an experimental group or a nonintervention control group. The subjects participated in 75-minute treatment sessions held three times a week for 4weeks (12 sessions). All 30 individuals were administered with Cognitive Emotion Regulation questionnaire (CERQ). Participants completed the questionnaire in pretest and post-test. Data obtained from the questionnaire was analyzed using Mancova. Results: Emotion Regulation significantly decreased the Cognitive Emotion Regulation problems patients with Multiple sclerosis (p < 0.001). Conclusions: Emotion Regulation can be used for the treatment of cognitive-emotion regulation problem in Multiple sclerosis.

Keywords: Multiple Sclerosis, cognitive-emotion regulation, emotion regulation, MS

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Authors: Sung-Uk Wee, Chang-Sung Seok, Jae-Mean Koo, Jeong-Min Lee

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Gas turbine blade is important part of power plant, so it is necessary to evaluate gas turbine reliability. For better heat efficiency, inlet temperature of gas turbine has been elevated more and more so gas turbine blade is exposed to high-temperature environment. Then, higher inlet temperature affects mechanical behavior of the gas turbine blade, so it is necessary that evaluation of mechanical property of gas turbine blade at high-temperature environment. In this study, tensile test and fatigue test were performed at various high temperature, and fatigue life was predicted by Coffin-Manson equation at each temperature. The experimental results showed that gas turbine blade has a lower elastic modulus and shorter fatigue life at higher temperature.

Keywords: gas turbine blade, tensile test, fatigue life, stress-strain

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Authors: Alexandra Shipley

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Background: Undergraduate paediatric teaching must overcome two major challenges: 1) balancing patient safety with active student engagement and 2) exposing students to a comprehensive range of pathologies within a relatively short clinical placement. Whilst lectures and shadowing on paediatric wards constitute the mainstay of learning, Simulation and Virtual Reality (VR) are emerging as effective teaching tools, which - immune to the unpredictability and seasonal variation of hospital presentations - could expose students to the entire syllabus more reliably, efficiently, and independently. We aim to evaluate the potential utility of Simulation and VR in addressing gaps within the traditional paediatric curriculum from the perspective of medical students. Summary of Work: Exposure to and perceived utility of various learning opportunities within the Paediatric and Emergency Medicine courses were assessed through a questionnaire completed by 5th year medical students (n=23). Summary of Results: Students reported limited exposure to several common acute paediatric presentations, such as bronchiolitis (41%), croup (32%) or pneumonia (14%), and to clinical emergencies, including cardiac/respiratory arrests or trauma calls (27%). Across all conditions, average self-reported confidence in assessment and management to the level expected of an FY1 is greater amongst those who observed at least one case (e.g. 7.6/10 compared with 3.6/10 for croup). Students rated exposure through Simulation or VR to be of similar utility to witnessing a clinical scenario on the ward. In free text responses, students unanimously favoured being ‘challenged’ through ‘hands-on’ patient interaction over passive shadowing, where it is ‘easy to zone out.’ In recognition of the fact that such independence is only appropriate in certain clinical situations, many students reported wanting more Simulation and VR teaching. Importantly, students raised the necessity of ‘proper debriefs’ after these sessions to maximise educational value. Discussion and Conclusion: Our questionnaire elicited several student-perceived challenges in paediatric education, including incomplete exposure to common pathologies and limited opportunities for active involvement in patient care. Indeed, these experiences seem to be important predictors of confidence. Quantitative and qualitative feedback suggests that VR and Simulation satisfy students’ self-reported appetite for independent engagement with authentic clinical scenarios. Take-aways: Our findings endorse further development of VR and Simulation as high-yield adjuncts to paediatric education.

Keywords: paediatric emergency education, simulation, virtual reality, medical education

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Authors: Venkat Garigapati

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To date, more than a dozen oligonucleotide products are approved as injectable products for clinical use. However, there is no single oligo nucleotide product approved for clinical use. Oral delivery of oligo nucleotides is patient friendly administration however, many challenges involved in the development of oral formulation. Over the course of last twenty plus years, the research in this space aimed to address these challenges. This paper describes the issues involved in solubility, stability, enzymatic (nuclease) induced degradation, and permeation of nucleotides in the Gastrointestinal (GI) and how to overcome these challenges. Also, the translation of in vitro data to in vivo models hinders the formulation development. This paper describes the challenges involved in the development of Oligo Nucleotide products for oral administration. It also discusses the chemistry and formulation strategies for oral administration of oligonucleotides.

Keywords: oral adminstration, oligo nucleotides, stability, permeation, gastrointestinal tract

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Authors: Gisele C. A. Martins, Leonardo A. Marcolin, Laurenn B. de Macedo, Francisco A. Rocco Lahr, Carlito Calil Jr

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The use and development of wood composite materials increased in the past few years. However, in Brazil there are some restrictions on these products regarding their use since it could be considered a potential risk in a fire situation. Thus, becomes evident the need for research aiming to fit these in safety standards. This study aims to evaluate the efficiency of two new fire retardant products produced by a Brazilian industry. Tests were performed on plywood panels of Pinus spp previously immersed, varying the products concentrations and compared with untreated samples. The test used to evaluate the flame spread in a panel was the modified Schlyter test. The product in question was proved efficient, before and after shutting off the burner. Comparing panels with the panels without treatment, there was a decrease of 400% of the height of the flame spread on the treated ones.

Keywords: fire retardant, flame spread, plywood, wood-based material

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Authors: Grzegorz Baranski, Piotr Kacejko, Konrad Pietrykowski, Mariusz Duk

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This paper discusses a model of a bus-driving scheme. Rapid changes in speed result in a constantly changing kinetic energy accumulated in a bus mass and an increased fuel consumption due to hardly recuperated kinetic energy. The model is based on the results achieved from chassis dynamometer, airport and city street researches. The verified model was applied to simulate the mechanical energy recuperation during the Japanese JE05 Emission Test Cycle. The simulations were performed for several values of vehicle mass. The research results show that fuel economy is impacted by kinetic energy recuperation.

Keywords: heavy duty vehicle, city bus, Japanese JE05 test cycle, kinetic energy, simulations

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Authors: Ouassila Bekkal Brikci Benhabib, Zahia Boucherit Otmani, Kebir Boucherit, A. Seghir

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The establishment of intravenous catheters in hospitalized patient is an act common in many clinical situations. These therapeutic tools, from their insertion in the body, represent gateways including fungal germs prone. The latter can generate the growth of biofilms, which can be the cause of fungal infection. Faced with this problem, we conducted a study at the University Hospital of Tlemcen in the neurosurgery unit and aims to isolate and identify Candida yeasts from intravenous catheters. Then test their ability to form biofilms. Materials and methods: 256 patient hospitalized in surgery of the hospital in west Algeria were submitted to this study. All samples were taken from peripheral venous catheters implanted for 72 hours or more days. A total of 31 isolates of Candida species were isolated. MIC and SMIC are determined at 80% inhibition by the test XTT tetrazolium measured at 490 nm. The final concentrations of antifungal agent being between 0.03 and 16 mg / ml for amphotericin B and from 0.015 to 8 mg / mL caspofungin. Results: 31 Candida species isolates from catheters including 14 Candida albicans and 17 Candida non albicans . 21 strains of all the isolates were able to form biofilms. In their form of Planktonic cells, all isolates are 100% susceptible to antifungal agents tested. However, in their state of biofilms, more isolates have become tolerant to the tested antifungals. Conclusion: Candida yeasts isolated from intravascular catheters are considered an important virulence factor in the pathogenesis of infections. Their involvement in catheter-related infections can be disastrous for their potential to generate biofilms. They survive high concentrations of antifungal where treatment failure. Pending the development of a therapeutic approach antibiofilm related to catheters, their mastery is going through: -The risk of infection prevention based on the training and awareness of medical staff, -Strict hygiene and maximum asepsis, and -The choice of material limiting microbial colonization.

Keywords: candida, biofilm, hospital, infection, amphotericin B, caspofungin

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Authors: Mohammed Abubakar Ndanusa, A. A. Hassan, R. W. Gimba, A. M. Alfa, M. T. Abari

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This study investigated the Impact of Mathematical Modeling on Mathematics Achievement, Attitude and Interest of Pre-Service Teachers in Niger States, Nigeria. It was an attempt to ease students’ difficulties in comprehending mathematics. The study used randomized pretest, posttest control group design. Two Colleges of Education were purposively selected from Niger State with a sample size of eighty-four 84 students. Three research instruments used are Mathematical Modeling Achievement Test (MMAT), Attitudes Towards Mathematical Modeling Questionnaire (ATMMQ) and Mathematical Modeling Students Interest Questionnaire (MMSIQ). Pearson Product Moment Correlation (PPMC) formula was used for MMAT and Alpha Cronbach was used for ATMMQ and MMSIQ to determine their reliability coefficient and the values the following values were obtained respectively 0.76, 0.75 and 0.73. Independent t-test statistics was used to test hypothesis One while Mann Whitney U-test was used to test hypothesis Two and Three. Findings revealed that students taught Mathematics using Mathematical Modeling performed better than their counterparts taught using lecture method. However, there was a significant difference in the attitude and interest of pre-service mathematics teachers after being exposed to mathematical modeling. The strategy, therefore, was recommended to be used by Mathematics teachers with a view to improving students’ attitude and interest towards Mathematics. Also, modeling should be taught at NCE level in order to prepare pre-service teachers towards real task in the field of Mathematics.

Keywords: achievement, attitude, interest, mathematical modeling, pre-service teachers

Procedia PDF Downloads 285

Authors: Janet Tolulope Olaseni

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Emotional well-being in adolescents is an important psychological factor that can enhance positive living, but if it is not well groomed, it can have adverse impacts on their development. Therefore, the present study examined the efficacy of psycho-education on the emotional well-being of adolescents who are visually impaired in Nigeria. A total of twenty-eight (28) participants, which comprisednineteen (19) males and nine (9) females (M=15.82, SD=2.23) from a Nigerian School for the Blind, participated in the quasi-experimental study. Randomized clinical trial designwas used to assigned the participants into three (Complete Psycho-education, Incomplete Psycho-education, and No Psycho-education) groups. Standardized scales were used to gather data from the respondents. The formulated hypotheses were tested using Dependent T-Test and Analysis of Co-Variance. The results showed that there was a significant effect of Psycho-education on the emotional well-being of the Visually Impaired Adolescents. Those who received complete Psycho-educationhad the highest level of emotional well-being compared to those in the other groups. In order to enhance the emotional well-being of the Visually Impaired Adolescents, the study recommended that complete Psycho-education programme should be incorporated into the school activities of the Visually Impaired Adolescents.

Keywords: emotional well-being, psycho-education, visually impaired adolescents, Nigeria

Procedia PDF Downloads 89

Authors: Volkan Ayik

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Loosening as a result of torque loss in bolted joints is one of the most encountered problems resulting in loss of connection between parts. The main reason for this is the dynamic loads to which the joints are subjected while the vehicle is moving. In particular, vibration-induced loads can loosen the joints in any size and geometry. The aim of this study is to study an improved method due to road-induced vibration in heavy commercial vehicles for estimating the vibration performance of bolted joints of the components connected to the chassis, before conducting prototype level vehicle structural strength tests on a proving ground. The frequency and displacements caused by the road conditions-induced vibration loads have been determined for the parts connected to the chassis, and various experimental design scenarios have been formed by matching specific components and vibration behaviors. In the studies, the performance of the torque, washer, test displacement, and test frequency parameters were observed by maintaining the connection characteristics on the vehicle, and the sensitivity ratios for these variables were calculated. As a result of these experimental design findings, tests performed on a developed device based on Junker’s vibration device and proving ground conditions versus test correlation levels were found.

Keywords: bolted joints, junker’s test, loosening failure, torque loss

Procedia PDF Downloads 112

Authors: Mauro Masili, Liliane Ventura

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It is still controversial in the literature the ultraviolet (UV) radiation effects on the ocular media, but the World Health Organization has established safe limits on the exposure of eyes to UV radiation based on reports in literature. Sunglasses play an important role in providing safety, and their lenses should provide adequate UV filters. Regarding UV protection for ocular media, the resistance-to-irradiance test for sunglasses under many national standards requires irradiating lenses for 50 uninterrupted hours with a 450 W solar simulator. This artificial aging test may provide a corresponding evaluation of exposure to the sun. Calculating the direct and diffuse solar irradiance at a vertical surface and the corresponding radiant exposure for the entire year, we compare the latter with the 50-hour radiant exposure of a 450 W xenon arc lamp from a solar simulator required by national standards. Our calculations indicate that this stress test is ineffective in its present form. We provide evidence of the need to re-evaluate the parameters of the tests to establish appropriate safe limits against UV radiation. This work is potentially significant for scientists and legislators in the field of sunglasses standards to improve the requirements of sunglasses quality and safety.

Keywords: ISO 12312-1, solar simulator, sunglasses standards, UV protection

Procedia PDF Downloads 183

Authors: Mette Pedersen

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This paper outlines the criteria that assessment specialists use when they design the 'Persuasive Essay' task for the four Advanced Placement World Language and Culture Exams (AP French, German, Italian, and Spanish). The 'Persuasive Essay' is a free-response, source-based, standardized measure of presentational writing. Each 'Persuasive Essay' item consists of three sources (an article, a chart, and an audio) and a prompt, which is a statement of the topic phrased as an interrogative sentence. Due to its richness of source materials and due to the amount of time that test takers are given to prepare for and write their responses (a total of 55 minutes), the 'Persuasive Essay' is the free-response task on the AP World Language and Culture Exams that goes to the greatest lengths to unleash the test takers' proficiency potential. The author focuses on the work that goes into designing the 'Persuasive Essay' task, outlining best practices for the selection of topics and sources, the interplay that needs to be present among the sources and the thinking behind the articulation of prompts for the 'Persuasive Essay' task. Using released 'Persuasive Essay' items from the AP World Language and Culture Exams and accompanying data on test taker performance, the author shows how different passages, and features of passages, have succeeded (and sometimes not succeeded) in eliciting writing proficiency among test takers over time. Data from approximately 215.000 test takers per year from 2014 to 2017 and approximately 35.000 test takers per year from 2012 to 2013 form the basis of this analysis. The conclusion of the study is that test taker performance improves significantly when the sources that test takers are presented with express directly opposing viewpoints. Test taker performance also improves when the interrogative prompt that the test takers respond to is phrased as a yes/no question. Finally, an analysis of linguistic difficulty and complexity levels of the printed sources reveals that test taker performance does not decrease when the complexity level of the article of the 'Persuasive Essay' increases. This last text complexity analysis is performed with the help of the 'ETS TextEvaluator' tool and the 'Complexity Scale for Information Texts (Scale)', two tools, which, in combination, provide a rubric and a fully-automated technology for evaluating nonfiction and informational texts in English translation.

Keywords: advanced placement world language and culture exams, designing presentational writing assessments, large-scale standardized assessments of written language proficiency, source-based language testing

Procedia PDF Downloads 121

Authors: Philip A. Szlosek, M. Susan Guyer, Mary G. Barnum, Elizabeth M. Mullin

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In the United States, athletic training is a healthcare profession that encompasses the prevention, examination, diagnosis, treatment, and rehabilitation of injuries and medical conditions. Athletic trainers work under the direction of or in collaboration with a physician and are recognized by the American Medical Association as allied healthcare professionals. Internationally, this profession is often known as athletic therapy. As healthcare professionals, athletic trainers must be prepared for autonomous practice immediately after graduation. However, new athletic trainers have been shown to have clinical areas of strength and weakness.To better assess professional readiness and improve the preparedness of new athletic trainers, the factors of athletic training professional readiness must be defined. Limited research exists defining the holistic aspects of professional readiness needed for athletic trainers. Confirming the factors of professional readiness in athletic training could enhance the professional preparation of athletic trainers and result in more highly prepared new professionals. The objective of this study was to further explore and confirm the factors of professional readiness in athletic training. Authors useda qualitative design based in grounded theory. Participants included athletic trainers with greater than 24 months of experience from a variety of work settings from each district of the National Athletic Trainer’s Association. Participants took the demographic questionnaire electronically using Qualtrics Survey Software (Provo UT). After completing the demographic questionnaire, 20 participants were selected to complete one-on-one interviews using GoToMeeting audiovisual web conferencing software. IBM Statistical Package for the Social Sciences (SPSS, v. 21.0) was used to calculate descriptive statistics for participant demographics. The first author transcribed all interviews verbatim and utilized a grounded theory approach during qualitative data analysis. Data were analyzed using a constant comparative analysis and open and axial coding. Trustworthiness was established using reflexivity, member checks, and peer reviews. Analysis revealed four overarching themes, including management, interpersonal relations, clinical decision-making, and confidence. Management was categorized as athletic training services not involving direct patient care and was divided into three subthemes, including administration skills, advocacy, and time management. Interpersonal Relations was categorized as the need and ability of the athletic trainer to properly interact with others. Interpersonal relations was divided into three subthemes, including personality traits, communication, and collaborative practice. Clinical decision-making was categorized as the skills and attributes required by the athletic trainer whenmaking clinical decisions related to patient care. Clinical decision-making was divided into three subthemes including clinical skills, continuing education, and reflective practice. The final theme was confidence. Participants discussed the importance of confidence regarding relationships building, clinical and administrative duties, and clinical decision-making. Overall, participants explained the value of a well-rounded athletic trainer and emphasized that athletic trainers need communication and organizational skills, the ability to collaborate, and must value self-reflection and continuing education in addition to having clinical expertise. Future research should finalize a comprehensive model of professional readiness for athletic training, develop a holistic assessment instrument for athletic training professional readiness, and explore the preparedness of new athletic trainers.

Keywords: autonomous practice, newly certified athletic trainer, preparedness for professional practice, transition to practice skills

Procedia PDF Downloads 131

Authors: Besher Gharaibeh

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This article addressed the issue of using physical exam in nursing. Nurses hold different attitudes toward using physical exam in the clinical settings. These attitudes determine to embrace physical examination in practice. So, the aim of the study was to examine registered nurses’ attitudes and practices, identify perceived barriers, and to identify the factors which influence the performance and the attitudes towards physical examinations. Results showed that even though nurses reported performing physical exam often, they had negative attitudes toward it. Stress and performing physical examinations on someone of the opposite gender (n=236; 87.4%) were the main barriers. Nurse's level of education influenced the attitude (t=-4.3; p < .01). These results indicated that RNs recognize the necessity of physical examinations, but they face many barriers and challenges which hinder the performance of the examination. Cultural factors and experience were the most influential barriers which deter performance of the physical examination.

Keywords: physical exam, nursing, barriers, practices, attitudes

Procedia PDF Downloads 151

Authors: Guillaume Craveur

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This study shows the opportunity to use numerical tools dedicated to Fire Safety Engineering for the Rolling Stock. Indeed, some lawful requirements can now be demonstrated by using numerical tools. The first part of this study presents the use of modelling evacuation tool to satisfy the criteria of evacuation time for the rolling stock. The buildingEXODUS software is used to model and simulate the evacuation of rolling stock. Firstly, in order to demonstrate the reliability of this tool to calculate the complete evacuation time, a comparative study was achieved between a real test and simulations done with buildingEXODUS. Multiple simulations are performed to capture the stochastic variations in egress times. Then, a new study is done to calculate the complete evacuation time of a train with the same geometry but with a different interior architecture. The second part of this study shows some applications of Computational Fluid Dynamics. This work presents the approach of a multi scales validation of numerical simulations of standardized tests with Fire Dynamics Simulations software developed by the National Institute of Standards and Technology (NIST). This work highlights in first the cone calorimeter test, described in the standard ISO 5660, in order to characterize the fire reaction of materials. The aim of this process is to readjust measurement results from the cone calorimeter test in order to create a data set usable at the seat scale. In the second step, the modelisation concerns the fire seat test described in the standard EN 45545-2. The data set obtained thanks to the validation of the cone calorimeter test was set up in the fire seat test. To conclude with the third step, after controlled the data obtained for the seat from the cone calorimeter test, a larger scale simulation with a real part of train is achieved.

Keywords: fire safety engineering, numerical tools, rolling stock, multi-scales validation

Procedia PDF Downloads 294

Authors: P. V. Pramila , V. Mahesh

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Pulmonary Function Tests are important non-invasive diagnostic tests to assess respiratory impairments and provides quantifiable measures of lung function. Spirometry is the most frequently used measure of lung function and plays an essential role in the diagnosis and management of pulmonary diseases. However, the test requires considerable patient effort and cooperation, markedly related to the age of patients esulting in incomplete data sets. This paper presents, a nonlinear model built using Multivariate adaptive regression splines and Random forest regression model to predict the missing spirometric features. Random forest based feature selection is used to enhance both the generalization capability and the model interpretability. In the present study, flow-volume data are recorded for N= 198 subjects. The ranked order of feature importance index calculated by the random forests model shows that the spirometric features FVC, FEF 25, PEF,FEF 25-75, FEF50, and the demographic parameter height are the important descriptors. A comparison of performance assessment of both models prove that, the prediction ability of MARS with the `top two ranked features namely the FVC and FEF 25 is higher, yielding a model fit of R2= 0.96 and R2= 0.99 for normal and abnormal subjects. The Root Mean Square Error analysis of the RF model and the MARS model also shows that the latter is capable of predicting the missing values of FEV1 with a notably lower error value of 0.0191 (normal subjects) and 0.0106 (abnormal subjects). It is concluded that combining feature selection with a prediction model provides a minimum subset of predominant features to train the model, yielding better prediction performance. This analysis can assist clinicians with a intelligence support system in the medical diagnosis and improvement of clinical care.

Keywords: FEV, multivariate adaptive regression splines pulmonary function test, random forest

Procedia PDF Downloads 289

Authors: Ilma Robo, Saimir Heta, Greta Plaka, Vera Ostreni

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Purpose: Drug gingival hyperplasia is an uncommon pathology encountered during routine work in dental units. The purpose of this paper is to present the clinical appearance of gingival hyperplasia caused by medications. There are already three classes of medications that cause hyperplasia and based on data from the literature, the clinical cases encountered and included in this study have been compared. Materials and Methods: The study was conducted in a total of 311 patients, out of which 182 patients were included in our study, meeting the inclusion criteria. After each patient's history was recorded and it was found that patients were in their knowledge of chronic illness, undergoing treatment of gingivitis hypertrophic drugs was performed with a clinical examination of oral cavity and assessment by vertical and horizontal evaluation according to the periodontal indexes. Results: Of the data collected during the study, it was observed that 97% of patients with gingival hyperplasia are treated with nifedipine. 84% of patients treated with selected medicines and gingival hyperplasia in the oral cavity has been exposed at time period for more than 1 year and 1 month. According to the GOI, in the first rank of this index are about 21% of patients, in the second rank are 52%, in the third rank are 24% and in the fourth grade are 3%. According to the horizontal growth index of gingival hyperplasia, grade 1 included about 61% of patients and grade 2 included about 39% of patients with gingival hyperplasia. Bacterial index divides patients by degrees: grading 0 - 8.2%, grading 1 - 32.4%, grading 2 - 14% and grading 3 - 45.1%. Conclusions: The highest percentage of gingival hyperplasia caused by drugs is due to dosing of nifedipine for a duration of dosing and application for systemic healing for more than 1 year.

Keywords: drug gingival hyperplasia, horizontal growth index, vertical growth index

Procedia PDF Downloads 165

Authors: Mahdi Eskandarlou, Mehrdad Taghipour

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Background: Partial-thickness skin graft is the cornerstone for scalp defect repair. Routine donor sites include abdomen, thighs, and buttocks. Given the potential side effects following harvesting from these sites and the potential advantages of harvesting from scalp (broad surface, rapid healing, and better cosmetics results), this study is trying to compare the outcomes of graft harvesting from scalp and lower limb. Methods: This clinical trial is conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to plastic surgery clinic at Besat Hospital during the time period between 2018 and 2019. Sampling was done by simple randomization using random digit table. Data gathering was performed using a designated checklist. The donor site in case group and control group was scalp and lower limb, respectively. The resultant data were analyzed using chi-squared and t-test and SPPS version 21 (SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). Results: Of the total 40 patients participating in this study, 28 patients (70%) were male, and 12 (30%) were female with and mean age of 63.62 ± 09.73 years. Hypertension and diabetes mellitus were the most common comorbidities among patients with basal cell carcinoma (BCC) and trauma being the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The most common anatomic location of defect for case and control groups was temporal and parietal, respectively. Most of the defects were deep to galea zone. The mean diameter of defect was 24.28 ± 45.37 mm for all of the patients. The difference between diameter of defect in both groups was statistically meaningful, while no such difference between graft diameter was seen. The graft 'Take' was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale, and the satisfaction was higher in them per Likert scale. Conclusion: Scalp can safely be used as donor site for skin graft to be used for scalp defects, which is associated with better results and lower complication rates compared to other donor sites.

Keywords: donor site, leg, partial-thickness graft, scalp

Procedia PDF Downloads 133