Search results for: prospective cohort

Authors: Charléa M. Smith, Raiden L. Schodowski, Arletty Pinel

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Due to the COVID-19 pandemic, the Faculty of Medical Sciences of The University of the West Indies (UWI) Mona in Kingston, Jamaica, had to rapidly migrate to digital and blended learning. Students in the preclinical stage of the program transitioned to full-time online learning, while students in the clinical stage experienced decreased daily patient contact and the implementation of a blend of online lectures and virtual clinical practice. Such sudden changes were coupled with the institutional pressure of the need to introduce a novel approach to education without much time for preparation, as well as additional strain endured by the faculty, who were overwhelmed by serving as frontline workers. During the period July 20 to August 23, 2021, this study surveyed preclinical and clinical students to capture their experiences with these changes and their recommendations for future use of digital modalities of learning to enhance medical education. It was conducted with a fellow student of the 2021 cohort of the MultiPod mentoring program. A questionnaire was developed and distributed digitally via WhatsApp to all medical students of the UWI Mona campus to assess students’ experiences and perceptions of the advantages, challenges, and impact on individual knowledge proficiencies brought about by the transition to predominantly digital learning environments. 108 students replied, 53.7% preclinical and 46.3% clinical. 67.6% of the total were female and 30.6 % were male; 1.8% did not identify themselves by gender. 67.2% of preclinical students preferred blended learning and 60.3% considered that the content presented did not prepare them for clinical work. Only 31% considered that the online classes were interactive and encouraged student participation. 84.5% missed socialization with classmates and friends and 79.3% missed a focused environment for learning. 80% of the clinical students felt that they had not learned all that they expected and only 34% had virtual interaction with patients, mostly by telephone and video calls. Observing direct consultations was considered the most useful, yet this was the least-used modality. 96% of the preclinical students and 100% of the clinical ones supplemented their learning with additional online tools. The main recommendations from the survey are the use of interactive teaching strategies, more discussion time with lecturers, and increased virtual interactions with patients. Universities are returning to face-to-face learning, yet it is unlikely that blended education will disappear. This study demonstrates that students’ perceptions of their experience during mobility restrictions must be taken into consideration in creating more effective, inclusive, and efficient blended learning opportunities.

Keywords: blended learning, digital learning, medical education, student perceptions

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Authors: Charles Ruffner, Michael Manton, Gintautas Kibirkstis, Gediminas Brazaitas, Vitas Marozas, Ekaterine Makrickiene, Rutile Pukiene, Per Angelstam

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In dynamic boreal forests, fire is an important natural disturbance, which drives regeneration and mortality of living and dead trees, and thus successional trajectories. However, current forest management practices focusing on wood production only have effectively eliminated fire as a stand-level disturbance. While this is generally well studied across much of Europe, in Lithuania, little is known about the historic fire regime and the role fire plays as a management tool towards the sustainable management of future landscapes. Focusing on Scots pine forests, we explore; i) the relevance of fire disturbance regimes on forestlands of Lithuania; ii) fire occurrence in the Dzukija landscape for dry upland and peatland forest sites, and iii) correlate tree-ring data with climate variables to ascertain climatic influences on growth and fire occurrence. We sampled and cross-dated 132 Scots pine samples with fire scars from 4 dry pine forest stands and 4 peatland forest stands, respectively. The fire history of each sample was analyzed using standard dendrochronological methods and presented in FHAES format. Analyses of soil moisture and nutrient conditions revealed a strong probability of finding forests that have a high fire frequency in Scots pine forests (59%), which cover 34.5% of Lithuania’s current forestland. The fire history analysis revealed 455 fire scars and 213 fire events during the period 1742-2019. Within the Dzukija landscape, the mean fire interval was 4.3 years for the dry Scots pine forest and 8.7 years for the peatland Scots pine forest. However, our comparison of fire frequency before and after 1950 shows a marked decrease in mean fire interval. Our data suggest that hemi-boreal forest landscapes of Lithuania provide strong evidence that fire, both human and lightning-ignited fires, has been and should be a natural phenomenon and that the examination of biological archives can be used to guide sustainable forest management into the future. Currently, fire use is prohibited by law as a tool for forest management in Lithuania. We recommend introducing trials that use low-intensity prescribed burning of Scots pine stands as a regeneration tool towards mimicking natural forest disturbance regimes.

Keywords: biodiversity conservation, cultural burning, dendrochronology, forest dynamics, forest management, succession

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Authors: Maria Sciammarella, Uttam M. Shrestha, Youngho Seo, Grant T. Gullberg, Elias H. Botvinick

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Background: Myocardial perfusion imaging (MPI) is typically performed with static imaging protocols and visually assessed for perfusion defects based on the relative intensity distribution. Dynamic cardiac SPECT, on the other hand, is a new imaging technique that is based on time varying information of radiotracer distribution, which permits quantification of myocardial blood flow (MBF). In this abstract, we report a progress and current status of dynamic cardiac SPECT using conventional gamma camera (Infinia Hawkeye 4, GE Healthcare) for estimation of myocardial blood flow and coronary flow reserve. Methods: A group of patients who had high risk of coronary artery disease was enrolled to evaluate our methodology. A low-dose/high-dose rest/pharmacologic-induced-stress protocol was implemented. A standard rest and a standard stress radionuclide dose of ⁹⁹ᵐTc-tetrofosmin (140 keV) was administered. The dynamic SPECT data for each patient were reconstructed using the standard 4-dimensional maximum likelihood expectation maximization (ML-EM) algorithm. Acquired data were used to estimate the myocardial blood flow (MBF). The correspondence between flow values in the main coronary vasculature with myocardial segments defined by the standardized myocardial segmentation and nomenclature were derived. The coronary flow reserve, CFR, was defined as the ratio of stress to rest MBF values. CFR values estimated with SPECT were also validated with dynamic PET. Results: The range of territorial MBF in LAD, RCA, and LCX was 0.44 ml/min/g to 3.81 ml/min/g. The MBF between estimated with PET and SPECT in the group of independent cohort of 7 patients showed statistically significant correlation, r = 0.71 (p < 0.001). But the corresponding CFR correlation was moderate r = 0.39 yet statistically significant (p = 0.037). The mean stress MBF value was significantly lower for angiographically abnormal than that for the normal (Normal Mean MBF = 2.49 ± 0.61, Abnormal Mean MBF = 1.43 ± 0. 0.62, P < .001). Conclusions: The visually assessed image findings in clinical SPECT are subjective, and may not reflect direct physiologic measures of coronary lesion. The MBF and CFR measured with dynamic SPECT are fully objective and available only with the data generated from the dynamic SPECT method. A quantitative approach such as measuring CFR using dynamic SPECT imaging is a better mode of diagnosing CAD than visual assessment of stress and rest images from static SPECT images Coronary Flow Reserve.

Keywords: dynamic SPECT, clinical SPECT/CT, selective coronary angiograph, ⁹⁹ᵐTc-Tetrofosmin

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Authors: Anu Chandran, Reena Esther Rani

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Background of the Study: Dotted with multiple Unique Destination Prepositions (UDPs), Tamil Nadu is an established tourism brand as regards leisure, MICE, culture, and ecological flavors. Albeit, the enchanting destination possesses distinctive attributes and resources yet to be tapped for better competitive advantage. Being a destination that allures an incredible variety of migratory birds, Tamil Nadu is deemed to be an ornithologist’s paradise. This study primarily explores the prospects of developing Kaliveli, recognized as a bird sanctuary in the Tindivanam forest division of the Villupuram district in the State. Kaliveli is an ideal nesting site for migratory birds and is currently apt for a prospective analysis of regenerative tourism. Objectives of the study: This research lays an accent on avian tourism as part and parcel of sustainable tourism ventures. The impacts of projects like the Ornithological Conservation Centre on tourists have been gauged in the present paper. It maps the futuristic proactive propositions linked to regenerative tourism on the site. How far technological innovations can do a world of good in Kaliveli through Artificial Intelligence, Smart Tourism, and similar latest coinages to entice real eco-tourists, have been conceptualized. The experiential dimensions of resource stewardship as regards facilitating tourists’ relish the offerings in a sustainable manner is at the crux of this work. Methodology: Modeled as a case study, this work tries to deliberate on the impact of existing projects attributed to avian fauna in Kalveli. Conducted in the qualitative research design mode, the case study method was adopted for the processing and presentation of study results drawn by applying thematic content analysis based on the data collected from the field. Result and discussion: One of the key findings relates to the kind of nature trails that can be a regenerative dynamic for eco-friendly tourism in Kaliveli. Field visits have been conducted to assess the niche tourism aspects which could be incorporated with the regenerative tourism model to be framed as part of the study.

Keywords: regenerative tourism, Kaliveli bird sanctuary, sustainable development, resource Stewardship, Ornithology, Avian Fauna

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Authors: Patti Kastanias, Wei Wang, Karyn Mackenzie, Sandra Robinson, Susan Wnuk

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Obesity is a worldwide epidemic and is recognized as a chronic disease. Pain in the obese individual is a multidimensional issue. An increase in BMI is positively correlated with pain incidence and severity, especially in central obesity where individuals are twice as likely to have chronic pain. Both obesity and chronic pain are also associated with mood disorders. Pain is worse among obese individuals with depression and anxiety. Bariatric surgery provides patients with an effective solution for long-term weight loss and associated health problems. However, not much is known about acute and chronic pain after bariatric surgery and its contributing factors, including mood disorders. Nurse practitioners (NPs) at one large multidisciplinary bariatric surgery centre led two studies to examine acute and chronic pain and pain management over time after bariatric surgery. The purpose of the initial study was to examine the incidence and severity of acute and chronic pain after bariatric surgery. The aim of the secondary study was to further examine chronic pain, specifically looking at psychological factors that influence severity or incidence of both neuropathic and somatic pain as well as changes in opioid use. The initial study was a prospective, longitudinal study where patients having bariatric surgery at one surgical center were followed up to 6 months postop. Data was collected at 7 time points using validated instruments for pain severity, pain interference, and patient satisfaction. In the second study, subjects were followed longitudinally starting preoperatively and then at 6 months and 1 year postoperatively to capture changes in chronic pain and influencing variables over time. Valid and reliable instruments were utilized for all major study outcomes. In the first study, there was a trend towards decreased acute post-operative pain over time. The incidence and severity of chronic pain was found to be significantly reduced at 6 months post bariatric surgery. Interestingly, interference of chronic pain in daily life such as normal work, mood, and walking ability was significantly improved at 6 months postop however; this was not the case with sleep. Preliminary results of the secondary study indicate that pain severity, pain interference, anxiety and depression are significantly improved at 6 months postoperatively. In addition, preoperative anxiety, depression and emotional regulation were predictive of pain interference, but not pain severity. The results of our regression analyses provide evidence for the impact of pre-existing psychological factors on pain, particularly anxiety in obese populations.

Keywords: bariatric surgery, mood disorders, obesity, pain

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Authors: Philip Friedlander, John Rutledge, Jason Suh

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Inhibition of programmed death-1 (PD-1) or its ligand PD-L1 confers therapeutic efficacy in a wide range of solid tumor malignancies. Primary or acquired resistance can develop through activation of immunosuppressive immune cells such as tumor-associated macrophages. The renin angiotensin system (RAS) systemically regulates fluid and sodium hemodynamics, but components are expressed on and regulate the activity of immune cells, particularly of myeloid lineage. We hypothesized that inhibition of RAS would improve the efficacy of PD-1/PD-L-1 treatment. A retrospective analysis was performed through a chart review of patients with solid metastatic malignancies treated with a PD-1/PD-L1 inhibitor between 1/2013 and 6/2019 at Valley Hospital, a community hospital in New Jersey, USA. Efficacy was determined by medical oncologist documentation of clinical benefit in visit notes and by the duration of time on immunotherapy treatment. The primary endpoint was the determination of efficacy differences in patients treated with an inhibitor of RAS ( ace inhibitor, ACEi, or angiotensin blocker, ARB) compared to patients not treated with these inhibitors. To control for broader antihypertensive effects, efficacy as a function of treatment with beta blockers was assessed. 173 patients treated with PD-1/PD-L-1 inhibitors were identified of whom 52 were also treated with an ACEi or ARB. Chi-square testing revealed a statistically significant relationship between being on an ACEi or ARB and efficacy to PD-1/PD-L-1 therapy (p=0.001). No statistically significant relationship was seen between patients taking or not taking beta blocker antihypertensives (p= 0.33). Kaplan-Meier analysis showed statistically significant improvement in the duration of therapy favoring patients concomitantly treated with ACEi or ARB compared to patients not exposed to antihypertensives and to those treated with beta blockers. Logistic regression analysis revealed that age, gender, and cancer type did not have significant effects on the odds of experiencing clinical benefit (p=0.74, p=0.75, and p=0.81, respectively). We conclude that retrospective analysis of the treatment of patients with solid metastatic tumors with anti-PD-1/PD-L1 in a community setting demonstrates greater clinical benefit in the context of concomitant ACEi or ARB inhibition, irrespective of gender or age. This data supports the development of prospective assessment through randomized clinical trials.

Keywords: angiotensin, cancer, immunotherapy, PD-1, efficacy

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Authors: Rosaline Govender, Shubnam Rambharos

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Universities are, to a certain extent, the source of under-preparedness ideologically, structurally, and pedagogically, particularly since organizational cultures often alienate students by failing to enable epistemological access. This is evident in the unsustainably low graduation rates that characterize South African higher education, which indicate that under 30% graduate in minimum time, under two-thirds graduate within 6 years, and one-third have not graduated after 10 years. Although the statistics for the Faculty of Accounting and Informatics at the Durban University of Technology (DUT) in South Africa have improved significantly from 2019 to 2021, the graduation (32%), throughput (50%), and dropout rates (16%) are still a matter for concern as the graduation rates, in particular, are quite similar to the national statistics. For our students to succeed, higher education should take a multi-pronged approach to ensure student success, and student engagement is one of the ways to support our students. Student engagement depends not only on students’ teaching and learning experiences but, more importantly, on their social and academic integration, their sense of belonging, and their emotional connections in the institution. Such experiences need to challenge students academically and engage their intellect, grow their communication skills, build self-discipline, and promote confidence. The aim of this mixed methods study is to explore the multi-pronged nature of student success within the Faculty of Accounting and Informatics at DUT and focuses on the enabling and constraining factors of student success. The sources of data were the Mid-year student experience survey (N=60), the Hambisa Student Survey (N=85), and semi structured focus group interviews with first, second, and third year students of the Faculty of Accounting and Informatics Hambisa program. The Hambisa (“Moving forward”) focus area is part of the Siyaphumelela 2.0 project at DUT and seeks to understand the multiple challenges that are impacting student success which create a large “middle” cohort of students that are stuck in transition within academic programs. Using the lens of the sociocultural influences on student engagement framework, we conducted a thematic analysis of the two surveys and focus group interviews. Preliminary findings indicate that living conditions, choice of program, access to resources, motivation, institutional support, infrastructure, and pedagogical practices impact student engagement and, thus, student success. It is envisaged that the findings from this project will assist the university in being better prepared to enable student success.

Keywords: social and academic integration, socio-cultural influences, student engagement, student success

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Authors: Dipanshu Sur, Ratnabali Chakravorty, Rimi Pal, Siddhartha Chatterjee, Joyshree Chaterjee, Amal Mallik

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Background: Polycystic ovary syndrome (PCOS) is a common endocrine disease in reproductive women with a complex hormonal disturbance that affects the menstrual cycle and leads to metabolic consequences in later life. Hyperandrogenaemia is noticeable features of PCOS and influence the process of folliculogenesis in women. The levels of Antimüllerian Hormone (AMH) reflect the number of pre-antral follicles and thus are a marker of oocyte pool – germinal reserve of the ovary for reproduction. Besides its utilization in IVF (In-vitro fertilization), determination of AMH may serve as an additional marker in the diagnostics of PCOS, where increased AMH levels reflect the severity of the disease. The positive correlation of serum AMH with the number of antral follicles was found also in patients with PCOS. Objective: The objective of this study was to investigate the relationship between AMH androgens and whether AMH contributes to altered folliculogenesis in non-obese women with PCOS. Methods: We designed a prospective study which included a total of 65 IVF individuals. It enrolled 26 cases of PCOS based on 2003 Rotterdam criteria and 39 ovulatory normal- non PCOS, healthy, age-matched controls. AMH levels and ovarian morphology were assessed. The relationships between AMH and androgenaemia in patients with and without PCOS were studied. Results: Mean age of PCOS patients were slightly higher than controls (32±4 and 28±3 years, respectively). AMH generally increased with antral follicle count (AFC) [P=0.001], testosterone, and luteinising hormone, and decreased with age, and serum sex hormone binding globulin (SHBG). No significant relationships were found between circulating AMH levels and BMI between PCOS and non-PCOS patients. The calculation of AMH production per antral follicle (AMH/AF) showed that there was a significant difference in median AMH/AF between PCOS and non-PCOS (P =0.001). Both PCOS and non-PCOS groups showed a very similar increase in AMH with increases in AFC, but the PCOS patients had consistently higher AMH across all AFC levels. Conclusions: These observations indicate that there is a connection between AMH and androgens levels between PCOS and non-PCOS East Indian women. Excessive granulosa cell activity may be implicated in the abnormal follicular dynamic of the syndrome. They are higher in women with PCOS and, on the other hand, very low in women with an ovarian failure.

Keywords: anti-Mullerian hormone, polycystic ovary syndrome, antral follicle count, androgens

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Authors: Om Kalthoum Sallem, Saidakilani, Kamiliya Ounaissa, Abdelmajid Abid

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Introduction and purposes: Olive oil is the main oil used in the Mediterranean diet. Virgin olive oil is valued for its organoleptic and nutritional characteristics and is resistant to oxidation due to its high monounsaturated fatty acid content (MUFAs), and low polyunsaturates (PUFAs) and the presence of natural antioxidants such as phenols, tocopherols and carotenoids. The fatty acid composition, especially the MUFA content, and the natural antioxidants provide advantages for health. The aim of the present study was to examine the impact of method of extraction on the chemical profiles of ‘Chemchali’ olive oil variety, which is cultivated in the city of Gafsa, and to compare it with chetoui and chemchali varieties. Methods: Our study is a qualitative prospective study that deals with ‘Chemchali’ olive oil variety. Analyses were conducted during three months (from December to February) in different oil mills in the city of Gafsa. We have compared ‘Chemchali’ olive oil obtained by continuous method to this obtained by superpress method. Then we have analyzed quality index parameters, including free fatty acid content (FFA), acidity, and UV spectrophotometric characteristics and other physico-chemical data [oxidative stability, ß-carotene, and chlorophyll pigment composition]. Results: Olive oil resulting from super press method compared with continuous method is less acid(0,6120 vs. 0,9760), less oxydazible(K232:2,478 vs. 2,592)(k270:0,216 vs. 0,228), more rich in oleic acid(61,61% vs. 66.99%), less rich in linoleic acid(13,38% vs. 13,98 %), more rich in total chlorophylls pigments (6,22 ppm vs. 3,18 ppm ) and ß-carotene (3,128 mg/kg vs. 1,73 mg/kg). ‘Chemchali’ olive oil showed more equilibrated total content in fatty acids compared with the varieties ’Chemleli’ and ‘Chetoui’. Gafsa’s variety ’Chemlali’ have significantly less saturated and polyunsaturated fatty acids. Whereas it has a higher content in monounsaturated fatty acid C18:2, compared with the two other varieties. Conclusion: The use of super press method had benefic effects on general chemical characteristics of ‘Chemchali’ olive oil, maintaining the highest quality according to the ecocert legal standards. In light of the results obtained in this study, a more detailed study is required to establish whether the differences in the chemical properties of oils are mainly due to agronomic and climate variables or, to the processing employed in oil mills.

Keywords: olive oil, extraction method, fatty acids, chemchali olive oil

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Authors: Siddharth Jain, Abhenil Mittal, Surendra Kumar Sharma

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Background: With its recent emergence and re-emergence, dengue has become a major international public health concern, imposing significant financial burden especially in developing countries. Despite aggressive control measures in place, India experienced one of its largest outbreaks in 2015 with Delhi being most severely affected. There is a lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak. Methods: This prospective observational study conducted at an apex tertiary care center in Delhi, India included confirmed adult dengue patients admitted between August-November 2015. Patient demographics, clinical details, and laboratory findings were recorded in a predesigned proforma. Appropriate statistical tests were used to summarize and compare the clinical and laboratory characteristics and derive predictors of mortality and severe disease, while developing a clinical risk score for mortality. Serotype analysis was also done for 75 representative samples to identify the dominant serotypes. Results: Data of 369 patients were analyzed (mean age 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (DHF Grade 1,2)and 46 (12%) developed dengue shock syndrome (DSS). Twenty two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnoea at rest were identified as independent predictors of severe disease. Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnoea) which, if ≥ 22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were DENV-2 and DENV-4. Conclusion: Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine the outcome in dengue patients. Timely referral/access to health care is important. Development and use of validated predictors of disease severity and simple clinical risk scores, which can be applied in all healthcare settings, can help minimize mortality and morbidity, especially in resource limited settings.

Keywords: dengue, mortality, predictors, severity

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Authors: Yi-Ting Chen, Yu-Fang Huang, Pei-Wei Wang, Hai-Wei Liang, Chun-Hao Lai, Mei-Lien Chen

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Background: Bisphenol A (BPA) is commonly used in consumer products, such as inner coatings of cans and polycarbonated bottles. BPA is considered to be an endocrine disrupting substance (EDs) that affects normal human hormones and may cause adverse effects on human health. Pregnant women and fetuses are susceptible groups of endocrine disrupting substances. Prenatal exposure to BPA has been shown to affect the fetus through the placenta. Therefore, it is important to evaluate the potential health risk of fetal exposure to BPA during pregnancy. The aims of this study were (1) to determine the urinary concentration of BPA in pregnant women, and (2) to investigate the association between BPA exposure during pregnancy and birth outcomes. Methods: This study recruited 117 pregnant women and their fetuses from 2012 to 2014 from the Taiwan Maternal- Infant Cohort Study (TMICS). Maternal urine samples were collected in the third trimester and questionnaires were used to collect socio-demographic characteristics, eating habits and medical conditions of the participants. Information about birth outcomes of the fetus was obtained from medical records. As for chemicals analysis, BPA concentrations in urine were determined by off-line solid-phase extraction-ultra-performance liquid chromatography coupled with a Q-Tof mass spectrometer. The urinary concentrations were adjusted with creatinine. The association between maternal concentrations of BPA and birth outcomes was estimated using the logistic regression model. Results: The detection rate of BPA is 99%; the concentration ranges (μg/g) from 0.16 to 46.90. The mean (SD) BPA levels are 5.37(6.42) μg/g creatinine. The mean ±SD of the body weight, body length, head circumference, chest circumference and gestational age at birth are 3105.18 ± 339.53 g, 49.33 ± 1.90 cm, 34.16 ± 1.06 cm, 32.34 ± 1.37 cm and 38.58 ± 1.37 weeks, respectively. After stratifying the exposure levels into two groups by median, pregnant women in higher exposure group would have an increased risk of lower body weight (OR=0.57, 95%CI=0.271-1.193), smaller chest circumference (OR=0.70, 95%CI=0.335-1.47) and shorter gestational age at birth newborn (OR=0.46, 95%CI=0.191-1.114). However, there are no associations between BPA concentration and birth outcomes reach a significant level (p < 0.05) in statistics. Conclusions: This study presents prenatal BPA profiles and infants in northern Taiwan. Women who have higher BPA concentrations tend to give birth to lower body weight, smaller chest circumference or shorter gestational age at birth newborn. More data will be included to verify the results. This report will also present the predictors of BPA concentrations for pregnant women.

Keywords: bisphenol A, birth outcomes, biomonitoring, prenatal exposure

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Authors: Alexander Heckman, Rohan Goswami, Zachi Attia, Paul Friedman, Peter Noseworthy, Demilade Adedinsewo, Pablo Moreno-Franco, Rickey Carter, Tathagat Narula

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Background: Postoperative atrial fibrillation (POAF) is associated with adverse health consequences, higher costs, and longer hospital stays. Utilizing existing predictive models that rely on clinical variables and circulating biomarkers, multiple societies have published recommendations on the treatment and prevention of POAF. Although reasonably practical, there is room for improvement and automation to help individualize treatment strategies and reduce associated complications. Methods and Results: In this retrospective cohort study of solid organ transplant recipients, we evaluated the diagnostic utility of a previously developed AI-based ECG prediction for silent AF on the development of POAF within 30 days of transplant. A total of 2261 non-cardiac transplant patients without a preexisting diagnosis of AF were found to have a 5.8% (133/2261) incidence of POAF. While there were no apparent sex differences in POAF incidence (5.8% males vs. 6.0% females, p=.80), there were differences by race and ethnicity (p<0.001 and 0.035, respectively). The incidence in white transplanted patients was 7.2% (117/1628), whereas the incidence in black patients was 1.4% (6/430). Lung transplant recipients had the highest incidence of postoperative AF (17.4%, 37/213), followed by liver (5.6%, 56/1002) and kidney (3.6%, 32/895) recipients. The AUROC in the sample was 0.62 (95% CI: 0.58-0.67). The relatively low discrimination may result from undiagnosed AF in the sample. In particular, 1,177 patients had at least 1 AI-ECG screen for AF pre-transplant above .10, a value slightly higher than the published threshold of 0.08. The incidence of POAF in the 1104 patients without an elevated prediction pre-transplant was lower (3.7% vs. 8.0%; p<0.001). While this supported the hypothesis that potentially undiagnosed AF may have contributed to the diagnosis of POAF, the utility of the existing AI-ECG screening algorithm remained modest. When the prediction for POAF was made using the first postoperative ECG in the sample without an elevated screen pre-transplant (n=1084 on account of n=20 missing postoperative ECG), the AUROC was 0.66 (95% CI: 0.57-0.75). While this discrimination is relatively low, at a threshold of 0.08, the AI-ECG algorithm had a 98% (95% CI: 97 – 99%) negative predictive value at a sensitivity of 66% (95% CI: 49-80%). Conclusions: This study's principal finding is that the incidence of POAF is rare, and a considerable fraction of the POAF cases may be latent and undiagnosed. The high negative predictive value of AI-ECG screening suggests utility for prioritizing monitoring and evaluation on transplant patients with a positive AI-ECG screening. Further development and refinement of a post-transplant-specific algorithm may be warranted further to enhance the diagnostic yield of the ECG-based screening.

Keywords: artificial intelligence, atrial fibrillation, cardiology, transplant, medicine, ECG, machine learning

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Authors: Ali Showail Ali Alasmari

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Introduction: Cataract is the loss of transparency of the lens inside the eye. It is the most common cause of visual loss and blindness worldwide. This study provides a systemic review of the recent findings on the association of vitamin D, and vitamin B12, and their possible role in preventing cataracts in senile (S) and diabetic mellitus (DM) patient groups. Objective: This study was intended to establish and investigate if there is any role between vitamin D and vitamin B12? Secondly, the connection between serum level of vitamin D and vitamin B12 in cataract incidence senile (s) vs. diabetic mellitus (DM) cataract patient groups. Furthermore, to evaluate and analyze cataract occurrence regarding vitamin D and vitamin B12 levels with other risk factors. Finally, to evaluate lens opacities pre and post treatment with vitamin D and vitaminB12 linked to age and visual acuity loss in both senile(S) and diabetic mellitus (DM) cataract patients’ groups. Methods: This study conducted at the ophthalmology clinic at Muhyail General Hospital. Select a prospective case-control to study the effect of vitamin D and Vit B12 on senile(S) cataracts that caused by age and diabetic mellitus (DM)cataract patients; then we compare these two groups. This study prospectively enrolled a total of 50 samples, 25 with senile cataract and 25 with diabetic cataract, from ophthalmology clinic at Muhyail General Hospital. Measuring 25-hydroxy vitamin D and vitamin B12 level concentrations in the assigned samples. Analyses were performed using SAS (statistical analysis software) program. Results: The most important finding in this study was that the senile(s) cataract patients’ group greatly benefited by the combination therapy of vitamin D, and Vitamin B12 reached (28.5±1.50 and 521.1±21.10) respectively; on the contrary, the diabetic cataract patient group hardly shows any significant improvement (21.5 ± 1.00 and 197.2 ± 7.20) respectively. This is because of the Metformin, the first line drug for treating diabetes, has been reported to potentially decrease vitamin B-12 status. This epigenetic modification was correlated with the diabetic mellitus (DM) cataract patients’ group not responding. Vitamin B12 deficiency also leads to an impairment of the conversion of methylmalonyl-CoA to succinyl-CoA, which has been associated with insulin resistance. There was no significant difference between the age, body mass index (BMI), the mean of Vit-D pre-treatments, and the mean values of Hemoglobin A1C of both senile (S) and diabetic mellitus (DM) cataract patient groups. On other hand, there was a highly significant difference between the mean values of glucose levels in both senile (S) and diabetic mellitus (DM) cataract patient groups. Conclusion: Here we conclude that diabetic mellitus (DM) cataract patient group hardly benefited from this combination therapy vitamin D and vitamin B12; on the other hand senile patient group (s) benefited a lot from the therapy.

Keywords: cataract patients, senile, diabetes mellitus, vitamin B12, vitamin D, Muhyail General Hospital, Saudi Arabia

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Authors: Jin-Hee Kim

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The way that globalization distinguishes itself from the previous changes is scope and intensity of changes, which together affect many parts of a nation’s system. In this way, globalization has its relation with the concept of ‘internationalization’ in that a nation state formulates a set of strategies in many areas of its governance to actively react to it. In short, globalization is a ‘catalyst,’ and internationalization is a ‘response’. In this regard, the field of higher education is one of the representative cases that globalization has several consequences that change the terrain of national policy-making. Started and been dominated mainly by the Western world, it has now been expanded to the ‘late movers,’ such as Asia-Pacific countries. The case of internationalization of Korean higher education is, therefore, located in a unique place in this arena. Yet Korea still is one of the major countries of sending its students to the so-called, ‘first world.’ On the other hand, it has started its effort to recruit international students from the world to its higher education system. After new Millennium, particularly, internationalization of higher education has been launched in its full-scale and gradually been one of the important global policy agenda, striving in both ways by opening its turf to foreign educational service providers and recruiting prospective students from other countries. Particularly the latter, recruiting international students, has been highlighted under the government project named ‘Study Korea,’ launched in 2004. Not only global, but also local issues and motivations were based to launch this nationwide project. Bringing international students means various desirable economic outcomes such as reducing educational deficit as well as utilizing them in Korean industry after the completion of their study, to name a few. In addition, in a similar vein, Korea's higher education institutes have started to have a new comers of adult learners. When it comes to the questions regarding the quality and access of this new learning agency, the answer is quite tricky. This study will investigate the different dimension of education provision and learning process to empower diverse group regardless of nationality, race, class and gender in Korea. Listening to the voices of international students and adult learning as non-traditional participants in a changing Korean higher educational space not only benefit students themselves, but Korean stakeholders who should try to accommodate more comprehensive and fair educational provisions for more and more diversifying groups of learners.

Keywords: education equity, access, globalisation, international students, adult learning, learning support

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Authors: Yori Gidron, Maartje Mol, Norbert Foudraine, Frits Van Osch, Joop Van Den Bergh, Moshe Farchi, Maud Straus

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Background: The worldwide pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-COV2), which began in 2019, also known as Covid-19, has infected over 136 million people and tragically took the lives of over 2.9 million people worldwide. Many of the complications and deaths are predicted by the inflammatory “cytokine storm.” One way to progress in the prevention of death is by finding a predictive and protective factor that inhibits inflammation, on the one hand, and which also increases anti-viral immunity on the other hand. The vagal nerve does precisely both actions. This study examined whether vagal nerve activity, indexed by heart-rate variability (HRV), predicts survival in patients with Covid-19. Method: We performed a pseudo-prospective study, where we retroactively obtained ECGs of 271 Covid-19 patients arriving at a large regional hospital in The Netherlands. HRV was indexed by the standard deviation of the intervals between normal heartbeats (SDNN). We examined patients’ survival at 3 weeks and took into account multiple confounders and known prognostic factors (e.g., age, heart disease, diabetes, hypertension). Results: Patients’ mean age was 68 (range: 25-95) and nearly 22% of the patients had died by 3 weeks. Their mean SDNN (17.47msec) was far below the norm (50msec). Importantly, relatively higher HRV significantly predicted a higher chance of survival, after statistically controlling for patients’ age, cardiac diseases, hypertension and diabetes (relative risk, H.R, and 95% confidence interval (95%CI): H.R = 0.49, 95%CI: 0.26 – 0.95, p < 0.05). However, since HRV declines rapidly with age and since age is a profound predictor in Covid-19, we split the sample by median age (40). Subsequently, we found that higher HRV significantly predicted greater survival in patients older than 70 (H.R = 0.35, 95%CI: 0.16 – 0.78, p = 0.01), but HRV did not predict survival in patients below age 70 years (H.R = 1.11, 95%CI: 0.37 – 3.28, p > 0.05). Conclusions: To the best of our knowledge, this is the first study showing that higher vagal nerve activity, as indexed by HRV, is an independent predictor of higher chances for survival in Covid-19. The results are in line with the protective role of the vagal nerve in diseases and extend this to a severe infectious illness. Studies should replicate these findings and then test in controlled trials whether activating the vagus nerve may prevent mortality in Covid-19.

Keywords: Covid-19, heart-rate Variability, prognosis, survival, vagal nerve

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Authors: Bouchekoua Myriam, Aloui Dorsaf, Trabelsi Sonia

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Introduction Food hygiene in hospitals is important, particularly among patients who could be more vulnerable than healthy subjects to microbiological and nutritional risks. The consumption of contaminated food may be responsible for foodborne diseases, which can be severe among hospitalized patients, especially those immunocompromised. The aim of our study was to assess the state of hygiene in the internal catering department of a Tunisian hospital. Methodology and major results: A prospective study was conducted for one year in the Parasitology-Mycology laboratory of Charles Nicolle Hospital. Samples were taken from the kitchen staff, worktops, and cooking utensils used in the internal catering department. Thirty one employees have benefited from stool exams and scotch tape in order to evaluate the degree of infestation of parasites. 35% of stool exams were positive. Protozoa were the only parasites detected. Blastocystis sp was the species mostly found in nine food handlers. Its role as a human pathogen is still controversial. Pathogenic protozoa were detected in two food handlers (Giardia intestinalis in one person and Dientamoeba fragilis in the other one. Non-pathogenic protozoa were found in two cases; among them, only one had digestive symptoms without a statistically significant association with the carriage of intestinal parasites. Moreover, samples were performed from the hands of the staff in order to search for a fungal carriage. Thus, 25 employees (81%) were colonized by fungi, including molds. Besides, mycological examination among food handlers with a suspected dermatomycosis for diagnostic confirmation concluded foot onychomycosis in 32% of cases and interdigital intertrigo in 26%. Only one person had hand onychomycosis. Among the 17 samples taken from worktops and kitchen utensils, fungal contamination was detected in 13 sites. Hot and cold equipment were the most contaminated. Molds were mainly identified as belonging to five different genera. Cladosporium sp was predominant. Conclusion: In the view of the importance of intestinal parasites among food handlers, the intensity of fungi hand carriage among these employees, and the high level of fungal contamination in worktops and kitchen utensils, a reinforcement of hygiene measures is more than essential in order to minimize the alimentary contamination-risk.

Keywords: hospital kitchen, environment, intestinal parasitosis, fungal carriage, fungal contamination

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Authors: Farah Amalina Mohamed Affandi, Redhwan Ahmad Al-Naggar, Seok Mui Wang, Thanikasalam Kathiresan

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Gestational choriocarcinoma is a condition in which there is an abnormal growth or a tumor inside the women’s uterus after conception. It is a type of gestational trophoblastic disease which is relatively rare and malignant. The current epidemiological data of this disease are inadequate. The purposes of this study are to examine the epidemiology of choriocarcinoma and their risk factors based on all available population-based and hospital-based data of the disease. In this study, we searched The MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases using the keywords ‘choriocarcinoma’, ‘gestational’, ‘gestational choriocarcinoma’ and ‘epidemiology’. We included only human studies published in English between 1995 and 2015 to ensure up to date evidence. Case studies, case reports, animal studies, letters to the editor, news, and review articles were excluded. Retrieved articles were screened in three phases. In the first phase, any articles that did not match the inclusion criteria based solely on titles were excluded. In the second phase, the abstracts of remaining articles were screened thoroughly; any articles that did not meet our inclusion criteria were excluded. In the final phase, full texts of the remaining articles were read and assessed to exclude articles that did not meet the inclusion criteria or any articles that fulfilled the exclusion criteria. Duplicates articles were also removed. Systematic reviews and meta-analysis were excluded. Extracted data were summarized in table and figures descriptively. The reference lists of included studies were thoroughly reviewed in search for other relevant studies. A total of ten studies met all the selection criteria. Nine were retrospective studies and one was cohort study. Total numbers of 4563 cases of choriocarcinoma were reviewed from several countries which are Korea, Japan, South Africa, USA, New Mexico, Finland, Turkey, China, Brazil and The Netherlands. Different studies included different range of age with their mean age of 28.5 to 30.0 years. All studies investigated on the disease’s incidence rate, only two studies examined on the risk factors or associations of the disease. Approximately 20% of the studies showed a reduction in the incidence of choriocarcinoma while the other 80% showed inconsistencies in rate. Associations of age, fertility age, occupations and socio-demographic with the status remains unclear. There is limited information on the epidemiological aspects of gestational choriocarcinoma. The observed results indicated there was a decrease in the incidence rate of gestational choriocarcinoma globally. These could be due to the reduction in the incidence of molar pregnancy and the efficacy of the treatment, mainly by chemotherapy.

Keywords: epidemiology, gestational choriocarcinoma, incidence, prevalence, risk factor

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Authors: Mustafa M. Donma, Ayşen Haksayar, Bahadır Batar, Buse Tepe, Birol Topçu, Orkide Donma

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Childhood obesity is an ever-increasing health problem. The Association of obesity with severe chronic diseases such as diabetes and cardiovascular diseases makes the problem life-threatening. Aside from psychological, societal and metabolic factors, genetic polymorphisms have gained importance concerning etiology in recent years. The aim of this study was to evaluate the relationship between rs10455872 gene polymorphism in the Lipoprotein (a) locus and the development of childhood obesity. This was a prospective study carried out according to the Helsinki Declarations. The study protocol was approved by the Institutional Ethics Committee. This study was supported by Tekirdag Namik Kemal University Rectorate, Scientific Research Projects Coordination Unit. Project No: NKUBAP.02.TU.20.278. A total of 180 children (103 obese (OB) and 77 healthy), aged 6-18 years, without any acute or chronic disease, participated in the study. Two different groups were created: OB and healthy control. Each group was divided into two further groups depending on the nature of the polymorphism. Anthropometric measurements were taken during the detailed physical examination. Laboratory tests and TANITA measurements were performed. For the statistical evaluations, SPSS version 28.0 was used. A P-value smaller than 0.05 was the statistical significance degree. The distribution of lipoprotein (a) rs10455872 gene polymorphism did not differ between OB and healthy children. Children with AG genotype in both OB and control groups had lower body mass index (BMI), diagnostic obesity notation model assessment index (DONMA II), body fat ratio (BFR), C-reactive protein (CRP), and metabolic syndrome index (MetS index) values compared to children with normal AA genotype. In the OB group, serum iron, vitamin B12, hemoglobin, MCV, and MCH values were found to be higher in the AG genotype group than those of children with the normal AA genotype. A significant correlation was found between the MetS index and BFR among OB children with normal homozygous genotype. MetS index increased as BFR increased in this group. However, such a correlation was not observed in the OB group with heterozygous AG genotype. To the best of our knowledge, the association of lipoprotein (a) rs10455872 gene polymorphism with the etiology of childhood obesity has not been studied yet. Therefore, this study was the first report suggesting polymorphism with AG genotype as a good risk factor for obesity.

Keywords: child, gene polymorphism, lipoprotein (a), obesity, rs10455872

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Authors: Priscilla Echeverria

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This paper addresses initial teacher formation as a formative space in which pedagogy students develop a pedagogical agency capacity to contribute to social justice, considering ethical, political, and epistemic dimensions. This paper is structured by discussing first the concepts of agency, pedagogical interaction, and social justice from a critical perspective; and continues offering preliminary results on the capacity of pedagogical agency in novice teachers after the analysis of critical incidents as a research methodology. This study is motivated by the concern that responding to the current neoliberal scenario, many initial teacher formation (ITF) programs have reduced the meaning of education to instruction, and pedagogy to methodology, favouring the formation of a technical professional over a reflective or critical one. From this concern, this study proposes that the restitution of the subject is an urgent task in teacher formation, so it is essential to enable him in his capacity for action and advance in eliminating institutionalized oppression insofar as it affects that capacity. Given that oppression takes place in human interaction, through this work, I propose that initial teacher formation develops sensitivity and educates the gaze to identify oppression and take action against it, both in pedagogical interactions -which configure political, ethical, and epistemic subjectivities- as in the hidden and official curriculum. All this from the premise that modelling democratic and dialogical interactions are basic for any program that seeks to contribute to a more just and empowered society. The contribution of this study lies in the fact that it opens a discussion in an area about which we know little: the impact of the type of interactions offered by university teaching at ITF on the capacity of future teachers to be pedagogical agents. For this reason, this study seeks to gather evidence of the result of this formation, analysing the capacity of pedagogical agency of novice teachers, or, in other words, how capable the graduates of secondary pedagogies are in their first pedagogical experiences to act and make decisions putting the formative purposes that they are capable of autonomously defining before technical or bureaucratic issues imposed by the curriculum or the official culture. This discussion is part of my doctoral research, "The importance of developing the capacity for ethical-political-epistemic agency in novice teachers during initial teacher formation to contribute to social justice", which I am currently developing in the Educational Research program of the University of Lancaster, United Kingdom, as a Conicyt fellow for the 2019 cohort.

Keywords: initial teacher formation, pedagogical agency, pedagogical interaction, social justice, hidden curriculum

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Authors: Mequanent Wale Mekonen, Edoardo Otranto, Angela Alibrandi

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Diabetic kidney disease is one of the main microvascular complications caused by diabetes. Several clinical and biochemical variables are reported to be associated with diabetic kidney disease in people with type 2 diabetes. However, their interrelations could distort the effect estimation of these variables for the disease's progression. The objective of the study is to determine how the biochemical and clinical variables in people with type 2 diabetes are interrelated with each other and their effects on kidney disease progression through advanced statistical methods. First, principal component analysis was used to explore how the biochemical and clinical variables intercorrelate with each other, which helped us reduce a set of correlated biochemical variables to a smaller number of uncorrelated variables. Then, ordered logit regression models (cumulative, stage, and adjacent) were employed to assess the effect of biochemical and clinical variables on the order-level response variable (progression of kidney function) by considering the proportionality assumption for more robust effect estimation. This retrospective cross-sectional study retrieved data from a type 2 diabetic cohort in a polyclinic hospital at the University of Messina, Italy. The principal component analysis yielded three uncorrelated components. These are principal component 1, with negative loading of glycosylated haemoglobin, glycemia, and creatinine; principal component 2, with negative loading of total cholesterol and low-density lipoprotein; and principal component 3, with negative loading of high-density lipoprotein and a positive load of triglycerides. The ordered logit models (cumulative, stage, and adjacent) showed that the first component (glycosylated haemoglobin, glycemia, and creatinine) had a significant effect on the progression of kidney disease. For instance, the cumulative odds model indicated that the first principal component (linear combination of glycosylated haemoglobin, glycemia, and creatinine) had a strong and significant effect on the progression of kidney disease, with an effect or odds ratio of 0.423 (P value = 0.000). However, this effect was inconsistent across levels of kidney disease because the first principal component did not meet the proportionality assumption. To address the proportionality problem and provide robust effect estimates, alternative ordered logit models, such as the partial cumulative odds model, the partial adjacent category model, and the partial continuation ratio model, were used. These models suggested that clinical variables such as age, sex, body mass index, medication (metformin), and biochemical variables such as glycosylated haemoglobin, glycemia, and creatinine have a significant effect on the progression of kidney disease.

Keywords: diabetic kidney disease, ordered logit model, principal component analysis, type 2 diabetes

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Authors: Andreea Molnar, Amalia Ardeljan, Lexi Frankel, Marissa Dallara, Brittany Nagel, Omar Rashid

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Background: Escherichia coli is a gram-negative, facultative anaerobic bacteria that belongs to the family Enterobacteriaceae and resides in the intestinal tracts of individuals. E.Coli has numerous strains grouped into serogroups and serotypes based on differences in antigens in their cell walls (somatic, or “O” antigens) and flagella (“H” antigens). More than 700 serotypes of E. coli have been identified. Although most strains of E. coli are harmless, a few strains, such as E. coli O157:H7 which produces Shiga toxin, can cause intestinal infection with symptoms of severe abdominal cramps, bloody diarrhea, and vomiting. Infection with E. Coli can lead to the development of systemic inflammation as the toxin exerts its effects. Chronic inflammation is now known to contribute to cancer development in several organs, including the prostate. The purpose of this study was to evaluate the correlation between E. Coli and the incidence of prostate cancer. Methods: Data collected in this cohort study was provided by a Health Insurance Portability and Accountability Act (HIPAA) compliant national database to evaluate patients infected with E.Coli infection and prostate cancer using the International Classification of Disease (ICD-10 and ICD-9 codes). Permission to use the database was granted by Holy Cross Health, Fort Lauderdale for the purpose of academic research. Data analysis was conducted through the use of standard statistical methods. Results: Between January 2010 and December 2019, the query was analyzed and resulted in 81, 037 patients after matching in both infected and control groups, respectively. The two groups were matched by Age Range and CCI score. The incidence of prostate cancer was 2.07% and 1,680 patients in the E. Coli group compared to 5.19% and 4,206 patients in the control group. The difference was statistically significant by a p-value p<2.2x10-16 with an Odds Ratio of 0.53 and a 95% CI. Based on the specific treatment for E.Coli, the infected group vs control group were matched again with a result of 31,696 patients in each group. 827 out of 31,696 (2.60%) patients with a prior E.coli infection and treated with antibiotics were compared to 1634 out of 31,696 (5.15%) patients with no history of E.coli infection (control) and received antibiotic treatment. Both populations subsequently developed prostate carcinoma. Results remained statistically significant (p<2.2x10-16), Odds Ratio=0.55 (95% CI 0.51-0.59). Conclusion: This retrospective study shows a statistically significant correlation between E.Coli infection and a decreased incidence of prostate cancer. Further evaluation is needed in order to identify the impact of E.Coli infection and prostate cancer development.

Keywords: E. Coli, prostate cancer, protective, microbiology

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Authors: J. George, M. Al Mutairi, W. Aljuryyad, A. Alhussanan, A. Alkashan, T. Aldoghiri, Z. Alamari, A. Albakr

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Introduction: Students make plans for their career and are keen in exploring options of employment in those carriers. They make their employment choice based on their desires and preferences. This study aims to identify if students of King Saud Bin Abdulaziz for Health Sciences, College of Applied Medical Sciences after obtaining appropriate education prefer to work as clinicians, university faculty, or full-time researchers. There are limited studies in Saudi Arabia exploring the university student’s employment choices and preferences. This study would help employers to build the required job positions and prevent misleading employers from opening undesired positions in the job market. Methodology: The study included 394 students from third and fourth years both male and female among the eighth programs of college of applied medical sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh campus. A prospective quantitative cross-sectional study was conducted; data were collected by distributing a seven item questionnaire and analyzed using SPSS. Results: Among the participants, 358 (90.9%) of them chose one of the three listed career choices, 263 (66.8%) decided to work as hospital staff after their education, 75 students (19.0%) chose to work as a faculty member in a university after obtaining appropriate degree, 20 students (5.1%) preferred to work as full-time researcher after obtaining appropriate degree, the remaining 36 students (9.1%) had different career goals, such as obtaining a master degree after graduating, to obtain a bachelor of medicine and bachelor in surgery degree, and working in the private sector. The most recurrent reason behind the participants' choice was "career goal", where 276 (70.1%) chose it as a reason. Conclusion: The findings of the study showed that most student’s preferred to work in hospitals as clinicians, followed by choice of working as a faculty in a university, the least choice was to be working as full-time researchers.

Keywords: College of Applied Medical Sciences, employment ambitions, graduating students, King Saud bin Abdulaziz University for Health Sciences

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Authors: Corinna Zeli, Silvia Calati, Marco Simeoni, Chiara Comastri

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Developmental stuttering affects about 10% of preschool children; although the high percentage of natural recovery, a quarter of them will become an adult who stutters. An effective early intervention should help those children with high persistence risk for the future. The Psicodizione method for early stuttering is an Italian behavior indirect treatment for preschool children who stutter in which method parents act as good guides for communication, modeling their own fluency. In this study, we give a preliminary measure to evaluate the long-term effectiveness of Psicodizione method on stuttering preschool children with a high persistence risk. Among all Italian children treated with the Psicodizione method between 2018 and 2019, we selected 8 kids with at least 3 high risk persistence factors from the Illinois Prediction Criteria proposed by Yairi and Seery. The factors chosen for the selection were: one parent who stutters (1pt mother; 1.5pt father), male gender, ≥ 4 years old at onset; ≥ 12 months from onset of symptoms before treatment. For this study, the families were contacted after an average period of time of 14,7 months (range 3 - 26 months). Parental reports were gathered with a standard online questionnaire in order to obtain data reflecting fluency from a wide range of the children’s life situations. The minimum worthwhile outcome was set at "mild evidence" in a 5 point Likert scale (1 mild evidence- 5 high severity evidence). A second group of 6 children, among those treated with the Piscodizione method, was selected as high potential for spontaneous remission (low persistence risk). The children in this group had to fulfill all the following criteria: female gender, symptoms for less than 12 months (before treatment), age of onset <4 years old, none of the parents with persistent stuttering. At the time of this follow-up, the children were aged 6–9 years, with a mean of 15 months post-treatment. Among the children in the high persistence risk group, 2 (25%) hadn’t had stutter anymore, and 3 (37,5%) had mild stutter based on parental reports. In the low persistency risk group, the children were aged 4–6 years, with a mean of 14 months post-treatment, and 5 (84%) hadn’t had stutter anymore (for the past 16 months on average).62,5% of children at high risk of persistence after Psicodizione treatment showed mild evidence of stutter at most. 75% of parents confirmed a better fluency than before the treatment. The low persistence risk group seemed to be representative of spontaneous recovery. This study’s design could help to better evaluate the success of the proposed interventions for stuttering preschool children and provides a preliminary measure of the effectiveness of the Psicodizione method on high persistence risk children.

Keywords: early treatment, fluency, preschool children, stuttering

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Authors: M. A. Hafiz, P. T. Matevenga

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Micro-level machining of metals is a developing field which has shown to be a prospective approach to produce features on the parts in the range of a few to a few hundred microns with acceptable machining quality. It is known that the mechanics (i.e. the material removal mechanism) of micro-machining and conventional machining have significant differences due to the scaling effects associated with tool-geometry, tool material and work piece material characteristics. Shape memory alloys (SMAs) are those metal alloys which display two exceptional properties, pseudoelasticity and the shape memory effect (SME). Nickel-titanium (NiTi) alloys are one of those unique metal alloys. NiTi alloys are known to be difficult-to-cut materials specifically by using conventional machining techniques due to their explicit properties. Their high ductility, high amount of strain hardening, and unusual stress–strain behaviour are the main properties accountable for their poor machinability in terms of tool wear and work piece quality. The motivation of this research work was to address the challenges and issues of micro-machining combining with those of machining of NiTi alloy which can affect the desired performance level of machining outputs. To explore the significance of range of cutting conditions on surface roughness and tool wear, machining tests were conducted on NiTi. Influence of different cutting conditions and cutting tools on surface and sub-surface deformation in work piece was investigated. Design of experiments strategy (L9 Array) was applied to determine the key process variables. The dominant cutting parameters were determined by analysis of variance. These findings showed that feed rate was the dominant factor on surface roughness whereas depth of cut found to be dominant factor as far as tool wear was concerned. The lowest surface roughness was achieved at the feed rate of equal to the cutting edge radius where as the lowest flank wear was observed at lowest depth of cut. Repeated machining trials have yet to be carried out in order to observe the tool life, sub-surface deformation and strain induced hardening which are also expecting to be amongst the critical issues in micro machining of NiTi. The machining performance using different cutting fluids and strategies have yet to be studied.

Keywords: nickel titanium, micro-machining, surface roughness, machinability

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Authors: Amr S. Fahil, Eman Ghoneim

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Egypt made significant efforts during the past few years to discover significant renewable energy sources. Regions in Egypt that have been identified for geothermal potential investigation include the Gulf of Suez and the Western Desert. One of the most promising sites for the development of Egypt's Northern Western Desert is Siwa Oasis. The geological setting of the oasis, a tectonically generated depression situated in the northernmost region of the Western desert, supports the potential for substantial geothermal resources. Field data obtained from 27 deep oil wells along the Western Desert included bottom-hole temperature (BHT) depth to basement measurements, and geological maps; data were utilized in this study. The major lithological units, elevation, surface gradient, lineaments density, and remote sensing multispectral and topographic were mapped together to generate the related physiographic variables. Eleven thematic layers were integrated in a geographic information system (GIS) to create geothermal maps to aid in the detection of significant potential geothermal spots along the Siwa Oasis and its vicinity. The contribution of total magnetic intensity data with reduction to the pole (RTP) to the first investigation of the geothermal potential in Siwa Oasis is applied in this work. The integration of geospatial data with magnetic field measurements showed a clear correlation between areas of high heat flow and magnetic anomalies. Such anomalies can be interpreted as related to the existence of high geothermal energy and dense rock, which also have high magnetic susceptibility. The outcomes indicated that the study area has a geothermal gradient ranging from 18 to 42 °C/km, a heat flow ranging from 24.7 to 111.3 m.W. k−1, a thermal conductivity of 1.3–2.65 W.m−1.k−1 and a measured amplitude temperature maximum of 100.7 °C. The southeastern part of the Siwa Oasis, and some sporadic locations on the eastern section of the oasis were found to have significant geothermal potential; consequently, this location is suitable for future geothermal investigation. The adopted method might be applied to identify significant prospective geothermal energy locations in other regions of Egypt and East Africa.

Keywords: magnetic data, SRTM, depth to basement, remote sensing, GIS, geothermal gradient, heat flow, thermal conductivity

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Authors: Ibrahim Mohamed Ibrahim Hassanin, Hany Hassan Mostafa, Mona Mohamed Shaban, Ahlam El Said Kamel

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Background: New so-called minimally invasive devices have been developed to limit groin pain after sling placement for treatment of stress urinary incontinence (SUI) to minimize the risk of postoperative pain and organ perforation. A new generation of suburethral slings was described that avoided skin incision to pull out and tension the sling. Evaluation of this device through prospective short-term series has shown controversial results compared with other tension-free techniques. The aim of this study is to compare success rates and complications for tension-free vaginal tape secur (TVT secur) and trans-obturator sub urethral tape inside-out technique (TVT-O) for treatment of stress urinary incontinence (SUI). Materials and Methods: Fifty patients with genuine SUI were divided into two groups: group S (n=25) were operated upon using (TVT secur) and group O (n=25) were operated upon using trans-obturator suburethral tape inside-out technique (TVT-O). Success rate, quality of life and postoperative complications such as groin pain, urgency, urine retention and vaginal tape erosion were reported in both groups at one, three, and six months after surgery. Results: As regards objective cure rate at one, three, six months intervals; there was a significant difference between group S (56%, 64%, and 60%), and group O (80%, 88%, and 88%) respectively (P <0.05). As regards subjective cure rate at one, three, six months intervals; there was a significant difference between group S (44%, 44%, and 48%), and group O (76%, 80%, and 80%) respectively (P <0.05). Quality of life (QoL) parameters improved significantly in cured patients with no difference between both groups. As regards complications, group O had a higher frequency of complications than group S; groin pain (12% vs 12% p= 0.05), urgency (4% (1 case) vs 0%), urine retention (8% (2 cases) vs 0%), vaginal tape erosion (4% (1 case) vs 0%). No cases were complicated with wound infection. Conclusion: Compared to TVT secur, TVT-O showed higher subjective and objective cure rates after six months but higher rate of complications. Both techniques were comparable as regards improvement of quality of life after surgery.

Keywords: stress urinary incontinence, trans-vaginal tape-obturator, TVT Secur, TVT-O

Procedia PDF Downloads 341

Authors: Daniela Magalhaes, Jorge Pedro, Pedro Souteiro, Joao S. Neves, Sofia Castro-Oliveira, Vanessa Guerreiro, Rita Bettencourt- Silva, Maria M. Costa, Ana Varela, Joana Queiros, Paula Freitas, Davide Carvalho

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Introduction: Obesity is an independent risk factor for renal dysfunction. Our aims were: (1) evaluate the impact of bariatric surgery (BS) on renal function; (2) clarify the factors determining the postoperative evolution of the glomerular filtration rate (GFR); (3) access the occurrence of oxalate-mediated renal complications. Methods: We investigated a cohort of 1448 obese patients who underwent bariatric surgery. Those with basal GFR (GFR0) < 30mL/min or without information about the GFR 2-year post-surgery (GFR2) were excluded. Results: We included 725 patients, of whom 647 (89.2%) women, with 41 (IQR 34-51) years, a median weight of 112.4 (IQR 103.0-125.0) kg and a median BMI of 43.4 (IQR 40.6-46.9) kg/m2. Of these, 459 (63.3%) performed gastric bypass (RYGB), 144 (19.9%) placed an adjustable gastric band (AGB) and 122 (16.8%) underwent vertical gastrectomy (VG). At 2-year post-surgery, excess weight loss (EWL) was 60.1 (IQR 43.7-72.4) %. There was a significant improve of metabolic and inflammatory status, as well as a significant decrease in the proportion of patients with diabetes, arterial hypertension and dyslipidemia (p < 0.0001). At baseline, 38 (5.2%) of subjects had hyperfiltration with a GFR0 ≥ 125mL/min/1.73m2, 492 (67.9%) had a GFR0 90-124 mL/min/1.73m2, 178 (24.6%) had a GFR0 60-89 mL/min/1.73m2, and 17 (2.3%) had a GFR0 < 60 mL/min/1.73m2. GFR decreased in 63.2% of patients with hyperfiltration (ΔGFR=-2.5±7.6), and increased in 96.6% (ΔGFR=22.2±12.0) and 82.4% (ΔGFR=24.3±30.0) of the subjects with GFR0 60-89 and < 60 mL/min/1.73m2, respectively ( p < 0.0001). This trend was maintained when adjustment was made for the type of surgery performed. Of 321 patients, 10 (3.3%) had a urinary albumin excretion (UAE) > 300 mg/dL (A3), 44 (14.6%) had a UAE 30-300 mg/dL (A2) and 247 (82.1%) has a UAE < 30 mg/dL (A1). Albuminuria decreased after surgery and at 2-year follow-up only 1 (0.3%) patient had A3, 17 (5.6%) had A2 and 283 (94%) had A1 (p < 0,0001). In multivariate analysis, the variables independently associated with ΔGFR were BMI (positively) and fasting plasma glucose (negatively). During the 2-year follow-up, only 57 of the 725 patients had transient urinary excretion of calcium oxalate crystals. None has records of oxalate-mediated renal complications at our center. Conclusions: The evolution of GFR after BS seems to depend on the initial renal function, as it decreases in subjects with hyperfiltration, but tends to increase in those with renal dysfunction. Our results suggest that BS is associated with improvement of renal outcomes, without significant increase of renal complications. So, apart the clear benefits in metabolic and inflammatory status, maybe obese adults with nondialysis-dependent CKD should be referred for bariatric surgery evaluation.

Keywords: albuminuria, bariatric surgery, glomerular filtration rate, renal function

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Authors: Fauzanah Fauzan El Muhammady

Abstract:

In the recent years, the Indonesian government has made tremendous efforts to improve the quality of Indonesia’s Islamic Higher Education Institutions (IHEIs) through the implementation of the institutional transformation policy. This policy has encouraged some IHEIs, such as Islamic Collages and Islamic Institutes to shift their institution from college to Institute or from Institute to university. As one of the requirements, the IHEIs should provide non-religious curriculum and integrate it with the religious curriculum (as the core curriculum of IHEIs). As results, since the 2000s, some Islamic Collages and Islamic Institutes have successfully developed the non-religious curriculum and achieved institutional transformation. However, after 15 years, the impact of the institutional transformation to the IHEIs is still debatable. The institutional transformation policy can be questioned as to whether the goal of status transformation has truly brought significant improvement to the quality of IHEIs. Therefore, based on the situation above, this study aims to explore how far the institutional transformation has effectively brought significant impact to the quality improvement of IHEIs. This study has used literature review method to investigate the current development of the institutional transformation in Indonesia’s IHEIs context. This is a part of literature review development to support the process of doctoral research. Based on the literature review, some studies found that the institutional transformation has led pro and cons to the academic community, society, and local government. Some agreed the institutional transformation has effectively facilitated non-religious curriculum development and it has significantly improved the number of prospective students and the student admitted at Islamic Universities. Meanwhile, others argue the development of non-religious curriculum will gradually eliminate the existence of the religious curriculum itself. On the other hand, the government suggests that the institutional transformation should be based on the quality standards. As a result, recently, the government has taken an initiative to restrict the institutional transformation (moratorium) in order to ensure the quality control of the institutional transformation application and to control the increasing number of the institutional transformation demands. This study provided the current issues that related to the contemporary of the institutional transformation in IHEIs context to disclosure how far both IHEIs and government overcome the quality issues of the institutional transformation development. The study results are expected can be used to advocate government, policymakers, and academic leaders in 1) reviewing the sustainability impact of the institutional transformation to the quality improvement of higher education institutions; 2) and finding effective solutions for the continuity of the institutional transformation in the future, particularly in the IHEIs context.

Keywords: curriculum, higher education, institutional transformation, quality

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Authors: Mathieu Audet, Monica Soliman, Emilie Eve Gravel, Rebecca Friesdorf

Abstract:

Access to higher education is critical for reducing social inequalities. The Canada Learning Bond (CLB) is a government savings incentive aimed at increasing higher education access for children of low income families by providing money toward a Registered Education Savings Plan. To better understand the educational and financial decision-making of low income families, Employment Social Development Canada conducted qualitative fieldwork with eligible parents and children, teachers, and community organizations promoting the Bond. Insights from this fieldwork were then used to develop letters to better target the needs and experiences of eligible families. In the present study, we conducted a randomized controlled trial with children ages 12 to 13, the oldest cohort of eligible children, to test the effectiveness of the new letters. Parents or caregivers of 150,088 eligible children were assigned to one of five letter conditions promoting the Bond or to a control condition that did not receive a letter. The letter conditions were: (a) the standard letter from past outreach, (b) a letter presenting the exact amount the child was eligible to receive, enhancing the salience of benefits, (c) a letter with a social norm, (d) a letter with an image emphasizing the feasibility of higher education by presenting the diversity of options (i.e., college, trade schools, apprenticeships) – many participants interviewed viewed that university was unfeasible, and (e) a letter minimizing references to 'saving' (i.e., not framing the Bond explicitly as a savings incentive) – a concept that did not resonate with low income families who felt they could not afford to save. The exact amount was also presented in letters (c) through (e). The letter minimizing references to 'saving' and presenting the exact amount had the highest net take-up rate at 6.6%, compared to 3.5% for the standard letter group. Furthermore, this trial’s BI-informed letters showed the largest impact on take-up so far, with a net take-up of 5.7% compared to 3.0% and 3.9% in the first two trials. This research highlights the value of mixed-method approaches combining qualitative and behavioural insights methods for developing context-sensitive interventions for social programs. By gaining a deeper understanding of the needs and experiences of program users through qualitative fieldwork, and then integrating these insights into behaviourally informed communications, we were able to increase take-up of an education savings program, which may ultimately improve access to higher education in children of low income families.

Keywords: access to higher education, behavioral insights, government, innovation, mixed-methods, social programs

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Authors: Samantha J. Hall, Luke Taylor, Kenneth I. Cumming, Jakki Bardsley, Scott S. P. Wildman

Abstract:

Medway School of Pharmacy – a joint collaboration between the University of Kent and the University of Greenwich – is a large school of pharmacy in the United Kingdom. The school primarily delivers the accredited Master or Pharmacy (MPharm) degree programme. Reportedly, some students may feel isolated from the larger student body that extends across four separate campuses, where a diverse range of academic subjects is delivered. In addition, student engagement has been noted as being limited in some areas, as evidenced in some cases by poor attendance at some lectures. In January 2015, the University of Kent launched a new initiative dedicated to Equality, Diversity and Inclusivity (EDI). As part of this project, Medway School of Pharmacy employed ‘Student Success Project Officers’ in order to analyse past and present school data. As a result, initiatives have been implemented to i) negate disparities in attainment and ii) increase engagement, particularly for Black, Asian and Minority Ethnic (BAME) students which make up for more than 80% of the pharmacy student cohort. Social media platforms are prevalent, with global statistics suggesting that they are most commonly used by females between the ages of 16-34. Student focus groups held throughout the academic year brought to light the school’s need to use social media much more actively. Prior to the EDI initiative, social media usage for Medway School of Pharmacy was scarce. Platforms including: Facebook, Twitter, Instagram, YouTube, The Student Room and University Blogs were either introduced or rejuvenated. This action was taken with the primary aim of increasing student engagement. By using a number of varied social media platforms, the university is able to capture a large range of students by appealing to different interests. Social media is being used to disseminate important information, promote equality and diversity, recognise and celebrate student success and also to allow students to explore the student life outside of Medway School of Pharmacy. Early data suggests an increase in lecture attendance, as well as greater evidence of student engagement highlighted by recent focus group discussions. In addition, students have communicated that active social media accounts were imperative when choosing universities for 2015/16. It allows students to understand more about the University and community prior to beginning their studies. By having a lively presence on social media, the university can use a multi-faceted approach to succeed in early engagement, as well as fostering the long term engagement of continuing students.

Keywords: engagement, social media, pharmacy, community

Procedia PDF Downloads 305