Search results for: medical resource cost

Authors: Prajakta Patil, Yash Huzurbazar, Abhijeet Shinde

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Aim: To develop a treatment protocol for the management of tinnitus through multi-modality brain stimulation. Methodology: Present study included 33 adults with unilateral (31 subjects) and bilateral (2 subjects) chronic tinnitus with and/or without hearing loss independent of their etiology. The Treatment protocol included 5 consecutive sessions with follow-up of 6 months. Each session was divided into 3 parts: • Pre-treatment: a) Informed consent b) Pitch and loudness matching. • Treatment: Bimanual paper pen task with tinnitus masking for 30 minutes. • Post-treatment: a) Pitch and loudness matching b) Directive counseling and obtaining feedback. Paper-pen task is to be performed bimanually that included carrying out two different writing activities in different context. The level of difficulty of the activities was increased in successive sessions. Narrowband noise of a frequency same as that of tinnitus was presented at 10 dBSL of tinnitus for 30 minutes simultaneously in the ear with tinnitus. Result: The perception of tinnitus was no longer present in 4 subjects while in remaining subjects it reduced to an intensity that its perception no longer troubled them without causing residual facilitation. In all subjects, the intensity of tinnitus decreased by an extent of 45 dB at an average. However, in few subjects, the intensity of tinnitus also decreased by more than 45 dB. The approach resulted in statistically significant reductions in Tinnitus Functional Index and Tinnitus Handicap Inventory scores. The results correlate with pre and post treatment score of Tinnitus Handicap Inventory that dropped from 90% to 0%. Discussion: Brain mapping(qEEG) Studies report that there is multiple parallel overlapping of neural subnetworks in the non-auditory areas of the brain which exhibits abnormal, constant and spontaneous neural activity involved in the perception of tinnitus with each subnetwork and area reflecting a specific aspect of tinnitus percept. The paper pen task and directive counseling are designed and delivered respectively in a way that is assumed to induce normal, rhythmically constant and premeditated neural activity and mask the abnormal, constant and spontaneous neural activity in the above-mentioned subnetworks and the specific non-auditory area. Counseling was focused on breaking the vicious cycle causing and maintaining the presence of tinnitus. Diverting auditory attention alone is insufficient to reduce the perception of tinnitus. Conscious awareness of tinnitus can be suppressed when individuals engage in cognitively demanding tasks of non-auditory nature as the paper pen task used in the present study. To carry out this task selective, divided, sustained, simultaneous and split attention act cumulatively. Bimanual paper pen task represents a top-down activity which underlies brain’s ability to selectively attend to the bimanual written activity as a relevant stimulus and to ignore tinnitus that is the irrelevant stimuli in the present study. Conclusion: The study suggests that this novel treatment approach is cost effective, time saving and efficient to vanish the tinnitus or to reduce the intensity of tinnitus to a negligible level and thereby eliminating the negative reactions towards tinnitus.

Keywords: multi-modality brain stimulation, neural subnetworks, non-auditory areas, paper-pen task, top-down activity

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Authors: Mohammed Flaih Alotaibi, Rasheed Ahemad Shaik, Mohammed Z. Nasrullah

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Diabetic foot ulcers are the foremost global healthcare burden. Hyperglycemia in diabetics is incriminating in impeding wound healing and it can allow for more severe medical issues. The study was intended to establish a nanoconjugate of cordycepin-melittin (COR-MEL) and evaluate its healing effects in wounded diabetic rats. Diabetes induced by injecting streptozotocin intraperitoneally (50 mg/kg, body weight). Therefore, animals were classified into various groups; diabetic untreated, vehicle-treated, COR alone, MEL alone, and COR-MEL nanoconjugate treated, respectively. Animals with diabetes were exposed to excision and treated with Vehicle, COR, MEL, or COR-MEL nanoconjugate topically. After 14 days, the wounded skin was sliced and subjected to histological and biochemical assessments. The formulated nanoconjugate has a particle size of 253.5± 17.4 nm by a polydispersity index of 0.36 ± 0.05, and a zeta potential of 1.72 ± 0.3 mV. The study demonstrated an accelerated wound contraction in COR-MEL-treated diabetic rats, which was further validated by histological analysis. The nanoconjugate further exhibited antioxidant activities by inhibiting the accumulation of malondialdehyde and exhaustion of superoxide dismutase and glutathione peroxidase enzymatic activities. The nanoconjugate further demonstrated an enhanced anti-inflammatory activity by retarding the expression of proinflammatory cytokines (IL-6 and TNF-α). Additionally, the nanoconjugate exhibits a strong expression of growth factors (TGF-β1, VEGF-A, and PDGFR-β), indicating enrichment of proliferation. Likewise, nanoconjugate increased the concentration of hydroxyproline as well as the mRNA expression of collagen, type I, alpha 1. Thus, it is concluded that the nanoconjugate possesses a potent wound-healing activity in diabetic rats via antioxidant, anti-inflammatory, and pro-angiogenetic mechanisms.

Keywords: diabetic wounds, cordycepin, melittin, nanoconjugate, wound healing

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Authors: Mohsen Shati, Seyede Salehe Mortazavi, Seyed Kazem Malakouti, Hamidreza Khanke Fazlollah Ahmadi

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Taking unnecessary or excessive medication or using drugs with no indication (polypharmacy) by people of all ages, especially the elderly, is associated with increased adverse drug reactions (ADR), medical errors, hospitalization and escalating the costs. It may be facilitated or impeded by the healthcare system. In this study, we are going to describe the role of the health system in the practice of polypharmacy in Iranian elderly. In this Inductive qualitative content analysis using Graneheim and Lundman methods, purposeful sample selection until saturation has been made. Participants have been selected from doctors, pharmacists, policy-makers and the elderly. A total of 25 persons (9 men and 16 women) have participated in this study. Data analysis after incorporating codes with similar characteristics revealed 14 subcategories and six main categories of the referral system, physicians’ accessibility, health data management, drug market, laws enforcement, and social protection. Some of the conditions of the healthcare system have given rise to polypharmacy in the elderly. In the absence of a comprehensive specialty and subspecialty referral system, patients may go to any physician office so may well be confused about numerous doctors' prescriptions. Electronic records not being prepared for the patients, failure to comply with laws, lack of robust enforcement for the existing laws and close surveillance are among the contributing factors. Inadequate insurance and supportive services are also evident. Age-specific care providing has not yet been institutionalized, while, inadequate specialist workforce playing a major role. So, one may not ignore the health system as contributing factor in designing effective interventions to fix the problem.

Keywords: elderly, polypharmacy, health system, qualitative study

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Authors: Mumtaz Ali Baloch

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This article aims at to review the policies and gaps including the socioeconomic and institutional factors that affected the enrollment of disabled children and caused drop-outs. It provides insights to scrutinize the gaps in policies, socioeconomic, and institutional factors with the specific concern in enrollment and drop out of disabled children in Pakistan, and Balochistan in particular. The findings of this study revealed that the old-age centralized policies and a number of socio-economic and institutional factors seemed to have significantly affected the enrollment and quality education in the case of physically disabled children. There were only a few schools functional in entire Balochistan. For example, an entire province (Balochistan) there are only two schools for disabled children, established in Quetta city. In the other 31 districts, an estimated population of 300,000 people of each district there were no schools for the disabled children. The findings of this study revealed that there is a great distinction between the policy and practice in the case of physically disabled children in Quetta, Balochistan. Consequently, such children seemed to have been out of schools. Dropout after the class eighth grade is almost 100%, as there are no high schools available for physically/disabled children, in Balochistan. The concerned organizations and authorities need to develop and ratify specific policies, provide required) facilities to the schools including sufficient budget, streamline the academic planning, and an effective monitoring and evaluation system. Only awareness and motivation could not help in improving the enrollment rate and decreasing the dropout in the case of physically disabled children. There is an urgent need to provide the required facilities to the schools. Almost all students needed assistive equipment, effective physical therapy as well as regular medical facilities. Such measures can improve the enrolment and rehabilitation of children.

Keywords: education policy, practices, physically disabled children, challenges, Balochistan, Pakistan

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Authors: Clemens Bulitta, Sasan Sadrizadeh, Sebastian Buhl

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Introduction: Ventilation technology in operating theatres (OT)is internationally regulated by dif-ferent standards, which define basic specifications for technical equipment and many times also the necessary operating and performance parameters. This confronts the operators of healthcare facilities with the question of finding the best ventilation and air conditioning system for the OT in order to achieve the goal of a large and robust surgicalworkzone with appropriate air quality and climate for patient safety and occupational health. Additionally, energy consumption and the potential need for clothing that limits transmission of bacteria must be considered as well as the total life cycle cost. However, the evaluation methodology of ventilation systems regarding these matters are still a topic of discussion. To date, there are neither any uniform standardized specifications nor any common validation criteria established. Thus, this study aimed to review data in the literature and add ourown research results to compare and assess the performance of different ventilations systems regarding infection preventive effects, energy efficiency, and staff comfort. Methods: We have conducted a comprehensive literature review on OT ventilation-related topics to understand the strengths and limitations of different ventilation systems. Furthermore, data from experimental assessments on OT ventilation systems at the University of Amberg-Weidenin Germany were in-cluded to comparatively assess the performance of Laminar Airflow (LAF), Turbulent Mixing Air-flow(TMA), and Temperature-controlled Airflow (TcAF) with regards to patient and occupational safety as well as staff comfort including indoor climate.CFD simulations from the Royal Institute of Technology in Sweden (KTH) were also studied to visualize the differences between these three kinds of ventilation systems in terms of the size of the surgical workzone, resilience to obstacles in the airflow, and energy use. Results: A variety of ventilation concepts are in use in the OT today. Each has its advantages and disadvantages, and thus one may be better suited than another depend-ing on the built environment and clinical workflow. Moreover, the proper functioning of OT venti-lation is also affected by multiple external and internal interfering factors. Based on the available data TcAF and LAF seem to provide the greatest effects regarding infection control and minimizing airborne risks for surgical site infections without the need for very tight surgical clothing systems. Resilience to obstacles, staff comfort, and energy efficiency seem to be favourable with TcAF. Conclusion: Based on literature data in current publications and our studies at the Technical Uni-versity of Applied Sciences Amberg-Weidenand the Royal Institute of Technoclogy, LAF and TcAF are more suitable for minimizing the risk for surgical site infections leading to improved clin-ical outcomes. Nevertheless, regarding the best management of thermal loads, atmosphere, energy efficiency, and occupational safety, overall results and data suggest that TcAF systems could pro-vide the economically most efficient and clinically most effective solution under routine clinical conditions.

Keywords: ventilation systems, infection control, energy efficiency, operating theatre, airborne infection risks

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Authors: Madison Meyer

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Dermatological conditions are one of the most viewed medical subjects on the social media platform TikTok, resulting in the rise of several prominent American board-certified dermatologists as influencers. Notably, dermatology is one of the least diverse specialties. This cross-sectional study aimed to assess individuals’ preferences related to race, gender, and sexual identity of doctors in terms of dermatology-related information on TikTok and which group posts more reliable information. This study qualitatively and quantitatively evaluated the racial, gender, and sexual diversity of the top 55 dermatologist influencers on TikTok based on their follower count. The DISCERN tool was used to determine the reliability of consumer health content based on a score ranging from 1-5. Among the top 55 dermatologist influencers, African American (54,241.60) and Latinx (6,696) groups had the lowest mean number of followers compared to Caucasian (1,046,298.50) and Asian (1,403,393.50) physicians. Latinx and African American dermatologists had the highest DISCERN scores of 2 and 1.9, respectively. None of the physicians identified as a different gender or as LGBTQIA+ in any racial category. There is a considerable lack of minority dermatologist influencers on TikTok, especially Latinx, African American, and LGBTQIA+ physicians. The lack of diversity in the dermatology specialty can lead to inequitable care and health outcomes for racial/ethnic, gender, and sexual minority patient populations. This study’s findings also suggest Latinx and African American dermatologists post more reliable content compared with their Caucasian and Asian counterparts.

Keywords: dermatology, social media, sexual and gender minorities, racial minorities, skin of color, tiktok

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Authors: Banafsheh Nikmehr, Mohsen Bahrami, Yueqiang Song, Anuradha Koduru, Ayse K. Vuruskan, Hongkun Lu, Mallory Pitts, Tolga B. Mesen, Tamer M. Yalcinkaya

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The number of people who receive in vitro fertilization (IVF) treatment has increased on a startling trajectory over the past two decades. Despite advances in this field, particularly the introduction of intracytoplasmic sperm injection (ICSI) and the preimplantation genetic screening (PGS), the IVF success remains low. A major factor contributing to IVF failure is embryonic aneuploidy (abnormal chromosome content), which often results in miscarriage and birth defects. Although PGS is often used as the standard diagnostic tool to identify aneuploid embryos, it is an invasive approach that could affect the embryo development, and yet inaccessible to many patients due its high costs. As such, there is a clear need for a non-invasive cost-effective approach to identify euploid embryos for single embryo transfer (SET). The reported differences between morphokinetic behaviors of aneuploid and euploid embryos has shown promise to address this need. However, current literature is inconclusive and further research is urgently needed to translate current findings into clinical diagnostics. In this ongoing study, we found significant differences between morphokinetic behaviors of euploid and aneuploid embryos that provides important insights and reaffirms the promise of such behaviors for developing non-invasive methodologies. Methodology—A total of 242 embryos (euploid: 149, aneuploid: 93) from 74 patients who underwent IVF treatment in Carolinas Fertility Clinics in Winston-Salem, NC, were analyzed. All embryos were incubated in an EmbryoScope incubator. The patients were randomly selected from January 2019 to June 2021 with most patients having both euploid and aneuploid embryos. All embryos reached the blastocyst stage and had known PGS outcomes. The ploidy assessment was done by a third-party testing laboratory on day 5-7 embryo biopsies. The morphokinetic variables of each embryo were measured by the EmbryoViewer software (Uniesense FertiliTech) on time-lapse images using 7 focal depths. We compared the time to: pronuclei fading (tPNf), division to 2,3,…,9 cells (t2, t3,…,t9), start of embryo compaction (tSC), Morula formation (tM), start of blastocyst formation (tSC), blastocyst formation (tB), and blastocyst expansion (tEB), as well as intervals between them (e.g., c23 = t3 – t2). We used a mixed regression method for our statistical analyses to account for the correlation between multiple embryos per patient. Major Findings— The average age of the patients was 35.04 yrs. The average patient age associated with euploid and aneuploid embryos was not different (P = 0.6454). We found a significant difference in c45 = t5-t4 (P = 0.0298). Our results indicated this interval on average lasts significantly longer for aneuploid embryos - c45(aneuploid) = 11.93hr vs c45(euploid) = 7.97hr. In a separate analysis limited to embryos from the same patients (patients = 47, total embryos=200, euploid=112, aneuploid=88), we obtained the same results (P = 0.0316). The statistical power for this analysis exceeded 87%. No other variable was different between the two groups. Conclusion— Our results demonstrate the importance of morphokinetic variables as potential biomarkers that could aid in non-invasively characterizing euploid and aneuploid embryos. We seek to study a larger population of embryos and incorporate the embryo quality in future studies.

Keywords: IVF, embryo, euploidy, aneuploidy, morphokinteic

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Authors: Theophilus Asante, Comfort Nyarko, Daniel Antwi

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Drug-resistant tuberculosis, together with the associated comorbidities like pulmonary fibrosis and silicosis, has been one of the most serious global public health threats that requires immediate action to curb or mitigate it. This prolongs hospital stays, increases the cost of medication, and increases the death toll recorded annually. Crinum asiaticum bulb (CAE) and betulin (BET) are known for their biological and pharmacological effects. Pharmacological effects reported on CAE include antimicrobial, anti-inflammatory, anti-pyretic, anti-analgesic, and anti-cancer effects. Betulin has exhibited a multitude of powerful pharmacological properties ranging from antitumor, anti-inflammatory, anti-parasitic, anti-microbial, and anti-viral activities. This work sought to investigate the anti-tuberculosis and resistant modulatory effects and also assess their effects on mitigating pulmonary fibrosis and silicosis. In the anti-tuberculosis and resistant modulatory effects, both CAE and BET showed strong antimicrobial activities (31.25 ≤ MIC ≤ 500) µg/ml against the studied microorganisms and also produced significant anti-efflux pump and biofilm inhibitory effects (ρ < 0.0001) as well as exhibiting resistance modulatory and synergistic effects when combined with standard antibiotics. Crinum asiaticum bulbs extract and betulin were shown to possess anti-pulmonary fibrosis effects. There was an increased survival rate in the CAE and BET treatment groups compared to the BLM-induced group. There was a marked decrease in the levels of hydroxyproline and collagen I and III in the CAE and BET treatment groups compared to the BLM-treated group. The treatment groups of CAE and BET significantly downregulated the levels of pro-fibrotic and pro-inflammatory cytokine concentrations such as TGF-β1, MMP9, IL-6, IL-1β and TNF-alpha compared to an increase in the BLM-treated groups. The histological findings of the lungs suggested the curative effects of CAE and BET following BLM-induced pulmonary fibrosis in mice. The study showed improved lung functions with a wide focal area of viable alveolar spaces and few collagen fibers deposition on the lungs of the treatment groups. In the anti-silicosis and pulmonoprotective effects of CAE and BET, the levels of NF-κB, TNF-α, IL-1β, IL-6 and hydroxyproline, collagen types I and III were significantly reduced by CAE and BET (ρ < 0.0001). Both CAE and BET significantly (ρ < 0.0001) inhibited the levels of hydroxyproline, collagen I and III when compared with the negative control group. On BALF biomarkers such as macrophages, lymphocytes, monocytes, and neutrophils, CAE and BET were able to reduce their levels significantly (ρ < 0.0001). The CAE and BET were examined for anti-oxidant activity and shown to raise the levels of catalase (CAT) and superoxide dismutase (SOD) while lowering the level of malondialdehyde (MDA). There was an improvement in lung function when lung tissues were examined histologically. Crinum asiaticum bulbs extract and betulin were discovered to exhibit anti-tubercular and resistance-modulatory properties, as well as the capacity to minimize TB comorbidities such as pulmonary fibrosis and silicosis. In addition, CAE and BET may act as protective mechanisms, facilitating the preservation of the lung's physiological integrity. The outcomes of this study might pave the way for the development of leads for producing single medications for the management of drug-resistant tuberculosis and its accompanying comorbidities.

Keywords: fibrosis, crinum, tuberculosis, antiinflammation, drug resistant

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Authors: Molly Parker

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Unintended pregnancy rates in Australia are amongst the highest in the developed world. Women with Substance Use Disorder often have riskier sexual behavior with nil contraceptive use and face disproportionately higher unintended pregnancies and Sexually Transmitted Infections, alongside Substance Use in Pregnancy (SUP) climbing at an alarming rate. In an inner-city Drug and Alcohol (D&A) service, significant barriers to sexual and reproductive health services have been identified, aligning with research. Rapid pathways were created for women seeking D&A treatment to be referred to Sexual and Reproductive Health services for the administration of Long-acting reversible contraception (LARC) and sexual health screening. For clients attending a D&A service, this is an opportunistic time to offer sexual and reproductive health services. Collaboration and multidisciplinary team input between D&A and sexual health and reproductive services are paramount, with rapid referral pathways being identified as the main strategy to improve access to sexual and reproductive health support for this population. With this evidence, a rapid referral pathway was created for women using the D&A service to access LARC, particularly in view of fertility often returning once stable on D&A treatment. A closed-ended survey was used for D&A staff to identify gaps in reproductive health knowledge and views of referral accessibility. Results demonstrated a lack of knowledge of contraception and appropriate referral processes. A closed-ended survey for clients was created to establish the need and access to services and to quantify data. A follow-up data collection will be reviewed to access uptake and satisfaction of the intervention from clients. Sexual health screening access was also identified as a deficit, particularly concerning due to the higher rates of STIs in this cohort. A rapid referral pathway will be undergoing implementation, reducing risks of untreated STIS both pre and post-conception. Similarly, pre and post-intervention structured surveys will be used to identify client satisfaction from the pathway. Although currently in progress, the research and pathway aim to be completed by December 2023. This research and implementation of sexual and reproductive health pathways from the D&A service have significant health and well-being benefits to clients and the wider community, including possible fetal/infancy outcomes. Women now have rapid access to sexual and reproductive health services, with the aim of reducing unplanned pregnancies, poor outcomes associated with SUP, client/staff trauma from termination of pregnancy, and client/staff trauma following the assumption of care of the child due to substance use, the financial cost for out of home care as required, the poor outcomes of untreated STIs to the fetus in pregnancy and the spread of STIs in the wider community. As evidence suggests, the implementation of a streamlined referral process is required between D&A and sexual and reproductive health services and has positive feedback from both clinicians and clients in improving care.

Keywords: substance use in pregnancy, drug and alcohol, substance use disorder, sexual health, reproductive health, contraception, long-acting reversible contraception, neonatal abstinence syndrome, FASD, sexually transmitted infections, sexually transmitted infections pregnancy

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Authors: Tesfaye Dagne, Dagmawit Solomon, Firmaye Bogale, Yosef Gebreyohannes, Samson Mideksa, Mamuye Hadis, Desalegn Ararso, Ermias Woldie, Tsegaye Getachew, Sabit Ababor, Zelalem Kebede

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Globally, road traffic accident (RTA) is causing millions of deaths and injuries every year. It is one of the leading causes of death among people of all age groups and the problem is worse among young reproductive age group. Moreover the problem is increasing with an increasing number of vehicles. The majority of the problem happen in low and middle income countries (LMIC), even if the number of vehicles in these countries is low compared to their population. So, the objective of this paper is to summarize the best available evidence on interventions that can reduce road traffic accidents in low and middle income countries (LMIC). Method: A rapid evidence synthesis approach adapted from the SURE Rapid Response Service was applied to search, appraise and summarize the best available evidence on effective intervention in reducing road traffic injury. To answer the question under review, we searched for relevant studies from databases including PubMed, the Cochrane Library, TRANSPORT, Health system evidence, Epistemonikos, and SUPPORT summary. The following key terms were used for searching: Road traffic accident, RTA, Injury, Reduc*, Prevent*, Minimiz*, “Low and middle-income country”, LMIC. We found 18 articles through a search of different databases mentioned above. After screening for the titles and abstracts of the articles, four of them which satisfy the inclusion criteria were included in the final review. Then we appraised and graded the methodological quality of systematic reviews that are deemed to be highly relevant using AMSTAR. Finding: The identified interventions to reduce road traffic accidents were legislation and enforcement, public awareness/education, speed control/ rumble strips, road improvement, mandatory motorcycle helmet, graduated driver license, street lighting. Legislation and Enforcement: Legislation focusing on mandatory motorcycle helmet usage, banning cellular phone usage when driving, seat belt laws, decreasing the legal blood alcohol content (BAC) level from 0.06 g/L to 0.02 g/L bring the best result where enforcement is there. Public Awareness/Education: focusing on seat belt use, child restraint use, educational training in health centers and schools/universities, and public awareness with media through the distribution of videos, posters/souvenirs, and pamphlets are effective in the short run. Speed Control: through traffic calming bumps, or speed bumps, rumbled strips are effective in reducing accidents and fatality. Mandatory Motorcycle Helmet: is associated with reduction in mortality. Graduated driver’s license (GDL): reduce road traffic injury by 19%. Street lighting: is a low-cost intervention which may reduce road traffic accidents.

Keywords: evidence synthesis, injury, rapid review, reducing, road traffic accident

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Authors: Shervin Rashidinia, Sara Shahmoradi, Seyyed Shahin Eftekhari, Mohsen Talebizadeh, Mohammad Saleh Sadeghi

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Background: Beta-thalassemia Major (BTM) is a kind of hereditary hemolytic anemia which depended on regular monthly blood transfusion. However, iron deposition into the organs leads to multi-organ damage. The present study is the first study which aimed to evaluate the average of five-years serum ferritin level and compared by the prevalence of short stature and hypocalcemia. Materials/Methods: A cross-sectional retrospective study which a total of 140 patients with beta-thalassemia who were referred to Qom Thalassemia Clinic between February 2011 and July 2016 were enrolled to be reviewed. The exclusion criteria were consisting of incomplete medical records, diagnosis less than 2-years-ago and the blood transfusion less than every 4 weeks. The data including age, gender, weight, height, age of initial blood transfusion, age of initial chelation therapy, ferritin, and calcium were collected and analysis by SPSS version 24. Results: A total of 140 patients were enrolled. Of them, 75 (53.4%) were female. The mean age of the patients was 13.4±4.6 years.The mean age of initial diagnosis was 20.2±7.4 months. Hypocalcemia and short stature were occurred in 41 (29.3%) and 37 (26.4%) patients, respectively. The mean five-years serum ferritin level was significantly higher in the patients with short stature and hypocalcemia (P<0.0001). However, rise in serum ferritin level significantly increases the risk of short-stature and hypocalcemia (1.0004- and 1.0029 fold, respectively). Conclusion: We demonstrated that prevalence of short stature and hypocalcemia were significantly higher in the BTM.However, ferritin significantly increases the risk of short stature and hypocalcemia.

Keywords: beta-thalassemia, ferritin, growth retardation, hypocalcemia

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Authors: Fazle Rabbi, Mashuda Khanom Tithi, Tasnim Mirza, Sanjida Rowshan Anannya, Ahmed Hossain

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Background: Low Back Pain (LBP) is one of the common health problems among the garment workers that causes workers absenteeism from the work. The purpose of the study is to identify the association between occupational factors and LBP among the female garment workers in Bangladesh. Materials and Methods: A cross-sectional study was conducted with 487 female garment workers from three compliant garment factories of Bangladesh. Face-to-face interview on four different LBP measures along with questions on socio-demographic, occupational, and physical factors were used to collect the data. Result: The prevalence rates for LBP lasts for at least one day during the last six months, chronic pain, intense pain, and seeking medical care for LBP were found 63.04%, 38.60%, 13.76%, and 18.89%, respectively among the female garments workers. The multivariate logistic regression analysis indicates that duration of employment (>5 years), regular weight bearing and extended weekly working hours (>48 hours) are positively associated with LBP. Besides, age, BMI, family income, marital status and number of children are also found positively associated with the LBP measures. Conclusion: The prevalence of LBP among female garment workers in Bangladesh is found high. The duration of employment (>5 years), regular weight bearing and extended weekly working hours (>48 hours) play a significant role in developing LBP among the female workers. Factories need to consider training programs on the appropriate technique of weight bearing. It is also important to conduct regular screening programs to identify LBP, especially with married, overweight/obese and older age group to reduce the occurrence of LBP.

Keywords: Bangladesh, garment workers, low back pain, occupational health

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Authors: Gwendy Darras, Mattias Desmet

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Previous research showed that psychological distress has a negative impact on the disease course of viral infections. For COVID-19, the same association was observed in small samples of specific segments of the population (e.g. health care workers). The present study presents a more refined analysis of this association, measuring a broader spectrum of psychological distress in a large sample (n=3084) of the general Flemish population. Several types of psychological distress (state, trait and health anxiety, depression, intra-, and interpersonal stress) are registered throughout three periods: one year before the contamination, one week before the contamination, and during the contamination. In doing so, validated scales such as DASS-21, IIP-32, and FCV-19S are used. Furthermore, the course of COVID-19 is registered in several ways: number of symptoms, number of days sick leave due to COVID-19, and number of days the symptoms have lasted. Also, different control variables such as vaccination status, medical and psychological history are taken into account. Statistical analysis shows that all types of psychological distress are positively correlated with the severity of the COVID-19 disease course. Anxiety during the contamination shows the strongest correlation, but psychological distress one year before the onset of COVID-19 was still significantly associated with the worsening of the disease course. As the assessment of the latter type of distress happened before the onset of the COVID-19 disease course, retrospective bias resulting in artificial associations between self-reported stress and COVID-19 severity is unlikely to have impacted the observations. In view of possible future pandemics, it is important to focus on general stress and anxiety reduction in the general population as soon as possible. It is also advisable to minimize the use of stress-inducing messages to encourage the population to adhere to the measures issued during a pandemic.

Keywords: anxiety, COVID-19, depression, psychoneuroimmunology, psychological distress, stress

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Authors: Jolanta Jonak

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All students demonstrate various learning preferences and learning styles that range from visual, auditory to kinesthetic preferences. These learning preferences are further impacted by individual cognitive profiles hat characterizes itself in linguistic strengths, logical- special, inter-or intra- personal, just to name a few. Students from culturally and linguistically diverse backgrounds (CLD) have an increased risk of being misunderstood by many school systems and even medical personnel. Students with disability, specifically Autism, are faced with another layer of learning differences. Research indicates that large numbers of students are not provided the type of education and types of supports they need in order to be successful in an academic environment. Multiple research findings indicate that significant numbers of school staff self-reports that they do not feel adequately prepared to work with students with disability and different learing profiles. It is very important for the school staff to be educated about different learning needs of students with autism spectrum disorders. Having the knowledge, school staff can avoid unnecessary referrals for office referrals and avoid inaccurate decisions about restrictive learning environments. This presentation will illustrate the cognitive differences in students with autism, how to recognize them, and how to support them through Differentiated Instruction. One way to ensure successful education for students with disability is by providing Differentiated Instruction (DI). DI is quickly gaining its popularity in the Unites States as a scientific- research based instructional approach for all students. This form of support ensures that regardless of the students’ learning preferences and cognitive learning profiles, they have an opportunity to learn through approaches that are suitable to their needs. It is extremely important for the school staff, especially school psychologists who often are the first experts to be consulted by educators, to be educated about differences due to learning preference styles and differentiation needs.

Keywords: special education, autism, differentiation, differences, differentiated instruction

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Authors: Maria Jose Mendoza Gordillo

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Introduction: Research regarding breastfeeding is devoted to how essential breastfeeding is to guarantee wellbeing for the mother and the baby from a medical standpoint relegating the cultural, material and social barriers for breastfeeding. Consequently, worldwide breastfeeding rates are low, and Ecuador is not the exception, especially among working mothers. Worldwide, health care providers have low rates of breastfeeding due to several barriers to lactation, such as the work schedule, a lack of private places for pumping while at work, and negative emotions. Goals and Methods: This study aimed to explore how do Ecuadorian women embrace their identities as nutritionists and mothers within their breastfeeding experience. The primary data come from 20 synchronous semi-structured interviews, which follow a topic guide. The interviews were recorded and transcribed verbatim. The data analysis followed the Phronetic Iterative Approach. Results: Women shifted the preconceived idea of the ideal breastfeeding that came from the medicalized discourse of breastfeeding, and that was constructed in their training as nutritionists. Although these women believe that breast milk and breastfeeding is the best way to feed a baby, the internalized ideal of breastfeeding shifted through the experience of motherhood. When these women developed their identity as mothers, they understood that the ideal breastfeeding is different from the medicalized discourse. Although they have that clash between the ideal and the external reality, they continued breastfeeding their babies and those experiences made them improve their professional practice. Conclusions: The narratives that women shared illustrate how complex it was to manage the different roles and identities that they wanted to fulfill to keep their identity of a good mother who breastfeeds her baby and, at the same time, a good healthcare provider identity. The process of breastfeeding for this group of women who are mothers and healthcare professionals appears to be a unique relational and identity negotiation process.

Keywords: breastfeeding, identity, nutritionist, qualitative

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Authors: Sameen Tariq, Saira Bano, Sayyada Ghufrana Nadeem

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The Ocean, which covers over 70% of the world's surface, is wealthy in biodiversity as well as a rich wellspring of microorganisms with huge potential. The oceanic climate is home to an expansive scope of plants, creatures, and microorganisms. Marine microbial networks, which incorporate microscopic organisms, infections, and different microorganisms, enjoy different benefits in biotechnological processes. Samples were collected from marine environments, including soil and water samples, to cultivate the uncultured marine organisms by using Zobell’s medium, Sabouraud’s dextrose agar, and casein media for this purpose. Following isolation, we conduct microscopy and biochemical tests, including gelatin, starch, glucose, casein, catalase, and carbohydrate hydrolysis for further identification. The results show that more gram-positive and gram-negative bacteria. The isolation process of marine organisms is essential for understanding their ecological roles, unraveling their biological secrets, and harnessing their potential for various applications. Marine organisms exhibit remarkable adaptations to thrive in the diverse and challenging marine environment, offering vast potential for scientific, medical, and industrial applications. The isolation process plays a crucial role in unlocking the secrets of marine organisms, understanding their biological functions, and harnessing their valuable properties. They offer a rich source of bioactive compounds with pharmaceutical potential, including antibiotics, anticancer agents, and novel therapeutics. This study is an attempt to explore the diversity and dynamics related to marine microflora and their role in biofilm formation.

Keywords: marine microorganisms, ecosystem, fungi, biofilm, gram-positive, gram-negative

Procedia PDF Downloads 37

Authors: Shah Rucksana Akhter Urme

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Agriculture is the main source of food for human consumption and feeding the world huge population, the pressure of food supply is increasing day by day. Undoubtedly, quality strain, improved plantation, farming technology, synthetic fertilizer, readily available irrigation, insecticides and harvesting technology are the main factors those to meet up the huge demand of food consumption all over the world. However, depended on this limited resources and excess amount of consuming lands, water, fertilizers leads to the end of the resources and severe climate effects has been left for our future generation. Agriculture is the most responsible to global warming, emitting more greenhouse gases than all other vehicles largely from nitrous oxide released by from fertilized fields, and carbon dioxide from the cutting of rain forests to grow crops . Farming is the thirstiest user of our precious water supplies and a major polluter, as runoff from fertilizers disrupts fragile lakes, rivers, and coastal ecosystems across the globe which accelerates the loss of biodiversity, crucial habitat and a major driver of wildlife extinction. It is needless to say that we have to more concern on how we can save the nutrients of the soil, storage of the water and avoid excessive depends on synthetic fertilizer and insecticides. In this case, eco- friendly cultivation could be a potential alternative solution to minimize effects of agriculture in our environment. The objective of this review paper is about organic cultivation following in particular biotechnological process focused on bio-fertilizer and bio-pesticides. Intense practice of chemical pesticides, insecticides has severe effect on both in human life and biodiversity. This cultivation process introduces farmer an alternative way which is nonhazardous, cost effective and ecofriendly. Organic fertilizer such as tea residue, ashes might be the best alternative to synthetic fertilizer those play important role in increasing soil nutrient and fertility. Ashes contain different essential and non-essential mineral contents that are required for plant growth. Organic pesticide such as neem spray is beneficial for crop as it is toxic for pest and insects. Recycled and composted crop wastes and animal manures, crop rotation, green manures and legumes etc. are suitable for soil fertility which is free from hazardous chemicals practice. Finally water hyacinth and algae are potential source of nutrients even alternative to soil for cultivation along with storage of water for continuous supply. Inorganic practice of agriculture, consuming fruits and vegetables becomes a threat for both human life and eco-system and synthetic fertilizer and pesticides are responsible for it. Farmers that practice eco-friendly farming have to implement steps to protect the environment, particularly by severely limiting the use of pesticides and avoiding the use of synthetic chemical fertilizers, which are necessary for organic systems to experience reduced environmental harm and health risk.

Keywords: organic farming, biopesticides, organic nutrients, water storage, global warming

Procedia PDF Downloads 54

Authors: T. Ghatauray, J. Ingram, P. Holborn

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The transition from a ‘carbon rich’ fossil fuel dependent to a ‘sustainable’ and ‘renewable’ hydrogen based society will see the deployment of hydrogen fuel cells (HFC) in transport applications and in the generation of heat and power for buildings, as part of a decentralised power network. Many deployments will be low power HFCs for domestic combined heat and power (CHP) and commercial ‘transportable’ HFCs for environmental situations, such as lighting and telephone towers. For broad commercialisation of small fuel cells to be achieved there needs to be significant confidence in their safety in both domestic and environmental applications. Low power HFCs are housed in protective steel enclosures. Standard enclosures have plain rectangular ventilation openings intended for thermal management of electronics and not the dispersion of a buoyant gas. Degradation of the HFC or supply pipework in use could lead to a low-level leak and a build-up of hydrogen gas in the enclosure. Hydrogen’s wide flammable range (4-75%) is a significant safety concern, with ineffective enclosure ventilation having the potential to cause flammable mixtures to develop with the risk of explosion. Mechanical ventilation is effective at managing enclosure hydrogen concentrations, but drains HFC power and is vulnerable to failure. This is undesirable in low power and remote installations and reliable passive ventilation systems are preferred. Passive ventilation depends upon buoyancy driven flow, with the size, shape and position of ventilation openings critical for producing predictable flows and maintaining low buoyant gas concentrations. With environmentally sited enclosures, ventilation openings with pressed horizontal and angled louvres are preferred to protect the HFC and electronics inside. There is an economic cost to adding louvres, but also a safety concern. A question arises over whether the use of pressed louvre vents impairs enclosure passive ventilation performance, when compared to same opening area plain vents. Comparison small enclosure (0.144m³) tests of same opening area pressed louvre and plain vents were undertaken. A displacement ventilation arrangement was incorporated into the enclosure with opposing upper and lower ventilation openings. A range of vent areas were tested. Helium (used as a safe analogue for hydrogen) was released from a 4mm nozzle at the base of the enclosure to simulate a hydrogen leak at leak rates from 1 to 10 lpm. Helium sensors were used to record concentrations at eight heights in the enclosure. The enclosure was otherwise empty. These tests determined that the use of pressed and angled louvre ventilation openings on the enclosure impaired the passive ventilation flow and increased helium concentrations in the enclosure. High-level stratified buoyant gas layers were also found to be deeper than with plain vent openings and were within the flammable range. The presence of gas within the flammable range is of concern, particularly as the addition of the fuel cell and electronics in the enclosure would further reduce the available volume and increase concentrations. The opening area of louvre vents would need to be greater than equivalent plain vents to achieve comparable ventilation flows or alternative schemes would need to be considered.

Keywords: enclosure, fuel cell, helium, hydrogen safety, louvre vent, passive ventilation

Procedia PDF Downloads 268

Authors: Maryam Borjali

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Introduction. Mortality due to noncommunicable diseases has increased in the world today with the advent of demographic shifts, growing age, and lifestyle patterns in the world, which have been affected by economic and social crises. Congenital heart defects are one of the forms of diseases that have raised infant mortality worldwide. e objective of present study was to identify nonmedical determinants related to this abnormality from the mother’s perspectives. Methods. is research was a qualitative study and the data collection method was a semistructured interview with mothers who had children with congenital heart diseases referring to the Shahid Rajaei Heart Hospital in Tehran, Iran. A thematic analysis approach was employed to analyze transcribed documents assisted by MAXQDA Plus version 12. Results. Four general themes and ten subthemes including social contexts (social harms, social interactions, and social necessities), psychological contexts (mood disorders and mental well-being), cultural contexts (unhealthy lifestyle, family culture, and poor parental health behaviors), and environmental contexts (living area and polluted air) were extracted from interviews with mothers of children with congenital heart diseases. Conclusions. Results suggest that factors such as childhood poverty, lack of parental awareness of congenital diseases, lack of proper nutrition and health facilities, education, and lack of medical supervision during pregnancy were most related with the birth of children with congenital heart disease from mothers’ prospective. In this regard, targeted and intersectorial collaborations are proposed to address nonmedical determinants related to the incidence of congenital heart diseases.

Keywords: congenital_cou, cultural, social, platform

Procedia PDF Downloads 95

Authors: Maimona A. E. Elimam, Suhair Rehan, Miskelyemen A. Elmekki, Mogahid M. Elhassan

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Staphylococcus aureus (Staph. aureus), a major cause of potentially life-threatening infections acquired in healthcare and community settings, has developed resistance to most classes of antimicrobial agents as determined by the dramatic increase. The present study aimed to determine the prevalence of MRSA, and VRSA in patients with different clinical manifestations in Khartoum state. The study population (n, 426) were males and females with different age categories, suffering either from wound infections (105), ear infections (121), or UTI (101), in addition to nasal carriers of medical staff (100). Cultures, Gram staining, and other biochemical tests were performed for conventional identification. Modified Kirby-Bauer disk diffusion method was applied and DNA was extracted from MRSA and VRSA isolates and PCR was then performed for amplification of arc, mecA, VanA, and VanB genes. The results confirmed the existence of Staph. aureus in 49/426 (11.5%) cases among which MRSA were isolated from 34/49 (69.4%) when modified Kirby-Bauer disk diffusion method was applied. Ten out of these 34 MRSA were confirmed as VRSA by cultures on BHI agar containing 6μg/ml vancomycin according to NCCLS criteria. PCR revealed that out of the 34 MRSA isolates, 26 were mecA positive (76.5%) while 8 (23.5%) were arcC positive. No vanA or VanB genes were detected. Molecular method confirmed the results for MRSA through the presence of either arcC or mecA genes while it failed to approve the occurrence of VRSA since neither VanA or VanB genes were detected. Thus, VRSA may be attributed to other factors.

Keywords: antibiotic resistance, Staphylococcus aureus, VRSA, MRSA, Khartoum, Sudan

Procedia PDF Downloads 431

Authors: Duvert A. Puentes T., Javier A. Maldonado E., Ivan Quintero., Diego F. Villegas

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Mechanical Computation is a great tool to study the performance of complex models. An example of it is the study of the human body structure. This paper took advantage of different types of software to make a 3D model of the glenohumeral joint and apply a finite element analysis. The main objective was to study the change in the biomechanical properties of the joint when it presents an injury. Specifically, a BANKART lesion, which consists in the detachment of the anteroinferior labrum from the glenoid. Stress and strain distribution of the soft tissues were the focus of this study. First, a 3D model was made of a joint without any pathology, as a control sample, using segmentation software for the bones with the support of medical imagery and a cadaveric model to represent the soft tissue. The joint was built to simulate a compression and external rotation test using CAD to prepare the model in the adequate position. When the healthy model was finished, it was submitted to a finite element analysis and the results were validated with experimental model data. With the validated model, it was sensitized to obtain the best mesh measurement. Finally, the geometry of the 3D model was changed to imitate a BANKART lesion. Then, the contact zone of the glenoid with the labrum was slightly separated simulating a tissue detachment. With this new geometry, the finite element analysis was applied again, and the results were compared with the control sample created initially. With the data gathered, this study can be used to improve understanding of the labrum tears. Nevertheless, it is important to remember that the computational analysis are approximations and the initial data was taken from an in vitro assay.

Keywords: biomechanics, computational model, finite elements, glenohumeral joint, bankart lesion, labrum

Procedia PDF Downloads 157

Authors: Imme Petersen, Wiebke Sick, Regine Kollek

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In systems medicine, high-throughput technologies produce large amounts of data on different biological and pathological processes, including (disturbed) gene expressions, metabolic pathways and signaling. The large volume of data of different types, stored in separate databases and often located at different geographical sites have posed new challenges regarding data handling and processing. Tools based on bioinformatics have been developed to resolve the upcoming problems of systematizing, standardizing and integrating the various data. However, the heterogeneity of data gathered at different levels of biological complexity is still a major challenge in data analysis. To build multilayer disease modules, large and heterogeneous data of disease-related information (e.g., genotype, phenotype, environmental factors) are correlated. Therefore, a great deal of attention in systems medicine has been put on data standardization, primarily to retrieve and combine large, heterogeneous datasets into standardized and incorporated forms and structures. However, this data-centred concept of standardization in systems medicine is contrary to the debate in science and technology studies (STS) on standardization that rather emphasizes the dynamics, contexts and negotiations of standard operating procedures. Based on empirical work on research consortia that explore the molecular profile of diseases to establish systems medical approaches in the clinic in Germany, we trace how standardized data are processed and shaped by bioinformatics tools, how scientists using such data in research perceive such standard operating procedures and which consequences for knowledge production (e.g. modeling) arise from it. Hence, different concepts and meanings of standardization are explored to get a deeper insight into standard operating procedures not only in systems medicine, but also beyond.

Keywords: data, science and technology studies (STS), standardization, systems medicine

Procedia PDF Downloads 334

Authors: Nasir Ullah

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Marketing strategies are important factors in the success of a company. Local pharmaceutical companies in Pakistan face several issues, such as low-level budgets, lack of skilled human resources, and challenges to competing with multinational competitors that have negative impacts on their success. However, still there exist local companies with great levels of success in the pharmaceutical sector. This study aims to evaluate the marketing strategies of successful local companies in the pharmaceutical sector of Khyber Pakhtunkhwa, Pakistan. The study employed a constructivist approach to know about successful strategies of the marketing managers that worked well. For this purpose, in-depth interviews were conducted with marketing managers of four pharmaceutical companies which were deemed as successful on the basis of their annual target achievements. Thematic analysis was conducted using Nvivo to devise major themes from the collected data. Four major themes or successful strategies were identified. These are i) share in the profit to marketing and sales staff, ii) invitation to the doctors for participation in free medical camps and health awareness seminars, iv) incentives for the Doctors and retailers, v) utilization of traditional capital (local social relationships) by the marketing officers. The study concludes that profit share to the employees, valuing doctors through their involvement and utilization of traditional capital are the successful marketing strategies of the successful pharmaceutical companies in the Pakhtun society of Pakistan. The study suggests hiring local staff that can utilize their traditional capital to influence doctors' decisions regarding the prescription of their medicine to the patients. The study also suggests profit share or increased bonuses to the marketing and sales staff as a measure of success.

Keywords: successful marketing strategies, pharmaceutical industry, traditional social capital, local companies

Procedia PDF Downloads 28

Authors: Hamzeh Alipour, Masoumeh Bagheri, Tahereh Karamzadeh, Abbasali Raz, Kourosh Azizi

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Netrin-A, a protein identified for conducting commissural axons, has a similar role in angiogenesis. In addition, studies have shown that one of the netrin-A receptors is expressed in the growing cells of small capillaries. It will be interesting to study this new group of molecules because their role in wound healing will become clearer in the future due to angiogenesis. The greenbottle blowfly Luciliasericata (L. sericata) larvae are increasingly used in maggot therapy of chronic wounds. This aim of this was the identification of moleculareatures of Netrin-A in L. sericata larvae. Larvae were reared under standard maggotarium conditions. The nucleic acid sequence of L. sericataNetrin-A (LSN-A) was then identified using Rapid Amplification of cDNA Ends (RACE) and Rapid Amplification of Genomic Ends (RAGE). Parts of the Netrin-A gene, including the middle, 3′-, and 5′-ends were identified, TA cloned in pTG19 plasmid, and transferred into DH5ɑ Escherichia coli. Each part was sequenced and assembled using SeqMan software. This gene structure was further subjected to in silico analysis. The DNA of LSN-A was identified to be 2407 bp, while its mRNA sequence was recognized as 2115 bp by Oligo0.7 software. It translated the Netrin-A protein with 704 amino acid residues. Its molecular weight is estimated to be 78.6 kDa. The 3-D structure ofNetrin-A drawn by SWISS-MODEL revealed its similarity to the Netrin-1 of humans with 66.8% identity. The LSN-A protein conduces to repair the myelin membrane in neuronal cells. Ultimately, it can be an effective candidate in neural regeneration and wound healing. Furthermore, our next attempt is to deplore recombinant proteins for use in medical sciences.

Keywords: maggot therapy, netrin-A, RACE, RAGE, lucilia sericata

Procedia PDF Downloads 102

Authors: C. G. Shashi Kumar, G. Arun Maiya, H. Manjunath Hande, K. V. Rajagopal

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Background: Diabetes mellitus (DM) is a metabolic disorder with involvement of neurovascular and muscular system. Studies have documented that the gait parameter is altered in type 2 diabetes mellitus with peripheral neuropathy. However, there is a dearth of literature regarding the gait characteristics in type 2 diabetes mellitus (T2DM) without peripheral neuropathy. Therefore, the present study is focused on identifying gait changes in early type 2 diabetes mellitus without peripheral neuropathy. Objective: To analyze the gait characteristics in Type 2 diabetes mellitus without peripheral neuropathy. Methods: After obtaining ethical clearance from Institutional Ethical Committee (IEC), 36 T2DM without peripheral neuropathy and 32 matched healthy subjects were recruited. Gait characteristics (step duration, gait cycle length, gait cycle duration, stride duration, step length, double stance duration) of all the subjects were analyzed using Windtrack dynamic foot scanner. Data were analyzed using Independent‘t’ test to find the difference between the groups (step duration, gait cycle length, gait cycle duration) and Mann-Whitney test was used to analyze the step length and double stance duration to find difference between the groups. Level of significance was kept at P<0.05. Results: Result analysis showed significant decrease in step duration, gait cycle length, gait cycle duration, step length, double stance duration in T2DM subjects as compared to healthy subjects. We also observed a mean increase in stride duration in T2DM subjects compared to healthy subjects.

Keywords: type 2 diabetes mellitus, dynamic foot scan, gait characteristics, medical and health sciences

Procedia PDF Downloads 432

Authors: Lamees Nasser, Yago Diez, Robert Martí, Joan Martí, Ibrahim Sadek

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Automated 3D breast ultrasound (ABUS) screening is a novel modality in medical imaging because of its common characteristics shared with other ultrasound modalities in addition to the three orthogonal planes (i.e., axial, sagittal, and coronal) that are useful in analysis of tumors. In the literature, few automatic approaches exist for typical tasks such as segmentation or registration. In this work, we deal with two problems concerning ABUS images: nipple and rib detection. Nipple and ribs are the most visible and salient features in ABUS images. Determining the nipple position plays a key role in some applications for example evaluation of registration results or lesion follow-up. We present a nipple detection algorithm based on color and shape of the nipple, besides an automatic approach to detect the ribs. In point of fact, rib detection is considered as one of the main stages in chest wall segmentation. This approach consists of four steps. First, images are normalized in order to minimize the intensity variability for a given set of regions within the same image or a set of images. Second, the normalized images are smoothed by using anisotropic diffusion filter. Next, the ribs are detected in each slice by analyzing the eigenvalues of the 3D Hessian matrix. Finally, a breast mask and a probability map of regions detected as ribs are used to remove false positives (FP). Qualitative and quantitative evaluation obtained from a total of 22 cases is performed. For all cases, the average and standard deviation of the root mean square error (RMSE) between manually annotated points placed on the rib surface and detected points on rib borders are 15.1188 mm and 14.7184 mm respectively.

Keywords: Automated 3D Breast Ultrasound, Eigenvalues of Hessian matrix, Nipple detection, Rib detection

Procedia PDF Downloads 326

Authors: Walter Rafael Ramos Villanueva

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The overwhelming majority of scholarship on David Chariandy’s novel Soucouyant focuses on how Adele’s dementia represents the preservation of “cultural memory” and the perniciousness of “historical trauma.” However, by metaphorizing Adele’s mental condition, these critics risk treating her dementia as mostly figurative, and they thus elide a more detailed discussion of the literal ramifications of her dementia diagnosis. To move beyond these readings, then, my paper will approach Adele’s disorder as a literal medical condition and explore how her caregiving needs affect not only her but also those around her. Soucouyant subverts traditional caregiving narratives by depicting the difficult and typically invisible labour of informal caregiving that is undertaken by the families and friends of those who are ill or otherwise disabled. Because Adele’s family is unable to access proper public healthcare resources within the community, the burden of care falls upon the protagonist and his brother, who become “parentified children.” Parentified children, according to Nancy D. Chase, are “parents to their parents, and fulfill this role at the expense of their own developmentally appropriate needs and pursuits.” The novel provides a depiction of informal caregiving that is multi-faceted and asks us to question why is it exactly that we place the burden of care on those who are not equipped to handle such pressures instead of putting the onus on the government and the public healthcare system to take care of its most vulnerable members. Ageing Studies scholar Larry Polvika notes that although policymakers often offer “pious expressions of appreciation” and acknowledge that informal caregiving is “the backbone of our long-term care system,” governmental support for these caregivers remains inadequate. It is my belief that, by showcasing the struggles of informal caregivers, Chariandy’s text combats this dangerous and empty political rhetoric.

Keywords: caregiving, dementia, literature, parentified children

Procedia PDF Downloads 162

Authors: Deepthinath Reghunathan, Satheesha Nayak, Sudarshan S., Prasad Alathady Maloor, Prakash Shetty

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Lumbar plexus is formed by the union of ventral rami of T12, L1, L2, L3 spinal nerves and the larger upper division of L4 lumbar spinal nerves. Variations in the normal anatomy of the lumbar and sacral plexus might be seen in some cases and are reported in the literature, but finding such an unusual case comprising of multiple variations which is normally not expected in a clinical setup, proves to be a vital piece of information for clinicians and medical practitioners. During the dissection of the abdomen and pelvis of an approximately 70 year old cadaver, we observed the following variations in the formation of the lumbar and sacral nerves. 1. The genitofemoral nerve bifurcated at a higher level; genital branch of genitofemoral nerve gave branches to the anterior abdominal wall muscles, 2. A communicating branch was given from the lateral cutaneous nerve of thigh to the medial cutaneous nerve of thigh, 3. A muscular branch was given from femoral nerve to psoas major, 4. There was absence of contribution of L4 spinal nerve in the formation of the lumbosacral trunk and 5. Lumbosacral trunk gave communicating branches to the femoral and obturator nerves. Most of the variations found were rare and finding all the above said variations in a single cadaver is even rare. Documentation of such rare cases with multiple variations in the formation of nerves from the lumbar plexus provides vital information on such occurrences. This information would in turn improve the knowledge of clinicians and surgeons dealing with this region. Emphasizing such knowledge of this region would prevent accidental damage to the structures with a variant anatomy.

Keywords: femoral nerve, genitofemoral nerve, lumbar plexus, lumbosacral trunk

Procedia PDF Downloads 283

Authors: Ching-Yi Huang, Pi-Fen Cheng, Hui-Zhu Chen, Shi Ting Huang, Heng-Hua Wang

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This is a case of oral cancer after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap. The nursing period lasted From September 25 to October 3, 2017, through observation, interview, physical assessment, and medical record review, the author identified the following nursing problems: acute pain, impaired oral mucous membrane, and body image change. During the nursing period, the author provided individual and overall nursing care and established mutual trust through the use of empathy. Author listened and eased the patient's physical indisposition, such as wound pain, we use medications and acupuncture massage to relieve pain. However, for oral mucosa change caused by surgery, provide continuous and complete oral care and oral exercise training to improve oral mucosal healing and restore swallowing function. In the body-image changes, guided him to express his feeling after the body-image change, and enhanced support and from the family, and encouraged him to attend head and neck cancer survivor alliance which allowed the patient to accept the altered body image and reaffirm self-worth. Hopefully, through sharing this nursing experience will help to the nursing care quality of nursing care for oral cancer patients after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap.

Keywords: oral cancer, acute pain, impaired oral mucous membrane, body image change

Procedia PDF Downloads 180

Authors: Tali Capua, Karin Hermon, Miguel Glatstein, Oren Tavor, Ayelet Rimon

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Background: Electric bicycles (E-bikes) are one of a wide range of light electric vehicles that provide convenient local transportation and attractive recreational opportunities. Along with their growing use worldwide, the E-bike related injury rate increases. To the best of our knowledge, this study is the first to specifically compare E-bike with classic bicycle related injuries in children. Methods: Data of all pediatric ( < 16 years of age) bicycle related injuries presenting to an urban level I trauma center between 2014 and 2015 were collected and analyzed. The recorded data included age, gender, details of the accident, as well severity of injury, medical diagnosis, and the outcome. Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) were calculated for each patient. Data of E-bike related injuries and classic bicycle were then compared. Results: A total of 124 bicycle related injuries and 97 E-bike related injuries presented to the emergency department. Once pedestrians and bicycle passengers were removed, the groups of riders consisted of 111 bikers and 85 E-bikers. The mean age of bikers was 9.9 years (range 3-16 years) and of E-bikers was 13.7 years (range 7.5-16 years). Injuries to the head and the extremities were common in both groups. Compared to bikers, E-bikers had significantly more injuries to intra-abdominal organs (p = 0.04). Twenty patients (16%) with bicycle related injuries were admitted, and 13 (15%) patients with E-bike related injuries, of the latter group four underwent surgical intervention. ISS scores were low overall, but the injuries of higher severity (ISS > 9) were among the E-bikers. Conclusions: This study provides unique information which suggests that injuries in E-bikers tend to be more severe than in classic bikers. There is a need for regulation regarding the use of E-bikes to enhance the safety of both bikers and other road and pavement users.

Keywords: bicycle, electric bicycle, injury, pediatric, trauma

Procedia PDF Downloads 178