Search results for: emotionally focused couple therapy

Authors: Luma Al-Tamimi, Hassan Farhat, Wessam Hasan

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A three-dimensional (3D) hybrid quasi-steady thermal lattice Boltzmann model is developed to couple the effects of surfactant, temperature, interfacial tension, and contact angle. This 3D model is an extended scheme of a previously introduced two-dimensional (2D) hybrid lattice Boltzmann model. The 3D model is used to study the combined multi-physics effects on emulsion systems flowing in rectangular microchannels with and without confinements, where the suspended phase is made of droplets, plugs, or a mixture of both. The simulation results show that emulsion systems with plugs as the suspended phase are more efficient than with droplets, whereas mixed systems that form large plugs through coalescence have even greater efficiency. The 3D contact angle model generates matching results to those of the 2D model, which were validated with experiments. Furthermore, the effects of various confinements on adhering single drop systems are investigated for delineating their influence on the power required for transporting the suspended phase through the channel. It is shown that the deeper the constriction is, the lower the system efficiency. Increasing the surfactant concentration or fluid temperature in a channel with confinement carries a substantial positive effect on oil droplet transportation.

Keywords: lattice Boltzmann method, thermal, contact angle, surfactants, high viscosity ratio, porous media

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Authors: Dean J. Hill

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This paper undertakes the task of conducting an in-depth textual analysis of the cli-fi genre. It examines how writing in the genre contributes to expressing and facilitating the articulation of environmental consciousness through the form of narrative. The paper begins by situating cli-fi within the literary continuum of ecological narratives and identifying the unique textual characteristics and thematic preoccupations of this area. The paper unfolds how cli-fi transforms the esoteric nature of climate science into credible narrative forms by drawing on language use, metaphorical constructs, and narrative framing. It also involves how descriptive and figurative language in the description of nature and disaster makes climate change so vivid and emotionally resonant. The work also points out the dialogic nature of cli-fi, whereby the characters and the narrators experience inner disputes in the novel regarding the ethical dilemma of environmental destruction, thus demanding the readers challenge and re-evaluate their standpoints on sustainability and ecological responsibilities. The paper proceeds with analysing the feature of narrative voice and its role in eliciting empathy, as well as reader involvement with the ecological material. In looking at how different narratorial perspectives contribute to the emotional and cognitive reaction of the reader to text, this study demonstrates the profound power of perspective in developing intimacy with the dominating concerns. Finally, the emotional arc of cli-fi narratives, running its course over themes of loss, hope, and resilience, is analysed in relation to how these elements function to marshal public feeling and discourse into action around climate change. Therefore, we can say that the complexity of the text in the cli-fi not only shows the hard edge of the reality of climate change but also influences public perception and behaviour toward a more sustainable future.

Keywords: cli-fi genre, ecological narratives, emotional arc, narrative voice, public perception

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Authors: Anoosh Eghdami

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Background and aim: Conventional anticancer drugs display significant shortcomings which limit their use in cancer therapy. For this reason, important progress has been achieved in the field of nanotechnology to solve these problems and offer a promising and effective alternative for cancer treatment. Tumor markers may also be measured periodically during cancer therapy. Tumor markers may also be measured after treatment has ended to check for recurrence the return of cancer. The aim of this study was to evaluate the effect of nano drug delivery in induced breast cancer with DMBA by using CA15-3 tumor marker. Material and method: the rats were divided into five groups. The first group (control n=15) were fed only sesame oil as a gavage. In the second group n=15,10 mg DMBA was dissolved in 5ml of sesame oil and were fed as a gavage. In addition to DMBA treatment as the second group, in the 3,4and 5 groups after cancer creation, respectively affected by alpha interferon (α-IFN),alpha interferon conjugated with single walled carbon nano tube (α-IFN-SWNT) and encapsulated in poly lactic poly glycolic acid (α-IFN-PLGA). Tumor marker was measured in recent three groups. Results: The ANOVA test was used to determine the differences among the groups. Cancer inducing in rats (group 2) caused a significant increase in blood levels of CA15-3 (P<0.05). Administration of α-IFN, α-IFN –SWNT and α-IFN-PLGA in 3 groups of cancerous rats caused a significant decrease in blood levels of CA15-3 only the group that treated with α-IFN-PLGA (p<0.05). Conclusion: the results of this study indicate that nano drugs more effective than traditional drug in cancer treatment, although further work is needed to elucidate the safety and side effect of these compound in human.

Keywords: breast cancer, nano drug, tumor markers, CA15-3, α-IFN-PLGA, -IFN –SWNT

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Authors: Alison Brown

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Through stories, children make sense of their world, see themselves through the eyes of another, and process emotions and lived experiences in a non-threatening and indirect manner. Building on research around the use of narrative techniques with adults and families, this research looked directly at the use of narratives as a therapeutic technique with children in counseling. Based on individual therapy sessions with children over a six-year period, this work of collective case studies tells the story of a practice incorporating children’s narratives, of children’s experiences in writing and sharing their narratives, and of the clinical impact of the use of narratives with children. Not all stories were narratives of success or happiness. Children documented their fears and anger as well as their achievements and hope for the future. What emerged through this study was an awareness of recurring themes in the way children responded to the narrative process and in the benefits and limitations of story writing with children. Consistent with previous studies focusing on narrative work with adults and families, the use of narratives with children provided opportunities for healing, acceptance, developing greater understanding, externalizing, and re-authoring a preferred future. In terms of the children’s experiences in writing and sharing their narratives, consistent themes emerged again, with many children finding the experience cathartic and liberating, empowering and hopeful, but most importantly, an opportunity that allowed them to feel and understand that they were not alone. Whilst a small collection of case studies tells the stories of a limited number of children, it is hoped that this research provides both a model and inspiration for others to explore similar uses of narratives with children. As a greater number of children’s narratives are created, the potential to share and benefit from the many rich stories and experiences of other children becomes more of a reality. Across cultures, economic and social settings, rural and urban environments, and varying family structures, it is important that we hear the voices of our children – ‘In their own words’.

Keywords: narrative therapy children counselling, social, emotional, zone of proximal development, scaffolding

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Authors: Musarrat Jabeen

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Thoughtful intelligence offers a sustainable position to enhance the influence of decision-makers. Thoughtful Intelligence implies the understanding to realize the impact of one’s thoughts, words and actions on the survival, dignity and development of the individuals, groups and nations. Thoughtful intelligence has received minimal consideration in the area of Decision Support Systems, with an end goal to evaluate the quantity of knowledge and its viability. This pattern degraded the imbibed contribution of thoughtful intelligence required for sustainable decision making. Given the concern, this paper concentrates on the question: How to present a model of Thoughtful Decision Support System (TDSS)? The aim of this paper is to appreciate the concepts of thoughtful intelligence and insinuate a Decision Support System based on thoughtful intelligence. Thoughtful intelligence includes three dynamic competencies: i) Realization about long term impacts of decisions that are made in a specific time and space, ii) A great sense of taking actions, iii) Intense interconnectivity with people and nature and; seven associate competencies, of Righteousness, Purposefulness, Understanding, Contemplation, Sincerity, Mindfulness, and Nurturing. The study utilizes two methods: Focused group discussion to count prevailing Decision Support Systems; 70% results of focus group discussions found six decision support systems and the positive inexistence of thoughtful intelligence among decision support systems regarding sustainable decision making. Delphi focused on defining thoughtful intelligence to model (TDSS). 65% results helped to conceptualize (definition and description) of thoughtful intelligence. TDSS is offered here as an addition in the decision making literature. The clients are top leaders.

Keywords: thoughtful intelligence, sustainable decision making, thoughtful decision support system

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Authors: Aristi Alopoudi, Sofia Beloka, Vassiliki Pliogou

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Autism is a complex neuro-developmental disorder with a variety of difficulties in many aspects such as social interaction, communication skills and verbal communication (speech). The aim of this study was to examine the impact of therapeutic horseback riding in improving the verbal and communication skills of children diagnosed with autism during 16 sessions. The researcher examined whether the expression of speech, the use of vocabulary, semantics, pragmatics, echolalia and communication skills were influenced by the therapeutic horseback riding when we increase the frequency of the sessions. The researcher observed two subjects of primary-school aged, in a two case observation design, with autism during 16 therapeutic horseback riding sessions (one riding session per week). Compared to baseline, at the end of the 16th therapeutic session, therapeutic horseback riding increased both verbal skills such as vocabulary, semantics, pragmatics, formation of sentences and communication skills such as eye contact, greeting, participation in dialogue and spontaneous speech. It was noticeable that echolalia remained stable. Increased frequency of therapeutic horseback riding was beneficial for significant improvement in verbal and communication skills. More specifically, from the first to the last riding session there was a great increase of vocabulary, semantics, and formation of sentences. Pragmatics reached a lower level than semantics but the same as the right usage of the first person (for example, I make a hug) and echolalia used for that. A great increase of spontaneous speech was noticed. The eye contact was presented in a lower level, and there was a slow but important raise at the greeting as well as the participation in dialogue. Last but not least; this is a first study conducted in therapeutic horseback riding studying the verbal communication and communication skills in autistic children. According to the references, therapeutic horseback riding is a therapy with a variety of benefits, thus; this research made clear that in the benefits of this therapy there should be included the improvement of verbal speech and communication.

Keywords: Autism, communication skills, speech, therapeutic horseback riding

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Authors: Aurelien Boutin

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In optical systems such as Variable Optical Delay Lines, where a collimated beam has to go back and forth, corner cubes are used in order to keep the reflected beam parallel to the incoming beam. However, the reflected beam can be laterally shifted, which will lead to losses. In this paper, we report on a patented optical design that allows keeping the reflected beam with the exact same position and direction whatever the displacement of the corner cube leading to zero losses. After explaining how the optical design works and theoretically allows to compensate for any defects in the translation of the corner cube, we will present the results of experimental comparisons between a standard layout (i.e., only corner cubes) and our optical layout. To compare both optical layouts, we used a fiber-to-fiber coupling setup. It consists of a couple of lights from one fiber to the other, thanks to two lenses. The ensemble [fiber+lense] is fixed and called a collimator so that the light is coupled from one collimator to another. Each collimator was precisely made in order to have a precise working distance. In the experiment, we measured and compared the Insertion Losses (IL) variations between both collimators with the distance between them (i.e., natural Gaussian beam coupling losses) and between both collimators in the different optical layouts tested, with the same optical length propagation. We will show that the IL variations of our setup are less than 0.05dB with respect to the IL variations of collimators alone.

Keywords: free-space optics, variable optical delay lines, optical cavity, auto-alignment

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Authors: Orathai Srithongtham, Ubonsri Thabuddha

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The youth with HIV positive is not difference from the general youth in term of sexual needs. Sexual health is crucial the most to support the youth with HIV positive to be sexual well-being. This study aims to elucidate the sexual health on protection from STDs (Sexual Transmitted Diseases) and HIV transmission and to explain sexual risk behavior of the youth with HIV positive. The target group was the youth with HIV positive about 23 cases from two provinces in northeastern part of Thailand. Qualitative method was applied for collecting data by in-depth interview. Content analysis was use for data analysis. The youth with HIV positive was protection from STDs and HIV transmission by using the condom during sexual activity. The reason to deny the condom use were ashamed, condom is not a part of life, no have fit size, and the youth fear to stigmatized as a mental disorder and fear to stigmatized as going to fuck someone. The youth who trust with nurse in clinic was dare to request the condom by face. Sexual activity without condom use is sexual risk behavior. The major causes were couple trust and the sexual enjoyment first and sexual active competition with friend without condom use. The concern on HIV was the boyfriend or girlfriend not accepts the HIV positive people, worry about the HIV transmutation, and finally not compliance to ARV drug. The youth with HIV positive was lacking of the knowledge on sexual health on the issues of access to condom and the concern to keep on relationship with the boyfriend or girlfriend. This concern issues was led to the non-adherence of ARV drug and HIV distribution. To provide the sexual health service is more essential to the youth with HIV positive.

Keywords: sexual health, sexual risk behavior, youth, HIV

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Authors: Lucas Derks, Christine Beenhakker, Michiel Brandt, Gert Arts, Ruud van Langeveld

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Background: The method Depression in Awareness Space (DAS) is a psychotherapeutic intervention technique based on the principles of spatial cognition and imagination therapy with spatial components. The basic assumptions are: mental space is the primary organizing principle in the mind, and all psychological issues can be treated by first locating and by next relocating the conceptualizations involved. The most clinical experience was gathered over the last 20 years in the area of social issues (with the social panorama model). The latter work led to the conclusion that a mental object (image) gains emotional impact when it is placed more central, closer and higher in the visual field – and vice versa. Changing the locations of mental objects in space thus alters the (socio-) emotional meaning of the relationships. The experience of depression seems always associated with darkness. Psychologists tend to see the link between depression and darkness as a metaphor. However, clinical practice hints to the existence of more literal forms of darkness. Aims: The aim of the method Depression in Awareness Space is to reduce the distress of clients with depression in the clinical counseling practice, as a reliable alternative method of psychological therapy for the treatment of depression. The method Depression in Awareness Space aims at making dark areas smaller, lighter and more transparent in order to identify the problem or the cause of the depression which lies behind the darkness. It was hypothesized that the darkness is a subjective side-effect of the neurological process of repression. After reducing the dark clouds the real problem behind the depression becomes more visible, allowing the client to work on it and in that way reduce their feelings of depression. This makes repression of the issue obsolete. Results: Clients could easily get into their 'sadness' when asked to do so and finding the location of the dark zones proved pretty easy as well. In a recent pilot study with five participants with mild depressive symptoms (measured on two different scales and tested against an untreated control group with similar symptoms), the first results were also very promising. If the mental spatial approach to depression can be proven to be really effective, this would be very good news. The Society of Mental Space Psychology is now looking for sponsoring of an up scaled experiment. Conclusions: For spatial cognition and the research into spatial psychological phenomena, the discovery of dark areas can be a step forward. Beside out of pure scientific interest, it is great to know that this discovery has a clinical implication: when darkness can be connected to depression. Also, darkness seems to be more than metaphorical expression. Progress can be monitored over measurement tools that quantify the level of depressive symptoms and by reviewing the areas of darkness.

Keywords: depression, spatial cognition, spatial imagery, social panorama

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Authors: Christine Ysabelle G. Roman, Pauline Torres

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Background: Hypertrophic cardiomyopathy is a disease of marked heterogeneity. It is a genetically determined heart disease characterized by significant myocardium hypertrophy that results in diastolic dysfunction, left ventricular outflow tract obstruction, and an increased risk of arrhythmias. The primary treatment in patients with such conditions is negative inotropic drugs, such as beta-blockers, calcium channel antagonists, and disopyramide. However, for those who remain symptomatic and need septal reduction therapy, surgical septal myectomy or alcohol septal ablation are options. Case Summary: A 19 – year old female presented in the authors’ institution with easy fatigability. The consult was done a year prior, and 2D echocardiography was requested which showed concentric left ventricular hypertrophy, asymmetrically hypertrophied interventricular septum (IVS) with the largest diameter of 3.3cm & subaortic dynamic obstruction with a maximum gradient of 47 mmHg. A repeat echo a year later showed asymmetric septal hypertrophy (IVS measuring at 3cm) with the systolic anterior motion of anterior mitral valve leaflet and left ventricular outflow tract obstruction (peak gradient of 50mmHg). The patient then underwent alcohol septal ablation and was discharged stable after four days of admission. Conclusion: Hypertrophic obstructive cardiomyopathy, a cardiovascular genetic disease, results in various patterns of left ventricular hypertrophy and abnormality of mitral valve apparatus. The patient is managed medically initially. However, despite optimal drug therapy and significant left ventricular outflow tract obstruction, significant heart failure symptoms or syncope require invasive treatment.

Keywords: hypertrophic obstructive cardiomyopathy, left ventricular outflow tract obstruction, alcohol septal ablation, alcohol

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Authors: Jeffrey Ansloos

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International trauma education in low and emerging economies requires innovative methods for capacity building in existing social service infrastructures. This study details the findings of a program evaluation used to assess the learning outcomes and community impact of an international trauma-focused graduate degree program in Guyana. Through a collaborative partnership between Lesley University, the Government of Guyana, and UNICEF, a 2-year low-residency masters degree graduate program in trauma-focused assessment, intervention, and treatment was piloted with a cohort of Guyanese mental health professionals. Through an analytical review of the program development, as well as qualitative data analysis of participant interviews and focus-groups, this study will address the efficacy of the programming in terms of preparedness of professionals to understand, evaluate and implement trauma-informed practices across various child, youth, and family mental health service settings. Strengths and limitations of this international trauma-education delivery model will be discussed with particular emphasis on the role of capacity-building interventions, community-based participatory curriculum development, innovative technological delivery platforms, and interdisciplinary education. Implications for further research and subsequent program development will be discussed.

Keywords: mental health promotion, global health promotion, trauma education, innovations in education, child, youth, mental health education

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Authors: Anjali Bansal

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Reproductive preferences mainly deal with two questions: when a couple wants children and how many they want. Questions related to these desires are often included in the fertility surveys as they can provide relevant information on the subsequent behavior. The aim of the study is to observe whether respondent’s response to these questions changed over time or not. We also tried to identify socio- economic and demographic factors associated with the stability (or instability) of fertility preferences. For this purpose, we used IHDS1 (2004-05) and follow up survey IHDS2 (2011-12) data and applied bivariate, multivariate and multilevel repeated measure analysis to it to find the consistency between responses. From the analysis, we found that preferences of women changes over the course of time as from the bivariate analysis we have found that 52% of women are not consistent in their desired family size and huge inconsistency are found in desire to continue childbearing. To get a better overlook of these inconsistencies, we have computed Intra Class Correlation (ICC) which tries to explain the consistency between individuals on their fertility responses at two time periods. We also explored that husband’s desire for additional child specifically male offspring contribute to these variations. Our findings lead us to a cessation that in India, individuals fertility preferences changed over a seven-year time period as the Intra Class correlation comes out to be very small which explains the variations among individuals. Concerted efforts should be made, therefore, to educate people, and conduct motivational programs to promote family planning for family welfare.

Keywords: change, consistency, preferences, over time

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Authors: Wai Yan Shih, Sau Man Wong, Wing Chung Chang, Wai Chi Chan

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Background: Late-life depression is associated with significant consequences. Although symptomatic reduction is achievable through pharmacological interventions, older adults are more vulnerable to the side effects than their younger counterparts. In addition, drugs do not address underlying cognitive dysfunctions such as rumination and reduced autobiographical memory specificity (AMS), both shown to be maladaptive coping styles that are associated with a poorer prognosis in depression. Considering how aging is accompanied by cognitive, psychological and physical changes, the interplay of these age-related factors may potentially aggravate and interfere with these depressive cognitive dysfunctions in late-life depression. Special care should, therefore, be drawn to ensure these cognitive dysfunctions are adequately addressed. Aim: This randomized controlled trial aims to examine the effect of mindfulness-based cognitive therapy (MBCT) on depressed older adults, and whether the potential benefits of MBCT are mediated by improvements in rumination and AMS. Method: Fifty-seven participants with an average age of 70 years old were recruited from multiple elderly centers and online mailing lists. Participants were assessed with: (1) Hamilton depression scale, (2) ruminative response scale, (3) autobiographical memory test, (4) mindful attention awareness scale, and (5) Montreal cognitive assessment. Eligible participants with mild to moderate depressive symptoms and normal cognitive functioning were randomly allocated to an 8-week MBCT group or active control group consisting of a low-intensity exercise program and health education. Post-intervention assessments were conducted after the 8-week program. Ethics approval was given by the Institutional Review Board of the University of Hong Kong/Hospital Authority. Results: Mixed-factorials ANOVAs demonstrated significant time x group interaction effects for depressive symptoms, AMS, and dispositional mindfulness. A marginally significant interaction effect was found for rumination. Simple effect analyses revealed a significant reduction in depressive symptoms for the both the MBCT group (mean difference = 7.1, p = .000), and control group (mean difference = 2.7, p = .023). However, only participants in the MBCT group demonstrated improvements in rumination, AMS, and dispositional mindfulness. Bootstrapping-based mediation analyses showed that the effect of MBCT in alleviating depressive symptoms was only mediated by the reduction in rumination. Conclusions: The findings support the use of MBCT as an effective intervention for depressed older adults, considering the improvements in depressive symptoms, rumination, AMS and dispositional mindfulness despite their age. Reduction in ruminative tendencies plays a major role in the cognitive mechanism of MBCT.

Keywords: mindfulness-based cognitive therapy, depression, older adults, rumination, autobiographical memory specificity

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Authors: Julia Wimmers-Klick

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At the Canadian University of British Columbia's Faculty of Medicine, anatomy has traditionally been taught through a combination of lectures and dissection labs in the first two years, with radiology taught separately through lectures and online modules. However, this separation may leave students underprepared for medical practice, as medical imaging is essential for diagnosing anatomical and pathological conditions. To address this, a pilot project was initiated aimed at integrating radiological imaging into anatomy dissection labs from day one of medical school. The incorporated radiological images correlated with the current dissection areas. Additional stations were added within the lab, tailored to the specific content being covered. These stations focused on bones, and quiz questions, along with light-box exercises using radiographs, CT scans, and MRIs provided by the radiology department. The images used were free of pathologies. Examples of these will be presented in the poster. Feedback from short interviews with students and instructors has been positive, particularly among second-year students who appreciated the integration compared to their first-year experience. This low-budget approach was easy to implement but faced challenges, as lab instructors were not radiologists and occasionally struggled to answer students' questions. Instructors expressed a desire for basic training or a refresher course in radiology image reading, particularly focused on identifying healthy landmarks. Overall, all participants agreed that integrating radiology with anatomy reinforces learning during dissection, enhancing students' understanding and preparation for clinical practice.

Keywords: quality improvement, radiology education, anatomy education, integration

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Authors: Selvan Bellan, Koji Matsubara, Nobuyuki Gokon, Tatsuya Kodama, Hyun Seok-Cho

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In concentrated solar thermal industry, fluidized-bed technology has been used to produce hydrogen by thermochemical two step water splitting cycles, and synthetic gas by gasification of coal coke. Recently, couple of fluidized bed reactors have been developed and tested at Niigata University, Japan, for two-step thermochemical water splitting cycles and coal coke gasification using Xe light, solar simulator. The hydrodynamic behavior of the gas-solid flow plays a vital role in the aforementioned fluidized bed reactors. Thus, in order to study the dynamics of dense gas-solid flow, a CFD-DEM model has been developed; in which the contact forces between the particles have been calculated by the spring-dashpot model, based on the soft-sphere method. Heat transfer and hydrodynamics of a solar thermochemical fluidized bed reactor filled with ceria particles have been studied numerically and experimentally for beam-down solar concentrating system. An experimental visualization of particles circulation pattern and mixing of two-tower fluidized bed system has been presented. Simulation results have been compared with experimental data to validate the CFD-DEM model. Results indicate that the model can predict the particle-fluid flow of the two-tower fluidized bed reactor. Using this model, the key operating parameters can be optimized.

Keywords: solar reactor, CFD-DEM modeling, fluidized bed, beam-down solar concentrating system

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Authors: M. L. Yeung

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With the surge of divorce rate and male cancer onset/death rates, the phenomenon of divorced wives in the facing cancer death of their ex-husbands is not uncommon in Hong Kong. Yet, there is a dearth of study on the experiences of bereaved-divorced wives in the Hong Kong cultural context. This project fills the knowledge gap by conducting a qualitative study for having interviewed four bereaved ex-wives, who returned to ex-husbands’ end-of-life caregiving and eventually grieved for the ex-spousal’s death. From the perspectives of attachment theory and disenfranchised grief in the Hong Kong cultural context, a ‘double-loss’ experience is found in which interviewees suffer from the first loss of divorce and the second loss of ex-husbands’ death. Traumatic childhood experiences, attachment needs, role ambiguity, unresolved emotions and unrecognized grief are found significant in their lived experiences which alert the ‘double-loss’ is worthy of attention. Extending a family-centered end-of-life and bereavement care services to divorced couples is called for, in which validation on the attachment needs, ex-couple reconciliation, and acknowledgement on the disenfranchised grief are essential for social work practice on this group of clienteles specifically in Hong Kong cultural context.

Keywords: changing family, disenfranchised grief, divorce, ex-spousal death, marriage

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Authors: Konrad Rejdak, Agnieszka Korchut, Sebastian Szklener, Urszula Skrobas, Justyna Gerlowska, Katarzyna Grabowska-Aleksandrowicz, Dorota Szczesniak-Stanczyk

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Introduction: Neurodegenerative diseases are frequently accompanied by loss and unwanted change in functional independence, social relationships, and economic circumstances. Currently, the achievements of social robots to date is being projected to improve multidimensional quality of life among people with cognitive impairment and others. Objectives: Identification of particular human needs in context of the changes occurring in course of neurodegenerative diseases. Methods: Based on the 110 surveys performed in Medical University of Lublin from medical staff, patients, and caregivers we made prioritization of the users' needs as: high, medium, and low. The issues included in the surveys concerned four aspects: user acceptance, functional requirements, design of the robotic assistant and preferred types of human-robot interaction. Results: We received completed questionnaires: 50 from medical staff, 30 from caregivers and 30 from potential users. Above 90% of the respondents from each of the three groups, accepted robotic assistant as a potential caregiver. High priority functional capability of assistive technology was to handle emergencies in a private home like recognizing life-threatening situations and reminding about medication intake. With reference to design of the robotic assistant, the majority of the respondent would like to have an anthropomorphic appearance with positive emotionally expressive face. The most important type of human-robot interaction was voice-operated system and by touchscreen. Conclusion: The results from our study might contribute to a better understanding of the system and users’ requirements for the development of a service robot intended to support patients with dementia.

Keywords: social robot, dementia, requirements, patients needs

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Authors: Syed Benazir Firdaus, Debosree Ghosh, Aindrila Chattyopadhyay, Kuladip Jana, Debasish Bandyopadhyay

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Gastro-toxic effect of piroxicam, a classical non-steroidal anti-inflammatory drug (NSAID), has restricted its use in arthritis and similar diseases. The present study aims to find if a combination of melatonin and Murraya koenigii leaf extract therapy can protect against piroxicam induced ulcerative damage in rats. For this study, rats were divided into four groups namely control group where rats were orally administered distilled water, only combination treated group, piroxicam treated group and combination pre-administered piroxicam treated group. Each group of rats consisted of six animals. Melatonin at a dose of 20mg/kg body weight and antioxidant rich Murraya koenigii leaf extract at a dose of 50 mg /kg body weight were successively administered at 30 minutes interval one hour before oral administration of piroxicam at a dose of 30 mg/kg body weight to Wistar rats in the combination pre-administered piroxicam treated group. The rats of the animal group which was only combination treated were administered both the drugs respectively without piroxicam treatment whereas the piroxicam treated animal group was administered only piroxicam at 30mg/kg body weight without any pre-treatment with the combination. Macroscopic examination along with histo-pathological study of gastric tissue using haemotoxylin-eosin staining and alcian blue dye staining showed protection of the gastric mucosa in the combination pre-administered piroxicam treated group. Determination of adherent mucus content biochemically and collagen content through Image J analysis of picro-sirius stained sections of rat gastric tissue also revealed protective effects of the combination in piroxicam mediated toxicity. Gelatinolytic activity of piroxicam was significantly reduced by pre-administration of the drugs which was well exhibited by the gelatin zymography study of the rat gastric tissue. Mean ulcer index determined from macroscopic study of rat stomach reduced to a minimum (0±0.00; Mean ± Standard error of mean and number of animals in the group=6) indicating the absence of ulcer spots on pre-treatment of rats with the combination. Gastro-friendly prostaglandin (PGE2) which otherwise gets depleted on piroxicam treatment was also well protected when the combination was pre-administered in the rats prior to piroxicam treatment. The requirement of the individual drugs in low doses in this combinatorial therapeutic approach will possibly minimize the cost of therapy as well as it will eliminate the possibility of any pro-oxidant side effects on the use of high doses of antioxidants. Beneficial activity of this combination therapy in the rat model raises the possibility that similar protective actions might be also observed if it is adopted by patients consuming NSAIDs like piroxicam. However, the introduction of any such therapeutic approach is subject to future studies in human.

Keywords: gastro-protective action, melatonin, Murraya koenigii leaf extract, piroxicam

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Authors: Ahmad Ghanem, Mohamad Yasin, Mona Abdel Rehim, Fabrice Gouanve, Eliane Espuche

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Biodegradable polymers are of great interest, especially for biomedical and packaging applications. Current research efforts are focused on the development of biopolymers with the purpose of reducing the plastic pollution induced by the widely used in biodegradable polyolefins. The main challenge is focused on the elaboration of biopolymers having properties competitive to those of polyolefins. On the other hand, graphene oxide (GO), a graphene derivative, is characterized by the presence of several functional groups on the surface such as carboxylic, hydroxyl and epoxide. This feature enables modification of GO surface with different modifiers to obtain versatile surface properties and overcome the problem of graphene sheets aggregations during inclusion in a polymer matrix. In this context, poly (butylene succinate) (PBS) as promising biopolyester is modified through blending with different ratios of functionalized (GO) to improve its barrier properties. Modification of GO has been carried out using different hyperbranched polymeric structures in order to increase miscibility of the nanosheets in the hosting polymeric matrix. Films have been prepared from the modified PBS and their mechanical, thermal and gas barrier properties were investigated. The results reveal enhancement in the thermal and mechanical properties beside observed improvement of the barrier properties for the films prepared from the modified PBS. This improvement is related to the strong dependence on tortuosity effects of dispersion, exfoliation levels of fillers into the polymer matrix and interactions between the fillers and the polymer matrix.

Keywords: gas barrier properties, graphene oxide, food packaging, transport properties

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Authors: Reshaa Alruwaili

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The primary aim of this study was to examine the hypothesis presented by Self Determination theory which suggests that autonomy impacts positively the expression of love. Other hypotheses were also examined which suggest that other variables explain the expression of love, including: dyadic adjustment (dyadic consensus, dyadic satisfaction and dyadic cohesion), couple satisfaction, age, gender, the length of marriage, number of children and attachment styles. The participants were Saudi couples, which provided the opportunity to consider the influence of Saudi culture on the expression of love. A questionnaire was employed to obtain measures of all the relevant variables, including a measure of expression of love that was built from 27 items, constituting verbal, physical and caring features, and a measure of autonomy based on three features: authorship, interest-taking and susceptibility. Data were collected from both members of 34 Saudi couples. Descriptive analysis of both expression of love and autonomy was conducted. Correlation and regression were used to assess the relationships between expression of love and autonomy and other variables. Results indicated that Saudi couples who most often express their love tend to be more than somewhat autonomous. Not much difference was found between husbands and wives in expressing love, although wives were slightly more autonomous than husbands. Expression of love was enhanced by the autonomy of the participants to a greater extent when dyadic satisfaction was controlled, since the latter was negatively correlated with autonomy and had no effect on the expression of love. Basic psychological needs, dyadic consensus and dismissive-avoidant attachment improve the expression of love, while it is decreased by the number of children.

Keywords: autonomy, determination theory, expression of love, dyadic adjustment

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Authors: Uraporn Vongvatcharanon, Kochakorn Sukjan, Wandee Udomuksorn, Ekkasit Kumarnsit, Surapong Vongvatcharanon

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Sarcopenia is a loss of muscle mass, and strength frequently found in menopause. Estrogen replacement has been shown to improve such a loss of muscle functions. However, there is an increased risk of cancer that has to be considered because of the estrogen replacement therapy. Thus, phytoestrogen supplementation has been suggested as an alternative therapy. Pueraria mirifica (PM) is a plant in the family Leguminosae, that is known to be phytoestrogen-rich and has been traditionally used for the treatment of menopausal symptoms. It contains isoflavones and other compounds such as miroestrol and its derivatives. Parvalbumin (PV) is a calcium binding protein and functions as a relaxing factor in fast twitch muscle fibers. A decrease of the PV level results in a reduction of the speed of the twitch relaxation. Therefore, this study aimed to investigate the effect of an ethanolic extract from Pueraria mirifica on the estrogen levels, skeletal muscle functions and PV levels in the extensor digitorum longus (EDL) and gastrocnemius of ovariectomized rats. Twelve-week old female Wistar rats (200-250 g) were divided into 6 groups: SHAM (un-ovariectomized rats, that received double distilled water), PM-0 (ovariectomized rats, OVX, receiving double distilled water), E (OVX, receiving an estradiol benzoate dose of 0.04 mg/kg), PM-50 (OVX receiving PM 50 mg/kg), PM-500 (OVX receiving PM 500 mg/kg), PM-1000 (OVX receiving PM 1000 mg/kg) all for 90 days. The PM-0 group had estrogen levels, uterus weights, muscle mass, myofiber cross-section areas, peak tension, fatigue resistance, speed of relaxation and parvalbumin levels of both EDL and gastrocnemius that were significantly reduced compared to those of the SHAM group (p<0.05). Also the α and β estrogen receptor immunoreactivities and the parvalbumin immunoreactivities of both EDL and gastrocnemius were decreased in the PM-0 group. In contrast the E, PM-50, PM-500 and PM-1000 group had estrogen levels, uterus weights, muscle mass, myofiber cross-section areas, peak tension, fatigue resistance, speed of relaxation of both EDL and gastrocnemius that were significantly increased compared with PM-0 group (p<0.05). In addition, the α and β estrogen receptor immunoreactivities and parvalbumin immunoreactivity of both the EDL and gastrocnemius were increased in the E, PM-50, PM-500 and PM-1000 group. In addition the extract of Pueraria mirifica replacement group at 50 and 500 mg/kg had significantly increased parvalbumin levels in the EDL muscle but in the gastrocnemius, only the dose of 500 mg/kg increased the parvalbumin levels (p<0.05). These results have demonstrated that the use of the Pueraria mirifica extract as a replacement therapy for estrogen produced estrogenic activity that was similar to that produced by the estradiol benzoate replacement. It seems that the phytoestrogens could bind with the estrogen receptors and stimulate the transcriptional activity to synthesise muscle protein that caused an increase in muscle mass and parvalbumin levels. Thus, muscle synthesis may restore parvalbumin levels resulting in an enhanced relaxation efficiency that would lead to a shortened latent period before the next contraction.

Keywords: Puereria mirifica, Parvalbumin, estrogen, ovariectomized rats

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Authors: Vildan Cırık, Emine Efe

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Complementary health approaches are growing in popularity worldwide and play a substantial role in health care. It is very important for paediatric nurses to have knowledge of practices affecting the medical conditions of patients and to communicate with them through integrative nursing care. The purpose of this study was to determine paediatric nurses’ knowledge and experiences of complementary health approaches (CHA) and their personal and professional attitudes to the use of complementary health approaches. This multicentre study was conducted with 1450 paediatric nurses in 18 hospitals in Turkey. Paediatric nurses included in the study were working in the following clinics: Paediatric Service, Paediatric Intensive Care, Paediatric Haematology/Oncology. Data collection focused on the paediatric nurses’ knowledge and experiences of CHA. A high proportion of our sample of paediatric nurses reported that they had used some form of CHA themselves; the most popular choices of CHA were prayer, massage, and vitamins techniques. Paediatric nurses reported positive experiences (drawing/music/art/dance therapies, prayer, herbs, thermal springs, massage, and reflexology) and negative experiences (herbs, thermal springs, prayer, and massage). This study may contribute to increased awareness of the potentially important role of paediatric nurses in the delivery of CHA. Paediatric nurses play important roles in helping patients to use complementary health approaches safely and accurately. Trainings on CHA should be organised, data collection forms including CHA should be created, and evidence-based studies should be focused towards improving the clinical practice of paediatric nurses.

Keywords: complementary health approaches, paediatric nurses, knowledge, experience, attitude, Turkey

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Authors: Maham Leeza Adil, Mahrukh Alvi, Muhammad Osman

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Introduction: Sheehan's syndrome (SS) is a rare cause of hypopituitarism resulting from postpartum hemorrhage and pituitary necrosis. It remains an underdiagnosed condition, especially in developing countries, due to poor obstetric care and home deliveries. This case report highlights the significance of recognizing atypical presentations of SS, such as pancytopenia, to aid in early diagnosis and management. Case Presentation: A 40-year-old female presented with acute abdomen symptoms and was initially diagnosed with acalculous cholecystitis. However, a detailed history revealed a history of postpartum hemorrhage 18 years prior, leading to a provisional diagnosis of SS. Further investigations confirmed panhypopituitarism, including hypothyroidism, hypocortisolism, and hypogonadism. Notably, the patient also exhibited pancytopenia, a rarely reported hematological manifestation of SS. Discussion: SS often presents with nonspecific symptoms, leading to delayed or missed diagnoses. In this case, the patient's initial presentation of acute abdomen symptoms was attributed to secondary adrenal insufficiency due to panhypopituitarism. The presence of pancytopenia, along with hyponatremia, further complicated the clinical picture. Hormone replacement therapy led to a remarkable improvement in the patient's condition, emphasizing the importance of early diagnosis and intervention. Conclusion: SS is a common cause of panhypopituitarism in developing countries, but its atypical presentations, such as pancytopenia, are rare and often overlooked. This case highlights the need for increased awareness among clinicians to consider SS in patients with unexplained hematological abnormalities, particularly in regions with high rates of postpartum hemorrhage. Early recognition and appropriate hormone replacement therapy can significantly improve patients' outcomes and prevent long-term complications associated with this underdiagnosed syndrome.

Keywords: Sheehan syndrome, panhypopituitarism, pancytopenia, delayed diagnosis

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Authors: Shelley Y. Hawkins

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Introduction/Background: As technology has grown exponentially in healthcare, nurse educators must prepare Advanced Practice Registered Nurse (APRN) graduates with the knowledge and skills in information systems/technology to support and improve patient care and health care systems. APRN’s are expected to lead in caring for populations who lack accessibility and availability through the use of technology, specifically telehealth. The capacity to effectively and efficiently use technology in patient care delivery is clearly delineated in the American Association of Colleges of Nursing (AACN) Doctor of Nursing Practice (DNP) and Master of Science in Nursing (MSN) Essentials. However, APRN’s have minimal, or no, exposure to formalized telehealth education and lack necessary technical skills needed to incorporate telehealth into their patient care. APRN’s must successfully master the technology using telehealth/telemedicine, electronic health records, health information technology, and clinical decision support systems to advance health. Furthermore, APRN’s must be prepared to lead the coordination and collaboration with other healthcare providers in their use and application. Aim/Goal/Purpose: The purpose of this presentation is to establish and operationalize telehealth-focused educational partnerships between one University School of Nursing and two health care systems in order to enhance the preparation of APRN NP students for practice, teaching, and/or scholarly endeavors. Methods: The proposed project was initially presented by the project director to selected multidisciplinary stakeholders including leadership, home telehealth personnel, primary care providers, and decision support systems within two major health care systems to garner their support for acceptance and implementation. Concurrently, backing was obtained from key university-affiliated colleagues including the Director of Simulation and Innovative Learning Lab and Coordinator of the Health Care Informatics Program. Technology experts skilled in design and production in web applications and electronic modules were secured from two local based technology companies. Results: Two telehealth-focused APRN Program academic/practice partnerships have been established. Students have opportunities to engage in clinically based telehealth experiences focused on: (1) providing patient care while incorporating various technology with a specific emphasis on telehealth; (2) conducting research and/or evidence-based practice projects in order to further develop the scientific foundation regarding incorporation of telehealth with patient care; and (3) participating in the production of patient-level educational materials related to specific topical areas. Conclusions: Evidence-based APRN student telehealth clinical experiences will assist in preparing graduates who can effectively incorporate telehealth into their clinical practice. Greater access for diverse populations will be available as a result of the telehealth service model as well as better care and better outcomes at lower costs. Furthermore, APRN’s will provide the necessary leadership and coordination through interprofessional practice by transforming health care through new innovative care models using information systems and technology.

Keywords: academic/practice partnerships, advanced practice nursing, nursing education, telehealth

Procedia PDF Downloads 242

Authors: M. Asl. Dehghan, M. H. Daemi, S. Radmard, S. H. Nabavi

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Thin disk lasers are engineered for efficient thermal cooling and exhibit superior performance for this task. However the disk thickness and large pumped area make the use of this gain format in a resonator difficult when constructing a single-mode laser. Choosing an unstable resonator design is beneficial for this purpose. On the other hand, the low gain medium restricts the application of unstable resonators to low magnifications and therefore to a poor beam quality. A promising idea to enable the application of unstable resonators to wide aperture, low gain lasers is to couple a fraction of the out coupled radiation back into the resonator. The output coupling gets dependent on the ratio of the back reflection and can be adjusted independently from the magnification. The excitation of the converging wave can be done by the use of an external reflector. The resonator performance is numerically predicted. First of all the threshold condition of linear, V and 2V shape resonator is investigated. Results show that the maximum magnification is 1.066 that is very low for high quality purposes. Inserting an additional reflector covers the low gain. The reflectivity and the related magnification of a 350 micron Yb:YAG disk are calculated. The theoretical model was based on the coupled Kirchhoff integrals and solved numerically by the Fox and Li algorithm. Results show that with back reflection mechanism in combination with increasing the number of beam incidents on disk, high gain and high magnification can occur.

Keywords: unstable resonators, thin disk lasers, gain, external reflector

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Authors: Gabriela Ilie, Robert D. H. Rutledge

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A review of the literature reveals a need for longitudinal studies to properly understand the quality of life of prostate cancer survivors during their prostate cancer journey in order to identify opportunities for patient support and care during prostate cancer survivorship. In this study, mental health and relationship satisfaction were assessed longitudinally and by treatment modality among a population-based sample of Canadian adult men with a history of prostate cancer diagnosis. A total of 98 men, aged 51 or older with a history of prostate cancer completed an on-line 15-minute survey between May 2017 and February 2018, assessing mental health (Kessler Psychological Distress Scale) and relationship satisfaction (Dyadic Adjustment Scale) at baseline and at three months post-treatment with either active or nonactive prostate cancer treatment. Almost 1 in 6 men in this sample screened positive for mental health issues (17.34%, n=17) irrespective of treatment modality and most (n=11) were not currently on medication for depression, anxiety or both. Mental health outcomes were poorer for men with multimorbidity. For every instance of screening positive for mental health issues, 2.021 (95% CI:1.1 to 3.8) times more comorbidities were recorded. Relationship satisfaction and dyadic cohesion were statistically significantly lower from first assessment to 3 months for men who underwent multiple treatment modalities (surgery and radiation with hormonal therapy). Relationship satisfaction was also lower at 3 months for men who underwent radiation therapy. Almost 1 in 2 men in this sample (74%) indicated they did not attend a prostate cancer support group. Results suggest that treatment for mental health is underutilized in men with prostate cancer. Men who undergo multiple forms of active treatment appear more vulnerable to relationship dissatisfaction and feeling disconnected from their partner. Data points to important opportunities for patient education and care support during survivorship.

Keywords: prostate cancer survivorship, mental health, quality of life, relationship satisfaction

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Authors: Izian Abd. Karim, Kachalla Mohammed, Nora Farah Abd Aznieta Aziz, Law Teik Hua

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The economic use and ease of construction of profiled deck composite slab is marred with the complex and un-economic strength verification required for the serviceability and general safety considerations. Beside these, albeit factors such as shear span length, deck geometries and mechanical frictions greatly influence the longitudinal shear strength, that determines the ultimate strength of profiled deck composite slab, and number of methods available for its determination; partial shear and slope-intercept are the two methods according to Euro-code 4 provision. However, the complexity associated with shear behavior of profiled deck composite slab, the use of these methods in determining the load carrying capacities of such slab yields different and conflicting values. This couple with the time and cost constraint associated with the strength verification is a source of concern that draws more attentions nowadays, the issue is critical. Treating some of these known shear strength influencing factors as random variables, the load carrying capacity violation of profiled deck composite slab from the use of the two-methods defined according to Euro-code 4 are determined using reliability approach, and comparatively studied. The study reveals safety values from the use of m-k method shows good standing compared with that from the partial shear method.

Keywords: composite slab, first order reliability method, longitudinal shear, partial shear connection, slope-intercept

Procedia PDF Downloads 354

Authors: Eun-Seop Kim, Eun-Ha Jang, Rana R. Kim, Sae-Byul Jang

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Objective: Preterm labor is the most common antecedent of preterm birth(PTB), which is characterized by regular uterine contraction before 37 weeks of pregnancy and cervical change. In acute preterm labor, tocolytics are administered as the first-line medication to suppress uterine contractions but rarely delay pregnancy to 37 weeks of gestation. On the other hand, according to the Korean Traditional Medicine, PTB is caused by the deficiency of Qi and unnecessary energy in the body of the mother. The aim of this study was to demonstrate the benefit of Traditional Korean Medicine as an adjuvant therapy in management of early uterine contractions and the prevention of PTB. Methods: It is a case report of a 38-year-old woman (0-0-6-0) hospitalized for irregular uterine contractions and cervical change at 33+3/7 weeks of gestation. Past history includes chemical pregnancies achieved by Artificial Rroductive Technology(ART), one stillbirth (at 7 weeks) and a laparoscopic surgery for endometriosis. After seven trials of IVF and articificial insemination, she had succeeded in conception via in-vitro fertilization (IVF) with help of Traditional Korean Medicine (TKM) treatments. Due to irregular uterine contractions and cervical changes, 2 TKM were prescribed: Gami-Dangguisan, and Antae-eum, known to nourish blood and clear away heat. 120ml of Gami-Dangguisan was given twice a day monring and evening along with same amount of Antae-eum once a day from 31 August 2013 to 28 November 2013. Tocolytics (Ritodrine) was administered as a first aid for maintenance of pregnancy. Information regarding progress until the delivery was collected during the patient’s visit. Results: On admission, the cervix of 15mm in length and cervical os with 0.5cm-dilated were observed via ultrasonography. 50% cervical effacement was also detected in physical examination. Tocolysis had been temporarily maintained. As a supportive therapy, TKM herbal preparations(gami-dangguisan and Antae-eum) were concomitantly given. As of 34+2/7 weeks of gestation, however intermittent uterine contractions appeared (5-12min) on cardiotocography and vaginal bleeding was also smeared at 34+3/7 weeks. However, enhanced tocolytics and continuous administration of herbal medicine sustained the pregnancy to term. At 37+2/7 weeks, no sign of labor with restored cervical length was confirmed. The woman gave a term birth to a healthy infant via vaginal delivery at 39+3/7 gestational weeks. Conclusions: This is the first successful case report about a preter labor patient administered with conventional tocolytic agents as well as TKM herbal decoctions, delaying delivery to term. This case deserves attention considering it is rare to maintain gestation to term only with tocolytic intervention. Our report implies the potential of herbal medicine as an adjuvant therapy for preterm labor treatment. Further studies are needed to assess the safety and efficacy of TKM herbal medicine as a therapeutic alternative for curing preterm birth.

Keywords: preterm labor, traditional Korean medicine, herbal medicine, integrative treatment, complementary and alternative medicine

Procedia PDF Downloads 371

Authors: Kathleen Canul

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Bullying is on the rise according to several recent studies. Workplace bullying has garnered less attention than other forms yet incidence rates range from 35-45%. The consequences of being bullied at work are broad, ranging from physiological to psychological to occupational. As the bullying progresses, employees begin to exhibit physical and psychological symptoms. Blood pressure rises, along with other cardiac related concerns. For men, covert coping with job unfairness was associated with a four-fold risk of heart attack and death. Gastrointestinal distress, headaches, muscle tension, sleep disorders and exhaustion are also common. Workplace bullying appears to contribute to the risk of subsequent psychotropic medication, as well. Emotionally, anxiety and depression increase along with lowered self-esteem and problems concentrating on the duties of the job. In an attempt to cope, individuals may succumb to unhealthy practices involving food, alcohol and other drugs. Patterns of bullying vary by gender, race, and ethnicity, as well as sexual orientation, with women, ethnic minorities and LGBTQ employees reporting higher rates of bullying in the workplace. Not only is this an issue of inequity on the job, but also a problem of health disparities as there are few mental health professionals confident and competent in dealing with workplace bullying issues, and the lack of culturally competent clinicians exacerbates this inequality in receiving adequate care. Alone, the topic of workplace bullying is not unique; however, the diverse experiences of underrepresented groups who disproportionately are affected on the job and suffer untreated, health related concerns represent a significant and emerging problem requiring attention. Conference participants who have experienced, witnessed or help those bullied on the job would benefit most from this review of the literature on the consequences of bullying experienced by diverse and underrepresented groups in the workplace.

Keywords: bullying, ethnic minorities, health disparities, workplace conflict

Procedia PDF Downloads 280

Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski

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Transient ischaemic attacks (TIAs) are warning signs for future strokes. TIA patients are at increased risk of stroke and cardio-vascular events after a first episode. A majority of studies on TIA focused on the occurrence of these ancillary events after a TIA. Long-term mortality after TIA received only limited attention. We undertook this study to determine the long-term hazards of all-cause mortality following a first episode of a TIA using anonymised electronic health records (EHRs). We used a retrospective case-control study using electronic primary health care records from The Health Improvement Network (THIN) database. Patients born prior to or in year 1960, resident in England, with a first diagnosis of TIA between January 1986 and January 2017 were matched to three controls on age, sex and general medical practice. The primary outcome was all-cause mortality. The hazards of all-cause mortality were estimated using a time-varying Weibull-Cox survival model which included both scale and shape effects and a random frailty effect of GP practice. 20,633 cases and 58,634 controls were included. Cases aged 39 to 60 years at the first TIA event had the highest hazard ratio (HR) of mortality compared to matched controls (HR = 3.04, 95% CI (2.91 - 3.18)). The HRs for cases aged 61-70 years, 71-76 years and 77+ years were 1.98 (1.55 - 2.30), 1.79 (1.20 - 2.07) and 1.52 (1.15 - 1.97) compared to matched controls. Aspirin provided long-term survival benefits to cases. Cases aged 39-60 years on aspirin had HR of 0.93 (0.84 - 1.00), 0.90 (0.82 - 0.98) and 0.88 (0.80 - 0.96) at 5 years, 10 years and 15 years, respectively, compared to cases in the same age group who were not on antiplatelets. Similar beneficial effects of aspirin were observed in other age groups. There were no significant survival benefits with other antiplatelet options. No survival benefits of antiplatelet drugs were observed in controls. Our study highlights the excess long-term risk of death of TIA patients and cautions that TIA should not be treated as a benign condition. The study further recommends aspirin as the better option for secondary prevention for TIA patients compared to clopidogrel recommended by NICE guidelines. Management of risk factors and treatment strategies should be important challenges to reduce the burden of disease.

Keywords: dual antiplatelet therapy (DAPT), General Practice, Multiple Imputation, The Health Improvement Network(THIN), hazard ratio (HR), Weibull-Cox model

Procedia PDF Downloads 149