Search results for: ethically problematic situations in clinical psychology

Authors: Claire Williams

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Randomised controlled Trials (RCTs) of efficacy are still perceived as the gold standard for the generation of evidence, and whilst advances in data collection methods are well developed, this progress has not been matched for the reporting of adverse events (AEs). Assessment and reporting of AEs in clinical trials are fraught with human error and inefficiency and are extremely time and resource intensive. Recent research conducted into the quality of reporting of AEs during clinical trials concluded it is substandard and reporting is inconsistent. Investigators commonly send reports to sponsors who are incorrectly categorised and lacking in critical information, which can complicate the detection of valid safety signals. In our presentation, we will describe an electronic data capture system, which has been designed to support clinical trial processes by reducing the resource burden on investigators, improving overall trial efficiencies, and making trials safer for patients. This proprietary technology was developed using expertise proven in the delivery of the world’s first prospective, phase 3b real-world trial, ‘The Salford Lung Study, ’ which enabled robust safety monitoring and reporting processes to be accomplished by the remote monitoring of patients’ EHRs. This technology enables safety alerts that are pre-defined by the protocol to be detected from the data extracted directly from the patients EHR. Based on study-specific criteria, which are created from the standard definition of a serious adverse event (SAE) and the safety profile of the medicinal product, the system alerts the investigator or study team to the safety alert. Each safety alert will require a clinical review by the investigator or delegate; examples of the types of alerts include hospital admission, death, hepatotoxicity, neutropenia, and acute renal failure. This is achieved in near real-time; safety alerts can be reviewed along with any additional information available to determine whether they meet the protocol-defined criteria for reporting or withdrawal. This active surveillance technology helps reduce the resource burden of the more traditional methods of AE detection for the investigators and study teams and can help eliminate reporting bias. Integration of multiple healthcare data sources enables much more complete and accurate safety data to be collected as part of a trial and can also provide an opportunity to evaluate a drug’s safety profile long-term, in post-trial follow-up. By utilising this robust and proven method for safety monitoring and reporting, a much higher risk of patient cohorts can be enrolled into trials, thus promoting inclusivity and diversity. Broadening eligibility criteria and adopting more inclusive recruitment practices in the later stages of drug development will increase the ability to understand the medicinal products risk-benefit profile across the patient population that is likely to use the product in clinical practice. Furthermore, this ground-breaking approach to AE detection not only provides sponsors with better-quality safety data for their products, but it reduces the resource burden on the investigator and study teams. With the data taken directly from the source, trial costs are reduced, with minimal data validation required and near real-time reporting enables safety concerns and signals to be detected more quickly than in a traditional RCT.

Keywords: more comprehensive and accurate safety data, near real-time safety alerts, reduced resource burden, safer trials

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Authors: Marisa Almeida AraúJo

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Artificial intelligence (AI) tools are being used (including in the criminal justice system) and becomingincreasingly popular. The many questions that these (future) super-beings pose the neuralgic center is rooted in the (old) problematic between rationality and morality. For instance, if we follow a Kantian perspective in which morality derives from AI, rationality will also surpass man in ethical and moral standards, questioning the nature of mind, the conscience of self and others, and moral. The recognition of superior intelligence in a non-human being puts us in the contingency of having to recognize a pair in a form of new coexistence and social relationship. Just think of the humanoid robot Sophia, capable of reasoning and conversation (and who has been recognized for Saudi citizenship; a fact that symbolically demonstrates our empathy with the being). Machines having a more intelligent mind, and even, eventually, with higher ethical standards to which, in the alluded categorical imperative, we would have to subject ourselves under penalty of contradiction with the universal Kantian law. Recognizing the complex ethical and legal issues and the significant impact on human rights and democratic functioning itself is the goal of our work.

Keywords: ethics, artificial intelligence, legal rules, principles, philosophy

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Authors: Justin Reverdi, Sixin Zhang, Serge Gratton, Said Aoues, Thomas Pellegrini

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In Vapor Cycle Systems, the flow sensor plays a key role in different monitoring and control purposes. However, physical sensors can be expensive, inaccurate, heavy, cumbersome, or highly sensitive to vibrations, which is especially problematic when embedded into an aircraft. The conception of a virtual sensor based on other standard sensors is a good alternative. In this paper, a data-driven model using a Convolutional Neural Network is proposed to estimate the flow of the compressor. To fit the model to our dataset, we tested different loss functions. We show in our application that a Dynamic Time Warping based loss function called DILATE leads to better dynamical performance than the vanilla mean squared error (MSE) loss function. DILATE allows choosing a trade-off between static and dynamic performance.

Keywords: deep learning, dynamic time warping, vapor cycle system, virtual sensor

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Authors: Zidani Abla

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Lymphoma is a common type of cancer that affects the lymphatic system, including the lymph nodes, spleen and other associated organs. There are two main types of lymphoma: Hodgkin's lymphoma and non-Hodgkin's lymphoma. The epidemiological, clinical and biological features of lymphoma are poorly studied in Algeria. The main objective of our study is to investigate the epidemiological, clinical, paraclinical, etiological, evolutionary and biological characteristics of non-Hodgkin's lymphoma (NHL) in the hematology department of the University Hospital Center (HUC) of Batna. This is a study of 10 patients diagnosed at Batna University Hospital. 70% were male and 30% female (sex ratio M/F= 2.33). Median age was 51.7 years. Pain, especially abdominal pain, was the main reason for consultation. Stage IV predominated (40%), followed by stage III (20%). Abdominal adenopathies (34%) were the most abundant. Secondary hepatic localization was predominant. Large B-cell NHL predominated, accounting for 60% of cases, followed by small B-cell NHL (30%). Serology for hepatitis B and C, and human immunodeficiency virus (HIV) was negative. Biologically, a predominance of hyperleukocytosis, polynuclear neutrophilic leukocytosis, lymphopenia and hypoalbuminemia were present in the majority of cases. In summary, our results remain to be compared with other works for other periods and other regions in order to generalize lymphoma percentages for the entire Algerian population.

Keywords: non Hodgkin's lymphoma, epidemiology, clinic, biology

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Authors: Peter Fedichev

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We studied fundamental aspects of aging to develop a mathematical model of gene regulatory network. We show that aging manifests itself as an inherent instability of gene network leading to exponential accumulation of regulatory errors with age. To validate our approach we studied age-dependent omic data such as transcriptomes, metabolomes etc. of different model organisms and humans. We build a computational platform based on our model to identify the targets and biomarkers of aging to design new drugs against aging and age-related diseases. As biomarkers of aging, we choose the rate of aging and the biological age since they completely determine the state of the organism. Since rate of aging rapidly changes in response to an external stress, this kind of biomarker can be useful as a tool for quantitative efficacy assessment of drugs, their combinations, dose optimization, chronic toxicity estimate, personalized therapies selection, clinical endpoints achievement (within clinical research), and death risk assessments. According to our model, we propose a method for targets identification for further interventions against aging and age-related diseases. Being a biotech company, we offer a complete pipeline to develop an anti-aging drug-candidate.

Keywords: aging, longevity, biomarkers, senescence

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Authors: Ahmed Atwa, Ashraf Hafez, Mohamed Abdelhameed, Adel Nabeeh, Mohamed Dawaba, Tamer Helmy

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Introduction and Objective: Tumour staging and grading do not usually reflect the future behavior of Wilms' tumor (WT) regarding mortality. Therefore, in this study, P53, Ki67 and cyclin A immunohistochemistry were used in a trial to predict WT cancer-specific survival (CSS). Methods: In this nonconcurrent cohort study, patients' archived data, including age at presentation, gender, history, clinical examination and radiological investigations, were retrieved then the patients were reviewed at the outpatient clinic of a tertiary care center by history-taking, clinical examination and radiological investigations to detect the oncological outcome. Cases that received preoperative chemotherapy or died due to causes other than WT were excluded. Formalin-fixed, paraffin-embedded specimens obtained from the previously preserved blocks at the pathology laboratory were taken on positively charged slides for IHC with p53, Ki67 and cyclin A. All specimens were examined by an experienced histopathologist devoted to the urological practice and blinded to the patient's clinical findings. P53 and cyclin A staining were scored as 0 (no nuclear staining),1 (<10% nuclear staining), 2 (10-50% nuclear staining) and 3 (>50% nuclear staining). Ki67 proliferation index (PI) was graded as low, borderline and high. Results: Of the 75 cases, 40 (53.3%) were males and 35 (46.7%) were females, and the median age was 36 months (2-216). With a mean follow-up of 78.6±31 months, cancer-specific mortality (CSM) occurred in 15 (20%) and 11 (14.7%) patients, respectively. Kaplan-Meier curve was used for survival analysis, and groups were compared using the Log-rank test. Multivariate logistic regression and Cox regression were not used because only one variable (cyclin A) had shown statistical significance (P=.02), whereas the other significant factor (residual tumor) had few cases. Conclusions: Cyclin A IHC should be considered as a marker for the prediction of WT CSS. Prospective studies with a larger sample size are needed.

Keywords: wilms’ tumour, nephroblastoma, urology, survival

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Authors: Merilin Ivanova Ivanova, Kalin Dimitrov Atanasov, Stefan Petrov Enchev

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Backgroud: Neuromyelitis optica spectrum disorder, also known as Devic’s disease, is a relapsing demyelinating autoimmune inflammatory disorder of the central nervous system associated with anti-aquaporin 4 (AQP4) antibodies that can manifest with devastating secondary neurological deficits. Most commonly affected are the optic nerves and the spinal cord-clinically this is often presented with optic neuritis (loss of vision), transverse myelitis(weakness or paralysis of extremities),lack of bladder and bowel control, numbness. APS is a core clinical entity of NMOSD and adds to the clinical representation the following symptoms: intractable nausea, vomiting and hiccup, it usually occurs isolated at onset, and can lead to a significant delay in the diagnosis. The condition may have features similar to multiple sclerosis (MS) but the episodes are worse in NMO and it is treated differently. It could be relapsing or monophasic. Possible complications are visual field defects and motor impairment, with potential blindness and irreversible motor deficits. In severe cases, myogenic respiratory failure ensues. The incidence of reported cases is approximately 0.3–4.4 per 100,000. Paediatric cases of NMOSD are rare but have been reported occasionally, comprising less than 5% of the reported cases. Objective: The case serves to show the difficulty when it comes to the diagnostic processes regarding a rare autoimmune disease with non- specific symptoms, taking large interval of rimes to reveal as complete clinical manifestation of the aforementioned syndrome, as well as the necessity of multidisciplinary approach in the setting of а general paediatric department in аn emergency hospital. Methods: itpatient's history, clinical presentation, and information from the used diagnostic tools(MRI with contrast of the central nervous system) lead us to the conclusion .This was later on confirmed by the positive results from the anti-aquaporin 4 (AQP4) antibody serology test. Conclusion: APS is a common symptom of NMOSD and is considered a challenge in a differential-diagnostic plan. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing thorough physical examinations are essential if we are to reduce and avoid misdiagnosis.

Keywords: neuromyelitis, devic's disease, hiccup, autoimmune, MRI

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Authors: Olivier Mulisya, Guelord Barasima, Henry Mark Lugobe, Philémon Matumo, Bienfait Mumbere Vahwere, Hilaire Mutuka, Zawadi Léocadie, Wesley Lumika

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Abdominal pregnancy is defined as pregnancy anywhere within the peritoneal cavity, exclusive of tubal, ovarian, or broad ligament locations. It is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be frequently missed in most poor-resource settings because of poor antenatal coverage, low socioeconomic status in most of the patients as well as lack of adequate medical resources. Clinical diagnosis can be very difficult and an ultrasound scan is very helpful during the early stages of gestation but can also be disappointing in the later stages. We report a case of a 25-year-old woman with severe abdominal pain not amended with any medication. A clinical picture of shock lead to an emergency laparotomy which confirmed the diagnosis of abdominal pregnancy. The ministry of health in developing countries should make an effort to make routine early ultrasounds accessible to pregnant women, and obstetricians should keep in mind the possibility of ectopic pregnancy, irrespective of the gestational age.

Keywords: abdominal pregnancy, live new bron, ultrasound imaging, abdominal pain

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Authors: Yu-Fong Lin

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The main purpose of this study is to explore the impact of different lighting arrangements that create different visual environments in a 3C retail store on the perception, psychology, and shopping tendencies of consumers of different genders. In recent years, the ‘emotional shopping’ model has been widely accepted in the consumer market; in addition to the emotional meaning and value of a product, the in-store ‘shopping atmosphere’ has also been increasingly regarded as significant. The lighting serves as an important environmental stimulus that influences the atmosphere of a store. Altering the lighting can change the color, the shape, and the atmosphere of a space. A successful retail lighting design can not only attract consumers’ attention and generate their interest in various goods, but it can also affect consumers’ shopping approach, behavior, and desires. 3C electronic products have become mainstream in the current consumer market. Consumers of different genders may demonstrate different behaviors and preferences within a 3C store environment. This study tests the impact of a combination of lighting contrasts and color temperatures in a 3C retail store on the visual perception and psychological reactions of consumers of different genders. The research design employs an experimental method to collect data from subjects and then uses statistical analysis adhering to a 2 x 2 x 2 factorial design to identify the influences of different lighting environments. This study utilizes virtual reality technology as the primary method by which to create four virtual store lighting environments. The four lighting conditions are as follows: high contrast/cool tone, high contrast/warm tone, low contrast/cool tone, and low contrast/warm tone. Differences in the virtual lighting and the environment are used to test subjects’ visual perceptions, emotional reactions, store satisfaction, approach-avoidance intentions, and spatial atmosphere preferences. The findings of our preliminary test indicate that female subjects have a higher pleasure response than male subjects in a 3C retail store. Based on the findings of our preliminary test, the researchers modified the contents of the questionnaires and the virtual 3C retail environment with different lighting conditions in order to conduct the final experiment. The results will provide information about the effects of retail lighting on the environmental psychology and the psychological reactions of consumers of different genders in a 3C retail store lighting environment. These results will enable useful practical guidelines about creating 3C retail store lighting and atmosphere for retailers and interior designers to be established.

Keywords: 3C retail store, environmental stimuli, lighting, virtual reality

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Authors: Funda Terzi, Elif Dogan, Ayse B. Kapcak

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In this report, clinical, radiological, macroscopic, and histopathological findings of apocrine sweat gland adenocarcinoma are presented in a 13-year-old male tabby cat. In clinical examination, soft tissue masses were detected in the caudal abdomen and left tuber coxae. On radiological examination, subcutaneous masses with soft tissue contrast appearance were detected, and the masses were surgically removed under general anesthesia. The sizes of the masses were approximately 2x2x3 cm in the caudal abdomen and approximately 1x1x2 cm in the tuber coxae region. The cross-section of the mass was whitish-yellow in color. After the masses were fixed in 10% formaldehyde solution, a routine histopathology procedure was applied. In histopathological examination, apocrine sweat glands in a cystic structure and extensions from the center of the cyst to the lumen were determined, and anisonucleosis, anisocytosis, and anaplastic cells with giant nuclei were observed in the epithelial cells of the gland facing the lumen. A diagnosis of papillary-cystic type apocrine sweat gland adenocarcinoma was made with these findings.

Keywords: apocrine sweat gland, carcinoma, cat, histopathology

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Authors: Abeer M. Orabi

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Midwives are being seen as a key factor in returning birth care to a normal physiologic process that is woman-centered. On the other hand, more needs to be done to increase access for every woman to professional midwifery care. Because of the nature of the midwifery specialty, the magnitude of the effect that can result from a lack of knowledge if midwives make a mistake in their care has the potential to affect a large number of the birthing population. So, the development, running, and management of midwifery educational programs should follow international standards and come after a thorough community needs assessment. At the same time, the number of accredited midwifery educational programs needs to be increased so that larger numbers of midwives will be educated and qualified, as well as access to skilled midwifery care will be increased. Indeed, the selection of promising midwives is important for the successful completion of an educational program, achievement of the program goals, and retention of graduates in the field. Further, the number of schooled midwives in midwifery education programs, their background, and their experience constitute some concerns in the higher education industry. Basically, preceptors and clinical sites are major contributors to the midwifery education process, as educational programs rely on them to provide clinical practice opportunities. In this regard, the selection of clinical training sites should be based on certain criteria to ensure their readiness for the intended training experiences. After that, communication, collaboration, and liaison between teaching faculty and field staff should be maintained. However, the shortage of clinical preceptors and the massive reduction in the number of practicing midwives, in addition to unmanageable workloads, act as significant barriers to midwifery education. Moreover, the medicalized approach inherent in the hospital setting makes it difficult to practice the midwifery model of care, such as watchful waiting, non-interference in normal processes, and judicious use of interventions. Furthermore, creating a motivating study environment is crucial for avoiding unnecessary withdrawal and retention in any educational program. It is well understood that research is an essential component of any profession for achieving its optimal goal and providing a foundation and evidence for its practices, and midwifery is no exception. Midwives have been playing an important role in generating their own research. However, the selection of novel, researchable, and sustainable topics considering community health needs is also a challenge. In conclusion, ongoing education and research are the lifeblood of the midwifery profession to offer a highly competent and qualified workforce. However, many challenges are being faced, and barriers are hindering their improvement.

Keywords: barriers, challenges, midwifery education, educational programs

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Authors: Marina Sousa, Célia Barreto Carvalho, Carolina da Motta, Joana Cabral, Vera Pereira, Suzana Nunes Caldeira, Ermelindo Peixoto

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Paranoid ideation is a common thought process that constitutes a defense against perceived social threats. The current study aimed at the characterization of paranoid ideation in youths and to explore the possible predictors involved in the development of paranoid ideations. Paranoid ideation, shame, submission, early childhood memories and current depressive, anxious and stress symptomatology was assessed in a sample of 1516 Portuguese youths. Higher frequencies of paranoid ideation were observed, particularly in females and youths from lower socio-economic status. The main predictors identified relates to submissive behaviors and adverse childhood experiences, and especially to shame feelings. The current study emphasizes that the these predictors are similar to findings in adults and clinical populations, and future implications to research and clinical practice aiming at paranoid ideations are discussed, as well as the pertinence of the study of mediating factors that allow a wider understanding of this thought process in younger populations and the prevention of psychopathology in adulthood.

Keywords: adolescence, early memories, paranoid ideation, parenting styles, shame, submissiveness

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Authors: Naheed Niaz, Nimra Naeem, Bushra Uzair, Riffat Tahira

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Antibacterial activity of different traditional plants essential oils against clinical isolates of Methicillin-resistant Staphylococcus aureus (MRSA) through disk diffusion method was evaluated. All the tested essential oils, in different concentrations, inhibited growth of S. aureus to varying degrees. Cinnamon and Thyme essential oils were observed to be the “best” against test pathogen. Even at lowest concentration of these essential oils i.e. 25 µl/ml, clear zone of inhibition was recorded 9+0.085mm and 8+0.051mm respectively, and at higher concentrations there was a total reduction in growth of MRSA. The study also focused on analyzing the synergistic effects of essential oils in combination with amoxicillin. Results showed that oregano and pennyroyal mint essential oils which were not very effective alone turned out to be strong synergistic enhancers. The activity increased with increase in concentration of the essential oils. It may be concluded from present results that cinnamon and thyme essential oils could be used as potential antimicrobial source for the treatment of infections caused by Methicillin-resistant Staphylococcus aureus (MRSA).

Keywords: Staphylococcus aureus, essential oils, antibiotics, combination therapy, minimum inhibitory concentration

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Authors: Abdoullah Nyassi, Golam Sarwar, Sarra Baldeh, Mamadou S. K. Jallow, Bai Lamin Dondeh, Isaac Osei, Grant A. Mackenzie

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A randomized controlled trial is the "gold standard" for evaluating the efficacy of an intervention. Large-scale, cluster-randomized trials are expensive and difficult to conduct, though. To guarantee the validity and generalizability of findings, high-quality, dependable, and accurate data management systems are necessary. Robust data management systems are crucial for optimizing and validating the quality, accuracy, and dependability of trial data. Regarding the difficulties of data gathering in clinical trials in low-resource areas, there is a scarcity of literature on this subject, which may raise concerns. Effective data management systems and implementation goals should be part of trial procedures. Publicizing the creative clinical data management techniques used in clinical trials should boost public confidence in the study's conclusions and encourage further replication. In the ongoing pneumococcal vaccine schedule study in rural Gambia, this report details the development and deployment of multi-data management systems and methodologies. We implemented six different data management, synchronization, and reporting systems using Microsoft Access, RedCap, SQL, Visual Basic, Ruby, and ASP.NET. Additionally, data synchronization tools were developed to integrate data from these systems into the central server for reporting systems. Clinician, lab, and field data validation systems and methodologies are the main topics of this report. Our process development efforts across all domains were driven by the complexity of research project data collected in real-time data, online reporting, data synchronization, and ways for cleaning and verifying data. Consequently, we effectively used multi-data management systems, demonstrating the value of creative approaches in enhancing the consistency, accuracy, and reporting of trial data in a poor resource setting.

Keywords: data management, data collection, data cleaning, cluster-randomized trial

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Authors: Bandhan Dey, Muhsina Bintoon Yiasha, Gulam Sulaman Choudhury

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Chest disease is one of the most problematic ailments in our regular life. There are many known chest diseases out there. Diagnosing them correctly plays a vital role in the process of treatment. There are many methods available explicitly developed for different chest diseases. But the most common approach for diagnosing these diseases is through X-ray. In this paper, we proposed a multi-classification deep learning model for diagnosing COVID-19, lung cancer, pneumonia, tuberculosis, and atelectasis from chest X-rays. In the present work, we used the transfer learning method for better accuracy and fast training phase. The performance of three architectures is considered: InceptionV3, VGG-16, and VGG-19. We evaluated these deep learning architectures using public digital chest x-ray datasets with six classes (i.e., COVID-19, lung cancer, pneumonia, tuberculosis, atelectasis, and normal). The experiments are conducted on six-classification, and we found that VGG16 outperforms other proposed models with an accuracy of 95%.

Keywords: deep learning, image classification, X-ray images, Tensorflow, Keras, chest diseases, convolutional neural networks, multi-classification

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Authors: Nibedita Priyadarsini

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It is said that Ethics has a wide range of application which mainly deals with human life and human behavior. All ethical decisions are ultimately concerned with life and death. Both life and death must be considered dignified. Medical ethics with its different topics mostly deals with life and death concepts among which euthanasia is one. Various types of debates continue over Euthanasia long since. The question of putting an end to someone’s life has aroused controversial in legal sphere as well as in moral sphere. To permit or not to permit has remained an enigma the world over. Modern medicine is in the stage of transcending limits that cannot be set aside. The morality of allowing people to die without treatment has become more important as methods of treatment have become more sophisticated. Allowing someone to die states an essential recognition that there is some point in any terminal illness when further curative treatment has no purpose and the patient in such situation should allow dying a natural death in comfort, peace, and dignity, without any interference from medical science and technology. But taking a human life is in general sense is illogical in itself. It can be said that when we kill someone, we cause the death; whereas if we merely let someone die, then we will not be responsible for anyone’s death. This point is often made in connection with the euthanasia cases and which is often debatable. Euthanasia in the pediatric age group involves some important issues that are different from those of adult issues. The main distinction that occurs is that the infants and newborns and young children are not able to decide about their future as the adult does. In certain cases, where the child born with some serious deformities with no hope of recovery, in that cases doctor decide not to perform surgery in order to remove the blockage, and let the baby die. Our aim in this paper is to examine, whether it is ethically justified to withhold or to apply euthanasia on the part of the defective infant. What to do with severely defective infants from earliest time if got to know that they are not going to survive at all? Here, it will deal mostly with the ethics in deciding the relevant ethical concerns in the practice of euthanasia with the defective newborns issues. Some cases in relation to disabled infants and newborn baby will be taken in order to show what to do in a critical condition, that the patient and family members undergoes and under which condition those could be eradicated, if not all but some. The final choice must be with the benefit of the patient.

Keywords: ethics, medical ethics, euthanasia, defective newborns

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Authors: Junaid Mahmood Alam

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Revalidating and harmonizing clinical chemistry analytical principles and optimizing methods through quality control programs and assessments is the preeminent means to attain optimal outcome within the clinical laboratory services. Present study reports revalidation of our existing IFCC regularized analytical methods, particularly hepatic and thyroid function tests, by optimization of precision analyses and processing through external and internal quality assessments and regression determination. Parametric components of hepatic (Bilirubin ALT, γGT, ALP), cardiac (LDH, AST, Trop I) and thyroid/pituitary (T3, T4, TSH, FT3, FT4) function tests were used to validate analytical techniques on automated chemistry and immunological analyzers namely Hitachi 912, Cobas 6000 e601, Cobas c501, Cobas e411 with UV kinetic, colorimetric dry chemistry principles and Electro-Chemiluminescence immunoassay (ECLi) techniques. Process of validation and revalidation was completed with evaluating and assessing the precision analyzed Preci-control data of various instruments plotting against each other with regression analyses R2. Results showed that: Revalidation and optimization of respective parameters that were accredited through CAP, CLSI and NEQAPP assessments depicted 99.0% to 99.8% optimization, in addition to the methodology and instruments used for analyses. Regression R2 analysis of BilT was 0.996, whereas that of ALT, ALP, γGT, LDH, AST, Trop I, T3, T4, TSH, FT3, and FT4 exhibited R2 0.998, 0.997, 0.993, 0.967, 0.970, 0.980, 0.976, 0.996, 0.997, 0.997, and R2 0.990, respectively. This confirmed marked harmonization of analytical methods and instrumentations thus revalidating optimized precision standardization as per IFCC recommended guidelines. It is concluded that practices of revalidating and harmonizing the existing or any new services should be followed by all clinical laboratories, especially those associated with tertiary care hospital. This is will ensure deliverance of standardized, proficiency tested, optimized services for prompt and better patient care that will guarantee maximum patients’ confidence.

Keywords: revalidation, standardized, IFCC, CAP, harmonized

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Authors: Vinko Viducic, Jelena Žanic Mikulicic, Maja Racic, Kristina Sladojevic

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The research presented in this paper has been focused on analyzing the impact of traffic on the sustainable development of tourism in Croatia's Dubrovacko-Neretvanska County by the year 2020, based on the figures and trends reported in 2014 and using the relevant variables that characterise the synergy of traffic and tourism in, speaking from the geographic viewpoint, the most problematic county in the Republic of Croatia. The basic hypothesis has been confirmed through scientifically obtained research results, through the quantification of the model's variables and the direct growth rates of the designed model. On the basis of scientific insights into the sustainable development of traffic and tourism in Dubrovacko-Neretvanska County, it is possible to propose a new information model for traffic at the service of the sustainable development of tourism in the County for the period 2014-2020.

Keywords: environment protection, hotel industry, private sector, quantification

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Authors: Liana Gomide, Juliana Rodrigues

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The morphology of the foot defines its mode of operation and a biomechanical reform indispensable for a symmetrical distribution of plantar pressures in order not to overload some of its components in isolation. High plantar pressures at specific points in the foot may be a causal factor in several orthopedic disorders that affect the feet such as pain and stress fracture. With digital baro-podometry equipment one can observe an intensity of pressures along the entire foot and quantify some of the movements, such as a subtalar pronation present in the midfoot region. Although, they are involved in microtraumas. In clinical practice, excessive movement has been limited with the use of different taping techniques applied on the plantar arch. Thus, the objective of the present study was to analyze and compare the influence of the inelastic and elastic taping on the distribution of plantar pressure of runners pronators. This is a randomized clinical trial and blind-crossover. Twenty (20) male subjects, mean age 33 ± 7 years old, mean body mass of 71 ± 7 kg, mean height of 174 ± 6 cm, were included in the study. A data collection was carried out by a single research through barop-odometry equipment - Tekscan, model F-scan mobile. The tests were performed at three different times. In the first, an initial barop-odometric evaluation was performed, without a bandage application, with edges at a speed of 9.0 km/h. In the second and third moments, the inelastic or elastic taping was applied consecutively, according to the definition defined in the randomization. As results, it was observed that both as inelastic and elastic taping, provided significant reductions in contact pressure and peak pressure values when compared to the moment without a taping. However, an elastic taping was more effective in decreasing contact pressure (no bandage = 714 ± 201, elastic taping = 690 ± 210 and inelastic taping = 716 ± 180) and no peak pressure in the midfoot region (no bandage = 1490 ± 42, elastic taping = 1273 ± 323 and inelastic taping = 1487 ± 437). It is possible to conclude that it is an elastic taping provided by pressure in the middle region, thereby reducing the subtalar pronunciation event during the run.

Keywords: elastic taping, inelastic taping, running, subtalar pronation

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Authors: Derick Shi-Chen Ou, Liang-Yu Chen

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Background: Acupuncture, a potential alternative, and complementary therapy revealed insufficient evidence in depression treatment. The efficacy of acupuncture treatment was still uncertainty. To evaluate the effect of acupuncture in treating depression, the randomized controlled trials (RCTs) were examined. Methods: RCTs of the acupuncture therapy in treating major depression were searched from MEDLINE from 2007 to 2017. Keywords used for searching strategy included acupuncture, acupoint, and major depressive disorder. Results: Among the nine RCTs, four studies demonstrated great improvement in acupuncture treatment and five studies revealed the effectiveness of acupuncture intervention in medication. General trends suggest that acupuncture treatment is as effective as antidepressants with minimal side effects. Conclusion: Despite the promising results from the RCTs, there are still a variety of limitations, including small sample size, imprecise enrollment criteria, difficulties with blinding, randomization, short duration of study and lack of longitudinal follow-up. Therefore, the evidence that acupuncture as an alternative therapy for depression is inconclusive. More rigorously designed RCTs should be conducted in the future.

Keywords: acupuncture, major depressive disorders, randomized clinical trials, antidepressants

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Authors: Neeraj Vij, Christian Leber, Kenneth Schmidt

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Introduction: Total knee arthroplasty is a common procedure. It is well known that the biomechanics of the knee do not fully return to their normal state. Motion analysis has been used to study the biomechanics of the knee after total knee arthroplasty. The purpose of this scoping review is to summarize the current use of gait analysis in total knee arthroplasty and to identify the preoperative motion analysis parameters for which a systematic review aimed at determining the reliability and validity may be warranted. Materials and Methods: This IRB-exempt scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist strictly. Five search engines were searched for a total of 279 articles. Articles underwent a title and abstract screening process followed by full-text screening. Included articles were placed in the following sections: the role of gait analysis as a research tool for operative decisions, other research applications for motion analysis in total knee arthroplasty, gait analysis as a tool in predicting radiologic outcomes, gait analysis as a tool in predicting clinical outcomes. Results: Eleven articles studied gait analysis as a research tool in studying operative decisions. Motion analysis is currently used to study surgical approaches, surgical techniques, and implant choice. Five articles studied other research applications for motion analysis in total knee arthroplasty. Other research applications for motion analysis currently include studying the role of the unicompartmental knee arthroplasty and novel physical therapy protocols aimed at optimizing post-operative care. Two articles studied motion analysis as a tool for predicting radiographic outcomes. Preoperative gait analysis has identified parameters than can predict postoperative tibial component migration. 15 articles studied motion analysis in conjunction with clinical scores. Conclusions: There is a broad range of applications within the research domain of total knee arthroplasty. The potential application is likely larger. However, the current literature is limited by vague definitions of ‘gait analysis’ or ‘motion analysis’ and a limited number of articles with preoperative and postoperative functional and clinical measures. Knee adduction moment, knee adduction impulse, total knee range of motion, varus angle, cadence, stride length, and velocity have the potential for integration into composite clinical scores. A systematic review aimed at determining the validity, reliability, sensitivities, and specificities of these variables is warranted.

Keywords: motion analysis, joint replacement, patient-reported outcomes, knee surgery

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Authors: Nagwa E. Abd Elazim, Maha S. El-naggar, Rania H. Mohamed, Sara M. Awad

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Background: Radiodermatitis is a common side effect of radiation therapy for breast cancer. However, there is no current consensus about effective standard therapy for the prevention and management of radiation dermatitis. Topical ectoine has demonstrated efficacy in the treatment of atopic dermatitis owing to its anti-inflammatory activity. Objective: To evaluate the efficacy of topical ectoine in comparison to traditional topical dexpanthenol treatment in the management of acute radiodermatitis in breast cancer patients undergoing adjuvant radiotherapy. Methods: Fifty patients were randomized to use either dexpanthenol 0.5% cream (25 patients), or ectoin 7% cream (25 patients), applied twice daily to the irradiated area during the radiation period and continued for 2 weeks after cessation of radiotherapy. Assessment of radiation skin toxicity using Common Terminology Criteria of Adverse Events (CTCAE) v4.0, radiation-associated symptoms, and adverse events were undertaken weekly during radiotherapy and 2 weeks after the end of radiotherapy. Results: Topical ectoine showed some clinical benefit over dexpanthenol, as shown by delayed time to onset (at week 3 versus week 2, respectively) and larger number of patients who reached grade 0 at the end of treatment (64% vs. 48%, respectively). The clinical symptoms of pain (p = 0.003) and itching (p = 0.001) attributable to radiation were less pronounced with ectoine than with dexpanthenol. Burning and hyperpigmentation were the most common side effects with ectoine. However, no significant difference between dexpanthenol and ectoine treatments was found in any of the side effects (p = 0.1). Conclusion: Ectoin was overall more effective in improving radiation dermatitis than topical dexpanthenol in breast cancer patients. Ectoin could be proposed as a preventive or curative treatment for patients undergoing postoperative irradiation for breast cancer. Further clinical studies with a larger number of patients are recommended for the confirmation of these preliminary results.

Keywords: breast cancer, dexapanthenol, ectoin, radiation dermatitis

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Authors: Sathyaseelan Subramaniam, Jacqueline Bober, Jennifer Chao, Shahriar Zehtabchi

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Background: Emergency physicians frequently evaluate skin and soft tissue infections in order to differentiate abscess from cellulitis. This helps determine which patients will benefit from incision and drainage. Our objective was to determine the operating characteristics of point-of-care ultrasound (POCUS) compared to clinical examination in identifying abscesses in emergency department (ED) patients with features of skin and soft tissue infections. Methods: We performed a comprehensive search in the following databases: Medline, Web of Science, EMBASE, CINAHL and Cochrane Library. Trials were included if they compared the operating characteristics of POCUS with clinical examination in identifying skin and soft tissue abscesses. Trials that included patients with oropharyngeal abscesses or that requiring abscess drainage in the operating room were excluded. The presence of an abscess was determined by pus drainage. No pus seen on incision or resolution of symptoms without pus drainage at follow up, determined the absence of an abscess. Quality of included trials was assessed using GRADE criteria. Operating characteristics of POCUS are reported as sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios and the respective 95% confidence intervals (CI). Summary measures were calculated by generating a hierarchical summary receiver operating characteristic model (HSROC). Results: Out of 3203 references identified, 5 observational studies with 615 patients in aggregate were included (2 adults and 3 pediatrics). We rated the quality of 3 trials as low and 2 as very low. The operating characteristics of POCUS and clinical examination in identifying soft tissue abscesses are presented in the table. The HSROC for POCUS revealed a sensitivity of 96% (95% CI = 89-98%), specificity of 79% (95% CI = 71-86), LR+ of 4.6 (95% CI = 3.2-6.8), and LR- of 0.06 (95% CI = 0.02-0.2). Conclusion: Existing evidence indicates that POCUS is useful in identifying abscesses in ED patients with skin or soft tissue infections.

Keywords: abscess, point-of-care ultrasound, pocus, skin and soft tissue infection

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Authors: Valentina Milanova, Kalina Mihaylova, Iva Lazarova

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The mechanisms by which female genital infections are detected are varied and include clinician-collected high vaginal swabs, clinician-collected endocervical swabs, patient-collected vaginal swabs, and first-pass urine samples. Vaginal health screening has chronically low rates of uptake. This highlights the unmet need for a screening tool with comparable diagnostic accuracy which is familiar, convenient and easy to use for people. The Daye™ medical grade tampon offers an alternative to traditional sampling methods with the potential of increasing screening uptake among people previously too embarrassed or busy to attend gynecological appointments. In this white paper, the results of stability studies and a comparative clinical trial are discussed to assess the suitability of the device for the collection of vaginal samples for various clinical assessments. The tampon has demonstrated good sample stability and comparable sample quality compared to a self-collected vaginal swab and a clinician-collected cervical swab.

Keywords: vaginal microbiome, vaginal infections, gynaecological infections, female health, menstrual tampons, in vitro diagnostics

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Authors: Rithi Baruah

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The aviation industry is one such sectors whose primary aim is to work for the safety and comfort of their clients and customers. The crew members in the aviation industry include pilots, flight attendants, air traffic controllers, baggage personnel and maintenance personnel. This study will concentrate on the frontline employees of the aviation industry, the flight attendants. Flight attendants belong to the niche group of population who are paid to smile. Although the profession seems to be very glamorous, it is physically and psychologically very taxing. Energy at workplace is a fairly new concept and is an organizational resource which helps employee attain their goals. Therefore, the researcher will aim to establish the relationship between relational energy and the major issue of emotional labor and cognitive flexibility among flight attendants. The researcher will hypothesize that there will be a negative relationship between relational energy and emotional labour, and a positive relationship between relational energy and cognitive flexibility. Also, a positive relationship will be expected between cognitive flexibility and emotional labour of cabin crew. A quantitative research design will be used to study the relationship among 50 flight attendants in India. The findings of the research will not only help the aviation sector but will be a major contribution to the existing literature of aviation psychology in India which is scanty. The relationships can also provide scope to develop a model using the same. From crew resource management and aviation psychology perspectives, relationships among the study variables will not only provide scope for helping the aviation employees in particular but also develop the performance and safety of aviation sector at large.

Keywords: cabin crew, cognitive flexibility, emotional labour, relational energy

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Authors: Claudius Peter Van Wyk

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Given the increasingly manifest phenomena, as described in complexity theory, of volatility, uncertainty, complexity and ambiguity (VUCA), Taleb's notion of 'antifragility, has a significant contribution to make to positive psychology applied to wellbeing. Antifragility is argued to be fundamentally different from the concepts of resiliency; as the ability to recover from failure, and robustness; as the ability to resist failure. Rather it describes the capacity to reorganise in the face of stress in such a way as to cope more effectively with systemic challenges. The concept, which has been applied in disciplines ranging from physics, molecular biology, planning, engineering, and computer science, can now be considered for its application in individual human and social wellbeing. There are strong correlations to Antonovsky's model of 'salutogenesis' in which an attitude and competencies are developed of transforming burdening factors into greater resourcefulness. We demonstrate, from the perspective of neuroscience, how technology measuring nervous system coherence can be coupled to acquired psychodynamic approaches to not only identify contextual stressors, utilise biofeedback instruments for facilitating greater coherence, but apply these insights to specific life stressors that compromise well-being. Employing an on-going case study with BMW South Africa, the neurological mapping is demonstrated together with 'reframing' and emotional anchoring techniques from neurolinguistic programming. The argument is contextualised in the discipline of psychoneuroimmunology which describes the stress pathways from the CNS and endocrine systems and their impact on immune function and the capacity to restore homeostasis.

Keywords: antifragility, complexity, neuroscience, psychoneuroimmunology, salutogenesis, volatility

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Authors: Michael Zaidman, Naum Simanovsky

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Introduction. Symptomatic tarsal coalition with rigid flat foot often demands operative solution. An isolated coalition resection does not guarantee pain relief; correction of co-existing foot deformity may be required. The objective of the study was to analyze the results of combination of tarsal coalition resection and arthroereisis. Patients and methods. We retrospectively reviewed medical records and radiographs of children operatively treated in our institution for symptomatic calcaneonavicular or talocalcaneal coalition between the years 2019 and 2022. Eight patients (twelve feet), 4 boys and 4 girls with mean age 11.2 years, were included in the study. In six patients (10 feet) calcaneonavicular coalition was diagnosed, two patients (two feet) sustained talonavicular coalition. To quantify degrees of foot deformity, we used calcaneal pitch angle, lateral talar-first metatarsal (Meary's) angle, and talonavicular coverage angle. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Score. Results. The mean follow-up was 28 month. The preoperative mean talonavicular coverage angle was 17,75º as compared with postoperative mean angle of 5.4º. The calcaneal pitch angle improved from mean 6,8º to 16,4º. The mean preoperative Meary’s angle of -11.3º improved to mean 2.8º. The preoperative mean AOFAS score improved from 54.7 to 93.1 points post-operatively. In nine of twelve feet, overall clinical outcome judged by AOFAS scale was excellent (90-100 points), in three feet was good (80-90 points). Six patients (ten feet) obviously improved their subtalar range of motion. Conclusion. For symptomatic stiff or rigid flat feet associated with tarsal coalition, the combination of coalition resection and arthroereisis leads to normalization of radiographic parameters, clinical and functional improvement with good patient’s satisfaction and likely to be more effective than the isolated procedures.

Keywords: rigid flat foot, tarsal coalition resection, arthroereisis, outcome

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Authors: Maria Do Carmo Baracho De Alencar

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Back pain is considered a worldwide public health problem and has led to numerous work-related absence from work and public spending on rehabilitation, as well as difficulties in the process of professional rehabilitation and return to work. Also, the rehabilitation of workers is one of the great challenges today and for the field of Workers' Health in Brazil. Aim: To investigate the procedures related to the professional rehabilitation of insured workers affected by chronic low back pain, based on the perceptions of professional counselors. Methods: A list of related professional counselors was obtained from the Professional Rehabilitation Coordination of the Baixada Santista (SP) region, and from the Social Security National Institute of Brazil, and in which cities they worked. Semistructured and individual interview was scheduled, based on a pre-elaborated script, containing questions about procedures, experiences at work and feelings. The interviews were recorded and transcribed in full for content analysis. Results: Ten (10) professional counselors of both genders and from nine (9) cities from the Baixada Santista region participated in the study. Aged between 31 and 64 years, and time in service between 4 and 38 years. Only one of the professionals was graduaded in Psychology. Among the testimonies emerged the high demand of work, the lack of interest of companies, medical authority, the social helplessness after rehabilitation process, difficulty in assessing invisible pain, and suffering, anguish, and frustration at work, between others. Conclusion: The study contributes to reflections about the importance of interdisciplinary actions and the Psychology in the processes of professional rehabilitation and readaptation in the process of return to work.

Keywords: low back pain, rehabilitation, work, occupational health

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Authors: Renzo Palomino, Alessandra Trujillo, Lidia Pacheco

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The document presents a study based on the incremental bearing capacity of silty clay soil with the incorporation of crushed PET fibers. For a better understanding of the behavior of soil, it is necessary to know its origin. The analyzed samples came from the subgrade layer of a highway that connects the cities of Muniches and Yurimaguas in Loreto, Peru. The material in this area usually has properties such as low support index, medium to high plasticity, and other characteristics that make it considered a ‘problematic’ soil due to factors such as climate, humidity, and geographical location. In addition, PET fibers are obtained from the decomposition of plastic bottles that are polluting agents with a high production rate in our country; in that sense, their use in a construction process represents a considerable reduction in environmental impact. Moreover, to perform a precise analysis of the behavior of this soil mixed with PET, tests such as the hydrometer test, Proctor and CBR with 15%, 10%, 5%, 4%, 3%, and 1% of PET with respect to the mass of the sample of natural soil were carried out. The results show that when a low percentage of PET is used, the support index increases.

Keywords: environmental impact, geotechnics, PET, silty clay soil

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Authors: Nadia K. Thalji

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In the timeless tapestry of human culture, theater, mythology, and psychology intersect to weave narratives that transcend temporal and spatial boundaries. For millennia, actors have stood as guardians of intuitive wisdom, their craft serving as a conduit for the collective unconscious. This paper embarks on a journey through the realms of creative expression, melding the insights of cross-cultural psychology with the mystical allure of serendipity and synchronicity. At the nexus of these disciplines lies the enigmatic process of active imagination, a gateway to the depths of the psyche elucidated by Jung. Within the hallowed confines of the black box theater at the Department of Performing Arts, UFRGS University in Brazil, this study unfolds. Over the span of four months, a cadre of artists embarked on a voyage of exploration, harnessing the powers of imagery, movement, sound, and dreams to birth a performance that resonated with the echoes of ancient wisdom. Drawing inspiration from the fabled Oracle of Delphi and the priestesses who once dwelled within its sacred precincts, the production delves into the liminal spaces where myth and history intertwine. Through the alchemy of storytelling, participants navigate the labyrinthine corridors of cultural memory, unraveling the threads that bind the past to the present. Central to this endeavor is the phenomenon of synchronicity, wherein seemingly disparate elements coalesce in a dance of cosmic resonance. Serendipity becomes a guiding force, leading actors and audience alike along unexpected pathways of discovery. As the boundaries between performer and spectator blur, the performance becomes a crucible wherein individual narratives merge to form a collective tapestry of shared experience. Yet, beneath the surface of spectacle lies a deeper truth: the exploration of the spiritual dimensions of artistic expression. Through intuitive inquiry and embodied practice, artists tap into reservoirs of insight that transcend rational comprehension. In the communion of minds and bodies, the stage becomes a sacred space wherein the numinous unfolds in all its ineffable glory. In essence, this paper serves as a testament to the transformative power of the creative act. Across cultures and epochs, the theater has served as a crucible wherein humanity grapples with the mysteries of existence. Through the lens of cross-cultural psychology, we glimpse the universal truths that underlie the myriad manifestations of human creativity. As we navigate the turbulent currents of modernity, the wisdom of the ancients beckons us to heed the call of the collective unconscious. In the synthesis of myth and meaning, we find solace amidst the chaos, forging connections that transcend the boundaries of time and space. And in the sacred precincts of the theater, we discover the eternal truth that art is, and always shall be, the soul's journey into the unknown.

Keywords: theater, mythology, cross-cultural, synchronicity, creativity, serendipity, spiritual

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