Search results for: clinical prediction models

Authors: Muhammad Khairi bin Sulaiman

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The utilization of Building Information Modelling (BIM) in the construction industry has provided an opportunity for designers in the Architecture, Engineering and Construction (AEC) industry to proceed from the conventional method of using manual drafting to a way that creates alternative designs quickly, produces more accurate, reliable and consistent outputs. By using BIM Software, designers can create digital content that manipulates the use of data using the parametric model of BIM. With BIM software, more alternative designs can be created quickly and design problems can be explored further to produce a better design faster than conventional design methods. Generally, BIM is used as a documentation mechanism and has not been fully explored and utilised its capabilities as a design tool. Relative to the current issue, Modular Coordination (MC) design as a sustainable design practice is encouraged since MC design will reduce material wastage through standard dimensioning, pre-fabrication, repetitive, modular construction and components. However, MC design involves a complex process of rules and dimensions. Therefore, a tool is needed to make this process easier. Since the parameters in BIM can easily be manipulated to follow MC rules and dimensioning, thus, the integration of BIM software with MC design is proposed for architects during the design stage. With this tool, there will be an improvement in acceptance and practice in the application of MC design effectively. Consequently, this study will analyse and explore the function and customization of BIM objects and the capability of BIM software to expedite the application of MC design during the design stage for architects. With this application, architects will be able to create building models and locate objects within reference modular grids that adhere to MC rules and dimensions. The parametric modeling capabilities of BIM will also act as a visual tool that will further enhance the automation of the 3-Dimensional space planning modeling process. (Method) The study will first analyze and explore the parametric modeling capabilities of rule-based BIM objects, which eventually customize a reference grid within the rules and dimensioning of MC. Eventually, the approach will further enhance the architect's overall design process and enable architects to automate complex modeling, which was nearly impossible before. A prototype using a residential quarter will be modeled. A set of reference grids guided by specific MC rules and dimensions will be used to develop a variety of space planning and configuration. With the use of the design, the tool will expedite the design process and encourage the use of MC Design in the construction industry.

Keywords: building information modeling, modular coordination, space planning, customization, BIM application, MC space planning

Procedia PDF Downloads 83

Authors: Tamar Lin, Nufar Buchshtab, Yifat Elharar, Julian Nicenboim, Rotem Edgar, Iddo Weiner, Lior Zelcbuch, Ariel Cohen, Sharon Kredo-Russo, Inbar Gahali-Sass, Naomi Zak, Sailaja Puttagunta, Merav Bassan

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Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder that is characterized by dry skin and flares of eczematous lesions and intense pruritus. Multiple lines of evidence suggest that AD is associated with increased colonization by Staphylococcus aureus, which contributes to disease pathogenesis through the release of virulence factors that affect both keratinocytes and immune cells, leading to disruption of the skin barrier and immune cell dysfunction. The aim of the current study is to develop a bacteriophage-based product that specifically targets S. aureus. Methods: For the discovery of phage, environmental samples were screened on 118 S. aureus strains isolated from skin samples, followed by multiple enrichment steps. Natural phages were isolated, subjected to Next-generation Sequencing (NGS), and analyzed using proprietary bioinformatics tools for undesirable genes (toxins, antibiotic resistance genes, lysogeny potential), taxonomic classification, and purity. Phage host range was determined by an efficiency of plating (EOP) value above 0.1 and the ability of the cocktail to completely lyse liquid bacterial culture under different growth conditions (e.g., temperature, bacterial stage). Results: Sequencing analysis demonstrated that the 118 S. aureus clinical strains were distributed across the phylogenetic tree of all available Refseq S. aureus (~10,750 strains). Screening environmental samples on the S. aureus isolates resulted in the isolation of 50 lytic phages from different genera, including Silviavirus, Kayvirus, Podoviridae, and a novel unidentified phage. NGS sequencing confirmed the absence of toxic elements in the phages’ genomes. The host range of the individual phages, as measured by the efficiency of plating (EOP), ranged between 41% (48/118) to 79% (93/118). Host range studies in liquid culture revealed that a subset of the phages can infect a broad range of S. aureus strains in different metabolic states, including stationary state. Combining the single-phage EOP results of selected phages resulted in a broad host range cocktail which infected 92% (109/118) of the strains. When tested in vitro in a liquid infection assay, clearance was achieved in 87% (103/118) of the strains, with no evidence of phage resistance throughout the study (24 hours). A S. aureus host was identified that can be used for the production of all the phages in the cocktail at high titers suitable for large-scale manufacturing. This host was validated for the absence of contaminating prophages using advanced NGS methods combined with multiple production cycles. The phages are produced under optimized scale-up conditions and are being used for the development of a topical formulation (BX005) that may be administered to subjects with atopic dermatitis. Conclusions: A cocktail of natural phages targeting S. aureus was effective in reducing bacterial burden across multiple assays. Phage products may offer safe and effective steroid-sparing options for atopic dermatitis.

Keywords: atopic dermatitis, bacteriophage cocktail, host range, Staphylococcus aureus

Procedia PDF Downloads 151

Authors: Ciaran Friel, Jerry Suls, Patrick Robles, Frank Vicari, Joan Duer-Hefele, Karina W. Davidson

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Physical activity guidelines focus on increasing moderate intensity activity for older adults, but adherence to recommendations remains low. This is despite the fact that scientific evidence supports that any increase in physical activity is positively correlated with health benefits. Behavior change techniques (BCTs) have demonstrated effectiveness in reducing sedentary behavior and promoting physical activity. This pilot study uses a Personalized Trials (N-of-1) design to evaluate the efficacy of using four BCTs to promote an increase in low-intensity physical activity (2,000 steps of walking per day) in adults aged 45-75 years old. The 4 BCTs tested were goal setting, action planning, feedback, and self-monitoring. BCTs were tested in random order and delivered by text message prompts requiring participant response. The study recruited health system employees in the target age range, without mobility restrictions and demonstrating interest in increasing their daily activity by a minimum of 2,000 steps per day for a minimum of five days per week. Participants were sent a Fitbit Charge 4 fitness tracker with an established study account and password. Participants were recommended to wear the Fitbit device 24/7, but were required to wear it for a minimum of ten hours per day. Baseline physical activity was measured by the Fitbit for two weeks. Participants then engaged with a clinical research coordinator to review comprehension of the text message content and required actions for each of the BCTs to be tested. Participants then selected a consistent daily time in which they would receive their text message prompt. In the 8 week intervention phase of the study, participants received each of the four BCTs, in random order, for a two week period. Text message prompts were delivered daily at a time selected by the participant. All prompts required an interactive response from participants and may have included recording their detailed plan for walking or daily step goal (action planning, goal setting). Additionally, participants may have been directed to a study dashboard to view their step counts or compare themselves with peers (self-monitoring, feedback). At the end of each two week testing interval, participants were asked to complete the Self-Efficacy for Walking Scale (SEW_Dur), a validated measure that assesses the participant’s confidence in walking incremental distances and a survey measuring their satisfaction with the individual BCT that they tested. At the end of their trial, participants received a personalized summary of their step data in response to each individual BCT. Analysis will examine the novel individual-level heterogeneity of treatment effect made possible by N-of-1 design, and pool results across participants to efficiently estimate the overall efficacy of the selected behavioral change techniques in increasing low-intensity walking by 2,000 steps, 5 days per week. Self-efficacy will be explored as the likely mechanism of action prompting behavior change. This study will inform the providers and demonstrate the feasibility of N-of-1 study design to effectively promote physical activity as a component of healthy aging.

Keywords: aging, exercise, habit, walking

Procedia PDF Downloads 128

Authors: Gulfam Haider, sana danish

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Convolutional Neural Networks (CNNs) have emerged as powerful tools for image classification, and the choice of optimizers profoundly affects their performance. The study of optimizers and their adaptations remains a topic of significant importance in machine learning research. While numerous studies have explored and advocated for various optimizers, the efficacy of these optimization techniques is still subject to scrutiny. This work aims to address the challenges surrounding the effectiveness of optimizers by conducting a comprehensive analysis and evaluation. The primary focus of this investigation lies in examining the performance of different optimizers when employed in conjunction with the popular activation function, Rectified Linear Unit (ReLU). By incorporating ReLU, known for its favorable properties in prior research, the aim is to bolster the effectiveness of the optimizers under scrutiny. Specifically, we evaluate the adjustment of these optimizers with both the original Softmax activation function and the modified ReLU activation function, carefully assessing their impact on overall performance. To achieve this, a series of experiments are conducted using a well-established benchmark dataset for image classification tasks, namely the Canadian Institute for Advanced Research dataset (CIFAR-10). The selected optimizers for investigation encompass a range of prominent algorithms, including Adam, Root Mean Squared Propagation (RMSprop), Adaptive Learning Rate Method (Adadelta), Adaptive Gradient Algorithm (Adagrad), and Stochastic Gradient Descent (SGD). The performance analysis encompasses a comprehensive evaluation of the classification accuracy, convergence speed, and robustness of the CNN models trained with each optimizer. Through rigorous experimentation and meticulous assessment, we discern the strengths and weaknesses of the different optimization techniques, providing valuable insights into their suitability for image classification tasks. By conducting this in-depth study, we contribute to the existing body of knowledge surrounding optimizers in CNNs, shedding light on their performance characteristics for image classification. The findings gleaned from this research serve to guide researchers and practitioners in making informed decisions when selecting optimizers and activation functions, thus advancing the state-of-the-art in the field of image classification with convolutional neural networks.

Keywords: deep neural network, optimizers, RMsprop, ReLU, stochastic gradient descent

Procedia PDF Downloads 125

Authors: Elena Pummer, Holger Schuettrumpf

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By today underground pumped storage plants as an outstanding alternative for classical pumped storage plants do not exist. They are needed to ensure the required balance between production and demand of energy. As a short to medium term storage pumped storage plants have been used economically over a long period of time, but their expansion is limited locally. The reasons are in particular the required topography and the extensive human land use. Through the use of underground reservoirs instead of surface lakes expansion options could be increased. Fulfilling the same functions, several hydrodynamic processes result in the specific design of the underground reservoirs and must be implemented in the planning process of such systems. A combined 3D numerical and experimental approach leads to currently unknown results about the occurring wave types and their behavior in dependence of different design and operating criteria. For the 3D numerical simulations, OpenFOAM was used and combined with an experimental approach in the laboratory of the Institute of Hydraulic Engineering and Water Resources Management at RWTH Aachen University, Germany. Using the finite-volume method and an explicit time discretization, a RANS-Simulation (k-ε) has been run. Convergence analyses for different time discretization, different meshes etc. and clear comparisons between both approaches lead to the result, that the numerical and experimental models can be combined and used as hybrid model. Undular bores partly with secondary waves and breaking bores occurred in the underground reservoir. Different water levels and discharges change the global effects, defined as the time-dependent average of the water level as well as the local processes, defined as the single, local hydrodynamic processes (water waves). Design criteria, like branches, directional changes, changes in cross-section or bottom slope, as well as changes in roughness have a great effect on the local processes, the global effects remain unaffected. Design calculations for underground pumped storage plants were developed on the basis of existing formulae and the results of the hybrid approach. Using the design calculations reservoirs heights as well as oscillation periods can be determined and lead to the knowledge of construction and operation possibilities of the plants. Consequently, future plants can be hydraulically optimized applying the design calculations on the local boundary conditions.

Keywords: energy storage, experimental approach, hybrid approach, undular and breaking Bores, 3D numerical approach

Procedia PDF Downloads 211

Authors: RAJ KUMAR G.C.

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There are tremendous opportunities to maximize smallholder farmers’ income from small-scale water resource development through micro irrigation and multiple-use water systems (MUS). MUS are an improved water management approach, developed and tested successfully by iDE that pipes water to a community both for domestic use and for agriculture using efficient micro irrigation. Different MUS models address different landscape constraints, water demand, and users’ preferences. MUS are complemented by micro irrigation kits, which were developed by iDE to enable farmers to grow high-value crops year-round and to use limited water resources efficiently. Over the last 15 years, iDE’s promotion of the MUS approach has encouraged government and other key stakeholders to invest in MUS for better planning of scarce water resources. Currently, about 60% of the cost of MUS construction is covered by the government and community. Based on iDE’s experience, a gravity-fed MUS costs approximately $125 USD per household to construct, and it can increase household income by $300 USD per year. A key element of the MUS approach is keeping farmers well linked to input supply systems and local produce collection centers, which helps to ensure that the farmers can produce a sufficient quantity of high-quality produce that earns a fair price. This process in turn creates an enabling environment for smallholders to invest in MUS and micro irrigation. Therefore, MUS should be seen as an integrated package of interventions –the end users, water sources, technologies, and the marketplace– that together enhance technical, financial, and institutional sustainability. Communities are trained to participate in sustainable water resource management as a part of the MUS planning and construction process. The MUS approach is cost-effective, improves community governance of scarce water resources, helps smallholder farmers to improve rural health and livelihoods, and promotes gender equity. MUS systems are simple to maintain and communities are trained to ensure that they can undertake minor maintenance procedures themselves. All in all, the iDE Nepal MUS offers multiple benefits and represents a practical and sustainable model of the MUS approach. Moreover, there is a growing national consensus that rural water supply systems should be designed for multiple uses, acknowledging that substantial work remains in developing national-level and local capacity and policies for scale-up.

Keywords: multiple-use water systems , small scale water resources, rural livelihoods, practical and sustainable model

Procedia PDF Downloads 288

Authors: N. E. Gallagher, C. E. Neville, N. Lyner, J. Yarnell, C. C. Patterson, J. E. Gallacher, Y. Ben-Shlomo, A. Fehily, J. V. Woodside

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Hearing loss is highly prevalent in older people and can reduce quality of life substantially. Emerging research suggests that potentially modifiable risk factors, including risk factors previously related to cardiovascular disease risk, may be associated with a decreased or increased incidence of hearing loss. This has prompted investigation into the possibility that certain nutrients, foods or dietary patterns may also be associated with incidence of hearing loss. The aim of this study was to determine any associations between dietary patterns and hearing loss in men enrolled in the Caerphilly study. The Caerphilly prospective cohort study began in 1979-1983 with recruitment of 2512 men aged 45-59 years. Dietary data was collected using a self-administered, semi-quantitative, 56-item food frequency questionnaire (FFQ) at baseline (1979-1983), and 7-day weighed food intake (WI) in a 30% sub-sample, while pure-tone unaided audiometric threshold was assessed at 0.5, 1, 2 and 4 kHz, between 1984 and 1988. Principal components analysis (PCA) was carried out to determine a posteriori dietary patterns and multivariate linear and logistic regression models were used to examine associations with hearing level (pure tone average (PTA) of frequencies 0.5, 1, 2 and 4 kHz in decibels (dB)) for linear regression and with hearing loss (PTA>25dB) for logistic regression. Three dietary patterns were determined using PCA on the FFQ data- Traditional, Healthy, High sugar/Alcohol avoider. After adjustment for potential confounding factors, both linear and logistic regression analyses showed a significant and inverse association between the Healthy pattern and hearing loss (P<0.001) and linear regression analysis showed a significant association between the High sugar/Alcohol avoider pattern and hearing loss (P=0.04). Three similar dietary patterns were determined using PCA on the WI data- Traditional, Healthy, High sugar/Alcohol avoider. After adjustment for potential confounding factors, logistic regression analyses showed a significant and inverse association between the Healthy pattern and hearing loss (P=0.02) and a significant association between the Traditional pattern and hearing loss (P=0.04). A Healthy dietary pattern was found to be significantly inversely associated with hearing loss in middle-aged men in the Caerphilly study. Furthermore, a High sugar/Alcohol avoider pattern (FFQ) and a Traditional pattern (WI) were associated with poorer hearing levels. Consequently, the role of dietary factors in hearing loss remains to be fully established and warrants further investigation.

Keywords: ageing, diet, dietary patterns, hearing loss

Procedia PDF Downloads 229

Authors: Shuo Li, Yannick Coffinier, Chann Lagadec, Fabrizio Cleri, Katsuhiko Nishiguchi, Akira Fujiwara, Soo Hyeon Kim, Nicolas Clément

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The need for single cell detection and analysis techniques has increased in the past decades because of the heterogeneity of individual living cells, which increases the complexity of the pathogenesis of malignant tumors. In the search for early cancer detection, high-precision medicine and therapy, the technologies most used today for sensitive detection of target analytes and monitoring the variation of these species are mainly including two types. One is based on the identification of molecular differences at the single-cell level, such as flow cytometry, fluorescence-activated cell sorting, next generation proteomics, lipidomic studies, another is based on capturing or detecting single tumor cells from fresh or fixed primary tumors and metastatic tissues, and rare circulating tumors cells (CTCs) from blood or bone marrow, for example, dielectrophoresis technique, microfluidic based microposts chip, electrochemical (EC) approach. Compared to other methods, EC sensors have the merits of easy operation, high sensitivity, and portability. However, despite various demonstrations of low limits of detection (LOD), including aptamer sensors, arrayed EC sensors for detecting single-cell have not been demonstrated. In this work, a new technique based on 20-nm-thick nanopillars array to support cells and keep them at ideal recognition distance for redox-labeled aptamers grafted on the surface. The key advantages of this technology are not only to suppress the false positive signal arising from the pressure exerted by all (including non-target) cells pushing on the aptamers by downward force but also to stabilize the aptamer at the ideal hairpin configuration thanks to a confinement effect. With the first implementation of this technique, a LOD of 13 cells (with5.4 μL of cell suspension) was estimated. In further, the nanosupported cell technology using redox-labeled aptasensors has been pushed forward and fully integrated into a single-cell electrochemical aptasensor array. To reach this goal, the LOD has been reduced by more than one order of magnitude by suppressing parasitic capacitive electrochemical signals by minimizing the sensor area and localizing the cells. Statistical analysis at the single-cell level is demonstrated for the recognition of cancer cells. The future of this technology is discussed, and the potential for scaling over millions of electrodes, thus pushing further integration at sub-cellular level, is highlighted. Despite several demonstrations of electrochemical devices with LOD of 1 cell/mL, the implementation of single-cell bioelectrochemical sensor arrays has remained elusive due to their challenging implementation at a large scale. Here, the introduced nanopillar array technology combined with redox-labeled aptamers targeting epithelial cell adhesion molecule (EpCAM) is perfectly suited for such implementation. Combining nanopillar arrays with microwells determined for single cell trapping directly on the sensor surface, single target cells are successfully detected and analyzed. This first implementation of a single-cell electrochemical aptasensor array based on Brownian-fluctuating redox species opens new opportunities for large-scale implementation and statistical analysis of early cancer diagnosis and cancer therapy in clinical settings.

Keywords: bioelectrochemistry, aptasensors, single-cell, nanopillars

Procedia PDF Downloads 114

Authors: Elvin P. Chizenga, Heidi Abrahamse

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Cancer cell resistance to therapy is the main cause of treatment failures and the poor prognosis of cancer convalescence. The progression of cervical cancer to other parts of the genitourinary system and the reported recurrence rates are overwhelming. Current treatments, including surgery, chemo and radiation have been inefficient in eradicating the tumor cells. These treatments are also associated with poor prognosis and reduced quality of life, including fertility loss. This has inspired the need for the development of new treatment modalities to eradicate cervical cancer successfully. Photodynamic Therapy (PDT) is a modern treatment modality that induces cell death by photochemical interactions of light and a photosensitizer, which in the presence of molecular oxygen, yields a set of chemical reactions that generate Reactive Oxygen Species (ROS) and other free radical species causing cell damage. Enhancing PDT using modified drug delivery can increase the concentration of the photosensitizer in the tumor cells, and this has the potential to maximize its therapeutic efficacy. In cervical cancer, all infected cells constitutively express genes of the E6 and E7 HPV viral oncoproteins, resulting in high concentrations of E6 and E7 in the cytoplasm. This provides an opportunity for active targeting of cervical cancer cells using immune-mediated drug delivery to maximize therapeutic efficacy. The use of nanoparticles in PDT has also proven effective in enhancing therapeutic efficacy. Gold nanoparticles (AuNps) in particular, are explored for their use in biomedicine due to their biocompatibility, low toxicity, and enhancement of drug uptake by tumor cells. In this present study, a biomolecule comprising of AuNPs, anti-E6 monoclonal antibodies, and Aluminium Phthalocyanine photosensitizer was synthesized for use in targeted PDT of cervical cancer. The AuNp-Anti-E6-Sulfonated Aluminium Phthalocyanine mix (AlPcSmix) photosensitizing biomolecule was synthesized by coupling AuNps and anti-E6 monoclonal antibodies to the AlPcSmix via Polyethylene Glycol (PEG) chemical links. The final product was characterized using Transmission Electron Microscope (TEM), Zeta Potential, Uv-Vis Spectrophotometry, Fourier Transform Infrared Spectroscopy (FTIR), and X-ray diffraction (XRD), to confirm its chemical structure and functionality. To observe its therapeutic role in treating cervical cancer, cervical cancer cells, HeLa cells were seeded in 3.4 cm² diameter culture dishes at a concentration of 5x10⁵ cells/ml, in vitro. The cells were treated with varying concentrations of the photosensitizing biomolecule and irradiated using a 673.2 nm wavelength of laser light. Post irradiation cellular responses were performed to observe changes in morphology, viability, proliferation, cytotoxicity, and cell death pathways induced. Dose-Dependent response of the cells to treatment was demonstrated as significant morphologic changes, increased cytotoxicity, and decreased cell viability and proliferation This study presented a synthetic biomolecule for targeted PDT of cervical cancer. The study suggested that PDT using this AuNp- Anti-E6- AlPcSmix photosensitizing biomolecule is a very effective treatment method for the eradication of cervical cancer cells, in vitro. Further studies in vivo need to be conducted to support the use of this biomolecule in treating cervical cancer in clinical settings.

Keywords: anti-E6 monoclonal antibody, cervical cancer, gold nanoparticles, photodynamic therapy

Procedia PDF Downloads 122

Authors: Sunita Boro, Saurabh Kumar Dixit

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Terroir, an intricate fusion of geography, climate, soil, and human expertise, has long been acknowledged as a defining factor in the character of wines and foods. This research embarks on an exploration of terroir's profound influence on gastronomic tourism, shedding light on the intricate interplay between the physical environment and culinary artistry. Delving into the intricate science of terroir, we scrutinize its role in shaping the sensory profiles of wines and foods, emphasizing the profound impact of specific regions on flavor, aroma, and texture. We deploy a multifaceted methodology, amalgamating sensory analysis, chemical profiling, geographical information systems, and qualitative interviews to unearth the nuanced nuances of terroir expression. Through an exhaustive review of the literature, we elucidate the historical roots of terroir, unveil the intricate cultural dimensions shaping it, and provide a comprehensive examination of prior studies in the field. Our findings underscore the pivotal role of terroir in promoting regional identities, enhancing the economic viability of locales, and attracting gastronomic tourists. The paper also dissects the marketing strategies employed to promote terroir-driven food and wine experiences. We elucidate the utilization of storytelling, branding, and collaborative endeavors in fostering a robust terroir-based tourism industry. This elucidates both the potential for innovation and the challenges posed by oversimplification or misrepresentation of terroir. Our research spotlights the intersection of terroir and sustainability, emphasizing the significance of environmentally conscious practices in terroir-driven productions. We discern the harmonious relationship between sustainable agriculture, terroir preservation, and responsible tourism, encapsulating the essence of ecological integrity in gastronomic tourism. Incorporating compelling case studies of regions and businesses excelling in the terroir-based tourism realm, we offer in-depth insights into successful models and strategies, with an emphasis on their replicability and adaptability to various contexts. Ultimately, this paper not only contributes to the scholarly understanding of terroir's role in the world of food and wine tourism but also provides actionable recommendations for stakeholders to leverage terroir's allure, preserve its authenticity, and foster sustainable and enriching culinary tourism experiences.

Keywords: terroir, food tourism, wine tourism, sustainability

Procedia PDF Downloads 58

Authors: Neil Singla, Derek Muse, Karen DiDonato, Pamela Palmer

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Introduction: Pain is the most common reason people visit emergency rooms. Studies indicate however, that Emergency Department (ED) physicians often do not provide adequate analgesia to their patients as a result of gender and age bias, opiophobia and insufficient knowledge of and formal training in acute pain management. Novel classes of analgesics have recently been introduced, but many patients suffer from acute pain in settings where the availability of intravenous (IV) access may be limited, so there remains a clinical need for rapid-acting, potent analgesics that do not require an invasive route of delivery. A sublingual sufentanil tablet (SST), dispensed using a single-dose applicator, is in development for treatment of moderate-to-severe acute pain in a medically-supervised setting. Objective: The primary objective of this study was to demonstrate the repeat-dose efficacy, safety and tolerability of sufentanil 20 mcg and 30 mcg sublingual tablets compared to placebo for the management of acute pain as determined by the time-weighted sum of pain intensity differences (SPID) to baseline over the 12-hour study period (SPID12). Key secondary efficacy variables included SPID over the first hour (SPID1), Total pain relief over the 12-hour study period (TOTPAR12), time to perceived pain relief (PR) and time to meaningful PR. Safety variables consisted of adverse events (AE), vital signs, oxygen saturation and early termination. Methods: In this Phase 2, double-blind, dose-finding study, an equal number of male and female patients were randomly assigned in a 2:2:1 ratio to SST 20 mcg, SS 30 mcg or placebo, respectively, following bunionectomy. Study drug was dosed as needed, but not more frequently than hourly. Rescue medication was available as needed. The primary endpoint was the Summed Pain Intensity Difference to baseline over 12h (SPIDI2). Safety was assessed by continuous oxygen saturation monitoring and adverse event reporting. Results: 101 patients (51 Male/50 Female) were randomized, 100 received study treatment (intent-to-treat [ITT] population), and 91 completed the study. Reasons for early discontinuation were lack of efficacy (6), adverse events (2) and drug-dosing error (1). Mean age was 42.5 years. For the ITT population, SST 30 mcg was superior to placebo (p=0.003) for the SPID12. SPID12 scores in the active groups were superior for both male (ANOVA overall p-value =0.038) and female (ANOVA overall p-value=0.005) patients. Statistically significant differences in favour of sublingual sufentanil were also observed between the SST 30mcg and placebo group for SPID1(p<0.001), TOTPAR12(p=0.002), time to perceived PR (p=0.023) and time to meaningful PR (p=0.010). Nausea, vomiting and somnolence were more frequent in the sufentanil groups but there were no significant differences between treatment arms for the proportion of patients who prematurely terminated due to AE or inadequate analgesia. Conclusions: Sufentanil tablets dispensed sublingually using a single-dose applicator is in development for treatment of patients with moderate-to-severe acute pain in a medically-supervised setting where immediate IV access is limited. When administered sublingually, sufentanil’s pharmacokinetic profile and non-invasive delivery makes it a useful alternative to IM or IV dosing.

Keywords: acute pain, pain management, sublingual, sufentanil

Procedia PDF Downloads 355

Authors: M. A. Okezue, K. L. Clase, S. R. Byrn

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The requirement for maintaining data integrity in laboratory operations is critical for regulatory compliance. Automation of procedures reduces incidence of human errors. Quality control laboratories located in low-income economies may face some barriers in attempts to automate their processes. Since data from quality control tests on pharmaceutical products are used in making regulatory decisions, it is important that laboratory reports are accurate and reliable. Zinc Sulphate (ZnSO₄) tablets is used in treatment of diarrhea in pediatric population, and as an adjunct therapy for COVID-19 regimen. Unfortunately, zinc content in these formulations is determined titrimetrically; a manual analytical procedure. The assay for ZnSO4 tablets involves time-consuming steps that contain mathematical formulae prone to calculation errors. To achieve consistency, save costs, and improve data integrity, validated spreadsheets were developed to simplify the two critical steps in the analysis of ZnSO4 tablets: standardization of 0.1M Sodium Edetate (EDTA) solution, and the complexometric titration assay procedure. The assay method in the United States Pharmacopoeia was used to create a process flow for ZnSO₄ tablets. For each step in the process, different formulae were input into two spreadsheets to automate calculations. Further checks were created within the automated system to ensure validity of replicate analysis in titrimetric procedures. Validations were conducted using five data sets of manually computed assay results. The acceptance criteria set for the protocol were met. Significant p-values (p < 0.05, α = 0.05, at 95% Confidence Interval) were obtained from students’ t-test evaluation of the mean values for manual-calculated and spreadsheet results at all levels of the analysis flow. Right-first-time analysis and principles of data integrity were enhanced by use of the validated spreadsheet calculators in titrimetric evaluations of ZnSO₄ tablets. Human errors were minimized in calculations when procedures were automated in quality control laboratories. The assay procedure for the formulation was achieved in a time-efficient manner with greater level of accuracy. This project is expected to promote cost savings for laboratory business models.

Keywords: data integrity, spreadsheets, titrimetry, validation, zinc sulphate tablets

Procedia PDF Downloads 168

Authors: Mohamed Dakki, Genevieve Robin, Marie Suet, Abdeljebbar Qninba, Mohamed A. El Agbani, Asmâa Ouassou, Rhimou El Hamoumi, Hichem Azafzaf, Sami Rebah, Claudia Feltrup-Azafzaf, Nafouel Hamouda, Wed a.L. Ibrahim, Hosni H. Asran, Amr A. Elhady, Haitham Ibrahim, Khaled Etayeb, Essam Bouras, Almokhtar Saied, Ashrof Glidan, Bakar M. Habib, Mohamed S. Sayoud, Nadjiba Bendjedda, Laura Dami, Clemence Deschamps, Elie Gaget, Jean-Yves Mondain-Monval, Pierre Defos Du Rau

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In biodiversity monitoring, large datasets are becoming more and more widely available and are increasingly used globally to estimate species trends and con- servation status. These large-scale datasets challenge existing statistical analysis methods, many of which are not adapted to their size, incompleteness and heterogeneity. The development of scalable methods to impute missing data in incomplete large-scale monitoring datasets is crucial to balance sampling in time or space and thus better inform conservation policies. We developed a new method based on penalized Poisson models to impute and analyse incomplete monitoring data in a large-scale framework. The method al- lows parameterization of (a) space and time factors, (b) the main effects of predic- tor covariates, as well as (c) space–time interactions. It also benefits from robust statistical and computational capability in large-scale settings. The method was tested extensively on both simulated and real-life waterbird data, with the findings revealing that it outperforms six existing methods in terms of missing data imputation errors. Applying the method to 16 waterbird species, we estimated their long-term trends for the first time at the entire North African scale, a region where monitoring data suffer from many gaps in space and time series. This new approach opens promising perspectives to increase the accuracy of species-abundance trend estimations. We made it freely available in the r package ‘lori’ (https://CRAN.R-project.org/package=lori) and recommend its use for large- scale count data, particularly in citizen science monitoring programmes.

Keywords: biodiversity monitoring, high-dimensional statistics, incomplete count data, missing data imputation, waterbird trends in North-Africa

Procedia PDF Downloads 153

Authors: Adiba Matin, Daniel Cabrera, Javiera Bellolio, Jasmine Stewart, Dana Gerberi (librarian), Nathan Cummins, Fernanda Bellolio

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OBJECTIVES: Artificial intelligence (AI) tools are becoming more prevalent in healthcare settings, particularly for diagnostic and therapeutic recommendations, with an expected surge in the incoming years. The bedside use of this technology for clinicians opens the possibility of disagreements between the recommendations from AI algorithms and clinicians’ judgment. There is a paucity in the literature analyzing nature and possible outcomes of these potential conflicts, particularly related to ethical considerations. The goal of this scoping review is to identify, analyze and classify current themes and potential strategies addressing ethical conflicts originating from the conflict between AI and human recommendations. METHODS: A protocol was written prior to the initiation of the study. Relevant literature was searched by a medical librarian for the terms of artificial intelligence, healthcare and liability, ethics, or conflict. Search was run in 2021 in Ovid Cochrane Central Register of Controlled Trials, Embase, Medline, IEEE Xplore, Scopus, and Web of Science Core Collection. Articles describing the role of AI in healthcare that mentioned conflict between humans and AI were included in the primary search. Two investigators working independently and in duplicate screened titles and abstracts and reviewed full-text of potentially eligible studies. Data was abstracted into tables and reported by themes. We followed methodological guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). RESULTS: Of 6846 titles and abstracts, 225 full texts were selected, and 48 articles included in this review. 23 articles were included as original research and review papers. 25 were included as editorials and commentaries with similar themes. There was a lack of consensus in the included articles on who would be held liable for mistakes incurred by following AI recommendations. It appears that there is a dichotomy of the perceived ethical consequences depending on if the negative outcome is a result of a human versus AI conflict or secondary to a deviation from standard of care. Themes identified included transparency versus opacity of recommendations, data bias, liability of outcomes, regulatory framework, and the overall scope of artificial intelligence in healthcare. A relevant issue identified was the concern by clinicians of the “black box” nature of these recommendations and the ability to judge appropriateness of AI guidance. CONCLUSION AI clinical tools are being rapidly developed and adopted, and the use of this technology will create conflicts between AI algorithms and healthcare workers with various outcomes. In turn, these conflicts may have legal, and ethical considerations. There is limited consensus about the focus of ethical and liability for outcomes originated from disagreements. This scoping review identified the importance of framing the problem in terms of conflict between standard of care or not, and informed by the themes of transparency/opacity, data bias, legal liability, absent regulatory frameworks and understanding of the technology. Finally, limited recommendations to mitigate ethical conflicts between AI and humans have been identified. Further work is necessary in this field.

Keywords: ethics, artificial intelligence, emergency medicine, review

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Authors: Emilie Vandevelde, Ellen Claes

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This study aims to develop a comprehensive model for the civic socialization process of teachers. Citizenship has become one of the main objectives for the European education systems. It is expected that teachers are well prepared and equipped with the necessary knowledge, skills, and attitudes to also engage students in democratic citizenship. While a lot is known about young peoples’ civic competence development and how schools and teachers (don’t) support this process, less is known about how teachers themselves engage with (the teaching of) civics. Other than the civic socialization process of young adolescents that focuses on personal competence development, the civic socialization process of teachers includes the development of professional, civic competences. These professional competences make that they are able to prepare pupils to carry out their civic responsibilities in thoughtful ways. Existing models for the civic socialization process of young adolescents do not take this dual purpose into account. Based on these observations, this paper will investigate (1)What personal and professional civic competences teachers need to effectively teach civic education and (2) how teachers acquire these personal and professional civic competences. To answer the first research question, a systematic review of literature of existing civic education frameworks was carried out and linked to literature on teacher training. The second research question was addressed by adapting the Octagon model, developed by the International Association for the Evaluation of Educational Achievement (IEA), to the context of teachers. This was done by carrying out a systematic review of the recent literature linking three theoretical topics involved in teachers’ civic competence development: theories about the civic socialization process of young adolescents, Schulmans (1987) theoretical assumptions on pedagogical content knowledge (PCK), and Nogueira & Moreira’s (2012) framework for civic education teachers’ knowledge and literature on teachers’ professional development. This resulted in a comprehensive conceptual framework describing the personal and professional civic competences of civic education teachers. In addition, this framework is linked to the OctagonT model: a model that describes the processes through which teachers acquire these personal and professional civic competences. This model recognizes that teachers’ civic socialization process is influenced by interconnected variables located at different levels in a multi-level structure (the individual teacher (e.g., civic beliefs), everyday contacts (e.g., teacher educators, the intended, informal and hidden curriculum of the teacher training program, internship contacts, participation opportunities in teacher training, etc.) and the influence of the national educational context (e.g., vision on civic education)). Furthermore, implications for teacher education programs are described.

Keywords: civic education, civic competences, civic socialization, octagon model, teacher training

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Authors: W. Mohammedsaeed, A. J. Mcbain, S. M. Cruickshank, C. A. O’Neill

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Many studies have demonstrated the importance of probiotics and their potential therapeutic effects within the gut. Recently, the possible therapeutic effects of probiotics in other tissues have also begun to be investigated. Comparatively few studies have evaluated the use of topical probiotics in relation to the skin. In this study, we have conducted preliminary investigations into whether a well-known probiotic, Lactobacillus rhamnosus GG (LGG), can increase the rate of re-epithelialization in a model wound. Full-thickness skin was obtained from individuals undergoing elective cosmetic surgery. This skin was wounded using excisional punch and cultured using a serum-free medium, either in the presence or absence of L. rhamnosus GG lysate. Histological staining of the sections was performed with Haematoxylin& Eosin E to quantify “epithelial tongue length”. This is the length of the new epithelial ‘tongue’ that grows and covers the exposed dermis at the inner wound edges. The length of the new epithelial ‘tongue’ was compared in untreated section and section treated with and L. rhamnosus GG made using108CFU/ml bacterial cells. L. rhamnosus GG lysate enhanced significantly the re-epithelialisation of treated wounds compared with that of untreated wounds (P=0.005, n=3). Tongue length, at day 1 was 7.55μm 0.15, at day 3 it was 18.5μm 0.25 and at day 7 was 22.9μm 0.35. These results can be compared with untreated cultures in which tongue length was 3.25μm 0.35, day 3 was 9.65μm 0.25 and day 7 was 13.5μm 0.15 post-wounding. In ex-vivo proliferation and migration cells were measured by determining the expression of nuclear proliferation marker Ki-67 and the expression of Phosphorylated cortactin respectively demonstrated that L. rhamnosus GG significantly increased NHEK proliferation and migration rates relative to controls. However, the dominant mechanism was migration because in ex-vivo skin treated with the L. rhamnosus GG up-regulated the gene expression of the chemokine receptor and ligands CXCR2 and CXCL2 comparing with controls (P=0.02, P=0.03 respectively, n=3). High levels of CXCL2/CXCL2 have already been implicated in multiple aspects of stimulation of wound healing through activation of keratinocyte migration. These data demonstrate that lysates from Lactobacillus rhamnosus GG increase re-epithelialization by stimulation of keratinocyte migration. The current study identifies the partial mechanism that contribute to stimulating the wound-healing process ex vivo in response to L. rhamnosus GG lysate is an increase in the production of CXCL2/ CXCR2 in ex vivo models. The use of probiotic lysates potentially offers new options to develop treatments that could improve wound healing.

Keywords: Lactobacillus rhamnosus GG, wounds, migration, lysate

Procedia PDF Downloads 327

Authors: Inje Cho

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The leading health risks threatening the world today are associated with a modern lifestyle characterized by sedentary behavior, stress, anxiety, and an obesogenic food environment. To counter this alarming trend, the Centers for Disease Control and Prevention have proffered Physical Activity guidelines to bolster physical engagement. Concurrently, the burgeon of smartphones and mobile applications has witnessed a proliferation of fitness applications aimed at invigorating exercise adherence and real-time activity monitoring. Grounded in the Uses and gratification theory, this study delves into the technological affordances of mobile fitness applications, discerning the mediating influences of escapism and social outcome expectations on attitudes and exercise intention. The theory explains how individuals employ distinct communication mediums to satiate their exigencies and desires. Technological affordances manifest as attributes of emerging technologies that galvanize personal engagement in physical activities. Several features of mobile fitness applications include affordances for goal setting, virtual rewards, peer support, and exercise information. Escapism, denoting the inclination to disengage from normal routines, has emerged as a salient motivator for the consumption of new media. This study postulates that individual’s perceptions technological affordances within mobile fitness applications, can affect escapism and social outcome expectations, potentially influencing attitude, and behavior formation. Thus, the integrated model has been developed to empirically examine the interrelationships between technological affordances, escapism, social outcome expectations, and exercise intention. Structural Equation Modelling serves as the methodological tool, and a cohort of 400 Fitbit users shall be enlisted from the Prolific, data collection platform. A sequence of multivariate data analyses will scrutinize both the measurement and hypothesized structural models. By delving into the effects of mobile fitness applications, this study contributes to the growing of new media studies in sport management. Moreover, the novel integration of the uses and gratification theory, technological affordances, via the prism of escapism, illustrates the dynamics that underlies mobile fitness user’s attitudes and behavioral intentions. Therefore, the findings from this study contribute to theoretical understanding and provide pragmatic insights to developers and practitioners in optimizing the impact of mobile fitness applications.

Keywords: technological affordances, uses and gratification, mobile fitness apps, escapism, physical activity

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Authors: A. B. Moldes, X. Vecino, L. Rodriguez-López, J. M. Dominguez, J. M. Cruz

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The concept of the circular economy is focus on the importance of providing goods and services sustainably. Thus, in a future it will be necessary to respond to the environmental contamination and to the use of renewables substrates by moving to a more restorative economic system that drives towards the utilization and revalorization of residues to obtain valuable products. During its evolution our industrial economy has hardly moved through one major characteristic, established in the early days of industrialization, based on a linear model of resource consumption. However, this industrial consumption system will not be maintained during long time. On the other hand, there are many industries, like the corn milling industry, that although does not consume high amount of non renewable substrates, they produce valuable streams that treated accurately, they could provide additional, economical and environmental, benefits by the extraction of interesting commercial renewable products, that can replace some of the substances obtained by chemical synthesis, using non renewable substrates. From this point of view, the use of streams from corn milling industry to obtain surface-active compounds will decrease the utilization of non-renewables sources for obtaining this kind of compounds, contributing to a circular and global economy. However, the success of the circular economy depends on the interest of the industrial sectors in the revalorization of their streams by developing relevant and new business models. Thus, it is necessary to invest in the research of new alternatives that reduce the consumption of non-renewable substrates. In this study is proposed the utilization of a corn milling industry stream to obtain an extract with surfactant capacity. Once the biosurfactant is extracted, the corn milling stream can be commercialized as nutritional media in biotechnological process or as animal feed supplement. Usually this stream is combined with other ingredients obtaining a product namely corn gluten feed or may be sold separately as a liquid protein source for beef and dairy feeding, or as a nutritional pellet binder. Following the productive scheme proposed in this work, the corn milling industry will obtain a biosurfactant extract that could be incorporated in its productive process replacing those chemical detergents, used in some point of its productive chain, or it could be commercialized as a new product of the corn manufacture. The biosurfactants obtained from corn milling industry could replace the chemical surfactants in many formulations, and uses, and it supposes an example of the potential that many industrial streams could offer for obtaining valuable products when they are manage properly.

Keywords: biosurfactantes, circular economy, corn, sustainability

Procedia PDF Downloads 261

Authors: Yuanyuan Zhang, Yujuan Zheng, Giuseppina Barutello, Sumako Kameishi, Kungchun Chiu, Katharina Hennig, Martial Balland, Federica Cavallo, Lars Holmgren

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Angiogenesis describes that new blood vessels migrate from pre-existing ones to form 3D lumenized structure and remodeling. During directional migration toward the gradient of pro-angiogenic factors, the endothelial cells, especially the tip cells need filopodia to sense the environment and exert the pulling force. Of particular interest are the integrin proteins, which play an essential role in focal adhesion in the connection between migrating cells and extracellular matrix (ECM). Understanding how these biomechanical complexes orchestrate intrinsic and extrinsic forces is important for our understanding of the underlying mechanisms driving angiogenesis. We have previously identified Angiomotin (Amot), a member of Amot scaffold protein family, as a promoter for endothelial cell migration in vitro and zebrafish models. Hence, we established inducible endothelial-specific Amot knock-out mice to study normal retinal angiogenesis as well as tumor angiogenesis. We found that the migration ratio of the blood vessel network to the edge was significantly decreased in Amotec- retinas at postnatal day 6 (P6). While almost all the Amot defect tip cells lost migration advantages at P7. In consistence with the dramatic morphology defect of tip cells, there was a non-autonomous defect in astrocytes, as well as the disorganized fibronectin expression pattern correspondingly in migration front. Furthermore, the growth of transplanted LLC tumor was inhibited in Amot knockout mice due to fewer vasculature involved. By using MMTV-PyMT transgenic mouse model, there was a significantly longer period before tumors arised when Amot was specifically knocked out in blood vessels. In vitro evidence showed that Amot binded to beta-actin, Integrin beta 1 (ITGB1), Fibronectin, FAK, Vinculin, major focal adhesion molecules, and ITGB1 and stress fibers were distinctly induced by Amot transfection. Via traction force microscopy, the total energy (force indicater) was found significantly decreased in Amot knockdown cells. Taken together, we propose that Amot is a novel partner of the ITGB1/Fibronectin protein complex at focal adhesion and required for exerting force transition between endothelial cell and extracellular matrix.

Keywords: angiogenesis, angiomotin, endothelial cell migration, focal adhesion, integrin beta 1

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Authors: Şeyma Saliha Fidan, Ozgur Serin, Ata Mugan

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While performing verification analyses under static and dynamic loads that composite structures used in aviation are exposed to, it is necessary to obtain the bearing strength limit value for mechanically connected composite structures. For this purpose, various tests are carried out in accordance with aviation standards. There are many companies in the world that perform these tests in accordance with aviation standards, but the test costs are very high. In addition, due to the necessity of producing coupons, the high cost of coupon materials, and the long test times, it is necessary to simulate these tests on the computer. For this purpose, various test coupons were produced by using reinforcement and alignment angles of the composite radomes, which were integrated into the aircraft. Glass fiber reinforced and Quartz prepreg is used in the production of the coupons. The simulations of the tests performed according to the American Society for Testing and Materials (ASTM) D5961 Procedure C standard were performed on the computer. The analysis model was created in three dimensions for the purpose of modeling the bolt-hole contact surface realistically and obtaining the exact bearing strength value. The finite element model was carried out with the Analysis System (ANSYS). Since a physical break cannot be made in the analysis studies carried out in the virtual environment, a hypothetical break is realized by reducing the material properties. The material properties reduction coefficient was determined as 10%, which is stated to give the most realistic approach in the literature. There are various theories in this method, which is called progressive failure analysis. Because the hashin theory does not match our experimental results, the puck progressive damage method was used in all coupon analyses. When the experimental and numerical results are compared, the initial damage and the resulting force drop points, the maximum damage load values ​​, and the bearing strength value are very close. Furthermore, low error rates and similar damage patterns were obtained in both test and simulation models. In addition, the effects of various parameters such as pre-stress, use of bushing, the ratio of the distance between the bolt hole center and the plate edge to the hole diameter (E/D), the ratio of plate width to hole diameter (W/D), hot-wet environment conditions were investigated on the bearing strength of the composite structure.

Keywords: puck, finite element, bolted joint, composite

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Authors: Junqi Zou

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As one of the world’s most tech-ready countries, Singapore has initiated the Smart Nation plan to harness the full power and potential of digital technologies to transform the way people live and work, through the more efficient government and business processes, to make the economy more productive. The key evolutions of digital technology transformation in healthcare and the increasing deployment of Internet of Things (IoTs), Big Data, AI/cognitive, Robotic Process Automation (RPA), Electronic Health Record Systems (EHR), Electronic Medical Record Systems (EMR), Warehouse Management System (WMS in the most recent decade have significantly stepped up the move towards an information-driven healthcare ecosystem. The advances in information technology not only bring benefits to patients but also act as a key force in changing management accounting in healthcare sector. The aim of this study is to investigate the impacts of digital technology transformation on Singapore’s healthcare sector from a management accounting perspective. Adopting a Balanced Scorecard (BSC) analysis approach, this paper conducted an exploratory case study of a newly launched Singapore public hospital, which has been recognized as amongst the most digitally advanced healthcare facilities in Asia-Pacific region. Specifically, this study gains insights on how the new technology is changing healthcare organizations’ management accounting from four perspectives under the Balanced Scorecard approach, 1) Financial Perspective, 2) Customer (Patient) Perspective, 3) Internal Processes Perspective, and 4) Learning and Growth Perspective. Based on a thorough review of archival records from the government and public, and the interview reports with the hospital’s CIO, this study finds the improvements from all the four perspectives under the Balanced Scorecard framework as follows: 1) Learning and Growth Perspective: The Government (Ministry of Health) works with the hospital to open up multiple training pathways to health professionals that upgrade and develops new IT skills among the healthcare workforce to support the transformation of healthcare services. 2) Internal Process Perspective: The hospital achieved digital transformation through Project OneCare to integrate clinical, operational, and administrative information systems (e.g., EHR, EMR, WMS, EPIB, RTLS) that enable the seamless flow of data and the implementation of JIT system to help the hospital operate more effectively and efficiently. 3) Customer Perspective: The fully integrated EMR suite enhances the patient’s experiences by achieving the 5 Rights (Right Patient, Right Data, Right Device, Right Entry and Right Time). 4) Financial Perspective: Cost savings are achieved from improved inventory management and effective supply chain management. The use of process automation also results in a reduction of manpower costs and logistics cost. To summarize, these improvements identified under the Balanced Scorecard framework confirm the success of utilizing the integration of advanced ICT to enhance healthcare organization’s customer service, productivity efficiency, and cost savings. Moreover, the Big Data generated from this integrated EMR system can be particularly useful in aiding management control system to optimize decision making and strategic planning. To conclude, the new digital technology transformation has moved the usefulness of management accounting to both financial and non-financial dimensions with new heights in the area of healthcare management.

Keywords: balanced scorecard, digital technology transformation, healthcare ecosystem, integrated information system

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Authors: Samantha Ramachandra, Avanthi Rupasinghe

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Demographic transition from lower to higher percentage of elderly population eventually coupled with epidemiological transition from communicable to non-communicable diseases (NCD). Higher percentage of NCD overload the health system as NCD survivors claims continuous health care. The demands are challenging to a resource constrained setting but reorganizing the system may find solutions. The study focused on the facilities available and their utilization at outpatient department (OPD) setting of the public hospitals of Sri Lanka for continuous medical care. This will help in identifying steps of reorganizing the system to provide better care with the maximum utilization of available facilities. The study was conducted as a situation analysis with secondary data at hospital planning units. Variable were identified according to the world health organization (WHO) recommendation on continuous health care for elders in “age-friendly primary health care toolkit”. Data were collected from secondary and tertiary care hospitals of Sri Lanka where most of the continuous care services are available. Out of 58 secondary and tertiary care hospitals, 16 were included in the study to represent each hospital categories. Average number of patient attending for episodic treatment at OPD and Clinical follow-up of chronic conditions shows vast disparity according to the category of the hospital ranging from 3750 – 800 per day at OPD and 1250 – 200 per clinic session. Average time spent per person at OPD session is low, range from 1.54 - 2.28 minutes, the time was increasing as the hospital category goes down. 93.7% hospitals had special arrangements for providing acute care on chronic conditions such as catheter, feeding tube and wound care. 25% hospitals had special clinics for elders, 81.2% hospitals had healthy lifestyle clinics (HLC), 75% hospitals had physical rehabilitation facilities and 68.8% hospitals had facilities for counselling. Elderly clinics and HLC were mostly available at lower grade hospitals where as rehabilitation and counselling facilities were mostly available at bigger hospitals. HLC are providing health education for both patients and their family members, refer patients for screening of complication but not provide medical examinations, investigations or treatments even though they operate in the hospital setting. Physical rehabilitation is basically offered for patients with rheumatological conditions but utilization of centers for injury rehabilitation and rehabilitation of survivors following major illness such as myocardial infarctions, stroke, cancer is not satisfactory (12.5%). Human Resource distribution within hospital shows vast disparity and there are 103 physiotherapists in the biggest hospital where only 36 physiotherapists available at the next level hospital. Counselling facilities also provided mainly for the patient with psychological conditions (100%) but they were not providing counselling for newly diagnosed patients with major illnesses (0%). According to results, most of the public-sector hospitals in Sri Lanka have basic facilities required in providing continuous care but the utilization of services need more focus. Hospital administration or the government need to have initial steps in proper utilization of them in improving continuous health care incorporating team approach of rehabilitation. The author wishes to acknowledge that this paper was made possible by the support and guidance given by the “Australia Awards Fellowships Program for Sri Lanka – 2017,” which was funded by the Department of Foreign Affairs and Trade, Australia, and co-hosted by Monash University, Australia and the Sri Lanka Institute of Development Administration.

Keywords: continuous care, outpatient department, non communicable diseases, rehabilitation

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Authors: Justin Fu, Thomas Mazzuchi, Shahram Sarkani

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A key factor in technological immaturity in defense weapons acquisition is lack of understanding critical integrations at the subsystem and component level. To address this shortfall, recent research in integration readiness level (IRL) combines with technology readiness level (TRL) to form a system readiness level (SRL). SRL can be enriched with more robust quantitative methods to provide the program manager a useful tool prior to committing to major weapons acquisition programs. This research harnesses previous mathematical models based on graph theory, Petri nets, and tropical algebra and proposes a modification of the desirable SRL mathematical properties such that a tightly integrated (multitude of interfaces) subsystem can display a lower SRL than an inherently less coupled subsystem. The synthesis of these methods informs an improved decision tool for the program manager to commit to expensive technology development. This research ties the separately developed manufacturing readiness level (MRL) into the network representation of the system and addresses shortfalls in previous frameworks, including the lack of integration weighting and the over-importance of a single extremely immature component. Tropical algebra (based on the minimum of a set of TRLs or IRLs) allows one low IRL or TRL value to diminish the SRL of the entire system, which may not be reflective of actuality if that component is not critical or tightly coupled. Integration connections can be weighted according to importance and readiness levels are modified to be a cardinal scale (based on an analytic hierarchy process). Integration arcs’ importance are dependent on the connected nodes and the additional integrations arcs connected to those nodes. Lack of integration is not represented by zero, but by a perfect integration maturity value. Naturally, the importance (or weight) of such an arc would be zero. To further explore the impact of grouping subsystems, a multi-objective genetic algorithm is then used to find various clusters or communities that can be optimized for the most representative subsystem SRL. This novel calculation is then benchmarked through simulation and using past defense acquisition program data, focusing on the newly introduced Middle Tier of Acquisition (rapidly field prototypes). The model remains a relatively simple, accessible tool, but at higher fidelity and validated with past data for the program manager to decide major defense acquisition program milestones.

Keywords: readiness, maturity, system, integration

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Authors: Hasmik V. Zanginyan, Gayane S. Ghazaryan, Laura M. Hovsepyan

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Experimental autoimmune encephalomyelitis (EAE) is an inflammatory demyelinating disease of the central nervous system that is induced in laboratory animals by developing an immune response against myelin epitopes. The typical clinical course is ascending palsy, which correlates with inflammation and tissue damage in the thoracolumbar spinal cord, although the optic nerves and brain (especially the subpial white matter and brainstem) are also often affected. With multiple sclerosis, there is a violation of lipid metabolism in myelin. When membrane lipids (glycosphingolipids, phospholipids) are disturbed, metabolites not only play a structural role in membranes but are also sources of secondary mediators that transmit multiple cellular signals. The purpose of this study was to investigate the effect of ganglioside as a therapeutic agent in experimental multiple sclerosis. The biological activity of a ganglioside-containing medicinal preparation (Cronassial) was evaluated in an experimental model of multiple sclerosis in laboratory animals. An experimental model of multiple sclerosis in rats was obtained by immunization with myelin basic protein (MBP), as well as homogenization of the spinal cord or brain. EAE was induced by administering a mixture of an encephalitogenic mixture (EGM) with Complete Freund’s Adjuvant. Mitochondrial fraction was isolated in a medium containing 0,25 M saccharose and 0, 01 M tris buffer, pH - 7,4, by a method of differential centrifugation on a K-24 centrifuge. Glutathione peroxidase activity was assessed by reduction reactions of hydrogen peroxide (H₂O₂) and lipid hydroperoxides (ROOH) in the presence of GSH. LPO activity was assessed by the amount of malondialdehyde (MDA) in the total homogenate and mitochondrial fraction of the spinal cord and brain of control and experimental autoimmune encephalomyelitis rats. MDA was assessed by a reaction with Thiobarbituric acid. For statistical data analysis on PNP, SPSS (Statistical Package for Social Science) package was used. The nature of the distribution of the obtained data was determined by the Kolmogorov-Smirnov criterion. The comparative analysis was performed using a nonparametric Mann-Whitney test. The differences were statistically significant when р ≤ 0,05 or р ≤ 0,01. Correlational analysis was conducted using a nonparametric Spearman test. In the work, refrigeratory centrifuge, spectrophotometer LKB Biochrom ULTROSPECII (Sweden), pH-meter PL-600 mrc (Israel), guanosine, and ATP (Sigma). The study of the process of lipid peroxidation in the total homogenate of the brain and spinal cord in experimental animals revealed an increase in the content of malonic dialdehyde. When applied, Cronassial observed normalization of lipid peroxidation processes. Reactive oxygen species, causing lipid peroxidation processes, can be toxic both for neurons and for oligodendrocytes that form myelin, causing a violation of their lipid composition. The high content of lipids in the brain and the uniqueness of their structure determines the nature of the development of LPO processes. The lipid layer of cellular and intracellular membranes performs two main functions -barrier and matrix (structural). Damage to the barrier leads to dysregulation of intracellular processes and severe disorders of cellular functions.

Keywords: experimental autoimmune encephalomyelitis, multiple sclerosis, neuroinflammation, therapy

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Authors: Inga Žukovaitė

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This paper aims to present postdoc research on remote criminal proceedings in court. In this period, when most countries have introduced the possibility of remote criminal proceedings in their procedural laws, it is not only possible to identify the weaknesses and strengths of the legal regulation but also assess the effectiveness of the instrument used and to develop an approach to the process. The example of some countries (for example, Italy) shows, on the one hand, that criminal procedure, based on orality and immediacy, does not lend itself to easy modifications that pose even a slight threat of devaluation of these principles in a society with well-established traditions of this procedure. On the other hand, such strong opposition and criticism make us ask whether we are facing the possibility of rethinking the traditional ways to understand the safeguards in order to preserve their essence without devaluing their traditional package but looking for new components to replace or compensate for the so-called “loss” of safeguards. The reflection on technological progress in the field of criminal procedural law indicates the need to rethink, on the basis of fundamental procedural principles, the safeguards that can replace or compensate for those that are in crisis as a result of the intervention of technological progress. Discussions in academic doctrine on the impact of technological interventions on the proceedings as such or on the limits of such interventions refer to the principles of criminal procedure as to a point of reference. In the context of the inferiority of technology, scholarly debate still addresses the issue of whether the court will not gradually become a mere site for the exercise of penal power with the resultant consequences – the deformation of the procedure itself as a physical ritual. In this context, this work seeks to illustrate the relationship between remote criminal proceedings in court and the principle of immediacy, the concept of which is based on the application of different models of criminal procedure (inquisitorial and adversarial), the aim is to assess the challenges posed for legal regulation by the interaction of technological progress with the principles of criminal procedure. The main hypothesis to be tested is that the adoption of remote proceedings is directly linked to the prevailing model of criminal procedure, arguing that the more principles of the inquisitorial model are applied to the criminal process, the more remote criminal trial is acceptable, and conversely, the more the criminal process is based on an adversarial model, more the remote criminal process is seen as incompatible with the principle of immediacy. In order to achieve this goal, the following tasks are set: to identify whether there is a difference in assessing remote proceedings with the immediacy principle between the adversarial model and the inquisitorial model, to analyse the main aspects of the regulation of remote criminal proceedings based on the examples of different countries (for example Lithuania, Italy, etc.).

Keywords: remote criminal proceedings, principle of orality, principle of immediacy, adversarial model inquisitorial model

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Authors: Havva Tutar Kahraman, Erol Pehlivan

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In recent years, environmental pollution by wastewater rises very critically. Effluents discharged from various industries cause this challenge. Different type of pollutants such as organic compounds, oxyanions, and heavy metal ions create this threat for human bodies and all other living things. However, heavy metals are considered one of the main pollutant groups of wastewater. Therefore, this case creates a great need to apply and enhance the water treatment technologies. Among adopted treatment technologies, adsorption process is one of the methods, which is gaining more and more attention because of its easy operations, the simplicity of design and versatility. Ion exchange process is one of the preferred methods for removal of heavy metal ions from aqueous solutions. It has found widespread application in water remediation technologies, during the past several decades. Therefore, the purpose of this study is to the removal of hexavalent chromium, Cr(VI), from aqueous solutions. Cr(VI) is considered as a well-known highly toxic metal which modifies the DNA transcription process and causes important chromosomic aberrations. The treatment and removal of this heavy metal have received great attention to maintaining its allowed legal standards. The purpose of the present paper is an attempt to investigate some aspects of the use of three anion exchange resins: Eichrom 1-X4, Lewatit Monoplus M800 and Lewatit A8071. Batch adsorption experiments were carried out to evaluate the adsorption capacity of these three commercial resins in the removal of Cr(VI) from aqueous solutions. The chromium solutions used in the experiments were synthetic solutions. The parameters that affect the adsorption, solution pH, adsorbent concentration, contact time, and initial Cr(VI) concentration, were performed at room temperature. High adsorption rates of metal ions for the three resins were reported at the onset, and then plateau values were gradually reached within 60 min. The optimum pH for Cr(VI) adsorption was found as 3.0 for these three resins. The adsorption decreases with the increase in pH for three anion exchangers. The suitability of Freundlich, Langmuir and Scatchard models were investigated for Cr(VI)-resin equilibrium. Results, obtained in this study, demonstrate excellent comparability between three anion exchange resins indicating that Eichrom 1-X4 is more effective and showing highest adsorption capacity for the removal of Cr(VI) ions. Investigated anion exchange resins in this study can be used for the efficient removal of chromium from water and wastewater.

Keywords: adsorption, anion exchange resin, chromium, kinetics

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Authors: Tirtha Raj Adhikari, Lochan Prasad Devkota

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This research studied the hydrological regime of three glacierized river basins in Khumbu, Langtang and Annapurna regions of Nepal using the Hydraologiska Byrans Vattenbalansavde (HBV), HVB-light 3.0 model. Future scenario of discharge is also studied using downscaled climate data derived from statistical downscaling method. General Circulation Models (GCMs) successfully simulate future climate variability and climate change on a global scale; however, poor spatial resolution constrains their application for impact studies at a regional or a local level. The dynamically downscaled precipitation and temperature data from Coupled Global Circulation Model 3 (CGCM3) was used for the climate projection, under A2 and A1B SRES scenarios. In addition, the observed historical temperature, precipitation and discharge data were collected from 14 different hydro-metrological locations for the implementation of this study, which include watershed and hydro-meteorological characteristics, trends analysis and water balance computation. The simulated precipitation and temperature were corrected for bias before implementing in the HVB-light 3.0 conceptual rainfall-runoff model to predict the flow regime, in which Groups Algorithms Programming (GAP) optimization approach and then calibration were used to obtain several parameter sets which were finally reproduced as observed stream flow. Except in summer, the analysis showed that the increasing trends in annual as well as seasonal precipitations during the period 2001 - 2060 for both A2 and A1B scenarios over three basins under investigation. In these river basins, the model projected warmer days in every seasons of entire period from 2001 to 2060 for both A1B and A2 scenarios. These warming trends are higher in maximum than in minimum temperatures throughout the year, indicating increasing trend of daily temperature range due to recent global warming phenomenon. Furthermore, there are decreasing trends in summer discharge in Langtang Khola (Langtang region) which is increasing in Modi Khola (Annapurna region) as well as Dudh Koshi (Khumbu region) river basin. The flow regime is more pronounced during later parts of the future decades than during earlier parts in all basins. The annual water surplus of 1419 mm, 177 mm and 49 mm are observed in Annapurna, Langtang and Khumbu region, respectively.

Keywords: temperature, precipitation, water discharge, water balance, global warming

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Authors: Neil Bar, Andrew Heweston

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Probability of failure (PF) often appears alongside factor of safety (FS) in design acceptance criteria for rock slope, underground excavation and open pit mine designs. However, the design acceptance criteria generally provide no guidance relating to how PF should be calculated for homogeneous and heterogeneous rock masses, or what qualifies a ‘reasonable’ PF assessment for a given slope design. Observational and kinematic methods were widely used in the 1990s until advances in computing permitted the routine use of numerical modelling. In the 2000s and early 2010s, PF in numerical models was generally calculated using the point estimate method. More recently, some limit equilibrium analysis software offer statistical parameter inputs along with Monte-Carlo or Latin-Hypercube sampling methods to automatically calculate PF. Factors including rock type and density, weathering and alteration, intact rock strength, rock mass quality and shear strength, the location and orientation of geologic structure, shear strength of geologic structure and groundwater pore pressure influence the stability of rock slopes. Significant engineering and geological judgment, interpretation and data interpolation is usually applied in determining these factors and amalgamating them into a geotechnical model which can then be analysed. Most factors are estimated ‘approximately’ or with allowances for some variability rather than ‘exactly’. When it comes to numerical modelling, some of these factors are then treated deterministically (i.e. as exact values), while others have probabilistic inputs based on the user’s discretion and understanding of the problem being analysed. This paper discusses the importance of understanding the key aspects of slope design for homogeneous and heterogeneous rock masses and how they can be translated into reasonable PF assessments where the data permits. A case study from a large open pit gold mine in a complex geological setting in Western Australia is presented to illustrate how PF can be calculated using different methods and obtain markedly different results. Ultimately sound engineering judgement and logic is often required to decipher the true meaning and significance (if any) of some PF results.

Keywords: probability of failure, point estimate method, Monte-Carlo simulations, sensitivity analysis, slope stability

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Authors: Soham Chakraborty

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This article examines the development of start-up culture in India, its development as well as related impact on the Indian society. Another vibrant synonym of start-up in the present century can be starting afresh. Startups have become the new flavor of this decade. A startup ecosystem is formed by mainly the new generation in the making. A startup ecosystem involves a variety of elements without which a startup can never prosper, they are—ideas, inventions, innovations as well as authentic research in the field into which one is interested, mentors, advisors, funding bodies, service provider organizations, angel, venture and so on. The culture of startup is quiet nascent but rampant in India. This is largely due to the widespread of media as a medium through which the newfangled entrepreneurs can spread their word of mouth far and wide. Different kinds of media such as Television, Radio, Internet, Print media and so on, act as the weapon to any startup company in India. The article explores how there is a sudden shift in the growing Indian economy due to the rise of startup ecosystem. There are various reasons, which are the result of the growing success of startup in India, firstly, entrepreneurs are building up startup ideas on the basis of various international startup but giving them a pinch of Indian flavor; secondly, business models are framed based on the current problems that people face in the modern century; thirdly, balance between social and technological entrepreneurs and lastly, quality of mentorship. The Government of India boasts startup as a flagship initiative. Bunch full of benefits and assistance was declared in an event named as 'Start Up India, Stand Up India' on 16th January 2016 by the current Prime Minister of India Mr. Narendra Modi. One of the biggest boon that increasing startups are creating in the society is the proliferation of self-employment. Noted Startups which are thriving in India are like OYO, Where’s The Food (WTF), TVF Pitchers, Flipkart and so on are examples of India is getting covered up by various innovative startups. The deep impact can be felt by each Indian after a few years as various governmental and non-governmental policies and agendas are helping in the sprawling up of startups and have mushroom growth in India. The impact of startup uprising in India is also possible due to increasing globalization which is leading to the eradication of national borders, thereby creating the environment to enlarge one’s business model. To conclude, this article points out on the correlation between rising startup in Indian market and its increasing developmental benefits for the people at large. Internationally, various business portals are tagging India to be the world’s fastest growing startup ecosystem.

Keywords: business, ecosystem, entrepreneurs, media, globalization, startup

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Authors: Fernandez liporace, Mercedes Uriel Fabiana

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Academic achievement in high school and college students is currently a matter of concern. National and international assessments show high schoolers as low achievers, and local statistics indicate alarming dropout percentages in this educational level. Even so, 80% of those students intend attending higher education. On the other hand, applications to Public National Universities are free and non-selective by examination procedures. Though initial registrations are massive (307.894 students), only 50% of freshmen pass their first year classes, and 23% achieves a degree. Low performances use to be a common problem. Hence, freshmen adaptation, their adjustment, dropout and low academic achievement arise as topics of agenda. Besides, the hinge between high school and college must be examined in depth, in order to get an integrated and successful path from one educational stratum to the other. Psychology aims at developing two main research lines to analyse the situation. One regarding psychometric scales, designing and/or adapting tests, examining their technical properties and their theoretical validity (e.g., academic motivation, learning strategies, learning styles, coping, perceived social support, parenting styles and parental consistency, paradoxical personality as correlated to creative skills, psychopathological symptomatology). The second research line emphasizes relationships within the variables measured by the former scales, facing the formulation and testing of predictive models of academic achievement, establishing differences by sex, age, educational level (high school vs college), and career. Pursuing these goals, several studies were carried out in recent years, reporting findings and producing assessment technology useful to detect students academically at risk as well as good achievers. Multiple samples were analysed totalizing more than 3500 participants (2500 from college and 1000 from high school), including descriptive, correlational, group differences and explicative designs. A brief on the most relevant results is presented. Providing information to design specific interventions according to every learner’s features and his/her educational environment comes up as a mid-term accomplishment. Furthermore, that information might be helpful to adapt curricula by career, as well as for implementing special didactic strategies differentiated by sex and personal characteristics.

Keywords: academic achievement, higher education, high school, psychological assessment

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