Search results for: clinical prediction rule

Authors: Wang Chung-Kwei, Lo Kuo Ying

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This study is aimed to examine main and moderation effect of Chinese traditional social wisdom ‘Ren-qing Shi-kuo’ on the adjustment of insurance workers. Rationale: Ren-qing Shi-ku as a social wisdom has been emphasized and practiced by collective-oriented Chinese for thousand years. The concept of‘Ren-qing Shi-ku’includes values, beliefs and behavior rituals, which helps Chinese to cope with interpersonal conflicts in a sophisticated and closely tied collective society. Based on interview and literature review, we found out Chinese still emphasized the importance of ‘Ren-qing Shi-ku’. The concepts contains five factors, including ‘proper emotion display’, ‘social ritual abiding’, ‘ make empathetic concession’, ‘harmonious and proper behavior’ and ‘tolerance for the interest of the whole’. We developed an indigenous ‘Ren-qing Shi-ku’scale based on interview data and a survey on social worker students. Research methods: We conduct a dyad survey between 294 insurance worker and their supervisors. Insurance workers’ response on ‘Ren-qing Shi-ku,emotion labor, emotional exhaustion, work stress and load, work satisfaction and well-being were collected. We also ask their supervisors to rate these workers ‘empathy, social rule abiding, work performance, and Ren-qing Shi-ku performance. Results: Students’self-ratings on Ren-qing Shi-ku scale are positively correlated with rating from their supervisors on all above indexes. Workers who have higher Ren-qing Shi-ku score also have lower work stress and emotion exhaustion, higher work satisfaction and well-being, more emotion deep acting. They also have higher work performance, social rule abiding, and Ren-qing Shi-ku performance rating from their supervisor. The finding of this study suggested Ren-qing Shi-ku is an effective indicator on insurance workers ‘adjustment. Since Ren-qing Shi-ku is trainable, we suggested that Ren-qing Shi-ku training might be beneficial to service industry in a collective-oriented culture.

Keywords: work stress, Ren-qing Shi-ku, emotional exhaustion, work satisfaction, well-being

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Authors: Yuhang Wang, Jorg Schluter, Sergiy Shelyag

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The high cost associated with high-resolution computational fluid dynamics (CFD) is one of the main challenges that inhibit the design, development, and optimisation of new combustion systems adapted for renewable fuels. In this study, we propose a physics-guided CNN-based model to predict turbulence evolution and mixing without requiring a traditional CFD solver. The model architecture is built upon U-Net and the inception module, while a physics-guided loss function is designed by introducing two additional physical constraints to allow for the conservation of both mass and pressure over the entire predicted flow fields. Then, the model is trained on the Large Eddy Simulation (LES) results of a natural turbulent mixing layer with two different Reynolds number cases (Re = 3000 and 30000). As a result, the model prediction shows an excellent agreement with the corresponding CFD solutions in terms of both spatial distributions and temporal evolution of turbulent mixing. Such promising model prediction performance opens up the possibilities of doing accurate high-resolution manifold-based combustion simulations at a low computational cost for accelerating the iterative design process of new combustion systems.

Keywords: computational fluid dynamics, turbulence, machine learning, combustion modelling

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Authors: Gi-Young Park, Dong Rak Kwon, Sung Cheol Cho

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Objective: The synovium is known to be involved in many pathological characteristic processes. Also, synovitis is common in advanced osteoarthritis. We aimed to evaluate the clinical, radiographic, and ultrasound findings in patients with knee osteoarthritis and to compare the clinical and imaging findings between knee osteoarthritis with and without synovial hypertrophy confirmed by ultrasound. Methods: One hundred knees (54 left, 46 right) in 95 patients (64 women, 31 men; mean age, 65.9 years; range, 43-85 years) with knee osteoarthritis were recruited. The Visual Analogue Scale (VAS) was used to assess the intensity of knee pain. The severity of knee osteoarthritis was classified according to Kellgren and Lawrence's (K-L) grade on a radiograph. Ultrasound examination was performed by a physiatrist who had 24 years of experience in musculoskeletal ultrasound. Ultrasound findings, including the thickness of joint effusion in the suprapatellar pouch, synovial hypertrophy, infrapatellar tendinosis, meniscal tear or extrusion, and Baker cyst, were measured and detected. The thickness of knee joint effusion was measured at the maximal anterior-posterior diameter of fluid collection in the suprapatellar pouch. Synovial hypertrophy was identified as the soft tissue of variable echogenicity, which is poorly compressible and nondisplaceable by compression of an ultrasound transducer. The knees were divided into two groups according to the presence of synovial hypertrophy. The differences in clinical and imaging findings between the two groups were evaluated by independent t-test and chi-square test. Results: Synovial hypertrophy was detected in 48 knees of 100 knees on ultrasound. There were no significant differences in demographic parameters and VAS score except in sex between the two groups (P<0.05). Medial meniscal extrusion and tear were significantly more frequent in knees with synovial hypertrophy than those in knees without synovial hypertrophy. K-L grade and joint effusion thickness were greater in patients with synovial hypertrophy than those in patients without synovial hypertrophy (P<0.05). Conclusion: Synovial hypertrophy in knee osteoarthritis was associated with greater suprapatellar joint effusion and higher K-L grade and maybe a characteristic ultrasound feature of late knee osteoarthritis. These results suggest that synovial hypertrophy on ultrasound can be regarded as a predictor of rapid progression in patients with knee osteoarthritis.

Keywords: knee osteoarthritis, synovial hypertrophy, ultrasound, K-L grade

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Authors: I. L. Kim, J. Y. Lee, A. K. Tekile

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In consequence of the very high urbanization rate of Korea, the number of traffic noise damages in areas congested with population and facilities is steadily increasing. The current environmental noise levels data in major cities of the country show that the noise levels exceed the standards set for both day and night times. This research was about comparative analysis in search for optimal soundproof panel shape and design factor that can minimize sound reflection noise. In addition to the normal flat-type panel shape, the reflection noise reduction of swelling-type, combined swelling and curved-type, and screen-type were evaluated. The noise source model Nord 2000, which often provides abundant information compared to models for the similar purpose, was used in the study to determine the overall noise level. Based on vehicle categorization in Korea, the noise levels for varying frequency from different heights of the sound source (directivity heights of Harmonize model) have been calculated for simulation. Each simulation has been made using the ray-tracing method. The noise level has also been calculated using the noise prediction program called SoundPlan 7.2, for comparison. The noise level prediction was made at 15m (R1), 30 m (R2) and at middle of the road, 2m (R3) receiving the point. By designing the noise barriers by shape and running the prediction program by inserting the noise source on the 2nd lane to the noise barrier side, among the 6 lanes considered, the reflection noise slightly decreased or increased in all noise barriers. At R1, especially in the cases of the screen-type noise barriers, there was no reduction effect predicted in all conditions. However, the swelling-type showed a decrease of 0.7~1.2 dB at R1, performing the best reduction effect among the tested noise barriers. Compared to other forms of noise barriers, the swelling-type was thought to be the most suitable for reducing the reflection noise; however, since a slight increase was predicted at R2, further research based on a more sophisticated categorization of related design factors is necessary. Moreover, as swellings are difficult to produce and the size of the modules are smaller than other panels, it is challenging to install swelling-type noise barriers. If these problems are solved, its applicable region will not be limited to other types of noise barriers. Hence, when a swelling-type noise barrier is installed at a downtown region where the amount of traffic is increasing every day, it will both secure visibility through the transparent walls and diminish any noise pollution due to the reflection. Moreover, when decorated with shapes and design, noise barriers will achieve a visual attraction than a flat-type one and thus will alleviate any psychological hardships related to noise, other than the unique physical soundproofing functions of the soundproof panels.

Keywords: reflection noise, shaped noise barriers, sound proof panel, traffic noise

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Authors: Anne C. Richer-De-Forges, Dominique Arrouays, Songchao Chen, Mercedes Roman Dobarco

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Most of the digital soil mapping (DSM) products rely on machine learning (ML) prediction models and/or the use or pedotransfer functions (PTF) in which calibration data come from soil analyses performed in labs. However, many other observations (often qualitative, nominal, or ordinal) could be used as proxies of lab measurements or as input data for ML of PTF predictions. DSM and ML are briefly described with some examples taken from the literature. Then, we explore the potential of an ordinal qualitative variable, i.e., the hand-feel soil texture (HFST) estimating the mineral particle distribution (PSD): % of clay (0-2µm), silt (2-50µm) and sand (50-2000µm) in 15 classes. The PSD can also be measured by lab measurements (LAST) to determine the exact proportion of these particle-sizes. However, due to cost constraints, HFST are much more numerous and spatially dense than LAST. Soil texture (ST) is a very important soil parameter to map as it is controlling many of the soil properties and functions. Therefore, comes an essential question: is it possible to use HFST as a proxy of LAST for calibration and/or validation of DSM predictions of ST? To answer this question, the first step is to compare HFST with LAST on a representative set where both information are available. This comparison was made on ca 17,400 samples representative of a French region (34,000 km2). The accuracy of HFST was assessed, and each HFST class was characterized by a probability distribution function (PDF) of its LAST values. This enables to randomly replace HFST observations by LAST values while respecting the PDF previously calculated and results in a very large increase of observations available for the calibration or validation of PTF and ML predictions. Some preliminary results are shown. First, the comparison between HFST classes and LAST analyses showed that accuracies could be considered very good when compared to other studies. The causes of some inconsistencies were explored and most of them were well explained by other soil characteristics. Then we show some examples applying these relationships and the increase of data to several issues related to DSM. The first issue is: do the PDF functions that were established enable to use HSFT class observations to improve the LAST soil texture prediction? For this objective, we replaced all HFST for topsoil by values from the PDF 100 time replicates). Results were promising for the PTF we tested (a PTF predicting soil water holding capacity). For the question related to the ML prediction of LAST soil texture on the region, we did the same kind of replacement, but we implemented a 10-fold cross-validation using points where we had LAST values. We obtained only preliminary results but they were rather promising. Then we show another example illustrating the potential of using HFST as validation data. As in numerous countries, the HFST observations are very numerous; these promising results pave the way to an important improvement of DSM products in all the countries of the world.

Keywords: digital soil mapping, improvement of digital soil mapping predictions, potential of using hand-feel soil texture, soil texture prediction

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Authors: Beth Jacobs

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The landmark movement of Western clinical psychology in the 20th century was the development of psychotherapy. The landmark movement of clinical psychology in the 21st century will be the absorption of meditation practices from Buddhist psychology. While millions of people explore meditation and related philosophy, very few people are exposed to the materials of original Buddhism on this topic, especially to the Theravadan Abhidharma. The Abhidharma is an intricate system of lists and matrixes that were used to understand and remember Buddha’s teaching. The Abhidharma delineates the first psychological system of Buddhism, how the mind works in the universe of reality and why meditation training strengthens and purifies the experience of life. Its lists outline the psychology of mental constructions, perception, emotion and cosmological causation. While the Abhidharma is technical, elaborate and complex, its essential purpose relates to the central purpose of clinical psychology: to relieve human suffering. Like Western depth psychology, the methodology rests on understanding underlying processes of consciousness and perception. What clinical psychologists might describe as therapeutic improvement, the Abhidharma delineates as a specific pathway of purified actions of consciousness. This paper discusses the concept of 'path' as presented in aspects of the Theravadan Abhidharma and relates this to current clinical psychological views of therapy outcomes and gains. The core path in Buddhism is the Eight-Fold Path, which is the fourth noble truth and the launching of activity toward liberation. The path is not composed of eight ordinal steps; it’s eight-fold and is described as opening the way, not funneling choices. The specific path in the Abhidharma is described in many steps of development of consciousness activities. The path is not something a human moves on, but something that moments of consciousness develop within. 'Cittas' are extensively described in the Abhidharma as the atomic-level unit of a raw action of consciousness touching upon an object in a field, and there are 121 types of cittas categorized. The cittas are embedded in the mental factors, which could be described as the psychological packaging elements of our experiences of consciousness. Based on these constellations of infinitesimal, linked occurrences of consciousness, citta are categorized by dimensions of purification. A path is a chain of citta developing through causes and conditions. There are no selves, no pronouns in the Abhidharma. Instead of me walking a path, this is about a person working with conditions to cultivate a stream of consciousness that is pure, immediate, direct and generous. The same effort, in very different terms, informs the work of most psychotherapies. Depth psychology seeks to release the bound, unconscious elements of mental process into the clarity of realization. Cognitive and behavioral psychologies work on breaking down automatic thought valuations and actions, changing schemas and interpersonal dynamics. Understanding how the original Buddhist concept of positive human development relates to the clinical psychological concept of therapy weaves together two brilliant systems of thought on the development of human well being.

Keywords: Abhidharma, Buddhist path, clinical psychology, psychotherapeutic outcome

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Authors: Huajuan Shi

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Background: The biopsy of the preimplantation embryo may increase the potential risk and concern of embryo viability. Clinically discarded spent embryo medium (SEM) has entered the view of researchers, sparking an interest in noninvasive embryo screening. However, one of the major restrictions is the extremelty low quantity of cf-RNA, which is difficult to efficiently and unbiased amplify cf-RNA using traditional methods. Hence, there is urgently need to an efficient and low bias amplification method which can comprehensively and accurately obtain cf-RNA information to truly reveal the state of SEM cf-RNA. Result: In this present study, we established an agarose PCR amplification system, and has significantly improved the amplification sensitivity and efficiency by ~90 fold and 9.29 %, respectively. We applied agarose to sequencing library preparation (named AG-seq) to quantify and characterize cf-RNA in SEM. The number of detected cf-RNAs (3533 vs 598) and coverage of 3' end were significantly increased, and the noise of low abundance gene detection was reduced. The increasing percentage 5' end adenine and alternative splicing (AS) events of short fragments (< 400 bp) were discovered by AG-seq. Further, the profiles and characterizations of cf-RNA in spent cleavage medium (SCM) and spent blastocyst medium (SBM) indicated that 4‐mer end motifs of cf-RNA fragments could remarkably differentiate different embryo development stages. Significance: This study established an efficient and low-cost SEM amplification and library preparation method. Not only that, we successfully described the characterizations of SEM cf-RNA of preimplantation embryo by using AG-seq, including abundance features fragment lengths. AG-seq facilitates the study of cf-RNA as a noninvasive embryo screening biomarker and opens up potential clinical utilities of trace samples.

Keywords: cell-free RNA, agarose, spent embryo medium, RNA sequencing, non-invasive detection

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Authors: Yu-Jia Jian, Emily Chia-Yu Su, Hui-Ling Hsu, Jian-Jhih Chen

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Coronary artery is the major supplier of myocardial blood flow. When fat and cholesterol are deposit in the coronary arterial wall, narrowing and stenosis of the artery occurs, which may lead to myocardial ischemia and eventually infarction. According to the World Health Organization (WHO), estimated 740 million people have died of coronary heart disease in 2015. According to Statistics from Ministry of Health and Welfare in Taiwan, heart disease (except for hypertensive diseases) ranked the second among the top 10 causes of death from 2013 to 2016, and it still shows a growing trend. According to American Heart Association (AHA), the risk factors for coronary heart disease including: age (> 65 years), sex (men to women with 2:1 ratio), obesity, diabetes, hypertension, hyperlipidemia, smoking, family history, lack of exercise and more. We have collected a dataset of 421 patients from a hospital located in northern Taiwan who received coronary computed tomography (CT) angiography. There were 300 males (71.26%) and 121 females (28.74%), with age ranging from 24 to 92 years, and a mean age of 56.3 years. Prior to coronary CT angiography, basic data of the patients, including age, gender, obesity index (BMI), diastolic blood pressure, systolic blood pressure, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary heart disease and exercise habits, were collected and used as input variables. The output variable of the prediction module is the degree of coronary artery stenosis. The output variable of the prediction module is the narrow constriction of the coronary artery. In this study, the dataset was randomly divided into 80% as training set and 20% as test set. Four machine learning algorithms, including logistic regression, stepwise regression, neural network and decision tree, were incorporated to generate prediction results. We used area under curve (AUC) / accuracy (Acc.) to compare the four models, the best model is neural network, followed by stepwise logistic regression, decision tree, and logistic regression, with 0.68 / 79 %, 0.68 / 74%, 0.65 / 78%, and 0.65 / 74%, respectively. Sensitivity of neural network was 27.3%, specificity was 90.8%, stepwise Logistic regression sensitivity was 18.2%, specificity was 92.3%, decision tree sensitivity was 13.6%, specificity was 100%, logistic regression sensitivity was 27.3%, specificity 89.2%. From the result of this study, we hope to improve the accuracy by improving the module parameters or other methods in the future and we hope to solve the problem of low sensitivity by adjusting the imbalanced proportion of positive and negative data.

Keywords: decision support, computed tomography, coronary artery, machine learning

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Authors: Mona Nada, Fahmy Fahmy

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Background: Pleomorphic dermal sarcoma is a rare form of skin cancer affecting cutaneous layer and, in some cases associated with recurrence and metastasis, very commonly to seen in elderly patient affecting the area of head and neck. Pleomorphic dermal sarcoma rises in ultraviolet light exposed areas. The symptoms and severity of this kind of skin cancer varies according to histological factors. The differentiation of Pleomorphic dermal sarcoma needs extensive immunohistochemistry, as the diagnosis depends mainly on exclusion to rule out other malignancy like poorly differentiated squamous cell carcinoma, melanoma, angiosarcoma and leiomyosarcoma. Objective: assessing the management of Pleomorphic dermal sarcoma in our unit and compared to the updated guidelines. Design: Retrospective study Collection of patient data from medical records at countess of Chester plastic surgery unit of the last 5 years, all histologically confirmed Pleomorphic dermal sarcoma (2017-2023). Data were collected confirmed to be Pleomorphic dermal sarcoma were included in the study. The data collected: clinical description of the lesions at first presentation, operation time, multidisciplinary team discussion, plan, referral as well as second operation and investigation done. With comparison of histological examination, immunohistochemistry staining, the excision and rate of recurrence. Results: data collected N19 from (2017-2023) showed the disease predominantly affecting males and the lesion mainly in head and neck, the diagnosis needed extensive immunohistochemistry to differentiate between other malignancy. recurrence present in numbers of the cases which managed after multidisciplinary team discussion either by excision or radiotherapy. Conclusion: Pleomorphic dermal sarcoma is a rare malignancy which needs more understanding and avoid missing as it is aggressive form of skin cancer, there is a chance of metastasis and recurrence which makes it very important to understand the process of development of the cancer and frequent review of the management guidelines.

Keywords: pleomorphic dermal sarcoma, recurrence, radiotherapy, surgical

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Authors: Ghazal Zahed, Leila Tabatabaee, Amirhossein Hosseini, Somaye Fatahi

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Functional retentive overflow incontinence (Retentive FI) is the most common cause of fecal soiling in children. Affected patients may have more problems with their parents and peer group, self-esteem issues, and more psychiatric comorbidities than the general population. Therapeutic interventions for Retentive FI and related problems and comorbid conditions are needed at the same time. Based on the clinical experiences, patients with retentive FI and comorbid psychiatric disorders, were accelerated in their treatment of fecal incontinence when they were being treated with Risperidone for their psychiatric comorbidities, therefore this study was conducted to evaluate the effect of Risperidone in the treatment of Retentive FI in children and adolescents. In this double-blind randomized clinical trial, 136 patients aged 4-18 years eligible for the study were randomly divided into two groups receiving Risperidone and placebo. About half of these patients had newly diagnosed psychiatric disorders and were drug naïve, this was considered in their division. In addition to polyethylene glycol, all the participants received family counseling and education for withholding behaviors and related behavioral interventions, and nonpharmacological interventions for psychiatric comorbidities. A significant correlation was observed between the duration of treatment with risperidone and the presence of psychiatric comorbidities (P <0.001) for diurnal fecal incontinence. Based on our findings in this study, Risperidone, used commonly for psychiatric disorders in children and adolescents, may be useful in the treatment of retentive fecal incontinence in the presence of psychiatric comorbidities, and along with other interventions.

Keywords: Retentive Fecal Incontinence, Risperidone, Treatment, Pediatric, Encopresis, Atypical Antipsychotics, Fecal Soiling

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Authors: Deniz Peksen

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This thesis aims to predict trend movement of closing price of stock and to maximize portfolio by utilizing the predictions. In this context, the study aims to define a stock portfolio strategy from models created by using Logistic Regression, Gradient Boosting and Random Forest. Recently, predicting the trend of stock price has gained a significance role in making buy and sell decisions and generating returns with investment strategies formed by machine learning basis decisions. There are plenty of studies in the literature on the prediction of stock prices in capital markets using machine learning methods but most of them focus on closing prices instead of the direction of price trend. Our study differs from literature in terms of target definition. Ours is a classification problem which is focusing on the market trend in next 20 trading days. To predict trend direction, fourteen years of data were used for training. Following three years were used for validation. Finally, last three years were used for testing. Training data are between 2002-06-18 and 2016-12-30 Validation data are between 2017-01-02 and 2019-12-31 Testing data are between 2020-01-02 and 2022-03-17 We determine Hold Stock Portfolio, Best Stock Portfolio and USD-TRY Exchange rate as benchmarks which we should outperform. We compared our machine learning basis portfolio return on test data with return of Hold Stock Portfolio, Best Stock Portfolio and USD-TRY Exchange rate. We assessed our model performance with the help of roc-auc score and lift charts. We use logistic regression, Gradient Boosting and Random Forest with grid search approach to fine-tune hyper-parameters. As a result of the empirical study, the existence of uptrend and downtrend of five stocks could not be predicted by the models. When we use these predictions to define buy and sell decisions in order to generate model-based-portfolio, model-based-portfolio fails in test dataset. It was found that Model-based buy and sell decisions generated a stock portfolio strategy whose returns can not outperform non-model portfolio strategies on test dataset. We found that any effort for predicting the trend which is formulated on stock price is a challenge. We found same results as Random Walk Theory claims which says that stock price or price changes are unpredictable. Our model iterations failed on test dataset. Although, we built up several good models on validation dataset, we failed on test dataset. We implemented Random Forest, Gradient Boosting and Logistic Regression. We discovered that complex models did not provide advantage or additional performance while comparing them with Logistic Regression. More complexity did not lead us to reach better performance. Using a complex model is not an answer to figure out the stock-related prediction problem. Our approach was to predict the trend instead of the price. This approach converted our problem into classification. However, this label approach does not lead us to solve the stock prediction problem and deny or refute the accuracy of the Random Walk Theory for the stock price.

Keywords: stock prediction, portfolio optimization, data science, machine learning

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Authors: Manely Ansary Mood, Farzaneh Aziizi, Mahmoud Akbarian

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This investigation included 130 cats diagnosed with FIP (Feb 2021-March 2022) in Iran, 74 with effusive FIP, and 56 with non-effusive FIP. The patients' initial dosage regime consisted of a subcutaneous injection of GS-441524 was 6-15mg/kg-every 24h (based on the wet or ocular and neurologic signs). The minimum treatment period was twelve weeks, extended in animals that still had abnormal lab values, clinical signs, and sonographic findings. The outcomes of the 130 cats that completed the duration of treatment (14 died, 116 cured) were checked and recorded. Clinical, sonographic, and laboratory responses were checked and compared on days 28, 56, and 83 of treatment. 2 of the 116 cured cats relapsed within observation days. At the time of this publication (May 2022), 114 of the studied patients remained healthy. We could conclude that GS-441524 appears to be an effective option for FIP treatment, and also, to the base of our knowledge, this is the first report for group treatment of infected cats of FIP with GS-441524 in Iran.

Keywords: FIP, cat, GS-441524, treatment

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Authors: Sela Adjei

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This paper aims to rationalize the need for media policy implementation and copyright enforcement to address various challenges faced within Ghana’s film industry. After Ghana transitioned to democratic rule in 1992, critics and media professionals advocated a national media policy. This advocacy subsequently resulted in agitation for media deregulation and loosening of grip on state-owned media organizations. The reinstatement of constitutional rule in 1992 paved the way for the state to lax its monopoly of the media within the democratic context of a free market economy. The National Media Commission proposed a media policy and broadcast bill which was presented to parliament but has still not been passed into law. This legislative lapse partly contributed to the influx of unregulated foreign content. Accessible foreign media content subsequently promoted a system of unfair competition that radically undermined locally produced content, putting a generation of thriving film producers out of work. Drawing on reflections from a series of structured interviews, focus group discussions and creative workshops, the findings of this study maintain that the various challenges confronting Ghanaian filmmakers is centred around inadequate funding opportunities, copyright violation and policy implementation issues. Using the film industry structure and value chain analysis, the various challenges faced by the selected film producers were discussed and critically analyzed. A significant aspect of this study is the solution-driven approach adopted in outlining the practical recommendations that will boost the aesthetic, cultural and economic value of Ghanaian film productions. Based on the discussions and conclusions drawn with the various stakeholders within Ghana’s creative industries, the paper makes a strong case for firm state regulation, copyright enforcement and policy implementation to grow Ghana’s film industry.

Keywords: film, value, copyright, media, policy, culture, regulation, economy

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Authors: Hui-Hsin Huang, Sheng-Tung Huang, Chi-Ming Lee, Chiao-Han Yen, Chun-Mao Lin

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At initiation stage, there are no symptoms at initiation stage; however, at late stage, patients suffer symptoms as soon as ovarian cancer metastasis. Moreover, ovarian cancer cells are resistant to some anti-ovarian cancer drugs in clinical. Thus, it is very important to find an effective treatment for resistant ovarian cancer. Anthraquinone derivatives are able to induce DNA damage and lead to cell apoptosis, so several derivatives have been used for clinical application. Therefore, to explore more effective anti-ovarian cancer drugs, this study investigates the mechanism of three new anthraquinone compounds bearing different functional groups to camptothecin-resistance ovarian cell line A2780R2000. Cell viability was determined by MTT assay after treating A2780R2000 with the three new anthraquinone compounds. The results indicated that IC50 values are 33.44μM (Compound I), 25.77μM (Compound II) and 24.59μM (Compound III). Next, through cell cycle analysis, the results demonstrated that three new anthraquinone compounds not only induced A2780R2000 cell cycle arrest at early stage but also apoptosis at late stage. Besides, through apoptosis assay, the results indicated new anthraquinone compound induced apoptosis at late stage. Furthermore, the results of western blot show that the three new anthraquinone compounds lead to A2780R2000 apoptosis through intrinsic pathway. Theses results suggested that three new anthraquinone compounds may be potential new drugs for clinical cancer treatment in the future.

Keywords: anthraquinone, camptothecin, resistance, ovarian cancer

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Authors: Kouorsh Zarea, Fatemeh Hassani, Samira Beiranvand, Akram Mohamadi

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Background and Objectives: Medication error in hospitals is a major cause of the errors which disrupt the health care system. The aim of this study was to assess the nurses’ medication errors and related factors. Material and methods: This was a descriptive study on 225 nurses in various hospitals, selected through multistage random sampling. Data was collected by three researcher made tools; demographic, medication error and related factors questionnaires. Data was analyzed by descriptive statistics, Chi-square, Kruskal-Wallis, One-way analysis of variance. Results: Based on the results obtained, the type of medication errors giving drugs to patients later or earlier (55.6%), multiple oral medication together regardless of their interactions (36%) and the postoperative analgesic without a prescription (34.2%), respectively. In addition, factors such as the shortage of nurses to patients’ ratio (57.3%), high load functions (51.1%) and fatigue caused by the extra work (40.4%), were the most important factors affecting the incidence of medication errors. The fear of legal issues (40%) are the most important factor is the lack of reported medication errors. Conclusions: Based on the results, effective management and promotion motivate nurses. Therefore, increasing scientific and clinical expertise in the field of nursing medication orders is recommended to prevent medication errors in various states of nursing intervention. Employing experienced staff in areas with high risk of medication errors and also supervising less-experienced staff through competent personnel are also suggested.

Keywords: medication error, nurse, clinical care, drug errors

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Authors: Rania E. Ramadan

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Dental esthetics is subjective, can be reported by the dentist and not noticed by the patient. However, if there is any imperfection seen by both the dentist and the patient, it is considered as an unesthetic like white and/or brown spot lesions. Many patients nowadays have been concerned about dental esthetics. Esthetic rehabilitation of anterior teeth and even maxillary premolars aid a lot in patients’ satisfaction of their smile consequently, gaining positive psychological impact for the patients. Many cases need esthetic rehabilitation such as diastema closure, spaced teeth and masking discolored teeth. Dental fluorosis and enamel hypo calcification can be presented as white and/or brown spot lesions. There are many treatment options for the management of these spotted teeth. Treatment options range from bleaching, microabrasion, direct composite restorations, porcelain veneers, and complete coverage crowns. The selection of certain options depends on many factors: the patient’s age, socioeconomic status and the severity of the lesion. In this clinical report, a 22-year-old male patient has been presented to the Department of Prosthodontics in Alexandria University, Egypt. His chief complaint was, “I was unpleased by white and brown spots in my teeth and I want to close the space between the two maxillary central.” Upon medical history, clinical examination, diagnostic photographs, and digital smile design by Exocad software, lithium disilicate veneers were chosen as the treatment of choice in maxillary anterior and first premolars.

Keywords: flourosis, ceramic veneers, case report, diastema closure

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Authors: Siti Hajar Muhamad Rosli, Xin Yi Lim, Terence Yew Chin Tan, Muhammad nor Farhan Sa’At, Syazwani Sirdar Ali, Ami Fazlin Syed Mohamed

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A growing interest on therapeutic benefits of hemp (Cannabis sativa subsp. sativa) is evident in the pharmaceutical market, attributed to its lower levels of psychoactive constituent delta-9-tetrahydronannabidiol (THC). Deemed as a legal and safer alternative to its counterpart marijuana, the use of medicinal hemp is highly debatable as current scientific evidence on the efficacy for clinical use is yet to be established This study was aimed to provide an overview of the current landscape of hemp research, through recent clinical findings specific to the pharmacological properties of the hemp plant and its derived compounds. A systematic search was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis-ScR (PRISMA) checklist on electronic databases (MEDLINE, OVID, Cochrane Library Central, and Clinicaltrials.gov) for articles published from 2009 to 2019. With predetermined inclusion criteria, all human trials with hemp intervention were included. A total of 18 human trials were identified, investigating therapeutic effects on the neuronal, gastrointestinal, musculoskeletal and immune system, with sample sizes ranging from one to 194 subjects. Three randomised controlled trials showed hempseed pills (in Traditional Chinese Medicine formulation MaZiRenWan) consumption significantly improved spontaneous bowel movement in functional constipation. The use of commercial cannabidiol (CBD) sourced from hemp suggested benefits in cannabis dependence, epilepsy, and anxiety disorders. However, there was insufficient evidence to suggest analgesic or anxiolytics effects of hemp being equivalent to marijuana. All clinical trials reviewed varied in terms of test item formulation and standardisation, which made it challenging to confirm overall efficacy for a specific disease or condition. Published efficacy data on hemp are still at a preliminary level, with limited high quality clinical evidence for any specific therapeutic indication. With multiple variants of this plant having different phytochemical and bioactive compounds, future empirical research should focus on uniformity in experimental designs to further strengthen the notion of using medicinal hemp.

Keywords: cannabis, complementary medicine, hemp, herbal medicine.

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Authors: Xiaoyuan Chen

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Background: This study aimed to characterize the epidemiological and clinical features of five rare subtypes of hepatocellular carcinoma (HCC) and to create a competing risk nomogram for predicting cancer-specific survival. Methods: This study used the Surveillance, Epidemiology, and End Results database to analyze the clinicopathological data of 50,218 patients with classic HCC and five rare subtypes (ICD-O-3 Histology Code=8170/3-8175/3) between 2004 and 2018. The annual percent change (APC) was calculated using Joinpoint regression, and a nomogram was developed based on multivariable competing risk survival analyses. The prognostic performance of the nomogram was evaluated using the Akaike information criterion, Bayesian information criterion, C-index, calibration curve, and area under the receiver operating characteristic curve. Decision curve analysis was used to assess the clinical value of the models. Results: The incidence of scirrhous carcinoma showed a decreasing trend (APC=-6.8%, P=0.025), while the morbidity of other rare subtypes remained stable from 2004 to 2018. The incidence-based mortality plateau in all subtypes during the period. Clear cell carcinoma was the most common subtype (n=551, 1.1%), followed by fibrolamellar (n=241, 0.5%), scirrhous (n=82, 0.2%), spindle cell (n=61, 0.1%), and pleomorphic (n=17, ~0%) carcinomas. Patients with fibrolamellar carcinoma were younger and more likely to have non-cirrhotic liver and better prognoses. Scirrhous carcinoma shared almost the same macro clinical characteristics and outcomes as classic HCC. Clear cell carcinoma tended to occur in the Asia-Pacific elderly male population, and more than half of them were large HCC (Size>5cm). Sarcomatoid (including spindle cell and pleomorphic) carcinoma was associated with larger tumor size, poorer differentiation, and more dismal prognoses. The pathological subtype, T stage, M stage, surgery, alpha-fetoprotein, and cancer history were identified as independent predictors in patients with rare subtypes. The nomogram showed good calibration, discrimination, and net benefits in clinical practice. Conclusion: The rare subtypes of HCC had distinct clinicopathological features and biological behaviors compared with classic HCC. Our findings could provide a valuable reference for clinicians. The constructed nomogram could accurately predict prognoses, which is beneficial for individualized management.

Keywords: hepatocellular carcinoma, pathological subtype, fibrolamellar carcinoma, scirrhous carcinoma, clear cell carcinoma, spindle cell carcinoma, pleomorphic carcinoma

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Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

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Objective: Serratia species are identified as aerobic, motile Gram negative rods. The species Serratia marcescens (S. marcescens) causes both opportunistic and nosocomial infections. The genus Providencia is Gram-negative bacilli and includes urease-producing that is responsible for a wide range of human infections. Although most Providencia infections involve the urinary tract, they are also associated with gastroenteritis, wound infections, and bacteremia. The aim of this study was evaluate the antimicrobial resistance rates of S. marcescens and Providencia spp. strains which had been isolated from various clinical materials obtained from different patients who belongs to intensive care units (ICU) and inpatient clinics. Methods: A total of 35 S. marcescens and Providencia spp. strains isolated from various clinical samples admitted to Medical Microbiology Laboratory, ANS Research and Practice Hospital, Afyon Kocatepe University between October 2013 and September 2015 were included in the study. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bio-Merieux, Marcy l’etoile, France) was used additionally. Antibacterial resistance tests were performed by using Kirby Bauer disc (Oxoid, Hampshire, England) diffusion method following the recommendations of CLSI. Results: The distribution of clinical samples were as follows: upper and lower respiratory tract samples 26, 74.2 % wound specimen 6, 17.1 % blood cultures 3, 8.5%. Of the 35 S. marcescens and Providencia spp. strains; 28, 80% were isolated from clinical samples sent from ICU. The resistance rates of S. marcescens strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 8.5 %, 22.8 %, 11.4 %, 2.8 %, 17.1 %, 40 %, 28.5 % and 5.7 % respectively. Resistance rates of Providencia spp. strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 10.2 %, 33,3 %, 18.7 %, 8.7 %, 13.2 %, 38.6 %, 26.7%, and 11.8 % respectively. Conclusion: S. marcescens is usually resistant to ampicillin, amoxicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefuroxime, cephamycins, nitrofurantoin, and colistin. The most effective antibiotic on the total of S. marcescens strains was found to be gentamicin 2.8 %, of the totally tested strains the highest resistance rate found against to ceftazidime 40 %. The lowest and highest resistance rates were found against gentamiycin and ceftazidime with the rates of 8.7 % and 38.6 % for Providencia spp.

Keywords: Serratia marcescens, Providencia spp., antibiotic resistance, intensive care unit

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Authors: Poglajen Andrej, Malečihar Špela

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Social work in rehabilitation needs constant development and embetterment of its practitioners. This became even more evident during the covid pandemic at times when outside sources of help, care and support were non-existent, or the access to such sources was severely limited. Social workers are, at our core, researchers of the rehabilitated world – from a personal and intrapersonal to a systematic perspective. This is also why a method of research was used in order to see if clinical social work practice can be further improved. The first stage of research showcased how action research and social work practice share many of the core values, whereas the Implementation of the new behaviour principle was severely lacking and thus became the main focus of the follow-up research. Twenty randomly selected case files of clinical social work practice in rehabilitation were qualitatively analyzed and potential benefits of action research on practice were assessed in the process of intervention while also getting feedback of the usefulness by the patients themselves using pre and post evaluation forms where a mixed-method approach was used. Implementation of new behaviour principle was recognized as a potential, improving factor of clinical social work practice in most analyzed cases, while it wasn’t deemed necessary in all of them. Potential improvements of newly implemented behaviour span across different areas of life and were also noted in the feedback from the rehabilitates. Despite the benefits of practice embetterment, the inclusion and focus on Implementation of new behaviour principle also caused additional workload, lack of time and stressful situations for the practitioners, which showcased the need to address certain systemic obstacles in the context of social work in healthcare in Slovenia.

Keywords: action research, practice, rehabilitation, social work

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Authors: Zhenzhen Xu, Chunfu Shao, Shengyou Wang, Chunjiao Dong

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To improve the satisfaction of residents' travel, this paper analyzes the characteristics and influencing factors of urban residents' travel behavior. First, a Multinominal Logit Model (MNL) model is built to analyze the characteristics of residents' travel behavior, reveal the influence of individual attributes, family attributes and travel characteristics on the choice of travel mode, and identify the significant factors. Then put forward suggestions for policy improvement. Finally, Support Vector Machine (SVM) and Multi-Layer Perceptron (MLP) models are introduced to evaluate the policy effect. This paper selects Futian Street in Futian District, Shenzhen City for investigation and research. The results show that gender, age, education, income, number of cars owned, travel purpose, departure time, journey time, travel distance and times all have a significant influence on residents' choice of travel mode. Based on the above results, two policy improvement suggestions are put forward from reducing public transportation and non-motor vehicle travel time, and the policy effect is evaluated. Before the evaluation, the prediction effect of MNL, SVM and MLP models was evaluated. After parameter optimization, it was found that the prediction accuracy of the three models was 72.80%, 71.42%, and 76.42%, respectively. The MLP model with the highest prediction accuracy was selected to evaluate the effect of policy improvement. The results showed that after the implementation of the policy, the proportion of public transportation in plan 1 and plan 2 increased by 14.04% and 9.86%, respectively, while the proportion of private cars decreased by 3.47% and 2.54%, respectively. The proportion of car trips decreased obviously, while the proportion of public transport trips increased. It can be considered that the measures have a positive effect on promoting green trips and improving the satisfaction of urban residents, and can provide a reference for relevant departments to formulate transportation policies.

Keywords: neural network, travel characteristics analysis, transportation choice, travel sharing rate, traffic resource allocation

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Authors: Priyadarsini Samal, Rajesh Singla

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Many mobile games come with the benefits of entertainment by introducing stress to the human brain. In recognizing this mental stress, the brain-computer interface (BCI) plays an important role. It has various neuroimaging approaches which help in analyzing the brain signals. Electroencephalogram (EEG) is the most commonly used method among them as it is non-invasive, portable, and economical. Here, this paper investigates the pattern in brain signals when introduced with mental stress. Two healthy volunteers played a game whose aim was to search hidden words from the grid, and the levels were chosen randomly. The EEG signals during gameplay were recorded to investigate the impacts of stress with the changing levels from easy to medium to hard. A total of 16 features of EEG were analyzed for this experiment which includes power band features with relative powers, event-related desynchronization, along statistical features. Support vector machine was used as the classifier, which resulted in an accuracy of 93.9% for three-level stress analysis; for two levels, the accuracy of 92% and 98% are achieved. In addition to that, another game that was similar in nature was played by the volunteers. A suitable regression model was designed for prediction where the feature sets of the first and second game were used for testing and training purposes, respectively, and an accuracy of 73% was found.

Keywords: brain computer interface, electroencephalogram, regression model, stress, word search

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Authors: Stig H. Jørgensen, Trond Nordfjærn, Øyvind Teige Hedenstrøm, Torbjørn Rundmo

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The aim of the paper is to estimate and forecast road traffic injuries in the coming 10-15 years given new targets in urban transport policy and shifts of mode of transport, including injury cross-effects of mode changes. The paper discusses possibilities and limitations in measuring and quantifying possible injury reductions. Injury data (killed and seriously injured road users) from six urban areas in Norway from 1998-2012 (N= 4709 casualties) form the basis for estimates of changing injury patterns. For the coming period calculation of number of injuries and injury rates by type of road user (categories of motorized versus non-motorized) by sex, age and type of road are made. A prognosticated population increase (25 %) in total population within 2025 in the six urban areas will curb the proceeded fall in injury figures. However, policy strategies and measures geared towards a stronger modal shift from use of private vehicles to safer public transport (bus, train) will modify this effect. On the other side will door to door transport (pedestrians on their way to/from public transport nodes) imply a higher exposure for pedestrians (bikers) converting from private vehicle use (including fall accidents not registered as traffic accidents). The overall effect is the sum of these modal shifts in the increasing urban population and in addition diminishing return to the majority of road safety countermeasures has also to be taken into account. The paper demonstrates how uncertainties in the various estimates (prediction factors) on increasing injuries as well as decreasing injury figures may partly offset each other. The paper discusses road safety policy and welfare consequences of transport mode shift, including reduced use of private vehicles, and further environmental impacts. In this regard, safety and environmental issues will as a rule concur. However pursuing environmental goals (e.g. improved air quality, reduced co2 emissions) encouraging more biking may generate more biking injuries. The study was given financial grants from the Norwegian Research Council’s Transport Safety Program.

Keywords: road injuries, forecasting, reduced private care use, urban, Norway

Procedia PDF Downloads 227

Authors: Chi Wu, Dean Wu, Wen-Te Liu, Cheng-Yu Tsai, Shin-Mei Hsu, Yin-Tzu Lin, Ru-Yin Yang

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Background: The results of previous studies compared the benefits and risks of receiving insomnia medication. However, the effects between hypnotic drugs used and enhancement of sleep quality were still unclear. Objective: The aim of this study is to establish a prediction model for hypnotic drugs' dosage used for insomnia subjects and associated the relationship between sleep stage ratio change and drug types. Methodologies: According to American Academy of Sleep Medicine (AASM) guideline, sleep stages were classified and transformed to hypnogram via the polysomnography (PSG) in a hospital in New Taipei City (Taiwan). The subjects with diagnosis for insomnia without receiving hypnotic drugs treatment were be set as the comparison group. Conversely, hypnotic drugs dosage within the past three months was obtained from the clinical registration for each subject. Furthermore, the collecting subjects were divided into two groups for training and testing. After training convolution neuron network (CNN) to predict types of hypnotics used and dosages are taken, the test group was used to evaluate the accuracy of classification. Results: We recruited 76 subjects in this study, who had been done PSG for transforming hypnogram from their sleep stages. The accuracy of dosages obtained from confusion matrix on the test group by CNN is 81.94%, and accuracy of hypnotic drug types used is 74.22%. Moreover, the subjects with high ratio of wake stage were correctly classified as requiring medical treatment. Conclusion: CNN with hypnogram was potentially used for adjusting the dosage of hypnotic drugs and providing subjects to pre-screening the types of hypnotic drugs taken.

Keywords: convolution neuron network, hypnotic drugs, insomnia, polysomnography

Procedia PDF Downloads 180

Authors: Guilherme Ribeiro, Alexandre Oliveira, Antonio Ferreira, Shyam Visweswaran, Gregory Cooper

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Patient-specific models are instance-based learning algorithms that take advantage of the particular features of the patient case at hand to predict an outcome. We introduce two patient-specific algorithms based on decision tree paradigm that use AUC as a metric to select an attribute. We apply the patient specific algorithms to predict outcomes in several datasets, including medical datasets. Compared to the patient-specific decision path (PSDP) entropy-based and CART methods, the AUC-based patient-specific decision path models performed equivalently on area under the ROC curve (AUC). Our results provide support for patient-specific methods being a promising approach for making clinical predictions.

Keywords: approach instance-based, area under the ROC curve, patient-specific decision path, clinical predictions

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Authors: Samaila Muazu Bawa

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Hydration process, crack potential and setting time of concrete grade C30, C40 and C50 were separately monitored using non-contact electrical resistivity apparatus, a plastic ring mould and penetration resistance method respectively. The results show highest resistivity of C30 at the beginning until reaching the acceleration point when C50 accelerated and overtaken the others, and this period corresponds to its final setting time range, from resistivity derivative curve, hydration process can be divided into dissolution, induction, acceleration and deceleration periods, restrained shrinkage crack and setting time tests demonstrated the earliest cracking and setting time of C50, therefore, this method conveniently and rapidly determines the concrete’s crack potential. The highest inflection time (ti), the final setting time (tf) were obtained and used with crack time in coming up with mathematical models for the prediction of concrete’s cracking age for the range being considered. Finally, ANSYS numerical simulations supports the experimental findings in terms of the earliest crack age of C50 and the crack location that, highest stress concentration is always beneath the artificially introduced expansion joint of C50.

Keywords: concrete hydration, electrical resistivity, restrained shrinkage crack, ANSYS simulation

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Authors: Fatemeh Sadeghi, Peyman Sheikhzadeh

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Introduction: Block Sequential Regularized Expectation Maximization (BSREM) reconstruction algorithm was recently developed to suppress excessive noise by applying a relative difference penalty. The aim of this study was to investigate the effect of various strengths of noise penalization factor in the BSREM algorithm under different acquisition duration and lesion sizes in order to determine an optimum penalty factor by considering both quantitative and qualitative image evaluation parameters in clinical uses. Materials and Methods: The NEMA IQ phantom and 15 clinical whole-body patients with prostate cancer were evaluated. Phantom and patients were injected withGallium-68 Prostate-Specific Membrane Antigen(68 Ga-PSMA)and scanned on a non-time-of-flight Discovery IQ Positron Emission Tomography/Computed Tomography(PET/CT) scanner with BGO crystals. The data were reconstructed using BSREM with a β-value of 100-500 at an interval of 100. These reconstructions were compared to OSEM as a widely used reconstruction algorithm. Following the standard NEMA measurement procedure, background variability (BV), recovery coefficient (RC), contrast recovery (CR) and residual lung error (LE) from phantom data and signal-to-noise ratio (SNR), signal-to-background ratio (SBR) and tumor SUV from clinical data were measured. Qualitative features of clinical images visually were ranked by one nuclear medicine expert. Results: The β-value acts as a noise suppression factor, so BSREM showed a decreasing image noise with an increasing β-value. BSREM, with a β-value of 400 at a decreased acquisition duration (2 min/ bp), made an approximately equal noise level with OSEM at an increased acquisition duration (5 min/ bp). For the β-value of 400 at 2 min/bp duration, SNR increased by 43.7%, and LE decreased by 62%, compared with OSEM at a 5 min/bp duration. In both phantom and clinical data, an increase in the β-value is translated into a decrease in SUV. The lowest level of SUV and noise were reached with the highest β-value (β=500), resulting in the highest SNR and lowest SBR due to the greater noise reduction than SUV reduction at the highest β-value. In compression of BSREM with different β-values, the relative difference in the quantitative parameters was generally larger for smaller lesions. As the β-value decreased from 500 to 100, the increase in CR was 160.2% for the smallest sphere (10mm) and 12.6% for the largest sphere (37mm), and the trend was similar for SNR (-58.4% and -20.5%, respectively). BSREM visually was ranked more than OSEM in all Qualitative features. Conclusions: The BSREM algorithm using more iteration numbers leads to more quantitative accuracy without excessive noise, which translates into higher overall image quality and lesion detectability. This improvement can be used to shorter acquisition time.

Keywords: BSREM reconstruction, PET/CT imaging, noise penalization, quantification accuracy

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Authors: Jan-Peter Mund, Christian Kind

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In view of the ongoing climate change and global warming, fires along railways in Germany are occurring more frequently, with sometimes massive consequences for railway operations and affected railroad infrastructure. In the absence of systematic studies within the infrastructure network of German Rail, little is known about the causes of such embankment fires. Since a further increase in these hazards is to be expected in the near future, there is a need for a sound knowledge of triggers and drivers for embankment fires as well as methodical knowledge of prediction tools. Two predictable future trends speak for the increasing relevance of the topic: through the intensification of the use of rail for passenger and freight transport (e.g..: doubling of annual passenger numbers by 2030, compared to 2019), there will be more rail traffic and also more maintenance and construction work on the railways. This research project approach uses satellite data to identify historical embankment fires along rail network infrastructure. The team links data from these fires with infrastructure and weather data and trains a machine-learning model with the aim of predicting fire hazards on sections of the track. Companies reflect on the results and use them on a pilot basis in precautionary measures.

Keywords: embankment fires, railway maintenance, machine learning, remote sensing, VIIRS data

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Authors: Karla Lebedoff, Susan Walsh, Michelle Bain

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Eczema is a chronic atopy condition requiring long-term daily management in children. Written action plans for other chronic atopic conditions, such as asthma and food allergies, are widely recommended and distributed to pediatric patients' parents and caregivers, seeking to improve clinical outcomes and become empowered to manage the patient's ever-changing symptoms. Written action plans for eczema, referred to as "asthma of the skin," are not routinely used in practice. Parents of children suffering from eczema rarely receive a written action plan to follow, and commendations supporting eczema action plans are inconsistent. Pediatric patients between birth and 18 years old who were followed for eczema at an urban Midwest community hospital were eligible to participate in this quality improvement project. At the initial visit, parents received instructions on individualized eczema action plans for their child and completed two validated surveys: Health Confidence Score (HCS) and Patient-Oriented Eczema Measure (POEM). Pre- and post-survey responses were collected, and clinical symptom presentation at follow-up were outcome determinants. Project implementation was guided by Institute for Healthcare Improvement's Step-up Framework and the Plan-Do-Study-Act cycle. This project measured clinical outcomes and parent confidence in self-management of their child's eczema symptoms with the responses from 26 participant surveys. Pre-survey responses were collected from 36 participants, though ten were lost to follow-up. Average POEM scores improved by 53%, while average HCS scores remained unchanged. Of seven completed in-person follow-up visits, six clinical progress notes documented improvement. Individualized eczema action plans can be seamlessly incorporated into primary and specialty care visits for pediatric patients suffering from eczema. Following a patient-specific eczema action plan may lessen the daily physical and mental burdens of uncontrolled eczema for children and parents, managing symptoms that chronically flare and recede. Furthermore, incorporating eczema action plans into practice potentially reduces the likely underestimated $5.3 billion economic disease burden of eczema on the U.S. healthcare system.

Keywords: atopic dermatitis, eczema action plan, eczema symptom management, pediatric eczema

Procedia PDF Downloads 128

Authors: Subhadip Biswas, Shivendra Maurya, Satish Chandra, Indrajit Ghosh

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Use of speed prediction models sometimes appears as a feasible alternative to laborious field measurement particularly, in case when field data cannot fulfill designer’s requirements. However, developing speed models is a challenging task specifically in the context of developing countries like India where vehicles with diverse static and dynamic characteristics use the same right of way without any segregation. Here the traffic composition plays a significant role in determining the vehicular speed. The present research was carried out to examine the effects of traffic volume and its composition on vehicular speed under mixed traffic conditions. Classified traffic volume and speed data were collected from different geometrically identical six lane divided arterials in New Delhi. Based on these field data, speed prediction models were developed for individual vehicle category adopting Kriging approximation technique, an alternative for commonly used regression. These models are validated with the data set kept aside earlier for validation purpose. The predicted speeds showed a great deal of agreement with the observed values and also the model outperforms all other existing speed models. Finally, the proposed models were utilized to evaluate the effect of traffic volume and its composition on speed.

Keywords: speed, Kriging, arterial, traffic volume

Procedia PDF Downloads 342