Search results for: procedures

Authors: Duaa Mughal, Syeda Areeba Nadeem, Shakil Ahmed, Ishtiaq Ahmed Khan

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The identification of porcine DNA in Halal food items is critical to ensuring compliance with dietary restrictions and religious beliefs. In Islam, Porcine is prohibited as clearly mentioned in Quran (Surah Al-Baqrah, Ayat 173). The purpose of this study was to compare two DNA extraction procedures for detecting 0.001% of porcine DNA in processed Halal food sample mixtures containing chicken, camel, veal, turkey and goat meat using the TaqMan Real-Time PCR technology. In this research, two different commercial kit protocols were compared. The processed sample mixtures were prepared by spiking known concentration of porcine DNA to non-porcine food matrices. Afterwards, TaqMan Real-Time PCR technique was used to target a particular porcine gene from the extracted DNA samples, which was quantified after extraction. The results of the amplification were evaluated for sensitivity, specificity, and reproducibility. The results of the study demonstrated that two DNA extraction techniques can detect 0.01% of porcine DNA in mixture of Halal food samples. However, as compared to the alternative approach, Eurofins| GeneScan GeneSpin DNA Isolation kit showed more effective sensitivity and specificity. Furthermore, the commercial kit-based approach showed great repeatability with minimal variance across repeats. Quantification of DNA was done by using fluorometric assay. In conclusion, the comparison of DNA extraction methods for detecting porcine DNA in Halal food sample mixes using the TaqMan Real-Time PCR technology reveals that the commercial kit-based approach outperforms the other methods in terms of sensitivity, specificity, and repeatability. This research helps to promote the development of reliable and standardized techniques for detecting porcine DNA in Halal food items, religious conformity and assuring nutritional.

Keywords: real time PCR (qPCR), DNA extraction, porcine DNA, halal food authentication, religious conformity

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Authors: Long-Shan Wu, Ming-Chen Ko, Chien-Chang Ho, Po-Fu Lee, Jenn-Woei Hsieh, Ching-Yu Tseng

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This study aimed to determine the effects of whole-body vibration (WBV) training on lower-extremity muscle strength and balance control performance among community-dwelling middle-aged and older adults in the United States. Twenty-nine participants without any contraindication of performing WBV exercise completed all the study procedures. Participants were randomly assigned to do body weight exercise with either an individualized vibration frequency and amplitude, a fixed vibration frequency and amplitude, or no vibration. Isokinetic knee extensor power, limits of stability, and sit-to-stand tests were performed at the baseline and after 8 weeks of training. Neither the individualized frequency-amplitude WBV training protocol nor the fixed frequency-amplitude WBV training protocol improved isokinetic knee extensor power. The limits of stability endpoint excursion score for the individualized frequency-amplitude group increased by 8.8 (12.9%; p = 0.025) after training. No significant differences were observed in fixed and control group. The maximum excursion score for the individualized frequency-amplitude group at baseline increased by 9.2 (11.5%; p = 0.006) after training. The average weight transfer time score significantly decreased by 0.21 s in the fixed group. The participants in the individualized group showed a significant increase (3.2%) in weight rising index score after 8 weeks of WBV training. These results suggest that 8 weeks of WBV training improved limit of stability and sit-to-stand performance. Future studies need to determine whether WBV training improves other factors that can influence posture control.

Keywords: whole-body vibration training, muscle strength, balance control, middle-aged and older adults

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Authors: Sara Alhabli, Eman Elashiry, Osama Felemban, Abdullah Almushayt, Faisal Dardeer, Ahmed Mohammad, Fajr Orri, Nada Bamashmous

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Background: In December of 2019, the coronavirus (SARS-CoV-2) first appeared and quickly spread to become a worldwide pandemic. This study aimed to evaluate the prevalence and types of pediatric dental emergencies during the COVID-19 lockdown in Jeddah, Saudi Arabia, at the University Dental Hospital (UDH) of King Abdulaziz University (KAU) and identified the management provided for these dental emergency visits. Materials and Methods: Data collection was done retrospectively from electronic dental records for children aged 0-18 that attended the UDH emergency clinic during the period from March 1st, 2020, to September 30th, 2020. An electronic form formulated specifically for this study was used to collect the required data from electronic patient records, including demographic data, emergency classification, management, and referrals. Results: A total of 3146 patients were seen at the emergency clinics during this period, of which 661 were children (21%). Types of emergency conditions included 0.8% emergency cases, 34% urgent, and 65.2% non-urgent conditions. Severe dental pain (73.1%) and abscesses (20%) were the most common urgent dental conditions. Most non-urgent conditions presented for initial or periodic visits, recalls, or routine radiographs (74%). Treatments rarely involved restorations, with 8% among urgent conditions and 5.4% among non-urgent conditions. Antibiotics were only prescribed to 6.9% of urgent conditions. Conclusions: The largest group of children presenting at the emergency dental clinics were found to be children with non-urgent conditions. Tele dentistry can be a solution to avoid large numbers of non-urgent patients presenting to emergency clinics. Additionally, dental care for non-urgent conditions during the pandemic should focus more on procedures with less aerosol generation.

Keywords: COVID-19 pandemic, dental emergencies, oral health, pediatric dentistry, children

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Authors: Payman Tajalli, Steven Segal

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Applied ethics is an area of ethics which is looked upon most favorably as the most appropriate and useful for educational purposes; after all if ethics finds no application would any investment of time, effort and finance by the educational institutions be warranted? The current approaches to ethics in business and management often entail appealing to various types of moral theories and to this end almost every major philosophical approach has been enlisted. In this paper, we look at ethics through the philosophy of Emmanuel Levinas to argue that since ethics is ‘first philosophy’ it can neither be rule-based nor rule-governed, not something that can be worked out first and then applied to a given situation, hence the overwhelming emphasis on ‘applied ethics’ as a field of study in business and management education is unjustified. True ethics is not applied ethics. This assertion does not mean that teaching ethical theories and philosophies need to be abandoned rather it is the acceptance of the fact that an increase in cognitive awareness of such theories and ethical models and frameworks, or the mastering of techniques and procedures for ethical decision making, will not affect the desired ethical transformation in our students. Levinas himself argued for an ethics without a foundation, not one that required us to go ‘beyond good and evil’ as Nietzsche contended, rather an ethics which necessitates going ‘before good and evil'. Such an ethics does not provide us with a set of methods or techniques or a decision tree that enable us determine the rightness of an action and what we ought to do, rather it is about a way of being, an ethical posture or approach one takes in the inter-subjective relationship with the other that holds the promise of ethical conduct. Ethics in this Levinasian sense then is one of infinite and unconditional responsibility for the other person in relationship, an ethics which is not subject to negotiation, calculation or reciprocity, and as such it could neither be applied nor taught through conventional pedagogy with its focus on knowledge transfer from the teacher to student, and to this end Levinas offers a non-maieutic, non-conventional approach to pedagogy. The paper concludes that from a Levinasian perspective on ethics and education, we may need to guide our students to move away from the clear and objective professionalism of the management and applied ethics towards the murky individual spiritualism. For Levinas, this is ‘the Copernican revolution’ in ethics.

Keywords: business ethics, ethics education, Levinas, maieutic teaching, ethics without foundation

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Authors: Gyorgy Deak, Marius C. Raischi, Lucian P. Georgescu, Tiberius M. Danalache, Elena Holban, Madalina G. Boboc, Monica Matei, Catalina Iticescu, Marius V. Olteanu, Stefan Zamfir, Gabriel Cornateanu

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At present, on the Lower Danube, different types of pressures have been identified that affect the anadromous sturgeons stocks with an impact that leads to their decline. This paper presents techniques and procedures used by Romanian experts in the tagging and monitoring of anadromous sturgeons, as well as unique results at international level obtained on the basis of an informational volume collected in over 7 years of monitoring on these species behavior (both for adults as well as for ultrasonically tagged juveniles) on the Lower Danube. The local impact of hydrotechnical constructions (bottom sill, maritime navigation channel), the global impact of the poaching phenomenon and the impact of the restocking programs with sturgeon juveniles were assessed. Thus, the bottom sill impact on the Bala branch, the Bastroe Channel (cross-border impact) and the poaching phenomenon at the level of the Lower Danube was analyzed on the basis of a unique informational volume obtained through the use of patented monitoring systems by the Romanian experts (DKTB respectively, DKMR-01T). At the same time, the results from the monitoring of ultrasonically tagged sturgeon juveniles from the 2015 repopulation program are presented. Conclusions resulting from research can ensure favorable premises for finding some conservation solutions for CITES-protected sturgeon species that have survived for millions of years, currently being 1 species on the brink of extinction - Russian sturgeon, 2 species in danger of extinction - Beluga sturgeon and Stellate sturgeon and 2 species already extinct from the Lower Danube, namely common sturgeon and ship sturgeon.

Keywords: Lower Danube, sturgeons monitoring (adults and juveniles), tagging, impact on conservation

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Authors: Suresh Vanguri, Suresh Palla, K. V. Kalyani, S. K. Chaturvedi, B. N. Mohapatra

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Enhancing the fly ash utilization in the manufacture of cement is identified as one of the key areas to mitigate the Green House Gas emissions from the cement industry. Though increasing the fly ash content in cement has economic and environmental benefits, it results in a decrease in the compressive strength values, particularly at early ages. Quality of clinker and fly ash were identified as predominant factors that govern the extent of absorption of fly ash in the manufacturing of cement. This paper presents systematic investigations on the effect of clinker and fly ash quality on the properties of resultant cement. Since mechanical activation alters the physicochemical properties such as particle size distribution, surface area, phase morphology, understanding the variation of these properties with activation is required for its applications. The effect of mechanical activation on fly ash surface area, specific gravity, flow properties, lime reactivity, comparative compressive strength (CCS), reactive silica and mineralogical properties were also studied. The fineness of fly ash was determined by Blaine’s method, specific gravity, lime reactivity, CCS were determined as per the method IS 1727-1967. The phase composition of fly ash was studied using the X-ray Diffraction technique. The changes in the microstructure and morphology with activation were examined using the scanning electron microscope. The studies presented in this paper also include evaluation of Portland Pozzolana Cement (PPC), prepared using high volume fly ash. Studies are being carried out using clinker from cement plants located in different regions/clusters in India. Blends of PPC containing higher contents of activated fly ash have been prepared and investigated for their chemical and physical properties, as per Indian Standard procedures. Changes in the microstructure of fly ash with activation and mechanical properties of resultant cement containing high volumes of fly ash indicated the significance of optimization of the quality of clinker and fly ash fineness for better techno-economical benefits.

Keywords: flow properties, fly ash enhancement, lime reactivity, microstructure, mineralogy

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Authors: Vahid Ebrahimipour

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Word representation and context meaning of text-based documents play an essential role in knowledge modeling. Business procedures written in natural language are meant to store technical and engineering information, management decision and operation experience during the production system life cycle. Context meaning representation is highly dependent upon word sense, lexical relativity, and sematic features of the argument. This paper proposes a method for lexical semantic analysis and context meaning representation of maintenance activity in a mass production system. Our approach constructs a straightforward lexical semantic approach to analyze facilitates semantic and syntactic features of context structure of maintenance report to facilitate translation, interpretation, and conversion of human-readable interpretation into computer-readable representation and understandable with less heterogeneity and ambiguity. The methodology will enable users to obtain a representation format that maximizes shareability and accessibility for multi-purpose usage. It provides a contextualized structure to obtain a generic context model that can be utilized during the system life cycle. At first, it employs a co-occurrence-based clustering framework to recognize a group of highly frequent contextual features that correspond to a maintenance report text. Then the keywords are identified for syntactic and semantic extraction analysis. The analysis exercises causality-driven logic of keywords’ senses to divulge the structural and meaning dependency relationships between the words in a context. The output is a word contextualized representation of maintenance activity accommodating computer-based representation and inference using OWL/RDF.

Keywords: lexical semantic analysis, metadata modeling, contextual meaning extraction, ontology modeling, knowledge representation

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Authors: Xiaoyang Zhao, Kaiying Wang

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The choice of stocking density in poultry farming is a potential way for determining welfare level of poultry. However, it is difficult to measure stocking densities in poultry farming because of a lot of variables such as species, age and weight, feeding way, house structure and geographical location in different broiler houses. A method was proposed in this paper to measure the differences of young broilers reared under different stocking densities by sound analysis. Vocalisations of broilers were recorded and analysed under different stocking densities to identify the relationship between sounds and stocking densities. Recordings were made continuously for three-week-old chickens in order to evaluate the variation of sounds emitted by the animals at the beginning. The experimental trial was carried out in an indoor reared broiler farm; the audio recording procedures lasted for 5 days. Broilers were divided into 5 groups, stocking density treatments were 8/m², 10/m², 12/m² (96birds/pen), 14/m² and 16/m², all conditions including ventilation and feed conditions were kept same except from stocking densities in every group. The recordings and analysis of sounds of chickens were made noninvasively. Sound recordings were manually analysed and labelled using sound analysis software: GoldWave Digital Audio Editor. After sound acquisition process, the Mel Frequency Cepstrum Coefficients (MFCC) was extracted from sound data, and the Support Vector Machine (SVM) was used as an early detector and classifier. This preliminary study, conducted in an indoor reared broiler farm shows that this method can be used to classify sounds of chickens under different densities economically (only a cheap microphone and recorder can be used), the classification accuracy is 85.7%. This method can predict the optimum stocking density of broilers with the complement of animal welfare indicators, animal productive indicators and so on.

Keywords: broiler, stocking density, poultry farming, sound monitoring, Mel Frequency Cepstrum Coefficients (MFCC), Support Vector Machine (SVM)

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Authors: C. Catalina Zapata, Z. Claudia Montoya

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Transplant from hematopoietic parents (THP) or medulla (MT) is a procedure used to replace the medulla that does not work as part of a disease or when it is destroyed either by a treatment of high medication doses against cancer or by radiation. The transplant process has three stages, a stage prior to transplant, during and after the transplant. It is held with the help of an interdisciplinary team, including nursing, carrying out mainly educative procedures to warrant the adhesion and the changes in lifestyles needed to whom will undergo this procedure. The aim of the study was to assess the results of an educative procedure by nursing, on adult patients subjected to a transplant from hematopoietic parents at a high complexity institution of Medellin city, Colombia. This study had an observational longitudinal design. According to the rules of protocol, the educative activity must be held on all patients joining the procedure. Four instruments were designed in order to collect all the information. One of them to measure the sociodemographic variables, another one to measure self-care practices, another one to measure transplant knowledge and its cares and the other one to measure the 30-day post-transplant complications. The last three instruments were applied before and after the educative procedure. A univaried analysis was carried out but the bivaried analysis was not carried out since there were not statistically meaningful differences before and after. Within the results, ten patients were evaluated. The average age was 38.2 (13.38 SD – standard deviation), 8/10 were men. Some self-care practices such us having pets and plants and consuming some specific food as well as little use of UV protection are all present in this type of patients and are not modified after the procedure. In measuring the knowledge, something stands out among the answers. It is the fact that some patients do not know what the medulla is, the nature of separating wastes at home and the need to consult about vomit and nausea. The most frequent complications during the first thirty days were: nausea, vomit, fever, and rash. They are considered to be expected within this period. Patients do not exhibit differences in their level of knowledge before and after the educative procedure by nursing. The patients’ self-care practices do not involve all the necessary ones to avoid complications. During the first 30 days, most of the complications are typical of the transplant process from hematopoietic parents.

Keywords: bone marrow transplant, education, family, nursing, patients, Transplantation of hematopoietic progenitors

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Authors: Simont Toussi

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Cameroon and the Central African Republic arebound by the provisions of many regional and international charters, which condemn the manipulation of information, obstacles to access reliable information, or the limitation of freedoms of expression and opinion. These two countries also have constitutional guarantees for free speech and access to true and liable information. However, they are yet to define specific policies and regulations for access to information, disinformation, or misinformation. Yet, certain countries’ laws and regulations related to information and communication technologies, to criminal procedures, to terrorism, or intelligence services contain provisions that rather hider human rights by condemning false information. Like many other African countries, Cameroon and the Central African Republic face a profound democratic regression, and governments use multiple methods to stifle online discourse and digital rights. Despite the increased uptake of digital tools for political participation, there is a lack of interactivity and adoption of these tools. This enables a scarcity of information and creates room for the spreading of disinformation in the public space, hamperingdemocracy and the respect for human rights. This research aims to analyse the adequacy of stakeholders’ responses to disinformation in Cameroon and the Central African Republic in periods of political contestation, such as elections and anti-government protests, to highlight the nature, perpetrators, strategies, and channels of disinformation, as well as its effects on democratic actors, including civil society, bloggers, government critics, activists, and other human rights defenders. The study follows a qualitative method with literature review, content analysis, andkey informant’sinterviews with stakeholders’ representatives, emphasized crowdsourcing as a data and information collecting method in the two countries.

Keywords: disinformation, democracy, political manipulation, social media, media, fake news, central Africa, cameroon, misinformation, free speech

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Authors: Siddarth Kannan

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Objectives: Deep Brain Stimulation (DBS) and Motor Cortex stimulation (MCS) are innovative interventions in order to treat various neuropathic pain disorders such as post-stroke pain. While each treatment has a varying degree of success in managing pain, comparative analysis has not yet been performed, and the success rates of these techniques using validated, objective pain scores have not been synthesised. The aim of this study was to compare the effect of pain relief offered by MCS and DBS on patients with post-stroke pain and to assess if either of these procedures offered better results. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to June 2023 were included (last search date 25 June 2023). Meta-analysis was performed using random effects models. We evaluated the performance of DBS or MCS by assessing studies that reported pain relief using the Visual Analogue Scale (VAS). Data analysis of descriptive statistics was performed using SPSS (Version 27; IBM; Armonk; NY; USA). R statistics (Rstudio Version 4.0.1) was used to perform meta-analysis. Results: Of the 478 articles identified, 27 were included in the analysis (232 patients- 117 DBS & 115 MCS). The pooled number of patients who improved after DBS was 0.68 (95% CI, 0.57-0.77, I2=36%). The pooled number of patients who improved after MCS was 0.72 (95% CI, 0.62-0.80, I2=59%). Further sensitivity analysis was done to include only studies with a minimum of 5 patients in order to assess if there was any impact on the overall results. Nine studies each for DBS and MCS met these criteria. There seemed to be no significant difference in results. Conclusions: The use of surgical interventions such as DBS and MCS is an upcoming field for the treatment of post-stroke pain, with limited studies exploring and comparing these two techniques. While our study shows that MCS might be a slightly better treatment option, further research would need to be done in order to determine the appropriate surgical intervention for post-stroke pain.

Keywords: post-stroke pain, deep brain stimulation, motor cortex stimulation, pain relief

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Authors: M. Nazem Salimi, C. Abrinia, M. Baniassadi, M. Ehsani

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Mechanical properties of epoxy based nanocomposites containing copper coated MWCNTs were investigated and a comparative study between nanocomposites containing functionalized MWCNTs and copper coated MWCNTs which are already functionalized was conducted. The MWCNTs was deposited with copper nanoparticles through electroless deposition process after accomplishment of "two-step" method as sensitization and activation procedures on oxidized MWCNTs. In addition, functionalization of MWCNTs was carried out through combination of two covalent and non-covalent funcionalization methods using HNO3 for acid solution of covalent treatment and Triton X100 as non-ionic surfactant of non-covalent treatment. The presence of functional groups and removal of impurities of MWCNTs were confirmed by FTIR and Raman spectroscopy, respectively. The layer of copper nanoparticles on the MWCNTs wall increasing its diameter was observed by SEM. Utilizing solution blending process, 0.1%, 0.5% and 1.5% wt loading of both copper coated MWCNTs and non-coated MWCNTs were used to prepare epoxy-based nanocomposites. The tensile, flexural and impact properties of nanocomposites were investigated. The results of tensile test demonstrated that nanocomposites containing copper coated MWCNTs exhibited brittle behavior compared to those reinforced with functionalized MWCNTs, whereas former one exhibited higher values of modulus than latter one for concentrations more than 0.4% wt. Presence of copper particles on MWCNTs surface decreased the tensile strength of nanocomposites. In comparison to pure epoxy, nanocomposites with treated-MWCNTs and Cu-MWCNTs loading of 0.1% wt showed an increase of 35% and 51.6% for flexural strength beside 20% and 30% increase in flexural modulus, respectively, whereas flexural properties of both naocomposites decreased with increasing of CNTs concentration. The results of impact strength of nanocomposites with Cu-CNTs demonstrated that impact properties decreased with increasing of filler content with a optimum value at 0.1% wt while in high concentrations impact properties of Cu-nanocomposites exhibited lower values than f-MWCNT nanocomposites.

Keywords: epoxyresin, nanocomposite, functionalization, copper, electroless deposition process, mechanical properties

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Authors: H. K. Ratre, M. Roy, S. Roy, M. S. Parmar, V. Bhagat

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Mastitis is a common problem of dairy industries. Reduction in milk production and an irreparable damage to the udder associated with the disease are common causes of culling of dairy cows. Milk from infected animals is not suitable for drinking and for making different milk products. So, it has a major economic importance in dairy cattle. The aims of this study were to investigate the bacteriological panorama in milk from udder quarters with subclinical mastitis and to carried out for the molecular characterization of the major isolated organisms, from subclinical mastitis-affected cows in and around Durg and Rajnandgaon district of Chhattisgarh. Isolation and identification of bacteria from the milk samples of subclinical mastitis-affected cows were done by standard and routine culture procedures. A total of 78 isolates were obtained from cows and among the various bacteria isolated, Staphylococcus spp. occupied prime position with occurrence rate of 51.282%. However, other bacteria isolated includeStreptococcus spp. (20.512%), Micrococcus spp. (14.102%), E. coli (8.974%), Klebsiela spp. (2.564%), Salmonella spp. (1.282%) and Proteus spp. (1.282%). Staphylococcus spp. was isolated as the major causative agent of subclinical mastitis in the studied area. Molecular characterization of Staphylococus aureusisolates was done for genetic expression of the virulence genes like ‘nuc’ encoding thermonucleaseexoenzyme, coa and spa by PCR amplification of the respective genes in 25 Staphylococcus isolates. In the present study, 15 isolates (77.27%) out of 20 coagulase positive isolates were found to be genotypically positive for ‘nuc’ where as 20 isolates (52.63%) out of 38 CNS expressed the presence of the same virulence gene. In the present study, three Staphylococcus isolates were found to be genotypically positive for coa gene. The Amplification of the coa gene yielded two different products of 627, 710 bp. The amplification of the gene segment encoding the IgG binding region of protein A (spa) revealed a size of 220 and 253bp in twostaphylococcus isolates. The X-region binding of the spa gene produced an amplicon of 315 bp in one Staphylococcal isolates. Staphylococcus aureus was found to be major isolate (51.28%) responsible for causing subclinical mastitis in cows which also showed expression of virulence genesnuc, coa and spa.

Keywords: mastitis, bacteria, characterization, expression, gene

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Authors: Salah A. Aly, Mohammed A. Ibrahim, Mostafa M. khttab

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The amount of construction and demolition (C&D) waste has increased considerably over the last few decades. From the viewpoint of environmental preservation and effective utilization of resources, crushing C&D concrete waste to produce coarse aggregate (CA) with different replacement percentage for the production of new concrete is one common means for achieving a more environment-friendly concrete. In the study presented herein, the investigation was conducted in two phases. In the first phase, the selection of the materials was carried out and the physical, mechanical and chemical characteristics of these materials were evaluated. Different concrete mixes were designed. The investigation parameter was Recycled Concrete Aggregate (RCA) ratios. The mechanical properties of all mixes were evaluated based on compressive strength and workability results. Accordingly, two mixes have been chosen to be used in the next phase. In the second phase, the study of the structural behavior of the concrete beams was developed. Sixteen beams were casted to investigate the effect of RCA ratios, the shear span to depth ratios and the effect of different locations and reinforcement of openings on the shear behavior of the tested specimens. All these beams were designed to fail in shear. Test results of the compressive strength of concrete indicated that, replacement of natural aggregate by up to 50% recycled concrete aggregates in mixtures with 350 Kg/m3 cement content led to increase of concrete compressive strength. Moreover, the tensile strength and the modulus of elasticity of the specimens with RCA have very close values to those with natural aggregates. The ultimate shear strength of beams with RCA is very close to those with natural aggregates indicating the possibility of using RCA as partial replacement to produce structural concrete elements. The validity of both the Egyptian Code for the design and implementation of Concrete Structures (ECCS) 203-2007 and American Concrete Institute (ACI) 318-2011Codes for estimating the shear strength of the tested RCA beams was investigated. It was found that the codes procedures gives conservative estimates for shear strength.

Keywords: construction and demolition (C&D) waste, coarse aggregate (CA), recycled coarse aggregates (RCA), opening

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Authors: Mark Linden, Rachel Leonard, Trisha Forbes, Michael Brown, Lynne Marsh, Stuart Todd, Nathan Hughes, Maria Truesdale

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Background: Current interventions which aim to improve the mental health of family carers are often face to face, which can create barriers to full participation. Online interventions can offer flexibility in delivery compared to face to face approaches. The primary objective of this study is to determine the feasibility of delivering the Carers-ID online intervention, while the secondary outcome is to improve the mental health of family carers of people with intellectual disabilities. Methods: Family carers (n = 120) will be randomised to receive the intervention (n=60) or assigned to a wait-list control (n=60) group. The intervention (www.Carers-ID.com) consists of fourteen modules which cover topics including promoting resilience, providing peer support, reducing anxiety, managing stress, accessing local supports, managing family conflict and information for siblings who are carers. Primary outcomes for this study include acceptability and feasibility of the outcome measures, recruitment, participation and retention rates and effect sizes. Secondary outcomes will be completed at three time points (baseline, following intervention completion and three months after completion). Secondary outcomes include, depression, anxiety, stress, well-being , resilience and social connectedness. Participants (n=12) who have taken part in the intervention arm of the research will be invited to participate in semi-structured interviews as part of the process evaluation. Discussion: To determine whether a full-scale randomised controlled effectiveness trial is warranted, feasibility testing of the intervention and trial procedures is a necessary first step. The Carers-ID intervention provides an accessible resource for family carers to support their mental health and well-being.

Keywords: intellectual disability, family carer, feasibility trial, online intervention

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Authors: Camila Plaza, Stefan Felder

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In October 2014, the TARMED reform was implemented in Switzerland. In an effort to even out the financial standing of general practitioners (including pediatricians) relative to that of specialists in the outpatient sector, the reform tackled two aspects: on the one hand, GPs would be able to bill an additional 9 CHF per patient, once per consult per day. This is referred to as the surcharge position. As a second measure, it reduced the fees for certain technical services targeted to specialists (e.g., imaging, surgical technical procedures, etc.). Given the fee-for-service reimbursement system in Switzerland, we predict that physicians reacted to the economic incentives of the reform by increasing the consults per patient and decreasing the average amount of time per consult. Within this framework, our treatment group is formed by GPs and our control group by those specialists who were not affected by the reform. Using monthly insurance claims panel data aggregated at the physician praxis level (provided by SASIS AG), for the period of January 2013-December 2015, we run difference in difference panel data models with physician and time fixed effects in order to test for the causal effects of the reform. We account for seasonality, and control for physician characteristics such as age, gender, specialty, and physician experience. Furthermore, we run the models on subgroups of physicians within our sample so as to account for heterogeneity and treatment intensities. Preliminary results support our hypothesis. We find evidence of an increase in consults per patients and a decrease in time per consult. Robustness checks do not significantly alter the results for our outcome variable of consults per patient. However, we do find a smaller effect of the reform for time per consult. Thus, the results of this paper could provide policymakers a better understanding of physician behavior and their sensitivity to financial incentives of reforms (both past and future) under the current reimbursement system.

Keywords: difference in differences, financial incentives, health reform, physician behavior

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Authors: Mateusz Meserszmit, Mariusz Chrabąszcz, Adriana Trojanowska-Olichwer, Zygmunt Kącki

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Semi-natural meadows are valuable communities from the point of view of biodiversity, but their survival is strongly related to human activity. Unfortunately, the current status of preservation of extensively used meadows in Europe is frequently assessed as “unfavorable”. This is due to agricultural activity, in particular the lack of appropriate conservation procedures such as the cutting of meadows or livestock grazing. However, for more effective protective measures, the preservation of the biological diversity of meadows requires an interdisciplinary approach from both scientists and practitioners from many fields. Our research aimed to present the possibility of conservation of semi-natural meadows using cut biomass for the production of bioenergy – biogas, taking into consideration the botanical characteristics of the studied habitat and the chemical properties of biomass. A field study was conducted in Poland, within an area covered by the European Union's nature conservation programme. The samples were collected on four dates (May 24th, July 1st, July 23rd, and September 1st) from a study site established within a Molinion meadow. The biomass collected at the earliest date mostly consisted of plants with flowers in bud or fully open flowers. At the later harvest dates, most plants were at the fruiting or seed shed stage. An earlier stage of plant growth contributed to a lower biomass yield, which also resulted in a lower methane yield per hectare. The methane yield per hectare was at the end of May 482 m3 CH4 ha-1, at the beginning of July 867 m3 CH4 ha-1, at the end of July 759 m3 CH4 ha-1 and at the beginning of September 730 m3 CH4 ha-1. The biomass harvested in May demonstrated a significantly higher content of the elements: N, P, and K, but a lower Ca content compared to later harvested biomass, which may affect the biogas production process. The use of hay as a source of renewable energy can become an important element of conservation adapted for this type of habitat.

Keywords: nature conservation, biomass, bioenergy, grassland

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

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

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

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Authors: Hardik Goswami, Gayatri Swarnakar

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-Mastitis disease has been known as one of the most costly diseases of dairy cattle and observed as an inflammatory disease of cow and buffalo udder. Mastitis badly affected animal health, quality of milk and economics of milk production along with cause’s great economic loss. Bacteria have been representing the most common etiological agents of mastitis. The antibiotic sensitivity test was important to attain accurate treatment of mastitis. The aim of present research work was to explore prevalence and antibiotic susceptibility pattern of bacterial isolates recovered from cow and buffalo clinical mastitis milk sample. During the period of April 2010 to April 2014, total 1487 clinical mastitis milk samples of cow and buffalo were tested to check the prevalence of mastitis causing bacterial isolates. Milk samples were collected aseptically from the udder at the time of morning milking. The most prevalent bacterial isolates were Staphylococcus aureus (24.34%) followed by coliform bacteria (15.87%), coagulase negative Staphylococcus aureus (13.85%), non-coliform bacteria (13.05%), mixed infection (12.51%), Streptococcus spp. (10.96%). Out of 1487, 140 (9.42%) mastitis milk samples showed no growth on culture media. Identification of bacteria made on the basis of Standard Microbial features and procedures. Antibiotic susceptibility of bacterial isolates was investigated by Kirby-Bauer disk diffusion method. In vitro Antibiotic susceptibility test of bacterial isolates revealed higher sensitivity to Gentamicin (74.6%), Ciprofloxacin (62.1%) and Amikacin (59.4%). The lower susceptibility was shown to Amoxicillin (21.6%), Erythromycin (26.4%) and Ceftizoxime (29.9%). Antibiotic sensitivity pattern revealed Gentamicin are the possible effective antibiotic against the major prevalent mastitis pathogens. Present research work would be helpful in increase production, quality and quantity of milk, increase annual income of dairy owners and improve health of cow and buffaloes.

Keywords: antibiotic, buffalo, cow, mastitis, prevalence

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Authors: Khawaja A. Wahaj Wani, Aykut Erkal

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Pakistan's construction industry, a key player in economic development, has experienced remarkable growth. However, the surge in activities has been accompanied by dangerous working conditions, attributed to legislative gaps and flaws. Unhealthy construction practices, uncertain site conditions, and hazardous environments contribute to a concerning rate of injuries and fatalities. The principal aim of this research study is to undertake a thorough evaluation based on the assessment of the current situation of Health & Safety policies and the surveys performed by stakeholders of Pakistan with the aim of providing solution-centric methodologies for the enforcement of health and safety regulations within construction companies operating on project sites. Recognizing the pivotal role that the construction industry plays in bolstering a nation's economy, it is imperative to address the pressing need for heightened awareness among site engineers and laborers. The study adopts a robust approach, utilizing questionnaire surveys and interviews. As an exclusive investigative study, it encompasses all stakeholders: clients, consultants, contractors, and subcontractors. Targeting PEC-registered companies. Safety performance was assessed through the examination of sixty safety procedures using SPSS-18. A high Cronbach's alpha value of 0.958 ensures data reliability, and non-parametric tests were employed due to the non-normal distribution of data. The safety performance evaluation revealed significant insights. "Using Hoists and Cranes" and "Precautionary Measures (Shoring and Excavation)" exhibited commendable safety levels. Conversely, "Trainings on Safety" displayed a lower safety performance, alongside areas such as "Safety in Contract Documentation," "Meetings for Safety," and "Worker Participation," indicating room for improvement. These findings provide stakeholders with a detailed understanding of current safety measures within Pakistan's construction industry.

Keywords: construction industry, health and safety regulations, Pakistan, risk management

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Authors: Xiaoqing Liu, Kurt Friese, Karsten Rinke

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Lacustrine sediment archives rich paleoenvironmental information in lake and surrounding environment. Additionally, modern sediment is used as an effective medium for the monitoring of lake. Organic carbon in sediment is a heterogeneous mixture with varying turnover times and qualities which result from the different biogeochemical processes in the deposition of organic material. Therefore, the isolation of different carbon pools is important for the research of lacustrine condition in the lake. However, the numeric available fractionation procedures can hardly yield homogeneous carbon pools on terms of stability and age. In this work, a multi-step fractionation protocol that treated sediment with hot water, HCl, H2O2 and Na2S2O8 in sequence was adopted, the treated sediment from each step were analyzed for the isotopic and structural compositions with Isotope Ratio Mass Spectrometer coupled with element analyzer (IRMS-EA) and Solid-state 13C Nuclear Magnetic Resonance (NMR), respectively. The sequential extractions with hot-water, HCl, and H2O2 yielded a more homogeneous and C3 plant-originating OC fraction, which was characterized with an atomic C/N ratio shift from 12.0 to 20.8, and 13C and 15N isotopic signatures were 0.9‰ and 1.9‰ more depleted than the original bulk sediment, respectively. Additionally, the H2O2- resistant residue was dominated with stable components, such as the lignins, waxes, cutans, tannins, steroids and aliphatic proteins and complex carbohydrates. 6M HCl in the acid hydrolysis step was much more effective than 1M HCl to isolate a sedimentary OC fraction with higher degree of homogeneity. Owing to the extremely high removal rate of organic matter, the step of a Na2S2O8 oxidation is only suggested if the isolation of the most refractory OC pool is mandatory. We conclude that this multi-step chemical fractionation procedure is effective to isolate more homogeneous OC pools in terms of stability and functional structure, and it can be used as a promising method for OC pools fractionation of sediment or soil in future lake research.

Keywords: 13C-CPMAS-NMR, 13C signature, lake sediment, OC fractionation

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Authors: Kholoud Sheba

Abstract:

Women refugees expectedly are physical, socially and mentally vulnerable due to their past traumatic experiences and their novel circumstances in their receiving countries. They may have a wide range of general, mental, and reproductive health problems, but reportedly avoid visiting health care facilities owing to complex elements. Women refugees are usually unfamiliar with their new country health system and unable to navigate it efficiently. They have limited English language skills, which makes it even harder to access culturally insensitive health services. This study examines barriers to health care for refugee women in Ottawa and offers suggestions to address these challenges. Drawing from culturally congruent health care models in Canada, the United Kingdom, and some parts of the United States, this study highlights the importance of cultivating compassion in the provision of health care for women refugees as a way of addressing some of the disparities in health care in Canada. To address the study purpose, a survey questionnaire was designed and pretested questionnaire and was administrated using SurveyMonkey, a paid source survey application, over a period of two weeks. Snowballing sampling procedures were used to recruit the participants. Data was measured using frequencies, percentages, t-test, ANOVA, and chi-square. The test of significance is set at p < .05. The study asked how refugees perceive their experience in accessing and navigating public health services in Ottawa; what challenges refugees face with healthcare in Canada, and, if gender is related to refugees’ perceptions of the health care system they are forced to use? Results show refugees perceived their experience accessing the healthcare services in Canada to be a positive experience and the health providers to be culturally sensitive and allowing enough time listening to their complaints. The language stood tall in their barriers accessing the services due to low English proficiency and the need for interpretation services to encourage them attending the services.

Keywords: women refugee, access barriers, Ottawa, resettlement

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Authors: Sherif Fayez Lewis Ghaly

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up to datefacupupdated planning has the mission of designing merchandise, plant life, procedures, enterprise, regions, and the development of a up to date. The requirements for up-to-date planning and the constructing of a updated have changed in recent years. everyday restructuring is turning inupupdated greater essential up-to-date hold the competitiveness of a manufacturing facilityupdated. restrictions in new regions, shorter existence cycles of product and manufacturing generation up-to-date a VUCA global (Volatility, Uncertainty, Complexity & Ambiguity) up-to-date greater frequent restructuring measures inside a manufacturing facilityupdated. A virtual up-to-date model is the making plans basis for rebuilding measures and up-to-date an fundamental up-to-date. short-time period rescheduling can now not be handled through on-web site inspections and manual measurements. The tight time schedules require 3177227fc5dac36e3e5ae6cd5820dcaa making plans fashions. updated the high variation fee of facup-to-dateries defined above, a method for rescheduling facupdatedries on the idea of a modern-day digital up to datery dual is conceived and designed for sensible software in updated restructuring projects. the point of interest is on rebuild approaches. The purpose is up-to-date preserve the planning basis (virtual up-to-date model) for conversions within a up to datefacupupdated updated. This calls for the application of a methodology that reduces the deficits of present techniques. The goal is up-to-date how a digital up to datery version may be up to date up to date during ongoing up to date operation. a method up-to-date on phoup to dategrammetry technology is presented. the focus is on developing a easy and fee-powerful up to date tune the numerous adjustments that arise in a manufacturing unit constructing in the course of operation. The method is preceded with the aid of a hardware and software assessment up-to-date become aware of the most cost effective and quickest version.

Keywords: building information modeling, digital factory model, factory planning, maintenance digital factory model, photogrammetry, restructuring

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Authors: Siamak Yaghoubi, Vahideh Rashtchi, Marzieh Khezri, Hamid Kayalha, Monadi Hamidfar

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Background and objectives: Effective postoperative pain management in abdominal surgeries, which are painful procedures, plays an important role in reducing postoperative complications and increasing patient’s satisfaction. There are many techniques for pain control, one of which is Patient-Controlled Analgesia (PCA). The aim of this study was to compare the analgesic effects of morphine, paracetamol and ketorolac in the patients undergoing open cholecystectomy, using PCA method. Material and Methods: This randomized controlled trial was performed on 330 ASA (American Society of Anesthesiology) I-II patients ( three equal groups, n=110) who were scheduled for elective open cholecystectomy in Shahid Rjaee hospital of Qazvin, Iran from August 2013 until September 2015. All patients were managed by general anesthesia with TIVA (Total Intra Venous Anesthesia) technique. The control group received morphine with maximum dose of 0.02mg/kg/h, the paracetamol group received paracetamol with maximum dose of 1mg/kg/h, and the ketorolac group received ketorolac with maximum daily dose of 60mg using IV-PCA method. The parameters of pain, nausea, hemodynamic variables (BP and HR), pruritus, arterial oxygen desaturation, patient’s satisfaction and pain score were measured every two hours for 8 hours following operation in all groups. Results: There were no significant differences in demographic data between the three groups. there was a statistically significant difference with regard to the mean pain score at all times between morphine and paracetamol, morphine and ketorolac, and paracetamol and ketorolac groups (P<0.001). Results indicated a reduction with time in the mean level of postoperative pain in all three groups. At all times the mean level of pain in ketorolac group was less than that in the other two groups (p<0.001). Conclusion: According to the results of this study ketorolac is more effective than morphine and paracetamol in postoperative pain control in the patients undergoing open cholecystectomy, using PCA method.

Keywords: analgesia, cholecystectomy, ketorolac, morphine, paracetamol

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Authors: Yakubu Adamu

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The aim of this research was to assess the factors contributing to the need for optimisation of the gastric emptying protocols in nuclear medicine and molecular imaging (SNMMI) procedures. The objective is to suggest whether optimisation is possible and provide supporting evidence for the current imaging protocols of gastric emptying examination used in nuclear medicine. The research involved the use of some selected patients with 30 dynamic series for the image processing using ImageJ, and by so doing, the calculated half-time, retention fraction to the 60 x1 minute, 5 minute and 10-minute protocol, and other sampling intervals were obtained. Results from the study IDs for the gastric emptying clearance half-time were classified into normal, abnormal fast, and abnormal slow categories. In the normal category, which represents 50% of the total gastric emptying image IDs processed, their clearance half-time was within the range of 49.5 to 86.6 minutes of the mean counts. Also, under the abnormal fast category, their clearance half-time fell between 21 to 43.3 minutes of the mean counts, representing 30% of the total gastric emptying image IDs processed, and the abnormal slow category had clearance half-time within the range of 138.6 to 138.6 minutes of the mean counts, representing 20%. The results indicated that the calculated retention fraction values from the 1, 5, and 10-minute sampling curves and the measured values of gastric emptying retention fraction from sampling curves of the study IDs had a normal retention fraction of <60% and decreased exponentially with an increase in time and it was evident with low percentages of retention fraction ratios of < 10% after the 4 hours. Thus, this study does not change categories suggesting that these values could feasibly be used instead of having to acquire actual images. Findings from the study suggest that the current gastric emptying protocol can be optimized by acquiring fewer images. The study recommended that the gastric emptying studies should be performed with imaging at a minimum of 0, 1, 2, and 4 hours after meal ingestion.

Keywords: gastric emptying, retention fraction, clearance halftime, optimisation, protocol

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Authors: Khlifa El Atrash, Gabriel Assaf

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Libya uses a volumetric analysis in designing asphalt mixtures, which can also be upgraded in hot, arid weather. However, in order to be effective, it should include many important aspects which are materials, environment, and method of construction. However, the quality of some roads was below a satisfactory level. This paper examines the factors that contribute to low quality of road performance in Libya. To evaluate these factors, a questionnaire survey and a laboratory comparative study were performed for a few mixes under-represented of temperature and traffic load. In laboratory, rutting test conducted on two different asphalt mixture, these mixes included, an asphalt concrete mix using local aggregate and asphalt binder B(60/70) at the optimum Marshall asphalt content, another mixes designed using Superpave design procedure with the same materials and performance asphalt binder grade PG (70-10). In the survey, the questionnaire was distributed to 55 engineers and specialists in this field. The interview was conducted to a few others, and the factors that were leading to poor performance of asphalt roads were listed as; 1) Owner Experience and technical staff 2) Asphalt characteristics 3) Updating and development of Asphalt Mix Design methods 4) Lack of data collection by authorization Agency 5) Construction and compaction process 6) Mentoring and controlling mixing procedure. Considering and improving these factors will play an important role to improve the pavement performances, longer service life, and lower maintenance costs. This research summarized some recommendations for making asphalt mixtures used in hot, dry areas. Such asphalt mixtures should use asphalt binder which is less affected by pavement temperature change and traffic load. The properties of the mixture, such as durability, deformation, air voids, and performance, largely depend on the type of materials, environment, and mixing method. These properties, in turn, affect the pavement performance.

Keywords: volumetric analysis, pavement performances, hot climate, traffic load, pavement temperature, asphalt mixture, environment, design and construction

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Authors: Michael Zaidman, Naum Simanovsky

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

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

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Authors: Maria Pratt, Lynn Martin

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Context: In nursing education, clinical instructors are crucial in assessing and evaluating students' performance in clinical courses. However, instructors often struggle when assigning failing grades to students at risk of failing. Research Aim: This qualitative study aims to understand clinical instructors' experiences evaluating students with unsatisfactory performance, including how reflection and collegial support impact this evaluation process. Methodology, Data Collection, and Analysis Procedures: This study employs Gadamer's Hermeneutic Inquiry as the research methodology. A purposive maximum variation sampling technique was used to recruit eight clinical instructors from a collaborative undergraduate nursing program in Southwestern Ontario. Semi-structured, open-ended, and audio-taped interviews were conducted with the participants. The hermeneutic analysis was applied to interpret the interview data to allow for a thorough exploration and interpretation of the instructors' experiences evaluating failing students. Findings: The main findings of this qualitative research indicate that evaluating failing students was emotionally draining for the clinical instructors who experienced multiple challenges, uncertainties, and negative feelings associated with assigning failing grades. However, the analysis revealed that ongoing reflection and collegial support played a crucial role in mitigating the challenges they experienced. Conclusion: This study contributes to the theoretical understanding of nursing education by shedding light on clinical instructors' challenges in evaluating failing students. It emphasizes the emotional toll associated with this process and the role that reflection and collegial support play in alleviating those challenges. The findings underscore the need for ongoing professional development and support for instructors in nursing education. By understanding and addressing clinical instructors' experiences, nursing education programs can better equip them to effectively evaluate struggling students and provide the necessary support for their professional growth.

Keywords: clinical instructor, student evaluation, nursing, reflection, support

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Authors: Dawit Assefa, Kassaye Tekie, Gebrie Alebachew, Degefu Beyene, Bikila Alemu, Naji Mohammed, Asnakech Agegnehu, Seble Tsehay, Geremew Tasew

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Background: Implementation of a Laboratory Quality Management System (LQMS) is critical to ensure accurate, reliable, and efficient laboratory testing of antimicrobial resistance (AMR). However, limited LQMS implementation and progress toward accreditation in the AMR surveillance laboratory testing setting exist in Ethiopia. By addressing non-conformances (NCs) and working towards accreditation, microbiology laboratories can improve the quality of their services, increase staff competence, and contribute to mitigate the spread of AMR. Methods: Using standard ISO 15189 horizontal and vertical assessment checklists, certified assessors identified NCs at Hawassa and Jimma Hospital microbiology laboratories. The Ethiopian Public Health Institute AMR mentors and IDDS staff prioritized closing the NCs through the implementation of an intensified mentorship program that included ISO 15189 orientation training, resource allocation, and action plan development. Results: For the two facilities to clear their NCs, an intensified mentorship approach was adopted by providing ISO 15189 orientation training, provision of buffer reagents, controls, standards, and axillary equipment, and facilitating equipment maintenance and calibration. Method verification and competency assessment were also conducted along with the implementation of standard operating procedures and recommended corrective actions. This approach enhanced the laboratory's readiness for accreditation. After addressing their NCs, the two laboratories applied to Ethiopian Accreditation Services for ISO 15189 accreditation. Conclusions: Clearing NCs through the implementation of intensified mentorship was crucial in preparing the two laboratories for accreditation and improving quality laboratory test results. This approach can guide other microbiology laboratories’ accreditation attainment efforts.

Keywords: non-conformance clearance, intensified mentorship, accreditation, ISO 15189

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Authors: S. Haque, M. Kanapathy, E. Bollen, I. Younis, A. Mosahebi

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Background: Implant loss due to infection is the most devastating complication of implant-based breast reconstruction. The use of negative pressure wound therapy with instillation (NPWTi) for salvage of infected implant-based breast reconstructions has shown promising results to allow early reinsertion of a new implant as an alternative to current management of delayed reinsertion. This study compares the cost implication of NPWTi against current management of delayed reinsertion of infected breast implants. Methods: 20 cases of an infected breast implant treated with NPWTi (V.A.C. VERAFLO™ Therapy) followed by early re-insertion of a new implant were compared with 20 cases who had delayed reinsertion (non-NPWTi). Average cost per person was calculated using total operative expenses, cost of inpatient stay, cost of investigations, cost of antibiotics, and cost of outpatient visits. Results: Treatment with NPWTi allowed for earlier re-insertion of a new implant (NPWTi: 9.04 ± 2.92 days vs. non-NPWTi: 236.25 ± 123.89 days). The average cost per patient for NPWTi and non-NPWTi was £14,343.13 ± £2,786.70 and £8,920.31 ± £3,005.73 respectively. All patients treated with NPWTi had one admission and spent 11.9 ± 4.1days as an inpatient while non-NPWTi patients had 2.1 ± 0.3 admissions with total length of inpatient stay of 7.1 ± 5.8days. Patients treated with NPWTi had more surgeries (NPWTi: 3.35 ± 0.81 vs. non-NPWTi: 2.2 ± 0.41), however 3 non-NPWTi cases required flap reconstruction. Patients treated with NPWTi had fewer total outpatient visits (NPWTi: 12 ± 6 vs. non-NPWTi: 14.2 ± 6.3). Conclusion: Patients treated with NPWTi incurred higher average cost per patient, longer inpatient stay, and more procedures; however, had early re-insertion of new implants and fewer admissions and outpatient visits. A further study on patient-reported outcome is essential to compare cost against patient benefit.

Keywords: breast reconstruction, cost evaluation, infection, negative pressure wound therapy

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