Search results for: evidence based medicine

Authors: Carlos V. Gonzalez

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Background: Providers of in-home and community based services strive for the elimination of preventable harm to the people under their care as well as to the employees who support them. Traditional models of safety and protection from harm have assumed that the absence of incidents of harm is a good indicator of safe practices. However, this model creates an illusion of safety that is easily shaken by sudden and inadvertent harmful events. As an alternative, we have developed and implemented an evidence-based resilient model of safety known as C.O.P.E. (Caring, Observing, Predicting and Evaluating). Within this model, safety is not defined by the absence of harmful incidents, but by the presence of continuous monitoring, anticipation, learning, and rapid response to events that may lead to harm. Objective: The objective was to evaluate the effectiveness of the C.O.P.E. model for the reduction of harm to individuals with mental disabilities who receive home and community based services. Methods: Over the course of 2 years we counted the number of incidents of harm and near misses. We trained employees on strategies to eliminate incidents before they fully escalated. We trained employees to track different levels of patient status within a scale from 0 to 10. Additionally, we provided direct support professionals and supervisors with customized smart phone applications to track and notify the team of changes in that status every 30 minutes. Finally, the information that we collected was saved in a private computer network that analyzes and graphs the outcome of each incident. Result and conclusions: The use of the COPE model resulted in: A reduction in incidents of harm. A reduction the use of restraints and other physical interventions. An increase in Direct Support Professional’s ability to detect and respond to health problems. Improvement in employee alertness by decreasing sleeping on duty. Improvement in caring and positive interaction between Direct Support Professionals and the person who is supported. Developing a method to globally measure and assess the effectiveness of prevention from harm plans. Future applications of the COPE model for the reduction of harm to people who receive home and community based services are discussed.

Keywords: harm, patients, resilience, safety, mental illness, disability

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Authors: Sana Fatima, Paul Sadler, Jon Cooper, David Mendel, Ayesha Jameel

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Background: Neurodiversity refers to intrinsic differences between human minds and encompasses dyspraxia, dyslexia, attention deficit hyperactivity disorder, dyscalculia, autism spectrum disorder, and Tourette syndrome. There is increasing recognition of neurodiversity in relation to disability/diversity in medical education and the associated impact on training, career progression, and personal and professional wellbeing. In addition, documented and anecdotal evidence suggests that medical educators and training providers in all four nations (UK) are increasingly concerned about understanding neurodiversity and identifying and providing support for neurodivergent trainees. Summary of Work: A national Neurodiversity Task and Finish group were established to survey Health Education England local office Professional Support teams about insights into infrastructure, training for educators, triggers for assessment, resources, and intervention protocols. This group drew from educational leadership, professional and personal neurodiverse expertise, occupational medicine, employer human resource, and trainees. An online, exploratory survey was conducted to gather insights from supervisors and trainers across England using the Professional Support Units' platform. Summary of Results: This survey highlighted marked heterogeneity in the identification, assessment, and approaches to support and management of neurodivergent trainees and highlighted a 'deficit' approach to neurodiversity. It also demonstrated a paucity of educational and protocol resources for educators and supervisors in supporting neurodivergent trainees. Discussions and Conclusions: In phase one, we focused on faculty development. An educational repository for all supervising trainees using a thematic approach was formalised. This was guided by our survey findings specific for neurodiversity and took a triple 'A' approach: awareness, assessment, and action. This is further supported by video material incorporating stories in training as well as mobile workshops for trainers for more immersive learning. The subtle theme from both the survey and Task and finish group suggested a move away from deficit-focused methods toward a positive holistic, interdisciplinary approach within a biopsychosocial framework. Contributions: 1. Faculty Knowledge and basic understanding of neurodiversity are key to supporting trainees with known or underlying Neurodiverse conditions. This is further complicated by challenges around non-disclosure, varied presentations, stigma, and intersectionality. 2. There is national (and international) inconsistency in the approach to how trainees are managed once a neurodiverse condition is suspected or diagnosed. 3. A carefully constituted and focussed Task and Finish group can rapidly identify national inconsistencies in neurodiversity and implement rapid educational interventions. 4. Nuanced findings from surveys and discussion can reframe the approach to neurodiversity; from a medical model to a more comprehensive, asset-based, biopsychosocial model of support, fostering a cultural shift, accepting 'diversity' in all its manifestations, visible and hidden.

Keywords: neurodiversity, professional support, human considerations, workplace wellbeing

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Authors: T. Nalowa, L. Foncha, S. Eposi

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Prostate enlargement, prostate cancer are major global health problems affecting many men as they advance in age. It is highly recommended to encourage older men to get Prostate Specific Antigen test screening frequently. Conventional treatments like radiation, chemotherapy are associated with many side effects. And this situation is a call for concern. Traditional medicine is affordable, easily prepared with little or no side effects and it contains many phytochemicals. The study aims to find the cure for prostate cancer and prostate enlargement by extracting products from plant tissues of specific herbs to determine anti-inflammatory, anti-cancer, and anti-hematuria properties. Descriptive statistical analysis was applied to describe the data process. The commonly used method of preparation was extraction. Overall, 40 patients were classified based on their medical conditions on their underlying user report. Rural communities in Fako are rich sources of plants with medicinal properties. The used plants consequently provide basic information and aid to investigate the cure of prostate cancer and prostate enlargement, with great significance.

Keywords: cancer, enlargement, metastases, prostate

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Authors: Zahra Yaghoubi

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One of the initial occurrences that, according to observations of those who have temporarily experienced death, arises is encountering beings or individuals possessing supernatural powers. For some, these beings are described as beautiful and radiant, while for others, they are portrayed as dark and terrifying. In some experiences, they are mentioned as young and beautiful individuals. Islamic religious sources refer to these beings as angels or celestial beings assigned by God to take and collect human souls. This research, conducted through library methods, examines and justifies the initial stage of observations from an Islamic perspective based on first and second-hand religious sources. It relies on evidence, observations, and oral narratives of near-death experiencers, as well as interviews published in television programs. The goal is to investigate Islamic sources and validate the presence of angels in near-death experiences. The use of visual interview reports direct reliance on the narrative rather than the written text by someone other than the experiencer, is among the main criteria for enhancing transparency and authenticity in conveying the individual's experiences.

Keywords: angel, angels of death, Islamic sources, near-death experiences, death, soul

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Authors: Kazem Shakouri, Alireza Pishgahi, Homayoun Sadeghi-bBazargani, Shahla Dareshiri

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Introduction: Carpal Tunnel Syndrome has numerous nonsurgical treatments including splint, physical therapy and corticosteroid injections. Aim: The purpose of this study was to evaluate the effectiveness of an ultrasound guided treatment procedure, for individuals with severe carpal tunnel syndrome. Materials and Method: 20 patients with an electrodiagnostic evidence of severe carpal tunnel syndrome were treated by an office-based ultrasound guided procedure (combination of percutaneous needle release of carpal tunnel and corticosteroid injection). Electrodiagnostic (nerve conduction study), clinical (Boston Carpal Tunnel Questionnaire, grip strength) and ultrasonic (median nerve and carpal tunnel cross-sectional area) measurements were recorded at baseline and one month after intervention. Results: Our preliminary data analysis showed that in one month follow up, patients had a significantly smaller cross-sectional area of the median nerve compared to pretreatment values (mean difference 0.06; 95%CI: 0.02-0.1; p < 0.001). In addition, patients had significantly less functional impairment (mean difference 35; 95% CI:28.7-43.4 ; p < 0.001), and an improved hand grip strength in one month follow up (mean difference 5.4; 95%CI: 3.1-7.8; p < 0.001;). There were no significant complications. Conclusion: Patients with severe carpal tunnel syndrome, who are candidates for surgical intervention, can consider office-based ultrasound guided needle release of carpal tunnel as an alternative safe treatment.

Keywords: Carpal Tunnel Syndrome, needle release, pain, ultrasound

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Authors: J. N. Bardi, N. Wright, S. Timmons, P. Crawford

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Introduction: In the United Kingdom (UK), the transfer of care from the asylums to the community has meant that some people with mental health problems (MHP) may not have access to suitable or adequate statutory community mental health services (CMHS). However, in addition to statutory CMHS, there are informal CMHS that provide spaces where people with MHP can attend such as faith communities, clubhouses, user-led organisations, day centres including drop-in-centres and community hubs and community mental health cafés (CMHCs). Aim: To qualitatively understand what happens in a community mental health café in relation to the place, people and processes, from the participant's perspective. Methodology: Ethnography Methods: Data collection will be field notes from observations written as thick description and interviews with participants. Data analysis will be thematic and narrative analysis. Relevance: The study seeks to observe what happens in a user-led community mental health café and explore if it provides the services that it claims to offer. Therefore, a literature review was conducted to examine the research evidence related to informal CMHS, focusing on similarities and differences. Results indicated that informal CMHS differ with regards to why, how, who set them up and who funds them, but they are similar because people with MHP who attend them report related psychological, vocational, and social interaction benefits. In addition to the differences listed above, CMHCs differ in their adoption of the commercial café model of social space and some CMHCs claim to address needs of social isolation and loneliness which they assert are not properly addressed by statutory CMHS and some informal CMHS. Therefore, CMHCs explicitly differentiate themselves from statutory CMHS and some informal CMHS such as day centres, hospitals and social services. However, CMHCs were found to be like drop-in-centres and community hubs which are also free for MHP to attend without the need for assessments, membership or appointments. To situate community mental health café within other informal CMHS and provide a rationale for the proposed study a scoping review was conducted to determine the scope of available research evidence on CMHCs. Findings from the scoping review reflected the literature review findings with regards to the benefits of attending informal CMHCs for people with MHP. Of the ten studies included in the scoping review, seven were on CMHCs for people living with dementia and two were on CMHCs for people with a broader range of MHP. The researcher hopes that findings from the proposed PhD study will build on the existing understanding of informal CMHS, extend the research evidence on CMHCs and address any gap in the literature.

Keywords: cafe, community, ethnography, mental health

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Authors: K. C. M. Wong, C. P. Y. Cheng, K. Y. Chan, G. S. C. Fung, T. F. O. Lau, K. F. C. Leung, J. P. C. Fok

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Hospital Authority (HA) is the statutory body to manage all public hospitals in Hong Kong. Occupational Care Medicine Service (OMCS) is an in-house multi-disciplinary team responsible for injury management in HA. Hospital administrative services (AS) provides essential support in hospital daily operation to facilitate the provision of quality healthcare services. An occupational health enhancement program in Tai Po Hospital (TPH) domestic service supporting unit (DSSU) was piloted in 2013 with satisfactory outcome, the keys to success were staff engagement and management support. Riding on the success, the program was rolled out to another 5 AS departments of Alice Ho Miu Ling Nethersole Hospital (AHNH) and TPH in 2015. This paper highlights the indispensable components of disability management and occupational health enhancement program in hospital settings. Objectives: 1) Facilitate workplace to support staff with health affecting work problem, 2) Enhance staff’s occupational health. Methodology: Hospital Occupational Safety and Health (OSH) team and AS departments (catering, linen services, and DSSU) of AHNH and TPH worked closely with OMCS. Focus group meetings and worksite visits were conducted with frontline staff engagement. OSH hazards were identified with corresponding OSH improvement measures introduced, e.g., invention of high dusting device to minimize working at height; tailor-made linen cart to minimize back bending at work, etc. Specific MHO trainings were offered to each AS department. A disability management workshop was provided to supervisors in order to enhance their knowledge and skills in return-to-work (RTW) facilitation. Based on injured staff's health condition, OMCS would provide work recommendation, and RTW plan was formulated with engagement of staff and their supervisors. Genuine communication among stakeholders with expectation management paved the way for realistic goals setting and success in our program. Outcome: After implementation of the program, a significant drop of 26% in musculoskeletal disorders related sickness absence day was noted in 2016 as compared to the average of 2013-2015. The improvement was postulated by innovative OSH improvement measures, teamwork, staff engagement and management support. Staff and supervisors’ feedback were very encouraging that 90% respondents rated very satisfactory in program evaluation. This program exemplified good work sharing among departments to support staff in need.

Keywords: disability management, occupational health, return to work, occupational medicine

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Authors: Ilana Singer, Anastasia Lučić, Julie Leclerc

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Introduction: Tics, characterized by repetitive, sudden, non-voluntary motor movements or vocalizations, are prevalent in chronic tic disorder (CT) and Tourette Syndrome (TS). These neurodevelopmental disorders often coexist with various psychiatric conditions, leading to challenges and reduced quality of life. While medication in conjunction with behavioral interventions, such as Habit Reversal Training (HRT), Exposure Response Prevention (ERP), and Comprehensive Behavioral Intervention for Tics (CBIT), has shown efficacy, a significant proportion of patients experience persistent tics. Thus, innovative treatment approaches are necessary to improve therapeutic outcomes, such as mindfulness-based approaches. Nonetheless, the effectiveness of mindfulness-based interventions in the context of CT and TS remains understudied. Objective: The objective of this scoping review is to provide an overview of the current state of research on mindfulness-based interventions for CT and TS, identify knowledge and evidence gaps, discuss the effectiveness of mindfulness-based interventions with other treatment options, and discuss implications for clinical practice and policy development. Method: Using guidelines from Peters (2020) and the PRISMA-ScR, a scoping review was conducted. Multiple electronic databases were searched from inception until June 2023, including MEDLINE, EMBASE, PsychInfo, Global Health, PubMed, Web of Science, and Érudit. Inclusion criteria were applied to select relevant studies, and data extraction was independently performed by two reviewers. Results: Five papers were included in the study. Firstly, we found that mindfulness interventions were found to be effective in reducing anxiety and depression while enhancing overall well-being in individuals with tics. Furthermore, the review highlighted the potential role of mindfulness in enhancing functional connectivity within the Default Mode Network (DMN) as a compensatory function in TS patients. This suggests that mindfulness interventions may complement and support traditional therapeutic approaches, particularly HRT, by positively influencing brain networks associated with tic regulation and control. Conclusion: This scoping review contributes to the understanding of the effectiveness of mindfulness-based interventions in managing CT and TS. By identifying research gaps, this review can guide future investigations and interventions to improve outcomes for individuals with CT or TS. Overall, these findings emphasize the potential benefits of incorporating mindfulness-based interventions as a smaller subset within comprehensive treatment strategies. However, it is essential to acknowledge the limitations of this scoping review, such as the exclusion of a pre-established protocol and the limited number of studies available for inclusion. Further research and clinical exploration are necessary to better understand the specific mechanisms and optimal integration of mindfulness-based interventions with existing behavioral interventions for this population.

Keywords: scoping reviews, Tourette Syndrome, tics, mindfulness-based, therapy, intervention

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Authors: Mayuri Roy Choudhury, Deepti Paul

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Many states in the United States are aiming for high renewable energy targets by the year 2045. In order to achieve this goal, they must do transition to Electrical Vehicles (EVS). We first applied the Multi-Level perspective framework to describe the inter-disciplinary complexities associated with the transition to EVs. Thereafter we addressed these complexities by creating an inter-disciplinary policy framework that uses data science algorithms to create evidence-based policies in favor of EVs. Our policy framework uses a systems level approach as it addresses transitions to EVs from a technology, economic, business and social perspective. By Systems-Level we mean approaching a problem from a multi-disciplinary perspective. Our systems-level approach could be a beneficial decision-making tool to a diverse number of stakeholders such as engineers, entrepreneurs, researchers, and policymakers. In addition, it will add value to the literature of electrical vehicles, sustainable energy, energy economics, and management as well as efficient policymaking.

Keywords: transition, electrical vehicles, systems-level, algorithms

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Authors: Obokhai Kess Asikhia

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This work explores design concept generation by understanding user needs through observation and interview. The aim is to examine several principles and guidelines in obtaining evidence from observing how users interact with the targeted product and interviewing them to acquire deep insights of their needs. With the help of Quality Function Deployment (QFD), the identified needs of the users while interacting with the product were ranked using the normalised weighting approach. Furthermore, a low fidelity prototype of the alarm clock is developed with a view of addressing the identified needs of the users. Finally, the low fidelity prototype design was evaluated with two design prototypes already existing in the market through a study involving 30 participants. Preliminary results reveal higher performance ratings by the majority of the participants of the new prototype compared to the other existing alarm clocks in the market used in the study.

Keywords: design concept, low fidelity prototype, normalised weighting approach, quality function deployment, user needs

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Authors: Nasreen Basoudan, Andrea Tales, Frederic Boy

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Non-clinical anxiety may be comprised of state anxiety - temporarily experienced anxiety related to a specific situation, and trait anxiety - a longer lasting response or a general disposition to anxiety. While temporary and occasional anxiety whether as a mood state or personality dimension is normal, nonclinical anxiety may influence many more components of information processing than previously recognized. In ageing and dementia-related research, disease characterization now involves attempts to understand a much wider range of brain function such as loss of inhibitory control, as against the more common focus on memory and cognition. However, in many studies, the tendency has been to include individuals with clinical anxiety disorders while excluding persons with lower levels of state or trait anxiety. Loss of inhibitory cognitive control can lead to behaviors such as aggression, reduced sensitivity to others, sociopathic thoughts and actions. Anxiety has also been linked to inhibitory control, with research suggesting that people with anxiety are less capable of inhibiting their emotions than the average person. This study investigates the relationship between anxiety and loss of inhibitory control in younger and older adults, using a variety of questionnaires and computers-based tests. Based on the premise that irrespective of classification, anxiety is associated with a wide range of physical, affective, and cognitive responses, this study explores evidence indicative of the potential influence anxiety per se on loss of inhibitory control, in order to contribute to discussion and appropriate consideration of anxiety-related factors in methodological practice.

Keywords: anxiety, ageing, dementia, inhibitory control

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Authors: Esther Chiramal, Kelvin Soh Boon Kai

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Explainable AI is a strong strategy implemented to understand complex black-box model predictions in a human-interpretable language. It provides the evidence required to execute the use of trustworthy and reliable AI systems. On the other hand, however, it also opens the door to locating possible vulnerabilities in an AI model. Traditional adversarial text attack uses word substitution, data augmentation techniques, and gradient-based attacks on powerful pre-trained Bidirectional Encoder Representations from Transformers (BERT) variants to generate adversarial sentences. These attacks are generally white-box in nature and not practical as they can be easily detected by humans e.g., Changing the word from “Poor” to “Rich”. We proposed a simple yet effective Grey-box cum Black-box approach that does not require the knowledge of the model while using a set of surrogate Transformer/BERT models to perform the attack using Explainable AI techniques. As Transformers are the current state-of-the-art models for almost all Natural Language Processing (NLP) tasks, an attack generated from BERT1 is transferable to BERT2. This transferability is made possible due to the attention mechanism in the transformer that allows the model to capture long-range dependencies in a sequence. Using the power of BERT generalisation via attention, we attempt to exploit how transformers learn by attacking a few surrogate transformer variants which are all based on a different architecture. We demonstrate that this approach is highly effective to generate semantically good sentences by changing as little as one word that is not detectable by humans while still fooling other BERT models.

Keywords: BERT, explainable AI, Grey-box text attack, transformer

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Authors: Anne Klimesch, Alejandra Martinez, Martin HäRter, Isabelle Scholl, Paulina Bravo

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Patient-centered care (PCC) is a key principle of high-quality healthcare. In Latin America, research on and promotion of PCC have taken place in the past. However, thorough implementation of PCC in practice is still missing. In Germany, an integrative model of patient-centeredness has been developed by synthesis of diverse concepts of PCC. The model could serve as a point of reference for further research on the implementation of PCC. However, it is predominantly based on research from Europe and North America. This scoping review, therefore, aims to accumulate research on PCC in Latin America in the past 15 years and analyse how PCC has been conceptualized. The resulting overview of PCC in Latin America will be a foundation for a subsequent study aiming at the adaptation of the integrative model of patient-centeredness to the Latin American health care context. Scientific databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Web of Science, SCIELO, Redalyc.) will be searched, and reference and citation tracking will be performed. Studies will be included if they were carried out in Latin America, investigated PCC in any clinical and community setting (public and private), and were published in English, Spanish, French, or Portuguese since 2006. Furthermore, any theoretical framework or conceptual model to guide how PCC is conceptualized in Latin America will be included. Two reviewers will be responsible for the identification of articles, screening of records, and full-text assessment. The results of the scoping review will be used in the development of a mixed-methods study with the aim to understand the needs for PCC, as well as barriers and facilitators in Latin America. Based on the outcomes, the integrative model of PCC will be translated to Spanish and adapted to the Latin American context. The integrative model will enable the dissemination of the concept of PCC in Latin America and will provide a common ground for further research on the topic. The project will thereby make an important contribution to an evidence-based implementation of PCC in Latin America.

Keywords: conceptual framework, integrative model of PCC, Latin America, patient-centered care

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Authors: Milton Ayoki, Edward Bbaale

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This paper analyses the relationship between innovation and employment at firm level with the objective of understanding the contribution of the different innovation strategies in fostering employment growth in Uganda. We use National Innovation Survey (micro-data of 705 Ugandan firms) for the period 2011-2014 and follow closely Harrison et al. (2014) structured approach, and relate employment growth to process innovations and to the growth of sales separately due to innovative and unchanged products. We find positive effects of product innovation on employment at firm level, while process innovation has no discernable impact on employment. Although there is evidence to suggest displacement of labour in some cases where firms only introduce new process, this effect is compensated by growth in employment from new products, which for most firms are introduced simultaneously with new process. Results suggest that source of innovation as well as size of innovating firms or end users of innovation matter for job growth. Innovation that develops from within the firm itself (user) and involving larger firms has greater impact on employment than that developed from outside or coming from within smaller firms. In addition, innovative firms are one and half times more likely to survive in the innovation driven economy environment than those that do not innovate. These results have important implications for policymakers and stakeholders in innovation ecosystem. Supporting policies need to be correctly tailored since the impacts depend on the innovation strategy (type) and characteristics and sector of the innovative firms (small, large, industry, etc.). Policies to spur investment, particularly in innovative sectors and firms with high growth potential would have long lasting effects on job creation. JEL Classification: D24, J0, J20, L20, O30.

Keywords: employment, process innovation, product innovation, Sub-Saharan Africa

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Authors: Hairin Taha, Aditya Arya, M. A. Hapipah, A. M. Mustafa

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Plants have been an important source of medicine since ancient times. Pseuduvaria monticola is a rare montane forest species from the Annonaceae family. Traditionally, the plant was used to cure symptoms of fever, inflammation, stomach-ache and also to reduce the elevated levels of blood glucose. Scientifically, we have evaluated the antidiabetic potential of the Pseuduvaria monticola bark methanolic extract on certain in vitro cell based assays, followed by in vivo study. Results from in vitro models displayed PMm upregulated glucose uptake and insulin secretion in mouse pancreatic β-cells. In vivo study demonstrated the PMm down-regulated hyperglycaemia, oxidative stress and elevated levels of pro-inflammatory cytokines in type 2 diabetic rat models. Altogether, the study revealed that Pseuduvaria monticola might be used as a potential candidate for the management of type 2 diabetes and its related complications.

Keywords: type 2 diabetes, Pseuduvaria monticola, insulin secretion, glucose uptake

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Authors: Fariba Tadayon, Nika Gharahgolooyan, Ateke Tadayon, Mostafa Jafarian

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Carotenoid pigments are a various group of lipophilic compounds that generate the yellow to red colors of many plants, foods and flowers. A well-known type of carotenoids which is pro-vitamin A is β-carotene. Due to the color of citrus fruit’s peel, the peel can be a good source of different carotenoids. Ostrich oil is one of the most valuable foundations in many branches of industry, medicine, cosmetics and nutrition. The animal-based ostrich oil could be considered as an alternative and green solvent. Following this study, wastes of citrus peel will recycle by a simple method and extracted carotenoids can increase properties of ostrich oil. In this work, a simple and efficient method for extraction of carotenoids from tangerine peel was designed. Ultrasound-assisted extraction (UAE) showed significant effect on the extraction rate by increasing the mass transfer rate. Ostrich oil can be used as a green solvent in many studies to eliminate petroleum-based solvents. Since tangerine peel is a complex source of different carotenoids separation and determination was performed by high-performance liquid chromatography (HPLC). In addition, the ability of ostrich oil and sunflower oil in carotenoid extraction from tangerine peel and carrot was compared. The highest yield of β-carotene extracted from tangerine peel using sunflower oil and ostrich oil were 75.741 and 88.110 (mg/L), respectively. Optimization of the process was achieved by response surface methodology (RSM) and the optimal extraction conditions were tangerine peel powder particle size of 0.180 mm, ultrasonic intensity of 19 W/cm2 and sonication time of 30 minutes.

Keywords: β-carotene, carotenoids, citrus peel, ostrich oil, response surface methodology, ultrasound-assisted extraction

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Authors: Suhayla Reda Al-Banai

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Problem Statement: Tooth whitening was used for over one hundred and fifty year. The question concerning the whiteness of teeth is a complex one since tooth whiteness will vary from individual to individual, dependent on age and culture, etc. Tooth whitening following treatment may be dependent on the type of whitening system used to whiten the teeth. There are a few side-effects to the process, and these include tooth sensitivity and gingival irritation. Some individuals may experience no pain or sensitivity following the procedure. Purpose: To systematically review the available published literature until 31st December 2021 to identify all relevant studies for inclusion and to determine whether there was any evidence demonstrating that the application of whitening procedures resulted in the tooth sensitivity. Aim: Systematically review the available published works of literature to identify all relevant studies for inclusion and to determine any evidence demonstrating that application of 10% & 15% carbamide peroxide in tooth whitening procedures resulted in tooth sensitivity. Material and Methods: Following a review of 70 relevant papers from searching both electronic databases (OVID MEDLINE and PUBMED) and hand searching of relevant written journals, 49 studies were identified, 42 papers were subsequently excluded, and 7 studies were finally accepted for inclusion. The extraction of data for inclusion was conducted by two reviewers. The main outcome measures were the methodology and assessment used by investigators to evaluate tooth sensitivity in tooth whitening studies. Results: The reported evaluation of tooth sensitivity during tooth whitening procedures was based on the subjective response of subjects rather than a recognized methodology for evaluating. One of the problems in evaluating was the lack of homogeneity in study design. Seven studies were included. The studies included essential features namely: randomized group, placebo controls, doubleblind and single-blind. Drop-out was obtained from two of included studies. Three of the included studies reported sensitivity at the baseline visit. Two of the included studies mentioned the exclusion criteria Conclusions: The results were inconclusive due to: Limited number of included studies, the study methodology, and evaluation of DS reported. Tooth whitening procedures adversely affect both hard and soft tissues in the oral cavity. Sideeffects are mild and transient in nature. Whitening solutions with greater than 10% carbamide peroxide causes more tooth sensitivity. Studies using nightguard vital bleaching with 10% carbamide peroxide reported two side effects tooth sensitivity and gingival irritation, although tooth sensitivity was more prevalent than gingival irritation

Keywords: dentine, sensitivity, bleaching, carbamide peroxde

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Authors: Chana Pavneet

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Background: In more recent years in dentistry, a greater emphasis has been placed on competency-based education (CBE) programmes. Undergraduate and postgraduate curriculums have been reformed to reflect these changes, and adopting a CBE approach has shown to be beneficial to trainees and places an emphasis on continuous lifelong learning. The literature is vast; however, very little work has been done specifically to the assessment of competence in dentistry and even less so in oral surgery. The majority of the literature tends to opinion pieces. Some small-scale studies have been undertaken in this area researching assessment tools which can be used to assess competence in oral surgery. However, there is a lack of general consensus on the preferable assessment methods. The aim of this review is to identify the assessment methods available and their usefulness. Methods: Electronic databases (Medline, Embase, and the Cochrane Database of systematic reviews) were searched. PRISMA guidelines were followed to identify relevant papers. Abstracts of studies were reviewed, and if they met the inclusion criteria, they were included in the review. Papers were reviewed against the critical appraisal skills programme (CASP) checklist and medical education research quality instrument (MERQSI) to assess their quality and identify any bias in a systematic manner. The validity and reliability of each assessment method or tool were assessed. Results: A number of assessment methods were identified, including self-assessment, peer assessment, and direct observation of skills by someone senior. Senior assessment tended to be the preferred method, followed by self-assessment and, finally, peer assessment. The level of training was shown to affect the preferred assessment method, with one study finding peer assessment more useful in postgraduate trainees as opposed to undergraduate trainees. Numerous tools for assessment were identified, including a checklist scale and a global rating scale. Both had their strengths and weaknesses, but the evidence was more favourable for global rating scales in terms of reliability, applicability to more clinical situations, and easier to use for examiners. Studies also looked into trainees’ opinions on assessment tools. Logbooks were not found to be significant in measuring the competence of trainees. Conclusion: There is limited literature exploring the methods and tools which assess the competence of oral surgery trainees. Current evidence shows that the most favourable assessment method and tool may differ depending on the stage of training. More research is required in this area to streamline assessment methods and tools.

Keywords: competence, oral surgery, assessment, trainees, education

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Authors: Yohannes Kelifa, Gomathi Periasamy, Aman Karim

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Introduction: Diabetes mellitus has become a major public health and economical problem across the globe. Modern antidiabetic drugs have a number of limitations, and scientific investigation of traditional herbal remedies used for diabetes may provide novel leads for the development of new antidiabetic drugs that can be used as alternative or complementary to available antidiabetic allopathic medications. Though Myrica salicifolia Hochst. ex A. Rich. is used for the management of diabetes in Ethiopian traditional medicine, there was no previous scientific evidence about its antidiabetic effect to the authors’ knowledge. This study was undertaken to evaluate the antidiabetic activity the root extracts of Myrica salicifolia in streptozotocin (STZ)-induced diabetic mice. Methods: Experimental diabetes was induced by intraperitoneal administration of STZ (150 mg/kg) in male mice. Diabetic mice were treated with oral doses of M. salicifolia root extracts at 200, 400 and 600 mg/kg, and its fractions (chloroform, ethyl acetate, n-butanol and aqueous) at a dose of 400 mg/kg daily for 15 days. Fasting blood glucose level (BGL) was measured at 0, 5th,10th, and 15th day. The free radical scavenging activity of the crude extract was determined using in vitro by DPPH assay. The statistical significance was assessed by one-way ANOVA, followed by Tukey’s multiple comparison tests. Results were considered significant when p < 0.05. Results: Daily administration of the M. salicifolia 80% methanol root extracts (at three different doses (200, 400 and 600 mg/kg) significantly (p < 0.05, p < 0.01 and p < 0.001) reduced fasting BGL compared with diabetic control. The aqueous and butanol fractions at a dose of 400 mg/kg resulted in maximum reduction of fasting BGL by 42.39%, and 52.13%, respectively at the 15th day in STZ-induced diabetic mice. Free radical scavenging activity of the 80% methanol extract of M. salicifolia was comparable to ascorbic acid. The IC50 values of the crude extract and ascorbic acid (a reference compound) were found to be 4.54 μg/ml and 4.39 μg/ml, respectively. Conclusion: These findings demonstrated that the methanolic extracts of M. salicifolia root and its fractions (n-butanol and aqueous) exhibit a significant antihyperglycemic activity in STZ-induced diabetic mice. Furthermore, the result of the present study indicates that M. salicifolia root extract is a potential source of natural antioxidants.

Keywords: antidiabetic, diabetes mellitus, DPPH, mice, Myrica salicifolia, streptozotocin

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Authors: Samara A. Testoni, Vander F. Melo, Lorna A. Dawson, Fabio A. S. Salvador

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Soil traces are useful as forensic evidence due to their potential to transfer and adhere to different types of surfaces on a range of objects or persons. The great variability expressed by soil physical, chemical, biological and mineralogical properties show soil traces as complex mixtures. Soils are continuous and variable, no two soil samples being indistinguishable, nevertheless, the complexity of soil characteristics can provide powerful evidence for comparative forensic purposes. This work aimed to establish a Standard Operating Procedure (SOP) for forensic soil analysis in Brazil. We carried out a simulated crime scene with double blind sampling to calibrate the sampling procedures. Samples were collected at a range of locations covering a range of soil types found in South of Brazil: Santa Candida and Boa Vista, neighbourhoods from Curitiba (State of Parana) and in Guarani and Guaraituba, neighbourhoods from Colombo (Curitiba Metropolitan Region). A previously validated sequential analyses of chemical, physical and mineralogical analyses was developed in around 2 g of soil. The suggested SOP and the sequential range of analyses were effective in grouping the samples from the same place and from the same parent material together, as well as successfully discriminated samples from different locations and originated from different rocks. In addition, modifications to the sample treatment and analytical protocol can be made depending on the context of the forensic work.

Keywords: clay mineralogy, forensic soils analysis, sequential analyses, kaolinite, gibbsite

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Authors: Chander Kant, Arun Kumar

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Biometric systems automatically recognize an individual based on his/her physiological and behavioral characteristics. There are also some traits like weight, age, height etc. that may not provide reliable user recognition because of there common and temporary nature. These traits are called soft bio metric traits. Although soft bio metric traits are lack of permanence to uniquely and reliably identify an individual, yet they provide some beneficial evidence about the user identity and may improve the system performance. Here in this paper, we have proposed an approach for integrating the soft bio metrics with fingerprint and face to improve the performance of personal authentication system. In our approach we have proposed a combined architecture of three different sensors to elevate the system performance. The approach includes, soft bio metrics, fingerprint and face traits. We have also proven the efficiency of proposed system regarding FAR (False Acceptance Ratio) and total response time, with the help of MUBI (Multimodal Bio metrics Integration) software.

Keywords: FAR, minutiae point, multimodal bio metrics, primary bio metric, soft bio metric

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Authors: Peter Lindstrom, Caroline Gyberg, Scott Goodwin

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The Swedish police organisation was fundamentally reorganized in 2015 when 21 regional police forces were combined into one national police authority divided in 7 larger police regions, 35 police areas, and some 100 local police districts. A central theme for the reform was that local crime prevention policing should be more unified in the country. In this paper, we review crime prevention strategies in Sweden from a criminological and policing perspective focusing, among other things, on differences between urban and rural areas. In the crime prevention field, words such as 'knowledge- and evidence-based', 'collaboration', and 'strategies' are common. Our objective is to investigate the relationship between theoretical and practical knowledge in local crime prevention work. Our research indicate that an elaborated and strategic connection between theoretical and practical perspectives is important for successful local crime prevention work. Universities may provide a platform such knowledge exchange.

Keywords: crime prevention, police reform, urban and rural areas, criminological and policing perspectives

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Authors: Busiswa Madikazi

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This systematic mapping study explores the underrepresentation of women's contributions to farming in the Global South within the development of Information and Communication Technologies (ICT)-based extension methods. Despite women farmers constituting 70% of the agricultural labour force, their productivity is hindered by various constraints, including illiteracy, household commitments, and limited access to credit and markets. A systematic mapping approach was employed with the aim of identifying evidence gaps in existing ICT extension for women farmers. The data collection protocol follows a structured approach, incorporating key criteria for inclusion, exclusion, search strategy, and coding and the PICO strategy (Population, Intervention, Comparator, and Outcome). The results yielded 119 articles that qualified for inclusion. The findings highlight that mobile phone apps (WhatsApp) and radio/television programming are the primary extension methods employed while integrating ICT with training, field visits, and demonstrations are underutilized. Notably, the study emphasizes the inadequate attention to critical issues such as food security, gender equality, and attracting youth to farming within ICT extension efforts. These findings indicate a significant policy and practice gap, neglecting community-driven approaches that cater to women's specific needs and enhance their agricultural production. Map highlights the importance of refocusing ICT extension efforts to address women farmers’ unique challenges, thereby contributing to their empowerment and improving agricultural practices.

Keywords: agricultural extension, ICT, women farmers, smallholders

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Authors: R. S. Remya, U. S. Sethulekshmi

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Detecting the authenticity of a video is an important issue in digital forensics as Video is used as a silent evidence in court such as in child pornography, movie piracy cases, insurance claims, cases involving scientific fraud, traffic monitoring etc. The biggest threat to video data is the availability of modern open video editing tools which enable easy editing of videos without leaving any trace of tampering. In this paper, we propose an efficient passive method for inter-frame video tampering detection, its type and location by estimating the optical flow of wavelet features of adjacent frames and thresholding the variation in the estimated feature. The performance of the algorithm is compared with the z-score thresholding and achieved an efficiency above 95% on all the tested databases. The proposed method works well for videos with dynamic (forensics) as well as static (surveillance) background.

Keywords: discrete wavelet transform, optical flow, optical flow variation, video tampering

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Authors: Anna Fredriksson Häägg, Charlotte Weil, Niklas Rönnberg

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Map-based dashboards are used for data exploration every day. The present study used an insight-based methodology for evaluating a map-based dashboard that presents research findings of water management and ecosystem services in the Amazon. In addition to analyzing the insights gained from using the dashboard, the evaluation method was compared to standardized questionnaires and task-based evaluations. The result suggests that the dashboard enabled the participants to gain domain-relevant, complex insights regarding the topic presented. Furthermore, the insight-based analysis highlighted unexpected insights and hypotheses regarding causes and potential adaptation strategies for remediation. Although time- and resource-consuming, the insight-based methodology was shown to have the potential of thoroughly analyzing how end users can utilize map-based dashboards for data exploration and decision making. Finally, the insight-based methodology is argued to evaluate tools in scenarios more similar to real-life usage compared to task-based evaluation methods.

Keywords: visual analytics, dashboard, insight-based evaluation, geographic visualization

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Authors: Rian O. Miranda, Lidia V. de Sa, Julio C. Suita

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The Brazilian Nuclear Energy Commission (CNEN) is the main manufacturer of radiopharmaceuticals in Brazil. The Nuclear Engineering Institute (IEN), located at Rio de Janeiro, is one of its main centers of research and production, attending public and private hospitals in the state. This radiopharmaceutical production is used in diagnostic and therapy procedures and allows one and a half million nuclear medicine procedures annually. Despite this, the country is not self-sufficient to meet national demand, creating the need for importation and consequent dependence on other countries. However, IEN facilities were designed in the 60's, and today its structure is inadequate in relation to the good manufacturing practices established by sanitary regulator (ANVISA) and radiological protection leading to the need for a new project. In order to adapt and increase production in the country, a new plant will be built and integrated to the existing facilities with a new 30 MeV Cyclotron that is actually in project detailing process. Thus, it is proposed to survey current CNEN and ANVISA standards for radiopharmaceutical production facilities, as well as the radiological protection analysis of each area of the plant, following good manufacturing practices recommendations adopted nationally besides licensing exigencies for radioactive facilities. In this way, the main requirements for proper operation, equipment location, building materials, area classification, and maintenance program have been implemented. The access controls, interlocks, segregation zones and pass-through boxes integrated into the project were also analyzed. As a result, IEN will in future have the flexibility to produce all necessary radioisotopes for nuclear medicine application, more efficiently by simultaneously bombarding two targets, allowing the simultaneous production of two different radioisotopes, minimizing radiation exposure and saving operating costs.

Keywords: cyclotron, legislation, norms, production, radiopharmaceuticals

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Authors: Danyi Wang, Andrew Schriefer, Dennis O'Rourke, Brajendra Kumar, Yang Liu, Fei Zhong, Juergen Scheuenpflug, Zheng Feng

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Purpose: It has been recognized that the microbiome plays critical roles in disease pathogenesis, including cancer, autoimmune disease, and multiple sclerosis. To develop a clinical-grade assay for exploring microbiome-derived clinical biomarkers across disease areas, a two-phase approach is implemented. 1) Identification of the optimal sample preparation reagents using pre-mixed bacteria and healthy donor stool samples coupled with proprietary Sigma-Aldrich® bioinformatics solution. 2) Exploratory analysis of patient samples for enabling precision medicine. Study Procedure: In phase 1 study, we first compared the 16S sequencing results of two ATCC® microbiome standards (MSA 2002 and MSA 2003) across five different extraction kits (Kit A, B, C, D & E). Both microbiome standards samples were extracted in triplicate across all extraction kits. Following isolation, DNA quantity was determined by Qubit assay. DNA quality was assessed to determine purity and to confirm extracted DNA is of high molecular weight. Bacterial 16S ribosomal ribonucleic acid (rRNA) amplicons were generated via amplification of the V3/V4 hypervariable region of the 16S rRNA. Sequencing was performed using a 2x300 bp paired-end configuration on the Illumina MiSeq. Fastq files were analyzed using the Sigma-Aldrich® Microbiome Platform. The Microbiome Platform is a cloud-based service that offers best-in-class 16S-seq and WGS analysis pipelines and databases. The Platform and its methods have been extensively benchmarked using microbiome standards generated internally by MilliporeSigma and other external providers. Data Summary: The DNA yield using the extraction kit D and E is below the limit of detection (100 pg/µl) of Qubit assay as both extraction kits are intended for samples with low bacterial counts. The pre-mixed bacterial pellets at high concentrations with an input of 2 x106 cells for MSA-2002 and 1 x106 cells from MSA-2003 were not compatible with the kits. Among the remaining 3 extraction kits, kit A produced the greatest yield whereas kit B provided the least yield (Kit-A/MSA-2002: 174.25 ± 34.98; Kit-A/MSA-2003: 179.89 ± 30.18; Kit-B/MSA-2002: 27.86 ± 9.35; Kit-B/MSA-2003: 23.14 ± 6.39; Kit-C/MSA-2002: 55.19 ± 10.18; Kit-C/MSA-2003: 35.80 ± 11.41 (Mean ± SD)). Also, kit A produced the greatest yield, whereas kit B provided the least yield. The PCoA 3D visualization of the Weighted Unifrac beta diversity shows that kits A and C cluster closely together while kit B appears as an outlier. The kit A sequencing samples cluster more closely together than both the other kits. The taxonomic profiles of kit B have lower recall when compared to the known mixture profiles indicating that kit B was inefficient at detecting some of the bacteria. Conclusion: Our data demonstrated that the DNA extraction method impacts DNA concentration, purity, and microbial communities detected by next-generation sequencing analysis. Further microbiome analysis performance comparison of using healthy stool samples is underway; also, colorectal cancer patients' samples will be acquired for further explore the clinical utilities. Collectively, our comprehensive qualification approach, including the evaluation of optimal DNA extraction conditions, the inclusion of positive controls, and the implementation of a robust qualified bioinformatics pipeline, assures accurate characterization of the microbiota in a complex matrix for deciphering the deep biology and enabling precision medicine.

Keywords: 16S rRNA sequencing, analytical validation, bioinformatics pipeline, metagenomics

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Authors: A. Raj Kumar, A. Okunseinde, P. Raghavan, V. Kapila

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Stroke is the leading cause of adult disability worldwide. With recent advances in immediate post-stroke care, there is an increasing number of young stroke survivors, under the age of 65 years. While most stroke survivors will regain the ability to walk, they often experience long-term arm and hand motor impairments. Long term upper limb rehabilitation is needed to restore movement and function, and prevent deterioration from complications such as learned non-use and learned bad-use. We have developed a novel virtual coach, a wearable instrumented rehabilitation jacket, to motivate individuals to participate in long-term skill re-learning, that can be personalized to their impairment profile. The jacket can estimate the movements of an individual’s arms using embedded off-the-shelf sensors (e.g., 9-DOF IMU for inertial measurements, flex-sensors for measuring angular orientation of fingers) and a Bluetooth Low Energy (BLE) powered microcontroller (e.g., RFduino) to non-intrusively extract data. The 9-DOF IMU sensors contain 3-axis accelerometer, 3-axis gyroscope, and 3-axis magnetometer to compute the quaternions, which are transmitted to a computer to compute the Euler angles and estimate the angular orientation of the arms. The data are used in a gaming environment to provide visual, and/or haptic feedback for goal-based, augmented-reality training to facilitate re-learning in a cost-effective, evidence-based manner. The full paper will elaborate the technical aspects of communication, interactive gaming environment, and physical aspects of electronics necessary to achieve our stated goal. Moreover, the paper will suggest methods to utilize the proposed system as a cheaper, portable, and versatile system vis-à-vis existing instrumentation to facilitate post-stroke personalized arm rehabilitation.

Keywords: feedback, gaming, Euler angles, rehabilitation, augmented reality

Procedia PDF Downloads 277

Authors: Margareth S. Zanchetta, Kateryna Metersky, Valerie Tan, Charissa Cordon, Stephanie Lucchese, Yana Siganevich, Prasha Sivasundaram, Truong Binh Nguyen, Imran Qureshi

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Due to a new area of practice, Canadian nurses possess knowledge gaps regarding the use of cannabis-based therapies by clients/patients. Education related to medical cannabis (MC) and recreational cannabis (RC) is required to promote nurses’ competency and confidence in supporting clients/patients using MC/RC toward the improvement of health outcomes. A team composed of nursing researchers and undergraduate/graduate students implemented a national survey to explore this theme with the population of undergraduate, graduate (MN and NP), and Post-Diploma (RN Bridging) nursing students enrolled in Canadian Universities Nursing Programs. Upon Research Ethics Board approval, survey recruitment was supported by major nursing stakeholders. The research questions were : (a) Which are the most preferred sources of information on MC/RC for nursing students? (b) Which are the factors and preferred learning modalities that could increase interest in learning about MC/RC, and (c) What are the future career plans among nursing students, and how would they consider the prospective use of cannabis in their practice? The survey was available from Sept. 2022 to Feb. 2023, hosted by a remote platform. An original questionnaire (English-French) was composed of 18 multiple choice questions and 2 open-ended questions. Sociodemographic information and closed-ended responses were compiled as descriptive statistics, while narrative accounts will be analysed through thematic analysis. Respondents (n=153) were from 7 Canadian provinces, national (99%) and international students (1%); the majority of respondents (61%) were in the age range of 21-30 years old. Results indicated that respondents perceive a gap in the undergraduate curriculum on the topics of MC/RC (91%) and that their learning needs include regulations (90%), data on effectiveness (88%), dosing best practices (86%), contraindications (83%), and clinical and medical indications (76%). Respondents reported motivation to learn more about MC/RC through online lectures/videos (65%), e-learning modules or online interactive training (61%), workshops (51%), webinars (36%), and social media (35%). Their primary career-related motivations regarding MC/RC knowledge include enhancing nursing practice (76%), learning about this growing scope of practice (61%), keeping up-to-date responding to scientific curiosity (59%), learning about evidence-based practice (59%), and utilizing alternative forms of medical treatment (37%). Respondents indicated that the integration of topics on cannabis in any course in the undergraduate and/or graduate curriculum would increase their desire to learn about MC/RC as equally as exposure within a clinical setting (75%). The emerging trend in the set of narrative responses (n=130) suggests that respondents believe educational MC/RC content should be integrated into core nursing courses. Respondents also urged educators to be well-informed about evidence-based practice related to MC/RC and to reflect upon stigma and biases surrounding its use. Future knowledge dissemination and translation activities include scholarly products and presentations to stimulate discussion amongst nursing faculty and students, as well as nurses in clinical settings. The goal is to mobilise talents and build collaboration for the development of a socially responsive curriculum on MC/RC competency to address the education-related expectations of all these social actors.

Keywords: Canada, medical cannabis, nursing education, nursing graduate student, nursing undergraduate student, online survey, recreational cannabis

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Authors: Ghibeche Abderrahmane

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To examine whether genes associated with cellular defense against oxidative stress are associated with insulin sensitivity, patients with type 2 diabetes (n=7) and age-matched (n=5) and young (n=9) control subjects underwent a euglycemic-hyperinsulinemic clamp for 120 min. Muscle samples were obtained before and after the clamp and analyzed for heat shock protein (HSP)72 and heme oxygenase (HO)-1 mRNA, intramuscular triglyceride content, and the maximal activities of β-hyroxyacyl-CoA dehydrogenase (β-HAD) and citrate synthase (CS). Basal expression of both HSP72 and HO-1 mRNA were lower (P < 0.05) by 33 and 55%, respectively, when comparing diabetic patients with age-matched and young control subjects, with no differences between the latter groups. Both basal HSP72 (r = 0.75, P < 0.001) and HO-1 (r = 0.50,P < 0.05) mRNA expression correlated with the glucose infusion rate during the clamp. Significant correlations were also observed between HSP72 mRNA and both β-HAD (r = 0.61, P < 0.01) and CS (r = 0.65, P < 0.01). HSP72 mRNA was induced (P < 0.05) by the clamp in all groups. Although HO-1 mRNA was unaffected by the clamp in both the young and age-matched control subjects, it was increased (P < 0.05) ∼70-fold in the diabetic patients after the clamp. These data demonstrate that genes involved in providing cellular protection against oxidative stress are defective in patients with type 2 diabetes and correlate with insulin-stimulated glucose disposal and markers of muscle oxidative capacity. The data provide new evidence that the pathogenesis of type 2 diabetes involves perturbations to the antioxidant defense mechanism within skeletal muscle.

Keywords: euglycemic-hyperinsulinemic, HSP72, mRNA, diabete

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