Search results for: cardiac rehabilitation

Authors: Michael Brave, Mark Kroll, Steven Karch, Charles Wetli, Michael Graham, Sebastian Kunz, Dorin Panescu

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Background: Conducted electrical weapons (CEW) are now used in 107 countries and are a common law enforcement less-lethal force practice in the United Kingdom (UK), United States of America (USA), Canada, Australia, New Zealand, and others. Use of these devices is rarely temporally associated with the occurrence of sudden arrest-related deaths (ARD). Because such deaths are uncommon, few Medical Examiners (MEs) ever encounter one, and even fewer offices have established comprehensive investigative protocols. Without sufficient scientific data, the role, if any, played by a CEW in a given case is largely supplanted by conjecture often defaulting to a CEW-induced fatal cardiac arrhythmia. In addition to the difficulty in investigating individual deaths, the lack of information also detrimentally affects being able to define and evaluate the ARD cohort generally. More comprehensive, better information leads to better interpretation in individual cases and also to better research. The purpose of this presentation is to provide MEs with a comprehensive evidence-based checklist to assist in the assessment of CEW-ARD cases. Methods: PUBMED and Sociology/Criminology data bases were queried to find all medical, scientific, electrical, modeling, engineering, and sociology/criminology peer-reviewed literature for mentions of CEW or synonymous terms. Each paper was then individually reviewed to identify those that discussed possible bioelectrical mechanisms relating CEW to ARD. A Naranjo-type pharmacovigilance algorithm was also employed, when relevant, to identify and quantify possible direct CEW electrical myocardial stimulation. Additionally, CEW operational manuals and training materials were reviewed to allow incorporation of CEW-specific technical parameters. Results: Total relevant PUBMED citations of CEWs were less than 250, and reports of death extremely rare. Much relevant information was available from Sociology/Criminology data bases. Once the relevant published papers were identified, and reviewed, we compiled an annotated checklist of data that we consider critical to a thorough CEW-involved ARD investigation. Conclusion: We have developed an evidenced-based checklist that can be used by MEs and their staffs to assist them in identifying, collecting, documenting, maintaining, and objectively analyzing the role, if any, played by a CEW in any specific case of sudden death temporally associated with the use of a CEW. Even in cases where the collected information is deemed by the ME as insufficient for formulating an opinion or diagnosis to a reasonable degree of medical certainty, information collected as per the checklist will often be adequate for other stakeholders to use as a basis for informed decisions. Having reviewed the appropriate materials in a significant number of cases careful examination of the heart and brain is likely adequate. Channelopathy testing should be considered in some cases, however it may be considered cost prohibitive (aprox $3000). Law enforcement agencies may want to consider establishing a reserve fund to help manage such rare cases. The expense may stay the enormous costs associated with incident-precipitated litigation.

Keywords: ARD, CEW, police, TASER

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Authors: F. A. Thomas, M. Schrafl-Altermatt, R. Treier, S. Kaufmann

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Stroke is the main cause of adult disability. Especially upper limb function is affected in most patients. Recently, cooperative hand movements have been shown to be a promising type of upper limb training in stroke rehabilitation. In these movements, which are frequently found in activities of daily living (e.g. opening a bottle, winding up a blind), the force of one upper limb has to be equally counteracted by the other limb to successfully accomplish a task. The use of standardized and reliable clinical assessments is essential to evaluate the efficacy of therapy and the functional outcome of a patient. Many assessments for upper limb function or impairment are available. However, the evaluation of cooperative hand movement tasks are rarely included in those. Thus, the aim of this study was (i) to develop a novel clinical assessment (CASA - Cooperative Activity Stroke Assessment) for the evaluation of patients’ capacity to perform cooperative hand movements and (ii) to test its inter- and interrater reliability. Furthermore, CASA scores were compared to current gold standard assessments for upper extremity in stroke patients (i.e. Fugl-Meyer Assessment, Box & Blocks Test). The CASA consists of five cooperative activities of daily living including (1) opening a jar, (2) opening a bottle, (3) open and closing of a zip, (4) unscrew a nut and (5) opening a clipbox. Here, the goal is to accomplish the tasks as fast as possible. In addition to the quantitative rating (i.e. time) which is converted to a 7-point scale, also the quality of the movement is rated in a 4-point scale. To test the reliability of CASA, fifteen stroke subjects were tested within a week twice by the same two raters. Intra-and interrater reliability was calculated using the intraclass correlation coefficient (ICC) for total CASA score and single items. Furthermore, Pearson-correlation was used to compare the CASA scores to the scores of Fugl-Meyer upper limb assessment and the box and blocks test, which were assessed in every patient additionally to the CASA. ICC scores of the total CASA score indicated an excellent- and single items established a good to excellent inter- and interrater reliability. Furthermore, the CASA score was significantly correlated to the Fugl-Meyer and Box & Blocks score. The CASA provides a reliable assessment for cooperative hand movements which are crucial for many activities of daily living. Due to its non-costly setup, easy and fast implementation, we suggest it to be well suitable for clinical application. In conclusion, the CASA is a useful tool in assessing the functional status and therapy related recovery in cooperative hand movement capacity in stroke patients.

Keywords: activitites of daily living, clinical assessment, cooperative hand movements, reliability, stroke

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Authors: Hung-Chih Hsu, Pey-Jium Chang, Ching-Hsein Chen, Jer-Liang Andrew Yeh

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Osteoarthritis (OA) is a common disorder in rehabilitation clinic. The main characteristics include joint pain, localized tenderness and enlargement, joint effusion, cartilage destruction, loss of adhesion of perichondrium, synovium hyperplasia. Synoviocytes inflammation might be a cause of local tenderness and effusion. Inflammation cytokines might also play an important role in joint pain, cartilage destruction, decrease adhesion of perichondrium to the bone. Treatments of osteoarthritis include non-steroid anti-inflammation drugs (NSAID), glucosamine supplementation, hyaluronic acid, arthroscopic debridement, and total joint replacement. Total joint replacement is commonly used in patients with severe OA who failed respond to pharmacological treatment. However, some patients received surgery had serious adverse events, including instability of the implants due to insufficient adhesion to the adjacent bony tissue or synovial inflammation. We tried to develop ideal nano-topographic oxidized silicon nanosponges by using with various chemicals to produce thickness difference in nanometers in order to study more about the cell-environment interactions in vitro like the alterations of cell adhesion, morphology, extracellular matrix secretions in the pathogenesis of osteoarthritis. Cytokines studies like growth factor, reactive oxygen species, reactive inflammatory materials (Like nitrous oxide and prostaglandin E2), extracellular matrix (ECM) degradation enzymes, and synthesis of collagen will also be observed and discussed. Extracellular and intracellular expression transforming growth factor beta (TGF-β) will be studied by reverse transcription-polymerase chain reaction (RT-PCR). The degradation of ECM will be observed by the bioactivity ratio of matrix metalloproteinase (MMP) and tissue inhibitors of metalloproteinase by ELISA (Enzyme-linked immunosorbent assay). When rabbit synoviocytes were cultured on these nano-topographic structures, they demonstrate better cell adhesion rate, decreased expression of MMP-2,9 and PGE2, and increased expression of TGF-β when cultured in nano-topographic oxidized silicon nanosponges than in the planar oxidized silicon ones. These results show cell behavior, cytokine production can be influenced by physical characteristics from different nano-topographic structures. Our study demonstrates the possibility of manipulating cell behavior in these nano-topographic biomaterials.

Keywords: osteoarthritis, synoviocyte, oxidized silicon surfaces, reactive oxygen species

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Authors: Said S. Almaiuof

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Integration Program Through Physical Education Lessons for The Influence of Some Physical Fitness Health-Related Components in Visual Handicapped Children. Propose of the study: The aim of this study is to design and evaluate a program for the physical education lesson to improve the cardio-respiratory endurance, considering the lesson of physical education as one of the educational means to achieve the society aims toward health and fitness, concerning the importance of the cardio-respiratory endurance as an essential one of the physical fitness health-related components. And this program tried to give them hand of help as a part of the society having the same rights as the rest of the society. Methodology: The researcher used the experimental method as a suitable method for this study and tested its hypothesis. The subject of the research selected randomly of the two classes from primary education in TRIPOLI-LIBYA, it was 28 boys (14-15) years old, then divided into groups, experimental group, n=13, which practiced the special exercises program and control group, n=15, which only practiced the normal school program. The selected child subjected to a medical examination in order to make sure that they are healthy, and the Vo2max measured by cycle ergometry and test some physical fitness makers before and after the program. Results: The study cleared that the experimental group developed in all physical variation in comparison with the control group which has a little development in a general balance only. Results are following: 1. The experimental group was successful more than the control group in all the research variation. 2. There were some improvements in time of keeping Balance in control group only. Discussion /conclusion: According to statistical analysis of data related to the values of the variables in this study; the suggested exercise program according to development the cardio respiratory endurance (CRE), and some physical fitness more than the program which already implemented in the school was less effective, just there is developing on keep balancing. It’s statistically significant (p<0.05) after applying this program. Improving the experimental group on (CRE), balance, running, sit and reach, from the suggested exercise program of what indicate the partaking program positive in improve those physical variables, and the selected exercises may contributed in improving the (CRE) for visual impairment and its pivotal in visual impairment children’s life. A health-related physical education curriculum can provide students with substantially more physical activity during physical education classes. The results show that the physical rehabilitation program for visual impairment children helped them in developing their defects due to the injury which means that this program should be in every organization having this part of people to increase their production and give them hand of help as a part of the society having the same rights as the rest of the society and to establish the idea of sport for all.

Keywords: visual handicapped, cardio-respiratory endurance, health, ergometry, education

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Authors: Hela Ghali, Sihem Ben Fredj, Mohamed Ben Rejeb, Sawssen Layouni, Salwa Khefacha, Lamine Dhidah, Houyem Said Laatiri

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Background: Antimicrobial resistance is a growing threat to public health and motivates to improve prevention and control programs both at international (WHO) and national levels. Despite their low pathogenicity, vancomycin-resistant enterococci (VRE) are common nosocomial pathogens in several countries. The high potential for transmission of VRE between patients and the threat to send its resistance genes to other bacteria such as staphylococcus aureus already resistant to meticilin, justify strict control measures. Indeed, in Europe, the proportion of Enterococcus faecium responsible for invasive infections, varies from 1% to 35% in 2011 and less than 5% were resistant to vancomycin. In addition, it represents the second cause of urinary tract and wound infections and the third cause of nosocomial bacteremia in the United States. The nosocomial outbreaks of VRE have been mainly described in intensive care services, hematology-oncology and haemodialysis. An epidemic of VRE has affected our hospital and the objective of this work is to describe the measures put in place. Materials/Methods: Following the alert given by the service of plastic surgery concerning a patient carrier of VRE, a team of the prevention and healthcare security service (doctor + technician) made an investigation. A review of files was conducted to draw the synoptic table and the table of cases. Results: By contacting the microbiology laboratory, we have identified four other cases of VRE and who were hospitalized in Medical resuscitation department (2 cases, one of them was transferred to the Physical rehabilitation department), and Nephrology department (2 cases). The visit has allowed to detect several malfunctions in professional practice. A crisis cell has allowed to validate, coordinate and implement control measures following the recommendations of the Technical Center of nosocomial infections. In fact, the process was to technically isolate cases in their sector of hospitalization, to restrict the use of antibiotics, to strength measures of basic hygiene, and to make a screening by rectal swab for both cases and contacts (other patients and health staff). These measures have helped to control the situation and no other case has been reported for a month. 2 new cases have been detected in the intensive care unit after a month. However, these are short-term strategies, and other measures in the medium and long term should be taken into account in order to face similar outbreaks. Conclusion: The efforts to control the outbreak were not efficient since 2 new cases have been reported after a month. Therefore, a continuous monitoring in order to detect new cases earlier is crucial to minimize the dissemination of VRE.

Keywords: hospitals, nosocomial infection, outbreak, vancomycin-resistant enterococci

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Authors: Tassana Boontong, Vilaivan Thongcharoen, Orapan Thosingha, Suphamon Chansakul, Anorut Jenwitheesuk, Chanin Chakkrapopyodhin, Isara Phiwchai, Mattika Chaichan, Rungnapha Khiewchaum

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According to Thailand health policy, subdistrict health promoting hospitals (SHPHs) serve as forefront facilities for inclusive health care service. Those services include health promotion, disease prevention, primary medical care and rehabilitation. However, SHPHs residing in some distant area, such as SHPHs residing on the islands, would deliver different services relevant to health needs of the local people and the tourists. This research aimed to study health care delivery services at SHPHs on the islands in Thailand. Data were collected using questionnaires. The result revealed that in Thailand, there are 58 SHPHs on the islands. During data collection process, the researchers were not allowed to collect data in 5 SHPHs in the southern part due to Covid-19 pandemic. The report is based on 53 SHPHs on the islands. Numbers of health care personnel were 201, 72.14 % were female, with the ages ranged from 22 to 60 years (mean = 35.56 years). About 53% were community health personnel, while 26.08% were professional nurses. In regard to work experiences, the range of year varied from less than 1 year to 30 years, with the mean of 8.36 years. The majority of their responsibilities focused on providing primary medical care (86.34%), caring of people with chronic illnesses (85.30%) and providing medical care procedures for patients with chronic illnesses at home (84.36%). Nurses were main health care personnel in performing primary medical care. Due to difficulty transportation from the islands to the mainland, nurses had to provide prompt emergency medical care while the patients arrived with emergency and critical illnesses such as severe head trauma, stroke or coronary artery disease. Although some medical procedures were complex and not covered by nursing and midwifery license, they decided to protect patients from life- threatening conditions and make them stable before transportation. In SHPHs, the workload exceeded manpower, health care personnel had to work overtime almost every day. In the famous tourist islands, health care personnel had to carry 3-4 folds of their workload during the holidays because of the large crowds of foreign and Thai tourists. It is recommended that SHPHs on the islands should scale up the level of services to cover advanced medical care. Health care personnel, in particular, professional nurses, should be equipped with emergency and critical care skills. The expected outcomes of the services should emphasize on rescuing patients with emergency and life-threatening illnesses and providing comprehensive care for people living on or visiting the islands.

Keywords: distant area, islands, sub district health promoting hospital, heath care services, Thailand

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Authors: Kadhim Alabady

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Background: Autism poses a particularly large public health challenge and an inspiring lifelong challenge for many families; it is a lifelong challenge of a different kind. Purpose: Therefore, it is important to understand what the key challenges are and how to improve the lives of children who are affected with autism in Dubai. Method: In order to carry out this research we have used a qualitative methodology. We performed structured in–depth interviews and focus groups with mental health professionals working at: Al Jalila hospital (AJH), Dubai Autism Centre (DAC), Dubai Rehabilitation Centre for Disabilities, Latifa hospital, Private Sector Healthcare (PSH). In addition to that, we conducted quantitative approach to estimate ASD prevalence or incidence data due to lack of registry. ASD estimates are based on research from national and international documents. This approach was applied to increase the validity of the findings by using a variety of data collection techniques in order to explore issues that might not be highlighted through one method alone. Key findings: Autism is the most common of the Pervasive Developmental Disorders. Dubai Autism Center estimates it affects 1 in 146 births (0.68%). If we apply these estimates to the total number of births in Dubai for 2014, it is predicted there would be approximately 199 children (of which 58 were Nationals and 141 were Non–Nationals) suffering from autism at some stage. 16.4% of children (through their families) seek help for ASD assessment between the age group 6–18+. It is critical to understand and address factors for seeking late–stage diagnosis, as ASD can be diagnosed much earlier and how many of these later presenters are actually diagnosed with ASD. Autism spectrum disorder (ASD) is a public health concern in Dubai. Families do not consult GPs for early diagnosis for a variety of reasons including cultural reasons. Recommendations: Effective school health strategies is needed and implemented by nurses who are qualified and experienced in identifying children with ASD. There is a need for the DAC to identify and develop a closer link with neurologists specializing in Autism, to work alongside and for referrals. Autism can be attributed to many factors, some of those are neurological. Currently, when families need their child to see a neurologist they have to go independently and search through the many that are available in Dubai and who are not necessarily specialists in Autism. Training of GP’s to aid early diagnosis of Autism and increase awareness. Since not all GP’s are trained to make such assessments increasing awareness about where to send families for a complete assessment and the necessary support. There is an urgent need for an adult autism center for when the children leave the safe environment of the school at 18 years. These individuals require a day center or suitable job training/placements where appropriate. There is a need for further studies to cover the needs of people with an Autism Spectrum Disorder (ASD).

Keywords: autism spectrum disorder, autism, pervasive developmental disorders, incidence

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Authors: Liliane Steiner

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Beyond the testimonial act, that sheds light on the feminine experience in the Holocaust, the survivors' writing voices first and foremost the abjection of the feminine self brutally inflicted by the Nazis in the Holocaust, and in the same movement redeems the self by the means of poetics, and brings it to an existential state of being a subject. This study aims to stress the poetics of this writing in order to promote the Holocaust literature from the margins to the mainstream and to contribute to the commemoration of the Holocaust in the next generations. Methodology: The study of the survivors' redeeming of self is based on Julia Kristeva's theory of the abject: the self-throws out everything that threatens its existence and Liliane Steiner's theory of the post- abjection of hell: the belated act of vomiting the abject experiences settles cores with the author of the abject to redeem the self. The research will focus on Ruth Sender's trilogy The Cage, To Life and The Holocaust Lady as a case study. Findings: The binary mode that characterizes this writing reflects the experience of Jewish women, who were subject(s), were treated violently as object(s), debased, defeminized and, eventually turned into abject by the Nazis. In a tour de force, this writing re-enacts the postponed resistance, that vomited the abject imposed on the feminine self by the very act of narration, which denounces the real abject, the perpetrators. The post-abjection of self is acted out in constructs of abject, relating the abject experience of the Holocaust as well as the rehabilitation of the surviving self (subject). The transcription of abject surfaces in deconstructing the abject through self- characterization, and in the elusive rendering of bad memories, having recourse to literary figures. The narrative 'I' selects, obstructs, mends and tells the past events from an active standpoint, as would a subject in control of its (narrative) fate. In a compensatory movement, the narrating I tells itself by reconstructing the subject and proving time and again that I is other. Moreover, in the belated endeavor to revenge, testify and narrate the abject, the narrative I defies itself, and represents itself as a dialectical I, splitting and multiplying itself in a deconstructing way. The dialectical I is never (one) I. It voices not only the unvoiced but also and mainly the other silenced 'I's. Drawing its nature and construct from traumatic memories, the dialectical I transgresses boundaries to narrate her story, and in the same breath, the story of Jewish women doomed to silence. In this narrative feat, the dialectical I stresses its essential dialectical existence with the past, never to be (one) again. Conclusion: The pattern of I is other generates patterns of subject(s) that defy, transgress and repudiate the abject and its repercussions on the feminine I. The feminine I writes itself as a survivor that defies the abject (Nazis) and takes revenge. The paradigm of metamorphosis that accompanies the journey of the Holocaust memoirist engenders life and surviving as well as a narration that defies stagnation and death.

Keywords: abject, feminine writing, holocaust, post-abjection

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Authors: A. Alzahrani, G. Arnold, W. Wang

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Background: Stroke commonly occurs in middle-aged and elderly populations, and the diagnosis of early stroke is still difficult. Patients who have suffered a stroke have different balance and gait patterns from healthy people. Advanced techniques of motion analysis have been routinely used in the clinical assessment of cerebral palsy. However, so far, little research has been done on the direct diagnosis of early stroke patients using motion analysis. Objectives: The aim of this study was to investigate whether patients with stroke have different balance and gait from healthy people and which biomechanical parameters could be used to predict and diagnose potential patients who are at a potential risk to stroke. Methods: Thirteen patients with stroke were recruited as subjects whose gait and balance was analysed. Twenty normal subjects at the matched age participated in this study as a control group. All subjects’ gait and balance were collected using Vicon Nexus® to obtain the gait parameters, kinetic, and kinematic parameters of the hip, knee, and ankle joints in three planes of both limbs. Participants stood on force platforms to perform a single leg balance test. Then, they were asked to walk along a 10 m walkway at their comfortable speed. Participants performed 6 trials of single-leg balance for each side and 10 trials of walking. From the recorded trials, three good ones were analysed using the Vicon Plug-in-Gait model to obtain gait parameters, e.g., walking speed, cadence, stride length, and joint parameters, e.g., joint angle, force, moments, etc. Result: The temporal-spatial variables of Stroke subjects were compared with the healthy subjects; it was found that there was a significant difference (p < 0.05) between the groups. The step length, speed, cadence were lower in stroke subjects as compared to the healthy groups. The stroke patients group showed significantly decreased in gait speed (mean and SD: 0.85 ± 0.33 m/s), cadence ( 96.71 ± 16.14 step/min), and step length (0.509 ± 017 m) in compared to healthy people group whereas the gait speed was 1.2 ± 0.11 m/s, cadence 112 ± 8.33 step/min, and step length 0.648 ± 0.43 m. Moreover, it was observed that patients with stroke have significant differences in the ankle, hip, and knee joints’ kinematics in the sagittal and coronal planes. Also, the result showed that there was a significant difference between groups in the single-leg balance test, e.g., maintaining single-leg stance time in the stroke patients showed shorter duration (5.97 ± 6.36 s) in compared to healthy people group (14.36 ± 10.20 s). Conclusion: Our result showed that there are significantly differences between stroke patients and healthy subjects in the various aspects of gait analysis and balance test, as a consequences of these findings some of the biomechanical parameters such as joints kinematics, gait parameters, and single-leg stance balance test could be used in clinical practice to predict and diagnose potential patients who are at a high risk of further stroke.

Keywords: gait analysis, kinetics, kinematics, single-leg stance, Stroke

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Authors: Elaheh Talebi, Fariba Yavari, Lucy Philip, Lesley Town

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The mining industry generates vast amounts of data, necessitating robust data management systems and advanced analytics tools to achieve better decision-making processes in the development of mining production and maintaining safety. This paper highlights the advantages of Power BI, a powerful intelligence tool, over traditional Excel-based approaches for effectively managing and harnessing mining data. Power BI enables professionals to connect and integrate multiple data sources, ensuring real-time access to up-to-date information. Its interactive visualizations and dashboards offer an intuitive interface for exploring and analyzing geotechnical data. Advanced analytics is a collection of data analysis techniques to improve decision-making. Leveraging some of the most complex techniques in data science, advanced analytics is used to do everything from detecting data errors and ensuring data accuracy to directing the development of future project phases. However, while Power BI is a robust tool, specific visualizations required by geotechnical engineers may have limitations. This paper studies the capability to use Python or R programming within the Power BI dashboard to enable advanced analytics, additional functionalities, and customized visualizations. This dashboard provides comprehensive tools for analyzing and visualizing key geotechnical data metrics, including spatial representation on maps, field and lab test results, and subsurface rock and soil characteristics. Advanced visualizations like borehole logs and Stereonet were implemented using Python programming within the Power BI dashboard, enhancing the understanding and communication of geotechnical information. Moreover, the dashboard's flexibility allows for the incorporation of additional data and visualizations based on the project scope and available data, such as pit design, rock fall analyses, rock mass characterization, and drone data. This further enhances the dashboard's usefulness in future projects, including operation, development, closure, and rehabilitation phases. Additionally, this helps in minimizing the necessity of utilizing multiple software programs in projects. This geotechnical dashboard in Power BI serves as a user-friendly solution for analyzing, visualizing, and communicating both new and historical geotechnical data, aiding in informed decision-making and efficient project management throughout various project stages. Its ability to generate dynamic reports and share them with clients in a collaborative manner further enhances decision-making processes and facilitates effective communication within geotechnical projects in the mining industry.

Keywords: geotechnical data analysis, power BI, visualization, decision-making, mining industry

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Authors: Fiona Jensen, Barb Goodwin, Nancy Kleiman, Rhonda Usunier

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Background: Clinical simulation is now a common component in many health profession curricula in preparation for clinical practice. In the Rady Faculty of Health Sciences (RFHS) college leads in simulation and interprofessional (IP) education, planned an eight hour simulated hospital day shift, where seventy students from six health professions across two campuses, learned with each other in a safe, realistic environment. Learning about interprofessional collaboration, an expected competency for many health professions upon graduation, was a primary focus of the simulation event. Method: Faculty representatives from the Colleges of Nursing, Medicine, Pharmacy and Rehabilitation Sciences (Physical Therapy, Occupation Therapy, Respiratory Therapy) and Pharmacy worked together to plan the IP event in a simulation facility in the College of Nursing. Each college provided a faculty mentor to guide the same profession students. Students were placed in interprofessional teams consisting of a nurse, physician, pharmacist, and then sharing respiratory, occupational, and physical therapists across the team depending on the needs of the patients. Eight patient scenarios were role played by health profession students, who had been provided with their patient’s story shortly before the event. Each team was guided by a facilitator. Results and Outcomes: On the morning of the event, all students gathered in a large group to meet mentors and facilitators and have a brief overview of the six competencies for effective collaboration and the session objectives. The students assuming their same profession roles were provided with their patient’s chart at the beginning of the shift, met with their team, and then completed professional specific assessments. Shortly into the shift, IP team rounds began, facilitated by the team facilitator. During the shift, each patient role-played a spontaneous health incident, which required collaboration between the IP team members for assessment and management. The afternoon concluded with team rounds, a collaborative management plan, and a facilitated de-brief. Conclusions: During the de-brief sessions, students responded to set questions related to the session learning objectives and expressed many positive learning moments. We believe that we have a sustainable simulation IP collaborative learning opportunity, which can be embedded into curricula, and has the capacity to grow to include more health profession faculties and students. Opportunities are being explored in the RFHS at the administrative level, to offer this event more frequently in the academic year to reach more students. In addition, a formally structured event evaluation tool would provide important feedback and inform the qualitative feedback to event organizers and the colleges about the significance of the simulation event to student learning.

Keywords: simulation, collaboration, teams, interprofessional

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Authors: Dina Farran, Mark Ashworth, Fiona Gaughran

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Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, is associated with an increased risk of stroke, contributing to heart failure and death. In this project, we aim to improve patient safety by screening for stroke risk among people with AF and co-morbid mental illness. To do so, we started by conducting a systematic review and meta-analysis on prevalence, management, and outcomes of AF in people with Serious Mental Illness (SMI) versus the general population. We then evaluated oral anticoagulation (OAC) prescription trends in people with AF and co-morbid SMI in King’s College Hospital. We also evaluated the association between mental illness severity and OAC prescription in eligible patients in South London and Maudsley (SLaM) NHS Foundation Trust. Next, we implemented an electronic clinical decision support system (eCDSS) consisting of a visual prompt on patient electronic Personal Health Records to screen for AF-related stroke risk in three Mental Health of Older Adults wards at SLaM. Finally, we assessed the feasibility and acceptability of the eCDSS by qualitatively investigating clinicians’ perspectives of the potential usefulness of the eCDSS (pre-intervention) and their experiences and their views regarding its impact on clinicians and patients (post-intervention). The systematic review showed that people with SMI had low reported rates of AF. AF patients with SMI were less likely to receive OAC than the general population. When receiving warfarin, people with SMI, particularly bipolar disorder, experienced poor anticoagulation control compared to the general population. Meta-analysis showed that SMI was not significantly associated with an increased risk of stroke or major bleeding when adjusting for underlying risk factors. The main findings of the first observational study were that among AF patients having a high stroke risk, those with co-morbid SMI were less likely than non-SMI to be prescribed any OAC, particularly warfarin. After 2019, there was no significant difference between the two groups. In the second observational study, patients with AF and co-morbid SMI were less likely to be prescribed any OAC compared to those with dementia, substance use disorders, or common mental disorders, adjusting for age, sex, stroke, and bleeding risk scores. Among AF patients with co-morbid SMI, warfarin was less likely to be prescribed to those having alcohol or substance dependency, serious self-injury, hallucinations or delusions, and activities of daily living impairment. In the intervention, clinicians were asked to confirm the presence of AF, clinically assess stroke and bleeding risks, record risk scores in clinical notes, and refer patients at high risk of stroke to OAC clinics. Clinicians reported many potential benefits for the eCDSS, including improving clinical effectiveness, better identification of patients at risk, safer and more comprehensive care, consistency in decision making and saving time. Identified potential risks included rigidity in decision-making, overreliance, reduced critical thinking, false positive recommendations, annoyance, and increased workload. This study presents a unique opportunity to quantify AF patients with mental illness who are at high risk of severe outcomes using electronic health records. This has the potential to improve health outcomes and, therefore patients' quality of life.

Keywords: atrial fibrillation, stroke, mental health conditions, electronic clinical decision support systems

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Authors: Elkington S. Mnguni

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Water and sanitation services in South Africa are characterized by both achievements and challenges. After the end of apartheid in 1994 the newly elected government faced the challenge of eradicating backlogs with respect to access to basic services, including water and sanitation. Capital investment made in the development of new water and sanitation infrastructure to provide basic services to previously disadvantaged communities has grown, to a certain extent, at the expense of investment in the operation and maintenance of new and existing infrastructure. Challenges resulting from aging infrastructure and poor plant performance highlight the need for investing in the maintenance, rehabilitation, and replacement of existing infrastructure to optimize the return on investment. Advanced water infrastructure asset management (IAM) is key to achieving adequate levels of service, particularly with regard to reliable and high quality drinking water supply, prevention of urban flooding, efficient use of natural resources and prevention of pollution and associated risks. Against this backdrop, this paper presents an appraisal of water and sanitation IAM systems in South Africa’s three utilities, being metropolitan cities in the Gauteng Province. About a quarter of the national population lives in the three rapidly urbanizing cities of Johannesburg, Ekurhuleni and Tshwane, located in a semi-arid region. A literature review has been done and field visits to some of the utility facilities are being conducted. Semi-structured interviews will be conducted with the three utilities. The following critical factors are being analysed in terms of compliance with the national Water Services IAM Strategy (2011) and other applicable legislation: asset registers; capacity of assets; current and predicted demand; funding availability / budget allocations; plans: operation & maintenance, renewal & replacement, and risk management; no-drop status (non-revenue water levels); blue drop status (water quality); green drop status (effluent quality); and skills availability. Some of the key challenges identified in the literature review include: funding constraints, Skills shortage, and wastewater treatment plants operating beyond their design capacities. These challenges will be verified during field visits and research interviews. Gaps between literature and practice will be identified and relevant recommendations made if necessary. The objective of this study is to contribute to the resolution of the challenges brought about by the backlogs in the operation and maintenance of water and sanitation assets in the country in general, and in the three cities in particular, thus improving the sustainability thereof.

Keywords: asset management, backlogs, levels of service, sustainability, water and sanitation infrastructure

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Authors: Ponchang Apollos Wuyep, Alice Njolke Mafe, Longchi Satkat Zacheaus, Dogun Ojochogu, Dabot Ayuba Yakubu

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Fungi causes huge losses when infections occur both in plants and animals. Synthetic Antifungal drugs are mostly very expensive and highly cytotoxic when taken. This study was aimed at determining the in vitro and in vivo antifungal activities of the leaves and stem extracts of Terminalia mantaly (Umbrella tree)H. Perrier on Aspergillus species in a bid to identify potential sources of cheap starting materials for the synthesis of new drugs to address the growing antimicrobial resistance. T. mantaly leave and stem powdered plant was extracted by fractionation using the method of solvent partition co-efficient in their graded form in the order n-hexane, Ethyl acetate, methanol and distilled water and phytochemical screening of each fraction revealed the presence of alkaloids, saponins, Tannins, flavonoids, carbohydrates, steroids, anthraquinones, cardiac glycosides and terpenoids in varying degrees. The Agar well diffusion technique was used to screen for antifungal activity of the fractions on clinical isolates of Aspergillus species (Aspergillus flavus and Aspergillus fumigatus). Minimum inhibitory concentration (MIC50) of the most active extracts was determined by the broth dilution method. The fractions test indicated a high antifungal activity with zones of inhibition ranging from 6 to 26 mm and 8 to 30mm (leave fractions) and 10mm to 34mm and 14mm to36mm (stem fractions) on A. flavus and A. fumigatus respectively. All the fractions indicated antifungal activity in a dose response relationship at concentrations of 62.5mg/ml, 125mg/ml, 250mg/ml and 500mg/ml. Better antifungal efficacy was shown by the Ethyl acetate, Hexane and Methanol fractions in the in vitro as the most potent fraction with MIC ranging from 62.5 to 125mg/ml. There was no statistically significant difference (P>0.05) in the potency of the Eight fractions from leave and stem (Hexane, Ethyl acetate, methanol and distilled water, antifungal (fluconazole), which served as positive control and 10% DMSO(Dimethyl Sulfoxide)which served as negative control. In the in vivo investigations, the ingestion technique was used for the infectious studies Female Drosophilla melanogaster(UAS-Diptericin)normal flies(positive control),infected and not treated flies (negative control) and infected flies with A. fumigatus and placed on normal diet, diet containing fractions(MSM and HSM each at concentrations of 10mg/ml 20mg/ml, 30mg/ml, 40mg/ml, 50mg/ml, 60mg/ml, 70mg/ml, 80mg/ml, 90mg/ml and 100mg/ml), diet containing control drugs(fluconazole as positive control)and infected flies on normal diet(negative control), the flies were observed for fifteen(15) days. Then the total mortality of flies was recorded each day. The results of the study reveals that the flies were susceptible to infection with A. fumigatus and responded to treatment with more effectiveness at 50mg/ml, 60mg/ml and 70mg/ml for both the Methanol and Hexane stem fractions. Therefore, the Methanol and Hexane stem fractions of T. mantaly contain therapeutically useful compounds, justifying the traditional use of this plant for the treatment of fungal infections.

Keywords: Terminalia mantaly, Aspergillus fumigatus, cytotoxic, Drosophila melanogaster, antifungal

Procedia PDF Downloads 62

Authors: Rozelle Labuschagne, Ronel Roos

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Individuals often experience a reduction in physical function, quality of life and basic activities of daily living after surgery. This is exponentially true for high-risk patients, especially the elderly and frail individuals. Not much is known about the physical function, physical activity preferences and factors associated with the six-minute walk test of elderly individuals who would undergo elective abdominal surgery in South Africa. Such information is important to design effective prehabilitation physiotherapy programs prior to elective surgery. The purpose of the study was to describe the demographic profile and physical function of elderly patients who would undergo elective surgery and to determine factors associated with their six-minute walk test distance findings. A cross-sectional descriptive study in elderly patients older than 60 years of age who would undergo elective abdominal surgery were consecutively sampled at a private hospital in Pretoria, South Africa. Participants’ demographics were collected and physical function assessed with the Functional Comorbidity Index (FCI), DeMorton Mobility Index (DEMMI), Lawton-Brody Instrumental Activities of Daily Living Scale (IADL) and six-minute walk test (6MWT). Descriptive and inferential statistics were used for data analysis with IBM SPSS 25. A p-value ≤ 0.05 were deemed statistically significant. The pilot study consisted of 12 participants (female (n=11, 91.7%), male (n=1, 8.3%) with a mean age of 65.8 (±4.5) years, body mass index of 28 (±4.2) kg.m2 with one (8.3%) participant being a current smoker and four (33.3%) participants having a smoking history. Nine (75%) participants lived independently at home and three (25%) had caregivers. Participants reported walking (n=6, 50%), stretching exercises (n=1, 8.3%), household chores & gardening (n=2, 16.7%), biking/swimming/running (n=1, 8.3%) as physical activity preferences. Physical function findings of the sample were: mean FCI score 3 (±1.1), DEMMI score 81.1 (±14.9), IADL 95 (±17.3), 6MWT 435.50 (IQR 364.75-458.50) with percentage 6MWT distance achieved 81.8% (IQR 64.4%-87.5%). A strong negative correlation was observed between 6MWT distance walked and FCI (r = -0.729, p=0.007). The majority of study participants reported incorporating some form of physical activity into their daily life as form of exercise. Most participants did not achieve their predicted 6MWT distance indicating less than optimal levels of physical function capacity. The number of comorbidities as determined by the FCI was associated with the distance that participants could walk with the 6MWT. The results of this pilot study could be used to indicate which elderly individuals would benefit most from a pre-surgical rehabilitation program. The main goal of such a program would be to improve physical function capacity as measured by the 6MWT. Surgeons could refer patients based on age and number of comorbidities, as determined by the FCI, to potentially improve surgical outcomes.

Keywords: abdominal surgery, elderly, physical function, six-minute walk test

Procedia PDF Downloads 179

Authors: Sima Hajiazizi

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Tehran is a capital of Iran, with the capitals of the world to natural disasters such as earthquake and flood vulnerable has known. City has stated on three faults, Ray, Mosha, and north according to report of JICA in 2000, the most casualties and destruction was the result of active fault Ray. In 2003, the prevention and management of crisis in Tehran to conduct prevention and rehabilitation of the city, under the Ministry has active. Given the breadth and lack of appropriate access in the city, was considered decentralized management for crisis management support, in each region, in order to position the crisis management headquarters at the time of crises and implementation of programs for prevention and education of the citizens and also to position the bases given in some areas of the neighboring provinces at the time of the accident for help and a number of databases to store food and equipment needed at the time of the disaster. In this study, the bases for one, six, nine and eleven regions of Tehran in the field of management and training are evaluated. Selected areas had local accident and experience of practice for disaster management and local training has been experiencing challenges. The research approach was used qualitative research methods underlying Ground theory. At first, the information obtained through the study of documents and Semi-structured interviews by administrators, officials of training and participant observation in the classroom, line by line, and then it was coded in two stages, by comparing and questioning concepts, categories and extract according to the indicators is obtained from literature studies, subjects were been central. Main articles according to the frequency and importance of the phenomenon were called and they were drawn diagram paradigm and at the end with the intersections phenomena and their causes with indicators extracted from the texts, approach each phenomenon and the effectiveness of the bases was measured. There are two phenomenons in management; 1. The inability to manage the vast and complex crisis events and to resolve minor incidents due to the mismatch between managers. 2. Weaknesses in the implementation of preventive measures and preparedness to manage crisis is causal of situations, fields and intervening. There are five phenomenons in the field of education; 1. In the six-region participation and interest is high. 2. In eleven-region training partnerships for crisis management were to low that next by maneuver in schools and local initiatives such as advertising and use of aid groups have increased. 3. In nine-region, contributions to education in the area of crisis management at the beginning were low that initiatives like maneuver in schools and communities to stimulate and increase participation have increased sensitivity. 4. Managers have been disagreement with the same training in all areas. Finally for the issues that are causing the main issues, with the help of concepts extracted from the literature, recommendations are provided.

Keywords: crises management, crisis management support bases, vulnerability, crisis management headquarters, prevention

Procedia PDF Downloads 158

Authors: John Gaber

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Objectives: Complementary and alternative medicine (CAM) is a medicine or health practice that is used alongside conventional practice. Nowadays, CAM is commonly used in North America and other countries, and there is a need for more scientific study to understand its efficacy in different clinical cases. This retrospective study explores the effectiveness and recovery time of CAMs such as cupping, acupuncture, and sotai to treat cases of non-specific low back pain (ANLBP). Methods: We assessed the effectiveness of acupuncture, cupping, and sotai methods on pain and for the treatment of ANLBP. We have compared the magnitude of pain relief using a pain scale assessment method to compare the efficacy of each treatment. The Face Pain Scale assessment was conducted before and 24 hours post-treatment. This retrospective study analyzed 40 patients and categorized them according to the treatment they received. The study included the control group, and the three intervention groups, each with ten patients. Each of the three intervention groups received one of the intervention methods. The first group received the cupping treatment, where cups were placed on the lower back of both sides on points: BL23, BL25, BL26, BL54, BL37, BL40, and BL57. After vacuuming, the cups will stay for 10-15 minutes under infrared light (IR) heating. IR heating is applied by an infrared heat lamp. The second group received the acupuncture treatment, placing needles on points: BL23, BL25, BL26, BL52BL54, GB30, BL37, BL40, BL57, BL59, BL60, and KI3. The needles will be simulated with IR light. The final group received the sotai treatment, a Japanese form of structural realignment that relieves pain, balance, and mobility -moving the body naturally and spontaneously towards a comfortable direction by focusing on the inner feeling and synchronizing with the patient’s breathing. The SPSS statistical software was used to analyze the data using repeated-measures ANOVA. The data collected demonstrates the change in the FPS assessment method value over the course of treatment. p<0.05 was considered statistically significant. Results: In the cupping, acupuncture, and sotai therapy groups, the mean of the FPS value reduced from 8.7±1.2, 8.8±1.2, 9.0±0.8 before the intervention to 3.5±1.4, 4.3±1.4, 3.3±1.3, 24 hours after the intervention, respectively. The data collected shows that the CAM methods included in this study all show improvements in pain relief 24 hours after treatment. Conclusion: Complementary and alternative medicine were developed to treat injuries and illnesses with the whole body in mind, designed to be used in addition to standard treatments. The data above shows that the use of these treatments can have a pain-relieving effect, but more research should be done on the matter, as finding CAM methods that are efficacious is crucial in the landscape of health sciences.

Keywords: acupuncture, cupping, alternative medicine, rehabilitation, acute injury

Procedia PDF Downloads 42

Authors: Vivek Hokam, Vishrut Landge

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An ideal maintenance program for an industrial road network is one that would maintain all sections at a sufficiently high level of functional and structural conditions. However, due to various constraints such as budget, manpower and equipment, it is not possible to carry out maintenance on all the needy industrial road sections within a given planning period. A rational and systematic priority scheme needs to be employed to select and schedule industrial road sections for maintenance. Priority analysis is a multi-criteria process that determines the best ranking list of sections for maintenance based on several factors. In priority setting, difficult decisions are required to be made for selection of sections for maintenance. It is more important to repair a section with poor functional conditions which includes uncomfortable ride etc. or poor structural conditions i.e. sections those are in danger of becoming structurally unsound. It would seem therefore that any rational priority setting approach must consider the relative importance of functional and structural condition of the section. The maintenance priority index and pavement performance models tend to focus mainly on the pavement condition, traffic criteria etc. There is a need to develop the model which is suitably used with respect to limited budget provisions for maintenance of pavement. Linear programming is one of the most popular and widely used quantitative techniques. A linear programming model provides an efficient method for determining an optimal decision chosen from a large number of possible decisions. The optimum decision is one that meets a specified objective of management, subject to various constraints and restrictions. The objective is mainly minimization of maintenance cost of roads in industrial area. In order to determine the objective function for analysis of distress model it is necessary to fix the realistic data into a formulation. Each type of repair is to be quantified in a number of stretches by considering 1000 m as one stretch. A stretch considered under study is having 3750 m length. The quantity has to be put into an objective function for maximizing the number of repairs in a stretch related to quantity. The distress observed in this stretch are potholes, surface cracks, rutting and ravelling. The distress data is measured manually by observing each distress level on a stretch of 1000 m. The maintenance and rehabilitation measured that are followed currently are based on subjective judgments. Hence, there is a need to adopt a scientific approach in order to effectively use the limited resources. It is also necessary to determine the pavement performance and deterioration prediction relationship with more accurate and economic benefits of road networks with respect to vehicle operating cost. The infrastructure of road network should have best results expected from available funds. In this paper objective function for distress model is determined by linear programming and deterioration model considering overloading is discussed.

Keywords: budget, maintenance, deterioration, priority

Procedia PDF Downloads 185

Authors: Wu Liching

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Aim This case aims to discuss the pathogenesis, clinical manifestations and medical treatment of strokes caused by mitochondrial gene mutations. Methods Diagnosis of ischemic stroke caused by mitochondrial gene defect by means of "next-generation sequencing mitochondrial DNA gene variation detection", imaging examination, neurological examination, and medical history; this study took samples from the neurology ward of a medical center in northern Taiwan cases diagnosed with acute cerebral infarction as the research objects. Result This case is a 49-year-old married woman with a rare disease, mitochondrial gene mutation inducing ischemic stroke. She has severe hearing impairment and needs to use hearing aids, and has a history of diabetes. During the patient’s hospitalization, the blood test showed that serum Lactate: 7.72 mmol/L, Lactate (CSF) 5.9 mmol/L. Through the collection of relevant medical history, neurological evaluation showed changes in consciousness and cognition, slow response in language expression, and brain magnetic resonance imaging examination showed subacute bilateral temporal lobe infarction, which was an atypical type of stroke. The lineage DNA gene has m.3243A>G known pathogenic mutation point, and its heteroplasmic level is 24.6%. This pathogenic point is located in MITOMAP and recorded as Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes (MELAS) , Leigh Syndrome and other disease-related pathogenic loci, this mutation is located in ClinVar and recorded as Pathogenic (dbSNP: rs199474657), so it is diagnosed as a case of stroke caused by a rare disease mitochondrial gene mutation. After medical treatment, there was no more seizure during hospitalization. After interventional rehabilitation, the patient's limb weakness, poor language function, and cognitive impairment have all improved significantly. Conclusion Mitochondrial disorders can also be associated with abnormalities in psychological, neurological, cerebral cortical function, and autonomic functions, as well as problems with internal medical diseases. Therefore, the differential diagnoses cover a wide range and are not easy to be diagnosed. After neurological evaluation, medical history collection, imaging and rare disease serological examination, atypical ischemic stroke caused by rare mitochondrial gene mutation was diagnosed. We hope that through this case, the diagnosis of rare disease mitochondrial gene variation leading to cerebral infarction will be more familiar to clinical medical staff, and this case report may help to improve the clinical diagnosis and treatment for patients with similar clinical symptoms in the future.

Keywords: acute stroke, MELAS, lactic acidosis, mitochondrial disorders

Procedia PDF Downloads 53

Authors: Gabriella Zarlenga, Martha L. Hall

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Introduction: Premature infants are at risk for neurodevelopmental deficits and hospital readmissions, which can increase the financial burden on the health care system and families. Kangaroo care (skin-to-skin contact) is a practice that can improve preterm infant health outcomes. Preterm infants can acquire adequate body temperature, heartbeat, and breathing regulation through lying directly on the mother’s abdomen and in between her breasts. Due to some infant’s condition, kangaroo care is not a feasible intervention. The purpose of this proof-of-concept research project is to create a device which simulates skin-to-skin contact for pre-term infants not eligible for kangaroo care, with the aim of promoting baby’s health outcomes, reducing the incidence of serious neonatal and early childhood illnesses, and/or improving cognitive, social and emotional aspects of development. Methods: The study design is a proof-of-concept based on a three-phase approach; (1) observational study and data analysis of the standard of care for 2 groups of pre-term infants, (2) design and concept development of a novel device for pre-term infants not currently eligible for standard kangaroo care, and (3) prototyping, laboratory testing, and evaluation of the novel device in comparison to current assessment parameters of kangaroo care. A single center study will be conducted in an area hospital offering Level III neonatal intensive care. Eligible participants include newborns born premature (28-30 weeks of age) admitted to the NICU. The study design includes 2 groups: a control group receiving standard kangaroo care and an experimental group not eligible for kangaroo care. Based on behavioral analysis of observational video data collected in the NICU, the device will be created to simulate mother’s body using electrical components in a thermoplastic polymer housing covered in silicone. It will be designed with a microprocessor that controls simulated respiration, heartbeat, and body temperature of the 'simulated caregiver' by using a pneumatic lung, vibration sensors (heartbeat), pressure sensors (weight/position), and resistive film to measure temperature. A slight contour of the simulator surface may be integrated to help position the infant correctly. Control and monitoring of the skin-to-skin contact simulator would be performed locally by an integrated touchscreen. The unit would have built-in Wi-Fi connectivity as well as an optional Bluetooth connection in which the respiration and heart rate could be synced with a parent or caregiver. A camera would be integrated, allowing a video stream of the infant in the simulator to be streamed to a monitoring location. Findings: Expected outcomes are stabilization of respiratory and cardiac rates, thermoregulation of those infants not eligible for skin to skin contact with their mothers, and real time mother Bluetooth to the device to mimic the experience in the womb. Results of this study will benefit clinical practice by creating a new standard of care for premature neonates in the NICU that are deprived of skin to skin contact due to various health restrictions.

Keywords: kangaroo care, wearable technology, pre-term infants, medical design

Procedia PDF Downloads 146

Authors: Pedro Llanos, Diego García

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Spaceflight is considered the last frontier in terms of science, technology, and engineering. But it is also the next frontier in terms of human physiology and performance. After more than 200,000 years humans have evolved under earth’s gravity and atmospheric conditions, spaceflight poses environmental stresses for which human physiology is not adapted. Hypoxia, accelerations, and radiation are among such stressors, our research involves suborbital flights aiming to develop effective countermeasures in order to assure sustainable human space presence. The physiologic baseline of spaceflight participants is subject to great variability driven by age, gender, fitness, and metabolic reserve. The objective of the present study is to characterize different physiologic variables in a population of STEM practitioners during an aerobatic flight. Cardiovascular and pulmonary responses were determined in Science Astronaut Candidates (SACs) during unusual attitude aerobatic flight indoctrination. Physiologic data recordings from 20 subjects participating in high-G flight training were analyzed. These recordings were registered by wearable sensor-vest that monitored electrocardiographic tracings (ECGs), signs of dysrhythmias or other electric disturbances during all the flight. The same cardiovascular parameters were also collected approximately 10 min pre-flight, during each high-G/unusual attitude maneuver and 10 min after the flights. The ratio (pre-flight/in-flight/post-flight) of the cardiovascular responses was calculated for comparison of inter-individual differences. The resulting tracings depicting the cardiovascular responses of the subjects were compared against the G-loads (Gs) during the aerobatic flights to analyze cardiovascular variability aspects and fluid/pressure shifts due to the high Gs. In-flight ECG revealed cardiac variability patterns associated with rapid Gs onset in terms of reduced heart rate (HR) and some scattered dysrhythmic patterns (15% premature ventricular contractions-type) that were considered as triggered physiological responses to high-G/unusual attitude training and some were considered as instrument artifact. Variation events were observed in subjects during the +Gz and –Gz maneuvers and these may be due to preload and afterload, sudden shift. Our data reveal that aerobatic flight influenced the breathing rate of the subject, due in part by the various levels of energy expenditure due to the increased use of muscle work during these aerobatic maneuvers. Noteworthy was the high heterogeneity in the different physiological responses among a relatively small group of SACs exposed to similar aerobatic flights with similar Gs exposures. The cardiovascular responses clearly demonstrated that SACs were subjected to significant flight stress. Routine ECG monitoring during high-G/unusual attitude flight training is recommended to capture pathology underlying dangerous dysrhythmias in suborbital flight safety. More research is currently being conducted to further facilitate the development of robust medical screening, medical risk assessment approaches, and suborbital flight training in the context of the evolving commercial human suborbital spaceflight industry. A more mature and integrative medical assessment method is required to understand the physiology state and response variability among highly diverse populations of prospective suborbital flight participants.

Keywords: g force, aerobatic maneuvers, suborbital flight, hypoxia, commercial astronauts

Procedia PDF Downloads 108

Authors: Narottam Puri, Bishnu Panigrahi, Narayan Pendse

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Background: Clinical Outcomes are the globally agreed upon, evidence-based measurable changes in health or quality of life resulting from the patient care. Reporting of outcomes and its continuous monitoring provides an opportunity for both assessing and improving the quality of patient care. In 2012, International Consortium Of HealthCare Outcome Measurement (ICHOM) was founded which has defined global Standard Sets for measuring the outcome of various treatments. Method: Monitoring of Clinical Outcomes was identified as a pillar of Fortis’ core value of Patient Centricity. The project was started as an in-house developed Clinical Outcomes Reporting Portal by the Fortis Medical IT team. Standard sets of Outcome measurement developed by ICHOM were used. A pilot was run at Fortis Escorts Heart Institute from Aug’13 – Dec’13.Starting Jan’14, it was implemented across 11 hospitals of the group. The scope was hospital-wide and major clinical specialties: Cardiac Sciences, Orthopedics & Joint Replacement were covered. The internally developed portal had its limitations of report generation and also capturing of Patient related outcomes was restricted. A year later, the company provisioned for an ICHOM Certified Software product which could provide a platform for data capturing and reporting to ensure compliance with all ICHOM requirements. Post a year of the launch of the software; Fortis Healthcare has become the 1st Healthcare Provider in Asia to publish Clinical Outcomes data for the Coronary Artery Disease Standard Set comprising of Coronary Artery Bypass Graft and Percutaneous Coronary Interventions) in the public domain. (Jan 2016). Results: This project has helped in firmly establishing a culture of monitoring and reporting Clinical Outcomes across Fortis Hospitals. Given the diverse nature of the healthcare delivery model at Fortis Network, which comprises of hospitals of varying size and specialty-mix and practically covering the entire span of the country, standardization of data collection and reporting methodology is a huge achievement in itself. 95% case reporting was achieved with more than 90% data completion at the end of Phase 1 (March 2016). Post implementation the group now has one year of data from its own hospitals. This has helped identify the gaps and plan towards ways to bridge them and also establish internal benchmarks for continual improvement. Besides the value created for the group includes: 1. Entire Fortis community has been sensitized on the importance of Clinical Outcomes monitoring for patient centric care. Initial skepticism and cynicism has been countered by effective stakeholder engagement and automation of processes. 2. Measuring quality is the first step in improving quality. Data analysis has helped compare clinical results with best-in-class hospitals and identify improvement opportunities. 3. Clinical fraternity is extremely pleased to be part of this initiative and has taken ownership of the project. Conclusion: Fortis Healthcare is the pioneer in the monitoring of Clinical Outcomes. Implementation of ICHOM standards has helped Fortis Clinical Excellence Program in improving patient engagement and strengthening its commitment to its core value of Patient Centricity. Validation and certification of the Clinical Outcomes data by an ICHOM Certified Supplier adds confidence to its claim of being leaders in this space.

Keywords: clinical outcomes, healthcare delivery, patient centricity, ICHOM

Procedia PDF Downloads 220

Authors: Cheryl Forchuk, Sandra Fisman, Steve Cordes, Dan Catunto, Katherine Krakowski, Melissa Jeffrey, John D’Oria

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The discharge of youth aged 16-25 from hospital into homelessness is a prevalent issue despite research indicating social, safety, health and economic detriments on both the individual and community. Lack of stable housing for youth discharged into homelessness results in long-term consequences, including exacerbation of health problems and costly health care service use and hospital readmission. People experiencing homelessness are four times more likely to be readmitted within one month of discharge and hospitals must spend $2,559 more per client. Finding safe housing for these individuals is imperative to their recovery and transition back to the community. People discharged from hospital to homelessness experience challenges, including poor health outcomes and increased hospital readmissions. Youth are the fastest-growing subgroup of people experiencing homelessness in Canada. The needs of youth are unique and include supports related to education, employment opportunities, and age-related service barriers. This study aims to identify the needs of youth at risk of homelessness by evaluating the efficacy of the “Preventing Discharge to No Fixed Address – Youth” (NFA-Y) program, which aims to prevent youth from being discharged from hospital into homelessness. The program connects youth aged 16-25 who are inpatients at London Health Sciences Centre and St. Joseph’s Health Care London to housing and financial support. Supports are offered through collaboration with community partners: Youth Opportunities Unlimited, Canadian Mental Health Association Elgin Middlesex, City of London Coordinated Access, Ontario Works, and Salvation Army’s Housing Stability Bank. This study was reviewed and approved by Western University’s Research Ethics Board. A series of interviews are being conducted with approximately ninety-three youth participants at three time points: baseline (pre-discharge), six, and twelve months post-discharge. Focus groups with participants, health care providers, and community partners are being conducted at three-time points. In addition, administrative data from service providers will be collected and analyzed. Since homelessness has a detrimental effect on recovery, client and community safety, and healthcare expenditure, locating safe housing for psychiatric patients has had a positive impact on treatment, rehabilitation, and the system as a whole. If successful, the findings of this project will offer safe policy alternatives for the prevention of homelessness for at-risk youth, help set them up for success in their future years, and mitigate the rise of the homeless youth population in Canada.

Keywords: youth homelessness, no-fixed address, mental health, homelessness prevention, hospital discharge

Procedia PDF Downloads 87

Authors: Guntur Bagus Pamungkas

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As part of a tropical country that is normally rich in forest land areas, Indonesia has always been in the world's spotlight due to its significantly increasing process of deforestation. In one hand, it is related to the mainstay for maintaining the sustainability of the earth's ecosystem functions. On the other hand, they also cover the various potential sources of the global economy. Therefore, it can always be the target of different scale of investors to excessively exploit them. No wonder the emergence of disasters in various characteristics always comes up. In fact, the deforestation phenomenon does not only occur in various forest land areas in the main islands of Indonesia but also includes Java Island, the most densely populated areas in the world. This island only remains the forest land of about 9.8% of the total forest land in Indonesia due to its long history of it, especially in Central Java Province, the most densely populated area in Java. Again, not surprisingly, this province belongs to the area with the highest frequency of disasters because of it, landslides in particular. One of the areas that often experience it is Banjarnegara District, especially in mountainous areas that lies in the range from 1000 to 3000 meters above sea level, where the remains of land forest area can easyly still be found. Even among them still leaves less untouchable tropical rain forest whose area also covers part of a neighboring district, Pekalongan, which is considered to be the rest of the world's little paradise on Earth. The district's landscape is indeed beautiful, especially in the Dieng area, a major tourist destination in Central Java Province after Borobudur Temple. However, annually hazardous always threatens this district due to this landslide disaster. Even, there was a tragic event that was buried with its inhabitants a few decades ago. This research aims to find part of the concept of effective forest management through monitoring the presence of remaining forest areas in this area. The research implemented monitoring of deforestation rates using the Stochastic Cellular Automata-Markov Chain (SCA-MC) method, which serves to provide a spatial simulation of land use and cover changes (LULCC). This geospatial process uses the Landsat-8 OLI image product with Thermal Infra-Red Sensors (TIRS) Band 10 in 2020 and Landsat 5 TM with TIRS Band 6 in 2010. Then it is also integrated with physical and social geography issues using the QGIS 2.18.11 application with the Mollusce Plugin, which serves to clarify and calculate the area of land use and cover, especially in forest areas—using the LULCC method, which calculates the rate of forest area reduction in 2010-2020 in Banjarnegara District. Since the dependence of this area on the use of forest land is quite high, concepts and preventive actions are needed, such as rehabilitation and reforestation of critical lands through providing proper monitoring and targeted forest management to restore its ecosystem in the future.

Keywords: deforestation, populous area, LULCC method, proper control and effective forest management

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Authors: Jesús Horacio, Alfredo Ollero, Víctor Bouzas-Blanco, Augusto Pérez-Alberti

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Rivers have traditionally been classified, assessed and managed in terms of hydrological, chemical and / or biological criteria. Geomorphological classifications had in the past a secondary role, although proposals like River Styles Framework, Catchment Baseline Survey or Stroud Rural Sustainable Drainage Project did incorporate geomorphology for management decision-making. In recent years many studies have been attracted to the geomorphological component. The geomorphological processes and their associated forms determine the structure of a river system. Understanding these processes and forms is a critical component of the sustainable rehabilitation of aquatic ecosystems. The fluvial auto-classification approach suggests that a river is a self-built natural system, with processes and forms designed to effectively preserve their ecological function (hydrologic, sedimentological and biological regime). Fluvial systems are formed by a wide range of elements with multiple non-linear interactions on different spatial and temporal scales. Besides, the fluvial auto-classification concept is built using data from the river itself, so that each classification developed is peculiar to the river studied. The variables used in the classification are specific stream power and mean grain size. A discriminant analysis showed that these variables are the best characterized processes and forms. The statistical technique applied allows to get an individual discriminant equation for each geomorphological type. The geomorphological classification was developed using sites with high naturalness. Each site is a control point of high ecological and geomorphological quality. The changes in the conditions of the control points will be quickly recognizable, and easy to apply a right management measures to recover the geomorphological type. The study focused on Galicia (NW Spain) and the mapping was made analyzing 122 control points (sites) distributed over eight river basins. In sum, this study provides a method for fluvial geomorphological classification that works as an open and flexible tool underlying the fluvial auto-classification concept. The hydrographic mapping is the visual expression of the results, such that each river has a particular map according to its geomorphological characteristics. Each geomorphological type is represented by a particular type of hydraulic geometry (channel width, width-depth ratio, hydraulic radius, etc.). An alteration of this geometry is indicative of a geomorphological disturbance (whether natural or anthropogenic). Hydrographic mapping is also dynamic because its meaning changes if there is a modification in the specific stream power and/or the mean grain size, that is, in the value of their equations. The researcher has to check annually some of the control points. This procedure allows to monitor the geomorphology quality of the rivers and to see if there are any alterations. The maps are useful to researchers and managers, especially for conservation work and river restoration.

Keywords: fluvial auto-classification concept, mapping, geomorphology, river

Procedia PDF Downloads 354

Authors: Geum Yeon Sim, Jasal Patel, Anand Kumthekar, Stanley Wainapel

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A 65-year-old right-hand dominant African-American man, formerly employed as a security guard, was referred to Rehabilitation Medicine with bilateral hand stiffness and weakness. His past medical history was only significant for myelofibrosis, diagnosed 4 years earlier, for which he was receiving scheduled blood transfusions. Approximately 2 years ago, he began to notice stiffness and swelling in his non-dominant hand that progressed to pain and decreased strength, limiting his hand function. Similar but milder symptoms developed in his right hand several months later. There was no history of prior injury or exposure to cold. Physical examination showed enlargement of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints with finger flexion contractures, Swan-neck and Boutonniere deformities, and associated joint tenderness. Changes were more prominent in the left hand. X-rays showed mild osteoarthritis of several bilateral PIP joints. Anti-nuclear antibodies, rheumatoid factor, and cyclic citrullinated peptide antibodies were negative. MRI of the hand showed no erosions or synovitis. A rheumatology consultation was obtained, and the cause of his symptoms was attributed to myelofibrosis-related arthropathy with secondary osteoarthritis. The patient was tried on diclofenac cream and received a few courses of Occupational Therapy with limited functional improvement. Primary myelofibrosis (PMF) is a rare myeloproliferative neoplasm characterized by clonal proliferation of myeloid cells with variable morphologic maturity and hematopoietic efficiency. Rheumatic manifestations of malignancies include direct invasion, paraneoplastic presentations, secondary gout, or hypertrophic osteoarthropathy. PMF causes gradual bone marrow fibrosis with extramedullary metaplastic hematopoiesis in the liver, spleen, or lymph nodes. Musculoskeletal symptoms are not common and are not well described in the literature. The first reported case of myelofibrosis related arthritis was seronegative arthritis due to synovial invasion of myeloproliferative elements. Myelofibrosis has been associated with autoimmune diseases such as systemic lupus erythematosus, progressive systemic sclerosis, and rheumatoid arthritis. Gout has been reported in patients with myelofibrosis, and the underlying mechanism is thought to be related to the high turnover of nucleic acids that is greatly augmented in this disease. X-ray findings in these patients usually include erosive arthritis with synovitis. Treatment of underlying PMF is the treatment of choice, along with anti-inflammatory medications. Physicians should be cognizant of recognizing this rare entity in patients with PMF while maintaining clinical suspicion for more common causes of joint deformities, such as rheumatic diseases.

Keywords: myelofibrosis, arthritis, arthralgia, malignancy

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Authors: Ayoola Adekunle Dada, Tolulope Omolola Fateropa

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There is no gain saying the fact that the Nigerian correctional services lack rehabilitation reformation. Owing to this, some so many inmates, including the female, become more emotionally bruised and hardened instead of coming out of the prison reformed. Although female inmates constitute only a small percentage worldwide, the challenges resulting from women falling under the provision of the penal system have prompted ficial and humanitarian bodies to consider female inmateas as vulnerable persons who need particular social work measures that meet their specific needs. Female inmates’condition may become worseinprisondue to the absence of the standard living condition. A survey of 100 female inmates will be used to determine the assessment of the living condition of the female inmates within the contexts in which they occur. Employing field methods from Medical Sociology and Law, the study seeks to make use of the collaboration of both disciplines for a comprehensive understanding of the scenario. Its specific objectives encompassed: (1) To examine access and use of health facilities among the female inmates;(2) To examine the effect of officers/warders attitude towards female inmates;(3)To investigate the perception of the female inmates towards the housing facilities in the centre and; (4) To investigate the feeding habit of the female inmates. Due to the exploratory nature of the study, the researchers will make use of mixed-method, such qualitative methods as interviews will be undertaken to complement survey research (quantitative). By adopting the above-explained inter-method triangulation, the study will not only ensure that the advantages of both methods are exploited but will also fulfil the basic purposes of research. The sampling for this study will be purposive. The study aims at sampling two correctional centres (Ado Ekiti and Akure) in order to generate representative data for the female inmates in South West Nigeria. In all, the total number of respondents will be 100. A cross-section of female inmates will be selected as respondents using a multi-stage sampling technique. 100 questionnaires will be administered. A semi structured (in-depth) interviews will be conducted among workers in the two selected correctional centres, respectively, to gain further insight on the living conditions of female inmates, which the survey may not readily elicit. These participants will be selected purposively in respect to their status in the organisation. Ethical issues in research on human subjects will be given due consideration. Such issues rest on principles of beneficence, non-maleficence, autonomy/justice and confidentiality. In the final analysis, qualitative data will be analyzed using manual content analysis. Both the descriptive and inferential statistics will be used for analytical purposes. Frequency, simple percentage, pie chart, bar chart, curve and cross-tabulations will form part of the descriptive analysis.

Keywords: assessment, health facilities, inmates, perception, living conditions

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Authors: Michael Josef Schwerer

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Background: Analyzing any aircraft accident is mandatory based on the regulations of the International Civil Aviation Organization and the respective country’s criminal prosecution authorities. Legal medicine investigations are unavoidable when fatalities involve the flight crew or when doubts arise concerning the pilot’s aeromedical health status before the event. As a result of frequently tremendous blunt and sharp force trauma along with the impact of the aircraft to the ground, consecutive blast or fire exposition of the occupants or putrefaction of the dead bodies in cases of delayed recovery, relevant findings can be masked or destroyed and therefor being inaccessible in standard pathology practice comprising just forensic autopsy and histopathology. Such cases are of considerable risk of remaining unsolved without legal consequences for those responsible. Further, no lessons can be drawn from these scenarios to improve flight safety and prevent future mishaps. Aims and Methods: To learn from previously unsolved aircraft accidents, re-evaluations of the investigation files and modern molecular pathology studies were performed. Genetic testing involved predominantly PCR-based analysis of gene regulation, studying DNA promotor methylations, RNA transcription and posttranscriptional regulation. In addition, the presence or absence of infective agents, particularly DNA- and RNA-viruses, was studied. Technical adjustments of molecular genetic procedures when working with archived sample material were necessary. Standards for the proper interpretation of the respective findings had to be settled. Results and Discussion: Additional molecular genetic testing significantly contributes to the quality of forensic pathology assessment in aviation mishaps. Previously undetected cardiotropic viruses potentially explain e.g., a pilot’s sudden incapacitation resulting from cardiac failure or myocardial arrhythmia. In contrast, negative results for infective agents participate in ruling out concerns about an accident pilot’s fitness to fly and the aeromedical examiner’s precedent decision to issue him or her an aeromedical certificate. Care must be taken in the interpretation of genetic testing for pre-existing diseases such as hypertrophic cardiomyopathy or ischemic heart disease. Molecular markers such as mRNAs or miRNAs, which can establish these diagnoses in clinical patients, might be misleading in-flight crew members because of adaptive changes in their tissues resulting from repeated mild hypoxia during flight, for instance. Military pilots especially demonstrate significant physiological adjustments to their somatic burdens in flight, such as cardiocirculatory stress and air combat maneuvers. Their non-pathogenic alterations in gene regulation and expression will likely be misinterpreted for genuine disease by inexperienced investigators. Conclusions: The growing influence of molecular pathology on legal medicine practice has found its way into aircraft accident investigation. As appropriate quality standards for laboratory work and data interpretation are provided, forensic genetic testing supports the medico-legal analysis of aviation mishaps and potentially reduces the number of unsolved events in the future.

Keywords: aviation medicine, aircraft accident investigation, forensic pathology, molecular pathology

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Authors: Ali Baker, Russel Krawitz

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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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Authors: Catharina Dwi Astuti Depari, Gregorius Agung Setyonugroho

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In concern for human safety, living in disaster-prone areas is twofold: it is profoundly cataclysmic yet perceptibly contributive. This paradox could be identified in Kalitengah Lor Sub-village community who inhabit Mount Merapi’s most hazardous area, putting them to the highest exposure to eruptions’ cataclysmic impacts. After the devastating incident in 2010, through the Action Plan for Rehabilitation and Reconstruction, the National Government with immediate aid from humanitarian agencies initiated a relocation program by establishing nearly 2,613 temporary shelters throughout the mountain’s region. The problem arose as some of the most affected communities including those in Kalitengah Lor Sub-village, persistently refused to relocate. The obnoxious experience of those living in temporary shelters resulted from the program’s failure to support a long-term living was assumed to instigate the rejection. From the psychological standpoint, this phenomenon reflects the emotional bond between the affected communities with their former dwellings. Regarding this, the paper aims to reveal the factors influencing the emotional attachment of Kalitengah Lor community to their former dwellings including the dwellings’ spatial design transformation prior and post the eruption in 2010. The research adopted Likert five scale-questionnaire comprising a wide range of responses from strongly agree to strongly disagree. The responses were then statistically measured, leading to consensus that provides bases for further interpretations toward the local’s characteristics. Using purposive unit sampling technique, 50 respondents from 217 local households were randomly selected. Questions in the questionnaire were developed with concerns on the aspects of place attachment concept: affection, cognitive, behavior, and perception. Combined with quantitative method, the research adopted diachronic method which was aimed to analyze the spatial design transformation of each dwelling in relation to the inhabitant’s daily activities and personal preferences. The research found that access to natural resources like sand mining, agricultural farms and wood forests, social relationship and physical proximity from house to personal asset like cattle shed, are the dominant factors encouraging the locals to emotionally attached to their former dwellings. Consequently, each dwelling’s spatial design is suffered from changes in which the current house is typically larger in dimension and the bathroom is replaced by public toilet located outside the house’s backyard. Relatively unchanged, the cattle shed is still located in front of the house, the continuous visual relationship, particularly between the living and family room, is maintained, as well as the main orientation of the house towards the local street.

Keywords: diachronic method, former dwellings, local’s characteristics, place attachment, spatial design transformation

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