Search results for: hospital acquired bloodstream infections
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3816

Search results for: hospital acquired bloodstream infections

2616 The Effect of Antibiotic Use on Blood Cultures: Implications for Future Policy

Authors: Avirup Chowdhury, Angus K. McFadyen, Linsey Batchelor

Abstract:

Blood cultures (BCs) are an important aspect of management of the septic patient, identifying the underlying pathogen and its antibiotic sensitivities. However, while the current literature outlines indications for initial BCs to be taken, there is little guidance for repeat sampling in the following 5-day period and little information on how antibiotic use can affect the usefulness of this investigation. A retrospective cohort study was conducted using inpatients who had undergone 2 or more BCs within 5 days between April 2016 and April 2017 at a 400-bed hospital in the west of Scotland and received antibiotic therapy between the first and second BCs. The data for BC sampling was collected from the electronic microbiology database, and cross-referenced with data from the hospital electronic prescribing system. Overall, 283 BCs were included in the study, taken from 92 patients (mean 3.08 cultures per patient, range 2-10). All 92 patients had initial BCs, of which 83 were positive (90%). 65 had a further sample within 24 hours of commencement of antibiotics, with 35 positive (54%). 23 had samples within 24-48 hours, with 4 (17%) positive; 12 patients had sampling at 48-72 hours, 12 at 72-96 hours, and 10 at 96-120 hours, with none positive. McNemar’s Exact Test was used to calculate statistical significance for patients who received blood cultures in multiple time blocks (Initial, < 24h, 24-120h, > 120h). For initial vs. < 24h-post BCs (53 patients tested), the proportion of positives fell from 46/53 to 29/53 (one-tailed P=0.002, OR 3.43, 95% CI 1.48-7.96). For initial vs 24-120h (n=42), the proportions were 38/42 and 4/42 respectively (P < 0.001, OR 35.0, 95% CI 4.79-255.48). For initial vs > 120h (n=36), these were 33/36 and 2/36 (P < 0.001,OR ∞). These were also calculated for a positive in initial or < 24h vs. 24-120h (n=42), with proportions of 41/42 and 4/42 (P < 0.001, OR 38.0, 95% CI 5.22-276.78); and for initial or < 24h vs > 120h (n=36), with proportions of 35/36 and 2/36 respectively (P < 0.001, OR ∞). This data appears to show that taking an initial BC followed by a BC within 24 hours of antibiotic commencement would maximise blood culture yield while minimising the risk of false negative results. This could potentially remove the need for as many as 46% of BC samples without adversely affecting patient care. BC yield decreases sharply after 48 hours of antibiotic use, and may not provide any clinically useful information after this time. Further multi-centre studies would validate these findings, and provide a foundation for future health policy generation.

Keywords: antibiotics, blood culture, efficacy, inpatient

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2615 Analyzing Doctors’ Knowledge of the United Kingdom Chief Medical Officer's Guidelines for Physical Activity: Survey of Secondary Care Doctors in a District General Hospital

Authors: Alexandra Von Guionneau, William Sloper, Charlotte Burford

Abstract:

The benefits of exercise for the prevention and management of chronic disease are well established and the importance of primary care practitioners in promoting exercise is becoming increasingly recognized. However, those with severe manifestations of the chronic disease are managed in a secondary care setting. Secondary care practitioners, therefore, have a role to play in promoting physical activity. Methods: In order to assess secondary care doctors’ knowledge of the Chief Medical Officer’s guidelines for physical activity, a 12-question survey was administered to staff working in a district general hospital in South England during team and unit meetings. Questions related to knowledge of the current guidelines for both 19 - 64 year olds and older adults (65 years and above), barriers to exercise discussion or prescription and doctors’ own exercise habits. Responses were collected anonymously and analyzed using SPSS Version 24.0. Results: 96 responses were collected. Doctors taking part in the survey ranged from foundation years (26%) to consultants (40%). 17.7% of participants knew the guidelines for moderate intensity activity for 19 - 64 year olds. Only one participant knew all of the guidance for both 19 - 64 year olds and older adults. While 71.6% of doctors felt they were adequately informed about how to exercise, only 45.6% met the minimum recommended guidance for moderate intensity activity. Conclusion: More work is needed to promote the physical activity guidelines and exercise prescription to doctors working within a secondary care setting. In addition, doctors require more support to personally meet the recommended minimum level of physical activity.

Keywords: exercise is medicine, exercise prescription, physical activity guidelines, exercise habits

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2614 Implementation of an Induction Programme to Help the International Medical Graduates in the NHS

Authors: Mohammad K. Rumjaun, Sana Amjed, Muhammad A. Ghazi, Safa G. Attar, Jason Raw

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Background: National Health Service (NHS) in England is one of the leading healthcare systems in the world and it heavily relies on the recruitment of overseas doctors. 30.7% of the doctors currently serving in NHS are overseas doctors. Most of these doctors do not receive the essential induction required to work in the NHS when they first arrive and therefore, they mostly struggle to work effectively in the first few months of their new jobs as compared to UK graduates. In our hospital, the clinical need for a dedicated induction programme for the International Medical Graduates (IMGs) was identified for their initial settling period and this programme was designed to achieve this. Methods: A questionnaire was designed for the previous 7 IMGs (Group 1) in order to identify the difficulties they faced in their initial phase. Thereafter, an induction programme consisting of presentations explaining the NHS and hospital framework, communication skills practice sessions, the clinical ceiling of care and patient simulation training was implemented for 6 new IMGs (Group 2). Another survey was done and compared with the previous. Results: After this programme, group 2 required only 1 week to understand the complexity of the IT systems as compared 3 weeks in group 1. 83% of group 2 was well-supported for their on-call duties after this programme as compared to 29% and 100% of group 2 was aware of their role in the job after the induction as compared to 0%. Furthermore, group 2 was able to function independently and confidently in their roles after only 1 month as compared to an average of 3 months for group 1. After running the PDSA cycles, our results show clear evidence that this programme has tremendously benefitted the IMGs in settling in the NHS. The IMGs really appreciated this initiative and have given positive feedback. Conclusion: Leaving your home country to begin your career in a different country is not an easy transition and undoubtedly, everyone struggles. It is important to invest in a well-structured induction programme for the IMGs in the initial phase of their jobs as this will improve not only their confidence and efficacy but also patients’ safety.

Keywords: induction programme, international medical graduates, NHS, overseas doctors struggles.

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2613 Risk Factors Associated with Ectoprotozoa Infestation of Wild and Farmed Cyprinids

Authors: M. A. Peribanez, G. Illan, I. De Blas, A. Muniesa, I. Ruiz-Zarzuela

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Intensive aquaculture is commonly associated with increased incidence of parasites. However, in Spain, the recent intensification of cyprinid production has not led to knowledge of the parasites that develop in the aquaculture facilities, the factors that affect their development and spread and the transmission between wild and cultivated fish species. The present study focuses on the knowledge of environmental factors, as well as host dependent factors, and their possible influence as risk factors in the incidence and intensity of parasitic infections. This work was conducted in the Duero River Basin, NW Spain. A total of 114 tenches (Tinca tinca) were caught in a fish farm and 667 specimens belonging to six species of cyprinid, not tench, in five rivers. An exhaustive search and microscopic identification of protozoa on skin and gills were carried out. Physical, chemical, and biological parameters of water samples from the capture points were determined. Only two ectoprotozoa were identified, Ichthyophthirius multifiliis and Tripartiella sp. In I. multifiliis, a high intensity of infection (more than 40 parasites on the body surface and more than 80 on gills) was determined in farmed tench (14%) and in Iberian barbel (Luciobarbus bocagei) (91%) and Duero nase (Pseudochondrostoma duriense) (71%) of middle stretches of rivers. The prevalence was similar between farmed tenches and cyprinids of middle courses. Tripartiella sp. was only found in barbels (prevalence in middle stretches, 0.7%) and in farmed tenches (63%), this species resulting in a high risk factor (odds ratio, OR= 1143) in the presence of the ciliate. There were no differences between the two species relative to the intensity of parasitization. Some of the physical, chemical and microbiological water quality parameters appear to be risk factors in the presence of I. multifiliis, with maximum OR of 8. Nevertheless, in Tripartiella sp., the risk is multiplied by 720 when the pH value exceeds 8.4, if we consider the total of the data, and it is increased more than 500 times if we only consider the values recorded in the fish farm (529 by nitrates > 3 mg/l; 530 by total coliforms > 100 CFU/100 ml). However, the high prevalence and risk of infection by I. multifiliis and Tripartiella sp. in fish farms should be related to environmental factors that dependent upon sampling point rather than in direct influence of the physical-chemical and biological parameters of the water. The high pH value recorded in the fish farm (9.62 ± 0.76) is the only parameter that we consider may have a substantial direct influence. Chronic exposure to alkaline pH levels can be a chronic stress generator, predisposing to parasitization by Tripartiella sp. In conclusion, often minor changes in ecosystem conditions, both natural and man-made, can modify the host-parasite relationship, resulting in an increase in the prevalence and intensity of parasitic infections in populations of cyprinids, sometimes causing disease outbreaks.

Keywords: cyprinids, fish, parasites, protozoa, risk factors

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2612 Outcomes of Using Guidelines for Caring and Referring ST Elevation Myocardial Infarction (STEMI) Patients at the Accident and Emergency Department of Songkhla Hospital, Thailand

Authors: Thanom Kaeniam

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ST-Elevation Myocardial Infarction (STEMI) is a state of sudden death of the heart muscle due to sudden blockage of the artery. STEMI patients are usually in critical condition and with a potential opportunity for sudden death. Therefore, management guidelines for safety in caring and referring STEMI patients are needed. The objective of this developmental research was to assess the effectiveness of using the guidelines for caring and referring STEMI patients at the Accident and Emergency Department of Songkhla Hospital. The subjects of the study were 22 nurses in the emergency room, and doctors on duty in the accident and emergency room selected using purposive sampling with inclusion criteria. The research instruments were the guidelines for caring and referring STEMI patients, and record forms for the effectiveness of using the guidelines for caring and referring STEMI patients (a general record form for STEMI patients, a record form for SK administering, a referring record form for PCI, and a record form for dead patient in the accident and emergency room and during referring). The instruments were tested for content validity by three experts, and the reliability was tested using Kuder-Richardson 20 (KR20). The descriptive statistic employed was the percentage. The outcomes of using the guidelines for caring and referring ST Elevation Myocardial Infarction (STEMI) Patients at the Accident and Emergency Department revealed that before using the guidelines in 2009, 2010, and 2011, there were 84, 73, and 138 STEMI patients receiving services at the accident and emergency room, of which, only 9, 32, and 48 patients were referred for PCI/SK medications, or 10.74; 43.84; and 34.78 percent, and the death rates were 10.71; 10.95; and 11.59 percent, respectively. However, after the use of the guidelines in 2012, 2013, and 2014, there were 97, 77, and 57 patients, of which, the increases to 77, 72, and 55 patients were referred for PCI /SK medications or 79.37; 93.51; and 96.49 percent, and the death rates were reduced to 10.30; 6.49; and 1.76 percent, respectively. The results of the study revealed that the use of the guidelines for caring and referring STEMI patients at the Accident and Emergency Department increased the effectiveness and quality of nursing, especially in terms of SK medication, caring and referring patients for PCI to reduce the death rate.

Keywords: outcomes, guidelines for caring, referring, myocardial infarction, STEMI

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2611 Study on the Knowledge, Attitude and Practice (KAP) of Patients with Hypertension in Aseer Hospital, Asir Region, Saudi Arabia

Authors: Ayesha Siddiqua

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Background: Hypertension is a silent killer disease and a common risk factor for considerable morbidity and mortality. Its effects can be seen on the organs like Heart; Brain; Kidneys. In Saudi Arabia, hypertension affects a sizeable enough proportion of the population, with a prevalence of 27.9% in urban and 22.4 in rural population. Despite these features, the magnitude and epidemiological characteristics of this disease have been rarely studied in Saudi Arabia. To fill this gap, we conducted a survey in Abha to study the KAP of hypertension. KAP study shows what people know about certain things, their feelings and behavior towards the disease management. An improvement in the Knowledge and Attitudes towards disease management can reform the kinds of practices which are followed. Objectives: To assess the level of Knowledge, Attitude and Practice of patients who suffer from Hypertension. To improve the Quality of life of patients. Methods: A prospective cross-sectional survey was conducted on a sample size of 130 Hypertensive patients of both the genders enrolled by simple random sampling technique admitted in the Aseer Central Hospital of Abha during the period from October 2016 to December 2016. Results: Altogether 130 hypertensive patients were enrolled in this study with equal no. of Males and Females. Most of the respondents were aged between 18-40 years (45%). On assessing the KAP of the patients, we found that the Knowledge and Attitude score was good but the Practice scores were moderate in both the genders. Conclusion: Our study concludes that a significant proportion of hypertensive patients show less Practice towards the disease management which can lead to severe complications in time being and also result in damage of other vital organs. So there is a need of intense educational intervention for the patients which can be done by Patient counselling by the clinical pharmacist. Strategies to modify lifestyle which help in control of hypertension can include providing leaflets as well as direct educational programs.

Keywords: Attitude, hypertension, Knowledge, practices

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2610 Nano Gold and Silver for Control of Mosquitoes Manipulating Nanogeometries

Authors: Soam Prakash, Namita Soni

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The synthesis of metallic nanoparticles is an active area of academic and more significantly, applied research in nanotechnology. Currently, nanoparticle research is an area of intense scientific interest. Silver (Ag) and Gold (Au) nanoparticles (NPs) have been the focus of fungi and plant based syntheses. Silver and gold nanoparticles are nanoparticles of silver and gold. These particles are of between 1 nm and 100 nm in size. Silver and gold have been use in the wide variety of potential applications in biomedical, optical, electronic field, treatment of burns, wounds, and several bacterial infections. There is a crucial need to produce new insecticides due to resistance and high-cost of organic insecticides which are more environmentally-friendly, safe, and target-specific. Synthesizing nanoparticles using plants and microorganisms can eliminate this problem by making the nanoparticles more biocompatible. Here we reviewed the mosquitocidal and antimicrobials activity of silver and gold nanoparticles using fungi, plants as well as bacteria.

Keywords: nano gold, nano silver, Malaria, Chikengunia, dengue control

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2609 Correlation of Hematological Indices with Fasting Blood Glucose Level and Anthropometric Measurements in Geriatric Diabetes Mellitus Subjects in Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

Authors: Dada. O.Akinola, Uche. I. Ebele, Bamiro .A.Rafatu, Akinbami A. Akinsegun, Dada O. Adeyemi, Adeyemi. O. Ibukun, Okunowo O.Bolanle, Abdulateef O. Kareem, Ibrahim.N. Ismaila, Dosu Rihanat

Abstract:

Background: Hyperglycaemia alters qualitatively and quantitatively all the full blood count parameters. The alterations among other factors are responsible for the macrovascular and microvascular complications associated with diabetes mellitus (DM). This study is aimed at correlating haematological parameters in DM subjects with their fasting blood glucose (FBG) and anthropometric parameters. Materials and Methods: This was a cross-sectional study of participants attending DM clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja. The study recruited one hundred and two (102) DM subjects and one hundred (100) non-DM controls. Venous blood samples were collected for full blood count (FBC) assay while FBG was done, structured questionnaires were administered, and anthropometric measurements of all participants were done. Data were analyzed with Statistical Package for Social Science (SPSS) version 23. P was set at ≤0.05. Results: The mean age of DM patients was 64.32± 11.31 years. Using a haemoglobin concentration cut-off of 11g/dl, 39.2%, and 13% DM and control participants respectively had values lower than 11g/dl. A total of 22.5% and 3% of DM and controls respectively gave a history of previous blood transfusion.White blood cells count and platelet count means were (6.12±1.60 and 5.30±7.52,p=0.59) and (213.31±73.58 and 228.91±73.21,p = 0.26) *109/L in DM subjects and controls respectively. FBG and all the anthropometric data in DM subjects were significantly higher than in controls. Conclusions: The prevalence of anaemia in DM subjects was three times higher than in controls. The white blood cell count was higher but not statistically significant in DM compared with controls. But platelet count was higher but not statistically significant in controls compared with DM subjects.

Keywords: haematological profile, diabetes mellitus, anthropometric data, fasting blood glucose

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2608 Prophylactic Replacement of Voice Prosthesis: A Study to Predict Prosthesis Lifetime

Authors: Anne Heirman, Vincent van der Noort, Rob van Son, Marije Petersen, Lisette van der Molen, Gyorgy Halmos, Richard Dirven, Michiel van den Brekel

Abstract:

Objective: Voice prosthesis leakage significantly impacts laryngectomies patients' quality of life, causing insecurity and frequent unplanned hospital visits and costs. In this study, the concept of prophylactic voice prosthesis replacement was explored to prevent leakages. Study Design: A retrospective cohort study. Setting: Tertiary hospital. Methods: Device lifetimes and voice prosthesis replacements of a retrospective cohort, including all patients with laryngectomies between 2000 and 2012 in the Netherlands Cancer Institute, were used to calculate the number of needed voice prostheses per patient per year when preventing 70% of the leakages by prophylactic replacement. Various strategies for the timing of prophylactic replacement were considered: Adaptive strategies based on the individual patient’s history of replacement and fixed strategies based on the results of patients with similar voice prosthesis or treatment characteristics. Results: Patients used a median of 3.4 voice prostheses per year (range 0.1-48.1). We found a high inter-and intrapatient variability in device lifetime. When applying prophylactic replacement, this would become a median of 9.4 voice prostheses per year, which means replacement every 38 days, implying more than six additional voice prostheses per patient per year. The individual adaptive model showed that preventing 70% of the leakages was impossible for most patients, and only a median of 25% can be prevented. Monte-Carlo simulations showed that prophylactic replacement is not feasible due to the high Coefficient of Variation (Standard Deviation/Mean) in device lifetime. Conclusion: Based on our simulations, prophylactic replacement of voice prostheses is not feasible due to high inter-and intrapatient variation in device lifetime.

Keywords: voice prosthesis, voice rehabilitation, total laryngectomy, prosthetic leakage, device lifetime

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2607 The Technique of Mobilization of the Colon for Pull-Through Procedure in Hirschsprung's Disease

Authors: Medet K. Khamitov, Marat M. Ospanov, Vasiliy M. Lozovoy, Zhenis N. Sakuov, Dastan Z. Rustemov

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With a high rectosigmoid transitional zone in children with Hirschsprung’s disease, the upper rectal, sigmoid, left colon arteries are ligated during the pull-through of the descending part of the colon. As a result, the inferior mesenteric artery ceases to participate in the blood supply to the descending part of the colon. As a result, the reduced colon is supplied with blood only by the middle colon artery, which originates from the superior mesenteric artery. Insufficiency of blood supply to the reduced colon is the cause of the development of chronic hypoxia of the intestinal wall or necrosis of the reduced descending colon. Some surgeons prefer to preserve the left colon artery. However, it is possible to stretch the mesentery, which can lead to bowel retraction to anastomotic leaks and stenosis. Chronic hypoxia of the reduced colon, in turn, is the cause of acquired (secondary) aganglionosis. The highest frequency of anastomotic leaks is observed in children older than five years. The purpose is to reduce the risk of complications in the pull-through procedure of the descending part of the colon in patients with Hirschsprung’s disease by ensuring its sufficient mobility and maintaining blood supply to the lower mesenteric artery. Methodology and events. Two children aged 5 and 7 years with Hirschsprung’s disease were operated under the conditions of the hospital in Nur-Sultan. The diagnosis was made using x-ray contrast enema and histological examination. Operational technique. After revision of the left part of the colon and assessment of the architectonics of its blood vessels, parietal mobilization of the affected sigmoid and rectum was performed on laparotomy access, while maintaining the arterial and venous terminal arcades of the sigmoid vessels. Then, the descending branch of the left colon artery was crossed (if there is an insufficient length of the reduced intestine, the left colonic artery itself may also be crossed). This manipulation provides additional mobility of the pull-through descending part of the colon. The resulting "windows" in the mesentery of the reduced intestine were sutured to prevent the development of an internal hernia. Formed a full-blooded, sufficiently long transplant from the transverse loops of the splenic angle and the descending parts of the colon with blood supply from the upper and lower mesenteric artery, freely, without tension, is reduced to the rectal zone with the coloanal anastomosis 1.5 cm above the dentate line. Results. The postoperative period was uneventful. Patients were discharged on the 7th day. The observation was carried out for six months. In no case, there was a bowel retraction, anastomotic leak, anastomotic stenosis, or other complications. Conclusion. The presented technique of mobilization of the colon for the pull-through procedure in a high transitional rectosigmoid zone of Hirschsprung’s disease allows to maintain normal blood supply to the distal part of the colon and to avoid the tension of the colon. The technique allows reducing the risk of anastomotic leak, bowel necrosis, chronic ischemia, to exclude colon retraction and anastomotic stenosis.

Keywords: blood supply, children, colon mobilization, Hirschsprung's disease, pull-through

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2606 Prognostic Significance of Nuclear factor kappa B (p65) among Breast Cancer Patients in Cape Coast Teaching Hospital

Authors: Precious Barnes, Abraham Mensah, Leonard Derkyi-Kwarteng, Benjamin Amoani, George Adjei, Ernest Adankwah, Faustina Pappoe, Kwabena Dankwah, Daniel Amoako-Sakyi, Samuel Victor Nuvor, Dorcas Obiri-Yeboah, Ewura Seidu Yahaya, Patrick Kafui Akakpo, Roland Osei Saahene

Abstract:

Context: Breast cancer is a prevalent and aggressive type of cancer among African women, with high mortality rates in Ghana. Nuclear factor kappa B (NF-kB) is a transcription factor that has been associated with tumor progression in breast cancer. However, there is a lack of published data on NF-kB in breast cancer patients in Ghana or other African countries. Research Aim: The aim of this study was to assess the prognostic significance of NF-kB (p65) expression and its association with various clinicopathological features in breast cancer patients at the Cape Coast Teaching Hospital in Ghana. Methodology: A total of 90 formalin-fixed breast cancer tissues and 15 normal breast tissues were used in this study. The expression level of NF-kB (p65) was examined using immunohistochemical techniques. Correlation analysis between NF-kB (p65) expression and clinicopathological features was performed using SPSS version 25. Findings: The study found that NF-kB (p65) was expressed in 86.7% of breast cancer tissues. There was a significant relationship between NF-kB (p65) expression and tumor grade, proliferation index (Ki67), and molecular subtype. High-level expression of NF-kB (p65) was more common in tumor grade 3 compared to grade 1, and Ki67 > 20 had higher expression of NF-kB (p65) compared to Ki67 ≤ 20. Triple-negative breast cancer patients had the highest overexpression of NF-kB (p65) compared to other molecular subtypes. There was no significant association between NF-kB (p65) expression and other clinicopathological parameters. Theoretical Importance: This study provides important insights into the expression of NF-kB (p65) in breast cancer patients in Ghana, particularly in relation to tumor grade and proliferation index. The findings suggest that NF-kB (p65) could serve as a potential biological marker for cancer stage, progression, prognosis and as a therapeutic target. Data Collection and Analysis Procedures: Formalin-fixed breast cancer tissues and normal breast tissues were collected and analyzed using immunohistochemical techniques. Correlation analysis between NF-kB (p65) expression and clinicopathological features was performed using SPSS version 25. Question Addressed: This study addressed the question of the prognostic significance of NF-kB (p65) expression and its association with clinicopathological features in breast cancer patients in Ghana. Conclusion: This study, the first of its kind in Ghana, demonstrates that NF-kB (p65) is highly expressed among breast cancer patients at the Cape Coast Teaching Hospital, especially in triple-negative breast cancer patients. The expression of NF-kB (p65) is associated with tumor grade and proliferation index. NF-kB (p65) could potentially serve as a biological marker for cancer stage, progression, prognosis, and as a therapeutic target.

Keywords: breast cancer, Ki67, NF-kB (p65), tumor grade

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2605 The Determination of Self-Esteem, Life Satisfaction, Anxiety and Depression Levels among Patients with Stoma

Authors: Tugba Cinarli, Tugba Kavalali Erdogan, Sevil Masat, Dilek Kiymaz, Nida Kiyici, Zeliha Koc

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This study was conducted in a descriptive and cross-sectional manner, in order to determine the self-esteem, life satisfaction and depression/anxiety levels of the patients with stoma. The study was conducted between June 15, 2016 and June 15, 2017 among 196 oncology patients that were hospitalized in the general surgery clinic of a public hospital in Turkey. The case group consisted of 98 cancer patients with stoma and the control group consisted of 98 cancer patients without stoma. The data were collected through the Coopersmith Self-Esteem Scale, Life Satisfaction Scale, the Hospital Anxiety and Depression Scale, and a 21-question survey that aimed to determine the sociodemographic and clinical properties of the patients. The data were analyzed with percentage analysis, Mann Whitney U-test, Chi-square test and Spearmen’s correlation test. It was determined that for the case group; 44.9% had colon cancer, 29.6% had rectal cancer; 50% underwent temporary colostomia, 15.3% underwent permanent colostomia, 34.7% underwent temporary ileostomy. The experimental group's findings for the Coopersmith Self-Esteem Scale, Life Satisfaction Scale, the Anxiety Subscale and the Depression subscale were 64 (20 - 84), 17 (5 - 38), 10 (1 - 18), and 9 (1 - 19), respectively. The control group's findings for the Coopersmith Self-Esteem Scale, Life Satisfaction Scale, the Anxiety Subscale and the Depression Subscale were 68 (32 - 92), 21 (7 - 31), 8.5 (1 - 18), and 8 (1 - 18), respectively. It was found that the Coopersmith Self-Esteem Scale, Life Satisfaction Scale, and the Anxiety Subscale findings were significantly different for the experimental and control groups (p<0.05). It was determined that the self-esteem levels were positively correlated with life satisfaction and negatively correlated with anxiety and depression; also, the life satisfaction levels were negatively correlated with anxiety and depression. It is suggested that the nursing interventions should be planned in order to improve life-satisfaction and self-esteem levels of the patients, and to decrease depression and anxiety.

Keywords: anxiety, cancer, life satisfaction, self-esteem

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2604 To Access the Knowledge, Awareness and Factors Associated With Diabetes Mellitus in Buea, Cameroon

Authors: Franck Acho

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This is a chronic metabolic disorder which is a fast-growing global problem with a huge social, health, and economic consequences. It is estimated that in 2010 there were globally 285 million people (approximately 6.4% of the adult population) suffering from this disease. This number is estimated to increase to 430 million in the absence of better control or cure. An ageing population and obesity are two main reasons for the increase. Diabetes mellitus is a chronic heterogeneous metabolic disorder with a complex pathogenesis. It is characterized by elevated blood glucose levels or hyperglycemia, which results from abnormalities in either insulin secretion or insulin action or both. Hyperglycemia manifests in various forms with a varied presentation and results in carbohydrate, fat, and protein metabolic dysfunctions. Long-term hyperglycemia often leads to various microvascular and macrovascular diabetic complications, which are mainly responsible for diabetes-associated morbidity and mortality. Hyperglycemia serves as the primary biomarker for the diagnosis of diabetes as well. Furthermore, it has been shown that almost 50% of the putative diabetics are not diagnosed until 10 years after onset of the disease, hence the real prevalence of global diabetes must be astronomically high. This study was conducted in a locality to access the level of knowledge, awareness and risk factors associated with people leaving with diabetes mellitus. A month before the screening was to be conducted, a health screening in some selected churches and on the local community radio as well as on relevant WhatsApp groups were advertised. A general health talk was delivered by the head of the screening unit to all attendees who were all educated on the procedure to be carried out with benefits and any possible discomforts after which the attendee’s consent was obtained. Evaluation of the participants for any leads to the diabetes selected for the screening was done by taking adequate history and physical examinations such as excessive thirst, increased urination, tiredness, hunger, unexplained weight loss, feeling irritable or having other mood changes, having blurry vision, having slow-healing sores, getting a lot of infections, such as gum, skin and vaginal infections. Out of the 94 participants the finding show that 78 were females and 16 were males, 70.21% of participants with diabetes were between the ages of 60-69yrs.The study found that only 10.63% of respondents declared a good level of knowledge of diabetes. Out of 3 symptoms of diabetes analyzed in this study, high blood sugar (58.5%) and chronic fatigue (36.17%) were the most recognized. Out of 4 diabetes risk factors analyzed in this study, obesity (21.27%) and unhealthy diet (60.63%) were the most recognized diabetes risk factors, while only 10.6% of respondents indicated tobacco use. The diabetic foot was the most recognized diabetes complication (50.57%), but some the participants indicated vision problems (30.8%),or cardiovascular diseases (20.21%) as diabetes complications.

Keywords: diabetes mellitus, non comunicable disease, general health talk, hyperglycemia

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2603 GIS Based Spatial Modeling for Selecting New Hospital Sites Using APH, Entropy-MAUT and CRITIC-MAUT: A Study in Rural West Bengal, India

Authors: Alokananda Ghosh, Shraban Sarkar

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The study aims to identify suitable sites for new hospitals with critical obstetric care facilities in Birbhum, one of the vulnerable and underserved districts of Eastern India, considering six main and 14 sub-criteria, using GIS-based Analytic Hierarchy Process (AHP) and Multi-Attribute Utility Theory (MAUT) approach. The criteria were identified through field surveys and previous literature. After collecting expert decisions, a pairwise comparison matrix was prepared using the Saaty scale to calculate the weights through AHP. On the contrary, objective weighting methods, i.e., Entropy and Criteria Importance through Interaction Correlation (CRITIC), were used to perform the MAUT. Finally, suitability maps were prepared by weighted sum analysis. Sensitivity analyses of AHP were performed to explore the effect of dominant criteria. Results from AHP reveal that ‘maternal death in transit’ followed by ‘accessibility and connectivity’, ‘maternal health care service (MHCS) coverage gap’ were three important criteria with comparatively higher weighted values. Whereas ‘accessibility and connectivity’ and ‘maternal death in transit’ were observed to have more imprint in entropy and CRITIC, respectively. While comparing the predictive suitable classes of these three models with the layer of existing hospitals, except Entropy-MAUT, the other two are pointing towards the left-over underserved areas of existing facilities. Only 43%-67% of existing hospitals were in the moderate to lower suitable class. Therefore, the results of the predictive models might bring valuable input in future planning.

Keywords: hospital site suitability, analytic hierarchy process, multi-attribute utility theory, entropy, criteria importance through interaction correlation, multi-criteria decision analysis

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2602 Multi-Disciplinary Rehabilitation in Osmotic Demyelination Syndrome: A Case Report

Authors: Wei Qu, Cassandra Agius, Nikki Varvazovsky, Angela Meade

Abstract:

The goals of the case study are to address the importance of early diagnosis of osmotic demyelination syndrome (ODS) and to analyse the types, duration, and intensities of the rehabilitation program to promote neurological and functional recovery. It can be associated with biphasic course of disease and severe neurological and neuropsychiatric symptoms. Although a few treatment modalities, such as plasmapheresis, immunoglobulin therapy, steroid, and thyrotrophin-releasing hormone, have been suggested, there is no effective treatment for ODS. The overall prognosis of established ODS is generally poor. A high proportion of patients have a severe permanent disability, which has led to social, economic, and emotional burdens to carers and societies. In this case, a 69-year-old retired pensioner with chronic alcoholism was admitted to the hospital with a reduced level of consciousness and tonic-clonic seizure. He had severe hyponatraemia (serum sodium 118 mmol/L) and hypokalemia (serum potassium 2.8 mmol/L). He was treated with anticonvulsants, 150ml 3% hypertonic saline over one hour, and 40 mmol potassium chloride over one hour, and his sodium was increased by 11 mmol/L in the first 24 hours. However, he had worsened neurological symptoms with quadriplegia, dysphagia, anarthria, and confusion, and the radiological features suggested the diagnosis of ODS. He had minimal neurological recovery during the first four weeks of hospital admission. He was treated with seven weeks of a multi-disciplinary intensive rehabilitation program. On discharge, he had made a significant cognitive and functional recovery and could mobilize independently without a walking aid. In conclusion, ODS can still occur despite correcting sodium following the current clinical guidelines. Patients with severe neurological deficits in the context of osmotic demyelination syndrome would benefit from intensive rehabilitation to facilitate their functional improvement and to promote their quality of life.

Keywords: osmotic demyelination syndrome, hyponatremia, central pontine and extrapontine myelinolysis, rehabilitation

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2601 Assessment of Nuclear Medicine Radiation Protection Practices Among Radiographers and Nurses at a Small Nuclear Medicine Department in a Tertiary Hospital

Authors: Nyathi Mpumelelo; Moeng Thabiso Maria

Abstract:

BACKGROUND AND OBJECTIVES: Radiopharmaceuticals are used for diagnosis, treatment, staging and follow up of various diseases. However, there is concern that the ionizing radiation (gamma rays, α and ß particles) emitted by radiopharmaceuticals may result in exposure of radiographers and nurses with limited knowledge of the principles of radiation protection and safety, raising the risk of cancer induction. This study aimed at investigation radiation safety awareness levels among radiographers and nurses at a small tertiary hospital in South Africa. METHODS: An analytical cross-sectional study. A validated two-part questionnaire was implemented to consenting radiographers and nurses working in a Nuclear Medicine Department. Part 1 gathered demographic information (age, gender, work experience, attendance to/or passing ionizing radiation protection courses). Part 2 covered questions related to knowledge and awareness of radiation protection principles. RESULTS: Six radiographers and five nurses participated (27% males and 73% females). The mean age was 45 years (age range 20-60 years). The study revealed that neither professional development courses nor radiation protection courses are offered at the Nuclear Medicine Department understudy. However, 6/6 (100%) radiographers exhibited a high level of awareness of radiation safety principles on handling and working with radiopharmaceuticals which correlated to their years of experience. As for nurses, 4/5 (80%) showed limited knowledge and awareness of radiation protection principles irrespective of the number of years in the profession. CONCLUSION: Despite their major role of caring for patients undergoing diagnostic and therapeutic treatments, the nurses showed limited knowledge of ionizing radiation and associated side effects. This was not surprising since they never received any formal basic radiation safety course. These findings were not unique to this Centre. A study conducted in a Kuwaiti Radiology Department also established that the vast majority of nurses did not understand the risks of working with ionizing radiation. Similarly, nurses in an Australian hospital exhibited knowledge limitations. However, nursing managers did provide the necessary radiation safety training when requested. In Guatemala and Saudi Arabia, where there was shortage of professional radiographers, nurses underwent radiography training, a course that equipped them with basic radiation safety principles. The radiographers in the Centre understudy unlike others in various parts of the world demonstrated substantial knowledge and awareness on radiation protection. Radiations safety courses attended when an opportunity arose played a critical role in their awareness. The knowledge and awareness levels of these radiographers were comparable to their counterparts in Sudan. However, it was much more above that of their counterparts in Jordan, Nigeria, Nepal and Iran who were found to have limited awareness and inadequate knowledge on radiation dose. Formal radiation safety and awareness courses and workshops can play a crucial role in raising the awareness of nurses and radiographers on radiation safety for their personal benefit and that of their patients.

Keywords: radiation safety, radiation awareness, training, nuclear medicine

Procedia PDF Downloads 61
2600 Diagnostic Properties of Exercise or Pharmacological Stress Myocardial Perfusion Scintigraphy in Per-Vessel Basis: A Clinical Validation Study

Authors: Ahmadreza Bagheri, Seyyed S. Eftekhari, Shervin Rashidinia

Abstract:

Background: Various stress tests have been proposed yet to assess patients with suspected coronary artery disease. However, their diagnostic properties in terms of sensitivity, specificity, and accuracy are variable and their applicability remained somewhat vague. The aim of this study is to validate per-vessel diagnostic properties of 3 types of stress myocardial perfusion scintigraphy in gated SPECT (Single-Photon Emission Computed Tomography) using either exercise or pharmacological stress testing with dipyridamole or dobutamine. Materials and Methods: Hospital records of 314 patients who referred to Imam Khomeini hospital of Tehran between September 2015 and January 2017 were completely reviewed in this study. All patients underwent coronary angiography within 3 months after stress myocardial perfusion scan. Eventually, the results were analyzed in per-vessel basis to find the proper modality for each involved vessel or scanned site. Results: The mean age of patients was 62.15 ± 4.94 years (30-85) and 35.03% were women. The overall sensitivity, specificity, and accuracy were calculated as 56.59%, 54.24%, and 55.09%, respectively. These values were 56.43% and 53.25%, 54.46% and 47.36%, 56.75% and 54.83% for dipyridamole and exercise, respectively. Ischemia of the anterior wall through exercise stress testing has the highest diagnostic accuracy in detecting LAD (Left Anterior Descending artery) involvement. Inferior wall hypokinesia and anterolateral wall ischemia during exercise stress testing have the highest diagnostic accuracy in detecting RCA (Right Coronary Artery) and LCX artery (Left Circumflex Artery) stenosis, respectively. Conclusion: Stress myocardial perfusion scan should be carried out on the basis of the findings of the preliminary investigations on suspicion of a specific coronary artery or involved myocardial wall.

Keywords: dipyridamole, dobutamine, single-photon emission computed tomography, stress myocardial perfusion scintigraphy

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2599 The Use of the Matlab Software as the Best Way to Recognize Penumbra Region in Radiotherapy

Authors: Alireza Shayegan, Morteza Amirabadi

Abstract:

The y tool was developed to quantitatively compare dose distributions, either measured or calculated. Before computing ɣ, the dose and distance scales of the two distributions, referred to as evaluated and reference, are re-normalized by dose and distance criteria, respectively. The re-normalization allows the dose distribution comparison to be conducted simultaneously along dose and distance axes. Several two-dimensional images were acquired using a Scanning Liquid Ionization Chamber EPID and Extended Dose Range (EDR2) films for regular and irregular radiation fields. The raw images were then converted into two-dimensional dose maps. Transitional and rotational manipulations were performed for images using Matlab software. As evaluated dose distribution maps, they were then compared with the corresponding original dose maps as the reference dose maps.

Keywords: energetic electron, gamma function, penumbra, Matlab software

Procedia PDF Downloads 288
2598 Outcome at the Extreme of Viability: A Single-Centre Experience

Authors: Antonia Harold-Barry, Eugene Dempsey

Abstract:

Background: The objective is to examine the survival and outcome of infants born under 26 weeks gestation in an Irish tertiary maternity hospital from 2007-2016 and to describe the survival and neurodevelopmental outcomes of these extremely preterm infants. Method: The population is 132 infants born at 23, 24, and 25 weeks in Cork University Maternity Hospital from 2007 to 2016. Ethical approval was granted by the Cork Clinical Research Ethics Committee. Patient details were obtained from the Vermont Oxford and Badger Networks. Survival rates and Bayley scores were calculated to assess neurodevelopmental outcomes. Statistical analysis with SPSS included frequencies, distributions, and comparisons between data from 2007-2011 and 2012-2016. Results: Overall survival rate was 63%. Of the surviving babies, 61% had Bayley scores calculated. Survival stood at 39% for delivery at 23 weeks, 50% at 24 weeks, and 83% at 25 weeks. The 2012 to 2016 cohort has shown further increases in survival, with 50% of babies at 23 weeks, 58% at 24 weeks, and 89% at 25 weeks. Corresponding figures for 2007-2011 are 20%, 39%, and 75%. Gestational age and incidence of periventricular leukomalacia were statistically significant, with a p-value of 0.022. Gestational age and delivery room deaths had a p-value of 0.025, as did gestational age and birth weight. A comparison of the two cohorts (2007-2011 and 2012-2016) with the administration of antenatal steroids showed a statistically significant p-value of 0.044. Conclusion: There is less morbidity and mortality in infants born at 25 than at 23 or 24 weeks. Survival of extremely premature infants has increased significantly over the past ten years. Survival rates with normal neurodevelopmental outcomes are comparable with international standards and reflect positive changes in attitude and practices in neonatal intensive care. This study will inform parents about the potential outcomes of extreme prematurity and policy regarding the management of extreme prematurity.

Keywords: extreme of viability, neurodevelopmental outcome, periventricular leukomalacia, prematurity

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2597 Inhibition of Food Borne Pathogens by Bacteriocinogenic Enterococcus Strains

Authors: Neha Farid

Abstract:

Due to the abuse of antimicrobial medications in animal feed, the occurrence of multi-drug resistant (MDR) pathogens in foods is currently a growing public health concern on a global scale. MDR infections have the potential to penetrate the food chain by posing a serious risk to both consumers and animals. Food pathogens are those biological agents that have the tendency to cause pathogenicity in the host body upon ingestion. The major reservoirs of foodborne pathogens include food-producing fauna like cows, pigs, goats, sheep, deer, etc. The intestines of these animals are highly condensed with several different types of food pathogens. Bacterial food pathogens are the main cause of foodborne disease in humans; almost 66% of the reported cases of food illness in a year are caused by the infestation of bacterial food pathogens. When ingested, these pathogens reproduce and survive or form different kinds of toxins inside host cells causing severe infections. The genus Listeria consists of gram-positive, rod-shaped, non-spore-forming bacteria. The disease caused by Listeria monocytogenes is listeriosis or gastroenteritis, which induces fever, vomiting, and severe diarrhea in the affected body. Campylobacter jejuni is a gram-negative, curved-rod-shaped bacteria causing foodborne illness. The major source of Campylobacter jejuni is livestock and poultry; particularly, chicken is highly colonized with Campylobacter jejuni. Serious public health concerns include the widespread growth of bacteria that are resistant to antibiotics and the slowing in the discovery of new classes of medicines. The objective of this study is to provide some potential antibacterial activities with certain broad-range antibiotics and our desired bacteriocins, i.e., Enterococcus faecium from specific strains preventing microbial contamination pathways in order to safeguard the food by lowering food deterioration, contamination, and foodborne illnesses. The food pathogens were isolated from various sources of dairy products and meat samples. The isolates were tested for the presence of Listeria and Campylobacter by gram staining and biochemical testing. They were further sub-cultured on selective media enriched with the growth supplements for Listeria and Campylobacter. All six strains of Listeria and Campylobacter were tested against ten antibiotics. Campylobacter strains showed resistance against all the antibiotics, whereas Listeria was found to be resistant only against Nalidixic Acid and Erythromycin. Further, the strains were tested against the two bacteriocins isolated from Enterococcus faecium. It was found that bacteriocins showed better antimicrobial activity against food pathogens. They can be used as a potential antimicrobial for food preservation. Thus, the study concluded that natural antimicrobials could be used as alternatives to synthetic antimicrobials to overcome the problem of food spoilage and severe food diseases.

Keywords: food pathogens, listeria, campylobacter, antibiotics, bacteriocins

Procedia PDF Downloads 57
2596 Catered Lunch Suspected Outbreak in a Garment Factory, Sleman District, Yogyakarta, Indonesia, 2017

Authors: Rieski Prihastuti, Meliana Depo, Trisno A. Wibowo, Misinem

Abstract:

On October 19, 2017, Yogyakarta Islamic Hospital reported 38 garment employees with nausea, vomiting, headache, abdominal pain, and diarrhea after they had lunch on October 18, 2017, to Sleman District Health Office. Objectives of this study were to ensure the outbreak and identify source and route of transmission. Case-control study was conducted to analyze food items that caused the outbreak. A case was defined as a person who got symptoms such as abdominal pain, diarrhea, nausea with/without vomiting, fever, and headache after they had lunch on October 18, 2017. Samples included leftover lunch box, vomit, tap water and drinking water had been sent to the laboratory. Data were analyzed descriptively as frequency table and analyzed by using chi-square in bivariate analysis. All of 196 garment employee was included in this study. The common symptoms of this outbreak were abdominal pain (84.4%), diarrhea (72.8%), nausea (61.6%), headache (52.8%), vomiting (12.8%), and fever (6.4%) with median incubation period 13 hours (range 1-34 hours). Highest attack rate and odds ratio was found in grilled chicken (Attack Rate 58,49%) with Odds Ratio 11,023 (Confidence Interval 95% 1.383 - 87.859; p value 0,005). Almost all samples showed mold, except drinking water. Based on its sign and symptoms, also incubation period, diarrheal Bacillus cereus and Clostridium perfringens were suspected to be the causative agent of the outbreak. Limitation of this study was improper sample handling and no sample of food handler and stools in the food caterer. Outbreak investigation training needed to be given to the hospital worker, and monitoring should be done to the food caterer to prevent another outbreak.

Keywords: disease outbreak, foodborne disease, food poisoning, outbreak

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2595 Measurement of the Neutron Spectrum of 241AmLi and 241AmF Sources Using the Bonner Sphere Spectrometers

Authors: Victor Rocha Carvalho

Abstract:

The Bonner Sphere Spectrometry was used to obtain the average energy, the fluence rate, and radioprotection quantities such as the personal and ambient dose equivalent of the ²⁴¹AmLi and ²⁴¹AmF isotopic neutron sources used in the Neutron Metrology Laboratory - LN. The counts of the sources were performed with six different spherical moderators around the detector. Through this, the neutron spectrum was obtained by means of the software named NeuraLN, developed by the LN, that uses the neural networks technique. The 241AmLi achieved a result close to the literature, and 241AmF, which contains few published references, acquired a result with a slight variation from the literature. Therefore, besides fulfilling its objective, the work raises questions about a possible standard of the ²⁴¹AmLi and about the lack of work with the ²⁴¹AmF.

Keywords: nuclear physics, neutron metrology, neutron spectrometry, bonner sphere spectrometers

Procedia PDF Downloads 86
2594 Selection of Rayleigh Damping Coefficients for Seismic Response Analysis of Soil Layers

Authors: Huai-Feng Wang, Meng-Lin Lou, Ru-Lin Zhang

Abstract:

One good analysis method in seismic response analysis is direct time integration, which widely adopts Rayleigh damping. An approach is presented for selection of Rayleigh damping coefficients to be used in seismic analyses to produce a response that is consistent with Modal damping response. In the presented approach, the expression of the error of peak response, acquired through complete quadratic combination method, and Rayleigh damping coefficients was set up and then the coefficients were produced by minimizing the error. Two finite element modes of soil layers, excited by 28 seismic waves, were used to demonstrate the feasibility and validity.

Keywords: Rayleigh damping, modal damping, damping coefficients, seismic response analysis

Procedia PDF Downloads 427
2593 Analyzing the Impact of the COVID-19 Pandemic on Clinicians’ Perceptions of Resuscitation and Escalation Decision-Making Processes: Cross-Sectional Survey of Hospital Clinicians in the United Kingdom

Authors: Michelle Hartanto, Risheka Suthantirakumar

Abstract:

Introduction Staff redeployment, increased numbers of acutely unwell patients requiring resuscitation decision-making conversations, visiting restrictions, and varying guidance regarding resuscitation for patients with COVID-19 disrupted clinicians’ management of resuscitation and escalation decision-making processes. While it was generally accepted that the COVID-19 pandemic disturbed numerous aspects of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process in the United Kingdom, a process which establishes a patient’s CPR status and treatment escalation plans, the impact of the pandemic on clinicians’ attitudes towards these resuscitation and decision-making conversations was unknown. This was the first study to examine the impact of the COVID-19 pandemic on clinicians’ knowledge, skills, and attitudes towards the ReSPECT process. Methods A cross-sectional survey of clinicians at one acute teaching hospital in the UK was conducted. A questionnaire with a defined five-point Likert scale was distributed and clinicians were asked to recall their pre-pandemic views on ReSPECT and report their current views at the time of survey distribution (May 2020, end of the first COVID-19 wave in the UK). Responses were received from 171 clinicians, and self-reported views before and during the pandemic were compared. Results Clinicians reported they found managing ReSPECT conversations more challenging during the pandemic, especially when conducted over the telephone with relatives, and they experienced an increase in negative emotions before, during, and after conducting ReSPECT conversations. Our findings identified that due to the pandemic there was now a need for clinicians to receive training and support in conducting resuscitation and escalation decision-making conversations over the telephone with relatives and managing these processes.

Keywords: cardiopulmonary resuscitation, COVID-19 pandemic, DNACPR discussion, education, recommended summary plan for emergency care and treatment, resuscitation order

Procedia PDF Downloads 96
2592 Problem Based Learning and Teaching by Example in Dimensioning of Mechanisms: Feedback

Authors: Nicolas Peyret, Sylvain Courtois, Gaël Chevallier

Abstract:

This article outlines the development of the Project Based Learning (PBL) at the level of a last year’s Bachelor’s Degree. This form of pedagogy has for objective to allow a better involving of the students from the beginning of the module. The theoretical contributions are introduced during the project to solving a technological problem. The module in question is the module of mechanical dimensioning method of Supméca a French engineering school. This school issues a Master’s Degree. While the teaching methods used in primary and secondary education are frequently renewed in France at the instigation of teachers and inspectors, higher education remains relatively traditional in its practices. Recently, some colleagues have felt the need to put the application back at the heart of their theoretical teaching. This need is induced by the difficulty of covering all the knowledge deductively before its application. It is therefore tempting to make the students 'learn by doing', even if it doesn’t cover some parts of the theoretical knowledge. The other argument that supports this type of learning is the lack of motivation the students have for the magisterial courses. The role-play allowed scenarios favoring interaction between students and teachers… However, this pedagogical form known as 'pedagogy by project' is difficult to apply in the first years of university studies because of the low level of autonomy and individual responsibility that the students have. The question of what the student actually learns from the initial program as well as the evaluation of the competences acquired by the students in this type of pedagogy also remains an open problem. Thus we propose to add to the pedagogy by project format a regressive part of interventionism by the teacher based on pedagogy by example. This pedagogical scenario is based on the cognitive load theory and Bruner's constructivist theory. It has been built by relying on the six points of the encouragement process defined by Bruner, with a concrete objective, to allow the students to go beyond the basic skills of dimensioning and allow them to acquire the more global skills of engineering. The implementation of project-based teaching coupled with pedagogy by example makes it possible to compensate for the lack of experience and autonomy of first-year students, while at the same time involving them strongly in the first few minutes of the module. In this project, students have been confronted with the real dimensioning problems and are able to understand the links and influences between parameter variations and dimensioning, an objective that we did not reach in classical teaching. It is this form of pedagogy which allows to accelerate the mastery of basic skills and so spend more time on the engineer skills namely the convergence of each dimensioning in order to obtain a validated mechanism. A self-evaluation of the project skills acquired by the students will also be presented.

Keywords: Bruner's constructivist theory, mechanisms dimensioning, pedagogy by example, problem based learning

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2591 Τhe Importance of Previous Examination Results, in Futural Differential Diagnostic Procedures and Especially in the Era of Covid-19

Authors: Angelis P. Barlampas

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Purpose or Learning Objective It is well known that previous examinations play a major role in futural diagnosis, thus avoiding unnecessary new exams that cost in time and money both for the patient and the health system. A case is presented in which past patient’s results, in combination with the least needed new tests, give an easy final diagnosis. Methods or Background A middle aged man visited the emergency department complaining of hard controlled, persisting fever for the last few days. Laboratory tests showed an elevated number of white blood cells with neutrophil shift and abnormal CRP. The patient was admitted to hospital a month ago for continuing lungs symptomatology after a recent covid-19 infection. Results or Findings Computed tomography scanning showed a solid mass with spiculating margins in right lower lobe. After intravenous iodine contrast administration, there was mildly peripheral enhancement and eccentric non enhancing area. A pneumonic cancer was suspected. Comparison with the patient’s latest computed tomography revealed no mass in the area of interest but only signs of recent post covid-19 lung parenchyma abnormalities. Any new mass that appears in a month’s time span can not be a cancer but a benign lesion. It was obvious that an abscess was the most suitable explanation. The patient was admitted to hospital, and antibiotic therapy was given, with very good results. After a few days, the patient was afebrile and in good condition. Conclusion In this case , a PET scan or a biopsy was avoided, thanks to the patient’s medical history and the availability of previous examinations. It is worthy encouraging the patients to keep their medical records and organizing more efficiently the health system with the current technology of archiving the medical examinations, too.

Keywords: covid-19, chest ct, cancer, abscess, fever

Procedia PDF Downloads 50
2590 Vibrations of Springboards: Mode Shape and Time Domain Analysis

Authors: Stefano Frassinelli, Alessandro Niccolai, Riccardo E. Zich

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Diving is an important Olympic sport. In this sport, the effective performance of the athlete is related to his capability to interact correctly with the springboard. In fact, the elevation of the jump and the correctness of the dive are influenced by the vibrations of the board. In this paper, the vibrations of the springboard will be analyzed by means of typical tools for vibration analysis: Firstly, a modal analysis will be done on two different models of the springboard, then, these two model and another one will be analyzed with a time analysis, done integrating the equations of motion od deformable bodies. All these analyses will be compared with experimental data measured on a real springboard by means of a 6-axis accelerometer; these measurements are aimed to assess the models proposed. The acquired data will be analyzed both in frequency domain and in time domain.

Keywords: springboard analysis, modal analysis, time domain analysis, vibrations

Procedia PDF Downloads 446
2589 Evaluation of the Radiolabelled 68GA-DOTATOC Complex in Adenocarcinoma Breast Cancer

Authors: S. Zolghadri, M. Naderi, H. Yousefnia, B. Alirzapour, A. R. Jalilian, A. Ramazani

Abstract:

Nowadays, 68Ga-DOTATOC has been known as a potential agent for the detection of neuroendocrine tumours and it has indicated higher sensitivity compared with the 111In-Octeroetide. The aim of this study was to evaluate the effectiveness of this new agent in the diagnosis of adenocarcinoma breast cancer. 68Ga-DOTATOC was prepared with the radiochemical purity of higher than 98% and by the specific activity of 39.6 TBq/mmol. 37 MBq of the complex was injected intravenously into the BULB/c mice with adenocarcinoma breast cancer. PET/CT images were acquired after 30, 60 and 90 min post injection demonstrated significant accumulation in the tumour sites. Also, considerable activity was observed in the kidney and bladder as the main routs of excretion. Generally, the results showed that 68Ga-DOTATOC can be considered as a suitable complex for diagnosis of the adenocarcinoma breast cancer using PET procedure.

Keywords: adenocarcinoma breast cancer, 68Ga, octreotide, imaging

Procedia PDF Downloads 331
2588 EMG Based Orthosis for Upper Limb Rehabilitation in Hemiparesis Patients

Authors: Nancy N. Sharmila, Aparna Mishra

Abstract:

Hemiparesis affects almost 80% of stroke patients each year. It is marked by paralysis or weakness on one half of the body. Our model provides both assistance and physical therapy for hemiparesis patients for swift recovery. In order to accomplish our goal a force is provided that pulls the forearm up (as in flexing the arm), and pushes the forearm down (as in extending the arm), which will also assist the user during ADL (Activities of Daily Living). The model consists of a mechanical component which is placed around the patient’s bicep and an EMG control circuit to assist patients in daily activities, which makes it affordable and easy to use. In order to enhance the neuromuscular system’s effectiveness in synchronize the movement, proprioceptive neuromuscular facilitation (PNF) concept is used. The EMG signals are acquired from the unaffected arm as an input to drive the orthosis. This way the patient is invigorated to use the orthosis for regular exercise.

Keywords: EMG, hemiparesis, orthosis, rehabilitation

Procedia PDF Downloads 434
2587 Examining the Change of Power Transmission Line in Urban Regeneration with Geographical Information System

Authors: C. Yagci, F. Iscan

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In this study, spatial differences of Power Transmission Line (PTL) and effects of the situation before and after the urban regeneration are studied by using Geographical Information System (GIS). In addition, a questionable and analyzable structure is acquired by developed system. In the study area many parcels on the PTL were analyzed. The amount of the parcels, which are affected by the negativity of PTL is clearly seen with the aid of generated maps. Some kind of changes are exhibited in the system, which are created by GIS, for instance before urban regeneration PTL was very close to people’s private properties and huge parts of PTL were among the buildings, however; after urban regeneration electricity lines were changed their locations to the underground. According to the results, GIS can be used as a device in planning and managing of PTL in urban regeneration projects and can be used for analyses. By the help of GIS technology, necessary investigations should be carried out in urban regeneration applications for creating sustainable cities.

Keywords: GIS, power transmission line, technology, urban regeneration

Procedia PDF Downloads 756