Search results for: College of Applied Medical Sciences

Authors: Scott M. Black, Craig Maclean, Pauline Hall Barrientos, Konstantinos Ritos, Asimina Kazakidi

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Aortic aneurysms and dissections are leading causes of death in cardiovascular disease. Both inevitably lead to hemodynamic instability without surgical intervention in the form of vascular stent-graft deployment. An accurate description of the aortic geometry and blood flow in patient-specific cases is vital for treatment planning and long-term success of such grafts, as they must generate physiological branch perfusion and in-stent hemodynamics. The aim of this study was to create patient-specific computational fluid dynamics (CFD) models through a multi-modality, multi-dimensional approach with boundary condition optimization to predict branch flow rates and in-stent hemodynamics in custom stent-graft configurations. Three-dimensional (3D) thoracoabdominal aortae were reconstructed from four-dimensional flow-magnetic resonance imaging (4D Flow-MRI) and computed tomography (CT) medical images. The former employed a novel approach to generate and enhance vessel lumen contrast via through-plane velocity at discrete, user defined cardiac time steps post-hoc. To produce patient-specific boundary conditions (BCs), the aortic geometry was reduced to a one-dimensional (1D) model. Thereafter, a zero-dimensional (0D) 3-Element Windkessel model (3EWM) was coupled to each terminal branch to represent the distal vasculature. In this coupled 0D-1D model, the 3EWM parameters were optimized to yield branch flow waveforms which are representative of the 4D Flow-MRI-derived in-vivo data. Thereafter, a 0D-3D CFD model was created, utilizing the optimized 3EWM BCs and a 4D Flow-MRI-obtained inlet velocity profile. A sensitivity analysis on the effects of stent-graft configuration and BC parameters was then undertaken using multiple stent-graft configurations and a range of distal vasculature conditions. 4D Flow-MRI granted unparalleled visualization of blood flow throughout the cardiac cycle in both the pre- and postsurgical states. Segmentation and reconstruction of healthy and stented regions from retrospective 4D Flow-MRI images also generated 3D models with geometries which were successfully validated against their CT-derived counterparts. 0D-1D coupling efficiently captured branch flow and pressure waveforms, while 0D-3D models also enabled 3D flow visualization and quantification of clinically relevant hemodynamic parameters for in-stent thrombosis and graft limb occlusion. It was apparent that changes in 3EWM BC parameters had a pronounced effect on perfusion distribution and near-wall hemodynamics. Results show that the 3EWM parameters could be iteratively changed to simulate a range of graft limb diameters and distal vasculature conditions for a given stent-graft to determine the optimal configuration prior to surgery. To conclude, this study outlined a methodology to aid in the prediction post-surgical branch perfusion and in-stent hemodynamics in patient specific cases for the implementation of custom stent-grafts.

Keywords: 4D flow-MRI, computational fluid dynamics, vascular stent-grafts, windkessel

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Authors: Thanduxolo Elford Fana

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Rationale and Purpose: Performance management and development system are central to effective and efficient service delivery, especially in highly labour intensive sectors such as South African public health. Performance management and development systems seek to ensure that good employee performance is rewarded accordingly, while those who underperform are developed so that they can reach their full potential. An effective and efficiently implemented performance management system motivates and improves employee engagement. The purpose of this study is to examine the implementation of the performance management and development system and the challenges that are encountered during its implementation in the Eastern Cape Provincial Department of Health. Methods: A qualitative research approach and a case study design was adopted in this study. The primary data were collected through observations, focus group discussions with employees, a group interview with shop stewards, and in-depth interviews with supervisors and managers, from April 2019 to September 2019. There were 45 study participants. In-depth interviews were held with 10 managers at facility level, which included chief executive officer, chief medical officer, assistant director’s in human resources management, patient admin, operations, finance, and two area manager and two operation managers nursing. A group interview was conducted with five shop stewards and an in-depth interview with one shop steward from the group. Five focus group discussions were conducted with clinical and non-clinical staff. The focus group discussions were supplemented with an in-depth interview with one person from each group in order to counter the group effect. Observations included moderation committee, contracting, and assessment meetings. Findings: The study shows that the performance management and development system was not properly implemented. There was non-compliance to performance management and development system policy guidelines in terms of time lines for contracting, evaluation, payment of incentives to good performers, and management of poor performance. The study revealed that the system is ineffective in raising the performance of employees and unable to assist employees to grow. The performance bonuses were no longer paid to qualifying employees. The study also revealed that lack of capacity and commitment, poor communication, constant policy changes, financial constraints, weak and highly bureaucratic management structures, union interference were challenges that were encountered during the implementation of the performance management and development system. Lastly, employees and supervisors were rating themselves three irrespective of how well or bad they performed. Conclusion: Performance management is regarded as vital to improved performance of the health workforce and healthcare service delivery among populations. Effective implementation of performance management and development system depends on well-capacitated and unbiased management at facility levels. Therefore, there is an urgent need to improve communication, link performance management to rewards, and capacitate staff on performance management and development system, as it is key to improved public health sector outcomes or performance.

Keywords: challenges, implementation, performance management and development system, public hospital

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Authors: Susanna Asatryan

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The author will introduce a single module related to English teaching methodology for master course students getting specialization “A Foreign Language Teacher of High Schools And Professional Educational Institutions” of Yerevan Brusov State University of Languages and Social Sciences. The overall aim of the presentation is to introduce learning and teaching strategies within EXE Computer program for Mastery student-teachers of the University. The author will display the advantages of the use of this program. The learners interact with the teacher in the classroom as well as they are provided an opportunity for virtual domain to carry out their learning procedures in association with assessment and self-assessment. So they get integrated into blended learning. As this strategy is in its piloting stage, the author has elaborated a single module, embracing 3 main sections: -Teaching English vocabulary at high school, -Teaching English grammar at high school, and -Teaching English pronunciation at high school. The author will present the above mentioned topics with corresponding sections and subsections. The strong point is that preparing this module we have planned to display it on the blended learning landscape. So for this account working with EXE program is highly effective. As it allows the users to operate several tools for self-learning and self-testing/assessment. The author elaborated 3 single EXE files for each topic. Each file starts with the section’s subject-specific description: - Objectives and Pre-knowledge, followed by the theoretical part. The author associated and flavored her observations with appropriate samples of charts, drawings, diagrams, recordings, video-clips, photos, pictures, etc. to make learning process more effective and enjoyable. Before or after the article the author has downloaded a video clip, related to the current topic. EXE offers a wide range of tools to work out or prepare different activities and exercises for the learners: 'Interactive/non-interactive' and 'Textual/non-textual'. So with the use of these tools Multi-Select, Multi-Choice, Cloze, Drop-Down, Case Study, Gap-Filling, Matching and different other types of activities have been elaborated and submitted to the appropriate sections. The learners task is to prepare themselves for the coming module or seminar, related to teaching methodology of English vocabulary, grammar, and pronunciation. The point is that the teacher has an opportunity for face to face communication, as well as to connect with the learners through the Moodle, or as a single EXE file offer it to the learners for their self-study and self-assessment. As for the students’ feedback –EXE environment also makes it available.

Keywords: blended learning, EXE program, learning/teaching strategies, self-study/assessment, virtual domain,

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Authors: A. Abubakar, A. Parsa, S. Walker

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Despite advances made in the diagnosis and management of drug-sensitive tuberculosis (TB) over the past decades, treatment of multidrug-resistant tuberculosis (MDR-TB) remains challenging and complex particularly in high burden countries including Nigeria. Treatment of MDR-TB is cost-prohibitive with success rate generally lower compared to drug-sensitive TB and if care is not taken it may become the dominant form of TB in future with many treatment uncertainties and substantial morbidity and mortality. Addressing these challenges requires collaborative efforts thorough sustained researches to evaluate the current treatment guidelines, particularly in high burden countries and prevent progression of resistance. To our best knowledge, there has been no research exploring the acceptability, effectiveness, and cost-effectiveness of community-based-MDR-TB treatment model in Nigeria, which is among the high burden countries. The previous similar qualitative study looks at the home-based management of MDR-TB in rural Uganda. This research aimed to explore patient’s views and acceptability of community-based-MDR-TB treatment model and to evaluate and compare the effectiveness and cost-effectiveness of community-based versus hospital-based MDR-TB treatment model of care from the Nigerian perspective. Knowledge of patient’s views and acceptability of community-based-MDR-TB treatment approach would help in designing future treatment recommendations and in health policymaking. Accordingly, knowledge of effectiveness and cost-effectiveness are part of the evidence needed to inform a decision about whether and how to scale up MDR-TB treatment, particularly in a poor resource setting with limited knowledge of TB. Mixed methods using qualitative and quantitative approach were employed. Qualitative data were obtained using in-depth semi-structured interviews with 21 MDR-TB patients in Nigeria to explore their views and acceptability of community-based MDR-TB treatment model. Qualitative data collection followed an iterative process which allowed adaptation of topic guides until data saturation. In-depth interviews were analyzed using thematic analysis. Quantitative data on treatment outcomes were obtained from medical records of MDR-TB patients to determine the effectiveness and direct and indirect costs were obtained from the patients using validated questionnaire and health system costs from the donor agencies to determine the cost-effectiveness difference between community and hospital-based model from the Nigerian perspective. Findings: Some themes have emerged from the patient’s perspectives indicating preference and high acceptability of community-based-MDR-TB treatment model by the patients and mixed feelings about the risk of MDR-TB transmission within the community due to poor infection control. The result of the modeling from the quantitative data is still on course. Community-based MDR-TB care was seen as the acceptable and most preferred model of care by the majority of the participants because of its convenience which in turn enhanced recovery, enables social interaction and offer more psychosocial benefits as well as averted productivity loss. However, there is a need to strengthen this model of care thorough enhanced strategies that ensure guidelines compliance and infection control in order to prevent the progression of resistance and curtail community transmission.

Keywords: acceptability, cost-effectiveness, multidrug-resistant TB treatment, community and hospital approach

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Authors: Catherine McWhorter

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Robotics is a fast-evolving field lacking comprehensive and harm-mitigating regulation; it also lacks critical data on how human-robot interaction (HRI) may affect human psychology. As most anthropomorphic robots are intended as substitutes for humans, this paper asserts that the commercial robotics industry should be preemptively regulated at the federal level such that robots capable of embodying a victim role in criminal scenarios (“vicbots”) are prohibited until clinical studies determine their effects on the user and society. The results of these studies should then inform more permanent legislation that strives to mitigate risks of harm without infringing upon fundamental rights or stifling innovation. This paper explores these concepts through the lens of the sex robot industry. The sexbot industry offers some of the most realistic, interactive, and customizable robots for sale today. From approximately 2010 until 2017, some sex robot producers, such as True Companion, actively promoted ‘vicbot’ culture with personalities like “Frigid Farrah” and “Young Yoko” but received significant public backlash for fetishizing rape and pedophilia. Today, “Frigid Farrah” and “Young Yoko” appear to have vanished. Sexbot producers have replaced preprogrammed vicbot personalities in favor of one generic, customizable personality. According to the manufacturer ainidoll.com, when asked, there is only one thing the user won’t be able to program the sexbot to do – “…give you drama”. The ability to customize vicbot personas is possible with today’s generic personality sexbots and may undermine the intent of some current legislative efforts. Current debate on the effects of vicbots indicates a lack of consensus. Some scholars suggest vicbots may reduce the rate of actual sex crimes, and some suggest that vicbots will, in fact, create sex criminals, while others cite their potential for rehabilitation. Vicbots may have value in some instances when prescribed by medical professionals, but the overall uncertainty and lack of data further underscore the need for preemptive regulation and clinical research. Existing literature on exposure to media violence and its effects on prosocial behavior, human aggression, and addiction may serve as launch points for specific studies into the hyperrealism of vicbots. Of course, the customization, anthropomorphism and artificial intelligence of sexbots, and therefore more mainstream robots, will continue to evolve. The existing sexbot industry offers an opportunity to preemptively regulate and to research answers to these and many more questions before this type of technology becomes even more advanced and mainstream. Robots pose complicated moral, ethical, and legal challenges, most of which are beyond the scope of this paper. By examining the possibility for custom vicbots via the sexbots industry, reviewing existing literature on regulation, media violence, and vicbot user effects, this paper strives to underscore the need for preemptive federal regulation prohibiting vicbot capabilities in robots while advocating for further research into the potential for the user and societal harm by the same.

Keywords: human-robot interaction effects, regulation, research, robots

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Authors: Headman Hebe, Arnold Taringa

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Background of the study: The benefits derived from Environmental and Sustainability Education (ESE) go beyond obtaining knowledge about the environment and the impact of human beings on the environment. Hence, it is sensible to expose learners to various resources that could enable meaningful environment-inclined pedagogy. The schoolgrounds, where they are utilised to promote ESE, benefit holistic learner development. However, empirical evidence, globally, suggests that young children’s contact with nature is declining due to urbanization, safety concerns by parents/guardians, and greater dependency on technology. Modern children spend much time on videogames and social media with very little time in the natural environment. Furthermore, national education departments in numerous countries have made tangible efforts to embed environmental and place-based learning to their school curricula. South Africa is one of those countries whose national school education curriculum advocates for ESE in pedagogy. Nevertheless, there is paucity of research conducted in South Africa on schoolgrounds as potential enablers of ESE and tools to foster a connection between youngsters and the natural environment. Accordingly, this study was essential as it seeks to determine the extent to which environmental learning is accommodated in pedagogy. Significantly, it investigates efforts made to use schoolgrounds for pedagogical purposes to connect children with the natural environment. Therefore, this study was conducted to investigate the accessibility and use of schoolgrounds for environment-inclined pedagogy in Natural and Social Sciences in two schools located in the Mpumalanga Province of South Africa. It tries to answer the question: To what extent are schoolgrounds used to promote environmental and sustainability education in the selected schools?The sub-questions: How do teachers and learners perceive the use of schoolgrounds for environmental and sustainability education activities? How does the organization of schoolgrounds offer opportunities for environmental education activities and accessibility for learners? Research method: This qualitative–interpretive case study used purposive and convenient sampling for participant selection. Forty-six respondents: 40 learners (twenty grade 7 learners per school), 2 school principals and 4 grade 7 participated in this study. Data collection tools were observations, interviews, audio-visual recordings and questionnaires while data analysis was done thematically. Major findings: The findings of the study point to: The lack of teacher training and infrastructure in the schoolgrounds and, no administrative support. Unclear curriculum guidelines on the use of schoolgrounds for ESE. The availability various elements in the schoolgrounds that could aid ESE activities. Learners denied access to certain parts of the schoolgrounds. Lack of time and curriculum demands constrain teachers from using schoolgrounds.

Keywords: affordances, environment and sustainability education, experiential learning, schoolgrounds

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Authors: Huda Abdelrhman Osman Ahmed, Paul Feyi Waboso

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Introduction: Placenta accreta spectrum (PAS) disorders present a significant challenge in obstetric management due to the high risk of hemorrhage and potential complications at delivery. This case describes a 27+3 weeks gestation in a patient with placenta accreta managed with classical cesarean section and peripartum hysterectomy. Case Description: AGravida 4P3 patient presented at 27+3 weeks gestation with painless, unprovoked vaginal bleeding and an estimated blood loss (EBL) of 300 mL. At the 20+5 week anomaly scan, a placenta previa was identified anterior, covering the os anterior uterus and containing lacunae with signs of myometrial thinning. At a 24+1 week scan conducted at a tertiary center, further imaging indicated placenta increta with invasion into the myometrium and potential areas of placenta percreta. The patient’s past obstetric history included three previous cesarean sections, with no significant medical or surgical history. Social history revealed heavy smoking but no alcohol use. No drug allergies were reported. Given the risks associated with PAS, a management plan was formulated, including an MRI at a later stage and cesarean delivery with a possible hysterectomy between 34-36 weeks. However, at 27+3 weeks, the patient experienced another episode of vaginal bleeding EBL 500 ml, necessitating immediate intervention. Management: As the patient was unstable, she was not transferred to the tertiary center. Completed and informed consent was obtained. MDT planning-group and cross-matching 4 units, uterotonics. Tranexamic acid blood products, cryo, cell salvage, 2 obstetric consultants and an anesthetic consultant, blood bank aware and hematologist. HDU bed and ITU availability. This study assisted in performing a classical Caesarean section, Where the urologist inserted JJ ureteric stents. Following this, we also assisted in a total abdominal hysterectomy with the conservation of ovaries. 4 units RBC and 1 unit FFP were transfused. The total blood loss was 2.3 L. Outcome: The procedure successfully achieved hemostasis, and the neonate was delivered with subsequent transfer to a neonatal intensive care unit for management. The patient’s postoperative course was monitored closely with no immediate complications. Discussion: This case highlights the complexity and urgency in managing placenta accreta spectrum disorders, particularly with the added challenges posed by remote location and limited tertiary support. The need for rapid decision-making and interdisciplinary coordination is emphasized in such high-risk obstetric cases. The case also underscores the potential for surgical intervention and the importance of family involvement in emergent care decisions. Conclusion: Placenta accreta spectrum disorders demand meticulous planning and timely intervention. This case contributes to understanding PAS management at earlier gestational ages and provides insights into the challenges posed by access to tertiary care, especially in urgent situations.

Keywords: Accreta, Hysterectomy, 3MDT, prematurity

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Authors: Jatinder Pal Singh, Harpreet Singh, Gagandeep Singh Digra, Mandeep Kaur Sidhu, Pawan Kumar

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Introduction: Ganglion cyst is a benign condition in which there is a cystic lesion in relation to a joint or a tendon sheath arising from myxoid degeneration of fibrous connective tissue. These can be unilocular or multilocular. In rare cases, there may be multiple ganglion cysts, known as cystic ganglionosis. They can occur at any age but are commonly seen in adults. Clinically they may be asymptomatic or present as swelling or mass effect in adjacent structures. These are common in extremities such as hands and feet. Case Presentation: 11-year-old female child presented with slowly progressive painless swelling of her right hand since the age of 4. Antenatal and perinatal history was unremarkable. Her family history was negative. She denies fever, malaise, morning stiffness, weight loss, fatigue, restriction of joint movements, or any sensory and motor deficit. Lab parameters were negative for inflammatory or infectious etiology. No other joint or extremity involvement was present. On physical examination, the swelling was present on the dorsum and palmer aspect of the right hand and wrist. They were non-tender on palpation without any motor or sensory deficit. MRI hand revealed multiple well-defined fluid signal intensity cystic appearing lesions in periarticular/intraarticular locations in relation to distal radio-ulnar, radio-carpal, intercarpal, carpometacarpal, metacarpophalangeal and interphalangeal joints as well as peritendinous location around flexor tendons more so in the region of wrist, palm, 1st and 5th digit and along extensor tendons in the region of wrist, largest one noted along flexor pollicis longus tendon in thenar region and along 1st digit measuring approx. 4.6 x 1.2 x 1.2 centimeter. Pressure erosions and bone remodelling were noted in the bases of the 2nd to 5th metacarpals, capitate, trapezoid, the distal shaft of 1st metacarpal, and proximal phalanx of 1st digit. Marrow edema was noted in the base and proximal shaft of the 4th metacarpal and proximal shaft of the 3rd metacarpal – likely stress or pressure related. The patient was advised of aspiration, but the family refused the procedure. Therefore the patient was kept on conservative treatment. Conclusion: Cystic ganglionosis is a rare condition with very few cases reported in the medical literature. Its prevalence and association are not known because of the rarity of this condition. It should be considered as an important differential in patients presenting with soft tissue swelling in extremities. Treatment option includes conservative management, aspiration, and surgery. Aspiration has a high recurrence rate. Although surgery has a low recurrence rate, it carries a high rate of complications. Imaging with MRI is essential for confirmation of the cystic nature of lesions and their relation with the joint capsules or tendons. This helps in differentiating from other soft tissue lesions and presurgical planning.

Keywords: radiology, rare, cystic ganglionosis, child

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Authors: Kumar Satyam Das, Murali Raghunathan

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This note discusses the feasibility of field development of a challenging shallow offshore field in South East Asia and how its learnings can be applied to marginal field development across the world especially developing marginal fields in this low oil price world. The field was found to be economically challenging even during high oil prices and the project was put on hold. Shell started development study with the aim to significantly reduce cost through competitively scoping and revive stranded projects. The proposed strategy to achieve this involved Improve Per platform recovery and Reduction in CAPEX. Methodology: Based on various Benchmarking Tool such as Woodmac for similar projects in the region and economic affordability, a challenging target of 50% reduction in unit development cost (UDC) was set for the project. Technical scope was defined to the minimum as to be a wellhead platform with minimum functionality to ensure production. The evaluation of key project decisions like Well location and number, well design, Artificial lift methods and wellhead platform type under different development concept was carried out through integrated multi-discipline approach. Key elements influencing per platform recovery were Wellhead Platform (WHP) location, Well count, well reach and well productivity. Major Findings: Reservoir being shallow posed challenges in well design (dog-leg severity, casing size and the achievable step-out), choice of artificial lift and sand-control method. Integrated approach amongst relevant disciplines with challenging mind-set enabled to achieve optimized set of development decisions. This led to significant improvement in per platform recovery. It was concluded that platform recovery largely depended on the reach of the well. Choice of slim well design enabled designing of high inclination and better productivity wells. However, there is trade-off between high inclination Gas Lift (GL) wells and low inclination wells in terms of long term value, operational complexity, well reach, recovery and uptime. Well design element like casing size, well completion, artificial lift and sand control were added successively over the minimum technical scope design leading to a value and risk staircase. Logical combinations of options (slim well, GL) were competitively screened to achieve 25% reduction in well cost. Facility cost reduction was achieved through sourcing standardized Low Cost Facilities platform in combination with portfolio execution to maximizing execution efficiency; this approach is expected to reduce facilities cost by ~23% with respect to the development costs. Further cost reductions were achieved by maximizing use of existing facilities nearby; changing reliance on existing water injection wells and utilizing existing water injector (W.I.) platform for new injectors. Conclusion: The study provides a spectrum of technically feasible options. It also made clear that different drivers lead to different development concepts and the cost value trade off staircase made this very visible. Scoping of the project through competitive way has proven to be valuable for decision makers by creating a transparent view of value and associated risks/uncertainty/trade-offs for difficult choices: elements of the projects can be competitive, whilst other parts will struggle, even though contributing to significant volumes. Reduction in UDC through proper scoping of present projects and its benchmarking paves as a learning for the development of marginal fields across the world, especially in this low oil price scenario. This way of developing a field has on average a reduction of 40% of cost for the Shell projects.

Keywords: benchmarking, full field development, CAPEX, feasibility

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Authors: Sajmina Khatun, Monika Pebam, Aravind Kumar Rengan

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Photothermal therapy, a subset of nanomedicine, takes advantage of light-absorbing agents to generate localized heat, selectively eradicating cancer cells. This innovative approach minimizes damage to healthy tissues and offers a promising avenue for targeted cancer treatment. Unlike conventional therapies, photothermal therapy harnesses the power of light to combat malignancies precisely and effectively, showcasing its potential to revolutionize cancer treatment paradigms. The combined strengths of nanomedicine and photothermal therapy signify a transformative shift toward more effective, targeted, and tolerable cancer treatments in the medical landscape. Utilizing natural products becomes instrumental in formulating diverse bioactive medications owing to their various pharmacological properties attributed to the existence of phenolic structures, triterpenoids, and similar compounds. Hyptis suaveolens, commonly known as pignut, stands as an aromatic herb within the Lamiaceae family and represents a valuable therapeutic plant. Flourishing in swamps and alongside tropical and subtropical roadsides, these noxious weeds impede the development of adjacent plants. Hyptis suaveolens ranks among the most globally distributed alien invasive species. The present investigation revealed that a versatile, biodegradable liposome nanosystem (HIL NPs), incorporating bioactive molecules from Hyptis suaveolens, exhibits effective bioavailability to cancer cells, enabling tumor ablation upon near-infrared (NIR) laser exposure. The components within the nanosystem, specifically the bioactive molecules from Hyptis, function as anticancer agents, aiding in the photothermal ablation of highly metastatic lung cancer cells. Despite being a prolific weed impeding neighboring plant growth, Hyptis suaveolens showcases therapeutic benefits through its bioactive compounds. The obtained HIL NPs, characterized as a photothermally active liposome nanosystem, demonstrate a pronounced fluorescence absorption peak in the NIR range and achieve a high photothermal conversion efficiency under NIR laser irradiation. Transmission electron microscopy (TEM) and particle size analysis reveal that HIL NPs possess a spherical shape with a size of 141 ± 30 nm. Moreover, in vitro assessments of HIL NPs against lung cancer cell lines (A549) indicate effective anticancer activity through a combined cytotoxic effect and hyperthermia. Tumor ablation is facilitated by apoptosis induced by the overexpression of ɣ-H2AX, arresting cancer cell proliferation. Consequently, the multifunctional and biodegradable nanosystem (HIL NPs), incorporating bioactive compounds from Hyptis, provides valuable perspectives for developing an innovative therapeutic strategy originating from a challenging weed. This approach holds promise for potential applications in both bioimaging and the combined use of phyto-photothermal therapy for cancer treatment.

Keywords: bioactive liposome, hyptis suaveolens, photothermal therapy, lung cancer

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Authors: Dalia Rimawi, Walid Salameh, Amal Al-Omari, Hadeel AbdelKhaleq

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Predication of Survival time of patients with cancer, is a core factor that influences oncologist decisions in different aspects; such as offered treatment plans, patients’ quality of life and medications development. For a long time proportional hazards Cox regression (ph. Cox) was and still the most well-known statistical method to predict survival outcome. But due to the revolution of data sciences; new predication models were employed and proved to be more flexible and provided higher accuracy in that type of studies. Artificial neural network is one of those models that is suitable to handle time to event predication. In this study we aim to compare ph Cox regression with artificial neural network method according to data handling and Accuracy of each model.

Keywords: Cox regression, neural networks, survival, cancer.

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Authors: Sabrina Neururer, Marco Schweitzer, Werner Hackl, Bernhard Tilg, Patrick Raudaschl, Andreas Huber, Bernhard Pfeifer

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History and the current outbreak of Covid-19 have shown the deadly potential of infectious diseases. However, infectious diseases also have a serious impact on areas other than health and healthcare, such as the economy or social life. These areas are strongly codependent. Therefore, disease control measures, such as social distancing, quarantines, curfews, or lockdowns, have to be adopted in a very considerate manner. Infectious disease modeling can support policy and decision-makers with adequate information regarding the dynamics of the pandemic and therefore assist in planning and enforcing appropriate measures that will prevent the healthcare system from collapsing. In this work, an agent-based simulation package named “survival” for simulating infectious diseases is presented. A special focus is put on SARS-Cov-2. The presented simulation package was used in Austria to model the SARS-Cov-2 outbreak from the beginning of 2020. Agent-based modeling is a relatively recent modeling approach. Since our world is getting more and more complex, the complexity of the underlying systems is also increasing. The development of tools and frameworks and increasing computational power advance the application of agent-based models. For parametrizing the presented model, different data sources, such as known infections, wastewater virus load, blood donor antibodies, circulating virus variants and the used capacity for hospitalization, as well as the availability of medical materials like ventilators, were integrated with a database system and used. The simulation result of the model was used for predicting the dynamics and the possible outcomes and was used by the health authorities to decide on the measures to be taken in order to control the pandemic situation. The survival package was implemented in the programming language Java and the analytics were performed with R Studio. During the first run in March 2020, the simulation showed that without measures other than individual personal behavior and appropriate medication, the death toll would have been about 27 million people worldwide within the first year. The model predicted the hospitalization rates (standard and intensive care) for Tyrol and South Tyrol with an accuracy of about 1.5% average error. They were calculated to provide 10-days forecasts. The state government and the hospitals were provided with the 10-days models to support their decision-making. This ensured that standard care was maintained for as long as possible without restrictions. Furthermore, various measures were estimated and thereafter enforced. Among other things, communities were quarantined based on the calculations while, in accordance with the calculations, the curfews for the entire population were reduced. With this framework, which is used in the national crisis team of the Austrian province of Tyrol, a very accurate model could be created on the federal state level as well as on the district and municipal level, which was able to provide decision-makers with a solid information basis. This framework can be transferred to various infectious diseases and thus can be used as a basis for future monitoring.

Keywords: modelling, simulation, agent-based, SARS-Cov-2, COVID-19

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Authors: Sujeeva Sebastian Pereira

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Language Anxiety (LA) – a distinct psychological construct of self-perceptions and behaviors related to classroom language learning – is perceived as a significant variable highly correlated with Second Language Acquisition (SLA). However, the existing scholarship has inadequately explored the nuances of LA in relation to South Asia, especially in terms of Sri Lankan higher education contexts. Thus, the current study, situated within the broad areas of Psychology of SLA and Applied Linguistics, investigates the impact of competency-based LA and identity-based LA on learner achievement among undergraduates of Sri Lanka. Employing a case study approach to explore the impact of LA, 750 undergraduates of the University of Sri Jayewardenepura, Sri Lanka, thus covering 25% of the student population from all seven faculties of the university, were selected as participants using stratified proportionate sampling in terms of ethnicity, gender, and disciplines. The qualitative and quantitative research inquiry utilized for data collection include a questionnaire consisting a set of structured and unstructured questions, and semi-structured interviews as research instruments. Data analysis includes both descriptive and statistical measures. As per the quantitative measures of data analysis, the study employed Pearson Correlation Coefficient test, Chi-Square test, and Multiple Correspondence Analysis; it used LA as the dependent variable, and two types of independent variables were used: direct and indirect variables. Direct variables encompass the four main language skills- reading, writing, speaking and listening- and test anxiety. These variables were further explored through classroom activities on grammar, vocabulary and individual and group presentations. Indirect variables are identity, gender and cultural stereotypes, discipline, social background, income level, ethnicity, religion and parents’ education level. Learner achievement was measured through final scores the participants have obtained for Compulsory English- a common first-year course unit mandatory for all undergraduates. LA was measured using the FLCAS. In order to increase the validity and reliability of the study, data collected were triangulated through descriptive content analysis. Clearly evident through both the statistical analysis and the qualitative analysis of the results is the significant linear negative correlation between LA and learner achievement, and the significant negative correlation between LA and culturally-operated gender stereotypes which create identity disparities in learners. The study also found that both competency-based LA and identity-based LA are experienced primarily and inescapably due to the apprehensions regarding speaking in English. Most participants who reported high levels of LA were from an urban socio-economic background of lower income families. Findings exemplify the linguistic inequality prevalent in the socio-cultural milieu in Sri Lankan society. This inequality makes learning English a dire need, yet, very much an anxiety provoking process because of many sociolinguistic, cultural and ideological factors related to English as a Second Language (ESL) in Sri Lanka. The findings bring out the intricate interrelatedness of both the dependent variable (LA) and the independent variables stated above, emphasizing that the significant linear negative correlation between LA and learner achievement is connected to the affective, cognitive and sociolinguistic domains of SLA. Thus, the study highlights the promise in linguistic practices such as code-switching, crossing and accommodating hybrid identities as strategies in minimizing LA and maximizing the experience of ESL.

Keywords: language anxiety, identity-based anxiety, competence-based anxiety, TESL, Sri Lanka

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Authors: Adela Diepoltova, Klara Konecna, Ondrej Jandourek, Petr Nachtigal

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A loss of control over antibiotic-resistant pathogens has become a global issue due to severe and often untreatable infections. This state is reflected in complicated treatment, health costs, and higher mortality. All these factors emphasize the urgent need for the discovery and development of new anti-infectives. One of the most common pathogens mentioned in the phenomenon of antibiotic resistance are bacteria of the genus Staphylococcus. These bacterial agents have developed several mechanisms against the effect of antibiotics. One of them is biofilm formation. In staphylococci, biofilms are associated with infections such as endocarditis, osteomyelitis, catheter-related bloodstream infections, etc. To author's best knowledge, no validated and standardized methodology evaluating candidate compound activity against staphylococcal biofilms exists. However, a variety of protocols for in vitro drug activity testing has been suggested, yet there are often fundamental differences. Based on our experience, a key methodological step that leads to credible results is to form a robust biofilm with appropriate attributes such as firm adherence to the substrate, a complex arrangement in layers, and the presence of extracellular polysaccharide matrix. At first, for the purpose of drug antibiofilm activity evaluation, the focus was put on various conditions (supplementation of cultivation media by human plasma/fetal bovine serum, shaking mode, the density of initial inoculum) that should lead to reproducible and robust in vitro staphylococcal biofilm formation in microtiter plate model. Three model staphylococcal reference strains were included in the study: Staphylococcus aureus (ATCC 29213), methicillin-resistant Staphylococcus aureus (ATCC 43300), and Staphylococcus epidermidis (ATCC 35983). The total biofilm biomass was quantified using the Christensen method with crystal violet, and results obtained from at least three independent experiments were statistically processed. Attention was also paid to the viability of the biofilm-forming staphylococcal cells and the presence of extracellular polysaccharide matrix. The conditions that led to robust biofilm biomass formation with attributes for biofilms mentioned above were then applied by introducing an alternative method analogous to the commercially available test system, the Calgary Biofilm Device. In this test system, biofilms are formed on pegs that are incorporated into the lid of the microtiter plate. This system provides several advantages (in situ detection and quantification of biofilm microbial cells that have retained their viability after drug exposure). Based on our preliminary studies, it was found that the attention to the peg surface and substrate on which the bacterial biofilms are formed should also be paid to. Therefore, further steps leading to the optimization were introduced. The surface of pegs was coated by human plasma, fetal bovine serum, and L-polylysine. Subsequently, the willingness of bacteria to adhere and form biofilm was monitored. In conclusion, suitable conditions were revealed, leading to the formation of reproducible, robust staphylococcal biofilms in vitro for the microtiter model and the system analogous to the Calgary biofilm device, as well. The robustness and typical slime texture could be detected visually. Likewise, an analysis by confocal laser scanning microscopy revealed a complex three-dimensional arrangement of biofilm forming organisms surrounded by an extracellular polysaccharide matrix.

Keywords: anti-biofilm drug activity screening, in vitro biofilm formation, microtiter plate model, the Calgary biofilm device, staphylococcal infections, substrate modification, surface coating

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Authors: Lola Rosalia Saavedra Guzman, Plamen Neytchev Netchev

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In general, agnosticism is perceived as an uncertainty between a well-structured (religious) belief (in some Christian or pagan deity) and its absolute and total absence, often causing the suspicion that an agnostic is an atheist, which is "reinsured" in case if their personal belief is wrong. All of this, along with the prevailing view among the naturalists that science has already demonstrated the inexistence of God, has compelled us to seek the foundation of agnosticism and faith in the contemporary formal human logic, advanced mathematics, and the natural sciences. Along the way, we will find that no natural science can demonstrate the existence of God, nor could it discard it for rational considerations, which show that there is something beyond. After all, it seems that the human intellect is insufficient to respond surely with yes or no to the existence of higher intelligences leaving unconditional faith as the only path to God for Christians and transcendent techniques, for pagan religious beliefs.

Keywords: agnosticism, formal logic, axioms and postulates, Gödel theorems, and logical faults

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Authors: Juliette Begin, Juliano Colapelle, Andrea Taratanu, Daniel Thirion, Amelie Marsot, Bryan A. Ross

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Chronic obstructive pulmonary disease (COPD), a leading cause of death globally, is characterized by chronic airflow obstruction and acute exacerbations (AECOPDs) that are often triggered by respiratory infections. Pseudomonas aeruginosa (P. aeruginosa), a potentially serious bacterial cause of AECOPDs, is treated with targeted anti-pseudomonal antibiotics. These select few antimicrobials are often used as first-line therapy in patients who are clinically unwell and/or in those suspected of P. aeruginosa-related infection prior to confirmation, potentially contributing to antimicrobial resistance. The present study evaluates prescribing practices in patients with a confirmed sputum history of P. aeruginosa admitted for AECOPD at the McGill University Health Centre (MUHC) and treated with anti-pseudomonal antibiotics. Serum antibiotic concentrations were measured from the same-day peak, trough, and mid-dose blood sampling intervals after reaching steady-state (on or after day 3) and were quantified using ultra-high-performance liquid chromatography (UHPLC). Demographic, clinical, and treatment outcomes were extracted from patient medical charts. Treatment failure was defined by respiratory-related death or mechanical ventilation after ≥3 days of antibiotics; antibiotic therapy extended beyond 2 weeks or a new antibiotic regimen started; or urgent care readmission within 30 days for AECOPD. To date, 9 of 30 planned participants have completed testing: seven received ciprofloxacin, one received meropenem, and one received piperacillin-tazobactam. Due to serum sample batching requirements, the serum ciprofloxacin concentration results for the first 2/8 participants are presented at the time of writing. The first participant had serum levels of 5.45mg/L (T₀), 4.74mg/L (T₅₀), and 4.49mg/L (T₁₀₀), while the second had serum levels of 5mg/L (T₀), 2.6mg/L (T₅₀), and 2.51mg/L (T₁₀₀). Pharmacokinetic parameters Cmax (5.18±0.43mg/L), T₁/₂ (23.56±18.94hours), and AUC (181.9±155.95mg*h/l) were higher than reported monograph values and met target AUC-to-MIC ratio of >125. The patients treated with meropenem and with piperacillin-tazobactam experienced treatment failure. Preliminary results suggest that standard ciprofloxacin dosing in patients experiencing an AECOPD and colonized with P. aeruginosa appears to achieve effective serum concentrations. Final cohort results will inform the pharmacokinetic appropriateness and clinical sufficiency of current AECOPD antimicrobial strategies in P. aeruginosa-colonized patients. This study will guide clinicians in determining the appropriate dosing for AECOPD treatment to achieve therapeutic levels, optimizing outcomes, and minimizing adverse effects. It could also highlight the value of routine antibiotic level monitoring in patients with treatment failure to ensure optimal serum concentrations.

Keywords: acute exacerbation, antimicrobial resistance, chronic obstructive pulmonary disease, pharmacokinetics/pharmacodynamics, Pseudomonas aeruginosa

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Authors: Mihaela Beregoi, Horia Iovu, Cristina Busuioc, Alexandru Evanghelidis, Elena Matei, Monica Enculescu, Ionut Enculescu

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Nanomaterials field is very attractive for all researchers who are attempting to develop new devices with the same or improved properties than the micro-sized ones, while reducing the reagents and power consumptions. In this way, a wide range of nanomaterials were fabricated and integrated in applications for electronics, optoelectronics, solar cells, tissue reconstruction and drug delivery. Obviously, the most appealing ones are those dedicated to the medical domain. Different types of nano-sized materials, such as particles, fibers, films etc., can be synthesized by using physical, chemical or electrochemical methods. One of these techniques is electrospinning, which enable the production of fibers with nanometric dimensions by pumping a polymeric solution in a high electric field; due to the electrostatic charging and solvent evaporation, the precursor mixture is converted into nonwoven meshes with different fiber densities and mechanical properties. Moreover, polyaniline is a conducting polymer with interesting optical properties, suitable for displays and electrochromic windows. Otherwise, polyaniline is an electroactive polymer that can contract/expand by applying electric stimuli, due to the oxidation/reduction reactions which take place in the polymer chains. These two main properties can be exploited in order to synthesize smart materials that change their dimensions, exhibiting in the same time good electrochromic properties. In the context aforesaid, a poly(methyl metacrylate) solution was spun to get webs composed of fibers with diameter values between 500 nm and 1 µm. Further, the polymer meshes were covered with a gold layer in order to make them conductive and also appropriate as working electrode in an electrochemical cell. The gold shell was deposited by DC sputtering. Such metalized fibers can be transformed into smart materials by covering them with a thin layer of conductive polymer. Thus, the webs were coated with a polyaniline film by the electrochemical route, starting from and aqueous solution of aniline and sulfuric acid, where sulfuric acid acts as oxidant agent. For the polymerization of aniline, a saturated calomel electrode was employed as reference, a platinum plate as counter electrode and the gold covered webs as working electrode. Chronoamperometry was selected as deposition method for polyaniline, by modifying the deposition time. Metalized meshes with different fiber densities were used, the transmission ranging between 70 and 80 %. The morphological investigation showed that polyaniline layer has a granular structure for all deposition experiments. As well, some preliminary optical tests were done by using sulfuric acid as electrolyte, which revealed the modification of polyaniline colour from green to dark blue when applying a voltage. In conclusion, new multilayered materials were obtained by a simple approach: the merge of the electrospinning method benefits with polyaniline chemistry. This synthesis method allows the fabrication of structures with reproducible characteristics, suitable for display or tissue substituents.

Keywords: electrospinning, fibers, smart materials, polyaniline

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Authors: Tatsiana Ihnatovich, Darya Nizheharodava, Mikalai Halabarodzka, Tatsiana Savitskaya, Marina Zafranskaya

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Liver fibrosis is a complex of histological changes resulting from chronic liver disease accompanied by an excessive production and deposition of extracellular matrix components in the hepatic parenchyma. Liver fibrosis is a serious medical and social problem. Hepatic stellate cells (HSCs) make a significant contribution to the extracellular matrix deposition due to liver injury. Mesenchymal stem cells (MSCs) have a pronounced anti-inflammatory, regenerative and immunomodulatory effect; they are able to differentiate into hepatocytes and induce apoptosis of activated HSCs that opens the prospect of their use for preventing the excessive fibro-formation and the development of liver cirrhosis. The aim of the study is to evaluate the effect of MSCs therapy on the expression of fibrogenesis markers genes in liver tissue and HSCs cultures of rats with experimental liver cirrhosis (ELC). Materials and methods: ELC was induced by the common bile duct ligation (CBDL) in female Wistar rats (n = 19) with an average body weight of 250 (220 ÷ 270) g. Animals from the control group (n = 10) were sham-operated. On the 56th day after the CBDL, the rats of the experimental (n = 12) and the control (n = 5) groups received intraportal MSCs in concentration of 1×106 cells/animal (previously obtained from rat’s bone marrow) or saline, respectively. The animals were taken out of the experiment on the 21st day. HSCs were isolated by sequential liver perfusion in situ with following disaggregation, enzymatic treatment and centrifugation of cell suspension on a two-stage density gradient. The expression of collagen type I (Col1a1) and type III (Col3a1), matrix metalloproteinase type 2 (MMP2) and type 9 (MMP9), tissue inhibitor of matrix metalloproteinases type 1 (TIMP1), transforming growth factor β type 1 (TGFβ1) and type 3 (TGFβ3) was determined by real-time polymerase chain reaction. Statistical analysis was performed using Statistica 10.0. Results: In ELC rats compared to sham-operated animals, a significant increase of all studied markers expression was observed. The administration of MSCs led to a significant decrease of all detectable markers in the experimental group compared to rats without cell therapy. In ELC rats, an increased MMP9/TIMP1 ratio after cell therapy was also detected. The infusion of MSCs in the sham-operated animals did not lead to any changes. In the HSCs from ELC animals, the expression of Col1a1 and Col3a1 exceeded the similar parameters of the control group (p <0.05) and statistically decreased after the MSCs administration. The correlation between Col3a1 (Rs = 0.51, p <0.05), TGFβ1 (Rs = 0.6, p <0.01), and TGFβ3 (Rs = 0.75, p <0.001) expression in HSCs cultures and liver tissue has been found. Conclusion: Intraportal administration of MSCs to rats with ELC leads to a decreased Col1a1 and Col3a1, MMP2 and MMP9, TIMP1, TGFβ1 and TGFβ3 expression. The correlation between the expression of Col3a1, TGFβ1 and TGFβ3 in liver tissue and in HSCs cultures indicates the involvement of activated HSCs in the fibrogenesis that allows considering HSCs to be the main cell therapy target in ELC.

Keywords: cell therapy, experimental liver cirrhosis, hepatic stellate cells, mesenchymal stem cells

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Authors: Al. Tsertsvadze. L. Ebralidze, I. Matchutadze. D. Berashvili, A. Bakuridze

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Peatlands are landscape elements, they are formed over a very long period by physical, chemical, biologic, and geologic processes. In the moderate zone of Caucasus, the Kolkheti lowlands are distinguished by the diversity of relictual plants, a high degree of endemism, orographic, climate, landscape, and other characteristics of high levels of biodiversity. The unique properties of the Kolkheti region lead to the formation of special, so-called, endemic peat peloids. The composition and properties of peloids strongly depend on peat-forming plants. Peat is considered a unique complex of raw materials, which can be used in different fields of the industry: agriculture, metallurgy, energy, biotechnology, chemical industry, health care. They are formed in permanent wetland areas. As a result of decay, higher plants remain in the anaerobic area, with the participation of microorganisms. Peat mass absorbs soil and groundwater. Peloids are predominantly rich with humic substances, which are characterized by high biological activity. Humic acids stimulate enzymatic activity, regenerative processes, and have anti-inflammatory activity. Objects of the research were Kolkheti peat peloids (Ispani, Anaklia, Churia, Chirukhi, Peranga) possessing different formation phases. Due to specific physical and chemical properties of research objects, the aim of the research was to develop analytical methods in order to study the chemical composition of the objects. The research was held using modern instrumental methods of analysis: Ultraviolet-visible spectroscopy and Infrared spectroscopy, Scanning Electron Microscopy, Centrifuge, dry oven, Ultraturax, pH meter, fluorescence spectrometer, Gas chromatography-mass spectrometry (GC-MS/MS), Gas chromatography. Based on the research ration between organic and inorganic substances, the spectrum of micro and macro elements, also the content of minerals was determined. The content of organic nitrogen was determined using the Kjeldahl method. The total composition of amino acids was studied by a spectrophotometric method using standard solutions of glutamic and aspartic acids. Fatty acid was determined using GC (Gas chromatography). Based on the obtained results, we can conclude that the method is valid to identify fatty acids in the research objects. The content of organic substances in the research objects was held using GC-MS. Using modern instrumental methods of analysis, the chemical composition of research objects was studied. Each research object is predominantly reached with a broad spectrum of organic (fatty acids, amino acids, carbocyclic and heterocyclic compounds, organic acids and their esters, steroids) and inorganic (micro and macro elements, minerals) substances. Modified methods used in the presented research may be utilized for the evaluation of cosmetological balneological and pharmaceutical means prepared on the base of Kolkheti's Sphagnum Peat Peloids.

Keywords: modern analytical methods, natural resources, peat, chemistry

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Authors: Ashkan Ebadi, Andrea Schiffauerova

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In spite of the global efforts toward gender equality, female researchers are still underrepresented in professional scientific activities. The gender gap is more seen in engineering and math-intensive technological scientific fields thus calling for a specific attention. This paper focuses on the Canadian funded researchers who are active in natural sciences and engineering, and analyses the gender aspects of researchers’ performance, their scientific collaboration patterns as well as their share of the federal funding within the period of 2000 to 2010. Our results confirm the existence of gender disparity among the examined Canadian researchers. Although it was observed that male researchers have been performing better in terms of number of publications, the impact of the research was almost the same for both genders. In addition, it was observed that research funding is more biased towards male researchers and they have more control over their scientific community as well.

Keywords: bibliometrics, collaboration, funding, gender differences, research output

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Authors: Lola T. Alimkhodjaeva, Lola T. Zakirova, Soniya S. Ziyavidenova

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Background: Breast cancer (BC) is still one of the urgent oncology problems. The essential obstacle to the full anti-tumor therapy implementation is drug resistance development. Taking into account the fact that chemotherapy is main antitumor treatment in BC patients, the important task is to improve treatment results. Certain success in overcoming this situation has been associated with the use of methods of extracorporeal blood treatment (ECBT), plasmapheresis. Materials and Methods: We examined 129 women with resistant BC stages 3-4, aged between 56 to 62 years who had previously received 2 courses of CAF chemotherapy. All patients additionally underwent 2 courses of CAF chemotherapy but against the background ECBT with ultrasonic exposure. We studied the following parameters: 1. The highlights of peripheral blood before and after therapy. 2. The state of cellular immunity and identification of activation markers CD23 +, CD25 +, CD38 +, CD95 + on lymphocytes was performed using monoclonal antibodies. Evaluation of humoral immunity was determined by the level of main classes of immunoglobulins IgG, IgA, IgM in serum. 3. The degree of tumor regression was assessed by WHO recommended 4 gradations. (complete - 100%, partial - more than 50% of initial size, process stabilization–regression is less than 50% of initial size and tumor advance progressing). 4. Medical pathomorphism in the tumor was determined by Lavnikova. 5. The study of immediate and remote results, up to 3 years and more. Results and Discussion: After performing extracorporeal blood treatment anemia occurred in 38.9%, leukopenia in 36.8%, thrombocytopenia in 34.6%, hypolymphemia in 26.8%. Studies of immunoglobulin fractions in blood serum were able to establish a certain relationship between the classes of immunoglobulin A, G, M and their functions. The results showed that after treatment the values of main immunoglobulins in patients’ serum approximated to normal. Analysis of expression of activation markers CD25 + cells bearing receptors for IL-2 (IL-2Rα chain) and CD95 + lymphocytes that were mediated physiological apoptosis showed the tendency to increase, which apparently was due to activation of cellular immunity cytokines allocated by ultrasonic treatment. To carry out ECBT on the background of ultrasonic treatment improved the parameters of the immune system, which were expressed in stimulation of cellular immunity and correcting imbalances in humoral immunity. The key indicator of conducted treatment efficiency is the immediate result measured by the degree of tumor regression. After ECBT performance the complete regression was 10.3%, partial response - 55.5%, process stabilization - 34.5%, tumor advance progressing no observed. Morphological investigations of tumor determined therapeutic pathomorphism grade 2 in 15%, in 25% - grade 3 and therapeutic pathomorphism grade 4 in 60% of patients. One of the main criteria for the effect of conducted treatment is to study the remission terms in the postoperative period (up to 3 years or more). The remission terms up to 3 years with ECBT was 34.5%, 5-year survival was 54%. Carried out research suggests that a comprehensive study of immunological and clinical course of breast cancer allows the differentiated approach to the choice of methods for effective treatment.

Keywords: breast cancer, immunoglobulins, extracorporeal blood treatment, chemotherapy

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Authors: Jade V. Rushby, Tony Loughland, Tracy L. Durksen, Hoa Nguyen, Robert M. Klassen

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This paper reports a study investigating the development and implementation of an online multi-session ‘scenario-based learning’ (SBL) program administered to preservice teachers in Australia. The transition from initial teacher education to the teaching profession can present numerous cognitive and psychological challenges for early career teachers. Therefore, the identification of additional supports, such as scenario-based learning, that can supplement existing teacher education programs may help preservice teachers to feel more confident and prepared for the realities and complexities of teaching. Scenario-based learning is grounded in situated learning theory which holds that learning is most powerful when it is embedded within its authentic context. SBL exposes participants to complex and realistic workplace situations in a supportive environment and has been used extensively to help prepare students in other professions, such as legal and medical education. However, comparatively limited attention has been paid to investigating the effects of SBL in teacher education. In the present study, the SBL intervention provided participants with the opportunity to virtually engage with school-based scenarios, reflect on how they might respond to a series of plausible response options, and receive real-time feedback from experienced educators. The development process involved several stages, including collaboration with experienced educators to determine the scenario content based on ‘critical incidents’ they had encountered during their teaching careers, the establishment of the scoring key, the development of the expert feedback, and an extensive review process to refine the program content. The 4-part SBL program focused on areas that can be challenging in the beginning stages of a teaching career, including managing student behaviour and workload, differentiating the curriculum, and building relationships with colleagues, parents, and the community. Results from prior studies implemented by the research group using a similar 4-part format have shown a statistically significant increase in preservice teachers’ self-efficacy and classroom readiness from the pre-test to the final post-test. In the current research, professional teaching identity - incorporating self-efficacy, motivation, self-image, satisfaction, and commitment to teaching - was measured over six weeks at multiple time points: before, during, and after the 4-part scenario-based learning program. Analyses included latent growth curve modelling to assess the trajectory of change in the outcome variables throughout the intervention. The paper outlines (1) the theoretical underpinnings of SBL, (2) the development of the SBL program and methodology, and (3) the results from the study, including the impact of the SBL program on aspects of participating preservice teachers’ professional identity. The study shows how SBL interventions can be implemented alongside the initial teacher education curriculum to help prepare preservice teachers for the transition from student to teacher.

Keywords: classroom simulations, e-learning, initial teacher education, preservice teachers, professional learning, professional teaching identity, scenario-based learning, teacher development

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Authors: Allison Herlene Du Plessis, Dalena (R.M.) Van Rooyen, Wilma Ten Ham-Baloyi, Sihaam Jardien-Baboo

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Introduction: Women die in pregnancy and childbirth for five main reasons—severe bleeding, infections, unsafe abortions, hypertensive disorders (pre-eclampsia and eclampsia), and medical complications including cardiac disease, diabetes, or HIV/AIDS complicated by pregnancy. In 2015, WHO classified sepsis as the third highest cause for maternal mortalities in the world. Chorioamnionitis is a clinical syndrome of intrauterine infection during any stage of the pregnancy and it refers to ascending bacteria from the vaginal canal up into the uterus, causing infection. While the incidence rates for chorioamnionitis are not well documented, complications related to chorioamnionitis are well documented and midwives still struggle to identify this condition in time due to its complex nature. Few diagnostic methods are available in public health services, due to escalated laboratory costs. Often the affordable biomarkers, such as C-reactive protein CRP, full blood count (FBC) and WBC, have low significance in diagnosing chorioamnionitis. A lack of screening impacts on effective and timeous management of chorioamnionitis, and early identification and management of risks could help to prevent neonatal complications and reduce the subsequent series of morbidities and healthcare costs of infants who are health foci of perinatal infections. Objective: This integrative literature review provides an overview of current best research evidence on the screening of women at risk for chorioamnionitis. Design: An integrative literature review was conducted using a systematic electronic literature search through EBSCOhost, Cochrane Online, Wiley Online, PubMed, Scopus and Google. Guidelines, research studies, and reports in English related to chorioamnionitis from 2008 up until 2020 were included in the study. Findings: After critical appraisal, 31 articles were included. More than one third (67%) of the literature included ranked on the three highest levels of evidence (Level I, II and III). Data extracted regarding screening for chorioamnionitis was synthesized into four themes, namely: screening by clinical signs and symptoms, screening by causative factors of chorioamnionitis, screening of obstetric history, and essential biomarkers to diagnose chorioamnionitis. Key conclusions: There are factors that can be used by midwives to identify women at risk for chorioamnionitis. However, there are a paucity of established sociological, epidemiological and behavioral factors to screen this population. Several biomarkers are available to diagnose chorioamnionitis. Increased Interleukin-6 in amniotic fluid is the better indicator and strongest predictor of histological chorioamnionitis, whereas the available rapid matrix-metalloproteinase-8 test requires further testing. Maternal white blood cells count (WBC) has shown poor selectivity and sensitivity, and C-reactive protein (CRP) thresholds varied among studies and are not ideal for conclusive diagnosis of subclinical chorioamnionitis. Implications for practice: Screening of women at risk for chorioamnionitis by health care providers providing care for pregnant women, including midwives, is important for diagnosis and management before complications arise, particularly in resource-constraint settings.

Keywords: chorioamnionitis, guidelines, best evidence, screening, diagnosis, pregnant women

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Authors: A. Sottomayor, M. Perez Duque, M. C. Henriques

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Introduction: Migration is not a new phenomenon; nomads often traveled, seeking better living conditions, including food and water. The increase of migrations affects all countries, rising health-related challenges. In Portugal, we have had migrant movements in the last decades, pairing with economic behavior. Irregular immigrants are detained in Santo António detention center from Portuguese Immigration and Borders Service (USHA-SEF) in Porto until court decision for a maximum of 60 days. It is the only long stay officially designated detention center for immigrants in Portugal. Immigrant health is important for public health (PH). It affects and is affected by the community. The XXVII Portuguese Government considered immigrant integration, including access to health, health promotion, protection and reduction of inequities a political priority. Many curative, psychological and legal services are provided for detainees, but until 2015, no structured health promotion or prevention actions were being held at USHA-SEF. That year, Porto Occidental PH Local Unit started to provide vaccination and health literacy on this theme for detainees and SEF workers. Our activities include a vaccine lecture, a medical consultation with vaccine prescription and administration, along with documented proof of vaccination. All vaccines are volunteer and free of charge. This action reduces the risk of importation and transmission of diseases, contributing to world eradication and elimination programs. We aimed to characterize the demography of irregular immigrant detained at UHSA-SEF and describe our activity. Methods: All data was provided by Porto Occidental Public Health Unit. All paper registers of vaccination were uploaded to MicrosoftExcel®. We included all registers and collected demographic variables, nationality, vaccination date, category, and administered vaccines. Descriptive analysis was performed using MicrosoftExcel®. Results: From 2015 to 2018, we delivered care to 256 individuals (179 immigrants; 77 workers). Considering immigrants, 72% were male, and 8 (16%) women were pregnant. 85% were between 20-54 years (ᵡ=30,8y; 2-71y), and 11 didn’t report any age. Migrants came from 48 countries, and India had the highest number (9%). MMR and Tetanus vaccines had > 90% vaccination rate and Poliomyelitis, hepatitis B and flu vaccines had around 85% vaccination rates. We had a consistent number of refusals. Conclusion: Our irregular migrant population comes from many different countries, which increases the risk of disease importation. Pregnant women are present as a particular subset of irregular migrants, and vaccination protects them and the baby. Vaccination of migrant is valuable for them and for the countries in which they pass. It contributes to universal health coverage, for eradication programmes and accomplishment of the Sustainable Development Goals. Peer influence may present as a determinant of refusals so we must consistently educate migrants before vaccination. More studies would be valuable, particularly on the migrant trajectory, duration of stay, destiny after court decision and health impact.

Keywords: migrants, public health, universal health coverage, vaccination

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Authors: Loretta Ichim, Dan Popescu, Grigore Stamatescu

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The paper reports the collaboration between a top university from Romania and three companies for the implementation of a research project in a multidisciplinary domain, focusing on the impact and benefits both for the education and industry. The joint activities were developed under the Space Technology and Advanced Research Program (STAR), funded by the Romanian Space Agency (ROSA) for a university-industry partnership. The context was defined by linking the European Space Agency optional programs, with the development and promotion national research, with the educational and industrial capabilities in the aeronautics, security and related areas by increasing the collaboration between academic and industrial entities as well as by realizing high-level scientific production. The project name is Multisensory Robotic System for Aerial Monitoring of Critical Infrastructure Systems (MUROS), which was carried 2013-2016. The project included the University POLITEHNICA of Bucharest (coordinator) and three companies, which manufacture and market unmanned aerial systems. The project had as main objective the development of an integrated system for combined ground wireless sensor networks and UAV monitoring in various application scenarios for critical infrastructure surveillance. This included specific activities related to fundamental and applied research, technology transfer, prototype implementation and result dissemination. The core area of the contributions laid in distributed data processing and communication mechanisms, advanced image processing and embedded system development. Special focus is given by the paper to analyzing the impact the project implementation in the educational process, directly or indirectly, through the faculty members (professors and students) involved in the research team. Three main directions are discussed: a) enabling students to carry out internships at the partner companies, b) handling advanced topics and industry requirements at the master's level, c) experiments and concept validation for doctoral thesis. The impact of the research work (as the educational component) developed by the faculty members on the increasing performances of the companies’ products is highlighted. The collaboration between university and companies was well balanced both for contributions and results. The paper also presents the outcomes of the project which reveals the efficient collaboration between high education and industry: master thesis, doctoral thesis, conference papers, journal papers, technical documentation for technology transfer, prototype, and patent. The experience can provide useful practices of blending research and education within an academia-industry cooperation framework while the lessons learned represent a starting point in debating the new role of advanced research and development performing companies in association with higher education. This partnership, promoted at UE level, has a broad impact beyond the constrained scope of a single project and can develop into long-lasting collaboration while benefiting all stakeholders: students, universities and the surrounding knowledge-based economic and industrial ecosystem. Due to the exchange of experiences between the university (UPB) and the manufacturing company (AFT Design), a new project, SIMUL, under the Bridge Grant Program (Romanian executive agency UEFISCDI) was started (2016 – 2017). This project will continue the educational research for innovation on master and doctoral studies in MUROS thematic (collaborative multi-UAV application for flood detection).

Keywords: education process, multisensory robotic system, research and innovation project, technology transfer, university-industry partnership

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Authors: Truong H. Le, Ngoc M. To, Quang N. Tran, Luu T. Cao, Chi V. Le

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Introduction: In Vietnam, the current monitoring and treatment for ordinary diabetic patient mostly based on glucose monitoring with HbA1c test for every three months (recommended goal is HbA1c < 6.5%~7%). For diabetes in pregnant women or Gestational diabetes mellitus (GDM), glycemic control until the time of delivery is extremly important because it could reduce significantly medical implications for both the mother and the child. Besides, GDM requires continuos glucose monitoring at least every two weeks and therefore an alternative marker of glycemia for short-term control is considering a potential tool for the healthcare providers. There are published studies have indicated that the glycosylated serum protein is a better indicator than glycosylated hemoglobin in GDM monitoring. Based on the actual practice in Vietnam, this study was designed to evaluate the role of serum fructosamine as a monitoring tool in GDM treament and its correlations with fasting blood glucose (G0), 2-hour postprandial glucose (G2) and glycosylated hemoglobin (HbA1c). Methods: A cohort study on pregnant women diagnosed with GDM by the 75-gram oralglucose tolerance test was conducted at Endocrinology Department, Cho Ray hospital, Vietnam from June 2014 to March 2015. Cho Ray hospital is the final destination for GDM patient in the southern of Vietnam, the study population has many sources from other pronvinces and therefore researchers belive that this demographic characteristic can help to provide the study result as a reflection for the whole area. In this study, diabetic patients received a continuos glucose monitoring method which consists of bi-weekly on-site visit every 2 weeks with glycosylated serum protein test, fasting blood glucose test and 2-hour postprandial glucose test; HbA1c test for every 3 months; and nutritious consultance for daily diet program. The subjects still received routine treatment at the hospital, with tight follow-up from their healthcare providers. Researchers recorded bi-weekly health conditions, serum fructosamine level and delivery outcome from the pregnant women, using Stata 13 programme for the analysis. Results: A total of 500 pregnant women was enrolled and follow-up in this study. Serum fructosamine level was found to have a light correlation with G0 ( r=0.3458, p < 0.001) and HbA1c ( r=0.3544, p < 0.001), and moderately correlated with G2 ( r=0.4379, p < 0.001). During study timeline, the delivery outcome of 287 women were recorded with the average age of 38.5 ± 1.5 weeks, 9% of them have macrosomia, 2.8% have premature birth before week 35th and 9.8% have premature birth before week 37th; 64.8% of cesarean section and none of them have perinatal or neonatal mortality. The study provides a reference interval of serum fructosamine for GDM patient was 112.9 ± 20.7 μmol/dL. Conclusion: The present results suggests that serum fructosamine is as effective as HbA1c as a reflection of blood glucose control in GDM patient, with a positive result in delivery outcome (0% perinatal or neonatal mortality). The reference value of serum fructosamine measurement provided a potential monitoring utility in GDM treatment for hospitals in Vietnam. Healthcare providers in Cho Ray hospital is considering to conduct more studies to test this reference as a target value in their GDM treatment and monitoring.

Keywords: gestational diabetes mellitus, monitoring tool, serum fructosamine, Vietnam

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Authors: Demet Devrimsel Dogan, Ecem Deniz Kirkpantur, Muharrem Dogan, Ahmet Aykut, Ebru Unal Akoglu, Ozge Ecmel Onur

Abstract:

Introduction: Median Arcuate Ligament Syndrome (MALS) is a rare cause of chronic abdominal pain due to external compression of the celiac trunk by a fibrous arch that unites diaphragmatic crura on each side of the aortic hiatus. While 10-24% of the population may suffer from compression of celiac trunk, it rarely causes patients to develop symptoms. The typical clinical triad of symptoms includes postprandial epigastric pain, weight loss and vomiting. The diagnosis can be made using thin section multi-detector computed tomography (CT) scans which delineate the ligament and the compressed vessel. The treatment of MALS is aimed at relieving the compression of the celiac artery to restore adequate blood flow through the vessel and neurolysis to address chronic pain. Case: A 68-year-old male presented to our clinic with acute postprandial epigastric pain. This was patients’ first attack, and the pain was the worst pain of his life. The patient did not have any other symptoms like nausea, vomiting, chest pain or dyspnea. In his medical history, the patient has had an ischemic cerebrovascular stroke 5 years ago which he recovered with no sequel, and he was using 75 mg clopidogrel and 100 mg acetylsalicylic acid. He was not using any other medication and did not have a story of cardiovascular disease. His vital signs were stable (BP:113/72 mmHg, Spo2:97, temperature:36.3°C, HR:90/bpm). In his electrocardiogram, there was ST depression in leads II, III and AVF. In his physical examination, there was only epigastric tenderness, other system examinations were normal. Physical examination through his upper gastrointestinal system showed no bleeding. His laboratory results were as follows: creatinine:1.26 mg/dL, AST:42 U/L, ALT:17 U/L, amylase:78 U/L, lipase:26 U/L, troponin:10.3 pg/ml, WBC:28.9 K/uL, Hgb:12.7 gr/dL, Plt:335 K/uL. His serial high-sensitive troponin levels were also within normal limits, his echocardiography showed no segmental wall motion abnormalities, an acute myocardial infarction was excluded. In his abdominal ultrasound, no pathology was founded. Contrast-enhanced abdominal CT and CT angiography reported ‘thickened diaphragmatic cruras are compressing and stenosing truncus celiacus superior, this is likely compatible with MALS’. The patient was consulted to general surgery, and they admitted the patient for laparoscopic ligament release. Results: MALS is a syndrome that causes postprandial pain, nausea and vomiting as its most common symptoms. Affected patients are normally young, slim women between the ages of 30 and 50 who have undergone extensive examinations to find the source of their symptoms. To diagnose MALS, other underlying pathologies should initially be excluded. The gold standard is aortic angiography. Although diagnosis and treatment of MALS are unclear, symptom resolution has been achieved with multiple surgical modalities, including open, laparoscopic or robotic ligament release as well as celiac ganglionectomy, which often requires celiac artery revascularisation.

Keywords: differential diagnosis, epigastric pain, median arcuate ligament syndrome, celiac trunk

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Authors: Jason Ceavers, Travis Thompson, Juan Torres, Ramanakumar Anam, Alan Wong, Andrei Carvalho, Shane Quo, Shawn Alonso, Moises Cintron, Ricardo C. Carrero, German Lopez, Vamsi Garimella, German Giese

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Introduction: Advance directives (AD) are essential for patients to communicate their wishes when they are not able to. Ideally, these discussions should not occur for the first time when a patient is hospitalized with an acute life-threatening illness. There is a large number of patients who do not have clearly documented ADs, resulting in the misutilization of resources and additional patient harm. This is a nationwide issue, and the Joint Commission has it as one of its national quality metrics. Presented here is a proposed protocol to increase the number of documented AD discussions in a community-based, internal medicine residency primary care clinic in South Florida. Methods: The SMART Aim for this quality improvement project is to increase documentation of AD discussions in the outpatient setting by 25% within three months in medicare patients. A survey was sent to stakeholders (clinic attendings, residents, medical assistants, front desk staff, and clinic managers), asking them for three factors they believed contributed most to the low documentation rate of AD discussions. The two most important factors were time constraints and systems issues (such as lack of a standard method to document ADs and ADs not being uploaded to the chart) which were brought up by 25% and 21.2% of the 32 survey responders, respectively. Pre-intervention data from clinic patients in 2020-2021 revealed 17.05% of patients had clear, actionable ADs documented. To address these issues, an AD pocket card was created to give to patients. One side of the card has a brief explanation of what ADs are. The other side has a column of interventions (cardiopulmonary resuscitation, mechanical ventilation, dialysis, tracheostomy, feeding tube) with boxes patients check off if they want the intervention done, do not want the intervention, do not want to discuss the topic, or need more information. These cards are to be filled out and scanned into their electronic chart to be reviewed by the resident before their appointment. The interventions that patients want more information on will be discussed by the provider. If any changes are made, the card will be re-scanned into their chart. After three months, we will chart review the patients seen in the clinic to determine how many medicare patients have a pocket card uploaded and how many have advance directives discussions documented in a progress note or annual wellness note. If there is not enough time for an AD discussion, a follow-up appointment can be scheduled for that discussion. Discussion: ADs are a crucial part of patient care, and failure to understand a patient’s wishes leads to improper utilization of resources, avoidable litigation, and patient harm. Time constraints and systems issues were identified as two major factors contributing to the lack of advance directive discussion in our community-based resident primary care clinic. Our project aims at increasing the documentation rate for ADs through a simple pocket card intervention. These are self-explanatory, easy to read and allow the patients to clearly express what interventions they desire or what they want to discuss further with their physician.

Keywords: advance directives, community-based, pocket card, primary care clinic

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Authors: Michael Radwan Omary

Abstract:

Context: This scientific innovation demonstrate organic catalysis engineered media effective desalination of surface and groundwater. The author has developed a technology called “Storm-Water Ions Filtration Treatment” (SWIFTTM) cold reactor modules designed to retrofit typical urban street storm drains or catch basins. SWIFT triggers biochemical redox reactions with water stream-embedded toxic total dissolved solids (TDS) and electrical conductivity (EC). SWIFTTM Catalysts media unlock the sub-molecular bond energy, break down toxic chemical bonds, and neutralize toxic molecules, bacteria and pathogens. Research Aim: This research aims to develop and design lower O&M cost, zero-brine discharge, energy input-free, chemical-free water desalination and disinfection systems. The objective is to provide an effective resilient and sustainable solution to urban storm-water and groundwater decontamination and disinfection. Methodology: We focused on the development of organic, non-chemical, no-plugs, no pumping, non-polymer and non-allergenic approaches for water and waste water desalination and disinfection. SWIFT modules operate by directing the water stream to flow freely through the electrically charged media cold reactor, generating weak interactions with a water-dissolved electrically conductive molecule, resulting in the neutralization of toxic molecules. The system is powered by harvesting sub-molecular bonds embedded in energy. Findings: The SWIFTTM Technology case studies at CSU-CI and CSU-Fresno Water Institute, demonstrated consistently high reduction of all 40 detected waste-water pollutants including pathogens to levels below a state of California Department of Water Resources “Drinking Water Maximum Contaminants Levels”. The technology has proved effective in reducing pollutants such as arsenic, beryllium, mercury, selenium, glyphosate, benzene, and E. coli bacteria. The technology has also been successfully applied to the decontamination of dissolved chemicals, water pathogens, organic compounds and radiological agents. Theoretical Importance: SWIFT technology development, design, engineering, and manufacturing, offer cutting-edge advancement in achieving clean-energy source bio-catalysis media solution, an energy input free water and waste water desalination and disinfection. A significant contribution to institutions and municipalities achieving sustainable, lower cost, zero-brine and zero CO2 discharges clean energy water desalination. Data Collection and Analysis Procedures: The researchers collected data on the performance of the SWIFTTM technology in reducing the levels of various pollutants in water. The data was analyzed by comparing the reduction achieved by the SWIFTTM technology to the Drinking Water Maximum Contaminants Levels set by the state of California. The researchers also conducted live oral presentations to showcase the applications of SWIFTTM technology in storm water capture and decontamination as well as providing clean drinking water during emergencies. Conclusion: The SWIFTTM Technology has demonstrated its capability to effectively reduce pollutants in water and waste water to levels below regulatory standards. The Technology offers a sustainable solution to groundwater and storm-water treatments. Further development and implementation of the SWIFTTM Technology have the potential to treat storm water to be reused as a new source of drinking water and an ambient source of clean and healthy local water for recharge of ground water.

Keywords: catalysis, bio electro interactions, water desalination, weak-interactions

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Authors: Mehrdad Abkenari, Naghmeh Pournayeb, Mohsen Ramezan Shirazi

Abstract:

Nano-science has been widely used in different engineering sciences. Generally, materials’ application can be determined through their chemical and physical properties. Nano-science has introduced as a new way in production systems that not only turns the materials into very small particles but also, gives them new and considerable properties. Like other fields of study, civil engineering has not been ignorant of benefits and characteristics of new nanotechnology and has used it in the construction industry and environmental engineering. Therefore, considering such chemical properties as elemental analysis and molecular or atomic structure, the present article is aimed at studying the effects of Nano-materials on different branches of civil engineering. Finally, by identifying new Nano-materials, this study attempts to introduce advantages of using these materials for increasing the strength of materials during construction as well as finding new approaches to prevent or reduce the entrance of chemical pollutants during or after construction to the environment.

Keywords: civil, nano-science, construction, environment

Procedia PDF Downloads 415