Search results for: Diagnostic errors

Authors: S. Gharbi, S. Labidi, M. Mars, M. Chelli, F. Ladeb

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The purpose of this study is to reduce radiation dose for chest CT examination by including Tube Current Modulation (TCM) to a standard CT protocol. A scan of an anthropomorphic male Alderson phantom was performed on a 128-slice scanner. The estimation of effective dose (ED) in both scans with and without mAs modulation was done via multiplication of Dose Length Product (DLP) to a conversion factor. Results were compared to those measured with a CT-Expo software. The size specific dose estimation (SSDE) values were obtained by multiplication of the volume CT dose index (CTDIvol) with a conversion size factor related to the phantom’s effective diameter. Objective assessment of image quality was performed with Signal to Noise Ratio (SNR) measurements in phantom. SPSS software was used for data analysis. Results showed including CARE Dose 4D; ED was lowered by 48.35% and 51.51% using DLP and CT-expo, respectively. In addition, ED ranges between 7.01 mSv and 6.6 mSv in case of standard protocol, while it ranges between 3.62 mSv and 3.2 mSv with TCM. Similar results are found for SSDE; dose was higher without TCM of 16.25 mGy and was lower by 48.8% including TCM. The SNR values calculated were significantly different (p=0.03<0.05). The highest one is measured on images acquired with TCM and reconstructed with Filtered back projection (FBP). In conclusion, this study proves the potential of TCM technique in SSDE and ED reduction and in conserving image quality with high diagnostic reference level for thoracic CT examinations.

Keywords: anthropomorphic phantom, computed tomography, CT-expo, radiation dose

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Authors: Mohammad Naeem Lakanwall

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Background:The thyroid gland, located just below the vocal cord on each side of and anterior to the trachea, is one of the main endocrine glands. Its normal weight is 15 to 20 grams in adults. The thyroid secretes two most important hormones, thyroxine and triiodothyronine, usually called T4 and T3, respectively. These hormones greatly increase the metabolic rate of the body. In addition to T3 and T4, the thyroid gland secrets calcitonin as well which is a significant hormone for calcium metabolism. Objective: The aim of this study is to estimate the proportion of and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Material and Methods: An analytical cross-sectional study design was conducted from July to Sep 2018. Blood samples were obtained, serum TSH levels were measured, and the patients were divided into three diagnostic categories according to their serum TSH concentrations. 1) Hypothyroidism 2) Hyperthyroidism 3) Normal thyroid Results: A total of 127 individuals were part of the sample for the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction and the majority of the female participants, (85%) were not pregnant in the last two years. Furthermore, 98% of participants, were non-smokers. Conclusion: The findings of the current study showed a high prevalence of thyroid dysfunctions in individuals coming to FMIC for thyroid functions tests. The findings also indicated that aging and smoking are the factors associated with thyroid dysfunctions. Further studies are needed to find out the prevalence of and factors associated with thyroid dysfunctions.

Keywords: Afghanistan, Kabul, hypothyroidism, hyperthyroidism, triiodothyronine, thyroxine

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Authors: Shukla Ila, Azmi Lubna, S. S. Gupta, Ch. V. Rao

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Oxidative stress has been increasingly associated with the induction and progression of liver damage. The current study was conducted to record the effect of combination of Lactobacillus and Lichen rangiferinus extract (LRE + Lac) on the severity of injury in experimental alcoholic liver disease and how it affects plasma levels of prostaglandin E2, endotoxin, thromboxane B2, and leukotriene B4. Male Wistar rats were grouped into five comprising six animals in each group. Group 1 served as negative control. Groups 2-5 were administered 10% ethanol for six weeks. Group 3 was administered with extract (200 mg/kg), group 4 received the diet containing 10% ethanol plus a bolus of lactobacilli GG (1010 CFU), and group 5 animals were given silymarin along with alcohol and it served as positive control. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein content, γ-glutamyltransferase, glutathione S-transferase, oxidative stress markers, glutathione, malondialdehyde and glutathione reductase were determined using standard diagnostic kits. Histopathological analysis of liver tissue was also made. A positive relation was found between plasma endotoxin levels and degree of liver injury. The pathology records were also related positively with leukotriene B4 and thromboxane B2. But a negative correlation was obtained with PgE2 levels. This study led us to hypothesize that the increased endotoxin levels modulate liver metabolism of eicosanoid, which gradually leads to liver injury. Endotoxemia increases leukotriene and thromboxane levels in plasma.

Keywords: lactobacillus, Lichen rangiferinus, endotoxemia, silymarin

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Authors: Seyed Davar Siadat, Samira Tarashi, Abolfazl Fateh, Arfa Moshiri

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Background: The global health issue of tuberculosis (TB) still affects patients in every country. TB control may not be as effective as it should be, especially when resistant strains are involved. In this regard, mycobacterial MTases play a major role in tuberculosis, but the mechanisms underlying their function have yet to be fully deciphered. Methods: Five resistant isolates of M.tb were accumulated. As a reference strain, M.tb H37Rv (ATCC 27249) was used. For this analysis, seven putative mycobacterial MTase genes (Rv0645c, Rv1694, Rv2966c, Rv3919c, Rv2756c, Rv1988, and Rv3263), as well as Rv1392 as SAM synthase, were selected. Comparing mutations and expression levels of MTases in different strains was accomplished by PCR-sequencing and qRT-PCR. The relative expression levels of these genes were calculated using the 2 -ΔΔCt method. Results: The Rv3919c gene (T to G in codon 341) and Rv1392 gene (G to A in codon 97) were the only mutations found in the INHR strain. In all sensitive and resistant isolates, Rv0645c, Rv3263, Rv2756c, and Rv2966c were overexpressed. However, the expression of Rv1988 and Rv3919c decreased in the sensitive strains, whereas the expression of Rv1694 increased. There was also a decreased expression of Rv1392 in the INHR isolate. Conclusion: The presence of mycobacterial MTases as well as resistance to antibiotics were found to be correlated in M.tb strains. Undoubtedly, there are some MTases that are associated with the virulence process. It is necessary to conduct additional studies to fully explore the impact of mycobacterial MTases within specific strains of M.tb to develop novel diagnostic and treatment strategies.

Keywords: mycobacterium tuberculosis, drug resistance, methyltransferases, s-adenosylmethionine

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Authors: Raneem Osama Salem, Ayesha Nuzhat, Fatimah Nasser Al Shehri, Nasser Al Hamdan

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Background: Recently, most medical schools around the globe are using simulation for teaching and assessing students’ clinical skills and competence. There are many obstacles that could face students and faculty when simulation sessions are introduced into undergraduate curriculum. Objective: The aim of this study is to obtain the opinion of undergraduate medical students and our faculty regarding the role of simulation in undergraduate curriculum, the simulation modalities used, and perceived barriers in implementing stimulation sessions. Methods: To address the role of simulation, modalities used, and perceived challenges to implementation of simulation sessions, a self-administered pilot tested questionnaire with 18 items using a 5 point Likert scale was distributed. Participants included undergraduate male medical students (n=125) and female students (n=70) as well as the faculty members (n=14). Result: Various learning outcomes are achieved and improved through the technology enhanced simulation sessions such as communication skills, diagnostic skills, procedural skills, self-confidence, and integration of basic and clinical sciences. The use of high fidelity simulators, simulated patients and task trainers was more desirable by our students and faculty for teaching and learning as well as an evaluation tool. According to most of the students,' institutional support in terms of resources, staff and duration of sessions was adequate. However, motivation to participate in the sessions and provision of adequate feedback by the staff was a constraint. Conclusion: The use of simulation laboratory is of great benefit to the students and a great teaching tool for the staff to ensure students learning of the various skills.

Keywords: simulators, medical students, skills, simulated patients, performance, challenges, skill laboratory

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Authors: Omar Farshad Jeelani, Makaire Njie, Viktoriia M. Korzhuk

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Recently, the application of AI-powered algorithms in healthcare continues to flourish. Particularly, access to healthcare information, including patient health history, diagnostic data, and PII (Personally Identifiable Information) is paramount in the delivery of efficient patient outcomes. However, as the exchange of healthcare information between patients and healthcare providers through AI-powered solutions increases, protecting a person’s information and their privacy has become even more important. Arguably, the increased adoption of healthcare AI has resulted in a significant concentration on the security risks and protection measures to the security and privacy of healthcare data, leading to escalated analyses and enforcement. Since these challenges are brought by the use of AI-based healthcare solutions to manage healthcare data, AI-based data protection measures are used to resolve the underlying problems. Consequently, this project proposes AI-powered safeguards and policies/laws to protect the privacy of healthcare data. The project presents the best-in-school techniques used to preserve the data privacy of AI-powered healthcare applications. Popular privacy-protecting methods like Federated learning, cryptographic techniques, differential privacy methods, and hybrid methods are discussed together with potential cyber threats, data security concerns, and prospects. Also, the project discusses some of the relevant data security acts/laws that govern the collection, storage, and processing of healthcare data to guarantee owners’ privacy is preserved. This inquiry discusses various gaps and uncertainties associated with healthcare AI data collection procedures and identifies potential correction/mitigation measures.

Keywords: data privacy, artificial intelligence (AI), healthcare AI, data sharing, healthcare organizations (HCOs)

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Authors: Catalina Albornoz, Giacomo Barbieri

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Crop monitoring has shown to reduce vulnerability to spreading plagues and pathologies in crops. Remote sensing with Unmanned Aerial Vehicles (UAVs) has made crop monitoring more precise, cost-efficient and accessible. Nowadays, remote monitoring involves calculating maps of vegetation indices by using different software that takes either Truecolor (RGB) or multispectral images as an input. These maps are then used to segment the crop into management zones. Finally, knowing the spectral signature of a crop (the reflected radiation as a function of wavelength) can be used as an input for decision-making and crop characterization. The calculation of vegetation indices using software such as Pix4D has high precision for monoculture plantations. However, this paper shows that using this software on mixed crops may lead to errors resulting in an incorrect segmentation of the field. Within this work, authors propose to filter all the elements different from the main crop before the calculation of vegetation indices and the spectral signature. A filter based on the Sobel method for border detection is used for filtering a coffee crop. Results show that segmentation into management zones changes with respect to the traditional situation in which a filter is not applied. In particular, it is shown how the values of the spectral signature change in up to 17% per spectral band. Future work will quantify the benefits of filtering through the comparison between in situ measurements and the calculated vegetation indices obtained through remote sensing.

Keywords: coffee, filtering, mixed crop, precision agriculture, remote sensing, spectral signature

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Authors: A. A. M. A. S. S. Perera, L. A. Ranasinghe, T. K. H. Nimeshika, D. M. Dhanushka Dissanayake, Namalie Walgampaya

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Nowadays, skin fungal diseases are mostly found in people of tropical countries like Sri Lanka. A skin fungal disease is a particular kind of illness caused by fungus. These diseases have various dangerous effects on the skin and keep on spreading over time. It becomes important to identify these diseases at their initial stage to control it from spreading. This paper presents an automated skin fungal disease identification system implemented to speed up the diagnosis process by identifying skin fungal infections in digital images. An image of the diseased skin lesion is acquired and a comprehensive computer vision and image processing scheme is used to process the image for the disease identification. This includes colour analysis using RGB and HSV colour models, texture classification using Grey Level Run Length Matrix, Grey Level Co-Occurrence Matrix and Local Binary Pattern, Object detection, Shape Identification and many more. This paper presents the approach and its outcome for identification of four most common skin fungal infections, namely, Tinea Corporis, Sporotrichosis, Malassezia and Onychomycosis. The main intention of this research is to provide an automated skin fungal disease identification system that increase the diagnostic quality, shorten the time-to-diagnosis and improve the efficiency of detection and successful treatment for skin fungal diseases.

Keywords: Circularity Index, Grey Level Run Length Matrix, Grey Level Co-Occurrence Matrix, Local Binary Pattern, Object detection, Ring Detection, Shape Identification

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Authors: Xin Yuan, Yuji Ryu

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The indoor environment has a significant impact on occupants and a suitable indoor thermal environment can improve the children’s physical health and study efficiency during school hours. In this study, we explored the thermal environment in infant facilities classrooms for infants and children aged 1-5 and evaluated their thermal comfort. An infant facility in Fukuoka, Japan was selected for a case study to capture the infant and children’s thermal comfort characteristics in summer and winter from August 2019 to February 2020. Previous studies have pointed out using PMV indices to evaluate the thermal comfort for children could create errors that may lead to misleading results. Thus, to grasp the actual thermal environment and thermal comfort characteristics of infants and children, we retrieved the operative temperature of each child through the thermal model, based on the sensible heat transfer from the skin to the environment, and the measured classroom indoor temperature, relative humidity, and pocket temperature of children’s shorts. The statistical and comparative analysis of the results shows that (1) the operative temperature showed a large individual difference among children, with the maximum reached 6.25 °C. (2) The children might feel slightly cold in the classrooms in summer, with the frequencies of operative temperature within the interval of 26-28 ºC were only 5.33% and 16.6% for children respectively. (3) The thermal environment around children is more complicated in winter the operative temperature could exceed or fail to reach the thermal comfort temperature zone (20-23 ºC interval). (4) The environmental conditions surrounding the children may account for the reduction of their thermal comfort. The findings contribute to improving the understanding of the infant and children’s thermal comfort and provide valuable information for designers and governments to develop effective strategies for the indoor thermal environment considering the perspective of children.

Keywords: infant and children, thermal environment, thermal model, operative temperature.

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Authors: Seyed Sadegh Naseralavi, Sadegh Balaghi, Ehsan Khojastehfar

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Time history seismic analysis is supposed to be the most accurate method to predict the seismic demand of structures. On the other hand, the required computational time of this method toward achieving the result is its main deficiency. While being applied in optimization process, in which the structure must be analyzed thousands of time, reducing the required computational time of seismic analysis of structures makes the optimization algorithms more practical. Apparently, the invented approximate methods produce some amount of errors in comparison with exact time history analysis but the recently proposed method namely, Complete Quadratic Combination (CQC) and Sum Root of the Sum of Squares (SRSS) drastically reduces the computational time by combination of peak responses in each mode. In the present research, the Basic Modal Displacement (BMD) method is introduced and applied towards estimation of seismic demand of main structure. Seismic demand of sampled structure is estimated by calculation of modal displacement of basic structure (in which the modal displacement has been calculated). Shear steel sampled structures are selected as case studies. The error applying the introduced method is calculated by comparison of the estimated seismic demands with exact time history dynamic analysis. The efficiency of the proposed method is demonstrated by application of three types of earthquakes (in view of time of peak ground acceleration).

Keywords: time history dynamic analysis, basic modal displacement, earthquake-induced demands, shear steel structures

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Authors: Monika Szpringer, Mariola Wojciechowska, Robert Dutkiewicz, Grażyna Nowak-Starz, Marzena Olędzka

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The main aim of this article is to determine the phenomenon of stress among academic teachers as well as to identify the extent to which the teachers experience work-related psychological risks. It is also important to support academic teachers trade unions in scope of stress-oriented activities, including psychological dangers in the assessment of risk in the workplace (college). The authors used a method of a diagnostic survey with a polling as a technique and authors’ questionnaire as a tool. The survey was conducted between September and December of 2013 and it comprised 1890 academic teachers from five voivodeships. The study reveals that 84.0% of the respondents found the work of an academic teacher to be borne with a considerable stress. The percentage values of the most frequent causes of stress are as follows: frequent changes of both organisational and didactic matters as well as overwhelming bureaucracy (77.8 %), time pressure regarding professional development and related risk of losing job (68.2 %), difficult working conditions (45.4%), conflicts and rivalry between teachers (44.1%), excessive amount of duties as well as increasing requirements and demanding attitude of students (33.7%). Work-related stress affects or significantly affects the private life of 69 % and 66.4 % of the respondents respectively. The majority of the people surveyed deals with stress by undertaking various activities, with 40% pointing at using various substances, mostly cigarettes and alcohol (p > 0,05) Physical ailments were experienced by 81% of the respondents, in 9% they were rare and 8 % of the respondents had never experienced such disorders. The entire group of the surveyed people (100 %) claimed that they have no possibility of contacting a psychologist at their workplace (p > 0.05), and they stated that the need of contacting specialists does exist.

Keywords: stress, academic teachers, psychological risks, work-related

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Authors: Ernesto A. Lagarda-Leyva, Manuel A. Valenzuela L., José G. Oshima C., Arnulfo A. Naranjo-Flores

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From August to December of 2016, a diagnostic and strategic planning study was carried out on the supply chain of the company Agropecuaria GABO S.A. de C.V. The final product of the study was the development of the strategic plan and a project portfolio to meet the demands of the three links in the supply chain of the Roma tomato exported annually to the United States of America. In this project, the strategic objective of ensuring the proper handling of the product was selected and one of the goals associated with this was the employment of quantitative methods to support decision making. Considering the antecedents, the objective of this case study was to develop a model to analyze the behavioral dynamics in the distribution chain, from the logistics of storage and shipment of Roma tomato in 81-case pallets (11.5 kg per case), to the two pre-cooling rooms and eventual loading onto transports, seeking to reduce the bottleneck and the associated costs by means of a dynamic interface. The methodology used was that of system dynamics, considering four phases that were adapted to the purpose of the study: 1) the conceptualization phase; 2) the formulation phase; 3) the evaluation phase; and 4) the communication phase. The main practical conclusions lead to the possibility of reducing both the bottlenecks in the cooling rooms and the costs by simulating scenarios and modifying certain policies. Furthermore, the creation of the dynamic interface between the model and the stakeholders was achieved by generating interaction with buttons and simple instructions that allow making modifications and observing diverse behaviors.

Keywords: agrilogistics, distribution, scenarios, system dynamics

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Authors: Aliasghar Golmohammadian, Sona Rostampour Yasouri

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One of the most important intestinal pathogenic strains is E. coli O₁₅₇:H₇. This pathogenic bacterium is transmitted to humans through water and food. E. coli O₁₅₇:H₇ is the main cause of Hemorrhagic colitis (HC), Hemolytic Uremic Syndrome (HUS), Thrombotic Thrombocytopenic Purpura (TTP) and in some cases death. Since E. coli O₁₅₇:H₇ can be transmitted through the consumption of different foods, including vegetables, agricultural products, and fresh dairy products, this study aims to identify and isolate E. coli O₁₅₇:H₇ from wastewater by PCR technique. One hundred twenty samples of water and wastewater were collected by Falcom Sterile from Shahrood and Neka cities. The samples were checked for colony formation after appropriate centrifugation and cultivation in the specific medium of Sorbitol MacConkey Agar (SMAC) and other diagnostic media of E. coli O₁₅₇:H₇. Also, the plates were observed macroscopically and microscopically. Then, the necessary phenotypic tests were performed on the colonies, and finally, after DNA extraction, the PCR technique was performed with specific primers related to rfbE and stx2 genes. The number of 5 samples (6%) out of all the samples examined were determined positive by PCR technique with observing the bands related to the mentioned genes on the agarose gel electrophoresis. PCR is a fast and accurate method to identify the bacteria E. coli O₁₅₇:H₇. Considering that E. coli bacteria is a resistant bacteria and survives in water and food for weeks and months, the PCR technique can provide the possibility of quick detection of contaminated water. Moreover, it helps people in the community control and prevent the transfer of bacteria to healthy and underground water and agricultural and even dairy products.

Keywords: E. coli O₁₅₇:H₇, PCR, water, wastewater

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Authors: Abdullah A. Al Qurashi, Hattan A. Hassani, Bader K. Alaslap

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Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) is an uncommon, inheritable cardiac disorder characterized by the progressive substitution of cardiac myocytes by fibro-fatty tissues. This pathologic substitution predisposes patients to ventricular arrhythmias and right ventricular failure. The underlying genetic defect predominantly involves genes encoding for desmosome proteins, particularly plakophilin-2 (PKP2). These aberrations lead to impaired cell adhesion, heightening the susceptibility to fibrofatty scarring under conditions of mechanical stress. Primarily, ARVD/C affects the right ventricle, but it can also compromise the left ventricle, potentially leading to biventricular heart failure. Clinical presentations can vary, spanning from asymptomatic individuals to those experiencing palpitations, syncopal episodes, and, in severe instances, sudden cardiac death. The establishment of a diagnostic criterion specifically tailored for ARVD/C significantly aids in its accurate diagnosis. Nevertheless, the task of early diagnosis is complicated by the disease's frequently asymptomatic initial stages, and the overall rarity of ARVD/C cases reported globally. In some cases, as exemplified by the adult female patient in this report, the disease may advance to terminal stages, rendering therapies like Ventricular Tachycardia (VT) ablation ineffective. This case underlines the necessity for increased awareness and understanding of ARVD/C to aid in its early detection and management. Through such efforts, we aim to decrease morbidity and mortality associated with this challenging cardiac disorder.

Keywords: arrhythmogenic right ventricular dysplasia, cardiac disease, interventional cardiology, cardiac electrophysiology

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Authors: Rajendra N. Ghosh, Paramjeet Singh, Niranjan Khandelwal, Sameer Vyas, Pratibha Singhi, Naveen Sankhyan

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Background: Tuberculoma and neurocysticercosis (NCC) are two most common intracranial infections in developing country. They often simulate on neuroimaging and in absence of typical imaging features cause significant diagnostic dilemmas. Differentiation is extremely important to avoid empirical exposure to antitubercular medications or nonspecific treatment causing disease progression. Purpose: Better characterization and differentiation of CNS tuberculoma and NCC by using morphological and multiple advanced functional MRI. Material and Methods: Total fifty untreated patients (20 tuberculoma and 30 NCC) were evaluated by using conventional and advanced sequences like CISS, SWI, DWI, DTI, Magnetization transfer (MT), T2Relaxometry (T2R), Perfusion and Spectroscopy. rCBV,ADC,FA,T2R,MTR values and metabolite ratios were calculated from lesion and normal parenchyma. Diagnosis was confirmed by typical biochemical, histopathological and imaging features. Results: CISS was most useful sequence for scolex detection (90% on CISS vs 73% on routine sequences). SWI showed higher scolex detection ability. Mean values of ADC, FA,T2R from core and rCBV from wall of lesion were significantly different in tuberculoma and NCC (P < 0.05). Mean values of rCBV, ADC, T2R and FA for tuberculoma and NCC were (3.36 vs1.3), (1.09x10⁻³vs 1.4x10⁻³), (0.13 x10⁻³ vs 0.09 x10⁻³) and (88.65 ms vs 272.3 ms) respectively. Tuberculomas showed high lipid peak, more choline and lower creatinine with Ch/Cr ratio > 1. T2R value was most significant parameter for differentiation. Cut off values for each significant parameters have proposed. Conclusion: Quantitative MRI in combination with conventional sequences can better characterize and differentiate similar appearing tuberculoma and NCC and may be incorporated in routine protocol which may avoid brain biopsy and empirical therapy.

Keywords: advanced functional MRI, differentiation, neurcysticercosis, tuberculoma

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Authors: Robin L. Rohrer

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Introduction: Pre-natal or early childhood exposure to the medical radiation used in diagnosis or treatment is an identified risk for childhood cancers but can be difficult to document. The author developed a family questionnaire/interview form to identify possible exposures. Aims: This retrospective study examines pre-natal and early childhood medical radiation exposure in a cohort of children diagnosed with a solid tumor including brain tumors from 1985-2015 at the Children’s Hospital of Pittsburgh (CHP). The hospital is a tri-state regional referral center which treats about 150-180 new cases of cancer in children per year. About 70% are diagnosed with a solid tumor. Methods: Each consented family so far (approximately 50% of the cohort) has been interviewed in person or by the phone call. Medical staff and psycho- social staff referred patient families for the interview with the author. Results: Among the families interviewed to date at least one medical radiation exposure has been identified (pre-conception, pre-natal or early childhood) in over 70% of diagnosed children. These exposures have included pre-conception sinus or chest CT or X-ray in either parent, sinus CT or X-ray in the mother or diagnostic radiation of chest or abdomen in children. Conclusions: Exposures to medical radiation for a child later diagnosed with cancer may occur at several critical junctures. These exposures may well contribute to a ‘perfect storm’ in the still elusive causes of childhood cancer. The author plans to expand the study from 1975 to present to hopefully further document these junctures.

Keywords: pediatric, solid tumors, medical radiation, cancer

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Authors: Jadwiga Klukow, Anna Ksykiewicz-Dorota

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An analysis of the distribution of nurses’ working time constitutes vital information for the management in planning employment. The objective of the study was to analyze the distribution of nurses’ working time in an emergency department. The study was conducted in an emergency department of a teaching hospital in Lublin, in Southeast Poland. The catalogue of activities performed by nurses was compiled by means of continuous observation. Identified activities were classified into four groups: Direct care, indirect care, coordination of work in the department and personal activities. Distribution of nurses’ working time was determined by work sampling observation (Tippett) at random intervals. The research project was approved by the Research Ethics Committee by the Medical University of Lublin (Protocol 0254/113/2010). On average, nurses spent 31% of their working time on direct care, 47% on indirect care, 12% on coordinating work in the department and 10% on personal activities. The most frequently performed direct care tasks were diagnostic activities – 29.23% and treatment-related activities – 27.69%. The study has provided information on the complexity of performed activities and utilization of nurses’ working time. Enhancing the effectiveness of nursing actions requires working out a strategy for improved management of the time nurses spent at work. Increasing the involvement of auxiliary staff and optimizing communication processes within the team may lead to reduction of the time devoted to indirect care for the benefit of direct care.

Keywords: emergency nurses, nursing care, workload, work sampling

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Authors: Mohammad Naeem Lakanwall, Jamshid Abdul-Ghafar

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Background: Endocrinopathies are a commonly occurring entity, particularly those of the thyroid gland; however, there is a lack of scientific literature from Afghanistan, a country with very limited health care facilities and resources. To our best knowledge, this is the first study aimed to describe the frequency of occurrence and factors associated with thyroid dysfunction in the Afghan population. The aim of this study is to estimate the frequency and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Methods: A cross-sectional study was conducted from July to Sep 2018 at the Department of Clinical Pathology, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan. Blood samples were obtained, serum TSH levels were analyzed, and the patients were divided into three diagnostic categories according to their serum TSH concentrations: 1) hypothyroidism, 2) hyperthyroidism, 3) normal. Results: A total of 127 individuals were included in the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction. 74% of the participants in the study had normal TSH levels classified as normal thyroid function, (14%) had lower TSH levels, and (12%) higher TSH levels, classified as hyper and hypothyroid, respectively. Conclusions: The findings of the current study showed a high frequency of thyroid dysfunctions from a single center. Further large-scale studies are needed to find out the prevalence and document this entity for better health outcomes in the country.

Keywords: Afghanistan, factors, frequency, hypothyroid, hyperthyroid, thyroid, thyroid stimulating hormone

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Authors: V. Mentl, V. Koula, P. Mazal, J. Volák

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Nowadays, the acoustic emission is a widely recognized method of material damage investigation, mainly in cases of cracks initiation and growth observation and evaluation. This is highly important in structures, e.g. pressure vessels, large steam turbine rotors etc., applied both in classic and nuclear power plants. Nevertheless, the acoustic emission signals must be correlated with the real crack progress to be able to evaluate the cracks and their growth by this non-destructive technique alone in real situations and to reach reliable results when the assessment of the structures' safety and reliability is performed and also when the remaining lifetime should be evaluated. The main aim of this study was to propose a methodology for evaluation of the early manifestations of the fatigue cracks and their growth and thus to quantify the material damage by acoustic emission parameters. Specimens made of several steels used in the power producing industry were subjected to fatigue loading in the low- and high-cycle regimes. This study presents results of the crack growth rate measurement obtained by the classic compliance change method and the acoustic emission signal analysis. The experiments were realized in cooperation between laboratories of Brno University of Technology and West Bohemia University in Pilsen within the solution of the project of the Czech Ministry of Industry and Commerce: "A diagnostic complex for the detection of pressure media and material defects in pressure components of nuclear and classic power plants" and the project “New Technologies for Mechanical Engineering”.

Keywords: fatigue, crack growth rate, acoustic emission, material damage

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Authors: H. El-Messiry, M. El-Zainy, D. Abdelkhalek

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Cone-beam computed tomography (CBCT) provides high-quality 3-dimensional images of dental structures because of its high spatial resolution. The study of dental morphology is important in research as it provides information about diversities within a population. Many studies have shown different shapes and numbers of roots canals among different races, especially in molars. The aim of this study was to determine the morphology of root canals of mandibular first and third molars in a sample of Egyptian population using CBCT scanning. Fifty mandibular first Molars (M1) and fifty mandibular third (M3) extracted molars were collected. Thick rectangular molds were made using pink wax to hold the samples. Molars were embedded in the wax mold by aligning them in rows leaving arbitrary 0.5cm space between them. The molds with the samples in were submitted for CBCT scan. The number and morphology of root canals were assessed and classified according to Vertucci's classification. The mesial and the distal roots were examined separately. Finally, data was analyzed using Fisher exact test. The most prevalent mesial root canal frequency in M1 was type IV (60%) and type II (40 %), while M3 showed prevalence of type I (40%) and II (40%). Distal root canal morphology showed prevalence of type I in both M1 (66%) and M3 (86%). So, it can be concluded that CBCT scanning provides supplemental information about the root canal configurations of mandibular molars in a sample of Egyptian population. This study may help clinicians in the root canal treatment of mandibular molars.

Keywords: cone beam computed tomography, mandibular first molar, mandibular third molar, root canal morphology

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Authors: Zahra Khan

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Surface-Enhanced Raman Spectroscopy (SERS) has received increased attention in recent years, focusing on biological and medical applications due to its great sensitivity as well as molecular specificity. In the context of biological samples, there are generally two methodologies for SERS based applications: label-free detection and the use of SERS tags. The necessity of tagging can make the process slower and limits the use for real life. Label-free detection offers the advantage that it reports direct spectroscopic evidence associated with the target molecule rather than the label. Reproducible, highly monodisperse gold nanoparticles (Au NPs) were synthesized using a relatively facile seed-mediated growth method. Different capping agents (TRIS, citrate, and CTAB) were used during synthesis, and characterization was performed. They were then mixed with different analyte solutions before drop-casting onto a glass slide prior to Raman measurements to see which NPs displayed the highest SERS activity as well as their stability. A host of different analytes were tested, both non-biomolecules and biomolecules, which were all successfully detected using this method at concentrations as low as 10-3M with salicylic acid reaching a detection limit in the nanomolar range. SERS was also performed on samples with a mixture of analytes present, whereby peaks from both target molecules were distinctly observed. This is a fast and effective rapid way of testing samples and offers potential applications in the biomedical field as a tool for diagnostic and treatment purposes.

Keywords: gold nanoparticles, label free, seed-mediated growth, SERS

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Authors: Awad Mohamed Elkhadir, Rajab M. Ben Yousef

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Background/Aim: Radiological technologists are medical professionals who perform diagnostic imaging tests such as X-rays, magnetic resonance imaging (MRI) scans, and computer tomography (CT) scans. Despite the recognition of image interpretation by British radiologists, it is still considered a problem in the Arab world. This study evaluates the perceptions of radiologists in the Middle East concerning the plain image interpretation of adults by radiologic technologist specialists. Methods: This is a cross-sectional study that follows a quantitative approach. A close-ended questionnaire was distributed among 103 participants who were radiologists by profession from various hospitals in Saudi Arabia and Sudan. The gathered data was then analyzed through Statistical Package for Social Sciences (SPSS). Results: The results showed that 29% recognized the Radiologic Technologist Specialist (RTS) role of writing image reports, while 61% did not. A total of 38% of participants believed that RTS image interpretation would help diagnose unreported radiographs. 47% of the sample responded that the workload and stress on radiologists would reduce by allowing reporting for RTS, while 37% did not. Lastly, 43% believe that image interpretation by RTS can be introduced into the Middle East in the future. Conclusion: The study's findings reveal that the combination of image reporting and radiography improves the care of the patients. The study's outcomes also show that the burden of the medical practitioners reduces due to image reporting of the radiographers. Further researches need to be conducted in the Arab World to obtain and measure the associated factors of the desired criteria.

Keywords: Arab world, image interpretation, radiographer, radiologist, Saudi Arabia, Sudan

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Authors: Diego Carrasco, Catarina Freitas, Hugo Rio Tinto, Ricardo Rio Tinto, Nuno Couto, Joaquim Gago, Carlos Carvalho

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Introduction: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) to drain the gallbladder can be a palliative care procedure for non-surgical oncologic patients with cholelithiasis and cholangitis process. Case description: A 59-years old Caucasian male diagnosed with extrahepatic cholangiocarcinoma with multiple liver, lung and peritoneum metastasis, unresponsive to treatment with gemcitabine/cisplatin, presented in the institution with fever, hypotension, and severe upper right abdominal pain secondary to cholelithiasis and cholangitis process. The patient was admitted and started on large spectrum antibiotics plus fluid-challenge. Afterward, a percutaneous transhepatic biliary drainage (PTBD) was performed to drain the gallbladder. This procedure temporarily stabilized the patient. However, the definitive solution required gallbladder removal. Since the patient exhibited an advanced oncologic disease and poor response to the chemotherapy, he was not a candidate for surgical intervention. Diagnostic Pathways: A self-expanding metal stent was placed from the duodenum into the bile duct by endoscopic ultrasound-guided. The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure. Conclusion and Discussion: The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure and successfully reversed the cholangitis process. EUS-CD is an effective and safe technique and can be used as a palliative care procedure for non-surgical oncologic patients.

Keywords: palliative care, cholangiocarcinoma, choledochoduodenostomy, endoscopic ultrasound-guided

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Authors: Kathleen Seers, Rachel Hogg

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Diagnosis of Autism Spectrum Disorder (ASD) in women is increasing, prompting research into the presentation of female ASD and exploring why females are failing to meet the diagnostic threshold. One explanation is the use of masking behaviors, where traits of ASD are suppressed and gender-appropriate behaviors are mimicked to reduce the visibility and victimization of ASD girls. Current research explores ASD presentation and the lived experiences of ASD girls and adolescents; however, there is a paucity of literature in relation to the intra- and inter- psychic experiences of ASD women. Through a social constructionist framework, this qualitative study sought to understand how the construction of gender and the medicalisation of ASD influences women’s experiences of ASD. This study also explored the use and consequence of masking strategies and the impact this has on well-being. Eight women were interviewed, and three major themes were identified. The themes outline the influence of gender expectations and social norms on the women’s experiences, the significance of diagnosis to their identity, and the influence of the medicalization of ASD. Participants shared experiences of feeling different and internalizing blame for this difference. The feeling of difference was a major contributor to the women’s positive or negative mental well-being. The process of diagnosis allowed participants to create and confirm their identity. Diagnosis also led to improvements in well-being, however, the findings also explore the complexity of labeling individuals with a disorder and the difficulties that arise from the construct of ‘functionality’ for those with Autism. The study also explores the temporal nature of ASD and the changing experiences of women as they mature. It is hoped this study promotes discussion and provides clinicians and those connected to ASD women with insights into the support ASD women require to live authentic lives.

Keywords: female autism, gender, masking, social constructionism

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Authors: J. K. Ebigwai, E. Asuquo

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Systematic affinities among Cucurbitaceae members are highly debatable as exemplified by diverging views on their phylogenies. Worst still is the overriding reliance on morphometric marker in the delimitation of cucurbitoideae members. Considerable symplesiomorphic and synapmorphic character states have been observed among some members of same genera than do with some members of other genera. The broad study aims at establishing phylogenies among species of Cucumis (Melothrieae), Momordica, Telfairia (Jolliffieae), Trichosanthes (Trichosantheae), Citrullus, Lagenaria, Luffa (Benincaseae) and Cucurbita (Cucurbita) using anatomical, cytological, Palynological, serological, and phytolith markers. However, this paper shall present preliminary findings on the phytolith character states for Cucumis melo, Momordica charantia, Telfairia occidentales, Trichosanthes dioica, Citrullus vulgaris, Lagenaria siceraria, Luffa cylindrical, Cucurbita pepo and Cucurbita maxima. Heavy liquid floatation method was employed in the extraction of the phytolith matter from the leaf tissues of these species. The result revealed that a bilobate short cell and a trapeziform sinuate form were absent in all the species except in Cucumis melo, Citrullus vulgaris and Lagenaria siceraria. Also a globular granulate form was observed exclusively in Telfairia occidentales, Cucurbita maxima, Momordica charantia and Luffa cylindrical. Other forms of phytolith observed were not diagnostic as they were not species specific. The results tentatively suggests a closer examination of the existing classification system.

Keywords: bilobate short cell, cucums, phytolith, telfairia, trapeziform sinuate

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Authors: Muhammad Ejaz1

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Rework has been defined as: "The unnecessary effort of re-doing a process or activity that was incorrectly implemented the first time." A great threat to the construction industry is rework. By and large due attention has not been given to avoid the causes of reworks, resulting time and cost over runs, in civil engineering projects. Besides these direct consequences, there might also be indirect consequences, such as stress, de-motivation or loss of future clients. When delivered products do not meet the requirements or expectations, work often has to be redone. Rework occurs in various phases of the construction process or in various divisions of a company. Rework can occur on the construction site or in a management department due to for example bad materials management. Rework can also have internal or external origins. Changes in clients’ expectations are an example of an external factor that might lead to rework. Rework can cause many costs to be higher than calculated at the start of the project. Rework events can have many different origins and for this research they have been categorized into four categories; changes, errors, omissions, and damages. The research showed that the major source of reworks were non professional attitude from technical hands and ignorance of total quality management principals by stakeholders. It also revealed that sources of reworks have not major differences among project categories. The causes were further analyzed by interviewing employees. Based on existing literature an extensive list of rework causes was made and during the interviews the interviewees were asked to confirm or deny statements regarding rework causes. The causes that were most frequently confirmed can be grouped into the understanding categories. 56% (max) of the causes are change-related, 30% (max) is error-related and 18% (max) falls into another category. Therefore, by recognizing above mentioned factors, reworks can be reduced to a great extent.

Keywords: total quality management, construction industry, cost overruns, rework, material management, client’s expectations

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Authors: Li-Te Lin, Chia-Jung Li, Kuan-Hao Tsui

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Cuproptosis, a newly identified cell death mechanism, has attracted attention for its association with various diseases. However, the genetic interplay between cuproptosis and ovarian aging remains largely unexplored. This study aims to address this gap by analyzing datasets related to ovarian aging and cuproptosis. Spatial transcriptome analyses were conducted in the ovaries of both young and aged female mice to elucidate the role of FDX1. Comprehensive bioinformatics analyses, facilitated by R software, identified FDX1 as a potential cuproptosis-related gene with implications for ovarian aging. Clinical infertility biopsies were examined to validate these findings, showing consistent results in elderly infertile patients. Furthermore, pharmacogenomic analyses of ovarian cell lines explored the intricate association between FDX1 expression levels and sensitivity to specific small molecule drugs. Spatial transcriptome analyses revealed a significant reduction in FDX1 expression in aging ovaries, supported by consistent findings in biopsies from elderly infertile patients. Pharmacogenomic investigations indicated that modulating FDX1 could influence drug responses in ovarian-related therapies. This study pioneers the identification of FDX1 as a cuproptosis-related gene linked to ovarian aging. These findings not only contribute to understanding the mechanisms of ovarian aging but also position FDX1 as a potential diagnostic biomarker and therapeutic target. Further research may establish FDX1's pivotal role in advancing precision medicine and therapies for ovarian-related conditions.

Keywords: cuproptosis, FDX1, ovarian aging, biomarker

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Authors: C. C. Chima, C. J. M. Anumaka

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This study evaluates environmental disclosures on the financial performance of quoted industrial goods manufacturing sectors in Nigeria. The study employed a quasi-experimental research design to establish the relationship that exists between the environmental disclosure index and financial performance indices (return on assets - ROA, return on equity - ROE, and earnings per share - EPS). A purposeful sampling technique was employed to select five (5) industrial goods manufacturing sectors quoted on the Nigerian Stock Exchange. Secondary data covering 2011 to 2020 financial years were extracted from annual reports of the study sectors using a content analysis method. The data were analyzed using SPSS, Version 23. Panel Ordinary Least Squares (OLS) regression method was employed in estimating the unknown parameters in the study’s regression model after conducting diagnostic and preliminary tests to ascertain that the data set are reliable and not misleading. Empirical results show that there is an insignificant negative relationship between the environmental disclosure index (EDI) and the performance indices (ROA, ROE, and EPS) of the industrial goods manufacturing sectors in Nigeria. The study recommends that: only relevant information which increases the performance indices should appear on the disclosure checklist; environmental disclosure practices should be country-specific; and company executives in Nigeria should increase and monitor the level of investment (resources, time, and energy) in order to ensure that environmental disclosure has a significant impact on financial performance.

Keywords: earnings per share, environmental disclosures, return on assets, return on equity

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Authors: Levent Dumenci, Laura A. Siminoff

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Health literacy has been shown to predict a variety of health outcomes. Reliable identification of persons with limited cancer health literacy (LCHL) has been proved questionable with existing instruments using an arbitrary cut point along a continuum. The CHLT-6, however, uses a latent mixture modeling approach to identify persons with LCHL. The purpose of this study was to estimate two-week and six-month stability of identifying persons with LCHL using the CHLT-6 with a discrete latent variable approach as the underlying measurement structure. Using a test-retest design, the CHLT-6 was administered to cancer patients with two-week (N=98) and six-month (N=51) intervals. The two-week and six-month latent test-retest agreements were 89% and 88%, respectively. The chance-corrected latent agreements estimated from Dumenci’s latent kappa were 0.62 (95% CI: 0.41 – 0.82) and .47 (95% CI: 0.14 – 0.80) for the two-week and six-month intervals, respectively. High levels of latent test-retest agreement between limited and adequate categories of cancer health literacy construct, coupled with moderate to good levels of change-corrected latent agreements indicated that the CHLT-6 classification of limited versus adequate cancer health literacy is relatively stable over time. In conclusion, the measurement structure underlying the instrument allows for estimating classification errors circumventing limitations due to arbitrary approaches adopted by all other instruments. The CHLT-6 can be used to identify persons with LCHL in oncology clinics and intervention studies to accurately estimate treatment effectiveness.

Keywords: limited cancer health literacy, the CHLT-6, discrete latent variable modeling, latent agreement

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Authors: Elad Vashdi

Abstract:

It is common to find speech deficit among children diagnosed with Autism. It can be found in the clinical field and recently in research. One of the DSM-V criteria suggests a speech delay (Delay in, or total lack of, the development of spoken language), but doesn't explain the cause of it. A common perception among professionals and families is that the inability to talk results from the autism. Autism is a name for a syndrome which just describes a phenomenon and is defined behaviorally. Since it is not based yet on a physiological gold standard, one can not conclude the nature of a deficit based on the name of the syndrome. A wide retrospective research (n=270) which included children with motor speech difficulties was conducted in Israel. The study analyzed entry evaluations in a private clinic during the years 2006-2013. The data was extracted from the reports. High percentage of children diagnosed with Autism (60%) was found. This result demonstrates the high relationship between Autism and motor speech problem. It also supports recent findings in research of Childhood apraxia of speech (CAS) occurrence among children with ASD. Only small percentage of the participants in this research (10%) were diagnosed with CAS even though their verbal deficits well fitted the guidelines for CAS diagnosis set by ASHA in 2007. This fact raises questions regarding the diagnostic procedure in Israel. The understanding that CAS might highly exist within Autism and can have a remarkable influence on the course of early development should be a guiding tool within the diagnosis procedure. CAS can explain the nature of the speech problem among some of the autistic children and guide the treatment in a more accurate way. Calculating the prevalence of CAS which includes the comorbidity with ASD reveals new numbers and suggests treating differently the CAS population.

Keywords: childhood apraxia of speech, Autism, treatment, speech

Procedia PDF Downloads 261