Search results for: complementary and aLternative medicine

Authors: Maris Eugênia Dela Rosa, Ana Luiza Menegatti Pavan, Marcela De Oliveira, Diana Rodrigues De Pina, Luis Carlos Vulcano

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In medical veterinary as well as in human medicine, radiological study is essential for a safe diagnosis in clinical practice. Thus, the quality of radiographic image is crucial. In last year’s there has been an increasing substitution of image acquisition screen-film systems for computed radiology equipment (CR) without technical charts adequacy. Furthermore, to carry out a radiographic examination in veterinary patient is required human assistance for restraint this, which can compromise image quality by generating dose increasing to the animal, for Occupationally Exposed and also the increased cost to the institution. The image optimization procedure and construction of radiographic techniques are performed with the use of homogeneous phantoms. In this study, we sought to develop a homogeneous phantom of canine chest to be applied to the optimization of these images for the CR system. In carrying out the simulator was created a database with retrospectives chest images of computed tomography (CT) of the Veterinary Hospital of the Faculty of Veterinary Medicine and Animal Science - UNESP (FMVZ / Botucatu). Images were divided into four groups according to the animal weight employing classification by sizes proposed by Hoskins & Goldston. The thickness of biological tissues were quantified in a 80 animals, separated in groups of 20 animals according to their weights: (S) Small - equal to or less than 9.0 kg, (M) Medium - between 9.0 and 23.0 kg, (L) Large – between 23.1 and 40.0kg and (G) Giant – over 40.1 kg. Mean weight for group (S) was 6.5±2.0 kg, (M) 15.0±5.0 kg, (L) 32.0±5.5 kg and (G) 50.0 ±12.0 kg. An algorithm was developed in Matlab in order to classify and quantify biological tissues present in CT images and convert them in simulator materials. To classify tissues presents, the membership functions were created from the retrospective CT scans according to the type of tissue (adipose, muscle, bone trabecular or cortical and lung tissue). After conversion of the biologic tissue thickness in equivalent material thicknesses (acrylic simulating soft tissues, bone tissues simulated by aluminum and air to the lung) were obtained four different homogeneous phantoms, with (S) 5 cm of acrylic, 0,14 cm of aluminum and 1,8 cm of air; (M) 8,7 cm of acrylic, 0,2 cm of aluminum and 2,4 cm of air; (L) 10,6 cm of acrylic, 0,27 cm of aluminum and 3,1 cm of air and (G) 14,8 cm of acrylic, 0,33 cm of aluminum and 3,8 cm of air. The developed canine homogeneous phantom is a practical tool, which will be employed in future, works to optimize veterinary X-ray procedures.

Keywords: radiation protection, phantom, veterinary radiology, computed radiography

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Authors: Zeenat Rupawalla, Nicole Robinson, Susanne Schmidt, Sijie Li, Selina Carruthers, Elodie Buisset, John Roles, Ben Hankamer, Juliane Wolf

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Agriculture has radically changed the global biogeochemical cycle of nitrogen (N). Fossil fuel-enabled synthetic N-fertiliser is a foundation of modern agriculture but applied to soil crops only use about half of it. To address N-pollution from cropping and the large carbon and energy footprint of N-fertiliser synthesis, new technologies delivering enhanced energy efficiency, decarbonisation, and a circular nutrient economy are needed. We characterised algae fertiliser (AF) as an alternative to synthetic N-fertiliser (SF) using empirical and modelling approaches. We cultivated microalgae in nutrient solution and modelled up-scaled production in nutrient-rich wastewater. Over four weeks, AF released 63.5% of N as ammonium and nitrate, and 25% of phosphorous (P) as phosphate to the growth substrate, while SF released 100% N and 20% P. To maximise crop N-use and minimise N-leaching, we explored AF and SF dose-response-curves with spinach in glasshouse conditions. AF-grown spinach produced 36% less biomass than SF-grown plants due to AF’s slower and linear N-release, while SF resulted in 5-times higher N-leaching loss than AF. Optimised blends of AF and SF boosted crop yield and minimised N-loss due to greater synchrony of N-release and crop uptake. Additional benefits of AF included greener leaves, lower leaf nitrate concentration, and higher microbial diversity and water holding capacity in the growth substrate. Life-cycle-analysis showed that replacing the most effective SF dosage with AF lowered the carbon footprint of fertiliser production from 2.02 g CO₂ (C-producing) to -4.62 g CO₂ (C-sequestering), with a further 12% reduction when AF is produced on wastewater. Embodied energy was lowest for AF-SF blends and could be reduced by 32% when cultivating algae on wastewater. We conclude that (i) microalgae offer a sustainable alternative to synthetic N-fertiliser in spinach production and potentially other crop systems, and (ii) microalgae biofertilisers support the circular nutrient economy and several sustainable development goals.

Keywords: bioeconomy, decarbonisation, energy footprint, microalgae

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Authors: Ana Lucia Molina

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Introduction: Fine motor skills refer to the use of the hands and coordination of the small muscles that control the fingers. A deficiency in fine motor skills is as important as a change in global movements, as fine motor skills directly affect activities of daily living. Fine movements are involved in some functions, such as motor control of the extremities, sensitivity, strength and tonus of the hands. A growing interest in the effects of non-invasive neuromodulation, such as transcranial stimulation technologies, through transcranial magnetic stimulation (TMS), has been observed in the scientific literature, with promising results in fine motor rehabilitation, as it provides modulation of the corresponding cortical activity in the area primary motor skills of the hands in both hemispheres (according to the International System 10-20, corresponding to C3 and C4). Objectives: to carry out a literature review about the effects of TMS on the cortical motor area corresponding to hand motricity. Methodology: This is a bibliographic survey carried out between October 2022 and March 2023 at Pubmed, Google Scholar, Lillacs and Virtual Health Library (BVS), with a national and international database. Some books on neuromodulation were included. Results: 28 articles and 5 books were initially found, and after reading the abstracts, only 14 articles and 3 books were selected, with publication dates between 2008 and 2022, to compose the literature review since it suited the purpose of this study. Conclusion: TMS has shown promising results in the treatment of fine motor rehabilitation, such as improving coordination, muscle strength and range of motion of the hands, being a complementary technique to existing treatments and thus providing more potent results for manual skills in activities of daily living. It is important to emphasize the need for more specific studies on the application of TMS for the treatment of manual disorders, which describe the uniqueness of each movement.

Keywords: transcranial magnetic stimulation, fine motor skills, motor rehabilitation, non-invasive neuromodulation

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Authors: Naira Sahakyan, Margarit Petrosyan, Armen Trchounian

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One of the tasks in contemporary biotechnology, pharmacology and other fields of human activities is to obtain biologically active substances from plants. They are very essential in the treatment of many diseases due to their actually high therapeutic value without visible side effects. However, sometimes the possibility of obtaining the metabolites is limited due to the reduction of wild-growing plants. That is why the plant cell cultures are of great interest as alternative sources of biologically active substances. Besides, during the monitored cultivation, it is possible to obtain substances that are not synthesized by plants in nature. Isolated culture of Ajuga genevensis with high growth activity and ability of regeneration was obtained using MS nutrient medium. The agar-diffusion method showed that aqueous extracts of callus culture revealed high antimicrobial activity towards various gram-positive (Bacillus subtilis A1WT; B. mesentericus WDCM 1873; Staphylococcus aureus WDCM 5233; Staph. citreus WT) and gram-negative (Escherichia coli WKPM M-17; Salmonella typhimurium TA 100) microorganisms. The broth dilution method revealed that the minimal and half maximal inhibitory concentration values against E. coli corresponded to the 70 μg/mL and 140 μg/mL concentration of the extract respectively. According to the photochemiluminescent analysis, callus tissue extracts of leaf and root origin showed higher antioxidant activity than the same quantity of A. genevensis intact plant extract. A. genevensis intact plant and callus culture extracts showed no cytotoxic effect on K-562 suspension cell line of human chronic myeloid leukemia. The GC-MS analysis showed deep differences between the qualitative and quantitative composition of callus culture and intact plant extracts. Hexacosane (11.17%); n-hexadecanoic acid (9.33%); and 2-methoxy-4-vinylphenol (4.28%) were the main components of intact plant extracts. 10-Methylnonadecane (57.0%); methoxyacetic acid, 2-tetradecyl ester (17.75%) and 1-Bromopentadecane (14.55%) were the main components of A. genevensis callus culture extracts. Obtained data indicate that callus culture of A. genevensis can be used as an alternative source of biologically active substances.

Keywords: Ajuga genevensis, antibacterial activity, antioxidant activity, callus cultures

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Authors: Krzysztof Plesiewicz, Izabela Plesiewicz, Krzysztof Chiżyński, Marzenna Zielińska

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Background: Obesity is an independent risk factor for cardiovascular diseases. There are several anthropometric parameters proposed to estimate the level of obesity, but until now there is no agreement which one is the best predictor of cardiometabolic risk. Scientists defined metabolically obese normal weight, who suffer from metabolic abnormalities, the same as obese individuals, and defined this syndrome as normal weight obesity (NWO). Aim of the study: The aim of our study was to determine the occurrence of overweight and obesity in a cohort of young, adult women, using standard and complementary methods of obesity assessment and to indicate those, who are at risk of obesity. The second aim of our study was to test additional methods of obesity assessment and proof that body mass index using alone is not sufficient parameter of obesity assessment. Materials and methods: 384 young women, aged 18-32, were enrolled into the study. Standard anthropometric parameters (waist to hips ratio (WTH), waist to height ratio (WTHR)) and two other methods of body fat percentage measurement (BFPM) were used in the study: electrical bioimpendance analysis (BIA) and skinfold measurement test by digital fat body mass clipper (SFM). Results: In the study group 5% and 7% of participants had waist to hips ratio and accordingly waist to height ratio values connected with visceral obesity. According to BMI 14% participants were overweight and obese. Using additional methods of body fat assessment, there were 54% and 43% of obese for BIA and SMF method. In the group of participants with normal BMI and underweight (not overweight, n =340) there were individuals with the level of BFPM above the upper limit, for the BIA 49% (n =164) and for the SFM 36 % (n=125). Statistical analysis revealed strong correlation between BIA and SFM methods. Conclusion: BMI using alone is not a sufficient parameter of obesity assessment. High percentage of young women with normal BMI values seem to be normal weight obese.

Keywords: electrical bioimpedance, normal weight obesity, skin-fold measurement test, women

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Authors: Jun-Ho Chung, Sung-Hyun Yoo, In-Hwan Choi, Hyun-Kook Lee, Moon-Kyu Song, Choon-Ki Ahn

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The extended finite impulse response (EFIR) filter is addressed to optimize membership functions (MFs) of the fuzzy model that has strong nonlinearity. MFs are important parts of the fuzzy logic system (FLS) and, thus optimizing MFs of FLS is one of approaches to improve the performance of output. We employ the EFIR as an alternative optimization option to nonlinear fuzzy model. The performance of EFIR is demonstrated on a fuzzy cruise control via a numerical example.

Keywords: fuzzy logic system, optimization, membership function, extended FIR filter

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Authors: Yousif Mohamed Y. Abdallah, Khalid H. Eltom

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This is an experimental study deals with measurement of the periodic physiological organ motion during lung external irradiation in order to reduce the exposure of healthy tissue during radiation treatments. The results showed for left lung displacement reading (4.52+1.99 mm) and right lung is (8.21+3.77 mm) which the radiotherapy physician should take suitable countermeasures in case of significant errors. The motion ranged between 2.13 mm and 12.2 mm (low and high). In conclusion, the calculation of tumour mobility can improve the accuracy of target areas definition in patients undergo Sterostatic RT for stage I, II and III lung cancer (NSCLC). Definition of the target volume based on a high resolution CT scan with a margin of 3-5 mm is appropriate.

Keywords: physiological motion, lung, external irradiation, radiation medicine

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Authors: Yohanes Kambaru Windi, Loetfia Dwi Rahariyani, Dyah Wijayanti, Eko Rustamaji

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Surabaya, the second largest city in Indonesia, has been struggling for years with waste production and its management. Nearly 11,000 tons of waste are generated daily by domestic, commercial and industrial areas. It is predicted that approximately 1,300 tons of waste overflew the Benowo Landfill daily in 2013 and projected that the landfill operation will be critical in 2015. The Super Depo Sutorejo (SDS) is a pilot project on waste management launched by the government of Surabaya in March 2013. The project is aimed to reduce the amount of waste dumped in landfill by sorting the recyclable and organic waste for composting by employing waste pickers to sort the waste before transported to landfill. This study is intended to assess the capacity of SDS to process and reduce waste and its complementary benefits. It also overviews the benefits of the project to the waste pickers in term of satisfaction to the job. Waste processing data-sheets were used to assess the difference between input and outputs waste. A survey was distributed to 30 waste pickers and interviews were conducted as a further insight on a particular issue. The analysis showed that SDS enable to reduce waste up to 50% before dumped in the final disposal area. The cost-benefits analysis using cost differential calculation revealed the economic benefit is considerable low, but composting may substitute tangible benefits for maintain the city’s parks. Waste pickers are mostly satisfied with their job (i.e. Salary, health coverage, job security), services and facilities available in SDS and enjoyed rewarding social life within the project. It is concluded that SDS is an effective and efficient model for sustainable waste management and reliable to be developed in developing countries. It is a strategic approach to empower and open up working opportunity for the poor urban community and prolong the operation of landfills.

Keywords: cost-benefits, integration, satisfaction, waste management

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Authors: S. Al-Khalasi, O. Mahgoub, H. Yaakub

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This study evaluated the use of raw or processed Prosopis juliflora (Meskit) pods as a major ingredient in a formulated ration to provide an alternative non-conventional concentrate for livestock feeding in Oman. Dry Meskit pods were reduced to lengths of 0.5- 1.0 cm to ensure thorough mixing into three diets. Meskit pods were subjected to two types of treatments; roasting and soaking. They were roasted at 150оC for 30 minutes using a locally-made roasting device (40 kg barrel container rotated by electric motor and heated by flame gas cooker). Chopped pods were soaked in tap water for 24 hours and dried for 2 days under the sun with frequent turning. The Meskit-pod-based diets (MPBD) were formulated and pelleted from 500 g/kg ground Meskit pods, 240 g/kg wheat bran, 200 g/kg barley grain, 50 g/kg local dried sardines and 10 g/kg of salt. Twenty four 10 months-old intact Omani male lambs with average body weight of 27.3 kg (± 0.5 kg) were used in a feeding trial for 84 days. They were divided (on body weight basis) and allocated to four diet combination groups. These were: Rhodes grass hay (RGH) plus a general ruminant concentrate (GRC); RGH plus raw Meskit pods (RMP) based concentrate; RGH plus roasted Meskit pods (ROMP) based concentrate; RGH plus soaked Meskit pods (SMP) based concentrate Daily feed intakes and bi-weekly body weights were recorded. MPBD had higher contents of crude protein (CP), acid detergent fibre (ADF) and neutral detergent fibre (NDF) than the GRC. Animals fed various types of MPBD did not show signs of ill health. There was a significant effect of feeding ROMP on the performance of Omani sheep compared to RMP and SMP. The ROMP fed animals had similar performance to those fed the GRC in terms of feed intake, body weight gain and feed conversion ratio (FCR).This study indicated that roasted Meskit pods based diet may be used instead of the commercial concentrate for feeding Omani sheep without adverse effects on performance. It offers a cheap alternative source of protein and energy for feeding Omani sheep. Also, it might help in solving the spread impact of Meskit trees, maintain the ecosystem and helping in preserving the local tree species.

Keywords: growth, Meskit, Omani sheep, Prosopis juliflora

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Authors: Boonyarat Chaleephay

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The purpose of this research paper was to describe the relationship of acupressure points on the anterior surface of the upper limb in accordance with Applied Thai Traditional Massage (ATTM) and the deep structures located at those acupressure points. There were 2 population groups; normal subjects and cadaver specimens. Eighteen males with age ranging from 20-40 years old and seventeen females with ages ranging from 30-97 years old were studies. This study was able to obtain a fundamental knowledge concerning acupressure point and the deep structures that related to those acupressure points. It might be used as the basic knowledge for clinically applying and planning treatment as well as teaching in ATTM.

Keywords: acupressure point (AP), applie Thai traditional medicine (ATTM), paresthesia, numbness

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Authors: Dawit Thomas

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Feeding and weaning practices vary from culture to culture and depend on different child-rearing values. The socio-cultural dimensions that influence the acceptable infant feeding practices are varied and complex. Understanding cultural differences in beliefs and practices relating to infant feeding is important to enhance designing programs for delivering successful psychological, social, physiological and economic well-being of mothers and infants. The main purpose of this study was exploring mothers infant feeding practices in the context of Hadiyya culture. After purposively selecting Harche Huyaya Uyaya Kebele eight infant feeding mothers were selected using snowball sampling technique. The study employed interviews and focus group discussion. The study found out early initiation and prolonged breastfeeding and early complementary feeding in some instances immediately after birth. In addition, infants were not forced to wean unless the mothers encounter pressing issues like pregnancy and health related problems. Furthermore, the main weaning techniques were putting unpleasant materials on the tip of nipples and sending infants to grandparents home. The study also found out gender difference in weaning, i.e., early initiation of weaning for girls. This can be indicative of gender-based bias on weaning practice. Finally, health extension workers, office of women and children affairs and Hadiyya Zone Tourism office should organize awareness raising programs to preserve vital infant feeding practices like prolonged breastfeeding and length of weaning. In addition, the offices should raise awareness among communities on negative side effects of sending infant to grandparents home that may weaken infant-mothers attachment and create favorable ground for the development of phobia.

Keywords: feeding, infant, practices, weaning

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Authors: Elmo Thiago Lins Cöuras Ford, Valentina Alessandra Carvalho do Vale

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Given the unquestionable need of environmental preservation, the natural fibers have been seen as a salutary alternative for production of composites in substitution to the synthetic fibers, vitreous and metallic. In this work, the behavior of a composite was analyzed done with fiber of the peel of the coconut as reinforcement and latex as head office, when submitted the source of heat. The temperature profiles were verified in the internal surfaces and it expresses of the composite as well as the temperature gradient in the same. It was also analyzed the behavior of this composite when submitted to a cold source. As consequence, in function of the answers of the system, conclusions were reached.

Keywords: natural fiber, composite, temperature, latex, gradient

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Authors: Sait Ozsoy, Hacer Yasar Teke, Mustafa Dalgic, Cetin Ketenci, Ertugrul Gok, Kenan Karbeyaz, Azem Irez, Mesut Akyol

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Self-mutilating behavior or self-injury behavior (SIB) is defined as: intentional harm to one’s body without intends to commit suicide”. SIB cases are commonly seen in psychiatry and forensic medicine practices. Despite variety of SIB methods, cuts in the skin is the most common (70-97%) injury in this group of patients. Subjects with SIB have one or more other comorbidities which include depression, anxiety, depersonalization, and feeling of worthlessness, borderline personality disorder, antisocial behaviors, and histrionic personality. These individuals feel a high level of hostility towards themselves and their surroundings. Researches have also revealed a strong relationship between antisocial personality disorder, criminal behavior, and SIB. This study has retrospectively evaluated 6,599 autopsy cases performed at forensic medicine institutes of six major cities (Ankara, Izmir, Diyarbakir, Erzurum, Trabzon, Eskisehir) of Turkey in 2013. The study group consisted of all cases with SIB findings (psychopathic cuts, cigarette burns, scars, and etc.). The relationship between causes of death in the study group (SIB subjects) and the control group was investigated. The control group was created from subjects without signs of SIB. Mann-Whitney U test was used for age variables and Chi-square test for categorical variables. Multinomial logistic regression analysis was used in order to analyze group differences in respect to manner of death (natural, accident, homicide, suicide) and analysis of risk factors associated with each group was determined by the Binomial logistic regression analysis. This study used SPSS statistics 15.0 for all its statistical and calculation needs. The statistical significance was p <0.05. There was no significant difference between accidental and natural death among the groups (p=0.737). Also there was a unit increase in number of cuts in psychopathic group while number of accidental death decreased (95% CI: 0.941-0.993) by 0.967 times (p=0.015). In contrast, there was a significant difference between suicidal and natural death (p<0.001), and also between homicidal and natural death (p=0.025). SIB is often seen with borderline and antisocial personality disorder but may be associated with many psychiatric illnesses. Studies have shown a relationship between antisocial personality disorders with criminal behavior and SIB with suicidal behavior. In our study, rate of suicide, murder and intoxication was higher compared to the control group. It could be concluded that SIB can be used as a predictor of possibility of one’s harm to him/herself and other people.

Keywords: autopsy, cause of death, forensic science, self-injury behaviour

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Authors: C. Bel, J. Nevado, F. Ciceri, M. Ropacki, T. Hoffmann, P. Lapunzina, C. Buesa

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Background: The Phelan-McDermid syndrome (PMS) is a genetic disorder caused by the deletion of the terminal region of chromosome 22 or mutation of the SHANK3 gene. Shank3 disruption in mice leads to dysfunction of synaptic transmission, which can be restored by epigenetic regulation with both Lysine Specific Demethylase 1 (LSD1) inhibitors. PMS subjects result in a variable degree of intellectual disability, delay or absence of speech, autistic spectrum disorders symptoms, low muscle tone, motor delays and epilepsy. Vafidemstat is an LSD1 inhibitor in Phase II clinical development with a well-established and favorable safety profile, and data supporting the restoration of memory and cognition defects as well as reduction of agitation and aggression in several animal models and clinical studies. Therefore, vafidemstat has the potential to become a first-in-class precision medicine approach to treat PMS patients. Aims: The goal of this research is to perform an observational trial to psychometrically characterize individuals carrying deletions in SHANK3 and build a foundation for subsequent precision psychiatry clinical trials with vafidemstat. Methodology: This study is characterizing the clinical profile of 20 to 40 subjects, > 16-year-old, with genotypically confirmed PMS diagnosis. Subjects will complete a battery of neuropsychological scales, including the Repetitive Behavior Questionnaire (RBQ), Vineland Adaptive Behavior Scales, Escala de Observación para el Diagnostico del Autismo (Autism Diagnostic Observational Scale) (ADOS)-2, the Battelle Developmental Inventory and the Behavior Problems Inventory (BPI). Results: By March 2021, 19 patients have been enrolled. Unsupervised hierarchical clustering of the results obtained so far identifies 3 groups of patients, characterized by different profiles of cognitive and behavioral scores. The first cluster is characterized by low Battelle age, high ADOS and low Vineland, RBQ and BPI scores. Low Vineland, RBQ and BPI scores are also detected in the second cluster, which in contrast has high Battelle age and low ADOS scores. The third cluster is somewhat in the middle for the Battelle, Vineland and ADOS scores while displaying the highest levels of aggression (high BPI) and repeated behaviors (high RBQ). In line with the observation that female patients are generally affected by milder forms of autistic symptoms, no male patients are present in the second cluster. Dividing the results by gender highlights that male patients in the third cluster are characterized by a higher frequency of aggression, whereas female patients from the same cluster display a tendency toward higher repetitive behavior. Finally, statistically significant differences in deletion sizes are detected comparing the three clusters (also after correcting for gender), and deletion size appears to be positively correlated with ADOS and negatively correlated with Vineland A and C scores. No correlation is detected between deletion size and the BPI and RBQ scores. Conclusions: Precision medicine may open a new way to understand and treat Central Nervous System disorders. Epigenetic dysregulation has been proposed to be an important mechanism in the pathogenesis of schizophrenia and autism. Vafidemstat holds exciting therapeutic potential in PMS, and this study will provide data regarding the optimal endpoints for a future clinical study to explore vafidemstat ability to treat shank3-associated psychiatric disorders.

Keywords: autism, epigenetics, LSD1, personalized medicine

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Authors: Doran C. Kalmin

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The descending genicular artery (DGA) perforator free flap provides an alternative to free flap reconstruction based on a review of the literature detailing both anatomical and clinical studies. The descending genicular artery (DGA) supplies skin, muscle, tendon, and bone located around the medial aspect of the knee that has been used in several pioneering reports in reconstructing defects located in various areas throughout the body. After the success of the medial femoral condyle flap in early studies, a small number of studies have been published detailing the use of the DGA in free flap reconstruction. Despite early success in the use of the DGA flap, acceptance within the Plastic and Reconstructive Surgical community has been limited due primarily to anatomical variations of the pedicle. This literature review is aimed at detailing the progression of the DGA perforator free flap and its variations as an alternative and reliable free flap for reconstruction of composite defects with an exploration into both anatomical and clinical studies. A literature review was undertaken, and the progression of the DGA flap is explored from the early review by Acland et al. pioneering the saphenous free flap to exploring modern changes and studies of the anatomy of the DGA. An extensive review of the literature was undertaken that details the anatomy and its variations, approaches to harvesting the flap, the advantages, and disadvantages of the DGA perforator free flap as well as flap outcomes. There are 15 published clinical series of DGA perforator free flaps that incorporate cutaneous, osteoperiosteal, cartilage, osteocutaneous, osteoperiosteal and muscle, osteoperiosteal and subcutaneous and tendocutatenous. The commonest indication for using a DGA free flap was for non-union of bone, particularly that of the scaphoid whereby the medial femoral condyle could be used. In the case series, a success rate of over 90% was established, showing that these early studies have had good success with a wide range of tissue transfers. The greatest limitation is the anatomical variation of the DGA and therefore, the challenges associated with raising the flap. Despite the variation in anatomy and around 10-15% absence of the DGA, the saphenous artery can be used as well as the superior medial genicular artery if the vascular bone is required as part of the flap. Despite only a handful of anatomical and clinical studies describing the DGA perforator free flap, it ultimately provides a reliable flap that can include a variety of composite structure used for reconstruction in almost any area throughout the body. Although it has limitations, it provides a reliable option for free flap reconstruction that can routinely be performed as a single-stage procedure.

Keywords: anatomical study, clinical study, descending genicular artery, literature review, perforator free flap reconstruction

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Authors: Olaifa Temitope Abimbola

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The spate of the occurrence of Ethnic Conflict in Nigeria and indeed Africa is sporadic and to say the least alarming. To scholars of Ethnic Conflict in Africa, it has defied all logical approaches to its resolution. Based on this fact international organisations have begun to look for alternative means of approaching these conflicts. Not a few have agreed that wars are better and cheaper prevented than resolved or transformed. In the light of this, this paper had set out to look at the concept of Preventive Diplomacy, Ethnic Conflict, Women and the role they play in mitigating conflict by researching into activities of women in pre and post-conflict situations in selected African conflict and has been able to establish the peculiar capacity of women in dousing tension both at domestic and communal levels.

Keywords: preventive diplomacy, gender, peacebuilding, low

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Authors: Roger-Claude Liwanga

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This article reflects on the normative aspects of the jurisprudence on the protection of human rights in times of war that the International Court of Justice (ICJ) developed in 2005 in the Case Concerning Armed Activities on the Territory of the Congo (Democratic Republic of Congo v. Uganda). The article focuses on theories raised in connection with the Democratic Republic of Congo (DRC)'s claim of the violation of human rights of its populations by Uganda as opposed to the violation of its territorial integrity claims. The article begins with a re-visitation of the doctrine of state extraterritorial responsibility for violations of human rights by suggesting that a state's accountability for the breach of its international obligations is not territorially confined but rather transcends the State's national borders. The article highlights the criteria of assessing the State's extraterritorial responsibility, including the circumstances: (1) where the concerned State has effective control over the territory of another State in the context of belligerent occupation, and (2) when the unlawful actions committed by the State's organs on the occupied territory can be attributable to that State. The article also analyzes the ICJ's opinions articulated in DRC v. Uganda with reference to the relationship between human rights law and humanitarian law, and it contends that the ICJ had revised the traditional interaction between these two bodies of law to the extent that human rights law can no longer be excluded from applying in times of war as both branches are complementary rather than exclusive. The article correspondingly looks at the issue of reparations for victims of human rights violations. It posits that reparations for victims of human rights violations should be integral (including restitution, compensation, rehabilitation, satisfaction, and guarantees of non-repetition). Yet, the article concludes by emphasizing that reparations for victims were not integral in DRC v. Uganda because: (1) the ICJ failed to set a reasonable timeframe for the negotiations between the DRC and Uganda on the amount of compensation, resulting in Uganda paying no financial reparation to the DRC since 2005; and (2) the ICJ did not request Uganda to domestically prosecute the perpetrators of human rights abuses.

Keywords: human rights law, humanitarian law, civilian protection, extraterritorial responsibility

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Authors: Gracious Tendai Matayaya

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The world is facing problems in finding alternative resources to offset the decline in global petroleum reserves. The use of fossil fuels has prompted biofuel development, particularly in the transportation sector. In these circumstances, looking for alternative renewable energy sources makes sense. Petroleum-based fuels also result in a lot of carbon dioxide being released into the environment causing global warming. Replacing petroleum and fossil fuel-based fuels with biofuels has the advantage of reducing undesirable aspects of these fuels, which are mostly the production of greenhouse gas and dependence on unstable foreign suppliers. Algae refer to a group of aquatic microorganisms that produce a lot of lipids up to 60% of their total weight. This project aims to exploit the large amounts of oil produced by these microorganisms in the Soxhlet extraction to make biodiesel. Experiments were conducted to establish the cultivability of algae, harvesting methods, the oil extraction process, and the transesterification process. Although there are various methods for producing algal oil, the Soxhlet extraction method was employed for this particular research. After extraction, the oil was characterized before being used in the transesterification process that used methanol and hydrochloric acid as the process reactants. The properties of the resulting biodiesel were then determined. Because there is a requirement to dry wet algae, the experimental findings showed that Soxhlet extraction was the optimum way to produce a higher yield of microalgal oil. Upon cultivating algae, Compound D fertilizer was added as a source of nutrients (Phosphorous and Nitrogen), and the highest growth of algae was observed at 6 days (using 2 g of fertilizer), after which it started to decrease. Butanol, hexane, heptane and acetone have been experimented with as solvents, and heptane gave the highest amount of oil (89ml of oil) when 300 ml of solvent was used. This was compared to 73.21ml produced by butanol, 81.90 produced by hexane and 69.57ml produced by acetone, and as a result, heptane was used for the rest of the experiments, which included a variation of the mass of dried algae and time of extraction. This meant that the oil composition of algae was higher than other oil sources like peanuts, soybean etc. Algal oil was heated at 150℃ for 150 minutes in the presence of methanol (reactant) and hydrochloric acid (HCl), which was used as a catalyst. A temperature of 200℃ produced 93.64%, and a temperature of 250℃ produced 92.13 of biodiesel at 150 minutes.

Keywords: microalgae, algal oil, biodiesel, soxhlet extraction

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Authors: Mazoun Nasser Rashid Al Kharusi, Nada Al Siyabi

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Objectives: The main aim of this study is to Find the rate of susceptibility of ESBL E. coli causing UTI to oral antibiotics. Secondary objectives: Prevalence of ESBL E. coli from community urine samples, identify the best empirical oral antibiotics with the least resistance rate for UTI and identify alternative oral antibiotics for testing and utilization. Methods: This study is a retrospective descriptive study of the last three years in five major hospitals in Oman (Khowla Hospital, AN’Nahdha Hospital, Rustaq Hospital, Nizwa Hospital, and Ibri Hospital) equipped with a microbiologist. Inclusion criteria include all eligible outpatient urine culture isolates, excluding isolates from admitted patients with hospital-acquired urinary tract infections. Data was collected through the MOH database. The MOH hospitals are using different types of testing, automated methods like Vitek2 and manual methods. Vitek2 machine uses the principle of the fluorogenic method for organism identification and a turbidimetric method for susceptibility testing. The manual method is done by double disc diffusion for identifying ESBL and the disc diffusion method is for antibiotic susceptibility. All laboratories follow the clinical laboratory science institute (CLSI) guidelines. Analysis was done by SPSS statistical package. Results: Total urine cultures were (23048). E. coli grew in (11637) 49.6% of the urine, whereas (2199) 18.8% of those were confirmed as ESBL. As expected, the resistance rate to amoxicillin and cefuroxime is 100%. Moreover, the susceptibility of those ESBL-producing E. coli to nitrofurantoin, trimethoprim+sulfamethoxazole, ciprofloxacin and amoxicillin-clavulanate is progressing over the years; however, still low. ESBL E. coli was predominating in the female gender and those aged 66-74 years old throughout all the years. Other oral antibiotic options need to be explored and tested so that we add to the pool of oral antibiotics for ESBL E. coli causing UTI in the community. Conclusion: High rate of ESBL E. coli in urine from the community. The high resistance rates to oral antibiotics highlight the need for alternative treatment options for UTIs caused by these bacteria. Further research is needed to identify new and effective treatments for UTIs caused by ESBL-E. Coli.

Keywords: UTI, ESBL, oral antibiotics, E. coli, susceptibility

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Authors: A. Coetzee, C. F. Kelly, E. Even-Zahav

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Dominant approaches to livestock production are harmful to the environment, human health and animal welfare, yet global meat consumption is rising. Sustainable alternative production approaches are therefore urgently required, and ‘free range’ is the main alternative for chicken meat offered in South Africa (and globally). Although the South African Poultry Association provides non-binding guidelines, there is a lack of formal definition and regulation of free range chicken production, meaning it is unclear what this alternative entails and if it is consistently practised (a trend observed globally). The objective of this exploratory qualitative case study is therefore to investigate who and what determines free range chicken. The case study, conducted from a social constructivist worldview, uses semi-structured interviews, photographs and document analysis to collect data. Interviews are conducted with those involved with bringing free range chicken to the market - farmers, chefs, retailers, and regulators. Data is analysed using thematic analysis to establish dominant patterns in the data. The five major themes identified (based on prevalence in data and on achieving the research objective) are: 1) free range means a bird reared with good animal welfare in mind, 2) free range means quality meat, 3) free range means a profitable business, 4) free range is determined by decision makers or by access to markets, and 5) free range is coupled with concerns about the lack of regulation. Unpacking the findings in the context of the literature reveals who and what determines free range. The research uncovers wide-ranging interpretations of ‘free range’, driven by the absence of formal regulation for free range chicken practices and the lack of independent private certification. This means that the term ‘free range’ is socially constructed, thus varied and complex. The case study also shows that whether chicken meat is free range is generally determined by those who have access to markets. Large retailers claim adherence to the internationally recognised Five Freedoms, also include in the South African Poultry Association Code of Good Practice, which others in the sector say are too broad to be meaningful. Producers describe animal welfare concerns as the main driver for how they practice/view free range production, yet these interpretations vary. An additional driver is a focus on human health, which participants achieve mainly through the use of antibiotic-free feed, resulting in what participants regard as higher quality meat. The participants are also strongly driven by business imperatives, with most stating that free range chicken should carry a higher price than conventionally-reared chicken due to increased production costs. Recommendations from this study focus on, inter alia, a need to understand consumers’ perspectives on free range chicken, given that those in the sector claim they are responding to consumer demand, and conducting environmental research such as life cycle assessment studies to establish the true (environmental) sustainability of free range production. At present, it seems the sector mostly responds to social sustainability: human health and animal welfare.

Keywords: chicken meat production, free range, socially constructed, sustainability

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Authors: Muuz Abraha Meshesha

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Illegal Migration, specifically Trafficking in person is one of the primary issues of the day affecting all states of the world with variation on the extent of the root causes and consequences that led people to migrate irregularly and the consequences it is costing on humanity. This paper intends to investigate the root causes and consequences of illegal migration in Ethiopia’s Tigray Regional state and come up with alternative intervening strategy. To come up with pertinent and robust research finding, this study employed mixed research approach involving qualitative and quantitative data in line with purposive and snow ball sampling selection technique. The study revealed that, though poverty is the most commonly sensed pushing factor for people to illegally migrate, the issue of psycho-social orientation and attitudinal immersion of the local community for illegal migration, both in thinking and action is the most pressing problem that urges serious intervention. Trafficking in persons and Illegal migration in general, is becoming the norm of the day in the study area that overtly reveal illegal migration is an issue beyond livelihood securing demand in practice. Basically, parties engaged in illegal migration and the accomplice with human traffickers these days in the study area are found to be more than urgency for food security and a need to escape from livelihood impoverishment. Therefore, this study come up with a new paradigm insight indicating that illegal migration is believed by the local community members as an optional path way of doing business in illegal way while the attitude of the community and officials authorized to regulate is being part of the channel or to the least tolerant of this grave global danger. The study also found that the effect of illegal migration is significantly manifested in long run than in short term periods. Therefore, a need for critical consideration on attitudinal based intervention and youth oriented and enforceable legal and policy framework accountability framework is required to face and control illegal migration by international, national, local stakeholders. Besides this, economy based development interventions that could engage and reorient the youth, as primary victims of trafficking, and expansion of large scale projects that can employ large number of youths at a time.

Keywords: human traficking, illegal migration, migration, tigray region

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Authors: Roseliza Mat Alipiah, David Raffaelli, J. C. R. Smart

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This research is a new approach as it integrates information from both environmental and social sciences to inform effective management of the wetlands. A three-stage research framework was developed for modelling the drivers and pressures imposed on the wetlands and their impacts to the ecosystem and the local communities. Firstly, a Bayesian Belief Network (BBN) was used to predict the probability of anthropogenic activities affecting the delivery of different key wetland ecosystem services under different management scenarios. Secondly, Choice Experiments (CEs) were used to quantify the relative preferences which key wetland stakeholder group (aquaculturists) held for delivery of different levels of these key ecosystem services. Thirdly, a Multi-Criteria Decision Analysis (MCDA) was applied to produce an ordinal ranking of the alternative management scenarios accounting for their impacts upon ecosystem service delivery as perceived through the preferences of the aquaculturists. This integrated ecosystem management approach was applied to a wetland ecosystem in Setiu, Terengganu, Malaysia which currently supports a significant level of aquaculture activities. This research has produced clear guidelines to inform policy makers considering alternative wetland management scenarios: Intensive Aquaculture, Conservation or Ecotourism, in addition to the Status Quo. The findings of this research are as follows: The BBN revealed that current aquaculture activity is likely to have significant impacts on water column nutrient enrichment, but trivial impacts on caged fish biomass, especially under the Intensive Aquaculture scenario. Secondly, the best fitting CE models identified several stakeholder sub-groups for aquaculturists, each with distinct sets of preferences for the delivery of key ecosystem services. Thirdly, the MCDA identified Conservation as the most desirable scenario overall based on ordinal ranking in the eyes of most of the stakeholder sub-groups. Ecotourism and Status Quo scenarios were the next most preferred and Intensive Aquaculture was the least desirable scenario. The methodologies developed through this research provide an opportunity for improving planning and decision making processes that aim to deliver sustainable management of wetland ecosystems in Malaysia.

Keywords: Bayesian belief network (BBN), choice experiments (CE), multi-criteria decision analysis (MCDA), aquaculture

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

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

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

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Authors: Sharon Waichman, Shahaf Froim, Ido Zukerman, Shmuel Barzilai, Shmual Hayun, Avi Raveh

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Boron carbide is a ceramic material with superior properties such as high chemical and thermal stability, high hardness and high wear resistance. Moreover, it has a big cross section for neutron absorption and therefore can be employed in nuclear based applications. However, an efficient attachment of boron carbide to a metal such as aluminum can be very challenging, mainly because of the formation of aluminum-carbon bonds that are unstable in humid environment, the affinity of oxygen to the metal and the different thermal expansion coefficients of the two materials that may cause internal stresses and a subsequent failure of the bond. Here, we aimed to achieving a strong and a durable attachment between the boron carbide coating and the aluminum substrate. For this purpose, we applied Ti as a thin intermediate layer that provides a gradual change in the thermal expansion coefficients of the configured layers. This layer is continuous and therefore prevents the formation of aluminum-carbon bonds. Boron carbide coatings with a thickness of 1-5 µm were deposited on the aluminum substrate by pulse-DC magnetron sputtering. Prior to the deposition of the boron carbide layer, the surface was pretreated by energetic ion plasma followed by deposition of the Ti intermediate adhesive layer in a continuous process. The properties of the Ti intermediate layer were adjusted by the bias applied to the substrate. The boron carbide/aluminum bond was evaluated by various methods and complementary techniques, such as SEM/EDS, XRD, XPS, FTIR spectroscopy and Glow Discharge Spectroscopy (GDS), in order to explore the structure, composition and the properties of the layers and to study the adherence mechanism of the boron carbide/aluminum contact. Based on the interfacial bond characteristics, we propose a desirable solution for improved adhesion of boron carbide to aluminum using a highly efficient intermediate adhesive layer.

Keywords: adhesion, boron carbide coatings, ceramic/metal bond, intermediate layer, pulsed-DC magnetron sputtering

Procedia PDF Downloads 158

Authors: Shuofen Hsu, Ya-Yi Chao, Chao-Wei Li

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This paper investigates the relationship between voluntary audit (hereafter, VA) of semi-annual consolidated financial statements decision and accounting conservatism. In general, there are four kinds of auditors' assurance services, which include audit, review, agreed-upon procedure and compliance engagements base on degree of assurance. The VA work by auditors may not only have the higher audit quality but an important signal of more reliable information than the review work. In Taiwan, The listed companies must prepare the semi-annual consolidated financial statements and with auditors' review before 2012, but some of the listed companies choose the assurance work from review to audit voluntarily. Due to the adoption of International Financial Reporting Standards, the listed companies were required to prepare the second quarterly consolidated financial statements which should be reviewed by auditors since 2013. This rule will change some of the assurance work from audit to review by auditors, and the information asymmetry maybe increased. To control the selection bias, we use two-stage model to test the relationship between VA decision and accounting conservatism. Our empirical results indicate that the VA decision and accounting conservatism have a significant positive relationship in firms with family-controlled. That is, firms with family-controlled are more likely to do VA and to prepare more conservative consolidated financial statements to reduce the information asymmetry, meaning that there is a complementary effect between VA and accounting conservatism for firms with more information asymmetry. But on the contrary, we find that the VA decision and accounting conservatism have a significant negative relationship in firms with professional managers-controlled, meaning that there is a substitution effect between VA and accounting conservatism for firms with less information asymmetry. Finally, the accounting conservatism of consolidated financial statements decrease after the adoption of IFRSs (International Financial Reporting Standards) in Taiwan. It means that the disclosure and transparency of consolidated financial statements had be improved.

Keywords: voluntary audit, accounting conservatism, audit quality, information asymmetry

Procedia PDF Downloads 224

Authors: Aaron Herve Mbwe Mbissik, Lotfi Khiari, Otmane Raji, Abdellatif Elghali, Abdelkarim Lajili, Muhammad Ouabid, Martin Jemo, Jean-Louis Bodinier

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Potassium (K) is an essential macronutrient for plant growth, helping to regulate several physiological and metabolic processes. Evaporite-related potash salts, mainly sylvite minerals (K chloride or KCl), are the principal source of K for the fertilizer industry. However, due to the high potash-supply risk associated with its considerable price fluctuations and uneven geographic distribution for most agriculture-based developing countries, the development of alternative sources of fertilizer K is imperative to maintain adequate crop yield, reduce yield gaps, and food security. Alkaline Igneous rocks containing significant K-rich silicate minerals such as K feldspar are increasingly seen as the best alternative available. However, these rocks may require to be hydrothermally treatment to enhance the release of potassium. In this study, we evaluate the fertilizing capacity of raw and hydrothermally treated K-bearing silicate rocks from different areas in Morocco. The effectiveness of rock powders was tested in a greenhouse experiment using ryegrass (Lolium multiflorum) by comparing them to a control (no K added) and to a conventional fertilizer (muriate of potash: MOP or KCl). The trial was conducted in a randomized complete block design with three replications, and plants were grown on K-depleted soils for three growing cycles. To achieve our objective, in addition to the analysis of the muriate response curve and the different biomasses, we also examined three necessary coefficients, namely: the K uptake, then apparent K recovery (AKR), and the relative K efficiency (RKE). The results showed that based on the optimum economic rate of MOP (230 kg.K.ha⁻¹) and the optimum yield (44 000 kg.K.ha⁻¹), the efficiency of K silicate rocks was as high as that of MOP. Although the plants took up only half of the K supplied by the powdered rock, the hydrothermal material was found to be satisfactory, with a biomass value reaching the optimum economic limit until the second crop cycle. In comparison, the AKR of the MOP (98.6%) and its RKE in the 1st cycle were higher than our materials: 39% and 38%, respectively. Therefore, the raw and hydrothermal materials mixture could be an appropriate solution for long-term agronomic use based on the obtained results.

Keywords: K-uptake, AKR, RKE, K-bearing silicate rock, MOP

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Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

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Aims: Lumbar punctures are a common bedside procedure performed in acute medicine. Published guidance exists on the standardised documentation of invasive procedures in order to reduce the risk of complications. The audit aim was to assess current standards of documentation in accordance with both the GMC and the National Standards for Invasive Procedures guidelines. A second cycle was conducted after introducing a standardised sticker created using current guidelines. This would assess whether the sticker improved documentation, aiming for 100% standard in each step of the procedure. Methods: An initial prospective audit of current practice was conducted over a 3-month period. Patients were identified by their presenting complaints and by colleagues assessing acute medical patients. Initial findings were presented locally, and a further prospective audit was conducted following the implementation of a standardised sticker. Results: 19 lumbar punctures were included in the first cycle and 13 procedures in the second. Pre-procedure documentation was collected for each cycle, whereby documentation of ‘Indication’ improved from 5.3% to 84.6%, ‘Consent’ from 84.2% to 100%, ‘Coagulopathy’ from 0% to 61.5%, ‘Drug Chart checked’ from 0% to 100%, ‘Position of patient’ from 26.3% to 100% and use of ‘Aseptic Technique’ from 83.3% to 100% from the first to the second cycle respectively. ‘Level of Doctor’ and ‘Supervision’ decreased from 53% to 31% and 53% to 46%, respectively, in the second cycle. Documentation of the procedure itself also demonstrated improvements, with ‘Level of Insertion’ 15.8% to 100%, ‘Name of Antiseptic Used’ 11.1% to 69.2%, ‘Local Anaesthetic Used’ 26.3% to 53.8%, ‘Needle Gauge’ 42.1% to 76.9%, ‘Number of Attempts’ 78.9% to 100% and ‘Traumatic/Atraumatic’ procedure 26.3% to 92.3%, respectively. A similar number of opening pressures were documented in each cycle at 57.9% and 53.8%, respectively, but its documentation was deemed ‘Not Applicable’ in a higher number of patients in the second cycle. Post-procedure documentation improved, with ‘Number of Samples obtained’ increasing from 52.6% to 92.3% and documentation of ‘Immediate Complications’ increasing from 78.9% to 100%. ‘Dressing Applied’ was poorly documented in the first cycle at 16.7%. This was not included on the standardised sticker, resulting in 0% documentation in the second cycle. Documentation of Clinicians’ Name and Bleep reduced from 63.2% to 15.4%, but when the name only was analysed, this increased to 84.6%. Conclusions: Standardised stickers for lumbar punctures do improve documentation and hence should result in improved patient safety. There is still room for improvement to reach 100% standard in each area, especially with respect to the clinician’s name and contact details being documented. Final adjustments will be made to the sticker before being included in a lumbar puncture kit, which will be made readily available in the acute medical wards. Future audits could be extended to include other common bedside procedures performed in acute medicine to ensure documentation of all these procedures reaches 100% standard.

Keywords: invasive procedure, lumbar puncture, medical record keeping, procedure checklist, procedure documentation, standardised documentation

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Authors: J. Trarbach, S. Schosser, B. Vogt

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Decision-makers tend to prefer the first alternative over subsequent alternatives which is called the primacy effect. To reliably measure this effect, we conducted an experiment with real consequences for preference statements. Therefore, we elicit preferences of subjects using a rating scale, i.e. hypothetical preferences, and willingness to pay, i.e. real preferences, for two sequences of pain. Within these sequences, both overall intensity and duration of pain are identical. Hence, a rational decision-maker should be indifferent, whereas the primacy effect predicts a stronger preference for the first sequence. What we see is a primacy effect only for hypothetical preferences. This effect vanishes for real preferences.

Keywords: decision making, primacy effect, real incentives, willingness to pay

Procedia PDF Downloads 288

Authors: Suehyun Cho, Darrell Harrington, Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Alex Kiselyov, Michael Shpigelmacher

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The Dandy-Walker malformation (DWM) represents a clinical syndrome manifesting as a combination of posterior fossa cyst, hypoplasia of the cerebellar vermis, and obstructive hydrocephalus. Anatomic hallmarks include hypoplasia of the cerebellar vermis, enlargement of the posterior fossa, and cystic dilatation of the fourth ventricle. Current treatments of DWM, including shunting of the cerebral spinal fluid ventricular system and endoscopic third ventriculostomy (ETV), are frequently clinically insufficient, require additional surgical interventions, and carry risks of infections and neurological deficits. Bionaut Labs develops an alternative way to treat Dandy-Walker Malformation (DWM) associated with non-communicating hydrocephalus. We utilize our discreet microsurgical Bionaut™ particles that are controlled externally and remotely to perform safe, accurate, effective fenestration of the Dandy-Walker cyst, specifically in the posterior fossa of the brain, to directly normalize intracranial pressure. Bionaut™ allows for complex non-linear trajectories not feasible by any conventional surgical techniques. The microsurgical particle safely reaches targets in the lower occipital section of the brain. Bionaut™ offers a minimally invasive surgical alternative to highly involved posterior craniotomy or shunts via direct fenestration of the fourth ventricular cyst at the locus defined by the individual anatomy. Our approach offers significant advantages over the current standards of care in patients exhibiting anatomical challenge(s) as a manifestation of DWM, and therefore, is intended to replace conventional therapeutic strategies. Current progress, including platform optimization, Bionaut™ control, and real-time imaging and in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of ovine models, will be discussed.

Keywords: Bionaut™, cerebral spinal fluid, CSF, cyst, Dandy-Walker, fenestration, hydrocephalus, micro-robot

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Authors: Malathi Iyer, Jayesh Vaidya

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The demographic dividend of India will last for thirty years from now. However, reduction in birth rate, an increase in working population, improvements in medicine and better health practices lead to an ever-expanding elderly population, bringing additional burden to the economy and putting an end to the demographic dividend. To reap the dividend India needs to train the youth for employability. The need of the hour is to improve their life skills which lead the youth to become industrious and have continuous employment. The study will be conducted in perceiving the skill gaps that exist in commerce students for employability. The analysis results indicate the relation between the core study and the right skills for the workforce, with the steps that are taken to open the window for the demographic dividend.

Keywords: demographic dividend, life skills, employability, workforce

Procedia PDF Downloads 518