Search results for: medical gases

Authors: Olga Sukhoveeva

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Carbon dioxide (CO2) is the main component of carbon biogeochemical cycle and one of the most important greenhouse gases (GHG). Agriculture, particularly arable soils, are one the largest sources of GHG emission for the atmosphere including CO2.Models may be used for estimation of GHG emission from agriculture if they can be adapted for different countries conditions. The only model used in officially at national level in United Kingdom and China for this purpose is DNDC (DeNitrification-DeComposition). In our research, the model DNDC is offered for estimation of GHG emission from arable soils in Russia. The aim of our research was to create the method of DNDC using for evaluation of CO2 emission in Russia based on official statistical information. The target territory was European part of Russia where many field experiments are located. At the first step of research the database on climate, soil and cropping characteristics for the target region from governmental, statistical, and literature sources were created. All-Russia Research Institute of Hydrometeorological Information – World Data Centre provides open daily data about average meteorological and climatic conditions. It must be calculated spatial average values of maximum and minimum air temperature and precipitation over the region. Spatial average values of soil characteristics (soil texture, bulk density, pH, soil organic carbon content) can be determined on the base of Union state register of soil recourses of Russia. Cropping technologies are published by agricultural research institutes and departments. We offer to define cropping system parameters (annual information about crop yields, amount and types of fertilizers and manure) on the base of the Federal State Statistics Service data. Content of carbon in plant biomass may be calculated via formulas developed and published by Ministry of Natural Resources and Environment of the Russian Federation. At the second step CO2 emission from soil in this region were calculated by DNDC. Modelling data were compared with empirical and literature data and good results were obtained, modelled values were equivalent to the measured ones. It was revealed that the DNDC model may be used to evaluate and forecast the CO2 emission from arable soils in Russia based on the official statistical information. Also, it can be used for creation of the program for decreasing GHG emission from arable soils to the atmosphere. Financial Support: fundamental scientific researching theme 0148-2014-0005 No 01201352499 ‘Solution of fundamental problems of analysis and forecast of Earth climatic system condition’ for 2014-2020; fundamental research program of Presidium of RAS No 51 ‘Climate change: causes, risks, consequences, problems of adaptation and regulation’ for 2018-2020.

Keywords: arable soils, carbon dioxide emission, DNDC model, European Russia

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Authors: Walid Moudani

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The healthcare environment is generally perceived as being information rich yet knowledge poor. However, there is a lack of effective analysis tools to discover hidden relationships and trends in data. In fact, valuable knowledge can be discovered from application of data mining techniques in healthcare system. In this study, a proficient methodology for the extraction of significant patterns from the coronary heart disease warehouses for heart attack prediction, which unfortunately continues to be a leading cause of mortality in the whole world, has been presented. For this purpose, we propose to enumerate dynamically the optimal subsets of the reduced features of high interest by using rough sets technique associated to dynamic programming. Therefore, we propose to validate the classification using Random Forest (RF) decision tree to identify the risky heart disease cases. This work is based on a large amount of data collected from several clinical institutions based on the medical profile of patient. Moreover, the experts’ knowledge in this field has been taken into consideration in order to define the disease, its risk factors, and to establish significant knowledge relationships among the medical factors. A computer-aided system is developed for this purpose based on a population of 525 adults. The performance of the proposed model is analyzed and evaluated based on set of benchmark techniques applied in this classification problem.

Keywords: multi-classifier decisions tree, features reduction, dynamic programming, rough sets

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Authors: Yasmine Aridi, Lara Nasreddine, Maya Khalil, Arafat Tfayli, Anas Mugharbel, Farah Naja

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Breast cancer is the most commonly diagnosed cancer site among women worldwide and the second most common cause of cancer mortality. Breast cancer rates differ vastly between geographical areas, countries, and within the same country. In Lebanon, the proportion of breast cancer to all other sites of tumor is 38.2%; these rates are still lower than those observed worldwide, but remain the highest among Arab countries. Studies and evidence based reviews show a strong association between breast cancer development and prognosis and dietary habits, specifically the Mediterranean diet (MD). As such, the aim of this study is to examine dietary patterns and adherence to the MD among a sample of 182 breast cancer female patients in Beirut, Lebanon. Subjects were recruited from two major hospitals; a private medical center and a public hospital. All subjects were administered two questionnaires: socio- demographics and Mediterranean diet adherence. Five Mediterranean scores were calculated: MS, MSDPS, PMDI, PREDIMED and DDS. The mean age of the participants was 53.78 years. The overall adherence to the Mediterranean diet (MD) was low since the sample means of 3 out of the 5 calculated scores were less than the scores’ medians. Given that 4 out of the 5 Mediterranean scores significantly varied between the recruitment sites, women in the private medical center were found to adhere more to the MD. Our results also show that the majority of the sample population’s intakes are exceeding the recommendations for total and saturated fat, while meeting the requirements for fiber, EPA, DHA and Linolenic Acid. Participants in the private medical center were consuming significantly more calories, carbohydrates, fiber, sugar, Lycopene, Calcium, Iron and Folate and less fat. After conducting multivariate linear regression analyses, the following significant results were observed: positive associations between MD (CPMDI, PREDIMED) and monthly income & current state of health, while negative associations between MD (MSDPS, PREDIMED) and age & employment status. Our findings indicated a low overall adherence to the MD and identified factors associated with it; which suggests a need to address dietary habits among BC patients in Lebanon, specifically encouraging them to adhere to their traditional Mediterranean diet.

Keywords: Adherence, Breast cancer, Dietary patterns, Mediterranean diet, Nutrition

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Authors: H. M. Wilhelm, P. O. Fernandes, L. P. Dill, C. Steffens, K. G. Moscon, S. M. Peres, V. Bender, T. Marchesan, J. B. Ferreira Neto

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Deterioration of insulating oil is a natural process that occurs during transformers operation. However, this process can be accelerated by some factors, such as oxygen, high temperatures, metals and, moisture, which rapidly reduce oil insulating capacity and favor transformer faults. Parts of building materials of a transformer can be degraded and yield soluble compounds and insoluble particles that shorten the equipment life. Physicochemical tests, dissolved gas analysis (including propane, propylene and, butane), volatile and furanic compounds determination, besides quantitative and morphological analyses of particulate are proposed in this study in order to correlate transformers building materials degradation with insulating oil characteristics. The present investigation involves tests of medium temperature overheating simulation by means of an electric resistance wrapped with the following materials immersed in mineral insulating oil: test I) copper, tin, lead and, paper (heated at 350-400 °C for 8 h); test II) only copper (at 250 °C for 11 h); and test III) only paper (at 250 °C for 8 h and at 350 °C for 8 h). A different experiment is the simulation of electric arc involving copper, using an electric welding machine at two distinct energy sets (low and high). Analysis results showed that dielectric loss was higher in the sample of test I, higher neutralization index and higher values of hydrogen and hydrocarbons, including propane and butane, were also observed. Test III oil presented higher particle count, in addition, ferrographic analysis revealed contamination with fibers and carbonized paper. However, these particles had little influence on the oil physicochemical parameters (dielectric loss and neutralization index) and on the gas production, which was very low. Test II oil showed high levels of methane, ethane, and propylene, indicating the effect of metal on oil degradation. CO₂ and CO gases were formed in the highest concentration in test III, as expected. Regarding volatile compounds, in test I acetone, benzene and toluene were detected, which are oil oxidation products. Regarding test III, methanol was identified due to cellulose degradation, as expected. Electric arc simulation test showed the highest oil oxidation in presence of copper and at high temperature, since these samples had huge concentration of hydrogen, ethylene, and acetylene. Particle count was also very high, showing the highest release of copper in such conditions. When comparing high and low energy, the first presented more hydrogen, ethylene, and acetylene. This sample had more similar results to test I, pointing out that the generation of different particles can be the cause for faults such as electric arc. Ferrography showed more evident copper and exfoliation particles than in other samples. Therefore, in this study, by using different combined analytical techniques, it was possible to correlate insulating oil characteristics with possible contaminants, which can lead to transformers failure.

Keywords: Ferrography, gas analysis, insulating mineral oil, particle contamination, transformer failures

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Authors: Hsin-Yi Lo, Huang-Ju Jiun, Yu-Chiao Chu

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Hemodynamic monitoring is an important in the intensive care unit. Advances in medical technology in recent years, more diversification of intensive care equipment, there are many kinds of instruments available for monitoring of hemodynamics, Edwards Lifesciences Hemodynamic Monitoring (FloTrac) is one of them. The recent medical safety incidents in parameters were changed, nurses have not to notify doctor in time, therefore, it is hoped to analyze the current problems and find effective improvement strategies. In August 2021, the survey found that only 74.0% of FloTrac correctness of operation, reasons include lack of education, the operation manual is difficulty read, lack of audit mechanism, nurse doesn't know those numerical changes need to notify doctor, work busy omission, unfamiliar with operation and have many nursing records then omissions. Improvement methods include planning professional nurse education, formulate the secret arts of FloTrac, enacting an audit mechanism, establish FloTrac action learning, make「follow the sun」care map, hold simulated training and establish monitoring data automatically upload nursing records. After improvement, FloTrac correctness of operation increased to 98.8%. The results are good, implement to the ICU of the hospital.

Keywords: hemodynamic monitoring, edwards lifesciences hemodynamic monitoring, multiple strategies, intensive care

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Authors: Mahnaz Khalafehnilsaz, Rozina Rahnama

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Introduction: The elderly population is growing rapidly, and with this growth comes an increased demand for healthcare services. Artificial intelligence (AI) has the potential to revolutionize the delivery of healthcare services to the elderly population. In this study, the various ways in which AI is used to create health content for elderly people and its transformative impact on the healthcare industry will be explored. Method: A systematic review of the literature was conducted to identify studies that have investigated the role of AI in creating health content specifically for elderly people. Several databases, including PubMed, Scopus, and Web of Science, were searched for relevant articles published between 2000 and 2022. The search strategy employed a combination of keywords related to AI, personalized health content, and the elderly. Studies that utilized AI to create health content for elderly individuals were included, while those that did not meet the inclusion criteria were excluded. A total of 20 articles that met the inclusion criteria were identified. Finding: The findings of this review highlight the diverse applications of AI in creating health content for elderly people. One significant application is the use of natural language processing (NLP), which involves the creation of chatbots and virtual assistants capable of providing personalized health information and advice to elderly patients. AI is also utilized in the field of medical imaging, where algorithms analyze medical images such as X-rays, CT scans, and MRIs to detect diseases and abnormalities. Additionally, AI enables the development of personalized health content for elderly patients by analyzing large amounts of patient data to identify patterns and trends that can inform healthcare providers in developing tailored treatment plans. Conclusion: AI is transforming the healthcare industry by providing a wide range of applications that can improve patient outcomes and reduce healthcare costs. From creating chatbots and virtual assistants to analyzing medical images and developing personalized treatment plans, AI is revolutionizing the way healthcare is delivered to elderly patients. Continued investment in this field is essential to ensure that elderly patients receive the best possible care.

Keywords: artificial intelligence, health content, older adult, healthcare

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Authors: Farzad Jalilian, Mehdi Mirzaei Alavijeh

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Background: E-interventions as a universal approach to prevent a high-risk behavior, such as alcohol drinking. This study was conducted to evaluate web-based alcohol drinking preventative intervention efficiency among medical university students in Iran. Methods: Overall, 150 freshman and sophomore male student’s college students participated in this study as intervention and control group. This was a longitudinal randomized pre- and post-test series control group design panel study to implement a behavior modification based intervention to alcohol drinking prevention among college students. Cross-tabulation, t-test, repeated measures, and GEE by using SPSS statistical package, version 21 was used for the statistical analysis. The participants were followed up for 6 months with data collection scheduled at baseline, 3 and 6 months. The primary outcomes are attitude, self-control, and sensation seeking. Furthermore, the secondary outcome is comparing alcohol drinking among the study groups. Results: It was found significant reduce in average response for an attitude towards alcohol drinking and sensation seeking among intervention group (P < 0.05). But after intervention not significant difference between intervention and control group of improve self-control and reduce alcohol drinking (P > 0.05). Conclusion: Our intervention has been accompanied with reducing alcohol use rate. These findings indicate that e-intervention may be effectiveness approach to address the alcohol prevention among college students.

Keywords: e-interventions, alcohol drinking, students, Iran

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Authors: Radah Yousuf, Ashraf Shebl

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Suicide is a tragic event with strong emotional repercussions for its survivors and for families of its victims. There were thousands of cases all over the world. There are many risk factors include mental disorders such as depression, and substance abuse, including alcoholism and use of benzodiazepines. Other suicides are impulsive acts due to stress such as from financial difficulties, troubles with relationships, or from bullying. The aim of work in this study is making a survey from archives of the suicidal cases, which had a medicolegal examination, in forensic medicine center in Al Madinah Almunawarah-KSA, for ten years in the period between 1428-1438h. In each case, some data are collected such as age, sex, time and place of an act, method of suicide, the presence of the witness, medical history. This study demonstrates that suicide is more common in male than female, and the 4th decade was the most period of age. The most common method of suicide was hanging followed by falling from the height. These results indicated that cultural and religious beliefs that discourage suicide and support self-preservation instinct, and suicide education programs provide information to students in high school, builds awareness, one of the most important issues in solving that problem. From the forensic view, circumstantial evidence of every forensic case must take and record, full history about the social, medical and psychological problems, attend the scene of death is a very important, complete medicolegal investigation for every case, and full autopsy with very skilled techniques and facilities can help in diagnosing what type of crimes.

Keywords: suicide, age, sex, hanging

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Authors: Bastien Sanglard, Simon Cayez, Guillaume Viau, Thomas Blon, Julian Carrey, Sébastien Lachaize

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The need to develop clean production processes is a key challenge of any industry. Steel and iron industries are particularly concerned since they emit 6.8% of global anthropogenic greenhouse gas emissions. One key step of the process is the high-temperature reduction of iron ore using coke, leading to large amounts of CO2 emissions. One route to decrease impacts is to get rid of fossil fuels by changing both the heat source and the reducer. The present work aims at investigating experimentally the possibility to use concentrated solar energy and carbon-free reducing agents. Two sets of experimentations were realized. First, in situ X-ray diffraction on pure and industrial powder of hematite was realized to study the phase evolution as a function of temperature during reduction under hydrogen and ammonia. Secondly, experiments were performed on industrial iron ore pellets, which were reduced by NH3 or H2 into a “solar furnace” composed of a controllable 1600W Xenon lamp to simulate and control the solar concentrated irradiation of a glass reactor and of a diaphragm to control light flux. Temperature and pressure were recorded during each experiment via thermocouples and pressure sensors. The percentage of iron oxide converted to iron (called thereafter “reduction ratio”) was found through Rietveld refinement. The power of the light source and the reduction time were varied. Results obtained in the diffractometer reaction chamber show that iron begins to form at 300°C with pure Fe2O3 powder and 400°C with industrial iron ore when maintained at this temperature for 60 minutes and 80 minutes, respectively. Magnetite and wuestite are detected on both powders during the reduction under hydrogen; under ammonia, iron nitride is also detected for temperatures between400°C and 600°C. All the iron oxide was converted to iron for a reaction of 60 min at 500°C, whereas a conversion ratio of 96% was reached with industrial powder for a reaction of 240 min at 600°C under hydrogen. Under ammonia, full conversion was also reached after 240 min of reduction at 600 °C. For experimentations into the solar furnace with iron ore pellets, the lamp power and the shutter opening were varied. An 83.2% conversion ratio was obtained with a light power of 67 W/cm2 without turning over the pellets. Nevertheless, under the same conditions, turning over the pellets in the middle of the experiment permits to reach a conversion ratio of 86.4%. A reduction ratio of 95% was reached with an exposure of 16 min by turning over pellets at half time with a flux of 169W/cm2. Similar or slightly better results were obtained under an ammonia reducing atmosphere. Under the same flux, the highest reduction yield of 97.3% was obtained under ammonia after 28 minutes of exposure. The chemical reaction itself, including the solar heat source, does not produce any greenhouse gases, so solar metallurgy represents a serious way to reduce greenhouse gas emission of metallurgy industry. Nevertheless, the ecological impact of the reducers must be investigated, which will be done in future work.

Keywords: solar concentration, metallurgy, ammonia, hydrogen, sustainability

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Authors: Jie Huo, Jonathan Wu

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Segmentation of anatomical structures in medical images is essential for scientific inquiry into the complex relationships between biological structure and clinical diagnosis, treatment and assessment. As a method of incorporating the prior knowledge and the anatomical structure similarity between a target image and atlases, multi-atlas segmentation has been successfully applied in segmenting a variety of medical images, including the brain, cardiac, and abdominal images. The basic idea of multi-atlas segmentation is to transfer the labels in atlases to the coordinate of the target image by matching the target patch to the atlas patch in the neighborhood. However, this technique is limited by the pairwise registration between target image and atlases. In this paper, a novel multi-atlas segmentation approach is proposed by introducing a dynamic energy model. First, the target is mapped to each atlas image by minimizing the dynamic energy function, then the segmentation of target image is generated by weighted fusion based on the energy. The method is tested on MICCAI 2012 Multi-Atlas Labeling Challenge dataset which includes 20 target images and 15 atlases images. The paper also analyzes the influence of different parameters of the dynamic energy model on the segmentation accuracy and measures the dice coefficient by using different feature terms with the energy model. The highest mean dice coefficient obtained with the proposed method is 0.861, which is competitive compared with the recently published method.

Keywords: brain MRI segmentation, dynamic energy model, multi-atlas segmentation, energy minimization

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Authors: Slawomir Pilip, Michal Wasilewski, Daniel Celinski, Leszek Szpakowski, Grzegorz Michalak

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The aim of the study was to evaluate the effectiveness of cardiopulmonary resuscitation taken by Medical Emergency Teams (MET) at the place of an accident including the usage of mechanical chest compression systems. In the period of January-May 2017, there were 137 cases of a sudden cardiac arrest in a chosen region of Eastern Poland with 360.000 inhabitants. Medical records and questionnaires filled by METs were analysed to prove the effectiveness of cardiopulmonary resuscitations that were considered to be effective when an early indication of spontaneous circulation was provided and the patient was taken to hospital. A chest compression system used by METs was applied in 60 cases (Lucas3 - 34 patients; Auto Pulse - 24 patients). The effectiveness of cardiopulmonary resuscitation among patients who were employed a chest compression system was much higher (43,3%) than the manual cardiac massage (36,4%). Thus, the usage of Lucas3 chest compression system resulted in 47% while Auto Pulse was 33,3%. The average ambulance arrival time could have had a significant impact on the subsequent effectiveness of cardiopulmonary resuscitation in these cases. Ambulances equipped with Lucas3 reached the destination within 8 minutes, and those with Auto Pulse needed 12,1 minutes. Moreover, taking effective basic life support (BLS) by bystanders before the ambulance arrival was much more frequent for ambulances with Lucas3 than Auto Pulse. Therefore, the percentage of BLS among the group of patients who were employed Lucas3 by METs was 26,5%, and 20,8% for Auto Pulse. The total percentage of taking BLS by bystanders before the ambulance arrival resulted in 25% of patients who were later applied a chest compression system by METs. Not only was shockable cardiac rhythm obtained in 47% of these cases, but an early indication of spontaneous circulation was also provided in all these patients. Both Lucas3 and Auto Pulse were evaluated to be significantly useful in improving the effectiveness of cardiopulmonary resuscitation by 97% of Medical Emergency Teams. Therefore, implementation of chest compression systems essentially makes the cardiopulmonary resuscitation even more effective. The ambulance arrival time, taking successful BLS by bystanders before the ambulance arrival and the presence of shockable cardiac rhythm determine an early indication of spontaneous circulation among patients after a sudden cardiac arrest.

Keywords: cardiac arrest, effectiveness, mechanical chest compression systems, resuscitation

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Authors: Lucie Cote, Sonia McFadden

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Mental health problems in the workplace are currently one of the main causes of absences. Research work has highlighted the importance of a collaborative process involving the stakeholders in the return-to-work process and has established the best management practices to ensure a successful return-to-work. However, very few studies have specifically explored the combination of various management models and determined whether they could satisfy the needs of the stakeholders. The objective of this study is to analyze two models for managing the return to work: the ‘medical-administrative’ and the ‘support of the worker’ in order to understand the actions and actors involved in these models. The study also aims to explore whether these models meet the needs of the actors involved in the management of the return to work. A qualitative case study was conducted in a Canadian federal organization. An abundant internal documentation and semi-directed interviews with six managers, six workers and four human resources professionals involved in the management of records of employees returning to work after a mental health problem resulted in a complete picture of the return to work management practices used in this organization. The triangulation of this data facilitated the examination of the benefits and limitations of each approach. The results suggest that the actions of management for employee return to work from both models of management ‘support of the worker’ and ‘medical-administrative’ are compatible and can meet the needs of the actors involved in the return to work. More research is needed to develop a structured model integrating best practices of the two approaches to ensure the success of the return to work.

Keywords: return to work, mental health, management models, organizations

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Authors: Shahrzad Yektatalab, Agrin Mohammadi, Ladan Zarshenas

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Background: Misophonia is a severe emotional response to repetitive sounds. This disorder may limit a person's communication, reduce their ability, or disrupt their social and personal life. This study aims to determine the prevalence of Misophonia and its relationship with obsessive-compulsive disorder, anxiety, and depression in undergraduate students of XXX University of Medical Sciences. Methods: The present study is an analytical descriptive study conducted in October 2020. The study samples are 390 undergraduate students of XXX University of medical sciences. A relative and systematic sampling method was used. In this study, a demographic questionnaire, misophonia questionnaire (A score of 7 or higher is considered as misophonia), Beck anxiety questionnaire, Beck depression questionnaire, and Maudsley questionnaire were used, and the data were analyzed using SPSS 24 software. Due to the non-normality of the data, the Spearman correlation coefficient was used for analyzing data. The significance level was considered less than 0.05. Results: 23.8% of students have misophonia. Of the 390 participants in the study, 93 had experienced misophonia. Among these 93 students, 37 (39.8%) had obsessive-compulsive disorder, 8 (8.6%) had anxiety and 9 (9.7%) had depression. There was a significant and direct relationship between all variables (p <0.001), which means that with the increase of each disorder, the probability of an increase in other disorders increases. Conclusion: Due to the high prevalence of misophonia in students and its direct relationship with obsessive-compulsive disorder, anxiety, and depression, It is recommended that future studies be conducted to identify ways to prevent and reduce the incidence of misophonia.

Keywords: misophonia, obsessive-compulsive disorder, anxiety, depression

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Authors: Alan S. Weber

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This contribution reviews the current biomedical and qualitative arts research on arts-in-health interventions to improve both individual and population health outcomes. Arts therapies–for example, music therapy with roots in Aristoxenus’s Ἁρμονικὰ στοιχεῖα and the Pythagorean sect–have long been employed in therapeutic contexts. However, the 20th century witnessed the increasing use of the visual and plastic arts (drawing, painting, sculpting), performing arts (drama and dance), and other expressive arts modalities into occupational therapy, well-being medicine, and psychological and psychiatric counselling, diagnosis, and treatment. A significant body of peer-reviewed evidence in the medical and neurological sciences on the role of arts-in-health has developed, and specifically, research on music and art therapy has led to their inclusion within the current biomedical paradigm of evidence-based practice. The arts cannot only aid in public and population health promotion (promoting healthy behaviors and lifestyles, preventing disease onset) but also in addressing psychological issues (regulation of emotion; stress, anxiety, and depression reduction), behavioural issues (basic life skills, coping), and physiological response (immune system function, hormonal regulation, homeostatis). Working as a cross-disciplinary researcher in the arts in an American medical college, the author has developed several successful arts-in-health programs at the national and international level.

Keywords: arts-in-health, evidence based medicine, arts for health, expressive arts therapies

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Authors: A/Prof Marjan Khajehei

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In the last century, the role of fathers in the birth has changed exponentially. Before the 1970s, the principal view was that birth was a female business and not a man’s place. Changing cultural and professional attitudes around the emotional bond between a man and a woman, family structure and the more proactive involved role of men in the family have encouraged fathers’ attendance at birth. There is evidence that fathers’ support can make birthing less traumatic for some women and can make couples closer. This has made some clinicians to believe the fathers should be more involved throughout the birth process. Some clinicians even go further and ask the fathers to watch the medical procedures, such as inserting vaginal speculum, forceps or vacuum, episiotomy and stitches. Although birth can unfold like a beautiful picture captured by birth photographers, with fathers massaging women’s backs by candle light and the miraculous moment of birth, it can be overshadowed by less attractive images of cervical mucous, emptying bowels and the invasive medical procedures. What happens in the birth room and the fathers’ reaction to the graphic experience of birthing can be unpredictable. Despite the fact that most men are absolutely thrilled to be in the delivery room, for some men, a very intimate body part can become completely desexualised, and they can experience psychological and sexual scarring. They see someone they cherish dramatically sliced open and can then associate their partners with a disturbing scene, and it can dramatically affect their relationships. While most women want the expectant fathers by their side for this life-changing event, not all of them may be happy for their partners to watch the perineum to be cut or stitched or when large blades of forceps are inserted inside the vagina. Anecdotal reports have shown that consent is not sought from the labouring women as to whether they want their partners to watch these procedures. The majority of research1, 2, 3 focuses on men’s and women’s retrospective attitudes towards their birth experience. However, the effect of witnessing invasive procedures during childbirth on a man's attraction to his partner, while she is most vulnerable, and also an increased risk of post-traumatic stress disorder in fathers have not been widely investigated. There is a lack of sufficient research investigating whether women need to be asked for their consent before inviting their partners to closely watch medical procedures during childbirth. Future research is required to provide a basis for better awareness and involve the consumers to understanding the men’s and women’s experience and their expectations for labour and birth.

Keywords: birth, childbirth, father, labour, men, women

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Authors: Aruha Khan, Brynn E. Kankel, Paraskevi Papadopoulou

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In recent years, extensive research upon ‘stress’ has provided insight into its two distinct guises, namely the short–term (fight–or–flight) response versus the long–term (chronic) response. Specifically, the long–term or chronic response is associated with the suppression or dysregulation of immune function. It is also widely noted that the occurrence of cancer is greatly correlated to the suppression of the immune system. It is thus necessary to explore the impact of long–term or chronic stress upon the prevalence and risk of cancer. To what extent can the dysregulation of immune function caused by long–term exposure to stress be controlled or minimized? This study focuses explicitly upon immunosuppression due to its ability to increase disease susceptibility, including cancer itself. Based upon an analysis of the literature relating to the fundamental structure of the immune system alongside the prospective linkage of chronic stress and the development of cancer, immunosuppression may not necessarily correlate directly to the acquisition of cancer—although it remains a contributing factor. A cross-sectional analysis of the survey data from the University of Tennessee Medical Center (UTMC) and Harvard Medical School (HMS) will provide additional supporting evidence (or otherwise) for the hypothesis of the study about whether immunosuppression (caused by the chronic stress response) notably impacts the prevalence of cancer. Finally, a multidimensional framework related to education on chronic stress and its effects is proposed.

Keywords: immune system, immunosuppression, long–term (chronic) stress, risk of cancer

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Authors: Abdulwhab Alotaibi, Abdullah Alzahrani, Ziyad Bokhari, Abdulelah Alghamdi

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First described in 1975 by Dr. Miller, Medical dressings are uncommon but possible cause of hand digital ischemia due the tourniquet-like effect. The incident of this complication has been reported across wide range of age-groups, yet it seems like that the pediatric population are specifically vulnerable. Multiple dressing types were reported to have caused ischemic injury, such as elastic wrap, tubular gauze, and self-adherent dressings. We present a case of medical dressing induced digital ischemia in patient with Congenital insensitivity to pain and anhidrosis (CIPA), which further challenge the discovery of the condition. An 8-year-old girl known case of CIPA. Brought by her mother to the ER after nail bed injury, which she managed by application of elastic wrap that was left for 24 hours. When the mother found out she immediately removed the elastic band, and noticed the fingertip was black and cold with tense bullae. The color then changed later when she arrived to the ER to dark purple with bluish discoloration on the tip. On examination there was well demarcated tense bullae on the distal right fifth finger. Neurovascular intact, pulse oximetry on distal digit 100%, capillary refill time was delayed. She was seen under Plastic surgery and conservative management recommended, and patient was discharged with safety netting. Two days later the patient came as follow-up visit at which her condition demonstrated significant improvement, the bullae has since ruptured leaving behind sloughed skin, capillary refill and pulse oximetry were both within normal limits, sensory function couldn’t be assessed but her motor function and ROM were normal, topical bacitracin and bandage dressings were applied for the eroded skin. Patient was scheduled for a follow-up in 2 weeks. Preventatively it’s advisable to avoid the commonly implicated dressings such as elastic, tubular gauze or self-adherent wraps in hand or digital injuries when possible, but in cases where the use of these dressings is of necessity the appropriate precautions must be taken, Dr. Makarewich proposed the following 5 measures to help minimize the incidence of the injury: 1-Unwrapping 12 inches of the dressing before rolling the injured finger. 2-Wrapping from distal to proximal with minimal tension to avoid vascular embarrassment. 3-The use of 5-25 inch to overlap the entire wrap. 4-Maintaining light pressure over the wrap to allow adherence of the dressing. 5-Minimization of the number of layers used to wrap the affected digit. Also assessing the capillary refill after the application can help in determining the patency of the supplying blood vessels. It’s also important to selectively determine if the patient is a candidate for conservative management, as tailored approach can help in maximizing the positive outcomes for our patients.

Keywords: congenital insensitivity to pain, digital ischemia, medical dressing, conservative management

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Authors: Florence A. Undiyaundeye, Aniashie Akpanke

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Early identification of developmental disorders in infants and toddlers is critical for the well being of children. It is also an integral function of the primary care medical provider and the early care given in the home or crèche. This paper is focused at providing information on special need infants and toddlers and strategies to support them in developmental concern to cope with the challenges in and out of the classroom and to interact with their peers without stigmatization and inferiority complex. The target children are from birth through three years of age. There is a strong recommendation for developmental surveillance to be incorporated at every well child preventive care program in training and practical stage of formal school settings. The paper posits that any concerns raised during surveillance should be promptly addressed with standardized developmental screening by appropriate health service providers. In addition screening tests should be administered regularly at age 9+, 19+ and 30 months of these infants. The paper also establishes that the early identification of these developmental challenges of the infants and toddlers should lead to further developmental and medical evaluation, diagnosis and treatment, including early developmental school intervention, control and teaching and learning integration and inclusion for proper career build up. Children diagnosed with developmental disorders should be identified as children with special needs so that management is initiated and its underlying etiology may also drive a range of treatment of the child, to parents. Conselling and school integration as applicable to the child’s specific need and care for sustenance in societal functioning.

Keywords: care, special need, support, infants and toddlers, management and developmental disorders

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Authors: Sara Iqbal

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Introduction:Renal transplant is increasingly one of the most popular transplants within the UK; with an aging population along with obesity epidemic we are witnessing increasing rates of diabetes – one of the commonest indications for renal transplant. However, the demand is far greater than supply. Many donors are provided by women of child-bearing age; however the long-term effects are still uncertain. Aim:Determine pregnancy outcomes and complications of women of child-bearing age following renal donation. Methods: A review of the current available literature was preformed using MEDLINE and EMBASE up to 2014. Search criteria included key terms such as pregnancy outcome post-renal donor, pregnancy outcomes and complications. Relevant articles were selected based on pure methodological medical research, after careful analysis, they were recorded within this review. Results: Out of 1141 women involved in transplant studies, 574 pregnancies reported having donated a single-renal donor prior to pregnancy. Of which a staggering miscarriage rate 32.4% (n=186) was reported, amongst this other complications included gestational hypertension of 10% (n=59) and gestational diabetes 2.3% (n=13). Other significantly noted complications included chronic hypertension, low-birth weights, and pregnancy-related death. Conclusions: After unilateral renal donor transplant, haemodynamics change along with pregnancy, predisposing women to developing several complications compared to pregnancies with no history any renal-donor transplant. Despite this, further investigation is required in order to accurately determine the safety of renal-donors in women of child-bearing age.

Keywords: renal transplant, pregnancy, complications, medical and health sciences

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Authors: Belgherbi Aicha, Hadjidj Ismahen, Bessaid Abdelhafid

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Interpretation of medical images benefits from anatomical and physiological priors to optimize computer-aided diagnosis applications. Segmentation of liver, spleen and kidneys is regarded as a major primary step in the computer-aided diagnosis of abdominal organ diseases. In this paper, a semi-automated method for medical image data is presented for the abdominal organ segmentation data using mathematical morphology. Our proposed method is based on hierarchical segmentation and watershed algorithm. In our approach, a powerful technique has been designed to suppress over-segmentation based on mosaic image and on the computation of the watershed transform. Our algorithm is currency in two parts. In the first, we seek to improve the quality of the gradient-mosaic image. In this step, we propose a method for improving the gradient-mosaic image by applying the anisotropic diffusion filter followed by the morphological filters. Thereafter, we proceed to the hierarchical segmentation of the liver, spleen and kidney. To validate the segmentation technique proposed, we have tested it on several images. Our segmentation approach is evaluated by comparing our results with the manual segmentation performed by an expert. The experimental results are described in the last part of this work.

Keywords: anisotropic diffusion filter, CT images, morphological filter, mosaic image, simultaneous organ segmentation, the watershed algorithm

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Authors: Joana Almeida, Kendall Reid, Jonas Bengtsson

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Pallets are devices that are used for moving and storing freight and are nearly omnipresent in supply chains. The market is dominated by timber pallets, with plastic being a common alternative. Either option underpins the use of important resources (oil, land, timber), the emission of greenhouse gases and additional waste generation in most supply chains. This study uses a dynamic approach to the life cycle assessment (LCA) of pallets. It demonstrates that what ultimately defines the environmental burden of pallets in the supply chain is how often the length of its lifespan, which depends on the durability of the material and on how pallets are utilized. This study proposes a life cycle assessment (LCA) of pallets in supply chains supported by an algorithm that estimates pallet durability in function of material resilience and of logistics. The LCA runs from cradle-to-grave, including raw material provision, manufacture, transport and end of life. The scope is representative of timber and plastic pallets in the Australian and South-East Asia markets. The materials included in this analysis are: -tropical mixed hardwood, unsustainably harvested in SE Asia; -certified softwood, sustainably harvested; -conventional plastic, a mix of virgin and scrap plastic; -recycled plastic pallets, 100% mixed plastic scrap, which are being pioneered by Re > Pal. The logistical model purports that more complex supply chains and rougher handling subject pallets to higher stress loads. More stress shortens the lifespan of pallets in function of their composition. Timber pallets can be repaired, extending their lifespan, while plastic pallets cannot. At the factory gate, softwood pallets have the lowest carbon footprint. Re > pal follows closely due to its burden-free feedstock. Tropical mixed hardwood and plastic pallets have the highest footprints. Harvesting tropical mixed hardwood in SE Asia often leads to deforestation, leading to emissions from land use change. The higher footprint of plastic pallets is due to the production of virgin plastic. Our findings show that manufacture alone does not determine the sustainability of pallets. Even though certified softwood pallets have lower carbon footprint and their lifespan can be extended by repair, the need for re-supply of materials and disposal of waste timber offsets this advantage. It also leads to most waste being generated among all pallets. In a supply chain context, Re > Pal pallets have the lowest footprint due to lower replacement and disposal needs. In addition, Re > Pal are nearly ‘waste neutral’, because the waste that is generated throughout their life cycle is almost totally offset by the scrap uptake for production. The absolute results of this study can be confirmed by progressing the logistics model, improving data quality, expanding the range of materials and utilization practices. Still, this LCA demonstrates that considering logistics, raw materials and material durability is central for sustainable decision-making on pallet purchasing, management and disposal.

Keywords: carbon footprint, life cycle assessment, recycled plastic, waste

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Authors: Ghodsieh Isapour Toutizad, Aiyong Wang, Joonsoo Han, Derek Creaser, Louise Olsson, Magnus Skoglundh, Hanna HaRelind

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Nitrous oxide (N2O), which is generally formed as a byproduct of industrial chemical processes and fossil fuel combustion, has attracted considerable attention due to its destructive role in global warming and ozone layer depletion. From various developed technologies used for lean NOx reduction, the selective catalytic reduction (SCR) of NOx with ammonia is presently the most applied method. Therefore, the development of catalysts for efficient lean NOx reduction without forming N2O in the process, or only forming it to a very small extent from the exhaust gases is of crucial significance. One type of catalysts that nowadays are used for this aim are zeolite-based catalysts. It is owing to their remarkable catalytic performance under practical reaction conditions such as high thermal stability and high N2 selectivity. Among all zeolites, copper ion-exchanged zeolites, with CHA, MFI, and BEA framework structure (like SSZ-13, ZSM-5 and Beta, respectively), represent higher hydrothermal stability, high activity and N2 selectivity. This work aims at investigating the effect of the zeolite framework structure on the formation of N2O during NH3-SCR reaction conditions over three Cu-based zeolites ranging from small-pore to large-pore framework structure. In the zeolite framework, Cu exists in two cationic forms, that can catalyze the SCR reaction by activating NO to form NO+ and/or surface nitrate species. The nitrate species can thereafter react with NH3 to form another intermediate, ammonium nitrate, which seems to be one source for N2O formation at low temperatures. The results from in situ diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS) indicate that during the NO oxidation step, mainly NO+ and nitrate species are formed on the surface of the catalysts. The intensity of the absorption peak attributed to NO+ species is higher for the Cu-CHA sample compared to the other two samples, indicating a higher stability of this species in small cages. Furthermore, upon the addition of NH3, through the standard SCR reaction conditions, absorption peaks assigned to N-H stretching and bending vibrations are building up. At the same time, negative peaks are evolving in the O-H stretching region, indicating blocking/replacement of surface OH-groups by NH3 and NH4+. By removing NH3 and adding NO2 to the inlet gas composition, the peaks in the N-H stretching and bending vibration regions show a decreasing trend in intensity, with the decrease being more pronounced for increasing pore size. It can probably be owing to the higher accumulation of ammonia species in the small-pore size zeolite compared to the other two samples. Furthermore, it is worth noting that the ammonia surface species are strongly bonded to the CHA zeolite structure, which makes it more difficult to react with NO2. To conclude, the framework structure of the zeolite seems to play an important role in the formation and reactivity of surface species relevant for the SCR process. Here we intend to discuss the connection between the zeolite structure, the surface species, and the formation of N2O during ammonia-SCR.

Keywords: fast SCR, nitrous oxide, NOx, standard SCR, zeolites

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Authors: Michael Sonne Kristensen, Frank Loesche, James Foster, Elif Ozcan, Judy Edworthy

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Auditory alarms play an integral role in intensive care nurses’ daily work. Most medical devices in the intensive care unit (ICU) are designed to produce alarm sounds in order to make nurses aware of immediate or prospective safety risks. The utilisation of sound as a carrier of crucial patient information is highly dependent on nurses’ presence - both physically and mentally. For ICU nurses, especially the ones who work with stationary alarm devices at the patient bed space, it is a challenge to display ‘appropriate’ alarm responses at all times as they have to navigate with great flexibility in a complex work environment. While being primarily responsible for a small number of allocated patients they are often required to engage with other nurses’ patients, relatives, and colleagues at different locations inside and outside the unit. This work explores the social strategies used by a team of nurses to comprehend and react to the information conveyed by the alarms in the ICU. Two main research questions guide the study: To what extent do alarms from a patient bed space reach the relevant responsible nurse by direct auditory exposure? By which means do responsible nurses get informed about their patients’ alarms when not directly exposed to the alarms? A comprehensive video-ethnographic field study was carried out to capture and evaluate alarm-related events in an ICU. The study involved close collaboration with four nurses who wore eye-level cameras and ear-level binaural audio recorders during several work shifts. At all time the entire unit was monitored by multiple video and audio recorders. From a data set of hundreds of hours of recorded material information about the nurses’ location, social interaction, and alarm exposure at any point in time was coded in a multi-channel replay-interface. The data shows that responsible nurses’ direct exposure and awareness of the alarms of their allocated patients vary significantly depending on work load, social relationships, and the location of the patient’s bed space. Distributed listening is deliberately employed by the nursing team as a social strategy to respond adequately to alarms, but the patterns of information flow prompted by alarm-related events are not uniform. Auditory Spatiotemporal Trajectory (AST) is proposed as a methodological label to designate the integration of temporal, spatial and auditory load information. As a mixed-method metrics it provides tangible evidence of how nurses’ individual alarm-related experiences differ from one another and from stationary points in the ICU. Furthermore, it is used to demonstrate how alarm-related information reaches the individual nurse through principles of social and distributed cognition, and how that information relates to the actual alarm event. Thereby it bridges a long-standing gap in the literature on medical alarm utilisation between, on the one hand, initiatives to measure objective data of the medical sound environment without consideration for any human experience, and, on the other hand, initiatives to study subjective experiences of the medical sound environment without detailed evidence of the objective characteristics of the environment.

Keywords: auditory spatiotemporal trajectory, medical alarms, social cognition, video-ethography

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Authors: Orogun Daniel Oghenekevhwe

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Africa being an agrarian continent has an abundance of fruits that are both nutritional and medicinal. Regardless of the abundance of these healing elements, Africa leads the statistics of poor healthcare globally. Among others, there are two noticeable challenges in the healthcare system which are ‘Poor access and high cost of medical healthcare’. The effects of both the access and economic implications are (1) Low responsiveness and (2) High mortality rate. While the United Nations and the global health community continue to work towards reduced mortality rates and poor responsiveness to healthcare and wellness, this paper investigates how some Africans use the spiritual symbols of African fruits as responsive catalysts to embrace naturopathy thereby reducing the effects and impacts of poor healthcare challenges in Africa. The main argument is whether there are links between spiritual symbols and fruits that influence Africans' response to naturopathy and low-cost healthcare. Following that is the question of how medical healthcare responds to such development. Bitter Kola (Garcinia) is the case study fruit, and Sunnyside in Pretoria, South Africa, has been spotted as one of the high-traffic selling points of herbal fruits. A mixed research method is applicable with an expected 20 Quantitative data respondents among sellers and nutritionists and 50 Qualitative Data respondents among consumers. Based on the results, it should be clear how spirituality contributes to alternative healthcare and how it can be further encouraged to bridge the gap between the high demand and low supply of healthcare in Africa and beyond.

Keywords: spiritual symbols, naturopathy, African fruits, spirituality, healthcare

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Authors: Joseph Kimuli Balikuddembe

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Road traffic incidents (RTIs) continue to be a serious public health and development burden around the globe. Compared to high-income countries (HICs), the low and middle-income countries (LMICs) bear the heaviest brunt of RTIs. Like other LMICs, Uganda, a country located in Eastern Africa, has been experiencing a worryingly high burden of RTIs and their associated impacts. Over the years, the highest number of all the total registered RTIs in Uganda has taken place in the Greater Kampala Metropolitan Area (GKMA). This places a tremendous demand on the few existing emergency medical services (EMS) to adequately respond to those affected. In this regard, the overall objective of the study was to risk map RTIs in the GKMA so as to help in the better planning of EMS for the victims of RTIs. Other objectives included: (i) identifying the factors affecting the exposure, vulnerability and EMS capacity for the victims of RTIs; (ii) identifying the RTI prone-areas and estimating their associated risk factors; (iii) identifying the weaknesses and capacities which affect the EMS systems for RTIs; and (iv) determining the strategies and priority actions that can help to improve the EMS response for RTI victims in the GKMA. To achieve these objectives, a mixed methodological approach was used in four phrases for approximately 15 months. It employed a systematic review based on the preferred reporting items for systematic reviews and meta-data analysis guidelines; a Delphi panel technique; retrospective data analysis; and a cross-sectional method. With Uganda progressing forward as envisaged in its 'Vision 2040', the GKMA, which is the country’s political and socioeconomic epicenter, is experiencing significant changes in terms of population growth, urbanization, infrastructure development, rapid motorization and other factors. Unless appropriate actions are taken, these changes are likely to worsen the already alarming rate of RTIs in Uganda, and in turn also to put pressure on the few existing EMS and facilities to render care for those affected. Therefore, road safety vis-à-vis injury prevention measures, which are needed to reduce the burden of RTIs, should be multifaceted in nature so that they closely correlate with the ongoing dynamics that contribute to RTIs, particularly in the GKMA and Uganda as a whole.

Keywords: emergency medical services, Kampala, risk mapping, road traffic incidents

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Authors: Aneta Nitsch-Osuch, Beata Pawlus, Maria Pawlak

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Introduction: Recently, the number of parents who refuse to vaccinate their children or present so-called hesitant behaviors has increased in many developed countries. The study aimed to analyze the completeness and timeliness of vaccinations against hepatitis B and tuberculosis in neonates in a single maternity hospital in Warsaw (Poland). Material and Methods: We analyzed medical records of children born in the hospital between 1st January 2015 and 31st December 2016 and calculated the proportion of newborns not vaccinated on time. Results: The percentage of unvaccinated newborns was similar in the analyzed years: 7.2% in 2015 and 6.7% in 2016. Parental decisions rather than medical contraindications caused non-immunization (4.3% vs. 2.9% in 2015, and 4.7% vs. 2% in 2016). Most parents refused both vaccinations (81%-84%), whereas 7-8% refused only hep B vaccination, and 9-11% refused alone tuberculosis vaccination. The majority of hesitant parents decided to delay both vaccinations (70-80%), while 10-11% of parents chose to delay only one vaccination (hep B). In consecutive years, an increase in the percentage of parents delaying tuberculosis vaccination was reported (10 vs. 19%). Discussion: The increase in the number of newborns who are not correctly vaccinated just after birth due to their parents' decision should be considered non-gradual, both for hepatitis B and tuberculosis. It is necessary to implement effective educational and informative measures targeted at future parents to reinforce positive attitudes towards vaccinations and to dispel doubts about them among parents who are hesitant.

Keywords: hepatitis B, tuberculosis, immunization, new-borns, coverage rate

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Authors: Christopher Celozzi, Sarah Kochav

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Our research investigates the numerous challenges faced by Chinese ESL university students enrolled in the medical and related healthcare professional fields. The over-arching research question is how gender influences classroom participation and learning. The second research question addressed is 'what instructional strategies may be utilized to promote student participation and language acquisition?'. Participants’ language ability has been assessed and evaluated in order to facilitate the establishment of a statistical baseline for the subsequent intervention. This research delves deeper into each individual’s personal and academic circumstances, in an effort to reveal any held intrinsic gender beliefs and social identities that may influence learning. Also considered is the impact on learning for a homogenized student population within a uniform, highly structured learning environment. Specially, what is the influence of China’s ‘one-child policy’ on individual learning habits? The impact of their millennial identity and reliance on social media is also examined. A qualitative methodology with a case study approach is employed, with interviews conducted among the participants. Student response to the intervention and selected remediation strategies are documented, analyzed and discussed. The findings of the study may serve to inform educator instructional practice, while advancing the student learner in their pursuit of English competency in highly competitive professions.

Keywords: Chinese students, gender, English, language acquisition

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Authors: Edda E. Falcone, Cinzia Federico, Sergio Bellomo, Lorenzo Brusca, Manfredi Longo, Walter D’Alessandro

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Although trace metals are an essential element for living beings, they can become toxic at high concentrations. Their potential toxicity is related not only to the total content in the environment but mostly upon their bioavailability. Volcanoes are important natural metal emitters and they can deeply affect the quality of air, water and soils, as well as the human health. Trace metals tend to accumulate in the tissues of living organisms, depending on the metal contents in food, air and water and on the exposure time. Birds are considered as bioindicators of interest, because their feathers directly reflects the metals uptake from the blood. Birds are exposed to the atmospheric pollution through the contact with rainfall, dust, and aerosol, and they accumulate metals over the whole life cycle. We report on the first data combining the rainfall metal content in three different areas of Mt Etna, variably fumigated by the volcanic plume, and the metal contents in the feathers of pigeons, collected in the same areas. Rainfall samples were collected from three rain gauges placed at different elevation on the Eastern flank of the volcano, the most exposed to airborne plume, filtered, treated with HNO₃ Suprapur-grade and analyzed for Fe, Cr, Co, Ni, Se, Zn, Cu, Sr, Ba, Cd and As by ICP-MS technique, and major ions by ion chromatography. Feathers were collected from single individuals, in the same areas where the rain gauges were installed. Additionally, some samples were collected in an urban area, poorly interested by the volcanic plume. The samples were rinsed in MilliQ water and acetone, dried at 50°C until constant weight and digested in a mixture of 2:1 HNO₃ (65%) - H₂O₂ (30%) Suprapur-grade for 25-50 mg of sample, in a bath at near-to-boiling temperature. The solutions were diluted up to 20 ml prior to be analyzed by ICP-MS. The rainfall samples most contaminated by the plume were collected at close distance from the summit craters (less than 6 km), and show lower pH values and higher concentrations for all analyzed metals relative to those from the sites at lower elevation. Analyzed samples are enriched in both metals directly emitted by the volcanic plume and transported by acidic gases (SO₂, HCl, HF), and metals leached from the airborne volcanic ash. Feathers show different patterns in the different sites related to the exposure to natural or anthropogenic pollutants. They show abundance ratios similar to rainfall for lithophile elements (Ba, Sr), whereas are enriched in Zn and Se, known for their antioxidant properties, probably as adaptive response to oxidative stress induced by toxic metal exposure. The pigeons revealed a clear heterogeneity of metal uptake in the different parts of the volcano, as an effect of volcanic plume impact. Additionally, some physiological processes can modify the fate of some metals after uptake and this offer some insights for translational studies.

Keywords: bioindicators, environmental pollution, feathers, trace metals, volcanic plume

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Authors: William Mahony, L. Jacqueline Hirth, Richard Rupp, Sandra Gonzalez, Roger Zoorob

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Background: The impact of the COVID-19 pandemic on physicians has been considered by many researchers, but less is known about non-physician healthcare workers. The aim of this study is to examine the association of COVID-19 safety training and communication with stress. Methods: A 91-item online survey was distributed, starting January 2, 2021, to non-physician healthcare workers, including physician assistants, nurse practitioners, and medical assistants (MAs) in the United States through email and social media. A $1 donation was made to the Red Cross for each completed survey. The survey consisted of demographics, occupational questions, and perceived stress (perceived stress scale, PSS). Items on the PSS were combined for an overall score and categorized according to the severity of perceived stress. Chi-square tests were performed for bivariate analyses of categorical variables. Results: Of the 284 participants consenting to complete the survey, 197 participants completed the full survey. MAs made up most of the sample at 79%. Among all respondents, 47% had moderate PSS scores (scored between 14 and 26), and 51% had severe PSS scores (scored between 27 and 40). Unvaccinated participants reported statistically significantly lower levels of perceived stress (p = 0.002). Performing tasks outside of typical job responsibilities was not associated with PSS scores (p = .667). Discussion: Non-physician healthcare workers demonstrated a high level of perceived stress overall. The association between vaccination status and perceived stress should be examined in order to evaluate whether vaccination levels could be improved with further education about the virus and associated risks.

Keywords: COVID-19, SARS-Cov-2, nursing, public health

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Authors: Jonathan Gong

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Purpose AI-driven solutions are at the forefront of many pathology and medical imaging methods. Using algorithms designed to better the experience of medical professionals within their respective fields, the efficiency and accuracy of diagnosis can improve. In particular, X-rays are a fast and relatively inexpensive test that can diagnose diseases. In recent years, X-rays have not been widely used to detect and diagnose COVID-19. The under use of Xrays is mainly due to the low diagnostic accuracy and confounding with pneumonia, another respiratory disease. However, research in this field has expressed a possibility that artificial neural networks can successfully diagnose COVID-19 with high accuracy. Models and Data The dataset used is the COVID-19 Radiography Database. This dataset includes images and masks of chest X-rays under the labels of COVID-19, normal, and pneumonia. The classification model developed uses an autoencoder and a pre-trained convolutional neural network (DenseNet201) to provide transfer learning to the model. The model then uses a deep neural network to finalize the feature extraction and predict the diagnosis for the input image. This model was trained on 4035 images and validated on 807 separate images from the ones used for training. The images used to train the classification model include an important feature: the pictures are cropped beforehand to eliminate distractions when training the model. The image segmentation model uses an improved U-Net architecture. This model is used to extract the lung mask from the chest X-ray image. The model is trained on 8577 images and validated on a validation split of 20%. These models are calculated using the external dataset for validation. The models’ accuracy, precision, recall, f1-score, IOU, and loss are calculated. Results The classification model achieved an accuracy of 97.65% and a loss of 0.1234 when differentiating COVID19-infected, pneumonia-infected, and normal lung X-rays. The segmentation model achieved an accuracy of 97.31% and an IOU of 0.928. Conclusion The models proposed can detect COVID-19, pneumonia, and normal lungs with high accuracy and derive the lung mask from a chest X-ray with similarly high accuracy. The hope is for these models to elevate the experience of medical professionals and provide insight into the future of the methods used.

Keywords: artificial intelligence, convolutional neural networks, deep learning, image processing, machine learning

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