Search results for: care pathways

Authors: Wanwadee Neamsakul

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VARK learning style is an effective method of learning that could enhance all skills of the students like visual (V), auditory (A), read/write (R), and kinesthetic (K). This learning style benefits the students in terms of professional competencies, critical thinking and lifelong learning which are the desirable characteristics of the nursing students. This study aimed to develop a model of teaching and learning clinical practicum at postpartum ward for nursing students by using VARK learning styles, and evaluate the nursing students’ opinions about the developmental model. A methodology used for this study was research and development (R&D). The model was developed by focus group discussion with five obstetric nursing instructors who have experiences teaching Maternal Newborn and Midwifery I subject. The activities related to practices in the postpartum (PP) ward including all skills of VARK were assigned into the matrix table. The researcher asked the experts to supervise the model and adjusted the model following the supervision. Subsequently, it was brought to be tried out with the nursing students who practiced on the PP ward. Thirty third year nursing students from one of the northern Nursing Colleges, Academic year 2015 were purposive sampling. The opinions about the satisfaction of the model were collected using a questionnaire which was tested for its validity and reliability. Data were analyzed using descriptive statistics. The developed model composed of 27 activities. Seven activities were developed as enhancement of visual skills for the nursing students (25.93%), five activities as auditory skills (18.52%), six activities as read and write skills (22.22%), and nine activities as kinesthetic skills (33.33%). Overall opinions about the model were reported at the highest level of average satisfaction (mean=4.63, S.D=0.45). In the aspects of visual skill (mean=4.80, S.D=0.45) was reported at the highest level of average satisfaction followed by auditory skill (mean=4.62, S.D=0.43), read and write skill (mean=4.57, S.D=0.46), and kinesthetic skill (mean=4.53, S.D=0.45) which were reported at the highest level of average satisfaction, respectively. The nursing students reported that the model could help them employ all of their skills during practicing and taking care of the postpartum women and newborn babies. They could establish self-confidence while providing care and felt proud of themselves by the benefits of the model. It can be said that using VARK learning style to develop the model could enhance both nursing students’ competencies and positive attitude towards the nursing profession. Consequently, they could provide quality care for postpartum women and newborn babies effectively in the long run.

Keywords: model, nursing students, postpartum ward, teaching and learning clinical practicum

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Authors: Valentina Marutyan

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Healthcare data mining is a rapidly developing field at the intersection of technology and medicine that has the potential to change our understanding and approach to providing healthcare. Healthcare and data mining is the process of examining huge amounts of data to extract useful information that can be applied in order to improve patient care, treatment effectiveness, and overall healthcare delivery. This field looks for patterns, trends, and correlations in a variety of healthcare datasets, such as electronic health records (EHRs), medical imaging, patient demographics, and treatment histories. To accomplish this, it uses advanced analytical approaches. Predictive analysis using historical patient data is a major area of interest in healthcare data mining. This enables doctors to get involved early to prevent problems or improve results for patients. It also assists in early disease detection and customized treatment planning for every person. Doctors can customize a patient's care by looking at their medical history, genetic profile, current and previous therapies. In this way, treatments can be more effective and have fewer negative consequences. Moreover, helping patients, it improves the efficiency of hospitals. It helps them determine the number of beds or doctors they require in regard to the number of patients they expect. In this project are used models like logistic regression, random forests, and neural networks for predicting diseases and analyzing medical images. Patients were helped by algorithms such as k-means, and connections between treatments and patient responses were identified by association rule mining. Time series techniques helped in resource management by predicting patient admissions. These methods improved healthcare decision-making and personalized treatment. Also, healthcare data mining must deal with difficulties such as bad data quality, privacy challenges, managing large and complicated datasets, ensuring the reliability of models, managing biases, limited data sharing, and regulatory compliance. Finally, secret code of data mining in healthcare helps medical professionals and hospitals make better decisions, treat patients more efficiently, and work more efficiently. It ultimately comes down to using data to improve treatment, make better choices, and simplify hospital operations for all patients.

Keywords: data mining, healthcare, big data, large amounts of data

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Authors: Wanwisa Deenin, Abdulhadee Yakoh, Chahya Kreangkaiwal, Orawon Chailapakul, Kanitha Patarakul, Sudkate Chaiyo

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LipL32 is an outer membrane protein present only on pathogenic Leptospira species, which are the causative agent of leptospirosis. Leptospirosis symptoms are often misdiagnosed with other febrile illnesses as the clinical manifestations are non-specific. Therefore, an accurate diagnostic tool for leptospirosis is indeed critical for proper and prompt treatment. Typical diagnosis via serological assays is generally performed to assess the antibodies produced against Leptospira. However, their delayed antibody response and complicated procedure are undoubtedly limited the practical utilization especially in primary care setting. Here, we demonstrate for the first time an early-stage detection of LipL32 by an integrated lateral-flow immunoassay with electrochemical readout (eLFIA). A ferrocene trace tag was monitored via differential pulse voltammetry operated on a smartphone-based device, thus allowing for on-field testing. Superior performance in terms of the lowest detectable limit of detection (LOD) of 8.53 pg/mL and broad linear dynamic range (5 orders of magnitude) among other sensors available thus far was established. Additionally, the developed test strip provided a straightforward yet sensitive approach for diagnosis of leptospirosis using the collected human sera from patients, in which the results were comparable to the real-time polymerase chain reaction technique.

Keywords: leptospirosis, electrochemical detection, lateral flow immunosensor, point-of-care testing, early-stage detection

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Authors: Juliana A. B. Silva, Caio H. T. L. Albuquerque, Leonardo L. dos Santos, Cristiane K. Oliveira, Ivani Malvestiti, Fernando Hallwass, Ricardo L. Longo

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Complexes with lanthanide ions have been extensively studied due to their applications as luminescent, magnetic and catalytic materials as molecular or extended crystals, thin films, glasses, polymeric matrices, ionic liquids, and in solution. NMR chemical shift data in solution have been reported and suggest fluxional structures in a wide range of coordination compounds with rare earth ions. However, the fluxional mechanisms for these compounds are still not established. This structural fluxionality may affect the photophysical, catalytic and magnetic properties in solution. Thus, understanding the structural interconversion mechanisms may aid the design of coordination compounds with, for instance, improved (electro)luminescence, catalytic and magnetic behaviors. The [Eu(btfa)₃bipy] complex, where btfa= 4,4,4-trifluoro-1-phenyl-1,3-butanedionate and bipy= 2,2’-bipiridyl, has a well-defined X-ray crystallographic structure and preliminary 1H NMR data suggested a structural fluxionality. Thus, we have investigated a series of coordination compounds with lanthanide ions [Ln(btfa)₃L], where Ln = La, Eu, Gd or Yb and L= bipy or phen (phen=1,10-phenanthroline) using a combined theoretical-experimental approach. These complexes were synthesized and fully characterized, and detailed NMR measurements were obtained. They were also studied by quantum chemical computational methods (DFT-PBE0). The aim was to determine the relevant factors in the structure of these compounds that favor or not the fluxional behavior. Measurements of the 1H NMR signals at variable temperature in CD₂Cl₂ of the [Eu(btfa)₃L] complexes suggest that these compounds have a fluxional structure, because the crystal structure has non-equivalent btfa ligands that should lead to non-equivalent hydrogen atoms and thus to more signals in the NMR spectra than those obtained at room temperature, where all hydrogen atoms of the btfa ligands are equivalent, and phen ligand has an effective vertical symmetry plane. For the [Eu(btfa)₃bipy] complex, the broadening of the signals at –70°C provides a lower bound for the coalescence temperature, which indicates the energy barriers involved in the structural interconversion mechanisms are quite small. These barriers and, consequently, the coalescence temperature are dependent upon the radii of the lanthanide ion as well as to their paramagnetic effects. The PBE0 calculated structures are in very good agreement with the crystallographic data and, for the [Eu(btfa)₃bipy] complex, this method provided several distinct structures with almost the same energy. However, the energy barrier for structural interconversion via dissociative pathways were found to be quite high and could not explain the experimental observations. Whereas the pseudo-rotation pathways, involving the btfa and bipy ligands, have very small activation barriers, in excellent agreement with the NMR data. The results also showed an increase in the activation barrier along the lanthanide series due to the decrease of the ionic radii and consequent increase of the steric effects. TD-DFT calculations showed a dependence of the ligand donor state energy with different structures of the complex [Eu(btfa)₃phen], which can affect the energy transfer rates and the luminescence. The energy required to promote the structural fluxionality may also enhance the luminescence quenching in solution. These results can aid in the design of more luminescent compounds and more efficient devices.

Keywords: computational chemistry, lanthanide-based compounds, NMR, structural fluxionality

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Authors: Shweh Fern Loo, Jun Yin Ong, Than Zaw Oo

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Acute respiratory distress syndrome (ARDS) is a common serious condition of bilateral lung infiltrates that develops secondary to various underlying conditions such as diseases or injuries. ARDS with severe hypercapnia is associated with higher ICU mortality and morbidity. Venovenous Extracorporeal membrane oxygenation (VV-ECMO) support has been established to avert life-threatening hypoxemia and hypercapnic respiratory failure despite optimal conventional mechanical ventilation. However, VV-ECMO is relatively not advisable in particular groups of patients, especially in multi-organ failure, advanced age, hemorrhagic complications and irreversible central nervous system pathology. We presented a case of a 79-year-old Chinese lady without any pre-existing lung disease admitted to our hospital intensive care unit (ICU) after acute presentation of breathlessness and chest pain. After extensive workup, she was diagnosed with rapidly progressing acute interstitial pneumonia with ARDS and hypercapnia respiratory failure. The patient received lung protective strategies of mechanical ventilation and neuromuscular blockage therapy as per clinical guidelines. However, hypercapnia respiratory failure was refractory, and she was deemed not a good candidate for VV-ECMO support given her advanced age and high vasopressor requirements from shock. Alternative therapy with extracorporeal CO2 removal (ECCO2R) was considered and implemented. The patient received 12 days of ECCO2R paired with muscle paralysis, optimization of lung-protective mechanical ventilation and dialysis. Unfortunately, the patient still had refractory hypercapnic respiratory failure with dual vasopressor support despite prolonged therapy. Given failed and futile medical treatment, the family opted for withdrawal of care, a conservative approach, and comfort care, which led to her demise. The effectivity of extracorporeal CO2 removal may depend on disease burden, involvement and severity of the disease. There is insufficient data to make strong recommendations about its benefit-risk ratio for ECCO2R devices, and further studies and data would be required. Nonetheless, ECCO2R can be considered an alternative treatment for refractory hypercapnic respiratory failure patients who are unsuitable for initiating venovenous ECMO.

Keywords: extracorporeal CO2 removal (ECCO2R), acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), hypercapnic respiratory failure

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Authors: Tanja Salary

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This paper discusses a study conducted in a juvenile justice facility regarding medication errors. It includes an introduction to data collected about medication errors in a juvenile justice facility from 2011 - 2019 and explores contributing factors that relate to those errors. The data was obtained from electronic incident records of medication errors that were documented from the years 2011 through 2019. In addition, the presentation reviews both current and historical research of empirical data about patient safety standards and quality care comparing traditional health care facilities to juvenile justice residential facilities and acknowledges a gap in research. The theoretical/conceptual framework for the research study was Bandura and Adams’s self-efficacy theory of behavioral change and Mark Friedman’s results-based accountability theory. Despite the lack of evidence in previous studies addressing medication errors in juvenile justice facilities, this presenter will share information that adds to the body of knowledge, including the potential relationship of medication errors and contributing factors of race and age. Implications for future research include the effect that education and training will have on the communication among juvenile justice staff, including nurses, who administer medications to juveniles to ensure adherence to patient safety standards. There are several opportunities for future research concerning other characteristics about factors that may affect medication administration errors within the residential juvenile justice facility.

Keywords: Juvenile justice, medication errors, juveniles, error reduction strategies

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Authors: Ankita Shukla

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The promotion and support of breastfeeding is a global priority with benefits for maternal and infant health, especially in low income and middle-income countries where the probability of child survival is still very low. In India too it has been well established that breastfeeding increases the survival of the child. However, the breastfeeding levels are quite low in the country. Examining the socio-economic inequality in breastfeeding pattern can help to the causal pathways responsible for early breastfeeding termination. This paper tries to understand the socio-economic differential in breastfeeding patterns among Indian women. Data is used from nationally representative National Family Health Survey-3. Using Cox regression modelling techniques, the analysis found that the likelihood of having small breastfeeding duration increased with increasing household wealth status similarly education also has negative effect on breastfeeding duration. The considerable gender difference is also visible in India, likelihood of stopping breastfeeding was significantly higher among female children compared with male children. To understand the cultural factors or norms responsible for the early termination of breastfeeding more in depth/qualitative studies are needed.

Keywords: breastfeeding, India, socio-economic inequality, women education

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Authors: Reuben Mugisha, Stella Bakibinga

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The cervical cancer burden is a global threat, but more so in low income settings where more than 85% of mortality cases occur due to lack of sufficient screening programs. There is consequently a lack of early detection of cancer and precancerous cells among women. Studies show that 3% to 35% of deaths could have been avoided through early screening depending on prognosis, disease progression, environmental and lifestyle factors. In this study, a systematic literature review is undertaken to understand potential barriers and facilitators as documented in previous studies that focus on the application of telehealth in cervical cancer screening programs for early detection of cancer and precancerous cells. The study informs future studies especially those from low income settings about lessons learned from previous studies and how to be best prepared while planning to implement telehealth for cervical cancer screening. It further identifies the knowledge gaps in the research area and makes recommendations. Using a specified selection criterion, 15 different articles are analyzed based on the study’s aim, theory or conceptual framework used, method applied, study findings and conclusion. Results are then tabulated and presented thematically to better inform readers about emerging facts on barriers and facilitators to telehealth implementation as documented in the reviewed articles, and how they consequently lead to evidence informed conclusions that are relevant to telehealth implementation for cervical cancer screening. Preliminary findings of this study underscore that use of low cost mobile colposcope is an appealing option in cervical cancer screening, particularly when coupled with onsite treatment of suspicious lesions. These tools relay cervical images to the online databases for storage and retrieval, they permit integration of connected devices at the point of care to rapidly collect clinical data for further analysis of the prevalence of cervical dysplasia and cervical cancer. Results however reveal the need for population sensitization prior to use of mobile colposcopies among patients, standardization of mobile colposcopy programs across screening partners, sufficient logistics and good connectivity, experienced experts to review image cases at the point-of-care as important facilitators to the implementation of mobile colposcope as a telehealth cervical cancer screening mechanism.

Keywords: cervical cancer screening, digital technology, hand-held colposcopy, knowledge-sharing

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Authors: M. Siedlikowski, F. Rauch, A. Tsimicalis

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Osteogenesis Imperfecta (OI) is a genetic disorder of childhood onset that causes frequent fractures after minimal physical stress. To date, OI research has focused on medically- and surgically-oriented outcomes with little attention on the perspective of the affected child. It is a challenge to elicit the child’s voice in health care, in other words, their own perspective on their symptoms, but software development offers a way forward. Sisom (Norwegian acronym derived from ‘Si det som det er’ meaning ‘Tell it as it is’) is an award-winning, rigorously tested, interactive, computerized tool that helps children with chronic illnesses express their symptoms to their clinicians. The successful Sisom software tool, that addresses the child directly, has not yet been adapted to attend to symptoms unique to children with OI. The purpose of this study was to develop a Sisom paper prototype for children with OI by seeking the perspectives of end users, particularly, children with OI and clinicians. Our descriptive qualitative study was conducted at Shriners Hospitals for Children® – Canada, which follows the largest cohort of children with OI in North America. Purposive sampling was used to recruit 12 children with OI over three cycles. Nine clinicians oversaw the development process, which involved determining the relevance of current Sisom symptoms, vignettes, and avatars, as well as generating new Sisom OI components. Data, including field notes, transcribed audio-recordings, and drawings, were deductively analyzed using content analysis techniques. Guided by the following framework, data pertaining to symptoms, vignettes, and avatars were coded into five categories: a) Relevant; b) Irrelevant; c) To modify; d) To add; e) Unsure. Overall, 70.8% of Sisom symptoms were deemed relevant for inclusion, with 49.4% directly incorporated, and 21.3% incorporated with changes to syntax, and/or vignette, and/or location. Three additions were made to the ‘Avatar’ island. This allowed children to celebrate their uniqueness: ‘Makes you feel like you’re not like everybody else.’ One new island, ‘About Me’, was added to capture children’s worldviews. One new sub-island, ‘Getting Around’, was added to reflect accessibility issues. These issues were related to the children’s independence, their social lives, as well as the perceptions of others. In being consulted as experts throughout the co-creation of the Sisom OI paper prototype, children coded the Sisom symptoms and provided sound rationales for their chosen codes. In rationalizing their codes, all children shared personal stories about themselves and their relationships, insights about their OI, and an understanding of the strengths and challenges they experience on a day-to-day basis. The child’s perspective on their health is a basic right, and allowing it to be heard is the next frontier in the care of children with genetic diseases. Sisom OI, a methodological breakthrough within OI research, will offer clinicians an innovative and child-centered approach to capture this neglected perspective. It will provide a tool for the delivery of health care in the center that established the worldwide standard of care for children with OI.

Keywords: child health, interactive computerized communication tool, participatory approach, symptom management

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Authors: Arash Sepehri bonab

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One of the regions of critical development in medical devices has been the part of the software - as an indispensable component of a therapeutic device, as a standalone device, and more as of late, as applications on portable gadgets. The chance related to a breakdown of the standalone computer program utilized inside healthcare is in itself not a model for its capability or not as a medical device. It is, subsequently, fundamental to clarify a few criteria for the capability of a stand-alone computer program as a medical device. The number of computer program items and therapeutic apps is persistently expanding and so as well is used in wellbeing education (e. g., in clinics and doctors' surgeries) for determination and treatment. Within the last decade, the use of information innovation in healthcare has taken a developing part. In reality, the appropriation of an expanding number of computer devices has driven several benefits related to the method of quiet care and permitted simpler get to social and health care assets. At the same time, this drift gave rise to modern challenges related to the usage of these modern innovations. The program utilized in healthcare can be classified as therapeutic gadgets depending on the way they are utilized and on their useful characteristics. In the event that they are classified as therapeutic gadgets, they must fulfill particular directions. The point of this work is to show a computer program improvement system that can permit the generation of secure and tall, quality restorative gadget computer programs and to highlight the correspondence between each program advancement stage and the fitting standard and/or regulation.

Keywords: medical devices, regulation, software, development, healthcare

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Authors: Innocent Atuhe, Babra Nalwadda, Grace Mulyowa Kitunzi, Annabella Haninka Ejiri

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Background: Atopic Dermatitis (AD) is one of the most prevalent and growing chronic inflammatory skin diseases in African prisons. AD care is limited in African due to lack of information about the disease amongst primary care workers, limited access to dermatologists, lack of proper training of healthcare workers, and shortage of appropriate treatments. We designed and implemented the Prisons Telederma project based on the recommendations of the International Society of Atopic Dermatitis. Our overall goal was to increase access to dermatologist-led care for prisoners with AD through teledermatology in Uganda. We aimed to; i) to increase awareness and understanding of teledermatology among prison health workers; and ii) to improve treatment outcomes of prisoners with atopic dermatitis through increased access to and utilization of consultant dermatologists through teledermatology in Uganda prisons: Approach: We used Store-and-forward Teledermatology (SAF-TD) to increase access to dermatologist-led care for prisoners and prisons staff with AD. We conducted a five days training for prison health workers using an adapted WHO training guide on recognizing neglected tropical diseases through changes on the skin together with an adapted American Academy of Dermatology (AAD) Childhood AD Basic Dermatology Curriculum designed to help trainees develop a clinical approach to the evaluation and initial management of patients with AD. This training was followed by blended e-learning, webinars facilitated by consultant Dermatologists with local knowledge of medication and local practices, apps adjusted for pigmented skin, WhatsApp group discussions, and sharing pigmented skin AD pictures and treatment via zoom meetings. We hired a team of Ugandan Senior Consultant dermatologists to draft an iconographic atlas of the main dermatoses in pigmented African skin and shared this atlas with prison health staff for use as a job aid. We had planned to use MySkinSelfie mobile phone application to take and share skin pictures of prisoners with AD with Consultant Dermatologists, who would review the pictures and prescribe appropriate treatment. Unfortunately, the National Health Service withdrew the app from the market due to technical issues. We monitored and evaluated treatment outcomes using the Patient Oriented Eczema Measure (POEM) tool. We held four advocacy meetings to persuade relevant stakeholders to increase supplies and availability of first-line AD treatments such as emollients in prison health facilities. Results: Draft iconographic atlas of the main dermatoses in pigmented African skin Increased proportion of prison health staff with adequate knowledge of AD and teledermatology from 20% to 80% Increased proportion of prisoners with AD reporting improvement in disease severity (POEM scores) from 25% to 35% in one year. Increased proportion of prisoners with AD seen by consultant dermatologist through teledermatology from 0% to 20% in one year. Increased the availability of AD recommended treatments in prisons health facilities from 5% to 10% in one year

Keywords: teledermatology, prisoners, reaching, un-reachable

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Authors: Hosein Maghsoudi

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Rheumatois arthritis (RA) is progressive inflammatory autoimmune diseases that primarily affect the joints, characterized by synovial hyperplasia and inflammatory cell infiltration, deformed and painful joints, which can lead tissue destruction, functional disability systemic complications, and early dead and socioeconomic costs. The cause of rheumatoid arthritis is unknown, but genetic and environmental factors are contributory and the prognosis is guarded. However, advances in understanding the pathogenesis of the disease have fostered the development of new therapeutics, with improved outcomes. The current treatment strategy, which reflects this progress, is to initiate aggressive therapy soon after diagnosis and to escalate the therapy, guided by an assessment of disease activity, in pursuit of clinical remission. The pathobiology of RA is multifaceted and involves T cells, B cells, fibroblast-like synoviocyte (FLSc) and the complex interaction of many pro-inflammatory cytokine. Novel biologic agents that target tumor necrosis or interlukin (IL)-1 and Il-6, in addition T- and B-cells inhibitors, have resulted in favorable clinical outcomes in patients with RA. Despite this, at least 30% of RA patients are résistance to available therapies, suggesting novel mediators should be identified that can target other disease-specific pathway or cell lineage. Among the inflammatory cell population that might participated in RA pathogenesis, FLSc are crucial in initiaing and driving RA in concert of cartilage and bone by secreting metalloproteinase (MMPs) into the synovial fluid and by direct invasion into extracellular matrix (ECM), further exacerbating joint damage. Invasion of fibroblast-like synoviocytes (FLSc) is critical in the pathogenesis of rheumatoid-arthritis. The metalloproteinase (MMPs) and activator of Toll-like receptor 4 (TLR4)/nuclear factor- κB pthway play a critical role in RA-FLS invasion induced by lipopolysaccharide (LPS). The present study aimed to explore the anti-invasion activity of Glycyrrhizic Acid as a pharmacologically safe phytochemical agent with potent anti-inflammatory properties on IL-1beta and TNF-alpha signalling pathways in Bovine fibroblast-like synoviocyte ex- vitro, on LPS-stimulated bovine FLS migration and invasion as well as MMP expression and explored the upstream signal transduction. Results showed that Glycyrrhizic Acid suppressed LPS-stimulated bovine FLS migration and invasion by inhibition MMP-9 expression and activity. In addition our results revealed that Glycyrrhizic Acid inhibited the transcriptional activity of MMP-9 by suppression the nbinding activity of NF- κB in the MMP-9 promoter pathway. The extract of licorice (Glycyrrhiza glabra L.) has been widely used for many centuries in the traditional Chinese medicine as native anti-allergic agent. Glycyrrhizin (GL), a triterpenoidsaponin, extracted from the roots of licorice is the most effective compound for inflammation and allergic diseases in human body. The biological and pharmacological studies revealed that GL possesses many pharmacological effects, such as anti-inflammatory, anti-viral and liver protective effects, and the biological effects, such as induction of cytokines (interferon-γ and IL-12), chemokines as well as extrathymic T and anti-type 2 T cells. GL is known in the traditional Chinese medicine for its anti-inflammatory effect, which is originally described by Finney in 1959. The mechanism of the GL-induced anti-inflammatory effect is based on different pathways of the GL-induced selective inhibition of the prostaglandin E2 production, the CK-II- mediated activation of both GL-binding lipoxygenas (gbLOX; 17) and PLA2, an anti-thrombin action of GL and production of the reactive oxygen species (ROS; GL exerts liver protection properties by inhibiting PLA2 or by the hydroxyl radical trapping action, leading to the lowering of serum alanine and aspartate transaminase levels. The present study was undertaken to examine the possible mechanism of anti-inflammatory properties GL on IL-1beta and TNF-alpha signalling pathways in bovine fibroblast-like synoviocyte ex-vivo, on LPS-stimulated bovine FLS migration and invasion as well as MMP expression and explored the upstream signal transduction. Our results clearly showed that treatment of bovine fibroblast-like synoviocyte with GL suppressed LPS-induced cell migration and invasion. Furthermore, it revealed that GL inhibited the transcription activity of MMP-9 by suppressing the binding activity of NF-κB in the MM-9 promoter. MMP-9 is an important ECM-degrading enzyme and overexpression of MMPs in important of RA-FLSs. LPS can stimulate bovine FLS to secret MMPs, and this induction is regulated at the transcription and translational levels. In this study, LPS treatment of bovine FLS caused an increase in MMP-2 and MMP-9 levels. The increase in MMP-9 expression and secretion was inhibited by ex- vitro. Furthermore, these effects were mimicked by MMP-9 siRNA. These result therefore indicate the the inhibition of LPS-induced bovine FLS invasion by GL occurs primarily by inhibiting MMP-9 expression and activity. Next we analyzed the functional significance of NF-κB transcription of MMP-9 activation in Bovine FLSs. Results from EMSA showed that GL suppressed LPS-induced NF-κB binding to the MMP-9 promotor, as NF-κB regulates transcriptional activation of multiple inflammatory cytokines, we predicted that GL might target NF-κB to suppress MMP-9 transcription by LPS. Myeloid differentiation-factor 88 (MyD88) and TIR-domain containing adaptor protein (TIRAP) are critical proteins in the LPS-induced NF-κB and apoptotic signaling pathways, GL inhibited the expression of TLR4 and MYD88. These results demonstrated that GL suppress LPS-induced MMP-9 expression through the inhibition of the induced TLR4/NFκB signaling pathway. Taken together, our results provide evidence that GL exerts anti-inflammatory effects by inhibition LPS-induced bovine FLSs migration and invasion, and the mechanisms may involve the suppression of TLR4/NFκB –mediated MMP-9 expression. Although further work is needed to clarify the complicated mechanism of GL-induced anti-invasion of bovine FLSs, GL might be used as a further anti-invasion drug with therapeutic efficacy in the treatment of immune-mediated inflammatory disease such as RA.

Keywords: glycyrrhizic acid, bovine fibroblast-like synoviocyte, tlr4/nf-κb, metalloproteinase-9

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Authors: Cecilia Fagerstrom, Solve Elmstahl, Lena S. Wranker

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The conditions of increased morbidity in an aging population cause the need for family care to become more common at an advanced age. The role of family caregivers may well last for a long time but may also change over time, from being caregivers to being non-caregivers or vice versa. Although demands associated with family caring change as individuals enter into, engage with, and exit from this role, the evidence regarding the impact of family caregiving transitions on the health of older carers is still limited. This study comprised individuals (n=2294, 60+years) from the southern part of Sweden included in the project Swedish National study of Aging and Care. Caregiving transitions are discussed in the categories: enter, exit, and continuing during a six-year period. Individuals who exited caregiving during the time were older than those who continued or entered into the role of caregiving. At the six-year follow-up, caregivers who were continuing or had exited caregiving were more often worried about their own health compared to baseline. Resembling findings were not found in those who entered caregiving. Family caregiving transitions of exiting, entering or continuing had no effect on the individuals’ functional, physical and mental health expect for participants who entered in caregiving. For them, entering the role of family caregiving was associated with an improvement in physical health during the six years follow up period. Conclusion: Although the health impact of different caregiving transitions in late life does not differ, individual conditions and health at baseline are important parameters to take into consideration to improve long-term health in family caregivers.

Keywords: family caregiving, health, old age, transition

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Authors: Adenike Adesanya, Nonthaphat Wong, Xiang-Yun Lan, Shea Ping Yip, Chien-Ling Huang

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Background: The most challenging mutation of the oncokinase BCR-ABL protein T315I, which is commonly known as the “gatekeeper” mutation and is notorious for its strong resistance to almost all tyrosine kinase inhibitors (TKIs), especially imatinib. Therefore, this study aims to identify T315I-dependent downstream microRNA (miRNA) pathways associated with drug resistance in chronic myeloid leukemia (CML) for prognostic and therapeutic purposes. Methods: T315I-carrying K562 cell clones (K562-T315I) were generated by the CRISPR-Cas9 system. Imatinib-treated K562-T315I cells were subjected to small RNA library preparation and next-generation sequencing. Putative lncRNA-miRNA-mRNA networks were analyzed with (i) DESeq2 to extract differentially expressed miRNAs, using Padj value of 0.05 as cut-off, (ii) STarMir to obtain potential miRNA response element (MRE) binding sites of selected miRNAs on lncRNA H19, (iii) miRDB, miRTarbase, and TargetScan to predict mRNA targets of selected miRNAs, (iv) IntaRNA to obtain putative interactions between H19 and the predicted mRNAs, (v) Cytoscape to visualize putative networks, and (vi) several pathway analysis platforms – Enrichr, PANTHER and ShinyGO for pathway enrichment analysis. Moreover, mitochondria isolation and transcript quantification were adopted to determine the new mechanism involved in T315I-mediated resistance of CML treatment. Results: Verification of the CRISPR-mediated mutagenesis with digital droplet PCR detected the mutation abundance of ≥80%. Further validation showed the viability of ≥90% by cell viability assay, and intense phosphorylated CRKL protein band being detected with no observable change for BCR-ABL and c-ABL protein expressions by Western blot. As reported by several investigations into hematological malignancies, we determined a 7-fold increase of H19 expression in K562-T315I cells. After imatinib treatment, a 9-fold increment was observed. DESeq2 revealed 171 miRNAs were differentially expressed K562-T315I, 112 out of these miRNAs were identified to have MRE binding regions on H19, and 26 out of the 112 miRNAs were significantly downregulated. Adopting the seed-sequence analysis of these identified miRNAs, we obtained 167 mRNAs. 6 hub miRNAs (hsa-let-7b-5p, hsa-let-7e-5p, hsa-miR-125a-5p, hsa-miR-129-5p, and hsa-miR-372-3p) and 25 predicted genes were identified after constructing hub miRNA-target gene network. These targets demonstrated putative interactions with H19 lncRNA and were mostly enriched in pathways related to cell proliferation, senescence, gene silencing, and pluripotency of stem cells. Further experimental findings have also shown the up-regulation of mitochondrial transcript and lncRNA MALAT1 contributing to the lncRNA-miRNA-mRNA networks induced by BCR-ABL T315I mutation. Conclusions: Our results have indicated that lncRNA-miRNA regulators play a crucial role not only in leukemogenesis but also in drug resistance, considering the significant dysregulation and interactions in the K562-T315I cell model generated by CRISPR-Cas9. In silico analysis has further shown that lncRNAs H19 and MALAT1 bear several complementary miRNA sites. This implies that they could serve as a sponge, hence sequestering the activity of the target miRNAs.

Keywords: chronic myeloid leukemia, imatinib resistance, lncRNA-miRNA-mRNA, T315I mutation

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Authors: Fangtian Fan, Zhaoguo Liu, Yin Lu

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Early recurrence (ER) (< 1 year) after liver resection is one of the most important factors that impacts the prognosis of patients with hepatocellular carcinoma (HCC). However, the molecular mechanisms and predictive indexes of ER after curative resection remain largely unknown. The present study aimed to exploit the role of EGFR signaling in EMT and early recurrence of HCC after curative resection and elucidate the molecular mechanisms. Our results showed that nuclear beta-catenin / PKM2 was a independent predictor of early recurrence after curative resection in EGFR-overexpressed HCC. Mechanistic investigation indicated that nuclear accumulation of beta-catenin and PKM2 induced by EGFR signal promoted HCC cell invasion and proliferation, which were required for early recurrence of HCC. These effects were mediated by PI3K/AKT and ERK pathways rather than the canonical Wnt signaling. In conclusions, EGFR signal induced-nuclear translocation of beta-catenin and PKM2 promotes HCC malignancy and indicates early recurrence after curative resection.

Keywords: beta-catenin, early recurrence, hepatocellular carcinoma, malignancy, PKM2

Procedia PDF Downloads 355

Authors: Ivannys Cappas Perez

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Worldwide the population of older adults is increasing. The World Health Organization (2022) estimates that it will double by 2050. Informal caregivers of older adults may experience contradictory impulses, overload, and multiple losses before the death of the older adult in their care. The general purpose of research was to identify and describe the affective ambivalence in informal caregivers of older adults in the face of loss and grief processes. The dimensions under study were affective ambivalence, informal caregivers of older adults, loss processes and the grieving process. A qualitative approach methodology and an empirical phenomenological design were used through Clark Moustakas' Multiangulation Model to describe, categorize and interpret, intentionality, temporality and intersubjectivity a problem never studied. Among the findings was the feminization of the role. Affective ambivalence is manifested through emotions, feelings, thoughts and behavior, including non-verbal language. The assumption of the role is highly influenced by an affective and moral factor, where a minimum of 35 hours per week are invested in without family and financial support. It was found that the participants experience objective and subjective overload. Furthermore, because of the role, they experienced loss of life, loss of aspects of themselves, loss of objects, emotional losses, and losses linked to development. On the other hand, up to two types of grief were found simultaneously. Finally, the presence of affective ambivalence was found with the same intensity 13 years after the loss of the older adult under care.

Keywords: affective ambivalence, informal caregivers of older adults, loss processes, grief processes

Procedia PDF Downloads 34

Authors: Stephane Maingard, Babu Paturi, Maura Daly, Finnola Armstrong

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Background: Perinatal optimization involves the implementation of twelve intervention bundles of care at Our Lady of Lourdes Hospital, reliably delivering evidence-based interventions in the antenatal, intrapartum, and neonatal period to improve preterm outcomes. These key interventions (e.g. Antenatal steroids, Antenatal counselling, Optimal cord management, Respiratory management etc.) are based on WHO (World Health Organization, BAPM (British Association of Perinatal Medicine), and the latest 2022 European Consensus guidelines recommendations. Methodology: In February 2023, a quality improvement project team (pediatricians, neonatologists, obstetricians, clinical skills managers) was established, and a project implementation plan was developed. The Program Study Act implemented the following: 1. Antenatal consultation pathway, 2. Creation and implementation of a perinatal checklist for preterm births less than 34 weeks of gestation, 3. Process changes to ensure the checklist is completed, 4. Completion of parent and staff surveys, 5. Ongoing training. We collected and compared a range of data before and after implementation. Results: Preliminary analysis so far at 1 month demonstrates improvement in the following areas: 50% increase in antenatal counselling. Right place of birth increased from 85% to 100%. Magnesium sulphate increased from 56% to 100%. No change was observed in buccal colostrum administration (28%), delayed cord clamping (75%), caffeine administration (100%), blood glucose level at one hour of life > 2,6mmol (85%). There was also no change noted in respiratory support at resuscitation, CPAP only (47%), IPPV with CPAP (45%), IPPV with intubation (20%), and surfactant administration (28%). A slight decrease in figures was noted in the following: steroid administration from 80% to 75% and thermal care obtaining optimal temperature on admission (65% to 50%). Discussion: Even though the findings are preliminary, the directional improvement shows promise. Improved communication has been achieved between all stakeholders, including our patients, who are key team members. Adherence to the bundles of care will help to improve survival and neurodevelopmental outcomes as well as reduce the length of stay, thereby overall reducing the financial cost, considering the lifetime cost of cerebral palsy is estimated at €800,000 and reducing the length of stay can result in savings of up to €206,000. Conclusion: Preliminary results demonstrate improvements across a range of patient, process, staff, and financial outcomes. Our future goal is a seamless pathway of patient centered care for babies and their families. This project is an interdisciplinary collaboration to implement best practices for a vulnerable patient cohort. Our two main challenges are changing our organization’s culture as well as ensuring the sustainability of the project.

Keywords: perinatal, optimization, antenatal, counselling, IPPV

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Authors: Dana Mohammed, Fatemah Abdullah, Hawraa Ali, Najat Al-Shaer, Rawan Al-Awadhi, , Magdy Helal

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We study the patient service performance at the emergency department of a major Kuwaiti public hospital, using discrete simulation and lean concepts. In addition to the common problems in such health care systems (over crowdedness, facilities planning and usage, scheduling and staffing, capacity planning) the emergency department suffered from several cultural and patient behavioural issues. Those contributed significantly to the system problems and constituted major obstacles in maintaining the performance in control. This led to overly long waiting times and the potential of delaying providing help to critical cases. We utilized the visual management tools to mitigate the impact of the patients’ behaviours and attitudes and improve the logistics inside the system. In addition a proposal is made to automate the date collection and communication within the department using RFID-based barcoding system. Discrete event simulation models were developed as decision support systems; to study the operational problems and assess achieved improvements. The simulation analysis resulted in cutting the patient delays to about 35% of their current values by reallocating and rescheduling the medical staff. Combined with the application of the visual management concepts, this provided the basis to improving patient service without any major investments.

Keywords: simulation, visual management, health care system, patient

Procedia PDF Downloads 474

Authors: Hamad Rafique

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The bioactive peptide RDFPITWPW (RW-9) identified from oat protein has been reported to be positive in memory deficits. However, no clarity on the mechanisms responsible for the neuroprotective effects of RW-9 peptide against AD-like symptoms. Herein, it found that RW-9 intervention showed various improving effects in cognitive-behavioral tests and alleviated oxidative stress and inflammation in the scopolamine-induced mice model. The hippocampus proteomics analysis revealed the upregulation of memory-related proteins, including Grin3a, Ppp2r1b, Stat6, Pik3cd, Slc5a7, Chrm2, mainly involved in cAMP signaling, PI3K-Akt signaling, and JAK-STAT signaling pathways. The administration of RW-9 significantly upregulated the neurotransmitters, including 5-HT, DA, and Arg, in mice brains. Moreover, it regulated the serum metabolic profile and increased the expression levels of ABC transporters, biosynthesis of amino acids, and Amino acyl-tRNA biosynthesis, among others. The 16s-rRNA results illustrated that the RW-9 restored the abundance of Muribaculaceae, Lachnospiraceae, Lactobacillus, Clostridia and Bactericides. Taken together, our results suggest that the RW-9 may prevent the AD-like symptoms via modulation of the gut-serum-brain axis.

Keywords: oat protein, active peptide, neuroprotective, gut-brain axis

Procedia PDF Downloads 25

Authors: Lukasz Baka

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Objective. The study aimed to investigate the direct and indirect - mediated through insomnia - effect of coronavirus anxiety on exhaustion from the perspective of Hobfol Conservation of Resources (COR) theory. According to COR theory, critical events (e.g. the coronavirus epidemic) make people fearful of losing their valuable resources. A prolonged state of anxiety may lead to sleep troubles, which over time, results in an increase in exhaustion. Materials and Methods: Data were collected among 440 Polish healthcare providers, including nurses and midwives, doctors, paramedics, medical assistance, and wardens. Three measurements were used: Coronavirus Anxiety Scale (CAS), Copenhagen Psychosocial Questionnaire (COPSOQ, sleep trouble subscale) and Oldenburg Burnout Inventory (OLBI, exhaustion subscale). Hypotheses were tested by the use of Structural Equation Modelling (SEM). Results: The obtained results fully support the hypotheses. Both the direct and indirect relationships between coronavirus anxiety and exhaustion were observed. Specifically, high coronavirus anxiety increased insomnia, which in turn contributed to the development of exhaustion. Conclusion: The results are consistent with the COR theory. Prolonged coronavirus anxiety and sleep problems depleted healthcare providers’ resources and made them feel exhausted. Exhaustion among these workers can have serious consequences not only for themselves but also for the health of their patients, therefore researches into effective ways to deal with coronavirus anxiety are needed.

Keywords: coronavirus anxiety, front-line healt-care workers, insomnia, job burnout

Procedia PDF Downloads 182

Authors: Kun-Ting Song, Christian Schott, Peter Schneider, Sebastian Watzele, Regina Kluge, Elena Gubanova, Aliaksandr S. Bandarenka

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The combination of electrochemical impedance spectroscopy (EIS) and the hydrodynamic technique like rotation disc electrode (RDE) provides a critical method for quantitively investigating mechanisms of hydrogen evolution reaction (HER) in acidic and alkaline media. Pt5Gd represented higher HER activities than polycrystalline Pt (Pt(pc)) by means of the surface strain effects. The model of the equivalent electric circuit to fit the impedance data under the RDE configurations is developed. To investigate the relative reaction contribution, the ratio of the charge transfer reactions of the Volmer-Heyrovsky and Volmer-Tafel pathways on Pt and Pt5Gd electrodes is determined. The ratio remains comparably similar in acidic media, but it changes in alkaline media with Volmer–Heyrovsky pathway dominating. This combined approach of EIS and RDE can help to study the electrolyte effects and other essential reactions for electrocatalysis in future work.

Keywords: hydrogen evolution reaction, electrochemical impedance spectroscopy, hydrodynamic methods, electrocatalysis, electrochemical interface

Procedia PDF Downloads 81

Authors: Sharon Milberger, Jane Turner, Denise White-Perkins

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Michigan shares the overall U.S. national need for more highly qualified professionals who have knowledge and experience in the use of evidence-based practices to meet the special health care needs of children, adolescents, and adults with neurodevelopmental disabilities including autism spectrum disorder (DD/ASD). The Michigan Leadership Education in Neurodevelopmental Disabilities (MI-LEND) program is a consortium of six universities that spans the state of Michigan and serves more than 181,800 undergraduate, graduate, and professional students. The purpose of the MI LEND program is to improve the health of infants, children and adolescents with disabilities in Michigan by training individuals from different disciplines to assume leadership roles in their respective fields and work across disciplines. The MI-LEND program integrates “L.I.F.E.” perspectives into all training components. L.I.F.E. is an acronym for Leadership, Interdisciplinary, Family-Centered and Equity perspectives. This paper will describe how L.I.F.E. perspectives are embedded into all aspects of the MI-LEND training program including the application process, didactic training, community and clinical experiences, discussions, journaling and projects. Specific curriculum components will be described including content from a training module dedicated to Equity. Upon completion of the Equity module, trainees are expected to be able to: 1) Use a population health framework to identify key social determinants impacting families and children; 2) Explain how addressing bias and providing culturally appropriate linguistic care/services can influence patient/client health and wellbeing; and 3) Describe the impact of policy and structural/institutional factors influencing care and services for children with DD/ASD and their families. Each trainee completes two self-assessments: the Cultural and Linguistic Competence Health Practitioner Assessment and the other assessing social attitudes/implicit bias. Trainees also conduct interviews with a family with a child with DD/ASD. In addition, interdisciplinary Equity-related group activities are incorporated into face-to-face training sessions. Each MI-LEND trainee has multiple ongoing opportunities for self-reflection through discussion and journaling and completion of a L.I.F.E. project as a culminating component of the program. The poster will also discuss the challenges related to teaching and measuring successful outcomes related to diversity/equity perspectives.

Keywords: disability, diversity, equity, training

Procedia PDF Downloads 164

Authors: Hamad Albadr

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Joint Commission International (JCI) accreditation process intent to improve the safety and quality of care in the international community through the provision of education, publications, consultation, and evaluation services. These standards apply to the entire organization as well as to each department, unit, or service within the organization. Medical Technology that contains both medical equipment and devices, is an essential part of health care. Appropriate management of equipment maintenance for ensuring medical technology safe, the equipment life is maximized, and the total costs are minimized. JCI medical technology evaluation and accreditation use standards, intents, and measurable elements. The paper focuses on evaluation of JCI standards for medical technology in Saudi Arabian hospitals: a Study Case of PSMMC that define the performance expectation, structures, or functions that must be in place for a hospital to be accredited by JCI through measurable elements that indicate a score during the survey process that identify the requirements for full compliance with the standard specially through Facility Management and Safety (FMS) section that require the hospital establishes and implements a program for inspecting, testing, and maintaining medical technology and documenting the results, to ensure that medical technology is available for use and functioning properly, the hospital performs and documents; an inventory of medical technology; regular inspections of medical technology; testing of medical technology according to its use and manufacturers’ requirements; and performance of preventive maintenance.

Keywords: joint commission international (JCI) accreditation, medical technology, Saudi Arabia, Saudi Arabian hospitals

Procedia PDF Downloads 555

Authors: N. H. D. P. Fonseka, I. H. Rajapakse, A. S. Dissanayake

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Background: Problem drinking, namely alcohol dependence (AD) and alcohol abuse (AA) are associated with major medical, social and economic adverse consequences. Problem drinking behavior is noted among those admitted to hospitals due to alcohol-related medical/surgical complaints as well as those with unrelated complaints. Literature shows an association between alcohol consumption and depression. Aims of this study were to determine the frequency of problem drinking and depression among males with a history of alcohol consumption tertiary care setting in Southern Sri Lanka. Method: Two-hundred male patients who consumed alcohol, receiving care in medical and surgical wards in Teaching Hospital Galle, were assessed. A validated J12 questionnaire of the Mini International Neuropsychiatric Interview was administered to determine frequency AA and AD. A validated PHQ 9 questionnaire to determine the prevalence and severity of depression. Results: Sixty-three participants (31%) had problem drinking. Of them, 61% had AD, and 39% had AA. Depression was noted in 39 (19%) subjects. In those who reported alcohol consumption not amounting to problem drinking, depression was noted in 23 (16%) participants. Mild depression was seen in 17, moderate in five and moderately severe in one. Among those who had problem drinking, 16 (25%) had depression. Mild depression was seen in four, moderate in seven, moderately severe in three and severe in two. Conclusions: A high proportion alcohol users had problem drinking. Adverse consequences associated with problem drinking places a major strain on the health system especially in a low resource setting where healthcare spending is limited and alcohol cessation support services are not well organised. Thus alcohol consumption and problem drinking behaviour need to be inquired into all medical consultations. Community prevalence of depression in Sri Lanka is approximately 10%. Depression among those consuming alcohol was two times higher compared to the general population. The rates of depression among those with problem drinking were especially high being 2.5 times more common than in the general population. A substantial proportion of these patients with depression had moderately severe or severe depression. When depression coexists with problem drinking, it may increase the tendency to consume alcohol as well as act as a barrier to the success of alcohol cessation interventions. Thus screening all patients who consume alcohol for depression, especially those who are problem drinkers becomes an important step in their clinical evaluation. In addition, in view of the high prevalence of problem drinking and coexistent depression, the need to organize a structured alcohol cessation support service in Sri Lanka as well as the need for increasing access to psychological evaluation and treatment of those with problem drinking are highlighted.

Keywords: alcohol abuse, alcohol, depression, problem drinking

Procedia PDF Downloads 159

Authors: Lolwa Alansari, Hanen Mrabet, Kholoud Khaled, Abdelhamid Azhaghdani, Sufia Athar, Aska Kaima, Zaineb Mhamdia, Zubaria Altaf, Almunzer Zakaria, Tamara Alshadafat

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Introduction: The Obstetrics and Gynecology Emergency Department at Alwakra Hospital has faced significant challenges, which have been further worsened by the impact of the COVID-19 pandemic. These challenges involve issues such as overcrowding, extended wait times, and a notable surge in demand for emergency care services. Moreover, prolonged waiting times have emerged as a primary factor contributing to situations where patients leave without receiving attention, known as left without being seen (LWBS), and unexpectedly abscond. Addressing the issue of insufficient patient mobility in the obstetrics and gynecology emergency department has brought about substantial improvements in patient care, healthcare administration, and overall departmental efficiency. These changes have not only alleviated overcrowding but have also elevated the quality of emergency care, resulting in higher patient satisfaction, better outcomes, and operational rewards. Methodology: The COVID-19 pandemic has served as a catalyst for substantial transformations in the obstetrics and gynecology emergency, aligning seamlessly with the strategic direction of Hamad Medical Corporation (HMC). The fundamental aim of this initiative is to revolutionize the operational efficiency of the OB-GYN ED. To accomplish this mission, a range of transformations has been initiated, focusing on essential areas such as digitizing systems, optimizing resource allocation, enhancing budget efficiency, and reducing overall costs. The project utilized the Plan-Do-Study-Act (PDSA) model, involving a diverse team collecting baseline data and introducing throughput improvements. Post-implementation data and feedback were analysed, leading to the integration of effective interventions into standard procedures. These interventions included optimized space utilization, real-time communication, bedside registration, technology integration, pre-triage screening, enhanced communication and patient education, consultant presence, and a culture of continuous improvement. These strategies significantly reduced waiting times, enhancing both patient care and operational efficiency. Results: Results demonstrated a substantial reduction in overall average waiting time, dropping from 35 to approximately 14 minutes by August 2023. The wait times for priority 1 cases have been reduced from 22 to 0 minutes, and for priority 2 cases, the wait times have been reduced from 32 to approximately 13.6 minutes. The proportion of patients spending less than 8 hours in the OB ED observation beds rose from 74% in January 2022 to over 98% in 2023. Notably, there was a remarkable decrease in LWBS and absconded patient rates from 2020 to 2023. Conclusion: The project initiated a profound change in the department's operational environment. Efficiency became deeply embedded in the unit's culture, promoting teamwork among staff that went beyond the project's original focus and had a positive influence on operations in other departments. This effectiveness not only made processes more efficient but also resulted in significant cost reductions for the hospital. These cost savings were achieved by reducing wait times, which in turn led to fewer prolonged patient stays and reduced the need for additional treatments. These continuous improvement initiatives have now become an integral part of the Obstetrics and Gynecology Division's standard operating procedures, ensuring that the positive changes brought about by the project persist and evolve over time.

Keywords: overcrowding, waiting time, person centered care, quality initiatives

Procedia PDF Downloads 64

Authors: Ryo Sato

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The United States and many other countries witness alarmingly low voting rates among youths, skewing democratic representation. Many scholars and pundits have ascribed to this trend young voters' laziness, indifference, and self-centeredness and placed blame on them. However, a growing body of research is focusing on structural barriers to voting, which are defined as built-in obstacles lying in electoral laws and procedures. Drawing on national survey data from 891 young adults in 2020 and extant literature on structural barriers to voting, the project aims to develop a framework for analyzing systematic obstacles to voting experienced by young people and offer tangible policy recommendations. The preliminary findings presented at this conference include an intersectional analysis of the survey data, focusing on how different social categories — race, gender, socioeconomic status, immigration status, and others — in combination create unique voting experiences and barriers. This project offers a critical framework to combat the individualized understanding of low voting rates among youths and inform pathways to functional democracy.

Keywords: youth voting behavior, structural barriers, intersectionality, democratic participation, S

Procedia PDF Downloads 55

Authors: J. Y. Sun, H. Z. Shen

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We study the photon blockade at exceptional points for a non-Hermitian optomechanical system coupled to the driven whispering-gallery-mode microresonator with two nanoparticles under the weak optomechanical coupling approximation, where exceptional points emerge periodically by controlling the relative angle of the nanoparticles. We find that conventional photon blockade occurs at exceptional points for the eigenenergy resonance of the single-excitation subspace driven by a laser field and discuss the physical origin of conventional photon blockade. Under the weak driving condition, we analyze the influences of the different parameters on conventional photon blockade. We investigate conventional photon blockade at nonexceptional points, which exists at two optimal detunings due to the eigenstates in the single-excitation subspace splitting from one (coalescence) at exceptional points to two at nonexceptional points. Unconventional photon blockade can occur at nonexceptional points, while it does not exist at exceptional points since the destructive quantum interference cannot occur due to the two different quantum pathways to the two-photon state not being formed. The realization of photon blockade in our proposal provides a viable and flexible way for the preparation of single-photon sources in the non-Hermitian optomechanical system.

Keywords: optomechanical systems, photon blockade, non-hermitian, exceptional points

Procedia PDF Downloads 138

Authors: Ruth Muturi Wanjiku

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HIV/AIDS in Kenya for unborn and young kids. HIV/AIDS is a significant health concern in Kenya, with an estimated 1.5 million people living with the disease. Unfortunately, many of these individuals are unaware of their HIV status, and the disease continues to spread among the population or unborn kids. HIV/AIDS can be transmitted from an infected mother during pregnancy, childbirth, or breastfeeding. However, with early testing and treatment, the risk of mother-to-child transmission can be significantly reduced. Therefore, it is crucial for pregnant women to get tested and receive appropriate medical care. For young kids, HIV/AIDS education is critical to preventing the spread of the disease. It is essential to teach children about the importance of safe sex practices, avoiding risky behaviors such as sharing needles and getting tested regularly. Additionally, children should be taught about the stigma surrounding HIV/AIDS and encouraged to treat individuals living with the disease with compassion and respect. In conclusion, HIV/AIDS is a significant health concern in Kenya that affects individuals of all ages. For unborn kids, early testing and treatment are critical to reducing the risk of mother-to-child transmission. For young kids, education about HIV/AIDS and safe sex practices is essential to preventing the spread of the disease and reducing stigma. It is essential to promote awareness and encourage individuals to get tested and seek medical care if they believe they may be infected with HIV/AIDS.

Keywords: AIDS, HIV, children, pregnant

Procedia PDF Downloads 67

Authors: Abdelbaset M. Elghriani, Abdelsalam M. Maatuk, Isam Denna, Amira Abdulla Werfalli

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Electronic prescription software (e-prescribing) benefits patients and physicians by preventing handwriting errors and giving accurate prescriptions. E-prescribing allows prescriptions to be written and sent to pharmacies electronically instead of using handwritten notes. Significant factors that may affect the adoption of e-prescription systems include lacking technical support, financial resources to operate the systems, and change resistance from some clinicians, which have been identified as barriers to the implementation of e-prescription systems. This study aims to explore the trends and opinions of physicians and pharmacists about e-prescriptions and to identify the obstacles and benefits of the application of e-prescriptions in the health care system. A cross-sectional descriptive study was conducted at three Libyan public hospitals. Data were collected through a self-constructed questionnaire to assess the opinions regarding potential constraining factors and benefits of implementing an e-prescribing system in hospitals. Data presented as mean, frequency distribution table, cross-tabulation, and bar charts. Data analysis was performed, and the results show that technical, financial, and organizational obstacles are the most important obstacles that prevent the application of e-prescribing systems in Libyan hospitals. In addition, there was awareness of the benefits of e-prescribing, especially reducing medication dispensing errors, and a desire of physicians and pharmacists to use electronic prescriptions.

Keywords: physicians, e-prescribing, health care system, pharmacists

Procedia PDF Downloads 126

Authors: Keshavamurthy Ganapathy Bhat, Manvinderpal Singh Marwaha

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Background: Coronary artery Disease (CAD) is a common cause of morbidity, mortality and reason for unfitness amongst aircrew. Coronary angioplasty and stenting are the standard of care for CAD. Antiplatelet drugs like Aspirin and Clopidogrel(Dual Antiplatelet therapy) are routinely prescribed post-stenting which are permitted for flying. However, in the recent past, Ticagrelor is being used in place of Clopidogrel as per ACC AHA and ESC guidelines. However Ticagrelor is not permitted for flying. Case Presentation: A 55-year-old pilot suffered Anterior Wall Myocardial Infarction. Angiography showed blockages in Left Anterior Descending Artery(LAD) and Right coronary artery (RCA). He underwent primary angioplasty and stenting LAD and subsequent stenting to RCA. Recovery was uneventful. One year later he was asymptomatic with normal Left ventricular function and no reversible perfusion defect on stress MPI. He had patent stents and coronaries on check angiogram. However, he was not allowed to fly since he was on Ticagrelor. He had to be switched over to Clopidogrel from Ticagrelor one year after stenting to permit him for flying. Similarly, switching had to be done in a 45-year-old pilot. Ticagrelor has been proven to be more effective than clopidogrel and as safe as Clopidogrel in preventing stent thrombosis. If Clopidogrel is being permitted, there is no need to restrict Ticagrelor. Hence "Policy" needs to be changed. Conclusions: Dual Antiplatelet therapy is the standard of care post coronary stenting which has been proved safe and effective. Policy needs to be changed to permit flying with Ticagrelor which is more effective than Clopidogrel and equally safe.

Keywords: antiplatelet drugs, coronary artery disease, stenting, ticagrelor

Procedia PDF Downloads 165