Search results for: clinical reasoning

Authors: Claire Baudry, Jessica Pearson, Laura-Emilie Savage, George Tarbulsy

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Introduction: Over the last decade, researchers have implemented attachment-based interventions to promote parental interactive sensitivity and child development among vulnerable families. In the context of the present study, these interventions have been shown to be effective to enhance cognitive development when child outcome was measured shortly after the intervention. Objectives: The goal of the study was to investigate the effects of an attachment-based intervention on child cognitive development one year post-intervention. Methods: Thirty-five mother-child dyads referred by Child Protective Services in the province of Québec, Canada, were included in this study: 21 dyads who received 6 to 8 intervention sessions and 14 dyads not exposed to the intervention and matched for the following variables: duration of child protective services, reason for involvement with child protection, age, sex and family status. Child cognitive development was measured using the WPPSI-IV, 12 months after the end of the intervention when the average age of children was 54 months old. Findings: An independent-samples t-test was conducted to compare the scores obtained on the WPPSI-IV for the two groups. In general, no differences were observed between the two groups. There was a significant difference on the fluid reasoning scale between children exposed to the intervention (M = 95,13, SD = 16,67) and children not exposed (M = 81, SD = 9,90). T (23) = -2,657; p= .014 (IC :-25.13;3.12). This difference was found only for children aged between 48 and 92 months old. Other results did not show any significant difference between the two groups (Global IQ or subscales). Conclusions: This first set of analyses suggest that relatively little effects of attachment-based intervention remain on the level of cognitive functioning 12-months post-intervention. It is possible that the significant findings concerning fluid reasoning may be pertinent in that fluid reasoning is linked to the capacity to analyse, to solve problems, and remember information, which may be important for promoting school readiness. As the study is completed and as more information is gained from other assessments of cognitive and socioemotional outcome, a clearer picture of the potential moderate-term impact of attachment-based intervention will emerge.

Keywords: attachment-based intervention, child development, child protective services, cognitive development

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Authors: Haixu Yu, Wenhui Cao

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Tailoring Large Language Models (LLMs) to perform legal reasoning has been a popular trend in the study of AI and law. Researchers have mainly employed two methods to unlock the potential of LLMs, namely by finetuning the LLMs to expand their knowledge of law and by restructuring the prompts (In-Context Learning) to optimize the LLMs’ understanding of the legal questions. Although claiming the finetuning and renovated prompting can make LLMs more competent in legal reasoning, most state-of-the-art studies show quite limited improvements of practicability. In this paper, drawing on the study of the complexity and low interpretability of legal texts, we propose a prompting strategy based on the Chain of Thought (CoT) method. Instead of merely instructing the LLM to reason “step by step”, the prompting strategy requires the tested LLM to identify the ambiguity in the questions as the first step and then allows the LLM to generate corresponding answers in line with different understandings of the identified terms as the following step. The proposed prompting strategy attempts to encourage LLMs to "interpret" the given text from various aspects. Experiments that require the LLMs to answer “case analysis” questions of bar examination with general LLMs such as GPT 4 and legal LLMs such as LawGPT show that the prompting strategy can improve LLMs’ ability to better understand complex legal texts.

Keywords: ambiguity-identification, prompt, large language model, legal text understanding

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Authors: Ilma Robo, Manola Kelmendi, Saimir Heta, Megi Tafa, Vera Ostreni

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Preservation of a natural tooth, even if endodontically treated, is more indicated than its replacement with an artificial tooth placed in prosthetic ways or with implant treatment. It is known how technology and endodontic treatment procedures have evolved significantly. It is also known that significant developments have been made in both dental prostheses and implant treatments, and again, in both specialties, it is emphasized that both the tooth placed with dental prostheses and the tooth placed with implant treatment cannot replace the natural tooth. The issue is whether long-term periapical tissue healing is achieved after a successful endodontic treatment, and for this, clinical data should be collected. In the cases when the apical closure or "apical filling" with the endodontic filling was carried out correctly clinically, but for various reasons, the healing of the periapical tissues did not occur, but also for those cases when the endodontic treatment did not reach the "apical filling" of the root canal. Teeth Endodontic retreatments have their clinical difficulty, but knowing the reason why endodontic treatment success has not been achieved clinically, the clinical endodontic approach is easier. In this process, it is important for the dentist to recognize the clinical and radiographic signs of persistent apical periodontitis or renewed apical periodontitis. After this initial procedure, dentists must know and evaluate the possibility of clinical endodontic retreatment by reporting, not precisely, but with very approximate values, the percentage of clinical success of endodontic retreatment. Depending on the reason for the performance, endodontic re-treatment may also need more specialized equipment or tools, for which even the professional who undertakes the re-treatment must be equipped with the relevant knowledge of their use and clinical application. Evaluating the clinical success of endodontic re-treatment is actually a more difficult process and requires more clinical responsibility since it must be considered that the initial treatment was performed by the same specialist as the specialist who undertakes the same endodontic re-treatment. Tooth So, the clinical endodontic re-treatment of a tooth should not be seen as a fund of clinical practice only of a good successful endodontist, but as part of routine endodontic treatments, nor should it be seen as a typical case where the tools and the most advanced technological devices in the endodontic field. So, the clinical picture of endodontic re-treatments offers the possibility of finding endodontic malpractice, the possibility of more accurate assessment of dental morphological anomalies, and above all, the cognitive and professional possibilities of the diagnosis of persistent apical periodontitis. This study offers the possibility of evaluating these three directions by presenting in numbers and in percentage the frequency of the reasons why the endodontic success of the root canal treatment is not always achieved.

Keywords: apical periodontitis, clinical susccess, endodontics, E.faecalis

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Authors: Maria Pratt, Lynn Martin

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Context: In nursing education, clinical instructors are crucial in assessing and evaluating students' performance in clinical courses. However, instructors often struggle when assigning failing grades to students at risk of failing. Research Aim: This qualitative study aims to understand clinical instructors' experiences evaluating students with unsatisfactory performance, including how reflection and collegial support impact this evaluation process. Methodology, Data Collection, and Analysis Procedures: This study employs Gadamer's Hermeneutic Inquiry as the research methodology. A purposive maximum variation sampling technique was used to recruit eight clinical instructors from a collaborative undergraduate nursing program in Southwestern Ontario. Semi-structured, open-ended, and audio-taped interviews were conducted with the participants. The hermeneutic analysis was applied to interpret the interview data to allow for a thorough exploration and interpretation of the instructors' experiences evaluating failing students. Findings: The main findings of this qualitative research indicate that evaluating failing students was emotionally draining for the clinical instructors who experienced multiple challenges, uncertainties, and negative feelings associated with assigning failing grades. However, the analysis revealed that ongoing reflection and collegial support played a crucial role in mitigating the challenges they experienced. Conclusion: This study contributes to the theoretical understanding of nursing education by shedding light on clinical instructors' challenges in evaluating failing students. It emphasizes the emotional toll associated with this process and the role that reflection and collegial support play in alleviating those challenges. The findings underscore the need for ongoing professional development and support for instructors in nursing education. By understanding and addressing clinical instructors' experiences, nursing education programs can better equip them to effectively evaluate struggling students and provide the necessary support for their professional growth.

Keywords: clinical instructor, student evaluation, nursing, reflection, support

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Authors: Simone Huber, Bianca Schnalzer, Baptiste Alcalde, Sten Hanke, Lampros Mpaltadoros, Thanos G. Stavropoulos, Spiros Nikolopoulos, Ioannis Kompatsiaris, Lina Pérez- Breva, Vallivana Rodrigo-Casares, Jaime Fons-Martínez, Jeroen de Bruin

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Developing new medicine and health solutions and improving patient health currently rely on the successful execution of clinical trials, which generate relevant safety and efficacy data. For their success, recruitment and retention of participants are some of the most challenging aspects of protocol adherence. Main barriers include: i) lack of awareness of clinical trials; ii) long distance from the clinical site; iii) the burden on participants, including the duration and number of clinical visits and iv) high dropout rate. Most of these aspects could be addressed with a new paradigm, namely the Remote Decentralized Clinical Trials (RDCTs). Furthermore, the COVID-19 pandemic has highlighted additional advantages and challenges for RDCTs in practice, allowing participants to join trials from home and not depend on site visits, etc. Nevertheless, RDCTs should follow the process and the quality assurance of conventional clinical trials, which involve several processes. For each part of the trial, the Building Blocks, existing software and technologies were assessed through a systematic search. The technology needed to perform RDCTs is widely available and validated but is yet segmented and developed in silos, as different software solutions address different parts of the trial and at various levels. The current paper is analyzing the availability of technology to perform RDCTs, identifying gaps and providing an overview of Basic Building Blocks and functionalities that need to be covered to support the described processes.

Keywords: architectures and frameworks for health informatics systems, clinical trials, information and communications technology, remote decentralized clinical trials, technology availability

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Authors: José Neves, M. Rosário Martins, Fátima Candeias, Diana Ferreira, Sílvia Arantes, Júlio Cruz-Morais, Guida Gomes, Joaquim Macedo, António Abelha, Henrique Vicente

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Some plants of genus Schinus have been used in the folk medicine as topical antiseptic, digestive, purgative, diuretic, analgesic or antidepressant, and also for respiratory and urinary infections. Chemical composition of essential oils of S. molle and S. terebinthifolius had been evaluated and presented high variability according with the part of the plant studied and with the geographic and climatic regions. The pharmacological properties, namely antimicrobial, anti-tumoural and anti-inflammatory activities are conditioned by chemical composition of essential oils. Taking into account the difficulty to infer the pharmacological properties of Schinus essential oils without hard experimental approach, this work will focus on the development of a decision support system, in terms of its knowledge representation and reasoning procedures, under a formal framework based on Logic Programming, complemented with an approach to computing centered on Artificial Neural Networks and the respective Degree-of-Confidence that one has on such an occurrence.

Keywords: artificial neuronal networks, essential oils, knowledge representation and reasoning, logic programming, Schinus molle L., Schinus terebinthifolius Raddi

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Authors: Rashida Suleiman, Asamoah Jnr. Boakye, Suleiman Ahmed Ibn Ahmed

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In recent years, there has been an enormous success in discoveries of scientific knowledge in medicine coupled with the advancement of technology. Despite all these successes, diagnoses and treatment of diseases have become complex. MYCIN is a groundbreaking illustration of a clinical decision support system (CDSS), which was developed to assist physicians in the diagnosis and treatment of bacterial infections by providing suggestions for antibiotic regimens. MYCIN was one of the earliest expert systems to demonstrate how CDSSs may assist human decision-making in complicated areas. Relevant databases were searched using google scholar, PubMed and general Google search, which were peculiar to clinical decision support systems. The articles were then screened for a comprehensive overview of the functionality, consultative style and statistical usage of MYCIN, a clinical decision support system. Inferences drawn from the articles showed some usage of MYCIN for problem-based learning among clinicians and students in some countries. Furthermore, the data demonstrated that MYCIN had completed clinical testing at Stanford University Hospital following years of research. The system (MYCIN) was shown to be extremely accurate and effective in diagnosing and treating bacterial infections, and it demonstrated how CDSSs might enhance clinical decision-making in difficult circumstances. Despite the challenges MYCIN presents, the benefits of its usage to clinicians, students and software developers are enormous.

Keywords: clinical decision support system, MYCIN, diagnosis, bacterial infections, support systems

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Authors: Yutong Xu, Wanting Zhang, Jia Wang, Zihan Guo, Weiguang Ma

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Background: The resilience education of intern nursing students has significant implications for the development and improvement of the nursing workforce. The clinical internship period is a critical time for enhancing resilience. Aims: To evaluate the resilience level of Chinese nursing interns and identify the factors affecting resilience early in their careers. Methods: The cross-sectional study design was adopted. From March 2022 to May 2023, 512 nursing interns in tertiary care hospitals were surveyed online with the Connor-Davidson Resilience Scale, the Clinical Learning Environment scale for Nurse, and the Career Adapt-Abilities Scale. Structural equation modeling was used to clarify the relationships among these factors. Indirect effects were tested using bootstrapped Confidence Intervals. Results: The nursing interns showed a moderately high level of resilience[M(SD)=70.15(19.90)]. Gender, scholastic attainment, had a scholarship, career adaptability and clinical learning environment were influencing factors of nursing interns’ resilience. Career adaptability and clinical learning environment positively and directly affected their resilience level (β = 0.58, 0.12, respectively, p＜0.01). career adaptability also positively affected career adaptability (β = 0.26, p < 0.01), and played a fully mediating role in the relationship between clinical learning environment and resilience. Conclusion: Career adaptability can enhance the influence of clinical learning environment on resilience. The promotion of career adaptability and the clinical teaching environment should be the potential strategies for nursing interns to improve their resilience, especially for those female nursing interns with low academic performance. Implications for Nursing Educators Nursing educators should pay attention to the cultivation of nursing students' resilience; for example, by helping them integrate to the clinical learning environment and improving their career adaptability. Reporting Method: The STROBE criteria were used to report the results of the observations critically. Patient or Public Contribution No patient or public contribution.

Keywords: resilience, clinical learning environment, career adaptability, nursing interns

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Authors: Yong Cang

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RJV001 is a subcutaneous injection containing mutated recombinant Collagenase H (ColH), leading to disruption of collagen matrix in adipose tissue and programmed cell death of adipocytes. Here we reported our clinical investigation of the safety, tolerance and pharmacodynamics of localized RJV001 injection into healthy human abdominal fat tissues (NCT04821648, Arizona Research Center). Investigate the safety, tolerance and clinical pharmacodynamics of subcutaneous RJV001 in humans. In the dose-escalating study, 18 subjects completed the study, 100% female, 78% white, with a mean age of 42[±9.9]. All three tested dose (0.05, 0.075 and 0.15 mg/injection), up to 30 injections, were safe and well-tolerated. Bruising and tenderness to palpation, mild to moderate, were the most frequent local skin reactions but nearly all resolved within 30 days. Additionally, physician-monitored ultrasound measurement showed that a reduction in abdominal fat tissue thickness was consistently observed in Cohort C (0.075, 0.15 mg/injection, 30injections), with a mean reduction of 7.37 [± 2.020] mm. Based on this clinical study, RJV001 has been advanced to phase II clinical studies. In the dose-escalating study, subcutaneously administered RJV001 was safe and well-tolerated in healthy adults up to 0.15 mg/injection, 30 injections. Fat reduction and adipocytolysis were observed by ultrasound measurements and histological analysis for exploratory purposes.

Keywords: fat reduction, mutant collagenase, clinical trial, subcutaneous injection

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Authors: Dení Stincer Gómez, Zuraya Monroy Nasr

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From the epistemology of emotions, one of the topics of current reflection is the function that emotions fulfill in the rational processes involved in scientific activity. So far, three functions have been assigned to them: selective, heuristic, and carriers of content. In this last function, it is argued that emotions, like our perceptual organs, contribute relevant content to reasoning, which is then converted into linguistic statements or graphic representations. In this paper, of a qualitative and philosophical nature, arguments are provided for two hypotheses 1) if emotions provide content to the mind, which then translates it into language or representations, then it is important to take up the idea of the Saussurean linguistic sign to understand this process. This sign has two elements: the signified and the signifier. Emotions would provide meanings, and reasoning creates the signifier, and 2) the meanings provided by emotions are properties and qualities of phenomena generally not accessible to the sense organs. These meanings must be imagined, and the imagination is nurtured by the feeling that "maybe this is the way." One way to access the content provided by emotions can be through imagined scientific drawings. The atomic models created since Thomson, the structure of crystals by René Just, the representations of lunar eclipses by Johannes, fractal geometry, and the structure of DNA, among others, have resulted fundamentally from the imagination. These representations, not provided by the sense organs, seem to come from the emotional involvement of scientists in their desire to understand, explain and discover.

Keywords: emotions, epistemic functions of emotions, scientific drawing, linguistic sign

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Authors: Julie Chuah Suan Choo

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Due to the continuous change in workforce and the demands of the global workplace, many employers had lamented that the majority of university graduates were not prepared in the key areas of employment such as critical thinking, writing, self-direction and global knowledge which are most needed for the purposes of promotion. Further, critical thinking skills are deemed as integral parts of transformational pedagogy which aims at having a more informed society. To add to this, literature teaching has recently been advocated for enhancing students’ critical thinking and reasoning. Thus this study explored the effects of incorporating a few strategies in teaching literature, namely a Shakespeare play, into a course design to enhance these skills. An experiment involving a pretest and posttest using the California Critical Thinking Skills Test (CCTST) were administered on 80 first-year students enrolled in the Bachelor of Arts programme who were randomly assigned into the control group and experimental group. For the next 12 weeks, the experimental group was given intervention which included guided in-class discussion with Socratic questioning skills, learning log to detect their weaknesses in logical reasoning; presentations and quizzes. The results of CCTST which included paired T-test using SPSS version 22 indicated significant differences between the two groups. Findings have significant implications on the course design as well as pedagogical practice in using literature to enhance students’ critical thinking skills.

Keywords: literature teaching, critical thinking, California critical thinking skills test (CCTST), course design

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Authors: Hossein Ghaedamini, Salman Farahbakhsh, Alireza Amirbeigi, Zahra Saghafi, Salman Daneshi, Alireza Ghaedamini

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Background: Assessing the challenges of clinical education of medical students is one of the most important and sensitive parts of medical education. The aim of this study was to investigate the views and experiences of Kerman medical students on the factors that facilitate and inhibit the quality of clinical education. Materials and Methods: This research was qualitative and used a phenomenological approach. The study population included medical interns of Kerman University of Medical Sciences in 1400. The method of data collection was in-depth interviews with participants. Data were encoded and analyzed by Claizey stepwise model. Results: First, about 540 primary codes were extracted in the form of two main themes (facilitators and inhibitors) and 10 sub-themes including providing motivational models and creating interest in interns, high scientific level of professors and the appropriate quality of their teaching, the use of technology in the clinical education process, delegating authority and freedom of action and more responsibilities to interns, inappropriate treatment of some officials, professors, assistants and department staff with their interns, inadequate educational programming, lack of necessary cooperation and providing inappropriate treatment by clinical training experts for interns, inadequate evaluation method in clinical training for interns, poor quality mornings, the unefficiency of grand rounds, the inappropriate way of evaluating clinical training for interns, the lack of suitable facilities and conditions with the position of a medical intern, and the hardwork of some departments were categorized. Conclusion: Clinical education is always mixed with special principles and subtleties, and special attention to facilitators and inhibitors in this process has an important role in improving its quality.

Keywords: clinical education, medical students, qualitative study, education

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Authors: Lu-Chiu Huang, Pei-Pei Chen, Li-Chin Yu, Chiao-Wen Kuo, Tsui-Tao Liu, Rung-Chuang Feng

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Purpose: People put increasing emphasis on demands of medical quality and protecting their interests. Patients' or family's dissatisfaction with medical care may easily lead to medical dispute. Physician-family communication plays an essential role in medical care. A sound communication cannot only strengthen patients' belief in the medical team but make patient have definite insight into treatment course of the disease. A family meeting provides an effective platform for communication between clinical staff, patients and family. Decisions and consensuses formed in family meetings can promote patients' or family's satisfaction with medical care. Clinical staff's attitudes toward family meeting may determine behavioral intentions to hold family meeting. This study aims to explore clinical staff's difficulties in holding family meeting and evaluate how their attitudes and behavior influence the effect of family meetings. Methods: This was a cross-sectional study. It was conducted at a regional teaching hospital in Taipei city. The research team developed its own structural questionnaires, whose expert validity was checked by the nursing experts. Participants filled in the questionnaires online. Data were collected by convenience sampling. A total of 568 participants were invited. They included doctors, nurses, social workers, and so on. Results: 1) The average score of ‘clinical staff’s attitudes to family meetings’ was 5.15 (SD=0.898). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It indicated that clinical staff had positive attitudes toward family meetings, 2) The average score of ‘clinical staff’s behavior to family meetings’ was 5.61 (SD=0.937). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It meant clinical staff tended to have positive behavior at the family meeting, and 3) The average score of ‘Difficulty in conducting family meetings’ was 5.15 (SD=0.897). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. The higher the score was, the less difficulty the clinical staff felt. It demonstrated clinical staff felt less difficulty in conducting family meetings. Clinical staff's identification with family meetings brought favored effects. Persistent and active promotion for family meetings can bring patients and family more benefits. Implications for practice: Understanding clinical staff's difficulty in participating family meeting and exploring their attitudes or behavior toward physician-family communication are helpful to develop modes of interaction. Consequently, quality and satisfaction of physician-family communication can be increased.

Keywords: clinical staff, communication, family meeting, physician-family

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Authors: Phawida Wattanasoonthorn

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Ventilator-associated pneumonia is a serious infection found to be among the top three infections in the hospital. To investigate the effects of clinical practice guideline on knowledge and preventive practices of nursing personnel, and incidences of ventilator-associated pneumonia. A pre-post quasi-experimental study on 17 professional nurses, and 123 ventilator-associated pneumonia patients admitted to the surgical intensive care unit, and the accident and surgical ward of Songkhla Hospital from October 2013 to January 2014. The study found that after using the clinical practice guideline, the subjects’ median score increased from 16.00 to 19.00. The increase in practicing correctly was from 66.01 percent to 79.03 percent with the statistical significance level of .05, and the incidences of ventilator-associated pneumonia decreased by 5.00 percent. The results of this study revealed that the use of the clinical practice guideline helped increase knowledge and practice skill of nursing personnel, and decrease incidences of ventilator-associated pneumonia. Thus, nursing personnel should be encouraged, reminded and promoted to continue using the practice guideline through various means including training, providing knowledge, giving feedback, and putting up posters to remind them of practicing correctly and sustainably.

Keywords: Clinical Practice Guideline, knowledge, Preventive Ventilator, Pneumonia

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Authors: Getachew Belay Kassahun

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Background: Locally established clinical laboratory reference intervals (RIs) are required to interpret laboratory test results for screening, diagnosis, and prognosis. The objective of this study was to establish a reference interval of clinical chemistry parameters among apparently healthy adolescents aged between 12 and 17 years in Mekelle, Tigrai, in the northern part of Ethiopia. Methods: Community-based cross-sectional study was employed from December 2018 to March 2019 in Mekelle City among 172 males and 172 females based on a Multi-stage sampling technique. Blood samples were tested for Fasting blood sugar (FBS), alanine amino transferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), Creatinine, urea, total protein, albumin (ALB), direct and indirect bilirubin (BIL.D and BIL.T) using 25 Bio system clinical chemistry analyzer. Results were analyzed using SPSS version 23 software and based on the Clinical Laboratory Standard Institute (CLSI)/ International Federation of Clinical Chemistry (IFCC) C 28-A3 Guideline which defines the reference interval as the 95% central range of 2.5th and 97.5th percentiles. Mann Whitney U test, descriptive statistics and box and whisker were statistical tools used for analysis. Results: This study observed statistically significant differences between males and females in ALP, ALT, AST, Urea and Creatinine Reference intervals. The established reference intervals for males and females, respectively, were: ALP (U/L) 79.48-492.12 versus 63.56-253.34, ALT (U/L) 4.54-23.69 versus 5.1-20.03, AST 15.7- 39.1 versus 13.3- 28.5, Urea (mg/dL) 9.33-24.99 versus 7.43-23.11, and Creatinine (mg/dL) 0.393-0.957 versus 0.301-0.846. The combined RIs for Total Protein (g/dL) were 6.08-7.85, ALB (g/dL) 4.42-5.46, FBS(mg/dL) 65-110, BIL.D (mg/dL) 0.033-0.532, and BIL.T (mg/dL) 0.106-0.812. Conclusions: The result showed a marked difference between sex and company-derived values for selected clinical chemistry parameters. Thus, the use of age and sex-specific locally established reference intervals for clinical chemistry parameters is recommended.

Keywords: reference interval, adolescent, clinical chemistry, Ethiopia

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Authors: Daphne Alroy-Thiberge

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Trauma-impacted individuals present unique treatment challenges that include high reactivity, hyper-and hypo-arousal, poor adherence to therapy, as well as powerful transference and counter-transference experiences in therapy. This work provides an overview of the clinical tenets most often encountered in trauma-impacted individuals. Further, it provides readily applicable clinical techniques to optimize therapeutic rapport and facilitate accelerated positive mental health outcomes. Finally, integrated neuroscience and clinical evidence-based data are discussed to shed new light on crisis states in trauma-impacted individuals. This knowledge is utilized to provide effective and concrete interventions towards rapid and successful de-escalation of the impacted individual. A highly interactive, adult-learning-principles-based modality is utilized to provide an organic learning experience for participants. The information and techniques learned aim to increase clinical effectiveness, reduce staff injuries and burnout, and significantly enhance positive mental health outcomes and self-determination for the trauma-impacted individuals treated.

Keywords: clinical competencies, crisis interventions, psychotherapy techniques, trauma informed care

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Authors: Shahnam Behnam Malekzadeh, Ian Kerr, Tyson Kaempffer, Teague Harper, Andrew Watson

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The Site C Hydroelectric dam is currently being constructed in north-eastern British Columbia on sub-horizontal sedimentary strata that dip approximately 15 meters from one bank of the Peace River to the other. More than 615 pressure sensors (Vibrating Wire Piezometers) have been installed on bedding planes (BPs) since construction began, with over 80 more planned before project completion. These pressure measurements are essential to monitor the stability of the rock foundation during and after construction and for dam safety purposes. BPs are identified by their clay gouge infilling, which varies in thickness from less than 1 to 20 mm and can be challenging to identify as the core drilling process often disturbs or washes away the gouge material. Without the use of depth predictions from nearby boreholes, stratigraphic markers, and downhole geophysical data, it is difficult to confidently identify BP targets for the sensors. In this paper, a Case-Based Reasoning (CBR) method was used to develop an empirical model called the Bedding Plane Elevation Prediction (BPEP) to help geologists and geotechnical engineers to predict geological features and bedding planes at new locations in a fast and accurate manner. To develop CBR, a database was developed based on 64 pressure sensors already installed on key bedding planes BP25, BP28, and BP31 on the Right Bank, including bedding plane elevations and coordinates. Thirteen (20%) of the most recent cases were selected to validate and evaluate the accuracy of the developed model, while the similarity was defined as the distance between previous cases and recent cases to predict the depth of significant BPs. The average difference between actual BP elevations and predicted elevations for above BPs was ±55cm, while the actual results showed that 69% of predicted elevations were within ±79 cm of actual BP elevations while 100% of predicted elevations for new cases were within ±99cm range. Eventually, the actual results will be used to develop the database and improve BPEP to perform as a learning machine to predict more accurate BP elevations for future sensor installations.

Keywords: case-based reasoning, geological feature, geology, piezometer, pressure sensor, core logging, dam construction

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Authors: Alexey Yu. Martynov, Sulejman Bayramov

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Introduction: The myocardial bridging is the most common anomaly of the coronary arteries (CA). Depending on the examination method, the frequency of detected myocardial bridges (MB) varies in a rather wide range. The typical clinical manifestations of MB are angina pectoris, arrhythmias, sudden cardiac death. Objective: To study the incidence of MB in patients hospitalized with coronary artery disease (CAD). To assess clinical manifestations of MB in patients admitted with CAD. Materials and methods: A retrospective analysis of 19159 case histories of patients admitted at clinical city hospital in Moscow from 01.01.2018 to 31.12 2019 with CAD was performed. 9384 patients’ coronary angiographies (CAG) were examined for MB. The localization of MB, the degree of coronary contraction by MB, the number of MB, isolated MB and combined with CAD were assessed. The clinical manifestations of MB were determined. Results: MB was detected in 52 patients all with one myocardial bridge. 20 patients with MB have intact CA, and 32 patients have MB combined with CAD. Among 20 patients with intact CA: I degree of MB contraction (up to 50%) was detected in 9 patients. Clinical manifestations in five cases were angina pectoris, in 3 myocardial infarction (MI) - 1 patients with ST segment elevation MI (STEMI), 2 without ST segment elevation MI (NSTEMI), 1 post-infarction cardiosclerosis (PICS). Stable angina II FC in 3, III FC in 1, vasospastic angina (VSA) in 1 patient. II degree of MB contraction (up to 50-70%) was determined in 9 patients: in seven cases angina pectoris was detected, 1 NSTEMI, 1 PICS. Stable angina II FC in 3, III FC in 1, VSA in 3 patients. III degree of MB contraction (> 70%) detected in 2 patients. II FC stable angina in one case, PICS in another. Among 32 patients having MB combined with CAD I degree of MB contraction was observed in 20 patients. Clinical manifestations in 12 cases were angina pectoris in 8 II FC and in 4 III FC, 7 MI 6 with STEMI and 1 NSTEMI, 1 PICS. II degree of MB contraction was detected in 7 patients, 4 of them had angina pectoris, 3 MI 2 with STEMI and 1 NSTEMI. Stable angina II FC in 3, VSA in 1 patients. III degree of MB contraction was diagnosed in five patients. In two cases, II FC and III FC stable angina were observed, 2 MI with STEMI and NSTEMI, 1 PICS. Conclusions: MB incidence is one in 368 patients with CAD. The most common involvement (68%) is MB combined with CA atherosclerotic lesions. MB with intact CA are detected in one-third (32%) of patients. The first-degree MB contraction is most frequent condition. MI is more often detected in intact CA with first degree MB than in the second degree. The degree of MB contraction was not correlated with the severity of the clinical manifestations.

Keywords: clinical manifestations, coronary angiography, coronary artery disease, myocardial bridging, myocardial infarction, stable angina

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Authors: Kamal Kaushik, Trisha, Dandapni, Sambit Nanda, A. Mukherjee, S. Pradhan

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INTRODUCTION: As complexity in radiotherapy practice and processes are increasing, there is a need to assure quality control to a greater extent. At present, no international literature available with regards to the optimal quality control indicators for radiotherapy; moreover, few clinical audits have been conducted in the field of radiotherapy. The primary aim is to improve the processes that directly impact clinical outcomes for patients in terms of patient safety and quality of care. PROCEDURE: A team of an Oncologist, a Medical Physicist and a Radiation Therapist was formed for weekly clinical audits of patient’s undergoing radiotherapy audits The stages for audits include Pre planning audits, Simulation, Planning, Daily QA, Implementation and Execution (with image guidance). Errors in all the parts of the chain were evaluated and recorded for the development of further departmental protocols for radiotherapy. EVALUATION: The errors at various stages of radiotherapy chain were evaluated and recorded for comparison before starting the clinical audits in the department of radiotherapy and after starting the audits. It was also evaluated to find the stage in which maximum errors were recorded. The clinical audits were used to structure standard protocols (in the form of checklist) in department of Radiotherapy, which may lead to further reduce the occurrences of clinical errors in the chain of radiotherapy. RESULTS: The aim of this study is to perform a comparison between number of errors in different part of RT chain in two groups (A- Before Audit and B-After Audit). Group A: 94 pts. (48 males,46 female), Total no. of errors in RT chain:19 (9 needed Resimulation) Group B: 94 pts. (61 males,33 females), Total no. of errors in RT chain: 8 (4 needed Resimulation) CONCLUSION: After systematic periodic clinical audits percentage of error in radiotherapy process reduced more than 50% within 2 months. There is a great need in improving quality control in radiotherapy, and the role of clinical audits can only grow. Although clinical audits are time-consuming and complex undertakings, the potential benefits in terms of identifying and rectifying errors in quality control procedures are potentially enormous. Radiotherapy being a chain of various process. There is always a probability of occurrence of error in any part of the chain which may further propagate in the chain till execution of treatment. Structuring departmental protocols and policies helps in reducing, if not completely eradicating occurrence of such incidents.

Keywords: audit, clinical, radiotherapy, improving functionality

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Authors: A. Satty, H. Mwambi

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Much clinical trials data-based research are characterized by the unavoidable problem of dropout as a result of missing or erroneous values. This paper aims to review some of the various techniques to address the dropout problems in longitudinal clinical trials. The fundamental concepts of the patterns and mechanisms of dropout are discussed. This study presents five general techniques for handling dropout: (1) Deletion methods; (2) Imputation-based methods; (3) Data augmentation methods; (4) Likelihood-based methods; and (5) MNAR-based methods. Under each technique, several methods that are commonly used to deal with dropout are presented, including a review of the existing literature in which we examine the effectiveness of these methods in the analysis of incomplete data. Two application examples are presented to study the potential strengths or weaknesses of some of the methods under certain dropout mechanisms as well as to assess the sensitivity of the modelling assumptions.

Keywords: incomplete longitudinal clinical trials, missing at random (MAR), imputation, weighting methods, sensitivity analysis

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Authors: Sekkal Nawel

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The Web of Things (WoT), integration of smart technologies from the Internet or network to Web architecture or application, is becoming more complex, larger, and dynamic. The WoT is associated with various elements such as sensors, devices, networks, protocols, data, functionalities, and architectures to perform services for stakeholders. These services operate in the context of the interaction of stakeholders and the WoT elements. Such context is becoming a key information source from which data are of various nature and uncertain, thus leading to complex situations. In this paper, we take interest in the development of intelligent Web services. The key ingredients of this “intelligent” notion are the context diversity, the necessity of a semantic representation to manage complex situations and the capacity to reason with uncertain data. In this perspective, we introduce a multi-layered architecture based on a generic intelligent Web service model dealing with various contexts, which proactively predict future situations and reactively respond to real-time situations in order to support decision-making. For semantic context data representation, we use PR-OWL, which is a probabilistic ontology based on Multi-Entity Bayesian Networks (MEBN). PR-OWL is flexible enough to represent complex, dynamic, and uncertain contexts, the key requirements of the development for the intelligent Web services. A case study was carried out using the proposed architecture for intelligent plant watering to show the role of proactive and reactive contextual reasoning in terms of WoT.

Keywords: smart web service, the web of things, context reasoning, proactive, reactive, multi-entity bayesian networks, PR-OWL

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Authors: Sujata Chaturvedi, Ishita Pant, Deepak Kumar Jha, Vinod Kumar Singh Gautam, Chandra Bhushan Tripathi

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Objective: To describe clinical, histopathological and immunohistochemical profile of glioblastoma in patients and to correlate these findings with patient survival. Material and methods: 30 cases of histopathologically diagnosed glioblastomas were included in this study. These cases were analysed in detail for certain clinical and histopathological parameters. Immunohistochemical staining for p53, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), mouse double minute 2 homolog (MDM2) and Ki67 was done and scores were calculated. Results of these findings were correlated with patient survival. Results: A retrospective analysis of the histopathology records and clinical case files was done in 30 cases of glioblastoma (WHO grade IV). The mean age of presentation was 50.6 years with a male predilection. The most common involved site was the frontal lobe. Amongst the clinical parameters, age of the patient and extent of surgical resection showed a significant correlation with the patient survival. Histopathological parameters showed no significant correlation with the patient survival, while amongst the immunohistochemical parameters expression of MDM2 showed a significant correlation with the patient survival. Conclusion: In this study incorporating clinical, histopathological and basic panel of immunohistochemistry, age of the patient, extent of the surgical resection and expression of MDM2 showed significant correlation with the patient survival.

Keywords: glioblastoma, p53, EGFR, VEGF, MDM2, Ki67

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Authors: Fatemeh Jannesarvatan, Ghazaal Parastooei, Jimmy frerejan, Saedeh Mokhtari, Peter Van Rosmalen

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Medical and dental education increasingly emphasizes the acquisition, integration, and coordination of complex knowledge, skills, and attitudes that can be applied in practical situations. Instructional design approaches have focused on using real-life tasks in order to facilitate complex learning in both real and simulated environments. The Four component instructional design (4C/ID) model has become a useful guideline for designing instructional materials that improve learning transfer, especially in health profession education. The objective of this study was to apply the 4C/ID model in the creation of virtual patients (VPs) that dental students can use to practice their clinical management and clinical reasoning skills. The study first explored the context and concept of complication factors and common errors for novices and how they can affect the design of a virtual patient program. The study then selected key dental information and considered the content needs of dental students. The design of virtual patients was based on the 4C/ID model's fundamental principles, which included: Designing learning tasks that reflect real patient scenarios and applying different levels of task complexity to challenge students to apply their knowledge and skills in different contexts. Creating varied learning materials that support students during the VP program and are closely integrated with the learning tasks and students' curricula. Cognitive feedback was provided at different levels of the program. Providing procedural information where students followed a step-by-step process from history taking to writing a comprehensive treatment plan. Four virtual patients were designed using the 4C/ID model's principles, and an experimental design was used to test the effectiveness of the principles in achieving the intended educational outcomes. The 4C/ID model provides an effective framework for designing engaging and successful virtual patients that support the transfer of knowledge and skills for dental students. However, there are some challenges and pitfalls that instructional designers should take into account when developing these educational tools.

Keywords: 4C/ID model, virtual patients, education, dental, instructional design

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Authors: Wafaa M. El- Kotb, Soheir Mohamed Weheida, Manal E. Fareed

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The aim of this study was to determine the effect of implementing a teaching module about diet and exercises on clinical outcomes of patients with gout. Subjects: A purposive sample of 60 adult gouty patients was selected and randomly and alternatively divided into two equal groups 30 patients in each. Setting: The study was conducted in orthopedic out patient's clinic of Menoufia University. Tools of the study: Three tools were utilized for data collection: Knowledge assessment structured interview questionnaire, Clinical manifestation assessment tools and Nutritional assessment sheet. Results: All patients of both groups (100 %) had poor total knowledge score pre teaching, while 90 % of the study group had good total knowledge score post teaching by three months compared to 3.3 % of the control group. Moreover the recovery outcomes were significantly improved among study group compared to control group post teaching. Conclusion: Teaching study group about diet and exercises significantly improved their clinical outcomes. Recommendation: Patient's education about diet and exercises should be ongoing process for patients with gout.

Keywords: clinical outcomes, diet, exercises, teaching module

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Authors: Juan Torralba

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Student digital artifacts were investigated, utilizing a qualitative exploratory research design to understand the ways in which students represented their knowledge of seventh-grade proportionality concepts as they participated in maker-based activities that culminated in the creation of digital 3-dimensional models of their dream homes. Representations of the geometric and numeric dimensions of proportionality were analyzed in the written, verbal, and visual data collected from the students. A directed content analysis approach was utilized in the data analysis, as this work aimed to build upon existing research in the field of maker-based STEAM Education. The results from this work show that students can represent their understanding of proportional reasoning through open-ended written responses more accurately than through verbal descriptions or digital artifacts. The geometric and numeric dimensions of proportionality and their respective components of attributes of similarity representation and percents, rates, and ratios representations were the most represented by the students than any other across the data, suggesting a maker-based instructional approach to teaching proportionality in the middle grades may be promising in helping students gain a solid foundation in those components. Recommendations for practice and research are discussed.

Keywords: learning through making, maker-based education, maker education in the middle grades, making in mathematics, the maker movement

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Authors: Caroline Denaes

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The ability to read is crucial for a successful path in school and in a social and professional context. Children with mild intellectual disability are confronted to serious difficulties in literacy. A lot of them do not read or are illiterate. Only one child out of five is able to acquire basic reading skills, which increases the likelihood to misfit in society, especially when these children grow up and cannot manage themselves in situations requiring higher reading levels. One way to help these children acquiring basic reading skills is to use analogical reasoning, as some researchers demonstrated that this mechanism is fundamental for any reading process. For this purpose, we developed computerized analogies displayed on a touch screen tablet. Analogies are comparisons that give children a framework they can use to understand new information. They work by comparing one thing to another in order to emphasize some mutual quality. If one of the items is unfamiliar, that mutual quality can help make it understandable, or it can cause the children to consider something familiar in some new way, such as transferring what they know about familiar words to help them identify unfamiliar words. In addition, using touch screen tablets represents several advantages: the ease of use, the relevance to this specific population and the appeal of a self-directed activity gives individuals and practitioners a modern tool that differs from the traditional paper-and-pencil material. In addition, the touch screen dimension is especially appropriate for children as assistive technology has been found to be more motivating that any other types of devices and improves the children’ attention span.

Keywords: literacy, intellectual disabilities, touch screen techonology, literacy skill

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Authors: Eun Jeong Yu, Inn Soo Kang, Tae Ki Yoon, Mi Kyoung Koong

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Advanced female age is associated with higher cycle cancelation rates, lower clinical pregnancy rate, increased miscarriage and aneuploidy rates in IVF (In Vitro Fertilization) cycles. This retrospective cohort study was conducted at a Cha Fertility Center, Seoul Station. All fresh non-donor IVF cycles performed in women aged 40 years and above from January 2016 to December 2016 were reviewed. Donor/recipient treatment, PGD/PGS (Preimplantation Genetic Diagnosis/ Preimplantation Genetic Screening) were excluded from analysis. Of the 1,166 cycles from 753 women who completed ovulation induction, 1,047 were appropriate for the evaluation according to inclusion and exclusion criterion. IVF cycles were categorized according to age and grouped into the following 1-year age groups: 40, 41, 42, 43, 44, 45 and > 46. The mean age of patients was 42.4 ± 1.8 years. The median AMH (Anti-Mullerian Hormone) level was 1.2 ± 1.5 ng/mL. The mean number of retrieved oocytes was 4.9 ± 4.3. The clinical pregnancy rate and live birth rate in women > 40 years significantly decreased with each year of advancing age (p < 0.001). The clinical pregnancy rate decreased from 21% at the age of 40 years to 0% at ages above 45 years. Live birth rate decreased from 12.3% to 0%, respectively. There were no clinical pregnancy outcomes among 95 patients aged above 45 years of age. The overall miscarriage rate was 40.7% (range, 36.7%-70%). The transfer of at least one good quality embryo was associated with about 4-9% increased chance of a clinical pregnancy rate. Therefore, IVF in old age women less than 46 had a reasonable chance for successful pregnancy outcomes especially when good quality embryo is transferred.

Keywords: advanced maternal age, in vitro fertilization, pregnancy rate, live birth rate

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Authors: Evgeniya V. Gavrilova, Sofya S. Belova

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The present study was aimed at clarifying the relationship between general intellectual abilities and efficiency in free recall and rhymed words generation task after incidental exposure to linguistic stimuli. The theoretical frameworks stress that general intellectual abilities are based on intentional mental strategies. In this context, it seems to be crucial to examine the efficiency of incidentally presented information processing in cognitive task and its relation to general intellectual abilities. The sample consisted of 32 Russian students. Participants were exposed to pairs of words. Each pair consisted of two common nouns or two city names. Participants had to decide whether a city name was presented in each pair. Thus words’ semantics was processed intentionally. The city names were considered to be focal stimuli, whereas common nouns were considered to be peripheral stimuli. Along with that each pair of words could be rhymed or not be rhymed, but this phonemic aspect of stimuli’s characteristic (rhymed and non-rhymed words) was processed incidentally. Then participants were asked to produce as many rhymes as they could to new words. The stimuli presented earlier could be used as well. After that, participants had to retrieve all words presented earlier. In the end, verbal and non-verbal abilities were measured with number of special psychometric tests. As for free recall task intentionally processed focal stimuli had an advantage in recall compared to peripheral stimuli. In addition all the rhymed stimuli were recalled more effectively than non-rhymed ones. The inverse effect was found in words generation task where participants tended to use mainly peripheral stimuli compared to focal ones. Furthermore peripheral rhymed stimuli were most popular target category of stimuli that was used in this task. Thus the information that was processed incidentally had a supplemental influence on efficiency of stimuli processing as well in free recall as in word generation task. Different patterns of correlations between intellectual abilities and efficiency in different stimuli processing in both tasks were revealed. Non-verbal reasoning ability correlated positively with free recall of peripheral rhymed stimuli, but it was not related to performance on rhymed words’ generation task. Verbal reasoning ability correlated positively with free recall of focal stimuli. As for rhymed words generation task, verbal intelligence correlated negatively with generation of focal stimuli and correlated positively with generation of all peripheral stimuli. The present findings lead to two key conclusions. First, incidentally processed stimuli had an advantage in free recall and word generation task. Thus incidental information processing appeared to be crucial for subsequent cognitive performance. Secondly, it was demonstrated that incidentally processed stimuli were recalled more frequently by participants with high nonverbal reasoning ability and were more effectively used by participants with high verbal reasoning ability in subsequent cognitive tasks. That implies that general intellectual abilities could benefit from operating by different levels of information processing while cognitive problem solving. This research was supported by the “Grant of President of RF for young PhD scientists” (contract № is 14.Z56.17.2980- MK) and the Grant № 15-36-01348a2 of Russian Foundation for Humanities.

Keywords: focal and peripheral stimuli, general intellectual abilities, incidental information processing

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Authors: Moon Jung Kim, Guil Rhim

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The clinical sensitivity of the “VEUPLEXTM TBI assay”, a clinical trial medical device, in mild traumatic brain injury was 28.6% (95% CI, 19.7%-37.5%), and the clinical specificity was 94.0% (95% CI, 89.3%). -98.7%). In addition, when the results analyzed by marker were put together, the sensitivity was higher when interpreting the two tests together than the two tests, UCHL1 and GFAP alone. Additionally, when sensitivity and specificity were analyzed based on CT results for the mild traumatic brain injury patient group, the clinical sensitivity for 2 CT-positive cases was 50.0% (95% CI: 1.3%-98.7%), and 19 CT-negative cases. The clinical specificity for cases was 68.4% (95% CI: 43.5% - 87.4%). Since the low clinical sensitivity for the two CT-positive cases was not statistically significant due to the small number of samples analyzed, it was judged necessary to secure and analyze more samples in the future. Regarding the clinical specificity analysis results for 19 CT-negative cases, there were a large number of patients who were actually clinically diagnosed with mild traumatic brain injury but actually received a CT-negative result, and about 31.6% of them showed abnormal results on VEUPLEXTM TBI assay. Although traumatic brain injury could not be detected in 31.6% of the CT scans, the possibility of actually suffering a mild brain injury could not be ruled out, so it was judged that this could be confirmed through follow-up observation of the patient. In addition, among patients with mild traumatic brain injury, CT examinations were not performed in many cases because the symptoms were very mild, but among these patients, about 25% or more showed abnormal results in the VEUPLEXTM TBI assay. In fact, no damage is observed with the naked eye immediately after traumatic brain injury, and traumatic brain injury is not observed even on CT. But in some cases, brain hemorrhage may occur (delayed cerebral hemorrhage) after a certain period of time, so the patients who did show abnormal results on VEUPLEXTM TBI assay should be followed up for the delayed cerebral hemorrhage. In conclusion, it was judged that it was difficult to judge mild traumatic brain injury with the VEUPLEXTM TBI assay only through clinical findings without CT results, that is, based on the GCS value. Even in the case of CT, it does not detect all mild traumatic brain injury, so it is difficult to necessarily judge that there is no traumatic brain injury, even if there is no evidence of traumatic brain injury in CT. And in the long term, more patients should be included to evaluate the usefulness of the VEUPLEXTM TBI assay in the detection of microscopic traumatic brain injuries without using CT.

Keywords: brain injury, traumatic brain injury, GFAP, UCHL1

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Authors: Krisztina Bohacs, Klaudia Markus

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To author’s best knowledge we are in absence of studies on cognitive program evaluation and we are certainly short of programs that prove to have high effect sizes with strong retention results. The purpose of our study was to investigate the effectiveness of a comprehensive cognitive training program, namely BrainRx. This cognitive rehabilitation program target and remediate seven core cognitive skills and related systems of sub-skills through repeated engagement in game-like mental procedures delivered one-on-one by a clinician, supplemented by digital training. A larger sample of children with learning disability were given pretest and post-test cognitive assessments. The experimental group completed a twenty-week cognitive training program in a BrainRx center. A matched control group received another twenty-week intervention with Feuerstein’s Instrumental Enrichment programs. A second matched control group did not receive training. As for pre- and post-test, we used a general intelligence test to assess IQ and a computer-based test battery for assessing cognition across the lifespan. Multiple regression analyses indicated that the experimental BrainRx treatment group had statistically significant higher outcomes in attention, working memory, processing speed, logic and reasoning, auditory processing, visual processing and long-term memory compared to the non-treatment control group with very large effect sizes. With the exception of logic and reasoning, the BrainRx treatment group realized significantly greater gains in six of the above given seven cognitive measures compared to the Feuerstein control group. Our one-year retention measures showed that all the cognitive training gains were above ninety percent with the greatest retention skills in visual processing, auditory processing, logic, and reasoning. The BrainRx program may be an effective tool to establish long-term cognitive changes in case of students with learning disabilities. Recommendations are made for treatment centers and special education institutions on the cognitive training of students with special needs. The importance of our study is that targeted, systematic, progressively loaded and intensive brain training approach may significantly change learning disabilities.

Keywords: cognitive rehabilitation training, cognitive skills, learning disability, permanent structural cognitive changes

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