Search results for: Carmel Khrisna Wong Moreno

Authors: Jamil Ahmed, Li P. Wong, Yan P. Chua

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The United Nation's sustainable development goals include the target to ensure access to water and sanitation for all; however, very few studies have assessed school-based drinking water in Pakistan. The purpose of this study was to characterize water quality in primary schools of Pakistan and to characterize how recent WASH interventions were associated with school water quality. We conducted a representative cross-sectional study of primary schools in the Sindh province of Pakistan. We used structured observations and structured interviews to ascertain the school’s WASH conditions. Our primary exposures of interest were the implementation of previous WASH interventions in the school and the water source type. Outcomes of interest included water quality (measured by various chemical and microbiological indicators) and water availability at the school’s primary drinking water source. We used log-binomial regression to characterize how WASH exposures were associated with water quality outcomes. We collected data from 256 schools. Groundwater was the primary drinking water source at most schools (87%). Water testing showed that 14% of the school’s water had arsenic above the WHO recommendations, and over 50% of the water samples exceeded recommendations for both lead and cadmium. A majority of the water sources (52%) had fecal coliform contamination. None of the schools had nitrate contamination (0%), and few had fluoride contamination (5%). Regression results indicated that having a recent WASH intervention at the school was not associated with either arsenic contamination (prevalence ratio=0.97; 95% CI: 0.46-2.1) or with fecal coliform contamination (PR=0.88; 95% CI: 0.67-1.17). Our assessment unveiled several water quality gaps that exist, including high heavy metal and fecal contamination. Our findings will help various stakeholders to take suitable action to improve water quality in Pakistani schools.

Keywords: WASH interventions, water quality, primary school children, heavy metals

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Authors: Siew Ming Thang, Wong Hoo Keat, Chee Hao Sue, Fung Lan Loo, Ahju Rosalind

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There are numerous studies that explored young learners’ literacy skills in Malaysia but none that uses the eye-tracking device to track their cognitive processes when reading picture storybooks. This study used this method to investigate two groups of prereaders’ cognitive processes in four conditions. (1) A congruent picture was presented, and a matching narration was read aloud by a recorder; (2) Children heard a narration telling about the same characters in the picture but involves a different scene; (3) Only a picture with matching text was present; (4) Students only heard the reading aloud of the text on the screen. The two main objectives of this project are to test which content of pictures helps the prereaders (i.e., young children who have not received any formal reading instruction) understand the narration and whether children try to create a coherent mental representation from the oral narration and the pictures. The study compares two groups of children from two different kindergartens. Group1: 15 Chinese children; Group2: 17 Malay children. The medium of instruction was English. An eye-tracker were used to identify Areas of Interest (AOI) of each picture and the five target elements and calculate number of fixations and total time spent on fixation of pictures and written texts. Two mixed factorial ANOVAs with the storytelling performance (good, average, or weak) and vocabulary level (low, medium, high) as between-subject variables, and the Areas of Interests (AOIs) and display conditions as the within-subject variables were performedon the variables.

Keywords: eye-tracking, cognitive processes, literacy skills, prereaders, visual attention

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Authors: Natalia Moreno-Castellanos, Amaia Rodriguez, Gema Frühbeck

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Introduction: In adipocytes, the cytoskeleton undergoes important expression and distribution in adipocytes rearrangements during adipogenesis and in obesity. Indeed, a role for these proteins in the regulation of adipocyte differentiation and response to insulin has been demonstrated. Recently, septins have been considered as new components of the cytoskeletal network that interact with other cytoskeletal elements (actin and tubulin) profoundly modifying their dynamics. However, these proteins have not been characterized as yet in adipose tissue. In this work, were examined the cellular, molecular and functional features of a member of this family, septin 11 (SEPT11), in adipocytes and evaluated the impact of obesity on the expression of this protein in human adipose tissue. Methods: Adipose gene and protein expression levels of SEPT11 were analysed in human samples. SEPT11 distribution was evaluated by immunocytochemistry, electronic microscopy, and subcellular fractionation techniques. GST-pull down, immunoprecipitation and a Yeast-Two Hybrid (Y2H) screening were used to identify the SEPT11 interactome. Gene silencing was employed to assess the role of SEPT11 in the regulation of insulin signaling and lipid metabolism in adipocytes. Results: SEPT11 is expressed in human adipocytes, and its levels increased in both omental and subcutaneous adipose tissue in obesity, with SEPT11 mRNA content positively correlating with parameters of insulin resistance in subcutaneous fat. In non-stimulated adipocytes, SEPT11 immunoreactivity showed a ring-like distribution at the cell surface and associated to caveolae. Biochemical analyses showed that SEPT11 interacted with the main component of caveolae, caveolin-1 (CAV1) as well as with the fatty acid-binding protein, FABP5. Notably, the three proteins redistributed and co-localized at the surface of lipid droplets upon exposure of adipocytes to oleate. In this line, SEPT11 silencing in 3T3-L1 adipocytes impaired insulin signaling and decreased insulin-induced lipogenesis. Conclusions: Those findings demonstrate that SEPT11 is a novel component of the adipocyte cytoskeleton that plays an important role in the regulation of lipid traffic, metabolism and can thus represent a potential biomarker of insulin resistance in obesity in adipocytes through its interaction with both CAV1 and FABP5.

Keywords: caveolae, lipid metabolism, obesity, septins

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Authors: Molly Pui Man Wong

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In this study, a blended and interactive e-learning Courseware that our team developed will be introduced, and our team’s experiences on how the e-learning Courseware and the flipped classroom benefit student learning in bioethics in the medical program will be shared. This study is a continuation of the previously established study, which provides a summary of the well-developed e-learning Courseware in a blended learning approach and an update on its efficiency and efficacy. First, a collection of animated videos capturing selected topics of bioethics and related ethical issues and dilemma will be introduced. Next, a selection of problem-based learning videos (“simulated doctor-patient role play”) with pop-up questions and discussions will be further discussed. Our recent findings demonstrated that these activities launched by the Courseware strongly engaged students in bioethics education and enhanced students’ critical thinking and creativity, which were consistent with the previous data in the preliminary studies. Moreover, the educational benefits of the online art exhibition, art jamming, and competition will be discussed, through which students could express bioethics through arts and enrich their learning in medical research in an interactive, fun, and entertaining way, strengthening their interests in bioethics. Furthermore, online survey questionnaires and focus group interviews were conducted. Consistent with the preliminary studies, our results indicated that implementing the e-learning Courseware with a flipped classroom in bioethics education enhanced both active learning and student engagement. In conclusion, our Courseware not only reinforces education in art, bioethics, and medicine but also benefits students in understanding and critical thinking in socio-ethical issues and serves as a valuable learning tool in bioethics teaching and learning.

Keywords: bioethics, courseware, e-learning, flipped classroom

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Authors: César Ramírez-Dolores, Jorge Wong-Loya, Jorge Andaverde, Caleb Becerra

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Low-depth geothermal energy can take advantage of the use of the subsoil as an air conditioning technique, being used as a passive system or coupled to an active cooling and/or heating system. This source of air conditioning is possible because at a depth less than 10 meters, the subsoil temperature is practically homogeneous and tends to be constant regardless of the climatic conditions on the surface. The effect of temperature fluctuations on the soil surface decreases as depth increases due to the thermal inertia of the soil, causing temperature stability; this effect presents several advantages in the context of sustainable energy use. In the present work, the thermal behavior of a horizontal Air-Water Heat Exchanger (AWHE) is evaluated, and the thermal effectiveness and temperature of the air at the outlet of the prototype immersed in groundwater is experimentally determined. The thermohydraulic aspects of the heat exchanger were evaluated using the Number of Transfer Units-Efficiency (NTU-ε) method under conditions of groundwater flow in a coastal region of sandy soil (southeastern Mexico) and air flow induced by a blower, the system was constructed of polyvinyl chloride (PVC) and sensors were placed in both the exchanger and the water to record temperature changes. The results of this study indicate that when the exchanger operates in groundwater, it shows high thermal gains allowing better heat transfer, therefore, it significantly reduces the air temperature at the outlet of the system, which increases the thermal effectiveness of the system in values > 80%, this passive technique is relevant for building cooling applications and could represent a significant development in terms of thermal comfort for hot locations in emerging economy countries.

Keywords: convection, earth, geothermal energy, thermal comfort

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Authors: Cheng Yang Kwa, Yoke Rung Wong

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Laminated composite materials are widely employed in automotive, aerospace, and other industries. These materials provide distinct benefits due to their high specific strength, high specific modulus, and ability to be customized for a specific function. However, delamination of laminated composite materials is one of the main defects which can occur during manufacturing, regular operations, or maintenance. Delamination can bring about considerable internal damage, unobservable by visual check, that causes significant loss in strength and stability, leading to composite structure catastrophic failure. Structural health monitoring (SHM) is known to be the automated method for monitoring and evaluating the condition of a monitored object. There are several ways to conduct SHM in aerospace. One of the effective methods is to monitor the natural frequency shift of structure due to the presence of defect. This study investigated the mechanical resonance frequency shift of a multi-layer composite cantilever beam due to interlaminar delamination. ANSYS Workbench® was used to create a 4-plies laminated composite cantilever finite element model with [90/0]s fiber setting. Epoxy Carbon UD (230GPA) Prepreg was chosen, and the thickness was 2.5mm for each ply. The natural frequencies of the finite element model with various degree of delamination were simulated based on modal analysis and then validated by using literature. It was shown that the model without delamination had natural frequency of 40.412 Hz, which was 1.55% different from the calculated result (41.050 Hz). Thereafter, the various degree of delamination was mimicked by changing the frictional conditions at the middle ply-to-ply interface. The results suggested that delamination in the laminated composite cantilever induced a change in its stiffness which alters its mechanical resonance frequency.

Keywords: structural health monitoring, NDT, cantilever, laminate

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Authors: Hebe Wong, Luz Fernandez Calventos

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Tandem language learning, a language exchange process based on the principles of autonomy and reciprocity, provides opportunities for interlocutors to learn each other’s language by communicating online or face-to-face. While much attention has been paid to the process and outcomes of tandem learning via email, little has been discussed about the effectiveness of face-to-face tandem learning on language and culture exchange for university students. The LACTS (Language and Culture Tandem Scheme), an 8-week project, was set up to study students’ perceptions of conducting tandem learning to assist their language and culture exchange. Students of both post-graduate and undergraduate programmes (N=103) from a Hong Kong SAR university were put in groups of 4 to 6 according to their availability and language preferences and met for an hour a week. While sample task sheets on a range of topics were provided to assist the language exchange, all groups were encouraged to take charge of their meeting format and choose their own topics. At the end of the project, a 19-item questionnaire, which included both open-and closed-ended questions investigating students’ perceptions of reciprocal teaching and cultural exchange, was administered. Thirty-minute individual interviews were conducted to elicit students’ views and experiences in the LACTS activities. Quantitative and qualitative data analysis showed that most students agreed that the project had enhanced their cultural awareness and helped create an inclusive and participatory learning environment. Significant differences were found in students’ confidence in speaking their targeted language after joining the scheme. The interviews also provided rich data on the variety of formats and leadership patterns in student-led meetings, which could shed light on student autonomy and future tandem language learning projects.

Keywords: autonomy, reciprocity, tandem language learning, university students

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Authors: Gema Gómez-Casado, Alba Rodríguez-Muñoz, Virginia Mela-Rivas, Pallavi Kompella, Francisco José Tinahones-Madueña, Isabel Moreno-Indias, Almudena Ortega-Gómez

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Obesity is a high-priority health problem worldwide due to its high prevalence. The proportion of obese and overweight subjects in industrialized countries exceeds half of the population in most cases. Beyond the metabolic problem, obesity boosts inflammation levels in the organism. The gut microbiota, considered an organ by itself, controls a high variety of processes at a systemic level. In fact, the microbiota interacts closely with the immune system, being crucial in determining the maturation state of neutrophils, key effectors of the innate immune response. It is known that changes in the diet exert strong effects on the variety and activity of the gut microbiota. The effect that those changes have on the axis microbiota-immune response is an unexplored field. In this study, 10 patients with obesity (weight 114,3 ± 14,5Kg, BMI 40,47±3,66) followed a Mediterranean-hypocaloric diet for 3 months, reducing their initial weight by 12,71 ± 3%. A transplant of microbiota from these patients before and after the diet was performed into wild type “germ-free” mice (n=10/group), treated with antibiotics. Six weeks after the transplant, mice were euthanized, and the presence of cells from the innate immune system were analysed in different organs (bone marrow, blood, spleen, visceral adipose tissue, and intestine) by flow cytometry. No differences were observed in the number of myeloid cells in bone marrow, blood, spleen, or visceral adipose tissue of mice transplanted with patient’s microbiota before and after following the Mediterranean diet. However, the intestine of mice that received post-diet microbiota presented a marked decrease in the number of neutrophils (whose presence is associated with tissue inflammation), as well as macrophages. In line with these findings, intestine monocytes from mice with post-diet microbiota showed a less inflammatory profile (lower Ly6Gˡᵒʷ proportion of cells). These results point toward a decrease in the inflammatory state of the intestinal tissue, derived from changes in the gut microbiota, which occurred after a 3-month Mediterranean diet.

Keywords: obesity, nutrition, Mediterranean diet, gut microbiota, immune system

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Authors: Manjula Weerasekera, Chris Sissons, Lisa Wong, Sally Anderson, Ann Holmes, Richard Cannon

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The aim of this study was to characterize bacterial population and yeasts in saliva by Polymerase chain reaction followed by denaturing gradient gel electrophoresis (PCR-DGGE) and measure yeast levels by culture. PCR-DGGE was performed to identify oral bacteria and yeasts in 24 saliva samples. DNA was extracted and used to generate DNA amplicons of the V2–V3 hypervariable region of the bacterial 16S rDNA gene using PCR. Further universal primers targeting the large subunit rDNA gene (25S-28S) of fungi were used to amplify yeasts present in human saliva. Resulting PCR products were subjected to denaturing gradient gel electrophoresis using Universal mutation detection system. DGGE bands were extracted and sequenced using Sanger method. A potential relationship was evaluated between groups of bacteria identified by cluster analysis of DGGE fingerprints with the yeast levels and with their diversity. Significant interpersonal variation of salivary microbiome was observed. Cluster and principal component analysis of the bacterial DGGE patterns yielded three significant major clusters, and outliers. Seventeen of the 24 (71%) saliva samples were yeast positive going up to 10³ cfu/mL. Predominately, C. albicans, and six other species of yeast were detected. The presence, amount and species of yeast showed no clear relationship to the bacterial clusters. Microbial community in saliva showed a significant variation between individuals. A lack of association between yeasts and the bacterial fingerprints in saliva suggests the significant ecological person-specific independence in highly complex oral biofilm systems under normal oral conditions.

Keywords: bacteria, denaturing gradient gel electrophoresis, oral biofilm, yeasts

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Authors: Aida Raissi, Holly Wong, Elma Raissi

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Background: Connection is a primal need established during infancy and reiterated in many forms of social interaction. When we make connections with others we experience growth, continuity, and gain an understanding of the other’s sense of the world. Feeling socially connected to another individual or community has been shown to increase self-esteem, happiness, and meaning. However, feeling connected to another individual or a specific community may also decrease the motivation to seek connection with more distant individuals or communities. Furthermore, we allow ourselves to interact with those in other communities as apart from us, and in some cases, to dehumanize their existence. Objective: The aim of this project is to bridge the gap between different communities, specifically religious communities and foster feelings of connection as one with all members through the medium of art, specifically photography. Method: Members of all major faiths including Agnosticism, Atheism, Buddhism, Catholicism, Christianity, Ismaili, Jewish, Ja’far Shia, Sunni will be interviewed. Participants will be asked to partake in a brief interview of two parts: A. Answering two questions: 1. What are you most looking forward to in the future, and why? 2. What does religion mean to you? B. Having their picture taken. Our questions aim to elicit individual stories that together, show that we have more in common, than differences, despite our faiths. With the completion of the interviews, the responses will be compiled together and major themes will be identified. Impact: The resulting stories and corresponding individual pictures provide an excellent opportunity to encourage and inspire people to get to know those of other beliefs and values, participate in each other’s communities and develop a sense of oneness within our shared humanity. Knowledge translation: The personal stories, and the common themes they illustrate, will be shared with various audiences, including the general public, academia and targeted groups such as students. This will be done through displaying the photographs and responses at art galleries, conferences, in print and online.

Keywords: social justice, religion, connection, understanding, community

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Authors: Ke Guek Nee, Wong Siew Fan, Nigel V. Marsh

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Excessive use of the Internet has become a cause for concern in many countries, including Malaysia. Such behaviour is reported to be more prevalent amongst young adults who are reported to be spending large amount of time on the Internet. The present study has three objectives. First one is designing a manual-based Cognitive Behavioural Therapy (CBT) programme to reduce problematic Internet use among young adults in Malaysia. Second one is examining the effectiveness of a manual-based CBT programme at the pilot study stage. Thirdly, the programme focuses on reducing the level of stress and anxiety in problematic Internet users. We adopted CBT with single subject experimental design method. A total of six participants completed the entire program. They were asked to report their daily Internet use and software was installed on their devices to record actual use. The data collection involved three time frame measurements: T1 (baseline), T2 (immediately during the last session of the intervention sessions), and T3 (follow-up). Three scales were used to measure the effectiveness of the program: Depression, Anxiety, Stress Scales (DASS), Social Interaction Anxiety Scale (SIAS), and Problematic Internet Use Questionnaire (PIUQ). The results revealed that the intervention programme has significantly improved two dimensions of problematic Internet use which were obsession and control disorder. The participants’ mental health also showed a deduction in means scores for depression, anxiety and stress with depression showing the greatest improvement after the intervention programme. The participants’ social anxiety showed a slight deduction in means scores. We concluded that the intervention programme designed was effective. However, its limitations need to be addressed in future research.

Keywords: excessive internet use, cognitive behavioral thearapy (CBT), psychological well-being, young adults

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Authors: Aurea C. L. Lacerda, Paulo R. H. Moreno, Bruna M. P. Vianna, Cristina H. R. Serra, Airton Martin, André R. Baby, Vladi O. Consiglieri, Telma M. Kaneko

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The modified Franz cell is the most widely used model for in vitro permeation studies, however it still presents some disadvantages. Thus, some alternative methods have been developed such as Skin PAMPA, which is a bio- artificial membrane that has been applied for skin penetration estimation of xenobiotics based on HT permeability model consisting. Skin PAMPA greatest advantage is to carry out more tests, in a fast and inexpensive way. The membrane system mimics the stratum corneum characteristics, which is the primary skin barrier. The barrier properties are given by corneocytes embedded in a multilamellar lipid matrix. This layer is the main penetration route through the paracellular permeation pathway and it consists of a mixture of cholesterol, ceramides, and fatty acids as the dominant components. However, there is no consensus on the membrane composition. The objective of this work was to compare the performance among different bio-artificial membranes for studying the permeation in skin PAMPA system. Material and methods: In order to mimetize the lipid composition`s present in the human stratum corneum six membranes were developed. The membrane composition was equimolar mixture of cholesterol, ceramides 1-O-C18:1, C22, and C20, plus fatty acids C20 and C24. The membrane integrity assay was based on the transport of Brilliant Cresyl Blue, which has a low permeability; and Lucifer Yellow with very poor permeability and should effectively be completely rejected. The membrane characterization was performed using Confocal Laser Raman Spectroscopy, using stabilized laser at 785 nm with 10 second integration time and 2 accumulations. The membrane behaviour results on the PAMPA system were statistically evaluated and all of the compositions have shown integrity and permeability. The confocal Raman spectra were obtained in the region of 800-1200 cm-1 that is associated with the C-C stretches of the carbon scaffold from the stratum corneum lipids showed similar pattern for all the membranes. The ceramides, long chain fatty acids and cholesterol in equimolar ratio permitted to obtain lipid mixtures with self-organization capability, similar to that occurring into the stratum corneum. Conclusion: The artificial biological membranes studied for Skin PAMPA showed to be similar and with comparable properties to the stratum corneum.

Keywords: bio-artificial membranes, comparison, confocal Raman, skin PAMPA

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Authors: Felipe Riveros, Ricardo Alvarez, Claudia Rahmann, Rodrigo Moreno

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Around the world, many countries have committed to a decarbonization of their electricity system. Under this global drive, converter-interfaced generators (CIG) such as wind and photovoltaic generation appear as cornerstones to achieve these energy targets. Despite its benefits, an increasing use of CIG brings several technical challenges in power systems, especially from a stability viewpoint. Among the key differences are limited short circuit current capacity, inertia-less characteristic of CIG, and response times within the electromagnetic timescale. Along with the integration of CIG into the power system, one enabling technology for the energy transition towards low-carbon power systems is battery energy storage systems (BESS). Because of the flexibility that BESS provides in power system operation, its integration allows for mitigating the variability and uncertainty of renewable energies, thus optimizing the use of existing assets and reducing operational costs. Another characteristic of BESS is that they can also support power system stability by injecting reactive power during the fault, providing short circuit currents, and delivering fast frequency response. However, most methodologies for sizing and allocating BESS in power systems are based on economic aspects and do not exploit the benefits that BESSs can offer to system stability. In this context, this paper presents a methodology for determining the optimal allocation of battery energy storage systems (BESS) in weak power systems with high levels of CIG. Unlike traditional economic approaches, this methodology incorporates stability constraints to allocate BESS, aiming to mitigate instability issues arising from weak grid conditions with low short-circuit levels. The proposed methodology offers valuable insights for power system engineers and planners seeking to maintain grid stability while harnessing the benefits of renewable energy integration. The methodology is validated in the reduced Chilean electrical system. The results show that integrating BESS into a power system with high levels of CIG with stability criteria contributes to decarbonizing and strengthening the network in a cost-effective way while sustaining system stability. This paper potentially lays the foundation for understanding the benefits of integrating BESS in electrical power systems and coordinating their placements in future converter-dominated power systems.

Keywords: battery energy storage, power system stability, system strength, weak power system

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Authors: Antonio Casero Martínez, María de Lluch Rayo Llinas

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This work is part of an investigation into the relationship between romantic love and self-esteem in college students, performed by the students of matter "methods and techniques of social research", of the Master Gender at the University of Balearic Islands, during 2014-2015. In particular, we have investigated the relationships that may exist between self-esteem, gender and field of study. They are known as gender differences in self-esteem, and the relationship between gender and branch of study observed annually by the distribution of enrolment in universities. Therefore, in this part of the study, we focused the spotlight on the differences in self-esteem between the sexes through the various branches of study. The study sample consists of 726 individuals (304 men and 422 women) from 30 undergraduate degrees that the University of the Balearic Islands offers on its campus in 2014-2015, academic year. The average age of men was 21.9 years and 21.7 years for women. The sampling procedure used was random sampling stratified by degree, simple affixation, giving a sampling error of 3.6% for the whole sample, with a confidence level of 95% under the most unfavorable situation (p = q). The Spanish translation of the Rosenberg Self-Esteen Scale (RSE), by Atienza, Moreno and Balaguer was applied. The psychometric properties of translation reach a test-retest reliability of 0.80 and an internal consistency between 0.76 and 0.87. In this paper we have obtained an internal consistency of 0.82. The results confirm the expected differences in self-esteem by gender, although not in all branches of study. Mean levels of self-esteem in women are lower in all branches of study, reaching statistical significance in the field of Science, Social Sciences and Law, and Engineering and Architecture. However, analysed the variability of self-esteem by the branch of study within each gender, the results show independence in the case of men, whereas in the case of women find statistically significant differences, arising from lower self-esteem of Arts and Humanities students vs. the Social and legal Sciences students. These findings confirm the results of numerous investigations in which the levels of female self-esteem appears always below the male, suggesting that perhaps we should consider separately the two populations rather than continually emphasize the difference. The branch of study, for its part has not appeared as an explanatory factor of relevance, beyond detected the largest absolute difference between gender in the technical branch, one in which women are historically a minority, ergo, are no disciplinary or academic characteristics which would explain the differences, but the differentiated social context that occurs within it.

Keywords: study branch, gender, self-esteem, applied psychology

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Authors: Malihe Moeinin, Robert Hill, Ferranti Wong

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Background: A white spot lesion (WSL) is defined as subsurface enamel porosity from carious demineralisation on the smooth surfaces of the tooth. It appears as a milky white opacity. Lesions shown an apparently intact surface layer, followed underneath by the more porous lesion body. The small pores within the body of the lesion act as diffusion pathway for both acids and minerals, so allowing the demineralisation of enamel to occur at the advancing front of the lesion. Objectives: The objective is to mapthe porosity and its size on WSL with Focused Ion Bean- Scanning Electron Microscopy (FIB-SEM) Method: The basic method used for FIB-SEM consisted of depositing a one micron thick layer of platinum over 25μmx 25μm of the interest region of enamel. Then, making a rough cut (25μmx 5μmx 20μm) with 3nA current and 30Kv was applied with the help of drift suppression (DS), using a standard “cross-sectional” cutting pattern, which ended at the front of the deposited platinum layer. Two adjacent areas (25μmx 5μmx 20μm) on the both sides of the platinum layer were milled under the same conditions. Subsequent, cleaning cross-sections were applied to polish the sub-surface edge of interest running perpendicular to the surface. The "slice and view" was carried out overnight for milling almost 700 slices with 2Kv and 4nA and taking backscattered (BS) images. Then, images were imported into imageJ and analysed. Results: The prism structure is clearly apparent on FIB-SEM slices of WSL with the dissolution of prism boundaries as well as internal porosity within the prism itself. Porosity scales roughly 100-400nm, which is comparable to the light wavelength (500nm). Conclusion: FIB-SEM is useful to characterize the porosity of WSL and it clearly shows the difference between WSL and normal enamel.

Keywords: white spot lesion, FIB-SEM, enamel porosity, porosity

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Authors: Muqadis Shazia Rajpar, Lawrence Mitelberg, Rubaiat S. Ahmed, Jemer Garrido, Rukhsana Hossain, Sergey M. Motov

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Distraction techniques have been used as a means to reduce pain, anxiety, and stress in various healthcare settings to facilitate care and make visits less unpleasant. Using virtual reality (VR) in the pediatric emergency setting can be a valuable, effective, and safe non-pharmacological alternative to the current standard of care for pain and anxiety management in pediatric patients. Our pilot study aimed to evaluate the effectiveness of a VR-based intervention as an alternative distraction modality to alleviate pain and anxiety associated with pediatric emergency department (ED) visits and acute pain conditions. The pilot study period was from November 16 to December 9, 2022, for pediatric ED visits for pain, anxiety, or both. Patients were selected based on a novel VR protocol to receive the VR intervention with the administration of pre and post-intervention surveys concerning pain/anxiety ratings and pain scores (Wong-Baker FACES/NRS). Descriptive statistics, paired t-test, and a Fisher Exact Test were used for data analysis, assuming a p-value of 0.05 for significance. A total of 33 patients (21 females, 12 males), ages 5-20 (M = 10.5, SD = 3.43) participated in this study – 12 patients had pain, 2 patients had anxiety, and 19 patients had both pain and anxiety. There was a statistically significant decrease in post-intervention pain scores of less than one point on the rating scale (6.48 vs. 5.62, p < .001). There was a statistically significant reduction in the percentage of patients suffering from “considerable” or “great” pain after the VR intervention (51.6% to 42.3%, p < .001). Similarly, we noticed an increase in the number of patients with “slight” or “moderate” pain post–VR intervention (48.4% to 57.7%, p < .001). Lastly, we demonstrated a decrease in anxiety among patients after utilizing VR (63.6% vs. 36.4%, p < .001). To conclude, VR can alleviate pain and anxiety in pediatric patients and be a useful non-pharmacological tool in the emergency setting.

Keywords: anxiety, emergency room, pain management, pediatric emergency medicine, virtual reality

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Authors: Lai Gwen Chan, Yining Ong, Audrey Yoke Poh Wong

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Background. The efficacy of electroconvulsive therapy (ECT) as a form of treatment to a range of mental disorders is well-established. However, ECT is often associated with either temporary or persistent cognitive side-effects, resulting in the failure of wider prescription. Of which, retrograde amnesia is the most commonly reported cognitive side-effect. Most studies found a recalling deficit in autobiographical memories to be short-term, although a few have reported more persistent amnesic effects. Little is known about ECT-related amnesic effects in Asian population. Hence, this study aims to resolve conflicting findings, as well as to better elucidate the effects of ECT on cognitive functioning in a local sample. Method: 12 patients underwent bilateral ECT under the care of Psychological Medicine Department, Tan Tock Seng Hospital, Singapore. Participants’ cognition and level of functioning were assessed at four time-points: before ECT, between the third and fourth induced seizure, at the end of the whole course of ECT, and two months after the index course of ECT. Results: It was found that Global Assessment of Functioning scores increased significantly at the completion of ECT. Case-by-case analyses also revealed an overall improvement in Personal Semantic and Autobiographical memory two months after the index course of ECT. A transient dip in both personal semantic and autobiographical memory scores was observed in one participant between the third and fourth induced seizure, but subsequently resolved and showed better performance than at baseline. Conclusions: The findings of this study suggest that ECT is an effective form of treatment to alleviate the severity of symptoms of the diagnosis. ECT does not affect attention, language, executive functioning, personal semantic and autobiographical memory adversely. The findings suggest that Asian patients may respond to bilateral ECT differently from Western samples.

Keywords: electroconvulsive therapy (ECT), autobiographical memory, cognitive impairment, psychiatric disorder

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Authors: Alberto Abello Moreno-Cid

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Mummification was the process through which immortality was granted to the deceased, so it was of extreme importance to the Egyptians. The techniques of embalming had evolved over the centuries, and specialists created increasingly sophisticated tools. However, due to its eminently religious nature, knowledge about everything related to this practice was jealously preserved, and the testimonies that have survived to our time are scarce. For this reason, embalming instruments found in archaeological excavations are uncommon. The tomb of the Vizier Amenhotep Huy (AT No. -28-), located in the el-Assasif necropolis that is being excavated since 2009 by the team of the Institute of Ancient Egyptian Studies, has been the scene of some discoveries of this type that evidences the existence of mummification practices in this place after the New Kingdom. The clysters or enemas are the fundamental tools in the second type of mummification described by the historian Herodotus to introduce caustic solutions inside the body of the deceased. Nevertheless, such objects only have been found in three locations: the tomb of Ankh-Hor in Luxor, where a copper enema belonged to the prophet of Ammon Uah-ib-Ra came to light; the excavation of the tomb of Menekh-ib-Nekau in Abusir, where was also found one made of copper; and the excavations in the Bucheum, where two more artifacts were discovered, also made of copper but in different shapes and sizes. Both of them were used for the mummification of sacred animals and this is the reason they vary significantly. Therefore, the object found in the tomb No. -28-, is the first known made of faience of all these peculiar tools and the oldest known until now, dated in the Third Intermediate Period (circa 1070-650 B.C.). This paper bases its investigation on the study of those parallelisms, the material, the current archaeological context and the full analysis and reconstruction of the object in question. The key point is the use of faience in the production of this item: creating a device intended to be in constant use seems to be a first illogical compared to other samples made of copper. Faience around the area of Deir el-Bahari had a strong religious component, associated with solar myths and principles of the resurrection, connected to the Osirian that characterises the mummification procedure. The study allows to refute some of the premises which are held unalterable in Egyptology, verifying the utilization of these sort of pieces, understanding its way of use and showing that this type of mummification was also applied to the highest social stratum, in which case the tools were thought out of an exceptional quality and religious symbolism.

Keywords: clyster, el-Assasif, embalming, faience enema mummification, Theban necropolis

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Authors: Kimberly Tasha Jiayi Tang, Changqing Lin, Zhe Wang, Tze-Wai Wong, Md. Shakhaoat Hossain, Jian Yu, Alexis Lau

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Hong Kong has practiced a risk-based Air Quality Health Index (AQHI) system that sums hospitalization risks associated with short-term exposure to air pollu-tants. As an air pollution risk communication tool, it informs the public about the current air quality, anchoring around the World Health Organization's (WHO) 2005 Air Quality Guidelines (AQGs). Given the WHO's recent update in 2021, assessing how Hong Kong’s air quality risk communication can be en-hanced using these updated guidelines is essential. Hong Kong’s AQHI is lim-ited by solely focusing on short-term health risks, which could lead the public to underestimate cumulative health impacts. Therefore, we propose the intro-duction of a composite AQHI that reports both long-term and short-term health risks. Additionally, the WHO interim targets will be considered as anchor points for various health risk categories. Furthermore, with the increasing ozone levels in Hong Kong and Southern China due to improved NOx mitigation measures, it has been a challenging task in balancing health protection against climate mitigation. However, our findings present a promising outlook. Despite the rise in ozone levels, the combined health risks in Hong Kong and Guang-dong have seen a decline, largely due to reductions in NO2 and PM concentra-tions, both having significant health implications. By shifting from a concentra-tion-based approach to a health risk-based system like the AQHI, our study highlights the prospective of harmonizing health protection and climate mitiga-tion goals. This health-focused framework suggests that rigorous NOx controls can effective-ly serve both objectives in parallel.

Keywords: air quality management, air quality health index, health risk management, air pollution

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Authors: Jeff Chak-Fu Wong, Tony Chun Yin Yip

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The transition from secondary school to university seems exciting for many first-year students but can be more challenging than expected. Enabling instructors to know students’ learning habits and styles enhances their understanding of the students’ learning backgrounds, allows teachers to provide better support for their students, and has therefore high potential to improve teaching quality and learning, especially in any mathematics-related courses. The aim of this research is to collect students’ data using online surveys, to analyze students’ factors using learning analytics and educational data mining and to discover the characteristics of the students at risk of falling behind in their studies based on students’ previous academic backgrounds and collected data. In this paper, we use correlation-based distance methods and mutual information for measuring student factor relationships. We then develop a factor network using the Minimum Spanning Tree method and consider further study for analyzing the topological properties of these networks using social network analysis tools. Under the framework of mutual information, two graph-based feature filtering methods, i.e., unsupervised and supervised infinite feature selection algorithms, are used to analyze the results for students’ data to rank and select the appropriate subsets of features and yield effective results in identifying the factors affecting students at risk of failing. This discovered knowledge may help students as well as instructors enhance educational quality by finding out possible under-performers at the beginning of the first semester and applying more special attention to them in order to help in their learning process and improve their learning outcomes.

Keywords: students' academic performance, correlation-based distance method, social network analysis, feature selection, graph-based feature filtering method

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Authors: José Ramón López-Mínguez, Estrella Suárez-Corchuelo, Sergio López-Tejero, Luis Nombela-Franco, Xavier Freixa-Rofastes, Guillermo Bastos-Fernández, Xavier Millán-Álvarez, Raúl Moreno-Gómez, José Antonio Fernández-Díaz, Ignacio Amat-Santos, Tomás Benito-González, Fernando Alfonso-Manterola, Pablo Salinas-Sanguino, Pedro Cepas-Guillén, Dabit Arzamendi, Ignacio Cruz-González, Juan Manuel Nogales-Asensio

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Background and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P = .008) and 6.37% vs 1.91% (HR, 3.34; P = .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group.

Keywords: stents, atrial fibrillation, anticoagulants, left atrial appendage occlusion

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Authors: A. Benedetto, P. Wong, N. Papouchis, L. W. Samstag

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Bowen’s concept of self-differentiation describes a healthy balance of autonomy and intimacy in close relationships, and it has been widely researched in the context of family dynamics. The current study aimed to clarify the impact of family dysfunction on self-differentiation by specifically examining conflict between parents, and by including young adults, an underexamined age group in this domain (N = 300; ages 18 to 30). It also identified a protective factor for offspring from conflictual homes. The 300 young adults (recruited online through Mechanical Turk) completed the Differentiation of Self Inventory (DSI), the Children’s Perception of Interparental Conflict Scale (CPIC), the Parental Bonding Instrument (PBI), and the Symptom Checklist-90-Revised (SCL-90-R). Analyses revealed that interparental conflict significantly impairs self-differentiation among young adult offspring. Specifically, exposure to parental conflict showed a negative impact on young adults’ sense of self, emotional reactivity, and interpersonal cutoff in the context of close relationships. Parental conflict was also related to increased psychological distress among offspring. Surprisingly, the study found that parental divorce does not impair self-differentiation in offspring, demonstrating the distinctly harmful impact of conflict. These results clarify a unique type of family dysfunction that impairs self-differentiation, specifically in distinguishing it from parental divorce; it examines young adults, a critical age group not previously examined in this domain; and it identifies a moderating protective factor (a strong parent-child bond) for offspring exposed to conflict. Overall, results suggest the need for modifications in parental behavior in order to protect offspring at risk of lasting emotional and interpersonal damage.

Keywords: divorce, family dysfunction, parental conflict, parent-child bond, relationships, self-differentiation, young adults

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Authors: Paul Lam, Kevin Wong, Chi Him Chan

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Constant practicing and accurate, immediate feedback are the keys to improving students’ speaking skills. However, traditional oral examination often fails to provide such opportunities to students. The traditional, face-to-face oral assessment is often time consuming – attending the oral needs of one student often leads to the negligence of others. Hence, teachers can only provide limited opportunities and feedback to students. Moreover, students’ incentive to practice is also reduced by their anxiety and shyness in speaking the new language. A mobile app was developed to use artificial intelligence (AI) to provide immediate feedback to students’ speaking performance as an attempt to solve the above-mentioned problems. Firstly, it was thought that online exercises would greatly increase the learning opportunities of students as they can now practice more without the needs of teachers’ presence. Secondly, the automatic feedback provided by the AI would enhance students’ motivation to practice as there is an instant evaluation of their performance. Lastly, students should feel less anxious and shy compared to directly practicing oral in front of teachers. Technically, the program made use of speech-to-text functions to generate feedback to students. To be specific, the software analyzes students’ oral input through certain speech-to-text AI engine and then cleans up the results further to the point that can be compared with the targeted text. The mobile app has invited English teachers for the pilot use and asked for their feedback. Preliminary trials indicated that the approach has limitations. Many of the users’ pronunciation were automatically corrected by the speech recognition function as wise guessing is already integrated into many of such systems. Nevertheless, teachers have confidence that the app can be further improved for accuracy. It has the potential to significantly improve oral drilling by giving students more chances to practice. Moreover, they believe that the success of this mobile app confirms the potential to extend the AI-assisted assessment to other language skills, such as writing, reading, and listening.

Keywords: artificial Intelligence, mobile learning, oral assessment, oral practice, speech-to-text function

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Authors: Kwok W. Mui, Ling T. Wong, Tsz W. Tsang

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Many Hong Kong people nowadays spend most of their lifetime working indoor. Since poor Indoor Air Quality (IAQ) potentially leads to discomfort, ill health, low productivity and even absenteeism in workplaces, a call for establishing statutory IAQ control to safeguard the well-being of residents is urgently required. Although policies, strategies, and guidelines for workplace IAQ diagnosis have been developed elsewhere and followed with remedial works, some of those workplaces or buildings have relatively late stage of the IAQ problems when the investigation or remedial work started. Screening for IAQ problems should be initiated as it will provide information as a minimum provision of IAQ baseline requisite to the resolution of the problems. It is not practical to sample all air pollutants that exit. Nevertheless, as a statutory control, reliable, rapid screening is essential in accordance with a compromise strategy, which balances costs against detection of key pollutants. This study investigates the feasibility of using an IAQ index as a parameter of IAQ control in Hong Kong. The index is a screening parameter to identify the unsatisfactory workplace IAQ and will highlight where a fully effective IAQ monitoring and assessment is needed for an intensive diagnosis. There already exist a number of representative common indoor pollutants based on some extensive IAQ assessments. The selection of pollutants is surrogate to IAQ control consists of dilution, mitigation, and emission control. The IAQ Index and assessment will look at high fractional quantities of these common measurement parameters. With the support of the existing comprehensive regional IAQ database and the IAQ Index by the research team as the pre-assessment probability, and the unsatisfactory IAQ prevalence as the post-assessment probability from this study, thresholds of maintaining the current measures and performing a further IAQ test or IAQ remedial measures will be proposed. With justified resources, the proposed IAQ Index and assessment protocol might be a useful tool for setting up a practical public IAQ surveillance programme and policy in Hong Kong.

Keywords: assessment, index, indoor air quality, surveillance programme

Procedia PDF Downloads 267

Authors: Naomi Huang Wenya, Xin Xiaohui, Vijaya Rao, Wong Ting Hway, Chow Kah Hoe Pierce, Tan Hiang Khoon

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Background: The majority of the cancelled elective surgeries caused by the COVID-19 pandemic globally were estimated to occur in low- and middle-income countries (LMICs), where surgical services had long been in short supply even before the pandemic. Therefore, minimising disruption to existing surgical care in LMICs is of crucial importance during a pandemic. This study aimed to explore contributory factors to the continuity of surgical care in LMICs, in the face of a pandemic. Methods: Semi-structured interviews were conducted over zoom, with surgical leaders of 25 tertiary hospitals from 11 LMICs in South and Southeast Asia, from September to October 2020. Key themes were subsequently identified from the interview transcripts, using Braun and Clarke's method of thematic analysis. Results: The COVID-19 pandemic affected all surgical services of participating institutions but to varying degrees. Overall, elective surgeries suffered the gravest disruption, followed by outpatient surgical care, and finally, emergency surgeries. Keeping healthcare workers safe and striving for continuity of essential surgical care emerged as notable response strategies observed across all participating institutions. Conclusion: This study suggested that four factors are important for the resilience of surgical care against COVID-19: adequate COVID-19 testing capacity and effective institutional infection control measures, designated COVID-19 treatment facilities, a whole-system approach to balancing pandemic response and meeting essential surgical needs, and active community engagement. These findings can inform healthcare institutions in other countries, especially LMICs, in their effort to tread a fine line between preserving healthcare capacity for pandemic response and protecting surgical services against pandemic disruption.

Keywords: COVID-19, pandemic, LMICs, continuity of surgical service

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Authors: Tais Basaco, Stefanie Pektor, Josue A. Moreno, Matthias Miederer, Andreas Türler

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Radiopharmaceuticals based in monoclonal anti-body (mAb) via chemical linkers have become a potential tool in nuclear medicine because of their specificity and the large variability and availability of therapeutic radiometals. It is important to identify the conjugation sites and number of attached chelator to mAb to obtain radioimmunoconjugates with required immunoreactivity and radiostability. Girentuximab antibody (G250) is a potential candidate for radioimmunotherapy of clear cell carcinomas (RCCs) because it is reactive with CAIX antigen, a transmembrane glycoprotein overexpressed on the cell surface of most ( > 90%) (RCCs). G250 was conjugated with the bifunctional chelating agent DOTA (1,4,7,10-Tetraazacyclododecane-N,N’,N’’,N’’’-tetraacetic acid) via a benzyl-thiocyano group as a linker (p-SCN-Bn-DOTA). DOTA-G250 conjugates were analyzed by size exclusion chromatography (SE-HPLC) and by electrophoresis (SDS-PAGE). The potential site-specific conjugation was identified by liquid chromatography–mass spectrometry (LC/MS-MS) and the number of linkers per molecule of mAb was calculated using the molecular weight (MW) measured by matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The average number obtained in the conjugates in non-reduced conditions was between 8-10 molecules of DOTA per molecule of mAb. The average number obtained in the conjugates in reduced conditions was between 1-2 and 3-4 molecules of DOTA per molecule of mAb in the light chain (LC) and heavy chain (HC) respectively. Potential DOTA modification sites of the chelator were identified in lysine residues. The biological activity of the conjugates was evaluated by flow cytometry (FACS) using CAIX negative (SKRC-18) and CAIX positive (SKRC-52). The DOTA-G250 conjugates were labelled with 177Lu with a radiochemical yield > 95% reaching specific activities of 12 MBq/µg. The stability in vitro of different types of radioconstructs was analyzed in human serum albumin (HSA). The radiostability of 177Lu-DOTA-G250 at high specific activity was increased by addition of sodium ascorbate after the labelling. The immunoreactivity was evaluated in vitro and in vivo. Binding to CAIX positive cells (SK-RC-52) at different specific activities was higher for conjugates with less DOTA content. Protein dose was optimized in mice with subcutaneously growing SK-RC-52 tumors using different amounts of 177Lu- DOTA-G250.

Keywords: mass spectrometry, monoclonal antibody, radiopharmaceuticals, radioimmunotheray, renal cancer

Procedia PDF Downloads 307

Authors: Liliana Villavicencio, Yohn Garcia, Pallavi Singh, Luis Fernando Cruz, Wilfrido Moreno

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Psychophysiological adaptive automation is a concept that combines human physiological data and computer algorithms to create personalized interfaces and experiences for users. This approach aims to enhance human learning by adapting to individual needs and preferences and optimizing the interaction between humans and machines. According to neurosciences, the working memory demand during the student learning process is modified when the student is learning a new subject or topic, managing and/or fulfilling a specific task goal. A sudden increase in working memory demand modifies the level of students’ attention, engagement, and cognitive load. The proposed psychophysiological adaptive automation system will adapt the task requirements to optimize cognitive load, the process output variable, by monitoring the student's brain activity. Cognitive load changes according to the student’s previous knowledge, the type of task, the difficulty level of the task, and the overall psychophysiological state of the student. Scaling the measured cognitive load as low, medium, or high; the system will assign a task difficulty level to the next task according to the ratio between the previous-task difficulty level and student stress. For instance, if a student becomes stressed or overwhelmed during a particular task, the system detects this through signal measurements such as brain waves, heart rate variability, or any other psychophysiological variables analyzed to adjust the task difficulty level. The control of engagement and stress are considered internal variables for the hypermedia system which selects between three different types of instructional material. This work assesses the feasibility of a fuzzy controller to track a student's physiological responses and adjust the learning content and pace accordingly. Using an industrial automation approach, the proposed fuzzy logic controller is based on linguistic rules that complement the instrumentation of the system to monitor and control the delivery of instructional material to the students. From the test results, it can be proved that the implemented fuzzy controller can satisfactorily regulate the delivery of academic content based on the working memory demand without compromising students’ health. This work has a potential application in the instructional design of virtual reality environments for training and education.

Keywords: fuzzy logic controller, hypermedia control system, personalized education, psychophysiological adaptive automation

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Authors: Ellis Kofi Akwaa-Sekyi, Jordi Moreno Gené

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Managerial actions which negatively profile banks and impair corporate reputation are addressed through effective internal control systems. Disregard for acceptable standards and procedures for granting credit have affected bank loan portfolios and could be cited for the crises in some European countries. The study intends to determine the effectiveness of internal control systems, investigate whether perceived agency problems exist on the part of board members and to establish the relationship between internal controls and credit risk among listed banks in the European Union. Drawing theoretical support from the behavioural compliance and agency theories, about seventeen internal control variables (drawn from the revised COSO framework), bank-specific, country, stock market and macro-economic variables will be involved in the study. A purely quantitative approach will be employed to model internal control variables covering the control environment, risk management, control activities, information and communication and monitoring. Panel data from 2005-2014 on listed banks from 28 European Union countries will be used for the study. Hypotheses will be tested and the Generalized Least Squares (GLS) regression will be run to establish the relationship between dependent and independent variables. The Hausman test will be used to select whether random or fixed effect model will be used. It is expected that listed banks will have sound internal control systems but their effectiveness cannot be confirmed. A perceived agency problem on the part of the board of directors is expected to be confirmed. The study expects significant effect of internal controls on credit risk. The study will uncover another perspective of internal controls as not only an operational risk issue but credit risk too. Banks will be cautious that observing effective internal control systems is an ethical and socially responsible act since the collapse (crisis) of financial institutions as a result of excessive default is a major contagion. This study deviates from the usual primary data approach to measuring internal control variables and rather models internal control variables in a quantitative approach for the panel data. Thus a grey area in approaching the revised COSO framework for internal controls is opened for further research. Most bank failures and crises could be averted if effective internal control systems are religiously adhered to.

Keywords: agency theory, credit risk, internal controls, revised COSO framework

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Authors: Alexander Heckman, Rohan Goswami, Zachi Attia, Paul Friedman, Peter Noseworthy, Demilade Adedinsewo, Pablo Moreno-Franco, Rickey Carter, Tathagat Narula

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Background: Postoperative atrial fibrillation (POAF) is associated with adverse health consequences, higher costs, and longer hospital stays. Utilizing existing predictive models that rely on clinical variables and circulating biomarkers, multiple societies have published recommendations on the treatment and prevention of POAF. Although reasonably practical, there is room for improvement and automation to help individualize treatment strategies and reduce associated complications. Methods and Results: In this retrospective cohort study of solid organ transplant recipients, we evaluated the diagnostic utility of a previously developed AI-based ECG prediction for silent AF on the development of POAF within 30 days of transplant. A total of 2261 non-cardiac transplant patients without a preexisting diagnosis of AF were found to have a 5.8% (133/2261) incidence of POAF. While there were no apparent sex differences in POAF incidence (5.8% males vs. 6.0% females, p=.80), there were differences by race and ethnicity (p<0.001 and 0.035, respectively). The incidence in white transplanted patients was 7.2% (117/1628), whereas the incidence in black patients was 1.4% (6/430). Lung transplant recipients had the highest incidence of postoperative AF (17.4%, 37/213), followed by liver (5.6%, 56/1002) and kidney (3.6%, 32/895) recipients. The AUROC in the sample was 0.62 (95% CI: 0.58-0.67). The relatively low discrimination may result from undiagnosed AF in the sample. In particular, 1,177 patients had at least 1 AI-ECG screen for AF pre-transplant above .10, a value slightly higher than the published threshold of 0.08. The incidence of POAF in the 1104 patients without an elevated prediction pre-transplant was lower (3.7% vs. 8.0%; p<0.001). While this supported the hypothesis that potentially undiagnosed AF may have contributed to the diagnosis of POAF, the utility of the existing AI-ECG screening algorithm remained modest. When the prediction for POAF was made using the first postoperative ECG in the sample without an elevated screen pre-transplant (n=1084 on account of n=20 missing postoperative ECG), the AUROC was 0.66 (95% CI: 0.57-0.75). While this discrimination is relatively low, at a threshold of 0.08, the AI-ECG algorithm had a 98% (95% CI: 97 – 99%) negative predictive value at a sensitivity of 66% (95% CI: 49-80%). Conclusions: This study's principal finding is that the incidence of POAF is rare, and a considerable fraction of the POAF cases may be latent and undiagnosed. The high negative predictive value of AI-ECG screening suggests utility for prioritizing monitoring and evaluation on transplant patients with a positive AI-ECG screening. Further development and refinement of a post-transplant-specific algorithm may be warranted further to enhance the diagnostic yield of the ECG-based screening.

Keywords: artificial intelligence, atrial fibrillation, cardiology, transplant, medicine, ECG, machine learning

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Authors: Maria Barbano Acevedo-Gomez, Elena Sonsoles Rodriguez-Lopez, Sofia Olivia Calvo-Moreno, Angel Basas-Garcia, Cristophe Ramirez

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Introduction: Urinary incontinence (UI) is defined as the involuntary leakage of urine. In persons who practice sport, its prevalence is 36.1% (95% CI 26.5%-46.8%) and varies as it seems to depend on the intensity of exercise, movements, and impact on the ground. Such high impact sports are likely to generate higher intra-abdominal pressures and leading to pelvic floor muscle weakness. Even though the emphasis of this research is on female athletes, all women should perform pelvic floor muscle exercises as a part of their general physical exercise. Pelvic floor exercises are generally considered the first treatment against urinary incontinence. Objective: The main objective of the present study was to determine the knowledge of the pelvic floor and of the UI in elite athletes and know if they incorporate pelvic floor strengthening in their training. Methods: This was an observational study conducted on 754 elite athletes. After collecting questions about the pelvic floor, UI, and sport-related data, participants completed the questionnaire International Consultation on Incontinence Questionnaire-UI Short-Form (ICIQ-SF). Results: 57.3% of the athletes reflect not having knowledge of their pelvic floor, 48.3% do not know what strengthening exercises are, and around 90% have never practiced them. 78.1% (n=589) of all elite athletes do not include pelvic floor exercises in their training. Of the elite athletes surveyed, 33% had UI according to ICIQ-SF (mean age 23.75 ± 7.74 years). In response to the question 'Do you think you have or have had UI?', Only 9% of the 754 elite athletes admitted they presently had UI, and 13.3% indicated they had had UI at some time. However, 22.7% (n=171) reported they had experienced urine leakage while training. Of the athletes who indicated they did not have UI in the ICIQ-SF, 25.7% stated they did experience urine leakage during training (χ² [1] = 265.56; p < 0.001). Further, 12.3% of the athletes who considered they did not have UI and 60% of those who admitted they had had UI on some occasion stated they had suffered some urine leakage in the past 3 months (χ² [1] = 287.59; p < 0.001). Conclusions: There is a lack of knowledge about UI in sport. Through the use of validated questionnaires, we observed a UI prevalence of 33%, and 22.7% reported they experienced urine leakage while training. These figures contrast with only 9% of athletes who reported they had or had in the past had UI. This discrepancy could reflect the great lack of knowledge about UI in sports and that sometimes an athlete may consider that urine leakage is normal and a consequence of the demands of training. These data support the idea that coaches, physiotherapists, and other professionals involved in maximizing the performance of athletes should include pelvic floor muscle exercises in their training programs. Measures such as this could help to prevent UI during training and could be a starting point for future studies designed to develop adequate prevention and treatment strategies for this embarrassing problem affecting young athletes, both male and female.

Keywords: athletes, pelvic floor, performance, prevalence, sport, training, urinary incontinence

Procedia PDF Downloads 126