Search results for: medical advantage

Authors: Cristina Gutiérrez Carranza

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Digital nomadism is a trend and lifestyle which combines work and traveling. This tourism tendency is motivated by the desire to have a fixed source of financial income while becoming independent from a specific work location. This study contextualizes Costa Rica and its potential prospects to take advantage of this tourism market niche. It explores the dynamics of digital nomadism in the context of Costa Rica, analyzing the current scenario, challenges, and opportunities related to this global phenomenon. The research covers several areas, including the conceptualization of digital nomadism, its historical background, and contemporary manifestations. The investigation delves into the present state of digital nomadism, evaluating the extent of digitalization in Costa Rica, mobile phone coverage, and fixed internet access. As part of the strategies implemented, as the study develops, mapping the most common destinations of digital nomads is a key factor, bringing a sight on the aspects that make Costa Rica an attractive location for this emerging tourist group. Additionally, the paper draws insights from hosting entrepreneurs and digital nomads with work visas in Costa Rica, offering a comprehensive understanding of the experiences and perspectives from both sides. Hence, the study includes data from a sample of 20 digital nomads holding visas for Costa Rica, offering a detailed analysis of their professional activities, experiences and needs as remote workers in the country. As well it adds in perceptions from 10 entrepreneurs engaged in providing accommodation services to digital nomads contribute to a degree of understanding of the way they have faced this growing movement. This research provides significant insights on the dynamics of digital nomadism in Costa Rica by integrating data from specific sources. Policymakers, entrepreneurs, and other stakeholders are anticipated to gain valuable data from the findings regarding the opportunities and challenges of hosting and accommodating digital nomads, which will ultimately aid in the creation of plans to capitalize on this worldwide trend for the nation's socioeconomic development.

Keywords: digital nomads, tourism, sustainability, digital nomads visa, remote jobs

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Authors: Sahraoui Halima, Dahani Ameur, Tigrine Abedelkader

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DigiMesh technology represents a pioneering advancement in wireless networking, offering cost-effective and energy-efficient capabilities. Its inherent simplicity and adaptability facilitate the seamless transfer of data between network nodes, extending the range and ensuring robust connectivity through autonomous self-healing mechanisms. In light of these advantages, this study introduces a medical platform harnessed with DigiMesh wireless network technology characterized by low power consumption, immunity to interference, and user-friendly operation. The primary application of this platform is the real-time, long-distance monitoring of Electrocardiogram (ECG) signals, with the added capacity for simultaneous monitoring of ECG signals from multiple patients. The experimental setup comprises key components such as Raspberry Pi, E-Health Sensor Shield, and Xbee DigiMesh modules. The platform is composed of multiple ECG acquisition devices labeled as Sensor Node 1 and Sensor Node 2, with a Raspberry Pi serving as the central hub (Sink Node). Two communication approaches are proposed: Single-hop and multi-hop. In the Single-hop approach, ECG signals are directly transmitted from a sensor node to the sink node through the XBee3 DigiMesh RF Module, establishing peer-to-peer connections. This approach was tested in the first experiment to assess the feasibility of deploying wireless sensor networks (WSN). In the multi-hop approach, two sensor nodes communicate with the server (Sink Node) in a star configuration. This setup was tested in the second experiment. The primary objective of this research is to evaluate the performance of both Single-hop and multi-hop approaches in diverse scenarios, including open areas and obstructed environments. Experimental results indicate the DigiMesh network's effectiveness in Single-hop mode, with reliable communication over distances of approximately 300 meters in open areas. In the multi-hop configuration, the network demonstrated robust performance across approximately three floors, even in the presence of obstacles, without the need for additional router devices. This study offers valuable insights into the capabilities of DigiMesh wireless technology for real-time ECG monitoring in healthcare applications, demonstrating its potential for use in diverse medical scenarios.

Keywords: DigiMesh protocol, ECG signal, real-time monitoring, medical platform

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Authors: Julie M. Novak, Simone K. Brennan, Lacey Brim

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Undergraduate medical education (UME) curriculum notably addresses micro-level communications (e.g., patient-provider, intercultural, inter-professional), yet frequently under-examines the role and impact of organizational communication, a more macro-level. Organizational communication, however, functions as foundation and through systemic structures of an organization and thereby serves as hidden curriculum and influences learning experiences and outcomes. Yet, little available research exists fully examining how students experience organizational communication while in medical school. Extant literature and best practices provide insufficient guidance for UME programs, in particular. The purpose of this study was to map and examine current organizational communication systems and processes in a UME program. Employing a phenomenology-grounded and participatory approach, this study sought to understand the organizational communication system from medical students' perspective. The research team consisted of a core team and 13 medical student co-investigators. This research employed multiple methods, including focus groups, individual interviews, and two surveys (one reflective of focus group questions, the other requesting students to submit ‘examples’ of communications). To provide context for student responses, nonstudent participants (faculty, administrators, and staff) were sampled, as they too express concerns about communication. Over 400 students across all cohorts and 17 nonstudents participated. Data were iteratively analyzed and checked for triangulation. Findings reveal the complex nature of organizational communication and student-oriented communications. They reveal program-impactful strengths, weaknesses, gaps, and tensions and speak to the role of organizational communication practices influencing both climate and culture. With regard to communications, students receive multiple, simultaneous communications from multiple sources/channels, both formal (e.g., official email) and informal (e.g., social media). Students identified organizational strengths including the desire to improve student voice, and message frequency. They also identified weaknesses related to over-reliance on emails, numerous platforms with inconsistent utilization, incorrect information, insufficient transparency, assessment/input fatigue, tacit expectations, scheduling/deadlines, responsiveness, and mental health confidentiality concerns. Moreover, they noted gaps related to lack of coordination/organization, ambiguous point-persons, student ‘voice-only’, open communication loops, lack of core centralization and consistency, and mental health bridges. Findings also revealed organizational identity and cultural characteristics as impactful on the medical school experience. Cultural characteristics included program size, diversity, urban setting, student organizations, community-engagement, crisis framing, learning for exams, inefficient bureaucracy, and professionalism. Moreover, they identified system structures that do not always leverage cultural strengths or reduce cultural problematics. Based on the results, opportunities for productive change are identified. These include leadership visibly supporting and enacting overall organizational narratives, making greater efforts in consistently ‘closing the loop’, regularly sharing how student input effects change, employing strategies of crisis communication more often, strengthening communication infrastructure, ensuring structures facilitate effective operations and change efforts, and highlighting change efforts in informational communication. Organizational communication and communications are not soft-skills, or of secondary concern within organizations, rather they are foundational in nature and serve to educate/inform all stakeholders. As primary stakeholders, students and their success directly affect the accomplishment of organizational goals. This study demonstrates how inquiries about how students navigate their educational experience extends research-based knowledge and provides actionable knowledge for the improvement of organizational operations in UME.

Keywords: medical education programs, organizational communication, participatory research, qualitative mixed methods

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Authors: Aslı Yörük, Mevla Yahya, Banu Tavat

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It is well established that bilinguals outperform monolinguals on executive function tasks. However, the effects of bilingualism on prospective memory (PM), which also requires executive functions, have not been investigated vastly. This study aimed to compare bi and monolingual participants' PM performance in focal and non-focal PM tasks. Considering that bilinguals have greater executive function abilities than monolinguals, we predict that bilinguals’ PM performance would be higher than monolinguals on the non-focal PM task, which requires controlled monitoring processes. To investigate these predictions, we administered the focal and non-focal PM task and measured the PM and ongoing task performance. Forty-eight Turkish-English bilinguals residing in North Macedonia and forty-eight Turkish monolinguals living in Turkey between the ages of 18-30 participated in the study. They were instructed to remember responding to rarely appearing PM cues while engaged in an ongoing task, i.e., spatial working memory task. The focality of the task was manipulated by giving different instructions for PM cues. In the focal PM task, participants were asked to remember to press an enter key whenever a particular target stimulus appeared in the working memory task; in the non-focal PM task, instead of responding to a specific target shape, participants were asked to remember to press the enter key whenever the background color of the working memory trials changes to a specific color (yellow). To analyze data, we performed a 2 × 2 mixed factorial ANOVA with the task (focal versus non-focal) as a within-subject variable and language group (bilinguals versus monolinguals) as a between-subject variable. The results showed no direct evidence for a bilingual advantage in PM. That is, the group’s performance did not differ in PM accuracy and ongoing task accuracy. However, bilinguals were overall faster in the ongoing task, yet this was not specific to PM cue’s focality. Moreover, the results showed a reversed effect of PM cue's focality on the ongoing task performance. That is, both bi and monolinguals showed enhanced performance in the non-focal PM cue task. These findings raise skepticism about the literature's prevalent findings and theoretical explanations. Future studies should investigate possible alternative explanations.

Keywords: bilingualism, executive functions, focality, prospective memory

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Authors: Melissa Angus Baboun

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Utilizing a Critical Discourse Analysis (CDA) methodology and a theoretical framework based on disability studies, how Jamaican and Trinidadian newspapers discussed issues relating to the Deaf community were examined. The term deaf was inputted into the search engine tool of the online website for the Jamaica Observer and the Trinidad & Tobago Guardian. All 27 articles that contained the term deaf in its content and were written between August 1, 2017 and November 15, 2017 were chosen for the study. The data analysis was divided into three steps: (1) listing and analysis instances of metaphorical deafness (e.g. fall on deaf ears), (2) categorization of the content of the articles into the models of disability discourse (the medical, socio-cultural, and superscrip models of disability narratives), and (3) the analysis of any additional data found. A total of 42% of the articles pulled for this study did not deal with the Deaf community in any capacity, but rather instances of the use of idiomatic expressions that use deafness as a metaphor for a non-physical, undesirable trait. The most common idiomatic expression found was fall on deaf ears. Regarding the models of disability discourse, eight articles were found to follow the socio-cultural model, two were found to follow the medical model, and two were found to follow the superscrip model. The additional data found in these articles include two instances of the term deaf and mute, an overwhelming use of lower case d for the term deaf, and the misuse of the term translator (to mean interpreter).

Keywords: deafness, disability, news coverage, Caribbean newspapers

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Authors: Sneha Singh, Abhimanyu Dev, Vinod Nigam

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The major issue which decides the impending use of gold nanoparticles (AuNPs) in nanobiotechnological applications is their particle size and stability. Often the AuNPs obtained biomimetically are considered useless owing to their instability in the aqueous medium and thereby limiting the widespread acceptance of this facile green synthesis procedure. So, the use of nontoxic surfactants is warranted to stabilize the biogenic nanoparticles (NPs). But does the surfactant only play a role in stabilizing by being adsorbed to the NPs surface or can it have any other significant contribution in synthesis process and controlling their size as well as shape? Keeping this idea in mind, AuNPs were synthesized by using surfactant treated (lechate) and untreated (cell lysate supernatant) Bacillus licheniformis cell extract. The cell extracts mediated reduction of chloroauric acid (HAuCl 4) in the presence of non-ionic surfactant, Tween 20 (TW20), and its effect on the AuNPs stability was studied. Interestingly, the surfactant used in the study served as potential alternative to harvest cellular enzymes involved in bioreduction process in a hassle free condition. The surfactants ability to solubilize/leach membrane proteins and simultaneously stabilizing the AuNPs could have advantage from process point of view as it will reduce the time and economics involve in the nanofabrication of biogenic NPs. The synthesis was substantiated with UV-Vis spectroscopy, Dynamic light scattering study, FTIR spectroscopy, and Transmission electron microscopy. The Zeta potential of AuNPs solutions was measured routinely to corroborate the stability observations recorded visually. Highly stable, ultra-small AuNPs of 2.6 nm size were obtained from the study. Further, the biological efficacy of the obtained AuNPs as potential antibacterial agent was evaluated against Bacilllus subtilis, Pseudomonas aeruginosa, and Escherichia coli by observing the zone of inhibition. This potential of AuNPs of size < 3 nm as antibacterial agent could pave way for development of new antimicrobials and overcoming the problems of antibiotics resistance

Keywords: antibacterial, bioreduction, nanoparticles, surfactant

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Authors: Xuhui Lin, Qiuchen Lu, Yi An, Tao Yang

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As global climate change intensifies, extreme weather events such as floods increasingly threaten urban infrastructure, making the vulnerability of urban road networks a pressing issue. Existing static repair strategies fail to adapt to the rapid changes in road network conditions during flood events, leading to inefficient resource allocation and suboptimal recovery. The main research gap lies in the lack of repair strategies that consider both the dynamic characteristics of networks and the progression of flood propagation. This paper proposes a topology-based dynamic repair strategy that adjusts repair priorities based on real-time changes in flood propagation and traffic demand. Specifically, a novel method is developed to assess and enhance the resilience of urban road networks during flood events. The method combines road network topological analysis, flood propagation modelling, and traffic flow simulation, introducing a local importance metric to dynamically evaluate the significance of road segments across different spatial and temporal scales. Using London's road network and rainfall data as a case study, the effectiveness of this dynamic strategy is compared to traditional and Transport for London (TFL) strategies. The most significant highlight of the research is that the dynamic strategy substantially reduced the number of stranded vehicles across different traffic demand periods, improving efficiency by up to 35.2%. The advantage of this method lies in its ability to adapt in real-time to changes in network conditions, enabling more precise resource allocation and more efficient repair processes. This dynamic strategy offers significant value to urban planners, traffic management departments, and emergency response teams, helping them better respond to extreme weather events like floods, enhance overall urban resilience, and reduce economic losses and social impacts.

Keywords: Urban resilience, road networks, flood response, dynamic repair strategy, topological analysis

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Authors: Lista Andriyati, Nurpudji A Taslim

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The human immunodeficiency virus (HIV) patients have potential nutritional and metabolic problems. HIV is a virus that attacks cells T helper and impairs the function of immune cells. Infected individuals gradually become immunodeficient, results in increased susceptibility to a wide range of infections such as tuberculosis (TB). Malnutrition has destructive effects on the immune system and host defense mechanisms. Effective and proper nutritional therapies are important to improve medical outcomes and quality of life, which is associated with functional improvement. A case of 38-years old man admitted to hospital with loss of consciousness and was diagnosed HIV infection and relapse lung TB with severe malnutrition, fever, oral candidiasis, anemia (6.3 g/dL), severe hypoalbuminemia (1.9 g/dL), severe hypokalemia (2.2 mmol/L), immune depletion (1085 /µL) and elevated liver enzyme (ALT 1198/AST 375 U/L). Nutritional intervention by giving 2300 kcal of energy, protein 2 g/IBW/day, carbohydrate 350 g, fat 104 g through enteral and parenteral nutrition. Supplementations administered are zinc, vitamin A, vitamin B1, vitamin B6, vitamin B12, vitamin C, vitamin D, and snakehead fish extract high content of protein albumin (Pujimin®). After 46 days, there are clinical and metabolic improvement in Hb (6.3 to 11.2 g/dL), potassium (2.2 to 3.4 mmol/L), albumin (1.9 to 2.3 g/dL), ALT 1198 to 47/AST 375 to 68 U/L) and improved awareness. In conclusion, nutritional therapy in HIV infection with adequate macronutrients and micronutrients fulfillment and immunonutrition is very important to avoid cachexia and to improve nutritional status and immune disfunction.

Keywords: HIV, hypoalbuminemia, malnutrition, tuberculosis

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Authors: Mark Heads, Carrie Adamson

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Introduction This study evaluated the educational merits of the teaching activities of ‘Sheffield Anatomy Society,’ a student society with minimal faculty oversight which delivers near peer teaching in a range of formats to support students in their revision. Near peer, teaching is defined as teaching delivered by more senior students who have themselves recently completed the course content. This study was conducted between early April and late May 2022. This programme aims to improve student knowledge of anatomy, increase student confidence in their anatomy learning and cultivate a sense of community. The sessions were delivered by more senior medical students and by medical students undertaking an intercalated Master's degree in Human Anatomy with Education. Background: The majority of studies concerning near peer teaching focus on faculty designed programmes. Few studies have examined entirely student led near peer teaching of anatomy. Existing studies have been favourable but have limited qualitative examination of the benefits and weaknesses of near peer teaching. Various drawbacks have been proposed in the literature but not extensively investigated in practice. This study examines student led near peer anatomy teaching across a range of formats and considers these proposed criticisms. Methods: The teaching series consisted of 11 online lectures, a small group teaching session, two in person mock spotter examinations, and an online mock examination. Feedback forms were given for each session, and follow up interviews were conducted. Thematic analysis utilising an interpretivist epistemology was conducted on the feedback form responses and interview transcripts. Findings: 207 first year medical students, 34 second year biomedical science students, and 12 third year biomedical science students completed one or more feedback forms following these sessions, with 875 responses being collected in total. Six interviews were conducted. 99.5% of respondents said that they would recommend these sessions to other students. The quantitative results ranged from a mean of 4.6-4.8/5 per session when asked to rate how useful the students found it. Qualitative: analysis yielded numerous strengths and some weaknesses of the programme. The most commonly cited strength was that students found the explanations readily comprehensible. Students also praised the interactive nature of the sessions, with students frequently saying they felt more able to engage with interactive elements and ask questions in these sessions than in faculty teaching. Students did, however, raise some issues. The most common drawback students mentioned was a desire for more help preparing for their examinations, especially more examination style questions. Criticisms of the teaching itself were less prominent and typically reflected time constraints and limited resources. Conclusions : This study suggests student organised near peer teaching, utilising interactive online lectures, small group teaching, and mock examinations, can be an effective method for supporting students studying anatomy. Students reported improvements in their knowledge as a result of the sessions, greater confidence approaching their examinations, and this programme has helped foster an environment where students feel able to ask questions outside of sessions and even get involved with teaching themselves the following academic year.

Keywords: medical education, near peer teaching, anatomy teaching, online learning

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Authors: Ayshan Gurbanova

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Despite based on the fact that drill bit which is the smallest part of bottom hole assembly costs only in between 10% and 15% of the total expenses made, they are the first equipment that is in contact with the formation itself. Hence, it is consequential to choose the appropriate type and dimension of drilling bit, which will prevent majority of problems by not demanding many tripping procedure. However, within the advance in technology, it is now seamless to be beneficial in the terms of many concepts such as subsequent time of operation, energy, expenditure, power and so forth. With the intention of applying the method to Azerbaijan, the field of Shallow Water Absheron Peninsula has been suggested, where the mainland has been located 15 km away from the wildcat wells, named as “NKX01”. It has the water depth of 22 m as indicated. In 2015 and 2016, the seismic survey analysis of 2D and 3D have been conducted in contract area as well as onshore shallow water depth locations. With the aim of indicating clear elucidation, soil stability, possible submersible dangerous scenarios, geohazards and bathymetry surveys have been carried out as well. Within the seismic analysis results, the exact location of exploration wells have been determined and along with this, the correct measurement decisions have been made to divide the land into three productive zones. In the term of the method, Electric Impulse Technology (EIT) is based on discharge energies of electricity within the corrosivity in rock. Take it simply, the highest value of voltages could be created in the less range of nano time, where it is sent to the rock through electrodes’ baring as demonstrated below. These electrodes- higher voltage powered and grounded are placed on the formation which could be obscured in liquid. With the design, it is more seamless to drill horizontal well based on the advantage of loose contact of formation. There is also no chance of worn ability as there are no combustion, mechanical power exist. In the case of energy, the usage of conventional drilling accounts for 1000 𝐽/𝑐𝑚3 , where this value accounts for between 100 and 200 𝐽/𝑐𝑚3 in EIT. Last but not the least, from the test analysis, it has been yielded that it achieves the value of ROP more than 2 𝑚/ℎ𝑟 throughout 15 days. Taking everything into consideration, it is such a fact that with the comparison of data analysis, this method is highly applicable to the fields of Azerbaijan.

Keywords: drilling, drill bit cost, efficiency, cost

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Authors: William Castillo, Hugo Viza, Arturo Vargas

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The Pacific Alliance is a trade bloc that is composed of four emerging economies: Chile, Colombia, Peru, and Mexico. These economies have gained macroeconomic stability in the past decade and as a consequence present future economic progress. Under this positive scenario, international business firms have flourished. However, the literature in this region has been widely unexamined. Therefore, it is critical to fill this theoretical gap, especially considering that Latin America is starting to become a global player and it possesses a different institutional context than developed markets. This paper analyzes the effect of international entrepreneurial orientation and institutionalism on international performance, for the Pacific Alliance small-to-medium enterprises (SMEs). The literature considers international entrepreneurial orientation to be a powerful managerial capability – along the resource based view- that firms can leverage to obtain a satisfactory international performance. Thereby, obtaining a competitive advantage through the correct allocation of key resources to exploit the capabilities here involved. Entrepreneurial Orientation is defined around five factors: innovation, proactiveness, risk-taking, competitive aggressiveness, and autonomy. Nevertheless, the institutional environment – both local and foreign, adversely affects International Performance; this is especially the case for emerging markets with uncertain scenarios. In this way, the study analyzes an Entrepreneurial Orientation, key endogenous variable of international performance, and Institutionalism, an exogenous variable. The survey data consists of Pacific Alliance SMEs that have foreign operations in at least another country in the trade bloc. Findings are still in an ongoing research process. Later, the study will undertake a structural equation modeling (SEM) using the variance-based partial least square estimation procedure. The software that is going to be used is the SmartPLS. This research contributes to the theoretical discussion of a largely postponed topic: SMEs in Latin America, that has had limited academic research. Also, it has practical implication for decision-makers and policy-makers, providing insights into what is behind international performance.

Keywords: institutional theory, international entrepreneurial orientation, international performance, SMEs, Pacific Alliance

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Authors: Vivek Ku, A. K. Janmeja, D. Aggarwal, R. Gupta

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Purpose: Pulmonary rehabilitation plays a key role in management of chronic lung diseases. However, pulmonary rehabilitation is an underused modality in the management of interstitial lung disease (ILD). This is because limited information is available in literature and no data is available from India on this issue so far. The study was carried out to evaluate the role of pulmonary rehabilitation on respiratory parameters in ILD patients. Methods: The present study was a prospective randomized non-blind case control study. Total of 40 ILD patients were randomized into 2 groups of 20 patients each viz ‘pulmonary rehabilitation group’ and ‘control group’. Pulmonary rehabilitation group underwent 8 weeks pulmonary rehabilitation (PR) along with medical management as per guidelines and the control group was advised only medical management. Results: Mean age in case group was 59.15 ± 10.39 years and in control group was 62.10 ± 14.54 years. The case and the control groups were matched for age and sex. Mean MRC grading at the end of 8 weeks showed significant improvement in the case group as compared to control group (p= 0.011 vs p = 0.655). Similarly, mean St. George Respiratory Questionnaire (SGRQ) score also showed significant improvement in pulmonary rehabilitation group at the end of the study (p= 0.001 vs p= 0.492). However, FEV1 and FVC had no significant change in the case and control group. Similarly, blood gases also did not show any significant difference in the group. Conclusion: Pulmonary rehabilitation improves breathlessness and thereby improves quality of life in the patients suffering from ILD. However, the pulmonary function values and blood gases are unaffected by pulmonary rehabilitation. Clinical Implications: Further large scale multicentre study is needed to ascertain the association.

Keywords: ILD, pulmonary rehabilitation, quality of life, pulmonary functions

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Authors: Thu Nhi Tran Caliste

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X-ray Bragg diffraction imaging (“topography”)entered into practical use when Lang designed an “easy” technical setup to characterise the defects / distortions in the high perfection crystals produced for the microelectronics industry. The use of this technique extended to all kind of high quality crystals, and deposited layers, and a series of publications explained, starting from the dynamical theory of diffraction, the contrast of the images of the defects. A quantitative version of “monochromatic topography” known as“Rocking Curve Imaging” (RCI) was implemented, by using synchrotron light and taking advantage of the dramatic improvement of the 2D-detectors and computerised image processing. The rough data is constituted by a number (~300) of images recorded along the diffraction (“rocking”) curve. If the quality of the crystal is such that a one-to-onerelation between a pixel of the detector and a voxel within the crystal can be established (this approximation is very well fulfilled if the local mosaic spread of the voxel is < 1 mradian), a software we developped provides, from the each rocking curve recorded on each of the pixels of the detector, not only the “voxel” integrated intensity (the only data provided by the previous techniques) but also its “mosaic spread” (FWHM) and peak position. We will show, based on many examples, that this new data, never recorded before, open the field to a highly enhanced characterization of the crystal and deposited layers. These examples include the characterization of dislocations and twins occurring during silicon growth, various growth features in Al203, GaNand CdTe (where the diffraction displays the Borrmannanomalous absorption, which leads to a new type of images), and the characterisation of the defects within deposited layers, or their effect on the substrate. We could also observe (due to the very high sensitivity of the setup installed on BM05, which allows revealing these faint effects) that, when dealing with very perfect crystals, the Kato’s interference fringes predicted by dynamical theory are also associated with very small modifications of the local FWHM and peak position (of the order of the µradian). This rather unexpected (at least for us) result appears to be in keeping with preliminary dynamical theory calculations.

Keywords: rocking curve imaging, X-ray diffraction, defect, distortion

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Authors: Migena Mana, Ahmed Khalid Syed, Abdul Malik, Nikhil Cherian

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In recent years, advancements in deep learning enabled researchers to tackle the problem of self-driving cars. Car companies use huge datasets to train their deep learning models to make autonomous cars a reality. However, this approach has certain drawbacks in that the state space of possible actions for a car is so huge that there cannot be a dataset for every possible road scenario. To overcome this problem, the concept of reinforcement learning (RL) is being investigated in this research. Since the problem of autonomous driving can be modeled in a simulation, it lends itself naturally to the domain of reinforcement learning. The advantage of this approach is that we can model different and complex road scenarios in a simulation without having to deploy in the real world. The autonomous agent can learn to drive by finding the optimal policy. This learned model can then be easily deployed in a real-world setting. In this project, we focus on three RL algorithms: Q-learning, Deep Deterministic Policy Gradient (DDPG), and Proximal Policy Optimization (PPO). To model the environment, we have used TORCS (The Open Racing Car Simulator), which provides us with a strong foundation to test our model. The inputs to the algorithms are the sensor data provided by the simulator such as velocity, distance from side pavement, etc. The outcome of this research project is a comparative analysis of these algorithms. Based on the comparison, the PPO algorithm gives the best results. When using PPO algorithm, the reward is greater, and the acceleration, steering angle and braking are more stable compared to the other algorithms, which means that the agent learns to drive in a better and more efficient way in this case. Additionally, we have come up with a dataset taken from the training of the agent with DDPG and PPO algorithms. It contains all the steps of the agent during one full training in the form: (all input values, acceleration, steering angle, break, loss, reward). This study can serve as a base for further complex road scenarios. Furthermore, it can be enlarged in the field of computer vision, using the images to find the best policy.

Keywords: autonomous driving, DDPG (deep deterministic policy gradient), PPO (proximal policy optimization), reinforcement learning

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Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

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

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

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Authors: Şenay Pehli̇van, Gülümser Kublay

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Female inmates placed in a Correctional Institution (CI) have more physical health problems than other women and their male counterparts. Thus, they require more health care services in the CI and nursing services in particular. CI nurses also have the opportunity to teach behaviors which will protect and improve their health to these women who are difficult to reach in the community. The aim of this study was to evaluate effect of nursing services provided in a CI on the physical health levels and health behaviors of female inmates. The study has a quasi-experimental design. The study was done in Female Closed CI in Ankara, Turkey. The study was conducted on 30 female inmates. Before the implementation of nursing interventions in the initial phase of the study, female inmates were evaluated in terms of physical health problems and health behavior using forms, a physical examination, medical history, health files (file containing medical information related to prisons) and the Omaha System (OS). Findings obtained from evaluations were grouped and symptoms-findings were expressed with OS diagnosis codes. Knowledge, behavior and status scores of prisoners in relation to health problems were determined. After the implementation of the nursing interventions, female inmates were evaluated in terms of physical health problems and health behavior using OS. The research data were collected using the Female Evaluation Form developed by the researcher and the OS. It was found that knowledge, behavior and status scores of prisoners significantly increased after the implementation of nursing interventions (p < 0.05).

Keywords: prison nursing, health promotion and protecting, nursi̇ng servi̇ces, omaha system

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Authors: Hossein Miri, Zhou YongQi, Chan Bormei-Suy

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The development of advanced technologies and innovative solutions has opened up exciting new possibilities for revolutionizing healthcare systems. One such emerging concept is the use of virtual and holographic health information platforms that aim to provide interactive and personalized medical information to users. This paper provides a review of notable virtual and holographic health information platforms. It begins by highlighting the need for information visualization and 3D representation in healthcare. It then proceeds to provide background knowledge on information visualization and historical developments in 3D visualization technology. Additional domain knowledge concerning holography, holographic computing, and mixed reality is then introduced, followed by highlighting some of their common applications and use cases. After setting the scene and defining the context, the need and importance of virtual and holographic visualization in medicine are discussed. Subsequently, some of the current research areas and applications of digital holography and holographic technology are explored, alongside the importance and role of virtual and holographic visualization in genetics and genomics. An analysis of the key principles and concepts underlying virtual and holographic health information systems is presented, as well as their potential implications for healthcare are pointed out. The paper concludes by examining the most notable existing mixed-reality applications and systems that help doctors visualize diagnostic and genetic data and assist in patient education and communication. This paper is intended to be a valuable resource for researchers, developers, and healthcare professionals who are interested in the use of virtual and holographic technologies to improve healthcare.

Keywords: virtual, holographic, health information platform, personalized interactive medical information

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Authors: Julia Wimmers Klick

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Interprofessional Education (IPE) is widely recognized as a valuable approach in healthcare education, despite the challenges it presents. This study explores IP surface anatomy lab sessions, with a focus on fostering trust and collaboration among healthcare students. The research is conducted within the context of rural healthcare settings in British Columbia (BC), where a medical school and a physical therapy (PT) program operate under the Faculty of Medicine at the University of British Columbia (UBC). While IPE sessions addressing soft skills have been implemented, the integration of hard skills, such as Anatomy, remains limited. To address this gap, a pilot feasibility study was conducted with a positive outcome, a follow-up study involved these IPE sessions aimed at exploring the influence of bonding and trust between medical and PT students. Data were collected through focus groups comprising participating students and faculty members, and a structured SWOC (Strengths, Weaknesses, Opportunities, and Challenges) analysis was conducted. The IPE sessions, 3 in total, consisted of a 2.5-hour lab on surface anatomy, where PT students took on the teaching role, and medical students were newly exposed to surface anatomy. The focus of the study was on the relationship-building process and trust development between the two student groups, rather than assessing the acquisition of surface anatomy skills. Results indicated that the surface anatomy lab served as a suitable tool for the application and learning of soft skills. Faculty members observed positive outcomes, including productive interaction between students, reversed hierarchy with PT students teaching medical students, practicing active listening skills, and using a mutual language of anatomy. Notably, there was no grade assessment or external pressure to perform. The students also reported an overall positive experience; however, the specific impact on the development of soft skill competencies could not be definitively determined. Participants expressed a sense of feeling respected, welcomed, and included, all of which contributed to feeling safe. Within the small group environment, students experienced becoming a part of a community of healthcare providers that bonded over a shared interest in health professions education. They enjoyed sharing diverse experiences related to learning across their varied contexts, without fear of judgment and reprisal that were often intimidating in single professional contexts. During a joint Christmas party for both cohorts, faculty members observed students mingling, laughing, and forming bonds. This emphasized the importance of early bonding and trust development among healthcare colleagues, particularly in rural settings. In conclusion, the findings emphasize the potential of IPE sessions to enhance trust and collaboration among healthcare students, with implications for their future professional lives in rural settings. Early bonding and trust development are crucial in rural settings, where healthcare professionals often rely on each other. Future research should continue to explore the impact of content-concentrated IPE on the development of soft skill competencies.

Keywords: interprofessional education, rural healthcare settings, trust, surface anatomy

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Authors: Alexandra Shipley

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Background: Undergraduate paediatric teaching must overcome two major challenges: 1) balancing patient safety with active student engagement and 2) exposing students to a comprehensive range of pathologies within a relatively short clinical placement. Whilst lectures and shadowing on paediatric wards constitute the mainstay of learning, Simulation and Virtual Reality (VR) are emerging as effective teaching tools, which - immune to the unpredictability and seasonal variation of hospital presentations - could expose students to the entire syllabus more reliably, efficiently, and independently. We aim to evaluate the potential utility of Simulation and VR in addressing gaps within the traditional paediatric curriculum from the perspective of medical students. Summary of Work: Exposure to and perceived utility of various learning opportunities within the Paediatric and Emergency Medicine courses were assessed through a questionnaire completed by 5th year medical students (n=23). Summary of Results: Students reported limited exposure to several common acute paediatric presentations, such as bronchiolitis (41%), croup (32%) or pneumonia (14%), and to clinical emergencies, including cardiac/respiratory arrests or trauma calls (27%). Across all conditions, average self-reported confidence in assessment and management to the level expected of an FY1 is greater amongst those who observed at least one case (e.g. 7.6/10 compared with 3.6/10 for croup). Students rated exposure through Simulation or VR to be of similar utility to witnessing a clinical scenario on the ward. In free text responses, students unanimously favoured being ‘challenged’ through ‘hands-on’ patient interaction over passive shadowing, where it is ‘easy to zone out.’ In recognition of the fact that such independence is only appropriate in certain clinical situations, many students reported wanting more Simulation and VR teaching. Importantly, students raised the necessity of ‘proper debriefs’ after these sessions to maximise educational value. Discussion and Conclusion: Our questionnaire elicited several student-perceived challenges in paediatric education, including incomplete exposure to common pathologies and limited opportunities for active involvement in patient care. Indeed, these experiences seem to be important predictors of confidence. Quantitative and qualitative feedback suggests that VR and Simulation satisfy students’ self-reported appetite for independent engagement with authentic clinical scenarios. Take-aways: Our findings endorse further development of VR and Simulation as high-yield adjuncts to paediatric education.

Keywords: paediatric emergency education, simulation, virtual reality, medical education

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Authors: Muluken Biadgelegn Wollele, Mebratu Assaye Mengistu

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Nanotechnology has created new opportunities for improving industrial efficiency and performance. One of the proposed approaches to improving the effectiveness of temperature exchangers is the use of nanofluids to improve heat transfer performance. The thermal conductivity of nanoparticles, as well as their size, diameter, and volume concentration, all played a role in influencing the rate of heat transfer. Nanofluids are commonly used in automobiles, energy storage, electronic component cooling, solar absorbers, and nuclear reactors. Convective heat transfer must be improved when designing thermal systems in order to reduce heat exchanger size, weight, and cost. Using roughened surfaces to promote heat transfer has been tried several times. Thus, both active and passive heat transfer methods show potential in terms of heat transfer improvement. There will be an added advantage of enhanced heat transfer due to the two methods adopted; however, pressure drop must be considered during flow. Thus, the current research aims to increase heat transfer by adding a twisted tap insert in a plain tube using a working fluid hybrid nanofluid (Al₂O₃-Cu) with a base fluid of water. A circular duct with inserts, a tube length of 3 meters, a hydraulic diameter of 0.01 meters, and tube walls with a constant heat flux of 20 kW/m² and a twist ratio of 125 was used to investigate Al₂O₃-Cu/H₂O hybrid nanofluid with inserts. The temperature distribution is better than with conventional tube designs due to stronger tangential contact and swirls in the twisted tape. The Nusselt number values of plain twisted tape tubes are 1.5–2.0 percent higher than those of plain tubes. When twisted tape is used instead of plain tube, performance evaluation criteria improve by 1.01 times. A heat exchanger that is useful for a number of heat exchanger applications can be built utilizing a mixed flow of analysis that incorporates passive and active methodologies.

Keywords: nanofluids, active method, passive method, Nusselt number, performance evaluation criteria

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Authors: Belgherbi Aicha, Hadjidj Ismahen, Bessaid Abdelhafid

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The interpretation of medical images benefits from anatomical and physiological priors to optimize computer- aided diagnosis applications. Segmentation of liver and liver lesion is regarded as a major primary step in computer aided diagnosis of liver diseases. Precise liver segmentation in abdominal CT images is one of the most important steps for the computer-aided diagnosis of liver pathology. In this papers, a semi- automated method for medical image data is presented for the liver and liver lesion segmentation data using mathematical morphology. Our algorithm is currency in two parts. In the first, we seek to determine the region of interest by applying the morphological filters to extract the liver. The second step consists to detect the liver lesion. In this task; we proposed a new method developed for the semi-automatic segmentation of the liver and hepatic lesions. Our proposed method is based on the anatomical information and mathematical morphology tools used in the image processing field. At first, we try to improve the quality of the original image and image gradient by applying the spatial filter followed by the morphological filters. The second step consists to calculate the internal and external markers of the liver and hepatic lesions. Thereafter we proceed to the liver and hepatic lesions segmentation by the watershed transform controlled by markers. The validation of the developed algorithm is done using several images. Obtained results show the good performances of our proposed algorithm

Keywords: anisotropic diffusion filter, CT images, hepatic lesion segmentation, Liver segmentation, morphological filter, the watershed algorithm

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Authors: Duncan Wallace, M-Tahar Kechadi

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In recent years, Machine Learning (ML) approaches have been successfully applied to an analysis of patient symptom data in the context of disease diagnosis, at least where such data is well codified. However, much of the data present in Electronic Health Records (EHR) are unlikely to prove suitable for classic ML approaches. Furthermore, as scores of data are widely spread across both hospitals and individuals, a decentralized, computationally scalable methodology is a priority. The focus of this paper is to develop a method to predict outliers in an out-of-hours healthcare provision center (OOHC). In particular, our research is based upon the early identification of patients who have underlying conditions which will cause them to repeatedly require medical attention. OOHC act as an ad-hoc delivery of triage and treatment, where interactions occur without recourse to a full medical history of the patient in question. Medical histories, relating to patients contacting an OOHC, may reside in several distinct EHR systems in multiple hospitals or surgeries, which are unavailable to the OOHC in question. As such, although a local solution is optimal for this problem, it follows that the data under investigation is incomplete, heterogeneous, and comprised mostly of noisy textual notes compiled during routine OOHC activities. Through the use of Deep Learning methodologies, the aim of this paper is to provide the means to identify patient cases, upon initial contact, which are likely to relate to such outliers. To this end, we compare the performance of Long Short-Term Memory, Gated Recurrent Units, and combinations of both with Convolutional Neural Networks. A further aim of this paper is to elucidate the discovery of such outliers by examining the exact terms which provide a strong indication of positive and negative case entries. While free-text is the principal data extracted from EHRs for classification, EHRs also contain normalized features. Although the specific demographical features treated within our corpus are relatively limited in scope, we examine whether it is beneficial to include such features among the inputs to our neural network, or whether these features are more successfully exploited in conjunction with a different form of a classifier. In this section, we compare the performance of randomly generated regression trees and support vector machines and determine the extent to which our classification program can be improved upon by using either of these machine learning approaches in conjunction with the output of our Recurrent Neural Network application. The output of our neural network is also used to help determine the most significant lexemes present within the corpus for determining high-risk patients. By combining the confidence of our classification program in relation to lexemes within true positive and true negative cases, with an inverse document frequency of the lexemes related to these cases, we can determine what features act as the primary indicators of frequent-attender and non-frequent-attender cases, providing a human interpretable appreciation of how our program classifies cases.

Keywords: artificial neural networks, data-mining, machine learning, medical informatics

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Authors: Gulcin Yildiz, Hao Feng

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Soybean proteins are the most widely used and researched proteins in the food industry. Due to soy allergies among consumers, however, alternative legume proteins having similar functional properties have been studied in recent years. These alternative proteins are also expected to have a price advantage over soy proteins. One such protein that has shown good potential for food applications is pea protein. Besides the favorable functional properties of pea protein, it also contains fewer anti-nutritional substances than soy protein. However, a comparison of the physicochemical properties of pea protein isolate (PPI)-starch nanocomplexes and soy protein isolate (SPI)-starch nanocomplexes treated by ultrasound has not been well documented. This study was undertaken to investigate the effects of ultrasound treatment on the physicochemical properties of PPI-starch and SPI-starch nanocomplexes. Pea protein isolate (85% pea protein) provided by Roquette (Geneva, IL, USA) and soy protein isolate (SPI, Pro-Fam® 955) obtained from the Archer Daniels Midland Company were adjusted to different pH levels (2-12) and treated with 5 minutes of ultrasonication (100% amplitude) to form complexes with starch. The soluble protein content was determined by the Bradford method using BSA as the standard. The turbidity of the samples was measured using a spectrophotometer (Lambda 1050 UV/VIS/NIR Spectrometer, PerkinElmer, Waltham, MA, USA). The volume-weighted mean diameters (D4, 3) of the soluble proteins were determined by dynamic light scattering (DLS). The emulsifying properties of the proteins were evaluated by the emulsion stability index (ESI) and emulsion activity index (EAI). Both the soy and pea protein isolates showed a U-shaped solubility curve as a function of pH, with a high solubility above the isoelectric point and a low one below it. Increasing the pH from 2 to 12 resulted in increased solubility for both the SPI and PPI-starch complexes. The pea nanocomplexes showed greater solubility than the soy ones. The SPI-starch nanocomplexes showed better emulsifying properties determined by the emulsion stability index (ESI) and emulsion activity index (EAI) due to SPI’s high solubility and high protein content. The PPI had similar or better emulsifying properties at certain pH values than the SPI. The ultrasound treatment significantly decreased the particle sizes of both kinds of nanocomplex. For all pH levels with both proteins, the droplet sizes were found to be lower than 300 nm. The present study clearly demonstrated that applying ultrasonication under different pH conditions significantly improved the solubility and emulsify¬ing properties of the SPI and PPI. The PPI exhibited better solubility and emulsifying properties than the SPI at certain pH levels

Keywords: emulsifying properties, pea protein isolate, soy protein isolate, ultrasonication

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Authors: Claudia Aguilar, Amen Farooq

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Among other cities in the United States, the city of Atlanta is experiencing levels of growth that surpass anything we have witnessed in the last century. With the surge of population influx, the available housing is practically bursting at the seams. Supply is low, and demand is high. In effect, the average one-bedroom apartment runs for 1,800 dollars per month. The city is desperately seeking new opportunities to provide affordable housing at an expeditious rate. This has been made evident by the recent updates to the city’s zoning. With the recent influx in the housing market, young professionals, in particular millennials, are desperately looking for alternatives to stay within the city. To remedy Atlanta’s affordable housing crisis, the city of Atlanta is planning to introduce 40 thousand of new affordable housing units by 2026. To achieve the urgent need for more affordable housing, the architectural response needs to adapt to overcome this goal. A method that has proven successful in modern housing is to practice modular means of development. A method that has been constrained to the dimensions of the max load for an eighteen-wheeler. This approach has diluted the architect’s ability to produce site-specific, informed design and rather contributes to the “cookie cutter” stigma that the method has been labeled with. This thesis explores the design methodology for modular housing by revisiting its constructability and adaptability. This research focuses on a modular housing type that could break away from the constraints of transport and deliver adaptive reconfigurable assemblies. The adaptive assemblies represent an integrated design strategy for assembling the future of affordable dwelling units. The goal is to take advantage of a component-based system and explore a scalable solution to modular housing. This proposal aims specifically to design a kit of parts that are made to be easily transported and assembled but also gives the ability to customize the use of components to benefit all unique conditions. The benefits of this concept could include decreased construction time, cost, on-site labor, and disruption while providing quality housing with affordable and flexible options.

Keywords: adaptive assemblies, modular architecture, adaptability, constructibility, kit of parts

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Authors: Katarina Rogulj, Ivana Racetin, Jelena Kilic

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In this study, the fuzzy logic approach (FLA) was developed for construction project management (CPM) under uncertainty and duality. The focus was on decision making in selecting the type of the glass facade for a residential-commercial building in the main design. The adoption of fuzzy sets was capable of reflecting construction managers’ reliability level over subjective judgments, and thus the robustness of the system can be achieved. An α-cuts method was utilized for discretizing the fuzzy sets in FLA. This method can communicate all uncertain information in the optimization process, taking into account the values of this information. Furthermore, FLA provides in-depth analyses of diverse policy scenarios that are related to various levels of economic aspects when it comes to the construction projects' valid decision making. The developed approach is applied to CPM to demonstrate its applicability. Analyzing the materials of glass facades, variants were defined. The development of the FLA for the CPM included relevant construction projec'ts stakeholders that were involved in the criteria definition to evaluate each variant. Using fuzzy Decision-Making Trial and Evaluation Laboratory Method (DEMATEL) comparison of the glass facade was conducted. This way, a rank, according to the priorities for inclusion into the main design, of variants is obtained. The concept was tested on a residential-commercial building in the city of Rijeka, Croatia. The newly developed methodology was then compared with the existing one. The aim of the research was to define an approach that will improve current judgments and decisions when it comes to the material selection of buildings facade as one of the most important architectural and engineering tasks in the main design. The advantage of the new methodology compared to the old one is that it includes the subjective side of the managers’ decisions, as an inevitable factor in each decision making. The proposed approach can help construction projects managers to identify the desired type of glass facade according to their preference and practical conditions, as well as facilitate in-depth analyses of tradeoffs between economic efficiency and architectural design.

Keywords: construction projects management, DEMATEL, fuzzy logic approach, glass façade selection

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Authors: Luiz Carlos Wrobel, Matjaz Hribersek, Jure Marn, Jurij Iljaz

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Dynamic thermography has been clinically proven to be a valuable diagnostic technique for skin tumor detection as well as for other medical applications such as breast cancer diagnostics, diagnostics of vascular diseases, fever screening, dermatological and other applications. Thermography for medical screening can be done in two different ways, observing the temperature response under steady-state conditions (passive or static thermography), and by inducing thermal stresses by cooling or heating the observed tissue and measuring the thermal response during the recovery phase (active or dynamic thermography). The numerical modelling of heat transfer phenomena in biological tissue during dynamic thermography can aid the technique by improving process parameters or by estimating unknown tissue parameters based on measured data. This paper presents a nonlinear numerical model of multilayer skin tissue containing a skin tumor, together with the thermoregulation response of the tissue during the cooling-rewarming processes of dynamic thermography. The model is based on the Pennes bioheat equation and solved numerically by using a subdomain boundary element method which treats the problem as axisymmetric. The paper includes computational tests and numerical results for Clark II and Clark IV tumors, comparing the models using constant and temperature-dependent thermophysical properties, which showed noticeable differences and highlighted the importance of using a local thermoregulation model.

Keywords: boundary element method, dynamic thermography, static thermography, skin tumor diagnostic

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Authors: Hayley Boal, Chloe Bromley, John Fairfield

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Novel Psychoactive Substances (NPS) are synthetic compounds designed to reproduce effects of illicit drugs. Cheap, potent, and readily available on UK highstreets from so-called ‘head shops’, in recent years their use has surged and with it have emerged side effects including seizures, aggression, palpitations, coma, and death. Rapid development of new substances has vastly outpaced pre-existing drug legislation but the Psychoactive Substances Act 2016 rendered all but tobacco, alcohol, and amyl nitrates, illegal. Drug use has long been rife within prisons, but the absence of a reliable screening tool alongside the availability of NPS makes them ideal for prison use. Here we examine the occurrence of NPS-related adverse side effects within HMP Leeds, comparing May-September of 2015 and 2017 using daily reports distributed amongst prison staff summarising medical and behavioural incidents of the previous day. There was a statistically-significant rise of over 200% in the use of NPS between 2015 and 2017: 0.562 and 1.149 incidents per day respectively. In 2017, 38.46% incidents required ambulances, fallen from 51.02% in 2015. Although the most common descriptions in both years were ‘seizure’ and ‘unresponsive’, by 2017 ‘inhalation by staff’ had emerged. Patterns of NPS consumption mirrored the prison regime, peaking when cell doors opened, and prisoners could socialise. Despite limited data, the Psychoactive Substances Act has clearly been an insufficient deterrent to the prison population; more must be done to understand and address substance misuse in prison. NPS remains a significant risk to prisoners’ health and wellbeing.

Keywords: legislation, novel psychoactive substances, prison, spice

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Authors: Danhua Xu, Zhenlan Qian, Zhu Wang, Jiayan Fu, Ling Wang

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A new business mode called rural complex is proposed by the China’s government to promote the development the economy in the rural area. However, for the sake of current national conditions including the great number of labor farmers owning the small scale farmlands and the uncertain enthusiasm from the enterprises, it is challenging to develop the big scale rural complex. To react to the dilemmas, this paper puts forward the micro-rural complex to boost the small scale farms by co-participation from a bottom-up mode. By analyzing the potential opportunities to find the suitable mode, exploring the interdisciplinary and interdepartmental co-participation way beyond architecture design and spatial planning between different actors, the paper tries to find a complete process towards the sustainable micro-rural complex and conducts an ongoing practice to optimize it, to bring new insights and reference to the rural development. According to the transformation of the economy, the micro-rural complex will develop into two phases, both of which can be discussed in three parts, the economic mode, the spatial support, and the Cooperating mechanism. The first stage is the agriculture co-participation based on the rise of Community supported agriculture (CSA) in which the consumers buy the products planted in an organic way from the farmers directly with a higher price to support the small-scale agriculture and overcome the food safety issues. The following stage sets up the agritourism catering the citizens with the restaurants, inns and other tourist service facilities to be planned and designed. In the whole process, the interdisciplinary co-participation will play an important role to provide the guidelines and consultation from the agronomists, architects and rural planners to the farmers. This mode has been applied to an on-going farm project, from which to explore the mode in a more practical way. In conclusion, the micro-rural complex aims at creating a balanced urban-rural relationship by co-participation taking advantage of the different actors. The spatial development is considered from the economic mode and social organization. The integration of the mode based on the small-scale agriculture will contribute to a sustainable growth and realize the long run development in the rural area.

Keywords: micro-rural complex, co-participation, sustainable development, China

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Authors: Sungpil Ha, Ju Yong Kang, Sangbaek Park, Seung-Ju Lee, Soo-Won Chae

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The growing number of obese patients in aging societies has led to an increase in the number of patients with knee medial osteoarthritis (OA). Artificial joint insertion is the most common treatment for knee medial OA. Surgery is effective for patients with serious arthritic symptoms, but it is costly and dangerous. It is also inappropriate way to prevent a disease as an early stage. Therefore Non-operative treatments such as toe-in gait are proposed recently. Toe-in gait is one of non-surgical interventions, which restrain the progression of arthritis and relieves pain by reducing knee adduction moment (KAM) to facilitate lateral distribution of load on to knee medial cartilage. Numerous studies have measured KAM in various foot progression angle (FPA), and KAM data could be obtained by motion analysis. However, variations in stress at knee cartilage could not be directly observed or evaluated by these experiments of measuring KAM. Therefore, this study applied motion analysis to major gait points (1st peak, mid –stance, 2nd peak) with regard to FPA, and to evaluate the effects of FPA on the human lower extremity, the finite element (FE) method was employed. Three types of gait analysis (toe-in, toe-out, baseline gait) were performed with markers placed at the lower extremity. Ground reaction forces (GRF) were obtained by the force plates. The forces associated with the major muscles were computed using GRF and marker trajectory data. MRI data provided by the Visible Human Project were used to develop a human lower extremity FE model. FE analyses for three types of gait simulations were performed based on the calculated muscle force and GRF. We observed the maximum stress point during toe-in gait was lower than the other types, by comparing the results of FE analyses at the 1st peak across gait types. This is the same as the trend exhibited by KAM, measured through motion analysis in other papers. This indicates that the progression of knee medial OA could be suppressed by adopting toe-in gait. This study integrated motion analysis with FE analysis. One advantage of this method is that re-modeling is not required even with changes in posture. Therefore another type of gait simulation or various motions of lower extremity can be easily analyzed using this method.

Keywords: finite element analysis, gait analysis, human model, motion capture

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Authors: Ana Elisa Ribeiro Costa, Sónia Daniela Ferreira Miranda, João Pedro De Carvalho Pereira, João Carlos Simões Bernardo

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Elastomeric thermoplastics (TPEs) have been widely used in the footwear industry over the years. Recently this industry has been requesting materials that can combine lightweight and high abrasion resistance. Although there are blowing agents on the market to improve the lightweight, when these are incorporated into molten polymers during the extrusion or injection molding, it is necessary to have some specific processing conditions (e.g. effect of temperature and hydrodynamic stresses) to obtain good properties and acceptable surface appearance on the final products. Therefore, it is a great advantage for the compounder industry to acquire compounds that already include the blowing agents. In this way, they can be handled and processed under the same conditions as a conventional raw material. In this work, the expandable TPEs compounds, namely a TPU and a SEBS, with the incorporation of blowing agents, have been developed through a co-rotating modular twin-screw parallel extruder. Different blowing agents such as thermo-expandable microspheres and an azodicarbonamide were selected and different screw configurations and temperature profiles were evaluated since these parameters have a particular influence on the expansion inhibition of the blowing agents. Furthermore, percentages of incorporation were varied in order to investigate their influence on the final product properties. After the extrusion of these compounds, expansion was tested by the injection process. The mechanical and physical properties were characterized by different analytical methods like tensile, flexural and abrasive tests, determination of hardness and density measurement. Also, scanning electron microscopy (SEM) was performed. It was observed that it is possible to incorporate the blowing agents on the TPEs without their expansion on the extrusion process. Only with reprocessing (injection molding) did the expansion of the agents occur. These results are corroborated by SEM micrographs, which show a good distribution of blowing agents in the polymeric matrices. The other experimental results showed a good mechanical performance and its density decrease (30% for SEBS and 35% for TPU). This study suggested that it is possible to develop optimized compounds for footwear applications (e.g., sole shoes), which only will be able to expand during the injection process.

Keywords: blowing agents, expandable thermoplastic elastomeric compounds, low density, footwear applications

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