Search results for: clinical benefit

Authors: Peter J. Riley

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Medical Imaging students must understand the roles of Photo-electric Absorption (PE) and Compton Scatter (CS) interactions in patients to enable optimal X-ray imaging in clinical practice. A simulator has been developed that shows relative interaction probabilities, color bars for patient dose from PE, % penetration to the detector, and obscuring CS as Peak Kilovoltage (kVp) changes. Additionally, an anthropomorphic chest X-ray image shows the relative tissue contrasts and overlying CS-fog at that kVp, which determine the detectability of a lesion in the image. A series of interactive exercises with MCQs evaluate the student's understanding; the simulation has improved student perception of the need to acquire "sufficient" rather than maximal contrast to enable patient dose reduction at higher kVp.

Keywords: patient dose optimization, radiological physics, simulation, tissue contrast

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Authors: Nitin Shravan, Sudarsun Santhiappan, B. Sivaselvan

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Subsection identification, in the context of Electronic Health Records (EHRs), is identifying the important sections for down-stream tasks like auto-coding. In this work, we classify the text present in EHRs according to their information, using machine learning and deep learning techniques. We initially describe briefly about the problem and formulate it as a text classification problem. Then, we discuss upon the methods from the literature. We try two approaches - traditional feature extraction based machine learning methods and deep learning methods. Through experiments on a private dataset, we establish that the deep learning methods perform better than the feature extraction based Machine Learning Models.

Keywords: deep learning, machine learning, semantic clinical classification, subsection identification, text classification

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Authors: C. K. Peter Chuah

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Essentially, the intention of reflective journal is meant for students to develop higher-order thinking skills and to provide a 'space' to make their learning experience and thinking, making and feeling visible, i.e., it provides students an opportunity to evaluate their learning critically by focusing on the rationale behind their thinking, making and feeling. In addition, reflective journal also gets the students to focus on how could things be done differently—the possibility, alternative point of views, and opportunities for change. It is hoped that by getting communication design students to reflect at various intervals, they could move away from mere working on the design project and pay more attention to what they thought they have learned in relation to the development of their design ability. Unfortunately, a closer examination—through content analysis—of the learning journals submitted by a group of design students revealed that most of the reflections were descriptive and tended to be a summary of what occurred in the learning experience. While many students were able to describe what they did, very few were able to explain how they were able to do something critically. It can be concluded that to get design students to reflect is a fairly easy task, but to get them to reflect critically could be very challenging. To ensure that design students could benefit from the use of reflective journal as a tool to develop their critical thinking skills, a more systematic and structured approach to the introduction of critical thinking and reflective journal should be built into the design curriculum to provide as much practice and sufficient feedback as other studio subjects.

Keywords: communication design education, critical thinking, reflection, reflective journal

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Authors: P. J. Sweeney, T. Ahtoniemi, J. Puoliväli, T. Laitinen, K.Lehtimäki, A. Nurmi, D. Wells

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Duchenne muscular dystrophy (DMD) is an X-linked, lethal muscle wasting disease for which there are currently no treatment that effectively prevents the muscle necrosis and progressive muscle loss. DMD is among the most common of inherited diseases affecting around 1/3500 live male births. MDX (X-linked muscular dystrophy) mice only partially encapsulate the disease in humans and display weakness in muscles, muscle damage and edema during a period deemed the “critical period” when these mice go through cycles of muscular degeneration and regeneration. Although the MDX mutant mouse model has been extensively studied as a model for DMD, to-date an extensive temporal, non-invasive imaging profile that utilizes magnetic resonance imaging (MRI) and 1H-magnetic resonance spectroscopy (1H-MRS) has not been performed.. In addition, longitudinal imaging characterization has not coincided with attempts to exacerbate the progressive muscle damage by exercise. In this study we employed an 11.7 T small animal MRI in order to characterize the MRI and MRS profile of MDX mice longitudinally during a 12 month period during which MDX mice were subjected to exercise. Male mutant MDX mice (n=15) and male wild-type mice (n=15) were subjected to a chronic exercise regime of treadmill walking (30 min/ session) bi-weekly over the whole 12 month follow-up period. Mouse gastrocnemius and tibialis anterior muscles were profiled with baseline T2-MRI and 1H-MRS at 6 weeks of age. Imaging and spectroscopy was repeated again at 3 months, 6 months, 9 months and 12 months of age. Plasma creatine kinase (CK) level measurements were coincided with time-points for T2-MRI and 1H-MRS, but also after the “critical period” at 10 weeks of age. The results obtained from this study indicate that chronic exercise extends dystrophic phenotype of MDX mice as evidenced by T2-MRI and1H-MRS. T2-MRI revealed extent and location of the muscle damage in gastrocnemius and tibialis anterior muscles as hyperintensities (lesions and edema) in exercised MDX mice over follow-up period.. The magnitude of the muscle damage remained stable over time in exercised mice. No evident fat infiltration or cumulation to the muscle tissues was seen at any time-point in exercised MDX mice. Creatine, choline and taurine levels evaluated by 1H-MRS from the same muscles were found significantly decreased in each time-point, Extramyocellular (EMCL) and intramyocellular lipids (IMCL) did not change in exercised mice supporting the findings from anatomical T2-MRI scans for fat content. Creatine kinase levels were found to be significantly higher in exercised MDX mice during the follow-up period and importantly CK levels remained stable over the whole follow-up period. Taken together, we have described here longitudinal prophile for muscle damage and muscle metabolic changes in MDX mice subjected to chronic exercised. The extent of the muscle damage by T2-MRI was found to be stable through the follow-up period in muscles examined. In addition, metabolic profile, especially creatine, choline and taurine levels in muscles, was found to be sustained between time-points. The anatomical muscle damage evaluated by T2-MRI was supported by plasma CK levels which remained stable over the follow-up period. These findings show that non-invasive imaging and spectroscopy can be used effectively to evaluate chronic muscle pathology. These techniques can be also used to evaluate the effect of various manipulations, like here exercise, on the phenotype of the mice. Many of the findings we present here are translatable to clinical disease, such as decreased creatine, choline and taurine levels in muscles. Imaging by T2-MRI and 1H-MRS also revealed that fat content or extramyocellar and intramyocellular lipids, respectively, are not changed in MDX mice, which is in contrast to clinical manifestation of the Duchenne’s muscle dystrophy. Findings show that non-invasive imaging can be used to characterize the phenotype of a MDX model and its translatability to clinical disease, and to study events that have traditionally been not examined, like here rigorous exercise related sustained muscle damage after the “critical period”. The ability for this model to display sustained damage beyond the spontaneous “critical period“ and in turn to study drug effects on this extended phenotype will increase the value of the MDX mouse model as a tool to study therapies and treatments aimed at DMD and associated diseases.

Keywords: 1H-MRS, MRI, muscular dystrophy, mouse model

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Authors: Aliyu Aminu Baba, Mustapha Makama

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Tertiary institutions are citadel of learning and societal orientation. Due to the huge investment of various government to tertiary institutions, these institutions are solely financed by the government alone. As stakeholders of society, corporations have to have to intervene and provide corporate social responsibility. The study intends to investigate the role of Entrepreneurs in incorporating social Responsibility. Tertiary institutions are citadel of learning and societal orientation. Due to the huge investment of various government to tertiary institutions, the study intends to investigate the role of businesses and Entrepreneurs, which could be among the important contributions of businesses and Entrepreneurs on corporate social Responsibility to Tertiary Institutions in Bauchi State. Corporate social responsibility is vital in enhancing the infrastructural development of the tertiary institution as almost all individuals and corporate bodies benefit from this tertiary institutions. The study intends to examine the impact of corporate social responsibility to tertiary institutions and entrepreneurs in Bauchi state Nigeria. Questionnaires would be distributed to tertiary institutions and entrepreneurs in the Bauchi metropolis. The data collected will be analyzed with the help of SPSS version 23. The main objective is to investigate the role of businesses and Entrepreneurs, which could be among the important contributions of businesses and entrepreneurs on corporate social Responsibility to Tertiary Institutions in Bauchi State.

Keywords: corporate social responsibility, tertiary, institutions, profitability

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Authors: Waleed El-Said Abou El-Amaiem

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Sole hemorrhages are considered as a main cause for sub clinical laminitis. In this study we aimed at discussing the most prominent risk factors associated with sole hemorrhages causing lameness in Egyptian water buffaloes and native breed cows. The final multivariate logistic regression model showed, a significant association between sub acute ruminal acidosis (P< 0.05), limb affected (P< 0.05) and weight (P< 0.05) and sole hemorrhages causing lameness in Egyptian water buffaloes and native breed cows. According to our knowledge, this is the first paper to discuss the risk factors associated with sole hemorrhages causing lameness in Egyptian water buffaloes and native breed cows.

Keywords: lameness, buffalo, sole hemorrhages, breed cows

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Authors: T. L. Granzyk, S. Scarborough, J. DeCosmo

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The use of health-related or medical narratives has gained increasing anecdotal and research-based support as a successful device for changing health behavior and outcomes. These narratives, in the form of oral storytelling, short films, and educational documentaries, for example, are most effective when including empathetic characters that transport viewers into the story and command both their attention and emotional response. This case study outlines how and why one large health system created a short narrative film for their internal Sepsis Awareness campaign, which told the dramatic story of a patient recovering from a missed sepsis diagnosis, leaving her a quad-amputee. Results include positive global anecdotal response to the film from healthcare professionals and patients, as well as use of the film to support legislation, ultimately passed in favor of the formation of Sepsis Awareness Workgroups in Maryland. Authors conclude that narrative films can be used successfully to initiate healthcare legislation and to increase internal and external awareness of health-related areas in need of greater improvement and support. As such, healthcare leaders and stakeholders would benefit from learning how to intentionally create, cultivate, and curate narratives from within their own health systems that elicit an empathetic response.

Keywords: healthcare policy, healthcare narratives, sepsis awareness, short films

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Authors: Chong Wang, Kellem M. Soares, Luis E. Kosteski

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The problem of toughening in brittle materials reinforced by fibers is complex, involving all the mechanical properties of fibers, matrix, the fiber/matrix interface, as well as the geometry of the fiber. An appropriate method applicable to the simulation and analysis of toughening is essential. In this work, we performed simulations and analysis of toughening in brittle matrix reinforced by randomly distributed fibers by means of the discrete elements method. At first, we put forward a mechanical model of the contribution of random fibers to the toughening of composite. Then with numerical programming, we investigated the stress, damage and bridging force in the composite material when a crack appeared in the brittle matrix. From the results obtained, we conclude that: (i) fibers with high strength and low elasticity modulus benefit toughening; (ii) fibers with relatively high elastic modulus compared to the matrix may result in considerable matrix damage (spalling effect); (iii) employment of high-strength synthetic fiber is a good option. The present work makes it possible to optimize the parameters in order to produce advanced ceramic with desired performance. We believe combination of the discrete element method (DEM) with the finite element method (FEM) can increase the versatility and efficiency of the software developed.

Keywords: bridging stress, discrete element method, fiber reinforced composites, toughening

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Authors: Anthony Cogrove, Shagun Saikia, Pradeep Deshpande

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Introduction: Management of anxiety in rehabilitation setting often is a challenge and is usually done by using medication. The role of psychology and the creation of a quite environment in order to reduce stimulation helps in the process. We have a hypothesis that feedback from a calm visual imagery with soothing music help in reducing anxiety in these setting Aim-To explore the possibility of using virtual reality in the management of anxiety in a setting of neuro-rehabilitation unit. Method: Six patients in an inpatient rehabilitation unit with acquired brain injury subjected to a low stimulation calming visual motion picture with calm music. Six sessions were conducted over 6 weeks. All sessions were performed in a separate purpose built room in the unit. . A cohort of 6 people with various neurological conditions were involved in 6 sessions of 30 minutes during their inpatient rehabilitation. They reported benefit from using the virtual reality environment in reducing their anxiety. Results: All reported improvement in their anxiety levels. They felt there was a calming effect of the session. There was a sense of feeling of self empowerment on direct questioning. Conclusion: Virtual reality environment can aid the traditional rehabilitation techniques used to manage the levels of anxiety experienced by people with acquired brain injury undergoing inpatient rehabilitation.

Keywords: neurological rehabilitation, virtual reality, anxiety, calming environment

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Authors: Abubakar Mohammed Bakoji

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The paper examine business ethics through it pursuit for corporate social responsibility to the society in which the business long existed, Zenith bank PLC was selected as case study for it longer period of its business in the state, in order to achieve the research objective of the paper which sought the following: i. To examine relationship between business ethics and corporate social responsibility in Zenith bank PLC Jalingo; ii. To establish whether or not such ethics statement that acclaim corporate social responsibility are adhere to by the Zenith bank PLC Jalingo; iii. To determine the benefit drive by the society on the corporate social responsibility of Zenith bank PLC Jalingo to the people of the state of their operation. The research was conducted using qualitative research design approach, where convenience sampling technique was adopted using semi structured interview to one of the key staff of Zenith bank PLC Jalingo and five other beneficiaries of Zenith bank PLC corporate social responsibility projects served as respondents. The data obtained was analyze using content analysis and the result of the findings revealed that Zenith bank PLC has a Good business ethics and they adhere to the ethics, that they have completed several viable projects to the state as their corporate social responsibility and the beneficiaries and the respondents beneficiaries has confirmed and have produced evidence of how the projects has assisted in stifle their hardship. Hence, business ethics has a significant relationship with corporate social responsibility in Zenith bank PLC Jalingo.

Keywords: business ethics, Corporate Social Responsibility, Zenith Bank PLC, business ethics

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Authors: Senthilkumar S, Vijayakumar R M , Soorianathasundaram K, Durga Devi D

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A study was conducted to assess the influence of brassinosteroid and other bioregulators as pre-harvest sprays on yield and quality of newly introduced Californian grape cv. Italia. The vines were exposed to standardized pruning level of pruning 50% of the canes to 5-6 bud level for fruiting and 50% of the canes to two bud level for vegetative growth. The influence of brassinosteroid was assessed using BR (1 ppm) alone and in combination with GA3 and CPPU, sprayed at three different stages over the control (water spray) were given as treatments. The results revealed that the bunches treated with Brassinosteroid (1 ppm) + GA3 (10 ppm) at pea stage i.e., 7-8 mm berry size, recorded the maximum values on yield characters like bunch weight (719.94 g), yield per vine (12.70 kg/vine) and yield per hectare (15.88 t). The berry characters and quality traits were also significantly influenced by the application of bioregulators. The maximum value for all those characters was registered under bunch sprays of Brassinosteroid (1 ppm) + GA3 (10 ppm) at pea stage. The economic feasibility indicated that the treatment combination Brassinosteroid (1 ppm) + GA3 (10 ppm) at pea stage (7-8 mm berry size) had registered the maximum benefit cost ratio of 3.13, as compared to 1.89 in control (water spray). Overall, it was observed that a combined bunch spray of Brassinosteroid (1 ppm) + GA3 (10 ppm) at pea stage (7-8 mm berry size) was adjudged as the best treatment for promoting the crop for better the bunch quality and yield.

Keywords: bioregulators, brassinosteroid, CPPU, GA3, Italia grape cultivar

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Authors: Sofia Papadimitriou

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INTRODUCTION: The differential diagnosis between acute viral and bacterial infections is an important cost-effectiveness parameter at the stage of the treatment process in order to achieve the maximum benefits in therapeutic intervention by combining the minimum cost to ensure the proper use of antibiotics.The discovery of sensitive and robust molecular diagnostic tests in response to the role of the host in infections has enhanced the accurate diagnosis and differentiation of infections. METHOD: The study used a sample of six independent blood samples (total=756) which are associated with human proteins-proteins, each of which at the transcription stage expresses a different response in the host network between viral and bacterial infections.Τhe individual blood samples are subjected to a sequence of computer filters that identify a gene panel corresponding to an autonomous diagnostic score. The data set and the correspondence of the gene panel to the diagnostic patents a new Bangalore -Viral Bacterial (BL-VB). FINDING: We use a biomarker based on the blood of 10 genes(Panel-VB) that are an important prognostic value for the detection of viruses from bacterial infections with a weighted average AUROC of 0.97(95% CL:0.96-0.99) in eleven independent samples (sets n=898). We discovered a base with a patient score (VB 10 ) according to the table, which is a significant diagnostic value with a weighted average of AUROC 0.94(95% CL: 0.91-0.98) in 2996 patient samples from 56 public sets of data from 19 different countries. We also studied VB 10 in a new cohort of South India (BL-VB,n=56) and found 97% accuracy in confirmed cases of viral and bacterial infections. We found that VB 10 (a)accurately identifies the type of infection even in unspecified cases negative to the culture (b) shows its clinical condition recovery and (c) applies to all age groups, covering a wide range of acute bacterial and viral infectious, including non-specific pathogens. We applied our VB 10 rating to publicly available COVID 19 data and found that our rating diagnosed viral infection in patient samples. RESULTS: Τhe results of the study showed the diagnostic power of the biomarker VB 10 as a diagnostic test for the accurate diagnosis of acute infections in recovery conditions. We look forward to helping you make clinical decisions about prescribing antibiotics and integrating them into your policies management of antibiotic stewardship efforts. CONCLUSIONS: Overall, we are developing a new property of the RNA-based biomarker and a new blood test to differentiate between viral and bacterial infections to assist a physician in designing the optimal treatment regimen to contribute to the proper use of antibiotics and reduce the burden on antimicrobial resistance, AMR.

Keywords: acute infections, antimicrobial resistance, biomarker, blood transcriptome, systems biology, classifier diagnostic score

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Authors: Archana Gandhi

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Indian apparel manufacturers see several benefits of Corporate Social Responsibility (CSR). At the same time, they clearly face steep challenges in its implementation. From the perspective of the participants, the challenges tend to outweigh the benefits. The short-term expenses, misperceptions about the financial benefits of CSR and the additional burden of implementing CSR-related policies and activities tend to overshadow perceptions of the long-term benefits. CSR activities currently seen in the Indian apparel industry are primarily people focused, society-focused or environment-focused. However, most CSR activities focus on employee welfare, including teaching employees about health and safety awareness, creating opportunities for community building, and providing general education to employees. Employee retention is very high in socially responsible Indian firms as compared to non-CSR firms, largely because CSR plays a crucial role in overall employee satisfaction, which translates to worker loyalty and low turnover. Employee retention and commitment are not the​ only potential benefits of CSR in the Indian apparel industry. CSR can also enhance a company’s image. Although it is a long-term benefit, being socially responsible can build a company’s social reputation and help it to gain others’ trust. Buyers do not hesitate to do business with these companies, since it is difficult to find socially responsible firms in India.

Keywords: corporate social responsibility, apparel industry, workers, improve work life

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Authors: Gerard Bray, Arya Bahadori, Sachinka Ranasinghe

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Renal cell carcinoma (RCC) is among the top 10 most common cancers worldwide, where metastatic disease carries a poor prognosis. Herein, we present a 74-year-old male presenting with asymptomatic solitary metachronous metastasis to the gall bladder 4 years following nephrectomy for clear cell RCC. Solitary RCC metastasis to the gall bladder following nephrectomy is rarely reported in the literature and brings with it a clinical conundrum of whether surgical resection or systemic therapy should be utilized. In this case, surgical excision with cholecystectomy was employed without systemic therapy. We, therefore, contribute a rare and interesting case that highlights that metastasectomy of a solitary metastasis can improve survival according to current literature.

Keywords: renal cell carcinoma, gall bladder metastasis, solitary metastasectomy, metachronous

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Authors: Raheel Shakoor Siddiqui, Shahbaz Malik, Manikandar Srinivas Cheruvu, Sanjay Narayana Murthy, Livio DiMascio

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Background: elderly traumatic hip fracture patients frequently present to trauma services globally. Rising low energy falls amongst an osteoporotic aging population is the commonest cause for injury. Hip fractures in this population are a major cause for severe pain, morbidity and mortality. The term hip fracture is interchangeable with neck of femur fracture, fractured neck of femur or proximal femur fracture. Hip fracture pain management protocols and guidelines suggest conventional analgesia, nerve block and opioid based treatment as rescue analgesia. There is a current global opioid crisis with overuse, abuse and dependence. Adverse opioid related complications in vulnerable elderly patients further adds to morbidity and mortality. Systematic reviews in literature have evidenced superiority of multimodal analgesia in osteoarthritic primary joint replacements compared to opioids however, this has not yet been conducted for elderly traumatic hip fracture patients. Aims: The primary aim of this systematic review is to provide standardised evidence following Cochrane and PRISMA guidance in determining advantages of perioperative multimodal analgesia over conventional opioid based treatments in elderly traumatic hip fractures. Methods: 5 databases were searched from January 2000-2023 which identified 8 randomised controlled trials and 446 total participants. These trials met defined PICOS eligibility criteria of patient mean age ≥ 65 years presenting with a unilateral traumatic fractured neck of femur for operative intervention. Analgesic intervention with perioperative multimodal analgesia has been compared to conventional opioid based analgesia. Outcomes of interest include, primarily, the change in postoperative opioid consumption within a 0-30 postoperative period and secondarily, the change in postoperative adverse events and complications. A qualitative synthesis has been performed due to clinical heterogenicity and variance amongst trials. Results: GRADE evidence of moderate quality supports perioperative multimodal analgesia leads to a reduction in postoperative opioid consumption however, low quality evidence supports a reduction of adverse effects and complications. Conclusion: Perioperative multimodal analgesia whether used preoperative, intraoperative and/or postoperative leads to a reduction in postoperative opioid consumption for elderly traumatic hip fracture patients. This review recommends the use of perioperative multimodal analgesia as part of hip fracture pain protocols however, caution and clinical judgement should be used as the risk of adverse effects may not be lower.

Keywords: trauma, orthopaedics, hip, fracture, neck of femur fracture, analgesia, multimodal analgesia, opioid

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Authors: Bayu Rizky Pratama, Hardiansyah Nur Sahaya

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Riau Province is the worst emitter for forest burning which causes the huge scale of externality such as declining of forest habitat, health disease, and climate change impact. Indonesia forum of budget transparency for Riau Province (FITRA) reported the length of forest burning reached about 186.069 hectares which is 7,13% of total national forest burning disaster, consisted of 107.000 hectares of peatland and the rest 79.069 hectares of mineral land. Anti-fire group, a voluntary group next to the forest, to help in protecting the forest burning and heavily smoke residual has been established but unfortunately the implementation still far from expectation. This research will emphasize on (1) how the anti-fire group contribute to fire hazard tackling; (2) the identification of SWOT analysis to enhance the group benefit; and (3) government policy implication to maximize the role of Anti-fire group and reduce the case of forest burning as well as heavily smoke which can raise climate change impact. As the observation found some weakness from SWOT identification such as (1) lack of education and training; (2) facility in extinguishing the fire damage; (3) law for economic incentive; (4) communication and field experience; (5) also the reporting the fire case.

Keywords: anti-fire group, forest burning impact, SWOT, climate change mitigation

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Authors: Y. Z. Gad

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Disorders of Sex Development (DSD) are defined as congenital conditions in which development of chromosomal, gonadal or anatomical sex is atypical. The DSD are relatively prevalent in Egypt. In spite of that, the relative rarity of the individual disease types or their molecular pathologies frequently resulted in reporting on single or few cases. This augmented the challenging nature of phenotype-genotype correlation in this disease group and its utilization in the management of such medical emergency. Through critical assessment of the published DSD reports, the current review aims at analyzing the clinical characteristics of the various DSD forms in relation to the underlying molecular pathologies. A systematic literature search was done in Pubmed, using relevant keywords (Egypt versus DSD, genital ambiguity or ambiguous genitalia, the old terms of 'intersex, hermaphroditism and pseudohermaphroditism', and a list of the DSD entities and their related genes). The search yielded 24 reports of molecular data in Egyptian patients presenting with ambiguous genitalia. However, only 21 publications fulfilled the criteria of inclusion of detailed clinical descriptions and definitive molecular diagnoses of individual patients. Curation of the data yielded a total of 53 cases that were ascertained from 40 families. Fifty-one patients present with ambiguous genitalia only while 2 had multiple congenital anomalies. Parental consanguinity was noted in 60% of cases. Sex of rearing at initial presentation was female in 75% and 60% in 46,XY and 46,XX DSD cases, respectively. The external genital phenotype in 2/3 of the 46,XY DSD cases showed moderate undermasculinization [Quigley scores 3 & 4] and 1/3 had severe presentations [scores 5 & 6]. For 46,XX subjects, 1 had severe virilization of the external genitalia while 8 had moderate phenotype. Hormonal data were inconclusive or contradictory to final diagnosis in a forth of cases. Collectively, 31 families [31/40, 77.5%] with 46,XY DSD had molecular defects in the genes, 5 alpha reductase 2 (SRD5A2) [12/31], 17 beta-hydroxysteroid dehydrogenase 3 [8/31], androgen receptor [7/31], Steroidogenic factor 1 [2/31], luteinizing hormone receptor [1/31], and fibroblast growth factor receptor 1 [1/31]. In a multiethnic study, 9 families afflicted with 46,XX DSD due to 11 beta hydroxylase (CYP11B1) deficiency were documented. Two recurrent mutations, G34R and N160D, in SRD5A2 were present, respectively, in 42 and 17% of cases. Similarly, 4 recurrent mutations resulted in 89% of the CYP11B1 presentations. In conclusion, this analysis highlights the importance of autosomal recessive inheritance and inbreeding among DSD presentations, the importance of founder effect in at least 2 disorders, the difficulties in relating the genotype with the indeterminate genital phenotype, the under-reporting of some DSD subtypes, and the notion that the reported mutational profiles among Egyptian DSD cases are relatively different from those reported in other ethnic groups.

Keywords: disorders of sex development, genital ambiguity, mutation, molecular diagnosis, Egypt

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Authors: Sofia Horjales, Florencia Palma

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Our society is currently experiencing a profound transformation, demanding a proactive response from governmental bodies and higher education institutions to empower the next generation as catalysts for change. Environmental sustainability is rooted in the critical need to maintain the equilibrium and integrity of natural ecosystems, ensuring the preservation of precious natural resources and biodiversity for the benefit of both present and future generations. It is an essential cornerstone of sustainable development, complementing social and economic sustainability. In this evolving landscape, active methodologies take a central role, aligning perfectly with the principles of the 2030 Agenda for Sustainable Development and emerging as a pivotal element of teacher education. The emphasis on active learning methods has been driven by the urgent need to nurture sustainability and instill social responsibility in our future leaders. The Universidad Tecnológica of Uruguay (UTEC) is a public, technologically-oriented institution established in 2012. UTEC is dedicated to decentralization, expanding access to higher education throughout Uruguay, and promoting inclusive social development. Operating through Regional Technological Institutes (ITRs) and associated centers spread across the country, UTEC faces the challenge of remote student populations. To address this, UTEC utilizes e-learning for equal opportunities, self-regulated learning, and digital skills development, enhancing communication among students, teachers, and peers through virtual classrooms. The Interdisciplinary Continuing Education Program is part of the Innovation and Entrepreneurship Department of UTEC. The main goal is to strengthen innovation skills through a transversal and multidisciplinary approach. Within this Program, we have developed a Case of Study and Project-Based Learning Virtual Course designed for university students and open to the broader UTEC community. The primary aim of this course is to establish a strong foundation for comprehending and addressing environmental sustainability issues from an interdisciplinary perspective. Upon completing the course, we expect students not only to understand the intricate interactions between social and ecosystem environments but also to utilize their knowledge and innovation skills to develop projects that offer enhancements or solutions to real-world challenges. Our course design centers on innovative learning experiences, rooted in active methodologies. We explore the intersection of these methods with sustainability and social responsibility in the education of university students. A paramount focus lies in gathering student feedback, empowering them to autonomously generate ideas with guidance from instructors, and even defining their own project topics. This approach underscores that when students are genuinely engaged in subjects of their choice, they not only acquire the necessary knowledge and skills but also develop essential attributes like effective communication, critical thinking, and problem-solving abilities. These qualities will benefit them throughout their lifelong learning journey. We are convinced that education serves as the conduit to merge knowledge and cultivate interdisciplinary collaboration, igniting awareness and instigating action for environmental sustainability. While systemic changes are undoubtedly essential for society and the economy, we are making significant progress by shaping perspectives and sparking small, everyday actions within the UTEC community. This approach empowers our students to become engaged global citizens, actively contributing to the creation of a more sustainable future.

Keywords: active learning, environmental education, project-based learning, soft skills development

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Authors: Noa Shriki, Atara Shriki

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Lifelong learning is considered as essential for teacher's professional development, which in turn has implications for the improvement of the entire education system. In recent years, many programs designed to support teachers' professional development are criticized for not achieving their goal. A variety of reasons have been proposed for the purpose of explaining the causes of the ineffectiveness of such programs. In this study, we put to test the possibility that teachers do not change as a result of their participation in professional programs due to a gap between the contents and approaches included in them and teacher's beliefs about teaching and learning. Eighteen elementary school mathematics teachers participated in the study. These teachers were involved in collaborating with their students in inquiring mathematical ideas, while implementing action research. Employing educational theories, the results indicated that this experience had a positive effect on teacher's professional development. In particular, there was an evident change in their beliefs regarding their role as mathematics teachers. However, while employing a different perspective for analyzing the data, the lens of Kurt Lewin's theory of re-education, we realized that this change of beliefs must be questioned. Therefore, it is suggested that analysis of educational processes should be carried out not only through common educational theories, but also on the basis of social and organizational theories. It is assumed that both the field of education and the fields of social studies and organizational consulting will benefit from the multifocal viewpoint

Keywords: educational theories, professional development, re-education, teachers' beliefs

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Authors: Brighton Chamunorwa

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The current remote sensing of water quality procedures does not provide a step representing physical visualisation of the monitored dam. The application of the remote sensing of water quality techniques may benefit from use of mathematical morphology operators for shape identification. Given an input of dam outline, morphological operators such as the hit or miss transform identifies if the water body is present on input remotely sensed images. This study seeks to determine the accuracy of the hit or miss transform to identify dams monitored by the water resources authorities in South Africa on satellite images. To achieve this objective the study download a Landsat image acquired in winter and tested the capability of the hit or miss transform using shapefile boundaries of dams in the crocodile marico catchment. The results of the experiment show that it is possible to detect most dams on the Landsat image after the adjusting the erosion operator to detect pixel matching a percentage similarity of 80% and above. Successfully implementation of the current study contributes towards optimisation of mathematical morphology image operators. Additionally, the effort helps develop remote sensing of water quality monitoring with improved simulation of the conventional procedures.

Keywords: hit or miss transform, mathematical morphology, remote sensing, water quality monitoring

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Authors: Emmylou Rahtz, Sarah Goldingay, Sara Warber, Ann Arbor, Paul Dieppe

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Introduction: Lourdes is a Catholic, Marian healing venue in South West France. Many miraculous cures have been attributed to visits there. In addition, many visitors seem to experience improvements in health and wellbeing, in the absence of a cure of disease. We wanted to investigate that phenomenon. Methods: We spent 10 days in Lourdes in 2017, carrying out ethnographic research, talking to many visitors, and carrying out formal, recorded interviews with several pilgrims, doctors, nurses, helpers, and priests. Results: Profound experiences and improvements in health and wellbeing were commonly reported. A number of ‘noetic’ experiences were also described. The paper will illustrate these phenomena. In addition, many participants in the research talked about why being in Lourdes was so beneficial to them. The community spirit, ethos of prayer, flow, synchronicity, and ability to find new meaning for life’s ills were cited as likely reasons. Conclusions: We believe that the ‘real miracle’ of Lourdes is the fact that of the many hundreds of thousands of people who go there each year, many find great benefit in health and wellbeing. It is likely that this is due to the ethos of the place, the community spirit, non-judgmental approach and loving acceptance of all aspects of humanity. Acknowledgments: We thank the BIAL foundation for generous funding of this research, and Dr. Alessandro de Franciscis and his team for facilitating our work, as well as all those who participated.

Keywords: healing, miracles, noetic experiences, wellbeing

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Authors: Michael Zaidman, Naum Simanovsky

Abstract:

The most of brachial birth palsies are transient. Children with incomplete recovery almost always develop an internal rotation and adduction contracture. The muscle imbalance around the shoulder results in glenohumeral joint deformity and functional limitations. Natural history of glenohumeral deformity is it’s progression with worsening of function. Anteversion glenoid osteotomy with latissimus dorsi and teres major tendon transfers could be an alternative procedure of proximal humeral external rotation osteotomy for patients with severe glenohumeral dysplasia secondary to brachial plexus birth palsy. We will discuss pre-operative planning and stepped operative technique of the procedure on clinical example.

Keywords: obstetric brachial plexus palsy, glenoid anteversion osteotomy, tendon transfer, operative technique

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Authors: Juan Manuel Martinez Alvarez, Michele Chiumenti

Abstract:

This work explores the benefit of the thermo-metallurgical simulation to tackle the Wire Laser Additive Manufacturing (WLAM) of low-carbon steel components. The Finite Element Analysis is calibrated by process monitoring via thermal imaging and thermocouples measurements, to study the complex thermo-metallurgical behavior inherent to the WLAM process of low carbon steel parts.A critical aspect is the analysis of the heterogeneity in the resulting microstructure. This heterogeneity depends on both the thermal history and the residual stresses experienced during the WLAM process. Because of low carbon grades are highly sensitive to quenching, a high-gradient microstructure often arises due to the layer-by-layer metal deposition in WLAM. The different phases have been identified by scanning electron microscope. A clear influence of the heterogeneities on the final mechanical performance has been established by the subsequent mechanical characterization. The thermo-metallurgical analysis has been used to determine the actual thermal history and the corresponding thermal gradients during the printing process. The correlation between the thermos-mechanical evolution, the printing parameters and scanning sequence has been established. Therefore, an enhanced printing strategy, including optimized process window has been used to minimize the microstructure heterogeneity at ArcelorMittal.

Keywords: additive manufacturing, numerical simulation, metallurgy, steel

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Authors: Shahid Iqbal, Haroon Z. Khan, Muhammad Arif

Abstract:

A sustainable agricultural system involving the improvement in soil properties and crop performance cannot be developed without organic fertilizer use. The effects of poultry manure compost (PMC) and pressmud compost (PrMC) at different levels on improving the soil properties and maize performance has not been yet described by any study comprehensively. Thus, field experiments (2011 and 2012) were conducted at Agronomy Research Area, University of Agriculture Faisalabad (31°26'5" N and 73°4'6" E) in sandy loam soil to determine the improvement in soil properties and maize performance due to application of PMC and PrMC each at five different levels (2, 4, 6, 8 and 10 t ha-1). A control (unamended) treatment was also included for comparison. The results indicated that performance of PMC levels was superior to PrMC levels. Increasing both composts levels improved soil properties, maize growth, and stover yield. Results showed that during both years’ highest rates of PMC i.e. 10 and 8 t ha-1 improved the soil properties: ECe, pH, inorganic N, OM, and WHC higher than other treatments. While, 10 and 8 t PMC ha-1 also significantly increased leaf area index (LAI), crop growth rate (CGR) and net assimilation rate (NAR), and stover yield. Similarly, 10 and 8 t PMC ha-1 also improved the grain protein content, but contrarily, grain oil was lowest for 10 and 8 t ha-1 PMC during both years. Moreover, in both years highest gross and net income, and benefit cost ratio was also achieved by 10 and 8 t ha-1 PMC. It is concluded that PMC at rate of 10 and 8 t ha-1 sustainably improved soil properties and maize performance.

Keywords: compost, soil, maize, growth, yield

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Authors: A. Dudek, P. Tylec, G. Torbicz, P. Duda, K. Proniewska, P. Major, M. Pedziwiatr

Abstract:

Background: Conservative treatments of obesity, based only on a proper diet and physical activity, without the support of an interdisciplinary team of specialist does not bring satisfactory bariatric results. Long-term maintenance of a proper metabolic results after rapid weight loss due to bariatric surgery requires engagement from patients. Mobile health tool may offer alternative model that enhance participant engagement in keeping the therapy. Objective: We aimed to assess the influence of constant monitoring and subsequent motivational alerts in perioperative period and on post-operative effects in the bariatric patients. As well as the study was designed to identify factors conductive urge to change lifestyle after surgery. Methods: This prospective clinical control study was based on a usage of a designed prototype of bariatric mHealth system. The prepared application comprises central data management with a comprehensible interface dedicated for patients and data transfer module as a physician’s platform. Motivation system of a platform consist of motivational alerts, graphic outcome presentation, and patient communication center. Generated list of patients requiring urgent consultation and possibility of a constant contact with a specialist provide safety zone. 31 patients were enrolled in continuous monitoring program during a 6-month period along with typical follow-up visits. After one year follow-up, all patients were examined. Results: There were 20 active users of the proposed monitoring system during the entire duration of the study. After six months, 24 patients took a part in a control by telephone questionnaires. Among them, 75% confirmed that the application concept was an important element in the treatment. Active users of the application indicated as the most valuable features: motivation to continue treatment (11 users), graphical presentation of weight loss, and other parameters (7 users), the ability to contact a doctor (3 users). The three main drawbacks are technical errors (9 users), tedious questionnaires inside the application (5 users), and time-consuming tasks inside the system (2 users). Conclusions: Constant monitoring and successive motivational alerts to continue treatment is an appropriate tool in the treatment after bariatric surgery, mainly in the early post-operative period. Graphic presentation of data and continuous connection with a clinical staff seemed to be an element of motivation to continue treatment and a sense of security.

Keywords: bariatric surgery, mHealth, mobile health tool, obesity

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Authors: Spira A., Marabelle A., Kientop D., Moser E., Mumm J.

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Background: Both interleukin-2 (IL-2) and interleukin-10 (IL-10) have been extensively studied for their stimulatory function on T cells and their potential to obtain sustainable tumor control in RCC, melanoma, lung, and pancreatic cancer as monotherapy, as well as combination with PD-1 blockers, radiation, and chemotherapy. While approved, IL-2 retains significant toxicity, preventing its widespread use. The significant efforts undertaken to uncouple IL-2 toxicity from its anti-tumor function have been unsuccessful, and early phase clinical safety observed with PEGylated IL-10 was not met in a blinded Phase 3 trial. Deka Biosciences has engineered a novel molecule coupling wild-type IL-2 to a high affinity variant of Epstein Barr Viral (EBV) IL-10 via a scaffold (scFv) that binds to epidermal growth factor receptors (EGFR). This patented molecule, termed DK210 (EGFR), is retained at high levels within the tumor microenvironment for days after dosing. In addition to overlapping and non-redundant anti-tumor function, IL-10 reduces IL-2 mediated cytokine release syndrome risks and inhibits IL-2 mediated T regulatory cell proliferation. Methods: DK210 (EGFR) is being evaluated in an open-label, dose-escalation (Phase 1) study with 5 (0.025-0.3 mg/kg) monotherapy dose levels and (expansion cohorts) in combination with PD-1 blockers, or radiation or chemotherapy in patients with advanced solid tumors overexpressing EGFR. Key eligibility criteria include 1) confirmed progressive disease on at least one line of systemic treatment, 2) EGFR overexpression or amplification documented in histology reports, 3) at least a 4 week or 5 half-lives window since last treatment, and 4) excluding subjects with long QT syndrome, multiple myeloma, multiple sclerosis, myasthenia gravis or uncontrolled infectious, psychiatric, neurologic, or cancer disease. Plasma and tissue samples will be investigated for pharmacodynamic and predictive biomarkers and genetic signatures associated with IFN-gamma secretion, aiming to select subjects for treatment in Phase 2. Conclusion: Through successful coupling of wild-type IL-2 with a high affinity IL-10 and targeting directly to the tumor microenvironment, DK210 (EGFR) has the potential to harness IL-2 and IL-10’s known anti-cancer promise while reducing immunogenicity and toxicity risks enabling safe concomitant cytokine treatment with other anti-cancer modalities.

Keywords: cytokine, EGFR over expression, interleukine-2, interleukine-10, clinical trial

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Authors: Wolfram Jahn, Jose Manuel Munita

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While computational fluid dynamics (CFD) simulations of fire scenarios are commonly used in the design of buildings, less attention has been given to the use of CFD simulations as an operational tool for the fire services. The reason of this lack of attention lies mainly in the fact that CFD simulations typically take large periods of time to complete, and their results would thus not be available in time to be of use during an emergency. Firefighters often face uncertain conditions when entering a building to attack a fire. They would greatly benefit from a technology based on predictive fire simulations, able to assist their decision-making process. The principal constraint to faster CFD simulations is the fine grid necessary to solve accurately the physical processes that govern a fire. This paper explores the possibility of overcoming this constraint and using coarse grid CFD simulations for fire scenarios, and proposes a methodology to use the simulation results in a meaningful way that can be used by the fire fighters during an emergency. Data from real scale compartment fire tests were used to compare CFD fire models with different grid arrangements, and empirical correlations were obtained to interpolate data points into the grids. The results show that the strongly predominant effect of the heat release rate of the fire on the fluid dynamics allows for the use of coarse grids with relatively low overall impact of simulation results. Simulations with an acceptable level of accuracy could be run in real time, thus making them useful as a forecasting tool for emergency response purposes.

Keywords: CFD, fire simulations, emergency response, forecast

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Authors: Vikram Singh

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This paper aims to take into account carbon tax or cap-and-trade legislation to manage Delhi carbon emissions after a post-Kyoto treaty. This report estimated the influence of the carbon taxes or rebate/compensation cost at the household level. Here, the three possible scenarios will help to comprehend the difference between a straightforward compensation/rebate, and two clearly denoting progressive formula. The straightforward compensation is basically minimizing the regressive applications that will bears on cost. On the other hand, both the progressive formula will generate extra revenue, which will help for feasibility of more efficient, vehicles, appliances and buildings in the low-income household. For the hypothetical case of carbon price $40/tonne, low-income household for both urban and rural region could experience price burden up to 5% and 9% on their income as compared to 3% and 7% for high-income household respectively. The survey report also shown that carbon emission due low-income household are primarily by the substantive requirement like housing and transportation whereas almost 40% emission due to high-income household are by luxurious and non-essential items. The equal distribution of revenue cum incentives will not completely overcome high-income household’s investment in inessential items. However, it will merely help in investing their income in energy efficient and less carbon intensive items. Therefore, the rebate distribution on per capita basis instead on per households will benefit more especially large families at low-income group.

Keywords: household emission, carbon credit, carbon intensity, green house gas emission, carbon generation based insentives

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Authors: Ahmed A. Abd El Rahim, Andrew Anis Fakhrey Mosaad

Abstract:

Background: An important psychological issue that has an impact on both mental and physical function is anxiety disorders. The general consensus is that aerobic exercise and physical activity are good for lowering anxiety and mood. Purpose: This study's goal was to look into how patients with anxiety disorders responded to aerobic exercise. Subjects: Anxiety disorders were identified in 30 individuals from the psychiatric hospital at Sohag University who were chosen based on inclusive criteria and had ages ranging from 25 to 45. Methods: Patients were split into two equal groups at random: For four weeks, three sessions per week, fifteen patients in group A (the study group), seven men and eight women, underwent medication therapy and aerobic exercise. Age (28.4 ± 2.11 years), weight (72.5 ± 10.06 kg), height (164.8 ± 9.64 cm), and BMI (26.65 ± 2.68 kg/m2) were all mean SD values. And in Group B (Control Group), only medication therapy was administered to 15 patients (9 males and 6 females). Age (29.6 ± 3.68), weight (75 ± 7.07 kg), height (166.9 ± 6.75) cm, and BMI (26.87 ± 1.11) kg/m2 were the mean SD values. Before and after the treatment, the Hamilton Anxiety Scale was used to gauge the patient's degree of anxiety. Results: Within the two groups, there were significant differences both before and after the treatment. Following therapy, there was a significant difference between the two groups; the study group displayed better improvement on the Hamilton Anxiety Scale. Conclusion: Patients with anxiety problems can benefit from aerobic activities and antianxiety drugs as effective treatments for lowering anxiety levels.

Keywords: aerobic exercises, anxiety disorders, antianxiety medications, Hamilton anxiety scale

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Authors: Julianne Cai, Weili Xue, Yibin Wu

Abstract:

Social media retailing (SMR) platforms have become popular nowadays. It is characterized by a creative combination of content creation and product selling, which differs from traditional e-tailing (TE) with product selling alone. Motivated by real-world practices like social media platforms “TikTok” and douyin.com, we endeavor to study if the SMR model performs better than the TE model in a monopoly setting. By building a stylized economic model, we find that the SMR model does not always outperform the TE model. Specifically, when the SMR platform collects less commission from the seller than the TE platform, the seller, consumers, and social welfare all benefit more from the SMR model. In contrast, the platform benefits more from the SMR model if and only if the creator’s social influence is high enough or the cost of content creation is small enough. For the incentive structure of the content rewards in the SMR model, we found that a strong incentive mechanism (e.g., the quadratic form) is more powerful than a weak one (e.g., the linear form). The previous one will encourage the creator to choose a much higher quality level of content creation and meanwhile allowing the platform, consumers, and social welfare to become better off. Counterintuitively, providing more generous content rewards is not always helpful for the creator (seller), and it may reduce her profit. Our findings will guide the platform to effectively design incentive mechanisms to boost the content creation and retailing in the SMR model and help the influencers efficiently create content, engage their followers (fans), and price their products sold on the SMR platform.

Keywords: content creation, creator economy, incentive strategy, platform retailing

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