Search results for: fractional order systems

Authors: Angelis P. Barlampas

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An 89 years old woman came to the emergency department complaining of long-lasting headaches and nausea. A CT examination was performed, and a homogeneous midline anterior cranial fossa lesion was revealed, which was situated near the base and measured 2,4 cm in diameter. The patient was allergic, and an i.v.c injection could not be done on the spot, and neither could an MRI exam because of metallic implants. How could someone narrow down the differential diagnosis? The interhemispheric meningioma is usually a silent midline lesion with no edema, and most often presents as a homogeneous, solid type, isodense, or slightly hyperdense mass ( usually the smallest lesions as this one ). Of them, 20-30% have some calcifications. Hyperostosis is typical for meningiomas that abut the base of the skull but is absent in the current case, presumably of a more cephalad location that is borderline away from the bone. Because further investigation could not be done, as the patient was allergic to the contrast media, some other differential options should be considered. Regarding the site of the lesion, the most common other entities to keep in mind are the following: Metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma, giant aneurysm of the anterior cerebral artery, midline lesion. Appearance will depend on whether the aneurysm is non-thrombosed, or partially, or completely thrombosed. Non-contrast: slightly hyperdense, well-defined round extra-axial mass, may demonstrate a peripheral calcified rim, olfactory neuroblastoma, midline lesion. The mass is of soft tissue attenuation and is relatively homogeneous. Focal calcifications are occasionally present. When an intracranial extension is present, peritumoral cysts between it and the overlying brain are often present. Final diagnosis interhemispheric meningioma (Known from the previous patient’s history). Meningiomas come from the meningocytes or the arachnoid cells of the meninges. They are usually found incidentally, have an indolent course, and their most common location is extra-axial, parasagittal, and supratentorial. Other locations include the sphenoid ridge, olfactory groove, juxtasellar, infratentorial, intraventricular, pineal gland area, and optic nerve meningioma. They are clinically silent entities, except for large ones, which can present with headaches, changes in personality status, paresis, or symptomatology according to their specific site and may cause edema of the surrounding brain tissue. Imaging findings include the presence of calcifications, the CSF cleft sign, hyperostosis of adjacent bone, dural tail, and white matter buckling sign. After i.v.c. injection, they enhance brightly and homogenously, except for large ones, which may exhibit necrotic areas or may be heavily calcified. Malignant or cystic variants demonstrate more heterogeneity and less intense enhancement. Sometimes, it is inevitable that the needed CT protocol cannot be performed, especially in the emergency department. In these cases, the radiologist must focus on the characteristic imaging features of the unenhanced lesion, as well as in previous examinations or a known lesion history, in order to come to the right report conclusion.

Keywords: computed tomography, emergency radiology, metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma

Procedia PDF Downloads 59

Authors: Natalie Riley, Anita Quigley, Robert M. I. Kapsa, George W. Greene

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As the fields of medicine and bionics grow rapidly in technological advancement, the future and success of it depends on the ability to effectively interface between the artificial and the biological worlds. The biggest obstacle when it comes to implantable, electronic medical devices, is maintaining a ‘clean’, low noise electrical connection that allows for efficient sharing of electrical information between the artificial and biological systems. Implant fouling occurs with the adhesion and accumulation of proteins and various cell types as a result of the immune response to protect itself from the foreign object, essentially forming an electrical insulation barrier that often leads to implant failure over time. Lubricin (LUB) functions as a major boundary lubricant in articular joints, a unique glycoprotein with impressive anti-adhesive properties that self-assembles to virtually any substrate to form a highly ordered, ‘telechelic’ polymer brush. LUB does not passivate electroactive surfaces which makes it ideal, along with its innate biocompatibility, as a coating for implantable bionic electrodes. It is the aim of the study to investigate LUB’s anti-fouling properties and its potential as a safe, bioinspired material for coating applications to enhance the performance and longevity of implantable medical devices as well as reducing the frequency of implant replacement surgeries. Native, bovine-derived LUB (N-LUB) and recombinant LUB (R-LUB) were applied to gold-coated mylar surfaces. Fibroblast, chondrocyte and neural cell types were cultured and grown on the coatings under both passive and electrically stimulated conditions to test the stability and anti-adhesive property of the LUB coating in the presence of an electric field. Lactate dehydrogenase (LDH) assays were conducted as a directly proportional cell population count on each surface along with immunofluorescent microscopy to visualize cells. One-way analysis of variance (ANOVA) with post-hoc Tukey’s test was used to test for statistical significance. Under both passive and electrically stimulated conditions, LUB significantly reduced cell attachment compared to bare gold. Comparing the two coating types, R-LUB reduced cell attachment significantly compared to its native counterpart. Immunofluorescent micrographs visually confirmed LUB’s antiadhesive property, R-LUB consistently demonstrating significantly less attached cells for both fibroblasts and chondrocytes. Preliminary results investigating neural cells have so far demonstrated that R-LUB has little effect on reducing neural cell attachment; the study is ongoing. Recombinant LUB coatings demonstrated impressive anti-adhesive properties, reducing cell attachment in fibroblasts and chondrocytes. These findings and the availability of recombinant LUB brings into question the results of previous experiments conducted using native-derived LUB, its potential not adequately represented nor realized due to unknown factors and impurities that warrant further study. R-LUB is stable and maintains its anti-fouling property under electrical stimulation, making it suitable for electroactive surfaces.

Keywords: anti-fouling, bioinspired, cell attachment, lubricin

Procedia PDF Downloads 115

Authors: Biva Samadder, Samita Manna

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India is a melting pot of races, tribes, castes and communities. The population of India can be roughly branched into the huge majority of “Civilized” Indians of the Plains and the minority of Tribal population of the hill area and the forest who constituting almost 16 percent of total population of India. The Kirat community composed of four ethnic tribes: Limbu, Lepcha, Dhimal, and Rai. These Kirat people were found to be rich in indigenous knowledge, skill and practices especially for the use on medicinal plants and livelihood purposes. The “Mundhum" is the oral scripture or the “Bible of the Limbus” which serves as the canon of the codes of the Limbu socialization, their moral values and the very orientation of their lifestyle. From birth till death the Limbus are disciplined in the life with full of religious rituals, traditions and culture governed by community norms with a rich legacy of indigenous knowledge and traditional practices. The present study has been conducted using both secondary as well as primary data by applying social methodology consisting of the social survey, questionnaire, interviews and observations in the Kalimpong Block-I of Darjeeling District of west Bengal of India, which is a heterogeneous zone in terms of its ethnic composition and where the Limbus are pre-dominantly concentrated. Due to their close contact with other caste and communities Limbus are now adjusted with the changing situation by borrowing some cultural traits from the other communities and changes that have taken place in their cultural practices, religious beliefs, economic aspects, languages and in social roles and relationships which is bringing the change in their material culture. Limbu language is placed in the Tibeto- Burman Language category. But due to the political and cultural domination of educationally sound and numerically dominant Bengali race, the different communities in this area forced to come under the one umbrella of the Nepali or Gorkhali nation (nation-people). Their respective identities had to be submerged in order to constitute as a strong force to resist Nepali domination and ensure their common survival. As Nepali is a lingua-franca of the area knowing and speaking Nepali language helps them in procuring economic and occupational facilities. Ironically, present day younger generation does not feel comfortable speaking in their own Limbu tongue. The traditional knowledge about medicinal plants, healing, and health culture is found to be wear away due to the lack of interest of young generation. Not only poverty, along with exclusion due to policies they are in the phase of extinction, but their capabilities are ignored and not documented and preserved especially in the case of Limbus who having a great cultural heritage of an oral tradition. Attempts have been made to discuss the persistence and changes in socioeconomic pattern of life in relation to the social structure, material culture, cultural practices, social relationships, indigenous technology, ethos and their values and belief system.

Keywords: changing social relationship, cultural transition, identity, indigenous knowledge, language

Procedia PDF Downloads 165

Authors: Agata Migdalska, Joanna Berczynska, Ewa Bieniek, Jacek Sterna

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Muscle relaxation is considered important during general anesthesia for spine stabilization. In a presented case peripherally acting muscle relaxant was applied during general anesthesia for spine stabilization surgery. The patient was a dog, 11-years old, 26 kg, male, mix breed. Spine fracture was situated between Th13-L1-L2, probably due to the car accident. Preanesthetic physical examination revealed no sign underlying health issues. The dog was premedicated with midazolam 0.2 mg IM and butorphanol 2.4 mg IM. General anesthesia was induced with propofol IV. After the induction, the dog was intubated with an endotracheal tube and connected to an open-ended rebreathing system and maintained with the use of inhalation anesthesia with isoflurane in oxygen. 0,5 mg/ kg of rocuronium was given IV. Use of muscle relaxant was accompanied by an assessment of the degree of neuromuscular blockade by peripheral nerve stimulator. Electrodes were attached to the skin overlying at the peroneal nerve at the lateral cranial tibia. Four electrical pulses were applied to the nerve over a 2 second period. When satisfying nerve block was detected dog was prepared for the surgery. No further monitoring of the effectiveness of blockade was performed during surgery. Mechanical ventilation was kept during anesthesia. During surgery dog maintain stable, and no anesthesiological complication occur. Intraoperatively surgeon claimed that neuromuscular blockade results in a better approach to the spine and easier muscle manipulation which was helpful in order to see the fracture and replace bone fragments. Finally, euthanasia was performed intraoperatively as a result of vast myelomalacia process of the spinal cord. This prevented examination of the recovering process. Neuromuscular blocking agents act at the neuromuscular junction to provide profound muscle relaxation throughout the body. Muscle blocking agents are neither anesthetic nor analgesic; therefore inappropriately used may cause paralysis in fully conscious and feeling pain patient. They cause paralysis of all skeletal muscles, also diaphragm and intercostal muscles when given in higher doses. Intraoperative management includes maintaining stable physiological conditions, which involves adjusting hemodynamic parameters, ensuring proper ventilation, avoiding variations in temperature, maintain normal blood flow to promote proper oxygen exchange. Neuromuscular blocking agent can cause many side effects like residual paralysis, anaphylactic or anaphylactoid reactions, delayed recovery from anesthesia, histamine release, recurarization. Therefore reverse drug like neostigmine (with glikopyrolat) or edrofonium (with atropine) should be used in case of a life-threatening situation. Another useful drug is sugammadex, although the cost of this drug strongly limits its use. Muscle relaxant improves surgical conditions during spinal surgery, especially in heavily muscled individuals. They are also used to facilitate the replacement of dislocated joints as they improve conditions during fracture reduction. It is important to emphasize that in a patient with muscle weakness neuromuscular blocking agents may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. This should not appear in patients with recent spine fracture or luxation. Therefore it is believed that neuromuscular blockers could be useful during spine stabilization procedures.

Keywords: anesthesia, dog, neuromuscular block, spine surgery

Procedia PDF Downloads 178

Authors: Beatriz González-rodrigo, Diego Hidalgo-leiva, Omar Flores, Claudia Germoso, Maribel Jiménez-martínez, Laura Navas-sánchez, Belén Orta, Nicola Tarque, Orlando Hernández- Rubio, Miguel Marchamalo, Juan Gregorio Rejas, Belén Benito-oterino

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Cities facing seismic hazard necessitate detailed risk assessments for effective urban planning and vulnerability identification, ensuring the safety and sustainability of urban infrastructure. Comprehensive studies involving seismic hazard, vulnerability, and exposure evaluations are pivotal for estimating potential losses and guiding proactive measures against seismic events. However, broad-scale traditional risk studies limit consideration of specific local threats and identify vulnerable housing within a structural typology. Achieving precise results at neighbourhood levels demands higher resolution seismic hazard exposure, and vulnerability studies. This research aims to bolster sustainability and safety against seismic disasters in three Central American and Caribbean capitals. It integrates geospatial techniques and artificial intelligence into seismic risk studies, proposing cost-effective methods for exposure data collection and damage prediction. The methodology relies on prior seismic threat studies in pilot zones, utilizing existing exposure and vulnerability data in the region. Emphasizing detailed building attributes enables the consideration of behaviour modifiers affecting seismic response. The approach aims to generate detailed risk scenarios, facilitating prioritization of preventive actions pre-, during, and post-seismic events, enhancing decision-making certainty. Detailed risk scenarios necessitate substantial investment in fieldwork, training, research, and methodology development. Regional cooperation becomes crucial given similar seismic threats, urban planning, and construction systems among involved countries. The outcomes hold significance for emergency planning and national and regional construction regulations. The success of this methodology depends on cooperation, investment, and innovative approaches, offering insights and lessons applicable to regions facing moderate seismic threats with vulnerable constructions. Thus, this framework aims to fortify resilience in seismic-prone areas and serves as a reference for global urban planning and disaster management strategies. In conclusion, this research proposes a comprehensive framework for seismic risk assessment in high-risk urban areas, emphasizing detailed studies at finer resolutions for precise vulnerability evaluations. The approach integrates regional cooperation, geospatial technologies, and adaptive fragility curve adjustments to enhance risk assessment accuracy, guiding effective mitigation strategies and emergency management plans.

Keywords: assessment, behaviour modifiers, emergency management, mitigation strategies, resilience, vulnerability

Procedia PDF Downloads 62

Authors: Stephen Tullis, M. David DiDonato, Hong Sung Park

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Rowing boats (shells) are often steered by a small rudder operated by one of the backward-facing rowers; the attention required of that athlete then slightly decreases the power that that athlete can provide. Reducing the steering distraction would then increase the overall boat speed. Races are straight 2000 m courses with each boat in a 13.5 m wide lane marked by small (~15 cm) widely-spaced (~10 m) buoys, and the boat trajectory is affected by both cross-currents and winds. An optical buoy recognition and tracking system has been developed that provides the boat’s location and orientation with respect to the lane edges. This information is provided to the steering athlete as either: a simple overlay on a video display, or fed to a simplified autopilot system giving steering directions to the athlete or directly controlling the rudder. The system is then effectively a “lane-assist” device but with small, widely-spaced lane markers viewed from a very shallow angle due to constraints on camera height. The image is captured with a lightweight 1080p webcam, and most of the image analysis is done in OpenCV. The colour RGB-image is converted to a grayscale using the difference of the red and blue channels, which provides good contrast between the red/yellow buoys and the water, sky, land background and white reflections and noise. Buoy detection is done with thresholding within a tight mask applied to the image. Robust linear regression using Tukey’s biweight estimator of the previously detected buoy locations is used to develop the mask; this avoids the false detection of noise such as waves (reflections) and, in particular, buoys in other lanes. The robust regression also provides the current lane edges in the camera frame that are used to calculate the displacement of the boat from the lane centre (lane location), and its yaw angle. The interception of the detected lane edges provides a lane vanishing point, and yaw angle can be calculated simply based on the displacement of this vanishing point from the camera axis and the image plane distance. Lane location is simply based on the lateral displacement of the vanishing point from any horizontal cut through the lane edges. The boat lane position and yaw are currently fed what is essentially a stripped down marine auto-pilot system. Currently, only the lane location is used in a PID controller of a rudder actuator with integrator anti-windup to deal with saturation of the rudder angle. Low Kp and Kd values decrease unnecessarily fast return to lane centrelines and response to noise, and limiters can be used to avoid lane departure and disqualification. Yaw is not used as a control input, as cross-winds and currents can cause a straight course with considerable yaw or crab angle. Mapping of the controller with rudder angle “overall effectiveness” has not been finalized - very large rudder angles stall and have decreased turning moments, but at less extreme angles the increased rudder drag slows the boat and upsets boat balance. The full system has many features similar to automotive lane-assist systems, but with the added constraints of the lane markers, camera positioning, control response and noise increasing the challenge.

Keywords: auto-pilot, lane-assist, marine, optical, rowing

Procedia PDF Downloads 127

Authors: Esna B. Buğday, Niray Tunçel

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Spirituality has a motivational influence on consumers' psychological states, lifestyles, and behavioral intentions. Spirituality refers to the feeling that there is a divine power greater than ourselves and a connection among oneself, others, nature, and the sacred. In addition, spirituality concerns the human soul and spirit against the material and physical world and consists of three dimensions: self-discovery, relationships, and belief in a higher power. Of them, self-discovery is to explore the meaning and the purpose of life. Relationships refer to the awareness of the connection between human beings and nature as well as respect for them. In addition, higher power represents the transcendent aspect of spirituality, which means to believe in a holy power that creates all the systems in the universe. Furthermore, a voluntary simplicity lifestyle is (1) to adopt a simple lifestyle by minimizing the attachment to and the consumption of material things and possessions, (2) to have an ecological awareness respecting all living creatures, and (3) to express the desire for exploring and developing the inner life. Voluntary simplicity is a multi-dimensional construct that consists of a desire for a voluntarily simple life (e.g., avoiding excessive consumption), cautious attitudes in shopping (e.g., not buying unnecessary products), acceptance of self-sufficiency (e.g., being self-sufficient individual), and rejection of highly developed functions of products (e.g., preference for simple functioned products). One of the main reasons for living simply is to sustain a spiritual life, as voluntary simplicity provides the space for achieving psychological and spiritual growth, cultivating self-reliance since voluntary simplifier frees themselves from the overwhelming externals and takes control of their daily lives. From this point of view, it is expected that people with a strong sense of spirituality will be likely to adopt a simple lifestyle. In this respect, the study aims to examine the impact of spirituality on consumers' voluntary simple lifestyle tendencies. As consumers' consumption attitudes and behaviors depend on their lifestyles, exploring the factors that lead them to embrace voluntary simplicity significantly predicts their purchase behavior. In this respect, this study presents empirical research based on a data set collected from 478 Turkish consumers through an online survey. First, exploratory factor analysis is applied to the data to reveal the dimensions of spirituality and voluntary simplicity scales. Second, confirmatory factor analysis is conducted to assess the measurement model. Last, the hypotheses are analyzed using partial least square structural equation modeling (PLS-SEM). The results confirm that spirituality's self-discovery and relationships dimensions positively impact both cautious attitudes in shopping and acceptance of self-sufficiency dimensions of voluntary simplicity. In contrast, belief in a higher power does not significantly influence consumers' voluntary simplicity tendencies. Even though there has been theoretical support drawing a positive relationship between spirituality and voluntary simplicity, to the best of the authors' knowledge, this has not been empirically tested in the literature before. Hence, this study contributes to the current knowledge by analyzing the direct influence of spirituality on consumers' voluntary simplicity tendencies. Additionally, analyzing this impact on the consumers of an emerging market is another contribution to the literature.

Keywords: spirituality, voluntary simplicity, self-sufficiency, conscious shopping, Turkish consumers

Procedia PDF Downloads 147

Authors: Shanhua Hu

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Social media as a critical propagandizing form of film, video games, and digital products has received substantial research attention, but there exists several critical barriers such as: (1) few studies exploring the internal and external connections of a product as part of the multimodal context that gives rise to readability and commercial return; (2) the lack of study of multimodal analysis in product’s official account of game publishers and its impact on users’ behaviors including purchase intention, social media engagement, and playing time; (3) no standardized ecologically-valid, game type-varying data can be used to study the complexity of official account’s postings within a time period. This proposed research helps to tackle these limitations in order to develop a model of readability study that is more ecologically valid, robust, and thorough. To accomplish this objective, this paper provides a more diverse dataset comprising different visual elements and messages collected from the official Twitter accounts of the Top 20 best-selling games of 2021. Video game companies target potential users through social media, a popular approach is to set up an official account to maintain exposure. Typically, major game publishers would create an official account on Twitter months before the game's release date to update on the game's development, announce collaborations, and reveal spoilers. Analyses of tweets from those official Twitter accounts would assist publishers and marketers in identifying how to efficiently and precisely deploy advertising to increase game sales. The purpose of this research is to determine how official game accounts use Twitter to attract new customers, specifically which types of messages are most effective at increasing sales. The dataset includes the number of days until the actual release date on Twitter posts, the readability of the post (Flesch Reading Ease Score, FRES), the number of emojis used, the number of hashtags, the number of followers of the mentioned users, the categorization of the posts (i.e., spoilers, collaborations, promotions), and the number of video views. The timeline of Twitter postings from official accounts will be compared to the history of pre-orders and sales figures to determine the potential impact of social media posts. This study aims to determine how the above-mentioned characteristics of official accounts' Twitter postings influence the sales of the game and to examine the possible causes of this influence. The outcome will provide researchers with a list of potential aspects that could influence people's judgments in limited-word posts. With the increased average online time, users would adapt more quickly than before in online information exchange and readings, such as the word to use sentence length, and the use of emojis or hashtags. The study on the promotion of official game accounts will not only enable publishers to create more effective promotion techniques in the future but also provide ideas for future research on the influence of social media posts with a limited number of words on consumers' purchasing decisions. Future research can focus on more specific linguistic aspects, such as precise word choice in advertising.

Keywords: engagement, official account, promotion, twitter, video game

Procedia PDF Downloads 68

Authors: M. Trousselard, D. Steiler, C. Drogou, P. van-Beers, G. Lamour, S. N. Crosnier, O. Bouilland, P. Dubost, M. Chennaoui, D. Léger

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According to published data, undersea navigation for long periods (nuclear-powered ballistic missile submarine, SSBN) constitutes an extreme environment in which crews are subjected to multiple stresses, including the absence of natural light, illuminance below 1,000 lux, and watch schedules that do not respect natural chronobiological rhythms, for a period of 60-80 days. These stresses seem clearly detrimental to the submariners’ sleep, with consequences for their affective (seasonal affective disorder-like) and cognitive functioning. In the long term, there are abundant publications regarding the consequences of sleep disruption for the occurrence of organic cardiovascular, metabolic, immunological or malignant diseases. It seems essential to propose countermeasures for the duration of the patrol in order to reduce the negative physiological effects on the sleep and mood of submariners. Light therapy, the preferred treatment for dysfunctions of the internal biological clock and the resulting seasonal depression, cannot be used without data to assist knowledge of submariners’ chronobiology (melatonin secretion curve) during patrols, given the unusual characteristics of their working environment. These data are not available in the literature. The aim of this project was to assess, in the course of two studies, the benefits of two environmental techniques for managing chronobiological stress: techniques for optimizing potential (TOP; study 1)3, an existing programme to help in the psychophysiological regulation of stress and sleep in the armed forces, and dawn and dusk simulators (DDS, study 2). For each experiment, psychological, physiological (sleep) or biological (melatonin secretion) data were collected on D20 and D50 of patrol. In the first experiment, we studied sleep and depressive distress in 19 submariners in an operational setting on board an SSBM during a first patrol, and assessed the impact of TOP on the quality of sleep and depressive distress in these same submariners over the course of a second patrol. The submariners were trained in TOP between the two patrols for a 2-month period, at a rate of 1 h of training per week, and assigned daily informal exercises. Results show moderate disruptions in sleep pattern and duration associated with the intensity of depressive distress. The use of TOP during the following patrol improved sleep and depressive mood only in submariners who regularly practiced the techniques. In light of these limited benefits, we assessed, in a second experiment, the benefits of DDS on chronobiology (daily secretion of melatonin) and depressive distress. Ninety submariners were randomly allocated to two groups, group 1 using DDS daily, and group 2 constituting the control group. Although the placebo effect was not controlled, results showed a beneficial effect on chronobiology and depressive mood for submariners with a morning chronotype. Conclusions: These findings demonstrate the difficulty of practicing the tools of psychophysiological management in real life. They raise the question of the subjects’ autonomy with respect to using aids that involve regular practice. It seems important to study autonomy in future studies, as a cognitive resource resulting from the interaction between internal positive resources and “coping” resources, to gain a better understanding of compliance problems.

Keywords: chronobiology, light therapy, seasonal affective disorder, sleep, stress, stress management, submarine

Procedia PDF Downloads 453

Authors: Lamia Bouzgarrou, Amira Omrane, Naima Bouatay, Chaima Harrathi, Samia Machroughl, Ahmed Mhalla

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Background and Aims: Professionals of health care sector are exposed to psychosocial constraints like stress, harassment, violence, which can lead to many mental health problems such as, depression, addictive behavior, and burn-out. Moreover, it’s well established that caregivers affected to intensive care units are more likely to experience such constraints and mental health problems. For these caregivers, the mental health state may affect care quality and patient’s safety. This study aims either to identify occupational psychosocial constraints and their mental health consequences among paramedical and medical caregivers affected to intensive units in Tunisian public hospital. Methods: An exhaustive three months cross-sectional study conducted among medical and paramedical staffs of intensive care units in three Tunisian university hospitals. After informed consent collection, we evaluated work-related stress, workplace harassment, depression, anxious troubles, addictive behavior, and self-esteems through an anonymous self-completed inquiry form. Five validated questionnaires and scales were included in this form: Karasek's Job Content Questionnaire, Negative Acts Questionnaire, Rosenberg, Beck depression inventory and Hamilton Anxiety scale. Results: We included 129 intensive unit caregivers; with a mean age of 36.1 ± 1.1 years and a sex ratio of 0.58. Among these caregivers, 30% were specialist or under-specialization doctors. The average seniority in the intensive care was 6.1 ± 1.2 (extremes=1 to 40 years). Atypical working schedules were noted among 36.7% of the subjects with an imposed choice in 52.4% of cases. During the last 12 months preceding the survey, 51.7% of care workers were absent from work because of a health problem with stops exceeding 15 days in 11.7%. Job strain was objective among 15% of caregivers and 38.33% of them were victims of moral harassment. A low or very low self-esteem was noted among 40% of respondents. Moreover, active smoking was reported by 20% subjects, alcohol consumption by 13.3% and psychotropic substance use by 1.7% of them. According to Beck inventory and Hamilton Anxiety scale, we concluded that 61.7% of intensive care providers were depressed, with 'severe' depression in 13.3% of cases and 49.9% of them present anxious disorders. Multivariate analysis objective that, job strain was correlated with young age (p=0.005) and shorter work seniority (p=0.001). Workplace and moral harassment was more prevalent among females (p=0.009), under-specialization doctor (p=0.021), those affected to atypical schedules (p=0.008). Concerning depression, it was more prevalent among staff in job strain situation (p = 0.004), among smokers caregivers (p = 0.048), and those with no leisure activity (p < 0.001). Anxious disorders were positively correlated to chronic diseases history (p = 0.001) and work-bullying exposure (p = 0.004). Conclusions: Our findings reflected a high frequency of caregivers who are under stress at work and those who are victims of moral harassment. These health professionals were at increased risk for developing psychiatric illness such depressive and anxious disorders and addictive behavior. Our results suggest the necessity of preventive strategies of occupational psychosocial constraints in order to preserve professional’s mental health and maximize patient safety and quality of care.

Keywords: health care sector, intensive care units, mental health, psychosocial constraints

Procedia PDF Downloads 150

Authors: Alison C. Essary, Victor Trastek

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Introduction: The current state of the health care system in the U.S. is characterized by an unprecedented number of people living with multiple chronic conditions, unsustainable rise in health care costs, inadequate access to care, and wide variation in health outcomes throughout the country. An estimated two-thirds of Americans are living with two or more chronic conditions, contributing to 75% of all health care spending. In 2013, the School for the Science of Health Care Delivery (SHCD) was charged with redesigning the health care system through education and research. Faculty in business, law, and public policy, and thought leaders in health care delivery, administration, public health and health IT created undergraduate, graduate, and executive academic programs to address this pressing need. Faculty and students work across disciplines, and with community partners and employers to improve care delivery and increase value for patients. Methods: Curricula apply content in health care administration and operations within the clinical context. Graduate modules are team-taught by faculty across academic units to model team-based practice. Seminars, team-based assignments, faculty mentoring, and applied projects are integral to student success. Cohort-driven models enhance networking and collaboration. This observational study evaluated two years of admissions data, and one year of graduate data to assess program outcomes and inform the current graduate-level curricula. Descriptive statistics includes means, percentages. Results: Fall 2013, the program received 51 applications. The mean GPA of the entering class of 37 students was 3.38. Ninety-seven percent of the fall 2013 cohort successfully completed the program (n=35). Sixty-six percent are currently employed in the health care industry (n=23). Of the remaining 12 graduates, two successfully matriculated to medical school; one works in the original field of study; four await results on the MCAT or DAT, and five were lost to follow up. Attrition of one student was attributed to non-academic reasons. Fall 2014, the program expanded to include both on-ground and online cohorts. Applications were evenly distributed between on-ground (n=70) and online (n=68). Thirty-eight students enrolled in the on-ground program. The mean GPA was 3.95. Ninety-five percent of students successfully completed the program (n=36). Thirty-six students enrolled in the online program. The mean GPA was 3.85. Graduate outcomes are pending. Discussion: Challenges include demographic variability between online and on-ground students; yet, both profiles are similar in that students intend to become change agents in the health care system. In the past two years, on-ground applications increased by 31%, persistence to graduation is > 95%, mean GPA is 3.67, graduates report admission to six U.S. medical schools, the Mayo Medical School integrates SHCD content within their curricula, and there is national interest in collaborating on industry and academic partnerships. This places SHCD at the forefront of developing innovative curricula in order to improve high-value, patient-centered care.

Keywords: delivery science, education, health care delivery, high-value care, innovation in education, patient-centered

Procedia PDF Downloads 277

Authors: Catherine S. Fichten, Tali Heiman, Mary Jorgensen, Mai Nhu Nguyen, Rhonda Amsel, Dorit Olenik-Shemesh

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The study examined Canadian and Israeli students' perceptions related to their intention to graduate from their program of studies. Canada and Israel are dissimilar in many ways that affect education, including language and alphabet. In addition, the postsecondary education systems differ. For example, in some parts of Canada (e.g., in Quebec, Canada’s 2nd largest province), students matriculate after 11 years of high school; in Israel, this typically occurs after 12 years. In addition, Quebec students attend two compulsory years of junior college before enrolling in a three-year university Bachelor program; in Israel students enroll in a three-year Bachelor program directly after matriculation. In addition, Israeli students typically enroll in the army shortly after high school graduation; in Canada, this is not the case. What the two countries do have in common is concern about the success of postsecondary students with disabilities. The present study was based on Ajzen’s Theory of Planned Behavior (TPB); the model suggests that behavior is influenced by Intention to carry it out. This, in turn, is predicted by the following correlated variables: Perceived Behavioral Control (i.e., ease or difficulty enacting the behavior - in this case graduation), Subjective Norms (i.e., perceived social/peer pressure from individuals important in the student’s life), and Attitude (i.e., positive or negative evaluation of graduation). A questionnaire was developed to test the TPB in previous Canadian studies and administered to 845 Canadian college students (755 nondisabled, 90 with LD/ADHD) who had completed at least one semester of studies) and to 660 Israeli university students enrolled in a Bachelor’s program (537 nondisabled, 123 with LD/ADHD). Because Israeli students were older than Canadian students we covaried age in SPSS-based ANOVA comparisons and included it in regression equations. Because females typically have better academic outcomes than males, gender was included in all analyses. ANOVA results indicate only a significant gender effect for Intention to graduate, with females having higher scores. Four stepwise regressions were conducted, with Intention to graduate as the predicted variable, and Gender and the three TPB predictors as independent variables (separate analyses for Israeli and Canadian samples with and without LD/ADHD). Results show that for samples with LD/ADHD, although Gender and Age were not significant predictors, the TPB predictors were, with all three TPB predictors being significant for the Canadian sample (i.e., Perceived Behavioral Control, Subjective Norms, Attitude, R2=.595), and two of the three (i.e., Perceived Behavioral Control, Subjective Norms) for the Israeli sample (R2=.528). For nondisabled students, the results for both countries show that all three TPB predictors were significant along with Gender: R2=.443 for Canada and R2=.332 for Israel; age was not significant. Our findings show that despite vast differences between our Canadian and Israeli samples, Intention to graduate was related to the three TPB predictors. This suggests that our TPB measure is valid for diverse samples and countries that it can be used as a quick, inexpensive way to predict graduation rates, and that strengthening the three predictor variables may result in higher graduation rates.

Keywords: disability, higher education, students, theory of planned behavior

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Authors: Chinasa U. Imo, Queen Chikwendu, Jonathan Ajuma, Mario Banuelos

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Background: Sociocultural norms primarily influence the health-seeking behavior of populations in rural communities. In the Nkporo community, Abia State, Nigeria, their sociocultural perception of diseases runs counter to biomedical definitions, wherein they rely heavily on traditional medicine and practices. In a state where birth asphyxia and sepsis account for the significant causes of death for neonates, malaria leads to the causes of other mortalities, followed by common preventable diseases such as diarrhea, pneumonia, acute respiratory tract infection, malnutrition, and HIV/AIDS. Most local mothers attribute their health conditions and that of their children to witchcraft attacks, the hand of God, and ancestral underlining. This influences how they see antenatal and postnatal care, choice of place of accessing care and birth delivery, response to children's illnesses, immunization, and nutrition. Method: To implement a community health improvement program, we adopted an asset-based community development model to address health's normative and social determinants. The first step was to use a qualitative approach to conduct a community health needs baseline assessment, involving focus group discussions with twenty-five (25) youths aged 18-25, semi-structured interviews with ten (10) officers-in-charge of primary health centers, eight (8) ward health committee members, and nine (9) community leaders. Secondly, we designed an intervention program. Going forward, we will proceed with implementing and evaluating this program. Result: The priority needs identified by the communities were malaria, lack of clean drinking water, and the need for behavioral change information. The study also highlighted the significant influence of youths on their peers, family, and community as caregivers and information interpreters. Based on the findings, the NGO SieDi-Hub collaborated with the Abia State Ministry of Health, the State Primary Healthcare Agency, and Empower Next Generations to design a one-year "Community Health Youth Champions Pilot Program." Twenty (20) youths in the community were trained and equipped to champion a participatory approach to bridging the gap between access and delivery of primary healthcare, to adjust sociocultural norms to improve health equity for people in Nkporo community – with limited education, lack of access to health information, and quality healthcare facilities using an innovative community-led improvement approach. Conclusion: Youths play a vital role in achieving health equity, being a vulnerable population with significant influence. To ensure effective primary healthcare, strategies must include cultural humility. The asset-based community development model offers valuable tools, and this article will share ongoing lessons from the intervention's behavioral change strategies with young people.

Keywords: asset-based community development, community health, primary health systems strengthening, youth empowerment

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Authors: Lauren B. Birney

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The BOP-CCERS (Billion Oyster Project- Curriculum and Community Enterprise for Restoration Science) Near-Peer Mentoring Program provides the long-term (five-year) support network to motivate and guide students toward restoration science-based CTE pathways. Students are selected from middle schools with actively participating BOP-CCERS teachers. Teachers will nominate students from grades 6-8 to join cohorts of between 10 and 15 students each. Cohorts are comprised primarily of students from the same school in order to facilitate mentors' travel logistics as well as to sustain connections with students and their families. Each cohort is matched with an exceptional undergraduate or graduate student, either a BOP research associate or STEM mentor recruited from collaborating City University of New York (CUNY) partner programs. In rare cases, an exceptional high school junior or senior may be matched with a cohort in addition to a research associate or graduate student. In no case is a high school student or minor be placed individually with a cohort. Mentors meet with students at least once per month and provide at least one offsite field visit per month, either to a local STEM Hub or research lab. Keeping with its five-year trajectory, the near-peer mentoring program will seek to retain students in the same cohort with the same mentor for the full duration of middle school and for at least two additional years of high school. Upon reaching the final quarter of 8th grade, the mentor will develop a meeting plan for each individual mentee. The mentee and the mentor will be required to meet individually or in small groups once per month. Once per quarter, individual meetings will be substituted for full cohort professional outings. The mentor will organize the entire cohort on a field visit or educational workshop with a museum or aquarium partner. In addition to the mentor-mentee relationship, each participating student will also be asked to conduct and present his or her own BOP field research. This research is ideally carried out with the support of the students’ regular high school STEM subject teacher; however, in cases where the teacher or school does not permit independent study, the student will be asked to conduct the research on an extracurricular basis. Near-peer mentoring affects students’ social identities and helps them to connect to role models from similar groups, ultimately giving them a sense of belonging. Qualitative and quantitative analytics were performed throughout the study. Interviews and focus groups also ensued. Additionally, an external evaluator was utilized to ensure project efficacy, efficiency, and effectiveness throughout the entire project. The BOP-CCERS Near Peer Mentoring program is a peer support network in which high school students with interest or experience in BOP (Billion Oyster Project) topics and activities (such as classroom oyster tanks, STEM Hubs, or digital platform research) provide mentorship and support for middle school or high school freshmen mentees. Peer mentoring not only empowers those students being taught but also increases the content knowledge and engagement of mentors. This support provides the necessary resources, structure, and tools to assist students in finding success.

Keywords: STEM education, environmental science, citizen science, near peer mentoring

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Authors: Kiran Datta, Daniella Holland-Hart, Anthony Byrne

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Introduction: Oesophago-gastric (OG) cancers are the fifth commonest in the UK, accounting for over 12,000 deaths each year. Most patients will present at later stages of the disease, with only 21% of patients with stage 4 disease surviving longer than a year. As a result, many patients are unsuitable for curative surgery and instead receive palliative treatment to improve prognosis and symptom burden. However, palliative chemotherapy can result in significant toxicity: almost half of the patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. In addition, clinical trials often exclude older and frailer patients due to strict inclusion criteria, meaning there is limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. Inappropriate chemotherapy administration is at odds with the goals of palliative treatment and care, which are to improve quality of life, and this also represents a significant resource expenditure. This literature review aimed to examine and appraise evidence regarding treatment resilience in order to guide clinicians in identifying the most suitable candidates for palliative chemotherapy. Factors influencing treatment resilience were assessed, as measured by completion rates, dose reductions, and toxicities. Methods: This literature review was conducted using rapid review methodology, utilising modified systematic methods. A literature search was performed across the MEDLINE, EMBASE, and Cochrane Library databases, with results limited to papers within the last 15 years and available in English. Key inclusion criteria included: 1) participants with either oesophageal, gastro-oesophageal junction, or gastric cancers; 2) patients treated with palliative chemotherapy; 3) available data evaluating the association between baseline participant characteristics and treatment resilience. Results: Of the 2326 papers returned, 11 reports of 10 studies were included in this review after excluding duplicates and irrelevant papers. Treatment resilience factors that were assessed included: age, performance status, frailty, inflammatory markers, and sarcopenia. Age was generally a poor predictor for how well patients would tolerate chemotherapy, while poor performance status was a better indicator of the need for dose reduction and treatment non-completion. Frailty was assessed across one cohort using multiple screening tools and was an effective marker of the risk of toxicity and the requirement for dose reduction. Inflammatory markers included lymphopenia and the Glasgow Prognostic Score, which assessed inflammation and hypoalbuminaemia. Although quick to obtain and interpret, these findings appeared less reliable due to the inclusion of patients treated with palliative radiotherapy. Sarcopenia and body composition were often associated with chemotherapy toxicity but not the rate of regimen completion. Conclusion: This review demonstrates that there are numerous measures that can estimate the ability of patients with oesophago-gastric cancer to tolerate palliative chemotherapy, and these should be incorporated into clinical assessments to promote personalised decision-making around treatment. Age should not be a barrier to receiving chemotherapy and older and frailer patients should be included in future clinical trials to better represent typical patients with oesophago-gastric cancers. Decisions regarding palliative treatment should be guided by these factors identified as well as patient preference.

Keywords: frailty, oesophago-gastric cancer, palliative chemotherapy, treatment resilience

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Authors: Keith Schofield, Garry R. Prentice

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The perceptions of the work an academic does, and the environment in which they do it, contributes to the professional identity of that academic. In turn, this has implications for the level of involvement they have in their job, their satisfaction, and their work product. This research explores academic identities in British and Irish institutions and considers the complex interplay between identity, practice, and participation. Theoretical assumptions made in this paper assert that meaningful work has positive effects on work pride, organisational commitment, organisational citizenship, and motivation; when employees participate enthusiastically they are likely to be more engaged, more successful, and more satisfied. Further examination is given to the context in which this participation happens; the nature of institutional process, management, and relationships with colleagues, team members, and students is considered. The present study follows a mixed-methods approach to explore work satisfaction constructs in a number of academic contexts in the UK and Ireland. The quantitative component of this research (Convenience Sample: 155 academics, and support/ administrative staff; 36.1% male, 63.9% female; 60.8% academic staff, 39.2% support/ administration staff; across a number of universities in the UK and Ireland) was based on an established emotional labour model and was tested across gender groups, job roles, and years of service. This was complimented by qualitative semi-structured interviews (Purposive Sample: 10 academics, and 5 support/ administrative staff across the same universities in the UK and Ireland) to examine various themes including values within academia, work conditions, professional development, and transmission of knowledge to students. Experiences from both academic and support perspectives were sought in order to gain a holistic view of academia and to provide an opportunity to explore the dynamic of the academic/administrator relationship within the broader institutional context. The quantitative emotional labour model, tested via a path analysis, provided a robust description of the relationships within the data. The significant relationships found within the quantitative emotional labour model included a link between non-expression of true feelings resulting in emotional labourious work and lower levels of intrinsic motivation and higher levels of extrinsic motivation. Higher levels of intrinsic motivation also linked positively to work pride. These findings were further explored in the qualitative elements of the research where themes emerged including the disconnection between faculty management and staff, personal fulfilment and the friction between the identities of teacher, researcher/ practitioner and administrator. The implications of the research findings from this study are combined and discussed in relation to possible identity-related and emotional labour management-related interventions. Further, suggestions are made to institutions concerning the application of these findings including the development of academic practices, with specific reference to the duality of identity required to service the combined teacher/ researcher role. Broader considerations of the paper include how individuals and institutions may engage with the changing nature of students-as-consumers as well as a recommendation to centralise personal fulfillment through the development of professional academic identities.

Keywords: academic work, emotional labour, identity friction, mixed methods

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Authors: Fadi Al Khatib, Raouf Mbarki, Malek Adouni

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In various sport and recreational activities, the patellofemoral joint undergoes large forces and moments while accommodating the significant knee joint movement. In doing so, this joint is commonly the source of anterior knee pain related to instability in normal patellar tracking and excessive pressure syndrome. One well-observed explanation of the instability of the normal patellar tracking is the patellofemoral ligaments and patellar tendon damage. Improved knowledge of the damage mechanism mediating ligaments and tendon injuries can be a great help not only in rehabilitation and prevention procedures but also in the design of better reconstruction systems in the management of knee joint disorders. This damage mechanism, specifically due to excessive mechanical loading, has been linked to the micro level of the fibred structure precisely to the tropocollagen molecules and their connection density. We argue defining a clear frame starting from the bottom (micro level) to up (macro level) in the hierarchies of the soft tissue may elucidate the essential underpinning on the state of the ligaments damage. To do so, in this study a multiscale fibril reinforced hyper elastoplastic Finite Element model that accounts for the synergy between molecular and continuum syntheses was developed to determine the short-term stresses/strains patellofemoral ligaments and tendon response. The plasticity of the proposed model is associated only with the uniaxial deformation of the collagen fibril. The yield strength of the fibril is a function of the cross-link density between tropocollagen molecules, defined here by a density function. This function obtained through a Coarse-graining procedure linking nanoscale collagen features and the tissue level materials properties using molecular dynamics simulations. The hierarchies of the soft tissues were implemented using the rule of mixtures. Thereafter, the model was calibrated using a statistical calibration procedure. The model then implemented into a real structure of patellofemoral ligaments and patellar tendon (OpenKnee) and simulated under realistic loading conditions. With the calibrated material parameters the calculated axial stress lies well with the experimental measurement with a coefficient of determination (R2) equal to 0.91 and 0.92 for the patellofemoral ligaments and the patellar tendon respectively. The ‘best’ prediction of the yielding strength and strain as compared with the reported experimental data yielded when the cross-link density between the tropocollagen molecule of the fibril equal to 5.5 ± 0.5 (patellofemoral ligaments) and 12 (patellar tendon). Damage initiation of the patellofemoral ligaments was located at the femoral insertions while the damage of the patellar tendon happened in the middle of the structure. These predicted finding showed a meaningful correlation between the cross-link density of the tropocollagen molecules and the stiffness of the connective tissues of the extensor mechanism. Also, damage initiation and propagation were documented with this model, which were in satisfactory agreement with earlier observation. To the best of our knowledge, this is the first attempt to model ligaments from the bottom up, predicted depending to the tropocollagen cross-link density. This approach appears more meaningful towards a realistic simulation of a damaging process or repair attempt compared with certain published studies.

Keywords: tropocollagen, multiscale model, fibrils, knee ligaments

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Authors: Dina Farran, Mark Ashworth, Fiona Gaughran

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Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, is associated with an increased risk of stroke, contributing to heart failure and death. In this project, we aim to improve patient safety by screening for stroke risk among people with AF and co-morbid mental illness. To do so, we started by conducting a systematic review and meta-analysis on prevalence, management, and outcomes of AF in people with Serious Mental Illness (SMI) versus the general population. We then evaluated oral anticoagulation (OAC) prescription trends in people with AF and co-morbid SMI in King’s College Hospital. We also evaluated the association between mental illness severity and OAC prescription in eligible patients in South London and Maudsley (SLaM) NHS Foundation Trust. Next, we implemented an electronic clinical decision support system (eCDSS) consisting of a visual prompt on patient electronic Personal Health Records to screen for AF-related stroke risk in three Mental Health of Older Adults wards at SLaM. Finally, we assessed the feasibility and acceptability of the eCDSS by qualitatively investigating clinicians’ perspectives of the potential usefulness of the eCDSS (pre-intervention) and their experiences and their views regarding its impact on clinicians and patients (post-intervention). The systematic review showed that people with SMI had low reported rates of AF. AF patients with SMI were less likely to receive OAC than the general population. When receiving warfarin, people with SMI, particularly bipolar disorder, experienced poor anticoagulation control compared to the general population. Meta-analysis showed that SMI was not significantly associated with an increased risk of stroke or major bleeding when adjusting for underlying risk factors. The main findings of the first observational study were that among AF patients having a high stroke risk, those with co-morbid SMI were less likely than non-SMI to be prescribed any OAC, particularly warfarin. After 2019, there was no significant difference between the two groups. In the second observational study, patients with AF and co-morbid SMI were less likely to be prescribed any OAC compared to those with dementia, substance use disorders, or common mental disorders, adjusting for age, sex, stroke, and bleeding risk scores. Among AF patients with co-morbid SMI, warfarin was less likely to be prescribed to those having alcohol or substance dependency, serious self-injury, hallucinations or delusions, and activities of daily living impairment. In the intervention, clinicians were asked to confirm the presence of AF, clinically assess stroke and bleeding risks, record risk scores in clinical notes, and refer patients at high risk of stroke to OAC clinics. Clinicians reported many potential benefits for the eCDSS, including improving clinical effectiveness, better identification of patients at risk, safer and more comprehensive care, consistency in decision making and saving time. Identified potential risks included rigidity in decision-making, overreliance, reduced critical thinking, false positive recommendations, annoyance, and increased workload. This study presents a unique opportunity to quantify AF patients with mental illness who are at high risk of severe outcomes using electronic health records. This has the potential to improve health outcomes and, therefore patients' quality of life.

Keywords: atrial fibrillation, stroke, mental health conditions, electronic clinical decision support systems

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Authors: Vaiddehi Bansal, Laura Hinson, Mayumi Rezwan, Erin Leasure, Mithila Iyer, Connor Roth, Poulomi Pal, Kareem Kysia

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As digital usage becomes increasingly ubiquitous worldwide, technology-facilitated gender-based violence (GBV) has garnered increasing attention in the recent years, especially during the COVID-19 pandemic. This form of violence is defined as “action by one or more people that harms others based on their sexual or gender identity or by enforcing harmful gender norms. This action is carried out using the internet and/or mobile technology that harms others based on their sexual or gender identity or by enforcing harmful gender norms”.Common forms of technology-facilitated GBV include cyberstalking, cyberbullying, sexual harassment, image-based abuse, doxing, hacking, gendertrolling, hate speech, and impersonation. Most literature on this pervasive yet complex issue has emerged from high-income countries, and few studies comprehensively summarize its prevalence, manifestations, and implications. This rigorous scoping review examines the evidence base of this phenomenon in low and middle-income countries across Asia, summarizing trends and gaps to inform actionable recommendations. The research team developed search terms to conduct a comprehensive search of peer-reviewed and grey literature. Query results were eligible for inclusion if they were published in English between 2006-2021 and with an explicit emphasis on technology-facilitated violence, gender, and the countries of interest in the Asia region. Title, abstracts, and full-texts were independently screened by two reviewers based on inclusion criteria, and data was extracted through deductive coding. Of 2,042 articles screened, 97 met inclusion criteria. The review revealed a gap in the evidence-base in Central Asia and the Pacific Islands. Findings across South and Southeast Asia indicate that technology-facilitated GBV comprises various forms of abuse, violence, and harassment that are largely shaped by country-specific societal norms and technological landscapes. The literature confirms that women, girls, and sexual minorities, especially those with intersecting marginalized identities, are often more vulnerable to experiencing online violence. Cultural norms and patriarchal structures tend to stigmatize survivors, limiting their ability to seek social and legal support. Survivors are also less likely to report their experience due to barriers such as lack of awareness of reporting mechanisms, the perception that digital platforms will not address their complaints, and cumbersome reporting systems. The COVID-19 pandemic has further exacerbated perpetration and strained support mechanisms. Prevalence varies by the form of violence but is difficult to estimate accurately due to underreporting and disjointed, outdated, or non-existent legal definitions. Addressing technology-facilitated GBV in Asia requires collective action from multiple actors, including government authorities, technology companies, digital and feminist movements, NGOs, and researchers.

Keywords: gender-based violence, technology, online sexual harassment, image-based abuse

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Authors: Pedro Llanos, Diego García

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Spaceflight is considered the last frontier in terms of science, technology, and engineering. But it is also the next frontier in terms of human physiology and performance. After more than 200,000 years humans have evolved under earth’s gravity and atmospheric conditions, spaceflight poses environmental stresses for which human physiology is not adapted. Hypoxia, accelerations, and radiation are among such stressors, our research involves suborbital flights aiming to develop effective countermeasures in order to assure sustainable human space presence. The physiologic baseline of spaceflight participants is subject to great variability driven by age, gender, fitness, and metabolic reserve. The objective of the present study is to characterize different physiologic variables in a population of STEM practitioners during an aerobatic flight. Cardiovascular and pulmonary responses were determined in Science Astronaut Candidates (SACs) during unusual attitude aerobatic flight indoctrination. Physiologic data recordings from 20 subjects participating in high-G flight training were analyzed. These recordings were registered by wearable sensor-vest that monitored electrocardiographic tracings (ECGs), signs of dysrhythmias or other electric disturbances during all the flight. The same cardiovascular parameters were also collected approximately 10 min pre-flight, during each high-G/unusual attitude maneuver and 10 min after the flights. The ratio (pre-flight/in-flight/post-flight) of the cardiovascular responses was calculated for comparison of inter-individual differences. The resulting tracings depicting the cardiovascular responses of the subjects were compared against the G-loads (Gs) during the aerobatic flights to analyze cardiovascular variability aspects and fluid/pressure shifts due to the high Gs. In-flight ECG revealed cardiac variability patterns associated with rapid Gs onset in terms of reduced heart rate (HR) and some scattered dysrhythmic patterns (15% premature ventricular contractions-type) that were considered as triggered physiological responses to high-G/unusual attitude training and some were considered as instrument artifact. Variation events were observed in subjects during the +Gz and –Gz maneuvers and these may be due to preload and afterload, sudden shift. Our data reveal that aerobatic flight influenced the breathing rate of the subject, due in part by the various levels of energy expenditure due to the increased use of muscle work during these aerobatic maneuvers. Noteworthy was the high heterogeneity in the different physiological responses among a relatively small group of SACs exposed to similar aerobatic flights with similar Gs exposures. The cardiovascular responses clearly demonstrated that SACs were subjected to significant flight stress. Routine ECG monitoring during high-G/unusual attitude flight training is recommended to capture pathology underlying dangerous dysrhythmias in suborbital flight safety. More research is currently being conducted to further facilitate the development of robust medical screening, medical risk assessment approaches, and suborbital flight training in the context of the evolving commercial human suborbital spaceflight industry. A more mature and integrative medical assessment method is required to understand the physiology state and response variability among highly diverse populations of prospective suborbital flight participants.

Keywords: g force, aerobatic maneuvers, suborbital flight, hypoxia, commercial astronauts

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Authors: Biao Hu, Mark E. J. Cutler, Alexandra C. Morel

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Global climate change introduces both opportunities and challenges for crop productivity, with differences in temperature stress across latitudes and crop types, one of the most important meteorological factors impacting crop productivity. The development and productivity of crops are particularly impacted when temperatures occur outwith their preferred ranges, which has implications for global agri-food sector. This study investigated the spatiotemporal dynamics of heat stress and cold stress on UK arable lands for rapeseed cropping between 1961 and 2020, using a 1 km spatial resolution temperature dataset. Stress indices, including heat stress index (fHS) defined as the ratio of “Tmax - Tcrit_h” to “Tlimit_h - Tcrit_h” where Tmax, Tcrit_h and Tlimit_h represent the daily maximum temperature (°C), critical high temperature threshold (°C) and limiting high temperature threshold (°C) of rapeseed crop respectively; cold degree days (CDD) as the difference between daily Tmin (minimum temperature) and Tcrit_l (critical low temperature threshold); and a normalized rapeseed production loss index (fRPL) as the product of fHS and attainable rapeseed yield in the same land pixel were established. The values of fHS and CDD, percentages of days experiencing each stress and fRPL were investigated. Results found increasing fHS and the areas impacted by heat stress during flowering (from April to May) and reproductive (from April to July) stages over time, with the mean fHS being negatively correlated with latitude. This pattern of increased heat stress agrees with previous research on rapeseed cropping, which have been noted at global scale in response to changes in climate. The decreasing number of CDD and frequency of cold stress suggest cold stress decreased during flowering, vegetative (from September to March next year) and reproductive stages, and the magnitude of cold stress in the south of the UK was smaller to that compared to northern regions over the studied periods. The decreasing CDD matches observed declining cold stress of global rapeseed and of other crops such as rice in the northern hemisphere. Notably, compared with previous studies which mainly tracked the trends of heat stress and cold stress individually, this study conducted a comparative analysis of the rate of their changes and found heat stress of rapeseed crops in the UK was increasing at a faster rate than cold stress, which was seen to decrease during flowering. The increasing values of fRPL, with statistically significant differences (p < 0.05) between regions of the UK, suggested an increasing loss in rapeseed due to heat stress in the studied period. The largest increasing trend in heat stress was observed in South-eastern England, where a decreasing cold stress was taking place. While the present study observed a relatively slowly increasing heat stress, there is a worrying trend of increasing heat stress for rapeseed cropping into the future, as the cases of other main rapeseed cropping systems in the northern hemisphere including China, European counties, the US, and Canada. This study demonstrates the negative impact of global warming on rapeseed cropping, highlighting the adaptation and mitigations strategies for sustainable rapeseed cultivation across the globe.

Keywords: rapeseed, UK, heat stress, cold stress, global climate change, spatiotemporal analysis, production loss index

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Authors: Awatef Ahmed Ben Ramadan, Aqsa Arshad

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Background: There is a huge Muslim migration movement to North America and Europe for several reasons, primarily refuge from war areas and partly to search for better work and educational chances. There are always concerns regarding first-Generation Immigrant women's health and computer literacy, an adequate understanding of the health systems, and the use of the existing healthcare technology and services effectively and efficiently. Language proficiency level, preference for cultural and traditional remedies, socioeconomic factors, fear of stereotyping, limited accessibility to health services, and general unfamiliarity with the existing health services and resources are familiar variables among these women. Aims: The current study aims to assess the health and digital literacy of first-generation Muslim women in Atlanta city. Also, the study aims to examine how the COVID-19 pandemic has encouraged the use of health information technology and increased technology awareness among the targeted women. Methods: The study design is cross-sectional correlational research. The study will be conducted to produce preliminary results that the investigators want to have to supplement an NIH grant application about leveraging information technology to reduce the health inequalities amongst the first-generation immigrant Muslim women in Atlanta City. The investigators will collect the study data in two phases using different tools. Phase one was conducted in June 2022; the investigators used tools to measure health and digital literacy amongst 42 first-generation immigrant Muslim women. Phase two was conducted in November 2022; the investigators measured the Knowledge, Attitude, and Practice (KAP) of using health information technology such as telehealth from a sample of 45 first-generation Muslim immigrant women in Atlanta; in addition, the investigators measured how the current pandemic has affected their KAP to use telemedicine and telehealth services. Both phases' study participants were recruited using convenience sampling methodology. The investigators collected around 40 of 18 years old or older first-generation Muslim immigrant women for both study phases. The study excluded Immigrants who hold work visas and second-generation immigrants. Results: At the point of submitting this abstract, the investigators are still analyzing the study data to produce preliminary results to apply for an NIH grant entitled "Leveraging Health Information Technology (Health IT) to Address and Reduce Health Care Disparities (R01 Clinical Trial Optional)". This research will be the first step of a comprehensive research project to assess and measure health and digital literacy amongst a vulnerable community group. The targeted group might have different points of view from the U.S.-born inhabitants on how to: promote their health, gain healthy lifestyles and habits, screen for diseases, adhere to health treatment and follow-up plans, perceive the importance of using available and affordable technology to communicate with their providers and improve their health, and help in making serious decisions for their health. The investigators aim to develop an educational and instructional health mobile application considering the language and cultural factors that affect immigrants' ability to access different health and social support sources, know their health rights and obligations in their communities, and improve their health behavior and behavior lifestyles.

Keywords: first-generation immigrant Muslim women, telehealth, COVID-19 pandemic, health information technology, health and digital literacy

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Authors: Shayan Mohajer Hamidi

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Federated Learning (FL) has emerged as a promising paradigm for training machine learning models on distributed data without the need for centralized data aggregation. In the realm of wireless communications, FL has the potential to leverage the vast amounts of data generated by wireless devices to improve model performance and enable intelligent applications. However, the fairness aspect of FL in wireless communications remains largely unexplored. This abstract presents an idea for fair federated learning in wireless communications, addressing the challenges of imbalanced data distribution, privacy preservation, and resource allocation. Firstly, the proposed approach aims to tackle the issue of imbalanced data distribution in wireless networks. In typical FL scenarios, the distribution of data across wireless devices can be highly skewed, resulting in unfair model updates. To address this, we propose a weighted aggregation strategy that assigns higher importance to devices with fewer samples during the aggregation process. By incorporating fairness-aware weighting mechanisms, the proposed approach ensures that each participating device's contribution is proportional to its data distribution, thereby mitigating the impact of data imbalance on model performance. Secondly, privacy preservation is a critical concern in federated learning, especially in wireless communications where sensitive user data is involved. The proposed approach incorporates privacy-enhancing techniques, such as differential privacy, to protect user privacy during the model training process. By adding carefully calibrated noise to the gradient updates, the proposed approach ensures that the privacy of individual devices is preserved without compromising the overall model accuracy. Moreover, the approach considers the heterogeneity of devices in terms of computational capabilities and energy constraints, allowing devices to adaptively adjust the level of privacy preservation to strike a balance between privacy and utility. Thirdly, efficient resource allocation is crucial for federated learning in wireless communications, as devices operate under limited bandwidth, energy, and computational resources. The proposed approach leverages optimization techniques to allocate resources effectively among the participating devices, considering factors such as data quality, network conditions, and device capabilities. By intelligently distributing the computational load, communication bandwidth, and energy consumption, the proposed approach minimizes resource wastage and ensures a fair and efficient FL process in wireless networks. To evaluate the performance of the proposed fair federated learning approach, extensive simulations and experiments will be conducted. The experiments will involve a diverse set of wireless devices, ranging from smartphones to Internet of Things (IoT) devices, operating in various scenarios with different data distributions and network conditions. The evaluation metrics will include model accuracy, fairness measures, privacy preservation, and resource utilization. The expected outcomes of this research include improved model performance, fair allocation of resources, enhanced privacy preservation, and a better understanding of the challenges and solutions for fair federated learning in wireless communications. The proposed approach has the potential to revolutionize wireless communication systems by enabling intelligent applications while addressing fairness concerns and preserving user privacy.

Keywords: federated learning, wireless communications, fairness, imbalanced data, privacy preservation, resource allocation, differential privacy, optimization

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Authors: Ina Filkobski, Eran Shor

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This article explores how newspapers cover murder of women by family members and intimate partners. Three major Israeli newspapers were compared in order to analyse the coverage of Jewish and Arab victims and culprits and to examine whether and in what ways the media contribute to the construction of symbolic boundaries between minority and dominant social groups. A sample of some 459 articles that were published between 2013 and 2015 was studied using a systematic qualitative content analysis. Our findings suggest that the treatment of murder cases by the media varies according to the ethnicity of both victims and culprits. The murder of Jews by family members or intimate partners was framed as a shocking and unusual event, a result of the individual personality or pathology of the culprit. Conversely, when Arabs were the killers, murders were often explained by focusing on the culture of the ethnic group, described as traditional, violent, and patriarchal. In two-thirds of the cases in which Arabs were involved, so-called ‘honor killing’ or other cultural explanations were proposed as the motive for the murder. This was often the case even before a suspect was detected, while police investigation was at its very early stages, and often despite forceful denials from victims’ families. In case of Jewish culprits, more than half of the articles in our sample suggested mental disorder to explain the acts and cultural explanations were almost entirely absent. Beyond the emphasis on psychological vs. cultural explanations, newspaper articles also tend to provide much more detail about Jewish culprits than about Arabs. Such detailed examinations convey a desire to make sense of the event by understanding the supposedly unique and unorthodox nature of the killer. The detailed accounts were usually absent from the reports on Arab killers. Thus, even if reports do not explicitly offer cultural motivations for the murder, the fact that reports often remain laconic leaves people to draw their own conclusions, which would then be likely based on existing cognitive scripts and previous reports on family murders among Arabs. Such treatment contributes to the notion that Arab and Muslim cultures, religions, and nationalities are essentially misogynistic and adhere to norms of honor and shame that are radically different from those of modern societies, such as the Jewish-Israeli one. Murder within the family is one of the most dramatic occurrences in the social world, and in societies that see themselves as modern it is a taboo; an ultimate signifier of danger. We suggest that representations of murder provide a valuable prism for examining the construction of group boundaries. Our analysis, therefore, contributes to the scholarly effort to understand the creation and reinforcement of symbolic boundaries between ‘society’ and its ‘others’ by systematically tracing the media constructions of ‘otherness’. While our analysis focuses on Israel, studies on the United States, Canada, and various European countries with ethnically and racially heterogeneous populations, make it clear that the stigmatisation and exclusion of visible, religious, and language minorities are not unique to the Israeli case.

Keywords: comparative study of media coverege of minority and majority groups, construction of symbolic group boundaries, murder of women by family members and intimate partners, Israel, Jews, Arabs

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Authors: Prince Chukwuneme Enwereji, Annelien Van Rooyen

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In recent years, technology integration in education has transformed the learning landscape, particularly in online institutions. One technological advancement that has gained popularity is e-tutoring, which offers personalised academic support to students through online platforms. While e-tutoring has become well-known and has been adopted to promote collaborative learning, there are still students who do not use these services for various reasons. However, little attention has been given to understanding the perspectives of students who have not utilized these services. The research objectives include identifying the perceived benefits that non-e-tutoring students believe e-tutoring could offer, such as enhanced academic support, personalized learning experiences, and improved performance. Additionally, the study explored the potential drawbacks or concerns that non-e-tutoring students associate with e-tutoring, such as concerns about efficacy, a lack of face-to-face interaction, and platform accessibility. The study adopted a quantitative research approach with a descriptive design to gather and analyze data on non-e-tutoring students' perspectives. Online questionnaires were employed as the primary data collection method, allowing for the efficient collection of data from many participants. The collected data was analyzed using the Statistical Package for the Social Sciences (SPSS). Ethical concepts such as informed consent, anonymity of responses and protection of respondents against harm were maintained. Findings indicate that non-e-tutoring students perceive a sense of control over their own pace of learning, suggesting a preference for self-directed learning and the ability to tailor their educational experience to their individual needs and learning styles. They also exhibit high levels of motivation, believe in their ability to effectively participate in their studies and organize their academic work, and feel comfortable studying on their own without the help of e-tutors. However, non-e-tutoring students feel that e-tutors do not sufficiently address their academic needs and lack engagement. They also perceive a lack of clarity in the roles of e-tutors, leading to uncertainty about their responsibilities. In terms of communication, students feel overwhelmed by the volume of announcements and find repetitive information frustrating. Additionally, some students face challenges with their internet connection and associated cost, which can hinder their participation in online activities. Furthermore, non-e-tutoring students express a desire for interactions with their peers and a sense of belonging to a group or team. They value opportunities for collaboration, teamwork in their learning experience, the importance of fostering social interactions and creating a sense of community in online learning environments. This study recommended that students seek alternate support systems by reaching out to professors or academic advisors for guidance and clarification. Developing self-directed learning skills is essential, empowering students to take charge of their own learning through setting objectives, creating own study plans, and utilising resources. For HEIs, it was recommended that they should ensure that a variety of support services are available to cater to the needs of all students, including non-e-tutoring students. HEIs should also ensure easy access to online resources, promote a supportive community, and regularly evaluate and adapt their support techniques to meet students' changing requirements.

Keywords: online-tutor;, student support;, online education, educational practices, distance education

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Authors: Tamal Roy, Anuradha Bhat

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Cognitive abilities aid fishes in foraging, avoiding predators & locating mates. Factors like predation pressure & habitat complexity govern learning & memory in fishes. This study aims to compare spatial learning & memory across four natural populations of zebrafish. Zebrafish, a small cyprinid inhabits a diverse range of freshwater habitats & this makes it amenable to studies investigating role of native environment in spatial cognitive abilities. Four populations were collected across India from waterbodies with contrasting ecological conditions. Habitat complexity of the water-bodies was evaluated as a combination of channel substrate diversity and diversity of vegetation. Experiments were conducted on populations under controlled laboratory conditions. A square shaped spatial testing arena (maze) was constructed for testing the performance of adult zebrafish. The square tank consisted of an inner square shaped layer with the edges connected to the diagonal ends of the tank-walls by connections thereby forming four separate chambers. Each of the four chambers had a main door in the centre. Each chamber had three sections separated by two windows. A removable coloured window-pane (red, yellow, green or blue) identified each main door. A food reward associated with an artificial plant was always placed inside the left-hand section of the red-door chamber. The position of food-reward and plant within the red-door chamber was fixed. A test fish would have to explore the maze by taking turns and locate the food inside the right-side section of the red-door chamber. Fishes were sorted from each population stock and kept individually in separate containers for identification. At a time, a test fish was released into the arena and allowed 20 minutes to explore in order to find the food-reward. In this way, individual fishes were trained through the maze to locate the food reward for eight consecutive days. The position of red door, with the plant and the reward, was shuffled every day. Following training, an intermission of four days was given during which the fishes were not subjected to trials. Post-intermission, the fishes were re-tested on the 13th day following the same protocol for their ability to remember the learnt task. Exploratory tendencies and latency of individuals to explore on 1st day of training, performance time across trials, and number of mistakes made each day were recorded. Additionally, mechanism used by individuals to solve the maze each day was analyzed across populations. Fishes could be expected to use algorithm (sequence of turns) or associative cues in locating the food reward. Individuals of populations did not differ significantly in latencies and tendencies to explore. No relationship was found between exploration and learning across populations. High habitat-complexity populations had higher rates of learning & stronger memory while low habitat-complexity populations had lower rates of learning and much reduced abilities to remember. High habitat-complexity populations used associative cues more than algorithm for learning and remembering while low habitat-complexity populations used both equally. The study, therefore, helped understand the role of natural ecology in explaining variations in spatial learning abilities across populations.

Keywords: algorithm, associative cue, habitat complexity, population, spatial learning

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Authors: Manuel de Pazos-Liano, Manuel Cifuentes-Antonio, Juan Fisac-Gozalo, Sara Perales-Momparler, Carlos Martinez-Montero

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The first-ever game in the Wanda Metropolitano Stadium, the new home of the Club Atletico de Madrid, was played on September 16, 2017, thanks to the work of a multidisciplinary team that made it possible to combine urban development with sustainability goals. The new football ground sits on a 1.2 km² land owned by the city of Madrid. Its construction has dramatically increased the sealed area of the site (transforming the runoff coefficient from 0.35 to 0.9), and the surrounding sewer network has no capacity for that extra flow. As an alternative to enlarge the existing 2.5 m diameter pipes, it was decided to detain runoff on site by means of an integrated and durable infrastructure that would not blow up the construction cost nor represent a burden on the municipality’s maintenance tasks. Instead of the more conventional option of building a large concrete detention tank, the decision was taken on the use of pervious pavement on the 3013 car parking spaces for sub-surface water storage, a solution aligned with the city water ordinance and the Madrid + Natural project. Making the idea a reality, in only five months and during the summer season (which forced to pour the porous concrete only overnight), was a challenge never faced before in Spain, that required of innovation both at the material as well as the machinery side. The process consisted on: a) defining the characteristics required for the porous concrete (compressive strength of 15 N/mm2 and 20% voids); b) testing of different porous concrete dosages at the construction company laboratory; c) stablishing the cross section in order to provide structural strength and sufficient water detention capacity (20 cm porous concrete over a 5 cm 5/10 gravel, that sits on a 50 cm coarse 40/50 aggregate sub-base separated by a virgin fiber polypropylene geotextile fabric); d) hydraulic computer modelling (using the Full Hydrograph Method based on the Wallingford Procedure) to estimate design peak flows decrease (an average of 69% at the three car parking lots); e) use of a variety of machinery for the application of the porous concrete to achieve both structural strength and permeable surface (including an inverse rotating rolling imported from USA, and the so-called CMI, a sliding concrete paver used in the construction of motorways with rigid pavements); f) full-scale pilots and final construction testing by an accredited laboratory (pavement compressive strength average value of 15 N/mm2 and 0,0032 m/s permeability). The continuous testing and innovating construction process explained in detail within this article, allowed for a growing performance with time, finally proving the use of the CMI valid also for large porous car park applications. All this process resulted in a successful story that converts the Wanda Metropolitano Stadium into a great demonstration site that will help the application of the Spanish Royal Decree 638/2016 (it also counts with rainwater harvesting for grass irrigation).

Keywords: construction machinery, permeable carpark, porous concrete, SUDS, sustainable develpoment

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Authors: Carina Emminger, Umut D. Cakmak, Evrim Burkut, Rene Preuer, Ingrid Graz, Zoltan Major

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Damping accompanies us daily in everyday life and is used to protect (e.g., in shoes) and make our life more comfortable (damping of unwanted motion) and calm (noise reduction). In general, damping is the absorption of energy which is either stored in the material (vibration isolation systems) or changed into heat (vibration absorbers). In case of the last, the damping mechanism can be split in active, passive, as well as semi-active (a combination of active and passive). Active damping is required to enable an almost perfect damping over the whole application range and is used, for instance, in sport cars. In contrast, passive damping is a response of the material due to external loading. Consequently, the material composition has a huge influence on the damping behavior. For elastomers, the material behavior is inherent viscoelastic, temperature, and frequency dependent. However, passive damping is not adjustable during application. Therefore, it is of importance to understand the fundamental viscoelastic behavior and the dissipation capability due to external loading. The objective of this work is to assess the limitation and applicability of viscoelastic material damping for applications in which currently coil-over shock absorbers are utilized. Coil-over shock absorbers are usually made of various mechanical parts and incorporate fluids within the damper. These shock absorbers are well-known and studied in the industry, and when needed, they can be easily adjusted during their product lifetime. In contrary, dampers made of – ideally – a single material are more resource efficient, have an easier serviceability, and are easier manufactured. However, they lack of adaptability and adjustability in service. Therefore, a case study with a remote-controlled sport car was conducted. The original shock absorbers were redesigned, and the spring-dashpot system was replaced by both an elastomer and a thermoplastic-elastomer, respectively. Here, five different formulations of elastomers were used, including a pure and an iron-particle filled thermoplastic poly(urethan) (TPU) and blends of two different poly(dimethyl siloxane) (PDMS). In addition, the TPUs were investigated as full and hollow dampers to investigate the difference between solid and structured material. To get comparative results each material formulation was comprehensively characterized, by monotonic uniaxial compression tests, dynamic thermomechanical analysis (DTMA), and rebound resilience. Moreover, the new material-based shock absorbers were compared with spring-dashpot shock absorbers. The shock absorbers were analyzed under monotonic and cyclic loading. In addition, an impact loading was applied on the remote-controlled car to measure the damping properties in operation. A servo-hydraulic high-speed linear actuator was utilized to apply the loads. The acceleration of the car and the displacement of specific measurement points were recorded while testing by a sensor and high-speed camera, respectively. The results prove that elastomers are suitable in damping applications, but they are temperature and frequency dependent. This is a limitation in applicability of viscous material damper. Feasible fields of application may be in the case of micromobility, like bicycles, e-scooters, and e-skateboards. Furthermore, the viscous material damping could be used to increase the inherent damping of a whole structure, e.g., in bicycle-frames.

Keywords: damper structures, material damping, PDMS, TPU

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Authors: Jan C. Droste, Justine Burns, Nithin Narayan

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Introduction: Life-threatening detrimental effects of inappropriate adrenaline (epinephrine) administration, e.g., by giving the wrong dose, in the context of anaphylaxis management is well documented in the medical literature. Half of the fatal anaphylactic reactions in the UK are iatrogenic, and the median time to a cardio-respiratory arrest can be as short as 5 minutes. It is therefore imperative that hospital doctors of all grades have active and accurate knowledge of the correct route, site, and dosage of administration of adrenaline. Given this time constraint and the potential fatal outcome with inappropriate management of anaphylaxis, it is alarming that surveys over the last 15 years have repeatedly shown only a minority of doctors to have accurate knowledge of adrenaline administration as recommended by the UK Resuscitation Council guidelines (2008 updated 2012). This comparison of survey results of the medical workforce over several years in a small NHS District General Hospital was conducted in order to establish the effect of the employment of multiple educational methods regarding adrenaline administration in anaphylaxis in adults. Methods: Between 2010 and 2017, several education methods and tools were used to repeatedly inform the medical workforce (doctors and advanced clinical practitioners) in a single district general hospital regarding the treatment of anaphylaxis in adults. Whilst the senior staff remained largely the same cohort, junior staff had changed fully in every survey. Examples included: (i) Formal teaching -in Grand Rounds; during the junior doctors’ induction process; advanced life support courses (ii) In-situ simulation training performed by the clinical skills simulation team –several ad hoc sessions and one 3-day event in 2017 visiting 16 separate clinical areas performing an acute anaphylaxis scenario using actors- around 100 individuals from multi-disciplinary teams were involved (iii) Hospital-wide distribution of the simulation event via the Trust’s Simulation Newsletter (iv) Laminated algorithms were attached to the 'crash trolleys' (v) A short email 'alert' was sent to all medical staff 3 weeks prior to the survey detailing the emergency treatment of anaphylaxis (vi) In addition, the performance of the surveys themselves represented a teaching opportunity when gaps in knowledge could be addressed. Face to face surveys were carried out in 2010 ('pre-intervention), 2015, and 2017, in the latter two occasions including advanced clinical practitioners (ACP). All surveys consisted of convenience samples. If verbal consent to conduct the survey was obtained, the medical practitioners' answers were recorded immediately on a data collection sheet. Results: There was a sustained improvement in the knowledge of the medical workforce from 2010 to 2017: Answers improved regarding correct drug by 11% (84%, 95%, and 95%); the correct route by 20% (76%, 90%, and 96%); correct site by 40% (43%, 83%, and 83%) and the correct dose by 45% (27%, 54%, and 72%). Overall, knowledge of all components -correct drug, route, site, and dose-improved from 13% in 2010 to 62% in 2017. Conclusion: This survey comparison shows knowledge of the medical workforce regarding adrenaline administration for treatment of anaphylaxis in adults can be considerably improved by employing a variety of educational methods.

Keywords: adrenaline, anaphylaxis, epinephrine, medical education, patient safety

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Authors: Piotr Jablonski, Krzysztof Mars, Wiktor Niemiec, Agnieszka Kyziol, Marek Hebda, Halina Krawiec, Karol Kyziol

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NiTi alloys, possessing unique mechanical properties such as pseudoelasticity and shape memory effect (SME), are suitable for many applications, including implanthology and biomedical devices. Additionally, these alloys have similar values of elastic modulus to those of human bones, what is very important in orthopedics. Unfortunately, the environment of physiological fluids in vivo causes unfavorable release of Ni ions, which in turn may lead to metalosis as well as allergic reactions and toxic effects in the body. For these reasons, the surface properties of NiTi alloys should be improved to increase corrosion resistance, taking into account biological properties, i.e. excellent biocompatibility. The prospective in this respect are layers based on DLC (Diamond-Like Carbon) structures, which are an attractive solution for many applications in implanthology. These coatings (DLC), usually obtained by PVD (Physical Vapour Deposition) and PA CVD (Plasma Activated Chemical Vapour Deposition) methods, can be also modified by doping with other elements like silicon, nitrogen, oxygen, fluorine, titanium and silver. These methods, in combination with a suitably designed structure of the layers, allow the possibility co-decide about physicochemical and biological properties of modified surfaces. Mentioned techniques provide specific physicochemical properties of substrates surface in a single technological process. In this work, the following types of layers based on DLC structures (incl. Si-DLC or Si/N-DLC) were proposed as prospective and attractive approach in surface functionalization of shape memory alloy. Nitinol substrates were modified in plasma conditions, using RF CVD (Radio Frequency Chemical Vapour Deposition). The influence of plasma treatment on the useful properties of modified substrates after deposition DLC layers doped with silica and/or nitrogen atoms, as well as only pre-treated in O2 NH3 plasma atmosphere in a RF reactor was determined. The microstructure and topography of the modified surfaces were characterized using scanning electron microscopy (SEM) and atomic force microscopy (AFM). Furthermore, the atomic structure of coatings was characterized by IR and Raman spectroscopy. The research also included the evaluation of surface wettability, surface energy as well as the characteristics of selected mechanical and biological properties of the layers. In addition, the corrosion properties of alloys after and before modification in the physiological saline were also investigated. In order to determine the corrosion resistance of NiTi in the Ringer solution, the potentiodynamic polarization curves (LSV – Linear Sweep Voltamperometry) were plotted. Furthermore, the evolution of corrosion potential versus immersion time of TiNi alloy in Ringer solution was performed. Based on all carried out research, the usefullness of proposed modifications of nitinol for medical applications was assessed. It was shown, inter alia, that the obtained Si-DLC layers on the surface of NiTi alloy exhibit a characteristic complex microstructure, increased surface development, which is an important aspect in improving the osteointegration of an implant. Furthermore, the modified alloy exhibits biocompatibility, the transfer of the metal (Ni, Ti) to Ringer’s solution is clearly limited.

Keywords: bioactive coatings, corrosion resistance, doped DLC structure, NiTi alloy, RF CVD

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