Search results for: orthodontic patient adherence

Authors: Lina Psarra, Manogj Sundaresan, Purjeet Sutar

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In response to the global imperative for sustainable solutions, this article proposes the development of a comprehensive circularity index applicable to a wide range of products across various industries. The absence of a consensus on using a universal metric to assess circularity performance presents a significant challenge in prioritizing and effectively managing sustainable initiatives. This circularity index serves as a quantitative measure to evaluate the adherence of products, processes, and systems to the principles of a circular economy. Unlike traditional distinct metrics such as recycling rates or material efficiency, this index considers the entire lifecycle of a product in one single metric, also incorporating additional factors such as reusability, scarcity of materials, reparability, and recyclability. Through a systematic approach and by reviewing existing metrics and past methodologies, this work aims to address this gap by formulating a circularity index that can be applied to diverse product portfolio and assist in comparing the circularity of products on a scale of 0%-100%. Project objectives include developing a formula, designing and implementing a pilot tool based on the developed Product Circularity Index (PCI), evaluating the effectiveness of the formula and tool using real product data, and assessing the feasibility of integration into various sustainability initiatives. The research methodology involves an iterative process of comprehensive research, analysis, and refinement where key steps include defining circularity parameters, collecting relevant product data, applying the developed formula, and testing the tool in a pilot phase to gather insights and make necessary adjustments. Major findings of the study indicate that the PCI provides a robust framework for evaluating product circularity across various dimensions. The Excel-based pilot tool demonstrated high accuracy and reliability in measuring circularity, and the database proved instrumental in supporting comprehensive assessments. The PCI facilitated the identification of key areas for improvement, enabling more informed decision-making towards circularity and benchmarking across different products, essentially assisting towards better resource management. In conclusion, the development of the Product Circularity Index represents a significant advancement in global sustainability efforts. By providing a standardized metric, the PCI empowers companies and stakeholders to systematically assess product circularity, track progress, identify improvement areas, and make informed decisions about resource management. This project contributes to the broader discourse on sustainable development by offering a practical approach to enhance circularity within industrial systems, thus paving the way towards a more resilient and sustainable future.

Keywords: circular economy, circular metrics, circularity assessment, circularity tool, sustainable product design, product circularity index

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Authors: M. Mousavi-Daramoroudi, H. Yousefnia, F. Abbasi-Davani, S. Zolghadri

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Dosimetry is an indispensable and precious factor in patient treatment planning to minimize the absorbed dose in vital tissues. In this study, compartmental model was used in order to estimate the human absorbed dose of ¹⁷⁷Lu-DOTATOC from the biodistribution data in wild type rats. For this purpose, ¹⁷⁷Lu-DOTATOC was prepared under optimized conditions and its biodistribution was studied in male Syrian rats up to 168 h. Compartmental model was applied to mathematical description of the drug behaviour in tissue at different times. Dosimetric estimation of the complex was performed using radiation absorbed dose assessment resource (RADAR). The biodistribution data showed high accumulation in the adrenal and pancreas as the major expression sites for somatostatin receptor (SSTR). While kidneys as the major route of excretion receive 0.037 mSv/MBq, pancreas and adrenal also obtain 0.039 and 0.028 mSv/MBq. Due to the usage of this method, the points of accumulated activity data were enhanced, and further information of tissues uptake was collected that it will be followed by high (or improved) precision in dosimetric calculations.

Keywords: compartmental modeling, human absorbed dose, ¹⁷⁷Lu-DOTATOC, Syrian rats

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Authors: Andrew Cummings, Rhianne Boag, Sarah Bryson, Gordon Turner

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Packages designed for transport of radioactive material must satisfy rigorous safety regulations specified by the International Atomic Energy Agency (IAEA). Higher Activity Waste (HAW) transport packages have to maintain containment of their contents during normal and accident conditions of transport (NCT and ACT). To ensure containment criteria is satisfied these packages are required to be leak-tight in all transport conditions to meet allowable activity release rates. Package design safety reports are the safety cases that provide the claims, evidence and arguments to demonstrate that packages meet the regulations and once approved by the competent authority (in the UK this is the Office for Nuclear Regulation) a licence to transport radioactive material is issued for the package(s). The standard approach to demonstrating containment in the RWM transport safety case is set out in BS EN ISO 12807. In this document a method for measuring a leak rate from the package is explained by way of a small interspace test volume situated between two O-ring seals on the underside of the package lid. The interspace volume is pressurised and a pressure drop measured. A small interspace test volume makes the method more sensitive enabling the measurement of smaller leak rates. By ascertaining the activity of the contents, identifying a releasable fraction of material and by treating that fraction of material as a gas, allowable leak rates for NCT and ACT are calculated. The adherence to basic safety principles in ISO12807 is very pessimistic and current practice in the demonstration of transport safety, which is accepted by the UK regulator. It is UK government policy that management of HAW will be through geological disposal. It is proposed that the intermediate level waste be transported to the geological disposal facility (GDF) in large cuboid packages. This poses a challenge for containment demonstration because such packages will have long seals and therefore large interspace test volumes. There is also uncertainty on the releasable fraction of material within the package ullage space. This is because the waste may be in many different forms which makes it difficult to define the fraction of material released by the waste package. Additionally because of the large interspace test volume, measuring the calculated leak rates may not be achievable. For this reason a justification for a lower releasable fraction of material is sought. This paper considers the use of aerosol processes to reduce the releasable fraction for both NCT and ACT. It reviews the basic coagulation and removal processes and applies the dynamic aerosol balance equation. The proposed solution includes only the most well understood physical processes namely; Brownian coagulation and gravitational settling. Other processes have been eliminated either on the basis that they would serve to reduce the release to the environment further (pessimistically in keeping with the essence of nuclear transport safety cases) or that they are not credible in the conditions of transport considered.

Keywords: aerosol processes, Brownian coagulation, gravitational settling, transport regulations

Procedia PDF Downloads 118

Authors: Devin Doos, Ashley Hughes, Trang Pham, Paul Barach, Rami Ahmed

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Over 115,000 Health Care Workers (HCWs) have died from COVID-19, and millions have been infected while caring for patients. HCWs have filed thousands of safety complaints surrounding safety concerns due to Personal Protective Equipment (PPE) shortages, which included concerns around inadequate and PPE reuse. Protocols for donning and doffing PPE remain ambiguous, lacking an evidence-base, and often result in wide deviations in practice. PPE donning and doffing protocol deviations commonly result in self-contamination but have not been thoroughly addressed. No evidence-driven protocols provide guidance on protecting HCW during periods of PPE reuse. Objective: The aim of this study was to examine safety-related threats and risks to Health Care Workers (HCWs) due to the reuse of PPE among Emergency Department personnel. Method: We conducted a prospective observational study to examine the risks of reusing PPE. First, ED personnel were asked to don and doff PPE in a simulation lab. Each participant was asked to don and doff PPE five times, according to the maximum reuse recommendation set by the Centers for Disease Control and Prevention (CDC). Each participant was videorecorded; video recordings were reviewed and coded independently by at least 2 of the 3trained coders for safety behaviors and riskiness of actions. A third coder was brought in when the agreement between the 2 coders could not be reached. Agreement between coders was high (81.9%), and all disagreements (100%) were resolved via consensus. A bowtie risk assessment chart was constructed analyzing the factors that contribute to increased risks HCW are faced with due to PPE use and reuse. Agreement amongst content experts in the field of Emergency Medicine, Human Factors, and Anesthesiology was used to select aspects of health care that both contribute and mitigate risks associated with PPE reuse. Findings: Twenty-eight clinician participants completed five rounds of donning/doffing PPE, yielding 140 PPE donning/doffing sequences. Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE materials. 100% of participants (n= 28) deviated from the CDC recommended order, and most participants (92.85%, n=26) self-contaminated at least once during reuse. Other frequent errors included failure to tie all ties on the PPE (92.85%, n=26) and failure to wash hands after a contamination event occurred (39.28%, n=11). Conclusions: There is wide variation and regular errors in how HCW don and doffPPE while including in reusing PPE that led to self-contamination. Some errors were deemed “recoverable”, such as hand washing after touching a patient-facing surface to remove the contaminant. Other errors, such as using a contaminated mask and accidentally spreading to the neck and face, can lead to compound risks that are unique to repeated PPE use. A more comprehensive understanding of the contributing threats to HCW safety and complete approach to mitigating underlying risks, including visualizing with risk management toolsmay, aid future PPE designand workflow and space solutions.

Keywords: bowtie analysis, health care, PPE reuse, risk management

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Authors: Shankar M. Bakkannavar, Smitha Nayak, Vinod C. Nayak, Ravi Bagali

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Attendance rate for hospital outpatient appointments plays a pivotal role in operational efficiency of a hospital. Strategic interventions like ‘reminder systems’ prior to the scheduled appointment has proved to be an effective strategy for outpatient appointment ‘show-ups’. This study is designed with an objective to assess the effectiveness of SMS reminders as an intervention to enhance the effectiveness of hospital outpatient attendance. Method: The survey was conducted at Columbia Asia Hosiptal, Bangalore. We surveyed 60 patients who had a scheduled outpatient appointment in Department of General Medicine, Department of Obstetrics and Gynecology and the Orthopedics department, as these departments had a heavy patient flow and had higher contributions to the top line of the hospital. Results: Majority (64%) of the patients preferred to be sent an SMS reminder on the outpatient appointment schedule. 37 (61%) respondents stated that the ideally, reminders could be effective only if they are sent 24-48 hours prior to the appointment schedule. 41(68%) respondents were of the opinion that a minimum of two reminders would be necessary to ensure patients show up for the appointment. 1% level of significance. It also observed that there is strong association between age and preference on mode of reminder (P=0.002).

Keywords: reminder systems, appointment show-ups, SMS reminders, health Information

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Authors: Amie Smith, Jodi-Lyn Benjamin

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In 2020, there are currently four generations in the nursing workforce: The Veterans, Boomers, Generation X and Generation Y (Gen Y). Understanding each generation and their growing needs will equip the workforce for when the Boomers prepare for retirement, with majority of nursing leadership positions to be potentially replaced with Gen Y nurses. In SA Medical Imaging(SAMI), at Flinders Medical Centre (FMC), it has been proven that despite challenges in succession planning, Gen Y nurse leaders are able to overcome these obstacles and provide the leadership necessary to meet the changing needs in healthcare and across organisations. Changing the culture in radiology nursing has been seen as an obstacle due to the historical nursing practices and resistance to adapt to current/future practice. As radiology advances so does the role of the nurse in imaging, this has required resilience and strong support through leadership as we change and develop the culture to keep up with the evolution of technology and standard of patient care. As a result of supporting Gen Y nurses in leadership roles, SAMI, FMC has seen a positive change in culture by creating a healthy work environment which has allowed Gen Y nurses to make long lasting contributions to the nursing profession.

Keywords: changing culture, Generation Y, radiology, nursing, leadership

Procedia PDF Downloads 138

Authors: Mukesh Roy, Basant Singh Sikarwar, Ravi Prakash, Priya Ranjan, Ayush Goyal

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More than 11% of people suffer from weakness in the bone resulting in inability in walking or climbing stairs or from limited upper body and limb immobility. This motivates a fresh bio-mimicking solution to the design of an exo-skeleton to support human movement in the case of partial or total immobility either due to congenital or genetic factors or due to some accident or due to geratological factors. A deeper insight and detailed understanding is required into the workings of the ball and socket joints. Our research is to mimic ball and socket joints to design snugly fitting exoskeletons. Our objective is to design an exoskeleton which is comfortable and the presence of which is not felt if not in use. Towards this goal, a parametric study is conducted to provide detailed design parameters to fabricate an exoskeleton. This work builds up on real data of the design of the exoskeleton, so that the designed exo-skeleton will be able to provide required strength and support to the subject.

Keywords: bio-mimicking, exoskeleton, ball joint, socket joint, artificial limb, patient rehabilitation, joints, human-machine interface, wearable robotics

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Authors: Hafiz Faisal Siddique, Adnan Ahmed Mazari, Antonin Havelka

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Compression socks are highly recommended textile garment for pressure exertion on the lower part of leg. The extent of compression that a patient can easily manage depends on stage (limb size and shape) of venous disease and his activities (mobility, age). Due to dynamic mechanical influence, the socks destroy their extent of pressure exertion around the leg. The main aim of this research is to investigate how the performance of compression socks is deteriorated due to expected induced wearing mechanical impacts. Wearing mechanical impacts influence the durability parameter i.e. tensile energy loss. For tensile energy loss, cut-strip samples were interacted to constant rate of loading and un-loading, cyclic-loading upto 15th cycles for ±5mm extension (considering muscles expansion and relaxation) and were dwelled (stayed) for 3 minutes at 25%, 50% and 75% extension levels, simultaneously. Statistical validation of tensile energy loss was performed by introducing measures of correlation, p-value (≤ 0.05), R-square values using MINITAB 17 software.

Keywords: compression socks, loading and unloading, 15th cyclic loading, Dwell time effect

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Authors: Sundru Manjulata Devi, Prakash M. Halami

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The immemorial use of fermented foods from vegetables, dairy and other biological sources are of great demand in India because of their health benefits. However, the diversity of Lactobacillus plantarum group (LPG) of vegetable origin has not been revealed yet, particularly with reference to their probiotic functionalities. In the present study, the different species of probiotic Lactobacillus plantarum group (LPG) i.e., L. plantarum subsp. plantarum MTCC 5422 (from fermented cereals), L. plantarum subsp. argentoratensis FG16 (from fermented bamboo shoot) and L. paraplantarum MTCC 9483 (from fermented gundruk) (as characterized by multiplex recA PCR assay) were considered to investigate their relative expression of MUB domains of mub gene (mucin binding protein) by Real time PCR. Initially, the allelic variation in the mub gene was assessed and found to encode three different variants (Type I, II and III). All the three types had 8, 9 and 10 MUB domains respectively (as analysed by Pfam database) and were found to be responsible for adhesion of bacteria to the host intestinal epithelial cells. These domains either get inserted or deleted during speciation or evolutionary events and lead to divergence. The reverse transcriptase qPCR analysis with mubLPF1+R1 primer pair supported variation in amplicon sizes with 300, 500 and 700 bp among different LPG strains. The relative expression of these MUB domains significantly unregulated in the presence of 1% mucin in overnight grown cultures. Simultaneously, the mub gene expressed efficiently by 7 fold in the culture L. paraplantarum MTCC 9483 with 10 MUB domains. An increase in the expression levels for L. plantarum subsp. plantarum MTCC 5422 and L. plantarum subsp. argentoratensis FG16 (MCC 2974) with 9 and 8 repetitive domains was around 4 and 2 fold, respectively. The detection and expression of an integrase (int) gene in the upstream region of mub gene reveals the excision and integration of these repetitive domains. Concurrently, an in vitro adhesion assay to mucin and exclusion of pathogens (such as Listeria monocytogenes and Micrococcus leuteus) was investigated and observed that the L. paraplantarum MTCC 9483 with more adhesion domains has more ability to adhere to mucin and inhibited the growth of pathogens. The production and expression of plantaricin-like bacteriocin (plnNC8 type) in MTCC 9483 suggests the pathogen inhibition. Hence, the expression of MUB domains can act as potential biomarkers in the screening of a novel probiotic LPG strain with adherence property. The present study provides a platform for an easy, rapid, less time consuming, low-cost methodology for the detection of potential probiotic bacteria. It was known that the traditional practices followed in the preparation of fermented bamboo shoots/gundruk/cereals of Indian foods contain different kinds of neutraceuticals for functional food and novel compounds with health promoting factors. In future, a detailed study of these food products can add more nutritive value, consumption and suitable for commercialization.

Keywords: adhesion gene, fermented foods, MUB domains, probiotics

Procedia PDF Downloads 271

Authors: Elnaz Lashgari, Emel Demircan

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Electromyography (EMG) is one of the most important interfaces between humans and robots for rehabilitation. Decoding this signal helps to recognize muscle activation and converts it into smooth motion for the robots. Detecting each muscle’s pattern during walking and running is vital for improving the quality of a patient’s life. In this study, EMG data from 10 muscles in 10 subjects at 4 different speeds were analyzed. EMG signals are nonlinear with high dimensionality. To deal with this challenge, we extracted some features in time-frequency domain and used manifold learning and Laplacian Eigenmaps algorithm to find the intrinsic features that represent data in low-dimensional space. We then used the Bayesian classifier to identify various patterns of EMG signals for different muscles across a range of running speeds. The best result for vastus medialis muscle corresponds to 97.87±0.69 for sensitivity and 88.37±0.79 for specificity with 97.07±0.29 accuracy using Bayesian classifier. The results of this study provide important insight into human movement and its application for robotics research.

Keywords: electromyography, manifold learning, ISOMAP, Laplacian Eigenmaps, locally linear embedding

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Authors: Tahsien Okasha

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Transplantation medicine is one of the most challenging and complex areas of modern medicine. Some of the key areas for medical management are the problems of transplant rejection, during which the body has an immune response to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient. When possible, transplant rejection can be reduced through serotyping to determine the most appropriate donor-recipient match and through the use of immunosuppressant drugs. Postoperative care actually begins before the surgery in terms of education, discharge planning, nutrition, pulmonary rehabilitation, and patient/family education. This also allows for expectations to be managed. A multidisciplinary approach is the key, and collaborative team meetings are essential to ensuring that all team members are "on the same page.". The following clinical pathway map and guidelines with the aim to decrease alteration in clinical practice and are intended for those healthcare professionals who look after organ transplant patients. They are also intended to be useful to both medical and surgical trainees as well as nurse specialists and other associated healthcare professionals involved in the care of organ transplant patients. This pathway is general pathway include the general guidelines that can be applicable for all types of organ transplant with special considerations to each organ.

Keywords: organ transplant, clinical pathway, postoperative care, same page

Procedia PDF Downloads 438

Authors: Ashlesha Khanapure, Harsh Kashyap, Abhinav Anand, Sanjana Habib, Anupama Bidargaddi

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Technologies that are developing quickly are being developed daily in a variety of disciplines, particularly the medical field. For the purpose of detecting bone fractures in X-ray pictures of different body segments, our work compares the ResNet-50 and MobileNetV3 architectures. It evaluates accuracy and computing efficiency with X-rays of the elbow, hand, and shoulder from the MURA dataset. Through training and validation, the models are evaluated on normal and fractured images. While ResNet-50 showcases superior accuracy in fracture identification, MobileNetV3 showcases superior speed and resource optimization. Despite ResNet-50’s accuracy, MobileNetV3’s swifter inference makes it a viable choice for real-time clinical applications, emphasizing the importance of balancing computational efficiency and accuracy in medical imaging. We created a graphical user interface (GUI) for MobileNet V3 model bone fracture detection. This research underscores MobileNetV3’s potential to streamline bone fracture diagnoses, potentially revolutionizing orthopedic medical procedures and enhancing patient care.

Keywords: CNN, MobileNet V3, ResNet-50, healthcare, MURA, X-ray, fracture detection

Procedia PDF Downloads 70

Authors: Aofan Liu, Qianqian Tan, Burra Venkata Durga Kumar

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Data security is of the utmost importance in the healthcare area, as sensitive patient information is constantly sent around and analyzed by many different parties. The use of federated learning, which enables data to be evaluated locally on devices rather than being transferred to a central server, has emerged as a potential solution for protecting the privacy of user information. To protect against data breaches and unauthorized access, federated learning alone might not be adequate. In this context, the application of blockchain technology could provide the system extra protection. This study proposes a distributed federated learning system that is built on blockchain technology in order to enhance security in healthcare. This makes it possible for a wide variety of healthcare providers to work together on data analysis without raising concerns about the confidentiality of the data. The technical aspects of the system, including as the design and implementation of distributed learning algorithms, consensus mechanisms, and smart contracts, are also investigated as part of this process. The technique that was offered is a workable alternative that addresses concerns about the safety of healthcare while also fostering collaborative research and the interchange of data.

Keywords: data privacy, distributed system, federated learning, machine learning

Procedia PDF Downloads 136

Authors: Mazdak Ganjalikhani, Mohamad Namgar, Alireza Peyman

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Introduction: The present study was carried out to measure the levels of inflammatory markers Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in tear of keratoconus patients and investigate their relationship with the severity of keratoconus. Materials and Methods: This study was performed on 81 patients with keratoconus (cases) and 85 healthy individuals (controls) who were selected through the convenience sampling method from patients visiting the Feiz Ophthalmology Hospital affiliated with the Isfahan University of Medical Sciences. Tear levels of IL-6 and TNF-α were measured after collecting the patient's tears from the lower eyelid through the Schirmer I method using a filter paper (Schirmer tear test strip) without anesthesia. Findings: The mean levels of IL-6 and TNF-α were 26.77±8.16 and 34.58±9.82 in the control group and 103.22±51.94, and 183.76±54.61 in the case group, respectively, indicating a significant difference between two groups (p<0.05). In addition, there was a significant relationship between the severity of the keratoconus and the mean levels of TNF-α and IL-6 in the case group (p<0.05). Conclusion: According to the results, the mean levels of IL-6 and TNF-α were higher in keratoconus cases than in the controls, and the disease severity was significantly associated with the levels of inflammatory markers IL-6 and TNF-α.

Keywords: keratoonus, cataract, tumor necrotic factor, interleukin 6

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Authors: Daniel Gredig, Annabelle Bartelsen-Raemy

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Social work services offered to people living with diabetes tend to be moulded by the prevailing understanding that social work is to support people living with diabetes in their adherence to medical prescription and/or life style changes. As diabetes has been conceived as a condition facing no stigma, discrimination of people living with diabetes has not been considered. However, there is growing evidence of stigma. To our knowledge, nevertheless, there have been no comprehensive, in-depth studies of stigma and its impact. Against this background and challenging the present layout of services for people living with diabetes, the present study aimed to establish whether: -people living with diabetes in Switzerland experience stigma, and if so, in what context and to what extent; -experiencing stigma impacts the quality of life of those affected. It was hypothesized that stigma would impact on their quality of life. It was further hypothesized that low self-esteem, psychological distress, depression, and a lack of social support would be mediating factors. For data collection an anonymous paper-and-pencil self-administered questionnaire was used which drew on a qualitative elicitation study. Data were analysed using descriptive statistics and structural equation modelling. To generate a large and diverse convenience sample the questionnaire was distributed to the readers of journal destined to diabetics living in Switzerland issued in German and French. The sample included 3347 people with type 1 and 2 diabetes, aged 16–96, living in diverse living conditions in the German- and French-speaking areas of Switzerland. Respondents reported experiences of discrimination in various contexts and stereotyping based on the belief that diabetics have a low work performance; are inefficient in the workplace; inferior; weak-willed in their ability to manage health-related issues; take advantage of their condition and are viewed as pitiful or sick people. Respondents who reported higher levels of perceived stigma reported higher levels of psychological distress (β = .37), more pronounced depressive symptoms (β=.33), and less social support (β = -.22). Higher psychological distress (β = -.29) and more pronounced depressive symptoms (β = -.28), in turn, predicted lower quality of life. These research findings challenge the prevailing understanding of social work services for people living with diabetes in Switzerland and beyond. They call for a less individualistic approach, the consideration of the social context service users are placed in their everyday life, and addressing stigma. So, social work could partner with people living with diabetes in order to fight against discrimination and stereotypes. This could include identifying and designing educational and public awareness strategies. In direct social work with people living with diabetes, this could include broaching experiences of stigma and modes of coping with. This study was carried out in collaboration with the Swiss Diabetes Association. The association accepted the challenging conclusions from this study. It connected to the results and is currently discussing the priorities and courses of action to be taken.

Keywords: diabetes, discrimination, quality of life, services, stigma

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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

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Authors: Loren S. Bernal., Catalina Castillo, Carel E. Carvajal, José F. Ibla

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Plastic pollution, specifically microplastics, has become a significant issue in aquatic ecosystems worldwide. The large amount of plastic waste carried by water tributaries has resulted in the accumulation of microplastics in water bodies. The polymer aging process caused by environmental influences such as photodegradation and chemical degradation of additives leads to polymer embrittlement and properties change that require degradation or reduction procedures in rivers. However, there is a lack of such procedures for freshwater entities that develop over extended periods. The aim of this study is evaluate the potential of Pleurotus ostreatus a fungus, in reducing lowdensity polyethylene microplastics present in freshwater samples collected from the middle basin of the Magdalena River in Colombia. The study aims to evaluate this process both in vitro and in silico by identifying the growth capacity of Pleurotus ostreatus in the presence of microplastics and identifying the most likely interactions of Pleurotus ostreatus enzymes and their affinity energies. The study follows an engineering development methodology applied on an experimental basis. The in vitro evaluation protocol applied in this study focused on the growth capacity of Pleurotus ostreatus on microplastics using enzymatic inducers. In terms of in silico evaluation, molecular simulations were conducted using the Autodock 1.5.7 program to calculate interaction energies. The molecular dynamics were evaluated by using the myPresto Portal and GROMACS program to calculate radius of gyration and Energies.The results of the study showed that Pleurotus ostreatus has the potential to degrade low-density polyethylene microplastics. The in vitro evaluation revealed the adherence of Pleurotus ostreatus to LDPE using scanning electron microscopy. The best results were obtained with enzymatic inducers as a MnSO4 generating the activation of laccase or manganese peroxidase enzymes in the degradation process. The in silico modelling demonstrated that Pleurotus ostreatus was able to interact with the microplastics present in LDPE, showing affinity energies in molecular docking and molecular dynamics shown a minimum energy and the representative radius of gyration between each enzyme and its substract. The study contributes to the development of bioremediation processes for the removal of microplastics from freshwater sources using the fungus Pleurotus ostreatus. The in silico study provides insights into the affinity energies of Pleurotus ostreatus microplastic degrading enzymes and their interaction with low-density polyethylene. The study demonstrated that Pleurotus ostreatus can interact with LDPE microplastics, making it a good agent for the development of bioremediation processes that aid in the recovery of freshwater sources. The results of the study suggested that bioremediation could be a promising approach to reduce microplastics in freshwater systems.

Keywords: bioremediation, in silico modelling, microplastics, Pleurotus ostreatus

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Authors: Haira Rizka, Imas Istiani

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The way women and men use language is an interesting topic to discuss. Nowadays, Instagram shows many videos which illustrate the difference of women’s and men’s language. Furthermore, the videos show how different genders behave in daily communication. This research aims to (1) investigate conversational characteristics of women represented in Indonesian Instagram videos, and (2) investigate how different genders behave in daily communication. To analyze the two research problems, this research employs Tannen’s theory of language and gender (1996). This is a descriptive qualitative research which describes phenomena of language and gender shown in Indonesian Instagram videos. The data were collected through observation. The collected data were then analyzed by employing ethnography and textual analysis. The research results show that in Indonesian Instagram videos, women dominate the conversation than men. Women’s are portrayed as a figure who are talkative, never wrong, and sensitive. Women’s dominating men proves that women always want to be understood, produce more words than men, and are more creative in producing verbal communication. Meanwhile, men are portrayed as calm, gentle, and patient creature who listen to women’s talk. Furthermore, men are portrayed to prefer being silent for avoiding conflict.

Keywords: gender, Instagram videos, language variety, women's language

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Authors: Trina Isabel D. Santiago, Juan Raphael M. Perez, Maria Angelica O. Soriano, Teresita B. Suing, Jumee F. Tayaban

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To achieve universal healthcare for everyone, the World Health Organization has emphasized the importance of National Medicines Policies for increased accessibility and utilization of high-quality and affordable medications. In the Philippines, significant challenges have been identified surrounding the sustainability of essential medicines, resulting in limited access such as high cost and dominance and market dominance and monopoly of multinational companies (MNCs) in the Philippine pharmaceutical industry. These identified challenges have been addressed by several initiatives, such as the Philippine National Drug Policy and Generics Act of 1988 (Republic Act 6675), to attempt to reduce drug prices. Despite these efforts, the concerns with drug accessibility and affordability continue to persist; hence, Republic Act 9502 was enacted. This paper attempts to review RA 9502 in the pursuit of making medicines more affordable for Filipinos, analyze and critique the problems and challenges associated with the law, and provide recommendations to address identified problems and challenges. A literature search and review, as well as an analysis of the law, has been done to evaluate the policy. RA 9502 recognizes the importance of market competition in drug price reduction and quality medicine accessibility. Contentious issues prior to enactment of the law include 1) parallel importation, pointing out that the drug price will depend on the global market price, 2) contrasting approaches in the drafting of the law as the House version focused on medicine price control while the Senate version prioritized market competition, and 3) MNCs opposing the amendments with concerns on discrimination, constitutional violations, and noncompliance with international treaty obligations. There are also criticisms and challenges with the implementation of the law in terms of content or modeling, interpretation and implementation, and other external factors or hindrances. The law has been criticized for its narrow scope as it only covers specific essential medicines with no cooperation with the national health insurance program. Moreover, the law has sections taking advantage of the TRIPS flexibilities, which disallow smaller countries to reap the benefits of flexibilities. The sanctions and penalties have an insignificant role in implementation as they only ask for a small portion of the income of MNCs. Proposed recommendations for policy improvement include aligning existing legislation through strengthened price regulation and expanded law coverage, strengthening penalties to promote law adherence, and promoting research and development to encourage and support local initiatives. Through these comprehensive recommendations, the issues surrounding the policy can be addressed, and the goal of enhancing the affordability and accessibility of medicines in the country can be achieved.

Keywords: drug accessibility, drug affordability, price regulation, Republic Act 9502

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Authors: Delly C. Lestari, Linosefa, Ardiana Kusumaningrum, Andi Yasmon, Anis Karuniawati

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The objective of this study is to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) harboring mecA genes from screening isolates among intensive care unit (ICU) patients. All MRSA screening isolates from ICU’s patients of Cipto Mangunkusumo Hospital during 2011 and 2014 were included in this study. Identification and susceptibility test was performed using Vitek2 system (Biomereux®). PCR was conducted to characterize the SCCmec of S. aureus harboring the mecA gene on each isolate. Patient’s history of illness was traced through medical record. 24 isolates from 327 screening isolates were MRSA positive (7.3%). From PCR, we found 17 (70.8%) isolates carrying SCCmec type I, 3 (12.5%) isolates carrying SCCmec type III, and 2 (8.3%) isolates carrying SCCmec type IV. In conclusion, SCCmec type I is the most prevalent MRSA colonization among ICU patients in Cipto Mangunkusumo Hospital.

Keywords: MRSA, mecA genes, ICU, colonization

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Authors: Maryum Nawaz

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Purpose: To determine the frequency of refractive errors in squinting eyes of children from 4 to 16 years presenting at tertiary care hospital. Study Design: A descriptive cross-sectional study was done. Place and Duration: The study was conducted in Pediatric Ophthalmology, Hayatabad Medical Complex, Peshawar. Materials and Methods: The sample size was 146 keeping 41.45%5 proportion of refractive errors in children with squinting eyes, 95% confidence interval and 8% margin of error under WHO sample size calculations. Non-probability consecutive sampling was done. Result: Mean age was 8.57±2.66 years. Male were 89 (61.0%) and female were 57 (39.0%). Refractive error was present in 56 (38.4%) and was not present in 90 (61.6%) of patients. There was no association of gender, age, parent refractive errors, or early usage of electric equipment with the refractive errors. Conclusion: There is a high prevalence of refractive errors in a patient with strabismus. There is no association of age, gender, parent refractive errors, or early usage of electric equipment in the occurrence of refractive errors. Further studies are recommended for confirmation of these.

Keywords: strabismus, refractive error, myopia, hypermetropia, astigmatism

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Authors: Allmin Susaiyah, Aki Härmä, Milan Petković

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Automatic generation of insights from data using insight mining systems (IMS) is useful in many applications, such as personal health tracking, patient monitoring, and business process management. Existing IMS face challenges in controlling insight extraction, scaling to large databases, and generalising to unseen domains. In this work, we propose a hybrid approach consisting of rule-based and neural components for generating insights from data while overcoming the aforementioned challenges. Firstly, a rule-based data 2CNL component is used to extract statistically significant insights from data and represent them in a controlled natural language (CNL). Secondly, a BERTSum-based CNL2NL component is used to convert these CNLs into natural language texts. We improve the model using task-specific and domain-specific fine-tuning. Our approach has been evaluated using statistical techniques and standard evaluation metrics. We overcame the aforementioned challenges and observed significant improvement with domain-specific fine-tuning.

Keywords: data mining, insight mining, natural language generation, pre-trained language models

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Authors: Joshua Abraham, Craig Wales

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Abstract—SIGN Guideline 122 recommends that all patients who are admitted to hospital are assessed for venous thromboembolism risk within 24 hours of admission. NHS Greater Glasgow and Clyde provide guidance on this in the form of a proforma. Patients are then subsequently prescribed either thrombo-embolic-deterrent stockings (TEDS)/low molecular weight heparin (LMWH) for the prevention of VTE based on their score. A retrospective casenote audit of a random sample of fifty oncology and trauma inpatients at the QEUH in December 2019 was performed. 90% of patients had a risk assessment conducted as evidenced by a completed proforma. In 78% of these patients, the proforma fully completed. Overall 94% of patients had some for of thromboprophylaxis prescribed in the form of TEDS or LMWH. A lack of 100% compliance against the given standards highlighted potential implications for patient safety, but also medico-legal ramifications for staff. Clinical judgement can only be relied upon if there is written documentation as evidence. Further staff education and the suggestion of a written prompt to the clerk-in documentation will hopefully improve compliance, whilst a repeat audit should demonstrate any improvement.

Keywords: Maxillofacial , Thromboembolism, Thromboprophylaxis , Prescription

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Authors: Shivani Dhande, Sanjiv Choudhary, Adarshlata Singh

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Introduction: Chemical peeling is a popular, relatively inexpensive day procedure and generally safe method for treatment of pigmentary skin disorders and for skin rejuvenation. Chemical peels are classified by the depth of action into superficial, medium, and deep peels.Various facial pigmentary conditions have significant impact on quality of life causing psychological stress, necessitating its safe and effective treatment.Aim & Objectives:To compare the efficacy of Salicylic acid, Trichloroaceticacid & Glycolic Acid in facial melanosis(melasma,photomelanosis& post acne pigmentation).To study the side effects of above mentioned peeling agents. Method and Materials:It was a randomized parallel control single blind study consisting of total of 36 cases, 12 cases each of melasma, photo melanosis and post acne pigmentation within age group 20-50 years having fitzpatrick’s skin type4. Woods lamp examination was done to confirm the type of melasma.Patients with keloidal tendency, active herpes infection or past history of hypersensitivity to salicylic acid, trichloroaceticand glycolic acid as well aspatients on systemic isotretinoin were excluded.Clinical photographs at the beginning of therapy and then serially, were taken to assess the clinical response. Prior to application a written informed consent was obtained. A post auricular test peel was performed. Patients were divided into 3 groups, containing 12 patients each of melasma, photomelanosis and post acnepigmentation.All the three peels SA peel 20% (done once in 2 weeks), GA peel 50% (done once in 3 weeks) and TCA 15% (done once in 3 weeks) were used with total six settings for each patient. Before application of peel patients were counseled to wash the face with soap and water. Then face was dried and cleaned with spirit and acetone to remove all cutaneous oils. GA, TCA, SA were applied with cotton buds/gauze withmild strokes. After a contact period off 5-10mins neutralization was done with cold water. Post peel topical sunscreen application was mandatory. MASI was used pre and post treatment to assess melasma. Investigator’s global improvement scale- overall hyperpigmentation (4-significant, 3-moderate, 2-mild, 1-minimal, 0-no change ) and Patient’s satisfaction grading scale (>70%- excellent response, 50-70%- good response, <50%- average response) was used to assess improvement in all the three facial melanosis.Results:In our study of 12 patients of melasma, 4 (33.33%)patients showed excellent results;3 (25%) with GAand 1(8.33%) of TCA.Good response was seen in 4 (33.33%) patients;1(8.33%) each for GA & SA and 2(16.66%) for TCA.Poor response was seen in 4(33.33%) patients;1(8.33%) for TCA and 3 (25%) for SA.Of 12 patients of photomelanosis, excellent resultswas seen in 3(25%)patients of TCA. Good response was seen in 4 (33.33%) patients, 1(8.33%) each of TCA &SA and 2(16.66%) of GA.Poor responsewas seen in 5(41.66%) patients;3 (25%) for SA and 2(16.66%) of GA.Of 12 patients of post acne pigmentation, excellent responsein 3 (25%) patients;2(16.66%) of SA and 1(8.33%) of TCA.Good responsewas seen in 5(41.66%) patients;2(16.66%) of SA and GA and1(8.33%) of TCA.Poor response was seen in 4 (33.33%) patients; 2 (16.66%) for SA and TCA both. No major side effects in the form of scarring or persistant pigmentation was seen. Transient blackening of skin with burning sensation was seen in cases treated with TCA and SA. Post procedural itching and redness was noted with GA peel. Conclusion- In our study GA(50%),TCA(15%) & SA(20%) peels showed excellent response in melasma, photomelanosis and post-acne pigmentation respectively.All the 3 peeling agents were well tolerated without any significant side-effects in the above specified concentrations.

Keywords: facial melanosis, gycolic acid, salicylic acid, trichloroacetic acid

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Authors: Wan Shan Chiang, Charn Ting Wang, Wei-Chih Kan, Hui-Chen Huang

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Dialysis patients have risk in Zoster virus because of low immune. Valacyclovir (product name: Valtex) 500mg/tab, an anti-zoster virus medicine, is digested in kidney and it has side-effect of nervous system in patients with malfunction kidneys. Although the clinical basis of the proposed administration, we found that patients still have side effects. So we want to explore the appropriate dose of peritoneal dialysis patients. We read small samples of case reports and analyze 8 cases in our hospital, some patients’ Kt/v, match the standard of dialysis, and still go to the toilet, they still have side effect seriously with 500mg portion. The solution to this includes stopping medicine, reduction of medicine, increase of liquid change and timely hemodialysis and all of them speed up the recovery. The safety of medication needs extra attention of medical care employee. If they can tell the doctor if the patient has urine or not in his or her Kt/v, the doctor can prescribe the medicine accordingly. About the limitation, due to the lack of cases and related pharmacokinetics numbers. Therefore, for peritoneal patients, we think 500mg/48hoursis the saves. We also want to remind pharmaceuticals to revise the portion taken by patients, so that the doctor may judge the use.

Keywords: herpes zoster, Valacyclovir, peritoneal dialysis, health education

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Authors: Georges F. Hatoum, Thomas H. Temple, Silvio Garcia, Xiaodong Wu

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Soft Tissue Sarcomas (STS) represent a diverse group of malignancies with heterogeneous clinical and pathological features. The treatment of extremity STS aims to achieve optimal local tumor control, improved survival, and preservation of limb function. The National Comprehensive Cancer Network guidelines, based on the cumulated clinical data, recommend radiation therapy (RT) in conjunction with limb-sparing surgery for large, high-grade STS measuring greater than 5 cm in size. Such treatment strategy can offer a cure for patients. However, when recurrence occurs (in nearly half of patients), the prognosis is poor, with a median survival of 12 to 15 months and with only palliative treatment options available. The spatially-fractionated-radiotherapy (SFRT), with a long history of treating bulky tumors as a non-mainstream technique, has gained new attention in recent years due to its unconventional therapeutic effects, such as bystander/abscopal effects. Combining single fraction of GRID, the original form of SFRT, with conventional RT was shown to have marginally increased the rate of pathological necrosis, which has been recognized to have a positive correlation to overall survival. In an effort to consistently increase the pathological necrosis rate over 90%, multiple fractions of Lattice RT (LRT), a newer form of 3D SFRT, interdigitated with the standard RT as neoadjuvant therapy was conducted in a preliminary clinical setting. With favorable results of over 95% of necrosis rate in a small cohort of patients, a Phase I/II clinical study was proposed to exam the safety and feasibility of this new strategy. Herein the design of the clinical study is presented. In this single-arm, two-stage phase I/II clinical trial, the primary objectives are >80% of the patients achieving >90% tumor necrosis and to evaluation the toxicity; the secondary objectives are to evaluate the local control, disease free survival and overall survival (OS), as well as the correlation between clinical response and the relevant biomarkers. The study plans to accrue patients over a span of two years. All patient will be treated with the new neoadjuvant RT regimen, in which one of every five fractions of conventional RT is replaced by a LRT fraction with vertices receiving dose ≥10Gy while keeping the tumor periphery at or close to 2 Gy per fraction. Surgical removal of the tumor is planned to occur 6 to 8 weeks following the completion of radiation therapy. The study will employ a Pocock-style early stopping boundary to ensure patient safety. The patients will be followed and monitored for a period of five years. Despite much effort, the rarity of the disease has resulted in limited novel therapeutic breakthroughs. Although a higher rate of treatment-induced tumor necrosis has been associated with improved OS, with the current techniques, only 20% of patients with large, high-grade tumors achieve a tumor necrosis rate exceeding 50%. If this new neoadjuvant strategy is proven effective, an appreciable improvement in clinical outcome without added toxicity can be anticipated. Due to the rarity of the disease, it is hoped that such study could be orchestrated in a multi-institutional setting.

Keywords: lattice RT, necrosis, SFRT, soft tissue sarcoma

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Authors: E.A. Kuchma

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Photodynamic therapy (PDT) is considered an alternative and minimally invasive cancer treatment modality compared to chemotherapy and radiation therapy. PDT includes three main components: a photosensitizer (PS), oxygen, and a light source. PS is injected into the patient's body and then selectively accumulates in the tumor. However, the light used in PDT (spectral range 400–700 nm) is limited to superficial lesions, and the light penetration depth does not exceed a few cm. The problem of PDT (poor visible light transmission) can be solved by using X-rays. The penetration depth of X-rays is ten times greater than that of visible light. Therefore, X-ray radiation easily penetrates through the tissues of the body. The aim of this work is to develop universal nanocomposites for X-ray photodynamic therapy of deep and superficial tumors using scintillation nanoparticles of gadolinium fluoride (GdF3), doped with Tb3+, coated with a biocompatible coating (PEG) and photosensitizer RB (Rose Bengal). PEG@GdF3:Tb3+(15%) – RB could be used as an effective X-ray, UV, and photoluminescent mediator to excite a photosensitizer for generating reactive oxygen species (ROS) to kill tumor cells via photodynamic therapy. GdF3 nanoparticles can also be used as contrast agents for computed tomography (CT) and magnetic resonance imaging (MRI).

Keywords: X-ray induced photodynamic therapy, scintillating nanoparticle, radiosensitizer, photosensitizer

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Authors: Amina Bayazid, Habiba Fetati, Houari Toumi

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Introduction: The clinical value of vitamin K antagonists (VKA) has been widely demonstrated in numerous indications. Unfortunately, VKA are not devoid of drawbacks and risk of serious bleeding. The iatrogenic induced by these drugs is a major public health problem. Patients & Methods: We conducted a retrospective study period extending from February 2012 to August 2013 in the pharmacovigilance service of EHUO (clinical pharmacology unit). The prescription of painkillers was analyzed in patients on VKA followed at our level. The influence of these analgesics on the evolution of the INR is an important component in our work. Results: We counted a total of 195 patients, of whom 32 (or 16.41% of the total population) had received analgesic treatment. The frequencies of different categories of analgesics administered were: • Analgesics opioids: 0% • Analgesics weak opioids: Tramadol: 21.87% • The non-opioid analgesics: -AINS: 71.87% (indomethacin: 68.75% ibuprofen: 3.12%) - Paracetamol: 6.25% -Salicyles (Acetylsalicylic acid): 0%. Conclusion: The management of pain in patients under vitamin K antagonists has special features, given their many drug interactions with analgesics and their influence on the evolution of the INR which can have dramatic consequences. As such, special attention must be paid to the use of analgesics in this type of patient.

Keywords: vitamin K antagonists, pain killers, interactions, INR

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Authors: Yun-Ching Tu, Yu-Chun Chih

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People with aphasia (PWA) may have communicative difficulties in their daily lives, but research on functional communication in aphasia is still limited in Taiwan. The aim of the study was to investigate the impact of aphasia-related factors on functional communication assessment. This study adopted a convenience sampling method. Thirty aphasic participants participated in the study. During the test, the examiner would ask questions that are encountered in daily life and record the participant‘s responses. Some questions would provide pictures to simulate situations in daily life. The results showed that the non-fluent aphasia group performed significantly worse than the fluent aphasia group. In addition, patients with severe aphasia performed significantly lower scores than patients with moderate aphasia and mild aphasia. However, group differences in the chronic stage and acute stage were not significant. In sum, since communication in daily life is diverse and language is still needed in the communication process, patients with aphasia who have better language ability may have relatively better functional communication. In contrast, the more severely impaired the language ability of a patient with aphasia is, the more functional communication will be affected, resulting in poor communication performance in daily life.

Keywords: adult, aphasia, assessment, functional communication

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Authors: John Chau, Tzvi Aviv

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Cardiometabolic conditions (hypertension, diabetes, and hyperlipidemia) are major public health concerns. Analysis of all prescription records from about 10 million patients at the largest network of pharmacies in Canada reveals small year-over-year increases in the treatment prevalence of cardiometabolic diseases prior to the COVID-19 pandemic. Cardiometabolic treatment rates increase with age and are higher in males than females. Hypertension treatment rates were 24% in males and 19% in females in 2021. Diabetes treatment rates were 10% in males and 7% in females in 2021. Geospatial analysis using patient addresses reveals interesting differences among provinces and neighborhoods in Canada. Using digital surveys distributed among 8,504 Canadian adults, an increase in hypertension awareness with age and female gender was observed. However, 7% of seniors and 6% of middle-aged Canadians reported uncontrolled blood pressure (>140/90 mmHg). In addition, elevated blood pressure (130-139/80-89 mmHg) was reported by 20% of seniors and 14% of middle-aged Canadians.

Keywords: cardiometabolic conditions, diabetes, hypertension, precision public health

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