Search results for: Pulmonary Embolism Severity Index (PESI) score
Commenced in January 2007
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Edition: International
Paper Count: 6180

Search results for: Pulmonary Embolism Severity Index (PESI) score

4050 Identifying Neighborhoods at Potential Risk of Food Insecurity in Rural British Columbia

Authors: Amirmohsen Behjat, Aleck Ostry, Christina Miewald, Bernie Pauly

Abstract:

Substantial research has indicated that socioeconomic and demographic characteristics’ of neighborhoods are strong determinants of food security. The aim of this study was to develop a Food Insecurity Neighborhood Index (FINI) based on the associated socioeconomic and demographic variables to identify the areas at potential risk of food insecurity in rural British Columbia (BC). Principle Component Analysis (PCA) technique was used to calculate the FINI for each rural Dissemination Area (DA) using the food security determinant variables from Canadian Census data. Using ArcGIS, the neighborhoods with the top quartile FINI values were classified as food insecure. The results of this study indicated that the most food insecure neighborhood with the highest FINI value of 99.1 was in the Bulkley-Nechako (central BC) area whereas the lowest FINI with the value of 2.97 was for a rural neighborhood in the Cowichan Valley area. In total, 98.049 (19%) of the rural population of British Columbians reside in high food insecure areas. Moreover, the distribution of food insecure neighborhoods was found to be strongly dependent on the degree of rurality in BC. In conclusion, the cluster of food insecure neighbourhoods was more pronounced in Central Coast, Mount Wadington, Peace River, Kootenay Boundary, and the Alberni-Clayoqout Regional Districts.

Keywords: neighborhood food insecurity index, socioeconomic and demographic determinants, principal component analysis, Canada census, ArcGIS

Procedia PDF Downloads 162
4049 Clinical Pathway for Postoperative Organ Transplants

Authors: Tahsien Okasha

Abstract:

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 432
4048 Dietary Diversity Practice and Associated Facrors Among Hypertension Patients at Tirunesh Beijing Hospital

Authors: Wudneh Asegedech Ayele

Abstract:

Background: Dietary diversity is strongly related with non-communicable disease (NCDs). Diet plays a key role as a risk factor for hypertension. Diets rich in fruits, vegetables, and low-fat dairy products that include whole grains, poultry, fish, and nuts, that contain only small amounts of red meat, sweets, and sugar-containing beverages, and that contain decreased amounts of total and saturated fat and cholesterol have been found to have a protective effect against hypertension. Methods: hospital based Cross-sectional study design was employed from June 1-June 25, 2021. Sampling technique was Systematic random sampling and data were collected using an interview method. Data were entered into Epi Data version 3.1 and exported to SPSS version 25 for processed and analysis respectively. Descriptive statistics were used to summarize data. Bivariate and multivariate logistic regression will employed to determine dietary diversity among hypertension patients. Results: Adequate dietary diversity score were 96 (24.68%). Most of them cereal, white roots and tubers, dark green leafy vegetables, Vitamin A rich fruits ,meat, egg and coffee or tea more intakes. Hypertensive patients who didn’t consume cereals four times less likely adequate dietary diversity than who consumed cereals [AOR= 4.083, 95%: CI (2.096 -7.352)]. Hypertensive patients who didn’t consume white roots and tubers 14 times less likely adequate dietary diversity than who consumed white roots and tubers [AOR= 13.733, 95% CI: (5.388-34.946)]. Conclusion and recommendation the study showed one of fourth part reported adequate dietary diversity score. Cereals, fruits, vegetables and milk and milk products were statistically associated with dietary diversity practice. Health education about dietary modifications and behavioral change to dietary diversity

Keywords: dietary diversity practice and associated facrors among hypertension patients at tirunesh beijing hospital, hypertension, dietary, diversity and tirunesh beijing hospital, associated facrors among hypertension patient, at tirunesh beijing hospita

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4047 Field Prognostic Factors on Discharge Prediction of Traumatic Brain Injuries

Authors: Mohammad Javad Behzadnia, Amir Bahador Boroumand

Abstract:

Introduction: Limited facility situations require allocating the most available resources for most casualties. Accordingly, Traumatic Brain Injury (TBI) is the one that may need to transport the patient as soon as possible. In a mass casualty event, deciding when the facilities are restricted is hard. The Extended Glasgow Outcome Score (GOSE) has been introduced to assess the global outcome after brain injuries. Therefore, we aimed to evaluate the prognostic factors associated with GOSE. Materials and Methods: In a multicenter cross-sectional study conducted on 144 patients with TBI admitted to trauma emergency centers. All the patients with isolated TBI who were mentally and physically healthy before the trauma entered the study. The patient’s information was evaluated, including demographic characteristics, duration of hospital stays, mechanical ventilation on admission laboratory measurements, and on-admission vital signs. We recorded the patients’ TBI-related symptoms and brain computed tomography (CT) scan findings. Results: GOSE assessments showed an increasing trend by the comparison of on-discharge (7.47 ± 1.30), within a month (7.51 ± 1.30), and within three months (7.58 ± 1.21) evaluations (P < 0.001). On discharge, GOSE was positively correlated with Glasgow Coma Scale (GCS) (r = 0.729, P < 0.001) and motor GCS (r = 0.812, P < 0.001), and inversely with age (r = −0.261, P = 0.002), hospitalization period (r = −0.678, P < 0.001), pulse rate (r = −0.256, P = 0.002) and white blood cell (WBC). Among imaging signs and trauma-related symptoms in univariate analysis, intracranial hemorrhage (ICH), interventricular hemorrhage (IVH) (P = 0.006), subarachnoid hemorrhage (SAH) (P = 0.06; marginally at P < 0.1), subdural hemorrhage (SDH) (P = 0.032), and epidural hemorrhage (EDH) (P = 0.037) were significantly associated with GOSE at discharge in multivariable analysis. Conclusion: Our study showed some predictive factors that could help to decide which casualty should transport earlier to a trauma center. According to the current study findings, GCS, pulse rate, WBC, and among imaging signs and trauma-related symptoms, ICH, IVH, SAH, SDH, and EDH are significant independent predictors of GOSE at discharge in TBI patients.

Keywords: field, Glasgow outcome score, prediction, traumatic brain injury.

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4046 Expression of Ki-67 in Multiple Myeloma: A Clinicopathological Study

Authors: Kangana Sengar, Sanjay Deb, Ramesh Dawar

Abstract:

Introduction: Ki-67 can be a useful marker in determining proliferative activity in patients with multiple myeloma (MM). However, using Ki-67 alone results in the erroneous inclusion of non-myeloma cells leading to false high counts. We have used Dual IHC (immunohistochemistry) staining with Ki-67 and CD138 to enhance specificity in assessing proliferative activity of bone marrow plasma cells. Aims and objectives: To estimate the proportion of proliferating (Ki-67 expressing) plasma cells in patients with MM and correlation of Ki-67 with other known prognostic parameters. Materials and Methods: Fifty FFPE (formalin fixed paraffin embedded) blocks of trephine biopsies of cases diagnosed as MM from 2010 to 2015 are subjected to H & E staining and Dual IHC staining for CD 138 and Ki-67. H & E staining is done to evaluate various histological parameters like percentage of plasma cells, pattern of infiltration (nodular, interstitial, mixed and diffuse), routine parameters of marrow cellularity and hematopoiesis. Clinical data is collected from patient records from Medical Record Department. Each of CD138 expressing cells (cytoplasmic, red) are scored as proliferating plasma cells (containing a brown Ki¬67 nucleus) or non¬proliferating plasma cells (containing a blue, counter-stained, Ki-¬67 negative nucleus). Ki-67 is measured as percentage positivity with a maximum score of hundred percent and lowest of zero percent. The intensity of staining is not relevant. Results: Statistically significant correlation of Ki-67 in D-S Stage (Durie & Salmon Stage) I vs. III (p=0.026) and ISS (International Staging System) Stage I vs. III (p=0.019), β2m (p=0.029) and percentage of plasma cells (p < 0.001) is seen. No statistically significant correlation is seen between Ki-67 and hemoglobin, platelet count, total leukocyte count, total protein, albumin, S. calcium, S. creatinine, S. LDH, blood urea and pattern of infiltration. Conclusion: Ki-67 index correlated with other known prognostic parameters. However, it is not determined routinely in patients with MM due to little information available regarding its relevance and paucity of studies done to correlate with other known prognostic factors in MM patients. To the best of our knowledge, this is the first study in India using Dual IHC staining for Ki-67 and CD138 in MM patients. Routine determination of Ki-67 will help to identify patients who may benefit with more aggressive therapy. Recommendation: In this study follow up of patients is not included, and the sample size is small. Studying with larger sample size and long follow up is advocated to prognosticate Ki-67 as a marker of survival in patients with multiple myeloma.

Keywords: bone marrow, dual IHC, Ki-67, multiple myeloma

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4045 The Comparison of Dismount Skill between National and International Men’s Artistic Gymnastics in Parallel Bars Apparatus

Authors: Chen ChihYu, Tang Wen Tzu, Chen Kuang Hui

Abstract:

Aim —To compare the dismount skill between Taiwanese and elite international gymnastics in parallel bars following the 2017-2020 code of points. Methods—The gymnasts who advanced to the parallel bars event finals of these four competitions including World Championships, Universiade, the National Games of Taiwan, and the National Intercollegiate Athletic Games of Taiwan both 2017 and 2019 were selected in this study. The dismount skill of parallel bars was analyzed, and the average difficulty score was compared by one-way ANOVA. Descriptive statistics were applied to present the type of dismount skill and the difficulty of each gymnast in these four competitions. The data from World Championships and Universiade were combined as the international group (INT), and data of Taiwanese National Games and National Intercollegiate Athletic Games were also combined as the national group (NAT). The differences between INT and NAT were analyzed by the Chi-square test. The statistical significance of this study was set at α= 0.05. Results— i) There was a significant difference in the mean parallel bars dismount skill in these four competitions analyzed by one-way ANOVA. Both dismount scores of World Championships and Universiade were significantly higher than in Taiwanese National Games and National Intercollegiate Athletic Games (0.58±0.08 & 0.56±0.08 > 0.42±0.06 & 40±0.06, p < 0.05). ii) Most of the gymnasts in World Championships and Universiade selected the 0.6-point skill as the parallel bars dismount element, and for the Taiwanese National Games and the National Intercollegiate Athletic Games, most of the gymnasts performed the 0.4-point dismount skill. iii) The result of the Chi-square test has shown that there was a significant difference in the selection of parallel bars dismount skill. The INT group used the E or E+ difficulty element as the dismount skill, and the NAT group selected the D or D- difficulty element. Conclusion— The level of parallel bars dismount in Taiwanese gymnastics is inferior to elite international gymnastics. It is suggested that Taiwanese gymnastics must try to practice the F difficulty dismount (double salto forward tucked with half twist) in the future.

Keywords: Artistic Gymnastics World Championships, dismount, difficulty score, element

Procedia PDF Downloads 138
4044 Perception of Tactile Stimuli in Children with Autism Spectrum Disorder

Authors: Kseniya Gladun

Abstract:

Tactile stimulation of a dorsal side of the wrist can have a strong impact on our attitude toward physical objects such as pleasant and unpleasant impact. This study explored different aspects of tactile perception to investigate atypical touch sensitivity in children with autism spectrum disorder (ASD). This study included 40 children with ASD and 40 healthy children aged 5 to 9 years. We recorded rsEEG (sampling rate of 250 Hz) during 20 min using EEG amplifier “Encephalan” (Medicom MTD, Taganrog, Russian Federation) with 19 AgCl electrodes placed according to the International 10–20 System. The electrodes placed on the left, and right mastoids served as joint references under unipolar montage. The registration of EEG v19 assignments was carried out: frontal (Fp1-Fp2; F3-F4), temporal anterior (T3-T4), temporal posterior (T5-T6), parietal (P3-P4), occipital (O1-O2). Subjects were passively touched by 4 types of tactile stimuli on the left wrist. Our stimuli were presented with a velocity of about 3–5 cm per sec. The stimuli materials and procedure were chosen for being the most "pleasant," "rough," "prickly" and "recognizable". Type of tactile stimulation: Soft cosmetic brush - "pleasant" , Rough shoe brush - "rough", Wartenberg pin wheel roller - "prickly", and the cognitive tactile stimulation included letters by finger (most of the patient’s name ) "recognizable". To designate the moments of the stimuli onset-offset, we marked the moment when the moment of the touch began and ended; the stimulation was manual, and synchronization was not precise enough for event-related measures. EEG epochs were cleaned from eye movements by ICA-based algorithm in EEGLAB plugin for MatLab 7.11.0 (Mathwork Inc.). Muscle artifacts were cut out by manual data inspection. The response to tactile stimuli was significantly different in the group of children with ASD and healthy children, which was also depended on type of tactile stimuli and the severity of ASD. Amplitude of Alpha rhythm increased in parietal region to response for only pleasant stimulus, for another type of stimulus ("rough," "thorny", "recognizable") distinction of amplitude was not observed. Correlation dimension D2 was higher in healthy children compared to children with ASD (main effect ANOVA). In ASD group D2 was lower for pleasant and unpleasant compared to the background in the right parietal area. Hilbert transform changes in the frequency of the theta rhythm found only for a rough tactile stimulation compared with healthy participants only in the right parietal area. Children with autism spectrum disorders and healthy children were responded to tactile stimulation differently with specific frequency distribution alpha and theta band in the right parietal area. Thus, our data supports the hypothesis that rsEEG may serve as a sensitive index of altered neural activity caused by ASD. Children with autism have difficulty in distinguishing the emotional stimuli ("pleasant," "rough," "prickly" and "recognizable").

Keywords: autism, tactile stimulation, Hilbert transform, pediatric electroencephalography

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4043 Soil Characteristics and Liquefaction Potential of the Bengkulu Region Based on the Microtremor Method

Authors: Aditya Setyo Rahman, Dwikorita Karnawati, Muzli, Dadang Permana, Sigit Pramono, Fajri Syukur Rahmatullah, Oriza Sativa, Moehajirin, Edy Santoso, Nur Hidayati Oktavia, Ardian Yudhi Octantyo, Robby Wallansha, Juwita Sari Pradita, Nur Fani Habibah, Audia Kaluku, Amelia Chelcea, Yoga Dharma Persada, Anton Sugiharto

Abstract:

Earthquake vibrations on the surface are not only affected by the magnitude of the earthquake and the distance from the hypocenter but also by the characteristics of the local soil. Variations and changes in soil characteristics from the depth of the bedrock to the surface can cause an amplification of earthquake vibrations that also affect the impact they may have on the surface. Soil characteristics vary widely even at relatively close distances, so for earthquake hazard mapping in cities with earthquake threats, it is necessary to study the characteristics of the local soil on a detailed or micro-scale (microzonation). This study proposes seismic microzonation and liquefaction potential based on microtremor observations. We carried out 143 microtremor observations, and the observation sites were spread across all populated sub-districts in Bengkulu City; the results showed that the dominance of Bengkulu City had medium soil types with a dominant period value of 0.4 < T₀ < 0.6, and there was one location with soft soil characteristics in the river, shaved with T₀ > 0.6. These results correlate with the potential for liquefaction as indicated by a seismic vulnerability index (K𝓰) greater than 5.

Keywords: microtremor, dominant period, microzonation, seismic vulnerability index

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4042 The Layout Analysis of Handwriting Characters and the Fusion of Multi-style Ancient Books’ Background

Authors: Yaolin Tian, Shanxiong Chen, Fujia Zhao, Xiaoyu Lin, Hailing Xiong

Abstract:

Ancient books are significant culture inheritors and their background textures convey the potential history information. However, multi-style texture recovery of ancient books has received little attention. Restricted by insufficient ancient textures and complex handling process, the generation of ancient textures confronts with new challenges. For instance, training without sufficient data usually brings about overfitting or mode collapse, so some of the outputs are prone to be fake. Recently, image generation and style transfer based on deep learning are widely applied in computer vision. Breakthroughs within the field make it possible to conduct research upon multi-style texture recovery of ancient books. Under the circumstances, we proposed a network of layout analysis and image fusion system. Firstly, we trained models by using Deep Convolution Generative against Networks (DCGAN) to synthesize multi-style ancient textures; then, we analyzed layouts based on the Position Rearrangement (PR) algorithm that we proposed to adjust the layout structure of foreground content; at last, we realized our goal by fusing rearranged foreground texts and generated background. In experiments, diversified samples such as ancient Yi, Jurchen, Seal were selected as our training sets. Then, the performances of different fine-turning models were gradually improved by adjusting DCGAN model in parameters as well as structures. In order to evaluate the results scientifically, cross entropy loss function and Fréchet Inception Distance (FID) are selected to be our assessment criteria. Eventually, we got model M8 with lowest FID score. Compared with DCGAN model proposed by Radford at el., the FID score of M8 improved by 19.26%, enhancing the quality of the synthetic images profoundly.

Keywords: deep learning, image fusion, image generation, layout analysis

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4041 An Information System for Strategic Performance Scoring in Municipal Management

Authors: Emin Gundogar, Aysegul Yilmaz

Abstract:

Strategic performance scoring is a significant procedure in management. There are various methods to improve this procedure. This study introduces an information system that is developed to score performance for municipal management. The application of the system is clarified by exemplifying municipal processes.

Keywords: management information system, municipal management, performance scoring

Procedia PDF Downloads 766
4040 Geomatic Techniques to Filter Vegetation from Point Clouds

Authors: M. Amparo Núñez-Andrés, Felipe Buill, Albert Prades

Abstract:

More and more frequently, geomatics techniques such as terrestrial laser scanning or digital photogrammetry, either terrestrial or from drones, are being used to obtain digital terrain models (DTM) used for the monitoring of geological phenomena that cause natural disasters, such as landslides, rockfalls, debris-flow. One of the main multitemporal analyses developed from these models is the quantification of volume changes in the slopes and hillsides, either caused by erosion, fall, or land movement in the source area or sedimentation in the deposition zone. To carry out this task, it is necessary to filter the point clouds of all those elements that do not belong to the slopes. Among these elements, vegetation stands out as it is the one we find with the greatest presence and its constant change, both seasonal and daily, as it is affected by factors such as wind. One of the best-known indexes to detect vegetation on the image is the NVDI (Normalized Difference Vegetation Index), which is obtained from the combination of the infrared and red channels. Therefore it is necessary to have a multispectral camera. These cameras are generally of lower resolution than conventional RGB cameras, while their cost is much higher. Therefore we have to look for alternative indices based on RGB. In this communication, we present the results obtained in Georisk project (PID2019‐103974RB‐I00/MCIN/AEI/10.13039/501100011033) by using the GLI (Green Leaf Index) and ExG (Excessive Greenness), as well as the change to the Hue-Saturation-Value (HSV) color space being the H coordinate the one that gives us the most information for vegetation filtering. These filters are applied both to the images, creating binary masks to be used when applying the SfM algorithms, and to the point cloud obtained directly by the photogrammetric process without any previous filter or the one obtained by TLS (Terrestrial Laser Scanning). In this last case, we have also tried to work with a Riegl VZ400i sensor that allows the reception, as in the aerial LiDAR, of several returns of the signal. Information to be used for the classification on the point cloud. After applying all the techniques in different locations, the results show that the color-based filters allow correct filtering in those areas where the presence of shadows is not excessive and there is a contrast between the color of the slope lithology and the vegetation. As we have advanced in the case of using the HSV color space, it is the H coordinate that responds best for this filtering. Finally, the use of the various returns of the TLS signal allows filtering with some limitations.

Keywords: RGB index, TLS, photogrammetry, multispectral camera, point cloud

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4039 Evaluating and Improving Healthcare Staff Knowledge of the [NG179] NICE Guidelines on Elective Surgical Care during the COVID-19 Pandemic: A Quality Improvement Project

Authors: Stavroula Stavropoulou-Tatla, Danyal Awal, Mohammad Ayaz Hossain

Abstract:

The first wave of the COVID-19 pandemic saw several countries issue guidance postponing all non-urgent diagnostic evaluations and operations, leading to an estimated backlog of 28 million cases worldwide and over 4 million in the UK alone. In an attempt to regulate the resumption of elective surgical activity, the National Institute for Health and Care Excellence (NICE) introduced the ‘COVID-19 rapid guideline [NG179]’. This project aimed to increase healthcare staff knowledge of the aforementioned guideline to a targeted score of 100% in the disseminated questionnaire within 3 months at the Royal Free Hospital. A standardized online questionnaire was used to assess the knowledge of surgical and medical staff at baseline and following each 4-week-long Plan-Study-Do-Act (PDSA) cycle. During PDSA1, the A4 visual summary accompanying the guideline was visibly placed in all relevant clinical areas and the full guideline was distributed to the staff in charge together with a short briefing on the salient points. PDSA2 involved brief small-group teaching sessions. A total of 218 responses was collected. Mean percentage scores increased significantly from 51±19% at baseline to 81±16% after PDSA1 (t=10.32, p<0.0001) and further to 93±8% after PDSA2 (t=4.9, p<0.0001), with 54% of participants achieving a perfect score. In conclusion, the targeted distribution of guideline printouts and visual aids, combined with small-group teaching sessions, were simple and effective ways of educating healthcare staff about the new standards of elective surgical care at the time of COVID-19. This could facilitate the safe restoration of surgical activity, which is critical in order to mitigate the far-reaching consequences of surgical delays on an unprecedented scale during a time of great crisis and uncertainty.

Keywords: COVID-19, elective surgery, NICE guidelines, quality improvement

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4038 Gender Differences in Walking Capacity and Cardiovascular Regulation in Patients with Peripheral Arterial Disease

Authors: Gabriel Cucato, Marilia Correia, Wagner Domingues, Aline Palmeira, Paulo Longano, Nelson Wolosker, Raphael Ritti-Dias

Abstract:

Women with peripheral arterial disease (PAD) present lower walking capacity in comparison with men. However, whether cardiovascular regulation is also different between genders is unknown. Thus, the aim of this study was to compare walking capacity and cardiovascular regulation between men and women with PAD. A total of 23 women (66±7 yrs) and 31 men (64±9 yrs) were recruited. Patients performed a 6-minute test and the onset claudication distance and total walking distance were measured. Additionally, cardiovascular regulation was assessed by arterial stiffness (pulse wave velocity and augmentation index) and heart rate variability (frequency domain). Independent T test or Mann-Whitney U test were performed. In comparison with men, women present lower onset claudication distance (108±66m vs. 143±50m; P=0.032) and total walking distance (286±83m vs. 361±91 m, P=0.007). Regarding cardiovascular regulation, there were no differences in heart rate variability SDNN (72±160ms vs. 32±22ms, P=0.587); RMSSD (75±209 vs. 25±22ms, P=0.726); pNN50 (11±17ms vs. 8±14ms, P=0.836) in women and men, respectively. Moreover, there were no difference in augmentation index (39±10% vs. 34±11%, P=0.103); pulse pressure (59±17mmHg vs. 56±19mmHg, P=0.593) and pulse wave velocity (8.6±2.6m\s vs. 9.0±2.7m/s, P=0.580). In conclusion, women have impaired walking capacity compared to men. However, sex differences were not observed on cardiovascular regulation in patients with PAD.

Keywords: exercise, intermittent claudication, cardiovascular load, arterial stiffness

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4037 GATA3-AS1 lncRNA as a Predictive Biomarker for Neoadjuvant Chemotherapy Response in Locally Advanced Luminal B Breast Cancer: An RNA ISH Study

Authors: Tania Vasquez Mata, Luis A. Herrera, Cristian Arriaga Canon

Abstract:

Background: Locally advanced breast cancer of the luminal B phenotype, poses challenges due to its variable response to neoadjuvant chemotherapy. A predictive biomarker is needed to identify patients who will not respond to treatment, allowing for alternative therapies. This study aims to validate the use of the lncRNA GATA3-AS1, as a predictive biomarker using RNA in situ hybridization. Research aim: The aim of this study is to determine if GATA3-AS1 can serve as a biomarker for resistance to neoadjuvant chemotherapy in patients with locally advanced luminal B breast cancer. Methodology: The study utilizes RNA in situ hybridization with predesigned probes for GATA3-AS1 on Formalin-Fixed Paraffin-Embedded tissue sections. The samples underwent pretreatment and protease treatment to enable probe penetration. Chromogenic detection and signal evaluation were performed using specific criteria. Findings: Patients who did not respond to neoadjuvant chemotherapy showed a 3+ score for GATA3-AS1, while those who had a complete response had a 1+ score. Theoretical importance: This study demonstrates the potential clinical utility of GATA3-AS1 as a biomarker for resistance to neoadjuvant chemotherapy. Identifying non-responders early on can help avoid unnecessary treatment and explore alternative therapy options. Data collection and analysis procedures: Tissue samples from patients with locally advanced luminal B breast cancer were collected and processed using RNA in situ hybridization. Signal evaluation was conducted under a microscope, and scoring was based on specific criteria. Questions addressed: Can GATA3-AS1 serve as a predictive biomarker for neoadjuvant chemotherapy response in locally advanced luminal B breast cancer? Conclusion: The lncRNA GATA3-AS1 can be used as a biomarker for resistance to neoadjuvant chemotherapy in patients with locally advanced luminal B breast cancer. Its identification through RNA in situ hybridization of tissue obtained from the initial biopsy can aid in treatment decision-making.

Keywords: biomarkers, breast neoplasms, genetics, neoadjuvant therapy, tumor

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4036 Hydrogeochemical Assessment, Evaluation and Characterization of Groundwater Quality in Ore, South-Western, Nigeria

Authors: Olumuyiwa Olusola Falowo

Abstract:

One of the objectives of the Millennium Development Goals is to have sustainable access to safe drinking water and basic sanitation. In line with this objective, an assessment of groundwater quality was carried out in Odigbo Local Government Area of Ondo State in November – February, 2019 to assess the drinking, domestic and irrigation uses of the water. Samples from 30 randomly selected ground water sources; 16 shallow wells and 14 from boreholes and analyzed using American Public Health Association method for the examination of water and wastewater. Water quality index calculation, and diagrams such as Piper diagram, Gibbs diagram and Wilcox diagram have been used to assess the groundwater in conjunction with irrigation indices such as % sodium, sodium absorption ratio, permeability index, magnesium ratio, Kelly ratio, and electrical conductivity. In addition statistical Principal component analysis were used to determine the homogeneity and source(s) influencing the chemistry of the groundwater. The results show that all the parameters are within the permissible limit of World Health Organization. The physico-chemical analysis of groundwater samples indicates that the dominant major cations are in decreasing order of Na+, Ca2+, Mg2+, K+ and the dominant anions are HCO-3, Cl-, SO-24, NO-3. The values of water quality index varies suggest a Good water (WQI of 50-75) accounts for 70% of the study area. The dominant groundwater facies revealed in this study are the non-carbonate alkali (primary salinity) exceeds 50% (zone 7); and transition zone with no one cation-anion pair exceeds 50% (zone 9), while evaporation; rock–water interaction, and precipitation; and silicate weathering process are the dominant processes in the hydrogeochemical evolution of the groundwater. The study indicates that waters were found within the permissible limits of irrigation indices adopted, and plot on excellent category on Wilcox plot. In conclusion, the water in the study area are good/suitable for drinking, domestic and irrigation purposes with low equivalent salinity concentrate and moderate electrical conductivity.

Keywords: equivalent salinity concentration, groundwater quality, hydrochemical facies, principal component analysis, water-rock interaction

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4035 Effect of Modified Atmosphere Packaging and Storage Temperatures on Quality of Shelled Raw Walnuts

Authors: M. Javanmard

Abstract:

This study was aimed at analyzing the effects of packaging (MAP) and preservation conditions on the packaged fresh walnut kernel quality. The central composite plan was used for evaluating the effect of oxygen (0–10%), carbon dioxide (0-10%), and temperature (4-26 °C) on qualitative characteristics of walnut kernels. Also, the response level technique was used to find the optimal conditions for interactive effects of factors, as well as estimating the best conditions of process using least amount of testing. Measured qualitative parameters were: peroxide index, color, decreased weight, mould and yeast counting test, and sensory evaluation. The results showed that the defined model for peroxide index, color, weight loss, and sensory evaluation is significant (p < 0.001), so that increase of temperature causes the peroxide value, color variation, and weight loss to increase and it reduces the overall acceptability of walnut kernels. An increase in oxygen percentage caused the color variation level and peroxide value to increase and resulted in lower overall acceptability of the walnuts. An increase in CO2 percentage caused the peroxide value to decrease, but did not significantly affect other indices (p ≥ 0.05). Mould and yeast were not found in any samples. Optimal packaging conditions to achieve maximum quality of walnuts include: 1.46% oxygen, 10% carbon dioxide, and temperature of 4 °C.

Keywords: shelled walnut, MAP, quality, storage temperature

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4034 Multi-Level Air Quality Classification in China Using Information Gain and Support Vector Machine

Authors: Bingchun Liu, Pei-Chann Chang, Natasha Huang, Dun Li

Abstract:

Machine Learning and Data Mining are the two important tools for extracting useful information and knowledge from large datasets. In machine learning, classification is a wildly used technique to predict qualitative variables and is generally preferred over regression from an operational point of view. Due to the enormous increase in air pollution in various countries especially China, Air Quality Classification has become one of the most important topics in air quality research and modelling. This study aims at introducing a hybrid classification model based on information theory and Support Vector Machine (SVM) using the air quality data of four cities in China namely Beijing, Guangzhou, Shanghai and Tianjin from Jan 1, 2014 to April 30, 2016. China's Ministry of Environmental Protection has classified the daily air quality into 6 levels namely Serious Pollution, Severe Pollution, Moderate Pollution, Light Pollution, Good and Excellent based on their respective Air Quality Index (AQI) values. Using the information theory, information gain (IG) is calculated and feature selection is done for both categorical features and continuous numeric features. Then SVM Machine Learning algorithm is implemented on the selected features with cross-validation. The final evaluation reveals that the IG and SVM hybrid model performs better than SVM (alone), Artificial Neural Network (ANN) and K-Nearest Neighbours (KNN) models in terms of accuracy as well as complexity.

Keywords: machine learning, air quality classification, air quality index, information gain, support vector machine, cross-validation

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4033 The Effect of Clover Honey Supplementation on the Anthropometric Measurements and Lipid Profile of Malnourished Infants and Children

Authors: Bassma A. Abdelhaleem, Mamdouh A. Abdulrhman, Nagwa I. Mohamed

Abstract:

Malnutrition in children is an increasing problem worldwide which may result in both short and long-term irreversible negative health outcomes. Severe Acute Malnutrition (SAM) affects more than 18 million children each year, mostly living in low-income settings. SAM contributes to 45% of all deaths in children less than five years of age. Honey is a natural sweetener, containing mainly monosaccharides (up to 80%), disaccharides (3–5%), water (17–20%), and a wide range of minor constituents such as vitamins, minerals, proteins, amino acids, enzymes, and phytochemicals, mainly phenolic acids, and flavonoids. Honey has been used in many cultures around the world due to its known nutritional and medicinal benefits including the treatment of hypercholesterolemia. Despite its use since ancient times yet little is known about its potential benefits for malnourished children. Honey has the potential to be an affordable solution for malnourished low-income children as it is nutrient-dense and calorie dense food, easily absorbed, highly palatable, enhances appetite, and boosts immunity. This study assessed the effect of clover honey supplementation on the anthropometric measurements and lipid profile of malnourished infants and children. A prospective interventional clinical trial was conducted between November 2019 to November 2020, on 40 malnourished infants and children divided into two groups: Group A (20 children; 11 males and 9 females) received honey in a dose of 1.75ml/kg/dose, twice weekly for 12 weeks and Group B (20 children; 6 males and 14 females) received placebo. Written informed consent was obtained for parents/guardians. Patients were recruited from the Pediatric Nutrition Clinic at Ain Shams University. Anthropometric measurements (weight, height, body mass index, head circumference, and mid-arm circumference) and fasting serum cholesterol levels were measured at baseline and after 3 months. The 3-month honey consumption had a statistically highly significant effect on increasing weight, height, and body mass index and lowering fasting serum cholesterol levels in primary malnourished infants and children. Weight, height, body mass index, and fasting serum cholesterol level before honey consumption were (9.49 ± 2.03, 81.45 ± 8.31, 14.24 ± 2.15, 178.00 ± 20.91) and after 3 months of honey consumption were (10.91 ± 2.11, 84.80 ± 8.23, 15.07 ± 2.05, 162.45 ± 19.73) respectively with P-value < 0.01. Our results showed a significant desirable effect of honey consumption on changes in nutritional status based on weight, height, and body mass index, and has a favourable effect on lowering fasting serum cholesterol levels. These results propose the use of honey as an affordable solution to improve malnutrition, particularly in low-income countries. However, further research needs to weigh benefits against potential harms including the risk of botulinum toxin that is historically associated with honey consumption in early childhood.

Keywords: clinical trial, dyslipidemia, honey, malnutrition

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4032 Clinical Pathway for Postoperative Organ Transplantation

Authors: Tahsien Okasha

Abstract:

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: postoperative care, organ transplant, clinical pathway, patient

Procedia PDF Downloads 451
4031 Green Windows of Opportunity in Latin American Countries

Authors: Fabianna Bacil, Zenathan Hasannundin, Clovis Freire

Abstract:

The green transition opens green windows of opportunity – temporary moments in which there are lower barriers and shorter learning periods for developing countries to enter emerging technologies and catch-up. However, taking advantage of these windows requires capabilities in national sectoral systems to adopt and develop technologies linked to green sectors as well as strong responses to build the required knowledge, skills, and infrastructure and foster the growth of targeted sectors. This paper uses UNCTAD’s frontier technology readiness index to analyse the current position of Latin America and the Caribbean to use, adopt, and adapt frontier technologies, examining the preconditions in the region to take up windows of opportunity that arise with the green transition. The index highlights the inequality across countries in the region, as well as gaps in capabilities dimensions, especially in terms of R&D. Moving to responses, it highlights industrial policies implemented to foster the growth of green technologies, emphasising the essential role played by the state to build and strengthen capabilities and provide infant industry protection that enables the growth of these sectors. Overall, while there are exceptions, especially in the Brazilian case, countries in Latin America and the Caribbean should focus on strengthening their capabilities to be better positioned, especially in terms of knowledge creation, infrastructure, and financing availability.

Keywords: Green technologies, Industrial policy, Latin America, windows of opportunity

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4030 The Effect of Balance Training on Stable and Unstable Surfaces under Cognitive Dual-Task Condition on the Two Directions of Body Sway, Functional Balance and Fear of Fall in Non-Fallers Older Adults

Authors: Elham Azimzadeh, Fahimeh Khorshidi, Alireza Farsi

Abstract:

Balance impairment and fear of falling in older adults may reduce their quality of life. Reactive balance training could improve rapid postural responses and fall prevention in the elderly during daily tasks. Performing postural training and simultaneously cognitive dual tasks could be similar to the daily circumstances. Purpose: This study aimed to determine the effect of balance training on stable and unstable surfaces under dual cognitive task conditions on postural control and fear of falling in the elderly. Methods: Thirty non-fallers of older adults (65-75 years) were randomly assigned to two training groups: stable-surface (n=10), unstable-surface (n=10), or a control group (n=10). The intervention groups underwent six weeks of balance training either on a stable (balance board) or an unstable (wobble board) surface while performing a cognitive dual task. The control group received no balance intervention. COP displacements in the anterioposterior (AP) and mediolateral (ML) directions using a computerized balance board, functional balance using TUG, and fear of falling using FES-I were measured in all participants before and after the interventions. Summary of Results: Mixed ANOVA (3 groups * 2 times) with repeated measures and post hoc test showed a significant improvement in both intervention groups in AP index (F= 11/652, P= 0/0002) and functional balance (F= 9/961, P= 0/0001). However, the unstable surface training group had more improvement. However, the fear of falling significantly improved after training on an unstable surface (p= 0/035). All groups had no significant improvement in the ML index (p= 0/817). In the present study, there was an improvement in the AP index after balance training. Conclusion: Unstable surface training may reduce reaction time in posterior ankle muscle activity. Furthermore, focusing attention on cognitive tasks can lead to maintaining balance unconsciously. Most of the daily activities need attention distribution among several activities. So, balance training concurrent to a dual cognitive task is challenging and more similar to the real world. According to the specificity of the training principle, it may improve functional independence and fall prevention in the elderly.

Keywords: cognitive dual task, elderly, fear of falling, postural control, unstable surface

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4029 Using Infrared Thermography, Photogrammetry and a Remotely Piloted Aircraft System to Create 3D Thermal Models

Authors: C. C. Kruger, P. Van Tonder

Abstract:

Concrete deteriorates over time and the deterioration can be escalated due to multiple factors. When deteriorations are beneath the concrete’s surface, they could be unknown, even more so when they are located at high elevations. Establishing the severity of such defects could prove difficult and therefore the need to find efficient, safe and economical methods to find these defects becomes ever more important. Current methods using thermography to find defects require equipment such as scaffolding to reach these higher elevations. This could become time- consuming and costly. The risks involved with personnel scaffold or abseil to such heights are high. Accordingly, by combining the technologies of a thermal camera and a Remotely Piloted Aerial System it could be used to find better diagnostic methods. The data could then be constructed into a 3D thermal model to easy representation of the results

Keywords: concrete, infrared thermography, 3D thermal models, diagnostic

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4028 Effects of Fire on Vegetation of the Prairies and Black Oak Sand Savannas of Kankakee, Illinois

Authors: Megan Alkazoff, Charles Ruffner

Abstract:

Tallgrass prairies and sand savannas, once covering northern to central Illinois, are ecosystems in need of restoration and conservation in the Midwestern United States. The Nature Conservancy manages five sites containing fragments of remaining tallgrass prairies and sand savannas within the Kankakee Sands using techniques such as prescribed burning and invasive species removal. The objective of this study was to conduct a ten-year resampling of transects established on these five sites during previous studies to assess whether the management tools applied there are helping maintain the tallgrass prairie and sand savannas. During the summer of 2020, permanent transect lines were sampled using a quadrat to determine the % Cover Class of each species rooted in the quadrat. Data gathered was analyzed using linear regression to illustrate the relationship between fire occurrence and species composition on the landscape. The fire frequency had a highly significant effect (P= 0.0025) on the species richness of all sites. The frequency of fire had a non-significant effect (P>0.05) on the Floristic Quality Index, percent C value 4-10, and bare-ground percentage of a site. These results suggest that fire on the landscape, both wild and prescribed, have increased biodiversity on all five sites but has not affected the Floristic Quality Index, percent C value 4-10, and the percentage of bare-ground on the sites.

Keywords: fire, floristic quality assessment, sand savanna, species richness, tallgrass prairie

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4027 A Study of the Prevalence of Hypertension and Pre Hypertension in Adolescence Age between 10-17 in Ahvaz (2008-2009)

Authors: Armaghan Moravej Aleali, Seyed Mahmoud Latifi, Homeira Rashidi

Abstract:

Objective: High blood pressure in a risk factor for some disease like stroke, coronary heart disease, and renal failure. High blood pressure in children is an increasing health problem. The aim of this present was to determine prevalence of hypertension and pre-hypertension age between 10 to 17 years old. Material & Methods: This descriptive-analytic study was conducted using multiphase sampling method in Ahvaz (Southwest of Iran). A questionnaire include: height, weight, and body mass index, systolic and diastolic blood pressures filled for each participant. Blood pressure was measured twice for each person. For the diagnosis of hypertension, the fourth report of the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents of the National Health Institute of United States was used. Results: The subject participants of the study were 1707children and adolescents including 922 boys (54%) and 785 girls 46%). The prevalence of high blood pressure was 1.7% (boys 2.5% girls 0.8%). The prevalence of pre-hypertension was 9 % (7.6% in boys, 10.6% in girls). The mean systolic and diastolic blood pressures increased with increasing body mass index. Conclusion: In this study, the prevalence of high blood pressure was found to be lower than other studies in our country. The prevalence of the high blood pressure in boys was significantly higher than girls. This study, like other studies, showed a high correlation between being overweight and an increase in systolic and diastolic blood pressure.

Keywords: hypertension, pre-hypertension, childhood, adolescence

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4026 Physical Properties of Crushed Aggregates in Some Selected Quarries in Kwara State, Nigeria

Authors: S. A. Agbalajobi, W. A. Bello

Abstract:

This study examines rock properties of crushed aggregate in some selected quarries in Kwara state, Nigeria. Some physical properties (chemical composition, mineral composition, particle size distribution) of gneiss sample were determined using ISRM standards. The physicomechanical properties (specific gravity, dry density, porosity, water absorption, point load index, tensile, and compressive strength) of the gneiss rock were evaluated. The analysis on the gneiss samples revealed the mean dry density and the unit weight are 2.52 g/m3, 2.63 g/m3, 2.38 g/m3; and 24.1 kN/m3, 25.78 kN/m3, 23.33 kN/m3, respectively (for locations A,B,C). The water absorption level of the gneiss rock sample ranged from 0.38 % – 0.57 % for the three locations. The mean Schmidt hammer rebound value ranged from 51.0 – 52.4 for the three locations and mean point load index values ranged from 9.89 – 10.56 MPa classified as very high strength while the uniaxial compressive strength of the rock samples revealed that its strength ranged from 120 - 139 MPa (for location A, B, and C) classified as strong rock. The aggregate impact value test and aggregate crushing value test conducted on the gneiss aggregates from the three locations in accordance with British Standard. The gneiss sample from the three locations (A, B, and C) is a good material for the production of construction works such as concrete, bricks, pavement, embankment among others, the compressive strength of the material is within the accepted limit.

Keywords: gneiss, aggregate impact, aggregate crushing, physic-mechanical properties, rock hardness

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4025 Role of Physical Properties of Maize Grains Towards Resistance to Sitotroga Cerealella (OLIV.) (Gelechiidae: Lepidoptera) in No Choice

Authors: Sohail Ahmed, Ahmad Raza

Abstract:

Physical properties of maize grains were correlated with levels of the life history of Sitotroga cerealella (Oliv.) (Gelechiidae: Lepidoptera) in no choice test to find out relative resistance in different varieties. Eight maize varieties /lines (EV-6089, Sahiwal-2002, Golden, 34N43, EV-1098, Sultan, China-1, EV-20) including seven yellow and one white were obtained from Maize and Millet Research Institute, Yousaf Wala, Sahiwal, Punjab, Pakistan. Freshly laid eggs (one day old) of S. cerealella were obtained and cultured on a susceptible maize variety for two generations for later on shifting to test varieties. Results showed that maximum moth emergence (10.33), fecundity (35.66), hatching (87.66%), moth weight (5.05 mg), development time (36.0 days) damage (93.35%) and grain weight loss (38.84%) was found in varieties, 34N43 and Golden, Sultan, Sahiwal 2002, 34N43, EV-6089, 34N43 and EV-1089, respectively. Varieties had significant difference with other varieties in these parameters (P<0.05). The varieties had positive as well as negative correlation between hardness index, grain weight and bulk density with the biological parameters of S. cerealella, percent grain damage and weight loss. Possible involvement of these grain properties in the resistance of maize grains towards S. cerealella is discussed.

Keywords: sitotroga cerealella, hardness index, grain damage, maize, varieties

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4024 Effect of Question Answer Relationship (QARs) in Science Reading on the Academic Achievement of Students in Biology

Authors: Helen Ngozi Ibe, Chimmuanya Ezere

Abstract:

The study investigated the effect of Question Answer Relationships (QARs) in science reading on secondary school students’ achievement in Biology in Owerri Education Zone II of Imo State. The study adopted a quasi-experimental design and was guided by two research questions and two hypotheses. The sample comprised of 67 SS2 Biology students. The sample was drawn using random sampling technique. One researcher made instrument titled: Biology Achievement Test (BAT) was used for collecting the data of the study. The reliability of the instrument was established using Kuder Richardson formula (KR-20) which yielded a reliability index of 0.85 and Cronbach alpha for the BSIRS with an index of 0.71. Research questions were answered using mean and standard deviation. T-test statistics was used to test the hypotheses at 0.05 level of significance. The major findings are that students exposed to QARs strategy in science reading had higher achievement mean scores in biology than students in the control group; there is no significant difference between the achievement mean scores of male and female students exposed to QARs. The researchers recommended that science teachers should teach students the Question Answer Relationship reading strategy and that science students should endeavour to use the question - answer relationship reading strategy in classroom and individual science reading in order to enhance high academic achievement in the subjects being read.

Keywords: academic achievement, biology, science reading, question-answer relationship

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4023 Assessing Suitability of Earthbag Technology for Temporary Housing: Sustainability Challenge

Authors: S. M. Amin Hosseini, Ana Blanco, Albert De La Fuente, Sergio Cavalaro

Abstract:

In emergency situations, it is fundamental to provide with a safe shelter to the population affected. However, the lack of resources and short time often represent a barrier difficult to overcome. A sustainable, rapid and low-cost construction technique is earthbag construction. This technique has spread as an alternative to the construction of emergency shelter, social housing, and even ecovillages. The earthbag construction consists of introducing soil in degradable bags that are stacked to form adobe structures. The present study aims to assess characteristics of the earthbag construction technique based on sustainability requirements and features of other methods used for temporary housing. In this case, after defining the sustainability criteria and emergency situation necessities, this study compares earthbag construction with other types of prefabricated temporary housing. Finally, the most suitable conditions for applying this technique based on the particular local properties and second life scenarios of superadobe temporary housing. The results of the study contribute to promote the earthbag and superadobe techniques as sustainable alternatives for temporary housing. However, the sustainability index of this technology highly depends on affected local conditions and characteristics. Consequently, in order to achieve a high sustainability index, emergency managers need to decide about this technology based on the highlighted results of this study, attention to the importance of specific local conditions and next functions of temporary housing.

Keywords: temporary housing, temporary shelter, earthbag, superadobe, sustainability, emergency

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4022 Diagnostic Clinical Skills in Cardiology: Improving Learning and Performance with Hybrid Simulation, Scripted Histories, Wearable Technology, and Quantitative Grading – The Assimilate Excellence Study

Authors: Daly M. J, Condron C, Mulhall C, Eppich W, O'Neill J.

Abstract:

Introduction: In contemporary clinical cardiology, comprehensive and holistic bedside evaluation including accurate cardiac auscultation is in decline despite having positive effects on patients and their outcomes. Methods: Scripted histories and scoring checklists for three clinical scenarios in cardiology were co-created and refined through iterative consensus by a panel of clinical experts; these were then paired with recordings of auscultatory findings from three actual patients with known valvular heart disease. A wearable vest with embedded pressure-sensitive panel speakers was developed to transmit these recordings when examined at the standard auscultation points. RCSI medical students volunteered for a series of three formative long case examinations in cardiology (LC1 – LC3) using this hybrid simulation. Participants were randomised into two groups: Group 1 received individual teaching from an expert trainer between LC1 and LC2; Group 2 received the same intervention between LC2 and LC3. Each participant’s long case examination performance was recorded and blindly scored by two peer participants and two RCSI examiners. Results: Sixty-eight participants were included in the study (age 27.6 ± 0.1 years; 74% female) and randomised into two groups; there were no significant differences in baseline characteristics between groups. Overall, the median total faculty examiner score was 39.8% (35.8 – 44.6%) in LC1 and increased to 63.3% (56.9 – 66.4%) in LC3, with those in Group 1 showing a greater improvement in LC2 total score than that observed in Group 2 (p < .001). Using the novel checklist, intraclass correlation coefficients (ICC) were excellent between examiners in all cases: ICC .994 – .997 (p < .001); correlation between peers and examiners improved in LC2 following peer grading of LC1 performances: ICC .857 – .867 (p < .001). Conclusion: Hybrid simulation and quantitative grading improve learning, standardisation of assessment, and direct comparisons of both performance and acumen in clinical cardiology.

Keywords: cardiology, clinical skills, long case examination, hybrid simulation, checklist

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4021 Using a Train-the-Trainer Model to Deliver Post-Partum Haemorrhage Simulation in Rural Uganda

Authors: Michael Campbell, Malaz Elsaddig, Kevin Jones

Abstract:

Background: Despite encouraging progress, global maternal mortality has remained stubbornly high since the declaration of the Millennium development goals. Sub-Saharan Africa accounts for well over half of maternal deaths with Post-Partum Haemorrhage (PPH) being the lead cause. ‘In house’ simulation training delivered by local doctors may be a sustainable approach for improving emergency obstetric care. The aim of this study was to evaluate the use of a Train-the-Trainer (TtT) model in a rural Ugandan hospital to ascertain whether it can feasibly improve practitioners’ management of PPH. Methods: Three Ugandan doctors underwent a training course to enable them to design and deliver simulation training. These doctors used MamaNatalie® models to simulate PPH scenarios for midwives, nurses and medical students. The main outcome was improvement in participants’ knowledge and confidence, assessed using self-reported scores on a 10-point scale. Results: The TtT model produced significant improvements in the confidence and knowledge scores of the ten participants. The mean confidence score rose significantly (p=0.0005) from 6.4 to 8.6 following the simulation training. There was also a significant increase in the mean knowledge score from 7.2 to 9.0 (p=0.04). Medical students demonstrated the greatest overall increase in confidence scores whilst increases in knowledge scores were largest amongst nurses. Conclusions: This study demonstrates that a TtT model can be used in a low resource setting to improve healthcare professionals’ confidence and knowledge in managing obstetric emergencies. This Train-the-Trainer model represents a sustainable approach to addressing skill deficits in low resource settings. We believe that its expansion across healthcare institutions in Sub-Saharan Africa will help to reduce the region’s high maternal mortality rate and step closer to achieving the ambitions of the Millennium development goals.

Keywords: low resource setting, post-partum haemorrhage, simulation training, train the trainer

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