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Authors: Natalia V. Minaeva, Natalia A. Zorina, Marina N. Khorobrikh, Philipp S. Sherstnev, Tatiana V. Krivokorytova, Alexander S. Luchinin, Maksim S. Minaev, Igor V. Paramonov

Abstract:

Background. Over the last few decades, the Center for International Blood and Marrow Transplant Research (CIBMTR) and the World Marrow Donor Association (WMDA) have been actively working to ensure the safety of the hematopoietic stem cell (HSC) donation process. Registration of adverse events that may occur during the donation period and establishing a relationship between donation and side effects are included in the WMDA international standards. The level of blood serum N-terminal pro-brain natriuretic peptide (NT-proBNP) is an early marker of myocardial stress. Due to the high analytical sensitivity and specificity, laboratory assessment of NT-proBNP makes it possible to objectively diagnose myocardial dysfunction. It is well known that the main stimulus for proBNP synthesis and secretion from atrial and ventricular cardiac myocytes is myocyte stretch and increasement of myocardial extensibility and pressure in the heart chambers. Аim. The aim of the study was to assess the dynamic changes in the levels of blood serum N-terminal pro-brain natriuretic peptide of unrelated donors at various stages of hematopoietic stem cell mobilization. Materials. We have examined 133 unrelated donors, including 92 men and 41 women, that have been included into the study. The NT-proBNP levels were measured before the start of mobilization, then on the day of apheresis, and after the donation of allogeneic HSC. The relationship between NT-proBNP levels and body mass index (BMI), ferritin, hemoglobin, and white blood cells (WBC) levels was assessed on the day of apheresis. The median age of donors was 34 years. Mobilization of HSCs was managed with filgrastim administration at a dose of 10 μg/kg daily for 4-5 days. The first leukocytapheresis was performed on day 4 from the start of filgrastim administration. Quantitative values of the blood serum NT-proBNP level are presented as a median (Me), first and third quartiles (Q1-Q3). Comparative analysis was carried out using the t-test and correlation analysis as well by Spearman method. Results. The baseline blood serum NT-proBNP levels in all 133 donors were within the reference values (<125 pg/ml) and equaled 21,6 (10,0; 43,3) pg/ml. At the same time, the level of NT-proBNP in women was significantly higher than that of men. On the day of the HSC apheresis, a significant increase of blood serum NT-proBNP levels was detected and equald 131,2 (72,6; 165,3) pg/ml (p<0,001), with higher rates in female donors. A statistically significant weak inverse correleation was established between the level of NT-proBNP and the BMI of donors (-0.18, p = 0,03), as well as the level of hemoglobin (-0.33, p <0,001), and ferritin levels (-0.19, p = 0,03). No relationship has been established between the magnitude of WBC levels achieved as a result of the mobilization of HSC on the day of leukocytapheresis. A day after the apheresis, the blood serum NT-proBNP levels still exceeded the reference values, but there was a decreasing tendency. Conclusion. An increase of the blood serum NT-proBNP level in unrelated donors during the mobilization of HSC was established. Future studies should clarify the reason for this phenomenon, as well as its effects on donors' long-term health.

Keywords: unrelated donors, mobilization, hematopoietic stem cells, N-terminal pro-brain natriuretic peptide

Procedia PDF Downloads 101

Authors: Celine Shi Ying Lee, Jong Jian Lee

Abstract:

Background: Infectious keratitis is one of the leading causes of blindness worldwide. Prompt treatment with effective medication will control the infection early, preventing corneal scarring and visual loss. fluoroquinolones ophthalmic medication is used because of its broad-spectrum properties, potency, good intraocular penetration, and low toxicity. The study aims to evaluate the treatment outcome of corneal ulcers using Levofloxacin 1.5% ophthalmic solution (LVFX) with adjuvant oral ciprofloxacin when indicated and apply this treatment strategy in primary health care as first-line treatment. Methods: Patients with infective corneal ulcer treated in an eye center were recruited. Inclusion criteria includes Corneal infection consistent with bacterial keratitis, single or multiple small corneal ulcers. Treatment regime: LVFX hourly for the first 2 days, 2 hourly from the 3rd day, and 3 hourly on the 5th day of review. Adjuvant oral ciprofloxacin 500mg BD was administered for 5 days if there were multiple corneal ulcers or when the location of the cornea ulcer was central or paracentral. Results: 47 subjects were recruited. There were 16 (34%) males and 31 (66%) females. 40 subjects (85%) were contact lens (CL) related to corneal ulcer, and 7 subjects (15%) were non-contact lens related. 42 subjects (89%) presented with one ulcer, of which 20 of them (48%) needed adjuvant therapy. 5 subjects presented with 2 or 3 ulcers, of which 3 needed adjuvant therapy. A total of 23 subjects (49%) was given adjuvant therapy (oral ciprofloxacin 500mg BD for 5 days).21 of them (91%) were CL related. All subjects recovered fully, and the average duration of treatment was 3.7 days, with 49% of the subjects resolved on the 3rd day, 38% on the 5thday of and 13% on the 7thday. All subjects showed symptoms of relief of pain, light-sensitivity, and redness on the 3rd day with full visual recovery post-treatment. No adverse drug reactions were recorded. Conclusion: Our treatment regime demonstrated good clinical outcome as first-line treatment for corneal ulcers. A corneal ulcer is a common eye condition in Singapore, mainly due to CL wear. Pseudomonas aeruginosa is the most frequent and potentially sight-threatening pathogen involved in CL related corneal ulcer. Coagulase-negative Staphylococci, Staphylococcus aureus, and Streptococcus Pneumoniae were seen in non-CL users. All these bacteria exhibit good sensitivity rates to ciprofloxacin and levofloxacin. It is therefore logical in our study to use LVFX Eyedrops and adjuvant ciprofloxacin oral antibiotics when indicated as first line treatment for most corneal ulcers. Our study of patients, both CL related and non-CL related, have shown good clinical response and full recovery using the above treatment strategy. There was also a full restoration of visual acuity in all the patients. Eye-trained primary Healthcare practitioners can consider adopting this treatment strategy as first line treatment in patients with corneal ulcers. This is relevant during the COVID pandemic, where hospitals are overwhelmed with patients and in regions with limited access to specialist eye care. This strategy would enable early treatment with better clinical outcome.

Keywords: corneal ulcer, levofloxacin hydrate, treatment strategy, ciprofloxacin

Procedia PDF Downloads 175

Authors: Alua Massalimova

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Situation analysis of Blood Service revealed that the strengths dominated over the weak 1.4 times. The possibilities dominate over the threats by 1.1 times. It follows that by using timely the possibility the Service, it is possible to strengthen its strengths and avoid threats. Priority directions of the resulting analysis are the use of subjective factors, such as personal management capacity managers of the Blood Center in the field of possibilities of legal activity of administrative decisions and the mobilization of stable staff in general market conditions. We have studied for the period 2011-2015 retrospectively indicators of Blood Service of Kazakhstan. Strengths of Blood Service of RK(Ps4,5): 1) indicators of donations for 1000 people is higher than in some countries of the CIS (in Russia 14, Kazakhstan - 17); 2) the functioning science centre of transfusiology; 3) the legal possibility of additional financing blood centers in the form of paid services; 4) the absence of competitors; 5) training on specialty Transfusiology; 6) the stable management staff of blood centers, a high level of competence; 7) increase in the incidence requiring transfusion therapy (oncohematology); 8) equipment upgrades; 9) the opening of a reference laboratory; 10) growth of the proportion of issued high-quality blood components; 11) governmental organization 'Drop of Life'; 12) the functioning bone marrow register; 13) equipped with modern equipment HLA-laboratory; 14) High categorization of average medical workers; 15) availability of own specialized scientific journal; 16) vivarium. The weaknesses (Ps = 3.5): 1) the incomplete equipping of blood centers and blood transfusion cabinets according to standards; 2) low specific weight of paid services of the CC; 3) low categorization of doctors; 4) high staff turnover; 5) the low scientific potential of industrial and clinical of transfusiology; 6) the low wages paid; 7) slight growth of harvested donor blood; 8) the weak continuity with offices blood transfusion; 9) lack of agitation work; 10) the formally functioning of Transfusion Association; 11) the absence of scientific laboratories; 12) high standard deviation from the average for donations in the republic. The possibilities (Ps = 2,7): 1): international grants; 2) organization of international seminars on clinical of transfusiology; 3) cross-sectoral cooperation; 4) to increase scientific research in the field of clinical of transfusiology; 5) reduce the share of donation unsuitable for transfusion and processing; 6) strengthening marketing management in the development of fee-based services; 7) advertising paid services; 8) strengthening the publishing of teaching aids; 9) team-building staff. The threats (Ps = 2.1): 1) an increase of staff turnover; 2) the risk of litigation; 3) reduction gemoprodukts based on evidence-based medicine; 4) regression of scientific capacity; 5) organization of marketing; 6) transfusiologist marketing; 7) reduction in the quality of the evidence base transfusions.

Keywords: blood service, healthcare, Kazakhstan, quantative swot analysis

Procedia PDF Downloads 228

Authors: Zeradam Yeshiwas, A. Krishnaia

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The aim of this study is to verify the resulting surface roughness of parts formed by the Single-Point Incremental Forming (SPIF) process for an ISO 3574 Drawing Quality Cold Rolled CR2 Steel. The chemical composition of drawing quality Cold Rolled CR2 steel is comprised of 0.12 percent of carbon, 0.5 percent of manganese, 0.035 percent of sulfur, 0.04 percent phosphorous, and the remaining percentage is iron with negligible impurities. The experiments were performed on a 3-axis vertical CNC milling machining center equipped with a tool setup comprising a fixture and forming tools specifically designed and fabricated for the process. The CNC milling machine was used to transfer the tool path code generated in Mastercam 2017 environment into three-dimensional motions by the linear incremental progress of the spindle. The blanks of Drawing Quality Cold Rolled CR2 steel sheets of 1 mm of thickness have been fixed along their periphery by a fixture and hardened high-speed steel (HSS) tools with a hemispherical tip of 8, 10 and 12mm of diameter were employed to fabricate sample parts. To investigate the surface roughness, hyperbolic-cone shape specimens were fabricated based on the chosen experimental design. The effect of process parameters on the surface roughness was studied using three important process parameters, i.e., tool diameter, feed rate, and step depth. In this study, the Taylor-Hobson Surtronic 3+ surface roughness tester profilometer was used to determine the surface roughness of the parts fabricated using the arithmetic mean deviation (Rₐ). In this instrument, a small tip is dragged across a surface while its deflection is recorded. Finally, the optimum process parameters and the main factor affecting surface roughness were found using the Taguchi design of the experiment and ANOVA. A Taguchi experiment design with three factors and three levels for each factor, the standard orthogonal array L9 (3³) was selected for the study using the array selection table. The lowest value of surface roughness is significant for surface roughness improvement. For this objective, the ‘‘smaller-the-better’’ equation was used for the calculation of the S/N ratio. The finishing roughness parameter Ra has been measured for the different process combinations. The arithmetic means deviation (Rₐ) was measured via the experimental design for each combination of the control factors by using Taguchi experimental design. Four roughness measurements were taken for a single component and the average roughness was taken to optimize the surface roughness. The lowest value of Rₐ is very important for surface roughness improvement. For this reason, the ‘‘smaller-the-better’’ Equation was used for the calculation of the S/N ratio. Analysis of the effect of each control factor on the surface roughness was performed with a ‘‘S/N response table’’. Optimum surface roughness was obtained at a feed rate of 1500 mm/min, with a tool radius of 12 mm, and with a step depth of 0.5 mm. The ANOVA result shows that step depth is an essential factor affecting surface roughness (91.1 %).

Keywords: incremental forming, SPIF, drawing quality steel, surface roughness, roughness behavior

Procedia PDF Downloads 62

Authors: M. Siedlikowski, F. Rauch, A. Tsimicalis

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Osteogenesis Imperfecta (OI) is a genetic disorder of childhood onset that causes frequent fractures after minimal physical stress. To date, OI research has focused on medically- and surgically-oriented outcomes with little attention on the perspective of the affected child. It is a challenge to elicit the child’s voice in health care, in other words, their own perspective on their symptoms, but software development offers a way forward. Sisom (Norwegian acronym derived from ‘Si det som det er’ meaning ‘Tell it as it is’) is an award-winning, rigorously tested, interactive, computerized tool that helps children with chronic illnesses express their symptoms to their clinicians. The successful Sisom software tool, that addresses the child directly, has not yet been adapted to attend to symptoms unique to children with OI. The purpose of this study was to develop a Sisom paper prototype for children with OI by seeking the perspectives of end users, particularly, children with OI and clinicians. Our descriptive qualitative study was conducted at Shriners Hospitals for Children® – Canada, which follows the largest cohort of children with OI in North America. Purposive sampling was used to recruit 12 children with OI over three cycles. Nine clinicians oversaw the development process, which involved determining the relevance of current Sisom symptoms, vignettes, and avatars, as well as generating new Sisom OI components. Data, including field notes, transcribed audio-recordings, and drawings, were deductively analyzed using content analysis techniques. Guided by the following framework, data pertaining to symptoms, vignettes, and avatars were coded into five categories: a) Relevant; b) Irrelevant; c) To modify; d) To add; e) Unsure. Overall, 70.8% of Sisom symptoms were deemed relevant for inclusion, with 49.4% directly incorporated, and 21.3% incorporated with changes to syntax, and/or vignette, and/or location. Three additions were made to the ‘Avatar’ island. This allowed children to celebrate their uniqueness: ‘Makes you feel like you’re not like everybody else.’ One new island, ‘About Me’, was added to capture children’s worldviews. One new sub-island, ‘Getting Around’, was added to reflect accessibility issues. These issues were related to the children’s independence, their social lives, as well as the perceptions of others. In being consulted as experts throughout the co-creation of the Sisom OI paper prototype, children coded the Sisom symptoms and provided sound rationales for their chosen codes. In rationalizing their codes, all children shared personal stories about themselves and their relationships, insights about their OI, and an understanding of the strengths and challenges they experience on a day-to-day basis. The child’s perspective on their health is a basic right, and allowing it to be heard is the next frontier in the care of children with genetic diseases. Sisom OI, a methodological breakthrough within OI research, will offer clinicians an innovative and child-centered approach to capture this neglected perspective. It will provide a tool for the delivery of health care in the center that established the worldwide standard of care for children with OI.

Keywords: child health, interactive computerized communication tool, participatory approach, symptom management

Procedia PDF Downloads 157

Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

Abstract:

Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

Procedia PDF Downloads 67

Authors: Jawad Arshad

Abstract:

Back and neck pain result in more than 3 million Emergency Department (ED) visits per year. Approximately 10-20% of patients with acute low back pain will continue to have moderate to severe pain after 3 months and 30% will develop chronic functional impairment. Strategies for analgesia for musculoskeletal pain upon ED discharge have been shown to be highly variable and provider dependent. The American College of Physicians, United Kingdom and Danish treatment guidelines all recommend exercise as the first line treatment for low back pain present >12 weeks and as an adjunctive treatment to education and encouraging continued mobility in acute low back pain. URL links and QR codes were embedded in Epic’s Electronic Medical Record (EMR) for seamless integration into discharge instructions. To our knowledge, this is the first time QR codes have been embedded and used as an adjunct to computer generated discharge instructions into an EMR nationwide. Materials and Methods: Eleven two-minute physical therapy (PT) videos treating a variety of common painful musculoskeletal conditions were prepared in collaboration between the Pain Management and Physical Therapy departments of a large academic center. The videos were hosted and made available on Vimeo for free public access. Dynamic QR codes and URL links were created for each video and integrated into the EPIC Electronic Medical Record discharge instructions. Both data from physician prescribed PT videos and results of public searches are included. As the case report is devoid of patient identifiable information, it is exempt from IRB review requirements as per IRB policy. Results/Case Report: From 2/6/2021 to 5/19/21, the videos were prescribed on Epic a total of 76 times, the dynamic QR codes were scanned a total of 84 times. Low back (n=32) followed by neck (n=8), shoulder (n=7) and radicular low back pain (n=7) were the most common painful complaints prescribed a PT video. The videos were played on Vimeo 790 times with 83% (n=656) being unique views and 17% returning users. Shoulder pain (n=489) followed by neck (n=36) and low back pain (n=37) were the most commonly played videos. Discussion: Patients are viewing their physical therapy videos via QR codes provided by their physicians. The large number of public views of the physical therapy videos are either from patients sharing the link/QR code or patients not affiliated with our institution are searching for videos to treat their painful complaints. The data suggests there is a need for reputable home PT videos to treat commonly encountered painful complaints with 17% of viewers returning for repeat view. The shoulder pain video was played significantly more than the others despite not being given to patients more frequently, which raised suspicion it may have received increased traffic via an outside affiliate, website or influencer. When eliminating shoulder pain from the data, individuals watched 67% of the entire video on average, indicating high engagement.

Keywords: pain, EMR, emergency medicine, discharge

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Authors: Eglal Y. Ali, Smita Rao, Anat Lubetzky, Wen Ling

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Background: Postural abnormalities, rigidity, clumsiness, and frequent falls are common among children with autism spectrum disorders (ASD). The central nervous system’s ability to process all reliable sensory inputs (weighting) and disregard potentially perturbing sensory input (reweighting) is critical for successfully maintaining standing postural control. This study examined how sensory inputs (visual and somatosensory) are weighted and reweighted to maintain standing postural control in children with ASD compared with typically developing (TD) children. Subjects: Forty (20 (TD) and 20 ASD) children and adolescents participated in this study. The groups were matched for age, weight, and height. Participants had normal somatosensory (no somatosensory hypersensitivity), visual, and vestibular perception. Participants with ASD were categorized with severity level 1 according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and Social Responsiveness Scale. Methods: Using one force platform, the center of pressure (COP) was measured during quiet standing for 30 seconds, 3 times first standing on stable surface with eyes open (Condition 1), followed by randomization of the following 3 conditions: Condition 2 standing on stable surface with eyes closed, (visual input perturbed); Condition 3 standing on compliant foam surface with eyes open, (somatosensory input perturbed); and Condition 4 standing on compliant foam surface with eyes closed, (both visual and somatosensory inputs perturbed). Standing postural control was measured by three outcome measures: COP sway area, COP anterior-posterior (AP), and mediolateral (ML) path length (PL). A repeated measure mixed model Analysis of Variance was conducted to determine whether there was a significant difference between the two groups in the mean of the three outcome measures across the four conditions. Results: According to all three outcome measures, both groups showed a gradual increase in postural sway from condition 1 to condition 4. However, TD participants showed a larger postural sway than those with ASD. There was a significant main effect of condition on three outcome measures (p< 0.05). Only the COP AP PL showed a significant main effect of the group (p<0.05) and a significant group by condition interaction (p<0.05). In COP AP PL, TD participants showed a significant difference between condition 2 and the baseline (p<0.05), whereas the ASD group did not. This suggests that the ASD group did not weight visual input as much as the TD group. A significant difference between conditions for the ASD group was seen only when participants stood on foam regardless of the visual condition, suggesting that the ASD group relied more on the somatosensory inputs to maintain the standing postural control. Furthermore, the ASD group exhibited significantly smaller postural sway compared with TD participants during standing on the stable surface, whereas the postural sway of the ASD group was close to that of the TD group on foam. Conclusion: These results suggest that participants with high functioning ASD (level 1, no somatosensory hypersensitivity in ankles and feet) over-rely on somatosensory inputs and use a stiffening strategy for standing postural control. This deviation in the reweighting mechanism might explain the postural abnormalities mentioned above among children with ASD.

Keywords: autism spectrum disorders, postural sway, sensory weighting and reweighting, standing postural control

Procedia PDF Downloads 54

Authors: Eglal Y. Ali, Smita Rao, Anat Lubetzky, Wen Ling

Abstract:

Background: Postural abnormalities, rigidity, clumsiness, and frequent falls are common among children with autism spectrum disorders (ASD). The central nervous system’s ability to process all reliable sensory inputs (weighting) and disregard potentially perturbing sensory input (reweighting) is critical for successfully maintaining standing postural control. This study examined how sensory inputs (visual and somatosensory) are weighted and reweighted to maintain standing postural control in children with ASD compared with typically developing (TD) children. Subjects: Forty (20 (TD) and 20 ASD) children and adolescents participated in this study. The groups were matched for age, weight, and height. Participants had normal somatosensory (no somatosensory hypersensitivity), visual, and vestibular perception. Participants with ASD were categorized with severity level 1 according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and Social Responsiveness Scale. Methods: Using one force platform, the center of pressure (COP) was measured during quiet standing for 30 seconds, 3 times first standing on stable surface with eyes open (Condition 1), followed by randomization of the following 3 conditions: Condition 2 standing on stable surface with eyes closed, (visual input perturbed); Condition 3 standing on a compliant foam surface with eyes open, (somatosensory input perturbed); and Condition 4 standing on a compliant foam surface with eyes closed, (both visual and somatosensory inputs perturbed). Standing postural control was measured by three outcome measures: COP sway area, COP anterior-posterior (AP), and mediolateral (ML) path length (PL). A repeated measure mixed model analysis of variance was conducted to determine whether there was a significant difference between the two groups in the mean of the three outcome measures across the four conditions. Results: According to all three outcome measures, both groups showed a gradual increase in postural sway from condition 1 to condition 4. However, TD participants showed a larger postural sway than those with ASD. There was a significant main effect of the condition on three outcome measures (p< 0.05). Only the COP AP PL showed a significant main effect of the group (p<0.05) and a significant group by condition interaction (p<0.05). In COP AP PL, TD participants showed a significant difference between condition 2 and the baseline (p<0.05), whereas the ASD group did not. This suggests that the ASD group did not weigh visual input as much as the TD group. A significant difference between conditions for the ASD group was seen only when participants stood on foam regardless of the visual condition, suggesting that the ASD group relied more on the somatosensory inputs to maintain the standing postural control. Furthermore, the ASD group exhibited significantly smaller postural sway compared with TD participants during standing on a stable surface, whereas the postural sway of the ASD group was close to that of the TD group on foam. Conclusion: These results suggest that participants with high-functioning ASD (level 1, no somatosensory hypersensitivity in ankles and feet) over-rely on somatosensory inputs and use a stiffening strategy for standing postural control. This deviation in the reweighting mechanism might explain the postural abnormalities mentioned above among children with ASD.

Keywords: autism spectrum disorders, postural sway, sensory weighting and reweighting, standing postural control

Procedia PDF Downloads 121

Authors: Farhan A. Alenizi

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Digital watermarking has evolved in the past years as an important means for data authentication and ownership protection. The images and video watermarking was well known in the field of multimedia processing; however, 3D objects' watermarking techniques have emerged as an important means for the same purposes, as 3D mesh models are in increasing use in different areas of scientific, industrial, and medical applications. Like the image watermarking techniques, 3D watermarking can take place in either space or transform domains. Unlike images and video watermarking, where the frames have regular structures in both space and temporal domains, 3D objects are represented in different ways as meshes that are basically irregular samplings of surfaces; moreover, meshes can undergo a large variety of alterations which may be hard to tackle. This makes the watermarking process more challenging. While the transform domain watermarking is preferable in images and videos, they are still difficult to implement in 3d meshes due to the huge number of vertices involved and the complicated topology and geometry, and hence the difficulty to perform the spectral decomposition, even though significant work was done in the field. Spatial domain watermarking has attracted significant attention in the past years; they can either act on the topology or on the geometry of the model. Exploiting the statistical characteristics in the 3D mesh models from both geometrical and topological aspects was useful in hiding data. However, doing that with minimal surface distortions to the mesh attracted significant research in the field. A 3D mesh blind watermarking technique is proposed in this research. The watermarking method depends on modifying the vertices' positions with respect to the center of the object. An optimal method will be developed to reduce the errors, minimizing the distortions that the 3d object may experience due to the watermarking process, and reducing the computational complexity due to the iterations and other factors. The technique relies on the displacement process of the vertices' locations depending on the modification of the variances of the vertices’ norms. Statistical analyses were performed to establish the proper distributions that best fit each mesh, and hence establishing the bins sizes. Several optimizing approaches were introduced in the realms of mesh local roughness, the statistical distributions of the norms, and the displacements in the mesh centers. To evaluate the algorithm's robustness against other common geometry and connectivity attacks, the watermarked objects were subjected to uniform noise, Laplacian smoothing, vertices quantization, simplification, and cropping. Experimental results showed that the approach is robust in terms of both perceptual and quantitative qualities. It was also robust against both geometry and connectivity attacks. Moreover, the probability of true positive detection versus the probability of false-positive detection was evaluated. To validate the accuracy of the test cases, the receiver operating characteristics (ROC) curves were drawn, and they’ve shown robustness from this aspect. 3D watermarking is still a new field but still a promising one.

Keywords: watermarking, mesh objects, local roughness, Laplacian Smoothing

Procedia PDF Downloads 161

Authors: Christian Bruss, Simona Gamba, Davide Azzolini, Federico Podestà

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In this paper, the authors assess the impact of different political and environmental shocks on the size and on the age and gender composition of asylum-related migration flows to Europe. With this paper, the authors contribute to the literature by looking at the impact of different political and environmental shocks on the gender and age composition of migration flows in addition to the size of these flows. Conflicting theories predict different outcomes concerning the relationship between political and environmental shocks and the migration flows composition. Analyzing the relationship between the causes of migration and the composition of migration flows could yield more insights into the mechanisms behind migration decisions. In addition, this research may contribute to better informing national authorities in charge of receiving these migrant, as women and children/the elderly require different assistance than young men. To be prepared to offer the correct services, the relevant institutions have to be aware of changes in composition based on the shock in question. The authors analyze the effect of different types of shocks on the number, the gender and age composition of first time asylum seekers originating from 154 sending countries. Among the political shocks, the authors consider: violence between combatants, violence against civilians, infringement of political rights and civil liberties, and state terror. Concerning environmental shocks, natural disasters (such as droughts, floods, epidemics, etc.) have been included. The data on asylum seekers applying to any of the 32 Schengen Area countries between 2008 and 2015 is on a monthly basis. Data on asylum applications come from Eurostat, data on shocks are retrieved from various sources: georeferenced conflict data come from the Uppsala Conflict Data Program (UCDP), data on natural disasters from the Centre for Research on the Epidemiology of Disasters (CRED), data on civil liberties and political rights from Freedom House, data on state terror from the Political Terror Scale (PTS), GDP and population data from the World Bank, and georeferenced population data from the Socioeconomic Data and Applications Center (SEDAC). The authors adopt a Difference-in-Differences identification strategy, exploiting the different timing of several kinds of shocks across countries. The highly skewed distribution of the dependent variable is taken into account by using count data models. In particular, a Zero Inflated Negative Binomial model is adopted. Preliminary results show that different shocks - such as armed conflict and epidemics - exert weak immediate effects on asylum-related migration flows and almost non-existent effects on the gender and age composition. However, this result is certainly affected by the fact that no time lags have been introduced so far. Finding the correct time lags depends on a great many variables not limited to distance alone. Therefore, finding the appropriate time lags is still a work in progress. Considering the ongoing refugee crisis, this topic is more important than ever. The authors hope that this research contributes to a less emotionally led debate.

Keywords: age, asylum, Europe, forced migration, gender

Procedia PDF Downloads 262

Authors: Neelam Taneja, Abhishek Mewara, Ajay Kumar

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Multidrug resistant shigellae have emerged as a therapeutic challenge in India. At our 2000 bed tertiary care referral centre in Chandigarh, North India, which caters to a large population of 7 neighboring states, antibiotic resistance in Shigella is being constantly monitored. Shigellae are isolated from 3 to 5% of all stool samples. In 1990 nalidixic acid was the drug of choice as 82%, and 63% of shigellae were resistant to ampicillin and cotrimoxazole respectively. Nalidixic acid resistance emerged in 1992 and rapidly increased from 6% during 1994-98 to 86% by the turn of 21st century. In the 1990s, the WHO recommended ciprofloxacin as the drug of choice for empiric treatment of shigellosis in view of the existing high level resistance to agents like chloramphenicol, ampicillin, cotrimoxazole and nalidixic acid. First resistance to ciprofloxacin in S. flexneri at our centre appeared in 2000 and rapidly rose to 46% in 2007 (MIC>4mg/L). In between we had an outbreak of ciprofloxacin resistant S.dysenteriae serotype 1 in 2003. Therapeutic failures with ciprofloxacin occurred with both ciprofloxacin-resistant S. dysenteriae and ciprofloxacin-resistant S. flexneri. The severity of illness was more with ciprofloxacin-resistant strains. Till 2000, elsewhere in the world ciprofloxacin resistance in S. flexneri was sporadic and uncommon, though resistance to co-trimoxazole and ampicillin was common and in some areas resistance to nalidixic acid had also emerged. Fluoroquinolones due to extensive use and misuse for many other illnesses in our region are thus no longer the preferred group of drugs for managing shigellosis in India. WHO presently recommends ceftriaxone and azithromycin as alternative drugs to fluoroquinolone-resistant shigellae, however, overreliance on this group of drugs also seems to soon become questionable considering the emerging cephalosporin-resistant shigellae. We found 15.1% of S. flexneri isolates collected over a period of 9 years (2000-2009) resistant to at least one of the third-generation cephalosporins (ceftriaxone/cefotaxime). The first isolate showing ceftriaxone resistance was obtained in 2001, and we have observed an increase in number of isolates resistant to third generation cephalosporins in S. flexneri 2005 onwards. This situation has now become a therapeutic challenge in our region. The MIC values for Shigella isolates revealed a worrisome rise for ceftriaxone (MIC90:12 mg/L) and cefepime (MIC90:8 mg/L). MIC values for S. dysenteriae remained below 1 mg/L for ceftriaxone, however for cefepime, the MIC90 has raised to 4 mg/L. These infections caused by ceftriaxone-resistant S. flexneri isolates were successfully treated by azithromycin at our center. Most worrisome development in the present has been the emergence of DSA(Decreased susceptibility to azithromycin) which surfaced in 2001 and has increased from 4.3% till 2011 to 34% thereafter. We suspect plasmid-mediated resistance as we detected qnrS1-positive Shigella for the first time from the Indian subcontinent in 2 strains from 2010, indicating a relatively new appearance of this PMQR determinant among Shigella in India. This calls for a continuous and strong surveillance of antibiotic resistance across the country. The prevention of shigellosis by developing cost-effective vaccines is desirable as it will substantially reduce the morbidity associated with diarrhoea in the country

Keywords: Shigella, antimicrobial, resistance, India

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Authors: Hyppolite Aignon, Souleymane Yorou, Martin Ryberg, Anneli Svanholm

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Climate change and human actions cause the extinction of wild mushrooms. In Benin, the diversity of fungi is large and may still contain species new to science but the inventory effort remains low and focuses on particularly edible species (Russula, Lactarius, Lactifluus, and also Amanita). In addition, inventories have started recently and some groups of fungi are not sufficiently sampled, however, the degradation of fungal habitat continues to increase and some species are already disappearing. (Yorou and De Kesel, 2011), however, the degradation of fungi habitat continues to increase and some species may disappear without being known. This genus (Inocybe) overlooked has a worldwide distribution and includes more than 700 species with many undiscovered or poorly known species worldwide and particularly in tropical Africa. It is therefore important to orient the inventory to other genera or important families such as Inocybe (Fungi, Agaricales) in order to highlight their diversity and also to know their phylogenetic positions with a combined approach of gene regions. This study aims to evaluate the species richness and phylogenetic position of Inocybe species and affiliated taxa in West Africa. Thus, in North Benin, we visited the Forest Reserve of Ouémé Supérieur, the Okpara forest and the Alibori Supérieur Forest Reserve. In the center, we targeted the Forest Reserve of Toui-Kilibo. The surveys have been carried during the raining season in the study area meaning from June to October. A total of 24 taxa were collected, photographed and described. The DNA was extracted, the Polymerase Chain Reaction was carried out using primers (ITS1-F, ITS4-B) for Internal transcribed spacer (ITS), (LROR, LWRB, LR7, LR5) for nuclear ribosomal (LSU), (RPB2-f5F, RPB2-b6F, RPB2- b6R2, RPB2-b7R) for RNA polymerase II gene (RPB2) and sequenced. The ITS sequences of the 24 collections of Inocybaceae were edited in Staden and all the sequences were aligned and edited with Aliview v1.17. The sequences were examined by eye for sufficient similarity to be considered the same species. 13 different species were present in the collections. In addition, sequences similar to the ITS sequences of the thirteen final species were searched using BLAST. The nLSU and RPB2 markers for these species have been inserted in a complete alignment, where species from all major Inocybaceae clades as well as from all continents except Antarctica are present. Our new sequences for nLSU and RPB2 have been manually aligned in this dataset. Phylogenetic analysis was performed using the RAxML v7.2.6 maximum likelihood software. Bootstrap replications have been set to 100 and no partitioning of the dataset has been performed. The resulting tree was viewed and edited with FigTree v1.4.3. The preliminary tree resulting from the analysis of maximum likelihood shows us that these species coming from Benin are much diversified and are distributed in four different clades (Inosperma, Inocybe, Mallocybe and Pseudosperma) on the seven clades of Inocybaceae but the phylogeny position of 7 is currently known. This study marks the diversity of Inocybe in Benin and the investigations will continue and a protection plan will be developed in the coming years.

Keywords: Benin, diversity, Inocybe, phylogeny placement

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Authors: Renata Hall

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This presentation seeks to highlight an arts-based, Black feminist, and community based participatory approach to exploring the strengths and pleasures, concerns and barriers, and wants and needs of diverse Black women in navigating formal and informal sexual and reproductive healthcare continuums. Recognizing the ongoing intersectional discrimination that Black women face interpersonally and systemically in community and healthcare spaces that service needs such as, early and unwanted pregnancy, sexually transmitted infection (STI) treatment and testing, human immune-deficiency virus (HIV) treatment and testing, pre and post-natal care, gynecology and obstetrics, sex education, sexual violence and assault reporting and support, gender affirming spaces and more, this presentation unveils the community and embodied pathways to caring for the sexual self through cultural practices, advocacy and peer support. The presentation will be grounded in the arts and lived experience of 8 Black women, aiming to highlight the sexual and reproductive subjectivities of Black women, through the application and discussion of Black feminist arts-based methodology and praxis. The presentation not only seeks to illuminate methods and grammars of Blackness but so too, invite practitioners to engage in cultural and community-based methods to care. There are many themes of the conference covered in this presentation; feminist methodologies revealing narratives community and inclusion, how the utilization of technology, social media and cultural forces can drive community feminist activism and self-advocacy, how feminist methodologies can uncover opportunities for anti-racist praxis, and lastly enhancing collaboration in research. Specifically revealing how Black feminist thought and associated methods can be enhanced through community based participatory action (CBPAR) research approaches such as, photovoice, this presentation reveals the systemic histories and modern-day experiences of Black women when accessing sexual and reproductive care whilst also uncovering embodied and community-based strengths that produce grassroots, digital, and self-advocacy within healthcare systems. The ways in which the arts, digital age, cultural influences, and lived experiences can come to the fore in collaborative data collection and analysis with research participants, will be the crux of my presentation, bridging to how both Black feminist, CBPAR, and arts-based methods can create tangible, anti-racist and racially reflexive implications for the healthcare and community sector seeking to pedestal Black women's strengths and resilience's and corroborate with their lived experiences. This conversation will center around 3 of the 9 themes derived from my dissertation research, which focuses on the strengths of Black women's community care, culturally informed self-care practices, and communication and vocal pathways to strengthen their sexual and reproductive self-concept and navigational skills in the face of intersectional discrimination in care continuums.

Keywords: sexual and reproductive healthcare, black feminisms, black feminist research, antiracist healthcare policy, antiracist healthcare delivery, arts based research, photovoice

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Authors: Tesfaldet Mekonnen Estifanos, Chen Hui, Afewerki Weldezgi

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Background: Youth in general and young females in particular, remain at the center of the HIV/AIDS epidemic. Sexual risk-taking among young unmarried women is relatively high and are the most vulnerable and highly exposed to HIV/AIDS. Improvements in the status of HIV/AIDS knowledge and acceptance attitude towards people living with HIV (PLWHIV) plays a great role in averting the incidence of HIV/AIDS. Thus, the aim of the study was to explore the level and correlates of HIV/AIDS knowledge and accepting attitude toward PLWHIV. Methods: A cross-sectional study was conducted using data from the Uganda Demographic Health Survey 2016 (UDHS-2016). National level representative household surveys using a multistage cluster probability sampling method, face to face interviews with standard questionnaires were performed. Unmarried women aged 15-24 years with a sample size of 2019 were selected from the total sample of 8674 women aged 15-49 years and were analyzed using SPSS version 23. Independent variables such as age, religion, educational level, residence, and wealth index were included. Two binary outcome variables (comprehensive HIV/AIDS knowledge and acceptance attitude toward PLWHIV) were utilized. We used the chi-square test as well as multivariate regression analysis to explore correlations of explanatory variables with the outcome variables. The results were reported by odds ratios (OR) with 95% confidence interval (95% CI), taking a p-value less than 0.05 as significant. Results: Almost all (99.3%) of the unmarried women aged 15-24 years were aware of HIV/AIDS, but only 51.2% had adequate comprehensive knowledge on HIV/AIDS. Only 69.4% knew both methods: using a condom every time had sex, and having only one faithful uninfected partner can prevent HIV/AIDS transmission. About 66.6% of the unmarried women reject at least two common local misconceptions about HIV/AIDS. Moreover, an alarmingly few (20.3%) of the respondents had a positive acceptance attitude to PLWHIV. On multivariate analysis, age (20-24 years), living in urban, being educated and wealthier, were predictors of having adequate comprehensive HIV/AIDS knowledge. On the other hand, research participants with adequate comprehensive knowledge about HIV/AIDS were highly likely (OR, 1.94 95% CI, 1.52-2.46) to have a positive acceptance attitude to PLWHIV than those with inadequate knowledge. Respondents with no education, Muslim, and Pentecostal religion were emerged less likely to have a positive acceptance attitude to PLWHIV. Conclusion: This study found out the highly accepted level of awareness, but the knowledge and positive acceptance attitude are not encouraging. Thus, expanding access to comprehensive sexuality and strengthening educational campaigns on HIV/AIDS in communities, health facilities, and schools is needed with a greater focus on disadvantaged women having low educational level, poor socioeconomic status, and those residing in rural areas. Sexual risk behaviors among the most affected people - young women have also a role in the spread of HIV/AIDS. Hence, further research assessing the significant contributing factors for sexual risk-taking might have a positive impact on the fight against HIV/AIDS.

Keywords: acceptance attitude, HIV/AIDS, knowledge, unmarried women

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Authors: Gabriela Wyszogrodzka, Przemyslaw Dorozynski, Barbara Gil, Maciej Strzempek, Bartosz Marszalek, Piotr Kulinowski, Wladyslaw Piotr Weglarz, Elzbieta Menaszek

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MOFs (Metal-Organic Frameworks) belong to a new group of porous materials with a hybrid organic-inorganic construction. Their structure is a network consisting of metal cations or clusters (acting as metallic centers, nodes) and the organic linkers between nodes. The interest in MOFs is primarily associated with the use of their well-developed surface and large porous. Possibility to build MOFs of biocompatible components let to use them as potential drug carriers. Furthermore, forming MOFs structure from cations possessing paramagnetic properties (e.g. iron cations) allows to use them as MRI (Magnetic Resonance Imaging) contrast agents. The concept of formation of particles that combine the ability to transfer active substance with imaging properties has been called theranostic (from words combination therapy and diagnostics). By building MOF structure from iron cations it is possible to use them as theranostic agents and monitoring the distribution of the active substance after administration in real time. In the study iron-MOF: Fe-MIL-101-NH2 was chosen, consisting of iron cluster in nodes of the structure and amino-terephthalic acid as a linker. The aim of the study was to investigate the possibility of applying Fe-MIL-101-NH2 as inhalable theranostic particulate system for the first-line anti-tuberculosis antibiotic – isoniazid. The drug content incorporated into Fe-MIL-101-NH2 was evaluated by dissolution study using spectrophotometric method. Results showed isoniazid encapsulation efficiency – ca. 12.5% wt. Possibility of Fe-MIL-101-NH2 application as the MRI contrast agent was demonstrated by magnetic resonance tomography. FeMIL-101-NH2 effectively shortening T1 and T2 relaxation times (increasing R1 and R2 relaxation rates) linearly with the concentrations of suspended material. Images obtained using multi-echo magnetic resonance imaging sequence revealed possibility to use FeMIL-101-NH2 as positive and negative contrasts depending on applied repetition time. MOFs micronization via ultrasound was evaluated by XRD, nitrogen adsorption, FTIR, SEM imaging and did not influence their crystal shape and size. Ultrasonication let to break the aggregates and achieve very homogeneously looking SEM images. MOFs cytotoxicity was evaluated in in vitro test with a highly sensitive resazurin based reagent PrestoBlue™ on L929 fibroblast cell line. After 24h no inhibition of cell proliferation was observed. All results proved potential possibility of application of ironMOFs as an isoniazid carrier and as MRI contrast agent in inhalatory treatment of tuberculosis. Acknowledgments: Authors gratefully acknowledge the National Science Center Poland for providing financial support, grant no 2014/15/B/ST5/04498.

Keywords: imaging agents, metal-organic frameworks, theranostics, tuberculosis

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Authors: Kenji Tanaka, Kazumi Sugita, Yuto Mizushima

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This paper introduces a noteworthy form of English communication training for the officers and operators of the Osaka-Bay Marine Traffic Information Service (Osaka MARTIS) of the Japan Coast Guard working in the congested area at the Akashi Strait in Hyogo Prefecture, Japan. The authors of this paper, Marine Technical College’s (MTC) English language instructors, have been holding about forty lectures and exercises in basic and normal Maritime English (ME) for several groups of MARTIS personnel at Osaka MARTIS annually since they started the training in 2005. Trainees are expected to be qualified Maritime Third-Class Radio Operators who are responsible for providing safety information to a daily average of seven to eight hundred vessels that pass through the Akashi Strait, one of Japan’s narrowest channels. As of 2022, the instructors are conducting 55 remote lessons at MARTIS. One lesson is 90 minutes long. All 26 trainees are given oral and written assessments. The trainees need to pass the examination to become qualified operators every year, requiring them to train and maintain their linguistic levels even during the pandemic of Corona Virus Disease-19 (COVID-19). The vessel traffic information provided by Osaka MARTIS in Maritime English language is essential to the work involving the use of very high frequency (VHF) communication between MARTIS and vessels in the area. ME is the common language mainly used on board merchant, fishing, and recreational vessels, normally at sea. ME was edited and recommended by the International Maritime Organization in the 1970s, was revised in 2002, and has undergone continual revision. The vessel’s circumstances are much more serious at the strait than those at the open sea, so these vessels need ME to receive guidance from the center when passing through the narrow strait. The imminent and challenging situations at the strait necessitate that textbooks’ contents include the basics of the phrase book for seafarers as well as specific and additional navigational information, pronunciation exercises, notes on keywords and phrases, explanations about collocations, sample sentences, and explanations about the differences between synonyms especially those focusing on terminologies necessary for passing through the strait. Additionally, short Japanese-English translation quizzes about these topics, as well as prescribed readings about the maritime sector, are include in the textbook. All of these exercises have been trained in the remote education system since the outbreak of COVID-19. According to the guidelines of ME edited in 2009, the lowest level necessary for seafarers is B1 (lower individual users) of The Common European Framework of Reference for Languages: Learning, Teaching, Assessment (CEFR). Therefore, this vocational ME language training at Osaka MARTIS aims for its trainees to communicate at levels higher than B1. A noteworthy proof of improvement from this training is that most of the trainees have become qualified marine radio communication officers.

Keywords: akashi strait, B1 of CEFR, maritime english communication training, osaka martis

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Authors: Ilaria Coppola, Davide Lacqua, Nadia Ranìa

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Over the past two decades, migration has gained central importance in the global landscape. Europe hosts the largest number of migrants, totaling 92.9 million people, approximately 37.4 million of whom are regular residents within the European Union's borders. Reception services and different modes of management have received increasing attention precisely because of the complexity of the phenomenon, which necessarily impacts the wider community. Indeed, opening a reception center in an area entails major challenges for that context, for the community that inhabits it, and for the people who use that service. Questioning the strategies needed to offer a functional reception service means listening to the different actors involved who daily face the difficulties involved in working in the field. Recognizing the importance of the professional figures who work closely with migrant people, each with their own specific experiences has led researchers to study and analyze the different types of reception centers and their management. This has led to the development of intervention models and best practices in various countries. However, research from this perspective is still limited, especially in Italy. From this theoretical framework, this study aims to bring out an innovative qualitative tool, such as the world café, the work experiences of 29 social workers working in shelters in the Italian context. Most of the participants were female and lived in the Northwest regions of Italy. Through this tool, the aim was to bring out and share reflections on the critical issues encountered in working in reception centers, with a view to identifying possible solutions for better management of services. The World café represents a tool used in participatory action research that promotes dialogue among participants through the sharing of reflections and ideas. In fact, from critical reflections, participants are invited to identify and share possible solutions to provide a more functional service with benefits to the entire community. Therefore, this research, through the innovative technique of the World café, aims to promote critical thinking processes that can help participants find solutions that can be introduced into their work contexts or proposed to decision-makers. Specifically, the findings shed light on several issues, including complex bureaucratic procedures, insufficient project planning, and inefficiencies in the services provided to migrants. These concerns collectively contribute to what participants perceive as a disorganized and uncoordinated system. In addition, the study explores potential solutions that promote more efficient networking practices, coordinated project management, and a more positive approach to cultural diversity. The main results obtained will be discussed with a focus on critical reflections and possible solutions identified.

Keywords: participatory action research, world café method, reception services, migration contexts, social workers, Italy

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Authors: Hasen Keder Edris, Ryuji Matsunaga, Toshi Yamanaka

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The issue of climate change and its impact is a major contemporary global concern. Ethiopia is one of the countries experiencing adverse climate change impact including frequent extreme weather events that are exacerbating drought and water scarcity. Due to this reason, the government of Ethiopia develops a strategic document which focuses on the climate resilience green economy. One of the major components of the strategic framework is designed to improve community adaptation capacity and mitigation of drought. For effective implementation of the strategy, identification of regions relative vulnerability to drought is vital. There is a growing tendency of applying Geographic Information System (GIS) and Remote Sensing technologies for collecting information on duration and severity of drought by direct measure of the topography as well as an indirect measure of land cover. This study aims to show an application of remote sensing technology and GIS for developing drought vulnerability index by taking lowland of Ethiopia as a case study. In addition, it assesses integrated Information Communication Technology (ICT) potential of Ethiopia lowland and proposes integrated solution. Satellite data is used to detect the beginning of the drought. The severity of drought risk prone areas of livestock keeping pastoral is analyzed through normalized difference vegetation index (NDVI) and ten years rainfall data. The change from the existing and average SPOT NDVI and vegetation condition index is used to identify the onset of drought and potential risks. Secondary data is used to analyze geographical coverage of mobile and internet usage in the region. For decades, the government of Ethiopia introduced some technologies and approach to overcoming climate change related problems. However, lack of access to information and inadequate technical support for the pastoral area remains a major challenge. In conventional business as usual approach, the lowland pastorals continue facing a number of challenges. The result indicated that 80% of the region face frequent drought occurrence and out of this 60% of pastoral area faces high drought risk. On the other hand, the target area mobile phone and internet coverage is rapidly growing. One of identified ICT solution enabler technology is telecom center which covers 98% of the region. It was possible to identify the frequently affected area and potential drought risk using the NDVI remote-sensing data analyses. We also found that ICT can play an important role in mitigating climate change challenge. Hence, there is a need to strengthen implementation efforts of climate change adaptation through integrated Remote Sensing and web based information dissemination and mobile alert of extreme events.

Keywords: climate changes, ICT, pastoral, remote sensing

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Authors: Tatiana G. Smirnova, Stan G. Benjamin

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Rapid Update Cycle (RUC) land surface model (LSM) was a land-surface component in several generations of operational weather prediction models at the National Center for Environment Prediction (NCEP) at the National Oceanic and Atmospheric Administration (NOAA). It was designed for short-range weather predictions with an emphasis on severe weather and originally was intentionally simple to avoid uncertainties from poorly known parameters. Nevertheless, the RUC LSM, when coupled with the hourly-assimilating atmospheric model, can produce a realistic evolution of time-varying soil moisture and temperature, as well as the evolution of snow cover on the ground surface. This result is possible only if the soil/vegetation/snow component of the coupled weather prediction model has sufficient skill to avoid long-term drift. RUC LSM was first implemented in the operational NCEP Rapid Update Cycle (RUC) weather model in 1998 and later in the Weather Research Forecasting Model (WRF)-based Rapid Refresh (RAP) and High-resolution Rapid Refresh (HRRR). Being available to the international WRF community, it was implemented in operational weather models in Austria, New Zealand, and Switzerland. Based on the feedback from the US weather service offices and the international WRF community and also based on our own validation, RUC LSM has matured over the years. Also, a sea-ice module was added to RUC LSM for surface predictions over the Arctic sea-ice. Other modifications include refinements to the snow model and a more accurate specification of albedo, roughness length, and other surface properties. At present, RUC LSM is being tested in the regional application of the Unified Forecast System (UFS). The next generation UFS-based regional Rapid Refresh FV3 Standalone (RRFS) model will replace operational RAP and HRRR at NCEP. Over time, RUC LSM participated in several international model intercomparison projects to verify its skill using observed atmospheric forcing. The ESM-SnowMIP was the last of these experiments focused on the verification of snow models for open and forested regions. The simulations were performed for ten sites located in different climatic zones of the world forced with observed atmospheric conditions. While most of the 26 participating models have more sophisticated snow parameterizations than in RUC, RUC LSM got a high ranking in simulations of both snow water equivalent and surface temperature. However, ESM-SnowMIP experiment also revealed some issues in the RUC snow model, which will be addressed in this paper. One of them is the treatment of grid cells partially covered with snow. RUC snow module computes energy and moisture budgets of snow-covered and snow-free areas separately by aggregating the solutions at the end of each time step. Such treatment elevates the importance of computing in the model snow cover fraction. Improvements to the original simplistic threshold-based approach have been implemented and tested both offline and in the coupled weather model. The detailed description of changes to the snow cover fraction and other modifications to RUC soil and snow parameterizations will be described in this paper.

Keywords: land-surface models, weather prediction, hydrology, boundary-layer processes

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Authors: Angelo Corallo, Maria Elena Latino, Marta Menegoli

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The link between man and food plays, in the social and economic system, a central role where cultural and multidisciplinary aspects intertwine: food is not only nutrition, but also communication, culture, politics, environment, science, ethics, fashion. This multi-dimensionality has many implications in the food economy. In recent years, the consumer became more conscious about his food choices, involving a consistent change in consumption models. This change concerns several aspects: awareness of food system issues, employment of socially and environmentally conscious decision-making, food choices based on different characteristics than nutritional ones i.e. origin of food, how it’s produced, and who’s producing it. In this frame the ‘consumption choices’ and the ‘interests of the citizen’ become one part of the others. The figure of the ‘Citizen Consumer’ is born, a responsible and ethically motivated individual to change his lifestyle, achieving the goal of sustainable consumption. Simultaneously the branding, that before was guarantee of the product quality, today is questioned. In order to meet these needs, Agri-Food companies are developing specific product lines that follow two main philosophies: ‘Back to basics’ and ‘Less is more’. However, the issue of ethical behavior does not seem to find an adequate on market offer. Most likely due to a lack of attention on the communication strategy used, very often based on market logic and rarely on ethical one. The label in its classic concept of ‘clean labeling’ can no longer be the only instrument through which to convey product information and its evolution towards a concept of ‘clear label’ is necessary to embrace ethical and transparent concepts in progress the process of democratization of the Food System. The implementation of a voluntary traceability path, relying on the technological models of the Internet of Things or Industry 4.0, would enable the Agri-Food Supply Chain to collect data that, if properly treated, could satisfy the information need of consumers. A change of approach is therefore proposed towards Agri-Food traceability that is no longer intended as a tool to be used to respond to the legislator, but rather as a promotional tool useful to tell the company in a transparent manner and then reach the slice of the market of food citizens. The use of mobile technology can also facilitate this information transfer. However, in order to guarantee maximum efficiency, an appropriate communication model based on the ethical communication principles should be used, which aims to overcome the pipeline communication model, to offer the listener a new way of telling the food product, based on real data collected through processes traceability. The Citizen Consumer is therefore placed at the center of the new model of communication in which he has the opportunity to choose what to know and how. The new label creates a virtual access point capable of telling the product according to different point of views, following the personal interests and offering the possibility to give several content modalities to support different situations and usability.

Keywords: agri food traceability, agri-food transparency, clear label, food system, internet of things

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Authors: Andrés Quiroz, Emilio Hormazabal, Ana Mutis, Fernando Ortega, Manuel Chacón-Fuentes, Leonardo Parra

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Red clover (Trifolium pratense L.) is an important forage species in temperate regions of the world. The main limitation of this species worldwide is a lack of persistence related to the high mortality of plants due to a complex of biotic and abiotic factors, determining a life span of two or three seasons. Because of the importance of red clover in Chile, a red clover breeding program was started at INIA Carillanca Research Center in 1989, with the main objective of improving the survival of plants, forage yield, and persistence. The main selection criteria for selecting new varieties have been based on agronomical parameters and biotic factors. The main biotic factor associated with red clover mortality in Chile is Hylastinus obscurus (Coleoptera: Curculionidae). Both larval and adults feed on the roots, causing weakening and subsequent death of clover plants. Pesticides have not been successful for controlling infestations of this root borer. Therefore, alternative strategies for controlling this pest are a high priority for red clover producers. Currently, the role of semiochemical in the interaction between H. obscurus and red clover plants has been widely studied for our group. Specifically, from the red clover foliage has been identified limonene is eliciting repellency from the root borer. Limonene is generated in the plant from two independent biosynthetic pathways, the mevalonic acid, and deoxyxylulose pathway. Mevalonate pathway enzymes are localized in the cytosol, whereas the deoxyxylulose phosphate pathway enzymes are found in plastids. In summary, limonene can be determinated by enzymatic bioassay using GPP as substrate and by limonene synthase expression. Therefore, the main objective of this work was to study genetic variation of limonene in material provided by INIA´s Red Clover breeding program. Protein extraction was carried out homogenizing 250 mg of leave tissue and suspended in 6 mL of extraction buffer (PEG 1500, PVP-30, 20 mM MgCl2 and antioxidants) and stirred on ice for 20 min. After centrifugation, aliquots of 2.5 mL were desalted on PD-10 columns, resulting in a final volume of 3.5 mL. Protein determination was performed according to Bradford with BSA as a standard. Monoterpene synthase assays were performed with 50 µL of protein extracts transferred into gas-tight 2 mL crimp seal vials after addition of 4 µL MgCl₂ and 41 µL assay buffer. The assay was started by adding 5 µL of a GPP solution. The mixture was incubated for 30 min at 40 °C. Biosynthesized limonene was quantified in a GC equipped with a chiral column and using synthetic R and S-limonene standards. The enzymatic the production of R and S-limonene from different Superqueli-Carillanca genotypes is shown in this work. Preliminary results showed significant differences in limonene content among the genotypes analyzed. These results constitute an important base for selecting genotypes with a high content of this repellent monoterpene towards H. obscurus.

Keywords: head space, limonene enzymatic determination, red clover, Hylastinus obscurus

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Authors: Gelareh Ghaderi

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the overall objective of this study is to develop two alternative plans of spatial and infrastructural development for the Netwerkstad Twente (Twente region) until 2040 and to assess the impacts of those two alternative plans. This region is located on the eastern border of the Netherlands, and it comprises of five municipalities. Based on the strengths and opportunities of the five municipalities of the Netwerkstad Twente, and in order develop the region internationally, strengthen the job market and retain skilled and knowledgeable young population, two alternative visions have been developed; environmental oriented vision, and economical oriented vision. Environmental oriented vision is based mostly on preserving beautiful landscapes. Twente would be recognized as an educational center, driven by green technologies and environment-friendly economy. Market-oriented vision is based on attracting and developing different economic activities in the region based on visions of the five cities of Netwerkstad Twente, in order to improve the competitiveness of the region in national and international scale. On the basis of the two developed visions and strategies for achieving the visions, land use and infrastructural development are modeled and assessed. Based on the SWOT analysis, criteria were formulated and employed in modeling the two contrasting land use visions by the year 2040. Land use modeling consists of determination of future land use demand, assessment of suitability land (Suitability analysis), and allocation of land uses on suitable land. Suitability analysis aims to determine the available supply of land for future development as well as assessing their suitability for specific type of land uses on the basis of the formulated set of criteria. Suitability analysis was operated using CommunityViz, a Planning Support System application for spatially explicit land suitability and allocation. Netwerkstad Twente has highly developed transportation infrastructure, consists of highways network, national road network, regional road network, street network, local road network, railway network and bike-path network. Based on the assumptions of speed limitations on different types of roads provided, infrastructure accessibility level of predicted land use parcels by four different transport modes is investigated. For evaluation of the two development scenarios, the Multi-criteria Evaluation (MCE) method is used. The first step was to determine criteria used for evaluation of each vision. All factors were categorized as economical, ecological and social. Results of Multi-criteria Evaluation show that Environmental oriented cities scenario has higher overall score. Environment-oriented scenario has impressive scores in relation to economical and ecological factors. This is due to the fact that a large percentage of housing tends towards compact housing. Twente region has immense potential, and the success of this project will define the Eastern part of The Netherlands and create a real competitive local economy with innovations and attractive environment as its backbone.

Keywords: economical oriented vision, environmental oriented vision, infrastructure, land use, multi criteria assesment, vision

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Authors: Jaci Marie Mastrandrea, Rosario Haro

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Background: The National Comprehensive Cancer Network (NCCN) recommends that healthcare institutions have established processes for integrating palliative care (PC) into cancer treatment and that all cancer patients be screened for PC needs upon initial diagnosis as well as throughout the entire continuum of care (National Comprehensive Cancer Network, 2021). Early PC screening and intervention is directly associated with improved patient outcomes. The Sky Lakes Cancer Treatment Center (SLCTC) is an institution that has access to PC services yet does not have protocols in place for identifying patients with palliative needs or a standardized referral process. The aim of this quality improvement project was to improve early access to PC services by establishing a standardized screening and referral process for outpatient oncology patients. Method: The sample population included all adult patients with an oncology diagnosis who presented to the SLCTC for treatment during the project timeline. The “Palliative and Supportive Needs Assessment'' (PSNA) screening tool was developed from validated, evidence-based PC referral criteria. The tool was initially implemented using paper forms, and data was collected over a period of eight weeks. Patients were screened by nurses on the SLCTC oncology treatment team. Nurses responsible for screening patients received an educational inservice prior to implementation. Patients with a PSNA score of three or higher received an educational handout on the topic of PC and education about PC and symptom management. A score of five or higher indicates that PC referral is strongly recommended, and the patient’s EHR is flagged for the oncology provider to review orders for PC referral. The PSNA tool was approved by Sky Lakes administration for full integration into Epic-Beacon. The project lead collaborated with the Sky Lakes’ information systems team and representatives from Epic on the tool’s aesthetic and functionality within the Epic system. SLCTC nurses and physicians were educated on how to document the PSNA within Epic and where to view results. Results: Prior to the implementation of the PSNA screening tool, the SLCTC had zero referrals to PC in the past year, excluding referrals to hospice. Data was collected from the completed screening assessments of 100 patients under active treatment at the SLCTC. Seventy-three percent of patients met criteria for PC referral with a score greater than or equal to three. Of those patients who met referral criteria, 53.4% (39 patients) were referred for a palliative and supportive care consultation. Patients that were not referred to PC upon meeting criteria were flagged in EPIC for re-screening within one to three months. Patients with lung cancer, chronic hematologic malignancies, breast cancer, and gastrointestinal malignancy most frequently met the criteria for PC referral and scored highest overall on the scale of 0-12. Conclusion: The implementation of a standardized PC screening tool at the SLCTC significantly increased awareness of PC needs among cancer patients in the outpatient setting. Additionally, data derived from this quality improvement project supports the national recommendation for PC to be an integral component of cancer treatment across the entire continuum of care.

Keywords: oncology, palliative and supportive care, symptom management, outpatient oncology, palliative screening tool

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Authors: Jeronimo Cox, Tomonari Furukawa

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Magnetometers have become more popular in inertial measurement units (IMU) for their ability to correct estimations using the earth's magnetic field. Accelerometer and gyroscope-based packages fail with dead-reckoning errors accumulated over time. Localization in robotic applications with magnetometer-inclusive IMUs has become popular as a way to track the odometry of slower-speed robots. With high-speed motions, the accumulated error increases over smaller periods of time, making them difficult to track with IMU. Tracking a high-speed motion is especially difficult with limited observability. Visual obstruction of motion leaves motion-tracking cameras unusable. When motions are too dynamic for estimation techniques reliant on the observability of the gravity vector, the use of magnetometers is further justified. As available magnetometer calibration methods are limited with the assumption that background magnetic fields are uniform, estimation in nonuniform magnetic fields is problematic. Hard iron distortion is a distortion of the magnetic field by other objects that produce magnetic fields. This kind of distortion is often observed as the offset from the origin of the center of data points when a magnetometer is rotated. The magnitude of hard iron distortion is dependent on proximity to distortion sources. Soft iron distortion is more related to the scaling of the axes of magnetometer sensors. Hard iron distortion is more of a contributor to the error of attitude estimation with magnetometers. Indoor environments or spaces inside ferrite-based structures, such as building reinforcements or a vehicle, often cause distortions with proximity. As positions correlate to areas of distortion, methods of magnetometer localization include the production of spatial mapping of magnetic field and collection of distortion signatures to better aid location tracking. The goal of this paper is to compare magnetometer methods that don't need pre-productions of magnetic field maps. Mapping the magnetic field in some spaces can be costly and inefficient. Dynamic measurement fusion is used to track the motion of a multi-link system with us. Conventional calibration by data collection of rotation at a static point, real-time estimation of calibration parameters each time step, and using two magnetometers for determining local hard iron distortion are compared to confirm the robustness and accuracy of each technique. With opposite-facing magnetometers, hard iron distortion can be accounted for regardless of position, Rather than assuming that hard iron distortion is constant regardless of positional change. The motion measured is a repeatable planar motion of a two-link system connected by revolute joints. The links are translated on a moving base to impulse rotation of the links. Equipping the joints with absolute encoders and recording the motion with cameras to enable ground truth comparison to each of the magnetometer methods. While the two-magnetometer method accounts for local hard iron distortion, the method fails where the magnetic field direction in space is inconsistent.

Keywords: motion tracking, sensor fusion, magnetometer, state estimation

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Authors: Aleksandra Rajewska-Rager, Maria Skibinska, Monika Dmitrzak-Weglarz, Natalia Lepczynska, Pawel Kapelski, Joanna Pawlak, Joanna Hauser

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Introduction: Inflammation and cytokines have emerged as a promising target in mood disorders research; however there are still very limited numbers of study regarding inflammatory alterations among adolescents and young adults with mood disorders. The Macrophage Migration Inhibitory Factor (MIF) and Stem Cell Factor (SCF) are the pleiotropic cytokines which may play an important role in mood disorders pathophysiology. The aim of this study was to investigate levels of these factors in serum of adolescent and young adults with mood disorders compared to healthy controls. Subjects: We involved 79 patients aged 12-24 years in 2-year follow-up study with a primary diagnosis of mood disorders: bipolar disorder (BP) and unipolar disorder with BP spectrum. Study group includes 23 males (mean age 19.08, SD 3.3) and 56 females (18.39, SD 3.28). Control group consisted 35 persons: 7 males (20.43, SD 4.23) and 28 females (21.25, SD 2.11). Clinical diagnoses according to DSM-IV-TR criteria were assessed using Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) and Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID) in young adults respectively. Clinical assessment includes evaluation of clinical factors and symptoms severity (rated using the Hamilton Depression Rating Scale and Young Mania Rating Scale). Clinical and biological evaluations were made at control visits respectively at baseline (week 0), euthymia (at month 3 or 6) and after 12 and 24 months. Methods: Serum protein concentration was determined by Enzyme-Linked Immunosorbent Assays (ELISA) method. Human MIF and SCF DuoSet ELISA kits were used. In the analyses non-parametric tests were used: Mann-Whitney U test, Kruskal-Wallis ANOVA, Friedman’s ANOVA, Wilcoxon signed rank test, Spearman correlation. We defined statistical significance as p < 0.05. Results: Comparing MIF and SCF levels between acute episode of depression/hypo/mania at baseline and euthymia (at month 3 or 6) we did not find any statistical differences. At baseline patients with age above 18 years old had decreased MIF level compared to patients younger than 18 years. MIF level at baseline positively correlated with age (p=0.004). Positive correlations of SCF level at month 3 and 6 with depression or mania occurrence at month 24 (p=0.03 and p=0.04, respectively) was detected. Strong correlations between MIF and SCF levels at baseline (p=0.0005) and month 3 (p=0.03) were observed. Discussion: Our results did not show any differences in MIF and SCF levels between acute episode of depression/hypo/mania and euthymia in young patients. Further studies on larger groups are recommended. Grant was founded by National Science Center in Poland no 2011/03/D/NZ5/06146.

Keywords: cytokines, MIF, mood disorders, SCF

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Authors: Natalia V. Naryzhnaya, Alexandr V. Mukhomedzyanov, Ivan A. Derkachev, Boris K. Kurbatov, Leonid N. Maslov

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Background: Techniques of adaptation to hypoxia and remote postconditioning (RPost) have great prospects for use in the clinic. However, recent studies have shown low efficacy of remote postconditioning in patients with AMI. We hypothesize that the reasons for this inefficiency may be metabolic disorders, which are very common, especially in patients with cardiovascular disease, and age of patients. The purpose of the study was to reveal the effectiveness of adaptation to chronic hypoxia and RPost. To determine the possible relationship between the decrease in the effectiveness of projective impacts and disorders of carbohydrate and lipid metabolism. Design: The study was carried out on Wistar rats 60 day old. MetS was induced by high-carbohydrate, high-fat diet (HСHFD). Modeling MS led to the formation of obesity, hypertension, impaired lipid and carbohydrate metabolism, hyperleptinemia, and moderate stress. Groups with adaptation to chronic hypoxia were subjected to hypoxia for 21 days at 12% O2 and 0.3% CO2 after complete of HСHFD. All animals were subjected to 45 min coronary occlusion and 120 min reperfusion. Groups with RPost, immediately after the end of ischemia, tourniquets were applied to the hind limbs in the area of the hip joint (3 times in the mode of 5 min ischemia, 5 min reperfusion). Results: RPost led to a twofold reduction of infarct size in rats with intact metabolism (р < 0.0001), while in rats with MetS, a decrease in infarct size during RPost was 25 % (p = 0.00003). A direct correlation was found between of infarct size during RPost and the serum leptin level of rats with MetC (r = 0.85). The presented data suggested that a decrease in the efficiency of remote postconditioning in rats with diet-induced metabolic syndrome depends on serum leptin. Chronic hypoxia resulted in a 38% reduced in infarct size in metabolically intact rats. The decrease of cardioprotection was observed in rats with chronic hypoxia and MetS. Infarct size showed a direct correlation with impaired glucose tolerance (AUC, glucose tolerance test, r = 0.034) and serum triglyceride levels (r = 0.39). Our study showed the dependence of cardioprotection in rats with metabolic syndrome during chronic hypoxia and DPost on opioids in the blood serum and myocardium, protein kinase C and NO synthase activity. Conclusion: The results obtained showed that the infarct-limiting efficiency of adaptation to hypoxia and remote postconditioning is reduced or completely absent in animals with metabolic syndrome. The increase in the infarction, in this case, directly depends on the disturbances in carbohydrate. lipid metabolism and opioids signaling. Funding: Investigation of effectiveness of chronic hypoxia at the metabolic syndrome was carried out within the support of Russian Science Foundation Grant 22-15-00048. Studies of the mechanisms of arterial hypertension in induced metabolic syndrome were carried out within the framework of the state assignment (122020300042-4). The work was performed using the Center for Collective Use "Medical Genomics".

Keywords: chronic hypoxia, opioids, remote postconditioning, metabolic syndrome

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Authors: Maria Cristina Tommaso, Maria Das Graças L. Silva, Carlos Jose Pacheco

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Have the advances of the Brazilian legislation reflected or have been consonant with the inclusion of PwD in higher education? In 1990 the World Declaration on Education for All, a document organized by the United Nations Educational, Scientific and Cultural Organization (UNESCO), stated that the basic learning needs of people with disabilities, as they were called, required special attention. Since then, legislation in signatory countries such as Brazil has made considerable progress in guaranteeing, in a gradual and increasing manner, the rights of persons with disabilities to education. Principles, policies, and practices of special educational needs were created and guided action at the regional, national and international levels on the structure of action in Special Education such as administration, recruitment of educators and community involvement. Brazilian Education Law No. 3.284 of 2003 ensures inclusion of people with disabilities in Brazilian higher education institutions and also in 2015 the Law 13,146/2015 - Brazilian Law on the Inclusion of Persons with Disabilities (Statute of the Person with Disabilities) regulates the inclusion of PwD by the guarantee of their rights. This study analyses data related to people with disability inclusion in High Education in the south region of Rio de Janeiro State - Brazil during the period between 2008 and 2018, based in its correlation with the changes in the Brazilian legislation in the last ten years that were subjected by PwD inclusion processes in the Brazilian High Education Systems. The region studied is composed by sixteen cities and this research refers to the largest one, Volta Redonda that represents 25 percent of the total regional population. The PwD reception process had the dicing data at the Volta Redonda University Center with 35 percent of high education students in this territorial area. The research methodology analyzed the changes occurring in the legislation about the inclusion of people with disability in High Education in the last ten years and its impacts on the samples of this study during the period between 2008 and 2018. It was verified an expressive increasing of the number of PwD students, from two in 2008 to 190 PwD students in 2018. The data conclusions are presented in quantitative terms and the aim of this study was to verify the effectiveness of the PwD inclusion in High Education, allowing visibility of this social group. This study verified that the fundamental human rights guarantees have a strong relation to the advances of legislation and the State as a guarantor instance of the rights of the people with disability and must be considered a mean of consolidation of their education opportunities isonomy. The recognition of full rights and the inclusion of people with disabilities requires the efforts of those who have decision-making power. This study aimed to demonstrate that legislative evolution is an effective instrument in the social integration of people with disabilities. The study confirms the fundamental role of the state in guaranteeing human rights and demonstrates that legislation not only protects the interests of vulnerable social groups, but can also, and this is perhaps its main mission, to change behavior patterns and provoke the social transformation necessary to the reduction of inequality of opportunity.

Keywords: high education, inclusion, legislation, people with disability

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Authors: George Zhou, Yunchan Chen, Candace Chien

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Kidney replacement therapy is the current standard of care for end-stage renal diseases. In-center or home hemodialysis remains an integral component of the therapeutic regimen. Arteriovenous fistulas (AVF) make up the vascular circuit through which blood is filtered and returned. Naturally, AVF patency determines whether adequate clearance and filtration can be achieved and directly influences clinical outcomes. Our aim was to build a deep learning model for automated AVF stenosis screening based on the sound of blood flow through the AVF. A total of 311 patients with AVF were enrolled in this study. Blood flow sounds were collected using a digital stethoscope. For each patient, blood flow sounds were collected at 6 different locations along the patient’s AVF. The 6 locations are artery, anastomosis, distal vein, middle vein, proximal vein, and venous arch. A total of 1866 sounds were collected. The blood flow sounds are labeled as “patent” (normal) or “stenotic” (abnormal). The labels are validated from concurrent ultrasound. Our dataset included 1527 “patent” and 339 “stenotic” sounds. We show that blood flow sounds vary significantly along the AVF. For example, the blood flow sound is loudest at the anastomosis site and softest at the cephalic arch. Contextualizing the sound with location metadata significantly improves classification performance. How to encode and incorporate categorical metadata is an active area of research1. Herein, we study ordinal (i.e., integer) encoding schemes. The numerical representation is concatenated to the flattened feature vector. We train a vision transformer (ViT) on spectrogram image representations of the sound and demonstrate that using scalar multiples of our integer encodings improves classification performance. Models are evaluated using a 10-fold cross-validation procedure. The baseline performance of our ViT without any location metadata achieves an AuROC and AuPRC of 0.68 ± 0.05 and 0.28 ± 0.09, respectively. Using the following encodings of Artery:0; Arch: 1; Proximal: 2; Middle: 3; Distal 4: Anastomosis: 5, the ViT achieves an AuROC and AuPRC of 0.69 ± 0.06 and 0.30 ± 0.10, respectively. Using the following encodings of Artery:0; Arch: 10; Proximal: 20; Middle: 30; Distal 40: Anastomosis: 50, the ViT achieves an AuROC and AuPRC of 0.74 ± 0.06 and 0.38 ± 0.10, respectively. Using the following encodings of Artery:0; Arch: 100; Proximal: 200; Middle: 300; Distal 400: Anastomosis: 500, the ViT achieves an AuROC and AuPRC of 0.78 ± 0.06 and 0.43 ± 0.11. respectively. Interestingly, we see that using increasing scalar multiples of our integer encoding scheme (i.e., encoding “venous arch” as 1,10,100) results in progressively improved performance. In theory, the integer values do not matter since we are optimizing the same loss function; the model can learn to increase or decrease the weights associated with location encodings and converge on the same solution. However, in the setting of limited data and computation resources, increasing the importance at initialization either leads to faster convergence or helps the model escape a local minimum.

Keywords: arteriovenous fistula, blood flow sounds, metadata encoding, deep learning

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Authors: Gabriel P. Fife, Saeyong Lee, David M. O'Sullivan

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Introduction: Although investigations into injury characteristics are represented well in the literature, few have investigated the biomechanical characteristics associated with head impacts in Taekwondo. Therefore, the purpose of this study was to identify the kinematic characteristics of head impacts due to taekwondo kicks among non-elite practitioners. Participants: Male participants (n= 11, 175 + 5.3 cm, 71 + 8.3 kg) with 7.5 + 3.6 years of taekwondo training volunteered for this study. Methods: Participants were asked to perform five repetitions of each technique (i.e., turning kick, spinning hook kick, spinning back kick, front axe kick, and clench axe kick) aimed at the Hybrid III head with their dominant kicking leg. All participants wore a protective foot pad (thickness = 12 mm) that is commonly used in competition and training. To simulate head impact in taekwondo, the target consisted of a Hybrid III 50th Percentile Crash Test Dummy (Hybrid III) head (mass = 5.1 kg) and neck (fitted with taekwondo headgear) secured to an aluminum support frame and positioned to each athlete’s standing height. The Hybrid III head form was instrumented with a 500 g tri-axial accelerometer (PCB Piezotronics) mounted to the head center of gravity to obtain resultant linear accelerations (RLA). Rotational accelerations were collected using three angular rate sensors mounted orthogonally to each other (Diversified Technical Systems ARS-12 K Angular Rate Sensor). The accelerometers were interfaced via a 3-channel, battery-powered integrated circuit piezoelectric sensor signal conditioner (PCB Piezotronics) and connected to a desktop computer for analysis. Acceleration data were captured using LABVIEW Signal Express and processed in accordance with SAE J211-1 channel frequency class 1000. Head injury criteria values (HIC) were calculated using the VSRSoftware. A one-way analysis of variance was used to determine differences between kicks, while the Tukey HSD test was employed for pairwise comparisons. The level of significance was set to an effect size of 0.20. All statistical analyses were done using R 3.1.0. Results: A statistically significant difference was observed in RLA (p = 0.00075); however, these differences were not clinically meaningful (η² = 0.04, 95% CI: -0.94 to 1.03). No differences were identified with ROTA (p = 0.734, η² = 0.0004, 95% CI: -0.98 to 0.98). A statistically significant difference (p < 0.001) between kicks in HIC was observed, with a medium effect (η2= 0.08, 95% CI: -0.98 to 1.07). However, the confidence interval of this difference indicates uncertainty. Tukey HSD test identified differences (p < 0.001) between kicking techniques in RLA and HIC. Conclusion: This study observed head impact levels that were comparable to previous studies of similar objectives and methodology. These data are important as impact measures from this study may be more representative of impact levels experienced by non-elite competitors. Although the clench axe kick elicited a lower RLA, the ROTA of this technique was higher than levels from other techniques (although not large differences in reference to effect sizes). As the axe kick has been reported to cause severe head injury, future studies may consider further study of this kick important.

Keywords: Taekwondo, head injury, biomechanics, kicking

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