Search results for: safe injection

Authors: Jelena Maletkovic

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Background: Endogenous Cushing’s syndrome is a rare disease, but iatrogenic or drug related Cushing syndrome from glucocorticoid products is commonly seen in clinical practice. With high dose and long term use of glucocorticoids, patients can develop isolated hypothalamic-pituitary-adrenal (HPA) suppression, or HPA axis suppression can be accompanied by overt iatrogenic Cushing’s syndrome. This is a rare case where severe Cushing’s syndrome developed from an unknown medication and was followed by severe and prolonged adrenal insufficiency and multiple potentially fatal complications. Case: This is a 37-year-old woman who is presented to Emergency Room (ER) with shortness of breath and chest pain. Four months prior to this presentation the patient was a generally healthy woman who was looking for improvement in her appearance and visited local Rejuvenation Clinic. After initial consultation with a nurse, she was contacted by a physician over the phone and was advised to start taking multiple injectable medications that will arrive by mail. Medications without any labels on bottles were delivered and the patient started daily intramuscular injections. Over the next two months, she noticed rounding of her face and swelling around her eyes. She gained 20 pounds, mostly abdominal fat and became extremely fatigued. Her muscles on legs were visibly decreasing in size and she felt significant muscle weakness. Unexplained bruising occurred. She started growing hair on face and developed secondary amenorrhea. New severe back pain started. She developed depression and headaches. Finally, over a few days, a number of red-purple stretch marks that were sensitive and painful appeared over her abdomen, upper part of arms and legs. She then became suspicious that these dramatic symptoms are caused by injectable medication and she discontinued injections. Over the next few days she presented to ER with low blood pressure and oxygen saturation of 75%. Studies revealed extensive pneumonia as well as multiple pulmonary emboli. Her white blood count was elevated with 32 000 and she also had acute kidney failure on admission. She was treated for sepsis and was also given stress dose steroids. Steroids were tapered over 48 hours and discontinued. After being discharged to home, on her first visit to endocrinology clinic she had undetectable ACTH of < 2pg/mL and undetectable 8am cortisol of < 0.2mcg/dL. She did not respond to an intramuscular injection of cosyntropin 250mcg and her repeated cortisol after 60 minutes was only 1mcg/dL. The patient was diagnosed with adrenal insufficiency and was started on hydrocortisone 20mg+10mg. It took close to 2 years of slow tapering for recovery of this patient’s HPA axis and resolve all the sequelae from Cushing’s syndrome. Conclusion: Misuse and abuse of glucocorticoids have been present almost since these medications were discovered. This is a rare case where not only severe Cushing’s syndrome in full clinical picture developed but also the patient suffered multiple potentially fatal complications and prolonged adrenal insufficiency. Visits to herbal, rejuvenation, esthetic, and similar clinics are becoming more and more popular and physicians need to be aware of possible non-benign nature of medications that their patients may be using.

Keywords: iatrogenic, Cushing's syndrome, adrenal crisis, steroid abuse

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Authors: Mateusz Bilski, Jakub Klas, Emilia Kowalczyk, Sylwia Koziej, Katarzyna Kulszo, Ludmiła Grzybowska- Szatkowska

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Background: Liver metastases are a common complication of primary solid tumors and sig-nificantly reduce patient survival. In the era of increasing diagnosis of oligometastatic disease and oligoprogression, methods of local treatment of metastases, i.e. MDT, are becoming more important. Implementation of such treatment can be considered for liver metastases, which are a common complication of primary solid tumors and significantly reduce patient survival. To date, the mainstay of treatment for oligometastatic disease has been surgical resection, but not all patients qualify for the procedure. As an alternative to surgical resection, radiotherapy techniques have become available, including stereotactic body radiation therapy (SBRT) or high-dose interstitial brachytherapy (iBT). iBT is an invasive method that emits very high doses of radiation from the inside of the tumor to the outside. This technique provides better tumor coverage than SBRT while having little impact on surrounding healthy tissue and elim-inates some concerns involving respiratory motion. Methods: We conducted a systematic re-view of the scientific literature on the use of brachytherapy in the treatment of liver metasta-ses from 2018 - 2023 using PubMed and ResearchGate browsers according to PRISMA rules. Results: From 111 articles, 18 publications containing information on 729 patients with liver metastases were selected. iBT has been shown to provide high rates of tumor control. Among 14 patients with 54 unresectable RCC liver metastases, after iBT LTC was 92.6% during a median follow-up of 10.2 months, PFS was 3.4 months. In analysis of 167 patients after treatment with a single fractional dose of 15-25 Gy with brachytherapy at 6- and 12-month follow-up, LRFS rates of 88,4-88.7% and 70.7 - 71,5%, PFS of 78.1 and 53.8%, and OS of 92.3 - 96.7% and 76,3% - 79.6%, respectively, were achieved. No serious complications were observed in all patients. Distant intrahepatic progression occurred later in patients with unre-sectable liver metastases after brachytherapy (PFS: 19.80 months) than in HCC patients (PFS: 13.50 months). A significant difference in LRFS between CRC patients (84.1% vs. 50.6%) and other histologies (92.4% vs. 92.4%) was noted, suggesting a higher treatment dose is necessary for CRC patients. The average target dose for metastatic colorectal cancer was 40 - 60 Gy (compared to 100 - 250 Gy for HCC). To better assess sensitivity to therapy and pre-dict side effects, it has been suggested that humoral mediators be evaluated. It was also shown that baseline levels of TNF-α, MCP-1 and VEGF, as well as NGF and CX3CL corre-lated with both tumor volume and radiation-induced liver damage, one of the most serious complications of iBT, indicating their potential role as biomarkers of therapy outcome. Con-clusions: The use of brachytherapy methods in the treatment of liver metastases of various cancers appears to be an interesting and relatively safe therapeutic method alternative to sur-gery. An important challenge remains the selection of an appropriate brachytherapy method and radiation dose for the corresponding initial tumor type from which the metastasis origi-nated.

Keywords: liver metastases, brachytherapy, CT-HDRBT, iBT

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Authors: Keenoo Bibi Sumera, Alsheikh Mona, Mubarak Jan Beebee Zeba Mahetaab

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Background: Due to the busy schedule of the practicing clinicians at the hospitals, students may not always be attended to, which is to their detriment. The clinicians at the hospitals are also not always acquainted with teaching and/or supervising students on their placements. Additionally, there is a high student-patient ratio. Since they are the prospective clinical doctors under training, they need to reach the competence levels in clinical decision-making skills to be able to serve the healthcare system of the country and to be safe doctors. Aims and Objectives: A reflective portfolio was used to provide a means for students to learn by reflecting on their experiences and obtaining continuous feedback. This practice is an attempt to compensate for the scarcity of lack of resources, that is, clinical placement supervisors and patients. It is also anticipated that it will provide learners with a continuous monitoring and learning gap analysis tool for their clinical skills. Methodology: A hardcopy reflective portfolio was designed and validated. The portfolio incorporated a mini clinical evaluation exercise (mini-CEX), direct observation of procedural skills and reflection sections. Workshops were organized for the stakeholders, that is the management, faculty and students, separately. The rationale of reflection was emphasized. Students were given samples of reflective writing. The portfolio was then implemented amongst the undergraduate medical students of years four, five and six during clinical clerkship. After 16 weeks of implementation of the portfolio, a survey questionnaire was introduced to explore how undergraduate students perceive the educational value of the reflective portfolio and its impact on their deep information processing. Results: The majority of the respondents are in MD Year 5. Out of 52 respondents, 57.7% were doing the internal medicine clinical placement rotation, and 42.3% were in Otorhinolaryngology clinical placement rotation. The respondents believe that the implementation of a reflective portfolio helped them identify their weaknesses, gain professional development in terms of helping them to identify areas where the knowledge is good, increase the learning value if it is used as a formative assessment, try to relate to different courses and in improving their professional skills. However, it is not necessary that the portfolio will improve the self-esteem of respondents or help in developing their critical thinking, The portfolio takes time to complete, and the supervisors are not useful. They had to chase supervisors for feedback. 53.8% of the respondents followed the Gibbs reflective model to write the reflection, whilst the others did not follow any guidelines to write the reflection 48.1% said that the feedback was helpful, 17.3% preferred the use of written feedback, whilst 11.5% preferred oral feedback. Most of them suggested more frequent feedback. 59.6% of respondents found the current portfolio user-friendly, and 28.8% thought it was too bulky. 27.5% have mentioned that for a mobile application. Conclusion: The reflective portfolio, through the reflection of their work and regular feedback from supervisors, has an overall positive impact on the learning process of undergraduate medical students during their clinical clerkship.

Keywords: Portfolio, Reflection, Feedback, Clinical Placement, Undergraduate Medical Education

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Authors: Eva Degraeuwe, Margo Vandenheede, Nicholas Rennie, Jolien Braem, Miryam Serry, Frederik Berrevoet, Piet Pattyn, Wouter Willaert, InciSioN Belgium Consortium

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Background: Worldwide, five billion people lack access to safe and affordable surgical care. An added 1.27 million surgeons, anesthesiologists, and obstetricians (SAO) are needed by 2030 to meet the target of 20 per 100,000 population and to reach the goal of the Lancet Commission on Global Surgery. A well-informed future generation exposed early on to the current challenges in global surgery (GS) is necessary to ensure a sustainable future. Methods: InciSioN, the International Student Surgical Network, is a non-profit organization by and for students, residents, and fellows in over 80 countries. InciSioN Belgium, one of the prominent national working groups, has made a vast progression and collaborated with other networks to fill the educational gap, stimulate advocacy efforts and increase interactions with the international network. This report describes a roadmap to achieve sustainable development and education within GS, with the example of InciSioN Belgium. Results: Since the establishment of the organization’s branch in 2019, it has hosted an educational workshop for first-year residents in surgery, engaging over 2500 participants, and established a recurring directing board of 15 members. In the year 2020-2021, InciSioN Ghent has organized three workshops combining educational and interactive sessions for future prime advocates and surgical candidates. InciSioN Belgium has set up a strong formal coalition with the Belgian Medical Students’ Association (BeMSA), with its own standing committee, reaching over 3000+ medical students annually. In 2021-2022, InciSioN Belgium broadened to a multidisciplinary approach, including dentistry and nursing students and graduates within workshops and research projects, leading to a member and exposure increase of 450%. This roadmap sets strategic goals and mechanisms for the GS community to achieve nationwide sustained improvements in the research and education of GS focused on future SAOs, in order to achieve the GS sustainable development goals. In the coming year, expansion is directed to a formal integration of GS into the medical curriculum and increased international advocacy whilst inspiring SAOs to integrate into GS in Belgium. Conclusion: The development and implementation of durable change for GS are necessary. The student organization InciSioN Belgium is growing and hopes to close the colossal gap in GS and inspire the growth of other branches while sharing the know-how of a student organization.

Keywords: advocacy, education, global surgery, InciSioN, student network

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Authors: Kirsi Snellman, Johannes Gartner, , Katja Upadaya

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A transition towards a future where the economy serves society so that it evolves within the safe operating space of the planet calls for fundamental changes in the way managers think, feel and act, and make decisions that relate to social and environmental issues. Sustainable decision-making in organizations are often challenging tasks characterized by trade-offs between environmental, social and financial aspects, thus often bringing forth ethical concerns. Although there have been significant developments in incorporating uncertainty into environmental decision-making and measuring constructs and dimensions in ethical behavior in organizations, the majority of sustainable decision-making models are rationalist-based. Moreover, research in psychology indicates that one’s readiness to make a decision depends on the individual’s state of mind, the feasibility of the implied change, and the compatibility of strategies and tactics of implementation. Although very informative, most of this extant research is limited in the sense that it often directs attention towards the rational instead of the emotional. Hence, little is known about the role of emotions in sustainable decision making, especially in situations where decision-makers evaluate a variety of options and use their feelings as a source of information in tackling the uncertainty. To fill this lacuna, and to embrace the uncertainty and perceived risk involved in decisions that touch upon social and environmental aspects, it is important to add emotion to the evaluation when aiming to reach the one right and good ethical decision outcome. This analysis builds on recent findings in moral psychology that associate feelings and intuitions with ethical decisions and suggests that emotions can sensitize the manager to evaluate the rightness or wrongness of alternatives if ethical concerns are present in sustainable decision making. Capturing such sensitive evaluation as triggered by intuitions, we suggest that rational justification can be complemented by using emotions as a tool to tune in to what feels right in making sustainable decisions. This analysis integrates ethical decision-making theories with recent advancements in emotion theories. It determines the conditions under which emotions play a role in sustainability decisions by contributing to a personal equilibrium in which intuition and rationality are both activated and in accord. It complements the rationalist ethics view according to which nothing fogs the mind in decision making so thoroughly as emotion, and the concept of cheater’s high that links unethical behavior with positive affect. This analysis contributes to theory with a novel theoretical model that specifies when and why managers, who are more emotional, are, in fact, more likely to make ethical decisions than those managers who are more rational. It also proposes practical advice on how emotions can convert the manager’s preferences into choices that benefit both common good and one’s own good throughout the transition towards a more sustainable future.

Keywords: emotion, ethical decision making, intuition, sustainability

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Authors: M. I. Ribah, M. Jibir, Y. A. Bashar, S. S. Manga

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Food safety is a significant and growing public health problem in the world and Nigeria as a developing country, since food-borne diseases are important contributors to the huge burden of sickness and death of humans. In Nigeria, traditional ready-to-eat meat products (RTE-MPs) like balangu, tsire, guru and dried meat products like kilishi, dambun nama, banda, were reported to be highly appreciated because of their eating qualities. The consumption of these products was considered as safe due to the treatments that are usually involved during their production process. However, during processing and handling, the products could be contaminated by pathogens that could cause food poisoning. Therefore, a hazard identification for pathogenic bacteria on some traditional RTE-MPs was conducted in Kebbi and Sokoto States, Nigeria. A total of 116 RTE-MPs (balangu-38, kilishi-39 and tsire-39) samples were obtained from retail outlets and analyzed using standard cultural microbiological procedures in general and selective enrichment media to isolate the target pathogens. A six-fold serial dilution was prepared and using the pour plating method, colonies were counted. Serial dilutions were selected based on the prepared pre-labeled Petri dishes for each sample. A volume of 10-12 ml of molten Nutrient agar cooled to 42-45°C was poured into each Petri dish and 1 ml each from dilutions of 102, 104 and 106 for every sample was respectively poured on a pre-labeled Petri plate after which colonies were counted. The isolated pathogens were identified and confirmed after series of biochemical tests. Frequencies and percentages were used to describe the presence of pathogens. The General Linear Model was used to analyze data on pathogen presence according to RTE-MPs and means were separated using the Tukey test at 0.05 confidence level. Of the 116 RTE-MPs samples collected, 35 (30.17%) samples were found to be contaminated with some tested pathogens. Prevalence results showed that Escherichia coli, salmonella and Staphylococcus aureus were present in the samples. Mean total bacterial count was 23.82×106 cfu/g. The frequency of individual pathogens isolated was; Staphylococcus aureus 18 (15.51%), Escherichia coli 12 (10.34%) and Salmonella 5 (4.31%). Also, among the RTE-MPs tested, the total bacterial counts were found to differ significantly (P < 0.05), with 1.81, 2.41 and 2.9×104 cfu/g for tsire, kilishi, and balangu, respectively. The study concluded that the presence of pathogenic bacteria in balangu could pose grave health risks to consumers, and hence, recommended good manufacturing practices in the production of balangu to improve the products’ safety.

Keywords: ready-to-eat meat products, retail outlets, public health, safety assessment

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Authors: Rajkumar Ghosh, Shyama Pada Gorai

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Access to safe drinking water is a fundamental human right; however, regions like Purulia, Bankura, Birbhum, Malda, Dinajpur in West Bengal, India, face formidable challenges due to heightened fluoride levels. This paper delves into the hurdles of fresh drinking water production, presenting comprehensive solutions derived from literature reviews, field surveys, and scientific analyses. Encompassing fluoride-affected areas in Purulia, Bankura, Birbhum, Malda, North-South Dinajpur, and South 24 Parganas, the study emphasizes an integrated and sustainable approach. Employing a multidisciplinary methodology, combining scientific analysis and community engagement, the study identifies key factors influencing water quality and proposes sustainable strategies. Elevated fluoride concentrations exceeding international health standards (Purulia: 0.126 – 8.16 mg/L, Bankura: 0.1 – 12.2 mg/L, Malda: 0.1 – 4.54 mg/L, Birbhum: 0.023 – 18 mg/L) necessitate urgent intervention. Infrastructure deficiencies impede water treatment and distribution, while limited awareness obstructs community participation. The proposed solutions embrace advanced water treatment technologies, infrastructure development, community education, and sustainable water management practices. This comprehensive effort aims to provide clean drinking water, safeguarding the health of affected populations. Building on these foundations, the study explores the potential of rooftop rainwater harvesting as an effective and sustainable strategy to mitigate challenges in fresh drinking water production. By addressing fluoride contamination concerns and promoting community involvement, this approach presents a holistic solution to water quality issues in affected regions. The findings underscore the importance of integrating sustainable practices with community engagement to achieve long-term water security in Purulia, Bankura, Birbhum, Malda, North-South Dinajpur, and South 24 Parganas. This study serves as a cornerstone for further research and policy development, addressing fluoride contamination's impact on public health in affected areas. Recommendations include the establishment of long-term monitoring programs to assess the effectiveness of implemented solutions and conducting health impact studies to understand the long-term effects of fluoride contamination on the local population.

Keywords: fluoride mitigation, rainwater harvesting, water quality, sustainable water management, community engagement

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Authors: Jyoti Singh, Ranju Bansal

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Fighting pain and inflammation is a common problem faced by physicians while dealing with a wide variety of diseases. Since ancient time nonsteroidal anti-inflammatory agents (NSAIDs) and opioids have been the cornerstone of treatment therapy, however, the usefulness of both these classes is limited due to severe side effects. NSAIDs, which are mainly used to treat mild to moderate inflammatory pain, induce gastric irritation and nephrotoxicity whereas opioids show an array of adverse reactions such as respiratory depression, sedation, and constipation. Moreover, repeated administration of these drugs induces tolerance to the analgesic effects and physical dependence. Further discovery of selective COX-2 inhibitors (coxibs) suggested safety without any ulcerogenic side effects; however, long-term use of these drugs resulted in kidney and hepatic toxicity along with an increased risk of secondary cardiovascular effects. The basic approaches towards inflammation and pain treatment are constantly changing, and researchers are continuously trying to develop safer and effective anti-inflammatory drug candidates for the treatment of different inflammatory conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriasis and multiple sclerosis. Synthetic 3(2H)-pyridazinones constitute an important scaffold for drug discovery. Structure-activity relationship studies on pyridazinones have shown that attachment of a lactam at N-2 of the pyridazinone ring through a methylene spacer results in significantly increased anti-inflammatory and analgesic properties of the derivatives. Further introduction of the heterocyclic ring at lactam nitrogen results in improvement of biological activities. Keeping in mind these SAR studies, a new series of compounds were synthesized as shown in scheme 1 and investigated for anti-inflammatory, analgesic, anti-platelet activities and docking studies. The structures of newly synthesized compounds have been established by various spectroscopic techniques. All the synthesized pyridazinone derivatives exhibited potent anti-inflammatory and analgesic activity. Homoveratryl substituted derivative was found to possess highest anti-inflammatory and analgesic activity displaying 73.60 % inhibition of edema at 40 mg/kg with no ulcerogenic activity when compared to standard drugs indomethacin. Moreover, 2-substituted-4-benzo[d][1,3]dioxole-6-phenylpyridazin-3(2H)-ones derivatives did not produce significant changes in bleeding time and emerged as safe agents. Molecular docking studies also illustrated good binding interactions at the active site of the cyclooxygenase-2 (hCox-2) enzyme.

Keywords: anti-inflammatory, analgesic, pyridazin-3(2H)-one, selective COX-2 inhibitors

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Authors: Natalie A. Sterk, Bernard van Vuuren, Petrie Marais, Bongani Mthombeni

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Injuries to the internal structures of the thorax and abdomen remain a leading cause of death among soldiers. Body armour is a standard issue piece of military equipment designed to protect the vital organs against ballistic and stab threats. When configured for maximum protection, the excessive weight and size of the armour may limit soldier mobility and increase physical fatigue and discomfort. Providing soldiers with more armour than necessary may, therefore, hinder their ability to react rapidly in life-threatening situations. The capability to determine the optimal trade-off between the amount of essential anatomical coverage and hindrance on soldier performance may significantly enhance the design of armour systems. The current study aimed to develop and pilot a methodology for relating internal anatomical structures with actual armour plate coverage in real-time using low-dose diagnostic X-ray scanning. Several pilot scanning sessions were held at Lodox Systems (Pty) Ltd head-office in South Africa. Testing involved using the Lodox eXero-dr to scan dummy trunk rigs at various degrees and heights of measurement; as well as human participants, wearing correctly fitted body armour while positioned in supine, prone shooting, seated and kneeling shooting postures. The verification of sizing and metrics obtained from the Lodox eXero-dr were then confirmed through a verification board with known dimensions. Results indicated that the low-dose diagnostic X-ray has the capability to clearly identify the vital internal structures of the aortic arch, heart, and lungs in relation to the position of the external armour plates. Further testing is still required in order to fully and accurately identify the inferior liver boundary, inferior vena cava, and spleen. The scans produced in the supine, prone, and seated postures provided superior image quality over the kneeling posture. The X-ray-source and-detector distance from the object must be standardised to control for possible magnification changes and for comparison purposes. To account for this, specific scanning heights and angles were identified to allow for parallel scanning of relevant areas. The low-dose diagnostic X-ray provides a non-invasive, safe, and rapid technique for relating vital internal structures with external structures. This capability can be used for the re-evaluation of anatomical coverage required for essential protection while optimising armour design and fit for soldier performance.

Keywords: body armour, low-dose diagnostic X-ray, scanning, vital organ coverage

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Authors: Judson P. LaGrone

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Simulation-based education in curricula was once a luxurious component of nursing programs but now serves as a vital element of an individual’s learning experience. A debriefing occurs after the simulation scenario or clinical experience is completed to allow the instructor(s) or trained professional(s) to act as a debriefer to guide a reflection with a purpose of acknowledging, assessing, and synthesizing the thought process, decision-making process, and actions/behaviors performed during the scenario or clinical experience. Debriefing is a vital component of the simulation process and educational experience to allow the learner(s) to progressively build upon past experiences and current scenarios within a safe and welcoming environment with a guided dialog to enhance future practice. The aim of this integrative review was to assess current practices of debriefing models in simulation-based education for health care professionals and students. The following databases were utilized for the search: CINAHL Plus, Cochrane Database of Systemic Reviews, EBSCO (ERIC), PsycINFO (Ovid), and Google Scholar. The advanced search option was useful to narrow down the search of articles (full text, Boolean operators, English language, peer-reviewed, published in the past five years). Key terms included debrief, debriefing, debriefing model, debriefing intervention, psychological debriefing, simulation, simulation-based education, simulation pedagogy, health care professional, nursing student, and learning process. Included studies focus on debriefing after clinical scenarios of nursing students, medical students, and interprofessional teams conducted between 2015 and 2020. Common themes were identified after the analysis of articles matching the search criteria. Several debriefing models are addressed in the literature with similarities of effectiveness for participants in clinical simulation-based pedagogy. Themes identified included (a) importance of debriefing in simulation-based pedagogy, (b) environment for which debriefing takes place is an important consideration, (c) individuals who should conduct the debrief, (d) length of debrief, and (e) methodology of the debrief. Debriefing models supported by theoretical frameworks and facilitated by trained staff are vital for a successful debriefing experience. Models differed from self-debriefing, facilitator-led debriefing, video-assisted debriefing, rapid cycle deliberate practice, and reflective debriefing. A reoccurring finding was centered around the emphasis of continued research for systematic tool development and analysis of the validity and effectiveness of current debriefing practices. There is a lack of consistency of debriefing models among nursing curriculum with an increasing rate of ill-prepared faculty to facilitate the debriefing phase of the simulation.

Keywords: debriefing model, debriefing intervention, health care professional, simulation-based education

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Authors: Gabrielle Robertson, Matthew Downs, Joseph Dagher

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Iron deposition in the brain has been linked with a host of neurological disorders such as Alzheimer’s, Parkinson’s, and Multiple Sclerosis. While some treatment options exist, there are no objective measurement tools that allow for the monitoring of iron levels in the brain in vivo. An emerging Magnetic Resonance Imaging (MRI) method has been recently proposed to deduce iron concentration through quantitative measurement of magnetic susceptibility. This is a multi-step process that involves repeated modeling of physical processes via approximate numerical solutions. For example, the last two steps of this Quantitative Susceptibility Mapping (QSM) method involve I) mapping magnetic field into magnetic susceptibility and II) mapping magnetic susceptibility into iron concentration. Process I involves solving an ill-posed inverse problem by using regularization via injection of prior belief. The end result from Process II highly depends on the model used to describe the molecular content of each voxel (type of iron, water fraction, etc.) Due to these factors, the accuracy and repeatability of QSM have been an active area of research in the MRI and medical imaging community. This work aims to estimate iron concentration in the brain via a single step. A synthetic numerical model of the human head was created by automatically and manually segmenting the human head on a high-resolution grid (640x640x640, 0.4mm³) yielding detailed structures such as microvasculature and subcortical regions as well as bone, soft tissue, Cerebral Spinal Fluid, sinuses, arteries, and eyes. Each segmented region was then assigned tissue properties such as relaxation rates, proton density, electromagnetic tissue properties and iron concentration. These tissue property values were randomly selected from a Probability Distribution Function derived from a thorough literature review. In addition to having unique tissue property values, different synthetic head realizations also possess unique structural geometry created by morphing the boundary regions of different areas within normal physical constraints. This model of the human brain is then used to create synthetic MRI measurements. This is repeated thousands of times, for different head shapes, volume, tissue properties and noise realizations. Collectively, this constitutes a training-set that is similar to in vivo data, but larger than datasets available from clinical measurements. This 3D convolutional U-Net neural network architecture was used to train data-driven Deep Learning models to solve for iron concentrations from raw MRI measurements. The performance was then tested on both synthetic data not used in training as well as real in vivo data. Results showed that the model trained on synthetic MRI measurements is able to directly learn iron concentrations in areas of interest more effectively than other existing QSM reconstruction methods. For comparison, models trained on random geometric shapes (as proposed in the Deep QSM method) are less effective than models trained on realistic synthetic head models. Such an accurate method for the quantitative measurement of iron deposits in the brain would be of important value in clinical studies aiming to understand the role of iron in neurological disease.

Keywords: magnetic resonance imaging, MRI, iron deposition, machine learning, quantitative susceptibility mapping

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Authors: Thanthrige Thiunuwan Priyathilaka, Don Anushka Sandaruwan Elvitigala, Bong-Soo Lim, Hyung-Bok Jeong, Jehee Lee

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Toll like receptors (TLRs) are a phylogeneticaly conserved family of pattern recognition receptors, which participates in the host immune responses against various pathogens and pathogen derived mitogen. TLR21, a non-mammalian type, is almost restricted to the fish species even though those can be identified rarely in avians and amphibians. Herein, this study was carried out to identify and characterize TLR21 from rock bream (Oplegnathus fasciatus) designated as RbTLR21, at transcriptional and genomic level. In this study, the full length cDNA and genomic sequence of RbTLR21 was identified using previously constructed cDNA sequence database and BAC library, respectively. Identified RbTLR21 sequence was characterized using several bioinformatics tools. The quantitative real time PCR (qPCR) experiment was conducted to determine tissue specific expressional distribution of RbTLR21. Further, transcriptional modulation of RbTLR21 upon the stimulation with Streptococcus iniae (S. iniae), rock bream iridovirus (RBIV) and Edwardsiella tarda (E. tarda) was analyzed in spleen tissues. The complete coding sequence of RbTLR21 was 2919 bp in length which can encode a protein consisting of 973 amino acid residues with molecular mass of 112 kDa and theoretical isoelectric point of 8.6. The anticipated protein sequence resembled a typical TLR domain architecture including C-terminal ectodomain with 16 leucine rich repeats, a transmembrane domain, cytoplasmic TIR domain and signal peptide with 23 amino acid residues. Moreover, protein folding pattern prediction of RbTLR21 exhibited well-structured and folded ectodomain, transmembrane domain and cytoplasmc TIR domain. According to the pair wise sequence analysis data, RbTLR21 showed closest homology with orange-spotted grouper (Epinephelus coioides) TLR21with 76.9% amino acid identity. Furthermore, our phylogenetic analysis revealed that RbTLR21 shows a close evolutionary relationship with its ortholog from Danio rerio. Genomic structure of RbTLR21 consisted of single exon similar to its ortholog of zebra fish. Sevaral putative transcription factor binding sites were also identified in 5ʹ flanking region of RbTLR21. The RBTLR 21 was ubiquitously expressed in all the tissues we tested. Relatively, high expression levels were found in spleen, liver and blood tissues. Upon induction with rock bream iridovirus, RbTLR21 expression was upregulated at the early phase of post induction period even though RbTLR21 expression level was fluctuated at the latter phase of post induction period. Post Edwardsiella tarda injection, RbTLR transcripts were upregulated throughout the experiment. Similarly, Streptococcus iniae induction exhibited significant upregulations of RbTLR21 mRNA expression in the spleen tissues. Collectively, our findings suggest that RbTLR21 is indeed a homolog of TLR21 family members and RbTLR21 may be involved in host immune responses against bacterial and DNA viral infections.

Keywords: rock bream, toll like receptor 21 (TLR21), pattern recognition receptor, genomic characterization

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Authors: Watin Alkhelaiwi, Iseult Wilson, Marian Traynor, Katherine Rogers

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Clinical nursing education allows nursing students to gain essential knowledge from practice experience and develop nursing skills in a variety of clinical environments. Integrating theoretical knowledge and practical skills is made easier for nursing students by providing opportunities for practice in a clinical environment. Nursing competency is an essential capability required to fulfill nursing responsibilities. Effective mentoring in clinical settings helps nursing students develop the necessary competence and promotes the integration of theory and practice. Preceptors play a considerable role in clinical nursing education, including the supervision of nursing students undergoing a rigorous clinical practicum. Preceptors are also involved in the clinical assessment of nursing students’ competency. The assessment of nursing students’ competence by professional practitioners is essential to investigate whether nurses have developed an adequate level of competence to deliver safe nursing care. Competency assessment remains challenging among nursing educators and preceptors, particularly owing to the complexity of the process. Consistency in terms of assessment methods and tools and valid and reliable assessment tools for measuring competence in clinical practice are lacking. Nurse preceptors must assess students’ competencies to prepare them for future professional responsibilities. Preceptors encounter difficulties in the assessment of competency owing to the nature of the assessment process, lack of standardised assessment tools, and a demanding clinical environment. The purpose of the study is to examine nursing preceptors’ experiences of assessing nursing interns’ competency in Saudi Arabia. There are three objectives in this study; the first objective is to examine the preceptors’ view of the Saudi assessment tool in relation to preceptorship, assessment, the assessment tool, the nursing curriculum, and the grading system. The second and third objectives are to examine preceptors’ view of "competency'' in nursing and their interpretations of the concept of competency and to assess the implications of the research in relation to the Saudi 2030 vision. The study uses an exploratory sequential mixed-methods design that involves a two-phase project: a qualitative focus group study is conducted in phase 1, and a quantitative study- a descriptive cross-sectional design (online survey) is conducted in phase 2. The results will inform the preceptors’ view of the Saudi assessment tool in relation to specific areas, including preceptorship and how the preceptors are prepared to be assessors, and assessment and assessment tools through identifying the appropriateness of the instrument for clinical practice. The results will also inform the challenges and difficulties that face the preceptors. These results will be analysed thematically for the focus group interview data, and SPSS software will be used for the analysis of the online survey data.

Keywords: clinical assessment tools, clinical competence, competency assessment, mentor, nursing, nurses, preceptor

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

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

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

Procedia PDF Downloads 64

Authors: Omar Faruqe Hamim, M. Shamsul Hoque, Rich C. McIlroy, Katherine L. Plant, Neville A. Stanton

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Road safety has become an alarming issue, especially in low-middle income developing countries. The traditional approaches lack the out of the box thinking, making engineers confined to applying usual techniques in making roads safer. A socio-technical approach has recently been introduced in improving road intersections through designing with intent. This Design With Intent (DWI) approach aims to give practitioners a more nuanced approach to design and behavior, working with people, people’s understanding, and the complexities of everyday human experience. It's a collection of design patterns —and a design and research approach— for exploring the interactions between design and people’s behavior across products, services, and environments, both digital and physical. Through this approach, it can be seen that how designing with people in behavior change can be applied to social and environmental problems, as well as commercially. It has a total of 101 cards across eight different lenses, such as architectural, error-proofing, interaction, ludic, perceptual, cognitive, Machiavellian, and security lens each having its own distinct characteristics of extracting ideas from the participant of this approach. For this research purpose, a three-legged accident blackspot intersection of a national highway has been chosen to perform the DWI workshop. Participants from varying fields such as civil engineering, naval architecture and marine engineering, urban and regional planning, and sociology actively participated for a day long workshop. While going through the workshops, the participants were given a preamble of the accident scenario and a brief overview of DWI approach. Design cards of varying lenses were distributed among 10 participants and given an hour and a half for brainstorming and generating ideas to improve the safety of the selected intersection. After the brainstorming session, the participants spontaneously went through roundtable discussions regarding the ideas they have come up with. According to consensus of the forum, ideas were accepted or rejected. These generated ideas were then synthesized and agglomerated to bring about an improvement scheme for the intersection selected in our study. To summarize the improvement ideas from DWI approach, color coding of traffic lanes for separate vehicles, channelizing the existing bare intersection, providing advance warning traffic signs, cautionary signs and educational signs motivating road users to drive safe, using textured surfaces at approach with rumble strips before the approach of intersection were the most significant one. The motive of this approach is to bring about new ideas from the road users and not just depend on traditional schemes to increase the efficiency, safety of roads as well and to ensure the compliance of road users since these features are being generated from the minds of users themselves.

Keywords: design with intent, road safety, human experience, behavior

Procedia PDF Downloads 118

Authors: Luisa Windhagen, Atsumi Hirose, Alex Bottle

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Global urbanization has resulted in the expansion of slums, leaving over 10 million Tanzanians in urban poverty and at risk of poor health. Whilst rural residence has historically been associated with an increased risk of adverse pregnancy outcomes, recent studies found higher perinatal mortality rates in urban Tanzania. This study aims to understand to what extent slum neighborhoods may account for the spatial disparities seen in Tanzania. We generated a slum indicator based on UN-HABITAT criteria to identify slum clusters within the 2015-2016 Tanzania Demographic and Health Survey. Descriptive statistics, disaggregated by urban slum, urban non-slum, and rural areas, were produced. Simple and multivariable logistic regression examined the association between cluster residence type and neonatal mortality and stillbirth. For neonatal mortality, we additionally built a multilevel logistic regression model, adjusting for confounding and clustering. The neonatal mortality ratio was highest in slums (38.3 deaths per 1000 live births); the stillbirth rate was three times higher in slums (32.4 deaths per 1000 births) than in urban non-slums. Neonatal death was more likely to occur in slums than in urban non-slums (aOR=2.15, 95% CI=1.02-4.56) and rural areas (aOR=1.78, 95% CI=1.15-2.77). Odds of stillbirth were over five times higher among rural than urban non-slum residents (aOR=5.25, 95% CI=1.31-20.96). The results suggest that slums contribute to the urban disadvantage in Tanzanian neonatal health. Higher neonatal mortality in slums may be attributable to lack of education, lower socioeconomic status, poor healthcare access, and environmental factors, including indoor and outdoor air pollution and unsanitary conditions from inadequate housing. However, further research is required to ascertain specific causalities as well as significant associations between residence type and other pregnancy outcomes. The high neonatal mortality, stillbirth, and slum formation rates in Tanzania signify that considerable change is necessary to achieve international goals for health and human settlements. Disparities in access to adequate housing, safe water and sanitation, high standard antenatal, intrapartum, and neonatal care, and maternal education need to urgently be addressed. This study highlights the spatial neonatal mortality shift from rural settings to urban informal settlements in Tanzania. Importantly, other low- and middle-income countries experiencing overwhelming urbanization and slum expansion may also be at risk of a reversing trend in residential neonatal health differences.

Keywords: urban health, slum residence, neonatal mortality, stillbirth, global urbanisation

Procedia PDF Downloads 48

Authors: Narayana Bhat, Majda Khalil, Hamad Al-Mansour, Anitha Manuvel, Vimla Yeddu

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The aim of this study was to assess the antimicrobial and antioxidant potential and phytochemical composition of Peganum harmala L. For this purpose, powdered shoot, root, and seed samples were extracted in an accelerated solvent extractor (ASE) with methanol, ethanol, acetone, and dichloromethane. The residues were reconstituted in the above solvents and 10% dimethyl sulphoxide (DMSO). The antimicrobial activity of these extracts was tested against two bacterial (Escherichia coli E49 and Staphylococcus aureus CCUG 43507) and two fungi Candida albicans ATCC 24433, Candida glabrata ATCC 15545) strains using the well-diffusion method. The minimum inhibitory concentration (MIC) and growth pattern of these test strains were determined using microbroth dilution method, and the phospholipase assay was performed to detect tissue damage in the host cells. Results revealed that ethanolic, methanolic, and dichloromethane extracts of seeds exhibited significant antimicrobial activities against all tested strains, whereas the acetone extract of seeds was effective against E. coli only. Similarly, ethanolic and methanolic extracts of roots were effective against two bacterial strains only. One sixth of percent (0.6%) yield of methanol extract of seeds was found to be the MIC for Escherichia coli E49, Staphylococcus aureus CCUG 43507, and Candida glabrata ATCC 15545. Overall, seed extracts had greater antimicrobial activities compared to roots and shoot extracts. The original plant extract and MIC dilutions prevented phospholipase secretion in Staphylococcus aureus CCUG 43507 and Candida albicans ATCC 24433. The 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging assay revealed radical scavenging activities ranging from 71.80 ± 4.36% to 87.75 ± 1.70%. The main compound present in the root extract was 1-methyl-7-methoxy-beta-carboline (RT: 44.171), followed by norlapachol (3.62%), benzopyrazine (2.20%), palmitic acid (2.12%) and vasicinone (1.96%). In contrast, phenol,4-ethenyl-2-methoxy was in abundance in the methonolic extract of the shoot, whereas 1-methyl-7-methoxy-beta-carboline (79.59%), linoleic acid (9.05%), delta-tocopherol (5.02%), 9,12-octadecadienoic acid, methyl ester (2.65%), benzene, 1,1-1,2 ethanediyl bis 3,4dimethyl (1.15%), anthraquinone (0.58%), hexadecanoic acid, methyl ester (0.54%), palmitic acid (0.35%) and methyl stearate (0.18%) were present in the methanol extract of seeds. Major findings of this study, along with their relevance to developing effective, safe drugs, will be discussed in this presentation.

Keywords: medicinal plants, secondary metabolites, phytochemical screening, bioprospecting, radical scavenging

Procedia PDF Downloads 155

Authors: Robby Y. Tallar, Nikodemus L., Yuri S., Jian P. Suen

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Research in the subject of ecological water resources management is full of trivial questions addressed and it seems, today to be one branch of science that can strongly contribute to the study of complexity (physical, biological, ecological, socio-economic, environmental, and other aspects). Existing literature available on different facets of these studies, much of it is technical and targeted for specific users. This study offered the combination all aspects in evaluation methodology for aquaculture lakes with its paradigm refer to hierarchical theory and to the effects of spatial specific arrangement of an object into a space or local area. Therefore, the process in developing a conceptual framework represents the more integrated and related applicable concept from the grounded theory. A design of integrated evaluation methodology for aquaculture lakes is presented. The method is based on the identification of a series of attributes which can be used to describe status of aquaculture lakes using certain indicators from aquaculture water quality index (AWQI), aesthetic aquaculture lake index (AALI) and rapid appraisal for fisheries index (RAPFISH). The preliminary preparation could be accomplished as follows: first, the characterization of study area was undertaken at different spatial scales. Second, an inventory data as a core resource such as city master plan, water quality reports from environmental agency, and related government regulations. Third, ground-checking survey should be completed to validate the on-site condition of study area. In order to design an integrated evaluation methodology for aquaculture lakes, finally we integrated and developed rating scores system which called Integrated Aquaculture Lake Index (IALI).The development of IALI are reflecting a compromise all aspects and it responds the needs of concise information about the current status of aquaculture lakes by the comprehensive approach. IALI was elaborated as a decision aid tool for stakeholders to evaluate the impact and contribution of anthropogenic activities on the aquaculture lake’s environment. The conclusion was while there is no denying the fact that the aquaculture lakes are under great threat from the pressure of the increasing human activities, one must realize that no evaluation methodology for aquaculture lakes can succeed by keeping the pristine condition. The IALI developed in this work can be used as an effective, low-cost evaluation methodology of aquaculture lakes for developing countries. Because IALI emphasizes the simplicity and understandability as it must communicate to decision makers and the experts. Moreover, stakeholders need to be helped to perceive their lakes so that sites can be accepted and valued by local people. For this site of lake development, accessibility and planning designation of the site is of decisive importance: the local people want to know whether the lake condition is safe or whether it can be used.

Keywords: aesthetic value, AHP, aquaculture lakes, integrated lakes, RAPFISH

Procedia PDF Downloads 214

Authors: Fossarello Maurizio, Mattana Giorgio, Tatti Filippo.

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The most widely performed surgical procedure in Open-Angle Glaucoma (OAG) is trabeculectomy. Although this filtering procedure is extremely effective, surgical failure and postoperative complications are reported. Due to the its invasive nature and possible complications, trabeculectomy is usually reserved, in practice, for patients who are refractory to medical and laser therapy. Recently, a number of micro-invasive surgical techniques (MIGS: Micro-Invasive Glaucoma Surgery), have been introduced in clinical practice. They meet the criteria of micro-incisional approach, minimal tissue damage, short surgical time, reliable IOP reduction, extremely high safety profile and rapid post-operative recovery. Xen45 Gel Implant (Allergan, Dublin, Ireland) is one of the MIGS alternatives, and consists in a porcine gelatin tube designed to create an aqueous flow from the anterior chamber to the subconjunctival space, bypassing the resistance of the trabecular meshwork. In this study we report the results of this technique as a favorable option in the treatment of OAG for its benefits in term of efficacy and safety, either alone or in combination with cataract surgery. This is a retrospective, single-center study conducted in consecutive OAG patients, who underwent Xen45 Gel Stent implantation alone or in combination with phacoemulsification, from October 2018 to June 2019. The primary endpoint of the study was to evaluate the reduction of both IOP and number of antiglaucoma medications at 12 months. The secondary endpoint was to correlate filtering bleb morphology evaluated by means of anterior segment OCT with efficacy in IOP lowering and eventual further procedures requirement. Data were recorded on Microsoft Excel and study analysis was performed using Microsoft Excel and SPSS (IBM). Mean values with standard deviations were calculated for IOPs and number of antiglaucoma medications at all points. Kolmogorov-Smirnov test showed that IOP followed a normal distribution at all time, therefore the paired Student’s T test was used to compare baseline and postoperative mean IOP. Correlation between postoperative Day 1 IOP and Month 12 IOP was evaluated using Pearson coefficient. Thirty-six eyes of 36 patients were evaluated. As compared to baseline, mean IOP and the mean number of antiglaucoma medications significantly decreased from 27,33 ± 7,67 mmHg to 16,3 ± 2,89 mmHg (38,8% reduction) and from 2,64 ± 1,39 to 0,42 ± 0,8 (84% reduction), respectively, at 12 months after surgery (both p < 0,001). According to bleb morphology, eyes were divided in uniform group (n=8, 22,2%), subconjunctival separation group (n=5, 13,9%), microcystic multiform group (n=9, 25%) and multiple internal layer group (n=14, 38,9%). Comparing to baseline, there was no significative difference in IOP between the 4 groups at month 12 follow-up visit. Adverse events included bleb function decrease (n=14, 38,9%), hypotony (n=8, 22,2%) and choroidal detachment (n=2, 5,6%). All eyes presenting bleb flattening underwent needling and MMC injection. The higher percentage of patients that required secondary needling was in the uniform group (75%), with a significant difference between the groups (p=0,03). Xen45 gel stent, either alone or in combination with phacoemulsification, provided a significant lowering in both IOP and medical antiglaucoma treatment and an elevated safety profile.

Keywords: anterior segment OCT, bleb morphology, micro-invasive glaucoma surgery, open angle glaucoma, Xen45 gel implant

Procedia PDF Downloads 121

Authors: Akmez Nabeerasool, Michaelis Massaros, Nigel Brown, David Sanderson, David Parocki, Charlotte Thompson, Mike Lodge, Mikael Khan

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The provision of clean and safe drinking water is of paramount importance and is a basic human need. Water scarcity coupled with tightening of regulations and the inability of current treatment technologies to deal with emerging contaminants and Pharmaceuticals and personal care products means that alternative treatment technologies that are viable and cost effective are required in order to meet demand and regulations for clean water supplies. Logistically, the application of water treatment in rural areas presents unique challenges due to the decentralisation of abstraction points arising from low population density and the resultant lack of infrastructure as well as the need to treat water at the site of use. This makes it costly to centralise treatment facilities and hence provide potable water direct to the consumer. Furthermore, across the UK there are segments of the population that rely on a private water supply which means that the owner or user(s) of these supplies, which can serve one household to hundreds, are responsible for the maintenance. The treatment of these private water supply falls on the private owners, and it is imperative that a chemical free technological solution that can operate unattended and does not produce any waste is employed. Arvia’s patented advanced oxidation technology combines the advantages of adsorption and electrochemical regeneration within a single unit; the Organics Destruction Cell (ODC). The ODC uniquely uses a combination of adsorption and electrochemical regeneration to destroy organics. Key to this innovative process is an alternative approach to adsorption. The conventional approach is to use high capacity adsorbents (e.g. activated carbons with high porosities and surface areas) that are excellent adsorbents, but require complex and costly regeneration. Arvia’s technology uses a patent protected adsorbent, Nyex™, which is a non-porous, highly conductive, graphite based adsorbent material that enables it to act as both the adsorbent and as a 3D electrode. Adsorbed organics are oxidised and the surface of the Nyex™ is regenerated in-situ for further adsorption without interruption or replacement. Treated water flows from the bottom of the cell where it can either be re-used or safely discharged. Arvia™ Technology Ltd. has trialled the application of its tertiary water treatment technology in treating reservoir water abstracted near Glasgow, Scotland, with promising results. Several other pilot plants have also been successfully deployed at various locations in the UK showing the suitability and effectiveness of the technology in removing recalcitrant organics (including pharmaceuticals, steroids and hormones), COD and colour.

Keywords: Arvia™ process, adsorption, water treatment, electrochemical oxidation

Procedia PDF Downloads 242

Authors: E. Fabre, C. Vale, E. Pereira, C. M. Silva

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Introduction: Mercury is one of the most troublesome toxic metals responsible for the contamination of the aquatic systems due to its accumulation and bioamplification along the food chain. The 2030 agenda for sustainable development of United Nations promotes the improving of water quality by reducing water pollution and foments an enhance in wastewater treatment, encouraging their recycling and safe water reuse globally. Sorption processes are widely used in wastewater treatments due to their many advantages such as high efficiency and low operational costs. In these processes the target contaminant is removed from the solution by a solid sorbent. The more selective and low cost is the biosorbent the more attractive becomes the process. Agricultural wastes are especially attractive approaches for sorption. They are largely available, have no commercial value and require little or no processing. In this work, banana peels were tested for mercury removal from low concentrated solutions. In order to investigate the applicability of this solid, six water matrices were used increasing the complexity from natural waters to a real wastewater. Studies of kinetics and equilibrium were also performed using the most known models to evaluate the viability of the process In line with the concept of circular economy, this study adds value to this by-product as well as contributes to liquid waste management. Experimental: The solutions were prepared with Hg(II) initial concentration of 50 µg L-1 in natural waters, at 22 ± 1 ºC, pH 6, magnetically stirring at 650 rpm and biosorbent mass of 0.5 g L-1. NaCl was added to obtain the salt solutions, seawater was collected from the Portuguese coast and the real wastewater was kindly provided by ISQ - Instituto de Soldadura e qualidade (Welding and Quality Institute) and diluted until the same concentration of 50 µg L-1. Banana peels were previously freeze-drying, milled, sieved and the particles < 1 mm were used. Results: Banana peels removed more than 90% of Hg(II) from all the synthetic solutions studied. In these cases, the enhance in the complexity of the water type promoted a higher mercury removal. In salt waters, the biosorbent showed removals of 96%, 95% and 98 % for 3, 15 and 30 g L-1 of NaCl, respectively. The residual concentration of Hg(II) in solution achieved the level of drinking water regulation (1 µg L-1). For real matrices, the lower Hg(II) elimination (93 % for seawater and 81 % for the real wastewaters), can be explained by the competition between the Hg(II) ions and the other elements present in these solutions for the sorption sites. Regarding the equilibrium study, the experimental data are better described by the Freundlich isotherm (R ^ 2=0.991). The Elovich equation provided the best fit to the kinetic points. Conclusions: The results exhibited the great ability of the banana peels to remove mercury. The environmental realist conditions studied in this work, highlight their potential usage as biosorbents in water remediation processes.

Keywords: banana peels, mercury removal, sorption, water treatment

Procedia PDF Downloads 134

Authors: Kim Haekyoung, Au Yunkyoung

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As digital technology continues to advance and become more widely accessible, young children are also growing up experiencing various media from infancy. In this changing environment, educating young children on media literacy has become an increasingly important task. With the diversification of media, it has become more necessary for children to understand, utilize, and critically explore the meaning of multimodal texts, which include text, images, and sounds connected to each other. Early childhood is a period when media literacy can bloom, and educational and policy support are needed to enable young children to express their opinions, communicate, and participate fully. However, most current media literacy education for young children focuses solely on teaching how to use media, with limited practical application and utilization. Therefore, this study aims to develop an inquiry-based media literacy education program for young children using topic-specific media content and explore the program's potential and impact on children's media literacy learning. Based on a theoretical and literature review on media literacy education, analysis of existing educational programs, and a survey on the current status and teacher perception of media literacy education for young children, this study developed a media literacy education program for young children considering the components of media literacy (understanding media characteristics, self-regulation, self-expression, critical understanding, ethical norms, social communication). To verify the effectiveness of the program, it was implemented with 20 five-year-old children from C City S Kindergarten, starting from March 24 to May 26, 2022, once a week for a total of 6 sessions. To explore quantitative changes before and after program implementation, repeated-measures analysis of variance was conducted, and qualitative analysis was used to analyze observed changes in the process. significant improvement in media literacy levels, such as understanding media characteristics, self-regulation, self-expression, critical understanding, ethical norms, and social communication. The developed inquiry-based media literacy education program for young children in this study can be effectively applied to enhance children's media literacy education and help improve their media literacy levels. Observed changes in the process also confirmed that children improved their ability to learn various topics, express their thoughts, and communicate with others using media content. These findings emphasize the importance of developing and implementing media literacy education programs and can help children develop the ability to safely and effectively use media in their media environment. Based on exploring the potential and impact of the inquiry-based media literacy education program for young children, this study confirmed positive changes in children's media literacy levels as a result of the program's implementation. These findings suggest that beyond education on how to use media, it can help develop children's ability to safely and effectively use media in their media environment. Furthermore, to improve children's media literacy levels and create a safe media environment, a variety of content and methodologies are needed, and continuous development and evaluation of educational programs are anticipated.

Keywords: young children, media literacy, media literacy education program, media content

Procedia PDF Downloads 45

Authors: Anna Slupik, Anna Mosiolek, Sebastian Wojtowicz, Dariusz Bialoszewski

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Introduction: Whole-body vibration (WBV) uses high frequency mechanical stimuli generated by a vibration plate and transmitted through bone, muscle and connective tissues to the whole body. Research has shown that long-term vibration-plate training improves neuromuscular facilitation, especially in afferent neural pathways, responsible for the conduction of vibration and proprioceptive stimuli, muscle function, balance and proprioception. Some researchers suggest that the vibration stimulus briefly inhibits the conduction of afferent signals from proprioceptors and can interfere with the maintenance of body balance. The aim of this study was to evaluate the influence of a single set of exercises associated with whole-body vibration on the joint position sense and body balance. Material and methods: The study enrolled 55 people aged 19-24 years. These individuals were randomly divided into a test group (30 persons) and a control group (25 persons). Both groups performed the same set of exercises on a vibration plate. The following vibration parameters: frequency of 20Hz and amplitude of 3mm, were used in the test group. The control group performed exercises on the vibration plate while it was off. All participants were instructed to perform six dynamic exercises lasting 30 seconds each with a 60-second period of rest between them. The exercises involved large muscle groups of the trunk, pelvis and lower limbs. Measurements were carried out before and immediately after exercise. Joint position sense (JPS) was measured in the knee joint for the starting position at 45° in an open kinematic chain. JPS error was measured using a digital inclinometer. Balance was assessed in a standing position with both feet on the ground with the eyes open and closed (each test lasting 30 sec). Balance was assessed using Matscan with FootMat 7.0 SAM software. The surface of the ellipse of confidence and front-back as well as right-left swing were measured to assess balance. Statistical analysis was performed using Statistica 10.0 PL software. Results: There were no significant differences between the groups, both before and after the exercise (p> 0.05). JPS did not change in both the test (10.7° vs. 8.4°) and control groups (9.0° vs. 8.4°). No significant differences were shown in any of the test parameters during balance tests with the eyes open or closed in both the test and control groups (p> 0.05). Conclusions. 1. Deterioration in proprioception or balance was not observed immediately after the vibration stimulus. This suggests that vibration-induced blockage of proprioceptive stimuli conduction can have only a short-lasting effect that occurs only as long as a vibration stimulus is present. 2. Short-term use of vibration in treatment does not impair proprioception and seems to be safe for patients with proprioceptive impairment. 3. These results need to be supplemented with an assessment of proprioception during the application of vibration stimuli. Additionally, the impact of vibration parameters used in the exercises should be evaluated.

Keywords: balance, joint position sense, proprioception, whole body vibration

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Authors: Sachin B. Patil, Narendra M. Kanhe

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A typical cane molasses based distillery generates 15 L of waste water per liter of alcohol production. Distillery waste with COD of over 1,00,000 mg/l and BOD of over 30,000 mg/l ranks high amongst the pollutants produced by industries both in magnitude and strength. Treatment and safe disposal of this waste is a challenging task since long. The high strength of waste water renders aerobic treatment very expensive and physico-chemical processes have met with little success. Thermophilic anaerobic treatment of distillery waste may provide high degree of treatment and better recovery of biogas. It may prove more feasible in most part of tropical country like India, where temperature is suitable for thermophilic micro-organisms. Researchers have reviled that, at thermophilic conditions due to increased destruction rate of organic matter and pathogens, higher digestion rate can be achieved. Literature review reveals that the variety of anaerobic reactors including anaerobic lagoon, conventional digester, anaerobic filter, two staged fixed film reactors, sludge bed and granular bed reactors have been studied, but little attempts have been made to evaluate the usefulness of thermophilic anaerobic treatment for treating distillery waste. The present study has been carried out, to study feasibility of thermophilic anaerobic digestion to facilitate the design of full scale reactor. A pilot scale anaerobic fixed film fixed bed reactor (AFFFB) of capacity 25m3 was designed, fabricated, installed and commissioned for thermophilic (55-65°C) anaerobic digestion at a constant pH of 6.5-7.5, because these temperature and pH ranges are considered to be optimum for biogas recovery from distillery wastewater. In these conditions, working of the reactor was studied, for different hydraulic retention times (HRT) (0.25days to 12days) and variable organic loading rates (361.46 to 7.96 Kg COD/m3d). The parameters such as flow rate and temperature, various chemical parameters such as pH, chemical oxygen demands (COD), biogas quantity, and biogas composition were regularly monitored. It was observed that, with the increase in OLR, the biogas production was increased, but the specific biogas yield decreased. Similarly, with the increase in HRT, the biogas production got decrease, but the specific biogas yield was increased. This may also be due to the predominant activity of acid producers to methane producers at the higher substrate loading rates. From the present investigation, it can be concluded that for thermophilic conditions the highest COD removal percentage was obtained at an HRT of 08 days, thereafter it tends to decrease from 8 to 12 days HRT. There is a little difference between COD removal efficiency of 8 days HRT (74.03%) and 5 day HRT (78.06%), therefore it would not be feasible to increase the reactor size by 1.5 times for mere 4 percent more efficiency. Hence, 5 days HRT is considered to be optimum, at which the biogas yield was 98 m3/day and specific biogas yield was 0.385 CH4 m3/Kg CODr.

Keywords: spent wash, anaerobic digestion, biomass, biogas

Procedia PDF Downloads 247

Authors: Belinda du Plooy, Ruth Albertyn, Christel Troskie-De Bruin, Ella Belcher

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In the academy, scholarliness or intellectual craftsmanship is considered the highest level of achievement, culminating in being consistently successfully published in impactful, peer-reviewed journals and books. Scholarliness implies rigorous methods, systematic exposition, in-depth analysis and evaluation, and the highest level of critical engagement and reflexivity. However, being a scholar does not happen automatically when one becomes an academic or completes graduate studies. A graduate qualification is an indication of one’s level of research competence but does not necessarily prepare one for the type of scholarly writing for publication required after a postgraduate qualification has been conferred. Scholarly writing for publication requires a high-level skillset and a specific mindset, which must be intentionally developed. The rite of passage to become a scholar is an iterative process with liminal spaces, thresholds, transitions, and transformations. The journey from researcher to published author is often fraught with rejection, insecurity, and disappointment and requires resilience and tenacity from those who eventually triumph. It cannot be achieved without support, guidance, and mentorship. In this article, the authors use collective auto-ethnography (CAE) to describe the phases and types of liminality encountered during the liminal journey toward scholarship. The authors speak as long-time facilitators of Writing for Academic Publication (WfAP) capacity development events (training workshops and writing retreats) presented at South African universities. Their WfAP facilitation practice is structured around experiential learning principles that allow them to act as critical reading partners and reflective witnesses for the writer-participants of their WfAP events. They identify three essential facilitation features for the effective holding of a generative, liminal, and transformational writing space for novice academic writers in order to enable their safe passage through the various liminal spaces they encounter during their scholarly development journey. These features are that facilitators should be agents of disruption and liminality while also guiding writers through these liminal spaces; that there should be a sense of mutual trust and respect, shared responsibility and accountability in order for writers to produce publication-worthy scholarly work; and that this can only be accomplished with the continued application of high levels of sensitivity and discernment by WfAP facilitators. These are key features for successful WfAP scholarship training events, where focused, individual input triggers personal and professional transformational experiences, which in turn translate into high-quality scholarly outputs.

Keywords: academic writing, liminality, scholarship, scholarliness, threshold experience, writing for publication

Procedia PDF Downloads 31

Authors: Jaeyoung Lee

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Autonomous driving systems require high reliability to provide people with a safe and comfortable driving experience. However, despite the development of a number of vehicle sensors, it is difficult to always provide high perceived performance in driving environments that vary from time to season. The image segmentation method using deep learning, which has recently evolved rapidly, provides high recognition performance in various road environments stably. However, since the system controls a vehicle in real time, a highly complex deep learning network cannot be used due to time and memory constraints. Moreover, efficient networks are optimized for GPU environments, which degrade performance in embedded processor environments equipped simple hardware accelerators. In this paper, a semantic segmentation network, matrix multiplication accelerator network (MMANet), optimized for matrix multiplication accelerator (MMA) on Texas instrument digital signal processors (TI DSP) is proposed to improve the recognition performance of autonomous driving system. The proposed method is designed to maximize the number of layers that can be performed in a limited time to provide reliable driving environment information in real time. First, the number of channels in the activation map is fixed to fit the structure of MMA. By increasing the number of parallel branches, the lack of information caused by fixing the number of channels is resolved. Second, an efficient convolution is selected depending on the size of the activation. Since MMA is a fixed, it may be more efficient for normal convolution than depthwise separable convolution depending on memory access overhead. Thus, a convolution type is decided according to output stride to increase network depth. In addition, memory access time is minimized by processing operations only in L3 cache. Lastly, reliable contexts are extracted using the extended atrous spatial pyramid pooling (ASPP). The suggested method gets stable features from an extended path by increasing the kernel size and accessing consecutive data. In addition, it consists of two ASPPs to obtain high quality contexts using the restored shape without global average pooling paths since the layer uses MMA as a simple adder. To verify the proposed method, an experiment is conducted using perfsim, a timing simulator, and the Cityscapes validation sets. The proposed network can process an image with 640 x 480 resolution for 6.67 ms, so six cameras can be used to identify the surroundings of the vehicle as 20 frame per second (FPS). In addition, it achieves 73.1% mean intersection over union (mIoU) which is the highest recognition rate among embedded networks on the Cityscapes validation set.

Keywords: edge network, embedded network, MMA, matrix multiplication accelerator, semantic segmentation network

Procedia PDF Downloads 106

Authors: Despina Giannadaki, Jos Lelieveld, Andrea Pozzer, John Evans

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Outdoor air pollution by fine particles ranks among the top ten global health risk factors that can lead to premature mortality. Epidemiological cohort studies, mainly conducted in United States and Europe, have shown that the long-term exposure to PM2.5 (particles with an aerodynamic diameter less than 2.5μm) is associated with increased mortality from cardiovascular, respiratory diseases and lung cancer. Fine particulates can cause health impacts even at very low concentrations. Previously, no concentration level has been defined below which health damage can be fully prevented. The World Health Organization ambient air quality guidelines suggest an annual mean PM2.5 concentration limit of 10μg/m3. Populations in large parts of the world, especially in East and Southeast Asia, and in the Middle East, are exposed to high levels of fine particulate pollution that by far exceeds the World Health Organization guidelines. The aim of this work is to evaluate the implementation of recent air quality standards for PM2.5 in the EU, the US and other countries worldwide and estimate what measures will be needed to substantially reduce premature mortality. We investigated premature mortality attributed to fine particulate matter (PM2.5) under adults ≥ 30yrs and children < 5yrs, applying a high-resolution global atmospheric chemistry model combined with epidemiological concentration-response functions. The latter are based on the methodology of the Global Burden of Disease for 2010, assuming a ‘safe’ annual mean PM2.5 threshold of 7.3μg/m3. We estimate the global premature mortality by PM2.5 at 3.15 million/year in 2010. China is the leading country with about 1.33 million, followed by India with 575 thousand and Pakistan with 105 thousand. For the European Union (EU) we estimate 173 thousand and the United States (US) 52 thousand in 2010. Based on sensitivity calculations we tested the gains from PM2.5 control by applying the air quality guidelines (AQG) and standards of the World Health Organization (WHO), the EU, the US and other countries. To estimate potential reductions in mortality rates we take into consideration the deaths that cannot be avoided after the implementation of PM2.5 upper limits, due to the contribution of natural sources to total PM2.5 and therefore to mortality (mainly airborne desert dust). The annual mean EU limit of 25μg/m3 would reduce global premature mortality by 18%, while within the EU the effect is negligible, indicating that the standard is largely met and that stricter limits are needed. The new US standard of 12μg/m3 would reduce premature mortality by 46% worldwide, 4% in the US and 20% in the EU. Implementing the AQG by the WHO of 10μg/m3 would reduce global premature mortality by 54%, 76% in China and 59% in India. In the EU and US, the mortality would be reduced by 36% and 14%, respectively. Hence, following the WHO guideline will prevent 1.7 million premature deaths per year. Sensitivity calculations indicate that even small changes at the lower PM2.5 standards can have major impacts on global mortality rates.

Keywords: air quality guidelines, outdoor air pollution, particulate matter, premature mortality

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Authors: Hemendra Singh Rathod

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Frequency is, among other factors, one of the governing parameters for maintaining electrical grid stability. The quality of an electrical transmission and supply system is mainly described by the stability of the grid frequency. Over the past few decades, energy generation by intermittent sustainable sources like wind and solar has seen a significant increase globally. Consequently, controlling the associated deviations in grid frequency within safe limits has been gaining momentum so that the balance between demand and supply can be maintained. Lithium-ion battery energy storage system (Li-Ion BESS) has been a promising technology to tackle the challenges associated with grid instability. BESS is, therefore, an effective response to the ongoing debate whether it is feasible to have an electrical grid constantly functioning on a hundred percent renewable power in the near future. In recent years, large-scale manufacturing and capital investment into battery production processes have made the Li-ion battery systems cost-effective and increasingly efficient. The Li-ion systems require very low maintenance and are also independent of geographical constraints while being easily scalable. The paper highlights the use of stationary and moving BESS for balancing electrical energy, thereby maintaining grid frequency at a rapid rate. Moving BESS technology, as implemented in the selected railway network in Germany, is here considered as an exemplary concept for demonstrating the same functionality in the electrical grid system. Further, using certain applications of Li-ion batteries, such as self-consumption of wind and solar parks or their ancillary services, wind and solar energy storage during low demand, black start, island operation, residential home storage, etc. offers a solution to effectively integrate the renewables and support Europe’s future smart grid. EMT software tool DIgSILENT PowerFactory has been utilised to model an electrical transmission system with 100% renewable energy penetration. The stability of such a transmission system has been evaluated together with BESS within a defined frequency band. The transmission system operators (TSO) have the superordinate responsibility for system stability and must also coordinate with the other European transmission system operators. Frequency control is implemented by TSO by maintaining a balance between electricity generation and consumption. Li-ion battery systems are here seen as flexible, controllable loads and flexible, controllable generation for balancing energy pools. Thus using Li-ion battery storage solution, frequency-dependent load shedding, i.e., automatic gradual disconnection of loads from the grid, and frequency-dependent electricity generation, i.e., automatic gradual connection of BESS to the grid, is used as a perfect security measure to maintain grid stability in any case scenario. The paper emphasizes the use of stationary and moving Li-ion battery storage for meeting the demands of maintaining grid frequency and stability for near future operations.

Keywords: frequency control, grid stability, li-ion battery storage, smart grid

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Authors: H. K. Esfahani, B. Datta

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Groundwater is one of the most important natural resources in many parts of the world; however it is widely polluted due to human activities. Currently, effective and reliable groundwater management and remediation strategies are obtained using characterization of groundwater pollution sources, where the measured data in monitoring locations are utilized to estimate the unknown pollutant source location and magnitude. However, accurately identifying characteristics of contaminant sources is a challenging task due to uncertainties in terms of predicting source flux injection, hydro-geological and geo-chemical parameters, and the concentration field measurement. Reactive transport of chemical species in contaminated groundwater systems, especially with multiple species, is a complex and highly non-linear geochemical process. Although sufficient concentration measurement data is essential to accurately identify sources characteristics, available data are often sparse and limited in quantity. Therefore, this inverse problem-solving method for characterizing unknown groundwater pollution sources is often considered ill-posed, complex and non- unique. Different methods have been utilized to identify pollution sources; however, the linked simulation-optimization approach is one effective method to obtain acceptable results under uncertainties in complex real life scenarios. With this approach, the numerical flow and contaminant transport simulation models are externally linked to an optimization algorithm, with the objective of minimizing the difference between measured concentration and estimated pollutant concentration at observation locations. Concentration measurement data are very important to accurately estimate pollution source properties; therefore, optimal design of the monitoring network is essential to gather adequate measured data at desired times and locations. Due to budget and physical restrictions, an efficient and effective approach for groundwater pollutant source characterization is to design an optimal monitoring network, especially when only inadequate and arbitrary concentration measurement data are initially available. In this approach, preliminary concentration observation data are utilized for preliminary source location, magnitude and duration of source activity identification, and these results are utilized for monitoring network design. Further, feedback information from the monitoring network is used as inputs for sequential monitoring network design, to improve the identification of unknown source characteristics. To design an effective monitoring network of observation wells, optimization and interpolation techniques are used. A simulation model should be utilized to accurately describe the aquifer properties in terms of hydro-geochemical parameters and boundary conditions. However, the simulation of the transport processes becomes complex when the pollutants are chemically reactive. Three dimensional transient flow and reactive contaminant transport process is considered. The proposed methodology uses HYDROGEOCHEM 5.0 (HGCH) as the simulation model for flow and transport processes with chemically multiple reactive species. Adaptive Simulated Annealing (ASA) is used as optimization algorithm in linked simulation-optimization methodology to identify the unknown source characteristics. Therefore, the aim of the present study is to develop a methodology to optimally design an effective monitoring network for pollution source characterization with reactive species in polluted aquifers. The performance of the developed methodology will be evaluated for an illustrative polluted aquifer sites, for example an abandoned mine site in Queensland, Australia.

Keywords: monitoring network design, source characterization, chemical reactive transport process, contaminated mine site

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Authors: Katerina Antoniou

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When examining conflicts around the world, it is evident that the majority of intractable conflicts are steeped in identity. Identity seems to be not only a causal variable for conflict, but also a catalytic parameter for the process of reconciliation that follows ceasefire. This paper focuses on the process of identity securitization that occurs between rival groups of heterogeneous collective identities – ethnic, national or religious – as well as on the relationship between identity securitization and the ability of the groups involved to reconcile. Are securitized identities obstacles to the process of reconciliation, able to hinder any prospects of peace? If the level to which an identity is securitized is catalytic to a conflict’s discourse and settlement, then which factors act as indicators of identity de-securitization? The level of an in-group’s identity securitization can be estimated through a number of indicators, one of which is narrative. The stories, views and stances each in-group adopts in relation to its history of conflict and relation with their rival out-group can clarify whether that specific in-group feels victimized and threatened or safe and ready to reconcile. Accordingly, this study discusses identity securitization through narrative in relation to intractable conflicts. Are there conflicts around the world that, despite having been identified as intractable, stagnated or insoluble, show signs of identity de-securitization through narrative? This inquiry uses the case of the Cyprus conflict and its partitioned societies to present official narratives from the two communities and assess whether these narratives have transformed, indicating a less securitized in-group identity for the Greek and Turkish Cypriots. Specifically, the study compares the official historical overviews presented by each community’s Ministry of Foreign Affairs website and discusses the extent to which the two official narratives present a securitized collective identity. In addition, the study will observe whether official stances by the two communities – as adopted by community leaders – have transformed to depict less securitization over time. Additionally, the leaders’ reflection of popular opinion is evaluated through recent opinion polls from each community. Cyprus is currently experiencing renewed optimism for reunification, with the leaders of its two communities engaging in rigorous negotiations, and with rumors calling for a potential referendum for reunification to be taking place even as early as within 2016. Although leaders’ have shown a shift in their rhetoric and have moved away from narratives of victimization, this is not the case for the official narratives used by their respective ministries of foreign affairs. The study’s findings explore whether this narrative inconsistency proves that Cyprus is transitioning towards reunification, or whether the leaders are risking sending a securitized population to the polls to reject a potential reunification. More broadly, this study suggests that in the event that intractable conflicts might be moving towards viable peace, in-group narratives--official narratives in particular--can act as indicators of the extent to which rival entities have managed to reconcile.

Keywords: conflict, identity, narrative, reconciliation

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