Search results for: paediatric palliative care

Authors: Rajni Kant Panik, Deependra Singh, Manju Singh

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Despite significant advances in the treatment of severe burn injury, infection and sepsis persist as frequent causes of morbidity and mortality for burn victims due to extensive compromise of the skin and contiguous tissue that serve as a protective barrier against microbial invasion. In the setting of a burn wound infection, Staphylococcus aureus is the most commonly isolated pathogens from bloodstream infections in burn care hospitals. We aimed to develop a biocompatible system of Poly vinyl alcohol (PVA)-sodium alginate hydrogel carrying multiple drugs- catalase and mupirocin in controlled manner for effective and complete burn wound healing. PLGA nanoparticles of Catalase and mupirocin were prepared by homogenization method and optimized system was incorporated in PVA-sodium alginate slurry. PVA-sodium alginate hydrogels were prepared by freeze thaw method. The prepared dispersion was casted into films to prepare multiphase hydrogel system and characterized by in vitro and in vivo studies. The study clearly showed the beneficial effect of antioxidant enzyme and antibiotic in the treatment of infected burn wound, as evidenced by the reduced incidence of wound infection and the shortening of healing time.

Keywords: burn wound, catalase, mupirocin, wound healing

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Authors: M. D. Antoine

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When a child is diagnosed with an illness, condition, or developmental disorder, the process involved in understanding and accepting this diagnosis can be a very stressful and isolating experience for parents and families. The healthcare providers’ ability to effectively communicate in such situations represents a vital lifeline for parents. In this context, communication becomes a crucial element not only for getting through the period of grief but also for the future. We mobilized the five stages of grief model to summarize existing literature regarding the ways in which the experience ofan autism spectrum disorder diagnosis disclosurealigns with the experience of grief to explore how this can inform best practices for effective communication with parents through the diagnosis disclosure. Fifteen publications met inclusion criteria. Findings from the scoping review of empirical studies show that parents/families experience grief-like emotions during the diagnosis disclosure. However, grief is not an outcome of the encounter itself. In fact, the experience of the encounter can help mitigate the grief experience. The way parents/families receive and react to the ‘news’ depends on their preparedness, knowledge, and the support received through the experience. Individual communication skills, as well as policies and regulations, should be examined to alleviate adverse reactions in this context. These findings highlight the importance of further research into effective parent-provider communication strategies and their place in supporting quality autism care.

Keywords: autism spectrum disorder, autism spectrum disorder diagnosis, diagnosis disclosure, parent-provider communication, parental grief

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Authors: Daming Xu, Yuanyuan Wang

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Abstract: Under the trend of rapid expansion of urbanization, the motorized urban characteristics become more and more obvious, and the walkability of urban space is seriously affected. The construction of walkability of space, as the main mode of travel for the elderly in their daily lives, has become more and more important in the current social context of serious aging. Settlement is the most basic living unit of residents, and daily shopping, medical care, and other daily trips are closely related to the daily life of the elderly. Therefore, it is of great practical significance to explore the impact of built environment on elderly people's daily walking trips at the settlement level for the construction of pedestrian-friendly settlements for the elderly. The study takes three typical settlements in Harbin Daoli District in three different periods as examples and obtains data on elderly people's walking trips and built environment characteristics through field research, questionnaire distribution, and internet data acquisition. Finally, correlation analysis and multinomial logistic regression model were applied to analyze the influence mechanism of built environment on elderly people's walkability based on the control of personal attribute variables in order to provide reference and guidance for the construction of walkability for elderly people in built environment in the future.

Keywords: built environment, elderly, walkability, multinomial logistic regression model

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Authors: Joanne M. Emmens

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This paper makes use of the case notes of a single psychoanalytically informed psychotherapy of a now 72-year-old man over a four-year period to explore the potential of qualitative data to be incorporated into a research methodology that can contribute theory and knowledge to the wider professional community involved in mental health care. The clinical material arising out of any psychoanalysis provides a potentially rich source of clinical data that could contribute valuably to our historical understanding of both individual and societal traumata. As psychoanalysis is primarily an investigation, it is argued that clinical case material is a rich source of qualitative data which has relevance for sociological and historical understandings and that it can potentially aluminate important ‘gaps’ and collective blind spots that manifest unconsciously and are a contributing factor in the transmission of trauma, silently across generations. By attending to this case material the hope is to illustrate the value of using a psychoanalytic centred methodology. It is argued that the study of individual defences and the manner in which they come into consciousness, allows an insight into group defences and the unconscious forces that contribute to the silencing or un-noticing of important sources (or originators) of mental suffering.

Keywords: dream furniture (Bion) and psychotic functioning, reverie, screen memories, selected fact

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Authors: Esra Bora, Alper Omeroglu, Zeynep Pelin Polat, Oguzhan Kara, Fatih Akdogan, Sema Ucak Basat

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Hyponatremia is one of the most encountered electrolyte imbalance among all medical fields. It has a wide range of symptoms as well as complications from fatigue to loss of consciousness. Although a lot of factors can cause low sodium levels in serum, combining specific medications can lead to severe hyponatremia in a rapid onset which can cause high mortality and morbidity. The objective of this case report was to underline that prescribing specific medications disregarding their side effects can cause this common electrolyte imbalance but in a more severe manner. In this case report, we present a 46-year-old male patient with a serum sodium level of 104 mEq/L who consumed hydrochlorothiazide for hypertension and was under treatment with selective serotonin reuptake inhibitors (SSRIs) for major depression. The patient had tonic-clonic seizures at the second hour of the treatment and intubation was needed due to loss of consciousness and hypoxia. After proper replacement of sodium with hypertonic solutions in intensive care unit for nine days, extubation indicated. Even in healthy young males, hyponatremia due to two separately prescribed medications can lead life-threatening hyponatremia. Physicians should be aware of the side effects of diuretics, especially hydrochlorothiazides and SSRIs and their combinations.

Keywords: diuretics, hydrochlorothiazide, hyponatremia, SSRI

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Authors: Madeline Foster

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Since the COVID-19 pandemic, telehealth usage for the delivery of psychotherapy has surged. The evidence base evaluating the success of telehealth interventions continues to grow, with both benefits as well as potential risks identified. This study compared two recent randomized clinical trials (RCTs) from Sweden that looked at the effectiveness of Cognitive Behavioral Therapy (CBT) delivered via telehealth (TH) versus face-to-face (FTF) for individuals with Obsessive Compulsive Disorder (OCD). The papers had mixed results. The first paper by Aspvall and colleagues compared the effect of a therapist-supported, internet-delivered stepped-care CBT program for children and adolescents aged 7 to 17 with face-to-face CBT (2021). In Aspvall’s study, the control scored a mean Y-BOCS of 10.57 and the TH intervention group scored a mean Y-BOCS of 11.57. The mean difference (0.91) met the criteria for noninferiority (p = 0.03). The second study by Lundström and colleagues also compared therapist-supported, internet-based CBT with FTF CBT for the treatment of those with DSM-5-diagnosed OCD. Conversely, while Lundström’s study reported improved symptoms across all groups, at follow up the difference in symptom severity between FTF and TH was clinically significant, with 77% of FTF participants responding to treatment compared to only 45% of TH participants. Due to the methodological limitations of Lundström’s study, it was concluded that Aspvall’s paper made a stronger scientific argument.

Keywords: telehealth, Sweden, RCT, cognitive-behavioral therapy, obsessive-compulsive disorder

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Authors: A. Kamel Abd Elaziz Mohamed, B. Sameh Kamal el Maraghi

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Introduction: Adaptive support ventilation (ASV) is an improved closed-loop ventilation mode that provides both pressure-controlled ventilation and PSV according to the patient’s needs. Aim of the work: To compare the short-term effects of Adaptive support ventilation (ASV), with conventional Pressure support ventilation (PSV) in weaning of intubated COPD patients. Patients and methods: Fifty patients admitted in the intensive care with acute exacerbation of COPD and needing intubation were included in the study. All patients were initially ventilated with control/assist control mode, in a stepwise manner and were receiving standard medical therapy. Patients were randomized into two groups to receive either ASV or PSV. Results: Out of fifty patients included in the study forty one patients in both studied groups were weaned successfully according to their ABG data and weaning indices. APACHE II score showed no significant difference in both groups. There were statistically significant differences between the groups in term of, duration of mechanical ventilation, weaning hours and length of ICU stay being shorter in (group 1) weaned by ASV. Re-intubation and mortality rate were higher in (group 11) weaned by conventional PSV, however the differences were not significant. Conclusion: ASV can provide automated weaning and achieve shorter weaning time for COPD patients hence leading to reduction in the total duration of MV, length of stay, and hospital costs.

Keywords: COPD patients, ASV, PSV, mechanical ventilation (MV)

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Authors: Claire Xu, Welton Wang, Manasvi Pinnaka, Anqi Pan, Michael Han

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Hospitalizations account for one-third of the total health care spending in the US. Early risk detection and intervention can reduce this high cost and increase the satisfaction of both patients and physicians. Due to the lack of awareness of the potential arising risks in home environment, the opportunities for patients to seek early actions of clinical visits are dramatically reduced. This research aims to offer a highly personalized remote patients monitoring and risk assessment AI framework to identify the potentially preventable hospitalization for both acute as well as chronic diseases. A hybrid-AI framework is trained with data from clinical setting, patients surveys, as well as online databases. 20+ risk factors are analyzed ranging from activities, biometric info, demographic info, socio-economic info, hospitalization history, medication info, lifestyle info, etc. The AI model yields high performance of 87% accuracy and 88 sensitivity with 20+ features. This hybrid-AI framework is proven to be effective in identifying the potentially preventable hospitalization. Further, the high indicative features are identified by the models which guide us to a healthy lifestyle and early intervention suggestions.

Keywords: hospitalization prevention, machine learning, remote patient monitoring, risk prediction

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Authors: R. Malathy

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High performance concrete is not only characterized by its high strength, workability, and durability but also by its smartness in performance without human care since the first day. If the concrete can cure on its own without external curing without compromising its strength and durability, then it is said to be high performance self-curing concrete. In this paper, an attempt is made on the performance study of internally cured concrete using biomaterials, namely Spinacea pleracea and Calatropis gigantea as self-curing agents, and it is compared with the performance of concrete with existing self-cure chemical, namely polyethylene glycol. The present paper focuses on workability, strength, and durability study on M20, M30, and M40 grade concretes replacing 30% of fly ash for cement. The optimum dosage of Spinacea pleracea, Calatropis gigantea, and polyethylene glycol was taken as 0.6%, 0.24%, and 0.3% by weight of cement from the earlier research studies. From the slump tests performed, it was found that there is a minimum variation between conventional concrete and self-cured concrete. The strength activity index is determined by keeping compressive strength of conventionally cured concrete for 28 days as unity and observed that, for self-cured concrete, it is more than 1 after 28 days and more than 1.15 after 56 days because of secondary reaction of fly ash. The performance study of concretes in aggressive environment like acid attack, sea water attack, and chloride attack was made, and the results are positive and encouraging in bio-self-cured concretes which are ecofriendly, cost effective, and high performance materials.

Keywords: bio materials, Calatropis gigantea, self curing concrete, Spinacea oleracea

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Authors: Dyana Zainudin, Atta Ur-Rahman, Thaier Hamed

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This paper explains about human nature concept as to understand the significance of information security in employees’ mentality including leaders in an organisation. By studying on a theory concept of the latest Von Solms fourth waves, information security governance basically refers to the concept of a set of methods, techniques and tools that responsible for protecting resources of a computer system to ensure service availability, confidentiality and integrity of information. However, today’s information security dilemma relates to the acceptance of employees mentality. The major causes are a lack of communication and commitment. These types of management in an organisation are labelled as immoral/amoral management which effects on information security compliance. A recovery action is taken based on ‘learn a lesson from incident events’ rather than prevention. Therefore, the paper critically analysed the Von Solms fourth waves’ theory with current human events and its correlation by studying secondary data and also from qualitative analysis among employees in public sectors. ‘Three-dimensions to failure’ of information security dilemma are explained as deny, don’t know and don’t care. These three-dimensions are the most common vulnerable behaviour owned by employees. Therefore, by avoiding the three-dimensions to failure may improve the vulnerable behaviour of employees which is often related to immoral/amoral management.

Keywords: information security management system, information security behaviour, information security governance, information security culture

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Authors: Riya Kartikee, Uday Shankar

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Background –.Happiness refers to a range of the balance of positive and pleasant emotions of joy, pride, contentment, gratitude, and living with ethics. Happiness is an experience combined with a sense that one’s life is good, meaningful, and worth a while, but in the context of orphans who have lost their birthgivers, their parents who play an important role in bringing necessities and comfort to them, but many terms of the above phases are missing in the life of orphan So, stress increases because of lack of love, attention, sympathy, care, they experience many kind of trauma and also in some cases their lives get worst as they face some physiological abuse, sexual abuse, they are forced to have stress at a not only mentally but physically also in the context of Patna, Bihar where many people are below poverty line, lack of resources is a normal condition for the Orphanages.AIM- The present study was intended to study the level of Happiness among the orphans of Patna District, also it was attempted to find the role of happiness in their lives as an individual.Method- The sample of 70 Orphans in the age group of 12 to 18 years were taken from the orphanages of Patna district-Apnaghar, Rainbow homes, etc. Purposive sampling was used in the study, There has been one research tool used in the study, which is Happiness scale by Dr.R.L Bhardwaj and Dr.Poonam R Das. Results- Results have revealed that Orphans have possessed a very low level of happiness and unhappiness was related due to their living conditions in the orphanage.Conclusion-It can be stated that the Level of happiness is an important missing determinant in the lives of orphans.

Keywords: happiness, orphans, patna, orphanage

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Authors: Preethi Sudarshanie Dassanayake, R. A. Sudath Weerasiri

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Objective: The objective of this study were to find out highest expectation and perception,highest gap between perception and expectation of service quality, and to find out such gaps between perception and expectation with regard to service quality dimensions were whether statistically significant. Methodology: This study carried out at the Out Patient Department (OPD) of the Veterinary Teaching Hospital (VTH), University of Peradeniya. Modified version of SERVQUAL with 22-pairs of items regarding expectation and perception of service quality in dimensions of tangible, reliability, responsiveness, assurance and empathy were included in Part 1 and the Part 2 of the questionnaire consisted of questions regarding socio-demographic factors. Sample size was 200 and sampling procedure was Systematic Random Sampling. Customers above 18 years of age, able to read, write and understand Sinhala or English language, visits more than twice in last six months and who willing to respond were selected. Findings: The analysis revealed customers expectations of service higher than the perceived for all 22- items of the SERVQUAL. This high expectation suggests that there is sufficient room for further improvement of service quality in all five dimensions. Originality/Value of the Paper: This study gave a new insight for poorly researched area of veterinary health service quality in Sri Lankan context. It provides hospital administrators and policy makers to develop strategies for further improvement of service quality according to customers' view.

Keywords: expectation, perception, service quality, SERVQUAL, veterinary health care

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Authors: M. Ridwanul Hassan, Samuel George

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Aims: Steroid injections are commonly used as a diagnostic tool or an alternative to surgical management of carpal tunnel syndrome (CTS) and are generally safe. Ischaemia is a rare complication with very few cases reported in the literature. Methods: We report a case of a 50-year-old female that presented with a necrotic wound to her left palm one month after a steroid injection into the carpal tunnel. She had a 2-year history of CTS in her left hand that was treated with six previous steroid injections in primary care during this period. The wound evolved from a blister to a necrotic ulcer which led to a painful, hollow defect in the centre of her palm. She did not report any history of trauma, nor did she have any co-morbidities. Clinical photographs were taken. Results: On examination, she had a 0.5 cmx1 cm defect in the palm of her left hand down to aponeurosis. There was purulent discharge in the wound with surrounding erythema but no spreading cellulitis. She had full function of her fingers but was very tender on movements and at rest. She was admitted for intravenous antibiotics and underwent a debridement, washout, and carpal tunnel release the next day. The defect was packed to heal by secondary intention and has now fully healed one month following her operation. Conclusions: This is an extremely rare complication of steroid injections to the carpal tunnel and may have been avoided by earlier referral for surgery rather than treatment using multiple steroid injections.

Keywords: hand surgery, complication, rare, carpal tunnel syndrome

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Authors: Serzhan Ashirov, Dana Nour, Rafat Rob, Khaled Alotaibi

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There has been a fast growth in the introduction and use of communications, information, monitoring, and sensing technologies. The new technologies are making their way to the Industrial Control Systems as embedded in products, software applications, IT services, or commissioned to enable integration and automation of increasingly global supply chains. As a result, the lines that separated the physical, digital, and cyber world have diminished due to the vast implementation of the new, disruptive digital technologies. The variety and increased use of these technologies introduce many cybersecurity risks affecting cyber-resilience of the supply chain, both in terms of the product or service delivered to a customer and members of the supply chain operation. US department of energy considers supply chain in the IR4 space to be the weakest link in cybersecurity. The IR4 identified the digitization of the field devices, followed by digitalization that eventually moved through the digital transformation space with little care for the new introduced cybersecurity risks. This paper will examine the best methodologies for securing the electrical substations from cybersecurity attacks due to supply chain risks, and due to digitization effort. SCADA systems are the most vulnerable part of the power system infrastructure due to digitization and due to the weakness and vulnerabilities in the supply chain security. The paper will discuss in details how create a secure supply chain methodology, secure substations, and mitigate the risks due to digitization

Keywords: cybersecurity, supply chain methodology, secure substation, digitization

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Authors: W. Ling, Mohamed Saufi Bin Awang

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Introduction: Mycobacterium tuberculosis post a major health problem worldwide. Central nervous system (CNS) infection by mycobacterium tuberculosis is one of the most devastating complications of tuberculosis. Although with advancement in medical fields, we are yet to understand the pathophysiology of how mycobacterium tuberculosis was able to cross the blood-brain barrier (BBB) and infect the CNS. CNS TB may present with nonspecific clinical symptoms which can mimic other diseases/conditions; this is what makes the diagnosis relatively difficult and challenging. Public health has to be informed and educated about the spread of TB, and early identification of TB is important as it is a curable disease. Case Report: A young 21-year-old Malay gentleman was initially presented to us with symptoms of ear discharge, tinnitus, and right-sided headache for the past one year. Further history reveals that the symptoms have been mismanaged and neglected over the period of 1 year. Initial investigation reveals features of inflammation of the ear. Further imaging showed the feature of chronic inflammation of the otitis media and atypical right cerebral abscess, which has the same characteristic features and consistency. He further underwent a biopsy, and results reveal positive Mycobacterium tuberculosis of the otitis media. With the results and the available imaging, we were certain that this is likely a case of disseminated tuberculosis causing CNS TB. Conclusion: We aim to highlight the challenge and difficult face in our health care system and public health in early identification and treatment.

Keywords: central nervous system tuberculosis, intracranial tuberculosis, tuberculous encephalopathy, tuberculous meningitis

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Authors: Sally Shepherd, Jessica Wong, David Read

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Traumatic brachiocephalic artery aneurysm is a rare injury that typically occurs as a result of a blunt chest injury. A 19-year-old female sustained a head-on, high speed motor vehicle crash into a tree. Upon release after 45 minutes of entrapment, she was tachycardic but normotensive, with a significant seatbelt sign across her chest and open deformed right thigh with weak pulses in bilateral lower limbs. A chest XR showed mild upper mediastinal widening. A CT trauma series plus gated CT chest revealed a grade 3a aortic arch transection with brachiocephalic pseudoaneurysm. Endovascular repair of the brachiocephalic artery was attempted post-presentation but was unsuccessful as the first stent migrated to the infrarenal abdominal aorta and the second stent across the brachiocephalic artery origin had a persistent leak at the base. She was transferred to Intensive Care for strict blood pressure control. She returned to theatre 5 hours later for a median sternotomy, aortic arch repair with an 8mm graft extraction, and excision of the innominate artery pseudoaneurysm. She had an uncomplicated post-operative recovery. This case highlights that brachiocephalic artery injury is a rare but potentially lethal injury as a result of blunt chest trauma. Safe management requires a combined Vascular and Cardiothoracic team approach, as stenting alone may be insufficient.

Keywords: blunt chest injury, Brachiocephalic aneurysm, innominate artery, trauma

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Authors: Felipa de Mello-Sampayo

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The aim of this study is to undertake, from patient’s perspective, the timing and probability of using teledermatology, comparing it with a conventional referral system. The dynamic stochastic model’s main value-added consists of the concrete application to patients waiting for dermatology surgical intervention. Patients with low health level uncertainty must use teledermatology treatment as soon as possible, which is precisely when the teledermatology is least valuable. The results of the model were then tested empirically with the teledermatology network covering the area served by the Hospital Garcia da Horta, Portugal, links the primary care centers of 24 health districts with the hospital’s dermatology department via the corporate intranet of the Portuguese healthcare system. Health level volatility can be understood as the hazard of developing skin cancer and the trend of health level as the bias of developing skin lesions. The results of the survival analysis suggest that the theoretical model can explain the use of teledermatology. It depends negatively on the volatility of patients' health, and positively on the trend of health, i.e., the lower the risk of developing skin cancer and the younger the patients, the more presurgical teledermatology one expects to occur. Presurgical teledermatology also depends positively on out-of-pocket expenses and negatively on the opportunity costs of teledermatology, i.e., the lower the benefit missed by using teledermatology, the more presurgical teledermatology one expects to occur.

Keywords: teledermatology, wait time, uncertainty, opportunity cost, survival analysis

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Authors: Dominika Pihikova, Stefan Belicky, Tomas Bertok, Roman Sokol, Petra Kubanikova, Jan Tkac

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Since aberrant glycosylation is frequently accompanied by both physiological and pathological processes in a human body (cancer, AIDS, inflammatory diseases, etc.), the analysis of tumor-associated glycan patterns have a great potential for the development of novel diagnostic approaches. Moreover, altered glycoforms may assist as a suitable tool for the specificity and sensitivity enhancement in early-stage prostate cancer diagnosis. In this paper we discuss the construction and optimization of ultrasensitive sandwich biosensor platform employing lectin as glycan-binding protein. We focus on the immunoassay development, reduction of non-specific interactions and final glycoprofiling of human serum samples including both prostate cancer (PCa) patients and healthy controls. The fabricated biosensor was measured by label-free electrochemical impedance spectroscopy (EIS) with further lectin microarray verification. Furthermore, we analyzed different biosensor interfaces with atomic force microscopy (AFM) in nanomechanical mapping mode showing a significant differences in the altitude. These preliminary results revealing an elevated content of α-2,3 linked sialic acid in PCa patients comparing with healthy controls. All these experiments are important step towards development of point-of-care devices and discovery of novel glyco-biomarkers applicable in cancer diagnosis.

Keywords: biosensor, glycan, lectin, prostate cancer

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Authors: Ismail Okur, Betul Taspinar, Turkan Pasali Kilit, Eda O. Okur, Ferruh Taspinar

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Type 2 Diabetes Mellitus (T2DM) is one of the most important global health emergencies and every year more and more people are affected by T2DM. T2DM causes life-changing complications by affecting organ and systems. Although diet and exercise are the best way to treat patients with T2DM, those patients generally have a sedentary life style. This study was planned to determine whether patients with T2DM have kinesiophobia (fear of movement). A controlled trial was conducted on 87 adults. Forty-one individuals with T2DM (study group, 34 female and 7 male) and 46 nondiabetic individuals (control group, 39 female and 7 male) were included in the study. Patients were screened for fear of movement using the Tampa Scale for Kinesiophobia (TSK). The data including age, sex, weight, height, and TSK scores were obtained. Mann Whitney U test were used to analyse the data. The mean ages and BMI of study and control groups were 51.98 ± 6.03 year and 49.52 ± 5.61 year and 31.82 ± 2.88 kg/m2 and 30.22 ± 2.91 kg/m2, respectively. The groups have similar demographic properties. The kinesiophobia scores of study and control groups were 42.78 ± 5.50 and 39.48 ± 5.05, respectively and the difference was statistically significant (p=0.05). This study showed that patients with T2DM had high kinesiophobia scores rather than nondiabetics. Those patients might avoid to do exercise. In other words, patients with T2DM might have lower physical activity level. Therefore the authors suggest that to evaluate and interfere with kinesiophobia before conducting exercise therapy will be useful for diabetes care.

Keywords: diabetes, fear of movement, kinesiophobia, type 2 diabetes mellitus

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Authors: G. La Scalia, M. Enea, R. Micale, O. Corona, L. Settanni

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The quality and condition of perishable products delivered to the market and their subsequent selling prices are directly affected by the care taken during harvesting and handling. Mechanical injury, in fact, occurs at all stages, from pre-harvest operations through post-harvest handling, packing and transport to the market. The main implications of this damage are the reduction of the product’s quality and economical losses related to the shelf life diminution. For most perishable products, the shelf life is relatively short and it is typically dictated by microbial growth related to the application of dynamic and static loads during transportation. This paper presents the correlation between vibration levels and microbiological growth on strawberries and woodland strawberries and detects the presence of volatile organic compounds (VOC) in order to develop an intelligent logistic unit capable of monitoring VOCs using a specific sensor system. Fresh fruits were exposed to vibrations by means of a vibrating table in a temperature-controlled environment. Microbiological analyses were conducted on samples, taken at different positions along the column of the crates. The values obtained were compared with control samples not exposed to vibrations and the results show that different positions along the column influence the development of bacteria, yeasts and filamentous fungi.

Keywords: microbiological analysis, shelf life, transport damage, volatile organic compounds

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Authors: Yen-An Tsai, Ching-Ling Lin, Jia-Woei Hou, Mei-Lien Chen

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Endocrine-disrupting chemicals (EDCs) adversely affect the endocrine system. Phthalates, also called phthalic acid esters (PAEs), are manmade chemicals that are used as stabilizing agents in personal care products such as perfumes, lotions, and cosmetics. The aim was to explore whether PAEs exposure was associated with central precocious puberty (CPP) or constitutional delays in growth (CDGP). This case-control study included 48 female with CPP, 37 male with constitutional delays in growth, and 127 normal children and was conducted from December 2011 to August 2014. All participants completed a structured questionnaire regarding socio-demographic characteristics, lifestyle, and secondary sexual characteristics. The analytical method was based on ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) with isotope dilution for the quantitative detection of several phthalate metabolites in human urine. The risk of CPP with mep, mnbp, LMW >50th percentile were higher than those with 50th percentile were higher than those with <50 percentile in model 2. In model 1, we only found higher CDGP risk in mep, mnbp, and ΣPAEs. It shows that high phthalate exposure may associate with CDGP. In this case-control study, we found PAEs exposure was associated with central precocious puberty (CPP) or constitutional delays in growth.

Keywords: phthalates, puberty, delays, growth

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Authors: Fatema Salman, Ridha Hammam, Fatima Khairallah, Fatima Aradi, Nafeesa Abdulla, Mohammed Alsafar

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Purpose: This study aims at measuring the extent of nurses’ knowledge and attitudes toward the use of physical restraints in different hospital wards at Salmaniya Medical Complex (SMC). Background: The habitual use of physical restraint is a widespread practice among nurses working in the clinical settings. Restraints inflict many deleterious consequences on patients physically and psychologically which in turn increases their morbidity and mortality risk and jeopardizes care quality. Nurses’ knowledge and attitudes toward physical restraints are crucial determinants of the persistence of this practice. Literature review: the evidence of lack of knowledge among nurses regarding the use of physical restraints is overwhelming in various clinical settings, especially in two main areas which are the negative consequences and the available alternatives to physical restraints. Studies explored nurses’ attitudes toward physical restraints yielded inconsistent findings. Equally comparable, some studies found that nurses hold positive attitudes toward the use of physical restraints while some others reported just the opposite. Methods: Self-administered knowledge and attitudes scales to 106 nurses working in the SMC. Findings: nurses hold the moderate level of knowledge about restraints (M=58%) with weak negative attitudes (M = -20%) toward using it. Significant moderately-strong negative correlation (r= -0.57, r2= 0.32, p= 0.000) was uncovered between nurses knowledge and their attitudes which provided an empirical explanation of this phenomenon (use of physical restraints). Recommendations: Induction of awareness program that especially focuses on the negative consequences and encourages the use of alternatives is an evident need. This effort necessarily should be adjoined with policy and procedure adjustments.

Keywords: attitudes, knowledge, nurses, restraints

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Authors: Ganesh Nivrutti Akhade

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This paper attempts to develop a reliable and valid instrument of measuring Healthcare service quality in India, and also analyses the impact of demographic factor of respondent on healthcare service quality. In this research paper , extant literature survey, discussion with stakeholder of healthcare system such as patients, patients relative, administrators of hospitals, clinics, professionals and expert interviews were used to develop a attributes of healthcare service quality dimensions. A pilot study was conducted with a sample of 31 healthcare patients of private sector, public sector ,trust hospital ,primary health care centers and clinics was surveyed in the Nagpur Metropolitan Area. At the end fifteen dimensions—reliability, assurance, responsiveness, tangibility, empathy, affordability, respect, and caring, Attitude of staff, Technical competence, Appropriateness, Safety, continuity, Effectiveness, Availability, Financial support. This fifteen-dimensional model was validated through a content validity and construct validity. The proposed research model shows acceptable fit indices. Impact of these dimensions on the Overall Healthcare Service Quality and customer satisfaction are analyzed using multiple regression technique. Findings indicate that all dimensions carry significant impact on the Overall Healthcare Service Quality perceptions and customer satisfaction. However, availability and effectiveness dimensions carry the maximum impact on the Overall healthcare Service Quality .

Keywords: healthcare, service quality, factor analysis (CFA), india, service quality dimensions

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Authors: Himer Khalid, Alami Ilyass, Kharchoufa Loubna, Elachouri Mostafa

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It has been estimated by the World Health Organization that 80% of the world's population relies on traditional medicine to meet their daily health requirements. In Morocco reliance on such medicine is partly owing to the high cost of conventional medicine and the inaccessibility of modern health care facilities. There was high agreement in the use of plants as medicine in Oriental Morocco. Our objective is to evaluate the informant’s knowledge on medicinal plants by the local population and to document the uses of medicinal plants by this community, for the treatment of different illnesses. Using an ethnopharmacological approach, we collected information concerning the traditional medicinal knowledge and the medicinal plants used, by interviewing successfully 458 informants living in oriental Morocco (from Debdou, Taourirt, Guersif a,d Laayoune districts). The data were analyzed by statistical methods (Component Analysis “CA”, Factorial Analysis “FA”) and other methods such as through Informant’s Consensus Factor (ICF) and Use Value (UV). Our results indicate that, more than 60% of the population in these regions relies on medicinal plants for the treatment of different ailments with predominance of women consumers. 135 plant species belonging to 61 families were documented. These plants were used by the population for the treatment of a group of illness (about 14 principal ailments). We conclude that, in oriental Morocco, till now, the population has some traditional knowledge commonly used as medical tradition. These wealthy heritage needs conservation and evaluation.

Keywords: Morocco, medicinal plants, traditional knowledge, wealthy heritage

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Authors: Katerine Moraes dos Satons, Gisele Massante Peixoto Tracera, Regina Célia Gollner Zeitoune

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To analyze the psychosocial risks related to the organization of nursing work in outpatient clinics of university hospitals. Cross-sectional epidemiological study developed in 11 outpatient units linked to the three public universities of the city of Rio de Janeiro, Brazil. Participants were 388 nursing professionals who worked in patient care at the time of the research. Data were collected from July to December 2018, using a self-applicable instrument. A questionnaire was used for sociodemographic, occupational and health characterization, and the Work Organization Scale. The bivariate analyses were performed using the odds ratio (OR), with a confidence interval of 95%, significance level of 5%. The organization of nursing work received an assessment of medium psychosocial risk by the professionals participating in the research, demanding interventions in the short and medium term. There was no association between sociodemographic, occupational and health characteristics and the organization of outpatient work. Interventional measures should be performed in the psychosocial risk factors presented in this research, with a view to improving the work environment, so that the importance of maintaining satisfactory material conditions is considered, as well as the adequate quantity of human resources. In addition, it aims to expand the spaces of nursing participation in decision- making, strengthening its autonomy as a profession.

Keywords: occupational risks, nursing, nursing team, worker’s health, psychosocial risks

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Authors: Shivalal Sharma, Sanjib K. Sharma, Madhab Lamsal

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Background: The aim of this study was to evaluate the clinical and laboratory changes three months after full-mouth scaling and root planing (SRP) in periodontitis patients with type 2 diabetes mellitus (DM). Methods: Forty-seven type 2 DM subjects with moderate to severe periodontitis were randomly divided into two groups. Treatment group (TG), 25 subjects, received full-mouth scaling and root planning; control group (CG), 22 subjects, received no treatment. At baseline and at the end of three months, glycated hemoglobin (HbA1c) values, fasting glucose, and clinical parameters like plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded in all the patients. Following SRP, the patients were enrolled in a monthly interval maintenance program for 3 months. Results: A statistically significant effect could be demonstrated for PI, GI, PPD, and CAL for the treatment group. HbA1c levels in the treatment group decreased significantly whereas the control group showed a slight but insignificant increase for these parameters. Conclusions: The results of this study showed that non-surgical periodontal treatment (SRP) is associated with improved glycemic control in type 2 DM patients and could be undertaken along with the standard measures for the diabetic patient care.

Keywords: periodontitis, type 2 diabetes mellitus, non-surgical periodontal therapy, SRP

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Authors: Agoubi Belgacem, Adel Kharroubi

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Geothermal groundwater is the main water source to supply various sectors in El Hamma city, southeastern Tunisia. This region was long the destination of thousands of people from Tunisia and neighboring countries for care and bathing. The main objective of this study is to understand the groundwater mineralization origins and factors that control. The second goal is the appraisal of radon in geothermal groundwater in the study area. For this aim, geothermal groundwater was sampled and collected from different locations (thermal baths and deep wells). Physical parameters were measured and major ions were analyzed. Results reveal three water types. The water first type has Na-Mg-Ca-SO4-Cl facies and T>55°C. The second water type dominated by Na-Ca-Cl-SO4 facies with a temperature < 45 °C. However the third water type is dominated by Ca-SO4-Na-Cl-Mg. The three water types may be controlled by depth and geology. The first represent groundwater from deep aquifer (lower cretaceous), the second type was the shallow aquifer and the first is mixed water from deep and shallow water with a temperature ranging from 45 to 55°C. Measured Radon shows that shallow aquifer has a higher 222Rn concentration (677 to 2903 Bq.m-3) than deep water (203 to 1100 Bq.m-3). R-222 in El Hamma thermal aquifer was controlled by structures, porosity and permeability of aquifers. Geostatistical analyses of hydrogeological data and radon activities confirm the vertical flow and communication between deep and shallow aquifers through vertical faults system.

Keywords: Radon-222, geothermal, water, environment, Tunisia

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Authors: Chaiyaporn Yuksen

Abstract:

Backgroud: Supraventricular tachycardia (SVT) is an abnormally fast atrial tachycardia characterized by narrow (≤ 120 ms) and constant QRS. Adenosine was the drug of choice; the first dose was 6 mg. It can be repeated with the second and third doses of 12 mg, with greater than 90% success. The study found that patients observed at 4 hours after normal sinus rhythm was no recurrence within 24 hours. The objective of this study was to investigate the factors that influence the recurrence of SVT after adenosine in the emergency department (ED). Method: The study was conducted retrospectively exploratory model, prognostic study at the Emergency Department (ED) in Faculty of Medicine, Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand. The study was conducted for ten years period between 2010 and 2020. The inclusion criteria were age > 15 years, visiting the ED with SVT, and treating with adenosine. Those patients were recorded with the recurrence SVT in ED. The multivariable logistic regression model developed the predictive model and prediction score for recurrence PSVT. Result: 264 patients met the study criteria. Of those, 24 patients (10%) had recurrence PSVT. Five independent factors were predictive of recurrence PSVT. There was age>65 years, heart rate (after adenosine) > 100 per min, structural heart disease, and dose of adenosine. The clinical risk score to predict recurrence PSVT is developed accuracy 74.41%. The score of >6 had the likelihood ratio of recurrence PSVT by 5.71 times Conclusion: The clinical predictive score of > 6 was associated with recurrence PSVT in ED.

Keywords: clinical prediction score, SVT, recurrence, emergency department

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Authors: Noel Busch-Armendariz, Caitlin Sulley

Abstract:

Introduction: This study investigated the development of college experiences, COVID-19 pandemic experiences, alcohol use, and sexual violence. The longitudinal study includes 656 college students living in the same dormitory. Students' alcohol use and social network structure were investigated to better understand the relationship with sexual violence risk. Basic Methodologies: Over two years, students repeated five web-based surveys, including a pre-college survey and surveys during four consecutive semesters. Questions were added in the fourth wave to assess students’ experiences of the COVID-19 pandemic, administered from November-January 2021, including mental and behavioral health. Analyses include the impact of COVID on living arrangements, drinking behaviors, and daily life; experiences of COVID symptoms, testing, and diagnosis, responses to COVID such as social distancing, quarantining, not working, increased health care needs; experience of fear, worry, stigma, emotional well-being, loneliness, and mental health; experiences of financial loss, lack of basic supplies, receiving emotional and financial support, and comparison with academic disengagement. Concluding Statement: Findings and discussion will include strategies to strengthen mental and behavioral health programs and policies.

Keywords: COVID, mental health, substance abuse, college students, sexual misconducts

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Authors: Elżbieta Antczak

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Cities offer important opportunities for economic development and for expanding access to basic services, including health care and education, for large numbers of people. Moreover, green areas (as an integral part of sustainable urban development) present a major opportunity for improving urban environments, quality of lives and livelihoods. This paper examines, using spatial concentration and spatial taxonomic measures, regional diversification of greenery in the cities of Poland. The analysis includes location quotients, Lorenz curve, Locational Gini Index, and the synthetic index of greenery and spatial statistics tools: (1) To verify the occurrence of strong concentration or dispersion of the phenomenon in time and space depending on the variable category, and, (2) To study if the level of greenery depends on the spatial autocorrelation. The data includes the greatest Polish cities, categories of the urban greenery (parks, lawns, street greenery, and green areas on housing estates, cemeteries, and forests) and the time span 2004-2015. According to the obtained estimations, most of cites in Poland are already taking measures to become greener. However, in the country there are still many barriers to well-balanced urban greenery development (e.g. uncontrolled urban sprawl, poor management as well as lack of spatial urban planning systems).

Keywords: greenery, urban areas, regional spatial diversification and concentration, spatial taxonomic measure

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