Search results for: patient engagement

Authors: Kasra Afsahi, Maryam Soheilifar

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COVID-19 has been associated with stroke and neurological complications. The patient was a 59-year- old male who presented with sudden left hemiparesis and diplopia due to cavernous sinus thrombosis (CST) on 28/03/2020. The COVID-19 test was positive. Multislice CT (MSCT) showed ischemic infarction. He underwent surgical sinectomy 9 days after admission. Physiotherapy began for him in August 2020. Our game-based virtual reality (VR) technology developed for stroke patients was based on upper extremity exercises and function for stroke. After 6 weeks of VR therapy plus conventional physiotherapy exercises (18 sessions, three times per week, 60 minutes each session), there were significant improvements in Brunnstrom Motor Recovery Stage (from “4” to “5”), Fugl-Meyer Scale score of upper extremity section (from 49 to 54), and Modified Barthel Index (from15 to 18). There were no adverse effects. This case with stroke post-COVID-19 due to the CST showed the usefulness of VR therapy used as an adjunct to conventional physiotherapy in improving affected upper extremity.

Keywords: COVID-19, stroke, virtual reality, rehabilitation

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Authors: V. Giacometti, R. Mirabelli, V. Patera, D. Pinci, A. Sarti, A. Sciubba, G. Traini, M. Marafini

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The particle therapy (PT) is a very modern technique of non invasive radiotherapy mainly devoted to the treatment of tumours untreatable with surgery or conventional radiotherapy, because localised closely to organ at risk (OaR). Nowadays, PT is available in about 55 centres in the word and only the 20\% of them are able to treat with carbon ion beam. However, the efficiency of the ion-beam treatments is so impressive that many new centres are in construction. The interest in this powerful technology lies to the main characteristic of PT: the high irradiation precision and conformity of the dose released to the tumour with the simultaneous preservation of the adjacent healthy tissue. However, the beam interactions with the patient produce a large component of secondary particles whose additional dose has to be taken into account during the definition of the treatment planning. Despite, the largest fraction of the dose is released to the tumour volume, a non-negligible amount is deposed in other body regions, mainly due to the scattering and nuclear interactions of the neutrons within the patient body. One of the main concerns in PT treatments is the possible occurrence of secondary malignant neoplasm (SMN). While SMNs can be developed up to decades after the treatments, their incidence impacts directly life quality of the cancer survivors, in particular in pediatric patients. Dedicated Treatment Planning Systems (TPS) are used to predict the normal tissue toxicity including the risk of late complications induced by the additional dose released by secondary neutrons. However, no precise measurement of secondary neutrons flux is available, as well as their energy and angular distributions: an accurate characterization is needed in order to improve TPS and reduce safety margins. The project MONDO (MOnitor for Neutron Dose in hadrOntherapy) is devoted to the construction of a secondary neutron tracker tailored to the characterization of that secondary neutron component. The detector, based on the tracking of the recoil protons produced in double-elastic scattering interactions, is a matrix of thin scintillating fibres, arranged in layer x-y oriented. The final size of the object is 10 x 10 x 20 cm3 (squared 250µm scint. fibres, double cladding). The readout of the fibres is carried out with a dedicated SPAD Array Sensor (SBAM) realised in CMOS technology by FBK (Fondazione Bruno Kessler). The detector is under development as well as the SBAM sensor and it is expected to be fully constructed for the end of the year. MONDO will make data tacking campaigns at the TIFPA Proton Therapy Center of Trento, at the CNAO (Pavia) and at HIT (Heidelberg) with carbon ion in order to characterize the neutron component and predict the additional dose delivered on the patients with much more precision and to drastically reduce the actual safety margins. Preliminary measurements with charged particles beams and MonteCarlo FLUKA simulation will be presented.

Keywords: secondary neutrons, particle therapy, tracking detector, elastic scattering

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Authors: Yasmine Abu Adla, Racha Soubra, Milana Kasab, Mohamad O. Diab, Aly Chkeir

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Over the past several years, researchers have shown a great interest in assessing the mobility of elderly people to measure their functional status. Usually, such an assessment is done by conducting tests that require the subject to walk a certain distance, turn around, and finally sit back down. Consequently, this study aims to provide an at home monitoring system to assess the patient’s status continuously. Thus, we proposed a technique to automatically detect when a subject sits down while walking at home. In this study, we utilized a Doppler radar system to capture the motion of the subjects. More than 20 features were extracted from the radar signals, out of which 11 were chosen based on their intraclass correlation coefficient (ICC > 0.75). Accordingly, the sequential floating forward selection wrapper was applied to further narrow down the final feature vector. Finally, 5 features were introduced to the linear discriminant analysis classifier, and an accuracy of 93.75% was achieved as well as a precision and recall of 95% and 90%, respectively.

Keywords: Doppler radar system, stand-to-sit phase, TUG test, machine learning, classification

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Authors: Douglas Nyathi, Mxolisi Sibanda, Joram Ndlovuu, Thulani Dube, Innocent T. Mahiya

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Communication of sexual matters between the parents and adolescents has been seen as one of the strategies that could play a cardinal role in encouraging adolescents to be responsible and delay sexual debut or avoid unprotected sexual intercourse. The increasing rate of teenage pregnancies and new HIV/AIDS infections among adolescents in Sub-Saharan Africa makes the phenomenon worth analysis. The purpose of this paper is to interrogate the dynamics of parent-adolescent communication on sexual and reproductive health in Sub-Sahara. Specifically the paper focuses on barriers to communication between parents and adolescents on sexual and reproductive health and its policy implications. It emanates from the paper that communication on sexual and reproductive health at household level is triggered by death of a relative from a sexual related illness, suspicion on sexual activity, radio programmes and in some instances fliers. Literature engagement reveals that communication between parents and adolescents on sexual and reproductive health is made difficult by economic factors (poverty, lack of privacy and low self-esteem), household demographics (age, sex, class, death), socio-cultural factors (beliefs and religious values) as well as social media. We argue that there is need to use broadcast mediato come up with radio and television programmes that create family environments in which sexual and reproductive health issues are discussed. We also recommend that government departments and Non-Governmental Organisations concerned with sexuality issues need to undertake studies that can help dismantle taboos, prejudices and stereotypes that impede sexual and reproductive health communication between parents and adolescents.

Keywords: parent, adolecsent, communication, sexual and reproductive health

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Authors: Nadeem Akhtar, An Ran, Cornelius B. Pratt

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China’s President Xi' vision of Belt and Road Initiative, an infrastructural project of development and connectivity, is attracting international students to Chinese universities, with Pakistan and India among the top-10 countries of origin of those students (Ministry of Education China, 2018). An additional factor in international students’ interest in Chinese universities is their improving global rankings of Chinese universities. Against that backdrop, this study addresses two overarching questions: (a) What factors explain South Asian students’ study-away experiences, particularly in their multicultural environments? and (b) What role do new media play in their adaptation to that environment? This study is guided by Stephen’s (2011) theoretical model, which suggests that social networks influence immigrants’ interactions with host and home culture. The present study used a structured questionnaire distributed through both WeChat and other online platforms to international students studying in Chinese universities. Preliminary results are threefold: (a) that the frequency of use of social media is a predictor of the level of adjustment of the students to their multicultural environment; (b) that social engagement with their international-student peers is a moderating factor in their experiential outcomes; and (c) length of stay in Chinese universities, surprisingly, was not a predictor of adaptation. A major implication of these findings is that, even though social media tend to be criticized for contributing to anomie and to diminishing social capital among youths and millennials, they can be poignant tools for cultural adaptation, particularly among international students in China. It remains to be seen if such outcomes occur among international students in other countries or world regions.

Keywords: adaptation, China's Belt and Road Initiative, international students, social media

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Authors: Shibinu S, Mohamed Haseeb N

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In times of crisis, the diaspora's role and the help it offers are seen to be vital in determining how many countries, particularly low- and middle-income nations that significantly rely on remittances, recover. Twenty-one lakh twenty thousand Keralites have emigrated abroad, with 81.2 percent of these outflows occurring in the Gulf Cooperative Council (GCC). Most of them are semi-skilled or low-skilled laborers employed in GCC nations. Additionally, a sizeable portion of migrants are employed in industrialized nations like the UK and the US. These nations have seen the development of a highly robust Indian Diaspora. India's development is largely dependent on the generosity of its diaspora, and the nation has benefited greatly from the substantial contributions made by several emigrant generations. Its strength was noticeable during the COVID-19 and Kerala floods. Millions of people were displaced, millions of properties were damaged, and many people died as a result of the 2018 Kerala floods. The Malayalee diaspora played a crucial role in the reconstruction of Kerala by providing support for the rescue efforts underway on the ground through their extensive worldwide network. During COVID-19, an analogous outreach was also noted, in which the diaspora assisted stranded migrants across the globe. Together with the work the diaspora has done for the state's development and recovery, there has also been a recent outpouring of assistance during the COVID-19 pandemic. The study focuses on the subtleties of diaspora philanthropic scholarship and how Kerala was able to recover from the COVID-19 pandemic and floods thanks to it. Semi-structured in-depth interviews with migrants, migrant organizations, and beneficiaries from the diaspora through snowball sampling to better understand the role that diaspora philanthropy plays in times of crisis.

Keywords: crises, diaspora, remittances, COVID-19, flood, economic development of Kerala

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Authors: Danilo Pesce, Emilio Paolucci, Mariolina Affatato

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Looking at the future and at the post-digital era, innovations commonly tend to dismiss the old and replace it with the new. The aim of this research is to study the role that digital innovation can play alongside the information chain within the traditional sectors and the subsequent value creation opportunities that actors and stakeholders can exploit. By drawing on a wide body of literature on innovation and strategic management and by conducting a case study on the cultural heritage industry, namely Google Arts & Culture, this study shows that technology augments complements, and amplifies the way people experience their cultural interests and experience. Furthermore, the study shows a process of democratization of art since museums can exploit new digital and virtual ways to distribute art globally. Moreover, new needs arose from the 2020 pandemic that hit and forced the world to a state of cultural fasting and caused a radical transformation of the paradigm online vs. onsite. Finally, the study highlights the capabilities that are emerging at different stages of the value chain, owing to the technological innovation available in the market. In essence, this research underlines the role of Google in allowing museums to reach users worldwide, thus unlocking new mechanisms of value creation in the cultural heritage industry. Likewise, this study points out how Google provides value to users by means of increasing the provision of artworks, improving the audience engagement and virtual experience, and providing new ways to access the online contents. The paper ends with a discussion of managerial and policy-making implications.

Keywords: big data, digital platforms, digital transformation, digitization, Google Arts and Culture, stakeholders’ interests

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Authors: John Yahng, Hansraj Riteesh Bookun

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Popliteal artery aneurysms (PAAs) are the most common arterial aneurysm of the periphery. It is defined as focal dilation of the artery more than 50% of the normal vessel diameter which usually varies between 7 mm to 11 mm. The most common presentation for PAAs is claudication due to luminal stenosis secondary to mural thrombus or acute limb ischaemia due to occlusive thrombosis or distal thromboembolism. It is less common for patients to present with non-ischaemic symptoms secondary to mass effect and compression of adjacent structures, and of these, presentation with common peroneal nerve compression is particularly uncommon. We present a rare case of a 92-year-old female patient presenting with 4-month history of left foot drop with radiological evidence of common peroneal nerve compression secondary to PAA of 22 mm by 21mm in size. To the best of our knowledge, this is the smallest reported popliteal aneurysm presenting with foot drop. We also present the endovascular treatment option taken in our case.

Keywords: aneurysm, foot drop, peroneal nerve, popliteal

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Authors: Foad Alzoughool

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Conflicting studies on the association between the rs5219 polymorphism and type 2 diabetes, some studies have confirmed a strong relationship between this variant and type2 diabetes, on the other hand, many studies denied the existence of this association. This study aimed to provide evidence about whether the rs5219 polymorphism has or hasn't a role as a risk factor for diabetes and meta-analysis to investigate the role of the control age group in the association. Genotyping of the rs5219 polymorphism was performed in a cohort of 266 healthy elderly subjects with a mean age (60.2 ± 5.1) with no history of diabetes (HbA1c < 6%) using standard Sanger sequencing methods. Lys/Lys alleles were detected in 20 persons (7.5%), Lys/Glu alleles in 96 persons (36.1%), and Glu/Glu in 150 persons (56.4%). The genotype distribution was consistent with Hardy–Weinberg equilibrium (P =0.7). Meta-analysis notably indicates no association between rs5219 polymorphism and type 2 diabetes in all studies used the younger age of the control group compared to the patient's age. In conclusion, our study sheds light on the importance of age factor among the control group recruited in case-control studies.

Keywords: Type 2 diabetes, rs5219 polymorphism, E23K, KCNJ11 gene

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Authors: Katharina Schuck

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For a long time, luxury hotels devoted little effort to sustainability, and also scientists were fairly attracted to this subject. While some luxury hotels are now increasingly showing engagement in sustainability, the extent of their commitment varies greatly, which makes the whole industry quite intransparent when it comes to sustainable practices. In general, each hotel companyand each individual hotel can decide for themselves to what extent they commit to sustainability as long as there are no legally prescribed minimum requirements in the respective countries. Despite pleading and compelling calls from industry experts and representatives of relevant sustainability institutions, this is still reality – although climate change and environmental disasters as well as poor treatment of workers and the local population are also issues in progressive and hotel-dense European cities. This paper therefore deals with the question which sustainability activities (environmental and social) have been established by European luxury hotels so far and to what extent these activities are rather a way to differentiate in the market or are simply evaluated as part of a necessary adaptation of the luxury hotel industry. For this purpose, interviews were conducted with both industry experts and hotel representatives in order to obtain a diverse picture of the current status. The studyrevealed that a clear agenda is missing so far, which takes luxury hotels by the handand supports them in the process towards more sustainable hotel management. While a large part of the luxury hotels addressed have already established initiatives and activities regarding sustainability, they are extremely diverse, and range from recyclable toiletries use to comprehensive concepts for energy generation. The study's findings provide insights for both practitioners who seek to implement sustainability in a luxury hotel setting as well as offer an extension of the existing research base on sustainability in hospitality.

Keywords: luxury hospitality, qualitative research methods, sustainability, sustainable hotels

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Authors: Kamal Prasad Acharya

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The related literature suggests that teaching and learning science at the basic level community schools in Nepal is based on book recitation. Consequently, the achievement levels and the understanding of basic science concepts is much below the policy expectations. In this context, this study intended to gain perception in the implementation practices of school gardens ‘One Garden One School’ for science learning and to meet the target of sustainable development goals that connects community wisdom regarding school gardening activities (SGAs) for science learning. This Participatory Action Research (PAR) study was done at the action school located in Province 3, Chitwan of Federal Nepal, supported under the NORHED/Rupantaran project. The purpose of the study was to connect the community wisdom related to gardening activities as contextual scaffolds for science learning. For this, in-depth interviews and focus group discussions were applied to collect data which were analyzed using a thematic analysis. Basic level students, science teachers, and parents reported having wonderful experiences such as active and meaningful engagement in school gardening activities for science learning as well as science teachers’ motivation in activity-based science learning. Overall, teachers, students, and parents reported that the school gardening activities have been found to have had positive effects on students’ science learning as they develop basic scientific concepts by connecting community wisdom as a contextual scaffold. It is recommended that the establishment of a school garden is important for science learning in community schools throughout Nepal.

Keywords: contextual scaffold, community wisdom, science and health learning, school garden

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Authors: Jatinder Pal Singh, Harpreet Singh, Gagandeep Singh Digra, Mandeep Kaur Sidhu, Pawan Kumar

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Introduction: Ganglion cyst is a benign condition in which there is a cystic lesion in relation to a joint or a tendon sheath arising from myxoid degeneration of fibrous connective tissue. These can be unilocular or multilocular. In rare cases, there may be multiple ganglion cysts, known as cystic ganglionosis. They can occur at any age but are commonly seen in adults. Clinically they may be asymptomatic or present as swelling or mass effect in adjacent structures. These are common in extremities such as hands and feet. Case Presentation: 11-year-old female child presented with slowly progressive painless swelling of her right hand since the age of 4. Antenatal and perinatal history was unremarkable. Her family history was negative. She denies fever, malaise, morning stiffness, weight loss, fatigue, restriction of joint movements, or any sensory and motor deficit. Lab parameters were negative for inflammatory or infectious etiology. No other joint or extremity involvement was present. On physical examination, the swelling was present on the dorsum and palmer aspect of the right hand and wrist. They were non-tender on palpation without any motor or sensory deficit. MRI hand revealed multiple well-defined fluid signal intensity cystic appearing lesions in periarticular/intraarticular locations in relation to distal radio-ulnar, radio-carpal, intercarpal, carpometacarpal, metacarpophalangeal and interphalangeal joints as well as peritendinous location around flexor tendons more so in the region of wrist, palm, 1st and 5th digit and along extensor tendons in the region of wrist, largest one noted along flexor pollicis longus tendon in thenar region and along 1st digit measuring approx. 4.6 x 1.2 x 1.2 centimeter. Pressure erosions and bone remodelling were noted in the bases of the 2nd to 5th metacarpals, capitate, trapezoid, the distal shaft of 1st metacarpal, and proximal phalanx of 1st digit. Marrow edema was noted in the base and proximal shaft of the 4th metacarpal and proximal shaft of the 3rd metacarpal – likely stress or pressure related. The patient was advised of aspiration, but the family refused the procedure. Therefore the patient was kept on conservative treatment. Conclusion: Cystic ganglionosis is a rare condition with very few cases reported in the medical literature. Its prevalence and association are not known because of the rarity of this condition. It should be considered as an important differential in patients presenting with soft tissue swelling in extremities. Treatment option includes conservative management, aspiration, and surgery. Aspiration has a high recurrence rate. Although surgery has a low recurrence rate, it carries a high rate of complications. Imaging with MRI is essential for confirmation of the cystic nature of lesions and their relation with the joint capsules or tendons. This helps in differentiating from other soft tissue lesions and presurgical planning.

Keywords: radiology, rare, cystic ganglionosis, child

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Authors: Cecília M. Antão, Paulo Jorge Nogueira

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Breast cancer (BC) is the first cause of cancer mortality among Portuguese women. This retrospective observational study aimed at identifying comorbidities associated with BC female patients admitted to Portuguese public hospitals (2010-2018), investigating the effect of comorbidities on BC mortality rate, and building a predictive model using logistic regression. Results showed that the BC mortality in Portugal decreased in this period and reached 4.37% in 2018. Adjusted odds ratio indicated that secondary malignant neoplasms of liver, of bone and bone marrow, congestive heart failure, and diabetes were associated with an increased chance of dying from breast cancer. Although the Lisbon district (the most populated area) accounted for the largest percentage of BC patients, the logistic regression model showed that, besides patient’s age, being resident in Bragança, Castelo Branco, or Porto districts was directly associated with an increase of the mortality rate.

Keywords: breast cancer, comorbidities, logistic regression, adjusted odds ratio

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Authors: Michelle Roesler, Ian Glendon, Francis O'Callaghan

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This study expands on recent findings and offers a new perspective on recovery from injury and return to work (RTW) after an acute traumatic occupational hand injury. Recovery is a complex medical and psychosocial process. A number of predictor variables were studied simultaneously to identify the bio-psychosocial variables that impede recovery. An unexpected phenomenon to emerge from this study was the high incidence of complications within the hand-injured patient sample. Twenty six percent (n = 71) of the total sample (N = 263) required a second operation due to complications. This warranted further investigation. Results confirmed that complications not only significantly delayed the RTW outcome but also had a profound psychological impact on the individuals affected. Research has found that surgical complications are usually the result of incorrect early assessment and management. A strategic plan needs to be implemented to ensure the optimal level of surgical care is provided for managing acute traumatic hand injuries to avoid such complications.

Keywords: occupational hand trauma, psychological recovery, return to work, psychology

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Authors: P. S. Jagadeesh Kumar, Mingmin Pan, Xianpei Li, Yanmin Yuan, Tracy Lin Huan

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Researchers are doing enchanting research into the inherited features of Alzheimer’s disease and probable consistent therapies. In Alzheimer’s, memories are extinct in reverse order; memories formed lately are more transitory than those from formerly. Reminiscence therapy includes the conversation of past actions, trials and knowledges with another individual or set of people, frequently with the help of perceptible reminders such as photos, household and other acquainted matters from the past, music and collection of tapes. In this manuscript, the competence of reminiscence therapy for Alzheimer’s disease is measured using logistic regression based linear bootstrap aggregating. Logistic regression is used to envisage the experiential features of the patient’s memory through various therapies. Linear bootstrap aggregating shows better stability and accuracy of reminiscence therapy used in statistical classification and regression of memories related to validation therapy, supportive psychotherapy, sensory integration and simulated presence therapy.

Keywords: Alzheimer’s disease, linear bootstrap aggregating, logistic regression, reminiscence therapy

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Authors: Mukisa Daphine Letisha

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Plea bargaining, a practice often associated with more developed legal systems, has emerged as a significant tool within Uganda's criminal justice system despite its absence in formal legal structures inherited from its colonial past. Initiated in 2013 with the aim of reducing case backlogs, expediting trials, and addressing prison congestion, plea bargaining reflects a pragmatic response to systemic challenges. While rooted in international statutes and domestic constitutional provisions, its implementation relies heavily on the Judicature (Plea Bargain) Rules of 2016, which outline procedural requirements and safeguards. Advocates argue that plea bargaining has yielded tangible benefits, including a reduction in case backlog and efficient allocation of resources, with notable support from judicial and prosecutorial authorities. Case examples demonstrate successful outcomes, with accused individuals benefitting from reduced sentences in exchange for guilty pleas. However, challenges persist, including procedural irregularities, inadequate statutory provisions, and concerns about coercion and imbalance of power between prosecutors and accused individuals. To enhance efficacy, recommendations focus on establishing monitoring mechanisms, stakeholder training, and public sensitization campaigns. In conclusion, while plea bargaining offers potential advantages in streamlining Uganda's criminal justice system, addressing its challenges requires careful consideration of procedural safeguards and stakeholder engagement to ensure fairness and integrity in the administration of justice.

Keywords: plea-bargaining, criminal-justice system, uganda, efficacy

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Authors: Lauren Zammerilla Westcott, Ronald C. Jones, James W. Fleshman

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The surgical treatment of breast cancer has rapidly evolved over the past 50 years, progressing from Halsted’s radical mastectomy to a public campaign of surgical options, aesthetic reconstruction, and patient empowerment. This article examines the happenings that led to the transition of breast surgery as a subset of general surgery to its own specialized field. Sparked by the research of Dr. Bernard Fisher and the first National Surgical Adjuvant Breast and Bowel Project trial in 1971, the field of breast surgery underwent significant growth over the next several decades, enabling general surgeons to limit their practices to the breast. High surgical volumes eventually led to the development of the first formal breast surgical oncology fellowship in a large community-based hospital at Baylor University Medical Center in 1982. The establishment of the American Society of Breast Surgeons, as well several landmark clinical trials and public campaign efforts, further contributed to the advancement of breast surgery, making it the specialized field of the current era.

Keywords: breast cancer, breast fellowship, breast surgery, surgical history

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Authors: Iliana Georganta, Clare Deehan, Marysia Thomson, Miriam McDonald, Kerrie McNulty, Anna Strachan, Elizabeth Anderson, Alyaa Mostafa

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Context: A meta-analysis of randomized controlled trials (RCTs) comparing hysterectomy versus endometrial ablation and resection in the management of heavy menstrual bleeding. Objective: To evaluate the clinical efficacy, satisfaction rates and adverse events of hysterectomy compared to more minimally invasive techniques in the treatment of HMB. Evidence Acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing hysterectomy with either endometrial ablation endometrial resection of both. The search had no language restrictions and was last updated in June 2020 using MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, PubMed, Google Scholar, PsycINFO, Clinicaltrials.gov and Clinical trials. EU. In addition, a manual search of the abstract databases of the European Haemophilia Conference on women's health was performed and further studies were identified from references of acquired papers. The primary outcomes were patient-reported and objective reduction in heavy menstrual bleeding up to 2 years and after 2 years. Secondary outcomes included satisfaction rates, pain, adverse events short and long term, quality of life and sexual function, further surgery, duration of surgery and hospital stay and time to return to work and normal activities. Data were analysed using RevMan software. Evidence synthesis: 12 studies and a total of 2028 women were included (hysterectomy: n = 977 women vs endometrial ablation or resection: n = 1051 women). Hysterectomy was compared with endometrial ablation only in five studies (Lin, Dickersin, Sesti, Jain, Cooper) and endometrial resection only in five studies (Gannon, Schulpher, O’Connor, Crosignani, Zupi) and a mixture of the Ablation and Resection in two studies (Elmantwe, Pinion). Of the 1² studies, 10 reported women’s perception of bleeding symptoms as improved. Meta-analysis showed that women in the hysterectomy group were more likely to show improvement in bleeding symptoms when compared with endometrial ablation or resection up to 2-year follow-up (RR 0.75, 95% CI 0.71 to 0.79, I² = 95%). Objective outcomes of improvement in bleeding also favored hysterectomy. Patient satisfaction was higher after hysterectomy within the 2 years follow-up (RR: 0.90, 95%CI: 0.86 to 0.94, I²:58%), however, there was no significant difference between the two groups at more than 2 years follow up. Sepsis (RR: 0.03, 95% CI 0.002 to 0.56; 1 study), wound infection (RR: 0.05, 95% CI: 0.01 to 0.28, I²: 0%, 3 studies) and Urinary tract infection (UTI) (RR: 0.20, 95% CI: 0.10 to 0.42, I²: 0%, 4 studies) all favoured hysteroscopic techniques. Fluid overload (RR: 7.80, 95% CI: 2.16 to 28.16, I² :0%, 4 studies) and perforation (RR: 5.42, 95% CI: 1.25 to 23.45, I²: 0%, 4 studies) however favoured hysterectomy in the short term. Conclusions: This meta-analysis has demonstrated that endometrial ablation and endometrial resection are both viable options when compared with hysterectomy for the treatment of heavy menstrual bleeding. Hysteroscopic procedures had better outcomes in the short term with fewer adverse events including wound infection, UTI and sepsis. The hysterectomy performed better when measuring more long-term impacts such as recurrence of symptoms, overall satisfaction at two years and the need for further treatment or surgery.

Keywords: menorrhagia, hysterectomy, ablation, resection

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Authors: Mahsa Ghafouri, Guita Farivarsadri

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In urban open spaces, furniture plays a crucial role in meeting various needs of the users over time. Furniture consists of elements that not only can facilitate physical needs individually but also fulfill social, psychological, and cultural demands on an urban scale. Creating adjustable urban spaces and using flexible furniture can provide the possibility of using urban spaces for a wide range of uses and activities and allow the engagement of users with distinct abilities and limitations in these activities. Flexibility in urban furniture can be seen as designing a number of modular components that are movable, expandable, adjustable, and changeable to accommodate various functions. Although there is a great amount of research related to flexibility and its distinct insights into achieving spaces that can cope with changing demands, this fundamental issue is often neglected in the design of urban furniture. However, in the long term, to address changing public needs over time, it can be logical to bring this quality into the design process to make spaces that can be sustained for a long time. This study aims to first introduce diverse kinds of flexible furniture that can be designed for urban public spaces and then to realize how this flexible furniture can improve the quality of public open spaces and social interaction and make them more adaptable over time and, as a result, achieve social sustainability. This research is descriptive and is mainly based on an extensive literature review and the analysis and classification of existing examples around the world. This research tends to illustrate various kinds of approaches that can help designers create flexible furniture to enhance the sustainability and quality of urban open spaces and, in this way, act as a guide for urban designers in this respect.

Keywords: flexible furniture, flexible design, urban open spaces, adaptability, moveability, social sustainability

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Authors: John Tolentino, Yong Seok Park

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There are currently many people living with limb loss in the USA. The main causes for amputation can range from vascular disease, to trauma, or cancer. This number is expected increase over the next decade. Many patients have a single prosthetic for the first year but end up getting a second one to accommodate their changing physique. Afterwards, the prosthesis gets replaced every three to five years depending on how often it is used. This could cost the patient up to $500,000 throughout their lifetime. Complications do not end there, however. Due to the absence of nerves, it becomes more difficult to traverse terrain with a prosthetic. Moving on an incline or decline becomes difficult, thus curbs and stairs can be a challenge. Certain physical activities, such as cycling, could be even more strenuous. It will need to be relearned to accommodate for the change in weight, center of gravity, and transfer of energy from the leg to the pedal. The purpose of this research project is to develop a new, alternate below-knee cycling prosthetic using Dieter & Schmidt’s design process approach. It will be subjected to fatigue analysis under dynamic loading to observe the limitations as well as the strengths and weaknesses of the prosthetic. Benchmark comparisons will be made between existing prosthetics and the proposed one, examining the benefits and disadvantages. The resulting prosthetic will be 3D printed using acrylonitrile butadiene styrene (ABS) or polycarbonate (PC) plastic.

Keywords: 3D Printing, Cycling, Prosthetic design, Synthetic design.

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Authors: Yasuyuki Takahashi, Genta Hoshi, Kyoko Saito

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Objectives: The objective of this study was to evaluate the reproducibility of I-123-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4- iodophenyl) nortropane (I-123 FP-CIT) SPECT by using specific binding ratio (SBR) in phantom studies and Parkinson’s Disease (PD) patients. Methods: We made striatum phantom originally and confirmed reproducibility. The phantom studies changed head position and accumulation of FP-CIT, each. And image processing confirms influence on SBR by 30 cases. 30 PD received a SPECT for 3 hours post injection of I-123 FP-CIT 167MBq. Results: SBR decreased in rotatory direction by the patient position by the phantom studies. And, SBR improved the influence after the attenuation and the scatter correction in the cases (y=0.99x+0.57 r2=0.83). However, Stage II recognized dispersion in SBR by low accumulation. Conclusion: Than the phantom studies that assumed the normal cases, the SPECT image after the attenuation and scatter correction had better reproducibility.

Keywords: 123I-FP-CIT, specific binding ratio, Parkinson’s disease

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Authors: Megan Burfoot, Shanta Budha-Magar, Ali Ghaffarianhoseini, Amirhoseini Ghaffarianhoseini

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Domestic backyards offer a valuable opportunity to contribute to biodiversity conservation efforts and promote ecological sustainability by cultivating native plant species. This study focuses on assessing the presence and maintenance of native plants in New Zealand's residential gardens through an online questionnaire. The survey was designed to collect data on the presence of native, exotic, and lawn plants in New Zealand backyards, alongside the allocation of maintenance resources for each category. Targeting a diverse range of residents and property sizes from different regions of New Zealand, this study sought to gain essential insights into practices related to native plant cultivation. Results reveal there is a collective inclination to reduce lawn coverage and introduce a higher abundance of native and exotic species. A thorough analysis of maintenance practices reveals a significant portion of respondents embracing environmentally friendly gardening, characterized by low-intensity fertilizer usage. Homeowners, especially those residing in their properties, demonstrate proactive engagement in backyard maintenance. Native plants were found to require more time, money and fertilizer for maintenance than those of exotic and lawn species. The insights gained from this study can guide targeted efforts to enhance urban biodiversity, making a significant contribution to the preservation and enrichment of New Zealand's unique biodiversity and ecological heritage in urban settings.

Keywords: biodiversity, backyards, planting behaviour, backyard maintenance, native planting

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Authors: Jalil Salimi, Mandana Asadi, Naser Fathi

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Urmia Lake (UL) has undergone a significant decline in water levels, resulting in severe environmental, socioeconomic, and health-related challenges. This paper examines the restoration process of UL from a water governance perspective. By applying a water governance model, the study evaluates the process based on six selected principles: stakeholder engagement, transparency and accountability, effectiveness, equitable water use, adaptation capacity, and water usage efficiency. The dominance of structural and physicalist approaches to water governance has led to a weak understanding of social and environmental issues, contributing to social crises. Urgent efforts are required to address the water crisis and reform water governance in the country, making water-related issues a top national priority. The UL restoration process has achieved significant milestones, including stakeholder consensus, scientific and participatory planning, environmental vision, intergenerational justice considerations, improved institutional environment for NGOs, investments in water infrastructure, transparency promotion, environmental effectiveness, and local issue resolutions. However, challenges remain, such as power distribution imbalances, bureaucratic administration, weak conflict resolution mechanisms, financial constraints, accountability issues, limited attention to social concerns, overreliance on structural solutions, legislative shortcomings, program inflexibility, and uncertainty management weaknesses. Addressing these weaknesses and challenges is crucial for the successful restoration and sustainable governance of UL.

Keywords: evaluation, restoration process, Urmia Lake, water governance, water resource management

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Authors: Maryam Panahiazar, Andrew M. Bishara, Yorick Chern, Roohallah Alizadehsani, Dexter Hadleye, Ramin E. Beygui

Abstract:

Early detection plays a crucial role in enhancing the outcome for a patient with coronary artery disease (CAD). We utilized a big data analytics platform on ~23,000 patients with CAD from a total of 960,129 UCSF patients in 8 years. We traced the patients from their first encounter with a physician to diagnose and treat CAD. Characteristics such as demographic information, comorbidities, vital, lab tests, medications, and procedures are included. There are statistically significant gender-based differences in patients younger than 60 years old from the time of the first physician encounter to coronary artery bypass grafting (CABG) with a p-value=0.03. There are no significant differences between the patients between 60 and 80 years old (p-value=0.8) and older than 80 (p-value=0.4) with a 95% confidence interval. This recognition would affect significant changes in the guideline for referral of the patients for diagnostic tests expeditiously to improve the outcome by avoiding the delay in treatment.

Keywords: electronic medical records, coronary artery disease, data analytics, young women

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Authors: Renjith George Pallivathukal, Preethy Mary Donald

Abstract:

Asymptomatic oral lesions are often ignored by the patients and usually will be identified only in advanced stages. Early detection of precancerous lesions is important for better prognosis. It is also important for the oral health care person to be aware of the regional prevalence of oral lesions in order to provide early care for the same. We conducted a retrospective study to assess the prevalence of oral lesions based on the information available from patient records in a teaching dental school. Dental records of patients who attended the department of Oral medicine and diagnosis between September 2014 and September 2016 were retrieved and verified for oral lesions. Results: The ages of the patients ranged from 13 to 38 years with a mean age of 21.8 years. The lesions were classified as white (40.5%), red (23%), ulcerated (10.5%), pigmented (15.2%) and soft tissue enlargements (10.8%). 52% of the patients were unaware of the oral lesions before the dental visit. Overall, the prevalence of lesions in dental patients lower to national estimates, but the prevalence of some lesions showed variations.

Keywords: oral mucosal lesion, pre-cancer, prevalence, soft tissue lesion

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Authors: Sarah Jacqueline Saram, Diya Baker, Jaishree Gandhewar

Abstract:

Named after the Slovakian microbiologist, Miroslav Kocur, the Kocuria spp. are an emerging cause of significant human infections. Their predilection for immunocompromised states, such as malignancy and metabolic disorders, is highlighted in the literature. The coagulase-negative, gram-positive cocci are commensals found in the skin and oropharynx of humans, and their growing presence as responsible organisms in ocular infections cannot be ignored. The severe, rapid, and unrelenting disease course associated with Kocuria keratitis is underlined in the literature. However, the clinical features are variable, which may impede making a diagnosis. Here, we describe a first account of an initial misdiagnosis due to reliance on subjective analysis features on a confocal microscope, which ultimately led to a delay in commencing the correct treatment. In documenting this, we hope to underline to clinicians the difficulties in recognising a Kocuria Rhizophilia keratitis due to its similar clinical presentation to an Acanthamoeba Keratitis, thus emphasizing the need for early investigations such as corneal scrapes to secure the correct diagnosis and prevent further harm and vision loss for the patient.

Keywords: keratitis, cornea, infection, rare, Kocuria

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Authors: K. Bensafia, A. Mansour, G. Le Maillot, B. Clement, O. Reynet, P. Ariès, S. Haddab

Abstract:

This paper presents a system designed for wireless acquisition, the recording of electrocardiogram (ECG) signals and the monitoring of the heart’s health during surgery. This wireless recording system allows us to visualize and monitor the state of the heart’s health during a surgery, even if the patient is moved from the operating theater to post anesthesia care unit. The acquired signal is transmitted via a Bluetooth unit to a PC where the data are displayed, stored and processed. To test the reliability of our system, a comparison between ECG signals processed by a conventional ECG monitoring system (Datex-Ohmeda) and by our wireless system is made. The comparison is based on the shape of the ECG signal, the duration of the QRS complex, the P and T waves, as well as the position of the ST segments with respect to the isoelectric line. The proposed system is presented and discussed. The results have confirmed that the use of Bluetooth during surgery does not affect the devices used and vice versa. Pre- and post-processing steps are briefly discussed. Experimental results are also provided.

Keywords: electrocardiography, monitoring, surgery, wireless system

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Authors: Amjad Al Shammari, Ashraf Ibrahim, Laila Seada

Abstract:

Background and Objectives: Incidence of thyroid carcinoma has been increasing world-wide. In the present study, we evaluated diagnostic accuracy of Fine needle aspiration (FNA) and its efficiency in early detecting neoplastic lesions of thyroid gland over a 3-year period. Methods: Data have been retrieved from pathology files in King Khalid Hospital. For each patient, age, gender, FNA, site & size of nodule and final histopathologic diagnosis were recorded. Results: Study included 490 cases where 419 of them were female and 71 male. Male to female ratio was 1:6. Mean age was 43 years for males and 38 for females. Cases with confirmed histopathology were 131. In 101/131 (77.1%), concordance was found between FNA and histology. In 30/131 (22.9%), there was discrepancy in diagnosis. Total malignant cases were 43, out of which 14 (32.5%) were true positive and 29 (67.44%) were false negative. No false positive cases could be found in our series. Conclusion: FNA could diagnose benign nodules in all cases, however, in malignant cases, ultrasound findings have to be taken into consideration to avoid missing of a microcarcinoma in the contralateral lobe.

Keywords: FNA, hail, histopathology, thyroid

Procedia PDF Downloads 336

Authors: W. Mazari, K. Boucherit, Z. Boucherit-Otmani, M. N. Rahmoun, M. Benabdallah

Abstract:

The hospital or any other establishment of care can be considered as an ecosystem where the patient comes into contact with a frightening microbial universe and a risk to contract infection that is referred to as nosocomial or health care-associated. In these last years, the incidence of these infections has risen sharply. Several microorganisms are the cause of these nosocomial infections and the emergence of resistance of the microbial strains against antibiotics creates a danger to public health. The search for new antimicrobial agents to overcome this problem has produced interesting compounds through chemical synthesis, which plays a very important role in the research and discovery of new drugs. It is in this framework that our study was conducted at our laboratory and it involves evaluating the antibacterial activity of thirteen 2-pyridone derivatives synthesized by two methods, the diffusion disc method and the dilution method against eight Gram negative bacterial strains. The results seem interesting especially for two products that have shown the best activities against Escherichia coli ATCC 25922 and Enterobacter cloacae ATCC 13047 with CMI of 512µg/ml.

Keywords: heterocyclic derivatives, chemical synthesis, antimicrobial activity, biotechnology

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Authors: Bar Y. Ainuz, Harry M. Salinas, Aleeza Ali, Eli B. Levitt, Austin J. Pourmoussa, Antoun Bouz, Miguel A. Medina

Abstract:

Introduction: Breast conservation therapy remains the mainstay surgical treatment for early breast cancer. Oncoplastic techniques, in conjunction with lumpectomy and adjuvant radiotherapy, have been demonstrated to achieve good aesthetic results without adversely affecting cancer outcomes in the treatment of patients with macromastia or significant ptosis. In our patient population, many women present for breast conservation with pre-existing cosmetic implants or with breast volumes too small for soft tissue, only oncoplastic techniques. Our study evaluated a consecutive series of patients presenting for breast conservation undergoing concomitant oncoplastic-augmentation-mastopexy (OAM) with a contralateral augmentation-mastopexy for symmetry. Methods: OAM surgical technique involves simultaneous lumpectomy with exchange or placement of implants, oncoplastic mastopexy, and concomitant contralateral augmentation mastopexy for symmetry. Patients undergoing lumpectomy for breast conservation as outpatients were identified via retrospective chart review at a high volume private academic affiliated community-based cancer center. Patients with ptosis and either pre-existing breast implants or insufficient breast volume undergoing oncoplastic implant placement (or exchange) and mastopexy were included in the study. Operative details, aesthetic outcomes, and complications were assessed. Results: Over a continuous three-year period, with a two-surgeon cohort, 30 consecutive patients (56 breasts, 4 unilateral procedures) were identified. Patients had an average age of 52.5 years and an average BMI of 27.5, with 40% smokers or former smokers. The average operative time was 2.5 hours, the average implant size removed was 352 cc, and the average implant size placed was 300 cc. All new implants were smooth silicone, with the majority (92%) placed in a retropectoral fashion. 40% of patients received chemotherapy, and 80% of patients received whole breast adjuvant photon radiotherapy with a total radiation dose of either 42.56 or 52.56 Gy. The average and median length of follow-up were both 8.2 months. Of the 24 patients that received radiotherapy, 21% had asymmetry due to capsular contracture. A total of 7 patients (29.2%) underwent revisions for either positive margins (12.5%), capsular contracture (8.3%), implant loss (4.2%), or cosmetic concerns (4.2%). One patient developed a pulmonary embolism in the acute postoperative period and was treated with anticoagulant therapy. Conclusion: Oncoplastic augmentation mastopexy is a safe technique with good aesthetic outcomes and acceptable complication rates for ptotic patients with breast cancer and a paucity of breast volume or pre-existing implants who wish to pursue breast-conserving therapy. The revision rates compare favorably with single-stage cosmetic augmentation procedures as well as other oncoplastic techniques described in the literature. The short-term capsular contracture rates seem lower than the rates in patients undergoing radiation after mastectomy and implant-based reconstruction. Long term capsular contractures and revision rates are too early to know in this cohort.

Keywords: breast conserving therapy, oncoplastic augmentation mastopexy, capsular contracture, breast reconstruction

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