Search results for: clinical decision support sytem

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

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

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

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Authors: Elizabeth Howarth, Dawn Green, Sean Connolly, Geena Vabulas, Sara Smolley

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Through the EU Horizon 2020 Nuvoic Project, the project team recruited 70 individuals in the UK and Ireland to test the Voiceitt speech recognition app and provide user feedback to developers. The app is designed for people with dysarthric speech, to support communication with unfamiliar people and access to speech-driven technologies such as smart home equipment and smart assistants. Participants with atypical speech, due to a range of conditions such as cerebral palsy, acquired brain injury, Down syndrome, stroke and hearing impairment, were recruited, primarily through organisations supporting disabled people. Most had physical or learning disabilities in addition to dysarthric speech. The project team worked with individuals, their families and local support teams, to provide access to the app, including through additional assistive technologies where needed. Testing was user-led, with participants asked to identify and test use cases most relevant to their daily lives over a period of three months or more. Ongoing technical support and training were provided remotely and in-person throughout the testing period. Structured interviews were used to collect feedback on users' experiences, with delivery adapted to individuals' needs and preferences. Informal feedback was collected through ongoing contact between participants, their families and support teams and the project team. Focus groups were held to collect feedback on specific design proposals. User feedback shared with developers has led to improvements to the user interface and functionality, including faster voice training, simplified navigation, the introduction of gamification elements and of switch access as an alternative to touchscreen access, with other feature requests from users still in development. This work offers a case-study in successful and inclusive co-design with the disabled community.

Keywords: co-design, assistive technology, dysarthria, inclusive speech recognition

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Authors: Sushil Kumar Singh, Vivek Tewarson, Sarvesh Kumar, Shobhit Kumar

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Objective: ‘Beating Heart coronary artery bypass grafting on Intermittent Pump Support’ is a more reliable method of coronary revascularization that takes advantage of off and on-pump CABG while eliminating the disadvantage of both techniques. Methods: From January 2015 to December 2021, a new technique, “Intermittent On pump beating heart CABG” using a suction stabilizer was used by putting aortic and venous cannulas electively in all the patients. Patients were supported by a pump intermittently, as and when required (Group 1, n=254). Retrospective data were collected from our record of the patients who underwent off-pump CABG electively by the same surgeon and team (Group 2, n=254). Results: Significant advantage was noted in Group 1 patients in terms of the number of grafts (3.31 ± 1.16 vs. 2.30 ±0.66), grafting of lateral vessels (316 vs.202), mean operating time (1.37 ± 0.23 hrs vs. 2.22 ± 0.45 hrs) and postoperative blood loss (406.30 ± 257.90 ml vs. 567.41 ± 265.20 ml).CPB support time was less than 15 minutes in the majority of patients (n=179, 70.37 %), with a mean of 16.81 minutes. It was required, particularly during the grafting of lateral vessels. A rise in enzymes level (CRP, CKMB, Trop I, and NTPro BNP) was noted in Group 1 patients. But, these did not affect the postoperative course in patients. There was no mortality in Group 1 patients, while four patients in Group 2 died. Coclusions: Intermittent on-pump CABG technique is a promising method of surgical revascularization for all patients requiring CABG. It has shown its superiority in terms of safety, the number of grafts, operating time, and better perioperative course.

Keywords: cardiopulmonary bypass, CABG, beating heart CABG, on-pump CABG

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Authors: Melissa Dorsey

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Moral distress and compassion fatigue plague nurses in the Cardiothoracic Intensive Care Unit (CTICU) and cause an unnecessary level of turnover. Dueling Burnout describes an initiative that was implemented in the CTICU to reduce the level of burnout the nurses endure by encouraging dual roles with collaborating departments. Purpose: Critical care nurses are plagued by burnout, moral distress, and compassion fatigue due to the intensity of care provided. The purpose of the dual role program was to decrease these issues by providing relief from the intensity of the critical care environment while maintaining full-time employment. Relevance/Significance: Burnout, moral distress, and compassion fatigue are leading causes of Cardiothoracic Critical Care (CTCU) turnover. A contributing factor to burnout is the workload related to serving as a preceptor for a constant influx of new nurses (RN). As a result of these factors, the CTICU averages 17% nursing turnover/year. The cost, unit disruption, and, most importantly, distress of the clinical nurses required an innovative approach to create an improved work environment and experience. Strategies/Implementation/Methods: In May 2018, a dual role pilot was initiated for nurses. The dual role constitutes .6 full-time equivalent hours (FTE) worked in CTICU in combination with .3 FTE worked in the Emergency Department (ED). ED nurses who expressed an interest in cross-training to CTICU were also offered the dual role opportunity. The initial hypothesis was that full-time employees would benefit from a change in clinical setting leading to increased engagement and job satisfaction. The dual role also presents an opportunity for professional development through the expansion of clinical skills in another specialty. Success of the pilot led to extending the dual role to areas beyond the ED. Evaluation/Outcomes/Results: The number of dual role clinical nurses has grown to 22. From the dual role cohort, only one has transferred out of CTICU. This is a 5% turnover rate for this group of nurses as compared to the average turnover rate of 17%. A role satisfaction survey conducted with the dual role cohort found that because of working in a dual role, 76.5% decreased their intent to leave, 100% decreased their level of burnout, and 100% reported an increase in overall job satisfaction. Nurses reported the ability to develop skills that are transferable between departments. Respondents emphasized the appreciation gained from working in multiple environments; the dual role served to transform their care. Conclusions/Implications: Dual role is an effective strategy to retain experienced nurses, decrease burnout and turnover, improve collaboration, and provide flexibility to meet staffing needs. The dual role offers RNs an expansion of skills, relief from high acuity and orientee demands, while improving job satisfaction.

Keywords: nursing retention, burnout, pandemic, strategic staffing, leadership

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Authors: Martyn Queen, Diane Crone, Andrew Parker, Saul Bloxham

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Rationale: There is a growing body of evidence that supports the use of physical activity during and after cancer treatment. However, activity levels for patients remain low. As more cancer patients are treated successfully, and treatment costs continue to escalate, physical activity may be a promising adjunct to a person-centred healthcare approach to recovery. Aim: The aim was to further understand how physical activity may enhance the recovery process for a group of mixed-site cancer patients. Objectives: The research investigated longitudinal changes in physical activity and perceived the quality of life between two and six month’s post-exercise interventions. It also investigated support systems that enabled patients to sustain these perceived changes. Method: The respondent cohort comprised 14 mixed-site cancer patients aged 43-70 (11 women, 3 men), who participated in a two-phase physical activity intervention that took place at a university in the South West of England. Phase 1 consisted of an eight-week structured physical activity programme; Phase 2 consisted of four months of non-supervised physical activity. Semi-structured interviews took place three times over six months with each participant. Grounded theory informed the data collection and analysis which, in turn, facilitated theoretical development. Findings: Our findings propose three theories on the impact of physical activity for recovering cancer patients: 1) Knowledge gained through a structured exercise programme can enable recovering cancer patients to independently sustain physical activity to four-month follow-up. 2) Sustaining physical activity for six months promotes positive changes in the quality of life indicators of chronic fatigue, self-efficacy, the ability to self-manage and energy levels. 3) Peer support from patients facilitates adherence to a structured exercise programme and support from a spouse, or life partner facilitates independently sustained physical activity to four-month follow-up. Conclusions: This study demonstrates that qualitative research can provide an evidence base that could be used to support future care plans for cancer patients. Findings also demonstrate that a physical activity intervention can be effective at helping cancer patients recover from the side effects of their treatment, and recommends that physical activity should become an adjunct therapy alongside traditional cancer treatments.

Keywords: physical activity, health, cancer recovery, quality of life, support systems, qualitative, grounded theory, person-centred healthcare

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Authors: Ande Nesmith

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There is an ongoing shortage of foster parents worldwide to take on a growing population of children in need of out-of-home care. Currently, resources are primarily aimed at recruitment rather than retention. Retention rates are extraordinarily low, especially in the first two years of fostering. Qualitative interviews with 19 foster parents averaging 20 years of service provided insight into the challenges they faced and how they overcame them. Thematic analysis of interview transcripts identified sources of stress and resiliency. Key stressors included lack of support and responsiveness from the children’s social workers, false maltreatment allegations, and secondary trauma from children’s destructive behaviors and emotional dysregulation. Resilient parents connected with other foster parents for support, engaged in creative problem-solving, recognized that positive feedback from children usually arrives years later, and through training, understood the neurobiological impact of trauma on child behavior. Recommendations include coordinating communication between the foster parent licensing agency social workers and the children’s social workers, creating foster parent support networks and mentoring, and continuous training on trauma including effective parenting strategies. Research is needed to determine whether these resilience indicators in fact lead to long-term retention. Policies should include a mechanism to develop a cohesive line of communication and connection between foster parents and the children’s social workers as well as their respective agencies.

Keywords: foster care stability, foster parent burnout, foster parent resiliency, foster parent retention, trauma-informed fostering

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Authors: Yvonne Nanaama Brew, Bismark Jampim Abrokwah

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Children with disabilities in Ghana are not routinely registered, and this can imply that they may be neglected in national policy planning since global estimates may not be near the exact numbers. Although there are some studies with reports on the prevalence of disability among children in Ghana, reliable information on the prevalence, types of disability in children, and children who die with disabilities in the Greater Accra region are lacking. The current study seeks to investigate the incidence of disability among children two to fourteen years at selected districts in the Greater Accra region of Ghana. A cross-sectional design is adapted with a quantitative method for this study. Parents with disabled children who access child welfare clinics at the Greater Accra regional hospital, Maamobi hospital, Ga west, and Ga south district hospitals will be selected through purposive sampling for the study. An adapted UNICEF structured Ten Questions will be used to collect relevant data about participants. The responses to the questions will be either 'Yes' or 'No'. Parents with children who answer 'Yes' to a disability and purposively sampled parents with children who answer 'No' to disability will be invited to Child Health Clinic at the Greater Accra regional hospital for a free clinical assessment. Data will be entered into Microsoft Office Excel 2013 and imported into STATA version 15 for analysis. The study is expected to provide reliable disaggregated data on less than fourteen years of children with disabilities in the Greater Accra region. The findings and recommendations of the study will demonstrate the importance of early detection of disability and facilitate more quality and holistic planning of appropriate programmes that best safeguard the rights of children with disabilities in Ghana. It will help in policy and decision-making on children less than fourteen years with disabilities in Ghana. Also, findings will be useful for health facilities in Ghana to plan services for disabled children. Finally, the study is expected to add to the guides for the National Council of Persons with Disabilities to fulfill its legal mandate for disabled persons in Ghana.

Keywords: prevalence, disability, children, Ghana

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Authors: Itsuo Yokoyama, Rika Kikuti, Naoko Watabe

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Introduction: It has been known that chronic kidney disease (CKD) patients can benefit from physical exercise during dialysis therapy improving aerobic capacity, muscle function, cardiovascular function, and overall health-related quality of life. This study aimed to evaluate the effectiveness of dialysis rehabilitation. Materials and Methods: A total of 55 patients underwent two-hour resistance exercise training during each hemodialysis session for three consecutive months. Various routine clinical data were collected, including the calculation of the planar dimension of the muscle area in both upper legs at the level of the ischial bone. This area calculation was possible in 26 patients who had yearly plain abdominal computed tomography (CT) scans. DICOM files from the CT scans were used with 3D Slicer software for area calculation. An age and sex-matched group of 26 patients without dialysis rehabilitation also had yearly CT scans during the study period for comparison. Clinical data were compared between the two groups: Group A (rehabilitation) and Group B (non-rehabilitation). Results: There were no differences in basic laboratory data between the two groups. The average muscle area before and after rehabilitation in Group A was 212 cm² and 216 cm², respectively. In Group B, the average areas were 230.0 cm² and 225.8 cm². While there was no significant difference in absolute values, the average percentage increase in muscle area was +1.2% (ranging from -7.6% to 6.54%) for Group A and -2.0% (ranging from -12.1% to 4.9%) for Group B, which was statistically significant. In Group A, 9 of 26 were diabetic (DM), and 13 of 26 in Group B were non-DM. The increase in muscle area for DM patients was 4.9% compared to -0.7% for non-DM patients, which was significantly different. There were no significant differences between the two groups in terms of nutritional assessment, Kt/V, or incidence of clinical complications such as cardiovascular events. Considerations: Dialysis rehabilitation has been reported to prevent muscle atrophy by increasing muscle fibers and capillaries. This study demonstrated that muscle volume increased after dialysis exercise, as evidenced by the increased muscle area in the thighs. Notably, diabetic patients seemed to benefit more from dialysis exercise than non-diabetics. Although this study is preliminary due to its relatively small sample size, it suggests that intradialytic physical training may improve insulin utilization in muscle fiber cells, particularly in type II diabetic patients where insulin receptor function and signaling are altered. Further studies are needed to investigate the detailed mechanisms underlying the muscle hypertrophic effects of dialysis exercise.

Keywords: dialysis, excercise, muscle, hypertrophy, diabetes, insulin

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Authors: Nguyen Quang Kim, Nguyen Thu Hien, Nguyen Thien Dung

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Flood disasters are increasing worldwide in both frequency and magnitude. Every year in Vietnam, flood causes great damage to people, property, and environmental degradation. The flood risk management policy in Vietnam is currently updated. The planning of flood mitigation strategies is reviewed to make a decision how to reach sustainable flood risk reduction. This paper discusses the basic approach where the measures of flood protection are chosen based on minimizing the present value of expected monetary expenses, total residual risk and costs of flood control measures. This approach will be proposed and demonstrated in a case study for flood risk management in Vinh Phuc province of Vietnam. Research also proposed the framework to find a solution of optimal protection level and optimal measures of the flood. It provides an explicit economic basis for flood risk management plans and interactive effects of options for flood damage reduction. The results of the case study are demonstrated and discussed which would provide the processing of actions helped decision makers to choose flood risk reduction investment options.

Keywords: drainage plan, flood planning, flood risk, residual risk, risk optimization

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Authors: Ryotaro Ishikawa

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INTRODUCTION: Post-traumatic stress disorder (PTSD) is a psychiatric label for a collection of psychological symptoms following a traumatic event. PTSD is as a result of a traumatic experience such as rape or sexual assault. A victim may have PTSD if she/he has experienced the following symptoms for at least a month: a) Stressor, b) Intrusion symptoms, c) Avoidance, d) Negative alterations in cognitions and mood, e) Alterations in arousal and reactivity. Studies on the cognitive theory of PTSD emphasized the roles of (a) negative appraisals of trauma memories in maintaining the symptomatology of PTSD, and (b) disorganized trauma memories in the development of PTSD. Mental contamination is primarily caused by experiences involving humans (e.g. violators or perpetrators) as opposed to substances (e.g. dirt or bodily fluids). Feelings of mental contamination may evoke following experiences of ill-treatment, sexual assault, domination, degradation, manipulation, betrayal, or humiliation. Some studies have demonstrated that traumatic thoughts related to sexual assault are particularly strong predictors of mental contamination. Treatment protocols based on cognitive-behavioral therapy appear to be beneficial in reducing the severity of PTSD and mental contamination. Studies on the cognitive theory of PTSD emphasized the roles of (A) negative appraisals of trauma memories in maintaining the symptomatology of PTSD, and (B) disorganized trauma memories in the development of PTSD. We will demonstrate a feasibility study of individual CBT for PTSD and mental contamination in Japanese clinical settings. METHOD: The single-arm trial is a group setting CBT intervention. The primary outcome is the self-rated Posttraumatic Stress Diagnostic Scale, with secondary measurements of depressive severity and mental pollution questionnaire. Assessments are conducted at baseline, after a waiting period before CBT, during CBT, and after CBT. RESULTS: Participants are eligible for the study and complete the outcome measures at all assessment points. In our hypothesis, receiving CBT would lead to improvements in primary and secondary PTSD severity. CONCLUSION: We will demonstrate a feasibility study of individual CBT for PTSD and mental contamination in Japanese clinical settings. Our treatment would achieve favorable treatment outcomes for PTSD with mental contamination in Japanese clinical settings.

Keywords: CBT, cognitive theory, PTSD, mental pollution

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Authors: Wenquan Gan, Peiyu Zhao, Xinyu Zhao

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Under the background of the rapid development of China’s ageing population, ageing-in-place has become a primary strategy to cope with this problem promoted by the Chinese government. However, most older adults currently living in old residential communities are insufficient to support their ageing-in-place. Therefore, exploring how to retrofit existing communities towards ageing-friendly standards to support older adults is essential for healthy ageing. To better cope with this issue, this study aims to shed light on the inter-relationship among the built environment, daily activities, and well-being of older adults in urban China. Using mixed research methods including GPS tracking, structured observation, and in-depth interview to examine: (a) what specific places or facilities are most commonly used by the elderly in the ageing-in-place process; (b) what specific built environment characteristics attract older adults in these frequently used places; (c) how has the use of these spaces impacted the well-being of older adults. Specifically, structured observation and GPS are used to record and map the older residents’ behaviour and movement in Suzhou, China, a city with a highly aged population and suitable as a research case. Subsequently, a follow-up interview is conducted to explore what impact of activities and the built environment on their well-being. Results showed that for the elderly with good functional ability, the facilities promoted by the Chinese government to support ageing-in-place, such as community nursing homes for the aged, day-care centre, and activity centres for the aged, are rarely used by older adults. Additionally, older adults have their preferred activities and built environment characteristics that contribute to their well-being. Our findings indicate that a complex interrelationship between the built environment and activities can influence the well-being of the elderly. Further investigations are needed to understand how to support healthy ageing-in-place, especially in addition to providing permanent elder-ly-care facilities, but to attend to the design interventions that can enhance these particularly built environment characteristics to facilitate a healthy lifestyle in later life.

Keywords: older adults, built environment, spatial behavior, community activity, healthy ageing

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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: Keiko Shimazu, Yasuhiro Maida, Tetsuya Sugata, Daisuke Tamakoshi, Kenji Makabe, Haruki Suzuki

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In this paper, we report how to acquire serious victims’ locations in the Acute Stage of Large-scale Disasters, in an Emergency Information Network System designed by us. The background of our concept is based on the Great East Japan Earthquake occurred on March 11^th, 2011. Through many experiences of national crises caused by earthquakes and tsunamis, we have established advanced communication systems and advanced disaster medical response systems. However, Japan was devastated by huge tsunamis swept a vast area of Tohoku causing a complete breakdown of all the infrastructures including telecommunications. Therefore, we noticed that we need interdisciplinary collaboration between science of disaster medicine, regional administrative sociology, satellite communication technology and systems engineering experts. Communication of emergency information was limited causing a serious delay in the initial rescue and medical operation. For the emergency rescue and medical operations, the most important thing is to identify the number of casualties, their locations and status and to dispatch doctors and rescue workers from multiple organizations. In the case of the Tohoku earthquake, the dispatching mechanism and/or decision support system did not exist to allocate the appropriate number of doctors and locate disaster victims. Even though the doctors and rescue workers from multiple government organizations have their own dedicated communication system, the systems are not interoperable.

Keywords: crisis management, disaster mitigation, messing, MGRS, military grid reference system, satellite communication system

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Authors: Fai-Ho E. Choi, Wing-Tung Au

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This study investigated the effects of embodiment on conflict management. As shown in the research literature, the physiological (i.e. bodily postures) can affect the emotional and cognitive proceedings of human beings, but little has been shown on whether such effects would have ramifications in decision-making related to other individuals. In this study, conflict is defined as when two parties have seemingly incompatible goals, and the two have to deal with each other in order to maximize one’s own gain. In a matched-gender experiment, university undergraduate students were randomly assigned to either the high power condition or the low power condition, with participants in each condition instructed to perform a fix set of bodily postures that would either embody them with a high sense of power or a low sense of power. One high-power participant would pair up with a low-power participant to engage in an integrative bargaining task and a dictator game. Participants also filled out a pre-trial questionnaire and a post-trial questionnaire measuring general sense of power, self-esteem and self-efficacy. Personality was controlled for. Results are expected to support our hypotheses that people who are embodied with power will be more unyielding in a conflict management situation, and that people who are dealing with another person embodied with power will be more yielding in a conflict management situation. As conflicts arise frequently both within and between organizations, a better understanding of how human beings function in conflicts is important. This study should provide evidence that bodily postures can influence the perceived sense of power of the parties involved and hence influence the conflict outcomes. Future research needs to be conducted to investigate further how people perceive themselves and how they perceive their opponents in conflicts, such that we can come up with a behavioral theory of conflict management.

Keywords: conflict management, embodiment, negotiation, perception

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Authors: John Toussaint

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Objective: Our society is suffering from an epidemic of body image dissatisfaction, and related disorders appear to be increasing globally for children. There is much to indicate that children's body image and eating attitudes are being affected negatively by socio-cultural factors such as parents, peers and media. Most studies and theories, however, have focused extensively on the daughter-mother relationship. Very few studies have investigated the role of attachment to the father as an important factor in the development of girls’ and women’s attitudes towards themselves and their bodies. Recently, data have shown that the father’s parenting style, as well as the quality of the relationship with him is crucial for the understanding of the development and persistence of body image disorders. This presentation is based on samples of participants with self-defined body image dissatisfaction, and the self-reported measures of their fathers’ parental behaviours, emotional warmth, support, or protection. Attachment theory does offer support in exploring these relationships and it is used in this presentation to assist in understanding the relationship between the father and his daughter in relation to body image and mental health. Clinical implications are also offered in respect to work with body image, eating disorders and relational therapy. Methods: As awareness of the increasing frequency of body image concerns in children grows, so too does the need for a simple, valid and reliable measure of body image. The Children's Body Image Scale (CBIS) designed in Australia, depicts seven male and females figures from which children are to choose their perceived body type and ideal body type. This was compared with a range of international body mass index (BMI) reference standards. These measures together with individual one-on-one interviews were completed by 158 children aged 7-12 years. Results: A high frequency of body image dissatisfaction was indicated in the children's responses. 55% of girls and 41% of boys said they would like to be thinner, and wished for an ideal BMI figure below the 10th percentile. This is an unhealthy and unattainable level of body fatness for the majority of children when considered in relation to the reported secular trend of their increasing average body size. Thin children were generally ranked as best and perceived as kind, happy, academically skilled, and socially successful. Fat children were perceived as unintelligent, lazy, greedy, unpopular, and unable to play physical games. Conclusions: Body image ideals and fat stereotypes are well entrenched among children. There is much to indicate that children's body image and eating attitudes are being affected negatively by sociocultural factors such as parents, peers and media. Teachers and health professionals could promote intervention programs for children involving knowledge and acceptance of genetic influences on body type; the dangerous effects of weight loss dieting; the importance of physical activity and eating healthy; and scepticism and critical analysis of mass media messages.

Keywords: body image, father attachment, mental health, eating disorders

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Authors: Douglas A. Menezes, Isabel D. Nunes, Ulrich Schiel

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Most Virtual Learning Environments do not provide support mechanisms for the integrated planning, construction and follow-up of Instructional Design supported by Learning Analytic results. The present work aims to present an authoring tool that will be responsible for constructing the structure of an Instructional Design (ID), without the data being altered during the execution of the course. The visual interface aims to present the critical situations present in this ID, serving as a support tool for the course follow-up and possible improvements, which can be made during its execution or in the planning of a new edition of this course. The model for the ID is based on High-Level Petri Nets and the visualization forms are determined by the specific kind of the data generated by an e-course, a population of students generating sequentially dependent data.

Keywords: educational data visualization, high-level petri nets, instructional design, learning analytics

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Authors: Ka C. Lam, Oluwafunmibi S. Idowu

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Uncertainty in cost is a major factor affecting performance of construction projects. To our knowledge, several conceptual cost models have been developed with varying degrees of accuracy. Incorporating conceptual quantities into conceptual cost models could improve the accuracy of early predesign cost estimates. Hence, the development of quantity models for estimating conceptual quantities of framed reinforced concrete structures using supervised machine learning is the aim of the current research. Using measured quantities of structural elements and design variables such as live loads and soil bearing pressures, response and predictor variables were defined and used for constructing conceptual quantities models. Twenty-four models were developed for comparison using a combination of non-parametric support vector regression, linear regression, and bootstrap resampling techniques. R programming language was used for data analysis and model implementation. Gross soil bearing pressure and gross floor loading were discovered to have a major influence on the quantities of concrete and reinforcement used for foundations. Building footprint and gross floor loading had a similar influence on beams and slabs. Future research could explore the modelling of other conceptual quantities for walls, finishes, and services using machine learning techniques. Estimation of conceptual quantities would assist construction planners in early resource planning and enable detailed performance evaluation of early cost predictions.

Keywords: bootstrapping, conceptual quantities, modelling, reinforced concrete, support vector regression

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Authors: Caio E. G. Reis, Sara Wassell, Adriana L. Porto, Angélica A. Amato, Leslie J. C. Bluck, Teresa H. M. da Costa

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Background: Multiple epidemiologic studies have consistently reported association between increased coffee consumption and a lowered risk of Type 2 Diabetes Mellitus. However, the mechanisms behind this finding have not been fully elucidated. Objective: We investigate the effect of coffee (caffeinated and decaffeinated) on glucose effectiveness and insulin sensitivity using the stable isotope minimal model protocol with oral glucose administration in healthy men. Design: Fifteen healthy men underwent 5 arms randomized crossover single-blinding (researchers) clinical trial. They consumed decaffeinated coffee, caffeinated coffee (with and without sugar), and controls – water (with and without sugar) followed 1 hour by an oral glucose tolerance test (75 g of available carbohydrate) with intravenous labeled dosing interpreted by the two compartment minimal model (225 minutes). One-way ANOVA with Bonferroni adjustment were used to compare the effects of the tested beverages on glucose metabolism parameters. Results: Decaffeinated coffee resulted in 29% and 85% higher insulin sensitivity compared with caffeinated coffee and water, respectively, and the caffeinated coffee showed 15% and 60% higher glucose effectiveness compared with decaffeinated coffee and water, respectively. However, these differences were not significant (p > 0.10). In overall analyze (0 – 225 min) there were no significant differences on glucose effectiveness, insulin sensitivity, and glucose and insulin area under the curve between the groups. The beneficial effects of coffee did not seem to act in the short-term (hours) on glucose metabolism parameters mainly on insulin sensitivity indices. The benefits of coffee consumption occur in the long-term (years) as has been shown in the reduction of Type 2 Diabetes Mellitus risk in epidemiological studies. The clinical relevance of the present findings is that there is no need to avoid coffee as the drink choice for healthy people. Conclusions: The findings of this study demonstrate that the consumption of caffeinated and decaffeinated coffee with or without sugar has no acute effects on glucose metabolism in healthy men. Further researches, including long-term interventional studies, are needed to fully elucidate the mechanisms behind the coffee effects on reduced risk for Type 2 Diabetes Mellitus.

Keywords: coffee, diabetes mellitus type 2, glucose, insulin

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Authors: Kayla Renteria

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This study explored the role animal-assisted psychotherapy (AAP) can play in treating Post-Traumatic Stress Disorder (PTSD) when incorporated into Trauma-informed cognitive behavioral therapy (TF-CBT). A review of the literature was performed to show how incorporating AAP could benefit TF-CBT since this treatment model often presents difficulties, such as client motivation and avoidance of the exposure element of the intervention. In addition, the fluidity of treatment goals during complex trauma cases was explored, as this issue arose in the case study. This study follows the course of treatment of a 12-year-old female presenting with symptoms of PTSD. Treatment consisted of traditional components of the TF-CBT model, with the added elements of AAP to address typical treatment obstacles in TF-CBT. A registered therapy dog worked with the subject in all sessions throughout her treatment. The therapy dog was incorporated into components such as relaxation and coping techniques, narrative therapy techniques, and psychoeducation on the cognitive triangle. Throughout the study, the client’s situation and clinical needs required the therapist to switch goals to focus on current safety and stability. The therapy dog provided support and neurophysiological benefits to the client through AAP during this shift in treatment. The client was assessed quantitatively using the Child PTSD Symptom Scale Self Report for DSM-5 (CPSS-SR-5) before and after therapy and qualitatively through a feedback form given after treatment. The participant showed improvement in CPSS-SR-V scores, and she reported that the incorporation of the therapy animal improved her therapy. The results of this study show how the use of AAP provided the client a solid, consistent relationship with the therapy dog that supported her through processing various types of traumas. Implications of the results of treatment and for future research are discussed.

Keywords: animal-assisted therapy, trauma-focused cognitive behavioral therapy, PTSD in children, trauma treatment

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Authors: Horesh Reinman Netta

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Objectives: To examine the relationship between stressful life events and recurrent major depressive disorders Methods: Three groups of 50 subjects were assessed. One group had a recurrent major depressive disorder with melancholic features; the second group met the criteria for borderline personality disorder, and the third consisted of healthy controls. The Structured Clinical Interview for AXIS I DSM-IV Disorders sand the Structured Clinical Interview for AXIS II DSM-IV Disorders were used for diagnosis. The Israel Psychiatric Epidemiology Research Interview (IPERI) Life Event Scale and the Coddington Life Events Schedule (CLES) were used to measure life events which were confirmed with a confirmatory semi-structured interview. The Beck Depression Inventory and the Satisfaction from Life scales were also administered. Results : The total number of loss-related events in childhood and in the year preceding the first episode was significantly higher in the affective disorder group than in the two control groups. Total number of LE, uncontrolled and independent events were also more common in the depressed patients in the year preceding the first episode. No category of SLE was differentiated among any of the three groups during any period of time following the first depressive episode. Conclusions: SLE play an important role in the onset of affective disorders. There appear to be specific kinds of SLE occurring in childhood and in the year preceding a first episode that have particular significance. SLE may have a lesser role in the maintenance of this illness.

Keywords: modd dosorders, recurrent depression, stress, life events

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Authors: F. Fabeil Noor, Roslinah Mahmud, Janice L. H. Nga, Rasid Mail

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In Malaysia, particularly in Sabah, the government has been promoting entrepreneurship among rural people to encourage them to earn their living by making good use of the diverse natural resources and local cultures of Sabah. Nevertheless, despite the government’s aim to encourage more local community in rural area to involve in entrepreneurship, the involvement of community in entrepreneurial activity is still low. It is crucial to identify the factors stimulate (or prevent) the involvement of rural community in Sabah in entrepreneurial activity. Therefore, this study tries to investigate the personal and contextual factors that may have impact on decision to start a business among the local community in Mantanani Island. In addition, this study also aims to identify the perceived benefits they receive from entrepreneurial activity. A structured face-to-face interview was conducted with 61 local communities in Mantanani Island. Data analysis revealed that passion, personal skills and self-confidence are the significant internal factors to entrepreneurial activity, whereas access to finance, labour and infrastructure are the significant external factors that are found to influence entrepreneurship. In terms of perceived rewards they received from taking up small business, it was found that respondents are predominantly agreed that entrepreneurship offers financial benefit than non-financial. In addition, this study also offers several suggestions for entrepreneurship development in Mantanani Island and it is hoped that this study may help the related agency to develop effective support policies in order to encourage more people in rural area to involve in entrepreneurship.

Keywords: entrepreneurship, motivation, perceived rewards, rural community

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Authors: Anmari Viljamaa, Elina Varamäki

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In this study we compare the profiles of transitory hybrid entrepreneurs and persistent hybrid entrepreneurs to determine how they differ. Hybrid entrepreneurs (HEs) represent a significant share of entrepreneurial activity yet little is known about them. We define HEs as individuals who are active as entrepreneurs but do no support themselves primarily by their enterprise. Persistent HEs (PHEs) are not planning to transition to fulltime entrepreneurship whereas transitory HEs (THEs) consider it probable. Our results show that THEs and PHEs are quite similar in background. THEs are more interested in increasing their turnover than PHEs, as expected, but also emphasize self-fulfillment as a motive for entrepreneurship more than PHEs. The clearest differences between THEs and PHEs are found in their views on how well their immediate circle supports full-time entrepreneurship, and their views of their own entrepreneurial abilities and the market potential of their firm. Our results support earlier arguments that hybrids should be considered separately in research on entrepreneurial entry and self-employment.

Keywords: hybrid entrepreneurship, part-time entrepreneurship, self-employment, Theory of Planned Behavior

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Authors: Jihene Bettaieb, Ghassen kharroubi, Rym mallekh, Ines Cherif, Taoufik Atawa, Kaouther Harrabech

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Brucellosis is a major worldwide zoonosis. It is a reportable condition in Tunisia where the disease remains endemic, especially in rural areas. The aim of this study was to describe the epidemiological, clinical, and bacteriological profile of human brucellosis cases notified in the district of Tunis. It was a retrospective descriptive study of cases reported in the district of Tunis through the national surveillance system between the 1st January and 31th December 2017. During the study period, 133 brucellosis confirmed cases were notified. The mean age was 37.5 ± 18.0 years, and 54.9% of cases were males. More than four-fifths (82.7%) of cases were reported in spring and summer with a peak in the month of May (36 cases). Fever and sweats were the most common symptoms; they occurred in 95% and 72% of cases, respectively. Osteoarticular complications occurred in 10 cases, meningitis in one case and endocarditis in one other case. Wright agglutination test and Rose Bengale test were positive in 100% and 91% of cases, respectively. While blood culture was positive in 9 cases and PCR in 2 cases. Brucella melitensis was the only identified specie (9 cases). Almost all cases (99.2%) reported the habit of consuming raw dairy products. Only 5 cases had a suspect contact with animals; among them, 3 persons were livestock breeders. The transmission was essentially due to raw dairy product consumption. It is important to enhance preventive measures to control animal Brucellosis and to educate the population regarding the risk factors of the disease.

Keywords: brucellosis, risk factors, surveillance system, Tunisia

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Authors: F. Ruiz-Navarro, M. Matzner, G. Kobinia

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Background: Cerebral palsy (CP) encompasses the largest group of childhood movement disorders, the patterns and severity varies widely. Today, the management focuses only on a rehabilitation therapy that tries to secure the functions remained and prevents complications. However the treatments are not aimed to cure the disease. Stem cells (SCs) transplant via intrathecal is a new approach to the disease. Method: Our aim was to performed a pilot study under the condition of unproven treatment on clinical practice to assessed the safety and efficacy of Neuron Point-of-care Stem cell Therapy (N-POCST), an ambulatory procedure of autologous bone marrow derived SCs (BM-SCs) harvested from the posterior superior iliac crest undergo an on-site cell separation for intrathecal infusion via lumbar puncture. Results: 82 patients were treated in a period of 28 months, with a follow-up after 6 months. They had a mean age of 6,2 years old and male predominance (65,9%). Our preliminary results show that: A. No patient had any major side effects, B. Only 20% presented mild headache due to LP, C. 53% of the patients had an improvement in spasticity, D. 61% improved the coordination abilities, 23% improved the motor function, 15% improved the speech, 23% reduced the number of convulsive events with the same doses or less doses of anti-convulsive medication and 94% of the patients report a subjective general improvement. Conclusions: These results support previous worldwide publications that described the safety and effectiveness of autologous BM-SCs transplant for patients wit CP.

Keywords: autologous transplant, cerebral palsy, point of care, childhood movement disorders

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Authors: S. Valarmathi, P. B. Harathi, R. Sridhar, S. Balasubramanian

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Machine learning tools in medical diagnosis is increasing due to the improved effectiveness of classification and recognition systems to help medical experts in diagnosing breast cancer. In this study, ID3 chooses the splitting attribute with the highest gain in information, where gain is defined as the difference between before the split versus after the split. It is applied for age, location, taluk, stage, year, period, martial status, treatment, heredity, sex, and habitat against Very Serious (VS), Very Serious Moderate (VSM), Serious (S) and Not Serious (NS) to calculate the gain of information. The ranked histogram gives the gain of each field for the breast cancer data. The doctors use TNM staging which will decide the risk level of the breast cancer and play an important decision making field in fuzzy logic for perception based measurement. Spatial risk area (taluk) of the breast cancer is calculated. Result clearly states that Coimbatore (North and South) was found to be risk region to the breast cancer than other areas at 20% criteria. Weighted value of taluk was compared with criterion value and integrated with Map Object to visualize the results. ID3 algorithm shows the high breast cancer risk regions in the study area. The study has outlined, discussed and resolved the algorithms, techniques / methods adopted through soft computing methodology like ID3 algorithm for prognostic decision making in the seriousness of the breast cancer.

Keywords: ID3 algorithm, breast cancer, fuzzy logic, MATLAB

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Authors: Tarek Dandashi

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WSNs may provide a fast and reliable solution for the early detection of environment events like forest fires. This is crucial for alerting and calling for fire brigade intervention. Sensor nodes communicate sensor data to a host station, which enables a global analysis and the generation of a reliable decision on a potential fire and its location. A WSN with TinyOS and nesC for the capturing and transmission of a variety of sensor information with controlled source, data rates, duration, and the records/displaying activity traces is presented. We propose a similarity distance (SD) between the distribution of currently sensed data and that of a reference. At any given time, a fire causes diverging opinions in the reported data, which alters the usual data distribution. Basically, SD consists of a metric on the Cumulative Distribution Function (CDF). SD is designed to be invariant versus day-to-day changes of temperature, changes due to the surrounding environment, and normal changes in weather, which preserve the data locality. Evaluation shows that SD sensitivity is quadratic versus an increase in sensor node temperature for a group of sensors of different sizes and neighborhood. Simulation of fire spreading when ignition is placed at random locations with some wind speed shows that SD takes a few minutes to reliably detect fires and locate them. We also discuss the case of false negative and false positive and their impact on the decision reliability.

Keywords: forest fire, WSN, wireless sensor network, algortihm

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Authors: Yuri Melis, Mattia Resteghini, Emanuela Apicella, Eugenia Dozio, Leonardo Mendolicchio

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Aim: This retrospective study was created to analyze the psychometric, anthropometric and body composition values in patients at the beginning and the discharge of their of hospitalization in the residential care clinic for eating and feeding disorders (EFD’s). Method: The sample was composed by (N=59) patients with mean age N= 33,50, divided in subgroups: Anorexia Nervosa (AN) (N=28), Bulimia Nervosa (BN) (N=13) and Binge Eating Disorders (BED) (N=14) recruited from a residential care clinic for eating and feeding disorders. The psychometrics level was measured with self-report questionnaires: Eating Disorders Inventory-3 (EDI-3) The Body Uneasiness Test (BUT), Minnesota Multiphasic Personality Inventory (MMPI – 2). The anthropometric and nutritional values was collected by Body Impedance Assessment (B.I.A), Body mass index (B.M.I.). Measurements were made at the beginning and at the end of hospitalization, with an average time of recovery of about 8,6 months. Results: The all data analysis showed a statistical significance (p-value >0,05 | power size N=0,950) in variation from T0 (start of recovery) to T1 (end of recovery) in the clinical scales of MMPI-2, AN group (Hypocondria T0 64,14 – T1 56,39) (Depression T0 72,93 – T1 59,50) (Hysteria T0 61,29 – T1 56,17) (Psychopathic deviation T0 64,00 – T1 60,82) (Paranoia T0 63,82 – T1 56,14) (Psychasthenia T0 63,82 – T1 57,86) (Schizophrenia T0 64,68 – T1 60,43) (Obsessive T0 60,36 – T1 55,68); BN group (Hypocondria T0 64,08 – T1 47,54) (Depression T0 67,46 – T1 52,46) (Hysteria T0 60,62 – T1 47,84) (Psychopathic deviation T0 65,69 – T1 58,92) (Paranoia T0 67,46 – T1 55,23) (Psychasthenia T0 60,77 – T1 53,77) (Schizophrenia T0 64,68 – T1 60,43) (Obsessive T0 62,92 – T1 54,08); B.E.D groups (Hypocondria T0 59,43 – T1 53,14) (Depression T0 66,71 – T1 54,57) (Hysteria T0 59,86 – T1 53,82) (Psychopathic deviation T0 67,39 – T1 59,03) (Paranoia T0 58,57 – T1 53,21) (Psychasthenia T0 61,43 – T1 53,00) (Schizophrenia T0 62,29 – T1 56,36) (Obsessive T0 58,57 – T1 48,64). EDI-3 report mean value is higher than clinical cut-off at T0, in T1, there is a significant reduction of the general mean of value. The same result is present in the B.U.T. test in the difference between T0 to T1. B.M.I mean value in AN group is (T0 14,83 – T1 18,41) BN group (T0 20 – T1 21,33) BED group (T0 42,32 – T1 34,97) Phase Angle results: AN group (T0 4,78 – T1 5,64) BN (T0 6 – T1 6,53) BED group (T0 6 – T1 6,72). Discussion and conclusion: The evident presence that on the whole sample, we have an altered serious psychiatric and clinic conditions at the beginning of recovery. The interesting conclusions that we can draw from this analysis are that a multidisciplinary approach that includes the entire care of the subject: from the pharmacological treatment, analytical psychotherapy, Psychomotricity, nutritional rehabilitation, and rehabilitative, educational activities. Thus, this Multidisciplinary treatment allows subjects in our sample to be able to restore psychopathological and metabolic values to below the clinical cut-off.

Keywords: feeding and eating disorders, anorexia nervosa, care clinic treatment, multidisciplinary treatment

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Authors: Martin Doran, Roy Sterritt, George Wilkie

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NASA, ESA, and NSSC space agencies have plans to put planetary rovers on Mars in 2020. For these future planetary rovers to succeed, they will heavily depend on sensors to detect obstacles. This will also become of vital importance in the future, if rovers become less dependent on commands received from earth-based control and more dependent on self-configuration and self-decision making. These planetary rovers will face harsh environments and the possibility of hardware failure is high, as seen in missions from the past. In this paper, we focus on using Autonomic principles where self-healing, self-optimization, and self-adaption are explored using the MAPE-K model and expanding this model to encapsulate the attributes such as Awareness, Analysis, and Adjustment (AAA-3). In the experimentation, a Pioneer P3-DX research robot is used to simulate a planetary rover. The sonar sensors on the P3-DX robot are used to simulate the sensors on a planetary rover (even though in reality, sonar sensors cannot operate in a vacuum). Experiments using the P3-DX robot focus on how our software system can be adapted with the loss of sonar sensor functionality. The autonomic manager system is responsible for the decision making on how to make use of remaining ‘enabled’ sonars sensors to compensate for those sonar sensors that are ‘disabled’. The key to this research is that the robot can still detect objects even with reduced sonar sensor capability.

Keywords: autonomic, self-adaption, self-healing, self-optimization

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Authors: Zahra Shokrolahi, Mohammad Reza Atashzar

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The goals of treating patients with breast cancer are to cure the disease, prolong survival, and improve quality of life. Immune cells in the tumor microenvironment have an important role in regulating tumor progression. The term of cellular immunotherapy refers to the administration of living cells to a patient; this type of immunotherapy can be active, such as a dendritic cell (DC) vaccine, in that the cells can stimulate an anti-tumour response in the patient, or the therapy can be passive, whereby the cells have intrinsic anti-tumour activity; this is known as adoptive cell transfer (ACT) and includes the use of autologous or allogeneic lymphocytes that may, or may not, be modified. The most important breast cancer cellular immunotherapies involving the use of T cells and natural killer (NK) cells in adoptive cell transfer, as well as dendritic cells vaccines. T cell-based therapies including tumour-infiltrating lymphocytes (TILs), engineered TCR-T cells, chimeric antigen receptor (CAR T cell), Gamma-delta (γδ) T cells, natural killer T (NKT) cells. NK cell-based therapies including lymphokine-activated killers (LAK), cytokine-induced killer (CIK) cells, CAR-NK cells. Adoptive cell therapy has some advantages and disadvantages some. TILs cell strictly directed against tumor-specific antigens but are inactive against tumor changes due to immunoediting. CIK cell have MHC-independent cytotoxic effect and also need concurrent high dose IL-2 administration. CAR T cell are MHC-independent; overcome tumor MHC molecule downregulation; potent in recognizing any cell surface antigen (protein, carbohydrate or glycolipid); applicable to a broad range of patients and T cell populations; production of large numbers of tumor-specific cells in a moderately short period of time. Meanwhile CAR T cells capable of targeting only cell surface antigens; lethal toxicity due to cytokine storm reported. Here we present the most popular cancer cellular immunotherapy approaches and discuss their clinical relevance referring to data acquired from clinical trials .To date, clinical experience and efficacy suggest that combining more than one immunotherapy interventions, in conjunction with other treatment options like chemotherapy, radiotherapy and targeted or epigenetic therapy, should guide the way to cancer cure.

Keywords: breast cancer , cell therapy , CAR T cell , CIK cells

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Authors: Jameela Ali, Hamid A. Jalab, Loay E. George, Abdul Rahim Ahmad, Azizah Suliman, Karim Al-Jashamy

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Red blood cells (RBC) are the most common types of blood cells and are the most intensively studied in cell biology. The lack of RBCs is a condition in which the amount of hemoglobin level is lower than normal and is referred to as “anemia”. Abnormalities in RBCs will affect the exchange of oxygen. This paper presents a comparative study for various techniques for classifying the RBCs as normal, or abnormal (anemic) using WEKA. WEKA is an open source consists of different machine learning algorithms for data mining applications. The algorithm tested are Radial Basis Function neural network, Support vector machine, and K-Nearest Neighbors algorithm. Two sets of combined features were utilized for classification of blood cells images. The first set, exclusively consist of geometrical features, was used to identify whether the tested blood cell has a spherical shape or non-spherical cells. While the second set, consist mainly of textural features was used to recognize the types of the spherical cells. We have provided an evaluation based on applying these classification methods to our RBCs image dataset which were obtained from Serdang Hospital-alaysia, and measuring the accuracy of test results. The best achieved classification rates are 97%, 98%, and 79% for Support vector machines, Radial Basis Function neural network, and K-Nearest Neighbors algorithm respectively.

Keywords: K-nearest neighbors algorithm, radial basis function neural network, red blood cells, support vector machine

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