Search results for: surgery outcome

Authors: Ogunmefun Folorunsho Muyideen, Aluko Tolulope Evelyn

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One of the trending menaces faced in the world today is centered on the porosity of borders and proliferation of illegal weapons among the state members without the state authorizations. The proliferation of weapons along porous borders remains a germane and unsolvable question among developed and developing nations due to crisis degenerated from the menace (loss of lives, properties, traumatization, civil unrest and retrogressive economic development). A mixed method was adopted while the survey method was used for communities’ selection (Oke-Odan, Ajilete, Illaise, Lanlate) at Ipokia Local Government as a sample frame. Multi-stage sampling was employed to break down the site into wards, streets, and different house numbers before randomizing administration of the questionnaires using face to face method, while purposive sampling was used for collecting verbal information through an in-depth interviews method. The population size for the site is 150.398, while 399 was the sample size derived from the use of Yamane sample size formula. After retrieval of structured questionnaires, 346 were found useful, while 10 percent (399) of the quantitative instruments was summed to 30 participants that were interviewed using the in-depth interviews technique. The result of the first hypothesis shows a composite relationship between the variables tested (independents and dependent). The result indicated that the porosity of the border, illegal possession of guns, and limited security staff jointly predispose insecurity among the residents of the selected study site. The result of the second hypothesis deciphers that the illegal gun possession (independent) variable predict business outcome among the residents of the study site because sporadic gun shoot will regress the business activities in the study area. The result of third result indicated that the independent (porosity of borders) variable predict social bonding network because a high level of insecurity will destroy the level of trust in the communication among the residents of the study area. The last questions give comprehensive meaning to one of the recommendations derived using content systematic analysis, which explains that out of 30 participants interviewed, 18 submitted individual involvement in monitoring communities will solve the problem, 7 out of 30 opines that governmental agents are to be trained for effective combat, 3 participants out 30 submits that the fight is for both government and the citizens while 2 participants out of 30 claimed that there must be an agreement between Nigerian and neighbouring countries on border security. International donors must totally control the sales of weapons to unauthorized personalities. Criminal cases must be treated with deterrence measures and target hardened procedures through decoying and blending, stakeout, and sting tactics.

Keywords: human security, illegal weapons, porous borders, development

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Authors: Ripon Sarkar, Kabita Chaterjee, Ananya Barui

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Smoking is one of the leading causes of oral cancer. Cigarette smoke affects various cellular parameters and alters molecular metabolism of cells. Epithelial cells losses their cytoskeleton structure, membrane integrity, cellular polarity that subsequently initiates the process of epithelial cells to mesenchymal transition due to long exposure of cigarette smoking. It changes the normal cellular metabolic activity which induces oxidative stress and enhances the reactive oxygen spices (ROS) formation. Excessive ROS and associated oxidative stress are considered to be a driving force in alteration in cellular phenotypes, polarity distribution and mitochondrial metabolism. Noninvasive assessment of such parameters plays essential role in development of routine screening system for early diagnosis of oral cancer. Electrical cell-substrate impedance sensing (ECIS) is one of such method applied for detection of cellular membrane impedance which can be correlated to cell membrane integrity. Present study intends to explore the alteration in cellular impedance along with the expression of cellular polarity molecules and cytoskeleton distributions in oral epithelial cells of habitual smokers and to correlate the outcome to that of clinically diagnosed oral leukoplakia and oral squamous cell carcinoma patients. Total 80 subjects were categorized into four study groups: nonsmoker (NS), cigarette smoker (CS), oral leukoplakia (OLPK) and oral squamous cell carcinoma (OSCC). Cytoskeleton distribution was analyzed by staining of actin filament and generation of ROS was measured using assay kit using standard protocol. Cell impedance was measured through ECIS method at different frequencies. Expression of E-cadherin and protease-activated receptor (PAR) proteins were observed through immune-fluorescence method. Distribution of actin filament is well organized in NS group however; distribution pattern was grossly varied in CS, OLPK and OSCC. Generation of ROS was low in NS which subsequently increased towards OSCC. Expressions of E-cadherin and change in cellular electrical impedance in different study groups indicated the hallmark of cancer progression from NS to OSCC. Expressions of E-cadherin, PAR protein, and cell impedance were decreased from NS to CS and farther OSCC. Generally, the oral epithelial cells exhibit apico-basal polarity however with cancer progression these cells lose their characteristic polarity distribution. In this study expression of polarity molecule and ECIS observation indicates such altered pattern of polarity among smoker group. Overall the present study monitored the alterations in intracellular ROS generation and cell metabolic function, membrane integrity in oral epithelial cells in cigarette smokers. Present study thus has clinical significance, and it may help in developing a noninvasive technique for early diagnosis of oral cancer amongst susceptible individuals.

Keywords: cigarette smoking, early oral cancer detection, electric cell-substrate impedance sensing, noninvasive screening

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Authors: Ashima Sharma

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Human Serum Albumin (HSA)- one of the most demanded therapeutic proteins with immense biotechnological applications- is a large multidomain protein containing 17 disulfide bonds. The current source of HSA is human blood plasma which is a limited and unsafe source. Thus, there exists an indispensable need to promote non-animal derived recombinant HSA (rHSA) production. Escherichia coli is one of the most convenient hosts which had contributed to the production of more than 30% of the FDA approved recombinant pharmaceuticals. It grows rapidly and reaches high cell density using inexpensive and simple substrates. E. coli derived recombinant products have more economic potential as fermentation processes are cheaper compared to the other expression hosts. The major bottleneck in exploiting E. coli as a host for a disulfide-rich multidomain protein is the formation of aggregates of overexpressed protein. The majority of the expressed HSA forms inclusion bodies (more than 90% of the total expressed rHSA) in the E. coli cytosol. Recovery of functional rHSA from inclusion bodies is not preferred because it is difficult to obtain a large multidomain disulfide bond rich protein like rHSA in its functional native form. Purification is tedious, time-consuming, laborious and expensive. Because of such limitations, the E. coli host system was neglected for rHSA production for the past few decades despite its numerous advantages. In the present work, we have exploited the capabilities of E. coli as a host for the enhanced functional production of rHSA (~60% of the total expressed rHSA in the soluble fraction). Parameters like intracellular environment, temperature, induction type, duration of induction, cell lysis conditions etc. which play an important role in enhancing the level of production of the desired protein in its native form in vivo have been optimized. We have studied the effect of assistance of different types of exogenously employed chaperone systems on the functional expression of rHSA in the E. coli host system. Different aspects of cell growth parameters during the production of rHSA in presence and absence of molecular chaperones in E. coli have also been studied. Upon overcoming the difficulties to produce functional rHSA in E. coli, it has been possible to produce significant levels of functional protein through engineering the biological system of protein folding in the cell, the E. coli-derived rHSA has been purified to homogeneity. Its detailed physicochemical characterization has been performed by monitoring its conformational properties, secondary and tertiary structure elements, surface properties, ligand binding properties, stability issues etc. These parameters of the recombinant protein have been compared with the naturally occurring protein from the human source. The outcome of the comparison reveals that the recombinant protein resembles exactly the same as the natural one. Hence, we propose that the E. coli-derived rHSA is an ideal biosimilar for human blood plasma-derived serum albumin. Therefore, in the present study, we have introduced and promoted the E. coli- derived rHSA as an alternative to the preparation from a human source, pHSA.

Keywords: recombinant human serum albumin, Escherichia coli, biosimilar, chaperone assisted protein folding

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Authors: Reuben Newell, Edward Archer, Alistair McIlhagger, Calvin Ralph

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Modern industry has developed a need for innovative 3D composite materials due to their attractive material properties. Composite materials are composed of a fibre reinforcement encased in a polymer matrix. The fibre reinforcement consists of warp, weft and binder yarns or tows woven together into a preform. The mechanical performance of composite material is largely controlled by the properties of the preform. As a result, the bulk of recent textile research has been focused on the design of high-strength preform architectures. Studies looking at optimisation of the weaving process have largely been neglected. It has been reported that yarns experience varying levels of damage during weaving, resulting in filament breakage and ultimately compromised composite mechanical performance. The weaving parameters involved in causing this yarn damage are not fully understood. Recent studies indicate that poor yarn tension control may be an influencing factor. As tension is increased, the yarn-to-yarn and yarn-to-weaving-equipment interactions are heightened, maximising damage. The correlation between yarn tension variation and weaving damage severity has never been adequately researched or quantified. A novel study is needed which accesses the influence of tension variation on the mechanical properties of woven yarns. This study has looked to quantify the variation of yarn tension throughout weaving and sought to link the impact of tension to weaving damage. Multiple yarns were randomly selected, and their tension was measured across the creel and shedding stages of weaving, using a hand-held tension meter. Sections of the same yarn were subsequently cut from the loom machine and tensile tested. A comparison study was made between the tensile strength of pristine and tensioned yarns to determine the induced weaving damage. Yarns from bobbins at the rear of the creel were under the least amount of tension (0.5-2.0N) compared to yarns positioned at the front of the creel (1.5-3.5N). This increase in tension has been linked to the sharp turn in the yarn path between bobbins at the front of the creel and creel I-board. Creel yarns under the lower tension suffered a 3% loss of tensile strength, compared to 7% for the greater tensioned yarns. During shedding, the tension on the yarns was higher than in the creel. The upper shed yarns were exposed to a decreased tension (3.0-4.5N) compared to the lower shed yarns (4.0-5.5N). Shed yarns under the lower tension suffered a 10% loss of tensile strength, compared to 14% for the greater tensioned yarns. Interestingly, the most severely damaged yarn was exposed to both the largest creel and shedding tensions. This study confirms for the first time that yarns under a greater level of tension suffer an increased amount of weaving damage. Significant variation of yarn tension has been identified across the creel and shedding stages of weaving. This leads to a variance of mechanical properties across the woven preform and ultimately the final composite part. The outcome from this study highlights the need for optimised yarn tension control during preform manufacture to minimize yarn-induced weaving damage.

Keywords: optimisation of preform manufacture, tensile testing of damaged tows, variation of yarn weaving tension, weaving damage

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Authors: Mangala. Sadasivan, Mary Hughes, Bryan Kelly

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Medical Education must focus on bridging the gap between teaching and learning when training pre-clinical year students in skills needed to keep up with medical knowledge and to meet the demands of health care in the future. The authors were interested in showing that a 3-S Model (building strength, developing stamina, and increasing speed) using a bridged curriculum design helps connect teaching and learning and improves students’ retention of basic science and clinical knowledge. The authors designed three learning modules using the 3-S Model within a systems course in a pre-clerkship medical curriculum. Each module focused on a bridge (concept map) designed by the instructor for specific content delivered to students in the course. This with-in-subjects design study included 304 registered MSU osteopathic medical students (3 campuses) ranked by quintile based on previous coursework. The instructors used the bridge to create self-directed learning exercises (building strength) to help students master basic science content. Students were video coached on how to complete assignments, and given pre-tests and post-tests designed to give them control to assess and identify gaps in learning and strengthen connections. The instructor who designed the modules also used video lectures to help students master clinical concepts and link them (building stamina) to previously learned material connected to the bridge. Boardstyle practice questions relevant to the modules were used to help students improve access (increasing speed) to stored content. Unit Examinations covering the content within modules and materials covered by other instructors teaching within the units served as outcome measures in this study. This data was then compared to each student’s performance on a final comprehensive exam and their COMLEX medical board examinations taken some time after the course. The authors used mean comparisons to evaluate students’ performances on module items (using 3-S Model) to non-module items on unit exams, final course exam and COMLEX medical board examination. The data shows that on average, students performed significantly better on module items compared to non-module items on exams 1 and 2. The module 3 exam was canceled due to a university shut down. The difference in mean scores (module verses non-module) items disappeared on the final comprehensive exam which was rescheduled once the university resumed session. Based on Quintile designation, the mean scores were higher for module items than non-module items and the difference in scores between items for Quintiles 1 and 2 were significantly better on exam 1 and the gap widened for all Quintile groups on exam 2 and disappeared in exam 3. Based on COMLEX performance, all students on average as a group, whether they Passed or Failed, performed better on Module items than non-module items in all three exams. The gap between scores of module items for students who passed COMLEX to those who failed was greater on Exam 1 (14.3) than on Exam 2 (7.5) and Exam 3 (10.2). Data shows the 3-S Model using a bridge effectively connects teaching and learning

Keywords: bridging gap, medical education, teaching and learning, model of learning

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Authors: Varun Joshi, M. S. Rawat

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The Indian Himalayan Region (IHR) is inherently fragile and susceptible to landslide hazard due to its extremely weak geology, highly rugged topography and heavy monsoonal rainfall. One of the most common hazards in the IHR is landslide, and this event is particularly frequent in Himalayan states of India i.e. Jammu & Kashmir, Himachal Pradesh, Uttarakhand, Sikkim, Manipur and Arunachal Pradesh. Landslides are mostly triggered by extreme rainfall events but the incidence increases during monsoon months (June to September). Natural slopes which are otherwise stable but they get destabilized due to anthropogenic activities like construction of various developmental activities and deforestation. These activities are required to fulfill the developmental needs and upliftment of societal status in the region. Landslides also trigger during major earthquakes and reported most observable and damaging phenomena. Studies indicate that the landslide phenomenon has increased many folds due to developmental activities in Himalayan region. Gradually increasing and devastating consequences of landslides turned into one of the most important hydro-geological hazards in Himalayan states especially in Uttarakhand and Sikkim states of India. The recent most catastrophic rainfall in June 2013 in Uttarakhand lead to colossal loss of life and property. The societal damage due to this incident is still to be recovered even after three years. Sikkim earthquake of September 2011 is witnessed for triggering of large number of coseismic landslides. The rescue and relief team faced huge problem in helping the trapped villagers in remote locations of the state due to road side blockade by landslides. The recent past incidences of landslides in Uttarakhand, as well as Sikkim states, created a new domain of research in terms of understanding the phenomena of landslide and management of disaster in such situation. Every year at many locations landslides trigger which force dwellers to either evacuate their dwelling or lose their life and property. The communication and transportation networks are also severely affected by landslides at several locations. Many times the drinking water supply disturbed and shortage of daily need household items reported during monsoon months. To minimize the severity of landslide in IHR requires in-depth research and developmental planning. For most of the areas in the present study, landslide hazard zonation is done on 1:50,000 scale. The land use planning maps on extensive basis are not available. Therefore, there is a need of large-scale landslide hazard zonation and land use planning maps. If the scientist conduct research on desired aspects and their outcome of research is utilized by the government in developmental planning then the incidents of landslide could be minimized, subsequent impact on society, life and property would be reduced. Along with the scientific research, there is another need of awareness generation in the region for stake holders and local dwellers to combat with the landslide hazard, if triggered in their location.

Keywords: coseismic, Indian Himalayan Region, landslide hazard zonation, Sikkim, societal, Uttarakhand

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Authors: Ifeyinwa Victor-Uadiale, Georgina Pearson, Sophie Witter, D. Reidpath

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Introduction: Smoking, alcohol misuse, unhealthy diet, and physical inactivity are the primary drivers of noncommunicable diseases (NCD), including cardiovascular diseases, cancers, respiratory diseases, and diabetes, worldwide. Collectively, these diseases are the leading cause of all global deaths, most of which are premature, affecting people between 30 and 70 years. Empirical evidence suggests that these risk behaviors can be modified by community-based interventions (CBI). However, there is little insight into the mechanisms and contextual factors of successful community interventions that impact risk behaviours for chronic diseases. This study examined “Under what circumstances, for whom, and how, do community-based interventions modify smoking, alcohol use, unhealthy diet, and physical inactivity among adults”. Adopting the Capability (C), Opportunity (O), Motivation (M), Behavior (B) (COM-B) framework for behaviour change, it sought to: (1) identify the mechanisms through which CBIs could reduce tobacco use and alcohol consumption and increase physical activity and the consumption of healthy diets and (2) examine the contextual factors that trigger the impact of these mechanisms on these risk behaviours among adults. Methods: Pawson’s realist review method was used to examine the literature. Empirical evidence and theoretical understanding were combined to develop a realist program theory that explains how CBIs influence NCD risk behaviours. Documents published between 2002 and 2020 were systematically searched in five electronic databases (CINAHL, Cochrane Library, Medline, ProQuest Central, and PsycINFO). They were included if they reported on community-based interventions aimed at cardiovascular diseases, cancers, respiratory diseases, and diabetes in a global context; and had an outcome targeted at smoking, alcohol, physical activity, and diet. Findings: Twenty-nine scientific documents were retrieved and included in the review. Over half of them (n = 18; 62%) focused on three of the four risk behaviours investigated in this review. The review identified four mechanisms: capability, opportunity, motivation, and social support that are likely to change the dietary and physical activity behaviours in adults given certain contexts. There were weak explanations of how the identified mechanisms could likely change smoking and alcohol consumption habits. In addition, eight contextual factors that may affect how these mechanisms impact physical activity and dietary behaviours were identified: suitability to work and family obligations, risk status awareness, socioeconomic status, literacy level, perceived need, availability and access to resources, culture, and group format. Conclusion: The findings suggest that CBIs are likely to improve the physical activity and dietary habits of adults if the intervention function seeks to educate, incentivize, change the environment, and model the right behaviours. The review applies and advances theory, realist research, and the design and implementation of community-based interventions for NCD prevention.

Keywords: community-based interventions, noncommunicable disease, realist program theory, risk behaviors

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Authors: Shreya Saxena

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Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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Authors: Sean Yao Zu Kong, Khong Yik Chew

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Introduction: We described a case report of the successful use of advanced surgical techniques in a patient with recurrent breast cancer who underwent a wide resection including the hemi-sternum, clavicle, multiple ribs, and a lobe of the lung due to tumor involvement. This extensive resection exposed critical structures, requiring a creative approach to reconstruction. To address this complex chest wall reconstruction, a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap were successfully utilized. The use of a free vascularized bone flap allowed for rapid osteointegration and resistance against osteoradionecrosis after adjuvant radiation, while a four-zone tram flap allowed for reconstruction of both the chest wall and breast mound. Although limited recipient vessels made free flaps challenging, the free fibula flap served as both a bony reconstruction and vascular conduit, supercharged with the distal peroneal artery and veins of the peroneal artery from the fibula graft. Our approach highlights the potential of advanced surgical techniques to improve outcomes in complex cases of chest wall reconstruction in patients with recurrent breast cancer, which is becoming increasingly relevant as breast cancer incidence rates increases. Case presentation: This report describes a successful reconstruction of a patient with recurrent breast cancer who required extensive resection, including the anterior chest wall, clavicle, and sternoclavicular joint. Challenges arose due to the loss of accessory muscles and the non-rigid rib cage, which could lead to compromised ventilation and instability. A free fibula osteocutaneous flap and a four-zone TRAM flap with vascular supercharging were utilized to achieve long-term stability and function. The patient has since fully recovered, and during the review, both flaps remained viable, and chest mound reconstruction was satisfactory. A planned nipple/areolar reconstruction was offered pending the patient’s decision after adjuvant radiotherapy. Conclusion: In conclusion, this case report highlights the successful use of innovative surgical techniques in addressing a complex case of recurrent breast cancer requiring extensive resection and radical reconstruction. Our approach, utilized a combination of a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap, demonstrates the potential for advanced techniques in chest wall reconstruction to minimize complications and ensure long-term stability and function. As the incidence of breast cancer continues to rise, it is crucial that healthcare professionals explore and utilize innovative techniques to improve patient outcomes and quality of life.

Keywords: free fibula flap, rectus abdominis musculocutaneous flap, post-adjuvant radiotherapy, reconstructive surgery, malignancy

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Authors: Pinar Erturk, Sevde Altuntas, Fatih Buyukserin

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In order to obtain an effective integration between an implant and a bone, implant surfaces should have similar properties to bone tissue surfaces. Especially mimicry of the chemical, mechanical and topographic properties of the implant to the bone is crucial for fast and effective osseointegration. Titanium-based biomaterials are more preferred in clinical use, and there are studies of coating these implants with oxide layers that have chemical/nanotopographic properties stimulating cell interactions for enhanced osseointegration. There are low success rates of current implantations, especially in craniofacial implant applications, which are large and vital zones, and the oxide layer coating increases bone-implant integration providing long-lasting implants without requiring revision surgery. Our aim in this study is to examine bone-cell behavior on titanium implants with an aluminum oxide layer (AAO) on effective osseointegration potential in the deformation of large zones with difficult spontaneous healing. In our study, aluminum layer coated titanium surfaces were anodized in sulfuric, phosphoric, and oxalic acid, which are the most common used AAO anodization electrolytes. After morphologic, chemical, and mechanical tests on AAO coated Ti substrates, viability, adhesion, and mineralization of adult bone cells on these substrates were analyzed. Besides with atomic layer deposition (ALD) as a sensitive and conformal technique, these surfaces were coated with pure alumina (5 nm); thus, cell studies were performed on ALD-coated nanoporous oxide layers with suppressed ionic content too. Lastly, in order to investigate the effect of the topography on the cell behavior, flat non-porous alumina layers on silicon wafers formed by ALD were compared with the porous ones. Cell viability ratio was similar between anodized surfaces, but pure alumina coated titanium and anodized surfaces showed a higher viability ratio compared to bare titanium and bare anodized ones. Alumina coated titanium surfaces, which anodized in phosphoric acid, showed significantly different mineralization ratios after 21 days over other bare titanium and titanium surfaces which anodized in other electrolytes. Bare titanium was the second surface that had the highest mineralization ratio. Otherwise, titanium, which is anodized in oxalic acid electrolyte, demonstrated the lowest mineralization. No significant difference was shown between bare titanium and anodized surfaces except AAO titanium surface anodized in phosphoric acid. Currently, osteogenic activities of these cells on the genetic level are investigated by quantitative real-time polymerase chain reaction (qRT-PCR) analysis results of RUNX-2, VEGF, OPG, and osteopontin genes. Also, as a result of the activities of the genes mentioned before, Western Blot will be used for protein detection. Acknowledgment: The project is supported by The Scientific and Technological Research Council of Turkey.

Keywords: alumina, craniofacial implant, MG-63 cell line, osseointegration, oxalic acid, phosphoric acid, sulphuric acid, titanium

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Authors: K. K. Balavenkatraman, B. Bertschi, K. Bigot, A. Grevot, A. Doelemeyer, S. D. Chibout, A. Wolf, F. Pognan, N. Manevski, O. Kretz, P. Swart, K. Litherland, J. Ashton-Chess, B. Ling, R. Wettstein, D. J. Schaefer

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Skin toxicity is poorly detected during preclinical studies, and drug-induced side effects in humans such as rashes, hyperplasia or more serious events like bullous pemphigus or toxic epidermal necrolysis represent an important hurdle for clinical development. In vitro keratinocyte-based epidermal skin models are suitable for the detection of chemical-induced irritancy, but do not recapitulate the biological complexity of full skin and fail to detect potential serious side-effects. Normal healthy skin explants may represent a valuable complementary tool, having the advantage of retaining the full skin architecture and the resident immune cell diversity. This study investigated several conditions for the maintenance of good morphological structure after several days of culture and the retention of phase II metabolism for 24 hours in skin explants in vitro. Human skin samples were collected with informed consent from patients undergoing plastic surgery and immediately transferred and processed in our laboratory by removing the underlying dermal fat. Punch biopsies of 4 mm diameter were cultured in an air-liquid interface using transwell filters. Different cultural conditions such as the effect of calcium, temperature and cultivation media were tested for a period of 14 days and explants were histologically examined after Hematoxylin and Eosin staining. Our results demonstrated that the use of Williams E Medium at 32°C maintained the physiological integrity of the skin for approximately one week. Upon prolonged incubation, the upper layers of the epidermis become thickened and some dead cells are present. Interestingly, these effects were prevented by addition of EGFR inhibitors such as Afatinib or Erlotinib. Phase II metabolism of the skin such as glucuronidation (4-methyl umbeliferone), sulfation (minoxidil), N-acetyltransferase (p-toluidene), catechol methylation (2,3-dehydroxy naphthalene), and glutathione conjugation (chlorodinitro benzene) were analyzed by using LCMS. Our results demonstrated that the human skin explants possess metabolic activity for a period of at least 24 hours for all the substrates tested. A time course for glucuronidation with 4-methyl umbeliferone was performed and a linear correlation was obtained over a period of 24 hours. Longer-term culture studies will indicate the possible evolution of such metabolic activities. In summary, these results demonstrate that human skin explants maintain a normal structure for several days in vitro and are metabolically active for at least the first 24 hours. Hence, with further characterisation, this model may be suitable for the study of drug-induced toxicity.

Keywords: human skin explant, phase II metabolism, epidermal growth factor receptor, toxicity

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Authors: Madan Chandra Maurya, A. R. Dar

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Among the entire natural calamities earthquake is the one which is most devastating. If the losses due to all other calamities are added still it will be very less than the losses due to earthquakes. So it means we must be ready to face such a situation, which is only possible if we make our structures earthquake resistant. A review of structural damages to the braced frame systems after several major earthquakes—including recent earthquakes—has identified some anticipated and unanticipated damage. This damage has prompted many engineers and researchers around the world to consider new approaches to improve the behavior of braced frame systems. Extensive experimental studies over the last fourty years of conventional buckling brace components and several braced frame specimens have been briefly reviewed, highlighting that the number of studies on the full-scale concentric braced frames is still limited. So for this reason the study surrounds the words plastic behavior, steel structure, brace frame system. In this study, there are two different analytical approaches which have been used to predict the behavior and strength of an un-braced frame. The first is referred as incremental elasto-plastic analysis a plastic approach. This method gives a complete load-deflection history of the structure until collapse. It is based on the plastic hinge concept for fully plastic cross sections in a structure under increasing proportional loading. In this, the incremental elasto-plastic analysis- hinge by hinge method is used in this study because of its simplicity to know the complete load- deformation history of two storey un-braced scaled model. After that the experiments were conducted on two storey scaled building model with and without bracing system to know the true or experimental load deformation curve of scaled model. Only way, is to understand and analyze these techniques and adopt these techniques in our structures. The study named as Plastic Behavior of Steel Frames using Different Concentric Bracing Configurations deals with all this. This study aimed at improving the already practiced traditional systems and to check the behavior and its usefulness with respect to X-braced system as reference model i.e. is how plastically it is different from X-braced. Laboratory tests involved determination of plastic behavior of these models (with and without brace) in terms of load-deformation curve. Thus, the aim of this study is to improve the lateral displacement resistance capacity by using new configuration of brace member in concentric manner which is different from conventional concentric brace. Once the experimental and manual results (using plastic approach) compared, simultaneously the results from both approach were also compared with nonlinear static analysis (pushover analysis) approach using ETABS i.e how both the previous results closely depicts the behavior in pushover curve and upto what limit. Tests results shows that all the three approaches behaves somewhat in similar manner upto yield point and also the applicability of elasto-plastic analysis (hinge by hinge method) to know the plastic behavior. Finally the outcome from three approaches shows that the newer one configuration which is chosen for study behaves in-between the plane frame (without brace or reference frame) and the conventional X-brace frame.

Keywords: elasto-plastic analysis, concentric steel braced frame, pushover analysis, ETABS

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Authors: Charlotte Bach, Albrecht Jahn, Mahnaz Motamedi, Maryam Karimi-Ghahfarokhi

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Background: Maternal and infant deaths are most prevalent in the first month after birth, emphasizing the critical need for quality healthcare services during this period. Immigrant women, who are more susceptible to adverse pregnancy outcomes, often face neglect in accessing proper healthcare. The lack of adequate postpartum care significantly contributes to mortality rates. Therefore, utilizing maternal health care services and implementing postpartum care is crucial in reducing maternal and child mortality. Aims: This study aims to evaluate the assessment of pre- and postnatal care among women with and without migration background. In addition, the study explores the impact of COVID-19 procedures on women's experiences during pregnancy, birth, and the postpartum period. Methods: This research employs a cross-sectional Mixed-Method design. Data collection was facilitated through structured questionnaires administered to participants, alongside the utilization of patient bases, including Maternity and child medical records. Following the assumption that the investigator aimed to gain comprehensive insights, qualitative sampling focused on individuals with substantial experiences related to COVID-19, regarded as rich cases. Results: our study highlighted the influence of educational level, marital status, and consensual partnerships on the likelihood of Cesarean deliveries. Regarding breastfeeding practices, migrant women exhibited higher rates of breastfeeding initiation and continuation. Contraception utilization revealed interesting patterns, with non-migrants displaying higher odds of contraceptive use. The qualitative component of our research adds depth to the exploration of women's experiences during the COVID-19 pandemic, revealing nuanced challenges related to anxiety, hospital restrictions, breastfeeding support, and postnatal ward routines. Conclusion: Dissimilarity among studies toward cesarean rate between migrants and non-migrants underscores the importance of targeted interventions considering the diverse needs of distinct population groups. It also acknowledges potential cultural, contextual, and healthcare system influences on the association between mode of delivery and infant feeding practices. Studies acknowledge the influence of contextual variables on contraceptive preferences among migrants and non-migrants, emphasizing the need for tailored healthcare policies. The findings contribute to existing research, highlighting the need for a nuanced understanding of the impact of birth preparation courses on maternal and infant outcomes. Furthermore, they emphasize the universality of certain maternity care experiences, regardless of pandemic contexts, reinforcing the importance of patient-centred approaches in healthcare delivery.

Keywords: migration background, pregnancy outcome, covid-19, postpartum

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Authors: Elaine Crable, Amit Sen

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Short-term study abroad programs have become a mainstay of MBA programs. The benefits of international business experiences, along with its exposure to global cultures, are well documented. However, developing a rewarding study, abroad program at the graduate level can be challenging for Faculty, especially when devising such a program for a group of part-time MBA students who come with a wide range of experiences and demographic characteristics. Each student has individual expectations for the study abroad experience. This study provides suggestions and considerations for Faculty that are planning to design a short-term study abroad program, especially for part-time MBA students. Insights are based on a recent experience leading a group of twenty-one students on a ten-day program to Morocco. The trip was designed and facilitated by two faculty members and a local Moroccan facilitator. This experience led to a number of insights and recommendations. First, the choice of location is critical. The choice of Morocco was very deliberate, owing to its multi-faceted cultural landscape and international business interest. It is an Islamic State with close ties to Europe both culturally and geographically and Morocco is a multi-lingual country with some combination of three languages spoken by most – English, Arabic, and French. Second, collaboration with a local ‘academic’ partner allowed the level of instruction to be both rigorous and significantly more engaging. Third, allowing students to participate in the planning of the trip enabled the trip participants to collaborate, negotiate, and share their own experiences and strengths. The pre-trip engagement was structured by creating four sub-groups, each responsible for an assigned city. Each student sub-group had to provide a historical background of the assigned city, plan the itinerary including sites to visit, cuisine to experience, industries to explore, markets to visit, plus provide a budget for that city’s expenses. The pre-planning segment of the course was critical for the success of the program as students were able to contribute to the design of the program through collaboration and negotiation with their peers. Fourth, each student sub-group was assigned industry to study within Morocco. The student sub-group prepared a presentation and a group paper with their analysis of the chosen industries. The pre-planning activities created strong bonds among the trip participants, which was evident when faced with on-ground challenges, especially when it was necessary to quickly evacuate due to a surprise USA COVID evacuation notice. The entire group supported each other when quickly making their way back to the United States. Unfortunately, the trip was cut short by two days due to this emergency exit, but the feedback regarding the program was very positive all around. While the program design put pressure on the Faculty leads regarding planning and coordination upfront, the outcome in terms of student engagement, student learning, collaboration and negotiation were all favorable and worth the effort. Finally, an added value, the cost of the program for the student was significantly lower compared to running a program with a professional provider.

Keywords: business education, experiential learning, international education, study abroad

Procedia PDF Downloads 154

Authors: Michela Del Vicario, Walter Quattrociocchi, Antonio Scala, Ana Lucía Schmidt, Fabiana Zollo

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Information, rumors, and debates may shape and impact public opinion heavily. In the latest years, several concerns have been expressed about social influence on the Internet and the outcome that online debates might have on real-world processes. Indeed, on online social networks users tend to select information that is coherent to their system of beliefs and to form groups of like-minded people –i.e., echo chambers– where they reinforce and polarize their opinions. In this way, the potential benefits coming from the exposure to different points of view may be reduced dramatically, and individuals' views may become more and more extreme. Such a context fosters misinformation spreading, which has always represented a socio-political and economic risk. The persistence of unsubstantiated rumors –e.g., the hypothetical and hazardous link between vaccines and autism– suggests that social media do have the power to misinform, manipulate, or control public opinion. As an example, current approaches such as debunking efforts or algorithmic-driven solutions based on the reputation of the source seem to prove ineffective against collective superstition. Indeed, experimental evidence shows that confirmatory information gets accepted even when containing deliberately false claims while dissenting information is mainly ignored, influences users’ emotions negatively and may even increase group polarization. Moreover, confirmation bias has been shown to play a pivotal role in information cascades, posing serious warnings about the efficacy of current debunking efforts. Nevertheless, mitigation strategies have to be adopted. To generalize the problem and to better understand social dynamics behind information spreading, in this work we rely on a tight quantitative analysis to investigate the behavior of more than 300M users w.r.t. news consumption on Facebook over a time span of six years (2010-2015). Through a massive analysis on 920 news outlets pages, we are able to characterize the anatomy of news consumption on a global and international scale. We show that users tend to focus on a limited set of pages (selective exposure) eliciting a sharp and polarized community structure among news outlets. Moreover, we find similar patterns around the Brexit –the British referendum to leave the European Union– debate, where we observe the spontaneous emergence of two well segregated and polarized groups of users around news outlets. Our findings provide interesting insights into the determinants of polarization and the evolution of core narratives on online debating. Our main aim is to understand and map the information space on online social media by identifying non-trivial proxies for the early detection of massive informational cascades. Furthermore, by combining users traces, we are finally able to draft the main concepts and beliefs of the core narrative of an echo chamber and its related perceptions.

Keywords: information spreading, misinformation, narratives, online social networks, polarization

Procedia PDF Downloads 271

Authors: J. Yan, B. Pieper, B. Bucsky, B. Nasseri, S. Klotz, H. H. Sievers, S. Mohamed

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Cryoablation is evermore applied for interventional treatment of paroxysmal (PAAF) or persistent atrial fibrillation (PEAF). In the cardiac surgery, this procedure is often combined with coronary arterial bypass graft (CABG) and valve operations. Three different methods are feasible in this sense in respect to practicing extents and mechanisms such as lone left atrial cryoablation, Cox-Maze IV and III in our heart center. 415 patients (68 ± 0.8ys, male 68.2%) with predisposed atrial fibrillation who initially required either coronary or valve operations were enrolled and divided into 3 matched groups according to deployed procedures: CryoLA-group (cryoablation of lone left atrium, n=94); Cox-Maze-IV-group (n=93) and Cox-Maze-III-group (n=8). All patients additionally received closure of the left atrial appendage (LAA) and regularly underwent three-year ambulant follow-up assessments (3, 6, 9, 12, 18, 24, 30 and 36 months). Burdens of atrial fibrillation were assessed directly by means of cardiac monitor (Reveal XT, Medtronic) or of 3-day Holter electrocardiogram. Herewith, attacks frequencies of AF and their circadian patterns were systemically analyzed. Furthermore, anticoagulants and regular rate-/rhythm-controlling medications were evaluated and listed in terms of anti-rate and anti-rhythm regimens. Concerning PAAF treatment, Cox Maze IV procedure provided therapeutically acceptable effect as lone left atrium (LA) cryoablation did (5.25 ± 5.25% vs. 10.39 ± 9.96% AF-burden, p > 0.05). Interestingly, Cox Maze III method presented a better short-term effect in the PEAF therapy in comparison to lone cryoablation of LA and Cox Maze IV (0.25 ± 0.23% vs. 15.31 ± 5.99% and 9.10 ± 3.73% AF-burden within the first year, p < 0.05). But this therapeutic advantage went lost during ongoing follow-ups (26.65 ± 24.50% vs. 8.33 ± 8.06% and 15.73 ± 5.88% in 3rd follow-up year). In this way, lone LA-cryoablation established its antiarrhythmic efficacy and 69.5% patients were released from the Vit-K-antagonists, while Cox Maze IV liberated 67.2% patients from continuous anticoagulant medication. The AF-recurrences mostly performed such attacks property as less than 60min duration for all 3 procedures (p > 0.05). In the sense of the circadian distribution of the recurrence attacks, weighted by ongoing follow-ups, lone LA cryoablation achieved and stabilized the antiarrhythmic effects over time, which was especially observed in the treatment of PEAF, while Cox Maze IV and III had their antiarrhythmic effects weakened progressively. This phenomenon was likewise evaluable in the therapy of circadian rhythm of reverting AF-attacks. Furthermore, the strategy of rate control was much more often applied to support and maintain therapeutic successes obtained than the one of rhythm control. Derived from experiences in our heart center, lone LA cryoablation presented equivalent effects in the treatment of AF in comparison to Cox Maze IV and III procedures. These therapeutic successes were especially investigable in the patients suffering from persistent AF (PEAF). Additional supportive strategies such as rate control regime should be initialized and implemented to improve the therapeutic effects of the cryoablations according to appropriate criteria.

Keywords: AF-burden, atrial fibrillation, cardiac monitor, COX MAZE, cryoablation, Holter, LAA

Procedia PDF Downloads 183

Authors: Drishti Sharma, Mona Duggal

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Background: WhatsApp can serve as a cost-effective, scalable, convenient, and popular medium for public health management related communication in the developing world where the existing system of communication is top-down and slow. The product supports sending and receiving a variety of media: text, photos, videos, documents, and location, as well as voice/video calls. With growing number of users of smartphones and improving access and penetration of internet, the scope of information technology remains immense in resolving the hurdles faced by traditional public health system. Poor infrastructure, gap in digital literacy, faulty documentation, strict organizational hierarchy and slow movement of information across desks and offices- all these, make WhatsApp an efficient prospect to complement the existing system for communication, feedback and leadership for public health system in India. Objective: This study investigates the benefits, challenges and limitations associated with WhatsApp usage as a public health management tool. Methods: The study was conducted within the Chandigarh Union Territory. We used a qualitative approach and conducted individual semi-structured interviews and group interviews (n = 10). Participants included medical officers (n 20), Program managers (n = 4), academicians (n=2) and administrators (n=2). Thematic and content qualitative analyses were conducted. Message log of the WhatsApp group of one of the health program was assessed. Results: Medical Officers said that WhatsApp helped them remain in touch with the program officer. They could easily give feedback and highlight those challenges which needed immediate intervention from the program managers, hence they felt supported. Also, the application helped them share pictures of their activities (meetings and field activities) with the group which they thought inspired others and gave themselves immense satisfaction. Also, it helped build stronger relationships and better coordination among themselves, the same being important in team events. For program managers, it had become a portal for coordinating large scale campaigns. Its reach and the fact that the feedback is real-time make WhatsApp ideal for district level events. Though the easy informal connectivity made them answerable to their staff but it also provided them with flexibility in operations. It turned out to be an important portal for sharing outcome and goals related feedback (both positive and negative) to the team. To be sure, using WhatsApp for the purpose of public health program presents considerable challenges, including technological barriers, organizational challenges, gender issues, confidentiality concerns and unplanned aftereffects. Nevertheless, its advantages in a low-cost setting make it an efficient alternative. Conclusion: WhatsApp has become an integral part of our lives. Use of this app for public health program management within closed groups looks promising and useful. At the same time, addressing the challenges involved would make its usage safer.

Keywords: communication, mobile technology, public health management, WhatsApp

Procedia PDF Downloads 154

Authors: Salma Akter, Md. Kamal Uddin

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This study aims to demonstrate how top-down shelter policy and its resultant dwelling environment leads to ‘everyday compromise’ by the grassroots according to subjective (satisfaction) and objective (physical design elements and physical environmental elements) indicators, which are measured across three levels of the settlement; macro (Community), meso (Neighborhood or shelter/built environment) and micro (family). Ashrayan Prakalpa is a resettlement /housing project of Government of Bangladesh for providing shelters and human resources development activities like education, microcredit, and training programme to landless, homeless and rootless people. Despite the integrated nature of the shelter policies (comprises poverty alleviation, employment opportunity, secured tenure, and livelihood training), the ‘quality of life’ issue at the different levels of settlements becomes questionable. As dwellers of shelter units (although formally termed as ‘barracks’ rather shelter or housing) remain on the receiving end of government’s resettlement policies, they often involve with spatial-physical and socio-economic negotiation and assume curious forms of spatial practice, which often upholds contradiction with policy planning. Thus, policy based shelter force dwellers to persistently compromise with their provided built environments both in overtly and covertly. Compromising with prescribed designed space and facilities across living places articulated their negotiation with the quality of allocated space, built form and infrastructures, which in turn exert as less quality of life. The top-down shelter project, Dakshin Chandani Mahal Ashrayan Prakalpa at Dighalia Upazila, the study area located at the Eastern fringe area of Khulna, Bangladesh, is still in progress to resettle internally displaced and homeless people. In terms of methodology, this research is primarily exploratory and adopts a case study method, and an analytical framework is developed through the deductive approach for evaluating the quality of life. Secondary data have been obtained from housing policy analysis and relevant literature review, while key informant interview, focus group discussion, necessary drawings and photographs and participant observation across dwelling, neighborhood, and community level have also been administered as primary data collection methodology. Findings have revealed that various shortages, inadequacies, and negligence of policymakers force to compromise with allocated designed space, physical infrastructure and economic opportunities across dwelling, neighborhood and mostly community level. Thus, the outcome of this study can be beneficial for a global-level understating of the compromising the ‘quality of life’ under top-down shelter policy. Locally, for instance, in the context of Bangladesh, it can help policymakers and concerned authorities to formulate the shelter policies and take initiatives to improve the well-being of marginalized.

Keywords: Ashrayan Prakalpa, compromise, displaced people, quality of life

Procedia PDF Downloads 132

Authors: Luci V. Hyett

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The criminal law of England and Wales currently deems that a person cannot consent to the infliction of injury upon their own body, where the level of harm is considered to be Actual or Grevious. This renders the defence of consent of the victim as being unavailable to those persons carrying out an Alternative Body Modification procedure. However, the criminalization of consensual injury is more appropriately deemed as being categorized as an offense against public morality and not one against the person, which renders the State’s involvement in the autonomous choices of a consenting adult, when determining what can be done to one’s own body, an arbitrary one. Furthermore, to recognise in law that a person is capable of giving a valid consent to socially acceptable cosmetic interventions that largely consist of procedures designed to aesthetically please men and, not those of people who want to modify their bodies for other reasons means that patriarchal attitudes are continuing to underpin public repulsion and inhibit social acceptance of such practices. Theoretical analysis will begin with a juridical examination of R v M(B) [2019] QB 1 where the High Court determined that Alternative Body Modification was not a special category exempting a person so performing from liability for Grevious Bodily Harm using the defence of consent. It will draw from its reasoning which considered that ‘the removal of body parts were medical procedures being carried out for no medical reason by someone not qualified to carry them out’ which will form the basis of this enquiry. It will consider the philosophical work of Georgio Agamben when analysing whether the biopolitical climate in the UK, which places the optimization of the perfect, healthy body at the centre of political concern can explain why those persons who wish to engage in Alternative Body Modification are treated as the ‘Exception’ to that which is normal using the ‘no medical reason’ canon to justify criminalisation, rather than legitimising the industry through regulation. It will consider, through a feminist lens, the current conflict in law between traditional cosmetic interventions which alter one’s physical appearance for socially accepted aesthetic purposes such as those to the breast, lip and buttock and, modifications described as more outlandish such as earlobe stretching, tooth filing and transdermal implants to create horns and spikes under the skin. It will assert that ethical principles relating to the psychological impact of body modification described as ‘alternative’ is used as a means to exclude person’s seeking such a procedure from receiving safe and competent treatment via a registered cosmetic surgeon which leads to these increasingly popular surgery’s being performed in Tattoo parlours throughout the UK as an extension to other socially acceptable forms of self-modification such as piercings. It will contend that only by ‘inclusive exclusion’ will those ‘othered’ through ostracisation be welcomed into the fold of normality and this can only be achieved through recognition of alternative body modification as a legitimate cosmetic intervention, subject to the same regulatory framework as existing practice. This would assist in refocusing the political landscape by erring on the side of liberty rather than that of biology.

Keywords: biopolitics, body modification, consent, criminal law

Procedia PDF Downloads 92

Authors: Yulia V. Krasavtseva, Tatiana V. Kornilova

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Risk-taking behaviors are not only dictated by cognitive components but also involve emotional aspects. Anticipatory emotions, involving both cognitive and affective mechanisms, are involved in decision-making in general, and risk-taking in particular. Affective reactions are prompted when an expectation or prediction is either validated or invalidated in the achieved result. This study aimed to combine predictions, anticipatory emotions, affective reactions, and personality traits in the context of risk-taking behaviors. An experimental online method Emotion and Prediction In a Casino (EPIC) was used, based on a casino-like roulette game. In a series of choices, the participant is presented with progressively riskier roulette combinations, where the potential sums of wins and losses increase with each choice and the participant is given a choice: to 'walk away' with the current sum of money or to 'play' the displayed roulette, thus accepting the implicit risk. Before and after the result is displayed, participants also rate their emotions, using the Self-Assessment Mannequin [Bradley, Lang, 1994], picking a picture, representing the intensity of pleasure, arousal, and dominance. The following personality measures were used: 1) Personal Decision-Making Factors [Kornilova, 2003] assessing risk and rationality; 2) I7 – Impulsivity Questionnaire [Kornilova, 1995] assessing impulsiveness, risk readiness, and empathy and 3) Subjective Risk Intelligence Scale [Craparo et al., 2018] assessing negative attitude toward uncertainty, emotional stress vulnerability, imaginative capability, and problem-solving self-efficacy. Two groups of participants took part in the study: 1) 98 university students (Mage=19.71, SD=3.25; 72% female) and 2) 94 online participants (Mage=28.25, SD=8.25; 89% female). Online participants were recruited via social media. Students with high rationality rated their pleasure and dominance before and after choices as lower (ρ from -2.6 to -2.7, p < 0.05). Those with high levels of impulsivity rated their arousal lower before finding out their result (ρ from 2.5 - 3.7, p < 0.05), while also rating their dominance as low (ρ from -3 to -3.7, p < 0.05). Students prone to risk-rated their pleasure and arousal before and after higher (ρ from 2.5 - 3.6, p < 0.05). High empathy was positively correlated with arousal after learning the result. High emotional stress vulnerability positively correlates with arousal and pleasure after the choice (ρ from 3.9 - 5.7, p < 0.05). Negative attitude to uncertainty is correlated with high anticipatory and reactive arousal (ρ from 2.7 - 5.7, p < 0.05). High imaginative capability correlates negatively with anticipatory and reactive dominance (ρ from - 3.4 to - 4.3, p < 0.05). Pleasure (.492), arousal (.590), and dominance (.551) before and after the result were positively correlated. Higher predictions positively correlated with reactive pleasure and arousal. In a riskier scenario (6/8 chances to win), anticipatory arousal was negatively correlated with the pleasure emotion (-.326) and vice versa (-.265). Correlations occur regardless of the roulette outcome. In conclusion, risk-taking behaviors are linked not only to personality traits but also to anticipatory emotions and affect in a modeled casino setting. Acknowledgment: The study was supported by the Russian Foundation for Basic Research, project 19-29-07069.

Keywords: anticipatory emotions, casino game, risk taking, impulsiveness

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Authors: Gabriel Malgaresi, Sara Borazjani, Hadi Madani, Pavel Bedrikovetsky

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Suspension-Colloidal flow in porous media occurs in numerous engineering fields, such as industrial water treatment, the disposal of industrial wastes into aquifers with the propagation of contaminants and low salinity water injection into petroleum reservoirs. The main effects are particle mobilization and captured by the porous rock, which can cause pore plugging and permeability reduction which is known as formation damage. Various factors such as fluid salinity, pH, temperature, and rock properties affect particle detachment. Formation damage is unfavorable specifically near injection and production wells. One way to control formation damage is pre-treatment of the rock with nanoparticles. Adsorption of nanoparticles on fines and rock surfaces alters zeta-potential of the surfaces and enhances the attachment force between the rock and fine particles. The main objective of this study is to develop a two-stage mathematical model for (1) flow and adsorption of nanoparticles on the rock in the pre-treatment stage and (2) fines migration and permeability reduction during the water production after the pre-treatment. The model accounts for adsorption and desorption of nanoparticles, fines migration, and kinetics of particle capture. The system of equations allows for the exact solution. The non-self-similar wave-interaction problem was solved by the Method of Characteristics. The analytical model is new in two ways: First, it accounts for the specific boundary and initial condition describing the injection of nanoparticle and production from the pre-treated porous media; second, it contains the effect of nanoparticle sorption hysteresis. The derived analytical model contains explicit formulae for the concentration fronts along with pressure drop. The solution is used to determine the optimal injection concentration of nanoparticle to avoid formation damage. The mathematical model was validated via an innovative laboratory program. The laboratory study includes two sets of core-flood experiments: (1) production of water without nanoparticle pre-treatment; (2) pre-treatment of a similar core with nanoparticles followed by water production. Positively-charged Alumina nanoparticles with the average particle size of 100 nm were used for the rock pre-treatment. The core was saturated with the nanoparticles and then flushed with low salinity water; pressure drop across the core and the outlet fine concentration was monitored and used for model validation. The results of the analytical modeling showed a significant reduction in the fine outlet concentration and formation damage. This observation was in great agreement with the results of core-flood data. The exact solution accurately describes fines particle breakthroughs and evaluates the positive effect of nanoparticles in formation damage. We show that the adsorbed concentration of nanoparticle highly affects the permeability of the porous media. For the laboratory case presented, the reduction of permeability after 1 PVI production in the pre-treated scenario is 50% lower than the reference case. The main outcome of this study is to provide a validated mathematical model to evaluate the effect of nanoparticles on formation damage.

Keywords: nano-particles, formation damage, permeability, fines migration

Procedia PDF Downloads 598

Authors: Elena Samarsky

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According to German national records and willingness to migrate surveys, emigration is much more attractive for better educated citizens employed in white-collar positions, with academics displaying the highest migration rate. The case study of academic migration from Germany is furthermore intriguing due to the country's financial power, competitive labour market and relatively good life-standards, working conditions and high wage rates. Investigation of such mobility challenges traditional economic view on migration, as it raises the question of why people chose to leave their highly-industrialized countries known for their high life-standards, stable political scene and prosperous economy. Within the regional domain, examining mobility of Germans contributes to the ongoing debate over the extent of influence of the EU mobility principle on migration decision. The latter is of particular interest, as it may shed the light on the extent to which it frames individual migration path, defines motivations and colours the experiences of migration action itself. The paper is based on the analysis of the migration decisions obtained through in-depth interviews with German academics employed in the UK. These retrospective interviews were conducted with German academies across selected universities in the UK, employed in a variety of academic fields, and different career stages. Interviews provide a detailed description of what motivated people to search for a post in another country, which attributes of such job are needed to be satisfied in order to facilitate migration, as well as general information on particularities of an academic career and institutions involved. In the course of the project, it became evident that although securing financial stability was non-negotiable factor in migration (e.g., work contract singed before relocation) non-pecuniary motivations played significant role as well. Migration narratives of this group - the highly skilled, whose human capital is transferable, and whose expertise is positively evaluated by countries, is mainly characterised by search for personal development and career advancement, rather than a direct increase in their income. Such records are also consistent in showing that in case of academics, scientific freedom and independence are the main attributes of a perfect job and are a substantial motivator. On the micro level, migration is rather depicted as an opportunistic action addressed in terms of voluntary and rather imposed decision. However, on the macro level, findings allow suggesting that such opportunities are rather an outcome embedded in the peculiarities of academia and its historical and structural developments. This, in turn, contributes significantly to emergence of a scene in which migration action takes place. The paper suggest further comparative research on the intersection of the macro and micro level, and in particular how both national academic institutions and the EU mobility principle shape migration of academics. In light of continuous attempts to make the European labour market more mobile and attractive such findings ought to have direct implications on policy.

Keywords: migration, EU, academics, highly skilled labour

Procedia PDF Downloads 240

Authors: Sumiti Saharan, Pallav Patankar, Lily W. Lee

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Understanding the health-seeking behaviors and attitudes of women towards maternal health in the context of gender roles and family dynamics is tremendously crucial for designing effective and impactful interventions aimed at improving maternal and child health outcomes. Further, as the digital world becomes more accessible and affordable, it is imperative to scope the potential of digital technology in enabling access to maternal health information in different socio-economic groups (SEGs). In the summer of 2017, we conducted a study with 500 women across different SEGs in urban India who were pregnant or had had a delivery in the last year. The study was undertaken to assess their maternal health information seeking behavior with a particular focus on probing their use of digital technology for health-related information. The study also measured women's decision-making autonomy in the context of maternal health, awareness of their rights to quality and respectful maternal healthcare, and agency to voice their rights. We probed the impact of key variables including education, age, and socioeconomic status on all outcome variables. In terms of health-seeking behaviors, we found that women heavily relied on medical professionals and/or their mothers and mothers-in-law for all maternal health advice. Digital adoption was found to be high across all SEGs, with around 70% of women from all populations using the internet several times a week. On the other hand, use of the internet for both accessing maternal health information and choosing maternity hospitals were both significantly dependent on SEG. The key reasons reported for not using the internet for health purposes were lack of awareness and lack of trust on content accuracy. Decisions around health practices and type of delivery were found to be jointly made by women and other family members. Almost all women reported their husbands to play a key role in all maternal health decisions and for decisions with a clear financial implication like choice of hospital for delivery, husbands were reported to be the sole decision maker by a majority of women. The agency of women was also found to be low in interactions with maternal healthcare providers with a third of respondents not comfortable with voicing their opinions and preferences to their doctors. Interestingly, we find that this relatively low agency was prominent in both lower middle class and middle-class SEGs. Recognition of the sociocultural determinants of behavior is the first step in developing actionable strategies for improving maternal health outcomes. Our study quantifies the agency and autonomy of women in urban India and the variables that impact them. Our findings emphasize the value of gender normative approaches that factor in the key role husbands play in guiding maternal health decisions. They also highlight the power of digital approaches for catalyzing access to maternal health information. These insights into the attitude and behaviors of mothers in context of their sociocultural environments—and their relationship with digital technology—can help pave the way towards designing effective, scalable maternal and child health programs in developing nations like India.

Keywords: access to healthcare information, behavior, digital health, maternal health

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Authors: Langhit Kurar, Loren Charles

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Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.

Keywords: ankle, fracture, BOAST, radiology

Procedia PDF Downloads 163

Authors: Jonardan Koner, Avinash Purandare

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In today’s globalized world international business is a very key area for the country's growth. Some of the strategic areas for holding up a country’s international business to grow are in the areas of connecting Ports, Road Network, and Rail Network. India’s International Business is booming both in Exports as well as Imports. Ports play a very central part in the growth of international trade and ensuring competitive ports is of critical importance. India has a long coastline which is a big asset for the country as it has given the opportunity for development of a large number of major and minor ports which will contribute to the maritime trades’ development. The National Economic Development of India requires a well-functioning seaport system. To know the comparative strength of Indian ports over South-east Asian similar ports, the study is considering the objectives of (I) to identify the key parameters of an international mega container port, (II) to compare the five selected container ports (JNPT, Chennai, Singapore, Dubai, and Colombo Ports) according to user of the ports and iii) to measure the growth of selected five container ports’ throughput over time and their comparison. The study is based on both primary and secondary databases. The linear time trend analysis is done to show the trend in quantum of exports, imports and total goods/services handled by individual ports over the years. The comparative trend analysis is done for the selected five ports of cargo traffic handled in terms of Tonnage (weight) and number of containers (TEU’s). The comparative trend analysis is done between containerized and non-containerized cargo traffic in the five selected five ports. The primary data analysis is done comprising of comparative analysis of factor ratings through bar diagrams, statistical inference of factor ratings for the selected five ports, consolidated comparative line charts of factor rating for the selected five ports, consolidated comparative bar charts of factor ratings of the selected five ports and the distribution of ratings (frequency terms). The linear regression model is used to forecast the container capacities required for JNPT Port and Chennai Port by the year 2030. Multiple regression analysis is carried out to measure the impact of selected 34 explanatory variables on the ‘Overall Performance of the Port’ for each of the selected five ports. The research outcome is of high significance to the stakeholders of Indian container handling ports. Indian container port of JNPT and Chennai are benchmarked against international ports such as Singapore, Dubai, and Colombo Ports which are the competing ports in the neighbouring region. The study has analysed the feedback ratings for the selected 35 factors regarding physical infrastructure and services rendered to the port users. This feedback would provide valuable data for carrying out improvements in the facilities provided to the port users. These installations would help the ports’ users to carry out their work in more efficient manner.

Keywords: throughput, twenty equivalent units, TEUs, cargo traffic, shipping lines, freight forwarders

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Authors: Jana Abu Ahmada, Zaineb Mohamed, Ilyasse Aksikas

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The linear quadratic control system of hyperbolic first order partial differential equations (PDEs) are presented. The aim of this research is to control chemical reactions. This is achieved by converting the PDEs system to ordinary differential equations (ODEs) using the method of characteristics to reduce the system to control it by using the integral reinforcement learning. The designed controller is applied to a catalytic cracking reactor. Background—Transport-Reaction systems cover a large chemical and bio-chemical processes. They are best described by nonlinear PDEs derived from mass and energy balances. As a main application to be considered in this work is the catalytic cracking reactor. Indeed, the cracking reactor is widely used to convert high-boiling, high-molecular weight hydrocarbon fractions of petroleum crude oils into more valuable gasoline, olefinic gases, and others. On the other hand, control of PDEs systems is an important and rich area of research. One of the main control techniques is feedback control. This type of control utilizes information coming from the system to correct its trajectories and drive it to a desired state. Moreover, feedback control rejects disturbances and reduces the variation effects on the plant parameters. Linear-quadratic control is a feedback control since the developed optimal input is expressed as feedback on the system state to exponentially stabilize and drive a linear plant to the steady-state while minimizing a cost criterion. The integral reinforcement learning policy iteration technique is a strong method that solves the linear quadratic regulator problem for continuous-time systems online in real time, using only partial information about the system dynamics (i.e. the drift dynamics A of the system need not be known), and without requiring measurements of the state derivative. This is, in effect, a direct (i.e. no system identification procedure is employed) adaptive control scheme for partially unknown linear systems that converges to the optimal control solution. Contribution—The goal of this research is to Develop a characteristics-based optimal controller for a class of hyperbolic PDEs and apply the developed controller to a catalytic cracking reactor model. In the first part, developing an algorithm to control a class of hyperbolic PDEs system will be investigated. The method of characteristics will be employed to convert the PDEs system into a system of ODEs. Then, the control problem will be solved along the characteristic curves. The reinforcement technique is implemented to find the state-feedback matrix. In the other half, applying the developed algorithm to the important application of a catalytic cracking reactor. The main objective is to use the inlet fraction of gas oil as a manipulated variable to drive the process state towards desired trajectories. The outcome of this challenging research would yield the potential to provide a significant technological innovation for the gas industries since the catalytic cracking reactor is one of the most important conversion processes in petroleum refineries.

Keywords: PDEs, reinforcement iteration, method of characteristics, riccati equation, cracking reactor

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Authors: Sandra Hartl, Meena Chavan

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This paper presents the outcome of a four year Ph.D. research on cross-cultural conflict management in transnational business relationships. An important and complex problem about managing conflicts that arise across cultures in business relationships is investigated, and conflict resolution strategies are identified. This paper particularly focuses on transnational relationships within a Chinese, German and Middle Eastern framework. Unlike many papers on this issue which have been built on experiments with international MBA students, this research provides real-life cases of cross-cultural conflicts which are not easy to capture. Its uniqueness is underpinned as the real case data was gathered by interviewing top executives at management positions in large multinational corporations through a qualitative case study method approach. This paper makes a valuable contribution to the theory of cross-cultural conflicts, and despite the sensitivity, this research primarily presents real-time business data about breaches of contracts between two counterparties engaged in transnational operating organizations. The overarching aim of this research is to identify the degree of significance for the cultural factors and the communication factors embedded in cross-cultural business conflicts. It questions from a cultural perspective what factors lead to the conflicts in each of the cases, what the causes are and the role of culture in identifying effective strategies for resolving international disputes in an increasingly globalized business world. The results of 20 face to face interviews are outlined, which were conducted, recorded, transcribed and then analyzed using the NVIVO qualitative data analysis system. The outcomes make evident that the factors leading to conflicts are broadly organized under seven themes, which are communication, cultural difference, environmental issues, work structures, knowledge and skills, cultural anxiety and personal characteristics. When evaluating the causes of the conflict it is to notice that these are rather multidimensional. Irrespective of the conflict types (relationship or task-based conflict or due to individual personal differences), relationships are almost always an element of all conflicts. Cultural differences, which are a critical factor for conflicts, result from different cultures placing different levels of importance on relationships. Communication issues which are another cause of conflict also reflect different relationships styles favored by different cultures. In identifying effective strategies for solving cross-cultural business conflicts this research identifies that solutions need to consider the national cultures (country specific characteristics), organizational cultures and individual culture, of the persons engaged in the conflict and how these are interlinked to each other. Outcomes identify practical dispute resolution strategies to resolve cross-cultural business conflicts in reference to communication, empathy and training to improve cultural understanding and cultural competence, through the use of mediation. To conclude, the findings of this research will not only add value to academic knowledge of cross-cultural conflict management across transnational businesses but will also add value to numerous cross-border business relationships worldwide. Above all it identifies the influence of cultures and communication and cross-cultural competence in reducing cross-cultural business conflicts in transnational business.

Keywords: business conflict, conflict management, cross-cultural communication, dispute resolution

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Authors: Anna Demian, Levi Howard, L. Ng, Leslie Simon, Mark Dragon, A. Desai, Timothy Devlantes, W. David Freeman

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Introduction: Out-of-hospital cardiac arrest (OHCA) can carry a high mortality. For survivors, the most common complication is hypoxic-ischemic brain injury (HIBI). Rarely, lumbosacral spinal cord and/or other spinal cord artery ischemia can occur due to anatomic variation and variable mean arterial pressure after the return of spontaneous circulation. We present a case of an OHCA survivor who later woke up with bilateral leg weakness with preserved sensation (ASIA grade B, L2 level). Methods: We describe a clinical, radiographic, and laboratory presentation, as well as a National Library of Medicine (NLM) search engine methodology, characterizing incidence/prevalence of this entity is discussed. A 70-year-old male, a longtime smoker, and alcohol user, suddenly collapsed at a bar surrounded by friends. He had complained of chest pain before collapsing. 911 was called. EMS arrived, and the patient was in pulseless electrical activity (PEA), cardiopulmonary resuscitation (CPR) was initiated, and the patient was intubated, and a LUCAS device was applied for continuous, high-quality CPR in the field by EMS. In the ED, central lines were placed, and thrombolysis was administered for a suspected Pulmonary Embolism (PE). It was a prolonged code that lasted 90 minutes. The code continued with the eventual return of spontaneous circulation. The patient was placed on an epinephrine and norepinephrine drip to maintain blood pressure. ECHO was performed and showed a “D-shaped” ventricle worrisome for PE as well as an ejection fraction around 30%. A CT with PE protocol was performed and confirmed bilateral PE. Results: The patient woke up 24 hours later, following commands, and was extubated. He was found paraplegic below L2 with preserved sensation, with hypotonia and areflexia consistent with “spinal shock” or anterior spinal cord syndrome. MRI thoracic and lumbar spine showed a conus medullaris level spinal cord infarction. The patient was given IV steroids upon initial discovery of cord infarct. NLM search using “cardiac arrest” and “spinal cord infarction” revealed 57 results, with only 8 review articles. Risk factors include age, atherosclerotic disease, and intraaortic balloon pump placement. AoA (Artery of Adamkiewicz) anatomic variation along with existing atherosclerotic factors and low perfusion were also known risk factors. Conclusion: Acute paraplegia from anterior spinal cord infarction of the AoA territory after cardiac arrest is rare. Larger prospective, multicenter trials are needed to examine potential interventions of hypothermia, lumbar drains, which are sometimes used in aortic surgery to reduce ischemia and/or other neuroprotectants.

Keywords: cardiac arrest, spinal cord infarction, artery of Adamkiewicz, paraplegia

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Authors: Julia Wimmers Klick

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Interprofessional Education (IPE) is widely recognized as a valuable approach in healthcare education, despite the challenges it presents. This study explores IP surface anatomy lab sessions, with a focus on fostering trust and collaboration among healthcare students. The research is conducted within the context of rural healthcare settings in British Columbia (BC), where a medical school and a physical therapy (PT) program operate under the Faculty of Medicine at the University of British Columbia (UBC). While IPE sessions addressing soft skills have been implemented, the integration of hard skills, such as Anatomy, remains limited. To address this gap, a pilot feasibility study was conducted with a positive outcome, a follow-up study involved these IPE sessions aimed at exploring the influence of bonding and trust between medical and PT students. Data were collected through focus groups comprising participating students and faculty members, and a structured SWOC (Strengths, Weaknesses, Opportunities, and Challenges) analysis was conducted. The IPE sessions, 3 in total, consisted of a 2.5-hour lab on surface anatomy, where PT students took on the teaching role, and medical students were newly exposed to surface anatomy. The focus of the study was on the relationship-building process and trust development between the two student groups, rather than assessing the acquisition of surface anatomy skills. Results indicated that the surface anatomy lab served as a suitable tool for the application and learning of soft skills. Faculty members observed positive outcomes, including productive interaction between students, reversed hierarchy with PT students teaching medical students, practicing active listening skills, and using a mutual language of anatomy. Notably, there was no grade assessment or external pressure to perform. The students also reported an overall positive experience; however, the specific impact on the development of soft skill competencies could not be definitively determined. Participants expressed a sense of feeling respected, welcomed, and included, all of which contributed to feeling safe. Within the small group environment, students experienced becoming a part of a community of healthcare providers that bonded over a shared interest in health professions education. They enjoyed sharing diverse experiences related to learning across their varied contexts, without fear of judgment and reprisal that were often intimidating in single professional contexts. During a joint Christmas party for both cohorts, faculty members observed students mingling, laughing, and forming bonds. This emphasized the importance of early bonding and trust development among healthcare colleagues, particularly in rural settings. In conclusion, the findings emphasize the potential of IPE sessions to enhance trust and collaboration among healthcare students, with implications for their future professional lives in rural settings. Early bonding and trust development are crucial in rural settings, where healthcare professionals often rely on each other. Future research should continue to explore the impact of content-concentrated IPE on the development of soft skill competencies.

Keywords: interprofessional education, rural healthcare settings, trust, surface anatomy

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Authors: Anthony S. Machi, Joseph Minardi

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We present a case report of left atrial myxoma diagnosed by bedside transesophageal (TEE) ultrasound. Left atrial myxoma is the most common benign cardiac tumor and can obstruct blood flow and cause valvular insufficiency. Common symptoms consist of dyspnea, pulmonary edema and other features of left heart failure in addition to thrombus release in the form of tumor fragments. The availability of bedside ultrasound equipment is essential for the quick diagnosis and treatment of various emergency conditions including cardiac neoplasms. A 48-year-old Caucasian female with a four-year history of an untreated renal mass and anemia presented to the ED with two months of sharp, intermittent, bilateral flank pain radiating into the abdomen. She also reported intermittent vomiting and constipation along with generalized body aches, night sweats, and 100-pound weight loss over last year. She had a CT in 2013 showing a 3 cm left renal mass and a second CT in April 2016 showing a 3.8 cm left renal mass along with a past medical history of diverticulosis, chronic bronchitis, dyspnea on exertion, uncontrolled hypertension, and hyperlipidemia. Her maternal family history is positive for breast cancer, hypertension, and Type II Diabetes. Her paternal family history is positive for stroke. She was a current everyday smoker with an 11 pack/year history. Alcohol and drug use were denied. Physical exam was notable for a Grade II/IV systolic murmur at the right upper sternal border, dyspnea on exertion without angina, and a tender left lower quadrant. Her vitals and labs were notable for a blood pressure of 144/96, heart rate of 96 beats per minute, pulse oximetry of 96%, hemoglobin of 7.6 g/dL, hypokalemia, hypochloremia, and multiple other abnormalities. Physicians ordered a CT to evaluate her flank pain which revealed a 7.2 x 8.9 x 10.5 cm mixed cystic/solid mass in the lower pole of the left kidney and a filling defect in the left atrium. Bedside TEE was ordered to follow up on the filling defect. TEE reported an ejection fraction of 60-65% and visualized a mobile 6 x 3 cm mass in the left atrium attached to the interatrial septum extending into the mitral valve. Cardiothoracic Surgery and Urology were consulted and confirmed a diagnosis of left atrial myxoma and clear cell renal cell carcinoma. The patient returned a week later due to worsening nausea and vomiting and underwent emergent nephrectomy, lymph node dissection, and colostomy due to a necrotic colon. Her condition declined over the next four months due to lung and brain metastases, infections, and other complications until she passed away.

Keywords: bedside ultrasound, echocardiography, emergency medicine, left atrial myxoma

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