Search results for: Mercedes Miller
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 123

Search results for: Mercedes Miller

63 Implementation of Video Education to Improve Patient’s Knowledge of Activating Emergency Medical System for Stroke Symptoms: Evidence- Based Practice Project on Inpatient Neurology Unit in the United States

Authors: V. Miller, T. Jariel, C. Cooper-Chadwick

Abstract:

Early treatment of stroke leads to higher survival and lower disability rates. Increasing knowledge to activate the emergency medical system for signs of stroke can improve outcomes for patients with stroke and decrease morbidity and mortality. Even though patients who get discharged from the hospital receive standard verbal and printed education, nearly 20% of them answer the question incorrectly when asked, “What will you do if you or someone you know have signs of stroke?” The main goal of this evidence-based project was to improve patients’ knowledge of what to do if they have signs of stroke. Evidence suggests that using video education in conjunction with verbal and printed education improves patient comprehension and retention. The percentage of patients who noted that they needed to call 911 for stroke symptoms increased from 80% to 87% in six months after project implementation. The results of this project demonstrate significant improvement in patients’ knowledge about the necessity of activation of emergency medical systems for stroke symptoms.

Keywords: emergency medical systems activation, evidence-based practice nursing, stroke education, video education

Procedia PDF Downloads 43
62 Predictive Power of Achievement Motivation on Student Engagement and Collaborative Problem Solving Skills

Authors: Theresa Marie Miller, Ma. Nympha Joaquin

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The aim of this study was to check the predictive power of social-oriented and individual-oriented achievement motivation on student engagement and collaborative problem-solving skills in mathematics. A sample of 277 fourth year high school students from the Philippines were selected. Surveys and videos of collaborative problem solving activity were used to collect data from respondents. The mathematics teachers of the participants were interviewed to provide qualitative support on the data. Systemaitc correlation and regression analysis were employed. Results of the study showed that achievement motivations−SOAM and IOAM− linearly predicted student engagement but was not significantly associated to the collaborative problem-solving skills in mathematics. Student engagement correlated positively with collaborative problem-solving skills in mathematics. The results contribute to theorizing about the predictive power of achievement motivations, SOAM and IOAM on the realm of academic behaviors and outcomes as well as extend the understanding of collaborative problem-solving skills of 21st century learners.

Keywords: achievement motivation, collaborative problem-solving skills, individual-oriented achievement motivation, social-oriented achievement motivation, student engagement

Procedia PDF Downloads 287
61 The Whole Is Greater than ‘Them’ and ‘Us’: The Effect of a Shared Workplace of Israeli-Jews and Non-Israeli Palestinians Physicians on Mutual Attitudes

Authors: Idit Miller

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This paper examines the effect of a common organizational identity on intergroup relations of Israeli-Jews and non-Israeli Palestinians medical interns who are employed together within the Israeli hospitals, while asymmetrical relationships and ongoing conflict between the two groups still exist. Using mixed theory, which included the Intergroup contact, Othering, and the Common social identity theories, the study examines the intra-organizational identities dynamic involved within the hospital department and its effects on intergroup relations. In-depth, semi-structured interviews with the Palestinian and Jews physicians were conducted. Findings show three social identity responses are being constructed during the shared employment: Them vs. Us construction, Them vs. Us deconstruction, and an 'Organizational Us' reconstruction. Despite the inequality inherent within the intergroup relations, by holding a universal identity and using a deconstruction pattern, positive emotions are demonstrated by both sides. The adoption of a shared professional super-identity is found as an essential component for fostering and maintaining positive attitudes between the parties. This finding strengthens the significance of a long-term continuous intergroup contact inside the organization and especially between two polarized groups.

Keywords: common social identity theory, intergroup contact theory, inequality, intergroup conflict, othering theory

Procedia PDF Downloads 126
60 Integrating Best Practices for Construction Waste in Quality Management Systems

Authors: Paola Villoria Sáez, Mercedes Del Río Merino, Jaime Santa Cruz Astorqui, Antonio Rodríguez Sánchez

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The Spanish construction industry generates large volumes of waste. However, despite the legislative improvements introduced for construction and demolition waste (CDW), construction waste recycling rate remains well below other European countries and also below the target set for 2020. This situation can be due to many difficulties. i.e.: The difficulty of onsite segregation or the estimation in advance of the total amount generated. Despite these difficulties, the proper management of CDW must be one of the main aspects to be considered by the construction companies. In this sense, some large national companies are implementing Integrated Management Systems (IMS) including not only quality and safety aspects, but also environment issues. However, although this fact is a reality for large construction companies still the vast majority of companies need to adopt this trend. In short, it is common to find in small and medium enterprises a decentralized management system: A single system of quality management, another for system safety management and a third one for environmental management system (EMS). In addition, the EMSs currently used address CDW superficially and are mainly focus on other environmental concerns such as carbon emissions. Therefore, this research determines and implements a specific best practice management system for CDW based on eight procedures in a Spanish Construction company. The main advantages and drawbacks of its implementation are highlighted. Results of this study show that establishing and implementing a CDW management system in building works, improve CDW quantification as the company obtains their own CDW generation ratio. This helps construction stakeholders when developing CDW Management Plans and also helps to achieve a higher adjustment of CDW management costs. Finally, integrating this CDW system with the EMS of the company favors the cohesion of the construction process organization at all stages, establishing responsibilities in the field of waste and providing a greater control over the process.

Keywords: construction and demolition waste, waste management, best practices, waste minimization, building, quality management systems

Procedia PDF Downloads 506
59 Synchronous Versus Asynchronous Telecollaboration in Intercultural Communication

Authors: Vita Kalnberzina, Lauren Miller Anderson

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The aim of the paper is to report on the results of the telecollaboration project results carried out between the students of the University of Latvia, National Louis University in the US, and Austral University in Chili during the Intercultural Communication course. The objectives of the study are 1) to compare different forms of student telecollaboration and virtual exchange, 2) to collect and analyse the student feedback on the telecollaboration project, 3) to evaluate the products (films) produced during the telecollaboration project. The methods of research used are as follows: Survey of the student feedback after the project, video text analysis of the films produced by the students, and interview of the students participating in the project. We would like to compare the results of a three-year collaboration project, where we tried out synchronous telecollaboration and asynchronous collaboration. The different variables that were observed were the impact of the different time zones, different language proficiency levels of students, and different curricula developed for collaboration. The main findings suggest that the effort spent by students to organize meetings in different time zones and to get to know each other diminishes the quality of the product developed and thus reduces the students' feeling of accomplishment. Therefore, we would like to propose that asynchronous collaboration where the national teams work on a film project specifically developed by the students of one university for the students of another university ends up with a better quality film, which in its turn appeals more to the students of the other university and creates a deeper intercultural bond between the collaborating students.

Keywords: telecollaboration, intercultural communication, synchronous collaboration, asynchronous collaboration

Procedia PDF Downloads 69
58 The Effectiveness of Group Spiritual Therapy on Increasing the Life Expectancy and Mental Health in Elderlies

Authors: Seyed Reza Mirmahdi, Seyedeh Maryam Hashemi Jabali

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This research was conducted to evaluate the effects of group spiritual therapy on increasing the life expectancy and mental health among the elderlies. This was a quasi-experimental research using a pretest-posttest design with a control group conducted over a population including all the elderly people of Tehran in 2012-13. A randomized sampling method was used to select 30 elderly people living in Parham nursing home that were then randomly assigned into two control and experimental groups of 15 people each. The instruments used were Miller’s life expectancy and mental health test (SCL.90.R) standard questionnaires. Individuals in experimental group received 12 sessions of group spiritual therapy while those in control group did not receive any kind of therapy. The tests were performed again for all the subjects (30 individuals) at the end of the experiment. To test the hypotheses, the data collected by questionnaires were analyzed using descriptive methods through relevant tables and charts and also inferential methods through the analysis of covariance using the SPSS software. Results showed that group spiritual therapy leads to a significant increase in both mental health and life expectancy in the experimental group of elderlies living in Parham nursing home compared to those in the control group.

Keywords: spiritual therapy, life expectancy, mental health, elderlies

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57 Evaluation of the UV Stability of Unidirectional Crossply Ultrahigh-Molecular-Weight-Polyethylene Composite

Authors: Jonmichael Weaver, David Miller

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Dyneema is an ultra-high molecular weight polyethylene (UHMWPE) fiber created by DSM. This fiber has many applications due to the high tensile strength, low weight, and inability to absorb water. DSM manufactures a non-woven unidirectional cross-ply [0,90]2 lamina, using the Dyneema fiber. Using this lamina system, various thickness panels are created for a 40% lighter weight alternative to Kevlar for the same ballistics protection. Environmental effects on the ply/laminate system alter the material properties, resulting in diminished ultimate performance. Understanding the specific environmental parameters and characterizing the resulting material property degradation is essential for determining the safety and reliability of Dyneema in service. Two laminas were contrasted for their response to accelerated aging by UV, humidity, and temperature cycling. Both lamina contain the same fiber, SK-99, but differ in matrix composition, Dyneema HB-210 employs a polyurethane (PUR) based matrix, and HB-212 contains a rubber-based matrix. Each system was inspected using a scanning electron microscope (SEM) and evaluated by dynamic mechanical analysis (DMA) to characterize the material property changes alongside the corresponding composite damage and matrix failure mode over the aging parameters. Overall, resulting in the HB-212 degrading faster compared with the HB-210.

Keywords: dyneema, accelerated aging, polymers, ballistics protection, armor, DSM, kevlar, composites

Procedia PDF Downloads 123
56 Changes of pH and Pseudomonas Aeruginosa Growth in Liquid Media

Authors: Sayaka Ono, Ryutaro Imai, Tomoko Ehara, Tetsuya Matsumoto, Hajime Matsumura

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Background: Wound pH affects a number of important factors in wound healing. We previously measured the pH value of the exudates collected from second-degree burns and found that the increase in pH was observed in the burn wounds in which colonized by Staphylococcus spp., and the increase in pH was evident prior to the clinical findings of local infection. To investigate the relationship between the changes of pH value and bacterial growth, we performed in vitro study using Pseudomonas aeruginosa and liquid medium as a locally infected wound equivalent model. Methods: Pseudomonas aeruginosa standard strain (ATCCR 10145TM) was cultured at 37 °C environment in Luria Broth Miller medium. The absorbance rate which means the amount of bacteria was measured by a microplate reader 2300EnSpireTM). The pH was measured using pH-indicator strips (MColorpHastTM). The statistical analysis was performed using the product-moment correlation coefficient of Pearson's. Results: The absorbance rate and pH value were increased along with culture period. There was a positive correlation between pH value and absorbance rate (n = 27, Pearson's r = 0.985). Moreover, there was a positive correlation between pH value and the culture period (n = 18, Pearson's r = 0.901). The bacteria was well growth in the media from pH 6.6 to pH 8.0 and the pH of culture media converged at 8 -9 along with the bacterial growth. Conclusion: From these results, we conclude that pH value of the wound is correlated with the number of viable bacteria and bacterial growth periods.

Keywords: colonization, potential of hydrogen, Pseudomonas aeruginosa, wound

Procedia PDF Downloads 246
55 Correlation Between Hydrogen Charging and Charpy Impact of 4340 Steel

Authors: J. Alcisto, M. Papakyriakou, J. Guerra, A. Dominguez, M. Miller, J. Foyos, E. Jones, N. Ula, M. Hahn, L. Zeng, Y. Li, O. S. Es-Said

Abstract:

Current methods of testing for hydrogen charging are slow and time consuming. The objective of this paper was to determine if hydrogen charging can be detected quantitatively through the use of Charpy Impact (CI) testing. CI is a much faster and simpler process than current methods for detecting hydrogen charging. Steel plates were Electro Discharge Machined (EDM) into ninety-six 4340 steel CI samples and forty-eight tensile bars. All the samples were heat treated at 900°C to austentite and then rapidly quenched in water to form martensite. The samples were tempered at eight different target strengths/target temperatures (145, 160, 170, 180, 190, 205, 220, to 250KSI, thousands of pounds per square inch)/(1100, 1013, 956, 898, 840, 754, 667, 494 degrees Celsius). After a tedious process of grinding and machining v-notches to the Charpy samples, they were divided into four groups. One group was kept as received baseline for comparison while the other three groups were sent to Alcoa (Fasteners) Inc. in Torrance to be cadmium coated. The three groups were coated with three thicknesses (2, 3 and 5 mils). That means that the samples were charged with ascending hydrogen levels. The samples were CI tested and tensile tested, and the data was tabulated and compared to the baseline group of uncharged samples of the same material. The results of this study were successful and indicated that CI testing was able to quantitatively detect hydrogen charging.

Keywords: Charpy impact toughness, hydrogen charging, 4340 steel, Electro Discharge Machined (EDM)

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54 Physico-Chemical and Antibacterial Properties of Neem Extracts

Authors: C. C. Igwe

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Several parts of Neem tree (Azadirachta indica) are used in traditional medicine in many West African countries for the treatment of various human diseases. The leaf, stem - bark and seed were air dried for 8, 5 and 7 days, respectively. The shells were carfully separated from the seeds, each powdered sample obtained with mechanical miller and 250 mm sieve. The neem samples were individually subjected to extraction with acetone, n-hexane for 48hr and 72 hr, respectively. Physico-chemical and antibacterial evaluation were carried out using standard methods. Results of physico - chemical analyses of the extracted oil from the seed shows that it has a brownish colour, with a smell similar to garlic while the moisture content, refractive index are 0.76% and 1.47 respectively. Other vital chemical results obtained from the neem oil such as saponification value (234.62), acid value (10.84 %), free fatty acid (5.84 %) and peroxide value (10.52%) indicated the oil extracted satisfied standard oils parameters for quality soap and cosmetics production. The antibacterial screening by disc diffusion revealed the oil demonstrated high activity against Staphylococcus aureus. Both the physio-chemical and antibacterial of samples have been certified by National Agency for Food and Drugs Administration and Control. The preliminary results of this study may validate the medicinal value of the plant. Further studies are in progress to clarify the in vivo potentials of neem extracts in the management of human communicable diseases and this is a subject of investigation in our group.

Keywords: anti-bacterial, neem extract, physico-chemical analyses, staphylococcus aureus

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53 Fatigue Life Evaluation of Al6061/Al2O3 and Al6061/SiC Composites under Uniaxial and Multiaxial Loading Conditions

Authors: C. E. Sutton, A. Varvani-Farahani

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Fatigue damage and life prediction of particle metal matrix composites (PMMCs) under uniaxial and multiaxial loading conditions were investigated. Three PMM composite materials of Al6061/Al2O3/20p-T6, Al6061/Al2O3/22p-T6 and Al6061/SiC/17w-T6 tested under tensile, torsion, and combined tension-torsion fatigue cycling were evaluated with various fatigue damage models. The fatigue damage models of Smith-Watson-Topper (S. W. T.), Ellyin, Brown-Miller, Fatemi-Socie, and Varvani were compared for their capability to assess the fatigue damage of materials undergoing various loading conditions. Fatigue life predication results were then evaluated by implementing material-dependent coefficients that factored in the effects of the particle reinforcement in the earlier developed Varvani model. The critical plane-energy approach incorporated the critical plane as the plane of crack initiation and early stage of crack growth. The strain energy density was calculated on the critical plane incorporating stress and strain components acting on the plane. This approach successfully evaluated fatigue damage values versus fatigue lives within a narrower band for both uniaxial and multiaxial loading conditions as compared with other damage approaches studied in this paper.

Keywords: fatigue damage, life prediction, critical plane approach, energy approach, PMM composites

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52 The Relationship between EFL Learners' Self-Regulation and Willingness to Communicate

Authors: Mania Nosratinia, Zahra Deris

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The purpose of the present study was to investigate the relationship between EFL learners' self-regulation (SR) and willingness to communicate (WTC). To this end, 520 male and female EFL learners, ranging between 19 and 34 years old (Mage = 26), majoring in English Translation, English Language Teaching and English Literature at Islamic Azad University, Fars Province, were randomly selected. They were given two questionnaires: Self-Regulation Questionnaire devised by Brown, Miller, and Lawendowski (1999) and Willingness to Communicate Scale devised by McCroskey and Baer (1985). Preliminarily, pertinent analyses were performed on the data to check the assumptions of normality, linearity, and homoscedasticity. Since the assumption of normality was violated, Spearman's rank-order correlation was employed to probe the relationships between SR and WTC. The results indicated a significant and positive correlation between the two variables, ρ = .56, n = 520, p < .05, which signified a large effect size supplemented by a very small confidence interval (0.503 – 0.619). The results of the Kruskal-Wallis tests indicated that there is a statistically significant difference in WTC score between the different levels of SR, χ2(2) = 157.843, p = 0.000 with a mean rank SR score of 128.13 for low-SR level, 286.64 for mid-SR level, and 341.12 for high-SR level. Also, a post-hoc comparison through running a Dwass-Steel-Critchlow-Fligner indicated significant differences among the SR level groups on WTC scores. Given the findings of the study, the obtained results may help EFL teachers, teacher trainers, and material developers to possess a broader perspective towards the TEFL practice and to take practical steps towards the attainments of the desired objectives and effective instruction.

Keywords: EFL learner, self-regulation, willingness to communicate, relationship

Procedia PDF Downloads 283
51 Investigation of Time Pressure and Instinctive Reaction in Moral Dilemmas While Driving

Authors: Jacqueline Miller, Dongyuan Y. Wang, F. Dan Richard

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Before trying to make an ethical machine that holds a higher ethical standard than humans, a better understanding of human moral standards that could be used as a guide is crucial. How humans make decisions in dangerous driving situations like moral dilemmas can contribute to developing acceptable ethical principles for autonomous vehicles (AVs). This study uses a driving simulator to investigate whether drivers make utilitarian choices (choices that maximize lives saved and minimize harm) in unavoidable automobile accidents (moral dilemmas) with time pressure manipulated. This study also investigates how impulsiveness influences drivers’ behavior in moral dilemmas. Manipulating time pressure results in collisions that occur at varying time intervals (4 s, 5 s, 7s). Manipulating time pressure helps investigate how time pressure may influence drivers’ response behavior. Thirty-one undergraduates participated in this study using a STISM driving simulator to respond to driving moral dilemmas. The results indicated that the percentage of utilitarian choices generally increased when given more time to respond (from 4 s to 7 s). Additionally, participants in vehicle scenarios preferred responding right over responding left. Impulsiveness did not influence utilitarian choices. However, as time pressure decreased, response time increased. Findings have potential implications and applications on the regulation of driver assistance technologies and AVs.

Keywords: time pressure, automobile moral dilemmas, impulsiveness, reaction time

Procedia PDF Downloads 27
50 A Comprehensive Analysis of the Phylogenetic Signal in Ramp Sequences in 211 Vertebrates

Authors: Lauren M. McKinnon, Justin B. Miller, Michael F. Whiting, John S. K. Kauwe, Perry G. Ridge

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Background: Ramp sequences increase translational speed and accuracy when rare, slowly-translated codons are found at the beginnings of genes. Here, the results of the first analysis of ramp sequences in a phylogenetic construct are presented. Methods: Ramp sequences were compared from 211 vertebrates (110 Mammalian and 101 non-mammalian). The presence and absence of ramp sequences were analyzed as a binary character in a parsimony and maximum likelihood framework. Additionally, ramp sequences were mapped to the Open Tree of Life taxonomy to determine the number of parallelisms and reversals that occurred, and these results were compared to what would be expected due to random chance. Lastly, aligned nucleotides in ramp sequences were compared to the rest of the sequence in order to examine possible differences in phylogenetic signal between these regions of the gene. Results: Parsimony and maximum likelihood analyses of the presence/absence of ramp sequences recovered phylogenies that are highly congruent with established phylogenies. Additionally, the retention index of ramp sequences is significantly higher than would be expected due to random chance (p-value = 0). A chi-square analysis of completely orthologous ramp sequences resulted in a p-value of approximately zero as compared to random chance. Discussion: Ramp sequences recover comparable phylogenies as other phylogenomic methods. Although not all ramp sequences appear to have a phylogenetic signal, more ramp sequences track speciation than expected by random chance. Therefore, ramp sequences may be used in conjunction with other phylogenomic approaches.

Keywords: codon usage bias, phylogenetics, phylogenomics, ramp sequence

Procedia PDF Downloads 128
49 Patient Care Needs Assessment: An Evidence-Based Process to Inform Quality Care and Decision Making

Authors: Wynne De Jong, Robert Miller, Ross Riggs

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Beyond the number of nurses providing care for patients, having nurses with the right skills, experience and education is essential to ensure the best possible outcomes for patients. Research studies continue to link nurse staffing and skill mix with nurse-sensitive patient outcomes; numerous studies clearly show that superior patient outcomes are associated with higher levels of regulated staff. Due to the limited number of tools and processes available to assist nurse leaders with staffing models of care, nurse leaders are constantly faced with the ongoing challenge to ensure their staffing models of care best suit their patient population. In 2009, several hospitals in Ontario, Canada participated in a research study to develop and evaluate an RN/RPN utilization toolkit. The purpose of this study was to develop and evaluate a toolkit for Registered Nurses/Registered Practical Nurses Staff mix decision-making based on the College of Nurses of Ontario, Canada practice standards for the utilization of RNs and RPNs. This paper will highlight how an organization has further developed the Patient Care Needs Assessment (PCNA) questionnaire, a major component of the toolkit. Moreover, it will demonstrate how it has utilized the information from PCNA to clearly identify patient and family care needs, thus providing evidence-based results to assist leaders with matching the best staffing skill mix to their patients.

Keywords: nurse staffing models of care, skill mix, nursing health human resources, patient safety

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48 Workload and Task Distribution in Public Healthcare: A Qualitative Explorative Study From Nurse Leaders’ Perceptions

Authors: Jessica Hemberg, Mikaela Miller

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Unreasonable workload and work-related stress can reduce nurse leaders’ job satisfaction and productivity and can increase absence and burnout. Nurse leaders’ workload in public healthcare settings is relatively unresearched. The aim of this study was to investigate nurse leaders’ perceptions of workload and task distribution with relation to leading work tasks in public healthcare. A qualitative explorative design was used. The data material consisted of texts from interviews with nurse leaders in public healthcare (N=8). The method was inspired by content analysis. The COREQ checklist was used. Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Six main themes were found: Increased and unreasonable workload, Length of work experience as nurse leader affects perception of workload, Number of staff and staff characteristics affect perception of workload, Versatile and flexible task distribution, Working overtime as a way of managing high workload, and Insufficient time for leadership mission. The workload for nurse leaders in a public healthcare setting was perceived to be unreasonable. Common measures for managing high workload included working overtime, delegating work tasks and organizing more staff resources in the form of additional staff. How nurse leaders perceive their workload was linked to both the number of staff and staff characteristics. These should both be considered equally important when determining staff levels and measuring nurse leaders’ workload. Future research should focus on investigating workload and task distribution from nurses’ perspectives.

Keywords: nurse leaders, workload, task distribution, public healthcare, qualitative

Procedia PDF Downloads 66
47 Nurse Practitioner Led Pediatric Primary Care Clinic in a Tertiary Care Setting: Improving Access and Health Outcomes

Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge

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Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.

Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework

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46 Value Generation of Construction and Demolition Waste Originated in the Building Rehabilitation to Improve Energy Efficiency; From Waste to Resources

Authors: Mercedes Del Rio Merino, Jaime Santacruz Astorqui, Paola Villoria Saez, Carmen Viñas Arrebola

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The lack of treatment of the waste from construction and demolition waste (CDW) is a problem that must be solved immediately. It is estimated that in the world not to use CDW generates an increase in the use of new materials close to 20% of the total value of the materials used. The problem is even greater in case these wastes are considered hazardous because the final deposition of them may also generate significant contamination. Therefore, the possibility of including CDW in the manufacturing of building materials, represents an interesting alternative to ensure their use and to reduce their possible risk. In this context and in the last years, many researches are being carried out in order to analyze the viability of using CDW as a substitute for the traditional raw material of high environmental impact. Even though it is true, much remains to be done, because these works generally characterize materials but not specific applications that allow the agents of the construction to have the guarantees required by the projects. Therefore, it is necessary the involvement of all the actors included in the life cycle of these new construction materials, and also to promote its use for, for example, definition of standards, tax advantages or market intervention is necessary. This paper presents the main findings reached in "Waste to resources (W2R)" project since it began in October 2014. The main goal of the project is to develop new materials, elements and construction systems, manufactured from CDW, to be used in improving the energy efficiency of buildings. Other objectives of the project are: to quantify the CDW generated in the energy rehabilitation works, specifically wastes from the building envelope; and to study the traceability of CDW generated and promote CDW reuse and recycle in order to get close to the life cycle of buildings, generating zero waste and reducing the ecological footprint of the construction sector. This paper determines the most important aspects to consider during the design of new constructive solutions, which improve the energy efficiency of buildings and what materials made with CDW would be the most suitable for that. Also, a survey to select best practices for reducing "close to zero waste" in refurbishment was done. Finally, several pilot rehabilitation works conform the parameters analyzed in the project were selected, in order to apply the results and thus compare the theoretical with reality. Acknowledgements: This research was supported by the Spanish State Secretariat for Research, Development and Innovation of the Ministry of Economy and Competitiveness under "Waste 2 Resources" Project (BIA2013-43061-R).

Keywords: building waste, construction and demolition waste, recycling, resources

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45 From Research to Practice: Upcycling Cinema Icons

Authors: Mercedes Rodriguez Sanchez, Laura Luceño Casals

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With the rise of social media, creative people and brands everywhere are constantly generating content. The students with Bachelor's Degrees in Fashion Design use platforms such as Instagram or TikTok to look for inspiration and entertainment, as well as a way to develop their own ideas and share them with a wide audience. Information and Communications Technologies (ICT) have become a central aspect of higher education, virtually affecting every aspect of the student experience. Following the current trend, during the first semester of the second year, a collaborative project across two subjects –Design Management and History of Fashion Design– was implemented. After an introductory class focused on the relationship between fashion and cinema, as well as a brief history of 20th-century fashion, the students freely chose a work team and an iconic look from a movie costume. They researched the selected movie and its sociocultural context, analyzed the costume and the work of the designer, and studied the style, fashion magazines and most popular films of the time. Students then redesigned and recreated the costume, for which they were compelled to recycle the materials they had available at home as an unavoidable requirement of the activity. Once completed the garment, students delivered in-class, team-based presentations supported by the final design, a project summary poster and a making-of video, which served as a documentation tool of the costume design process. The methodologies used include Challenge-Based Learning (CBL), debates, Internet research, application of Information and Communications Technologies, and viewing clips of classic films, among others. After finishing the projects, students were asked to complete two electronic surveys to measure the acquisition of transversal and specific competencies of each subject. Results reveal that this activity helped the students' knowledge acquisition, a deeper understanding of both subjects and their skills development. The classroom dynamic changed. The multidisciplinary approach encouraged students to collaborate with their peers, while educators were better able to keep students' interest and promote an engaging learning process. As a result, the activity discussed in this paper confirmed the research hypothesis: it is positive to propose innovative teaching projects that combine academic research with playful learning environments.

Keywords: cinema, cooperative learning, fashion design, higher education, upcycling

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44 Examining Pre-Consumer Textile Waste Recycling, Barriers to Implementation, and Participant Demographics: A Review of Literature

Authors: Madeline W. Miller

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The global textile industry produces pollutants in the form of liquid discharge, solid waste, and emissions into the natural environment. Textile waste resulting from garment production and other manufacturing processes makes a significant contribution to the amount of waste landfilled globally. While the majority of curbside and other convenient recycling methods cater to post-consumer paper and plastics, pre-consumer textile waste is often discarded with trash and is commonly classified as ‘other’ in municipal solid waste breakdowns. On a larger scale, many clothing manufacturers and other companies utilizing textiles have not yet identified or began using the most sustainable methods for discarding their post-industrial, pre-consumer waste. To lessen the amount of waste sent to landfills, there are post-industrial, pre-consumer textile waste recycling methods that can be used to give textiles a new life. This process requires that textile and garment manufacturers redirect their waste to companies that use industrial machinery to shred or fiberize these materials in preparation for their second life. The goal of this literature review is to identify the recycling and reuse challenges faced by producers within the clothing and textile industry that prevent these companies from utilizing the described recycling methods, causing them to opt for landfill. The literature analyzed in this review reflects manufacturer sentiments toward waste disposal and recycling. The results of this review indicate that the cost of logistics is the determining factor when it comes to companies recycling their pre-consumer textile waste and that the most applicable and successful textile waste recycling methods require a company separate from the manufacturer to account for waste production, provide receptacles for waste, arrange waste transport, and identify a secondary use for the material at a price-point below that of traditional waste disposal service.

Keywords: leadership demographics, post-industrial textile waste, pre-consumer textile waste, industrial shoddy

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43 Calcitonin gene-related peptide Receptor Antagonists for Chronic Migraine – Real World Outcomes

Authors: B. J. Mahen, N. E. Lloyd-Gale, S. Johnson, W. P. Rakowicz, M. J. Harris, A. D. Miller

Abstract:

Background: Migraine is a leading cause of disability in the world. Calcitonin gene-related peptide (CGRP) receptor antagonists offer an approach to migraine prophylaxis by inhibiting the inflammatory and vasodilatory effects of CGRP. In recent years, NICE licensed the use of three CGRP-receptor antagonists: Fremanezumab, Galcanezumab, and Erenumab. Here, we present the outcomes of CGRP-antagonist treatment in a cohort of patients who suffer from episodic or chronic migraine and have failed at least three oral prophylactic therapies. Methods: We offered CGRP antagonists to 86 patients who met the NICE criteria to start therapy. We recorded the number of headache days per month (HDPM) at 0 weeks, 3 months, and 12 months. Of those, 26 patients were switched to an alternative treatment due to poor response or side effects. Of the 112 total cases, 9 cases did not sufficiently maintain their headache diary, and 5 cases were not followed up at 3 months. We have therefore included 98 sets of data in our analysis. Results: Fremanezumab achieved a reduction in HDPM by 51.7% at 3 months (p<0.0001), with 63.7% of patients meeting NICE criteria to continue therapy. Patients trialed on Galcanezumab attained a reduction in HDPM by 47.0% (p=0.0019), with 51.6% of patients meeting NICE criteria to continue therapy. Erenumab, however, only achieved a reduction in HDPM by 17.0% (p=0.29), and this was not statistically significant. Furthermore, 34.4%, 9.7%, and 4.9% of patients taking Fremanezumab, Galcanezumab, and Erenumab, respectively, continued therapy beyond 12 months. Of those who attempted drug holidays following 12 months of treatment, migraine symptoms relapsed in 100% of cases. Conclusion: We observed a significant improvement in HDPM amongst episodic and chronic migraine patients following treatment with Fremanezumab or Galcanezumab.

Keywords: migraine, CGRP, fremanezumab, galcanezumab, erenumab

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42 Risk Management and Resiliency: Evaluating Walmart’s Global Supply Chain Leadership Using the Supply Chain Resilience Assessment and Management Framework

Authors: Meghan Biallas, Amanda Hoffman, Tamara Miller, Kimmy Schnibben, Janaina Siegler

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This paper assesses Walmart’s supply chain resiliency amidst continuous supply chain disruptions. It aims to evaluate how Walmart can use supply chain resiliency theory to retain its status as a global supply chain leader. The Bloomberg terminal was used to organize Walmart’s 754 Tier-1 suppliers by the size of their relationship to Walmart. Additional data from IBISWorld and Statista was also used in the analysis. This research focused on the top ten Tier-1 suppliers, with the greatest percentage of their revenue attributed to Walmart. This paper also applied the firm’s information to the Supply Chain Resilience Assessment and Management (SCRAM) framework for supply chain resiliency to evaluate the firm’s capabilities, vulnerabilities, and gaps. A rubric was created to quantify Walmart’s risks using four pillars: flexibility, velocity, visibility, and collaboration. Information and examples were reported from Walmart’s 10k filing. For each example, a rating of 1 indicated “high” resiliency, 0 indicated “medium” resiliency, and -1 indicated “low” resiliency. Findings from this study include the following: (1) Walmart has maintained its leadership through its ability to remain resilient with regard to visibility, efficiency, capacity, and collaboration. (2) Walmart is experiencing increases in supply chain costs due to internal factors affecting the company and external factors affecting its suppliers. (3) There are a number of emerging supply chain risks with Walmart’s suppliers, which could cause issues for Walmart to remain a supply chain leader in the future. Using the SCRAM framework, this paper assesses how Walmart measures up to the Supply Chain Resiliency Theory, identifying areas of strength as well as areas where Walmart can improve in order to remain a global supply chain leader.

Keywords: supply chain resiliency, zone of balanced resilience, supply chain resilience assessment and management, supply chain theory.

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41 Effect of Supplementation of Rough Lemon Juice, Amla Juice and Aloe Vera Gel on Physio-biochemical and Hematological Parameters of Broiler Chicken During Summer Season

Authors: Suraj Amrutkar, R. Gowri, Asma Khan, Nazam Khan, Vikas Mahajan, Manpreet Kour And Bharti Deshmukh

Abstract:

Herbal additives are rich in vitamin C, A and other biological active compounds and may act as surrogate source to subdue heat stress in chicken. Among various herbal additives such as rough lemon (Citrus Jambhiri Lush) juice, amla (Emblica officinalis) juice and aloe vera (Aloe barbadensis miller) gel are easily available during summer (stress period) and also cost less as comparison to synthetic feed additives in market. In order to analyze the performance by supplementation of rough lemon juice, amla juice and aloe vera gel in broiler under heat stress conditions. Study was carried out with a random distribution of day old straight run chicks (240 No.) in to four treatment group (n=60) was done. All the groups were given basal diet (Maize-Soya based; T0) was same for all the groups with supplementation of rough lemon juice (T1), amla juice (T2) and aloe vera (T3) @ 2% in drinking water. Experiment trial lasted for 42 days during heat stress period (June-July) with minimum THI (78.2) and Maximum THI (88.02). Feed and water were offered ad-libitum throughout the trial. Results revealed significantly higher (P<0.05) body weight in T3 and T2, followed by T1 and least in T0 at 42 days of age. The overall mean of Feed conversion ratio of various treatment T0, T1, T2 andT3 were 2.16, 1.98, 1.89 and 1.82, respectively. The mortality percentage in various treatment, T0, T1, T2 and T3, were 6.67, 3.33, 0.0 and 1.67, respectively. pH value, PCV (%), Sodium (mmol/L) and Potassium (mmol/L) was higher in T3 than rest of the groups. HL ratio is significantly lower (P<0.05) in T3, T2 followed by T1 than T0 at 42 days of age. It may be inferred that amongst these phyto-additives, aloe vera leads in alleviating heat stress in broiler in an economical way, followed by amla and rough lemon.

Keywords: rough lemon, amla, aloe vera, heat stress, broiler

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40 Psychological Variables Predicting Academic Achievement in Argentinian Students: Scales Development and Recent Findings

Authors: Fernandez liporace, Mercedes Uriel Fabiana

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Academic achievement in high school and college students is currently a matter of concern. National and international assessments show high schoolers as low achievers, and local statistics indicate alarming dropout percentages in this educational level. Even so, 80% of those students intend attending higher education. On the other hand, applications to Public National Universities are free and non-selective by examination procedures. Though initial registrations are massive (307.894 students), only 50% of freshmen pass their first year classes, and 23% achieves a degree. Low performances use to be a common problem. Hence, freshmen adaptation, their adjustment, dropout and low academic achievement arise as topics of agenda. Besides, the hinge between high school and college must be examined in depth, in order to get an integrated and successful path from one educational stratum to the other. Psychology aims at developing two main research lines to analyse the situation. One regarding psychometric scales, designing and/or adapting tests, examining their technical properties and their theoretical validity (e.g., academic motivation, learning strategies, learning styles, coping, perceived social support, parenting styles and parental consistency, paradoxical personality as correlated to creative skills, psychopathological symptomatology). The second research line emphasizes relationships within the variables measured by the former scales, facing the formulation and testing of predictive models of academic achievement, establishing differences by sex, age, educational level (high school vs college), and career. Pursuing these goals, several studies were carried out in recent years, reporting findings and producing assessment technology useful to detect students academically at risk as well as good achievers. Multiple samples were analysed totalizing more than 3500 participants (2500 from college and 1000 from high school), including descriptive, correlational, group differences and explicative designs. A brief on the most relevant results is presented. Providing information to design specific interventions according to every learner’s features and his/her educational environment comes up as a mid-term accomplishment. Furthermore, that information might be helpful to adapt curricula by career, as well as for implementing special didactic strategies differentiated by sex and personal characteristics.

Keywords: academic achievement, higher education, high school, psychological assessment

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39 Using Soil Texture Field Observations as Ordinal Qualitative Variables for Digital Soil Mapping

Authors: Anne C. Richer-De-Forges, Dominique Arrouays, Songchao Chen, Mercedes Roman Dobarco

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Most of the digital soil mapping (DSM) products rely on machine learning (ML) prediction models and/or the use or pedotransfer functions (PTF) in which calibration data come from soil analyses performed in labs. However, many other observations (often qualitative, nominal, or ordinal) could be used as proxies of lab measurements or as input data for ML of PTF predictions. DSM and ML are briefly described with some examples taken from the literature. Then, we explore the potential of an ordinal qualitative variable, i.e., the hand-feel soil texture (HFST) estimating the mineral particle distribution (PSD): % of clay (0-2µm), silt (2-50µm) and sand (50-2000µm) in 15 classes. The PSD can also be measured by lab measurements (LAST) to determine the exact proportion of these particle-sizes. However, due to cost constraints, HFST are much more numerous and spatially dense than LAST. Soil texture (ST) is a very important soil parameter to map as it is controlling many of the soil properties and functions. Therefore, comes an essential question: is it possible to use HFST as a proxy of LAST for calibration and/or validation of DSM predictions of ST? To answer this question, the first step is to compare HFST with LAST on a representative set where both information are available. This comparison was made on ca 17,400 samples representative of a French region (34,000 km2). The accuracy of HFST was assessed, and each HFST class was characterized by a probability distribution function (PDF) of its LAST values. This enables to randomly replace HFST observations by LAST values while respecting the PDF previously calculated and results in a very large increase of observations available for the calibration or validation of PTF and ML predictions. Some preliminary results are shown. First, the comparison between HFST classes and LAST analyses showed that accuracies could be considered very good when compared to other studies. The causes of some inconsistencies were explored and most of them were well explained by other soil characteristics. Then we show some examples applying these relationships and the increase of data to several issues related to DSM. The first issue is: do the PDF functions that were established enable to use HSFT class observations to improve the LAST soil texture prediction? For this objective, we replaced all HFST for topsoil by values from the PDF 100 time replicates). Results were promising for the PTF we tested (a PTF predicting soil water holding capacity). For the question related to the ML prediction of LAST soil texture on the region, we did the same kind of replacement, but we implemented a 10-fold cross-validation using points where we had LAST values. We obtained only preliminary results but they were rather promising. Then we show another example illustrating the potential of using HFST as validation data. As in numerous countries, the HFST observations are very numerous; these promising results pave the way to an important improvement of DSM products in all the countries of the world.

Keywords: digital soil mapping, improvement of digital soil mapping predictions, potential of using hand-feel soil texture, soil texture prediction

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38 Identifying Indicative Health Behaviours and Psychosocial Factors Affecting Multi-morbidity Conditions in Ageing Populations: Preliminary Results from the ELSA study of Ageing

Authors: Briony Gray, Glenn Simpson, Hajira Dambha-Miller, Andrew Farmer

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Multimorbidity may be strongly affected by a variety of conditions, factors, and variables requiring higher demands on health and social care services, infrastructure, and expenses. Holding one or more conditions increases one’s risk for development of future conditions; with patients over 65 years old at highest risk. Psychosocial factors such as anxiety and depression are rising exponentially globally, which has been amplified by the COVID19 pandemic. These are highly correlated and predict poorer outcomes when held in coexistence and increase the likelihood of comorbid physical health conditions. While possible future reform of social and healthcare systems may help to alleviate some of these mounting pressures, there remains an urgent need to better understand the potential role health behaviours and psychosocial conditions - such as anxiety and depression – may have on aging populations. Using the UK healthcare scene as a lens for analysis, this study uses big data collected in the UK Longitudinal Study of Aging (ELSA) to examine the role of anxiety and depression in ageing populations (65yrs+). Using logistic regression modelling, results identify the 10 most significant variables correlated with both anxiety and depression from data categorised into the areas of health behaviour, psychosocial, socioeconomic, and life satisfaction (each demonstrated through literature review to be of significance). These are compared with wider global research findings with the aim of better understanding the areas in which social and healthcare reform can support multimorbidity interventions, making suggestions for improved patient-centred care. Scope of future research is outlined, which includes analysis of 59 total multimorbidity variables from the ELSA dataset, going beyond anxiety and depression.

Keywords: multimorbidity, health behaviours, patient centred care, psychosocial factors

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37 Needs-Gap Analysis on Culturally and Linguistically Diverse Grandparent Carers ‘Hidden Issues’: An Insight for Community Nurses

Authors: Mercedes Sepulveda, Saras Henderson, Dana Farrell, Gaby Heuft

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In Australia, there is a significant number of Culturally and Linguistically Diverse (CALD) Grandparent Carers who are sole carers for their grandchildren. Services in the community such as accessible healthcare, financial support, legal aid, and transport to services can assist Grandparent Carers to continue to live in their own home whilst caring for their grandchildren. Community nurses can play a major role by being aware of the needs of these grandparents and link them to services via information and referrals. The CALD Grandparent Carer experiences have only been explored marginally and may be similar to the general Grandparent Carer population, although cultural aspects may add to their difficulties. This Needs-Gap Analysis aimed to uncover ‘hidden issues’ for CALD Grandparent Carers such as service gaps and actions needed to address these issues. The stakeholders selected for this Needs-Gap Analysis were drawn from relevant service providers such as community and aged care services, child and/or grandparents support services and CALD specific services. One hundred relevant service providers were surveyed using six structured questions via face to face, phone interviews, or email correspondence. CALD Grandparents who had a significant or sole role of being a carer for grandchildren were invited to participate through their CALD community leaders. Consultative Forums asking five questions that focused on the caring role, issues encountered, and what needed to be done, were conducted with the African, Asian, Spanish-Speaking, Middle Eastern, European, Pacific Islander and Maori Grandparent Carers living in South-east Queensland, Australia. Data from the service provider survey and the CALD Grandparent Carer forums were content analysed using thematic principles. Our findings highlighted social determinants of health grouped into six themes. These were; 1) service providers and Grandparent Carer perception that there was limited research data on CALD grandparents as carers; 2) inadequate legal and financial support; 3) barriers to accessing information and advice; 4) lack of childcare options in the light of aging and health issues; 5) difficulties around transport; and 6) inadequate technological skills often leading to social isolation for both carer and grandchildren. Our Needs-Gap Analysis provides insight to service providers especially health practitioners such as doctors and community nurses, particularly on the impact of caring for grandchildren on CALD Grandparent Carers. Furthermore, factors such as cultural differences, English language difficulties, and migration experiences also impacted on the way CALD Grandparent Carers are able to cope. The findings of this Need-Gap Analysis signposts some of the ‘ hidden issues’ that CALD Grandparents Carers face and draws together recommendations for the future as put forward by the stakeholders themselves.

Keywords: CALD grandparents, carer needs, community nurses, grandparent carers

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36 Emotional Processing Difficulties in Recovered Anorexia Nervosa Patients: State or Trait

Authors: Telma Fontao de Castro, Kylee Miller, Maria Xavier Araújo, Isabel Brandao, Sandra Torres

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Objective: There is a dearth of research investigating the long-term emotional functioning of individuals recovered from anorexia nervosa (AN). This 15-year longitudinal study aimed to examine whether difficulties in cognitive processing of emotions persisted after long-term AN recovery and its link to anxiety and depression. Method: Twenty-four females, who were tested longitudinally during their acute and recovered AN phases, and 24 healthy control (HC) women, were screened for anxiety, depression, alexithymia, and emotion regulation difficulties (ER; only assessed in recovery phase). Results: Anxiety, depression, and alexithymia levels decreased significantly with AN recovery. However, scores on anxiety and difficulty in identifying feelings (alexithymia factor) remained high when compared to the HC group. Scores on emotion regulation difficulties were also lower in HC group. The abovementioned differences between AN recovered group and HC group in difficulties in identifying and accepting feelings and lack of emotional clarity were no longer present when the effect of anxiety and depression was controlled. Conclusions: Findings suggest that emotional dysfunction tends to decrease in AN recovered phase. However, using an HC group as a reference, we conclude that several emotional difficulties are still increased after long-term AN recovery, in particular, limited access to emotion regulation strategies, and difficulty controlling impulses and engaging in goal-directed behavior, thus suggesting to be a trait vulnerability. In turn, competencies related to emotional clarity and acceptance of emotional responses seem to be state-dependent phenomena linked to anxiety and depression. In sum, managing emotions remains a challenge for individuals recovered from AN. Under this circumstance, maladaptive eating behavior can serve as an affect regulatory function, increasing the risk of relapse. Emotional education and stabilization of depressive and anxious symptomatology after recovery emerge as an important avenue to protect from long-term AN relapse.

Keywords: alexithymia, anorexia nervosa, emotion recognition, emotion regulation

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35 Application and Utility of the Rale Score for Assessment of Clinical Severity in Covid-19 Patients

Authors: Naridchaya Aberdour, Joanna Kao, Anne Miller, Timothy Shore, Richard Maher, Zhixin Liu

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Background: COVID-19 has and continues to be a strain on healthcare globally, with the number of patients requiring hospitalization exceeding the level of medical support available in many countries. As chest x-rays are the primary respiratory radiological investigation, the Radiological Assessment of Lung Edema (RALE) score was used to quantify the extent of pulmonary infection on baseline imaging. Assessment of RALE score's reproducibility and associations with clinical outcome parameters were then evaluated to determine implications for patient management and prognosis. Methods: A retrospective study was performed with the inclusion of patients testing positive for COVID-19 on nasopharyngeal swab within a single Local Health District in Sydney, Australia and baseline x-ray imaging acquired between January to June 2020. Two independent Radiologists viewed the studies and calculated the RALE scores. Clinical outcome parameters were collected and statistical analysis was performed to assess RALE score reproducibility and possible associations with clinical outcomes. Results: A total of 78 patients met inclusion criteria with the age range of 4 to 91 years old. RALE score concordance between the two independent Radiologists was excellent (interclass correlation coefficient = 0.93, 95% CI = 0.88-0.95, p<0.005). Binomial logistics regression identified a positive correlation with hospital admission (1.87 OR, 95% CI= 1.3-2.6, p<0.005), oxygen requirement (1.48 OR, 95% CI= 1.2-1.8, p<0.005) and invasive ventilation (1.2 OR, 95% CI= 1.0-1.3, p<0.005) for each 1-point increase in RALE score. For each one year increased in age, there was a negative correlation with recovery (0.05 OR, 95% CI= 0.92-1.0, p<0.01). RALE scores above three were positively associated with hospitalization (Youden Index 0.61, sensitivity 0.73, specificity 0.89) and above six were positively associated with ICU admission (Youden Index 0.67, sensitivity 0.91, specificity 0.78). Conclusion: The RALE score can be used as a surrogate to quantify the extent of COVID-19 infection and has an excellent inter-observer agreement. The RALE score could be used to prognosticate and identify patients at high risk of deterioration. Threshold values may also be applied to predict the likelihood of hospital and ICU admission.

Keywords: chest radiography, coronavirus, COVID-19, RALE score

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34 The Involvement of the Homing Receptors CCR7 and CD62L in the Pathogenesis of Graft-Versus-Host Disease

Authors: Federico Herrera, Valle Gomez García de Soria, Itxaso Portero Sainz, Carlos Fernández Arandojo, Mercedes Royg, Ana Marcos Jimenez, Anna Kreutzman, Cecilia MuñozCalleja

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Introduction: Graft-versus-host disease (GVHD) still remains the major complication associated with allogeneic stem cell transplantation (SCT). The pathogenesis involves migration of donor naïve T-cells into recipient secondary lymphoid organs. Two molecules are important in this process: CD62L and CCR7, which are characteristically expressed in naïve/central memory T-cells. With this background, we aimed to study the influence of CCR7 and CD62L on donor lymphocytes in the development and severity of GVHD. Material and methods: This single center study included 98 donor-recipient pairs. Samples were collected prospectively from the apheresis product and phenotyped by flow cytometry. CCR7 and CD62L expression in CD4+ and CD8+ T-cells were compared between patients who developed acute (n=40) or chronic GVHD (n=33) and those who did not (n=38). Results: The patients who developed acute GVHD were transplanted with a higher percentage of CCR7+CD4+ T-cells (p = 0.05) compared to the no GVHD group. These results were confirmed when these patients were divided in degrees according to the severity of the disease; the more severe disease, the higher percentage of CCR7+CD4+ T-cells. Conversely, chronic GVHD patients received a higher percentage of CCR7+CD8+ T-cells (p=0.02) in comparison to those who did not develop the complication. These data were also confirmed when patients were subdivided in degrees of the disease severity. A multivariable analysis confirmed that percentage of CCR7+CD4+ T-cells is a predictive factor of acute GVHD whereas the percentage of CCR7+CD8+ T-cells is a predictive factor of chronic GVHD. In vitro functional assays (migration and activation assays) supported the idea of CCR7+ T-cells were involved in the development of GVHD. As low levels of CD62L expression were detected in all apheresis products, we tested the hypothesis that CD62L was shed during apheresis procedure. Comparing CD62L surface levels in T-cells from the same donor immediately before collecting the apheresis product, and the final apheresis product we found that this process down-regulated CD62L in both CD4+ and CD8+ T cells (p=0.008). Interestingly, when CD62L levels were analysed in days 30 or 60 after engraftment, they recovered to baseline (p=0.008). However, to investigate the relation between CD62L expression and the development of GVHD in the recipient samples after the engraftment, no differences were observed comparing patients with GVHD to those who did not develop the disease. Discussion: Our prospective study indicates that the CCR7+ T-cells from the donor, which include naïve and central memory T-cells, contain the alloreactive cells with a high ability to mediate GVHD (in the case of both migration and activation). Therefore we suggest that the proportion and functional properties of CCR7+CD4+ and CCR7+CD8+ T-cells in the apheresis could act as a predictive biomarker to both acute and chronic GVHD respectively. Importantly, our study precludes that CD62L is lost in the apheresis and therefore it is not a reliable biomarker for the development of GVHD.

Keywords: CCR7, CD62L, GVHD, SCT

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