Search results for: analogue

Authors: Sung Hee Ahn, Ju Rang Han

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Background: With increasing importance in healthcare organization on patient satisfaction and nurses’ job satisfaction, many studies have been conducted. But no research has been administered how nurses’ satisfaction with healthcare organization influence patient satisfaction and loyalty. Purpose: This study aims to conceptualize nurses‘ satisfaction, patient satisfaction with and patient loyalty to hospitals using a hypothetical linear structural equation model, and to identify the significance of path coefficients and goodness of fit index of the structural equation model as well. Method: A total of 2,079 nurses and 6,776 patients recruited from 5 university hospitals in South Korea participated in this study. The data on nurses, including ward nurses and outpatient nurses, were collected from June 24th to July 12th, at the 204 departments of the 5 hospitals through an on-line survey. The data on the patients, including both inpatients and outpatients, were collected from September 30th to October 24th, 2013 at the 5 hospitals using a structured questionnaire. The variable of nurses’ satisfaction was measured using a scale evaluating internal client satisfaction, which is used in SSM Health Care System in the US. Patient satisfaction with the hospital and nurses and patient loyalty were measured by assessing the patient’s intention to revisit and to recommending the hospital to others using a visual analogue scale. The data were analyzed using SPSS version 21.0 and AMOS version 21.0. Result: The hypothetical model was fairly good in terms of goodness of fit (χ2= 64.897 (df=24, p <. 001), GFI=. 906, AGFI=.823, CFI=.921, NFI=.951, NNFI=.952. RMSEA=.114). The significance of path coefficients includes followings 1)The nurses’ satisfaction has significant influence on the patient satisfaction with nurses. 2)The patient satisfaction with nurses has significant influence on the patient satisfaction with the hospital. 3)The patient satisfaction with the hospital has significant influence on the patients’ revisit intention. 4)The patient satisfaction with the hospital has significant influence on the patients’ intention to the recommendations of the hospital. Conclusion: These results provide several practical implications to hospital administrators, who should incorporate ways of improving nurses' and patients' satisfaction with the hospital into their health care marketing strategies.

Keywords: linear structural equation model, loyalty, nurse, patient satisfaction

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Authors: Gi-Young Park, Dong Rak Kwon, Sung Cheol Cho

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Objective: The synovium is known to be involved in many pathological characteristic processes. Also, synovitis is common in advanced osteoarthritis. We aimed to evaluate the clinical, radiographic, and ultrasound findings in patients with knee osteoarthritis and to compare the clinical and imaging findings between knee osteoarthritis with and without synovial hypertrophy confirmed by ultrasound. Methods: One hundred knees (54 left, 46 right) in 95 patients (64 women, 31 men; mean age, 65.9 years; range, 43-85 years) with knee osteoarthritis were recruited. The Visual Analogue Scale (VAS) was used to assess the intensity of knee pain. The severity of knee osteoarthritis was classified according to Kellgren and Lawrence's (K-L) grade on a radiograph. Ultrasound examination was performed by a physiatrist who had 24 years of experience in musculoskeletal ultrasound. Ultrasound findings, including the thickness of joint effusion in the suprapatellar pouch, synovial hypertrophy, infrapatellar tendinosis, meniscal tear or extrusion, and Baker cyst, were measured and detected. The thickness of knee joint effusion was measured at the maximal anterior-posterior diameter of fluid collection in the suprapatellar pouch. Synovial hypertrophy was identified as the soft tissue of variable echogenicity, which is poorly compressible and nondisplaceable by compression of an ultrasound transducer. The knees were divided into two groups according to the presence of synovial hypertrophy. The differences in clinical and imaging findings between the two groups were evaluated by independent t-test and chi-square test. Results: Synovial hypertrophy was detected in 48 knees of 100 knees on ultrasound. There were no significant differences in demographic parameters and VAS score except in sex between the two groups (P<0.05). Medial meniscal extrusion and tear were significantly more frequent in knees with synovial hypertrophy than those in knees without synovial hypertrophy. K-L grade and joint effusion thickness were greater in patients with synovial hypertrophy than those in patients without synovial hypertrophy (P<0.05). Conclusion: Synovial hypertrophy in knee osteoarthritis was associated with greater suprapatellar joint effusion and higher K-L grade and maybe a characteristic ultrasound feature of late knee osteoarthritis. These results suggest that synovial hypertrophy on ultrasound can be regarded as a predictor of rapid progression in patients with knee osteoarthritis.

Keywords: knee osteoarthritis, synovial hypertrophy, ultrasound, K-L grade

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Authors: Chiara Colarusso, Michela Terlizzi, Aldo Pinto, Rosalinda Sorrentino

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Cigarette smoking is the main cause and the most common risk factor for both COPD and lung cancer. In our previous studies, we proved that caspase-11 in mice and its human analogue, caspase-4, are involved in lung carcinogenesis and that AIM2 inflammasome might play a pro-cancerous role in lung cancer. Therefore, the aim of this study was to investigate potential crosstalk between COPD and lung cancer, focusing on AIM2 and caspase-11-dependent inflammasome signaling pathway. To mimic COPD, we took advantage of an experimental first-hand smoking mouse model and, to confirm what was observed in mice, we used human samples of lung adenocarcinoma patients stratified according to the smoking and COPD status. We demonstrated that smoke exposure led to emphysema-like features, bronchial tone impairment, and release of IL-1-like cytokines (IL-1α, IL-1β, IL-33, IL-18) in a caspase-1 independent manner in C57Bl/6N. Rather, a dysfunctional caspase-11 in smoke-exposed 129Sv mice was associated to lower bronchial inflammation, collagen deposition, and IL-1-like inflammation. In addition, for the first time, we found that AIM2 inflammasome is involved in lung inflammation in smoking and COPD, in that its expression was higher in smoke-exposed C57Bl/6N compared to 129Sv smoking mice, who instead did not show any alteration of AIM2 in both macrophages and dendritic cells. Moreover, we found that AIM2 expression in the cancerous tissue, albeit higher than non-cancerous tissue, was not statistically different according to the COPD and smoking status. Instead, the higher expression of AIM2 in non-cancerous tissue of smoker COPD patients than smokers who did not have COPD was correlated to a higher hazard ratio of poor survival rate than patients who presented lower levels of AIM2. In conclusion, our data highlight that caspase-11 in mice is associated to smoke-induced lung latent inflammation which could drive the establishment of lung cancer, and that AIM2 inflammasome plays a role at the crosstalk between smoking/COPD and lung adenocarcinoma in that its higher presence is correlated to lower survival rate of smoker COPD adenocarcinoma.

Keywords: COPD, inflammasome, lung cancer, lung inflammation, smoke

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Authors: Minhal Abidi, Moinuddin

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Diabetes mellitus (DM) induced metabolic abnormalities causes oxidative stress which leads to the pathogenesis of complications associated with diabetes like retinopathy, nephropathy periodontitis etc. Combination of glycation and oxidation 'glycoxidation' occurs when oxidative reactions affect the early state of glycation products. Low density lipoprotein (LDL) is prone to glycoxidative attack by sugars and methylglyoxal (MGO) being a strong glycating agent may have severe impact on its structure and consequent role in diabetes. Pro-inflammatory cytokines like IL1β and TNFα produced by the action of gram negative bacteria in periodontits (PD) can in turn lead to insulin resistance. This work discusses modifications to LDL as a result of glycoxidation. The changes in the protein molecule have been characterized by various physicochemical techniques and the immunogenicity of the modified molecules was also evaluated as they presented neo-epitopes. Binding of antibodies present in diabetes patients to the native and glycated LDL has been evaluated. Role of modified epitopes in the generation of antibodies in diabetes and periodontitis has been discussed. The structural perturbations induced in LDL were analyzed by UV–Vis, fluorescence, circular dichroism and FTIR spectroscopy, molecular docking studies, thermal denaturation studies, Thioflavin T assay, isothermal titration calorimetry, comet assay. MALDI-TOF, ketoamine moieties, carbonyl content and HMF content were also quantitated in native and glycated LDL. IL1β and TNFα levels were also measured in the type 2 DM and PD patients. We report increased carbonyl content, ketoamine moieties and HMF content in glycated LDL as compared to native analogue. The results substantiate that in hyperglycemic state MGO modification of LDL causes structural perturbations making the protein antigenic which could obstruct normal physiological functions and might contribute in the development of secondary complications in diabetic patients like periodontitis.

Keywords: advanced glycation end products, diabetes mellitus, glycation, glycoxidation, low density lipoprotein, periodontitis

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Authors: S. F. Kanaan, Fatima Al-Kadi, H. Khrais

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Background: Fibromyalgia is a chronic condition that is characterized by chronic pain that limits physical and functional activities. To our best knowledge, there is currently no key physiotherapy approach recommended to reduce pain and improve function. In addition, there are scarce studies that investigated the effect of manual therapy in the management of Fibromyalgia, and no study investigated the efficacy of Mulligan´s mobilization with movement (MWM) in particular. Methods: A 51-year-old female diagnosed with Fibromyalgia for more than a year. The patient was complaining of generalized pain including neck, lower back, shoulders, elbows, hips, and knees. In addition, the patient reported severe limitation in activities and inability to complete her work as a lawyer. The Intervention provided for the patient consisted of 4 sessions (in two weeks) of MWM for neck, lower back, shoulders, elbows, sacroiliac joint, hips, and knees. The Visual Analogue Scale of pain (VAS), Range of Motion (ROM), 10-minute walk test, Roland Morris Low Back Pain and Disability Questionnaire (RMQ), Disability of the Arm, Shoulder and Hand Score (DASH) were collected at the baseline and at the end of treatment. Results: Average improvement of ROM in the neck, lower back, shoulder, elbows, hips, and knees was 45%. VAS scale changed from pre-treatment to post-treatment as the following: neck pain (9 to 0), lower back pain (8 to 1), shoulders pain (8 to 2), elbows pain (7 to 1), and knees pain (9 to 0). The patient demonstrated improvement in all functional scale from pre-intervention to post-intervention: 10-meter walk test (9.8 to 4.5 seconds), RMQ (21 to 11/24), and DASH (88.7% to 40.5%). The patient did not report any side effect of using this approach. Conclusion: Fibromyalgia can cause joint 'faulty position' leading to pain and dysfunction, which can be reversed by using MWM. MWM showed to have clinically significant improvement in ROM, pain, and ability to walk and a clinically significant reduction in disability in only 4 sessions. This work can be expanded in a larger sample.

Keywords: mobilization, fibromyalgia, dysfunction, manual therapy

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Authors: Adesola Odole, Nse Odunaiya, Samuel Adewale

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Chronic Mechanical Low Back Pain (CMLBP) is prevalent in the aging population; some studies have documented the association among pain intensity, functional disability and physical activity in the general population but very few studies in the elderly. This study was designed to investigate the association among pain intensity, functional disability and physical activity of elderly individuals with CMLBP in the University College Hospital (UCH), Ibadan, Nigeria and also to determine the difference in physical activity, pain intensity and functional disability between males and females. A total of 96 participants diagnosed with CMLBP participated in this cross-sectional survey. They were conveniently sampled from selected units in the UCH, Ibadan, Nigeria. Data on sex, marital status, occupation and duration of onset of pain of participants were obtained from the participants. The Physical Activity Scale for the Elderly, Visual Analogue Scale and Oswestry Disability Questionnaire were used to measure the physical activity, pain intensity and functional disability of the participants respectively. Data was analysed using Spearman correlation, independent t-test; and α was set at 0.05. Participants (25 males, 71 females) were aged 69.64±7.43 years. The majority (76.0%) of the participants were married, and over half (55.2%) were retirees. Participants’ mean pain intensity score was 5.21±2.03 and mean duration of onset of low back pain was 63.63 ± 90.01 months. The majority (67.6%) of the participants reported severe to crippled functional disability. Their mean functional disability was 46.91 ± 13.99. Participants’ mean physical activity score was 97.47 ± 82.55. There was significant association between physical activity and pain intensity (r = -0.21, p = 0.04). There was significant association between physical activity and functional disability (r = -0.47, p = 0.00). Male (87.26 ± 79.94) and female (101.07 ± 83.71) participants did not differ significantly in physical activity (t = 0.00, p = 0.48). In addition, male (5.48 ± 2.06) and female (5.11 ± 2.02) participants’ pain intensity were comparable (t = 0.26, p = 0.44). There was also no significant difference in functional disability (t = 0.05, p = 0.07) between male (42.56 ±13.85) and female (48.45 ± 13.81) participants. It can be concluded from this study that majority of the elderly individuals with chronic mechanical low back pain had a severe to crippled functional disability. Those who reported increased physical activity had reduced pain intensity and functional disability. Male and female elderly individuals with chronic mechanical low back pain are comparable in their pain intensity, functional disability, and physical activity. Elderly individuals with CMLBP should be educated on the importance of participating in physical activity which could reduce their pain symptoms and improve functional disability.

Keywords: elderly, functional disability, mechanical low back pain, pain intensity, physical activity

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Authors: Daniel Scherman, Daniel Madani, Shanu Gambhir, Marcus Ling Zhixing, Yingda Li

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Objective: This study aims to identify clinical factors that may predict failed endoscopic lumbar spine surgery to guide surgeons with patient selection during the initial learning curve. Methods: This is an Australasian prospective analysis of the first 105 patients to undergo lumbar endoscopic spine decompression by 3 surgeons. Modified MacNab outcomes, Oswestry Disability Index (ODI) and Visual Analogue Score (VAS) scores were utilized to evaluate clinical outcomes at 6 months postoperatively. Descriptive statistics and Anova t-tests were performed to measure statistically significant (p<0.05) associations between variables using GraphPad Prism v10. Results: Patients undergoing endoscopic lumbar surgery via an interlaminar or transforaminal approach have overall good/excellent modified MacNab outcomes and a significant reduction in post-operative VAS and ODI scores. Regardless of the anatomical location of disc herniations, good/excellent modified MacNab outcomes and significant reductions in VAS and ODI were reported post-operatively; however, not in patients with calcified disc herniations. Patients with central and foraminal stenosis overall reported poor/fair modified MacNab outcomes. However, there were significant reductions in VAS and ODI scores post-operatively. Patients with subarticular stenosis or an associated spondylolisthesis reported good/excellent modified MacNab outcomes and significant reductions in VAS and ODI scores post-operatively. Patients with disc herniation and concurrent degenerative stenosis had generally poor/fair modified MacNab outcomes. Conclusion: The outcomes of endoscopic spine surgery are encouraging, with a low complication and reoperation rate. However, patients with calcified disc herniations, central canal stenosis or a disc herniation with concurrent degenerative stenosis present challenges during the initial learning curve and may benefit from traditional open or other minimally invasive techniques.

Keywords: complications, lumbar disc herniation, lumbar endoscopic spine surgery, predictors of failed endoscopic spine surgery

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Authors: Mustafa Gulsen, Mitat Koz

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The aim of this study is to investigate the effect of lumbar stabilisation and proprioceptive neuromuscular facilitation (PNF) training on muscle strength and muscle endurance. The participants were 64 between the ages of 15-69 (53.04 ± 14.59), who were graded protrusion and bulging lumbar herniation according to 'Macnab Classification'. The participants were divided into four groups as each group had 16 participants: lumbar stabilitation training, PNF training, physical therapy and control groups. Sociodemographic features were recorded. Then their muscle strength tests (by isokinetic dynamometer (Cybex 770 Norm Lumex Inc, Ronkonkoma, NY, USA) were recorded. Before and after applications; visual analogue scale (VAS), Oswestry Disability İndex were applied by a physical therapist. The participants in lumbar stabilisation group performed 45 minutes, 5 days in a week for 4 weeks strength training with a physical therapist observation. The participants in PNF group performed 5 days in a week for 4 weeks with pelvic patterns of PNF by a physiotherapist. The participants in physical therapy group underwent Hotpack, Tens and Ultrasound therapy 5 days in a week for 4 weeks. The participants in control group didn’t take any training programme. After 4 weeks, the evaluations were repeated. There were significant increases in muscle strength and muscle endurance in lumbar stabilization training group. Also in pain intensity at rest and during activity in this group and in Oswestry disability index of patients, there were significant improvements (p < 0.05). In PNF training group likewise, there were significant improvements in muscle strength, muscle endurance, pain intensity at rest and with activity and in Oswestry disability index (p < 0.05). But improvements in the Lumbar Stabilization group was better than PNF Group. We found significant differences only in pain intensity at rest and with activity and in Oswestry disability index (p < 0.05). in the patients in Physical Therapy group. We think that appropriate physiotherapy and rehabilitation program which will be prepared for patients, to protect the waist circumference of patients with low muscle strength and low muscle endurance will increase muscle strength and muscle endurance. And it is expected that will reduce pain and will provide advances toward correcting functional disability of the patients.

Keywords: disc herniation, endurance, lumbar stabilitation exercises, PNF, strength

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Authors: Andrea Gion Saluz, Tal Hertig, Axel Heinrich, Stefan Stevanovic

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Higher temperatures, seasonal changes in precipitation, and extreme weather events are increasingly affecting trees. To counteract the increasing challenges of urban trees, strategies are increasingly being sought to preserve existing tree populations on the one hand and to prepare for the coming years on the other. One such strategy lies in strategic climate tree species selection. The search is on for species or varieties that can cope with the new climatic conditions. Many efforts in German-speaking countries deal with this in detail, such as the tree lists of the German Conference of Garden Authorities (GALK), the project Stadtgrün 2021, or the instruments of the Climate Species Matrix by Prof. Dr. Roloff. In this context, different methods for a correct species selection are offered. One possibility is to select certain physiological attributes that indicate the climate resilience of a species. To calculate the dissimilarity of the present climate of different geographic regions in relation to the future climate of any city, a weighted (standardized) Euclidean distance (SED) for seasonal climate values is calculated for each region of the Earth. The calculation was performed in the QGIS geographic information system, using global raster datasets on monthly climate values in the 1981-2010 standard period. Data from a European forest inventory were used to identify tree species growing in the calculated analogue climate regions. The inventory used is the compilation of georeferenced point data at a 1 km grid resolution on the occurrence of tree species in 21 European countries. In this project, the results of the methodological application are shown for the city of Zurich for the year 2060. In the first step, analog climate regions based on projected climate values for the measuring station Kirche Fluntern (ZH) were searched for. In a further step, the methods mentioned above were applied to generate tree species lists for the city of Zurich. These lists were then qualitatively evaluated with respect to the suitability of the different tree species for the Zurich area to generate a cleaned and thus usable list of possible future tree species.

Keywords: climate change, climate region, climate tree, urban tree

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Authors: Prashant Neupane, Sumitra Kafle, Asmi Pandey, Laura Mitchell

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Pain following caesarean section can influence recovery, patient satisfaction, breast feeding success and mother-child bonding. Since the introduction of enhanced recovery protocols, mothers are often discharged 24 hours later. We identified concerns within our hospital with mothers tolerating poorly controlled pain in order to achieve earlier discharge and subsequently suffering significant pain at home with inadequate analgesia. Methods: We conducted a prospective audit of analgesic prescribing and post-operative pain scores after caesarean section. Mothers were seen on post-operative day one, their pain score recorded on a verbal analogue score from 0-10, and their prescription chart reviewed. A follow-up phone call was then made on post-operative day 3-7 to enquire about pain scores and analgesia use at home. Following this, a standardized proforma for prescribing after the caesarean section was introduced, including the addition of dihydrocodeine that patients can take home following discharge. There were educational update sessions for anesthetists and midwifes, and then a re-audit was conducted months later. Results: Data was collected from 50 women before and after the introduction of the change. Initial audit showed that there was considerable variation in prescribing, with four women prescribed no regular analgesia at all and inconsistency in the dose of oral morphine prescribed. Women were not given any form of analgesia to take home after discharge and were advised to take regular paracetamol and ibuprofen. However, 31/50 (62%) reported that they needed additional analgesia and eight women (16%) even sought prescription for additional analgesia from elsewhere. After the introduction of the change, prescribing was more consistent with all patients prescribed regular analgesia. 46/50 patients were given dihydrocodeine on discharge. Mean pain scores on post-operative day one improved from 5.16 to 3.9, and at home improved from 6.18 to 2.58. Use of dihydrocodeine at home significantly improved patients reporting of severe pain at home from 24% to zero. Discussion: Lack of strong analgesia out of the hospital and the increased demands on activity levels means that women are frequently in more pain at home after discharge. Introduction of a standardized prescription proforma, including the use of to-take-out dihydrocodeine, was successful in improving patient pain scores and the requirement for additional analgesia, both in hospital and at home.

Keywords: analgesia, caesarean section, post-operative pain, standardised

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Authors: Ramona-Niculina Jurcau, Ioana-Marieta Jurcau

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Background: Preparing in the stress field (SF) is, increasingly, a concern for doctors of different specialties. Aims: The aim was to evaluate the importance of an e-learning program for doctors postgraduate courses, in SF. Methods: Doctors (n= 40 male, 40 female) of different specialties and ages (31-71 years), who attended postgraduate courses in SF, voluntarily responded to a questionnaire that included the following themes: Importance of SF courses for specialty practiced by each respondent doctor (using visual analogue scale, VAS); What SF themes would be indicated as e-learning (EL); Preferred form of SF information assimilation: Classical lectures (CL), EL or a combination of these methods (CL+EL); Which information on the SF course are facilitated by EL model versus CL; In their view which are the first four advantages and the first four disadvantages of EL compared to CL, for SF. Results: To most respondents, the SF courses are important for the specialty they practiced (VAS by an average of 4). The SF themes suggested to be done as EL were: Stress mechanisms; stress factor models for different medical specialties; stress assessment methods; primary stress management methods for different specialties. Preferred form of information assimilation was CL+EL. Aspects of the course facilitated by EL versus CL model: Active reading of theoretical information, with fast access to keywords details; watching documentaries in everyone's favorite order; practice through tests and the rapid control of results. The first four EL advantages, mentioned for SF were: Autonomy in managing the time allocated to the study; saving time for traveling to the venue; the ability to read information in various contexts of time and space; communication with colleagues, in good times for everyone. The first three EL disadvantages, mentioned for SF were: It decreases capabilities for group discussion and mobilization for active participation; EL information accession may depend on electrical source or/and Internet; learning slowdown can appear, by temptation of postponing the implementation. Answering questions was partially influenced by the respondent's age and genre. Conclusions: 1) Post-graduate courses in SF are of interest to doctors of different specialties. 2) The majority of participating doctors preferred EL, but combined with CL (CL+EL). 3) Preference for EL was manifested mainly by young or middle age men doctors. 4) It is important to balance the proper formula for chosen EL, to be the most efficient, interesting, useful and agreeable.

Keywords: stress field, doctors’ postgraduate courses, classical lectures, e-learning lecture

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Authors: Mancho Manev

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The concept of almost paracontact Riemannian manifolds (abbr., apcR manifolds) was introduced by I. Sato in 1976 as an analogue of almost contact Riemannian manifolds. The notion of an apcR manifold of type (p,q) was defined by S. Sasaki in 1980, where p and q are respectively the numbers of the multiplicity of the structure eigenvalues 1 and -1. It also has a simple eigenvalue of 0. In our work, we consider (2n+1)-dimensional apcR manifolds of type (n,n), i.e., the paracontact distribution of the studied manifold can be considered as a 2n-dimensional almost paracomplex Riemannian distribution with almost paracomplex structure and structure group O(n) × O(n). The aim of the present study is to introduce a new class of apcR manifolds. Such a manifold is obtained using the construction of a certain Riemannian cone over it, and the resulting manifold is a paraholomorphic paracomplex Riemannian manifold (abbr., phpcR manifold). We call it a para-Sasaki-like Riemannian manifold (abbr., pSlR manifold) and give some explicit examples. We study the structure of pSlR spaces and find that the paracontact form η is closed and each pSlR manifold locally can be considered as a certain product of the real line with a phpcR manifold, which is locally a Riemannian product of two equidimensional Riemannian spaces. We also obtain that the curvature of the pSlR manifolds is completely determined by the curvature of the underlying local phpcR manifold. Moreover, the ξ-directed Ricci curvature is equal to -2n, while in the Sasaki case, it is 2n. Accordingly, the pSlR manifolds can be interpreted as the counterpart of the Sasaki manifolds; the skew-symmetric part of ∇η vanishes, while in the Sasaki case, the symmetric part vanishes. We define a hyperbolic extension of a (complete) phpcR manifold that resembles a certain warped product, and we indicate that it is a (complete) pSlR manifold. In addition, we consider the hyperbolic extension of a phpcR manifold and prove that if the initial manifold is a complete Einstein manifold with negative scalar curvature, then the resulting manifold is a complete Einstein pSlR manifold with negative scalar curvature. In this way, we produce new examples of a complete Einstein Riemannian manifold with negative scalar curvature. Finally, we define and study para contact conformal/homothetic deformations by deriving a subclass that preserves the para-Sasaki-like condition. We then find that if we apply a paracontact homothetic deformation of a pSlR space, we obtain that the Ricci tensor is invariant.

Keywords: almost paracontact Riemannian manifolds, Einstein manifolds, holomorphic product manifold, warped product manifold

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Authors: Emel Sonmezer, Hayri Baran Yosmaoglu

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The negative impact of chronic pain syndromes on sexual function has been reported in several studies; however, the influences of treatment strategies on sexual dysfunction have not been evaluated widely. The aim of this study was to determine the effects of pelvic floor exercise on sexual dysfunction in female patients with chronic low back pain. Forty-two patient with chronic low back pain were enrolled this study. Subjects were divided into two groups. Group 1 received conventional physiotherapy consist of heat therapy, ergonomic education, William flexion exercise during 6 weeks. Group 2 received pelvic floor exercises in addition to conventional physiotherapy. Female Sexual Function Index (FSFI) was used for the assessment of sexual function. Pain intensity was assessed with Visual Analogue Scale. Quality of life was assessed with World Health Organization Quality of Life Scale. All measurements were taken before and after treatment. In conventional physiotherapy group; there were significant improvement in pain intensity (p= 0,003), physical health (p=0,011), psychological health (p=0,042) subscales of quality of life scale, arousal (p=0,042), lubrication (p=0,028) and pain (p= 0,034) subscales of FSFI. In additional pelvic floor exercise group; there were significant improvement in pain intensity (p= 0,005), physical health (p=0,012) psychological health (p=0,039) subscales of quality of life scale, arousal (p=0,024), lubrication (p=0,011), orgasm (p=0,035) and pain (p= 0,015) subscales and total score (p=0,016) of FSFI. Total FSFI score (p=0,025) and orgasm (p=0,017) subscale of FSFI were significantly higher for the additional pelvic floor exercise group than the conventional physiotherapy group.The outcome of this study suggested that conventional physiotherapy may contribute to improve pain, quality of life and some parameters of the sexual function in patients with low back pain. Although additional pelvic floor exercise did not reveal more treatment effect in terms of quality of life and pain intensity, it caused significant improvement in sexual function. It is recommended that pelvic floor exercise should be added to treatment programs in order to manage sexual dysfunction more effectively in patients with chronic low back pain.

Keywords: physiotherapy, chronic pain, sexual dysfunction, pelvic floor

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Authors: Wan-Ting Liao, Angela K. Tzeng

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Empathy has been an important issue in psychology, education, as well as cognitive neuroscience. Empathy has two major components: cognitive and emotional. Cognitive component refers to the ability to understand others’ perspectives, thoughts, and actions, whereas emotional component refers to understand how others feel. Empathy can be induced, attitude can then be changed, and with enough attitude change, helping behavior can occur. This finding leads us to two questions: is attitude change really necessary for prosocial behavior? And, what roles cognitive and affective empathy play? For the second question, participants with different psychopathic personality (PP) traits are critical because high PP people were found to suffer only affective empathy deficit. Their cognitive empathy shows no significant difference from the control group. 132 college students voluntarily participated in the current three-stage study. Stage 1 was to collect basic information including Interpersonal Reactivity Index (IRI), Psychopathic Personality Inventory-Revised (PPI-R), Attitude Scale, Visual Analogue Scale (VAS), and demographic data. Stage two was for empathy induction with three controversial scenarios, namely domestic violence, depression with a suicide attempt, and an ex-offender. Participants read all three stories and then rewrite the stories by one of two perspectives (empathetic vs. objective). They would then complete the VAS and Attitude Scale one more time for their post-attitude and emotional status. Three IVs were introduced for data analysis: PP (High vs. Low), Responsibility (whether or not the character is responsible for what happened), and Perspective-taking (Empathic vs. Objective). Stage 3 was for the action. Participants were instructed to freely use the 17 tokens they received as donations. They were debriefed and interviewed at the end of the experiment. The major findings were people with higher empathy tend to take more action in helping. Attitude change is not necessary for prosocial behavior. The controversy of the scenarios and how familiar participants are towards target groups play very important roles. Finally, people with high PP tend to show more public prosocial behavior due to their affective empathy deficit. Pre-existing value and belief as well as recent dramatic social events seem to have a big impact and possibly reduce the effect of the independent variables (IV) in our paradigm.

Keywords: empathy, cognitive, emotional, psychopathy

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Authors: Allyson Augusta Shrikhande, Alexa Rains, Tayyaba Ahmed, Marjorie Mamsaang, Rakhi Vyas, Janaki Natarajan, Erika Moody, Christian Reutter, Kimberlee Leishear, Yogita Tailor, Sandra Sandhu-Restaino, Lora Liu, Neha James, Rosemarie Filart

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Characterized by consistent difficulty getting and keeping an erection firm enough for intercourse, Erectile Dysfunction may affect up to 15% of adult men. Although awareness and access to treatment have improved in recent years, many patients do not actively seek diagnosis or treatment due to the stigma surrounding this condition. Patients who do seek treatment are often dissatisfied by the efficacy of the medication. The condition inhibits patients’ quality of life by worsening mental health and relationships. The purpose of this study was to test the effectiveness of an outpatient neuromuscular treatment protocol in treating the symptoms of Chronic Pelvic Pain and Erectile Dysfunction, improving pain and function. 56 patients ages 20-79 presented to an outpatient clinic for treatment of pelvic pain and Erectile Dysfunction symptoms. These symptoms had persisted for an average of 4 years. All patients underwent external ultrasound-guided hydro-dissection technique targeted at pelvic peripheral nerves in combination with pelvic floor musculature trigger-point injections. To measure the effects of this treatment, a five question Erectile Dysfunction questionnaire was completed by each patient at their first visit to a clinic and three months after treatment began. Answers were summed for a total score of 5-25, with a higher score indicating optimal function. The average score before treatment was 14.125 (SD 5.411) (a=0.05; CI 12.708-15.542), which increased by 18% to an average of 16.625 (SD 6.423) (a=0.05; CI 14.943-18.307) after treatment (P=0.0004). Secondary outcome variables included a Visual Analogue Scale (VAS) to measure pelvic pain intensity and the Functional Pelvic Pain Scale (FPPS) to measure function across multiple areas. VAS scores reduced by 51% after three months. Before treatment, the mean VAS score was 5.87, and the posttreatment mean VAS score was 2.89. Pelvic pain functionality improved by 34% after three months. Pretreatment FPPS scores averaged at 7.48, decreasing to 4.91 after treatment. These results indicate that this unique treatment was very effective at relieving pain and increasing function for patients with Erectile Dysfunction.

Keywords: chronic pelvic pain, erectile dysfunction, nonsurgical, outpatient, trigger point injections

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Authors: Surabhi Gautam, Uma Kumar, Rima Dada

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A sustained acute-phase response in Rheumatoid Arthritis (RA) is associated with increased joint damage and inflammation leading to progressive disability. It is induced continuously by consecutive stimuli of proinflammatory cytokines, following a wide range of pathophysiological reactions, leading to increased synthesis of acute phase proteins like C - reactive protein (CRP) and dysregulation in levels of immunomodulatory soluble Human Leukocyte Antigen-G (HLA-G) molecule. This study was designed to explore the effect of yoga and meditation based lifestyle intervention (YMLI) on inflammatory markers in RA patients. Blood samples of 50 patients were collected at baseline (day 0) and after 30 days of YMLI. Patients underwent a pretested YMLI under the supervision of a certified yoga instructor for 30 days including different Asanas (physical postures), Pranayama (breathing exercises), and Dhayna (meditation). Levels of CRP, IL-6, IL-17A, soluble HLA-G and erythrocyte sedimentation rate (ESR) were measured at day 0 and 30 interval. Parameters of disease activity, disability quotient, pain acuity and quality of life were also assessed by disease activity score (DAS28), health assessment questionnaire (HAQ), visual analogue scale (VAS), and World Health Organization Quality of Life (WHOQOL-BREF) respectively. There was reduction in mean levels of CRP (p < 0.05), IL-6 (interleukin-6) (p < 0.05), IL-17A (interleukin-17A) (p < 0.05) and ESR (p < 0.05) and elevation in soluble HLA-G (p < 0.05) at 30 days compared to baseline level (day 0). There was reduction seen in DAS28-ESR (p < 0.05), VAS (p < 0.05) and HAQ (p < 0.05) after 30 days with respect to the base line levels (day 0) and significant increase in WHOQOL-BREF scale (p < 0.05) in all 4 domains of physical health, psychological health, social relationships, and environmental health. The present study has demonstrated that yoga practices are associated with regression of inflammatory processes by reducing inflammatory parameters and regulating the levels of soluble HLA-G significantly in active RA patients. Short term YMLI has significantly improved pain perception, disability quotient, disease activity and quality of life. Thus this simple life style intervention can reduce disease severity and dose of drugs used in the treatment of RA.

Keywords: inflammation, quality of life, rheumatoid arthritis, yoga and meditation

Procedia PDF Downloads 130

Authors: Mubarack Ahmed, Gabriele Gradoni, Stephen C. Creagh, Gregor Tanner

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High-frequency cables commonly connect modern devices and sensors. Interestingly, the proportion of electric components is rising fast in an attempt to achieve lighter and greener devices. Modelling the propagation of signals through these cable networks in the presence of parameter uncertainty is a daunting task. In this work, we study the response of high-frequency cable networks using both Transmission Line and Quantum Graph (QG) theories. We have successfully compared the two theories in terms of reflection spectra using measurements on real, lossy cables. We have derived a generalisation of the vertex scattering matrix to include non-uniform networks – networks of cables with different characteristic impedances and propagation constants. The QG model implicitly takes into account the pseudo-chaotic behavior, at the vertices, of the propagating electric signal. We have successfully compared the asymptotic growth of eigenvalues of the Laplacian with the predictions of Weyl law. We investigate the nearest-neighbour level-spacing distribution of the resonances and compare our results with the predictions of Random Matrix Theory (RMT). To achieve this, we will compare our graphs with the generalisation of Wigner distribution for open systems. The problem of scattering from networks of cables can also provide an analogue model for wireless communication in highly reverberant environments. In this context, we provide a preliminary analysis of the statistics of communication capacity for communication across cable networks, whose eventual aim is to enable detailed laboratory testing of information transfer rates using software defined radio. We specialise this analysis in particular for the case of MIMO (Multiple-Input Multiple-Output) protocols. We have successfully validated our QG model with both TL model and laboratory measurements. The growth of Eigenvalues compares well with Weyl’s law and the level-spacing distribution agrees so well RMT predictions. The results we achieved in the MIMO application compares favourably with the prediction of a parallel on-going research (sponsored by NEMF21.)

Keywords: eigenvalues, multiple-input multiple-output, quantum graph, random matrix theory, transmission line

Procedia PDF Downloads 121

Authors: Mohd Shazad, K. K. Gupta

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Vector borne diseases are a serious global concern. Aedes aegypti, the primary vector for viruses that cause dengue fever, dengue haemorrhagic fever, chikungunya and yellow fever is widespread over large areas of the tropics and subtropics. In last decade, diseases transmitted by Aedes aegypti are of serious concern. In past decade, number of cases of dengue fever, dengue hemorrhagic fever, and chikungunya has increased multifold. Present research work focused on impact of ethanol extract of Ocimum sanctum on dengue vector Aedes aegypti. 0-24 hr. old fourth instar larvae of lab-bred population of Aedes aegypti were exposed to ethanol leaf extract of Ocimum with concentrations ranging from 50 ppm to 400 ppm. Survival and development and the treated larvae and reproductive behaviour of the adults emerged from the treated larvae was evaluated. Our results indicated larvicidal potential of the leaf ethanol extract. The influence of the extract was dose dependent. 77.2% mortality was observed in the larvae exposed to 400 ppm for 24 hr. Treatment at lower concentrations revealed delayed toxicity. The larvae survived after treatment showed severe developmental anomalies. Consequently, there was the significant increase in duration of fourth instar larva. The L4 treated with 400-ppm extract moulted after 4.6 days; this was in sharp contrast to control where the larval period of the fourth instar lasts three days. The treated fourth instar larvae in many cases transformed into larva-pupa intermediates with the combination of larva, pupa characters. The larva-pupa intermediates had reduced life span and failed to moult successfully. The adults emerged from the larvae treated with lower doses had reduced reproductive potential. The females exhibited longer preoviposition period, reduced oviposition rate, abnormal oviposition behaviour and decreased fertility. Our studies indicated the possibility of the presence of JH mimic or JH analogue in the leaf ethanol extract of Ocimum. The present research work explored the potentials of Ocimum sanctum, also known as the queen of herbs, in integrated vector management programme of Aedes aegypti, which is a serious threat to human health.

Keywords: Aedes aegypti, development, mortality, Ocimum sanctum reproduction

Procedia PDF Downloads 212

Authors: R. Clancy, M. Ahern, D. O’Sullivan, K. Bruton

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The manufacturing industry is currently undergoing a digital transformation as part of the mega-trend Industry 4.0. As part of this phase of the industrial revolution, traditional manufacturing processes are being combined with digital technologies to achieve smarter and more efficient production. To successfully digitally transform a manufacturing facility, the processes must first be digitized. This is the conversion of information from an analogue format to a digital format. The objective of this study was to explore the research area of digitizing manufacturing data as part of the worldwide paradigm, Industry 4.0. The formal methodology of a systematic mapping study was utilized to capture a representative sample of the research area and assess its current state. Specific research questions were defined to assess the key benefits and limitations associated with the digitization of manufacturing data. Research papers were classified according to the type of research and type of contribution to the research area. Upon analyzing 54 papers identified in this area, it was noted that 23 of the papers originated in Germany. This is an unsurprising finding as Industry 4.0 is originally a German strategy with supporting strong policy instruments being utilized in Germany to support its implementation. It was also found that the Fraunhofer Institute for Mechatronic Systems Design, in collaboration with the University of Paderborn in Germany, was the most frequent contributing Institution of the research papers with three papers published. The literature suggested future research directions and highlighted one specific gap in the area. There exists an unresolved gap between the data science experts and the manufacturing process experts in the industry. The data analytics expertise is not useful unless the manufacturing process information is utilized. A legitimate understanding of the data is crucial to perform accurate analytics and gain true, valuable insights into the manufacturing process. There lies a gap between the manufacturing operations and the information technology/data analytics departments within enterprises, which was borne out by the results of many of the case studies reviewed as part of this work. To test the concept of this gap existing, the researcher initiated an industrial case study in which they embedded themselves between the subject matter expert of the manufacturing process and the data scientist. Of the papers resulting from the systematic mapping study, 12 of the papers contributed a framework, another 12 of the papers were based on a case study, and 11 of the papers focused on theory. However, there were only three papers that contributed a methodology. This provides further evidence for the need for an industry-focused methodology for digitizing and analyzing manufacturing data, which will be developed in future research.

Keywords: analytics, digitization, industry 4.0, manufacturing

Procedia PDF Downloads 79

Authors: Fathima M. A., Milu Maria Anto

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Aim: The current study aims to explore the understanding about Mental Health and the likelihood to seek help for mental health problems among adolescents in the state of Kerala (India). Method: A cross sectional exploratory design was used. Samples were selected using convenience sampling. Ninety nine high school and higher secondary school students who had enrolled in the program “Responsible Adolescents (READ)” organized by MKMS Education from Kerala participated in this study. The data for the present study was collected using google forms prior to the commencement of the READ programme. Open-ended questions were used to explore the understanding of participants about mental health, mental health problems, causes of mental health problems and the role of mental health professionals. The likelihood to seek help (from friends, parents, teachers and mental health professionals) for mental health problems was assessed using a visual analogue scale. Further open-ended questions were used to identify what changes in teachers and parents will make them feel more comfortable to approach them when they need help. Content analysis was used to identify themes and coded data was further analyzed using correlation. Results: The results show that students have a fair idea about what Mental Health is. Even though the majority is familiar with the names of mental health disorders, relatively fewer students identify it as irregularity in mental functions such as thoughts, emotions and behaviors. The students tend to attribute symptoms of mental health problems as the cause of mental health problems. Very few students have the understanding that biological variations and adverse childhood experiences are primary causes for the development of mental health problems. Less than half of the students were aware of the role of psychiatrists and psychologists in mental health treatment. The students were more likely to seek help from parents and friends during distress. They had a medium inclination to seek help from mental health professionals and showed even lower likelihood to seek help from teachers. The majority of the students responded that they would be more comfortable approaching teachers if they were more open-minded and approachable as well as non-judgmental and non-dismissive. Conclusion: Findings show that there is inadequate awareness among adolescents about mental health problems and their causes. There is a lack of understanding about the roles of two main mental health professionals which can pose a big hurdle in accessing adequate help from the appropriate professional at the right time. The low likelihood to seek help from teachers for mental health problems is very concerning. The major barriers reported by the students in seeking help from teachers were the judgmental and dismissive approach. The findings throw light on the current level of awareness about mental health and mental health help-seeking, which can be utilized in framing mental health awareness programs for students as well as teachers.

Keywords: Mental Health Awareness, Adolescent Mental Health, Help Seeking Behavior, School Mental Health

Procedia PDF Downloads 238

Authors: Sujata Sharma, Avinash Singh, Lovely Gautam, Pradeep Sharma, Mau Sinha, Asha Bhushan, Punit Kaur, Tej P. Singh

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Peptidyl-tRNA hydrolase (Pth) Pth is an essential bacterial enzyme that catalyzes the release of free tRNA and peptide moeities from peptidyl tRNAs during stalling of protein synthesis. In order to design inhibitors of Pth from Pseudomonas aeruginosa (PaPth), we have determined the structures of PaPth in its native state and in the bound states with two compounds, amino acylate-tRNA analogue (AAtA) and 5-azacytidine (AZAC). The peptidyl-tRNA hydrolase gene from Pseudomonas aeruginosa was amplified by Phusion High-Fidelity DNA Polymerase using forward and reverse primers, respectively. The E. coliBL21 (λDE3) strain was used for expression of the recombinant peptidyl-tRNA hydrolase from Pseudomonas aeruginosa. The protein was purified using a Ni-NTA superflow column. The crystallization experiments were carried out using hanging drop vapour diffusion method. The crystals diffracted to 1.50 Å resolution. The data were processed using HKL-2000. The polypeptide chain of PaPth consists of 194 amino acid residues from Met1 to Ala194. The centrally located β-structure is surrounded by α-helices from all sides except the side that has entrance to the substrate binding site. The structures of the complexes of PaPth with AAtA and AZAC showed the ligands bound to PaPth in the substrate binding cleft and interacted with protein atoms extensively. The residues that formed intermolecular hydrogen bonds with the atoms of AAtA included Asn12, His22, Asn70, Gly113, Asn116, Ser148, and Glu161 of the symmetry related molecule. The amino acids that were involved in hydrogen bonded interactions in case of AZAC included, His22, Gly113, Asn116, and Ser148. As indicated by fittings of two ligands and the number of interactions made by them with protein atoms, AAtA appears to be a more compatible with the structure of the substrate binding cleft. However, there is a further scope to achieve a better stacking than that of O-tyrosyl moiety because it is not still ideally stacked. These observations about the interactions between the protein and ligands have provided the information about the mode of binding of ligands, nature and number of interactions. This information may be useful for the design of tight inhibitors of Pth enzymes.

Keywords: peptidyl tRNA hydrolase, Acinetobacter baumannii, Pth enzymes, O-tyrosyl

Procedia PDF Downloads 385

Authors: Zenah Gheblawi, Susan Armijo-Olivo, Elisa B. Pelai, Vaishali Sharma, Musa Tashfeen, Angela Fung, Francisca Claveria

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Due to physiological differences between men and women, pain is experienced differently between the two sexes. Chronic pain disorders, notably temporomandibular disorders (TMDs), disproportionately affect women in diagnosis, and pain severity in opposition of their male counterparts. TMDs are a type of musculoskeletal disorder that target the masticatory muscles, temporalis muscle, and temporomandibular joints, causing considerable orofacial pain which can usually be referred to the neck and back. Therapeutic methods are scarce, and are not TMD-centered, with the latest research suggesting that subjects with chronic musculoskeletal pain disorders have abnormal alterations in the grey matter of their brains which can be remedied with exercise, and thus, decreasing the pain experienced. The aim of the study is to investigate the effects of exercise therapy in TMD female patients experiencing chronic jaw pain and to assess the consequential effects on brain activity. In a randomized controlled trial, the effectiveness of an exercise program to improve brain alterations and clinical outcomes in women with TMD pain will be tested. Women with chronic TMD pain will be randomized to either an intervention arm or a placebo control group. Women in the intervention arm will receive 8 weeks of progressive exercise of motor control training using visual feedback (MCTF) of the cervical muscles, twice per week. Women in the placebo arm will receive innocuous transcutaneous electrical nerve stimulation during 8 weeks as well. The primary outcomes will be changes in 1) pain, measured with the Visual Analogue Scale, 2) brain structure and networks, measured by fractional anisotropy (brain structure) and the blood-oxygen level dependent signal (brain networks). Outcomes will be measured at baseline, after 8 weeks of treatment, and 4 months after treatment ends and will determine effectiveness of MCTF in managing TMD, through improved clinical outcomes. Results will directly inform and guide clinicians in prescribing more effective interventions for women with TMD. This study is underway, and no results are available at this point. The results of this study will have substantial implications on the advancement in understanding the scope of plasticity the brain has in regards with pain, and how it can be used to improve the treatment and pain of women with TMD, and more generally, other musculoskeletal disorders.

Keywords: exercise therapy, musculoskeletal disorders, physical therapy, rehabilitation, tempomandibular disorders

Procedia PDF Downloads 262

Authors: Manuela Villani, Anila Xhahysa, Christopher Brooks, Marco Pagani

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The geological structure of Western Balkans is strongly affected by the collision between Adria microplate and the southwestern Euroasia margin, resulting in a considerably active seismic region. The Harmonization of Seismic Hazard Maps in the Western Balkan Countries Project (BSHAP) (2007-2011, 2012-2015) by NATO supported the preparation of new seismic hazard maps of the Western Balkan, but when inspecting the seismic hazard models produced later by these countries on a national scale, significant differences in design PGA values are observed in the border, for instance, North Albania-Montenegro, South Albania- Greece, etc. Considering the fact that the catalogues were unified and seismic sources were defined within BSHAP framework, obviously, the differences arise from the Ground Motion Prediction Equations selection, which are generally the component with highest impact on the seismic hazard assessment. At the time of the project, a modest database was present, namely 672 three-component records, whereas nowadays, this strong motion database has increased considerably up to 20,939 records with Mw ranging in the interval 3.7-7 and epicentral distance distribution from 0.47km to 490km. Statistical analysis of the strong motion database showed the lack of recordings in the moderate-to-large magnitude and short distance ranges; therefore, there is need to re-evaluate the Ground Motion Prediction Equation in light of the recently updated database and the new generations of GMMs. In some cases, it was observed that some events were more extensively documented in one database than the other, like the 1979 Montenegro earthquake, with a considerably larger number of records in the BSHAP Analogue SM database when compared to ESM23. Therefore, the strong motion flat-file provided from the Harmonization of Seismic Hazard Maps in the Western Balkan Countries Project was merged with the ESM23 database for the polygon studied in this project. After performing the preliminary residual analysis, the candidate GMPE-s were identified. This process was done using the GMPE performance metrics available within the SMT in the OpenQuake Platform. The Likelihood Model and Euclidean Distance Based Ranking (EDR) were used. Finally, for this study, a GMPE logic tree was selected and following the selection of candidate GMPEs, model weights were assigned using the average sample log-likelihood approach of Scherbaum.

Keywords: residual analysis, GMPE, western balkan, strong motion, openquake

Procedia PDF Downloads 45

Authors: Sara De Pelsmaeker, Catarina Ferreira da Silva, Janne Prawit

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Recent studies show that enzymatically hydrolysed collagen is absorbed and distributed to joint tissues, where it has analgesic and active anti-inflammatory properties. Reviews of the associated relevant literature also support this theory. However, these studies are all using hydrolyzed collagen from animal hide or skin. This study looks into the effect of daily supplementation of hydrolyzed cartilage collagen (HCC), which has a different composition. A consumer study was set up using a double-blind placebo-controlled design with a control group using twice a day 0.5gr of maltodextrin and an experimental group using twice 0.5g of HCC, over a trial period of 12 weeks. A follow-up phase of 4 weeks without supplementation was taken into the experiment to investigate the ‘wash-out’ phase. As this consumer study was conducted during the lockdown periods, a specific app was designed to follow up with the participants. The app had the advantage that in this way, the motivation of the participants was enhanced and the drop-out range of participants was lower than normally seen in consumer studies. Participants were recruited via various sports and health clubs across the UK as we targeted a general population of people that considered themselves in good health. Exclusion criteria were ‘not experiencing any medical conditions’ and ‘not taking any prescribed medication’. A minimum requirement was that they regularly engaged in some level of physical activity. The participants had to log the type of activity that they conducted and the duration of the activity. Weekly, participants were providing feedback on their joint health and subjective pain using the validated pain measuring instrument Visual Analogue Scale (VAS). The weekly repoAbstract Public Health and Wellbeing Conferencerting section in the app was designed with simplicity and based on the accuracy demonstrated in previous similar studies to track subjective pain measures of participants. At the beginning of the trial, each participant indicated their baseline on joint pain. The results of this consumer study indicated that HCC significantly improved joint health and subjective pain scores compared to the placebo group. No significant differences were found between different demographic groups (age or gender). The level of activity, going from high intensive training to regular walking, did not significantly influence the effect of the HCC. The results of the wash-out phase indicated that when the participants stopped the HCC supplementation, their subjective pain scores increased again to the baseline. In conclusion, the results gave a positive indication that the daily supplementation of HCC can contribute to the overall mobility and wellbeing of a general active population

Keywords: VAS-score, food supplement, mobility, joint health

Procedia PDF Downloads 137

Authors: Desjardin, Michaels, Martinez, Ulmann

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Copper IUD is one of the most efficient and cost-effective contraception. However, pain at insertion hampers the use of this method. This is especially unfortunate in nulliparous women, often younger, who are excellent candidates for this contraception, including Emergency Contraception. Standard insertion procedure of a copper IUD usually involves measurement of uterine cavity with an hysterometer and the use of a tenaculum in order to facilitate device insertion. Both procedures lead to patient pain which often constitutes a limitation of the method. To overcome these issues, we have developed a modified insertor combined with a copper IUD. The singular design of the inserter includes a flexible inflatable membrane technology allowing an easy access to the uterine cavity even in case of abnormal uterine positions or narrow cervical canal. Moreover, this inserter makes possible a direct IUD insertion with no hysterometry and no need for tenaculum. To assess device effectiveness and patient-reported pain, a study was conducted at two clinics in Fance with 31 individuals who wanted to use a copper IUD as contraceptive method. IUD insertions have been performed by four healthcare providers. Operators completed questionnaire and evaluated effectiveness of the procedure (including IUD correct fundal placement and other usability questions) as their satisfaction. Patient also completed questionnaire and pain during procedure was measured on a 10-cm Visual Analogue Scale (VAS). Analysis of the questionnaires indicates that correct IUD placement took place in more than 93% of women, which is a standard efficacy rate. It also demonstrates that IUD insertion resulted in no, light or moderate pain predominantly in nulliparous women. No insertion resulted in severe pain (none above 6cm on a 10-cm VAS). This translated by a high level of satisfaction from both patients and practitioners. In addition, this modified inserter allowed a simplification of the insertion procedure: correct fundal placement was ensured with no need for hysterometry (100%) prior to insertion nor for cervical tenaculum to pull on the cervix (90%). Avoidance of both procedures contributed to the decrease in pain during insertion. Taken together, the results of the study demonstrate that this device constitutes a significant advance in the use of copper IUDs for any woman. It allows a simplification of the insertion procedure: there is no need for pre-insertion hysterometry and no need for traction on the cervix with tenaculum. Increased comfort during insertion should allow a wider use of the method for nulliparous women and for emergency contraception. In addition, pain is often underestimated by practitioners, but fear of pain is obviously one of the blocking factors as indicated by the analysis of the questionnaire. This evaluation brings interesting information on the use of this modified inserter for standard copper IUD and promising perspectives to set up a changement in the standard of IUD insertion procedure.

Keywords: contraceptio, IUD, innovation, pain

Procedia PDF Downloads 49

Authors: Michael Mihalicz, Aziz Guergachi

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Background: The science of modelling choice preferences has evolved over centuries into an interdisciplinary field contributing to several branches of Microeconomics and Mathematical Psychology. Early theories in Decision Science rested on the logic of rationality, but as it and related fields matured, descriptive theories emerged capable of explaining systematic violations of rationality through cognitive mechanisms underlying the thought processes that guide human behaviour. Cognitive limitations are not, however, solely responsible for systematic deviations from rationality and many are now exploring the effect of visceral factors as the more dominant drivers. The current study builds on the existing literature by exploring sleep deprivation, thermal comfort, stress, hunger, fear, anger and sadness as moderators to three distinct elements that define individual risk preference under Cumulative Prospect Theory. Methodology: This study is designed to compare the risk preference of participants experiencing an elevated affective or visceral state to those in a neutral state using nonparametric elicitation methods across three domains. Two experiments will be conducted simultaneously using different methodologies. The first will determine visceral states and risk preferences randomly over a two-week period by prompting participants to complete an online survey remotely. In each round of questions, participants will be asked to self-assess their current state using Visual Analogue Scales before answering a series of lottery-style elicitation questions. The second experiment will be conducted in a laboratory setting using psychological primes to induce a desired state. In this experiment, emotional states will be recorded using emotion analytics and used a basis for comparison between the two methods. Significance: The expected results include a series of measurable and systematic effects on the subjective interpretations of gamble attributes and evidence supporting the proposition that a portion of the variability in human choice preferences unaccounted for by cognitive limitations can be explained by interacting visceral states. Significant results will promote awareness about the subconscious effect that emotions and other drive states have on the way people process and interpret information, and can guide more effective decision making by informing decision-makers of the sources and consequences of irrational behaviour.

Keywords: decision making, emotions, prospect theory, visceral factors

Procedia PDF Downloads 126

Authors: Pascale Brasseur, Binu Gurung, Nicholas Halfpenny, James Eaton

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Development of minimally invasive treatments in recent years provides a potential alternative to invasive surgical interventions which are of limited value to patients with spinal metastases due to short life expectancy. A systematic review was conducted to explore the efficacy and safety of radiofrequency ablation (RFA), a minimally invasive treatment in patients with spinal metastases. EMBASE, Medline and CENTRAL were searched from database inception to March 2017 for randomised controlled trials (RCTs) and non-randomised studies. Conference proceedings for ASCO and ESMO published in 2015 and 2016 were also searched. Fourteen studies were included: three prospective interventional studies, four prospective case series and seven retrospective case series. No RCTs or studies comparing RFA with another treatment were identified. RFA was followed by cement augmentation in all patients in seven studies and some patients (40-96%) in the remaining seven studies. Efficacy was assessed as pain relief in 13/14 studies with the use of a numerical rating scale (NRS) or a visual analogue scale (VAS) at various time points. Ten of the 13 studies reported a significant decrease in pain outcome, post-RFA compared to baseline. NRS scores improved significantly at 1 week (5.9 to 3.5, p < 0.0001; 8 to 4.3, p < 0.02 and 8 to 3.9, p < 0.0001) and this improvement was maintained at 1 month post-RFA compared to baseline (5.9 to 2.6, p < 0.0001; 8 to 2.9, p < 0.0003; 8 to 2.9, p < 0.0001). Similarly, VAS scores decreased significantly at 1 week (7.5 to 2.7, p=0.00005; 7.51 to 1.73, p < 0.0001; 7.82 to 2.82, p < 0.001) and this pattern was maintained at 1 month post-RFA compared to baseline (7.51 to 2.25, p < 0.0001; 7.82 to 3.3; p < 0.001). A significant pain relief was achieved regardless of whether patients had cement augmentation in two studies assessing the impact of RFA with or without cement augmentation on VAS pain scores. In these two studies, a significant decrease in pain scores was reported for patients receiving RFA alone and RFA+cement at 1 week (4.3 to 1.7. p=0.0004 and 6.6 to 1.7, p=0.003 respectively) and 15-36 months (7.9 to 4, p=0.008 and 7.6 to 3.5, p=0.005 respectively) after therapy. Few minor complications were reported and these included neural damage, radicular pain, vertebroplasty leakage and lower limb pain/numbness. In conclusion, the efficacy and safety of RFA were consistently positive between prospective and retrospective studies with reductions in pain and few procedural complications. However, the lack of control groups in the identified studies indicates the possibility of selection bias inherent in single arm studies. Controlled trials exploring efficacy and safety of RFA in patients with spinal metastases are warranted to provide robust evidence. The identified studies provide an initial foundation for such future trials.

Keywords: pain relief, radiofrequency ablation, spinal metastases, systematic review

Procedia PDF Downloads 148

Authors: Dr. Jenit Gandhi, Dr. Manojith SS, Dr. Nakul GV, Dr. Sharath Honnani, Dr. Shaurav Ghosh, Dr. Neel Shetty, Dr. Nagabhushan JS, Dr. Manish Joshi

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Introduction: Acute pancreatitis is an inflammatory condition of the pancreas which begins in pancreatic acinar cells and triggers local inflammation that may progress to systemic inflammatory response (SIRS) and causing distant organ involvement and its function and ending up with multiple organ dysfunction syndromes (MODS). Aim: A comparative study in acute pancreatitis to find out the effectiveness of early addition of Ulinastatin to current standard care in Indian subjects . Methodology: A current prospective observational study is done during study period of 1year (Dec 2018 –Dec 2019) duration to evaluate the effect of early addition of Ulinastatin to the current standard treatment and its efficacy to reduce the early complication, analgesic requirement and duration of hospital stay in patients with Acute Pancreatitis. Results: In the control group 25 were males and 05 were females. In the test group 18 were males and 12 females. Majority was in the age group between 30 - 70 yrs of age with >50% in the 30-50yrs age group in both test and control groups. The VAS was median grade 3 in control group as compared to median grade 2 in test group , the pain was more in the initial 2 days in test group compared to 4 days in test group , the analgesic requirement was used for more in control group (median 6) to test group( median 3 days ). On follow up after 5 days for a period of 2 weeks none of the patients in the test group developed any complication. Where as in the control group 8 patients developed pleural effusion, 04-Pseudopancreatic cyst, 02 – patient developed portal vein and splenic vein thrombosis, 02 patients – ventilator with ARDS which were treated symptomatically whereas in test group 02 patient developed pleural effusions and 01 pseudo pancreatic cyst with splenic artery aneurysm, 01 – patient with AKI and MODS symptomatically treated. The duration of hospital stay for a median period of 4 days (2 – 7 days) in test group and 7 days (4 -10 days) in control group. All patients were able to return to normal work on an average of 5days compared 8days in control group, the difference was significant. Conclusion:The study concluded that early addition of Ulinastatin to current standard treatment of acute Pancreatitis is effective in reducing pain, early complication and duration of hospital stay in Indian subject

Keywords: Ulinastatin, VAS – visual analogue score , AKI – acute kidney injury , ARDS – acute respiratory distress syndrome

Procedia PDF Downloads 94

Authors: R. Khare, R. V. Gelamo, M. A. More, D. J. Late, Chandra Sekhar Rout

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Graphene emerges out as a promising material for various applications ranging from complementary integrated circuits to optically transparent electrode for displays and sensors. The excellent conductivity and atomic sharp edges of unique two-dimensional structure makes graphene a propitious field emitter. Graphene analogues of other 2D layered materials have emerged in material science and nanotechnology due to the enriched physics and novel enhanced properties they present. There are several advantages of using 2D nanomaterials in field emission based devices, including a thickness of only a few atomic layers, high aspect ratio (the ratio of lateral size to sheet thickness), excellent electrical properties, extraordinary mechanical strength and ease of synthesis. Furthermore, the presence of edges can enhance the tunneling probability for the electrons in layered nanomaterials similar to that seen in nanotubes. Here we report electron emission properties of multilayer graphene and effect of plasma (CO2, O2, Ar and N2) treatment. The plasma treated multilayer graphene shows an enhanced field emission behavior with a low turn on field of 0.18 V/μm and high emission current density of 1.89 mA/cm2 at an applied field of 0.35 V/μm. Further, we report the field emission studies of layered WS2/RGO and SnS2/RGO composites. The turn on field required to draw a field emission current density of 1μA/cm2 is found to be 3.5, 2.3 and 2 V/μm for WS2, RGO and the WS2/RGO composite respectively. The enhanced field emission behavior observed for the WS2/RGO nanocomposite is attributed to a high field enhancement factor of 2978, which is associated with the surface protrusions of the single-to-few layer thick sheets of the nanocomposite. The highest current density of ~800 µA/cm2 is drawn at an applied field of 4.1 V/μm from a few layers of the WS2/RGO nanocomposite. Furthermore, first-principles density functional calculations suggest that the enhanced field emission may also be due to an overlap of the electronic structures of WS2 and RGO, where graphene-like states are dumped in the region of the WS2 fundamental gap. Similarly, the turn on field required to draw an emission current density of 1µA/cm2 is significantly low (almost half the value) for the SnS2/RGO nanocomposite (2.65 V/µm) compared to pristine SnS2 (4.8 V/µm) nanosheets. The field enhancement factor β (~3200 for SnS2 and ~3700 for SnS2/RGO composite) was calculated from Fowler-Nordheim (FN) plots and indicates emission from the nanometric geometry of the emitter. The field emission current versus time plot shows overall good emission stability for the SnS2/RGO emitter. The DFT calculations reveal that the enhanced field emission properties of SnS2/RGO composites are because of a substantial lowering of work function of SnS2 when supported by graphene, which is in response to p-type doping of the graphene substrate. Graphene and 2D analogue materials emerge as a potential candidate for future field emission applications.

Keywords: graphene, layered material, field emission, plasma, doping

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Authors: T. N. Goh, M. Hashmi, O. Hussain

Abstract:

Temporomandibular joint (TMJ) dysfunction (TMD) is a condition that may affect patients via restricted mouth opening, significant pain during normal functioning, and/or reproducible joint noise. TMD includes myofascial pain, TMJ functional derangements (internal derangement, dislocation), and TMJ degenerative/inflammatory joint disease. Internal derangement (ID) is the most common cause of TMD-related clicking and locking. These patients are managed in a stepwise approach, from patient education (homecare advice and analgesia), splint therapy, physiotherapy, botulinum toxin treatment, to arthrocentesis. Arthrotomy is offered when the aforementioned treatment options fail to alleviate symptoms and improve quality of life. The aim of this prospective study was to review the outcomes of jaw joint open surgery in TMD patients. Patients who presented from 2015-2022 at the Oral and Maxillofacial Surgery Department in the Doncaster NHS Foundation Trust, UK, with a Wilkes classification of III -V were included. These patients underwent either i) discopexy with bone-anchoring suture (9); ii) intrapositional temporalis flap (ITF) with bone-anchoring suture (3); iii) eminoplasty and discopexy with suturing to the capsule (3); iii) discectomy + ITF with bone-anchoring suture (1); iv) discoplasty + bone-anchoring suture (1); v) ITF (1). Maximum incisal opening (MIO) was assessed pre-operatively and at each follow-up. Pain score, determined via the visual analogue scale (VAS, with 0 being no pain and 10 being the worst pain), was also recorded. A total of 18 eligible patients were identified with a mean age of 45 (range 22 - 79), of which 16 were female. The patients were scored by Wilkes Classification as III (14), IV (1), or V (4). Twelve patients had anterior disc displacement without reduction (66%) and six had degenerative/arthritic changes (33%) to the TMJ. The open joint procedure resulted in an increase in MIO and reduction in pain VAS and for the majority of patients, across all Wilkes Classifications. Pre-procedural MIO was 22.9 ± 7.4 mm and VAS was 7.8 ± 1.5. At three months post-procedure there was an increase in MIO to 34.4 ± 10.4 mm (p < 0.01) and a decrease in the VAS to 1.5 ± 2.9 (p < 0.01). Three patients were lost to follow-up prior to six months. Six were discharged at six month review and five patients were discharged at 12 months review as they were asymptomatic with good mouth opening. Four patients are still attending for annual botulinum toxin treatment. Two patients (Wilkes III and V) subsequently underwent TMJ replacement (11%). One of these patients (Wilkes III) had improvement initially to MIO of 40 mm, but subsequently relapsed to less than 20 mm due to lack of compliance with jaw rehabilitation device post-operatively. Clinical improvements in 89% of patients within the study group were found, with a return to near normal MIO range and reduced pain score. Intraoperatively, the operator found bone-anchoring suture used for discopexy/discoplasty more secure than the soft tissue anchoring suturing technique.

Keywords: bone anchoring suture, open temporomandibular joint surgery, temporomandibular joint, temporomandibular joint dysfunction

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