Search results for: clinical characteristics

Authors: Jitendra Jain, Cassandra Hidajat, Hansraj Riteesh Bookun

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Graft patency underpins long-term prognosis after coronary artery bypass grafting surgery (CABG). The benefits of the combined use of only the left internal mammary artery and radial artery, referred to as total arterial revascularisation (TAR), on long-term clinical outcomes and quality of life are relatively unknown. The aim of this study was to identify whether there were differences in long term clinical outcomes between recipients of TAR compared to a cohort of mostly arterial revascularization involving the left internal mammary, at least one radial artery and at least one saphenous vein graft. A retrospective analysis was performed on all patients who underwent TAR or were re-vascularized with supplementary saphenous vein graft from February 1996 to December 2004. Telephone surveys were conducted to obtain clinical outcome parameters including major adverse cardiac and cerebrovascular events (MACCE) and Short Form (SF-36v2) Health Survey responses. A total of 176 patients were successfully contacted to obtain postop follow up results. The mean follow-up length from time of surgery in our study was TAR 12.4±1.8 years and conventional 12.6±2.1. PCS score was TAR 45.9±8.8 vs LIMA/Rad/ SVG 44.9±9.2 (p=0.468) and MCS score was TAR 52.0±8.9 vs LIMA/Rad/SVG 52.5±9.3 (p=0.723). There were no significant differences between groups for NYHA class 3+ TAR 9.4% vs. LIMA/Rad/SVG 6.6%; or CCS 3+ TAR 2.35% vs. LIMA/Rad/SVG 0%.

Keywords: CABG; MACCEs; quality of life; total arterial revascularisation

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Authors: Xiaoxue Jin, Qiong Zhang

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The rapid influx and ongoing flow of young migrants in large cities, alongside the emergence and evolution of new social media, have led to increased interpersonal alienation and weakened place attachment. In the interplay between individuals and space, urban public spaces play a pivotal role in meeting the multifaceted needs of individuals and fostering a sense of attachment. This article aims to investigate the relationship between the place characteristics of public spaces and individuals' needs and perceptions, with an aim to identify the factors influencing place attachment among the youth. This study is conducted in the Shekou community of Shenzhen, focusing on the youth residents to evaluate their place attachment levels and to analyze their perceptions of the place characteristics of selected public spaces. The influencing factors of public spaces on place attachment were sorted out through detailed data analysis. Research has found that rapid urbanization has led to spatial homogenization and spatial segregation caused by uneven resource distribution, which in turn diminishes the utilization of public spaces. The social characteristics of public spaces, such as the quality of social activities and spatial openness, are critical in forming place attachment. In this research, place characteristics impacting place attachment are categorized, aiming to reconstruct the characteristics of public space places and use them as a medium to explore the place attachment of young people, promote their independent creation and participation in public life, and enhance the dynamism between individuals and spaces.

Keywords: place attachment, place characteristics, public spaces, spatial perception

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Authors: Aniruddha Kulkarni

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In very few cases of external hernias we require imaging modalities as on most occasions clinical examination tests are good enough. Ultrasound will help in chronic abdominal or groin pain, equivocal clinical results & complicated hernias. Ultrasound is useful in assessment of cause of raised intrabdominal pressure. In certain cases will comment about etiology, complications and chronicicty of lesion. Screening of rest of abdominal organs too is important advantage being real time modality. Cost effectiveness, no radiation allows modality be used repeatedly in indicated cases. Sonography is better accepted by patients too as it is cost effective. Best advanced tissue harmonic equipment and increasing expertise making it popular. Ultrasound can define surgical anatomy, rent size, contents, etiological /recurrence factors in great detail and with authority hence accidental findings in a planned surgical procedure can be easily avoided. Clinical dynamic valselva and reducibility test can better documented by real time ultrasound study. In case of recurrence, Sonography will help in assessing the hernia details better as being dynamic real time investigation. Ultrasound signs in case of internal hernias are well comparable with CT findings.

Keywords: laparoscopic repair, Hernia, CT findings, chronic pain

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Authors: Chamtouri I., Kechida M.

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Background: Evaluation has a prominent role in medical education and graduation. This evaluation has usually done in face-to-face, by written or oral questions. Simulation is increasingly taking a part as a method of evaluation. Due to the Covid-19 pandemic, which disrupted face-to-face evaluation, simulation using serious games (SG) is emerging in the field of training and assessment of medical students. The aim of our study is to compare the results of the evaluation of medical students by virtual simulation by online serious games versus clinical case-multiple choice questions (MCQ) and to assess the degree of satisfaction from these two evaluation methods. Methods: Medical students from the same study level were voluntarily participated in this study. Groupe 1 had an evaluation by SG dealing with “diagnosis and management of ST-segment elevationmyocardialinfarction (STEMI)alreadyprepared on the website www.Mediactiv.com. Groupe 2 were evaluated by clinical case-MCQ having thes same topic as SG. Results of the two groups were compared. Satisfaction questionnaire was filled by the two groups. Satisfaction degree was compared between the two groups. Results. In this study, 64 medical students (G1:31 and G2: 33) were enrolled. Obtaining complete notes in the "questioning" and "clinical examination" parts is significantly more important in-group 1 compared to group 2. No significant difference detected between the two groups in terms of “ECG interpretation” and “diagnosis of STEMI” parts. A greater number of students of group 1 obtained the full note compared to group 2 in “the initial treatment part” (54.8% vs. 39.4%; p = 0.04). Thirty learners (96.8%) in-group 1 obtained a total score ≥ 50% versus 69.7% in-group 2 (p = 0.004). The full score of 100% was obtained in three learners in-group1, while no student scored 100% in-group2 (p = 0.027). Medical evaluation using SG was reported as more innovative, fun, and realistic compared to evaluation by clinical case-MCQ. No significant difference detected between the two methods in terms of stress. Conclusion: Simulation by SG can be considered as an innovative and effective method in evaluating medical students with a higher degree of satisfaction.

Keywords: evaluation, serious games, medical students, satisfaction

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Authors: Shanza Akram, Sameen Toor, Heba Harb Abu Alkass, Zainab Abdulsalam Altaha, Sara Taha Abdulla, Saleem Imran

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Acute pulmonary embolism (PE) is a common disease and can be fatal. The clinical presentation is variable and nonspecific, making accurate diagnosis difficult. Testing patients with suspected acute PE has increased dramatically. However, the overuse of some tests, particularly CT and D-dimer measurement, may not improve care while potentially leading to patient harm and unnecessary expense. CTPA is the investigation of choice for PE. Its easy availability, accuracy and ability to provide alternative diagnosis has lowered the threshold for performing it, resulting in its overuse. Guidelines have recommended the use of clinical pretest probability tools such as ‘Wells score’ to assess risk of suspected PE. Unfortunately, implementation of guidelines in clinical practice is inconsistent. This has led to low risk patients being subjected to unnecessary imaging, exposure to radiation and possible contrast related complications. Aim: To study the diagnostic yield of CT PA, clinical pretest probability of patients according to wells score and to determine whether or not there was an overuse of CTPA in our service. Methods: CT scans done on patients with suspected P.E in our hospital from 1st January 2014 to 31st December 2014 were retrospectively reviewed. Medical records were reviewed to study demographics, clinical presentation, final diagnosis, and to establish if Wells score and D-Dimer were used correctly in predicting the probability of PE and the need for subsequent CTPA. Results: 100 patients (51male) underwent CT PA in the time period. Mean age was 57 years (24-91 years). Majority of patients presented with shortness of breath (52%). Other presenting symptoms included chest pain 34%, palpitations 6%, collapse 5% and haemoptysis 5%. D Dimer test was done in 69%. Overall Wells score was low (<2) in 28 %, moderate (>2 - < 6) in 47% and high (> 6) in 15% of patients. Wells score was documented in medical notes of only 20% patients. PE was confirmed in 12% (8 male) patients. 4 had bilateral PE’s. In high-risk group (Wells > 6) (n=15), there were 5 diagnosed PEs. In moderate risk group (Wells >2 - < 6) (n=47), there were 6 and in low risk group (Wells <2) (n=28), one case of PE was confirmed. CT scans negative for PE showed pleural effusion in 30, Consolidation in 20, atelactasis in 15 and pulmonary nodule in 4 patients. 31 scans were completely normal. Conclusion: Yield of CT for pulmonary embolism was low in our cohort at 12%. A significant number of our patients who underwent CT PA had low Wells score. This suggests that CT PA is over utilized in our institution. Wells score was poorly documented in medical notes. CT-PA was able to detect alternative pulmonary abnormalities explaining the patient's clinical presentation. CT-PA requires concomitant pretest clinical probability assessment to be an effective diagnostic tool for confirming or excluding PE. . Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being considered. Combining Wells scores with clinical and laboratory assessment may reduce the need for CTPA.

Keywords: CT PA, D dimer, pulmonary embolism, wells score

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Authors: Youssouf Benmeriem

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Shear strength of sandy soils has been considered as the important parameter to study the stability of different civil engineering structures when subjected to monotonic, cyclic and earthquake loading conditions. The proposed research investigated the effect of grading characteristics on the shear strength and mechanical behavior of granular classes of sands mixed with silt in loose and dense states (Dr = 15% and 90%). The laboratory investigation aimed at understanding the extent or degree at which shear strength of sand-silt mixture soil is affected by its gradation under static loading conditions. For the purpose of clarifying and evaluating the shear strength characteristics of sandy soils, a series of Casagrande shear box tests were carried out on different reconstituted samples of sand-silt mixtures with various gradations. The soil samples were tested under different normal stresses (100, 200 and 300 kPa). The results from this laboratory investigation were used to develop insight into the shear strength response of sand and sand-silt mixtures under monotonic loading conditions. The analysis of the obtained data revealed that the grading characteristics (D10, D50, Cu, ESR, and MGSR) have significant influence on the shear strength response. It was found that shear strength can be correlated to the grading characteristics for the sand-silt mixture. The effective size ratio (ESR) and mean grain size ratio (MGSR) appear as pertinent parameters to predict the shear strength response of the sand-silt mixtures for soil gradation under study.

Keywords: grading characteristics, granular classes of sands, mechanical behavior, sand-silt, shear strength

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Authors: Do Jaesoo, Kim Kyoung Seok

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Under the recent difficult economic conditions, a number of people are increasingly expecting fostering ventures as the breakthrough in economic recovery and thus more attention is socially paid to an entrepreneur spirit. However, even though the role of managers is very important for the success of a venture company, programs to cultivate their qualities and skills are quite insufficient. In recent years, programs to foster entrepreneurs and business men have proliferated, which are led mainly by national agencies, research institutions, and large corporations. However, these programs still remain at a tottering stage, since there is no accumulated knowledge in many aspects, including systemic know-how and education. Therefore, this study attempted to introduce the definition of the entrepreneur (founder’s) spirit and furthermore identify the characteristics required for entrepreneurs as the subject of management. It thus tried to examine how those characteristics have an influence on entrepreneurs as their successful conditions, and presented foreign cases after analyzing the entrepreneur spirit through case studies. The entrepreneur spirit and the venture management emerge as a new field in business administration and scholars have reported various theories. Further research activities and efforts for active exchanges are also needed thereof.

Keywords: venture, entrepreneur, entrepreneur (founder’s) spirit, characteristics of entrepreneur spirit

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Authors: Abdela Bulbula

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Background: Marek’s disease virus is a devastating infection, causing high morbidity and mortality in chickens in Ethiopia. Methods: The current study was conducted from March to November, 2021 with the general objective of performing antemortem and postmortem, isolation, and molecular detection of Marek’s disease virus from outbreak cases in southwestern Ethiopia. Accordingly, based on outbreak information reported from the study sites namely, Bedelle, Yayo, and Bonga towns in southwestern Ethiopia, 50 sick chickens were sampled. The backyard and intensive farming systems of chickens were included in the sampling and priorities were given for chickens that showed clinical signs that are characteristics of Marek’s disease. Results: By clinical examinations, paralysis of legs and wings, gray eye, loss of weight, difficulty in breathing, and depression were recorded on all chickens sampled for this study and death of diseased chickens was observed. In addition, enlargement of the spleen and gross lesions of the liver and heart were recorded during postmortem examination. The death of infected chickens was observed in both vaccinated and non-vaccinated flocks. Out of 50 pooled feather follicle samples, Marek’s disease virus was isolated from 14/50 (28%) by cell culture method and out of six tissue samples, the virus was isolated from 5/6(83.30%). By Real time polymerization chain reaction technique, which was targeted to detect the Meq gene, Marek’s disease virus was detected from 18/50 feather follicles which accounts for 36% of sampled chickens. Conclusion: In general, the current study showed that the circulating Marek’s disease virus in southwestern Ethiopia was caused by the oncogenic Gallid herpesvirus-2 (Serotype-1). Further research on molecular characterization of revolving virus in current and other regions is recommended for effective control of the disease through vaccination.

Keywords: Ethioi, Marek's disease, isolation, molecular

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Authors: Haiqiang Song, Huiqing Liu

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The Doseo basin in Chad, Central Africa is one of the most important oil and gas blocks in the world. However, the low degree of oil and gas exploration and the lack of relevant geological data restrict the understanding and resource evaluation of the basin. To further develop the Doseo basin efficiently, it is urgent to deeply analyze the source rock characteristics and hydrocarbon generation potential of the Doseo basin. Based on seismic and drilling data in recent years, this paper systematically evaluates the geochemical characteristics of source rocks and their generated oils in Doseo Basin, explores the development, distribution, and evolution characteristics of source rocks, and evaluates the exploration potential of Doseo Basin according to the hydrocarbon enrichment law. The results show that the Lower Cretaceous Baliemian and Apudian source rocks in Doseo Basin are well developed, with high organic matter abundance (average TOC≥3%) and good organic matter types (type I~II), which are the main development layers of source rocks, but the organic matter maturity is generally low (Ro of the drilled source rocks is mainly between 0.4%~0.8%). The planar structure also shows that the main hydrocarbon accumulation mode in Doseo sag is the forward tectonic reservoirs such as near source anticlines and faulted noses. Finally, it is estimated that the accumulative resources of the main source rocks in the Doseo Basin are about 4.33× 108T in Apudite and Balim terrace layers. The results of this study will help guide the next step of oil and gas exploration, which is expected to drive the next step of oil and gas development.

Keywords: Doseo basin, lower cretaceous, source rock characteristics, developmental characteristics, hydrocarbon generation potential

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Authors: Diego Alejandro Espíndola-Fernández, Ana María Posada-Cano, Dagnóvar Aristizábal-Ocampo, Jaime Alberto Gallo-Villegas

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Background: With the increase in life expectancy, aging has been subject of frequent research, and therefore multiple strategies have been proposed to quantify the advance of the years based on the known physiology of human senescence. For several decades, attempts have been made to characterize these changes through the concept of biological age, which aims to integrate, in a measure of time, structural or functional variation through biomarkers in comparison with simple chronological age. The objective of this scoping review is to deepen the updated concept of measuring biological age composed of biomarkers in the general population and to summarize recent evidence to identify gaps and priorities for future research. Methods: A scoping review was conducted according to the five-phase methodology developed by Arksey and O'Malley through a search of five bibliographic databases to February 2021. Original articles were included with no time or language limit that described the biological age composed of at least two biomarkers in those over 18 years of age. Results: 674 articles were identified, of which 105 were evaluated for eligibility and 65 were included with information on the measurement of biological age composed of biomarkers. Articles from 1974 of 15 nationalities were found, most observational studies, in which clinical or paraclinical biomarkers were used, and 11 different methods described for the calculation of the composite biological age were informed. The outcomes reported were the relationship with the same measured biomarkers, specified risk factors, comorbidities, physical or cognitive functionality, and mortality. Conclusions: The concept of biological age composed of biomarkers has evolved since the 1970s and multiple methods of its quantification have been described through the combination of different clinical and paraclinical variables from observational studies. Future research should consider the population characteristics, and the choice of biomarkers against the proposed outcomes to improve the understanding of aging variables to direct effective strategies for a proper approach.

Keywords: biological age, biological aging, aging, senescence, biomarker

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Authors: Aya Al Masri, Stefaan Carpentier, Fabrice Leroy, Thibault Julien, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may become very high for a burn, necrosis and ulceration to appear. In order to prevent these deterministic effects, an accurate calculation of the patient skin-dose mapping is essential. For most machines, the 'Dose Area Product (DAP)' and fluoroscopy time are the only information available for the operator. These two parameters are a very poor indicator of the peak skin dose. We developed a mathematical model that reconstructs the magnitude (delivered dose), shape, and localization of each irradiation field on the patient skin. In case of critical dose exceeding, the system generates warning alerts. We present the results of its comparison with clinical studies. Materials and methods: Two series of comparison of the skin-dose mapping of our mathematical model with clinical studies were performed: 1. At a first time, clinical tests were performed on patient phantoms. Gafchromic films were placed on the table of the IR machine under of PMMA plates (thickness = 20 cm) that simulate the patient. After irradiation, the film darkening is proportional to the radiation dose received by the patient's back and reflects the shape of the X-ray field. After film scanning and analysis, the exact dose value can be obtained at each point of the mapping. Four experimentation were performed, constituting a total of 34 acquisition incidences including all possible exposure configurations. 2. At a second time, clinical trials were launched on real patients during real 'Chronic Total Occlusion (CTO)' procedures for a total of 80 cases. Gafchromic films were placed at the back of patients. We performed comparisons on the dose values, as well as the distribution, and the shape of irradiation fields between the skin dose mapping of our mathematical model and Gafchromic films. Results: The comparison between the dose values shows a difference less than 15%. Moreover, our model shows a very good geometric accuracy: all fields have the same shape, size and location (uncertainty < 5%). Conclusion: This study shows that our model is a reliable tool to warn physicians when a high radiation dose is reached. Thus, deterministic effects can be avoided.

Keywords: clinical experimentation, interventional radiology, mathematical model, patient's skin-dose mapping.

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Authors: J. Balaraju, M. Govinda Raj, C. S. N. Murthy

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Every industry is constantly looking for enhancement of its day to day production and productivity. This can be possible only by maintaining the men and machinery at its adequate level. Prediction of performance characteristics plays an important role in performance evaluation of the equipment. Analytical and statistical approaches will take a bit more time to solve complex problems such as performance estimations as compared with software-based approaches. Keeping this in view the present study deals with an Artificial Neural Network (ANN) modelling of a Load-Haul-Dump (LHD) machine to predict the performance characteristics such as reliability, availability and preventive maintenance (PM). A feed-forward-back-propagation ANN technique has been used to model the Levenberg-Marquardt (LM) training algorithm. The performance characteristics were computed using Isograph Reliability Workbench 13.0 software. These computed values were validated using predicted output responses of ANN models. Further, recommendations are given to the industry based on the performed analysis for improvement of equipment performance.

Keywords: load-haul-dump, LHD, artificial neural network, ANN, performance, reliability, availability, preventive maintenance

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Authors: L. Ramirez, E. Guillén, J. Sánchez

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Some of the main goals about telecare such as monitoring, treatment, telediagnostic are deployed with the integration of applications with specific appliances. In order to achieve a coherent model to integrate software, hardware, and healthcare systems, different telehealth models with Internet of Things (IoT), cloud computing, artificial intelligence, etc. have been implemented, and their advantages are still under analysis. In this paper, we propose an integrated model based on IoT architecture and cloud computing telehealth center. Analytics module is presented as a solution to control an ideal diagnostic about some diseases. Specific features are then compared with the recently deployed conventional models in telemedicine. The main advantage of this model is the availability of controlling the security and privacy about patient information and the optimization on processing and acquiring clinical parameters according to technical characteristics.

Keywords: analytics, telemedicine, internet of things, cloud computing

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Authors: Jonathan H. Westover, Maureen S. Andrade, Angela Schill, Jeff Peterson, Samuel Choi

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The purpose of this research is to understand employee perspectives on their work characteristics and conditions, particularly related to the COVID-19 pandemic and the future of work. Working conditions impact job satisfaction. People tend to measure job satisfaction by comparing aspects of the job they have with those they want. Job satisfaction is related to the value that one places on specific aspects of a job, such as autonomy, pay and benefits, challenge, growth, or meaningful work, and the degree to which such elements are present. The value one places on these various job characteristics may differ based on gender, age, personality, occupation, context, or other factors. This study will examine various job characteristics and working conditions with an emphasis on COVID-19 to determine how managers and leaders and better support and develop their employees.

Keywords: COVID-19, employee perspectives nature of work, future of work

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Authors: Siriporn Sikkaphun

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Food is essential for living, and receiving correct, suitable, and adequate food is advantageous to the body, especially for patients because it can enable good recovery. Feeding through a gastrostomy tube is one useful way that is widely used because it is easy, convenient, and economical.To compare the effectiveness of using the clinical guidelines for feeding through a gastrostomy tube in critically ill surgical patients.This is a pre-post quasi-experimental study on 15 critically ill surgical or accident patients who needed intubation and the gastrostomy tube from August 2011 to November 2012. The data were collected using the guidelines, and an evaluation form for effectiveness of guidelines for feeding through a gastrostomy tube in critically ill surgical patients. After using the guidelines for feeding through a gastrostomy tube in critically ill surgical patients, it was found that The average number of days from the admission date to the day the patients received food through the G-tube significantly reduced at the level .05. The number of personnel who practiced nursing activities correctly and suitably for patients with complications during feeding significantly increased at the level .05.The number of patients receiving energy to the target level significantly increased at the level .05. The results of this study indicated that the use of the guidelines for feeding through a gastrostomy tube in critically ill surgical patients was feasible in practice, and the outcomes were beneficial to the patients.

Keywords: clinical guidelines, feeding, gastrostomy tube, critically ill, surgical patients

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Authors: Bindu I. Somarajan, Viney Gupta, Gagandeep Kaur Walia, Jasbir Kaur, Sunil Kumar, Shikha Gupta, Abadh K. Chaurasia, Dinesh Gupa, Abhinav Kaushik, Aditi Mehta, Vipin Gupta, Arundhati Sharma

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Background: Juvenile onset primary open angle glaucoma (JOAG), affects individuals under the age of 40 years. Studies on a few families of JOAG, that led to the discovery of the Myocilin gene, reported the disease to have an autosomal dominant pattern of inheritance. However, sporadic forms of JOAG been seen to be more common in some populations. Most pathological homozygous mutations in the CYP1B1 gene associated with JOAG have been seen among sporadic cases. Given the higher prevalence of sporadic JOAG cases in our population, we aimed to look for common mutations E229K and R368H, the two most common variants in the CYP1B1 gene associated with glaucoma. Objective: To determine the frequency and evaluate genotype phenotype correlation of CYP1B1 E229K and R368H mutations in a cohort of 120 sporadic Juvenile open angle glaucoma patients.Methods: Unrelated JOAG patients whose first degree relatives had been examined and found to be unaffected were included in the study. The patients and their parents were screened for E229K and R368H mutations. The phenotypic characteristics were compared between probands with and with out these mutations by SPSS v16. Results: Out of 120 JOAG patients included in the study, the E229K mutation was seen in 9 probands (7.5%) and R368H in 7 (5.8%). The average age of onset of the disease (p=0.3) and the highest untreated IOP (p=0.4) among those carrying mutations was not significantly different from those who did not have these mutations. The proportion of probands with angle dysgenesis among those with E229K and R368H mutations was 70% (11 out of 16) in comparison to 65% (67 out of 104) of those who did not harbour these mutations (p=0.56). Similarly the probands with moderate to high myopia among those with E229K and R368H mutations was 20% (3 out of 16) in comparison to 18% (18 out of 104) of those who did not harbour these mutations(p=0.59). Conclusion: The frequency of E229K and R368H mutations of the CYP1B1 gene is low even among sporadic JOAG patients. Moreover there is no clinical correlation between the presence of these mutations and disease severity

Keywords: CYP1B1, gene, IOP, JOAG, mutation

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Authors: Mohamed Elassaly

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The damage status of RC buildings is greatly influenced by the characteristics of the imposed ground motion. Peak Ground Acceleration and frequency contents are considered the main two factors that affect ground motion characteristics; hence, affecting the seismic response of RC structures and consequently their damage state. A detailed investigation on the combined effects of these two factors on damage assessment of RC buildings, is carried out. Twenty one earthquake records are analyzed and arranged into three groups, according to their frequency contents. These records are used in an investigation to define the expected damage state that would be attained by RC buildings, if subjected to varying ground motion characteristics. The damage assessment is conducted through examining drift ratios and damage indices of the overall structure and the significant structural components of RC building. Base and story shear of RC building model, are also investigated, for cases when the model is subjected to the chosen twenty one earthquake records. Nonlinear dynamic analyses are performed on a 2-dimensional model of a 12-story R.C. building.

Keywords: damage, frequency content, ground motion, PGA, RC building, seismic

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Authors: Ilana Margalith, Yaron Niv

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One of the most important factors of professional health treatment is teamwork, in which each discipline contributes its expert knowledge, thus ensuring quality and a high standard of care as well as efficient communication (one of the International Patient Safety Goals). However, in most countries, students are educated separately by each health discipline. They are exposed to teamwork only during their clinical experience, which in some cases is short and skill-oriented. In addition, health organizations in most countries are hierarchical and although changes have occurred in the hierarchy of the medical system, there are still disciplines that underrate the unique contributions of other health professionals, thus, young graduates of health professions develop and base their perception of their peers from other disciplines on insufficient knowledge. In order to establish a wide-ranging perception among nursing students as to the contribution of different health professionals to the health of their patients, students at the Clalit Nursing Academy, Rabin Campus (Dina), Israel, participated in an interdisciplinary clinical discussion with students from several different professions, other than nursing, who were completing their clinical experience at Rabin Medical Center in medicine, health psychology, social work, audiology, physiotherapy and occupational therapy. The discussion was led by a medical-surgical nursing instructor. Their tutors received in advance, a case report enabling them to prepare the students as to how to present their professional theories and interventions regarding the case. Mutual stimulation and acknowledgment of the unique contribution of each part of the team enriched the nursing students' understanding as to how their own nursing interventions could be integrated into the entire process towards a safe and speedy recovery of the patient.

Keywords: health professions' students, interdisciplinary clinical discussion, nursing education, patient safety

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Authors: Behrang Ekrami, Amin Tamadon

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Caspian red deer or maral (Cervus elaphus maral) is a ruminant from the family of Cervidae. Maintenance and protection of maral requires knowing the behavioral, physiological, environmental characteristics and factors harmful to this species. In this article, reproductive and behavioral traits of this species in both sexes are presented based on observations and the available records of protected deer in Wildlife Refuge of Semeskande, Sari (one of the sites that preserve the maral in the Free Zones of Hyrcanian forest) from 2006 to 2011. Hart characteristics including sexual behavior, apparent changes during reproductive season and reproductive physiology; and hind characteristics including of ovulation, reproductive cycle, mating, pregnancy and parturition, have been evaluated. Identification of maral reproductive characteristics in Wildlife Refuge of Semeskande, Sari is one of the most important information requirements to preserve and breed this species and will open up new routes for performing new methods of reproduction of this species in Iran wildlife parks or other refuge areas.

Keywords: caspian red deer, reproduction, behavior, Iran

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Authors: Jun-Geol Park, Kyoung-Il Do, Min-Ju Kwon, Kyung-Hyun Park, Yong-Seo Koo

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In this paper, we proposed the SCR (Silicon Controlled Rectifier)-based ESD (Electrostatic Discharge) protection circuit for latch-up immunity. The proposed circuit has a lower trigger voltage and a higher holding voltage characteristic by using the zener diode structure. These characteristics prevent latch-up problem in normal operating conditions. The proposed circuit was analyzed to figure out the electrical characteristics by the variations of design parameters D1, D2 and stack technology to obtain the n-fold electrical characteristics. The simulations are accomplished by using the Synopsys TCAD simulator. When using the stack technology, 2-stack has the holding voltage of 6.9V and 3-stack has the holding voltage of 10.9V.

Keywords: ESD, SCR, trigger voltage, holding voltage

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Authors: Vesile Unver, Tulay Basak, Hatice Ayhan, Ilknur Cinar, Emine Iyigun, Nuran Tosun

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The aim of this study is to analyze the effects of the hybrid simulation. In this simulation, types standardized patients and task trainers are employed simultaneously. For instance, in order to teach the IV activities standardized patients and IV arm models are used. The study was designed as a quasi-experimental research. Before the implementation an ethical permission was taken from the local ethical commission and administrative permission was granted from the nursing school. The universe of the study included second-grade nursing students (n=77). The participants were selected through simple random sample technique and total of 39 nursing students were included. The views of the participants were collected through a feedback form with 12 items. The form was developed by the authors and “Patient intervention self-confidence/competence scale”. Participants reported advantages of the hybrid simulation practice. Such advantages include the following: developing connections between the simulated scenario and real life situations in clinical conditions; recognition of the need for learning more about clinical practice. They all stated that the implementation was very useful for them. They also added three major gains; improvement of critical thinking skills (94.7%) and the skill of making decisions (97.3%); and feeling as if a nurse (92.1%). In regard to the mean scores of the participants in the patient intervention self-confidence/competence scale, it was found that the total mean score for the scale was 75.23±7.76. The findings obtained in the study suggest that the hybrid simulation has positive effects on the integration of theoretical and practical activities before clinical activities for the nursing students.

Keywords: hybrid simulation, clinical practice, nursing education, nursing students

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Authors: M. Shadmand

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The curing process of insulation system for electrical machines plays a determinative role for its durability and reliability. Polar structure of insulating resin molecules and used filler of insulation system can be taken as an occasion to leverage it to enhance overall characteristics of insulation system, mechanically and electrically. The curing process regime for insulating system plays an important role for its mechanical and electrical characteristics by arranging the polymerization of chain structure for resin. In this research, the effect of electrical field application on in-curing insulating system for Global Vacuum Pressurized Impregnation (GVPI) system for traction motor was considered by performing the dissipation factor, polarization and de-polarization current (PDC) and voltage endurance (aging) measurements on sample test objects. Outcome results depicted obvious improvement in mechanical strength of the insulation system as well as higher electrical characteristics with routing and long-time (aging) electrical tests. Coming together, polarization of insulation system during curing process would enhance the machine life time. 

Keywords: insulation system, GVPI, PDC, aging

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Authors: Kyoung-il Do, Byung-seok Lee, Hee-guk Chae, Jeong-yun Seo Yong-seo Koo

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In this paper, a Silicon Controlled Rectifier (SCR)-based Electrostatic Discharge (ESD) protection circuit with high holding voltage and high robustness characteristics is proposed. Unlike conventional SCR, the proposed circuit has low trigger voltage and high holding voltage and provides effective ESD protection with latch-up immunity. In addition, the TCAD simulation results show that the proposed circuit has better electrical characteristics than the conventional SCR. A stack technology was used for voltage-specific applications. Consequentially, the proposed circuit has a trigger voltage of 17.60 V and a holding voltage of 3.64 V.

Keywords: ESD, SCR, latch-up, power clamp, holding voltage

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Authors: Jui-Pui Hung, Yong-Run Chen, Wei-Cheng Shih, Chun-Wei Lin

Abstract:

This study was aimed to assess the variations of the modal characteristics of the feeding stage with different linear guide modulus. The dynamic characteristics of the feeding stage were characterized in terms of the modal stiffness, modal frequency and modal damping, which are assessed from the vibration tests. According to the experimental measurements, the actual preload of the linear guide modulus was found to deviate from the rated values as setting in factory. This may be due to the assemblage errors of guide modules. For the stage with linear guides, the dynamic stiffness was affected to change by the preload set on the rolling balls. The variation of the dynamic stiffness at first and second modes is 20.8 and 10.5%, respectively when the linear guide preload is adjusted from medium and high amount. But the modal damping ratio is reduced by 8.97 and 9.65%, respectively. For high-frequency mode, the modal stiffness increases by 171.2% and the damping ratio reduced by 34.4%. Current results demonstrate the importance in the determining the preloaded amount of linear guide modulus in practical application.

Keywords: contact stiffness, feeding stage, linear guides, modal characteristics, pre-load

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Authors: S. J. Yune, S. Y. Lee, S. J. Im, B. S. Kam, S. Y. Baek

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This study aimed to determine the reliability of clinical performance assessments, having been emphasized by ability-based education, and professors overall assessment methods. We addressed the following problems: First, we try to find out whether there is a difference in what we consider to be the main variables affecting the clinical performance test according to the evaluator’s working period and the number of evaluation experience. Second, we examined the relationship among the global rating score (G), analytic global rating score (Gc), and the sum of the analytical checklists (C). What are the main factors affecting clinical performance assessments in relation to the numbers of times the evaluator had administered evaluations and the length of their working period service? What is the relationship between overall assessment score and analytic checklist score? How does analytic global rating with 6 components in OSCE and 4 components in sub-domains (Gc) CPX: aseptic practice, precision, systemic approach, proficiency, successfulness, and attitude overall assessment score and task-specific analytic checklist score sum (C) affect the professor’s overall global rating assessment score (G)? We studied 75 professors who attended a 2016 Bugyeoung Consortium clinical skills performances test evaluating third and fourth year medical students at the Pusan National University Medical school in South Korea (39 prof. in OSCE, 36 prof. in CPX; all consented to participate in our study). Each evaluator used 3 forms; a task-specific analytic checklist, subsequent analytic global rating scale with sub-6 domains, and overall global scale. After the evaluation, the professors responded to the questionnaire on the important factors of clinical performance assessment. The data were analyzed by frequency analysis, correlation analysis, and hierarchical regression analysis using SPSS 21.0. Their understanding of overall assessment was analyzed by dividing the subjects into groups based on experiences. As a result, they considered ‘precision’ most important in overall OSCE assessment, and ‘precise accuracy physical examination’, ‘systemic approaches to taking patient history’, and ‘diagnostic skill capability’ in overall CPX assessment. For OSCE, there was no clear difference of opinion about the main factors, but there was for CPX. Analytic global rating scale score, overall rating scale score, and analytic checklist score had meaningful mutual correlations. According to the regression analysis results, task-specific checklist score sum had the greatest effect on overall global rating. professors regarded task-specific analytic checklist total score sum as best reflecting overall OSCE test score, followed by aseptic practice, precision, systemic approach, proficiency, successfulness, and attitude on a subsequent analytic global rating scale. For CPX, subsequent analytic global rating scale score, overall global rating scale score, and task-specific checklist score had meaningful mutual correlations. These findings support explanations for validity of professors’ global rating in clinical performance assessment.

Keywords: global rating, clinical performance assessment, medical education, analytic checklist

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Authors: Ian McCulloh, Andrew Placona, Darren Stewart, Daniel Gause, Kevin Kiernan, Morgan Stuart, Christopher Zinner, Laura Cartwright

Abstract:

An estimated 22-25% of viable deceased donor kidneys are discarded every year in the US, while waitlisted candidates are dying every day. As many as 85% of transplanted organs are refused at least once for a patient that scored higher on the match list. There are hundreds of clinical variables involved in making a clinical transplant decision and there is rarely an ideal match. Decision makers exhibit an optimism bias where they may refuse an organ offer assuming a better match is imminent. We propose a semi-parametric Cox proportional hazard model, augmented by an accelerated failure time model based on patient specific suitable organ supply and demand to estimate a time-to-next-offer. Performance is assessed with Cox-Snell residuals and decision curve analysis, demonstrating improved decision support for up to a 5-year outlook. Providing clinical decision makers with quantitative evidence of likely patient outcomes (e.g., time to next offer and the mortality associated with waiting) may improve decisions and reduce optimism bias, thus reducing discarded organs and matching more patients on the waitlist.

Keywords: decision science, KDPI, optimism bias, organ transplant

Procedia PDF Downloads 72

Authors: B. R. O. Omidiwura, A. F. Agboola, E. A. Iyayi

Abstract:

Pure form of L-Dopa is used to enhance muscular development, fat breakdown and suppress Parkinson disease in humans. However, the L-Dopa in mucuna seed, when present with other antinutritional factors, causes nutritional disorders in monogastric animals. Information on the utilisation of pure L-Dopa in monogastric animals is scanty. Therefore, effect of L-Dopa on growth performance and carcass characteristics in broiler chickens was investigated. Two hundred and forty one-day-old chicks were allotted to six treatments, which consisted of a positive control (PC) with standard energy (3100Kcal/Kg) and negative control (NC) with high energy (3500Kcal/Kg). The rest 4 diets were NC+0.1, NC+0.2, NC+0.3 and NC+0.4% L-Dopa, respectively. All treatments had 4 replicates in a completely randomized design. Body weight gain, final weight, feed intake, dressed weight and carcass characteristics were determined. Body weight gain and final weight of birds fed PC were 1791.0 and 1830.0g, NC+0.1% L-Dopa were 1827.7 and 1866.7g and NC+0.2% L-Dopa were 1871.9 and 1910.9g respectively, and the feed intake of PC (3231.5g), were better than other treatments. The dressed weight at 1375.0g and 1357.1g of birds fed NC+0.1% and NC+0.2% L-Dopa, respectively, were similar but better than other treatments. Also, the thigh (202.5g and 194.9g) and the breast meat (413.8g and 410.8g) of birds fed NC+0.1% and NC+0.2% L-Dopa, respectively, were similar but better than birds fed other treatments. The drum stick of birds fed NC+0.1% L-Dopa (220.5g) was observed to be better than birds on other diets. Meat to bone ratio and relative organ weights were not affected across treatments. L-Dopa extract, at levels tested, had no detrimental effect on broilers, rather better bird performance and carcass characteristics were observed especially at 0.1% and 0.2% L-Dopa inclusion rates. Therefore, 0.2% inclusion is recommended in diets of broiler chickens for improved performance and carcass characteristics.

Keywords: broilers, carcass characteristics, l-dopa, performance

Procedia PDF Downloads 286

Authors: Lina María Martínez Sánchez, Juliana Molina Valencia, Esteban Vallejo Agudelo, Daniel Gallego González, María Isabel Pérez Palacio, Juan Ricardo Gaviria García, María De Los Ángeles Rodríguez Gázquez, Gloria Inés Martínez Domínguez

Abstract:

Alternative and complementary therapies constitute a vast and complex combination of interventions, philosophies, approaches, and therapies that acquire a holistic healthcare point of view, becoming an alternative for the treatment of patients with chronic pain. Objective: determine the characteristics of the use of alternative and complementary therapies in patients with chronic pain who consulted in a medical institution. Methodology: cross-sectional and descriptive study, with a population of patients that assisted to the outpatient consultation and met the eligibility criteria. Sampling was not conducted. A form was used for the collection of demographic and clinical variables and the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) was validated. The analysis and processing of information was carried out using the SPSS program vr.19. Results: 220 people with chronic pain were included. The average age was 54.7±16.2 years, 78.2% were women, and 75.5% belonged to the socioeconomic strata 1 to 3. Musculoskeletal pain (77.7%), migraine (15%) and neuralgia (9.1%) were the most frequently types of chronic pain. 33.6% of participants have used some kind of alternative and complementary therapy; the most frequent were: homeopathy (14.5%), phytotherapy (12.7%), and acupuncture (11.4%). The total average HCAMQ score for the study group was 30.2±7.0 points, which shows a moderate attitude toward the use of complementary and alternative medicine. The highest scores according to the type of pain were: neuralgia (32.4±5.8), musculoskeletal pain (30.5±6.7), fibromyalgia (29.6±7.3) and migraine (28.5±8.8). The reliability of the HCAMQ was acceptable (Cronbach's α: 0.6). Conclusion: it was noted that the types of chronic pain and the clinical or therapeutic management of patients correspond to the data available in current literature. Despite the moderate attitude toward the use of these alternative and complementary therapies, one of every three patients uses them.

Keywords: chronic pain, complementary therapies, homeopathy, acupuncture analgesia

Procedia PDF Downloads 480

Authors: Atitallah Sofien, Bouyahia Olfa, Hadj Salah Ibrahim, Ben Saleh Foued, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir

Abstract:

Introduction: Carbon monoxide (CO) poisoning is a common pathology responsible for high morbidity and mortality worldwide. Aim: The purpose of this study was to determine the epidemiological profile of CO poisoning as well as its clinical, paraclinical, therapeutic, and evolutionary aspects. Methods: Our study included observations of CO poisoning in children hospitalized in the pediatric department C of the Children's Hospital in Tunis over a period of 3 years. Results: We have collected 199 cases of CO poisoning in children. The average age was 5.43 years, with a sex ratio of 0.98. The source of CO was inside the home in 73.2% of cases, and it was the gas bath heater in 68.8% of cases. The intoxication was collective in 93.5% of the cases, and it occurred during the month of January in 35.8% of the cases. The clinical manifestations were headaches in 69.5% of cases. The rate of carboxyhemoglobin was pathological in 73.9% of cases. All patients received normobaric oxygen therapy, and only 3.6% of patients had a hyperbaric oxygen therapy session. We did not deplore any case of death in our study. Conclusion: CO poisoning remains a public health problem in Tunisia with high morbidity. The risk of secondary complications, particularly neuropsychiatric, requires clinical and possibly neuroradiological monitoring of these victims.

Keywords: poisoning, carbon monoxide, children, hyperbaric oxygenation

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Authors: Srinivas Bathini, Duraichelvan Raju, Simona Badilescu, Muthukumaran Packirisamy

Abstract:

A bio-sensing method, based on the plasmonic property of gold nano-islands, has been developed for detection of exosomes in a clinical setting. The position of the gold plasmon band in the UV-Visible spectrum depends on the size and shape of gold nanoparticles as well as on the surrounding environment. By adsorbing various chemical entities, or binding them, the gold plasmon band will shift toward longer wavelengths and the shift is proportional to the concentration. Exosomes transport cargoes of molecules and genetic materials to proximal and distal cells. Presently, the standard method for their isolation and quantification from body fluids is by ultracentrifugation, not a practical method to be implemented in a clinical setting. Thus, a versatile and cutting-edge platform is required to selectively detect and isolate exosomes for further analysis at clinical level. The new sensing protocol, instead of antibodies, makes use of a specially synthesized polypeptide (Vn96), to capture and quantify the exosomes from different media, by binding the heat shock proteins from exosomes. The protocol has been established and optimized by using a glass substrate, in order to facilitate the next stage, namely the transfer of the protocol to a microfluidic environment. After each step of the protocol, the UV-Vis spectrum was recorded and the position of gold Localized Surface Plasmon Resonance (LSPR) band was measured. The sensing process was modelled, taking into account the characteristics of the nano-island structure, prepared by thermal convection and annealing. The optimal molar ratios of the most important chemical entities, involved in the detection of exosomes were calculated as well. Indeed, it was found that the results of the sensing process depend on the two major steps: the molar ratios of streptavidin to biotin-PEG-Vn96 and, the final step, the capture of exosomes by the biotin-PEG-Vn96 complex. The microfluidic device designed for sensing of exosomes consists of a glass substrate, sealed by a PDMS layer that contains the channel and a collecting chamber. In the device, the solutions of linker, cross-linker, etc., are pumped over the gold nano-islands and an Ocean Optics spectrometer is used to measure the position of the Au plasmon band at each step of the sensing. The experiments have shown that the shift of the Au LSPR band is proportional to the concentration of exosomes and, thereby, exosomes can be accurately quantified. An important advantage of the method is the ability to discriminate between exosomes having different origins.

Keywords: exosomes, gold nano-islands, microfluidics, plasmonic biosensing

Procedia PDF Downloads 149