Search results for: critical patients

Authors: Naghmeh M. Bandari, Javad Dargahi, Muthukumaran Packirisamy

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Robot-assisted minimally invasive surgery (RMIS) has been widely performed around the world during the last two decades. RMIS demonstrates significant advantages over conventional surgery, e.g., improving the accuracy and dexterity of a surgeon, providing 3D vision, motion scaling, hand-eye coordination, decreasing tremor, and reducing x-ray exposure for surgeons. Despite benefits, surgeons cannot touch the surgical site and perceive tactile information. This happens due to the remote control of robots. The literature survey identified the lack of force feedback as the riskiest limitation in the existing technology. Without the perception of tool-tissue contact force, the surgeon might apply an excessive force causing tissue laceration or insufficient force causing tissue slippage. The primary use of force sensors has been to measure the tool-tissue interaction force in real-time in-situ. Design of a tactile sensor is subjected to a set of design requirements, e.g., biocompatibility, electrical-passivity, MRI-compatibility, miniaturization, ability to measure static and dynamic force. In this study, a planar optical fiber-based sensor was proposed to mount at the surgical grasper. It was developed based on the light intensity modulation principle. The deflectable part of the sensor was a beam modeled as a cantilever Euler-Bernoulli beam on rigid substrates. A semi-cylindrical indenter was attached to the bottom surface the beam at the mid-span. An optical fiber was secured at both ends on the same rigid substrates. The indenter was in contact with the fiber. External force on the sensor caused deflection in the beam and optical fiber simultaneously. The micro-bending of the optical fiber would consequently result in light power loss. The sensor was simulated and studied using finite element methods. A laser light beam with 800nm wavelength and 5mW power was used as the input to the optical fiber. The output power was measured using a photodetector. The voltage from photodetector was calibrated to the external force for a chirp input (0.1-5Hz). The range, resolution, and hysteresis of the sensor were studied under monotonic and harmonic external forces of 0-2.0N with 0 and 5Hz, respectively. The results confirmed the validity of proposed sensing principle. Also, the sensor demonstrated an acceptable linearity (R2 > 0.9). A minimum external force was observed below which no power loss was detectable. It is postulated that this phenomenon is attributed to the critical angle of the optical fiber to observe total internal reflection. The experimental results were of negligible hysteresis (R2 > 0.9) and in fair agreement with the simulations. In conclusion, the suggested planar sensor is assessed to be a cost-effective solution, feasible, and easy to use the sensor for being miniaturized and integrated at the tip of robotic graspers. Geometrical and optical factors affecting the minimum sensible force and the working range of the sensor should be studied and optimized. This design is intrinsically scalable and meets all the design requirements. Therefore, it has a significant potential of industrialization and mass production.

Keywords: force sensor, minimally invasive surgery, optical sensor, robotic surgery, tactile sensor

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Authors: Vinti Davar

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Introduction: Childhood overweight increases the risk for certain medical and psychological conditions. Millions of school-age children worldwide are affected by serious yet easily treatable and preventable illnesses that inhibit their ability to learn. Healthier children stay in school longer, attend more regularly, learn more and become healthier and more productive adults. Schools are an important setting for nutrition education because one can reach most children, teachers and parents. These years offer a key window for shaping their lifetime habits, which have an impact on their health throughout life. Against this background, an attempt was made to impart nutrition education to school children in Haryana state of India to promote healthy food choices and assess the effectiveness of this program. Methodology: This study was completed in two phases. During the first phase, pre-intervention anthropometric and dietary survey was conducted; the teaching materials for nutrition intervention program were developed and tested; and the questionnaire was validated. In the second phase, an intervention was implemented in two schools of Kurukshetra, Haryana for six months by personal visits once a week. A total of 350 children in the age group of 6-12 years were selected. Out of these, 279 children, 153 boys and 126 girls completed the study. The subjects were divided into four groups namely: underweight, normal, overweight and obese based on body mass index-for-age categories. A power point colorful presentation to improve the quality of tiffin, snacks and meals emphasizing inclusion of all food groups especially vegetables every day and fruits at least 3-4 days per week was used. An extra 20 minutes of aerobic exercise daily was likewise organized and a healthy school environment created. Provision of clean drinking water by school authorities was ensured. Selling of soft drinks and energy-dense snacks in the school canteen as well as advertisements about soft drink and snacks on the school walls were banned. Post intervention, anthropometric indices and food selections were reassessed. Results: The results of this study reiterate the critical role of nutrition education and promotion in improving the healthier food choices by school children. It was observed that normal, overweight and obese children participating in nutrition education intervention program significantly (p≤0.05) increased their daily seasonal fruit and vegetable consumption. Fat and oil consumption was significantly reduced by overweight and obese subjects. Fast food intake was controlled by obese children. The nutrition knowledge of school children significantly improved (p≤0.05) from pre to post intervention. A highly significant increase (p≤0.00) was noted in the nutrition attitude score after intervention in all four groups. Conclusion: This study has shown that a well-planned nutrition education program could improve nutrition knowledge and promote positive changes in healthy food choices. A nutrition program inculcates wholesome eating and active life style habits in children and adolescents that could not only prevent them from chronic diseases and early death but also reduce healthcare cost and enhance the quality of life of citizens and thereby nations.

Keywords: children, eating habits healthy food, obesity, school going, fast foods

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Authors: Frederica Pettit

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Contribution: Stakeholder involvement in CSR is essential to ensuring pro-environmental attitudes and behaviours across multi-stakeholder groups. Despite increased awareness of the benefits surrounding a collaborative approach to sustainability communications, its success is limited by difficulties engaging with active online conversations with stakeholder groups. Whilst previous research defines the effectiveness of sustainability communications; this paper contributes to knowledge through the development of a theoretical framework that explores the processes to achieving pro-environmental attitudes and behaviours in stakeholder groups. The research will also consider social media as an opportunity to communicate CSR information to all stakeholder groups. Approach: A systematic review was chosen to investigate the effectiveness of the types of sustainability communications used in the hospitality and tourism industries. The systematic review was completed using Web of Science and Scopus using the search terms “sustainab* communicat*” “effective or effectiveness,” and “hospitality or tourism,” limiting the results to peer-reviewed research. 133 abstracts were initially read, with articles being excluded for irrelevance, duplicated articles, non-empirical studies, and language. A total of 45 papers were included as part of the systematic review. 5 propositions were created based on the results of the systematic review, helping to develop a theoretical framework of the processes needed for companies to encourage pro-environmental behaviours across multi-stakeholder groups. Results: The theoretical framework developed in the paper determined the processes necessary for companies to achieve pro-environmental behaviours in stakeholders. The processes to achieving pro-environmental attitudes and behaviours are stakeholder-focused, identifying the need for communications to be specific to their targeted audience. Collaborative communications that enable stakeholders to engage with CSR information and provide feedback lead to a higher awareness of CSR shared visions and pro-environmental attitudes and behaviours. These processes should also aim to improve their relationships with stakeholders through transparency of CSR, CSR strategies that match stakeholder values and ethics whilst prioritizing sustainability as part of their job role. Alternatively, companies can prioritize pro-environmental behaviours using choice editing by mainstreaming sustainability as the only option. In recent years, there has been extensive research on social media as a viable source of sustainability communications, with benefits including direct interactions with stakeholders, the ability to enforce the authenticity of CSR activities and encouragement of pro-environmental behaviours. Despite this, there are challenges to implementing CSR, including difficulties controlling stakeholder criticisms, negative stakeholder influences and comments left on social media platforms. Conclusion: A lack of engagement with CSR information is a reoccurring reason for preventing pro-environmental attitudes and behaviours across stakeholder groups. Traditional CSR strategies contribute to this due to their inability to engage with their intended audience. Hospitality and tourism companies are improving stakeholder relationships through collaborative processes which reduce single-use plastic consumption. A collaborative approach to communications can lead to stakeholder satisfaction, leading to changes in attitudes and behaviours. Different sources of communications are accessed by different stakeholder groups, identifying the need for targeted sustainability messaging, creating benefits such as direct interactions with stakeholders, the ability to enforce the authenticity of CSR activities, and encouraging engagement with sustainability information.

Keywords: hospitality, pro-environmental attitudes and behaviours, sustainability communication, social media

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Authors: Jessica J. Gillies

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Awareness of the tragedy that is human trafficking has increased exponentially over the past two decades. The four pillars widely recognised as global solutions to the problem are prevention, prosecution, protection, and partnership between government and non-government organisations. While ‘sex-trafficking’ initially received major attention, this focus has shifted to other industries that conceal broader experiences of exploitation. However, within the regions of focus for this study, namely Australia and Thailand, trafficking for the purpose of sexual exploitation remains the commonly uncovered narrative of criminal justice investigations. In these regions anti-trafficking action is characterised by government-led prevention and prosecution efforts; whereas protection and reintegration practices have received criticism. Typically, non-government organisations straddle the critical chasm between policy and practice; therefore, they are perfectly positioned to contribute valuable experiential knowledge toward understanding how both sectors can support survivors in the post-trafficking experience. The aim of this research is to inform improved partnerships throughout government and non-government post-trafficking services by illuminating gaps in protection and reintegration initiatives. This research will explore government and non-government responses to human trafficking in Thailand and Australia, in order to understand how meaning is constructed in this context and how the construction of meaning effects survivors in the post-trafficking experience. A qualitative, three-stage methodology was adopted for this study. The initial stage of enquiry consisted of a discursive analysis, in order to deconstruct the broader discourses surrounding human trafficking. The data included empirical papers, grey literature such as publicly available government and non-government reports, and anti-trafficking policy documents. The second and third stages of enquiry will attempt to further explore the findings of the discourse analysis and will focus more specifically on protection and reintegration in Australia and Thailand. Stages two and three will incorporate process observations in government and non-government survivor support services, and semi-structured interviews with employees and volunteers within these settings. Two key findings emerged from the discursive analysis. The first exposed conflicting feminist arguments embedded throughout anti-trafficking discourse. Informed by conflicting feminist discourses on sex-work, a discursive relationship has been constructed between sex-industry policy and anti-trafficking policy. In response to this finding, data emerging from the process observations and semi-structured interviews will be interpreted using a feminist theoretical framework. The second finding progresses from the construction in the first. The discursive construction of sex-trafficking appears to have had influence over perceptions of the legitimacy of survivors, and therefore the support they receive in the post-trafficking experience. For example; women who willingly migrate for employment in the sex-industry, and on arrival are faced with exploitative conditions, are not perceived to be deserving of the same support as a woman who is not coerced, but rather physically forced, into such circumstances, yet both meet the criteria for a victim of human trafficking. The forthcoming study is intended to contribute toward building knowledge and understanding around the implications of the construction of legitimacy; and contextualise this in reference to government led protection and reintegration support services for survivors in the post-trafficking experience.

Keywords: Australia, government, human trafficking, non-government, reintegration, Thailand

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Authors: Varun Kumar, Chandra Shakher

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Micro-optical components such as microlenses and microlens array have numerous engineering and industrial applications for collimation of laser diodes, imaging devices for sensor system (CCD/CMOS, document copier machines etc.), for making beam homogeneous for high power lasers, a critical component in Shack-Hartmann sensor, fiber optic coupling and optical switching in communication technology. Also micro-optical components have become an alternative for applications where miniaturization, reduction of alignment and packaging cost are necessary. The compliance with high-quality standards in the manufacturing of micro-optical components is a precondition to be compatible on worldwide markets. Therefore, high demands are put on quality assurance. For quality assurance of these lenses, an economical measurement technique is needed. For cost and time reason, technique should be fast, simple (for production reason), and robust with high resolution. The technique should provide non contact, non-invasive and full field information about the shape of micro- optical component under test. The interferometric techniques are noncontact type and non invasive and provide full field information about the shape of the optical components. The conventional interferometric technique such as holographic interferometry or Mach-Zehnder interferometry is available for characterization of micro-lenses. However, these techniques need more experimental efforts and are also time consuming. Digital holography (DH) overcomes the above described problems. Digital holographic microscopy (DHM) allows one to extract both the amplitude and phase information of a wavefront transmitted through the transparent object (microlens or microlens array) from a single recorded digital hologram by using numerical methods. Also one can reconstruct the complex object wavefront at different depths due to numerical reconstruction. Digital holography provides axial resolution in nanometer range while lateral resolution is limited by diffraction and the size of the sensor. In this paper, Mach-Zehnder based digital holographic interferometric microscope (DHIM) system is used for the testing of transparent microlenses. The advantage of using the DHIM is that the distortions due to aberrations in the optical system are avoided by the interferometric comparison of reconstructed phase with and without the object (microlens array). In the experiment, first a digital hologram is recorded in the absence of sample (microlens array) as a reference hologram. Second hologram is recorded in the presence of microlens array. The presence of transparent microlens array will induce a phase change in the transmitted laser light. Complex amplitude of object wavefront in presence and absence of microlens array is reconstructed by using Fresnel reconstruction method. From the reconstructed complex amplitude, one can evaluate the phase of object wave in presence and absence of microlens array. Phase difference between the two states of object wave will provide the information about the optical path length change due to the shape of the microlens. By the knowledge of the value of the refractive index of microlens array material and air, the surface profile of microlens array is evaluated. The Sag of microlens and radius of curvature of microlens are evaluated and reported. The sag of microlens agrees well within the experimental limit as provided in the specification by the manufacturer.

Keywords: micro-optics, microlens array, phase map, digital holographic interferometric microscopy

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Authors: Leonie Bradfield, Stephen Fityus, John Simmons

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The shearing behavior of current and planned coal mine spoil dumps up to 400m in height is studied using large-sample-high-stress direct shear tests performed on a range of spoils common to the coalfields of Eastern Australia. The motivation for the study is to address industry concerns that some constructed spoil dump heights ( > 350m) are exceeding the scale ( ≤ 120m) for which reliable design information exists, and because modern geotechnical laboratories are not equipped to test representative spoil specimens at field-scale stresses. For more than two decades, shear strength estimation for spoil dumps has been based on either infrequent, very small-scale tests where oversize particles are scalped to comply with device specimen size capacity such that the influence of prototype-sized particles on shear strength is not captured; or on published guidelines that provide linear shear strength envelopes derived from small-scale test data and verified in practice by slope performance of dumps up to 120m in height. To date, these published guidelines appear to have been reliable. However, in the field of rockfill dam design there is a broad acceptance of a curvilinear shear strength envelope, and if this is applicable to coal mine spoils, then these industry-accepted guidelines may overestimate the strength and stability of dumps at higher stress levels. The pressing need to rationally define the shearing behavior of more representative spoil specimens at field-scale stresses led to the successful design, construction and operation of a large direct shear machine (LDSM) and its subsequent application to provide reliable design information for current and planned very-high dumps. The LDSM can test at a much larger scale, in terms of combined specimen size (720mm x 720mm x 600mm) and stress (σn up to 4.6MPa), than has ever previously been achieved using a direct shear machine for geotechnical testing of rockfill. The results of an extensive LDSM testing program on a wide range of coal-mine spoils are compared to a published framework that widely accepted by the Australian coal mining industry as the standard for shear strength characterization of mine spoil. A critical outcome is that the LDSM data highlights several non-compliant spoils, and stress-dependent shearing behavior, for which the correct application of the published framework will not provide reliable shear strength parameters for design. Shear strength envelopes developed from the LDSM data are also compared with dam engineering knowledge, where failure envelopes of rockfills are curved in a concave-down manner. The LDSM data indicates that shear strength envelopes for coal-mine spoils abundant with rock fragments are not in fact curved and that the shape of the failure envelope is ultimately determined by the strength of rock fragments. Curvilinear failure envelopes were found to be appropriate for soil-like spoils containing minor or no rock fragments, or hard-soil aggregates.

Keywords: coal mine, direct shear test, high dump, large scale, mine spoil, shear strength, spoil dump

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Authors: A. Newman-Tancredi, R. Depoortère, P. Gruca, E. Litwa, M. Lason, M. Papp

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The N-methyl-D-aspartic acid (NMDA) receptor antagonist, ketamine, can elicit rapid-acting antidepressant (RAAD) effects in treatment-resistant patients, but it requires parenteral co-administration with a classical antidepressant under medical supervision. In addition, ketamine can also produce serious side effects that limit its long-term use, and there is much interest in identifying RAADs based on ketamine’s mechanism of action but with safer profiles. Ketamine elicits GABAergic interneuron inhibition, glutamatergic neuron stimulation, and, notably, activation of serotonin 5-HT1A receptors in the prefrontal cortex (PFC). Direct activation of the latter receptor subpopulation with selective ‘biased agonists’ may therefore be a promising strategy to identify novel RAADs and, consistent with this hypothesis, the prototypical cortical biased agonist, NLX-101, exhibited robust RAAD-like activity in the chronic mild stress model of depression (CMS). The present study compared the effects of a novel, selective 5-HT1A receptor-biased agonist, NLX-204, with those of ketamine and NLX-101. Materials and methods: CMS procedure was conducted on Wistar rats; drugs were administered either intraperitoneally (i.p.) or by bilateral intracortical microinjection. Ketamine: 10 mg/kg i.p. or 10 µg/side in PFC; NLX-204 and NLX-101: 0.08 and 0.16 mg/kg i.p. or 16 µg/side in PFC. In addition, interaction studies were carried out with systemic NLX-204 or NLX-101 (each at 0.16 mg/kg i.p.) in combination with intracortical WAY-100635 (selective 5-HT1A receptor antagonist; 2 µg/side) or muscimol (GABA-A receptor agonist, 12.5 ng/side). Anhedonia was assessed by CMS-induced decrease in sucrose solution consumption; anxiety-like behavior was assessed using the Elevated Plus Maze (EPM), and cognitive impairment was assessed by the Novel Object Recognition (NOR) test. Results: A single administration of NLX-204 was sufficient to reverse the CMS-induced deficit in sucrose consumption, similarly to ketamine and NLX-101. NLX-204 also reduced CMS-induced anxiety in the EPM and abolished CMS-induced NOR deficits. These effects were maintained (EPM and NOR) or enhanced (sucrose consumption) over a subsequent 2-week period of treatment. The anti-anhedonic response of the drugs was also maintained for several weeks Following treatment discontinuation, suggesting that they had sustained effects on neuronal networks. A single PFC administration of NLX-204 reversed deficient sucrose consumption, similarly to ketamine and NLX-101. Moreover, the anti-anhedonic activities of systemic NLX-204 and NLX 101 were abolished by coadministration with intracortical WAY-100635 or muscimol. Conclusions: (i) The antidepressant-like activity of NLX-204 in the rat CMS model was as rapid as that of ketamine or NLX-101, supporting targeting cortical 5-HT1A receptors with selective, biased agonists to achieve RAAD effects. (ii)The anti-anhedonic activity of systemic NLX-204 was mimicked by local administration of the compound in the PFC, confirming the involvement of cortical circuits in its RAAD-like effects. (iii) Notably, the effects of systemic NLX-204 and NLX-101 were abolished by PFC administration of muscimol, indicating that they act by (indirectly) eliciting a reduction in cortical GABAergic neurotransmission. This is consistent with ketamine’s mechanism of action and suggests that there are converging NMDA and 5-HT1A receptor signaling cascades in PFC underlying the RAAD-like activities of ketamine and NLX-204. Acknowledgements: The study was financially supported by NCN grant no. 2019/35/B/NZ7/00787.

Keywords: depression, ketamine, serotonin, 5-HT1A receptor, chronic mild stress

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Authors: Sini George

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Active learning pedagogies are valued for their success in increasing 21st-century learners’ engagement, developing transferable skills like critical thinking or quantitative reasoning, and creating deeper and more lasting educational gains. 'Blended learning' is an active learning pedagogical approach in which direct instruction moves from the group learning space to the individual learning space, and the resulting group space is transformed into a dynamic, interactive learning environment where the educator guides students as they apply concepts and engage creatively in the subject matter. This project aimed to develop a blended learning instructional approach to teaching concepts around pharmaceutical calculations to year 1 pharmacy students. The wrong dose, strength or frequency of a medication accounts for almost a third of medication errors in the NHS therefore, progression to year 2 requires a 70% pass in this calculation test, in addition to the standard progression requirements. Many students were struggling to achieve this requirement in the past. It was also challenging to teach these concepts to students of a large class (> 130) with mixed mathematical abilities, especially within a traditional didactic lecture format. Therefore, short screencasts with voice-over of the lecturer were provided in advance of a total of four teaching sessions (two hours/session), incorporating core content of each session and talking through how they approached the calculations to model metacognition. Links to the screencasts were posted on the learning management. Viewership counts were used to determine that the students were indeed accessing and watching the screencasts on schedule. In the classroom, students had to apply the knowledge learned beforehand to a series of increasingly difficult set of questions. Students were then asked to create a question in group settings (two students/group) and to discuss the questions created by their peers in their groups to promote deep conceptual learning. Students were also given time for question-and-answer period to seek clarifications on the concepts covered. Student response to this instructional approach and their test grades were collected. After collecting and organizing the data, statistical analysis was carried out to calculate binomial statistics for the two data sets: the test grade for students who received blended learning instruction and the test grades for students who received instruction in a standard lecture format in class, to compare the effectiveness of each type of instruction. Student response and their performance data on the assessment indicate that the learning of content in the blended learning instructional approach led to higher levels of student engagement, satisfaction, and more substantial learning gains. The blended learning approach enabled each student to learn how to do calculations at their own pace freeing class time for interactive application of this knowledge. Although time-consuming for an instructor to implement, the findings of this research demonstrate that the blended learning instructional approach improves student academic outcomes and represents a valuable method to incorporate active learning methodologies while still maintaining broad content coverage. Satisfaction with this approach was high, and we are currently developing more pharmacy content for delivery in this format.

Keywords: active learning, blended learning, deep conceptual learning, instructional approach, metacognition, pharmaceutical calculations

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Authors: Ricardo Alberto Chiong Zevallos, Eduardo Moraes Rego Reis

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Pancreatic adenocarcinoma (PDAC) patients have a less than 10% 5-year survival rate. PDAC has no defined diagnostic and prognostic biomarkers. Gemcitabine is the first-line drug in PDAC and several other cancers. Long non-coding RNAs (lncRNAs) contribute to the tumorigenesis and are potential biomarkers for PDAC. Although lncRNAs aren’t translated into proteins, they have important functions. LncRNAs can decoy or recruit proteins from the epigenetic machinery, act as microRNA sponges, participate in protein translocation through different cellular compartments, and even promote chemoresistance. The chromatin remodeling enzyme EZH2 is a histone methyltransferase that catalyzes the methylation of histone 3 at lysine 27, silencing local expression. EZH2 is ambivalent, it can also activate gene expression independently of its histone methyltransferase activity. EZH2 is overexpressed in several cancers and interacts with lncRNAs, being recruited to a specific locus. EZH2 can be recruited to activate an oncogene or silence a tumor suppressor. The lncRNAs misregulation in cancer can result in the differential recruitment of EZH2 and in a distinct epigenetic landscape, promoting chemoresistance. The relevance of the EZH2-lncRNAs interaction to chemoresistant PDAC was assessed by Real Time quantitative PCR (RT-qPCR) and RNA Immunoprecipitation (RIP) experiments with naïve and gemcitabine-resistant PDAC cells. The expression of several lncRNAs and EZH2 gene targets was evaluated contrasting naïve and resistant cells. Selection of candidate genes was made by bioinformatic analysis and literature curation. Indeed, the resistant cell line showed higher expression of chemoresistant-associated lncRNAs and protein coding genes. RIP detected lncRNAs interacting with EZH2 with varying intensity levels in the cell lines. During RIP, the nuclear fraction of the cells was incubated with an antibody for EZH2 and with magnetic beads. The RNA precipitated with the beads-antibody-EZH2 complex was isolated and reverse transcribed. The presence of candidate lncRNAs was detected by RT-qPCR, and the enrichment was calculated relative to INPUT (total lysate control sample collected before RIP). The enrichment levels varied across the several lncRNAs and cell lines. The EZH2-lncRNA interaction might be responsible for the regulation of chemoresistance-associated genes in multiple cancers. The relevance of the lncRNA-EZH2 interaction to PDAC was assessed by siRNA knockdown of a lncRNA, followed by the analysis of the EZH2 target expression by RT-qPCR. The chromatin immunoprecipitation (ChIP) of EZH2 and H3K27me3 followed by RT-qPCR with primers for EZH2 targets also assess the specificity of the EZH2 recruitment by the lncRNA. This is the first report of the interaction of EZH2 and lncRNAs HOTTIP and PVT1 in chemoresistant PDAC. HOTTIP and PVT1 were described as promoting chemoresistance in several cancers, but the role of EZH2 is not clarified. For the first time, the lncRNA LINC01133 was detected in a chemoresistant cancer. The interaction of EZH2 with LINC02577, LINC00920, LINC00941, and LINC01559 have never been reported in any context. The novel lncRNAs-EZH2 interactions regulate chemoresistant-associated genes in PDAC and might be relevant to other cancers. Therapies targeting EZH2 alone weren’t successful, and a combinatorial approach also targeting the lncRNAs interacting with it might be key to overcome chemoresistance in several cancers.

Keywords: epigenetics, chemoresistance, long non-coding RNAs, pancreatic cancer, histone modification

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Authors: Teresa Wanjiru Mbatia

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On 7th June 2011, the government Minister of Roads in Kenya announced the proposed construction of a major highway known as a southern bypass to run on the northern border of the Nairobi National Park. The following day on 8th June 2011, the chairperson of the Friends of Nairobi National Park (FONNAP) posted a protest statement on their website, with the heading, ‘Nairobi Park is Not a cake’ alerting its members and conservation groups, with the aim of getting support to the campaign against the government’s intention to hive off a section of the park for road construction. This was the first and earliest statement that led to a series of other events that culminated in conservationists and some other members of the public campaign against the government’s plan to hive off sections of the park to build road and railway infrastructure in or around the park. Together with other non-state actors, mostly non-governmental organisations in conservation/environment and tourism businesses, FoNNAP issued a series of other statements on social, print and electronic media to battle against road and railway construction. This paper examined the strategies, outcomes and interests of actors involved in opposing/proposing the development of transport infrastructure in and around the Nairobi National Park. Specifically, the objectives were to analyse the: (1) Arguments put forward by the eco-warriors to protest infrastructure development; (2) Background and interests of the eco-warriors; (3) Needs/interests and opinions of ordinary common citizens on transport infrastructural development, particularly in and around the urban nature reserve and (4) Final outcomes of the eco-politics surrounding infrastructure development in and around Nairobi National Park. The methodological approach used was environmental history and the social construction of nature. The study collected combined qualitative data using four main approaches, the grounded theory approach, narratives, case studies and a phenomenological approach. The information collected was analysed using critical discourse analysis. The major findings of the study were that under the guise of “public participation,” influential non-state actors have the capacity to perpetuate social-spatial inequalities in the form of curtailing the majority from accessing common public goods. A case in point in this study is how the efforts of powerful conservationists, environmentalists, and tourism businesspersons managed to stall the construction of much-needed road and railway infrastructure severally through litigations in lengthy environmental court processes involving injunctions and stop orders to the government bodies in charge. Moreover, powerful non-state actors were found to have formed informal and sometimes formal coalitions with politicians with selfish interests, which serves to deepen the exclusionary practices and the common good. The study concludes that mostly composed of certain types of elites (NGOs, business communities, politicians and privileged social-cultural groups), non-state actors have used participatory policies to advance their own interests at the expense of the majority whom they claim to represent. These practices are traced to the historically unjust social, political, and economic forces involved in the production of space in Nairobi.

Keywords: eco-politics, exclusion, infrastructure, Nairobi national park, non-state actors, protests

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Authors: V. Jayanthi

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Urbanization and pace of urbanization have increased tremendously in last few decades. More towns are now getting converted into cities. Urbanization trend is seen all over the world but is becoming most dominant in Asia. Today, the scale of urbanization in India is so huge that Indian cities are among the fastest-growing in the world, including Bangalore, Hyderabad, Pune, Chennai, Delhi, and Mumbai. Urbanization remains a single predominant factor that is continuously linked to the destruction of urban green spaces. With reference to Chennai as a case study, which is suffering from rapid deterioration of its green spaces, this paper sought to fill this gap by exploring key factors aside urbanization that is responsible for the destruction of green spaces. The paper relied on a research approach and triangulated data collection techniques such as interviews, focus group discussion, personal observation and retrieval of archival data. It was observed that apart from urbanization, problem of ownership of green space lands, low priority to green spaces, poor maintenance, enforcement of development controls, wastage of underpass spaces, and uncooperative attitudes of the general public, play a critical role in the destruction of urban green spaces. Therefore the paper narrows down to a point, that for a city to have a proper sustainable urban green space, broader city development plans are essential. Though rapid urbanization is an indicator of positive development, it is also accompanied by a host of challenges. Chennai lost a lot of greenery, as the city urbanized rapidly that led to a steep fall in vegetation cover. Environmental deterioration will be the big price we pay if Chennai continues to grow at the expense of greenery. Soaring skyscrapers, multistoried complexes, gated communities, and villas, frame the iconic skyline of today’s Chennai city which reveals that we overlook the importance of our green cover, which is important to balance our urban and lung spaces. Chennai, with a clumped landscape at the center of the city, is predicted to convert 36% of its total area into urban areas by 2026. One major issue is that a city designed and planned in isolation creates underused spaces all around the cities which are of negligence. These urban voids are dead, underused, unused spaces in the cities that are formed due to inefficient decision making, poor land management, and poor coordination. Urban voids have huge potential of creating a stronger urban fabric, exploited as public gathering spaces, pocket parks or plazas or just enhance public realm, rather than dumping of debris and encroachments. Flyovers need to justify their existence themselves by being more than just traffic and transport solutions. The vast, unused space below the Kathipara flyover is a case in point. This flyover connects three major routes: Tambaram, Koyambedu, and Adyar. This research will focus on the concept of urban voids, how these voids under the flyovers, can be used for place making process, how this space beneath flyovers which are neglected, can be a part of the urban realm through urban design and landscaping.

Keywords: landscape design, flyovers, public spaces, reclaiming lost spaces, urban voids

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Authors: Mikaela Kutrolli, Noah S. Pereira, Vanessa Scanlon, Mohamadmahdi Samandari, Ali Tamayol

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Bone tissue engineering has drawn significant attention and various biomaterials have been tested. Polymers such as polycaprolactone (PCL) offer excellent biocompatibility, reasonable mechanical properties, and biodegradability. However, PCL scaffolds suffer a critical drawback: a lack of micro/mesoporosity, affecting cell attachment, tissue integration, and mineralization. It also results in a slow degradation rate. While 3D-printing has addressed the issue of macroporosity through CAD-guided fabrication, PCL scaffolds still exhibit poor smaller-scale porosity. To overcome this, we generated composites of PCL, hydroxyapatite (HA), and powdered sucrose (PS). The latter serves as a sacrificial material to generate porous particles after sucrose dissolution. Additionally, we have incorporated dexamethasone (DEX) to boost the PCL osteogenic properties. The resulting scaffolds maintain controlled macroporosity from the lattice print structure but also develop micro/mesoporosity within PCL fibers when exposed to aqueous environments. The study involved mixing PS into solvent-dissolved PCL in different weight ratios of PS to PCL (70:30, 50:50, and 30:70 wt%). The resulting composite was used for 3D printing of scaffolds at room temperature. Printability was optimized by adjusting pressure, speed, and layer height through filament collapse and fusion test. Enzymatic degradation, porogen leaching, and DEX release profiles were characterized. Physical properties were assessed using wettability, SEM, and micro-CT to quantify the porosity (percentage, pore size, and interconnectivity). Raman spectroscopy was used to verify the absence of sugar after leaching. Mechanical characteristics were evaluated via compression testing before and after porogen leaching. Bone marrow stromal cells (BMSCs) behavior in the printed scaffolds was studied by assessing viability, metabolic activity, osteo-differentiation, and mineralization. The scaffolds with a 70% sugar concentration exhibited superior printability and reached the highest porosity of 80%, but performed poorly during mechanical testing. A 50% PS concentration demonstrated a 70% porosity, with an average pore size of 25 µm, favoring cell attachment. No trace of sucrose was found in Raman after leaching the sugar for 8 hours. Water contact angle results show improved hydrophilicity as the sugar concentration increased, making the scaffolds more conductive to cell adhesion. The behavior of bone marrow stromal cells (BMSCs) showed positive viability and proliferation results with an increasing trend of mineralization and osteo-differentiation as the sucrose concentration increased. The addition of HA and DEX also promoted mineralization and osteo-differentiation in the cultures. The integration of PS as porogen at a concentration of 50%wt within PCL scaffolds presents a promising approach to address the poor cell attachment and tissue integration issues of PCL in bone tissue engineering. The method allows for the fabrication of scaffolds with tunable porosity and mechanical properties, suitable for various applications. The addition of HA and DEX further enhanced the scaffolds. Future studies will apply the scaffolds in an in-vivo model to thoroughly investigate their performance.

Keywords: bone, PCL, 3D printing, tissue engineering

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Authors: Yogesh Kumar Singh, T. S. Murugesh Prabhu, Upasana Dutta, Girishchandra Yendargaye, Rahul Yadav, Rohini Gopinath Kale, Binay Kumar, Manoj Khare

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The Indian subcontinent is severely affected by floods that cause intense irreversible devastation to crops and livelihoods. With increased incidences of floods and their related catastrophes, an Early Warning System for Flood Prediction and an efficient Flood Management System for the river basins of India is a must. Accurately modeled hydrological conditions and a web-based early warning system may significantly reduce economic losses incurred due to floods and enable end users to issue advisories with better lead time. This study describes the design and development of an EWS-FP using advanced computational tools/methods, viz. High-Performance Computing (HPC), Remote Sensing, GIS technologies, and open-source tools for the Mahanadi River Basin of India. The flood prediction is based on a robust 2D hydrodynamic model, which solves shallow water equations using the finite volume method. Considering the complexity of the hydrological modeling and the size of the basins in India, it is always a tug of war between better forecast lead time and optimal resolution at which the simulations are to be run. High-performance computing technology provides a good computational means to overcome this issue for the construction of national-level or basin-level flash flood warning systems having a high resolution at local-level warning analysis with a better lead time. High-performance computers with capacities at the order of teraflops and petaflops prove useful while running simulations on such big areas at optimum resolutions. In this study, a free and open-source, HPC-based 2-D hydrodynamic model, with the capability to simulate rainfall run-off, river routing, and tidal forcing, is used. The model was tested for a part of the Mahanadi River Basin (Mahanadi Delta) with actual and predicted discharge, rainfall, and tide data. The simulation time was reduced from 8 hrs to 3 hrs by increasing CPU nodes from 45 to 135, which shows good scalability and performance enhancement. The simulated flood inundation spread and stage were compared with SAR data and CWC Observed Gauge data, respectively. The system shows good accuracy and better lead time suitable for flood forecasting in near-real-time. To disseminate warning to the end user, a network-enabled solution is developed using open-source software. The system has query-based flood damage assessment modules with outputs in the form of spatial maps and statistical databases. System effectively facilitates the management of post-disaster activities caused due to floods, like displaying spatial maps of the area affected, inundated roads, etc., and maintains a steady flow of information at all levels with different access rights depending upon the criticality of the information. It is designed to facilitate users in managing information related to flooding during critical flood seasons and analyzing the extent of the damage.

Keywords: flood, modeling, HPC, FOSS

Procedia PDF Downloads 68

Authors: Luciano Tarantino

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Gas gangrene is a rare, severe infection with a very high mortality rate caused by Clostridium species. The infection causes a non-suppurative localized producing gas lesion from which harmful toxins that impair the inflammatory response cause vessel damage and multiple organ failure. Gas gangrene of the liver is very rare and develops suddenly, often as a complication of abdominal surgery and liver transplantation. The present paper deals with a case of gas gangrene of the liver that occurred after percutaneous MW ablation of hepatocellular carcinoma, resulting in progressive liver necrosis and multi-organ failure in spite of specific antibiotics administration. The patient was successfully treated with percutaneous Radiofrequency ablation. Case report: Female, 76 years old, Child A class cirrhosis, treated with synchronous insertion of 3 MW antennae for large HCC (5.5 cm) in the VIII segment. 24 hours after treatment, the patient was asymptomatic and left the hospital . 2 days later, she complained of fever, weakness, abdominal swelling, and pain. Abdominal US detected a 2.3 cm in size gas-containing area, eccentric within the large (7 cm) ablated area. The patient was promptly hospitalized with the diagnosis of anaerobic liver abscess and started antibiotic therapy with Imipenem/cilastatine+metronidazole+teicoplanine. On the fourth day, the patient was moved to the ICU because of dyspnea, congestive heart failure, atrial fibrillation, right pleural effusion, ascites, and renal failure. Blood tests demonstrated severe leukopenia and neutropenia, anemia, increased creatinine and blood nitrogen, high-level FDP, and high INR. Blood cultures were negative. At US, unenhanced CT, and CEUS, a progressive enlargement of the infected liver lesion was observed. Percutaneous drainage was attempted, but only drops of non-suppurative brownish material could be obtained. Pleural and peritoneal drainages gave serosanguineous muddy fluid. The Surgeon and the Anesthesiologist excluded any indication of surgical resection because of the high perioperative mortality risk. Therefore, we asked for the informed consent of the patient and her relatives to treat the gangrenous liver lesion by percutaneous Ablation. Under conscious sedation, percutaneous RFA of GG was performed by double insertion of 3 cool-tip needles (Covidien LDT, USA ) into the infected area. The procedure was well tolerated by the patient. A dramatic improvement in the patient's condition was observed in the subsequent 24 hours and thereafter. Fever and dyspnea disappeared. Normalization of blood tests, including creatinine, was observed within 4 days. Heart performance improved, 10 days after the RFA the patient left the hospital and was followed-up with weekly as an outpatient for 2 months and every two months thereafter. At 18 months follow-up, the patient is well compensated (Child-Pugh class B7), without any peritoneal or pleural effusion and without any HCC recurrence at imaging (US every 3 months, CT every 6 months). Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients non-responder to antibiotics and when surgery and liver transplantation are not feasible. A fast and early indication is needed in case of rapid worsening of patient's conditions.

Keywords: liver tumor ablation, interventional ultrasound, liver infection, gas gangrene, radiofrequency ablation

Procedia PDF Downloads 51

Authors: Mukondi Esther Nethavhakone

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In 2020 World Health Organization announced the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as Coronavirus disease 2019 (COVID-19) pandemic. To curb or contain the spread of the novel coronavirus (COVID 19), global governments implemented social distancing and lockdown regulations. Subsequently, it was no longer business as per usual, life as we knew it had changed, and so many aspects of people's lives were negatively affected, including financial and employment stability. Mainly, because companies/businesses had to put their operations on hold, some had to shut down completely, resulting in the loss of income for many people globally. Finances and employment insecurities are some of the issues that exacerbated many social issues that the world was already faced with, such as school drop-outs, teenage pregnancies, sexual assaults, gender-based violence, crime, child abuse, elderly abuse, to name a few. Expectedly the majority of the population's mental health state was threatened. This resulted in an increased number of people seeking mental healthcare services. The increasing need for mental healthcare services in Low and Middle-income countries proves to be a challenge because it is a well-known fact due to financial constraints and not well-established healthcare systems, mental healthcare provision is not as prioritised as the primary healthcare in these countries. It is against this backdrop that the researcher seeks to find viable, cost-effective, and accessible mental health solutions for low and middle-income countries amid the pressures of any pandemic. The researcher will undertake a systematic review of the technology-based mental health solutions that have been implemented/adopted by developed countries during COVID 19 lockdown and social distancing periods. This systematic review study aims to determine if low and middle-income countries can adopt the cost-effective version of digital mental health solutions for the healthcare system to adequately provide mental healthcare services during critical times such as pandemics (when there's an overwhelming diminish in mental health globally). The researcher will undertake a systematic review study through mixed methods. It will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The mixed-methods uses findings from both qualitative and quantitative studies in one review study. It will be beneficial to conduct this kind of study using mixed methods because it is a public health topic that involves social interventions and it is not purely based on medical interventions. Therefore, the meta-ethnographic (qualitative data) analysis will be crucial in understanding why and which digital methods work and for whom does it work, rather than only the meta-analysis (quantitative data) providing what digital mental health methods works. The data collection process will be extensive, involving the development of a database, table of summary of evidence/findings, and quality assessment process lastly, The researcher will ensure that ethical procedures are followed and adhered to, ensuring that sensitive data is protected and the study doesn't pose any harm to the participants.

Keywords: digital, mental health, covid, low and middle-income countries

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Authors: Sahar Yousef, Chantelle Niblock, Gul Kacmaz

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Salt City, in the context of Jordan’s heritage landscape, is a significant case to explore when it comes to the interaction between tangible and intangible qualities of liveable cities. Most city centers, including Jerash, Salt, Irbid, and Amman, are historical locations. Six of these extraordinary sites were designated UNESCO World Heritage Sites. Jordan is widely acknowledged as a developing country characterized by swift urbanization and unrestrained expansion that exacerbate the challenges associated with the preservation of historic urban areas. The aim of this study is to conduct an examination and analysis of the existing condition of heritage connectivity within heritage city centers. This includes outdoor staircases, pedestrian pathways, footpaths, and other public spaces. Case study-style analysis of the urban core of As-Salt is the focus of this investigation. Salt City is widely acknowledged for its substantial tangible and intangible cultural heritage and has been designated as ‘The Place of Tolerance and Urban Hospitality’ by UNESCO since 2021. Liveability in urban heritage, particularly in historic city centers, incorporates several factors that affect our well-being; its enhancement is a critical issue in contemporary society. The dynamic interaction between humans and historical materials, which serves as a vehicle for the expression of their identity and historical narrative, constitutes preservation that transcends simple conservation. This form of engagement enables people to appreciate the diversity of their heritage recognising their previous and planned futures. Heritage preservation is inextricably linked to a larger physical and emotional context; therefore, it is difficult to examine it in isolation. Urban environments, including roads, structures, and other infrastructure, are undergoing unprecedented physical design and construction requirements. Concurrently, heritage reinforces a sense of affiliation with a particular location or space and unifies individuals with their ancestry, thereby defining their identity. However, a considerable body of research has focused on the conservation of heritage buildings in a fragmented manner without considering their integration within a holistic urban context. Insufficient attention is given to the significance of the physical and social roles played by the heritage staircases and baths that serve as connectors between these valued historical buildings. In doing so, the research uses a methodology that is based on consensus. Given that liveability is considered a complex matter with several dimensions. The discussion starts by making initial observations on the physical context and societal norms inside the urban center while simultaneously establishing the definitions of liveability and connectivity and examining the key criteria associated with these concepts. Then, identify the key elements that contribute to liveable connectivity within the framework of urban heritage in Jordanian city centers. Some of the outcomes that will be discussed in the presentation are: (1) There is not enough connectivity between heritage buildings as can be seen, for example, between buildings in Jada and Qala'. (2) Most of the outdoor spaces suffer from physical issues that hinder their use by the public, like in Salalem. (3) Existing activities in the city center are not well attended because of lack of communication between the organisers and the citizens.

Keywords: connectivity, Jordan, liveability, salt city, tangible and intangible heritage, urban heritage

Procedia PDF Downloads 37

Authors: Helen S. Joyner (Melito), Mohammad Anvari

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Concentrated emulsions stabilized by proteins are systems of great importance in food, pharmaceutical and cosmetic products. Controlling emulsion rheology is critical for ensuring desired properties during formation, storage, and consumption of emulsion-based products. Studies on concentrated emulsions have focused on rheology of monodispersed systems. However, emulsions used for industrial applications are polydispersed in nature, and this polydispersity is regarded as an important parameter that also governs the rheology of the concentrated emulsions. Therefore, the objective of this study was to characterize rheological (small and large deformation behaviors) and microstructural properties of concentrated emulsions which were not truly monodispersed as usually encountered in food products such as margarines, mayonnaise, creams, spreads, and etc. The concentrated emulsions were prepared at different concentrations of fish gelatin (0.2, 0.4, 0.8% w/v in the whole emulsion system), oil-water ratio 80-20 (w/w), homogenization speed 10000 rpm, and 25oC. Confocal laser scanning microscopy (CLSM) was used to determine the microstructure of the emulsions. To prepare samples for CLSM analysis, FG solutions were stained by Fluorescein isothiocyanate dye. Emulsion viscosity profiles were determined using shear rate sweeps (0.01 to 100 1/s). The linear viscoelastic regions (LVRs) of the emulsions were determined using strain sweeps (0.01 to 100% strain) for each sample. Frequency sweeps were performed in the LVR (0.1% strain) from 0.6 to 100 rad/s. Large amplitude oscillatory shear (LAOS) testing was conducted by collecting raw waveform data at 0.05, 1, 10, and 100% strain at 4 different frequencies (0.5, 1, 10, and 100 rad/s). All measurements were performed in triplicate at 25oC. The CLSM results revealed that increased fish gelatin concentration resulted in more stable oil-in-water emulsions with homogeneous, finely dispersed oil droplets. Furthermore, the protein concentration had a significant effect on emulsion rheological properties. Apparent viscosity and dynamic moduli at small deformations increased with increasing fish gelatin concentration. These results were related to increased inter-droplet network connections caused by increased fish gelatin adsorption at the surface of oil droplets. Nevertheless, all samples showed shear-thinning and weak gel behaviors over shear rate and frequency sweeps, respectively. Lissajous plots, or plots of stress versus strain, and phase lag values were used to determine nonlinear behavior of the emulsions in LAOS testing. Greater distortion in the elliptical shape of the plots followed by higher phase lag values was observed at large strains and frequencies in all samples, indicating increased nonlinear behavior. Shifts from elastic-dominated to viscous dominated behavior were also observed. These shifts were attributed to damage to the sample microstructure (e.g. gel network disruption), which would lead to viscous-type behaviors such as permanent deformation and flow. Unlike the small deformation results, the LAOS behavior of the concentrated emulsions was not dependent on fish gelatin concentration. Systems with different microstructures showed similar nonlinear viscoelastic behaviors. The results of this study provided valuable information that can be used to incorporate concentrated emulsions in emulsion-based food formulations.

Keywords: concentrated emulsion, fish gelatin, microstructure, rheology

Procedia PDF Downloads 253

Authors: Ishita Singh

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Social-dimension of Climate Change is no longer peripheral to Science, Technology and Innovation (STI). Indeed, STI is being mobilized to address small farmers’ vulnerability and adaptation to Climate Change. The experiences from the cold desert of Leh (Ladakh) in North-West Himalaya illustrate the potential of STI to address the challenges of Climate Change and the needs of small farmers through the use of Artificial Glacier Techniques. Small farmers have a unique technique of water harvesting to augment irrigation, called “Artificial Glaciers” - an intricate network of water channels and dams along the upper slope of a valley that are located closer to villages and at lower altitudes than natural glaciers. It starts to melt much earlier and supplements additional irrigation to small farmers’ improving their livelihoods. Therefore, the issue of vulnerability, adaptive capacity and adaptation strategy needs to be analyzed in a local context and the communities as well as regions where people live. Leh (Ladakh) in North-West Himalaya provides a Case Study for exploring the ways in which adaptation to Climate Change is taking place at a community scale using Artificial Glacier Technology. With the above backdrop, an attempt has been made to analyze the rural poor households' vulnerability and adaptation practices to Climate Change using this technology, thereby drawing lessons on vulnerability-livelihood interactions in the cold desert of Leh (Ladakh) in North-West Himalaya, India. The study is based on primary data and information collected from 675 households confined to 27 villages of Leh (Ladakh) in North-West Himalaya, India. It reveals that 61.18% of the population is driving livelihoods from agriculture and allied activities. With increased irrigation potential due to the use of Artificial Glaciers, food security has been assured to 77.56% of households and health vulnerability has been reduced in 31% of households. Seasonal migration as a livelihood diversification mechanism has declined in nearly two-thirds of households, thereby improving livelihood strategies. Use of tactical adaptations by small farmers in response to persistent droughts, such as selling livestock, expanding agriculture lands, and use of relief cash and foods, have declined to 20.44%, 24.74% and 63% of households. However, these measures are unsustainable on a long-term basis. The role of policymakers and societal stakeholders becomes important in this context. To address livelihood challenges, the role of technology is critical in a multidisciplinary approach involving multilateral collaboration among different stakeholders. The presence of social entrepreneurs and new actors on the adaptation scene is necessary to bring forth adaptation measures. Better linkage between Science and Technology policies, together with other policies, should be encouraged. Better health care, access to safe drinking water, better sanitary conditions, and improved standards of education and infrastructure are effective measures to enhance a community’s adaptive capacity. However, social transfers for supporting climate adaptive capacity require significant amounts of additional investment. Developing institutional mechanisms for specific adaptation interventions can be one of the most effective ways of implementing a plan to enhance adaptation and build resilience.

Keywords: climate change, adaptation, livelihood, stakeholders

Procedia PDF Downloads 37

Authors: Devin Doos, Ashley Hughes, Trang Pham, Paul Barach, Rami Ahmed

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Over 115,000 Health Care Workers (HCWs) have died from COVID-19, and millions have been infected while caring for patients. HCWs have filed thousands of safety complaints surrounding safety concerns due to Personal Protective Equipment (PPE) shortages, which included concerns around inadequate and PPE reuse. Protocols for donning and doffing PPE remain ambiguous, lacking an evidence-base, and often result in wide deviations in practice. PPE donning and doffing protocol deviations commonly result in self-contamination but have not been thoroughly addressed. No evidence-driven protocols provide guidance on protecting HCW during periods of PPE reuse. Objective: The aim of this study was to examine safety-related threats and risks to Health Care Workers (HCWs) due to the reuse of PPE among Emergency Department personnel. Method: We conducted a prospective observational study to examine the risks of reusing PPE. First, ED personnel were asked to don and doff PPE in a simulation lab. Each participant was asked to don and doff PPE five times, according to the maximum reuse recommendation set by the Centers for Disease Control and Prevention (CDC). Each participant was videorecorded; video recordings were reviewed and coded independently by at least 2 of the 3trained coders for safety behaviors and riskiness of actions. A third coder was brought in when the agreement between the 2 coders could not be reached. Agreement between coders was high (81.9%), and all disagreements (100%) were resolved via consensus. A bowtie risk assessment chart was constructed analyzing the factors that contribute to increased risks HCW are faced with due to PPE use and reuse. Agreement amongst content experts in the field of Emergency Medicine, Human Factors, and Anesthesiology was used to select aspects of health care that both contribute and mitigate risks associated with PPE reuse. Findings: Twenty-eight clinician participants completed five rounds of donning/doffing PPE, yielding 140 PPE donning/doffing sequences. Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE materials. 100% of participants (n= 28) deviated from the CDC recommended order, and most participants (92.85%, n=26) self-contaminated at least once during reuse. Other frequent errors included failure to tie all ties on the PPE (92.85%, n=26) and failure to wash hands after a contamination event occurred (39.28%, n=11). Conclusions: There is wide variation and regular errors in how HCW don and doffPPE while including in reusing PPE that led to self-contamination. Some errors were deemed “recoverable”, such as hand washing after touching a patient-facing surface to remove the contaminant. Other errors, such as using a contaminated mask and accidentally spreading to the neck and face, can lead to compound risks that are unique to repeated PPE use. A more comprehensive understanding of the contributing threats to HCW safety and complete approach to mitigating underlying risks, including visualizing with risk management toolsmay, aid future PPE designand workflow and space solutions.

Keywords: bowtie analysis, health care, PPE reuse, risk management

Procedia PDF Downloads 62

Authors: Adriana Haulica

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Powered by Machine Learning, Precise medicine is tailored by now to use genetic and molecular profiling, with the aim of optimizing the therapeutic benefits for cohorts of patients. As the majority of Machine Language algorithms come from heuristics, the outputs have contextual validity. This is not very restrictive in the sense that medicine itself is not an exact science. Meanwhile, the progress made in Molecular Biology, Bioinformatics, Computational Biology, and Precise Medicine, correlated with the huge amount of human biology data and the increase in computational power, opens new healthcare challenges. A more accurate diagnosis is needed along with real-time treatments by processing as much as possible from the available information. The purpose of this paper is to present a deeper vision for the future of Artificial Intelligence in Precise medicine. In fact, actual Machine Learning algorithms use standard mathematical knowledge, mostly Euclidian metrics and standard computation rules. The loss of information arising from the classical methods prevents obtaining 100% evidence on the diagnosis process. To overcome these problems, we introduce MEDICOMPILLS, a new architectural concept tool of information processing in Precise medicine that delivers diagnosis and therapy advice. This tool processes poly-field digital resources: global knowledge related to biomedicine in a direct or indirect manner but also technical databases, Natural Language Processing algorithms, and strong class optimization functions. As the name suggests, the heart of this tool is a compiler. The approach is completely new, tailored for omics and clinical data. Firstly, the intrinsic biological intuition is different from the well-known “a needle in a haystack” approach usually used when Machine Learning algorithms have to process differential genomic or molecular data to find biomarkers. Also, even if the input is seized from various types of data, the working engine inside the MEDICOMPILLS does not search for patterns as an integrative tool. This approach deciphers the biological meaning of input data up to the metabolic and physiologic mechanisms, based on a compiler with grammars issued from bio-algebra-inspired mathematics. It translates input data into bio-semantic units with the help of contextual information iteratively until Bio-Logical operations can be performed on the base of the “common denominator “rule. The rigorousness of MEDICOMPILLS comes from the structure of the contextual information on functions, built to be analogous to mathematical “proofs”. The major impact of this architecture is expressed by the high accuracy of the diagnosis. Detected as a multiple conditions diagnostic, constituted by some main diseases along with unhealthy biological states, this format is highly suitable for therapy proposal and disease prevention. The use of MEDICOMPILLS architecture is highly beneficial for the healthcare industry. The expectation is to generate a strategic trend in Precise medicine, making medicine more like an exact science and reducing the considerable risk of errors in diagnostics and therapies. The tool can be used by pharmaceutical laboratories for the discovery of new cures. It will also contribute to better design of clinical trials and speed them up.

Keywords: bio-semantic units, multiple conditions diagnosis, NLP, omics

Procedia PDF Downloads 48

Authors: Adam J. Bowen

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Abstract— Should robots have rights or legal protections. Often debates concerning whether robots and AI should be afforded rights focus on conditions of personhood and the possibility of future advanced forms of AI satisfying particular intrinsic cognitive and moral attributes of rights-holding persons. Such discussions raise compelling questions about machine consciousness, autonomy, and value alignment with human interests. Although these are important theoretical concerns, especially from a future design perspective, they provide limited guidance for addressing the moral and legal standing of current and near-term AI that operate well below the cognitive and moral agency of human persons. Robots and AI are already being pressed into service in a wide range of roles, especially in healthcare and biomedical contexts. The design and large-scale implementation of robots in the context of core societal institutions like healthcare systems continues to rapidly develop. For example, we bring them into our homes, hospitals, and other care facilities to assist in care for the sick, disabled, elderly, children, or otherwise vulnerable persons. We enlist surgical robotic systems in precision tasks, albeit still human-in-the-loop technology controlled by surgeons. We also entrust them with social roles involving companionship and even assisting in intimate caregiving tasks (e.g., bathing, feeding, turning, medicine administration, monitoring, transporting). There have been advances to enable severely disabled persons to use robots to feed themselves or pilot robot avatars to work in service industries. As the applications for near-term AI increase and the roles of robots in restructuring our biomedical practices expand, we face pressing questions about the normative implications of human-robot interactions and collaborations in our collective worldmaking, as well as the moral and legal status of robots. This paper argues that robots operating in public and private spaces be afforded some protections as either moral patients or legal agents to establish prohibitions on robot abuse, misuse, and mistreatment. We already implement robots and embed them in our practices and institutions, which generates a host of human-to-machine and machine-to-machine relationships. As we interact with machines, whether in service contexts, medical assistance, or home health companions, these robots are first encountered in relationship to us and our respective roles in the encounter (e.g., surgeon, physical or occupational therapist, recipient of care, patient’s family, healthcare professional, stakeholder). This proposal aims to outline a framework for establishing limiting factors and determining the extent of moral or legal protections for robots. In doing so, it advocates for a relational approach that emphasizes the priority of mapping the complex contextually sensitive roles played and the relations in which humans and robots stand to guide policy determinations by relevant institutions and authorities. The relational approach must also be technically informed by the intended uses of the biomedical technologies in question, Design History Files, extensive risk assessments and hazard analyses, as well as use case social impact assessments.

Keywords: biomedical robots, robot ethics, robot laws, human-robot interaction

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Authors: Linda Fellag, Arlene Caney

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E-learning has earned an essential place in academia because it promotes learner autonomy, student engagement, and technological aptitude, and allows for flexible learning. However, despite advantages, educators have been slower to embrace e-learning for ESL and other non-traditional students for fear that such students will not succeed without the direct faculty contact and academic support of face-to-face classrooms. This study aims to determine if a non-traditional student-friendly online course can produce student retention and performance rates that compare favorably with those of students in standard online sections of the same course aimed at traditional college-level students. One Music faculty member is currently collaborating with an English instructor to redesign an online college-level Music Appreciation course for non-traditional college students. At Community College of Philadelphia, Introduction to Music Appreciation was recently designated as one of the few college-level courses that advanced ESL, and developmental English students can take while completing their language studies. Beginning in Fall 2017, the course will be critical for international students who must maintain full-time student status under visa requirements. In its current online format, however, Music Appreciation is designed for traditional college students, and faculty who teach these sections have been reluctant to revise the course to address the needs of non-traditional students. Interestingly, presenters maintain that the online platform is the ideal place to develop language and college readiness skills in at-risk students while maintaining the course's curricular integrity. The two faculty presenters describe how curriculum rather than technology drives the redesign of the digitized music course, and self-study materials, guided assignments, and periodic assessments promote independent learning and comprehension of material. The 'scaffolded' modules allow ESL and developmental English students to build on prior knowledge, preview key vocabulary, discuss content, and complete graded tasks that demonstrate comprehension. Activities and assignments, in turn, enhance college success by allowing students to practice academic reading strategies, writing, speaking, and student-faculty and peer-peer communication and collaboration. The course components facilitate a comparison of student performance and retention in sections of the redesigned and existing online sections of Music Appreciation as well as in previous sections with at-risk students. Indirect, qualitative measures include student attitudinal surveys and evaluations. Direct, quantitative measures include withdrawal rates, tests of disciplinary knowledge, and final grades. The study will compare the outcomes of three cohorts in the two versions of the online course: ESL students, at-risk developmental students, and college-level students. These data will also be compared with retention and student outcomes data of the three cohorts in f2f Music Appreciation, which permitted non-traditional student enrollment from 1998-2005. During this eight-year period, the presenter addressed the problems of at-risk students by adding language and college success support, which resulted in strong retention and outcomes. The presenters contend that the redesigned course will produce favorable outcomes among all three cohorts because it contains components which proved successful with at-risk learners in f2f sections of the course. Results of their study will be published in 2019 after the redesigned online course has met for two semesters.

Keywords: college readiness, e-learning, music appreciation, online courses

Procedia PDF Downloads 152

Authors: Payam Mousavi, Andrew L. Stewart, Huiwen You, Aryeh F. G. Fayerman

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We present a decision-support tool to assist an operator in the detection and tracking of a suspect vehicle traveling to an unknown target destination. Multiple data sources, such as traffic cameras, traffic information, weather, etc., are integrated and processed in real-time to infer a suspect’s intended destination chosen from a list of pre-determined high-value targets. Previously, we presented our work in the detection and tracking of vehicles using traffic and airborne cameras. Here, we focus on the fusion and processing of that information to predict a suspect’s behavior. The network of cameras is represented by a directional graph, where the edges correspond to direct road connections between the nodes and the edge weights are proportional to the average time it takes to travel from one node to another. For our experiments, we construct our graph based on the greater Los Angeles subset of the Caltrans’s “Performance Measurement System” (PeMS) dataset. We propose a Bayesian approach where a posterior probability for each target is continuously updated based on detections of the suspect in the live video feeds. Additionally, we introduce the concept of ‘soft interventions’, inspired by the field of Causal Inference. Soft interventions are herein defined as interventions that do not immediately interfere with the suspect’s movements; rather, a soft intervention may induce the suspect into making a new decision, ultimately making their intent more transparent. For example, a soft intervention could be temporarily closing a road a few blocks from the suspect’s current location, which may require the suspect to change their current course. The objective of these interventions is to gain the maximum amount of information about the suspect’s intent in the shortest possible time. Our system currently operates in a human-on-the-loop mode where at each step, a set of recommendations are presented to the operator to aid in decision-making. In principle, the system could operate autonomously, only prompting the operator for critical decisions, allowing the system to significantly scale up to larger areas and multiple suspects. Once the intended target is identified with sufficient confidence, the vehicle is reported to the authorities to take further action. Other recommendations include a selection of road closures, i.e., soft interventions, or to continue monitoring. We evaluate the performance of the proposed system using simulated scenarios where the suspect, starting at random locations, takes a noisy shortest path to their intended target. In all scenarios, the suspect’s intended target is unknown to our system. The decision thresholds are selected to maximize the chances of determining the suspect’s intended target in the minimum amount of time and with the smallest number of interventions. We conclude by discussing the limitations of our current approach to motivate a machine learning approach, based on reinforcement learning in order to relax some of the current limiting assumptions.

Keywords: autonomous surveillance, Bayesian reasoning, decision support, interventions, patterns of life, predictive analytics, predictive insights

Procedia PDF Downloads 94

Authors: Kuo Chieh Chao, Thishani Amarathunga, Sangam Shrestha

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Rainfall induced slope failures are one of the most damaging and disastrous natural hazards which occur frequently in the world. This type of sliding mainly occurs in the zone above the groundwater level in silty/sandy soils. When the rainwater begins to infiltrate into the vadose zone of the soil, the negative pore-water pressure tends to decrease and reduce the shear strength of soil material. Climate change has resulted in excessive and unpredictable rainfall in all around the world, resulting in landslides with dire consequences to human lives and infrastructure. Such problems could be overcome by examining in detail the causes for such slope failures and recommending effective repair plans for vulnerable locations by considering future climatic change. The selected area for this study is located in the road rehabilitation section from Maubara to Mota Ain road in Timor-Leste. Slope failures and cracks have occurred in 2013 and after repairs reoccurred again in 2017 subsequent to heavy rains. Both observed and future predicted climate data analyses were conducted to understand the severe precipitation conditions in past and future. Observed climate data were collected from NOAA global climate data portal. CORDEX data portal was used to collect Regional Climate Model (RCM) future predicted climate data. Both observed and RCM data were extracted to location-based data using ArcGIS Software. Linear scaling method was used for the bias correction of future data and bias corrected climate data were assigned to GeoStudio Software. Precipitations of wet seasons (December to March ) in 2007 to 2013 is higher than 2001-2006 period and it is more than nearly 40% higher precipitation than usual monthly average precipitation of 160mm.The results of seepage analyses which were carried out using SEEP/W model with observed climate, clearly demonstrated that the pore water pressure within the fill slope was significantly increased due to the increase of the infiltration during the wet season of 2013.One main Regional Climate Models (RCM) was analyzed in order to predict future climate variation under two Representative Concentration Pathways (RCPs).In the projected period of 76 years ahead from 2014, shows that the amount of precipitation is considerably getting higher in the future in both RCP 4.5 and RCP 8.5 emission scenarios. Critical pore water pressure conditions during 2014-2090 were used in order to recommend appropriate remediation methods. Results of slope stability analyses indicated that the factor of safety of the fill slopes was reduced from 1.226 to 0.793 during the dry season to wet season in 2013.Results of future slope stability which were obtained using SLOPE/W model for the RCP emissions scenarios depict that, the use of tieback anchors and geogrids in slope protection could be effective in increasing the stability of slopes to an acceptable level during the wet seasons. Moreover, methods and procedures like monitoring of slopes showing signs or susceptible for movement and installing surface protections could be used to increase the stability of slopes.

Keywords: climate change, precipitation, SEEP/W, SLOPE/W, unsaturated soil

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Authors: Jennifer Buz, Alvin Spivey

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The most common greenhouse gas emitted through human activities, carbon dioxide (CO2), is naturally consumed by plants during photosynthesis. This process is actively being monetized by companies wishing to offset their carbon dioxide emissions. For example, companies are now able to purchase protections for vegetated land due-to-be clear cut or purchase barren land for reforestation. Therefore, by actively preventing the destruction/decay of plant matter or by introducing more plant matter (reforestation), a company can theoretically offset some of their emissions. One of the biggest issues in the carbon credit market is validating and verifying carbon offsets. There is a need for a system that can accurately and frequently ensure that the areas sold for carbon credits have the vegetation mass (and therefore for carbon offset capability) they claim. Traditional techniques for measuring vegetation mass and determining health are costly and require many person-hours. Orbital Sidekick offers an alternative approach that accurately quantifies carbon mass and assesses vegetation health through satellite hyperspectral imagery, a technique which enables us to remotely identify material composition (including plant species) and condition (e.g., health and growth stage). How much carbon a plant is capable of storing ultimately is tied to many factors, including material density (primarily species-dependent), plant size, and health (trees that are actively decaying are not effectively storing carbon). All of these factors are capable of being observed through satellite hyperspectral imagery. This abstract focuses on speciation. To build a species classification model, we matched pixels in our remote sensing imagery to plants on the ground for which we know the species. To accomplish this, we collaborated with the researchers at the Teakettle Experimental Forest. Our remote sensing data comes from our airborne “Kato” sensor, which flew over the study area and acquired hyperspectral imagery (400-2500 nm, 472 bands) at ~0.5 m/pixel resolution. Coverage of the entire teakettle experimental forest required capturing dozens of individual hyperspectral images. In order to combine these images into a mosaic, we accounted for potential variations of atmospheric conditions throughout the data collection. To do this, we ran an open source atmospheric correction routine called ISOFIT1 (Imaging Spectrometer Optiman FITting), which converted all of our remote sensing data from radiance to reflectance. A database of reflectance spectra for each of the tree species within the study area was acquired using the Teakettle stem map and the geo-referenced hyperspectral images. We found that a wide variety of machine learning classifiers were able to identify the species within our images with high (>95%) accuracy. For the most robust quantification of carbon mass and the best assessment of the health of a vegetated area, speciation is critical. Through the use of high resolution hyperspectral data, ground-truth databases, and complex analytical techniques, we are able to determine the species present within a pixel to a high degree of accuracy. These species identifications will feed directly into our carbon mass model.

Keywords: hyperspectral, satellite, carbon, imagery, python, machine learning, speciation

Procedia PDF Downloads 95

Authors: Jungyeol Hong, Dongjoo Park

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The primary purpose of this study is to develop a methodological framework to predict daily subway ridership at a station-level and to examine the association between subway ridership and bus demand incorporating commercial business facility in the vicinity of each subway station. The socio-economic characteristics, land-use, and built environment as factors may have an impact on subway ridership. However, it should be considered not only the endogenous relationship between bus and subway demand but also the characteristics of commercial business within a subway station’s sphere of influence, and integrated transit network topology. Regarding a statistical approach to estimate subway ridership at a station level, therefore it should be considered endogeneity and heteroscedastic issues which might have in the subway ridership prediction model. This study focused on both discovering the impacts of bus demand, commercial business characteristics, and network topology on subway ridership and developing more precise subway ridership estimation accounting for its statistical bias. The spatial scope of the study covers entire Seoul city in South Korea and includes 243 stations with the temporal scope set at twenty-four hours with one-hour interval time panels each. The data for subway and bus ridership was collected Seoul Smart Card data from 2015 and 2016. Three-Stage Least Square(3SLS) approach was applied to develop daily subway ridership model as capturing the endogeneity and heteroscedasticity between bus and subway demand. Independent variables incorporating in the modeling process were commercial business characteristics, social-economic characteristics, safety index, transit facility attributes, and dummies for seasons and time zone. As a result, it was found that bus ridership and subway ridership were endogenous each other and they had a significantly positive sign of coefficients which means one transit mode could increase another transportation mode’s ridership. In other words, two transit modes of subway and bus have a mutual relationship instead of the competitive relationship. The commercial business characteristics are the most critical dimension among the independent variables. The variables of commercial business facility rate in the paper containing six types; medical, educational, recreational, financial, food service, and shopping. From the model result, a higher rate in medical, financial buildings, shopping, and food service facility lead to increment of subway ridership at a station, while recreational and educational facility shows lower subway ridership. The complex network theory was applied for estimating integrated network topology measures that cover the entire Seoul transit network system, and a framework for seeking an impact on subway ridership. The centrality measures were found to be significant and showed a positive sign indicating higher centrality led to more subway ridership at a station level. The results of model accuracy tests by out of samples provided that 3SLS model has less mean square error rather than OLS and showed the methodological approach for the 3SLS model was plausible to estimate more accurate subway ridership. Acknowledgement: This research was supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Science and ICT (2017R1C1B2010175).

Keywords: subway ridership, bus ridership, commercial business characteristic, endogeneity, network topology

Procedia PDF Downloads 123

Authors: Shayan Mohajer Hamidi

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Federated Learning (FL) has emerged as a promising paradigm for training machine learning models on distributed data without the need for centralized data aggregation. In the realm of wireless communications, FL has the potential to leverage the vast amounts of data generated by wireless devices to improve model performance and enable intelligent applications. However, the fairness aspect of FL in wireless communications remains largely unexplored. This abstract presents an idea for fair federated learning in wireless communications, addressing the challenges of imbalanced data distribution, privacy preservation, and resource allocation. Firstly, the proposed approach aims to tackle the issue of imbalanced data distribution in wireless networks. In typical FL scenarios, the distribution of data across wireless devices can be highly skewed, resulting in unfair model updates. To address this, we propose a weighted aggregation strategy that assigns higher importance to devices with fewer samples during the aggregation process. By incorporating fairness-aware weighting mechanisms, the proposed approach ensures that each participating device's contribution is proportional to its data distribution, thereby mitigating the impact of data imbalance on model performance. Secondly, privacy preservation is a critical concern in federated learning, especially in wireless communications where sensitive user data is involved. The proposed approach incorporates privacy-enhancing techniques, such as differential privacy, to protect user privacy during the model training process. By adding carefully calibrated noise to the gradient updates, the proposed approach ensures that the privacy of individual devices is preserved without compromising the overall model accuracy. Moreover, the approach considers the heterogeneity of devices in terms of computational capabilities and energy constraints, allowing devices to adaptively adjust the level of privacy preservation to strike a balance between privacy and utility. Thirdly, efficient resource allocation is crucial for federated learning in wireless communications, as devices operate under limited bandwidth, energy, and computational resources. The proposed approach leverages optimization techniques to allocate resources effectively among the participating devices, considering factors such as data quality, network conditions, and device capabilities. By intelligently distributing the computational load, communication bandwidth, and energy consumption, the proposed approach minimizes resource wastage and ensures a fair and efficient FL process in wireless networks. To evaluate the performance of the proposed fair federated learning approach, extensive simulations and experiments will be conducted. The experiments will involve a diverse set of wireless devices, ranging from smartphones to Internet of Things (IoT) devices, operating in various scenarios with different data distributions and network conditions. The evaluation metrics will include model accuracy, fairness measures, privacy preservation, and resource utilization. The expected outcomes of this research include improved model performance, fair allocation of resources, enhanced privacy preservation, and a better understanding of the challenges and solutions for fair federated learning in wireless communications. The proposed approach has the potential to revolutionize wireless communication systems by enabling intelligent applications while addressing fairness concerns and preserving user privacy.

Keywords: federated learning, wireless communications, fairness, imbalanced data, privacy preservation, resource allocation, differential privacy, optimization

Procedia PDF Downloads 47

Authors: Agata Migdalska, Joanna Berczynska, Ewa Bieniek, Jacek Sterna

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Muscle relaxation is considered important during general anesthesia for spine stabilization. In a presented case peripherally acting muscle relaxant was applied during general anesthesia for spine stabilization surgery. The patient was a dog, 11-years old, 26 kg, male, mix breed. Spine fracture was situated between Th13-L1-L2, probably due to the car accident. Preanesthetic physical examination revealed no sign underlying health issues. The dog was premedicated with midazolam 0.2 mg IM and butorphanol 2.4 mg IM. General anesthesia was induced with propofol IV. After the induction, the dog was intubated with an endotracheal tube and connected to an open-ended rebreathing system and maintained with the use of inhalation anesthesia with isoflurane in oxygen. 0,5 mg/ kg of rocuronium was given IV. Use of muscle relaxant was accompanied by an assessment of the degree of neuromuscular blockade by peripheral nerve stimulator. Electrodes were attached to the skin overlying at the peroneal nerve at the lateral cranial tibia. Four electrical pulses were applied to the nerve over a 2 second period. When satisfying nerve block was detected dog was prepared for the surgery. No further monitoring of the effectiveness of blockade was performed during surgery. Mechanical ventilation was kept during anesthesia. During surgery dog maintain stable, and no anesthesiological complication occur. Intraoperatively surgeon claimed that neuromuscular blockade results in a better approach to the spine and easier muscle manipulation which was helpful in order to see the fracture and replace bone fragments. Finally, euthanasia was performed intraoperatively as a result of vast myelomalacia process of the spinal cord. This prevented examination of the recovering process. Neuromuscular blocking agents act at the neuromuscular junction to provide profound muscle relaxation throughout the body. Muscle blocking agents are neither anesthetic nor analgesic; therefore inappropriately used may cause paralysis in fully conscious and feeling pain patient. They cause paralysis of all skeletal muscles, also diaphragm and intercostal muscles when given in higher doses. Intraoperative management includes maintaining stable physiological conditions, which involves adjusting hemodynamic parameters, ensuring proper ventilation, avoiding variations in temperature, maintain normal blood flow to promote proper oxygen exchange. Neuromuscular blocking agent can cause many side effects like residual paralysis, anaphylactic or anaphylactoid reactions, delayed recovery from anesthesia, histamine release, recurarization. Therefore reverse drug like neostigmine (with glikopyrolat) or edrofonium (with atropine) should be used in case of a life-threatening situation. Another useful drug is sugammadex, although the cost of this drug strongly limits its use. Muscle relaxant improves surgical conditions during spinal surgery, especially in heavily muscled individuals. They are also used to facilitate the replacement of dislocated joints as they improve conditions during fracture reduction. It is important to emphasize that in a patient with muscle weakness neuromuscular blocking agents may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. This should not appear in patients with recent spine fracture or luxation. Therefore it is believed that neuromuscular blockers could be useful during spine stabilization procedures.

Keywords: anesthesia, dog, neuromuscular block, spine surgery

Procedia PDF Downloads 155

Authors: Ma Chu Jui

Abstract:

Culture plays a pivotal role in shaping societal responses to change and fostering adaptability. In the realm of healthcare provision, hospitals serve as dynamic settings molded by the cultural consciousness of healthcare professionals. This intricate interplay extends to their expectations of leadership, communication styles, and attitudes towards patient care. Recognizing the cultural inclinations of healthcare professionals becomes imperative in navigating this complex landscape. This study will utilize Hofstede's Value Survey Module 2013 (VSM 2013) as a comprehensive analytical tool. The targeted participants for this research are in-service nursing professionals with a tenure of at least three months, specifically employed in the nursing department of an Eastern hospital. This quantitative approach seeks to quantify diverse cultural tendencies among the targeted nursing professionals, elucidating not only abstract cultural concepts but also revealing their cultural inclinations across different dimensions. The study anticipates gathering between 400 to 500 responses, ensuring a robust dataset for a comprehensive analysis. The focused approach on nursing professionals within the Eastern hospital setting enhances the relevance and specificity of the cultural insights obtained. The research aims to contribute valuable knowledge to the understanding of cultural tendencies among in-service nursing personnel in the nursing department of this specific Eastern hospital. The VSM 2013 will be initially distributed to this specific group to collect responses, aiming to calculate scores on each of Hofstede's six cultural dimensions—Power Distance Index (PDI), Individualism vs. Collectivism (IDV), Uncertainty Avoidance Index (UAI), Masculinity vs. Femininity (MAS), Long-Term Orientation vs. Short-Term Normative Orientation (LTO), and Indulgence vs. Restraint (IVR). the study unveils a significant correlation between different cultural dimensions and healthcare professionals' tendencies in understanding leadership expectations through PDI, grasping behavioral patterns via IDV, acknowledging risk acceptance through UAI, and understanding their long-term and short-term behaviors through LTO. These tendencies extend to communication styles and attitudes towards patient care. These findings provide valuable insights into the nuanced interconnections between cultural factors and healthcare practices. Through a detailed analysis of the varying levels of these cultural dimensions, we gain a comprehensive understanding of the predominant inclinations among the majority of healthcare professionals. This nuanced perspective adds depth to our comprehension of how cultural values shape their approach to leadership, communication, and patient care, contributing to a more holistic understanding of the healthcare landscape. A profound comprehension of the cultural paradigms embraced by healthcare professionals holds transformative potential. Beyond a mere understanding, it acts as a catalyst for elevating the caliber of healthcare services. This heightened awareness fosters cohesive collaboration among healthcare teams, paving the way for the establishment of a unified healthcare ethos. By cultivating shared values, our study envisions a healthcare environment characterized by enhanced quality, improved teamwork, and ultimately, a more favorable and patient-centric healthcare landscape. In essence, our research underscores the critical role of cultural awareness in shaping the future of healthcare delivery.

Keywords: hofstede's cultural, cultural dimensions, cultural values in healthcare, cultural awareness in nursing

Procedia PDF Downloads 35

Authors: Islam Sherif, Ahmed Ashour, Ahmed Hassan, Hatem Osman

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Anterior Cruciate Ligament (ACL) injuries are common among athletes and individuals participating in sports with sudden stops, pivots, and changes in direction. Arthroscopic surgery is the gold standard for ACL reconstruction, aiming to restore knee stability and function. Recent years have witnessed significant advancements in arthroscopic surgery techniques, graft materials, and technological innovations, revolutionizing the field of ACL reconstruction. This presentation delves into the latest advancements in arthroscopic surgery techniques for ACL reconstruction and their potential impact on patient outcomes. Traditionally, autografts from the patellar tendon, hamstring tendon, or quadriceps tendon have been commonly used for ACL reconstruction. However, recent studies have explored the use of allografts, synthetic scaffolds, and tissue-engineered grafts as viable alternatives. This abstract evaluates the benefits and potential drawbacks of each graft type, considering factors such as graft incorporation, strength, and risk of graft failure. Moreover, the application of augmented reality (AR) and virtual reality (VR) technologies in surgical planning and intraoperative navigation has gained traction. AR and VR platforms provide surgeons with detailed 3D anatomical reconstructions of the knee joint, enhancing preoperative visualization and aiding in graft tunnel placement during surgery. We discuss the integration of AR and VR in arthroscopic ACL reconstruction procedures, evaluating their accuracy, cost-effectiveness, and overall impact on surgical outcomes. Beyond graft selection and surgical navigation, patient-specific planning has gained attention in recent research. Advanced imaging techniques, such as MRI-based personalized planning, enable surgeons to tailor ACL reconstruction procedures to each patient's unique anatomy. By accounting for individual variations in the femoral and tibial insertion sites, this personalized approach aims to optimize graft placement and potentially improve postoperative knee kinematics and stability. Furthermore, rehabilitation and postoperative care play a crucial role in the success of ACL reconstruction. This abstract explores novel rehabilitation protocols, emphasizing early mobilization, neuromuscular training, and accelerated recovery strategies. Integrating technology, such as wearable sensors and mobile applications, into postoperative care can facilitate remote monitoring and timely intervention, contributing to enhanced rehabilitation outcomes. In conclusion, this presentation provides an overview of the cutting-edge advancements in arthroscopic surgery techniques for ACL reconstruction. By embracing innovative graft materials, augmented reality, patient-specific planning, and technology-driven rehabilitation, orthopedic surgeons and sports medicine specialists can achieve superior outcomes in ACL injury management. These developments hold great promise for improving the functional outcomes and long-term success rates of ACL reconstruction, benefitting athletes and patients alike.

Keywords: arthroscopic surgery, ACL, autograft, allograft, graft materials, ACL reconstruction, synthetic scaffolds, tissue-engineered graft, virtual reality, augmented reality, surgical planning, intra-operative navigation

Procedia PDF Downloads 63