Search results for: patient monitoring

Authors: Ogunmefun Folorunsho Muyideen, Aluko Tolulope Evelyn

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

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

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Authors: Bhupendra G. Prajapati, Alpesh R. Patel

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The aim of this research work is to develop sustained release multi-particulates dosage form of Dexketoprofen trometamol, which is the pharmacologically active isomer of ketoprofen. The objective is to utilization of active enantiomer with minimal dose and administration frequency, extended release multi-particulates dosage form development for better patience compliance was explored. Drug loaded and sustained release coated pellets were prepared by fluidized bed coating principle by wurster coater. Microcrystalline cellulose as core pellets, povidone as binder and talc as anti-tacking agents were selected during drug loading while Kollicoat SR 30D as sustained release polymer, triethyl citrate as plasticizer and micronized talc as an anti-adherent were used in sustained release coating. Binder optimization trial in drug loading showed that there was increase in process efficiency with increase in the binder concentration. 5 and 7.5%w/w concentration of Povidone K30 with respect to drug amount gave more than 90% process efficiency while higher amount of rejects (agglomerates) were observed for drug layering trial batch taken with 7.5% binder. So for drug loading, optimum Povidone concentration was selected as 5% of drug substance quantity since this trial had good process feasibility and good adhesion of the drug onto the MCC pellets. 2% w/w concentration of talc with respect to total drug layering solid mass shows better anti-tacking property to remove unnecessary static charge as well as agglomeration generation during spraying process. Optimized drug loaded pellets were coated for sustained release coating from 16 to 28% w/w coating to get desired drug release profile and results suggested that 22% w/w coating weight gain is necessary to get the required drug release profile. Three critical process parameters of Wurster coating for sustained release were further statistically optimized for desired quality target product profile attributes like agglomerates formation, process efficiency, and drug release profile using central composite design (CCD) by Minitab software. Results show that derived design space consisting 1.0 to 1.2 bar atomization air pressure, 7.8 to 10.0 gm/min spray rate and 29-34°C product bed temperature gave pre-defined drug product quality attributes. Scanning Image microscopy study results were also dictate that optimized batch pellets had very narrow particle size distribution and smooth surface which were ideal properties for reproducible drug release profile. The study also focused on optimized dexketoprofen trometamol pellets formulation retain its quality attributes while administering with common vehicle, a liquid (water) or semisolid food (apple sauce). Conclusion: Sustained release multi-particulates were successfully developed for dexketoprofen trometamol which may be useful to improve acceptability and palatability of a dosage form for better patient compliance.

Keywords: dexketoprofen trometamol, pellets, fluid bed technology, central composite design

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Authors: C. Bateira, J. Fernandes, A. Costa

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The Douro Demarked Region (DDR) is a production Porto wine region. On the NE of Portugal, the strong incision of the Douro valley developed very steep slopes, organized with agriculture terraces, have experienced an intense and deep transformation in order to implement the mechanization of the work. The old terrace system, based on stone vertical wall support structure, replaced by terraces with earth embankments experienced a huge terrace instability. This terrace instability has important economic and financial consequences on the agriculture enterprises. This paper presents and develops cartographic tools to access the embankment instability and identify the area prone to instability. The priority on this evaluation is related to the use of physically based mathematical models and develop a validation process based on an inventory of the past embankment instability. We used the shallow landslide stability model (SHALSTAB) based on physical parameters such us cohesion (c’), friction angle(ф), hydraulic conductivity, soil depth, soil specific weight (ϱ), slope angle (α) and contributing areas by Multiple Flow Direction Method (MFD). A terraced area can be analysed by this models unless we have very detailed information representative of the terrain morphology. The slope angle and the contributing areas depend on that. We can achieve that propose using digital elevation models (DEM) with great resolution (pixel with 40cm side), resulting from a set of photographs taken by a flight at 100m high with pixel resolution of 12cm. The slope angle results from this DEM. In the other hand, the MFD contributing area models the internal flow and is an important element to define the spatial variation of the soil saturation. That internal flow is based on the DEM. That is supported by the statement that the interflow, although not coincident with the superficial flow, have important similitude with it. Electrical resistivity monitoring values which related with the MFD contributing areas build from a DEM of 1m resolution and revealed a consistent correlation. That analysis, performed on the area, showed a good correlation with R2 of 0,72 and 0,76 at 1,5m and 2m depth, respectively. Considering that, a DEM with 1m resolution was the base to model the real internal flow. Thus, we assumed that the contributing area of 1m resolution modelled by MFD is representative of the internal flow of the area. In order to solve this problem we used a set of generalized DEMs to build the contributing areas used in the SHALSTAB. Those DEMs, with several resolutions (1m and 5m), were built from a set of photographs with 50cm resolution taken by a flight with 5km high. Using this maps combination, we modelled several final maps of terrace instability and performed a validation process with the contingency matrix. The best final instability map resembles the slope map from a DEM of 40cm resolution and a MFD map from a DEM of 1m resolution with a True Positive Rate (TPR) of 0,97, a False Positive Rate of 0,47, Accuracy (ACC) of 0,53, Precision (PVC) of 0,0004 and a TPR/FPR ratio of 2,06.

Keywords: agricultural terraces, cartography, landslides, SHALSTAB, vineyards

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Authors: M. Amo, A. Alvaro, A. Astudillo, R. Mc Culloch, J. C. del Castillo, M. Gómez, J. M. Martín

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Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) of course comprise a range of highly toxic compounds that may exist as particulates within the air or accumulate within water supplies, soil, or vegetation. They may be created either ubiquitously or naturally within the environment as a product of forest fires or volcanic eruptions. It is only since the industrial revolution, however, that it has become necessary to closely monitor their generation as a byproduct of manufacturing/combustion processes, in an effort to mitigate widespread contamination events. Of course, the environmental concentrations of these toxins are expected to be extremely low, therefore highly sensitive and accurate methods are required for their determination. Since ionization of non-polar compounds through electrospray and APCI is difficult and inefficient, we evaluate the performance of a novel low-flow Atmospheric Pressure Photoionization (APPI) source for the trace detection of various dioxins and furans using rapid Mass Spectrometry workflows. Air, soil and biota (vegetable matter) samples were collected monthly during one year from various locations within the vicinity of an industrial incinerator in Spain. Analytes were extracted and concentrated using soxhlet extraction in toluene and concentrated by rotavapor and nitrogen flow. Various ionization methods as electrospray (ES) and atmospheric pressure chemical ionization (APCI) were evaluated, however, only the low-flow APPI source was capable of providing the necessary performance, in terms of sensitivity, required for detecting all targeted analytes. In total, 10 analytes including 2,3,7,8-tetrachlorodibenzodioxin (TCDD) were detected and characterized using the APPI-MS method. Both PCDDs and PCFDs were detected most efficiently in negative ionization mode. The most abundant ion always corresponded to the loss of a chlorine and addition of an oxygen, yielding [M-Cl+O]- ions. MRM methods were created in order to provide selectivity for each analyte. No chromatographic separation was employed; however, matrix effects were determined to have a negligible impact on analyte signals. Triple Quadrupole Mass Spectrometry was chosen because of its unique potential for high sensitivity and selectivity. The mass spectrometer used was a Sciex´s Qtrap3200 working in negative Multi Reacting Monitoring Mode (MRM). Typically mass detection limits were determined to be near the 1-pg level. The APPI-MS2 technology applied to the detection of PCDD/Fs allows fast and reliable atmospheric analysis, minimizing considerably operational times and costs, with respect other technologies available. In addition, the limit of detection can be easily improved using a more sensitive mass spectrometer since the background in the analysis channel is very low. The APPI developed by SEADM allows polar and non-polar compounds ionization with high efficiency and repeatability.

Keywords: atmospheric pressure photoionization-mass spectrometry (APPI-MS), dioxin, furan, incinerator

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Authors: Ashima Sharma

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

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

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Authors: Josiah O. Carter, Charlotte Hayden, Elizabeth Arthurs

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Background: During the COVID-19 pandemic, hospital management policies have changed frequently and rapidly. This has created novel challenges in keeping the workforce abreast of these changes to enable them to deliver safe and effective care. Traditional communication methods, e.g. email, do not keep pace with the rapidly changing environment in the hospital, resulting in inaccurate, irrelevant, or outdated information being communicated, resulting in inefficiencies in patient care. Methods: The creation of a WhatsApp messaging group within the medical division at the Bristol Royal Infirmary has enabled senior clinicians and the hospital management team to update the medical workforce in real-time. It has two primary functions: (1) To enable dissemination of a concise, important operational summary. This comprises information on bed status and infection control procedural changes. It is fed directly from a daily critical incident briefing (2) To facilitate a monthly scheduled question and answer (Q&A) session for junior doctors to clarify issues with clinical directors, rota, and management staff. Additional ad-hoc updates are sent out for time-critical information; otherwise, it mainly functions as a broadcast-only group to prevent important information from being lost amongst other communication. All junior doctors within the medical division were invited to join the group. At present, the group comprises 131 participants, of which 10 are administrative staff (rota coordinators, management staff & clinical directors); the remaining 121 are junior clinicians working within the medical division. An electronic survey via Microsoft forms was sent out to junior doctors via the WhatsApp group and via email to assess its utilisation and effectiveness with the aim of quality improvements. Results: Of the 121 group participants, 19 completed the questionnaire (response rate 15.7%). Of these, 16/19 (84.2%) used it regularly, and 12/19 (63.2%) rated it as the most useful source for reliable updates relating to the hospital response to the COVID-19 pandemic, whereas only 2/19 (10.5%) found the trust intranet and the trust COVID-19 operational email update most useful. Respondents rated the WhatsApp group more useful as an information source (mean score 7.7/10) than as a means of providing feedback to management staff (mean score 6.3/10). Qualitative feedback suggested information around ward closures and changes to COVID cohorting, along with updates on staffing issues, were most useful. Respondents also noted the Q&A sessions were an efficient way of relaying feedback about management decisions but that it would be preferable if these sessions could be delivered more frequently. Discussion: During the current global COVID-19 pandemic, there is an increased need for rapid dissemination of critical information within NHS trusts; this includes communication between junior doctors, managers, and senior clinicians. The versatility of WhatsApp permits a variety of functions allowing for regular updates, the dissemination of time-critical information, and enables conversing and feedback. The project has demonstrated that reserved and well-managed use of a WhatsApp group is a welcome, efficient and practical means of communication between the senior management team and the junior medical workforce.

Keywords: communication, COVID-19, hospital management, WhatsApp

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Authors: Theresa Bacon-Baguley, Martina Reinhold

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Introduction: The purpose of this paper is to discuss the importance of both formative and summative evaluation of a Physician Assistant (PA) program with a distant campus delivered through Interactive Television (ITV) to assure equity of educational experiences. Methodology: A needs assessment utilizing a case-control design determined the need and interest in expanding the existing PA program to northern Michigan. A federal grant was written and funded, which supported the hiring of two full-time faculty members and support staff at the distant site. The strengths and weaknesses of delivering a program through ITV were evaluated using weekly formative evaluation, and bi-semester summative evaluation. Formative evaluation involved discussion of lecture content to be delivered, special ITV needs, orientation of new lecturers to the system, student concerns, support staff updates, and scheduling of student/faculty traveling between the two campuses. The summative evaluation, designed from a literature review of barriers to ITV, included 19 statements designed to evaluate the following items: quality of technology (audio, video, etc.), confidence in the ITV system, quality of instruction and instructor interaction between the two locations, and availability of resources at each location. In addition, students were given the opportunity to write qualitative remarks for each course delivered between the two locations. This summative evaluation was given to all students at mid-semester and at the end of the semester. The goal of the summative evaluation was to have 80% or greater of the students respond favorably (‘Very Good’ or ‘Good’) to each of the 19 statements. Results: Prior to the start of the first cohort at the distant campus, the technology was tested. During this time period, the formative evaluations identified key components needing modification, which were rapidly addressed: ability to record lectures, lighting, sound, and content delivery. When the mid-semester summative survey was given to the first cohort of students, 18 of the 19 statements in the summative evaluation met the goal of 80% or greater in the favorable category. When the summative evaluation statements were stratified by the two cohorts, the summative evaluation identified that students at the home location responded that they did not have adequate access to printers, and students at the expansion location responded that they did not have adequate access to library resources. These results allowed the program to address the deficiencies through contacting informational technology for additional printers, and to provide students with knowledge on how to access library resources. Conclusion: Successful expansion of programs to a distant site utilizing ITV technology requires extensive monitoring using both formative and summative evaluation. The formative evaluation allowed for quick identification of issues that could immediately be addressed, both at the planning and developing stage, as well as during implementation. Through use of the summative evaluation the program is able to monitor the success/ effectiveness of the expansion and identify specific needs of students at each location.

Keywords: assessment, distance learning, formative feedback, interactive television (ITV), student experience, summative feedback, support

Procedia PDF Downloads 219

Authors: Ludmila Polechonska, Agnieszka Klink

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The biogeochemical studies of macrophytes shed light on elements bioavailability, transfer through the food webs and their possible effects on the biota, and provide a basis for their practical application in aquatic monitoring and remediation. Measuring the accumulation of elements in plants can provide time-integrated information about the presence of chemicals in aquatic ecosystems. The aim of the study was to determine and compare the contents of micro- and macroelements in two cosmopolitan macrophytes, submerged Ceratophyllum demersum (hornworth) and free-floating Hydrocharis morsus-ranae (European frog-bit), in order to assess their bioaccumulation potential, elements stock accumulated in each plant and their role in nutrients cycling in small water reservoirs. Sampling sites were designated in 25 oxbow lakes in urban areas in Lower Silesia (SW Poland). In each sampling site, fresh whole plants of C. demersum and H. morsus-ranae were collected from squares of 1x1 meters each where the species coexisted. European frog-bit was separated into leaves, stems and roots. For biomass measurement all plants growing on 1 square meter were collected, dried and weighed. At the same time, water samples were collected from each reservoir and their pH and EC were determined. Water samples were filtered and acidified and plant samples were digested in concentrated nitric acid. Next, the content of Ca, Cu, Fe, K, Mg, Mn, Ni and Zn was determined using atomic absorption method (AAS). Statistical analysis showed that C. demersum and organs of H. morsus-ranae differed significantly in respect of metals content (Kruskal-Wallis Anova, p<0.05). Contents of Cu, Mn, Ni and Zn were higher in hornwort, while European frog-bit contained more Ca, Fe, K, Mg. Bioaccumulation Factors (BCF=content in plant/concentration in water) showed similar pattern of metal bioaccumulation – microelements were more intensively accumulated by hornwort and macroelements by frog-bit. Based on BCF values both species may be positively evaluated as good accumulators of Cu, Fe, Mn, Ni and Zn. However, the distribution of metals in H. morsus-ranae was uneven – the majority of studied elements were retained in roots, which may indicate to existence of physiological barriers developed for dealing with toxicity. Some percent of Ca and K was actively transported to stems, but to leaves Mg only. Although the biomass of C. demersum was two times greater than biomass of H. morsus-ranae, the element off-take was greater only for Cu, Mn, Ni and Zn. Nevertheless, it can be stated that despite a relatively small biomass, compared to other macrophytes, both species may have an influence on the removal of trace elements from aquatic ecosystems and, as they serve as food for some animals, also on the incorporation of toxic elements into food chains. There was a significant positive correlation between content of Mn and Fe in water and roots of H. morus-ranae (R=0.51 and R=0.60, respectively) as well as between Cu concentration in water and in C. demersum (R=0.41) (Spearman rank correlation, p<0.05). High bioaccumulation rates and correlation between plants and water elements concentrations point to their possible use as passive biomonitors of aquatic pollution.

Keywords: aquatic plants, bioaccumulation, biomonitoring, macroelements, phytoremediation, trace metals

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Authors: Priyajeet Kaur Kaleka

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Introduction: A dentist is often the first responder in the battle for a patient’s healthy body and maybe the first health professional to observe signs of child abuse, be it physical, emotional, and/or sexual mistreatment. Therefore, it is an ethical responsibility for the dental clinician to detect and report suspected cases of child abuse and neglect (CAN). The main reasons for not reporting suspected cases of CAN, with special emphasis on the third: 1) Uncertainty of the diagnosis, 2) Lack of knowledge of the reporting procedure, and 3) Child abuse and neglect somewhat remained the subject of ignorance among dental professionals because of a lack of advance clinical training. Given these epidemic proportions, there is a scope of further research about dental school curriculum design. Purpose: This study aimed to assess the knowledge and attitude of dentists in Canada regarding signs and symptoms of child abuse and neglect (CAN), reporting procedures, and whether educational strategies followed by dental schools address this sensitive issue. In pursuit of that aim, this abstract summarizes the evidence related to this question. Materials and Methods: Data was collected through a specially designed questionnaire adapted and modified from the author’s previous cross-sectional study on (CAN), which was conducted in Pune, India, in 2016 and is available on the database of PubMed. Design: A random sample was drawn from the targeted population of registered dentists and dental students in Canada regarding their knowledge, professional responsibilities, and behavior concerning child abuse. Questionnaire data were distributed to 200 members. Out of which, a total number of 157 subjects were in the final sample for statistical analysis, yielding response of 78.5%. Results: Despite having theoretical information on signs and symptoms, 55% of the participants indicated they are not confident to detect child physical abuse cases. 90% of respondents believed that recognition and handling the CAN cases should be a part of undergraduate training. Only 4.5% of the participants have correctly identified all signs of abuse due to inadequate formal training in dental schools and workplaces. Although nearly 96.3% agreed that it is a dentist’s legal responsibility to report CAN, only a small percentage of the participants reported an abuse case in the past. While 72% stated that the most common factor that might prevent a dentist from reporting a case was doubt over the diagnosis. Conclusion: The goal is to motivate dental schools to deal with this critical issue and provide their students with consummate training to strengthen their capability to care for and protect children. The educational institutions should make efforts to spread awareness among dental students regarding the management and tackling of CAN. Clinical Significance: There should be modifications in the dental school curriculum focusing on problem-based learning models to assist graduates to fulfill their legal and professional responsibilities. CAN literacy should be incorporated into the dental curriculum, which will eventually benefit future dentists to break this intergenerational cycle of violence.

Keywords: abuse, child abuse and neglect, dentist knowledge, dental school curriculum, problem-based learning

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Authors: Bruno RamaëL, GwenaëL Page, Catherine Knopf-Lenoir, Olivier Baledent, Anne-Virginie Salsac

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No routine technique currently exists for clinicians to measure the mechanical properties of vascular walls non-invasively. Most of the data available in the literature come from traction or dilatation tests conducted ex vivo on native blood vessels. The objective of the study is to develop a non-invasive characterization technique based on Magnetic Resonance Imaging (MRI) measurements of the deformation of vascular walls under pulsating blood flow conditions. The goal is to determine the mechanical properties of the vessels by inverse analysis, coupling imaging measurements and numerical simulations of the fluid-structure interactions. The hyperelastic properties are identified using Solidworks and Ansys workbench (ANSYS Inc.) solving an optimization technique. The vessel of interest targeted in the study is the common carotid artery. In vivo MRI measurements of the vessel anatomy and inlet velocity profiles was acquired along the facial vascular network on a cohort of 30 healthy volunteers: - The time-evolution of the blood vessel contours and, thus, of the cross-section surface area was measured by 3D imaging angiography sequences of phase-contrast MRI. - The blood flow velocity was measured using a 2D CINE MRI phase contrast (PC-MRI) method. Reference arterial pressure waveforms were simultaneously measured in the brachial artery using a sphygmomanometer. The three-dimensional (3D) geometry of the arterial network was reconstructed by first creating an STL file from the raw MRI data using the open source imaging software ITK-SNAP. The resulting geometry was then transformed with Solidworks into volumes that are compatible with Ansys softwares. Tetrahedral meshes of the wall and fluid domains were built using the ANSYS Meshing software, with a near-wall mesh refinement method in the case of the fluid domain to improve the accuracy of the fluid flow calculations. Ansys Structural was used for the numerical simulation of the vessel deformation and Ansys CFX for the simulation of the blood flow. The fluid structure interaction simulations showed that the systolic and diastolic blood pressures of the common carotid artery could be taken as reference pressures to identify the mechanical properties of the different arteries of the network. The coefficients of the hyperelastic law were identified using Ansys Design model for the common carotid. Under large deformations, a stiffness of 800 kPa is measured, which is of the same order of magnitude as the Young modulus of collagen fibers. Areas of maximum deformations were highlighted near bifurcations. This study is a first step towards patient-specific characterization of the mechanical properties of the facial vessels. The method is currently applied on patients suffering from facial vascular malformations and on patients scheduled for facial reconstruction. Information on the blood flow velocity as well as on the vessel anatomy and deformability will be key to improve surgical planning in the case of such vascular pathologies.

Keywords: identification, mechanical properties, arterial walls, MRI measurements, numerical simulations

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Authors: Saurabh Sharma

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Introduction: The case study deals with the ground stabilisation of Nabi Karim Metro Station in Delhi, India, wherein an extremely complex geology was encountered while excavating the tunnelling shaft for launching Tunnel Boring Machine. The borelog investigation and the Seismic Refraction Technique (SRT) indicated towards the presence of an extremely hard rocky mass from a depth of 3-4 m itself, and accordingly, the Geotechnical Interpretation Report (GIR) concluded the presence of Grade-IV rock from 3m onwards and presence of Grade-III and better rock from 5-6m onwards. Accordingly, it was planned to retain the ground by providing secant piles all around the launching shaft and then excavating the shaft vertically after leaving a berm of 1.5m to prevent secant piles from getting exposed. To retain the side slopes, rock bolting with shotcreting and wire meshing were proposed, which is a normal practice in such strata. However, with the increase in depth of excavation, the rock quality kept on decreasing at an unexpected and surprising pace, with the Grade-III rock mass at 5-6 m converting to conglomerate formation at the depth of 15m. This worsening of geology from high grade rock to slushy conglomerate formation can never be predicted and came as a surprise to even the best geotechnical engineers. Since the excavation had already been cut down vertically to manage the shaft size, the execution was continued with enhanced cautions to stabilise the side slopes. But, when the shaft work was about to finish, a collapse was encountered on one side of the excavation shaft. This collapse was unexpected and surprising since all measures to stabilise the side slopes had been taken after face mapping, and the grid size, diameter, and depth of the rockbolts had already been readjusted to accommodate rock fractures. The above scenario was baffling even to the best geologists and geotechnical engineers, and it was decided that any further slope stabilisation scheme shall have to be designed in such a way to ensure safe completion of works. Accordingly, following revisions to excavation scheme were made: The excavation would be carried while maintaining a slope based on type of soil/rock. The rock bolt type was changed from SN rockbolts to Self Drilling type anchor. The grid size of the bolts changed on real time assessment. the excavation carried out by implementing a ‘Bench Release Approach’. Aggressive Real Time Instrumentation Scheme. Discussion: The above case Study again asserts vitality of correct interpretation of the geological strata and the need of real time revisions of the construction schemes based on the actual site data. The excavation is successfully being done with the above revised scheme, and further details of the Revised Slope Stabilisation Scheme, Instrumentation Schemes, Monitoring results, along with the actual site photographs, shall form the part of the final Paper.

Keywords: unconfined compressive strength (ucs), rock mass rating (rmr), rock bolts, self drilling anchors, face mapping of rock, secant pile, shotcrete

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Authors: Nejmeddine Ouhichi, Fethi Lachaal, Radhouane Hamdi, Olivier Grunberger

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Located in Cap Bon peninsula (Tunisia), the Lebna dam was built in 1987 to balance local water salt intrusion taking place in the coastal aquifer of Korba. The first intention was to reduce coastal groundwater over-pumping by supplying surface water to a large irrigation system. The unpredicted beneficial effect was recorded with the occurrence of a direct localized recharge to the coastal aquifer by leakage through the geological material of the southern bank of the lake. The hydrological balance of the reservoir dam gave an estimation of the annual leakage volume, but dynamic processes and sound quantification of recharge inputs are still required to understand the localized effect of the recharge in terms of piezometry and quality. Present work focused on simulating the recharge process to confirm the hypothesis, and established a sound quantification of the water supply to the coastal aquifer and extend it to multi-annual effects. A spatial frame of 30km² was used for modeling. Intensive outcrops and geophysical surveys based on 68 electrical resistivity soundings were used to characterize the aquifer 3D geometry and the limit of the Plio-quaternary geological material concerned by the underground flow paths. Permeabilities were determined using 17 pumping tests on wells and piezometers. Six seasonal piezometric surveys on 71 wells around southern reservoir dam banks were performed during the 2019-2021 period. Eight monitoring boreholes of high frequency (15min) piezometric data were used to examine dynamical aspects. Model boundary conditions were specified using the geophysics interpretations coupled with the piezometric maps. The dam-groundwater flow model was performed using Visual MODFLOW software. Firstly, permanent state calibration based on the first piezometric map of February 2019 was established to estimate the permanent flow related to the different reservoir levels. Secondly, piezometric data for the 2019-2021 period were used for transient state calibration and to confirm the robustness of the model. Preliminary results confirmed the temporal link between the reservoir level and the localized recharge flow with a strong threshold effect for levels below 16 m.a.s.l. The good agreement of computed flow through recharge cells on the southern banks and hydrological budget of the reservoir open the path to future simulation scenarios of the dilution plume imposed by the localized recharge. The dam reservoir-groundwater flow-model simulation results approve a potential for storage of up to 17mm/year in existing wells, under gravity-feed conditions during level increases on the reservoir into the three years of operation. The Lebna dam groundwater flow model characterized a spatiotemporal relation between groundwater and surface water.

Keywords: leakage, MODFLOW, saltwater intrusion, surface water-groundwater interaction

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Authors: Ayesha Akbar

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Public service delivery has witnessed a significant improvement with the integration of information communication technology (ICT). It not only improves management structure with advanced technology for surveillance of service delivery but also provides evidence for informed decisions and policy. Pakistan’s public sector organizations have not been able to produce some good results to ensure service delivery. Notwithstanding, some of the public sector organizations in Pakistan has diffused modern technology and proved their credence by providing better service delivery standards. These good indicators provide sound basis to integrate technology in public sector organizations and shift of policy towards evidence based policy making. Rescue-1122 is a public sector organization which provides emergency services and proved to be a successful model for the provision of service delivery to save human lives and to ensure human development in Pakistan. The information about the organization has been received by employing qualitative research methodology. The information is broadly based on primary and secondary sources which includes Rescue-1122 website, official reports of organizations; UNDP (United Nation Development Program), WHO (World Health Organization) and by conducting 10 in-depth interviews with the high administrative staff of organizations who work in the Lahore offices. The information received has been incorporated with the study for the better understanding of the organization and their management procedures. Rescue-1122 represents a successful model in delivering the services in an efficient way to deal with the disaster management. The management of Rescue has strategized the policies and procedures in such a way to develop a comprehensive model with the integration of technology. This model provides efficient service delivery as well as maintains the standards of the organization. The service delivery model of rescue-1122 works on two fronts; front-office interface and the back-office interface. Back-office defines the procedures of operations and assures the compliance of the staff whereas, front-office equipped with the latest technology and good infrastructure handles the emergency calls. Both ends are integrated with satellite based vehicle tracking, wireless system, fleet monitoring system and IP camera which monitors every move of the staff to provide better services and to pinpoint the distortions in the services. The standard time of reaching to the emergency spot is 7 minutes, and during entertaining the case; driver‘s behavior, traffic volume and the technical assistance being provided to the emergency case is being monitored by front-office. Then the whole information get uploaded to the main dashboard of Lahore headquarter from the provincial offices. The latest technology is being materialized by Rescue-1122 for delivering the efficient services, investigating the flaws; if found, and to develop data to make informed decision making. The other public sector organizations of Pakistan can also develop such models to integrate technology for improving service delivery and to develop evidence for informed decisions and policy making.

Keywords: data, e-governance, evidence, policy

Procedia PDF Downloads 219

Authors: Md. Wasiul Islam, Md. Jamius Shams Sowrov

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The Sundarbans is the largest single tract of mangrove forest in the world. This is located in the southwest corner of Bangladesh. This is a unique ecosystem which is a great breeding and nursing ground for a great biodiversity. It supports the livelihood of about 3.5 million coastal dwellers and also protects the coastal belt and inland areas from various natural calamities. Historically, the management of the Sundarbans was controlled by the Bangladesh Forest Department following top-down approach without the involvement of local communities. Such fence and fining-based blue-print approach was not effective to protect the forest which caused Sundarbans to degrade severely in the recent past. Fifty percent of the total tree cover has been lost in the last 30 years. Therefore, local multi-stakeholder based bottom-up co-management approach was introduced at some of the parts of the Sundarbans in 2006 to improve the biodiversity status by enhancing the protection level of the forest. Various co-management organizations were introduced under co-management approach where the local community people could actively involve in various activities related to the management and welfare of the Sundarbans including the decision-making process to achieve the goal. From this backdrop, the objective of the study was to assess the performance of co-management organizations to facilitate sustainable management of the Sundarbans mangrove forests. The qualitative study followed face-to-face interview to collect data using two sets of semi-structured questionnaires. A total of 40 respondents participated in the research that was from eight villagers under two forest ranges. 32 representatives from the local communities as well as 8 official representatives involved in co-management approach were interviewed using snowball sampling technique. The study shows that the co-management approach improved governance system of the Sundarbans through active participation of the local community people and their interactions with the officials via the platform of co-management organizations. It facilitated accountability and transparency system to some extent through following some formal and informal rules and regulations. It also improved the power structure of the management process by fostering local empowerment process particularly the women. Moreover, people were able to learn from their interactions with and within the co-management organizations as well as interventions improved environmental awareness and promoted social learning. The respondents considered good governance as the most important factor for achieving the goal of sustainable management and biodiversity conservation of the Sundarbans. The success of co-management planning process also depends on the active and functional participation of different stakeholders including the local communities where co-management organizations were considered as the most functional platform. However, the governance system was also facing various challenges which resulted in barriers to the sustainable management of the Sundarbans mangrove forest. But still there were some members involved in illegal forest operations and created obstacles against sustainable management of the Sundarbans. Respondents recommended greater patronization from the government, financial and logistic incentives for alternative income generation opportunities with effective participatory monitoring and evaluation system to improve sustainable management of the Sundarbans.

Keywords: Bangladesh, co-management approach, co-management organizations, governance, Sundarbans, sustainable management

Procedia PDF Downloads 145

Authors: Sarah A. Harris, Fleur L. McIntyre, Paola T. Chivers, Benjamin G. Piggott, Fiona H. Farringdon

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Australian Rules Football (ARF) is an invasion based, contact field sport with over one million participants. The contact nature of the game increases exposure to all injuries, including head trauma. Evidence suggests that both concussion and sub-concussive traumas such as head knocks may damage the brain, in particular the prefrontal cortex. The prefrontal cortex may not reach full maturity until a person is in their early twenties with males taking longer to mature than females. Repeated trauma to the pre-frontal cortex during maturation may lead to negative social, cognitive and emotional effects. It is also during this period that males exhibit high levels of risk taking behaviours. Risk propensity and the incidence of injury is an unexplored area of research. Little research has considered if the level of player’s (especially younger players) risk propensity in everyday life places them at an increased risk of injury. Hence the current study, investigated if a relationship exists between risk propensity and self-reported injuries including diagnosed concussion and head knocks, among male ARF players aged 18 to 31 years. Method: The study was conducted over 22 weeks with one West Australian Football League (WAFL) club during the 2015 competition. Pre-season risk propensity was measured using the 7-item self-report Risk Propensity Scale. Possible scores ranged from 9 to 63, with higher scores indicating higher risk propensity. Players reported their self-perceived injuries (concussion, head knocks, upper body and lower body injuries) fortnightly using the WAFL Injury Report Survey (WIRS). A unique ID code was used to ensure player anonymity, which also enabled linkage of survey responses and injury data tracking over the season. A General Linear Model (GLM) was used to analyse whether there was a relationship between risk propensity score and total number of injuries for each injury type. Results: Seventy one players (N=71) with an age range of 18.40 to 30.48 years and a mean age of 21.92 years (±2.96 years) participated in the study. Player’s mean risk propensity score was 32.73, SD ±8.38. Four hundred and ninety five (495) injuries were reported. The most frequently reported injury was head knocks representing 39.19% of total reported injuries. The GLM identified a significant relationship between risk propensity and head knocks (F=4.17, p=.046). No other injury types were significantly related to risk propensity. Discussion: A positive relationship between risk propensity and head trauma in contact sports (specifically WAFL) was discovered. Assessing player’s risk propensity therefore, may identify those more at risk of head injuries. Potentially leading to greater monitoring and education of these players throughout the season, regarding self-identification of head knocks and symptoms that may indicate trauma to the brain. This is important because many players involved in WAFL are in their late teens or early 20’s hence, may be at greater risk of negative outcomes if they experience repeated head trauma. Continued education and research into the risks associated with head injuries has the potential to improve player well-being.

Keywords: football, head injuries, injury identification, risk

Procedia PDF Downloads 311

Authors: Seyed Reza Aghili, Tahereh Shokohi, Shirin Sadat Hashemi Fesharaki, Mohammad Ali Boroumand, Bahar Salmanian

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Introduction: Intravenous catheter-associated fungal infection as nosocomial infection continue to be a deep problem among hospitalized patients, decreasing quality of life and adding healthcare costs. The capacity of catheters in the spread of candidemia in heart failure patients is obvious. The aim of this study was to evaluate the prevalence and genetic identification of Candida species in heart disorder patients. Material and Methods: This study was conducted in Tehran Hospital of Cardiology Center (Tehran, Iran, 2014) during 1.5 years on the patients hospitalized for at least 7 days and who had central or peripheral vein catheter. Culture of catheters, blood and skin of the location of catheter insertion were applied for detecting Candida colonies in 223 patients. Identification of Candida species was made on the basis of a combination of various phenotypic methods and confirmed by sequencing the ITS1-5.8S-ITS2 region amplified from the genomic DNA using PCR and the NCBI BLAST. Results: Of the 223 patients samples tested, we identified totally 15 Candida isolates obtained from 9 (4.04%) catheter cultures, 3 (1.35%) blood cultures and 2 (0.90%) skin cultures of the catheter insertion areas. On the base of ITS region sequencing, out of nine Candida isolates from catheter, 5(55.6%) C. albicans, 2(22.2%) C. glabrata, 1(11.1%) C. membranifiaciens and 1 (11.1%) C. tropicalis were identified. Among three Candida isolates from blood culture, C. tropicalis, C. carpophila and C. membranifiaciens were identified. Non-candida yeast isolated from one blood culture was Cryptococcus albidus. One case of C. glabrata and one case of Candida albicans were isolated from skin culture of the catheter insertion areas in patients with positive catheter culture. In these patients, ITS region of rDNA sequence showed a similarity between Candida isolated from the skin and catheter. However, the blood samples of these patients were negative for fungal growth. We report two cases of catheter-related candidemia caused by C. membranifiaciens and C. tropicalis on the base of genetic similarity of species isolated from blood and catheter which were treated successfully with intravenous fluconazole and catheter removal. In phenotypic identification methods, we could only identify C. albicans and C. tropicalis and other yeast isolates were diagnosed as Candida sp. Discussion: Although more than 200 species of Candida have been identified, only a few cause diseases in humans. There is some evidence that non-albicans infections are increasing. Many risk factors, including prior antibiotic therapy, use of a central venous catheter, surgery, and parenteral nutrition are considered to be associated with candidemia in hospitalized heart failure patients. Identifying the route of infection in candidemia is difficult. Non-albicans candida as the cause of candidemia is increasing dramatically. By using conventional method, many non-albicans isolates remain unidentified. So, using more sensitive and specific molecular genetic sequencing to clarify the aspects of epidemiology of the unknown candida species infections is essential. The positive blood and catheter cultures for candida isolates and high percentage of similarity of their ITS region of rDNA sequence in these two patients confirmed the diagnosis of intravenous catheter-associated candidemia.

Keywords: catheter-associated infections, heart failure patient, molecular genetic sequencing, ITS region of rDNA, Candidemia

Procedia PDF Downloads 303

Authors: Wint Wint Thu, Htet Ko Ko Win, Myat Mon San, Zaw Lin Tun, Nandar Than Aye, Khin Nyein Myat, Hayman Nyo Oo, Nay Aung Lin, Kusum Thapa, Kyaw Htet Aung

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Background: In Myanmar, the intense political instability happened to start in Feb-2021, while the COVID-19 pandemic waves are also threatening the public health system, which subsequently led to severe health sector crisis, including difficulties in accessing maternal and newborn health care for vulnerable women and children. The Remote Pregnant and Newborn Care (RPNC) uses a telehealth approach United States Agency for International Development (USAID)-funded Essential Health Project. Implementation: The Remote Pregnant and Newborn Care (RPNC) service has adapted to the MNCH needs of vulnerable pregnant women and was implemented to mitigate the risk of limited access to essential quality MNH care in Yangon, Myanmar, under women, and the project trained 13 service providers on a telehealth care package for pregnancy and newborn developed Jhpiego to ensure understanding of evidence-based MNCH care practices. The phone numbers of the pregnant women were gathered through the preexisting and functioning community volunteers, who reach the most vulnerable pregnant women in the project's targeted area. A total of 212 pregnant women have been reached by service providers for RPNC during the implementation period. The trained service providers offer quality antenatal and postnatal care, including newborn care, via telephone calls. It includes 24/7 incoming calls and time-allotted outgoing calls to the pregnant women during antenatal and postnatal periods, including the newborn care. The required data were collected daily in time with the calls, and the quality of the medical services is made assured with the track of the calls, ensuring data privacy and patient confidentiality. Lessons learned: The key lessons are 1) cost-effectiveness: RPNC service could reduce out of pocket expenditure of pregnant women as it only costs 1.6 United States dollars (USD) per one telehealth call while it costs 8 to 10 USD per one time in-person care service at private service providers, including transportation cost, 2) network of care: telehealth call could not replace the in-person antenatal and postnatal care services, and integration of telehealth calls with in-person care by local healthcare providers with the support of the community is crucial for accessibility to essential MNH services by poor and vulnerable women, and 3) sharing information on health access points: most of the women seem to have financial barriers in accessing private health facilities while public health system collapse and telehealthcare could provide information on low-cost facilities and connect women to relevant health facilities. These key lessons are important for future efforts regarding the implementation of remote pregnancy and newborn care in Myanmar, especially during the political crisis and COVID-19 pandemic situation.

Keywords: telehealth, accessibility, maternal care, newborn care

Procedia PDF Downloads 66

Authors: Innocent Atuhe, Babra Nalwadda, Grace Mulyowa, Annabella Habinka Ejiri

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Background: Atopic Dermatitis (AD) is one of the most prevalent and growing chronic inflammatory skin diseases in African prisons. AD care is limited in African due to a lack of information about the disease amongst primary care workers, limited access to dermatologists, lack of proper training of healthcare workers, and shortage of appropriate treatments. We designed and implemented the Prisons Telederma project based on the recommendations of the International Society of Atopic Dermatitis. We aimed at; i) increase awareness and understanding of teledermatology among prison health workers and ii) improve treatment outcomes of prisoners with atopic dermatitis through increased access to and utilization of consultant dermatologists through teledermatology in Uganda prisons. Approach: We used Store-and-forward Teledermatology (SAF-TD) to increase access to dermatologist-led care for prisoners and prison staff with AD. We conducted five days of training for prison health workers using an adapted WHO training guide on recognizing neglected tropical diseases through changes on the skin together with an adapted American Academy of Dermatology (AAD) Childhood AD Basic Dermatology Curriculum designed to help trainees develop a clinical approach to the evaluation and initial management of patients with AD. This training was followed by blended e-learning, webinars facilitated by consultant Dermatologists with local knowledge of medication and local practices, apps adjusted for pigmented skin, WhatsApp group discussions, and sharing pigmented skin AD pictures and treatment via zoom meetings. We hired a team of Ugandan Senior Consultant dermatologists to draft an iconographic atlas of the main dermatoses in pigmented African skin and shared this atlas with prison health staff for use as a job aid. We had planned to use MySkinSelfie mobile phone application to take and share skin pictures of prisoners with AD with Consultant Dermatologists, who would review the pictures and prescribe appropriate treatment. Unfortunately, the National Health Service withdrew the app from the market due to technical issues. We monitored and evaluated treatment outcomes using the Patient-Oriented Eczema Measure (POEM) tool. We held four advocacy meetings to persuade relevant stakeholders to increase supplies and availability of first-line AD treatments such as emollients in prison health facilities. Results: We have the very first iconographic atlas of the main dermatoses in pigmented African skin. We increased; i) the proportion of prison health staff with adequate knowledge of AD and teledermatology from 20% to 80%; ii) the proportion of prisoners with AD reporting improvement in disease severity (POEM scores) from 25% to 35% in one year; iii) increased proportion of prisoners with AD seen by consultant dermatologist through teledermatology from 0% to 20% in one year and iv)Increased the availability of AD recommended treatments in prisons health facilities from 5% to 10% in one year. Our study contributes to the use, evaluation, and verification of the use of teledermatology to increase access to specialist dermatology services to the most hard to reach areas and vulnerable populations such as that of prisoners.

Keywords: teledermatology, prisoners, reaching, un-reachable

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Authors: Christabel Ihedike, John Mooney, Monica Price

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Summary: This study aims to critically evaluate effect of photochemical smog on respiratory health in Nigeria. Cohort of chronic obstructive pulmonary disease (COPD) patients was recruited from two large hospitals in Abuja Nigeria. Respiratory health questionnaires, daily diaries, dyspnoea scale and lung function measurement were used to obtain health data and investigate the relationship with air quality data (principally ozone, NOx and particulate pollution). Concentrations of air pollutants were higher than WHO and Nigerian air quality standard. The result suggests a correlation between measured air quality and exacerbation of respiratory illness. Introduction: Photochemical smog is a significant health challenge in most cities and its effect on respiratory health is well acknowledged. This type of pollution is most harmful to the elderly, children and those with underlying respiratory disease. This study aims to investigate impact of increasing temperature and photo-chemically generated secondary air pollutants on respiratory health in Abuja Nigeria. Method and Result: Health data was collected using spirometry to measure lung function on routine attendance at the clinic, daily diaries kept by patients and information obtained using respiratory questionnaire. Questionnaire responses (obtained using an adapted and internally validated version of St George’s Hospital Respiratory Questionnaire), shows that ‘time of wheeze’ showed an association with participants activities: 30% had worse wheeze in the morning: 10% cannot shop, 15% take long-time to get washed, 25% walk slower, 15% if hurry have to stop and 5% cannot take-bath. There was also a decrease in Forced expiratory volume in the first second and Forced Vital Capacity, and daily change in the afternoon–morning may be associated with the concentration level of pollutants. Also, dyspnoea symptoms recorded that 60% of patients were on grade 3, 25% grade 2 and 15% grade 1. Daily frequency of the number of patients in the cohort that cough /brought sputum is 78%. Air pollution in the city is higher than Nigerian and WHO standards with NOx and PM10 concentrations of 693.59ug/m-3 and 748ugm-3 being measured respectively. The result shows that air pollution may increase occurrence and exacerbation of respiratory disease. Conclusion: High temperature and local climatic conditions in urban Nigeria encourages formation of Ozone, the major constituent of photochemical smog, resulting also in the formation of secondary air pollutants associated with health challenges. In this study we confirm the likely potency of the pattern of secondary air pollution in exacerbating COPD symptoms in vulnerable patient group in urban Nigeria. There is need for better regulation and measures to reduce ozone, particularly when local climatic conditions favour development of photochemical smog in such settings. Climate change and likely increasing temperatures add impetus and urgency for better air quality standards and measures (traffic-restrictions and emissions standards) in developing world settings such as Nigeria.

Keywords: Abuja-Nigeria, effect, photochemical smog, respiratory health

Procedia PDF Downloads 193

Authors: Grant Bifolchi

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As global environmental problems continue to have highly adverse effects, finding long-term, sustainable solutions to combat ecological distress are of growing paramount concern. Ghost Gear—also known as abandoned, lost or otherwise discarded fishing gear (ALDFG) and derelict fishing gear (DFG)—represents one of the greatest threats to the world’s oceans, posing a significant hazard to human health, livelihoods, and global food security. In fact, according to the UN Food and Agriculture Organization (FAO), abandoned, lost and discarded fishing gear represents approximately 10% of marine debris by volume. Around the world, many governments, governmental and non-profit organizations are doing their best to manage the reporting and retrieval of nets, lines, ropes, traps, floats and more from their respective bodies of water. However, these organizations’ ability to effectively manage files and documents about the environmental problem further complicates matters. In Ghost Gear monitoring and management, organizations face additional complexities. Whether it’s data ingest, industry regulations and standards, garnering actionable insights into the location, security, and management of data, or the application of enforcement due to disparate data—all of these factors are placing massive strains on organizations struggling to save the planet from the dangers of Ghost Gear. In this 90-minute educational session, globally recognized Ghost Gear technology expert Grant Bifolchi CET, BBA, Bcom, will provide real-world insight into how governments currently manage Ghost Gear and the technology that can accelerate success in combatting ALDFG and DFG. In this session, attendees will learn how to: • Identify specific technologies to solve the ingest and management of Ghost Gear data categories, including type, geo-location, size, ownership, regional assignment, collection and disposal. • Provide enhanced access to authorities, fisheries, independent fishing vessels, individuals, etc., while securely controlling confidential and privileged data to globally recognized standards. • Create and maintain processing accuracy to effectively track ALDFG/DFG reporting progress—including acknowledging receipt of the report and sharing it with all pertinent stakeholders to ensure approvals are secured. • Enable and utilize Business Intelligence (BI) and Analytics to store and analyze data to optimize organizational performance, maintain anytime-visibility of report status, user accountability, scheduling, management, and foster governmental transparency. • Maintain Compliance Reporting through highly defined, detailed and automated reports—enabling all stakeholders to share critical insights with internal colleagues, regulatory agencies, and national and international partners.

Keywords: ghost gear, ALDFG, DFG, abandoned, lost or otherwise discarded fishing gear, data, technology

Procedia PDF Downloads 71

Authors: Jing Zhang, Yvonne Reinwald, Nick Poulson, Alicia El Haj, Chung See, Mike Somekh, Melissa Mather

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Biomedical imaging of native tissue using light offers the potential to obtain excellent structural and functional information in a non-invasive manner with good temporal resolution. Image contrast can be derived from intrinsic absorption, fluorescence, or scatter, or through the use of extrinsic contrast. A major challenge in applying optical microscopy to in vivo tissue imaging is the effects of light attenuation which limits light penetration depth and achievable imaging resolution. Recently Selective Plane Illumination Microscopy (SPIM) has been used to map the 3D distribution of fluorophores dispersed in biological structures. In this approach, a focused sheet of light is used to illuminate the sample from the side to excite fluorophores within the sample of interest. Images are formed based on detection of fluorescence emission orthogonal to the illumination axis. By scanning the sample along the detection axis and acquiring a stack of images, 3D volumes can be obtained. The combination of rapid image acquisition speeds with the low photon dose to samples optical sectioning provides SPIM is an attractive approach for imaging biological samples in 3D. To date all implementations of SPIM rely on the use of fluorescence reporters be that endogenous or exogenous. This approach has the disadvantage that in the case of exogenous probes the specimens are altered from their native stage rendering them unsuitable for in vivo studies and in general fluorescence emission is weak and transient. Here we present for the first time to our knowledge a label-free implementation of SPIM that has downstream applications in the clinical setting. The experimental set up used in this work incorporates both label-free and fluorescent illumination arms in addition to a high specification camera that can be partitioned for simultaneous imaging of both fluorescent emission and scattered light from intrinsic sources of optical contrast in the sample being studied. This work first involved calibration of the imaging system and validation of the label-free method with well characterised fluorescent microbeads embedded in agarose gel. 3D constructs of mammalian cells cultured in agarose gel with varying cell concentrations were then imaged. A time course study to track cell proliferation in the 3D construct was also carried out and finally a native tissue sample was imaged. For each sample multiple images were obtained by scanning the sample along the axis of detection and 3D maps reconstructed. The results obtained validated label-free SPIM as a viable approach for imaging cells in a 3D gel construct and native tissue. This technique has the potential use in a near-patient environment that can provide results quickly and be implemented in an easy to use manner to provide more information with improved spatial resolution and depth penetration than current approaches.

Keywords: bioimaging, optics, selective plane illumination microscopy, tissue imaging

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Authors: Suliman Al-Fayoumi, Sherri Amberg, Huafeng Zhou, Jack W. Singer, James P. Dean

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Pacritinib is an oral kinase inhibitor with specificity for JAK2, FLT3, IRAK1, and CSF1R. In clinical studies, pacritinib was well tolerated with clinical activity in patients with myelofibrosis. The most frequent adverse events (AEs) observed with pacritinib are gastrointestinal (diarrhea, nausea, and vomiting; mostly grade 1-2 in severity) and typically resolve within 2 weeks. A human ADME mass balance study demonstrated that pacritinib is predominantly cleared via hepatic metabolism and biliary excretion (>85% of administered dose). The major hepatic metabolite identified, M1, is not thought to materially contribute to the pharmacological activity of pacritinib. Hepatic diseases are known to impair hepatic blood flow, drug-metabolizing enzymes, and biliary transport systems and may affect drug absorption, disposition, efficacy, and toxicity. This phase 1 study evaluated the pharmacokinetics (PK) and safety of pacritinib and the M1 metabolite in study subjects with mild, moderate, or severe hepatic impairment (HI) and matched healthy subjects with normal liver function to determine if pacritinib dosage adjustments are necessary for patients with varying degrees of hepatic insufficiency. Study participants (aged 18-85 y) were enrolled into 4 groups based on their degree of HI as defined by Child-Pugh Clinical Assessment Score: mild (n=8), moderate (n=8), severe (n=4), and healthy volunteers (n=8) matched for age, BMI, and sex. Individuals with concomitant renal dysfunction or progressive liver disease were excluded. A single 400 mg dose of pacritinib was administered to all participants. Blood samples were obtained for PK evaluation predose and at multiple time points postdose through 168 h. Key PK parameters evaluated included maximum plasma concentration (Cmax), time to Cmax (Tmax), area under the plasma concentration time curve (AUC) from hour zero to last measurable concentration (AUC0-t), AUC extrapolated to infinity (AUC0-∞), and apparent terminal elimination half-life (t1/2). Following treatment, pacritinib was quantifiable for all study participants at 1 h through 168 h postdose. Systemic pacritinib exposure was similar between healthy volunteers and individuals with mild HI. However, there was a significant difference between those with moderate and severe HI and healthy volunteers with respect to peak concentration (Cmax) and plasma exposure (AUC0-t, AUC0-∞). Mean Cmax decreased by 47% and 57% respectively in participants with moderate and severe HI vs matched healthy volunteers. Similarly, mean AUC0-t decreased by 36% and 45% and mean AUC0-∞ decreased by 46% and 48%, respectively in individuals with moderate and severe HI vs healthy volunteers. Mean t1/2 ranged from 51.5 to 74.9 h across all groups. The variability on exposure ranged from 17.8% to 51.8% across all groups. Systemic exposure of M1 was also significantly decreased in study participants with moderate or severe HI vs. healthy participants and individuals with mild HI. These changes were not significantly dissimilar from the inter-patient variability in these parameters observed in healthy volunteers. All AEs were grade 1-2 in severity. Diarrhea and headache were the only AEs reported in >1 participant (n=4 each). Based on these observations, it is unlikely that dosage adjustments would be warranted in patients with mild, moderate, or severe HI treated with pacritinib.

Keywords: pacritinib, myelofibrosis, hepatic impairment, pharmacokinetics

Procedia PDF Downloads 274

Authors: Indra Bahadur Chand

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This paper will focus on the need for development and application of global protocols and policy in planning, designing, development, and management of systems of eco-towns and eco-villages so that sustainable development will be assured from the perspective of environmental, economical, peace, and harmonized social dynamics. This perspective is essential for the development of civilized and eco-friendly human settlements in the town and rural areas of the nation that will be a milestone for developing a happy and sustainable lifestyle of rural and urban communities of the nation. The urban population of most of the town of developing economies has been tremendously increasing, whereas rural people have been tremendously migrating for the past three decades. Consequently, the urban lifestyle in most towns has stressed in terms of environmental pollution, water crisis, congested traffic, energy crisis, food crisis, and unemployment. Eco-towns and villages should be developed where lifestyle of all residents is sustainable and happy. Built up environment of settlement should reduce and minimize the problems of non ecological CO2 emissions, unbalanced utilization of natural resources, environmental degradation, natural calamities, ecological imbalance, energy crisis, water scarcity, waste management, food crisis, unemployment, deterioration of cultural heritage, social, the ratio among the public and private land ownership, ratio of land covered with vegetation and area of settlement, the ratio of people in the vehicles and foot, the ratio of people employed outside of town and village, ratio of resources recycling of waste materials, water consumption level, the ratio of people and vehicles, ratio of the length of the road network and area of town/villages, a ratio of renewable energy consumption with total energy, a ratio of religious/recreational area out of the total built-up area, the ratio of annual suicide case out of total people, a ratio of annual injured and death out of total people from a traffic accident, a ratio of production of agro foods within town out of total food consumption will be used to assist in designing and monitoring of each eco-towns and villages. An eco-town and villages should be planned and developed to offer sustainable infrastructure and utilities that maintain CO2 level in individual homes and settlements, home energy use, transport, food and consumer goods, water supply, waste management, conservation of historical heritages, healthy neighborhood, conservation of natural landscape, conserving bio-diversity and developing green infrastructures. Eco-towns and villages should be developed on the basis of master planning and architecture that affect and define the settlement and its form. Master planning and engineering should focus in delivering the sustainability criteria of eco towns and eco village. This will involve working with specific landscape and natural resources of locality.

Keywords: eco-town, ecological habitation, master plan, sustainable development

Procedia PDF Downloads 151

Authors: Jiri Cecrdle

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This paper describes the concept of the W-WING whirl flutter aeroelastic demonstrator. Whirl flutter is the specific case of flutter that accounts for the additional dynamic and aerodynamic influences of the engine rotating parts. The instability is driven by motion-induced unsteady aerodynamic propeller forces and moments acting in the propeller plane. Whirl flutter instability is a serious problem that may cause the unstable vibration of a propeller mounting, leading to the failure of an engine installation or an entire wing. The complicated physical principle of whirl flutter required the experimental validation of the analytically gained results. W-WING aeroelastic demonstrator has been designed and developed at Czech Aerospace Research Centre (VZLU) Prague, Czechia. The demonstrator represents the wing and engine of the twin turboprop commuter aircraft. Contrary to the most of past demonstrators, it includes a powered motor and thrusting propeller. It allows the changes of the main structural parameters influencing the whirl flutter stability characteristics. Propeller blades are adjustable at standstill. The demonstrator is instrumented by strain gauges, accelerometers, revolution-counting impulse sensor, sensor of airflow velocity, and the thrust measurement unit. Measurement is supported by the in house program providing the data storage and real-time depiction in the time domain as well as pre-processing into the form of the power spectral densities. The engine is linked with a servo-drive unit, which enables maintaining of the propeller revolutions (constant or controlled rate ramp) and monitoring of immediate revolutions and power. Furthermore, the program manages the aerodynamic excitation of the demonstrator by the aileron flapping (constant, sweep, impulse). Finally, it provides the safety guard to prevent any structural failure of the demonstrator hardware. In addition, LMS TestLab system is used for the measurement of the structure response and for the data assessment by means of the FFT- and OMA-based methods. The demonstrator is intended for the experimental investigations in the VZLU 3m-diameter low-speed wind tunnel. The measurement variant of the model is defined by the structural parameters: pitch and yaw attachment stiffness, pitch and yaw hinge stations, balance weight station, propeller type (duralumin or steel blades), and finally, angle of attack of the propeller blade 75% section (). The excitation is provided either by the airflow turbulence or by means of the aerodynamic excitation by the aileron flapping using a frequency harmonic sweep. The experimental results are planned to be utilized for validation of analytical methods and software tools in the frame of development of the new complex multi-blade twin-rotor propulsion system for the new generation regional aircraft. Experimental campaigns will include measurements of aerodynamic derivatives and measurements of stability boundaries for various configurations of the demonstrator.

Keywords: aeroelasticity, flutter, whirl flutter, W WING demonstrator

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Authors: Kuo-Kai Lin, Po-Lun Chang

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Research Background and Purpose: Following the development of the Internet and multimedia, the Internet and information technology have become crucial avenues of modern communication and knowledge acquisition. The advantages of using mobile devices for learning include making learning borderless and accessible. Mobile learning has become a trend in disease management and health promotion in recent years. End-stage renal disease (ESRD) is an irreversible chronic disease, and patients who do not receive kidney transplants can only rely on hemodialysis or peritoneal dialysis to survive. Due to the complexities in caregiving for patients with ESRD that stem from their advanced age and other comorbidities, the patients’ incapacity of self-care leads to an increase in the need to rely on their families or primary caregivers, although whether the primary caregivers adequately understand and implement patient care is a topic of concern. Therefore, this study explored whether primary caregivers’ health care provisions can be improved through the intervention of an automatic speech intelligent system, thereby improving the objective health outcomes of patients undergoing long-term dialysis. Method: This study developed an automatic speech intelligent system with healthcare functions such as health information voice prompt, two-way feedback, real-time push notification, and health information delivery. Convenience sampling was adopted to recruit eligible patients from a hemodialysis center at a regional teaching hospital as research participants. A one-group pretest-posttest design was adopted. Descriptive and inferential statistics were calculated from the demographic information collected from questionnaires answered by patients and primary caregivers, and from a medical record review, a health care scale (recorded six months before and after the implementation of intervention measures), a subjective health assessment, and a report of objective physiological indicators. The changes in health care behaviors, subjective health status, and physiological indicators before and after the intervention of the proposed automatic speech intelligent system were then compared. Conclusion and Discussion: The preliminary automatic speech intelligent system developed in this study was tested with 20 pretest patients at the recruitment location, and their health care capacity scores improved from 59.1 to 72.8; comparisons through a nonparametric test indicated a significant difference (p < .01). The average score for their subjective health assessment rose from 2.8 to 3.3. A survey of their objective physiological indicators discovered that the compliance rate for the blood potassium level was the most significant indicator; its average compliance rate increased from 81% to 94%. The results demonstrated that this automatic speech intelligent system yielded a higher efficacy for chronic disease care than did conventional health education delivered by nurses. Therefore, future efforts will continue to increase the number of recruited patients and to refine the intelligent system. Future improvements to the intelligent system can be expected to enhance its effectiveness even further.

Keywords: automatic speech intelligent system for health care, primary caregiver, long-term hemodialysis, health care capabilities, health outcomes

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Authors: Sunitha Sampathi, Pankaj Kumar Tiriya, Sonia Gera, Sravanthi Reddy Pailla, V. Likhitha, A. J. Maruthi

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Surgical site infections (SSIs) are the most common nosocomial infections localized at the incision site. With an estimated 27 million surgical procedures each year in USA, approximately 2-5% rate of SSIs are predicted to occur annually. SSIs are treated with antibiotic medication. Current trend suggest that the direct drug delivery from the suture to the scared tissue can improve patient comfort and wound recovery. For that reason coating the surface of the medical device such as suture and catguts with broad spectrum antibiotics can prevent the formation of bactierial colonies with out comprimising the mechanical properties of the sutures.Hence, the present study was aimed to develop and evaluate a surgical suture coated with an antibiotic Ciprofloxacin hydrochloride loaded on gold nanoparticles. Gold nanoparticles were synthesized by chemical reduction method and conjugated with ciprofloxacin using Polyvinylpyrolidone as stabilizer and gold as carrier. Ciprofloxacin conjugated gold nanoparticles were coated over an absorbable surgical suture made of Polyglactan using sodium alginate as an immobilising agent by slurry dipping technique. The average particle size and Polydispersity Index of drug conjugated gold NPs were found to be 129±2.35 nm and 0.243±0.36 respectively. Gold nanoparticles are characterized by UV-Vis absorption spectroscopy, Fourier Transform Infrared Spectroscopy (FT-IR), Scanning electron microscopy and Transmission electron microscopy. FT-IR revealed that there is no chemical interaction between drug and polymer. Antimicrobial activity for coated sutures was evaluated by disc diffusion method on culture plates of both gram negative (E-coli) and gram positive bacteria (Staphylococcus aureus) and results found to be satisfactory. In vivo studies for coated sutures was performed on Swiss albino mice and histological evaluation of intestinal wound healing parameters such as wound edges in mucosa, muscularis, presence of necrosis, exudates, granulation tissue, granulocytes, macrophages, restoration, and repair of mucosal epithelium and muscularis propria on day 7 after surgery were studied. The control animal group, sutured with plain suture (uncoated suture) showed signs of restoration and repair, but presence of necrosis, heamorraghic infiltration and granulation tissue was still noticed. Whereas the animal group treated with ciprofloxacin and ciprofloxacin gold nanoparticle coated sutures has shown promising decrease in terms of haemorraghic infiltration, granulation tissue, necrosis and better repaired muscularis layers on comparision with plain coated sutures indicating faster rate of repair and less chance of sepsis. Hence coating of sutures with broad spectrum antibiotics can be an alternate technique to reduce SSIs.

Keywords: ciprofloxacin hydrochloride, gold nanoparticles, surgical site infections, sutures

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Authors: Elizaveta S. Prokofyeva, Svetlana V. Maltseva, Roman D. Zaitsev

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Rapidly evolving modern data analysis technologies in healthcare play a large role in understanding the operation of the system and its characteristics. Nowadays, one of the key tasks in urban healthcare is to optimize the resource allocation. Thus, the application of data analysis in medical institutions to solve optimization problems determines the significance of this study. The purpose of this research was to establish the dependence between the indicators of the effectiveness of the medical institution and its resources. Hospital discharges by diagnosis; hospital days of in-patients and in-patient average length of stay were selected as the performance indicators and the demand of the medical facility. The hospital beds by type of care, medical technology (magnetic resonance tomography, gamma cameras, angiographic complexes and lithotripters) and physicians characterized the resource provision of medical institutions for the developed models. The data source for the research was an open database of the statistical service Eurostat. The choice of the source is due to the fact that the databases contain complete and open information necessary for research tasks in the field of public health. In addition, the statistical database has a user-friendly interface that allows you to quickly build analytical reports. The study provides information on 28 European for the period from 2007 to 2016. For all countries included in the study, with the most accurate and complete data for the period under review, predictive models were developed based on historical panel data. An attempt to improve the quality and the interpretation of the models was made by cluster analysis of the investigated set of countries. The main idea was to assess the similarity of the joint behavior of the variables throughout the time period under consideration to identify groups of similar countries and to construct the separate regression models for them. Therefore, the original time series were used as the objects of clustering. The hierarchical agglomerate algorithm k-medoids was used. The sampled objects were used as the centers of the clusters obtained, since determining the centroid when working with time series involves additional difficulties. The number of clusters used the silhouette coefficient. After the cluster analysis it was possible to significantly improve the predictive power of the models: for example, in the one of the clusters, MAPE error was only 0,82%, which makes it possible to conclude that this forecast is highly reliable in the short term. The obtained predicted values of the developed models have a relatively low level of error and can be used to make decisions on the resource provision of the hospital by medical personnel. The research displays the strong dependencies between the demand for the medical services and the modern medical equipment variable, which highlights the importance of the technological component for the successful development of the medical facility. Currently, data analysis has a huge potential, which allows to significantly improving health services. Medical institutions that are the first to introduce these technologies will certainly have a competitive advantage.

Keywords: data analysis, demand modeling, healthcare, medical facilities

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Authors: Abdou Elhendy

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Numerous study have shown the efficacy of the percutaneous intervention (PCI) and coronary stenting in improving left ventricular function and relieving exertional angina. Furthermore, PCI remains the main line of therapy in acute myocardial infarction. Improvement of procedural techniques and new devices have resulted in an increased number of PCI in those with difficult and extensive lesions, multivessel disease as well as total occlusion. Immediate and late outcome may be compromised by acute thrombosis or the development of fibro-intimal hyperplasia. In addition, progression of coronary artery disease proximal or distal to the stent as well as in non-stented arteries is not uncommon. As a result, complications can occur, such as acute myocardial infarction, worsened heart failure or recurrence of angina. In a stent, restenosis can occur without symptoms or with atypical complaints rendering the clinical diagnosis difficult. Routine invasive angiography is not appropriate as a follow up tool due to associated risk and cost and the limited functional assessment. Exercise and pharmacologic stress testing are increasingly used to evaluate the myocardial function, perfusion and adequacy of revascularization. Information obtained by these techniques provide important clues regarding presence and severity of compromise in myocardial blood flow. Stress echocardiography can be performed in conjunction with exercise or dobutamine infusion. The diagnostic accuracy has been moderate, but the results provide excellent prognostic stratification. Adding myocardial contrast agents can improve imaging quality and allows assessment of both function and perfusion. Stress radionuclide myocardial perfusion imaging is an alternative to evaluate these patients. The extent and severity of wall motion and perfusion abnormalities observed during exercise or pharmacologic stress are predictors of survival and risk of cardiac events. According to current guidelines, stress echocardiography and radionuclide imaging are considered to have appropriate indication among patients after PCI who have cardiac symptoms and those who underwent incomplete revascularization. Stress testing is not recommended in asymptomatic patients, particularly early after revascularization, Coronary CT angiography is increasingly used and provides high sensitive for the diagnosis of coronary artery stenosis. Average sensitivity and specificity for the diagnosis of in stent stenosis in pooled data are 79% and 81%, respectively. Limitations include blooming artifacts and low feasibility in patients with small stents or thick struts. Anatomical and functional cardiac imaging modalities are corner stone for the assessment of patients after PCI and provide salient diagnostic and prognostic information. Current imaging techniques cans serve as gate keeper for coronary angiography, thus limiting the risk of invasive procedures to those who are likely to benefit from subsequent revascularization. The determination of which modality to apply requires careful identification of merits and limitation of each technique as well as the unique characteristic of each individual patient.

Keywords: coronary artery disease, stress testing, cardiac imaging, restenosis

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Authors: Lucile Rapin, Cynthia El Hage, Rihab Gamaoun, Maria-Fernanda Arboleda, Erin Prosk

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Introduction: Sante Cannabis (SC), a Canadian group of clinics dedicated to medical cannabis, based in Montreal and in the province of Quebec, has served more than 8000 patients seeking cannabis-based treatment over the past five years. As randomized clinical trials with natural medical cannabis are scarce, real-world evidence offers the opportunity to fill research gaps between scientific evidence and clinical practice. Data on the use of medical cannabis products from SC patients were prospectively collected, leading to a large real-world database on the use of medical cannabis. The aim of this study was to report information on the profiles of both patients and prescribed medical cannabis products at SC clinics, and to assess the safety of medical cannabis among Canadian patients. Methods: This is an observational retrospective study of 1342 adult patients who were authorized with medical cannabis products between October 2017 and September 2019. Information regarding demographic characteristics, therapeutic indications for medical cannabis use, patterns in dosing and dosage form of medical cannabis and adverse effects over one-year follow-up (initial and 4 follow-up (FUP) visits) were collected. Results: 59% of SC patients were female, with a mean age of 56.7 (SD= 15.6, range= (19-97)). Cannabis products were authorized mainly for patients with a diagnosis of chronic pain (68.8% of patients), cancer (6.7%), neurological disorders (5.6%), and mood disorders (5.4 %). At initial visit, a large majority (70%) of patients were authorized exclusively medical cannabis products, 27% were authorized a combination of pharmaceutical cannabinoids and medical cannabis and 3% were prescribed only pharmaceutical cannabinoids. This pattern was recurrent over the one-year follow-up. Overall, oil was the preferred formulation (average over visits 72.5%) followed by a combination of oil and dry (average 19%), other routes of administration accounted for less than 4%. Patients were predominantly prescribed products with a balanced THC:CBD ratio (59%-75% across visits). 28% of patients reported at least one adverse effect (AE) at the 3-month follow-up visit and 12% at the six-month FUP visit. 84.8% of total AEs were mild and transient. No serious AE was reported. Overall, the most common side effects reported were dizziness (11.95% of total AEs), drowsiness (11.4%), dry mouth (5.5%), nausea (4.8%), headaches (4.6%), cough (4.4%), anxiety (4.1%) and euphoria (3.5%). Other adverse effects accounted for less than 3% of total AE. Conclusion: Our results confirm that the primary area of clinical use for medical cannabis is in pain management. Patients in this cohort are largely utilizing plant-based cannabis oil products with a balanced ratio of THC:CBD. Reported adverse effects were mild and included dizziness and drowsiness. This real-world data confirms the tolerable safety profile of medical cannabis and suggests medical indications not yet validated in controlled clinical trials. Such data offers an important opportunity for the investigation of the long-term effects of cannabinoid exposure in real-life conditions. Real-world evidence can be used to direct clinical trial research efforts on specific indications and dosing patterns for product development.

Keywords: medical cannabis, safety, real-world data, Canada

Procedia PDF Downloads 100

Authors: Gabriela Prins, Quinette Louw, Dawn Ernstzen

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Background: Access to rehabilitation services is a major challenge globally, especially in low-and-middle income countries (LMICs) where resources and infrastructure are extremely limited. Telerehabilitation (TR) has emerged in recent decades as a highly promising method to dramatically expand accessibility to rehabilitation services globally. TR provides rehabilitation care remotely using communication technologies such as video conferencing, smartphones, and internet-connected devices. This boosts accessibility to underprivileged regions and allows for greater flexibility for patients. Despite this, TR is hindered by several factors, including limited technological resources, high costs, lack of digital access, and the unavailability of healthcare systems, which are major barriers to widespread adoption among LMIC patients. These barriers have collectively hindered the potential implementation and adoption of TR services in LMICs healthcare settings. Adoption of TR will also require the buy-in of end users and limited information is known on the perspectives of the SA population. Aim: The study aimed to understand patients' perspectives regarding the use of digital technology as part of their OA rehabilitation at a public community healthcare centre in the Cape Metropole Area. Methods: A qualitative descriptive study design was used on 10 OA patients from a public community rehabilitation centre in South Africa. Data collection included semi-structured interviews and patient-reported outcome measures (PSFS, ASES-8, and EuroQol EQ-5D-5L) on functioning and quality of life. Transcribed interview data were coded in Atlas.ti. 22.2 and analyzed using thematic analysis. The results were narratively documented. Results: Four themes arose from the interviews. The themes were Telerehabilitation awareness (Use of Digital Technology Information Sources and Prior Experience with Technology /TR), Telerehabilitation Benefits (Access to healthcare providers, Access to educational information, Convenience, Time and Resource Efficiency and Facilitating Family Involvement), Telerehabilitation Implementation Considerations (Openness towards TR Implementation, Learning about TR and Technology, Therapeutic relationship, and Privacy) and Future use of Telerehabilitation (Personal Preference and TR for the next generation). The ten participants demonstrated limited awareness and exposure to TR, as well as minimal digital literacy and skills. Skepticism was shown when comparing the effectiveness of TR to in-person rehabilitation and valued physical interactions with health professionals. However, some recognized potential benefits of TR for accessibility, convenience, family involvement and improving community health in the long term. Willingness existed to try TR with sufficient training. Conclusion: With targeted efforts addressing identified barriers around awareness, technological literacy, clinician readiness and resource availability, perspectives on TR may shift positively from uncertainty towards endorsement of this expanding approach for simpler rehabilitation access in LMICs.

Keywords: digital technology, osteoarthritis, primary health care, telerehabilitation

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