Search results for: remote decentralized clinical trials

Authors: Virgil Miranda, Gissele Mosqueda, Pablo Delgado, Yimesker Yihun

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Muscular fatigue affects the muscle activation that is needed for producing the desired clinical outcome. Integrating optimal muscle relaxation periods into a variety of health care rehabilitation protocols is important to maximize the efficiency of the therapy. In this study, four muscle relaxation periods (30, 60, 90 and 120 seconds) and their effectiveness in producing consistent muscle activation of the muscle biceps brachii between sets of an elbow flexion and extension task were investigated among a sample of 10 subjects with no disabilities. The same resting periods were then utilized in a controlled exoskeleton-based exercise for a sample size of 5 subjects and have shown similar results. On average, the muscle activity of the biceps brachii decreased by 0.3% when rested for 30 seconds, and it increased by 1.25%, 0.76% and 0.82% when using muscle relaxation periods of 60, 90 and 120 seconds, respectively. The preliminary results suggest that a muscle relaxation period of about 60 seconds is needed for optimal continuous muscle activation within rehabilitation regimens. Robot-based rehabilitation is good to produce repetitive tasks with the right intensity and knowing the optimal resting period will make the automation more effective.

Keywords: Rest intervals, muscle biceps brachii, robot rehabilitation, muscle fatigue.

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Authors: Miriam I. Lautenschläger, Max H. Scheiwe, Kay A. Weidenmann, Frank Henning, Peter Elsner

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Due to increasing environmental awareness jute fibers are more often used in fiber reinforced composites. In the Sheet Molding Compound (SMC) process, the mold cavity is filled via material flow allowing more complex component design. But, the difficulty of using jute fibers in this process is the decreased capacity of fiber movement in the mold. A comparative flow study with jute nonwoven reinforced SMC was conducted examining the influence of the fiber volume content, the grammage of the jute nonwoven textile and a mechanical modification of the nonwoven textile on the flowability. The nonwoven textile reinforcement was selected to support homogeneous fiber distribution. Trials were performed using two SMC paste formulations differing only in filler type. Platy-shaped kaolin with a mean particle size of 0.8 μm and ashlar calcium carbonate with a mean particle size of 2.7 μm were selected as fillers. Ensuring comparability of the two SMC paste formulations the filler content was determined to reach equal initial viscosity for both systems. The calcium carbonate filled paste was set as reference. The flow study was conducted using a jute nonwoven textile with 300 g/m² as reference. The manufactured SMC sheets were stacked and centrally placed in a square mold. The mold coverage was varied between 25 and 90% keeping the weight of the stack for comparison constant. Comparing the influence of the two fillers kaolin yielded better results regarding a homogeneous fiber distribution. A mold coverage of about 68% was already sufficient to homogeneously fill the mold cavity whereas for calcium carbonate filled system about 79% mold coverage was necessary. The flow study revealed a strong influence of the fiber volume content on the flowability. A fiber volume content of 12 vol.-% and 25 vol.-% were compared for both SMC formulations. The lower fiber volume content strongly supported fiber transport whereas 25 vol.-% showed insignificant influence. The results indicate a limiting fiber volume content for the flowability. The influence of the nonwoven textile grammage was determined using nonwoven jute material with 500 g/m² and a fiber volume content of 20 vol.-%. The 500 g/m² reinforcement material showed inferior results with regard to fiber movement. A mold coverage of about 90 % was required to prevent the destruction of the nonwoven structure. Below this mold coverage the 500 g/m² nonwoven material was ripped and torn apart. Low mold coverages led to damage of the textile reinforcement. Due to the ripped nonwoven structure the textile was modified with cuts in order to facilitate fiber movement in the mold. Parallel cuts of about 20 mm length and 20 mm distance to each other were applied to the textile and stacked with varying orientations prior to molding. Stacks with unidirectional orientated cuts over stacks with cuts in various directions e.g. (0°, 45°, 90°, -45°) were investigated. The mechanical modification supported tearing of the textile without achieving benefit for the flowability.

Keywords: Filler, flowability, jute fiber, nonwoven, sheet molding compound.

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Authors: Anthony Bawa, Konstantinos Banitsas

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Rheumatism is a muscular disorder that affects the muscles of the upper and lower limbs. This condition could potentially progress to impair the movement of patients. This study aims to investigate the hip muscular imbalance in patients with chronic rheumatism. A clinical trial involving a total of 15 participants, made up of 10 patients and five control subjects, took place in KATH Hospital between August and September. Participants recruited for the study were of age 54 ± 8 years, weight 65 ± 8 kg, and height 176 ± 8 cm. Muscle signals were recorded from the rectus femoris, and vastus lateralis on the right and left hip of participants. The parameters used in determining the hip muscular imbalances were the maximum voluntary contraction (MVC%), the mean difference, and hip muscle fatigue levels. The mean signals were compared using a t-test, and the metrics for muscle fatigue assessment were based on the root mean square (RMS), mean absolute value (MAV) and mean frequency (MEF), which were computed between the hip muscles of participants. The results indicated that there were significant imbalances in the muscle coactivity between the right and left hip muscles of patients. The patients’ MVC values were observed to be above 10% when compared with control subjects. Furthermore, the mean difference was seen to be higher with p > 0.002 among patients, which indicated clear differences in the hip muscle contraction activities. The findings indicate significant hip muscular imbalances for patients with rheumatism compared with control subjects. Information about the imbalances among patients will be useful for clinicians in designing therapeutic muscle-strengthening exercises.

Keywords: Muscular, imbalances, rheumatism, hip.

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Authors: B. Farahani, R. Fadil, A. Aboonabi, B. Hoffmann, J. Loscheider, K. Tavakolian, S. Arzanpour

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Wheelchair users spend long hours in a sitting position, and selecting the right cushion is highly critical in preventing pressure ulcers in that demographic. Pressure Mapping Systems (PMS) are typically used in clinical settings by therapists to identify the sitting profile and pressure points in the sitting area to select the cushion that fits the best for the users. A PMS is a flexible mat composed of arrays of distributed networks of pressure sensors. The output of the PMS systems is a color-coded image that shows the intensity of the pressure concentration. Therapists use the PMS images to compare different cushions fit for each user. This process is highly subjective and requires good visual memory for the best outcome. This paper aims to develop an image processing technique to analyze the images of PMS and provide an objective measure to assess the cushions based on their pressure distribution mappings. In this paper, we first reviewed the skeletal anatomy of the human sitting area and its relation to the PMS image. This knowledge is then used to identify the important features that must be considered in image processing. We then developed an algorithm based on those features to analyze the images and rank them according to their fit to the user's needs. 

Keywords: cushion, image processing, pressure mapping system, wheelchair

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Authors: Amer A. Hasan, Mehri Igci, Ersin Borazan, Rozhgar A. Khailany, Emine Bayraktar, Ahmet Arslan

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Gastric Cancer (GC) has high morbidity and fatality rate in various countries. It is still one of the most frequent and deadly diseases. Gastrokine1 (GKN1) and gastrokine2 (GKN2) genes are highly expressed in the normal stomach epithelium and play important roles in maintaining the integrity and homeostasis of stomach mucosal epithelial cells. In this study, 47 paired samples that were grouped according to the types of gastric cancer and the clinical characteristics of the patients, including gender and average of age. They were investigated with gene expression analysis and mutation screening by monitoring RT-PCR, SSCP and nucleotide sequencing techniques. Both GKN1 and GKN2 genes were observed significantly reduced found by (Wilcoxon signed rank test; p<0.05). As a result of gene screening, no mutation (no different genotype) was detected. It is considered that gene mutations are not the cause of gastrokines inactivation. In conclusion, the mRNA expression level of GKN1 and GKN2 genes statistically was decreased regardless the gender, age, or cancer type of patients. Reduced of gastrokine genes seem to occur at the initial steps of gastric cancer development.

Keywords: Diagnostic biomarker, gastric cancer, nucleotide sequencing, semi-quantitative RT-PCR.

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Authors: A. I. A. Rahman, Sh-Hussain Salleh, K. Ahmad, K. Anuar

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Analysis of vocal fold vibration is essential for understanding the mechanism of voice production and for improving clinical assessment of voice disorders. This paper presents a Dynamic Time Warping (DTW) based approach to analyze and objectively classify vocal fold vibration patterns. The proposed technique was designed and implemented on a Glottal Area Waveform (GAW) extracted from high-speed laryngeal images by delineating the glottal edges for each image frame. Feature extraction from the GAW was performed using Linear Predictive Coding (LPC). Several types of voice reference templates from simulations of clear, breathy, fry, pressed and hyperfunctional voice productions were used. The patterns of the reference templates were first verified using the analytical signal generated through Hilbert transformation of the GAW. Samples from normal speakers’ voice recordings were then used to evaluate and test the effectiveness of this approach. The classification of the voice patterns using the technique of LPC and DTW gave the accuracy of 81%.

Keywords: Dynamic Time Warping, Glottal Area Waveform, Linear Predictive Coding, High-Speed Laryngeal Images, Hilbert Transform.

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Authors: Shahriar Farzam, Maryam Rastgarpour

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Image denoising plays extremely important role in digital image processing. Enhancement of clinical image research based on Curvelet has been developed rapidly in recent years. In this paper, we present a method for image contrast enhancement for cone beam CT (CBCT) images based on fast discrete curvelet transforms (FDCT) that work through Unequally Spaced Fast Fourier Transform (USFFT). These transforms return a table of Curvelet transform coefficients indexed by a scale parameter, an orientation and a spatial location. Accordingly, the coefficients obtained from FDCT-USFFT can be modified in order to enhance contrast in an image. Our proposed method first uses a two-dimensional mathematical transform, namely the FDCT through unequal-space fast Fourier transform on input image and then applies thresholding on coefficients of Curvelet to enhance the CBCT images. Consequently, applying unequal-space fast Fourier Transform leads to an accurate reconstruction of the image with high resolution. The experimental results indicate the performance of the proposed method is superior to the existing ones in terms of Peak Signal to Noise Ratio (PSNR) and Effective Measure of Enhancement (EME).

Keywords: Curvelet transform, image enhancement, CBCT, image denoising.

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Authors: Emily Kislik, Gabriel Mantilla Saltos, Gladys Torres, Mercy Borbor-Córdova

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The Galápagos Marine Reserve (GMR) is an internationally-recognized region of consistent upwelling events, high productivity, and rich biodiversity. Despite its high-nutrient, low-chlorophyll condition, the archipelago has experienced phytoplankton blooms, especially in the western section between Isabela and Fernandina Islands. However, little is known about how climate variability will affect future phytoplankton standing stock in the Galápagos, and no consistent protocols currently exist to quantify phytoplankton biomass, identify species, or monitor for potential harmful algal blooms (HABs) within the archipelago. This analysis investigates physical, chemical, and biological oceanic variables that contribute to algal blooms within the GMR, using 4 km Aqua MODIS satellite imagery and 0.125-degree wind stress data from January 2003 to December 2016. Furthermore, this study analyzes chlorophyll-a concentrations at varying spatial scales— within the greater archipelago, as well as within five smaller bioregions based on species biodiversity in the GMR. Seasonal and interannual trend analyses, correlations, and hotspot identification were performed. Results demonstrate that chlorophyll-a is expressed in two seasons throughout the year in the GMR, most frequently in September and March, with a notable hotspot in the Elizabeth Bay bioregion. Interannual chlorophyll-a trend analyses revealed highest peaks in 2003, 2007, 2013, and 2016, and variables that correlate highly with chlorophyll-a include surface temperature and particulate organic carbon. This study recommends future in situ sampling locations for phytoplankton monitoring, including the Elizabeth Bay bioregion. Conclusions from this study contribute to the knowledge of oceanic drivers that catalyze primary productivity and consequently affect species biodiversity within the GMR. Additionally, this research can inform policy and decision-making strategies for species conservation and management within bioregions of the Galápagos.

Keywords: Bioregions, ecological monitoring, phytoplankton, remote sensing.

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Authors: H. Merhni, A. Sbiti, I. Ratbi, A. Sefiani

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The proximal spinal muscular atrophy (SMA) is a group of neuromuscular disorders characterized by progressive muscle weakness due to the degeneration and loss of anterior motor neurons of the spinal cord. Depending on the age of onset of symptoms and their evolution, four types of SMA, varying in severity, result in a mutations of the SMN gene (survival of Motor neuron). We have analyzed the DNA of 295 patients referred to our genetic counseling; since January 1996 until October 2014; for suspected SMA. The homozygous deletion of exon 7 of the SMN gene was found in 133 patients; of which, 40.6% were born to consanguineous parents. In countries like Morocco, where the frequency of heterozygotes for SMA is high, genetic testing should be offered as first-line and, after careful clinical assessment, especially in newborns and infants with congenital hypotonia unexplained and prognosis compromise. The molecular diagnosis of SMA allows a quick and certainly diagnosis, provide adequate genetic counseling for families at risk and suggest, for couples who want prenatal diagnosis. The analysis of the SMN gene is a perfect example of genetic testing with an excellent cost/benefit ratio that can be of great interest in public health, especially in low-income countries. We emphasize in this work for the benefit of the generalization of molecular diagnosis of SMA by the technique of PCR-enzymatic digestion in other centers in Morocco.

Keywords: Exon7, PCR-digestion, SMA, SMN gene.

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Authors: Ali Pashaee, Parisa Shooshtari, Gholamreza Atae, Nasser Fatouraee

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Phase-Contrast MR imaging methods are widely used for measurement of blood flow velocity components. Also there are some other tools such as CT and Ultrasound for velocity map detection in intravascular studies. These data are used in deriving flow characteristics. Some clinical applications are investigated which use pressure distribution in diagnosis of intravascular disorders such as vascular stenosis. In this paper an approach to the problem of measurement of intravascular pressure field by using velocity field obtained from flow images is proposed. The method presented in this paper uses an algorithm to calculate nonlinear equations of Navier- Stokes, assuming blood as an incompressible and Newtonian fluid. Flow images usually suffer the lack of spatial resolution. Our attempt is to consider the effect of spatial resolution on the pressure distribution estimated from this method. In order to achieve this aim, velocity map of a numerical phantom is derived at six different spatial resolutions. To determine the effects of vascular stenoses on pressure distribution, a stenotic phantom geometry is considered. A comparison between the pressure distribution obtained from the phantom and the pressure resulted from the algorithm is presented. In this regard we also compared the effects of collocated and staggered computational grids on the pressure distribution resulted from this algorithm.

Keywords: Flow imaging, pressure distribution estimation, phantom, resolution.

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Authors: Stela Papa, Klementina Puto, Migena Pllaha

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HCV is a hepatotropic RNA virus, transmitted primarily via the blood route, which causes progressive disease such as chronic hepatitis, liver cirrhosis, or hepatocellular carcinoma. HCV nowadays is a global healthcare problem. A variety of immunoassays including old and new technologies are being applied to detect HCV in our country. These methods include Immunochromatography assays (ICA), Fluorescence immunoassay (FIA), Enzyme linked fluorescent assay (ELFA), and Enzyme linked immunosorbent assay (ELISA) to detect HCV antibodies in blood serum, which lately is being slowly replaced by more sensitive methods such as rapid automated analyzer chemiluminescence immunoassay (CLIA). The aim of this study is to estimate HCV infection in carriers and chronic acute patients and to evaluate the use of new diagnostic methods. This study was realized from September 2016 to May 2018. During this study period, 2913 patients were analyzed for the presence of HCV by taking samples from their blood serum. The immunoassays performed were ICA, FIA, ELFA, ELISA, and CLIA assays. Concluding, 82% of patients taken in this study, resulted infected with HCV. Diagnostic methods in clinical laboratories are crucial in the early stages of infection, in the management of chronic hepatitis and in the treatment of patients during their disease.

Keywords: CLIA, ELISA, hepatitis C virus, immunoassay.

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Authors: A. Gruzdz, A. Ihnatowicz, J. Siddiqi, B. Akhgar

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MATCH project [1] entitle the development of an automatic diagnosis system that aims to support treatment of colon cancer diseases by discovering mutations that occurs to tumour suppressor genes (TSGs) and contributes to the development of cancerous tumours. The constitution of the system is based on a) colon cancer clinical data and b) biological information that will be derived by data mining techniques from genomic and proteomic sources The core mining module will consist of the popular, well tested hybrid feature extraction methods, and new combined algorithms, designed especially for the project. Elements of rough sets, evolutionary computing, cluster analysis, self-organization maps and association rules will be used to discover the annotations between genes, and their influence on tumours [2]-[11]. The methods used to process the data have to address their high complexity, potential inconsistency and problems of dealing with the missing values. They must integrate all the useful information necessary to solve the expert's question. For this purpose, the system has to learn from data, or be able to interactively specify by a domain specialist, the part of the knowledge structure it needs to answer a given query. The program should also take into account the importance/rank of the particular parts of data it analyses, and adjusts the used algorithms accordingly.

Keywords: Bioinformatics, gene expression, ontology, selforganizingmaps.

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Authors: Adile Shaqiri, Arjeta Shaqiri Latifi

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Domestic violence, trafficking with human beings especially violence against children, is a worldwide problem. Hence, it remains one of the most widespread forms of violence in Kosovo and which often continues to be described as a "closed door issue". Recognition, acceptance and prioritization of cases of domestic violence definitely require a much greater awareness of individuals in institutions for the risks, consequences and costs that the lack of such a well-coordinated response brings to the country. Considering that children are the future and the wealth of the country, violence and neglect against them should be treated as carefully as possible. The purpose of this paper is to identify steps towards prevention of the domestic violence and trafficking with human beings, so that the reflection of the consequences and the psychological flow do not reflect to a large extent in society. In this study is described: How is the phenomenon of domestic violence related to trafficking in human beings? The methods used are: historical, comparative, qualitative. Data derived from the relevant institutions were presented, i.e., by the actors who are the first reactors as well as the policy makers. Although these phenomena are present in all countries of the world, Kosovo is no exception and therefore comparisons of the development of child abuse have been made with other countries in the region as well. Since Kosovo is a country in transition, a country with a relatively high level of education, low economic development, high unemployment, political instability, dysfunctional legal infrastructure, it can be concluded that the potential for the development of negative phenomena is present and inevitable. Thus, during the research, the stages of development of these phenomena are analyzed, determining the causes and consequences which come from abuse, neglect of children and the impact on trafficking in human beings. The Kosovar family (parental responsibility), culture and religion, social services, the dignity of the abused child, etc. were analyzed. The review was also done on the legislation, educational institutions (curricula), governmental and non-governmental institutions their responsibilities and cooperation towards combating child abuse and trafficking. It is worth noting that during the work on paper, recommendations and conclusions have been drawn where it is concluded that we need an environment with educational reforms, stability in the political environment, economic development, a review of social policies, greater awareness of society, more adequate information through media, so that information and awareness could penetrate even in the most remote places of Kosovo society.

Keywords: Awareness, education, information, society, violence.

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Authors: Lubis A., Setiawati L., Setyoningrum A. R., Suryawan A., Irwanto

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Asthma is a condition that causing chronic health problems in children. In addition to basic therapy against disease, we must try to reduce the impact of chronic health problems and also optimize their medical aspect of growth and development. A boy with mild asthma attack frequent episode did not showed any improvement with medical treatment and his asthma control test was 11. From radiologic examination he got hyperaerated lung and billateral sinusitis maxillaris; skin test results were house dust, food and pet allergy; an overweight body; bad school grades; psychological and environmental problem. We followed and evaluated this boy in 6 months, treated holistically. Even we could not do much on environmental but no more psychological and school problems, his on a good bodyweight and his asthma control test was 22. A case of a child with mild asthma attack frequent episode was reported. Asthma clinical course show no significant improvement when other predisposing factor is not well-controlled and a child’s growth and development may be affected. Improving condition of the patient can be created with the help of loving and caring way of nurturing from the parents and supportive peer group. Therefore, continuous and consistent monitoring is required because prognosis of asthma is generally good when regularly and properly controlled.

Keywords: Asthma, chronic health problems, growth and development.

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Authors: Sara S. Fouad, Omneya Messallam

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Egypt has countless prestigious buildings and diversity of cultural heritage which are located in many cities. Most of the researchers, archaeologists, stakeholders and governmental bodies are paying more attention to the big cities such as Cairo and Alexandria, due to the country’s centralization nature. However, there are other historic cities that are grossly neglected and in need of emergency conservation. For instance, Port Said which is a former colonial city that was established in nineteenth century located at the edge of the northeast Egyptian coast between the Mediterranean Sea and the Suez Canal. This city is chosen because it presents one of the important Egyptian archaeological sites that archive Egyptian architecture of the 19^th and 20^th centuries. The historic urban fabric is divided into three main districts; the Arab, the European (Al-Afrang), and Port Fouad. The European district is selected to be the research case study as it has culture diversity, significant buildings, and includes the largest number of the listed heritage buildings in Port Said. Based on questionnaires and interviews, since 2003 several initiative trials have been taken by Alliance Francaise, the National Organization for Urban Harmony (NOUH), some Non-Governmental Organizations (NGOs), and few number of community residents to highlight the important city legacy and protect it from being demolished. Unfortunately, the limitation of their participation in decision-making policies is considered a crucial threat facing sustainable heritage conservation. Therefore, encouraging the local community to participate in their architecture heritage conservation would create a self-confident one, capable of making decisions for the city’s future development. This paper aims to investigate the role of the local inhabitants in protecting their buildings heritage through listing the community level of participations twice (2012 and 2018) in preserving their heritage based on the ladder citizen participation approach. Also, it is to encourage community participation in order to promote city architecture conservation, heritage management, and sustainable development. The methodology followed in this empirical research involves using several data assembly methods such as structural observations, questionnaires, interviews, and mental mapping. The questionnaire was distributed among 92 local inhabitants aged 18-60 years. However, the outset of this research at the beginning demonstrated the majority negative attitude, motivation, and confidence of the local inhabitants’ role to safeguard their architectural heritage. Over time, there was a change in the negative attitudes. Therefore, raising public awareness and encouraging community participation by providing them with a real opportunity to take part in the decision-making. This may lead to a positive relationship between the community residents and the built heritage, which is essential for promoting its preservation and sustainable development.

Keywords: Al-Afrang/Port Said, community participation, heritage conservation, ladder of citizen participation, NGOs.

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Authors: Tausif A. Ishtiaque, Zarrin T. Tasin, Kazi S. Akter

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Current trend of urban expansion, especially in the developing countries has caused significant changes in land cover, which is generating great concern due to its widespread environmental degradation. Energy consumption of the cities is also increasing with the aggravated heat island effect. Distribution of land surface temperature (LST) is one of the most significant climatic parameters affected by urban land cover change. Recent increasing trend of LST is causing elevated temperature profile of the built up area with less vegetative cover. Gradual change in land cover, especially decrease in vegetative cover is enhancing the Urban Heat Island (UHI) effect in the developing cities around the world. Increase in the amount of urban vegetation cover can be a useful solution for the reduction of UHI intensity. LST and Normalized Difference Vegetation Index (NDVI) have widely been accepted as reliable indicators of UHI and vegetation abundance respectively. Chittagong, the second largest city of Bangladesh, has been a growth center due to rapid urbanization over the last several decades. This study assesses the intensity of UHI in Chittagong city by analyzing the relationship between LST and NDVI based on the type of land use/land cover (LULC) in the study area applying an integrated approach of Geographic Information System (GIS), remote sensing (RS), and regression analysis. Land cover map is prepared through an interactive supervised classification using remotely sensed data from Landsat ETM+ image along with NDVI differencing using ArcGIS. LST and NDVI values are extracted from the same image. The regression analysis between LST and NDVI indicates that within the study area, UHI is directly correlated with LST while negatively correlated with NDVI. It interprets that surface temperature reduces with increase in vegetation cover along with reduction in UHI intensity. Moreover, there are noticeable differences in the relationship between LST and NDVI based on the type of LULC. In other words, depending on the type of land usage, increase in vegetation cover has a varying impact on the UHI intensity. This analysis will contribute to the formulation of sustainable urban land use planning decisions as well as suggesting suitable actions for mitigation of UHI intensity within the study area.

Keywords: Land cover change, land surface temperature, normalized difference vegetation index, urban heat island.

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Authors: Masaki Yamaguchi, Daimei Sasayama, Shinsuke Washizuka

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The goal of this study was to examine the possibility of salivary cytokines for the screening of attention deficit hyperactivity disorder (ADHD) in children. We carried out a case-control study, including 19 children with ADHD and 17 healthy children (controls). A multiplex bead array immunoassay was used to conduct a multi-analysis of 27 different salivary cytokines. Six salivary cytokines (interleukin (IL)-1β, IL-8, IL12p70, granulocyte colony-stimulating factor (G-CSF), interferon gamma (IFN-γ), and vascular endothelial growth factor (VEGF)) were significantly associated with the presence of ADHD (p < 0.05). An informative salivary cytokine panel was developed using VEGF by logistic regression analysis (odds ratio: 0.251). Receiver operating characteristic analysis revealed that assessment of a panel using VEGF showed “good” capability for discriminating between ADHD patients and controls (area under the curve: 0.778). ADHD has been hypothesized to be associated with reduced cerebral blood flow in the frontal cortex, due to reduced VEGF levels. Our study highlights the possibility of utilizing differential salivary cytokine levels for point-of-care testing (POCT) of biomarkers in children with ADHD.

Keywords: Cytokine, saliva, attention deficit hyperactivity disorder, child, biomarker.

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Authors: Faith-Michael E. Uzoka, Boluwaji A. Akinnuwesi, Taiwo Amoo, Flora Aladi, Stephen Fashoto, Moses Olaniyan, Joseph Osuji

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The overarching aim of this study is to develop a soft-computing system for the differential diagnosis of tropical diseases. These conditions are of concern to health bodies, physicians, and the community at large because of their mortality rates, and difficulties in early diagnosis due to the fact that they present with symptoms that overlap, and thus become ‘confusable’. We report on the first phase of our study, which focuses on the development of a fuzzy cognitive map model for early differential diagnosis of tropical diseases. We used malaria as a case disease to show the effectiveness of the FCM technology as an aid to the medical practitioner in the diagnosis of tropical diseases. Our model takes cognizance of manifested symptoms and other non-clinical factors that could contribute to symptoms manifestations. Our model showed 85% accuracy in diagnosis, as against the physicians’ initial hypothesis, which stood at 55% accuracy. It is expected that the next stage of our study will provide a multi-disease, multi-symptom model that also improves efficiency by utilizing a decision support filter that works on an algorithm, which mimics the physician’s diagnosis process.

Keywords: Medical diagnosis, tropical diseases, fuzzy cognitive map, decision support filters, malaria differential diagnosis.

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Authors: Juliana Panova

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Severe symptoms, such as dissociation, depersonalization, self-mutilation, suicidal ideations and gestures, are the main reasons for a person to be diagnosed with Borderline Personality Disorder (BPD) and admitted to an inpatient Psychiatric Hospital. However, these symptoms are also indicators of a severe traumatic history as indicated by the extensive research on the topic. Unfortunately patients with such clinical presentation often are treated repeatedly only for their symptomatic behavior, while the main cause for their suffering, the trauma itself, is usually left unaddressed therapeutically. All of the highly structured, replicable, and manualized treatments lack the recognition of the uniqueness of the person and fail to respect his/her rights to experience and react in an idiosyncratic manner. Thus the communicative and adaptive meaning of such symptomatic behavior is missed. Only its pathological side is recognized and subjected to correction and stigmatization, and the message that the person is damaged goods that needs fixing is conveyed once again. However, this time the message would be even more convincing for the victim, because it is sent by mental health providers, who have the credibility to make such a judgment. The result is a revolving door of very expensive hospitalizations for only a temporary and patchy fix. In this way the patients, once victims of abuse and hardship are left invalidated and thus their re-victimization is perpetuated in their search for understanding and help. Keywordsborderline personality disorder (BPD), complex PTSD, integrative treatment of trauma, re-victimization of trauma victims.

Keywords: borderline personality disorder (BPD), complex PTSD, integrative treatment of trauma, re-victimization of trauma victims.

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Authors: Dhurgham Al-Karawi, Nisreen Polus, Shakir Al-Zaidi, Sabah Jassim

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The management of COVID-19 patients based on chest imaging is emerging as an essential tool for evaluating the spread of the pandemic which has gripped the global community. It has already been used to monitor the situation of COVID-19 patients who have issues in respiratory status. There has been increase to use chest imaging for medical triage of patients who are showing moderate-severe clinical COVID-19 features, this is due to the fast dispersal of the pandemic to all continents and communities. This article demonstrates the development of machine learning techniques for the test of COVID-19 patients using Chest X-Ray (CXR) images in nearly real-time, to distinguish the COVID-19 infection with a significantly high level of accuracy. The testing performance has covered a combination of different datasets of CXR images of positive COVID-19 patients, patients with viral and bacterial infections, also, people with a clear chest. The proposed AI scheme successfully distinguishes CXR scans of COVID-19 infected patients from CXR scans of viral and bacterial based pneumonia as well as normal cases with an average accuracy of 94.43%, sensitivity 95%, and specificity 93.86%. Predicted decisions would be supported by visual evidence to help clinicians speed up the initial assessment process of new suspected cases, especially in a resource-constrained environment.

Keywords: COVID-19, chest x-ray scan, artificial intelligence, texture analysis, local binary pattern transform, Gabor filter.

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Authors: Ceren Kaya, Okan Erkaymaz, Orhan Ayar, Mahmut Özer

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Diabetes Mellitus (Diabetes) is a disease based on insulin hormone disorders and causes high blood glucose. Clinical findings determine that diabetes can be diagnosed by electrophysiological signals obtained from the vital organs. 'Diabetic Retinopathy' is one of the most common eye diseases resulting on diabetes and it is the leading cause of vision loss due to structural alteration of the retinal layer vessels. In this study, features of horizontal and vertical Video-Oculography (VOG) signals have been used to classify non-proliferative and proliferative diabetic retinopathy disease. Twenty-five features are acquired by using discrete wavelet transform with VOG signals which are taken from 21 subjects. Two models, based on multi-layer perceptron and radial basis function, are recommended in the diagnosis of Diabetic Retinopathy. The proposed models also can detect level of the disease. We show comparative classification performance of the proposed models. Our results show that proposed the RBF model (100%) results in better classification performance than the MLP model (94%).

Keywords: Diabetic retinopathy, discrete wavelet transform, multi-layer perceptron, radial basis function, video-oculography.

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Authors: S. Abed, S. O’Neill

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This research explored ward nurses’ views about the characteristics of effective nurse leaders in the context of Iraq as a developing country, where the delivery of health care continues to face disruption and change. It is well established that the provision of modern health care requires effective nurse leaders, but in countries such as Iraq the lack of effective nurse leaders is noted as a major challenge. In a descriptive quantitative study, a survey questionnaire was administered to 210 ward nurses working in two public hospitals in a major city in the north of Iraq. The participating nurses were of the opinion that the effectiveness of their nurse leaders was evident in their ability to demonstrate: good clinical knowledge, effective communication and managerial skills. They also viewed their leaders as needing to hold high-level nursing qualifications, though this was not necessarily the case in practice. Additionally, they viewed nurse leaders’ personal qualities as important, which included politeness, ethical behaviour, and trustworthiness. When considered against the issues raised in interviews with a smaller group (20) of senior nurse leaders, representative of the various occupational levels, implications identify the need for professional development that focuses on how the underpinning competencies relate to leadership and how transformational leadership is evidenced in practice.

Keywords: Health care, nurse education, nurse leadership, nursing in Iraq, transformational leadership.

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Authors: Salama Meghriche, Amer Draa, Mohammed Boulemden

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Heart failure is the most common reason of death nowadays, but if the medical help is given directly, the patient-s life may be saved in many cases. Numerous heart diseases can be detected by means of analyzing electrocardiograms (ECG). Artificial Neural Networks (ANN) are computer-based expert systems that have proved to be useful in pattern recognition tasks. ANN can be used in different phases of the decision-making process, from classification to diagnostic procedures. This work concentrates on a review followed by a novel method. The purpose of the review is to assess the evidence of healthcare benefits involving the application of artificial neural networks to the clinical functions of diagnosis, prognosis and survival analysis, in ECG signals. The developed method is based on a compound neural network (CNN), to classify ECGs as normal or carrying an AtrioVentricular heart Block (AVB). This method uses three different feed forward multilayer neural networks. A single output unit encodes the probability of AVB occurrences. A value between 0 and 0.1 is the desired output for a normal ECG; a value between 0.1 and 1 would infer an occurrence of an AVB. The results show that this compound network has a good performance in detecting AVBs, with a sensitivity of 90.7% and a specificity of 86.05%. The accuracy value is 87.9%.

Keywords: Artificial neural networks, Electrocardiogram(ECG), Feed forward multilayer neural network, Medical diagnosis, Pattern recognitionm, Signal processing.

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Authors: SunWoo Lee, TaeBum Lee, YoonHwa Park, YooJeong Kim

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Solar lentigines appear predominantly on chronically sun-exposed areas of skin, such as the face and the back of the hands. Among the several ways to lentigines treatment, quality-switched lasers are well-known effective treatment for removing solar lentigines. The present pilot study was therefore designed to assess the efficacy of quality-switched ruby laser treatment of such lentigines compare between pretreatment and posttreatment of skin brightness. Twenty-two adults with chronic sun-damaged skin (mean age 52.8 years, range 37–74 years) were treated at the Korean site. A 694 nm Q-switched ruby laser was used, with the energy density set from 1.4 to 12.5 J/cm2, to treat solar lentigines. Average brightness of skin color before ruby laser treatment was 137.3 and its skin color was brightened after ruby laser treatment by 150.5. Also, standard deviation of skin color was decreased from 17.8 to 16.4. Regarding the multivariate model, age and energy were identified as significant factors for skin color brightness change in lentigo depigmentation by ruby laser treatment. Their respective odds ratios were 1.082 (95% CI, 1.007–1.163), and 1.431 (95% CI, 1.051–1.946). Lentigo depigmentation treatment using ruby lasers resulted in a high performance in skin color brightness. Among the relative factors involve with ruby laser treatment, age and energy were the most effective factors which skin color change to brighter than pretreatment.

Keywords: Depigmentation, lentigo, quality switched ruby laser, skin color.

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Authors: R. S. Giraddi, B. Thirupam Reddy, D. N. Kambrekar

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Chilli (Capsicum annum L.) an important commercial vegetable crop is ravaged by a number of insect-pests during both vegetative and reproductive phase resulting into significant crop loss.Thrips, Scirtothripsdorsalis, mite, Polyphagotarsonemuslatus and whitefly, Bemisiatabaci are the key sap feeding insects, their infestation leads to leaf curl, stunted growth and yield loss.During flowering and fruit formation stage, gall midge fly, Asphondyliacapparis (Rubsaaman) infesting flower buds and young fruits andHelicoverpaarmigera (Hubner) feeding on matured green fruits are the important insect pests causing significant crop loss.The pest is known to infest both flower buds and young fruits resulting into malformation of flower buds and twisting of fruits.In order to manage these insect-pests a combi product consisting of imidacloprid and betacyfluthrin (Soloman 300 OD) was evaluated for its bio-efficacy, phytotoxicity and effect on predator activity.Imidacloprid, a systemic insecticide belonging to neo-nicotinoid group, is effective against insect pests such as aphids, whiteflies (sap feeders) and other insectsviz., termites and soil insects.Beta-Cyfluthrin is an insecticide of synthetic pyrethroid group which acts by contact action and ingestion. It acts on the insects' nervous system as sodium channel blocker consequently a disorder of the nervous system occurs leading finally to the death. The field experiments were taken up during 2015 and 2016 at the Main Agricultural Research Station of University of Agricultural Sciences, Dharwad, Karnataka, India.The trials were laid out in a Randomized Block Design (RBD) with three replications using popular land race of Byadagi crop variety.Results indicated that the product at 21.6 + 50.4% gai/ha (240 ml/ha) and 27.9 + 65% gai/ha (310 ml/ha) was found quite effective in controlling thrips (0.00 to 0.66 thrips per six leaves) as against the standard check insecticide recommended for thrips by the University of Agricultural Sciences, Dharwad wherein the density of thrips recorded was significantly higher (1.00 to 2.00 Nos./6 leaves). Similarly, the test insecticide was quite effective against other target insects, whiteflies, fruit borer and gall midge fly as indicated by lower insect population observed in the treatments as compared to standard insecticidal control. The predatory beetle activity was found to be normal in all experimental plots. Highest green fruit yield of 5100-5500 kg/ha was recorded in Soloman 300 OD applied crop at 310 ml/ha rate as compared to 4750 to 5050 kg/ha recorded in check. At present 6-8 sprays of insecticides are recommended for management of these insect-pests on the crop. If combi-products are used in pest management programmes, it is possible to reduce insecticide usages in crop ecosystem.

Keywords: Imidacloprid, Betacyfluthrin, gallmidge fly, thrips, chilli.

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Authors: Paria Soleimani, Arezoo Neshati

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Myocardial infarction is one of the leading causes of death in the world. Some of these deaths occur even before the patient reaches the hospital. Myocardial infarction occurs as a result of impaired blood supply. Because the most of these deaths are due to coronary artery disease, hence the awareness of the warning signs of a heart attack is essential. Some heart attacks are sudden and intense, but most of them start slowly, with mild pain or discomfort, then early detection and successful treatment of these symptoms is vital to save them. Therefore, importance and usefulness of a system designing to assist physicians in early diagnosis of the acute heart attacks is obvious. The main purpose of this study would be to enable patients to become better informed about their condition and to encourage them to seek professional care at an earlier stage in the appropriate situations. For this purpose, the data were collected on 711 heart patients in Iran hospitals. 28 attributes of clinical factors can be reported by patients; were studied. Three logistic regression models were made on the basis of the 28 features to predict the risk of heart attacks. The best logistic regression model in terms of performance had a C-index of 0.955 and with an accuracy of 94.9%. The variables, severe chest pain, back pain, cold sweats, shortness of breath, nausea and vomiting, were selected as the main features.

Keywords: Coronary heart disease, acute heart attacks, prediction, logistic regression.

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Authors: Nevila Alliu, Saimir Heta, Ilma Robo, Vera Ostreni

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Periodontitis as an oral pathology caused by specific bacterial flora functions as a focal infection for the onset and aggravation of arteriosclerosis. These two distant pathologies, since they affect organs at a distance from each other, communicate with each other with correlation at the level of markers of inflammation in the blood. Fluctuations in the level of fibrinogen in the blood, depending on the active or passive phase of the existing periodontitis, affect the promotion of arteriosclerosis. The study is of the brief communication article type with the aim to analyze the effect of non-surgical periodontal treatment on fluctuations in the level of fibrinogen in the blood. The reduction of fibrinogen's level in blood after non-surgical periodontal treatment of periodontitis in the patient's oral cavity, is a common consequence supported by literature sources. Also, the influence of a high amount of fibrinogen in blood on the occurrence of arteriosclerosis at the same patient, is also another important data that again rely on many sources of literature. Thromboembolism and arteriosclerosis, as risk factors expressed in clinical data, have temporary bacteremia in the blood, which can occur significantly and often between phases of non-surgical periodontal treatment of periodontitis, treatments performed with treatment phases and protocols of predetermined treatment. Arterial thromboembolism has a significant factor, such as high levels of fibrinogen in the blood, which are significantly reduced during the period of non-surgical periodontal treatment.

Keywords: Fibrinogen, refractory periodontitis, atherosclerosis, non-surgical, periodontal treatment.

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Authors: Seyed Mazyar Mortazavi, Masod Memari, Hasan Ali Ahmadi, Zhaleh Abed

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VACTERL association is a rare disorder with various congenital malformations. The aetiology remains unknown. Combination of at least three congenital anomalies of the following criteria is required for diagnosis: vertebral defects, anal atresia, cardiac anomalies, tracheo-esophageal fistula, renal anomalies, and limb defects. The first case was 1-day old male neonate with multiple congenital anomalies was bore from 28 years old mother. The mother had history of pregnancy with lymphocyte therapy. His anomalies included: defects in thoracic and lumbar vertebral, anal atresia, bilateral hydronephrosis, atrial septal defect, and lower limb abnormality. Other anomalies were cryptorchidism and nasal canal narrowing. The second case was born with 32 weeks gestational age from mother with history of pregnancy with lymphocyte therapy. He had thoracic vertebral defect, cardiac anomalies and renal defect. diagnosis based on clinical finding is VACTERL association. Early diagnosis is very important to investigation and treatment of other coexistence anomalies. VACTERL association in mothers with history of pregnancy with lymphocyte therapy has suggested possibly of relationship between VACTERL association and this method of pregnancy.

Keywords: Anal atresia, tracheo-esophageal fistula, atrial septal defect, lymphocyte therapy.

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Authors: Sumathi Poobal, G. Ravindran

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Image compression is one of the most important applications Digital Image Processing. Advanced medical imaging requires storage of large quantities of digitized clinical data. Due to the constrained bandwidth and storage capacity, however, a medical image must be compressed before transmission and storage. There are two types of compression methods, lossless and lossy. In Lossless compression method the original image is retrieved without any distortion. In lossy compression method, the reconstructed images contain some distortion. Direct Cosine Transform (DCT) and Fractal Image Compression (FIC) are types of lossy compression methods. This work shows that lossy compression methods can be chosen for medical image compression without significant degradation of the image quality. In this work DCT and Fractal Compression using Partitioned Iterated Function Systems (PIFS) are applied on different modalities of images like CT Scan, Ultrasound, Angiogram, X-ray and mammogram. Approximately 20 images are considered in each modality and the average values of compression ratio and Peak Signal to Noise Ratio (PSNR) are computed and studied. The quality of the reconstructed image is arrived by the PSNR values. Based on the results it can be concluded that the DCT has higher PSNR values and FIC has higher compression ratio. Hence in medical image compression, DCT can be used wherever picture quality is preferred and FIC is used wherever compression of images for storage and transmission is the priority, without loosing picture quality diagnostically.

Keywords: DCT, FIC, PIFS, PSNR.

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Authors: E. Batista, R. Mendes, A. Furtado, M. C. Ferreira, I. Godinho, J. A. Sousa, M. Alvares, R. Martins

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Syringe pumps are commonly used for drug delivery in hospitals and clinical environments. These instruments are critical in neonatology and oncology, where any variation in the flow rate and drug dosing quantity can lead to severe incidents and even death of the patient. Therefore it is very important to determine the accuracy and precision of these devices using the suitable calibration methods. The Volume Laboratory of the Portuguese Institute for Quality (LVC/IPQ) uses two different methods to calibrate syringe pumps from 16 nL/min up to 20 mL/min. The Interferometric method uses an interferometer to monitor the distance travelled by a pusher block of the syringe pump in order to determine the flow rate. Therefore, knowing the internal diameter of the syringe with very high precision, the travelled distance, and the time needed for that travelled distance, it was possible to calculate the flow rate of the fluid inside the syringe and its uncertainty. As an alternative to the gravimetric and the interferometric method, a methodology based on the application of optical technology was also developed to measure flow rates. Mainly this method relies on measuring the increase of volume of a drop over time. The objective of this work is to compare the results of the calibration of two syringe pumps using the different methodologies described above. The obtained results were consistent for the three methods used. The uncertainties values were very similar for all the three methods, being higher for the optical drop method due to setup limitations.

Keywords: Calibration, interferometry, syringe pump, optical method, uncertainty.

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