Search results for: patient database

Authors: Shende Suraj Balu, A. B. Deoghare, K. M. Pandey

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The human middle ear (ME) is a delicate and vital organ. It has a complex structure that performs various functions such as receiving sound pressure and producing vibrations of eardrum and propagating it to inner ear. It consists of Tympanic Membrane (TM), three auditory ossicles, various ligament structures and muscles. Incidents such as traumata, infections, ossification of ossicular structures and other pathologies may damage the ME organs. The conditions can be surgically treated by employing prosthesis. However, the suitability of the prosthesis needs to be examined in advance prior to the surgery. Few decades ago, this issue was addressed and analyzed by developing an equivalent representation either in the form of spring mass system, electrical system using R-L-C circuit or developing an approximated CAD model. But, nowadays a three-dimensional ME model can be constructed using micro X-Ray Computed Tomography (μCT) scan data. Moreover, the concern about patient specific integrity pertaining to the disease can be examined well in advance. The current research work emphasizes to develop the ME model from the stacks of μCT images which are used as input file to MIMICS Research 19.0 (Materialise Interactive Medical Image Control System) software. A stack of CT images is converted into geometrical surface model to build accurate morphology of ME. The work is further extended to understand the dynamic behaviour of Harmonic response of the stapes footplate and umbo for different sound pressure levels applied at lateral side of eardrum using finite element approach. The pathological condition Cholesteatoma of ME is investigated to obtain peak to peak displacement of stapes footplate and umbo. Apart from this condition, other pathologies, mainly, changes in the stiffness of stapedial ligament, TM thickness and ossicular chain separation and fixation are also explored. The developed model of ME for pathologies is validated by comparing the results available in the literatures and also with the results of a normal ME to calculate the percentage loss in hearing capability.

Keywords: Computed tomography, human middle ear, harmonic response, pathologies, tympanic membrane.

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Authors: Glenda Wrenn, Juliet Muzere, Meldra Hall, Allyson Belton, Kisha Holden, Chanita Hughes-Halbert, Martha Kent, Bekh Bradley

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Understanding the help seeking decision making process and experiences of health disparity populations with posttraumatic stress disorder (PTSD) is central to development of trauma-informed, culturally centered, and patient focused services. Yet, little is known about the decision making process among adult Black women who are non-treatment seekers as they are, by definition, not engaged in services. Methods: Audiotaped interviews were conducted with 30 African American adult women with clinically significant PTSD symptoms who were engaged in primary care, but not in treatment for PTSD despite symptom burden. A qualitative interview guide was used to elucidate key themes. Independent coding of themes mapped to theory and identification of emergent themes were conducted using qualitative methods. An existing quantitative dataset was analyzed to contextualize responses and provide a descriptive summary of the sample. Results: Emergent themes revealed that active mental avoidance, the intermittent nature of distress, ambivalence, and self-identified resilience as undermining to help seeking decisions. Participants were stuck within the help-seeking phase of ‘recognition’ of illness and retained a sense of “it is my decision” despite endorsing significant social and environmental negative influencers. Participants distinguished ‘help acceptance’ from ‘help seeking’ with greater willingness to accept help and importance placed on being of help to others. Conclusions: Elucidation of the decision-making process from the perspective of non-treatment seekers has implications for outreach and treatment within models of integrated and specialty systems care. The salience of responses to trauma symptoms and stagnation in the help seeking recognition phase are findings relevant to integrated care service design and community engagement.

Keywords: Culture, help-seeking, integrated care, PTSD.

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Authors: Nami Matsumoto

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This study explores the experiences of cross-linguistic medical encounters by patients, and their views of receiving language support therein, with a particular focus on Japanese-English cases. The aim of this study is to investigate the reason for the frequent use of a spouse as a communication mediator from a Japanese perspective, through a comparison with that of English speakers. This study conducts an empirical qualitative analysis of the accounts of informants. A total of 31 informants who have experienced Japanese-English cross-linguistic medical encounters were recruited in Australia and Japan for semi-structured in-depth interviews. A breakdown of informants is 15 English speakers and 16 Japanese speakers. In order to obtain a further insight into collected data, additional interviews were held with 4 Australian doctors who are familiar with using interpreters. This study was approved by the Australian National University Human Research Ethics Committee, and written consent to participate in this study was obtained from all participants. The interviews lasted up to over one hour. They were audio-recorded and subsequently transcribed by the author. Japanese transcriptions were translated into English by the author. An analysis of interview data found that patients value relationship in communication. Particularly, Japanese informants, who have an English-speaking spouse, value trust-based communication interventions by their spouse, regardless of the language proficiency of the spouse. In Australia, health care interpreters are required to abide by the national code of ethics for interpreters. The Code defines the role of an interpreter exclusively to be language rendition and enshrines the tenets of accuracy, confidentiality and professional role boundaries. However, the analysis found that an interpreter who strictly complies with the Code sometimes fails to render the real intentions of the patient and their doctor. Findings from the study suggest that an interpreter should not be detached from the context and should be more engaged in the needs of patients. Their needs are not always communicated by an interpreter when they simply follow a professional code of ethics. The concept of relationship-centred care should be incorporated in the professional practice of health care interpreters.

Keywords: Health care, Japanese-English medical encounters, language barriers, trust.

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Authors: May Fadheel Estephan, Richard Perks

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Cancer is a serious health concern that affects millions of people worldwide. Early detection and treatment are essential for improving patient outcomes. However, current methods for cancer detection have limitations, such as low sensitivity and specificity. The aim of this study was to develop an optical sensor for cancer detection using elastic light scattering spectroscopy (ELSS). ELSS is a non-invasive optical technique that can be used to characterize the size and concentration of particles in a solution. An optical probe was fabricated with a 100-μm-diameter core and a 132-μm centre-to-centre separation. The probe was used to measure the ELSS spectra of polystyrene spheres with diameters of 2 μm, 0.8 μm, and 0.413 μm. The spectra were then analysed to determine the size and concentration of the spheres. The results showed that the optical probe was able to differentiate between the three different sizes of polystyrene spheres. The probe was also able to detect the presence of polystyrene spheres in suspension concentrations as low as 0.01%. The results of this study demonstrate the potential of ELSS for cancer detection. ELSS is a non-invasive technique that can be used to characterize the size and concentration of cells in a tissue sample. This information can be used to identify cancer cells and assess the stage of the disease. The data for this study were collected by measuring the ELSS spectra of polystyrene spheres with different diameters. The spectra were collected using a spectrometer and a computer. The ELSS spectra were analysed using a software program to determine the size and concentration of the spheres. The software program used a mathematical algorithm to fit the spectra to a theoretical model. The question addressed by this study was whether ELSS could be used to detect cancer cells. The results of the study showed that ELSS could be used to differentiate between different sizes of cells, suggesting that it could be used to detect cancer cells. The findings of this research show the utility of ELSS in the early identification of cancer. ELSS is a non-invasive method for characterizing the number and size of cells in a tissue sample. To determine cancer cells and determine the disease's stage, this information can be employed. Further research is needed to evaluate the clinical performance of ELSS for cancer detection.

Keywords: Elastic Light Scattering Spectroscopy, Polystyrene spheres in suspension, optical probe, fibre optics.

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Authors: Abhay Asthana, Gyati Shilakari Asthana

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It is the patient compliance and stability in combination with controlled drug delivery and biocompatibility that forms the core feature in present research and development of sustained biodegradable patch formulation intended for wound healing. The aim was to impart sustained degradation, sterile formulation, significant folding endurance, elasticity, biodegradability, bio-acceptability and strength. The optimized formulation comprised of polymers including Hydroxypropyl methyl cellulose, Ethylcellulose, and Gelatin, and Citric Acid PEG Citric acid (CPEGC) triblock dendrimers and active Curcumin. Polymeric mixture dissolved in geometric order in suitable medium through continuous stirring under ambient conditions. With continued stirring Curcumin was added with aid of DCM and Methanol in optimized ratio to get homogenous dispersion. The dispersion was sonicated with optimum frequency and for given time and later casted to form a patch form. All steps were carried out under strict aseptic conditions. The formulations obtained in the acceptable working range were decided based on thickness, uniformity of drug content, smooth texture and flexibility and brittleness. The patch kept on stability using butter paper in sterile pack displayed folding endurance in range of 20 to 23 times without any evidence of crack in an optimized formulation at room temperature (RT) (24 ± 2°C). The patch displayed acceptable parameters after stability study conducted in refrigerated conditions (8±0.2°C) and at RT (24 ± 2°C) up to 90 days. Further, no significant changes were observed in critical parameters such as elasticity, biodegradability, drug release and drug content during stability study conducted at RT 24±2°C for 45 and 90 days. The drug content was in range 95 to 102%, moisture content didn’t exceeded 19.2% and patch passed the content uniformity test. Percentage cumulative drug release was found to be 80% in 12h and matched the biodegradation rate as drug release with correlation factor R2>0.9. The biodegradable patch based formulation developed shows promising results in terms of stability and release profiles.

Keywords: Sustained biodegradation, wound healing, polymeric patch, stability.

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Authors: Mustafa M. Donma, Orkide Donma, Murat Aydin, Muhammet Demirkol, Burcin Nalbantoglu, Aysin Nalbantoglu, Birol Topcu

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Childhood obesity is an ever increasing global health problem, affecting both developed and developing countries. Accurate evaluation of obesity in children requires difficult and detailed investigation. In our study, obesity in children was evaluated using new body fat ratios and indices. Assessment of anthropometric measurements, as well as some ratios, is important because of the evaluation of gender differences particularly during the late periods of obesity. A total of 239 children; 168 morbid obese (MO) (81 girls and 87 boys) and 71 normal weight (NW) (40 girls and 31 boys) children, participated in the study. Informed consent forms signed by the parents were obtained. Ethics Committee approved the study protocol. Mean ages (years)±SD calculated for MO group were 10.8±2.9 years in girls and 10.1±2.4 years in boys. The corresponding values for NW group were 9.0±2.0 years in girls and 9.2±2.1 years in boys. Mean body mass index (BMI)±SD values for MO group were 29.1±5.4 kg/m² and 27.2±3.9 kg/m² in girls and boys, respectively. These values for NW group were calculated as 15.5±1.0 kg/m² in girls and 15.9±1.1 kg/m² in boys. Groups were constituted based upon BMI percentiles for age-and-sex values recommended by WHO. Children with percentiles >99 were grouped as MO and children with percentiles between 85 and 15 were considered NW. The anthropometric measurements were recorded and evaluated along with the new ratios such as trunk-to-appendicular fat ratio, as well as indices such as Index-I and Index-II. The body fat percent values were obtained by bio-electrical impedance analysis. Data were entered into a database for analysis using SPSS/PASW 18 Statistics for Windows statistical software. Increased waist-to-hip circumference (C) ratios, decreased head-to-neck C, height ‘to’ ‘two’-‘to’-waist C and height ‘to’ ‘two’-‘to’-hip C ratios were observed in parallel with the development of obesity (p≤0.001). Reference value for height ‘to’ ‘two’-‘to’-hip ratio was detected as approximately 1.0. Index-II, based upon total body fat mass, showed much more significant differences between the groups than Index-I based upon weight. There was not any difference between trunk-to-appendicular fat ratios of NW girls and NW boys (p≥0.05). However, significantly increased values for MO girls in comparison with MO boys were observed (p≤0.05). This parameter showed no difference between NW and MO states in boys (p≥0.05). However, statistically significant increase was noted in MO girls compared to their NW states (p≤0.001). Trunk-to-appendicular fat ratio was the only fat-based parameter, which showed gender difference between NW and MO groups. This study has revealed that body ratios and formula based upon body fat tissue are more valuable parameters than those based on weight and height values for the evaluation of morbid obesity in children.

Keywords: Anthropometry, childhood obesity, gender, Morbid obesity.

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Authors: Siti Aisya Gany, Swee Ching Tan, Sook Yee Gan

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Diminished antioxidant defense or increased production of reactive oxygen species in the biological system can result in oxidative stress which may lead to various neurodegenerative diseases including Alzheimer’s disease (AD). Microglial activation also contributes to the progression of AD by producing several proinflammatory cytokines, nitric oxide (NO) and prostaglandin E2 (PGE2). Oxidative stress and inflammation have been reported to be possible pathophysiological mechanisms underlying AD. In addition, the cholinergic hypothesis postulates that memory impairment in patient with AD is also associated with the deficit of cholinergic function in the brain. Although a number of drugs have been approved for the treatment of AD, most of these synthetic drugs have diverse side effects and yield relatively modest benefits. Marine algae have great potential in pharmaceutical and biomedical applications as they are valuable sources of bioactive properties such as anticoagulation, antimicrobial, antioxidative, anticancer and anti-inflammatory. Hence, this study aimed to provide an overview of the properties of Malaysian seaweeds (Padina australis, Sargassum polycystum and Caulerpa racemosa) in inhibiting oxidative stress, neuroinflammation and cholinesterase enzymes. These seaweeds significantly exhibited potent DPPH and moderate superoxide anion radical scavenging ability (P<0.05). Hexane and methanol extracts of S. polycystum exhibited the most potent radical scavenging ability with IC50 values of 0.157±0.004mg/ml and 0.849±0.02mg/ml for DPPH and ABTS assays, respectively. Hexane extract of C. racemosa gave the strongest superoxide radical inhibitory effect (IC50 of 0.386±0.01mg/ml). Most seaweed extracts significantly inhibited the production of cytokine (IL-6, IL-1 β, TNFα) and NO in a concentration-dependent manner without causing significant cytotoxicity to the lipopolysaccharide (LPS)-stimulated microglia cells (P<0.05). All extracts suppressed cytokine and NO level by more than 50% at the concentration of 0.4mg/ml. In addition, C. racemosa and S. polycystum also showed anti-acetylcholinesterase activities with the IC50 values ranging from 0.086-0.115 mg/ml. Moreover, C. racemosa and P. australis were also found to be active against butyrylcholinesterase with IC50 values ranging from 0.118- 0.287 mg/ml.

Keywords: Anticholinesterase, antioxidative, neuroinflammation, seaweeds.

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Authors: Cathal Merz, Gareth O’Donnell

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Coil reinforced thin-walled (CRTW) tubes are used in medicine to treat problems affecting blood vessels within the body through minimally invasive procedures. The CRTW tube considered in this research makes up part of such a device and is inserted into the patient via their femoral or brachial arteries and manually navigated to the site in need of treatment. This procedure replaces the requirement to perform open surgery but is limited by reduction of blood vessel lumen diameter and increase in tortuosity of blood vessels deep in the brain. In order to maximize the capability of these procedures, CRTW tube devices are being manufactured with decreasing wall thicknesses in order to deliver treatment deeper into the body and to allow passage of other devices through its inner diameter. This introduces significant stresses to the device materials which have resulted in an observed increase in the breaking of the proximal segment of the device into two separate pieces after it has failed by buckling. As there is currently no international standard for measuring the mechanical properties of these CRTW tube devices, it is difficult to accurately analyze this problem. The aim of the current work is to address this discrepancy in the biomedical device industry by developing a measurement system that can be used to quantify the effect of process and design changes on CRTW tube performance, aiding in the development of better performing, next generation devices. Using materials testing frames, micro-computed tomography (micro-CT) imaging, experiment planning, analysis of variance (ANOVA), T-tests and regression analysis, test methods have been developed for assessing the impact of process and design changes on the device. The major findings of this study have been an insight into the suitability of buckle and three-point bend tests for the measurement of the effect of varying processing factors on the device’s performance, and guidelines for interpreting the output data from the test methods. The findings of this study are of significant interest with respect to verifying and validating key process and design changes associated with the device structure and material condition. Test method integrity evaluation is explored throughout.

Keywords: Buckling, coil reinforced thin-walled tubes, fracture, test method.

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Authors: Nadezhda M. Usmanova, Nikolai V. Tomilin

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Mammalian genomes contain large number of retroelements (SINEs, LINEs and LTRs) which could affect expression of protein coding genes through associated transcription factor binding sites (TFBS). Activity of the retroelement-associated TFBS in many genes is confirmed experimentally but their global functional impact remains unclear. Human SINEs (Alu repeats) and mouse SINEs (B1 and B2 repeats) are known to be clustered in GCrich gene rich genome segments consistent with the view that they can contribute to regulation of gene expression. We have shown earlier that Alu are involved in formation of cis-regulatory modules (clusters of TFBS) in human promoters, and other authors reported that Alu located near promoter CpG islands have an increased frequency of CpG dinucleotides suggesting that these Alu are undermethylated. Human Alu and mouse B1/B2 elements have an internal bipartite promoter for RNA polymerase III containing conserved sequence motif called B-box which can bind basal transcription complex TFIIIC. It has been recently shown that TFIIIC binding to B-box leads to formation of a boundary which limits spread of repressive chromatin modifications in S. pombe. SINEassociated B-boxes may have similar function but conservation of TFIIIC binding sites in SINEs located near mammalian promoters has not been studied earlier. Here we analysed abundance and distribution of retroelements (SINEs, LINEs and LTRs) in annotated sequences of the Database of mammalian transcription start sites (DBTSS). Fractions of SINEs in human and mouse promoters are slightly lower than in all genome but >40% of human and mouse promoters contain Alu or B1/B2 elements within -1000 to +200 bp interval relative to transcription start site (TSS). Most of these SINEs is associated with distal segments of promoters (-1000 to -200 bp relative to TSS) indicating that their insertion at distances >200 bp upstream of TSS is tolerated during evolution. Distribution of SINEs in promoters correlates negatively with the distribution of CpG sequences. Using analysis of abundance of 12-mer motifs from the B1 and Alu consensus sequences in genome and DBTSS it has been confirmed that some subsegments of Alu and B1 elements are poorly conserved which depends in part on the presence of CpG dinucleotides. One of these CpG-containing subsegments in B1 elements overlaps with SINE-associated B-box and it shows better conservation in DBTSS compared to genomic sequences. It has been also studied conservation in DBTSS and genome of the B-box containing segments of old (AluJ, AluS) and young (AluY) Alu repeats and found that CpG sequence of the B-box of old Alu is better conserved in DBTSS than in genome. This indicates that Bbox- associated CpGs in promoters are better protected from methylation and mutation than B-box-associated CpGs in genomic SINEs. These results are consistent with the view that potential TFIIIC binding motifs in SINEs associated with human and mouse promoters may be functionally important. These motifs may protect promoters from repressive histone modifications which spread from adjacent sequences. This can potentially explain well known clustering of SINEs in GC-rich gene rich genome compartments and existence of unmethylated CpG islands.

Keywords: Retroelement, promoter, CpG island, DNAmethylation.

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Authors: C. Silveira, A. Ascenso, J. Ferreira, A. I. Miranda, P. Tuccella, G. Curci

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Poor air quality is one of the main environmental causes of premature deaths worldwide, and mainly in cities, where the majority of the population lives. It is a consequence of successive land cover (LC) and use changes, as a result of the intensification of human activities. Knowing these landscape modifications in a comprehensive spatiotemporal dimension is, therefore, essential for understanding variations in air pollutant concentrations. In this sense, the use of air quality models is very useful to simulate the physical and chemical processes that affect the dispersion and reaction of chemical species into the atmosphere. However, the modelling performance should always be evaluated since the resolution of the input datasets largely dictates the reliability of the air quality outcomes. Among these data, the updated LC is an important parameter to be considered in atmospheric models, since it takes into account the Earth’s surface changes due to natural and anthropic actions, and regulates the exchanges of fluxes (emissions, heat, moisture, etc.) between the soil and the air. This work aims to evaluate the performance of the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem), when different LC classifications are used as an input. The influence of two LC classifications was tested: i) the 24-classes USGS (United States Geological Survey) LC database included by default in the model, and the ii) CLC (Corine Land Cover) and specific high-resolution LC data for Portugal, reclassified according to the new USGS nomenclature (33-classes). Two distinct WRF-Chem simulations were carried out to assess the influence of the LC on air quality over Europe and Portugal, as a case study, for the year 2015, using the nesting technique over three simulation domains (25 km², 5 km² and 1 km² horizontal resolution). Based on the 33-classes LC approach, particular emphasis was attributed to Portugal, given the detail and higher LC spatial resolution (100 m x 100 m) than the CLC data (5000 m x 5000 m). As regards to the air quality, only the LC impacts on tropospheric ozone concentrations were evaluated, because ozone pollution episodes typically occur in Portugal, in particular during the spring/summer, and there are few research works relating to this pollutant with LC changes. The WRF-Chem results were validated by season and station typology using background measurements from the Portuguese air quality monitoring network. As expected, a better model performance was achieved in rural stations: moderate correlation (0.4 – 0.7), BIAS (10 – 21µg.m^-3) and RMSE (20 – 30 µg.m^-3), and where higher average ozone concentrations were estimated. Comparing both simulations, small differences grounded on the Leaf Area Index and air temperature values were found, although the high-resolution LC approach shows a slight enhancement in the model evaluation. This highlights the role of the LC on the exchange of atmospheric fluxes, and stresses the need to consider a high-resolution LC characterization combined with other detailed model inputs, such as the emission inventory, to improve air quality assessment.

Keywords: Land cover, tropospheric ozone, WRF-Chem, air quality assessment.

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Authors: Bill D. Geis, Frederick Newman

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Suicide and wrongful death forensic cases are the fastest rising tort in mental health law. Most suicide-related personal injury claims fall into the legal category of “wrongful death.” Though mental health experts may be called on to address a range of forensic questions in wrongful death cases, the central consultation that most experts provide is about the negligence element—specifically, the issue of whether the clinician met the clinical standard of care in assessing, treating, and managing the deceased person’s mental health care. Standards of care, varying from US state to state, are broad and address what a reasonable clinician might do in a similar circumstance. This fact leaves the issue of the suicide standard of care, in each case, up to forensic experts to put forth a reasoned estimate of what the standard of care should have been in the specific case under litigation. Because the general state guidelines for standard of care are broad, forensic experts are readily retained to provide scientific and clinical opinions about whether or not a clinician met the standard of care in their suicide assessment, treatment, and management of the case. In the past and in much of current practice, the assessment of suicide has centered on the elicitation of verbalized suicide ideation. But suicide ideation, in the matter of suicide risk determination, may be a necessary but insufficient target of lethal suicide risk assessment. Assessment of near-term suicide risk—assessment that goes beyond verbalized suicide ideation and relates to acute crisis variables—is likely needed. Specifically, such other or additional suicide risk variable assessment may be required in the context of lethal suicide risk situations, as opposed to the discernment of general, nonlethal suicide behavior as a standard of practice (whether a patient is having suicidal thoughts or exhibiting an ambivalent suicide attempt potential). In the current study, verbalized suicide ideation information was unhelpful in the assessment of lethal risk. The Lethal Suicide Risk Assessment, Acute Model, and other dynamic, near-term risk models (such as the Acute Suicide Affective Disorder Model and the Suicide Crisis Syndrome Model)—going beyond elicited suicide ideation—need to be incorporated into current clinical suicide assessment training and become the legal standard of care for expected clinical behavior. Without this expanded clinical assessment perspective, the standard of care for suicide assessment is out of sync with current knowledge—an emerging dilemma for the forensic evaluation of suicide wrongful death cases.

Keywords: Forensic evaluation, standard of care, suicide, suicide assessment, wrongful death.

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Authors: Z. A. Ahmad Noor Syukri, A. J. Nawal Aswan, S. V. Wong

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The motorcycle has become one of the most common type of vehicles used on the road, particularly in the Asia region, including Malaysia, due to its size-convenience and affordable price. This study focuses only on crashes involving motorcycles with passenger cars consisting 43 real world crashes obtained from in-depth crash investigation process from June 2016 till July 2017. The study collected and analyzed vehicle and site parameters obtained during crash investigation and injury information acquired from the patient-treating hospital. The investigation team, consisting of two personnel, is stationed at the Emergency Department of the treatment facility, and was dispatched to the crash scene once receiving notification of the related crashes. The injury information retrieved was coded according to the level of severity using the Abbreviated Injury Scale (AIS) and classified into different body regions. The data revealed that weekend crashes were significantly higher for the night time period and the crash occurrence was the highest during morning hours (commuting to work period) for weekdays. Bad weather conditions play a minimal effect towards the occurrence of motorcycle – passenger vehicle crashes and nearly 90% involved motorcycles with single riders. Riders up to 25 years old are heavily involved in crashes with passenger vehicles (60%), followed by 26-55 year age group with 35%. Male riders were dominant in each of the age segments. The majority of the crashes involved side impacts, followed by rear impacts and cars outnumbered the rest of the passenger vehicle types in terms of crash involvement with motorcycles. The investigation data also revealed that passenger vehicles were the most at-fault counterpart (62%) when involved in crashes with motorcycles and most of the crashes involved situations whereby both of the vehicles are travelling in the same direction and one of the vehicles is in a turning maneuver. More than 80% of the involved motorcycle riders had sustained yellow severity level during triage process. The study also found that nearly 30% of the riders sustained injuries to the lower extremities, while MAIS level 3 injuries were recorded for all body regions except for thorax region. The result showed that crashes in which the motorcycles were found to be at fault were more likely to occur during night and raining conditions. These types of crashes were also found to be more likely to involve other types of passenger vehicles rather than cars and possess higher likelihood in resulting higher ISS (>6) value to the involved rider. To reduce motorcycle fatalities, it first has to understand the characteristics concerned and focus may be given on crashes involving passenger vehicles as the most dominant crash partner on Malaysian roads.

Keywords: Motorcycle crash, passenger vehicle, in-depth crash investigation, injury mechanism.

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Authors: S. Moustafa El Shanawany, I. Labib Salem, F. Mohamed Magdy Badr El Dine, H. Tag El Deen Abd Allah

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Thermal injuries remain a global health problem and a common issue encountered in forensic pathology. They are a devastating cause of morbidity and mortality in children and adults especially in developing countries, causing permanent disfigurement, scarring and grievous hurt. Burns have always been a matter of legal concern in cases of suicidal burns, self-inflicted burns for false accusation and homicidal attempts. Assessment of burn injuries as well as rating permanent disabilities and disfigurement following thermal injuries for the benefit of compensation claims represents a challenging problem. This necessitates the development of reliable scoring systems to yield an expected likelihood of permanent disability or fatal outcome following burn injuries. The study was designed to identify the risk factors of mortality in acute burn patients and to evaluate the applicability of FLAMES (Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex) and BOBI (Belgian Outcome in Burn Injury) model scores in predicting the outcome. The study was conducted on 100 adult patients with acute burn injuries admitted to the Burn Unit of Alexandria Main University Hospital, Egypt from October 2014 to October 2015. Victims were examined after obtaining informed consent and the data were collected in specially designed sheets including demographic data, burn details and any associated inhalation injury. Each burn patient was assessed using both BOBI and FLAMES scoring systems. The results of the study show the mean age of patients was 35.54±12.32 years. Males outnumbered females (55% and 45%, respectively). Most patients were accidently burnt (95%), whereas suicidal burns accounted for the remaining 5%. Flame burn was recorded in 82% of cases. As well, 8% of patients sustained more than 60% of total burn surface area (TBSA) burns, 19% of patients needed mechanical ventilation, and 19% of burnt patients died either from wound sepsis, multi-organ failure or pulmonary embolism. The mean length of hospital stay was 24.91±25.08 days. The mean BOBI score was 1.07±1.27 and that of the FLAMES score was -4.76±2.92. The FLAMES score demonstrated an area under the receiver operating characteristic (ROC) curve of 0.95 which was significantly higher than that of the BOBI score (0.883). A statistically significant association was revealed between both predictive models and the outcome. The study concluded that both scoring systems were beneficial in predicting mortality in acutely burnt patients. However, the FLAMES score could be applied with a higher level of accuracy.

Keywords: BOBI, Burns, FLAMES, scoring systems, outcome.

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Authors: A. Appe, B. Poluparthi, L. Kasivajjula, U. Mv, S. Bagadi, P. Modi, A. Singh, H. Gunupudi, S. Troiano, J. Paul, J. Stovall, J. Yamamoto

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The necessity of data-driven decisions in healthcare strategy formulation is rapidly increasing. A reliable framework which helps identify factors impacting a healthcare provider facility or a hospital (from here on termed as facility) market share is of key importance. This pilot study aims at developing a data-driven machine learning-regression framework which aids strategists in formulating key decisions to improve the facility’s market share which in turn impacts in improving the quality of healthcare services. The US (United States) healthcare business is chosen for the study, and the data spanning 60 key facilities in Washington State and about 3 years of historical data are considered. In the current analysis, market share is termed as the ratio of the facility’s encounters to the total encounters among the group of potential competitor facilities. The current study proposes a two-pronged approach of competitor identification and regression approach to evaluate and predict market share, respectively. Leveraged model agnostic technique, SHAP (SHapley Additive exPlanations), to quantify the relative importance of features impacting the market share. Typical techniques in literature to quantify the degree of competitiveness among facilities use an empirical method to calculate a competitive factor to interpret the severity of competition. The proposed method identifies a pool of competitors, develops Directed Acyclic Graphs (DAGs) and feature level word vectors, and evaluates the key connected components at the facility level. This technique is robust since it is data-driven, which minimizes the bias from empirical techniques. The DAGs factor in partial correlations at various segregations and key demographics of facilities along with a placeholder to factor in various business rules (for e.g., quantifying the patient exchanges, provider references, and sister facilities). Identified are the multiple groups of competitors among facilities. Leveraging the competitors' identified developed and fine-tuned Random Forest Regression model to predict the market share. To identify key drivers of market share at an overall level, permutation feature importance of the attributes was calculated. For relative quantification of features at a facility level, incorporated SHAP, a model agnostic explainer. This helped to identify and rank the attributes at each facility which impacts the market share. This approach proposes an amalgamation of the two popular and efficient modeling practices, viz., machine learning with graphs and tree-based regression techniques to reduce the bias. With these, we helped to drive strategic business decisions.

Keywords: Competition, DAGs, hospital, healthcare, machine learning, market share, random forest, SHAP.

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Authors: Cherryl Lowe

Abstract:

Background - The TrendCare Patient Dependency System is currently used by a large number of maternity Services across Australia, New Zealand and Singapore. In 2012, 2013 and 2014 validation studies were initiated in all three countries to validate the acuity tools used for women in labour, and postnatal mothers and babies. This paper will present the findings of the validation study. Aim - The aim of this study was to; identify if the care hours provided by the TrendCare acuity system was an accurate reflection of the care required by women and babies; obtain evidence of changes required to acuity indicators and/or category timings to ensure the TrendCare acuity system remains reliable and valid across a range of maternity care models in three countries. Method - A non-experimental action research methodology was used across maternity services in four District Health Boards in New Zealand, a large tertiary and a large secondary maternity service in Singapore and a large public maternity service in Australia. Standardised data collection forms and timing devices were used to collect midwife contact times, with women and babies included in the study. Rejection processes excluded samples when care was not completed/rationed, and contact timing forms were incomplete. The variances between actual timed midwife/mother/baby contact and the TrendCare acuity category times were identified and investigated. Results - Thirty two (88.9%) of the 36 TrendCare acuity category timings, fell within the variance tolerance levels when compared to the actual timings recorded for midwifery care. Four (11.1%) TrendCare categories provided less minutes of care than the actual timings and exceeded the variance tolerance level. These were all night shift category timings. Nine postnatal categories were not able to be compared as the sample size for these categories was statistically insignificant. 100% of labour ward TrendCare categories matched actual timings for midwifery care, all falling within the variance tolerance levels. The actual time provided by core midwifery staff to assist lead maternity carer (LMC) midwives in New Zealand labour wards showed a significant deviation to previous studies. The findings of the study demonstrated the need for additional time allocations in TrendCare to accommodate an increased level of assistance given to LMC midwives. Conclusion - The results demonstrated the importance of regularly validating the TrendCare category timings with actual timings of the care hours provided. It was evident from the findings that variances to models of care and length of stay in maternity units have increased midwifery workloads on the night shift. The level of assistance provided by the core labour ward staff to the LMC midwife has increased substantially. Outcomes - As a consequence of this study, changes were made to the night duty TrendCare maternity categories, additional acuity indicators were developed and times for assisting LMC midwives in labour ward increased. The updated TrendCare version was delivered to maternity services in 2014.

Keywords: Maternity, acuity, midwifery research, midwifery workloads.

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