10,133 research outputs found

    Annual SHOT Report 2018

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    SHOT is affiliated to the Royal College of PathologistsAll NHS organisations must move away from a blame culture towards a just and learning culture. All clinical and laboratory staff should be encouraged to become familiar with human factors and ergonomics concepts. All transfusion decisions must be made after carefully assessing the risks and benefits of transfusion therapy. Collaboration and co-ordination among staff is vital

    AnuĂĄrio cientĂ­fico da Escola Superior de Tecnologia da SaĂșde de Lisboa - 2021

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    É com grande prazer que apresentamos a mais recente edição (a 11.ÂȘ) do AnuĂĄrio CientĂ­fico da Escola Superior de Tecnologia da SaĂșde de Lisboa. Como instituição de ensino superior, temos o compromisso de promover e incentivar a pesquisa cientĂ­fica em todas as ĂĄreas do conhecimento que contemplam a nossa missĂŁo. Esta publicação tem como objetivo divulgar toda a produção cientĂ­fica desenvolvida pelos Professores, Investigadores, Estudantes e Pessoal nĂŁo Docente da ESTeSL durante 2021. Este AnuĂĄrio Ă©, assim, o reflexo do trabalho ĂĄrduo e dedicado da nossa comunidade, que se empenhou na produção de conteĂșdo cientĂ­fico de elevada qualidade e partilhada com a Sociedade na forma de livros, capĂ­tulos de livros, artigos publicados em revistas nacionais e internacionais, resumos de comunicaçÔes orais e pĂłsteres, bem como resultado dos trabalhos de 1Âș e 2Âș ciclo. Com isto, o conteĂșdo desta publicação abrange uma ampla variedade de tĂłpicos, desde temas mais fundamentais atĂ© estudos de aplicação prĂĄtica em contextos especĂ­ficos de SaĂșde, refletindo desta forma a pluralidade e diversidade de ĂĄreas que definem, e tornam Ășnica, a ESTeSL. Acreditamos que a investigação e pesquisa cientĂ­fica Ă© um eixo fundamental para o desenvolvimento da sociedade e Ă© por isso que incentivamos os nossos estudantes a envolverem-se em atividades de pesquisa e prĂĄtica baseada na evidĂȘncia desde o inĂ­cio dos seus estudos na ESTeSL. Esta publicação Ă© um exemplo do sucesso desses esforços, sendo a maior de sempre, o que faz com que estejamos muito orgulhosos em partilhar os resultados e descobertas dos nossos investigadores com a comunidade cientĂ­fica e o pĂșblico em geral. Esperamos que este AnuĂĄrio inspire e motive outros estudantes, profissionais de saĂșde, professores e outros colaboradores a continuarem a explorar novas ideias e contribuir para o avanço da ciĂȘncia e da tecnologia no corpo de conhecimento prĂłprio das ĂĄreas que compĂ”e a ESTeSL. Agradecemos a todos os envolvidos na produção deste anuĂĄrio e desejamos uma leitura inspiradora e agradĂĄvel.info:eu-repo/semantics/publishedVersio

    An investigation of the relationship between perioperative characteristics and perioperative anaesthesia on the postoperative systemic inflammatory response and clinical outcome in patients undergoing surgery for colorectal cancer

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    In UK, colorectal cancer (CRC) is the fourth most common cancer and the second most common cause of cancer death. Until now, surgical resection remains the cornerstone for the management of CRC in all stages, however, stress response elicit from surgery may cause different changes through multiple systems in human body including neural, endocrine, metabolic, inflammatory, and immunological changes. In addition, other perioperative factors such as volatile anaesthetic and opioids may induce the immunosuppression. There is a proportional correlation between the stress response and the magnitude of the inflammatory immune response, invasiveness, and duration of surgery. The pre-operative and post-operative status of patients are important when considering the prognosis. The systemic inflammatory response (SIR) has been recognised to correlate with tumour progression and the prognosis of CRC. An exaggerated postoperative SIR is associated with postoperative infective complications and poor survival. Several predictive markers of the SIR have been used, such as the neutrophil to lymphocyte ratio (NLR), serum C-reactive protein (CRP) level, and Glasgow prognostic score (GPS). Some evidence reported that general anaesthesia (GA) combined with regional anaesthesia (RA) are better than the single use of general anaesthesia in reducing the post-operative immuno-suppression in some degrees. Furthermore, the peri-operative inflammatory process may be affected by the choice of anaesthetic technique, with propofol reported to have anti-inflammatory effect by targeting neutrophil activity. Up to now, there is insufficient evidence to recommend any specific anaesthetic or analgesic technique for patients undergoing surgery for tumour resection based on inflammatory response, recurrence, and metastasis. The work presented in this thesis further examines the relationship between the perioperative characteristics, perioperative anaesthesia, and the postoperative systemic inflammatory response following surgery for colorectal cancer. Several preoperative medications along with anaesthesia might influence the postoperative systemic inflammatory response but the question is whether the post-operative systemic inflammatory response affected by the administration of different types of anaesthesia or not following surgery for colorectal cancer. Chapter 1 discusses the epidemiology, aetiology, carcinogenesis, risk factors of colorectal cancer, pro-carcinogenic factors, anti-carcinogenic agents, inflammation and cancer, the post-operative systemic inflammatory response, tumour staging, screening, and diagnosis of colorectal cancer. Chapter 2 discusses the treatment of colorectal cancer. Chapter 3 discusses different anaesthetic techniques and agents. Chapter 4 provides summary and aims of the thesis. Chapter 5 represents findings from a systematic review and meta-analysis about the effect of anaesthesia on the postoperative systemic inflammatory response in patients undergoing surgery. The results conclude that there was some evidence that anaesthetic regimens may reduce the magnitude of the post-operative SIR. However, the studies identified in this systematic review were heterogeneous and generally of low quality. Chapter 6 represents a retrospective cohort study about the relationship between anaesthetic technique, clinicopathological characteristics and the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colon cancer. The results show that the type of anaesthesia varied over time and appears to influence the magnitude of the postoperative SIR on post-operative day 2 for those patients who underwent for open surgery but not laparoscopic surgery. Chapter 7 represents a prospective cohort study about the effect of anaesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway. The results show that there was a modest but an independent association between regional anaesthesia (RA) and a lower magnitude of the postoperative SIR. Chapter 8 represents the relationship between pre-operative medications, the type of anaesthesia and post-operative sequelae in patients undergoing surgery for colorectal cancer. The results show that there was no association between the preoperative administration of aspirin, statins and ACE inhibitors and anaesthesia. Chapter 9 represents the relationship between nutritional status, anaesthetic approach, and peri-operative characteristics of patients undergoing surgery for colorectal cancer. The results show that there was no significant association between measures of nutritional status and anaesthetic approach. Chapter 10 represents the relationship between opioid administration, type of anaesthesia and clinicopathological characteristics in patients undergoing surgery for colorectal cancer. The results show that opioid administration was independently associated with both anaesthetic and operative factors. Chapter 11 represents the main findings of the thesis and some recommendation for a future work

    Pupillometry and the vigilance decrement: Task‐evoked but not baseline pupil measures reflect declining performance in visual vigilance tasks

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    Baseline and task-evoked pupil measures are known to reflect the activity of the nervous system's central arousal mechanisms. With the increasing availability, affordability and flexibility of video-based eye tracking hardware, these measures may one day find practical application in real-time biobehavioural monitoring systems to assess performance or fitness for duty in tasks requiring vigilant attention. But real-world vigilance tasks are predominantly visual in their nature and most research in this area has taken place in the auditory domain. Here, we explore the relationship between pupil size—both baseline and task-evoked—and behavioural performance measures in two novel vigilance tasks requiring visual target detection: (1) a traditional vigilance task involving prolonged, continuous and uninterrupted performance (n = 28) and (2) a psychomotor vigilance task (n = 25). In both tasks, behavioural performance and task-evoked pupil responses declined as time spent on task increased, corroborating previous reports in the literature of a vigilance decrement with a corresponding reduction in task-evoked pupil measures. Also in line with previous findings, baseline pupil size did not show a consistent relationship with performance measures. Our data offer novel insights into the complex interplay of brain systems involved in vigilant attention and question the validity of the assumption that baseline (prestimulus) pupil size and task-evoked (poststimulus) pupil measures reflect the tonic and phasic firing modes of the locus coeruleus

    Investigating and mitigating the role of neutralisation techniques on information security policies violation in healthcare organisations

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    Healthcare organisations today rely heavily on Electronic Medical Records systems (EMRs), which have become highly crucial IT assets that require significant security efforts to safeguard patients’ information. Individuals who have legitimate access to an organisation’s assets to perform their day-to-day duties but intentionally or unintentionally violate information security policies can jeopardise their organisation’s information security efforts and cause significant legal and financial losses. In the information security (InfoSec) literature, several studies emphasised the necessity to understand why employees behave in ways that contradict information security requirements but have offered widely different solutions. In an effort to respond to this situation, this thesis addressed the gap in the information security academic research by providing a deep understanding of the problem of medical practitioners’ behavioural justifications to violate information security policies and then determining proper solutions to reduce this undesirable behaviour. Neutralisation theory was used as the theoretical basis for the research. This thesis adopted a mixed-method research approach that comprises four consecutive phases, and each phase represents a research study that was conducted in light of the results from the preceding phase. The first phase of the thesis started by investigating the relationship between medical practitioners’ neutralisation techniques and their intention to violate information security policies that protect a patient’s privacy. A quantitative study was conducted to extend the work of Siponen and Vance [1] through a study of the Saudi Arabia healthcare industry. The data was collected via an online questionnaire from 66 Medical Interns (MIs) working in four academic hospitals. The study found that six neutralisation techniques—(1) appeal to higher loyalties, (2) defence of necessity, (3) the metaphor of ledger, (4) denial of responsibility, (5) denial of injury, and (6) condemnation of condemners—significantly contribute to the justifications of the MIs in hypothetically violating information security policies. The second phase of this research used a series of semi-structured interviews with IT security professionals in one of the largest academic hospitals in Saudi Arabia to explore the environmental factors that motivated the medical practitioners to evoke various neutralisation techniques. The results revealed that social, organisational, and emotional factors all stimulated the behavioural justifications to breach information security policies. During these interviews, it became clear that the IT department needed to ensure that security policies fit the daily tasks of the medical practitioners by providing alternative solutions to ensure the effectiveness of those policies. Based on these interviews, the objective of the following two phases was to improve the effectiveness of InfoSec policies against the use of behavioural justification by engaging the end users in the modification of existing policies via a collaborative writing process. Those two phases were conducted in the UK and Saudi Arabia to determine whether the collaborative writing process could produce a more effective security policy that balanced the security requirements with daily business needs, thus leading to a reduction in the use of neutralisation techniques to violate security policies. The overall result confirmed that the involvement of the end users via a collaborative writing process positively improved the effectiveness of the security policy to mitigate the individual behavioural justifications, showing that the process is a promising one to enhance security compliance

    Statistical Learning for Gene Expression Biomarker Detection in Neurodegenerative Diseases

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    In this work, statistical learning approaches are used to detect biomarkers for neurodegenerative diseases (NDs). NDs are becoming increasingly prevalent as populations age, making understanding of disease and identification of biomarkers progressively important for facilitating early diagnosis and the screening of individuals for clinical trials. Advancements in gene expression profiling has enabled the exploration of disease biomarkers at an unprecedented scale. The work presented here demonstrates the value of gene expression data in understanding the underlying processes and detection of biomarkers of NDs. The value of novel approaches to previously collected -omics data is shown and it is demonstrated that new therapeutic targets can be identified. Additionally, the importance of meta-analysis to improve power of multiple small studies is demonstrated. The value of blood transcriptomics data is shown in applications to researching NDs to understand underlying processes using network analysis and a novel hub detection method. Finally, after demonstrating the value of blood gene expression data for investigating NDs, a combination of feature selection and classification algorithms were used to identify novel accurate biomarker signatures for the diagnosis and prognosis of Parkinson’s disease (PD) and Alzheimer’s disease (AD). Additionally, the use of feature pools based on previous knowledge of disease and the viability of neural networks in dimensionality reduction and biomarker detection is demonstrated and discussed. In summary, gene expression data is shown to be valuable for the investigation of ND and novel gene biomarker signatures for the diagnosis and prognosis of PD and AD

    Exploring the effects of spinal cord stimulation for freezing of gait in parkinsonian patients

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    Dopaminergic replacement therapies (e.g. levodopa) provide limited to no response for axial motor symptoms including gait dysfunction and freezing of gait (FOG) in Parkinson’s disease (PD) and Richardson’s syndrome progressive supranuclear palsy (PSP-RS) patients. Dopaminergic-resistant FOG may be a sensorimotor processing issue that does not involve basal ganglia (nigrostriatal) impairment. Recent studies suggest that spinal cord stimulation (SCS) has positive yet variable effects for dopaminergic-resistant gait and FOG in parkinsonian patients. Further studies investigating the mechanism of SCS, optimal stimulation parameters, and longevity of effects for alleviating FOG are warranted. The hypothesis of the research described in this thesis is that mid-thoracic, dorsal SCS effectively reduces FOG by modulating the sensory processing system in gait and may have a dopaminergic effect in individuals with FOG. The primary objective was to understand the relationship between FOG reduction, improvements in upper limb visual-motor performance, modulation of cortical activity and striatal dopaminergic innervation in 7 PD participants. FOG reduction was associated with changes in upper limb reaction time, speed and accuracy measured using robotic target reaching choice tasks. Modulation of resting-state, sensorimotor cortical activity, recorded using electroencephalography, was significantly associated with FOG reduction while participants were OFF-levodopa. Thus, SCS may alleviate FOG by modulating cortical activity associated with motor planning and sensory perception. Changes to striatal dopaminergic innervation, measured using a dopamine transporter marker, were associated with visual-motor performance improvements. Axial and appendicular motor features may be mediated by non-dopaminergic and dopaminergic pathways, respectively. The secondary objective was to demonstrate the short- and long-term effects of SCS for alleviating dopaminergic-resistant FOG and gait dysfunction in 5 PD and 3 PSP-RS participants without back/leg pain. SCS programming was individualized based on which setting best improved gait and/or FOG responses per participant using objective gait analysis. Significant improvements in stride velocity, step length and reduced FOG frequency were observed in all PD participants with up to 3-years of SCS. Similar gait and FOG improvements were observed in all PSP-RS participants up to 6-months. SCS is a promising therapeutic option for parkinsonian patients with FOG by possibly influencing cortical and subcortical structures involved in locomotion physiology

    II tĂŒĂŒpi kollageeni neoepitoop C2C uriinis kui pĂ”lve osteoartriidi diagnoosimise ja kulu prognoosimise biomarker

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    VĂ€itekirja elektrooniline versioon ei sisalda publikatsiooneOsteoartriit (OA) on sagedasim liigeshaigus, tabades ligi poolt miljardit inimest maailmas. PĂ”lv on ĂŒks peamisi kahjustuskohti. Haiguse kaasaegse kĂ€sitluse jĂ€rgi arenevad kahjustused molekulaarsetest muutustest kuni kudede (kĂ”hr, luu, sĂŒnoviaalkest, menisk, sidemed) struktuuri muutusteni. OA on aastate jooksul ebaĂŒhtlase kiirusega sĂŒvenev haigus, mille puhul stabiilsemad perioodid vahelduvad kiiremate muutustega, kulgedes varajases jĂ€rgus haigustunnusteta. SeetĂ”ttu pakuvad kudede ainevahetuse muutusi peegeldavad molekulaarsed markerid varajast hoiatust koekahjustuse tekkest, vĂ”imalust hinnata haiguse kulgu ning tulevikus ka ravivastust. Kuna II tĂŒĂŒpi kollageen (Kol2) on kĂ”hre peamine struktuurne komponent, on OA hindamiseks loodud mitmeid Kol2 lammutamist mÔÔtvaid teste. KĂ€esolevas uurimuses hindasime OA uue biomarkeri, uC2C kasutusvĂ”imalusi pĂ”lve OA (pOA) korral. uC2C on Kol2 lĂ”hustumise neoepitoop C2C uriinis. VĂ”rdlesime uC2C vÀÀrtusi röntgenleiu, kĂ”hre otsese vaatlusleiu ja patsiendi kliinilise seisundiga, kasutades erinevaid statistilisi mudeleid. Selgus, et uC2C on sobiv kandidaat pOA varajase diagnostilise testi arendamiseks. C2C sisaldus tĂ”useb juba haiguse varajases jĂ€rgus ja on seotud haiguse mitme pĂ”hiprotsessiga: kĂ”hre lammutamise ja luukasviste tekkega pĂ”lveliigese eri osades. uC2C on hea progressioonimarker naistel: uC2C kĂ”rgem algvÀÀrtus ennustab naistel vĂ€ga hĂ€sti (>90%) pOA teket vĂ”i sĂŒvenemist jĂ€rgneva 3 aasta jooksul. uC2C tase on kĂ”rgem suuremate röntgenmuutuste korral, seega uC2C tase on seotud pOA raskusastmega. uC2C vÀÀrtused on suurimad kOA lĂ”ppjĂ€rgus olevatel haigetel, kes jĂ”uavad liigeseasenduseni suhteliselt noorelt (50–70 a vanuses). PĂ€rast pĂ”lveliigese asendamist vĂ”ib C2C eritumine uriiniga vĂ€heneda, suureneda vĂ”i jÀÀda muutumatuks. Seega ei peata liigeseasendus paljudel juhtudel Kol2 lammutamist organismis ja OA on sĂŒsteemsem haigus, kui on seni arvatud. uC2C nĂ€ib olevat naistel vĂ”rreldes meestega parem pOA biomarker.Osteoarthritis (OA) is the most common joint disease, affecting about half a billion people worldwide. The knee is one of the main sites of impairment. According to the new approach to the disease, the alterations develop from the molecular level to structural changes in tissues (cartilage, bone, synovium, meniscus, ligaments). OA is a disease with an alternating course, with no signs of disease at an early stage. Therefore, molecular markers that reflect changes in tissue metabolism provide an early warning of tissue damage, an opportunity to assess the course of the disease, and a response to future treatment. Because type II collagen (Col2) is a major structural component of cartilage, several tests have been developed to measure Col2 degradation. In the current study, we evaluated the potential use of a new OA biomarker, C2C, in knee OA (kOA). uC2C is a Col2 cleavage neoepitope in urine. We compared uC2C values with X-ray findings, direct visual assessment of cartilage, and clinical status using different statistical models. uC2C is a good candidate for the development of an early diagnostic test for kOA. The level of uC2C is increased in the early stages of kOA and is related to several main processes of kOA: the cartilage lesions and the osteophytes in distinct knee compartments. uC2C is a good marker of progression in women–a higher baseline uC2C is an excellent predictor (> 90%) of the initiation or worsening of kOA over the next 3 years. uC2C is higher in higher X-ray grades, so uC2C levels are associated with the severity of kOA. uC2C values are highest in patients with end-stage kOA who reach joint replacement at a relatively young age (50-70 years). After knee replacement, urinary excretion of C2C may decrease, increase, or remain unchanged. Thus, in many cases, joint replacement does not stop the breakdown of Col2 in the body, and OA is a more systemic disease than previously thought. uC2C appears to be a better biomarker of pOA in women than in men.https://www.ester.ee/record=b550707

    Exploring individual characteristics related to community-based sentence compliance: Is there an association between neuropsychological functioning, traumatic brain injury, and non-compliance with a community-based sentence?

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    Non-compliance with a community-based sentence can result in serious consequences for an individual, including imprisonment. Probation officers, who supervise those on community sentences, play an essential role in supporting compliance and determining how to respond when non-compliance occurs; however, little research has explored how probation officers use their discretion. Neuropsychological dysfunction and a history of traumatic brain injury (TBI) are overrepresented amongst incarcerated offenders and associated with poorer outcomes (recidivism, treatment attrition, disciplinary infractions). However, much less is known about the neuropsychological function and history of TBI amongst community-based offenders (i.e., supervisees). Thus, this research project sought to understand probation officers’ perspectives on and responses to non-compliance and explore the association between a supervisee’s compliance and current neuropsychological functioning and recent TBI. The first study involved two focus groups with 17 New Zealand probation officers; the aim was to explore probation officers’ views on compliance and how they practice supervision. All probation officers reported using ‘social worker’ type, evidenced-based practices such as building quality relationships and using motivational interviewing. Probation officers viewed problems with cognitive skills as a key barrier to sentence compliance and reported using various strategies to support the compliance of supervisees with cognitive issues. The second study, involved 106 adult men (n = 82, 77.4%) and women (n = 24, 22.6%) on community sentences who participated in an initial interview that included a screen for a history of TBI and consent to collect compliance (arrests, sentence violations) and related variables (e.g., risk scores) from the New Zealand Department of Corrections database and police records over six months. At the conclusion of the initial interview, supervisees were invited to return and complete neuropsychological tests. Sixty-four men (n = 47, 73.4%) and women (n = 17, 26.5%) returned and completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Comprehensive Trail Making Test, and Color-Word Inference Test, and the Behavior Rating Inventory of Executive Function- Adult Version (BRIEF-A). Twenty-six probation officers, whose supervisees participated in the study, were interviewed regarding their supervisees’ compliance. The first manuscript from this study focused on the executive functioning of this sample compared to a normative sample and investigated the association between executive functioning and compliance with sentence conditions. The results indicated that the community-based sample had significantly poorer executive functioning compared to a normative sample. Still, contrary to what was expected, those supervisees who complied with their sentence conditions had poorer executive functioning than those who were non-compliant. However, exploratory analyses showed that those with poorer executive functioning received more probation officer support to comply with sentence conditions. The second manuscript described the sample’s neuropsychological function compared to a normative sample and investigated the association between sustaining a TBI in the last year (i.e., within the year prior to joining the study) and current neuropsychological function. We then explored if a TBI in the last year or current neuropsychological function were associated with compliance with sentence conditions and compliance with the law (i.e., being arrested). The results indicated that the community-based sample’s neuropsychological functioning was significantly poorer than a normative sample. Our findings also suggested that a TBI in the last year was a significant predictor of arrest, even when controlling for risk of reconviction and current substance use. However, a recent TBI was not associated with non-compliance with sentence conditions nor with poorer performance on the neuropsychological tests. In addition, no significant associations were found between performance on the neuropsychological tests and either measure of non-compliance. Overall, the results from this thesis suggested that individual characteristics like TBI and neuropsychological functioning impact compliance with a community-based sentence in different ways: A recent TBI was predictive of re-arrest while serving a community sentence, and poorer neuropsychological functioning was significantly associated with increased support from the probation officer to comply. The main implications of this research for corrections departments are that supervisees on a community sentence with poor neuropsychological functioning or a recent TBI may need additional monitoring or support to reduce the risk of non-compliance and reoffending. While further research needs to be undertaken to inform any changes in policy or practices, the results from this thesis suggest that community corrections would benefit from the implementation of services and screens to target important responsivity issues like TBI and poor neuropsychological functioning. Corrections departments attention to these issues may help alleviate the risk of individuals getting trapped in the criminal justice system for non-criminal activities (e.g., not attending an appointment)
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