Efficiency of Aerosol Therapy through Jet Nebulizer, Breath-Actuated Nebulizer, and Pressurized Metered Dose Inhaler in a Simulated Spontaneous Breathing Adult

BACKGROUND: Aerosol therapy using albuterol is one of the most prescribed asthma treatments. The most frequently used methods of aerosol delivery are pneumatic jet nebulizer (JN), pressurized metered-dose inhaler (pMDI), and breath-actuated nebulizer (BAN). Choosing among these devices is usually not based on thorough comparison of efficiency or cost. We compare the efficiency of these three devices using a spontaneously breathing adult model. METHODS: We connected each aerosol generator—JN, BAN, or pMDI with a valved holding chamber (VHC)—to the face of an adult teaching manikin. Below the bifurcation, an elbow adaptor was connected to a corrugated tube and was angled to be at a lower level than the collecting filter to prevent droplets from dripping directly into the collecting filter. From the collecting filter, another corrugated tube was connected to a prevention filter, which was then connected to an adult breathing simulator. Spontaneous breathing parameters were VT 450 mL, RR 20/min, and I: E ratio 1:2. First, we compared JN, BAN (2.5 mg/3 mL), and pMDI (4 puffs); second, we compared JN and BAN 2.5 mg/0.5 mL plus 0.5 mL normal saline. Data were analyzed using spectrophotometry (276 nm). One-way ANOVA and independent sample t-tests were used (p\u3c0.05). RESULTS: There were no differences in inhaled mass percentage (p=0.172) JN, BAN, and pMDI in the first experiment. Treatment time with BAN was significantly longer (p=0.0001) than with JN or pMDI. In the second experiment, BAN delivered more medication (p=0.004) than jet nebulizer. Treatment time was significantly less with JN (p=0.010). There was no difference in residual volume among JN and BAN in both experiment (p=0.765, p=0.115). CONCLUSIONS: All the devices that were compared using a 3 ml or 4 pMDI puffs delivered comparable amount of medication with no significant difference. However, BAN using 1ml fill volume delivers more drug compared to JN. Additionally, treatment time was longest with BAN. Even with reduction of its filling volume, BAN delivers a higher amount of medication to that of pMDI but was not statistically significant

Respiratory Therapy Student Perception of Patient Simulation Education at a Large Urban University

Background: Patient simulations have become a basis of training for numerous health care professions. In the field of Respiratory Therapy (RT), it has been proven to influence and motivate the students in proactively participating in learning through the use of clinical demonstrations and technology. However, there remains a limited number of studies that investigate the impact of simulation in RT. PURPOSE: The aim of this study was to determine the perceptions of RT students at an urban university on what they have learned from their patient simulation sessions. METHODS: A self-reporting descriptive survey was used. It was a modification of the Student Satisfaction and Self-confidence in Learning NLN/Laerdal Research tool. The participants included 34 undergraduate and graduate RT students from the Georgia State University. RESULTS: With a response rate of 88.2%, the majority of the RT students were satisfied with their present learning and felt supportive of simulation experience, availability and access to various learning materials and activities, simulation as their motivation, and the way instructors taught the simulation. It also revealed that self-confidence and enthusiasm in learning increased with simulation activities. Majority of RT students perceive simulation education as a helpful and effective teaching method (x̅ 3.13 SD ± 0.73). RT students perceive developing the skills and obtaining the required knowledge from simulation to perform necessary tasks in the clinical setting as the most important clinical benefit they acquire from simulation education (x̅ 3.16, SD ± 0.74). The RT students also believe it is their responsibility to learn what is needed to know from simulation activity and they agree that they know how to get help when they do not understand the concepts covered in the simulation (x̅ 3.53, SD ± .50). CONCLUSION: RT students agree that patient simulations are beneficial and effective as a supportive learning method in their learning. They also agreed that simulation activities increase their self-confidence and enthusiasm in learning, but further research and studies about simulations should be encouraged in order to determine its future importance in preparing future RT professionals in real clinical settings and clinical exploration

The effect of therapy on arousal from sleep in patients with respiratory sleep disorders

Vibrotactile positional therapy (PT) is a relatively new treatment for positional obstructive sleep apnoea (POSA). It uses vibrotactile stimulus to encourage the sleeper to change position when supine. The overall aim of this thesis was to investigate the efficacy of vibrotactile PT as a clinical treatment for patients with POSA. To achieve this, different experimental approaches were used, including a systematic review and meta-analysis, a clinical trial, and a physiological study. The systematic review was carried out to evaluate the effect of vibrotactile PT on apnoea hypopnoea index (AHI), percentage of time spent in supine (%Tsupine), and patient-centred outcomes in patients with POSA compared to baseline. The results showed that vibrotactile PT was effective in reducing both AHI and %Tsupine. Although the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire minimally improved, these changes did not reach clinically important differences; however, limited data were found on quality of life (SF-36) vitality score. A prospective, three-month, multicentre, randomised, parallel, double-blind trial (The POSA Trial, ISRCTN51740863) was developed to investigate the effect of vibrotactile PT on AHI, quality of life and daytime functioning at follow-up, adjusted for the baseline, in patients with POSA compared to sham-vibrotactile PT. Baseline data (AHI, quality of life and daytime functioning) obtained from the participants recruited at the Royal Brompton Hospital are presented in the thesis. The mean baseline AHI for RBH participants was in the mild OSA category compared to the patients in the systematic review; however, a higher baseline %Tsupine was found. The baseline patient-centred outcomes were also comparable to those found in the systematic review. A physiological study in healthy participants (n=27) was carried out to investigate the effect of vibrotactile stimulus on arousability from sleep. A novel analysis method was developed to measure arousability. This included the duration from the vibrotactile stimulus to the position change using polysomnography. The results of this study showed heterogenous arousability responses to the vibrotactile stimulus with different phenotypes. Compared to males, healthy females took longer to respond to the vibrotactile stimulus and, therefore, were more resilient to arousability. In summary, the findings of this thesis have shown that vibrotactile PT devices are effective in treating patients with POSA. However, limited data on sensitive patient-centred outcomes exist. The POSA trial will provide data to address this evidence gap. Furthermore, the physiological findings in people without OSA showed that males are more arousable than females. This information may be of value when considering personalisation of clinical treatment. Future research of POSA will need to consider the arousability phenotype when planning treatment options.Open Acces

Knowledge Sharing in International Business: A Literature Review Study

In an era where global trade has developed along with the massive number and expansion of knowledge, the necessity of exchanging knowledge and international business has continuously increased. This is in light of international business organizations’ intellectual capital, which propels them into global competition and provides them with a competitive advantage if utilized properly. The purpose of this research is to examine and assess two topics, namely, knowledge sharing and international business, as well as their location in research studies, importance, definitions and histories of those terms, and research interests for each one of these two dimensions. The review focused on the topic of knowledge sharing in international business organizations, with analysis and discussion of the most important research, studies, and trends along three axes: knowledge sharing, international business organizations, and earlier studies. The study concluded that knowledge sharing is an essential aspect of knowledge management since it connects the previous processes of acquiring knowledge capital to the subsequent processes of application and practice, which is especially important for international business organizations that need to benefit from knowledge in a variety of ways. In addition to the scarcity of studies that coupled knowledge sharing and international business, there is a great scope for developing models and applications in this field of study. We were unable to find studies that combined the two themes through research, but they were implicitly addressed within the research to highlight the importance of knowledge sharing in international business, and this is what motivates more research in this field due to the shortcoming of studies on the subject. It seemed to be that the essential element to organizational innovation is knowledge development and sharing

How can technological creativity be taught in the Saudi Arabian elementary school context?

Teaching technological creativity in the Saudi Arabian school context can support the inclusion of technology education in general education. To support this view, the thesis proposes that technological creativity be a topic taught in the elementary school context. The intention is to assist pupils aged six to twelve years to learn how to be creative through planning and carrying out activities. The thesis attempts to introduce the concept of technological creativity to gain insights that can help to enlighten pupils technologically in a way that aligns with Islamic culture. A Critical Interpretative Synthesis (CIS) methodological approach was conducted to identify, select, synthesise, and analyse integrated papers on teaching technological creativity at the elementary school level from 21 developed countries. Papers from a variety of sources, 135 altogether, were selected for the synthesis and to develop a synthesising argument (theoretical framework), derived from constructs generated in the papers included. The text of each of the papers was treated as data and objects of inquiry. This makes CIS different from meta-ethnography (ME) in that it does not aim only at aggregating or summarising findings from studies but rather at developing a clear argument around the chosen topic in order to produce a mid-range theory based on a large, diverse body of literature. The analyses were performed in two major stages: identification, inclusion, analysis and the appraisal of papers; and developing a synthesising argument derived from the synthetic constructs embedded in the integrated papers dealing with the question, how can technological creativity be taught in the Saudi Arabian elementary school context? The synthesising argument provides a new model of interpretation developed from the findings of CIS and the synthesis process. The thesis argues that a true understanding of the benefits of this topic can be achieved through a consideration of the findings of this thesis based on the critique of relevant papers drawn from the research literature of a number of developed countries. The research study seeks to encourage the education of pupils through teaching them creative processes and helping them both appreciate and enjoy technology education. Thus the aim includes developing their personality and sense of self-worth. It is also hoped that this research will be of interest to teachers in elementary education, curriculum developers, Saudi scholars and future researchers of technology education

Synthesis and characterization of Schiff-base complexes as medical imaging precursors

Schiff-base compounds have been utilized in the medical field as antibiotics, antifungal, anti-inflammatory and antiviral agents. The presence of nitrogen, oxygen and sulphur atoms in chelating Schiff-base compounds showed great biological activities. Furthermore, their derivative metal complexes have exhibited greater effects in many reported cases. Some Schiff-base complexes have been reported as medical imaging agents. The aim of my work is to synthesis novel Schiff base ligands and their metal derivatives that have the potential to be used as medical imaging precursors. A novel macrocyclic Schiff-base ligand was developed from 3,5- diformyl-4-hydroxybenzoic acid and 2,2’-oxydianiline. Also, a novel crystal structure for a known macrocyclic Schiff-base was synthesized from 2,2’-oxydianiline and 4-tert-butyl-2,6-diformylphenol. Finally, a novel copper Schiff-base complex synthesized

Sex Differences in White Matter Hyperintensities in the Ageing Brain

Cerebral white matter hyperintensities (WMH) appear in the brain magnetic resonance imaging scan at early age and become more prevalent at older age. Despite that old age is known as the main risk factor for WMH accumulation, the literature has shown that many vascular risk factors contribute significantly to the existence and progression of WMH. Women were shown to have higher WMH volume compared to men in the literature. However, the existing literature lacks comprehensive evidence to address why such pattern is noted. Therefore, this thesis aims to examine sex differences in WMH. Specifically, three studies were conducted: (1) investigating sex differences in the associations between vascular risk factors and WMH, (2) examining the contribution of the hormonal risk factors to WMH and their moderation effects on the associations between vascular risk factors and WMH, and (3) examining sex differences in longitudinal associations between vascular risk factors and WMH, and the effects of WMH progression on cognitive decline. Results showed that the pattern of higher WMH in women compared to men was identified across the studies, however, men had stronger contributions of vascular risk factors, especially obesity measures, to WMH. The second study showed that hypertensive postmenopausal women benefited significantly from using hormone replacement therapy, especially when taken early and for longer duration. Diabetic women and women with increased pulse wave velocity had increased deep WMH when post-menopausal duration was one standard deviation below the mean. In men, smokers with higher testosterone levels had significant increase in WMH. In the third study, significant sex differences were found in the association between WMH progression and cognition. Specifically, increases in periventricular WMH volume over time was associated with greater decline in visuospatial abilities in men, but not in women. In women, but not in men, higher average periventricular WMH volumes across time-points was associated with poorer executive function. The thesis comprehensively examined sex differences in vascular and hormonal risk factors associated with WMH, as well as in cognitive consequences of the progression of WMH. The findings highlight the importance of taking sex differences into consideration clinically and for future clinical research of WMH

Shilajit elicits apoptosis and suppresses cell migration in oral cancer cells through targeting Urokinase-type plasminogen activator (uPA) and its receptor (uPAR) and chemokine signaling pathways

Shilajit (Mumio) is a humic substance with a dark brown colour that comes from rocks found at high altitudes. For centuries, shilajit has been a widely employed traditional medicinal remedy to address various physical ailments. Given the prevalence of oral cancer, there is a growing need for more effective therapies in its treatment. In this in vitro study, the impact of shilajit on normal human gingival fibroblast cells (hGFs) and oral cancer cells (KB-1, subline of the KERATIN-forming tumor cell line HeLa) was compared. The MTT and Annexin-V tests were used to measure the KB-1 cells growth and apoptosis after they were exposed to varying concentrations of Shilajit for 24h. An inverted microscope was used to evaluate the shilajit treated cell morphology. On the other hand, AO/EtBr dual staining was employed to analyse cellular apoptosis quantitatively. ROS production analysis was carried out utilizing DCFH-DA staining, while the gene expression of proapoptotic and antiapoptotic proteins was assessed through real-time PCR

Role of Mumio in periodontal wound healing–an in vitro study on human PDL cells

Mumio, used in ancient medicine for almost 4000 years, is the gold standard of traditional medicine. Mumio, a tar-like compound made from rock dissolved minerals and degraded organic matter, takes a century to form. Dibenzo-alpha-pyrones, humic acid, and fulvic acid are important in Mumio, which includes 60–80% humus, benzoic acid, fatty acids, ichthyol, ellagic acid, resin, triterpenes, sterol, aromatic carboxylic acids, bioactive 3,4-benzokoumarins, amino acids, phenol Active chemicals improve Mumio\u27s antioxidant effects. Despite its anti-ulcerogenic, anti-inflammatory, antioxidant, immunomodulatory, memory-enhancing, and anxiolytic characteristics, mumio has been studied rarely on oral tissues. The present study examined the cytotoxic, antioxidant, anti-inflammatory, and reparative effects of the aqueous fraction of Mumio on primary cultures of human periodontal ligament (PDL) fibroblasts

Analysis of Total Lip Score System and Total Groove Score for gender identification: A cross sectional study

Endless ink and pixel space have been spent to validate the use of cheiloscopy classification systems in the field of identification. It is becoming evident that lip-print patterns may provide indications about an individual\u27s gender, race, occupation, habits, blood type, and paternity. Over the course of time, much data has been collected on a substantial population in this field. In the present study, we strive to see how well a noble total lip scoring system (TLS) works in identifying a person\u27s gender among College of Dentistry students. We also quantified the total groove score (TGS) and compared it with each quadrant for better authentication of the set study design