Search results for: children with intellectual disability
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4287

Search results for: children with intellectual disability

1167 A Machine Learning-Based Analysis of Autism Prevalence Rates across US States against Multiple Potential Explanatory Variables

Authors: Ronit Chakraborty, Sugata Banerji

Abstract:

There has been a marked increase in the reported prevalence of Autism Spectrum Disorder (ASD) among children in the US over the past two decades. This research has analyzed the growth in state-level ASD prevalence against 45 different potentially explanatory factors, including socio-economic, demographic, healthcare, public policy, and political factors. The goal was to understand if these factors have adequate predictive power in modeling the differential growth in ASD prevalence across various states and if they do, which factors are the most influential. The key findings of this study include (1) the confirmation that the chosen feature set has considerable power in predicting the growth in ASD prevalence, (2) the identification of the most influential predictive factors, (3) given the nature of the most influential predictive variables, an indication that a considerable portion of the reported ASD prevalence differentials across states could be attributable to over and under diagnosis, and (4) identification of Florida as a key outlier state pointing to a potential under-diagnosis of ASD there.

Keywords: autism spectrum disorder, clustering, machine learning, predictive modeling

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1166 Indigenizing Social Work Practice: Best Practice of Family Service Agency (LK3) State Islamic University (UIN) Syarif Hidayatullah Jakarta

Authors: Siti Napsiyah, Ismet Firdaus, Lisma Dyawati Fuaida, Ellies Sukmawati

Abstract:

This paper examines the existence, role, and challenge of Family Service Agency, in Bahasa Indonesia known as Lembaga Konsultasi Kesejahteraan Keluarga (LK3) of Syarif Hidayatullah State Islamic University (UIN) Jakarta. It has been established since 2012. It is an official agency under the Ministry of Social Affairs of Indonesia. The establishment of LK3 aims to provide psychosocial services for families of students who has psychosocial problem in their life. The study also aims to explore the trend of psychosocial problems of its client (student) for the past three years (2014-2016). The research method of the study is using a qualitative social work research method. A review of selected data of the client of LK3 UIN Syarif Hidayatullah Jakarta around five main issues: Family background, psychosocial mapping, potential resources, student coping mechanism strategy, client strength and network. The study also uses a review of academic performance report as well as an interview and observation. The findings show that the trend of psychosocial problems of the client of LK3 UIN Syarif Hidayatullah Jakarta vary as follow: bad academic performance, low income family, broken home, domestic violence, disability, mental disorder, sexual abuse, and the like. LK3 UIN Syarif Hidayatullah Jakarta has significant roles to provide psychosocial support and services for the survival of the students to deal with their psychosocial problems. Social worker of LK3 performs indigenous social work practice: individual counseling, family counseling, group therapy, home visit, case conference, Islamic Spiritual Approach, and Spiritual Emotional Freedom Technique (SEPT).

Keywords: psychosocial, indigenizing social work, resiliency, coping mechanism

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1165 Natural Radioactivity in Tunisian Bottled Mineral Waters

Authors: Salam Labidi, Sonia Machraoui, Souha Gharbi

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Radium isotopes (226Ra, 228Ra) and uranium isotopes (234U, 238U) activity concentrations were determined in most popular Tunisian bottled mineral waters samples. Activity concentrations of uranium were studied by radiochemical separation procedures followed by alpha spectrometry and that of radium isotopes by gamma-ray spectrometry. The activity concentrations of 238U, 234U, 226Ra and 228Ra in water samples varied in range 3.3 - 22.5 mBq.L−1, 4.0 - 34.2 mBq L−1, 2.0 - 67.0 mBq L−1 and 2.0 - 30.2 mBq L−1, respectively. These values are comparable with those reported for many other countries in the world for different types of water. Based on the activity concentration results obtained in this study, the estimated annual ingestion dose rates for three different age groups (babies, children and adults) due to the ingestion of radium and uranium isotopes through drinking water are lower than the limit of intake prescribed by WHO. The annual doses exceed the recommended value of 0.1 mSv y-1 in one case for babies.

Keywords: mineral water, natural radioactivity, radiation dose, radium, uranium

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1164 Real-World Economic Burden of Musculoskeletal Disorders in Nigeria

Authors: F. Fatoye, C. E. Mbada, T. Gebrye, A. O. Ogunsola, C. Fatoye, O. Oyewole

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Musculoskeletal disorders (MSDs) such as low back pain (LBP), cervical spondylosis (CSPD), sprain, osteoarthritis (OA), and post immobilization stiffness (PIS) have a major impact on individuals, health systems and society in terms of morbidity, long-term disability, and economics. This study estimated the direct and indirect costs of common MSDs in Osun State, Nigeria. A review of medical charts for adult patients attending Physiotherapy Outpatient Clinic at the Obafemi Awolowo University Teaching Hospitals Complex, Osun State, Nigeria between 2009 and 2018 was carried out. The occupational class of the patients was determined using the International Labour Classification (ILO). The direct and indirect costs were estimated using a cost-of-illness approach. Physiotherapy related health resource use, and costs of the common MSDs, including consultation fee, total fee charge per session, costs of consumables were estimated. Data were summarised using descriptive statistics mean and standard deviation (SD). Overall, 1582 (Male = 47.5%, Female = 52.5%) patients with MSDs population with a mean age of 47.8 ± 25.7 years participated in this study. The mean (SD) direct costs estimate for LBP, CSPD, PIS, sprain, OA, and other conditions were $18.35 ($17.33), $34.76 ($17.33), $32.13 ($28.37), $35.14 ($44.16), $37.19 ($41.68), and $15.74 ($13.96), respectively. The mean (SD) indirect costs estimate of LBP, CSPD, PIS, sprain, OA, and other MSD conditions were $73.42 ($43.54), $140.57 ($69.31), $128.52 ($113.46), sprain $140.57 ($69.31), $148.77 ($166.71), and $62.98 ($55.84), respectively. Musculoskeletal disorders contribute a substantial economic burden to individuals with the condition and society. The unacceptable economic loss of MSDs should be reduced using appropriate strategies. Further research is required to determine the clinical and cost effectiveness of strategies to improve health outcomes of patients with MSDs. The findings of the present study may assist health policy and decision makers to understand the economic burden of MSDs and facilitate efficient allocation of healthcare resources to alleviate the burden associated with these conditions in Nigeria.

Keywords: economic burden, low back pain, musculoskeletal disorders, real-world

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1163 Towards an Equitable Proprietary Regime: Property Rights Over Human Genes as a Case Study

Authors: Aileen Editha

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The legal recognition of property rights over human genes is a divisive topic to which there is no resolution. As a frequently discussed topic, scholars and practitioners often highlight the inadequacies of a proprietary regime. However, little has been said in regard to the nature of human genetic materials (HGMs). This paper proposes approaching the issue of property over HGMs from an alternative perspective that looks at the personal and social value and valuation of HGMs. This paper will highlight how the unique and unresolved status of HGMs is incompatible with the main tenets of property and, consequently, contributes to legal ambiguity and uncertainty in the regulation of property rights over human genes. HGMs are perceived as part of nature and a free-for-all while also being within an individual’s private sphere. Additionally, it is also considered to occupy a unique “not-private-nor-public” status. This limbo-like position clashes with property’s fundamental characteristic that relies heavily on a clear public/private dichotomy. Moreover, as property is intrinsically linked to the legal recognition of one’s personhood, this irresolution benefits some while disadvantages others. In particular, it demands the publicization of once-private genes for the “common good” but subsequently encourages privatization (through labor) of these now-public genes. This results in the gain of some (already privileged) individuals while enabling the disenfranchisement of members of minority groups, such as Indigenous communities. This paper will discuss real and intellectual property rights over human genes, such as the right to income or patent rights, in Canada and the US. This paper advocates for a sui generis approach to governing rights and interests over human genes that would not rely on having a strict public/private dichotomy. Not only would this improve legal certainty and clarity, but it would also alleviate—or, at the very least, minimize—the role that the current law plays in further entrenching existing systemic inequalities. Despite the specificity of this topic, this paper argues that there are broader lessons to be learned. This issue is an insightful case study on the interconnection of various principles in law, society, and property, and what must be done when discordance between one or more of those principles has detrimental societal outcomes. Ultimately, it must be remembered that property is an adaptable and malleable instrument that can be developed to ensure it contributes to equity and flourishing.

Keywords: property rights, human genetic materials, critical legal scholarship, systemic inequalities

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1162 Pregnant Individuals in Rural Areas Benefit from Cognitive Behavioral Therapy: A Literature Review

Authors: Kushal Patel, Manasa Dittakavi, Cyrus Falsafi, Gretchen Lovett

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Rural America has seen a surge in opioid addiction rates and overdose deaths in recent years, becoming a significant public health crisis. This may be due to a variety of factors, such as lack of access to healthcare or other economic and social factors that can contribute to addiction such as poverty, unemployment, and social isolation. As the opioid epidemic has disproportionately affected rural communities, pregnant women in these areas may be highly susceptible and face additional difficulties in facing the appropriate care they need. Opioid use disorder has many negative effects on prenatal infants. These include changes in their microbiome, mental health, neurodevelopment and cognition. These can affect how the child performs in various activities in life and how they interact with others. It has been demonstrated that using cognitive behavioral therapy improves not just pain-related results but also mobility, quality of life, disability, and mood outcomes. This indicates that cognitive behavioral therapy (CBT) may be a useful therapeutic strategy for enhancing general health and wellbeing in people with opioid use problems. In terms of treating psychiatric diseases, CBT carries fewer dangers than opioids. One study that illustrates the potential for CBT to promote a reduction in opioid use disorder used self-reported drug use patterns 6 months prior to and during their pregnancy. At the beginning of the study, participants reported an average of 3.78 drug or alcohol use days in the previous 28 days, which decreased to 1.63 days after treatment. The study also found a decrease in depression scores, as measured by IDS scores, from 23.9 to 17.1 at the end of treatment. These and other results show that CBT can have meaningful impacts on pregnant women in Rural America who struggle with an opioid use disorder. This project has been approved by the West Virginia School of Osteopathic Medicine- Office of Research and Sponsored Programs and deemed non-research scholarly work.

Keywords: appalachia, CBT, opiods, pregnancy

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1161 The Incidence of Acetylcholine Receptor Antibody Positive Myasthenia Gravis in South Africa

Authors: Mombaur Busisiwe, Lesosky Maia, Liebenberg Lisa, Heckmann Jeannine

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Introduction: To assess age- and gender-specific incidence rates (IR) of acetylcholine receptor (AChR)-antibody positive myasthenia gravis (MG) in South Africa, and geographical variation in incidence. Methods: IRs were calculated from positive AChR antibody laboratory data between 2011 and 2012, using 2011 population census data. Results:890 individuals were seropositive, for an annual IR of 8.5 per million. Age-standardized IR for early- (< 50) and late-onset (≥ 50) MG were 4.1 and 24 per million, respectively, and for juveniles, 4.3 per million. The IR between provinces ranged from 1 to 19 per million. Conclusions: In this Southern hemisphere African population, the overall IR and peak IR (in older men) for seropositive MG is comparable to that in Europe and North America, arguing against environmental factors. However, IRs may be higher among children with African genetic ancestry. Geographical variation in incidence underscores the importance of outreach programs for regions with limited resources.

Keywords: incidence rates (IR), acetylcholine receptor (AChR), myasthenia gravis (MG), South Africa

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1160 Current Status of Inclusive Education for Students with Disabilities in Punjab, Pakistan

Authors: Muhammad Shahid Shah, Akram Maqbool, Samina Ashraf

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Since start of this century, world has adopted inclusion as a trend in special education. To meet the challenges of inclusion response, the Punjab government has developed a progressive policy to implement inclusive education. The objectives of this research were to analyze the administration and implementation process by consideration on the management, student’s admission process, screening and assessment, adaptations in curriculum and instruction along with an evaluation, government and nonprofit organizations support. The sample consisted of 50 schools both public and private with a total of 3000 students, 9 percent of which (270) were students with disabilities. Among all the students with disabilities, 63 percent (170) were male and 37 percent (100) were female. The concluded remarks regarding management revealed that a large number of inclusive schools was lacking in terms of developing a certain model for inclusion, including the managerial breakup of staff, the involvement of stakeholders, and conducted frequent meetings. Many of schools are not able to restructure their school organizations due to lack of financial resources, consultations, and backup. As for as student’s admission/identification/assessment was concerned, only 12 percent schools applied a selection process regarding student admission, half of which used different procedures for disable candidates. Approximately 5 percent of inclusive schools had modified their curriculum, including a variety of standards. In terms of instruction, 25 percent of inclusive schools reported that they modified their instructional process. Only a few schools, however, provided special equipment for students with visual impairment, physical impairment, speech and hearing problems, students with mild intellectual disabilities, and autism. In a student evaluation, more than 45 percent reported that test items, administration, time allocations, and students’ reports were modified. For the primary board examination conducted by the Education Department of Government of Punjab, this number decreased dramatically. Finally, government and nonprofit organizations support in the forms of funding, coaching, and facilities were mostly provided by provincial governments and by Ghazali Education Trust.

Keywords: inclusion, identification, assessment, funding, facilities, evaluation

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1159 Translation and Transculturality in Contemporary Chinese Art: A Case Study of Gu Wenda’s 'Forest of Stone Steles' and 'United Nations: Temple of Heaven'

Authors: Rui Zhang

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Translation has been elevated to one of the key notions in contemporary cultural discourse for a wide range of fields. It focuses not only on communication or transmission of meaning between different languages, but also on ways in which the very act of translation can be understood as a metaphor for cultural process. In recent years, the notion of translation is employed by some contemporary Chinese artists in a conceptual way, whose works contribute to constructing/deconstructing global/local cultural discourse and their own cultural identities. This study examines two artworks by contemporary Chinese artist Gu Wenda from a translational perspective, namely Forest of Stone Steles - Retranslation & Rewriting of Tang Poetry and United Nations - China Monument: Temple of Heaven, aiming to broaden the scope of Translation Studies to investigate visual culture and enrich methodological approach to contemporary Chinese art. Focusing on the relationship between translation, visuality and materiality in these two works, this study explores the nature of translation as part of the production of cultural discourse in the age of globalization as well as a way of establishing cultural identity. Gu Wenda, one of the most prestigious artists in contemporary China, is considered a pioneer in ‘85 Art Movement of China, and thereafter he went abroad for his artistic pursuits. His transnational experience enriches his cultural identity and the underlying discourse constructed/deconstructed in many of his works. In the two works already mentioned, the concept of translation is deployed by Gu Wenda on both linguistic level and metaphorical level for artistic expression. These two works produce discourses in which the artist’s perception of cultural identity in a transnational context is articulated by the tension between source text and target text. Based on the conceptual framework of cultural identity proposed by Stuart Hall, analyses of Gu Wenda’s cultural identity revealed through translation in these two works are centred on two axes, i.e., the axis of similarity and continuity with Chinese intellectual culture and the axis of difference and rupture with it, and the dialogic relationship between these two vectors. It argues that besides serving as a means of constructing visuality in the two works, translation metaphorizes Gu Wenda’s journey from overcoming his cultural identity anxiety to re-establishing a transcultural identity embedded in the underlying discourse.

Keywords: contemporary Chinese art, cultural identity, transculturality, translation

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1158 Development of Peaceful Wellbeing in Executive Practitioners through Mindfulness-Based Practices

Authors: Narumon Jiwattanasuk, Phrakrupalad Pannavoravat, Pataraporn Sirikanchana

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Mindfulness has become a perspective addressing positive wellbeing these days. The aims of this paper are to analyze the problems of executive meditation practitioners at the Buddhamahametta Foundation in Thailand and to provide recommendations on the process to develop peaceful wellbeing in executive meditation practitioners by applying the principles of the four foundations of mindfulness. This study is particularly focused on executives because there is not much research focusing on the well-being development of executives, and the researcher recognizes that executives can be an example within their organizations. This would be a significant influence on their employees and their families to be interested in practicing mindfulness. This improvement will then grow from an individual to the surrounding community such as family, workplace, society, and the nation. This would lead to happiness at the national level, which is the expectation of this research. The paper highlights mindfulness practices that can be performed on a daily basis. This study is qualitative research, and there are 10 key participants who are executives from various sectors such as hospitality, healthcare, retail, power energy, and so on. Three mindfulness-based courses were conducted over a period of 8 months, and in-depth interviews were done before the first course as well as at the end of every course. In total, four in-depth interviews were conducted. The information collected from the interviews was analyzed in order to create the process to develop peaceful well-being. Focus group discussions with the mindfulness specialists were conducted to help develop the mindfulness program as well. As a result of this research, it is found that the executives faced the following problems: stress, negative thinking loops, losing temper, seeking acceptance, worry about uncontrollable external factors, unable to control their words, and weight gain. The cultivation of the four foundations of mindfulness can develop peaceful wellbeing. The results showed that after the key informant executives attended the mindfulness courses and practiced mindfulness regularly, they have developed peaceful well-being in all aspects such as physical, psychological, behavioral, and intellectual by applying 12 mindfulness-based activities. The development of wellbeing, in the conclusion of this study, also includes various tools to support the continuing practice, including the handout of guided mindfulness practice, VDO clips about mindfulness practice, the online dhamma channel, and mobile applications to support regular mindfulness-based practices.

Keywords: executive, mindfulness activities, stress, wellbeing

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1157 Immunological and Genetic Studies of Patients with Atopic Dermatitis

Authors: Alaa Jawad Hassan, Saad Marza Al-Aaraji, Fadil Abbas Hamad

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The current study was designed to assess some immunological parameters and pedigree analysis for atopic dermatitis patients, as the study included 64 patients (37 males and 27 females) and 24 healthy individuals (12 males and 12 females) with no history of the AD. The cases of this study were divided into two age groups; the first is infant and children (1-10 years), while the second is adolescent and adults (11- 60 years). The number of cases was 51 and 13 in each age group respectively. Sera samples from confirmed AD patients and healthy control were analysed by mean of ELISA for assessment the concentrations of IL-1β, IL-2, IL-4 and IgE. The study showed that a significant increase (P < 0.05) in IL-1β, IL-4 and IgE levels in the patients compared with the control group in both age groups and gender, while there was no significant difference (P < 0.05) in the concentration of IL-2. The study of pedigree analysis shows the genetic tendency in the frequency of disease depending on the genetic history of family, where more patients returning to families in which both parents or one of them infected with AD, whereas the patients were no parents infected with AD they are suffering from asthma and the disease recurs in their uncles.

Keywords: atopic dermatitis, cytokines, IgE, molecular biology

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1156 Relationship Between Brain Entropy Patterns Estimated by Resting State fMRI and Child Behaviour

Authors: Sonia Boscenco, Zihan Wang, Euclides José de Mendoça Filho, João Paulo Hoppe, Irina Pokhvisneva, Geoffrey B.C. Hall, Michael J. Meaney, Patricia Pelufo Silveira

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Entropy can be described as a measure of the number of states of a system, and when used in the context of physiological time-based signals, it serves as a measure of complexity. In functional connectivity data, entropy can account for the moment-to-moment variability that is neglected in traditional functional magnetic resonance imaging (fMRI) analyses. While brain fMRI resting state entropy has been associated with some pathological conditions like schizophrenia, no investigations have explored the association between brain entropy measures and individual differences in child behavior in healthy children. We describe a novel exploratory approach to evaluate brain fMRI resting state data in two child cohorts, and MAVAN (N=54, 4.5 years, 48% males) and GUSTO (N = 206, 4.5 years, 48% males) and its associations to child behavior, that can be used in future research in the context of child exposures and long-term health. Following rs-fMRI data pre-processing and Shannon entropy calculation across 32 network regions of interest to acquire 496 unique functional connections, partial correlation coefficient analysis adjusted for sex was performed to identify associations between entropy data and Strengths and Difficulties questionnaire in MAVAN and Child Behavior Checklist domains in GUSTO. Significance was set at p < 0.01, and we found eight significant associations in GUSTO. Negative associations were found between two frontoparietal regions and cerebellar posterior and oppositional defiant problems, (r = -0.212, p = 0.006) and (r = -0.200, p = 0.009). Positive associations were identified between somatic complaints and four default mode connections: salience insula (r = 0.202, p < 0.01), dorsal attention intraparietal sulcus (r = 0.231, p = 0.003), language inferior frontal gyrus (r = 0.207, p = 0.008) and language posterior superior temporal gyrus (r = 0.210, p = 0.008). Positive associations were also found between insula and frontoparietal connection and attention deficit / hyperactivity problems (r = 0.200, p < 0.01), and insula – default mode connection and pervasive developmental problems (r = 0.210, p = 0.007). In MAVAN, ten significant associations were identified. Two positive associations were found = with prosocial scores: the salience prefrontal cortex and dorsal attention connection (r = 0.474, p = 0.005) and the salience supramarginal gyrus and dorsal attention intraparietal sulcus (r = 0.447, p = 0.008). The insula and prefrontal connection were negatively associated with peer problems (r = -0.437, p < 0.01). Conduct problems were negatively associated with six separate connections, the left salience insula and right salience insula (r = -0.449, p = 0.008), left salience insula and right salience supramarginal gyrus (r = -0.512, p = 0.002), the default mode and visual network (r = -0.444, p = 0.009), dorsal attention and language network (r = -0.490, p = 0.003), and default mode and posterior parietal cortex (r = -0.546, p = 0.001). Entropy measures of resting state functional connectivity can be used to identify individual differences in brain function that are correlated with variation in behavioral problems in healthy children. Further studies applying this marker into the context of environmental exposures are warranted.

Keywords: child behaviour, functional connectivity, imaging, Shannon entropy

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1155 Changing Emphases in Mental Health Research Methodology: Opportunities for Occupational Therapy

Authors: Jeffrey Chase

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Historically the profession of Occupational Therapy was closely tied to the treatment of those suffering from mental illness; more recently, and especially in the U.S., the percentage of OTs identifying as working in the mental health area has declined significantly despite the estimate that by 2020 behavioral health disorders will surpass physical illnesses as the major cause of disability worldwide. In the U.S. less than 10% of OTs identify themselves as working with the mentally ill and/or practicing in mental health settings. Such a decline has implications for both those suffering from mental illness and the profession of Occupational Therapy. One reason cited for the decline of OT in mental health has been the limited research in the discipline addressing mental health practice. Despite significant advances in technology and growth in the field of neuroscience, major institutions and funding sources such as the National Institute of Mental Health (NIMH) have noted that research into the etiology and treatment of mental illness have met with limited success over the past 25 years. One major reason posited by NIMH is that research has been limited by how we classify individuals, that being mostly on what is observable. A new classification system being developed by NIMH, the Research Domain Criteria (RDoc), has the goal to look beyond just descriptors of disorders for common neural, genetic, and physiological characteristics that cut across multiple supposedly separate disorders. The hope is that by classifying individuals along RDoC measures that both reliability and validity will improve resulting in greater advances in the field. As a result of this change NIH and NIMH will prioritize research funding to those projects using the RDoC model. Multiple disciplines across many different setting will be required for RDoC or similar classification systems to be developed. During this shift in research methodology OT has an opportunity to reassert itself into the research and treatment of mental illness, both in developing new ways to more validly classify individuals, and to document the legitimacy of previously ill-defined and validated disorders such as sensory integration.

Keywords: global mental health and neuroscience, research opportunities for ot, greater integration of ot in mental health research, research and funding opportunities, research domain criteria (rdoc)

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1154 Patients' Quality of Life and Caregivers' Burden of Parkinson's Disease

Authors: Kingston Rajiah, Mari Kannan Maharajan, Si Jen Yeen, Sara Lew

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Parkinson’s disease (PD) is a progressive neurodegenerative disorder with evolving layers of complexity. Both motor and non-motor symptoms of PD may affect patients’ quality of life (QoL). Life expectancy for an individual with Parkinson’s disease depends on the level of care the individual has access to, can have a direct impact on length of life. Therefore, improvement of the QoL is a significant part of therapeutic plans. Patients with PD, especially those who are in advanced stages, are in great need of assistance, mostly from their family members or caregivers in terms of medical, emotional, and social support. The role of a caregiver becomes increasingly important with the progression of PD, the severity of motor impairment and increasing age of the patient. The nature and symptoms associated with PD can place significant stresses on the caregivers’ burden. As the prevalence of PD is estimated to more than double by 2030, it is important to recognize and alleviate the burden experienced by caregivers. This study focused on the impact of the clinical features on the QoL of PD patients, and of their caregivers. This study included PD patients along with their caregivers and was undertaken at the Malaysian Parkinson's Disease Association from June 2016 to November 2016. Clinical features of PD patients were assessed using the Movement Disorder Society revised Unified Parkinson Disease Rating Scale (MDS-UPDRS); the Hoehn and Yahr Staging of Parkinson's Disease were used to assess the severity and Parkinson's disease activities of daily living scale were used to assess the disability of Parkinson’s disease patients. QoL of PD patients was measured using the Parkinson's Disease Questionnaire-39 (PDQ-39). The revised version of the Zarit Burden Interview assessed caregiver burden. At least one of the clinical features affected PD patients’ QoL, and at least one of the QoL domains affected the caregivers’ burden. Clinical features ‘Saliva and Drooling’, and ‘Dyskinesia’ explained 29% of variance in QoL of PD patients. The QoL domains ‘stigma’, along with ‘emotional wellbeing’ explained 48.6% of variance in caregivers’ burden. Clinical features such as saliva, drooling and dyskinesia affected the QoL of PD patients. The PD patients’ QoL domains such as ‘stigma’ and ‘emotional well-being’ influenced their caregivers’ burden.

Keywords: carers, quality of life, clinical features, Malaysia

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1153 The Effect of Artificial Intelligence on Autism Attitudes and Laws

Authors: Nermin Noshi Esraeil Abdalla

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Inclusive schooling offerings for college kids with Autism stays in its early developmental levels in Thailand. despite many greater youngsters with autism are attending schools since the Thai authorities brought the training Provision for human beings with Disabilities Act in 2008, the services students with autism and their families obtain are typically missing. This quantitative examine used attitude and Preparedness to educate college students with Autism Scale (APTSAS) to investigate 110 number one faculty teachers’ attitude and preparedness to educate college students with autism inside the widespread training school room. Descriptive statistical evaluation of the records discovered that scholar behavior changed into the most good sized factor in constructing teachers’ terrible attitudes students with autism. the majority of teachers additionally indicated that their pre-service schooling did not put together them to fulfill the mastering needs of children with autism especially, folks who are non-verbal. The take a look at is substantial and offers path for enhancing trainer education for inclusivity in Thailand.

Keywords: attitude, autism, teachers, sports activities, movement skills, motor skills

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1152 Identification of Bioactive Metabolites from Ficus carica and Their Neuroprotective Effects of Alzheimer's Disease

Authors: Hanan Khojah, RuAngelie Edrada-Ebel

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Neurodegenerative disease including Alzheimer’s disease is a major cause of long-term disability. Oxidative stress is frequently implicated as one of the key contributing factors to neurodegenerative diseases. Protection against neuronal damage remains a great challenge for researchers. Ficus carica (commonly known as fig) is a species of great antioxidant nutritional value comprising a protective mechanism against innumerable health disorders related to oxidative stress as well as Alzheimer’s disease. The purpose of this work was to characterize the non-polar active metabolites in Ficus carica endocarp, mesocarp, and exocarp. Crude extracts were prepared using several extraction solvents, which included 1:1 water: ethylacetate, acetone and methanol. The dried extracts were then solvent partitioned between equivalent amounts of water and ethylacetate. Purification and fractionation were accomplished by high-throughput chromatography. The isolated metabolites were tested on their effect on human neuroblastoma cell line by cell viability test and cell cytotoxicity assay with acrolein. Molecular weights of the active metabolites were determined via LC–HRESIMS and GC-EIMS. Metabolomic profiling was performed to identify the active metabolites by using differential expression analysis software (Mzmine) and SIMCA for multivariate analysis. Structural elucidation and identification of the interested active metabolites were studied by 1-D and 2-D NMR. Significant differences in bioactivity against a concentration-dependent assay on acrolein radicals were observed between the three fruit parts. However, metabolites obtained from mesocarp and the endocarp demonstrated bioactivity to scavenge ROS radical. NMR profiling demonstrated that aliphatic compounds such as γ-sitosterol tend to induce neuronal bioactivity and exhibited bioactivity on the cell viability assay. γ-Sitosterol was found in higher concentrations in the mesocarp and was considered as one of the major phytosterol in Ficus carica.

Keywords: alzheimer, Ficus carica, γ-Sitosterol, metabolomics

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1151 Psychological Stress As A Catalyst For Multiple Sclerosis Progression: Clarifying Pathways From Neural Activation to Immune Dysregulation

Authors: Noah Emil Glisik

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Multiple sclerosis (MS) is a chronic, immune-mediated disorder characterized by neurodegenerative processes and a highly variable disease course. Recent research highlights a complex interplay between psychological stress and MS progression, with both acute and chronic stressors linked to heightened inflammatory activity, increased relapse risk, and accelerated disability. This review synthesizes findings from systematic analyses, cohort studies, and neuroimaging investigations to examine how stress contributes to disease dynamics in MS. Evidence suggests that psychological stress influences MS progression through neural and physiological pathways, including dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and heightened activity in specific brain regions, such as the insular cortex. Notably, functional MRI studies indicate that stress-induced neural activity may predict future atrophy in gray matter regions implicated in motor and cognitive function, thus supporting a neurobiological link between stress and neurodegeneration in MS. Longitudinal studies further associate chronic stress with reduced quality of life and higher relapse frequency, emphasizing the need for a multifaceted therapeutic approach that addresses both the physical and psychological dimensions of MS. Evidence from intervention studies suggests that stress management strategies, such as cognitive-behavioral therapy and mindfulness-based programs, may reduce relapse rates and mitigate lesion formation in MS patients. These findings underscore the importance of integrating stress-reducing interventions into standard MS care, with potential to improve disease outcomes and patient well-being. Further research is essential to clarify the causal pathways and develop targeted interventions that could modify the stress response in MS, offering an avenue to address disease progression and enhance quality of life.

Keywords: multiple sclerosis, psychological stress, disease progression, neuroimaging, stress management

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1150 Tabu Search to Draw Evacuation Plans in Emergency Situations

Authors: S. Nasri, H. Bouziri

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Disasters are quite experienced in our days. They are caused by floods, landslides, and building fires that is the main objective of this study. To cope with these unexpected events, precautions must be taken to protect human lives. The emphasis on disposal work focuses on the resolution of the evacuation problem in case of no-notice disaster. The problem of evacuation is listed as a dynamic network flow problem. Particularly, we model the evacuation problem as an earliest arrival flow problem with load dependent transit time. This problem is classified as NP-Hard. Our challenge here is to propose a metaheuristic solution for solving the evacuation problem. We define our objective as the maximization of evacuees during earliest periods of a time horizon T. The objective provides the evacuation of persons as soon as possible. We performed an experimental study on emergency evacuation from the tunisian children’s hospital. This work prompts us to look for evacuation plans corresponding to several situations where the network dynamically changes.

Keywords: dynamic network flow, load dependent transit time, evacuation strategy, earliest arrival flow problem, tabu search metaheuristic

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1149 Motherhood Factors Influencing the Business Growth of Women-Owned Sewing Businesses in Lagos, Nigeria: A Mixed Method Study

Authors: Oyedele Ogundana, Amon Simba, Kostas Galanakis, Lynn Oxborrow

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The debate about factors influencing the business growth of women-owned businesses has been a topical issue in business management. Currently, scholars have identified the issues of access to money, market, and management as canvasing factors influencing the business growth of women-owned businesses. However, the influence of motherhood (household/family context) on business growth is inconclusive in the literature; despite that women are more family-oriented than their male counterparts. Therefore, this research study considers the influence of motherhood factor (household/family context) on the business growth of women-owned sewing businesses (WOSBs) in Lagos, Nigeria. The sewing business sector is chosen as the fashion industry (which includes sewing businesses) currently accounts for the second largest number of jobs in Sub-Saharan Africa, following agriculture. Thus, sewing businesses provide a rich ground for contributing to existing scholarly work. Research questions; (1) In what way does the motherhood factor influence the business growth of WOSBs in Lagos? (2) To what extent does the motherhood factor influence the business growth of WOSBs in Lagos? For the method design, a pragmatic approach, a mixed-methods technique and an abductive form of reasoning are adopted. The method design is chosen because it fits, better than other research perspectives, with the research questions posed in this study. For instance, using a positivist approach will not sufficiently answer research question 1, neither will an interpretive approach sufficiently answer research question 2. Therefore, the research method design is divided into 2 phases, and the results from one phase are used to inform the development of the subsequent phases (only phase 1 has been completed at the moment). The first phase uses qualitative data and analytical method to answer research question 1. While the second phase of the research uses quantitative data and analytical method to answer research question 2. For the qualitative phase, 5 WOSBs were purposefully selected and interviewed. The sampling technique is selected as it was not the intention of the researcher to make any statistical inferences, at this phase, rather the purpose was just exploratory. Therefore, the 5 sampled women comprised of 2 unmarried women, 1 married woman with no child, and 2 married women with children. A 40-60 minutes interview was conducted per participants. The interviews were audio-recorded and transcribed. Thereafter, the data were analysed using thematic analysis in order to unearth patterns and relationships. Findings for the first phase of this research reveals that motherhood (household/family context) directly influences (positively/negatively) the performance of WOSBs in Lagos. Apart from a direct influence on WOSBs, motherhood also moderates (positively/negatively) other factors–e.g., access to money, management/human resources and market/opportunities– influencing WOSBs in Lagos. To further strengthen this conclusion, a word frequency query result shows that ‘family,’ ‘husband’ and ‘children’ are among the 10 words used frequently in all the interview transcripts. This first phase contributes to existing studies by showing the various forms by which motherhood influences WOSBs. The second phase (which data are yet to be collected) would reveal the extent to which motherhood influence the business growth of WOSBs in Lagos.

Keywords: women-owned sewing businesses, business growth, motherhood, Lagos

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1148 Factors Influencing Savings of People between 30-40 Years Old in Dusit District, Bangkok Metropolis

Authors: Charawee Butbumrung

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The purpose of this research were to study the factors influencing savings of people between 30-40 years old in Dusit District, Bangkok Metropolis. The statistic used in data analysis were frequency, mean and standard deviation, t-test, one-way ANOVA and Pearson’s correlation coefficient based on social science statistic program. Result of hypothesis testing showed that married people earning different monthly salary generally saved by depositing into the bank at different level. People of different occupation saved in form of life insurance at different level at statistical significance 0.05. Result of influence testing between saving motivation was found that people saved for use upon sickness or getting older, saved for the children. Worthiness and certainty influenced saving in the same direction at high level while saving motivation in public relation, annual tax reduction, inducement by the others, bonus gift influenced saving in the same direction at moderate level at statistical significance 0.05.

Keywords: Dusit District, factors, saving, Bangkok Metropolis

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1147 Ecology, Value-Form and Metabolic Rift: Conceptualizing the Environmental History of the Amazon in the Capitalist World-System (19th-20th centuries)

Authors: Santiago Silva de Andrade

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In recent decades, Marx's ecological theory of the value-form and the theory of metabolic rift have represented fundamental methodological innovations for social scientists interested in environmental transformations and their relationships with the development of the capital system. However, among Latin American environmental historians, such theoretical and methodological instruments have been used infrequently and very cautiously. This investigation aims to demonstrate how the concepts of metabolic rift and ecological value-form are important for understanding the environmental, economic and social transformations in the Amazon region between the second half of the 19th century and the end of the 20th century. Such transformations manifested themselves mainly in two dimensions: the first concerns the link between the manufacture of tropical substances for export and scientific developments in the fields of botany, chemistry and agriculture. This link was constituted as a set of social, intellectual and economic relations that condition each other, configuring an asymmetrical field of exchanges and connections between the demands of the industrialized world - personified in scientists, naturalists, businesspeople and bureaucrats - and the agencies of local social actors, such as indigenous people, riverside dwellers and quilombolas; the second dimension concerns the imperative link between the historical development of the capitalist world-system and the restructuring of the natural world, its landscapes, biomes and social relations, notably in peripheral colonial areas. The environmental effects of capitalist globalization were not only seen in the degradation of exploited environments, although this has been, until today, its most immediate and noticeable aspect. There was also, in territories subject to the logic of market accumulation, the reformulation of patterns of authority and institutional architectures, such as property systems, political jurisdictions, rights and social contracts, as a result of the expansion of commodity frontiers between the 16th and 21st centuries. . This entire set of transformations produced impacts on the ecological landscape of the Amazon. This demonstrates the need to investigate the histories of local configurations of power, spatial and ecological - with their institutions and social actors - and their role in structuring the capitalist world-system , under the lens of the ecological theory of value-form and metabolic rift.

Keywords: amazon, ecology, form-value, metabolic rift

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1146 Organisational Change: The Impact on Employees and Organisational Development

Authors: Maureen Royce, Joshi Jariwala, Sally Kah

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Change is inevitable, but the change process is progressive. Organisational change is the process in which an organisation changes strategies, operational methods, systems, culture, and structure to affect something different in the organisation. This process can be continuous or developed over a period and driven by internal and external factors. Organisational change is essential if organisations are to survive in dynamic and uncertain environments. However, evidence from research shows that many change initiatives fail, leading to severe consequences for organisations and their resources. The complex models of third sector organisations, i.e., social enterprise, compounds the levels of change in these organisations. Interestingly, innovation is associated with a change in social enterprises due to the hybridity of product and service development. Furthermore, the creation of social intervention has offered a new process and outcomes to the lifecycle of change. Therefore, different forms of organisational innovation are developed, i.e., total, evolutionary, expansionary, and developmental, which affect the interventions of social enterprises. This raises both theoretical and business concerns on how the competing hybrid nature of social enterprises change, how change is managed, and the impact on these organisations. These perspectives present critical questions for further investigation. In this study, we investigate the impact of organisational change on employees and organisational development at DaDaFest –a disability arts organisation with a social focus based in Liverpool. The three main objectives are to explore the drivers of change and the implementation process; to examine the impact of organisational change on employees and; to identify barriers to organisation change and development. To address the preceding research objectives, qualitative research design is adopted using semi-structured interviews. Data is analysed using a six-step thematic analysis framework, which enables the study to develop themes depicting the impact of change on employees and organisational development. This study presents theoretical and practical contributions for academics and practitioners. The knowledge contributions encapsulate the evolution of change and the change cycle in a social enterprise. However, practical implications provide critical insights into the change management process and the impact of change on employees and organisational development.

Keywords: organisational change, change management, organisational change system, social enterprise

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1145 Organizational Learning, Job Satisfaction and Work Performance among Nurses

Authors: Rafia Rafique, Arifa Khadim

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This research investigates the moderating role of job satisfaction between organizational learning and work performance among nurses. Correlation research design was used. Non-probability purposive sampling technique was utilized to recruit a sample of 110 nurses from public hospitals situated in the city of Lahore. The construct of organizational learning was measured using subscale of Integrated Scale for Measuring Organizational Learning. Job satisfaction was measured with the help of Job Satisfaction Survey. Performance of employees (task performance, contextual performance and counterproductive work behavior) was assessed by Individual Work Performance Questionnaire. Job satisfaction negatively moderates the relationship between organizational learning and counterproductive work behavior. Education has a significant positive relationship with organizational learning. Age, current hospital experience, marital satisfaction and salary of the nurses have positive relationship while number of children has significant negative relationship with counterproductive work behavior. These outcomes can be insightful in understanding the dynamics involved in work performance. Based on the result of this study relevant solutions can be proposed to improve the work performance of nurses.

Keywords: counterproductive work behavior, nurses, organizational learning, work performance

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1144 Understanding the Basics of Information Security: An Act of Defense

Authors: Sharon Q. Yang, Robert J. Congleton

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Information security is a broad concept that covers any issues and concerns about the proper access and use of information on the Internet, including measures and procedures to protect intellectual property and private data from illegal access and online theft; the act of hacking; and any defensive technologies that contest such cybercrimes. As more research and commercial activities are conducted online, cybercrimes have increased significantly, putting sensitive information at risk. Information security has become critically important for organizations and private citizens alike. Hackers scan for network vulnerabilities on the Internet and steal data whenever they can. Cybercrimes disrupt our daily life, cause financial losses, and instigate fear in the public. Since the start of the pandemic, most data related cybercrimes targets have been either financial or health information from companies and organizations. Libraries also should have a high interest in understanding and adopting information security methods to protect their patron data and copyrighted materials. But according to information security professionals, higher education and cultural organizations, including their libraries, are the least prepared entities for cyberattacks. One recent example is that of Steven’s Institute of Technology in New Jersey in the US, which had its network hacked in 2020, with the hackers demanding a ransom. As a result, the network of the college was down for two months, causing serious financial loss. There are other cases where libraries, colleges, and universities have been targeted for data breaches. In order to build an effective defense, we need to understand the most common types of cybercrimes, including phishing, whaling, social engineering, distributed denial of service (DDoS) attacks, malware and ransomware, and hacker profiles. Our research will focus on each hacking technique and related defense measures; and the social background and reasons/purpose of hacker and hacking. Our research shows that hacking techniques will continue to evolve as new applications, housing information, and data on the Internet continue to be developed. Some cybercrimes can be stopped with effective measures, while others present challenges. It is vital that people understand what they face and the consequences when not prepared.

Keywords: cybercrimes, hacking technologies, higher education, information security, libraries

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1143 Study of the Association between Salivary Microbiological Data, Oral Health Indicators, Behavioral Factors, and Social Determinants among Post-COVID Patients Aged 7 to 12 Years in Tbilisi City

Authors: Lia Mania, Ketevan Nanobashvili

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Background: The coronavirus disease COVID-19 has become the cause of a global health crisis during the current pandemic. This study aims to fill the paucity of epidemiological studies on the impact of COVID-19 on the oral health of pediatric populations. Methods: It was conducted an observational, cross-sectional study in Georgia, in Tbilisi (capital of Georgia), among 7 to 12-year-old PCR or rapid test-confirmed post-Covid populations in all districts of Tbilisi (10 districts in total). 332 beneficiaries who were infected with Covid within one year were included in the study. The population was selected in schools of Tbilisi according to the principle of cluster selection. A simple random selection took place in the selected clusters. According to this principle, an equal number of beneficiaries were selected in all districts of Tbilisi. By July 1, 2022, according to National Center for Disease Control and Public Health data (NCDC.Ge), the number of test-confirmed cases in the population aged 0-18 in Tbilisi was 115137 children (17.7% of all confirmed cases). The number of patients to be examined was determined by the sample size. Oral screening, microbiological examination of saliva, and administration of oral health questionnaires to guardians were performed. Statistical processing of data was done with SPSS-23. Risk factors were estimated by odds ratio and logistic regression with 95% confidence interval. Results: Statistically reliable differences between the averages of oral health indicators in asymptomatic and symptomatic covid-infected groups are: for caries intensity (DMF+def) t=4.468 and p=0.000, for modified gingival index (MGI) t=3.048, p=0.002, for simplified oral hygiene index (S-OHI) t=4.853; p=0.000. Symptomatic covid-infection has a reliable effect on the oral microbiome (Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus epidermalis); (n=332; 77.3% vs n=332; 58.0%; OR=2.46, 95%CI: 1.318-4.617). According to the logistic regression, it was found that the severity of the covid infection has a significant effect on the frequency of pathogenic and conditionally pathogenic bacteria in the oral cavity B=0.903 AOR=2.467 (CL 1.318-4.617). Symptomatic covid-infection affects oral health indicators, regardless of the presence of other risk factors, such as parental employment status, tooth brushing behaviors, carbohydrate meal, fruit consumption. (p<0.05). Conclusion: Risk factors (parental employment status, tooth brushing behaviors, carbohydrate consumption) were associated with poorer oral health status in a post-Covid population of 7- to 12-year-old children. However, such a risk factor as symptomatic ongoing covid-infection affected the oral microbiome in terms of the abundant growth of pathogenic and conditionally pathogenic bacteria (Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus epidermalis) and further worsened oral health indicators. Thus, a close association was established between symptomatic covid-infection and microbiome changes in the post-covid period; also - between the variables of oral health indicators and the symptomatic course of covid-infection.

Keywords: oral microbiome, COVID-19, population based research, oral health indicators

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1142 The Effects of Gender and Socioeconomic Status on Academic Motivation: The Case of Lithuania

Authors: Ausra Turcinskaite-Balciuniene, Jonas Balciunas, Gediminas Merkys

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The problematic of gender and socioeconomic status biased differences in academic motivation patterns is discussed. Gender identity is understood according to symbolic interactionism perspective: as a result of reflected appraisals, social comparisons, self-attributions, and identifications, shaped by social environment and family context. The effects of socioeconomic status on academic motivation are conceptualized according to Bourdieu’s habitus concept, reflecting the role of unconscious and internalized cultural signals, proper to low and high socioeconomic status family contexts. Since families differ by various socioeconomic features, the hypothesis about possible impact of parents’ socioeconomic status on their children’s academic motivation interfering with gender socialization effects is held. The survey, aiming to seize gender differences in academic motivation and self-recorded improvement-oriented efforts as a result of socialization processes operating in the families of low and high socioeconomic status, was designed. The results of Lithuanian higher education students’ survey are presented and discussed.

Keywords: academic motivation, gender, socialization, socioeconomic status

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1141 Disciplined Care for Disciplined Patients: Results from Daily Experiences of Hospitalized Patients with Blindness

Authors: Mahmood Shamshiri

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While visual sensation is the key gate for human-being to understand the world, visual impairment is one of the common cause of disability around the world. There is no doubt about the importance of eye sight in daily life among people, even it is understood the best gift of God to human-beings in many societies. Blind people are admitted to hospital for different health issues. Nurses and other health professionals who provide care for this group of patients need to understand their patients. Understanding the lived experience of blind people helps nurses to expand their knowledge regarding blind patients in order to provide a holistic care and improve the quality of care for blind patients. This phenomenological inquiry aimed to describe the meaning of discipline in daily life of blind people admitted in hospital. An interpretive phenomenology underpinned the philosophical approach of the study. While the interpretive phenomenology played as an umbrella role in the overall point of the study, the six methodical activities which introduced by van Manen helped the researchers to conduct the study. ‘Disciplined care for disciplined patients’ was the main theme emerged from dialogues of blind patients about their daily life in the hospital. Almost all of participants called themselves as disciplined people. The theme ‘disciplined care for disciplined patients’ appeared from four sub-themes including discipline through careful touching and listening, discipline as the ideal way of existence, discipline the preferred way of being independent, desire to take disciplined and detailed care, reactions to the undisciplined caring culture. This phenomenological inquiry to the experiences of patients with blindness in hospital revealed that they commonly are disciplined people and want to be cared in well-organized caring environment. Furthermore, they need to be familiar with the new caring environment. Well-organized and familiar environment help blind patients to increase the level of independency. In addition, blind patients prefer a detail informed and disciplined caring culture. Health professionals have to consider the concept of disciplined care in order to provide a holistic and comprehensive competent care.

Keywords: disciplined people, disciplined care, lived experience, patient with blindness

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1140 Predictive Value Modified Sick Neonatal Score (MSNS) On Critically Ill Neonates Outcome Treated in Neonatal Intensive Care Unit (NICU)

Authors: Oktavian Prasetia Wardana, Martono Tri Utomo, Risa Etika, Kartika Darma Handayani, Dina Angelika, Wurry Ayuningtyas

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Background: Critically ill neonates are newborn babies with high-risk factors that potentially cause disability and/or death. Scoring systems for determining the severity of the disease have been widely developed as well as some designs for use in neonates. The SNAPPE-II method, which has been used as a mortality predictor scoring system in several referral centers, was found to be slow in assessing the outcome of critically ill neonates in the Neonatal Intensive Care Unit (NICU). Objective: To analyze the predictive value of MSNS on the outcome of critically ill neonates at the time of arrival up to 24 hours after being admitted to the NICU. Methods: A longitudinal observational analytic study based on medical record data was conducted from January to August 2022. Each sample was recorded from medical record data, including data on gestational age, mode of delivery, APGAR score at birth, resuscitation measures at birth, duration of resuscitation, post-resuscitation ventilation, physical examination at birth (including vital signs and any congenital abnormalities), the results of routine laboratory examinations, as well as the neonatal outcomes. Results: This study involved 105 critically ill neonates who were admitted to the NICU. The outcome of critically ill neonates was 50 (47.6%) neonates died, and 55 (52.4%) neonates lived. There were more males than females (61% vs. 39%). The mean gestational age of the subjects in this study was 33.8 ± 4.28 weeks, with the mean birth weight of the subjects being 1820.31 ± 33.18 g. The mean MSNS score of neonates with a deadly outcome was lower than that of the lived outcome. ROC curve with a cut point MSNS score <10.5 obtained an AUC of 93.5% (95% CI: 88.3-98.6) with a sensitivity value of 84% (95% CI: 80.5-94.9), specificity 80 % (CI 95%: 88.3-98.6), Positive Predictive Value (PPV) 79.2%, Negative Predictive Value (NPV) 84.6%, Risk Ratio (RR) 5.14 with Hosmer & Lemeshow test results p>0.05. Conclusion: The MSNS score has a good predictive value and good calibration of the outcomes of critically ill neonates admitted to the NICU.

Keywords: critically ill neonate, outcome, MSNS, NICU, predictive value

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1139 Executive Functions Directly Associated with Severity of Perceived Pain above and beyond Depression in the Context of Medical Rehabilitation

Authors: O. Elkana, O Heyman, S. Hamdan, M. Franko, J. Vatine

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Objective: To investigate whether a direct link exists between perceived pain (PP) and executive functions (EF), above and beyond the influence of depression symptoms, in the context of medical rehabilitation. Design: Cross-sectional study. Setting: Rehabilitation Hospital. Participants: 125 medical records of hospitalized patients were screened for matching to our inclusion criteria. Only 60 patients were found fit and were asked to participate. 19 decline to participate on personal basis. The 41 neurologically intact patients (mean age 46, SD 14.96) that participated in this study were in their sub-acute stage of recovery, with fluent Hebrew, with intact upper limb (to neutralize influence on psychomotor performances) and without an organic brain damage. Main Outcome Measures: EF were assessed using the Wisconsin Card Sorting Test (WCST) and the Stop-Signal Test (SST). PP was measured using 3 well-known pain questionnaires: Pain Disability Index (PDI), The Short-Form McGill Questionnaire (SF-MPQ) and the Pain Catastrophizing Scale (PCS). Perceived pain index (PPI) was calculated by the mean score composite from the 3 pain questionnaires. Depression symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Results: The results indicate that irrespective of the presence of depression symptoms, PP is directly correlated with response inhibition (SST partial correlation: r=0.5; p=0.001) and mental flexibility (WSCT partial correlation: r=-0.37; p=0.021), suggesting decreased performance in EF as PP severity increases. High correlations were found between the 3 pain measurements: SF-MPQ with PDI (r=0.62, p<0.001), SF-MPQ with PCS (r=0.58, p<0.001) and PDI with PCS (r=0.38, p=0.016) and each questionnaire alone was also significantly associated with EF; thus, no specific questionnaires ‘pulled’ the results obtained by the general index (PPI). Conclusion: Examining the direct association between PP and EF, beyond the contribution of depression symptoms, provides further clinical evidence suggesting that EF and PP share underlying mediating neuronal mechanisms. Clinically, the importance of assessing patients' EF abilities as well as PP severity during rehabilitation is underscored.

Keywords: depression, executive functions, mental-flexibility, neuropsychology, pain perception, perceived pain, response inhibition

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1138 Designing Stochastic Non-Invasively Applied DC Pulses to Suppress Tremors in Multiple Sclerosis by Computational Modeling

Authors: Aamna Lawrence, Ashutosh Mishra

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Tremors occur in 60% of the patients who have Multiple Sclerosis (MS), the most common demyelinating disease that affects the central and peripheral nervous system, and are the primary cause of disability in young adults. While pharmacological agents provide minimal benefits, surgical interventions like Deep Brain Stimulation and Thalamotomy are riddled with dangerous complications which make non-invasive electrical stimulation an appealing treatment of choice for dealing with tremors. Hence, we hypothesized that if the non-invasive electrical stimulation parameters (mainly frequency) can be computed by mathematically modeling the nerve fibre to take into consideration the minutest details of the axon morphologies, tremors due to demyelination can be optimally alleviated. In this computational study, we have modeled the random demyelination pattern in a nerve fibre that typically manifests in MS using the High-Density Hodgkin-Huxley model with suitable modifications to account for the myelin. The internode of the nerve fibre in our model could have up to ten demyelinated regions each having random length and myelin thickness. The arrival time of action potentials traveling the demyelinated and the normally myelinated nerve fibre between two fixed points in space was noted, and its relationship with the nerve fibre radius ranging from 5µm to 12µm was analyzed. It was interesting to note that there were no overlaps between the arrival time for action potentials traversing the demyelinated and normally myelinated nerve fibres even when a single internode of the nerve fibre was demyelinated. The study gave us an opportunity to design DC pulses whose frequency of application would be a function of the random demyelination pattern to block only the delayed tremor-causing action potentials. The DC pulses could be delivered to the peripheral nervous system non-invasively by an electrode bracelet that would suppress any shakiness beyond it thus paving the way for wearable neuro-rehabilitative technologies.

Keywords: demyelination, Hodgkin-Huxley model, non-invasive electrical stimulation, tremor

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