Search results for: patient collaboration

Authors: Swanand Pathak, Kiran R. Giri, Reena R. Giri, Kamlesh Palandurkar, Sangita Totade, Rajesh Jha, S. S. Patel

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Background: Population burden, illiteracy, availability of few doctors for larger group of population leads to many unanswered questions left in a patient’s mind. Incomplete information results into noncompliance, therapeutic failure, and adverse drug reactions (ADR). It is very important to establish a system which will provide noncommercial, independent, unbiased source of medicine information. Medicines Info OPD is a concept and step towards safe and appropriate use of medicines. Objective: (1) to assess the present status of knowledge about the medicines in the patients and its correlation with education; (2) to assess the medicine information dispensing modalities, their use and sufficiency from the patients view point; (3) to assess the overall need for Medicines Information OPD in present scenario. Materials and Methods: A pre-validated questionnaire based study was conducted amongst 500 patients of tertiary health care hospital. The questionnaire consisted of specific questions regarding understanding of prescription, knowledge about adverse drug reaction, view about self-medication and opinion regarding the need of Medicines Info OPD. Results: Significantly large proportion of patients opined that doctors do not have sufficient time in current Indian healthcare to explain the prescription and they are not aware of adverse drug reactions, expiry date or use the package inserts etc. Conclusion: Clinically relevant, up to date, user specific, independent, objective and unbiased Medicines Info OPD is essential for appropriate drug use and can help in a big way to common public to address many problems faced by them.

Keywords: information, prescription, unbiased, clinically relevant

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Authors: T. J. O Ceallaigh

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Subject matter driven programs such as immersion programs are increasingly popular across the world. These programs have allowed for extensive experimentation in the realm of second language teaching and learning and have been at the centre of many research agendas since their inception. Even though immersion programs are successful, especially in terms of second language development, they remain complex to implement and not always as successful as what we would hope them to be. Among all the challenges these varied programs face, research indicates that the primary issue lies in the difficulty to create well-balanced programs where both content instruction and language/literacy instruction can be targeted simultaneously. Initial teacher education and professional development experiences are key drivers of successful language immersion education globally. They are critical to the supply of teachers with the mandatory linguistic and cultural competencies as well as associated pedagogical practices required to ensure learners’ success. However, there is a significant dearth of research on professional development experiences of immersion teachers. We lack an understanding of the nature of their expertise and their needs in terms of professional development as well as their perceptions of the primary challenges they face as they attempt to formulate a coherent pedagogy of integrated language and content instruction. Such an understanding is essential if their specific needs are to be addressed appropriately and thus improve the overall quality of immersion programs. This paper reports on immersion teacher perceptions of online professional development experiences that have a positive impact on their ability to facilitate language and content connections in instruction. Twenty Irish-medium immersion teachers engaged in the instructional integration of language and content in a systematic and developmental way during a year-long online professional development program. Data were collected from a variety of sources e.g., an extensive online questionnaire, individual interviews, reflections, assignments and focus groups. This study provides compelling evidence of the potential of online professional development experiences as a pedagogical framework for understanding the complex and interconnected knowledge demands that arise in content and language integration in immersion. Findings illustrate several points of access to classroom research and pedagogy and uncover core aspects of high impact online experiences. Teachers identified aspects such as experimentation and risk-taking, authenticity and relevance, collegiality and collaboration, motivation and challenge and teacher empowerment. The potential of the online experiences to foster teacher language awareness was also identified as a contributory factor to success. The paper will conclude with implications for designing meaningful and effective online CLIL professional development experiences.

Keywords: content and language integrated learning , immersion pedagogy, professional development, teacher language awareness

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Authors: Awais Naeem, Osama Shakeel, Aamir Ali Syed, Shahid Khattak

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Introduction: Laparoscopic right hemicolectomy is an advanced cancer surgery in today's era. The aim of this study was to evaluate the surgical and initial oncological outcomes after curative, laparoscopic resection of right sided colonic tumors. Also to compare our results with those of previous randomized trials. Methods And Procedures: We retrospectively analyzed the medical record files of all the patients who presented to our hospital with the diagnosis of right sided colon carcinoma from January 2012 to December 2017 and underwent laparoscopic right hemicolectomy. Demographics, operative findings and histopathological reports were all recorded on a preformed data sheet. All the analysis was performed on SPSS 20. Results: Total of 48 patients were included. There were 37 male and 11 female patients with mean age of 49.7 (range from 25 – 82). Mean hospital stay was 8.25 ± 3.17 days. Blood loss was 80mls and operative mean time was 240 minutes. Eighteen patients had extended right hemicolectomy. Median length of the specimen retrieved was 31cm (range, 14-59cm). Mean size of tumor was 6.44cm + 2.53. Total number of lymph nodes removed was 20.5 + 8.3. All had R0 resection. Post-operatively 2 patients had pelvic collection and there was no 30 day mortality. In 33 patients there was T3 disease, 5 had T2 and 10 had T4 disease. There was distant recurrence in 4 patients with peritoneal metastasis in 3 and liver metastasis in 1 patient. Forty-six patients are still alive and 44 are disease free. The mean follow-up period was 25.31 (12 to 60) months. Conclusion: Our early experience with Laparascopic Right hemicolectomy as a safe and oncologically feasible surgical option. We attained comparable surgical results with curative intent.

Keywords: right hemicolectomy, right sided colonic tumors, laparoscopic, curative intent

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Authors: Igone Guerra, Xabier Barandiaran

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The deep crisis (economic, social and cultural) in which Europe and Gipuzkoa, in the Basque Country (Spain), have been immersed in since 2008 forces governments to face a necessary transformation. These challenges demand different solutions and answers to meet the needs of the citizens. Adapting to continuous and sometimes abrupt changes in the social and political landscape requires an undeniable will to reinvent the way in which governments practice politics. This reinvention of government should help us build different organizations that, first, develop challenging public services, second, respond effectively to the needs of the citizens, and third, manage scarce resources, ultimately offering a contemporary concept of public value. In this context, the Etorkizuna Eraikiz initiative was designed to face the future challenges of the territory in a collaborative way. The aim of the initiative is to promote an alternative form of governance to generate common good and greater public value. In Etorkizuna Eraikiz democratic values, such as collaboration, participation, and accountability are prominent. This government approach is based on several features such as the creation of relational spaces to design and deliberate about the public politics or the promotion of a team-working approach, breaking down the silos between and within organizations, as an exercise in defining a shared vision regarding the Future of the Territory. A future in which the citizens are becoming actors in the problem-solving process and in the construction of a culture of participation and collective learning. In this paper, the Etorkizuna Eraikiz initiative will be presented (vision and methodology) as a model of a local approach to public policy innovation resulting in a way of governance that is more open and collaborative. Based on this case study, this paper explores the way in which collaborative governance leads to better decisions, better leadership, and better citizenry. Finally, the paper also describes some preliminary findings of this local approach, such as the level of knowledge of the citizenry about the projects promoted within Etorkizuna Eraikiz as well as the link between the challenges of the territory, as identified by the citizenry, and the political agenda promoted by the provincial government. Regarding the former, the Survey on the socio-political situation of Gipuzkoa showed that 27.9% of the respondents confirmed that they knew about the projects promoted within the initiative and gave it a mark of 5.71. In connection with the latter, over the last three years, 65 millions of euros have been allocated for a total of 73 projects that have covered socio-economic and political challenges such as aging, climate change, mobility, participation in democratic life, and so on. This governance approach of Etorkizuna Eraikiz has allowed the local government to match the needs of citizens to the political agenda fostering in this way a shared vision about the public value.

Keywords: collaborative governance, citizen participation, public good, social listening, public innovation

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Authors: Isaura Bonneux

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District heating and cooling (DHC) is increasingly recognized as a viable path towards sustainable heating and cooling. While some countries like Sweden and Denmark have a longstanding tradition of DHC, Belgium is lacking behind. The Northern part of Belgium, Flanders, had only a total of 95 heating networks in July 2023. Nevertheless, it is increasingly exploring its possibilities to enhance the scope of DHC. DHC is a complex energy system, requiring a lot of collaboration between various stakeholders on various levels. Therefore, it is of interest to look closer at policy-related documents at the Flemish (regional) level, as these policies set the scene for DHC development in the Flemish region. This kind of analysis has not been undertaken so far. This paper has the following research question: “Who talks about DHC, and in which way and context is DHC discussed in Flemish policy-related documents?” To answer this question, the Overton policy database was used to search and retrieve relevant policy-related documents. Overton retrieves data from governments, think thanks, NGOs, and IGOs. In total, out of the 244 original results, 117 documents between 2009 and 2023 were analyzed. Every selected document included theme keywords, policymaking department(s), date, and document type. These elements were used for quantitative data description and visualization. Further, qualitative content analysis revealed patterns and main themes regarding DHC in Flanders. Four main conclusions can be drawn: First, it is obvious from the timeframe that DHC is a new topic in Flanders with still limited attention; 2014, 2016 and 2017 were the years with the most documents, yet this number is still only 12 documents. In addition, many documents talked about DHC but not much in depth and painted it as a future scenario with a lot of uncertainty around it. The largest part of the issuing government departments had a link to either energy or climate (e.g. Flemish Environmental Agency) or policy (e.g. Socio-Economic Council of Flanders) Second, DHC is mentioned most within an ‘Environment and Sustainability’ context, followed by ‘General Policy and Regulation’. This is intuitive, as DHC is perceived as a sustainable heating and cooling technique and this analysis compromises policy-related documents. Third, Flanders seems mostly interested in using waste or residual heat as a heating source for DHC. The harbors and waste incineration plants are identified as potential and promising supply sources. This approach tries to conciliate environmental and economic incentives. Last, local councils get assigned a central role and the initiative is mostly taken by them. The policy documents and policy advices demonstrate that Flanders opts for a bottom-up organization. As DHC is very dependent on local conditions, this seems a logic step. Nevertheless, this can impede smaller councils to create DHC networks and slow down systematic and fast implementation of DHC throughout Flanders.

Keywords: district heating and cooling, flanders, overton database, policy analysis

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Authors: Marina Fomina

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The paper focuses on the category of semantic subject within the framework of a functional approach to linguistics. The semantic subject is related to similar notions such as the grammatical subject and the bearer of predicative feature. It is the multifaceted nature of the category of subject that 1) triggers a number of issues that, syntax-wise, remain to be dealt with (cf. semantic vs. syntactic functions / sentence parts vs. parts of speech issues, etc.); 2) results in a variety of approaches to the category of subject, such as formal grammatical, semantic/syntactic (functional), communicative approaches, etc. Many linguists consider the prototypical approach to the category of subject to be the most instrumental as it reveals the integrity of denotative and linguistic components of the conceptual category. This approach relates to subject as a source of non-passive predicative feature, an element of subject-predicate-object situation that can take on a variety of semantic roles, cf.: 1) an agent (He carefully surveyed the valley stretching before him), 2) an experiencer (I feel very bitter about this), 3) a recipient (I received this book as a gift), 4) a causee (The plane broke into three pieces), 5) a patient (This stove cleans easily), etc. It is believed that the variety of roles stems from the radial (prototypical) structure of the category with some members more central than others. Translation-wise, the most “treacherous” subject types are the peripheral ones. The paper 1) features a peripheral status of spatial impersonal sentence models such as U menia v ukhe zvenit (lit. I-Gen. in ear buzzes) within the category of semantic subject, 2) makes a structural and semantic analysis of the models, 3) focuses on their Russian-English translation patterns, 4) reveals non-prototypical features of subjects in the English equivalents.

Keywords: bearer of predicative feature, grammatical subject, impersonal sentence model, semantic subject

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Authors: Harini Chakkera

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Background: Inpatient hyperglycemia is an established independent risk factor among several patient cohorts with hospital readmission. This has not been studied after kidney transplantation. Nearly one-third of patients who have undergone a kidney transplant reportedly experience 30-day readmission. Methods: Data on first-time solitary kidney transplantations were retrieved between September 2015 to December 2018. Information was linked to the electronic health record to determine a diagnosis of diabetes mellitus and extract glucometeric and insulin therapy data. Univariate logistic regression analysis and the XGBoost algorithm were used to predict 30-day readmission. We report the average performance of the models on the testing set on five bootstrapped partitions of the data to ensure statistical significance. Results: The cohort included 1036 patients who received kidney transplantation, and 224 (22%) experienced 30-day readmission. The machine learning algorithm was able to predict 30-day readmission with an average AUC of 77.3% (95% CI 75.30-79.3%). We observed statistically significant differences in the presence of pretransplant diabetes, inpatient-hyperglycemia, inpatient-hypoglycemia, and minimum and maximum glucose values among those with higher 30-day readmission rates. The XGBoost model identified the index admission length of stay, presence of hyper- and hypoglycemia and recipient and donor BMI values as the most predictive risk factors of 30-day readmission. Additionally, significant variations in the therapeutic management of blood glucose by providers were observed. Conclusions: Suboptimal glucose metrics during hospitalization after kidney transplantation is associated with an increased risk for 30-day hospital readmission. Optimizing the hospital blood glucose management, a modifiable factor, after kidney transplantation may reduce the risk of 30-day readmission.

Keywords: kidney, transplant, diabetes, insulin

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Authors: Sara E. Baumann, Megan A. Rabin, Mary Hawk, Bhimsen Devkota, Kajol Upadhyaya, Guna Raj Shrestha, Brigit Joseph, Annika Agarwal, Jessica G. Burke

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In Nepal, prevailing sociocultural norms associated with menstruation prompt adherence to stringent rules that limit participation in daily activities. Chhaupadi is a specific menstrual tradition in Nepal in which women and girls segregate themselves and follow a series of restrictions during menstruation. Despite having numerous physical and mental health implications, extant interventions have yet to sustainably address the harms associated with chhaupadi. In this study, the authors describe insights garnered from a collaboration with community members in Dailekh district, who formulated their own approaches to mitigate the adverse facets of chhaupadi. Envisaged as an entry point to improve women’s menstrual health experiences, this investigation employed an approach that uses Human-centered Design and a community-engaged approach. The authors conducted a four-day design workshop which unfolded in two phases: The Discovery Phase, to uncover chhaupadi context and key stakeholders, and the Design Phase, to design contextually relevant interventions. Diverse community-members, including those with lived experience practicing chhaupadi, developed five intervention concepts: 1) harnessing Female Community Health Volunteers as role models, for counseling, and raising awareness; 2) focusing on mothers and mother’s groups to instigate behavioral shifts; 3) engaging the broader community in behavior change efforts; 4) empowering fathers to effect change in their homes through counseling and education; and 5) training and emboldening youth to advocate for positive change through advocacy in their schools and homes. This research underscores the importance of employing multi-level approaches tailored to specific stakeholder groups, given Nepal’s rich cultural diversity. The engagement of Female Community Health Volunteers emerged as a promising yet underexplored intervention concept for chhaupadi, warranting broader implementation. Crucially, it is also imperative for interventions to prioritize tackling deleterious aspects of the chhaupadi tradition, emphasizing safety considerations, all while acknowledging chhaupadi’s entrenched cultural history; for some, there are positive aspects of the tradition that women and girls wish to preserve.

Keywords: human-centered design, menstrual health, Nepal, community-engagement, intervention development, women's health, rural health

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Authors: A. H. Bekhet, N. Helmy

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Background: Physical therapists are knowledgeable in treatment and prevention of musculoskeletal injuries; however, they have occupational musculoskeletal injuries because Physical therapy profession requires effort that may lead to work-related musculoskeletal disorders. No previous studies among physical therapists have been reported in Egypt. We aim to assess the prevalence and risk factors of musculoskeletal disorders among physical therapist’s seniors versus internship students. Method: We conducted a cross-sectional study in faculty of physical therapy Cairo university Prevalence and risk factors of musculoskeletal injuries were assessed using self-administered questionnaire with closed-ended questions. Seniors therapist was defined as a physical therapist with more than 5 years of work experience. Data were analyzed using SPSS 22.0 for Windows. Results: The study included 106 physical therapists (Junior = 72; senior = 34), the mean age of senior therapists was 30.1 (SD 6.3) years and junior therapists were 22.8 (SD 2.4). Female subjects constituted 83.9% of the studied sample. The mean hours of contact with patients was higher among junior therapists 6.4 (SD 2.6) vs. 5.7 (SD 2.1) among senior therapists. The prevalence of a musculoskeletal injury, once or more in their lifetime, was significantly higher among senior therapists (86% vs. 66.7%; p = 0.04). The highest risk factor in increasing the symptoms of the injury among junior therapists was maintaining a position for a prolonged period of time at 28% while performing manual therapy techniques was the highest risk factor among senior therapists at 32%. 53% of senior therapists have limited their patient contact time as a result of their injury in comparison to 25% of junior therapists (p = 0.09). Conclusion: the presented study shows that the prevalence of musculoskeletal injuries, once or more in their lifetime, is significantly higher among senior therapists.

Keywords: musculoskeletal injuries, occupational injuries, physical therapists, work related disorders

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Authors: Nilgün Katrancı, Pınar Göv

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The privatization of public services has intensified and extended the delivery of healthcare services at hospitals, which leads to an increase in health and safety risks for healthcare professionals. More efficient and effective delivery of healthcare services can be realized through the provision of occupational safety of healthcare professionals. However, healthcare professionals are exposed to more dangers, accidents, and diseases because of such reasons as present working conditions, hospital infections, lack of ergonomic design, medication, wastes, excessive work load, negligent attitudes of workers, violence, psychological risks, etc. Unsafe working conditions cause fear, injury and wearing impacts in healthcare professionals in many countries. Thus, it is emphasized that the protection of the health of healthcare professionals is important to have educated, healthy workers and adequate workforce. Occupational health and safety measures applied in health facilities are aimed at protecting workers and providing the safety of services and facilities. All activities to be undertaken at hospitals with regard to occupational safety in accordance with these goals will help to reduce costs and provide continuous services. At the same time, a safe working environment will increase worker satisfaction and motivation, sense of institutional belonging and indirectly patient safety and satisfaction. In addition, the control and correction of occupational safety activities are also as important as the implementation. Occupational health and safety practices in the facilities will also lead to positive developments for national economy and society. This study emphasizes that approaching occupational safety practices for healthcare professionals in a sensitive manner is important for enabling healthcare professionals to do more productive works in terms of physical, social and psychological aspects, maintaining the continuity of healthcare services and social and economic contributions.

Keywords: health facilities, healthcare professional, occupational health, occupational safety

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Authors: Sri Suparwitri

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When an orthodontic force is applied to a tooth, an inflammatory response is initiated then lead to bone remodeling process, and the process accommodates tooth movement. One of cytokine that plays a prominent role in bone remodeling process was transforming growth factor-beta 1 (TGF-β1). The purpose of this study was to identify and compare changes of TGF-β1 in human gingival crevicular fluid during canine retraction using elastic chain and closed coil spring. Ten patients (mean age 20.7 ± 2.9 years) participated. The patients were entering the space closure phase of fixed orthodontic treatment. An upper canine of each patient was retracted using elastic chain, and the contralateral canine was retracted using closed coil spring. Gingival crevicular fluid samples were collected from the canine teeth before and 7 days after the force was applied. Transforming growth factor-beta 1 was determined by enzyme-linked immunosorbent assay (ELISA). The concentrations of TGF-β1 at 7 days were significantly higher compared to before canine retraction in both groups. In the evaluation of between-group difference, before retraction, the difference was insignificant, whereas at 7 days significantly higher values were determined in the closed coil spring group compared to elastic chain group. The result suggests that TGF-β1 is associated with the bone remodeling that occurs during canine distalization movement. Closed coil spring gave higher TGF-β1 concentrations thus more bone remodeling occurred and may be considered the treatment of choice.

Keywords: closed coil spring, elastic chain, gingival crevicular fluid, TGF-β1

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Authors: Nizar Ghali, Bernard Fortin, Guy Lacroix

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In Quebec, colonoscopies volumes have continued to rise in recent years in the absence of effective monitoring mechanism for the appropriateness and the quality of these exams. In 2010, November, Quebec Government introduced the colorectal cancer-screening program in the objective to control for volume and cost imperfection. This program is based on clinical standards and was initiated for first group of institutions. One year later, Government adds financial incentives for participants institutions. In this analysis, we want to assess for the causal effect of the two components of this program: clinical pathways and financial incentives. Especially we assess for the reform effect on healthcare quality and population health in the context that medical remuneration is not directly dependent on this additional funding offered by the program. We have data on admissions episodes and deaths for 8 years. We use multistate model analog to difference in difference approach to estimate reform effect on the transition probability between different states for each patient. Our results show that the reform reduced length of stay without deterioration in hospital mortality or readmission rate. In the other hand, the program contributed to decrease the hospitalization rate and a less invasive treatment approach for colorectal surgeries. This is a sign of healthcare quality and population health improvement. We demonstrate in this analysis that physicians’ behavior can be affected by both clinical standards and financial incentives even if offered to facilities.

Keywords: multi-state and multi-episode transition model, healthcare quality, length of stay, transition probability, difference in difference

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Authors: Marcia Teresa Gildo

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The United Nations High Commissioner for Refugees (UNHCR) is responsible to provide international protection and humanitarian assistance to refugees and to seek permanent solutions to their situation. To fulfil this mandate, the agency works in collaboration with its partners and governments. This paper aims to analyse the agency's actions to protect and provide assistance to Mozambican refugees in Malawi. Since July 2015, approximately 12.000 people have fled Mozambique to neighbouring Malawi due to the political-military conflict between the government of Mozambique and RENAMO (the country’s largest opposition party). This led to a series of military clashes between the two parties and the consequent flight of some Mozambicans to Malawi, in search of asylum. Most arrived from the province of Tete, in the central region of Mozambique, and, to a lesser extent, from the province of Zambezia. The asylum seekers arrived in small groups and settled in the village of Kapise in the Mwanza district of Thambani, as well as in Chikwawa and Nsanje districts in Malawi. UNHCR led an interinstitutional response action to manage the flow of Mozambican asylum seekers to Malawi. In view of these aspects and the ongoing challenge of protecting refugees and finding permanent solutions to their situation, UNHCR remains an indispensable international organization. However, there are significant gaps in the international refugee protection regime, and there have been many occasions when UNHCR has failed to fulfill its mandate. The analysis was carried out through qualitative research methods and techniques based essentially on consultation of books, newspapers and scientific articles, television and journalistic reports and interviews with the people who were involved in the process. From the data obtained, it was concluded that UNHCR worked in coordination with its partners and the government of Malawi to provide protection and emergency assistance to the refugees. However, existing funds covered only the immediate needs of refugees, more funds had to be allocated. That was made through an interinstitutional appeal. Although the funds allocated were not sufficient, they allowed the agency to protect and assist the refugees until a permanent solution was found. UNHCR also worked in coordination with the governments of Malawi and Mozambique so that a tripartite agreement was signed between the parties for the voluntary repatriation of Mozambican refugees, since security conditions were guaranteed and the refugees had expressed their willingness to return to their country of origin. UNHCR's actions to protect Mozambican refugees in Malawi have enabled humanitarian conditions to be respected and the rights of refugees to be guaranteed. Cooperation with the different actors involved in the response has allowed UNHCR to fulfil its mandate.

Keywords: assistance , cooperation, international protection, refugees

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Authors: R. F. Mesquita Brandão

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Act Local, Think Global is the name of a campaign implemented at Superior Institute of Engineering of Porto (ISEP), one of schools of Polytechnic of Porto, with the main objective of increase the sustainability of the campus. ISEP has a campus with 52.000 m2 and more than 7.000 students. The campaign started in 2019 and the results are very clear. In 2019 only 16% of the waste created in the campus was correctly separate for recycling and now almost 50% of waste goes to the correct waste container. Actions to reduce the energy consumption were implemented with significantly results. One of the major problems in the campus are the water leaks. To solve this problem was implemented a methodology for water monitoring during the night, a period of time where consumptions are normally low. If water consumption in the period is higher than a determinate value it may mean a water leak and an alarm is created to the maintenance teams. In terms of energy savings, some measurements were implemented to create savings in energy consumption and in equivalent CO₂ produced. In order to reduce the use of plastics in the campus, was implemented the prohibition of selling 33 cl plastic water bottles and in collaboration with the students association all meals served in the restaurants changed the water plastic bottle for a glass that can be refilled with water in the water dispensers. This measures created a reduction of use of more than 75.000 plastic bottles per year. In parallel was implemented the ISEP water glass bottle to be used in all scientific meetings and events. Has a way of involving all community in sustainability issues was developed and implemented a vertical garden in aquaponic system. In 2019, the first vertical garden without soil was installed inside a large campus building. The system occupies the entire exterior façade (3 floors) of the entrance to ISEP's G building. On each of these floors there is a planter with 42 positions available for plants. Lettuces, strawberries, peppers are examples of some vegetable produced that can be collected by the entire community. Associated to the vertical garden was developed a monitoring system were some parameters of the system are monitored. This project is under development because it will work in a stand-alone energy feeding, with the use of photovoltaic panels for production of energy necessities. All the system was, and still is, developed by students and teachers and is used in class projects of some ISEP courses. These and others measures implemented in the campus, will be more developed in the full paper, as well as all the results obtained, allowed ISEP to be the first Portuguese high school to obtain the certification “Coração Verde” (Green Heart), awarded by LIPOR, a Portuguese company with the mission of transform waste into new resources through the implementation of innovative and circular practices, generating and sharing value.

Keywords: aquaponics, energy efficiency, recycling, sustainability, waste separation

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Authors: Madison Meyer

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Dermatological conditions are one of the most viewed medical subjects on the social media platform TikTok, resulting in the rise of several prominent American board-certified dermatologists as influencers. Notably, dermatology is one of the least diverse specialties. This cross-sectional study aimed to assess individuals’ preferences related to race, gender, and sexual identity of doctors in terms of dermatology-related information on TikTok and which group posts more reliable information. This study qualitatively and quantitatively evaluated the racial, gender, and sexual diversity of the top 55 dermatologist influencers on TikTok based on their follower count. The DISCERN tool was used to determine the reliability of consumer health content based on a score ranging from 1-5. Among the top 55 dermatologist influencers, African American (54,241.60) and Latinx (6,696) groups had the lowest mean number of followers compared to Caucasian (1,046,298.50) and Asian (1,403,393.50) physicians. Latinx and African American dermatologists had the highest DISCERN scores of 2 and 1.9, respectively. None of the physicians identified as a different gender or as LGBTQIA+ in any racial category. There is a considerable lack of minority dermatologist influencers on TikTok, especially Latinx, African American, and LGBTQIA+ physicians. The lack of diversity in the dermatology specialty can lead to inequitable care and health outcomes for racial/ethnic, gender, and sexual minority patient populations. This study’s findings also suggest Latinx and African American dermatologists post more reliable content compared with their Caucasian and Asian counterparts.

Keywords: dermatology, social media, sexual and gender minorities, racial minorities, skin of color, tiktok

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Authors: Professor Jo Angouri, Polina Mesinioti, Chris Turner

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In order for a group of ad-hoc professional to perform as a team, a shared understanding of the problem at hand and an agreed action plan are necessary components. This is particularly significant in complex, time sensitive professional settings such as in trauma emergencies. In this context, team briefings prior to the patient arrival (pre-briefings) constitute a critical event for the performance of the team; they provide the necessary space for co-constructing a shared understanding of the situation through summarising information available to the team: yet the act of summarising is widely assumed in medical practice but not systematically researched. In the vast teamwork literature, terms such as ‘shared mental model’, ‘mental space’ and ‘cognate labelling’ are used extensively, and loosely, to denote the outcome of the summarising process, but how exactly this is done interactionally remains under researched. This paper reports on the forms and functions of pre-briefings in a major trauma centre in the UK. Taking an interactional approach, we draw on 30 simulated and real-life trauma emergencies (15 from each dataset) and zoom in on the use of pre-briefings, which we consider focal points in the management of trauma emergencies. We show how ad hoc teams negotiate sharedness of future orientation through summarising, synthesising information, and establishing common understanding of the situation. We illustrate the role, characteristics, and structure of pre-briefing sequences that have been evaluated as ‘efficient’ in our data and the impact (in)effective pre-briefings have on teamwork. Our work shows that the key roles in the event own the act of summarising and we problematise the implications for leadership in trauma emergencies. We close the paper with a model for pre-briefing and provide recommendations for clinical practice, arguing that effective pre-briefing practice is teachable.

Keywords: summarising, medical emergencies, interaction analysis, shared/mental models

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Authors: Shivam Patel, Abdullah Y. Usmani

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Physiological flow under rest and exercise conditions in patient-specific cerebral aneurysm models is numerically investigated. A finite-volume based code with BiCGStab as the linear equation solver is used to simulate unsteady three-dimensional flow field through the incompressible Navier-Stokes equations. Flow characteristics are first established in a healthy cerebral artery for both physiological conditions. The effect of saccular aneurysm on cerebral hemodynamics is then explored through a comparative analysis of the velocity distribution, nature of flow patterns, wall pressure and wall shear stress (WSS) against the reference configuration. The efficacy of coil embolization as a potential strategy of surgical intervention is also examined by modelling coil as a homogeneous and isotropic porous medium where the extended Darcy’s law, including Forchheimer and Brinkman terms, is applicable. The Carreau-Yasuda non-Newtonian blood model is incorporated to capture the shear thinning behavior of blood. Rest and exercise conditions correspond to normotensive and hypertensive blood pressures respectively. The results indicate that the fluid impingement on the outer wall of the arterial bend leads to abnormality in the distribution of wall pressure and WSS, which is expected to be the primary cause of the localized aneurysm. Exercise correlates with elevated flow velocity, vortex strength, wall pressure and WSS inside the aneurysm sac. With the insertion of coils in the aneurysm cavity, the flow bypasses the dilatation, leading to a decline in flow velocities and WSS. Particle residence time is observed to be lower under exercise conditions, a factor favorable for arresting plaque deposition and combating atherosclerosis.

Keywords: 3D FVM, Cerebral aneurysm, hypertension, coil embolization, non-Newtonian fluid

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Authors: Fatemeh Noori

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The fashion industry is a dynamic and ever-evolving realm that continuously shapes societal perceptions of beauty and style. Within this industry, fashion modeling plays a crucial role, acting as the visual representation of brands and designers. However, behind the glamorous façade lies a complex web of legal considerations that govern the rights, responsibilities, and ethical practices within the field. This paper aims to explore the legal landscape surrounding fashion modeling, shedding light on key issues such as contract law, intellectual property, labor rights, and the increasing importance of ethical considerations in the industry. Fashion modeling involves the collaboration of various stakeholders, including models, designers, agencies, and photographers. To ensure a fair and transparent working environment, it is imperative to establish a comprehensive legal framework that addresses the rights and obligations of each party involved. One of the primary legal considerations in fashion modeling is the contractual relationship between models and agencies. Contracts define the terms of engagement, including payment, working conditions, and the scope of services. This section will delve into the essential elements of modeling contracts, the negotiation process, and the importance of clarity to avoid disputes. Models are not just individuals showcasing clothing; they are integral to the creation and dissemination of artistic and commercial content. Intellectual property rights, including image rights and the use of a model's likeness, are critical aspects of the legal landscape. This section will explore the protection of models' image rights, the use of their likeness in advertising, and the potential for unauthorized use. Models, like any other professionals, are entitled to fair and ethical treatment. This section will address issues such as working conditions, hours, and the responsibility of agencies and designers to prioritize the well-being of models. Additionally, it will explore the global movement toward inclusivity, diversity, and the promotion of positive body image within the industry. The fashion industry has faced scrutiny for perpetuating harmful standards of beauty and fostering a culture of exploitation. This section will discuss the ethical responsibilities of all stakeholders, including the promotion of diversity, the prevention of exploitation, and the role of models as influencers for positive change. In conclusion, the legal considerations in fashion modeling are multifaceted, requiring a comprehensive approach to protect the rights of models and ensure ethical practices within the industry. By understanding and addressing these legal aspects, the fashion industry can create a more transparent, fair, and inclusive environment for all stakeholders involved in the art of modeling.

Keywords: fashion modeling contracts, image rights in modeling, labor rights for models, ethical practices in fashion, diversity and inclusivity in modeling

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Authors: Rachel S. E. Lim, Winnie L. C. Tan

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Visual literacy is about making meaning through the interaction of images, words, and sounds. Graphic communication students typically develop visual literacy through critique and production of studio-based projects for their portfolios. However, the abrupt switch to online learning during the COVID-19 pandemic has made it necessary to consider new strategies of visualization and planning to scaffold teaching and learning. This study, therefore, investigated how MIRO, a cloud-based visual collaboration platform, could be used to develop the visual literacy confidence of 30 diploma in graphic communication students attending a graphic design course at a Singapore arts institution. Due to COVID-19, the course was taught fully online throughout a 16-week semester. Guided by Kolb’s Experiential Learning Cycle, the two lecturers developed students’ engagement with visual literacy concepts through different activities that facilitated concrete experiences, reflective observation, abstract conceptualization, and active experimentation. Throughout the semester, students create, collaborate, and centralize communication in MIRO with infinite canvas, smart frameworks, a robust set of widgets (i.e., sticky notes, freeform pen, shapes, arrows, smart drawing, emoticons, etc.), and powerful platform capabilities that enable asynchronous and synchronous feedback and interaction. Students then drew upon these multimodal experiences to brainstorm, research, and develop their motion design project. A survey was used to examine students’ perceptions of engagement (E), confidence (C), learning strategies (LS). Using multiple regression, it¬ was found that the use of MIRO helped students develop confidence (C) with visual literacy, which predicted performance score (PS) that was measured against their application of visual literacy to the creation of their motion design project. While students’ learning strategies (LS) with MIRO did not directly predict confidence (C) or performance score (PS), it fostered positive perceptions of engagement (E) which in turn predicted confidence (C). Content analysis of students’ open-ended survey responses about their learning strategies (LS) showed that MIRO provides organization and structure in documenting learning progress, in tandem with establishing standards and expectations as a preparatory ground for generating feedback. With the clarity and sequence of the mentioned conditions set in place, these prerequisites then lead to the next level of personal action for self-reflection, self-directed learning, and time management. The study results show that the affordances of MIRO can develop visual literacy and make up for the potential pitfalls of student isolation, communication, and engagement during online learning. The context of how MIRO could be used by lecturers to orientate students for learning in visual literacy and studio-based projects for future development are discussed.

Keywords: design education, graphic communication, online learning, visual literacy

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Authors: Manee Hasap, Mongkolchai Hasap, Tasanee Nasae

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The purpose of this study was to evaluate the primary caregivers’ knowledge and capabilities for providing quality care to be hospitalized post-hip fracture surgery elderly patients. The theoretical framework of the study was derived from the concepts of dependent care agency in Orem’s Self-Care theory, and family care provision for the elderly and chronically ill patients. 59 subjects were purposively selected. The subjects were primary caregivers of post-operated hip fracture elderly patients who had been admitted to the Orthopaedic Ward of Songklanagarind Hospital. Demographic data of the caregivers and patients were collected by non-participant observation using the evaluation and recording forms. The reliability of caregivers’ knowledge measurement (0.86) was obtained by KR-20 and that of caregivers’ capabilities for post-operative care evaluation form (0.97) obtained from 2 observers by interrater reliability. The data were analyzed using descriptive statistic, which were frequency, percentage, mean, and standard deviation. The result of this study indicated that elderly patients with post-hip fracture surgery had many pre-discharge self care limitations. Approximately, 75% of the caregivers had knowledge to respond to patient’s essential needs at a high level, while the rest (25%) had this knowledge a moderate level. For observation, 57.63% of the subjects had capabilities in care practice at a moderate level; 28.81% had capabilities in care practice at a high level, while 13.56% had at a low level. The result of this study can be used as basic information for patients and caregivers capabilities developing plan especially, providing patients’ activities, accident surveillance and complications prevention for a good life quality of elderly patients after hip surgery both hospitalization and rehabilitation at home.

Keywords: care givers’ knowledge, care givers’ capabilities, elderly hip fracture patients, patients

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Authors: Ines Cherif, Ghassen Kharroubi, Leila Bouabid, Adel Gharbi, Aicha Boukthir, Margaret Mccarron, Nissaf Ben Alaya, Afif Ben Salah, Jihene Bettaieb

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Healthcare workers' flu vaccination prevents influenza disease among both patients and caregivers. We aimed in this study to assess influenza vaccine (IV) coverage in 2018-2019 among Tunisian physicians and to determine factors associated with IV receipt. A cross sectional study was carried out in Tunisian primary and secondary health care facilities in the 2018-2019 influenza season. Physicians with direct patient contact were recruited according to a self-weighted multistage sampling. Data were collected through a face to face questionnaire containing questions on knowledge, attitudes, and practices regarding IV. Bivariate analysis was used in order to determine factors associated with IV receipt. A total of 167 physicians were included in the study with a mean age of 48.2 ± 7.7 years and a sex-ratio (M: F) of 0.37. Among participants, 15.1% (95% CI: [9.7%-20.3%]) were vaccinated against influenza in the 2018-2019 influenza season. Bivariate analysis revealed that previous flu immunization in the four years preceding the 2018-2019 influenza season (OR=32.3; p < 10-3), belief that vaccinating healthcare workers may reduce work absenteeism (OR=4.7, p=0.028), belief that flu vaccine should be mandatory to healthcare workers (OR=3.3, p=0.01) and high confidence towards IV efficacy in preventing influenza among caregivers (OR= 4.5, p=0.01) were associated with a higher IV receipt in 2018-2019 among physicians. Less than one fifth of Tunisian physicians were vaccinated against influenza in 2018-2019. Higher vaccine uptake was related to a higher belief in vaccine efficacy in preventing influenza disease among both patients and caregivers. This underscores the need for periodic educational campaigns to raise physicians' awareness about IV efficacy. The switch to an IV mandatory policy should also be considered.

Keywords: influenza vaccine, physicians, Tunisia, vaccination uptake

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Authors: Christine Maleesha Withanachchi, Eithne Heffernan, Derek Hoare

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Background: Social isolation (SI} is a major consequence of hearing loss (HL}. Isolation can lead to serious health problems (e.g., dementia and depression). Hearing Aids (HA) is the primary intervention for HL. However, these are less effective in social situations. Interventions are needed for SI in adults with hearing loss (AHL). Objectives: Investigated the relationship between HL and SI. Explored the views of AHL and hearing healthcare professionals (HHP) towards interventions for isolation. Methods: Individual and group semi-structured interviews were conducted. Interviews were conducted at the Nottingham Institute of Health Research (NIHR) Biomedical Research Centre (BRC). Six AHL and seven HHP were recruited via maximum variation sampling. The interview transcripts were analyzed using inductive thematic analysis. Results: Social impacts of HL: Most participants described that HL hurt them. This was in the form of social withdrawal, strain on relationships, and identity loss. Downstream effects of HL: Most audiologists acknowledged that isolation from HL could lead to depression. HL can also lead to exhaustion and unemployment. Impact of stigma: There are negative connotations around HL and HA (e.g. old age) and there is difficulty talking about isolation. The complexity of SI: There can be difficulty separating SI due to HL from SI due to other contributing factors (e.g. comorbidities). Potential intervention for isolation: Participants were unfamiliar with interventions for isolation and few, if any, were targeted for AHL specifically. Most participants thought an intervention should be patient-centered and run by an AHL in the community. Opinions differed regarding whether it should hear specific or generic. Implementation of intervention: Challenges to the implementation of an intervention for SI exist due to the sensitivity of the subject. Conclusions: This study demonstrated that SI is a major consequence of HL and uncovered novel findings related to its interventions. Uptake of interventions offered to AHL to reduce loneliness and social isolation is expected to be better if led by AHL in the community as opposed to HHP led interventions in the hospital or clinic settings.

Keywords: adults with hearing loss, hearing aids, interventions, social isolation

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Authors: F. Ruiz-Navarro, M. Matzner, G. Kobinia

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Background: Cerebral palsy (CP) encompasses the largest group of childhood movement disorders, the patterns and severity varies widely. Today, the management focuses only on a rehabilitation therapy that tries to secure the functions remained and prevents complications. However the treatments are not aimed to cure the disease. Stem cells (SCs) transplant via intrathecal is a new approach to the disease. Method: Our aim was to performed a pilot study under the condition of unproven treatment on clinical practice to assessed the safety and efficacy of Neuron Point-of-care Stem cell Therapy (N-POCST), an ambulatory procedure of autologous bone marrow derived SCs (BM-SCs) harvested from the posterior superior iliac crest undergo an on-site cell separation for intrathecal infusion via lumbar puncture. Results: 82 patients were treated in a period of 28 months, with a follow-up after 6 months. They had a mean age of 6,2 years old and male predominance (65,9%). Our preliminary results show that: A. No patient had any major side effects, B. Only 20% presented mild headache due to LP, C. 53% of the patients had an improvement in spasticity, D. 61% improved the coordination abilities, 23% improved the motor function, 15% improved the speech, 23% reduced the number of convulsive events with the same doses or less doses of anti-convulsive medication and 94% of the patients report a subjective general improvement. Conclusions: These results support previous worldwide publications that described the safety and effectiveness of autologous BM-SCs transplant for patients wit CP.

Keywords: autologous transplant, cerebral palsy, point of care, childhood movement disorders

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Authors: Surabhi Agrawal Kohli, Sunita Gupta, Esha Khanuja, Parul Garg, P. Gupta

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Background: Adenomyosis is a common gynaecological condition that affects the menstruating women. Uterine enlargement, dysmenorrhoea, and menorrhagia are regarded as the cardinal clinical symptoms of adenomyosis. Classically it was thought, compared with ultrasonography, when adenomyosis is suspected, MRI enables more accurate diagnosis of the disease. Materials and Methods: 172 subjects were enrolled after an informed consent that had complaints of HMB, dyspareunia, dysmenorrhea, and chronic pelvic pain. Detailed history of the enrolled subjects was taken, followed by a clinical examination. These patients were then subjected to TVS where myometrial echo texture, presence of myometrial cysts, blurring of endomyometrial junction was noted. MRI was followed which noted the presence of junctional zone thickness and myometrial cysts. After hysterectomy, histopathological diagnosis was obtained. Results: 78 participants were analysed. The mean age was 44.2 years. 43.5% had parity of 4 or more. heavy menstrual bleeding (HMB) was present in 97.8% and dysmenorrhea in 93.48 % of HPE positive patient. Transvaginal sonography (TVS) and MRI had a sensitivity of 89.13% and 80.43%, specificity of 90.62% and 84.37%, positive likelihood ratio of 9.51 and 5.15, negative likelihood ratio of 0.12 and 0.23, positive predictive value of 93.18% and 88.1%, negative predictive value of 85.29% and 75% and a diagnostic accuracy of 89.74% and 82.5%. Comparison of sensitivity (p=0.289) and specificity (p=0.625) showed no statistically significant difference between TVS and MRI. Conclusion: Prevalence of 30.23%. HMB with dysmenorrhoea and chronic pelvic pain helps in diagnosis. TVS (Endomyometrial junction blurring) is both sensitive and specific in diagnosing adenomyosis without need for additional diagnostic tool. Both TVS and MRI are equally efficient, however because of certain additional advantages of TVS over MRI, it may be used as the first choice of imaging. MRI may be used additionally in difficult cases as well as in patients with existing co-pathologies.

Keywords: adenomyosis, heavy menstrual bleeding, MRI, TVS

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Authors: J. Magerman, P. Martin

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Nursing students' clinical abilities is highly dependent on the quality of the clinical experience obtained while placed in the clinical environment. The clinical environment has amongst other, key role players which include the clinical supervisor. The primary role of the clinical supervisor is to guide nursing students to become the best practice nursing professionals. However, globally literature alludes to the failure of educating institutions to deliver competent nursing professionals to meet the needs of patients and deliver quality patient care. At the participating university, this may be due to various factors such as large student numbers and social and environmental challenges experienced by clinical supervisors. The aim of this study was to explore and describe the lived experiences of clinical supervisors who supervise nursing students at a higher education institution. The study employed a qualitative research approach utilizing a descriptive phenomenological design. Purposive sampling was used to select participants, who supervised first and second year nursing studnets at the higher education institution under study. TH esample comprised of eight clinical supervisors who supervise first and secon year nursing studnets at teh institution under study. Data was collected by means of in-depht interviews. Data was analysed using Collaizzi's seven steps method of qualitative analysis. Five major themes identified , focussed on the experiences regarding time a sa constraint to job productivity, the impact of teh organisational culture on the fluidity of support, interpersonal relationships a sa dynamic communication process, impact on the self, and limited resources. Trustworthiness of the data was ensured by means of applying Guba's model of truth value, applicability, consistency and neutrality. Reflexivity was also used by the researcher to further enhance trustworthiness.

Keywords: clinical supervision, clinical supervisors, nursing students, clinical placements

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Authors: V. Esteves

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As products of participatory culture, internet memes represent a global form of interaction with online culture. These digital objects draw upon a rich historical engagement with remix practices that dates back decades: from the copy and paste practices of Dadaism and punk to the re-appropriation techniques of the Situationist International; memes echo a long established form of cultural creativity that pivots on the art of the remix. Online culture has eagerly embraced the changes that the Web 2.0 afforded in terms of making use of remixing as an accessible form of societal expression, bridging these remix practices of the past into a more widely available and accessible platform. Memes embody the idea of 'intercreativity', allowing global creative collaboration to take place through networked digital media; they reflect the core values of participation and interaction that are present throughout much internet discourse whilst also existing in a historical remix continuum. Memes hold the power of cultural symbolism manipulated by global audiences through which societies make meaning, as these remixed digital objects have an elasticity and low literacy level that allows for a democratic form of cultural engagement and meaning-making by and for users around the world. However, because memes are so elastic, their ability to be re-appropriated by other powers for reasons beyond their original intention has become evident. Recently, corporations have made use of internet memes for advertising purposes, engaging in the circulation and re-appropriation of internet memes in commercial spaces – which has, in turn, complicated this relation between online users and memes' democratic possibilities further. By engaging in a widespread online ethnography supplemented by in-depth interviews with meme makers, this research was able to not only track different online meme use through commercial contexts, but it also allowed the possibility to engage in qualitative discussions with meme makers and users regarding their perception and experience of these varying commercial uses of memes. These can be broadly put within two categories: internet memes that are turned into physical merchandise and the use of memes in advertising to sell other (non-meme related) products. Whilst there has been considerable acceptance of the former type of commercial meme use, the use of memes in adverts in order to sell unrelated products has been met with resistance. The changes in reception regarding commercial meme use is dependent on ideas of cultural ownership and perceptions of authorship, ultimately uncovering underlying socio-cultural ideologies that come to the fore within these overlapping contexts. Additionally, this adoption of memes by corporate powers echoes the recuperation process that the Situationist International endured, creating a further link with older remix cultures and their lifecycles.

Keywords: commodification, internet culture, memes, recuperation, remix

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Authors: Amel M. A. Osman, Roy Mahony, Lisa Dann, McKenna S.

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Background: Computed Tomography (CT) is a significant source of radiation in the pediatric population. A new head injury (HI) pathway was introduced in 2021, which altered the previous process of HI being jointly admitted with general pediatrics and surgery to admit these patients under the Emergency Medicine Team. Admitted patients included those with positive CT findings not requiring immediate neurosurgical intervention and those who did not meet current criteria for urgent CT brain as per NICE guidelines but were still symptomatic for prolonged observations. This approach aims to decrease the number of CT scans performed. The main aim is to assess the variation in CT scanning rates since the change in the admitting process. A retrospective review of patients presenting to CHI PECU with HI over 6-month period (01/01/19-31/05/19) compared to a 6-month period post introduction of the new pathway (01/06/2022-31/12/2022). Data was collected from the electronic record databases, symphony, and PACS. Results: In 2019, there were 869 presentations of HI, among which 32 (3.68%) had CT scans performed. 2 (6.25%) of those scanned had positive findings. In 2022, there were 1122 HI presentations, with 47 (4.19%) CT scans performed and positive findings in 5 (10.6%) cases. 57 patients were admitted under the new pathway for observation, with 1 having a CT scan following admission. Conclusion: Quantitative lifetime radiation risks for children are not negligible. While there was no statistically significant reduction in CTs performed amongst HIs presenting to our department, a significant group met the criteria for admission under the PECU consultant for prolonged monitoring. There was also a greater proportion of abnormalities on CT scans performed in 2022, demonstrating improved patient selection for imaging. Further data analysis is ongoing to determine if those who were admitted would have previously been scanned under the old pathway.

Keywords: head injury, CT, admission, guidline

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Authors: Vedat Kurt, Tansel Koyunoglu, Gamze Kurt, Ozgen Aras

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Low back pain is one of the most common health problem in public. Common symptoms that can be associated with low back pain include; pain, functional disability, gait disturbances. The aim of the study was to investigate the differences between disability scores and gait parameters in subjects with low back pain. Sixty participants are included in our study, (35 men, 25 women, mean age: 37.65±10.02 years). Demographic characteristics of participants were recorded. Pain (visual analog scale) and disability level (Oswestry Disability Index(ODI)) were evaluated. Gait parameters were measured with Zebris-FDM-2 platform. Independent samples t-test was used to analyse the differences between subjects with under 40 points (n=31, mean age:35.8±11.3) and above 40 points (n=29, mean age:39.6±8.1) of ODI scores. Significant level in statistical analysis was accepted as 0.05. There was no significant difference between the ODI scores and groups’ ages. Statistically significant differences were found in step width between subjects with under 40 points of ODI and above 40 points of ODI score(p < 0.05). But there were non-significant differences with other gait parameters (p > 0.05). The differences between gait parameters and pain scores were not statistically significant (p > 0.05). Researchers generally agree that individuals with LBP walk slower and take shorter steps and have asymmetric step lengths when compared with than their age-matched pain-free counterparts. Also perceived general disability may have moderate correlation with walking performance. In the current study, the patients classified as minimal/moderate and severe disability level by using ODI scores. As a result, a patient with LBP who have higher disability level tends to increase support surface. On the other hand, we did not find any relation between pain intensity and gait parameters. It may be caused by the classification system of pain scores. Additional research is needed to investigate the effects of functionality level and pain intensity on gait in subjects with low back pain under different classification types.

Keywords: functionality, low back pain, gait, pain

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Authors: Ghaleb Bin Huraib, Fahad Al Harthi, Misbahul Arfin, Abdulrahman Al-Asmari

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Atopic dermatitis (AD), also known as atopic eczema, is a chronic inflammatory skin disease characterized by severe itching and recurrent relapsing eczema-like skin lesions, affecting up to 20% of children and 10% of adults in industrialized countries. AD is a complex multifactorial disease, and its exact etiology and pathogenesis have not been fully elucidated. The aim of this study was to investigate the impact of gene polymorphisms of T helper cell subtype Th1 and Th2 cytokines, interferon-gamma (IFN-γ), interleukin-6 (IL-6) and transforming growth factor (TGF)-β1on AD susceptibility in a Saudi cohort. One hundred four unrelated patients with AD and 195 healthy controls were genotyped for IFN-γ (874A/T), IL-6 (174G/C) and TGF-β1 (509C/T) polymorphisms using ARMS-PCR and PCR-RFLP technique. The frequency of genotypes AA and AT of IFN-γ (874A/T) differed significantly among patients and controls (P 0.001). The genotype AT was increased while genotype AA was decreased in AD patients as compared to controls. AD patients also had higher frequency of T containing genotypes (AT+TT) than controls (P = 0.001). The frequencies of allele T and A were statistically different in patients and controls (P = 0.04). The frequencies of genotype GG and allele G of IL-6 (174G/C) were significantly higher while genotype GC and allele C were lower in AD patients than controls. There was no significant difference in the frequencies of alleles and genotypes of TGF-β1 (509C/T) polymorphism between patient and control groups. These results showed that susceptibility to AD is influenced by presence or absence of genotypes of IFN-γ (874A/T) and IL-6 (174G/C) polymorphisms. It is concluded that T-allele and T-containing genotypes (AT+TT) of IFN-γ (874A/T) and G-allele and GG genotype ofIL-6 (174G/C) polymorphisms are susceptible to AD in Saudis.On the other hand, the TGF-β1 (509C/T) polymorphism may not be associated with AD risk in Saudi population however further studies with large sample size are required to confirm these findings.

Keywords: atopic dermatitis, interferon-γ, interleukin-6, transforming growth factor-β1, polymorphism

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Authors: Alieh Farshbaf

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Introduction: Current anti-retroviral drugs have some restrictions for treatment of HIV-1 infection. The efficacy of retroviral drugs is not same in different infected patients and the virus rebound from latent reservoirs after stopping them. Recently, the engineering of stem cells and gene therapy provide new approaches to eliminate some drug problems by induction of resistance to HIV-1. Literature review: Up to now, AIDS-restriction genes (ARGs) were suitable candidate for gene and cell therapies, such as cc-chemokine receptor-5 (CCR5). In this manner, CCR5 provide effective cure in Berlin and Boston patients by inducing of HIV-1 resistance with allogeneic stem cell transplantation. It is showed that Zinc Finger Nuclease (ZFN) could induce HIV-1 resistance in stem cells of infected patients by homologous recombination or non-end joining mechanism and eliminate virus loading after returning the modified cells. Then, gene modification by HIV restriction factors, as TRIM5, introduced another gene candidate for HIV by interfering in infection process. These gene modifications/editing provided by stem cell futures that improve treatment in refractory disease such as HIV-1. Conclusion: Although stem cell transplantation has some complications, but in compare to retro-viral drugs demonstrated effective cure by elimination of virus loading. On the other hand, gene therapy is cost-effective for an infected patient than retroviral drugs payment in a person life-long. The results of umbilical cord blood stem cell transplantation showed that gene and cell therapy will be applied easier than previous treatment of AIDS with high efficacy.

Keywords: stem cell, AIDS, gene modification, cell engineering

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