Search results for: virtual background

Authors: Silas Webb, Joseph Hartland

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Background: Long-term retention of patients on ART has become a major health challenge in Sub-Saharan Africa (SSA). In 2010 a systematic review of 39 papers found that 30% of patients were no longer taking their ARTs two years after starting treatment. In the same review, it was noted that there was a paucity of data as to why patients become lost to follow-up (LTFU) in SSA. This project was performed in Mulanje Mission Hospital in Malawi as part of Swindon Academy’s Global Health eSSC. The HIV prevalence for Malawi is 10.3%, one of the highest rates in the world, however prevalence soars to 18% in the Mulanje. Therefore it is essential that patients at risk of being LTFU are identified early and managed appropriately to help them continue to participate in the service. Methodology: All patients on adult antiretroviral formulations at MMH, who were classified as ‘defaulters’ (patients missing a scheduled follow up visit by more than two months) over the last 12 months were included in the study. Demographic varibales were collected from Mastercards for data analysis. A comparison group of patients currently not lost to follow up was created by using all of the patients who attended the HIV clinic between 18th-22nd July 2016 who had never defaulted from ART. Data was analysed using the chi squared (χ²) test, as data collected was categorical, with alpha levels set at 0.05. Results: Overall, 136 patients had defaulted from ART over the past 12 months at MMH. Of these, 43 patients had missing Mastercards, so 93 defaulter datasets were analysed. In the comparison group 93 datasets were also analysed and statistical analysis done using Chi-Squared testing. A higher proportion of men in the defaulting group was noted (χ²=0.034) and defaulters tended to be younger (χ²=0.052). 94.6% of patients who defaulted were taking Tenofovir, Lamivudine and Efavirenz, the standard first line ART therapy in Malawi. The mean length of time on ART was 39.0 months (RR: -22.4-100.4) in the defaulters group and 47.3 months (RR: -19.71-114.23) in the control group, with a mean difference of 8.3 less months in the defaulters group (χ ²=0.056). Discussion: The findings in this study echo the literature, however this review expands on that and shows the demographic for the patient at most risk of defaulting and being LTFU would be: a young male who has missed more than 4 doses of ART and is within his first year of treatment. For the hospital, this data is important at it identifies significant areas for public health focus. For instance, fear of disclosure and stigma may be disproportionately affecting younger men, so interventions can be aimed specifically at them to improve their health outcomes. The mean length of time on medication was 8.3 months less in the defaulters group, with a p-value of 0.056, emphasising the need for more intensive follow-up in the early stages of treatment, when patients are at the highest risk of defaulting.

Keywords: anti-retroviral therapy, ART, HIV, lost to follow up, Malawi

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Authors: Abi Miller, Eleanor Wilson, Claire Diver

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Background: UK Head and Neck Cancer incidence and prevalence were rising related to better treatment outcomes and changed demographics. More people of working-age now survive Head and Neck Cancer. For individuals, work provides income, purpose, and social connection. For society, work increases economic productivity and reduces welfare spending. In the UK, a cancer diagnosis is classed as a disability and more disabled people leave the workplace than non-disabled people. Limited evidence exists on return-to-work after Head and Neck Cancer, with no UK qualitative studies. Head and Neck Cancer survivors appear to return to work less when compared to other cancer survivors. This study aimed to explore the effects of Head and Neck Cancer disability on survivors’ return-to-work experience. Methodologies: This was an exploratory qualitative study using a critical realist approach to carry out semi-structured one-off interviews with Head and Neck Cancer survivors who had returned to work. Interviews were informed by an interview guide and carried out remotely by Microsoft Teams or telephone. Interviews were transcribed verbatim, pseudonyms allocated, and transcripts anonymized. Data were interpreted using Reflexive Thematic Analysis. Findings: Thirteen Head and Neck Cancer survivors aged between 41 -63 years participated in interviews. Three major themes were derived from the data: changed identity and meaning of work after Head and Neck Cancer, challenging and supportive work experiences and impact of healthcare professionals on return-to-work. Participants described visible physical appearance changes, speech and eating challenges, mental health difficulties and psycho-social shifts following Head and Neck Cancer. These factors affected workplace re-integration, ability to carry out work duties, and work relationships. Most participants experienced challenging work experiences, including stigmatizing workplace interactions and poor communication from managers or colleagues, which further affected participant confidence and mental health. Many participants experienced job change or loss, related both to Head and Neck Cancer and living through a pandemic. A minority of participants experienced strategies like phased return, which supported workplace re-integration. All participants, bar one, wanted conversations with healthcare professionals about return-to-work but perceived these conversations as absent. Conclusion: All participants found returning to work after Head and Neck Cancer to be a challenging experience. This appears to be impacted by participant physical, psychological, and functional disability following Head and Neck Cancer, work interaction and work context.

Keywords: disability, experience, head and neck cancer, qualitative, return-to-work

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Authors: Irina M. Kolesnikova, Andrey M. Gaponov, Sergey A. Roumiantsev, Tatiana V. Grigoryeva, Alexander V. Laikov, Alexander V. Shestopalov

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Background. Neuropathy is a common complication of obesity. In this regard, the content of neurotrophins in such patients is of particular interest. Neurotrophins are the proteins that regulate neuron survival and neuroplasticity and include brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF). However, the risk of complications depends on the metabolic type of obesity. Metabolically unhealthy obesity (MUHO) is associated with a high risk of complications, while this is not the case with metabolically healthy obesity (MHO). Therefore, the aim of our work was to study the effect of the obesity metabolic type on serum neurotrophins levels. Patients, materials, methods. The study included 134 healthy donors and 104 obese patients. Depending on the metabolic type of obesity, the obese patients were divided into subgroups with MHO (n=40) and MUHO (n=55). In the blood serum, the concentration of BDNF and NGF was determined. In addition, the content of adipokines (leptin, asprosin, resistin, adiponectin), myokines (irisin, myostatin, osteocrin), indicators of carbohydrate, and lipid metabolism were measured. Correlation analysis revealed the relationship between the studied parameters. Results. We found that serum BDNF concentration was not different between obese patients and healthy donors, regardless of obesity metabolic type. At the same time, in obese patients, there was a decrease in serum NGF level versus control. A similar trend was characteristic of both MHO and MUHO. However, MUHO patients had a higher NGF level than MHO patients. The literature indicates that obesity is associated with an increase in the plasma concentration of NGF. It can be assumed that in obesity, there is a violation of NGF storage in platelets, which accelerates neurotrophin degradation. We found that BDNF concentration correlated with irisin levels in MUHO patients. Healthy donors had a weak association between NGF and VEGF levels. No such association was found in obese patients, but there was an association between NGF and leptin concentrations. In MHO, the concentration of NHF correlated with the content of leptin, irisin, osteocrin, insulin, and the HOMA-IR index. But in MUHO patients, we found only the relationship between NGF and adipokines (leptin, asprosin). It can be assumed that in patients with MHO, the replenishment of serum NGF occurs under the influence of muscle and adipose tissue. In the MUHO patients only the effect of adipose tissue on NGF was observed. Conclusion. Obesity, regardless of metabolic type, is associated with a decrease in serum NGF concentration. We showed that muscle and adipose tissues make a significant contribution to the serum NGF pool in the MHO patients. In MUHO there is no effect of muscle on the NGF level, but the effect of adipose tissue remains.

Keywords: neurotrophins, nerve growth factor, NGF, brain-derived neurotrophic factor, BDNF, obesity, metabolically healthy obesity, metabolically unhealthy obesity

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Authors: Mari Murakami, Hiromi Kawasaki, Saori Fujimoto, Yoko Ueno

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Background: In Japan, one of the goals of midwifery education is the development of one’s ability to comprehensively support the child-rearing generation in collaboration with professionals from other disciplines. However, in order to prevent the spread of Covid-19, it has become extremely difficult to provide face-to-face support for mothers and children. Early on in the pandemic, we sought help from three parenting midwives as an alternative and attempted an online visit. Since midwives who are raising children respond to the training as both mothers who are care recipients and midwives as care providers. Therefore, we attempted to verify the usefulness of midwives experiencing training as mothers by clarifying the effects on those midwives who are raising children and who have experienced online visit training by students. Methods: The online visitations were conducted in June 2020. The collaborators were three midwives who were devoted to childcare. During the online visit training, we used the feedback records of their questions given by the collaborators (with their permission) to the students. The verbatim record was created from the records. Qualitative descriptive analysis was used, and subcategories and categories were extracted. This study was approved by the Ethical Committee for Epidemiology of Hiroshima University. Results: The average age of the three midwives was 36.3 years, with an average of 12.3 years of experience after graduation. They were each raising multiple children (ranging between a minimum of 2 and a maximum of 4 children). Their youngest infants were 6.7 months old on average for all. Five categories that emerged were: contributing to the development of midwifery students as a senior; the joy of accepting the efforts of a mother while raising children; recalling the humility of beginners through the integrity of midwifery students; learning opportunities about the benefits of online visits; and suggesting further challenges for online visits. Conclusion: The online visit training was an opportunity for midwives who are raising their own children to reinforce an honest and humble approach based on the attitude of the students, for self-improvement, and to reflect on the practice of midwifery from another person’s viewpoint. It was also noted that the midwives contributed to the education of midwifery students. Furthermore, they also agreed with the use of online visitations and considered the advantages and disadvantages of its use from the perspective of mothers and midwives. Online visits were seen to empower midwives on childcare leave, as their child-rearing was accepted and admired. Online visits by students were considered to be an opportunity to not only provide a sense of fulfillment as a recipient of care but also to think concretely about career advancement, during childcare leave, regarding the ideal way for midwifery training and teaching.

Keywords: child-rearing midwife, COVID-19 pandemic, online visit practice, qualitive descriptive study

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Authors: Ana Campina, José Caramelo Gomes, Maria Emília Teixeira, Cristina Costa-Lobo

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In the pursuit of educational equity within Human Rights and European Fundamental Laws, the reality presents serious problems based on the psychologic, social understanding. Take into account the miscellaneous cultures in the global context and the nowadays numbers of Human mobilities, there are serious problems affecting the societies. This justifies the diagnosed need of a renew pedagogical and social education strategy to achieve the integration positive context preventing violence and discrimination, especially in Education systems. Consequently, it is important to have in mind the respect, acceptance, and integration of special needs students in all study degrees, as it is law but a complex reality. Despite the UN and International Human Rights, European Fundamental Chart, and all EU Treats, as the 28th EU State Member’s fundamental laws forecast the right of Education, the respect, the action and promotion of different cultures and the Education for ‘Difference’ integration – cultures; ideologies, Special Needs Students/Citizens – there are different and severe problems. Firstly, there are questions/contexts/problems not denounced by the lack of investments, political, social or ‘powers’ pressures, so, consequently, the authorities don’t have the action as laws demand and the transgressors haven´t any juridical or judicial punishment. Secondly, and our most important point: Governments, authorities and even victims hide these violations/violence/problems what disable the effective protection and law enforcement. Finally, the official and non-official strategies to get around the duties, break away the laws, failing the victims protection and consequently enable the problems increase dramatically. With this research, we observed that there are international Organizations/regions and States acting without respect to the Education right despite their democratic ideology and the generated external ‘image’ of law-abiding and Human Rights defenders. Nevertheless, it is urgent to develop a consistent Human Rights Education program aiming to protect, promote and implement the Right to be different and be respected by the law, the governments, institutions official and non-official, adapted to the needs in each society. The background of this research is the International and European laws, in accordance with the state’s legal systems. The approaches and the differences of the Education for Human and Fundamental Rights execution in the different EU countries, studying the pedagogy and social inclusion programs/strategies, with particular analysis of the Special Needs students. The results aim to construct a European Education profiling, with the governments and EU interventions need, as well as the panorama of the Special Needs Students effective integration achieving a renewed strategy to promote the respect of the Differences and an Inclusive School life.

Keywords: international human rights, culture, differences, European education profiling

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Authors: Steven G. Sclan

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Background: Since December 2019, the world has been afflicted by the spread of the Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2), which is responsible for the condition referred to as Covid-19. The illness has had a cataclysmic impact on the political, social, economic, and overall well-being of the population of the entire globe. While Covid-19 has had a substantial universal fatality impact, it may have an even greater effect on the socioeconomic, medical well-being, and healthcare planning for remaining societies. Significance: As these numbers illustrate, many more persons survive the infection than die from it, and many of those patients have noted ongoing, persistent symptoms after successfully enduring the acute phase of the illness. Recognition and understanding of these symptoms are crucial for developing and arranging efficacious models of care for all patients (whether or not having been hospitalized) surviving acute covid illness and plagued by post-acute symptoms. Furthermore, regarding Covid infection in children (< 18 y/o), although it may be that Covid “+” children are not major vectors of infective transmission, it now appears that many more children than initially thought are carrying the virus without accompanying obvious symptomatic expression. It seems reasonable to wonder whether viral effects occur in children – those children who are Covid “+” and now asymptomatic – and if, over time, they might also experience similar symptoms. An even more significant question is whether Covid “+” asymptomatic children might manifest increased multiple health problems as they grow – i.e., developmental complications (e.g., physical/medical, metabolic, neurobehavioral, etc.) – in comparison to children who had been consistently Covid “ - ” during the pandemic. Topics Addressed and Theoretical Importance: This review is important because of the description of both quantitative and qualitative methods for clinical and biomedical research. Topics reviewed will consider the importance of well-designed, comprehensive (i.e., quantitative and qualitative methods) longitudinal studies of Post Covid-19 symptoms in both adults and children. Also reviewed will be general characteristics of longitudinal studies and a presentation of a model for a proposed study. Also discussed will be the benefit of longitudinal studies for the development of efficacious interventions and for the establishment of cogent, practical, and efficacious community healthcare service planning for post-acute covid patients. Conclusion: Results of multi-dimensional, longitudinal studies will have important theoretical implications. These studies will help to improve our understanding of the pathophysiology of long COVID and will aid in the identification of potential targets for treatment. Such studies can also provide valuable insights into the long-term impact of COVID-19 on public health and socioeconomics.

Keywords: COVID-19, post-COVID-19, long COVID, longitudinal research, quantitative research, qualitative research

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Authors: Payal Sudhan

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Popular films in India, Bollywood, and other local industries make a range of commercial films that attract vast viewership. Love, Heroism, Action, Adventure, Revenge, etc., are some of the dearest themes chosen by many filmmakers of various popular film Industries across the world. However, sexuality has become an issue to address within the cinema. Such films feature in small numbers compared to other themes. One can easily assume that homosexuality is unlikely to be a favorite theme found in Indian popular cinema. It doesn’t mean that there is absolutely no film made on the issues of homosexuality. There have been several attempts. Earlier, some movies depicted homosexual (gay) characters as comedians, which continued until the beginning of the 21st century. The study aims to explore how modern homophobia and stereotype are represented in the films and how it affects homosexuality in the recent Malayalam Cinema. The study wills primarily focusing on Mumbai Police (2013) and My Life Partner (2014). The study tries to explain social space, the idea of a cure, and criminality. The film that has been selected for the analysis Mumbai Police (2013) is a crime thriller. The nonlinear narration of the movie reveals, towards the end, the murderer of ACP Aryan IPS, who was shot dead in a public meeting. In the end, the culprit is the enquiring officer, ACP Antony Moses, himself a close friend and colleague of the victim. Much to one’s curiosity, the primary cause turns out to be the sexual relation Antony has. My Life Partner generically can be classified as a drama. The movie puts forth male bonding and visibly riddles the notions of love and sex between Kiran and his roommate Richard. Running through the same track, the film deals with a different ‘event.’ The ‘event’ is the exclusive celebration of male bonding. The socio-cultural background of the cinema is heterosexual. The elements of heterosexual social setup meet the ends of diplomacy of the Malayalam queer visual culture. The film reveals the life of two gays who were humiliated by the larger heterosexual society. In the end, Kiran dies because of extreme humiliation. The paper is a comparative and cultural analysis of the two movies, My Life Partner and Mumbai Police. I try to bring all the points of comparison together and explain the similarities and differences, how one movie differs from another. Thus, my attempt here explains how stereotypes and homophobia with other related issues are represented in these two movies.

Keywords: queer cinema, homophobia, malayalam cinema, queer films

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Authors: Abdul Rahman Hamdan

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The Fourth Industrial Revolution (4IR) has brought unprecedented technological advancements that have disrupted many industries worldwide. In keeping up with the technological advances and rapid disruption by the introduction of many technological advancements brought forth by the 4IR, the use of technology road mapping has emerged as one of the critical tools for organizations to leverage. Technology road mapping can be used by many companies to guide them to become more adaptable and anticipate future transformation and innovation, and avoid being redundant or irrelevant due to the rapid changes in technological advancement. This research paper provides a comprehensive analysis of technology road mapping within the context of the 4IR. The objectives of the paper are to provide companies with practical insights and a strategic framework of technology road mapping for them to navigate the fast-changing nature of the 4IR. This study also contributes to the understanding and practice of technology road mapping in the 4IR and, at the same time, provides organizations with the necessary tools and critical insight to navigate the 4IR transformation by leveraging technology road mapping. Based on the literature review and case studies, the study analyses key principles, methodologies, and best practices in technology road mapping and integrates them with the unique characteristics and challenges of the 4IR. The research paper gives the background of the fourth industrial revolution. It explores the disruptive potential of technologies in the 4IR and the critical need for technology road mapping that consists of strategic planning and foresight to remain competitive and relevant in the 4IR era. It also highlights the importance of technology road mapping as an organisation’s proactive approach to align the organisation’s objectives and resources to their technology and product development in meeting the fast-evolving technological 4IR landscape. The paper also includes the theoretical foundations of technology road mapping and examines various methodological approaches, and identifies external stakeholders in the process, such as external experts, stakeholders, collaborative platforms, and cross-functional teams to ensure an integrated and robust technological roadmap for the organisation. Moreover, this study presents a comprehensive framework for technology road mapping in the 4IR by incorporating key elements and processes such as technology assessment, competitive intelligence, risk analysis, and resource allocation. It provides a framework for implementing technology road mapping from strategic planning, goal setting, and technology scanning to road mapping visualisation, implementation planning, monitoring, and evaluation. In addition, the study also addresses the challenges and limitations related to technology roadmapping in 4IR, including the gap analysis. In conclusion of the study, the study will propose a set of practical recommendations for organizations that intend to leverage technology road mapping as a strategic tool in the 4IR in driving innovation and becoming competitive in the current and future ecosystem.

Keywords: technology management, technology road mapping, technology transfer, technology planning

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Authors: Deanne McArthur, Melinda Wall, Claire Hanlon, Dana Agnolin, Krista Davis, Melanie Dennis, Elizabeth Glidden, Anne Marie Smith, Claudette Thomson

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Background and significance: Patients with eating disorders have traditionally been an underserviced population within the publicly-funded Canadian healthcare system. This situation was worsened by the COVID-19 pandemic and accompanying public health measures, such as “lockdowns” which led to increased isolation, changes in routine, and other disruptions. Illness severity and prevalence rose significantly with corresponding increases in patient suffering and poor outcomes. In Ontario, Canada, the provincial government responded by increasing funding for the treatment of eating disorders, including the launch of a new day program at an intermediate, regional health centre that already housed an outpatient treatment service. The funding was received in March 2022. The care team sought to optimize this opportunity by designing a program that would fit well within the resource-constrained context in Ontario. Methods: This case study will detail how the team consulted the literature and sought patient and family input to design a program that optimizes patient outcomes and supports for patients and families while they await treatment. Early steps include a review of the literature, expert consultation and patient and family focus groups. Interprofessional consensus was sought at each step with the team adopting a shared leadership and patient-centered approach. Methods will include interviews, observations and document reviews to detail a rich description of the process undertaken to design the program, including evaluation measures adopted. Interim findings pertaining to the early stages of the program-building process will be detailed as well as early lessons and ongoing evolution of the program and design process. Program implementation and outcome evaluation will continue throughout 2022 and early 2023 with further publication and presentation of study results expected in the summer of 2023. The aim of this study is to contribute to the body of knowledge pertaining to the design and implementation of eating disorder treatment services that combine outpatient and day treatment services in a resource-constrained context.

Keywords: eating disorders, day program, interprofessional, outpatient, adolescents, transitional aged youth

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Authors: Michael Mihalicz, Aziz Guergachi

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Background: The science of modelling choice preferences has evolved over centuries into an interdisciplinary field contributing to several branches of Microeconomics and Mathematical Psychology. Early theories in Decision Science rested on the logic of rationality, but as it and related fields matured, descriptive theories emerged capable of explaining systematic violations of rationality through cognitive mechanisms underlying the thought processes that guide human behaviour. Cognitive limitations are not, however, solely responsible for systematic deviations from rationality and many are now exploring the effect of visceral factors as the more dominant drivers. The current study builds on the existing literature by exploring sleep deprivation, thermal comfort, stress, hunger, fear, anger and sadness as moderators to three distinct elements that define individual risk preference under Cumulative Prospect Theory. Methodology: This study is designed to compare the risk preference of participants experiencing an elevated affective or visceral state to those in a neutral state using nonparametric elicitation methods across three domains. Two experiments will be conducted simultaneously using different methodologies. The first will determine visceral states and risk preferences randomly over a two-week period by prompting participants to complete an online survey remotely. In each round of questions, participants will be asked to self-assess their current state using Visual Analogue Scales before answering a series of lottery-style elicitation questions. The second experiment will be conducted in a laboratory setting using psychological primes to induce a desired state. In this experiment, emotional states will be recorded using emotion analytics and used a basis for comparison between the two methods. Significance: The expected results include a series of measurable and systematic effects on the subjective interpretations of gamble attributes and evidence supporting the proposition that a portion of the variability in human choice preferences unaccounted for by cognitive limitations can be explained by interacting visceral states. Significant results will promote awareness about the subconscious effect that emotions and other drive states have on the way people process and interpret information, and can guide more effective decision making by informing decision-makers of the sources and consequences of irrational behaviour.

Keywords: decision making, emotions, prospect theory, visceral factors

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Authors: Benedicta N. Nkeh-Chungag, Constance R. Sewani-Rusike, Isaac M. Malema, Daniel T. Goon, Oladele V. Adeniyi, Idowu A. Ajayi

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Background: Childhood and adolescent obesity is an important predictor of adult cardiometabolic diseases. Current data on age- and gender-specific cardiometabolic risk factors are lacking in the peri-urban Eastern Cape Province, South Africa. However, such information is important in designing innovative strategies to promote healthy living among children and adolescents. The purpose of this pilot study was to compare and determine the extent of cardiometabolic risk factors between samples of lean and overweight/obese adolescent population in a peri-urban township of South Africa. Methods: In this case-control study, age-matched, non-pregnant and non-lactating female adolescents consisting of equal number of cases (50 overweight/obese) and control (50 lean) participated in the study. Fasting venous blood samples were obtained for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (Trig), highly sensitive C-reactive protein (hsCRP) and blood sugar. Anthropometric measurements included weight, height, waist and hip circumferences. Body mass index was calculated. Blood pressure was measured; and metabolic syndrome was assessed using appropriate diagnostic criteria for children and adolescents. Results: Of the 76 participants with complete data, 12/38 of the overweight/obese and 1/38 of the lean group met the criteria for adolescent metabolic syndrome. All cardiometabolic risk factors were elevated in the overweight/obese group compared with the lean group: low HDL-C (RR = 2.21), elevated TC (RR = 1.23), elevated LDL-C (RR = 1.42), elevated Trig (RR = 1.73), and elevated hsCRP (RR = 1.9). There were significant atherosclerotic indices among the overweight/obese group compared with the lean group: TC/HDL and LDL/HDL (2.99±0.91 vs 2.63±0.48; p=0.016 and 1.73±0.61 vs 1.41±0.46; p= 0.014, respectively). Conclusion: There are multiple cardiometabolic risk factors among the overweight/obese female adolescent group compared with lean adolescent group in the study. Female adolescent who are overweight and obese have higher relative risks of developing cardiometabolic diseases compared with their lean counterparts in the peri-urban Mthatha, South Africa. School health programme focusing on promoting physical exercise, healthy eating and keeping appropriate weight are needed in the country.

Keywords: adolescents, cardiometabolic risk factors, obesity, peri-urban South Africa

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Authors: Zohar Manber, Ran Elkon

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Accumulation of somatic mutations (SMs) in the genome is a major driving force of cancer development. Most SMs in the tumor's genome are functionally neutral; however, some cause damage to critical processes and provide the tumor with a selective growth advantage (termed cancer driver mutations). Current research on functional significance of SMs is mainly focused on finding alterations in protein coding sequences. However, the exome comprises only 3% of the human genome, and thus, SMs in the noncoding genome significantly outnumber those that map to protein-coding regions. Although our understanding of noncoding driver SMs is very rudimentary, it is likely that disruption of regulatory elements in the genome is an important, yet largely underexplored mechanism by which somatic mutations contribute to cancer development. The expression of most human genes is controlled by multiple enhancers, and therefore, it is conceivable that regulatory SMs are distributed across different enhancers of the same target gene. Yet, to date, most statistical searches for regulatory SMs have considered each regulatory element individually, which may reduce statistical power. The first challenge in considering the cumulative activity of all the enhancers of a gene as a single unit is to map enhancers to their target promoters. Such mapping defines for each gene its set of regulating enhancers (termed "set of regulatory elements" (SRE)). Considering multiple enhancers of each gene as one unit holds great promise for enhancing the identification of driver regulatory SMs. However, the success of this approach is greatly dependent on the availability of comprehensive and accurate enhancer-promoter (E-P) maps. To date, the discovery of driver regulatory SMs has been hindered by insufficient sample sizes and statistical analyses that often considered each regulatory element separately. In this study, we analyzed more than 2,500 whole-genome sequence (WGS) samples provided by The Cancer Genome Atlas (TCGA) and The International Cancer Genome Consortium (ICGC) in order to identify such driver regulatory SMs. Our analyses took into account the combinatorial aspect of gene regulation by considering all the enhancers that control the same target gene as one unit, based on E-P maps from three genomics resources. The identification of candidate driver noncoding SMs is based on their recurrence. We searched for SREs of genes that are "hotspots" for SMs (that is, they accumulate SMs at a significantly elevated rate). To test the statistical significance of recurrence of SMs within a gene's SRE, we used both global and local background mutation rates. Using this approach, we detected - in seven different cancer types - numerous "hotspots" for SMs. To support the functional significance of these recurrent noncoding SMs, we further examined their association with the expression level of their target gene (using gene expression data provided by the ICGC and TCGA for samples that were also analyzed by WGS).

Keywords: cancer genomics, enhancers, noncoding genome, regulatory elements

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Authors: Zahra Mohagheghian, Fatema Agharebparast

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The comparative study of religions is one of the ways which provides peace and makes the believers of religions closer together. Finding the common notions could be a foundation for the dialog among the monotheistic religions and a background to eliminate the misunderstandings and to reach common point of views. The cornerstone of all the common efforts of the believers of the religions is to reach an understanding for building a better world where true peace is established. So, the article seeks to verify the notion of positive thinking in the religious resources of Islam and Christianity. In order to understand the foundations of the religious teachings and to provide a better understanding among the believers, then, the article tries to discover the common fundamentals and the opposing points about the positive thinking in these two religions. We first try to explain the notion of positive thinking in Islam and Christianity and then offer recommended ways in both religions to create and to strengthen this way of thinking. As the different parts of the New Testament is not theologically homogeneous, this collection has been verified and explained in four different parts: Three Gospels (Matthew, Mark and Luke), John's thoughts, thoughts and ideas of Paul and finally the Christian sects . The findings of the survey show that the notion of positive thinking in the monotheistic religions of Islam and Christianity can be traced back by the keyword "hope". It is only the hope which could finally create the soul of positive attitude and thinking inside the humankind. This hope is accompanied by the prospect and causes the humankind to work hard to reach their goals. However, there are some opposing points in these two religions about the basic foundation of this true hope. From the Quran viewpoint, the main foundation of the hope is God and the human is obliged to follow his worldly goals in accordance with this foundation as well as faith to God and avoidance of committing sins. On the other hand, the basic foundation of hope in the Three Gospels (Matthew, Mark and Luke) and the teachings of Paul is the promise of a coming Kingdom. Although there are some opposing views about the meaning of this as well as the ways to attain this hope, this hope is generally related to the purpose of human life and afterlife. The Christ, in the John's thoughts, is the source of hope and everybody, believing in God, must also have hope for Jesus Christ. Effects and functions of such hope are strengthening the spirit of love and kindness to others. Hence, in Christianity, the hope and positive thinking about the future, along with good deeds, reflects different viewpoints. On the other hand, in Quran, this is faith to God and fulfilling the Sharia orders which ignite and strengthen this hope and way of thinking. This is the base that continues nowadays with Vilāya and the love for Ahlulbeit in the Shiite views.

Keywords: God, new testament, positive thinking, Quran

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Authors: Roya Yumul, Ofelia Loani Elvir-Lazo, Sevan Komshian, Ruby Wang, Jun Tang

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BACKGROUND: An objective means for monitoring the anti-nociceptive effects of perioperative medications has long been desired as a way to provide anesthesiologists information regarding a patient’s level of antinociception and preclude any untoward autonomic responses and reflexive muscular movements from painful stimuli intraoperatively. To this end, electroencephalogram (EEG) based tools including BIS and qCON were designed to provide information about the depth of sedation while qNOX was produced to inform on the degree of antinociception. The goal of this study was to compare the reliability of qCON/qNOX to BIS as specific indicators of response to nociceptive stimulation. METHODS: Sixty-two patients undergoing general anesthesia with LMA were included in this study. Institutional Review Board (IRB) approval was obtained, and informed consent was acquired prior to patient enrollment. Inclusion criteria included American Society of Anesthesiologists (ASA) class I-III, 18 to 80 years of age, and either gender. Exclusion criteria included the inability to consent. Withdrawal criteria included conversion to the endotracheal tube and EEG malfunction. BIS and qCON/qNOX electrodes were simultaneously placed on all patients prior to induction of anesthesia and were monitored throughout the case, along with other perioperative data, including patient response to noxious stimuli. All intraoperative decisions were made by the primary anesthesiologist without influence from qCON/qNOX. Student’s t-distribution, prediction probability (PK), and ANOVA were used to statistically compare the relative ability to detect nociceptive stimuli for each index. Twenty patients were included for the preliminary analysis. RESULTS: A comparison of overall intraoperative BIS, qCON and qNOX indices demonstrated no significant difference between the three measures (N=62, p> 0.05). Meanwhile, index values for qNOX (62±18) were significantly higher than those for BIS (46±14) and qCON (54±19) immediately preceding patient responses to nociceptive stimulation in a preliminary analysis (N=20, * p= 0.0408). Notably, certain hemodynamic measurements demonstrated a significant increase in response to painful stimuli (MAP increased from 74 ±13 mm Hg at baseline to 84 ± 18 mm Hg during noxious stimuli [p= 0.032] and HR from 76 ± 12 BPM at baseline to 80 ± 13 BPM during noxious stimuli [p=0.078] respectively). CONCLUSION: In this observational study, BIS and qCON/qNOX provided comparable information on patients’ level of sedation throughout the course of an anesthetic. Meanwhile, increases in qNOX values demonstrated a superior correlation to an imminent response to stimulation relative to all other indices

Keywords: antinociception, BIS, general anesthesia, LMA, qCON/qNOX

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Authors: Allaire Eric, Hauet Pascal, Floresco Jean, Beley Sebastien, Sussman Helene, Virag Ronald

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Background: Caverno-venous leakage (CVL) is devastating, although barely known disease, the first cause of major physical impairment in men under 25, and responsible for 50% of resistances to phosphodiesterase 5-inhibitors (PDE5-I), affecting 30 to 40% of users in this medication class. In this condition, too early blood drainage from corpora cavernosa prevents penile rigidity and penetration during sexual intercourse. The role of conservative surgery in this disease remains controversial. Aim: Assess complications and results of combined open surgery and embolization for CVL. Method: Between June 2016 and September 2021, 133 consecutive patients underwent surgery in our institution for CVL, causing severe erectile dysfunction (ED) resistance to oral medical treatment. Procedures combined vein embolization and ligation with microsurgical techniques. We performed a pre-and post-operative clinical (Erection Harness Scale: EHS) hemodynamic evaluation by duplex sonography in all patients. Before surgery, the CVL network was visualized by computed tomography cavernography. Penile EMG was performed in case of diabetes or suspected other neurological conditions. All patients were optimized for hormonal status—data we prospectively recorded. Results: Clinical signs suggesting CVL were ED since age lower than 25, loss of erection when changing position, penile rigidity varying according to the position. Main complications were minor pulmonary embolism in 2 patients, one after airline travel, one with Factor V Leiden heterozygote mutation, one infection and three hematomas requiring reoperation, one decreased gland sensitivity lasting for more than one year. Mean pre-operative pharmacologic EHS was 2.37+/-0.64, mean pharmacologic post-operative EHS was 3.21+/-0.60, p<0.0001 (paired t-test). The mean EHS variation was 0.87+/-0.74. After surgery, 81.5% of patients had a pharmacologic EHS equal to or over 3, allowing for intercourse with penetration. Three patients (2.2%) experienced lower post-operative EHS. The main cause of failure was leakage from the deep dorsal aspect of the corpus cavernosa. In a 14 months follow-up, 83.2% of patients had a clinical EHS equal to or over 3, allowing for sexual intercourse with penetration, one-third of them without any medication. 5 patients had a penile implant after unsuccessful conservative surgery. Conclusion: Open surgery combined with embolization for CVL is an efficient approach to CVL causing severe erectile dysfunction.

Keywords: erectile dysfunction, cavernovenous leakage, surgery, embolization, treatment, result, complications, penile duplex sonography

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Authors: Marlin Mubarak

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Background: Endometriosis is a complex disabling disease affecting young females in the reproductive period mainly. The aim of this project is to generate a diagnostic model to predict severity and stage of endometriosis prior to Laparoscopic surgery. This will help to improve the pre-operative diagnostic accuracy of stage 3 & 4 endometriosis and as a result, refer relevant women to a specialist centre for complex Laparoscopic surgery. The model is based on the British Society of Gynaecological Endoscopy (BSGE) pain questionnaire, clinical examination and ultrasound scan. Design: This is a prospective, observational, study, in which women completed the BSGE pain questionnaire, a BSGE requirement. Also, as part of the routine preoperative assessment patient had a routine ultrasound scan and when recto-vaginal and deep infiltrating endometriosis was suspected an MRI was performed. Setting: Luton & Dunstable University Hospital. Patients: Symptomatic women (n = 56) scheduled for laparoscopy due to pelvic pain. The age ranged between 17 – 52 years of age (mean 33.8 years, SD 8.7 years). Interventions: None outside the recognised and established endometriosis centre protocol set up by BSGE. Main Outcome Measure(s): Sensitivity and specificity of endometriosis diagnosis predicted by symptoms based on BSGE pain questionnaire, clinical examinations and imaging. Findings: The prevalence of diagnosed endometriosis was calculated to be 76.8% and the prevalence of advanced stage was 55.4%. Deep infiltrating endometriosis in various locations was diagnosed in 32/56 women (57.1%) and some had DIE involving several locations. Logistic regression analysis was performed on 36 clinical variables to create a simple clinical prediction model. After creating the scoring system using variables with P < 0.05, the model was applied to the whole dataset. The sensitivity was 83.87% and specificity 96%. The positive likelihood ratio was 20.97 and the negative likelihood ratio was 0.17, indicating that the model has a good predictive value and could be useful in predicting advanced stage endometriosis. Conclusions: This is a hypothesis-generating project with one operator, but future proposed research would provide validation of the model and establish its usefulness in the general setting. Predictive tools based on such model could help organise the appropriate investigation in clinical practice, reduce risks associated with surgery and improve outcome. It could be of value for future research to standardise the assessment of women presenting with pelvic pain. The model needs further testing in a general setting to assess if the initial results are reproducible.

Keywords: deep endometriosis, endometriosis, minimally invasive, MRI, ultrasound.

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Authors: Hugo Ribadeau Dumas

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In India, cities represent intense battlefields where patriarchal norms are simultaneously defied and reinforced. While Indian metropolises have witnessed numerous initiatives where women boldly claimed their right to the city, urban spaces still remain disproportionately unfriendly to female city-dwellers. As a result, the presence of strees (women, in Hindi) in the streets remains a socially and politically potent phenomenon. This paper explores how, in India, women engage with the city as compared to men. Borrowing analytical tools from urban geography, it uses Hindi cinema as a medium to map the extent to which activities, attitudes and experiences in urban spaces are highly gendered. The sample consists of 30 movies, both mainstream and independent, which were released between 2010 and 2020, were set in an urban environment and comprised at least one pivotal female character. The paper adopts a quantitative approach, consisting of the scrutiny of close to 3,000 minutes of footage, the labeling and time count of every scene, and the computation of regressions to identify statistical relationships between characters and the way they navigate the city. According to the analysis, female characters spend half less time in the public space than their male counterparts. When they do step out, women do it mostly for utilitarian reasons; inversely, in private spaces or in pseudo-public commercial places – like malls – they indulge in fun activities. For male characters, the pattern is the exact opposite: fun takes place in public and serious work in private. The characters’ attitudes in the streets are also greatly gendered: men spend a significant amount of time immobile, loitering, while women are usually on the move, displaying some sense of purpose. Likewise, body language and emotional expressiveness betray differentiated gender scripts: while women wander in the streets either smiling – in a charming role – or with a hostile face – in a defensive mode – men are more likely to adopt neutral facial expressions. These trends were observed across all movies, although some nuances were identified depending on the character's age group, social background, and city, highlighting that the urban experience is not the same for all women. The empirical pieces of evidence presented in this study are helpful to reflect on the meaning of public space in the context of contemporary Indian cities. The paper ends with a discussion on the link between universal access to public spaces and women's empowerment.

Keywords: cinema, Indian cities, public space, women empowerment

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Authors: Chia-Ching Sun, Li-Yin Chien, Chun-Ting Hsiao

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Background: Appropriate gestation weight gain benefits pregnant women and their children; however, excessive weight gain could raise the risk of adverse health outcomes and chronicle diseases. Nevertheless, there is currently limited evidence on the effect of physical activities on pregnant women’s gestational weight gain. Purpose: This study aimed to explore the correlation between the level of physical activity and gestation weight gain during the second and third trimester of pregnancy. Methods: This longitudinal study enrolled 800 healthy pregnant women aged over 20 from six hospitals in northern Taiwan. Structured questionnaires were used to collect data twice for each participant during 14-27 and 28-40 weeks of gestation. Variables included demographic data, maternal health history, and lifestyle. The International Physical Activity Questionnaire-short form was used to measure the level of physical activity from walking and of moderate-intensity and vigorous-intensity before and during pregnancy. Weight recorded at prenatal checkups were used to calculate average weight gain in each trimester of pregnancy. T-tests, ANOVA, chi-squared tests, and multivariable logistic regression models were applied to determine the predicting factors for weight gain during the second and third trimester. Result: Participants who had achieved recommended physical activity level (150 minutes of moderate physical activity or 75 minutes of vigorous physical activity a week) before pregnancy (aOR=1.85, 95% CI=1.27-2.67) or who achieved recommended walking level (150 minutes a week) during the second trimester of pregnancy (aOR=1.43, 95% CI= 1.00-2.04) gained significantly more weight during the second trimester. Compared with those who did not reach recommended level of moderate-intensity physical activity (150 minutes a week), women who had reached that during the second trimester were more likely to be in the less than recommended weight gain group than in the recommended weight gain group (aOR=2.06, CI=1.06-4.00). However, there was no significant correlation between physical activity level and weight gain in the third trimester. Other predicting factors of excessive weight gain included education level which showed a negative correlation (aOR=0.38, CI=0.17-0.88), whereas overweight and obesity before pregnancy showed a positive correlation (OR=3.97, CI=1.23-12.78). Conclusions/implications for practice: Participants who had achieved recommended physical activity level before pregnancy significantly reduced exercise during pregnancy and gained excessive weight during the second trimester. However, women who engaged in the practice of physical activity as recommended could effectively control weight gain in the third trimester. Healthcare professionals could suggest that pregnant women who exercise maintain their pre-pregnancy level of physical activity, given activities requiring physical contact or causing falls are avoided. For those who do not exercise, health professionals should encourage them to gradually increase the level of physical activity. Health promotion strategies related to weight control and physical activity level achievement should be given to women before pregnancy.

Keywords: pregnant woman, physical activity, gestation weight gain, obesity, overweight

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Authors: D. O. Miranda, L. R. Azevedo, J. F. C. Cordeiro, A. H. Dos Santos, S. F. Lisboa, F. S. Guimarães, G. S. Bisson

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Background: The Colorectal cancer (CRC) is one of the most common cancers and the fourth leading cause of cancer death in the world. The prevalence of psychiatric-disorders among CRC patients, mainly depression, is high, resulting in impaired quality of life and side effects of primary treatment. High levels of proinflammatory cytokines at tumor microenvironment is a feature of CRC and the literature suggests that those mediators could contribute to the development of psychiatric disorders. Nevertheless, the ability of tumor-associated biological processes to affect the central nervous system (CNS) has only recently been explored in the context of symptoms of depression and is still not well understood. Therefore, the aim of the present study was to test the hypothesis that depressive-like behavior in an experimental model of CCR induced by N-methyl-N-nitro-N-nitrosoguanidine (MNNG) was correlated to proinflammatory profile in the periphery and in the brain. Methods: Colorectal carcinogenesis was induced in adult C57BL/6 mice (n=12) by administration of MNNG (5mg/kg, 0.1ml/intrarectal instillation) 2 times a week, for 2 week. Control group (n=12) received saline (0.1ml/intrarectal instillation). Eight weeks after beginning of MNNG administration animals were submitted to the forced swim test (FST) and the sucrose preference test for evaluation, respectively, of depressive- and anhedonia-like behaviors. After behavioral evaluation, the colon was collected and brain regions dissected (cortex-C, striatum-ST and hippocampus-HIP) for posterior evaluation of cytokine levels (IL-1β, IL-10, IL-17, and CX3CL1) by ELISA. Results: MNNG induced depressive-like behavior, represented by increased immobility time in the FST (Student t test, p < 0.05) and lower sucrose preference (Student t test, p < 0.05). Moreover, there were increased levels of IL-1β, IL-17 and CX3CL1 in the colonic tissue (Student t test, p < 0.05) and in the brain (IL-1 β in the ST and HIP, Student t test, p < 0.05; IL-17 and CX3CL1 in the C and HIP, p < 0.05). IL-10 levels, in contrast, were decreased in both the colon (p < 0.05) and the brain (C and HIP, p < 0.05). Conclusions: The results obtained in the present work support the notion that tumor growth induces neuroinflammation in stress-related brain regions and depressive-like behavior, which could be related to the high incidence of depression in colorectal carcinogenesis. This work have important clinical and research implications, taken into account that cytokine levels may be a marker promissory for the developing depression in CRC patients. New therapeutic strategies to assist in alleviating mental suffering in cancer patients might result from a better understanding of the role of cytokines in the pathophysiology of depression in these subjects.

Keywords: cytokines, brain, depression, colorectal cancer

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Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser

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Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.

Keywords: adverse events, global trigger tool, patient safety, record review

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Authors: Kaila A. Vento

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Within the field of sports science, financial situations have been reported as a key barrier in purchasing high-quality foods. A lack of proper nutrition leads to insecurities of health, impairs training, and diminishes optimal performances. Consequently, insufficient nutrient intake, disordered eating patterns, and eating disorders may arise, leading to poor health and well-being. Athletic scholarships, nutrition resources, and meal programs are available, yet are disproportionally allocated, favoring male sports, Caucasian athletes, and higher sport levels. Direct athlete finances towards nutrition at various sport levels and the role race influences aid received has yet to be examined. Additionally, a diverse female athlete population is missing in the sports science literature, specifically in nutrition. To address this gap, the current project assesses how financial and nutrition support and nutrition knowledge impacts physical health, dietary intake, and overall quality of life of a diverse sample of female athletes at the National Collegiate Athletic Association (NCAA), National Junior Collegiate Athletic Association (NJCAA), and cub sport levels. The project will identify differences in financial support in relation to race, as well. Approximately (N = 120) female athletes will participate in a single 30-minute lab visit. At this visit, body composition (i.e., height, weight, body mass index, and fat percent), blood health indicators (fasted blood glucose and lipids), and resting blood pressure are measured. In addition, three validated questionnaires pertaining to nutrition knowledge (Sports Nutrition Knowledge Questionnaire; SNKQ), dietary intake (Rapid Eating Assessment for Participants; REAP), and quality of life (World Health Organization Quality of Life Brief; WHOQL-B) are gathered. Body composition and blood health indicators will be compared with the results of self-reported sports nutrition knowledge, dietary intake, and quality of life questionnaires. It is hypothesized that 1) financial and nutrition support and nutrition knowledge will differ between the sport levels and 2) financial and nutrition support and nutrition knowledge will have a positive association with quality of dietary intake and blood health indicators, 3) financial and nutrition support will differ significantly among racial background across the various competition levels, and 4) dietary intake will influence blood health indicators and quality of life. The findings from this study could have positive implications on athletic associations' policies on equity of financial and nutrition support to improve the health and safety of all female athletes across several sport levels.

Keywords: athlete, equity, finances, health, resources

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Authors: Christian T. Lystbaek

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Background: The importance of innovation management has traditionally been ascribed to private production companies, however, there is an increasing interest in public services innovation management. One of the major theoretical challenges arising from this situation is to understand public values justifying public services innovation management. However, there is not single and stable definition of public value in the literature. The research question guiding this paper is: What is the supposed added value operating in the public sphere? Methodology: The study takes an action research strategy. This is highly contextualized methodology, which is enacted within a particular set of social relations into which on expects to integrate the results. As such, this research strategy is particularly well suited for its potential to generate results that can be applied by managers. The aim of action research is to produce proposals with a creative dimension capable of compelling actors to act in a new and pertinent way in relation to the situations they encounter. The context of the study is a workshop on public services innovation within elderly care. The workshop brought together different actors, such as managers, personnel and two groups of users-citizens (elderly clients and their relatives). The process was designed as an extension of the co-construction methods inherent in action research. Scenario methods and focus groups were applied to generate dialogue. The main strength of these techniques is to gather and exploit as much data as possible by exposing the discourse of justification used by the actors to explain or justify their points of view when interacting with others on a given subject. The approach does not directly interrogate the actors on their values, but allows their values to emerge through debate and dialogue. Findings: The public values related to public services innovation management in elderly care were identified in two steps. In the first step, identification of values, values were identified in the discussions. Through continuous analysis of the data, a network of interrelated values was developed. In the second step, tracking group consensus, we then ascertained the degree to which the meaning attributed to the value was common to the participants, classifying the degree of consensus as high, intermediate or low. High consensus corresponds to strong convergence in meaning, intermediate to generally shared meanings between participants, and low to divergences regarding the meaning between participants. Only values with high or intermediate degree of consensus were retained in the analysis. Conclusion: The study shows that the fundamental criterion for justifying public services innovation management is the capacity for actors to enact public values in their work. In the workshop, we identified two categories of public values, intrinsic value and behavioural values, and a list of more specific values.

Keywords: public services innovation management, public value, co-creation, action research

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Authors: Esam Roshdy, Saleh AlRashdi, Turki Alharbi, Rawan Eskandarani, Zurina Cabilo

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Introduction/ background: Consultation in the Emergency Department constitute a major part of the work flow every day. Any delay in the consultation process have a major impact on the length of stay and patient disposition and thus affect the total waiting time of patients in the ED. King Fahad medical City in Riyadh City, Saudi Arabia is considered a major Tertiary hospital where there is high flow of patients of different categories visiting the ED. The importance of decreasing consultation time and decision for final disposition of patients was recognized and interpreted in this project to find ways to improve the patient flow in the department and thus the total patient disposition and outcome. Aim / Objectives: 1. To monitor the time of consultation for patients in the Emergency department and its impact on the length of stay of patients in the ED. 2. To detect and assess the problems that lead to long consultation times in the ED, and reach a targeted time of 2 hours for final disposition of patients, according to recognized international and our institutional consultation policy, to reach the final goal of decreasing total length of stay and thus improve the patient flow in the ED. Methods: Data was collected retrospectively for a 92 charts of consultations done in the ED over 2 month’s period. The data was analyzed to get the median of Total Consultation Time. A survey was conducted among all ED staff to determine the level of knowledge about the total consultation time and the compliance to the institutional policy target of 2 hours. A second Data sample of 168 chart was collected after awareness campaign and education of all ED staff about the importance of reaching the target consultation time and compliance to the institutional policy. Results: We have found that there is room for improvement in our overall consultation time. This was found to be more frequent with certain specialties. Our surveys have showed that many ED staff are not familiar or not compliant with our consultation policy which was not clear for everyone. Post-intervention data have showed that awareness of the importance to decrease the total consultation time and compliance alone to the targeted goal have had a huge impact on overall improvement and decreasing the time of final decision and disposition of the patient and the overall patient length of stay in the ED. Conclusion: Working on improving Consultation time in the Emergency Department is a major factor in improving overall length of stay and patient flow. This improvement helps in the overall patient disposition and satisfaction. Plan: As a continuation of our project we are planning to focus on the conflict of admission cases where more than one specialty is involved in the care of patients. We are planning to collect data on the time it takes to resolve and reach final disposition of those patients, and its impact on the length of stay and our department flow and the overall patient outcome and satisfaction.

Keywords: consultation time, impact, length of stay, in the ED

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Authors: Muhammad Naveed Babur, Maria Liaqat

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Background & Objective: People with disabilities especially neurological disabilities have many unmet health and rehabilitation needs, face barriers in accessing mainstream health-care services, and consequently have poor health. There are not sufficient epidemiological studies from Pakistan which assess barriers to neurorehabilitation and ways to counter it. Objectives: The objective of the study was to determine the challenges and to evaluate the barriers for neuro-rehabilitation services in developing countries. Methods: This is Exploratory sequential qualitative study based on the Panel discussion forum in International rehabilitation sciences congress and national rehabilitation conference 2017. Panel group discussion has been conducted in February 2017 with a sample size of eight professionals including Rehabilitation medicine Physician, Physical Therapist, Speech Language therapist, Occupational Therapist, Clinical Psychologist and rehabilitation nurse working in multidisciplinary/Interdisciplinary team. A comprehensive audio-videography have been developed, recorded, transcripted and documented. Data was transcribed and thematic analysis along with characteristics was drawn manually. Data verification was done with the help of two separate coders. Results: After extraction of two separate coders following results are emerged. General category themes are disease profile, demographic profile, training and education, research, barriers, governance, global funding, informal care, resources and cultural beliefs and public awareness. Barriers identified at the level are high cost, stigma, lengthy course of recovery. Hospital related barriers are lack of social support and individually tailored goal setting processes. Organizational barriers identified are lack of basic diagnostic facilities, lack of funding and human resources. Recommendations given by panelists were investment in education, capacity building, infrastructure, governance support, strategies to promote communication and realistic goals. Conclusion: It is concluded that neurorehabilitation in developing countries need attention in following categories i.e. disease profile, demographic profile, training and education, research, barriers, governance, global funding, informal care, resources and cultural beliefs and public awareness. This study also revealed barriers at the level of patient, hospital, organization. Recommendations were also given by panelists.

Keywords: disability, neurorehabilitation, telerehabilitation, disability

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Authors: Yael Wolff Sagy, Yiska Loewenberg Weisband, Vered Kaufman Shriqui, Michal Krieger, Arie Ben Yehuda, Ronit Calderon Margalit

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Background: Obesity is both a risk factor and common comorbidity of diabetes. Obesity impedes the achievement of glycemic control, and enhances damage caused by hyperglycemia to blood vessels; thus it increases diabetes-related complications. This study assessed the prevalence of obesity and morbid obesity among Israeli adults with diabetes, and estimated disparities associated with sex and socioeconomic position (SEP). Methods: A cross-sectional study was conducted in the setting of the Israeli National Program for Quality Indicators in Community Healthcare. Data on all the Israeli population is retrieved from electronic medical records of the four health maintenance organizations (HMOs). The study population included all Israeli patients with diabetes aged 20-64 with documented body mass index (BMI) in 2016 (N=180,451). Diabetes was defined as the existence of one or more of the following criteria: (a) Plasma glucose level >200 mg% in at least two tests conducted at least one month apart in the previous year; (b) HbA1c>6.5% at least once in the previous year (c) at least three prescriptions of diabetes medications were dispensed during the previous year. Two measures were included: the prevalence of obesity (defined as last BMI≥ 30 kg/m2 and <35 kg/m2) and the prevalence of morbid obesity (defined as last BMI≥ 35 kg/m2) in individuals aged 20-64 with diabetes. The cut-off value for morbid obesity was set in accordance with the eligibility criteria for bariatric surgery in diabetics. Data were collected by the HMOs and aggregated by age, sex and SEP. SEP was based on statistical areas ranking by the Israeli Central Bureau of Statistics and divided into 4 categories, ranking from 1 (lowest) to 4 (highest). Results: BMI documentation among adults with diabetes was 84.9% in 2016. The prevalence of obesity in the study population was 30.5%. Although the overall rate was similar in both sexes (30.8% in females, 30.3% in males), SEP disparities were stronger in females (32.7% in SEP level 1 vs. 27.7% in SEP level 4; 18.1% relative difference) compared to males (30.6% in SEP level 1 vs. 29.3% in SEP level 4; 4.4% relative difference). The overall prevalence of morbid obesity in this population was 20.8% in 2016. The rate among females was almost double compared to the rate in males (28.1% and 14.6%, respectively). In both sexes, the prevalence of morbid obesity was strongly associated with lower SEP. However, in females, disparities between SEP levels were much stronger (34.3% in SEP level 1 vs. 18.7% in SEP level 4; 83.4% relative difference) compared to SEP-disparities in males (15.7% in SEP level 1 vs. 12.3% in SEP level 4; 27.6% relative difference). Conclusions: The overall prevalence of BMI≥ 30 kg/m2 among adults with diabetes in Israel exceeds 50%; and the prevalence of morbid obesity suggests that 20% meet the BMI-criteria for bariatric surgery. Prevalence rates show major SEP- and sex-disparities; especially strong SEP disparities in morbid obesity among females. These findings highlight the need for greater consideration of different population groups when implementing interventions.

Keywords: diabetes, health disparities, health policy, obesity, socio-economic position

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Authors: Haile Nega Mulata, Seifu Daniel, Umeta Melaku, Wendwesson Ergete, Natesan Gnanasekaran

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Background: In Ethiopia, medicinal plants have been used for various human and animal diseases. In this study, we have examined the potential effect of hydroethanolic extract of Calpurnia aurea seed against hepatotoxicity and haematotoxicity induced by Highly Active Antiretroviral Therapy (HAART) drugs in Albino Wistar rats. Methods: We collected Matured dried seeds of Calpurnia aurea from northern Ethiopia (south Tigray and south Gondar) in June 2013. The powder of the dried seed sample was macerated with 70% ethanol and dried using rotavapor. We have investigated the Preliminary phytochemical tests and in-vitro antioxidant properties. Then, we induced toxicity with HAART drugs and gave the experimental animals different doses of the crude extract orally for thirty-five days. On the 35th day, the animals were fasted overnight and sacrificed by cervical dislocation. We collected the blood samples by cardiac puncture. We excised the liver and brain tissues for further histopathological studies. Subsequently, we analysed serum levels of the liver enzymes- Alanine Aminotransferase, Aspartate Aminotransferase, Alkaline Phosphatase, Total Bilirubin, and Serum Albumin, using commercial kits in Cobas Integra 400 Plus Roche Analyzer Germany. We have also assessed the haematological profile using an automated haematology Analyser (Sysmex KX-2IN). Results: A significant (P<0.05) decrease in serum enzymes (ALT and AST) and total bilirubin were observed in groups that received the highest dose (300mg/kg) of the seed extract. And significant (P<0.05) elevation of total red blood cell count, haemoglobin, and hematocrit percentage was observed in the groups that received the seed extract compared to the HAART-treated groups. The WBC count mean values showed a statistically significant increase (p<0.05) in groups that received HAART and 200 and 300mg/kg extract, respectively. The histopathological observations also showed that the oral administration of varying doses of the crude extract of the seed reversed to a normal state. Conclusion: The hydroethanolic extract of the Calpurnia aurea seed lowered the hepatotoxicity and haematotoxicity in a dose-dependent manner. The antioxidant properties of the Calpurnia aurea seed extract may have possible protective effects against the drug's toxicity.

Keywords: calpurnia aurea, hepatotoxicity, haematotoxicity, antioxidant, histopathology, HAART

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Authors: Subhankar Kumar Sarkar

Abstract:

Scarab beetles composing the family Scarabaeidae is one of the largest families in the order Coleoptera. The family is comprised of 11 subfamilies. Of these, the subfamily Scarabaeinae includes 13 tribes globally. Indian species are however considered within 2 tribes Scarabaeini and Coprini. Scarab beetles under this subfamily also known as Coprophagus beetles play an indispensable role in forestry and agriculture. Both adults and larvae of these beetles do a remarkable job of carrying excrement into the soil thus enriching the soil to a great extent. Eastern and North Eastern states of India are heavily rich in diversity of organisms as this region exhibits the tropical rain forests of the eastern Himalayas, which exhibits one of the 18 biodiversity hotspots of the world and one of the three of India. Buxa Tiger Reserve located in Dooars between latitudes 26°30” to 26°55” North & longitudes 89°20” to 89°35” East is one such fine example of rain forests of the eastern Himalayas. Despite this, the subfamily is poorly known, particularly from this part of the globe and demands serious revisionary studies. It is with this background; the attempt is being made to assess the Scarabaeinae fauna of the forest. Both extensive and intensive surveys were conducted in different beats under different ranges of Buxa Tiger Reserve. For collection sweep nets, bush beating and collection in inverted umbrella, hand picking techniques were used. Several pit fall traps were laid in the collection localities of the Reserve to trap ground dwelling scarabs. Dung of various animals was also examined to make collections. In the evening hours UV light, trap was used to collect nocturnal beetles. The collected samples were studied under Stereozoom Binocular Microscopes Zeiss SV6, SV11 and Olympus SZ 30. The faunistic investigation of the forest revealed in the recognition of 19 species under 6 genera distributed over 2 tribes. Of these Heliocopris tyrannus Thomson, 1859 was recorded new from the Country, while Catharsius javanus Lansberge, 1886, Copris corpulentus Gillet, 1910, C. doriae Harold, 1877 and C. sarpedon Harold, 1868 from the state. 4 species are recorded as endemic to India. The forest is dominated by the members of the Genus Onthophagus, of which Onthophagus (Colobonthophagus) dama (Fabricius, 1798) is represented by highest number of individuals. Their seasonal distribution is most during Premonsoon followed by Monsoon and Postmonsoon. Zoogeographically all the recorded species are of oriental distribution.

Keywords: buxa tiger reserve, diversity, India, new records, scarabaeinae, scarabaeidae

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Authors: Anupriya Sharma, Sapna Narula

Abstract:

Over the past decade, sustainability has gone mainstream as more people are worried about environment-related issues than ever before. These issues are of even more concern for industries which leave a significant impact on the environment. Following these ecological issues, corporates are beginning to comprehend the impact on their business. Many such initiatives have been made to address these emerging issues in the consumer-driven textile industry. Demand from customers, local communities, government regulations, etc. are considered some of the major factors affecting environmental decision-making. Research also shows that motivations to go green are inevitably determined by the way top managers perceive environmental issues as managers personal values and ethical commitment act as a motivating factor towards corporate social responsibility. Little empirical research has been conducted to examine the relationship between top managers’ personal environmental attitudes and corporate environmental behaviors for the textile industry in the Indian context. The primary purpose of this study is to determine the current state of environmental management in textile industry and whether the attitude of textile firms’ top managers is significantly related to firm’s response to environmental issues and their perceived benefits of environmental management. To achieve the aforesaid objectives of the study, authors used structured questionnaire based on literature review. The questionnaire consisted of six sections with a total length of eight pages. The first section was based on background information on the position of the respondents in the organization, annual turnover, year of firm’s establishment and so on. The other five sections of the questionnaire were based upon (drivers, attitude, and awareness, sustainable business practices, barriers to implementation and benefits achieved). To test the questionnaire, a pretest was conducted with the professionals working in corporate sustainability and had knowledge about the textile industry and was then mailed to various stakeholders involved in textile production thereby covering firms top manufacturing officers, EHS managers, textile engineers, HR personnel and R&D managers. The results of the study showed that most of the textile firms were implementing some type of environmental management practice, even though the magnitude of firm’s involvement in environmental management practices varied. The results also show that textile firms with a higher level of involvement in environmental management were more involved in the process driven technical environmental practices. It also identified that firm’s top managers environmental attitudes were correlated with perceived advantages of environmental management as textile firm’s top managers are the ones who possess managerial discretion on formulating and deciding business policies such as environmental initiatives.

Keywords: attitude and awareness, Environmental management, sustainability, textile industry

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Authors: Khadija Al-Hosni, Moon Fai Chan, Mohammed Al-Azri

Abstract:

Background: Several studies suggest that most school-age adolescents are poorly informed on cancer warning signs and risk factors. Providing adolescents with sufficient knowledge would increase their awareness in adulthood and improve seeking behaviors later. Significant: The results will provide a clear vision in assisting key decision-makers in formulating policies on the students' awareness programs towards cancer. So, the likelihood of avoiding cancer in the future will be increased or even promote early diagnosis. Objectives: to evaluate the effectiveness of an education program designed to increase awareness of cancer signs and symptoms risk factors, improve the behavior of seeking help among school students in Oman, and address the barriers to obtaining medical help. Methods: A randomized controlled trial with two groups was conducted in Oman. A total of 1716 students (n=886/control, n= 830/education), aged 15-17 years, at 10th and 11th grade from 12 governmental schools 3 in governorates from 20-February-2022 to 12-May-2022. Basic demographic data were collected, and the Cancer Awareness Measure (CAM) was used as the primary outcome. Data were collected at baseline (T0) and 4 weeks after (T1). The intervention group received an education program about cancer's cause and its signs and symptoms. In contrast, the control group did not receive any education related to this issue during the study period. Non-parametric tests were used to compare the outcomes between groups. Results: At T0, the lamp was the most recognized cancer warning sign in control (55.0%) and intervention (55.2%) groups. However, there were no significant changes at T1 for all signs in the control group. In contrast, all sign outcomes were improved significantly (p<0.001) in the intervention group, the highest response was unexplained pain (93.3%). Smoking was the most recognized risk factor in both groups: (82.8% for control; 84.1% for intervention) at T0. However, there was no significant change in T1 for the control group, but there was for the intervention group (p<0.001), the highest identification was smoking cigarettes (96.5%). Too scared was the largest barrier to seeking medical help by students in the control group at T0 (63.0%) and T1 (62.8%). However, there were no significant changes in all barriers in this group. Otherwise, being too embarrassed (60.2%) was the largest barrier to seeking medical help for students in the intervention group at T0 and too scared (58.6%) at T1. Although there were reductions in all barriers, significant differences were found in six of ten only (p<0.001). Conclusion: The intervention was effective in improving students' awareness of cancer symptoms, warning signs (p<0.001), and risk factors (p<0.001 reduced the most addressed barriers to seeking medical help (p<0.001) in comparison to the control group. The Ministry of Education in Oman could integrate awareness of cancer within the curriculum, and more interventions are needed on the sociological part to overcome the barriers that interfere with seeking medical help.

Keywords: adolescents, awareness, cancer, education, intervention, student

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Authors: Anastasia Constantinou, Panayiotis Laouris, Stephen Morris

Abstract:

Background: Climate change has been reported as one of the worst threats to healthcare. The healthcare sector is a significant contributor to greenhouse gas emissions with primary care being responsible for 23% of the NHS’ total carbon footprint. Digital interventions, primarily focusing on telemedicine, offer a route to change. This systematic review aims to quantify and characterize the carbon footprint savings associated with the implementation of digital interventions in the setting of primary care. Methods: A systematic review of published literature was conducted according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, PubMed, and Scopus databases as well as Google scholar were searched using key terms relating to “carbon footprint,” “environmental impact,” “sustainability”, “green care”, “primary care,”, and “general practice,” using citation tracking to identify additional articles. Data was extracted and analyzed in Microsoft Excel. Results: Eight studies were identified conducted in four different countries between 2010 and 2023. Four studies used interventions to address primary care services, three studies focused on the interface between primary and specialist care, and one study addressed both. Digital interventions included the use of mobile applications, online portals, access to electronic medical records, electronic referrals, electronic prescribing, video-consultations and use of autonomous artificial intelligence. Only one study carried out a complete life cycle assessment to determine the carbon footprint of the intervention. It estimate that digital interventions reduced the carbon footprint at primary care level by 5.1 kgCO2/visit, and at the interface with specialist care by 13.4 kg CO₂/visit. When assessing the relationship between travel-distance saved and savings in emissions, we identified a strong correlation, suggesting that most of the carbon footprint reduction is attributed to reduced travel. However, two studies also commented on environmental savings associated with reduced use of paper. Patient savings in the form of reduced fuel cost and reduced travel time were also identified. Conclusion: All studies identified significant reductions in carbon footprint following implementation of digital interventions. In the future, controlled, prospective studies incorporating complete life cycle assessments and accounting for double-consulting effects, use of additional resources, technical failures, quality of care and cost-effectiveness are needed to fully appreciate the sustainable benefit of these interventions

Keywords: carbon footprint, environmental impact, primary care, sustainable healthcare

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