Search results for: clinical skills

Authors: Milan N. A. Van Der Kuil, Anne M. A. Visser-Meily, Andrea W. M. Evers, Ineke J. M. Van Der Ham

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Navigation ability is essential for autonomy and mobility in daily life. In patients with acquired brain injury, navigation impairment is frequently impaired; however, in this study, we tested the effectiveness of a serious gaming training protocol as a tool for cognitive rehabilitation to reduce navigation impairment. In total, 38 patients with acquired brain injury and subjective navigation complaints completed the experiment, with a partially blind, randomized control trial design. An objective navigation test was used to construct a strengths and weaknesses profile for each patient. Subsequently, patients received personalized compensation training that matched their strengths and weaknesses by addressing an egocentric or allocentric strategy or a strategy aimed at minimizing the use of landmarks. Participants in the experimental condition received psychoeducation and a home-based rehabilitation game with a series of exercises (e.g., map reading, place finding, and turn memorization). The exercises were developed to stimulate the adoption of more beneficial strategies, according to the compensatory approach. Self-reported navigation ability (wayfinding questionnaire), participation level, and objective navigation performance were measured before and after 1 and 4 weeks after completing the six-week training program. Results indicate that the experimental group significantly improved in subjective navigation ability both 1 and 4 weeks after completion of the training, in comparison to the score before training and the scores of the control group. Similarly, goal attainment showed a significant increase after the first and fourth week after training. Objective navigation performance was not affected by the training. This navigation training protocol provides an effective solution to address navigation impairment after acquired brain injury, with clear improvements in subjective performance and goal attainment of the participants. The outcomes of the training should be re-examined after implementation in a clinical setting.

Keywords: spatial navigation, cognitive rehabilitation, serious gaming, acquired brain injury

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Authors: Vasupradaa Manivannan, Santosh Maruthy

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Background/Aims: Preliminary evidence suggests that code-switching and code-mixing may act as one of the voluntary coping behavior to avoid the stuttering characteristics in children and adults; however, less is known about the types and patterns of code-mixing (CM) and code-switching (CS). Further, it is not known how it is different between children to adults who stutter. This study aimed to identify and compare the CM and CS patterns between Kannada-English bilingual children and adults who stutter. Method: A standard group comparison was made between five children who stutter (CWS) in the age range of 9-13 years and five adults who stutter (AWS) in the age range of 20-25 years. The participants who are proficient in Kannada (first language- L1) and English (second language- L2) were considered for the study. There were two tasks given to both the groups, a) General conversation (GC) with 10 random questions, b) Narration task (NAR) (Story / General Topic, for example., A Memorable Life Event) in three different conditions {Mono Kannada (MK), Mono English (ME), and Bilingual (BIL) Condition}. The children and adults were assessed online (via Zoom session) with a high-quality internet connection. The audio and video samples of the full assessment session were auto-recorded and manually transcribed. The recorded samples were analyzed for the percentage of dysfluencies using SSI-4 and CM, and CS exhibited in each participant using Matrix Language Frame (MLF) model parameters. The obtained data were analyzed using the Statistical Package for the Social Sciences (SPSS) software package (Version 20.0). Results: The mean, median, and standard deviation values were obtained for the percentage of dysfluencies (%SS) and frequency of CM and CS in Kannada-English bilingual children and adults who stutter for various parameters obtained through the MLF model. The inferential results indicated that %SS significantly varied between population (AWS vs CWS), languages (L1 vs L2), and tasks (GC vs NAR) but not across free (BIL) and bound (MK, ME) conditions. It was also found that the frequency of CM and CS patterns varies between CWS and AWS. The AWS had a lesser %SS but greater use of CS patterns than CWS, which is due to their excessive coping skills. The language mixing patterns were more observed in L1 than L2, and it was significant in most of the MLF parameters. However, there was a significantly higher (P<0.05) %SS in L2 than L1. The CS and CS patterns were more in conditions 1 and 3 than 2, which may be due to the higher proficiency of L2 than L1. Conclusion: The findings highlight the importance of assessing the CM and CS behaviors, their patterns, and the frequency of CM and CS between CWS and AWS on MLF parameters in two different tasks across three conditions. The results help us to understand CM and CS strategies in bilingual persons who stutter.

Keywords: bilinguals, code mixing, code switching, stuttering

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Authors: Abdolamir Allameh, Seyyed Mortaza Haghgoo, Adnan Khosravi, Esmaeil Mortaz, Mihan Pourabdollah-Toutkaboni, Sharareh Seifi

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Non-Small Cell Lung Carcinoma (NSCLC) is associated with a number of gene mutations in epidermal growth factor receptor (EGFR). The prognostic significance of mutations in exons 19 and 21, together with serum levels of EGFR, amphiregulin (AR), and Transforming Growth Factor-alpha (TGF-α) are implicated in diagnosis and treatment. The aim of this study was to examine the relationship of EGFR mutations in selected exons with the expression of relevant ligands in sera samples of NSCLC patients. For this, a group of NSCLC patients (n=98) referred to the hospital for lung surgery with a mean age of 59±10.5 were enrolled (M/F: 75/23). Blood specimen was collected from each patient. Besides, formalin fixed paraffin embedded tissues were processed for DNA extraction. Gene mutations in exons 19 and 21 were detected by direct sequencing, following DNA amplification which was done by PCR (Polymerase Chain Reaction). Also, serum levels of EGFR, AR, and TGF-α were measured by ELISA. The results of our study show that EGFR mutations were present in 37% of Iranian NSCLC patients. The most frequently identified mutations were deletions in exon 19 (72.2%) and substitutions in exon 21 (27.8%). The most frequently identified alteration, which is considered as a rare mutation, was the E872K mutation in exon 21, which was found in 90% (9 out of 10) cases. EGFR mutation detected in exon 21 was significantly (P<0.05) correlated with the levels of its ligands, EGFR and TGF-α in serum samples. Furthermore, it was found that increased serum AR (>3pg/ml) and TGF-α (>10.5 pg/ml) were associated with shorter overall survival (P<0.05). The results clearly showed a close relationship between EGFR mutations and serum EGFR and serum TGF-α. Increased serum EGFR was associated with TGF-α and AR and linked to poor prognosis of NSCLC. These findings are implicated in clinical decision-making related to EGFR-Tyrosine kinase inhibitors (TKIs).

Keywords: lung cancer, Iranian patients, epidermal growth factor, mutation, prognosis

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Authors: Maria Do Carmo Baracho De Alencar, Marciene Campos Fialho, Maria Do Carmo Vitório Ramos

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The subjects affected by Repetitive Strain Injury/Work Related Musculoskeletal Disorder (RSI/WRMSD) face an everyday life marked by pain, feelings of worthlessness and incapacity caused by the disease, and aggravated often because of discrimination society. Aim: To investigate the experiences and feelings of workers affected by RSI/WRMSD in removal from work situations and to understand the repercussions on mental health. Methods: Clinical records of workers were consulted, opened from July 1, 2014, to July 1, 2015, at the Reference Center for Worker's Health, in Santos city-SP. Selection of workers affected by RSI /WRMSD and who had experienced the removal from work situation due to the disease, and invitation to participate in the study. Semi-structured and individual interviews were carried out based on a pre-elaborated script, and for thematic content analysis. Results: Of a total of 502 medical records, 157 were selected, and of these, 18 workers participated in the interviews, both gender, most of them with low education level, aged between 35 and 56 years, and from different professions. Diseases affected several physical body regions and some workers had more than one body region affected by chronic pain. In the testimonies emerged the psychic suffering by the process of illness at work, fear of dismissal, invisibility of pain, in medical expertise attendance, by the incapacity to perform tasks that were easily achievable, with feelings of uselessness, revolt, and injustice, among others. Conclusion: The workers need to be readapted to new life situations, and the study promotes reflections on the need for more interdisciplinary actions and of the Psychology to the workers affected by RSI/ WRMSD.

Keywords: repetitive strain injury, cumulative trauma disorder, absence from work, mental health, occupational health

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Authors: Shasline Gedeon, Tiffany W. Ardley, Ying Wang, Nathan J. Gesmundo, Katarina A. Sarris, Ana L. Aguirre

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Drug discovery and delivery involve drug targeting, an approach that helps find a drug against a chosen target through high throughput screening and other methods by way of identifying the physical properties of the potential lead compound. Physical properties of potential drug candidates have been an imperative focus since the unveiling of Lipinski's Rule of 5 for oral drugs. Throughout a compound's journey from discovery, clinical phase trials, then becoming a classified drug on the market, the desirable properties are optimized while minimizing/eliminating toxicity and undesirable properties. In the pharmaceutical industry, the ability to generate molecules in parallel with maximum efficiency is a substantial factor achieved through sp²-sp² carbon coupling reactions, e.g., Suzuki Coupling reactions. These reaction types allow for the increase of aromatic fragments onto a compound. More recent literature has found benefits to decreasing aromaticity, calling for more sp³-sp² carbon coupling reactions instead. The objective of this project is to provide a comparison between various sp³-sp² carbon coupling methods and reaction conditions, collecting data on production of the desired product. There were four different coupling methods being tested amongst three cores and 4-5 installation groups per method; each method ran under three distinct reaction conditions. The tested methods include the Photoredox Decarboxylative Coupling, the Photoredox Potassium Alkyl Trifluoroborate (BF3K) Coupling, the Photoredox Cross-Electrophile (PCE) Coupling, and the Weix Cross-Electrophile (WCE) Coupling. The results concluded that the Decarboxylative method was very difficult in yielding product despite the several literature conditions chosen. The BF3K and PCE methods produced competitive results. Amongst the two Cross-Electrophile coupling methods, the Photoredox method surpassed the Weix method on numerous accounts. The results will be used to build future libraries.

Keywords: drug discovery, high throughput chemistry, photoredox chemistry, sp³-sp² carbon coupling methods

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Authors: Min L. Stewart, Patrick Johnston

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Predictive coding has been proposed as a general explanatory framework for understanding the neural mechanisms of perception. As such, an underweighting of perceptual priors has been hypothesised to underpin a range of differences in inferential and sensory processing in autism spectrum disorders. However, empirical evidence to support this has not been well established. The present study uses an electroencephalography paradigm involving changes of facial identity and person category (actors etc.) to explore how levels of autistic traits (AT) affect predictive coding at multiple stages in the visual processing hierarchy. The study uses a rapid serial presentation of faces, with hierarchically structured sequences involving both periodic and aperiodic repetitions of different stimulus attributes (i.e., person identity and person category) in order to induce contextual expectations relating to these attributes. It investigates two main predictions: (1) significantly larger and late neural responses to change of expected visual sequences in high-relative to low-AT, and (2) significantly reduced neural responses to violations of contextually induced expectation in high- relative to low-AT. Preliminary frequency analysis data comparing high and low-AT show greater and later event-related-potentials (ERPs) in occipitotemporal areas and prefrontal areas in high-AT than in low-AT for periodic changes of facial identity and person category but smaller ERPs over the same areas in response to aperiodic changes of identity and category. The research advances our understanding of how abnormalities in predictive coding might underpin aberrant perceptual experience in autism spectrum. This is the first stage of a research project that will inform clinical practitioners in developing better diagnostic tests and interventions for people with autism.

Keywords: hierarchical visual processing, face processing, perceptual hierarchy, prediction error, predictive coding

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Authors: Arunima Datta, Prathama Guha Chaudhuri, Ashis Mukhopadhyay

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Background: Acceptance and commitment therapy (ACT) is one of the newer forms (third wave) therapy. This therapy helps a cancer patient to increase acceptance level about their disease as well as their present situation. Breast cancer patients are known to suffer from depression and mild cognitive impairment; both affect their quality of life. Objectives:The present study had assessed effect of structured ACT intervention on cognitive function and acceptance level among breast cancer patients who were undergoing chemotherapy. Method: Data was collected from 123 breast cancer patients those who were undergoing chemotherapy were willing to undergo psychological treatment, with no history of past psychiatric illness. Their baseline of cognitive function and acceptance levels were assessed using validated tools. The effect of sociodemographic factors and clinical factors on cognitive function was determined at baseline.The participants were randomly divided into two groups: experimental (ACT, 4 sessions over 2 months) and control group. Cognitive function and acceptance level were measured during post intervention on 2months follow-up. Appropriate statistical analyses were performed to determine the effect on cognitive function and acceptance level in two groups. Result: At baseline, the factors that significantly influenced slower speed of task performance were ER PR HER2 status; number of chemo cycle, treatment type (Adjuvant and neo-adjuvant) was related with that. Sociodemographic characteristics did not show any significant difference between slow and fast performance. Per and post intervention analysis showed that ACT intervention resulted in significant difference both in terms of speed of cognitive performance and acceptance level. Conclusion: ACT is an effective therapeutic option for treating mild cognitive impairment and improve acceptance level among breast cancer patients undergoing chemotherapy.

Keywords: acceptance and commitment therapy, breast cancer, quality of life, cognitive function

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Authors: Muñiz-Lino Marcos Agustín, Vazquez Borbolla Jessica, Licéaga-Escalera Carlos

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The ectomesenchymal tissues involved in tooth development and their remnants are the origin of different odontogenic lesions, including tumors and cysts of the jaws, with a wide range of clinical behaviors. Dentigerous cyst (DC) represents approximately 20% of all cases of odontogenic cysts, and it has been demonstrated that it can develop benign and malignant odontogenic tumors. DC is characterized by bone destruction of the area surrounding the crown of a tooth which has not erupted and it contain is liquid. The treatment of odontogenic tumors and cysts usually are partial or total removal of the jaw, causing important secondary co-morbidities. However, molecules implicated in DC pathogenesis as well in its development to odontogenic tumors remains unknown. A cellular model may be useful to study these molecules, but that model has not been established yet. Here, we reported the establishment of a cell culture derived from a dentigerous cyst. This cell line was named DeCy-1. In spite of its ectomesenchymal morphology, DeCy-1 cells express epithelial markers such as cytokeratins 5, 6, and 8. Furthermore, these cells express the ODAM protein, which is present in odontogenesis and in dental follicle, indicating that DeCy-1 cells derived from odontogenic epithelium. Analysis by electron microscopy of this cell line showed that it has a high vesicular activity, suggesting that DeCy-1 could secrete molecules that may be involved in DC pathogenesis. Thus, secreted proteins were analyzed by PAGE-SDS, where we observed approximately 11 bands. In addition, the capacity of these secretions to degrade proteins was analyzed by gelatin substrate zymography. A degradation band of about 62 kDa was found in these assays. Western blot assays suggested that the matrix metalloproteinase 2 (MMP-2) is responsible of this protease activity. Thus, our results indicate that the establishment of a cell line derived from DC is a useful in vitro model to study the biology of this odontogenic lesion and its participation in the development of odontogenic tumors.

Keywords: dentigerous cyst, MMP20, cancer, cell culture

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Authors: Rubina Jahan, Mohammad Zayeed Bin Alam, Razia Sultana, Md Faroque Miah

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Mental health remains a significant global public health challenge, profoundly affecting millions worldwide. In Bangladesh, the situation is dire, with the National Mental Health Survey 2018-19 indicating that 19% of adults suffer from any kind of mental disorders, including severe mental disorder of around 2%. Despite these high prevalence rates, there is a substantial treatment gap in low- and middle-income countries, including Bangladesh, where up to 92% of individuals with mental illnesses do not receive adequate care. This gap is exacerbated by social barriers such as stigma, discrimination, social exclusion, poverty, homelessness, and human rights violations. To address these challenges, the SAJIDA Foundation launched the Proshanti in November 2022. Proshanti is a community based supportive housing intervention designed to provide cost-effective, sustainable, long-term care for individuals with chronic mental illnesses. It aims to rehabilitate participants by improving their mental health, quality of life, and equipping them with skills necessary for independent living and social mobility. Currently, Proshanti operates seven houses in Manikganj and Habiganj districts of Bangladesh, accommodating up to 40 individuals. Over a two-year period, individuals have received personalized support from trained personal assistants and care coordinators, regular health checkups, and opportunities for vocational training and community engagement. In this presentation, we will present the outcome of such intervention on individual’s functionality, quality of life and psychological health generated from 24 months of journey. Additionally, a qualitative approach will be employed to understand the facilitators and barriers of program implementation. The Proshanti program represents a promising model for addressing the significant mental health treatment gap in Bangladesh at the community level. Our findings will provide crucial insights into the program's feasibility, effectiveness, and the factors influencing its implementation, potentially guiding future mental health interventions in similar contexts.

Keywords: mental health, community based supportive housing, treatment gap, bangladesh

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Authors: Shringika Soni, Utkarsh Jain, Nidhi Chauhan

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Aptamers are recently discovered ~80-100 bp long artificial oligonucleotides that not only demonstrated their applications in therapeutics; it is tremendously used in diagnostic and sensing application to detect different biomarkers and drugs. Synthesizing aptamers for proteins or genomic template is comparatively feasible in laboratory, but drugs or other chemical target based aptamers require major specification and proper optimization and validation. One has to optimize all selection, amplification, and characterization steps of the end product, which is extremely time-consuming. Therefore, we performed asymmetric PCR (polymerase chain reaction) for random oligonucleotides pool synthesis, and further use them in Systematic evolution of ligands by exponential enrichment (SELEX) for anti-psychotic drugs based aptamers synthesis. Anti-psychotic drugs are major tranquilizers to control psychosis for proper cognitive functions. Though their low medical use, their misuse may lead to severe medical condition as addiction and can promote crime in social and economical impact. In this work, we have approached the in-vitro SELEX method for ssDNA synthesis for anti-psychotic drugs (in this case ‘target’) based aptamer synthesis. The study was performed in three stages, where first stage included synthesis of random oligonucleotides pool via asymmetric PCR where end product was analyzed with electrophoresis and purified for further stages. The purified oligonucleotide pool was incubated in SELEX buffer, and further partition was performed in the next stage to obtain target specific aptamers. The isolated oligonucleotides are characterized and quantified after each round of partition, and significant results were obtained. After the repetitive partition and amplification steps of target-specific oligonucleotides, final stage included sequencing of end product. We can confirm the specific sequence for anti-psychoactive drugs, which will be further used in diagnostic application in clinical and forensic set-up.

Keywords: anti-psychotic drugs, aptamer, biosensor, ssDNA, SELEX

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Authors: Mahdi Akhbardeh

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St John's wort plant can help to treat depression disease through decreasing this disease symptom, due to having some similar features of Prozac (Fluoxetine Hcl) pill. People suffering from slight depression who have fear of using antidepressants side effects can use St John's wort drops under doctor observation. This method of treatment is proposed specially to those women who are spending menopause or depression resulted from this period. St John's wort plant have proposed traditional and plant medicine as newest researches in treating mood disorders compared to Prozac (Fluoxetine Hcl) drug in treating depression disease which is being administrated in clinic research center of Washington. Objective: the aim of this study is to find an alternative treatment method in people suffering from depression which are treated with Prozac (Fluoxetine Hcl). Almost 70 percent of treatment failures with Prozac (Fluoxetine Hcl) drug in patients suffering from slight to normal depression is due to intensive side effects including: decrease in blood pressure, reduce in sexual desire and 30 percent of it is due to this drug affectless in treatment procedure which leads to leaving treatment. Results of Hypercuim plant function are exactly similar to antidepressants. Increase in serotonin amount in brain synopsis terminal end causes increase in existence time of this material in this part. In fact these two drugs have similar function. Though side effects of Hypercuim plant(St John's wort) including headache and slight nausea tolerable. Results: St John's wort plant can be used lonely in slight to normal depressions in which patients are avoiding Prozac (Fluoxetine Hcl) drug due to it's side effects. In intensive depressions through which general patients don’t indicate positive response to drug, it is probably expected relative or even complete treatment through combining antidepressants drugs with this plant. This treatment method has been investigated and confirmed in clinical tests and researches.

Keywords: depression, St John's wort, Prozac, antidepressant

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Authors: Eirini Konstanta, Cedric Gouedard, Aggeliki Delimitsou, Stefania Patera, Samuel Murray

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Introduction: Quality reference DNA standards (QRS) for molecular testing by next-generation sequencing (NGS) are essential for accurate quantitation of copy number variations (CNV) for germline and variant allelic frequencies (VAF) for somatic analyses. Objectives: Presently, several molecular analytics for oncology patients are reliant upon quantitative metrics. Test validation and standardisation are also reliant upon the availability of surrogate control materials allowing for understanding test LOD (limit of detection), sensitivity, specificity. We have developed a dual calibration platform allowing for QRS pairs to be included in analysed DNA samples, allowing for accurate quantitation of CNV and VAF metrics within and between patient samples. Methods: QRS™ blocks up to 500nt were designed for common NGS panel targets incorporating ≥ 2 identification tags (IDTDNA.com). These were analysed upon spiking into gDNA, somatic, and ctDNA using a proprietary CalSuite™ platform adaptable to common LIMS. Results: We demonstrate QRS™ calibration reproducibility spiked to 5–25% at ± 2.5% in gDNA and ctDNA. Furthermore, we demonstrate CNV and VAF within and between samples (gDNA and ctDNA) with the same reproducibility (± 2.5%) in a clinical sample of lung cancer and HBOC (EGFR and BRCA1, respectively). CNV analytics was performed with similar accuracy using a single pair of QRS calibrators when using multiple single targeted sequencing controls. Conclusion: Dual paired QRS™ calibrators allow for accurate and reproducible quantitative analyses of CNV, VAF, intrinsic sample allele measurement, inter and intra-sample measure not only simplifying NGS analytics but allowing for monitoring clinically relevant biomarker VAF across patient ctDNA samples with improved accuracy.

Keywords: calibrator, CNV, gene copy number, VAF

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Authors: Sahar El-Achkar, Mizan Ahmad

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Poor adaptation of developmental milestones over the lifespan can significantly impact emotional experiences and Satisfaction with Life (SWL) post-retirement. Thus, it is important to understand how adaptive behaviour over the life course can predict emotional experiences. Broadly emotional experiences are either Positive Affect (PA) or Negative Affect (NA). This study sought to explore the impact of successful adaptation of developmental milestones throughout one’s life on emotional experiences and satisfaction with life following retirement. A cross-sectional self-report survey was completed by 132 Australian retirees between the ages 55 and 70 years. Three hierarchical regression models were fitted, controlling for age and gender, to predict PA, NA, and SWL. The full model predicting PA was statistically significant overall, F (8, 121) = 17.97, p < .001, account for 57% of the variability in PA. Industry/Inferiority were significantly predictive of PA. The full model predicting NA was statistically significant overall, F (8, 121) = 12.00, p < .001, accounting for 51% of the variability in NA. Age and Trust/Mistrust were significantly predictive of NA. The full model predicting NA was statistically significant overall, F (8, 121) = 12.00, p < .001, accounting for 51% of the variability in NA. Age and Trust/Mistrust were significantly predictive of NA. The full model predicting SWL, F (8, 121) = 11.05, p < .001, accounting for 45% of the variability in SWL. Trust/Mistrust and Ego Integrity/Despair were significantly predictive of SWL. A sense of industry post-retirement is important in generating PA. These results highlight that individuals presenting with adaptation and identity issues are likely to present with adjustment challenges and unpleasant emotional experiences post-retirement. This supports the importance of identifying and understanding the benefits of successful adaptation and development throughout the lifespan and its significance for the self-concept. Most importantly, the quality of lives of many may be improved, and the future risk of continued poor emotional experiences and SWL post-retirement may be mitigated. Specifically, the clinical implications of these findings are that they support the promotion of successful adaption over the life course and healthy ageing.

Keywords: adaptation, development, negative affect, positive affect, retirement, satisfaction with life

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Authors: Lisa Chandler, Alistair Ward

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A significant component of design pedagogy is the need to foster design thinking in various contexts and to support students in understanding links between educational exercises and their potential application in professional design practice. It is also important that educators provide opportunities for students to engage with new technologies and encourage them to imagine applying their design skills for a range of outcomes. Problem solving is central to design so it is also essential that students understand that there can be multiple solutions to a design brief, and are supported in undertaking creative experimentation to generate imaginative outcomes. This paper presents a case study examining some innovative approaches to addressing these elements of design pedagogy. It investigates the effectiveness of the Immerse Lab, a three wall projection room at the University of the Sunshine Coast, Australia, as a learning context for design practice, for generating ideas and for supporting learning involving the comparative display of design outcomes. The project required first year design students to create a simple graphic design derived from an ordinary object and to incorporate specific design criteria. Utilizing custom-designed software, the students’ solutions were projected together onto the Immerse walls to create a large-scale, immersive grid of images, which was used to compare and contrast various responses to the same problem. The software also enabled individual student designs to be transformed, multiplied and enlarged in multiple ways and prompted discussions around the applicability of the designs in real world contexts. Teams of students interacted with their projected designs, brainstorming imaginative applications for their outcomes. Analysis of 77 anonymous student surveys revealed that the majority of students found: learning in the Immerse Lab to be beneficial; comparative review more effective than in standard tutorial rooms; that the activity generated new ideas; it encouraged students to think differently about their designs; it inspired students to develop their existing designs or create new ones. The project demonstrates that curricula involving immersive spaces can be effective in supporting engaging and relevant design pedagogy and might be utilized in other disciplinary areas.

Keywords: design pedagogy, immersive education, technology-enhanced learning, visualization

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Authors: Isabelle Lorge, Napoleon Katsos

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BACKGROUND: Children growing up in a multilingual environment face challenges related to the need to monitor the speaker’s linguistic abilities, more frequent communication failures, and having to acquire a large number of words in a limited amount of time compared to monolinguals. As a result, bilingual learners may develop different word learning strategies, rely more on some strategies than others, and engage cognitive resources such as theory of mind and attention skills in different ways. HYPOTHESIS: The goal of our study is to investigate whether multilingual exposure leads to improvements in the ability to use pragmatic inference for word learning, i.e., to use speaker cues to derive their referring intentions, often by overcoming lower level salience effects. The speaker cues we identified as relevant are (a) use of a modifier with or without stress (‘the WET dax’ prompting the choice of the referent which has a dry counterpart), (b) referent extension (‘this is a kitten with a fep’ prompting the choice of the unique rather than shared object), (c) referent novelty (choosing novel action rather than novel object which has been manipulated already), (d) teacher versus random sampling (assuming the choice of specific examples for a novel word to be relevant to the extension of that new category), and finally (e) emotional affect (‘look at the figoo’ uttered in a sad or happy voice) . METHOD: To this end, we implemented on a touchscreen computer a task corresponding to each of the cues above, where the child had to pick the referent of a novel word. These word learning tasks (a), (b), (c), (d) and (e) were adapted from previous word learning studies. 113 children have been tested (54 reception and 59 year 1, ranging from 4 to 6 years old) in a London primary school. Bilingual or monolingual status and other relevant information (age of onset, proficiency, literacy for bilinguals) is ascertained through language questionnaires from parents (34 out of 113 received to date). While we do not yet have the data that will allow us to test for effect of bilingualism, we can already see that performances are far from approaching ceiling in any of the tasks. In some cases the children’s performances radically differ from adults’ in a qualitative way, which means that there is scope for quantitative and qualitative effects to arise between language groups. The findings should contribute to explain the puzzling speed and efficiency that bilinguals demonstrate in acquiring competence in two languages.

Keywords: bilingualism, pragmatics, word learning, attention

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Authors: Dyna Ann C. Sevilles, Noel J. Belonguel, Jarungchai Anton S. Vatanagul, Mary Jeanne O. Flordelis, Grace G. Anota

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Guillain Barre syndrome is an acute inflammatory polyradiculoneuropathy causing progressive symmetrical weakness which can be debilitating to the patient. Early diagnosis is important especially in the acute phase when treatment favors good outcome and reduces the incidence of the need for mechanical ventilation. Electrodiagnostic studies aid in the evaluation of patients suspected with GBS. However, the characteristic electrical changes may not be evident until after several weeks. Thus, studies performed early in the course may give unclear results. The aim of this study is to associate the symptom onset of patients diagnosed with Guillain Barre syndrome with the EMG NCV results and determine the earliest time when there is evident findings supporting the diagnosis. This is a retrospective descriptive chart review study involving patients of >/= 18 years of age with GBS written on their charts in a Tertiaty hospital in Cebu City, Philippines from January 2000 to July 2014. Twenty patients showed electrodiagnostic findings suggestive of GBS. The mean day of illness when EMG NCV was carried out was 7 days. The earliest with suggestive findings was done on day 2 (10%) of illness. Moreover, the highest frequency with positive results was done on day 3 (20%) of illness. Based on the Dutch Guillain Barre Study group criteria, the most frequent variables noted were: prolonged distal motor latency in both median and ulnar nerves(65%) and both peroneal and tibial nerves (71%); and reduced CMAP in both median and ulnar nerves (65%) and both tibial and peroneal nerves (71%). The EMG NCV findings showed majority of demyelinating type (59%). Electrodiagnostic studies are helpful in aiding the physician in the diagnosis and treatment of the disease in the early stage. Based on this study, neurophysiologic evidence of GBS can be seen in as early as day 2 of clinical illness.

Keywords: Acute Inflammatory Demyelinating Polyneuropathy, electrophysiologic study, EMG NCV, Guillain Barre Syndrome

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Authors: Shan Wang, Fahad Alhathal, Daniel Hobson

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User-centered design skills play an important role in crafting a positive and intuitive user experience for software applications. Embracing a user-centric design approach involves understanding the needs, preferences, and behaviors of the end-users throughout the design process. This mindset not only enhances the usability of the software but also fosters a deeper connection between the digital product and its users. This paper encompasses a 6-month knowledge exchange collaboration project between an academic institution and an external industry in 2023, aims to improve the user experience of a digital platform utilized for a knowledge management tool, to understand users' preferences for features, identify sources of frustration, and pinpoint areas for enhancement. This research conducted one of the most effective methods to implement user-centered design through co-design workshops for testing user onboarding experiences that involve the active participation of users in the design process. More specifically, in January 2023, we organized eight workshops with a diverse group of 11 individuals. Throughout these sessions, we accumulated a total of 11 hours of qualitative data in both video and audio formats. Subsequently, we conducted an analysis of user journeys, identifying common issues and potential areas for improvement. This analysis was pivotal in guiding the knowledge management software in prioritizing feature enhancements and design improvements. Employing a user-centered design thinking process, we developed a series of graphic design solutions in collaboration with the software management tool company. These solutions were targeted at refining onboarding user experiences, workplace interfaces, and interactive design. Some of these design solutions were translated into tangible interfaces for the knowledge management tool. By actively involving users in the design process and valuing their input, developers can create products that are not only functional but also resonate with the end-users, ultimately leading to greater success in the competitive software landscape. In conclusion, this paper not only contributes insights into designing onboarding user experiences for software within a co-design approach but also presents key theories on leveraging the user-centered design process in software design to enhance overall user experiences.

Keywords: user experiences, co-design, design process, knowledge management tool, user-centered design

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Authors: Zinaida Shelkovnikova

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The language in science is changing and meets the demands of the society. We shall argue that in the varied modern world there are important reasons for the integration of narratives into scientific discourse. As far as nowadays scientists are faced with extremely prompt science development and progress; modern scientific society lives in the conditions of tough competition. The integration of narratives into scientific discourse is thus a good way to prompt scientific experience to different audiences and to express covert prestige of the discourse. Narratives also form the identity of the persuasive narrator. Using the narrative approach to the scientific discourse analysis we reveal the sociocultural diversity of the scientists. If you want to attract audience’s attention to your scientific research, narratives should be integrated into your scientific discourse. Those who understand this consistent pattern are considered the leading scientists. Taking into account that it is prestigious to be renowned, celebrated in science, it is a covert prestige to write narratives in science. We define a science narrative as the intentional, consequent, coherent, event discourse or a discourse fragment, which contains the author creativity, in some cases intrigue, and gives mostly qualitative information (compared with quantitative data) in order to provide maximum understanding of the research. Science narratives also allow the effective argumentation and consequently construct the identity of the persuasive narrator. However, skills of creating appropriate scientific discourse reflect the level of prestige. In order to teach postgraduate students to be successful in English scientific writing and to be prestigious in the scientific society, we have defined the science narrative and outlined its main features and characteristics. Narratives contribute to audience’s involvement with the narrator and his/her narration. In general, the way in which a narrative is performed may result in (limited or greater) contact with the audience. To gain these aim authors use emotional fictional elements; descriptive elements: adjectives; adverbs; comparisons and so on; author’s evaluative elements. Thus, the features of science narrativity are the following: descriptive tools; authors evaluation; qualitative information exceeds the quantitative data; facts take the event status; understandability; accessibility; creativity; logics; intrigue; esthetic nature; fiction. To conclude, narratives function covert prestige of the scientific discourse and shape the identity of the persuasive scientist.

Keywords: covert prestige, narrativity, scientific discourse, scientific narrative

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Authors: David Obafemi Adebayo

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An occupational challenge has been identified as one of the factors that could cripple set goals and life ambitions of an Internally Displaced Person (IDP). The main thrust of this study is therefore, explore the use of life support/adjustment strategy with a view to repositioning these internally displaced persons in Nigeria in revamping their goals and achieving their life-long ambitions. The study intends to investigate whether there exist, on the basis of gender, religion, years of working experience and educational qualification any significant difference in the occupational challenges and adjustment strategies of IDPs. The study being descriptive of survey type adopted a multi-stage sampling technique to select the minimum of 400 internally displaced persons from IDP camps in Yimitu Village, Waru District in the Federal Capital Territory (FCT), Abuja. The research instrument used for the study was a researcher-designed questionnaire entitled “Questionnaire on Occupational Challenges and Adjustment Strategy of Internally Displaced Persons (QOCASIDPs)”. Eight null hypotheses were tested at 0.05 alpha levels of significance. Frequency counts and percentages, means and rank order, t-test, Analysis of Variance (ANOVA) and Duncan Multiple Range Test (DMRT) (where applicable) were employed to analyze the data. The Study determined whether occupational challenges of internally displaced persons included loss of employment, vocational discrimination, marginalization by employers of labour, isolation due to joblessness, lack of occupational freedom, which were found to be true. The results were discussed in line with the findings. The study established the place of notable adjustment strategies adopted by internally displaced person like engaging in petty trading, sourcing soft loans from NGOs, setting up small-scale businesses in groups, acquiring new skills, engaging in further education, among others. The study established that there was no significant difference in the occupational challenges of IDPs on the basis of years of working experience and highest educational qualifications, though there was significant difference on the basis of gender as well as religion. Based on the findings of the study, recommendations were made.

Keywords: internally displaced persons, occupational challenges, adjustment strategies, Abuja-Nigeria

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Authors: Magdalena Bury-Kaminska, Aneta Szudy-Szczyrek, Aleksandra Nowaczynska, Olga Jankowska-Lecka, Marek Hus, Klaudia Kot

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Introduction: The aim of the research was to determine the changes in cognitive functioning in patients with plasma cell myeloma by comparing patients’ state before the treatment and during chemotherapy as well as to determine the biological factors that can be used to predict patients’ cognitive state. Methods: The patients underwent the research procedure twice: before chemotherapy and after 4-6 treatment cycles. A psychological test and measurement of the following biological variables were carried out: TNF-α (tumor necrosis factor), IL-6 (interleukin 6), IL-10 (interleukin 10), BDNF (brain-derived neurotrophic factor). The following research methods were implemented: the Montreal Cognitive Assessment (MoCA), Battery of Tests for Assessing Cognitive Functions PU1, experimental and clinical trials based on the Choynowski’s Memory Scale, Stroop Color-Word Interference Test (SCWT), depression measurement questionnaire. Results: The analysis of the research showed better cognitive functions of patients during chemotherapy in comparison to the phase before it. Moreover, neurotrophin BDNF allows to predict the level of selected cognitive functions (semantic fluency and execution control) already at the diagnosis stage. After 4-6 cycles, it is also possible to draw conclusions concerning the extent of working memory based on the level of BDNF. Cytokine TNF-α allows us to predict the level of letter fluency during anti-cancer treatment. Conclusions: It is possible to presume that BDNF has a protective influence on patients’ cognitive functions and working memory and that cytokine TNF-α co-occurs with a diminished execution control and better material grouping in terms of phonological fluency. Acknowledgment: This work was funded by the National Science Center in Poland [grant no. 2017/27/N/HS6/02057.

Keywords: chemobrain, cognitive impairment, non−central nervous system cancers, hematologic diseases

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Authors: Dona Pamoda W. Jayatunga, Veer Bala Gupta, Eugene Hone, Ralph N. Martins

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Being a neurodegenerative disorder, Alzheimer’s disease (AD) affects a majority of the elderly demented worldwide. The key risk factors for AD are age, metabolic syndrome, allele status of APOE gene, head injuries and lifestyle. The progressive nature of AD is characterized by symptoms of multiple cognitive deficits exacerbated over time, leading to death within a decade from clinical diagnosis. However, it is revealed that AD originates via a prodromal phase that spans from one to few decades before symptoms first manifest. The key pathological hallmarks of AD brains are deposition of amyloid beta (Aβ) plaques and neurofibrillary tangles (NFT). However, the yet unknown etiology of the disease fails to distinguish mitochondrial dysfunction between a cause or an outcome. The absence of early diagnosis tools and definite therapies for AD have permitted recruits of nutraceutical-based approaches aimed at reducing the risk of AD by modulating lifestyle or be used as preventive tools during AD prodromal state before widespread neurodegeneration begins. The objective of the present study was to investigate beneficial effects of luteolin, a plant-based flavone compound, against AD. The neuroprotective effects of luteolin on amyloid beta (Aβ) (1-42)-induced neurotoxicity was measured using cultured human neuroblastoma BE(2)-M17 cells. After exposure to 20μM Aβ (1-42) for 48 h, the neuroblastoma cells exhibited marked apoptotic death. Co-treatment of 20μM Aβ (1-42) with luteolin (0.5-5μM) significantly protected the cells against Aβ (1-42)-induced toxicity, as assessed by the MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2(4sulfophenyl)-2H-tetrazolium, inner salt; MTS] reduction assay and the lactate dehydrogenase (LDH) cell death assay. The results suggest that luteolin prevents Aβ (1-42)-induced apoptotic neuronal death. However, further studies are underway to determine its protective mechanisms in AD including the activity against tau hyperphosphorylation and mitochondrial dysfunction.

Keywords: Aβ (1-42)-induced toxicity, Alzheimer’s disease, luteolin, neuroblastoma cells

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Authors: Tiffany Karalis Noel

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The purpose of this study was to examine the factors attributed to the self-efficacy of beginning secondary content area teachers as they moved through their student teaching experiences. This study used a narrative inquiry methodology to understand the variables attributed to teacher self-efficacy among a group of secondary content area teacher candidates. The primary purpose of using a narrative inquiry methodology was to share the stories of content area teacher candidates’ student teaching experiences. Focused research questions included: (1) To what extent does teacher education preparation affect the self-efficacy of beginning content area teachers? (2) Which recurrent elements of teacher education affect the self-efficacy of beginning teachers, regardless of content area? (3) How do the findings from research questions 1 and 2 inform teacher educators? The findings of this study suggest that teacher education preparation affects the self-efficacy of beginning secondary teacher candidates across the content areas; accordingly, the findings of this study provide insight for teacher educators to consider the areas where teacher education programs are failing to provide adequate preparation. These teacher candidates emphasized the value of adequate preparation throughout their teacher education programs to help inform their student teaching experiences. In order to feel effective and successful as beginning teachers, these teacher candidates required additional opportunities to apply the practical application of their teaching skills prior to the student teaching experience, the incorporation of classroom management strategy coursework into their curriculum, and opportunities to explore the extensive demands of the teaching profession ranging from time management to dealing with difficult parents, to name a few referenced examples. The teacher candidates experienced feelings of self-doubt related to their effectiveness as teachers when they were unable to employ successful classroom management strategies, pedagogical techniques, or even feel confidence in navigating challenging conversations with students, parents, and/or administrators. In order to help future teacher candidates and beginning teachers in general overcome these barriers, additional coursework, fieldwork, and practical application experiences should be provided in teacher education programs to help boost the self-efficacy of student teachers.

Keywords: self-efficacy, teacher efficacy, secondary preservice teacher education, teacher candidacy, student teaching

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Authors: Shoaib Rasool

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Migration trends in rural areas of Gujrat are increasing day by day among illiterate people as they consider it as a source of attraction and charm of destination. It affects the life standard both positive and negative way to their families left behind in the context of poverty, socio-economic status and life standards. It also promotes material items and as well as social indicators of living, housing conditions, schooling of their children’s, health seeking behavior and to some extent their family environment. The nature of the present study is to analyze socio-economic conditions regarding life standard of emigrant families left behind in rural areas of Gujrat district, Pakistan. A survey design was used on 150 families selected from rural areas of Gujrat districts through purposive sampling technique. A well-structured questionnaire was administered by the researcher to explore the nature of the study and for further data collection process. The measurement tool was pretested on 20 families to check the workability and reliability before the actual data collection. Statistical tests were applied to draw results and conclusion. The preliminary findings of the study show that emigration has left deep social-economic impacts on life standards of rural families left behind in Gujrat. They improved their life status and living standard through remittances. Emigration is one of the major sources of development of economy of household and it also alleviate poverty at house household level as well as community and country level. The rationale behind migration varies individually and geographically. There are popular considered attractions in Pakistan includes securing high status, improvement in health condition, coping other, getting married then to acquire nationality, using the unfair means, opting educational visas etc. Emigrants are not only sending remittances but also returning with newly acquired skills and valuable knowledge to their country of origin because emigrants learn new methods of living and working. There are also women migrants who experience social downward mobility by engaging in jobs that are beneath their educational qualifications.

Keywords: emigration, life standard, families, left behind, rural area, Gujrat

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Authors: A. Ibovi Mouondayi, S. Zaher, R. Assadi, K. Erraoui, S. Sboul, J. Daoudim, S. Bousselham, K. Nassar, S. Janani

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Introduction: Neuropathic pain (NP) is chronic pain; it can be observed in a large number of clinical situations. This pain results from a lesion of the peripheral or central nervous system. It is a frequent reason for consultations in rheumatology. This pain being chronic, can become disabling for the patient, thereby altering his quality of life. Objective: The objective of this study was to evaluate the impact of neuropathic pain on the quality of life of patients followed-up for chronic neuropathic pain. Material and Method: This is a monocentric, cross-sectional, descriptive, retrospective study conducted in our department over a period of 19 months from October 2020 to April 2022. The missing parameters were collected during phone calls of the patients concerned. The diagnostic tool adopted was the DN4 questionnaire in the dialectal Arabic version. The impact of NP was assessed by the visual analog scale (VAS) on pain, sleep, and function. The impact of PN on mood was assessed by the hospital anxiety, and depression scale (HAD) score in the validated Arabic version. The exclusion criteria were patients followed up for depression and other psychiatric pathologies. Results: A total of 1528 patient data were collected; the average age of the patients was 57 years (standard deviation: 13 years) with extremes ranging from 17 years to 94 years, 91% were women and 9% men with a sex ratio man/woman equal to 0.10. 67% of our patients were married, and 63% of our patients were housewives. 43% of patients were followed-up for degenerative pathology. The NP was cervical radiculopathy in 26%, lumbosacral radiculopathy in 51%, and carpal tunnel syndrome in 20%. 23% of our patients had poor sleep quality, and 54% had average sleep quality. The pain was very intense in 5% of patients; 33% had severe pain, and 58% had moderate pain. The function was limited in 55% of patients. The average HAD score for anxiety and depression was 4.39 (standard deviation: 2.77) and 3.21 (standard deviation: 2.89), respectively. Conclusion: Our data clearly illustrate that neuropathic pain has a negative impact on the quality of sleep and function, as well as the mood of patients, thus influencing their quality of life.

Keywords: neuropathic pain, sleep, quality of life, chronic pain

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Authors: Jansirani Natarajan, Mickael Antoinne Joseph

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The COVID-19 pandemic has interrupted face-to-face education and forced universities into an emergency remote teaching curriculum over a short duration. This abrupt transition in the Spring 2020 semester left both faculty and students without proper preparation for continuing higher education in an online environment. Online learning took place in different formats, including fully synchronous, fully asynchronous, and blended in our university through the e-learning platform MOODLE. Studies have shown that students’ engagement, is a critical factor for optimal online teaching. Very few studies have assessed online engagement with ERT during the COVID-19 pandemic. Purpose: Therefore, this study, sought to understand how the sudden transition to emergency remote teaching impacted nursing students’ engagement with online courses in a Middle Eastern public university. Method: A cross-sectional descriptive research design was adopted in this study. Data were collected through a self-reported online survey using Dixon’s online students’ engagement questionnaire from a sample of 177 nursing students after the ERT learning semester. Results The maximum possible engagement score was 95, and the maximum scores in the domains of skills engagement, emotional engagement, participation engagement, and performance engagement were 30, 25, 30, and 10 respectively. Dixson (2010) noted that a mean item score of ≥3.5 (total score of ≥66.5) represents a highly engaged student. The majority of the participants were females (71.8%) and 84.2% were regular BSN students. Most of them (32.2%) were second-year students and 52% had a CGPA between 2 and 3. Most participants (56.5%) had low engagement scores with ERT learning during the COVID lockdown. Among the four engagement domains, 78% had low engagement scores for the participation domain. There was no significant association found between the engagement and the demographic characteristics of the participants. Conclusion The findings supported the importance of engaging students in all four categories skill, emotional, performance, and participation. Based on the results, training sessions were organized for faculty on various strategies for engaging nursing students in all domains by using the facilities available in the MOODLE (online e-learning platform). It added value as a dashboard of information regarding ERT for the administrators and nurse educators to introduce numerous active learning strategies to improve the quality of teaching and learning of nursing students in the University.

Keywords: engagement, perception, emergency remote learning, COVID-19

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Authors: Azizollah Arbabisarjou, Leila Safabakhsh, Mozhgan Jahantigh, Mahshid Nazemzadeh, Shahindokht Navabi

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Background: Health promotion is an essential strategy for reduction of health disparities. Health promotion includes all activities that encourage optimum physical, spiritual, and mental function. The aim of this study was to determine the impact of a Health Promotion Program (HPP) on behavior in terms of the dimensions of the Health Promoting Lifestyle Profile (HPLP) in patients after Coronary Artery Bypass Graft (CABG). Methods and Materials: In this clinical trial study, 80 patients who had undergone CABG surgery (2011-2012) were selected and randomly divided in two groups: Experimental and Control that investigated by (HPLP II). Then the experimental group was educated about diet, walking and stress management. The program process was followed up for 3months and after that all variables were investigated again. The overall score and the scores for the six dimensions of the HPLP (self-actualization, health responsibility, exercise, nutrition, interpersonal support and stress management) were measured in the pre- and post-test periods. Statistical analysis was performed using Student's t-test and paired t-test. Results: Results showed that Score of stress management (p=.036), diet (p=.002), Spiritual Growth (p=.001) and interrelationship (p=002) increase in experimental group after intervention .Average scores after 3 months in the control group had no significant changes; except responsibility for health (p < .05). Results of the study revealed that comparison the scores of the experimental group were significantly different from the control group in all lifestyle aspects except for spiritual growth. Conclusion: This study showed that Health promoting program on lifestyle and health promotion in patients who suffer from CAD could enhance patient's awareness of healthy behaviors and improves the quality of life.

Keywords: coronary artery bypass graft, health promotion, lifestyle, education

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Authors: Okugbe Ebiotubo Ohore, Jingli Zhang, Binessi Edouard Ifon, Mathieu Nsenga Kumwimba, Xiaoying Mu, Dai Kuang, Zhen Wang, Ji-Dong Gu, Guojing Yang

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Antibiotic pollution and the evolution of antibiotic resistance genes (ARGs) are increasingly viewed as major threats to both ecosystem security and human health, and has drawn attention. This study investigated the fate of antibiotics in aqueous and sedimentary substrates and the impact of ecosystem shifts between water and sedimentary phases on resistome profiles. The findings indicated notable variations in the concentration and distribution patterns of antibiotics across various environmental phases. Based on the partition coefficient (Kd), the total antibiotic concentration was significantly greater in the surface water (1405.45 ng/L; 49.5%) compared to the suspended particulate matter (Kd =0.64; 892.59 ng/g; 31.4%) and sediment (Kd=0.4; 542.64 ng/g; 19.1%). However, the relative abundance of ARGs in surface water and sediment was disproportionate to the abundance of antibiotics concentration, and sediments were the predominant ARGs reservoirs. Phylogenetic divergence of the microbial communities between the surface water and the sedimentary ecosystems potentially played important roles in driving the ARGs profiles between the two distinctive ecosystems. ARGs of Clinical importance; including blaGES, MCR-7.1, ermB, tet(34), tet36, tetG-01, and sul2 were significantly increased in the surface water, while blaCTX-M-01, blaTEM, blaOXA10-01, blaVIM, tet(W/N/W), tetM02, and ermX were amplified in the sediments. cfxA was an endemic ARG in surface-water ecosystems while the endemic ARGs of the sedimentary ecosystems included aacC4, aadA9-02, blaCTX-M-04, blaIMP-01, blaIMP-02, bla-L1, penA, erm(36), ermC, ermT-01, msrA-01, pikR2, vgb-01, mexA, oprD, ttgB, and aac. These findings offer a valuable information for the identification of ARGs-specific high-risk reservoirs.

Keywords: antibiotic resistance genes, microbial diversity, suspended particulate matter, sediment, surface water

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Authors: Daniel F. Bohorquez, Luis M. Agudelo, Henry H. León

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Heart rate variability (HRV) is defined as the temporary variation between heartbeats or RR intervals (distance between R waves in an electrocardiographic signal). This distance is currently a recognized biomarker. With the analysis of the distance, it is possible to assess the sympathetic and parasympathetic nervous systems. These systems are responsible for the regulation of the cardiac muscle. The analysis allows health specialists and researchers to diagnose various pathologies based on this variation. For the acquisition and analysis of HRV taken from a cardiac electrical signal, electronic equipment and analysis software that work independently are currently used. This complicates and delays the process of interpretation and diagnosis. With this delay, the health condition of patients can be put at greater risk. This can lead to an untimely treatment. This document presents a single portable device capable of acquiring electrocardiographic signals and calculating a total of 19 HRV metrics. This reduces the time required, resulting in a timelier intervention. The device has an electrocardiographic signal acquisition card attached to a microcontroller capable of transmitting the cardiac signal wirelessly to a mobile device. In addition, a mobile application was designed to analyze the cardiac waveform. The device calculates the RR and different metrics. The application allows a user to visualize in real-time the cardiac signal and the 19 metrics. The information is exported to a cloud database for remote analysis. The study was performed under controlled conditions in the simulated hospital of the Universidad de la Sabana, Colombia. A total of 60 signals were acquired and analyzed. The device was compared against two reference systems. The results show a strong level of correlation (r > 0.95, p < 0.05) between the 19 metrics compared. Therefore, the use of the portable system evaluated in clinical scenarios controlled by medical specialists and researchers is recommended for the evaluation of the condition of the cardiac system.

Keywords: biological signal análisis, heart rate variability (HRV), HRV metrics, mobile app, portable device.

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Authors: Emilia K. H. Danielsson-Waters, Malaz Elsaddig, Kevin Jones

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Unfortunately, it is well known that neonatal deaths are a common and potentially preventable occurrence across the world. Neonatal resuscitation is a simple and inexpensive intervention that can effectively reduce this rate, and can be taught and implemented globally. This project is a follow-on from one in 2012, which found that neonatal resuscitation simulation was valuable for education, but would be better improved by being delivered by local staff. Methods: This study involved auditing the neonatal admission and death records within a rural Ugandan hospital, alongside implementing a Train-The-Trainer teaching scheme to teach Neonatal Resuscitation. One local doctor was trained for simulating neonatal resuscitation, whom subsequently taught an additional 14 staff members in one-afternoon session. Participants were asked to complete questionnaires to assess their knowledge and confidence pre- and post-simulation, and a survey to identify barriers and drivers to simulation. Results: The results found that the neonatal mortality rate in this hospital was 25% between July 2016- July 2017, with birth asphyxia, prematurity and sepsis being the most common causes. Barriers to simulation that were identified predominantly included a lack of time, facilities and opportunity, yet all members stated simulation was beneficial for improving skills and confidence. The simulation session received incredibly positive qualitative feedback, and also a 0.58-point increase in knowledge (p=0.197) and 0.73-point increase in confidence (0.079). Conclusion: This research shows that it is possible to create a teaching scheme in a rural hospital, however, many barriers are in place for its sustainability, and a larger sample size with a more sensitive scale is required to achieve statistical significance. This is undeniably important, because teaching neonatal resuscitation can have a direct impact on neonatal mortality. Subsequently, recommendations include that efforts should be put in place to create a sustainable training scheme, for example, by employing a resuscitation officer. Moreover, neonatal resuscitation teaching should be conducted more frequently in hospitals, and conducted in a wider geographical context, including within the community, in order to achieve its full effect.

Keywords: neonatal resuscitation, sustainable medical education, train-the-trainer, Uganda

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Authors: Deepthy Ann Joy, N. Sreedevi

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Hearing impairment (HI) at an early age, identified before the onset of language development can reduce the negative effect on speech and language development of children. Early rehabilitation is very important in the improvement of speech production in children with HI. Other than conventional hearing aids, Cochlear Implants are being used in the rehabilitation of children with HI. However, delay in acquisition of speech and language milestones persist in children with Cochlear Implant (CI). Delay in speech milestones are reflected through speech sound errors. These errors reflect the temporal and spectral characteristics of speech. Hence, acoustical analysis of the speech sounds will provide a better representation of speech production skills in children with CI. The present study aimed at investigating the acoustic characteristics of vowels in Malayalam speaking children with a cochlear implant. The participants of the study consisted of 20 Malayalam speaking children in the age range of four and seven years. The experimental group consisted of 10 children with CI, and the control group consisted of 10 typically developing children. Acoustic analysis was carried out for 5 short (/a/, /i/, /u/, /e/, /o/) and 5 long vowels (/a:/, /i:/, /u:/, /e:/, /o:/) in word-initial position. The responses were recorded and analyzed for acoustic parameters such as Vowel duration, Ratio of the duration of a short and long vowel, Formant frequencies (F₁ and F₂) and Formant Centralization Ratio (FCR) computed using the formula (F₂u+F₂a+F₁i+F₁u)/(F₂i+F₁a). Findings of the present study indicated that the values for vowel duration were higher in experimental group compared to the control group for all the vowels except for /u/. Ratio of duration of short and long vowel was also found to be higher in experimental group compared to control group except for /i/. Further F₁ for all vowels was found to be higher in experimental group with variability noticed in F₂ values. FCR was found be higher in experimental group, indicating vowel centralization. Further, the results of independent t-test revealed no significant difference across the parameters in both the groups. It was found that the spectral and temporal measures in children with CI moved towards normal range. The result emphasizes the significance of early rehabilitation in children with hearing impairment. The role of rehabilitation related aspects are also discussed in detail which can be clinically incorporated for the betterment of speech therapeutic services in children with CI.

Keywords: acoustics, cochlear implant, Malayalam, vowels

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