Search results for: Dukka (suffering)

Authors: Teresa Sarmento de Beires, Sofia Padilha, Pedro Arantes, Joana Ribeiro, Andreia Eiras

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Background: Trichotillomania is a psychiatric condition that is very challenging to treat, with no first-line medications approved by any medical agency. It is defined as a recurrent compulsive habit of pulling out one's own hair, usually from the scalp and eyebrows area, but it can also affect eyelashes or any other hair-bearing area. N-acetylcysteine, a glutamate modulator, has been studied as a possible treatment for several psychiatric and neurological disorders, considering its role in attenuating pathophysiological processes responsible for compulsive behaviors and, therefore, trichotillomania. Objective: This study aims to determine the efficacy of N-acetylcysteine in the treatment of adults with trichotillomania. Methodology: The authors researched guidelines, standards of clinical guidance, systematic reviews, meta-analyses, and randomized clinical trials, published in the last 20 years using the MeSH terms: "Trichotillomania” and “N-acetylcysteine” in the following databases: PubMed, Cochrane library, National Guideline Clearing House, National Institute of Health and Care Excellence (NICE), Canadian Medical Association Practice Guidelines and Database of Abstracts of Reviews of Effectiveness (DARE). The Strength of Recommendation Taxonomy (SORT) Scale, from the American Family Physician, was used to evaluate the level of evidence and assign the strength of recommendation. Results: The research found fifteen articles, among which only three were eligible according to the inclusion criteria: 1. systematic review and 2. meta-analyses. There was evidence of a probable beneficial effect of N-acetylcysteine on treatment response and reduction of trichotillomania symptom severity in adults, with moderate certainty in the effect estimate. There was no evidence of effectiveness with the use of inositol, antioxidants, naltrexone, or selective serotonin reuptake inhibitors (SSRIs) in the treatment of adults with trichotillomania. Clomipramine and Olanzapine showed potential treatment benefits, with low certainty. N-acetylcysteine had the least severe side effect profile in adults compared with the other potentially beneficial pharmacological treatments. Conclusion: Evidence points towards the effectiveness of N-acetylcysteine in the treatment of adults with trichotillomania, which exhibits a good tolerability profile with minimal adverse effects. Therefore, the authors attribute a level of evidence 2, the strength of recommendation B, to the prescription of N-acetylcysteine in the treatment of adults suffering from trichotillomania (SORT analysis). Further investigation is needed in order to extract high-quality conclusions from the meta-analysis.

Keywords: trichotillomania, hair pulling, treatment, n-acetylcysteine

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Authors: K. J. Keerthi, Vasundhara Kamineni, A. Ravi Shanker, T. Rammurthy, A. Vijaya Lakshmi, Q. Hasan

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Pancreatic β-cells are the predominant insulin-producing cell types within the Islets of Langerhans and insulin is the primary hormone which regulates carbohydrate and fat metabolism. Apoptosis of β-cells or insufficient insulin production leads to Diabetes Mellitus (DM). Current therapy for diabetes includes either medical management or insulin replacement and regular monitoring. Replacement of β- cells is an attractive treatment option for both Type-1 and Type-2 DM in view of the recent paper which indicates that β-cells apoptosis is the common underlying cause for both the Types of DM. With the development of Edmonton protocol, pancreatic β-cells allo-transplantation became possible, but this is still not considered as standard of care due to subsequent requirement of lifelong immunosuppression and the scarcity of suitable healthy organs to retrieve pancreatic β-cell. Fetal pancreatic cells from abortuses were developed as a possible therapeutic option for Diabetes, however, this posed several ethical issues. Hence, in the present study Mesenchymal stem cells (MSCs) were differentiated into insulin producing cells which were isolated from Human Umbilical cord (HUC) tissue. MSCs have already made their mark in the growing field of regenerative medicine, and their therapeutic worth has already been validated for a number of conditions. HUC samples were collected with prior informed consent as approved by the Institutional ethical committee. HUC (n=26) were processed using a combination of both mechanical and enzymatic (collagenase-II, 100 U/ml, Gibco ) methods to obtain MSCs which were cultured in-vitro in L-DMEM (Low glucose Dulbecco's Modified Eagle's Medium, Sigma, 4.5 mM glucose/L), 10% FBS in 5% CO2 incubator at 37°C. After reaching 80-90% confluency, MSCs were characterized with Flowcytometry and Immunocytochemistry for specific cell surface antigens. Cells expressed CD90+, CD73+, CD105+, CD34-, CD45-, HLA-DR-/Low and Vimentin+. These cells were differentiated to β-cells by using H-DMEM (High glucose Dulbecco's Modified Eagle's Medium,25 mM glucose/L, Gibco), β-Mercaptoethanol (0.1mM, Hi-Media), basic Fibroblast growth factor (10 µg /L,Gibco), and Nicotinamide (10 mmol/L, Hi-Media). Pancreatic β-cells were confirmed by positive Dithizone staining and were found to be functionally active as they released 8 IU/ml insulin on glucose stimulation. Isolating MSCs from usually discarded, abundantly available HUC tissue, expanding and differentiating to β-cells may be the most feasible cell therapy option for the millions of people suffering from DM globally.

Keywords: diabetes mellitus, human umbilical cord, mesenchymal stem cells, differentiation

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Authors: Santiago Quesada-García, María Lozano-Gómez, Pablo Valero-Flores

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The recent digital revolution, together with modern technologies, is changing the environment and the way people interact with inhabited space. However, in society, the elderly are a very broad and varied group that presents serious difficulties in understanding these modern technologies. Outpatients with cognitive disabilities, such as those suffering from Alzheimer's disease (AD), are distinguished within this cluster. This population group is in constant growth, and they have specific requirements for their inhabited space. According to architecture, which is one of the health humanities, environments are designed to promote well-being and improve the quality of life for all. Buildings, as well as the tools and technologies integrated into them, must be accessible, inclusive, and foster health. In this new digital paradigm, artificial intelligence (AI) appears as an innovative resource to help this population group improve their autonomy and quality of life. Some experiences and solutions, such as those that interact with users through chatbots and voicebots, show the potential of AI in its practical application. In the design of healthy spaces, the integration of AI in architecture will allow the living environment to become a kind of 'exo-brain' that can make up for certain cognitive deficiencies in this population. The objective of this paper is to address, from the discipline of neuroarchitecture, how modern technologies can be integrated into everyday environments and be an accessible resource for people with cognitive disabilities. For this, the methodology has a mixed structure. On the one hand, from an empirical point of view, the research carries out a review of the existing literature about the applications of AI to build space, following the critical review foundations. As a unconventional architectural research, an experimental analysis is proposed based on people with AD as a resource of data to study how the environment in which they live influences their regular activities. The results presented in this communication are part of the progress achieved in the competitive R&D&I project ALZARQ (PID2020-115790RB-I00). These outcomes are aimed at the specific needs of people with cognitive disabilities, especially those with AD, since, due to the comfort and wellness that the solutions entail, they can also be extrapolated to the whole society. As a provisional conclusion, it can be stated that, in the immediate future, AI will be an essential element in the design and construction of healthy new environments. The discipline of architecture has the compositional resources to, through this emerging technology, build an 'exo-brain' capable of becoming a personal assistant for the inhabitants, with whom to interact proactively and contribute to their general well-being. The main objective of this work is to show how this is possible.

Keywords: Alzheimer’s disease, artificial intelligence, healthy architecture, neuroarchitecture, architectural design

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Authors: Stephanie Remedios, Linda Veronica Rios

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Background. Pediatric obesity is a serious health problem linked to multiple physical diseases and ailments, including diabetes, heart disease, and joint issues. While research has shown pediatric obesity can bring about an array of physical illnesses, it is less known how such a condition can affect children’s cognitive development. With childhood overweight and obesity prevalence rates on the rise, it is essential to understand the scope of their cognitive consequences. The present review of the literature tested the hypothesis that poor physical health, such as childhood obesity or malnutrition, negatively impacts a child’s cognitive development. Methodology. A systematic review was conducted to determine the relationship between poor physical health and lower cognitive functioning in children ages 4-16. Electronic databases were searched for studies dating back to ten years. The following databases were used: Science Direct, FIU Libraries, and Google Scholar. Inclusion criteria consisted of peer-reviewed academic articles written in English from 2012 to 2022 that analyzed the relationship between childhood malnutrition and obesity on cognitive development. A total of 17,000 articles were obtained, of which 16,987 were excluded for not addressing the cognitive implications exclusively. Of the acquired articles, 13 were retained. Results. Research suggested a significant connection between diet and cognitive development. Both diet and physical activity are strongly correlated with higher cognitive functioning. Cognitive domains explored in this work included learning, memory, attention, inhibition, and impulsivity. IQ scores were also considered objective representations of overall cognitive performance. Studies showed physical activity benefits cognitive development, primarily for executive functioning and language development. Additionally, children suffering from pediatric obesity or malnutrition were found to score 3-10 points lower in IQ scores when compared to healthy, same-aged children. Conclusion. This review provides evidence that the presence of physical activity and overall physical health, including appropriate diet and nutritional intake, has beneficial effects on cognitive outcomes. The primary conclusion from this research is that childhood obesity and malnutrition show detrimental effects on cognitive development in children, primarily with learning outcomes. Assuming childhood obesity and malnutrition rates continue their current trade, it is essential to understand the complete physical and psychological implications of obesity and malnutrition in pediatric populations. Given the limitations encountered through our research, further studies are needed to evaluate the areas of cognition affected during childhood.

Keywords: childhood malnutrition, childhood obesity, cognitive development, cognitive functioning

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Authors: Dhaneswar Bhoi

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In Indian History, the Dalits (Scheduled Castes) were exploited with caste, since the Vedic Age (1500 BCE). They were deprived of many rights in the society and their education was also restricted by the upper castes since the introduction of the Law of Manu (1500 BCE). The Dalits were treated as lower castes (Sudras and Ati-Sudra) in the society. Occupation of these caste groups were attached to some low profile and menial occupation. Whereas, the upper caste (Brahamins) declared themselves as the top most caste groups who chose the occupation of priests and had the supreme right to education. During those days occupation was not decided by the caliber of a person rather, it was decided by the upper caste Brahamins and kept on transferring from one generation to another generation. At this juncture of the society, the upper caste people oppressed and suppressed the lower caste people endlessly. To get rid of these social problems the emancipator and the charismatic leader (Prophet for the lower caste communities), Dr. Babasaheb Ambedkar appeard in the scene of Indian unjust society. Restlessly he fought against the caste oppression, social dogmas and tyranny on the basis of caste. Finally, he succeeded to affirm statutory safeguards for the oppressed and depressed or lower caste communities. Today these communities are scheduled as Scheduled Castes to access social justice for their upliftment and development. Through the liberty, equality and fraternity, he established social justice for the first time in the Indian history with the implementation of Indian Constitution on 26th January 1950. Since then the social justice has been accessed through the Constitution and Indian Republics. However, even after sixty five years of the Indian Republic and Constitutional safeguards the Scheduled Castes (SCs) are suffering many problems in the phases of their life. Even if there are special provisions made by the state aimed to meet the challenges of the weaker sections, they are still deprived of access to it, which is true especially for the Dalits or SCs. Many of the people of these communities are still not accessing education and particularly, higher education. Those who are managing to access the education have been facing many challenges in their educational premises as well as in their social life. This paper tries to find out the problem of discrimination in educational and societal level. Secondly, this paper aims to know the relation between the discrimination and access to social justice for the SCs in the educational institution and society. It also enquires the experiences of SCs who faced discrimination in their educational and social life. This study is based on the both quantitative and qualitative methods. Both of which were interpreted through the data triangulation method in mixed methodology approach. In this paper, it is found that the SCs are struggling with injustice in their social and educational spheres. Starting from their primary level to higher education, they were discriminated in curricular, co-curricular and extra-curricular activities.

Keywords: social justice, discrimination, caste, scheduled castes, education

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Authors: Robin Root

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A fundamental premise of medical anthropology is that clinical phenomena are simultaneously cultural, political, and economic: none more so than the linked acronyms HIV/AIDS. For the medical researcher, HIV/AIDS signals an epidemiological pandemic and a pathophysiology. For persons diagnosed with an HIV-related condition, the acronym often conjures dread, too often marking and marginalizing the afflicted irretrievably. Critical medical anthropology is uniquely equipped to theorize the linkages that bind individual and social wellbeing to global structural and culture-specific phenomena. This paper reports findings from an anthropological study of HIV/AIDS in Swaziland, site of the highest HIV prevalence in the world. The project, initiated in 2005, has documented experiences of HIV/AIDS, religiosity, and treatment and care as well as drought and famine. Drawing on interviews with Swazi religious and traditional leaders about their experiences of leadership amidst worsening economic conditions, environmental degradation, and an ongoing global health crisis, the paper provides uncommon insights for global health practitioners whose singular paradigm for designing and delivering interventions is biomedically-based. In contrast, this paper details the role of local leaders in mediating extreme social suffering and resilience in ways that medical science cannot model but which radically impact how sickness is experienced and health services are delivered and accessed. Two concepts help to organize the paper’s argument. First, a ‘moral economy of language’ is central to showing up the implicit ‘technologies of knowledge’ that inhere in scientific and religious discourses of HIV/AIDS; people draw upon these discourses strategically to navigate highly vulnerable conditions. Second, Paulo Freire’s ethnographic focus on a culture’s 'dangerous words' opens up for examination how ‘sex’ is dangerous for religion and ‘god’ is dangerous for science. The paper interrogates hegemonic and ‘lived’ discourses, both biomedical and religious, and contributes to an important literature on the moral economies of health, a framework of explication and, importantly, action appropriate to a wide-range of contemporary global health phenomena. The paper concludes by asserting that it is imperative that global health planners reflect upon and ‘check’ their hegemonic policy platforms by, one, collaborating with local authoritative agents of ‘what sickness means and how it is best treated,’ and, two, taking account of the structural barriers to achieving good health.

Keywords: Africa, biomedicine, HIV/AIDS, qualitative research , religion

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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: Pikria Vardosanidze

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The term Apokatástasis (Greek: Apokatástasis) is Greek and means "re-establishment", the universal resurrection. The term dates back to ancient times, in Stoic thought denoting the end of a constantly evolving cycle of the universe and the beginning of a new beginning, established in Christendom by the Eastern Fathers and Origen as the return of the entire created world to a state of goodness. "Universal resurrection" means the resurrection of mankind after the second coming of Jesus Christ. The first thing the Savior will do immediately upon His glorious coming will be that "the dead will be raised up first by Christ." God's animal action will apply to all the dead, but not with the same result. The action of God also applies to the living, which is accomplished by changing their bodies. The degree of glorification of the resurrected body will be commensurate with the spiritual life. An unclean body will not be glorified, and the soul will not be happy. He, as a resurrected body, will be unbelieving, strong, and spiritual, but because of the action of the passions, all this will only bring suffering to the body. The court judges both the soul and the flesh. At the same time, St. The letter nowhere says that at the last 4trial, someone will be able to change their own position. In connection with this dogmatic teaching, one of the greatest fathers of the Church, Sts. Gregory Nossell had a different view. He points out that the miracle of the resurrection is so glorious and sublime that it exceeds our faith. There are two important circumstances: one is the reality of the resurrection itself, and the other is the face of its fulfillment. The first is founded by Gregory Nossell on the Uado authority, Sts. In the letter: Jesus Christ preached about the resurrection of Christ and also foretold many other events, all of which were later fulfilled. Gregory Nossell clarifies the issues of the substantiality of good and evil and the relationship between them and notes that only good has an inherent dependence on nothing because it originated from nothing and exists eternally in God. As for evil, it has no self-sustaining substance and, therefore, no existence. It appears only through the free will of man from time to time. As St., The Father says that God is the supreme goodness that gives beings the power to exist in existence , all others who are without Him are non-existent. St. The above-mentioned opinion of the father about the universal apocatastasis comes from the thought of Origen. This teaching was introduced by the resolution of the Fifth World Ecclesiastical Assembly. Finally, it was unanimously stated by ecclesiastical figures that the doctrine of universal salvation is not valid. For if the resurrection takes place in this way, that is, all beings, including the evil spirit, are resurrected, then the worldly controversy between good and evil, the future common denominator, the eternal torment - all that Christian dogma acknowledges.

Keywords: apolatastasisi ortodox, orthodox doctrine, gregogory of nusse, eschatology

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Authors: Merina Islam

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There are many environmental problems. Various counter measures have been taken for environmental problems. Philosophy is an important contributor to environmental studies as it takes deep interest in meaning analysis of the concept environment and other related concepts. The Buddhist frame, which is virtue ethical, remains a better alternative to the traditional environmental outlook. Granting the unique role of man in immoral deliberations, the Buddhist approach, however, maintains a holistic concept of ecological harmony. Buddhist environmental ethics is more concerned about the complete moral community, the total ecosystem, than any particular species within the community. The moral reorientation proposed here has resemblance to the concept of 'deep ecology. Given the present day prominence of virtue ethics, we need to explore further into the Buddhist virtue theory, so that a better framework to treat the natural world would be ensured. Environment has turned out to be one of the most widely discussed issues in the recent times. Buddhist concepts such as Pratityasamutpadavada, Samvrit Satya, Paramartha Satya, Shunyata, Sanghatvada, Bodhisattva, Santanvada and others deal with interdependence in terms of both internal as well external ecology. The internal ecology aims at mental well-being whereas external ecology deals with physical well-being. The fundamental Buddhist concepts for dealing with environmental Problems are where the environment has the same value as humans as from the two Buddhist doctrines of the Non-duality of Life and its Environment and the Origination in Dependence; and the inevitability of overcoming environmental problems through the practice of the way of the Bodhisattva, because environmental problems are evil for people and nature. Buddhism establishes that there is a relationship among all the constituents of the world. There is nothing in the world which is independent from any other thing. Everything is dependent on others. The realization that everything in the universe is mutually interdependent also shows that the man cannot keep itself unaffected from ecology. This paper would like to focus how the Buddhist’s identification of nature and the Dhamma can contribute toward transforming our understanding, attitudes, and actions regarding the care of the earth. Environmental Ethics in Buddhism presents a logical and thorough examination of the metaphysical and ethical dimensions of early Buddhist literature. From the Buddhist viewpoint, humans are not in a category that is distinct and separate from other sentient beings, nor are they intrinsically superior. All sentient beings are considered to have the Buddha-nature, that is, the potential to become fully enlightened. Buddhists do not believe in treating of non-human sentient beings as objects for human consumption. The significance of Buddhist theory of interdependence can be understood from the fact that it shows that one’s happiness or suffering originates from ones realization or non-realization respectively of the dependent nature of everything. It is obvious, even without emphasis, which in the context of deep ecological crisis of today there is a need to infuse the consciousness of interdependence.

Keywords: Buddhism, deep ecology, environmental problems, Pratityasamutpadavada

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Authors: Carmiña L. Vargas-Zapata, María A. Conde-Sarmiento, Maria Consuelo Maestre-Vargas

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Calcium is an essential element for good growth and development of the organism, and its requirement is increased at school age. Low socio-economic populations of developing countries such as Colombia may have food deficiency of this mineral in schoolchildren that could be reflected in calcium biochemical indicators, bone alterations and anthropometric indicators. The objective of this investigation was to evaluate some calcium biochemical indicators in a group of schoolchildren of low socioeconomic level from Barranquilla city and to correlate with body mass index. 60 schoolchildren aged 7 to 15 years were selected from Jesus’s Heart Educational Institution in Barranquilla-Atlántico, apparently healthy, without suffering from infectious or gastrointestinal diseases, without habits of drinking alcohol or smoking another hallucinogenic substance and without taking supplementation with calcium in the last six months or another substance that compromises bone metabolism. The research was approved by the ethics committee at Universidad del Atlántico. The selected children were invited to donate a blood and urine sample in a fasting time of 12 hours, the serum was separated by centrifugation and frozen at ˗20 ℃ until analyzed and the same was done with the urine sample. On the day of the biological collections, the weight and height of the students were measured to determine the nutritional status by BMI using the WHO tables. Calcium concentrations in serum and urine (SCa, UCa), alkaline phosphatase activity total and of bone origin (SAPT, SBAP) and urinary creatinine (UCr) were determined by spectrophotometric methods using commercial kits. Osteocalcin and Cross-linked N-telopeptides of type I collagen (NTx-1) in serum were measured with an enzyme-linked inmunosorbent assay. For statistical analysis the Statgraphics software Centurium XVII was used. 63% (n = 38) and 37% (n = 22) of the participants were male and female, respectively. 78% (n = 47), 5% (n = 3) and 17% (n = 10) had a normal, malnutrition and high nutritional status, respectively. The averages of evaluated indicators levels were (mean ± SD): 9.50 ± 1.06 mg/dL for SCa; 181.3 ± 64.3 U/L for SAPT, 143.8 ± 73.9 U/L for SBAP; 9.0 ± 3.48 ng/mL for osteocalcin and 101.3 ± 12.8 ng/mL for NTx-1. UCa level was 12.8 ± 7.7 mg/dL that adjusted with creatinine ranged from 0.005 to 0.395 mg/mg. Considering serum calcium values, approximately 7% of school children were hypocalcemic, 16% hypercalcemic and 77% normocalcemic. The indicators evaluated did not correlate with the BMI. Low values ​​were observed in calcium urinary excretion and high in NTx-1, suggesting that mechanisms such as increase in renal retention of calcium and in bone remodeling may be contributing to calcium homeostasis.

Keywords: calcium, calcium biochemical, indicators, school children, low socioeconomic status

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

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In Canada, as prevalence rates and severity of illness have increased among patients suffering from eating disorders, wait times have grown substantially. Patients in Canada often face wait times in excess of 12 months. It is known that delaying treatment for eating disorders contributes to poor patient outcomes and higher rates of symptom relapse. Improving interim services for adult patients awaiting outpatient treatment is a priority for an outpatient eating disorders clinic in Ontario, Canada. The clinical setting currently provides care for adults diagnosed with anorexia nervosa, bulimia nervosa and binge eating disorder. At present, the only support provided while patients are on the waitlist consists of communication with primary care providers regarding parameters for medical monitoring. The significance of this study will be to test the feasibility, acceptability and efficacy of an intervention to support adult patients awaiting outpatient eating disorder treatment for anorexia nervosa, bulimia nervosa and binge eating disorder. Methods: An intervention including psychoeducation, supportive resources, self-monitoring, and auxiliary referral will be pilot-tested with a group of patients in the summer of 2022 and detailed using a prospective cohort case study research design. The team will host patient focus groups in May 2022 to gather input informing the content of the intervention. The intervention will be pilot tested with newly-referred patients in June and July 2022. Patients who participate in the intervention will be asked to complete a survey evaluating the utility of the intervention and for suggestions, they may have for improvement. Preliminary findings describing the existing literature pertaining to waitlist interventions for patients with eating disorders, data gathered from the focus groups and early pilot testing results will be presented. Data analysis will continue throughout 2022 and early 2023 for follow-up publication and presentation in the summer of 2023. The aim of this study is to contribute to the body of knowledge pertaining to providing interim support to those patients waiting for treatment for eating disorders and, by extension, to improve outcomes for this population.

Keywords: eating disorders, waitlist management, intervention study, pilot test

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Authors: Mohammad Ali Al Qatawneh, Bespalchuk Pavel Ivanovich

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Computer navigation has been introduced in total knee arthroplasty to improve the accuracy of the procedure. Computer navigation improves the accuracy of bone resection in the coronal and sagittal planes. It was also noted that it normalizes the rotational alignment of the femoral component and fully assesses and balances the deformation of soft tissues in the coronal plane. The work is devoted to the advantages of using computer navigation technology in total knee arthroplasty in 62 patients (11 men and 51 women) suffering from gonarthrosis, aged 51 to 83 years, operated using a computer navigation system, followed up to 3 years from the moment of surgery. During the examination, the deformity variant was determined, and radiometric parameters of the knee joints were measured using the Knee Society Score (KSS), Functional Knee Society Score (FKSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scales. Also, functional stress tests were performed to assess the stability of the knee joint in the frontal plane and functional indicators of the range of motion. After surgery, improvement was observed in all scales; firstly, the WOMAC values decreased by 5.90 times, and the median value to 11 points (p < 0.001), secondly KSS increased by 3.91 times and reached 86 points (p < 0.001), and the third one is that FKSS data increased by 2.08 times and reached 94 points (p < 0.001). After TKA, the axis deviation of the lower limbs of more than 3 degrees was observed in 4 patients at 6.5% and frontal instability of the knee joint just in 2 cases at 3.2%., The lower incidence of sagittal instability of the knee joint after the operation was 9.6%. The range of motion increased by 1.25 times; the volume of movement averaged 125 degrees (p < 0.001). Computer navigation increases the accuracy of the spatial orientation of the endoprosthesis components in all planes, reduces the variability of the axis of the lower limbs within ± 3 °, allows you to achieve the best results of surgical interventions, and can be used to solve most basic tasks, allowing you to achieve excellent and good outcomes of operations in 100% of cases according to the WOMAC scale. With diaphyseal deformities of the femur and/or tibia, as well as with obstruction of their medullary canal, the use of computer navigation is the method of choice. The use of computer navigation prevents the occurrence of flexion contracture and hyperextension of the knee joint during the distal sawing of the femur. Using the navigation system achieves high-precision implantation for the endoprosthesis; in addition, it achieves an adequate balance of the ligaments, which contributes to the stability of the joint, reduces pain, and allows for the achievement of a good functional result of the treatment.

Keywords: knee joint, arthroplasty, computer navigation, advantages

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Authors: Le Jiang, Chua Jinxing

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Introduction: The recent outbreak of Ebola virus disease in the west Africa has drawn global concern. With a high fatality rate and direct human-to-human transmission, it has spread between countries and caused great damages for patients and family who are affected. Being the designated hospital to manage epidemic outbreak in Singapore, Tan Tock Seng Hospital (TTSH) is facing great challenges in preparation and managing of potential outbreak of emerging infectious disease such as Ebola virus disease. Aim: We conducted an infection control drill in TTSH emergency department to assess the readiness of healthcare and allied health workers in managing suspected Ebola patients. It also helps to review current Ebola clinical protocol and work instruction to ensure more smooth and safe practice in managing Ebola patients in TTSH emergency department. Result: General preparedness level of staffs involved in managing Ebola virus disease in TTSH emergency department is not adequate. Knowledge deficits of staffs on Ebola personal protective equipment gowning and degowning process increase the risk of potential cross contamination in patient care. Loopholes are also found in current clinical protocol, such as unclear instructions and inaccurate information, which need to be revised to promote better staff performance in patient management. Logistic issues such as equipment dysfunction and inadequate supplies can lead to ineffective communication among teams and causing harm to patients in emergency situation. Conclusion: The infection control drill identified the need for more well-structured and clear clinical protocols to be in place to promote participants performance. In addition to quality protocols and guidelines, systemic training and annual refresher for all staffs in the emergency department are essential to prepare staffs for the outbreak of Ebola virus disease. Collaboration and communication with allied health staffs are also crucial for smooth delivery of patient care and minimising the potential human suffering, properties loss or injuries caused by disease. Therefore, more clinical drills with collaboration among various departments involved are recommended to be conducted in the future to monitor and assess readiness of TTSH emergency department in managing Ebola virus disease.

Keywords: ebola, emergency department, infection control drill, Tan Tock Seng Hospital

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Authors: Ginpreet Kaur, Mohammad Yasir Usmani, Mohammed Kamil Khan

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Diabetes mellitus is a disease with a high global burden and results in significant morbidity and mortality. In India, the number of people suffering with diabetes is expected to rise from 19 to 57 million in 2025. At present, interest in herbal remedies is growing to reduce the side effects associated with conventional dosage form like oral hypoglycemic agents and insulin for the treatment of diabetes mellitus. Our aim was to investigate the antidiabetic activities of combinatorial extract of N. sativa & C. cassia in Streptozotocin induced type-I Diabetic Rats. Thus, the present study was undertaken to screen postprandial glucose excursion potential through α- glucosidase inhibitory activity (In Vitro) and effect of combinatorial extract of N. sativa & C. cassia in Streptozotocin induced type-I Diabetic Rats (In Vivo). In addition changes in body weight, plasma glucose, lipid profile and kidney profile were also determined. The IC50 values for both extract and Acarbose was calculated by extrapolation method. Combinatorial extract of N. sativa & C. cassia at different dosages (100 and 200 mg/kg orally) and Metformin (50 mg/kg orally) as the standard drug was administered for 28 days and then biochemical estimation, body weights and OGTT (Oral glucose tolerance test) were determined. Histopathological studies were also performed on kidney and pancreatic tissue. In In-Vitro the combinatorial extract shows much more inhibiting effect than the individual extracts. The results reveals that combinatorial extract of N. sativa & C. cassia has shown significant decrease in plasma glucose (p<0.0001), total cholesterol and LDL levels when compared with the STZ group The decreasing level of BUN and creatinine revealed the protection of N. sativa & C. cassia extracts against nephropathy associated with diabetes. Combination of N. sativa & C. cassia significantly improved glucose tolerance to exogenously administered glucose (2 g/kg) after 60, 90 and 120 min interval on OGTT in high dose streptozotocin induced diabetic rats compared with the untreated control group. Histopathological studies shown that treatment with N. sativa & C. cassia extract alone and in combination restored pancreatic tissue integrity and was able to regenerate the STZ damaged pancreatic β cells. Thus, the present study reveals that combination of N. sativa & C. cassia extract has significant α- glucosidase inhibitory activity and thus has great potential as a new source for diabetes treatment.

Keywords: lipid levels, OGTT, diabetes, herbs, glucosidase

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Authors: D. M. Lewis, L. Frisby, U. Stead

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Objective: Many patients are receiving invasive treatments in acute care or are dying in hospital without having had comprehensive goals of care conversations. Some of these treatments may not align with the patient’s wishes, may be futile, and may cause unnecessary suffering. While many staff may recognize the benefits of engaging patients and families in Serious Illness Conversations (a goal of care framework developed by Ariadne Labs in Boston), few staff feel confident and/or competent in having these conversations in acute care. Another barrier to having these conversations may be due to a lack of incorporation in the current workflow. An educational exercise, titled the Two Question Challenge, was initiated on four medical units across two Vancouver Coastal Health (VCH) hospitals in attempt to engage the entire interdisciplinary team in asking patients and families questions around goals of care and to improve the documentation of these expressed wishes and preferences. Methods: Four acute care units across two separate hospitals participated in the Two Question Challenge. On each unit, over the course of two eight-hour shifts, all members of the interdisciplinary team were asked to select at least two questions from a selection of nine goals of care questions. They were asked to pose these questions of a patient or family member throughout their shift and then asked to document their conversations in a centralized Advance Care Planning/Goals of Care discussion record in the patient’s chart. A visual representation of conversation outcomes was created to demonstrate to staff and patients the breadth of conversations that took place throughout the challenge. Staff and patients were interviewed about their experiences throughout the challenge. Two palliative approach leads remained present on the units throughout the challenge to support, guide, or role model these conversations. Results: Across four acute care medical units, 47 interdisciplinary staff participated in the Two Question Challenge, including nursing, allied health, and a physician. A total of 88 questions were asked of patients, or their families around goals of care and 50 newly documented goals of care conversations were charted. Two code statuses were changed as a result of the conversations. Patients voiced an appreciation for these conversations and staff were able to successfully incorporate these questions into their daily care. Conclusion: The Two Question Challenge proved to be an effective way of having teams explore the goals of care of patients and families in an acute care setting. Staff felt that they gained confidence and competence. Both staff and patients found these conversations to be meaningful and impactful and felt they were notably different from their usual interactions. Documentation of these conversations in a centralized location that is easily accessible to all care providers increased significantly. Application of the Two Question Challenge in non-medical units or other care settings, such as long-term care facilities or community health units, should be explored in the future.

Keywords: advance care planning, goals of care, interdisciplinary, palliative approach, serious illness conversations

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Authors: Narayani Sepaha

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In earlier days, the sufferer was burdened to prove the offence as well as to put the offender to punishment. The adversary system of legal procedure was characterized simply by two parties: the prosecution and the defence. With the onset of this system, firstly the judge started acting as a neutral arbitrator, and secondly, the state inadvertently started assuming the lead role and thereby relegated the victims to the position of oblivion. In this process, with the increasing role of police forces and the government, the victims got systematically excluded from the key stages of the case proceedings and were reduced to the stature of a prosecution witness. This paper tries to emphasise the increasing control over the various stages of the trial, by other stakeholders, leading to the marginalization of victims in the trial process. This monopolization has signalled the onset of an era of gross neglect of victims in the whole criminal justice system. This consciousness led some reformists to raise their concerns over the issue, during the early part of the 20th century. They started supporting the efforts which advocated giving prominence to the participation of victims in the trial process. This paved the way for the evolution of the science of victimology. Markedly the innovativeness to work out facts, seek opinions and statements of the victims and reassure that their voice is also heard has ensured the revival of their rightful roles in the justice delivery system. Many countries, like the US, have set an example by acknowledging the advantages of participation of victims in trials like in the proceedings of the Ariel Castro Kidnappings of Cleveland, Ohio and enacting laws for protecting their rights within the framework of the legal system to ensure speedy and righteous delivery of justice in some of the most complicated cases. An attempt has been made to flag that the accused have several rights in contrast to the near absence of separate laws for victims of crime, in India. It is sad to note that, even in the initial process of registering a crime the victims are subjected to the mercy of the officers in charge and thus begins the silent suffering of these victims, which continues throughout the process of their trial. The paper further contends, that the degree of victim participation in trials and its impact on the outcomes, can be debated and evaluated, but its potential to alter their position and make them regain their lost status cannot be ignored. Victim participation in trial proceedings will help the court in perceiving the facts of the case in a better manner and in arriving at a balanced view of the case. This will not only serve to protect the overall interest of the victims but will act to reinforce the faith in the criminal justice delivery system. It is pertinent to mention that there is an urgent need to review the accused centric prosecution system and introduce appropriate amendments so that the marginalization of victims comes to an end.

Keywords: victim participation, criminal justice, India, trial, marginalised

Procedia PDF Downloads 145

Authors: Amel Fayed, Shaden AlSubaih, Nouf Al-Qahtani, Asmaa Gosty, Asma Aljuhaimi

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Introduction: Sleep difficulties are vastly predominant among adults and affect different aspects of their life. Many literatures found out that females are more liable to suffer from sleeping problems. College students are typical example of people dealing with daily pressure and stress to fulfill the daily tasks and responsibilities. In addition to their ultimate goal of achieving excellent academic records which require their full concentration and effort. Consequently, many of them start complaining of sleep deprivations which can undesirably affect their academic achievements. This study was aiming to investigate how prevalent is sleeping disorders among different colleges in the university and its relation their academic achievements. Methods: A cross-sectional study of female university students at Princess Norah Bint Abdulrahman University using self-administered questionnaire was conducted. Insomnia Severity Index (ISI) was used to assess different grades of insomnia. Students were requested to answer the questions evaluating their sleeping habits over the last two weeks. Participants reported their latest Grade Point Average (GPA). According to ISI, insomnia severity is reported as ‘No clinically significant’, ‘Subthreshold ‘,’ Clinical moderate insomnia’ and ‘Clinical severe’. Results: In the current study, 228 students participated; 172(75.4%) from medical colleges and 56 (24.6%) from non-medical colleges. About 80% of them claimed to have never taken any medications to help them sleep while only three students confirmed their regular use of sleep-inducing medications. About 16% of the students drink milk or other hot drinks to help them fall asleep. None of the students was suspected of having obstructive sleep apnea or apparent psychiatric disorder. According to ISI, 182 (79.8%) students suffered from subthreshold insomnia, 37 (16.2%) had clinical insomnia (moderate severity) and 9 (3.9%) of students had sleeping problems of non-clinically significance level. However, none of students was found to have severe clinical insomnia. Clinical moderate insomnia was reported in 15.1% of medical students and 19.6% of non-medical students. Moreover, about 82% of medical students suffered from subthreshold insomnia compared to 73.2% of non-medical students. This difference was not statistically significant (P=0.24). About 63% of medical students and 48% of non-medical students believed that high percentage of their colleagues are suffering from insomnias (p-value 0.08) The association between GPA and insomnia revealed that; 19.5% of low GPA group compared to 9.3% of high GPA group had clinical moderate insomnia. This association was not statistically significant (p=0.15). The correlation between the GPA and the ISI score was negative but not conclusive (r=-0.08, p-value = 0.29). More than 92% of all students agreed that sleeping problems affect their academic achievement to varying degrees. Conclusion: our results suggest that insomnia is commonly prevalent among female university students and might affect the students’ achievement. This study provides preliminary data about the quality of sleep among medical and non-medical university students which may be used to promote the healthy sleeping habits among female students.

Keywords: academic achievement, females, insomnia, university student

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Authors: Mei-Hsia Dai

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Venerable Master Di-Chiao has been devoted all her life practicing the Earth Store Bodhisattva’s spirit and is one of the greatest masters in modern Buddhism. All Buddha and Bodhisattvas pay great respect to the Earth Store Bodhisattva because He vowed that He would not become Buddha until the hell is empty, and He would only achieve Bodhi until all sentient beings have been saved. The aim of this study is to investigate Venerable Master Di-Chiao, who actualizes the Buddha’s teaching and practices the Earth Store Bodhisattva’s compassion and apply them to help people. In fact, she has integrated her learning to teach people how to eliminate their karmic suffering with her close attention and full effort, even though she would be hurt all over or she had to sacrifice her own life. This qualitative research gathers data in terms of a field study, including an interview with Venerable Master Di-Chiao, a book about the Master and three books about true stories of people saved by the Master, and about 300 online feedbacks from her disciples and followers explaining how they were helped by the Master through their difficulties, together with a year-long observation at the Dharma services held in Taipei Di-Zang Temple. This article is divided into four parts: The first part depicts Master Di-Chiao’s original intent of being a nun and her three-step-one-bow pilgrimage experience around Taiwan. Part two illustrates the invitation of the Master’s being the Abbess of Tsiang-Te Temple, which was designated by Bodhisattva Avalokitesvara in a manager’s dream of the temple, and many unexpected difficulties ahead of the cultivation in the Master’s Buddha Path. In addition to maintenance of Tsiang-Te Temple, the third part will discuss the purpose of founding Taipei Di-Zang Temple, in which the Master always tries her best with various methods to cultivate good seeds for her disciples and followers and watches out for their karma and does her utmost effort to help them overcome it. The final part will briefly explain the Three Buddhalization: Buddhist wedding, Buddhist prenatal education and Buddhist family, which the Master has been advocating and considers them the essence of constructing a harmonious society and having a meaningful and enlightening life. Extraordinary results of practicing the Three Buddhalization will be given. Findings show that Master’s Di-Chiao’s actualization of Buddha’s teaching and Bodhisattva’s compassion is incredibly amazing and powerful, and she has helped countless people to conquer their difficulties and purify their evil habits. With the Master’s assistance and their hardworking and faith to the Master’s teaching, some of her disciples and followers have gone to the Maitreya Inside Realm, where the future Buddha has resided, and continue their cultivation. True stories will be presented to illuminate the incredibility of the Master’s compassion, her brevity and perseverance in the course of the Buddhahood. Venerable Master Di-Chiao is the embodiment of the Earth Store Bodhisattva for her disciples and followers.

Keywords: compassion, the Earth Store Bodhisattva, three Buddhalization, venerable Master Di-Chiao

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Authors: Sree Sanyal

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Research in ageing often highlights the age-related health dimension more than the psycho-social characteristics of the elderly, which also influences and challenges the health outcomes. Multimorbidity is defined as the person having more than one chronic non-communicable diseases and their prevalence increases with ageing. The study aims to evaluate the influence of social ties on self-reported prevalence of multimorbidity (selected chronic non-communicable diseases) among the selected states of elderly population in India. The data is accessed from Building Knowledge Base on Population Ageing in India (BKPAI), collected in 2011 covering the self-reported chronic non-communicable diseases like arthritis, heart disease, diabetes, lung disease with asthma, hypertension, cataract, depression, dementia, Alzheimer’s disease, and cancer. The data of the above diseases were taken together and categorized as: ‘no disease’, ‘one disease’ and ‘multimorbidity’. The predicted variables were demographic, socio-economic, residential types, and the variable of social ties includes social support, social engagement, perceived support, connectedness, and importance of the elderly. Predicted probability for multiple logistic regression was used to determine the background characteristics of the old in association with chronic morbidities showing multimorbidity. The finding suggests that 24.35% of the elderly are suffering from multimorbidity. Research shows that with reference to ‘no disease’, according to the socio-economic characteristics of the old, the female oldest old (80+) from others in caste and religion, widowed, never had any formal education, ever worked in their life, coming from the second wealth quintile standard, from rural Maharashtra are more prone with ‘one disease’. From the social ties background, the elderly who perceives they are important to the family, after getting older their decision-making status has been changed, prefer to stay with son and spouse only, satisfied with the communication from their children are more likely to have less single morbidity and the results are significant. Again, with respect to ‘no disease’, the female oldest old (80+), who are others in caste, Christian in religion, widowed, having less than 5 years of education completed, ever worked, from highest wealth quintile, residing in urban Kerala are more associated with multimorbidity. The elderly population who are more socially connected through family visits, public gatherings, gets support in decision making, who prefers to spend their later years with son and spouse only but stays alone shows lesser prevalence of multimorbidity. In conclusion, received and perceived social integration and support from associated neighborhood in the older days, knowing about their own needs in life facilitates better health and wellbeing of the elderly population in selected states of India.

Keywords: morbidity, multi-morbidity, prevalence, social ties

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Authors: Ismatilla Mardanov

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There are three types of countries, the first of which is willing to attract foreign direct investment (FDI) in enormous amounts and do whatever it takes to make this happen. Therefore, FDI pours into such countries. In the second cluster of countries, even if the country is suffering tremendously from the shortage of investments, the governments are hesitant to attract investments because they are at the hands of local oligarchs/cartels. Therefore, FDI inflows are moderate to low in such countries. The third type is countries whose companies prefer investing in the most efficient locations globally and are hesitant to invest in the homeland. Sorting countries into such clusters, the present study examines the essential institutions and economic factors that make these countries different. Past literature has discussed various determinants of FDI in all kinds of countries. However, it did not classify countries based on government motivation, institutional setup, and economic factors. A specific approach to each target country is vital for corporate foreign direct investment risk analysis and decisions. The research questions are 1. What specific institutional and economic factors paint the pictures of the three clusters; 2. What specific institutional and economic factors are determinants of FDI; 3. Which of the determinants are endogenous and exogenous variables? 4. How can institutions and economic and political variables impact corporate investment decisions Hypothesis 1: In the first type, country institutions and economic factors will be favorable for FDI. Hypothesis 2: In the second type, even if country economic factors favor FDI, institutions will not. Hypothesis 3: In the third type, even if country institutions favorFDI, economic factors will not favor domestic investments. Therefore, FDI outflows occur in large amounts. Methods: Data come from open sources of the World Bank, the Fraser Institute, the Heritage Foundation, and other reliable sources. The dependent variable is FDI inflows. The independent variables are institutions (economic and political freedom indices) and economic factors (natural, material, and labor resources, government consumption, infrastructure, minimum wage, education, unemployment, tax rates, consumer price index, inflation, and others), the endogeneity or exogeneity of which are tested in the instrumental variable estimation. Political rights and civil liberties are used as instrumental variables. Results indicate that in the first type, both country institutions and economic factors, specifically labor and logistics/infrastructure/energy intensity, are favorable for potential investors. In the second category of countries, the risk of loss of assets is very high due to governmentshijacked by local oligarchs/cartels/special interest groups. In the third category of countries, the local economic factors are unfavorable for domestic investment even if the institutions are well acceptable. Cluster analysis and instrumental variable estimation were used to reveal cause-effect patterns in each of the clusters.

Keywords: foreign direct investment, economy, institutions, instrumental variable estimation

Procedia PDF Downloads 148

Authors: Kadhim Alabady

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Background: Autism poses a particularly large public health challenge and an inspiring lifelong challenge for many families; it is a lifelong challenge of a different kind. Purpose: Therefore, it is important to understand what the key challenges are and how to improve the lives of children who are affected with autism in Dubai. Method: In order to carry out this research we have used a qualitative methodology. We performed structured in–depth interviews and focus groups with mental health professionals working at: Al Jalila hospital (AJH), Dubai Autism Centre (DAC), Dubai Rehabilitation Centre for Disabilities, Latifa hospital, Private Sector Healthcare (PSH). In addition to that, we conducted quantitative approach to estimate ASD prevalence or incidence data due to lack of registry. ASD estimates are based on research from national and international documents. This approach was applied to increase the validity of the findings by using a variety of data collection techniques in order to explore issues that might not be highlighted through one method alone. Key findings: Autism is the most common of the Pervasive Developmental Disorders. Dubai Autism Center estimates it affects 1 in 146 births (0.68%). If we apply these estimates to the total number of births in Dubai for 2014, it is predicted there would be approximately 199 children (of which 58 were Nationals and 141 were Non–Nationals) suffering from autism at some stage. 16.4% of children (through their families) seek help for ASD assessment between the age group 6–18+. It is critical to understand and address factors for seeking late–stage diagnosis, as ASD can be diagnosed much earlier and how many of these later presenters are actually diagnosed with ASD. Autism spectrum disorder (ASD) is a public health concern in Dubai. Families do not consult GPs for early diagnosis for a variety of reasons including cultural reasons. Recommendations: Effective school health strategies is needed and implemented by nurses who are qualified and experienced in identifying children with ASD. There is a need for the DAC to identify and develop a closer link with neurologists specializing in Autism, to work alongside and for referrals. Autism can be attributed to many factors, some of those are neurological. Currently, when families need their child to see a neurologist they have to go independently and search through the many that are available in Dubai and who are not necessarily specialists in Autism. Training of GP’s to aid early diagnosis of Autism and increase awareness. Since not all GP’s are trained to make such assessments increasing awareness about where to send families for a complete assessment and the necessary support. There is an urgent need for an adult autism center for when the children leave the safe environment of the school at 18 years. These individuals require a day center or suitable job training/placements where appropriate. There is a need for further studies to cover the needs of people with an Autism Spectrum Disorder (ASD).

Keywords: autism spectrum disorder, autism, pervasive developmental disorders, incidence

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Authors: Jacob Dangerfield, Jacob Pollard, Jennifer DeCou

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Introduction: Burnout, anxiety, and depression are three conditions that are prevalent in medical providers. This is especially the case in the field of anesthesia, which has a high number of providers suffering from burnout and burnout syndrome. A major contributor to this issue is isolation in the workplace, with a perceived lack of peer support as a major risk factor for burnout. Two organizational interventions that can be done to help improve this issue are small group sessions and providing affordable mental health services. Per American College of Graduate Medical Education (ACGME) Guidelines, these affordable mental health services are a requirement of all residency programs, but for a variety of reasons, many residents do not access them. As physicians, we are often not good at asking for help. With this in mind, we hypothesized that carrying out small group resiliency sessions facilitated by Graduate Medical Education (GME) Wellness Counselors would improve both resident peer support as well as the likelihood that a resident will reach out to GME Wellness in a time of need. Methods: We held small group resiliency sessions with the GME Wellness Mental Health Professionals during protected didactic time. These sessions were small groups, including the members of one’s class (i.e., first-year residents on their own), and were facilitated by 1-2 mental health professionals. After these sessions, we surveyed residents who attended using a short Google Forms survey and using a 5-point Likert Scale, asked residents about some outcomes from the session. A “strongly agree” or “agree” was considered a positive response. Results: Results from our survey showed that the resident sessions had multiple positive outcomes. This survey was sent to 29 residents, and we had a 62% response rate. We found out through this survey that these small group sessions had a perceived positive impact on resident personal well-being, increased perceived peer support from classmates, and made residents more likely to reach out to GME Wellness in the future. Perceived positive impact on well-being was found in 83% of resident respondents, improved perceived peer support in 83% of respondents, and 78% of resident respondents stated that this session increased their likelihood of reaching out to mental health professionals. Conclusions: Through this study, we can conclude that our hypothesis was correct in that Small Group Resiliency Sessions that are facilitated by GME Wellness Counselors improve both resident peer support as well as the likelihood a resident reaches out to these mental health professionals in time of need. We believe these findings are very important as they address two important factors that can aid in decreasing a provider’s risk of experiencing burnout. Through this simple means, we believe other residency programs can help the well-being of their residents, and together, we can decrease the number of cases of burnout in anesthesia.

Keywords: anesthesiology, burnout, wellness, depression, residents, trainees, mental health

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Authors: Shams Khaled Abdelrahman Abdallah Elbaz, Alaa Aldeen Abd Al Hakeem Balbaa

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Purpose: The purpose of this study was to compare the effects of Positional Release Technique versus Kinesio Tape on pain level, pressure pain threshold level and functional disability in patients with back myofascial pain syndrome at iliocostalis lumborum. Backgrounds/significance: Myofascial Pain Syndrome is a common muscular pain syndrome that arises from trigger points which are hyperirritable, painful and tender points within a taut band of skeletal muscle. In more recent literature, about 75% of patients with musculoskeletal pain presenting to a community medical centres suffer from myofascial pain syndrome.Iliocostalis lumborum are most likely to develop active trigger points. Subjects: Thirty patients diagnosed as back myofascial pain syndrome with active trigger points in iliocostalis lumborum muscle bilaterally had participated in this study. Methods and materials: Patients were randomly distributed into two groups. The first group consisted of 15 patients (8 males and 7 females) with mean age 30.6 (±3.08) years, they received positional release technique which was applied 3 times per session, 3/week every other day for 2 weeks. The second group consisted of 15 patients(5 males, 10 females) with a mean age 30.4 (±3.35) years, they received kinesio tape which was applied and changed every 3 days with one day off for a total 3 times in 2 weeks. Both techniques were applied over trigger points of the iliocostalis lumborum bilaterally. Patients were evaluated pretreatment and posttreatment program for Pain intensity (Visual analogue scale), pressure pain threshold (digital pressure algometry), and functional disability (The Oswestry Disability Index). Analyses: Repeated measures MANOVA was used to detect differences within and between groups pre and post treatment. Then the univariate ANOVA test was conducted for the analysis of each dependant variable within and between groups. All statistical analyses were done using SPSS. with significance level set at p<0.05 throughout all analyses. Results: The results revealed that there was no significant difference between positional release technique and kinesio tape technique on pain level, pressure pain threshold and functional activities (p > 0.05). Both groups of patients showed significant improvement in all the measured variables (p < 0.05) evident by significant reduction of both pain intensity and functional disability as well as significant increase of pressure pain threshold Conclusions : Both positional release technique and kinesio taping technique are effective in reducing pain level, improving pressure pain threshold and improving function in treating patients who suffering from back myofascial pain syndrome at iliocostalis lumborum. As there was no statistically significant difference was proven between both of them.

Keywords: positional release technique, kinesio tape, myofascial pain syndrome, Iliocostalis lumborum

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Authors: Fabiola Xavier Leal, Lara Campanharo, Sueli Aparecida Rodrigues Lucas

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The phenomenon of judicialization in health policy brings with it a great deal of problematization, but in general, it means that some issues that were previously solved by traditional political bodies are being decided by the Judiciary bodies. It is, therefore, a controversial topic that has generated many reflections both in the academic and political fields, considering that not only a dispute of public funds is at stake, but also the debate on access to social rights provided for in the Brazilian Federal Constitution of 1988 and in the various public policies, such as healthcare. With regard to the phenomenon in the Mental Health Policy focusing on people who use drugs, the disputes that permeate this scenario are evident: moral, cultural, sanitary, economic, psychological aspects. There are also the individual and collective dimensions of suffering. And in this process, we all question: What is the role of the Brazilian State in this matter? In this context, another question that needs to be answered is the amount spent on this procedure in the state of Espírito Santo (ES), Brazil (in the last 04 years, around R$121,978,591.44 were paid only for compulsory hospitalization of individuals) in the field in question, which is the financing of the services of the Psychosocial Care Network (RAPS). Therefore, this article aims to problematize the phenomenon of judicialization in Mental Health Policy through the compulsory hospitalization of people who use drugs in Espírito Santo (ES). We proposed a study that sought to understand how this has been occurring and making an impact on the provision of RAPS services in the Espírito Santo scenario. Therefore, the general objective of this study is to analyze the expenses with compulsory hospitalizations for drug use carried out by the State Health Department (SESA) between 2014 and 2019, in which we will seek to identify its destination and the impact of these actions on public health policy. For the purposes of this article, we will present the preliminary data of this study, such as the amount spent by the state and the receiving institutions. For data collection, the following data sources were used: documents available publicly on the Transparency Portal (payments made per year, institutions that received, subjects hospitalized, period and the amount of the daily rates paid); as well as the processes generated by SESA through its own system - ONBASE. For qualitative analysis, content analysis was used; and for quantitative analysis, descriptive statistics was used. Thus, we seek to problematize the issue of judicialization for compulsory hospitalizations, considering the current situation in which this resource has been widely requested to legitimize the war on drugs. This scenario highlights the moral-legal discourse, pointing out strategies through the control of bodies and through faith as an alternative.

Keywords: compulsory hospitalization, drugs, judicialization, mental health

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Authors: Rahul Rajak, Archana Kumari Roy

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Purpose: Development brings about structural change in the society. It is essential for socio-economic progress of the society, but it also causes pain to the people who are forced to displace from their motherland. Most of the people who are displaced due to development are poor and tribes. Development and displacement are interlinked with each other in the sense development sometimes leads to displacement of people. These studies mainly focus on socio-economic profile of villages and villagers likely to be affected by the Airport Project and they examine the issues of compensation and people’s level of satisfaction. Methodology: The study is based on Descriptive design; it is basically observational and correlation study. Primary data is used in this study. Considering the time and resource constrains, 100 people were interviewed covering socio-economic and demographic diversities from 6 out of 10 affected villages. Due to Navi Mumbai International Airport Project ten villages have to be displaced. Out of ten villages, this study is based on only six villages. These are Ulwe, Ganeshpuri, Targhar Komberbuje, Chincpada and Kopar. All six villages situated in Raigarh district under the Taluka Panvel in Maharashtra. Findings: It is revealed from the survey that there are three main castes of affected villages that are Agri, Koli, and Kradi. Entire village population of migrated person is very negligible. All three caste have main occupation are agricultural and fishing activities. People’s perception revealed that due to the establishment of the airport project, they may have more opportunities and scope of development rather than the adverse effect, but vigorously leave a motherland is psychological effect of the villagers. Research Limitation: This study is based on only six villages, the scenario of the entire ten affected villages is not explained by this research. Practical implication: The scenario of displacement and resettlement signifies more than a mere physical relocation. Compensation is not only hope for villagers, is it only give short time relief. There is a need to evolve institutions to protect and strengthen the right of Individuals. The development induced displacement exposed them to a new reality, the reality of their legality and illegality of stay on the land which belongs to the state. Originality: Mumbai has large population and high industrialized city have put land at the center of any policy implication. This paper demonstrates through the actual picture gathered from the field that how seriously the affected people suffered and are still suffering because of the land acquisition for the Navi Mumbai International Airport Project. The whole picture arise the question which is how long the government can deny the rights to farmers and agricultural laborers and remain unwilling to establish the balance between democracy and development.

Keywords: compensation, displacement, land acquisition, project affected person (PAPs), rehabilitation

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Authors: Souradip Paul, Arijit Paramanick, M. Suheshkumar Singh

Abstract:

Traumatic injury is the leading worldwide health problem. Annually, millions of surgical wounds are created for the sake of routine medical care. The healing of these unintended injuries is always monitored based on visual inspection. The maximal restoration of tissue functionality remains a significant concern of clinical care. Although minor injuries heal well with proper care and medical treatment, large injuries negatively influence various factors (vasculature insufficiency, tissue coagulation) and cause poor healing. Demographically, the number of people suffering from severe wounds and impaired healing conditions is burdensome for both human health and the economy. An incomplete understanding of the functional and molecular mechanism of tissue healing often leads to a lack of proper therapies and treatment. Hence, strong and promising medical guidance is necessary for monitoring the tissue regeneration processes. Photoacoustic imaging (PAI), is a non-invasive, hybrid imaging modality that can provide a suitable solution in this regard. Light combined with sound offers structural, functional and molecular information from the higher penetration depth. Therefore, molecular and structural mechanisms of tissue repair will be readily observable in PAI from the superficial layer and in the deep tissue region. Blood vessel formation and its growth is an essential tissue-repairing components. These vessels supply nutrition and oxygen to the cell in the wound region. Angiogenesis (formation of new capillaries from existing blood vessels) contributes to new blood vessel formation during tissue repair. The betterment of tissue healing directly depends on angiogenesis. Other optical microscopy techniques can visualize angiogenesis in micron-scale penetration depth but are unable to provide deep tissue information. PAI overcomes this barrier due to its unique capability. It is ideally suited for deep tissue imaging and provides the rich optical contrast generated by hemoglobin in blood vessels. Hence, an early angiogenesis detection method provided by PAI leads to monitoring the medical treatment of the wound. Along with functional property, mechanical property also plays a key role in tissue regeneration. The wound heals through a dynamic series of physiological events like coagulation, granulation tissue formation, and extracellular matrix (ECM) remodeling. Therefore tissue elasticity changes, can be identified using non-contact photoacoustic elastography (PAE). In a nutshell, angiogenesis and biomechanical properties are both critical parameters for tissue healing and these can be characterized in a single imaging modality (PAI).

Keywords: PAT, wound healing, tissue coagulation, angiogenesis

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Authors: B. Shahzamanian, S. Varga, D. C. Alarcón-Padilla

Abstract:

Desalination is considered the primary alternative to increase water supply for domestic, agricultural and industrial use. Sustainable desalination is only possible in places where renewable energy resources are available. Solar energy is the most relevant type of renewable energy to driving desalination systems since most of the areas suffering from water scarcity are characterized by a high amount of available solar radiation during the year. Multi-Effect Desalination (MED) technology integrated with solar thermal concentrators is a suitable combination for heat-driven desalination. It can also be coupled with thermal vapour compressors or absorption heat pumps to boost overall system performance. The most interesting advantage of MED is the suitability to be used with a transient source of energy like solar. An experimental study was carried out to assess the performance of the most important life-size multi-effect desalination plant driven by solar energy located in the Plataforma Solar de Almería (PSA). The MED plant is used as a reference in many studies regarding multi-effect distillation. The system consists of a 14-effect MED plant coupled with a double-effect absorption heat pump. The required thermal energy to run the desalination system is supplied by means of hot water generated from 60 static flat-plate solar collectors with a total aperture area of 606 m2. In order to compensate for the solar energy variation, a thermal storage system with two interconnected tanks and an overall volume of 40 m3 is coupled to the MED unit. The multi-effect distillation unit is built in a forward feed configuration, and the last effect is connected to a double-effect LiBr-H2O absorption heat pump. The heat pump requires steam at 180 ºC (10 bar a) that is supplied by a small-aperture parabolic trough solar field with a total aperture area of 230 m2. When needed, a gas boiler is used as an auxiliary heat source for operating the heat pump and the MED plant when solar energy is not available. A set of experiments was carried out for evaluating the impact of the heating water temperature (Th), top brine temperature (TBT) and temperature difference between effects (ΔT) on the performance ratio of the MED plant. The considered range for variation of Th, TBT and ΔT was 60-70°C, 54-63°C and 1.1-1.6°C, respectively. The performance ratio (PR), defined as kg of distillate produced for every 2326 kJ of thermal energy supplied to the MED system, was almost independent of the applied variables with a variation of less than 5% for all the cases. The maximum recorded PR was 12.4. The results indicated that the system demonstrated robustness for the whole range of operating conditions considered. Author gratitude is expressed to the PSA for providing access to its installations, the support of its scientific and technical staff, and the financial support of the SFERA-III project (Grant Agreement No 823802). Special thanks to the access provider staff members who ensured the access support.

Keywords: multi-effect distillation, performance ratio, robustness, solar energy

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Authors: M. Shukry

Abstract:

According to the United Nations Declaration of Human Rights in 1948, every human being is entitled to rights in life that should be respected by others and protected by the state and community. Such rights are inherent regardless of colour, ethnicity, gender, religion or otherwise, and it is expected that all humans alike have the right to live without discrimination of any sort. However, that has not been the case with Aborigines in Australia. Over a long period of time, the governments of the State and the Territories and the Australian Commonwealth denied the Aboriginal and Indigenous inhabitants of the Torres Strait Islands such rights. Past Australian governments set policies and laws that enabled them to forcefully remove Indigenous children from their parents, which resulted in creating lost generations living the trauma of the loss of cultural identity, alienation and even their own selfhood. Intending to reduce that population of natives and their Aboriginal culture while, on the other hand, assimilate them into mainstream society, they gave themselves the right to remove them from their families with no hope of return. That practice has led to tragic consequences due to the trauma that has affected those children, an experience that is depicted by Jane Harrison in her play Stolen. The drama is the outcome of a six-year project on lost children and which was first performed in 1997 in Melbourne. Five actors only appear on the stage, playing the role of all the different characters, whether the main protagonists or the remaining cast, present or non-present ones as voices. The play outlines the life of five children who have been taken from their parents at an early age, entailing a disastrous negative impact that differs from one to the other. Unknown to each other, what connects between them is being put in a children’s home. The purpose of this paper is to analyse the play’s text in light of the 1948 Declaration of Human Rights, using it as a lens that reflects the atrocities practiced against the Aborigines. It highlights how such practices formed an outrageous violation of those natives’ rights as human beings. Harrison’s dramatic technique in conveying the children’s experiences is through a non-linear structure, fluctuating between past and present that are linked together within each of the five characters, reflecting their suffering and pain to create an emotional link between them and the audience. Her dramatic handling of the issue by fusing tragedy with humour as well as symbolism is a successful technique in revealing the traumatic memory of those children and their present life. The play has made a difference in commencing to address the problem of the right of all children to be with their families, which renders the real meaning of having a home and an identity as people.

Keywords: aboriginal, audience, Australia, children, culture, drama, home, human rights, identity, Indigenous, Jane Harrison, memory, scenic effects, setting, stage, stage directions, Stolen, trauma

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Authors: M. Iqbal Hossain, Azharul Islam Khan, S. M. Rafiqul Islam, Tahmeed Ahmed

Abstract:

Objective: Moderate acute malnutrition (MAM) is a major cause of morbidity and mortality in under-5 children of low-income countries. Approximately 14.6% of all under-5 mortality worldwide is attributed to MAM with >3 times increased risk of death compared to well-nourished peers. Prevalence of MAM among under-5 children in Bangladesh is ~12% (~1.7 million). Providing a diet containing adequate nutrients is the mainstay of treatment of children with MAM. It is now possible to process fish into fish peptides with longer shelf-life without refrigerator, known as ‘Fish Surimi peptide’ and this could be an attractive alternative to supply fish protein in the diet of children in low-income countries like Bangladesh. We conducted this study to assess the acceptability of Fish Surimi peptide given with various foods/meals in 2-5 years old children with MAM. Design/methods: Fish Surimi peptide is broken down from white fish meat using plant-derived enzyme and the ingredient is just fish meat consisted of 20 different kinds of amino acids including nine essential amino acids. In a convenience sample of 34 children we completed the study ward of Dhaka Hospital of icddr,b in Bangladesh during November 2014 through February 2015. For each child the study was for two consecutive days: i.e. direct observation of food intake of two lunches and two suppers. In a randomly and blinded manner and cross over design an individual child received Fish Surimi peptide (5g at lunch and 5g at supper) mixed meal [e.g. 30g rice and 30g dahl (thick lentil soup) or 60g of a vegetables-lentil-rice mixed local dish known as khichuri in one day and the same meal on other day without any Fish Surimi peptide. We observed the completeness and eagerness of eating and any possible side effect (e.g. allergy, vomiting, diarrhea etc.) over these two days. Results: The mean±SD age of the enrolled children was 38.4±9.4 months, weight 11.22±1.41 kg, height 91.0±6.3 cm, and WHZ was -2.13±0.76. Their mean±SD total feeding time (minutes) for lunch was 25.4±13.6 vs. 20.6±11.1 (p=0.130) and supper was 22.3±9.7 vs. 19.7±11.2 (p=0.297), and total amount (g) of food eaten in lunch and supper was found similar 116.1±7.0 vs. 117.7±8.0 (p=3.01) in A (Fish Surimi) and B group respectively. Score in Hedonic scale by mother on test of food given to children at lunch or supper was 3.9±0.2 vs. 4.0±0.2 (p=0.317) and on overall acceptance (including the texture, smell, and appearance) of food at lunch or supper was 3.9±0.2 vs. 4.0±0.2 (p=0.317) for A and B group respectively. No adverse event was observed in any food group during the study period. Conclusions: Fish Surimi peptide may be a cost effective supplementary food, which should be tested by appropriately designed randomized community level intervention trial both in wasted children and stunted children.

Keywords: protein-energy malnutrition, moderate acute malnutrition, weight-for-height z-score, mid upper arm circumference, acceptability, fish surimi peptide, under-5 children

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