Search results for: extrapyramidal side effects/disorder

Authors: Adam Al-Harbi, Chanel Powell, Katelyn Ward

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In the age of social media and online body forums, the perception of body image among teenagers is constantly evolving. Growing up in an era of instant comparison facilitated by the internet, adolescents often struggle with self-identity, comparing their lives and bodies to countless others online. This environment has made it easier for them to access information on restrictive diets and fasting, contributing to the unfortunate glamorization of eating disorders. Although beauty standards have existed for centuries, social media amplifies these pressures. Platforms such as Instagram and TikTok have created spaces where teens are constantly exposed to idealized body types and beauty standards. This exposure often leads to harmful comparisons, fostering feelings of inadequacy and negative self-worth. Research indicates that adolescents, especially young girls, are at heightened risk for developing eating disorders like anorexia nervosa as they internalize these unrealistic standards. Anorexia nervosa, which has the highest mortality rate of any psychiatric disorder, is particularly alarming, with one in five anorexia deaths resulting from suicide. Young individuals with anorexia are twelve times more likely to die than their peers without the disorder. This paper aims to summarize the current state of literature comparing cognitive-behavioral therapy (CBT) and family-based therapy (FBT) in reducing morbidity, and mortality, and preventing symptom recurrence among adolescents with anorexia. CBT is a widely used treatment for eating disorders, particularly anorexia nervosa, while FBT is notable for its involvement of family members, which is crucial for developing teens and adolescents.

Keywords: psychology, CBT, FBT, eating disorders, anorexia, therapeutic modalities

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Authors: Danielle Page

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Foregoing studies, statistics, and medical evaluations have established a relationship between Posttraumatic stress disorder (PTSD) and criminal justice involvement in Vietnam veterans. War is highly trauma inducing and can leave combat veterans with mental disorders ranging from psychopathic thoughts to suicidal ideation. The majority of those suffering are unaware that they have PTSD, and as a coping mechanism, they often turn to self isolation. Beyond isolation, many veterans with symptomatic PTSD turn to aggression and substance abuse to cope with their internal agony. The most common crimes committed by veterans with PTSD fall into the assault and drug/alcohol abuse categories. Thus, a relationship is established between veteran populations and the criminal justice system. This research aims to define the relationship between PTSD and criminal justice involvement in veterans, explore the mediating factors in this relationship, and analyze numerous court cases in this subject area. Further, it will examine the ways in which crime rates can be reduced for veterans with symptoms of PTSD. This ranges from the improvement of healthcare systems to the implementation of special courts to handle veteran cases. The contribution of this work to the field of forensic psychology will be significant, as it will analyze preexisting case studies and experimental data in an effort to improve the ways in which veteran cases are handled in the criminal justice system. Military personnel involved in the criminal justice system are a vulnerable population in need of healthcare and legislative attention, and this work will bring us one step closer to providing them with just that.

Keywords: forensic psychology, psychotraumatology, PTSD, veterans

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Authors: Louise Penzenstadler, Tiphaine Robet, Radu Iuga, Daniele Zullino

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Context: The outpatient clinic of the psychiatric addiction service of Geneva University Hospital has been providing support to individuals affected by various narcotics for 30 years. However, the increasing consumption of crack cocaine in Geneva has presented a new challenge for the healthcare system. Research Aim: The aim of this research is to evaluate the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder. Methodology: The research utilizes a combination of quantitative and qualitative retrospective data analysis to evaluate the effectiveness of the outreach intervention. Findings: The data collected from October 2023 to December 2023 show that the outreach program successfully made 1,071 contacts with drug users and led to 15 new requests for care and enrollment in treatment. Patients expressed high satisfaction with the intervention, citing easy and rapid access to treatment and social support. Theoretical Importance: This research contributes to the understanding of the challenges and specific needs of a complex group of drug users who face severe health problems. It highlights the importance of outreach interventions in establishing trust, connecting users with care, and facilitating medication-assisted treatment for opioid addiction. Data Collection: Data was collected through the outreach program's interactions with drug users, including street outreach interventions and presence at locations frequented by users. Patient satisfaction surveys were also utilized. Analysis Procedures: The collected data was analyzed using both quantitative and qualitative methods. The quantitative analysis involved examining the number of contacts made, new requests for care, and treatment enrollment. The qualitative analysis focused on patient satisfaction and their perceptions of the intervention. Questions Addressed: The research addresses the following questions: What is the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder? How effective is the outreach program in connecting drug users with care and initiating medication-assisted treatment? Conclusion: The outreach program has proven to be an effective intervention in establishing trust with crack users, connecting them with care, and initiating medication-assisted treatment for opioid addiction. It has also highlighted the importance of addressing the specific challenges faced by this group of drug users.

Keywords: crack addiction, outreach treatment, peer intervention, polydrug use

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Authors: Natalia Kartushina

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Foreign (second) language (L2) learning is highly promoted in modern society. Students are encouraged to study abroad (SA) to achieve the most effective learning outcomes. However, L2 learning has side effects for native language (L1) production, as L1 sounds might show a drift from the L1 norms towards those of the L2, and this, even after a short period of L2 learning. L1 assimilatory drift has been attributed to a strong perceptual association between similar L1 and L2 sounds in the mind of L2 leaners; thus, a change in the production of an L2 target leads to the change in the production of the related L1 sound. However, nowadays, it is quite common that speakers acquire two languages from birth, as, for example, it is the case for many bilingual communities (e.g., Basque and Spanish in the Basque Country). Yet, it remains to be established how FL learning affects native production in individuals who have two native languages, i.e., in simultaneous or very early bilinguals. Does FL learning (here a third language, L3) affect bilinguals’ both languages or only one? What factors determine which of the bilinguals’ languages is more susceptible to change? The current study examines the effects of L3 (English) learning on the production of vowels in the two native languages of simultaneous Spanish-Basque bilingual adolescents enrolled into the Erasmus SA English program. Ten bilingual speakers read five Spanish and Basque consonant-vowel-consonant-vowel words two months before their SA and the next day after their arrival back to Spain. Each word contained the target vowel in the stressed syllable and was repeated five times. Acoustic analyses measuring vowel openness (F1) and backness (F2) were performed. Two possible outcomes were considered. First, we predicted that L3 learning would affect the production of only one language and this would be the language that would be used the most in contact with English during the SA period. This prediction stems from the results of recent studies showing that early bilinguals have separate phonological systems for each of their languages; and that late FL learner (as it is the case of our participants), who tend to use their L1 in language-mixing contexts, have more L2-accented L1 speech. The second possibility stated that L3 learning would affect both of the bilinguals’ languages in line with the studies showing that bilinguals’ L1 and L2 phonologies interact and constantly co-influence each other. The results revealed that speakers who used both languages equally often (balanced users) showed an F1 drift in both languages toward the F1 of the English vowel space. Unbalanced speakers, however, showed a drift only in the less used language. The results are discussed in light of recent studies suggesting that the amount of language use is a strong predictor of the authenticity in speech production with less language use leading to more foreign-accented speech and, eventually, to language attrition.

Keywords: language-contact, multilingualism, phonetic drift, bilinguals' production

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Authors: Hannah Bigelow, Marcus D. Gottlieb, Michelle Ogrodnik, Jeffrey, D. Graham, Barbara Fenesi

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Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders affecting approximately 6% of children worldwide. ADHD is characterized by a combination of persistent deficits including impaired inhibitory control, working memory and task-switching. Many children with ADHD also have comorbid mental health issues such as anxiety and depression. There are several treatment options to manage ADHD impairments, including drug and behavioural management therapy, but they all have drawbacks, such as worsening mood disturbances or being inaccessible to certain demographics. Both physical exercise and mindfulness meditation serve as alternative options to potentially help mitigate ADHD symptoms. Although there is extensive support for the benefits of long-term physical exercise or mindfulness meditation programs, there is insufficient research investigating how acute bouts (i.e., single, short bouts) can help children with ADHD. Thus, the current study aimed to understand how single, short bouts of exercise and mindfulness meditation impacts executive functioning and psycho-emotional well-being in children with ADHD, as well as to directly compare the efficacy of these two interventions. The study used a a pre- post-test, within-subjects design to assess the effects of a 10-minute bout of moderate intensity exercise versus a 10-minute bout of mindfulness meditation (versus 10 minutes of a reading control) on the executive functioning and psycho-emotional well-being of 16 children and youth with ADHD aged 10-14 (male=11; White=80%). Participants completed all three interventions: 10 minutes of exercise, 10 minutes of mindfulness meditation, and 10 minutes of reading (control). Executive functioning (inhibitory control, working memory, task-switching) and psycho-emotional well-being (mood, self-efficacy) were assessed before and after each intervention. Mindfulness meditation promoted executive functioning, while exercise enhanced positive mood and self-efficacy. Critically, this work demonstrates that a single, short bout of mindfulness meditation session can promote inhibitory control among children with ADHD. This is especially important for children with ADHD as inhibitory control deficits are among the most pervasive challenges that they face. Furthermore, the current study provides preliminary evidence for the benefit of acute exercise for promoting positive mood and general self-efficacy for children and youth with ADHD. These results may increase the accessibility of acute exercise for children with ADHD, providing guardians and teachers a feasible option to incorporate just 10 minutes of exercise to assist children emotionally. In summary, this research supports the use of acute exercise and mindfulness meditation on varying aspects of executive functioning and psycho-emotional well-being in children and youth with ADHD. This work offers important insight into how behavioural interventions could be personalized according to a child’s needs.

Keywords: attention-deficit hyperactivity disorder (ADHD), acute exercise, mindfulness meditation, executive functioning, psycho-emotional well-being

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Authors: Arindam Roy

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Public policy is an intriguing terrain, which involves complex interplay of administrative, social political and economic components. There is hardly any fit-for all formulation of public policy as Lindbloom has aptly categorized it as a science of muddling through. In fact, policies are both temporally and contextually determined as one the proponents of policy sciences Harold D Lasswell has underscored it in his ‘contextual-configurative analysis’ as early as 1950s. Though, a lot of theoretical efforts have been made to make sense of this intricate dynamics of policy making, at the end of the day the applied area of public policy negates any such uniform, planned and systematic formulation. However, our policy makers seem to have learnt very little of that. Until recently, policy making was deemed as an absolutely specialized exercise to be conducted by a cadre of professionally trained seasoned mandarin. Attributes like homogeneity, impartiality, efficiency, and neutrality were considered as the watchwords of delivering common goods. Citizen or clientele was conceptualized as universal political or economic construct, to be taken care of uniformly. Moreover, policy makers usually have the proclivity to put anything into straightjacket, and to ignore the nuances therein. Hence, least attention has been given to the ground level reality, especially the socio-cultural milieu where the policy is supposed to be applied. Consequently, a substantial amount of public money goes in vain as the intended beneficiaries remain indifferent to the delivery of public policies. The present paper in the light of Reproductive Health Care policy in rural West Bengal has tried to underscore the criticality of socio-cultural factors in public health delivery. Indian health sector has traversed a long way. From a near non-existent at the time of independence, the Indian state has gradually built a country-wide network of health infrastructure. Yet it has to make a major breakthrough in terms of coverage and penetration of the health services in the rural areas. Several factors are held responsible for such state of things. These include lack of proper infrastructure, medicine, communication, ambulatory services, doctors, nursing services and trained birth attendants. Policy makers have underlined the importance of supply side in policy formulation and implementation. The successive policy documents concerning health delivery bear the testimony of it. The present paper seeks to interrogate the supply-side oriented explanations for the failure of the delivery of health services. Instead, it identified demand side to find out the answer. The state-led and bureaucratically engineered public health measures fail to engender demands as these measures mostly ignore socio-cultural nuances of health and well-being. Hence, the hiatus between supply side and demand side leads to huge wastage of revenue as health infrastructure, medicine and instruments remain unutilized in most cases. Therefore, taking proper cognizance of these factors could have streamlined the delivery of public health.

Keywords: context, policy, socio-cultural factor, uniformity

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Authors: Eun Ho Kim

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Innovations have conjured up a mode of treating GBM cancer cells in the newly diagnosed patients in a period of 4.9 months at an improved median OS, which brings along only a few minor side effects in the phase III of the clinical trial. This mode has been termed the Alternating Electric Fields (AEF). The study at hand is aimed at determining whether the AEF treatment is beneficial in sensitizing the GBM cancer cells through the process of increasing the AEF –induced senescence. The methodology to obtain the findings for this research ranged across various components, such as obtaining and testing SA-β-gal staining, flow cytometry, Western blotting, morphology, and Positron Emission Tomography (PET) / Computed Tomography (CT), immunohistochemical staining and microarray. The number of cells that displayed a senescence-specific morphology and positive SA-ß-Gal activity gradually increased up to 5 days. These results suggest that p16, p21 and p27 are essential regulators of AEF -induced senescence via NF-κB activation. The results showed that the AEF treatment is functional in enhancing the AEF –induced senescence in the GBM cells via an apoptosis- independent mechanism. This research concludes that this mode of treatment is a trustworthy protocol that can be effectively employed to overcome the limitations of the conventional mode of treatment on GBM.

Keywords: alternating electric fields, senescence, glioblastoma, cell death

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Authors: Navah Z. Ratzon, Shlomit Cohen, Sigal Portnoy

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This work focuses on posture and risk factors for the musculoskeletal disorder in guitarists, which constitutes the largest group of musicians today. The source of the problems experienced by these musicians is linked to physical, psychosocial and personal risk factors. These muscular problems are referred to as Playing Related Musculoskeletal Disorder (PRMD). There is not enough research that specifically studies guitar players, and to the extent of our knowledge, there is almost no reference to the characteristics of their movement patterns while they play. This is in spite of the high prevalence of PRMD in this population. Kinematic research may provide a basis for the development of a prevention plan for this population and their unique characteristics of playing patterns. The aim of the study was to investigate the correlation between risk factors for PRMD among guitar players and self-reporting of pain in the skeletal muscles, and specifically to test whether there are differences in the kinematics of the upper body while playing in a sitting or standing posture. Twenty-five guitarists, aged 18-35, participated in the study. The methods included a motion analysis using a motion capture system, anthropometric measurements and questionnaires relating to risk factors. The questionnaires used were the Standardized Nordic Questionnaire for the Analysis of Musculoskeletal Symptoms and the Demand Control Support Questionnaire, as well as a questionnaire of personal details. All of the study participants complained of musculoskeletal pain in the past year; the most frequent complaints being in the left wrist. Statistically significant correlations were found between biodemographic indices and reports of pain in the past year and the previous week. No significant correlations were found between the physical posture while playing and reports of pain among professional guitarists. However, a difference was found in several kinematic parameters between seated and standing playing postures. In a majority of the joints, the joint angles while playing in a seated position were more extreme than those during standing. This finding may suggest a higher risk for musculoskeletal disorder while playing in a seated position. In conclusion, the results of the present research highlight the prevalence of musculoskeletal problems in guitar players and its correlation with various risk factors. The finding supports the need for intervention in the form of prevention through identifying the risk factors and addressing them. Relating to the person, to their occupation and environment, which are the basis of proper occupational therapy, can help meet this need.

Keywords: body posture, motion tracking, PRMD, guitarists

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Authors: Linda Frost, Lindsay Anderson, Jana Borras, Ariel Dysangco, Vimabayi Makwaira

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The academic environment in which nursing students are immersed in comes with many demands and expectations. Course load, clinical placements, and financial expenses are examples of the pressures facing students each semester. These pressures contribute to student stress and impact their overall well-being and mental fitness. Students' ability to cope with stress and bounce back from adversity is enhanced when we build their mental fitness. Building mental fitness has the benefit of improving physical health, relationships, self-esteem, resilience, work productivity, and overall contentment, happiness and life satisfaction. While self-care is encouraged to avoid burnout, there is a gap in literature on programs to help build nursing students’ mental health and ability to engage in self-care. There is an opportunity and a need to design programs and implement actions aimed at reducing stress and its adverse effects on nursing students. Nursing students require the support of people who understand the complexities of the nursing profession, multifaceted work environments in which they operate, and the impact these environments have on their mental fitness. Nursing academia is in the best position to ensure that tools are in place to support the next generation of nurses who face a career with significant emotional and physical demands. This is a mixed-method study using an embedded design. We utilized a pretest-posttest design to compare the difference in psychological capital (PsyCap) and burnout in students who have received the Mastering My Mental Fitness-Nurses™ (MMMF-N™) workshops (n=8) and the control group (n=9) who have not. Semi structured interviews were conducted with the eight nursing students in the intervention group, along with data from feedback forms to explore the impact of the workshops on student’s burnout and PsyCap and determine how to improve the workshops for future students. The quantitative and qualitative data will be merged using a side-by-side comparison. This will be in a discussion format that allows for the comparison of the results from both phases. The findings will be available January 2025. We anticipate that students in the control and intervention group will report similar levels of burnout. As well, students in the intervention group will indicate the benefits of the MMMF-N™ workshops through qualitative interviews and workshop feedback forms.

Keywords: burnout, mental fitness, nursing students, psychological capital

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Authors: Yasser R. Tawfic, Mohamed A. Eid

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Foundation differential settlement and supported structure tilting is an occasionally occurred engineering problem. This may be caused by overloading, changes in ground soil properties or unsupported nearby excavations. Engineering thinking points directly toward the logic solution for such problem by uplifting the settled side. This can be achieved with deep foundation elements such as micro-piles and macro-piles™, jacked piers and helical piers, jet grouted soil-crete columns, compaction grout columns, cement grouting or with chemical grouting, or traditional pit underpinning with concrete and mortar. Although, some of these techniques offer economic, fast and low noise solutions, many of them are quite the contrary. For tilted structures, with limited inclination, it may be much easier to cause a balancing settlement on the less-settlement side which shall be done carefully in a proper rate. This principal has been applied in Leaning Tower of Pisa stabilization with soil extraction from the ground surface. In this research, the authors attempt to introduce a new solution with a different point of view. So, micro-tunneling technique is presented in here as an intended ground deformation cause. In general, micro-tunneling is expected to induce limited ground deformations. Thus, the researchers propose to apply the technique to form small size ground unsupported holes to produce the target deformations. This shall be done in four phases: •Application of one or more micro-tunnels, regarding the existing differential settlement value, under the raised side of the tilted structure. •For each individual tunnel, the lining shall be pulled out from both sides (from jacking and receiving shafts) in slow rate. •If required, according to calculations and site records, an additional surface load can be applied on the raised foundation side. •Finally, a strengthening soil grouting shall be applied for stabilization after adjustment. A finite element based numerical model is presented to simulate the proposed construction phases for different tunneling positions and tunnels group. For each case, the surface settlements are calculated and induced plasticity points are checked. These results show the impact of the suggested procedure on the tilted structure and its feasibility. Comparing results also show the importance of the position selection and tunnels group gradual effect. Thus, a new engineering solution is presented to one of the structural and geotechnical engineering challenges.

Keywords: differential settlement, micro-tunneling, soil-structure interaction, tilted structures

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Authors: A. Y. Tsidulko, T. M. Pankova, E. V. Grigorieva

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High-grade gliomas are the most frequent and most aggressive brain tumors which are characterized by active invasion of tumor cells into the surrounding brain tissue, where the extracellular matrix (ECM) plays a crucial role. Disruption of ECM can be involved in anticancer drugs effectiveness, side-effects and also in tumor relapses. The anti-inflammatory agent dexamethasone is a common drug used during high-grade glioma treatment for alleviating cerebral edema. Although dexamethasone is widely used in the clinic, its effects on normal brain tissue ECM remain poorly investigated. It is known that proteoglycans (PGs) are a major component of the extracellular matrix in the central nervous system. In our work, we studied the effects of dexamethasone on the ECM proteoglycans (syndecan-1, glypican-1, perlecan, versican, brevican, NG2, decorin, biglican, lumican) using RT-PCR in the experimental animal model. It was shown that proteoglycans in rat brain have age-specific expression patterns. In early post-natal rat brain (8 days old rat pups) overall PGs expression was quite high and mainly expressed PGs were biglycan, decorin, and syndecan-1. The overall transcriptional activity of PGs in adult rat brain is 1.5-fold decreased compared to post-natal brain. The expression pattern was changed as well with biglycan, decorin, syndecan-1, glypican-1 and brevican becoming almost equally expressed. PGs expression patterns create a specific tissue microenvironment that differs in developing and adult brain. Dexamethasone regimen close to the one used in the clinic during high-grade glioma treatment significantly affects proteoglycans expression. It was shown that overall PGs transcription activity is 1.5-2-folds increased after dexamethasone treatment. The most up-regulated PGs were biglycan, decorin, and lumican. The PGs expression pattern in adult brain changed after treatment becoming quite close to the expression pattern in developing brain. It is known that microenvironment in developing tissues promotes cells proliferation while in adult tissues proliferation is usually suppressed. The changes occurring in the adult brain after dexamethasone treatment may lead to re-activation of cell proliferation due to signals from changed microenvironment. Taken together obtained data show that dexamethasone treatment significantly affects the normal brain ECM, creating the appropriate microenvironment for tumor cells proliferation and thus can reduce the effectiveness of anticancer treatment and promote tumor relapses. This work has been supported by a Russian Science Foundation (RSF Grant 16-15-10243)

Keywords: dexamthasone, extracellular matrix, glioma, proteoglycan

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Authors: Mohammed E. Ibrahim, Baraa A. Taha, Kamil M. A. Shabban

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Background: Epilepsy is a common but widely misunderstood illness. Consequently, patients with epilepsy suffer from considerable stigmatization in society. This social stigma and discrimination often cause more suffering for the patients than the disease itself. Since very few studies have explored the misperceptions about epilepsy among university students in Sudan, it is not possible to provide focused intervention aimed at eliminating this discrimination. Methods: A cross-sectional study was applied among the first-year medical students at the University of Khartoum between December (2020) and February (2021). A 29-item standardized questionnaire was self-administered by 198 students (out of 320) who agreed to participate in this study. Google form was the tool used to collect the data. The data were analyzed using the Statistical Package for Social Science software version 26. Result: Overall, the results indicate a negative trend in knowledge and attitude toward epilepsy. The vast majority of the respondents (84.8%) have read or heard about epilepsy, while 43.9% had seen someone with epilepsy. Only 7.5% of the participants reported that epilepsy is contagious, whereas 43.4% of them think that epilepsy is a psychological disorder. About 62.2% of students think head/birth trauma is a cause of epilepsy. On the other side, about 15.7% and 5.1% believed that evil spirits and punishment from god can also be a possible cause of epilepsy; we found these false beliefs are more common in participants from rural areas (p-value < 0.05). In regard to attitude, 19.7% of students thought that it is inappropriate for a patient with epilepsy to have a child. This attitude correlates with the mother’s education as the percentage is higher for those who have lower mother’s education (through secondary school education and below) (p < 0.05). The majority of Our participant knew that some people with epilepsy need life-long drug treatment; this belief was found to be more common in females than their counterparts(p < 0.05). . Finally, most of the respondents (93.9%) thought that a child with epilepsy Can be successful in a normal class. This belief is four-time as common in participants whose mothers have higher education (through university education and above) compared with corresponding respondents (p < 0.05). Conclusion: This study concludes that students' knowledge about epilepsy is limited and requires immediate intervention through educational campaigns to develop a well-informed and tolerant community.

Keywords: epilepsy, awareness, attitude, university students, Sudan

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Authors: Yi-De Liu

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For many European cities, a key motivation in developing event strategies is to use event as a catalyst for urban regeneration. One type of event that is particularly used as a means of urban development is the European Capital of Culture (ECOC) initiative. Based on a case study of the 2008 ECOC Liverpool, this paper aims at conceptualising the significance of major event for a city’s economic, cultural and social regenerations. In terms of economic regeneration, the role of the ECOC is central in creating Liverpool’s visitor economy and reshaping city image. Liverpool planned different themes for eight consecutive years as a way to ensure economic sustainability. As far as cultural regeneration is concerned, the ECOC contributed to the cultural regeneration of Liverpool by stimulating cultural participation and interest from the demand side, as well as improving cultural provision and collaboration within the cultural sector from the supply side. So as to social regeneration, Liverpool treated access development as a policy guideline and considered the ECOC as an opportunity to enhance the sense of place. The most significant lesson learned from Liverpool is its long-term planning and efforts made to integrate the ECOC into the overall urban development strategy. As a result, a more balanced and long-term effect on urban regeneration could be achieved.

Keywords: cultural event, urban regeneration, european capital of culture, Liverpool

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Authors: Xinrong Li, Jiawei Dai

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Food production, food safety, and the food supply chain are causing a great challenge to human health and the environment. Different kinds of food have different environmental costs. Therefore, a healthy diet can alleviate this problem to a certain extent. In this project, an online questionnaire was conducted to understand the purchase behaviour of consumers and their attitudes towards basic food information. However, the data shows that the public's current consumption habits and ideology do not meet the long-term development of sustainable social needs. In order to solve the environmental problems caused by the unbalanced diet of the public and the social problems of unequal food distribution, the purpose of this paper is to explore how to use the emerging media of VR to visualize food supply chain information so as to attract users' attention to the environmental cost of food. In this project, the food supply chain of imported and local cheese was compared side-by-side in the virtual reality environment, including the origin, transportation, sales, and other processes, which can effectively help users understand the difference between the two processes and environmental costs. Besides, the experimental data demonstrated that the participant would like to choose low environmental cost food after experiencing the whole process.

Keywords: virtual reality, information design, food supply chain, environmental cost

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Authors: Asma Zaib, Saeed Khan, Ayaz Ahmed Noonari, Sehrish Bint-e-Mohsin

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Breast cancer is the most common cancer among females worldwide and is estimated that more than 450,000 deaths are reported each year. It accounts for about 14% of all female cancer deaths. Angiogenesis plays an essential role in Breast cancer development, invasion, and metastasis. Breast cancer predominantly begins in luminal epithelial cells lining the normal breast ducts. Breast carcinoma likely requires coordinated efforts of both increased proliferation and increased motility to progress to metastatic stages.Resveratrol: a natural stilbenoid, has anti-inflammatory and anticancer effects that inhibits proliferation of variety of human cancer cell lines, including breast, prostate, stomach, colon, pancreatic, and thyroid cancers.The objective of this study is:To investigate anti-neoangiogenesis effects of Resveratrol in breast cancer and to analyze inhibitory effects of resveratrol on aromatase, Erα, HER2/neu, and VEGFR.Docking is the computational determination of binding affinity between molecule (protein structure and ligand).We performed molecular docking using Swiss-Dock and to determine docking effects of (1) Resveratrol with Aromatase, (2) Resveratrol with ERα (3) Resveratrol with HER2/neu and (4) Resveratrol with VEGFR2.Docking results of resveratrol determined inhibitory effects on aromatase with binding energy of -7.28 kcal/mol which shows anticancerous effects on estrogen dependent breast tumors. Resveratrol also show inhibitory effects on ERα and HER2/new with binging energy -8.02, and -6.74 respectively; which revealed anti-cytoproliferative effects upon breast cancer. On the other hand resveratrol v/s VEGFR showed potential inhibitory effects on neo-angiogenesis with binding energy -7.68 kcal/mol, angiogenesis is the important phenomenon that promote tumor development and metastasis. Resveratrol is an anti-breast cancer agent conformed by in silico studies, it has been identified that resveratrol can inhibit breast cancer cells proliferation by acting as competitive inhibitor of aromatase, ERα and HER2 neo, while neo-angiogemesis is restricted by binding to VEGFR which authenticates the anti-carcinogenic effects of resveratrol against breast cancer.

Keywords: angiogenesis, anti-cytoproliferative, molecular docking, resveratrol

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Authors: Afsaneh Ghorbanzadeh, Afshin Farahbakhsh, Zakieh Bayat

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The drug capsulation was used for release and targeted delivery in determined time, place and temperature or pH. The DOX nanocapsules were used to reduce and to minimize the unwanted side effects of drug. In this paper, the encapsulation methods of doxorubicin (DOX) and the labeling it by the magnetic core of iron (Fe3O4) has been studied. The Fe3O4 was conjugated with DOX via hydrazine bond. The solution was capsuled by the sensitive polymer of heat or pH such as chitosan-g-poly (N-isopropylacrylamide-co-N,N-dimethylacrylamide), dextran-g-poly(N-isopropylacrylamide-co-N,N-dimethylacrylamide) and mPEG-G2.5 PAMAM by hydrazine bond. The drug release was very slow at temperatures lower than 380°C. There was a rapid and controlled drug release at temperatures higher than 380°C. According to experiments, the use mPEG-G2.5PAMAM is the best method of DOX nanocapsules synthesis, because in this method, the drug delivery time to certain place is lower than other methods and the percentage of released drug is higher. The synthesized magnetic carrier system has potential applications in magnetic drug-targeting delivery and magnetic resonance imaging.

Keywords: drug carrier, drug release, doxorubicin, iron oxide NPs

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Authors: Omaymah Al-Otoom, Rajesh Mehta

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Introduction: Migration is an established risk factor in the development of schizophrenia and other forms of psychosis. The exposure to different social adversities, including social isolation, discrimination, and economic stress, is thought to contribute to elevated rates of psychosis in immigrants and their children. We present a case of resistant schizophrenia in an immigrant adolescent. Case: The patient is a 15-year-old male immigrant. In October 2021, the patient was admitted for irritability, suicidal ideations, and hallucinations. He was treated with Fluoxetine 10 mg daily for irritability. In November 2021, he presented with similar manifestations. Fluoxetine was discontinued, and Risperidone 1 mg at bedtime was started for psychotic symptoms. In March 2022, he presented with commanding auditory hallucinations (voices telling him that people were going to kill his father). Risperidone was gradually increased to 2.5 mg twice daily for hallucinations. The outpatient provider discontinued Risperidone and started Olanzapine 7.5 mg and Lurasidone 40 mg daily. In August 2022, he presented with worsening paranoia due to medication non-adherence. The patient had limited improvement on medications. In October 2022, the patient presented to the ED for visual hallucinations and aggression towards the family. His medications were Olanzapine 10 mg daily, Lurasidone 60 mg daily, and Haloperidol 2.5 mg twice daily. In the ED, he received multiple as-needed medications and was placed in seclusion for his aggressive behavior. The patient showed a positive response to a higher dose of Olanzapine and decreased dose of Lurasidone. The patient was discharged home in stable condition. Two days after discharge, he was brought for bizarre behavior, visual hallucinations, and homicidal ideations at school. Due to concerns for potential antipsychotic side effects and poor response, Lurasidone and Olanzapine were discontinued, and he was discharged home on Haloperidol 5 mg in the morning and 15 mg in the evening. Clozapine treatment was recommended on an outpatient basis. He has no family history of psychotic disorders. He has no history of substance use. A medical workup was done, the electroencephalogram was normal, and the urine toxicology was negative. Discussion: Our patient was on three antipsychotics at some point with no improvement in his psychotic symptoms, which qualifies as treatment-resistant schizophrenia (TRP). It is well recognized that migrants are at higher risk of different psychiatric disorders, including posttraumatic stress disorder, affective disorders, schizophrenia, and psychosis. This is thought to be related to higher exposure to traumatic life events compared to the general population. In addition, migrants are more likely to experience poverty, separation from family members, and discrimination which could contribute to mental health issues. In one study, they found that people who migrated before the age of 18 had twice the risk of psychotic disorders compared to the native-born population. It is unclear whether migration increases the risk of treatment resistance. In a Canadian study, neither ethnicity nor migrant status was associated with treatment resistance; however, this study was limited by its small sample size. There is a need to implement psychiatric prevention strategies and outreach programs through research to mitigate the risk of mental health disorders among immigrants.

Keywords: psychosis, immigrant, adolescent, treatment resistant schizophrenia

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Authors: Mohamed Akbi, Aissa Bouchou

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The present work aims to throw light on the effects of arcing in air on the surface state of contact pastilles made of silver-nickel Ag-Ni (60/40). Also, the photoelectric emission from these electrical contacts has been investigated in the spectral range of 196-256 nm. In order to study the effects of arcing on the EWF, the metallic samples were subjected to electrical arcs in air, at atmospheric pressure and room temperature, after that, they have been introduced into the vacuum chamber of an experimental UHV set-up for EWF measurements. Both Fowler method of isothermal curves and linearized Fowler plots were used for the measurement of the EWF by the photoelectric effect. It has been found that the EWF varies with the number of applied arcs. Thus, after 500 arcs in air, the observed EWF increasing is probably due to progressive inclusion of oxide on alloy surface. Microscopic examination is necessary to get better understandings on EWF of silver alloys, for both virgin and arced electrical contacts.

Keywords: Ag-Ni contact materials, arcing effects, electron work function, Fowler methods, photoemission

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Authors: Ramona-Niculina Jurcau, Ioana-Marieta Jurcau, Dong Hun Kwak, Nicolae-Alexandru Colceriu

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Background: Stress management (SM) is a topic of great academic interest and equally a task to accomplish. In addition, it is recognized the beneficial role of unconventional therapies (UCT) in stress modulation. Aims: The aim was to evaluate medical (MS) versus non-medical students’ (NMS) opinions about academic stress management (ASM) using UCT. Methods: MS (n=103, third year males and females) and NMS (n=112, males and females, from humanities faculties, different years of study), out of their academic program, voluntarily answered to a questionnaire concerning: a) Classification of the four most important academic stress factors; b) The extent to which their daily life influences academic stress; c) The most important SM methods they know; d) Which of these methods they are applying; e) the UCT they know or about which they have heard; f) Which of these they know to have stress modulation effects; g) Which of these UCT, participants are using or would like to use for modulating stress; and if participants use UTC for their own choose or following a specialist consultation in those therapies (SCT); h) If they heard about the following UCT and what opinion they have (using visual analogue scale) about their use (following CST) for the ASM: Phytotherapy (PT), apitherapy (AT), homeopathy (H), ayurvedic medicine (AM), traditional Chinese medicine (TCM), music therapy (MT), color therapy (CT), forest therapy (FT). Results: Among the four most important academic stress factors, for MS more than for NMS, are: busy schedule, large amount of information taught; high level of performance required, reduced time for relaxing. The most important methods for SM that MS and NMS know, hierarchically are: listen to music, meeting friends, playing sport, hiking, sleep, regularly breaks, seeing positive side, faith; of which, NMS more than MS, are partially applying to themselves. UCT about which MS and less NMS have heard, are phytotherapy, apitherapy, acupuncture, reiki. Of these UTC, participants know to have stress modulation effects: some plants, bee’s products and music; they use or would like to use for ASM (the majority without SCT) certain teas, honey and music. Most of MS and only some NMS heard about PT, AT, TCM, MT and much less about H, AM, CT, TT. NMS more than MS, would use these UCT, following CST. Conclusions: 1) Academic stress is similarly reflected in MS and NMS opinions. 2) MS and NMS apply similar but very few UCT for stress modulation. 3) Information that MS and NMS have about UCT and their ASM application is reduced. 4) It is remarkable that MS and especially NMS, are open to UCT use for ASM, following an SCT.

Keywords: academic stress, stress management, stress modulation, medical students, non-medical students, unconventional therapies

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Authors: Niringiye Fred

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Banyabunagana has always had access to land resources for grazing animals, sand mining, and farmland across the border in the Democratic Republic of Congo during the pre-colonial and colonial times, usually on an informal arrangement facilitated by kinship ties and rent transactions for these resources. However, in recent periods, the government of the Democratic Republic of the Congo (DRC) has been pursuing a policy of constructing barriers such as walls and fences so that Banyabunagana communities do not access the land on the DRC side of the border. This is happening in the background of increased and intensified demand for land use on the side of the Ugandan community. This paper will attempt to discuss the reasons behind the construction of walls, fences, and other barriers which deny access to land for Banyabunagana communities in Bunagana Parish, Muramba Sub-county- Kisoro district, Uganda. The research will attempt to answer the following main questions, among others, whether there are the factors that explain the construction of walls and fences which could limit or deny access to the informal use of land and other resources and whether policy options to ensure continued access to land and other resources for local communities.

Keywords: border, walls, fences, land resource access

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Authors: Showkat Ahmad Bhat, M. S. Bhatt

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The study evaluates the ex-post impact of institutional credit on agricultural output. It first examines the key factors that influence the accessibility of institutional credit by farm households. For quantitative analysis both program participant and non-participant respondents were drawn and cross-sectional survey data were collected from 412 households in Pulwama District of Jammu & Kashmir (India). Propensity Score Matching Method was employed to analyze the impact of the institutional credit on agricultural output. Results show that institutional credit has a positive and significant impact on the agricultural output measured in terms of farm income and crop productivity. To estimate the accessibility of credit, an examination of both demand side and supply side factors were carried out. The demand for credit was measured with respect to respondents who applied for credit. Supply side credit allocation measured in terms of the proportion of ‘credit amount’ farmers obtained. Logit and Two-limit Tobit Regression Models were used to investigate the determinants that influence the accessibility of formal credit for Demand for and supply of credit respectively. The estimated results suggested that the demand for credit is positively and significantly affected by the factors such as: age of the household head, formal education, membership, cash crop grown, farm size and saving account. All the variables were found significantly increasing the household’s likelihood to demand for and supply of credit from banks. However, the impact of these factors varies considerably across the credit markets. Factors which were found negatively and significantly influencing the accessibility of credit were: ‘square of the age’, household assets and rate of interest. The credit constraints analysis suggested that square of the age; household assets and rate of interest were the three most important factors that increased the probability of being constrained. The study finally discusses these results in detail and draws some recommendations.

Keywords: institutional credit, agriculture, propensity score matching logit model, Tobit model

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Authors: Nabila N. El-Maraghy, Amany Essa, Yousra Abdel–Mottaleb, Nada Ismail

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The use of combination of chemotherapy and natural products to influence the cell death with low doses of chemotherapeutic agents and few side effects has recently emerged as a new method of cancer therapy. Aim: Evaluation the modulatory effect of Thymoquinone on HepG2 cells treated with Sorafenib. Methods: Hepatocellular Carcinoma HepG2 cell line was treated with Sorafenib and TQ individually and in combination. The effect of these treatments on cell viability (MTT assay), apoptosis (Expression of Caspase-3) and oxidative markers (GSH content and extent of lipid peroxidation) was determined. Results: When compared the effect of both agents alone and the combination of the IC50 of Sorafenib and the IC50 TQ, the combination resulted in reduction of cell inhibition and apoptosis and antagonize their actions on GSH content and extent of lipid peroxidation which are increased. This study showed potent anti-tumor activity of both TQ and Sorafenib separately on HepG2 but upon combination surprisingly they interacted and give antagonistic effect. Conclusion: Co-treatment resulted in antagonistic interaction between Sorafenib and Thymoquinone.

Keywords: antagonism, hepatocellular carcinoma, sorafenib, thymoquinone

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Authors: Fahad Almehmadi, Abdullah Alrajhi, Bader K. Alaslab, Abdullah A. Al Qurashi, Hattan A. Hassani

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Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) is an uncommon, inheritable cardiac disorder characterized by the progressive substitution of cardiac myocytes by fibro-fatty tissues. This pathologic substitution predisposes patients to ventricular arrhythmias and right ventricular failure. The underlying genetic defect predominantly involves genes encoding for desmosome proteins, particularly plakophilin-2 (PKP2). These aberrations lead to impaired cell adhesion, heightening the susceptibility to fibrofatty scarring under conditions of mechanical stress. Primarily, ARVD/C affects the right ventricle, but it can also compromise the left ventricle, potentially leading to biventricular heart failure. Clinical presentations can vary, spanning from asymptomatic individuals to those experiencing palpitations, syncopal episodes, and, in severe instances, sudden cardiac death. The establishment of a diagnostic criterion specifically tailored for ARVD/C significantly aids in its accurate diagnosis. Nevertheless, the task of early diagnosis is complicated by the disease's frequently asymptomatic initial stages, and the overall rarity of ARVD/C cases reported globally. In some cases, as exemplified by the adult female patient in this report, the disease may advance to terminal stages, rendering therapies like Ventricular Tachycardia (VT) ablation ineffective. This case underlines the necessity for increased awareness and understanding of ARVD/C to aid in its early detection and management. Through such efforts, we aim to decrease morbidity and mortality associated with this challenging cardiac disorder.

Keywords: ARVD/C, cardiology, interventional cardiology, cardiac electrophysiology

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Authors: Linda Saili, Amel Hanini, Chiraz Smirani, Iness Azzouz, Amina Azzouz, Hafedh Abdemelek, Zihad Bouslama

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Electrocardiogram and arterial pressure measurements were studied under acute exposures to WIFI (2.45 GHz) during one hour in adult male rabbits. Antennas of WIFI were placed at 25 cm at the right side near the heart. Acute exposure of rabbits to WIFI increased heart frequency (+ 22%) and arterial blood pressure (+14%). Moreover, analysis of ECG revealed that WIFI induced a combined increase of PR and QT intervals. By contrast, the same exposure failed to alter the maximum amplitude and P waves. After intravenously injection of dopamine (0.50 ml/kg) and epinephrine (0.50ml/kg) under acute exposure to RF we found that WIFI alter catecholamines(dopamine, epinephrine) action on heart variability and blood pressure compared to control. These results suggest for the first time, as far as we know, that exposure to WIFI affect heart rhythm, blood pressure, and catecholamines efficacy on cardiovascular system; indicating that radio frequency can act directly and/or indirectly on the cardiovascular system.

Keywords: heart rate (HR), arterial pressure (PA), electrocardiogram (ECG), the efficacy of catecholamines, dopamine, epinephrine

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Authors: Mubashra Khalid, Saadia Amir

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This study initiated to explore the empirical relationship between psychological effects of economic recession on the educated youth in Pakistan. The diminishing economic resources during recession can create certain psychological consequences on the physical and cognitive aspects of the individuals. It may generate symptoms like aggression, depression, anxiety, frustration, stress and physical health related problems among the young generation. The sample of the study was consisted of 300 students belonging to six public sector universities of the Punjab province of Pakistan. Two hypotheses were advanced in this study regarding the relationship between recession and its effects on educated youth. The findings of the research represent that a significant relationship exists between decrease in employment opportunities and growing rate of aggression among educated youth and a significant association was found between economic instability and its influence on the learning abilities of the students during recession.

Keywords: psychological effects, recession, educated youth

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Authors: J. Jessa

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Background: Autism is a pervasive developmental disorder, the incidence of which has significantly increased in recent years. Children with autism have impairments in social skills, communication, and imagination. Children with autism has more common than healthy children feeding problems: food selectivity, problems with gastrointestinal tract: diarrhea, constipations, abdominal pain, reflux and others. Many parents of autistic children report that after implementation of gluten-, casein- and sugar free diet those symptoms disappear and even cognitive functions become better. Some children begin to understand speech and to communicate with parents, regain eye contact, become more calm, sleep better and has better concentration. Probably at the root of this phenomenon lies elimination from the diet peptides construction of which is similar to opiates. Enhanced permeability of gut causes absorption of not fully digested opioid-like peptides from food, like gluten and casein and probably others (proteins from soy and corn) which impact on brain of autistic children. Aim of the study: The aim of the study is to assess the safety of gluten-free diet in children with autism, aged 2,5-7. Methods: Participants of the study (n=70) – children aged 2,5-7 with autism are divided into 3 groups. The first group (research group) are patients whose parents want to implement a gluten-free diet. The second group are patients who have been recommended to eliminate from the diet artificial substances, such as preservatives, artificial colors and flavors, and others (control group 1). The third group (control group 2) are children whose parents did not agree for implementation of the diet. Caregivers of children on the diet are educated about the specifics of the diet and how to avoid malnutrition. At the start of the study we exclude celiac disease. Before the implementation of the diet we performe a blood test for patients (morphology, ferritin, total cholesterol, dry peripheral blood drops to detect some genetic metabolic diseases), plasma aminogram) and urine tests (excretion of ions: Mg, Na, Ca, the profile of organic acids in urine), which assess nutritional status as well as the psychological test assessing the degree of the child's psychological functioning (PEP-R). All of these tests will be repeated after one year from the implementation of the diet. Results: To the present moment we examined 42 children with autism. 12 of children are on gluten- free diet. Our preliminary results are promising. Parents of 9 of them report that, there is a big improvement in child behavior, concentration, less aggression incidents, better eye contact and better verbal skills. Conclusion: Our preliminary results suggest that dietary intervention may positively affect developmental outcome for some children diagnosed with ASD.

Keywords: gluten free diet, autism spectrum disorder, autism, blood test

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Authors: Anand K. Vinu, Vaishnav Vimal, Sasi Gopalan

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All spacecraft components have a range of allowable temperatures that must be maintained to meet survival and operational requirements during all mission phases. Due to heat absorption, transfer, and emission on one side, the satellite surface presents an asymmetric temperature distribution and causes a change in momentum, which can manifest in spinning and non-spinning satellites in different manners. This problem can cause orbital decays in satellites which, if not corrected, will interfere with its primary objective. The thermal analysis of any satellite requires data from the power budget for each of the components used. This is because each of the components has different power requirements, and they are used at specific times in an orbit. There are three different cases that are run, one is the worst operational hot case, the other one is the worst non-operational cold case, and finally, the operational cold case. Sunlight is a major source of heating that takes place on the satellite. The way in which it affects the spacecraft depends on the distance from the Sun. Any part of a spacecraft or satellite facing the Sun will absorb heat (a net gain), and any facing away will radiate heat (a net loss). We can use the state-of-the-art foldable hybrid insulator/radiator panel. When the panels are opened, that particular side acts as a radiator for dissipating the heat. Here the insulator, in our case, the aerogel, is sandwiched with solar cells and radiator fins (solar cells outside and radiator fins inside). Each insulated side panel can be opened and closed using actuators depending on the telemetry data of the CubeSat. The opening and closing of the panels are dependent on the special code designed for this particular application, where the computer calculates where the Sun is relative to the satellites. According to the data obtained from the sensors, the computer decides which panel to open and by how many degrees. For example, if the panels open 180 degrees, the solar panels will directly face the Sun, in turn increasing the current generator of that particular panel. One example is when one of the corners of the CubeSat is facing or if more than one side is having a considerable amount of sun rays incident on it. Then the code will analyze the optimum opening angle for each panel and adjust accordingly. Another means of cooling is the passive way of cooling. It is the most suitable system for a CubeSat because of its limited power budget constraints, low mass requirements, and less complex design. Other than this fact, it also has other advantages in terms of reliability and cost. One of the passive means is to make the whole chase act as a heat sink. For this, we can make the entire chase out of heat pipes and connect the heat source to this chase with a thermal strap that transfers the heat to the chassis.

Keywords: passive cooling, CubeSat, efficiency, satellite, stationary satellite

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Authors: Francisca Alves, Diana Figueiredo, Paula Vagos, Luiza Lima, Maria do Céu Salvador, Daniel Rijo

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In recent years, Acceptance and Commitment Therapy (ACT) has been shown to be effective in the treatment of numerous anxiety disorders, including social anxiety disorder (SAD). However, limited evidence exists on its therapeutic gains for adolescents with SAD. The current work presents a weekly 10-session manualized online ACT approach to adolescent SAD, being the first study to do so in a clinical sample of adolescents. The intervention ACT@TeenSAD addresses the six proposed processes of psychological inflexibility (i.e., experiential avoidance, cognitive fusion, lack of values clarity, unworkable action, dominance of the conceptualized past and future, attachment to the conceptualized self) in social situations relevant to adolescents (e.g., doing a presentation). It is organized into four modules. The first module explores the role of psychological (in)flexibility in SAD (session 1 and 2), addressing psychoeducation (i.e., functioning of the mind) according to ACT, the development of an individualized model, and creative hopelessness. The second module focuses on the foundation of psychological flexibility (session 3, 4, and 5), specifically on the development and practice of strategies to promote clarification of values, contact with the present moment, the observing self, defusion, and acceptance. The third module encompasses psychological flexibility in action (sessions 6, 7, 8, and 9), encouraging committed action based on values in social situations relevant to the adolescents. The fourth modules’ focus is the revision of gains and relapse prevention (session 10). This intervention further includes two booster sessions after therapy has ended (3 and 6-month follow-up) that aim to review the continued practice of learned abilities and to plan for their future application to potentially anxious social events. As part of an ongoing clinical trial, the intervention will be assessed on its feasibility with adolescents diagnosed with SAD and on its therapeutic efficacy based on a longitudinal design including pretreatment, posttreatment, 3 and 6-month follow-up. If promising, findings may support the online delivery of ACT interventions for SAD, contributing to increased treatment availability to adolescents. This availability of an effective therapeutic approach will be helpful not only in relation to adolescents who face obstacles (e.g., distance) when attending to face-to-face sessions but also particularly to adolescents with SAD, who are usually more reluctant to look for specialized treatment in public or private health facilities.

Keywords: acceptance and commitment therapy, social anxiety disorder, adolescence, manualized online approach

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Authors: Manjinder Singh, Anish Sachdeva

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Research on total quality management (TQM), total productive maintenance (TPM), international organization for standardization (ISO) and six sigma generally investigate the implementation and impact of these programs in isolation. However, none of these quality improvement programs is self-sufficient and they may not be powerful enough to deliver the improvements and innovations that are required nowadays to ensure the survival and growth of a firm. They are not mutually exclusive and inconsistent. On the contrary, they need complementary support and may reinforce mutually to make use of their complementarity, inducement of side-effects in favor of other quality improvement program, mutual simulation and exploitation of shared values. In this paper, first of all, the various management activities were identified which are normally under focus when any quality improvement program is implemented in any organization. Then TOPSIS methodology was applied to establish the ranking of various quality improvement programs (total quality management, total productive maintenance, ISO and six sigma which were brought to the corporate boardroom to improve the quality) with respect to different management activities (operations related activities, quality related activities, maintenance related activities, organizational related activities, human related activities and finance related activities).

Keywords: total productive maintenance (TPM), total quality management (TQM), TOPSIS, international organization for standardization (ISO)

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Authors: Lucile Rapin, Cynthia El Hage, Rihab Gamaoun, Maria-Fernanda Arboleda, Erin Prosk

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Introduction: Sante Cannabis (SC), a Canadian group of clinics dedicated to medical cannabis, based in Montreal and in the province of Quebec, has served more than 8000 patients seeking cannabis-based treatment over the past five years. As randomized clinical trials with natural medical cannabis are scarce, real-world evidence offers the opportunity to fill research gaps between scientific evidence and clinical practice. Data on the use of medical cannabis products from SC patients were prospectively collected, leading to a large real-world database on the use of medical cannabis. The aim of this study was to report information on the profiles of both patients and prescribed medical cannabis products at SC clinics, and to assess the safety of medical cannabis among Canadian patients. Methods: This is an observational retrospective study of 1342 adult patients who were authorized with medical cannabis products between October 2017 and September 2019. Information regarding demographic characteristics, therapeutic indications for medical cannabis use, patterns in dosing and dosage form of medical cannabis and adverse effects over one-year follow-up (initial and 4 follow-up (FUP) visits) were collected. Results: 59% of SC patients were female, with a mean age of 56.7 (SD= 15.6, range= (19-97)). Cannabis products were authorized mainly for patients with a diagnosis of chronic pain (68.8% of patients), cancer (6.7%), neurological disorders (5.6%), and mood disorders (5.4 %). At initial visit, a large majority (70%) of patients were authorized exclusively medical cannabis products, 27% were authorized a combination of pharmaceutical cannabinoids and medical cannabis and 3% were prescribed only pharmaceutical cannabinoids. This pattern was recurrent over the one-year follow-up. Overall, oil was the preferred formulation (average over visits 72.5%) followed by a combination of oil and dry (average 19%), other routes of administration accounted for less than 4%. Patients were predominantly prescribed products with a balanced THC:CBD ratio (59%-75% across visits). 28% of patients reported at least one adverse effect (AE) at the 3-month follow-up visit and 12% at the six-month FUP visit. 84.8% of total AEs were mild and transient. No serious AE was reported. Overall, the most common side effects reported were dizziness (11.95% of total AEs), drowsiness (11.4%), dry mouth (5.5%), nausea (4.8%), headaches (4.6%), cough (4.4%), anxiety (4.1%) and euphoria (3.5%). Other adverse effects accounted for less than 3% of total AE. Conclusion: Our results confirm that the primary area of clinical use for medical cannabis is in pain management. Patients in this cohort are largely utilizing plant-based cannabis oil products with a balanced ratio of THC:CBD. Reported adverse effects were mild and included dizziness and drowsiness. This real-world data confirms the tolerable safety profile of medical cannabis and suggests medical indications not yet validated in controlled clinical trials. Such data offers an important opportunity for the investigation of the long-term effects of cannabinoid exposure in real-life conditions. Real-world evidence can be used to direct clinical trial research efforts on specific indications and dosing patterns for product development.

Keywords: medical cannabis, safety, real-world data, Canada

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