Search results for: medical decision support

Authors: O. V. Jurieva, O. U. Jurieva, R. H. Yagudin, P. B. Chursin

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In the recent scientific researches on the problems of public service the idea of the use of innovative technologies of management of personnel processes is accurately formulated. Authors made an attempt to analyze the changes in the public service organizations and to understand how the studied situation is interpreted by the government employees themselves. For this purpose the strategy of sociological research was carried out on the basis of application of questionnaire developed by M. Rokich and focus group research. For the research purposes it was necessary to get to microlevel in order to include daily activities of employees of an organization, their life experience and values in the focus of the analysis. Based on P. Bourdieu's methodology, authors investigated the established patterns of consciousness and behavior of officials (doxa) and also analyzed the tendencies of re-thinking (change) of the settled content of values (heterodoxy) by them. The distinctive feature of the conducted research is that the public servants who have different length of service in the public service took part in the research procedure. The obtained data helped to answer the following question: what are the specifics of doxs of the public servants who work in the public civil service more than 7-10 years and what perception of values of civil service have junior experts whose work experience doesn't exceed 3 years. Respondents were presented by two groups: (1) public servants of the level of main positions in the public civil service of the Republic of Tatarstan. (2) Public servants of the level of lower positions in the ministries and departments of the Republic of Tatarstan. For the study of doxa or of the existing values of public servants, the research with use of the questionnaire based on M. Rokich's system is conducted. Two types of values are emphasised: terminal and instrumental, which are united by us in the collective concept doxa. Doxa: the instrument of research of the established patterns of consciousness and behavior which can either resist to changes in the organization or, on the contrary, support their implementation. In the following stage an attempt to deepen our understanding of the essence and specifics of doxa of officials by means of the applied sociological research which is carried out by focus group method is made. Information obtained by authors during the research convinces that for the success of policy of changes in the organizations of public service it is necessary to develop special technologies of informing employees about the essence and inevitability of the developed innovations, to involve them in the process of changes, to train and to develop the younger generation of civil servants, seriously to perceive additional training and retraining of officials.

Keywords: innovative technologies, public service organizations, public servants

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Authors: Dipankar Saha, J. P. Singh, C. B. Pandey

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Indian Thar desert being the seventh largest in the world is the main hot sand desert occupies nearly 385,000km2 and about 9% of the area of the country harbours several species likely the flora of 682 species (63 introduced species) belonging to 352 genera and 87 families. The degree of endemism of plant species in the Thar desert is 6.4 percent, which is relatively higher than the degree of endemism in the Sahara desert which is very significant for the conservationist to envisage. The advent and development of computer technology for digitization and data base management coupled with the rapidly increasing importance of biodiversity conservation resulted in the invention of biodiversity informatics as discipline of basic sciences with multiple applications. Aichi Target 19 as an outcome of Convention of Biological Diversity (CBD) specifically mandates the development of an advanced and shared biodiversity knowledge base. Information on species distributions in space is the crux of effective management of biodiversity in the rapidly changing world. The efficiency of biodiversity management is being increased rapidly by various stakeholders like researchers, policymakers, and funding agencies with the knowledge and application of biodiversity informatics. Herbarium specimens being a vital repository for biodiversity conservation especially in climate change scenario the digitization process usually aims to improve access and to preserve delicate specimens and in doing so creating large sets of images as a part of the existing repository as arid plant information facility for long-term future usage. As the leaf characters are important for describing taxa and distinguishing between them and they can be measured from herbarium specimens as well. As a part of this activity, laminar characterization (leaves being the most important characters in assessing climate change impact) initially resulted in classification of more than thousands collections belonging to ten families like Acanthaceae, Aizoaceae, Amaranthaceae, Asclepiadaceae, Anacardeaceae, Apocynaceae, Asteraceae, Aristolochiaceae, Berseraceae and Bignoniaceae etc. Taxonomic diversity indices has also been worked out being one of the important domain of biodiversity informatics approaches. The digitization process also encompasses workflows which incorporate automated systems to enable us to expand and speed up the digitisation process. The digitisation workflows used to be on a modular system which has the potential to be scaled up. As they are being developed with a geo-referencing tool and additional quality control elements and finally placing specimen images and data into a fully searchable, web-accessible database. Our effort in this paper is to elucidate the role of BIs, present effort of database development of the existing botanical collection of institute repository. This effort is expected to be considered as a part of various global initiatives having an effective biodiversity information facility. This will enable access to plant biodiversity data that are fit-for-use by scientists and decision makers working on biodiversity conservation and sustainable development in the region and iso-climatic situation of the world.

Keywords: biodiversity informatics, climate change, digitization, herbarium, laminar characters, web accessible interface

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Authors: Vithya Veeramani, Karunanidhi Subbaiah

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Emotional problems were found to be the predominant cause of suicide and second leading cause of death among adolescents in India. Emotional problems seem to be the underlying cause for various other severe psycho-social problems experienced in adolescence and also in later years of life. The Corporation schools in Chennai city are named as Chennai High School or Chennai Higher Secondary School run by the Corporation of Chennai. These schools fulfill the educational needs of students who hail from lower socio-economic status living in slums of the Chennai city. Adolescent students of Chennai schools tend to lack basic needs like food, clothes, shelter, etc. Some of the other significant problems faced by them are broken family, lack of parental support, frequent quarrel between parents, alcoholic parents, drug abuse and substance abuse among parents and neighbors, extended family, illiterate parents, deprivation of love and care, and lack of sense of belongingness. This prevailing condition may affect them emotionally and could lead to maladaptive behaviour, aggressiveness, poor interpersonal relationship with others, school refusal behaviour, school drop-out, suicide, etc. Therefore, it is very important to investigate the emotional problems faced by the adolescent students studying in Chennai schools, Chennai. A cross-sectional survey design was used to find the prevalence of emotional problems among adolescent students. Cluster sampling technique was used to select the schools for the present study considering the school as a cluster. In total, there are 15 zones, under the control of Chennai Corporation, of which only 7 zones have Corporation Schools in Chennai city, comprising of 32 Chennai Higher Secondary Schools and 38 Chennai High Schools. Out of these 70 schools, 29 schools comprising of 17 high schools and 12 higher secondary schools were selected randomly using lottery method. A sample of 2594 adolescent students from 9th standard and 11th standard was chosen for the study. Percentage analysis was done to find out the prevalence rate of emotional problems among adolescents students studying in Chennai Schools. Results of the study revealed that, out of 2594 students surveyed, 21.04% adolescent students were found to have academic problems (n = 546), 15.99% adolescent students had social problems (n = 415), behaviour problems was found to be prevalent among 12.87% adolescent students (n = 334), depression was prevalent among 15.88% adolescent students (n = 412) and anxiety was prevalent among 14.42% adolescent students (n = 374). Prevalence of emotional problems among male and female revealed that academic problems were more prevalent compared to other problems. Behaviour problems were least prevalent among boys and anxiety was least prevalent among girls than other problems. The overall prevalence rate of emotional problems was found to be on an increasing trend among adolescent students of low socio-economic status in Chennai city. The findings indicated the need for intervention to prevent and rehabilitate these adolescent students.

Keywords: adolescents, corporation schools, emotional problems, prevalence

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Authors: Cedillo Ortiz Cesar Isaac, Marañón-Ruiz Virginia-Francisca, Lozano-Alvarez Juan Antonio, Jáuregui-Rincón Juan, Roger Chiu Zarate

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Introduction: The contamination of water with the azo-dye is a problem worldwide as although wastewater contaminate is treated in a municipal sewage system, still contain a considerable amount of dyes. In the present, there are different processes denominated tertiary method in which it is possible to lower the concentration of the dye. One of these methods is by adsorption onto various materials which can be organic or inorganic materials. The xanthan is a biomaterial as removal agents to decrease the dye content in aqueous solution. The Zimm-Bragg model described the experimental isotherms obtained when this biopolymer was used in the removal of textile dyes. Nevertheless, it was not established if a possible correlation between dye structure and removal efficiency exists. In this sense, the principal objective of this report is to propose a qualitative relationship between the structure of three azo-dyes (Congo Red (CR), Methyl Red (MR) and Methyl Orange (MO)) and their removal efficiency from aqueous environment when xanthan are used as dye sequestering agents. Methods: The dyes were subjected to different pH and ionic strength values to obtain the conditions of maximum dye removal. Afterward, these conditions were used to perform the adsorption isotherm as was reported in the previous study in our group. The Zimm-Bragg model was used to describe the experimental data and the parameters of nucleation (Ku) and cooperativity (U) were obtained by optimization using the R statistical software. The spectra from UV-Visible (aqueous solution), Infrared absorption and Raman spectroscopies (dry samples) were obtained from the biopolymer-dye complex. Results: The removal percent with xanthan in each dye are as follows: with CR had 99.98 % when the pH is 12 and ionic strength is 10.12, with MR had 84.79 % when the pH is 9.5 and ionic strength is 43 and finally the MO had 30 % in pH 4 and 72. It can be seen that when xanthan is used to remove the dyes, exists a lower dependence between structure and removal efficiency. This may be due to the different tendency to form aggregates of each dye. This aggregation capacity and the charge of each dye resulting from the pH and ionic strength values of aqueous solutions are key factors in the dye removal. The experimental isotherm of MR was only that adequately described by Zimm-Bragg model. Because with the CR had the 100 % of remove thus is very difficult obtain de experimental isotherm and finally MO had results fluctuating and therefore was impossible get the accurate data. Conclusions: The study of the removal of three dyes with xanthan as dye sequestering agents suggests that aggregation capacity of dyes and the charge resulting from structural characteristics such as molecular weight and functional groups have a relationship with the removal efficiency. Acknowledgements: We are gratefully acknowledged support for this project by Consejo Nacional de Ciencia y Tecnología, México (CONACyT, Grant No. 632694.)

Keywords: adsorption, azo dyes, xanthan gum, Zimm Bragg theory

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Authors: Georgia H. Mega

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Art street, a category of artwork displayed in public spaces, has been recognized as a potential tool for promoting reflective thinking in both adult and primary education. Educational techniques that encourage critical and creative thinking, as well as deeper reflection, have been developed and applied in educational curricula. This paper aims to explore the potential of art street in cultivating learners' reflective awareness toward multiculturalism. The main objective of this case study is to investigate the possibilities that art street offers in terms of developing learners' critical reflection, regardless of their age. The study compares two art street works from Greece and Norway, focusing on their common theme of multiculturalism. The study adopts a qualitative methodology, specifically a case study approach. This approach allows for an in-depth analysis of the two selected art street works and their impact on learners' reflective thinking. The study demonstrates that art street can effectively cultivate learners' reflective awareness of multiculturalism. The selected works of art, despite being created by different artists and displayed in different cities, share similar content and convey messages that facilitate reflective dialogue on cultural osmosis. Both adult and primary education approaches utilize the same art street works to achieve reflective awareness. This paper contributes to the existing literature on reflective learning processes by highlighting the potential of art street as a means for encouraging reflective thinking. It builds upon the theoretical frameworks of adult education theorists such as Freire and Mezirow, as well as those of primary education theorists such as Perkins and Project Zero. Data for this study were collected through observation and analysis of two art street works, one from Greece and one from Norway. These works were selected based on their common theme of multiculturalism. Analysis Procedures: The collected data were analyzed using qualitative analysis techniques. The researchers examined the content and messages conveyed by the selected art street works and explored their impact on learners' reflective thinking. The central question addressed in this study is whether art street can develop learners' critical reflection toward multiculturalism, regardless of their age. The findings of this study support the notion that art street can effectively cultivate learners' reflective awareness toward multiculturalism. The selected art street works, despite their differences in origin and location, share common themes that encourage reflective dialogue. The use of art street in both adult and primary education approaches showcases its potential as a tool for promoting reflective learning processes. Overall, this paper contributes to the understanding of art street as a means for reflective thinking in the field of adult and primary education.

Keywords: art street, educational techniques, multiculturalism, observation of artworks, reflective awareness

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Authors: Sree Vennela P., V. Samyuktha Bhardwaj

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Hyponatremia is an electrolyte disturbance in which the sodium ion concentration in the serum is lower than normal. Sodium is the dominant extracellular cation (positive ion) and cannot freely cross from the interstitial space through the cell membrane, into the cell. Its homeostasis (stability of concentration) inside the cell is vital to the normal function of any cell. Normal serum sodium levels are between 135 and 145 mEq/L. Hyponatremia is defined as a serum level of less than 135 mEq/L and is considered severe when the serum level is below 125 mEq/L. In the vast majority of cases, Hyponatremia occurs as a result of excess body water diluting the serum sodium (salt level in the blood). Hyponatremia is often a complication of other medical illnesses in which excess water accumulates in the body at a higher rate than can be excreted (for example in congestive heart failure, syndrome of inappropriate antidiuretic hormone, SIADH, or polydipsia). Sometimes it may be a result of over-hydration (drinking too much water).Lack of sodium (salt) is very rarely the cause of Hyponatremia, although it can promote Hyponatremia indirectly. In particular, sodium loss can lead to a state of volume depletion (loss of blood volume in the body), with volume depletion serving as a signal for the release of ADH (anti-diuretic hormone). As a result of ADH-stimulated water retention (too much water in the body), blood sodium becomes diluted and Hyponatremia results.

Keywords: Tolvaptan, hyponatremia, syndrome of insufficient anti diuretic hormone (SIADH), euvolemic hyponatremia

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Authors: Khalil Ibrahim, Ahmed Ramadan, Mohamed Fanni, Yo Kobayashi, Ahmed Abo-Ismail, Masakatus G. Fujie

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This paper deals with the design process and the dynamic control simulation of a new type of 4-DOFs parallel mechanism that can be used as an endoscopic surgical manipulator. The proposed mechanism, 2-PUU_2-PUS, is designed based on the screw theory and the parallel virtual chain type synthesis method. Based on the structure analysis of the 4-DOF parallel mechanism, the inverse position equation is studied using the inverse analysis theory of kinematics. The design and the stress analysis of the mechanism are investigated using SolidWorks software. The virtual prototype of the parallel mechanism is constructed, and the dynamic simulation is performed using ADAMS TM software. The system model utilizing PID and PI controllers has been built using MATLAB software. A more realistic simulation in accordance with a given bending angle and point to point control is implemented by the use of both ADAMS/MATLAB software. The simulation results showed that this control method has solved the coordinate control for the 4-DOF parallel manipulator so that each output is feedback to the four driving rods. From the results, the tracking performance is achieved. Other control techniques, such as intelligent ones, are recommended to improve the tracking performance and reduce the numerical truncation error.

Keywords: parallel mechanisms, medical robotics, tracjectory control, virtual chain type synthesis method

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Authors: Francisco J. Cedano, Laura M. Pinzón, Camila I. Castro, Felipe Salcedo, Juan P. Casas, Juan C. Briceño

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Complex fractures located in articular surfaces are challenging to treat and their reduction with conventional treatments could compromise the functionality of the affected limb. An adhesive material to treat those fractures is desirable for orthopedic surgeons. This adhesive must be biocompatible and have a high adhesion to bone surface in an aqueous environment. The proposed adhesive is based on chitosan, given its adhesive and biocompatibility properties. Chitosan is mixed with calcium carbonate and hydroxyapatite, which contribute to structural support and a gel like behavior, and glutaraldehyde is used as a cross-linking agent to keep the adhesive mechanical performance in aqueous environment. This work aims to evaluate the rheological, adhesion strength and biocompatibility properties of the proposed adhesive using in vitro tests. The gelification process of the adhesive was monitored by oscillatory rheometry in an ARG-2 TA Instruments rheometer, using a parallel plate geometry of 22 mm and a gap of 1 mm. Time sweep experiments were conducted at 1 Hz frequency, 1% strain and 37°C from 0 to 2400 s. Adhesion strength is measured using a butt joint test with bovine cancellous bone fragments as substrates. The test is conducted at 5 min, 20min and 24 hours after curing the adhesive under water at 37°C. Biocompatibility is evaluated by a cytotoxicity test in a fibroblast cell culture using MTT assay and SEM. Rheological results concluded that the average gelification time of the adhesive is 820±107 s, also it reaches storage modulus magnitudes up to 106 Pa; The adhesive show solid-like behavior. Butt joint test showed 28.6 ± 9.2 kPa of tensile bond strength for the adhesive cured for 24 hours. Also there was no significant difference in adhesion strength between 20 minutes and 24 hours. MTT showed 70 ± 23 % of active cells at sixth day of culture, this percentage is estimated respect to a positive control (only cells with culture medium and bovine serum). High vacuum SEM observation permitted to localize and study the morphology of fibroblasts presented in the adhesive. All captured fibroblasts presented in SEM typical flatted structure with filopodia growth attached to adhesive surface. This project reports an adhesive based on chitosan that is biocompatible due to high active cells presented in MTT test and these results were correlated using SEM. Also, it has adhesion properties in conditions that model the clinical application, and the adhesion strength do not decrease between 5 minutes and 24 hours.

Keywords: bioadhesive, bone adhesive, calcium carbonate, chitosan, hydroxyapatite, glutaraldehyde

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Authors: Mohammad Arabi

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The development of advanced technologies in the field of signal processing and vibration analysis has enabled more accurate analysis and fault detection in electrical systems. This research investigates the application of temporal and frequency features in detecting faults in electric motor bearings, aiming to enhance fault detection accuracy and prevent unexpected failures. The use of methods such as deep learning algorithms and neural networks in this process can yield better results. The main objective of this research is to evaluate the efficiency and accuracy of methods based on temporal and frequency features in identifying faults in electric motor bearings to prevent sudden breakdowns and operational issues. Additionally, the feasibility of using techniques such as machine learning and optimization algorithms to improve the fault detection process is also considered. This research employed an experimental method and random sampling. Vibration signals were collected from electric motors under normal and faulty conditions. After standardizing the data, temporal and frequency features were extracted. These features were then analyzed using statistical methods such as analysis of variance (ANOVA) and t-tests, as well as machine learning algorithms like artificial neural networks and support vector machines (SVM). The results showed that using temporal and frequency features significantly improves the accuracy of fault detection in electric motor bearings. ANOVA indicated significant differences between normal and faulty signals. Additionally, t-tests confirmed statistically significant differences between the features extracted from normal and faulty signals. Machine learning algorithms such as neural networks and SVM also significantly increased detection accuracy, demonstrating high effectiveness in timely and accurate fault detection. This study demonstrates that using temporal and frequency features combined with machine learning algorithms can serve as an effective tool for detecting faults in electric motor bearings. This approach not only enhances fault detection accuracy but also simplifies and streamlines the detection process. However, challenges such as data standardization and the cost of implementing advanced monitoring systems must also be considered. Utilizing temporal and frequency features in fault detection of electric motor bearings, along with advanced machine learning methods, offers an effective solution for preventing failures and ensuring the operational health of electric motors. Given the promising results of this research, it is recommended that this technology be more widely adopted in industrial maintenance processes.

Keywords: electric motor, fault detection, frequency features, temporal features

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Authors: Zhuang Hou, Xiaolei Cao

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The general public and medical professionals recognized the importance of accurately measuring and storing blood oxygen levels and heart rate during the COVID-19 pandemic. The demand for accurate contactless devices was motivated by the need for cross-infection reduction and the shortage of conventional oximeters, partially due to the global supply chain issue. This paper evaluated a contactless mini program HealthyPai’s heart rate (HR) and oxygen saturation (SpO2) measurements compared with other wearable devices. In the HR study of 185 samples (81 in the laboratory environment, 104 in the real-life environment), the mean absolute error (MAE) ± standard deviation was 1.4827 ± 1.7452 in the lab, 6.9231 ± 5.6426 in the real-life setting. In the SpO2 study of 24 samples, the MAE ± standard deviation of the measurement was 1.0375 ± 0.7745. Our results validated that HealthyPai utilizing the Integrated Image Deep Learning Solution (IIDLS) framework, can accurately measure HR and SpO2, providing the test quality at least comparable to other FDA-approved wearable devices in the market and surpassing the consumer-grade and research-grade wearable standards.

Keywords: remote photoplethysmography, heart rate, oxygen saturation, contactless measurement, mini program

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Authors: Muhammad Irfan

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The rise of radicalization within Islam has spawned a new era of global terror. The battlefield Successes of ISIS and the Taliban are fuelled by an ideological war waged, largely and successfully, in the media arena. This research will examine how Islamic extremist groups are using media modalities and populist narratives to influence migrant Muslim populations in Europe towards extremism. In 2014, ISIS shocked the world in exporting horrifically graphic forms of violence on social media. Their Muslim support base was largely disgusted and reviled. In response, they reconfigured their narrative by introducing populist 'hooks', astutely portraying the Muslim populous as oppressed and exploited by unjust, corrupt autocratic regimes and Western power structures. Within this crucible of real and perceived oppression, hundreds of thousands of the most desperate, vulnerable and abused migrants left their homelands, risking their lives in the hope of finding peace, justice, and prosperity in Europe. Instead, many encountered social stigmatization, detention and/or discrimination for being illegal migrants, for lacking resources and for simply being Muslim. This research will examine how Islamic extremist groups are exploiting the disenfranchisement of these migrant populations and using populist messaging on social media to influence them towards violent extremism. ISIS, in particular, formulates specific encoded messages for newly-arriving Muslims in Europe, preying upon their vulnerability. Violence is posited, as a populist response, to the tyranny of European oppression. This research will analyze the factors and indicators which propel Muslim migrants along the spectrum from resilience to violence extremism. Expected outcomes are identification of factors which influence vulnerability towards violent extremism; an early-warning detection framework; predictive analysis models; and de-radicalization frameworks. This research will provide valuable tools (practical and policy level) for European governments, security stakeholders, communities, policy-makers, and educators; it is anticipated to contribute to a de-escalation of Islamic extremism globally.

Keywords: populism, radicalization, de-radicalization, social media, ISIS, Taliban, shariah, jihad, Islam, Europe, political communication, terrorism, migrants, refugees, extremism, global terror, predictive analysis, early warning detection, models, strategic communication, populist narratives, Islamic extremism

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Authors: Fatma Abdel Moneim Al Tawil

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Low back pain (LBP) among nurses has been the subject of research studies worldwide. However, evidence of the influence of patients lifting behaviors and LBP among nurses in Saudi Arabia remains scarce. The purpose of this study was to investigate the relationship between LBP and nurses lifting behaviors. LBP questionnaire was distributed to 100 nurses working in Alsadairy Hospital distributed as Emergency unit(9),Coronary Care unit (9), Intensive Care Unit (7), Dialysis unit (30), Burn unit (5), surgical unit (11), Medical (14) and, X-ray unit (15). The questionnaire included demographic data, attitude scale, Team work scale, Back pain history and Knowledge scale. Regarding to emergency unit, there is appositive significant relation between teamwork scale and Knowledge as r = (0.807) and P =0.05. Regarding to ICU unit, there is a positive significant relation between teamwork scale and attitude scale as r= (0.781) and P =0.05. Regarding to Dialysis unit, there is a positive significant relation between attitude scale and teamwork scale as r=(0.443) and P =0.05. The findings suggest enhanced awareness of occupational safety with safe patient handling practices among nursing students must be emphasized and integrated into their educational curriculum. Moreover, back pain prevention program should incorporate the promotion of an active lifestyle and fitness training the implementation of institutional patient handling policies.

Keywords: low back pain, lifting behaviors, nurses, team work

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Authors: Behnam Shakerian, Negin Razavi

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The pathogenesis of coronary artery disease is multifactorial. The epicardial fat pad is a localized fat depot lying between the myocardium and the visceral layer of the pericardium. The mechanisms through which epicardial fat pad can cause atherosclerosis are complex. The epicardial fat pad can surround the coronary arteries and contributes to the development and progression of coronary artery disease. Methods: we selected 50 patients who underwent coronary artery angiography for the evaluation of coronary artery disease that results were positive for coronary artery disease. All patients underwent an echocardiographic examination after coronary angiography to measure epicardial fat pad thickness. The epicardial fat pad was defined as an echo-free space between the myocardium's outer wall and the pericardium's visceral layer. Results: The epicardial fat pad was measured on the right ventricle apex in 46 patients. Sixty- five percent of the studied patients were male. The most common vessel with stenosis was the left anterior descending artery. A significant correlation was observed between epicardial fat pad thickness and the severity of coronary artery disease. Discussions: The epicardial fat pad provides a horizon on the pathophysiology of cardiovascular diseases. It directly contributes to the development and progression of coronary artery disease by causing inflammation and endothelial damage. Further investigations are needed to determine whether medical treatment can reduce the mass of epicardial fat pad and can help to improve atherosclerosis. Conclusion: The epicardial fat pad measurement could be used as an indicator of coronary arteries’ atherosclerosis. Therefore, thickness measurement of the epicardial fat pad in the clinical practice could be of assistance in identifying patients at risk and if required, undergoing supplementary diagnosis with coronary angiography.

Keywords: epicardial, fat pad, coronary artery disease, echocardiography

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Authors: John Paul Q. Tomas, Mark Wilson L. de los Reyes, Kirsten Joyce P. Vasquez

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The most frequent type of fracture is a wrist fracture, which often makes it difficult for medical professionals to find and locate. In this study, fractures in wrist x-ray pictures were located and identified using deep learning and computer vision. The researchers used image filtering, masking, morphological operations, and data augmentation for the image preprocessing and trained the RetinaNet and Faster R-CNN models with ResNet50 backbones and Adam optimizers separately for each image filtering technique and projection. The RetinaNet model with Anisotropic Diffusion Smoothing filter trained with 50 epochs has obtained the greatest accuracy of 99.14%, precision of 100%, sensitivity/recall of 98.41%, specificity of 100%, and an IoU score of 56.44% for the Posteroanterior projection utilizing augmented data. For the Lateral projection using augmented data, the RetinaNet model with an Anisotropic Diffusion filter trained with 50 epochs has produced the highest accuracy of 98.40%, precision of 98.36%, sensitivity/recall of 98.36%, specificity of 98.43%, and an IoU score of 58.69%. When comparing the test results of the different individual projections, models, and image filtering techniques, the Anisotropic Diffusion filter trained with 50 epochs has produced the best classification and regression scores for both projections.

Keywords: Artificial Intelligence, Computer Vision, Wrist Fracture, Deep Learning

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Authors: Sanober Khanum, Barerah Siddiqui, Asim Qidwai

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Objective: To determine the risk factors and frequency of depressive trends in children and adolescents suffering from Beta-Thalassemia. Background: Thalassemia is a chronic disease affecting 10,000 people in 60 countries. Many studies show that prolonged medical conditions cause depression. Due to the invasive procedures and suffering, Beta-Thalassemia cause great psychological distress to both children and their caregivers. The study shows 14-24% prevalence of psychiatric problems in Thalassemic patients. Method: Sample consisted of 195 registered patients of A.M.T.F (Female=95 and Male=100). Based on age range the sample was divided into two groups, Group A = children (4-9 years) and Group B = adolescent (10-16 years). A detailed interview with a self-made screening measure was administered on parents to find out the level of depression in patients. Statistics: Chi-square and t-test was applied in order to analyze the data. Results show high prevalence of depression, depression n= 131(66.83%), no depression n=65(33.16%). Analyses reflect that age influences the level of depression Adolescent (71.05%) and Children (64.16%). The analysis also shows a difference in level of depression between both genders. (t=2.975, p < .05). Conclusion: There is a high possibility of developing depressive trend in children affected with Beta Thalassemia; especially females. Therefore, there is a dire need for psychological screening and appropriate treatment in order to improve physical; as well as mental health.

Keywords: childhood depression, chronic illness, psychopathology, Thalassemia

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Authors: Magdalena Hasplova, Katerina Ivanova

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Perinatal palliative care is a relatively young and developing field that includes the care of a fetus or newborn with a life-threatening or limiting defect and his family. However, the training of midwives in perinatal palliative care is insufficient and midwives do not feel prepared for this aspect of their work. This fact can affect the barriers to communication with the mother or family of the endangered child. The main aim was to analyze the awareness of midwifery students on the issue of perinatal palliative care in the Czech Republic. Based on the analysis, draw attention to possible communication barriers that may be caused by insufficient information. The research was carried out using a qualitative method, the method of data collection was a semi-structured interview. Eleven female students took part in the research, and the respondents were selected using the Snowballing method. Some methods of grounded theory (open coding and category creation) were used to analyze the data. Based on the results of the research, questions were set in a questionnaire focused on communication barriers between mothers (family) and health care professionals in the care of newborns with life-threatening or limiting disabilities. Based on the analysis of data, categories 1 were determined. Knowledge of perinatal palliative care 2. Education 3. Practical experience 4. Readiness and concerns in the provision of perinatal palliative care 6. Supervision. The questions in the questionnaire were then derived taking into account the data obtained, and the operationalization of health literacy in the field of perinatal palliative care was performed. The analysis of the interviews revealed that the education of midwives in the Czech Republic in the issue of perinatal palliative care is not uniform. The research confirmed the insufficient knowledge and skills of midwifery students preparing to provide perinatal palliative care. Respondents reported feelings of unpreparedness in the areas of communication with a woman after perinatal loss, psychological support for a woman and her family, the care of a stillborn or dying child, or self-coping with death. The questions in the questionnaire then develop these areas. We assumed that by analyzing and interpreting the data obtained from our research, we will help to better understand the concerns and motivations of students in providing holistic perinatal palliative care. We came to the conclusion that it would be appropriate to set up a unified and comprehensive education on this issue in the Czech Republic. Healthcare professionals are in a unique position that can positively or negatively affect the intensity of perinatal loss. Already properly set up education of health professionals leads to overcoming barriers in communication between health professionals and the family, experiencing perinatal loss.

Keywords: midwife, perinatal loss, perinatal palliative care, communication, barriers, mothers, family

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Authors: Hossain A., Chowdhury S. I.

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Introduction: The use of a gamma camera is a standard procedure in nuclear medicine facilities or hospitals to diagnose chronic kidney disease (CKD), but the gamma camera does not precisely stage the disease. The authors sought to determine whether they could use an artificial neural network to determine whether CKD was in normal or abnormal stages based on GFR values (ANN). Method: The 250 kidney patients (Training 188, Testing 62) who underwent an ultrasonography test to diagnose a renal test in our nuclear medical center were scanned using a gamma camera. Before the scanning procedure, the patients received an injection of ⁹⁹ᵐTc-DTPA. The gamma camera computes the pre- and post-syringe radioactive counts after the injection has been pushed into the patient's vein. The artificial neural network uses the softmax function with cross-entropy loss to determine whether CKD is normal or abnormal based on the GFR value in the output layer. Results: The proposed ANN model had a 99.20 % accuracy according to K-fold cross-validation. The sensitivity and specificity were 99.10 and 99.20 %, respectively. AUC was 0.994. Conclusion: The proposed model can distinguish between normal and abnormal stages of CKD by using an artificial neural network. The gamma camera could be upgraded to diagnose normal or abnormal stages of CKD with an appropriate GFR value following the clinical application of the proposed model.

Keywords: artificial neural network, glomerular filtration rate, stages of the kidney, gamma camera

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Authors: Joseph K. A. Johnson

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Hypertension affects 20 percent of the people within the ages 55 upward in Ghana. Of these, almost one-third are unaware of their condition. Also at the age of 55, more men turned to have hypertension than women. After that age, the condition becomes more prevalent with women. Hypertension is significantly more common in African Americans of both sexes than the racial or ethnic groups. This study was conducted to determine the causes of high blood pressure in Ashanti Region, Ghana. The study employed One Hundred and Seventy (170) respondents. The sample population for the study was all the available respondents at the time of the data collection. The research was conducted using primary data where convenience sampling was used to locate the respondents. A set of questionnaire were used to gather the data for the study. The gathered data was analysed using principal component analysis. The study revealed that, personal description, lifestyle behavior and risk awareness as some of the causes of high blood pressure in Ashanti Region. The study therefore recommend that people must be advice to see to their personal characteristics that may contribute to high blood pressure such as controlling of their temper and how to react perfectly to stressful situations. They must be educated on the factors that may increase the level of their blood pressure such as the essence of seeing a medical doctor before taking in any drug. People must also be made known by the public health officers to those lifestyles behaviour such as smoking and drinking of alcohol which are major contributors of high blood pressure.

Keywords: high blood pressure, principal component analysis, hypertension, public health

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Authors: Daming Xu, Yuanyuan Wang

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Abstract: Under the trend of rapid expansion of urbanization, the motorized urban characteristics become more and more obvious, and the walkability of urban space is seriously affected. The construction of walkability of space, as the main mode of travel for the elderly in their daily lives, has become more and more important in the current social context of serious aging. Settlement is the most basic living unit of residents, and daily shopping, medical care, and other daily trips are closely related to the daily life of the elderly. Therefore, it is of great practical significance to explore the impact of built environment on elderly people's daily walking trips at the settlement level for the construction of pedestrian-friendly settlements for the elderly. The study takes three typical settlements in Harbin Daoli District in three different periods as examples and obtains data on elderly people's walking trips and built environment characteristics through field research, questionnaire distribution, and internet data acquisition. Finally, correlation analysis and multinomial logistic regression model were applied to analyze the influence mechanism of built environment on elderly people's walkability based on the control of personal attribute variables in order to provide reference and guidance for the construction of walkability for elderly people in built environment in the future.

Keywords: built environment, elderly, walkability, multinomial logistic regression model

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Authors: Kiran Datta, Daniella Holland-Hart, Anthony Byrne

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Introduction: Oesophago-gastric (OG) cancers are the fifth commonest in the UK, accounting for over 12,000 deaths each year. Most patients will present at later stages of the disease, with only 21% of patients with stage 4 disease surviving longer than a year. As a result, many patients are unsuitable for curative surgery and instead receive palliative treatment to improve prognosis and symptom burden. However, palliative chemotherapy can result in significant toxicity: almost half of the patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. In addition, clinical trials often exclude older and frailer patients due to strict inclusion criteria, meaning there is limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. Inappropriate chemotherapy administration is at odds with the goals of palliative treatment and care, which are to improve quality of life, and this also represents a significant resource expenditure. This literature review aimed to examine and appraise evidence regarding treatment resilience in order to guide clinicians in identifying the most suitable candidates for palliative chemotherapy. Factors influencing treatment resilience were assessed, as measured by completion rates, dose reductions, and toxicities. Methods: This literature review was conducted using rapid review methodology, utilising modified systematic methods. A literature search was performed across the MEDLINE, EMBASE, and Cochrane Library databases, with results limited to papers within the last 15 years and available in English. Key inclusion criteria included: 1) participants with either oesophageal, gastro-oesophageal junction, or gastric cancers; 2) patients treated with palliative chemotherapy; 3) available data evaluating the association between baseline participant characteristics and treatment resilience. Results: Of the 2326 papers returned, 11 reports of 10 studies were included in this review after excluding duplicates and irrelevant papers. Treatment resilience factors that were assessed included: age, performance status, frailty, inflammatory markers, and sarcopenia. Age was generally a poor predictor for how well patients would tolerate chemotherapy, while poor performance status was a better indicator of the need for dose reduction and treatment non-completion. Frailty was assessed across one cohort using multiple screening tools and was an effective marker of the risk of toxicity and the requirement for dose reduction. Inflammatory markers included lymphopenia and the Glasgow Prognostic Score, which assessed inflammation and hypoalbuminaemia. Although quick to obtain and interpret, these findings appeared less reliable due to the inclusion of patients treated with palliative radiotherapy. Sarcopenia and body composition were often associated with chemotherapy toxicity but not the rate of regimen completion. Conclusion: This review demonstrates that there are numerous measures that can estimate the ability of patients with oesophago-gastric cancer to tolerate palliative chemotherapy, and these should be incorporated into clinical assessments to promote personalised decision-making around treatment. Age should not be a barrier to receiving chemotherapy and older and frailer patients should be included in future clinical trials to better represent typical patients with oesophago-gastric cancers. Decisions regarding palliative treatment should be guided by these factors identified as well as patient preference.

Keywords: frailty, oesophago-gastric cancer, palliative chemotherapy, treatment resilience

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Authors: Rikke Lybæk

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This paper delves into the intricacies of recycling household plastic waste within Denmark, employing an exploratory case study methodology to shed light on the technical, strategic, and market dynamics of the plastic recycling value chain. Focusing on circular economy principles, the research identifies critical gaps and opportunities in recycling processes, particularly regarding plastic packaging waste derived from households, with a notable absence in food packaging reuse initiatives. The study uncovers the predominant practice of downcycling in the current value chain, underscoring a disconnect between the potential for high-quality plastic recycling and the market's readiness to embrace such materials. Through detailed examination of three leading companies in Denmark's plastic industry, the paper highlights the existing support for recycling initiatives, yet points to the necessity of assured quality in sorted plastics to foster broader adoption. The analysis further explores the importance of reuse strategies to complement recycling efforts, aiming to alleviate the pressure on virgin feedstock. The paper ventures into future perspectives, discussing different approaches such as biological degradation methods, watermark technology for plastic traceability, and the potential for bio-based and PtX plastics. These avenues promise not only to enhance recycling efficiency but also to contribute to a more sustainable circular economy by reducing reliance on virgin materials. Despite the challenges outlined, the research demonstrates a burgeoning market for recycled plastics within Denmark, propelled by both environmental considerations and customer demand. However, the study also calls for a more harmonized and effective waste collection and sorting system to elevate the quality and quantity of recyclable plastics. By casting a spotlight on successful case studies and potential technological advancements, the paper advocates for a multifaceted approach to plastic waste management, encompassing not only recycling but also innovative reuse and reduction strategies to foster a more sustainable future. In conclusion, this study underscores the urgent need for innovative, coordinated efforts in the recycling and management of plastic waste to move towards a more sustainable and circular economy in Denmark. It calls for the adoption of comprehensive strategies that include improving recycling technologies, enhancing waste collection systems, and fostering a market environment that values recycled materials, thereby contributing significantly to environmental sustainability goals.

Keywords: case study, circular economy, Denmark, plastic waste, sustainability, waste management

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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: Ebenezer Kwesi Armah-Ansah, Kenneth Fosu Oteng, Esther Selasi Avinu, Eugene Budu, Edward Kwabena Ameyaw

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Background: Maternal mortality, particularly in Benin, is a major public health concern in Sub-Saharan Africa. To provide a positive pregnancy experience and reduce maternal morbidities, all pregnant women must get appropriate and timely prenatal support. However, many pregnant women in developing countries, including Benin, begin antenatal care late. There is a paucity of empirical literature on the prevalence and predictors of early antenatal care visits in Benin. As a result, the purpose of this study is to investigate the prevalence and predictors of early antenatal care visits among women of productive age in Benin. Methods: This is a secondary analysis of the 2017/2018 Benin Demographic and Health Survey (BDHS) data. The study involved 6,919 eligible women. Data analysis was conducted using Stata version 14.2 for Mac OS. We adopted a multilevel logistic regression to examine the predictors of early ANC visits in Benin. The results were presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and p-value <0.05 to determine the significant associations. Results: The prevalence of early ANC visits among pregnant women in Benin was 57.03% [95% CI: 55.41-58.64]. In the final multilevel logistic regression, early ANC visit was higher among women aged 30-34 [aOR=1.60, 95% CI=1.17-2.18] compared to those aged 15-19, women with primary education [aOR=1.22, 95% CI=1.06-142] compared to the non-educated women, women who were covered by health insurance [aOR=3.03, 95% CI=1.35-6.76], women without a big problem in getting the money needed for treatment [aOR=1.31, 95% CI=1.16-1.49], distance to the health facility, not a big problem [aOR=1.23, 95% CI=1.08-1.41], and women whose partners had secondary/higher education [aOR=1.35, 95% CI=1.15-1.57] compared with those who were not covered by health insurance, had big problem in getting money needed for treatment, distance to health facility is a big problem and whose partners had no education respectively. However, women who had four or more births [aOR=0.60, 95% CI=0.48-0.74] and those in Atacora Region [aOR=0.50, 95% CI=0.37-0.68] had lower odds of early ANC visit. Conclusion: This study revealed a relatively high prevalence of early ANC visits among women of reproductive age in Benin. Women's age, educational status of women and their partners, parity, health insurance coverage, distance to health facilities, and region were all associated with early ANC visits among women of reproductive in Benin. These factors ought to be taken into account when developing ANC policies and strategies in order to boost early ANC visits among women in Benin. This will significantly reduce maternal and newborn mortality and help achieve the World Health Organization’s recommendation that all pregnant women should initiate early ANC visits within the first three months of pregnancy.

Keywords: antenatal care, Benin, maternal health, pregnancy, DHS, public health

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Authors: MD. Kamruzzaman

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As a developing country, Bangladesh has seen an increase in total GDP in recent years. But it can be further improved by developing “Health-Care” (HC) services because it has enormous infrastructure problems all over the country. Bangladesh's HC system is now clearly poised to undergo reform at any process level, including prevention, diagnosis, and treatment. Although the Bangladeshi government is trying to develop the HC sector, due to health corruption in this sector, the improvement has not accelerated yet. For this reason, lots of Bangladeshi people are facing acute diseases. Regarding the prevention, diagnosis, and treatment of disease, this research will illustrate the law relating to health and HC to ensure excellent health and well-being. Firstly, this paper investigates health under Bangladeshi law from different perspectives related to the HC system. A massive gap has been investigated in this research after comparing Bangladeshi and international health law (HL). Secondly, a practical scenario is investigated and compared with international HC law. It is evident that the Bangladeshi HC system did not achieve a satisfactory standard level concerning international law. A staggering 70% of Bangladesh's population lives in rural areas, with no restrictions on access to hospitals and clinics. However, it is clear that proper HC infrastructure and some new medical practices are urgently needed to ensure HC quality. Finally, this research provides suggestions for developing a HC system to ensure the health of all Bangladeshi people that needs to be immediately implemented by the Bangladeshi government. This research has practical implications in the HC system for any developing country to maintain their citizen's safety.

Keywords: HC system, law relating, bangladeshi HL, international HL, human HC suggestions

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Authors: Xinyuan Y. Song, Kai Kang

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Joint models for analyzing longitudinal and survival data are widely used to investigate the relationship between a failure time process and time-variant predictors. A common assumption in conventional joint models in the survival analysis literature is that all predictors are observable. However, this assumption may not always be supported because unobservable traits, namely, latent variables, which are indirectly observable and should be measured through multiple observed variables, are commonly encountered in the medical, behavioral, and financial research settings. In this study, a joint modeling approach to deal with this feature is proposed. The proposed model comprises three parts. The first part is a dynamic factor analysis model for characterizing latent variables through multiple observed indicators over time. The second part is a random coefficient trajectory model for describing the individual trajectories of latent variables. The third part is a proportional hazard model for examining the effects of time-invariant predictors and the longitudinal trajectories of time-variant latent risk factors on hazards of interest. A Bayesian approach coupled with a Markov chain Monte Carlo algorithm to perform statistical inference. An application of the proposed joint model to a study on the Alzheimer's disease neuroimaging Initiative is presented.

Keywords: Bayesian analysis, joint model, longitudinal data, time-to-event data

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Authors: Zakia Hammouni

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Healthcare professionals’ well-being is becoming a priority during this Covid-19 pandemic due to stress, fatigue, and workload. Well before this pandemic, contemporary hospitals are endowed with environmental attributes that contribute to achieving well-being within their environment with the emphasis on the patient. The patient-centered care approach has been followed by the patient-centered design approach. Studies that have focused on the physical environment in hospitals have dealt with the patient's recovery process and his well-being. Prior scientific literature has placed less emphasis on the healthcare professionals’ interactions within the physical environment and to guide hospital designers to make evidence-based design choices to meet the needs and expectations of hospital users by considering, in addition to patients, healthcare professionals. This paper examines these issues related to the daily stress of professionals who provide care in a hospital environment. In this exploratory study, the interest was to grasp the issues related to this environment and explores the current realities of newly built hospitals based on design approaches and what attributes of the physical setting support healthcare professional’s well-being. Within a constructivist approach, this study was conducted in two care units in a new hospital in a big city in Canada before the Covid-19 pandemic (august 2nd to November 2nd 2018). A spatial evaluation of these care units allowed us to understand the interaction of health professionals in their work environment, to understand the spatial behavior of these professionals, and the narratives from 44 interviews of various healthcare professionals. The mental images validated the salient components of the hospital environment as perceived by these healthcare professionals. Thematic analysis and triangulation of the data set were conducted. Among the key attributes promoting the healthcare professionals’ well-being as revealed by the healthcare professionals are the overall light-color atmosphere in the hospital and care unit, particularly in the corridors and public areas of the hospital, the maintenance and cleanliness. The presence of the art elements also brings well-being to the health professionals as well as panoramic views from the staff lounge and corridors of the care units or elevator lobbies. Despite the overall positive assessment of this environment, some attributes need to be improved to ensure the well-being of healthcare professionals and to provide them with a restructuring environment. These are the supply of natural light, softer colors, sufficient furniture, comfortable seating in the restroom, and views, which are important in allowing these healthcare professionals to recover from their work stress. Noise is another attribute that needs to be further improved in the hospital work environment, especially in the nursing workstations and consultant's room. In conclusion, this study highlights the importance of providing healthcare professionals with work and rest areas that allow them to resist the stress they face, particularly during periods of extreme stress and fatigue such as a Covid-19 pandemic.

Keywords: healthcare facilities, healthcare professionals, physical environment, well-being

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Authors: Sven Tackenberg, Sönke Duckwitz, Andreas Petz, Christopher M. Schlick

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This paper introduces an extension to the well-established Resource-Constrained Project Scheduling Problem (RCPSP) to apply it to complex maintenance problems. The problem is to assign technicians to a team which has to process several tasks with multi-level skill requirements during a work shift. Here, several alternative activities for a task allow both, the temporal shift of activities or the reallocation of technicians and tools. As a result, switches from one valid work process variant to another can be considered and may be selected by the developed evolutionary algorithm based on the present skill level of technicians or the available tools. An additional complication of the observed scheduling problem is that the locations of the construction sites are only temporarily accessible during a day. Due to intensive rail traffic, the available time slots for maintenance and repair works are extremely short and are often distributed throughout the day. To identify efficient working periods, a first concept of a Bayesian network is introduced and is integrated into the extended RCPSP with pre-emptive and non-pre-emptive tasks. Thereby, the Bayesian network is used to calculate the probability of a maintenance task to be processed during a specific period of the shift. Focusing on the domain of maintenance of the railway infrastructure in metropolitan areas as the most unproductive implementation process at construction site, the paper illustrates how the extended RCPSP can be applied for maintenance planning support. A multi-criteria evolutionary algorithm with a problem representation is introduced which is capable of revising technician-task allocations, whereas the duration of the task may be stochastic. The approach uses a novel activity list representation to ensure easily describable and modifiable elements which can be converted into detailed shift schedules. Thereby, the main objective is to develop a shift plan which maximizes the utilization of each technician due to a minimization of the waiting times caused by rail traffic. The results of the already implemented core algorithm illustrate a fast convergence towards an optimal team composition for a shift, an efficient sequence of tasks and a high probability of the subsequent implementation due to the stochastic durations of the tasks. In the paper, the algorithm for the extended RCPSP is analyzed in experimental evaluation using real-world example problems with various size, resource complexity, tightness and so forth.

Keywords: maintenance management, scheduling, resource constrained project scheduling problem, genetic algorithms

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Authors: Irene Kretchy, Frances Owusu-Daaku, Samuel Danquah

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Hypertension is the leading risk factor for cardiovascular diseases, and a major cause of death and disability worldwide. This study examined whether psychosocial variables influenced patients’ perception and experience of side effects of their medicines, how they coped with these experiences and the impact on mental health and medication adherence to conventional hypertension therapies. Methods: A hospital-based mixed methods study, using quantitative and qualitative approaches was conducted on hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms, and coping mechanisms with the aid of standard questionnaires. Information from the quantitative phase was analyzed with the Statistical Package for Social Sciences (SPSS) version 20. The interviews from the qualitative study were audio-taped with a digital audio recorder, manually transcribed and analyzed using thematic content analysis. The themes originated from participant interviews a posteriori. Results: The experiences of side effects – such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion - were categorized as no/low (39.75%), moderate (53.0%) and high (7.25%). Significant relationships between depression (x 2 = 24.21, P < 0.0001), anxiety (x 2 = 42.33, P < 0.0001), stress (x 2 = 39.73, P < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association are reported – depression [OR = 1.9 (1.03 – 3.57), p = 0.04], anxiety [OR = 1.5 (1.22 – 1.77), p = < 0.001], and stress [OR = 1.3 (1.02 – 1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95% CI 1.07 – 1.85), p = 0.04] with social factors, media influences and attitudes of primary caregivers further explaining this relationship. The personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments, and interventions made by clinicians were the main forms of coping with side effects. Conclusions: Results from this study show that contrary to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The result offers more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care. Additionally, medication side effects should be considered as a possible cause of non-adherence among hypertensive patients, thus addressing this problem from a Biopsychosocial perspective in any intervention may improve adherence and invariably control blood pressure.

Keywords: biopsychosocial, hypertension, medication adherence, psychological disorders

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Authors: Sajadian Akram, Tavasoli F.

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Breast cancer is the second most common cancer in the world and certainly the most frequent cancer mostly among women. This study was aimed to compare the effectiveness of individual counseling and group narrative therapy on female patients' life expectancy afflicted by breast cancer. The present study is a pre-test-post-test clinical trial. Fifty-five patients with breast cancer were randomly selected in the follow-up period and after their active medical treatment completion. Then, they were randomly divided into two groups: individual counseling and group counseling. Herth hope index (HHI) was used to measure the patients' hope level. Data were analyzed using t-test and SPSS software. hope rate was statistically significant in both groups receiving individual and group narrative therapy in the post-test compared to the pre-test (P <00000). Moreover, the comparative evaluation of hope in both groups (individual & group counseling) in the post-test showed that group narrative counseling is more effective than individual narrative counseling (P <00000). Conclusion: Narrative therapy promotes hope in breast cancer patients effectively. Due to the nature of breast cancer and its psychological effects in the post-treatment period, providing narrative group therapy can improve life quality. Patients' life quality changes in tandem with changes in hope.

Keywords: hope, narrative therapy, counseling, breast cancer

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Authors: Mohamed Radwan

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Introduction: Polycystic ovary syndrome is becoming very common among girls from ages 14 to 21 years old, alongside women in their childbearing period. A combination of menstrual irregularities, overweight or obesity, insulin resistance (type 2 diabetes), and symptoms of virilization are characteristics of these cases. Background: A multidisciplinary team should be involved in managing these cases and may consist of A gynecologist, endocrinologist, nutritionist, and psychologist. The role of nutritionists is crucial in these cases in weight reduction and nutritional management. It is mandatory to present some questions that may help in expanding further our understanding of the nutritional management of this syndrome, such as it is not an easy process to reduce the weight of PCO patients (2) we need to know what suitable nutritional plans for these cases are. Methodology: It is not successful to use one diet plan for all patients or a specific plan, but we need to give tailored plans for each patient. We will summarize the medical, nutritional therapy and weight management in polycystic ovary patients and highlight the best eating plan and dietary composition in the treatment of these women. We will also discuss the role of dieticians in treating polycystic ovary cases and overcoming the challenges these women face. Conclusion: All diet plans would decrease the weight of Polycystic ovary cases as low calory diet, low glycemic index diet, high protein diet, as well as Dash diet, but the most suitable diet plan to improve hormones and lead to spontaneous pregnancy is the Mediterranean diet.

Keywords: obesity, PCO mediteranian diet, dash diet, high protein diet

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