Search results for: medical record

Authors: Narupon Kunbootsri, P. Sirasaporn

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Frozen shoulder is a common problem present by pain and limit range of motion. The prevalence of frozen shoulder showed 18-31% of population. The effect of frozen shoulder lead to limit activities daily living life, high medical care cost and so on. Physiotherapy is one of the treatments for frozen shoulder but there was no data about the treatment of physiotherapy. Moreover, it is question about onset of symptom relate to physiotherapy program and obtaining physical modalities and delayed start physiotherapy program lead to delayed improvement. Thus the aim of this study was to investigate physiotherapy program for frozen shoulder relate to onset of symptom, range of motion and obtaining physical modalities. A retrospective study design was conducted. 182 medical records of patients with frozen shoulder were reviewed. These frozen shoulders were treated at physiotherapy unit, department of Rehabilitation last 3 years (January, 2014- December, 2016). The data consist of onset of symptom, range of motion and obtaining physical modalities were recorded. There was a statistically significant increase in shoulder flexion [mean difference 38.88 with 95%CI were [16.00-61.77], shoulder abduction [mean difference 48.47 with 95%CI were 16.07-90.59], shoulder internal rotation [mean difference 22.36 with 95%CI were 2.81-37.18] and shoulder external rotation [mean difference 32.12 with 95%CI were [(-2.47)-(46.91)]. In addition, the onset of symptom was 76.42±46.90 days. And the physical modalities used frequently were hot pack 14.8% and ultrasound diathermy 13.7%. In conclusion, the physiotherapy program including, hot pack and ultrasound diathermy seem to be useful for frozen shoulder. But onset of symptom is too long to start physiotherapy programs.

Keywords: frozen shoulder, range of motions, onset of symptom, physiotherapy, physical modality

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Authors: Mohammed Alateeq, Abdulaziz Alrshoud

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Objectives: To examine the attitude and practice of family physicians in giving smoking cessation advice at King Abdul-Aziz Medical City for National Guard, Riyadh. Methods: Cross sectional study using validated self-reported questionnaire that distributed to all family physicians and primary health care doctors at the four main family medicine and primary health care centers, KAMC, Riyadh. Results: 73 physicians are contributed in this study. 28 (38.4%) physicians were from (KASHM ALAN) clinic, 26 (35.6%) physicians were from (UM ALHAMAM) Clinic. 13 (17.8%) physicians were from (ISKAN) clinic. 6 (8.2%) physicians were from the Employee Health Clinic. 73 (100%) of the target population agreed that giving brief smoking cessation advice is part of their duties. 67 (91.7%) agreed that Presence of hospital guidelines and special clinics for smoking cessation will encourage them to provide advice. Only 5 (6.84%) received training courses (1-4 weeks) in smoking cessation interventions. Conclusion: Most of the target population agreed that brief smoking cessation advice is part of their duties. Also, they agreed that Presence of hospital guidelines and special clinics for smoking cessation will encourage them to provide advice although most of them did not received a formal training in smoking cessation advice.

Keywords: advice, attitude, cessation, family physicians, smoking

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Authors: S. Zith Dey Babu, S. Kour, S. Verma, C. Verma, V. Pathania, A. Agrawal, V. Chaudhary, A. Manoj Puthur, R. Goyal, A. Pal, T. Danti Dey, A. Kumar, K. Wadhwa, O. Ved

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Background: Skin cancer is now is the buzzing button in the field of medical science. The cyst's pandemic is drastically calibrating the body and well-being of the global village. Methods: The extracted image of the skin tumor cannot be used in one way for diagnosis. The stored image contains anarchies like the center. This approach will locate the forepart of an extracted appearance of skin. Partitioning image models has been presented to sort out the disturbance in the picture. Results: After completing partitioning, feature extraction has been formed by using genetic algorithm and finally, classification can be performed between the trained and test data to evaluate a large scale of an image that helps the doctors for the right prediction. To bring the improvisation of the existing system, we have set our objectives with an analysis. The efficiency of the natural selection process and the enriching histogram is essential in that respect. To reduce the false-positive rate or output, GA is performed with its accuracy. Conclusions: The objective of this task is to bring improvisation of effectiveness. GA is accomplishing its task with perfection to bring down the invalid-positive rate or outcome. The paper's mergeable portion conflicts with the composition of deep learning and medical image processing, which provides superior accuracy. Proportional types of handling create the reusability without any errors.

Keywords: computer-aided system, detection, image segmentation, morphology

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Authors: Sylvie Ekanga Lumumba

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Background and Significance of the Study: Over the past three decades, the perception of sexual violence has changed significantly, it is now recognized that men and boys are victims of sexual violence. However, the body of research on male victims and particularly on their attackers is much more limited. Research on the above is thus more than required. To contribute to the above quest for further studies, the researcher conducted this study on sexual violence perpetrated against men and boys by women, in the Municipality of Ibanda, Town of Bukavu, Province of South Kivu, Democratic Republic of Congo. The main study objectives were the following: to investigate on the statement of sexual violence perpetrated against men and boys in the Municipality of Ibanda, to investigate into its consequences and the statement of medical and psycho-social care given to victims. Methodology: Data were collected using valid and reliable Survey Questionnaire and Interview Schedule. Study population: the 85,882 men and boys from the Municipality of Ibanda. Sampling: led to 150 men and boys, received discreetly by the researcher during November-December 2015. Major findings: First, findings related to sexual abuse and its procedure: 74.2% of men and boys were victims of sexual violence perpetrated by a woman, more than a year ago. 13.3% however, were victims for less than a year now. 79.7% of victims have experienced sexual violence by a sexual act; 3.9% through the intention of the woman to cause the death of the victim, by serious injury to the genitals. The Second group of findings related to the consequences of sexual violence revealed that HIV/AIDS is the most important physical consequence experienced by 77.3 % of victims. Physical psychological consequences are: urinary or defecation problems (72.7%); while key psycho-emotional and behavioral consequence is: living a state of deep shame and humiliation: 68.8%. As for sexual consequences: 71.1% indicated a chronic avoidance of sexual activity and 57% reported sexual dysfunctions. The third group of findings is related to medical and psycho-social care: repetitively, more than 80% of male victims affirmed that with the help of friends and traditional healers, they took care of themselves for all the eight WHO phases of clinical care of rape victims, this was hence not effectively done. Concluding Statement: for this study, the statement of sexual violence of men and boys by women in the Eastern Congo and its consequences are not researched upon and are underestimated; the study also revealed that the care of male victims is grossly ill-conducted, as opposed to female victims care. It therefore calls for further research and further vulgarization of the research results, to convince other stakeholders (politicians for example) to immediately take action.

Keywords: sexual violence, men and boys, medical care, psycho-social care

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Authors: Denise Ben-Porath, Tracy Masterson

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In the past, individuals who struggled with and sought treatment for mental health difficulties were stigmatized. However, the current generation holds more open attitudes around mental health issues. Indeed, public figures such as Demi Lovato, Naomi Osaka, and Simone Biles have taken to social media to break the silence around mental health, discussing their own struggles and the benefits of treatment. Thus, there is considerable reason to believe that this generation would hold fewer stigmatizing attitudes toward mental health difficulties and treatment compared to previous ones. In this study, we explored possible changes in stigma on mental health diagnosis and treatment seeking behavior between two generations: Gen Z, the current generation, and Gen X, those born between 1965-1980. It was hypothesized that Gen Z would hold less stigmatizing views on mental illness than Gen X. To examine possible changes in stigma attitudes between these two generations, we conducted a cross-generational cohort design by using the same methodology employed 20 years ago from the Ben-Porath (2002) study. Thus, participants were randomly assigned to read one of the following four case vignettes employed in the Ben-Porath (2002) study: (a) “Tom” who has received psychotherapy due to depression (b) “Tom” who has been depressed but received no psychological help, (c) “Tom” who has received medical treatment due to a back pain, or (d) “Tom” who had a back pain but did not receive medical attention. After reading the vignette, participants rated “Tom” on various personality dimensions using the IFQ Questionnaire and answered questions about their frequency of social media use and willingness to seek mental health treatment on a scale from 1-10. Identical to the results 20 years prior, a significant main effect was found for diagnosis with “Tom” being viewed in more negative terms when he was described as having depression vs. a medical condition (back pain) [F (1, 376) = 126.53, p < .001]. However, in the study conducted 20 years earlier, a significant interaction was found between diagnosis and help-seeking behavior [F (1, 376) = 8.28, p < .005]. Specifically, “Tom” was viewed in the most negative terms when described as depressed and seeking treatment. Alternatively, the current study failed to find a significant interaction between depression and help seeking behavior. These findings suggest that while individuals who hold a mental health diagnosis may still be stigmatized as they were 20 years prior, seeking treatment for mental health issues may be less so. Findings are discussed in the context of social media use and its impact on destigmatization.

Keywords: stigma, mental illness, help-seeking, social media

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Authors: Arash M. Shahidi, Tilak Dias, Gayani K. Nandasiri

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While graduated compression is the foundation of treatment and management of many medical complications such as leg ulcer, varicose veins, and lymphedema, monitoring the interface pressure has been conducted using different sensors that operate based on diverse approaches. The variations existed from the pressure readings collected using different interface pressure measurement systems would cause difficulties in taking a decision regarding the compression therapy. It is crucial to acknowledge the differences existing between direct and indirect pressure measurement systems while considering the commercially available systems such as AMI, Picopress and OPM which are under direct measurements systems, and HATRA (BSI), HOSY (RAL-GZ) and FlexiForce which comes under the indirect measurement system. Furthermore, Piezo-resistive sensors (Flexiforce) can measure the changes in resistance corresponding to the applied force on the sensing area. Direct pressure measuring systems are capable of measuring interface pressure on the three-dimensional states, while the indirect pressure measuring systems stretch the fabric in the two-dimensional direction and extrapolate pressure from surface tension measured on the device and neglect the vital factor which is the radius of curvature. In this study, a leg mannequin of known dimensions is selected with a knitted class 3 compression stocking. It has been decided to evaluate the data collected from different available systems (AMI, PicoPress, FlexiForce, and HATRA) and compare the results. The results showed a discrepancy between Hatra, AMI, Picopress, and Flexiforce against the pressure standard used to generate class 3 compression stocking. As predicted a higher pressure value with direct interface measuring systems were monitored against HATRA due to the effect of the radius of curvature.

Keywords: AMI, FlexiForce, graduated compression, HATRA, interface pressure, PicoPress

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Authors: A. Erragh, K. Amanzoui, M. Elharit, H. Salem, M. Ababneh, K. Elfakhr, S. Kalouch, A. Chlilek

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Guillain-Barre syndrome (GBS) is the most common form of acute polyradiculoneuritis (PRNA). It is a medical emergency in pediatrics that requires rapid diagnosis and immediate assessment of the severity criteria for the implementation of appropriate treatment. Retrospective, descriptive study in 24 patients under the age of 18 who presented with GBS between September 2017 and July 2021 and were hospitalized in the multipurpose pediatric intensive care unit of the Abderrahim EL Harouchi children's hospital in Casablanca. The average age was 7.91 years, with extremes ranging from 18 months and 14 years and a male predominance of 75%. After a prodromal event, most often infectious (80%) and a free interval of 12 days on average, 2 types of motor disorders begin either hypo or arereflectic flaccid paralysis of the lower limbs (45.8%) or flaccid quadriplegia hypo or arereflectic (54.2%). During GBS, the most formidable complication is respiratory distress, which can occur at any time. In our study, respiratory impairment was observed in 70.8% of cases. In addition, other signs of severity, such as swallowing disorders (75%) and dysautonomic disorders (8.33%), were also observed, which justified care in the intensive care unit for all of our patients. The use of invasive ventilation was necessary in 76.5% of cases, and specific treatments based on immunoglobulins were administered in all our patients. Despite everything, the death rate remains high (25%) and is mainly due to complications related to hospitalization. Guillain Barré syndrome is, therefore, a pediatric emergency that requires rapid diagnosis and immediate assessment of severity criteria for the implementation of appropriate treatment.

Keywords: guillain barre syndrome, emergency, children, medical

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Authors: Shehnila Kanwal

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Murree-Kotli Sattian-Kahta National Park (MKKNP) was declared in 2009. However, not much is known about the diversity and relative abundance of the mammalian fauna of this park. In the current study, we used field sign survey and infrared camera trapping techniques to get an insight into the diversity of mammalian species and their relative abundance. We conducted field surveys in different areas of the park at various elevations from April 2023 up to March 2024 to record the field signs (scats, pug marks etc.) of the mammals’ species; in addition, we deployed a total of 22 infrared trail camera traps in different areas of the park, for 116 nights. We obtained a total of 5201 photographs using camera trapping. Results of camera trapping coupled with field sign surveys confirmed the presence of a total of twenty-one different mammalian species (large, meso and small mammals) recorded in the study area. The common leopard was recorded at four different sites in the park, with an altitudinal range between 648m-1533m. Distribution of Asiatic jackal and a red fox was recorded positive at all the sites surveyed in the park with an altitudinal range between 498m-1287m and 433m-2049m, respectively. Leopard cats were recorded at two different sites within the altitudinal range between 498m-894m. Jungle cat was recorded at three sites within an altitudinal range between 498m-846. Asian palm civets and small Indian civets were both recorded at three sites. Grey mongoose and small Indian mongoose were recorded at four and three sites. We also collected a total of 75 scats of different mammal species in the park to further confirm their occurrence. For the Indian pangolin, we recorded three field burrows at two different sites. Diversity index (H’=2.369960) and species evenness (E=0.81995) were calculated. Analysis of data revealed that wild boar (Sus sucrofa) was the most abundant species in the park; most of the mammal species were found nocturnal; these remain active from dusk throughout the night, and some of them remain active at dawn time. Leopard and Asian palm civets were highly overlapping species in the study area. Their temporal activity pattern overlapped 61%. Barking deer and Indian crested porcupine were also found to be nocturnal species they remained active throughout the night.

Keywords: MKKNP, diversity, abundance, evenness, distribution, mammals, overlapped

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Authors: G. R. Constantine, M.C.K. Thilakasiri, V.S. Mohottala, T.V. Soundaram, D.S. Rathnayake, E.G.H.E. De Silva, A.L.S. Mohamed, V.R. Weerasekara

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Orthostatic hypotension is prevalent in the elderly population, and it is an important risk factor contributing to falls in the elderly. This study aims to evaluate the prevalence of orthostatic hypotension in hospitalized elderly patients, changes in blood pressure during the hospital stay, morbidities associated with it and its association with falls in the elderly. A cross-sectional descriptive study was conducted in the National Hospital of Sri Lanka (NHSL) in a sample of 120 patients of age 65 years or above who were admitted to the medical wards. The demographic, clinical data was obtained by an interviewer-administered questionnaire. Two validated questionnaires were used to assess symptoms and effects of orthostatic hypotension and risk factors associated with falls. Orthostatic hypotension on admission and after 3 days of hospital stay was measured by bed-side mercury sphygmomanometer. Prevalence of orthostatic hypotension among the study population was 63.3%(76 patients). But no significant change in the orthostatic hypotension noted after 3 days of hospital admission (SND 0.61, SE= 5.59, p=0.27). There was no significant association found between orthostatic hypotension and its symptoms (dizziness and vertigo, vision problems, malaise, fatigue, poor concentration, neck stiffness), impact on standing or walking and non-communicable diseases. Falls were experienced by 27.5 % (33 patients) of the study population and prevalence of patients with orthostatic hypotension who had experienced falls was 25.9% (28 patients). In conclusions, orthostatic hypotension is more prevalent among elderly patients, but It wasn’t associated with symptoms, and non-communicable diseases, or as a risk factor for falls in elderly.

Keywords: orthostatic hypotension, elderly falls, emergency geriatric, Sri Lanka

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Authors: M. A. Askari, M. A. Nazari, P. Perrier, Y. Payan

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Growth and remodeling of biological structures have gained lots of attention over the past decades. Determining the response of living tissues to mechanical loads is necessary for a wide range of developing fields such as prosthetics design or computerassisted surgical interventions. It is a well-known fact that biological structures are never stress-free, even when externally unloaded. The exact origin of these residual stresses is not clear, but theoretically, growth is one of the main sources. Extracting body organ’s shapes from medical imaging does not produce any information regarding the existing residual stresses in that organ. The simplest cause of such stresses is gravity since an organ grows under its influence from birth. Ignoring such residual stresses might cause erroneous results in numerical simulations. Accounting for residual stresses due to tissue growth can improve the accuracy of mechanical analysis results. This paper presents an original computational framework based on gradual growth to determine the residual stresses due to growth. To illustrate the method, we apply it to a finite element model of a healthy human face reconstructed from medical images. The distribution of residual stress in facial tissues is computed, which can overcome the effect of gravity and maintain tissues firmness. Our assumption is that tissue wrinkles caused by aging could be a consequence of decreasing residual stress and thus not counteracting gravity. Taking into account these stresses seems therefore extremely important in maxillofacial surgery. It would indeed help surgeons to estimate tissues changes after surgery.

Keywords: finite element method, growth, residual stress, soft tissue

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Authors: Rihab Idoudi, Karim Saheb Ettabaa, Basel Solaiman, Kamel Hamrouni

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Medical association rules induction is used to discover useful correlations between pertinent concepts from large medical databases. Nevertheless, ARs algorithms produce huge amount of delivered rules and do not guarantee the usefulness and interestingness of the generated knowledge. To overcome this drawback, we propose an ontology based interestingness measure for ARs ranking. According to domain expert, the goal of the use of ARs is to discover implicit relationships between items of different categories such as ‘clinical features and disorders’, ‘clinical features and radiological observations’, etc. That’s to say, the itemsets which are composed of ‘similar’ items are uninteresting. Therefore, the dissimilarity between the rule’s items can be used to judge the interestingness of association rules; the more different are the items, the more interesting the rule is. In this paper, we design a distinct approach for ranking semantically interesting association rules involving the use of an ontology knowledge mining approach. The basic idea is to organize the ontology’s concepts into a hierarchical structure of conceptual clusters of targeted subjects, where each cluster encapsulates ‘similar’ concepts suggesting a specific category of the domain knowledge. The interestingness of association rules is, then, defined as the dissimilarity between corresponding clusters. That is to say, the further are the clusters of the items in the AR, the more interesting the rule is. We apply the method in our domain of interest – mammographic domain- using an existing mammographic ontology called Mammo with the goal of deriving interesting rules from past experiences, to discover implicit relationships between concepts modeling the domain.

Keywords: association rule, conceptual clusters, interestingness measures, ontology knowledge mining, ranking

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Authors: Azita Ramezani, Ghazal Mashhadiagha, Bahareh Sanabakhsh

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This study researches the combination of Random. Forest classifiers with large language models (LLMs) and natural language processing (NLP) to improve diagnostic accuracy in chest X-ray analysis using the Indiana University dataset. Utilizing advanced NLP techniques, the research preprocesses textual data from radiological reports to extract key features, which are then merged with image-derived data. This improved dataset is analyzed with Random Forest classifiers to predict specific clinical results, focusing on the identification of health issues and the estimation of case urgency. The findings reveal that the combination of NLP, LLMs, and machine learning not only increases diagnostic precision but also reliability, especially in quickly identifying critical conditions. Achieving an accuracy of 99.35%, the model shows significant advancements over conventional diagnostic techniques. The results emphasize the large potential of machine learning in medical imaging, suggesting that these technologies could greatly enhance clinician judgment and patient outcomes by offering quicker and more precise diagnostic approximations.

Keywords: natural language processing (NLP), large language models (LLMs), random forest classifier, chest x-ray analysis, medical imaging, diagnostic accuracy, indiana university dataset, machine learning in healthcare, predictive modeling, clinical decision support systems

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Authors: Kay-Anne Haykal, Issack Biyong

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The post-traumatic stress disorder (PTSD) rises from exposure to a traumatic event and appears by a persistent experience of this event. Several psychiatric co-morbidities are associated with PTSD and include mood disorders, anxiety disorders, and substance abuse. The main objective was to compare the criteria for PTSD according to the literature to those used to diagnose a patient in a francophone hospital and to check the correspondence of these two criteria. 700 medical charts of admitted patients on the medicine or psychiatric unit at the Montfort Hospital were identified with the following diagnoses: major depressive disorder, bipolar disorder, anxiety disorder, substance abuse, and PTSD for the period of time between April 2005 and March 2006. Multiple demographic criteria were assembled. Also, for every chart analyzed, the PTSD criteria, according to the Manual of Mental Disorders (DSM) IV were found, identified, and grouped according to pre-established codes. An analysis using the receiver operating characteristic (ROC) method was elaborated for the study of data. A sample of 57 women and 50 men was studied. Age was varying between 18 and 88 years with a median age of 48. According to the PTSD criteria in the DSM IV, 12 patients should have the diagnosis of PTSD in opposition to only two identified in the medical charts. The ROC method establishes that with the combination of data from PTSD and depression, the sensitivity varies between 0,127 and 0,282, and the specificity varies between 0,889 and 0,917. Otherwise, if we examine the PTSD data alone, the sensibility jumps to 0.50, and the specificity varies between 0,781 and 0,895. This study confirms the presence of an underdiagnosed and treated PTSD that causes severe perturbations for the affected individual.

Keywords: post-traumatic stress disorder, co-morbidities, diagnosis, mental health disorders

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Authors: Karim Hajjar, Luis Lillo, Diego Martinez, Manuel Hermosilla, Nicholas Risko

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Objectives: This study examines the relationship between universal health coverage (UCH) and the burden of emergency diseases at a global level. Methods: Data on Disability-Adjusted Life Years (DALYs) from emergency conditions were extracted from the Institute for Health Metrics and Evaluation (IHME) database for the years 2015 and 2019. Data on UHC, measured using two variables, 1) coverage of essential health services and 2) proportion of population spending more than 10% of household income on out-of-pocket health care expenditure, was extracted from the World Bank Database for years preceding our outcome of interest. Linear regression was performed, analyzing the effect of the UHC variables on the DALYs of emergency diseases, controlling for other variables. Results: A total of 133 countries were included. 44.4% of the analyzed countries had coverage of essential health services index of at least 70/100, and 35.3% had at least 10% of their population spend greater than 10% of their household income on healthcare. For every point increase in the coverage of essential health services index, there was a 13-point reduction in DALYs of emergency medical diseases (95% CI -16, -11). Conversely, for every percent decrease in the population with large household expenditure on healthcare, there was a 0.48 increase in DALYs of emergency medical diseases (95% CI -5.6, 4.7). Conclusions: After adjusting for multiple variables, an increase in coverage of essential health services was significantly associated with improvement in DALYs for emergency conditions. There was, however, no association between catastrophic health expenditure and DALYs.

Keywords: emergency medicine, universal healthcare, global health, health economics

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Authors: John Peter Dacanay, Edison Ramos, Cristopher James Dicang

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Waste management is a global concern due to increasing waste production from changing consumption patterns and population growth. Proper waste disposal management is a critical aspect of public health and environmental protection. In the healthcare industry, medical waste is generated in large quantities, and if not disposed of properly, it poses a significant threat to human health and the environment. Efficient waste management conserves natural resources and prevents harm to human health, and implementing an effective waste management system can save human lives. The study aimed to assess the level of awareness and practices on waste disposal management, highlighting the understanding of proper disposal, potential hazards, and environmental implications among Medical Technology students. This would help to provide more recommendations for improving waste management practices in healthcare settings as well as for better waste management practices in educational institutions. From the collected data, a female of 21 years of age stands out among the respondents. With the frequency and percentage of medical technology students' knowledge of laboratory waste management being high, it indicates that all respondents demonstrated a solid understanding of proper disposal methods, regulations, risks, and handling procedures related to laboratory waste. That said, the findings emphasize the significance of education and awareness programs in equipping individuals involved in laboratory practices with the necessary knowledge to handle and dispose of hazardous and infectious waste properly. Most respondents demonstrate positive practices or are highly mannered in laboratory waste management, including proper segregation and disposal in designated containers. However, there are concerns about the occasional mixing of waste types, emphasizing the reiteration of proper waste segregation. Students show a strong commitment to using personal protective equipment and promptly cleaning up spills. Some students admit to improper disposal due to rushing, highlighting the importance of time management and safety prioritization. Overall, students follow protocols for hazardous waste disposal, indicating a responsible approach. The school's waste management system is perceived as adequate, but continuous assessment and improvement are necessary. Encouraging reporting of issues and concerns is crucial for ongoing improvement and risk mitigation. The analysis reveals a moderate positive relationship between the respondents' knowledge and practices regarding laboratory waste management. The statistically significant correlation with a p-value of 0.26 (p-value 0.05) suggests that individuals with higher levels of knowledge tend to exhibit better practices. These findings align with previous research emphasizing the pivotal role of knowledge in influencing individuals' behaviors and practices concerning laboratory waste management. When individuals possess a comprehensive understanding of proper procedures, regulations, and potential risks associated with laboratory waste, they are more inclined to adopt appropriate practices. Therefore, fostering knowledge through education and training is essential in promoting responsible and effective waste management in laboratory settings.

Keywords: waste disposal management, knowledge, attitude, practices

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Authors: Hilal Naimi, Amelbahahouda Adamou-Mitiche, Lahcene Mitiche

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The main problem in the area of medical imaging has been image denoising. The most defying for image denoising is to secure data carrying structures like surfaces and edges in order to achieve good visual quality. Different algorithms with different denoising performances have been proposed in previous decades. More recently, models focused on deep learning have shown a great promise to outperform all traditional approaches. However, these techniques are limited to the necessity of large sample size training and high computational costs. This research proposes a denoising approach basing on LDTCWT (Lifting Dual Tree Complex Wavelet Transform) using Hybrid Thresholding with Wiener filter to enhance the quality image. This research describes the LDTCWT as a type of lifting wavelets remodeling that produce complex coefficients by employing a dual tree of lifting wavelets filters to get its real part and imaginary part. Permits the remodel to produce approximate shift invariance, directionally selective filters and reduces the computation time (properties lacking within the classical wavelets transform). To develop this approach, a hybrid thresholding function is modeled by integrating the Wiener filter into the thresholding function.

Keywords: lifting wavelet transform, image denoising, dual tree complex wavelet transform, wavelet shrinkage, wiener filter

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Authors: Souhir Chelly, Chahida Harizi, Aicha Hechaichi, Sihem Aissaoui, Leila Ben Ayed, Maha Bergaoui, Mohamed Kouni Chahed

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Introduction: The International Classification of Primary Care (ICPC) is part of the morbidity classification system. It had 17 chapters, and each is coded by an alphanumeric code: the letter corresponds to the chapter, the number to a paragraph in the chapter. The objective of this study is to show the utility of this classification in the coding of the reasons for demand for care in Primary health care (PHC), its advantages and limits. Methods: This is a cross-sectional descriptive study conducted in 4 PHC in Ariana district. Data on the demand for care during 2 days in the same week were collected. The coding of the information was done according to the CISP. The data was entered and analyzed by the EPI Info 7 software. Results: A total of 523 demands for care were investigated. The patients who came for the consultation are predominantly female (62.72%). Most of the consultants are young with an average age of 35 ± 26 years. In the ICPC, there are 7 rubrics: 'infections' is the most common reason with 49.9%, 'other diagnoses' with 40.2%, 'symptoms and complaints' with 5.5%, 'trauma' with 2.1%, 'procedures' with 2.1% and 'neoplasm' with 0.3%. The main advantage of the ICPC is the fact of being a standardized tool. It is very suitable for classification of the reasons for demand for care in PHC according to their specificity, capacity to be used in a computerized medical file of the PHC. Its current limitations are related to the difficulty of classification of some reasons for demand for care. Conclusion: The ICPC has been developed to provide healthcare with a coding reference that takes into account their specificity. The CIM is in its 10th revision; it would gain from revision to revision to be more efficient to be generalized and used by the teams of PHC.

Keywords: international classification of primary care, medical file, primary health care, Tunisia

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Authors: Victor N. Anisimov, Lyubov A. Boyko, Yazgul R. Almukhametova, Natalia V. Galkina, Alexander V. Latanov

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Modern commercials presented on billboards, TV and on the Internet contain a lot of information about the product or service in text form. However, this information cannot always be perceived and understood by consumers. Typical sociological focus group studies often cannot reveal important features of the interpretation and understanding information that has been read in text messages. In addition, there is no reliable method to determine the degree of understanding of the information contained in a text. Only the fact of viewing a text does not mean that consumer has perceived and understood the meaning of this text. At the same time, the tools based on marketing analysis allow only to indirectly estimate the process of reading and understanding a text. Therefore, the aim of this work is to develop a valid method of recording objective indicators in real time for assessing the fact of reading and the degree of text comprehension. Psychophysiological parameters recorded during text reading can form the basis for this objective method. We studied the relationship between multimodal psychophysiological parameters and the process of text comprehension during reading using the method of correlation analysis. We used eye-tracking technology to record eye movements parameters to estimate visual attention, electroencephalography (EEG) to assess cognitive load and polygraphic indicators (skin-galvanic reaction, SGR) that reflect the emotional state of the respondent during text reading. We revealed reliable interrelations between perceiving the information and the dynamics of psychophysiological parameters during reading the text in commercials. Eye movement parameters reflected the difficulties arising in respondents during perceiving ambiguous parts of text. EEG dynamics in rate of alpha band were related with cumulative effect of cognitive load. SGR dynamics were related with emotional state of the respondent and with the meaning of text and type of commercial. EEG and polygraph parameters together also reflected the mental difficulties of respondents in understanding text and showed significant differences in cases of low and high text comprehension. We also revealed differences in psychophysiological parameters for different type of commercials (static vs. video, financial vs. cinema vs. pharmaceutics vs. mobile communication, etc.). Conclusions: Our methodology allows to perform multimodal evaluation of text perusal and the quality of text reading in commercials. In general, our results indicate the possibility of designing an integral model to estimate the comprehension of reading the commercial text in percent scale based on all noticed markers.

Keywords: reading, commercials, eye movements, EEG, polygraphic indicators

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Authors: Hadis Hosseinzadehnaseri

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The red tide is a kind of algae blooming, caused different problems at different sizes for the human life and the environment, so it has become one of the serious global concerns in the field of Oceanography in few recent decades. This phenomenon has affected on Iran's water, especially the Persian Gulf's since last few years. Collecting data associated with this phenomenon and comparison in different parts of the world is significant as a practical way to study this phenomenon and controlling it. Effective factors to occur this phenomenon lead to the increase of the required nutrients of the algae or provide a good environment for blooming. In this study, we examined the probability of relation between the earthquake and the harmful algae blooming in the Persian Gulf's water through comparing the earthquake data and the recorded Red tides. On the one hand, earthquakes can cause changes in seawater temperature that is effective in creating a suitable environment and the other hand, it increases the possibility of water nutrients, and its transportation in the seabed, so it can play a principal role in the development of red tide occurrence. Comparing the distribution spatial-temporal maps of the earthquakes and deadly red tides in the Persian Gulf and Oman Sea, confirms the hypothesis, why there is a meaningful relation between these two distributions. Comparing the number of earthquakes around the world as well as the number of the red tides in many parts of the world indicates the correlation between these two issues. This subject due to numerous earthquakes, especially in recent years and in the southern part of the country should be considered as a warning to the possibility of re-occurrence of a critical state of red tide in a large scale, why in the year 2008, the number of recorded earthquakes have been more than near years. In this year, the distribution value of the red tide phenomenon in the Persian Gulf got measured about 140,000 square kilometers and entire Oman Sea, with 10 months Survival in the area, which is considered as a record among the occurred algae blooming in the world. In this paper, we could obtain a logical and reasonable relation between the earthquake frequency and this phenomenon occurrence, through compilation of statistics relating to the earthquakes in the southern Iran, from 2000 to the end of the first half of 2013 and also collecting statistics on the occurrence of red tide in the region as well as examination of similar data in different parts of the world. As shown in Figure 1, according to a survey conducted on the earthquake data, the most earthquakes in the southern Iran ranks first in the fourth Gregorian calendar month In April, coincided with Ordibehesht and Khordad in Persian calendar and then in the tenth Gregorian calendar month In October, coincided in Aban and Azar in Persian calendar.

Keywords: red tide, earth quake, persian gulf, harmful algae bloom

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Authors: Nuha Alamro

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Besides achieving of weight loss, Bariatric surgery (BS) shown metabolic improvement including reduction of cardiovascular disease, insulin resistance and diabetes. This study aimed to measure BS effects on Framingham Risk Score (FRS) and metabolic syndrome (MetS) among patients who underwent BS. Additionally, to determine the effect of BS on TSH among euthyroid obese patients. A Retrospective follow-up study was conducted in King Abdullah Medical City. A total of 160 participants who underwent BS and completed one year of follow ups. Medical history, biochemical, anthropometric, and hormonal parameters were evaluated at baseline and 3-12 months after BS. International Diabetes Federation (IDF) criteria were used to diagnose MetS pre and postoperative. The mean age of participants was 41.9 ± 10.6 with Body Mass Index (BMI) of 48.8 ± 7.3. After 3 months, Systolic, Diastolic blood pressure (SBP, DBP), glycated haemoglobin (HBA1C), Low-density lipoprotein (LDL), cholesterol, triglycerides and Thyroid stimulating hormone (TSH) were significantly decrease (P < 0.001). Significant decrease was seen in Mets, BMI, FRS, SBP, DBP, HBA1C, LDL, triglycerides, cholesterol, liver enzyme, with significant increase in high-density lipoprotein (HDL) level 12 months post-op (P < 0.001). After 1 year, the prevalence of MetS, DM, HTN, FRS were significantly decrease from 72.5%, 43.1%, 78.1%, 11.4 to 16.3%, 9.4%, 22.5% and 5.4, respectively. Besides achieving substantial weight loss, MetS resolution was linked to improvement in cardiovascular risk profile.

Keywords: bariatric surgery, cardiovascular disease, metabolic syndrome, thyroid stimulating hormone

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Authors: Vinayak Malhotra, Samanyu Raina, Ajinkya Vajurkar

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Enhancing the rocket efficiency by controlling the external factors in solid rockets motors has been an active area of research for most of the terrestrial and extra-terrestrial system operations. Appreciable work has been done, but the complexity of the problem has prevented thorough understanding due to heterogenous heat and mass transfer. On record, severe issues have surfaced amounting to irreplaceable loss of mankind, instruments, facilities, and huge amount of money being invested every year. The coupled effect of an external heat source and external heat sink is an aspect yet to be articulated in combustion. Better understanding of this coupled phenomenon will induce higher safety standards, efficient missions, reduced hazard risks, with better designing, validation, and testing. The experiment will help in understanding the coupled effect of an external heat sink and heat source on the burning process, contributing in better combustion and fire safety, which are very important for efficient and safer rocket flights and space missions. Safety is the most prevalent issue in rockets, which assisted by poor combustion efficiency, emphasizes research efforts to evolve superior rockets. This signifies real, engineering, scientific, practical, systems and applications. One potential application is Solid Rocket Motors (S.R.M). The study may help in: (i) Understanding the effect on efficiency of core engines due to the primary boosters if considered as source, (ii) Choosing suitable heat sink materials for space missions so as to vary the efficiency of the solid rocket depending on the mission, (iii) Giving an idea about how the preheating of the successive stage due to previous stage acting as a source may affect the mission. The present work governs the temperature (resultant) and thus the heat transfer which is expected to be non-linear because of heterogeneous heat and mass transfer. The study will deepen the understanding of controlled inter-energy conversions and the coupled effect of external source/sink(s) surrounding the burning fuel eventually leading to better combustion thus, better propulsion. The work is motivated by the need to have enhanced fire safety and better rocket efficiency. The specific objective of the work is to understand the coupled effect of external heat source and sink on propellant burning and to investigate the role of key controlling parameters. Results as of now indicate that there exists a singularity in the coupled effect. The dominance of the external heat sink and heat source decides the relative rocket flight in Solid Rocket Motors (S.R.M).

Keywords: coupled effect, heat transfer, sink, solid rocket motors, source

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Authors: Nassim Salmi

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This study aimed to identify the administrative, social, cultural, economic and psychological challenges facing the nursing s ector in the Tebessa Algeria. It also seeks to identify whether there are differences between the opinions of managers in public and private hospitals about these challenges. To achieve the objectives of the study, the descriptive analytical method was adopted. The study also used the questionnaire as a tool for collecting the necessary data and information, which was applied to a sample of directors of public and private hospitals in the Tebessa, which amounted to (114) individuals. The study reached a set of results, including: that there are no statistically significant differences between the opinions of managers in public and private hospitals about the administrative, social, cultural, economic and psychological challenges facing the nursing sector in the Tebessa . The results also showed agreement between the views of managers in private public hospitals that the most important administrative challenges are the lack of training programs that affect the efficiency and performance of nursing work, and that the most important social and cultural challenges are the hospital’s failure to provide suitable nurseries for Saudi female nurses, and that the most important economic challenges are the lack of Availability of medical equipment and devices, and the most important psychological challenge is the tense relationship between the administration and the hospital's nursing staff. The study recommended focusing on the importance of rehabilitation and training together, activating the role of training in the ministry and making it compulsory and a condition of renewal for practicing and continuing the nursing profession, and providing the social and economic needs of the nursing staff.

Keywords: postoperative care, gynecology, nursing documentation, database

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Authors: Hassan Ali Abood Nassrullah, Jabbar Fadeel Mahdi, Mohammed Salih Mahdi Alkurdi, Ali Al Mousawi, Saad Ibrahim Al-Ghabban, Abdul Amir H. Kadhum, Ahmed Al-Amiery

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Background: Q fever is a zoonotic disease characterized by its clinical polymorphism and can present acutely as fever, pneumonia, hepatitis, and chronically as infective endocarditis, arthritis, osteomyelitis, or hepatitis. Objective: The aim of this study is To estimate the prevalence of cases of Q fever in hospitalized febrile patients in Imam Al Hussain Teaching Medical City in Karbala. Methods: One hundred patients with pyrexia were admitted to the medical ward from 1st August to 31st December 2019. Serological procedures fortified by Enzyme-linked Immunosorbent Assay test. Patients were considered to have acute Q fever when the specific antibodies (IgM and IgG) of phase II of Coxiella burnetii were positive. Results: The mean age of the patients was 35.05±12.93 years; females constituted 60% of them. Eighteen patients (18%) showed positive results for IgM, a lower proportion (13% n=13) had positive IgG levels, and 9% showed equivocal results. Statistical analysis revealed a significant association between positive IgM levels of the female gender and in patients consuming unpasteurized milk. One patient (female aged 60 years) died in the hospital, while all other patients were discharged well. Two female patients were pregnant, and one of them had an abortion. Conclusions: Q fever is more common in febrile patients. The study indicates that this disease should not be overlooked in the differential diagnosis of acute fever. Serological testing should be performed in all patients with acute febrile illness with an unsettling diagnosis.

Keywords: antibodies, frequency, immunoglobulin IgM, Q fever

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Authors: Doriane Micaela Andeme Bikoro, Samuel Fosso Wamba, Jean Robert Kala Kamdjoug

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Currently one of the leading fields in the market of technological innovation is digital health. In developed countries, this booming innovation is experiencing an exponential speed. We understand that in developed countries, e-health could also revolutionize the practice of medicine and therefore fill the many failures observed in medical care. Everything leads to believe that future technology is oriented towards the medical sector. The aim of this work is to explore at the same time the technological resources and the potential of health care based on new technologies; it is a case study in a rural area of Southern Cameroon. Among other things, we will make a census of the shortcomings and problems encountered, and we will propose various appropriate solutions. The work methodology used here is essentially qualitative. We used two qualitative data collection techniques, direct observation, and interviews. In fact, we spent two weeks in the field observing and conducting some semi-directive interviews with some of those responsible for these health structures. This study was conducted in three health facilities in the south of the country; including two health centers and a rural hospital. Many technological failures have been identified in the day-to-day management of these health facilities and especially in the administration of health care to patients. We note major problems such as the digital divide, the lack of qualified personnel, the state of isolation of this area. This is why various proposals are made to improve the health sector in Cameroon both technologically and medically.

Keywords: Cameroon, capacities, census, digital health, qualitative method, rural area

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Authors: Harriet Bothwell, Lowri Evans, Kevin Jones

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Background: The University of Bristol provides all medical students the opportunity to undertake student selected components (SSCs) at multiple stages of the undergraduate programme. SSCs enable students to explore areas of interest that are not necessarily covered by the curriculum. Students are required to produce a written report and most use SSCs as an opportunity to undertake an audit or small research project. In 2013 Swindon Academy, based at the Great Western Hospital, offered eight students the opportunity of a global health SSC which included a two week trip to rural hospital in Uganda. This SSC has since expanded and in 2017 a total of 20 students had the opportunity to undertake small research projects at two hospitals in rural Uganda. 'Tomorrows Doctors' highlights the importance of understanding healthcare from a 'global perspective' and student feedback from previous SSCs suggests that self-assessed knowledge of global health increases as a result of this SSC. Through the most recent version of this SSC students had the opportunity to undertake projects in a wide range of specialties including paediatrics, palliative care, surgery and medical education. Methods: An anonymous online questionnaire was made available to students following the SSC. There was a response rate of 80% representing 16 out of the 20 students. This questionnaire surveyed students’ satisfaction and experience of the SSC including the level of academic, project and spiritual support provided as well as perceived challenges in completing the project and barriers to healthcare delivery in the low resource setting. This survey had multiple open questions allowing the collection of qualitative data. Further qualitative data was collected from the students’ project report. The suggested format included a reflection and all students completed these. All qualitative data underwent thematic analysis. Results: All respondents rated the overall experience of the SSC as 'good' or 'excellent'. Preliminary data suggest that students’ confidence in their knowledge of global health, diagnosis of tropical diseases and management of tropical diseases improved after completing this SSC. Thematic analysis of students' reflection is ongoing but suggests that students gain far more than improved knowledge of tropical diseases. Students reflect positively on having the opportunity to research in a low resource setting and feel that by completing these projects they will be 'useful' to the hospital. Several students reflect the stark contrast to healthcare delivery in the UK and recognise the 'privilege' of having a healthcare system that is free at the point of access. Some students noted the different approaches that clinicians in Uganda had to train in 'taking ownership' of their own learning. Conclusions: Students completing this SSC report increased knowledge of global health and tropical medicine. However, their reflections reveal much broader learning outcomes and demonstrate considerable insight in multiple topics including conducting research in the low resource setting, training and healthcare inequality.

Keywords: global health, medical education, student feedback, undergraduate

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Authors: Byeongju Choi, Sanggil Lee, Kyung-Eun Lee

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Introduction: In the republic of Korea, the number of workers in the beauty industry has been increasing. Because the prevalence of hepatitis B carriers in Korea is higher than in other countries, the risk of blood-borne infection including viral hepatitis B and C, among the workers by using the sharp and contaminated instruments during procedure can be expected among beauty salon workers. However, the health care policies for the workers to prevent the blood-borne infection are not established due to the lack of evidences. Moreover, the workers in hair and nail salon were mostly employed at small businesses, where national mandatory systems or policies for workers’ health management are not applied. In this study, the risk of the viral hepatitis B and C from the job experiencing the hair and nail procedures in the mortality was assessed. Method: We conducted a retrospective review of the job histories and causes of death in the female deaths from 2006-2016. 132,744 of female deaths who had one more job experiences during their lifetime were included in this study. Job histories were assessed using the employment insurance database in Korea Employment Information Service (KEIS) and the causes of death were in death statistics produced by Statistics Korea. Case group (n= 666) who died from viral hepatitis was classified the death having record involved in ‘B15-B19’ as a cause of deaths based on Korean Standard Classification of Diseases(KCD) with the deaths from other causes, control group (n=132,078). The group of the workers in the beauty service industry were defined as the employees who had ever worked in the industry coded as ‘9611’ based on Korea Standard Industry Classification (KSIC) and others were others. Other than job histories, birth year, marital status, education level were investigated from the death statistics. Multiple logistic regression analysis were used to assess the risk of deaths from viral hepatitis in the case and control group. Result: The number of the deaths having ever job experiences at the hair and nail salon was 255. After adjusting confounders of age, marital status and education, the odds ratio(OR) for deaths from viral hepatitis was quite high in the group having experiences with working in the beauty service industry with 3.14(95% confidence interval(CI) 1.00-9.87). Other associated factors with increasing the risk of deaths from viral hepatitis were low education level(OR=1.34, 95% CI 1.04-1.73), married women (OR=1.42, 95% CI 1.02-1.97). Conclusion: The risk of deaths from viral hepatitis were high in the workers in the beauty service industry but not statistically significant, which might attributed from the small number of workers in beauty service industry. It was likely that the number of workers in beauty service industry could be underestimated due to their temporary job position. Further studies evaluating the status and the incidence of viral infection among the workers with consideration of the vertical transmission would be required.

Keywords: beauty service, viral hepatitis, blood-borne infection, viral infection

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Authors: Sahraoui Halima, Dahani Ameur, Tigrine Abedelkader

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DigiMesh technology represents a pioneering advancement in wireless networking, offering cost-effective and energy-efficient capabilities. Its inherent simplicity and adaptability facilitate the seamless transfer of data between network nodes, extending the range and ensuring robust connectivity through autonomous self-healing mechanisms. In light of these advantages, this study introduces a medical platform harnessed with DigiMesh wireless network technology characterized by low power consumption, immunity to interference, and user-friendly operation. The primary application of this platform is the real-time, long-distance monitoring of Electrocardiogram (ECG) signals, with the added capacity for simultaneous monitoring of ECG signals from multiple patients. The experimental setup comprises key components such as Raspberry Pi, E-Health Sensor Shield, and Xbee DigiMesh modules. The platform is composed of multiple ECG acquisition devices labeled as Sensor Node 1 and Sensor Node 2, with a Raspberry Pi serving as the central hub (Sink Node). Two communication approaches are proposed: Single-hop and multi-hop. In the Single-hop approach, ECG signals are directly transmitted from a sensor node to the sink node through the XBee3 DigiMesh RF Module, establishing peer-to-peer connections. This approach was tested in the first experiment to assess the feasibility of deploying wireless sensor networks (WSN). In the multi-hop approach, two sensor nodes communicate with the server (Sink Node) in a star configuration. This setup was tested in the second experiment. The primary objective of this research is to evaluate the performance of both Single-hop and multi-hop approaches in diverse scenarios, including open areas and obstructed environments. Experimental results indicate the DigiMesh network's effectiveness in Single-hop mode, with reliable communication over distances of approximately 300 meters in open areas. In the multi-hop configuration, the network demonstrated robust performance across approximately three floors, even in the presence of obstacles, without the need for additional router devices. This study offers valuable insights into the capabilities of DigiMesh wireless technology for real-time ECG monitoring in healthcare applications, demonstrating its potential for use in diverse medical scenarios.

Keywords: DigiMesh protocol, ECG signal, real-time monitoring, medical platform

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Authors: Nicola S. Schutte, John M. Malouff

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Introduction: Curiosity is a positive emotion and motivational state that consists of the desire to know. Curiosity consists of several related dimensions, including a desire for exploration, deprivation sensitivity, and stress tolerance. Creativity involves generating novel and valuable ideas or products. How curiosity may prompt greater creativity remains to be investigated. The phenomena of flow may link curiosity and creativity. Flow is characterized by intense concentration and absorption and gives rise to optimal performance. Objective of Study: The objective of the present study was to investigate whether the phenomenon of flow may link curiosity with creativity. Methods and Design: Fifty-seven individuals from Australia (45 women and 12 men, mean age of 35.33, SD=9.4) participated. Participants were asked to design a program encouraging residents in a local community to conserve water and to record the elements of their program in writing. Participants were then asked to rate their experience as they developed and wrote about their program. Participants rated their experience on the Dimensional Curiosity Measure sub-scales assessing the exploration, deprivation sensitivity, and stress tolerance facets of curiosity, and the Flow Short Scale. Reliability of the measures as assessed by Cronbach's alpha was as follows: Exploration Curiosity =.92, Deprivation Sensitivity Curiosity =.66, Stress Tolerance Curiosity =.93, and Flow=.96. Two raters independently coded each participant’s water conservation program description on creativity. The mixed-model intraclass correlation coefficient for the two sets of ratings was .73. The mean of the two ratings produced the final creativity score for each participant. Results: During the experience of designing the program, all three types of curiosity were significantly associated with the flow. Pearson r correlations were as follows: Exploration Curiosity and flow, r =.68 (higher Exploration Curiosity was associated with more flow); Deprivation Sensitivity Curiosity and flow, r =.39 (higher Deprivation Sensitivity Curiosity was associated with more flow); and Stress Tolerance Curiosity and flow, r = .44 (more stress tolerance in relation to novelty and exploration was associated with more flow). Greater experience of flow was significantly associated with greater creativity in designing the water conservation program, r =.39. The associations between dimensions of curiosity and creativity did not reach significance. Even though the direct relationships between dimensions of curiosity and creativity were not significant, indirect relationships through the mediating effect of the experience of flow between dimensions of curiosity and creativity were significant. Mediation analysis using PROCESS showed that flow linked Exploration Curiosity with creativity, standardized beta=.23, 95%CI [.02,.25] for the indirect effect; Deprivation Sensitivity Curiosity with creativity, standardized beta=.14, 95%CI [.04,.29] for the indirect effect; and Stress Tolerance Curiosity with creativity, standardized beta=.13, 95%CI [.02,.27] for the indirect effect. Conclusions: When engaging in an activity, higher levels of curiosity are associated with greater flow. More flow is associated with higher levels of creativity. Programs intended to increase flow or creativity might build on these findings and also explore causal relationships.

Keywords: creativity, curiosity, flow, motivation

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Authors: Neha Bharti, Martin Sénéchal, Danielle R. Bouchard

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Mostly attributed to lack of time, only 15% of adults currently reach the International Physical Activity Guidelines, which state that every adult should achieve minimum of 150 minutes of aerobic exercise per week at moderate to vigorous intensity in minimum bouts of 10 minutes each, in addition to two days of resistance training. Recent studies have suggested that any bout of aerobic exercise reaching moderate intensity has potential to improve health. If one could reach moderate intensity while doing resistance training, this could reduce the total weekly time involvement to reach the International Physical Activity Guidelines. Objectives: 1) To determine whether overweight and older adults can reach a minimum of moderate intensity while doing resistance training compared with young non-overweight adults, 2) To identify if the proportion of time spent at moderate to vigorous intensity is different in overweight adults and older adults when compared with young non-overweight adults when lifting 70% or 80% of maximal load, 3) To determine variables associated with proportion of time spent at moderate to vigorous intensity while doing resistance training. Methods: Sixty participants already doing resistance training were recruited (20 young non-overweight adults, 20 overweight adults, and 20 older adults). Participants visited fitness facility three times, separated by at least 48 hours, and performed eight resistance exercises each time. First visit was to collect baseline measurements and to measure maximal load for each of the eight exercises. Second and third visits were performed wearing a heart rate monitor to record heart rate and to measure exercise intensity. The two exercise sessions were performed at 70% and 80% of maximal capacity. Moderate intensity was defined as 40% of heart rate reserve. Results: The proportion of time spent at moderate to vigorous intensity ranged from 51% to 93% among the three groups. No difference was observed between the young group and the overweight adults group in the proportion of time spent at moderate to vigorous intensity, 82.6% (69.2-94.6) vs 92.5% (73.3-99.1). However, older adults spent lower proportion of time at moderate to vigorous intensity for both sessions 51.5% (22.0-86.6); P < .01. When doing resistance training at 70% and 80% of maximal capacity, the proportion of time spent at moderate to vigorous intensity was 82.3% (56.1-94.7) and 82.0% (59.2-98.0) with no significant difference (P=.83). Conclusion: This study suggests that overweight adults and older adults can reach moderate intensity for at least 51% of the time spent doing resistance training. However, time spent at moderate to vigorous intensity was lower for older adults compared to young non-overweight adults. For adults aged 60 or less, three resistance training sessions of 60 minutes weekly could be enough to reach both aerobic and resistance training components of the International Physical Activity Guidelines. Further research is needed to test if resistance training at moderate to vigorous intensity can have the same health benefits compared with adults completing the International Physical Activity Guidelines as currently suggested.

Keywords: aerobic exercise, international physical activity guidelines, moderate to vigorous intensity, resistance training

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Authors: Julie M. Novak, Simone K. Brennan, Lacey Brim

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Undergraduate medical education (UME) curriculum notably addresses micro-level communications (e.g., patient-provider, intercultural, inter-professional), yet frequently under-examines the role and impact of organizational communication, a more macro-level. Organizational communication, however, functions as foundation and through systemic structures of an organization and thereby serves as hidden curriculum and influences learning experiences and outcomes. Yet, little available research exists fully examining how students experience organizational communication while in medical school. Extant literature and best practices provide insufficient guidance for UME programs, in particular. The purpose of this study was to map and examine current organizational communication systems and processes in a UME program. Employing a phenomenology-grounded and participatory approach, this study sought to understand the organizational communication system from medical students' perspective. The research team consisted of a core team and 13 medical student co-investigators. This research employed multiple methods, including focus groups, individual interviews, and two surveys (one reflective of focus group questions, the other requesting students to submit ‘examples’ of communications). To provide context for student responses, nonstudent participants (faculty, administrators, and staff) were sampled, as they too express concerns about communication. Over 400 students across all cohorts and 17 nonstudents participated. Data were iteratively analyzed and checked for triangulation. Findings reveal the complex nature of organizational communication and student-oriented communications. They reveal program-impactful strengths, weaknesses, gaps, and tensions and speak to the role of organizational communication practices influencing both climate and culture. With regard to communications, students receive multiple, simultaneous communications from multiple sources/channels, both formal (e.g., official email) and informal (e.g., social media). Students identified organizational strengths including the desire to improve student voice, and message frequency. They also identified weaknesses related to over-reliance on emails, numerous platforms with inconsistent utilization, incorrect information, insufficient transparency, assessment/input fatigue, tacit expectations, scheduling/deadlines, responsiveness, and mental health confidentiality concerns. Moreover, they noted gaps related to lack of coordination/organization, ambiguous point-persons, student ‘voice-only’, open communication loops, lack of core centralization and consistency, and mental health bridges. Findings also revealed organizational identity and cultural characteristics as impactful on the medical school experience. Cultural characteristics included program size, diversity, urban setting, student organizations, community-engagement, crisis framing, learning for exams, inefficient bureaucracy, and professionalism. Moreover, they identified system structures that do not always leverage cultural strengths or reduce cultural problematics. Based on the results, opportunities for productive change are identified. These include leadership visibly supporting and enacting overall organizational narratives, making greater efforts in consistently ‘closing the loop’, regularly sharing how student input effects change, employing strategies of crisis communication more often, strengthening communication infrastructure, ensuring structures facilitate effective operations and change efforts, and highlighting change efforts in informational communication. Organizational communication and communications are not soft-skills, or of secondary concern within organizations, rather they are foundational in nature and serve to educate/inform all stakeholders. As primary stakeholders, students and their success directly affect the accomplishment of organizational goals. This study demonstrates how inquiries about how students navigate their educational experience extends research-based knowledge and provides actionable knowledge for the improvement of organizational operations in UME.

Keywords: medical education programs, organizational communication, participatory research, qualitative mixed methods

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