Search results for: family therapy

Authors: Kristina De Milt, Nicole Huang, Jihye Park

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Opioids have been a mainstay of the treatment of chronic pain, but their overprescription and misuse have led to an opioid epidemic. Recently, as an attempt to decrease the number of opioids prescribed, the use of cannabinoid therapy has become an increasingly popular adjunctive chronic pain management choice among providers. This review of literature investigates the effects of adjunctive cannabinoids to opioids in the management of chronic pain. The nine articles are included in the literature review range from observational studies to meta-analyses published in the year 2016 and after. A majority of the studies showed a decrease in the need for opioids after adjunctive cannabinoids were introduced and, in some instances, the cessation of opioid consumption. More high-quality evidence is needed to further support this stance and providers should weigh the benefits and risks of adjunctive cannabinoids according to the clinical picture.

Keywords: cannabis, chronic pain, opioids, pain management

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Authors: Ibrahim Auwalu

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The main thrust of this paper is the examination of Quality Education as opposed to low level knowledge acquisition in the promotion of quality of life, health, individual and national growth and development. The paper reviews the role education plays in developed, developing and third world economies. It further explores the real meaning of poverty in the context it exists. That is poverty in terms of its dimensions– shortened lives, illiteracy, social exclusion and lack of material means to improve family circumstances. The paper concludes that education not only helps individuals escape poverty by developing the skills needed to improve their livelihoods, but also generates productivity gains that fuel economic growth.

Keywords: quality, education, global, poverty alleviation

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Authors: Sardar Ameer Akram Khan, Shahzad Amin Sheikh

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Blind equalization is an important technique amongst equalization family. Multimodulus algorithms based on blind equalization removes the undesirable effects of ISI and cater ups the phase issues, saving the cost of rotator at the receiver end. In this paper a new algorithm combination of recursive least square and Multimodulus algorithm named as RLSMMA is proposed by providing few assumption, fast convergence and minimum Mean Square Error (MSE) is achieved. The excellence of this technique is shown in the simulations presenting MSE plots and the resulting filter results.

Keywords: blind equalizations, constant modulus algorithm, multi-modulus algorithm, recursive least square algorithm, quadrature amplitude modulation (QAM)

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Authors: L. Parisi

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Kinematic data wisely correlate vector quantities in space to scalar parameters in time to assess the degree of symmetry between the intact limb and the amputated limb with respect to a normal model derived from the gait of control group participants. Furthermore, these particular data allow a doctor to preliminarily evaluate the usefulness of a certain rehabilitation therapy. Kinetic curves allow the analysis of ground reaction forces (GRFs) to assess the appropriateness of human motion. Electromyography (EMG) allows the analysis of the fundamental lower limb force contributions to quantify the level of gait asymmetry. However, the use of this technological tool is expensive and requires patient’s hospitalization. This research work suggests overcoming the above limitations by applying artificial neural networks.

Keywords: kinetics, kinematics, cyclograms, neural networks, transtibial amputation

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Authors: Şule Yanık, Emel Ertürk-Mustul, Zerrin Turan, Hasan Gürgür

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It is known that there are policies that will support the early special education (ESE) for children requiring special care including the children with hearing loss (CHL) in many countries that give importance to early childhood (0-6 years) education, accordingly ESE services have been gradually increasing and these services provide positive contributions to the child and family. These services begin with medical diagnostics, provision of the use of assistive technologies for hearing and the orientation of children towards early education program (EEP) for the CHL. In 0-3 years of age EEP, education and support services are provided to the children and their families. In 3-6 years of age, children are supported in a pre-school education program (PSE) in which their peers and teachers are present. Therefore, the children with hearing loss and their families are going through a series of medical, educational and social transition process after diagnosed with hearing loss. Depending on their age and development, CHL also go through a transition period from hospital to home, from home to EEP and from EEP to PSE. It is seen that there is no legal regulation regarding the transition process in Turkey and hence different processes have been carried out in the transition process from EEP to PSE. The aim of this study is to reveal the problems confronted by the CHL during the transition period from EEP to PSE and the solution proposals for these problems. In this study, a document review was made by reviewing the national and international studies about transition processes of the CHL in Turkey from EEP to PSE. Accordingly, in the study carried out in two stages, firstly, a review of the body of literature was performed by creating key words related to the subject. Secondly, the problems confronted by the CHL in Turkey during the transition period from EEP to PSE and the solution proposals for these problems were demonstrated by analyzing the obtained data. According to the body of literature, it is seen that there are no laws concerning the transition processes of the children who require special care including the CHL in Turkey from EEP (sending) to PSE (receiving), and correspondingly numerous problems have been experienced during the transition period. It seems that the EEP adopts family-centered approaches for strengthening the families of the CHL. However, PSE program aims to prepare the children to school life by focusing on their social and academical development rather with the adoption of children-centered approaches. Therefore, while the families feel an inseparable part of the team in EEP, they indicated that they felt like a stranger in the school team after their children have started to PSE. Therefore, families find the transition processes worrisome and state that they are not satisfied with the process. We discovered that in the process of transition from EEP to PSE, families are not informed, there is a limited number of PSE options available, children cannot adapt to the new educational environment and cannot benefit from the existing PSE.

Keywords: early education program, early special education, children with hearing loss, transition

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Authors: Arwa Alnowaiser, Hala Shoukri

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The ‘FreeAITherapist’ is an artificial intelligence application that uses the power of AI to offer advice and mental health counseling to its users through its chatbot services. The AI therapist is designed to understand users' issues, concerns, and problems and respond appropriately; it provides empathy and guidance and uses evidence-based therapeutic techniques. With its user-friendly platform, it ensures accessibility for individuals in need, regardless of their geographical location. This website was created in direct response to the growing demand for mental health support, aiming to provide a cost-effective and confidential solution. Through promising confidentiality, it considers user privacy and data security. The ‘FreeAITherapist’ strives to bridge the gap in mental health services, offering a reliable resource for individuals seeking guidance and counseling to improve their overall well-being.

Keywords: artificial intelligence, mental health, AI therapist, website, counseling

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Authors: Dariusz Jacek Jakóbczak

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Mathematics and computer science are interested in methods of 2D curve interpolation and extrapolation using the set of key points (knots). A proposed method of Hurwitz- Radon Matrices (MHR) is such a method. This novel method is based on the family of Hurwitz-Radon (HR) matrices which possess columns composed of orthogonal vectors. Two-dimensional curve is interpolated via different functions as probability distribution functions: polynomial, sinus, cosine, tangent, cotangent, logarithm, exponent, arcsin, arccos, arctan, arcctg or power function, also inverse functions. It is shown how to build the orthogonal matrix operator and how to use it in a process of curve reconstruction.

Keywords: 2D data interpolation, hurwitz-radon matrices, MHR method, probabilistic modeling, curve extrapolation

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Authors: Melissa K. Hord, Stephen P. Whiteside

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Impairment in functioning is a requirement for diagnosing psychopathology, identifying individuals in need of treatment, and documenting improvement with treatment. Further, identifying different types of functional impairment can guide educators and treatment providers. However, most assessment tools focus on symptom severity and few measures assess impairment associated with childhood anxiety disorders. The child- and parent-report versions of the Child Sheehan Disability Scale (CSDS) are measures that may provide useful information regarding impairment. The purpose of the present study is to examine whether children diagnosed with different anxiety disorders have greater impairment in school or home functioning based on self or parent report. The sample consisted of 844 children ages 5 to 19 years of age (mean 13.43, 61% female, 90.9% Caucasian), including 281 children diagnosed with obsessive compulsive disorder (OCD), 200 with generalized anxiety disorder (GAD), 176 with social phobia, 83 with separation anxiety, 61 with anxiety not otherwise specified (NOS), 30 with panic disorder, and 13 with panic with agoraphobia. To assess whether children and parents reported greater impairment in school or home functioning, a multivariate analysis of variance was conducted. (The assumptions of independence and homogeneity of variance were checked and met). A significant difference was found, Pillai's trace = .143, F (4, 28) = 4.19, p < .001, partial eta squared = .04. Post hoc comparisons using the Tukey HSD test indicated that children report significantly greater impairment in school with panic disorder (M=5.18, SD=3.28), social phobia (M=4.95, SD=3.20), and OCD (M=4.62, SD=3.32) compared to other diagnoses; whereas parents endorse significantly greater school impairment when their child has a social phobia (M=5.70, SD=3.39) diagnosis. Interestingly, both children and parents reported greater impairment in family functioning for an OCD (child report M=5.37, SD=3.20; parent report M=5.59, SD=3.38) diagnosis compared to other anxiety diagnoses. (Additional findings for the anxiety disorders associated with less impairment will also be presented). The results of the current study have important implications for educators and treatment providers who are working with anxious children. First, understanding that differences exist in how children and parents view impairment related to childhood anxiety can help those working with these families to be more sensitive during interactions. Second, evidence suggests that difficulties in one environment do not necessarily translate to another environment, thus caregivers may benefit from careful explanation of observations obtained by educators. Third, results support the use of the CSDS measure by treatment providers to identify impairment across environments in order to more effectively target interventions.

Keywords: anxiety, childhood, impairment, school functioning

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Authors: Rutcher M. Lacaza, Stephen Jun V. Villejo

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This paper investigated the patterns of private transfers in the Philippines using the Family Income Expenditure Survey (FIES) 2009, conducted by the Philippine government’s National Statistics Office (NSO) every three years. The paper performed bivariate analysis on net transfers, using the identified determinants for a household to be either a net receiver or a net giver. The household characteristics considered are the following: age, sex, marital status, employment status and educational attainment of the household head, and also size, location, pre-transfer income and the number of employed members of the household. The variables net receiver and net giver are determined by computing the net transfer, subtracting total gifts from total receipts. The receipts are defined as the sum of cash received from abroad, cash received from domestic sources, total gifts received and inheritance. While gifts are defined as the sum of contributions and donations to church and other religious institutions, contributions and donations to other institutions, gifts and contributions to others, and gifts and assistance to private individuals outside the family. Both in kind and in cash transfers are considered in the analysis. It also performed a multiple regression analysis on transfers received and income including other household characteristics to examine the motives for giving transfers – whether altruism or exchanged. It also used the binary logistic regression to estimate the probability of being a net receiver or net giver given the household characteristics. The study revealed that receiving tends to be universal – both the non-poor and the poor benefit although the poor receive substantially less than the non-poor. Regardless of whether households are net receivers or net givers, households in the upper deciles generally give and receive more than those in the lower deciles. It also appears that private transfers may just flow within economic groups. Big amounts of transfers are, therefore, directed to the non-poor and the small amounts go to the poor. This was also supported by the increasing function of gross transfers received and the income of households – the poor receiving less and the non-poor receiving more. This is contrary to the theory that private transfers can help equalize the distribution of income. This suggested that private transfers in the Philippines are not altruistically motivated but exchanged. However, bilateral data on transfers received or given is needed to test this theory directly. The results showed that transfers are much needed by the poor and it is important to understand the nature of private transfers, to ensure that government transfer programs are properly designed and targeted so as to prevent the duplication of private safety nets already present among the non-poor.

Keywords: private transfers, net receiver, net giver, altruism, exchanged.

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Authors: Tariku Nefo Duke

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Embelia is a genus of climbing shrubs in the family Myrsinaceae. Embelia schimperi is as important in traditional medicine as the other species in the genus. The plant has been much known as a local medicine for the treatment of tapeworms. In this project, extraction, phytochemical screening tests, isolation, and characterization of berries of the Embelia schimperi plant have been conducted. The chemical investigations of methanol and ethyl acetate (1:1) ratio extracts of the berries lead to the isolation of three new compounds. The compounds were identified to be alkaloids coded as AD, AN, and AG. Structural elucidations of the isolated compounds were accomplished using spectroscopic methods (IR, UV, ¹H NMR, ¹³C NMR, DEPT and 2D NMR, HPLC, and LC-MS). The alkaloid coded as (AN) has a wide MIC range of 6.31-25.46 mg/mL against all tested bacteria strains.

Keywords: Embelia schimper, HPLC, alkaloids, 2D NMR, MIC

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Authors: Omar Shafqat, Jaime Arias, Cristian Bogdan, Björn Palm

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Heating constitutes a major part of the overall energy consumption in Sweden. In 2013 heating and hot water accounted for about 55% of the total energy use in the housing sector. Historically, the end users have not been able to make a significant impact on their consumption on account of traditional control systems that do not facilitate interaction and control of the heating systems. However, in recent years internet connected home energy management systems have become increasingly available which allow users to visualize the indoor temperatures as well as control the heating system. However, the adoption of these systems is still in its nascent stages. This paper presents the outcome of a study carried out in a community of single-family houses in Stockholm. Heating in the area is provided through district heating, and the neighbourhood is connected through a local micro thermal grid, which is owned and operated by the local community. Heating in the houses is accomplished through a hydronic system equipped with radiators. The system installed offers the households to control the indoor temperature through a mobile application as well as through a physical thermostat. It was also possible to program the system to, for instance, lower the temperatures during night time and when the users were away. The users could also monitor the indoor temperatures through the application. It was additionally possible to create different zones in the house with their own individual programming. The historical heating data (in the form of billing data) was available for several previous years and has been used to perform quantitative analysis for the study after necessary normalization for weather variations. The experiment involved 30 households out of a community of 178 houses. The area was selected due to uniform construction profile in the area. It was observed that despite similar design and construction period there was a large variation in the heating energy consumption in the area which can for a large part be attributed to user behaviour. The paper also presents qualitative analysis done through survey questions as well as a focus group carried out with the participants. Overall, considerable energy savings were accomplished during the trial, however, there was a considerable variation between the participating households. The paper additionally presents recommendations to improve the impact of home energy management systems for heating in terms of improving user engagement and hence the energy impact.

Keywords: energy efficiency in buildings, energy behavior, heating control system, home energy management system

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Authors: Danielle G. Saique

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Introduction: Promoting Gender Equality, Equity and Empowerment of Women (GEE&EW) can be attained by practicing thereby exercising Sexual and Reproductive Health and Rights (SRHR). Gender Inequality is manifested thru Violence Against Women (VAW). Objectives: This study presents causes, prevalence, effects of Gender Inequality for not practicing and violating SRHR. This proposes Action Plan by promoting, integrating SRHR in the “holistic approach” of Social Work education, practice and service-delivery in any work-set-ups. Limitations: VAW cases showed victim and violator are known, related and living together. Cases transpired at home, reported, investigated in the police and filed in the legal court of law for the year 2013. Methods: Data from blotters, reports, filed cases, case studies gathered by the Social Worker (SWr). Qualitative analysis identified cause, prevalence of VAW related in violating SRHR. SWr serves innovative interventions in any work settings by applying SRHR background, skills in educating, counseling client-victims. Results: 65 VAW cases on non-negotiation or refusal of practicing SRHR. Non-acceptance of Family Planning yielded unwanted, unplanned pregnancies, abandoned children, battered women. Neglected pre-post natal maternal care caused complications or death. Rape, incest led trauma or death. Unsafe, unprotected sex transmitted STDs. Conclusions: Non-availing SRHR from health facilities, from Medical Health SWr concluded to non-practicing or violating rights to life, health care, protection, rights to information, education, rights to plan family, rights from torture, ill-treatment. VAW brings undesirable effects to the well-being, wellness and humaneness of the victim. Recommendations: The innovative intervention services on SRHR of a SWr and the findings, results in violating SRHR are recommendations in Action Planning by adding “The SRHR Concepts” in Social Work thereby preventing VAW; empowering women’s rights to development, gender equality, equity liberty, security, freedom; resilience and involvement in promoting, practicing, exercising SRHR at home. Recommended therefore to duplicate this innovative practice and experience on SRHR as implemented by the SWr in any work setting.

Keywords: women development, promoting gender equality, equity, empowerment of women

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Authors: M. Azharul Islam, M. Russel Sarker, M. Shahadat Hossen

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Air pollution is one of the major environmental problems that have gained importance in all over the world. Air pollution is a problem for all of us. The present study was conducted to explore the people’s perception level and awareness of air pollution in selected areas of Mymensingh in Bangladesh. Health impacts of air pollution also studied through personal interview and structured questionnaire. The relationship of independent variables (age, educational qualification, family size, residence and communication exposure) with the respondent’s perception level and awareness of air pollution (dependent variable) was studied to achieve the objectives of the study. About 600 respondents were selected randomly from six sites for collecting data during the period of July 2016 to June 2017. Pearson’s product-moment correlation coefficients were computed to examine the relationship between the concerned variables. The results revealed that about half (46.67%) of the respondents had a medium level of perception and awareness about air pollution in their areas where 31.67 percent had low, and 21.67 percent had a high level. In rural areas of the study sites, 43.33 percent respondents had low, 50 percent had medium, and only 6.67 percent had high perception and awareness on air pollution. In case of urban areas, 20 percent respondents had low, 43.33 percent had medium, and 36.67 percent had a high level of awareness and perception on air pollution. The majority of the respondents (93.33 percent) were lacking of proper awareness about air pollution in rural areas while 63.33 percent in urban areas. Out of five independent variables, three variables such as- educational qualification, residence status and communication exposure had positive and significant relationship. Age of respondents had negative and significant relationship with their awareness of air pollution where family size of the respondents had no significant relationship with their perception and awareness of air pollution. Thousands of people live in urban areas where urban smog, particle pollution, and toxic pollutants pose serious health concerns. But most of the respondents of the urban sites are not familiarize about the real causes of air pollution. Respondents exposed higher level of experience for air pollutants, such as- irritation of the eyes, coughing, tightness of chest and many health difficulties. But respondents of both rural and urban area hugely suffered such health problems and the tendency of certain difficulties increased day by day. In this study, most of the respondents had lack of knowledge on the causes of such health difficulties due to their lower perception level. Proper attempts should be taken to raise literacy level, communication exposure to increase the perception and awareness of air pollution among the respondents of the study areas. Extra care with above concerned fields should be taken to increase perception and awareness of air pollution in rural areas.

Keywords: air pollution, awareness, health impacts, perception of people

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Authors: Nina Robson, Kenneth John Faller II, Vishalkumar Ahir, Arthur Ricardo Deps Miguel Ferreira, John Buchanan, Amarnath Banerjee

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This paper describes the development of a virtual-reality system ARWED, which will be used in physical rehabilitation of patients with reduced upper extremity mobility to increase limb Active Range of Motion (AROM). The ARWED system performs a symmetric reflection and real-time mapping of the patient’s healthy limb on to their most affected limb, tapping into the mirror neuron system and facilitating the initial learning phase. Using the ARWED, future experiments will test the extension of the action-observation priming effect linked to the mirror-neuron system on healthy subjects and then stroke patients.

Keywords: physical rehabilitation, mirror neuron, virtual reality, stroke therapy

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Authors: Belachew Gebrewold

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The Horn of Africa is marred by complex and systematic internal and external political, economic and social-cultural causes of conflict that result in internal displacement and migration. This paper engages with them and shows how such a study can help us to understand migration, both in this region and more generally. The conflict has occurred within states, between states, among proxies, between armies. Human insecurities as a result of the state collapse of Somalia, the rise of Islamic fundamentalism in the whole region, recurrent drought affecting the livelihoods of subsistence farmers as well as nomads, exposure to hunger, environmental degradation, youth unemployment, rapid growth of slums around big cities, and political repression (especially in Eritrea) have been driving various segments of the regional population into regional and international migration. Eritrea has been going through a brutal dictatorship which pushes many Eritreans to flee their country and be exposed to human trafficking, torture, detention, and agony on their way to Europe mainly through Egypt, Libya and Israel. Similarly, Somalia has been devastated since 1991 by unending civil war, state collapse, and radical Islamists. There are some important aspects to highlight in the conflict-migration nexus in the Horn of Africa: first, the main push factor for the Somalis and Eritreans to leave their countries and risk their lives is the physical insecurity they have been facing in their countries. Secondly, as a result of the conflict the economic infrastructure is massively destroyed. Investment is rare; job opportunities are out of sight. Thirdly, in such a grim situation the politically and economically induced decision to migrate is a household decision, not only an individual decision. Based on this third point this research study took place in the Horn of Africa between 2014 and 2016 during different occasions. The main objective of the research was to understanding how the increasing migration is affecting the socio-economic and socio-political environment, and conversely how the socio-economic and socio-political environments are increasing migration decisions; and whether and how these decisions are individual or family decisions. The main finding is the higher the human insecurity, the higher the family decision; the lower the human insecurity, the higher the individual decision. These findings apply not only to the Eritrean, Somali migrants but also to Ethiopian migrants. But the general impacts of migration on sending countries’ human security is quite mixed and complex.

Keywords: Eritrea, Ethiopia, Horn of Africa, insecurity, migration, Somalia

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Authors: Fahad Alamoudi, Yaser Miaji

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The growing popularity of swimming pools and other activities in the water for sport, fitness, therapy or just enjoyable relaxation have led to the increased use of swimming pools and the establishment of a variety of specific-use pools such as spa pools, water slides, and more recently, hydrotherapy and wave pools. In this research, a few simple equipment is used for test, detect and alert for detection of water cleanness and pollution. YSI Photometer Systems, TDSTestr High model, Rio 12HF and Electrode A1. The researchers used electrolysis as a method of separating bonded elements and compounds by passing an electric current through them. The results which use 41 experiments show the higher the salt concentration, the more efficient the electrode and the smaller the gap between the plates, the lower the electrode voltage. Furthermore, it is proved that the larger the surface area, the lower the cell voltage and the higher current used the more chlorine produced.

Keywords: photometer, electrode, electrolysis, swimming pool chlorination

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Authors: Shubha T., Latha H. K. E., Yogananth Karuppiah

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Accessing and sharing automobiles will become much simpler thanks to the wide range of automotive use cases made possible by digital keys. This study aims to provide digital keys to car owners and drivers so they can lock or unlock their automobiles and start the engine using a smartphone or other Bluetooth low energy-enabled mobile device. Private automobile owners can digitally lend their car keys to family members or friends without having to physically meet them, possibly for a certain period of time. Owners of company automobile fleets can electronically distribute car keys to staff members, possibly granting access for a given day or length of time. Customers no longer need to physically pick up car keys at a rental desk because automobile owners can digitally transfer keys with them.

Keywords: NFC, BLE, CCC, digital key, OEM

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Authors: Kakali Roy, Sahana P. Raju, Subhra Dhar, Sandipan Dhar

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Introduction: Xeroderma pigmentosa (XP) is a rare inherited (autosomal recessive) disease resulting from impairment in DNA repair that involves recognition and repair of ultraviolet radiation (UVR) induced DNA damage in the nucleotide excision repair pathway. Which results in increased photosensitivity, UVR induced damage to skin and eye, increased susceptibility of skin and ocular cancer, and progressive neurodegeneration in some patients. XP is present worldwide, with higher incidence in areas having frequent consanguinity. Being extremely rare, there is limited literature on XP and associated complications. Here, the clinico-pathological experience (spectrum of clinical presentation, histopathological findings of malignant skin lesions, and progression) of managing 8 cases of XP is presented. Methodology: A retrospective study was conducted in a pediatric tertiary care hospital in eastern India during a ten-year period from 2013 to 2022. A clinical diagnosis was made based on severe sun burn or premature photo-aging and/or onset of cutaneous malignancies at early age (1st decade) in background of consanguinity and autosomal recessive inheritance pattern in family. Results: The mean age of presentation was 1.2 years (range of 7month-3years), while three children presented during their infancy. Male to female ratio was 5:3, and all were born of consanguineous marriage. They presented with dermatological manifestations (100%) followed by ophthalmic (75%) and/or neurological symptoms (25%). Patients had normal skin at birth but soon developed extreme sensitivity to UVR in the form of exaggerated sun tanning, burning, and blistering on minimal sun exposure, followed by abnormal skin pigmentation like freckles and lentiginosis. Subsequently, over time there was progressive xerosis, atrophy, wrinkling, and poikiloderma. Six patients had varied degree of ocular involvement, while three of them had severe manifestation, including madarosis, tylosis, ectropion, Lagopthalmos, Pthysis bulbi, clouding and scarring of the cornea with complete or partial loss of vision, and ophthalmic malignancies. 50% (n=4) cases had skin and ocular pre-malignant (actinic keratosis) and malignant lesions, including melanoma and non melanoma skin cancer (NMSC) like squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in their early childhood. One patient had simultaneous occurrence of multiple malignancies together (SCC, BCC, and melanoma). Subnormal intelligence was noticed as neurological feature, and none had sensory neural hearing loss, microcephaly, neuroregression, or neurdeficit. All the patients had been being managed by a multidisciplinary team of pediatricians, dermatologists, ophthalmologists, neurologists and psychiatrists. Conclusion: Although till date there is no complete cure for XP and the disease is ultimately fatal. But increased awareness, early diagnosis followed by persistent vigorous protection from UVR, and regular screening for early detection of malignancies along with psychological support can drastically improve patients’ quality of life and life expectancy. Further research is required on formulating optimal management of XP, specifically the role and possibilities of gene therapy in XP.

Keywords: childhood malignancies, dermato-pathological findings, eastern India, Xeroderma pigmentosa

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Authors: Pim Terachinda, Witaya Wannasuphoprasit, Wasuwat Kitisomprayoonkul, Anan Srikiatkhachorn

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Restoration of hand function and dexterity remain challenges in rehabilitation after stroke. We have developed soft exoskeleton hand robot in which using tendon-driven mechanism. Finger flexion and extension can be triggered by a foot switch and force can be adjusted manually depending on patient’s grip strength. The objective of this study is to investigate feasibility and safety of this device. The study was done in 2 stroke patients with the strength of the finger flexors/extensors grade 1/0 and 3/1 on Medical Research Council scale, respectively. Grasp and release training was performed for 30 minutes. No complication was observed. Results demonstrated that the device is safe, and therapy can be tailored to individual patient’s need. However, further study is required to determine recovery and rehabilitation outcomes after training in patients after nervous system injury.

Keywords: hand, rehabilitation, robot, stroke

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Authors: Abdikarim Yusuf

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This study uses data from Somalia to analyse child labour using a descriptive and qualitative method. The study set out to identify root causes of child labour in Hargeisa and its implications for children. The study shows that poverty, droughts, family separation, and loss of properties are primary drivers of child labour in Hargeisa. The study found that children work in very difficult jobs such as car wash, casual work, and shoe shining for boys while girls work as housemaids, selling tea, Khat and sometimes are at risk of exploitation such as sexual abuse, rape and harassment. The majority of the parents responded that they don’t know any policy, act or law that protects children. Men showed greater awareness than the women respondents in recognizing child labour as a child rights violation.

Keywords: abuse, child, violence, protection

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Authors: M. Yakoubi, N. Belboukhari, A. Cheriti, K. Sekoum

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Launaea nudicaulis (L.) Hook.f. is a desert, spontaneous plant and endemic to northem Sahara, which belongs to the Asteraceae family. This species exists in the region of Bechar (Local name; El-Rghamma). In our knowledge, no work has been founded, except studies showing the antimicrobial and antifungal activity of methalonic extract of this plant. The present paper describes the chemical composition of the essential oil from Launaea nudicaulis and qualification of isolation and identification of some pure products by column chromatography. The essential oil from the aerial parts of Launaea nudicaulis (Asteraceae) was obtained by hydroditillation in 0.4% yield, led to isolation of four several new products. The isolation is made by column chromatography and followed by GC-IK and GC-MS analysis.

Keywords: Launaea nudicaulis, asteraceae, essential oil, column chromatography, GC-FID, GC-MS

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Authors: Vidyadhar Suram, D. Chamundeeswari, Umamaheswara Rao, Krishna Mohan Chinnala

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Peltophorum pterocarpum known as copper pod belongs to the family Fabaceae, native to tropical south-eastern asia and a popularly ornamental tree grown around the world. In traditional medicine it is used as an astringent to cure or relieve intestinal disorders after pain at childbirth, sprains, bruises and swelling or as a lotion for eye troubles, muscular pains and sores. It is also used for gargles and tooth powders. Medcinally; it has proven to possess various pharmacological activities. The powdered root part of Peltophorum pterocarpum (250gr) were extracted exhaustively using different solvents and phytochemical investigations has shown the presence of various secondary metabolites like alkaloids, flavanoids, tannins, saponins, proteins, glycosides, steriods, and volatile.

Keywords: antibacterialactivity, fabaceae, peltophorum pterocarpum, isocoumari, alkaloids

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Authors: Ashan Wijekoon, Abi Beane, Subashini Jayawardana

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Background: Soldiers' physical rehabilitation and long term health status has been hindered due to limited investment in and access to rehabilitation services. Home-based rehabilitation programmes could offer a potentially feasible alternative to facilitate long-term recovery. Objectives: To explore Sri Lankan soldiers' perceptions of barriers and facilitators to a home-based physical rehabilitation programme.Methods and Materials: We conducted qualitative semi-structured interviews with community re-integrated army veterans who had undergone unilateral lower limb amputation following war related trauma. Veterans were identified from five districts of Sri Lanka, based on a priori knowledge of veteran community settlements (Disabled Category Registry) obtained from Directorate of Rehabilitation, MoD, Sri Lanka. Individuals were stratified for purposive selection. The interview guide was developed from existing methods and adapted for context. Verbatim transcripts of interviews were analyzed for emerging themes using an inductive approach. Following consent, participants met the researcher (AW- a trained physiotherapist fluent in Sinhalese). Results: Twenty-five Interviews were conducted, totaling 7.2 hours of new data (Mean±SD: 0.28±0.11). All participants were male, aged 30-55 years (Mean±SD: 46.1±7.4), and had experienced traumatic amputation as a result of conflict. Twenty-four sub themes were identified. Inadequate space for exercises, absence of equipment and assistance to conduct the exercises at home, alongside absence of community healthcare services were all barriers. Burden of comorbidities, including chronic pain and disability level, were also barriers. Social support systems, including soldier societies, family, and kinship with other amputees, were seen as facilitators to an at-home programme. Motivation for independence was a strong indicator of engagement. Conclusion: Environment, chronic pain, and absence of well-established community health services were key barriers. Family and soldier support was a facilitator. Engagement with community healthcare providers (physiotherapist and primary care physicians) will be essential to the success of an at-home rehabilitation program.

Keywords: physical rehabilitation, home-based, soldiers, disability, lower-limb amputation, qualitative

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Authors: Radia Chemlal, Salim Mehenni, Dahbia Leila Anes-boulahbal, Mohamed Kherat, Nabil Mameri

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The application of the electric field is considered to be a very promising method in cancer therapy. Indeed, cancer cells are very sensitive to the electric field, although the cellular response is not entirely clear. The tests carried out consisted in subjecting the RD cell line under the effect of the continuous electric field while varying certain parameters (voltage, exposure time, and cell concentration). The response surface methodology (RSM) was used to assess the effect of the chosen parameters, as well as the existence of interactions between them. The results obtained showed that the voltage, the cell concentration as well as the interaction between voltage and exposure time have an influence on the mortality rate of the RD cell line.

Keywords: continuous electric field, RD cancer cell line, RSM, voltage

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Authors: F. O’Dowd, G. Murphy, M. Roche, E. Shudell, F. Keane, M. O’Kane

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Intoduction: Apremilast (Otezla®) is an oral phosphodiesterase-4 (PDE4) inhibitor indicated for treatment of adult patients with moderate to severe plaque psoriasis who have contraindications to have failed or intolerant of standard systemic therapy and/or phototherapy; and adult patients with active psoriatic arthritis. Apremilast influences intracellular regulation of inflammatory mediators. Two randomized, placebo-controlled trials evaluating apremilast in 1426 patients with moderate to severe plague psoriasis (ESTEEM 1 and 2) demonstrated that the commonest adverse reactions (AE’s) leading to discontinuation were nausea (1.6%), diarrhoea (1.0%), and headaches (0.8%). The overall proportion of subjects discontinuing due to adverse reactions was 6.1%. At week 16 these trials demonstrated significant more apremilast-treated patients (33.1%) achieved the primary end point PASI-75 than placebo (5.3%). We began prescribing apremilast in July 2015. Aim: To evaluate efficacy and tolerability of apremilast in an Irish teaching hospital psoriasis population. Methods: A proforma documenting clinical evaluation parameters, prior treatment experience and AE’s; was completed prospectively on all patients commenced on apremilast since July 2015 – July 2017. Data was collected at week 0,6,12,24,36 and week 52 with 20/71 patients having passed week 52. Efficacy was assessed using Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). AE’s documented included GI effects, infections, changes in weight and mood. Retrospective chart review and telephone review was utilised for missing data. Results: A total of 71 adult subjects (38 male, 33 female; age range 23-57), with moderate to severe psoriasis, were evaluated. Prior treatment: 37/71 (52%) were systemic/biologic/phototherapy naïve; 14/71 (20%) has prior phototherapy alone;20/71 (28%) had previous systemic/biologic exposure; 12/71 (17%) had both psoriasis and psoriatic arthritis. PASI responses: mean baseline PASI was 10.1 and DLQI was 15.Week 6: N=71, n=15 (21%) achieved PASI 75. Week 12: N= 48, n=6 (13%) achieved a PASI 100%; n=16 (34.5%) achieved a PASI 75. Week 24: N=40, n=10 (25%) achieved a PASI 100; n=15 (37.5%) achieved a PASI 75. Week 52: N= 20, n=4 (20%) achieved a PASI 100; n= 16 (80%) achieved a PASI 75. (N= number of pts having passed the time point indicated, n= number of pts (out of N) achieving PASI or DLQI responses at that time). DLQI responses: week 24: N= 40, n=30 (75%) achieved a DLQI score of 0; n=5 (12.5%) achieved a DLQI score of 1; n=1 (2.5%) achieved a DLQI score of 10 (due to lack of efficacy). Adverse Events: The proportion of patients that discontinued treatment due to AE’s was n=7 (9.8%). One patient experienced nausea alleviated by dose reduction; another developed significant dysgeusia for certain foods, both continued therapy. Two patients lost 2-3 kg. Conclusion: Initial Irish patient experience of Apremilast appears comparable to that observed in trials with good efficacy and tolerability.

Keywords: Apremilast, introduction, Ireland, clinical audit

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Authors: Oluwaseun Adeleke, Samuel O. Ikani, Fidelis Edet, Anthony Nwala, Mopelola Raji, Simeon Christian Chukwu

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Background: The Delivering Innovations in Selfcare (DISC) project aims to increase access to self-care options for women of reproductive age, starting with self-inject subcutaneous depot medroxyprogesterone acetate (DMPA-SC) contraception services. However, the project has faced challenges in ensuring the continuous availability of the commodity in health facilities. Although most states in the country rely on the federal ministry of Health for supplies, some are gradually funding the procurement of Family Planning (FP) commodities. This attempt is, however, often accompanied by procurement delays and purchases inadequate to meet demand. This dilemma was further exacerbated by the commencement of demand generation activities by the project in supported states which geometrically increased commodity utilization rates and resulted in receding stock and occasional service disruptions. Strategies: The project deployed various strategies were implemented to ensure the continuous availability of commodities. These include facilitating inter-facility transfer, monthly tracking of commodity utilization, and alerting relevant authorities when stock levels reach a minimum. And supporting state-level procurement of DMPA-SC commodities through catalytic interventions. Results: Effective monitoring of commodity inventory at the facility level and strategic engagement with federal and state-level logistics units have proven successful in mitigating stock-out of commodities. It has helped secure up to 13,000 units of DMPA-SC commodities from federal logistics units and enabled state units to prioritize supported sites. This has ensured the continuity of DMPA-SC services and an increasing trend in the practice of self-injection. Conclusion: A functional supply chain is crucial to achieving commodity security, and without it, health programs cannot succeed. Stakeholder engagement, stock management and catalytic interventions have provided both short- and long-term measures to mitigate stock-outs and ensured a consistent supply of commodities to clients.

Keywords: family planning, contraception, DMPA-SC, self-care, self-injection, commodities, stock-out

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Authors: Germans Natuhwera, Peter Ellis, Acuda Wilson, Anne Merriman, Martha Rabwoni

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Objective: The aim of the study was to diagnose the socio-economic burden and impact of a diagnosis of cervical cancer (CC) in rural women in the context of low-resourced country Uganda, using a phenomenological enquiry. Methods: This was a multi-site phenomenological inquiry, conducted at three hospice settings; Mobile Hospice Mbarara in southwestern, Little Hospice Hoima in Western, and Hospice Africa Uganda Kampala in central Uganda. A purposive sample of women with a histologically confirmed diagnosis of CC was recruited. Data was collected using open-ended audio-recorded interviews conducted in the native languages of participants. Interviews were transcribed verbatim in English, and Braun and Clarke’s (2019) framework of thematic analysis was used. Results: 13 women with a mean age of 49.2 and age range 29-71 participated in the study. All participants were of low socioeconomic status. The majority (84.6%) had advanced disease at diagnosis. A fuller reading of transcripts produced four major themes clustered under; (1) socioeconomic characteristics of women, (2) impact of CC on women’s relationships, (3) disrupted and impaired activities of daily living (ADLs), and (4) economic disruptions. Conclusions: A diagnosis of CC introduces significant socio-economic disruptions in a woman’s and her family’s life. CC causes disability, impairs the woman and her family’s productivity hence exacerbating levels of poverty in the home. High and expensive out-of-pocket expenditure on treatment, investigations, and transport costs further compound the socio-economic burden. Decentralizing cancer care services to regional centers, scaling up screening services, subsidizing costs of cancer care services, or making cervical cancer care treatment free of charge, strengthening monitoring mechanisms in public facilities to curb the vice of healthcare workers soliciting bribes from patients, increased mass awareness campaigns about cancer, training more healthcare professionals in cancer investigation and management, and palliative care, and introducing an introductory course on gynecologic cancers into all health training institutions are recommended.

Keywords: activities of daily living, cervical cancer, out-of-pocket, expenditure, phenomenology, socioeconomic

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Authors: Abdul Aziz, Muhammad Qamar Masood, Saadia Sattar, Saira Fatima, Najmul Islam

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Introduction: The most common endocrine tumor is thyroid cancer. Follicular Thyroid Carcinoma (FTC) accounts for 5%–10% of all thyroid cancers. Patients with FTC frequently present with more advanced stage diseases and a higher occurrence of distant metastases because of the propensity of vascular invasion. FTC is mainly treated with surgery, while radioactive iodine therapy is the main adjuvant therapy as per ATA guidelines. In many developing countries, surgical facilities and radioactive iodine are in short supply; therefore, understanding follicular thyroid cancer trends may help developing countries plan and use resources more effectively. Methodology: It was a retrospective observational study of FTC patients of age 18 years and above conducted at Aga Khan University Hospital, Karachi, from 1st January 2010 to 31st December 2019. Results: There were 404 patients with thyroid carcinoma, out of which forty (10.1%) were FTC. 50% of the patients were in the 41-60 years age group, and the female to male ratio was 1.5: 1. Twenty-four patients (60%) presented with complain of neck swelling followed by metastasis (20%) and compressive symptoms (20%). The most common site of metastasis was bone (87.5%), followed by lung (12.5%). The pre-operative thyroglobulin level was done in six out of eight metastatic patients (75%) in which it was elevated. This emphasizes the importance of checking thyroglobulin level in unusual presentation (bone pain, fractures) of a patient having neck swelling also to help in establishing the primary source of tumor. There was no complete documentation of ultrasound features of the thyroid gland in all the patients, which is an important investigation done in the initial evaluation of thyroid nodule. On FNAC, 50% (20 patients) had Bethesda category III-IV nodules, while 10% ( 4 patients ) had Bethesda category II. In sixteen patients, FNAC was not done as they presented with compressive symptoms or metastasis. Fifty percent had a total thyroidectomy and 50% had subtotal followed by completion thyroidectomy, plus ten patients had lymph node dissection, out of which seven had histopathological lymph node involvement. On histopathology, twenty-three patients (57.5%) had minimally invasive, while seventeen (42.5%) had widely invasive follicular thyroid carcinoma. The capsular invasion was present in thirty-three patients (82.5%); one patient had no capsular invasion, but there was a vascular invasion. Six patients' histopathology had no record of capsular invasion. In contrast, the lymphovascular invasion was present in twenty-six patients (65%). In this study, 65 % of the patients had clinical stage 1 disease, while 25% had stage 2 and 10% had clinical stage 4. Seventeen patients (42.5%) had received RAI 30-100 mCi, while ten patients (25%) received more than 100 mCi. Conclusion: FTC demographic and clinicopathological presentation are the same in Pakistan as compared to other countries. Surgery followed by RAI is the mainstay of treatment. Thus understanding the trend of FTC and proper planning and utilization of the resources will help the developing countries in effectively treating the FTC.

Keywords: thyroid carcinoma, follicular thyroid carcinoma, clinicopathological features, developing countries

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Authors: Mohammad Hassan Heidari, Amir Hossein Goodarzi, Majid Azarniush

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Radiation doses to tissues and organs were measured using the anthropomorphic phantom as an equivalent to the human body. When high-energy X-rays are externally applied to treat laryngeal cancer, the absorbed dose at the laryngeal lumen is lower than given dose because of air space which it should pass through before reaching the lesion. Specially in case of high-energy X-rays, the loss of dose is considerable. Three-dimensional absorbed dose distributions have been computed for high-energy photon radiation therapy of laryngeal and hypo pharyngeal cancers, using a coaxial pair of opposing lateral beams in fixed positions. Treatment plans obtained under various conditions of irradiation.

Keywords: 3D treatment planning, anthropomorphic phantom, larynx cancer, radiotherapy

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Authors: Kim Toyer, Belinda Thompson, Louise Koelmeyer

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Lymphoedema is a chronic condition caused by dysfunction of the lymphatic system, which limits the drainage of fluid and tissue waste from the interstitial space of the affected body part. The normal physiological changes in pregnancy cause an increased load on a normal lymphatic system which can result in a transient lymphatic overload (oedema). The interaction between lymphoedema and pregnancy oedema is unclear. Women with pre-existing lymphoedema require accurate information and additional strategies to manage their lymphoedema during pregnancy. Currently, no resources are available to guide women or their healthcare providers with accurate advice and additional management strategies for coping with lymphoedema during pregnancy until they have recovered postnatally. This study explored the experiences of Australian women with pre-existing lymphoedema during recent pregnancy and the early postnatal period to determine how their usual lymphoedema management strategies were adapted and what were their additional or unmet needs. Interactions with their obstetric care providers, the hospital maternity services, and usual lymphoedema therapy services were detailed. Participants were sourced from several Australian lymphoedema community groups, including therapist networks. Opportunistic sampling is appropriate to explore this topic in a small target population as lymphoedema in women of childbearing age is uncommon, with prevalence data unavailable. Inclusion criteria were aged over 18 years, diagnosed with primary or secondary lymphoedema of the arm or leg, pregnant within the preceding ten years (since 2012), and had their pregnancy and postnatal care in Australia. Exclusion criteria were a diagnosis of lipedema and if unable to read or understand a reasonable level of English. A mixed-method qualitative design was used in two phases. This involved an online survey (REDCap platform) of the participants followed by online semi-structured interviews or focus groups to provide the transcript data for inductive thematic analysis to gain an in-depth understanding of issues raised. Women with well-managed pre-existing lymphoedema coped well with the additional oedema load of pregnancy; however, those with limited access to quality conservative care prior to pregnancy were found to be significantly impacted by pregnancy, including many reporting deterioration of their chronic lymphoedema. Misinformation and a lack of support increased fear and apprehension in planning and enjoying their pregnancy experience. Collaboration between maternity and lymphoedema therapy services did not happen despite study participants suggesting it. Helpful resources and unmet needs were identified in the recent Australian context to inform further research and the development of resources to assist women with lymphoedema who are considering or are pregnant and their supporters, including health care providers.

Keywords: lymphoedema, management strategies, pregnancy, qualitative

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