Search results for: motor and non-motor symptoms

Authors: Joana PaScoa Pinheiro, David Goncalves Ferreira, Filipe Ramos, Joaquim Soares Do Brito, Samuel Martins, Marco Sarmento

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Introduction: The SARS-CoV-2 (COVID-19) pandemic was identified in January 2020 in China, in the city of Wuhan. The increase in the number of cases over the following months was responsible for the restructuring of hospitals and departments in order to accommodate admissions related to COVID-19. Essential services, such as trauma, had to readapt to maintain their functionality and thus guarantee quick and safe access in case of an emergency. Objectives: This study describes the impact of COVID-19 on a Level III Trauma Center and particularly on the clinical management of hospitalized patients with spine injuries. Study Design & Methods: This is a retrospective cohort study whose results were obtained through the medical records of patients with spine injuries who underwent surgical intervention in the years 2019 and 2020 (period from March 1st to December 31st). A comparison between the two groups was made. In the study patients with injuries in the context of trauma were included who underwent surgery in the periods previously described. Patients hospitalized with a spine injury in a non-traumatic context and/or were not surgically treated were excluded. Results: In total, 137 patients underwent trauma spine surgery of which 71 in 2019 (51.8%) were without significant differences in intergroup comparisons. The most frequent injury mechanism in 2019 was motor vehicle crash (47.9%) compared to 2020 which was of a person falling from a height between 2-4 meters (37.9%). Cervical trauma was reported to be the most frequent spine injury in both years. There was a significant decrease in the need for intensive care in 2020, 51.4% vs 30.3%, p = .015 and the number of complications was also lower in 2020 (1.35% vs 0.98%), including the number of deaths, being the difference marginally significant. There were no significant differences regarding time for presentation to surgery or in the total days of hospitalization. Conclusions: The restructuring made in the trauma unit at a Level III Trauma Center in the context of the current COVID-19 pandemic was effective, with no significant differences between the years of 2019 vs 2020 when compared with the time for presentation to surgery or the number of days of hospitalization. It was also found that lockdown rules in 2020 were probably responsible for the decrease in the number of road traffic accidents, which justifies a significant decrease in the need for intensive care as well as in the number of complications in patients hospitalized in the context of spine trauma.

Keywords: trauma, spine, impact, covid-19

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Authors: Erna Judith Roach, Nalini Bhaskaranand

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Background & Significance: Asthma is the most common chronic disease among children. Education is the cornerstone of management of asthma to help the affected children. In India there are about 1.5- 3.0 million asthmatic children in the age group of 5-11 years. Many parents face management dilemmas in administration of medications to their children. Mothers being primary caregivers of children are often responsible for administering medications to them. The purpose of the study was to develop an educational package on techniques of drug administration for mothers of asthmatic children and determine its effectiveness in terms of improvement in skill in drug administration. Methodology: A quasi- experimental time series pre-test post -test control group design was used. Mothers of asthmatic children attending paediatric outpatient departments of selected hospitals along with their children between 5 and 12 years were included. Sample size consisted of 40 mothers in the experimental and 40 mothers in the control groups. Block randomization was used to assign samples to both the groups. The data collection instruments used were Baseline Proforma, Clinical Proforma, Daily asthma drug intake and symptoms diary and Observation Rating Scales on technique of using a metered dose inhaler with spacer; metered dose inhaler with facemask; metered dose inhaler alone and dry powder inhaler. The educational package consisted of a video and booklet on techniques of drug administration. Data were collected at baseline, 1, 3 and 6 months. Findings: The mean post-test scores in techniques of drug administration were higher than the mean pre-test scores in the experimental group in all techniques. The Friedman test (p < 0.01), Wilcoxon Signed Rank test (p < 0.008) and Mann Whitney U (p < 0.01) showed statistically significant difference in the experimental group than the control group. There was significant decrease in the average number of symptom days (11 Vs. 4 days/ month) and hospital visits (5 to 1 per month) in the experimental group when compared to the control group. Conclusion: The educational package was found to be effective in improving the skill of mothers in drug administration in all the techniques, especially with using the metered dose inhaler with spacer.

Keywords: childhood asthma, drug administration, mothers of children, inhaler

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Authors: Thaer Khaleel Swaid, Maryam Al Ahmad, Ishtiaq Ahmad

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47-year-old female, known to have a liver cyst and hemangiomas, presented to the gastroenterology clinic for chronic moderate postprandial epigastric pain, which is aggravated by food, leaning forward and relieved on lying flat. The pain was associated with nausea, vomiting, heartburn and excessive burping. She opened her bowel daily, having well-formed stools without blood or mucus. The patient denied NSAID intake, smoking or alcohol. On physical examination during the episode of pain abdomen revealed a soft, lax abdomen and mild tenderness in the epigastric region without organomegaly. Bowel sounds were audible. Her routine hematological and biochemical parameters were within normal, including CBC, Celiac serology, Lipase, Metabolic profile and H pylori stool antigen. The patient underwent an Ultrasound of the abdomen which showed multiple liver cysts, hemangioma, normal GB and biliary tree. Based on the clinical picture and to narrow our differential diagnosis, an ultrasound Doppler for the abdomen was ordered, and it showed celiac artery peak systolic velocity in expiration is 270cm/s, suggestive of median arcuate ligament syndrome. She Had computerized tomography abdomen done and showed a Narrowing of the celiac artery at the origin, likely secondary to low insertion of the median arcuate ligament. Furthermore, Gastroscopy and, later on colonoscopy were done, which was unremarkable. A laparoscopic decompression of the celiac trunk was indicated, for which the patient was referred to vascular surgery. This case confirms that Median Arcuate Ligament syndrome is an unusual diagnosis and is always challenging. Usually, patients undergo extensive workups before a final diagnosis is achieved. Our case highlights the challenge of diagnosing MALS since this entity is rare. It is a good choice to perform abdominal ultrasound with Doppler imaging on a patient with symptoms such as postprandial angina.

Keywords: Unveiling the Mystery, MALS, rare entity, Rare vascular phenomenon

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Authors: Renu Pattanshetty

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The aim of this narrative review is to highlight the impact of menopause on osteoporosis and weight gain. The review also aims to summarize physiotherapeutic strategies to combat the same.A thorough literature search was conducted using electronic databases like MEDline, PUBmed, Highwire Press, PUBmed Central for English language studies that included search terms like menopause, osteoporosis, obesity, weight gain, exercises, physical activity, physiotherapy strategies from the year 2000 till date. Out of 157 studies that included metanalyses, critical reviews and randomized clinical trials, a total of 84 were selected that met the inclusion criteria. Prevalence of obesity is increasing world - wide and is reaching epidemic proportions even in the menopausal women. Prevalence of abdominal obesity is almost double than that general obesity with rates in the US with 65.5% in women ages 40-59 years and 73.8 in women aged 60 years or more. Physical activities and exercises play a vital role in prevention and treatment of osteoporosis and weight gain related to menopause that aim to boost the general well-being and any symptoms brought about by natural body changes. Endurance exercises lasting about 30 minutes /day for 5 days/ week has shown to decrease weight and prevent weight gain. In addition, strength training with at least 8 exercises of 8-12 repetitions working for whole body and for large muscle groups has shown to result positive outcomes. Hot flashes can be combatted through yogic breathing and relaxation exercises. Prevention of fall strategies and resistance training are key to treat diagnosed cases of osteoporosis related to menopause. One to three sets with five to eight repetitions of four to six weight bearing exercises have shown positive results. Menopause marks an important time for women to evaluate their risk of obesity and osteoporosis. It is known fact that bone benefit from exercises are lost when training is stopped, hence, practicing bone smart habits and strict adherence to recommended physical activity programs are recommended which are enjoyable, safe and effective.

Keywords: menopause, osteoporosis, obesity, weight gain, exercises, physical activity, physiotherapy strategies

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Authors: Hyo Seon Choi, Ju Sun Kim, DY Kim

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Introduction: This study was aimed to evaluate temporo-spatial patterns during the reach and grasp task in hemiplegic stroke patients and to identify movement pattern according to severity of motor impairment. Method: 29 subacute post-stroke patients were enrolled in this study. The temporo-spatial and kinematic data were obtained during reach and grasp task through 3D motion analysis (VICON). The reach and grasp task was composed of four sub-tasks: reach (T1), transport to mouth (T2), transport back to table (T3) and return (T4). The movement time, joint angle and sum of deviation angles from normative data were compared between affected side and unaffected side. They were also compared between two groups (mild to moderate group: 28~66, severe group: 0~27) divided by upper-Fugl-Meyer Assessment (FMA) scale. Result: In affected side, total time and durations of all four tasks were significantly longer than those in unaffected side (p < 0.001). The affected side demonstrated significant larger shoulder abduction, shoulder internal rotation, wrist flexion, wrist pronation, thoracic external rotation and smaller shoulder flexion during reach and grasp task (p < 0.05). The significant differences between mild to moderate group and severe group were observed in total duration, durations of T1, T2, and T3 in reach and grasp task (p < 0.01). The severe group showed significant larger shoulder internal rotation during T2 (p < 0.05) and wrist flexion during T2, T3 (p < 0.05) than mild to moderate group. In range of motion during each task, shoulder abduction-adduction during T2 and T3, shoulder internal-external rotation during T2, elbow flexion-extension during T1 showed significant difference between two groups (p < 0.05). The severe group had significant larger total deviation angles in shoulder internal-external rotation and wrist extension-flexion during reach and grasp task (p < 0.05). Conclusion: This study suggests that post-stroke hemiplegic patients have an unique temporo-spatial and kinematic patterns during reach and grasp task, and the movement pattern may be related to affected upper limb severity. These results may be useful to interpret the motion of upper extremity in stroke patients.

Keywords: Fugl-Meyer Assessment (FMA), motion analysis, reach and grasp, stroke

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Authors: Mark Davies, Carolyn Wallace, Christina Lloydwin, Tom Powell

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Background: Frailty is increasingly recognized as a public health problem within an aging population. It is often characterized as an accumulation of clinical symptoms with progressive decline. We contend that dehydration is potentially the missing link driving the cycle of frailty; it contributes to malnutrition and cognitive decline and is a risk factor for other conditions. Frailty may also impact on fluid intake in cognitively intact older adults, indicating the cyclical nature of dehydration contributing to increasing frailty. Aim: To examine the relationships between fluid, hydration, and frailty in older adults in order to determine what works, for whom, how, why, and in what circumstances. Methods: A Realist Synthesis was first undertaken with n=50 studies, leading to the development of a Refined Programme Theory (RPT) articulating what hydration interventions work, for whom, to what degree, in what contexts, and how & why. Within the subsequent evaluation, the RPT was further confirmed/refuted/refined following semi-structured interviews with n=8 participants (healthcare professionals and patients). The RAMESES Quality Standards were followed throughout the study. Results: The Refined Programme Theory (RPT) highlighted three factors that result in optimized hydration for frail older people, i.e., Developing an Understanding Around Hydration, Empowering Participation, and System Reconfiguration. Our RPT indicates that hydration interventions work by developing an understanding of the importance of hydration, mitigating physical & cognitive barriers, increasing the agency of the patient, using a prompting process to reinforce drinking behavior, and routinizing hydration as a dimension of overall care. Conclusion: The study indicates that a greater understanding of the importance of hydration is required for all parties. Patients also require physical and psychological support if they are to be active agents in meeting their hydration needs. At a wider ‘system’ level, organizations must work in an integrated manner introducing processes that enable continuing professional development (CPD), encourage ongoing holistic assessment, and routinize hydration support.

Keywords: frailty, dehydration, older adults, realist review, realist evaluation

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Authors: Sungpil Ha, Ju Yong Kang, Sangbaek Park, Seung-Ju Lee, Soo-Won Chae

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The growing number of obese patients in aging societies has led to an increase in the number of patients with knee medial osteoarthritis (OA). Artificial joint insertion is the most common treatment for knee medial OA. Surgery is effective for patients with serious arthritic symptoms, but it is costly and dangerous. It is also inappropriate way to prevent a disease as an early stage. Therefore Non-operative treatments such as toe-in gait are proposed recently. Toe-in gait is one of non-surgical interventions, which restrain the progression of arthritis and relieves pain by reducing knee adduction moment (KAM) to facilitate lateral distribution of load on to knee medial cartilage. Numerous studies have measured KAM in various foot progression angle (FPA), and KAM data could be obtained by motion analysis. However, variations in stress at knee cartilage could not be directly observed or evaluated by these experiments of measuring KAM. Therefore, this study applied motion analysis to major gait points (1st peak, mid –stance, 2nd peak) with regard to FPA, and to evaluate the effects of FPA on the human lower extremity, the finite element (FE) method was employed. Three types of gait analysis (toe-in, toe-out, baseline gait) were performed with markers placed at the lower extremity. Ground reaction forces (GRF) were obtained by the force plates. The forces associated with the major muscles were computed using GRF and marker trajectory data. MRI data provided by the Visible Human Project were used to develop a human lower extremity FE model. FE analyses for three types of gait simulations were performed based on the calculated muscle force and GRF. We observed the maximum stress point during toe-in gait was lower than the other types, by comparing the results of FE analyses at the 1st peak across gait types. This is the same as the trend exhibited by KAM, measured through motion analysis in other papers. This indicates that the progression of knee medial OA could be suppressed by adopting toe-in gait. This study integrated motion analysis with FE analysis. One advantage of this method is that re-modeling is not required even with changes in posture. Therefore another type of gait simulation or various motions of lower extremity can be easily analyzed using this method.

Keywords: finite element analysis, gait analysis, human model, motion capture

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Authors: Megumi Nishida, Naoya Motegi, Takurou Kikuchi, Tomoko Tokumura

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In recent years, power system has been changed and flexible power pricing system such as demand response has been sought in Japan. The demand response system is simple in the household sector and the owner, decision-maker, can gain the benefits of power saving. On the other hand, the execution of the demand response in the office building is more complex than household because various people such as owners, building administrators and occupants are involved in making decisions. While the owners benefit from the demand saving, the occupants are forced to be exposed to demand-saved environment certain benefits. One of the reasons is that building systems are usually centralized control and each occupant cannot choose either participate demand response event or not, and contribution of each occupant to demand response is unclear to provide incentives. However, the recent development of IT and building systems enables the personalized control of office environment where each occupant can control the lighting level or temperature around him or herself. Therefore, it can be possible to have a system which each occupant can make a decision of demand response participation in office building. This study investigates the personal behavior upon demand response requests, under the condition where each occupant can adjust their brightness individually in their workspace. Once workers participate in the demand response, their task lights are automatically turned off. The participation rates in the demand response events are compared between four groups which are divided by different motivation, the presence or absence of incentives and the way of participation. The result shows that there are the significant differences of participation rates in demand response event between four groups. The way of participation has a large effect on the participation rate. ‘Opt-out’ group, where the occupants are automatically enrolled in a demand response event if they don't express non-participation, will have the highest participation rate in the four groups. The incentive has also an effect on the participation rate. This study also reports that the impact of low illumination office environment on the occupants, such as stress or fatigue. The electrocardiogram and the questionnaire are used to investigate the autonomic nervous activity and subjective symptoms about the fatigue of the occupants. There is no big difference between dim workspace during demand response event and bright workspace in autonomic nervous activity and fatigue.

Keywords: demand response, illumination, questionnaire, electrocardiogram

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Authors: Tsu-Yin Wu, Jenni Hoffman, Lydia McMurrows, Sarah Lally

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Recent events of the Flint Water Crisis and elevated lead levels in Detroit public school water have highlighted a specific public health disparity and shown the need for better education of healthcare providers on lead education. Identifying children and pregnant women with a high risk for lead poisoning and ensuring lead testing is completed is critical. The purpose of this study is to explore the impact of an educational intervention on knowledge and confidence levels among nursing students enrolled in the prelicensure Bachelor of Science in Nursing (BSN) and Registered Nurse to BSN program (R2B). The study used both quantitative and qualitative research methods to assess the impact of multi-modal pedagogy on knowledge and confidence of lead screening and prevention among prelicensure and R2B nursing students. The students received lead poisoning and prevention content in addition to completing an e-learning module developed by the Pediatric Environmental Health Specialty Units. A total of 115 students completed the pre-and post-test instrument that consisted of demographic, lead knowledge, and confidence items. Despite the increase of total knowledge, three dimensions of lead poisoning, and confidence from pre- to post-test scores for both groups, there was no statistical significance on the increase between prelicensure and R2B students. Thematic analysis of qualitative data showed five themes from participants' learning experiences: lead exposure, signs and symptoms of lead poisoning, screening and diagnosis, prevention, and policy and statewide issues. The study is limited by a small sample and participants recalling some correct answers from the pretest, thus, scoring higher on the post-test. The results contribute to the minimally existent literature examining a critical public health concern regarding lead health exposure and prevention education of nursing students. Incorporating such content area into the nursing curriculum is essential in ensuring that such public health disparities are mitigated.

Keywords: lead poisoning, emerging public health issue, community health, nursing edducation

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Authors: Allan F. F. Alves, Fernando A. Bacchim Neto, Guilherme Giacomini, Marcela de Oliveira, Ana L. M. Pavan, Maria E. D. Rosa, Diana R. Pina

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Stroke is a worldwide concern, only in Brazil it accounts for 10% of all registered deaths. There are 2 stroke types, ischemic (87%) and hemorrhagic (13%). Early diagnosis is essential to avoid irreversible cerebral damage. Non-enhanced computed tomography (NECT) is one of the main diagnostic techniques used due to its wide availability and rapid diagnosis. Detection depends on the size and severity of lesions and the time spent between the first symptoms and examination. The Alberta Stroke Program Early CT Score (ASPECTS) is a subjective method that increases the detection rate. The aim of this work was to implement an image segmentation system to enhance ischemic stroke and to quantify the area of ischemic and hemorrhagic stroke lesions in CT scans. We evaluated 10 patients with NECT examinations diagnosed with ischemic stroke. Analyzes were performed in two axial slices, one at the level of the thalamus and basal ganglion and one adjacent to the top edge of the ganglionic structures with window width between 80 and 100 Hounsfield Units. We used different image processing techniques such as morphological filters, discrete wavelet transform and Fuzzy C-means clustering. Subjective analyzes were performed by a neuroradiologist according to the ASPECTS scale to quantify ischemic areas in the middle cerebral artery region. These subjective analysis results were compared with objective analyzes performed by the computational algorithm. Preliminary results indicate that the morphological filters actually improve the ischemic areas for subjective evaluations. The comparison in area of the ischemic region contoured by the neuroradiologist and the defined area by computational algorithm showed no deviations greater than 12% in any of the 10 examination tests. Although there is a tendency that the areas contoured by the neuroradiologist are smaller than those obtained by the algorithm. These results show the importance of a computer aided diagnosis software to assist neuroradiology decisions, especially in critical situations as the choice of treatment for ischemic stroke.

Keywords: ischemic stroke, image processing, CT scans, Fuzzy C-means

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Authors: Les Moncrieff

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In a world awash with potent opioids flaming an international crisis, the need to explore safe alternatives has never been more urgent. Bio-electrode Therapy is a novel adjunctive treatment method for relieving acute opioid withdrawal symptoms and many types of complex acute and chronic pain (often the underlying cause of opioid dependence). By combining the science of developmental bioelectricity with Traditional Chinese Medicine’s theory of meridians, rapid relief from pain is routinely being achieved in the clinical setting. Human body functions are dependent on electrical factors, and acupuncture points on the body are known to have higher electrical conductivity than surrounding skin tissue. When tiny gold- and silver-plated electrodes are secured to the skin at specific acupuncture points using established Chinese Medicine principles and protocols, an enhanced microcurrent and electrical field are created between the electrodes, influencing the entire meridian and connecting meridians. No external power source or electrical devices are required. Endogenous DC electric fields are an essential fundamental component for development, regeneration, and wound healing. Disruptions in the normal ion-charge in the meridians and circulation of blood will manifest as pain and development of disease. With the application of these simple electrodes (gold acting as cathode and silver as anode) according to protocols, the resulting microcurrent is directed along the selected meridians to target injured or diseased organs and tissues. When injured or diseased cells have been stimulated by the microcurrent and electrical fields, the permeability of the cell membrane is affected, resulting in an immediate relief of pain, a rapid balancing of positive and negative ions (sodium, potassium, etc.) in the cells, the restoration of intracellular fluid levels, replenishment of electrolyte levels, pH balance, removal of toxins, and a re-establishment of homeostasis.

Keywords: bioelectricity, electrodes, electrical fields, acupuncture meridians, complex pain, opioid withdrawal management

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Authors: Seyed Reza Alvani, Norzarina Mohd Zaharim

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Diabetes mellitus is one of the chronic, progressive illnesses that has reached a widespread level all over the world and considered an extreme life-threatening condition in South East Asian countries region include Malaysia. Co-morbid psychological factors like diabetes-related distress and low level of psychological well-being are related to high levels of blood sugar and hypo/hyperglycemia complications. As a result, the implementation of any effective psychological interventions among diabetes patients is necessary. One such intervention is cognitive behavioural therapy (CBT) that is approved and suggested by many professionals as an empirically-supported technique of treatment for people how are suffering from diabetes around the world where there is no clear evidence of using this technique in Malaysia. The target of this study was to see whether or not participation in group CBT would end in an improvement of psychological well-being (by decreasing the levels of depression and anxiety) and diabetes-related distress followed by lower level of blood sugar level. The sample of the present study was 60 type 2 diabetes adults (ages 20-65) with HbA1c ≥ 7 from Universiti Sains Malaysia (USM) clinic. All participants were selected by the convenience sampling technique. Participants completed Well-Being Questionaire (W-BQ) and Distress Scale (DDS-17) after signing written consent form. Those participants who were interested to join CBT groups were placed to the experimental groups, and people who were not interested were assigned to the control group. The experimental groups (n = 30) received group CBT, whereas participants in the control group (n = 30) did not receive any kind of psychological intervention. For testing the effect of intervention, mixed between-within ANOVA used. The entire intervention program took three months, and a significant improvement in the level of psychological well-being and decline in the level of diabetes distress observed among participants from experimental group, but not for those in the control group. Additionally, the result of the study suggested that group CBT could help participants in experimental group achieve more acceptable HbA1c levels in comparison with those in the control group. Malaysian Ministry of Health, researcher and governors should give due interest and commitment to psychological care as a pathway to diabetes mitigation among Malaysian adults.

Keywords: cognitive behavioral therapy, diabetes related distress, diabetes type 2, Malaysia, well-being

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Authors: S. Yesmin, N. F.Rahman, R. Akther, T. Begum, T. Tahmid, T. Chowdury, S. Afrin, J. D. Hamadani

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Abstract: Maternal depression is one of the risk factors of developmental delay in young children in low-income countries. Maternal depressions during pregnancy are rarely reported in Bangladesh. Objectives: The purpose of the present study was to examine the efficacy of a community based psychosocial intervention on women with mild to moderate depressive illness during the perinatal period and on their children from birth to 12 months on mothers’ mental status and their infants’ growth and development. Methodology: The study followed a prospective longitudinal approach with a randomized controlled design. Total 250 pregnant women aged between 15 and 40 years were enrolled in their third trimester of pregnancy of which 125 women were in the intervention group and 125 in the control group. Women in the intervention group received the “Thinking Healthy (CBT based) program” at their home setting, from their last month of pregnancy till 10 months after delivery. Their children received psychosocial stimulation from birth till 12 months. The following instruments were applied to get the outcome information- Bangla version of Edinburgh Postnatal Depression Scale (BEPDS), Prenatal Attachment Inventory (PAI), Maternal Attachment Inventory (MAI), Bayley Scale of Infant Development-Third version (Bayley–III) and Family Care Indicator (FCI). In addition, sever morbidity; breastfeeding, immunization, socio-economic and demographic information were collected. Data were collected at three time points viz. baseline, midline (6 months after delivery) and endline (12 months after delivery). Results: There was no significant difference between any of the socioeconomic and demographic variables at baseline. A very preliminary analysis of the data shows an intervention effect on Socioemotional behaviour of children at endline (p<0.001), motor development at midline (p=0.016) and at endline (p=0.065), language development at midline (p=0.004) and at endline (p=0.023), cognitive development at midline (p=0.008) and at endline (p=0.002), and quality of psychosocial stimulation at midline (p=0.023) and at endline (p=0.010). EPDS at baseline was not different between the groups (p=0.419), but there was a significant improvement at midline (p=0.027) and at endline (p=0.024) between the groups following the intervention. Conclusion: Psychosocial intervention is found effective in reducing women’s low and moderate depressive illness to cope with mental health problem and improving development of young children in Bangladesh.

Keywords: mental health, maternal depression, infant development, CBT, EPDS

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Authors: Qingjin Liu, Jinpeng Niu, Kangjia Chen, Jiao Li, Huafu Chen, Wei Liao

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Functional connectomics is essential in cognitive science and neuropsychiatry, offering insights into the brain's complex network structures and dynamic interactions. Although neuroimaging has uncovered functional connectivity issues in Major Depressive Disorder (MDD) patients, the dynamic shifts in connectome topology and their link to gene expression are yet to be fully understood. To explore the differences in dynamic connectome topology between MDD patients and healthy individuals, we conducted an extensive analysis of resting-state functional magnetic resonance imaging (fMRI) data from 434 participants (226 MDD patients and 208 controls). We used multilayer network models to evaluate brain module dynamics and examined the association between whole-brain gene expression and dynamic module variability in MDD using publicly available transcriptomic data. Our findings revealed that compared to healthy individuals, MDD patients showed lower global mean values and higher standard deviations, indicating unstable patterns and increased regional differentiation. Notably, MDD patients exhibited more frequent module switching, primarily within the executive control network (ECN), particularly in the left dorsolateral prefrontal cortex and right fronto-insular regions, whereas the default mode network (DMN), including the superior frontal gyrus, temporal lobe, and right medial prefrontal cortex, displayed lower variability. These brain dynamics predicted the severity of depressive symptoms. Analyzing human brain gene expression data, we found that the spatial distribution of MDD-related gene expression correlated with dynamic module differences. Cell type-specific gene analyses identified oligodendrocytes (OPCs) as major contributors to the transcriptional relationships underlying module variability in MDD. To the best of our knowledge, this is the first comprehensive description of altered brain module dynamics in MDD patients linked to depressive symptom severity and changes in whole-brain gene expression profiles.

Keywords: major depressive disorder, module dynamics, magnetic resonance imaging, transcriptomic

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Authors: Thyagi Ponnamperuma

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Background: Comorbidity between posttraumatic stress disorder (PTSD) and other psychological problems is common. Recent studies focused to investigate the underlying relationship between PTSD and comorbid psychopathologies. Among adolescents, higher rates of emotional and behavioral problems (EBP) have been reported following trauma, often coexisted with PTSD. The current study, thus, examined the relationship of posttraumatic stress symptoms to EBP in adolescents exposed to a variety of traumatic events. Further, the study investigated the relationship of trauma and comorbid PTSS to the self-perceived negative impact of EBP on daily functioning. Methods: Participants were 729 Sri Lankan adolescents (age 12 to 16 years; 54.9% female) living in areas impacted in varying degrees by the 2004 tsunami. In 2008, school-based screening was conducted and completed measures of, trauma exposure, PTSS, EBP, and related functional impairment. Results: Participants reported a high prevalence of trauma exposure (n = 438), including interpersonal violence (n = 155). DSM-IV criteria for full or partial PTSD were met by 23.7% of the trauma-exposed sample. Across all participants, 13.4% and 16.7% displayed clinically relevant levels of EBP and functional impairment, respectively. Among the trauma-exposed, 7% met criteria for both EBP and PTSD. EBP total scores and caseness were significantly higher in trauma-exposed adolescents with PTSD than in either those without PTSD or the non-traumatized control group. In subscale analysis, higher prevalence of serious emotional, conduct, and hyperactivity problems were reported in the PTSD positive group; the PTSD negative group did not differ significantly from the control group on any of the problem scales. In regression analyses, PTSS (β = .28, p < .001) and interpersonal violence (β = .13, p = .033) were significant predictors of EBP, cumulative trauma (β = .11, p = .076) showed no significant effect. Further, PTSS exacerbated the impact of EBP on daily functioning (β = 0.29, p = .023). Conclusion: PTSS were closely linked to EBP in adolescents, even years after the traumatic experience. PTSD and emotional and behavioral problems together pose a heightened risk for impaired daily functioning. Longitudinal studies are needed to clarify the causal pathway.

Keywords: adolescents, comorbidity, emotional and behavioral problems, functional impairment, posttraumatic stress, traumatic events

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Authors: Nafiseh Mirabdolhosseini, Jerry Zhou, Vincent Ho

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The dramatic global rise in acid reflux has also led to oesophageal adenocarcinoma (OAC) becoming the fastest-growing cancer in developed countries. While gastroscopy with biopsy is used to diagnose OAC patients, this labour-intensive and expensive process is not suitable for population screening. This study aims to design, develop, and implement a minimally invasive system to capture optical data of the distal oesophagus for rapid screening of potential abnormalities. To develop the system and understand user requirements, a user-centric approach was employed by utilising co-design strategies. Target users’ segments were identified, and 38 patients and 14 health providers were interviewed. Next, the technical requirements were developed based on consultations with the industry. A minimally invasive optical system was designed and developed considering patient comfort. This system consists of the sensing catheter, controller unit, and analysis program. Its procedure only takes 10 minutes to perform and does not require cleaning afterward since it has a single-use catheter. A prototype system was evaluated for safety and efficacy for both laboratory and clinical performance. This prototype performed successfully when submerged in simulated gastric fluid without showing evidence of erosion after 24 hours. The system effectively recorded a video of the mid-distal oesophagus of a healthy volunteer (34-year-old male). The recorded images were used to develop an automated program to identify abnormalities in the distal oesophagus. Further data from a larger clinical study will be used to train the automated program. This system allows for quick visual assessment of the lower oesophagus in primary care settings and can serve as a screening tool for oesophageal adenocarcinoma. In addition, this system is able to be coupled with 24hr ambulatory pH monitoring to better correlate oesophageal physiological changes with reflux symptoms. It also can provide additional information on lower oesophageal sphincter functions such as opening times and bolus retention.

Keywords: endoscopy, MedTech, oesophageal adenocarcinoma, optical system, screening tool

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Authors: Teris Cheung, Joyce Yuen Ting Lam, Kwan Hin Fong, Yuen Shan Ho, Tim Man Ho Li, Andy Choi-Yeung Tse, Cheng-Ta Li, Calvin Pak-Wing Cheng, Roland Beisteiner

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Transcranial pulse stimulation (TPS) is a non-intrusive brain stimulation technology that has been proven effective in older adults with mild neurocognitive disorders and adults with major depressive disorder. Given these robust evidences, TPS might be an adjunct treatment options in neuropsychiatric disorders, for example, autism spectrum disorder (ASD) – which is a common neurodevelopmental disorder in children. This trial aimed to investigate the effects of TPS on right temporoparietal junction, a key node for social cognition for Autism Spectrum Disorder (ASD), and to examine the association between TPS, executive functions and social functions. Design: This trial adopted a two-armed (verum TPS group vs. sham TPS group), double-blinded, randomized, sham-controlled design. Sampling: 32 subjects aged between 12 and 17, diagnosed with ASD were recruited. All subjects were computerized randomized into either verum TPS group or the sham TPS group on a 1:1 ratio. All subjects undertook functional MRI before and after the TPS interventions. Intervention: Six 30-min TPS sessions were administered to subjects in 2 weeks’ time on alternate days assessing neural connectivity changes. Baseline measurements and post-TPS evaluation of the ASD symptoms, executive functions, and social functions were conducted. Participants were followed up at 2-weeks, at 1-month and 3-month, assessing the short-and long-term sustainability of the TPS intervention. Data analysis: Generalized Estimating Equations with repeated measures were used to analyze the group and time difference. Missing data were managed by multiple imputations. The level of significance was set at p < 0.05. To our best knowledge, this is the first study evaluating the efficacy and safety of TPS among adolescents with ASD in Hong Kong and nationwide. Results emerging from this study will develop insight on whether TPS can be used as an adjunct treatment on ASD in neuroscience and clinical psychiatry. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT05408793.

Keywords: adolescents, autism spectrum disorder, neuromodulation, rct, transcranial pulse stimulation

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Authors: Lalita Khuna, Sugalya Amatachaya, Pipatana Amatachaya, Thiwabhorn Thaweewannakij, Pattra Wattanapan

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The five times sit-to-stand test (FTSST) has been widely used to quantify lower extremity motor strength (LEMS), dynamic balance ability, and risk of falls in many individuals. Recently, it has been used in ambulatory patients with spinal cord injury (SCI) but variously using with or without hands according to patients’ ability. This difference might affect the validity of the test in these individuals. Thus, this study assessed the concurrent validity of the FTSST in ambulatory individuals with SCI, separately for those who could complete the test with or without hands using LEMS and standard functional measures as gold standards. Moreover, the data of the tests from those who completed the FTSST with and without hands were compared. A total of 56 ambulatory participants with SCI who could complete sit-to-stand with or without hands were assessed for the time to complete the FTSST according to their ability. Then they were assessed for their LEMS scores and functional abilities, including the 10-meter walk test (10MWT), the walking index for spinal cord injury II (WISCI II), the timed up and go test (TUGT), and the 6-minute walk test (6MWT). The Mann-Whitney U test was used to compare the different findings between the participants who performed the FTSST with and without hands. The Spearman rank correlation coefficient (ρ) was applied to analyze the levels of correlation between the FTSST and standard tests (LEMS scores and functional measures). There were significant differences in the data between the participants who performed the test with and without hands (p < 0.01). The time to complete the FTSST of the participants who performed the test without hands showed moderate to strong correlation with total LEMS scores and all functional measures (ρ = -0.71 to 0.69, p < 0.001). On the contrary, the FTSST data of those who performed the test with hands were significantly correlated only with the 10MWT, TUGT, and 6MWT (ρ = -0.47 to 0.57, p < 0.01). The present findings confirm the concurrent validity of the FTSST when performed without hands for LEMS and functional mobility necessary for the ability of independence and safety of ambulatory individuals with SCI. However, the test using hands distort the ability of the outcomes to reflect LEMS and WISCI II that reflect lower limb functions. By contrast, the 10MWT, TUGT, and 6MWT allowed upper limb contribution in the tests. Therefore, outcomes of these tests showed a significant correlation to the outcomes of FTSST when assessed using hands. Consequently, the use of FTSST with or without hands needs to consider the clinical application of the outcomes, i.e., to reflect lower limb functions or mobility of the patients.

Keywords: mobility, lower limb muscle strength, clinical test, rehabilitation

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Authors: Zsuzsanna Schnell, Francesca Ervas

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Background: Our study aims to clarify how language fosters further cognitive development and how we eventually arrive at the complex human specific skill of pragmatic competence and reveal what levels of mentalization and theory of mind are in place before language. Method: Our experimental pragmatic investigation maps the interaction of mentalization and pragmatic competence. We map the different levels of mentalization that empower different levels of pragmatic meaning construction and evaluate the results with statistical analysis (MannWhitney and ANOVA). Analyzing the comprehension of literal and non-compositional (figurative) utterances, we apply linguistic trials, among them metaphor-, irony-, irony with surface cue-, humor- and the recognition of maxim infringements trial in neurotypical (NT) preschoolers with a coherent and comparative methodology. Results: The findings reveal the relationship and direction of interaction between Language and theory of mind. On the one hand social-cognitive skills enhance, facilitate and provide a basis for language acquisition, and in return linguistic structures (DeVilliers 2000, 2007) provide a framework for further development of mentalizing skills. Conclusions: Findings confirm that this scaffolding becomes a mutually supportive system where language and social cognition develops in interaction. Certain stages in ToM development serve as a precursor of understanding grammatically complex sentences, like embedded phrases which mirror embedded mental states; which, in turn, facilitates the development of pragmatic competence, thus, the social use of language, integrating social, cognitive, linguistic and psychological factors in discourse. Future implications: Our investigation functions as a differential-diagnostic measure, with typically developing results thus serve as a baseline in further empirical research for atypical cases. This enables the study of populations where language and ToM development is disturbed, reveals how language and ToM are acquired and interact, and gives an insight into what this has to do with clinical symptoms. This in turn can reveal the causal link to the syndrome at hand, which can set directions for therapeutic development and training.

Keywords: theory of mind, language development, mentalization, language philosophy, experimental pragmatics

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Authors: Manal Anis, Bin Bakhti Sayeed

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With the encroachment of automobile upon our communities for decades and the concomitant urban sprawl resulting in a loss of public place, it was only a matter of time before people, realizing the role of streets in stimulating urban prosperity, would start reclaiming them to rebuild their communities. In order for this restoration of communities to take effect it is imperative that streets be freed from the dominance of motor vehicles. A holistic approach to pedestrian-friendly street environment can help build communities that embody the cities in which they are found. While the developed countries are finding more and more innovative ways to integrate walkable streets to foster communal living, the developing countries still have a long way to go. Since Dhaka is still struggling to balance the growing needs of accommodating automobiles for increased population with the loss of urban community life that comes with it, it is high time that alternate approaches are looked into. This study aims to understand streets as a living corridor through which one discovers and identifies with the city. The research area is chosen to be Manik Mia Avenue, overlooking the South Plaza of the National Parliament Building in Dhaka city. Being the site of supreme power, it is precisely this symbolic importance that the National Parliament Building has in the psyche of Bangladeshis, which has given Manik Mia Avenue a significant place in the country’s history. Above all, being an avenue it is essentially a neutral territory, universally accessible, inclusive and pluralist. The needs of the Avenue’s frequent users are analyzed with the help of a multi-method approach to survey consisting of an empirical study, a questionnaire survey and interview with relevant users. The research then tries to understand the concept of walkability by exploring the different ways in which the built environment influences walking. For this analysis, the six dimensions of Matthew Carmona are taken as a guideline for a holistic approach toward the different interacting facets of an urban public space. Based on the studies, a set of criteria is proposed to evaluate, plan and design streets that are more contextual in nature. The study concludes with how the existing street patterns of Dhaka city can be rethought and redesigned to cater to peoples’ need for a public place. The proposal is meant to be an inspiration for further studies in this respect in the context of Bangladesh.

Keywords: public space, six dimensions, street, urban, walkability

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Authors: Tasha L. Golden

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Girls in the U.S. juvenile justice system are most often arrested for truancy, drug use, or running from home, all of which are symptoms of abuse. In fact, some have called this 'The Sexual Abuse to Prison Pipeline.' Such abuse has consequences for girls' health, education, employment, and parenting, often resulting in significant health disparities. Yet when arrested, girls rarely encounter services designed to meet their unique needs. Instead, they are expected to cope with a system that was historically designed for males. In fact, even literature advocating for increased gender equity frequently fails to include girls’ voices and firsthand accounts. In response to these combined injustices, public health researchers launched a trauma-informed creative writing intervention in a southern juvenile detention facility. The program was designed to improve the health of detained girls, while also establishing innovative methods of both data collection and social justice advocacy. Girls’ poems and letters were collected and coded, adding rich qualitative data to traditional survey responses. In addition, as part of the intervention, these poems are regularly published by international literary publisher Sarabande Books—and distributed to judges, city leaders, attorneys, state representatives, and more. By utilizing a creative medium, girls generated substantial civic engagement with their concerns—thus expanding their influence and improving policy advocacy efforts. Researchers hypothesized that having access to their communities and policy makers would provide its own health benefits for incarcerated girls: cultivating self-esteem, locus of control, and a sense of leadership. This paper discusses the establishment of this intervention, examines findings from its evaluation, and includes several girls’ poems as exemplars. Grounded in social science regarding expressive writing, stigma, muted group theory, and health promotion, the paper theorizes about the application of arts-based advocacy efforts to other social justice endeavors.

Keywords: advocacy, public health, social justice, women’s health

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Authors: Paulina Ojeda, Damaris Estrella, Hector Rubio

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Insomnia is a disorder characterized by difficulty falling asleep, staying asleep or both. It negatively affects the life quality of people, it hinders the concentration, attention, memory, motor skills, among other abilities that complicate work or learning. Some studies show that women are more susceptible to insomnia. Medicine curricula usually involve a great deal of theoretical and memory content, especially in the early years of the course. The way to accredit a university course is to demonstrate the level of competence or acquired knowledge. In Mexico the most widely used form of measurement is written exams, with numerical scales results. The prevalence of sleep disorders in university students is usually high, so it is important to know if insomnia has an effect on school performance in men and women. A cross-sectional study was designed that included a probabilistic sample of 118 regular students from the School of Medicine of the Autonomous University of Yucatan, Mexico. All on legally age. The project was authorized by the School of Medicine and all the ethical implications of the case were monitored. Participants completed anonymously the following questionnaires: Pittsburgh Sleep Quality Index, Insomnia Severity Index, AUDIT test, epidemiological and clinical data. Academic performance was assessed by the average number of official grades earned on written exams, as well as the number of approved or non-approved courses. These data were obtained officially through the corresponding school authorities. Students with at least one unapproved course or average less than 70 were considered to be poor performers. With all courses approved and average between 70-79 as regular performance and with an average of 80 or higher as a good performance. Statistical analysis: t-Student, difference of proportions and ANOVA. 65 men with a mean age of 19.15 ± 1.60 years and 53 women of 18.98 ± 1.23 years, were included. 96% of the women and 78.46% of the men sleep in the family home. 16.98% of women and 18.46% of men consume tobacco. Most students consume caffeinated beverages. 3.7% of the women and 10.76% of the men complete criteria of harmful consumption of alcohol. 98.11% of the women and 90.76% of the men are perceived with poor sleep quality. Insomnia was present in 73% of women and 66% of men. Women had higher levels of moderate insomnia (p=0.02) compared to men and only one woman had severe insomnia. 50.94% of the women and 44.61% of the men had poor academic performance. 18.86% of women and 27% of men performed well. Only in the group of women we found a significant association between poor performance with mild (p= 0.0035) and moderate (p=0.031) insomnia. The medical students reported poor sleep quality and insomnia. In women, levels of insomnia were associated with poor academic performance.

Keywords: scholar-average, sex, sleep, university

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Authors: Ziwei Song, Junjun Fan, Jeremy Teo, Yang Yu, Yukun Ma, Jie Yan, Shupei Mo, Lisa Tucker-Kellogg, Peter So, Hanry Yu

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Liver is the center of detoxification and exposed to toxic metabolites all the time. It is highly regenerative after injury, with the ability to restore even after 70% partial hepatectomy. Most of the previous studies were using hepatectomy as injury models for liver regeneration study. There is limited understanding of small-scale liver injury, which can be caused by either low dose drug consumption or hepatocyte routine metabolism. Although these small in situ injuries do not cause immediate symptoms, repeated injuries will lead to aberrant wound healing in liver. Therefore, the cellular dynamics during liver regeneration is critical for our understanding of liver regeneration mechanism. We aim to study the liver regeneration of small-scale in situ liver injury in transgenic mice labeling actin (Lifeact-GFP). Previous studies have been using sample sections and biopsies of liver, which lack real-time information. In order to trace every individual hepatocyte during the regeneration process, we have developed and optimized an intravital imaging system that allows in vivo imaging of mouse liver for consecutive 5 days, allowing real-time cellular tracking and quantification of hepatocytes. We used femtosecond-laser ablation to make controlled and repeatable liver injury model, which mimics the real-life small in situ liver injury. This injury model is the first case of its kind for in vivo study on liver. We found that small-scale in situ liver injury is repaired by the coordination of hypertrophy and migration of hepatocytes. Hypertrophy is only transient at initial phase, while migration is the main driving force to complete the regeneration process. From cellular aspect, Akt/mTOR pathway is activated immediately after injury, which leads to transient hepatocyte hypertrophy. From mechano-sensing aspect, the actin cable, formed at apical surface of wound proximal hepatocytes, provides mechanical tension for hepatocyte migration. This study provides important information on both chemical and mechanical signals that promote liver regeneration of small in situ injury. We conclude that hypertrophy and migration play a dominant role at different stages of liver regeneration.

Keywords: hepatocyte, hypertrophy, intravital imaging, liver regeneration, migration

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Authors: Joana Gato, Ahmed Abotabekh, Panayoti Bachkangi

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Introduction: Oestrogen is an essential gonadal hormone that plays a vital role in the reproductive system of women1. The average age of menopause in the UK is 512. Women who go through premature menopause should be offered Hormone replacement therapy (HRT). Similarly, women who undergo surgical menopause should be offered HRT, unless contraindicated, depending on the indication of their surgery2,3. Aim: To assess if the patients in our department are counselled regarding HRT after surgical treatment and if HRT was prescribed. Methodology: A retrospective audit in a busy district hospital, examining all the patients who had a hysterectomy. The audit examined if HRT was discussed pre-operatively, prescribed on discharge and if a follow up was arranged. For women with contraindication to HRT, the audit assessed if the reasons were discussed pre-operatively and communicated to the Inclusion criteria: woman having a total or subtotal hysterectomy, with or without bilateral salpingo-ophorectomy (BSO), between April and September 2022. Exclusion criteria: woman having a vaginal hysterectomy. Results: 40 patients in total had hysterectomy; 27 (68%) were under the age of 51. 15 out of 27 patients bad BSO. 9 women were prescribed HRT, but 8 were offered HRT immediately, and 1 of them were offered a follow up. Of women who underwent surgical menopause, 7 were not given any HRT. The HRT choice was diverse, however, the majority was prescribed oral HRT. 40% of women undergoing surgical menopause did not have a discussion about HRT prior to their surgery. In postmenopausal women (n=13; 33%), still two were given HRT for preexisting menopausal symptoms. Discussion: Only 59% of the pre-menopausal patients had oophorectomy, therefore undergoing surgical menopause. Of these, 44% were not given any HRT, and 40% had no discussion about HRT prior to surgery. Interestingly, the majority of these women have no obvious contraindication to HRT. The choice of HRT was diverse, but the majority was commenced on oral HRT. Our unit is still working towards meeting all the NICE guidance standards of offering HRT and information prior to surgery to women planning to undergo surgical menopause. Conclusion: Starting HRT at the onset of menopause has been shown to improve quality of life and reduce the risk of cardiovascular disease and osteoporotic fractures4. Our unit still has scope for improvement to comply with the current NICE guidance. All pre-menopausal women undergoing surgical menopause should have a discussion regarding HRT prior to surgery and be offered it if there are no contraindications. This discussion should be clearly documented in the notes. At the time of this report, some of the patients have not yet had a follow up, which we recognize as a limitation to our audit.

Keywords: hormone replacement therapy, menopause, premature ovarian insufficiency, surgical management

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Authors: S. Kershaw, P. J. Barry, K. Webb

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Background: Cystic Fibrosis (CF) is a chronic lung disease where patients have chronic lung infection punctuated by acute exacerbations that require intermittent intravenous (IV) antibiotics during their lives. With time, peripheral venous access can become difficult and limited. Accessing these veins can become arduous, traumatic, painful and unworkable. A permanent intravascular access device or Port is a small device that is inserted into the central venous system that allows the delivery of medicine eliminating the need for peripheral venous access. Ports represent a convenient and efficient method when venous access is required on a permanent basis however they are also associated with significant vascular complications. Superior Vena Cava Obstruction (SVCO) is a rare but significant vascular complication of ports in this setting. Objective: We aimed to look at a single CF centre’s experience of port-related SVCO over a thirty year period. Methods: Retrospective data was extracted using patient’s notes, electronic radiological reports and local databases over a period in excess of 30 years from 1982 to 2014. Results: 13 patients were identified with SVCO as a result of their port. 11 patients had CF (9 female, 2 male), one male patient had Primary Ciliary Dyskinesia and one female patient had severe Asthma. The mean port function was 1532 days (range 110 – 4049) and the mean age at SVCO was 24 years (range 11.1 to 36.5 years). The most common symptoms were facial oedema (n=8, 61.5%) and dilated veins (n=6, 46.2%). 7 patients had their Ports removed after SVCO. 6 patients underwent attempted stenting (46.2%) and 6 did not. 4 out of the 6 who underwent stenting required/had re-intervention. 3 of the 6 patients who underwent stenting had symptom resolution, however, 4 of the 6 patients who were not stented had symptom resolution also. Symptom resolution was not guaranteed with stenting and required re-intervention in two-thirds. Conclusion: This case series represents the experience of one of the longest established CF units in the UK and represents the largest cohort ever reported in the literature.

Keywords: ports, Superior Vena Cava Obstruction, cystic fibrosis, access devices

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Authors: Ladda Her, Juntip Kanjanasilp, Ratree Sawangjit, Nathorn Chaiyakunapruk

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Cough is the common symptom of the respiratory tract infections or non-infections; the duration of cough indicates a classification and severity of disease. Herbal medicines can be used as the alternative to drugs for relief of cough symptoms from acute and chronic disease. Eucalyptus was used for reducing cough with evidences suggesting it has an active role in reduction of airway inflammation. The present study aims to evaluate efficacy and safety of eucalyptus for relief of cough symptom in respiratory disease. Method: The Cochrane Library, MEDLINE (PubMed), Scopus, CINAHL, Springer, Science direct, ProQuest, and THAILIS databases. From its inception until 01/02/2019 for randomized control trials. We follow for the efficacy and safety of eucalyptus for reducing cough. Methodological quality was evaluated by using the Cochrane risk of bias tool; two reviewers in our team screened eligibility and extracted data. Result: Six studies were included for the review and five studies were included in the meta-analysis, there were 1.911 persons including children (n: 1) and adult (n: 5) studies; for study in children and adult were between 1 and 80 years old, respectively. Eucalyptus was used as mono herb (n: 2) and in combination with other herbs form (n: 4). All of the studies with eucalyptus were compared for efficacy and safety with placebo or standard treatment, Eucalyptus dosage form in studies included capsules, spray, and syrup. Heterogeneity was 32.44 used random effect model (I² = 1.2%, χ² = 1.01; P-value = 0.314). The efficacy of eucalyptus was showed a reduced cough symptom statistically significant (n = 402, RR: 1.40, 95%CI [1.19, 1.65], P-value < 0.0001) when compared with placebo. Adverse events (AEs) were reported mild to moderate intensity with mostly gastrointestinal symptom. The methodological quality of the included trials was overall poor. Conclusion: Eucalyptus appears to be beneficial and safe for relieving in respiratory diseases focus on cough frequency. The evidence was inconclusive due to limited quality trial. Well-designed trials for evaluating the effectiveness in humans, the effectiveness for reducing cough symptom in human is needed. Eucalyptus had safety as monotherapy or in combination with other herbs.

Keywords: cough, eucalyptus, cineole, herbal medicine, systematic review, meta-analysis

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Authors: A. Talaei, M. Ahiduzzaman, A. Kumar

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In Canada, an increase in the production of iron and steel is anticipated for satisfying the increasing demand of iron and steel in the oil sands and automobile industries. It is predicted that GHG emissions from iron and steel sector will show a continuous increase till 2030 and, with emissions of 20 million tonnes of carbon dioxide equivalent, the sector will account for more than 2% of total national GHG emissions, or 12% of industrial emissions (i.e. 25% increase from 2010 levels). Therefore, there is an urgent need to improve the energy intensity and to implement energy efficiency measures in the industry to reduce the GHG footprint. This paper analyzes the current energy consumption in the Canadian iron and steel industries and identifies energy efficiency opportunities to improve the energy intensity and mitigate greenhouse gas emissions from this industry. In order to do this, a demand tree is developed representing different iron and steel production routs and the technologies within each rout. The main energy consumer within the industry is found to be flared heaters accounting for 81% of overall energy consumption followed by motor system and steam generation each accounting for 7% of total energy consumption. Eighteen different energy efficiency measures are identified which will help the efficiency improvement in various subsector of the industry. In the sintering process, heat recovery from coolers provides a high potential for energy saving and can be integrated in both new and existing plants. Coke dry quenching (CDQ) has the same advantages. Within the blast furnace iron-making process, injection of large amounts of coal in the furnace appears to be more effective than any other option in this category. In addition, because coal-powered electricity is being phased out in Ontario (where the majority of iron and steel plants are located) there will be surplus coal that could be used in iron and steel plants. In the steel-making processes, the recovery of Basic Oxygen Furnace (BOF) gas and scrap preheating provides considerable potential for energy savings in BOF and Electric Arc Furnace (EAF) steel-making processes, respectively. However, despite the energy savings potential, the BOF gas recovery is not applicable in existing plants using steam recovery processes. Given that the share of EAF in steel production is expected to increase the application potential of the technology will be limited. On the other hand, the long lifetime of the technology and the expected capacity increase of EAF makes scrap preheating a justified energy saving option. This paper would present the results of the assessment of the above mentioned options in terms of the costs and GHG mitigation potential.

Keywords: Iron and Steel Sectors, Energy Efficiency Improvement, Blast Furnace Iron-making Process, GHG Mitigation

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Authors: AliAkbar Hafezi, Jamshid Abedi, Jalal Taherian, Behnam Kadkhodaei, Mahsa Elahi

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Background. Peripheral neuropathy is a common side effect of the administration of neurotoxic chemotherapy agents. This adverse effect is a major dose-limiting factor of many commonly used chemotherapy drugs. Currently, there are no Food and Drug Administration (FDA) approved medications for the prevention or treatment of chemotherapy-induced peripheral neuropathy. Therefore, this study was performed to investigate the efficacy and safety of metformin on paclitaxel-induced peripheral neuropathy (PIPN). Methods. In this randomized clinical trial, cancer patients who were candidates for chemotherapy with paclitaxel referred to the radiation oncology departments in Iran from 2022 to 2023 were studied. Patients were randomly divided into two groups; 1- Case group (n = 30) received metformin 500 mg orally twice a day after meals during chemotherapy with paclitaxel, and 2- Control group (30 people) received chemotherapy without metformin or any additional medication. Patients were visited in terms of numbness or other neurological symptoms two weeks before chemotherapy, 1-2 days before and weekly during chemotherapy, and at the end of the study. They were assessed by nerve conduction study (NCS) before intervention and one week after the end of chemotherapy. The primary outcome was the efficacy in reducing PIPN and the secondary outcome was adverse effects. Eventually, the outcomes were compared between the two groups of patients. Results. A total of 60 female cancer patients receiving chemotherapy with paclitaxel were evaluated in two groups. The groups were matched in terms of age, body mass index, fasting blood sugar, smoking, pathologic stage, and creatinine levels. The results showed that 18 patients (60.0 %) in the case group and 23 patients (76.6 %) in the control group had PIPN clinically (P = 0.267), and NCS showed 11 patients (36.6 %) in the case group and 15 patients (50.0 %) in the control group suffered from PIPN which no significant difference was observed between the two groups (P = 0.435). Diarrhea (n = 3; 10.0 %) and nausea (n = 3; 10.0 %) were the most common side effects of metformin in the case group and no serious side effects (lactic acidosis and anemia) were found in these patients. Conclusion. This study indicated that metformin did not significantly prevent PIPN in cancer patients receiving chemotherapy, although the frequency of peripheral neuropathy in the case group was lower than in the control group. The use of metformin in the patients had acceptable safety and no serious side effects were reported.

Keywords: peripheral neuropathy, chemotherapy, paclitaxel, metformin

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Authors: Lauren Kathryn Stretch

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A study was conducted in the underprivileged setting of Nelson Mandela Bay, South Africa in order to monitor the progress of learners whose teachers receive training through the Early Inspiration Training Programme. Through tracking children’s growth & development, the effectiveness of the practitioner-training programme, which focuses on empowering women from underprivileged communities in South Africa, was analyzed. The aim was to identify impact & reach and to assess the effectiveness of this intervention programme through identifying impact on children’s growth and development. A Pre- and Post-Test was administered on about 850 young children in Pre-Grade R and Grade R classes in order to understand children’s ability level & the growth that would be evident as a result of effective teacher training. A pre-test evaluated the level of each child’s abilities, including physical-motor development, language, and speech development, cognitive development including visual perceptual skills, social-emotional development & play development. This was followed by a random selection of the classes of children into experimental and control groups. The experimental group’s teachers (practitioners) received 8-months of training & intervention, as well as mentorship & support. After the 8-month training programme, children from the experimental & control groups underwent post-assessment. The results indicate that the impact of effective practitioner training and enhancing a deep understanding of stimulation on young children, that this understanding is implemented in the classroom, highlighting the areas of growth & development in the children whose teachers received additional training & support, as compared to those who did not receive additional training. Monitoring & Evaluation systems not only track children’s ability levels, but also have a core focus on reporting systems, mentorship and providing ongoing support. As a result of the study, an Online Application (for Apple or Android Devices) was developed which is used to track children’s growth via age-appropriate assessments. The data is then statistically analysed to provide direction for relevant & impactful intervention. The App also focuses on effective reporting strategies, structures, and implementation to support organizations working with young children & maximize on outcomes.

Keywords: early childhood development, developmental child assessments, online application, monitoring and evaluating online

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Authors: Alexis Winfield, Carly Sugar, Barbara Fenesi

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The COVID-19 pandemic uprooted regular routines forcing many children to learn from home, requiring many adults to work from home, and cutting families off from support outside the home. Public health restrictions associated with the pandemic caused widespread psychological distress, including depression and anxiety, increased fear, panic, and stress. These trends are particularly concerning for families raising neuroatypical children, such as those with Attention-Deficit Hyperactivity Disorder (ADHD), as these children are already more likely than their typically developing peers to experience comorbid mental health issues and to experience greater distress when required to stay indoors. Families with children who have ADHD are also at greater risk for experiencing heightened familial stress due to the challenges associated with managing ADHD behavioural symptoms, greater parental discord and divorce, and greater financial difficulties compared to other families. The current study engaged families comprised of at least one child diagnosed with ADHD to elucidate 1) the unique ways that the COVID-19 pandemic affected their mental health and 2) the specific barriers these families faced to maintaining optimal mental wellbeing. A total of 33 participants (15 parent-child dyads) engaged in virtual interviews. Content analysis revealed that the most frequently identified mental health effects for families were increased child anxiety and disconnectedness, as well as deteriorating parental mental health. The most frequently identified barriers to maintaining optimal mental well-being were lack of routine, lack of social interaction and social support, and uncertainty and fear. Findings underscore areas of need during times of large-scale social isolation, bring voice to the families of children with ADHD, and contribute to our understanding of the pandemic’s impact on the wellbeing of vulnerable families. This work contributes to a growing body of research aimed at creating safeguards to support mental wellbeing for vulnerable families during times of crisis.

Keywords: attention-deficit hyperactivity disorder, COVID-19, mental health, vulnerable families

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