Search results for: virtual fracture clinic

Authors: Nanteza Rachel

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Background: Worldwide, there were 36.7 million people living with Human Immunodeficiency Virus (HIV) in 2015, up from 35 million at the end of 2013. Wakiso district is one of the hotspots for the Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) infection in Uganda, with the prevalence of 8.1 %. Herbal medicine has gained popularity among Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) patients as adjuvant therapy to reduce the adverse effects of ART. Regardless of the subsidized and physical availability of the Anti-Retroviral Therapy (ART), majority of Africans living with Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) resort to adding to their ART traditional medicine. Result found out from a pilot observation made by the PI that indicate 13 out of 30 People Living with AIDS(PLWA) who are attending Human Immunodeficiency Virus (HIV) clinics in Wakiso district reported to be using herbal preparations despite the fact that they were taking Anti Retro Viral (ARVs) this prompted this study to be done. Purpose of the study: To determine the prevalence and factors associated with concurrent use of herbal medicine and anti-retroviral therapy among HIV/AIDS patients attending selected HIV clinics in Wakiso district. Methodology: This was a cross sectional study with both quantitative data collection (use of a questionnaire) and qualitative data collection (key informants’ interviews). A mixed method of sampling was used, that is, purposive and random sampling. Purposive sampling was based on the location in the district and used to select 7 health facilities basing on the 7 health sub districts from Wakiso. Simple random sampling was used to select one HIV clinic from each of the 7 health sub districts. Furthermore, the study units were enrolled in to the study as they entered into the HIV clinics, and 105 respondents were interviewed. Both manual and computer packages (SPSS) were used to analyze the data Results: The prevalence of concurrent use of herbal medicine and ART was 38 (36.2%). Commonly HIV symptom treated with herbs was fever 27(71.1%), diarrhea 3(7.9%) and cough 2(5.3%). Commonly used herbs for fever (Omululuza (Vernonica amydalina), Ekigagi (Aloe sp), Nalongo (Justicia betonica Linn) while for diarrhea was Ntwatwa. The side effects also included; too much pain, itchy pain of HIV, aneamia,felt sick, loss/gain appetite, joint pain and bad dreams. Herbs used to sooth the side effects were; for aneamia was avocado leaves Parea Americana mill The significant factors associated with concurrent use of herbal medicine were being familiar with herbs and conventional medicine for management HIV symptoms being expensive. The other significant factor was exhibiting hostility to patients by health personnel providing HIV care. Conclusion: Herbal medicine is widely used by clients in HIV/AIDS care. Patients being familiar with herbs and conventional medicine being expensive were associated with concurrent use of herbal medicine and ART. The exhibition of hostility to the HIV/AIDS patients by the health care providers was also associated with concurrent use of herbal medicine and ART among HIV/AIDS patients.

Keywords: HIV patients, herbal medicine, antiretroviral therapy, factors associated

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Authors: Cesar Augusto Hoil Rosas, José Luis Vázquez Burgos, José Juan Carbajal Hernandez

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White fish (Chirostoma estor estor) is an endemic species that habits in the Patzcuaro Lake, located in Michoacan, Mexico; being an important source of gastronomic and cultural wealth of the area. Actually, it have undergone an immense depopulation of individuals, due to the high fishing, contamination and eutrophication of the lake water, resulting in the possible extinction of this important species. This work proposes a new computational model for monitoring and assessment of critical environmental parameters of the white fish ecosystem. According to an Analytical Hierarchy Process, a mathematical model is built assigning weights to each environmental parameter depending on their water quality importance on the ecosystem. Then, a development of an advanced system for the monitoring, analysis and control of water quality is built using the virtual environment of LabVIEW. As results, we have obtained a global score that indicates the condition level of the water quality in the Chirostoma estor ecosystem (excellent, good, regular and poor), allowing to provide an effective decision making about the environmental parameters that affect the proper culture of the white fish such as temperature, pH and dissolved oxygen. In situ evaluations show regular conditions for a success reproduction and growth rates of this species where the water quality tends to have regular levels. This system emerges as a suitable tool for the water management, where future laws for white fish fishery regulations will result in the reduction of the mortality rate in the early stages of development of the species, which represent the most critical phase. This can guarantees better population sizes than those currently obtained in the aquiculture crop. The main benefit will be seen as a contribution to maintain the cultural and gastronomic wealth of the area and for its inhabitants, since white fish is an important food and economical income of the region, but the species is endangered.

Keywords: Chirostoma estor estor, computational system, lab view, white fish

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Authors: Eric Lacoste

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Laboratory animals are currently widely used as a model of human pathologies in dermatology such as atopic dermatitis (AD). These models provide a better understanding of the pathophysiology of this complex and multifactorial disease, the discovery of potential new therapeutic targets and the testing of the efficacy of new therapeutics. However, confirmation of the correct development of AD is mainly based on histology from skin biopsies requiring invasive surgery or euthanasia of the animals, plus slicing and staining protocols. However, there are currently accessible imaging technologies such as Optical Coherence Tomography (OCT), which allows non-invasive visualization of the main histological structures of the skin (like stratum corneum, epidermis, and dermis) and assessment of the dynamics of the pathology or efficacy of new treatments. Briefly, female immunocompetent hairless mice (SKH1 strain) were sensitized and challenged topically on back and ears for about 4 weeks. Back skin and ears thickness were measured using calliper at 3 occasions per week in complement to a macroscopic evaluation of atopic dermatitis lesions on back: erythema, scaling and excoriations scoring. In addition, OCT was performed on the back and ears of animals. OCT allows a virtual in-depth section (tomography) of the imaged organ to be made using a laser, a camera and image processing software allowing fast, non-contact and non-denaturing acquisitions of the explored tissues. To perform the imaging sessions, the animals were anesthetized with isoflurane, placed on a support under the OCT for a total examination time of 5 to 10 minutes. The results show a good correlation of the OCT technique with classical HES histology for skin lesions structures such as hyperkeratosis, epidermal hyperplasia, and dermis thickness. This OCT imaging technique can, therefore, be used in live animals at different times for longitudinal evaluation by repeated measurements of lesions in the same animals, in addition to the classical histological evaluation. Furthermore, this original imaging technique speeds up research protocols, reduces the number of animals and refines the use of the laboratory animal.

Keywords: atopic dermatitis, mouse model, oxzolone model, histology, imaging

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Authors: Heena Akbar, Winnie Niumata, Danielle Gallegos

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Type 2 diabetes is a significant public health problem for Māori and Pasifika communities in Queensland, who are experiencing a higher burden of morbidity and mortality from the condition. Despite this higher burden, there are few initiatives that are culturally tailored to improve prevention and management. Modification of personal behaviors through women’s wellness programs aimed at early intervention has been shown to reduce the risk of developing complications in established type 2 diabetes and may reduce hospitalization rates from preventable complications related to this disease. The 24-week Pasifika Women’s Diabetes Wellness Program (PWDWP) was culturally co-designed and co-developed with Māori and Pasifika women with type 2 diabetes through a community-academia partnership in Queensland. Underpinned by Social Cognitive Theory and the Indigenous Pacific Health frameworks to include family culture & spirituality and integrating a collectivist and whānau (family) centered approach to self-care, the program takes into consideration the cultural shame associated with acknowledging the disease and tailors the interventions using talanoa (storytelling or conversation in a relational context) as the key strategy to come to a shared meaning for behavior change. The pilot trial is a 12-week intervention followed by a 12-week follow-up period conducted with 50 women with type 2 diabetes, 25 women who will receive the intervention and 25 women who will receive usual care. The pilot program provides in-person and virtual access to culturally supported prevention and self-management of Māori and Pasifika women with type 2 diabetes with the aim to improve healthy lifestyles and reduce late hospital presentations from diabetes-related complications for better diabetes-related outcomes. This study will test and evaluate the effectiveness of the PWDWP pilot trial in partnership with Māori & Pasifika community organizations and key stakeholders for improved glycated hemoglobin (HbA1c) levels associated with poor management of type 2 diabetes.

Keywords: culturally co-designed intervention, Indigenous methodology, Māori and Pasifika communities, type 2 diabetes self-management

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Authors: Christabel Ihedike, John Mooney, Monica Price

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Summary: This study aims to critically evaluate effect of photochemical smog on respiratory health in Nigeria. Cohort of chronic obstructive pulmonary disease (COPD) patients was recruited from two large hospitals in Abuja Nigeria. Respiratory health questionnaires, daily diaries, dyspnoea scale and lung function measurement were used to obtain health data and investigate the relationship with air quality data (principally ozone, NOx and particulate pollution). Concentrations of air pollutants were higher than WHO and Nigerian air quality standard. The result suggests a correlation between measured air quality and exacerbation of respiratory illness. Introduction: Photochemical smog is a significant health challenge in most cities and its effect on respiratory health is well acknowledged. This type of pollution is most harmful to the elderly, children and those with underlying respiratory disease. This study aims to investigate impact of increasing temperature and photo-chemically generated secondary air pollutants on respiratory health in Abuja Nigeria. Method and Result: Health data was collected using spirometry to measure lung function on routine attendance at the clinic, daily diaries kept by patients and information obtained using respiratory questionnaire. Questionnaire responses (obtained using an adapted and internally validated version of St George’s Hospital Respiratory Questionnaire), shows that ‘time of wheeze’ showed an association with participants activities: 30% had worse wheeze in the morning: 10% cannot shop, 15% take long-time to get washed, 25% walk slower, 15% if hurry have to stop and 5% cannot take-bath. There was also a decrease in Forced expiratory volume in the first second and Forced Vital Capacity, and daily change in the afternoon–morning may be associated with the concentration level of pollutants. Also, dyspnoea symptoms recorded that 60% of patients were on grade 3, 25% grade 2 and 15% grade 1. Daily frequency of the number of patients in the cohort that cough /brought sputum is 78%. Air pollution in the city is higher than Nigerian and WHO standards with NOx and PM10 concentrations of 693.59ug/m-3 and 748ugm-3 being measured respectively. The result shows that air pollution may increase occurrence and exacerbation of respiratory disease. Conclusion: High temperature and local climatic conditions in urban Nigeria encourages formation of Ozone, the major constituent of photochemical smog, resulting also in the formation of secondary air pollutants associated with health challenges. In this study we confirm the likely potency of the pattern of secondary air pollution in exacerbating COPD symptoms in vulnerable patient group in urban Nigeria. There is need for better regulation and measures to reduce ozone, particularly when local climatic conditions favour development of photochemical smog in such settings. Climate change and likely increasing temperatures add impetus and urgency for better air quality standards and measures (traffic-restrictions and emissions standards) in developing world settings such as Nigeria.

Keywords: Abuja-Nigeria, effect, photochemical smog, respiratory health

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Authors: Floriane Shala, Evangeline Wagner, Yichun Zhao

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Background: Proper educational training and support are proven to be major components of EHR (Electronic Health Record) implementation and use. However, the majority of health providers are not sufficiently trained in EHR use, leading to adverse events, errors, and decreased quality of care. In response to this, students studying Health Information Science, Public Health, Nursing, and Medicine should all gain a thorough understanding of EHR use at different levels for different purposes. The design of a usable and safe EHR system that accommodates the needs and workflows of different users, user groups, and disciplines is required for EHR learning to be efficient and effective. Objectives: This project builds several artifacts which seek to address both the educational and usability aspects of an educational EHR. The artifacts proposed are models for and examples of such an EHR with a configurable UI to be learned by students who need a background in EHR use during their degrees. Methods: Review literature and gather professional opinions from domain experts on usability, the use of workflow patterns, UI configurability and design, and the educational aspect of EHR use. Conduct interviews in a semi-casual virtual setting with open discussion in order to gain a deeper understanding of the principal aspects of EHR use in educational settings. Select a specific task and user group to illustrate how the proposed solution will function based on the current research. Develop three artifacts based on the available research, professional opinions, and prior knowledge of the topic. The artifacts capture the user task and user’s interactions with the EHR for learning. The first generic model provides a general understanding of the EHR system process. The second model is a specific example of performing the task of MRI ordering with a configurable UI. The third artifact includes UI mock-ups showcasing the models in a practical and visual way. Significance: Due to the lack of educational EHRs, medical professionals do not receive sufficient EHR training. Implementing an educational EHR with a usable and configurable interface to suit the needs of different user groups and disciplines will help facilitate EHR learning and training and ultimately improve the quality of patient care.

Keywords: education, EHR, usability, configurable

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Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter

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The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.

Keywords: imaging, guidelines, emergency medicine, audit

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Authors: Bruno Biagianti, Angela Tseng, Kathy Wannaviroj, Allison Corlett, Megan DuBois, Kyu Lee, Suma Jacob

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Background: ASD is characterized by pervasive Sensory Processing Abnormalities (SPA) and social cognitive deficits that persist throughout the course of the illness and have been linked to functional abnormalities in specific neural systems that underlie the perception, processing, and representation of sensory information. SPA and social cognitive deficits are associated with difficulties in interpersonal relationships, poor development of social skills, reduced social interactions and lower academic performance. Importantly, they can hamper the effects of established evidence-based psychological treatments—including PEERS (Program for the Education and Enrichment of Relationship Skills), a parent/caregiver-assisted, 16-weeks social skills intervention—which nonetheless requires a functional brain capable of assimilating and retaining information and skills. As a matter of fact, some adolescents benefit from PEERS more than others, calling for strategies to increase treatment response rates. Objective: We will present interim data on CICADAS (Care Improving Cognition for ADolescents on the Autism Spectrum)—a clinician-assisted, closed-loop technology mobile application for adolescents with ASD. Via ten mobile assessments, CICADAS captures data on sensory processing abnormalities and associated cognitive deficits. These data populate a machine learning algorithm that tailors the delivery of ten neuroplasticity-based social cognitive training (NB-SCT) exercises targeting sensory processing abnormalities. Methods: In collaboration with the Autism Spectrum and Neurodevelopmental Disorders Clinic at the University of Minnesota, we conducted a fully remote, three-arm, randomized crossover trial with adolescents with ASD to document the acceptability of CICADAS and evaluate its potential as a stand-alone treatment or as a treatment enhancer of PEERS. Twenty-four adolescents with ASD (ages 11-18) have been initially randomized to 16 weeks of PEERS + CICADAS (Arm A) vs. 16 weeks of PEERS + computer games vs. 16 weeks of CICADAS alone (Arm C). After 16 weeks, the full battery of assessments has been remotely administered. Results: We have evaluated the acceptability of CICADAS by examining adherence rates, engagement patterns, and exit survey data. We found that: 1) CICADAS is able to serve as a treatment enhancer for PEERS, inducing greater improvements in sensory processing, cognition, symptom reduction, social skills and behaviors, as well as the quality of life compared to computer games; 2) the concurrent delivery of PEERS and CICADAS induces greater improvements in study outcomes compared to CICADAS only. Conclusion: While preliminary, our results indicate that the individualized assessment and treatment approach designed in CICADAS seems effective in inducing adaptive long-term learning about social-emotional events. CICADAS-induced enhancement of processing and cognition facilitates the application of PEERS skills in the environment of adolescents with ASD, thus improving their real-world functioning.

Keywords: ASD, social skills, cognitive training, mobile app

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Authors: Soumya Mishra, Elena Neiterman

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Aligned with the growing interest in the impact of the pandemic on academic experiences of university students, this study aimed to examine the challenges Canadian undergraduate students experienced during the university closures due to COVID-19. Using qualitative methodological approach, the study utilized semi-structured interviews conducted with 20 undergraduate students enrolled in an Ontario university to explore their thoughts and experience regarding online learning during the peak of the COVID-19 pandemic, from January 2021 to March 2021. The interviews yielded four major themes with the following associated subthemes: Personal Challenges Associated with Adapting to the Pandemic (Change in the Type of Stress Experienced, Unique Impact on Certain Groups of Students, Decreased Motivation, Crucial Role of Resilience), Social Challenges Associated with Adapting to the Pandemic (Increased Loneliness, Challenges Faced while Communicating, Perception of Group work, Role of Living Conditions), Challenges associated with Accessing University Resources (Crucial Role of Professors, Perception of Virtual Events, Importance of Physical Spaces). Overall, the analysis showed that the COVID-19 pandemic fostered resilience and psychological flexibility amongst all students. However, the mental health and social wellbeing of students deteriorated during the COVID-19 pandemic and they reported experiencing chronic stress, anxiety and loneliness. International students, first year and final year students experienced a unique set of challenges. It was hard for participants in our study to make strong new connections with their classmates and maintain existing friendships with their peers. The importance of professors in facilitating learning was amplified in the online environment due to the lack of in-person interaction with other students. Despite these challenges, most participants reported that they received high grades during online learning. The findings from this study could be helpful for organizations and individuals working towards fostering the wellbeing of undergraduate students. They can also help in making post-secondary institutions more resilient to future emergencies by creating contingency plans regarding online instructions and risk management techniques.

Keywords: Canadian, COVID-19, university students, wellbeing

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

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

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

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Authors: Mohamed Dhouibi, Bogdan Stirbu, Chabotier André, Marc Pirlot

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Internal barrel wear is a major factor affecting the performance of small caliber guns in their different life phases. Wear analysis is, therefore, a very important process for understanding how wear occurs, where it takes place, and how it spreads with the aim on improving the accuracy and effectiveness of small caliber weapons. This paper discusses the measurement and analysis of combustion chamber wear for a small-caliber gun using a Coordinate Measuring Machine (CMM). Initially, two different NATO small caliber guns: 5.56x45mm and 7.62x51mm, are considered. A Micura Zeiss Coordinate Measuring Machine (CMM) equipped with the VAST XTR gold high-end sensor is used to measure the inner profile of the two guns every 300-shot cycle. The CMM parameters, such us (i) the measuring force, (ii) the measured points, (iii) the time of masking, and (iv) the scanning velocity, are investigated. In order to ensure minimum measurement error, a statistical analysis is adopted to select the reliable CMM parameters combination. Next, two measurement strategies are developed to capture the shape and the volume of each gun chamber. Thus, a task-specific measurement uncertainty (TSMU) analysis is carried out for each measurement plan. Different approaches of TSMU evaluation have been proposed in the literature. This paper discusses two different techniques. The first is the substitution method described in ISO 15530 part 3. This approach is based on the use of calibrated workpieces with similar shape and size as the measured part. The second is the Monte Carlo simulation method presented in ISO 15530 part 4. Uncertainty evaluation software (UES), also known as the Virtual Coordinate Measuring Machine (VCMM), is utilized in this technique to perform a point-by-point simulation of the measurements. To conclude, a comparison between both approaches is performed. Finally, the results of the measurements are verified through calibrated gauges of several dimensions specially designed for the two barrels. On this basis, an experimental database is developed for further analysis aiming to quantify the relationship between the volume of wear and the muzzle velocity of small caliber guns.

Keywords: coordinate measuring machine, measurement uncertainty, erosion and wear volume, small caliber guns

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Authors: Ayesha Mushtaq

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Asthma is a pulmonary disease in which blockade of the airway takes place due to inflammation as a response to certain allergens. Breathing troubles, cough, and dyspnea are one of the few symptoms. Several studies have indicated a significant effect on asthma due to changes in dietary routines. Certain food items, such as oily foods and other materials, are known to cause an increase in the symptoms of asthma. Low dietary intake of fruits and vegetables may be important in relation to asthma prevalence. The objective of this study is to assess and compare the nutritional status of asthmatic and non-asthmatic patients. The significance of this study lies in the factor that it will help nutritionists to arrange a feasible dietary routine for asthmatic patients. This research was conducted at the Pulmonology Department of the Pakistan Institute of Medical Science Islamabad. About thirty hundred thirty-four million people are affected by asthma worldwide. Pakistan is on the verge of being an uplifted urban population and asthma cases are increasingly high these days. Several studies suggest an increase in the Asthmatic patient population due to improper diet. Other studies conducted at different institutions have conducted research on similar topics. These studies have suggested that there is a substantial alteration in the nutritional status of asthmatic and non-Asthmatic patients. This is a cross-sectional study aimed at assessing the nutritious standing of Asthmatic and non-asthmatic patients. This research took place at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. The research included asthmatic and non-asthmatic patients coming to the pulmonology department clinic at the Pakistan Institute of Medical Sciences (PIMS). These patients were aged between 20-60 years. A questionnaire was developed for these patients to estimate their dietary plans in these patients. The methodology included four sections. The first section was the Socio-Demographic profile, which included age, gender, monthly income and occupation. The next section was anthropometric measurements which included the weight, height and body mass index (BMI) of the individual. The next section, section three, was about the biochemical attributes, such as for biochemical profiling, pulmonary function testing (PFT) was performed. In the next section, Dietary habits, which were assessed by using a food frequency questionnaire (FFQ) through food habits and consumption pattern, was assessed. The next section life style data, in which the person's level of physical activity, sleep and smoking habits were assessed. The next section was statistical analysis. All the data obtained from the study were statistically analyzed and assessed. Most of the asthma Patients were females, with weight more than normal or even obese. Body Mass Index (BMI) was higher in asthma Patients than those in non-Asthmatic ones. When the nutritional Values were assessed, we came to know that these patients were low on certain nutrients and their diet included more junk and oily food than healthy vegetables and fruits. Beverages intake was also included in the same assessment. It is evident from this study that nutritional status has a contributory effect on asthma. So, patients on the verge of developing asthma or those who have developed asthma should focus on their diet, maintain good eating habits and take healthy diets, including fruits and vegetables rather than oily foods. Proper sleep may also contribute to the control of asthma.

Keywords: NUTRI, BMI, asthma, food

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Authors: Owonikoko Abayomi Dele

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Epilepsy is an unresolved disease that needs urgent attention. It is a brain disorder that affects over sixty-five (65) million people around the globe. Despite the availability of commercial anti-epileptic drugs, the war against this unmet condition is yet to be resolved. Most epilepsy patients are resistant to available anti-epileptic medications thus the need for affordable novel therapy against epilepsy is a necessity. Numerous phytochemicals have been reported for their potency, efficacy and safety as therapeutic agents against many diseases. This study investigated 99 isolated phytochemicals from Chasmanthera dependens and Carissa edulis against carbonic anhydrase (ii) drug target. The absorption, distribution, metabolism, excretion and toxicity (ADMET) of the isolated compounds were examined using admet SAR-2 web server while Swiss ADME was used to analyze the oral bioavailability, drug-likeness and lead-likeness properties of the selected leads. PASS web server was used to predict the biological activities of selected leads while other important physicochemical properties and interactions of the selected leads with the active site of the target after successful molecular docking simulation with the pyrx virtual screening tool were also examined. The results of these study identified seven lead compounds; C49- alpha-carissanol (-7.6 kcal/mol), C13- Catechin (-7.4 kcal/mol), C45- Salicin (-7.4 kcal/mol), C6- Bisnorargemonine (-7.3 kcal/mol), C36- Pallidine (-7.1 kcal/mol), S4- Lacosamide (-7.1 kcal/mol), and S7- Acetazolamide (-6.4 kcal/mol) for CA II (3HS4 receptor). These leads compounds are probable inhibitors of this drug target due to the observed good binding affinities and favourable interactions with the active site of the drug target, excellent ADMET profiles, PASS Properties, drug-likeness, lead-likeness and oral bioavailability properties. The identified leads have better binding energies as compared to the binding energies of the two standards. Thus, seven identified lead compounds can be developed further towards the development of new anti-epileptic medications.

Keywords: drug-likeness, phytochemicals, carbonic anhydrases, metalloeazymes, active site, ADMET

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Authors: Eman M. Sarhan, Doaa A. Ghareeb, Gabriella Ortore, Amr A. Amara, Mohamed M. El-Sayed

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Drug salting and nanoparticle-based drug delivery formulations are considered to be an effective means for rendering the hydrophobic drugs’ nano-scale dispersion in aqueous media, and thus circumventing the pitfalls of their poor solubility as well as enhancing their membrane permeability. The current study aims to increase the bioavailability of quaternary ammonium berberine through acid salting and biodegradable bovine serum albumin (BSA)-based nanoparticulate drug formulation. Berberine hydroxide (BBR-OH) that was chemically synthesized by alkalization of the commercially available berberine hydrochloride (BBR-HCl) was then acidified to get Di-berberine sulfate (BBR)₂SO₄. The purified crystals were spectrally characterized. The desolvation technique was optimized for the preparation of size-controlled BSA-BBR-HCl, BSA-BBR-OH, and BSA-(BBR)₂SO₄ nanoparticles. Particle size, zeta potential, drug release, encapsulation efficiency, Fourier transform infrared spectroscopy (FTIR), tandem MS-MS spectroscopy, energy-dispersive X-ray spectroscopy (EDX), scanning and transmitting electron microscopic examination (SEM, TEM), in vitro bioactivity, and in silico drug-polymer interaction were determined. BSA (PDB ID; 4OR0) protonation state at different pH values was predicted using Amber12 molecular dynamic simulation. Then blind docking was performed using Lamarkian genetic algorithm (LGA) through AutoDock4.2 software. Results proved the purity and the size-controlled synthesis of berberine-BSA-nanoparticles. The possible binding poses, hydrophobic and hydrophilic interactions of berberine on BSA at different pH values were predicted. Antioxidant, anti-hemolytic, and cell differentiated ability of tested drugs and their nano-formulations were evaluated. Thus, drug salting and the potentially effective albumin berberine nanoparticle formulations can be successfully developed using a well-optimized desolvation technique and exhibiting better in vitro cellular bioavailability.

Keywords: berberine, BSA, BBR-OH, BBR-HCl, BSA-BBR-HCl, BSA-BBR-OH, (BBR)₂SO₄, BSA-(BBR)₂SO₄, FTIR, AutoDock4.2 Software, Lamarkian genetic algorithm, SEM, TEM, EDX

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Authors: Somnath Bhattacharya, Kamal Sharma, Vaibhav Sonkar

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Composite materials emerged in the middle of the 20th century as a promising class of engineering materials providing new prospects for modern technology. Recently, a new class of composite materials known as functionally graded materials (FGMs) has drawn considerable attention of the scientific community. In general, FGMs are defined as composite materials in which the composition or microstructure or both are locally varied so that a certain variation of the local material properties is achieved. This gradual change in composition and microstructure of material is suitable to get gradient of properties and performances. FGMs are synthesized in such a way that they possess continuous spatial variations in volume fractions of their constituents to yield a predetermined composition. These variations lead to the formation of a non-homogeneous macrostructure with continuously varying mechanical and / or thermal properties in one or more than one direction. Lightweight functionally graded composites with high strength to weight and stiffness to weight ratios have been used successfully in aircraft industry and other engineering applications like in electronics industry and in thermal barrier coatings. In the present work, elastic-plastic crack growth problems (using Ramberg-Osgood Model) in an FGM plate under cyclic load has been explored by extended finite element method. Both edge and centre crack problems have been solved by taking additionally holes, inclusions and minor cracks under plane stress conditions. Both soft and hard inclusions have been implemented in the problems. The validity of linear elastic fracture mechanics theory is limited to the brittle materials. A rectangular plate of functionally graded material of length 100 mm and height 200 mm with 100% copper-nickel alloy on left side and 100% ceramic (alumina) on right side is considered in the problem. Exponential gradation in property is imparted in x-direction. A uniform traction of 100 MPa is applied to the top edge of the rectangular domain along y direction. In some problems, domain contains major crack along with minor cracks or / and holes or / and inclusions. Major crack is located the centre of the left edge or the centre of the domain. The discontinuities, such as minor cracks, holes, and inclusions are added either singly or in combination with each other. On the basis of this study, it is found that effect of minor crack in the domain’s failure crack length is minimum whereas soft inclusions have moderate effect and the effect of holes have maximum effect. It is observed that the crack growth is more before the failure in each case when hard inclusions are present in place of soft inclusions.

Keywords: elastic-plastic, fatigue crack, functionally graded materials, extended finite element method (XFEM)

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Authors: David Serero, Loic Couton, Jean-Denis Parisse, Robert Leroy

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This paper presents an analysis method of airflow at the periphery of several typologies of architectural volumes. To understand the complexity of the urban environment on the airflows in the city, we compared three sites at different architectural scale. The research sets a method to identify the optimal location for the installation of wind turbines on the edges of a building and to achieve an improvement in the performance of energy extracted by precise localization of an accelerating wing called “aero foil”. The objective is to define principles for the installation of wind turbines and natural ventilation design of buildings. Instead of theoretical winds analysis, we combined numerical aeraulic simulations using STAR CCM + software with wind data, over long periods of time (greater than 1 year). If airflows computer fluid analysis (CFD) simulation of buildings are current, we have calibrated a virtual wind tunnel with wind data using in situ anemometers (to establish localized cartography of urban winds). We can then develop a complete volumetric model of the behavior of the wind on a roof area, or an entire urban island. With this method, we can categorize: - the different types of wind in urban areas and identify the minimum and maximum wind spectrum, - select the type of harvesting devices - fixing to the roof of a building, - the altimetry of the device in relation to the levels of the roofs - The potential nuisances around. This study is carried out from the recovery of a geolocated data flow, and the connection of this information with the technical specifications of wind turbines, their energy performance and their speed of engagement. Thanks to this method, we can thus define the characteristics of wind turbines to maximize their performance in urban sites and in a turbulent airflow regime. We also study the installation of a wind accelerator associated with buildings. The “aerofoils which are integrated are improvement to control the speed of the air, to orientate it on the wind turbine, to accelerate it and to hide, thanks to its profile, the device on the roof of the building.

Keywords: wind energy harvesting, wind turbine selection, urban wind potential analysis, CFD simulation for architectural design

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Authors: Jiazhen Chen, Yue Sun, Joanne Yip, Kit-Lun Yick

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The design of sports bras poses a considerable challenge due to the difficulty in accurately predicting the wearing result after computer-aided design (CAD). It needs repeated physical try-on or virtual try-on to obtain a comfortable pressure range during motion. Specifically, in the context of running, the exact support area and force exerted on the breasts remain unclear. Consequently, obtaining an effective method to design the sports bra pads shape becomes particularly challenging. This predicament hinders the successful creation and production of sports bras that cater to women's health needs. The purpose of this study is to propose an effective method to obtain the 3D shape of sports bra pads and to understand the relationship between the supporting force and the 3D shape parameters of the pads. Firstly, the static 3D shape of the sports bra pad and human motion data (Running) are obtained by using the 3D scanner and advanced 4D scanning technology. The 3D shape of the sports bra pad is parameterised and simplified by Free-form Deformation (FFD). Then the sub-models of sports bra and human body are constructed by segmenting and meshing them with MSC Apex software. The material coefficient of sports bras is obtained by material testing. The Marc software is then utilised to establish a dynamic contact model between the human breast and the sports bra pad. To realise the reverse design of the sports bra pad, this contact model serves as a forward model for calculating the inverse problem. Based on the forward contact model, the inverse problem of the 3D shape parameters of the sports bra pad with the target bra-wearing pressure range as the boundary condition is solved. Finally, the credibility and accuracy of the simulation are validated by comparing the experimental results with the simulations by the FE model on the pressure distribution. On the one hand, this research allows for a more accurate understanding of the support area and force distribution on the breasts during running. On the other hand, this study can contribute to the customization of sports bra pads for different individuals. It can help to obtain sports bra pads with comfortable dynamic pressure.

Keywords: sports bra design, breast motion, running, inverse problem, finite element dynamic model

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Authors: Brenagh E. Schlingermann, Clare Lodge, Paula Rankin

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Background: Gaelic football, hurling and camogie are highly popular field games in Ireland. Research into the epidemiology of injury in Gaelic games revealed that approximately three quarters of the injuries in the games occur in the lower extremity. These injuries can have player, team and institutional impacts due to multiple factors including financial burden and time loss from competition. Research has shown it is possible to record injury data consistently with the GAA through a closed online recording system known as the GAA injury surveillance database. It has been established that determining the incidence of injury is the first step of injury prevention. The goals of this study were to create a dynamic GAA15 injury prevention programme which addressed five key components/goals; avoid positions associated with a high risk of injury, enhance flexibility, enhance strength, optimize plyometrics and address sports specific agilities. These key components are internationally recognized through the Prevent Injury, Enhance performance (PEP) programme which has proven reductions in ACL injuries by 74%. In national Gaelic games the programme is known as the GAA15 which has been devised from the principles of the PEP. No such injury prevention strategies have been published on this cohort in Gaelic games to date. This study will investigate the effects of the GAA15 on injury incidence and neuromuscular function in Gaelic games. Methods: A total of 154 players (mean age 20.32 ± 2.84) were recruited from the GAA teams within the Institute of Technology Carlow (ITC). Preseason and post season testing involved two objective screening tests; Y balance test and Three Hop Test. Practical workshops, with ongoing liaison, were provided to the coaches on the implementation of the GAA15. The programme was performed before every training session and game and the existing GAA injury surveillance database was accessed to monitor player’s injuries by the college sports rehabilitation athletic therapist. Retrospective analysis of the ITC clinic records were performed in conjunction with the database analysis as a means of tracking injuries that may have been missed. The effects of the programme were analysed by comparing the intervention groups Y balance and three hop test scores to an age/gender matched control group. Results: Year 1 results revealed significant increases in neuromuscular function as a result of the GAA15. Y Balance test scores for the intervention group increased in both the posterolateral (p=.005 and p=.001) and posteromedial reach directions (p= .001 and p=.001). A decrease in performance was determined for the three hop test (p=.039). Overall twenty-five injuries were reported during the season resulting in an injury rate of 3.00 injuries/1000hrs of participation; 1.25 injuries/1000hrs training and 4.25 injuries/1000hrs match play. Non-contact injuries accounted for 40% of the injuries sustained. Year 2 results are pending and expected April 2016. Conclusion: It is envisaged that implementation of the GAA15 will continue to reduce the risk of injury and improve neuromuscular function in collegiate Gaelic games athletes.

Keywords: GAA15, Gaelic games, injury prevention, neuromuscular training

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Authors: Vaishali Patil, Neeraj Masand

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In older people, Alzheimer’s disease (AD) is turning out to be a lethal disease. According to the amyloid hypothesis, aggregation of the amyloid β–protein (Aβ), particularly its 42-residue variant (Aβ42), plays direct role in the pathogenesis of AD. Aβ is generated through sequential cleavage of amyloid precursor protein (APP) by β–secretase (BACE) and γ–secretase (GS). Thus in the treatment of AD, γ-secretase modulators (GSMs) are potential disease-modifying as they selectively lower pathogenic Aβ42 levels by shifting the enzyme cleavage sites without inhibiting γ–secretase activity. This possibly avoids known adverse effects observed with complete inhibition of the enzyme complex. Virtual screening, via drug-like ADMET filter, QSAR and molecular docking analyses, has been utilized to identify novel γ–secretase modulators with sulphonamide nucleus. Based on QSAR analyses and docking score, some novel analogs have been synthesized. The results obtained by in silico studies have been validated by performing in vivo analysis. In the first step, behavioral assessment has been carried out using Scopolamine induced amnesia methodology. Later the same series has been evaluated for neuroprotective potential against the oxidative stress induced by Scopolamine. Biochemical estimation was performed to evaluate the changes in biochemical markers of Alzheimer’s disease such as lipid peroxidation (LPO), Glutathione reductase (GSH), and Catalase. The Scopolamine induced amnesia model has shown increased Acetylcholinesterase (AChE) levels and the inhibitory effect of test compounds in the brain AChE levels have been evaluated. In all the studies Donapezil (Dose: 50µg/kg) has been used as reference drug. The reduced AChE activity is shown by compounds 3f, 3c, and 3e. In the later stage, the most potent compounds have been evaluated for Aβ42 inhibitory profile. It can be hypothesized that this series of alkyl-aryl sulphonamides exhibit anti-AD activity by inhibition of Acetylcholinesterase (AChE) enzyme as well as inhibition of plaque formation on prolong dosage along with neuroprotection from oxidative stress.

Keywords: gamma-secretase inhibitors, Alzzheimer's disease, sulphonamides, QSAR

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Authors: Demet Devrimsel Dogan, Ecem Deniz Kirkpantur, Muharrem Dogan, Ahmet Aykut, Ebru Unal Akoglu, Ozge Ecmel Onur

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Introduction: Median Arcuate Ligament Syndrome (MALS) is a rare cause of chronic abdominal pain due to external compression of the celiac trunk by a fibrous arch that unites diaphragmatic crura on each side of the aortic hiatus. While 10-24% of the population may suffer from compression of celiac trunk, it rarely causes patients to develop symptoms. The typical clinical triad of symptoms includes postprandial epigastric pain, weight loss and vomiting. The diagnosis can be made using thin section multi-detector computed tomography (CT) scans which delineate the ligament and the compressed vessel. The treatment of MALS is aimed at relieving the compression of the celiac artery to restore adequate blood flow through the vessel and neurolysis to address chronic pain. Case: A 68-year-old male presented to our clinic with acute postprandial epigastric pain. This was patients’ first attack, and the pain was the worst pain of his life. The patient did not have any other symptoms like nausea, vomiting, chest pain or dyspnea. In his medical history, the patient has had an ischemic cerebrovascular stroke 5 years ago which he recovered with no sequel, and he was using 75 mg clopidogrel and 100 mg acetylsalicylic acid. He was not using any other medication and did not have a story of cardiovascular disease. His vital signs were stable (BP:113/72 mmHg, Spo2:97, temperature:36.3°C, HR:90/bpm). In his electrocardiogram, there was ST depression in leads II, III and AVF. In his physical examination, there was only epigastric tenderness, other system examinations were normal. Physical examination through his upper gastrointestinal system showed no bleeding. His laboratory results were as follows: creatinine:1.26 mg/dL, AST:42 U/L, ALT:17 U/L, amylase:78 U/L, lipase:26 U/L, troponin:10.3 pg/ml, WBC:28.9 K/uL, Hgb:12.7 gr/dL, Plt:335 K/uL. His serial high-sensitive troponin levels were also within normal limits, his echocardiography showed no segmental wall motion abnormalities, an acute myocardial infarction was excluded. In his abdominal ultrasound, no pathology was founded. Contrast-enhanced abdominal CT and CT angiography reported ‘thickened diaphragmatic cruras are compressing and stenosing truncus celiacus superior, this is likely compatible with MALS’. The patient was consulted to general surgery, and they admitted the patient for laparoscopic ligament release. Results: MALS is a syndrome that causes postprandial pain, nausea and vomiting as its most common symptoms. Affected patients are normally young, slim women between the ages of 30 and 50 who have undergone extensive examinations to find the source of their symptoms. To diagnose MALS, other underlying pathologies should initially be excluded. The gold standard is aortic angiography. Although diagnosis and treatment of MALS are unclear, symptom resolution has been achieved with multiple surgical modalities, including open, laparoscopic or robotic ligament release as well as celiac ganglionectomy, which often requires celiac artery revascularisation.

Keywords: differential diagnosis, epigastric pain, median arcuate ligament syndrome, celiac trunk

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Authors: James Skon, Irina Beshentseva, Michelle Polak

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Wifi solutions come in two major classes. Small Office/Home Office (SOHO) WiFi, characterized by inexpensive WiFi routers, with one or two service set identifiers (SSIDs), and a single shared passphrase. These access points provide no significant user management or monitoring, and no aggregation of monitoring and control for multiple routers. The other solution class is managed enterprise WiFi solutions, which involve expensive Access Points (APs), along with (also costly) local or cloud based management components. These solutions typically provide portal based login, per user virtual local area networks (VLANs), and sophisticated monitoring and control across a large group of APs. The cost for deploying and managing such managed enterprise solutions is typically about 10 fold that of inexpensive consumer APs. Low revenue organizations, such as schools, non-profits, non-government organizations (NGO's), small businesses, and even homes cannot easily afford quality enterprise WiFi solutions, though they may need to provide quality WiFi access to their population. Using available lower cost Wifi solutions can significantly reduce their ability to provide reliable, secure network access. This project explored and created a new approach for providing secured managed enterprise WiFi based on low cost hardware combined with both new and existing (but modified) open source software. The solution provides a cloud based management interface which allows organizations to aggregate the configuration and management of small, medium and large WiFi solutions. It utilizes a novel approach for user management, giving each user a unique passphrase. It provides unlimited SSID's across an unlimited number of WiFI zones, and the ability to place each user (and all their devices) on their own VLAN. With proper configuration it can even provide user local services. It also allows for users' usage and quality of service to be monitored, and for users to be added, enabled, and disabled at will. As inferred above, the ultimate goal is to free organizations with limited resources from the expense of a commercial enterprise WiFi, while providing them with most of the qualities of such a more expensive managed solution at a fraction of the cost.

Keywords: wifi, enterprise, cloud, managed

Procedia PDF Downloads 63

Authors: Sharon Harel, Rachel Kizony, Yoram Feldman, Gabi Zeilig, Mordechai Shani

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Multiple Sclerosis (MS) is a neurological disease that may cause restriction in participation in daily activities of young adults. Main symptoms include fatigue, weakness and cognitive decline. The appearance of symptoms, their severity and deterioration rate, change between patients. The challenge of health services is to provide long-term rehabilitation services to people with MS. The objective of this presentation is to describe a course of tele-rehabilitation service of a woman with MS. Methods; R is a 48 years-old woman, diagnosed with MS when she was 22. She started to suffer from weakness of her non-dominant left upper extremity about ten years after the diagnosis. She was referred to the tele-rehabilitation service by her rehabilitation team, 16 years after diagnosis. Her goals were to improve ability to use her affected upper extremity in daily activities. On admission her score in the Mini-Mental State Exam was 30/30. Her Fugl-Meyer Assessment (FMA) score of the left upper extremity was 48/60, indicating mild weakness and she had a limitation of her shoulder abduction (90 degrees). In addition, she reported little use of her arm in daily activities as shown in her responses to the Motor Activity Log (MAL) that were equal to 1.25/5 in amount and 1.37 in quality of use. R. received two 30 minutes on-line sessions per week in the tele-rehabilitation service, with the CogniMotion system. These were complemented by self-practice with the system. The CogniMotion system provides a hybrid (synchronous-asynchronous), the home-based tele-rehabilitation program to improve the motor, cognitive and functional status of people with neurological deficits. The system consists of a computer, large monitor, and the Microsoft’s Kinect 3D sensor. This equipment is located in the client’s home and connected to a clinician’s computer setup in a remote clinic via WiFi. The client sits in front of the monitor and uses his body movements to interact with games and tasks presented on the monitor. The system provides feedback in the form of ‘knowledge of results’ (e.g., the success of a game) and ‘knowledge of performance’ (e.g., alerts for compensatory movements) to enhance motor learning. The games and tasks were adapted for R. motor abilities and level of difficulty was gradually increased according to her abilities. The results of her second assessment (after 35 on-line sessions) showed improvement in her FMA score to 52 and shoulder abduction to 140 degrees. Moreover, her responses to the MAL indicated an increased amount (2.4) and quality (2.2) of use of her left upper extremity in daily activities. She reported high level of enjoyment from the treatments (5/5), specifically the combination of cognitive challenges while moving her body. In addition, she found the system easy to use as reflected by her responses to the System Usability Scale (85/100). To-date, R. continues to receive treatments in the tele-rehabilitation service. To conclude, this case report shows the potential of using tele-rehabilitation for people with MS to provide strategies to enhance the use of the upper extremity in daily activities as well as for maintaining motor function.

Keywords: motor function, multiple-sclerosis, tele-rehabilitation, daily activities

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Authors: Alice Khachian, Shoaleh Bigdeli, Azita Shoghie, Leili Borimnejad

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Background and aim: The hidden curriculum is crucial in nursing education and can determine professionalism and professional competence. It has a significant effect on their moral performance in relation to patients. The present study was conducted with the aim of identifying the hidden curriculum components in the nursing and midwifery faculty. Methodology: The ethnographic study was conducted over two years using the Spradley method in one of the nursing schools located in Tehran. In this focused ethnographic research, the approach of Lincoln and Goba, i.e., transferability, confirmability, and dependability, was used. To increase the validity of the data, they were collected from different sources, such as participatory observation, formal and informal interviews, and document review. Two hundred days of participatory observation, fifty informal interviews, and fifteen formal interviews from the maximum opportunities and conditions available to obtain multiple and multilateral information added to the validity of the data. Due to the situation of COVID, some interviews were conducted virtually, and the activity of professors and students in the virtual space was also monitored. Findings: The components of the hidden curriculum of the faculty are: the atmosphere (physical environment, organizational structure, rules and regulations, hospital environment), the interaction between activists, and teaching-learning activities, which ultimately lead to “A disconnection between goals, speech, behavior, and result” had revealed. Conclusion: The mutual effects of the atmosphere and various actors and activities on the process of student development, since the students have the most contact with their peers first, which leads to the most learning, and secondly with the teachers. Clinicians who have close and person-to-person contact with students can have very important effects on students. Students who meet capable and satisfied professors on their way become interested in their field and hope for their future by following the mentor of these professors. On the other hand, weak and dissatisfied professors lead students to feel abandoned, and by forming a colony of peers with different backgrounds, they distort the personality of a group of students and move away from family values, which necessitates a change in some cultural practices at the faculty level.

Keywords: hidden curriculum, nursing education, ethnography, nursing

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Authors: Isabelle Gobatto

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Based on an anthropological approach, this paper explores the medical profession and the construction of medical practices by considering the multiform articulations between structural poverty and the production of care from a low-resource francophone West African country, Burkina Faso. This country is considered in its exemplary dimension of culturally differentiated countries of the African continent that share the same situation of structural poverty. The objective is to expose the effects of structural poverty on the ways of constructing professional knowledge and thinking about the sense of the medical profession. If doctors are trained to have the same capacities in South and West countries, which are to treat and save lives whatever the cultural contexts of the practice of medicine, the ways of investing their role and of dealing with this context of action fracture the homogenization of the medical profession. In the line of anthropology of biomedicine, this paper outlines the complex effects of structural poverty on health care, care relations, and the moral economy of doctors. The materials analyzed are based on an ethnography including two temporalities located thirty years apart (1990-1994 and 2020-2021), based on long-term observations of care practices conducted in healthcare institutions, interviews coupled with the life histories of physicians. The findings reveal that disabilities faced by doctors to deliver care are interpreted as policy gaps, but they are also considered by physicians as constitutive of the social and cultural characteristics of patients, making their capacities and incapacities in terms of accompanying caregivers in the production of care. These perceptions have effects on know-how, structured around the need to act even when diagnoses are not made so as not to see patients desert health structures if the costs of care are too high for them. But these interpretations of highly individualizing dimensions of these difficulties place part of the blame on patients for the difficulties in using learned knowledge and delivering effective care. These situations challenge the ethics of caregivers but also of ethnologists. Firstly because the interpretations of disabilities prevent caregivers from considering vulnerabilities of care as constituting a common condition shared with their patients in these health systems, affecting them in an identical way although in different places in the production of care. Correlatively, these results underline that these professional conceptions prevent the emergence of a figure of victim, which could be shared between patients and caregivers who, together, undergo working and care conditions at the limit of the acceptable. This dimension directly involves politics. Secondly, structural poverty and its effects on care challenge the ethics of the anthropologist who observes caregivers producing, without intent to arm, experiences of care marked by an ordinary violence, by not giving them the care they need. It is worth asking how anthropologists could get doctors to think in this light in west-African societies.

Keywords: Africa, care, ethics, poverty

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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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Authors: Kirstin Griffin

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During a period of increased anxiety and stress, communication became the essential tool to help the public stay informed and feel prepared during the Covid-19 pandemic. However, certain groups of patients were not feeling as reassured. The news and media blasted the message that patients with diabetes were “high-risk" in regards to contracting the Covid-19 infection. Routine clinics were being cancelled, GP practices were closing their doors, and patients with type 1 diabetes were understandably scared. The influx of calls to diabetes specialists nurses from concerned patients highlighted the need for better and more specialised information. An Application specifically for patients with type 1 diabetes was created to deliver this information, and it proved to be the essential communication tool that was desperately needed. The Application for patients with type 1 diabetes aimed to deliver specialist information to patients in regards to their diagnosis, management, and ongoing follow-up commitments. The Application gives practical advice on multiple areas of diabetes management, including sick-day rules and diabetic emergencies, as well as up-to-date information on technology, including setting up Libre devices and downloading glucose meters to facilitate attending virtual clinics. Delivery of this information in an easy-to-understand and comprehensive way is intended to improve patient engagement with diabetes services and ultimately empower patients in the control of their own disease. The application also offers a messaging service to allow the diabetes team to send out alerts to patient groups on specific issues, such as changes to clinics, or respond to recent news updates regarding Covid-19. The App was launched in NHS Fife in June 2020 and has amassed 800 active users so far. There is growing engagement with the App since its launch, with over 1000 user interactions in the last month alone. Feedback shows that 100% of users like the App and have found it useful in the management of their diabetes. The App has proven to be an essential tool in communication with one of the most vulnerable groups during the Covid-19 pandemic, and its ongoing development will continue to increase patient engagement and improve glycaemic control for patients with type 1 diabetes. The future of chronic disease management should involve digital solutions such as apps to further empower patients in their healthcare.

Keywords: diabetes, endocrinology, digital healthcare, medical apps

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Authors: Lucas Berrini

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Academic libraries have always struggled with engaging with students and faculty. Striking the balance between what the community needs and what the library can afford has also been a point of contention for libraries. As academia begins to return to a new normal after COVID, library staff are rethinking how remind patrons that the library is open and ready for business. NC Wesleyan, a small liberal arts school in eastern North Carolina, decided to be proactive and reach out to the academic community. After shutting down in 2020 for COVID, the campus library saw a marked decrease in in-person attendance. For a small school whose operational budget was tied directly to tuition payments, it was imperative for the library to remind faculty and staff that they were open for business. At the beginning of the Summer 2022 term and continuing into the fall, the reference team created a marketing plan using email, physical meetings, and virtual events targeted at students and faculty as well as community members who utilized the facilities prior to COVID. The email blasts were gentle reminders that the building was open and available for use The target audiences were the community at large. Several of the emails contained reminders of previous events in the library that were student centered. The next phase of the email campaign centers on reminding the community about the libraries physical and electronic resources, including the makerspace lab. Language will indicate that student voices are needed, and a QR code is included for students to leave feedback as to what they want to see in the library. The final phase of the email blasts were faculty focused and invited them to connect with library reference staff for an in-person consultation on their research needs. While this phase is ongoing, the response has been positive, and staff are compiling data in hopes of working with administration to implement some of the requested services and materials. These email blasts will be followed up by in-person meetings with faculty and students who responded to the QR codes. This research is ongoing. This type of targeted outreach is new for Wesleyan. It is the hope of the library that by the end of Fall 2022, there will be a plan in place to address the needs and concerns of the students and faculty. Furthermore, the staff hopes to create a new sense of community for the students and staff of the university.

Keywords: academic, education, libraries, outreach

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Authors: Paloma Mendes Saldanha

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Access to information is a prerequisite for democracy while also guiding the material construction of fundamental rights. The exercise of citizenship requires knowing, understanding, questioning, advocating for, and securing rights and responsibilities. In other words, it goes beyond mere active electoral participation and materializes through awareness and the struggle for rights and responsibilities in the various spaces occupied by the population in their daily lives. In times of hyper-cultural connectivity, active citizenship is shaped through ethical trust processes, most often established between humans and algorithms. Automated decisions, so prevalent in various everyday situations, such as purchase preference predictions, virtual voice assistants, reduction of accidents in autonomous vehicles, content removal, resume selection, etc., have already found their place as a normalized discourse that sometimes does not reveal or make clear what violations of fundamental rights may occur when algorithmic explainability is lacking. In other words, technological and market development promotes a normalization for the use of automated decisions while silencing possible restrictions and/or breaches of rights through a culturally modeled, unethical, and unexplained trust process, which hinders the possibility of the right to a healthy, transparent, and complete exercise of citizenship. In this context, the article aims to identify the violations caused by the absence of algorithmic explainability in the exercise of citizenship through the construction of an unethical and silent trust process between humans and algorithms in automated decisions. As a result, it is expected to find violations of constitutionally protected rights such as privacy, data protection, and transparency, as well as the stipulation of algorithmic explainability as a fundamental right in the exercise of Brazilian citizenship in the era of virtualization, facing a threefold foundation called trust: culture, rules, and systems. To do so, the author will use a bibliographic review in the legal and information technology fields, as well as the analysis of legal and official documents, including national documents such as the Brazilian Federal Constitution, as well as international guidelines and resolutions that address the topic in a specific and necessary manner for appropriate regulation based on a sustainable trust process for a hyperconnected world.

Keywords: artificial intelligence, ethics, citizenship, trust

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Authors: Theresa Veach, Erin Crisp

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It has been shown that traditional students flourish as a function of several factors including level of academic challenge, student/faculty interactions, active/collaborative learning, enriching educational experiences, and supportive campus environment. With the increase in demand for remote or online courses, factors that result in academic flourishing in the virtual classroom have become more crucial to understand than ever before. This study seeks to give insight into those factors that impact student learning, overall student wellbeing, and flourishing among college students enrolled in an online program. 4160 unique students participated in the completion of End of Course Survey (EOC) before final grades were released. Quantitative results from the survey are used by program directors as a measure of student satisfaction with both the curriculum and the faculty. In addition, students also submitted narrative comments in an open comment field. No prompts were given for the comment field on the survey. The purpose of this analysis was to report on the qualitative data available with the goal of gaining insight into what matters to students. Survey results from July 1st, 2016 to December 1st, 2016 were compiled into spreadsheet data sets. The analysis approach used involved both key word and phrase searches and reading results to identify patterns in responses and to tally the frequency of those patterns. In total, just over 25,000 comments were included in the analysis. Preliminary results indicate that it is the professor-student relationship, frequency of feedback and overall engagement of both instructors and students that are indicators of flourishing in college programs offered in an online format. This qualitative study supports the notion that college students flourish with regard to 1) education, 2) overall student well-being and 3) program satisfaction when overall engagement of both the instructor and the student is high. Ways to increase engagement in the online college environment were also explored. These include 1) increasing student participation by providing more project-based assignments, 2) interacting with students in meaningful ways that are both high in frequency and in personal content, and 3) allowing students to apply newly acquired knowledge in ways that are meaningful to current life circumstances and future goals.

Keywords: college, engagement, flourishing, online

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Authors: Neslihan Demirci, Serdar Durdağı

Abstract:

Mycobacterium tuberculosis is still a worldwide disease-causing agent that, according to WHO, led to the death of 1.5 million people from tuberculosis (TB) in 2020. The bacteria reside in macrophages located specifically in the lung. There is a known quadruple drug therapy regimen for TB consisting of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB). Over the past 60 years, there have been great contributions to treatment options, such as recently approved delamanid (OPC67683) and bedaquiline (TMC207/R207910), targeting mycolic acid and ATP synthesis, respectively. Also, there are natural compounds that can block the tryptophanyl-tRNA synthetase (TrpRS) enzyme, chuangxinmycin, and indolmycin. Yet, already the drug resistance is reported for those agents. In this study, the newly released TrpRS enzyme structure is investigated for potential inhibitor drugs from already synthesized molecules to help the treatment of resistant cases and to propose an alternative drug for the quadruple drug therapy of tuberculosis. Maestro, Schrodinger is used for docking and molecular dynamic simulations. In-house library containing ~8000 compounds among FDA-approved indole-containing compounds, a total of 57 obtained from the ChemBL were used for both ATP and tryptophan binding pocket docking. Best of indole-containing 57 compounds were subjected to hit expansion and compared later with virtual screening workflow (VSW) results. After docking, VSW was done. Glide-XP docking algorithm was chosen. When compared, VSW alone performed better than the hit expansion module. Best scored compounds were kept for ten ns molecular dynamic simulations by Desmond. Further, 100 ns molecular dynamic simulation was performed for elected molecules according to Z-score. The top three MMGBSA-scored compounds were subjected to steered molecular dynamic (SMD) simulations by Gromacs. While SMD simulations are still being conducted, ponesimod (for multiple sclerosis), vilanterol (β₂ adrenoreceptor agonist), and silodosin (for benign prostatic hyperplasia) were found to have a significant affinity for tuberculosis TrpRS, which is the propulsive force for the urge to expand the research with in vitro studies. Interestingly, top-scored ponesimod has been reported to have a side effect that makes the patient prone to upper respiratory tract infections.

Keywords: drug repurposing, molecular dynamics, tryptophanyl-tRNA synthetase, tuberculosis

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