Search results for: disease severity perception

Authors: Mukolwe D. Lubembe, Odongo O. David, Githaka Naftali, Kanduma Esther, Marinda Oosthuizen, Kgomotso P. Sibeko

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Theileriosis is a tick-borne disease of cattle caused by an apicomplexan protozoan parasite of the genus Theileria. In eastern and southern Africa, Theileria infections in cattle are caused by the species Theileria parva whose natural reservoir is the African buffalo (Syncerus caffer). Currently, East Coast Fever (ECF) caused by the cattle-derived Theileria parva is still a major problem in eastern Africa and some parts of southern Africa but not in South Africa following its eradication in the 1950s. However, Corridor disease (CD) caused by the buffalo-derived Theileria parva still remains a concern in South Africa. The diversity of Theileria parva in South Africa in comparison to other affected countries is poorly defined yet its known to be the survival strategy of this parasite. We assessed the antigenic diversity of Theileria parva isolates from Buffalo and cattle at the wildlife-livestock interface comparing samples from South Africa, Zimbabwe, Kenya, Tanzania, and Uganda. Antigenic epitopes of eight schizont antigen genes (Tp1, Tp3, Tp4, Tp5, Tp6, Tp7, Tp8 and Tp10) were amplified by PCR from genomic DNA extracted from blood samples collected from cattle and buffalo at the wildlife-livestock interface. Amplicons were purified and then sequenced on NGS platform. Full length open reading frames (ORFs) of two schizont antigen genes (Tp2 and Tp9) and one sporozoite antigen gene, p67 were also amplified from genomic DNA. Amplicons were then purified and cloned for sequencing. Analysis was based on sequence differences in the genes. Preliminary results show an extensively diverse population of Theileria parva circulating in buffalo and cattle populations at the wildlife-livestock interface. Diversity of the antigen genes contributes to the evasion of the immune system of the host by Theileria parva. This possess a concern in that, some of the Theileria parva populations may re-assort and become adapted to cattle to cause a form of theileriosis that is as fatal as ECF in areas where ECF was eradicated or is absent

Keywords: Theileria parva, east coast fever, corridor diseases, antigen genes, diversity

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

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

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

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Authors: David Sarpong, Waleed Khursheed, Ernest Danquah, Erin Murphy

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Shigella is a pathogenic bacterium responsible for shigellosis, a severe diarrheal disease that claims the lives of immunocompromised individuals worldwide. To develop therapeutics against this disease, an understanding of the molecular mechanisms underlying the pathogen’s physiology is crucial. Small non-coding RNAs (sRNAs) have emerged as important regulators of bacterial physiology, including as components of toxin-antitoxin systems. In this study, we investigated the role of RyfA in S. flexneri physiology and virulence. RyfA, originally identified as an sRNA in Escherichia coli, is conserved within the Enterobacteriaceae family, including Shigella. Whereas two copies of ryfA are present in S. dysenteriae, all other Shigella species contain only one copy of the gene. Additionally, we identified a putative open reading frame within the RyfA transcript, suggesting that it may be a dual-functioning gene encoding a small protein in addition to its sRNA function. To study ryfA in vitro, we cloned the gene into an inducible plasmid and observed the effect on bacterial growth. Here, we report that RyfA production inhibits the growth of S. flexneri, and this inhibition is dependent on the contained open reading frame. In-silico analyses have revealed the presence of two divergently transcribed sRNAs, RyfB1 and RyfB2, which share nucleotide complementarity with RyfA and thus are predicted to function as anti-toxins. Our data demonstrate that RyfB2 has a stronger antitoxin effect than RyfB1. This regulatory pattern suggests a novel form of a toxin-antitoxin system in which the activity of a single toxin is inhibited to varying degrees by two sRNA antitoxins. Studies are ongoing to investigate the regulatory mechanism(s) of the antitoxin genes, as well as the downstream targets and mechanism of growth inhibition by the RyfA toxin. This study offers distinct insights into the regulatory mechanisms underlying Shigella physiology and may inform the development of new anti-Shigella therapeutics.

Keywords: sRNA, shigella, toxin-antitoxin, Type 1 toxin antitoxin

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Authors: Sherine Farouk, Fauzia Jabeen

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The purpose of this study is to examine the role played by ethical climate and CSR on organizational performance in public sector organizations. In particular, the research will shed light on the link between formalized ethical procedures and employee responses including corporate social responsibility, and organizational performance among public sector employees. Data was collected from 425 employees working in public sector organizations in Abu Dhabi, the capital of United Arab Emirates. Structural Equation Modeling will be used to test the proposed hypotheses. The paper contributes to the literature by being one of the first to study CSR and ethical climate within a Middle Eastern context, and will offer important implications for theory and practice.

Keywords: corporate social responsibility, ethical climate, organizational performance, United Arab Emirates

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Authors: Alina Petronela Negrea, Valentin Cojanu

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The article examines the synergy between innovation and entrepreneurship by means of a qualitative research on actors in the automotive industry in the Romanian southern region, Muntenia. The region is of particular interest because most of the industry suppliers are located there, as well as because it gathers the full range of key actors involved in the innovation process. The research design aims (1) to reflect entrepreneurs’ approach to and perception on innovation; (2) to underline forces driving or stifling innovation in the automotive industry; and (3) to evaluate the awareness of the existing knowledge database and the communication channels through which it is transferred within and between innovation networks. Empirical evidence results from triangula¬tion of three data collection methods: statistical data and other publicly available materials; semi - structured inter¬views, and experiential visits. The conclusions emphasize the convergent opinion of the entrepreneurs about the vital role of innovation in their investment plans.

Keywords: automotive industry, entrepreneurship, innovation, Romania

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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: Shaleeza Sohail

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Self, and peer evaluations are some of the main components in almost all group assignments and projects in higher education institutes. These evaluations provide students an opportunity to better understand the learning outcomes of the assignment and/or project. A number of online systems have been developed for this purpose that provides automated assessment and feedback of students’ contribution in a group environment based on self and peer evaluations. All these systems lack a progressive aspect of these assessments and feedbacks which is the most crucial factor for ongoing improvement and life-long learning. In addition, a number of assignments and projects are designed in a manner that smaller or initial assessment components lead to a final assignment or project. In such cases, the evaluation and feedback may provide students an insight into their performance as a group member for a particular component after the submission. Ideally, it should also create an opportunity to improve for next assessment component as well. Self and Peer Progressive Assessment and Feedback System encourages students to perform better in the next assessment by providing a comparative analysis of the individual’s contribution score on an ongoing basis. Hence, the student sees the change in their own contribution scores during the complete project based on smaller assessment components. Self-Assessment Factor is calculated as an indicator of how close the self-perception of the student’s own contribution is to the perceived contribution of that student by other members of the group. Peer-Assessment Factor is calculated to compare the perception of one student’s contribution as compared to the average value of the group. Our system also provides a Group Coherence Factor which shows collectively how group members contribute to the final submission. This feedback is provided for students and teachers to visualize the consistency of members’ contribution perceived by its group members. Teachers can use these factors to judge the individual contributions of the group members in the combined tasks and allocate marks/grades accordingly. This factor is shown to students for all groups undertaking same assessment, so the group members can comparatively analyze the efficiency of their group as compared to other groups. Our System provides flexibility to the instructors for generating their own customized criteria for self and peer evaluations based on the requirements of the assignment. Students evaluate their own and other group members’ contributions on the scale from significantly higher to significantly lower. The preliminary testing of the prototype system is done with a set of predefined cases to explicitly show the relation of system feedback factors to the case studies. The results show that such progressive feedback to students can be used to motivate self-improvement and enhanced team skills. The comparative group coherence can promote a better understanding of the group dynamics in order to improve team unity and fair division of team tasks.

Keywords: effective group work, improvement of team skills, progressive feedback, self and peer assessment system

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Authors: Antoine Vikkey Hinson, Ranty Jolianelle Dassi, Menonli Adjobimey, Rose Mikponhoue, Paul Ayelo

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Introduction: The psychological hardship of the teaching profession maintains a chronic stress that inevitably evolves into burnout (BO) in the absence of adequate preventive measures. The objective of this study is to study the prevalence and factors associated with burnout among secondary school teachers in the city of Cotonou in 2022. Methods: This was a descriptive cross-sectional study with an analytical aim and prospective data collection that took place over a period of 2 months, from July 19 to August 19 and from October 1 to October 31, 2022. Sampling was done using a three-stage probability sampling technique. Data analysis was performed using R 4.1.1 software. Bivariate logistic regression was used to identify associated factors. The significance level chosen was 5% (p < 0.05). Results: A total of 270 teachers were included in the study, of whom 208 (77.00%) were men. The mean age of the workers was 38.03 ± 8.30 years. According to the Maslach Burnout Inventory, 58.51% of the teachers had burnout, with 41.10% of teachers in emotional exhaustion, 27.40% in depersonalization and 21.90% in loss of personal accomplishment. The severity of the syndrome was low to moderate in almost all teachers. The occurrence of BO was associated with), not practicing sports (ORa= 2,38 [1,32; 4,28]), jobs training (ORa= 1,86 [1,04; 3,34]) and an imbalance of effort/reward (ORa= 5,98 [2,24;15,98]). Conclusion: The prevalence of BO is high among secondary school teachers in the city of Cotonou. A larger scale study, including research on its consequences on the teacher and the learner, is necessary in order to act quickly to implement a prevention program.

Keywords: burnout, teachers, Maslach burnout inventory, associated factors, Benin

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Authors: Cristina Maria Mendoza Sanchez, Maria Angeles Navarro Perán

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Introduction: Nursing as a profession, from its initial formation and after its development in practice, has been built and identified mainly from its technical competence and professionalization within the positivist approach of the XIX century that provides a conception of the disease built on the basis of to the biomedical paradigm, where the care provided is more focused on the physiological processes and the disease than on the suffering person understood as a whole. The main issue that is in need of study here is a review of the nursing profession's history to get to know how the nursing profession was before the XIX century. It is unclear if there were organizations or people with knowledge about looking after others or if many people survived by chance. The holistic care, in which the appearance of the disease directly affects all its dimensions: physical, emotional, cognitive, social and spiritual. It is not a concept from the 21st century. It is common practice, most probably since established life in this world, with the final purpose of covering all these perspectives through quality care. Objective: In this paper, we describe and analyze the history of education in nursing learning in terms of reviewing and analysing theoretical foundations of clinical teaching and learning in nursing, with the final purpose of determining and describing the development of the nursing profession along the history. Method: We have done a descriptive systematic review study, doing a systematically searched of manuscripts and articles in the following health science databases: Pubmed, Scopus, Web of Science, Temperamentvm and CINAHL. The selection of articles has been made according to PRISMA criteria, doing a critical reading of the full text using the CASPe method. A compliment to this, we have read a range of historical and contemporary sources to support the review, such as manuals of Florence Nightingale and John of God as primary manuscripts to establish the origin of modern nursing and her professionalization. We have considered and applied ethical considerations of data processing. Results: After applying inclusion and exclusion criteria in our search, in Pubmed, Scopus, Web of Science, Temperamentvm and CINAHL, we have obtained 51 research articles. We have analyzed them in such a way that we have distinguished them by year of publication and the type of study. With the articles obtained, we can see the importance of our background as a profession before modern times in public health and as a review of our past to face challenges in the near future. Discussion: The important influence of key figures other than Nightingale has been overlooked and it emerges that nursing management and development of the professional body has a longer and more complex history than is generally accepted. Conclusions: There is a paucity of studies on the subject of the review to be able to extract very precise evidence and recommendations about nursing before modern times. But even so, as more representative data, an increase in research about nursing history has been observed. In light of the aspects analyzed, the need for new research in the history of nursing emerges from this perspective; in order to germinate studies of the historical construction of care before the XIX century and theories created then. We can assure that pieces of knowledge and ways of care were taught before the XIX century, but they were not called theories, as these concepts were created in modern times.

Keywords: nursing history, nursing theory, Saint John of God, Florence Nightingale, learning, nursing education

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Authors: Natalia Kajka, Agnieszka Kulik

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The aim of the study is to present the results regarding differences in perception of cognitive progress of children with Attention Deficit Hyperactivity Disorder (ADHD) by adults and children themselves. The experiment was attended by 45 children with ADHD, their parents and teachers. The children attended the 3-month metacognitive training. Both children and adults were examined before and after joining this project. In order to show significant differences between the first and second measurement of the test, non-parametric Wilcoxon tests were performed. The analysis showed statistically significant differences in the change of cognitive functioning in children with ADHD participating in metacognitive training, this was also confirmed by the results of the parents' research. There were no significant differences in the teachers' assessment of these children.

Keywords: ADHD, executive function, Golem effect metacognitive training

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Authors: A. Papachristou, A. Ntikoudi, L. Makris, V. Saridakis

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Introduction: More than 10 million people are imprisoned or detained worldwide. Figures from 2011-12 show that prison inmates are more likely than the general population to suffer from chronic or infectious diseases, while most inmates are overweight or obese, and more than a quarter have high blood pressure. In 2011/12, the proportion of prisoners reporting diabetes or hyperglycemia was 899 per 10,000 prisoners, almost double the 2004 figure (483 per 10,000). It is important to ensure that this population has access to the same standard of care as people outside prisons, as access to services should be need-based. Diabetes is a public health problem associated with increased morbidity and mortality worldwide. According to the International Diabetes Federation (IDF) in 2017, approximately 425 million people worldwide had diabetes. This number is expected to increase to 629 million by 2045. Poor management of diabetes in prisons can lead to poor blood sugar control and increase the risk of complications. Aim: The aim of this review was to systematically evaluate all the available literature on diabetes care in custodial settings. Methods: An extensive literature search was conducted through electronic databases (PubMed, Scopus and CINAHL) with the terms ‘custody’, ‘diabetes Mellitus, ‘detention centers and ‘chronic disease’. Articles published in English until September 2022, were included; no other criteria on publication dates were set. Results: Most of the studies mentioned a diabetes prevalence of approximately 10%, among other common chronic. Hypertension, obesity, smoking, sedentary lifestyle were the most common comorbidities associated with diabetes. Conclusion: Good glycemic control is fundamental to managing diabetes, and while many prisoners enter prison poorly, access to regular medication and meals, as well as exercise, offers the potential for improvement. Not being able to get help as quickly as in the past can be extremely stressful, and some prisoners may deliberately raise their blood sugar levels to avoid the risk of developing hypoglycemia, especially if they know they have had previous episodes of nocturnal hypoglycemia. Thus, appropriate training and resources are critical to providing quality care to incarcerated people with diabetes.

Keywords: custody, diabetes mellitus, detention centers, chronic disease

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Authors: Haruna Karamba, Nafisa Muhammad Danyaro

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The study describe the action of natural latex (extract) of two sub-aquatic macrophytes plants i.e., Cassia occidentalis and Physalis angulata which were tested against two water snail species; Bulinus globusus and Lymnaea natalensis, the intermediate host of Bilharziasis (chistosomiasis) in the tropical countries. Bilherziasis is a disease prevalent and endermic to tropical Africa, seriously undermining health status of Nigerian youth. The easiest way to eradicate the disease is to eliminate the secondary host of the pathogen, chistosoma species. Therefore we carried out a research to investigate the molluscicidal effect of the leaf extract of C. occidentalis and P. angulata on mortality rate of B. globusus and L. natalensis water snails using pond water in the laboratory of science laboratory department of Kano State Polytechnic, Nigeria. One hundred and fifty juveniles’ snails were collected from Jakara Dam in the Northeastern part of Kano, Nigeria. The snails were put inside a plastic container and transported immediately to the laboratory where they were transferred into reservoir tank containing pond water and kept for 48 hours to get acclimatized with laboratory environment. Twelve water bathes 2/3 filled with pond water were prepared and kept in the laboratory. Leaf extract of the plants were obtained by blending and homogenizing the leaf tissue from which the extract were obtained and prepared in 10, 20, 30, 40 and 50 ppm, in addition to 0 ppm, which served as control. Ten snails were placed in each of the twelve water bathes. Six water bathes for the species of C. accidentalis extract and other six for P. angulata. The treatment combinations were maintained for 2 days after which the number of living snails present in each water bathes were counted and subsequently at 2 days intervals. The result indicated that extracts from both plants were lethal to the snails as concentration of the extract increases particularly mortality rate was highest at 40 and 50 ppm. Conclusively the toxicity of the extracts from these plants proven lethal to snails and hence can be used as molluscicides for cheap and easy method of eliminating water snails and therefore reducing the incidence of Bilharziasis.

Keywords: schistosomiasis, bilharziasis, Bulinus globusus, Lymnea natalensis, Physalis angulata, Cassia occidentalis, Kano

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Authors: Aliyu Uthman Abdulkadir

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Insurgent reports in Nigeria have become a recurring focus in the media due to the significance of language choices. This paper investigates these reports with the aim of identifying various pragmatic practices and exploring the role of the media in shaping public perception of insurgency. Three Nigerian newspapers The Punch, This Day, and The Guardian were selected for analysis between December 2022 and January 2023. Five media reports were examined to uncover the pragmatic functions embedded in the discourse. The study reveals that the media employ implicit acts such as exposing, sensitizing, informing, castigating, reprimanding, and shaming to depict insurgent activities in the country. The analysis also highlights how the use of presupposed ideologies enhances the delivery and acceptance of information related to insurgent actions. The study concludes that the media's portrayal of insurgency is often biased, as reflected in the data analysis.

Keywords: insurgency, pragmatic acts, bias, framing, ideoligies

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Authors: Dagmara A. Niedziela, Mark P. Murphy, Orla M. Keane, Finola C. Leonard

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Staphylococcus aureus is the most frequent cause of clinical and subclinical bovine mastitis in Ireland. Mastitis caused by S. aureus is often chronic and tends to recur after antibiotic treatment. This may be due to several virulence factors, including attributes that enable the bacterium to internalize into bovine mammary epithelial cells, where it may evade antibiotic treatment, or evade the host immune response. Four bovine-adapted lineages (CC71, CC97, CC151 and ST136) were identified among a collection of Irish S. aureus mastitis isolates. Genotypic variation of mastitis-causing strains may contribute to different presentations of the disease, including differences in milk somatic cell count (SCC), the main method of mastitis detection. The objective of this study was to investigate the influence of bacterial strain and lineage on host immune response, by employing cell culture methods in vitro as well as an in vivo infection model. Twelve bovine adapted S. aureus strains were examined for internalization into bovine mammary epithelial cells (bMEC) and their ability to induce an immune response from bMEC (using qPCR and ELISA). In vitro studies found differences in a variety of virulence traits between the lineages. Strains from lineages CC97 and CC71 internalized more efficiently into bovine mammary epithelial cells (bMEC) than CC151 and ST136. CC97 strains also induced immune genes in bMEC more strongly than strains from the other 3 lineages. One strain each of CC151 and CC97 that differed in their ability to cause an immune response in bMEC were selected on the basis of the above in vitro experiments. Fourteen first-lactation Holstein-Friesian cows were purchased from 2 farms on the basis of low SCC (less than 50 000 cells/ml) and infection free status. Seven cows were infected with 1.73 x 102 c.f.u. of the CC97 strain (Group 1) and another seven with 5.83 x 102 c.f.u. of the CC151 strain (Group 2). The contralateral quarter of each cow was inoculated with PBS (vehicle). Clinical signs of infection (temperature, milk and udder appearance, milk yield) were monitored for 30 days. Blood and milk samples were taken to determine bacterial counts in milk, SCC, white blood cell populations and cytokines. Differences in disease presentation in vivo between groups were observed, with two animals from Group 2 developing clinical mastitis and requiring antibiotic treatment, while one animal from Group 1 did not develop an infection for the duration of the study. Fever (temperature > 39.5⁰C) was observed in 3 animals from Group 2 and in none from Group 1. Significant differences in SCC and bacterial load between groups were observed in the initial stages of infection (week 1). Data is also being collected on cytokines and chemokines secreted during the course of infection. The results of this study suggest that a strain from lineage CC151 may cause more severe clinical mastitis, while a strain from lineage CC97 may cause mild, subclinical mastitis. Diversity between strains of S. aureus may therefore influence the clinical presentation of mastitis, which in turn may influence disease detection and treatment needs.

Keywords: Bovine mastitis, host immune response, host-pathogen interactions, Staphylococcus aureus

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Authors: Mahnaz Seyedoshohadaee, Azadeh Nematolahi, Parsa Rahimi

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Introduction: Rehabilitation training after hip joint surgery is one of the priorities of nursing, which can be helpful in today's world with the advancement of technology. This study was conducted with the aim of the effect of Tele rehabilitation Education on outcomes of hip osteoarthritis. Methods: The present study was a semi-experimental study that was conducted on patients after hip replacement in the first half of 2023. To perform the work, 70 patients who were available were included in the study and were divided into two intervention and control groups by a nonrandom method. Inclusion criteria included: a maximum of 6 months had passed since the hip joint replacement, age between 30-70 years, the ability to follow instructions by the subject, the absence of accompanying orthopedic lesions such as fractures, and having access to the Internet, a smartphone, and the Skype program. Exclusion criteria were severe speech disorder and non-participation in a training session. The research tool included a demographic profile form and Hip disability and osteoarthritis outcome score (HOOS), which were completed by the patients before and after the training. Training for people in the intervention group in 4 sessions, including introduction of the disease, risk factors, symptoms, management of disease symptoms, medication, diet, appropriate exercises and pain relief methods, one session per week for 30 to 45 minutes in the groups 4 to 6 people were offered through Skype software. SPSS version 22 statistical software was used to analyze the data. Results: The average score of osteoarthritis outcomes in the patients before the intervention was 112.74±29.64 in the test group and 110.41±16.34 in the control group, which had no significant difference (P=0.682). After the intervention, it reached 85.25±21.43 and 109.94±15.74, respectively, and this difference was significant (P<0.001). The comparison of the average scores of osteoarthritis results in the test group indicated a significant difference from the pre-test to the post-test time (p<0.001). But in the control group, this difference was not significant (p=0.130). Conclusion: The results showed that Tele rehabilitation Education has a positive effect on reducing the outcomes of hip osteoarthritis, so it is recommended that nurses use Tele rehabilitation Education in their training in order to empower patients.

Keywords: training, rehabilitation, hip osteoarthritides, patient, complications

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Authors: Bui Phuong Linh, Yuki Sakakibara, Ryuto Tanaka, Elizabeth H. Pigney, Taishi Hashiguchi

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NASH is an increasingly prevalent chronic liver disease that can progress to hepatocellular carcinoma and now is attracting interest worldwide. The STAM™ model is a clinically-correlated murine NASH model which shows the same pathological progression as NASH patients and has been widely used for pharmacological and basic research. The multiple parallel hits hypothesis suggests abnormalities in adipocytokines, intestinal microflora, and endotoxins are intertwined and could contribute to the development of NASH. In fact, NASH patients often exhibit gut dysbiosis and dysfunction in adipose tissue and metabolism. However, the analysis of the STAM™ model has only focused on the liver. To clarify whether the STAM™ model can also mimic multiple pathways of NASH progression, we analyzed the organ crosstalk interactions between the liver and the gut and the phenotype of adipose tissue in the STAM™ model. NASH was induced in male mice by a single subcutaneous injection of 200 µg streptozotocin 2 days after birth and feeding with high-fat diet after 4 weeks of age. The mice were sacrificed at NASH stage. Colon samples were snap-frozen in liquid nitrogen and stored at -80˚C for tight junction-related protein analysis. Adipose tissue was prepared into paraffin blocks for HE staining. Blood adiponectin was analyzed to confirm changes in the adipocytokine profile. Tight junction-related proteins in the intestine showed that expression of ZO-1 decreased with the progression of the disease. Increased expression of endotoxin in the blood and decreased expression of Adiponectin were also observed. HE staining revealed hypertrophy of adipocytes. Decreased expression of ZO-1 in the intestine of STAM™ mice suggests the occurrence of leaky gut, and abnormalities in adipocytokine secretion were also observed. Together with the liver, phenotypes in these organs are highly similar to human NASH patients and might be involved in the pathogenesis of NASH.

Keywords: Non-alcoholic steatohepatitis, hepatocellular carcinoma, fibrosis, organ crosstalk, leaky gut

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Authors: Mai M. Helmy

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Although the role of either nitric oxide (NO) or endothelin receptors modulation in the severity of cisplatin-induced nephrotoxicity has been recognized in previous studies including our own, the possible interaction between the two pathways remains obscure. In this study, we tested the possible interaction between the nitrergic and endothelin pathways in cisplatin-induced nephrotoxicity in male rats. Sprague Dawley male rats (200 to 250 g) were divided into four groups: Control (given a single dose of normal saline, i.p.), cisplatin (6 mg/kg, i.p.), cisplatin+Sildenafil (2 mg/kg, i.p.), cisplatin+Sildenafil+BQ-123 (1 mg/kg, i.p.). Each of the co-administered drugs was given in two doses; one hour before and one day after the cisplatin dose. Acute cisplatin administration resulted in significant increases in BUN and serum creatinine levels at 96 h following cisplatin injection. Increased levels of MDA, TNF-α and caspase-3, decreased nitrite/nitrate level and SOD activity in kidney homogenates were also observed following cisplatin injection. According to the obtained results, the co-adminstration of sildenafil alone with cisplatin offered a reno-protective effect comparable to that obtained following the concurrent administration of both sildenafil and the selective ETAR antagonist BQ-123. Thus, the current study is the first to reveal that the presence of an intact NO/cGMP system may offer a moderate reno-protective effect against cisplatin-induced nephrotoxicity even in the presence of ETAR-mediated vasoconstriction, suggesting the absence of obvious functional interaction between the nitrergic and endothelin pathways in cisplatin-induced nephrotoxicity in male rats.

Keywords: BQ-123, cisplatin, endothelin-1, nephrotoxicity, sildenafil

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Authors: Jaspal Rana

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Oxidative stress has been identified as an underlying cause of ischemia-reperfusion (IR) related cognitive dysfunction and brain damage. Therefore, antioxidant based therapies to treat IR injury are being investigated. Allium cepa L. (onion) is used as culinary medicine and is documented to have marked antioxidant effects. Hence, the present study was designed to evaluate the effect of A. cepa outer scale extract (ACE) against IR induced cognition and biochemical deficit in mice. ACE was prepared by maceration with 70% methanol and fractionated into ethylacetate and aqueous fractions. Bilateral common carotid artery occlusion for 10 min followed by 24 h reperfusion was used to induce cerebral IR injury. Following IR injury, ACE (100 and 200 mg/kg) was administered orally to animals for 7 days once daily. Behavioral outcomes (memory and sensorimotor functions) were evaluated using Morris water maze and neurological severity score. Cerebral infarct size, brain thiobarbituric acid reactive species, reduced glutathione, and superoxide dismutase activity was also determined. Treatment with ACE significantly ameliorated IR mediated deterioration of memory and sensorimotor functions and rise in brain oxidative stress in animals. The results of the present investigation revealed that ACE improved functional outcomes after cerebral IR injury which may be attributed to its antioxidant properties.

Keywords: ischemia-reperfusion, neuroprotective, stroke, antioxidant

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Authors: John Lachapelle

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Introduction: Neural stimulation is increasingly targeted toward treatment of back pain, PTSD, Parkinson’s disease, and for sensory perception. Sensory recording during stimulation is important in order to examine neural response to stimulation. Most neural amplifiers (headstages) focus on noise efficiency factor (NEF). Conversely, neural headstages need to handle artifacts from several sources including power lines, movement (EMG), and neural stimulation itself. In this work a layered approach to artifact rejection is used to reduce corruption of the neural ENG signal by 60dBv, resulting in recovery of sensory signals in rats and primates that would previously not be possible. Methods: The approach combines analog techniques to reduce and handle unwanted signal amplitudes. The methods include optimized (1) sensory electrode placement, (2) amplifier configuration, and (3) artifact blanking when necessary. The techniques together are like concentric moats protecting a castle; only the wanted neural signal can penetrate. There are two conditions in which the headstage operates: unwanted artifact < 50mV, linear operation, and artifact > 50mV, fast-settle gain reduction signal limiting (covered in more detail in a separate paper). Unwanted Signals at the headstage input: Consider: (a) EMG signals are by nature < 10mV. (b) 60 Hz power line signals may be > 50mV with poor electrode cable conditions; with careful routing much of the signal is common to both reference and active electrode and rejected in the differential amplifier with <50mV remaining. (c) An unwanted (to the neural recorder) stimulation signal is attenuated from stimulation to sensory electrode. The voltage seen at the sensory electrode can be modeled Φ_m=I_o/4πσr. For a 1 mA stimulation signal, with 1 cm spacing between electrodes, the signal is <20mV at the headstage. Headstage ASIC design: The front end ASIC design is designed to produce < 1% THD at 50mV input; 50 times higher than typical headstage ASICs, with no increase in noise floor. This requires careful balance of amplifier stages in the headstage ASIC, as well as consideration of the electrodes effect on noise. The ASIC is designed to allow extremely small signal extraction on low impedance (< 10kohm) electrodes with configuration of the headstage ASIC noise floor to < 700nV/rt-Hz. Smaller high impedance electrodes (> 100kohm) are typically located closer to neural sources and transduce higher amplitude signals (> 10uV); the ASIC low-power mode conserves power with 2uV/rt-Hz noise. Findings: The enhanced neural processing ASIC has been compared with a commercial neural recording amplifier IC. Chronically implanted primates at MGH demonstrated the presence of commercial neural amplifier saturation as a result of large environmental artifacts. The enhanced artifact suppression headstage ASIC, in the same setup, was able to recover and process the wanted neural signal separately from the suppressed unwanted artifacts. Separately, the enhanced artifact suppression headstage ASIC was able to separate sensory neural signals from unwanted artifacts in mouse-implanted peripheral intrafascicular electrodes. Conclusion: Optimizing headstage ASICs allow observation of neural signals in the presence of large artifacts that will be present in real-life implanted applications, and are targeted toward human implantation in the DARPA HAPTIX program.

Keywords: ASIC, biosensors, biomedical signal processing, biomedical sensors

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Authors: Pawan Hinge, Priya Gupta

Abstract:

Due to cutting edge competitions between organizations and war for talent, the workforce as an asset is gaining significance. The employees are considered as the brand ambassadors of an organization, and their interactions with the clients and customers might impact directly or indirectly on the overall value of the organization. Especially, organizations in the healthcare industry the value of an organization in the perception of their employees can be one of the revenue generating and talent retention strategy. In such context, it is essential to understand that the brand awareness among employees can effect on employer brand image and brand value since the brand ambassadors are the interface between organization and customers and clients. In this exploratory study, we have adopted both quantitative and qualitative approaches for data analysis. Our study shows existing variation among nurses working in different business units of the same organization in terms of their customer interface or interactions and brand awareness.

Keywords: brand awareness, brand image, brand value, customer interface

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Authors: Madhura Bapat, Uma Krishnan

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Exploring the redefinition of masculinity through the experiences of male Indian classical dancers, this qualitative research focuses on their perceived quality of life, psychosocial challenges, and coping strategies. This study aims to explore the mental health nuances of male Indian classical dancers through an in-depth understanding of their lived experiences with dance. The benefits and personal journeys of dancers, particularly in Indian classical forms, reveal insights into culture, gender, and societal expectations. Men in Indian classical dance frequently encounter stigma due to prevailing gender norms in the arts and society. Acknowledgment of these experiences is key to understanding issues of identity, mental wellness, and communal acceptance of male Indian classical dancers in the Indian dance scenario. This study follows an interpretive phenomenological approach to follow the lived experiences of male Indian classical dancers. Male Indian classical dancers were selected using criterion-based sampling. The participants are male, fluent in English and pursue Indian classical dance styles professionally, like Kathak, Bharatanatyam, Chhau, etc. Six participants were recruited for personal, semi-structured, in-depth interviews. A focus group discussion with four participants was conducted to explore the stigma surrounding their roles. The data were analyzed using interpretive phenomenological analysis (IPA), revealing superordinate themes of (1) identity fragmentation and negotiation in gendered social contexts; (2) gendered constraints and artistic expression; (3) psychosocial distress and mental health challenges; (4) coping mechanisms and resilience; and (5) stigmatization and social integration dynamics. Male Indian classical dancers grapple with identity formation, navigating a paradox of self-perception, artistic identity, and societal expectation. They reported experiencing emasculation, compromising artistic expression, and struggling with gender norms and gendered training constraints. They have faced name-calling, bullying, taunting, slandering, and discrimination. These experiences have led to psychological challenges and distress. However, the paradox continues as male dancers use adaptive coping strategies despite the adversities that intertwine self-perception, societal pressures, and their passion for dance. This research sheds light on the intersection of gender, mental health, and art. These findings provide a strong foundation for making changes in the dance community for acceptance of male dancers, policy making for better job opportunities for male dancers and mental health services to be provided to help them deal with distress. The study offers valuable insights into how male classical dancers navigate stigma and mental health challenges in gendered social contexts, contributing to a deeper understanding of identity formation in the arts.

Keywords: gendered experiences, Indian classical dance, male dancers, mental health, stigma

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Authors: Sophie-Bo Heinkel, Andrea Rechenburg, Thomas Kistemann

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The current status of wellbeing and life satisfaction of subsistence farmers in a wetland in Uganda and the contributing role of place attachment has been assessed. The aim of this study is to shed light on environmental factors supporting wellbeing in a wetland setting. Furthermore, it has been assessed, how the emotional bonding to the wetland as ‘place’ influences the peoples’ wellbeing and life satisfaction. The results shed light on the human-environment-relationship. A survey was carried out in three communities in urban and rural areas in a wetland basin in Uganda. A sample (n=235) provided information about the attachment to the wetland, the participants’ relation to the place of their residence and their emotional wellbeing. The Wellbeing Index (WHO-5) was assessed as well as the Perceived Stress Scale (PSS-10) and Rosenberg’s Self-Esteem scale (RSE). Furthermore, the Satisfaction With Life Scale (SWLS) was applied as well as the Place Attachment Inventory (PAI), which consists of the two intertwined dimensions of place identity and place dependence. Beside this, binary indicators as ‘feeling save’ and ‘feeling comfortable’ and ‘enjoying to live at the place of residence’ have been assessed. A bivariate correlation analysis revealed a high interconnectivity between all metric scales. Especially, the subscale ‘place identity’ showed significances with all other scales. A cluster analysis revealed three groups, which differed in the perception of place-related indicators and their attachment to the wetland as well as the status of wellbeing. First, a cluster whose majority is dissatisfied with their lives, but mainly had a good status of emotional well-being. This group does not feel attached to the wetland and lives in a town. Comparably less persons of this group feel safe and comfortable at their place of residence. In the second cluster, persons feel highly attached to the wetland and identify with it. This group was characterized by the high number of persons preferring their current place of residence and do not consider moving. All persons feel well and satisfied with their lives. The third group of persons is mainly living in rural areas and feels highly attached to the wetland. They are satisfied with their lives, but only a small minority is in a good emotional state of wellbeing. The emotional attachment to a place influences life satisfaction and, indirectly, the emotional wellbeing. In the present study it could be shown that subsistence farmers are attached to the wetland, as it is the source of their livelihood. While those living in areas with a good infrastructure are less dependent on the wetland and, therefore, less attached to. This feeling also was mirrored in the perception of a place as being safe and comfortable. The identification with a place is crucial for the feeling of being at “home”. Subsistence farmers feel attached to the ecosystem, but they also might be exposed to environmental and social stressors influencing their short-term emotional wellbeing. The provision of place identity is an ecosystem service provided by wetlands, which supports the status of wellbeing in human beings.

Keywords: mental health, positive environments, quality of life, wellbeing

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Authors: Kelsi Hagerty, Ami Rosen, Aaliyah Heyward, Nadia Ali, Emily Brown, Erin Demo, Yue Guan, Modele Ogunniyi, Brianna McDaniels, Alanna Morris, Kunal Bhatt

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Hereditary transthyretin amyloidosis (hATTR) is a progressive, multi-systemic, and life-threatening disease caused by a disruption in the TTR protein that delivers thyroxine and retinol to the liver. This disruption causes the protein to misfold into amyloid fibrils, leading to the accumulation of the amyloid fibrils in the heart, nerves, and GI tract. Over 130 variants in the TTR gene are known to cause hATTR. The Val122Ile variant is the most common in the United States and is seen almost exclusively in people of African descent. TTR variants are inherited in an autosomal dominant fashion and have incomplete penetrance and variable expressivity. Individuals with hATTR may exhibit symptoms from as early as 30 years to as late as 80 years of age. hATTR is characterized by a wide range of clinical symptoms such as cardiomyopathy, neuropathy, carpal tunnel syndrome, and GI complications. Without treatment, hATTR leads to progressive disease and can ultimately lead to heart failure. hATTR disproportionately affects individuals of African descent; the estimated prevalence of hATTR among Black individuals in the US is 3.4%. Unfortunately, hATTR is often underdiagnosed and misdiagnosed because many symptoms of the disease overlap with other cardiac conditions. Due to the progressive nature of the disease, multi-systemic manifestations that can lead to a shortened lifespan, and the availability of free genetic testing and promising FDA-approved therapies that enhance treatability, early identification of individuals with a pathogenic hATTR variant is important, as this can significantly impact medical management for patients and their relatives. Furthermore, recent literature suggests that TTR genetic testing should be performed in all patients with suspicion of TTR-related cardiomyopathy, regardless of age, and that follow-up with genetic counseling services is recommended. Relatives of patients with hATTR benefit from genetic testing because testing can identify carriers early and allow relatives to receive regular screening and management. Despite the striking prevalence of hATTR among Black individuals, hATTR remains underdiagnosed in this patient population, and germline genetic testing for hATTR in Black individuals seems to be underrepresented, though the reasons for this have not yet been brought to light. Historically, Black patients experience a number of barriers to seeking healthcare that has been hypothesized to perpetuate the underdiagnosis of hATTR, such as lack of access and mistrust of healthcare professionals. Prior research has described a myriad of factors that shape an individual’s decision about whether to pursue presymptomatic genetic testing for a familial pathogenic variant, such as family closeness and communication, family dynamics, and a desire to inform other family members about potential health risks. This study explores these factors through 10 in-depth interviews with patients with hATTR about what factors may be contributing to the underdiagnosis of hATTR in the Black population. Participants were selected from the Emory University Amyloidosis clinic based on having a molecular diagnosis of hATTR. Interviews were recorded and transcribed verbatim, then coded using MAXQDA software. Thematic analysis was completed to draw commonalities between participants. Upon preliminary analysis, several themes have emerged. Barriers identified include i) Misdiagnosis and a prolonged diagnostic odyssey, ii) Family communication and dynamics surrounding health issues, iii) Perceptions of healthcare and one’s own health risks, and iv) The need for more intimate provider-patient relationships and communication. Overall, this study gleaned valuable insight from members of the Black community about possible factors contributing to the underdiagnosis of hATTR, as well as potential solutions to go about resolving this issue.

Keywords: cardiac amyloidosis, heart failure, TTR, genetic testing

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Authors: Mohammed Eltayeb Salih Elamin

Abstract:

This study discusses the concept of the artificial heart using engineering concepts, of the fluid mechanics and the characteristics of the non-Newtonian fluid. For the purpose to serve heart patients and improve aspects of their lives and since the Statistics review according to world health organization (WHO) says that heart disease and blood vessels are the first cause of death in the world. Statistics shows that 30% of the death cases in the world by the heart disease, so simply we can consider it as the number one leading cause of death in the entire world is heart failure. And since the heart implantation become a very difficult and not always available, the idea of the artificial heart become very essential. So it’s important that we participate in the developing this idea by searching and finding the weakness point in the earlier designs and hoping for improving it for the best of humanity. In this study a pump was designed in order to pump blood to the human body and taking into account all the factors that allows it to replace the human heart, in order to work at the same characteristics and the efficiency of the human heart. The pump was designed on the idea of the diaphragm pump. Three models of blood obtained from the blood real characteristics and all of these models were simulated in order to study the effect of the pumping work on the fluid. After that, we study the properties of this pump by using Ansys15 software to simulate blood flow inside the pump and the amount of stress that it will go under. The 3D geometries modeling was done using SOLID WORKS and the geometries then imported to Ansys design modeler which is used during the pre-processing procedure. The solver used throughout the study is Ansys FLUENT. This is a tool used to analysis the fluid flow troubles and the general well-known term used for this branch of science is known as Computational Fluid Dynamics (CFD). Basically, Design Modeler used during the pre-processing procedure which is a crucial step before the start of the fluid flow problem. Some of the key operations are the geometry creations which specify the domain of the fluid flow problem. Next is mesh generation which means discretization of the domain to solve governing equations at each cell and later, specify the boundary zones to apply boundary conditions for the problem. Finally, the pre–processed work will be saved at the Ansys workbench for future work continuation.

Keywords: Artificial heart, computational fluid dynamic heart chamber, design, pump

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Authors: Razieh Zarei, Hassan zm, Abolghasem Ajami, Darush Moslemi, Narges Afsary, Amrollah Mostafa-zade

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Introduction: IL-23 is responsible for the differentiation and expansion of Th17/ThIL-17 cells from naive CD4+ T cells. Therefore, may be IL-23/IL17 axis involve in a variety of allergic and autoimmune diseases, such as RA, MS, inflammatory bowel disease (IBD), and asthma. TGF-β is also share for the differentiation Th17 producing IL-17 and CD4+CD25+Foxp3hiT regulatory cells from naïve CD4+ T cells which are involved in the regulation of immune response, maintaining immunological self-tolerance and immune homeostasis ,and the control of autoimmunity and cancer surveillance. Therefore, T regulatory cells play a key role in autoimmunity, allergy, cancer, infectious disease, and the induction of transplantation tolerance. Vitamin A and it's derivatives (retinoids) inhibit or reverse the carcinogenic process in some types of cancers in oral cavity,head and neck, breast, skin, liver, and blood cells. Shark is a murine organism and its cartilage has antitumor peptides to prevent angiogenesis, in vitro. Our purpose is whether simultaneous oral treatment vitamin A and shark cartilage can modulate IL-23/IL-17 and CD4CD25Foxp3 T regulatory cell/TGF-β pathways and Th1/Th2 immunity in patients with gastric cancer. Materials and Methods: First investigated an imbalanced supernatant of cytokines exist in patients with gastric cancer by ELISA. Associated with cytokines measuring such as IL-23,IL-17,TGF-β,IL-4 and γ-IFN, then flow cytometry was employed to determine whether the peripheral blood mononuclear cells such as CD4+CD25+Foxp3highT regulatory cells in patients with gastric cancer were changed correspondingly. Results: An imbalance between IL-17 secretion and TGF-β/Foxp3 t regulatory cell pathway and so, Th1 immunity (γ-IFN production) and TH2 immunity (IL-4 secretion) was not seen in patients with gastric cancer treated by vitamin A and shark cartilage. But, the simultaneously presented down-regulation of IL-23 indicated, at least cytokine level. Conclusion: Il-23, as a pro-angiogenesis cytokine, probably, help to tumor growth. Hence, suggested that down-regulation of IL-23, at least cytokine level, is useful for anti-tumor immune responses in patients with gastric cancer.

Keywords: IL-23/IL17 axis, TGF-β/CD4CD25Foxp3 T regulatory pathway, γ-IFN, IL-4, shark cartilage and gastric cancer

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Authors: Shahruhaida Adayu Mohd Paili, Abd Latif Abdul Rahman, Asmadi Mohammed Ghazali

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Digital library was developed by many organizations, especially universities. The digital library can be considered as a new information system. Digital library brings many benefits to the users. There are many researches that have investigated the importance of the digital library, the acceptance, and continuance use of digital library. The investigation towards the digital library is important and it is crucial to understand the reason why users accept and continued use of digital library. Users can search the information and available resources through the digital library website. It is important to know the user’s perception towards the aesthetics of the digital library. Besides that, because of digital library provided information to the users, the researcher also needed to investigate the quality of information in digital library. This study used Extending the Unified Theory of Acceptance and Use of Technology (UTAUT2) in order to know the user’s intention to continued use of digital library.

Keywords: digital library, aesthetics, information quality, intention to continued use of digital library, UTAUT2

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Authors: Muhammad Munir, Riffat Mehboob, Samina Naeem, Muhammad Salman, Shehryar Ahmed, Irshad Hussain Qureshi, Tahira Murtaza Cheema, Ashraf Sultan, Akmal Laeeq, Nakhshab Choudhry, Asad Aslam Khan, Fridoon Jawad Ahmad

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A dengue outbreak in Lahore, Pakistan during 2011 was unprecedented in terms of severity and magnitude. This research aims to determine the serotype distribution of dengue virus during this outbreak and classify the patients demographically. 5ml of venous blood was drawn aseptically from 166 patients with dengue-like signs to test for the virus between the months of August to November 2011. The samples were sent to the CDC, Atlanta, Georgia for the purpose of molecular assays to determine their serotype. RT-PCR protocol was performed targeting at the 4 dengue serotypes. Out of 166 cases, dengue infection was detected with RT-PCR in 95 cases, all infected with same serotype DEN-2. 75% of positive cases were males while 25% were females. Most positive patients were in the age range of 16-30 years. 33% positive cases had accompanying bleeding. This is first study during the 2011 dengue epidemic in Lahore that reports DEN-2 as the only prevalent serotype. It also indicates that more infected patients were males, adults, within age range of 16-30 years, peaked in the month of November, Dengue hemorrhagic fever (DHF) is manifested more in females, Ravi town was heavily hit by dengue virus infection.

Keywords: dengue, serotypes, Pakistan, DEN 2, Lahore, demography, serotype distrbution, 2011 epidemic

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Authors: Amenah Dhannoon, Ciaran Martin Hurley, Laura Wrafter, Podraic J. Regan

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Introduction: The COVID-19 pandemic continues to present unprecedented challenges for healthcare systems. This has resulted in the pragmatic shift in the practice of plastic surgery units worldwide. During this period, many units reported a significant fall in urgent melanoma referrals, leading to patients presenting with advanced disease requiring more extensive surgery and inferior outcomes. Our objective was to evaluate our unit's experience with both non-invasive and invasive melanoma during the COVID-19 pandemic and characterize our experience and contrast it to that experienced by our neighbors in the UK, mainland Europe and North America. Methods: a retrospective chart review was performed on all patients diagnosed with invasive and non-invasive cutaneous melanoma between March to December of 2019 (control) compared to 2020 (COVID-19 pandemic) in a single plastic surgery unit in Ireland. Patient demographics, referral source, surgical procedures, tumour characteristics, radiological findings, oncological therapies and follow-up were recorded. All data were anonymized and stored in Microsoft Excel. Results: A total of 589 patients were included in the study. Of these, 314 (53%) with invasive melanoma, compared to 275 (47%) with the non-invasive disease. Overall, more patients were diagnosed with both invasive and non-invasive melanoma in 2020 than in 2019 (p<0.05). However, significantly longer waiting times in 2020 (64 days) compared to 2019 (28 days) (p<0.05), with the majority of the referral being from GP in 2019 (83%) compared to 61% in 2020. Positive sentinel lymph node were higher in 2019 at 56% (n=28) compared to 24% (n=22) in 2020. There was no statistically significant difference in the tutor characteristics or metastasis status. Discussion: While other countries have noticed a fall in the melanoma diagnosis. Our units experienced a higher number of disease diagnoses. This can be due to multiple reasons. In Ireland, the government reached an early agreement with the private sector to continue elective surgery on an urgent basis in private hospitals. This allowed access to local anesthetic procedures and local skin cancer cases were triaged to non-COVID-19 provider centers. Our unit also adapted a fast, effective and minimal patient contact strategy for triaging skin cancer based on telemedicine. Thirdly, a skin cancer nurse specialist maintained patient follow-ups and triaging a dedicated email service. Finally, our plastic surgery service continued to maintain a virtual complex skin cancer multidisciplinary team meeting during the pandemic, ensuring local clinical governance has adhered to each clinical case. Conclusion: Our study highlights that with the prompt efficient restructuring of services, we could reserve successful management of skin cancer even in the most devastating times. It is important to reflect on the success during the pandemic and emphasize the importance of preparation for a potentially difficult future

Keywords: malignant melanoma, skin cancer, COVID-19, triage

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Authors: Mustafa M. Donma, Orkide Donma

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Obesity is defined as a severe chronic disease characterized by a low-grade inflammatory state. Therefore, inflammatory markers gained utmost importance during the evaluation of obesity and metabolic syndrome (MetS), a disease characterized by central obesity, elevated blood pressure, increased fasting blood glucose and elevated triglycerides or reduced high density lipoprotein cholesterol (HDL-C) values. Some inflammatory markers based upon complete blood cell count (CBC) are available. In this study, it was questioned which inflammatory marker was the best to evaluate the differences between various obesity groups. 514 pediatric individuals were recruited. 132 children with MetS, 155 morbid obese (MO), 90 obese (OB), 38 overweight (OW) and 99 children with normal BMI (N-BMI) were included into the scope of this study. Obesity groups were constituted using age- and sex-dependent body mass index (BMI) percentiles tabulated by World Health Organization. MetS components were determined to be able to specify children with MetS. CBC were determined using automated hematology analyzer. HDL-C analysis was performed. Using CBC parameters and HDL-C values, ratio markers of inflammation, which cover neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte-to-HDL-C ratio (MHR) were calculated. Statistical analyses were performed. The statistical significance degree was considered as p < 0.05. There was no statistically significant difference among the groups in terms of platelet count, neutrophil count, lymphocyte count, monocyte count, and NLR. PLR differed significantly between OW and N-BMI as well as MetS. Monocyte-to HDL-C value exhibited statistical significance between MetS and N-BMI, OB, and MO groups. HDL-C value differed between MetS and N-BMI, OW, OB, MO groups. MHR was the ratio, which exhibits the best performance among the other CBC-based inflammatory markers. On the other hand, when MHR was compared to HDL-C only, it was suggested that HDL-C has given much more valuable information. Therefore, this parameter still keeps its value from the diagnostic point of view. Our results suggest that MHR can be an inflammatory marker during the evaluation of pediatric MetS, but the predictive value of this parameter was not superior to HDL-C during the evaluation of obesity.

Keywords: children, complete blood cell count, high density lipoprotein cholesterol, metabolic syndrome, obesity

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Authors: Annette Davies

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This paper examines a collection of four fan letters written by two fans to the early film star, Lillian Gish. The letters were sent to Gish between 1929 and 1962 and were later archived at the New York Library of Performing Arts in Manhattan, New York. This paper also analyzes the media's portrayal of Gish during the time period of these written letters in order to identify parallels between the portrayal of Gish in the media and the perception of Gish by her fans, which is espoused in these fan letters. The media analyzed includes newspapers, fan magazines, Paine's 1932 biography Life and Lillian Gish, a film publicity poster for Gish's film Intolerance, and the film roles performed by Gish. Several parallels are found and assessed using the four processes of audience involvement with a media persona-transportation, parasocial interaction, identification, and worship.

Keywords: celebrity, congruency, fan, persona

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