Search results for: vaccine preventable
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 296

Search results for: vaccine preventable

176 Phage Display-Derived Vaccine Candidates for Control of Bovine Anaplasmosis

Authors: Itzel Amaro-Estrada, Eduardo Vergara-Rivera, Virginia Juarez-Flores, Mayra Cobaxin-Cardenas, Rosa Estela Quiroz, Jesus F. Preciado, Sergio Rodriguez-Camarillo

Abstract:

Bovine anaplasmosis is an infectious, tick-borne disease caused mainly by Anaplasma marginale; typical signs include anemia, fever, abortion, weight loss, decreased milk production, jaundice, and potentially death. Sick bovine can recover when antibiotics are administered; however, it usually remains as carrier for life, being a risk of infection for susceptible cattle. Anaplasma marginale is an obligate intracellular Gram-negative bacterium with genetic composition highly diverse among geographical isolates. There are currently no vaccines fully effective against bovine anaplasmosis; therefore, the economic losses due to disease are present. Vaccine formulation became a hard task for several pathogens as Anaplasma marginale, but peptide-based vaccines are an interesting proposal way to induce specific responses. Phage-displayed peptide libraries have been proved one of the most powerful technologies for identifying specific ligands. Screening of these peptides libraries is also a tool for studying interactions between proteins or peptides. Thus, it has allowed the identification of ligands recognized by polyclonal antiserums, and it has been successful for the identification of relevant epitopes in chronic diseases and toxicological conditions. Protective immune response to bovine anaplasmosis includes high levels of immunoglobulins subclass G2 (IgG2) but not subclass IgG1. Therefore, IgG2 from the serum of protected bovine can be useful to identify ligands, which can be part of an immunogen for cattle. In this work, phage display random peptide library Ph.D. ™ -12 was incubating with IgG2 or blood sera of immunized bovines against A. marginale as targets. After three rounds of biopanning, several candidates were selected for additional analysis. Subsequently, their reactivity with sera immunized against A. marginale, as well as with positive and negative sera to A. marginale was evaluated by immunoassays. A collection of recognized peptides tested by ELISA was generated. More than three hundred phage-peptides were separately evaluated against molecules which were used during panning. At least ten different peptides sequences were determined from their nucleotide composition. In this approach, three phage-peptides were selected by their binding and affinity properties. In the case of the development of vaccines or diagnostic reagents, it is important to evaluate the immunogenic and antigenic properties of the peptides. Immunogenic in vitro and in vivo behavior of peptides will be assayed as synthetic and as phage-peptide for to determinate their vaccine potential. Acknowledgment: This work was supported by grant SEP-CONACYT 252577 given to I. Amaro-Estrada.

Keywords: bovine anaplasmosis, peptides, phage display, veterinary vaccines

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175 Enhancing Nursing Students’ Communication Using TeamSTEPPS to Improve Patient Safety

Authors: Stefanie Santorsola, Natasha Frank

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Improving healthcare safety necessitates examining current trends and beliefs about safety and devising strategies to improve. Errors in healthcare continue to increase and be experienced by patients, which is preventable and directly correlated to a breakdown in healthcare communication. TeamSTEPPS is an evidence-based process designed to improve the quality and safety of healthcare by improving communication and team processes. Communication is at the core of effective team collaboration and is vital for patient safety. TeamSTEPPS offers insights and strategies for improving communication and teamwork and reducing preventable errors to create a safer healthcare environment for patients. The academic, clinical, and educational environment for nursing students is vital in preparing them for professional practice by providing them with foundational knowledge and abilities. This environment provides them with a prime opportunity to learn about errors and the importance of effective communication to enhance patient safety, as nursing students are often unprepared to deal with errors. Proactively introducing and discussing errors through a supportive culture during the nursing student’s academic beginnings has the potential to carry key concepts into practice to improve and enhance patient safety. TeamSTEPPS has been used globally and has collectively positively impacted improvements in patient safety and teamwork. A workshop study was introduced in winter 2023 of registered practical nurses (RPN) students bridging to the baccalaureate nursing program; the majority of the RPNs in the bridging program were actively employed in a variety of healthcare facilities during the semester. The workshop study did receive academic institution ethics board approval, and participants signed a consent form prior to participating in the study. The premise of the workshop was to introduce TeamSTEPPS and a variety of strategies to these students and have students keep a reflective journal to incorporate the presented communication strategies in their practicum setting and keep a reflective journal on the effect and outcomes of the strategies in the healthcare setting. Findings from the workshop study supported the objective of the project, resulting in students verbalizing notable improvements in team functioning in the healthcare environment resulting from the incorporation of enhanced communication strategies from TeamSTEPPS that they were introduced to in the workshop study. Implication for educational institutions is the potential of further advancing the safety literacy and abilities of nursing students in preparing them for entering the workforce and improving safety for patients.

Keywords: teamstepps, education, patient safety, communication

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174 The Awareness of Cardiovascular Diseases among General Population in Western Regions of Saudi Arabia

Authors: Ali Saeed Alghamdi, Basel Mazen Alsolami, Basel Saeed Alghamdi, Muhanad Saleh Alzahrani Alamri, Salman Anwar Thabet, Abdulhalim J. Kinsara

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Objectives: This study measures the knowledge of the cardiovascular disease among the general population in western regions of Saudi Arabia, and it aimed to increase the level of awareness about cardiovascular diseases among the general population by providing an awareness lecture that included information about the risk factors, major symptoms, and prevention of cardiovascular diseases. The lecture has been attached at the end of the questionnaire. Setting: This study was conducted through an online questionnaire that included our aim and main objectives that targeted the general population in the Western regions of Saudi Arabia (Makkah and Madinah regions). Participants: This study participants were 460 collected through an online questionnaire. Methods: All Saudi citizens and residents who live in the western region of Saudi Arabia aged 18 years and above will be invited to participate voluntarily. A pre-structured questionnaire was designed to collect data on age, gender, marital status, education level, occupation, lifestyle habits, and history of heart diseases, with cardiac symptoms and risk factors sections. Results: The majority of respondents were females (74.8%) and Saudis. The knowledge about cardiovascular disease risk factors was weak. Only (18.5%) scores an excellent response regarding risk factors awareness. Lack of exercise, stress, and obesity were the most known risk factors. Regarding cardiovascular disease symptoms, chest pain scores the highest symptom (87.6%) among other symptoms like dyspnea, syncope, and excessive sweating. Participants revealed a poor awareness regarding cardiovascular disease symptoms also (0.9%). However, preventable factors for cardiovascular diseases were more knowledgeable than others categories in this study (60% fall into excellent knowledge). Smoking cessation, normal cholesterol level, and normal blood pressure score the highest preventable methods (92.2%), (88.6%), and (78.7%) respectively. 83.7% of the participant have attended the awareness lecture, and 99 of the attendees reported that the lecture increased their knowledge about cardiovascular disease. Conclusion: This study discussed the level of community awareness of cardiovascular disease in terms of symptoms, risk factors, and protective factors. We found a huge lack of the participant's level of knowledge about the disease and how to prevent it. Moreover, we measure the prevalence of the comorbidities among our participants (diabetes, hypertension, hypercholesterolemia/ hypertriglyceridemia) and their extent of adherence to their medication. In conclusion, this study not only demonstrates awareness of cardiovascular disease risk factors, symptoms, management, and the association between each domain but also provides educational material. Further educational material and campaigns are required to increase awareness and knowledge about cardiovascular diseases.

Keywords: awareness, cardiovascular diseases, education, prevention, risk factors

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173 Going Viral: Expanding a Student-Run COVID-19 Journal Club to Social Media

Authors: Joseph Dodson, Robert Roth, Alexander Hodakowski, Leah Greenfield, Melissa Porterhouse, Natalie Maltby, Rachel Sadowsky

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Introduction: Throughout the COVID-19 pandemic, countless research publications were released regarding SARS-CoV-2 and its variants, suggested treatments, and vaccine safety and efficacy. Daily publication of research became overwhelming for health professionals and the general public to stay informed. To address this problem, a group of 70 students across the four colleges at Rush University created the “Rush University COVID-19 Journal Club.” To broaden the available audience, the journal club then expanded to social media. Methods: Easily accessible and understandable summaries of the research were written by students and sent to faculty sponsors for feedback. Following the revision, summaries were published weekly on the Rush University COVID-19 Journal Club website for clinicians and students to use for reference. An Instagram page was then created, and information was further condensed into succinct posts to address COVID-19 “FAQs.” Next, a survey was distributed to followers of the Instagram page with questions meant to assess the effectiveness of the platform and gain feedback. A 5-point Likert scale was used as the primary question format. Results: The Instagram page accrued 749 followers and posted 52 unique posts over a 2 year period. Preliminary results from the surveys demonstrate that over 80% of respondents strongly agree that the Instagram posts 1) are an effective platform for the public presentation of factual COVID-19-related information; 2) provide relevant and valuable information; 3) provide information that is clear, concise, and can be easily understood. Conclusion: These results suggest that the Rush COVID-19 Journal Club was able to successfully create a social media presence and convey information without sacrificing scholarly integrity. Other academic institutions may benefit from the application of this model to help students and clinicians with the interpretation and evaluation of research topics with large bodies of evidence.

Keywords: SARS-CoV-2, COVID-19, public health, social media, SARS-CoV-2 vaccine, SARS-CoV-2 variants

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172 Absolute Quantification of the Bexsero Vaccine Component Factor H Binding Protein (fHbp) by Selected Reaction Monitoring: The Contribution of Mass Spectrometry in Vaccinology

Authors: Massimiliano Biagini, Marco Spinsanti, Gabriella De Angelis, Sara Tomei, Ilaria Ferlenghi, Maria Scarselli, Alessia Biolchi, Alessandro Muzzi, Brunella Brunelli, Silvana Savino, Marzia M. Giuliani, Isabel Delany, Paolo Costantino, Rino Rappuoli, Vega Masignani, Nathalie Norais

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The gram-negative bacterium Neisseria meningitidis serogroup B (MenB) is an exclusively human pathogen representing the major cause of meningitides and severe sepsis in infants and children but also in young adults. This pathogen is usually present in the 30% of healthy population that act as a reservoir, spreading it through saliva and respiratory fluids during coughing, sneezing, kissing. Among surface-exposed protein components of this diplococcus, factor H binding protein is a lipoprotein proved to be a protective antigen used as a component of the recently licensed Bexsero vaccine. fHbp is a highly variable meningococcal protein: to reflect its remarkable sequence variability, it has been classified in three variants (or two subfamilies), and with poor cross-protection among the different variants. Furthermore, the level of fHbp expression varies significantly among strains, and this has also been considered an important factor for predicting MenB strain susceptibility to anti-fHbp antisera. Different methods have been used to assess fHbp expression on meningococcal strains, however, all these methods use anti-fHbp antibodies, and for this reason, the results are affected by the different affinity that antibodies can have to different antigenic variants. To overcome the limitations of an antibody-based quantification, we developed a quantitative Mass Spectrometry (MS) approach. Selected Reaction Monitoring (SRM) recently emerged as a powerful MS tool for detecting and quantifying proteins in complex mixtures. SRM is based on the targeted detection of ProteoTypicPeptides (PTPs), which are unique signatures of a protein that can be easily detected and quantified by MS. This approach, proven to be highly sensitive, quantitatively accurate and highly reproducible, was used to quantify the absolute amount of fHbp antigen in total extracts derived from 105 clinical isolates, evenly distributed among the three main variant groups and selected to be representative of the fHbp circulating subvariants around the world. We extended the study at the genetic level investigating the correlation between the differential level of expression and polymorphisms present within the genes and their promoter sequences. The implications of fHbp expression on the susceptibility of the strain to killing by anti-fHbp antisera are also presented. To date this is the first comprehensive fHbp expression profiling in a large panel of Neisseria meningitidis clinical isolates driven by an antibody-independent MS-based methodology, opening the door to new applications in vaccine coverage prediction and reinforcing the molecular understanding of released vaccines.

Keywords: quantitative mass spectrometry, Neisseria meningitidis, vaccines, bexsero, molecular epidemiology

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171 Prospective Service Evaluation of Physical Healthcare In Adult Community Mental Health Services in a UK-Based Mental Health Trust

Authors: Gracie Tredget, Raymond McGrath, Karen Ang, Julie Williams, Nick Sevdalis, Fiona Gaughran, Jorge Aria de la Torre, Ioannis Bakolis, Andy Healey, Zarnie Khadjesari, Euan Sadler, Natalia Stepan

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Background: Preventable physical health problems have been found to increase morbidity rates amongst adults living with serious mental illness (SMI). Community mental health clinicians have a role in identifying, and preventing physical health problems worsening, and supporting primary care services to administer routine physical health checks for their patients. However, little is known about how mental health staff perceive and approach their role when providing physical healthcare amongst patients with SMI, or the impact these attitudes have on routine practice. Methods: The present study involves a prospective service evaluation specific to Adult Community Mental Health Services at South London and Maudsley NHS Foundation Trust (SLaM). A qualitative methodology will use semi-structured interviews, focus groups and observations to explore attitudes, perceptions and experiences of staff, patients, and carers (n=64) towards physical healthcare, and barriers or facilitators that impact upon it. 1South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK 2 Centre for Implementation Science, King’s College London, London, SE5 8AF, UK 3 Psychosis Studies, King's College London, London, SE5 8AF, UK 4 Department of Biostatistics and Health Informatics, King’s College London, London, SE5 8AF, UK 5 Kings Health Economics, King's College London, London, SE5 8AF, UK 6 Behavioural and Implementation Science (BIS) research group, University of East Anglia, Norwich, UK 7 Department of Nursing, Midwifery and Health, University of Southampton, Southampton, UK 8 Mind and Body Programme, King’s Health Partners, Guy’s Hospital, London, SE1 9RT *[email protected] Analysis: Data from across qualitative tasks will be synthesised using Framework Analysis methodologies. Staff, patients, and carers will be invited to participate in co-development of recommendations that can improve routine physical healthcare within Adult Community Mental Health Teams at SLaM. Results: Data collection is underway at present. At the time of the conference, early findings will be available to discuss. Conclusions: An integrated approach to mind and body care is needed to reduce preventable deaths amongst people with SMI. This evaluation will seek to provide a framework that better equips staff to approach physical healthcare within a mental health setting.

Keywords: severe mental illness, physical healthcare, adult community mental health, nursing

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170 Model Based Optimization of Workplace Ergonomics by Workpiece and Resource Positioning

Authors: Edward Hage, Pieter Lietaert, Gabriel Abedrabbo

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Musculoskeletal disorders are an important category of work-related diseases. They are often caused by working in non-ergonomic postures and are preventable with proper workplace design, possibly including human-machine collaboration. This paper presents a methodology and a supporting software prototype to design a simple assembly cell with minimal ergonomic risk. The methodology helps to determine the optimal position and orientation of workpieces and workplace resources for specific operator assembly actions. The methodology is tested on an industrial use case: a collaborative robot (cobot) assisted assembly of a clamping device. It is shown that the automated methodology results in a workplace design with significantly reduced ergonomic risk to the operator compared to a manual design of the cell.

Keywords: ergonomics optimization, design for ergonomics, workplace design, pose generation

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169 Co-Factors of Hypertension and Decomposition of Inequalities in Its Prevalence in India: Evidence from NFHS-4

Authors: Ayantika Biswas

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Hypertension still remains one of the most important preventable contributors to adult mortality and morbidity and a major public health challenge worldwide. Studying regional and rural-urban differences in prevalence and assessment of the contributions of different indicators is essential in determining the drivers of this condition. The 2015-16 National Family Health Survey data has been used for the study. Bivariate analysis, multinomial regression analysis, concentration indices and decomposition of concentration indices assessing contribution of factors has been undertaken in the present study. An overall concentration index of 0.003 has been found for hypertensive population, which shows its concentration among the richer wealth quintiles. The contribution of factors like age 45 to 49 years, years of schooling between 5 to 9 years are factors that are important contributors to inequality in hypertension occurrence. Studies should be conducted to find approaches to prevent or delay the onset of the condition.

Keywords: hypertension, decomposition, inequalities, India

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168 Investigation of Occupational Health and Safety of Bakeries in Izmir, Turkey

Authors: Pinar Ercan, Bulut Mert

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The baking industry is prone to occupational health challenges like other industries. Workers in bakeries face many hazards in their work environment; hazards have the potential for causing injury, illness or work accidents. Most of these hazards are preventable and arise from the neglect of occupational safety measures. Some bakeries in Izmır Turkey was evaluated according to occupational health and safety. First of all, the production process was evaluated. The survey was administered to a total of 50 employees. The survey consisted of two sections. The first one comprised only demographic questions and items related to job characteristics. The remaining section was assessing the satisfaction and confidence about occupational health and safety in terms of employees consist of a 10-item questionnaire by using HSE (2010) survey with some modifications. Also, hazards, risks and control measures in the bakeries were determined. Risk assessment has been done by the use of '5x5 Risk Assessment Table' for this purpose.

Keywords: bakeries, occupational health and safety, hazards, risks, risk assessment

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167 Sheep Pox Virus Recombinant Proteins To Develop Subunit Vaccines

Authors: Olga V. Chervyakova, Elmira T. Tailakova, Vitaliy M. Strochkov, Kulyaisan T. Sultankulova, Nurlan T. Sandybayev, Lev G. Nemchinov, Rosemarie W. Hammond

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Sheep pox is a highly contagious infection that OIE regards to be one of the most dangerous animal diseases. It causes enormous economic losses because of death and slaughter of infected animals, lower productivity, cost of veterinary and sanitary as well as quarantine measures. To control spread of sheep pox infection the attenuated vaccines are widely used in the Republic of Kazakhstan and other Former Soviet Union countries. In spite of high efficiency of live vaccines, the possible presence of the residual virulence, potential genetic instability restricts their use in disease-free areas that leads to necessity to exploit new approaches in vaccine development involving recombinant DNA technology. Vaccines on the basis of recombinant proteins are the newest generation of prophylactic preparations. The main advantage of these vaccines is their low reactogenicity and this fact makes them widely used in medical and veterinary practice for vaccination of humans and farm animals. The objective of the study is to produce recombinant immunogenic proteins for development of the high-performance means for sheep pox prophylaxis. The SPV proteins were chosen for their homology with the known immunogenic vaccinia virus proteins. Assay of nucleotide and amino acid sequences of the target SPV protein genes. It has been shown that four proteins SPPV060 (ortholog L1), SPPV074 (ortholog H3), SPPV122 (ortholog A33) and SPPV141 (ortholog B5) possess transmembrane domains at N- or C-terminus while in amino acid sequences of SPPV095 (ortholog А 4) and SPPV117 (ortholog А 27) proteins these domains were absent. On the basis of these findings the primers were constructed. Target genes were amplified and subsequently cloned into the expression vector рЕТ26b(+) or рЕТ28b(+). Six constructions (pSPPV060ΔТМ, pSPPV074ΔТМ, pSPPV095, pSPPV117, pSPPV122ΔТМ and pSPPV141ΔТМ) were obtained for expression of the SPV genes under control of T7 promoter in Escherichia coli. To purify and detect recombinant proteins the amino acid sequences were modified by adding six histidine molecules at C-terminus. Induction of gene expression by IPTG was resulted in production of the proteins with molecular weights corresponding to the estimated values for SPPV060, SPPV074, SPPV095, SPPV117, SPPV122 and SPPV141, i.e. 22, 30, 20, 19, 17 and 22 kDa respectively. Optimal protocol of expression for each gene that ensures high yield of the recombinant protein was identified. Assay of cellular lysates by western blotting confirmed expression of the target proteins. Recombinant proteins bind specifically with antibodies to polyhistidine. Moreover all produced proteins are specifically recognized by the serum from experimentally SPV-infected sheep. The recombinant proteins SPPV060, SPPV074, SPPV117, SPPV122 and SPPV141 were also shown to induce formation of antibodies with virus-neutralizing activity. The results of the research will help to develop a new-generation high-performance means for specific sheep pox prophylaxis that is one of key moments in animal health protection. The research was conducted under the International project ISTC # K-1704 “Development of methods to construct recombinant prophylactic means for sheep pox with use of transgenic plants” and under the Grant Project RK MES G.2015/0115RK01983 "Recombinant vaccine for sheep pox prophylaxis".

Keywords: prophylactic preparation, recombinant protein, sheep pox virus, subunit vaccine

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166 Learning the Most Common Causes of Major Industrial Accidents and Apply Best Practices to Prevent Such Accidents

Authors: Rajender Dahiya

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Investigation outcomes of major process incidents have been consistent for decades and validate that the causes and consequences are often identical. The debate remains as we continue to experience similar process incidents even with enormous development of new tools, technologies, industry standards, codes, regulations, and learning processes? The objective of this paper is to investigate the most common causes of major industrial incidents and reveal industry challenges and best practices to prevent such incidents. The author, in his current role, performs audits and inspections of a variety of high-hazard industries in North America, including petroleum refineries, chemicals, petrochemicals, manufacturing, etc. In this paper, he shares real life scenarios, examples, and case studies from high hazards operating facilities including key challenges and best practices. This case study will provide a clear understanding of the importance of near miss incident investigation. The incident was a Safe operating limit excursion. The case describes the deficiencies in management programs, the competency of employees, and the culture of the corporation that includes hazard identification and risk assessment, maintaining the integrity of safety-critical equipment, operating discipline, learning from process safety near misses, process safety competency, process safety culture, audits, and performance measurement. Failure to identify the hazards and manage the risks of highly hazardous materials and processes is one of the primary root-causes of an incident, and failure to learn from past incidents is the leading cause of the recurrence of incidents. Several investigations of major incidents discovered that each showed several warning signs before occurring, and most importantly, all were preventable. The author will discuss why preventable incidents were not prevented and review the mutual causes of learning failures from past major incidents. The leading causes of past incidents are summarized below. Management failure to identify the hazard and/or mitigate the risk of hazardous processes or materials. This process starts early in the project stage and continues throughout the life cycle of the facility. For example, a poorly done hazard study such as HAZID, PHA, or LOPA is one of the leading causes of the failure. If this step is performed correctly, then the next potential cause is. Management failure to maintain the integrity of safety critical systems and equipment. In most of the incidents, mechanical integrity of the critical equipment was not maintained, safety barriers were either bypassed, disabled, or not maintained. The third major cause is Management failure to learn and/or apply learning from the past incidents. There were several precursors before those incidents. These precursors were either ignored altogether or not taken seriously. This paper will conclude by sharing how a well-implemented operating management system, good process safety culture, and competent leaders and staff contributed to managing the risks to prevent major incidents.

Keywords: incident investigation, risk management, loss prevention, process safety, accident prevention

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165 Pattern of Valvular Involvement and Demographic Features of Patients on Benzathine Penicillin at Dhulikhel Hospital

Authors: Sanjaya Humagain, Rajendra Koju

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Background: Rheumatic heart disease (RHD) is the most common cardiovascular disease in children and young adults. Though declined and almost non-existent in developed nations, RHD is still one of the leading cause for premature death and disability in developing countries. Prevalence of RHD is high in both rural as well as urban area of Nepal. Present study is designed to look at the pattern of valvular involvement and demographic features in RHD. Methods: 326 patients indicated for inj. Benzathine penicillin were selected and echocardiograph performed to see the pattern of vavular involvement. Data analysis was done using SPSS 17. Result: The most common type of lesion was mixed type with mitral valve involvement. MR was the most common isolated lesion. MS was more commonly seen in females whereas AS was more common in males. Secondary prophylaxis was more common than primary prophylaxis. Conclusion: RHD still being a major problem and a preventable disease so extensive screening program is required to identify them early and prevent the complication.

Keywords: acute rheumatic fever, RHD, MS, MR, AS, AR, Inj benzathine penicillin

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164 RNA-Seq Analysis of Coronaviridae Family and SARS-Cov-2 Prediction Using Proposed ANN

Authors: Busra Mutlu Ipek, Merve Mutlu, Ahmet Mutlu

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Novel coronavirus COVID-19, which has recently influenced the world, poses a great threat to humanity. In order to overcome this challenging situation, scientists are working on developing effective vaccine against coronavirus. Many experts and researchers have also produced articles and done studies on this highly important subject. In this direction, this special topic was chosen for article to make a contribution to this area. The purpose of this article is to perform RNA sequence analysis of selected virus forms in the Coronaviridae family and predict/classify SARS-CoV-2 (COVID-19) from other selected complete genomes in coronaviridae family using proposed Artificial Neural Network(ANN) algorithm.

Keywords: Coronaviridae family, COVID-19, RNA sequencing, ANN, neural network

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163 The Design and Development of Online Infertility Prevention Education in the Frame of Mayer's Multimedia Learning Theory

Authors: B. Baran, S. N. Kaptanoglu, M. Ocal, Y. Kagnici, E. Esen, E. Siyez, D. M. Siyez

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Infertility is the fact that couples cannot have children despite 1 year of unprotected sexual life. Infertility can be considered as an important problem affecting not only sexual life but also social and psychological conditions of couples. Learning about information about preventable factors related to infertility during university years plays an important role in preventing a possible infertility case in older ages. The possibility to facilitate access to information with the internet has provided the opportunity to reach a broad audience in the diverse learning environments and educational environment. Moreover, the internet has become a basic resource for the 21st-century learners. Providing information about infertility over the internet will enable more people to reach in a short time. When studies conducted abroad about infertility are examined, interactive websites and online education programs come to the fore. In Turkey, while there is no comprehensive online education program for university students, it seems that existing studies are aimed to make more advertisements for doctors or hospitals. In this study, it was aimed to design and develop online infertility prevention education for university students. Mayer’s Multimedia Learning Theory made up the framework for the online learning environment in this study. The results of the needs analysis collected from the university students in Turkey who were selected with sampling to represent the audience for online learning contributed to the design phase. In this study, an infertility prevention online education environment designed as a 4-week education was developed by explaining the theoretical basis and needs analysis results. As a result; in the development of the online environment, different kind of visual aids that will increase teaching were used in the environment of online education according to Mayer’s principles of extraneous processing (coherence, signaling, spatial contiguity, temporal contiguity, redundancy, expectation principles), essential processing (segmenting, pre-training, modality principles) and generative processing (multimedia, personalization, voice principles). For example, the important points in reproductive systems’ expression were emphasized by visuals in order to draw learners’ attention, and the presentation of the information was also supported by the human voice. In addition, because of the limited knowledge of university students in the subject, the issue of female reproductive and male reproductive systems was taught before preventable factors related to infertility. Furthermore, 3D video and augmented reality application were developed in order to embody female and male reproductive systems. In conclusion, this study aims to develop an interactive Online Infertility Prevention Education in which university students can easily access reliable information and evaluate their own level of knowledge about the subject. It is believed that the study will also guide the researchers who want to develop online education in this area as it contains design-stage decisions of interactive online infertility prevention education for university students.

Keywords: infertility, multimedia learning theory, online education, reproductive health

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162 A Quality Improvement Project on Eye Care in the Intensive Care Unit

Authors: Julius Lenaerts, Ahmed Elsaadawy, Mohammed Bashir

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Background Sedated and paralyzed patients have an impaired blink reflex leading to ophthalmic complications such as conjunctivitis, epithelial defects, bacterial keratitis, and more. These are entirely preventable complications through regular eye care. Methods Patients at level 3 or above (intubated/paralyzed) care in the Intensive Care Unit (ICU) were reviewed between February and April. Data was pulled from Metavision and adherence was compared to Royal College of Ophthalmology (RCOphth) recommendations[4]. Using a multi-pronged approach through posters, individual teaching sessions and faculty teaching, we aimed to educate staff about eye care in the ICU. Patients were reaudited in the period July to August. Results Out of 40 patients, only 23% were assessed for eye care needs on admission compared to 77% after teaching; eye care was only delivered 59% of the time it was due, compared to 61%; 2.5% of patients had eyedrops prescribed compared to 41%. This shows an overall increase in meeting RCOphth standards. Key messages Eye care is an overlooked aspect of patient care in the ICU, associated with avoidable ocular complications. Healthcare staff need further rigorous education on the provision and importance of eye care to reduce avoidable complications.

Keywords: ICU, eye care, risk, QIP

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161 A Comprehensive Analysis of LACK (Leishmania Homologue of Receptors for Activated C Kinase) in the Context of Visceral Leishmaniasis

Authors: Sukrat Sinha, Abhay Kumar, Shanthy Sundaram

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The Leishmania homologue of activated C kinase (LACK) is known T cell epitope from soluble Leishmania antigens (SLA) that confers protection against Leishmania challenge. This antigen has been found to be highly conserved among Leishmania strains. LACK has been shown to be protective against L. donovani challenge. A comprehensive analysis of several LACK sequences was completed. The analysis shows a high level of conservation, lower variability and higher antigenicity in specific portions of the LACK protein. This information provides insights for the potential consideration of LACK as a putative candidate in the context of visceral Leishmaniasis vaccine target.

Keywords: bioinformatics, genome assembly, leishmania activated protein kinase c (lack), next-generation sequencing

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160 Immuno-Protective Role of Mucosal Delivery of Lactococcus lactis Expressing Functionally Active JlpA Protein on Campylobacter jejuni Colonization in Chickens

Authors: Ankita Singh, Chandan Gorain, Amirul I. Mallick

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Successful adherence of the mucosal epithelial cells is the key early step for Campylobacter jejuni pathogenesis (C. jejuni). A set of Surface Exposed Colonization Proteins (SECPs) are among the major factors involved in host cell adherence and invasion of C. jejuni. Among them, constitutively expressed surface-exposed lipoprotein adhesin of C. jejuni, JlpA, interacts with intestinal heat shock protein 90 (hsp90α) and contributes in disease progression by triggering pro-inflammatory response via activation of NF-κB and p38 MAP kinase pathway. Together with its ability to express in the bacterial surface, higher sequence conservation and predicted predominance of several B cells epitopes, JlpA protein reserves its potential to become an effective vaccine candidate against wide range of Campylobacter sps including C. jejuni. Given that chickens are the primary sources for C. jejuni and persistent gut colonization remain as major cause for foodborne pathogenesis to humans, present study explicitly used chickens as model to test the immune-protective efficacy of JlpA protein. Taking into account that gastrointestinal tract is the focal site for C. jejuni colonization, to extrapolate the benefit of mucosal (intragastric) delivery of JlpA protein, a food grade Nisin inducible Lactic acid producing bacteria, Lactococcus lactis (L. lactis) was engineered to express recombinant JlpA protein (rJlpA) in the surface of the bacteria. Following evaluation of optimal surface expression and functionality of recombinant JlpA protein expressed by recombinant L. lactis (rL. lactis), the immune-protective role of intragastric administration of live rL. lactis was assessed in commercial broiler chickens. In addition to the significant elevation of antigen specific mucosal immune responses in the intestine of chickens that received three doses of rL. lactis, marked upregulation of Toll-like receptor 2 (TLR2) gene expression in association with mixed pro-inflammatory responses (both Th1 and Th17 type) was observed. Furthermore, intragastric delivery of rJlpA expressed by rL. lactis, but not the injectable form, resulted in a significant reduction in C. jejuni colonization in chickens suggesting that mucosal delivery of live rL. lactis expressing JlpA serves as a promising vaccine platform to induce strong immune-protective responses against C. jejuni in chickens.

Keywords: chickens, lipoprotein adhesion of Campylobacter jejuni, immuno-protection, Lactococcus lactis, mucosal delivery

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159 Comparison of the Use of Vaccines or Drugs against Parasitic Diseases

Authors: H. Al-Khalaifa, A. Al-Nasser

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The viewpoint towards the use of drugs or vaccines against avian parasitic diseases is one of the most striking challenges in avian medical parasitology. This includes many difficulties associated with drug resistance and in developing prophylactic vaccines. In many instances, the potential success of a vaccination in controlling parasitic diseases in poultry is well-documented. However, some medical, technical and financial limitations are still paramount. On the other hand, chemotherapy is not very well-recommended due to a number of medical limitations. But in the absence of an effective vaccine, drugs are used against parasitic diseases. This paper sheds light on some the advantages and disadvantages of using vaccination and drugs in controlling parasitic diseases in poultry species. The usage of chemotherapeutic drugs is discussed with some examples. Then, more light will be shed on using vaccines as a potentially effective and promising control tool.

Keywords: drugs, parasitology, poultry, vaccines

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158 TNF-Kinoid® in Autoimmune Diseases

Authors: Yahia Massinissa, Melakhessou Med Akram, Mezahdia Mehdi, Marref Salah Eddine

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Cytokines are natural proteins which act as true intercellular communication signals in immune and inflammatory responses. Reverse signaling pathways that activate cytokines help to regulate different functions at the target cell, causing its activation, its proliferation, the differentiation, its survival or death. It was shown that malfunctioning of the cytokine regulation, particularly over-expression, contributes to the onset and development of certain serious diseases such as chronic rheumatoid arthritis, Crohn's disease, psoriasis, lupus. The action mode of Kinoid® technology is based on the principle vaccine: The patient's immune system is activated so that it neutralizes itself and the factor responsible for the disease. When applied specifically to autoimmune diseases, therapeutic vaccination allows the body to neutralize cytokines (proteins) overproduced through a highly targeted stimulation of the immune system.

Keywords: cytokines, Kinoid tech, auto-immune diseases, vaccination

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157 Alternative Hypotheses on the Role of Oligodendrocytes in Neurocysticercosis: Comprehensive Review

Authors: Humberto Foyaca Sibat, Lourdes de Fátima Ibañez Valdés

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Background Cysticercosis (Ct) is a preventable and eradicable zoonotic parasitic disease secondary to a cestode infection by the larva form of pig tapeworm Taenia solium (Ts), mainly seen in people living in developing countries. When the cysticercus is in the brain parenchymal, intraventricular system, subarachnoid space (SAS), cerebellum, brainstem, optic nerve, or spinal cord, then it has named neurocysticercosis (NCC), and the often-clinical manifestations are headache and epileptic seizures/epilepsy among other less frequent symptoms and signs. In this study, we look for a manuscript related to the role played by oligodendrocytes in the pathogenesis of NCC. We review this issue and formulate some hypotheses regarding its role and the role played in the pathogenesis of calcified NCC and epileptic seizures, and secondary epilepsy. Method: We searched the medical literature comprehensively, looking for published medical subject heading (MeSH) terms like "neurocysticercosis", "pathogenesis of neurocysticercosis", "comorbidity in NCC"; OR "oligodendrocytes"; OR "oligodendrocyte precursor cells(OPC/NG2)"; OR "epileptic seizures(ES)/Epilepsy(Ep)/NCC" OR "oligodendrocytes(OLG)/ES/Ep”; OR "calcified NCC/OLG"; OR “OLG Ca2+.” Results: All selected manuscripts were peer-reviewed, and we did not find publications related to OLG/NCC.

Keywords: oligodendrocytes, neurocysticercosis, oligodendrocytes, oligodendrocyte precursor cell, KG2, calcified neurocysticercosis, cellular calcium influx.

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156 Production of Recombinant VP2 Protein of Canine Parvovirus 2a Using Baculovirus Expression System

Authors: Soo Dong Cho, In-Ohk Ouh, Byeong Sul Kang, Seyeon Park, In-Soo Cho, Jae Young Song

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An VP2 gene from the current prevalent CPV (Canine Parvovirus) strain (new CPV-2a) in the Republic of Korea was expressed in a baculovirus expression system. Genomic DNA was extracted from the isolate strain CPV-2a. The recombinant baculovirus, containing the coding sequences of VP2 with the histidine tag at the N-terminus, were generated by using the Bac-to-Bac system. For production of the recombinant VP2 proteins, SF9 cells were transfection into 6 wells. Propagation of recombinant baculoviruses and expression of the VP2 protein were performed in the Sf9 cell line maintained. The proteins were detected to Western blot anlaysis. CPV-2a VP2 was detected by Western blotting the monoclonal antibodies recognized 6x His and the band had a molecular weight of 65 KDa. We demonstrated that recombinant CPV-2a VP2 expression in baculovirus. The recombinant CPV-2a VP2 may able to development of specific diagnostic test and vaccination of against CPV2. This study provides a foundation for application of CPV2 on the development of new CPV2 subunit vaccine.

Keywords: baculovirus, canine parvovirus 2a, Dog, Korea

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155 Consumer Cognitive Models of Vaccine Attitudes: Behavioral Informed Strategies Promoting Vaccination Policy in Greece

Authors: Halkiopoulos Constantinos, Koutsopoulou Ioanna, Gkintoni Evgenia, Antonopoulou Hera

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Immunization appears to be an essential part of health care service in times of pandemics such as covid-19 and aims not only to protect the health of the population but also the health and sustainability of the economies of the countries affected. It is reported that more than 3.44 billion doses have been administered so far, which accounts for 45 doses for 100 people. Vaccination programs in various countries have been promoted and accepted by people differently and therefore they proceeded in different ways and speed; most countries directing them towards people with vulnerable chronic or recent health statuses. Large scale restriction measures or lockdown, personal protection measures such as masks and gloves and a decrease in leisure and sports activities were also implemented around the world as part of the protection health strategies against the covid-19 pandemic. This research aims to present an analysis based on variations on people’s attitudes towards vaccination based on demographic, social and epidemiological characteristics, and health status on the one hand and perception of health, health satisfaction, pain, and quality of life on the other hand. 1500 Greek e-consumers participated in the research, mainly through social media who took part in an online-based survey voluntarily. The questionnaires included demographic, social and medical characteristics of the participants, and questions asking people’s willingness to be vaccinated and their opinion on whether there should be a vaccine against covid-19. Other stressor factors were also reported in the questionnaires and participants’ loss of someone close due to covid-19, or staying at home quarantine due to being infected from covid-19. WHOQUOL-BREF and GLOBAL PSYCHOTRAUMA SCREEN- GPS were used with kind permission from WHO and from the International Society for Traumatic Stress Studies in this study. Attitudes towards vaccination varied significantly related to aging, level of education, health status and consumer behavior. Health professionals’ attitudes also varied in relation to age, level of education, profession, health status and consumer needs. Vaccines have been the most common technological aid of human civilization so far in the fight against viruses. The results of this study can be used for health managers and digital marketers of pharmaceutical companies and also other staff involved in vaccination programs and for designing health policy immunization strategies during pandemics in order to achieve positive attitudes towards vaccination and larger populations being vaccinated in shorter periods of time after the break out of pandemic. Health staff needs to be trained, aided and supervised to go through with vaccination programs and to be protected through vaccination programs themselves. Feedback in each country’s vaccination program, short backs, deficiencies and delays should be addressed and worked out.

Keywords: consumer behavior, cognitive models, vaccination policy, pandemic, Covid-19, Greece

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154 Prediction and Identification of a Permissive Epitope Insertion Site for St Toxoid in cfaB from Enterotoxigenic Escherichia coli

Authors: N. Zeinalzadeh, Mahdi Sadeghi

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Enterotoxigenic Escherichia coli (ETEC) is the most common cause of non-inflammatory diarrhea in the developing countries, resulting in approximately 20% of all diarrheal episodes in children in these areas. ST is one of the most important virulence factors and CFA/I is one of the frequent colonization factors that help to process of ETEC infection. ST and CfaB (CFA/I subunit) are among vaccine candidates against ETEC. So, ST because of its small size is not a good immunogenic in the natural form. However to increase its immunogenic potential, here we explored candidate positions for ST insertion in CfaB sequence. After bioinformatics analysis, one of the candidate positions was selected and the chimeric gene (cfaB*st) sequence was synthesized and expressed in E. coli BL21 (DE3). The chimeric recombinant protein was purified with Ni-NTA columns and characterized with western blot analysis. The residue 74-75 of CfaB sequence could be a good candidate position for ST and other epitopes insertion.

Keywords: bioinformatics, CFA/I, enterotoxigenic E. coli, ST toxoid

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153 Hepatitis B Virus Infection Among Egyptian Children Vaccinated during Infancy

Authors: Iman I. Salama, Samia M. Sami, Somaia I. Salama, Zeinab N. Said, Thanaa M. Rabah, Aida M. Abdel-Mohsin

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This is a national community-based project to evaluate the effectiveness of HBV vaccination program in prevention of infection. HBV markers were tested in the sera of 3600 vaccinated children. Infected children were followed up for 1 year. Prevalence of HBV infection was 0.39 % (0.28% positive for anti-HBc, 0.03% positive for HBsAg and 0.08% positive for both). One year later, 50% of positive anti-HBc children turned negative with sustained positivity for positive HBsAg cases. HBV infection was significantly higher at age above 9 years (0.6%) compared to 0.2% at age 3-9 years and 0% at younger age (P < 0.05). Logistic analysis revealed that predictors for HBV infection were history of blood transfusion, regular medical injection, and family history of either HBV infection or drug abuse (adjusted odds ratios 6.2, 5.6, 7.6 & 19.1 respectively). HBV vaccination program produced adequate protection. Adherence to infection control measures and safe blood transfusion are recommended.

Keywords: HBV infection, HBV vaccine, children, Egypt

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152 Burden of Communicable and Non-Communicable Disease in India: A Regional Analysis

Authors: Ajit Kumar Yadav, Priyanka Yadav, F. Ram

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In present study is an effort to analyse the burden of diseases in the state. Disability Adjusted Life Years (DALY) is estimated non-communicable diseases. Multi-rounds (52nd, 60th and 71st round) of the National Sample Surveys (NSSO), conducted in 1995-96, 2004 and 2014 respectively, and Million Deaths Study (MDS) of 2001-03, 2006 and 2013-14 datasets are used. Descriptive and multivariate analyses are carried out to identify the determinants of different types of self-reported morbidity and DALY. The prevalence was higher for population aged 60 and above, among females, illiterates, and rich across the time period and for all the selected morbidities. The results were found to be significant at P<0.001. The estimation of DALY revealed that, the burden of communicable diseases was higher during infancy, noticeably among males than females in 2002. However, females aged 1-5 years were more vulnerable to report communicable diseases than the corresponding males. The age distribution of DALY indicates that individuals aged below 5 years and above 60 year were more susceptible to ill health. The growing incidence of non-communicable diseases especially among the older generations put additional burden on the health system in the state. The state has to grapple with the unsettled preventable infectious diseases in one hand and growing non-communicable in other hand.

Keywords: disease burden, non-communicable, communicable, India and region

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151 A Review of Literature on Theories of Construction Accident Causation Models

Authors: Samuel Opeyemi Williams, Razali Bin Adul Hamid, M. S. Misnan, Taki Eddine Seghier, D. I. Ajayi

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Construction sites are characterized with occupational risks. Review of literature on construction accidents reveals that a lot of theories have been propounded over the years by different theorists, coupled with multifarious models developed by different proponents at different times. Accidents are unplanned events that are prominent in construction sites, involving materials, objects and people with attendant damages, loses and injuries. Models were developed to investigate the causations of accident with the aim of preventing its occurrence. Though, some of these theories were criticized, most especially, the Heinrich Domino theory, being mostly faulted for placing much blame on operatives rather than the management. The purpose of this paper is to unravel the significant construction accident causation theories and models for the benefit of understanding of the theories, and consequently enabling construction stakeholders identify the possible potential hazards on construction sites, as all stakeholders have significant roles to play in preventing accident. Accidents are preventable; hence, understanding the risk factors of accident and the causation theories paves way for its prevention. However, findings reveal that still some gaps missing in the existing models, while it is recommended that further research can be made in order to develop more models in order to maintain zero accident on construction sites.

Keywords: domino theory, construction site, site safety, accident causation model

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150 Ocular Complications, Adverse Effects of the Procedure, Side-effects of Medications Used for Graft Survival, and Preventable Vision Loss in Live-related Renal Transplant Recipients: Experience at a Transplant Centre in Pakistan

Authors: Fatema Ali Lanewala, Akhtar Jamal Khan

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The ocular complications in renal transplant recipients at the biggest transplant center in Pakistan were seen to be diverse, multiple, and sight-threatening. These complications could mainly be due to the primary disease causing renal failure, the process of transplantation, and/or the medications used pre and post-transplantation. A retrospective case series recently published in the Journal of Pakistan Medical Association highlights the common ocular pathologies encountered in renal transplant population. Majority of the patients suffered from cataract, which is a known side-effect of long-term steroids routinely used for graft survival. There was a unique finding in Pakistani population, never reported before from any other transplant centre world over; a large number of recipients was reported to be suffering from night blindness, which significantly improved on vitamin A supplementation. There were a variety of other ocular complications seen which emphasizes the necessity of ocular care and routine examination of transplant recipient’s eyes by an ophthalmologist in order to avoid visual compromise and improve the quality of life of the transplant recipient.

Keywords: cataract, night blindness, ocular complications, renal transplantation

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149 Comparison of Sensitivity and Specificity of Pap Smear and Polymerase Chain Reaction Methods for Detection of Human Papillomavirus: A Review of Literature

Authors: M. Malekian, M. E. Heydari, M. Irani Estyar

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Human papillomavirus (HPV) is one of the most common sexually transmitted infection, which may lead to cervical cancer as the main cause of it. With early diagnosis and treatment in health care services, cervical cancer and its complications are considered to be preventable. This study was aimed to compare the efficiency, sensitivity, and specificity of Pap smear and polymerase chain reaction (PCR) in detecting HPV. A literature search was performed in Google Scholar, PubMed and SID databases using the keywords 'human papillomavirus', 'pap smear' and 'polymerase change reaction' to identify studies comparing Pap smear and PCR methods for the detection. No restrictions were considered.10 studies were included in this review. All samples that were positive by pop smear were also positive by PCR. However, there were positive samples detected by PCR which was negative by pop smear and in all studies, many positive samples were missed by pop smear technique. Although The Pap smear had high specificity, PCR based HPV detection was more sensitive method and had the highest sensitivity. In order to promote the quality of detection and high achievement of the maximum results, PCR diagnostic methods in addition to the Pap smear are needed and Pap smear method should be combined with PCR techniques according to the high error rate of Pap smear in detection.

Keywords: human papillomavirus, cervical cancer, pap smear, polymerase chain reaction

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148 A Study of Ocular Morbidity in Road Traffic Accidents

Authors: Nikhat Iqbal Tamboli

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INTRODUCTION: road traffic accidents (RTAs) are one of the leading and common causes of ocular injuries especially in developing countries like India which are preventable with certain measures and so it is of public health importance. AIM: To study incidence and clinical presentation of ocular morbidity in road traffic accidents. METHOD: Prospective cross-sectional study was conducted on 360 patients reported in department of ophthalmology. Detailed ocular examination and relevant investigations done. RESULTS: Incidence of ocular injuries is 23%. male:female ratio is 4.5:1.Cases having Sub conjunctival haemorrhage [74].eccymosis[217]. lid lcerations [164]orbital fracture[12] corneal tear [7]corneal abrasion[2] sclera tear[6] hyphaema[4] traumatic mydriasis [7]traumatic cataract [2]vitreous haemorrhage [1]traumatic optic neuropathy[1].Maximum cases in age group 20-40 years, with two wheeler vehicles 94.7% .Under influence of alcohol 13.3%. CONCLUSION: Younger age group with male preponderance is involved in ocular trauma due to road traffic accidents .maximum cases reported are with anterior segment injuries. Alcohol and two wheeler vehicles are common risk factors. Injuries involving cornea had bad prognosis and involving retina had worst prognosis.

Keywords: ocular morbidity, eye trauma, RTA, eye injury

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147 Opportunities and Challenges: Tracing the Evolution of India's First State-led Curriculum-based Media Literacy Intervention

Authors: Ayush Aditya

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In today's digitised world, the extent of an individual’s social involvement is largely determined by their interaction over the internet. The Internet has emerged as a primary source of information consumption and a reliable medium for receiving updates on everyday activities. Owing to this change in the information consumption pattern, the internet has also emerged as a hotbed of misinformation. Experts are of the view that media literacy has emerged as one of the most effective strategies for addressing the issue of misinformation. This paper aims to study the evolution of the Kerala government's media literacy policy, its implementation strategy, challenges and opportunities. The objective of this paper is to create a conceptual framework containing details of the implementation strategy based on the Kerala model. Extensive secondary research of literature, newspaper articles, and other online sources was carried out to locate the timeline of this policy. This was followed by semi-structured interview discussions with government officials from Kerala to trace the origin and evolution of this policy. Preliminary findings based on the collected data suggest that this policy is a case of policy by chance, as the officer who headed this policy during the state level implementation was the one who has already piloted a media literacy program in a district called Kannur as the district collector. Through this paper, an attempt is made to trace the history of the media literacy policy starting from the Kannur intervention in 2018, which was started to address the issue of vaccine hesitancy around measles rubella(MR) vaccination. If not for the vaccine hesitancy, this program would not have been rolled out in Kannur. Interviews with government officials suggest that when authorities decided to take up this initiative in 2020, a huge amount of misinformation emerging during the COVID-19 pandemic was the trigger. There was misinformation regarding government orders, healthcare facilities, vaccination, and lockdown regulations, which affected everyone, unlike the case of Kannur, where it was only a certain age group of kids. As a solution to this problem, the state government decided to create a media literacy curriculum to be taught in all government schools of the state starting from standard 8 till graduation. This was a tricky task, as a new course had to be immediately introduced in the school curriculum amid all the disruptions in the education system caused by the pandemic. It was revealed during the interview that in the case of the state-wide implementation, every step involved multiple checks and balances, unlike the earlier program where stakeholders were roped-in as and when the need emerged. On the pedagogy, while the training during the pilot could be managed through PowerPoint presentation, designing a state-wide curriculum involved multiple iterations and expert approvals. The reason for this is COVID-19 related misinformation has lost its significance. In the next phase of the research, an attempt will be made to compare other aspects of the pilot implementation with the state-wide implementation.

Keywords: media literacy, digital media literacy, curriculum based media literacy intervention, misinformation

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