Search results for: visually impaired

Authors: Amit Zriker, Anat Freund

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The aim of the study was to conduct a thorough examination into the multiple complexities of bringing a foreign caregiver into the home to care for older adults in the Haredi society, by relating to the perspectives of the older adult and his family members. Research questions were: What is the meaning of bringing a foreign caregiver into the home in Haredi society, from the point of view of the older adult’s family members, and what are the implications of these meanings in the context of developing social policies and interventions? The current study was a qualitative-phenomenological study, which relates to “the lived experience” of those involved in the studied phenomenon. In the framework of the study, the participants included 15 adult Haredi sons and daughters of elderly impaired parents who receive homecare from a foreign caregiver. Data collection was carried out using in-depth, semi-structured interviews; the interview guidelines are comprised of the following content worlds: the meanings of aging in Haredi families; the decision-making process in relation to providing home care assistance for elderly impaired parents; making decisions regarding bringing a foreign caregiver into the home to care for an elderly parent; the daily routine after bringing in a foreign caregiver; bringing in a foreign caregiver vs. the society and vs. the Haredi establishment; and more. The issue of bringing a foreign caregiver into the home in the context of a faith-based society has received only scant and partial research attention to date. Nevertheless, in light of the growing elderly population in the Haredi society in Israel, and in closed, faith-based societies, in general; there is a growing need to bring foreign caregivers into the home as a possible solution to the “aging-in-place” problem in these societies. The separatist nature, and the collectivist and faith-based lifestyle of the Haredi society present unique challenges and needs in the process of employing a foreign caregiver. Moreover, the foreign caregiver also brings his/her own cultural world to the encounter, meaning, this process involves the elderly impaired individual, his/her family members, as well as the foreign caregiver. Therefore, it is important to understand their attitudes, perceptions and interactions, in order to create a good fit among all involved parties. The innovation and uniqueness of the current study is in its in-depth exploration of a phenomenon through an emotional-cultural lens. The study findings also contribute to the creation of social policy in the field of nursing, which will be adapted and culturally sensitive to Haredi society, and other faith-based societies.

Keywords: culturally-sensitive intervention, faith-based society, foreign caregiver, Haredi society

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Authors: Clare Flood, Shareen Forbes

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Background: Type 1 diabetes mellitus (T1DM) is an autoimmune disorder affecting >400,000 people in the UK alone, with the global prevalence expected to double in the next decade. Islet transplant offers a minimally-invasive procedure with very low morbidity and almost no mortality, and is now as effective as whole pancreas transplant. The procedure was introduced to the UK in 2011 for patients with the most severe type 1 diabetes mellitus (T1DM) – those with unstable blood glucose, frequently occurring episodes of severe hypoglycemia and impaired awareness of hypoglycemia (IAH). Objectives: To evaluate the effectiveness of islet transplantation in improving glycemic control, reducing the burden of hypoglycemia and improving awareness of hypoglycemia through a single-centre cohort study at the Royal Infirmary of Edinburgh. Glycemic control and degree of hypoglycemic awareness will be determined and monitored pre- and post-transplantation to determine effectiveness of the procedure. Methods: A retrospective analysis of data collected over three years from the 16 patients who have undergone islet transplantation in Scotland. Glycated haemoglobin (HbA1c) was measured and continuous glucose monitoring systems (CGMS) were utilised to assess glycemic control, while Gold and Clarke score questionnaires tested IAH. Results: All patients had improved glycemic control following transplant, with optimal control seen visually at 3 months post-transplant. Glycemic control significantly improved, as illustrated by percentage time in hypoglycemia in the months following transplant (p=0.0211) and HbA1c (p=0.0426). Improved Clarke (p=0.0034) and Gold (p=0.0001) scores indicate improved glycemic awareness following transplant. Conclusion: While the small sample of islet transplant recipients at the Royal Infirmary of Edinburgh prevents definitive conclusions being drawn, it is indicated that through our retrospective, single-centre cohort study of 16 patients, islet transplant is capable of improving glycemic control, reducing the burden of hypoglycemia and IAH post-transplant. Data can be combined with similar trials at other centres to increase statistical power but from research in Edinburgh, it can be suggested that the minimally invasive procedure of islet transplantation offers selected patients with extremely unstable T1DM the incredible opportunity to regain control of their condition and improve their quality of life.

Keywords: diabetes, islet, transplant, CGMS

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Authors: Irene M. Arora

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Hypothesis: Attention Deficit Hyperactivity Disorder is the result of an underdeveloped prefrontal cortex which is the primary cause for the signs and symptoms seen as defining features of ADHD. Methods: Through ‘PubMed’, ‘Wiley’ and ‘Google Scholar’ studies published between 2011-2018 were evaluated, determining if a dysfunctional prefrontal cortex caused the characteristic symptoms associated with ADHD. The search terms "prefrontal cortex", "Attention-Deficit/Hyperactivity Disorder", "cognitive control", "frontostriatal tract" among others, were used to maximize the assortment of relevant studies. Excluded papers were systematic reviews, meta-analyses and publications published before 2010 to ensure clinical relevance. Results: Nine publications were analyzed in this review, all of which were non-randomized matched control studies. Three studies found a decrease in the functional integrity of the frontostriatal tract fibers in conjunction with four studies finding impaired frontal cortex stimulation. Prefrontal dysfunction, specifically medial and orbitofrontal areas, displayed abnormal functionality of reward processing in ADHD patients when compared to their normal counterparts. A total of 807 subjects were studied in this review, yielding that a little over half (54%) presented with remission of symptoms in adulthood. Conclusion: While the prefrontal cortex shows the highest consistency of impaired activity and thinner volumes in patients with ADHD, this is a heterogenous disorder implicating its pathophysiology to the dysfunction of other neural structures as well. However, remission of ADHD symptomatology in adulthood was found to be attributable to increased prefrontal functional connectivity and integration, suggesting a key role for the prefrontal cortex in the development of ADHD.

Keywords: prefrontal cortex, ADHD, inattentive, impulsivity, reward processing

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Authors: Güllü Yakar, Adnan Tepecik

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A university campus resembles an independent city that is spread over a wide area. Campuses that incorporate thousands of new domestic and international users at the beginning of every academic period also host scientific, cultural and sportive events, in addition to embodying regular users such as students and staff. Wayfinding and signage systems are necessary for the regulation of vehicular traffic, and they enable users’ to navigate without losing time or feeling anxiety. While designing the system or testing the functionality of it, opinions of existing users or likely behaviors of typical user profiles (personas) provide designers with insight. The purpose of this study is to identify the wayfinding attitudes and expectations of Kastamonu University Kuzeykent Campus users. This study applies a mixed method in which a questionnaire, developed by the researcher, constitute the quantitative phase of the study. The survey was carried out with 850 participants who filled a questionnaire form which was tested in terms of construct validity by using Exploratory Factor Analysis. While interpreting the data obtained, Chi-Square, T- Test and ANOVA analyses were applied as well as descriptive analyses such as frequency (f) and percentage (%) values. The results of this survey, which was conducted during the absence of systematic wayfinding signs in the campus, reveals the participants expectations for insertion of floor plans and wayfinding signs to indoors, maps to outdoors, symbols and color codes to the existing signs and for the adequate arrangement of those for the use of visually impaired people. The fact that there is a direct proportional relation between the length of institution membership and wayfinding competency within campus, leads to the conclusion that especially the new comers are in need of wayfinding signs. In order to determine the effectiveness of campus-wide wayfinding system implemented after the survey and in order to identify the further expectations of users in this respect, a semi-structured interview form developed by the researcher and assessments of 20 participants are compiled. Subjected to content analysis, this data constitute the qualitative dimension of the study. Research results indicate that despite the presence of the signs, the participants experienced either inability or stress while finding their way, showed tendency to receive help from others and needed outdoor maps and signs, in addition to bigger-sized texts.

Keywords: environmental graphic design, environmental perception, wayfinding and signage design, wayfinding system

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Authors: Ayperi̇ Haspolat Özcan, Meltem Anafarta Şendağ

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This study aimed to establish a model in the light of current approaches for understanding the mediating role of early maladaptive schemas in the relationship between attachment and anger. Accordingly, the proposed mediation model was tested by mediation with bootstrapping technique, considering gender and attachment figure differences. The university students (N= 444) with ages ranging from 17 to 28 participated in the study. Participants filled out Parental and Peer Attachment Scale Short Form, Young Schema Questionnaire - Short Form 3, Trait Anger and Anger Expression Scales. The mediating role of early maladaptive schemas (impaired autonomy, disconnection and rejection, unrelenting standards, other-directedness, and impaired limits) in the relationship between attachment (mother and father) and anger aspects (trait anger, anger in, anger out and anger control) were found to be significant for both male and female participants. Separate mediation analyses for both genders and different attachment figures have also drawn attention to noticeable differences in the results. Specifically, for females, various paths were discovered in predicting various aspects of anger (anger in, anger out, anger control, and trait anger). On the other hand, for males only anger directed inwards was found to be predicted by any source of attachment through disconnection and rejection schema only. These obvious gender differences in understanding the mechanism of anger are discussed in the light of cultural gender roles and the social acceptance of anger in males. In the area of application, the study of various aspects of anger with particular attention to attachment and early maladaptive schemas as well as the importance of distinguishing the gender differences are emphasized as important points.

Keywords: anger expression, attachment, early maladaptive schemas, trait anger

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Authors: T. Thein, S. Kalyar Myo

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Human uses visual information for understanding the speech contents in noisy conditions or in situations where the audio signal is not available. The primary advantage of visual information is that it is not affected by the acoustic noise and cross talk among speakers. Using visual information from the lip movements can improve the accuracy and robustness of automatic speech recognition. However, a major challenge with most automatic lip reading system is to find a robust and efficient method for extracting the linguistically relevant speech information from a lip image sequence. This is a difficult task due to variation caused by different speakers, illumination, camera setting and the inherent low luminance and chrominance contrast between lip and non-lip region. Several researchers have been developing methods to overcome these problems; the one is lip reading. Moreover, it is well known that visual information about speech through lip reading is very useful for human speech recognition system. Lip reading is the technique of a comprehensive understanding of underlying speech by processing on the movement of lips. Therefore, lip reading system is one of the different supportive technologies for hearing impaired or elderly people, and it is an active research area. The need for lip reading system is ever increasing for every language. This research aims to develop a visual teaching method system for the hearing impaired persons in Myanmar, how to pronounce words precisely by identifying the features of lip movement. The proposed research will work a lip reading system for Myanmar Consonants, one syllable consonants (င (Nga)၊ ည (Nya)၊ မ (Ma)၊ လ (La)၊ ၀ (Wa)၊ သ (Tha)၊ ဟ (Ha)၊ အ (Ah) ) and two syllable consonants ( က(Ka Gyi)၊ ခ (Kha Gway)၊ ဂ (Ga Nge)၊ ဃ (Ga Gyi)၊ စ (Sa Lone)၊ ဆ (Sa Lain)၊ ဇ (Za Gwe) ၊ ဒ (Da Dway)၊ ဏ (Na Gyi)၊ န (Na Nge)၊ ပ (Pa Saug)၊ ဘ (Ba Gone)၊ ရ (Ya Gaug)၊ ဠ (La Gyi) ). In the proposed system, there are three subsystems, the first one is the lip localization system, which localizes the lips in the digital inputs. The next one is the feature extraction system, which extracts features of lip movement suitable for visual speech recognition. And the final one is the classification system. In the proposed research, Two Dimensional Discrete Cosine Transform (2D-DCT) and Linear Discriminant Analysis (LDA) with Active Contour Model (ACM) will be used for lip movement features extraction. Support Vector Machine (SVM) classifier is used for finding class parameter and class number in training set and testing set. Then, experiments will be carried out for the recognition accuracy of Myanmar consonants using the only visual information on lip movements which are useful for visual speech of Myanmar languages. The result will show the effectiveness of the lip movement recognition for Myanmar Consonants. This system will help the hearing impaired persons to use as the language learning application. This system can also be useful for normal hearing persons in noisy environments or conditions where they can find out what was said by other people without hearing voice.

Keywords: feature extraction, lip reading, lip localization, Active Contour Model (ACM), Linear Discriminant Analysis (LDA), Support Vector Machine (SVM), Two Dimensional Discrete Cosine Transform (2D-DCT)

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Authors: Lai-Fen Yang

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In this increasingly visual world, how can we best decipher and understand the many ways that our everyday lives are organized around looking practices and the many images we encounter each day? Indeed, how we interact with and interpret visual images is a basic component of human life. Today, however, we are living in one of the most artificial visual and image-saturated cultures in human history, which makes understanding the complex construction and multiple social functions of visual imagery more important than ever before. Themes regarding our experience of a visually pervasive mediated culture, here, termed visual spectacle.

Keywords: visual culture, contemporary, images, literacy

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Authors: Ching-Yi Huang, Pi-Fen Cheng, Hui-Zhu Chen, Shi Ting Huang, Heng-Hua Wang

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This is a case of oral cancer after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap. The nursing period lasted From September 25 to October 3, 2017, through observation, interview, physical assessment, and medical record review, the author identified the following nursing problems: acute pain, impaired oral mucous membrane, and body image change. During the nursing period, the author provided individual and overall nursing care and established mutual trust through the use of empathy. Author listened and eased the patient's physical indisposition, such as wound pain, we use medications and acupuncture massage to relieve pain. However, for oral mucosa change caused by surgery, provide continuous and complete oral care and oral exercise training to improve oral mucosal healing and restore swallowing function. In the body-image changes, guided him to express his feeling after the body-image change, and enhanced support and from the family, and encouraged him to attend head and neck cancer survivor alliance which allowed the patient to accept the altered body image and reaffirm self-worth. Hopefully, through sharing this nursing experience will help to the nursing care quality of nursing care for oral cancer patients after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap.

Keywords: oral cancer, acute pain, impaired oral mucous membrane, body image change

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Authors: Somaiya Mateen, Shagufta Moin, Mohammad Owais, Abdul Khan, Atif Zafar

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In rheumatoid arthritis (RA), impaired oxidative metabolism and imbalance between pro-and anti-inflammatory cytokines are responsible for causing inflammation and the degradation of cartilage and bone. The present study was done to evaluate the level and hence the role of reactive oxygen species (ROS) and inflammatory cytokines in the pathogenesis of RA. The present study was performed in the blood of 80 RA patients and 55 age and sex-matched healthy controls. The level of ROS (in 5% hematocrit) and the plasma level of pro-inflammatory cytokines [TNF-α, interleukin-6 (IL-6), IL-22] and anti-inflammatory cytokines (IL-4 and IL-5) were monitored in healthy subjects and RA patients. For evaluating the role of rheumatoid factor (RF) in the pathogenesis of RA, patients were sub-divided on the basis of presence or absence of RF. Reactive species and inflammatory cytokines were correlated with disease activity measure-Disease Activity Score for 28 joints (DAS28). The level of ROS, TNF-α, IL-6 and IL-22 were found to be significantly higher in RA patients as compared to the healthy controls, with the increase being more significant in patients positive for rheumatoid factor and those having high disease severity. On the other hand, a significant decrease in the level of IL-4 and IL-10 were observed in RA patients compared with healthy controls, with the decrease being more prominent in severe cases of RA. Higher ROS (indicative of impaired anti-oxidant defence system) and pro-inflammatory cytokines level in RA patients may lead to the damage of biomolecules which in turn contributes to tissue damage and hence to the development of more severe RA. The imbalance between pro-and anti-inflammatory cytokines may lead to the development of multi-system immune complications. ROS and inflammatory cytokines may also serve as a potential biomarker for assessing the disease severity.

Keywords: rheumatoid arthritis, reactive oxygen species, pro-inflammatory cytokines, anti-inflammatory cytokines

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Authors: Marielle Leijten, Catherine Meulemans, Sven De Maeyer, Luuk Van Waes

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For the diagnosis of Alzheimer's disease (AD), a large variety of neuropsychological tests are available. In some of these tests, linguistic processing - both oral and written - is an important factor. Language disturbances might serve as a strong indicator for an underlying neurodegenerative disorder like AD. However, the current diagnostic instruments for language assessment mainly focus on product measures, such as text length or number of errors, ignoring the importance of the process that leads to written or spoken language production. In this study, it is our aim to describe and test differences between cognitive and impaired elderly on the basis of a selection of writing process variables (inter- and intrapersonal characteristics). These process variables are mainly related to pause times, because the number, length, and location of pauses have proven to be an important indicator of the cognitive complexity of a process. Method: Participants that were enrolled in our research were chosen on the basis of a number of basic criteria necessary to collect reliable writing process data. Furthermore, we opted to match the thirteen cognitively impaired patients (8 MCI and 5 AD) with thirteen cognitively healthy elderly. At the start of the experiment, participants were each given a number of tests, such as the Mini-Mental State Examination test (MMSE), the Geriatric Depression Scale (GDS), the forward and backward digit span and the Edinburgh Handedness Inventory (EHI). Also, a questionnaire was used to collect socio-demographic information (age, gender, eduction) of the subjects as well as more details on their level of computer literacy. The tests and questionnaire were followed by two typing tasks and two picture description tasks. For the typing tasks participants had to copy (type) characters, words and sentences from a screen, whereas the picture description tasks each consisted of an image they had to describe in a few sentences. Both the typing and the picture description tasks were logged with Inputlog, a keystroke logging tool that allows us to log and time stamp keystroke activity to reconstruct and describe text production processes. The main rationale behind keystroke logging is that writing fluency and flow reveal traces of the underlying cognitive processes. This explains the analytical focus on pause (length, number, distribution, location, etc.) and revision (number, type, operation, embeddedness, location, etc.) characteristics. As in speech, pause times are seen as indexical of cognitive effort. Results. Preliminary analysis already showed some promising results concerning pause times before, within and after words. For all variables, mixed effects models were used that included participants as a random effect and MMSE scores, GDS scores and word categories (such as determiners and nouns) as a fixed effect. For pause times before and after words cognitively impaired patients paused longer than healthy elderly. These variables did not show an interaction effect between the group participants (cognitively impaired or healthy elderly) belonged to and word categories. However, pause times within words did show an interaction effect, which indicates pause times within certain word categories differ significantly between patients and healthy elderly.

Keywords: Alzheimer's disease, keystroke logging, matching, writing process

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Authors: Yafit Gabay

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Attention deficit hyperactivity disorder (ADHD) has been associated with both suboptimal functioning in the striatum and prefrontal cortex. Such abnormalities may impede the acquisition of perceptual categories, which are important for fundamental abilities such as object recognition and speech perception. Indeed, prior research has supported this possibility, demonstrating that children with ADHD have similar visual category learning performance as their neurotypical peers but use suboptimal learning strategies. However, much less is known about category learning processes in the auditory domain or among adults with ADHD in which prefrontal functions are more mature compared to children. Here, we investigated auditory and visual perceptual category learning in adults with ADHD and neurotypical individuals. Specifically, we examined learning of rule-based categories – presumed to be optimally learned by a frontal cortex-mediated hypothesis testing – and information-integration categories – hypothesized to be optimally learned by a striatally-mediated reinforcement learning system. Consistent with striatal and prefrontal cortical impairments observed in ADHD, our results show that across sensory modalities, both rule-based and information-integration category learning is impaired in adults with ADHD. Computational modeling analyses revealed that individuals with ADHD were slower to shift to optimal strategies than neurotypicals, regardless of category type or modality. Taken together, these results suggest that both explicit, frontally mediated and implicit, striatally mediated category learning are impaired in ADHD. These results suggest impairments across multiple learning systems in young adults with ADHD that extend across sensory modalities and likely arise from domain-general mechanisms.

Keywords: ADHD, category learning, modality, computational modeling

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Authors: Parker Townes, Aisouda Savadlou, Shoshana Weiss, Marina Jarenova, Suzzane Ferris, Dan Devoe, Russel Schachar, Scott Patten, Tomas Lange, Marlena Colasanto, Holly McGinn, Paul Arnold

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Some research suggests obsessive-compulsive disorder (OCD) is associated with impaired executive functioning: higher-level mental processes involved in carrying out tasks and solving problems. Relevant literature was identified systematically through online databases. Meta-analyses were conducted for task performance metrics reported by at least two articles. Results were synthesized by the executive functioning domain measured through each performance metric. Heterogeneous literature was identified, typically involving few studies using consistent measures. From 29 included studies, analyses were conducted on 33 performance metrics from 12 tasks. Results suggest moderate associations of working memory (two out of five tasks presented significant findings), planning (one out of two tasks presented significant findings), and visuospatial abilities (one out of two tasks presented significant findings) with OCD in youth. There was inadequate literature or contradictory findings for other executive functioning domains. These findings suggest working memory, planning, and visuospatial abilities are impaired in pediatric OCD, with mixed results. More work is needed to identify the effect of age and sex on these results. Acknowledgment: This work was supported by the Alberta Innovates Translational Health Chair in Child and Youth Mental Health. The funders had no role in the design, conducting, writing, or decision to submit this article for publication.

Keywords: obsessive-compulsive disorder, neurocognition, executive functioning, adolescents, children

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Authors: Selim A., Albasher N., Bakrmom G., Alanzi S.

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Irritable bowel syndrome (IBS) is a chronic functional bowel disorder characterized by abdominal discomfort or pain and associated with alteration in frequency and/or form of bowel habit among other symptoms. This diagnosis is associated with increased levels of psychological distress, maladaptive coping, genetic risk factors, abnormal small and colonic intestine transit, change in stool frequency or form and abdominal discomfort or pain. Aim: The aim of the study was to assess psychological alarm among individuals suffering from Irritable Bowel Syndrome (IBS). Methods: A cross-sectional correlational research design was used to conduct the current study. A convenience sample of 504 participants was included in the present study. Data were collected using a self-report questionnaire. The questionnaire included socio-demographic data, ROME III to identify Irritable Bowel Syndrome (IBS) and Psychological Alarm Questionnaire. Results: Out of 504 participants who reported abdominal discomfort, 297 (58.9 %) participants met the diagnostic criteria of IBS. The mean age of the IBS participants was 30.16 years, females composed 75.1% of the IBS participants, and 55.2% did not seek medical help. Psychological alarms such as feeling anxious, feeling depressed, having suicidal ideations, bodily pain, having impaired functioning due to pain and feeling unable to cope with pain were significantly high among IBS individuals when compared to individuals not suffering from IBS. Psychological alarms such as feeling anxious, feeling depressed, having suicidal ideations, bodily pain, having impaired functioning due to pain and feeling unable to cope with pain were significantly high among IBS individuals compared to individuals not suffering from IBS. Conclusion: IBS is highly associated with significant psychological alarms including depression, anxiety and suicidal ideas.

Keywords: abdominal pain , irritable bowel syndrome, distress, psychological alarms

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Authors: Karen L. Middlemiss, Denham G. Cook, Peter Jaksons, Alistair Jerrett, William Davison

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Lateralisation of cognitive function is a common phenomenon found throughout the animal kingdom. Strong biases in functional behaviours have evolved from asymmetrical brain hemispheres which differ in structure and/or cognitive function. In fish, lateralisation is involved in visually mediated behaviours such as schooling, predator avoidance, and foraging, and is considered to have a direct impact on species fitness. Currently, there is very little literature on the role of lateralisation in fish schools. The yellow-eyed mullet (Aldrichetta forsteri), is an estuarine and coastal species found commonly throughout temperate regions of Australia and New Zealand. This study sought to quantify visually mediated behaviours in yellow-eyed mullet to identify the significance of lateralisation, and the factors which influence functional behaviours in schooling fish. Our approach to study design was to conduct a series of tank based experiments investigating; a) individual and population level lateralisation, b) schooling behaviour, and d) optic lobe anatomy. Yellow-eyed mullet showed individual variation in direction and strength of lateralisation in juveniles, and trait specific spatial positioning within the school was evidenced in strongly lateralised fish. In combination with observed differences in schooling behaviour, the possibility of ontogenetic plasticity in both behavioural lateralisation and optic lobe morphology in adults is suggested. These findings highlight the need for research into the genetic and environmental factors (epigenetics) which drive functional behaviours such as schooling, feeding and aggression. Improved knowledge on collective behaviour could have significant benefits to captive rearing programmes through improved culture techniques and will add to the limited body of knowledge on the complex ecophysiological interactions present in our inshore fisheries.

Keywords: cerebral asymmetry, fisheries, schooling, visual bias

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Authors: B. Dejanova, S. Petrovska, L. Todorovska, J. Pluncevic, S. Mancevska, V. Antevska, E. Sivevska, I. Karagjozova

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Introduction: Aging process is mainly related to endothelial function which may be impaired by oxidative stress (OS). Exercise is known to be beneficial to aging process, which may improve health and prevent appearance of chronic diseases in elderly. The aim of the study was to investigate the OS markers related to exercise. Methods: A number of 80 subjects (healthy volunteers) were examined (38 male and 32 female), divided in 3 age groups: group I ≤ 30 years (n=24); group II – 31-50 years (n=24); group III - ≥ 51 year (n=32). Each group was divided to subgroups of sedentary subjects (SS) and subjects who exercise (SE). Group I: SS (n=11), SE (n=13); group II: SS (n=13), SE (n=10); group III: SS (n=23) SE (n=9). Lipid peroxidation (LP) as a fluorimetric method with thiobarbituric acid was used to estimate OS. Antioxidative status was determined by cell antioxidants such as enzymes - superoxide dismutase (SOD), glutathione peroxidase (GPx) and glucose 6 phosphate (G-6-PD); and by extra cell antioxidants such as glutathione reductase (GR), nitric oxide (NO) and total antioxidant capacity (TAC). Results: Increased values of LP were noticed along the aging process: group I – 3.30±0.3 µmol/L; group II – 3.91±0.2 µmol/L; group III – 3.94±0.8 µmol/L (p<0.05), while no statistical significance was found between male and female subjects. Statistical significance for OS was not found between SS and SE in group I as it was found in group II (p<0.05) and in group III (p<0.01). No statistical significance was found for all cell antioxidants and GR within the groups, while NO and TAC showed lower values in SS compared to SE in II (p<0.05) and in group III (p<0.05). Discussion and conclusion: Aging process showed increased OS which may be either due to impaired function of scavengers of free radicals or due to their enormous production. Well balanced exercise might be one of the factors that keep the integrity of blood vessel endothelium which slows down the aging process. Possible mechanism of exercise beneficial influence is shear stress by upregulation of genes coding for nitric oxide bioavailability. Thus, due to obtained results we may conclude that OS is found to be diminished in the subject groups who perform exercise.

Keywords: oxidative stress, aging process, exercise, endothelial function

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Authors: Göksel Doğan, Murat Öztürk, Didar Tuğçe Karakulak, Mehmet Nurullah Orman, Nicolas Sylvius, Matthew Blades, Mustafa Sandıkçı, Cengiz Ünsal, Mehtap Kılıç Eren, Funda Kıral, Levent Karagenç

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Assisted reproduction is associated with impaired glucose metabolism in adulthood. miRNAs are key regulators of glucose metabolism. Whether embryo culture and/or transfer alters the expression of miRNAs and to what extent this process affects glucose metabolism remain largely unknown. The purpose of the present study was to examine the expression of miRNAs in the liver in mice obtained by the transfer of blastocysts. The study was comprised of an experimental (EG) and a control group (CG). EG was generated by embryo transfer to pseudo-pregnant females. Mice born from naturally ovulating females were used as the CG. Differential expression of miRNAs, blood glucose, plasma insulin, liver glycogen, and activities of some of the rate-limiting enzymes involved in glucose metabolism were determined at ten weeks of age. Blood glucose, plasma insulin, and glycogen concentrations were similar between the groups in both sexes. Activities of enzymes were similar among females. EG males had significantly less glucokinase and phosphofructokinase activity compared to CG males. None of the miRNAs were differentially expressed in males. On the other hand, miR-143-3p expression was upregulated in EG females. Expression of none of the genes targeted by miR143-3p differed between the groups. These results demonstrate that miR143-3p, a novel regulator of type 2 diabetes, is upregulated in mice generated by assisted reproduction in a sexually-dimorphic manner with no apparent effect on glucose and insulin levels at ten weeks of age. It remains to be determined if this process is associated with impaired glucose homeostasis in the long term.

Keywords: assisted reproduction, blastocyst, embryo culture, glucose metabolism, miR143-3p, oxygen

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Authors: Jordan Gallant

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In the compound word processing literature, much attention has been paid to the relationship between a compound’s denotational meaning and that of its morphological whole-word constituents, which is referred to as ‘semantic transparency’. However, the parallel relationship between a compound’s connotation and that of its constituents has not been addressed at all. For instance, while a compound like ‘painkiller’ might be semantically transparent, it is not ‘affectively transparent’. That is, both constituents have primarily negative connotations, while the whole compound has a positive one. This paper investigates the role of affective transparency on compound processing using two methodologies commonly employed in this field: a lexical decision task and a typing task. The critical stimuli used were 112 English bi-constituent compounds that differed in terms of the effective transparency of their constituents. Of these, 36 stimuli contained constituents with similar connotations to the compound (e.g., ‘dreamland’), 36 contained constituents with more positive connotations (e.g. ‘bedpan’), and 36 contained constituents with more negative connotations (e.g. ‘painkiller’). Connotation of whole-word constituents and compounds were operationalized via valence ratings taken from an off-line ratings database. In Experiment 1, compound stimuli and matched non-word controls were presented visually to participants, who were then asked to indicate whether it was a real word in English. Response times and accuracy were recorded. In Experiment 2, participants typed compound stimuli presented to them visually. Individual keystroke response times and typing accuracy were recorded. The results of both experiments provided positive evidence that compound processing is influenced by effective transparency. In Experiment 1, compounds in which both constituents had more negative connotations than the compound itself were responded to significantly more slowly than compounds in which the constituents had similar or more positive connotations. Typed responses from Experiment 2 showed that inter-keystroke intervals at the morphological constituent boundary were significantly longer when the connotation of the head constituent was either more positive or more negative than that of the compound. The interpretation of this finding is discussed in the context of previous compound typing research. Taken together, these findings suggest that affective transparency plays a role in the recognition, storage, and production of English compound words. This study provides a promising first step in a new direction for research on compound words.

Keywords: compound processing, semantic transparency, typed production, valence

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Authors: Hessah Alsulami, Majedah Aldosari

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Introduction: Platelet threshold of 10x109 /L is recommended for clinically stable thrombocytopenic pediatric patients. Transfusions at a higher level (given the absence of research evidence, as determined by clinical circumstances, generally at threshold of 40x109 /L) may be required for patients with signs of bleeding, high fever, hyper-leukocytosis, rapid fall in platelet count, concomitant coagulation abnormality, critically ill patients, and those with impaired platelet function (including drug induced). Transfusions at a higher level may be also required for patients undergoing invasive procedures. Method: This study is a retrospective observational analysis of platelet transfusion thresholds in a single secondary pediatric hospital in Riyadh. From the blood bank database, the list of the patients who received platelet transfusions in the second half of 2018 was retrieved. Patients were divided into two groups; group A, those belong to the category of high platelet level for transfusion (such as those with bleeding, high fever, rapid fall in platelet count, impaired platelet function or undergoing invasive procedures) and group B, those who were not. Then we looked at the pre and post transfusion platelet levels for each group. The data was analyzed using GraphPad software and the data expressed as Mean ± SD. Result: A total of 112 of transfusion episodes in 61 patients (38% female) were analyzed. The age ranged from 24 days to 8 years. The distribution of platelet transfusion episodes was 64% (n=72) for group A and 36% (n= 40) for group B. The mean pre-transfusion platelet count was 46x103 ± (11x 103) for group A and 28x103 ± (6x103) for group B. the post-transfusion mean platelet count was 61 x 103 ± (14 x 103) and 60 x103 ± (24 x 103) for group A and B respectively. Among the groups the rise in the mean platelet count after transfusion was significant among stable patients (group B) compared to unstable patients (group A) (P < 0.001). Conclusion: The platelet count threshold for transfusion varied with the clinical condition and is higher among unstable patients’ group which is expected. For stable patients the threshold was higher than what it should be which means that the clinicians don’t follow the guidelines in this regard. The rise of platelet count after transfusion was higher among stable patients.

Keywords: platelet, transfusion, threshold, pediatric

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Authors: Gokhan Egilmez, Erika Hatfield, Julie Turner

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In this study, we investigated the impacts of service-learning integration on an undergraduate level business analytics course from multiple perspectives, including academic proficiency, community awareness, engagement, social responsibility, and reflection. We assessed the impact of the service-learning experience by using a survey developed primarily based on the literature review and secondarily on an ad hoc group of researchers. Then, we implemented the survey in two sections, where one of the sections was a control group. We compared the results of the empirical survey visually and statistically.

Keywords: business analytics, service learning, experiential education, statistical analysis, survey research

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Authors: Jiangang Shen

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Olfactory dysfunction is a common symptom companied by anxiety- and depressive-like behaviors in depressive patients. Chronic stress triggers hormone responses and inhibits the proliferation and differentiation of neural stem cells (NSCs) in the hippocampus and subventricular zone (SVZ)-olfactory bulb (OB), contributing to depressive behaviors and olfactory dysfunction. However, the cellular signaling molecules to regulate chronic stress mediated olfactory dysfunction are largely unclear. Adaptor proteins containing the pleckstrin homology domain, phosphotyrosine binding domain, and leucine zipper motif (APPLs) are multifunctional adaptor proteins. Herein, we tested the hypothesis that APPL2 could inhibit hippocampal neurogenesis by affecting glucocorticoid receptor (GR) signaling, subsequently contributing to depressive and anxiety behaviors as well as olfactory dysfunctions. The major discoveries are included: (1) APPL2 Tg mice had enhanced GR phosphorylation under basic conditions but had no different plasma corticosterone (CORT) level and GR phosphorylation under stress stimulation. (2) APPL2 Tg mice had impaired hippocampal neurogenesis and revealed depressive and anxiety behaviors. (3) GR antagonist RU486 reversed the impaired hippocampal neurogenesis in the APPL2 Tg mice. (4) APPL2 Tg mice displayed higher GR activity and less capacity for neurogenesis at the olfactory system with lesser olfactory sensitivity than WT mice. (5) APPL2 negatively regulates olfactory functions by switching fate commitments of NSCs in adult olfactory bulbs via interaction with Notch1 signaling. Furthermore, baicalin, a natural medicinal compound, was found to be a promising agent targeting APPL2/GR signaling and promoting adult neurogenesis in APPL2 Tg mice and chronic corticosterone-induced depression mouse models. Behavioral tests revealed that baicalin had antidepressant and olfactory-improving effects. Taken together, APPL2 is a critical therapeutic target for antidepressant treatment.

Keywords: APPL2, hippocampal neurogenesis, depressive behaviors and olfactory dysfunction, stress

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Authors: Ivana Cabarkapa, Zorica Tomicic, Olivera Duragic

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Antimicrobial resistance represents one of the major challenges facing humanity in the last decades. Increasing antibiotic-resistant pathogens indicates the need for the development of alternative antibacterial drugs and new treatment strategies. One of the innovative emerging treatments in overcoming multidrug-resistant pathogens certainly represents the inhibition anti-quorum sensing system. For most of the food-borne pathogens, the expression of the virulence depends on their capability communication with other members of the population by means of quorum sensing (QS). QS represents a specific way of bacterial intercellular communication, which enabled owing to their ability to detect and to respond to cell population density by gene regulation. QS mechanisms are responsible for controls the pathogenesis, virulence luminescence, motility, sporulation and biofilm formation of many organisms by regulating gene expression. Therefore, research in this field is being an attractive target for the development of new natural antibacterial agents. Anti-QS compounds are known to have the ability to prohibit bacterial pathogenicity. Considering the importance of quorum sensing during bacterial pathogenesis, this research has been focused on evaluation anti - QS properties of four essential oils (EOs) Origanum heracleoticum, Origanum vulgare, Thymus vulgare, and Thymus serpyllum, using biomonitor strain of Chromobacterium violaceum CV026. Tests conducted on Luria Bertani agar supplemented with N hexanol DL homoserine lacton (HHL) 10µl/50ml of agar. The anti-QS potential of the EOs was assayed in a range of concentrations of 200 – 0.39 µl/ml using the disc diffusion method. EOs of Th. vulgaris and T. serpyllum were exhibited anti-QS activity indicated by a non- pigmented ring with a dilution-dependent manner. The lowest dilution of EOs T. vulgaris and T. serpyllum in which they exhibited visually detectable inhibition of violacein synthesis was 6.25 µl/ml for both tested EOs. EOs of O. heracleoticum and O. vulgare were displayed different active principles, i.e., antimicrobial activity indicated by the inner clear ring and anti-QS activity indicated by the outer non-pigmented ring, in a concentration-dependent manner. The lowest dilution of EOs of O. heracleoticum and O. vulgare in which exhibited visually detectable inhibition of violacein synthesis was 1.56 and 3.25 µl/ml, respectively. Considering that, the main constituents of the tested EOs represented by monoterpenes (carvacrol, thymol, γ-terpinene, and p-cymene), anti - QS properties of tested EOs can be mainly attributed to their activity. In particular, from the scientific literature, carvacrol and thymol show a sub-inhibitory effect against foodborne pathogens. Previous studies indicated that sub-lethal concentrations of carvacrol reduced the mobility of bacteria due to the ability of interference using QS mechanism between the bacterial cells, and thereby reducing the ability of biofilm formation The precise mechanism by which carvacrol inhibits biofilm formation is still not fully understood. Our results indicated that EOs displayed different active principles, i.e., antimicrobial activity indicated by the inner clear ring and anti-QS activity indicated by an outer non- pigmented ring with visually detectable inhibition of violacein. Preliminary results suggest that EOs represent a promising alternative for effective control of the emergence and spread of resistant pathogens.

Keywords: anti-quorum sensing activity, Chromobacterium violaceum, essential oils, violacein

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Authors: Kelly Jo Hollingsworth

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Conversational Solfege, a research-based, 12-step music literacy instructional method using the sound-before-sight approach, was used to teach rhythm-reading to 128-second grade students at a public school in the southeastern United States. For each step, multiple scripted techniques are supplied to teach each skill. Unit one was the focus of this study, which is quarter note and barred eighth note rhythms. During regular weekly music instruction, students completed method steps one through five, which includes aural discrimination, decoding familiar and unfamiliar rhythm patterns, and improvising rhythmic phrases using quarter notes and barred eighth notes. Intact classes were randomly assigned to two treatment groups for teaching steps six through eight, which was the visual presentation and identification of quarter notes and barred eighth notes, visually presenting and decoding familiar patterns, and visually presenting and decoding unfamiliar patterns using said notation. For three weeks, students practiced steps six through eight during regular weekly music class. One group spent five-minutes of class time on steps six through eight technique work, while the other group spends ten-minutes of class time practicing the same techniques. A pretest and posttest were administered, and ANOVA results reveal both the five-minute (p < .001) and ten-minute group (p < .001) reached statistical significance suggesting Conversational Solfege is an efficient, effective approach to teach rhythm-reading to second grade students. After two weeks of no instruction, students were retested to measure retention. Using a repeated-measures ANOVA, both groups reached statistical significance (p < .001) on the second posttest, suggesting both the five-minute and ten-minute group retained rhythm-reading skill after two weeks of no instruction. Statistical significance was not reached between groups (p=.252), suggesting five-minutes is equally as effective as ten-minutes of rhythm-reading practice using Conversational Solfege techniques. Future research includes replicating the study with other grades and units in the text.

Keywords: conversational solfege, length of instructional time, rhythm-reading, rhythm instruction

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Authors: Surjit Angra, Gajanan Rane, Vinod Kumar, Sushma Rani

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This paper presents metallurgical investigation of failed helical gear of diesel engine gear box used in a car. The failure had occurred near the bottomland of the tooth spacing. The failed surface was studied under Scanning Electron Microscope (SEM) and also visually investigated. The images produced through SEM at various magnifications were studied. Detailed metallurgical study indicates that failure was due to foreign material inclusion which is a casting defect. Further study also revealed pitting, spalling and inter-granular fracture as the causes of gear failure.

Keywords: helical gear, scanning electron microscope, casting defect, pitting

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Authors: Aisyiyah Fauziah Rahmah

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Generally, an urban city has a rapid growth, it has frequent a variety of problems, especially of convenience in public space usage. The density of population in urban areas and the high activity is also indicated as a cause of urban resident lifestyle for the worse in social relationships and allow for the stress. Streets and green space (parks) are the only public space in a residential area which is used as a place to build social activity, to meet and interact with the other housing dweller. The high level of activity and social interaction that occurs will affect the spatial arrangement. It can be effected the space structures in housing more complex. Ease in access to public space is the reason many dweller prefer doing social activities there. Hillier in Carmona et al (2003) explains that the pattern and intensity of movement of individuals is influenced by the configuration of space, even the space structure can be regarded as the single most influential determinant of movements in the space. Whyte in Zhang and Lawson (2009) also suggest some factors such as seats, trees, water and legibility of space encourage people to stay in public outdoor space. Furthermore this activities can attract more activities. Villa Bukit Tidar is a housing in Lowokwaru District which highest number of people in Malang City, so social activity is also high there. It has natural and recreational concept and provided with view of Malang City from heights. This potential is able to attract the people who live there to stay in public outdoor space and doing activities there. From this study we can find whether the ease of access to public space and visual satisfaction of Villa Bukit Tidar housing affect the usage of public space. This study was carried out by observing the streets pattern and plot pattern to know the configuration space of Villa Bukit Tidar housing through values of connectivity and integrity by resulting from space sintax analysis. Distributing questionnaires also carried out to determine the level of satisfaction and importance perception of visual condition in the public space in Villa Bukit Tidar housing through Important Performance Analysis (IPA). Results of this research indicated that the public spaces in Villa Bukit Tidar housing who has high connectivity and integrity is considered to be visually satisfied and it has a higher public space usage than has low connectivity and integrity are considered to be visually dissatisfied.

Keywords: configuration space, visual perception, social activities, public space usage

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Authors: Vivek Saxena, Shreshtha Saxena

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Background: Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance first recognized during pregnancy. Uncontrolled or untreated GDM is associated with various adverse outcomes to the maternal and fetal health. Overt diabetes mellitus may also develop in such patients. It is universally accepted fact that first and foremost management to treat GDM is dietary control and lifestyle modification even before starting any oral hypoglycemic agent (OHA) or insulin. So, proper dietary management and little changes in the patient’s lifestyle are very effective for reducing her plasma glucose level. Objectives: Proper counselling of the patients and flexibility in their lifestyle and diet can effectively control the plasma glucose level in GDM patients. Methods: Total 60 GDM patients of age > 18 years were taken. We had three counselling sessions with the patient and other members of the family like husband, parents, and in-laws at different intervals, discussed their lifestyle and diet pattern, helped them to eliminate the factors those had an adverse effect on plasma glucose level and promoted them to acquire a healthy lifestyle. We have counselled the patient and her family member separately and then together also. They have explained how increased plasma glucose level can be effectively controlled with the little modification in their diet and routine activities. They were also taught to remain stress-free during their rest of antenatal period. We have excluded the patients from our study who were diabetic before pregnancy and patients with other comorbid illnesses like hypothyroidism and valvular heart disease. Results and conclusions: Results were very rewarding as patients could acquire a lifestyle of their choice. They were happy because extra pill burden was not there. All the 60 patients were normoglycemic in remaining antenatal period, 48 patients were delivered normally and 12 patients underwent cesarean section due to various reasons.Regular counselling of the patients regarding their disease and little alterations in diet and lifestyle controlled the plasma glucose level much effectively. The things were more easier and effective when we included other family members during our counselling session because they play a major role in patient’s day to day activity and influence her life.

Keywords: dietary management, gestational diabetes mellitus, impaired glucose tolerance, oral hypoglycemic agent, pregnancy

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Authors: Rupinder Kaur, Harjot Kaur

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The objective of this paper is to present the study of the effect of varying thickness on rotating composite disks made from Al-SiC_P having different particle sizes. Mathematical modeling is used to calculate the effect of varying thickness with different particle sizes on rotating composite disks in radial as well as tangential directions with thermal gradients. In comparison to various particle sizes with varied thicknesses, long-term deformation occurs. The results are displayed visually, demonstrating how creep deformation decreases with changing particle size and thickness.

Keywords: creep, varying thickness, particle size, stresses and strain rates

Procedia PDF Downloads 52

Authors: Elham Azimzadeh, Saeedeh Sepehri, Hamidollah Hassanlouei

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Obesity is associated with postural instability, might influence the quality of daily life, and could be considered a potential factor for falling in obese people. The fat body mass especially in the abdominal area may increase body sway. Furthermore, loss of visual feedback may induce a larger postural sway in obese people. Moreover, Muscle fatigue may impair the work capacity of the skeletal muscle and may alter joint proprioception. So, the purpose of this study was to investigate the effect of physical fatigue and visual feedback on body sway and strength of lower extremities in obese people. 12 obese (4 female, 8 male; BMI >30 kg/m2), and 12 normal weight (4 female, 8 male; BMI: 20-25 kg/m2) subjects aged 37- 47 years participated in this study. The postural stability test on the Biodex balance system was used to characterize postural control along the anterior-posterior (AP) and mediolateral (ML) directions in eyes open and eyes closed conditions and maximal voluntary contraction (MVC) of knee extensors and flexors were measured before and after the high-intensity exhausting exercise protocol on the ergometer bike to confirm the presence of fatigue. Results indicated that the obese group demonstrated significantly greater body sway, in all indices (ML, AP, overall) compared with the normal weight group (eyes open). However, when visual feedback was eliminated, fatigue impaired the balance in the overall and AP indicators in both groups; ML sway was higher only in the obese group after exerting the fatigue in the eyes closed condition. Also, maximal voluntary contraction of knee extensors was impaired in the fatigued normal group but, there was no significant impairment in knee flexors MVC in both group. According to the findings, peripheral fatigue was associated with altered postural control in upright standing when eyes were closed, and that mechanoreceptors of the feet may be less able to estimate the position of the body COM over the base of support in the loss of visual feedback. This suggests that the overall capability of the postural control system during upright standing especially in the ML direction could be lower due to fatigue in obese individuals and could be a predictor of future falls.

Keywords: maximal voluntary contraction, obesity, peripheral fatigue, postural control, visual feedback

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Authors: Maria Sciammarella, Uttam M. Shrestha, Youngho Seo, Grant T. Gullberg, Elias H. Botvinick

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Background: Myocardial perfusion imaging (MPI) is typically performed with static imaging protocols and visually assessed for perfusion defects based on the relative intensity distribution. Dynamic cardiac SPECT, on the other hand, is a new imaging technique that is based on time varying information of radiotracer distribution, which permits quantification of myocardial blood flow (MBF). In this abstract, we report a progress and current status of dynamic cardiac SPECT using conventional gamma camera (Infinia Hawkeye 4, GE Healthcare) for estimation of myocardial blood flow and coronary flow reserve. Methods: A group of patients who had high risk of coronary artery disease was enrolled to evaluate our methodology. A low-dose/high-dose rest/pharmacologic-induced-stress protocol was implemented. A standard rest and a standard stress radionuclide dose of ⁹⁹ᵐTc-tetrofosmin (140 keV) was administered. The dynamic SPECT data for each patient were reconstructed using the standard 4-dimensional maximum likelihood expectation maximization (ML-EM) algorithm. Acquired data were used to estimate the myocardial blood flow (MBF). The correspondence between flow values in the main coronary vasculature with myocardial segments defined by the standardized myocardial segmentation and nomenclature were derived. The coronary flow reserve, CFR, was defined as the ratio of stress to rest MBF values. CFR values estimated with SPECT were also validated with dynamic PET. Results: The range of territorial MBF in LAD, RCA, and LCX was 0.44 ml/min/g to 3.81 ml/min/g. The MBF between estimated with PET and SPECT in the group of independent cohort of 7 patients showed statistically significant correlation, r = 0.71 (p < 0.001). But the corresponding CFR correlation was moderate r = 0.39 yet statistically significant (p = 0.037). The mean stress MBF value was significantly lower for angiographically abnormal than that for the normal (Normal Mean MBF = 2.49 ± 0.61, Abnormal Mean MBF = 1.43 ± 0. 0.62, P < .001). Conclusions: The visually assessed image findings in clinical SPECT are subjective, and may not reflect direct physiologic measures of coronary lesion. The MBF and CFR measured with dynamic SPECT are fully objective and available only with the data generated from the dynamic SPECT method. A quantitative approach such as measuring CFR using dynamic SPECT imaging is a better mode of diagnosing CAD than visual assessment of stress and rest images from static SPECT images Coronary Flow Reserve.

Keywords: dynamic SPECT, clinical SPECT/CT, selective coronary angiograph, ⁹⁹ᵐTc-Tetrofosmin

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Authors: M. Isabel Santos, Ana Breda, Ana Margarida Almeida

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Research on academic abilities of individuals with autism spectrum disorder (ASD) underlines the importance of mathematics interventions. Yet the proposal of digital applications for children and youth with ASD continues to attract little attention, namely, regarding the development of mathematical reasoning, being the use of the digital technologies an area of great interest for individuals with this disorder and its use is certainly a facilitative strategy in the development of their mathematical abilities. The use of digital technologies can be an effective way to create innovative learning opportunities to these students and to develop creative, personalized and constructive environments, where they can develop differentiated abilities. The children with ASD often respond well to learning activities involving information presented visually. In this context, we present the digital Learning Environment on Mathematics for Autistic children (LEMA) that was a research project conducive to a PhD in Multimedia in Education and was developed by the Thematic Line Geometrix, located in the Department of Mathematics, in a collaboration effort with DigiMedia Research Center, of the Department of Communication and Art (University of Aveiro, Portugal). LEMA is a digital mathematical learning environment which activities are dynamically adapted to the user’s profile, towards the development of mathematical abilities of children aged 6–12 years diagnosed with ASD. LEMA has already been evaluated with end-users (both students and teacher’s experts) and based on the analysis of the collected data readjustments were made, enabling the continuous improvement of the prototype, namely considering the integration of universal design for learning (UDL) approaches, which are of most importance in ASD, due to its heterogeneity. The learning strategies incorporated in LEMA are: (i) provide options to custom choice of math activities, according to user’s profile; (ii) integrates simple interfaces with few elements, presenting only the features and content needed for the ongoing task; (iii) uses a simple visual and textual language; (iv) uses of different types of feedbacks (auditory, visual, positive/negative reinforcement, hints with helpful instructions including math concept definitions, solved math activities using split and easier tasks and, finally, the use of videos/animations that show a solution to the proposed activity); (v) provides information in multiple representation, such as text, video, audio and image for better content and vocabulary understanding in order to stimulate, motivate and engage users to mathematical learning, also helping users to focus on content; (vi) avoids using elements that distract or interfere with focus and attention; (vii) provides clear instructions and orientation about tasks to ease the user understanding of the content and the content language, in order to stimulate, motivate and engage the user; and (viii) uses buttons, familiarly icons and contrast between font and background. Since these children may experience little sensory tolerance and may have an impaired motor skill, besides the user to have the possibility to interact with LEMA through the mouse (point and click with a single button), the user has the possibility to interact with LEMA through Kinect device (using simple gesture moves).

Keywords: autism spectrum disorder, digital technologies, inclusion, mathematical abilities, mathematical learning activities

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Authors: Mmamapudi Kubjane, Natacha Berkowitz, Rene Goliath, Naomi S. Levitt, Robert J. Wilkinson, Tolu Oni

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Background: South Africa remains a high tuberculosis (TB) burden country globally and the burden of diabetes – a TB risk factor is growing rapidly. As an infectious disease, TB also induces transient hyperglycaemia. Therefore, screening for diabetes in newly diagnosed tuberculosis patients may result in misclassification of transient hyperglycaemia as diabetes. Objective: The objective of this study was to determine and compare the prevalence of hyperglycaemia (diabetes and impaired glucose regulation (IGR)) in TB patients and to assess the cross-sectional association between TB and hyperglycaemia at enrolment and after three months of follow-up. Methods: Consecutive adult TB and non-TB participants presenting at a TB clinic in Cape Town were enrolled in this cross-sectional study and follow-up between July 2013 and August 2015. Diabetes was defined as self-reported diabetes, fasting plasma glucose (FPG) ≥ 7.0 mmol·L⁻¹ or glycated haemoglobin (HbA1c) ≥ 6.5%. IGR was defined as FPG 5.5– < 7.0 mmol·L⁻¹ or HbA1c 5.7– < 6.5%. TB patients initiated treatment. After three months, all participants were followed up and screened for diabetes again. The association between TB and hyperglycaemia was assessed using logistic regression adjusting for potential confounders including sex, age, income, hypertension, waist circumference, previous prisoner, marital status, work status, HIV status. Results: Diabetes screening was performed in 852 participants (414 TB and 438 non-TB) at enrolment and in 639 (304 TB and 335 non-TB) at three-month follow-up. The prevalence of HIV-1 infection was 69.6% (95% confidence interval (CI), 64.9–73.8 %) among TB patients, and 58.2% (95% CI, 53.5–62.8 %) among the non-TB participants. Glycaemic levels were much higher in TB patients than in the non-TB participants but decreased over time. Among TB patients, the prevalence of IGR was 65.2% (95% CI 60.1 - 69.9) at enrollment and 21.5% (95% CI 17.2-26.5) at follow-up; and was 50% (45.1 - 54.94) and 32% (95% CI 27.9 - 38.0) respectively, among non-TB participants. The prevalence of diabetes in TB patients was 12.5% (95% CI 9.69 – 16.12%) at enrolment and 9.2% (95% CI, 6.43–13.03%) at follow-up; and was 10.04% (95% CI, 7.55–13.24%) and 8.06% (95% CI, 5.58–11.51) respectively, among non-TB participants. The association between TB and IGT was significant at enrolment (adjusted odds ratio (OR) 2.26 (95% CI, 1.55-3.31) but disappeared at follow-up 0.84 (0.53 - 1.36). However, the TB-diabetes association remained positive and significant both at enrolment (2.41 (95% CI, 1.3-4.34)) and follow-up (OR 3.31 (95% CI, 1.5 - 7.25)). Conclusion: Transient hyperglycaemia exists during tuberculosis. This has implications on diabetes screening in TB patients and suggests a need for diabetes confirmation tests during or after TB treatment. Nonetheless, the association between TB and diabetes noted at enrolment persists at 3 months highlighting the importance of diabetes control and prevention for TB control. Further research is required to investigate the impact of hyperglycaemia (transient or otherwise) on TB outcomes to ascertain the clinical significance of hyperglycemia at enrolment.

Keywords: diabetes, impaired glucose regulation, transient hyperglycaemia, tuberculosis

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