articles+ search results

Choose a surgeon, Factors, Social media, surgeon's qualifications, Public attitudes, Surgery, and RD1-811

Aim: It is a complex decision for patients and their families to select a qualified surgeon who meets their needs. Understanding these needs enables surgeons to build stronger relationship with patients. This study aimed to identify influencing factors, variables, and criteria that individuals consider when selecting surgeons for elective surgeries. Methods: This is a nationwide cross-sectional study conducted among patients who have undergone elective surgeries in Saudi Arabia. The data were collected with an anonymous self-administered pre-validated questionnaire. The collection of data was carried out through web-based questionnaires using google forms. The questionnaire contains socio-demographic characteristics (i.e., age, gender, education, etc.) and different factors to assess patients' perceptions in choosing a surgeon. Result: Patients' overall number was 3133 (56.2 % females vs 43.8 % males). The most common age group was 18 to 34 years old (63.7 %). The prevalence of patients who were able to choose the right surgeon to perform an operation was 79.8 %. Patients' top choice when selecting a surgeon was according to the surgeon's manner followed by the qualifications then the reputation. Females are choosing a surgeon according to his/her manner while males are choosing according to his/her qualifications. Conclusion: Surgeons' manner and qualifications are the most considered factors among when selecting a surgeon while the realistic factors such as accreditation of a facility and surgeon's scientific roles, quality improvement, and patient safety are ignored among the public. This requires condensed educational efforts and further research to determine the advertisements and social media effects on patients' decisions related to their health.

Social isolation, Depression, Socialization, Adolescents, Psychiatry, and RC435-571

Abstract Background Social isolation can be defined as the absence of social interactions, contacts, and relationships with family, friends, and neighbors. According to some studies, social isolation was associated with depressive symptoms. At least one out of every five teenagers suffer from a diagnosable mental health problem that impairs their function. Saudi Arabia has a significant adolescent population; however, there are few studies conducted in Saudi Arabia to assess social isolation and its psychological impact among adolescents. This research is intended to study the prevalence of social isolation among adolescents in Riyadh and its association with depression symptoms. Methods A cross-sectional study was conducted among 483 adolescents living in Riyadh, Saudi Arabia. An online self-administered questionnaire was used, and it was composed of three sections which are sociodemographic characteristics, assessment of social isolation, and assessment of depression symptoms. Results The study reported the prevalence of social isolation among adolescents was 10.14%. The prevalence of depression symptoms among adolescents was high (31.68%). There was a significant association between social isolation and symptoms of depression among the studied sample (χ 2 = 12.3, p = 0.002). It was found that being a male, living with both parents, and having low income are significant predictors of social isolation among adolescents; with r 2 = 0.08 and p-value

Epidermolysis bullosa, Supraglottic stenosis, Laryngeal manifestation, Otorhinolaryngology, and RF1-547

Epidermolysis bullosa (EB) is a group of inherited disorders characterized by increased vulnerability to mechanical stress at the dermo-epidermal junction and basilar layer of the epidermis. Laryngeal EB involvement is a major and life-threatening manifestation of the disease. Due to the nature of EB, granulation tissue and stenosis can occur, usually at the glottic, subglottic, or supraglottic levels, as seen in our patients.We described cases in which four patients with EB presented with supraglottic stenosis and were managed at tertiary hospital in Saudi Arabia. The clinical and therapeutic characteristics of all patients are discussed.

Nursing and RT1-120

Introduction Pregnancy is a significant transitional life experience. It can also be one of the most stressful experiences in life and some women go on to develop postpartum depression. Adopting mindfulness techniques during childbirth may allow women to experience less labor pain and require fewer medical interventions, which improve the mother's health. Objective To investigate the effectiveness of mindfulness in reducing childbirth stress in primigravid women in Saudi Arabia. Methods The researcher recruited primigravid women from an antenatal clinic in a government hospital in the Eastern Province of Saudi Arabia. The study adopted a qualitative interpretive descriptive design, using individual interviews to collect the data before conducting thematic content analysis using NVivo 10.1 software. Results Five key themes emerged from the data: (a) stress reduction, (b) recognition of thoughts and feelings, (c) life satisfaction, (d) insufficient knowledge leads to challenges, and (e) empowerment of a spiritual aspect. Conclusions Mindfulness is an effective technique that supports a mother's physical and psychological well-being.

Nursing and RT1-120

Introduction The postpartum period is accompanied by health risks that impact many women. Postpartum depression (PPD) is a mental health problem that has been neglected in maternal healthcare services. Objective The purpose of this study was to explore nurses’ perceptions towards health services’ contribution to lowering the incidence of PPD. Methods An interpretive phenomenological approach was adopted in a tertiary hospital in Saudi Arabia. A convenience sample of 10 postpartum nurses was interviewed face-to-face. The analysis followed Colaizzi's data analysis method. Results Seven main themes emerged on how to improve maternal health services to contribute to reducing the incidence of PPD among women: (1) maternal mental health, (2) follow-up of mental health status, (3) screening mental health status, (4) enhancing health education, (5) reducing stigma toward mental health, (6) updating resources, and (7) empowering nurses. Conclusion The integration of mental health services into maternal services that are provided to women needs to be considered in the context of Saudi Arabia. This integration will result in high-quality holistic maternal care.

Epilepsy, Neurological conditions, WES, Saudi Arabia, Variants, Medicine, Genetics, and QH426-470

Abstract Background Epilepsy, a serious chronic neurological condition effecting up to 100 million people globally, has clear genetic underpinnings including common and rare variants. In Saudi Arabia, the prevalence of epilepsy is high and caused mainly by perinatal and genetic factors. No whole-exome sequencing (WES) studies have been performed to date in Saudi Arabian epilepsy cohorts. This offers a unique opportunity for the discovery of rare genetic variants impacting this disease as there is a high rate of consanguinity among large tribal pedigrees. Results We performed WES on 144 individuals diagnosed with epilepsy, to interrogate known epilepsy-related genes for known and functional novel variants. We also used an American College of Medical Genetics (ACMG) guideline-based variant prioritization approach in an attempt to discover putative causative variants. We identified 32 potentially causative pathogenic variants across 30 different genes in 44/144 (30%) of these Saudi epilepsy individuals. We also identified 232 variants of unknown significance (VUS) across 101 different genes in 133/144 (92%) subjects. Strong enrichment of variants of likely pathogenicity was observed in previously described epilepsy-associated loci, and a number of putative pathogenic variants in novel loci are also observed. Conclusion Several putative pathogenic variants in known epilepsy-related loci were identified for the first time in our population, in addition to several potential new loci which may be prioritized for further investigation.

Acute annular outer retinopathy, Acute zonal occult outer retinopathy, Invasive ductal carcinoma, Retinal disease, Case report, Ophthalmology, and RE1-994

Abstract Background Acute annular outer retinopathy (AAOR) is an uncommon disease. To date, there are few documented cases in the literature. Our case report is the first to describe a case of acute annular outer retinopathy in a patient with invasive ductal breast carcinoma. Case presentation The patient presented with photopsias and visual loss approximately 3 weeks prior to a diagnosis of invasive ductal breast carcinoma. We have documented the outer annular white ring seen in the acute phase of this disease and correlate it anatomically with Spectral-domain optical coherence tomography (SD-OCT) imaging. We identified RPE atrophy with nodular hyperreflectivity and loss of ellipsoid layer within the white annular ring with corresponding visual field loss. Fundus autofluorescence correlated with structural alterations seen on SD-OCT and showed both presumed active hyperautofluorescent zones with patchy hypoautofluorescent zones of atrophy and a classic annular hyperautofluorescent border. This case provides additional information about the natural history of this rare entity and its prognosis and varied presentation. Conclusions The authors report a single case of acute annular outer retinopathy in a patient with invasive ductal breast carcinoma with the corresponding SD-OCT, fundus autofluorescence and visual field findings, during the acute phase of the disease. These findings provide new insight into the characteristic features, etiology and progression of this rare disease.

decolonial design education, design pedagogy, minor gestures, decoloniality, critical pedagogy, Drawing. Design. Illustration, and NC1-1940

This paper lays out the groundwork for a concept we define as minor gestures within design education. Moving away from a conversation centered around decolonization—a term, we argue, that has been co-opted to become a placeholder for equality, diversity, and inclusion, and tick-box exercises within academic institutions— we assert that minor gestures create the conditions for meaningful conversations on what it actually means to move towards decolonizing design education. Using examples from our own pedagogical practices, we sketch out and outline a proposition for minor gestures as theory-in-the-making, or an incomplete pathway towards meaningful, structural change.

Core muscles strength, Dynamic balance, Hospital staff, Miscellaneous systems and treatments, and RZ409.7-999

Abstract Background Healthcare workers are at the risk of developing weakness in core muscles and balance disturbance due to stress at the workplace. The purpose of this study was to examine the relationship between core muscle strength measured with a plank test and dynamic balance assessed with the modified Star Excursion Balance Test (MSEBT) among hospital staff. A convenience sample of 27 healthy male employees at Rabigh General Hospital participated in the study; participants performed MSEBT and plank tests in the gym of the physical therapy department at the hospital. Results The mean age of the 27 participants was 32.19, standard deviation (SD) 4.16 years; mean height was 171.15, SD 6.39 cm; mean weight was 72.37, SD 11 kg; and body mass index was 24.73, SD 3.62 kg/m2. Pearson’s correlation coefficient showed a positive significant correlation between scores on the plank test with leg reach scores on MSEBT. The data showed a highest correlation between scores on plank test with dominant anterior leg reach scores on MSEBT (r = 0.446, p = 0.010), and lowest with non-dominant anterior leg reach scores on MSEBT (r = 0.335, p = 0.044). Conclusion Weak to moderate positive significant correlation between the plank test of isometric core muscle strength and both the right and dominant of the anterior, posteromedial, and composite score on the MSEBT of the lower limb and significantly with non-dominant anterior reach. There was no significant difference between the administrative and health practitioner on the plank test or MSEBT.

Government, Perception, Middle East, Arab countries, COVID-19, Level of satisfaction, Public aspects of medicine, and RA1-1270

Abstract Background Public acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as well as low- and middle-income countries (LMICs). The ability of LMICs to respond to the challenge of the COVID-19 pandemic has been limited and may have affected the impact of governmental strategies to control the spread of COVID-19. This study aimed to evaluate and compare public opinion on the governmental COVID-19 response of high and LMICs in the Middle East and benchmark it to international countries. Methods An online, self-administered questionnaire was distributed among different Middle Eastern Arab countries. Participants’ demographics and level of satisfaction with governmental responses to COVID-19 were analyzed and reported. Scores were benchmarked against 19 international values. Results A total of 7395 responses were included. Bahrain scored highest for satisfaction with the governmental response with 38.29 ± 2.93 on a scale of 40, followed by the Kingdom of Saudi Arabia (37.13 ± 3.27), United Arab Emirates (36.56 ± 3.44), Kuwait (35.74 ± 4.85), Jordan (23.08 ± 6.41), and Lebanon (15.39 ± 5.28). Participants’ country of residence was a significant predictor of the satisfaction score (P

self-healing concrete, finite element modeling, structural resilience, sustainability, Building construction, and TH1-9745

The formation of cracks in concrete structures occurs due to a multitude of causes ranging from shrinkage to external loading and environmental exposure. This phenomenon can significantly affect the lifecycle of concrete structures. Self-healing concrete (SHC) is considered a promoted innovation capable of overcoming this inevitable occurrence. In accordance with current SHC development processes, this paper utilizes the numerical simulation approach to test the performance of reinforced SHC beam specimens modeled using the commercial software ABAQUS 6.14 (Vélizy-Villacoublay, France). This paper aims to contribute to the scarce literature on SHC models by utilizing the overlooked dicyclopentadiene (DCPD) agent and ambiguous variability of crystalline admixtures. The SHC is introduced to the beam models at various depths and analyzed using load against displacement curves compared with a reference model of ordinary concrete. The effects of SHC on the mechanical properties of structural elements were determined. The results show a distinct improvement of the load-carrying capacity of SHC beams, indicating an efficient contribution of SHC in structural applications.

drugs, FDA, oligonucleotides, peptides, vutrisiran, gadopiclenol, Medicine, Pharmacy and materia medica, and RS1-441

A total of 37 new drug entities were approved in 2022; although that year registered the lowest number of drug approvals since 2016, the TIDES class consolidated its presence with a total of five authorizations (four peptides and one oligonucleotide). Interestingly, 23 out of 37 drugs were first-in-class and thus received fast-track designation by the FDA in categories such as breakthrough therapy, priority review voucher, orphan drug, accelerated approval, and so on. Here, we analyze the TIDES approved in 2022 on the basis of their chemical structure, medical target, mode of action, administration route, and common adverse effects.

active stretching, pectoralis muscles, rounded shoulder posture, strength training, trapezius muscle, and Medicine

Background: The shortening of the pectoralis minor muscle (PMi-M) and weakening of the lower trapezius muscle (LTr-M) affect scapular movement, resulting in the development of a rounded shoulder posture and reduction in the shoulder flexion range of motion (SFROM). Objective: This study evaluated the combined effect of LTr-M strengthening and PMi-M stretching on correcting the rounded shoulder postures and SFROM among young Saudi females. Methods: This study was based on a two-arm parallel-group repeated measures randomized comparative design. A total of sixty female participants with rounded shoulder postures were recruited and randomly allocated into groups 1 and 2 (n = 30/group). Each group performed supervised PMi-M stretching; however, group 2 performed a combination of LTr-M strengthening and PMi-M stretching. The outcomes, including rounded shoulder posture and SFROM, were assessed using the pectoralis minor length test (PMLT) and universal goniometer. A repeated measure ANOVA was used to compare the differences within-group and between-group for the outcomes measures at one-week (baseline) pre-intervention, two weeks, and three -weeks post-intervention. The significance level was set at q > 2.00 and p < 0.05 for all respective statistical analyses. Results: The within-group comparison revealed significant improvements (q > 2.00) in the outcomes of PMLT and SFROM when comparing their post-intervention scores to the baseline scores. The between-group comparison revealed a significant and an insignificant (q < 2.00) difference in the outcomes of PMLT and SFROM, respectively when comparing their scores at the second- and third-week post-intervention. Furthermore, the effect size of the intervention suggests an advantage of group 2 over group 1 in increasing the resting length of the PMi-M only among young Saudi females. Conclusions: The combined effect of LTr-M strengthening and PMi-M stretching was more beneficial than PMi-M stretching alone in correcting the rounded shoulder posture among young Saudi females by increasing PMi-M resting length. However, it could not yield a differential improvement in the SFROM outcome among them.

Social Sciences, Management. Industrial management, and HD28-70

This study aims to provide comprehensive insights into the social media marketing characteristics affecting customer buying intention. The model was theoretically based on and explored using a quantitative approach. A survey strategy was adopted, and a five-point Likert questionnaire was distributed to Jordanian citizens. A total of 237 responses were received. The hypothesis testing followed structural equation modeling using SPSS software. The findings suggest that all social media marketing subcontracts exhibit a significant positive effect on buying intention, whereby accessibility is the highest. Customer involvement also moderates the relationship between social media marketing and customer buying intention. The proposed model provides new insights into social media marketing drivers affecting buying intentions and engagement with an entrepreneurial brand or product. This study reaffirms that social media marketing can significantly influence the success of Jordanian entrepreneurial firms and understanding how to use this tool effectively can significantly change how businesses operate.

covid-19, medical education, acceptance, vaccine, and Medicine

Background: COVID-19 was declared a public health emergency of global concern by the World Health Organization (WHO) on January 30, 2020. Vaccination is one of the most effective methods for halting the pandemic and preventing complications. Vaccine hesitancy is a possible threat to global public health. Understanding the key determinants that influence the community's preferences and demands for a future vaccine may aid in the development of strategies to improve the global vaccination program. The aim of this study was to assess the beliefs, barriers, and acceptance of COVID-19 vaccination among Taif University students in Saudi Arabia. Materials and Method: This was a descriptive cross-sectional study, based study in Taif University, Saudi Arabia. Data was collected using a designed self-administered questionnaire that was shared as a link through social media. 332 students were considered eligible to participate voluntarily. Data were analyzed using the (SPSS) program version 25. Results: Out of 332 participants, 278 (83.7%) were accepting to take the covid vaccine, while 54 (16.3%) refused. Believes in vaccine safety and effectiveness and trust in the ability of the vaccine to prevent the complication, were all associated with high acceptance rate. Fear about side effects is considered a major factor for vaccination refusal. Conclusion: Most of the participants have the willingness to be vaccinated. The majority of students who agreed to take the vaccine were in the medical field, and that is mostly due to their high knowledge exposure. This indicates the importance of raising the awareness of the non-medical students.

Night eating syndrome, Binge eating, Psychological symptoms, Depression, Anxiety, Impulsiveness, Science (General), and Q1-390

The objective of this meta-analysis was to find out the prevalence of Night Eating Syndrome (NES) associated with psychological disorders among university students. Extensive search of database yielded 1541 articles matching the search keywords, out of which were 1528 were excluded due to difference in population, outcome, and study design. At the end, only 13 articles were retrieved which aligned with the inclusion criteria. Prevalence of NES associated with psychological disorders in 9432 participants was 8.2% (95% CI 4.9: 13.4) but there was high level of heterogeneity. Female university students had a higher prevalence of the disorder (7.2%) with a high degree of heterogeneity (τ2 = 0.687, I2 = 96%, P

Medicine (General) and R5-920

Introduction: The aim of this study was to evaluate the change in the healthcare providers’ perceptions regarding the World Health Organization Surgical Safety Checklist (WHO SSC) and patient safety in the operating room (OR) at a tertiary hospital in Riyadh, Saudi Arabia. Methods: This cross-sectional study was conducted at King Abdulaziz Medical City. Data were collected from two years (2011 and 2019) for comparison. The co-investigators distributed a self-administered Likert scale questionnaire in the various operating areas (35 ORs). Results: The total sample was 461. Number of participants enrolled from both years was 235 (51%) and 226 (49%), respectively. The results indicated a statistically significant difference in the attitude of the participants regarding all aspects of patient safety in the OR when the two periods were compared (p < 0.001). Similarly, healthcare providers’ perceptions regarding the importance of the WHO SSC increased from 50% (2011) excellent to 68% excellent (2019) (p < 0.001). Conclusions: Currently, more healthcare providers recognize the importance of the WHO SSC, and more have a positive attitude toward teamwork, communication, and feeling free to speak out when surgical safety is compromised. All of these cultural changes have positive impact on the overall safety of the OR; however, there are still aspects requiring improvement to provide a safer OR and surgery. Educational interventions regarding the importance of communication and teamwork would improve the safety of surgical care in the OR.

Eastern Mediterranean region, honor killing, violence against women, femicide, homicide, and Medicine

Honor killing is a violent crime committed by one or more perpetrators, in which the crime’s intention is to restore honor to their family. In this narrative review, the authors investigate the epidemiology of honor killing in the Eastern Mediterranean Region. Furthermore, the social, cultural, and legal aspects of honor killing are discussed. Numerous socio-cultural factors lead to the action of killing for honor in this region. They include deeply rooted patriarchal dominance, the desire to maintain social status, and being poorly educated. Honor killing perpetrators have similar characteristics, such as rating female chastity at a higher price and justifying violence against women. The impact of honor killing on family members is much greater than the perceived families’ beliefs of the community’s rejection of the female’s dishonorable behavior. Silence culture dominates these societies, and many crimes are under-reported in this region. Often, a judicial trial is not conducted for such heinous crimes. Penal code reforms, campaigns to promote human rights, steps to improve the education level, and active participation of civil society in condemning such crimes are a few essential measures that need to be considered in order to curb the social evil of honor killing.

Efficacy, vestibular rehabilitation, balance, systematic review., Medicine (General), and R5-920

Background: Numerous strategies and techniques are designed to treat disorders that cause body imbalance. These techniques, known as vestibular rehabilitation, focus on various exercises ranging from substitution, adaptation, habituation, and compensation. This systematic review aimed to assess the effectiveness of vestibular rehabilitation in improving balance among patients with different disorders. Material and Methods: A search of research articles in 2021 was accomplished by exploring electronic databases such as Embase, PubMed, and Scopus. Following a systematic screening and searching of articles. Fourteen relevant articles were found that were included in the review. As per the eligibility criteria, all eligible research studies were randomized controlled trials (RCTs). Results: All the included studies revealed the positive effect of vestibular rehabilitation in improving balance, and other symptoms (fatigue, vertigo, ankle sway, falls, and disequilibrium) among patients with different conditions, except one study did not find any difference between vestibular rehabilitation and standard of care. Furthermore, the reported studies indicated the benefits of the vestibular rehabilitation programs tailored to the patient's needs and requirements compared with a single program that may not fit everyone. Conclusion: Vestibular rehabilitation protocols integrated with some technological techniques and home-based exercise programs can be considered safe and effective in improving balance among older adults suffering from different conditions affecting their balance. However, future studies with a relatively large sample size are required to assess the effectiveness of the same interventions in resource-poor settings before large-scale implementation.

medical students, medical schools, social accountability, social responsibility, medical education, Education (General), and L7-991

BackgroundGlobally, there is a rising interest in the concept of social accountability (SA). The literature evaluating SA of medical schools is limited; however, some international studies have revealed a lack of understanding of SA by medical students. This study evaluated the perception of SA among medical students at a governmental university in Saudi Arabia.MethodA cross-sectional study with 336 currently enrolled medical students was conducted from September 2020 to May 2021. The data were collected using an electronic survey comprised of the THEnet questionnaire that included 12 items to assess the perception of SA and some demographic variables. The total score was categorized into four groups and compared with the demographic profile of students.ResultsOut of the 336 participants, the mean age was 21.26 ± 0.5 years, with most students in the 19–21 age group (n = 154, 46%), and 189 (56.3%) were males. In addition, preclinical and clinical students had similar representation: 170 (51%) and 166 (49%), respectively. Most participants (173, 52%) scored in the 18–36 range, reflecting good perceived SA. The demographic profile of students (i.e., age, GPA, and year of study) was significantly associated with perceived SA (p = 0.003, 0.002, and < 0.001, respectively).ConclusionThe study concludes that most medical students had a good level of perceived SA about their institution. The preclinical year students exhibited a better perception of SA. The final-year students were more critical about the SA of the institution compared to other students.

Strength, Functional performance, Sprint, Collegiate male football players, Plyometric training, NMES, and Medicine

Background The study’s objective was to analyze the influence of an 8-week neuromuscular electrical stimulation (NMES) with a plyometric (PT) and strength training (ST) program on muscular, sprint, and functional performances in collegiate male football players. Methods Sixty collegiate male football players participated in this randomized controlled trial single-blind study. All the participants were randomly divided into two groups: (1) NMES group (Experimental, n = 30) who received NMES assisted ST and (2) sham NMES group (Control, n = 30) who received sham NMES assisted ST. In addition, participants from both groups received a PT program; both groups received intervention on three days a week for 8-weeks. The study’s outcomes, such as muscular, sprint, and functional performances, were assessed using a strength test (STN) for quadriceps muscle, sprint test (ST), and single-leg triple hop test (SLTHT), respectively, at baseline pre-intervention and 8-week post-intervention. The interaction between group and time was identified using a mixed design (2 × 2) ANOVA. Results Significant difference found across the two time points for the scores of STN: F (1.58) = 5,479.70, p < 0.05; SLTHT: F (1.58) = 118.17, p < 0.05; and ST: F (1.58) = 201.63, p < 0.05. Similarly, the significant differences were found between groups averaged across time for the scores of STN: F (1.58) = 759.62, p < 0.05 and ST: F (1.58) = 10.08, p < 0.05. In addition, after 8-week of training, Cohen’s d observed between two groups a large to medium treatment’s effect size for the outcome STN (d = 10.84) and ST (d = 1.31). However, a small effect size was observed only for the SLTHT (d = 0.613). Conclusions Findings suggest that the effect of PT and ST with either NMES or sham NMES are equally capable of enhancing muscular, sprint, and functional performances in collegiate male football players. However, PT and ST with NMES have shown an advantage over PT and ST with sham NMES in improving muscular performance and sprint performance among the same participants.

Medicine

Foreign bodies, Respiratory tract, Bronchoscopy, Tracheostomy, Case report, Otorhinolaryngology, and RF1-547

Aspiration of foreign body into the airway is a common emergency in pediatric population and has high risk of morbidity and mortality. Clinical presentation of foreign body aspiration varies between children. Some children may present to emergency department with acute life-threatening presentations that require immediate intervention, while others might have long term coarse of symptoms that were misdiagnosed and mistreated for long time. Variation of clinical presentations based on location of dislodged foreign body in the airway tree and size of the aspirated foreign body. Large impacted foreign body creates extra challenge and possible complications during attempt of retrieval via endoscopy alone. We report a case of large aspirated foreign body that had multiple failed attempts of endoscopic removal, and eventually retrieved using combined endoscopic and open approach without tracheostomy. This technique is safe and efficient in cases that failed conventional endoscopy due to large foreign body size.

Online Learning, Teaching, Pedagogy of Care, Technology, Holistic Education, Digital Learning, Special aspects of education, and LC8-6691

This article discusses the importance of pedagogy of care designed for online teaching and learning settings. We offer a model for care in online education built on theoretical foundations, including Jerome Bruner’s (1996) work on folk pedagogies. Through the lens of Bruner’s folk pedagogies, there are new possibilities for developing folk pedagogies designed for care in online spaces. Threading this with experiential learning, humanistic psychology, and theory about technologies, we identify tensions within human-technological intersections, including the intersections of agency between human and machine. While such tensions are important to identify, there is also a need to move beyond the tensions and the implied binary between the human and the technological to envision new assemblages and creative possibilities that afford care and allow for student agency. Stemming from this model, we offer practical implications for educators and researchers towards a human-centered pedagogy of care for online learning pointing to technological futures.

amphibian, biodiversity, landscape connectivity, urban conservation, Environmental sciences, GE1-350, Ecology, and QH540-549.5

Abstract Cities worldwide are expanding in area and human population, posing multiple challenges to amphibian populations, including habitat loss from removal of wetlands and terrestrial upland habitat, habitat fragmentation due to roads and the built environment, and habitat degradation from pollutants, extensive human use and introduced species. We developed an eight‐step urban amphibian conservation framework based on established monitoring, analytical methods and community engagement to enable amphibian conservation in a large urban centre. The framework outlines a process used to conserve biodiversity in a complex landuse and decision‐making environment supported by a series of successive complementary modelling techniques to measure amphibian presence, priority habitat and functional connectivity. We applied the framework in Calgary, Alberta, Canada to illustrate its potential. Here, urbanization has reduced wetlands by 90% and ecological knowledge on amphibians was poor. We improved knowledge on amphibian diversity and distribution, identified core wetlands and movement pathways for amphibian species and identified barriers in the wetland network where construction or restoration measures could re‐establish amphibians or increase their densities. This knowledge was shared with ecologists and city planners for implementation through appropriate policies and plans. Our framework provides a series of stepwise products to improve an urban municipality's ability to restore or conserve priority habitat and movement pathways necessary for amphibian survival under pressure from multiple land uses. The framework provides a platform to identify city plans, policy and or programmes and to derive necessary information to support amphibian conservation.

Nanosponges, crosslinker, nanocarrier, cyclodextrin, analgesics, drug efficacy, Therapeutics. Pharmacology, and RM1-950

AbstractCyclodextrin nanosponges are solid nanoparticles, designed by cross-linking of cyclodextrin polymer; it has been used widely as a good delivery system for water insoluble drugs. The aim of this study is to enhance the solubility of Piroxicam (PXM) using β-Cyclodextrin based nanosponges formulations. PXM nanosponge (PXM-NS) formulations were prepared using β-cyclodextrin and carbonyldiimidazole as a cross linker, three ratios of β-cyclodextrin to crosslinker in addition to three drug to nanosponges ratios were tested. Piroxicam nanosponge formulations were characterized for its particle size, zeta potential, physical compatibility and in vitro release. Stability studies at three temperatures (4 °C, 25 °C and 40 °C) were done for optimal formula. Finally, the in vivo analgesic activity and pharmacokinetic parameters of the optimal formula were conducted. The optimized PXM-NS formula (PXM-NS10) showed particle size (362 ± 14.06 nm), polydispersity index (0.0518), zeta potential (17 ± 1.05 mV), and %EE (79.13 ± 4.33). The dissolution study showed a significant increase in the amount of PXM dissolved compared with the unformulated drug. Stability studies confirmed that nanosponge showed accepted stability for 90 days at 4 °C and 25 °C. In vivo analgesic studies verified that there was a significant enhancement in the analgesic response to PXM in mice, and 1.42 fold enhancement in the relative bioavailability of PXM-NS10 as compared to commercial tablets. Nanosponge prepared under optimal conditions is an encouraging formula for increasing the solubility and therefore the bioavailability of Piroxicam.

Biomarkers, Breast cancer, Ceramide expression, Molecular subtypes, Saudi Arabia, Therapeutics. Pharmacology, and RM1-950

Background/Introduction: Despite advances in the diagnosis and management of breast cancer (BC), it is still associated with high mortality rates. New biomarkers are being developed for the diagnosis, treatment, and prediction of responses of BC. Ceramide (CER), a bioactive sphingolipid, has emerged recently as a useful diagnostic tool in several types of tumors. In this study, we evaluated CER expression in invasive BC and assessed its relation to the molecular subtypes of BC. Materials and methods: The clinical data and histopathological slides of 50 patients with invasive ductal carcinoma were retrieved and reviewed. The cases were then stained with a mouse monoclonal anti-ceramide antibody. Pearson correlation was used to assess the correlation between CER percentage and intensity and other clinical and pathological variables. Results: CER expression showed a direct relationship with estrogen and progesterone receptors Allred scores. However, it showed an inverse relation with tumor grade, HER2/neu status and Ki-67 index. Conclusions: CER expression is likely to be associated with luminal BC molecular subtypes. However, more research is needed to confirm these results and to explore its relation to the different clinical outcomes, including response to treatment and prognosis.

Human papillomavirus, Female schoolteachers, Unawareness, HPV vaccine, HPV vaccine uptake, HPV transmission routes, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, and RA1-1270

Background: Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. This cross-sectional study among female schoolteachers assessed the prevalence of i) unawareness of HPV infection’s causal role in cervical cancer; ii) unawareness of HPV vaccine availability and iii) examined the sociodemographic variables associated both the outcome variables. Methods: This cross-sectional study was conducted among female schoolteachers employed in public and private sectors schools in Kuwait using a structured questionnaire for data collection. Prevalence of each of the outcome variables was computed. Multivariable logistic regression analyses were used to evaluate independent predictors of two dependent variables. Results: A total 1341 female schoolteachers were enrolled. Of the participants, 60% were unaware of HPV causal role in cervical cancer and 88% were unaware of HPV vaccine availability. Among those who were aware of HPV vaccine availability, 83.8% were unvaccinated. Multivariable logistic regression (MLR) model showed that 20–29 years old participants or those with low family income (< 500 KD/month) were significantly (p < 0.05) more likely to be unaware of HPV causal role in cervical cancer. Moreover, participants with family/ personal history of cervical cancer were significantly (p < 0.05) less likely to be unaware of HPV role in causation of cervical cancer. A separate MLR model revealed that the participants were significantly more likely to be unaware of HPV vaccine availability if they were Kuwaiti nationals or non-Kuwaiti Arabs (p < 0.05), employed in public schools (p = 0.003) or less likely to be unaware if they had personal or family history of cervical cancer (p < 0.001). Conclusion: High prevalences of unawareness of causal role of HPV in cervical cancer and unawareness of HPV vaccine availability were recorded. Targeted education among identified sociodemographic groups with high levels of unawareness is warranted. If undertaken, future studies may evaluate the impact of recommended efforts.

Vestibular rehabilitation, Referral, Physical therapy modalities, Evidence-based practice, Vestibular disorders, Balance disorders, and Medicine

Objectives There is compelling scientific evidence about the role of physiotherapists in vestibular rehabilitation. However, patients with vestibular-associated dizziness and balance disturbances are seldom referred to physiotherapists in Saudi Arabia. Therefore, this study aims to achieve insight into perceptions, knowledge, attitudes, and referral practices among Saudi Arabian medical doctors relating to the role of physiotherapists in vestibular rehabilitation. Methods A sample of 381 medical doctors practicing in Saudi Arabia participated in this nationwide cross-sectional study. The sample was obtained from 226 hospitals across 13 provinces of Saudi Arabia by stratified sampling method. The 23-item questionnaire developed by a team of experts was emailed to medical doctors practicing in various hospitals across Saudi Arabia. Results Out of 1,231 medical doctors invited, 381 medical doctors responded, giving a response rate of 30.9%. One hundred ninety-three (50.6%) medical doctors reported managing patients with vestibular rehabilitation. The most preferred specialist for managing patients with vestibular disorders was an Ear Nose Throat (ENT) specialist (n = 173, 89.6%). Related Sample Cochran’s Q test showed statistically significant difference between preferred specialist for managing patients with vestibular disorders (ENT specialists, physiotherapists, nurses, occupational therapists and audiologists) (χ2(4) = 482.476, p = 0.001). Out of 193 medical doctors, 153 (79.2%) reported no role of the physiotherapist in vestibular rehabilitation. One hundred forty-five (75.1%) of medical doctors reported that they were not aware of the role of physiotherapists in vestibular rehabilitation. Only 27 (15.5%) medical doctors reported referring patients with vestibular disorders to physiotherapists. Conclusion The study reports that physiotherapy services are underutilized in vestibular rehabilitation due to limited referral from Saudi Arabian medical doctors. Therefore, there is a need to increase the awareness among Saudi Arabian doctors about the physiotherapist’s role in vestibular rehabilitation.

Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, and RA1-1270

Objective: Many studied investigated the manifestations of COVID-19, yet few described the pattern and severity of otolaryngological symptoms. We aim to describe the picture of COVID-19-associated otorhinolaryngological manifestations and recovery to explore individualized treatment, onward referral, and complications prevention. Design: Prospective longitudinal questionnaire-based study. Setting: The online questionnaire was filled 3 times through a remote interview over a period of 1 month from June 2020 to July 2020. Participants: Patients with confirmed COVID-19 by RT-PCR who were clinically stable. Main Outcome Measures: Date of diagnosis, sociodemographic data, and the presence of predictive factors, such as nasal and paranasal disease, anosmia and dysgeusia. Validated tools were used, such as Sino-nasal Outcome Test (SNOT-22), smell test (medical academy screening tool), Voice Handicap Index (VHI), and Reflux Symptoms Index (RSI). Result: The questionnaire was sent to 363 patients and the response rate was 70.80% (n = 257). The mean age was 34.58 years (SD = 11.22) and the rate of male participants was 60.7%. The most common otorhinolaryngological symptoms at the time of enrollment was fever (48.6%), whilst the commonest severe symptom was cough (57%). After 1 month, only 11 participants had persistent severe symptoms, especially sleep and psychological symptoms (73%), and the majority were female (63.6%). All of them had at least 1 comorbidity. There was a significant difference between the mean age of participants with severe symptoms (mean = 27.45, SD = 8.39) and without severe symptoms (mean = 34.90, SD = 2.53, t (255) = 2.17, P = .031). Conclusion: COVID-19 has a wide-ranged spectrum of presentations, with otorhinolaryngological symptoms being the commonest and most serious. Studying these symptoms is vital to advance management options.

Technology and Science

Over the years, energy harvesting technologies have been used in various self-powered systems. These technologies have several methods of application depending on their usage. Renewable energy is one of the types of energy harvesting technologies where energy is generated from naturally replenished sources. One of the energy harvesting methods that is commonly used is piezoelectric transducers. Piezoelectric materials are groups of elements that can be used to generate electricity when mechanical energy is applied. When external mechanical stress is applied, the inner lattice is deformed, resulting in the separation of the positive and negative centers of the molecule and thus the generation of a small dipole. Therefore, this paper aims to discuss the output of the piezoelectric transducer by reviewing it depending on two different material types and in other energy harvesting structures. Furthermore, a comparison was made in order to compare the power output of the two materials. Similarly, the most used piezoelectric transducer structures for power harvesting applications were revised. In addition, the parameters that affect the value of the generated power output were discussed using the figures of merit (FOM) concept. Moreover, the according to the FOM concepts, when stress is applied, the electrical energy extracted from a piezoelectric energy harvesting material is determined by the change in stored electrical energy within a piezoelectric material. The figures of merit (FOM) depend on the piezoelectric strain and its permittivity. The piezoelectric strain directly relates to FOM, while the permittivity has an inverse relationship with FOM. Thus, the highest strain constant and low permittivity material will provide the highest energy output. Additionally, lead-based (PZT) material has a strain coefficient d33 equal to 390 Coul/Nx10-12, and permittivity value ranging from 1000 to 3500 and can generate power output that is equal to 52mW at 100Hz, which is higher than the output of the lead-free-based material Barium Titanate (BaTiO3). The output of piezoelectric also depends on the piezoelectric transducer's structure. The circular diaphragm's power output is greater than the bimorph cantilever's power output due to the presence of a proof mass in the center of the diaphragm that provides prestress to the piezoelectric which improves the low-frequency performance of the energy harvester.

Medicine (General) and R5-920

Summary: Background: Hearing loss affects over 50% of people in the US across their lifespan and there is a lack of decision modeling frameworks to inform optimal hearing healthcare delivery. Our objective was to develop and validate a microsimulation model of hearing loss across the lifespan in the US. Methods: We collaborated with the Lancet Commission on Hearing Loss to outline model structure, identify input data sources, and calibrate/validate DeciBHAL-US (Decision model of the Burden of Hearing loss Across the Lifespan). We populated the model with literature-based estimates and validated the conceptual model with key informants. We validated key model endpoints to the published literature, including: 1) natural history of sensorineural hearing loss (SNHL), 2) natural history of conductive hearing loss (CHL), and 3) the hearing loss cascade of care. We reported the coefficient of variance root mean square error (CV-RMSE), considering values ≤15% to indicate adequate fit. Findings: For SNHL prevalence, the CV-RMSE for model projected male and female age-specific prevalence compared to sex-adjusted National Health and Nutrition Examination Survey (NHANES) data was 4.9 and 5.7%, respectively. Incorporating literature-based age-related decline in SNHL, we validated mean four-frequency average hearing loss in the better ear (dB) among all persons to longitudinal data (CV-RMSE=11.3%). We validated the age-stratified prevalence of CHL to adjusted NHANES data (CV-RMSE=10.9%). We incorporated age- and severity-stratified time to first hearing aid (HA) use data and HA discontinuation data (adjusted for time-period of use) and validated to NHANES estimates on the prevalence of adult HA use (CV-RMSE=10.3%). Interpretation: Our results indicate adequate model fit to internal and external validation data. Future incorporation of cost and severity-stratified utility data will allow for cost-effectiveness analysis of US hearing healthcare interventions across the lifespan. Further research might expand the modeling framework to international settings. Funding: This study was funded by the National Institute on Deafness and Other Communication Disorders and the National Institute on Aging (3UL1-TR002553–03S3 and F30 DC019846).

arts and design, college students, creativity, meditation, mindfulness, Social sciences (General), and H1-99

Given the applied nature of creativity in the arts and design, it is important to understand the conditions and practices that support it. Most research suggests that ideal conditions for creativity are often mental and emotional – involving relaxed, yet alert and focused, states of mind. This article explores the connection between mindfulness and creativity in the experiences of students in a college of arts and design, through a mindfulness teaching practice to support creative processes. In a “scholarship of teaching and learning” inquiry, we consider how mindfulness practice may affect arts and design learners’ feelings about their own creativity. Students in a large United States university school of arts and design practiced mindfulness meditation for several months, and submitted a written reflection on their experience. We qualitatively analyze this to consider how mindfulness supports creative practices in arts and design learners’ education. Our findings involve three key themes, which are: “Processing anxiety and negative feelings”, “Focusing the mind”, and “Managing the ‘Voice of Judgment’”. These thematic findings reflect how arts and design students perceive the effects of mindfulness on their creative process. We offer implications for teaching practices related to mindfulness meditation practice aimed to support learners’ perceptions of their creativity.

low-carbon concrete, sustainability, structural resilience, self-healing concrete application, Building construction, and TH1-9745

The sustainability of the construction industry is a priority in innovations made towards mitigating its notoriously high carbon emissions. Developments in low-carbon concrete technology are of peak interest today under the scrutiny of emerging policy pressures. Concrete is the external part of most structures vulnerable to permanent degradation and weathering, the possibility of an intrinsic restoration of its engineering properties promises unprecedented advancements towards structural resilience. Existing research in self-healing concrete (SHC) has often concerned the scope of material development and evaluation with inconclusive field testing, hindering its progress towards structural feasibility. This paper presents an overview of recent progress in SHC, and possible opportunities and challenges of popular healing systems are discussed. Moreover, trends are observed to investigate SHC’s influence on the engineering properties of concrete, and future projections of SHC are suggested with identification of potential research needs.

Miscellaneous systems and treatments and RZ409.7-999

fibroblast, myofibroblast, fibrosis, Canada, cell biology, metabolism, Biology (General), and QH301-705.5

Fibroblasts are stromal cells found in virtually every tissue and organ of the body. For many years, these cells were often considered to be secondary in functional importance to parenchymal cells. Over the past 2 decades, focused research into the roles of fibroblasts has revealed important roles for these cells in the homeostasis of healthy tissue, and has demonstrated that activation of fibroblasts to myofibroblasts is a key step in disease initiation and progression in many tissues, with fibrosis now recognized as not only an outcome of disease, but also a central contributor to tissue dysfunction, particularly in the heart and lungs. With a growing understanding of both fibroblast and myofibroblast heterogeneity, and the deciphering of the humoral and mechanical cues that impact the phenotype of these cells, fibroblast biology is rapidly becoming a major focus in biomedical research. In this review, we provide an overview of fibroblast and myofibroblast biology, particularly in the heart, and including a discussion of pathophysiological processes such as fibrosis and scarring. We then discuss the central role of Canadian researchers in moving this field forwards, particularly in cardiac fibrosis, and highlight some of the major contributions of these individuals to our understanding of fibroblast and myofibroblast biology in health and disease.

Children, Intensive care, SARS-CoV-2, Mortality, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, and RA1-1270

Background: Characteristics of critical Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) infection in children is not well understood. This study described the clinical characteristics of children admitted to intensive care units (ICU) and explored factors associated with the need for invasive ventilation or mortality. Methods: A multicenter, retrospective, cohort study was conducted over eight medical centers, including all patients younger than 18 years of age and admitted to the ICU due to a direct consequence of coronavirus disease 2019 (COVID-19). Patients who were admitted to the ICU for any alternate reason and tested positive for SARS-CoV-2 by screening test, and patients who were admitted due to multi-inflammatory syndrome in children, were excluded. Demographic, laboratory, imaging, and clinical data were collected. Descriptive statistics were used to compare survivors and non-survivors. Fine and Gray’s hazard model was used to estimate the association between clinical variables and ICU death. Results: During the study period, 25 pediatric COVID-19 patients received care in the ICUs. The median age was 2.78 years (IQR 0.21–8.51), and 60% were male. Only three patients were reported to be previously healthy at admission. Nine (36%) patients required invasive mechanical ventilation, including two were on extracorporeal membrane oxygenation. Four (16%) patients died during ICU care. In univariate analysis, the presence of comorbidity (HR 0.0001; 95%CI 0.00001–0.00016), platelets count (HR 0.99; 95% CI 0.98–0.99), elevated procalcitonin (HR 1.05; 95%CI 1.016–1.09), and circulatory compromise (HR 16.34; 95%CI 1.99–134.35), all at the time of ICU admission, were associated with in-ICU mortality. Conclusion: Our findings suggest that children admitted to the ICU with SARS-CoV-2 infection, generally, have a favorable outcome. Low platelets count, elevated procalcitonin, presence of comorbidity, and shock at the time of ICU admission were associated with death. This study may shed more light on the disease dynamics of critical pediatric COVID-19.

age of acquisition, bilingualism, english as a second language, perception of speech in noise, signal-to-noise ratio, snr loss, Otorhinolaryngology, RF1-547, Industrial medicine. Industrial hygiene, and RC963-969

Background: Previous studies have highlighted that bilingual listeners have a deficit in speech perception in their second language compared with monolingual listeners in noisy listening environments. This deficit may give rise to educational and occupational implications for bilingual speakers who are studying or working in non-native language environments in poor acoustic conditions. Objectives: To compare the speech perception performance of monolingual English speakers and English as a second language (ESL) bilinguals within environments with various levels of background noise and to examine whether bilinguals with an early age of second language acquisition would perform better than those with a late age of acquisition. Study sample: Two groups of adult listeners with normal hearing participated: monolingual British English listeners (N = 15) and bilingual Arabic listeners for whom English was their second language and who were proficient in English (N = 15). The quick speech-in-noise (QuickSIN) test was used to assess signal-to-noise ratio (SNR) loss and SNR-50 for both groups. Results: The QuickSIN test results indicated that bilingual Arabic listeners with normal hearing displayed a mild SNR loss comparable to that observed for a person with hearing loss, indicating a higher SNR needed for this population to achieve a comparable level of comprehension to their monolingual English peers. Conclusion: Results highlight the importance of measuring SNR loss to obtain accurate diagnosis and potential rehabilitative information that is not available from audiogram studies.

Polycystic ovary syndrome, Binge eating disorder, Health related quality of life, Depression disorder, Riyadh, Biology (General), and QH301-705.5

Background & objectives: Polycystic ovary syndrome (PCOS) is the most common endocrinal disorder, and the greatest cause of infertility in women. Despite availability of individual data on impact of multiple endocrinal, reproductive and even metabolic factors in PCOS individuals, the data on the co-existence of BED and depression in PCOS patients with its relationship on the quality of life in Saudi Arabian females is not found. Hence this study is aimed to elucidate the implication of PCOS on eating behaviour, induction of depression and general health quality in Saudi Arabian population of Riyadh. Materials and methods: This is a cross-sectional study carried out in multiple health facilities of Riyadh from January to March 2019. The study samples (494) were recruited by convenience sampling and administered validated questionnaire by trained research participants. The data obtained was analysed by binary logistic regression using SPSS-IBM 25. Results: Of the total 494 women participated in the study, 23.48% (116) were PCOS individuals. The odds of developing abnormal health related quality of (HRQ) in patients with PCOS was significantly (P = 0.000, OR = 3.472) high when compared to non-PCOS participants. The odds of showing high binge eating disorder (BED, P = 0.007, OR = 2.856) and depression (P = 0.000, OR = 2.497) scores in PCOS participants were significantly more than patients who were not having PCOS. Out of the three parameters studied, abnormal health related quality of life possessed a higher influence of PCOS compared to depression and abnormal eating behavior. Interpretation & conclusion: In conclusion, the present study shows that women with PCOS are at a significant risk for depressive disorders, disorganized eating behavior and impaired quality of life. Therefore, necessary care and screening is required to minimize the impact of PCOS on already burdened individuals.

citizen science, conservation, evaluation, grizzly bear, government, principles, Veterinary medicine, SF600-1100, Zoology, and QL1-991

Citizen science offers an excellent opportunity to engage the public in scientific data collection, educational opportunities, and applied management. However, the practicalities of developing and implementing citizen science programming are often more complex than considered. Some challenges to effective citizen science include scientists’ skepticism about the ability of public participants to rigorously collect quality data; a lack of clarity on or confidence in the utility of data; scientists’ hesitancy in engaging the public in projects; limited financial commitments; and challenges associated with the temporal and geographic scales of projects. To address these challenges, and provide a foundation upon which practitioners, scientists, and the public can credibly engage in citizen science, the Government of Alberta developed a set of citizen science principles. These principles offer a framework for planning, designing, implementing, and evaluating citizen science projects that extend beyond Alberta. Here, we present a case study using these principles to evaluate GrizzTracker, a citizen science program developed to help inform provincial species-at-risk recovery efforts. While we found that GrizzTracker applied each of the six principles in some way, including successful public engagement, strengthened relationships, and raising public awareness about northwest Alberta’s grizzly bears, we also identified a number of challenges. These included ongoing skepticism from the traditional scientific community about the utility of citizen science and governance challenges related to program leadership, staff capacity, and funding. By using the principles as a guideline, we provide policy recommendations for future citizen science efforts, including considerations for program design, implementation, and evaluation.

cardiac fibrosis, energy metabolism, fibroblast, myofibroblast, glutaminolysis, transcription, Biology (General), and QH301-705.5

Fibrosis is an energy-intensive process requiring the activation of fibroblasts to myofibroblasts, resulting in the increased synthesis of extracellular matrix proteins. Little is known about the transcriptional control of energy metabolism in cardiac fibroblast activation, but glutaminolysis has been implicated in liver and lung fibrosis. Here we explored how pro-fibrotic TGFβ and its effector scleraxis, which drive cardiac fibroblast activation, regulate genes involved in glutaminolysis, particularly the rate-limiting enzyme glutaminase (GLS1). The GLS1 inhibitor CB-839 attenuated TGFβ-induced fibroblast activation. Cardiac fibroblast activation to myofibroblasts by scleraxis overexpression increased glutaminolysis gene expression, including GLS1, while cardiac fibroblasts from scleraxis-null mice showed reduced expression. TGFβ induced GLS1 expression and increased intracellular glutamine and glutamate levels, indicative of increased glutaminolysis, but in scleraxis knockout cells, these measures were attenuated, and the response to TGFβ was lost. The knockdown of scleraxis in activated cardiac fibroblasts reduced GLS1 expression by 75%. Scleraxis transactivated the human GLS1 promoter in luciferase reporter assays, and this effect was dependent on a key scleraxis-binding E-box motif. These results implicate scleraxis-mediated GLS1 expression as a key regulator of glutaminolysis in cardiac fibroblast activation, and blocking scleraxis in this process may provide a means of starving fibroblasts of the energy required for fibrosis.

Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, and RA1-1270

Background COVID-19 has affected global communities with multiple neurological complications in addition to other critical medical issues. COVID-19 binds to the host’s angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in the neurons and glial cells, acting as an entry port to the central nervous system (CNS). ACE2 receptors are abundantly expressed on dopamine neurons, which may worsen the prognosis of motor symptoms in Parkinson’s disease (PD). SARS-CoV-2 may lead to an indirect response via immune-mediated cytokine storms and propagate through the CNS leading to damage. In this systematic review, we aim to provide thorough analyses of associations between COVID-19 and neurological outcomes for patients with PD. Methods Using PRISMA statement 2020, a systematic review was conducted to isolate confirmed COVID-19 patients and analyze the PD-associated neurological outcomes using the following databases: PubMed, Science Direct, Google Scholar, and Cochrane databases. The following keywords were used “COVID19, SARS-CoV-2, Parkinson’s disease, Pandemic, Mortality.” A modified Delphi process was employed. Results Of the 355 studies located during the initial round of screening, 16 were included in the final synthesis. Of PD patients who tested positive for SARS-CoV-2, worsening motor symptoms and other viral-associated symptoms were reported. These symptoms included bradykinesia, tremors, gait disturbances, delirium and dementia, and severe spasms of arms and legs. Encephalopathy was presented in 2 of the included studies. Increased mortality rates were identified for hospitalized patients due to COVID-19 and PD as compared to other patient groups. Conclusion Patients with PD may experience substantial worsening of symptoms due to COVID 19. Given the novelty of neurological-viral associations, clinical studies in the future ought to explore the disease severity and neurological outcomes in COVID-19 positive patients with PD as compared to non-PD patients, in addition to understanding the role of ACE2 in increased vulnerability to contracting the infection and as a treatment modality.

digital health (eHealth), evidence-based & research methodology, pediatrics - children, health system - organization and administration, mobile application (app), Medicine, Public aspects of medicine, RA1-1270, Electronic computers. Computer science, and QA75.5-76.95

Embedding digital technologies in healthcare has the potential to streamline and personalize medical care. However, healthcare systems are often fragmented, and therefore achieving a truly integrated digital health program can be challenging. To promote a streamlined, evidence-based approach to implementing digital health solutions in a healthcare system, the Murdoch Children's Research Institute (MCRI) established the Digital Health Translation and Implementation Program (DHTI) bringing together clinicians, researchers and digital health experts. From the program commencement, frontline clinical innovators have collaborated with DHTI team members to develop and implement digital solutions to address pain-points in the healthcare system. Throughout this program, important lessons have been learnt relating to the development, evaluation and implementation of digital solutions in the healthcare system. This paper explores these lessons and makes recommendations for the successful implementation of digital health solutions in healthcare systems under five main categories: (1) design and usability, (2) stakeholder engagement and uptake, (3) project management and resourcing, (4) process and implementation, and (5) evaluation. Recommendations suggested here are designed to support future healthcare-based digital health programs to maximize the impact digital solutions can have on the healthcare system and patients.

drugs, FDA, oligonucleotides, peptides, antibody-drug conjugate, inclisiran, Medicine, Pharmacy and materia medica, and RS1-441

From the medical, pharmaceutical, and social perspectives, 2021 has been a year dominated by the COVID-19 pandemic. However, despite this global health crisis, the pharmaceutical industry has continued its endeavors, and 2021 could be considered an excellent year in terms of the drugs accepted by the US Food and Drug Administration (FDA). Thus, during this year, the FDA has approved 50 novel drugs, of which 36 are new chemical entities and 14 biologics. It has also authorized 10 TIDES (8 peptides, 2 oligonucleotides), in addition to 2 antibody-drug conjugates (ADCs) whose structures contain peptides. Thus, TIDES have accounted for about 24% of the approvals in the various drug categories. Importantly, this percentage has surpassed the figure in 2020 (10%), thus reflecting the remarkable success of TIDES. In this review, the approved TIDE-based drugs are analyzed on the basis of their chemical structure, medical target, mode of action, administration route, and adverse effects.

epiregulin, leptin receptor, ERK, EGFR, glucose uptake, energy metabolism, Biology (General), and QH301-705.5

The leptin receptor (LepR) acts as a signaling nexus for the regulation of glucose uptake and obesity, among other metabolic responses. The functional role of LepR under leptin-deficient conditions remains unclear. This study reports that epiregulin (EREG) governed glucose uptake in vitro and in vivo in Lepob mice by activating LepR under leptin-deficient conditions. Single and long-term treatment with EREG effectively rescued glucose intolerance in comparative insulin and EREG tolerance tests in Lepob mice. The immunoprecipitation study revealed binding between EREG and LepR in adipose tissue of Lepob mice. EREG/LepR regulated glucose uptake without changes in obesity in Lepob mice via mechanisms, including ERK activation and translocation of GLUT4 to the cell surface. EREG-dependent glucose uptake was abolished in Leprdb mice which supports a key role of LepR in this process. In contrast, inhibition of the canonical epidermal growth factor receptor (EGFR) pathway implicated in other EREG responses, increased glucose uptake. Our data provide a basis for understanding glycemic responses of EREG that are dependent on LepR unlike functions mediated by EGFR, including leptin secretion, thermogenesis, pain, growth, and other responses. The computational analysis identified a conserved amino acid sequence, supporting an evolutionary role of EREG as an alternative LepR ligand.

medical students, mental illness, mentally ill, stigma, and Medicine

Aim: The study aimed to measure the level of the stigma of medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh campus, towards mentally ill patients. Material and Methods: A cross-sectional survey was conducted in King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh. The data collection was started in July 2017 till March 2018. The students completed a self-administered questionnaire consisting of sociodemographic data and the Community Attitudes toward the Mentally Ill (CAMI) Scale. Results: The sample size was realized as 274 participants. There were no significant differences in all CAMI subscales for the different academic years except for Authoritarianism which showed a significant increase in the level of stigma (P-value = 0.04). Male gender, previous psychiatric treatment, and having a relative with psychiatric illness were associated with higher Authoritarianism and Social Restrictiveness scores and lower Benevolence and CMHI scores. Discussion: More stigma was observed among the 4th year students and it might be due to insufficient academic preparation as well as more exposure to psychiatric rotations. Conclusion: The results support the importance of implementing anti-stigma programs throughout the medical program to improve the healthcare provided to mentally ill patients.

COVID-19 epidemic, country lockdown, online learning, Malaysia, Electrical engineering. Electronics. Nuclear engineering, and TK1-9971

The COVID-19 pandemic has struck the world and forced countries to go into lockdown including education sector. Students have been staying in hostels or houses, unable to go to university campuses. This situation has left university administrators no choice, but to have an online learning channel. Malaysian universities in particular have gone through many challenges to bring their online learning system up and ready to resume education process. However, students have found themselves caught in this situation (pure online learning) with no plan or readiness. Literature reviews showed that students encountered some challenges that could not be easily resolved. This study explored the challenges encountered by students of a government-linked university. This university is one of the largest in Malaysia with over 10 campuses across the country. This study collected 284 valid answers. The findings show that respondents lacked full readiness in this situation physically, environmentally, and psychologically with some differences in perspectives according to their gender, age, and residing state. Respondents were concerned about the implications of lockdown on their performance. The findings of this study indicate that a sudden switch to a pure online alternative creates considerable challenges to students who have no plans to be physically apart from classes. The findings also indicate that the current blended learning process which uses online learning as a support mechanism for face-to-face learning has faced a considerable challenge to replace it, particularly with unprepared students.

Theory and practice of education and LB5-3640