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May 2025 DOI 10.14302/issn.2641-5526.jmid-25-5466
McCue JohnCorresponding author
Information on adverse drug event (ADE) assessment and prevention within Electronic Health Records (EHRs) is difficult for clinicians to use and produces wide-ranging results. Challenges include inconsistent ADE and drug product definition and documentation, workflows, terminology standardization, interoperability, and clinical decision support (CDS) to inform clinical decision-making within EHRs. These factors contribute to care issues for clinicians, such as alert fatigue and provider burden for clinicians and medical errors, patient harm, and even death for patients. Clinicians play the primary role in documenting, reviewing, detecting, and preventing ADEs within EHRs. It is essential that clinicians, clinical informaticists, nursing informaticists, pharmacy informaticists, and the health informatics profession understand the current electronic ADE paradigm to advocate for improved detection and prevention of ADEs within EHRs.
Apr 2020 DOI 10.14302/issn.2372-6601.jhor-20-3293
Demiral SelcukCorresponding author
Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
Objective Meningiomas are most common intracranial benign tumors comprising around one third of all intracranial neoplasms, and typically have benign and indolent nature with slow-growing behaviour. Benign meningiomas are slow growing tumors typically following an indolent disease course. Nevertheless, atypical or anaplastic meningiomas may follow a more aggressive disease course with invasion of critical structures and recurrences. In the current study, we evaluate the incorporation of magnetic resonance imaging (MRI) for radiosurgery treatment planning of atypical meningiomas. Materials and Methods Atypical meningioma radiosurgery target volume determination with and without incorporation of MRI has been evaluated. Ground truth target volume used as the reference has been outlined by the board-certified group of radiation oncologists after comprehensive assessment, thorough collaboration and consensus. Results Target volume definition by use of Computed Tomography (CT)-only imaging and by CT-MR fusion based imaging has been comparatively evaluated in this study for linear accelerator (LINAC)-based radiosurgical management of atypical meningioma. Ground truth target volume defined by the board-certified radiation oncologists after detailed evaluation, collaboration, colleague peer review and consensus has been found to be identical to target determination by use of CT-MR fusion based imaging. Conclusion Despite significant progress in neurosurgical techniques over the years, complete surgical resection may not be feasible in the presence of meningiomas located at eloquent brain areas in close association with important neurovascular structures. RT may have a role in multidisciplinary management of meningiomas. Incorporation of MRI into treatment planning for radiosurgery of atypical meningiomas may improve target definition despite the need for further supporting evidence.
Feb 2014 DOI 10.14302/ISSN.2372-6601.JHOR-13-344
Raddaoui EmadCorresponding author
Department of Pathology, King Khalid University Hospital; College of Medicine, King Saud University.
Context: Fine needle aspiration cytology (FNA) is increasingly replacing excisional lymph node biopsy in the assessment of various lymphoid lesions. Recent changes in the classification of non-Hodgkin’s lymphoma, namely the WHO (World Health Organization) Classification of Tumors of Haematopoietic and Lymphoid Tissues has considerably expanded its classification of lymphomas based on the molecular and cytogenetic profiling and immunophenotyping. FNA diagnosis includes varied cytomorphologic diagnostic categories; one of them is the atypical/suspicious. Objective: The atypical/suspicious category constitutes about 20 % of all cases studied by FNA cytology. The objective of this study is to determine the definition and the outcome of this unique category. Design: A retrospective analysis of 34 fine needle aspirations with the diagnosis of atypical/suspicious cases were obtained during the period between 1995 –2000, and the histological and/or clinical follow-up was performed. Results: Flow cytometry was performed on all of the atypical/suspicious lesions. It was positive/diagnostic in 16 (47%) and negative in 18(53%) cases. Excisional follow-up biopsy was obtained in 30 cases. Of these 7(21%) confirmed to be negative, 17(50%) Non-Hodgkin’s lymphoma and 6 (18%) Hodgkin’s Lymphoma. Conclusion: The atypical/suspicious category by fine needle aspiration is a crucial diagnosis as it has proved to represent some type of lymphoma in about two third (68%) of cases.
Jan 2026
Donald CourtneyCorresponding author
There is no shortage of terms that are used to describe and articulate the strategies, practices, and underpinnings associated with the work engaged in by behavior analysis. Two terms that a clinic-focused behavior analyst may hear often are maladaptive behavior and problem behavior. These terms are not only common within our everyday practice, but they are also peppered throughout behavioral literature. Despite their permanency in the behavior analyst's repertoire, their meanings remain inconsistent, interchangeable, and conceptually unclear. For over a century, this lack of precision has gone unchecked, despite extensive research on undesirable or clinically significant behaviors. This article offers individuals a recount of the history, definitional limitations, and functional implications of these terms. From the perspective of early psychological scholarship and contemporary behavior-analytic sources, I argue that the field of Applied Behavior Analysis (ABA) will benefit from distinguishing maladaptive behavior as the presence of behavior that adversely affects the individual, while problem behavior should refer to the absence or inhibition of adaptive responses in relation to others' social behaviors. Furthermore, I propose that both terms be used to describe the effects on the person engaging in the behavior, instead of others around the individual, as a method of improving directionality and functional clarity. As a field focused on verbal behavior, becoming more conceptually precise with our own verbal behavior will lead to a more coherent basis for interpreting and treating behaviors that interfere with individuals' adaptation and well-being.
Dec 2025
Waine ArnoldCorresponding author
Background Intravenous Fluids use during surgery is a common practice for many reasons. However recent evaluation of perioperative abdominal surgery patients have poised many issues. Mostly on the type of fluid and quantity of volume usage on major abdominal surgery. Many studies into this aspect of perioperative fluid usage have been done, and volume definition have been accrued either restrictive (Maintenance fluid of less than 1.75 Liters) or liberal or standard (Maintenance fluid between 1.75 Liters to 2.75 Liters) usage. The outcome was assessed to ascertain the best patient recovery without complications from the two fluid regime. Result/Discussion After PRISMA exclusion criteria, there were eight randomized control studies assessed to provide a summary, comparing all the studies using either restrictive fluid or liberal fluids used in major abdominal surgery. Post operative complications and the length of hospital stay were assessed as the major outcomes end points and the cumulative result favored those with restrictive fluid usage. Conclusion Although the restrictive use of fluids in abdominal surgery is favored from the measured outcomes, there are inherent cofounders and heterogenicity in the eight studies that require more detail studies involving multiple study centers and population.
Dec 2024 DOI 10.14302/issn.2470-0436.jos-24-5322
Pestana Aguiar CatarinaCorresponding author
Studies show that individuals with limited health literacy skills experience worse health outcomes in a multitude of chronic diseases including glaucoma. These patients have poorer compliance, worse disease understanding and greater disease progression. The main purpose of our study was to evaluate the knowledge about glaucoma basic concepts in patients with this disease. A 24 question survey was given to patients followed by the glaucoma department, by phone or in person. Epidemiological data and personal therapeutic regimens were collected as well as data concerning the pathophysiology, treatment and prognosis of the disease. Survey responses were obtained from 79 patients with a mean age of 72 years old. Most of the patients had a low education level. The majority of patients could not enumerate glaucoma risk factors (74.5%), their glaucoma type (94.9%) or the best glaucoma definition (57%). However, they were able to relate the disease to a high IOP (75.9%) and the possibility of it leading to blindness (96.2%). We believe that patients, when observed in their glaucoma appointments, tend to retain information related to the prognosis and consequences of the disease and not focus on the understanding of its pathophysiology, causes and mechanisms, which may reflect their concern about their own future. However, this may lead to some misconceptions about the definition of glaucoma and specially about what can cause this disease. Some investment should be done to improve health literacy in the glaucoma population, with appropriate language and handed material.
Apr 2023 DOI 10.14302/issn.2643-2811.jmbr-22-4274
Verstapp Bund ArgerCorresponding author
A methodological note proposes formal structures for correlational studies of water problems. It emphasizes variable definition, confounding control, and reproducibility.
Dec 2022 DOI 10.14302/issn.2641-4538.jphi-22-4369
Zubizarreta PedroCorresponding author
Hospital de Pediatría Garrahan, Argentina
An opinion revisits definitions of success in pediatric Hodgkin lymphoma, balancing survival metrics with late effects and quality of life to inform patient‑centered care.
Jan 2022 DOI 10.14302/issn.2768-0207.jbr-21-4048
Donald L. BureshCorresponding author
The purpose of this essay is to discuss the advantages and disadvantages and the benefits and costs of Big Data. The paper outlines the relevant federal and state privacy laws, including the California Consumer Privacy Act as amended, the Virginia Consumer Data Protection Act, and the Colorado Privacy Act. While highlighting several Federal Trade Commission privacy violation cases, the effects of Big Data collection and government surveillance are described in some detail. Advertising and marketing are defined, where it is argued that while the scanning of emails by email providers may be legal, it should be accomplished with consent, or not at all. The essentials of contract law and specific contract negotiation techniques are outlined for the benefit of attorneys. Finally, it is argued that although Big Data is the wave of the future, like all human institutions, it has in its definition the inherent paradoxes of transparency, identity, power, and exclusion that may potentially spell its undoing.
Oct 2021 DOI 10.14302/issn.2639-3166.jar-21-3952
Narain PremCorresponding author
Professor and Independent Researcher, 29278 Glen Oaks Blvd. West, Farmington Hills, USA.
This methods‑focused review addresses missing heritability and co‑heritability in genomic studies, considering polygenicity, rare variants, gene–gene and gene–environment interactions, and phenotype definition. It surveys analytical strategies—from improved GWAS modeling to partitioning heritability and family‑based designs—to better capture shared genetic architecture. Recommendations emphasize data integration and robust inference to close current explanatory gaps.
Apr 2021 DOI 10.14302/issn.2692-1537.ijcv-21-3741
Assegid SahiluCorresponding author
MD, MPH, Associate Professor of Epidemiology Jimma University, Jimma, Ethiopia
Background Ethiopia confirmed its 1st case of COVID-19 on Friday 13th February 2020. The burden increased dramatically by August/2020. The conditions that led to this rise were not reviewed. Objective To exploreCOVID-19 related phenomena in Ethiopia during 2019-2020. Materials and Methods Review of journals, books, and letters to editors, e-sources, news, personal experiences, observations, and communications. Results The zoonotic source of SARS- CoV-2 (Severe Acute Respiratory Distress Syndrome- Coronavirus-2) is not confirmed. The precedent events; and exact mechanism of COVID-19 is not clear. Dynamic models were required on the time line of dynamics of COVID-19; dynamics of infectiousness of COVID-19, and mechanism of transmission of COVID-19. Incubatory carriers might have been missed. Screening based on temperature had been problematic. The time spent in the development of diagnostic test for COVID-19 might have contributed to the early spread. Uninterrupted flights to China during the epidemic by Ethiopian Airlines as well as uninterrupted domestic flights; IDP (Internally Displaced People); and others put Ethiopia (and other countries) at great risk. Demographic adjustment may not be applicable for Ethiopia due to lack of census which had to be conducted every 10 year, was conducted only in 2007. This adds to the problem of error projection. The impact of HIV (Human Immuno-Deficiency Virus Disease) and war in Ethiopia before 2000 might have had affected people who would be now old age and who would be at the most risk of death. This made the impact of COVID-19 to appear low as revealed by the lower number of COVID-related deaths in Ethiopia. There were also hesitations inconsistencies in case definitions; implementations of quarantine; and burial regulations. Conclusion Even though uninhibited foreign flight to China as well as domestic flights; inconsistencies in the implementation of regulations pertaining to COVID-19 have contributed to COVID- 19 emergence in Ethiopia, the absence of census; the demographic impact of HIV and war before 2000 might have made the impact of COVID-19 to appear low as revealed by the lower number of COVID-related deaths in Ethiopia. Recommendation Accurate and current evaluation of the impact of COVID-19 in Ethiopia may require the absence of census; demographic consequences of HIV; and war before 2000 into consideration.
Feb 2021 DOI 10.14302/issn.2641-5526.jmid-21-3739
Ralph J. JohnsonCorresponding author
Background As healthcare markets have become more dynamic and turbulent, healthcare organizations have evolved by becoming increasingly “Smart-Agile” in their business practices. Smart-Agility definition-ally ensures success due to its inherent ability to rapidly detect and react appropriately to varied and evolving unclear, complex, and seemingly tumultuous situations and produce high-quality, low-cost goods and services with high customer satisfaction. Thus, there is a vital need for Smart-Agile healthcare IT systems for collection, analyses, and reporting of substantial quantities of healthcare data to inform patient treatment and organizational decisions. EPIC® and its meaningful-use components appear increasingly popular, capturing a majority portion of the healthcare Electronic Healthcare Records (EHR) IT market (>~30%).Yet, there are few, if any, studies reporting on EPIC in terms of Smart-Agility. Aim The intent of this article is to report a systematic review of scientific literature regarding EPIC’s healthcare IT systems meaningful-use features cross-compared with Smart-Agility aspects to produce a positive vs. negative report card—and whether its features are critical vs. non-critical in terms of Smart-Agility. Method Findings reported herein derive from a grounded, iterative review of open-source, peer-reviewed scientific literature following PRISMA. Findings Report card results were mixed. EPIC clearly succeeds and excels (better than average) on Smart-Agile healthcare IT system core aspects that are the most central, critical and valuable in terms of informing healthcare organizations’ decisions and their patients’ care (6 out of 7; B+, -A), specifically: Standardized Data Collection / Connectivity, Real-Time Data Warehousing/Outcome Measures, Enhanced Patient Safety, Patient Tracking and Follow-up (Continuity of Care), Patient Involvement, and Potential Use in Medical Education. The only critical core criterion it failed on was End-User Satisfaction, and some of that appears to dissipate with new users’ software familiarity. Conclusion EPIC provides a solid and relatively inexpensive foundation with great potential for enabling Smart Agility in healthcare organizations with its high-quality collection and management of vast amounts of inter-connected raw data, auto-analysis, and fast report generation. But it does so with hidden costs and inefficiencies. Avenues of further inquiry are suggested.
Jun 2020 DOI 10.14302/issn.2688-5328.ijp-20-3386
Pruneti CarloCorresponding author
Dept. of Medicine and Surgery, Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology Labs., University of Parma, Italy.
How to define pain? One of the most accredited definition is certainly “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (IASP (International Association for the Study of Pain - 1986) and World Health Organization (WHO) 1. However, what are the essential components of pain experience? Certainly many factors are involved such as, among others: Perceptual ability / suitability / subjective threshold; The "subjective" experience; Multidimensionality; Occasionally or chronicity. All these components have to be taken into consideration in the treatment of these disorders which, very often, require a multidisciplinary approach. From a clinical psychological point of view, much can also be offered at a diagnostic level, from the reception to listening to the patient's suffering, to the evaluation with standardized tests and psychophysiological analysis procedures in order to arrive at an effective personalization of treatments
May 2020 DOI 10.14302/issn.2692-5915.jafs-20-3354
Donald L. BureshCorresponding author
The question that this paper answer is whether the Illinois Reporter’s Privilege should protect an online blogger. The definitions of the terms “reporter,” “news medium,” and “source” quoted from 735 ILCS 5/8-902, followed by several examples. Second, a brief history of journalism is presented, where it is demonstrated that for hundreds of years, journalists and publishers alike engaged in their profession with little formal training, but rather with a sincere desire to convey the facts and the truth to their peers. Second, the essay outlines how Illinois and federal courts have employed the privilege in case law. In answering the question, the work examines whether WikiLeaks qualifies under the Illinois Reporter’s Privilege. The position taken is that the answer is yes. The idea is that if WikiLeaks qualifies under the privilege, then other online blogs also qualify. The opinion of the author is that the law is sufficient as it stands. There is no need to change its wording. Finally, some loose ends are discussed before reiterating the conclusion that the Illinois Reporters’ should not be changed.
Oct 2019 DOI 10.14302/issn.2691-5014.jphn-19-3038
Roy SmrityCorresponding author
Medical officer, Pediatrics outdoor, Rangpur Medical College Hospital.
Background Persistent diarrhoea is a commonly observed phenomenon both in Bangladesh and all over the developing countries. It is the single most important cause of diarrhoea related deaths in the community, accounting for over half of them. If associated factors are properly identified & treated, it is possible to prevent most cases of persistent diarrhoea. Objective This study was undertaken to find out the possible risk factors associated with persistent diarrhoea in children below 5 years of age. Methods This was a prospective analytical case control study carried out in a tertiary care hospital, Dhaka. A total of 30 consecutive cases of persistent diarrhoea and 60 consecutive acute diarrhoea controls (matched for age and sex) under 5 comprised the study subjects in this study. Children beyond the age and whose parents didn’t give written consent were excluded from the study. Data were collected using a structured questionnaire and a standered case definition of acute & persistent diarrhoeawere adopted. Data were later processed and analyzed using SPSS (Statistical Package for Social Science version 12) in the year 2012. Results were considered statistically significant when p value was <0.05. Results According to the study, 56.6% of cases and 63.3% of controls were in the ‘6 to 12 months’ age group and about two-third of the participants in both cases 20 (66.7%) and controls 39 (65.0%) were males.Strong association was found with ‘bottle feeding’ RR=2.2556; 95% CI: 1.259, ‘presence of blood/mucus’ RR=2.5038; 95% CI: 1.4129, ‘WAZ≤ 2)’ RR=2.8867; 95% CI: 1.7202 and ‘early complementary feeding [RR=4.67; 95% CI: 2.5017-8.7175 and OR=7.8858; 95% CI: 3.6791-16.9 Conclusion In the present studyfour factors showed some association with persistent diarrhoea, namely: ‘use of animal milk’; ‘antibiotic use during acute diarrhoea’; ‘history of diarrhoea in previous 3 months’ and ‘pre-lacteal feed’. Strong association was found with ‘bottle feeding practices’ ‘presence of blood &/or mucus in stool’, WAZ <-2 and ‘early complementary feeding
Oct 2019 DOI 10.14302/issn.2372-6601.jhor-19-2986
Riede IsoldeCorresponding author
Independent Cancer Research, Im Amann 7, Ueberlingen D-88662.
With the definition of four gene classes, all differences between tumor cells and normal cells can be explained. Proliferative mutations induce a shortcut, forcing the cell to divide. They allow replication without control, induce somatic pairing defects of chromosomes and genome instability. Intact Tumor Supressors or mutant Switch Functions can inhibit this process. Oncogene mutations optimize the growth of the cells.
Sep 2019 DOI 10.14302/issn.2574-450X.jom-19-3000
Hayat Khan SikandarCorresponding author
Department of pathology PNS HAFEEZ
Background Polycystic ovarian syndrome (PCOS) is increasingly being diagnosed and treated with sometimes variable lifestyle advice and pharmacological interventions. Obesity is considered as the sole culprit and variable definitions in clinics compound the understanding of pathogenic heterogeneity of this syndrome. We evaluated the differences between various simple to calculate anthropometric indices along with some anthropometric-biochemical equations in subjects with or without PCOS. Objective To compare traditional measures like waist to hip and height ratio (WHpR and WHtR), BMI, newer markers depicting central obesity like Abdominal Volume index(AVI), Body roundness index (BRI), A Body Shape index (ABSI), Conicity index (C-index) along with biochemical-anthropometric equations like lipid Accumulation Products (LAP), Visceral Adiposity Index (VAI) and Chinese Visceral Adiposity Index (CVAI) for diagnosing PCOS as per the Rotterdam criteria Design Cross-sectional analysis Place & Study Duration Naval hospital, Islamabad from Jan- 2018 to July- 2019 Subjects and Methods From our finally evaluated 333 female subjects we initially compared the differences for the presence of hirsutism as per modified Ferrimen Gallwey scores and biochemical hyperandrogenism by measuring free androgen index (Total testosterone/SHBG x 1000. We evaluated waist circumference, BMI, WHpR, WHtR,AVI, BRI, ABSI, C-index along with biochemical-anthropometric equations like LAP, VAI and CVAI for differences in subjects diagnosed to have PCOS by Rotterdam criteria or ultrasonography alone. Results Differences in hirsutism as defined by modified FG score between subjects defined to have PCOS or otherwise as per Rotterdam defined criteria were as [(PCOS=169, Mean=17.33 + 9.05) (No PCOS=164, Mean=8.21 + 5.74), p< 0.001] and ultrasound [(PCOS=87, Mean=16.95 + 9.57) (No PCOS=246, Mean=11.38 + 8.51), p< 0.001]. Similarly, the differences in FAI between subjects defined to have PCOS or otherwise as per Rotterdam criteria and ultrasound were as [(PCOS=169, Mean=6.41 + 4.88) (No PCOS=164, Mean=2.77 + 1.79), p< 0.001] and [(PCOS=87, Mean=5.75 + 5.01) (No PCOS=246, Mean=4.22 + 3.68), p= 0.011]. Anthropometric measures and anthropometric-mathematical equations were raised in non-PCOS subjects than PCOS subjects. Lean-PCOS demonstrated lower degree of hirsutism and biochemical hyperandrogenism in comparison to obese-PCOS. Conclusion Hirsutism and free androgen indices were raised in PCOS females. Anthropometric based measurements were not different in PCOS cases and non-PCOS females. Lean-PCOS demonstrated lower degree of hirsutism and biochemical hyperandrogenism in comparison to obese-PCOS.
Feb 2019 DOI 10.14302/issn.2470-5020.jnrt-18-2554
Volicer LadislavCorresponding author
School of Aging Studies, University of South Florida, Tampa FL, USA
Background Controversy exists about definition of agitation and especially about inclusion of aggression as a part of agitation in people with dementia. Methods Papers describing neurobiological indices related to behavioral symptoms of dementia were reviewed. Papers comparing indices in persons exhibiting aggression and persons exhibiting agitation were selected for this review. Results The survey found seven papers which compared neuroanatomical indices and three papers which compared neurochemical indices. The neuroanatomical indices differentiating agitation and aggression included changes in brain perfusion, sizes of brain areas, distribution of neurofibrillary tangles, and white matter changes. The neurochemical indices differentiating agitation and aggression included relationships with neurotransmitter variables and the cell count in the locus coeruleus. Conclusion Despite the small number of papers and some methodological problems, the presented information clearly indicates that aggression and agitation are two distinct unrelated syndromes in persons with dementia.
Feb 2019 DOI 10.14302/issn.2643-6655.jcap-18-2570
Emanuela ZappellaCorresponding author
Department of Human and Social Sciences, University of Bergamo, Italy
Self-determination is a key concept to promote greater self-awareness in the subjects with disability, to build appropriate educational or professional projects and to evaluate the already active programs. Using PRISMA checklist, I selected articles from different databases (CINAHL, Medline, Psych INFO, Cochrane Library, ERIC, Scholar. The 9 evaluation measures identified are analyzed with respect to: choice of the points of view to be collected, domains, items and data collection methods. The results show that while some scales focus on autonomy, empowerment, self-realisation and self-regulation and others focus on knowledge, skills and abilities, attitudes and beliefs. Two instruments added also: opportunities and support. With respect to the choice of the points of view to be collected: in some cases the student’s opinion is collected but in other cases their point of view is integrated or replaced with that of teachers and parents. Only one tool is designed for all children and starts from the belief that self-determination is important for all people, including those with a disability. A third element of the analysis is the possibility of answering the questions posed by the various evaluation tools. A typical form is Likert scale while in other cases open questions are used. The analysis highlights two critical issues. The variety of definitions of self-determination is inevitably reflected in the choice of domains and items and therefore self-determination is only partially investigated. Secondly the opinion and people with disabilities are sometimes completed or replaced by that of third persons as parents and teachers. Starting from the analysis of existing instruments. the article closes with a reflection on the possibility of constructing a scale that considers all the aspects of self-determination offered in the literature (at the individual and environmental level) and collects the opinion of all the subjects involved in self-determination projects. This synthesis represents a first step in the construction of a possible universal scale starting from the analysis of the literature. A comparison would then be necessary with the students with intellectual disabilities, the family members and the other actors involved to understand which domains are really meaningful to them and to build indicators that correspond to the elements that are important to them. In this way we would have a tool capable of combining the point of view of literature with that of the people directly involved.
Dec 2018 DOI 10.14302/issn.2324-7339.jcrhap-18-2333
Joseph Afe AbayomiCorresponding author
Community Medicine Department, Equitable Health Access Initiative, Lagos, Nigeria
Introduction: The introduction of preexposure prophylaxis (PrEP) against incident HIV infection has changed the epidemiology of disease as continuous treatment with tenofovir and emtricitabine among high risk groups can reduce the relative risk for incident HIV infection by over 90%.However,despite the approved use of TDF+FTC, as a fixed dose combination of emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg, for oral PrEP since 2012 , it does not appear to have become widely accepted and in use among healthcare workers especially those in low income countries. Researches are therefore needed to consider the awareness and practice of health workers towards the availability of PrEP services in this part of the world. Healthcare workers are expected to be promoters of the use of PrEP services. Method: A cross sectional questionnaire-based study conducted in southern Nigerian over a 6 months period. Data were collected from 250 healthcare workers using interviewer-administered questionnaires. The data analysis was done using statistical package for the social sciences (SPSS) for windows version 20.0 software (SPSS Inc; Chicago, IL, USA). Frequency counts were generated for all variables and statistical test of significance was performed with chi-square test. Significance was fixed at P < 0.05 and highly significance if P < 0.01. Results: A high proportion of the respondents(>60%) were highly educated healthcare workers(majorly Nurses and medical doctors) and about half (55%) having at least 10yrs working experience in the health sector with most especially on the HIV program(>90%), majority (94%) of the health workers were aware about ARV pre-exposure prophylaxis but very few ( 6% )could give the standard definition for PrEP as the use of ARV drugs by HIV negative persons to prevent the acquisition of HIV.Most(67%) of them gave wrong definition for PrEP and worse still about one fifth (20%) had no idea what PrEP was all about. Most (70%) could not correctly identify all the ARV drugs in a standard PrEP regimen while about 35% had no idea at all of the approved ARVs used for PrEP. Though PrEP services was not available at any of the facilities where the respondents were working ,the approved drugs(TDF+FTC) for PrEP were available at about 40% of the health facilities(public and private) and 15% community pharmacies in the vicinity of the respondents . Only 60% of the respondents were willing to access PrEP service for themselves if indicated while 35% would not use such services even if it is indicated for reasons which include concern about adverse effects and safety.Awareness of PrEP was significantly associated with the ability of the healthcare workers to identify the correct ARV regimen, ARV dosages and also correct indication for PrEP. Awareness was also associated with the knowledge of the correct proven efficacy for PrEP(>95%) and high likelihood of seeing a patient placed on PrEP and willingness to use PrEP based on personal indication Conclusion: The level of awareness of PrEP among healthcare workers was very high at about 90% yet many(60%) could not give correct standard definitions of PrEP, PrEP ARV regimen, dosages and level of efficacy of PrEP. Also none of the respondent had PrEP services available either at their center or any known referral centers. This is unacceptable in a country with second highest HIV burden in the world and has adopted PrEP in her national HIV guideline with ongoing PrEP demonstration studies. The few healthcare workers who were able to mentioned this information were more likely to have seen a patient placed on PrEP and were more willing to use PrEP based on personal indication. Recommendations: There is need to deepen the and knowledge of PrEP among healthcare workers especially those in poor resource settings by engaging them through update courses outreach, educational resources, campaigns/seminars and workshops and various job aids. All healthcare service providers should be very comfortable to carry out HIV risk assessment of their clients and provide PrEP to those indicated directly or indirectly through referral
Aug 2018
Paranina AlinaCorresponding author
Department of physical geography and environmental management, Herzen State Pedagogical University of Russia, Russia
Journal of Biosemiotic Research is a new periodical devoted to a young, actively developing science. A review of recent scientific publications shows that in the broad scientific space of biosemiotics contemporary questions and "eternal themes" interact, not finding an answer in the private sciences - anthropology, semiotics of culture and philosophy1,2. To solve them, the fundamental foundations of science and new achievements, the opportunities of the latest technologies and scientific communications are attracted. Like all young sciences, biosemiotics has many definitions. We give here the most famous ones. "Biosemiotics: (bios, life + semion = sign) is an interdisciplinary field of theoretical and empirical research, analyzing communication and signification in living systems. Signed processes, ranging from molecular to ecological and evolutionary, have been studied throughout the history of biology; however, very often descriptions of information and communication aspects of living systems were considered only metaphorical, believing that the essence of them can be understood with the help of physical and chemical descriptions. In biosemiotics, on the other hand, information sign processes are considered as the primordial, basic system of phenomena of life, requiring a new understanding..."3. "Biosemiotics explores sign systems of various levels: molecular biological (genetic code), intracellular (signal peptides), intercellular (mediators, immune interactions), intraorganism (hormones, conditioned reflex reactions) and interorganism (telergons, pheromones, attractants) ... In addition, biosemiotics covers all the problems associated with the problem of the existence of language and thinking in animals." However, today we can go further and add to the analysis the next stage of evolution, standing between animals and modern human (Homo sapiens sapiens).
Feb 2018 DOI 10.14302/issn.2689-4602.jes-18-1967
Mikhailovsky GeorgeCorresponding author
Global Mind Share, Norfolk, VA, United States
A strict definition of the hierarchy of material systems is formulated. Based on this definition, the main hierarchical structure of the Universe was divided to 15 levels belonging to 2 branches. Process of the Universe evolution (megaevolution) is considered as hierarchogenesis, i.e., a process of new hierarchy levels formation. The main driver of the hierachogenesis is an attraction that takes different forms for different steps of the megaevolution. Duration and time of each this step on the Universe timeline were estimated using the data of the other investigators. Biological evolution is considered as essential part of the general megaevolution where symbiosis plays role of the hierarchogenetic attraction. Semantic consideration of the hierarchogenesis allowed to build a mathematical model of its dynamics. It appeared that this model describes general megaevolution of the Universe well enough to estimate time of macromolecules appearance, that is still unknown, and to predict when the next hierarchogenetic step will take a place.
Feb 2018
Paganelli RobertoCorresponding author
Department of Medicine & Sciences of Aging University "G. 'Annunzio", Chair of Clinical Immunology and Rheumatology, Chieti – Pescara, Italy
The possibility of tailoring treatment on specific characteristics of patients – i.e. personalized medicine – has received attention in the field of rheumatic diseases since biological DMARDs targeting a unique pathway have become available. However the idea of personalized rheumatology has advanced slowly, at different paces in different disease groups, and it is only now surfacing in the recommendations for assessment and treatment of rheumatoid arthritis (RA). Many of the difficulties encountered stem from the recognition that many rheumatic diseases are not a single entity but encompass different subsets identified on the basis of genetic traits, cellular and molecular characterization both in blood and in tissues, laboratory markers and clinical manifestations (most notably in SLE). These differences suggest a multiplicity of pathogenetic triggers, whose various combination results in slightly or very diverse presentations. Developments in companion diagnostics and the identification of distinct subsets within complex syndromes are going to allow the definition of predictive biomarkers able to reduce poor treatment outcome, thus ensuring that we are treating “the right patient with the right drug”.
Jan 2018 DOI 10.14302/issn.2471-2140.jaa-17-1927
V.I.PetukhovCorresponding author
Vladimir State University, Vladimir, Russia
The work is dedicated to the problem of the norm in the quantitative evaluation of metal content in the epidermal cells (hair) obtained by the method of spectrometry. Authors have analyzed the hair samples for Zn, Cu, and Fe content, which were obtained from 10000 healthy subjects (5000 males and 5000 females aged 20 to 45). The definition of the norm, in the authors’ opinion, is closely related to the basic positions of the theory of self-organized criticality (SC). The observed shifts in the homeostasis of essential metals are local and therefore cannot serve as a criterion of sufficient (or insufficient) metal content throughout the body.
Jun 2017 DOI 10.14302/issn.2474-7785.jarh-17-1578
Wilson DaisyCorresponding author
Institute of Ageing and Inflammation, University of Birmingham, Edgbaston, Birmingham, UK, B15 2GW
Frailty describes a medical syndrome that confers increased vulnerability to disproportionate changes in health status following minor stressors. With loss of homeostatic reserve in multiple physiological systems, frailty conveys an increased risk of adverse health outcomes. Despite the lack of a clear universal definition, the utilisation of two landmark operational models has allowed a rapid expansion in frailty-centred research. The pathophysiology of frailty is yet to be elucidated in the literature, but a critical role for a heightened inflammatory state is hypothesised. Raised levels of pro-inflammatory cytokines are associated with frailty, with emerging evidence relating their biochemical action with development of the frailty phenotype. Dysregulation of both the innate and adaptive immune system are key components of the frailty syndrome. Remodelling of the T cell compartment and upregulated inflammatory pathways are theorised to propagate the heightened inflammatory state critical in the frailty syndrome. Increased neutrophil counts, in conjunction with ineffective neutrophil migration associated with age, is theorised to produce tissue damage and secondary inflammation conducive of the inflammatory picture in frailty. Beyond the gold standard of the comprehensive geriatric assessment, management of frailty is a fast-evolving area of research. Exercise interventions have shown promising results, improving functional ability and showing beneficial immunomodulation. Vitamin D supplementation, with proposed anti-inflammatory effects, nutritional support and pharmacological treatments all provide promising areas for future therapeutic intervention.
Jun 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-174
Rajesh RadhakrishnanCorresponding author
Radhakrishnan Rajesh M.Pharm, Asst Professor (Senior Grade), Department of Pharmacy Practice, Manipal College of pharmaceutical Sciences, Manipal University, Manipal- 576 104, Karnataka, India.
Background: In India, Human immunodeficiency (HIV) infected patients with highly active antiretroviral therapy (HAART) are at higher risk of developing adverse drug reactions (ADRs). Objectives: The aim of this study was to characterize the pattern of use of HAART, occurrence, incidence, severity and causality of ADRs to HAART in Indian HIV positive patients. Methods: This was a prospective observational study conducted between August 2009 and May 2012. Enrolled HIV positive patients were intensively monitored for ADRs with fixed dose antiretroviral therapy as per National AIDS Control organization (NACO).World Health Organization (WHO) definition of ADR was adopted to detect ADRs to HAART and classified based on WHO adverse reaction terminologies. Naranjo’s scale was used for causality assessment of ADRs. Preventability was assessed using Thornton and Schuman criteria and severity was assessed using the modified Hart wig and Siegel scale. Pattern of ADRs was assessed with patient demographics, ADRs characteristics, and pattern of drug and reaction characteristics. P-value <0.05 was considered as statistically significant. Results: A total of 426 ADRs to HAART were evaluated from 1982 HIV positive patients during the study period. The overall incidence of ADRs to HAART was 21.4%. Significant difference was seen in the incidence of ADRs in the age group of 41-60 years (p <0.001), CD4+T-cell counts of 350-500 cells/µl (p <0.001), females (p <0.001). Three fatal ADRs of with cutaneous drug eruptions of Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) was 1.1%. Anemia (31.7%) accounted for majority of the reports followed by vomiting (15.5%), skin rash (12.9%) and peripheral neuropathy (10.7%). The suspected drug was withdrawn for the management of the ADRs in majority (27.9%) of the reports. Higher incidence rate of ADRs was noted with lamivudine (3TC) + nevirapine (NVP) + stavudine (D4T) (22.9%). In, naranjo's causality assessment, majority of the ADR reports were rated as possible (69%). Symptomatic treatment for ADRs was given in 91.8% of the reports and 86.4% of the reports the patient recovered from the suspected adverse reaction at the time of evaluation. Conclusion: In India, occurrence of ADRs to HAART in HIV infected patients was found to be higher with zidovudine induced anemia (31.7%). The higher percentage of ADRs to HAART was seen with female patients, age 41-60 years; CD4+ T-cell counts 350-500 cells/µl. Physician must focus for monitoring all lab investigations for early detection and prevention of adverse effects associated with HAART.