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What If the Clinical and Older Adults’ Perspectives about Frailty Converge? A Call for a Mixed Conceptual Model of Frailty: A Traditional Literature Review
Get PDFExisting frailty models have enhanced research and practice; however, none of the models accounts for the perspective of older adults upon defining and operationalizing frailty. We aim to propose a mixed conceptual model that builds on the integral model while accounting for older adults’ perceptions and lived experiences of frailty. We conducted a traditional literature review to address frailty attributes, risk factors, consequences, perceptions, and lived experiences of older adults with frailty. Frailty attributes are vulnerability/susceptibility, aging, dynamic, complex, physical, psychological, and social. Frailty perceptions and lived experience themes/subthemes are refusing frailty labeling, being labeled “by others” as compared to “self-labeling”, from the perception of being frail towards acting as being frail, positive self-image, skepticism about frailty screening, communicating the term “frail”, and negative and positive impacts and experiences of frailty. Frailty risk factors are classified into socio-demographic, biological, physical, psychological/cognitive, behavioral, and situational/environmental factors. The consequences of frailty affect the individual, the caregiver/family, the healthcare sector, and society. The mixed conceptual model of frailty consists of interacting risk factors, interacting attributes surrounded by the older adult’s perception and lived experience, and interacting consequences at multiple levels. The mixed conceptual model provides a lens to qualify frailty in addition to quantifying it. © 2023 by the authors
Prevalence of intestinal parasites during pre- and post-COVID-19 pandemic at a tertiary care center in Lebanon
Get PDFIntroduction: Intestinal parasitic infections (IPIs) are a major medical and public health problem, especially in developing countries. This study aimed at comparing the prevalence and types of IPI during pre- and post-COVID-19 pandemics, and with data reported in Lebanon a decade ago. Methodology: Stool specimen results from a total of 4,451 and 4,158 patients were examined using the concentration method during the pre-covid (2017-2018) and post-covid (2020-2021) pandemic periods, respectively. Demographic information related to patient’s age and gender was recorded. Results: The overall positive detected parasites among the total tested in these two periods were 589 (13.2%) and 310 (7.5%), respectively. The protozoa accounted for most parasites (e.g., Blastocystis hominis, Entamoeba coli (E. coli), Entamoeba histolytica, and Giardia lamblia). Only B. hominis and E. coli showed significant differences; B. hominis was more prevalent in the post-covid period (33.5%) whereas E. coli in the pre-covid phase (44.5%). Among gender, E. histolytica was higher in males during the post-covid period (13.3% vs. 6.3%). Regarding age, adults (between 26 and 55 years) had the highest prevalence, with a noticeable decrease among the elderly in the post-covid time. Compared to the previous decade, the prevalence of B. hominis and E. coli remained higher, and that of E. histolytica and G. lamblia was almost the same. Conclusions: These findings indicate an overall reduction in the prevalence of IPI during the post-covid period, though IPIs persistence remains high. This highlights the need for enhancing public health awareness efforts to improve hygiene and sanitation to reduce parasitic prevalence in Lebanon. Copyright © 2023 El Achkar et al
Fiscal asymmetries and debt crises: Evidence from Lebanon using a sign restricted structural VAR model
Get PDFThis study identifies empirically Lebanon's fiscal asymmetries and shocks and traces their effects on GDP using a sign-restricted structural VAR approach. Following Arias et al.’s (2018) identification procedure of sign and zero restrictions, our empirical findings point to a sluggish effect of fiscal policy on economic activity, stipulating that fiscal policy is conducted with non-Keynesian features. The study also documents evidence in favor of crowding out effects given that central government's borrowings are mainly from the local financial market. Moreover, with a non-Keynesian effect of fiscal policy, policy makers should refrain from using fiscal tools to counteract business-cycle fluctuations. It is shown that in order to break through government expenditure's inefficiency, the government must curb a rising budget deficit, which is harnessing an increasing cost of capital and impinging negatively on debt and its service. A rising sovereign debt, in turn, has subsequently triggered a sovereign debt crisis in October 2019. © 2023 Elsevier B.V
Modeling dislocation interactions with grain boundaries in lath martensitic steels
Get PDFMartensitic steels are widely used as a structural material in critical components of fossil fuel and nuclear power plants, such as boilers, pipes, and fittings. Martensitic steels are known to have a hierarchical microstructure that follows the Kurdjumov–Sachs (K–S) orientation relationship, where a prior austenite grain is composed of packets separated by high angle grain boundaries or packet boundaries, which are, in turn, divided into blocks or variants segregated by high angle grain boundaries called block boundaries. Blocks themselves are an agglomeration of laths divided by low angle grain boundaries named lath boundaries which have precipitates scattered on them. This work seeks to examine, using a couple dislocation dynamics—continuum mechanics approach called multiscale dislocation dynamics plasticity (MDDP), the interactions between dislocations and packet, block, lath boundaries, and precipitates under uniaxial tension loading and their effect on the mechanical response of the material. The simulations are conducted at a strain rate of 105 s−1 at room temperature. The main crystallographic features that arise during the deformation process were extracted and analyzed in terms of their contribution to the mechanical response of the material. The orientation relationship governing the microstructure of martensitic steels, namely, the K–S orientation relationship, was incorporated in MDDP in an effort to accurately capture the deformation behavior of the material in question. The strength of lath martensitic steel was analyzed as a function of the lath width, block size, and packet size to determine the appropriate effective grain size. © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature
Designing a Cultural Competency Training Program for Nurses in a Hospital in Saudi Arabia
Get PDFIntroduction & Purpose: Cultural competency is highly expected from nurses, who form the largest group of the healthcare workforce. Al-Moosa Specialist Hospital, located in Saudi Arabia, hires nurses from different regions across the world. Yet there are no cultural competency training programs or educational sessions in the hospital.
The purpose of this project is to develop a cultural competency training program for nurses in the hospital.
Method: A literature review was performed to explore the different cultural competency theoretical models, the various cultural competency assessment tools, and the factors of successful cultural competency training programs to build on their experience when designing our training.
Proposed Training: The Purnell Model for Cultural Competence is the foundation for the content. The program employed a backward design, which starts with defining the learning objectives before choosing the instructional strategies and evaluation methods that will best enable each objective be met. The delivery format is blended and includes two parts. Part one is online and asynchronous, comprising an interactive lecture with complimentary videos and diagrams. The second part is practical and will be offered as an onsite workshop structured according to Gagné's 9 Events of Instruction Storyboard. An implementation and evaluation plan were developed as well.
Discussion: The suggested training has several advantages. First, the Purnell model and its organizing structure will serve as a guide for nurses when evaluating the culture of patients; a program at Pittsburg State University to teach cultural competence uses the same model to enrich its core curriculum. Second, a Cochrane study suggested that the use of mixed interactive and didactic formats and an emphasis on results were essential for the success of instructional sessions.
Conclusion: Ensuring a culturally competent health workforce is essential to increase the quality and safety of care (Cai, 2016). The proposed program is designed to enhance the intercultural communication of nurses, enabling them to build a therapeutic relationship with their patients and strengthen the person-centered approach used at the hospital
VEGF-A: A Novel Mechanistic Link Between CYP2C-Derived EETs and Nox4 in Diabetic Kidney Disease
No full textDiabetes is associated with decreased epoxyeicosatrienoic acid (EET) bioavailability and increased levels of glomerular vascular endothelial growth factor A (VEGF-A) expression. We examined whether a soluble epoxide hydrolase inhibitor protects against pathologic changes in diabetic kidney disease and whether the inhibition of the VEGF-A signaling pathway attenuates diabetes-induced glomerular injury. We also aimed to delineate the cross talk between cyto-chrome P450 2C (CYP2C)–derived EETs and VEGF-A. Streptozotocin-induced type 1 diabetic (T1D) rats were treated with 25 mg/L of 12-(3-adamantan-1-yl-ureido)-do-decanoic acid (AUDA) in drinking water for 6 weeks. In par-allel experiments, T1D rats were treated with either SU5416 or humanized monoclonal anti–VEGF-A neutralizing antibody for 8 weeks. Following treatment, the rats were eu-thanized, and kidney cortices were isolated for further analysis. Treatment with AUDA attenuated the diabetes-induced decline in kidney function. Furthermore, treatment with AUDA decreased diabetes-associated oxidative stress and NADPH oxidase activity. Interestingly, the downregulation of CYP2C11-derived EET formation is found to be correlated with the activation of the VEGF-A signaling pathway. In fact, inhibiting VEGF-A using anti-VEGF or SU5416 markedly attenuated diabetes-induced glomerular injury through the inhibition of Nox4-induced reactive oxygen species production. These findings were replicated in vitro in rat and human podocytes cultured in a diabetic milieu. Taken together, our results indicate that hy-perglycemia-induced glomerular injury is mediated by the downregulation of CYP2C11-derived EET formation, fol-lowed by the activation of VEGF-A signaling and upregula-tion of Nox4. To our knowledge, this is the first study to highlight VEGF-A as a mechanistic link between CYP2C11-derived EET production and Nox4. © 2023 by the American Diabetes Association
School Neighborhood Food Environments and Schoolchildren’s Nutrition in Greater Tunis.
No full textBackground
Over the last decades, childhood overweight and obesity have dramatically increased in low- and middle-income countries (LMICs), with the Middle East and North Africa (MENA) region experiencing one of the largest increases in childhood obesity rates. School neighborhood food environments include the multitude of food options available to children on their daily trajectories to/from school, and are thus considered a key contributor to children’s food choices and subsequent weight status. While there is considerable research from high-income countries on food environments, scarce evidence exists in low and middle-income countries (LMICs). This study aimed to fill this research gap by exploring school neighborhood food environments in Greater Tunis, Tunisia – a context typical of a highly developed and urbanized middle-income setting with an ongoing nutrition transition and increasing rates of childhood obesity. The objectives of this study were to: (1) document the obesogenicity of school neighborhood food environments using geospatial data, by measuring availability and accessibility of food retailers and advertisements in Greater Tunis; and (2) examine the impact of the retail food environment on children’s weight status in this same setting. It is the first study to do so in an LMIC of the MENA region.
Methods
In this cross-sectional study conducted in 2020, a representative sample of 9 to 12-year-old schoolchildren in Greater Tunis were recruited from 50 schools. Geographic coordinates and pictures of all food retailers and advertisements, available within an 800-meter road-network buffer of primary schools, were collected through ground truthing using geospatial static methods. Retailers were classified into typologies (e.g. supermarket, ambulant vendor, pastry shop) and advertisements into food groups (e.g. fresh fruits and vegetables, processed meats, sugar-sweetened beverages). Then, they were all further categorized as healthy, mixed, or unhealthy according to an adapted NOVA classification system. Data at the child-, household-, and school-level were collected through questionnaires and included socio-demographic, dietary habits, and school-food policy variables, among others. Anthropometric measurements were taken and overweight and obesity were defined based on WHO growth standards. Count, density, and distance from schools to nearest retailers were assessed. Associations between school characteristics and types of food retailers or advertisement were explored by relative prevalence ratios (RPR) using crude and adjusted multinomial regression models. Association between availability (i.e., count and count/area) as well accessibility (i.e., distance from school to nearest retailer) of the different types of food retailers and children’s weight status was assessed using crude and adjusted multilevel logistic regressions to account for clustering of subjects within schools. A directed acyclic graph (DAG) was drawn to identify the set of confounding variables to be added in our models. Sensibility analyses were conducted using different metrics (counts and count/area) and weight-related outcomes (obesity, overweight, and BMI z-score) to assess the robustness of findings and support comparability across studies.
Results
Overall, 3,621 food retailers and 2,098 advertisements were mapped. The median counts of food retailers and advertisements were 64/school (IQR=47-95) and 36/school (IQR=25-53), respectively. About two thirds of food retailers and advertisements were labeled as unhealthy. Most retailers were traditional corner stores (22%) and only 6% were fruit and vegetable markets. For advertisements, the prevailing food group promoted was carbonated and sugar-sweetened beverages (22%). The adjusted relative prevalence ratio of unhealthy to healthy food retailers was 1.9 times significantly higher in schools located in the richest areas (i.e., lowest poverty rates) as compared to the poorest areas (ARPR=1.9, 95% CI [1.3-2.7]). No significant associations were found between advertisements and school characteristics. Of the 2,465 children included in the study, 37% were overweight of whom 17% were obese. One quarter of children purchased foods from restaurants/ shops around schools. The adjusted multilevel models showed that the odds of being obese for children whose school neighborhoods had a medium or a high density of unhealthy food retailers was 1.6 times (95% CI [1.08; 2.41]) and 1.7 times (95% CI [1.05; 2.76]) that of children whose school neighborhoods had low density of unhealthy retailers. A closer exploration of the data revealed that a medium and a high density of all the subtypes of unhealthy retailers were all positively associated with obesity with statistical significance being reached only for two categories: Bakeries and pastries as well as fast-food restaurants. As for distance from schools to nearest unhealthy retailers, we found no significant pattern across the different types. Our sensitivity analyses showed that results were comparable when using different metrics to assess availability of food retailers around schools; but not when using different weight-related outcomes.
Conclusion
Our study showed that school neighborhood food environments included predominantly unhealthy food retailers and advertisements; and correlated the availability of unhealthy food retailers with children’s obesity in this context. As the global discourse around promoting healthy food environments has recently amplified, this study provides high-quality evidence on the impact of food environments on childhood obesity, and contributes to reducing the related research gaps in LMICs. It also contributes evidence in support of calls for policies to promote healthy food options and limit unhealthy ones in school neighborhoods, in an attempt to curb the emerging childhood obesity epidemic, particularly in nutrition transition contexts
Perceived Impact of Professional Development Programs on Faculty Members’ Attitudes Toward Teaching and Learning, Professional Development, Knowledge, and Practice at The American University of Beirut
No full textProfessional development (PD) has gained prominence as one of the best strategies to support faculty members to use research-based teaching approaches that have the potential to enhance student learning (Saroyan & Trigwell, 2015). Since its inception, professional development was employed to initiate and respond to change in higher education and has evolved from individual to collective development and from largely uncoordinated activities to coordinated ones often centralized in specialized units. This study will examine the perceived impact of programs aimed at improving teaching in higher education on faculty members’ knowledge, practice, and attitudes toward PD programs at the American University of Beirut from the faculty members’ perspective. To conduct this research study, a qualitative research design and specifically a case study approach (Merriam, 2009) was utilized. In-depth interviews were conducted with 14 current AUB faculty members who attended the Faculty seminar event organized by AUB CTL. This research showed that there is a significant positive impact of PD programs on faculty members' attitudes, practice, and knowledge due to their participation in professional development programs. A number of recommendations were deduced as a result of this study. Those recommendations will help CTL improve its operations and meet the needs of the faculty members. Moreover, more research is still recommended to bridge the gap of lack of research in the Arab world and Lebanon regarding the impact of PD events on faculty members
Yang-Mills as a constrained Gaussian
Get PDFYang-Mills is reformulated in terms of the logarithmic derivative of the holonomies. The classical equations of motion are recovered, and the path integral is rewritten in two ways, both of which are of the form of a Gaussian satisfying a quadratic constraint. © (2023). All Rights Reserved