Face coverings Mask Effective Communication - Juniper Publishers

 Gerontology & Geriatric Medicine - Juniper Publishers

Editorial

The face of medicine has changed, and face masks are here to stay. The mandatory requirement for face coverings in care settings is likely to continue for the foreseeable future. Nearly a year of the pandemic should have given health care bodies ample time to anticipate the needs of vulnerable members of the population negatively affected by masks. In particular, older adults with hearing difficulties and/or cognitive impairment are particularly susceptible to experiencing problems with wearing masks themselves and interacting with others using them.

Those with hearing loss are more likely to struggle to communicate in healthcare settings, and this already contributes to worse health outcomes [1]. This is likely to be exacerbated by the ongoing need for mandatory face masks. Furthermore, there are communication issues for those without hearing loss, due to the loss of non-verbal cues such as facial expression. For example, wearing face masks during consultations has a significant negative impact on perceived empathy [2]. There are fears that use of personal protective equipment will hinder attempts to orientate older patients, thereby increasing the risk of delirium [3].

We surveyed healthcare professionals (HCP) and patients on a geriatric ward to gather information about their views on the impact of face masks. HCP were concerned about the effect face masks had on their ability to provide good care, with 54% reporting face masks affected their verbal communication. Furthermore, 85% felt that face masks affected their non-verbal communication to patients, with all of them agreeing that face masks affected their ability to build rapport with patients.

70% of patients felt that HCP wearing face masks affected their ability to communicate with them, exacerbated by pre-existing hearing difficulties. 65% reported they had missed non-verbal communication cues and 80% felt it more difficult to recognize members of their team.

Older adults have been disproportionately affected by COVID-19. We feel that HCP wearing masks in clinical environments leads to worse communication, increased delirium, and poorer overall care, particularly for those with cognitive impairment. Therefore, we welcome the Government’s purchase of clear face masks in an attempt to improve care for at risks groups’ [4]. Once available different masks should be compared to understand any benefit. We should endeavor to ensure that we do not contribute to poorer outcomes for our vulnerable patients by using a ‘one size fits all’ facemask policy.

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Triage System and Emergency Pediatric Medical Care - Juniper Publishers

Global Journal of Nanomedicine - Juniper Publishers

Abstract

Triage system is a process that is critical to the effective management of modern emergency departments. The triage systems aim not only to provide a fair clinical evaluation for the sick, injured and poisoned children, but also to provide a good effective approach to the organization, monitoring and evaluation of emergency medical care in the pediatric emergency departments Over the past 20 years in the world and in Europe, triage systems have been standardized in a number of countries and are making efforts to ensure sustainability of compulsory implementation. In addition, differences at international levels in triad systems, but limits capacities to benchmark standards.

The purpose of this paper is to enable pediatric emergency pediatric healthcare professionals to quickly evaluate, monitor, treat, and transport medical care, and to understand, learn, and apply the newest guidelines of the triage system with priorities. The research of the paper aims to make pediatric emergent medical care professionals in hospital settings to do a fairly fast triage, reducing morbidity, invalidity and mortality in the pediatric emergency department at the hospital. Triage systems in our country at three levels of health care do not work, is a chaotic system because there are no clinical guidelines, algorithms important component should create mandatory triads in three health care providers, advancing, strengthening the triad system as an important component of health care. Education, training of professionals of health care professionals for the three levels of health care should be an obligatory component to increase the quality of emergency medical care in life-threatening children. It’s time to develop and test a triad scheme that will be based on a triad system that will respond and adapt to the conditions of our health system.

Keywords: Triage; Pediatrician; Seriously Ill Critical Children; Convulsive Attacks; Shock; Health Care; Clinical Signs; Life Threatening

Introduction

Pediatric emergency triage system and emergency medical care is a process that is critical to the effective management of modern emergency departments [1]. Trial Systems aim not only to provide a fair clinical assessment for sick, injured and poisoned children, but also to provide a good effective approach to the organization, monitoring and evaluation of emergency medical care in pediatric emergency departments. Over the last 20 years in the world and in Europe, triage systems have been standardized in a number of countries and are making efforts to ensure the sustainability of enforcement [2]. In addition, differences at international level in triage systems but limit the capacity to benchmark. The country-level triage system in chaotic, disorganized Kosovo does not function as a synchronized system but there is no official standard, normative tri-level triage system for health system organization [3].

WHO Emergency triage, assessment and treatment guidelines are used to identify children with life-threatening problems who present with signs and symptoms that should be treated as medical emergencies. But the Kosovo Ministry of Health should bear in mind that this important component should create mandatory triage standards in the three health care needs. It also needs advanced, empowered EMEA and the triage system as an important component of healthcare with education, education, training of health care professionals to enhance the quality of emergency medical care for children at risk.

Purpose of Work

The purpose of this paper is to enable and enable pediatric emergency health care professionals to do rapid triage, assessment, monitoring, treatment, and transport with medical care. To understand, learn, apply the newest triage system guidelines with priority by reducing morbidity, disability and mortality in the hospital pediatric emergency department.

Material and Methods

The research material was obtained from the Children’s Clinic archive at the UCCK Pediatric Emergency Department for the period January - December 2016. The research is retrospective, descriptive, and qualitative. 17 years of age with acute lifethreatening illnesses by researching the pattern of triage, gender, age, place of residence, seasons of the year, monitoring, observation, diagnosis, treatment, complications, referral and education of pediatric emergency medical professionals [4-8]. The sample surveyed 220 cases of children with triad of lifethreatening life-threatening illnesses by pediatric emergency medical professionals with serious illnesses such as febrile convulsive attacks, severe dehydration, hypoxemia, pneumonia, shock, metabolic problem, respiratory distress, cardiac arrest, electrolyte imbalance. Description of data processing Description of data processing is performed statistical parameters, (worked out Exel Word) structure index, arithmetic mean and standard deviation. Statistical tests: X2-test and T-test. Test verification was done for the 95% and 99% confidence levels, respectively for p <0.01 and p <0.05 [9-11].

Results

The research material was obtained from the Children’s Clinic archive at the UCCK Pediatric Emergency Department for the period January - December 2016. The research is retrospective, descriptive, qualitative. Only 28-day-old babies up to the age of 17 with acute life-threatening illnesses treated in Department of Pediatric Emergency of UCCK in Prishtina, out of the total number were 23,320 cases 99.69%, and of them were 327 emergency cases or 1.31%. (Table 1). The average age of the patients included in the study was 1-10 years; the youngest patient was over 28 days and the oldest was a child 16 years (Graph 1) (Table 2) . From the total number of 327 children affected by child sex, male cases were 177 cases or 54.12% and female children 150 cases or 45.88%. (X2- test = 39.4, P <0.001), (Graph 2). The average age of the patients included in the study was 1-10 years; the youngest patient was over 28 days and the oldest was a child 16 years. (Graph 2). Number of cases according to systemic acute life-threatening diseases Neurological 56 cases or 17.12%, Cardiac cases 34 or 10.39%, Respiratory cases 80 or 24.46%, Gastroenterology 125 cases or 38.2%, Metabolic 20 cases or 6.11%, and Toxicological cases 12 or 3.66 % (Table 3).

Number of cases with acute illnesses, children with cardiac arrest 7 cases or 2.23%, asthmatic attack 60 cases or 16.43%, respiratory distress 14 cases 4.22%, convulsive febrile attack 80 cases or 25.43%, shock 18 cases or 5.50%, Diarrhea 118 cases or 36.08%, Hypoglycemia 17 cases or 5.19%, Hyperglycemia 13 cases 4.92% (Graph 3). Number of cases that required emergency medical services with life-threatening illnesses by month of the year [12-16]. January-December with obstructive bronchitis were 49 cases or 15.04%, June-September with diarrhea were 126 cases or febrile conditions were 152 cases or 46.44%. (Graph 4) (Table 4). According to the place of residence, the largest number of cases of potentially life-threatening children were from the city 199 cases or 60.86% and from the village were 128 cases or 39.14% Table 7 (Graph 5). Of the 327 cases reported, only 18 or 5.50% of them were in shock, whereas hypovolemic cases were 8 cases or 44.49%, cardiogenic shock 3 cases or 16.6%, vasodilator shock 2 cases or 11.11%, allergic reactions anaphylactic 1 case or 5.54% and with septic shock 2 cases or 11.19% (Graph 8).

Triage and management of pediatric cases with life-threatening and circulatory injury signs determined based on three clinical criteria such as cold hands and extremities or capillary refills> 3 s and with poor and rapid pulse in all children with these clinical signs have been categorized in children with shock or circulatory impairment [17-21] (Table 5). The number of shock cases defined by three clinical criteria of 18 cases of children with any of the clinical signs of children with cold extremes were 4 cases or 22.23%, capillary duration> 3 s 6 cases or 33.33 and with poor and rapid pulse 8 cases or 44.44% (Table 9) (Graph 9). Children with multiple clinical manifestations of shock may be evaluated in settings restricted by non-specialist healthcare professionals, only with the presence of three clinical signs, and the presence of one or two of these signs indicates a nonspecific impairment of blood circulation that may be due to conditions different from circulatory disorders [22,23] (Graph 6). The total number of 327 cases of them with Respiratory or Obstructive Problems, Absence, Central Cyanosis and Severe Respiratory Disturbances were 74 cases or 22.62%, of them with Respiratory Impairment 61 cases or 82.45%, Respiratory missing 3 cases or 4.05%, central cyanosis respiration 6 cases or 8.10% and respiratory distress respiratory distress 4 cases or 5.40% (Table 9 Graph 9) (Graph 7).

(Graph 7) The total number of 327 cases was 79 cases or 24.15%, with problems of consciousness disorders, whereas 59 cases or 74.68% with consciousness problems and 20 cases or 25.32% with no consciousness problems (Table 6). The total number of 327 cases out of them 118 cases or 36.08%, children with signs of severe dehydration, defined as the presence of diarrhea or any other dehydration condition were with vomiting or insufficient fluid intake 63 cases or 53.40% , with fever were 41 cases or 34.74% and with lethargic or unconscious signs, eyes in orbit, cold skin less capillary filling (> 2 s) were 14 cases or 11.86% (Table 6) (Graph 8). Out of a total of 327 children screened, monitored, observed, diagnosed and treated only needed additional laboratory and diagnostic examinations, biochemical and hematological analysis (hemogram electrolytes, glycemia, urea, creatinine), were 240 cases or 73.39%, Function. lumbal 30 cases or 9.19%, ECG 37 cases or 11.31 and EEG 20 cases or 6.11%.

Blood tests for glucose and sodium recommend that routine blood glucose measurement is not required for all children with febrile convulsions and as the information for the diagnosis from blood cultures of children with febrile convulsions does not differ much from that obtained in the pediatric emergency departments. Of the total number of 327 cases in children is the needed CT scan 109 cases or 33.33%, Magnetic resonance 38 cases or 11.63%, and Radiologic Assist 180 cases or 55.04%. X-ray imaging, computed tomography (CT) or magnetic resonance imaging (MRI), but although CT and MRI devices are often not available in secondary care settings, X-ray skull management is useful in the diagnosis of febrile attack (Table 7) (Graph 5). Use of antipyretic and anticonvulsant drugs in the management of high temperature and convulsive ataxia. The use of antipyretics and anticonvulsants with Ibuprofen were 11 cases or 13.75%, Paracetamol 7 cases or 8.75%, Diazepam rectal shin 37 cases or 46.25, Phenobarbitone Clobazam 25 cases or 31.25%, and drugs respectively. others such as Lorazepam, Valproate, and Phenytoin which are not used at all due to the absence of these drugs (Table 8). The administration of infusions and medications during CPR is considered an important component of critical emergency care of infants and children with serious illness, and fluid use within the first 1-2 hours after initial evaluation.

Isotonic solutions were treated 195 cases or 60.63%, Isotonic solutions containing salt and sugar (NaCl 0.9% and Glucosum 5%) treated 70 cases or 21.8%, hypotonic solutions 0.45% NaCL 0.45% with 5% glucose were treated 12 cases or 4.03%, Adrenaline glucose treated 12 cases or 4.03%, Adenosine treated 7 cases or 2.14%, Amiodarone treated 9 cases or 2.75%, Diuretic treated 12 cases 4.03%, and Verapamil 10 cases or 3.05% were treated (Table 9). Of the total number of 327 cases required was masked oxygen administration in 34 cases or 10.39%, 146 cases monitored or 45.64%, unchecked 20 cases or 6.11%, masked oxygen delivery 36 cases or 11.%, intubated 7 cases or 2.14%, RKP 7 cases or 2.14%, respiratory oxygen delivery 7 cases or 2.14%.

Of the total number of 327 cases with emergency medical care, advanced life care treatment were 575 cases or 17.43%, and treatment with basic medical life care was 270 cases or 82.57%. From the total number of 327 cases with complications were 123 cases or 37.69%, without complications 207 cases or 63.31%. Number of cases after admission, monitoring, observation, medical diagnostics, medical consultations, out of 327 cases hospitalized were 305 cases or 93.27%, after emergency treatment were left home for further treatment. 12 cases or 93.27%. Immediate treatment begins when rapid triage is made and life-threatening medical problems are identified such as: airway, respiratory and circulatory evaluation, ABC in case of injuries, and circulatory diseases, airways and respiratory tract CAB).

Discussion

Over the last 20 years in the world and in Europe, triage systems have been standardized in a number of countries and are making efforts to ensure the sustainability of enforcement. But important, however, are the three most common emergencies such as: respiratory distress (hypoxemia), severe circulation (shock), and consciously disordered convulsive attacks and rapid onset by utilizing triage priorities and a more acceptable model for the country. No uniform triage system exists in the United States (USA), this creates a widespread dilemma of assessing the sick and injured, and each region has its own US emergency medical service network. The lack of a uniform system in the US is in contrast to other industrialized countries such as Canada and Australia. Formation of methods that integrate field and hospital needs will support an emergency medical service system that ensures the best continuity of care.

Nursing (IT) nurses need to adapt the approach and assessment based on the child’s chronological and emotional age, especially when feelings and emotions can predominate and capable of expressing themselves. Barriers exist during nursing triage such as age, very young, older persons generally present more difficulties for inexperienced nurses. Non-hospital and hospital systems - In pre-hospital and hospital settings emergency nursing triage aims to determine the priorities of treatment and transportation of the sick and injured. Design principles and protocols must be developed and promulgated by the appropriate medical authorities. In case of major disasters: earthquakes, floods, fires, severe traffic accidents, mines, where a large number of people can be injured within a short period of time, it is difficult to properly trace because working conditions are similar to those of war

Assessing infants and children is a major challenge but these should be assessed as life signs as in an adult, with except the pulse will drop. in the brachial artery and not in the radial artery. Assessment of vital signs monitoring and recording, detailed examination of the body. A child who is upset, crying or screaming or examining the chest and abdomen will be difficult. But using games or entertaining can help the nurse’s nurse to assess breathing rhythm. The trauma nurse in children should never forget the vital signs, all of which can be recorded on the scene and the triage rooms in the priority cards. From this triage, patients can be sent to treatment rooms according to the severity of the disease. Limited space in the treatment area can cause the triage nurse a lot of problems with labeling priorities which may be incorrectly applied to the waiting room, so a quick retrofit should be done

Rapid triage and rapid, aggressive fluid resuscitation is the basis or cornerstone in hypovolemic and septic shock management; concluding that fluid boluses were potentially harmful to children with signs of severe circulatory damage including shock shock International guidelines and training courses such as advanced life support for children (Mackway-Jones et al., 2005. 2010. 2015) and advanced pediatric life support (Fuchs et al., 2007) provide criteria for clinical signs that if present indicate that a child is in ‘shock’. Febrile seizures are the most common childhood attacks, occurring on average in 4% of children. Three-tiered healthcare systems in our country do not work is a chaotic system because there is a lack of clinical guidelines, algorithms and protocols to make a correct pediatric triage system. It is high time to develop and test a triage scheme or model that will rely on a responsive triage system adapting to the conditions of our health system.

Conclusion

Health care institutions should develop and test an adaptable triage scheme that will rely on a triage system that will respond to and adapt to the conditions of our health system. Department of Pediatric Emergency of UCCK in Prishtina, out of the total number were 23,320 cases 99.69%, and of them were 327 emergency cases or 1.31%. The median age of the patients included in the study was 1-10 years; the youngest patient was over 28 days and the oldest was a child 16 years. From the total number of 327 children affected by child sex, male cases were 177 cases or 54.12% and female children 150 cases or 45.88%. (X2-test = 39.4, P <0.001. Number of cases with acute illnesses, children with cardiac arrest 7 cases or 2.23%, asthmatic attack 60 cases or 16.43%, respiratory distress 14 cases 4.22%, convulsive febrile attack80 cases or 25.43%, shock 18 cases or 5.50%, Diarrhea 118 cases or 36.08%, Hypoglycemia 17 cases or 5.19%, Hyperglycemia 13 cases 4.92%. The number of shock cases defined by three clinical criteria of 18 cases of children with any of the clinical signs of children with cold extremes were 4 cases or 22.23%, capillary duration> 3 s 6 cases or 33.33 and with poor and rapid pulse 8 cases or 44.44%.

The pediatric emergency department triage rooms should be operational and supported with medical equipment, drugs, medical supplies and assistive devices based on international standards of triage. The Ministry of Health of Kosovo should bear in mind that this important component should create a model of training for the needs of our country, standard clinical guidelines, algorithms and protocols to make a correct pediatric triage compulsory triage system correctly. health care, by advancing, strengthening the triage system as an important health care component Education, education, training of health care professionals for the three levels of health care should be an obligatory component to enhance the quality of emergency medical care for children at risk. It is high time to develop and test a conceptual triage scheme or model that will rely on a triage system that responds to the conditions of our health system.

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Anesthesia Management in a Patient with Synthetic Cannabinoid Dependence: A Case Report - Juniper Publishers

 Juniper Online Journal of Public Health - Juniper Publishers

Abstract

Patients with synthetic cannabinoid dependence can hide themselves because of their fear. The suspicious approach of the anesthesiologist to these cases, careful preoperative examination, plays an important role in solving the problems that may be encountered in the preoperative and postoperative period.

Keywords: Synthetic cannabinoid dependence; Hypertension; Tachycardia; Anesthesia, Dependence; Public health problem

Abbreviations: NIBP: Noninvasive Blood Pressure; HR: Heart Rate; ECG: Electrocardiogram; CHS: Cannabinoid Hyperemesis Syndrome; IV: Intravenously

Introduction

Synthetic cannabinoid dependence is a serious public health problem. Synthetic cannabinoids have increased in popularity among drug addicts in recent years. Anesthesiologists also encounter patients with synthetic cannabinoid dependence more frequently. Synthetic cannabinoids may have cardiovascular, respiratory and neurological effects in anesthetized patients. In this article, anesthesia management in a dependent patient with tachycardia and hypertension is shared.

Case Report

A 24-year-old male patient who was scheduled for appendectomy operation had no systemic disease or drug use in his preoperative examination. Noninvasive blood pressure (NIBP) 178/106 mmHg, heart rate (HR) 122/min, electrocardiogram (ECG), respiratory sounds and chest radiography were normal. The patient was evaluated as ASA 1E. Laboratory tests were normal except white blood cell 16×103/μL(4,511,00×103/ μL), aspartate aminotransferase 65 U/L (<31 U/L), alanine aminotransferase 58 U/L (<33 U/L). In the operating room, he was anxious, NIBP 185/120 mmHg, HR 135/min, and peripheral oxygen saturation was 97%. I asked to the patient again if there was any disease or drug use. It was learned that he had been using synthetic cannabinoid for 3 years. He stated that; he could not say before, because his family was near him in the surgical department. The last substance use was 18 hours ago. There was no history of ICU stay due to synthetic cannabinoid use. Although the patient was hypertensive and tachycardic, anesthesia was given to the patient because of the emergency operation. Rapid sequence intubation with cricoid compression was planned. The patient was hypertensive and tachycardic after induction and intubation, and invasive artery monitoring was performed. The dose of remifentanil infusion was increased.

Propofol 1 mg/kg was administered intravenously (iv) to increase the depth of anesthesia, to the tachycardic and hypertensive patient. The dose of remifentanil was increased to 1mcq/kg/ min. The patient was still hypertensive in the followup, and esmolol infusion was started at a dose of 50mcq/kg/min. Paracetamol 1000 mg and tramadol 1 mg/kg were administered for postoperative analgesia. Perioperative systolic BP was 185- 140 mmHg, diastolic BP was 120-95 mmHg, and HR was 115- 160 / min. At the end of the 45-minute operation, the patient was extubated after sugammadex 4 mg/kg iv administration. The artery catheter was removed. The patient’s systolic BP was between 148 and 135 mmHg, diastolic BP was between 85 and 75 mmHg, and HR was between 110 to 120/min in the post anesthesia care unit. No additional medication was administered during the 1-hour follow-up. When modified aldrete score of the patient was 9, he was sent to the surgical department with recommendations.

Discussion

Cocaine, heroin, opioids, amphetamines and synthetic cannabinoids are commonly used by addicts. The use of synthetic cannabinoids has increased in recent years due to their cheap and easy accessibility [1,2]. Cannabinoids; endocannabinoids (naturally found in humans), phyto cannabinoids (produced from plants) and synthetic cannabinoids (chemical production) are divided into three groups (2). Synthetic cannabinoids are used by inhalation, orally or intravenously. They act via CB1 and CB2 receptors [3]. CB1 receptors are responsible for the effects of cannabinoids such as cardiovascular, euphoria, anxiety and are mainly located in the limbic system, hippocampus and basal ganglions [4]. CB2 receptors which in immune mediated cells are responsible for anti-inflammatory effects [4].

A carefully preoperative examination in substance addicts plays a key role in resolving the problems that the anesthesiologist may encounter in the perioperative or postoperative period. Knowing the substance used is important in terms of determining the dose of anesthetic medication, preventing possible withdrawal syndrome and awareness in anesthesia [5]. There was no evidence of substance addiction in the presented case. If cardiovascular problems are suspected due to the substance dependence, echocardiography should be performed. There was no cardiac sound or murmur in the presented case, ECG was tachycardic but normal sinus rhythm. Also, ECG of the patient was normal sinus rhythm during the follow-up in post anesthesia care unit. Respiratory depression and atelectasis may be seen in patients with substance use by inhalation for a long time, and pulmonary edema or pleural effusion may be seen on chest radiographs [6]. Pulmonary sounds and chest radiography of the presented case were normal.

Cannabinoid hyperemesis syndrome (CHS) was described in 2004 [7]. Cannabinoid hyperemesis syndrome, which is seen in synthetic cannabinoid addicts with severe nausea and vomiting attacks, is important for anesthesiologists [7]. Rapid sequence intubation was performed in this patient, and any complications did not develop during ventilation and intubation. Delusions, hallucinations, blurred consciousness, bradycardia, tachycardia, hypertension, hypotension, arrhythmia, coronary artery disease, liver failure, gastritis, peptic ulcer and renal failure may also be seen in the patients with synthetic cannabinoid dependence [6]. Although most of these problems can be detected preoperatively, some of them may be seen in the peroperative or postoperative period. All these symptoms and diseases are important for the anesthesiologist and can change the anesthesia plan. There was no pathological laboratory finding except mild liver enzyme elevation and leukocytosis in the presented case.

Conclusion

As synthetic cannabinoid dependence increases, anesthesiologists will encounter these patients more frequently in operating rooms. There are many studies on treatment approaches in patients with synthetic cannabinoid dependence in emergency and intensive care units. However, studies are limited in terms of anesthesia applications. Therefore, I think it will be beneficial to make more studies about anesthesia management in these patients.

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Graves’s Ophthalmopathy and Covid19: Choices and Cautions - Juniper Publishers

 Endocrinology and Thyroid Research - Juniper Publishers

Abstract

Graves is a common autoimmune disease of the thyroid which results in many complications especially ophthalmopathy. Graves’s ophthalmopathy is an inflammatory process that results in the enlargement of orbital soft tissues and vision problems. There are different approaches offered to the treatment of this problem. Recently the world has faced with covid 19 outbreak crises which can influence other disease and their treatment plans. We performed a review to determine the management of Graves’s ophthalmopathy in regards to the SARS-CoV-2 pandemic. We concluded despite common reports of thyroid dysfunction in covid 19 diseases; it is not associated with an increased risk of COVID-19 related hospitalization or a worse outcome. We also recommend orbital radiotherapy and corticosteroid plus selenium supplement as the best choice for Graves ophthalmopathy.

Keywords: Covid 19; Graves; Ophthalmopathy

Introduction

Coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2, has developed into a global pandemic. The mean rate of mortality has been reported to be nearly 14.4% which is higher in patients with underlying diseases [1]. Graves is a common autoimmune disease of the thyroid which results in many complications especially ophthalmopathy. Graves’s ophthalmopathy is an inflammatory process that results in enlargement of orbital soft tissues and extraocular muscles which lead to eyelid retraction and proptosis and also vision problems [2]. According to the pathophysiological features of the thyroid dysfunction with regards to SARS-CoV-2 infection, the current Review discusses the management of graves ophthalmopathy during the covid 19 pandemic.

Discussion

Angiotensin-converting enzyme 2 used by covid 19 virus as a cellular entry receptor. Some endocrine glands like the thyroid do express ACE2 [3]. It has been established that follicular cells were injured in SARS-infected patients. Evidence of the presence of viruses or their components in the thyroid are established for some other viruses so could be one of mechanism leads to low serum triiodothyronine and thyroxine levels in patients with covid 19 infection, however it is not clarified that are these viruses responsible for thyroid diseases or just inactive components [4,5]. A study conducted during the SARS outbreak in 2003 and also recent study in 2019 showed that serum T3 and T4 levels were lower in patients with SARS and covid 19 and this decrease linked with severity of the infection [6,7]. There are some studies which reported covid 19 related subacute thyroiditis too [8,9]. Thyroid hormones could increase the antiviral action of IFN-γ and the immune system dysfunction duo to hypothyroidism may increase infection risk despite pathophysiological documents which show high probable infection risk in thyroid dysfunction, hypothyroidism is not associated with increased risk of COVID-19 related hospitalization or a worse outcome so far, Coronavirus disease 2019 [COVID‐19] involved the respiratory system regularly, also complicated by viremia and SIRS [10-14]. The hyper-inflammatory state associated with severe covid 19 diseases could have triggered an immunological reaction which leads to graves exacerbation and related problem includes ophthalmopathy [15]. The progression of Graves’s ophthalmopathy varies among different patients. Males and smokers are associated to severe disease [16].

Selenium may modulate immune system and according to some studies and theoretically could help graves ophthalmopathy improvement. Furthermore, it has a potential effect on the prevention of covid 19 [17]. In 50_200 μg/day dosage no side effects were reported [18]. Chloroquine is another treatment that showed efficacy in the control of adipogenesis and hyaluronan production in graves ophthalmopathy by inhibiting autophagy mechanism These features plus its antiviral activity could make it selective for treatment but unfortunately, it has serious adverse ophthalmic reactions like extraocular muscle palsy, anterior uveitis, and optical neuritis which are more frequent in high cumulative dose [19-21]. Patients with graves that use antithyroid drugs are at risk of agranulocytosis that is more likely to occur in the initiation of treatment.

Agranulocytosis could lead to severe infections and is more necessary to inform the patient about alarm signs follow them accurately especially in the covid 19 pandemic [22]. Orbital radiotherapy and corticosteroids both available and effective treatment in graves ophthalmopathy however Combination of them results in better outcomes [23], but corticosteroid decreases immune system response which is linked to a high risk of viral disease and some studies advice corticosteroid should be postponed in covid 19 time Surgery as an alternative approach and after the failure of first-line treatment or in severe situations like compressive optic neuropathy should be implemented [24,25].

Conclusion

Combination of corticosteroid and orbital radiotherapy plus selenium supplement and stop smoking is recommended for graves ophthalmopathy during covid 19 pandemic in this review. Physicians need to be extra attentive in the management of thyroid dysfunction due to their effects on immunity.

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Liquid Chromatography-Mass Spectrometry Based Isotopic Abundance Ratio Analysis of the Consciousness Energy Healing Treated L-Cysteine - Juniper Publishers

 Juniper Online Journal Material Science - Juniper Publishers

Abstract

L-cysteine is a semi-essential sulfur-containing amino acid found in nails, skin, hair, etc. in the body. This study was performed to investigate the impact of the Trivedi Effect® on the structural properties and the isotopic abundance ratio of L-cysteine using LC-MS analytical techniques. L-cysteine sample was divided into control and treated parts. The treated part only received the Trivedi Effect®-Consciousness Energy Healing Treatment remotely by a renowned Biofield Energy Healer, Dahryn Trivedi. The LC-MS spectra of both the control and treated samples at retention time (Rt) 1.96 minutes exhibited the mass of the molecular ion peak adduct with hydrogen ion at 122 along with low molecular fragmented mass peaks at m/z 105, 102, 87, 76, and 59 for C₃H₅O₂S⁺, C₃H₂O₂S^•+, C₃H₅NO₂²⁺ or C₃H₅NS^•+, C₂H₆NO₂⁺, and C₂H₃O₂⁺, respectively were also observed. The peak area of the treated sample (1960679.58) was significantly increased by 8.02% compared to the control sample (1815060.18). The isotopic abundance ratios of P_M+1/P_M (²H/¹H or ¹³C/¹²C or ¹⁵N/¹⁴N or ¹⁷O/¹⁶O or ³³S/³²S) and P_M+2/P_M (³⁴S/³²S) in the treated L-cysteine was significantly increased by 41.86% and 32.39%, respectively compared with the control sample. Hence, the ¹³C, ²H, ¹⁵N, ¹⁷O, ³³S, and ³⁴S contributions from C₃H₈NO₂S⁺ to m/z 123 and 124 in the treated L-cysteine were significantly increased compared to the control sample. The changes in peak area and isotopic abundance ratios might be the cause of changes in nuclei, possibly through the interference of neutrino particles via the Trivedi Effect®-Consciousness Energy Healing Treatment. The increased isotopic abundance ratio of the treated L-cysteine may increase the intra-atomic bond strength, increase its stability, and shelf-life. The novel Biofield Energy Treated L-cysteine might have increased the stability, solubility, bioavailability, and shelf-life compared to the control sample. 

The new form of treated L-cysteine would be a better and more stable precursor in the food, cosmetics, pharmaceuticals, personal-care products, additives to cigarettes (act as an expectorant), preventative or antidote for some of the negative effects of alcohol, acetaminophen overdose, clinically used ranging from baldness to psoriasis, excellent for the treatment of asthmatics by enabling them to stop theophylline and other medications, enhances the effect of topically applied silver, tin and zinc salts for preventing dental cavities. In the near future, this Biofield Energy Treated L-cysteine may play a better role in the treatment of diabetes, psychosis, cancer, and seizures.

Keywords: Biofield Energy; Consciousness Energy Healing Treatment; L-cysteine; The Trivedi Effect®; LC-MS

Introduction

Cysteine is a semi-essential sulfur-containing amino acid found in nails, skin, hair, etc. in the body. It contains a thiol group and available as a chiral molecule with dextrorotation (D) and levorotation (L) forms [1]. Cysteine is a non-essential amino acid but may be essential for new-borns, the elderly, and individuals with specific metabolic disease or malabsorption syndromes. The cysteine plenty available in egg, meat, milk, garlic, onions, red peppers, oats, broccoli, wheat germ, brussels sprout, sprouted lentils, etc. Industrially it is also prepared from animal feathers, hair, and even from chemical synthesis [1-3].

Due to its high reactivity of the sulfhydryl group of cysteine (nucleophilic in nature) has numerous biological functions, i.e., it acts, as a precursor to the antioxidant glutathione and iron-sulfur clusters, metal cofactors in enzymes, detoxification, metabolic functions, protein synthesis, collagen production, translation of messenger RNA molecules to produce polypeptides, etc. [1-6]. It is also a precursor in the food, cosmetics, pharmaceuticals, personal-care industries, additives to cigarettes (as an expectorant), preventative or antidote for some of the harmful effects of alcohol (i.e., liver damage and hangover), acetaminophen overdose, production of more wool from sheep, clinically used ranging from baldness to psoriasis, used for the treatment of asthma, enhances the effect of topically applied silver, tin and zinc salts for preventing dental cavities [1,6-9]. Many research work claiming that, in the near future, cysteine may play an important role in the treatment of diabetes, psychosis, cancer, and seizures [10]. The stability of L-cysteine is an issue in the neutral or slightly alkaline aqueous solutions, which is oxidized to cystine by air, and on decomposition, it emits very toxic fumes of sulphur oxides and nitrogen oxides [6].

The physicochemical properties of L-cysteine pay a very important role in the food, cosmetic, pharmaceutical, nutraceutical, and other industries. The Trivedi Effect®- Consciousness Energy Healing Treatment has the astonishing abilities to transform the characteristic properties of both living and non-living object(s) [11-15]. The Trivedi Effect® is a natural and only scientifically proven phenomenon in which an expert can harness this inherently intelligent energy from the “Universal Energy Field” and transmit it anywhere on the planet via the possible mediation of neutrinos [16]. An energy field generated around the body due to the continuous movement of the charged particles in the body known as “Biofield”. The object(s) received the “Energy Therapy” respond to a useful way is known as the Biofield Energy Healing Treatment. There are several Biofield based Energy Therapies that are used nowadays against various disease conditions [17-19]. Biofield Energy Healing therapy has been recognized worldwide as a Complementary and Alternative Medicine (CAM) health care approach by the National Center of Complementary and Integrative Health (NCCIH) with other therapies, medicines and practices such as Ayurvedic medicine, yoga, meditation, homeopathy, traditional Chinese herbs and medicines, naturopathy, chiropractic/osteopathic manipulation, Qi Gong, Tai Chi, aromatherapy, acupressure, acupuncture, healing touch, hypnotherapy, Reiki, cranial-sacral therapy, etc. [20]. These CAM therapies have been adopted by most of the U.S.A. population with several advantages [21]. Similarly, the Trivedi Effect®- Consciousness Energy Healing Treatment also been reported with significant impact on the properties of polymers, ceramics, metals, organic compounds, cancer cell line, microbes, improved skin health, bone health, improved agricultural crop yield, productivity, and quality, and altered the isotopic abundance ratio, improved bioavailability of pharmaceutical/ nutraceutical compounds [22- 37].

The analysis of the natural stable isotope has the importance of many applications to understand the isotope effects resulting from the alterations of the isotopic composition [38-40]. Gas chromatography–mass spectrometry (GC-MS) and liquid chromatography–mass spectrometry (LC-MS) analytical techniques are the widely used analytical techniques for the analysis of isotope ratio with sufficient precision [39]. The Trivedi Effect®-Consciousness Energy Healing Treatment could be an economical approach to alter the isotopic abundance of L-cysteine with improved physicochemical properties for the food, cosmetic, pharmaceutical/ nutraceutical, and other industries. Thus, this study was designed and evaluated the LC-MS based structural characterization and the isotopic abundance ratios in the Trivedi Effect® - Consciousness Energy Healing Treated L-cysteine compared to the control sample.

Materials and Methods

Chemicals and Reagents

The test sample L-cysteine (>98%, titration method) was purchased from Alfa Aesar, India. Other chemicals like methanol, acetonitrile, and ammonium acetate were purchased from Merck, India.

Consciousness Energy Healing Treatment Strategies

The test sample L-cysteine powder was divided into two parts. One part of the L-cysteine powder sample did not receive the Biofield Energy Treatment called the control sample. However, the other part of L-cysteine was received the Trivedi Effect®- Consciousness Energy Healing Treatment remotely under standard laboratory conditions for 3 minutes by the renowned Biofield Energy Healer, Dahryn Trivedi, USA, known as the Biofield Energy Treated L-cysteine. Further, the control sample was treated with a “sham” healer, who did not have any knowledge about the Biofield Energy Treatment. After that, both the Biofield Energy Treated and untreated L-cysteine samples were kept in sealed conditions and characterized using LC-MS analytical techniques.

Characterization

Liquid Chromatography-Mass Spectrometry (LC-MS) Analysis and Calculation of Isotopic Abundance Ratio

The liquid chromatography-mass spectrometric analysis of the L-cysteine was carried out with the help of LC-MS ThermoFisher Scientific, USA, equipped with an ion trap detector connected with a triple-stage quadrupole mass spectrometer. The column used here was a reversed phase Thermo Scientific Synchronis C18 (250mm × 4.6mm × 5micron), maintained at 25˚C. The diluent used for the sample preparation was methanol. The L-cysteine solution injection volume was 20μL and the analyte was eluted using acetonitrile (92%) + 0.1% ammonium acetate (8%) pumped at a constant flow rate of 0.8mL/min. Chromatographic separation was achieved using gradient condition and the total run time was 10 min. Peaks were monitored at 210 nm using the PDA detector. Mass spectrometric analysis was performed under ESI +ve ion mode. The total ion chromatogram, peak area% and mass spectrum of the individual peak which was appeared in LC along with the full scan were recorded.

The natural abundance of each isotope (C, H, N, O, and S) can be predicted from the comparison of the height of the isotope peak with respect to the base peak. The values of the natural isotopic abundance of the common elements are obtained from the literature [40-43]. The LC-MS based isotopic abundance ratios (P_M+1/P_M and P_M+2/P_M) for the control and Biofield Energy Treated L-cysteine (C₃H₈NO₂S⁺) were calculated.

Percentage (%) change in isotopic abundance ratio = [(IAR_Treated–IAR_Control)/ IAR_Control)] × 100

Where IAR_Treated = isotopic abundance ratio in the treated sample and IARControl = isotopic abundance ratio in the control sample.

Results and Discussion

Liquid Chromatography-Mass Spectrometry (LC-MS)

The LC-SM of the L-cysteine showed a single major peak at retention time (Rt) of 1.96 minutes in both the chromatograms (Figure 1). The peak area of the Biofield Energy Treated sample (1960679.58) was significantly increased by 8.02% compared to the control sample (1815060.18). This indicated that the solubility of the Biofield Energy Treated L-cysteine might have increased compared to the control sample. The finding was supported by the published literature data [12].

The mass spectra of both the samples of the L-cysteine are shown in Figure 2. The mass spectra of both the samples at Rt of 1.96 minutes exhibited the presence of the molecular ion of L-cysteine (Figure 2) at m/z 122 (calcd for C₃H₈NO₂S⁺, 122.03). Along with the molecular ion peak, low molecular fragmented mass peaks at m/z 105, 102, 87, 76, and 59 for C₃H₅O₂S⁺, C₃H₂O₂S^•+, C₃H₅NO₂²⁺ or C₃H₅NS^•+, C₂H₆NO₂⁺, and C₂H₃O²⁺ were observed in case of both the samples (Figures 2 & 3). The experimental data were well supported by the published literature [44].

Isotopic Abundance Ratio Analysis

The L-cysteine samples showed the mass of a molecular ion at m/z 122 (calcd for C₃H₈NO₂S⁺, 122.03) with 100% relative abundance in the spectra. The theoretical calculation of isotopic peak PM+1 for the protonated L-cysteine presented as below:

P (¹³C) = [(3 x 1.1%) × 100% (the actual size of the M+ peak)] / 100% = 3.3%

P (²H) = [(8 x 0.015%) × 100%] / 100%= 0.12%

P (¹⁵N) = [(1 x 0.4%) × 100%] / 100% = 0.4%

P (¹⁷O) = [(2 x 0.04%) × 100%] / 100% = 0.08%

P (³³S) = [(1 x 0.08%) × 100%] / 100% = 0.08%

P_M+1 i.e. ¹³C, ²H, ¹⁵N, ¹⁷O, and ³³S contributions from C₃H₈NO₂S⁺ to m/z 123 = 3.98%

Similarly, the theoretical calculation of PM+2 for L-cysteine was presented as below:

P (³⁴S) = [(1 × 4.21%) × 100%] / 100% = 4.21%

P_M+2, i.e. ³⁴S contributions from C₃H₈NO₂S⁺ to m/z 124 = 4.21%

The calculated isotopic abundance of P_M+1 (3.98%) and P_M+2 (4.21%) values was very close to the experimental values 4.3% and 4.6% (Table 1). From the above calculation, it has been found that ¹³C, ¹⁵N, and 34S have the major contribution to m/z 123 and 124.

The isotopic abundance ratio analysis P_M, P_M+1, and P_M+2 for L-cysteine near m/z 122, 123, and 124, respectively of both the samples were obtained from the observed relative peak intensities of [M⁺], [(M+1)⁺], and [(M+2)⁺] peaks, respectively in the mass spectra (Table 1). The isotopic abundance ratio of P_M+1/P_M (²H/¹H or ¹³C/¹²C or ¹⁵N/¹⁴N or ¹⁷O/¹⁶O or ³³S/³²S) and P_M+2/P_M (³⁴S/³²S) in Consciousness Energy Healing Treated L-cysteine was significantly increased by 41.86% and 32.39% compared to the control sample (Table 1). Thus, the ¹³C, ²H, ¹⁵N, ¹⁷O, ³³S, and ³⁴S contributions from C₃H₈NO₂S+ to m/z 123 and 124 in the Biofield Energy Treated sample was significantly increased compared to the control sample.

The isotopic abundance ratios of P_M+1/P_M (²H/¹H or ¹³C/¹²C or ¹⁵N/¹⁴N or ¹⁷O/¹⁶O or ³³S/³²S) and P_M+2/P_M (³⁴S/³²S) in the Biofield Energy Treated L-cysteine were significantly increased compared to the control sample. The changes in isotopic abundance could be due to the possible interference of neutrino particles via the Trivedi Effect®-Consciousness Energy Healing Treatment [16]. The altered isotopic composition in the molecular level of the treated L-cysteine might have altered the neutron to proton ratio in the nucleus. A neutrino is an elementary particle that interacts through the weak subatomic force and gravity. The neutrinos have the ability to interact with protons and neutrons in the nucleus, which indicated a close relationship between neutrino and the isotope formation [39,40]. The isotopic abundance ratios ²H/¹H or ¹³C/¹²C or ¹⁵N/¹⁴N or ¹⁷O/¹⁶O or ³³S/³²S or ³⁴S/³²S would influence the atomic bond vibration of treated L-cysteine [45]. The increased isotopic abundance ratio of the treated L-cysteine may increase the intra-atomic bond strength, increase its stability, and shelf-life. The novel Biofield Energy Treated L-cysteine might have increased the stability, solubility, bioavailability, and shelf-life compared to the control sample. The novel Biofield Energy Treated L-cysteine would be more important to the food, cosmetic, pharmaceutical/ nutraceutical, and other industries compared to the control sample.

Conclusion

The Trivedi Effect®-Consciousness Energy Healing Treatment showed a significant impact on the chromatographic peak area and isotopic abundance ratio of L-cysteine. The LC-MS spectra of both the control and Biofield Energy Treated samples at Rt 1.96 minutes exhibited the mass of the molecular ion peak adduct with hydrogen ion at 122 along with low molecular fragmented mass peaks were also observed. The peak area of the Biofield Energy Treated sample was significantly increased by 8.02% compared to the control sample. The isotopic abundance ratios of P_M+1/P_M (²H/¹H or ¹³C/¹²C or ¹⁵N/¹⁴N or ¹⁷O/¹⁶O or ³³S/³²S) and P_M+2/P_M (³⁴S/³²S) in the Biofield Energy Treated L-cysteine was significantly increased by 41.86% and 32.39%, respectively compared with the control sample. Hence, the ¹³C, ²H, ¹⁵N, ¹⁷O, ³³S, and ³⁴S contributions from C₃H₈NO₂S⁺ to m/z 123 and 124 in the Biofield Energy Treated L-cysteine was significantly increased compared to the control sample. The changes in peak area and isotopic abundance ratios might be the cause of changes in nuclei possibly through the interference of neutrino particles via the Trivedi Effect®-Consciousness Energy Healing Treatment. The increased isotopic abundance ratio of the Biofield Energy Treated L-cysteine may increase the intra-atomic bond strength, increase its stability, and shelf-life. The novel Biofield Energy Treated L-cysteine might have increased the stability, solubility, bioavailability, and shelf-life compared to the control sample. The new form of Biofield Energy Treated L-cysteine would be a better and more stable precursor in the food, cosmetics, pharmaceuticals, personal-care products, additives to cigarettes (act as an expectorant), preventative or antidote for some of the negative effects of alcohol, acetaminophen overdose, clinically used ranging from baldness to psoriasis, excellent for the treatment of asthmatics by enabling them to stop theophylline and other medications, enhances the effect of topically applied silver, tin and zinc salts for preventing dental cavities. In the near future, this Biofield Energy Treated L-cysteine may play a better role in the treatment of diabetes, psychosis, cancer, and seizures.

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Association of Sleep paralysis with Insomnia and Sleep Quality - Juniper Publishers

 Annals of Reviews and Research - Juniper Publishers  

Abstract

Background: Sleep paralysis, accompanied by hypnopompic and hypnogagic hallucinations is commonly occurring phenomenon affecting number of individuals and it is found to be usually associated with sleeplessness and poor sleeping habits and quality.
Aims: To obtain an association between sleep paralysis and insomnia and sleep quality.
Methods: This was a cross sectional examination led on medical undergraduates in a local medical college of Pakistan. A survey containing segment data, a sleep paralysis related questionnaire, a scale for insomnia; Insomnia Severity Index and a scale for sleep quality; Pittsberg Sleep Quality Index was completed by 100 participants.
Results: Positive association was found between sleep paralysis and Insomnia and sleep quality with p=-0.11 and d=0.247, p<0.001 and=-0.417 respectively. Medical undergraduates have high prevalence (52.8%) of sleep paralysis. Also, the high rate of occurrence among the females than males and higher rates in adolescents are particularly of concern.
Conclusion: There is a positive association between frequency of occurrence of sleep paralysis and insomnia and sleep quality. Better sleep schedules, enhancement of sleep quality with possible eradication of insomnia should be done in order to prevent terrible experience of sleep paralysis.

Keywords: Sleep paralysis; Insomnia; Sleep quality

Abbreviations: SP: Sleep Paralysis; REM: Rapid Eye Movement; ISP: Isolated Sleep Paralysis; ISI: Insomnia Severity Index; PSQI: Pittsberg Sleep Qualty Index; USEQ: Unusual Sleep Experience Questionnaire

Introduction

Sleep paralysis (SP) is a neurophysiological occurrence triggered by transitory desynchrony in the infrastructure of rapid eye movement (REM) sleep. As far as elaboration of SP is concerned, it may be characterized as “concise intercepts of incapacity to locomote, to communicate and also to open one’s eyes on arousing (hypnapompic or postdormital SP) or maybe more infrequently when going to sleep , this whole event has a similarity with REM, may be due to the presence of control centers in the pons which are basically responsible for causing muscle atonia and other features of REM sleep. The incidence rate of SP is 5-62% and so is rather a commonly occurring phenomenon. Since most suffered people have solitary or sporadic occurrence of SP, it can be repetitive, or may take place in conjunction with narcolepsy. When SP does not occur with any other malady such as narcolepsy, it is called isolated sleep paralysis (ISP). ISP events were intricate and frequently exteroceptive occurrences and after assessing a preponderance of symptoms they usually accompany clinically important echelon of fright/anguish.

The various groups of people suffering from it, 7.6% of it includes the general population, 28.3% of students, and 31.9% of psychiatric patients. Purposes behind elevated rates in the last two populaces are fairly hazy, however could be because of components, for example, a higher recurrence of rest disturbances, use of various kinds of drugs, and more factor rest plan [1]. To the extent dynamic rest factors, more horrendous rest quality has been found in various examinations to be connected with extended odds of SP. Likewise, a sleeping disorder side effects, insomnia (yet not an analyzed a sleeping disorder issue) have additionally been found to anticipate SP. Treatment nonremitters (who don’t transmit with psychotherapy) had altogether more regrettable emotional rest quality and essentially raised phasic REM as estimated by various examinations. May be obviously, the presence and recurrence of rest loss of motion (SP) share a cozy relationship with helpless rest quality all the more by and large. Understanding the idea of this affiliation is significant both for promoting our essential agreement of SP and for the motivations behind creating medicines to decrease or even wipe out SP among the masses who suffer from the ill effects of it. So, the fundamental point of this examination is to locate an essential connection between SP with sleep quality and sleep deprivation (insomnia) among medical undergraduates who by and large have helpless rest wake cycles.

Methodology

Study duration and study population

A cross-sectional study with the administration of questionnaire was carried out at local Pakistani Medical College, Lahore in June and July 2020. The study population consisted of undergraduate medical students. Ethical approval from Ethical Review Board of CMH Lahore Medical College was taken prior to the conduction of study.

Sample size and study design

The example size was determined to be 100.We mentioned 150 clinical understudies to round out our study structures and 105 consented to participate. Educated assent was taken before the filling of the structures. It was obviously referenced that none of their own data will be revealed and all the data they give will be utilized to investigate reason as it were. Moreover, they can pull out from the examination whenever they need. Any inquiries or worries of members with respect to the poll were explained in detail [2] structures were disposed of because of inappropriate filling. The collaboration rate was 85.33%. Irregular examining was finished. 100 reactions were considered for the last investigation.

Materials

The questionnaire consisted of demographic information,the questionnaire on sleep paralysis and scales for Insomnia Severity Index (ISI) and Pittsberg Sleep Qualty Index (PSQI). Segment qualities included age, sexual orientation, spot of living etc.Assessment of Sleep Paralysis; its essence highlights, and recurrence, was finished utilizing Unusual Sleep Experience Questionnaire (USEQ) . This questionnaire has been used to assess sleep paralysis in USA. Side effects of a sleeping disorder were evaluated utilizing the Insomnia Severity Index (ISI) . The ISI is brief, legitimate, and solid self-report screening measure that surveys the presence, nature, and seriousness of sleep deprivation manifestations. The seven things of the ISI are appraised on a 5-point Likert scale and yield an all-out score with set up clinical short Cronbach’s Alphabet of 0.92. The scale used to observe sleep quality is Pittsberg Sleep Quality Index (PSQI) having Cronbach’s Alphabet of 0.82.

Statistical analysis

The information gathered will be broke down utilizing SPSS rendition 25. Expressive insights will be introduced as mean ± SD for quantitative factors and recurrence and rates for subjective factors. Independent t-test will be applied for examination of gathering implies. A p esteem ≤ 0.05 will be viewed as noteworthy.

Results

Frequency and features of SP in the Sample of Investigation Fifty-two point eight(52.8%) percent of members revealed in any event one lifetime scene of SP, and 20.8%% of the individuals who detailed at any rate one lifetime scene had encountered one to two and roughly 20% have encountered multiple scenes during the earlier year. Among the individuals who had encountered SP, 55.3% revealed pre or post dormital illusions (visual, hearable, and material) during SP and 76% detailed it to be in a state incapable to move. For a correlation of segment qualities of SP positive and SP negative individuals, see Table 1.

Sleep Paralysis and elf-reported measures of ISI Symptoms and PSQI

a) SP and ISI the SP+ people show positive relation having p=-0.11 and d=0.247 and the rate of frequency indicating a much higher relation with p=0.02 and d=0.227

b) SP and PSQI the SP+ people have also reported high values of PSQI the relation being p<0.001 and d=-0.417 suggesting a positive relation between the two (Table 2- 3).

Discussion

SP has been discovered to happen in the typical individuals [3,4] and leaving with them a great deal of stress and dread prompting upset life and redirected consideration of people in their everyday life, so it is of much worry in mental circles nowadays and may be of worry to the overall population when the mindfulness will emerge about it. The outcomes indicated that the greater part roughly 52.8% answered to be SP sufferers among the ordinary people and this is exceptionally near the recently done researches [3] and further avows the possibility that of SP in typical people which is a disturbing circumstance as a result of its impacts on rest cycles and general emotional well-being of the person and among them almost 20% were found to have experienced SP more than 4 times during the past year. This high recurrence of SP asserts repeating secluded rest loss of motion and this is disturbing as the more explicit symptomatic condition of “Recurrent Isolated Sleep Paralysis” is a perceived sleep wake problem, it isn’t broadly known to non-sleep trained professionals. The occasions experienced during ISP are likewise very comparable regarding pre and post dormital mind flights and failure to move which have been accounted for by 76% of the people which is portrayed as far as visual pipedreams by Hinton and partners demonstrating that roughly 90% of exceptionally damaged Cambodian Refugees have visual mental trips during a scene of SP

With regard to the demographic profile, it has been observed that sleep paralysis is present among females than males.

The higher rates of occurrence among females then males seen in current study may be due to the high stress levels in females than in males as this sample is taken from Pakistani population so the social challenges of females are far more than males leading to their high stress levels and also because SP has also been seen to have a direct relation with Perceived Stress. As far as the age group is concerned the higher rates of SP is observed many times during teenage followed by many dreadful illusions which again affirms the anxiety among the adolescents. With regards to the discipline of study MBBS students generally show high frequency of occurrence of sleep paralysis as compared to the other professions which is possibly due to the disturbed schedule and poor sleep wake cycle of MBBS students which is also indicated in former literature [5] as compared to the students of other disciplines. The relationship between sleep paralysis and insomnia (self-measured using ISI), it has been shown to be positive which is in accordance with the previous literature [6]. A relationship between Insomnia and Depression has been observed. Since the downturn patients for the most part show significant levels of pressure thus report restlessness or daytime dozing achieving an ever-increasing number of scenes of rest loss of motion.

Moreover, many studies have suggested a relationship of sleep paralysis with REM [7] and REM is usually accompanied by a low level of sleep as shown by delta waves on EEG. Anyway, along with affiliation another highlight note is the event of rest loss of motion over the previous month and past year is huge. This high recurrence of event of SP is especially of worry as this gives the possibility of Recurrent Isolated Sleep Paralysis as it is perceived as a rest wake disorder [8]. Treatments which diminish sleep deprivation or potentially broad sleep disruptions might be useful for mitigating ISP [2]. The PSQI shows a positive relationship of SP and sleep quality which is likewise in conjunction with past literature [3]. This affiliation can be advocated by the recently done research [5] demonstrating helpless rest quality to be connected with high phasic REM and REM rest has an immediate relationship with rest loss of motion as appeared by recently done researches [7,9]. Study limitations and recommendations. In this study selfreported measures are taken for insomnia and sleep quality, but a better relation can be found out using clinically diagnosed insomnia. Clinical trials should be done [10-19].

Conclusion

ISP scenes were perplexing and frequently multisensorial encounters, and most of surveyed indications were related with clinically critical degrees of dread/trouble. Striking mental trips of others and substances were basic also. It is suggested as well that ISP be evaluated when sufferers informs about apparently odd encounters. Also, a positive connection has been found among SP and ISI and PSQI. So, the endeavors ought to be made to eliminate the overall side effects of a sleeping disorder and to have sound rest in order to wipe out this rest loss of motion problem.

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Data-driven Design and Curation for Consumer-centric Fast Fashion - Juniper Publishers

 Fashion Technology & Textile Engineering - Juniper Publishers

Introduction

The key premise of fast fashion business model and the respective supply chain is the design, development, production and merchandising of on-trend and high-value products at a rapid rate [1]. Among all these factors, the element of design is of paramount importance due to the fact that ultimately the consumer must like and desire a particular article of fashion, which its purchase will support the respective business model. Additionally, the underlying creative process must be responsive to the data, which is reflective of the current trends, popular demand, seasonality, operational limits, cost-effectiveness, etc. Therefore, holistically, one could refer to this concept as data-driven, consumer-centric fashion design (D2C2-FD). In principle, the D2C2-FD concept seeks to create fast fashion products that not only satisfy the needs and desires of the consumer but also generate a profitable and sustainable revenue stream for the brand. Furthermore, an optimal implantation of the D2C2-FD concept will minimize the merchandise liquidation and waste due to overstock inventory.

To a varying degree in sophistication and complexity, every major participant in the fast fashion industry has developed and utilizes a D2C2-FD methodology. From extracting browsing data on popular social media platforms to their own internal sales statistics, these companies have devised effective predictive analytics to identify the main optimal design attributes in each product category, including: apparel, footwear, sportswear, accessories, jewelries, etc. In some cases [2], a framework consisting of artificial intelligence, machine-learning and data analytics combined with expert curation creates the most optimal design for its intended purpose. In the following, a number of popular D2C2-FD methodologies are reviewed and discussed briefly.

Methodologies

Figure 1 shows the design process flowchart for a basic D2C2-FD methodology, in which, for a targeted product, a combination of internal sales data (customer preferences, inventory statistics, customer feedback) and external trend data (social media sentiment, current trends) is used to produce a preliminary optimal set of design variants. Subsequently, this initial set is down selected to a qualified final design based on expert curation. The specific sources of data and their analyses may vary; however, the logic behind the process remains the same in principle.

Figure 2 shows the design process flowchart for an esoteric D2C2-FD methodology, which combines data analytics within an artificial intelligence framework and expert curation to produce the ideal design variant(s). The data comprises the input set of global style trends (also known as mode analysis), social media consensus (aka media analysis) and relevant market insights (aka market analysis). The guidance from the analysis of this data drives the design development process, which consists of generative design synthesis (aka iterative design creation), algorithmic design optimization (aka parametric design augmentation), and hybrid design curation (expert-assisted design derivation) as carried out by the designer(s).

Figure 3 shows the design process flowchart for a mutative D2C2-FD methodology, in which, a detailed taxonomy of the design elements is utilized to define and synthesize an optimal combination of such elements to produce new variants of existing popular designs. The overall optimization process is stochastic and based on principles of genetic algorithms. The steps involved include algorithmic selection, algorithmic recombination and algorithmic mutation leading to new designs, which are subsequently curated by the fashion designer(s) to produce a set of new optimal designs.

Figure 4 shows the design process flowchart for an iterative D2C2-FD methodology, which uses a three-step process to generate new qualified designs for its brand within the specified category. The customers’ desirements, in terms of style preferences, initiates the first main step of the process, which consists of trend analysis based on global fashion trends as well sales statistics extracted from real-time sales activity. The conclusions from this step are compared and contrasted against those based on social media consensus to identify the common attributes for new designs during the second step of the process. Finally, assisted by the fashion designer(s), a set of new designs are developed and qualified iteratively to result in new style sets and/or produce complementary style assortments.

Conclusion

Data-driven, consumer-centric design process is an integral and critical element of the fast fashion concept. Although a variety of methodologies are employed to accomplish this task, the objective remains the same, that is, creation of optimal on-trend and high-value products for the consumer using the relevant data sets.

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