Journal articles on the topic 'Urban Therapeutic Environment'

The global pandemic of COVID-19, which enforced strict isolation, demonstrated the responsibility of architects and planners for public health promotion. While the concept of therapeutic landscapes is rather new, the quest for designing health-promoting human environment is at least as old as urban planning. The garden suburbs of Ebenezer Howard and Patrick Geddes were planned to promote health and well-being. The ultimate goal of Le Corbusier was to provide daylight and fresh air to each apartment. However, towers in open green space, which were built according to his visions, turned into unfriendly large suburbs. Today, the definition of therapeutic landscapes encompasses not only physical aspects of environment but also social and psychological factors. This study focuses on attempts to create health-promoting places. The interesting question is what are the architectural features linked to health promotion? Although the individual perception of health-promoting places is subjective and may vary, there are some objective qualities of eco-neighbourhoods that are conducive to human health and longevity. This study combines literature review with field observation and resultes in the development of the conceptual framework which can be consolidated into the universal standards for health-promoting places.

Abstract Nature, childhood, and ecopsychology can to be connected in the landscape of a schoolyard. The landscape architecture of the natural environments serves as a wide-open green space for outdoor activities, creating imaginative and inventive urban environmental layouts and connecting natural elements. School-based green experience, either indoor or outdoor, can be a physical and mental activity for children. In the case of individuals, it makes` easy to access a natural, green environment and to be actively involved in a natural setting, developing either social and/or cognitive functions and improving concentration and creativity. Therapeutic horticulture activity, such as planting indoor plants, can be a good experience for developing team work, the proprioceptive (kinase) receptors, affectivity, socialization, permanent care, and responsibility. The potential benefits of ornamental plants for children involved in public education include spending time in outdoor spaces, fresh air and sunshine, experiencing a sense of control, and being exposed to sensory stimulations. Physical and psychological education based on therapeutic horticulture activities in Romanian schools, such as planting and green care, can provide important opportunities for children to develop their attachment to nature, offering sustainable education solutions to an active part of the natural environment.

Adolescents have significant capacity to engage in theological inquiry and theological reflection. How do at-risk teens articulate their faith and practice? This study explores how at-risk youth practice and articulate their beliefs through semi-formal qualitative interviews. This research suggests a caution to a simple therapeutic interpretation of adolescents’ faith without first taking into account the traumatogenic nature of their environment. Best practices for faith articulation and recommendations for further study are included.

Healing and therapeutic landscape design proposals are particularly suitable for medical facilities and, in general, facilities for people with health disorders, where they become a major support in difficult situations and can serve as a supplement to treatment. They do not replace medical help and different therapies, and neither do they exclude their need. However, their effects can improve and accelerate the recovery process in patients. In Slovakia, medical facilities do not often meet modern medical care requirements in terms of their technologies and equipment. For this reason, it is necessary to mainly transform hospital facilities and their exteriors in order to create the required natural foundation for patients in the form of healing and therapeutic landscape design. Using the example of the Philippe Pinel Psychiatric Hospital in Pezinok (Slovakia, Central Europe), we present a proposal for a green vegetation-scaping using the existing space, adding elements that highlight and support the therapeutic effect of the proposed space. The aim of the proposal is to create an environment that will bring positive changes for patients while serving as a relaxation space for employees.

The article deals with the problem of forming an adaptive "therapeutic" environment for the system of maternity hospitals and perinatal centers that has developed in the country. This problem is considered in a comprehensive manner, highlighting several aspects, such as: socio-historical-cultural, functional planning, architectural-spatial, figurative-semantic aspect. On this basis, the study proposes several promising approaches to creating an adaptive therapeutic environment for maternity facilities using various architectural modernization tools and identifying a number of typological models of such an environment. The following approaches are presented: "urban planning approach", which takes into account the optimization of various options for urban planning placement of maternity hospitals and perinatal centers; “environmental approach”, which allows considering perinatal centers as a set of exterior and interior spaces, commensurate with a person, his behavioral stereotypes, emotional state. "Ecological approach" - involves the introduction of natural components into the interior and exterior of the complex, which makes the period of rehabilitation of women in labor effective. "Architectural and planning approach" - is aimed at improving the functional and planning links of the objects of the perinatal center. "Scenario-functional approach" in the formation of a comfortable therapeutic environment of a medical institution allows us to consider communications in the space of a medical institution as a kind of spatio-temporal scenario on the way of the main routes of movement inside the interiors and exteriors along the "axis": entrance area - admission department - lobby, hall, etc. .d. The "artistic-figurative approach" assumes that a "typical" ward in medical institutions should not be limited only by the technological and functional component, and the comfort of patients' stay should take into account their emotional state. The "compositional approach" to the formation of the therapeutic environment of maternity facilities takes into account the "competent" formation of the architectural space, taking into account the laws of architectural harmonization, aesthetic and compositional principles. The systematization of the identified approaches and directions for designing a comfortable architectural "therapeutic" environment for perinatal centers creates a methodological basis for the development of promising architectural and typological models of these objects, taking into account their modernization and new construction

We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

Background. Despite increasing attention toward forest therapy as an alternative medicine, very little evidence continues to be available on its therapeutic effects. Therefore, this study was focused on elucidating the health benefits of forest walking on cardiovascular reactivity.Methods. Within-group comparisons were used to examine the cardiovascular responses to walking in forest and urban environments. Forty-eight young adult males participated in the two-day field research. Changes in heart rate variability, heart rate, and blood pressure were measured to understand cardiovascular reactivity. Four different questionnaires were used to investigate the changes in psychological states after walking activities.Results. Forest walking significantly increased the values of ln(HF) and significantly decreased the values of ln(LF/HF) compared with the urban walking. Heart rate during forest walking was significantly lower than that in the control. Questionnaire results showed that negative mood states and anxiety levels decreased significantly by forest walking compared with urban walking.Conclusion. Walking in the forest environment may promote cardiovascular relaxation by facilitating the parasympathetic nervous system and by suppressing the sympathetic nervous system. In addition, forest therapy may be effective for reducing negative psychological symptoms.

Urban gardening mainly means growing edible vegetables in a town. This practice has been traditionally used for economic reasons (subsistence agriculture), but now it has also acquired educational, nutraceutical, therapeutic and social relevance. The educational aspect of urban gardening has been the subject of a proposal for the newly born Science Shop in Florence (Italy). In the spirit of action-research, in our project we first decided to involve all (or many) potentially interested people. This has brought into light the galaxy of different aspects related to urban gardening and allowed the establishing of promising research lines. We discovered that this is a multi-disciplinary subject that touches themes dealing with agriculture, botany, psychology, chemistry, city planning and politics. We examine here the various aspects of urban gardening in the towns of Florence and Prato, two very different urban environments despite their proximity.

The increasing reported incidents of knife crime in cities and the release on parole of “rehabilitated” violent criminals are creating an unsafe urban environment. Such occurrences suggest that measures taken to address psychopathic-oriented behaviour may have been ineffective because the individual’s degree of “moral deficit” is not fully accounted for in the application of specific therapies. This study developed a theoretical model of “moral deficit” that is aligned with the appropriateness of therapy, ranging from the extreme “classical approach” of total confinement justified by a belief in the incurability of psychopaths to the modern therapy that aims to reintegrate the psychopath with society using “moralizing therapy”. Analysis of secondary data from extant literature was used to develop the theoretical model of “moral deficit”. Secondary data analysis suggests that the extent of psychopathic “moral deficit” may be an important factor in the selection of appropriate therapeutic measures for psychopathy treatment and the rehabilitation of psychopaths as law-abiding members of society. We conclude that a specific type of psychopathic moral deficit may have an important bearing on the appropriateness of treatment. It is recommended that the treatment of psychopathy makes greater provision for the extent and type of psychopathic “moral deficit” in assessing the most appropriate applications for the treatment of psychopathy and promoting the safety of urban environments.

While previous studies have documented the trials of rural-to-urban migration in postreform China, little is known of the consequences of urban demolition and attendant uncertainty on migrant mental health. Exploring the affective and subjective dimensions of life lived amidst rubble in a migrant neighborhood on the outskirts of Shanghai, this essay describes and analyzes smallscale practices of endurance through dynamics of time, place, and sociality. These modes of dwelling in a ruined environment are key to what the authors refer to as the management of subjectivity, producing moments of being that potentially enable to feel and act otherwise. Considering the management of subjectivity in its own right rather than as mere echoes of postsocialist governmentalities, the authors sustain a dialogue with recent writing on the production of happy and self-reliant marginalized subjects through the Chinese authorities’ turn to “therapeutic governance.”

In this paper, the case of the Coastal Strip in Gdańsk is presented. Gdańsk has natural and cultural heritage of great value and is included on Tentative list of UNESCO World Heritage List as “Gdansk—Town of Memory and Freedom”. The Coastal Strip is a rare example of landscape with natural dunes located within walking distance from densely populated residential districts. Therefore, the economic pressure for urban development is extremely strong. At the same time, the rise of social awareness about potential consequences of urbanization brought numerous efforts by local activists and researchers to prevent further development of the Coastal Strip. This study consisted of assessment of therapeutic qualities of The Coastal Strip using a conceptual framework—a universal standard for health promoting places. The results demonstrated that The Coastal Strip is a health-promoting place, thus adding new research-based evidence against plans for urban development of that area.

AbstractDuring the colonial period sexually transmitted infections (STIs) came to be recognised as a major public health problem in African cities. Thus, STI control and urban modernisation became deeply entangled as authorities redrew spatial and social boundaries to manage populations and their cross-cultural interaction. Public health measures, urban planning and policing were part of a coordinated effort to neutralise the potential impact of rapidly growing African urban migration on the Belgian Congo’s ‘model’ capital Leopoldville. While STI control was facilitated by new drugs (arsenicals, sulfonamides and antibiotics) to treat syphilis, chancroid, gonorrhoea and chlamydia (bacterial STIs), the effects of the 1929 economic crisis and urban social change illustrated the limits of colonial authority. Redesigning urban spaces and repressive measures to curb polygyny and prostitution operated in a parallel fashion with the expansion of health coverage, new treatments and awareness campaigns. To gain a better understanding of the evolution of STI incidence among African urban populations during the colonial period between 1910 and 1960, extensive archival records and secondary literature were consulted to assess the interplay between improved screening, diagnostic and therapeutic methods with demographic and social change. They show that STI rates, probably peaked during the pre-1929 period and apart from a short period in the early 1930s associated with mass screening, declined until becoming residual in the 1950s. Reflecting upon sanitary interventions and their broader dimensions, the article analyses the evolution of treatment regimes and their impact in the changing urban organisation and environment of the colony’s capital.

Urban riverfront space has diversified ecosystem services, but due to excessive changes in the geographical environment, such as drastic changes in land use, people gain social value at a great ecological cost. Obtaining benefits from the ecosystem in this way is not sustainable. Therefore, this paper uses the SolVES model to evaluate the social value of ecosystem services on the east bank of the Fenghe River, while also studying the contribution of different environmental variables to social value. The main results are as follows. (1) Environmental variables affect the spatial distribution characteristics of social value. The distance to water (DTW) means the social value was distributed in strips, and the distance to road (DTR) concentrated the social value along the road. The landscape type (LT) means the social value was concentrated in the landscape space. (2) When DTW, DTR, and LT were collectively used as environmental variables, the distribution characteristics of various social values were similar to when LT was used as the only environmental variable. (3) The results of MaxEnt show that LT made a greater contribution to the aesthetic, recreation, therapeutic, and historic values, and was the largest contribution factor to the aesthetic, therapeutic, and historic values, with contribution rates of 47.6, 50.5, and 80.0%, respectively. DTW is the factor that contributed the most to recreation, with a contribution rate of 43.1%. Improving social value based on the influence and contribution of environmental variables can reduce the damage to the ecological environment caused by changes in geographic factors. This is sustainable for both the ecosystem and the services it provides to mankind.

Purpose – The purpose of this paper is to present a study assessing residents’ satisfaction with the integration of natural environment in public housing designs in Enugu urban, Nigeria. Design/methodology/approach – The study followed qualitative and quantitative strategies. Personal observations and one-on-one interviews were conducted where necessary. A survey of 898 households residing in two main prevalent residential building typologies, systematically selected based on quota of their existence in seven public housing estates, was conducted, with a questionnaire as the key data collection instrument. A five-point Likert scale was used in measuring residents’ level of satisfaction of three key housing environment sub-components. Data collected were analyzed using descriptive statistics. Findings – Residents expressed dissatisfaction with overall housing estate environment in terms of naturalness in the estate landscaping and availability of green areas, and also with immediate dwelling unit environments in terms open spaces and naturalness in external finishes. Many of the residents, however, claimed to be indifferent about the extent of response of layout designs to natural factors, and street layout concepts to climatic influences. This reveals a high level of apathy of residents to their estates designs. Research limitations/implications – Collecting relevant data from the government agency that are the providers of the public housing studied was a herculean task, as there was no existing organized data bank. Consequently, the researcher depended more on extensive field work. In addition to the above, getting the questionnaire respondents to agree to participate in the study was another major challenge, as they were not used to participating in such studies before the current study. Social implications – Findings from the study imply that residents’ are adaptable to whatever housing environment they are provided with; therefore, therapeutic housing environment, if provided, would enhance healthy living for public housing residents in Nigeria. Originality/value – This work is a pioneering effort at evaluating public housing environment in the study area in relation to residents’ perception.

Abstract The article discusses individual approaches to the formation of the architectural and spatial environment of maternity hospitals and perinatal centres contributing to social distancing. A ‘functional-spatial’ approach is proposed, in which the boundaries of spaces in the most active functional areas of the maternity hospital are changed: entrance area, reception of women in labour, area for relatives and visitors of the hospital, delivery of newborns, consultations in the polyclinic department of the maternity hospital. As a planning technique for distancing is proposed the formation of a system of space ‘soft borders’ using flexible, inclined, semi-cylindrical and ‘flowing’ translucent partitions. The second, ‘environmental approach’, is based on changing the scheme of communication and environmental situations in the internal environment of the maternity hospital due to the thoughtful arrangement of furniture and interior equipment, as well as due to light, colour and graphic navigation. Such a reorganization of the architectural and spatial structure of the maternity hospitals, based on the requirements of social distancing, preserves the value characteristics of the therapeutic environment.

The european Alpine “stone arch” has its own natural and cultural identity. It represents “proto-architecture” that offers artistic inspiration, formal references, therapeutic effects. Slovenia and its Alps are small (like a fractal pattern of the big ones), but diverse in their landscapes, settlement culture and architectural traditions. Historically we were always part of Middle European cultural context (between the Alps, Mediteranean and Pannonian plains). Mostly part of bigger states, their culture reflected in built environment and architecture: from regulated order of the monarchy, the transition to modernity between WWI and WWII, “self-made” modernism of socialism, global capitalism free market trends after independance. The result is manifested in dispersed “urban sprawl” territories, a theme of “healing process” for younger urban planning and architectural generations to face with. Luckily less in the Alps with their strong traditions and topographies, where many compact historic settlements still witness their original urban matryx, (medieval) “spatial language” with its organic logic and very precise urban wisdom. Some extraordinary designers in Slovenia helped to create high level of architecture culture in XXth century (also in the alpine space): besides two great personalities, Maks Fabiani and Jože Plečnik, the latter started – together with Juan Vurnik – with “Ljubljana school of architecture”, there was also his follower Edvard Ravnikar (who worked also at Le Corbusier’s), who continued with the architecture. school and raised many good, modern architects. After the independence (1991) the younger generation reflects global trends, but also continues with architecture of high quality, found in some beautifull, diverse projects in the Alps. Today our alpine communites care more for their urban heritage and renew it, reurbanise their squares, streets and parks and support models of sustainable development, in which high level of building culture is an essential part of.

Urban collective gardens (UCG) are considered alternatives to face the environmental problems generated by urbanization, contributing to the sustainability of cities. This study aims to characterize UCG and its contributions to the local sustainability in Mexico City (CdMx). From bibliographic searches, consultation on social networks, and expert suggestions, our research group identified 40 gardens for CdMx, based on which we constructed a UCG typology. For deeper studies, we selected 19 UCGs based on several criteria: Number of members (at least three persons managing UCG), UCG age (at least one year), disposition of collaborating in the study, and availability for evaluation. The selected UCGs were evaluated qualitatively following the Framework for the Evaluation of Natural Resource Management Systems incorporating Sustainability Indicators (MESMIS, for its acronym in Spanish) through in-depth interviews and participant observation. We identified critical points or factors that drive or limit UCG (e.g., biological diversity, training of people participating, social and economic stability, access to space and financial support, economic diversification, input dependency, security of land tenure, and contamination risk). We concluded that UCG of CdMX contribute to local sustainability through processes like creating jobs, recovering connections with nature, knowledge transmission, experimental practices, and offers of therapeutic benefits, among others.

The herb Equisetum arvense is an herbaceous plant, commonly known as horsetail and as a medicinal plant. Its therapeutic resource is diffused intensely in the urban environment as an alternative or complementary form to allopathic medicines, therefore it is an important theme focused on medicine and popular health. In this context, the focus of the present work was to characterize the product of the tea from a manipulation form made by specialized pharmacy (M) and other natural product banking (B). The two horsetails were extracted in aqueous medium since this is the form in which the material is absorbed by the organisms. The M and B lyophilized products were preliminary characterized by infrared spectroscopy (FTIR), visible ultraviolet (Uv-vis), scanning electron microscopy (SEM) and X-ray dispersive energy (EDX). The resulting biomass adsorption (wastes) were applied in the cupric ions adsorption and the maximum adsorption capacity (Nfmax of M and B horsetail were 4.4x10-4 mol g-1 and 2.6x10-4 mol g-1 respectively.

In order to study the seasonal effects on the energy supply of immunocompetent blood cells (IBC) in pregnant women living in different conditions of the Amur region, and to substantiate additional methods of diagnosis, prevention and treatment of the identified disorders, a study of the mitochondrial membrane potential (MMP) by flow laser cytometry was conducted in 198 subjects. The data of different types of IBC (lymphocytes, granulocytes and monocytes) at early gestation of women living in urban (Khabarovsk) and rural (Jewish Autonomous region) areas of the Amur region were analyzed. Eight (8) groups were formed according to seasons: winter, spring, summer and autumn. The results of a comprehensive survey indicate some features of intracellular bioenergy processes of IBC depending on the environmental conditions in different seasonal periods. Conditions of women from urban areas are characterized by a significant increase in lymphocytes with reduced MMP which was more pronounced in winter, and by a tendency to increase monocytes in spring-and-summer season. The state of low energy supply of IBC in rural residents differs significantly by means of granulocytes in all presented periods of a year, combinations of various types of IBC in winters and tendency to simultaneous increase in the number of all IBCs with the reduced MMP. The number of IBC with optimal MMP content in urban environment was observed in pregnant women in autumn (23.3%), in rural areas in summer (57.1%). Thus, the study has shown the need to expand the range of diagnostic methods for the formation of pregnancy complications risk groups. Determination of the substrate-energy value in the cells of the immune system is an indication for the individual selection of complex vitamin and mineral medications taking into account seasonal changes. MMP studies allow to monitor the dynamics and evaluate the effectiveness of preventive and therapeutic prescriptions.

Human urine is currently the subject of biomedical investigations as a potential therapeutic resource and it continues to be used in remedies in different cultures and societies, including the Spanish culture. In this study we gather etnomedical knowledge about urotherapy and determine their associated symbolisms in Spain. A literature overview and a case study were carried out to compile urine-based remedies and as a direct analysis of symbolic systems. Urotherapy is widespread in Spanish folk medicine. Among the 204 collected remedies, those related to treatment of diseases or skin conditions predominate (63%). Remedies have been reported for the treatment of skin diseases such as eczema, chloasma, alopecia, etc. to treat or alleviate burns, chilblains, wounds or skin chapping, and as a treatment of venomous bites. Most of the collected remedies have an associated naturalist symbolism, based on local traditions and the transmission of empirical initial knowledge. The use of urine in Spain is a result of the interaction of two types of practice: a local and traditional urotherapy, rural and with a utilitarian purpose, and a technical urotherapy, limited to an urban environment and a naturopathic medicine.

Circus training can benefit children diagnosed on the autistic spectrum and their families. In 2010, as Head Trainer at Flipside Circus in Brisbane, Kristy Seymour developed a method for using circus as a therapeutic tool for children with autism. In this article, she and Patricia Wise work between experiential and theoretical positions to explore how circus can open up a new world to such children, enabling them to take risks physically and emotionally, and to stretch the capacities of their bodies in an environment that enriches their social development. Seymour and Wise deploy the idea of ‘chaosmos’ from Deleuze and Guattari, Pope, and others to argue that, counter-intuitively, children with autism benefit from the environment of creative chaos that attends circus. Through Agamben's work on being and singularity they discuss how circus values difference and inclusivity, building community in ways also captured by Probyn's notion of ‘outside belonging’. Kristy Seymour has worked for over sixteen years in contemporary circus as an aerialist, trainer, artistic director, creative producer, and choreographer. She has a significant profile in the youth circus sector, and is completing doctoral research on Australian contemporary circus in Griffith University's School of Humanities, Languages and Social Science. An Associate Professor in the same School, Patricia Wise is a cultural theorist whose publications range over cultural policy and urban studies, inflected by interests in spatiality, materiality and gender. This article reflects a parallel concern with cultural practices in communities of difference, as does a recent co-publication on the value of participatory music for the welbeing of detained asylum seekers.

Hospitals are controlled yet complex ecosystems which provide a therapeutic environment that promotes healing, wellbeing and work efficiency for patients and staff. As these buildings accommodate the sick and vulnerable, occupant wellbeing and good indoor environmental quality (IEQ) that deals with indoor air quality (IAQ), thermal comfort, lighting and acoustics are important objectives. As the specialist nature of hospital function demands highly controlled indoor environments, this makes them energy intensive buildings due to the complex and varying specifications for their functions and operations. This paper reports on a holistic building performance evaluation covering aspects of indoor air quality, thermal comfort, lighting, acoustics, and energy use. It assesses the performance issues and inter-relationships between IEQ and energy in a new building on a hospital campus in the city of Bristol, United Kingdom. The empirical evidence collated from this case study and the feedback received from the hospital staff help identify the endemic issues and constraints related to hospital buildings, such as the need for robust ventilation strategies in hospitals in urban areas that mitigate the effect of indoor and outdoor air pollution and ensuring the use of planned new low-carbon technologies. Whilst the existing guidelines for building design provide useful instructions for the protection of hospital buildings against ingress of particulate matter from outdoors, more advanced filtration strategies may be required to enact chemical reactions required to control the concentration levels of pollutants such as nitrogen dioxide and benzene. Further lessons for improved performance in operation and maintenance of hospitals are highlighted. These include ensuring that the increasingly available metering and monitoring data in new buildings, through building management systems, is used for efficient and optimal building operations for better IEQ and energy management. Overall, the study highlights the need for an integrated and holistic approach to building performance to ensure that healthy environments are provided while energy efficiency targets are met.

AbstractIntroduction:Objectives of this study were to determine the number of prehospital emergency patients who were given advanced life support (ALS) drugs and to compare utilization rates for ALS drugs in urban and rural environments. Certified ALS emergency medical technicians (Arizona) have 29 therapeutic agents authorized for prehospital administration. These agents may be administered only under direction of a medical control authority or by following standing orders.Methods:A retrospective review was made of prehospital emergency encounter records. They were acquired by the Arizona Office of Emergency Medical Services (OEMS) from rural EMS providers who used optically scannable forms and from a metropolitan fire department's medical emergency response records.Results:In 1989 and 1990, 273,611 emergency patient encounter records were entered into the EMS database; 197,260 were urban responses and 76,351 were rural responses. Drugs (ALS) were administered to 16,730 (8.5%) urban emergency patients and to 5,359 (7%) rural emergency patients at the incident site or during transport to a medical care facility. Nitrostat, 0.4 mg sublingual tablet, was the drug most frequently administered to emergency patients in the prehospital setting. Utilization rates found in the urban and the rural data sets were consistent for the indivdual agents. Variations in use frequency between urban and rural setting were noted for some drugs. Of the 29 approved ALS drugs, seven (24%) were administered to 10% or more urban patients who received drugs. In the rural areas, eight (27.6%) were administered to 10% or more patients who received drugs. There were nine (31%) agents administered to less than 1% of all patients who received drugs. A majority of the approved drugs, 17 (59%) were administered at a rate below 5% of all patients receiving medications.Conclusion:Severity of illness or injury prompted administration of ALS drugs to 8.1% of patients receiving prehospital emergency care. The most frequently utilized medication in the urban/rural areas was for treatment of cardiac symptoms. Variations between urban/rural drug utilization reflected the drugs of choice which are compatible with long transport times to a medical facility.

INTRODUCTION: The lack of basic knowledge on venomous arthropods and the benignity of the clinical manifestations contribute to the centipede bite victims' not being taken to a treatment reference center, leading to underestimation of the number of cases and minimizing the possibility of a broader epidemiological view. An inventory of the centipede bite occurrences in Greater S. Paulo, Brazil, and the therapeutic methods employed, by the main Brazilian medical center for the notification of poisoning by venomous animals, is presented. METHOD: All patient cards of the period 1980-1989 have been checked as to place, month and time of occurrence; sex, age, affected part of the body, signs and symptoms have been observed, as well as the therapeutic methods employed. The centipedes that caused the accidents were identified at the Arthropods Laboratory. RESULTS: It was registered 216 accidents, with a 69% predominance of the Greater S. Paulo and in only 63% of the cases (136) was the agent brought in by the victim for identification. The genera most frequently represented were Cryptops (58%), Otostigmus (33%) and Scolopendra (4%). Of the 136 cases, 87% showed erythema, edema, hemorrhage, burns, cephalalgia, and intense pain. There was a predominance of accidents in the warm rainy season, in the morning and for females between 21 and 60 years of age. Hands and feet were the parts of the body most affected. The benign evolution of the clinical picture (54%) made therapeutical treatment unnecessary. Only the victims of Scolopendra and Otostigmus (46%) were medicated with anesthetics (51%), analgesics (25%), antihistamines and cortisone (24%). CONCLUSION: The reproductive period of the centipedes, associated with their sinanthropic habits, contributes to the greater incidence of accidents in urban areas in the warm rainy season. Only patients bitten by Scolopendra and Otostigmus require therapeutical treatment.

BackgroundDespite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.ObjectivesTo understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.DesignThe programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.Main outcome measuresThe main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.ResultsWe developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration;p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12;p = 0.002; interactionp-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18;p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146;p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98;p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward;p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward;p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage;p = 0.77).Strengths and limitationsWe have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.Future workOur database will be used to develop an understanding of the mediating and moderating factors for improving care quality.Trial registrationCurrent Controlled Trials ISRCTN06545047.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.

In May 2016, a wildfire devastated a northern region of Alberta, Canada, resulting in negative consequences on physical and mental stress, social relationships, and overall resilience among Indigenous residents. Research on coping and managing stress following a disaster has failed to incorporate unique characteristics from Indigenous perspectives. Sharing circles were held in urban and rural community settings to capture: (a) Indigenous perspectives of coping, (b) individual and collective strengths that helped Indigenous residents and communities to cope during and after the wildfire, and (c) intergenerational experiences of coping from stress among Indigenous residents. Indigenous residents’ experience with coping from the wildfire was shaped by: (a) heightened physical and emotional stress, (b) existing structural inequities, and (c) strong community cohesion and connection to culture. An unexpected outcome of this research was the therapeutic value of the sharing circles for participants to share their experience.

Antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) have been widely identified as emerging pollutants in various aquatic compartments. Concerns have been raised that the antibiotic resistance determinants may occur in treated drinking water and wastewater, weakening the therapeutic efficacy of antibiotics and so posing threat to public health. Most often, laboratory trials are conducted to assess the removal efficiency of ARB and ARGs in individual treatment processes (e.g., disinfection). However, the random variations of microbial distribution and chemical compositions in real-world environments cannot be entirely simulated, presumably leading to false-positive results as a consequence. It is therefore useful to provide a summary of recent advancements regarding the antibiotic resistance attenuation during full-scale water/wastewater treatments, which has not been adequately evaluated so far. In this review, the prevalence, proliferation and transmission of ARB and ARGs in urban water cycle, coupled with corresponding detection methods are presented as a short overview. The fate of ARB and ARGs in the sequential drinking water and wastewater processing units is critically summarized, the aim of which is to provide guidance for improving the current water treatment facilities to further reduce the antibiotic resistance in finished water.

Purpose The purpose of this paper is to present a model of democratic therapeutic community (DTC) for people with a diagnosis of schizophrenia and psychotic disorder, namely the Group-Apartment (GA). The authors will describe it in more detail, discussing the ideas which lie behind it, considering the relative cost of treating people in larger residential DTCs and in GAs, outlining findings from the first data gathered on a GA and looking at the usefulness of this model in post-modern societies, with particular reference to Sicily. Design/methodology/approach In brief a GA is a flat, located in an urban apartment building, inhabited by a small group of people. In this paper the authors consider an apartment inhabited by a group of three or four patients with the presence of clinical social workers who work in shifts for several hours a day on all or most days of the week (Barone et al., 2009, 2010). GA is also inspired by the pioneering work of Pullen (1999, 2003), in the UK tradition of the apartment post TC for psychosis. Findings GAs in Italy have become one of the main methods of support housing in recovery-oriented treatment, because it allows the empowerment of the users and fights against the stigma of mental illness (Barone et al., 2014; Bruschetta et al., 2014). The main therapeutic activities provided in the GA depend on the type of recovery route being supported, on the level of autonomy being developed and on the level of participation in the democratic life of the local community. Originality/value GAs appear better, cheaper and a more appropriate treatment for mental problems in the current financial and social climate than larger institutions. Where they have been tried out, they have been found to be effective, by users and by stakeholders. They exemplify the advantages of the DTC for encouraging recovery, but cost less to run. In accordance with DTC principles, the social democratic process is used not only to evaluate the clinical effectiveness of GAs, but also to build a network to support the development of innovative mental health services and new enabling environments (Haigh et al., 2012).

Abstract Background Our previous studies have shown little or no difference in the overall survival (OS) of urban over rural cohorts with lymphoma. Autologous hematopoietic stem cell transplantation (Auto-HSCT) is a frequently used treatment for non-Hodgkin lymphoma (NHL), but the elderly tend to tolerate transplant less well than their young counterparts. Increased prevalence of chronic conditions, comorbidity and frailty, serve to further complicate treatment in the elderly. We hypothesize that the same factors that contribute to the complexity of Auto-HSCT in the elderly may also contribute to outcome disparity according to area of residence. Aim To determine if area of residence is an independent risk factor for the following clinical outcomes: relapse, non-relapse mortality (NRM), disease-free survival (DFS) and OS following Auto-HSCT in the elderly with NHL. Methods This is a retrospective cohort study of patients (pts) age ≥60y who underwent first Auto-HSCT for NHL between 1985 and 2012. Using pts' residential ZIP codes at the time of transplant, the primary area of residence was categorized as urban or rural according to the Rural-Urban Commuting Area Codes classification system. Multivariate analyses (MVA) were performed using Cox proportional hazards regression analysis to evaluate the association between area of residence and all outcomes while adjusting for significant patient-, disease-, and treatment-related variables. Results During the study period, 1616 pts underwent Auto-HSCT for NHL; 321 (20%) of whom were elderly. A total of 286 (89%) had classifiable U.S. ZIP codes: urban (n=182, 64%) and rural (n=104, 36%). The median age was 65y (range 60-77), 64% males, and 93% of the NHL types are high-grade. We failed to detect significant differences in all patient-, disease-, and treatment-related factors between the two cohorts except for disease stage at the time of transplant (p=0.03); urban pts tend to be in relapse at the time of transplant (35% vs 25%), while rural pts tend to be in second or more complete remission ( 34% vs 18%). MVA results are summarized in the table below. We failed to detect differences in the risk of relapse and NRM between urban and rural cohorts. Both risk for treatment-failure (inverse of DFS) and mortality were time-dependent such that the association between area of residence and outcome varied before and after 6 months post-transplant. The risk of treatment-failure and mortality was significantly lower in the rural cohort compared to the urban cohort after 6 months; while similar in the first 6 months. Age and year of transplant were significantly associated with DFS and OS; disease stage at the time of transplant was not significant. The probability of OS (see figure) at 5 and 10 years post-transplant in urban and rural cohorts were 44% vs 54% and 26% vs 38%, respectively. The causes of death were not statistically different between the two groups with most dying from relapse, multi-organ failure and second malignancies. Conclusions The absence of clear differences in characteristics of elderly NHL pts who underwent Auto-HSCT according to area of residence suggests a similar selection process. The better DFS and OS after 6 months that persist over time and is not explainable by marked differences in relapse, NRM or treatment received suggests interplay of other non-biological factors including: attitudes, health seeking behaviors, environment-related factors, or health care follow-up. Further research is needed to determine the underlying cause of the observed outcome disparity among elderly NHL transplant pts. Disclosures: Armitage: Ziopharm: Consultancy; Roche: Consultancy; Genetech : Consultancy; Seattle Genetics: Consultancy; GlaxoSmith Kline : Consultancy; Tesaro bio, Inc. : Membership on an entity’s Board of Directors or advisory committees. Vose:Sanofi-Aventis US, Inc.: Research Funding; Pharmacyclics: Research Funding; Onyx Pharmaceuticals: Research Funding; Millennium: Research Funding; Janssen Biotech : Research Funding; Incyte Corp.: Research Funding; GlaxoSmithKLINE: Research Funding; Genentech: Research Funding; Celgene: Research Funding; Bristol-Myers Squibb: Research Funding; Allos Therapeutics/Spectrum: Research Funding; US Biotest, Inc. : Research Funding.

AbstractNature has been shown to be beneficial to our overall health and well-being. We are all connected to nature and it is important to maintain this vital connection for our health and well-being. Spending time outside in nature or urban parks has been shown to positively affect a person’s emotions and improve their sense of well-being. Access to nature balances circadian rhythms, lowers blood pressure, reduces stress and increases absorption of Vitamin D. Increasingly, evidence demonstrates that contactwith the living world around us is an important part of healing and recovery. The natural world’s role in human well-being is an essential, yet often forgotten, aspect of healthcare. Of particular importance are the benefits one can derive through interaction with natural environments. Reincorporating the natural world is practiced to move healthcare toward being more “green”. Spiritual well-being is enhanced through the experience of greater interconnections, and it occurs when interacting with the natural world. One study examined the physiological and psychological responses to real forest landscapes as well as the therapeutic uses of forests relative to urban environments.Lower levels of the stress hormone cortisol have been reported in adults subsequent to performing the same mental activities in a garden setting vs. an indoor classroom. A separate study involving over 11,000 adults from Denmark showed that living more than 1 km away from green space (forests, parks, beaches, lakes) were 42 percent more likely to report high stress and had the worst scores on evaluations of general health, vitality, mental health and bodily pain The landscape itself offers retreat from daily routine. The aim of our research was to measure the effects of Forest SPA programs on attendants’ well-being. Research has been organized in cooperation between Health college Belgrade and Medical SPA Association of Serbia. There were fourteen participants taking part in the research. Prior to Forest SPA program all participants, 14 students on specialization in Medical Wellness were invited to half-an-hour active imagination (mandala drawing) workshop. Drawing Mandala is a meditation in motion, dreaming with open eyes, and during the process of active imagination the unconscious self is active and not passive like in dreams. Using the data and research methodology from Henderson’s Empirical Study of the Healing Nature of Artistic Expression we designed our investigation. After 90 minutes of Forest SPA program in selected Urban park, participants were invited to draw mandala to describe how they feel at that moment. Several participants (8 of them) attended a 90-minute City SPA program with Tibetan bowls vibration massage. At the end of the SPA program they were invited to draw mandala. Analyzing symbols and colors, number of symbols and their relationship in presented mandalas we can realize the effects of the Forest SPA programs in urban parks on achieving better emotional balance and enhancing individualization process in participants. Our pilot research of Active imagination (by drawing mandalas) revealed that it can be used as a part of Forest SPA program as ART therapy and at the same time as an instrument for individual approach to the client of Forest SPA program as a medical SPA concept.

Background Concerns have been expressed about potential toxicity of the smoke produced by the burning of moxa in traditional Chinese medicine. With the advent of strict anti-smoking legislation in the UK, it was decided to test the volatiles produced by moxibustion and compare them with current agreed safe exposure levels. Method Moxa, in the form of cigar shaped moxa “sticks” or “rolls”, was tested under International Organization for Standardization conditions in a tobacco testing laboratory, and the quantities of a number of pre-determined volatiles measured. The smoke tested was “sidestream smoke”, the smoke which arises from the burning tip of the moxa. The test results were then scaled up to reflect normal use and to provide direct comparisons with agreed national safety standards for both short- and long-term exposure levels. Results Levels of only two volatiles produced were equivalent or greater than the safe exposure levels, as was the carbon monoxide level reported, both as a consequence of using worst case assumptions for comparison. Under normal operating conditions neither volatile nor carbon monoxide would present a safety hazard. One group of chemicals tested, the aromatic amines, with known carcinogenic properties have no agreed safety levels. Results for these in the study compared favourably with background levels reported in urban environments. Conclusion There are no immediate concerns arising from the continued use of moxa as a therapeutic modality in traditional Chinese medicine. Further testing may be required to establish whether current recommendations for ventilation and cleansing of treatment room surfaces may need to be revised. Stronger recommendations may also be necessary on the inadvisability of using moxa on broken skin.

Background & Aims. The pharmaceutical care practice represents a model of responsible pharmacist involvement in the pharmacotherapy optimization of various population groups, including the elderly, known to be at risk for drug-related problems. Romanian pharmacists could use validated pharmaceutical care experiences to confirm their role as health-care professionals.This descriptive research presents the application in two real and different environments of practice of a structured pharmaceutical care approach conceived as the basis for a medication review activity and aiming at the identification and resolution of the drug related problems in the elderly.Patients and methods. Two patients with similar degree of disease-burden complexity, receiving care in different health-care environments (The Geriatric Ward of the Royal Victoria Hospital from the McGill University Health Centre in Montréal, Québec, Canada, in November 2010, and an urban nursing-home facility in Cluj-Napoca, Romania, in March 2011), were chosen for the analysis. One clinical pharmacist suggested solutions for the management of each of the active drug-related problems identified, using the systematic pharmaceutical care approach and specific published geriatric pharmacotherapy recommendations. The number of the drug-related problems identified and the degree of the care-team acceptance of the pharmacists’ solutions were noted for each patient.Results. The pharmacist found 6 active drug-related problems for the hospitalized patient (72 year-old, Chronic Disease Score 9) and 7 potential ones for the nursing-home resident (79 year-old, Chronic Disease Score 8), involving misuse, underuse and overuse of medications. Each patient had 3 geriatric syndromes at baseline. The therapy changes suggested by the pharmacist were implemented for the hospitalized patient, through collaboration with the health-care team. For the nursing home resident, the pharmacist identified the need for additional 6 medications and safety and efficacy arguments to cease 7 initial therapies, simplifying the therapeutic daily schedule (from 24 daily doses to 15).Conclusion. The pharmacist’s potential contribution to the optimization of the Romanian elderly patients’ pharmacotherapy needs further exploration, as potential drug related problems reported as characteristic for this population were easily identified. The presented structured and validated model of pharmaceutical care approach could be used to this end. Its dissemination and use could be encouraged along with the enhancement of pharmacotherapy information and care team collaboration skills.

Abstract Objective: To describe outcomes of adolescents with eating disorders treated by an interdisciplinary adolescent medicine service at a large children’s hospital and to identify factors, including hospitalization, associated with outcome. Design: The study design was a retrospective chart review of patients. Setting: The setting was an inpatient and outpatient adolescent service in a large urban children’s hospital. Participants: A total of 218 adolescents diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified participated in the study. Intervention: Interdisciplinary inpatient and outpatient treatment for eating disorders was adopted for intervention. Outcome measures: Patient outcomes were categorized as fully recovered, partially recovered/improved, or poorly recovered/exhibiting chronicity. Results: Being admitted to the study hospital once and longer duration of follow-up were associated with full or partial recovery. In contrast, being readmitted to the study hospital and longer duration of illness prior to the initial contact with this service were associated with poor recovery. Premorbid obesity was unrelated to outcome. Conclusions: Earlier detection and referral of adolescents with eating disorders are needed because a high percentage of patients, especially those with anorexia nervosa, required hospitalization at initial contact. The benefits of inpatient admission may extend beyond medical stabilization of the most medically compromised patients to include improved therapeutic relationship with the treatment team and improved follow-up. Many patients prematurely terminate treatment; factors contributing to premature termination of therapy need further exploration.

OBJECTIVE: Trace the pattern of drug use during delivery hospitalization. METHOD: Cross-sectional study carried out from June to October 2015, included in the 2015 Pelotas births cohort. All women living in the urban area of the city who were hospitalized for delivery were part of the sample. We collected information regarding drug prescription and drug use by mothers during the whole period of hospitalization. Sociodemographic data were obtained in interview after delivery, and other data were obtained from medical charts. The drugs were classified according to the Anatomical Therapeutic Chemical system. RESULTS: All study participants (1,392 women) used at least one drug, with the mean amount being larger the higher the age of the mother, both prepartum/during delivery and postpartum. It was also higher in cases of spinal anesthesia or general anesthesia, cesarean deliveries, school hospitals, and longer hospitalizations. Analysis of the sample as a whole showed no significant difference in the number of drugs used according to hospitalization type, but when stratified by length of hospital stay the mean was higher in SUS hospitalizations than in private and health insurance hospitalizations. Drugs for the nervous system were the most used (30.5%), followed by drugs for the alimentary tract and metabolism (13.8%). The use of anti-infective agents and drugs that act on the cardiovascular and respiratory systems was higher in mothers who underwent cesarean delivery. This study showed high drug consumption in the delivery hospitalization period, and showed cesarean delivery and epidural anesthesia as the main factors related to high drug consumption in this period. CONCLUSIONS: We found high drug consumption in the delivery hospitalization period, and the main factors were cesarean delivery and epidural anesthesia. Drugs that act on the nervous system were the most used.

Abstract Rapid development of pharmaceutical industry, and thus widespread availability of different types of therapeutical and increased intake of pharmaceuticals, results in elevated concentrations of pharmaceuticals in municipal wastewater subjected to treatment in wastewater treatment plants. Pharmaceuticals present in raw wastewater discharged from hospitals, households, veterinary and health care clinics eventually end up in wastewater treatment plants. Commonly applied methods for treating wastewater do not allow complete removal of these contaminants. As a consequence, pharmaceuticals still present in treated wastewater are introduced to water environment. The most frequently identified pharmaceuticals in surface water belong to the following groups: non steroidal anti inflammatory drugs, beta-blockers, estrogens and lipid regulators. The most difficult is removal of diclofenac, clofibric acid and carbamazepine as these substances show low biodegradability. Diclofenac can be removed in the process of wastewater treatment by 40%, carbamazepine by 10%, and clofibric acid from 26 to 50%. The presence of diclofenac sodium in the rivers in Poland was confirmed and the concentrations were following: 380 ng/dm3 (the Warta river), 470 ng/dm3 (the Odra river), 140 ng/dm3 (the Vistula river). Naproxene was found in the Warta river at the concentration of 100 ng/dm3. The presence of pharmaceuticals in surface water can be toxic to aqueous microorganisms and fish. Recent studies confirmed also the presence of pharmaceuticals in drinking water. This is considered as a problem especially in urban agglomerations such as Berlin or large cities in Spain and China. The studies showed that pharmaceuticals were also identified in the samples taken from the Polish rivers and drinking water. The presence of naproxene and diclofenac at the concentrations of 13 and 4 ng/dm3 was identified in drinking water sampled from water intakes in Poznan. Surface water and drinking water showed also the presence of illegal drugs.

AbstractObjective:To compare the microbiological profile, clinical course and outcome of acute diarrhoea in children aged <5 years having severe acute malnutrition (SAM) with those of children having normal nutritional status.Design:Cross-sectional comparative study.Setting:Tertiary-care hospital catering mainly to the urban poor of East Delhi, India.Participants:Children aged <5 years (n 140; seventy with SAM (cases) and seventy with normal anthropometry (controls)) with acute diarrhoea (duration < 14 d). Stool samples were collected for conventional culture, microscopy, acid-fast staining, rotavirus and Cryptosporidium antigen detection, and subtyping of diarrhoeagenic Escherichia coli (DEC). We followed-up these children for persistent diarrhoea and subsequent diarrhoeal episode in the next 3 months.Results:Rotavirus was detected in six (9 %) cases and in fifteen (21 %) controls (P = 0·03; OR = 0·34; 95 % CI 0·12, 0·94). DEC was isolated significantly more in cases compared with controls (93 v. 64 %; P < 0·001; OR = 7·25; 95 % CI 2·57, 20·4). Cryptosporidium was detected in seven (10 %) cases and five (7 %) controls. Total duration of diarrhoea and percentage change in weight after resolution of diarrhoea were comparable between cases and controls. At 3-month follow-up, number of subsequent episodes of diarrhoea and persistent diarrhoea were comparable between the two groups.Conclusions:Rotavirus was found significantly less frequently, whereas DEC was detected more frequently in children with SAM in comparison to non-malnourished children. To further reduce diarrhoea-related mortality, preventive and therapeutic interventions need to be designed against organisms causing diarrhoea in children with SAM.

Obesity is now pandemic, affecting millions of people in worldwide [1]. Obesity is defined as the excessive fat accumulation which may damage the health. Two groups of beneficial bacteria are dominant in the human gut, the Bacteroidetes and the Firmicutes. The relative proportion of Bacteroidetes is decreased in obese people by comparison with lean people and this proportion increases with weight loss on two types of low-calorie diet. Obesity has a microbial component which might have potential therapeutic implications [2]. Third National Health and Nutrition Examination Survey (NHANES III) provides the detailed population based overweight and obesity prevalence data [3]. Body mass index (BMI) is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2). BMI provides the useful to measure of obesity and it is same for both sexes and for all ages. BMI value from 25 to 30 kg/m2 (overweight), 30 to 35 kg/m2 (obesity) points used by the World Health Organization (WHO) [4] and the National Institutes of Health (NIH) [5]. The basic cause of obesity is an energy imbalance between calories consumed and calories expended. Stevens et al. [6] viewing the burden of obesity showed that moderate obesity generally results in a 1 to 3-year reduction in life expectancy, depending on age. Obesity is a major cause of mortality [7] in the United States. Obesity substantially increases morbidity and impairs quality of life [8]. Metabolic clearance of Vitamin D may increase in obesity, possibly with enhanced uptake by adipose tissue [9]. Foetal macrosomia is more common in the obese non-diabetic mother compared to the lean mother with gestational diabetes [10]. Amino acids are insulin secretagogues and an increased flux on amino acids could stimulate foetal hyperinsulinemia. Triglycerides are energy rich and placental lipases can cleave triglyceride and transfer free fatty acids to the foetus [11]. Raised BMI is a major risk factor for cardiovascular diseases, diabetes, osteoarthritis and some cancers. Lower income people can afford more fat (from edible oils) and this upward shift in fat consumption is important for explaining part of the nutrition transition in China [12]. The increases in prevalence of overweight and obesity in Canada between 1985 and 2003 are cause for concern for increased risk of premature death and musculoskeletal complications arising from morbid obesity [13]. A large hip or thigh circumference or both, which could be due to a greater lean mass in the abdominal regions is negatively associated with all-cause mortality [14]. The US Preventive Services Task Force recently recommended screening all adult patients for obesity due in part to the strong association between obesity and chronic diseases [15]. The direct medical costs attributable to adult obesity in Canada are estimated to have been $1.8 billion in 1997 [16]. Obese individuals are frequently stigmatized in online news photographs; this phenomenon has important implications for public perceptions of obese persons and may reinforce pervasive prejudice and discrimination [17]. Understanding the trends in childhood obesity is important because obesity in childhood has many adverse effects on health in both childhood and adulthood [18]. NHANES I and NHANES III were cross-sectional representative samples of the US civilian non institutionalized population. Both surveys used to standardize the protocols for all interviews and examinations. Data on weight and height were collected for each individual in a fully equipped mobile examination center through direct physical examinations [19]. Letters ISSN: 2469-4142 J Nutri Bio, 3(1): 174-176 (2018) 175 It is important to note that shifts toward reduced adult obesity in Brazil do not appear to have reached older children and adolescents [20]. Systematic education of administrators and teachers, better physical education and nutritional improvement in the beverages and food products are available in Singapore schools [21]. United Nations reveal the comparative information on trends in childhood and adolescent underweight and overweight status approximately one-third of the global population [22]. China National Nutrition Survey data showed an increase in the prevalence of overweight and a remarkable decrease in under nutrition in children [23]. BMI cutoffs are linked to adult cutoffs for overweight and obesity, which are good indicators of risks for adverse health outcomes [24]. Television watching is a major cause of children’s inactivity and has been linked to childhood obesity [25]. The weight trends in Russia are very different from other countries, the sex difference initiate in the changing prevalence of underweight may suggest that Russian males and females have been prejudiced differently by the socioeconomic difficulties in the society [26]. Studies have demonstrated that changes in lifestyle are effective in preventing both diabetes and obesity in high-risk adults with impaired glucose tolerance [27]. Less than 20% of US adults who were trying to lose or maintain weight were following recommendations to eat fewer calories and increase physical activity to at least 150 minutes per week [28]. Strategies aimed at improving dopamine function may be beneficial in the treatment of obese individuals [29]. Obesity’s impact is diverse and extreme that it is one of the greatest neglected public health problems [30]. Holmes [31] explained that obesity is a societal problem and it’s an illness can be framed as a risk to the individual, a threat to populations. Schneider and Ingram [32] described that social constructions of populations influence the choices of policymakers and children as dependents: a powerless, positively viewed group who are not expected to be responsible for their own well being. Creating a toxic environment of food industry which promotes high density and low nutrient food, physical activity is low because of a reliance on cars as a result of poor urban planning and neighborhoods perceived to be unsafe [33]. Margaret Chan, Director General of the WHO, was reported in the media calling for the multinational corporations who driven by commercial interests, aggressively advertise cheap food and drinks laden with fat and sugar to share the responsibility for the obesity epidemic [34]. Obesity is generally agreed to be primarily linked to increased energy intake and decreased energy expenditure facilitated by environmental influences that favor energy dense diets and sedentary lifestyles [35]. Numerous studies have shown that the public, identify the media as their primary source of science and medical information [36]. Healthier lifestyle will decrease the obesity problems.

List of abstracts and authors:1. Comparative benefits of Atypical antipsychoticsDiana P Morrison2. Evidence-based management of depression in SchizophreniaAndre F Joubert3. Second generation Antipsychotics: An African updateDave Swingler4. The drug management of patients with HIV/Aids in the Mental Health Care setting: A therapeutic challengeDenise White5. New developments in the treatment of Bipolar depressionJospeh R Calabrese6. Dual action antidepressants: Faster onset, more remission, better value?Roger M Pinder7. Antisocial personality disorder: A reviewDonald W Black8. The South African study of stress and health: An overviewDavid R Williams9. Ugliness is in the eye of the beholder: Psychiatric apsects of body image disturbanceDavid Castle10. Over diagnosed or under recognized? Treating ADHDDora Wynchank11. The contagious effects of trauma and their impact on human service organisationsKerry Gibson12. Temporal lobe epilepsy in adolescence - 'Understanding the narrative'Helen Clark13. The effectiveness of treatment programs for Methaqualone (Mandrax) dependenceGreg McCarthy, Nandi Siegfried, Bronwyn Myers14. Community influence on alcohol and marijuanaAlan J Flisher, Robyn Mallett, Gary King, Neo Morojele, Martie Muller, Carl Lombard15. Psychiatric presentations of medical illnessSebastian Akalula16. Imaging of brain function using SpectJames Warwick17. Selected neuropsychological test performances and SSRI usageTheophilus Lazarus18. Comparative effectiveness and safety of antipsychotic treatments for outpatient SchizophreniaFrans Korb, Adel Sadak, Aly Akram, Sunar Birsoz, Abderrahmane Belaid19. Evidence-based mental healthcare - What do you know, think, feel?Nandi Siegfried, George Swingler, Soraya Seedat, Martie Muller, Rachel Churchill, Dan Stein20. Competitions Act - Anti-competitive health care practicesZ Nthakwana21. Unique approach to mental wellness by medical SchemesPetro Kempen22. What happens to my medical aid contribution?Eugene Allers23. Financial issues in a modern private practiceMike Edwards24. Transcranial magnetic stimulation: Uses in brain function research and medical interventionAlan St Clair Gibson25. The Neurochemistry of dreams: Implications for PsychiatryMark Solms26. Tenascin-R expression in the Central Nervvous system of lower vertebratesRuth Jarvis, N-. Hsu, P. Pesheva and D.M. Lang25. Localisation of the Nogo-A receptor in Neronal Lipid raftsEdward Nyatia, D.M. Lang26. Characterising an animal model for early life trauma using time dependent sensitisationJoachim D.K. Uys, Willie M.U. Daniels, Dan J. Stein27. Tolmetin affords protection against Quinoclinic acid induced Neurotoxixity in Rat brainAmichand Dairam, S Daya28. Acetaminophen and aspirin inhibit superoxide anion generation and Lipid Peroxidation, and protect against 1-Methyl-4Phenyl Pyridinim-induced Dopaminergic Neurotoxicity in ratsH. Maharaj, D.S. Maharaj, K. S. Saravanan, K.P. Mohanakumar, S. Daya29. Can exercise provide Neuroprotection in a rat model for Parkinson's disease?M Mabandla, L Kellaway, A St Clair Gibson, M Lambert, V Russell30. Treatment of rapid cycling Bipolar disorderJoseph R. Calabrese31. Depression as a Neurodegenerative Disorder: The need for achieving remissionRoger M Pinder32. Side-effects induced by modern antidepressants- Overview and managementFranco Colin33. The Placebo response in antidepressant clinical trialsRobin Emsley34. Impulse control disorders: An overviewDonald W. Black35. Post traumatic stress disorder: The Wits trauma clinic experienceUgash Subramaney36. Post traumatic stress disorder among recently diagnosed patients with HIV in South AfricaSoraya Seedat, Bo Olley, D J Stein37. Improving outcome in SchizophreniaDiana P Morrison38. Reviewing post Graduate trainingCliff W Allwood39. Ethics in HIV ResearchKeimanthro Moodley40. Improving and maintaining ethical standrads in Psychiatric researchTuviah Zabow=============================================================Posters: Neurosciences section (Presenting author only)1. Blunted Acth response correlates with altered Neurotransmitter function in maternally separatedratsW M U Daniels2. A mechanism for zinc toxicity in Neuroblastoma cellsW M U Daniels3. The effects of Hypericum Perforatum, Quercetin, and Fluoxetine on receptor densities in the Rat BrainL Heiderman4. Trichotillomania and obsessive-compulsive disorder: Clinical and genetic comparisons within a South African populationS M J Hemmings5. Expression of Nogo-A in the amphibian central nervous systemN. J. Hsu6. Biochemical model for inflammation of the brain: The role of iron, transferring and toxiferring in Lipid PeroxidationS J Van Rensburg7. Improvement in Alzheimer's disease patients with antioxidant supplementation over 15 monthsS J Van Rensburg8. The Placebo effect - Is it all in the mind?S J Van Rensburg9. Very low serum iron concentrations in elderly patients with active CarcinomaS J van Rensburg10. Melatonin affords protection against Rotenone-induced NeurotoxicityR John11. Effect of enriched environment on Ca uptake via NMDA receptors into barrel cortex slices of spontaneously HypertensiveratsM Lehohla12. Effects of Methylpenidate in a rat model for Attention Deficit Hyperactivity DisorderG. L. S. Lelaka13. 6-Hydroxymelatonin converts Fe (III) to Fe(II) and reduces iron-induced Lipid PeroxidationD S Maharaj14. Metrofinate Potentiates Quinolinic Acid and Potassium Cyanide induced NeurotoxicityA Ramsunder15. The effect of chronic Intra-Amylgdala CRF injections on rat behaviour and HPA-Axis functionL Richter16. Effect of Glutamate in the Prefrontal Cortex of a rat model for Attention-Deficit Hyperactivity DisorderV Russell17. An investigation into the relationship between Corticosterone and Neuron Cell deathP J Van Vuuren=============================================================41. Blunted Acth response correlates with altered Neurotransmitter function in maternally separated RatsW M U Daniels, C Y Pietersen, M E Carstens, D J Stein42. A mechanism for Zinc Toxicity in NeuroBlastoma CellsW M U Daniels, J Hendricks, R Salie, S J Van Rensburg43. The effects of Hypericum Perforatum, Quercetin and Fluoxetine on receptor densities in the rat brainL Heideman and S Daya44. Trichotillomania and obsessive-compulsive disorder: Clinical and genetic comparisons withn a South African populationS M J Hemmings, C J Kinnear, C Lochner, H Moolman-Smook, D J H Niehaus, V Corfield, D J Stein45. Expression of Nogo-A in the amphibian central nervous systemN. J. Hsu, R Jarvis, D. M. Lang46. Biochemical model for inflammation of the brain: The role of iron, transferring and Toxiferring in Lipid PeroxidationS J Van Rensburg, R T Erasmus, J M van Zyl, D Hon, W M U Daniels, F C V Potocnik, M J Kotze, N J De Villiers, P R Hurly47. Improvement in Alzheimer's Disease patients with antioxidant supplementation over 15 monthsS J van Rensburg, F C V Potocnik, J M Van Zyl, B J Van der Walt, D Hon, A Roos, E Rienhardt, R T Erasmus48. The Placebo effect - Is it all in the mind?S J van Rensburg, R A Emsley, C M Smuts, M Kidd, S Van der Merwe, C C Myburgh, P Oosthuizen, H Bleeker49. Very low serum Iron concentrations in elderly patients with active CarcinomaS J van Rensburg, R Erasmus, D Hon, C Bouwens50. Melatonin affords protection against Rotenone-induced NeurotoxicityR John, S Daya51. Effect of enriched environment on Ca uptake via NMDA Receptors into barrel Cortex slices of spontaneously Hypertensive ratsM Lehohla, V Russell, L Kellaway52. Effects of Methylpenidate in a rat model for Attention-Deficit Hyperactivity DisorderG. L. S. Lelaka, V. A. Russel, L. A. Kellaway53. 6-Hydroxymelatonin converts Fe (III) to Fe (II) and reduces iron-induced Lipid PeroxidationD S Maharaj, S Daya54. Metrofinate Potentiates Quinolinic Acid and Potassium Cyanide induced NeurotoxicityA Ramsunder, S Daya55. The effect of chronic Intra-Amygdala CRF injections on rat behaviour and HPA-Axis functionL Richter, W Daniels, D J Stein56. Effect of Glutamate in the Prefrontal Cortex of a rat model for Attention-Deficit Hyperactivity DisorderV Russell, M Lehohla, L Kellaway57. An investigation into the relationship between Corticosterone and Neuron cell deathP J Van Vuuren, J Hendricks, W M U Daniels=============================================================Posters: Psychiatry Section1. Descriptive study of Tardive Dyskinesia in a South African Xhosa populationS Brink2. Alcohol drinking problems at three urban High Schools in UmtataO Alonso Betancourt3. Childhood and adolescent sexual abuse - Demographic, traumatic and clinical signpostsP D Carey4. Inositol in the treatment of Obsessive Compulsive DisorderP D Carey5. A review of factors associated with Suicidal behaviour in children and adolescents admitted to Tygerberg HospitalT Du Plessis6. Psychological and physical outcomes fo elective abortion; Local Anaesthesia vs Intravenous SedationT Ericksen7. Mental health literacy of Human Resource Practitioners in South AfricaC J Hugo8. The importance of a specialized clinic for the care of patients with first episodes of psychosisN Keyter9. Self-report vs Urinary drug screening in Schizophrenia: A pilot studyL Koen10. The effect of aggression on the use of Psychotropics in Schizophrenia: A naturalistic studyH Lategan11. Factor analysis of obsessive-compulsive spectrum disorders in patients with obssessive-compulsive disorder: Clinical and Genetic correlatesC Lochner12. Experiences in obsessive-compulsive Disorder and Trichotillomania: Role of childhood traumaC Lochner13. Delusional systems in Xhosa Schizophrenia SibpairsJ E Muller14. OCD Heteogeneity reflected by lack of Genealogically determined founder effectD J H Niehaus15. The efficacy and tolerbaility of low-dose vs standard dose Haloperidol in first episode Psychosis. A randomised, double-blind studyP P Oosthuizen16. Treatment with low-dose Haloperidol does not protect against Tardive DyskinesiaP P Oosthuizen17. Do healthcare funders discriminate against members on the grounds of mental illness?O Scholtz18. Treatment strategies in patients with Clozaopine-resistant Schizophrenia at Stikland Hospital: A critical evaluation of one optionA Schulte19. Early coadministration of Clonazepam with Paroxetine for generalized social anxiety disorderS Seedat20. Trauma exposure and post-traumatic stress symptoms in adolescents: A schools' survey in Cape Town (South Africa) and Nairobi (Kenya)S Seedat21. The QTC effects of Thioridazine when used as a second line Anti-psychotic ( at Stikland Hospital)C Seller22. Brain imaging and substance related disordersD J Stein23. Gender differences in trauma exposure & post traumatic stress disorder in a clinic sampleS Suliman24. Assessing the prevalence of anxiety and depressive symptoms among clinica at Tygerbeg Academic Hospital and controlsH Van der Bijl25. Pharmacological challenge with a serotonin ID Agonist in alcohol dependenceB Vythilingum26. The treatment of ADHD in adultsW Verbeeck=============================================================58. Descriptive study of Tardive Dyskinesia in a South African Xhosa populationS Brink, D J H Niehaus, L Koen, J E Muller59. Alcohol drinking problems at three Urban High Schools in UmtataO Alonso Betancourt, M Morales Herrera60. Childhood and adolescent sexual abuse - Demographic, traumatic and clinical signpostsP D Carey, J Walker, S Seedat, D J Stein61. Inositol in the treatment of obsessive compulsive DisorderP D Carey, S Seedat, D J Stein62. A review of factors associated with suicidal behaviour in children and adolescents admitted to Tygerberg HospitalT Du Plessis, S M Hawkridge, F H Theron, S A Du Plessis63. Psychological and physical outcomes of elective abortion: Local anaestheisa vs Intravenous sedationT Ericksen, S Seedat, P Labuschagne, D J Stein64. Mental health literacy of Human resource practitioners in South AfricaC J Hugo, H D Vos, D J Stein65. The importance of a specialized clinic for the care of patients with first episodes of psychosisN Keyter, P P Oosthuizen, R A Emsley, H J Turner66. Self-reort vs urinary drug screening in Schizophrenia: A pilot studyL Koen, D J H Niehaus, J E Muller, C Seller, N Keyter67. The effect of aggression on the use of Psychotropics in Schizophrenia: A naturalistic studyH Lategan, L Koen, D J H Niehaus68. Factor analysis of obsessive-compulsive spectrum disorders in patients with obsessive-compulsive Disorder: Clinical and genetic correlatesC Lochner, D J H Niehaus, S M J Hemmings, C J Kinnear, V A Corfield, J C Moolman-Smook, D J Stein69. Experiences in obsessive-compulsive disorder and Trichotillomania: Role of childhood traumaC Lochner, S Seedat, P D Carey, D J Stein70. Delusional systems in Xhosa Schizophrenia SibpairsJ E Muller, D J H Niehaus, L Koen, C Seller, N Keyter, C Laurent, R A Emsley71. OCD Heteogeneity reflected by lack of Genealogically determined founder effectD J H Niehaus, L Endeman, I Bosman, S Hemmings, C Lochner, L Koen, H Moolman-Smook, V A Corfield, D J Stein72. The efficacy and tolerability of low-dose vs standard dose Haloperidol in first episode Psychosis. A randomised, double-blind studyP P Oosthuizen, R A Emsley, H J Turner, N Keyter73. Treatment with low-dose Haloperidol does not protect against Tardive DyskinesiaP P Oosthuizen, R A Emsley, H J Turner, N Keyter74. Do healthcare funders discriminate against members on the grounds of mental illness?O Scholtz, P P Oosthuizen, C Hugo, B Richards75. Treatment strategies in patients with Clozapine resistant Schizophrenia at Stikland Hospital: A critical evaluation of one optionA Schulte, D J H Niehaus, L Koen, J E Muller, P P Oosthuizen, R A Emsley76. Early coadministration of Clonazepam with Paroxetine for generalised Social Anxiety DisorderS Seedat, M B Stein77. Trauma exposure and post-traumatic stress symptoms in adolescents: A schools' survey in Cape Town (South Africa) and Nairobi (Kenya)S Seedat, C Nyamap, F Njenga, B Vythilingum, D J Stein78. The QTC effects of Thioridazine when used as a second line Antipsychotic (at Stikland Hospital)C Seller, P P Oosthuizen79. Brain imaging and substance related disordersD J Stein80. Gender differences in trauma exposure & post traumatic stress disorder in a clinic sampleS Suliman, S Seedat, F Gxama, J Walker, W Rossouw81. Assessing the prevalence of anxiety and depressive symptoms among clinicians at Tygerberg Academic Hospital and controlsH Van der Bijl, P P Oosthuizen82. Pharmacological challenge with a Serotonin ID agonist in alcohol dependenceB Vythilingum, C Wessels, S Maritz, W P Pienaar, D J Stein83. The treatment of ADHD in adultsW Verbeeck

Abstract Introduction: Stroke is one of the most devastating complications of sickle cell anemia (SCA). The STOP (Stroke Prevention Trial in Sickle Cell Anemia) protocol has been adopted by National Heart Lung and Blood Institute (NHLBI) as the guideline for stroke screening using transcranial Doppler ultrasound (TCD) and prevention with chronic red cell transfusion therapy (CRCT). Evidence from the STOP I/II studies indicates the protocol is highly effective, yet wide scale implementation has not been achieved. The DISPLACE (Dissemination and Implementation Looking at the Care Environment) project is a multicenter, NHLBI funded consortium of 28 sites across the United States whose purpose is to identify barriers to the implementation of the STOP protocol and test novel methods for overcoming barriers. The purpose of this study was to use data on practice patterns to evaluate current measurement and practice standards at DISPLACE consortia sites. This abstract presents reported TCD screening and CRCT practices. Methods: A practice patterns survey was sent to the principal investigator (PI) for each DISPLACE site via RedCap ©. PIs were hematology/oncology specialty care providers for children with SCA. Sites represent urban and rural regions, large and small academic institutions, and community-based institutions. The survey was developed by the study investigators; questions were predominantly in a multiple-choice format. Items pertaining to TCD screening included: screening technique (including type of TCD); screening frequency; follow-up for abnormal, conditional, and inadequate results; standard value ranges. Results: All 28 PIs completed the survey. About half of the respondents were female (53.5%). Most identified as White (77.8%), followed by Asian (11.1%) and Black or African American (7.4%). Two identified as Hispanic or Latino (7.4%). Slightly more sites reported using standard TCD (57.1%) versus imaging TCD (TCDi) (42.9%). To calculate the time-averaged mean of the maximum (TAMM) velocities and characterize TCD results, nearly all sites use the middle cerebral artery (96.4%); a majority also use the anterior cerebral artery and/or the terminal internal cerebral artery or distal internal cerebral artery (71.4%). Fewer sites use the posterior cerebral artery (35.7%) or the basilar artery (14.3%). In 7.1% of sites, the radiologist determines which vessels to use during the exam. TCD screening is ordered for children with SCA annually in 92.9% of sites and every 6 months in 7.1% of sites. When TCD screening indicates abnormal TAMM velocities, 85.7% of sites initiate CRCT, 7.1% initiate hydroxyurea (HU) therapy, and 3.6% initiate both HU and CRCT. For additional evaluation, an MRI/MRA is obtained at 64.3% of sites. For high conditional results, the most common action is to initiate HU (67.9%). Other responses include obtaining an MRI/MRA (46.4%) and/or repeating the TCD in 2-4 weeks (25.0%), 6-8 weeks (35.7%), or 12-16 weeks (7.1%). Results deemed inadequate led to repeating the TCD in 2-12 weeks (57.1%) or in one year (3.6%), obtaining an MRI/MRA (57.1%), beginning HU therapy (7.1%), or no repeat TCD or change in management (3.6%). Actions for low conditional results include repeating the TCD (71.4%), obtaining an MRI/MRA (32.3%), and/or initiating HU therapy (57.1%). Surprisingly, sites use different TAMM ranges to characterize the normal/abnormal findings (Table 1). Conclusions: Nearly all DISPLACE sites order TCD screening annually, as recommended in the guidelines, with some ordering screening more frequently. A few sites did not report initiation of CRCT per STOP protocol for abnormal TCD results; however, over half of the sites reported following up with an MRI/MRA, which may suggest evaluating for vasculopathy prior to CRCT. Some sites reported beginning HU therapy for abnormal results; this may reflect consideration of patients for whom CRCT is not possible, but data were not collected for confirmation. Interestingly, results suggest a reliance on MRI/MRA since sites commonly reported ordering neuroradiology studies for abnormal, conditional, and inadequate TCD results. This may suggest an unclear pathway for children with borderline TCD results, and an area for future study. While reported value ranges closely approximated those in the STOP protocol, results indicate sites conducting screening with TCDi may use more conservative values than the validated protocol. Disclosures Phillips: NHLBI: Research Funding. Mueller:NHLBI: Research Funding. Schlenz:NHLBI: Research Funding. Melvin:NHLBI: Research Funding. Adams:NHLBI: Research Funding. Kanter:AstraZeneca: Membership on an entity's Board of Directors or advisory committees; bluebird bio: Membership on an entity's Board of Directors or advisory committees, Research Funding; Global Blood Therapeutics: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sancilio: Research Funding; NHLBI: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Apopharma: Research Funding; ASH: Membership on an entity's Board of Directors or advisory committees.

Abstract Introduction: Current stroke prevention guidelines in pediatric sickle cell anemia (SCA) specify the use of transcranial Doppler (TCD) and chronic red cell transfusion therapy (CRCT) for detection and prevention of stroke. Guidance on the use of MRI/MRA in the context of stroke prevention, screening, and monitoring is less clear. While overt stroke is able to be identified clinically, silent stroke can be more difficult to diagnose and screening guidelines have not been developed. The DISPLACE Consortium (Dissemination and Implementation Looking at the Care Environment) is a multi-center study funded to evaluate optimal implementation of stroke prevention guidelines. The purpose of the present study was to provide information on practice patterns across the DISPLACE Consortium as they relate to the use of MRI/MRA and CRCT for monitoring and treating stroke in pediatric patients with SCA. Methods: DISPLACE is a multi-site study in SCA including 28 centers across the United States. A practice patterns survey was sent to the principal investigator (PI) for each DISPLACE site through RedCap. All PIs are specialty care providers in hematology/oncology who provide care to pediatric patients with SCA. The sites were chosen to represent a range of characteristics, including both urban and rural regions, large and small academic institutions, and community-based institutions. The survey was developed by the study investigators and questions were provided predominantly in a multiple choice format. The following types of questions were asked about MRI/MRA: indication for pediatric patients with SCA in general and for those on CRCT for stroke prevention. The following types of questions were asked about CRCT: indication and frequency of CRCT and target hemoglobin S level. Results: All 28 providers completed the survey (100%). About half of providers were female (53.5%). Most providers identified as White (77.8%), followed by Asian (11.1%) and Black or African American (7.4%). Two identified as Hispanic or Latino (7.4%). MRI was used for the following indications: abnormal TCD (85.7%), conditional TCD (46.4%), recurrent headaches (78.6%), and behavior issues (53.6%). A few sites also reported obtaining an MRI if a child has had poor school performance (10.7%) or if there was concern for developmental delay (3.7%). Indications for MRA were similar. Notably, many sites reported the use of a screening or baseline MRI in the absence of other indications (25.0%). The most common indications for initiating CRCT were abnormal TCD (96.4%) and overt stroke (92.9%), followed by silent stroke (53.6%) and abnormal MRA (50.0%). The majority of sites reported scheduling CRCT at a frequency of every 4 weeks (63.0%), though many (37.0%) described other more frequent transfusions intended to either more rapidly reduce hemoglobin S levels or maintain a level under 30%. Most sites used a target of 30% hemoglobin S, though a few sites noted alternatives including 40% (3.7%) and 50% (3.7%). The frequency of MRI for patients receiving CRCT for stroke prevention was as follows: annually (44.4%), every 2 years (14.8%), and every 5 years (3.7%). Several sites reported obtaining MRIs only if there were new changes or concerns (14.8%) or reported alternative practices (14.8%) that depended on patient characteristics. Frequency for MRA was similar for patients on CRCT. Conclusions: The results of the DISPLACE practice patterns survey suggested nearly universal adoption of CRCT for children with abnormal TCD and prior overt stroke across sites. The use of MRI/MRA in detecting potential cerebrovascular abnormalities in the absence of clinical neurologic symptoms and for monitoring patients on CRCT was much more variable, which likely reflects the minimal amount of guidance for the use of MRI/MRA in SCA. Notably, a number of sites were using MRI/MRA to screen pediatric patients for cerebrovascular abnormalities and to monitor patients on CRCT. The variability in responses for MRI/MRA highlights the importance of future studies evaluating best neuroimaging practices for detecting cerebrovascular abnormalities (apart from TCD) and for using MRI/MRA to monitor patients on CRCT. Disclosures Schlenz: NHLBI: Research Funding. Mueller:NHLBI: Research Funding. Phillips:NHLBI: Research Funding. Melvin:NHLBI: Research Funding. Adams:NHLBI: Research Funding. Kanter:bluebird bio: Membership on an entity's Board of Directors or advisory committees, Research Funding; NHLBI: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Apopharma: Research Funding; Sancilio: Research Funding; Global Blood Therapeutics: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees; ASH: Membership on an entity's Board of Directors or advisory committees.

- G.W.J. Drewes, Taufik Abdullah, Islam and society in Southeast Asia, Institute of Southeast Asian studies, Singapore, 1986, XII and 348 pp., Sharon Siddique (eds.) - Th. van den End, T.Valentino Sitoy, A history of Christianity in the Philippines. The initial encounter , Vol. I, Quezon City (Philippines): New day publishers, 1985. - R. Hagesteijn, David G. Marr, Southeast Asia in the 9th to 14th centuries, Singapore: Institute of Southeast Asian studies and the research school of Pacific studies of the Australian National University, 1986, 416 pp., A.C. Milner (eds.) - R. Hagesteijn, Constance M. Wilson, The Burma-Thai frontier over sixteen decades - Three descriptive documents, Ohio University monographs in international studies, Southeast Asia series No. 70, 1985,120 pp., Lucien M. Hanks (eds.) - Barbara Harrisson, John S. Guy, Oriental trade ceramics in South-east Asia, ninth to sixteenth century, Oxford University Press, Singapore, 1986. 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As the global population ages, the number of people suffering from Alzheimer’s disease (AD) increases. AD is the most common cause of dementia. In recent years interactive architecture has been developed to enhance the lives of people coping with this disease. This article presents an extensive literature review from existent research projects on how assistive technology (AT) has been used as a physical and cognitive rehabilitation aid to AD and other dementia patients. The review served to identify gaps in AT implemented place. That revealed the following findings: (1) a notable improvement in both physical and cognitive rehabilitation when integrating AT in patients’ therapeutic environments, (2) a positive effect for caregivers when patients used AT individually, and (3) a lack of clarity due to limited studies on the use of AT for daily activities in residents’ rooms at healthcare centers. However, further studies are necessary to explore the AT potential integrating strategies to promote daily activities in the residents’ rooms at healthcare centers, and the architectural factors that could affect ATs’ efficiency.

During resettlement in a new environment Former Refugees often face challenges for their physical, social and mental health and wellbeing such as past trauma, language and cultural differences. This article uses the therapeutic landscapes concept to explore how the physical, symbolic and social aspects of outdoor places in Dunedin, New Zealand, such as the beach and urban green spaces contribute to former refugees’ wellbeing during the resettlement process. 15 former Syrian refugees (from 4 families) participated in group interviews and at times shared photographs to illustrate what outdoor places they enjoyed and were therapeutic for them. This article argues that participants had diverse therapeutic landscapes that ranged from pristine scenic spots to everyday places such as the local park, but to enjoy and utilise the therapeutic values of these places more attention needs to be paid to access barriers.

<em>The design of Health Resort and Spa is considered by urban people health concerns due to the high level of anxiety as well as unhealthy life pattern. Urban people tend to issuing high cost to restore their physical and psychological conditions. This tendency can be captured as one of the potential to develop a health resort and spa. The purpose of this design is to get a building design that can embody the activity of a health resort and spa that is integrated with the Cumpleng Warm Spring in a Healing Environment or design environment that provides therapeutic effect for visitors.</em> <em>The question of the design to be resolved include: designing the facilities at the resort and spa that are able to maximize the potential of Cumpleng Warm Spring; site designing that support the activities therein; landscape designing that suit to the needs of the users of the building;</em> <em>applying the healing environment concept in shape, appearance, and interior of the building.</em> <em>The used method is a method of designing architecture with the approach of the concept of a healing environment. The result is a resort and spa with health and fitness facilities that is integrated with the Cumpleng Warm Spring area that serve an environment with therapeutic effects to restore physical and psychological condition of the visitors.</em>

The article discusses the problems of the architectural environment of the system of maternity hospitals and perinatal centers of our country. Various approaches to the modernization of such institutions are described, including on the basis of the formation of an “optimal” architectural and spatial environment that has a therapeutic and therapeutic effect on the patient. The methodological base of the study is determined, which allows to assess the state of the architectural environment of obstetric facilities using the example of individual cities in southern Russia. Field surveys are carried out based on the methodology of complex pre-project studies, covering the action of various factors, and including: urban planning analysis; architectural and landscape analysis; social, historical and cultural analysis. During the examination, the characteristic qualities of the external and internal environment of obstetric care institutions are identified and systematized, including: a) at the city-planning level, the geographical and city-planning location of some objects with a perinatal function, the convenience of their placement and layout of buildings, and zoning of the territory are assessed; b) at the level of architectural and landscape analysis, the presence of natural components, recreational and green zones in the areas was determined; c) at the level of socio-historical, cultural, and compositional analysis, the plasticity and scale of the facade solutions of perinatal centers are assessed, the style and imaginative-emotional qualities of their interiors are analyzed, and the prevailing level of visual “comfort” of the architectural spaces of maternity hospitals with physical, emotional rehabilitation of patients is assessed. The results obtained allows to outline ways of modernizing objects with a perinatal function and forming a new therapeutic architectural environment in them.