3rd International Webinar on Global Healthcare and Nutrition | November 2023

webinar title: 3rd International Webinar on Global Healthcare and Nutrition
Date: November 20-21, 2023

Scientex Conferences are focused on attaining excellence through the provision of exceptional chances for experts to investigate the domains of the scientific research community and generate possible innovations. Considering the success of Global Healthcare and Nutrition 2023, we are pleased to announce the “4th International Webinar on Global Healthcare and Nutrition” dated November 14 – 15, 2024 (GMT+7).

Playlist:

00:12 Symptomatic small spigelian hernia: Extraperitoneal primary laparoscopic closure
(Vinicio Rizza, Maria SS dello Splendore” Hospital Giulianova, ASL Teramo, Italy)

05:20 Impact of the intake of snacks and lifestyle behaviors on obesity among university students living in Jeddah, Saudi Arabia
(Najlaa Aljefree, King Abdulaziz University, KSA)

16:50 Amiodarone-induced lung toxicity, a case initially not correctly framed
(Marco Umberto Scaramozzino, Head of Thoracic Endoscopy Villa Aurora Hospital, Italy)

27:15 Challenging diagnosis of amebiasis in a non-endemic region: Case report
(Elvira Akhmedova, Polyclinica.ru, Russian Federation)

43:26 Three decades of cannabis research: What are the obstacles?
(Michael Dor, Ariel University, Israel)

01:01:00 Toxoplasmosis in the practice of a neurologist
(Natalia Lashch, Pirogov Russian National Research Medical University, Russian Federation)

01:10:08 Pandemic “COVID-19” – “POST-COVID SYNDROME”: Hirudotherapy as an effective and dominant monotherapy
(Albert Ivanovich Krashenyuk, Academy of Hirudotherapy, Russian Federation)

01:23:28 The VOICE model for inclusive public health
(Gillie Gabay, Achva Academic College, Israel)

01:43:42 Effect assessment of good practices on breastfeeding duration in pregnant women at the hospital of Orvieto district (Umbria Region, Italy) from January 2017 to June 2018
(Marco Cristofori, AUSL Umbria 2, Italy)

01:55:34 Prognostic significance of variant left common pulmonary vein after transcatheter pulmonary vein isolation
(Marton Kiss, Semmelweis University, Hungary)

02:07:11 A partial least squares structural equation modeling analysis of early fertility, knowledge and behaviors among indigenous young women in Guatemala
(Shiho Hansen, Finnmark Hospital Trust, Norway)

02:21:48 Conceptualizing robotic agency. Social robots in elder care in contemporary Japan
(Anne Aronsson, Yale University, Sweden

02:40:30 Pantomime & Psychotheapy
(Jean Marie Bottequin, Ulm University, Germany)

02:51:09 Changes for a better health and a better nation policy reform in Spain based on the Catalonian HiAP model
(Samantha Strelzer, Quinnipiac University Frank H. Netter School of Medicine, USA)

03:03:32 Quaternary prevention and / or hypermedicalization. Fragility (disease) and / or lobbying
(Giovanni Colucci, MedOnLine-Statte, Italy)

03:11:34 A survey of LLM applications in healthcare
(Zeyu Zhou, Carl Zeiss Xray Microscope, USA)

03:24:11 The impact of a monolingual on Spanish language code-switching
(Lily Halsted, Queens University of Charlotte, USA)

03:42:40 A large lung abscess in an electronic cigarette user: To drain or not to drain
(Natasha Dudiki, Indiana University Health Ball Memorial Hospital, USA)

Global Healthcare Event: https://www.healthcare.scientexconference.com/

Webinar: https://www.healthcare.scientexconference.com/webinar

Organizer Website: https://www.scientexconference.com/

Contact Email: healthcare@scientexconferences.com

#HealthcareFutures #PatientCareSummit #WellnessRevolution #TelemedicineTrends #HealthTech2024 #MedicalInnovationForum #HealthcareEquityConference #PrecisionMedicineSummit #GlobalHealthConclave #GlobalImpactConference

Uh good morning everybody thanks for in vain I am Vish Rita a surgeon of Maria santis hosp in adrianel described similar line in 1,645 but Joseph kinglos in 1,764 defin the spigelia Hera as a defect in the similar line the fats in the aerosis of transverse abdominal muscle have been considered as a

Principal ethologic Factor the aerosis of transvers abdominal muscle is limited by the similaris line LLY and the lateral edge of the rectus muscle mediately this type ofia represents about 1.5% of a her formation cases over the abdominal wall and can be a congenital or qu def in despian aerosis it is much

Less common than hinal or fmal heras the principal symptom is that abdominal pain diagnosis often results misunderstood in case of Uncertain Imaging the laparoscopic approach is necessary to diagosis and the treatment in our case the abdominal objective examination show the whole small tumor to the left abdominal flank of unclear nature aing

With a diameters inferior to 5 mm not usable in abdominal cavity abdominal TC was performed without contrast medium to study the abdominal wall thec report was negative for abdominal earance in according to the literature We performed a laparoscopic approach with one 12 mm on bical troger one 5 mm

Troger in right F and 5 mm strugles inog gastric region laparoscopic exploration showed a little peronal depression to the anterior abdominal wall just left sem line of an evident a ring because during general anesthesia the external perator exploration showed a small par defect in a correspondance of peronal depression we

Laparoscopically opened the anterior ponum near the present def the opened perum show the extra peronal and Inter paral fat tissue passing through the transversus and Sprint out beneath the intact aonis of the external oblique muscle muscle the her ring at a diameter at diameter less than five millimet in the transverse

Aerosis reduces the f in abdominal cavity we the ear ring by ABD suture ancored with no AB clip the F exp allowed the closure of the perum with absorbable suture cord with no otheros has been placed the in abdominal cavity this is the intra peronal surgical outcome we decided to use primary

Defect closure because the defect had a diameter inferior to the T access and because only aonis of the transvers abdominal muscle was inured all other muscular structures of the abdominal wall were intact several different surgical strategies have been adopted for spian repair open approach with or not plement laparoscopic approach like

Simple primary defect closure intraperitonial online method trans abdominal prepal mes placment toally extra mesh placment our allowed a minimal postoperatory risk with the early disappearance of pain and early and the safe discour several recent technical Innovation have allowed us to repair the pelan her as sh in this care report our

Technique was performed successfully highlighting its safety and visibility thank you everybody for attention afternoon everyone uh my name is njla Jeffrey I am an assistant professor in nutrition uh in King abdulaziz University jida Saudi Arabia today I will present my research titled imp of the inake of snacks and lifestyle

Behaviors on oppos among University students living in jeda Saudi Arabia okay today we will I will present a brief background why I conduct the study and what is the aim of This research and after that I will uh talk about the research methods are the most important results and finally

Conclusion has greatly increased over the last decade the prevalence rates of overweight and obese adults are estimated to be approximately between 25 to 50% uh respectively uh in the Arabian Gulf States including Saudi Arabia so we have a very high rates of obesity obesity is linked to several controllable variables

Including physical inactivity sedentary lifestyle and poor dietary habits snacking is a term used to describe the intake of food and beverages such as ships chocolates and soft drinks snacking is frequently linked to the to negative Health outcomes and B dietary habits and has thus been considered contributing factors in overweight or obese individuals

University is a critical age of young adults uh University is a critical age for young adults in terms of di choices and weight gain so why we conduct the study studies uh the the previous studies that have assessed the association between snacking and obesity have generated contradictory results snacking may not

Always promote an individual to obesity as a higher eating frequency may be beneficial in terms of body weight regulation and energy balance snacking could decrease calorie intake when replacing M meals regard regardless of the possible length between snack intake and obesity the frequency of snacking among young adults has not been truly

Examined in Saudi Arabia there therefore this study aimed to investigate the association between obesity and the intake of snacks and lifestyle behaviors among University students in Saudi Arabia from both genders made up the study samples and the total population of students in KU uh in 2019 was almost was approximately 18,000 students giving

This number you and using the sample size calculator uh the uh the sample size needed to achieve sufficient statistical power was 659 students uh this is the cross-sectional study uh which was approved by the biomedical ethic research committee at KU the invitation to participate in the survey was forwarded to students via

University email the official email the email and the introduction to the online questioner explained the aim of the study and provided guarantees of anonymity throughout the investigation the questionnaire was written in Arabic the questions included in the survey were developed using data from previous studies questionnaire design an online

Survey collected data on social demographic characteristics including age gender social status nationality monthly household income also data uh regarding height and weight to calculate BMI was provided uh uh information regarding lifestyle behaviors including physical activity time spin toring TV or using mobile phone your day uh watch Food advertisement and sleeping hours also

Information regarding de habits number of M meals consumed per day breakfast consumption and uh data regarding snack intake including the frequency of snack intake per week time of snacks activities while eating snacks and the type of snacks as well the most important results revealed from this um research was

Um uh uh as follows the data were obtained from 662 University students as we said previously the majority of study participants were female were singles were Saudis and were aged uh between 18 to 21 years old so they’re fairly young there were insignificant Association the the the results revealed insignificant association between C

Demographic characteristic and obesity the prevalence of normal weight overweight and obesity was reported as 48% 18% and almost 13% uh respectively among study participant is my voice um can you hear my voice yes okay uh this table present uh results regarding the lifestyle behaviors of a studi population according to

BMI uh as we can see from this table uh there was no significant differences between uh obese students and nonobese students regarding in terms of Lifestyle behaviors including physical activity watching TV or using mobile phone watching food advertisement sleeping hours time of sleep and sleeping disorders uh the second tables present

Um information regard regarding meals and breakfast pattern of the study population according to BMI as we can see from this um uh table uh both um both groups non obese and obese students uh had um uh uh two to three meals per day uh and there was a significant differences

Between the both group in number of meals uh as we can see obes students uh consume two meals uh greater than nonobese students also time of of breakfast type of breakfast consumed uh there was um the results revealed that there was a significant differences as obes students uh were uh

Significantly consumed higher amount of cereals in breakfast than nonobese students while nonobese students um had higher intake of beverages uh than obese students had significantly higher intake of beverages than of students um there was no significant differences between both groups in uh eating breakfast and uh eating breakfast at

University Okay the third table uh represent the intake of snacks of the study population uh according to BMI uh as we can see uh uh both groups non obes un obese students consumed like onethird of them consumed uh uh breakfast or um uh consumed breakfast in a daily basis uh

And almost uh one quarter consumed breakfast one to two uh times per week and three to four times per week however there was no significant differences between obese and nonobese students in frequency of eating breakfast and in the time of snacking and activ during snacking on the other hand there was h a

Significant differences between obese and nonobese students in terms of type of snacks we can see from this uh table that potato that obese students consumed was were sign significantly consumed higher amount of potato ships and uh popcorns and biscuits than nonobese students while nonobese students while uh nonobese students uh

Had consumed higher amount of salads than obese students so the results actually make sense in conclusion the current study INF phisticated lifestyle behaviors and type of snacks related to risk of obesity among University students snacks consumed contribute to the intake of daily energy and nutrients and thus

Affect the overall quality of the diet the most highly consumed snacked among uh our study participants were considered unhealthy items except for fruits vegetables and nuts consumption of potato chips popcorn and biscuits as snacks items were highly associated with obesity risk where salad’s intake was associated with a decreased obesity risk the university

Environment was associated with reduced consumption of healthy types of snacks such as fruits vegetables nuts and diary products health education plans and program among University students are crucial to encourage healthy eating habits including eating breakfast and frequency uh frequent consumption of healthy snacks universities should also focus on the food environment of cuses

And ensure access to healthy snacks at reasonable price is which is essential in developing healthy dietary behaviors decreasing the high rates of obesity in young adults and ultimately improving public health and this is the references thank you so much for listening and uh if there’s any questions I’m here thank

You is um clinical case that I present and the title is Amon induc lung induced lung toxicity a case not not correctly framed intially um I I work um as a head of T thoracic endoscopy service at Vora Hospital in Regio gabria and I have on out patient Clinic where patients come

For visit and uh as you you can see um there is a x-ray uh chest radaph that um you you can see uh shows a pattern of a rular p pattern bilateral that is one of presentation of uh intersticial lung disease the interstitial lung disease um it’s

Um a a disease that um uh have uh some uh some diseases uh that includes a set of pathologies that must be excluded when the patient come to us in fact in diagnostic workup of ipf idopathic pulmonary fibrosis it is an important it is important to have a good history and clinical Examination

For excluded specific diagnosis one of the most uh important diagnosis specific diagnosis is drug induced pulmonary fibrosis it’s important the work up the diagnostic work up because a true and comprehensive history may provide invaluable information that can suggest certain entities and provide suspicion that a patient may have specific diagnosis like

Say Ad wels and KY mayor in Translation respiratory medicine the clinical case presentation is a presentation of uh six year old Caucasian female former smoker of 10 p presented to the emergency department of poista Hospital uh for dispa and evening febril episodes in December uh 2022 the

Patient had a clinical history of no exposure to chemicals Ving pets including birds or tubes or humidifiers esophagal yatala uh um surgery previous surgery for a cerebral aneurism past sscope 2 infection in July 2022 and uh arhythmic he disease uh for which she had been taking on indication of Cardiology

Specialist Amon at do of 200 milligrams per day for the last two years the patient declares on hospital admission that have normal vial parameters on thoracic examination have redu reduced vular mour with bilateral Vite cords and bilateral hotr transmitted tactil fridus and clear pulmonary sound on admission at the

Emergency department was not performed bronos broncoscopy because the hospital did not have the possibility to to carry out uh the endoscopy procedure due to a lack of instrumentation and when the patient came to my outp clinic she showed me her documentation and I carry out as spirometry with uh the machine

That you can see calls pulon mini box plus that documented moderated restrictive part pattern out you can see in this table in this table you can see the laboratory exams and the spirometry results we can see that there is an increase of white blood cells uh with uh increasing in level

Increasing increased levels of LDH and uh High eosinophilic count self count um at Leos it count in speedometry you can see that there is a reduction of total L capacity uh with restrictive pattern and uh reducing in Peak flow um after I treat the patient with uh

Antibotics uh OCS OCS and uh IC laba for three months uh she repeat laboratory exams and um spirometry and as you can see uh there is a reduction uh strongly reduction in white blood cells with reduction of LBH and um Marly um reduction in elop uh count with um reduction of

PCR and increasing in TLC in P percentage and P the city scan uh show um there is uh in this slide city scan at time zero and at three months after therapy uh in the time zero you can see that there is a areas of bilateral appical and centry lobular consolidation

With thickening of pulmonary reticular inum of intra interlobular SEPTA with predominance in the right opical zones with the presence in both lungs at subm zones of solid centry L consolidation in um on the on the right right you can see the CD scan uh at three months that show that the patient

After or oral corticosteroid inal corticosteroid and long Bronco delator delator there is a improve in Aral midle and basal areas and almost a complete Reg of areas of consolidation H the case was concluded was concluded with the following diagnosis I a PT amod induced pulmon toxicity that is a disease that represent the

45% of patient with suspicious of ipf H pulmonary function tests highlight a moderately restrictive pattern on spirometry with lowed forced vetal capacity and a small reduction in diffusing lung uh capacity of carbon monoxide dlco there is an important variation of peak flow in two speedometry on therapy prescribed that indicate indicates

Suspicious of asmatic pattern in smoker blood test uh can suggest the presence of no specific infam INF inflammatory syndrome and showing mid leucocitosis and higher values of erro arthrite sedimentation rate and C reactive protein however there are no specific markers that identify pulmonary inflammation the role of LDH in

Monitoring the pathology is for me A New Perspective and it is necessary to add in common routine laboratory tests the scarcity of human and instrumental resources in publical hospitals in Italy uh it’s increasing increasingly directs and directs patient to turn to private specialist and allows them to see cases

That are normally dealt with in a hospital setting ER I conclude with uh the the last take on message that says that the territorial specialist is therefore required to find out about the systemic side effect of drugs of individual drugs which make it possible to manage the patient without subjecting patient to PO

Potentially invasive procedure because in this case report the patient don’t perform broncoscopy that is an invasive procedure and uh I conclude thank you for the attention thank you for opportunity to present the case challenging diagnosis of amasis in nonendemic reg region and as you know amasis is infection

Caused with par prone parasite and to metica and the genus consists of at least eight species that are able to inhabit in human intestine and intima is the only pathogenic spy of intimia is transmitted through the ingestion of cyst found in FAL contaminated food or water sources the life cycle is uh relatively

Simple and consists of two stages infective C stage and invasive trophozoite stage and the humans are a primary known reservoir for Ania the main source of transmission is chronical infected human so the stool infected with the cyst form of parasite May contaminate fresh food and water

Sources and uh other common uh source of transmission is sexual contact uh ingested uh infective cyst travel through the good Lumen uh to the small intestine here cysts undergo exist and invasive forms of uh inba May invade intestinal imps epithelial cells and cause the inflammation in addition they

Can travel uh through the blood and invade uh in liver lungs brain uh sometimes there are cardiac sides and new generated cists are excreted in stool so according to the World Health Organization uh approximately 500 million people could be infected with inba uh only 10% of these IND

Individuals likely have species of Ana hyola and the other rest nonpathogenic spe species aasis can cost the up to thousand tests annually it’s third leading cause of death due to protone infection and in addition it is the third most frequently isolated pathogen among the returning Travelers here is demonstrated schematic

Presentation of endemic Forum of intestinal and extraintestinal amasis in each echozone as for incidence of protone infection in the Russian Federation according to the federal service for supervision of consumer rights uh protection and human well-being from 2018 uh the incidence of amasis per 100,000 population exceeds the national

Average in 16 subjects uh mostly prevalence of Ms is in South regions as it’s shown here on the map uh up to 19% of Amic infections are asymptomatic approximately 10% of those infected progressing to have symptoms Amic colitis is the most common symptomatic manifestation with diarrhea with blood and mucose high fever

Abdominal pain uh sometimes formation of tumor like granulation math referred to as amoma and if troid disseminate they can cause extraintestinal sites so um laboratory tests are diagnostic of intestinal amasis is challenging because it relies on clinical symptoms and Laboratory test that lack High sensitivity and specifity uh diagnostic methods are

Based on parasitological immunological and molecular techniques the laboratory uh diagnostic of intestinal disease can be made by microscopy biochemical matters such as culture and EO en analysis antigen detection tests uh molecular based test and point of care tests microscopy is still frequently practiced in many Laboratories particularly in developing

Countries the direct examination of fresh samples uh it’s not a sensitive method uh disadvantages of the method are lack of trained microscopists uh to identify moly trop ooids stool samples need to be examined within one hour of collection or should be used good fixatives and um the higher

Possibility to find the in loose is higher in loose tool and uh sometimes is uh it’s very difficult to differentiate among among the protone uh among the species of inba so um in Russian Federation we are still using microscopic examination uh we have PCR test and antibody detection of in in

Blood the laboratory diagnostic of extraintestinal amasis is a little bit different patients with extraintestinal amias may not have have a concurrent Amic colitis so analyzis of stool pces are generally not performed instrumental diagnostic uh includes ultrasound city scan MRI and colonoscopy uh ultrasound and CD scan in Amic colitis can uh demonstrate the

Typical involvement of seeum and rectum uh that are high sensitive meod but not specific um ultrasonography is prefer preferred because of low cost rapidity and lack of Adverse Events uh but CD scan may be slightly more sensitive than ultrasonography uh for example in cerebral amasis it can show The Irregular rels without surrounding

Capsule or enhancement colonoscopy may show the ulcers AOS in seeum and ascending colon and in rectum can biopsies can be done but the negative biopsies doesn’t rule out amasis and the images of the colon could be similar with other diseases what will I show later on the later

Slides so the treatment um of amasis consist in application of two groups of amdes uh tissue amides and luminal amdes first are absorbed in Blood and AC in tissue and the Primary Therapy of choice is metronidazol it’s still effective and Commercial lav will at low cost and the

Luminal amdes Act only in intestinal Lumen and are used to eliminate the cists so um about our case report uh it’s young female 38y old living in Moscow uh from her anomis in 2019 uh she entered emergency with epigastric pain radiating to the right hypogastrium and the same time her blood

Tests were normal and ultrasound showed the thickening wall of seum and appendix and infiltration near appendix She was transferred to the surgical Department uh under supervision with her symptomatic therapy uh after a week of symptomatic therapy ultrasound showed the regression of infiltra near Sean appendix and it was decided to do a

Colonoscopy her colonoscopy in May 2019 uh findings included snome infiltration ulcers in ascending and transverse colon and AOS changes in sigmoid colon uh biopsy was not so specific a pieces of colon mosa with AA scattered lymphatic infiltration and formation of granuloma in one area uh small bowel followup through

Barum examination uh didn’t reveal any changes so she was diagnosed with inflammatory bowel disease undifferentiated colitis more suspicion to Crohn’s disease and she was prescribed a treatment with mesalazine four grams per in eight weeks and after control colonoscopy which showed the mild inflammation in [ __ ] and sigmoid colon It

Was decided to continue with mesalazine uh so in April 2021 with complaints on abdominal bloating and bowel growling uh she entered our gastroenterology department and due to her priv previous diagnose and treatment with mesalazine uh we did some examinations uh her blood tests were normal CRP was normal too FAL ctin was three

Norms higher uh and due to her diagnos of Chon colitis or undifferentiated colitis we did a colonoscopy and the findings included multiply regular shaped uh ulcers uh with uh the surrounding Emma and uh they were covered with yellowish um exudate uh the changes were in seeum and ascending

Colon and uh mosa between the ulcers was normal so the amasis could mimic colonic chosis tuberculosis and inflammatory B disease sometimes cancer and these are the images of confirmed chosis of Binum flap uh it showed the same irregular ulcers covered by exudate and uh some redness punctate

Spots um these are the images of confirmed tuberculosis uh the ulcers are often surrounded and uh surrounded by peral inflammatory shaft and the ERS often merge with each other occupying the significant lens of intestine they can scare form an an anular grow narrowing um of the intestine and uh suggested changes for

Cron colitis are deep ulcers uh large deep ulcers and Cobblestone appearance mosal nidity again edema and stenosis and it mainly show um segmental invol involvement and could be paranal diseases uh the consequences of not recognizing Amic colitis can be catastrophic it may result in administration of steroids or or major

Cases of intestinal reection for suspected inflammatory bowel disease and according to the review of cases of corticosteroid therapy for initially misdiagnosed colitis including IBD intestinal vascules and tuberculosis 24 cases of patients developed a severe and lant Amic colitis and the main role is a well collected an amnes uh including their

Travel to endemic regions in our case it was Asia in 2019 she was in Indonesia and 2020 Sri Lanka uh after colonoscopy we did additional diagnostic uh for uh to exclude the bacterial infections too and stool feces microscopy with formal in Easy concentration revealed the POS was positive for in maybe

Histolytica uh the same time we received the serology uh it was positive with antibodies serology are safe for other bacteriological diseases such as alono chosis and yosis were negative Clum def Tex test um toxin test feis was negative we did abdominal ultrasound it doesn’t revealed any sides

In organs in liever and small bowel follow through Barum examination was without changes too the same time uh we received the histology uh it was with perent necrotic detros with presence of microfi like structures and oval void shape with granular as anilic cytoplasm and with presence of rounded nucle and uh the it

Was a past positive cytoplasm reaction so uh she was diagnosed with intestinal amasis and uh we stopped we stopped mesalazine and started metronidazol and uh her feis control feis I say in three months was normal without any intica and we recommend her to control colonoscopy to rule out inflammatory B

Disease because it can be the same time inflammatory B disease and amasis and as you see on image and the images the ulcers secured and the MOs of colon is normal so however in 2022 after 7 month of um her disease and treatment she relapses with positive tests on realtime PCR and

Microscopy and her colon ultrasound again showed the seening wall of seeum initial part of ascending colon and elastical region was not narrowed and um we used the second line of treatment with tinidazol and due to Chronic course of disease it was suggested to find paroma sign which is not a available in Russian

Federation it’s not registered and only after this um drug we achieved the long-term remission and this year in February uh because of fear of relapse patient uh did a colonoscopy and it was without any pathological changes so to conclusion amasis is not a diagnose of endemic regions Amic colitis

Should be included in differential diagnosis of all patients with suspected inflammatory bowel disease and uh before prescribing steroids and our case shows long-term misdiagnosis of amas due to lack of awareness and alertness of Physicians uh the absence of pathognomonic symptoms is clinical in in this clinical case uh made it difficult

To timely diagnose and treat The Chronic prazone infection and also the unava unavailability of Lumin besides delayed the treatment and she relapsed and the correct diagnos of intestinal myasis is critical for controlling the spre of infection and avoiding unnecessary treatments and I want to conclude with a

Quote of Johan G we see only what we know for a long period of time here in Russia we have been teaching doctors to be veryy in terms of diagnos noing inflammatory bowel disease but now we need to learn that not every erosive and ulive changes um in intestine means inflammatory bowel

Disease and special thanks for my colleagues uh for helping me with this presentation and with their endoscopic pictures from self archives with tuberculosis thank you very much for your attention I’m basically family physician I graduated T Aviv University and then many years later I was asked to

Lead the Canabis unit in the Israeli Medic in Israeli cannabis medical unit in the Ministry of Health I did it for six years a very interesting times and not very Simple okay before starting I want to make a tribute to Professor who died few months ago Professor was the ER one who Began ER the research and development of the Cannabis field he was the first one to describe the THC the all over the world and I was lucky enough to be a student um the subject I want to say few words about is the canist is so famous all over the world thousand thousand

Millions of people use it for thousand of years we believe that more than 6,000 6,000 years it was used and uh when we try to check it together according to the medical quality control standards we have a lot a lot of very poorly design research projects and very little good uh quality

Research and it’s very frustrating because as a physician you we want to use it and you want to use it according to the medical standards GMP and everything but uh it is not progressing as it should so what I was trying to evaluate the obstacles why the Cannabis research is so problematic

What is holding it and the first and the most important thing is the basic the legislation the regulations that prevent research I don’t intend to go into death to the reason of such legislation of course usually everything it there is based on money competition other products that they that perceived the Canabis is

Something which is very competitive to their products anyway especially in the states they made some terrible legislation and forbid usage of cannabis even it was 100 years ago it was largely used for many many indications some of them we do believe today they still should be

Used but it was forbidden and what is worse the registration forbid also cannabis research and this is something that prevented quality control and the research to use to larger use of cannabis ER of course along with the medical approach there is also a part which is a lot larger is the usage of

Cannabis for social purposes the moment those two Fields contradicted many people perceived that the medical usage of cannabis is kind of point of entry for usage for suchal purposes and it stopped the many good physician just didn’t want to be mixed with something which is illegal and they leading to problems like Abit Formation during the last years I said last 15 years many countries stopped this roach and started process of legislation that today most of the countries one of the states in the United State already allow Canabis for medical purposes many allow also for social purposes today we are quite sure

That all those intimidations about the side effect of canies are not based a Okay so after mentioning the legislation problems we have one teral problem which is Prejudice Prejudice of people who are afraid of Canabis being sure it’s kind of that it should be put with cocain and heroine like being something so dangerous as that which is not and we have enough

Um uh research today to be sure that it is not as dangerous as the other substances and I don’t try to say that it has no problems we have problems even of Abit formation addiction but those numbers are very very little I would believe that about 13

13% of the users will create some kind of addiction but usually it could be taken without such problem so Prejudice Prejudice is on the Physicians level which usually is connected to lack of knowledge Prejudice is connected with the patients on the patients level and there is one interesting point here

I don’t mention here the media the media is not prejudiced well it is prejudiced but in the opposite direction many large parts of the media are sure that cannabis is kind of pania kind of medication that will cure everything and they promote the use of cannabis to

Level which have nothing to do with reality they create expectations of the patients that it will cure everything many patients are sure the Cannabis will cure cancer which we doubt of course there are some new research studies about influence of cannabis on certain types of cancer where are very

Interesting maybe even promising but far away from describing cannabis as a cure to cancer now as a result of this unsafe ground we step on no legislation in many places the Physicians are responsible if a physician will give cannabis to somebody he will be liable to Mal practice

Sus and this is something that every physician is afraid of as long as it not recognized as medication as it is not produced under strict GMP standards we as very very careful Physicians are not sure what to do about it in my country the solution was a paper that was prepared by professionals

With the leading by the ministry of health and I was I’m proud to say that I was part of this process and this a paper became to have some kind of a backup for physician if you don’t have a good research studies and you want to

Use the Cannabis you can say okay I did with the Ministry of Health out and then you have kind of Defense the second problem about research is the the Cannabis is very complex plant it is composed of about 600 different cannabinoids 60 froids and 60 tpin and I’m sure those numbers are

Not accurate numbers everybody will give you other but this is more or less the number of substances in each plant now if you grow the cannabis with lights or heat you will get different results than if you do it under other conditions so the moment you have this

Plant to become kind of medication you want it to be consistent produ product produce and same circumstances with the same quality control with the same result and those we are only at the beginning of creating some such process so the production is problematic and if you don’t have consistent material

Consistent medication you cannot do research you cannot do research giving the patient one day this Canabis and day another day another way of administrations it is also problematic because most most of our patients prefer the respiratory system approach and that means smoking and as a physician we hate

Smoking we don’t know how what is the amount absorbed and so uh we do everything we can to promote research of if you want to take it through lamps because the inflence is quicker then maybe use inhalers like cetamol or steroids this is lot better but it’s on the stage of development the

Digestive system with oil the Canabis is soluble in oil skin PES even Rector root now the new development which I believe will be really important is usage of nanotchnology as a system to introduce the Cannabis those guys that use the nanot technology and I’m proud to say that

Some of them are also in Israel they can insert the Cannabis in a very small package nanot technology and they can direct it to places which we were not able to approach first for for example to cross the blood brain barrier and to use it for intra chanial us intra cerebral or in

Other places this is a really interesting and promising fil the moment we don’t have reliable information research then our colleagues from the media celebrate with the information that cannabis is doing all the problems in the world then using others think about it as a pan that will sorry cure

Everything and since there are no reliable sources we have a very unable media and results just one very small thing but I believe it’s important as you noticed I use only the word cannabis I don’t use the name mariuana because this is kind of a racial term that what invented in the

States in the 20s of the last century what is marijuana marijuana is Maria when she used cannabis and she became the war a wh or a Juan the male partner that used by and starts killing or raping white women so it’s kind of a a very very insulting

Term I prefer not to use it we use the name of cannabis now uh this is multi-million dollar industry medications are only small part of it because of the problems I mentioned about the production but there are three Fields with billions of dollar options one is to use the cannabis for

Cosmetics Cosmetics is usually based on CBD which is a non psychological influencing a substance I I remember when I was walking in a market in Mont Vio and there were a lot of people selling cosmetic with CBD with a promise you put it on your face to the lady and you will

Become Young and Beautiful forever and believe me many many very nice women including my wife bought it immediately food supplements in many places all over the world you can see food supplements including CBD but I believe that we should go on with direction that we should exclude

The CBD out of the narcotic convention this should could be sell so in the open places in Supermarket I don’t care because it has no problems the products that include THC this is different issue Veterinary products most of the medication we use for human could be used for veterinary problems I I saw

Once a ape I mean monkey in zoo that it has a terrible arthritis and in order to help him I was asked to give him cannabis and it really could be done so what is the summary what is the conclusions of my short lecture I believe that we shall start with asking our

Legislations to do the best as we can to change the legislation the first step should be taking the CBD out of the narcotic convention the second is the education of Physicians and patients and promoting the production of O the future medication under strict GMP is rules um thank you I hope the problem

Was presented and thank you for the opportunity to do it thank you to to speak here today so let’s start um and humans with a worldwide distribution and it is estimated that about onethird of the global population is infected with Len toxoplasmosis Toxoplasma gondi is a widespread intracellular prazone parasite acute Toxoplasma gondi

Infection is usually subclinical in the waste majority of IM immun competent individuals and it is very rarely associated with severe clinical manifestations on the other hand cerebral toxoplasmosis is coasted almost exclusively due to reactivation of Len brain cysts and can cause devastating consequence quences and host immuno compromised patients particularly this applies to

People living with HIV if un tweeted Cal toxoplasmosis is uniformly feral Toxoplasma gundi is widespread in the external environment being a pathogen it has a large range of intermidate hosts High stability in the external environment active reproductive ability and a of transmission routes also we cannot put

Out the fact of a close and frequent cat human contact let me remind that the cat is the final host of this parasite as invited cat realizes up to 20 million oets however the number of ined cats average about 1% uh summary of the pathogenesis of the Toxoplasma gondi life

Cycle again the cat is a definitive host of the parasite which multiplies in the animals intestines infection in humans occurs by consuming food or water contaminated with oist excreted in cat pieces of or bread Otis containing cists in row of purely cooked meat then they’re introduced into the epithelial cells or

The intestine and turn into ttis and with a flow of blood and lymph are carried throughout the human body as a result of the host immune response parasites disappear from the blood and C form covered with a dense shell inside the target cells it retains its viability indefinitely for the development of cereal

Toxoplasmosis it is necessary to multiply tootis in the cells of the central nervous system and penetrate through the blood brain barrier under certain conditions for example imuno deficiency States the infection reactivates and toxoplasmosis develops the clinical classification of toxoplasmosis can be presented as follows according to the methods of

Infections it is divided into congenital and acquired by pathogenetic stage it can be divided into acute asymptomatic and manifest forms and into chronic stage according to the state of the human immune system with immune deficiency and without immune deficiency acquired toxoplasmosis is presented into two stages stages accute

And chronic on this slide you can see the symptoms of both of them for example the acute stage is characterized by lymphadenopathy capat and Etc while The Chronic stage is characterized by memory loss headache and other symptoms you can see on the screen the use of diagnostic categories

Is widely used in infectious and neurological diseases the following diagnostic categories are offered for the diagnosis of terrible toxoplasmosis all the criteria require the presence of clinical symptoms and changes on MRI or the brain uh the first one histology confirms cereal toxoplasmosis the first category includes a brain biopsy or postm

Examination then the laboratory confirms cereal toxoplasmosis it includes evidence of toxoplasmosis G DNA in cerebros spinal fluids probable cereal txop plasmosis includes radiological response from 10 to 14 days of empiric an Toxoplasma therapy and the last one is possible several toxoplasmosis uh it includes presence of serum txop plasm gondi imun

Immunoglobulin G anti antibodies and no other alternative diagnosis the first two categories I mean histology confirmed and laboratory confirmed cereal txop plasmosis can be considered a definite a definite diagnosis etiotropic therapy is well known and includes the use of pamine and Su sulfonamides or a combination of a sop metazol plus

Dropr the efficiency of treatment is assessed by the clinical condition of the patient regression of signs or the disease and let me introduce you a clinical case from our Hospital a 46 year old man suffered a car Virus Infection Complicated by retinol trombosis in November uh 2020 after 3 months uh the patient

Entered the clinical the clinic with cognitive impairments such as general weakness fting ftic for forgetfulness and episodes of disorientation in time their neurological status revealed disorient disorientation in time he even couldn’t name the year month day and time of year a a culia fixation Amnesia nagos tendon

Reflexes from the legs increased with an exp Ed reflexogenic Zone uh symptom Babinski from two sides and stos AIA other symptoms are not identified according to the Montreal cognitive scale the patient showed 14 points brain magnetic resonance imaging MRI um identify Aion with a significant post contrast enhancement there were detected more

Than 20 multiply lesions with a perip focal edema and peripheral contrast assimilation there were size from 4 to 20 mm uh multiple laor tests of blood and C spinal fluid were performed the tests were negative for various infections and finally uh antibodies in the blood and DNA in the cereal spinal fluid

For Toxoplasma gundi were detected th the diagnosis of cereal toxoplasmosis was established and etiotropic therapy was performed after two courses of therapy there was no Toxoplasma in the cereal spinal fluid and there was a positive Dynamics on MRI or the brain and Improvement of cognitive functions this slide show the positive

Dynamics of changes in the MRI or the brain in various images MRI you can see MRI at the beginning of the disease and then after 1 month and six month after therapy important to remember uh the development of acur or re activation or The Chronic form of Toxoplasma is

Possible in the absence of HIV infection especially if there is a history of immun suppression for for example after a viral infection taking immunosuppressive drugs so that’s all I wanted to tell you thanks you thank you for your attention problem of reducing maturity from pneumonia and other complications caused by

Covid-19 this alternative treatment is the use of system meth me of reaching SML the proposed solution is based on almost 30 years of experiments in the use of SML in elderly people with multiorgan pathology and children treated at the Academy of hero therapy of St Petersburg our experiments in the

Treatment of postco syndrome 202 to 2023 shows that it is possible moreover with high efficiency based on the analysis of the mechanism of pathogenesis of the covid-19 virus our article was published priority of April 21 2021 in relation to the treatment of postco syndrome uh this work was published in ACTA scientific medical

Sciences even earli an article was published in reducing maturity from complication of postco syndrome as well as in complications arising from vaccination against Corona virus regardless to the type of vaccines used the second publication in ACTA scientifical medican science postco 19 postco syndrome the author of this message owns

A series of application in the p the 2020 to 2023 highlighting the features of pathogenesis of a new disease covid-19 postco syndrome as well as a method of treatment and prevention of the disease based on the scientifically proven medicinal properties of the medical Le hudo medicinalis the editors of six

Scientific medical journals adopted the concept of the name of the disease covid-19 postco syndrome this definition of a new pandemic is important not only from a taxonomic point of view but about all from a mental point of view since it gives the doctor the understanding of the complexity of the disease and

Requires monitoring patients throughout this period for example monitoring the Dynamics of dmer proin time plit count and the level of fibrinogen in the blood of conent now these are the most informative markers of the danger of trombosis next slide the term long Co doesn’t reflect the substance of the disease process in

Addition in this series of publication we analyze the most recent and proven various aspects of the pathogenesis of covid-19 postco syndrome as a result of this campaign our recommendation are the follows in the acute perod of this disease we conduct leeching causes daily and in the second phase of the disease two sessions

Per week for 18 to 24 Mones this technology is a serious alternative to oral anti-coagulant and plasma fasis the use of direct anti-coagulants has a number of significant contraindications and complications in the def in the def of the central nervous system can cause bleeding nozzle throut and renal plasma

Feses is available only to well equipped Clinic well equipped clinics next next uh as the auor of mention publication I want to note a whole series of Works published in 2020 to 21 23 in the different journals in this works a number of new fundamental data have been published that Mak it

Possible to evaluate Herod therapy as apath gentic method of treating complications of covid-19 postco syndrome and vaccinations against Corona virus regardless of its strain characteristics these are the discoveries of a new effect of Huda therapy energy n stimulating wave acoustic detoxification neg Tropic Aqua structuring antiviral resonance wave and

Others in addition the SML allows you to strengthen the therapeutic effect from synthetic drugs recommended by the National Health Centers of the world in the treatment of covid-19 postco syndrome the proposed treatment technology has proven its Effectiveness and the possibility to preventing complications from this disease in Russia saved many

Leaves uh the following research method were used in this study the medical leech is used not only as a therapeutic agent but also as a research two Aqua system of men uh the next slide uh on the next slide you can see the uh different discoveries uh the about the

New effects of Hoda therapy or leeching uh the next Slide the in of Herod therapy on the results of gdv the kog graphy uh the left picture before and a right picture after the application of Lees next slide what and microwave discharge the simple dissocation of Aqua system gives us the energy

55.4 kilog per mole and um stimulating dissociation of Aqua system gives us the energy uh in 10 uh Times Higher 532.2 kilog per mole next slide uh we can see now the argonot typic culture of the chicken embryo spinal gangler uh stimulation of nerve cells neurons observed the by fast contrast

Microscopy in the culture of ner gangl cells of 10day chicken embryo ah the the left picture initial State B after exposure to riches visible characteristic growth of ntis processes from uh our published work next slide changes in electromagnetic activity of the child’s brain after session of Hoda

Therapy uh on this picture we can see the activation of the most neurotransmitters of the brain of child with diagnosis of alalia uh it was the picture of post factum and now I can show you Dynamics the next slide of response activation of neurotransmitter system of the brain

During a session of Herod theotherapy and we can see the changes of the fields of neurotransmitters in the brain uh I mean the Dynamics of sponse activation of neot transmitter system of the brain and a session of Hoda therapy brain of a four year old child with diagnosis alaria next slide investigation of

Acoustic effect of medical Lees the high pitch sensor the center the beginning and the low picture the finish of uh Le application next slide uh the high picture the original record signal of Lites in the process of blood suck and uh we can see the S glitches and its Spectrum recording an acoustic

Signal of Lites in the process of blood sucking after for year transform this is a real uh Symphony of Lees next Slide the demonstration of toxicity of the blood of patients with um covid-19 a postco syndrome uh here you can see the Dynamics of death of Le treatment in a

Patient with chronic drug poisoning diagnosis kov epilepsy the small form of epilepsy the period of pharmacological treatment is 11 years uh and we can see the toxicity of blood and after of leement we can a normal blood next slide patient young lady 33 years old diagnoses aarian sees the state after to

Operation for the removal of ovaries bad habits smoking experien 20 years the followup period is 25 mons and you can see also the toxicity of Le of blood and after Leach treatment uh we can see the normal blood uh uh second the third history patient 68 years old diagnoses

Hypertension of at thep Lumar intertial heras common osteochondrosis prostate nor aconic prostatitis systemic connective tissue disease from anamnesis 25 years ago he wept with mer and Souls of have Metals in a research laboratory and you can see that during two years uh uh his blood demonstrate the high level of

Toxicity and the next uh slide this is a SP mold of destabilize 2 uh destabilize 2 is the enzyme that can destroy the trums uh in the whistles uh spical model of the stabilized to stretch in combination with noock 3 and aetl glucosamine most important hydrogen connections between

Between side chains are shown by doted lines Z all summary uh in the uh during the pandemic covid-19 postco syndrome we have we have demonstrated that Herod therapy may be uh as an effective and dominant monotherapy thank you very much for your attention well we’re going through a very very

Difficult and complex time so I’m happy to join you today my key note focuses on health policy during covid based on 12 studies that I performed throughout the five waves of Co and I hope that although we are from different disciplines you’ll still be able to get some insights regarding your

Field okay so um many Health Systems in the world are National Health Systems and um that means that they are progressive that citizens pay in Israel we we each pay 88.3% of the income and that aims to provide everyone regardless of the socioeconomic status race gender beliefs Etc um an

Eal um level of uh scope and quality of Health Services um the Bloomberg organization ranked Israel consec itively as six in efficiency out of 51 Health Systems and the question is does this ranking affect patient centered care or the quality of care and we will see based on the

Studies that it is not necessarily so um so many National Health Systems Aspire at minimizing disparities um as far as religious minorities in Israel 37.5% of the population um comprises religious minorities these are Jewish Orthodox Muslims Christians beduins Jews bahis um they are uh characterized as close-nit communities with very large um families

Where the collective um value values uh transcribe the personal ones they uh these groups have specific death rituals and values and beliefs that transcend those of individuals and they all have complicated relationships with the government and they are mostly Guided by their spiritual leadership um throughout the um covid pandemic although physical distancing

Was vital to contain the virus the compliance across the different religious minorities was very poor compared to the um uh compliance of the majority of the population for example the Jewish Ultra Orthodox compris 12.6% of the population but because the compliance with the guidelines was so low 40% of hospitalized patients due to

Covid were from the Jewish Ultra Orthodox minority the same could be said regarding the Arab Muslims they comprise 21% of the population but 33% of hospitalized covid patients were Muslims there was a failure to contain the virus resulting in a very high morbidity and spread um across groups of the population and

The government was unsuccessful in reducing this morbidity and um then the Pinnacle of science happened and the vaccines arrived and everyone in the world could read that in two months 70% of the Israeli population was uh vaccinated making Israel first among the oecd countries the vaccinations were widely

Available um but 12% and these are minority populations rejected the vaccine now we know that public health depends on coverage among all groups of the population So within three months Israel dropped in its international ranking there was an acute rise in infection ratees which required a booster vaccine the Health authorities issued a

Vaccine passport to restrict the movement of nonvaccinated people but lo and behold 48% of the population rejected the booster vaccine which reflects um a high level of distrust uh distrust in the health authorities distrust in health policy makers um the media however uh kept sending messages that um increased the

Polarization and the discrimination against minorities who were perceived as those that do not comply with guidelines and risk the rest of the population the goals of my studies were to complement epidemiology iCal Studies by voicing these minorities and respond to previous calls to experience um what religious minorities um to examine their

Experiences During the covid-19 period the importance was that these studies can direct changes in health policies not only in emergencies but also in regular times and focus on the issue of inclusiveness of Public Health Services so the research questions focused on lived experiences and perceptions among members of Health

Minorities I wanted to understand what underlies the harnessing of guidelines what are the main causes of cultural clashes and what can we learn from these experiences of the covid-19 um going forward there were many challenges um performing these 12 studies challenges that were related to the fact that I was perceived as a

Potential covid-19 vehicle that the guidelines inhibited traditional data collection um I wanted to bring timely actionable insights and there were also operations related challenges like like having to use the zoom platform with minority populations that aren’t necessarily um using uh WiFi and um internet platform um and I needed to examine my

Own values and make sure that I’m not patronizing when I um interview these populations that chose to conduct themselves differently from um the guidelines and also being a secular um woman um made it challenging to approach these um communities but um I overcame these uh challenges I worked with moderators from

These communities I had the endorsement of their spiritual leaders who um for the sake of learning and enhancing the knowledge encourage me members of their um communities to cooperate and um participate in the studies so let’s see the findings and I’ll present them by the um major uh minorities the Jewish

Orthodox minority and the Muslim minority and what did they experience um the Jewish Orthodox leaders decided that since hospitalization of members was um isolating them from the community in overflowing hospitals um they developed this distrust in health authorities and refused to hospitalized members of the community six Jewish Orthodox

Neighborhoods became home to underground home Hospital secret unsupervised um hospitals that um underground home hospitals which was a great example of patient centered care um during a crisis during a um pandemic um everything was done so that the community will be able to preserve its values and not die in solitude in

Overflowing hospitals but be surrounded by their families um and go about their um um home activities as much as possible they purchased equipment and um had many Physicians volunteer to come and monitor the patients twice three times a day um as for the Muslim Community the lack of rituals inhibited respectful um

Meeting and respectful realization of their values as they believe that the deceased um will meet God but in the lack of those rituals that wouldn’t be possible the lack of um having the spiritual leader the Imam and the family reciting verses from the Quran was also something that they perceived that

Jeopardizes their peaceful um departure from this world the burials were very different um guided um by the health authorities without attendance that enables forgiveness enables sharing enables final words of prayers and the imam’s thought of Alternatives that can still Accord with the guidelines but they weren’t asked about it there was one

Health policy guidelines that were guidelines for all and the leadership felt that they are being invalidated which caused anger and distrust at Health authorities now why is this important why am I um focusing on this because this trust was proven to reduced utilization of health services and what it caused is

The deterioration in um health conditions of all of these religious minorities and it deepens the soci soal um polarization because of these clashes which compounded the poor experience that everyone had during the pandemic but for religious minorities it was um traumatic they suffered as they believed they witnessed clashes between the

Formal guidelines and their beliefs and religious um practices and altogether it’s called secondary traumatic stress um which could have been mitigated had the health authorities considered the beliefs values and needs of the different um minority groups in the population maybe that’s not possible in the first and

Second wave of the pandemic but as we go forward in the different waves that we had we had five or six waves it would have been possible and that’s what I recommend to stop and analyze the needs of all the groups of the population if it’s a national health system so what

Happened in terms of the conduct of the health authori there was no acknowledgment of the loss of communities there was an invalidation of spiritual leaders of those minorities um no awareness of the need to adapt to to the different values and beliefs of the different groups there

Were no resources allocated to help um plan and and um achieve practical needs after the death of community members no grief support and no access to communication platforms to process grief um and as I obtained the insights and recommendations I created The Voice model The Voice model is a model that shows how

Inclusiveness could be um a major component in health policies even in health emergencies what does voice stand for it stands for values and openness and if we all have the value of inclusiveness in National Health Systems it has to be expressed in practical uh guidelines throughout the emergencies

Inquiry of these values how they come about how they are reflected and expressed in the health policy communicate and collaborate and explore um the the new ideas that we have and that we Implement in our health policies in order to make National Health Systems much more inclusive what

Are the practice implications when I talk about the voice model so at a leadership level we’re talking about validating the leadership to create trust approaching the minority leadership and providing them with transparent empirical data so that they can guide their uh community members um with members of the community

We want to understand the sources of distrust the sources of objections to guidelines and use culturally appropriate channels to communicate with community members we can engage clinicians from those minorities just as um the Orthodox Jewish community did when they established those underground home hospitals in order to facilitate

Collaborations and we can Target a community-based effort of uh collaboration get with leaders um we can use measures for preventing infringement of civil rights of minorities I don’t think that any health authority in the world developed measures for testing whether or not our um rights uh are infringed or

Respected um another recommendation is to intervene by channels to to increase Mutual understanding and encourage collaborations for community-based support for all ages and all backgrounds how do we do that um I actually developed a model of engaging and rewarding inclusiveness by defining the problem addressing the lack of diverse

Talents from all minorities we need to ask who the health authori is prise um which minorities are part of boards in health authority Boards of policymaking we need to consider bias of ideas generations and develop inclusive Solutions we need to generate evidence to test the policies the extent to which they are

Adaptive to different cultures and to also address communication biases because the mainstream communication channels don’t always address or um even used by different minorities um we have a problem of snowy white pics who is engaged in policy making is the communication inclusive is the public engaged enough when we think forward of future

Policymaking how many agents do we have from minority groups are advisory groups inclusive enough and if they’re not in order to maintain health conditions and prevent the deterioration of health of members of um religious minorities we need to do these things and measure trust and measure the utilization of

Services if we want to reduce discrimination through leadership education we need the health leadership to be comprised of people from the different minorities in order to influence the behavior of policy makers and reduce inequity and discrimination we need to critically appraise our practices and experiences and influence the leadership

To create connections and rebuild Trust of religious minorities um to promote inclusiveness and engagement will which will make our health system our health systems much more resilience we need to build capacity for inclusive leadership we need to reward inclusive practices change perceptions about where the knowledge lies because the knowledge

Isn’t just with the health authority there was a lot of knowledge that we could have translated into much better uh life quality for all of us we need to be attentive in that way because people are not just empty vessels we need to take into an account the beliefs of

Minority groups not just the majority groups to Value the experiences that religious minorities went through throughout the waves of the covid and invest in establishing that um tressed not only in emergency but also in routine times so thanks very much for listening I hope you could take um

Several points to your health systems to make them more inclusive and if there are any questions I’ll be happy to answer them I will thank the event organizer and of course all those who participate in the in this research Um the title is a effect assessment for of good practics on breastfeeding duration in plant women at the hospital of District umia region Italy from January 2017 to June 20188 now we see that breastfeeding is both right and a public care priority the aim of this study is to investigate

Whether care and support practics carried out during the Pinal periods and influence breastfeeding start and duration the sub represent a progressive input short study that involved 608 woman 68 woman women H and and had given birth from January to December at the hospital Santa Maria de in with followups at three and six

Month the time period I I’ve seen the time period or is a small country hospital and it’s a Suburban Hospital that way collected by means of a structor intervie byans and the participants underwent two followups at three and at six Ms from the child birs 80% of women women has Italian

Citizenship and half resided in orto District the others come from neighboring the zones mean age of Italian women in our sample was ch2 years and 50 years for the for ones uh the variable an analyz the word useful for good practics as recommended by the world organization and other

International institution and they are citizenship number of child births participation to B support anding courses child birth hpe resort to Old Nursery School of rooming resort to skin to skin resort to help to home help breastfeeding carry out a discharge at the third Mount from B and six Mount from

Bir more than half a woman women interviewed gave birth for the first time the best rate in Italy is very low and uh about one and five child for woman but uh we know from the scientific literator that the habits to join meeting that prepare for birth is a very

Helpful resource for women who improve their awareness and knowledge about good practics during pregnancy and is useful also for their children this is true not only for breastfeeding but even for other Healthy Lifestyles for example aloh assumption active and passive smoking the Assumption of fully folic acid and the

Right way to arrange the child in the cred ET unfortunately only 44% of woman women interv in our sample joined a training course for supporting child birth okay is it it’s also very important to take into account the rule of predicative factors for a good breastfeeding in particular some

Variable variable as the child birth type cesarian or spontaneous we have in Italy an high percentage of cesarians uh birth child may be inappropriate unappropriated 30% roing and all child to stay together the model R in nursing home 20% of cases skin to skin practics based on the Abid

Contact of G with Mom skin 68% of cases then postpartum home support was AED by 17% of women interview breastfeeding considering the breastfeeding at this jge almost 90% of women performed the exclusive one only 1 and 7% was not able to autonomously bread feed the child both for rooming 94% versus

81% and child birth type more care for spontaneous child birth now we go to the followup and a third and six Mount exclusive breastfeeding at the third Mount from bir still remained H H 67% and decreased to 53% at the sixth month nworth the absence of breastfeeding slightly increased from

133% and at the third Mount to 20% at the sixth Month but uh there are significant difference and so it means good tactics uh the exclusive uh breastfeeding for skin to skin is more important and we can see a significant difference between women that had skinto skin practics 63 at a third Mount 63% versus 64% and at the six Mount

61% and 48% there is a significant difference another practics that is a good and significant differ is rooming in in this case women who practiced rooming in also feed more in an exclusive way with respect to to the others and you can see 94 uh versus 81 Etc it’s important

Uh the breastfeeding child uh type uh uh in women who received a cesarian section the probability to breastfeed the exclusive way was lower and decreasing from 72 to 58% and uh another significant difference is the exclusive breast feeding test and six mount for critical issue during the hospital permanence although only women

Out of them experience a critical issue especially about communication a significant difference was observed between those who did not meet critical issues and those who did add a thir of six month and now another uh important factors is the citizenship also had an impact for a women are prone to exclusive

Breastfeeding for longer time and we we can see the the difference at six Mount 54 versus 68% for forign uh mom at the end of this study we have uh a multivar statistical analysis with the logistic regression methods and it detected that the most robust variable in predicting the extension of exclusive breastfeeding

Until the six month was participation to a training cses ciens ship and skin to schem practics the sample detection of some data about the child bir and breastfeeding all to perform epidemological analysis and obtain significant data for orienting planning of health and practices in this study and our study was realiz realized

As a with descriptive analysis and then with the multivar analysis despit as more sample size the research highlighted some statistically significant association between good practics and the extension of exclusive breastfeeding period um in some data collection even in a way that not increases the burden of healthare professional confirms that

It’s important to be uh to assess and ameliorate action and hair practics and uh at the end we uh we have seen some limitation small population size all with only limited analysis however the data obtained were statistically Rob survey forms should be filled in more carefully since each missing information

Or mistake increases the heterogenity and the error rate more attention is needed at the followup SS dropout rate was during the suring at last an adjustment of the items in the form to those used and at International level is uh needed thank you for your attention University Budapest Hungary

And I am working as a Cardiology resident in godan National Cardiovascular Center uh in Budapest Hungary and I would i’ would like to introduce my topic which is the prognostic significance of variant left common pulmonary vein after trans catheter palmary vein isolation so um um atrial fibrillation

Is um the most common uh arthia in the clinical practice its increasing incidence and prevalence make it a global health problem and the p pathomechanism is based on triggered activity originating mainly from the pulmonary veins and on atrial structural and electrical remodeling um which favors the the formation of micro reentry circuits thus

The basis of the treatment of atrial fibrillation is pulmonary vein isolation which was first described by haer and his colleagues uh which you can see on the left side on the right side of the slide uh shortly the um three pillars of the management of atrial fibrillation

According to the ABC principle are the anticoagulation and stroke prevention symptom control including Rhythm control and of course catheter ablation which I would like to highlight as part of my current topic and uh the recognition of cardiovascular and other comorbidities is also a key key part of the AF

Treatment so ponary vein isolation or shortly pvi um in atrial fibrillation now can be used as a firstline treatment catheter ablation is included as a class one indication in patients with heart failure with a reduced ejection fraction and uh in patients with a therapeutic refractory paroxysmal or persistent atrio

Fibrillation and in addition um in patients not receiving anti ormic uh therapy pvi as a treatment option is also available based on patient preference what is the goal of the ablation procedure itself so basically we would like to uh reach a complete isolation of the pulmonary oia and two

Techniques are currently u in use to achieve this and are rely used in our institution as well so one of them is um a so-called Point by Point uh radio frequency oblation um with radio frequency energy performed with a 3D mapping system and ablation with cryo energy basically

Freezing the pulmonary OA with Cry of balloons in normer left atrial Anatomy um four pulmonary veins in inserted in the into the left atrium with separate orifices and the key word here here is the separate because the left common trunk uh is the most common anatomical variant uh but right or bilateral uh

Pulmonary Trunks and occasional accessory pulmonary veins can also be seen and these variants are associated with a higher incidence of atrial fibrillation according to literature data based on the cardiac CT scan uh we Define a left common pulmonary V is Strunk uh when the coalesence of the inferior and Superior pulmonary vein is

At least um 5 mm before the insertion into left atrium when this distance exceeds 15 mm we it considered a long Common trunk and below 15 mm we call it a short common trunk you can see in the right uh picture uh there is a long Comon trunk with a 31.4 MM trunk

Distance and on the left uh it’s a bit shorter it’s a short common trunk so um experience uh to date shows that the left common pulmonary Venice trunk has not significantly affected the success of pulmonary vein isolation in addition it has been described that catheter ablation with cry balloon is

Similarly effective to radio frequency ablation in patients with a left common trunk however in our country we are not aware of any studies to date on this so our aim was to compare the procedural data and clinical outcomes in patients with left common pulmonary vein versus normal left atrial Anatomy uh for radio

Frequency and cry cure ablation in our retrospective study in God Zan National Cardiovascular Center between October 2019 and March 2022 the presence of a left common pulmonary vein was detected in 42 out of 210 patients uh with cardiac CD scan undergoing pulmonary vein isolation for atrial fibrillation in addition 60

Patients with normal left atrial Anatomy were included and formed the contral group in the lcpb group the radio frequency ceter ablation was performed in more than half of the patients this ablation technique um in the cryon ablation in the Contra group uh was used in 35% of the

Cases during the 12 months followup period We performed a um halter ECG examination a trans telephonic ECG examination as part of the outpatient follow-up visits and reached patients by telephone to assess atrial fibrillation recurrence this slid shows the statistical methods used in this study so basically a total of 40 uh 34

Uh women and 68 men were included in the study with an average age of 62.6 years of those included in the study eight patients had a known history of for failure and a total of two patients has left uh had left ventricular ejection fraction of 40% and

Less based on a transic EOC cardiography before interventions and as you can see no significant difference was found in the main comorbidities between the groups and there was no significant difference in the use of major anti rmic agents between uh the studi groups and the mean left ventricular ejection

Fraction in the study population was uh 58.7% in the lcpb group um short common trunk was detected in 25 cases um at all and long Common trunk was detected in 17 cases the mean distance of the left Comon trunk in the cry ablation group

Was um 16.4 mm and it was 13.1 mm in the radio frequency group and and the following results and figures are taken from uh our article published in early 2023 firstly I would like to um um speak about the complete isolation um uh results so basically after radio frequency catheter ablation the complete

Isolation was achieved in 9 5.7% of the cases this number was 96.4% of the cases after cry balloon ablation group uh grouped according to the ablation method we compared the procedural data for both radio frequency and both and and cry ballon ablation in patients with left common pulmonary V

Strong and the control group for radio frequency Cal radio frequency ablation and cryon ablation also um the procedural data such as procedural time fluoroscopy time and fluoroscopy dose um did not differ significantly between the group with lcpv and the control group as you can see at the diagrams recurrence of atrial

Fibrillation at the 12 months followup uh with radio frequency ablation was observed in seven uh cases in the group with u in the group with a common trunk and five cases in the control group after a cbal ination six um and 12 uh cases of Aria recurrence was observed uh in patients

With a common trunk and in a control group respectively after 12 months of followup um after cry balloon ablation complete freedom from arthia was achieved in 64.7 uh% of patients with a common ven strong and in 69.2% uh of patients in the CRA group there was no significant difference in

Even free survival as shown by the Klan mayor U curve at and the low rank test for radio frequency ablation success rates uh at 12 months uh were 72% and 7 26.2% uh with common V rank and in a control group respectively so there wasn’t significant difference between the two

Group thus we can conclude that the prevalence of left common pulmonary ve was 20% in our institution during the study period and there was no significant difference in proced procedural parameters such as procedural time fluoroscopy time and FL opy dose between patients with a left common pulmonary vein and the Contra

Group and no significant difference in nature of fibrillation recurrence was observed between patients with common pulmonary vein and the control group after either radio frequency or cryoballoon ablation although the so-called single shot devices such as cryoballoon were not developed exactly for common trunks they are well suited for use in this

Population as well and finally I’d like to thank my colleagues at Goden National Cardiovascular Center for the opportunity and the high level of professional uh support and assistance and thank you very much for your kind attention early fertility knowledge and behavior among Indi indigenous young woman in Guatemala now I’m working in a

Research and development department in Norway but before that I used to work in Central America for health development project so this study is based on my experience and this study use kind of secondary data analys analysis to De you the existing that data data set the background or indigenous people in Guatemala

In Guatemala and there exist High rates of in inequality inequality among the indigenous and Indigenous people who comprises nearly 45% of the population many studies on indigenous women in Guatemala have focus on Maternal Child Health but a few studies focus on Adolescent and reproductive Health such as a fertility among young

Women including rural and urban disparities and when generally there exist High a huge rural urban disparity in Low Middle income country including Guatemala and in guat as I said the 45% comprise the population of the indigenous 45% of population as indigenous people so some people many indigenous also people live in urban

Area not only rural area so we need to consider the G geographical Factor when we conduct studies interrupt you but we we see just the first slide oh okay so I will try it some so it’s not in presentation mode sorry not present okay I’ll try with

This now you see the whole presentation yeah perfect perfect the slides show slides show yes I mean yes okay so the purpose is of this study is to investigate Association mechanisms in influencing early fertility among young indigenous women G using mediation analysis and this to investigate the rural urban disparities among indigenous

And non-indigenous young people young woman and Method and data source this study uses the secondary data from guala demographic Health survey or inquest National salant the samples are woman aged 20 to 24 years old in Guatemala which is divided to four groups which is uh non indigenous woman in urban area

Indigenous woman in urban area non- indigenous woman in rural area and Indigenous women in rural area and data analysis there are two data analysis methods were used first pairwise comparisons was conducted among all four groups and second partially Square structure equation modeling was conducted among three

Groups so here I um first I will call the PLS the par list score bra the PLS to make it shorter and I will explain a bit about the PLS PLS is a combination of multiple regression analysis and factor analysis H or this is a extension version of multiple regression analysis

And examinate a mediating Association in addition to the direct association between predictors and outcome also PLS use latent variable as a kind of part of factor analysis and latent variables are an observed variable that combine several observed or measured variables model development for this study a hypothetical model analysis was

Developed based on existing health behavior change models and theories and the model for this study consists of four level the first outcome level and exous variables and two level of mediators in between imperialist analysis the term exogeneous variable used instead of independent variable okay so exogeneous variable or

Independent variable there are are four variables which is which are media exposure which is relent variable with three measured variables and highest education level literacy and wealth index uses measure variables only a outcome is a refer treat and latent variable consisted of two measured variable mediators a first level of mediators are

Consist of three consist of three variables all three variables are latent variables on attitudes and knowledge on pregnancy prevention on contraceptive views and attitudes toward the gender based violence a second level of mediator are two variables the actual contraceptive use was measured variable and risky sexual behavior is a latent variable

With two measured variables H results and discussion or findings H there are three main findings from this study first a early fertility among indigenous people in rural area is influenced by more factors than those among non- indigenous people in rural area and Indigenous in urban area and this findings was drawn from

The results of PLS PLS analysis or the direct and mediating Association that is show in this figure uh in this figure if there is a l line or the path between variables that means that there is a significant association between variables and if there’s no path between variables that

Means that there’s no significant Association and path with red color means that there was a mediation Association pass between exogeneous variables or independent variable and outcome so as clear in those figure a indigenous woman in rural area the group in indigenous woman in R area has the biggest number of both

Direct and mediating association with outcomes showing that or fertility among indigenous people in rural area is influenced by more Factor than those other group other groups second findings and Geographic Factor has stronger influence than ethnicity uh this findings was drawn from distric on pise comparison and PLS an analysis

This figure show the P pise multiple comparison of variables among four groups and the table shows par values showing in this table are P value as shown in the red highlighted columns there are statistic I Ally significant differences in all variable or all but three variables between a indigenous people who live in

Urban area and Indigenous people who live in rural area as well as a non-indigenous people who live in urban area or nonous people who live in a rural area this mean that between the same ethnic group but live in different residence area on the other hand and show in the light blue highlighted

Columns around 40% variables were not significant between H the people the groups living in the same residence area or Urban or rural but different ethnic group and PLS analysis is showed also similar uh similar association association parents between a indigenous and non- indigenous women both living in rural area compared with those H

Between urban indigenous people who live in urban area also in rural area or the indigenous woman living yes either Urban or rural area so both Parise comparison and PLS analysis shows the geographical factors have stronger influence to early fertility than ethnicity third findings having better knowledge or attitude toward contraceptive use did

Not really reduce sexual risk behavior or increased the condom use H this findings was drawn from the result on PLS analysis that shows a competitive Medi mediator and competitive mediator or competive mediation mediating association means that uh the mediating Association and the direct Association points to in the opposite

Direction as the example show that the left figure in this slide shows slide shows that path core efficient on Direct association between education and sexual behavior is positive while the pass Co [ __ ] Excuse me while the pass coefficient or the indirect Association via contraceptive use is minus because a plus multiple

Minus um neg H positive and negative become a negative coefficient value so this was assumed that some factors underline the past between attitude and knowledge contraceptive and sexual behavior around this this path would impl influence the competitive mediation one of the explanation is whether women have a power of actual decision making on

Prevention preventing risky sexual behavior and contraceptive use for example in uh Latin America maet of beliefs that me that men are superior to woman is prevalence including guala regarded regardless ethnicity so matism can be one of the reason that woman cannot have actual decision making on pres preventing risky sexual be

Behaviors although the woman have enough knowledge of contraceptive method H however this study used the existing data set and did not include the data and those data set did not include the variable indicators on which the man or woman made an actual decision related to prevention risky sexual

Behaviors so it will be suggested to investigate actual decision making power of woman related in Risky sexual behavior so conclusion H this study introduced the concept of mediators by using PSM analysis to investigate Association mechanism influencing early fertility among young indigenous woman in Guatemala a early fertility among

Indigenous people in rural area is associated with with more influential Factor than that in non- indigenous people in rural area and Indigenous in urban area for especially for example media exposure attitude knowledge on pregnancy prevention contraceptive use in addition to the education risky Health sexual behaviors so Improvement of those factors among

Inin young women in rural area is suggested to reduce early fertility at the same time a geographic Factor has stronger had stronger influence theic among young women in Guatemala so reducing geographical Gap is also important important the further discussion on elaboration of variables measuring the actual decision making related to risk

Sexual behavior as suggested due to the use of existing data set there was a limitation in selecting the variables related to attitude and sexual behavior especially variables measuring the actual decision making related to risky sexual behaviors okay thank you very much for the presentation and I just want to mention

That the pictures shown here are the one that I took uh the picture that I took when I was working in the health Redevelopment project in Guatemala also Target is for indigenous people of course thank you thank you Dr Hansen for a G presentation uh if anybody has any questions please go ahead

Is by training and my fieldwork research is in Japan so recent multispecies ethnographic Works have challenged the anthropocentric understanding of agency and applied agency to non-humans most notably non-human animals an even more radical school has argued against a biotic Prejudice and suggested that liveness is not necessarily a prerequisite to expressing agency

Anthropologists have long been aware that most societies also apply agency to non-living nonhumans such as Spirits ancestors the dead and gods some researchers extend the term liveliness even to chemical species such as rocks or weather systems however if we continue to broaden the term agency does it not at some point lose specificity

And become arbit arbitrary and thus no longer useful for academic discussions furthermore should there not be a difference between humans attributing agency to a being and these beings having an inherent ability to express agency if so how would we know if we cannot even enter the minds of

Other uh humans let alone those of nonhumans so in this presentation I want to discuss these questions using the example of a humanoid robot named Pepper that is used in Elder Care Homes in Japan the results from the fieldwork I conducted in 2019 suggests that elderly people develop an emotional attachment

To such devices by attributing agency to them I argue that robots as their machine learning routines grow more sophisticated will eventually interact in such a way with humans that the dichotomy between attributed and inherent non-human agency becomes meaningless so humanoid robots are still rare in most Western countries however

In Japan their usage has increased drastically in recent years as a hyper aging Society with one of the highest life expectancies in the world Japan is currently undergoing a demographic transition that Western Nations have yet to experience showing us possible avenues for our own future as the population has aged the workforce

Has shrunk leaving the increasing elderly Japanese population with an insufficient number of caregivers to meet their needs hoping that robots will fill this growing Gap in the workforce Japanese authorities have sought to introduce robotic devices that can perform some of the needed work despite the enthusiasm with which the Japanese government is encouraging

Robotic solutions to solve the Elder Care labor shortage the introduction of social robots into the realm of care might be considered contentious the potential problem is that while these devices May fulfill all the outwardly necessary requirements that are essential for the provision of care they can only express algorithms

That imitate feelings these machines speak and appear to listen and by interacting with them we appear to attribute a humanistic nature to objects that have none in this ethnographic excerpt I present a brief interaction between an elderly woman ero who resides in a Tokyo public nursing home and the humanoid

Social robot pepper this new mode of social interaction is used to discuss the non-human agency of social robots and I propose that Louis adamiano and Paul D Michelle’s affective Loop approach as a processual type of agency can help to better comprehend the human robot interaction involving the Quasi

Other social robot and the emotions and feelings it generates in the human as seen in this excerpt ero seems to believe that pepper is somewhat alive but she had trouble articulating exactly how she felt that the robotic device is alive the AI functions embedded in the robot are able to execute numerous

Functions that a toy cannot and perhaps these are what make the robot appear to be somewhat alive alternatively maybe it is io’s own expression of authentic feelings toward pepper that makes her perceive it as somehow alive it would make no sense for ero an adult with full cognitive capacities to invest authentic

Social emotions in a lifeless toy as children do with dolls so the robot must be somehow somewhat alive to protect it O’s dignity moreover io’s use of words such as him and really like shows that she does not view the robot as an object

But as a some form of a quasi other with the social reality she constructs co-shaping the Quasi social relation so as the descriptions from the field side illustrate IO appears to be projecting a mind onto a non-human and attributes human cognitive abilities to Pepper in a process that enables her to

Regard a nonhuman as an other within a social interaction the interaction between pepper and Edo compels us to rethink the role of nonhuman agency in regard to artificial uh abiotic devices that mimic social interactions and are thus perceived as somewhat alive now this illusion of agency is exactly what

Developers of social robots are aiming for when they model social robots after us rather than seeing in the computer the model of the human mind social robotics uses Human Social and cognitive competences as a model for the Social and cognitive performances of artificial social agents so I argue that the

Discussion of the possible agency of social robots can be viewed through the framework of multispecies ethnographical writing multispecies ethnography concentrates on the links between multi mple organisms humans non-human animals plants and in this case the artificial nature of social robots while primarily focusing on comprehending humans emergence as a result of these

Relations this different outlook on what it is to be human can showcase an alternative set of Ethics to live by in the world and in order to achieve this multispecies ethnography needs to present Humanity’s links with other species to s stimulate new ways of thinking in my reading of the literature

There are at least three different ways that non-human agencies commonly used in academic writing so let’s start with the first first and most commonly is the linguistic or grammatical agency and it is often used in conversation or writing to avoid a passive voice so when I ask

The woman how does pepper make you feel the grammatical structure of the sentence indicates that pepper is an independent actor that has the capacity to alter the emotions of Edo now this form of agency is seen quite often in not only everyday conversation but also academic writing for example when an

Essay is started with the following statement this essay argues now in this last case neither the author nor the reader will likely take this sentence literally but regard it as simply a stylistic choice nevertheless as language does shape our thinking we cannot definitely say that it does not leave an

Unconscious impression on the receiver especially in the case of pepper where the discussion itself was centered on whether the robot was alive or not the phrasing of the question by me could have already um influenced the perception of the woman and made her more likely to attribute agency to

Pepper in the answers that she gave a second way to use non-human agency is the attribution of ageny to someone or something so when she states that I really like pepper and I hope he likes me me back the woman attributes agency to Pepper by alluding that he it

Has the ability to like someone now this form of non-human agency is encountered by many anthropologists in uh in the field while attributing agency is helpful when describing our ethnographic felds there remains always the question of whom we as Scholars should Grant agency in our writing Bruno L’s actor

Network theory has already included abiotic actants in the analytical framework here agency is completely decoupled from human characteristics rather it asks whether an entity inside a network makes or promotes a change in another entity the requirements for agency are lowered to such an extent that even a volcanic eruption would constitute

Agency as other entities must react to it however this definition could lead to unsatisfactory results in the end the question remains as follows does pepper only have agency in so far as ital attributes agency to him or should we as researchers look for a deeper form of agency one that transcends the mere

Outside attributions of such and how would an academic definition of inherent agency defer from that of our research subjects or is every rationalization of inherent agency at best just a more sophisticated form of attributed agency now lastly the inherent agency of lifeless objects in multispecies ethnographic writing the theoretical

Framework that I mentioned earlier it is largely uncontested that non-human animals at least are also inherent bearers of agency more contested is the question of whether under certain preconditions in organic matter could also have the ability to express agency unsurprisingly not all anthropologists agree with such an open-ended interpretation of non-human Agency for

Example the Anthropologist eduard Doon argues that things cannot be agents he puts forward the notion that only living beings are selves as only they can express thoughts and create a personal reality allowing them to depict the world with symbols in his interpretation thoughts expressed in a symbolic language allow

Selves to learn from mistakes and react differently in a similar situation as a result of the learning process for K there is a difference between attributing animacy to all types of entities including abiotic ones and recognizing the ontological reality that certain beings possess thought and are reacting to outside Behavior as he

Explains representation intentionality and selfhood still need to be accounted for and because the way such processes emerge and operate beyond the human is not theorized latorian science studies is forced to fall back on humanlike forms of representation and intentionality as operative in the world beyond the human

Now building on Corn’s work I suggest that there is a third form of non-human agency writing which I call inherent agency so sorry I have to go back one slide here um K argues that it is possible to see the intention of a self when it acts in a certain way because of

Experiences in the past and expectations of the future so for me this means that the bearer of an inherent agency must have the ability to learn from the past to intentionally change its future behavior and it can do this because in its mind it has created through mistakes

And observations its own version of reality on which it bases its actions however here I must return to what anthropologists Marco M has called the skepticism of the other mind how can we be sure without the ability to enter other Minds that a self has has a mind

That is capable of learning one indication is that the potential bearer of an inherent agency shows signs of attributing agency to other Minds K offers an Illuminating example of a scarecrow that I adapt to a recent occurrence in takagawa city on the Northern island of Hokkaido Japan after

An increase in Bear appearances near the village farmers in takawa devised a ploy uh to deter bears in the future they purchased that gigantic robotic device which looks like a fearsome wolf as you can see on the slide here and has rudimentary motion abilities to deter

The Bears the farmers hope that the bear would mistake the device for a wolf and refrain from coming near the village indeed no further bear sightings have been made since no human looking at the picture of the robotic wolf would likely mistake it for a real wolf but according

To hor the human perspective is also not the point the robot is an attempt to imagine how a bear would see a wolf now if the farmer’s Ploy worked a bear seeing the robot would believe it to be a wolf that has the ability to harm it and it would therefore exercise caution

And avoid the area in the scenario both the farmer and the bear are bearers of an inherent agency as the farmer attributes agency to the bear that it would mistake a machine for a wolf while the bear attributes agency to the wolf believing it to be dangerous now

Over time the bear might eventually even figure out that the robot poses no danger and ignore all similar devices it Encounters in the future meanwhile the robotic wolf might have received attributed agency from the bear but it does not hold inherent agency as it cannot think or act independently the

Problem with this example is of course that we cannot be sure what the beay really thinks while the farmers believe that the new device is responsible for the lack of further bear sightings the reasons for this change could be numerous and completely unrelated to the notion that bears have mistaken the

Robot for a wolf through careful observations and extrapolations we can make educated guesses about whether others possess inherent agency but we can never be completely sure so let me now quickly return to Edo and pepper and discuss whether pepper is more like the bear or the robotic wolf

Now if we follow corn closely I have concluded that pepper is not a living being and therefore cannot be counted as a self thus disqualifying it from expressing inherent agency however if we only look at Pepper’s Behavior the case becomes Less clearcut in a direct conversation pepper

React in a seemingly meaningful way to to Edo’s inquiries and thus passes the touring test this interaction causes confusion for for Io as on the one hand she’s aware that pepper is only a machine while on the other hand engaging in a meaningful conversation has throughout her life been a clear

Indication of encountering another self IO partially suspends her skepticism when she says that pepper feels alive so since we might best understand pepper as a having a form of distributed agency that is a processual type of agency I return to the affective Loop approach pepper has the ability to engage Edo in

A dynamic interaction that includes affective expressions and appropriate responses and thereby triggering further reaction on the part of both the human and his her artificial partner as such pepper prompts IO to respond effectively and gradually to feel increasingly involved with it in a way that augments the social presence of the social robot

And thus favors human robot social interaction nevertheless a longer and more critical interaction with pepper might eventually destroy the illusion of another self when for example it becomes clear to her that pepper is only able to react to outward stimuli in pre-programmed ways and fails to anticipate future questions or

Behaviors now in conclusion as AI based on machine learning progresses it will become more difficult to destroy this illusion the basis of machine learning is that we need to ask whether a program learns through millions of observations and mistakes to anticipate and react accurately to future events without

Relying on pre-programmed code now in this way machine learning comes very close to my former definition of inherent agency as a constru structs its own reality to face unknown challenges machines are already embedded within our lives but as we start to treat machines as if they are almost

Human we may begin to develop habits that will cause us to treat human beings as almost machines and we need to consider not only what social robots are capable of doing now and in the future but also what humans will become by increasingly forming such relationships with these machines thank

You thank you Dr arenson um if anybody has any questions please go ahead far too many things are already going only over our heads and uh perhaps the mind didn’t want it or psyche works for the first time with our feelings and emotions the rest is a lot of Expos

Exposition and explanation we are going now immediately to our hypophysis and Trigger our amigdala and activate our left brain in it is this area of feelings movement and body language and the Art of Mind well this ability or the art of MIM is means it means wordless language

Which is 93% of our signals so the nonverbal communication and that has more to do with our million years old limbic system than our with our younger neocortex the cohesion of our physical sensual and mental balance this delicate mechanism is not only possible through efficient breathing it is the various

Methods teach us to use this unrecognized power classical mime wants to reduce everything that is possible in its pure representation and express the balance between thinking and feeling in a minimalist way in order to convey the ense of a message in the best possible and artistic way with concentrated almost invisible fine

Muscular strength the Mind unbelievably packs only what is necessary to allow deep human feelings to be experienced he doesn’t just show them he experiened them himself allowing his audience to share in them emotionally and that we will try now unfort unfortunately I can’t give you here a performance but I

Can try to invite you to be like children now and be still be astonished unfortunally Wonder has been lost in our world we are overfat and overwhelmed frighten it and mostly sublimate or worries you know certainly all the Beautiful film The Beauty and the Beast isn’t so well you remember when the

Beauty CES in there were sculptur and I would like know that you are all doing that you feel that you are a sculptor and she’s coming here from the right you know and just you only your eyes are looking now on the right I do it on the

Left that’s you see that’s on the right and you follow the beauty what is coming into this Castle now and the head is going first the eyes and then the heads and showing do all please all the same and you feel in this beautiful big castle beauty is coming hey

Look with you only with your eyes and she’s far away now and the sculptor go down the head again this is a marvelous feeling to make a sculptor living we are playing we are not playing we are working with our brains now but the left part and the limpic

System and all that what I did is with a long breathing a long one breathing the whole thing you know until on the end and then breathing out so with the three chambers the belly the chest and the back of the head but there’s another exercise what is the expressive expressive

M well I would like to invite you now immediately by the first now and you feel your children and you’re so happy for this first snow and this part of your body now is moving not your hand only the pulse and ah yeah please please feel this snow is coming oh yes yes

Completely difference if you would like to pick cherries so now we are all trying to pick cherries so you see the big tree ah you you want really now to to eat them already now what happen is in your brain is unbelievable for the moment now and you’re going with your fingers

You see here ah I taste the did you taste the Cherry completely different if you see an apple you want to pick the Apple it’s not with your fingers now is with the whole hand and your fingers you know and then it’s the water is coming in your mouth yeah and then CL maybe you’re very hungry maybe feel the waters coming out taste the Apple you can’t believe that’s a robot cannot do that it’s the whole body now and the whole brain is busy only with this taste and this Envy to do it just to try and you know

Uh it’s it’s different in our old facial expression but it’s with the whole body we are doing it we have a universal code for the mind for the body language it’s a universal in the whole world the same and nobody knows that but you know Leonardo DaVinci so vertical

Upwards with the hands with the arms Jesus Li this is air this is sky this is th this is mind vertical upwards so when I’m doing that here it means I’m thinking I’m thinking I’m thinking I’m I’m thinking it’s light It’s a Sky it’s blue just the opposite is when are going vertically

Downwards having heavy fire water feelings mother how deeper the vertical gesture downwards the feelings become great emotions horizontal left this is my own pasts here here my pasts my future so but if we teach somebody we are going we are in the front and talking to

Somebody we have to split we have to mirror so this is your future and it is your past I don’t know if you see me in a mirror now because this is my left side and it is your right side so so this is your future but it’s my past very

Complicated what the brains are doing but we see it immediately we understand people in the front of us Aha and you’re thinking about the mind it is something light it’s the father is the brain no it’s heavy it’s emotion it’s the matter it’s the past it’s the fure

Future is that not fantastic is that not unbelievable so maybe you are scientifical people you are from the medicine try to do it in a scientifical way to analyze what happened here in our brain this million and million of limic system it’s so beautiful to communicates Again

Naturally with each other I hope you enjoy it and I thank you very much je Mari bka living in Munich Germany thank you Dr pakan for the amazing presentation um if anybody has any questions please go ahead so um we’re going to be looking at what is health and all policies the

Focus of the research and then going into the research itself and the lessons learned and extrapolations so what is health and all policies or high up health and all policies is a european-based policy mechanism it employs a systematic approach based on population Behavior social sciences and

Both the need and influence of Health on policies specifically the strategy is to work horizontally across government sectors and not just in health to ensure that health is in every policy the goal is of prioritization of Health usually with a specific metric being targeted for instance the first iteration was in

Finland they focus on reducing the prevalence of cardiovascular heart disease or CHD and obesity in the 1970s they launched a project with health and all policies as its framework Finland invested in intersectoral collaboration integrating into existing policies and focus on epidemiology and social deterence of Health they were able to

Revitalize Health resulting in the 75% decrease in CHD mortality rate due to the multifaceted nature of the policy changes made the population’s use of butter on bread also dropped from 90% to 5% between 1972 and 2009 health and all policy mechanisms result in better more informed policymaking that can

Innovatively decrease burden of disease on the population this figure demonstrates the policy considerations and processes in coordinating efforts from a number of sectors of society to accomplish the health outcomes desired looking at the Spanish example not more than 50 years ago Spain was held tightly under control of conservative dictatorship since become

Becoming a democratic regime in 1978 Spain has achieved substantial Health outcomes with impressive decreases in mortality rates and increases in life expectancy as compared to other countries in the European Union for instance in 2015 Spain had the highest life expectancy in the EU with an average of 83 years compared to that of

80 80.6 years of the EU this is very powerful as Spanish GDP Health expenditure is less than that of the EU average these dramatic improvements are attributed to Spain’s national healthcare system which has made these strides for shockingly low price debt Spain spends 3.5 times less than the US

On Healthcare despite being a public system due to systemic efficiencies also Spain has been considered a model for newly industrialized countries to create uh an affordable and National healthare that addresses determins nonetheless certain Spains certain regions in Spain perform exceptionally more robustly because they utilize holistic approaches

Due to the ability of the autonomous communities to control over expenditure leving taxes Healthcare and reallocation funds so the question is why and how are these Healthcare successes achieved So In This research I reviewed 36 sources and I also travel to Barcelona Valencia and Madrid to conduct semi-structured interviews in Spanish with government

Healthcare officials I use Rapid qualitative analysis that I integrated into the literature review and then wrote the paper so our findings the biggest thing is that we focus on people and their needs Catalonia has assumed a singular approach based on the health and all policy model which has proven

Very effective in particular they step outside of the traditional roles of government oversight to forecast Visionary policymaking techniques One path that has been implemented in Catalonia is pla interdepartmental e inter sectorial Des salute Pua or pin stop which was first introduced in 2009 has since then had more iterations pin

Stop stresses the importance of developing policies that prze health and improving lives from multiple standpoints in 2016 the catalonian government approved policy legislator to incorporate a national sustainable development goals plan and ensure that the targets listed in the 2030 sustainable development goals agenda are Incorporated in Catalonia as such pinap

Seeks to optimize the health of the population the creation of Public Health policies and initiatives designed for health promotion its main focus is to emphasize the role of governance for health at different levels and not just a generalized National Healthcare by integrating Health into every policy put forth catalon ensured that decision-

Making prioritizes citizen health first and foremost when all shareholders are on the same plane better conversations can be facilitated to better avoid potential issues backed by The Who the most up-to-date pinap includes multiple objectives for implementation they have the priority to engage all levels of government and Society to positively

Influence Health this follows the 17 sustainable development goals to ensure sustainability and Equity next pinap looked to coordinate efforts amongst Department plans on all levels they acknowledg the individuality of different zones within the region and encouraged UTI utilization of resources in each Zone that best reflects the

Needs of the people in the area with that in mind pinap bolsters Community Health projects to improve all communities within Catalonia this ensures that not just communities are not just a few communities are cared for but that all are to improve life in order to promote a healthier Catalonia

Over 14 actions and programs have been introduced that have greatly improved the catalon lifestyle more specifically one of the most impressive reforms is the nutrition program Spang ranks ninth in the world of the 28 countries that have implemented sugar taxes worldwide specifically Catalonia passed law 5/27 as a means to regulate sugary

Beverages furthermore Studies have demonstrated the success of a Mediterranean based diet as such the government through the program coined ahed has aided in the accreditation of 500 plus establishments and 95% of hospitals to adopt a Mediterranean diet specifically the government has implemented healthier means in meals in cafeterias and

Schools and factories and that this gives more nutrition options for these populations another tenant of this program is the concept of M comia or menos this also in English means more change to less which is in accordance with the policy instructed by the 17 sustainable development goals this was

Branded as small changes to eat better this beneficial and instructive information clearly demonstrates nutrition simplistically so that the citizens can easily understand and utilize it to improve their dietary habits this engaging resource facilitates a conversation of the power of placing Health First this policy and its philosophy has positively changed nutritional outcomes

For school children and Factory workers they’ve begun to furthermore to prescribe exercise as a form of treatment for certain diagnoses this activity based prescription instead of pharmaceutical has manifested in a program called fit joov and there exist pilot programs in multiple cataloni municipalities additionally this idea exists outside the healthcare sector and

Promoted in the social prescription program where social activities and community particip patient are prescribed to promote quality of life with positive mental health the government works with the social enrichment and public zoning sectors to build free outdoor gyms as you can see in these pictures and public spaces to further impart awareness accessibility

And engagement for the population in this table we see that from the pin out policies that extend from the catalonian government to the localized program that are horizontal measure the healthcare outcomes have vastly improved across multiple sectors as you can see in the table life expectancy has improved as

Well as mortality for 1,000 habitants habitants and tobacco consumption nevertheless there are of course key issues that language such as obesity obesity is influenced by many factors including social environmental effects in response to this weight epidemic the catalonian government has responded on multiple levels they’ve introduced taxes

On select unhealthy foods such as the sugar tax that we talked about earlier improving public transportation increasing education around obesity and nutrition and working alongside architectural authorities to control and diminish the prevalence of obesity in Society so the question is what lessons have we learned from this first is the

Intersectoral approach health is and is always an aspect of life that interweaves all other soci economic factors policy changes must be introduced to improve communication and coordination thereby introducing horizontal collaborative Partnerships across government sectors there is an accountability that exists as a main tenant of health and all policies

Understanding Health as a priority the first measure of implementation towards a Better Health care system is aligning the vision and actions of policy makers plus underscoring prevalence of healthcare and policy and decisions it has been found that when health is improved education is more readily accessed income security is improved and

Unemployment and social exclusion is reduced this enhances capacity building and creates more proactive conversations about health win-win strategies policy makers must take into account the agenda of each stakeholder shared objectives and what instrumentation is available for oper operationalization this step is is built on respect amongst policy makers with

The knowledge that a reciprocal relationship is beneficial furthermore without each consolatory shareholder contributing to improved healthare policy or if certain agents act as free riters without reaping the benef by reaping the benefits without eating themselves health and all policy will fail therefore once again accountability is Paramount to success there are of

Course prevailing challenges with something like a health and all policy model larger scale implementation would require willingness to coordinate human resources and the planning of fiscal um uh resources and therefore needs and contribution on both vertical and horizontal ples of government and power tenants of health and all policy

Acknowledges and works with prevailing inequities but may be difficult to sustain on a grand scale while has been successful successful a number of regions and different smaller countries like Finland larger health systems are often entrenched in a battle of delivering Healthcare and bureaucracy through the AFF forementioned Implement implementation techniques health and all

Policy can be realized and successful in serving a population so extrapolation how can we utilize this in other countries we must engage the local community revise Health reporting create sustainable changes build Bridges and prioritize health for a step in this direction it is necessary to introduce or revise Health reporting systems to

Understand precisely where regions are lagging concerning Health outcomes attaining the next level of Health outcomes could require a significant upheaval to the current status quo and policy perspectives but a health and all policy approach could be what is necessary in order to sustainably bridge Science Care and policy thus determinant

Can be addressed proactively by enabling the system to predict Health outcomes and consequences of policies thereby reducing not only the amount of trial and error but also the expenditure on health these lessons can provide directionality for other Healthcare Systems if other countries employ a model that works across sectors and

Champions its population needs citiz will have a better quality of life transiting in all aspects of life including an increased productivity and it may reduce inefficiencies in spending on in government on the Long Term champing Policy structures based on the cataloni health and all policy model will increase dialogue surrounding the

Perance of Health a reformed policymaking process will materialize an effective coordination tactics where every key component is involved during policymaking processes ultimately a health and all policy model allows for optimal experimentation evaluation planning communication efficiency and policy decisions that directly involve and ref the regional population and ultimately uplift the national

Healthcare System by no means will inequities or inequalities disappear overnight each Country Must action a successful policy process where all shareholders can and will contribute it benefiting from the win-win strategies I mentioned earlier in summary in order to facilitate a holistic process across all regions from the individual citizen to

The national government the Visionary catalonian Healthcare policy should and can be extrapolated to to subsequently be successful in implementing life improving Health outcomes on a broader scale thank you so much to the Victor scholar research Grant which funded This research when I was in my undergraduate at wake Force university in the United

States thank you to clasis Pena and JMA Miranda and thank you of course to this conference on the global Healthcare and intution that allowed me to to present this today here we see um the link if you’d like to scan this OR see this later this is the link to the full

Research as well as my LinkedIn if you’d like to at all later thank you very much and I look forward to any questions should you have them thank you so much Dr trer if anyone has uh any questions please go ahead General practi specialist Mor okay good morning to everyone today I

Want to explain our project about quaternary prevention and hm medicalization and about fragility disease and Ling approximately 15 20% of passion doctor meetings are defined by the ladder as difficult difficult passion are defined as those who h strong negative emotion for their Physicians if not acknowledged and managed correctly these feelings can

Lead to diagnostic errors unpleasant confrontation and Troublesome complaints and legal claims so there are no difficult patient but difficult relationship due to characteristics of the patient the doctor or influences of society uh in this second and third slide we can see different tables which administrated to the attending general medicine

Course the a of the study is evaluate the relationship of the paent with over medicalization and how much it can affect the clinical practice and public material and methods work group of the vocational training of general practice of a agent has devation from on difficult passion and over medicalization which was

Administrated to doctors who attended the general practice office in this table um we uh we can see the questionnaire was was subed to1 doctors attending the specific train course in general medicine in this table and in particular in First Column we can see different type of patient hypochondriac elaborating psychological nonmedical

Source excessive medical appeal exent suspicious lie and other in the second column we found the number about each patient in particular in the first line we are with 97.5% hypochondria patient follow by not collaborating excessive medical appeal and on medical source with 95.9% in the third column we have

Excessive and inadequate use of health services and we found which 51.2% about excess of medicine causes Dage to health we found not collaborating with 28.9% followed by psychological with 24.8% and followed by sup um for 24% finally um uh here we have use of validated Medical Practice where the

Benefits are not clear potentially armful and of w and we find we found nonmedical sources for 51.2% followed by no collaborating 32.2% uh in this table we can see four different definition uh prevention but the most doctor answered correctly with 76.9% like action taken to the identify patient at risk of over medicalization

To protect them from an aggressive medical approach and suggest intervention that are ethically at a table in this table in the first part we found pathologies in which we can found the over medicalization in particular we found chronic generative disease with the 35.5% followed by acute disease and

Cancer the second part we found pathologies which there is an Evidence of over diagnosis um so uh we have demia with 42.2% followed by hypertensive Earth disease 3.9% and followed by mayor depression with 32.2% here we can see um the causes of over of sov medicalization and in particular with

60.3% we found lack integration between MMG and specialist followed by um defensive medicine with the 58.7% followed by comp competence reports depression record of patient with 55.4% followed by mass media pressure with 36.4% and finally followed by economic reason with 33.1% like industrial pressure professional interest and social

Cultural in this graph we have underlined through our study uh that quaternary prevention can be linked to disease to illness pathologies but we have a greater con option um caused by pathologies that are poorly codified or by um Luby like um defensive medicine or mass media pressure stable so um we understand that

Quaternary prevention has many limitation and so it takes a lot of studies to improve our ordinary work uh we present the table to improve the health system uh about some Advantage um for example we have uh we can have Implement in the last years of University uh the Practical intership of the general

Practice uh or um uh coordinate the execution of examination and Therapies in comorbidities uh adoption of standard designed protocols and tele medicine for example um clearly after um internship and practical uh medicine um about conclusion it emerged that from the observation of the colle collaboration between various figures general practice and specialist is

Opportune to better identify the so I have finished it I hope that it was interesting uh thank you thank you Rosaria and thank you Dr Ki for the amazing presentation if anybody has any questions please go ahead so here’s the overview I’ve in ruce the concept of larger language

Models Healthcare Training topics larger language model applications and challenges in healthare and the future perspectives so to start with what are large language models so large language models are Advanced AI algorithms focused on processing human Languages by using deep learning and was Text data sets make them a part of natural

Language processing and which which is also called NLP you can find the development milestones of NLP starting by 2013 from the graph during 20 2014 to 2018 Google introduced the world to Vector sequence to sequence Transformer and the bird rwork and later opening eyes gbt2 and gbd3 released in 2019 and

2020 respectively marked a new era in AI text generation capabilities and then CH gbt came out in 2022 forther bridge the gap between human and AI communication making inter interaction more similar than natural and nowadays in in your real sense the most applicable language models are gbt 4.0 from openi B from

Google and Cloud to from ropic and llama fora so in the graph in our examination of contemporary Healthcare we identify several key aspects that have undergone extensive investigation yet continue to offer expensive opportunities for future exploration the personal the personalized treatment plan digital health records patient data analytics medical regulations patient

Interactions Global Health monitoring professional medication education enhancing Diagnostics okay now let’s think about how the large language models can be applied in health care especially for those and those aspects mentioned in the last slide for the text for the medical text related task like data management medical documentation generation Health

Literature review professional education Can it can easily convert unstructed data into structed data for easier reading or further processing with the help of large language model for the multimodal medical data the large langage model could also be beneficial by joints text and imaging analysis from symptoms and patients histories to provide quick diagnosis

Instead of waiting days or weeks and additionally they can enhance the communication across the language barriers and help patients understand the medical information more clearly so that’s the power of large dung model okay so so nowadays the large language models are more integrated with the healthcare system in the form of

Chatboard so typically this kind of chatboard systems consist of several key modules like the natural language understanding knowledge base dialogue management s sentiment analysis personalization M model inter action but consider the example from film Big Hero 6 where the character bmax introduc introduces itself with a line hello I’m Baymax your personal

Health care companion how can I help you so in response the protagonist eror simply has to issue a requested in format of hey bmax could you based on this request bmax then activates the relevant subsystem to provide an appropriate response and this interaction exemplifies the the the

Concept of prompting in the context of large models since I typically operates as a blackbox researchers s end uses Mastercraft specific promps to elicit the desired responses and the effectiveness of the interaction largely depends on how accurately these prompts are formulated to guide the towards to the intended

Output okay so turning our attention to some real world implementations let’s discuss the M PM um a substantial large L model with 540 billion parameters developed by Google this model is specifically to deliver high quality responses to Medical inquiries remarkably the medom has demonstrated an impressive accuracy rate of

86.5% on questions styled after the United States medical licensing examination and medom is distinguished by its ability to generate detailed useful long-term long form answers to consumer health questions and these responses have been regular rigorously evaluated and validated by panels of Physicians and users for their accuracy and utility looking towards to the

Future there is a potential for metap Palm to surpass human performance in certain aspects representing a significant advancement in Aid driven Healthcare Solutions and this one in my research conducted earlier this year I focus on utilizing chpt uh which is also large langage model to autonomously connect information from patients and

Generate useful medical case reports without the need or a direct intervention by medical professionals and throughout the experimental phase the chbt demonstrated the ability to accurately extracts essential information and produce precise responses Guided by specific prompts with the implementation of a predefined structure for case reports and Sor and through multiple

Rounds of prompt tuning and CHT was able to produce transcri transcripts that were reasonably accurate and the detailed and the third one okay so you can see two figures in the in this Slide the figure on the left illustrates the T the T medicine application CH doctor which leverages

The open source model Lama fine tuned with medical question and answer data from the actual cases in from um I clean it remarkably this approach has has achieved a Precision rate of 84.44% slightly surpassing ches 83.7% in similar tasks and on the right we observe the metap pals capabilities in

Interpreting medical images and this system not only comprehends the content of the images but also can provide detailed analysis and segmentation show showc casting its Advanced functionality and while there are numerous other Explorations and imputations in the field space constraints limit the inclusions in this presentation however it’s important to know that this

Examples represent only a fraction of the potential applications and advancements being made with ls in the healthare so of mentions application highlight the considerable potential of large language models in enhancing Health Care Services the large large language models significantly improve the speed and accuracy of clinical documentation and data entry and additionally they

Facilitate the extraction and synthesiz of information playing a crucial role in DEC in decision making processes through advanced language anal es however it’s imperative to acknowledge that the large language models in health scale are not without the challenges so key so there something needs to be think about the firstly the the data

Privacy the safety and adequacy of VES in place to protect the patient privacy and the potential for biases in responses generated by these models and lastly the operational transparency of these models particularly in terms of compliance with existing Healthcare regulations and standards and those problems are not

Easy to solve and probably in a long time people will keep working on that okay the last one so I’m quite confident that in the near future the larger language models will play an integral role in transforming the traditional healthare their impact will extend far beyond just a few areas we

Are looking at the future where large models contribut significantly to Advan the personalization offering bespoke Health Care Solutions P to individual in needs they opposed to enhance the diagnostic tools providing more accurate and neurons diagnosis in tele medicine log models promise to facilitate smoother and more efficient patient provider interactions and the

Integration with smart variables will enable realtime Health monitoring and insight and insight in Surgical and Rehabilitation robotics the large range models can offer precision and adap adapt adaptability they hold the potential to revolutionize The Clinical Choice and research making this processes more efficient and the large langage model we also support augmented

Decision making providing TS with data driven sites Additionally the role in automated health education will be provoked in dis disseminating personalize the health information and lastly the development of ethical AI Frameworks will ensure this this advancements are implemented responsibil with responsibility and with equality and this is a reference thank you any

Questions thank you so much for your presentation if anybody has any questions please go ahead uh this morning and as we know with the ever increasing Global World um bilinguality is becoming is prevalent in all areas of life including health and Medicine uh what I’m going to talk about

Is a series of studies that was done in the past few years about bilinguality and code switching let’s first Define our Concepts bilinguality is defined has a capability to speak more than one language there are different kinds of bilinguality simultaneous is when you learn both languages during childhood at

The same time sequential is when you one learns one language first and then the second language is learned a slightly later and late bilinguality is when um language the second language is learned during the maybe high school or college Years um in percentage wise all over the world

Bilinguals are um ever increas in population although historically um bilinguality it was even in the country I live United States was very prevalent more prevalent that it was now that it is now currently between 50 to 70% of the world population um are bilinguals considered and 66% of children in Europe

It’s about 56% of Europe according to European commission survey in 2006 Canada has 35% unfortunately in United States the percentage ranges from 18 to 20% uh why is why should one be by lingual what are the advantages what are the disadvantages um advantages of bilingual have been proven through scientific

Studies in the past 50 60 years uh one of the advantages is sustain attention and bilingual seem to be um being able to pay attention closer to the task at hand uh inhibition when a bilingual speaks one language there are two languages in the brain that could be

Activated the bilingual has to inhibit one language and release another this capability to inhibit something it’s really helpful in doing all sorts of cognitive task and in life and other one is of course a bilingual and monolingual switch between one language to another so bilinguality helps you in switching

From one cognitive task to another and bilinguals are also seem to be slightly better in managing distraction and they seem to be having better attentional control as they grow older this results in one they seem to have a slightly better academic achievement and for bilinguals just like monolinguals do get a dementia however

Because of the more robustly you know exercise brain H they seems to be the signs of dementia even though the brain structures are equally damaged as monolinguals bilinguals show these signs much later some of the studies show as late as five years later in addition a bilingual Sy to have a

Cognitive mechanisms that um it seems to be uh a structurally a slightly changing the brain is brain which um in turn enables them to be better at cognitive task and also they have the ability to communicate with diverse groups and which is obviously being able to speak more than one language enables

You to communicate for with more people finally they seem to do better in jobs and travel as a result of capability to communicate with more people what are the disadvantage of bilinguality obviously the bilinguals have two lexicons two mental dictionaries at the size of each one of these is a slightly

Smaller than monolinguals who only have one they have less um a slower and less accurate naming pictures again accessing two different um mental dictionaries sometimes it takes a slightly long and also when they are trying to retrieve award seems to be require a little more effort um now code switching what is

Code switching code switching is um defined as moving from one language to another could be a phrase could be a clause or complete conversation more than a word because a word does not count as codeing that’s code mixing H this is a strategy that it use among all

Languages all bilinguals who speak all sorts of different languages all over the world why would someone Cod swi there are many reasons for it one is would be the you know if bilingual doesn’t know a word in one language they utilize the other language they sometimes need to paraphrase something to get their

Meaning across better or when there is no exact equivalent in one language versus another so there are many of the Eastern languages that have words for um dignity that are very much more subtle um um honor things like that that are more subtle than some of the western

Languages um the social reasons for it why would you cot Swit would be one would be to exclude other people so if you are having a private conversation in a public place it is helpful to code switch to a language people around you don’t understand U want or wanting to

Include others so there other people walking and you know you want to include them in the conversation uh sometimes it is a social tension in when there is a conflict and sometimes um you know is a way to distance yourself especially some studies show some people say tend to

Avoid a cursing in their own first language but they they are more comfortable to do it in their second language or talking about private matters um and then also is is using utilizing two languages it’s a way to emphasize an important Point um this is the first one of the

Stud is that we done um about um my myself and my lab about code switching what makes people code switch is it possible to cause code switching under laboratory condition so to see what really brings it on in terms of the social Co reging not psycholinguistic um first is um and what

Are the factors what are the backgrounds in one’s linguistic history that makes a person more likely to co reach our first study was done in 2015 the study I came up with a design that myself and my lab I have been utilizing in a number of years and that

Is um for the first study there were 24 bilinguals they were all Spanish four men 20 women um I work in a university that um is about 60 to four 60% women to 40% men and especially in Psychology department there are more women than men so that’s why they kind of slightly SK

Skewed population um what we did um the design that was uh took place was that the participant are invited into a room they have a they are told that their interview is going to be purely in Spanish and no word would be spoken in English they’re asked to participate

Only in Spanish and not to switch in English obviously the participants have to be uh capable of bilingual enough to be able to sit through a um half hour interview the questions that are asked are about their linguistic history about their um you know family history of

Language and their what their work their life um simple um everyday conversations about uh halfway through the interview uh the inter interview is interrupted by a monolingual person who does not speak Spanish comes in that ignores the participant approaches the interviewer and ask them some questions as you see

These are obviously not these are my um assistants not um participants because it would not be ethical to show the participants H and then the person remains in the room as you see the young woman with the clipboards comes in approaches the interviewer asks the interviewer number of questions in

English and then remains in the room without ever engaging the uh the participant after the completion of the interview the uh the participant completes an online 87 question all in English um questionnaire about again their languis history and all that uh the interviews are recorded audio tapes

Videotape um the point of this is this at what point the person who is told not to Cod switch it starts Cod switching would it be after the the interruption was done by a minor lingual so to including the monolingual in the conversation or realizing oh the person was interviewing me also speaks

English um these are the kind of questions that they would get in the in the questionnaire you know some obvious one do you speak a different language all that and how how fluent they are where did they learn the language and how often do they speak the language so the results show that

33% of the participants in fact code switched uh although they were told not to and this was all after the after the interruption um they seem to be um the coast SES are seem to be older um population and also more likely to commun be community members and the

Mothers were born in the US uh so um the that study just showed us it is technically proof of concept it is possible to quot induce cot s on the laboratory condition then we continued with this another study in 2018 what if there is something about Spanish language and culture that makes

It a specific that people are more likely to cach S what if we try four different languages uh and see if the cing can be um induced in those languages so we included the Spanish but added French German and finally Arabic Spanish French and German obviously are Proto Indo European languages and Arabic

Is afroasiatic language for each group there were 20 participants and um each interviewer was just like the previous study native born completely fluent a speaker of language we steered away from anybody who um the any interviewer whose language was a second language we wanted you know native born German native born Arabic

Native born French and Spanish the same experimental technique was followed and these are some of the information about the characteristics of the participants uh for a Spanish age range ranged from 18 to 60 um French 19 to 62 German 17 to 74 and Arabic speaker

20 to 52 um and mean Age and what percentage the English was their second language and what percentage their mother was born in the United States um the results show that again 10% the smaller percentage is that previous study of Spanish speakers C 55% of French at 20% of Arabic speakers but

None of the German speakers ever C switch during those interviews um Spanish speakers um who Court which were again older age and um an age of a language acquisition did not seem to make it difference or for Spanish French and Arabic um and there was non significant um you know if it

Was um quot or non quot based on anything age you know a fluency comfort in speaking or frequen of embarrassment in speaking in public the conclusion of this study was that um you know seemed to be um on other languages we can induce Cod switching on the laboratory condition but not in

German and um the question the puzzling aspect was why not German well obviously uh it is well established that German uh grammar is much more rigid and Rule based than most other languages that may have something to do with that if you’re believing the waran hypothesis and um

That you know sometimes um the structure of the language influences this the way that people uh think and interact with the bo uh this brings me to the actually the most recent a study that was conducted in 21 and this one we went back to um interviewing um another group of

Subjects this time uh only 52 Spanish bilinguals but uh the there is a difference in the design of this study uh the question was what if people not Germans but all the other speakers just that random C switch and does nothing to do with the interruption or a

Monolingual being present in the room so for this study a controlled um group was created so the participants were uh assigned at random to the control or experimental group um and um you know the interviewer didn’t know who is going to be in which group um only the one of the

Experimenters know and so with the group that was experimental just like before a monolingual cot um um monolingual person researcher enters the room engages the interviewer in English remains in the room until the end of the interview for the control group no one enters they intervie view goes on just like from

Beginning to the end and with no interruption uh what and these are the participant characteristics 18 to 24 mean age this one we even stayed away from the community members we tried to purely have a students um that were students at Queens University and um there were 100% of students a percentage

Of uh male female um again in um experimental and um control group was very similar um and mothers born in United States was very similar so we tried to keep everything um you know the same except for one group was interrupted and another group wasn’t um post Interruption results

Showed that again experimental group um before the interruption um participants only qu reach 12 % among the experimental and 19% among the control group post Interruption 38% in experimental and 4% in uh in control groups so obviously and significantly Interruption by a by a monolingual and remaining in the room

Somehow push the bilingual to code switch and use more English in their conversation so based on all these three studies um if clearly Cod switching can be induced in English Arabic and French speakers um it could not be induced among German speakers and cod sing took place um significantly more often among

Spanish speakers um and which you know the which were interrupted by a code switch by a experimental and resulted in their code switch currently we my lab is conducting a study on German speakers among the students of the University with control to see one if we can replicate the result past result that

Germans simply do not Cod switch and two if um in fact and the if there is any code switching does it happen after the interruption or before the interruption um these are my sources and my gratitude to uh my um students any questions I will be very happy to

Answer um hello yes thank you for that Dr hosted I actually do have a brief question um you know this has been very interesting I I’m SP speaker I think please very good um so the topic I would like to discuss today is um a large lung

Absis in a young female patient so um as we know lung abses refer to a focal cavitary area in the parena filled with pent or necrotic um necrotic material usually is the result of a microbial infection and um the way you would know it is based on clinical presentation and

Um and symptoms so uh a lot of times lung abses are kind of C categorized as primary or secondary primary is direct infection of the lung current command usually this is the result of aspiration with uh organisms like staphilococcus strepto cacus anerobic bacteria Etc uh secondary lung

Abses on the other hand are the result of you know underlying lung conditions like bronchial obstruction by a tumor um septic embo or other uh host related uh factors like impaired uh host defenses immunity Etc um more recently since 2019 the event uh the introduction of electronic cigarettes we have seen a few

Case reports and cases of um ecigarettes being associated with the development of lung abses so um going to our case um we have a 21-year-old female with a past medical history significant for anxiety for which she takes an anti-depressant came to the emergency room with complaints of

Fever uh cough and lipsed pain she didn’t have any Associated um symptoms including weight loss or night sweats or joint pains um new swelling new rash new lymph anop nothing of that sort um sort of pinent U medical history is that about 2 and a half weeks ago she had a

What appeared to be a URI which Got Back with conservative management no um history of sick contacts no recent travel um she denied smoking tobacco products or um consuming alcohol or other recreational substances she did how endorsed to using electronic cigarettes with nicotine for about six months prior to

Presentation so hor vital um other than some mild sinus Tachi cardia on presentation everything else was okay um her physical exam showed some coarse lung sounds on oscilation on the left upper chest and um initially a chest xray was obtained which showed a cavitary um left upper Lo Consolidated

Opacity and so subsequently we obtained a uh computed tomography of the chest uh which showed a complex loculated uh fluid and gas cavity in the left upper low measuring it was quite large measuring up to 14.5 by 13 3 cm uh with some adjacent airspace consolidation the right lung the right

Lung looked okay and the plural space was okay as well um if you guys could look at the CAT scan the cat the cat scan image on the left that’s the CT image on presentation um so her lab data was significant for lucyisanerd protein her urine drug screen was negative for other recreational

Substances um Co influenza PCR testing rapid respiratory viral panel testing was negative uh we also obtained blood andp blood and sputum cultures which were negative as well uh Legionella streptococcal urinary antigen was negative beta Del glucan um galao manin HIV four generation testing quan4 on tuberculosis test were also negative um

Some people might know this fact so uh Indiana Ohio are endemic for some fungal infections like histoplasmosis blasto micosis so we obtained serologies for those as well which were negative so um we admitted her uh we started her on broadspectrum antibiotics initially vomisin and pipelin tazobactam to cover uh broader

Uh microbial micro broader microbes and um she she started improving in a few days we did um have this concern of you know the cavity being very large if just antibiotic therapy would be enough so uh we kind of discussed this with infectious diseases and CT surgery as

Well and and everybody kind of agreed to the fact that um we should treat it with antibiotics first um and in case of any nonresponsive non- respon no responsive treatment or other complications along the way then we would consider uh like a percutaneous aspiration but otherwise um the recommended treatment for lung abses

Is a prolonged antibiotic therapy for at least four to six weeks so we kind of went along with it and um so we started her on pretty broad spectrum IV antibiotics switched her later to augmen in on discharge and um she completed a six- week total therapy with

Significant Improvement uh we obtained a repeat CAT scan around four to five weeks and you can see the CAT scan image on the right which shows Improvement like actual res resolution of the air fluid level she is left with the cavity which I believe is to be expected when

You have such a large cavity on presentation and she had no fevers her appetite actually started improving she we recommended she stopped using electronic cigarettes which she did um so coming to the discussion part of it you’re all aware of uh lung abesses they are not extremely common in clinical

Practice but they do happen uh I think the most important um two most important things in this case are one what do you do for really large lung abses you know do you go ahead and consider interventions like you know percutaneous drainage Etc or do you stick to the

Usual antibiotic therapy for a longer duration so we did some literature review to see what’s the data behind it and um all that all the 99% of the studies actually support you know going ahead with good antibiotic coverage for at least four to six weeks and percutaneous drainage or chest drainage

Is still a second line approach and you do them in cases where they are not really responding to your treatment and the reason why uh it is considered a second line therapy is because uh they can have they can have complications when you when you attempt uh interventions like that including uh

Bronol plural fistula spillage to uh spillage to your plural space infection Etc and coming to the second uh second learning point in this case is you know we were quite um we were quite surprised how a healthy female would develop you know such a large lung absis without any predisposing condition so uh

We were suspecting if her electronic cigarette use has something to do with it so as we all know uh using electronic cigarettes has um a lot of pulmonary manifestations and broadly it’s termed as evali electronic um ecigarette or vaping product use Associated lung injury initially recognized in 2019 and um iali can be

Can include pulmonary manifestations like ards acute exophilic pneumonia hyper sensitive D neumonitis organizing pneumonia lipoid pneumonia pneumothorax pneumo medianum Etc there are some case reports where uh electronic cigarette use is associated with uh development of lung abses and we hypothesize that that would have had some role in the patients

Development of uh lung absis um fortunately the Patient responded uh really well to antibiotic therapy without need for any any interventions um yep if anybody has any questions I’ll be happy to answer

3rd International Webinar on Global Healthcare and Nutrition | November 2023 | Part 1