Summary responses from Likert scale-based student satisfaction responses were collected. A total of 24 students took the course: 12 in each offering. Performance was similar whether the student was assigned to the evaluation team or the clinical team for all of the comparisons . Students were very satisfied with the course. Of the 19 questions assessing the qualitative aspects of the course, all of the students agreed or strongly agreed to 17 statements, and all of the students were neutral, agreed, or strongly agreed to the remaining two statements. Direct participation and active observation in simulation-based experiences appear to be equally valuable in the learning process, as evidenced by examination performance.A three-credit, simulation-based, emergency medicine elective course was designed and offered to doctor of pharmacy students for two years. The primary objective was to determine if there was a difference in exam performance stratified by student simulation experience, namely either as an active observer or as part of bedside clinical care. The secondary objective was to report student satisfaction. Examination performance for simulation-based questions was compared based on the student role  using the Student’s  High-fidelity simulation has been used to imitate a behavior or process as part of training in military, aviation, and medical professions . Its useThe sole professional pharmacy degree in the Unites States is the doctor of pharmacy (PharmD). Doctor of pharmacy degree programs must be accredited by the Accreditation Council for Pharmacy Education by meeting minimum standards in the professional curriculum . CoursewOver the last decade, emergency pharmacy practice expanded in the United States, with recent data indicating that 16.4% of hospitals were assigning a pharmacist to the emergency department (ED) . The praThe elective course was called Topics in Emergency Medicine, a Simulated Approach. It was designed to give students the opportunity to expand their experiences and practice pharmacy in a simulated hospital setting that included both clinical and operational pharmacy experiences. It was offered and capped at 12 students in the spring semester of the second professional year in a doctor of pharmacy program. Bedside simulation activities were conducted using the simulation suite housed in the college of pharmacy building. The simulation suite contained a high-fidelity mannequin  and was made to look like a hospital room a. It hadBoth didactic and simulation-based educational strategies were used for each week of this three-credit elective. Topics were chosen by the instructor based on their ability to design simulation activities, and when pharmacotherapy principles were essential for the care of patients in an emergency setting. Each week, a new disease state or condition was covered in a 75-min lecture-based class. After about three weeks of fundamental material, specific clinical content was introduced. Topics included: basic life support, advanced cardiovascular life support, anaphylaxis, electrolyte emergencies, hypertensive emergency, venous thromboembolism, seizures, acute ischemic stroke, acute toxicology, and rapid sequence intubation with post-sedation management. The lectures served as the foundational knowledge that students would need in the simulation experiences. The next 75-min class period was devoted to simulation experiences. At the beginning of the semester, the instructor assigned each student to one of two teams. On simulation days, the class would report to either the mock pharmacy or the simulation area based on their assigned team. Each team had 35 min in each area every week. The teams would switch and report to the other area (mock pharmacy or simulation area).Although the main focus of the course was related to emergency pharmacy practice, students were also given the opportunity to experience the operational aspects of a mock hospital pharmacy. When the course was designed, the instructor wanted learners in the course to experience a full sense of realism whenever possible. Using the mock pharmacy allowed expanded realism, decreased group size in the simulation suite, and allowed the practice of previously learned skills such as making parenteral compounds. For example, if a medication was needed in the simulation suite, a verbal order would need to be called in to the inpatient mock pharmacy, and subsequently the medication would be prepared, checked, and delivered to the bedside. These steps of the medication use processes are important for pharmacy practice in the hospital environment. They allowed students in the mock pharmacy to exercise practical skills while increasing a sense of realism. As students reported to their assigned area, they would learn their assigned role for the day. There were six defined roles in the mock pharmacy. These were designed so that students would have a variety of rotating experiences. Each role had an associated letter labeled: A, a, B, b, C, c. The roles and responsibilities were reviewed prior to the first simulation experience, and the definitions of each role were included on printed instructions located in the mock pharmacy. The responsibility of each role was as follows: ‘A’ received telephone orders, entered the orders into the pharmacy order entry system (Neehr Perfect), and answered the drug information question. The role of ‘a’ was to help the ‘A’ with the drug information question, verify the appropriate entry of the medication order, and print any labels that were needed for the telephone order. There were two roles  focused on parenteral medications. One was responsible for cleaning the laminar flow hood, and they were responsible for preparation of parenteral products. The other role was responsible for checking a pre-arranged intravenous (IV) batch. This was typically five to six products that contained two to three planted mistakes. Any mistakes identified required the student making parenteral products to prepare the correct product. The final two roles  were focused on the entry and verification of admission orders. Printed orders were provided, and medication orders were entered into the pharmacy order entry system with subsequent verification. All six roles were intentionally designed to provide students with practical experiences in inpatient pharmacy environments. Since the course had multi-week simulations, each student had experience in each role.The teams in the mock pharmacy use operational pharmacy notes to track the completion of their tasks . This teThe other team was further split into two groups of three, and reported to the simulation area. One group entered a classroom adjacent to the simulation suite, and was responsible for evaluating and debriefing the clinical team that was taking care of the patient. If students were on the clinical team one week, they would be on the evaluation team the following week, and vice versa. This allowed an equal distribution of experiences. They had several camera views projected onto a large screen of the team interacting with the high-fidelity mannequin in addition to a feed that showed the vital signs and waveforms  of the mannequin. The debrief team used a form that was designed for this class to guide the debrief of the clinical team on five domains , and provide feedback on areas of strength (+) and areas of improvement (delta) for each domain . The three students who were assigned to the simulation suite had limited or no information about the patient before entering the room. However, students were aware that the main problem would be from the previous class’s didactic material. When they entered the room, they needed to gather information from multiple sources. Information may come from an actor playing the part of a family member in the room, the patient, the medical chart, or a combination of these elements. During the 15-min simulation, students needed to synthesize the important information that was necessary to make decisions . If the patient required immediate treatment, including pharmacotherapy, it was the students’ responsibility to order it from the mock pharmacy (if not in the crash cart) or administer it to the patient (if it was in the crash cart) with appropriate reassessment. At the end of 15 min, the simulation was terminated, and the clinical team had 15 min to compose a clinical progress note. During this time, the debrief team (those watching from the adjacent room) also used this time to discuss their observations and complete the debrief form. After 15 min, the debrief team entered the simulation suite and guided a discussion about the team’s performance, including positive elements and opportunities for improvement. Similar to the mock pharmacy experience, the roles of students rotated from week to week, and each student had multiple experiences with each role throughout the semester.During simulation days, the main role of the instructor was facilitator. Due to the time-sensitive nature of each activity, the instructor would provide time cues or delegate time cues as appropriate. However, every effort was made to avoid entering the simulation room until the time was up with the high-fidelity mannequin in order to preserve authenticity. The instructor would stop into the mock pharmacy and ensure there were not any questions or technology issues. Oftentimes, students would ask about procedural issues that they may face as a pharmacist in a hospital setting. While the debrief team watched the simulation, the instructor could probe the small group for questions on how the simulation group was doing with communication, therapeutic decision making, acting on critical vital signs, or similar lines of questioning. All of the simulation events were recorded, archived, and available to the instructor for review. This investigation focused on two areas of assessment. The first was performance on examination questions stratified by student role in the simulation , and the second was student satisfaction with the course. Performance in this course was evaluated through assignment completion, participation, and examination performance. A total of 55% of the course grade was group performance, and 45% was based on individual efforts. Group efforts were graded through assessing clinical (25%) and operational pharmacy notes (25%) against a grading rubric. Additionally, groups were assessed on their debrief note and discussion with the clinical team (5%) Individually, students were assessed for professionalism and participation (10%) and performance on two written examinations, a mid-term (17.5%) and comprehensive final examination (17.5%). The examinations were paper-based and included fill-in-the-blank, multiple choice, and matching. The questions covered material from simulations and the didactic portion of the course. Twenty-four students were enrolled in the course: 12 in each semester it was offered. One student in the second offering of the course was unable to finish, but did complete the mid-term examination and associated course activities. t-test, clinical and evaluation teams performed similarly on mid-term and final examinations over two years. The amount of each examination that was directly attributed to simulation objectives was: 25 out of 50 (50%) for the mid-term in 2015; 57 out of 77 (74%) for the final in 2015; 19 out of 52 (37%) for the mid-term in 2016; and 37 out of 77 (48%) for the final in 2016. The course design allowed students to equally experience simulation at the bedside and being part of the debrief team. Examination questions were written based on learning objectives for the didactic portion of the course. Some learning objectives were reinforced during the bedside simulation activities. Content on examinations could be derived solely from the didactic lecture or, when it was also experienced, in the simulation suite. Using the simulation objectives, the instructor determined whether every question on mid-term and final examinations addressed experiences in the simulation. Since students were either on the clinical team or evaluation team for every simulation, this allowed for a comparison of exam performance on questions directly addressed by their role in the simulation experiences . Using tFeedback on the class was sought from students using a standard course evaluation instrument and a supplementary set of questions specific to this course. These evaluations were administered during the last week of each semester according to guidelines established at the college of pharmacy. Each question or domain was assessed on a five-point Likert scale . Students were also free to submit open-ended comments. n = 68; 94%), and were categorized into seven categories: Enjoyable (n = 23), Challenging (n = 10), Effective/Beneficial (n = 10), Teamwork (n = 2), Realism (n = 8), and Learning (n = 15). The comments that were related to improvement opportunities included two that felt increased time for simulation would be beneficial, and one desired a different pharmacy order entry system.Students rated a total of 21 evaluative statements. The course was very well received. All of the students agreed or strongly agreed to 19 of the statements, and 95% agreed or strongly agreed to the two remaining statements. No statement received a score of less than neutral. The complete results are shown in In this novel simulation-based emergency medicine elective course, performance on objective examination questions did not differ based on participation in bedside simulation activities on the clinical team or active observation through participation on the evaluation team. Additionally, the course was well received, and students felt that the experiences prepared them for authentic patient care activities. This course is unique in educating pharmacy learners in emergency medicine because it provided repeat simulation experiences over the entire semester. This repetitive element is a core feature that leads to effective learning using simulation . Only onStudents were exposed to eight to 10 simulation activities. For about half of the activities, students were active observers of the clinical team in the simulation suite, and for the other half of the activities, the students were active participants as part of the clinical team. Simulation-based learning activities allow students to practice taking care of patients in safe environments where mistakes become teachable moments instead of medical errors. Simulation-based activities help students practice skills such as communication and physical assessment while integrating clinical aspects of care. There is an ongoing debate as to the “practice readiness” of doctor of pharmacy graduates ,18. It lIn regards to student perceptions of the course, the results were very positive, and are consistent with other reports of student perceptions of learning and the effectiveness of simulation-based activities ,11,23,24This course provided weekly opportunities for students to apply material learned in the classroom and test their understanding in settings that they will encounter in a hospital-based practice. They were challenged to provide formative feedback to their peers and work under tight time constraints to get all of the work done. Over the semester, they became more efficient and adept at each of the assigned tasks. Observationally, they seemed to treat the mannequin as a real patient. Students conducted themselves in a professional manner while at the bedside. One element that was likely underestimated at the genesis of the course was the importance of communication as a central feature. Over time, the teams improved their ability to gather information from the patient, the chart, and the patient monitor. Students improved internal communication, and worked more efficiently and effectively as a team. The clinical team received both praise and criticism from the debrief team, which shaped and improved communication and decision making in the simulation suite. The debrief teams demonstrated interpersonal communication skills as they filled out the debrief worksheet, and decided what elements to include. Finally, they communicated their findings with respect. Students actively watching the simulation had the luxury of talking without disrupting the simulation. It also afforded opportunities for the instructor to capitalize on teachable moments while in the room observing the simulation. Although not directly assessed on examinations, the experiences in the mock pharmacy provided realistic experiences. The operational pharmacy teams rotated their roles, and each student had experiences that were similar to an inpatient hospital pharmacy. They worked to support the care of the patient in the simulation suite by taking a telephone order, properly labeling the product, and delivering it to the bedside in a short amount of time. The focus during each simulation experience was less about the right decision, and more about the process and learning from mistakes. When common misconceptions arose, these were reviewed during the didactic class time.The qualities represented in this course are especially important since the publication and endorsement of the core entrustable professional activities (EPAs) for new pharmacy graduates . The expAn essential aspect of this course was the use of a high-fidelity simulation mannequin. While this may be a perceived barrier, many colleges and schools have access to this technology. A survey conducted in 2013 reported that of the 88 responding schools, 30 had their own high-fidelity mannequin, and 47 had access to a formal simulation center [To increase realism in the operational pharmacy, basic supplies were purchased. These included syringes, needles, alcohol pads, intravenous piggyback solutions in various sizes, and cleaning supplies for the laminar flow hood. Fortunately, there was a working laminar flow hood where parenteral products could be made in the mock pharmacy. This helped to increase realism; however, the activity could also be done on a workbench, and a flat surface could be defined as the laminar flow hood. Since simulated drugs can be expensive, every attempt was made to reuse supplies. For example, empty vials were used for the batch, and base solutions were continuously reused. Standard address labels containing drug names and concentrations were affixed to 10 mL of sterile water or 0.9% sodium chloride vials so that virtually any drug could be made available. Each week, about six to eight vials were used with the associated syringes and needles. To maintain realism, when compounding parenteral products, students would only use new vials, needles, and syringes.There are several limitations to this investigation. First, there was some heterogeneity with respect to content delivery and testing from the first to second year. This was based on continuous improvement efforts and course refinement. However, the framework of the course remained unchanged, it was taught by a single instructor, and data analysis was conducted based on the experiences of each cohort. Secondly, the number of students was relatively small, and the investigation was conducted at a single institution. It should be noted that implementing a course such as this could be very time consuming, especially during the planning phases. If details are not worked out, realism soon fades, and student confidence in the design may suffer. Checklists worked well to mitigate this potential challenge. Performance on objective examination questions did not differ based on participation in bedside simulation activities or evaluating the clinical team. The course was very well received, and students felt that it prepared them for APPE experiences in the hospital setting, and to ultimately take care of patients.


The expansion of bacterial swarms and the spreading of biofilms can be described by a unified biophysical theory that involves both active and passive processes. Related research article Srinivasan S, Kaplan CN, Mahadevan L. 2019. A multiphase theory for spreading microbial swarms and films. eLife8:e42697. doi: 10.7554/eLife.42697A long-held paradigm in microbiology has been that bacteria are unicellular creatures, and that the effect of a large population of bacteria is the sum of the effects of all the individual cells. However, this view of bacterial life has changed fundamentally over the last few decades , and it Bacterial swarms and biofilms are typically viewed as two fundamentally different phenotypes because they are regulated by different genes, are caused by different cellular processes, and display obvious differences at the microscopic scale: swarms involve highly motile cells that move collectively , whereaseLife, inspired by these similarities, Siddarth Srinivasan, Nadir Kaplan and L Mahadevan of Harvard University report that they have developed a unifying theory that can describe the expansion of both swarms and biofilms  determine both the architecture of a biofilm and the collective movement of a swarm . This suet al. are another step forward in efforts to identify general principles that are able to explain the behavior of bacterial communities across a range of length scales and across species.Taken together with previous work on the similarities between swarms and biofilms at microscopic length scales , the res


The external environment directly influences human health. However, what happens inside? This work deals with the effect that the interior thermal variables have on the propagation of respiratory diseases and focused on the relation of the temperature and relative humidity inside social housing in the 1040 parishes of Ecuador and the transmission of influenza. On the one hand, historical weather-related variables were used to simulate and estimate the interior conditions, and thresholds on temperature and humidity were determined. On the other hand, the health-related variable was determined by analyzing the statistics corresponding to the influenza and viral pneumonia in 2009 since that year was critical for these diseases; the data were divided by month for each parish. Finally, the correlation of these variables determines the relative importance of the interior conditions on the respiratory health of its inhabitants. The preliminary results indicate that the places with the lowest temperatures and relative humidity could favor the virus transmission. Also, the analysis indicated that respiratory diseases increase in August and October. In this way, it is clear that social housing projects in Ecuador require a study which guarantees not only energy efficiency and sustainability related issues but also the well-being of their inhabitants. Latin America faced sanitation and hygiene problems during the colonial period since Europeans imported those problems with them. In addition, to exert all their power, the settlers replaced the way of life, food, hygiene practices, and culture of natives by their own customs, which not necessarily were the best for the new world since the environmental conditions are different between America and Europe. For example, Latin American countries that are closest to the Equatorial line do not have four marked seasons. Despite those differences, the housings used in the new colonial cities did not consider the local conditions. Initial approaches to building analysis include overcrowding, ventilation, humidity, lighting, acoustics, and waste disposal .Since the new houses do not follow the practices of the colonial era, new problems appeared. For instance, migration or displacement caused by political, social, and economic problems or natural disasters contributes to overcrowded spaces with restricted areas to live, where the constructions have sanitary deficiencies, promoting the transmission of respiratory or infectious diseases . AccordiFor this reason, the structure of houses and the conditions in rooms have a direct influence on health . AccordiThis lack of proper living conditions directly affects the indoor air quality . The infIn the same way, the exterior environment and the interior microclimate of inhabited spaces interact with the construction materials and influence the interior . VariablA high percentage of buildings are vulnerable to climatic conditions, mainly to the temperature changes depending on the time of the day . These hOn the contrary, influenza is “… an acute respiratory infectious disease related to climate and seasonal clustering cycles” , which hIt is important to consider that people live in social housing are mostly kids and elders  spend moThe rapid transmission in crowded areas including schools and nursing homes has been confirmed by the WHO. The main objective of this study is to raise the hypothesis about relationship between the thermal conditions inside social housing projects and respiratory diseases in Ecuador. Specifically, the relation between influenza virus transmission, temperature, and relative humidity (RH), as potential conditions for the increasing virus transmission, is analyzed. For the analysis, it was considered the temperature information and relative humidity stimulates virus transmission (A/Panama/2007/99 virus), based on results of experiments done on guinea pigs in controlled spaces and inoculated with a human stain of the virus and healthy guinea pigs.In Ecuador, local governments have between their competences to promote “… safe and healthy habitat and guarantee the right to have a dwelling” , supportThe compliance with the code and the use of improved construction materials will allow to solve short- and long-term overcrowding problems , in addiA previous study introduced the topic of spatially relating infectious diseases with climatic and housing conditions in Ecuador without statistics evaluation of the link . This woFor this work, an epidemiologic approach has been used, but as the data available were aggregated by geographic unit, only the ecologic type of study can be applied, adapting the quantitative method of relative risk estimation to it, in order to relate possible determinants to spatial distribution of disease . TemperaOn the contrary, cases from hospital records were processed and mapped by parish, selecting the International Disease Codes from J09 to J12 , in order to verify if some relations exist. In relation to the risk factors for influenza virus transmission by contagion, the threshold encountered in one of the few experimental studies on the subject  was usedThe conditions of temperature and relative humidity indoor a social interest house, and its hourly variation during one year has been estimated for each parish , using tThe spatial division of Ecuador was identified by a six-digit primary code that represents each parish as a political-administrative unit . This tyThe source for the elevation digital model is the NASA Shuttle Radar Topography Mission (SRTM) at a resolution of one arc-second (approximately 30 meters) available for most of the land surfaces that lay between 60°N and 54°S . Once imTo define weather conditions, we generated meteorological information in EPW format with hourly data, through Meteonorm software for each parish. Because of the large quantity of iterations and combinations, it was necessary to use an automatization process. Once the working environment was defined, we used a virtual box to assemble all the tools over a virtual machine (VM), Mouse Recorder Pro (MRP), which was used to record the sequence that Met provides to obtain the files. MRP calendar allowed scheduling the task to be performed at a specific hour; besides, it was used to repeat the cycle as many times as needed. Once the configuration was done, the VM was turned off and its status was saved. The current VM was cloned 10 times; hence, for gaining velocity and saving space, a cloned cycle was linked to the original VM.The reports created in the VM were configured to simulate them with different data; thus, they were distributed between them. The start mode without windows was used to keep running the VMs simultaneously. When the simulation on Met was finished, all the results were grouped and then the VMs were deleted. For validating the results, a script was programmed in Python with the aim of verifying that the coordinates and the specified height per each block were the same in the weather files and also in the ones that were used to obtain the results.The database used to obtain the influenza morbidity was the hospital registry made available by the INEC. The cases of 2009, considering the code J09 to J12, have been summed by parish, which is the smallest political-administrative limit available in the database. To obtain the disease rates, the population used as the denominator was extracted from the 2010 INEC census since one-year difference will not affect the relative value between parishes.The disease group selected included the J09-influenza, related to the zoonotic or pandemic influenza virus, the J10-influenza related to the seasonal influenza virus, the J11-influenza, which is a not identified virus, and the J12-viral pneumonia, which has not been classified elsewhere. The last one has been included since its propagation is similar to the influenza .The data of indoor conditions were obtained using simulations of the thermal behavior of house models. EnergyPlus linked with the DesignBuilder (DB) environment was used to perform simulations with virtual building models. EnergyPlus is capable of performing simulations with “time steps of less than an hour, modular systems and plant integrated with heat balance-based zone simulation, multizone air flow, thermal comfort, and photovoltaic systems” . Also, “The weather files needed to be converted in EPW format before using them. This task was performed only once. The input data for the DB software simulate and assess the indoor thermal behavior in each parish were as follows.2 of construction area and has two bedrooms and one bathroom, living room, and kitchen in a single area. All these areas are distributed in one floor and covered by an inclined roof  tool of the Pentaho Suite of business intelligence was used to upload all the information in the database.To evaluate the association between the disease and the exposure to specific climatic and housing conditions, the relative risk (RR), Equation , was useA relative risk over 2 indicates a positive association between exposure and disease; meanwhile, a value lower than 2 indicates that the exposure could be considered as a protection against the disease. A value of one does an inconclusive result . There iThe amplitude of the RR is calculated by obtaining the confidence interval (CI), in a range between the upper interval (UI) and lower interval (LI) (Equation ) 55]. R. R55]. RA correlation of 0.96 between external and internal temperature was observed in every analyzed parish, with an average temperature difference of 4.38°C.In a normal year, the annual mean temperature ranges between 17 and 20°C. Nevertheless, those values vary according to their proximity to the Pacific coast, the Highlands region, or the Amazonia.Because of the equatorial location of the country, the temperature during the year in Ecuador is relatively constant, with a difference between day and night of 3°C, approximately .The indoor temperature and relative humidity for each one of the 1040 parishes were extracted for the simulation results. Using the control thresholds of 20°C for temperature and 35% for relative humidity , the simThe indoor thermal behavior significantly varied between day to night; consequently, the hourly variation within a day is an important parameter. The period between 18 : 00 PM and 08 : 00 AM has been selected for the analysis since it coincides with an occupancy rate between 75% and 100%. The monthly results of relative risk, taking into account the 1040 parishes, are not constant and present values statistically significant in August and October . For thoConsidering the theory of multicausality in diseases , there cAt a country level, in 2009, the results confirm the hypothesis that low indoor temperature and low relative humidity are significant factors that increase the risk of transmission of influenza, particularly in August and October.Despite the climatic conditions being relatively stable during the year in Ecuador, hourly oscillations impact the temperature and relative humidity inside the house. These characteristics are similar in territories located in the equatorial zone where habitability conditions are assumed and, generally, the buildings are not adapted to the environment or adopt inappropriate standards.The followed methodology allowed a preliminary analysis that suggests what the next steps in this research should be. A recent document was published by the World Health Organization  that oneThe results can be refined if more reliable statistics related to respiratory diseases are obtained, or if more detailed climatic data are available. It is important to consider that the indoor quality environment affects the inhabitants, mainly in houses where people spend a significant amount of time resting and recovering from their daily activities.Climatic parameters that could affect the well-being of the people must be included when energy efficiency standards are updated. Currently, in Ecuador, Chapter 13th Energy Efficiency in residential buildings of the Ecuadorian Building Standard (Norma Ecuatoriana de la Construction (NEC)) is being driven by Miduvi. However, temperature and relative humidity indoor defined in standards in energy efficiency would be consider the health condition of the occupants since it could also have an impact on public health.In Ecuador, the temperature inside the social housing is correlated with the outside temperature. However, the temperature difference between day and night can be up to 10°C, approximately. In this sense, the variation of temperature in one day can affect the health of the occupants of the edifications and much more to those of social housing. Statistically, these conditions could contribute to influenza virus contagion, particularly during August and October, as a consequence of the correlation between the indoor and outdoor temperatures during the periods of maximum occupancy.It is important to analyze the different factors of housing which can contribute to improve the conditions inside. One of them, thermal insulation is not used in enclosures of space. This factor can affect the stability of conditions inside the house and consequently impact on occupants' health, but this relationship should be validated with real-field measurements.The temperature and relative humidity conditions inside the homes are related with the outside climate, but these can change depending on the characteristics of the materials of housing envelope, infiltration, percentage of glazing, height of the roof, and among many other construction features that must be appropriate to the climate. The indoor microclimate varies, being able to increase or decrease the transmission of diseases among its inhabitants. This work found that a part of the housings that do not comply with temperature and relative humidity standards in the interior are built with inappropriate materials so that the well-being of their inhabitants is affected. In addition, an increased rate of influenza spreading, in combination with overcrowding, converts these housings in origin of spreading diseases.In addition, the analysis shows that the socioeconomic status of people and an absence of laws that regulate the hygiene in the housings  will negatively impact the health and economic situation of Ecuadorians. This fact was already demonstrated and addressed since some codes and laws has been stablished; nevertheless, these laws should be updated to account for specific local weather conditions and the use of modern materials.This ecological study makes it possible to prioritize study areas in which housings are affected or could be affected depending on climatic conditions and the characteristics of the housings.


Component fingerprints are a recognized method used worldwide to evaluate the quality of traditional Chinese medicines (TCMs). To foster the strengths and circumvent the weaknesses of the fingerprint technique in TCM, spectrum-effect relationships would complementarily clarify the nature of pharmacodynamic effects in the practice of TCM. The application of the spectrum-effect relationship method is crucial for understanding and interpreting TCM development, especially in the view of the trends towards TCM modernization and standardization. The basic requirement for using this method is in-depth knowledge of the active material basis and mechanisms of action. It is a novel and effective approach to study TCMs and great progress has been made, but to make it more accurate for TCM research purposes, more efforts are needed. In this review, the authors summarize the current knowledge about the spectrum-effect relationship method, including the fingerprint methods, pharmacodynamics studies and the methods of establishing relationships between the fingerprints and pharmacodynamics. Some speculation regarding future perspectives for spectrum-effect relationship approaches in TCM modernization and standardization are also proposed. Traditional Chinese medicines (TCMs) have been performing an increasingly important role in protecting health and controlling disease in China for thousands of years . Based oThe term “spectrum-effect relationship” refers to linking the TCM fingerprint peaks with specific pharmacodynamic data to form a relationship, and then using this relationship to look for the effective materials in Chinese medicines and formulate control standards to reflect their internal quality. The spectrum-effect relationship method is developed based on the fingerprint technology. To overcome the shortcomings of fingerprints, it uses data processing technology to analyze the weight coefficients of components, monitoring efficacy despite changes of the peaks and their areas in the fingerprint . This isThe Journal of Ethnopharmacology, Analytica Chimica Acta and Journal of Chromatography B, etc. In the field of TCM research, there are 34 projects funded by National Natural Science Foundation from the year 2006. Moreover, more and more reviews have focused on spectrum-effect relationships and it is already widely applied in the quality control of TCM preparations in China. The concept of the spectrum (fingerprint)-effect relationship was a brand new way of thinking at the frontier of the modernization of TCMs proposed by TCM researchers. It could reflect the real and comprehensive pharmacological information of active constituents. It was also more adequate for controlling the quality of TCMs. It has thus become a hotspot in TCM studies. The amount of published research work related to spectrum-effect relationship studies has been displaying a rising trend year after year. Based on the evolution, current research status and future perspectives, the purpose of this review is to summarize and merge the topics and research methods of the spectrum-effect relationship technique, so as to guide researchers to master this technology and encourage further research on TCMs.As early as 2000 the WHO stated the following: “Research on traditional medicine safety and effectiveness of data are far from enough to meet the criteria that are needed to support its use around the world. It is because of a lack of adequate or accepted research methodology for evaluating traditional medicine, not only the deficiency of health care policies”. Containing a myriad of compounds, no matter whether a single herb medicine or a Chinese herbal formula, TCMs all need a unique methodology system to evaluate their quality. Characterized by multiple targets, components and links, TCM is based on a holistic philosophy that is totally different from Western medical practices. All these factors have led to the application of fingerprints in TCM research.Obtained by using several techniques, both chromatographic and spectroscopic, a fingerprint is a characteristic pattern or profile which reflects the chemical constituents and usually represents as much information as possible ,6. DeterTCM fingerprints can reflect the type and content of their chemical composition. Thus, they give an overall description and evaluation of herb quality. At present, the herbal medicine fingerprint technique is considered a powerful tool for the quality control of multi-component TCMs. Moreover, it has also internationally accepted as a feasible way to evaluate and control the quality of TCMs and their preparations around the world. Japanese scientists take fingerprints obtained from standard extraction methods as the standard fingerprint and the formula decoctions made from verified medicinal sources are regarded as the standard extract. Fingerprints have also started to be accepted by the US Food and Drug Administration, because the fingerprint method can be utilized in named material chemistry, manufacture and control (CMC) applications of Investigational New Drugs (INDs) to control the quality of Botanical Drug Substances and Botanical Drug Products. Besides, many countries and organizations such as Britain, France, Germany, India and the WHO have used fingerprinting to control the quality of medicinal plants. It has also been allowed and accepted by the Chinese State Food and Drug Administration (SFDA) for monitoring and risk management of TCM drug safety.et al. were the first to clearly propose the notion of the systematic chromatographic-pharmacodynamics relationships of TCMs in 2002. They first proposed the concept and called it “spectrum-effect relationship” [Using the chemical fingerprint to evaluate a TCM’s pros or cons obviously has some limitations. Some components embodied by fingerprints are not necessarily the efficacious ingredients, and the connection between the chemical composition and efficacy is thus unclear. Moreover, different preparation methods and different analysis methods or conditions may afford different fingerprints. Therefore, the fingerprint method was far from being a comprehensive way to control the quality of TCMs, because it cannot describe the authentic and general active pharmacological constituent information . In 2001“Spectrum-effect relationship” thus refers to linking the TCM fingerprint peaks with specific pharmacodynamic data to form a relationship, and using this relationship to look for the effective material(s) in Chinese medicines and to help formulate control standards to reflect its internal quality. To summarize, this Introduction has given details of the following topics: I. The fingerprint only considers the known chemical composition qualitatively or quantitatively, while the efficacy is not taken into account. Only on the premise of the curative effect of drugs, can the characteristic chemicals of a TCM fingerprint be related to its biological activity to better reflect the quality of the TCM. “Spectrum-efficiency relationships” may provide the possibility to compensate for the abovementioned shortcoming of fingerprints.II. Through the analytic statistics method, “spectrum-efficiency relationships” could establish a mathematical model of a TCM’s chemical composition and efficacy; the “spectrum-effect relationship” technique uses informatics methods to find the alignment of key active compounds; it optimizes the compatibility of TCMs through the forecasting model of multi-component effects, and then builds the multi-factors regulating a network model of therapeutic effects; it finally explores the synergy mechanisms of the variety of aligned TCM active compounds. III. The changes in the peaks and their areas in established TCM fingerprints reflect differences in each component and its content; the pharmacodynamic model and indexes are chosen carefully so as to evaluate the pharmacological activity of the components more precisely; then using data processing technology we can analyze the weight coefficients of the components contributing to the observed efficacy; data processing methods have their respective pertinence, and various mathematical processing methods used in combination can complement each other and improve the precision and accuracy; then effective ingredient groups with synergism or antagonism effects can be sought out to further reveal the TCM effective material basis and establish the relationship between the spectrum and efficiency of TCM. The general content of spectrum-effect relationship studies can be summarized as shown in IV Being an interdisciplinary and cutting-edge science, the spectrum-effect relationship is technology that integrates the Chinese medicine chemistry, analytical chemistry, pharmacodynamics and chemometrics of a TCM, so it is considered to be more accurate to study TCM active materials. Based on Based on the habits of TCM drug usage, the research objects of spectrum-effect relationships may contain a single herb  or a Chinese herbal formula. In addition, Chinese herbal preparations and sera containing drugs are two special study forms requiring special focus. In order to simplify the study, researchers use some different and appropriate processing approaches for each of them. The basic hierarchical chart of the research objects is shown in In Chinese medicine, a single herb has an unmatched effect. It can cure disease by itself or with the help of other herbs. For a feasible intricate interaction of different compounds, a single herb study would be a good start. Different ways of processing a single herb were done to reduce the degree of study difficulty. Through investigating the literature, we found that most related work is about the spectrum-effect relationships of single herbs . It is dDB refers to a single herb from a different production area, resource and collection time. DE comes from a single herb and different parts of one herb. Their extractive solvents may have different polarity. Their combination, sometimes with an orthogonal method, namely DEC, was also investigated.Through DPW, different Chinese medicines showing different effects could be prepared from one kind of herb. This process is called “Paozhi”. It refers to different processing methods such as water treatment, fire treatment, both water and fire treatment and other ways. DPWs have a certain impact on the efficacy and toxicity. In standard TCM use practice, DPWs applied to the same Chinese herbal medicine may affect different symptoms and the toxicity will vary, so what makes this effect change is also a research hotspot. Chinese herbal formulas, consisting of various single herbs, are the most common form used in clinical applications. Compared with single herbs, they possess unparalleled advantages when faced with miscellaneous diseases. The correlative research is relatively rare , althougThe reason is mainly that the compounds in TCMs are so complicated and it is not easy to find out the component(s) related to a particular effect. Here, Chinese herbal formulas are divided into three objects: DE, DEC and herb combinations (HCs).et al. used this method to analyze Sheng Hua Tang. They found that the total formula was superior to the decomposed recipe, and 13 compounds were identified as the likely material basis of the activity [HC refers to a herb and its contents in an orthogonal formula combination. It can look for the best drug combination to display a synergy or attenuation effect. It also probes into the active substance or the main drugs in a formula. One way is considering the pharmacodynamic effect of a total formula, then removing a single drug or a group of drugs from the formula to measure the effect of the remaining part, and thus evaluate the removed drugs’ influence on the effect of the total formula. This method is applied to study the interaction of a single herb in a whole formula. Chen activity .et al. identified four components as its material basis [Another method is on the basis of the efficacy of a whole formula, doing parallel experiments using the same dose or different doses of each herb, or dividing them into several groups in accordance with the principle of “jun, chen, zuo, shi” or “medicine pairs” to do parallel experiments. Through the study of the dose variation of each herb in Wu Zhu Yu Tang, Ning al basis . Houttuynia cordata injections, Lu et al. preliminarily solved the problem of its quality evaluation [With the development of Chinese medicine, many Chinese medicine preparations such as granules, capsules, pills and injections are now produced in order to cater to the demands of customers. To guarantee these preparations’ quality, fingerprints have been widely recognized around the world as a holistic system because they provide the possibility for the control of TCM quality. Fingerprints are based on the characteristics of systemacity and stability and they determine a few active ingredients or marker compounds. This is far from enough to control the quality of TCMs, and the chemical medicine control mode is not suitable for TCMs without a comprehensive evaluation of overall quality. Spectrum-effect relationship studies would be a better choice. For instance, in the spectrum-effect relationship study of aluation . Relatedin vivo. However, their complexity has hindered development to some extent.Serum fingerprints, being a research hotpot since Shinichi  put forwTCMs contain many ingredients, and only the ingredients absorbed into the bloodstream can produce an effect. That is to say, the “transitional ingredients” in serum are likely to be the real basis of efficacy. Thus, by analyzing the components present in serum after oral administration, it is able to quickly and accurately determine the direct effect(s) the compounds are causing.Due to the fact that the regularity of distribution, absorption, metabolism and excretion of various components in the compound are different; the variation of the characteristic peaks in the corresponding fingerprints will be diverse. This provides a good entry point to understand the changes of complex components in the body. Serum fingerprints have been reported . With thSeen from the introduction of the above four research objectives, the efficacy of TCMs comes from a variety of active ingredients acting in synergy, or even the collaborative or antagonistic effects of some inactive ingredient(s), other than simply a single active chemical ingredient. Nowadays, some researchers only study the spectrum-effect relationships of different single fractions without considering their superposition. We suggest that establishing a continuous dynamic fingerprint with different polarity combinations can readily find the above functional components.There are a variety of methods to establish TCM fingerprints, including thin layer chromatography (TLC), high-performance liquid chromatography (HPLC), gas chromatography (GC), high speed counter current chromatography (HSCCC), mass spectroscopy (MS) and capillary electrophoresis (CE) . NowadayWhen studying the spectrum-effect relationship, the fingerprints generally come from two sources: the chemical fingerprint of the TCM and the serum fingerprint of the TCM. Currently the most used method to establish fingerprints is HPLC, which offers a high degree of separation. A complex chemical composition can be easily separated into high or low peaks forming a chromatogram, but because of the high sensitivity, choosing the appropriate peaks always involves technical difficulties that can be hard to conquer. HPLC is mainly used to identify the corresponding ingredients of the fingerprint peaks and can provide a lot of information. It is also limited by the available detectors, for example the UV detector can only discern compounds having conjugated structures, and ELSD is for more volatile components only.etc., is used to study the spectrum activity relationships of Chinese medicines containing volatile components. On the other hand GC is difficult to use in the analysis of thermally unstable substances and large molecular weight components, so its applications have been limited in spectrum-activity relationship studies.GC, with its high separation efficiency, high sensitivity, small amount of sample, Different methods for establishing fingerprints are suitable for different samples. Besides, when the relationship between a continuous dynamic fingerprint and the related effect(s) is established, common peaks, characteristic peaks with high content and the peaks whose content is changing in the fingerprint should all be chosen.in vivo and in vitro experiments. In vivo experiments use artificial animal pathology models to maintain the integrity of the body, ensuring normal contact with the external environment. Experimental studies can be carried while the animals are anesthetized or awake. In vitro experiments using organs or cells investigate the role of drugs on a particular portion of the overall body separately, so it is more intuitive [When performing spectrum-effect relationship studies, usually there are two ways to obtain the effects. One is to choose a Chinese medicine extract to do pharmacodynamics studies, the other one is choosing serum containing the drug to do pharmacological experiments. Pharmacodynamics studies of Chinese medicines include ntuitive . We summin vitro culture system to observe the effect. These experimental methods were carried out in in vivo and in vitro experiments.In the pharmacodynamics studies of TCM extracts, after extraction and separation, the extract of the medicine was added directly to the reaction system or in vitro experiments directly using TCM crude extracts. This approach ignores that the vast majority of cases clinical administration of TCMs is through oral administration. After being metabolized by the gastrointestinal tract and liver, the components that finally reach the blood are usually not the original drug ingredients. There are also some metabolism ingredients. Besides, in the clinic TCM focuses on dialectical therapy. That is to say, TCM treats diseases in the case where certain syndromes exist . It is hard to copy a disease which may be affected by other body systems. What’s more, TCMs consist of a variety of ingredients, thus the overall effect of the multi-component mixture is not equal to the effect of the various parts. Therefore, it is difficult to reflect the pharmacological effects and changing rules of the body in the real blood concentration.There are some problems and defects in the methodology to do in vitro or in vivo experiments is thus also a research hotpot. Many ingredients in TCMs can only act after absorption into the bloodstream. The blood contained ingredients may be the substances playing a direct role in the body. Research on the components in the serum could be an effective approach to identify the effective substance(s). Using drug-containing serum instead of the decoction or crude extracts to do in vitro experiment refers to when after oral administration of a Chinese medicine or Chinese herbal compound to animals, a certain time later the animal’s blood is collected, the serum separated, and then this drug-containing serum is used to do pharmacological experiments. This can reflect not only the pharmacological effects of the components coming into the body and their metabolites, but also the role played by any drug-induced endogenous components. It can objectively simulate the process producing the pharmacological effects of the drug in an in vivo environment. The experimental conditions are closer to the internal environment where the drug plays is effects in the body, greatly improving the credibility of the experimental results.The so-called drug-containing serum We should base experiments on the clinical indications of Chinese medicine products to carry out pharmacodynamics studies at different levels of the whole body, organ, cell and molecular biology, to look for activity indicators which can more accurately reflect the observed effects. A TCM’s effect such as “strengthening the spleen”, “activating blood circulation to dissipate blood stasis”, “nourishing yin” and other effects are difficult to obtain or express by modern pharmacodynamic models. This needs further study . Data processing methods play a key role in “spectrum-effect relationship” studies. Different data processing methods will obviously affect the experiment results. For this reason, one or more data processing methods are used in combination when spectrum-effect relationships are established. A variety of methods each have their respective focus points. Combinations of multiple analysis methods and a secondary analysis of the data is the recommended pathway. Finally, the optimal spectrum-effect relationship will be obtained.et al. selected a Back Propagation Network (BPN) and Radial Basis Function Network (RBFN) to establish spectrum-activity relationship models of TCMs [L.chuanxiong Hort., indicating the good application prospects for developing quality evaluation methods which can reflect the efficacy of TCMs in spectrum-effect relationship models. However, the data processing methods used have their respective defects, and one method alone is not always enough. Various mathematical processing methods using combined can be complement to each other, insure information maximization and improve accuracy. How to better combine them is another problem scholars should be delved into.In recent years, scholars have been constantly improving the data processing methods applied in establishing the relationships. The processing methods used are not uniform, mainly including correlation analysis (CA), cluster analysis, regression analysis , gray correlation degree analysis (GRDA), fuzzy mathematical analysis (FMA), neural network analysis (GRNN) and the principal component analysis (PCA). According to the frequency of application, a simple introduction is shown as  of TCMs , and theAs a feasible approach to evaluate the effectiveness and safety of TCMs, spectrum-effect relationships has been considered for many years, though they are still at a preliminary stage, and this field has not yet formed mature and stable research ideas and methods.There are some debatable issues in the existing research content . We haveAs shown in etc. Through the combination of multi-analytical technology, multi- fingerprints possessing various and complementary information can be established, so as to integrally express the overall chemical features of complicated material systems. By connecting the multi- fingerprints with effects, and seeking out the fingerprint peaks or component group related to the effects, an effect-fingerprint that can reflect the inherent quality is hopefully established, and thus we can evaluate the TCM quality by its chemical fingerprint. Therefore, the use of a variety of modern analytical technologies is especially necessary to identify the structures corresponding to the main peaks. The common modern analytical technology includes HPLC-MS, UPLC-MS, GC-MS, in vitro and in vivo multi-indicators of TCM activity. The choice of a suitable pharmacodynamic index is also very important for the studies of multi-dimensional spectrum-effect relationships. Many westernized pharmacological models used nowadays in pharmacodynamics studies do not reflect the clinical efficacy of TCMs well. However, taking into account the needs for TCMs around the world, establishing appropriate models and indicators for evaluation of the efficacy of TCMs is an urgent problem that should be solved today . When seAt the present, data processing methods used in TCM research are not standardized, and a variety of data processing methods each have their particular focus. For this reason, it is crucial to select the appropriate data processing method in TCM research, but there are many difficulties in choosing a proper data processing method, because of the complexity of TCMs and data processing methods.The various methods each have their respective strengths and weaknesses. One solution is to try to use them in combination, but different methods often produce different results because of the information loss, so further work should be done to establish more exclusive mathematical models, test their rationality, and use the model to identify chromatographic peaks that have positive and negative correlations with efficacy. Then enrich and prepare samples and proceed with structural identification, testing and verification of efficacy, and even identifying the active portion of a TCM instead of stopping at the point of the spectrum-effect relationship.Spectrum-effect relationship studies are used to put forward new ideas and methods for exploring effective substances, optimizing formulas, improving preparation processes, tracking and separating target active ingredients, and for the development of new TCM drugs. It is actually interdisciplinary and cutting-edge science. More professional talents need to be introduced to the development of related software engineering. If people with different professional background contribute to TCM research by co-operating, there may be wider world waiting for us to explore. In short, the area of spectrum-effect relationships is a hot and difficult spot in the field of research on multi-component, multi-target, and multi-link TCMs, and it should be constantly addressed and perfected in practice.


To analyze the scientific literature regarding the effects of externalvariables on KTK motor test scores and to verify which motor tests areassociated with KTK.Körperkoordinationstest für Kinder andKTK were presented in the title, abstract and keywords.Inclusion criteria were: articles published in English or Portuguese fromJanuary 2006 to December 2016; free access to the article in full and textsavailable online; presenting the descriptor terms mentioned above in thetitle, abstract or keywords; containing sample with children and adolescentsaged 4 to 16 years old; being indexed in a journal with a rating of B2 orhigher  for the area of physical education. Thefollowing were excluded: studies in books, chapters of books, theses anddissertations; duplicate scientific articles; conference summaries; articlespublished in proceedings and abstracts of congresses. Four databases  were used to search for studies in which the descriptors After the three stages of selection  and the criteria proposed at the PICOS scale, 29 studies wereincluded in this review. Body composition and the regular practice of physical activities were thevariables that presented the greatest influence on KTK. It is important thathealth professionals working with the pediatric public encourage regularphysical activity to improve body composition and, thus, to obtain betterKTK scores. Additionally, the Movement Assessment Battery for Children(M-ABC) test had the highest positive correlation with the KTK test. Körperkoordinationstest für Kinder (KTK) testbattery.,The scientific literature reports several tests for the analysis of the motorperformance pattern in children. However, some variables may influence the resultsof certain tasks that are part of these tests, such as, for example, bodycomposition in the ,,,,,Investigations conducted with the application of motor tests in children seek toassist in the early diagnosis of motor disorders. This fact is justified by therelevance of a greater possibility of effective interventions as soon as movementdifficulty is identified, aiming both at the decrease of these disordersIn addition to mechanical limitations, motor disorders also seem to influence theinterpersonal relationships of children. The literature suggests that, duringrecreational sports, children with motor disorders tend to be excluded or evenself-excluded from such practices,In fact, different variables may influence the results of the KTK motor test.Previous studies using this test have verified that factors such as the maturationalphase,,Initially proposed in 1974 by Kiphard and Schilling,Task 1: balance beam.Task 2: single-lever jumps.Task 3: lateral jumps.Task 4: transfers on platforms.It is suitable for children with a typical motor development pattern, as well as forchildren with brain disorders, behavioral problems, or learning difficulties.,,,,In addition to KTK, other tests are proposed in the literature to access motorperformance in children. The Movement Assessment Battery for Children (M-ABC), theTest of Gross Motor Development 2 (TGMD-2) and Motor-Proficiency-Test for Childrenbetween 4 and 6 Years of Age (MOT 4-6) are the most common. The M-ABC assesses thelevel of development of daily life movement skills , focusing detecting delays or deficits in the development of theseskills in children. It also measures the level of treatment evolution and has aduration of 20 to 30 minutes.,Considering the importance of the reproducibility of the findings in the differenttests, some authors conducted comparisons among the different testsGiven this and considering the complexity of the constructs related to the motorbehavior of children, this review aims to identify the variables that exertsignificant influence on the KTK motor test and, secondarily, to review which othertests reported in the literature have more similarities or differences whenassociated to KTK.Aiming at the objectives of this study, the methodology adopted was a systematicreview of the scientific literature. The process of identifying pre-selected andselected studies was carried out independently by two researchers, aiming toguarantee scientific rigor.Körperkoordinationstest für Kinder and KTK, selected in thetitle, abstract or keywords.For the selection of articles, a retrospective search of manuscripts published fromJanuary 2006 to December 2016 was conducted in PubMed , Science Direct (Elsevier Group), LatinAmerican and Caribbean Health Sciences Literature (LILACS) and Scientific ElectronicLibrary Online (SciELO). The terms adopted, included in the list of Health SciencesDescriptors (DeCs) and Medical Subject Headings (MeSH), wereThe following inclusion criteria were adopted: only articles published in English orPortuguese; free access in full and texts available online; having the descriptorterms mentioned above in the title, abstract or keywords; including children andyoung people aged four to 16 years as participants in the study; being indexed in ajournal with a rating of B2 or higher, according to the WebQualis evaluation for the area of physical education. On the other hand, were excluded:studies in books, chapters of books, theses and dissertations; duplicate scientificarticles; conference summaries; articles published in proceedings and abstracts ofcongresses. Initially, the titles related to the theme were shows. The studies werethen selected by reading the titles, based on previously established inclusion andexclusion criteria. This was the first stage in the selection process.participants (age range between 4 and 16 years). Theintervention considered was the application of KTK and/or theM-ABC, TGMD-2 and MOT 4-6 tests. Regarding the comparison, it wasobserved whether or not there was a comparison between the effects of differentexternal variables or whether there was a comparison between the motor tests.Regarding the results, the external factors that influenced the KTKscores were analyzed. When considering the study design,intervention and observational studies were considered. These strategies havealready been widely adopted and recommended for systematic reviews.,The strategy of searching the studies included in this review  was condOnce this was done, a detailed reading of the abstracts was carried out, and then thearticles whose summaries did not meet the mentioned eligibility criteria wereexcluded. This was considered the second stage of selection. Finally, in the thirdstage of the process, the remaining texts were evaluated in their entirety. Inaddition, the list of references of the selected ones was analyzed in order to lookfor other relevant manuscripts.For the moment, it is important to note that, when the results of the studiesreported effects, it was analyzed whether there was a negative or positive effect. Apositive effect is understood as an improvement on the KTK scores that the authorsreported to be related to the external variable investigated. On the other hand, anegative effect is understood as worse KTK scores that the authors reported to berelated to the external variable investigated.At the end of the first stage of searches in the databases, 5,988 papers were found:74 in PubMed, 5,845 in Science Direct, 32 in SciELO and 37 in LILACS. Next, thearticles were filtered based on the criteria proposed in the second selection stage,and thus, 79 articles were selected . After conducting the analyses in the third stage (fullreading of the 79 articles), 50 articles were excluded because they did not fullymeet all criteria and filters proposed for the construction of this study. Thus, 29articles were selected to compose the final version of this systematic review .The objectives of this review were to identify the variables that exert significantinfluence on the KTK motor test and to analyze other tests that have positive ornegative associations with KTK. After analysis of the manuscripts, the main findingof this review was that body composition is the external variable with greater powerof influence on the KTK test scores. In addition, the M-ABC test appears to be theone with the highest correlation with KTK when comparing the results of bothtests.,,,,,Motor performance tends to be influenced by the physical aspects of the individualsevaluated, such as height, body fat percentage, gender and even birth weight.Freitas et al.Seeking to associate the maturational period with motor coordination through the KTK,Rocha et al.,,,Body composition is a variable that exerts a direct influence on motor performanceregardless of the age and gender of the individual evaluated.Overweight children aged 10 to 12 years tend to have significantly lower motorperformance scores when compared to children aged 5 to 7 years.,,,With daily physical exercise and body mass reduction, the influence of fat percentageon motor performance tends to decrease, but there is no significant difference inthree months of intervention, thus requiring a longer time of practice of physicalexercise so that statistically significant changes can be noted.Other factors that can positively influence the improvement of children’s motorperformance are training with overloadTherefore, according to the main findings of the studies listed here, the children’sbody composition has a strong influence on the scores obtained in KTK tasks. Inaddition, this relationship becomes relevant given the limitations that childrenwith motor disorders go through to develop their daily physical practices, inaddition to these disorders being possible predictors for overweight andobesity.,Concerning the different motor tests, there is a primary interest in determining thedifferent motor disorders more accurately. To this end, the statistical correlationof the results of different motor test batteries seems to be an efficient strategy.In this perspective, Van Aken et al.In one study, Fransen et al.,In another study, Rudd et al.Debrabant et al.Hanewinkel et al.According to D’hondt et al.,Thus, it is important to identify other developed and validated motor coordinationtests whose results can be positively related to those found in the KTK tests, withthe aim of reducing the probability of errors in the diagnosis of individuals withmovement difficulties and increasing the reproducibility of the findings.,Finally, this study presented some limitations. Considering the time when the KTK wascreated,,,,Still, it is worth mentioning that, although studies with samples composed ofsubjects with some type of disability were not included in this review because theydid not fulfill the proposed eligibility criteria, some studies with this populationthat applied KTK pre- and post-intervention with physical exercises showedsignificant improvements in motor performance.Having said this and associating such data to the findings of the studies included inthis review, increasing physical exercise levels seems to have established itself asan important tool for multiprofessional work, integrating the different health areasthat work with the pediatric population.Based on the selected studies, it was safely concluded that the variable that exertsthe greatest influence on the level of development of motor coordination in the KTKis body composition. Importantly, but to a lesser extent, regular practice ofphysical activities also exerts influence on the KTK motor test results. Therefore,it is suggested that health professionals working with the pediatric population encouragethe regular practice of exercises, both to improve body composition and to improvethe KTK scores, as this test is a predictor of more physically active behaviors inadult life.Among the motor coordination assessment tests, the results found in the applicationof the M-ABC test are considered to be the best when associated with the KTKresults, thus evidencing the reliability of the application of the two tests for thediagnosis of children with movement difficulties. However, it is worth mentioningthat more association studies between motor tests are necessary for more robustassertions about the subject, thus allowing greater comparability among the testsavailable to health professionals.


Diabetes is becoming a public health burden for sub-Saharan countries due to its prevalence which is growing rapidly. Traditional medicine is more and more used to treat diabetes in RD Congo as well as in other African countries. This study was undertaken in order to list plants used in the management of diabetes by traditional healers in four agglomerations of southern area of Katanga in the Democratic Republic of Congo.Forty-nine traditional healers were randomly met and interviewed about diabetes treatment in traditional medicine. The survey concerned the plant identification, their part used, method of preparation and the route of administration. The inquest concerned also traditional medicine users.Ninety-five plants from 47 families were indicated as antidiabetic. Fabaceae (24.2%), Euphorbiaceae (7.4%), Apocynaceae and Strychnaceae (4.2 each) are the more representative families. This inventory showed that the root is the most used part of the cited plants, the decoction with water as the main preparation method and the oral administration as the principal way to give antidiabetic traditional formulations.In Lubumbashi region, many plant species are used to treat diabetes either through traditional praticians or by anyone from well-known ancestral knowledge. Diabetes mellitus is a metabolic syndrome characterized by chronic high-blood glucose concentrations resulting from defects in insulin secretion, insulin action or both and having consequences on lipids and proteins metabolism ,2. AccorThis ethnobotanical survey was realized by interviews conducted with the help of a guide-questionnaire in the town of Lubumbashi, and in the cities of Kasumbalesa, Kipushi and Likasi, in the southern area of Katanga province, in the Democratic Republic of Congo from September 2005 to July 2007, according to principles stated by the Declaration of Helsinki on personal data . To be sAlbizia adianthifolia (Schum.) WF Wight, Antidesma venosum Meyer, Cassia occidentalis L, Jatropha curcas L and Strychnos spinosa Lam, were known as antidiabetic by two or more traditional healers  and so far uncited herbs that must be evaluated for hypoglycemic and antihyperglycemic and other diabetic related symptoms; so that they may possibly be used in the management of diabetes.For this topic, it is known that the population of Lubumbashi and its surroundings uses traditional medicine to treat various diseases. It is also known that in most cases, this traditional medicine exploits plant resources as a source of medicines. Some of these plants are used in the treatment of diabetes.The novelty of this study is summarized in that: (i) this study lists for the first time the plants used against diabetes in Lubumbashi and its surroundings; (ii) Among the inventoried species, some have not yet been studied in this field and are probably a particularity of Congolese traditional medicine; (iii) For the first time, the profile of providers of traditional diabetes care in Lubumbashi is given.The authors declare no competing interests.


Unmanned aerial vehicles, also known as drones, can play a significant role in military and civil emergency medicine. The aim of the study was to present the real possibilities of using them in rescue operations and to provide examples from all over the world. Unmanned aerial vehicles can be applied to transport goods on demand, provide blood in urban areas, save sinking people, analyse the scale of damages, monitor large human gatherings, perform exploration activities, deliver blood samples and other analysis material, provide automated external defibrillators, support rescue operations and air transport, and perform agricultural activities. One must, however, be aware of the existing regulations regarding drone flights as an appearance of an unreported unmanned aircraft in the controlled space is identified worldwide as affecting aviation safety. Air transport is widely used in military and civil emergency medicine owing to the speed of action, lack of restrictions characteristic of ground vehicles, and the ability to reach distant, otherwise inaccessible places. However, apart from these undoubted benefits, air transport also has limitations, which include dependence on weather conditions, relatively lower load capacity compared with ground ambulances, and much higher costs than in the case of land transport.th century saw the development of unmanned aerial vehicles controlled by radio waves, but it was the turn of the 20th and 21st centuries that resulted in an increased interest in their application for military purposes, mainly as an element of object recognition or antimissile exercises. Work on unmanned aircrafts for direct transport and medical evacuation has started recently [Unmanned aerial vehicles, commonly known as drones, may be an alternative. The 20These machines, in spite of their relatively small dimensions, are capable of carrying up to 5000 kg of cargo, including people and weaponry. In battlefield conditions, they can effectively replace medevac helicopters in the area of evacuation of the wounded , 3.The aim of the study is to present the real possibilities of using unmanned aerial vehicles in rescue operations through an analysis of examples.The opening of the aviation market to the civil use of unmanned aircrafts has started a new era for aviation . Today, Significantly, the rapid development of unmanned aircrafts and their operations is also possible because, contrary to manned aviation, in some countries there were no regulations regarding the design, production, or rules for the use of unmanned aircrafts . HoweverThe United Nations Institute for Training and Research (UNITAR) was one of the pioneers in the use of new technologies in the United Nations. The UNITAR Operational Satellite Applications Programme (UNOSAT) aims to facilitate change in key areas such as people's security and humanitarian aid. The first use of drones under this programme took place in 2010 in Haiti to analyse the damage caused by earthquake . Drones Drones can be used even in cloudy conditions thanks to their low flight altitude, which could be difficult or completely impossible with normal helicopters. Another advantage of drone monitoring is the fact that the recording from the cameras can be played back again, so the video content can be viewed by several people. This minimizes the risk of overlooking important details and is of particular importance.Scientific literature indicates numerous applications of unmanned aerial vehicles during exploration activities. An example is the use of thermal imaging cameras by the Canadian police. The action ended with locating a man in a car wreck in a desert area, thanks to which the rescue services could reach the victim more quickly.Drones are also used as means of transport. One of the first examples was in 2015, when search and rescue services delivered life jackets to people trapped on rocks in the middle of the Little Androscoggin River in the state of Maine. The water rescue services in Chile and Iran are equipped with drones with a lifebelt, as well as audio and video tools to communicate with the person to be rescued.Two hospitals in Switzerland started using drones to deliver blood samples and other analysis material. This is the first case of a commercial application of unmanned aerial vehicles for medical purposes, giving hope for saving peoples' lives faster than nowadays. These drones can carry light loads, of less than 2 kg, and move at speeds of up to 36 km/h; their maximum range is 20 km. In case of a breakdown, the machines are also equipped with parachutes so they can safely fall to the ground surface without destroying the delicate cargo .The first drone which already performs commercial transportation flights is MD4-100 from a German company MicroDrones, in the fleet of DHL. This unmanned aircraft in the airspace of the German Air Control Service (DFS) transports drugs several times a week between the German island of Juist (North Sea) and Norddeich, a city located in the north of Germany .The Karolinska Institute in Sweden connected a defibrillator to a drone owned by a fire station in Norrtälje, located in rural areas near Stockholm, and then sent it to a place at a distance of 10 km where there were reports of heart attacks in the last 8 years. It turned out that the average time from 18 flights of the drone was 5 minutes and 21 seconds compared with 22 minutes when using an ambulance , 10. An A study published by Bogle et al. described drone-based AED deployment networks. The authors revealed that all analysed drone networks improved AED delivery time and suggested that they can improve out-of-hospital cardiac arrest survival outcomes .Currently, work is in progress on the international and regional levels (European Union regulation) to establish common rules on using drones. A new European Union regulation on remotely piloted aircraft systems (RPAS) will enter into force in the coming months. The legislative process that aims at the extension of the European Union competence to include safety regulations in this area is ongoing. On September 11, 2018, the revised basic regulation  has enteEnabling the operation of remotely controlled aircrafts or even the application of automated flight control systems  requires the development of detailed solutions for a number of technical and operational aspects, which include, inter alia, the following issues. First of all, the issue of airworthiness, i.e., rules of design, production, release to service, and maintenance of the devices, including ground control stations of unmanned aircrafts. Secondly, data transmission from a ground control station of unmanned aircrafts. This includes ensuring continuity of data transmission, protection from unauthorized interference, available radio frequencies, or other data transmission techniques. Moreover, the available radio frequencies for data transmission systems, motion detection and collision avoidance systems, emergency systems , unmanned aircraft operators including training and competence requirements, and the rules of the air including procedures for air traffic services .Smolyanskiy et al. presented a micro-aerial vehicle (MAV) system, built with inexpensive off-the-shelf hardware, for autonomously following trails in unstructured, outdoor environments. This system is based on a deep neural network enabling view orientation and lateral offset of the MAV. This system is able to navigate forest trails more robustly than previous techniques, including autonomous flights of 1 km. This construction is an important stage in the development of drones towards more autonomous devices, especially in difficult terrain, such as flying on the forest land .Loquercio et al. in contrast to traditional “map-localize-plan” methods, propose DroNet: a neural network that can safely drive a drone through the streets of a city. This system allows drones to successfully fly at relative high altitudes and even in indoor environments, such as parking lots and corridors .Palossi et al. analysed autonomous unmanned aerial vehicles (UAVs) with advanced computer vision techniques based on computationally expensive algorithms, to navigate in difficult environments. Taking into account that autonomous flight is considered unaffordable in the context of nanoscale UAVs, they have presented the first vertically integrated system for fully autonomous deep neural network-based navigation on nanosize UAVs .Passalis and Tefas proposed a deep reinforcement learning method for continuous fine-grained drone control that allows for acquiring high-quality frontal view person shots for various aerial cinematography tasks. They have demonstrated that the proposed method can be also effectively combined with simulation environments that support only discrete control commands, improving the control accuracy. Such technological solutions may also be used in the case of drones used for emergency purposes, including medical use .Drafting regulations that would enable the operation and development of unmanned aircrafts is therefore an extremely difficult task. The regulations must assume the necessity of integrating unmanned and manned aviation. Achieving this integration requires, first and foremost, a further development of technology whereby the level of safety of unmanned flight operations will be at least the same as that achieved in manned aviation. The availability of proven technological or organizational solutions will, as a result, allow for the development of legislations that will enable a wider use of unmanned aviation and the safe integration with manned aviation .It is very important for the usage of drones for medical purposes that law allows for the so-called beyond visual line of sight (BVLOS) operations. In most countries, it is now possible to operate with the visual line of sight (VLOS). BVLOS operations, usually more complex, still remain not possible in most countries, and in others they are allowed under strict conditions. Just recently, in Poland, a new regulation allowing BVLOS operations has been published. Poland is thus among the first European countries that created special regulations in this area.The Polish Air Force Institute of Technology created a drone called AtraxM, designed to support rescue operations and air transport. The drone can perfectly identify the place of the accident, the number of victims, and the scale of the event before the arrival of emergency services. For medical purposes, AtraxM has been equipped with replaceable trays for transferring first aid kits containing basic dressing materials, life-saving shock-recovery kits (when there is a person entitled to administer medicines like a doctor or nurse at the place of the event), medicines directly prepared for the patient's need for immediate administration  when symptoms are known and a quick reaction is required, medicines for people living in areas affected by natural disasters, e.g., floods, and blood bags , 18.The institute is working on the development of AtraxM; the goal is to include a container for the first diagnosis with such medical devices as ECG, glucometer, devices for measuring blood pressure and temperature , with data sent directly to the rescuer-dispatcher, who will give further instructions on how to proceed; and an automated external defibrillator for safe defibrillation in the event of cardiac arrest and a container with an oxygen concentrator or nebulizer for quick reaction in situations of respiratory failure .Another Polish project, called AirVein, assumes the creation of a system that will help hospitals and Regional Centres of Blood Donation and Blood Treatment in a quicker exchange of blood. The goal is to create a fleet of unmanned aerial vehicles, terrestrial infrastructure equipped with a hybrid navigation system, modules for storing and moving blood while maintaining the required parameters, and an information technology system coordinating the delivery , 20.Regarding the legislation, Poland was one of the first European countries which created the possibility to fly with drones (VLOS operation). The Aviation Law Act of July 3, 2002 , in its The Regulation of the Minister of Transport, Construction and Maritime Economy of March 26, 2013, on the exclusion of certain provisions of the Aviation Law Act—for certain types of aircraft and the specification of conditions and requirements for the use of these aircrafts  was the As for BVLOS operations, the Aviation Law allows them to be conducted only in prior segregated airspace, and the operator must file a motion to the Polish Air Navigation Services Agency (PANSA).On January 17, 2019, a new Regulation was published and entered into force, amending the 2016 Regulation, introducing some changes for VLOS operations, and creating new rules for BVLOS operations in order to facilitate them . First oFinally, the term “automatic flight” has been defined in the regulation as a flight on a programmed route without the participation of an operator, but with the capability to immediately take over the remote control. Automatic flights can be performed up to 50 m above ground level or up to the height of 10 m above the highest obstacle within a radius of 100 m from the place of flights and at a horizontal distance of at least 150 m from settlements and other population centres.The creation of such rules not only enables the technical development of unmanned systems in Poland but also helps different entities to do their job better and quicker. This refers to the police, border guards, firefighting, health, search and rescue teams, etc. Finally, there is a hope to save more peoples' lives quicker. Only 1 of 10 people survive cardiac arrest outside a hospital. Each minute without defibrillation increases the risk of death by 10% . Thus, 5The use of drones for medical purposes brings many advantages, such as quick help, shortening the time of traveling to the patient, reduction of complications in the injured owing to a short time to wait for rescue, support and improvement of basic operations of medical emergency teams, and the opportunity to reach places inaccessible for basic means of medical transport  .It is very important, however, to be aware of the existing regulations. There are several safety information campaigns but neither information campaigns nor the most perfect regulations will protect against threats that may be caused by the presence of a drone in a place not intended for. An appearance of an unreported unmanned aircraft in the controlled space is an issue identified worldwide as affecting aviation safety. Examples may be filming a large passenger aircraft from a close distance, or an interruption of approach to an international airport associated with an identification of a drone .