Rhetorical inquires have shown connections between representation and power, workplace fashion and development of ethos, and the rhetoric of glamour through women’s fashion and dress. One element absent from that conversation is how the life course, which typically differs for women because of existing power structures advantaging men, may impact the experience of women as they age, their choice of dress, and the rhetorical implications of those decisions. To explore dress and rhetoric from a life course perspective, this project traces the evolution of Serena Williams’ work apparel across her professional tennis career to the catsuit worn at the 2018 French Open, which is the focus of the project. Press reports on the 2018 catsuit by Nike, New York Times, Sports Illustrated, Business Insider, BBC Sport, Washington Post, and Los Angeles Times, interviews given by Williams, and the television documentary, Becoming Serena, will be analyzed for their treatment of Williams’ work attire and the life course. Responses to the catsuit emphasize attitudes about gender, race, and class, either discounting or ignoring the life course implications such as motherhood and changes in health status. Despite professional success, responses about the catsuit may reflect that Williams faces the same jeopardies, and invisibility, common to many women as they age, and the rhetorical perspective provides new methodological and pedagogical possibilities for instruction in aging.


The diagnosis of multiple sclerosis (MS) is difficult considering its complexity, variety in signs and symptoms, and its similarity to the signs and symptoms of other neurological diseases. The purpose of this study is to design and develop a clinical decision support system (CDSS) to help physicians diagnose MS with a relapsing-remitting phenotype. The CDSS software was developed in four stages: requirement analysis, system design, system development, and system evaluation. The Rational Rose and SQL Server were used to design the object-oriented conceptual model and develop the database. The C sharp programming language and the Visual Studio programming environment were used to develop the software. To evaluate the efficiency and applicability of the software, the data of 130 medical records of patients aged 20 to 40 between 2017 and 2019 were used along with the Nilsson standard questionnaire. SPSS Statistics was also used to analyze the data. For MS diagnosis, CDSS had a sensitivity, specificity and accuracy of 1, 0.97 and 0.99, respectively, and the area under the ROC curve was 0.98. The agreement rate of kappa coefficient (κ) between software diagnosis and physician’s diagnosis was 0.98. The average score of software users was 98.33%, 96.65%, and 96.9% regarding the ease of learning, memorability, and satisfaction, respectively. Therefore, the applicability of the CDSS for MS diagnosis was confirmed by the neurologists. The evaluation findings show that CDSS can help physicians in the accurate and timely diagnosis of MS by using the rule-based method. Multiple sclerosis (MS) is an inflammatory disease of the central nervous system -2. It us1.The diversity, instability and vagueness of the signs and symptoms , 5, 8, 92.Its differential diagnosis from other diseases such as acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica (NMO), and small vessel ischemic disease (SVID) -16;3.The absence of any definitive diagnostic tests for it -5;4.Limited specificity and accuracy of laboratory methods , 12, 15,Moreover, there is a significant delay from the stage of awareness of the initial signs and symptoms of MS to its diagnosis , 14, 18,In recent years, intelligent systems such as the clinical decision support system (CDSS) have been used to solve many complicated issues -27. ThesMany researchers use software techniques to diagnose diseases and disorders of the nervous system , 33. VarThe purpose of this study is to develop a CDSS software and evaluate it in the case of relapsing-remitting MS to accelerate and improve the diagnosis of this disease.The software was developed in four stages, as shown in 1.Extraction of the requirements of system users: At the requirements analysis stage, data requirements, functional and non-functional requirements were determined in interviewers with 10 expert neurologists based on a semi-structured questionnaire. The questionnaire's validity was evaluated through its content validity, and its reliability was determined using the test-retest method (r = 0.87);2.Software design: The software was designed in two stages, including designing the software's knowledge base and designing an object-oriented conceptual model.In order to design a knowledge base, the following should be conducted:•Knowledge acquisition: Acquiring medical knowledge and identifying important and effective parameters regarding the diagnosis of MS occurs in two steps. In the first step, books, specialized texts, and articles concerning central nervous system diseases, MS diagnostic criteria, and MS diagnosis guidelines are studied, followed by identifying clinical signs and symptoms of MS diagnosis. In the second step, targeted interviews are conducted with 10 expert neurologists to determine the effective parameters in the diagnosis of MS, the relationship between clinical decision-making parameters and MS, the incidence of clinical signs, and the relationship between clinical signs and symptoms and the location of plaques in the central nervous system.•Knowledge representation: The decision tables  and 3 an•Knowledge analysis: A rule-based method and MS diagnostic algorithm  are usedTo design the software database, the object-oriented methodology was developed using the IBM Rational Rose Enterprise v9. Operational, structural, and behavioral models of the software were created by drawing use cases, class-responsibility-collaboration (CRC), class, sequence, activity, state and collaboration diagrams.3.Software development and implementation: SQL SERVER 2017 and Visual Studio 2017 v 15.8.9 and the C sharp programming language were used to codify the decision support software. Finally, the CDSS was deployed at the Neurology Department of the Shahid Beheshti Hospital of Kashan.4.System evaluation: The software was evaluated in terms of efficiency and applicability. The efficiency of the CDSS for MS diagnosis was calculated using the real data recorded in 130 cases of patients admitted at the Shahid Beheshti Hospital of Kashan. Ninety-one patients with MS and 39 patients with stroke, neuromyelitis optica (NMO), brain and spinal cord tumors, and acute encephalomyelitis in the age range of 20 to 40 years between 2017 and 2019 were included based on sensitivity, specificity and accuracy with the use of IBM SPSS Statistics v25.0.The receiver-operating characteristic (ROC) curve and surface area under the curve were also plotted to judge the performance and efficiency of the system. Also, the Kappa test was conducted, and its results were interpreted to evaluate the agreement of the physician's diagnosis and the proposed system's. The software applicability was evaluated by 10 neurologists based on the Nielsen standard questionnaire in three distinct areas, including the ease of learning, memorability, and satisfaction. The validity of the applicability questionnaire designed in this study was evaluated using content validity based on valid sources, and its reliability was determined by calculating Cronbach's alpha (α = 0.87).The findings of this study are presented in 5 parts, as seen below.The software input data were divided into five sections: demographic data, historical data, physical examinations, radiographic data, and laboratory data, which are described in The functional requirements of the system include simulation of the physician's decision-making process, thought and diagnosis, storing and creating a database of patients' data at each encounter, providing guidance and advice to the physician, providing reports required by physicians for decision making, presenting a summary of records to patients for them to find out the condition of their illness and back up their data to present to any neurologist.Non-functional requirements of the system features include maintaining privacy and security of patients' data, tracking users' operations in software, the capability of maintaining and updating the system knowledge base based on new criteria of MS diagnosis, the capability of software extension, addition of new features and heightening its processing speed in the future.The software includes the main sections of the patient profile, physician profiles, and reports. Patient profiles incorporate sub-parts for medical recording, recording explanations and examination data, recording MRI data, recording laboratory data, diagnosis, and a summary of the records. Physicians are able to edit their information on their profile and their patient's medical record. They can also provide their reports and information in the software reporting section. The system output is the diagnosis of MS with a degree of certainty as well as the diagnosis of other diseases and suggestions for the examination of the differential diagnosis of MS. The software developed in this study provides the output and new advice to the physician at each encounter of the patient based on newly recorded data in the system. The system also provides users with the capability of describing their responses and reasons. The decision support software developed in this paper has a sensitivity of 100%, a specificity of 97%, an accuracy of 99%, and a surface area under the ROC curve of 0.987 . Also, tThe average score of software users was 98.33%, 96.65%, and 96.9%, regarding ease of learning, memorability, and satisfaction, respectively. Therefore, the applicability of the CDS software for MS diagnosis was confirmed by the neurologists.The results of the software evaluation revealed that there was a complete consistency between the system diagnosis and the final diagnosis recorded in the patient records, and also reflected the high acceptability of the system and the satisfaction of all users' operational expectations, as well as the system's applicability in health environments.All the diagnostic parameters affected the efficiency and performance of software diagnosis. In this paper, 45 parameters presented in A powerful knowledge base is one of the strengths of CDSSs because it makes its inference engine optimal, smart, and more error-tolerant. According to the studies, decision tables, decision trees, and semantic networks are helpful in designing a knowledge base for decision support and expert systems and represent the link between signs and symptoms and diseases, and the rules of production are derived from them. The expert system for the diagnosis of neuromuscular disorders has used the decision tree, and the neurological expert system has used the decision table and the decision tree. The decision table has been used in the design of the knowledge base of the diagnostic system for nervous demyelination diseases and neurological disorders. The Fuzzy Expert System for MS diagnosis in Italy used the graphic diagram of the semantic network to organize and represent the knowledge base. In this paper, the approaches to the decision table and the semantic network are used to represent the production rules.et al. used the computer-assisted diagnostic system for the differential diagnosis of MS using logistic regression and artificial neural networks in Germany. The sensitivity and accuracy of the statistical method in the classification of patients were 0.84 and 0.54, respectively, and the sensitivity and accuracy for the artificial neural network in the classification of MS patients from other patients were 0.95 and 0.83, respectively [Using a suitable reasoning method and technique to diagnose in decision support systems is important in the efficiency of the software. A rule-based method is one of the most widely used methods to diagnose diseases, especially MS . This meectively . The difectively . The fuzectively . The artectively , 45.The use of an object-oriented conceptual model helps software analysts to design quick and logical systems in the changing conditions of the business atmosphere, enhancing the quality of analysis of the users' requirements and software design documentation. The system developed in this paper and the Neurology Diagnose System Project at the University of Tryp Habana used object-oriented design and UML modeling language diagrams, which are deemed to be strengths of the software and show the operational, structural, and behavioral perspectives of the software.In order to access the proposed system, we encountered limitations such as the limited number of medical records of patients with NMO and ADEM, incomplete data records in the medical records of patients, and their removal in the evaluation stage.Given that a rule-based method has limited flexibility, it is suggested that a combination of rule-based and case-based methods be used to overcome this problem in decision support systems. Also, to overcome the uncertainty problems in medicine, and the different parameters of MS diagnosis and their values in different patients, a combination of rule-based and fuzzy logic methods should be used. The proposed decision system in this study could be expanded for the diagnosis of other types of MS phenotypes and for their management and treatment.The results of the evaluations of the efficiency and applicability of the software demonstrate the high acceptability of the system and satisfaction of all the operational expectations of users, and that CDSS provides guidance in decision-making and helps physicians in the timely and accurate diagnosis of MS. These are the results of proper knowledge engineering and the use of effective parameters in the diagnosis, analysis process and object-oriented conceptual design of the software, the use of appropriate reasoning methods, and the development of MS diagnosis algorithm based on the latest McDonald's MS diagnosis criteria and guideline, as well as the centrality of final users and neurologists in the design of the graphical user interface of the system.The rule-based method is one of the most widely used reasoning methods for the diagnosis of MS having proper efficiency and benefits such as modularity and general combination and description of the results. Being understood and well accepted by physicians, this method manages well-defined issues with text-based knowledge. In CDSSs and expert systems, a combination of different reasoning methods can be used based on the system's objective in order to enhance the efficiency and intelligence of the system.The authors declare that there is no conflict of interest.


The relationship between diet and the diversity and function of the intestinal microbiome and its importance for human health is currently the subject of many studies. The type and proportion of microorganisms found in the intestines can determine the energy balance of the host. Intestinal microorganisms perform many important functions, one of which is participation in metabolic processes, e.g., in the production of short-chain fatty acids—SCFAs . These acids represent the main carbon flow from the diet to the host microbiome. Maintaining intestinal balance is necessary to maintain the host’s normal health and prevent many diseases. The results of many studies confirm the beneficial effect of probiotic microorganisms on the balance of the intestinal microbiome and produced metabolites, including SCFAs. The aim of this review is to summarize what is known on the effects of probiotics on the production of short-chain fatty acids by gut microbes. In addition, the mechanism of formation and properties of these metabolites is discussed and verified test results confirming the effectiveness of probiotics in human nutrition by modulating SCFAs production by intestinal microbiome is presented. Firmicutes, Bacteroides, Actinobacteria, Fusobacteria, Proteobacteria, Verrucomicrobia, Cyanobacteria, and Spirochaetes) ..BifidobaEnterobacteriaceae fermentation and is carried out by some bacteria belonging to this family, including Escherichia, Proteus, Salmonella, and Shigella . P. PLactobnfection  and in r disease .Maintaining the balance of the intestinal microbiome is crucial for maintaining normal human health and preventing many diseases. Short-chain fatty acids, as metabolites of intestinal bacteria, perform many important functions. The concentration of SCFAs depends on the composition and size of the population of intestinal microorganisms, genetic factors, environmental factors and the diet conditioning access to appropriate substrates. Imbalance of the intestinal microbiome and a decrease in the number of bacteria producing metabolites such as SCFAs  are often diagnosed in patients with inflammatory bowel diseases (IBD), irritable bowel syndrome (IBS), type 2 diabetes (T2D), obesity, infections bacterial, autoimmune disorders, or cancer patients. Numerous scientific reports confirm the effectiveness of probiotics in modulating the intestinal microbiome and their effect on the SCFAs content in the colon. Many studies, in addition to acting in the digestive system, concern the effect of SCFAs produced by intestinal microbiome on functions of distant tissues and organs. Researchers highlight the immunomodulatory effect of SCFAs produced by probiotics, but the mechanisms of their action still need further study. The use of probiotic microorganisms to prevent and treat intestinal dysbiosis, leading to an increase in SCFAs in the colon, seems to be an important direction for further research. Research on SCFAs in relation to diseases covered by the review is much-needed to understand their etiology and pathogenesis, and to propose new therapies. Clinical studies in human populations in this area are highly desirable.


In March 2020, the rapid increase in COVID-19 cases overburdened the Italian health system, with the country becoming the pandemic’s epicenter.  We present a narrative review based on manuscripts, official documents, and newspaper articles regarding COVID-19 in Italy.  Characteristics of the epidemic, possible causes for its worsening, and the measures adopted across Italian regions are presented.  In the early stages of an epidemic, effective decision-making is essential to contain the number of cases. Medical support for patients and social isolation measures are the most appropriate strategies currently available to reduce the spread and lethality of COVID-19. In March 2020, the epidemic caused by the novel coronavirus (or SARS-CoV-2) turned into a global pandemic, with Italy leading the tally with regard to the number of COVID-19 cases as well as fatalities. This turn of events raises an important question: what happened in Italy, the first Western country to be hit by COVID-19, for it to become the epicenter of the pandemic? And, most significantly for us, what can we learn from the Italian experience to reduce the impact of the pandemic in Brazil? Here, we present a narrative review of articles published from February to April 2020 in scientific journals, on institutional websites, and in the press in general, referring to the COVID-19 pandemic in Italy.,During the month of March, the press and social networks broadcast shocking images of Italian hospitals-crowded emergency rooms, patients on stretchers in corridors, surgical centers transformed into intensive care units (ICUs), health professionals becoming ill (and dying), 50-70% of hospital beds occupied by patients with COVID-19, and so on. The scarcity of the necessary equipment put doctors in the position of having to make the drastic decision of who would be placed on respirators based on their chances of survivalIt should be noted that Italy has one of the best public health systems in the worldBased on data from May 17, Italy was the third country by number of COVID-19 deaths , behind the United States of America  and the United Kingdom Nursing homes for older adults in Italy have become high-risk locations for their residents, who, in addition to old age, have multiple comorbidities; the nursing home setting has witnessed a large number of deaths by COVID-19. The province of Bergamo, for example, recorded more than 600 deaths in 20 days , and 40% of the professionals working in these asylums were on sick leave or in isolationHarvard Business Review, Pisano et al.The advanced age of a large part of the Italian population may be one of the causes of the significant number of deaths, but it is not a comprehensive explanation. Political decisions aimed at limiting the spread of the epidemic across the entire territory were slow to be taken. In an article published in the The delay in adopting social isolation measures and restricting movement, together with a public event in late February that involved politicians in Milan exchanging handshakes to symbolize that the economy could not stop because of the epidemic, contributed to misinformation about the risks of virus transmission. In the same month, public events brought together thousands of people in Lombardy. Agricultural fairs in Bergamo and Brescia, a soccer match between Atalanta (Bergamo) and Valencia (Spain) for the Champions League in MilanIn the article by Pisano et al.The decentralization of the Italian health system also prevented uniform measures from being adopted across the countryIn Italy, hospitals receive around 45% of health system funding, which is higher than the Organisation for Economic Co-operation and Development average (38%)At the time of writing this article, on May 17, Italy had reported 223,885 cases of COVID-19. However, after so much desolation, the number of deaths, which in one day almost reached the quota of 1,000, began to fall to less than 200In Brazil, we are in the ascending phase of the pandemic curve, with an exponential progression of cases and, consequently, deathsFrom the above, and in the absence of proven effective treatments or a preventive vaccine, we must offer supportive treatment to patients and adopt non-pharmacological measures since, at the moment, the best way for each of us to contribute to slowing the spread of SARS-CoV-2 is to avoid contact with other people. Behaving in this way, we will allow time for the preparation of the health system, increasing our chances of receiving adequate medical care and surviving this new virus.


The highest Road Traffic Deaths (RTDs) are related to Low and Middle-Income Countries (LMIC). The efforts for decreasing the incidence and deaths of RTDs can be successful if there is precise information about its related risk factors. This study is aimed at modeling the effective factors of economic, population, road, and vehicles on road traffic deaths in Iran.This is an ecologic study which has been done using the covariates of; the proportion of the population, economic growth, urbanization, distance traveled (km) in 100 thousand people, the length of urban roads, the length of rural roads and the number of vehicles for each province in 2015. The regression model of Negative Binomial (NB) was used to modeling these covariates on the deaths of RTDs. The statistical software of STATA edition 14. Was used.The average of road traffic deaths was 474 (SD= 70.59) in 2015. The result of the multivariate negative binomial model showed that the covariates of the proportion of the population and Gross Domestic Production (GDP) were statistically significant on the number of RTDs.The covariates of the proportion of population and GDP were effective on the RTDs with the direct and indirect relationship respectively.Death, Road traffic crash, Modeling, Iran


Cystic echinococcosis (CE) is distributed worldwide, extending from China to the Middle East and from Mediterranean countries to the sub-Saharan Africa and South America. According to WHO, one million people around the world are suffering from CE with an estimated burden of 183,573 DALYs. The annual monetary burden of the disease due to treatment costs and CE-related livestock losses has been estimated at US$ 3 billion. CE is endemic in all countries within the WHO Eastern Mediterranean Regional Office (EMRO). The region, which includes most of the Middle East and North Africa, is one of the most ancient foci of the domestic cycle of CE and is recognized as one of the major hotspots of CE. There are 22 countries in the EMRO, where about 688 million people are living at risk of CE. In many EMRO countries, little is known about CE epidemiology and transmission. WHO included echinococcosis in a list of 17 neglected tropical diseases (NTDs) and 12 neglected zoonotic diseases (NZDs). Accordingly, different regional offices of WHO organized several initiatives for CE control and prevention. WHO’s Western Pacific regional office considered echinococcosis as one of the region’s major health topics, and several preventive measures have been implemented in the American region with the support of Pan American Health Organization (PAHO) in Argentina, Peru, Uruguay, and Chile. Although CE is endemic in all 22 EMRO countries, surprisingly, CE is absent from the health topics list of diseases and conditions in this region. Therefore, CE clearly requires further attention in the WHO EMRO agenda, and the need for elaboration of specific measures for CE control is becoming apparent in EMRO countries, where substantial collaborations among the member states and WHO EMRO is of paramount importance. Major topics of collaborative activities include training programs and health communication on different aspects of CE control, analysis of CE burden, national and international surveillance and disease registry systems, technical support to promote epidemiological studies for collecting baseline data, cost–benefit analysis of control interventions, and intersectoral cooperation among the agriculture, veterinary, medical, and health sectors. Echinococcus granulosus. CE is distributed worldwide, extending from China and Central Asia to the Middle East and Mediterranean countries  as well as sub-Saharan Africa and South America [Cystic echinococcosis (CE) is a major parasitic disease of humans and animals caused by the small intestinal tapeworm of carnivores,  America .According to WHO, 1 million people around the world are suffering from CE, and an estimated burden of 183,573  disability-adjusted life years (DALYs) has been attributed to this zoonotic infection [WHO Eastern Mediterranean Region (EMRO), which includes most of the Middle East and North Africa (MENA), is one of the most ancient foci of the domestic cycle of CE and is recognized as one of the major hotspots of CE ,5. The sThere are 22 countries in EMRO, where about 688 million people are living at risk of CE. Actually, CE is endemic in all EMRO countries. In many EMRO countries, little is known about CE epidemiology and transmission. For instance, although CE is endemic in Pakistan, the country has been neglected in international collaborations on echinococcosis control, largely due to the paucity of information in the country . There aWHO included echinococcosis in a list of 17 neglected tropical diseases (NTDs) and 12 neglected zoonotic diseases (NZDs) ,11. AccoCE as a major neglected infectious disease has received special attention in the Americas through the “South American Initiative for the Control and Surveillance of Cystic Echinococcosis /Hydatidosis”. Several preventive measures have been implemented in the region with the support of PAHO in Argentina, Peru, Uruguay, and China .WHO EMRO has announced plans for training, monitoring, and epidemiological evaluation of several NTDs, including lymphatic filariasis, trachoma, leishmaniasis, schistosomiasis, and soil-transmitted helminths . AlthougMajor topics of collaborative activities include training programs and health communication on different aspects of CE control, analysis of CE burden, national and international surveillance and disease registry systems, technical support to promote epidemiological studies for collecting baseline data, cost–benefit analysis of control interventions, and intersectoral cooperation among the agriculture, veterinary, medical, and health sectors.As part of the new roadmap on NTDs, WHO would coordinate and support member states to develop intervention programs for the prevention and control of NTDS, including cystic and alveolar echinococcosis. Initiatives need to be started by EMRO and its members through practical participatory planning to mobilize resources for incorporating echinococcosis and other human zoonotic diseases into the One Health domains.


More than 5 million people die each year as a result of: injuries, resulting from acts of violence against oneself or others, road traffic crashes, burns, drowning, falls, poisonings, among other causes. That is the reason for Safe Community program in every part of the world. Because Safe Communities are an Essential need for a Modern-Day Society. Safe Community is our present and future. Safe Community does not know the state boundaries, nationality, religion, skin color, age and gender. Safe Community is a global program and global movement for the preservation and protection of the environment, life and health of every inhabitant of this planet. Safe Community is a safe environment in which people can develop all their work and productive potentials. European safe Community Network aims at strengthening existing International Safe Communities in Europe and promotion of the formation of new communities to be accepted into the Safe community movement. The Global Burden of Disease Studies has documented unfair distribution of injury by socioeconomic strata in Europe. This gradient, existing within and between countries, must be addressed. Our board has representatives from Novi Sad in South Eastern Europe through the Baltics and as far north in Scandinavia as 200 kilometers north of the Arctic Circle in Norway. Together we are working against public indifference towards the burden of injury and trying to promote community based interventions against injuries e.g. traffic accidents , drowning, burns, falls, violence, and suicide. In the 53 countries of the WHO European Region injuries are estimated to cause 790 000 deaths yearly. This is 9% of deaths from all causes. An estimate for the 27 countries in the European Union is 252 000 injury related deaths and about 7 million hospital admissions yearly . Injury is the greatest thief of life years in the age group from one year to the mid-forties. The first Safe Community was designated in 1989. Several Swedish and Norwegian communities followed in Falkopings, footsteps during the next two decades. There are 58 designated Safe Communities in Europe. Of these 36 are in Sweden and Norway. Norway has a strong National Safe Community Network, Norwegian Safety Forum and are steadily recruiting communities up to the present. Sweden he s recruited few new safe communities the last two decades, probably due to the dissolving of the Swedish National Network. However, existing Swedish Safe Communities are active and strong and thus redesigned. Key success on participation in National and International Safe Communities Networks are: Statistics, Research, Strategy, Motivation, Education, Training and Collaboration.Safe Community, European Network, Statistics, Research, Strategy, Motivation, Education, Training and Collaboration


We examine the distribution of residential care in California, showing geographical disparities in care supply and need. We mapped the ratio of beds to older women in Los Angeles and San Diego County census tracts and concentrations of small and large facilities in the Cities of Los Angeles and San Diego. The largest ratios of residential care beds per older women occur on the border of the City of San Diego and on the periphery of Los Angeles County away from the City of Los Angeles. Clusters of small facilities take place in northern Los Angeles and southeastern San Diego, while clusters of large facilities occur in Downtown Los Angeles and near La Jolla. Understanding geographical disparities in residential care supply and need in California can help residential care developers, service providers, and local and state agencies partner in planning for residential care facility development in underserved areas. As lifeAs a result, the demand for residential care is expected to grow, putting pressure on cities and local governments to incentivize and plan for more care facilities to meet the growing long-term care need, particularly in the highly populated and urbanized regions of California, the largest state by older adult population. At present, more than a third of residential care facilities are located in the western US , and morLittle is known, however, regarding the number and distribution of residential care facilities in Californian cities and surrounding areas, containing large populations of older adults who need or will soon need such care. The vast majority of facilities in the state are situated near coastal areas, in major metropolitan centers, as demonstrated by Because residential care is regulated primarily at the state level in the US and is funded and developed almost exclusively by private means, it is subjected to less governmental oversight and regional planning than institutional facilities such as skilled nursing care, which have historically been planned and developed via federal partnerships . The devSince the residential care industry in California is concentrated in major metropolitan areas, and because the development of such facilities varies substantially by neighborhood, in this study, we present spatial and cartographic analyses of the availability of residential care in the two largest Californian cities and surrounding counties by census tract, using 2015 California Department of Social Services residential care for the elderly and American Community Survey data. To understand the geography of residential care in these areas, we map the ratio of facility beds to older women with a disability. To evaluate the spatial distribution of facilities, we present maps of locations and spatial clustering of small and large facilities in California’s largest cities and residential care markets relative to the concentration of older women with disability.2.2.1.We acquired 2015 California Department of Social Services (CDSS) residential care facility data, a census of all licensed facilities in the state, and geocoded facilities based on their address information. We also used data from the 2015 American Community Survey (ACS) 5-year estimates to create measures of the proportion of older women with disability in the census tract, which serves as a proxy for the potential long-term care need in the older adult population. In ACS, disability is defined as having hearing, cognitive, ambulatory, self-care, or independent living difficulty . Geocode2.2.To spatially analyze residential care facility beds and older women with disability, we calculated the number of beds and older women in Los Angeles and San Diego County census tracts. In evaluating the relationship between beds and older women, we mapped the ratio of beds and older women, categorizing the ratio of the two as above and below the adequate supply and undersupply equilibrium break point of 1.0. Densities of beds and older women and the ratio of the two were categorized and illustrated in county choropleth maps, using graduated colors to show increases in values of each in census tracts.To investigate the spatial distribution of facilities, we employed hot spot analysis, testing for clusters of small and large sized facilities using the Getis-Ord Gi* statistic . Applyin3.We show the spatial distribution of residential care in Los Angeles County and its principal city, Los Angeles and in San Diego County and its principal city, San Diego.The main map portrays the ratio of residential care facility beds to older women in Los Angeles County census tracts in Figure ①, highlighting areas with no beds per older women, as shown in white, areas with less than one bed per older woman, as represented by the lightest shade of gray, and areas with more than one bed per older woman, as shown in darker gray and black. Ratios shown in the lightest gray represent areas of undersupply or fewer beds than older women. Ratios shown in darker gray to black represent areas of adequate supply or more beds than older women. The majority of county census tracts show no beds per older women or an undersupply of beds, whereas only select and widely scattered areas of the county indicate an adequate supply. The highest ratios of adequate supply in the county occur in Santa Monica, Claremont, south of Beverly Hills, portions of the San Fernando Valley, Long Beach, Alhambra, Arcadia, south of Torrance, and north of Humphreys and Lancaster, toward the northern end of the county.The map displays the location and clustering of residential care facilities in the City of Los Angeles in Figure ③, drawn over the concentration of older women with disability. The map shows where facilities are sited, where clusters of small and large facilities congregate, as shown in blue and red respectively, and where large enclaves of older women are located, increasing in density, as shown in dot patterning to gray to black, indicating zero to low to high density. Dot patterning in city census tracts specifies areas with no older women, typically representing open space or public areas, such as Griffith Park and Topanga State Park. Areas shown in white within the larger boundary of the City of Los Angeles denote independently incorporated cities, including San Fernando, Beverly Hills, and Culver City. The majority of facilities are located in the San Fernando Valley, most of them small board and care facilities, six or fewer beds in size. Fewer facilities are located south of this suburban area, inside and west of the downtown district, most of them large assisted living and CCRC facilities. In general, clusters of small facilities group in areas of lower densities of older women, such as the San Fernando Valley, while clusters of large facilities congregate in areas of higher densities of the demographic, surrounding and west of the downtown area. However, certain areas with high concentrations of older women lack an immediate residential care presence, such as portions of Hollywood and neighborhoods east, west, and south of the downtown area.The map document also shows the spatial distribution of residential care in San Diego County and the City of San Diego in Figure ②. It shows the ratio of residential care facility beds to older women in county census tracts, displaying areas with zero beds per older women, as depicted in white, areas with less than one bed per one older woman, as shown by the lightest shade of gray, and areas with more than one bed per one older woman, as shown in darker gray and black. Similar to Los Angeles, the majority of county census tracts show no beds per older women or an undersupply of beds, whereas only select and fairly dispersed areas of the county indicate adequate supply. The greatest ratios of adequate supply in the county take place in central San Diego, south of La Presa, south of Escondido, and north of Encinitas.The main map displays the siting and concentration of residential care facilities in the City of San Diego, illustrated on top of the density of older women with disability in Figure ④. It shows the location of facilities, clusters of small and large facilities, and enclaves of older women. As in Los Angeles, the categorization of the density of older women increases from dot patterning to gray to black, representing zero to low to high density. Dot patterning in city tracts indicates areas with no older women, representing military installations, including Miramar. The majority of facilities are located in the southern half of the city, where most of the clustering of small and large facilities arises. Fewer facilities are located in the northernmost portion of the city, where only small amounts of clustering take place. Unlike Los Angeles, clusters of small facilities in San Diego do not congregate in areas of lower densities of older women, and clusters of large facilities do not coalesce in areas of higher densities of the demographic. In fact, a nearly opposite pattern takes place in the map, in which significant groupings of large assisted living and CCRC facilities cluster adjacent to lower densities of older women in La Jolla, and substantial concentrations of small facilities cluster in neighborhoods of higher densities of older women near Lincoln Park. However, in general, facilities in the jurisdiction appear to follow the pattern of densities of older women, with the development of facilities in or near higher densities of older women, as opposed to the lowest density of older women, as shown in the lightest shade of gray.4.We show that residential care in California’s two largest counties is largely undersupplied with respect to the potential long-term care need. We also demonstrate that the patterns of residential care facility development and hot spots of small and large facilities in terms of size more or less match the pattern of concentrations of older women with disability, with the exception of the City of San Diego, in which clusters of large facilities are located in neighborhoods with smaller densities of older women and clusters of small facilities are located in neighborhoods with larger densities of older women.The overwhelming majority of census tracts display no supply of residential care facility beds or an undersupply of beds, emphasizing the limited and exclusive nature of the industry, which faces many institutional and economic obstacles to growth. These obstacles include a shortage of land supply in metro areas, difficulties in facility development permitting where applicable, and a growing but privileged clientele, who pay an average of $3,500 per month for residential care in the US . These fIn focusing on areas of adequate supply in Los Angeles and San Diego Counties, a number of scattered census tracts come into high relief. In Los Angeles County, the most extreme examples of adequate supply occur in Santa Monica, Lakewood, Van Nuys, Claremont, and in and near Beverly Hills. Taking a closer look at the underlying data, in each of these tracts, which represent the highest ratios of facility beds to older women as shown in black in the map, there are less than ten older women per square mile, and in one case, as few as two per square mile. In these same tracts, however, there are as many as 80 beds per square mile. In comparison, in census tracts with lower ratios of beds to older women, the number of older women per square mile is typically greater, as is the number of beds per square mile. In other words, the typical configuration of the ratio of beds per older women is greater in both the numerator and denominator, creating a distribution of ratios above .9 that overwhelmingly falls beneath 6.0 and a distribution of ratios below 1.0 that represent the bulk of the dataset, as shown in the map.In San Diego County, the most extreme instances of adequate supply take place near La Presa, Oceanside, coastal and central San Diego, the eastern outskirts of San Diego, Escondido, and Encinitas. Due to the miniscule square mileage of some of these census tracts, which produce extremely large ratios of facility beds per square mile and older women per square mile, comparing the distribution of total beds and total women is more helpful in analyzing the greatest ratios of beds to older women in the county. The range of total women in these tracts is one to 357, whereas the range of total beds is six to 1334, the smallest and largest of each corresponding to each other. In comparison, the total number of beds appears to grow more stable in tracts with lower ratios of beds to women, and the total number of women seems to increase as well. As with Los Angeles, the vast majority of census tracts contain a ratio of beds to women under 3.4, as illustrated in the map, and a distribution of ratios below 1.0 that represent most of the data.Areas of adequate supply in both counties appear primarily to be the result of extremely low counts of older women compared to facility beds in census tracts, perhaps indicative of tracts that older women are pushed or pulled to move from to live in other locations . It is aAccordingly, understanding the spatial distribution of residential care can help city and regional planners, community stakeholders, and local representatives address areas of concentrated and underserviced long-term care need through administrative and discretionary planning tools that encourage development of this critically important type of senior housing. In other words, research of this kind, on the geographical disparities in healthcare, can help governmental agencies and communities pinpoint and address the long-term care need of older adults with respect to residential care supply and other forms of housing services and supports outside of the home.Related to counts of older women in tracts are some of the limitations of this research, including 2015 ACS census tract estimates. 2015 ACS estimates were based on sampling over 60 months of time and are not a complete enumeration of people, as in the 2010 Decennial Census . AlthougFuture research is needed to track the increase of residential care in Los Angeles and San Diego along with other major cities in California, investigating how residential care has increased by number of facilities and total beds in jurisdictions relative to the potential long-term care need of older adults through time series analysis of residential care and older age population growth.5.In decimal degrees, the geographical coordinates of the City and County of Los Angeles are 34.052235, −118.243683 (WGS84 datum). The geographical coordinates of the City and County of San Diego are 32.715736, −117.161087 (WGS84 datum) in decimal degrees.ArcMap as part of Esri’s ArcGIS was used to produce all of the maps in this article. California Department of Social Services (CDSS) residential care facilities were geocoded and spatially joined with Los Angeles and San Diego County census tracts, and spatially referenced using the North American Datum (NAD) 1983, California State Plane 2011V FIPS 0405 Feet Lambert Conformal Conic projection. The spheroid of this datum and projection is the Geodetic Reference System (GRS) 1980. We symbolized the data in graduated color choropleth maps, using the Jenks Natural Breaks Classification Method, which maximizes the variance between classifications, while minimizing the variance within each classification. The only exception to this is the variable of the ratio of beds to older women in either county, in which we distinguished classifications as either above or below the equilibrium point of 1.0, between the second and third classifications, to categorize census tracts as having either oversupply or undersupply of residential care. Finally, we plotted residential care facilities, including clusters of small and large facilities, in the Cities of Los Angeles and San Diego, on top of choropleth maps of older women with disability, showing where concentrations of small board and care and large assisted living and continuing care retirement communities (CCRC) occur relative to the potential need in either jurisdiction.Main Map


NMDA receptors, on its turn, control the impulses of dopamine neurons. Therefore following theories of schizophrenia are proposed. They are a) activation of astrocytes for neuroinflammation, b) glutamate and dopamine theory, as astrocyte products control the activity of NMDA receptors, which influence on the dopamine neurons.The levels of the astrocyte markers  were increased unevenly in patients with schizophrenia. Reactive astrogliosis was found in approximately 70% of patients with schizophrenia. The astrocytes play a major role in etiology and pathogenesis of schizophrenia. Astrocytes produce the components that altered in schizophrenia extracellular matrix system which are involved in inflammation, functioning of interneurons, glio-, and neurotransmitter system, especially glutamate system. Astrocytes activate the interneurons through glutamate release and ATP. Decreased expression of astrocyte glutamate transporters was observed in patients with schizophrenia. Astrocytes influence on N-methyl-d-aspartate (NMDA) receptors  Schizophrenia is a mental disorder, determined as a complex of positive, negative and cognitive symptoms . PositivThe dopamine theory of schizophrenia, based on hyperactive dopamine projections in the mesolimbic system and reduced dopamine projections in the mesocortical system , is the Glutamate theory of schizophrenia is based on the ability of N-methyl-d-aspartate (NMDA) antagonists, such as ketamine, induced schizophrenia-like psychosis . DisturbNeuroinflammation theory of schizophrenia is based on increased expression of proinflammatory agents and the presence of autoantibodies. Epidemiological studies associate schizophrenia with autoimmune disorders, autoantibodies affect synapses and NMDA-type glutamate receptors and cause damages in the brain . InflammThe glial theory of schizophrenia assumes that initial disturbances in glial cells can lead to the abnormalities of the neurons and neurotransmitters. The glial theory of schizophrenia based on the proven inflammatory response and elevated levels of the characteristic markers of active glia—S100B and glial fibrillary acidic protein (GFAP) . In schiPatients with schizophrenia show increased activation of glia, especially astrocytes, which play a role in the development and functioning of synapses, glutamate release, water-electrolyte balance, regulation of blood circulation, and neuroprotection . The funpostmortem human studies of astrocyte alterations in schizophrenia have focused on the number of glial cells. The number of astrocytes was reduced in the cingulate cortex -12, and astrocytes inhibit the production of IL-12 and produce type 2 cytokines, for example, IL-10 . The dysStimulation of mGluR5 and a1-noradrenergic astrocyte receptors provokes mild inflammatory processes, including the release of prostaglandins and other eicosanoids, which can regulate communication between neurons and blood vessels .via secreted cytokines  including LPS and associated cytokines . Astrocyytokines .During pathogenesis of schizophrenia, glia loses the ability to form compartments and connections, which leads to disruption of perception and an inability to think, which can be included in the development of cognitive symptoms in schizophrenia. Supposing that astrocyte gap junctions are the site of memory formation and intentional programming, their functions must be essential for cognition and higher information processing . This suvia inhibitory GABAergic interneurons.Reduced expression of Reelin, which is also a part of extracellular matrix, was noted in patients with schizophrenia in several brain regions, including the hippocampus, prefrontal and temporal cortex, cerebellum and caudate nucleus . In adulIn schizophrenia, there is hypofunction of NMDA receptors, which leads to a decrease in prefrontal cortex functions . WeakeneThe basis of the modified glutamate transmission is increased glutamate excretion in the hippocampus, in which the dysfunction of inhibitory interneurons in the hippocampus and prefrontal cortex also plays a role . ReducedPostmortem studies of patients with schizophrenia showed a simultaneous decrease in the levels of parvalbumin interneurons  and glutamic acid decarboxylase in the dorsolateral prefrontal cortex  . Ninety KYNA acts as an antagonist of all 3 ionotropic glutamate receptors, including NMDA, AMPA, and receptors kainate, while KYNA is the only currently known endogenous antagonist of NMDA . KYNA prConversion kynurenine to KYNA occurs mainly in astrocytes since these cells contain kynurenine aminotransferase (KAT) . In adulThe possible role of KYNA as a functional link between the stimulation of dopamine receptors and the neurotoxicity of NMDA in the striatum was noted in rats . An incrThe impact of the increased level of KYNA in schizophrenia symptoms is ambiguous. Elevated levels of KYNA provoked cognitive defects in animals: auditory sensory gating, prepulse inhibition, contextual discriminations, spatial working memory . The levGABA acts on astrocytes through GABA receptors, contributing to the release of chlorine and depolarization of astrocytes, and GABA receptors, activating calcium-dependent mechanisms and contributing to the growth of gliotransmitter  . ActivatGABA entering the astrocyte is mediated by a GABA-transporter operating on the principle of symport with sodium, increasing the content of intracellular sodium can contribute to the reversible operation of GABA-transporter . ReducedAdenosine acts through two types of receptors—A1 and A2 . A1-receRecently gaining popularity adenosine theory of schizophrenia. It consists of the hyper-activation of adenosine kinase, which reduces the level of adenosine . It is sStriatal astrocytes express the heterodimer native receptors A2A-D2 . D2 receThe morphological basis of the accepted dopaminergic theory of schizophrenia is the dysregulation of the dopaminergic system primarily in the striatum , which iPostmortem examinations showed an increase in the level of dopamine in the striatum and an increase in the density of the D2 receptor but without changes in dopamine active transporter (DAT) densities  also take part in it. The presence of markers of activation of glia  in serum and cerebrospinal fluid indicates a growing activation of astrocytes. Isolation of pro-inflammatory agents  and KYNA indicates a violation in the metabolism of astrocytes and surrounding cells. As a result, this leads to changes in the structure of the brain. Morphological manifestations include a decrease in astrocyte density in the frontal cortex, changes in the composition of the extracellular matrix and glial hypertrophy. Of course, in addition to the obvious changes in the brain, astrocytes make a significant contribution to the negative, positive, and cognitive symptoms of schizophrenia.The number of astrocytes was reduced in the prefrontal cortex, that connects altered astrocyte system with mesocortical system, and nucleus accumbens, anterior cingulate cortex, which proves the changes in glial cells in the mesolimbic system, although in the hippocampus it was increased. The differences between the number of astrocytes in the mesocortical and mesolimbic system can affect on the manifestation of schizophrenia symptoms. Associations between GFAP and symptoms have not been found. At the same time the levels of another astrocyte markers, S100B and myoinositol, positively correlated with negative and positive symptoms, respectively. This finding suggests the dual alterations in astrocyte in brain regions, related with different symptom complexes.The imbalance between microglia and astrocytes, which occurs in neuroinflammation, influence on different neurotransmitters, such as GABA and dopamine. GABAergic interneurons, affected by oxidative stress, modulate the activity of prefrontal cortex, hippocampus and amygdala, that worsen alterations in dopamine system and, therefore, symptoms of schizophrenia.The contribution of glia to the development of cognitive symptoms was unexpected; normally it forms compartments and connections between neurons, but altered astrocyte themselves and extracellular matrix, affected by them, disturbs these interconnections.via KYNA and altered in schizophrenia glutamate transporters, as on the glycine system via non-synaptic GlyT-1 and D-serine. NMDA receptors and adenosine receptors, on its turn, control the dopamine release which is still considered the main schizophrenia neurotransmitter.NMDA receptors, related with all the groups of schizophrenia symptoms, associated also with astrocytes, since NMDA antagonist increased the number of GFAP-positive astrocytes in the prefrontal cortex. Astrocyte affects as on the glutamate system The study of the contribution of astrocytes to the etiology, pathogenesis, and symptoms of schizophrenia is associated with certain problems. The researches have been focused on the study of glia in different areas of the brain, which not only makes it difficult to generalize and analyze heterogeneous reactions of astrocytes but also eliminates the relationship between these areas and their respective astrocytes. In particular, the glia of “striatum-prefrontal cortex” axis, which supposedly plays a major role in the pathogenesis of schizophrenia, requires further analysis to study the contribution of NMDA receptors. Also, the study of the genetic patterns of astrocyte pathology is needed. Some problems are associated with the astrocytes themselves, for example, there is evidence of their heterogeneity, which means that it is impossible to accurately judge the suppression or activation of astrocytes in any structure of the brain. This problem is supplemented by the dependence of astrocyte functioning on the age of patients, which is not always taken into account in case-control studies.Further study of the effect of astrocytes on neurotransmission may clarify the currently controversial aspects of brain function in schizophrenia and explain the characteristic symptoms. For example, it is not clear why a decrease in the expression of NMDA receptors is observed in both the prefrontal cortex and the striatum, if NMDA receptors have an activating effect on dopamine neurons. A separate role in this can play KYNA, NMDA receptor antagonist, an association of which was found with all types of symptoms of schizophrenia. Special attention should be paid to the study of GLT-1, whose effect on the symptoms of schizophrenia is heterogeneous (VVT, AAS, VNC, SSS, PM, DL, SGS, CEK, SOB, and GA conceptualized and designed the study. PM and DL collected and analyzed the data. All of the authors discussed the analyses, the results, and their interpretation, revised and improved the various drafts. VT, AAS, VNC, SSS, PM, DL, SGS, CEK, SOB, and GA wrote the original draft. All authors have reviewed and approved the manuscript before submission.This research was supported within the framework of the grant provided by CSP Ministry of the Health Russian Federation, and by the IPAC RAS State Targets Project # 0090-2019-0005”. This work was also supported by the Russian Academic Excellence Project “5-100” for the Sechenov University, Moscow, Russia.GA is employed by GALLY International Biomedical Research LLC, San Antonio, TX, USA.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In modern foods, the delivery systems for bioactive compounds play a fundamental role in health promotion, wellbeing, and disease prevention through diet. Nanotechnology has secured a fundamental role in the fabrication of delivery systems with the capability of modulating the in-product and in-body behavior for augmenting bioavailability and activity of bioactive compounds. Structured nanoemulsions and nanoparticles, liposomes, and niosomes can be designed to improve bioactives preservation after ingestion, mucoadhesion, as well as of their release and pathophysiological relevance. In the future, it is expected that the delivery systems will also contribute to augment the efficacy of the bioactive compounds, for example by improving the intestinal absorption and delivery in the bloodstream, as well as promoting the formation of additional bioactive metabolites by regulating the transformations taking place during digestion and the interaction with the intestinal microbiota. The growing demand for health promotion, wellbeing and disease prevention through diet and nutrition has stimulated the development of smart foods, characterized by advanced functionality for the delivery to the target sites of the bioactive compounds they contain. Until recently, the main challenges to the incorporation of bioactive compounds, such as phytochemicals, micronutrients, and dietary fibers, in foods were related to overcoming the issues of poor dispersibility in the food matrix, unpleasant taste and physicochemical instability under food processing conditions  ,2,3. HowThe food industry has extensively relied on the use of nanotechnology, as an essential tool to extend the capability of controlling the in-product and in-body behavior of delivery systems for bioactive compounds, with applications in agriculture, foodstuffs transformation, packaging, and storage, and the production of dietary supplements ,7. CoherRecently, Martínez-Ballesta et al. have reviewed the use of novel nanosized encapsulation and delivery systems to expand the field of application of bio-functional nutraceutical compounds , which cNanoemulsions offer several inherent advantages for the food industry, especially the simplicity of production, high loading capability, high stability against creaming, and optical transparency ,13, but Although biocompatible particles are generally considered as safe for human consumption , the risBecause of the lack of knowledge on potential risks, Martínez-Ballesta et al. suggest that the next generation of delivery systems for bioactive compounds should focus on enhancing the bioavailability and activity of the bioactive compounds, to reduce dosages . This ca


The repercussions of the COVID-19 pandemic for medical students are enormous and not limited to the interruption of courses in medical schools and/or hospital training rotations, the introduction of teaching exclusively online, postponement of examinations, and of the new academic year, but extend beyond that. The mobility of students within the framework of the International Federation of Medical Students’ Associations (IFMSA) is also strongly affected by the unexpected interruption of this program and the deprivation of thousands of students worldwide of this fine opportunity for training, exchange and sharing. The International Federation of Medical Students’ Associations (IFMSA) was founded in 1951 and currently maintains 135 National Member Organizations (NMOs) from 125 countries, representing a network of 1.3 million medical students around the globe. Moroccan students, members of IFMSA like students from other countries, are also concerned. Clinical and research exchanges, carried out under the auspices of the IFMSA, allow all the students to discover the health care and medical education systems of another country in a different sociocultural environment. To maintain student motivation and deal with the repercussions of cancelled exchanges, IFMSA could propose online training programs, adapted to student needs during this period of confinement and deconfinement from June to September 2020. The repercussions of the COVID-19 pandemic for medical students are enormous and not limited to the interruption of courses in medical schools and/or hospital training rotations, the introduction of teaching exclusively online, postponement of examinations, and of the new academic year, but extend beyond that. The mobility of students within the framework of the International Federation of Medical Students’ Associations (IFMSA) is also strongly affected by the unexpected interruption of this program and the deprivation of thousands of students worldwide of this fine opportunity for training, exchange and sharing. IFMSA was founded in 1951 and currently maintains 135 National Member Organizations (NMOs) from 125 countries, representing a network of 1.3 million medical students around the globe (1). IFMSA is recognized as a non-governmental organization within the United Nations system and the World Health Organization and works in collaboration with world medical associations. It thus represents one of the world’s oldest and largest student-run organizations. Each year, more than 15,000 medical students embark on a journey to explore health care delivery and health systems in different cultural and social settings. An organization that annually, fulfills the dream of thousands of students, including those living in the most distant and most disadvantaged regions of the world. Students at all levels of medical studies are involved, from the first year to graduation with the degree in medicine. On average, these exchanges last four weeks and some may last eight weeks.Very excited, motivated, and involved, students will leave their countries for several weeks, perhaps for the first time, heading to different destinations on five continents with the aim of learning, and discovering the functioning of other systems of health care and medical education. IFMSA-Morocco is the national member organization that has represented Morocco at IFMSA since 2012, year that the country officially joined this giant international student organization (2). However, it required two years of preparation and acquisition of the necessary documents, including the agreements and signatures of the deans of the faculties of medicine and the directors of university hospital centers of Morocco, before exchanges could really occur and membership take effect. The first exchanges from and to Morocco thus began in 2014/2015. It should be noted that the ‘academic year’ for the exchange program corresponds to the period between April of the year in progress and March of the following year. From the year 2014–2015 to the year −2019, 1,039 non-Moroccan students came to do 861 clinical exchanges and 178 research exchanges in Morocco. During this same period, 1,202 Moroccan students did 991 clinical and 211 research exchanges abroad. The Faculty of Medicine of Oujda, a city in the northeast of Morocco, received 106 foreign students of 25 different nationalities  between the years 2015 and 2019, while 130 students left for 28 different destinations .The training programs through IFMSA provide an immense opportunity for Moroccan students to acquire new knowledge, develop new skills and consolidate acquired knowledge in two areas of medical studies, whether clinical or research. These exchanges are experiences that are not only very rich, rewarding, and interesting, but also marked by deep sharing and exchange between students of different nationalities and socio-cultural milieus. They also allow students to examine and participate in treatment of patients with diseases not usually encountered in their countries, such as malaria, brucellosis, typhoid, tuberculosis, leptospirosis, leishmaniasis, bilharziasis, hemorrhagic fevers, etc., diseases often studied in the lecture halls of the faculties or in medical textbooks, but rarely or never seen in hospital practice.The students, in the framework of IFMSA exchanges, are received in hospital departments and/or affiliated research facilities, participate in different educational activities of the department, are integrated into the medical and paramedical teams, and accomplish predetermined objectives stipulated in their training handbooks, objectives that are appropriate to their level of study and type of exchange, clinical or research. Their educational progress is directly supervised by a senior educator of the hospital department or the director of a research facility. These exchanges also aim to develop more than the student’s medical and research abilities. Very important also for a young doctor, are the interpersonal, communication and management skills needed to communicate with all actors in the health system. Moreover, these exchanges provide an opportunity to strengthen language skills, and English is the universal language of communication between students of different nationalities. Students from Francophone countries may find difficulties in mastering English and language then becomes a real obstacle for some, limiting the choice of countries, and thus of exchange sites.Beyond the educational and research goals, the students discover other cultural and social environments in a climate of respect, tolerance, sympathy and generosity. They are thus better prepared to approach and treat patients of foreign nationalities in their respective countries and develop ethical and cultural competencies accordingly. The activities of IFMSA are far from being limited to training programs, and extend to the organization of general assemblies, large international and regional events, medical prevention campaigns, and conferences.The COVID-19 pandemic, triggered in December 2019, has affected more than seven million inhabitants in 218 countries, has immobilized air traffic in most of the affected countries, and has thus interrupted, across the world, the exchange program of students who should have started their assignments in April 2020. Thousands of students found themselves unable to take part in these exchanges, so desired and eagerly awaited. One part of these programs, notably those scheduled between August and March 2020, could resume if the land or air borders between countries were open and non-essential flights authorized. The exchanges that cannot be conducted this year will be postponed to next year, but this option deprives a great many students of the opportunity to participate.https://ifmsa.org/2020/05/26/climate-change-in-medical-curricula-a-need-for-current-and-future-physicians.International Federation of Medical Students’ Associations. International Federation of Medical Students’ Associations- Morocco.To maintain student motivation and to make up for the exchanges cancelled because of the COVID-19 pandemic, IFMSA could propose special, adapted online training programs during the period of suspension, between June and September 2020, in the form of webinars, workshops, videos of medical simulation scenarios, and courses on diseases with active teaching methods and evaluation tools. Training on the acquisition of the fundamental bases of clinical research could also be organized in the same way as clinical training. It could also organize training sessions on student stress during this period of confinement and deconfinement. These types of training could be moderated by expert senior educators and co-moderated by IFMSA students. IFMSA could also organize, in collaboration with major accredited language centers and organizations, a rigorous, accelerated, certifying program to strengthen language skills, especially in English and Spanish, to benefit the students. IFMSA should play its supportive role for medical students during this period of the COVID-19 pandemic.http://ifmsa-morocco.org


Several approaches were proposed to describe the geomorphology of drainage networks and the abiotic/biotic factors determining their morphology. There is an intrinsic complexity of the explicit qualification of the morphological variations in response to various types of control factors and the difficulty of expressing the cause-effect links. Traditional methods of drainage network classification are based on the manual extraction of key characteristics, then applied as pattern recognition schemes. These approaches, however, have low predictive and uniform ability. We present a different approach, based on the data-driven supervised learning by images, extended also to extraterrestrial cases. With deep learning models, the extraction and classification phase is integrated within a more objective, analytical, and automatic framework. Despite the initial difficulties, due to the small number of training images available, and the similarity between the different shapes of the drainage samples, we obtained successful results, concluding that deep learning is a valid way for data exploration in geomorphology and related fields. The three-dimensional configuration of a watercourse is generally connected to the tectonic-climatic formation conditions and the evolving morpho-climatic system. The recurrence and ubiquity of some networks in different continental areas also depend on regional macroscale aspects, such as geological outcrops and substrate, gradient, climate, type, and extent of the plant cover. At the local microscale, rock fracturing degree, layers attitude, erosive-depositional processes extent, and resistance to erosion are also involved in the modeling process5.The hydrographic networks of the Earth represent morphologies of the continental landscape characterized by variable dimensions from hundreds of meters to thousands of kilometers and complex geometry, derived by the mutual interaction of numerous physical, biotic and anthropic factors evolving in space and time due to a non-linear physicse.g., Mars and Titan9.However, similar boundary conditions in different regions do not always lead to the same hydrographic patterns modeling: there are phenomena of superimposition of the most recent networks on inherited landscapes, modeled in tectonic and climatic contexts of the past, very different from the current ones. On the contrary, in very different climatic and geological-structural contexts, characterized by active tectonics or volcanism, similar patterns are often observed, due to the morphological convergence and morpho-selection phenomena. These considerations also apply to geometries present in environments very different from terrestrial ones, such as in regions of some Solar System planets and satellites, 10 and references therein). By comparing the various drainage systems present in the two planets and the satellite of Saturn, a greater similarity between those of Titan and Mars was found. In particular, unlike the Earth, in the other two cases the lack of telluric phenomena in the recent past, together with the absence of movements of the tectonic plates, avoided the succession of deviations and anomalies of the river paths, which instead have controlled the modeling of many drainage patterns on the Earth. This means that on the surface of both Mars and Titan, mainly mechanical erosion processes acted. A dense network of large basins was observed on Mars, due to the frequent impact of meteorite bodies and asteroids, which shaped the surface and also conditioned the course of rivers. Recently, this phenomenon was confirmed on Titan by standardizing the resolution of the maps available for the three bodies10. This favored the possibility of carrying out a comparative analysis of drainage patterns on different bodies of the Solar System, classifying them directly from the images, fully combining the experience acquired on Earth and the effectiveness of recent data-driven methodologies.As known, since the beginning of their history, about 4.5 billion years ago, the Earth and Mars planets shared the phenomenon of the modeling of their surface by watercourses, although today, unlike our planet, the surface of Mars appears completely arid. Even the largest moon in the Saturnian system, Titan, resembles the Earth, being the only planetary body in the Solar System characterized by rivers still flowing today, although in the case of Titan they are powered by liquid methane. Despite this, recently was highlighted how the evolutionary history of Titan is unknown  the overall drainage network symmetry and on (ii) the pattern dimensional scaling. The former is rarely present in these natural systems, while the latter is proven mostly for limited portions (sub-basins), rather than for the entire river network. This depends on the difficulty of the geomorphology physics interpretation12. Therefore, we tend to identify a series of main and recurrent dimensionless patterns and their derivations  processes from secondary ones (erosion), through the interpretation of the fractal dimension. As the latter increases, the effect linked to erosion processes compared to tectonic ones, increases, hence the irregularity of pattern too25.The geomorphic-quantitative analysis in river geomorphology26. The apophenia or astronomical “pareidolia”, that is the ability to see forms known or not in clouds, mountains, streams, stars, or planets, is one of the most extraordinary illusions of the human mind which permeates countless anthropic and scientific disciplines, such as religion, mythology, art, astronomy, and geology27. In such a context, the morphology of drainage patterns is perceived and described based on the prevalent configuration attributed to a single dominant pattern. However, this classification is unsatisfactory and imprecise.In short, the hydrographic networks appear formed by a set of minor networks of the tributaries of the mainstem, characterized by a different geometry. It is known that the human classification of bi- and tridimensional objects, natural or not, is based on complex and little understood brain perception models, which are also used in Robotics34, the Machine Learning (ML) paradigms allowed a rapid and growing diffusion of Artificial Intelligence (AI) in all sectors of anthropic and scientific activities. The real challenge of AI is that this sophisticated methodology proved to be decisive for computer tasks apparently easy for people, but difficult to describe formally and extremely time-consuming. Among these, there are problems that we solve intuitively and automatically such as recognizing words, faces, or structures within images38.In the analysis of many complex natural systems, e.g. in Astrophysics, Earth and Planetary Sciences41.The complexity of the human intelligence emulation of natural phenomena by data-driven systems highlights the need to acquire knowledge, extracting conceptual schemes and complex data correlations directly from the primary source, which is the observed data of the studied phenomenonThe Deep Learning (DL) models incorporate both the characterization of the parameter space and the classification system, becoming particularly suitable in use cases where: (i) the expert user can recognize the structures within images, but at the cost of an impractical and long process, often affected by interpretation controversies; (ii) it is extremely complex to extract the information potentially contained in the images. This implies the intrinsic difficulty of applying traditional analytical methods or classic ML models, particularly sensitive to the negative effects induced by incomplete, noisy, and/or insufficient data.The scientific problem of an unbiased classification of drainage networks is characterized by the two mentioned aspects, approached through DL in our research. Different from other methods, by adding data, the DL model reinforces the learning power based on its acquired experience, which is used to generalize the ability to classify new samples, thus improving the accuracy and reliability of the classification of new drainage patterns. Such method, directly applied to images, has the real potentiality to define a new, more objective classification of these complex natural elements, characterized by an irregular and asymmetrical geometry, thus contributing to a better characterization and analysis of terrestrial and extraterrestrial examples.In such a scenario, the primary objective of the present work is to classify the drainage networks in an unambiguous, reliable, and as automated as possible way. Unambiguous means guaranteeing the utmost accuracy in assigning the right class, in accordance, but also on a complementary base, with the broadest and most objective consensus provided by the community of experts in the field.In order to reach this consensus, this work intends to promote the "River Zoo" survey initiative, aimed primarily at involving the entire scientific community interested in the field and inspired by the well-known category of "citizen science projects". The idea behind such an initiative is mostly to solve the problem of the current lack of drainage network samples useful for facing the exercise of multi-class classification in a statistically consistent and balanced way. Therefore, the multiple participation in the expert survey would be able to guarantee a more reliable assignment of the class to each sample, improving the quality and ensuring an incremental strengthening of the training set for DL models.The DL approach is also able to guarantee the repeatability, coherence, and consistency of classification, by maximizing the incremental acquisition of experience , thus ensuring the application of same and consolidated criteria to other drainage network samples over time.Furthermore, another significant aspect of the presented method is to exploit the aseptic and complete information deriving directly from the analysis of the images, avoiding the use of potentially biased, incomplete, and ambiguous derived information, i.e., traditionally extrapolated from processed physical and environmental parameters. Finally, the method is intrinsically automated, thus able to minimize the human intervention in the classification process, relegating it to an a posteriori analysis and the scientific exploitation of the results obtained.Certainly, the long-term goal of the project, for which this work is a fundamental premise, is the multi-class classification using at least the taxonomy highlighted in Fig. This work is organized as follows: “http://dame.oacn.inaf.it/riverzoo_files/DrainagePatternsReferences.txt). For the supervised DL experiments, we assigned class labels to the collected Earth examples by distinguishing between two classes, respectively, dendritic (D), including subtypes sub-dendritic, pinnate and high-relief pinnate, versus not-dendritic (ND), including other subtypes, such as trellis, parallel, rectangular, angular, annular, radial, centripetal, herringbone and barbed. The intrinsic difficulty to provide a sufficient amount of training samples motivated the choice to apply data augmentation techniques to improve the model training capability. This procedure included uniform sizing of all images to 540 × 540 pixels and their augmentation, obtaining five further samples for each original image, through three rotations of, respectively, 90, 180, and 270 degrees and two flipping operations concerning, respectively, horizontal and vertical axis. A further advantage was to make the trained model invariant to different orientations of drainage networks within images. Furthermore, we vectorized the images, to make the morphology of a network in a simple, but informative and quantitative form and converted them in grayscale, to simplify the extrapolation of the network pattern. Then the images were cleaned to remove residual noise and to re-arrange parts of the reticle partially lost by the conversion. The labeled dataset of 131 Earth samples was then subdivided into three subsets, using, respectively, 70% for training, 10% for training validation, and the last 20% as a blind test set used to estimate the statistical performances.Both Earth and extraterrestrial drainage network images have been extracted from public literature and dedicated websites  and two variants of gradient descent methods, respectively, Adadelta48 and ADAM49.As known, the experiments based on DL are characterized by a long test campaign for the heuristic optimization of its hyper-parameters, highly dependent on the degree of the intrinsic difficulty of the problem, and only partially mitigated by the experience in the use of such methods. Our test campaign led to the final selection of three customized models, respectively, VGGNet + Adam, VGGNet + RF, and AlexNet + Adadelta Fig. . VGGNet 43 inspired by two typologies known in the literature. These neural networks are inspired by the behavior of the biological model (human brain). Artificial neurons are organized into several layers, hierarchically connected. As in the biological model, the variation in synaptic connections is related to the learning mechanism. During training, these connections between layers  are adapted through a mechanism of propagation of the signal back and forth in the network. At the end of the training process, the supervised model  establishes a non-linear input–output relationship, coded by the resulting weight matrix.The two DL model architectures chosen downstream of a test campaign are two CNNs41.The CNN model represents one of the most widespread supervised DL methods, whose peculiarity is the presence of a set of so-called receptor fields that identify the synaptic activity of neurons. A receptor field can be represented by a matrix  that connects two consecutive layers through a convolution operation. Similar to the mechanism behind the adaptation of weights in a classic neural network, the kernels are modified during training. The important prerogative is the ability of a CNN to automatically extract the representative features of pixel regions distributed in the image, such as arcs, shapes, structures of various forms, variations in contrast and intensity. Then, these features are coded in a vector at the end of the sequence of internal layers, supplied as input to any classification model, which assigns the category to each structure identified in the starting image. The basic idea of a CNN is the multi-layer mechanism in which convolution and synthesis (pooling) levels of the propagated information alternate. This stratification process usually is made up of dozens of layers, in each of which the convolution level acts as a filter, thus emphasizing or suppressing different features of the image. The pooling level ensures the conservation and propagation of essential information (not redundant) extracted up to that pointUnlike the layers of a classic neural network, in which the neurons of one layer are all connected by weights with each neuron of the next layer, in a CNN these connections are "scattered", i.e., limited to a reduced fraction. This reduces the number and complexity of operations, the amount of memory required, and therefore the computing time. The output of each layer consists of a set of sub-images, smaller in size than the original image, called "feature maps".49.Another useful operation, even if optional, in the propagation process, is the so-called "dropout", which is a series of random interruptions between the neural connections, to avoid excessive "specialization" of the network to the images provided in phase training and keeping it more "flexible", that is, able to extrapolate the recognition of structures similar but different from those of the training set, a problem known as "training overfitting". In the tests carried out in this work, various dropout percentages were used in some cases, to avoid the occurrence of this problem, together with the use of the common early stopping training methodIn the case of classification problems, the final output of a CNN + classifier model is represented in the form of a probability matrix, in which each input sample (image) has associated a probability of belonging to each of the classes of the problem.50. The adaptation of the weights of the network, at each training cycle, is performed to minimize an error function . In the case of the models used in this work, this function is the "cross-entropy"51:The final attribution of the class takes place through the classic "softmax" function, which normalizes an array of values to a probability distribution47;Random Forest: ML method composed of a set of decision trees, built from subsets of features, randomly chosen, capable of attributing, through a "majority" mechanism, the class of belonging to each structure present in the image provided as input48;Adadelta: optimization method based on the descending gradient technique, which adapts the learning rate to each iteration, avoiding an excessive reduction of the gradient value of the error function49.ADAM (Adaptive Moment Estimation): a method similar to Adadelta which, in addition to reducing the gradient through the variable learning rate, introduces a mechanism for updating the weights taking into account the moments (mean and variance) of distribution of gradient functionThe first CNN model selected was derived from the VGGNet network45. The network consists of a series of layers, in which the alternation between convolution and pooling is performed by considering several consecutive convolution levels before each pooling level. This model was chosen by considering its high classification performances, already verified in other scientific fields, characterized by the high complexity of data52, like those subject of the present work.Amongst the various classification algorithms used during the test campaign, the so-called optimizers, placed as the last layer of the CNN models, three methods resulted in the best candidates:45. In addition to the succession of layers formed by the alternation of convolution and pooling, its main feature is the final "dense" triple-layer, composed of thousands of neurons fully connected.The second CNN model selected is inspired by the AlexNet network53: (i) the average efficiency (AE), obtained from the sum of the correctly classified samples, weighed concerning the total of the samples of the test set; (ii) purity (P), also known as precision; (iii) completeness (C), also known as recall; (iv) F1-score (F1), obtained as the harmonic mean of purity and completeness. These last three estimators were derived for each class  is about 2.65 times lower than Earth (0.981 g). In this case, the drainage networks were not modeled due to the lower weight of water and sediments, but from the higher speed of water and the intense surface run-off in the pastBy predicting the class of extraterrestrial patterns, using models trained only on Earth samples, the results were in agreement with human expert analysis in 88% of cases. Therefore, the DL approach appears quite robust in the prediction, even in cases of different morphologies, and with a high rate of generalization accuracy.As outlined in the previous sections, this work was mainly based on two fundamental aspects, both deriving from the intrinsic multidisciplinary nature of the pursued approach.First, the absolute novelty of the application of methodologies, already widely used and validated in other scientific fields, to a specific scientific use case, in this case, the geomorphology one. This had the primary purpose of (i) minimizing, in perspective, the subjective human interpretation in the classification of drainage patterns and (ii) performing the pattern recognition directly from images, thus avoiding any bias effect induced by the selection of the parameter space, i.e. the physical and environmental parameters extracted from images, which is at the base of most traditional approaches.Secondly, due to the novelty of the approach, we had to proceed from the initial level, that is, from the simplest and most general possible case of the two macro-class classification, for instance, dendritic versus non-dendritic, avoiding in the first instance the well-known problem of error propagation in the case of a hierarchical pairwise classification of different sub-classes. This, to validate the methodological approach and to acquire the necessary experience to be subsequently poured into the harder multi-class problem. Naturally, the simultaneous multi-class classification, that is the attribution of a drainage pattern to one of the ten classes, enucleated in Fig. Precisely for this reason, we launched the River Zoo initiative, which aims at quantitatively enriching the database, both in terms of quantity and variety of examples suitable for training the Deep Learning models, through the direct involvement of the wider community of experts interested in the scientific problem.http://dame.oacn.inaf.it/riverzoo.html). Such initiative, inspired by what was done in Astrophysics60, by exploiting the scientist experience, has the role to provide reliable ground truth for DL-based classification.Due to the high sensitivity to the subjective class labeling of training samples, we implemented a public survey addressed to interested researchers, called “River Zoo” and available on the Web (Main goal of this project is to perform a statistical evaluation of the classification of terrestrial and extraterrestrial drainage networks by human experts.The idea is to analyze the degree of reliability of class assignment to drainage samples, driven by user expert decisions, taken just by looking at their image and choosing the right pattern type Fig. . In thisThe DL approach represents a useful method for the analysis and classification of Earth and extraterrestrial physical geomorphological objects like drainage networks, here applied for the first time.The study of terrestrial drainage patterns is suitable for the research of geological processes responsible for the formation of a specific morphology and may have significant results even at a multidisciplinary level. Considering that the geological-climatic context and the network shape are mutually interconnected, the analysis of Earth, Mars, and Titan basins assumes an important relevance for the study of paleoclimate and indicates a morphological convergence of different and complex erosion processes, suggesting that some patterns could be ubiquitous in the Solar System.Finally, we are confident that the River Zoo public survey initiative could contribute to improving the knowledge about morphological and geologic-climatic aspects of drainage patterns, besides its potential to improve their classification and to extend the training ground truth.