Smart agriculture applications (monitoring, sensing, automation and control) of micro-climate and environmental conditions for different agriculture production sectors and scales, decision-makers and researchers need to take it into consideration to strengthen the efforts of mitigation and adaption of climate change impacts as well as maximize the natural resources use efficiencies and food production. Motivate the farmers to implement smart agriculture applications, especially in developed and poor countries, strong cooperation for technology transfer and build up the technology infrastructure of information and communication (ICT) plus the internet of things (IoT).
Thousands of tons of biodegradable organic waste generates in urban and rural areas every day, creating disposal problems. Urban organic waste can be converted into valuable output products (vermicompost, vermin-liquid, and earthworms) by applying a vermicomposting technique that had different. Implementing green roofs via soilless culture systems as micro-scale farms led to increasing natural resource use efficiencies as well as producing fresh food. The integration of both techniques will create not just reduce pollution and climate change impacts but also for increasing food production and security in urban, enhance the lifestyle and increase public awareness of environmental issues. This process is profitable at any scale of operation.
Saliva is produced by and secreted from salivary glands. It is an extra-cellular fluid, 98% water, plus electrolytes, mucus, white blood cells, epithelial cells, enzymes, and anti-microbial agents. Saliva serves a critical role in the maintenance of oral, dental, and general health and well-being. Hence, alteration(s) in the amount/quantity and/or quality of secreted saliva may induce the development of several oro-dental variations, thereby the negatively-impacting overall quality of life. Diverse factors may affect the process of saliva production and quantity/quality of secretion, including medications, systemic or local pathologies and/or reversible/irreversible damage. Herein, chemo- and/or radio-therapy, particularly, in cases of head and neck cancer, for example, are well-documented to induce serious damage and dysfunction to the radio-sensitive salivary gland tissue, resulting in hypo-salivation, xerostomia (dry mouth) as well as numerous other adverse Intra-/extra-oral, medical and quality-of-life issues. Indeed, radio-therapy inevitably causes damage to the normal head and neck tissues including nerve structures (brain stem, spinal cord, and brachial plexus), mucous membranes, and swallowing muscles. Current commercially-available remedies as well as therapeutic interventions provide only temporary symptom relief, hence, do not address irreversible glandular damage. Further, despite salivary gland-sparing techniques and modified dosing strategies, long-term hypo-function remains a significant problem. Although a single governing mechanism of radiation-induced salivary gland tissue damage and dysfunction has not been yet elucidated, the potential for synergy in radio-protection (mainly, and possibly -reparation) via a combinatorial approach of mechanistically distinct strategies, has been suggested and explored over the years. This is, undoubtfully, in parallel to the ongoing efforts in improving the precision, safety, delivery, and efficacy of clinical radiotherapy protocols/outcomes, and in designing, developing, evaluating and optimizing (for translation) new artificial intelligence, technological and bio-pharmaceutical alternatives, topics covered in this review.
Philip Osei Bonsu, Ronald Osei Mensah* and Agyemang Frimpong
Published on: 20th December, 2022
In Ghana, there is evidence of the direct influence of climate change on the environment, such as rising temperatures, variable rainfall, and precipitation. These manifestations affect various facets of Ghana socio-economic structure especially with its high reliance on sectors that are particularly sensitive to climate change like agriculture. In the settlements of Bonsua and Amoawi in the Offinso South District, the study concentrated on the influence of climate change variables on food crop production and how farmers are adapting to the various climate change measures. Out of the total of 650 staple food crop farmers in the dorminated selected communities namely, Amoawi and Bonsua, 160 farmers were chosen for the study using systematic random sampling. The study included both primary and secondary data. Descriptive cross sectional survey was employed for the study. The data collection instrument employed was Structured and semi-structured interviews. SPSS was used to analyse the data. The data collected for the study were analysed using both descriptive and inferential analytical tools. Findings from the study indicate that climate change is a challenge to food crop production since agriculture activity in the two communities are mostly rain feed (97.5%). The majority of the crops grown in the two areas are climate change vulnerable. Another study finding reveals that most respondents have modified their coping mechanisms such as such as growing different crop varieties, early and late planting, irrigation and soil conservation to deal with how climate change is affecting agriculture. Therefore, the study suggests that both government and non-governmental organizations should support farmers in building irrigation systems to continuously irrigate their food crops during the dry season, increasing their farm productivity.
Noura Ali Moosa Al Balushi, Shabib Sulaiman Ali Al Rashdi*, Nageswara Rao Lakkimsetty and Fatema Almarhoon
Published on: 28th December, 2022
Due to the adverse environmental impacts of synthetic plastics, biodegradable plastics development for both industrial and commercial applications is essential for the present scenario. In addition to the non-degradability of petroleum-based plastic and its impacts, so it is very important to find an alternative to petroleum-based plastic. Starch-based bioplastics are an excessive substitute for petroleum-based plastics due to their significant properties compared with natural sources. This research aims to formalize five new formulas of bioplastic by combining two sources of starch, extracted from various biomass sources, its properties and comparison between them. The moisture content shows 2.07% and 0.984% for samples F and B respectively and that indicates that the samples which contain a high amount of corn starch have less moisture content. The highest results of biodegradation percentages were 68.27% and 52.6% which are for samples A and D respectively, and the lowest biodegradation percentage were 34.33% and 31.29% which are for samples F and B respectively.
Climate change is increasing the frequency of climate-related disasters, creating greater risks of hunger and the breakdown of food systems. The sustainability of our planet is currently a major concern for the global community and has been a central theme for a number of major global initiatives in recent years. Climate change has prevalent, multi-faceted, and temporal impacts on food security. Higher temperatures, water scarcity, extreme events like droughts and floods and greater CO2 concentrations in the atmosphere have already begun to impact staple crops around the world. The warming climate is already taking a toll on human health, causing widespread hunger and illness that will grow exponentially worse, and will pose a major threat to human well-being. In this article, an attempt has been made to discuss some critical issues relevant to the four dimensions of food security and to provide broader perspectives on climate change and its impacts on the food system, food security and human well-being.“Humanity is facing a rare challenge. But it is a common challenge. There are no sides in the fight for climate justice” (Kofi Annan’s message prior to the UN Climate Conference in Copenhagen 2009).
Gopikumar S*, Sundararajan S, Allwyn Kingsly Gladston J, Antony Vasantha Kumar C, Hari Babu K and Jeyakumar K
Published on: 14th February, 2023
The main focus of this study concentrates on evaluating the quality of groundwater in and around the zone of pattamadai where the production of the mat in this region is a landmark industry, which is using dyes in a larger volume. The primary work starts with the collection of water samples from 13 boreholes and 13 hand-dug wells in different time intervals in the month of March 2021, which is a dry season. As per standards the water quality parameters have been evaluated and observed to be within the range. All the physico-chemical parameters for the samples have been studied for boreholes and hand-dug wells as all the values are observed to be within the range and are highlighted in the results.
Yunfei Li#, Huali Liu#, Linlin Ding, Liwei You, Yuqiang Zhang, Xingxing Wang, Xueyuan Lin and Liquan Yang*
Published on: 23rd February, 2023
The pathogenesis of an ovarian disease is connected with PTN and its receptor protein tyrosine phosphatase receptor Z1 (PTPRZ1). Paclitaxel is the first-line drug for the therapy of ovarian cancer. With the increment of paclitaxel chemotherapy, paclitaxel obstruction happens in the late phase of therapy frequently. By treating A2780 and SKOV-3 cells with PTN, we found the development of the two cell lines was enhanced. Different concentrations of PTN were added to A2780 and SKOV-3 cells treated with paclitaxel and the results of MTT showed that the inhibitory effect of paclitaxel on these two cell lines was weakened. The results of apoptosis assays showed that PTN could slow down the rate of apoptosis and its concentration dependence in both cell lines. To further investigate the impact of PTN on the paclitaxel responsiveness of ovarian malignant growth cells, A2780 and SKOV-3 cells were transfected with sh-PTN-1, sh-PTN-2 and sh-NC plasmids. The results of PCR and Western Blot showed that both RNA-interfering plasmids could inhibit PTN in A2780 and SKOV-3 cells. The results of MTT showed that the inhibitory effect of paclitaxel on cells transfected with sh-PTN-1 expanded compared with the benchmark group. Apoptosis assays showed that the complete apoptosis pace of A2780 and SKOV-3 cells with sh-PTN-1 plasmid induced by paclitaxel was accelerated obviously compared with the benchmark group. To summarize, the results suggested that PTN could enhance the resistance to paclitaxel in ovarian cancer cells, which provides a groundwork for studying on drug resistance of cancer cells to paclitaxel and a new perspective for ovarian cancer therapy.
Elena-Rodica Popescu*, Bianca Augusta Oroian, Vasile Chiriță and Roxana Chiriță
Published on: 10th March, 2023
Introduction: Self-harm and depression are two related mental health issues that often co-occur and can have serious impacts on individuals and their well-being. Major Depressive Disorder (MDD) is a complex and multifaceted mental health condition that is prevalent among young adults. It is a significant public health concern that affects individuals, families and society as a whole, contributing to considerable social, economic, and health-related costs. Despite the high prevalence of depression in young adults, there is a lack of understanding of its etiology, risk factors, and optimal treatment strategies. Self-harm behavior is a concerning manifestation of MDD that can have serious consequences, including injury, infection, or even death.Methods: In this article, we report a case of an MDD patient with self-harm behavior and discuss the assessment method and treatment options. Our aim is to raise awareness of these pathologies among psychiatrists and the general population and to highlight the importance of early diagnosis and effective treatment in reducing the risk of self-harm behavior and suicide.Conclusion: In light of the case presented, it is evident that early detection and targeted intervention are crucial in mitigating the risk of self-injurious behavior in MDD patients. The utilization of a comprehensive assessment methodology, inclusive of a thorough review of the patient’s clinical history and utilization of standardized rating scales, proved indispensable in the tailoring of an individualized treatment regimen. The amalgamation of pharmacotherapy and psychotherapy proved to be a successful strategy in the amelioration of depressive symptoms and consequent self-harm behavior. As such, we trust that this case report will serve to sensitize clinicians to the importance of early identification and prompt management of these pathologies, in the quest for enhanced mental health outcomes.
Carles Cañameras Fugasot, Oriol Rodríguez-Leor, Josep Riera Sadurní, Edgar Fadeuilhe, Javier Paul Martínez, Marina Urrutia Jou, Jordi Bover and Maribel Troya-Saborido*
Published on: 16th March, 2023
Hypertension is a risk factor for the development of heart failure and has a negative impact on the survival of these patients. Although patients with these two conditions usually take different antihypertensive medications, some patients do not achieve adequate blood pressure control and their hypertension becomes resistant or refractory. In this scenario, percutaneous renal denervation has emerged in recent years as an alternative to achieve blood pressure control goals. We present the case of a 53-year-old woman with a medical history of essential hypertension, hypercholesterolemia, unipolar depression, and diabetes, who was diagnosed with dilated cardiomyopathy with reduced left ventricular ejection fraction (33%). Despite the initiation of multiple antihypertensive medications and placement of a cardiac resynchronization therapy pacemaker, the patient remained hypertensive with a left ventricular ejection fraction of 40%. At that time, percutaneous renal denervation was performed without complications, and one year after the procedure, the patient had improved better blood pressure control and the left ventricular ejection fraction increased to 51%. This case illustrates one of the clinical scenarios in which it has been suggested that renal denervation may be more beneficial, as in the situation of patients with refractory hypertension and heart failure.
Wayne J Caputo*, George Fahoury, Donald Beggs and Patricia Monterosa
Published on: 11th April, 2023
The COVID-19 Pandemic, which began in March 2020, and its associated surges, had an immense impact on our medical staff and their ability to perform their daily duties.The COVID-19 Pandemic necessitated hospital modifications, including the expansion of the Emergency Department, ICU, and Isolation units. The overwhelmed staff and overburdened ER and ICU required adjustments to deal with the Inpatient impasse. For example, temporary patient care rooms needed to be set up for the overflow of patients. The tsunami of the Pandemic almost overwhelmed our hospital.With the challenges presented to our hospital during the Pandemic, we needed a fresh perspective to our multi-disciplinary approach. Thus, we fathomed that the use and cost-effectiveness of both Dalbavancin, a long-acting lipoglycopeptide antibiotic combined with the diagnostic Moleculight Imaging Device would be a sound decision.We hypothesized that with the use of this cost-effective antibiotic in conjunction with the use of the Moleculight Imaging Device, with its fluorescent imaging, we could detect the presence of bacteria and assist our wound treatment and decision-making.A shift in patients from the Emergency Room/Inpatient Department to the Outpatient Department/Wound Care Center was made possible with the use of these two novel products.
Michelle N Lende*, Paul J Feustel, Erica K Nicasio and Tara A Lynch
Published on: 24th April, 2023
Background: Pregnant individuals with early cervical dilation have a high risk for preterm birth. The authors encountered cases where cervical dilation increased after anesthesia administration for a cerclage. Objective: The primary objective was to assess if a change in cervical dilation after anesthesia administration for a cerclage was associated with a shorter latency to delivery. Study design: This was a retrospective chart review of pregnancies from January 1, 2011, to December 31, 2021, who had a cerclage and delivered at our institution. Maternal demographics, obstetrical history, operative details, and delivery information were collected. Multi-fetal gestations, un-indicated cerclages, and abdominal cerclages were excluded. The primary outcome was the difference in cervical dilation between the office and the operating room after spinal anesthesia administration. A multivariable regression was performed. Results: A total of 183 pregnancies were included. The mean gestational age at cerclage placement was 18 weeks (STDEV 3.6). Twenty-nine percent of patients (53/183) were more dilated in the operating room compared to the office The latency between cerclage and delivery was not different if there was a cervical change between these settings (p = 0.655). There was an increased risk for preterm delivery with dilation in the office (OR 1.01, CI 1.01 to 2.5), but not with dilation in the operating room (OR 1.4, CI 0.9 to 2.0). Conclusion: Cervical dilation between the office and the operating room is different. Pregnancies with more dilation delivered at earlier gestations. However, a change in dilation between the office and the operating room was not associated with a shorter latency.
Dabholkar Yogesh, Shah Tanush, Rathod Roheet, Paspulate Akhila, Veligandla Krishna Chaitanya, Rathod Rahul, Devesh Kumar Joshi* and Kotak Bhavesh
Published on: 25th April, 2023
The manifestation and severity of Allergic rhinitis symptoms show diurnal variation which negatively impacts the patient’s quality of life, day-to-day activities, and productivity at the workplace. The symptoms worsen at night or early morning and therefore administration of levocetirizine towards evening may be more acceptable. Consequently, the present study evaluated the effectiveness of evening Levocetirizine administration on 24-hour symptom control, Physical and mental health, and daytime somnolence in patients with allergic rhinitis the study was a prospective, open-labeled, single-arm, two-center, observational study among patients with allergic rhinitis. Levocetirizine was prescribed as 5 mg or 10 mg once a day evening oral dose for at least 7 days before sleep. The 24-hour total nasal symptom scores (TNSS) for self-reported signs and symptoms of allergic rhinitis were recorded. Additionally, study evaluations included the SF-12 scale (Quality of Life), Stanford Sleepiness Scale (degree of sleepiness), and work productivity and activity impairment (WPAI) questionnaires. These evaluations were performed at baseline (Day 0) and at scheduled intervals of Day 1 (24-hour), Day 3, and Day 7. Results demonstrated that evening administration of Levocetirizine facilitates 24-hour symptom control while having no significant effect on daytime somnolence, daily activities, and the work productivity of patients.
Muna Ahmed Al Saadoon*, Mohammed Saif Allouyahi and Shahad Abdullah Almamari and Syed Rizvi
Published on: 29th May, 2023
Introduction: Child Protection Services (CPSs) are dedicated to providing protection and responding to any threats a child could face as children worldwide could be abused. Recently, the COVID-19 pandemic affected all aspects of life. Procedures implemented to restrict the spread of the disease (such as reduced access to services, school closure, and social distancing measures) had an impact on child life and maltreatment. Therefore, it is important to know the impact of this pandemic on child abuse and protection. Aim and rationales: This study aimed to assess the impact of COVID-19 on CPSs in Oman by studying the change in the number of reported cases of child abuse and the change in the reporting procedure at the Ministry of Social Development (MOSD). In addition, know the impact of the restriction measures on child rights and risk factors of child maltreatment based on CPSs workers’ opinions and experience. To understand the adaptation of the CPSs to the change in work and life environment imposed by COVID-19. Method: A cross-section study was conducted using a semi-structured questionnaire, that was distributed to the workers involved in the CPSs at the MOSD in Oman. Data also were collected from the statistical bulletins on the Ministry’s website. Results: COVID-19 pandemic was not found associated with a significant change in the number and type of child abuse cases reported to the MOSD. The reporting procedures also did not change. In addition, the pattern of child abuse types did not change before and during the pandemic, as neglect cases were the most. The participants judged the restriction measures affecting family life through separation, cyber abuse, and reduced educational support. With regard to intervention and follow-up procedures, the main difference was in the communication processes by using online communication methods and reducing the fieldwork for mild cases.Conclusion: CPSs in Oman were not much affected by the COVID-19 pandemic, which may reflect the success of this system in dealing with the restriction measures. However, more solutions should be developed to adapt to these circumstances in the future altogether.
Kwokori Christopher O, Ogbonna Brian O*, Anetoh Maureen U, Mbagwu Sonne I and Offu Ogochukwu F
Published on: 5th June, 2023
Background: The socioeconomic impact of drug and substance abuse on secondary school students in Nigeria is yet to be fully evaluated even in the face of the current surge in abuse of substances among the younger folks who constitute more than half of the entire population.Objective: This study narratively reviewed the studies on the socioeconomic impacts of drug and substance abuse on secondary school students and studies by researchers in Nigeria. Methods: The study was a narrative review of the literature covering the socioeconomic impacts of drug and substance abuse on secondary school students in Nigeria from 1980 to 2023. Data were extracted and summarized with descriptive statistics. Results: All the studies took place between 2012 and 2023; 6 (100%). The studies carried out were all observational studies 6 (100%). All the studies fell below average in the benchmark for the hierarchy of evidence-based studies. The studies mostly took place in the South-West 3 (50.00%), while 1 (16.67%) took place in the South-East, North-West, and North-Central respective regions of Nigeria.Conclusion: The available studies done on the impacts of drug and substance abuse focused more on the social impacts, with little or no attention to the economic effect. The available studies however remain at the observational level in the evidence-based ladder. Future Research on the reviewed theme should focus on the economic implications of the social effects of drug and substance abuse on secondary school students in Nigeria.
Patrick Ting*, Aayaan Sahu, Nishad Wajge, Vineet Rao, Hiresh Poosarla and Phil Mui
Published on: 12th June, 2023
Background: In light of the COVID-19 pandemic and the health crisis left in its wake, our goal is to develop extensive machine-learning techniques to provide a clear picture of the treatment, and possible mistreatment, of specific patient demographics during hospital triaging.Objective: We aim to reveal whether a patient’s treatment and hospital disposition is related to the following attributes - Emergency Severity Index (ESI), gender, employment status, insurance status, race, or ethnicity which our 100 MB dataset included.Materials and methods: Our work is separated into two parts - the classification task and data analysis. As part of the classification task, we used the k-Nearest-Neighbor classifier, the F1-score, and a random forest. We then analyze the data using SHapley Additive exPlanations (SHAP) values to determine the importance of each attribute.Results: Our findings show that significance varies for each attribute. Notably, we found that patients with private insurance programs receive better treatment compared to patients with federal-run healthcare programs (e.g. Medicaid, Medicare). Furthermore, a patient’s ethnicity has a greater impact on treatment for patients under 40 years of age for any given ESI level. Surprisingly, our findings show language is not a barrier during treatment.Discussion and conclusion: We, therefore, conclude that although hospitals may not be doing so intentionally, there is a systemic bias in hospital triaging for specific patient demographics. For future works, we hope to aggregate additional patient data from hospitals to find whether specific demographics of patients receive better healthcare in different parts of the United States.
Saber A Amin, Morshed Alam, Bangchen Wang, Weining Zhen, Chi Lin, Apar Kishor Ganti, Vinicius Ernani, Alissa Marr, Tony JC Wang, Simon K Cheng, Michael Baine and Chi Zhang*
Published on: 24th June, 2023
Purpose: Stereotactic body radiation therapy (SBRT) has emerged as an alternative to surgery for patients with inoperable early-stage non-small cell lung cancer (NSCLC). The majority of inoperable NSCLC patients are elderly and frequently have comorbidities including cardiovascular diseases for which they frequently receive angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs). The interactions of these medications with SBRT are not clear. The objective of the current study is to investigate the interaction of ARBs and ACEIs with SBRT for the outcomes of early-stage NSCLC. Methods and Materials: A retrospective chart review of patients treated with SBRT for Stage I and II NSCLC (AJCC 7th edition) at a single institution between 2006 and 2017 was conducted. Information on the use of ARBs, ACEIs, demographics, and tumor-related factors was collected. Kaplan-Meier and Cox proportional hazard analyses were performed to assess the impact of ARBs and ACEIs combined with SBRT respectively on the treatment outcomes of these patients. Results: In total, 116 patients were included in the study, among whom 38/116 (32.76%) received ACEIs, and 20/116 (17.24%) received ARBs. In the multivariable analysis, the use of ARBs, but not ACEIs, with SBRT, was significantly associated with the increased risk of dissemination (Hazard Ratio (HR): 2.97; CI: 1.40-6.27; p < 0.004) compared to SBRT without ARBs. The tumor size of > = 3 cm was associated with significantly decreased time to local failure and OS compared to tumor size <3cm. Conclusion: In the current retrospective study, the use of ARBs, in combination with SBRT, was associated with a significantly increased risk of disease dissemination in early-stage NSCLC compared to SBRT alone. The findings warrant further investigations on the concurrent use of ARBs, ACEIs, and other medicines used for chronic diseases with SBRT for early-stage NSCLC.
Urticaria corresponds to a papular edematous pruriginous fleeting rash on the skin whose cause is most often allergic (food, medicines, insect bites, etc.).Its management is often difficult because of its significant impact on quality of life. Its prevalence is estimated at 0.6% - 1.3% of the general population. Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) or Hansen’s bacillus (BH). Considered as the great simulator leprosy can pose a diagnostic problem with many other dermatological pathologies. This is a 36-year-old patient with a history of chronic urticaria treated with Loratadine 10 mg who consulted the Bamako Dermatology Hospital for a large erythematous cupboard, oedematous fixed on the buttocks evolving for more than 3 days. The interrogation found the notion of pruritus, hives, and physical examination, showed large erythematous plaques, edematous very limited, dark red color, and slightly copper resembling the closet infiltrated by leprosy. The pruriginous nature of the lesions and the absence of other cardinal signs of leprosy allowed us to make the diagnosis of chronic urticaria.
The well-documented therapeutic potential of group singing for patients living with Alzheimer’s disease (PLAD) has been hindered by COVID-19 restrictions, exacerbating loneliness and cognitive decline among seniors in residential and long-term care centers (CHSLDs). Addressing this challenge, the multidisciplinary study aims to develop a patient-oriented virtual reality (XR) interaction system facilitating group singing for mental health support during confinement and enhancing the understanding of the links between Alzheimer’s disease, social interaction, and singing. The researchers also propose to establish an early AD detection system using voice, facial, and non-invasive biometric measurements and validate the efficacy of selected intervention practices. The methodology involves co-designing an intelligent environment with caregivers to support PLAD mental health through online group singing, addressing existing constraints in CHSLDs. The researchers will engage volunteers in remote singing interactions and validate the impact of voice stimulation for PLADs using a control group. The primary expected outcome is the development of an “Intelligent Learning Health Environment,” fostering interactions while adapting to individual PLAD situations and incrementally accumulating knowledge on AD signs. This environment will facilitate the transfer of knowledge and technologies to promote non-verbal interactions via singing, enabling intervention at the first symptoms. Additionally, the research will contribute to transforming CHSLDs’ living environments, informed by neuroscience insights, and potentially extend the “collaborative self-care” approach to support seniors in aging safely and healthily at home.
The digital transformation in the health sector represents an extraordinary challenge not only concerning patient care and assistance processes but also for the purpose of promoting new models capable of responding to the growing complexity of the environment and its impact on health. Psychological services are among the non-medical healthcare services heavily invested by this radical transformation. The constant increase in online psychology demand by users follows the need to carefully regulate its practice since this digital space, virtually a non-place, is the focus of large commercial interests. Being a part of the application of digital technologies to psychological performance, the aim of the paper was to emphasize clinical work, especially focused on childhood and adolescence with the need of identifying the limits and problems of digital health psychology in this group of subjects. Considering also that the massive use of digitization in healthcare also raises considerations of a bioethical nature regarding the priority of the principle of patient autonomy in the complex and articulated process of healthcare and protection. In conclusion, although TM is spread in our area in an uneven way, the representations of TM are mostly positive. However, it seems to emerge a picture in which part of some professionals still look to be too cautious and resist this new way.
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