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Objective: This study discusses strategies to overcome hypertension patient compliance to manage self-care. The purpose of the study is to provide a summary of the importance of attention to managing hypertension. Method: a review of literature relevant to hypertension, policies, and management, both pharmacological and non-pharmacological, through cross-programs or sectors. Result: This study found that the ministry of health had compiled various policies to reduce the prevalence of hypertension, including technical guidelines for its implementation, but the strategy has not yet fully reached the minimum service standard, which is because it has not fully involved the relevant cross sectors. Conclusion: Improve the coordination system by “Joint Decree” between the Ministry of Health and the Ministry of Villages, PDT and Transmigration, the Ministry of Social Affairs, Indonesian National Army, police, and NGOs to carry out activities simultaneously to the community.

Papillary thyroid cancer (PTC) is the most common subtype of thyroid cancer and a highly curable malignancy [1]. However, despite its excellent prognosis, cervical lymph node metastases (CLNMs) are present in a significant percentage of patients with papillary thyroid cancer (PTC) (upto 50% - 60%) [2].

Introduction: Obesity defined as increased fatty mass is progressively rising in recently, even though its affects begins to all systems in childhood and adolescence periods, the most important morbidity and mortality reason of obesity is its effects on the cardiovascular system. Researches point out endothelial dysfunction and atherosclerosis as the reason of the cardiovascular system disease in obesity. The studies conducted on childhood period related to this subject are highly limited and the results of these are also controversial. Therefore in our study the effects of obesity on endothelial functions in children and adolescents was assessed by flow mediated dilation (FMD) method. In addition to that, effects of epidemiological, biochemical, hormonal and clinical features of cases to FMD were investigated. Material and method: A total number of 104 cases were cover in this study. Obese group (group 1) was consisted of 59 children whose body mass index (BMI) was ≥ 95th percentile and mean age was 12 ± 2.8 years old. The control group (group 2) consisted of 45 children whose body mass index (BMI) was between 25th -84th percentil and mean age was 11.4 ± 2.9 years old. The detailed history, epidemiological data and physical examination were performed. The population classified three groups according to sport activities. 97th percentile and higher values were accepted as morbid obesity. The blood pressure was measured with a mercury sphygmomanometer with utilizing the proper size cuff in compliance with the criterion used by the “National High Blood Pressure Education Program Working Group”. The complete blood count and biochemistry tests (renal and liver function tests, electrolytes, lipids, hsCRP) of the cases were analysed with biochemistry Roche Cobas Integra 800 and hormon assays of the cases (thyroid function tests, diurnal cortisol, ACTH, 17 OHP, prolactin, DHEA-S) were analysed by ECLIA method on Roche Elecsys 2010 device in the laboratory of our hospital. IR-HOMA values > 2.5 in prepuberal and > 4 in pubertal were defined as the insulin resistance. Bone ages of cases were evaluated with left hand wrist X-ray by using Greulich and Pyle Bone Age Atlas. flow mediated dilation (FMD) was used to assess the endothelial functions of all cases. The brachial artery was evaluated with SPG 12 MHz surface probes by using GE voluson ultrasound system in this method. FMD was expresses as percent (%) increase according to the basal vein dimension. 7% mean value was taken as the limit in the comparisons. Results: The ratio of male and female was 20/39 in group 1 and 14/31 in group 2. 32.3% of the cases in group 1 and 47.6% of the cases in group 2 were prepubertal. The waist and hip circumferences ratio of the group 1 (0.86 ± 0.05) was significantly higher than group 2 (0.80 ± 0.07). While there was no difference between groups 1 and 2 in terms of the birth weight, using duration period of vitamin D and beginning time to additional nutrition, breastfeeding duration of group 1 (10.6 ± 7.8 months) was significantly shorter than group 2 (14 ± 7.4 months). BMIs of the mothers in group 1 were statistically higher than the mothers in group 2 (27.5 ± 4.8 kg/m² and 24.3 ± 3.2 kg/m² respectively. The mean of IR-HOMA was 4 ± 2.9 in group 1 and 1.9 ± 0.8 in group 2 and there was the insulin resistance in 51% of the obese cases. The dyslipidemia was diagnosed in 38.5% of the cases in group 1. The systolic and diastolic blood pressures in group 1 (117 ± 12.2 mmHg and 73.7 ± 9.4 mmHg respectively) were significantly higher than in group 2 (107.5 ± 9.1 mmHg and 68.2 ± 7.1 mmHg respectively). Hypertension was determined in 25% of the cases included in group 1. The minimum values of FMD in groups 1 and 2 were 1.01% and 3.1% respectively. The maximum values of FMD in groups 1 and 2 were 9.7% and 15% respectively. The mean values of FMD was %5 ± 2.3 in group 1 and %8.1 ± 3.5 in group 2. Compared with group 2, group 1 demonstrated significantly impaired FMD. There was no association between FMD and the birth weight, breastfeeding duration, physical exercises in two groups. A negative correlation was found between FMD and BMI (p < 0.01, r = -0.402). The correlation was determined between FMD and BMI of the mother (p = 0.017, r = -0.305) and the presence of obese individuals in the family (p = 0.021, r =-0.413). It was found that a significant negative correlation between FMD and waist-hip circumference ratio (p = 0.003, r = -0.421). When each groups were assessed in terms of biochemical and hormonal characteristics, there was low negative correlation between FMD and uric acid level and strong negative correlation between FMD and ALT level were determined in group 1. Conclusion: In our study showed that the obesity begins in the childhood period may cause to the endothelial dysfunction. For this reason, according to our opinion, recognition prior indicators of endothelial dysfunction in early time may be helpful both to take the precautions required and to prevent cardiovascular complications in childhood and influences to the adult period. The rising sizes of the waist and hip circumferences, positive family history for obesity and obesity of the parents were determined as the most important parameters negative affecting FMD. Unlike the literature, the association between endothelial dysfunction and GGT level the indicator of the hepatosteatosis in obese children was also found as well as FMD and ALT have also a close association independent from BMI in this study. Thus, a different point of view was formed since ALT may possibly have a predictor value in the assessment of the endothelial functions and it is also found as a highlighted risk factors for the endothelial dysfunction in this study. Because of this reason, it can be recommended that when the liver function tests carry out in obese children it does not show only hepatosteatosis but also can be used as an early indicator of the cardiovascular complications of obesity. Another important subject to be emphasize that the ALT level in the childhood period may be an early cardiovascular risk indicator in both obese and nonobese children.

Background: The main cause of adrenal insufficiency (AI) in paediatric patients is prolonged treatment with corticosteroids. Determination of plasma cortisol (PC) during ACTH test is the most used adrenal function indicator in clinical practice. However, determination of salivary cortisol (SC), a simple test especially useful in children in order to avoid invasive procedures, can be used as an alternative technique for the diagnosis of adrenal disease. Methods: A two-year prospective study (January 2014-January 2016) in paediatric patients (2-18 years of age) treated with corticosteroids for more than fifteen days, who were investigated for suspected AI. Low-dose ACTH test was used to determine adrenal function and samples for SC and PC were obtained simultaneously in basal situation and during the test (at 30, 60 and 90 minutes). Results: 230 samples (118 PC-112 SC) of 30 studies belonging to 20 patients (4 males), mean age 10.93 years ± 3.69 SD. Pearson’s correlation coefficient showed a positive correlation between PC and SC (r = 0.618, p < 0.001). All the studies with some determination of PC higher than 18 μg/dL (n = 8) had a SC peak higher than 0.61 μg/dL with a specificity of 66.67% and a sensitivity of 93.94% (ROC analysis). Conclusion: Measurement of SC is a less invasive, easier and quicker test than PC to measure plasma free cortisol levels. In our study, a SC peak in low-dose ACTH test higher than 0.61 μg/dL was able to discriminate patients without AI, and proved to be a useful tool in the initial evaluation of children with suspected AI.Introduction The activation of the hypothalamic-pituitary-adrenal axis in response to critical illness and the resulting release of cortisol from the adrenal cortex are essential to stress adaptation. Adrenal insufficiency (AI) is described as the inability of adrenal glands to produce an appropriate hormonal secretion not only under stress but also in basal situation. Therefore, a low baseline plasma cortisol (PC) (< 5 μg/dL) and a poor cortisol response to stimulation with exogenous adrenocorticotropic hormone (peak < 18 μg/dL) are some of the defining criteria of this condition [1,2]. It is well known that the main cause of AI in paediatric patients is prolonged treatment with exogenous corticosteroids, which is an iatrogenic cause derived from the increasing complexity of paediatric pathologies and the increased use of prolonged high-dose corticosteroid therapy. In clinical practice, adrenal function is usually assessed by the total PC (determined by low-dose ACTH test). This implies the placement of a vascular access which is often a traumatic experience for children. PC includes protein-bound fraction and serum-free cortisol. The latter constitutes the biologically active form of the hormone and is responsible for glucocorticoid activity on peripheral organs. Most of the circulating cortisol is bound to plasma proteins (over 90%), such as cortisol-binding globulin (CBG) and albumin, whereas only about 10% of circulating cortisol is free. Hence, the measurement of plasma-free cortisol level has been considered more representative of adrenal function (especially in critically ill adults and children) [1,2], because some conditions, such as hypoalbuminaemia or hypoproteinaemia (frequent in critically ill patients or in patients with cirrhosis), may lead to misinterpretation of adrenal function with an overestimation of the prevalence of AI. But the direct measurement of free PC is a laboratory-dependent and time-consuming procedure that is not available for routine use. Salivary cortisol (SC) is one of the several indirect methods available to determine free PC [3], as SC levels accurately reflect free PC [4] even in cases of hypoalbuminaemia or CBG abnormality [1,5]. For this reason, in the last years, this technique (SC) has been introduced as a non-invasive tool in the diagnosis of adrenal cortical disorders, for its simplicity and applicability in the paediatric population. However, few studies to date have evaluated the usefulness of SC as a diagnostic method in children with AI. No interactions between exogenous corticoids and SC have been described [6]. The aim of the present study was to assess the usefulness of determining salivary cortisol levels as a diagnostic tool in children with suspected secondary iatrogenic AI. 

The actions exerted by waves on a coastal structure very much depend upon hydrodynamic processes that originate on shallow waters; even though significant progresses have been made in the last few years towards a full understanding of wave breaking, design work is still largely based on classical stability formulas. The recent availability of reliable models based on the numerical integration of full Navier-Stokes equations provides an important tool, but the evaluation of forces on vertical structures in shallow waters is still a particularly delicate application because of the complex hydrodynamic issues involved. The paper presents deals with the numerical simulation of wave effects on front of a vertical obstacle on a sloping bottom, with the objective of clarifying some physical issues which are relevant towards the applicability of numerical Navier-Stokes simulation as a design tool.

Water resources play an integral part in the life of a living being. The various water resources that are present on the earth’s surface are in the form of oceans, seas, lakes, rivers, ponds, waterfalls etc. Among these water resources Lakes and reservoirs are vital for people’s life, industrial activities and many other day to day activities. These water resources help in obtaining water for drinking after being treated. They also provide water for agriculture and industrial usage, fishery resource, flood control functions and many other activities. Due to the closed nature of lakes’, the waste material from sewage, agricultural effluents, domestic and industrial fields, gets accumulated around the surface of these water resources and once the water gets polluted, it gets strenuous to improve the quality of the water. In the study, the authors have examined different effective ways by which the quality of lake water can be improved.

Bacteria has been known to grow in pipes of water distribution systems and bottled drinking water. Its growth in reusable drinking water bottles is not clear even though they have become more popular and used by children and adults daily everywhere. This study found that there is an extremely high level of bacteria content and a rapid microbial growth in reusable drinking water bottles. The bacteria content tested by heterotrophic plate count (HPC) is in a range of 0-2.4x105 CFU/mL with an average of about 34,000 bacteria counts/ml for bottles used by children and 75,000 bacteria counts/ml for bottles used by adults. Bacteria number can quickly increases to 1-2 million counts/ml in the bottles one day later. Considering the high level of HPC bacteria content in the reusable drinking water bottles, it may be necessary to have some control measures to reduce the bacteria level and to minimize the associated likely health risk of the disease spreading since many people use reusable water bottles every day. 

The paper presents and develops the issue of Cumulative Effect Assessment (CEA) in the Environmental Impact Assessment (EIA) screening procedure established by the State and Regional regulations In Italy. In the period 2001-15 in the territory of the Venice province (north east Italy, Veneto region) n. 328 projects (and the related environmental preliminary/definitive studies) were applied to competent Authorities (6% to the State, 39% to the Region and 55% to the Province). All the Environmental Impact Studies (EISs) and Environmental Preliminary Studies (EPSs) referring to the this territory officially applied to competent Authorities in the period 2001-2010, have been analysed with focus on the identification and assessment of cumulative effects (CEs); the projects considered and analysed for this purpose comprise a total of n. 181 EIA screening and ordinary procedures; the remaining 147 projects in the period 2011-15 (for a total of 328) are here considered only for statistical reason to an update assessment of project typologies in the same territory. The methodology applied for the analysis of the sample of environmental studies in the period 2001-10 refers to that presented by Cooper and Sheate (2002) with modifications. The investigation has been developed looking for the way in which the topic is performed by practitioners in the environmental studies as from qualitative as well as quantitative point of view. Specific attention has been paid to waste management plants which are always subject to EIA screening procedure since 2008 according to Directive 97/11/EEC and in case to the whole EIA procedure. The approach proposed by Lombardia Region (North Italy; 2010) for EIA screening procedure of waste management plants has been applied to identify CEs and modified according to the characteristics of the considered territory; it allows the performance of the project-based approach and must be completed with a regional-based approach (Dubè, 2003). The proposed approach can be useful in case of waste management and IPPC (Integrated Pollution Prevention and Control, Directive 96/61/EEC, amended with Directives 2008/1/EC and 2010/75/EU) plants to define the financial warranties required for the authorization of operative activity of the plants to cover potential environmental damages produced in cases of accidents and other conditions as required in Europe (art. 14 Directive 2004/35/EC on environmental liability). Several project categories were chosen and their EISs analysed as an exemplificative case according to the potential generation of cumulative impacts and the characteristics of the territory. With reference to the completed procedures where the competent Authority presented a final judgement, it has been observed that the CEA has been seldom developed due to not compulsory legal requirements as already observed by Burris and Canter (1997). Moreover, when it is considered, the methodology is limited and not systemized. Indices of impact have been identified according to emission for the main environmental components focussed with the analysis of the pressure factors of the plants. The study points out the need to analyse and evaluate the cumulative effects (CEs) at a strategic level (within the Strategic Environmental Assessment-SEA- procedure) with a view to preparing the study for EIA/EPS framework procedure for the projects derived from the corresponding plan/program. A sound knowledge of the considered territory and in particular of its pressure sources is of main importance for CEA assessment and impacts’ prevention. Geographic Information Sytesm (GIS) application is strongly needed for pressure sources’ census and control data storing

Geosynthetics used in landfills provides a technical and economic advantages over traditional clay liners. It may create stability issue and even lead to landfill failure due to its low interface or internal shear strength if improperly designed and/or constructed. The most common failure mechanism in geosynthetic-lined landfills is transitional failure involving waste and bottom liner (deep-seated failure) or only final cover system (shallow failure). Shear strengths of geosynthetic-geosynthetic and geosynthetic-soil have a wide range of variations. Shear strengths of interface from literature may be used in preliminary design. For final design, site-specific interface shear strengths shall be used. Internal shear strengths of unreinforced geosynthetic clay liner (GCL) are less than those of reinforced GCLs. Unreinforced GCLs are not recommended for slopes steeper than 1:10 (1 Vertical and 10 Horizontal). Peak shear strength of interface and internal GCLs can be used in bottom liner; residual shear strength of interface and internal GCLs shall be used for geosynthetic placed along the slopes. Site-specific shear strengths of waste are recommended to be used in the design. Landfill failure could be triggered by static loadings including excessive leachate, pore pressure above the bottom liners, gas pressure, and excessive wetness of the geomembrane-GCL, and earthquake loading. The factor of safety of 1.5 is recommended for static loading and 1.0 for earthquake loading. A higher factor of safety is recommended if a failure could have a catastrophic effect on human health or the environment, and if large uncertainty exists in input parameters to calculate the factors of safety. The main objective of this review article is to provide a comprehensive knowledge of slope failure mechanisms, causes, and probable remedies in one place.

The carried work has based on transient vibration response of multiple degrees of freedom (MDOF) system. By this work study of Time–history analysis and prediction of the displacement for excitation has done. For the MDOF system, we have taken the four-storey building to done transient vibration. We establish the equivalent spring-mass system. Transient analysis has done for both Undamped and Damped of the forced system of multiple degrees of freedom (MDOF) system. In the case of the Damped system, we have done three stages of damping, i.e., (1) Underdamped system, (2) Critically damped system, (3) Overdamped system. The time-history graph obtained for two different time stages i.e. 0.001 sec & 0.01 sec with initial time 0.000001 sec. The natural frequency has determined by both theoretical calculation and ANSYS. The whole study of transient vibration makes it possible to predict the damping values that oppose any kind of sudden impact or force vibration, such as blasts, earthquakes and tsunamis. The ANSYS is the modelling and simulation software is used to perform the transient vibration response. The Mode Superposition method is used by ANSYS to calculate the structure response

The study proved that in gully systems with the largest catchment area ranging from 5.0 to 28.8 km2, the degree of dismemberment of gully systems is small, varies mainly from 1 to 3 km / km2, less often from 3 to 5 km / km2. As can be seen, the average annual growth of ravines is 0.34 ... 7.48 m in length, 0.20 ... 2.48 m in width, 0.10 ... 1.16 m in depth. The intensity of erosion development (ravine, planar, etc.) is mediated by their catchment area. Moreover, the degree of division of individual gully systems here is not dependent on their catchment area, moreover, the greatest dissection is observed in gully systems that have the smallest catchment area, which is associated with the conditions of their location.

Background: Early and effective identification of childhood neurodevelopmental disorders remains a critical task of all pediatric healthcare professionals, which is critical to the well-being of children and their families. Methods: A retrospective review of medical records of all preschool children referred to a Child Development Centre (CDC) in North-West England, over a six-month period between Sept 2014 and Feb 2015 was conducted. The local multi-professional approach to the clinical assessment and management of preschool children was described and the published literature on this topic was reviewed. Results: Twenty four different categories of professionals spanning the whole range of primary, secondary, and tertiary healthcare, social care and educational services were involved in the management of the patients. The largest group of professionals was the primary healthcare specialists. The ten different primary care professionals managed an average of 42% of the patients. The secondary healthcare providers were involved in the care of an average of 17%, tertiary care providers 10%, educational specialists 25% and social care professionals were involved with 5% of all the patients. The commonest diagnostic disorders were Speech/Language delay (56%), Global developmental delay (33%), Behavior difficulties (26%), Social communication concerns (21%) and Autistic spectrum disorder (19%). Conclusion: The high number and specialties of various healthcare professionals at all levels of care indicates the high social and economic investment required in managing the affected preschool children in the region. Childhood neurodevelopmental disorders in the preschool age represents a high level of public health significance.

ADHD is the most common neurodevelopmental disorder in children and adolescents with prevalence ranging between 5% and 12% in developed countries. There is ample evidence that carefully structured enhanced behavioural parenting programmes are useful in the management of ADHD. We assessed the outcome of an ADHD group parenting training programme (APEG) offered between 2014 and 2015 by the Peterborough Neurodevelopmental Service (NDS) in improving the knowledge and skills of carers using a pre-/post-training intervention study. APEG follows a Parent Advisor Model, consisting of a 6-session programme of evidence-based parenting training. A total of 27 parents completed the 53 pre- and post-course questionnaires. The knowledge and understanding of the parents increased significantly about all aspects of ADHD diagnosis and management in response to all the 5 questions. The difference between the scores of 0 to 3 and 4 or 5 pre- and post-intervention was statistically significant (chi square 239, df 1, p value <0.01). The study suggests that provision of a psychosocial intervention programme for parents of ADHD children through the APEG parenting training proved to be effective in significantly improving the level of knowledge and understanding of parents regarding several aspects of ADHD diagnosis, symptom identification and behaviour control.

Managing municipal solid waste correctly is critical to the success of a society. Many regions and countries in the world are behind others in the context of solid waste management. In order to compare three such regions within this context, a meta-analysis was conducted in order to develop a decision matrix. Within this decision matrix, the United States, Europe, and Asia were compared to determine which region is managing municipal solid waste the best. This research design allowed for compiling information from many sources to increase the accuracy of data used in the justifications for the decision matrix. Purposive sampling was used to select and evaluate sources that discuss solid waste management to discern which region’s processes are most favorable in many parameters. The decision matrix consists of nine parameters: main management techniques; finances; landfill taxes; jobs created; waste generation; waste composition; waste storage, collection, and transportation; energy recovery; and environmental health. Each was scored on a scale from zero to ten, ten being the best score and zero being the worst. The final score from the decision matrix suggested that Europe had the most favorable municipal solid waste management (MSWM) system, and the United States had a notably close yet lower score. Asia had the lowest score that was hardly comparable to the other two regions.

The article discusses approaches to solving problems of accurately determining strength in kinematic pairs. It is known that the nature of the bonds imposed by kinematic pairs is determined by the geometric shapes of the elements of the pairs. For what, here, the bonds acted during the entire time the mechanism was moving, so that the elements of the kinematic pairs would continuously touch each other. Where it is recognized that one of the simplest methods for taking into account the inertia of a link is the principal moment method. How the contradiction is sought is here because the normal acceleration has a direction opposite because normal acceleration has a direction opposite to the link (directed toward the center), and the image of tangential acceleration is directed parallel to this acceleration. The following simplification can be made if the main vector of inertia is considered together with the weight of the link.

Industrial control systems (ICS) are critical, as in these systems, cyber threats have the potential to affect, disorganize, change their mode of operation, act as an information extraction vehicle, and ultimately turn against itself. Creating risks to the system itself, infrastructure, downtime, leakage of sensitive data, and even loss of human life. Industrial control systems (ICS) are vital to the operation of all the modern automated infrastructure in the western world, such as power plant and power stations. Industrial control systems (ICS) differ from the traditional information systems and infrastructures of organizations and companies, a standard cyber security strategy cannot be implemented but part of it adapting to the real facts and needs of each country, legislation and infrastructure. These systems require continuous operation, reliability and rapid recovery when attacked electronically with automated control, isolation and attack management processes. Incorrect settings and lack of strategic planning can lead to unprotected operation of critical installations, as they do not meet the cyber security requirements. Industrial control systems (ICS) require special protection in their networks, as they should be considered vulnerable in all their areas, they need protection from cyber attacks against ICS, SCADA servers, workstations, PLC automations, etc. Security policies to be implemented should provide protection against cyber threats, and systems recovery without affecting the operation and reliability of operating processes. Security policies such as security assessment, smart reporting, vulnerability and threat simulation, integrity control analysis, apply security policy to shared systems, intrusion detection and prevention, and finally firewall with integrated antivirus and sandbox services should be considered essential entities.

Humanity has destroyed 70% of the land by arable land, reservoirs, asphalt, concrete, garbage and ore landfills. Each of us sends 400-500 kg of garbage to the landfill per year. If from the garbage that the inhabitants of Russia throw out in a year, they built a tower with an area of ​​one meter by one meter, then it would be possible to get to the Moon through it: https://greenpeace.ru/wp-content/uploads/2019/10/report-RUSSIA -GARBAGE.pdf The area of ​​the world’s landfill on land is the size of Mexico, and it is growing.

Introduction and goal: From the perspective of Islam, spiritual health means having a Sound Heart (a calm, confident and optimistic soul, with hope for God’s mercy, satisfaction with destiny and vitality). The way to achieve spiritual health is strengthening the faith and taking good deeds based on religious spirituality. This study was conducted with the aim of determining the impact of spiritual health (Sound Heart) on the other aspects of health at different levels of prevention. Methods: In nine phases of research in 16 years, after designing and validating the “Sound Heart Model”. The spiritual problems of patients and healthy clients were determined. Spiritual care guidelines and the spiritual counseling model in patients and healthy clients were designed. Then “Parent’s Spiritual Empowerment Program”, “inter-professional spiritual health care training program” was extracted. Based on the findings of the previous steps, the effect of spiritual health on other aspects of health at different levels of prevention was extracted. Findings: Belief in God and divine love creates spiritual health (Sound heart) with wisdom, chastity, courage, justice, dignity, kindness, and sincerity in action. Faith prevents neglecting from the God’s remembrance and its consequences such as: unhealthy lifestyle, risky behaviors, destructive excitements, psychosocial diseases in clients and eliminates the fear, anxiety, sadness and disappointment in patients. Spiritual health causes living in the present time with patience and grace of God, creates hope, optimism for the future, courage to face life crises. By creating mental health, it improves the psycho-neuron-immunologic function and improves physical health. Conclusion: Considering the great impact of spiritual health on the other aspects of health at all levels of prevention, it is imperative that students and health care staff, by referring to these concepts, carry out spiritual care/counseling.

Aim: With the continuing trend in the incidence of diabetic ulcer, the current researches on wound care and healing will bring best and effective practices on wound care and healing among patients suffering from diabetes mellitus. Methods: This study utilized a systematic review of literatures in light of wound care through Pub Med database with the key words “Diabetes Mellitus,” “wound practices,” “wound healing,” and “systematic review.” The searched literatures were of case reports, interventional studies, and review papers whose main texts were in English. Results: There were 7,988 published articles yielded from the keywords used and 16 were included in this study. The practiced management and techniques in these literatures focused on comfortable and cost efficient means of wound care and healing with the involvement of group participation than individual plan of care. Conclusions: There are meager evidences of feasible wound and healing options that needs further studies in resolving wound issues among patients with Diabetes Mellitus. This systematic review establishes the insufficiency of high level of evidence based studies on wound healing in DM patients and brings a track for continuity of rigid studies concerning this topic.

The concept of space-matter motion in the new Cartesian physics, based on the identity of space and matter, creates the basis for the study of consciousness as the action of the brain in space inside and outside itself and offers a way of materialistic explanation of life on Earth. She claims that consciousness in living matter arises when the brain begins to create the surrounding space the image of themselves and the world. And since space according to Descartes is identical to matter, the images created by the brain of itself and the external world in the surrounding space have a material basis and therefore the displayed organs interact with each other and the external world.