Qatar Foundation Annual Research Conference Proceedings Volume 2016 Issue 1

Background: End-Stage Renal Disease (ESRD) is a progressive worsening of kidney function over a period of months or years. It is a complex debilitating disease that needs a lifelong treatment. Because patients with ESRD cannot be cured of their underlying conditions and mostly underwent hemodialysis program, it usually leads to many physical and medical consequences and complications, and beside them, there are lots of concealed social and spiritual factors that can affect people who have this disease or are on renal dialysis. Some studies about medical and clinical consequences of ESRD and renal dialysis were conducted but this study will be the first one to determine the factors affecting the social and spiritual wellbeing of patients who are on renal dialysis in Gaza Strip. Objectives: It is important to give a detailed picture about the social and spiritual wellbeing of patients who are on renal dialysis to help the medical professionals to recognize the social and spiritual variables, so early intensive intervention can be performed once necessary. Methods: A total of 120 patients who had ESRD and were treated with hemodialysis completed face to face questionnaires. A self-designed questionnaire has been used; the end result is a questionnaire consisted of 6 sections including demographic data, physical, social, psychological and spiritual wellbeing, degree of coping with current condition, uncertainties about health in future, self-esteem and dependency, and the impact on marital relationship. Results: Among 120 participants, 55% were females and the mean age was 48.5 (SD: 16.7).

An eighty one point seven percent were unemployed and 81.7% of the participants were of low educational level. Thirty percent of the patients have family history of hemodialysis; 55.6% of them are first degree relatives and 44.4% for the second and third degree relatives. Seventy two point two of patients have co-morbidities, mostly hypertension (49.4%). Fatigue (93.8%) and insomnia (56.2%) are the two major physical complaints after the process of hemodialysis, however, (53.3%) of the patients felt more comfortable after it.

Seventy seven percent of the patients suffered from a financial impact and 60.3% had weak social relationships. Sixty percent considered that the process of hemodialysis makes their life restless to the extent that makes their daily activities to be negatively affected by 73.8%.

Among 85 married patients, the sexual performance and the sexual desire were negatively affected by 54.2% and 52.2% respectively. Only 50% of the patients stated that they have a goal they want to achieve in their life. Seventy eight percent of the patients were uncertain about their health and 67.3% were worried from about the future. However, 70% of the participants claimed that spiritual devotions and stronger faith has made them more able to accept their disease and deals in a positive manner towards being involved in the hemodialysis program. Conclusion: Social and spiritual well-being should be considered as important predictive factors for a better quality of life in hemodialysis patients. Results also suggest that assessing and addressing social and spiritual well-being among hemodialysis patients may help in providing a holistic medical care.

Background: Pharmaceutical care (PC) is changing pharmacy practice in to patient -centered care and personalized medicine approach. It focuses on maximizing drug therapy outcomes and improving patient's quality of life (QOL). Pharmacy students who are the future pharmacy practitioner, need to have adequate knowledge, skills and positive attitudes to apply PC when they graduate. However, comparative studies are limited among pharmacy students from different pharmacy schools within the Middle East region about the PC teaching received, preparedness to deliver the service in practice, and expected barriers. Objectives: This study's aims are exploring the attitudes and perceptions of final year pharmacy students in the College of Pharmacy at Qatar University (QU-CPH) and Faculty of Pharmacy in Kuwait University (KU-FoP) towards PC, assessing students’ preparedness to provide PC when they graduate and investigating the perceived barriers against the application of PC. Methods: Descriptive, cross-sectional, web based survey was used to collect data. The study instrument was developed based on validated tools: Pharmaceutical Care Attitude Survey (PCAS) and Preparedness to Provide Pharmaceutical Care (PREP). The data were analyzed using the IBM Statistical Package for Social Sciences (SPSS®) Version 22. Chi-Square tests and independent t-test were used to compare between the 2 universities for categorical data. P ≤  0.05 was considered statistical significant. The results were summarized using tables and figures generated by Excel. The final questionnaire included five sections: demographics of the students (6 items); perception of PC (7 items); attitudes towards PC (13 items); preparedness to deliver PC (25 items) and; barriers that may affect applying PC (5 items). The survey was administered using SurveyMonkey®. Results: Of a total of 77 students, 63 students completed the questionnaire (21 students from QU and 42 students from KU) overall response rate 82%. The mean age of the students was similar between the two universities. The majority of the respondents (95.2%) from both universities were female (QU-CPH is female-only college). KU-FoP had significantly higher proportion of national students than QU-CPH. Both QU-CPH and KU-FoP students prefer to work in the hospital setting in the future (57.1%, 64.3% respectively). No significant differences between the two universities in terms of students’ confidence and perception in applying PC (P ≥  0.05). There were no significant differences between the students’ attitude in the two programs about the provision of PC (P ≥  0.05), and all respondents believed that PC services will improve health outcomes. There was a statistically significant differences in documenting information related to detecting, resolving and preventing drug-related problem (p = 0.044). Some of the barriers identified by students from both institutions include: lack of private counseling area, limited pharmacists time, lack of patients records, lack of policy for pharmacists’ patient care role. No differences in opinions between QU and KU students regarding the most important barrier that may affect PC provision above. There was statistical significant difference between students’ opinions in considering poor image of pharmacists role in society as barrier. Conclusion: Final year pharmacy from Qatar and Kuwait had demonstrated positive attitudes towards PC and its potential application in practice when they graduate. They have, however, identified some potential barriers. Students in KU-FoP placed low expectation of the pharmacist's role by the society and within health care team as important barrier; while students in QU-CPH thought that documentation and communication between pharmacists and healthcare providers can have an impact on PC services. More efforts should be directed to resolve the perceived barriers in order to optimize PC provision and ultimately patient care outcomes.

Background and Aim: In the United States alone, diabetic limb complications and amputations are estimated to cost $17 billion. Significant risk factors that may lead to amputation of the diabetic foot include ineffective wound healing and infection of a wound or ulcer. Previous studies have shown that wound healing is slowed and patient's susceptibility to infection is increased when a patient is under chronic stress. To date, objective measures of stress have not been used to determine if stress affects the rate at which wounds heal. Our study used novel real-time monitoring of patient's heart rate variability to objectively determine the stress levels of patients visiting a surgery clinic for wound dressing changes. The wound healing rates of patients with high stress levels were compared to healing rates of low-stress individuals to assess the effect of stress on rates of wound healing among diabetics with a history of foot ulceration. Methods: Twenty patients (age: 56.7 ±  12.2 years) with diabetic foot ulcers were equipped with a chest-worn sensor (Bioharness 3, Zephyr Technology Corp., Annapolis, MD) during their 45-minute appointments where the patients’ wound was re-dressed. The chest sensor contained a uni-channel ECG recorder, and a novel algorithm was developed to determine heart rate variability from sensor output. Low frequency (0.04 to 0.15 Hz) HRV signals were isolated from high frequency signals (0.15 to 0.40 Hz), and the ratio of their amplitudes was used as a measure of stress. Patients were categorized as low-stress if the ratio of the signals was less than 1, and were otherwise categorized as high-stress individuals. Regardless of classification, each patient's wound size (length, width, depth) was recorded at baseline and in follow-up visits. High and low-stress patients were compared to see if wound sizes decreased more rapidly in either group. Results: Results indicate that patients with low levels of stress reduced their wound size by 79% between baseline and the first follow-up appointment (1.36 mm³ to 0.28 mm³). In contrast, patients with high levels of stress had adverse outcomes, with their wound sizes increasing nearly four times between baseline and follow-up (0.17 mm³ vs 0.84 mm³). Although high stress individuals had smaller wound sizes than low stress individuals initially (0.17 mm³ vs. 1.36 mm³, p <  0.05), the wound sizes of high stress individuals were nearly 3 times larger by the first follow-up (0.84 mm³ vs. 0.28 mm³, p =  0.10). Conclusion: Our research proposes that an individual's stress level can be objectively measured using an algorithm that processes ECG data from a single body-worn sensor that is lightweight and comfortable to wear. The stress levels measured with our algorithm are predictive of positive clinical outcomes. Specifically, individuals with low levels of recorded stress at baseline have faster healing rates and greater reductions in wound size by their second clinical appointment. This indicates that real-time patient stress monitoring using body-worn sensors may help clinicians identify risk factors that prolong wound healing times. In addition, it can be inferred that managing stress in diabetic patients will quicken the pace of wound healing. Surprisingly, however, our results suggest that initial wound sizes are not good indicators of stress levels in patients during initial clinical appointments. In fact, wound sizes of high stress individuals were significantly lower than low-stress individuals at baseline.

Background & objective: The gliptins, dipeptidyl peptidase inhibitors (DPP-4 inhibitors) are a relatively new class of antidiabetic drugs that, via their inhibition of DPP-4, a cell membrane–associated serine-type protease enzyme, promote the effects of the endogenous incretins such as glucagon-like peptide 1 (GLP-1) and enhance glucose disposal. The advantage of the gliptins over GLP-1 analogues is that they are orally effective whereas the clinically used incretins, exenatide and liraglutide, have to be administered via sub-cutaneous injection. The first gliptin, sitagliptin, was approved by the FDA in 2006 and six other gliptins have subsequently been approved – vildagliptin (2007 in Europe); saxagliptin (2009, FDA); linagliptin (2011, FDA); anagliptin (2012, Japan); teneligliptin (2012, Japan); alogliptin (2013, FDA). There is a close association between diabetes and cardiovascular disease (CVD) and vascular complications associated with diabetes are responsible for 75% of the deaths of diabetics. Therefore it is important that for any new class of antidiabetic drugs introduced for clinical use that we determine whether such drugs not only show therapeutic efficacy as antidiabetic drugs, but also that they are vasculoprotective and reduce both cardiovascular morbidity and mortality. Endothelial dysfunction that can be functionally defined as a reduced vasorelaxation response to an endothelium-dependent vasodilator, such as acetylcholine, or, at the molecular level, a reduction in the bioavailability of nitric oxide (NO) and/or reduced activity of the enzyme responsible for the generation of NO, namely, endothelial nitric oxide synthase (eNOS). Endothelial dysfunction is a very early indicator of the onset of vascular disease and thus determining whether the gliptins also reduce endothelial dysfunction is very important. The literature concerning the vasculoprotective effects of the gliptins is contradictory with some of the clinical data suggesting a negative effect of the gliptins on vascular function. Thus, the objective of this study was to determine whether the gliptins possess positive or negative effects on endothelial function. Materials & methods: In the present study we used a cell culture protocol with mouse vascular endothelial endothelial cells (MS1-VEGF; CRL-2460, from ATCC, USA) of micro-vascular endothelial origin. The endothelial cells, MMECs, were either cultured under normoglycaemic (NG) conditions for a mouse, 11 mM, or high glucose 40 mM (HG) – a level that equates to the plasma glucose levels that are seen in mouse models of type 2 diabetes, such as the db/db leptin receptor mutant model of type 2 diabetes. The gliptin, alogliptin was chosen for this study and the protocols were designed to determine whether this gliptin reduced, or prevented, the high glucose induced reduction in eNOS phosphorylation at serine 1177 (p-eNOSser1177) as determined by western immunoblot densitometry quantification. A reduction in p-eNOSser1177 will result in a reduced activity of eNOS and hence a reduction in the generation of NO. Thus, the quantification of p-eNOSser1177 serves as a measure of endothelial function. The band densities of the western blot images for eNOS and p-eNOSser1177 were quantified using the basic Quantity One software (Biorad, Inc. CA, USA). Statistical analysis was performed using one-way analysis of variance (ANOVA) and post-hoc comparisons between groups were performed by Tukey's multiple comparison tests. ‘p’ values less than 0.05 were considered to be statistically significant. Results: Our data indicates that a 24-hour exposure to HG reduced p-eNOSser1177 phosphorylation, but the presence of alogliptin reverses the effects of HG and significantly increased the phosphorylation of eNOS, suggesting that this gliptin does protect the microvascular endothelium against hyperglycaemia-induced endothelial dysfunction. Furthermore, the effects of alogliptin were concentration-dependent and were significant with 50 or 100 μM, but not 10 μM alogliptin. Conclusion: Our findings indicate that, in a concentration-dependent manner, alogliptin protects endothelial cells against the negative effects that hyperglycaemia (high glucose) has on endothelial function as measured by alogliptin-induced changes in the phosphorylation of eNOS at serine 1177. Further studies are underway, using a functional myograph assay, to determine whether alogliptin can also prevent hyperglycaemia-induced endothelial dysfunction in mouse aortic vessels.

Acknowledgement

This work was supported by a Summer Student Research Fellowship (SSRF) from Weill Cornell Medicine-Qatar and an Undergraduate Research Experience Program grant, UREP 18-055-3-012 from the Qatar National Research Fund (QNRF). The statements made herein are solely the responsibility of the authors.

Background: Around 14.1 million new cancer cases and 8.2 million deaths caused by cancer were reported in 2012, expected to rise up to 22 million within the next 2 decades. The parenteral route (intravenous dosage form) has been the most common administration route for chemotherapeutic agents, which is associated with the need for hospitalization and a range of significant adverse drug reaction. A new generation of chemotherapies that is orally administered has been introduced to practices as a superior and more efficient therapeutic alternative. Oral anticancer drugs (OACDs) have shown to be eliminating the need for hospitalization, decreasing the rate of adverse drug reactions and, ultimately, improving patients' quality of life. Economically, this translates into reduction in inpatient hospitalization costs, including several of the associated costs, such as the cost of treating side effects. A disadvantage of OACDs however, is the increased acquisition costs as compared to those for the intravenously administered alternatives. This resulted into resistance to include OACDs by several international insurance schemes and drug formulary practices, including in Qatar. Objectives: The current project sought to analyze the medical literature in relation to published economic evaluations (pharmacoeconomics) of OACDs, especially as compared to the parenteral alternatives. This will identify the decision analytic modeling conducted as well as the variety of methods used. Strengths and weaknesses of study designs will be determined, including gaps in knowledge. Methodology: A thematic systematic review was conducted using the search engines: PubMed, Medline, EconLit, Embase and Economic Evaluation Database. The following 3 categories were considered: (i) therapy (chemotherapy [Mesh]); (ii) dosage form (oral [Mesh]); and (iii) research design (economics [Mesh] OR cost-benefit analysis [Mesh]). These included full-text, English articles incorporating comparative economic evaluations of oral chemotherapies. Excluded studies were: non-comparative, non-economic based models, of secondary indications (not cancer), and/or reviews. This process was followed by two stages of manual exclusion; based on title/abstract content and, then, the full-text article content. A data extraction form was developed and pilot tested for the purpose of data collection. Article inclusion and data collection was conducted twice, each by a different investigator. Included articles were finally summarized according to methodological themes of interest. Results: A total of 235 records were identified. After screening and removing duplicates, only 18 studies were deemed eligible study inclusion. It was found that the pharmacoeconomics evaluations were mostly of cost-utility analyses (13 out of 18), measuring cost per quality adjusted life years (QALY) gained, and from the payer perspective (15 out of 18). Primary sources of clinical and economic data were randomized clinical trials, expert panels and medical charts. Other sources included medicine databases, reimbursement schedules, drug policies and price lists, treatment guidelines, case reports and patient interviews. In 13 out of 18 cases, dominance status was reported in favor of OACDs, in relation to cost and/or clinical effect. Decision analytic modeling was used in the majority of studies, mostly constituting Markov modeling for the simulation of life long use of drugs. Sensitivity analyses were conducted in most studies, mostly constituting one-way sensitivity analysis to ensure robustness of study results. The types of cancers, where the effect of OACDs was studied, were the metastatic renal carcinoma, gastrointestinal tumors, colon cancer, chronic myeloid leukemia and non-small cell lung cancer. Most included articles were published during the last seven years. Most studies were conducted in the UK, US and Europe, while none were conducted in Australia or the Middle East. Conclusion: This is first systematic review of the economic methods used in the evaluation of OACDs. There seems to be a recent increasing interest of this type of research, whereby the QALYs measurement is of priority for the decision making in relation to the comparative value of OACDs in practices. Most important, is that despite the higher acquisition cost, OACDs were demonstrated to be mostly superior over the parenteral alternatives. Furthermore, the decision analytic modeling, mostly constituting Markov modeling, is valued and enables a structured decision analyses of therapies. The pharmacoeconomics research is difficult to generalize, whereby published economic evaluations are locally specific, especially for the purpose of practical interpretation. The current review of literature proposes valuable methods for the local Qatari implementation and guidance of decision makers. This is most relevant to National Center for Cancer Care & Research (NCCCR), which is the only tertiary service provider of cancer therapy in Qatar, where confusion in relation to the use of oral chemotherapies exists, particularly the therapies vinorelbine and capacitabine.

Background: The interest in the economic evaluations of “prophylactic” systemic antifungals is on the rise, especially with the emergence of newer expensive agents for prophylaxis of invasive fungal infections (IFI). Decision analytic modeling is a systematic approach that has become integral in the economic evaluation process for the purpose of simplifying the decision making. This systematic review aims to identify the prevalence of decision-analytic modeling in the pharmacoeconomic literature regarding prophylactic therapies for systemic fungal infections, and to identify variations in model designs used along with defining specific areas of strengths and weaknesses. Method: A systematic literature search was conducted using the e-databases Pubmed, Medline, Embase, Economic Evaluation, Econlit, and Cochrane to obtain all model-based economic evaluations of antifungal agents. Search terms were under three categories: (i) therapy (antifungal agent [Mesh] OR Prophylaxis); (ii) disease (mycosis [Mesh] OR fungal disease [Mesh] OR invasive OR systemic); and (iii) research design (economics [Mesh] OR decision analysis [Mesh] OR costs and cost analysis [Mesh]). Publications were included if they were journal articles, full text publications, human studies, English language. Study articles were excluded if they were reviews, studying topical antifungal, non-invasive infections, or non-economic models. Journal article inclusion and data extraction, via a data collection form, were conducted twice, each by different researcher. Results: Out of 841 citations, only 19 articles were eligible for inclusion. Most of studies were relatively recent, conducted in 2008–2013. Seventeen of them used sources of clinical data from pooled randomized control trials. Evaluations were mostly in USA (7), the remaining in Australia, Canada, Spain, The Netherland, Korea, Greece, France, Germany, and Switzerland (1–2 articles each). All articles utilized the cost-effectiveness method using decision tree models; including 10 using Markov modeling for simulating future use of medications. This was, as appropriate, associated with discounting type of cost adjustment. Drug comparisons in included studies (27/29) were mostly between an old cheaper antifungals and more expensive newer ones. The 19 articles incorporated 15 studies with cost per life year gained measure, six with cost per IFI avoided, one with cost per Quality Adjusted Life Year, and four included cost saving per patient measure. Most important, is that same clinical measures were defined differently in different studies. Most studies reported dominance state, the majority were in favor of posaconazole (9 out of 12), and five studies required incremental cost effectiveness ratio analysis. Only direct medical costs were considered in studies despite that six articles had social perspectives instead of the hospital perspective. All articles had adjusted costs either for inflation (9/19 articles) or discounting. Fourteen articles used only one way sensitivity analysis while few used a combination with multivariate (2) or scenario (3) analyses. Conclusion: Decision making in relation to prophylactic antifungals is not complex, including the economic considerations; whereby straightforward therapy dominance status was demonstrated in the majority of studies. Most important, is that the literature evidence in relation the cost-effectiveness of systematic antifungals is not cumulative in nature, which is due to that same outcomes are defined differently in studies. This also meant that literature economic models are incomparable and not generalizable since different decision makers appear to be interested in different outcomes, including for the same antifungal agent. Studies are limited by not considering cost of side effects and alternative therapy options. Further studies are needed to compare among the newer more expensive agents, where evidence is lacking. Also, studies should be enhanced by better adhering to guidelines in relation to standardized definitions of health states, enabling a cumulative evidence generation and generalizability of findings.

Middle East Respiratory Syndrome (MERS) is a severe, acute respiratory illness caused by Corona Virus (CDC, 2015). Globally, there are 1599 cases diagnosed with MERS Corona virus and at least 574 related death cases were reported in the year 2012 (WHO, 2015). In Qatar, a total of 17 cases were reported between November 2013–May 2015 (WHO, 2015). The routes of transmission of MERS-COV includes direct contact with an infected person, touching contaminated objects or surfaces then touching your mouth, nose or eyes and direct contact with infected camels. A study in Qatar showed that MERS-COV was detected in 3 camels out of 14 from nose swabs taken from these camels. It also showed that the virus fragments were similar to what was found in two human cases from the same farm (Haagmans et al., 2014). Another study was conducted at Al-Shahaniya-Qatar in 2014 confirmed the presence of MERS-CoV in the milk of five camels. This explains that camels are a source of transmission of MERS-COV in the State of Qatar (Reusken et al., 2014). The purpose of this study is to examine knowledge of MERS-CoV transmission, symptoms and prevention techniques among female students at Qatar University, and further evaluate the effect of an awareness event organized by the Public Health Program. Participants (N =  33) were female students at Qatar University aged from 18–26 years old. Public health students designed a survey to test the knowledge of MERS-CoV transmission, symptoms and prevention techniques among female students at Qatar University. A pre-test survey was distributed in an awareness event of MERS-CoV that was held on the 19th of November 2015 at the college of Arts and Sciences. The survey included questions about demographics such as age, college, and nationality. It also included five questions to examine the level of knowledge about transmission routes for the virus, symptoms associated with the infection, the prevention techniques and the preferred strategy to be educated about the disease among students. Later, participants attended activities organized by public health students to be educated about MERS-CoV. They were exposed to epidemiological facts through distributed flyers and screen slides. The transmission routes were explained to the students using a creative and meaningful poster, Moreover, students were informed about the symptoms by another poster and a demonstration of MERS-CoV model. The prevention techniques regarding MERS-CoV were also explained through a poster and attractive, colorful brochures. The same recipients answered same questions as a post-test to measure changes in knowledge about MERS-CoV. For the analysis, SPSS software was used to analyze the pre- and post-test data. The McNemar's Test was used to compare the pre- and post-test results. P-value less than 0.05 was considered to be significant. The results showed the percentage of recipients aged (18-20) years and (21-23) years was the same (45.5%) for both age groups. The majority of the recipients were from the college of Science (57.6%); however, neither was from the college of Medicine nor the college of Law. Moreover, due to the high diversity in Qatar University, students form different nationalities participated in our survey such as, Qatari, Gulf countries, Egyptian, Palestinian, Iranian, Jordanian, Sudanese, Pakistani and Others. Most of the students were Qatari (21.2%), whereas Iranian and Pakistani had the lowest number of recipients (3.0%), (see Table 1). The results showed that prior to the educational event, the majority of the recipients thought that they didn't have enough knowledge about MERS-Corona Virus (54.5%). However, after the event, the majority agreed that they have enough knowledge about MERS-CoV, McNemar's Test (P = 0.000). In addition, the findings regarding transmission routes showed that the majority of recipients didn't know any of the transmission routes (33.3%), on the other hand, after the event 78% of the recipients were aware of all the transmission routes, McNemar's Test (P = 0.000). The next result showed that, most recipients knew about the symptoms associated with MERS-Corona Virus in pretest (51.5%), additively, the majority showed that they knew about these symptoms, but their knowledge improved compared to pre-test (90.9%), McNemar's Test (P = 0.001). When it comes to prevention, most recipients chose washing hands as preventive methods (33.3%) in pretest. However, the results after the event showed that recipients were aware of all of the preventive methods, but without statistical significance, McNemar's Test (P = 0.424). Finally, the pretest regarding the best educational methods showed that all the strategic methods were effective to educate about MERS-Corona Virus (75.8%). The percentage increased in the post-test (84.4%) but without statistical significance, McNemar's Test (P = 0.375) (see Table 2). Future research should focus more on comprehensive educational interventions that are needed to facilitate adoption of precautions associated with MERS-COV, and more follow up studies to see if these educational interventions promote changes in knowledge and behavior of students.

References

Center of Disease and Control (2015). Middle East Respiratory Syndrome (MERS). Retrieved from: http://www.cdc.gov/coronavirus/mers/.

Haagmans, B. L., Al Dhahiry, S. H., Reusken, C. B., Raj, V. S., Galiano, M., Myers, R.,… & Koopmans, M. P. (2014). Middle East respiratory syndrome coronavirus in dromedary camels: an outbreak investigation. The Lancet infectious diseases, 14(2), 140–145.

Reusken, C. B., Farag, E. A., Jonges, M., Godeke, G. J., El-Sayed, A. M., Pas, S. D., & Koopmans, M. P. (2014). Middle East respiratory syndrome coronavirus (MERS-CoV) RNA and neutralising antibodies in milk collected according to local customs from dromedary camels, Qatar, April 2014. Euro Surveill, 19(23), pii20829.

World Heath Organization (2015). Middle East respiratory syndrome coronavirus (MERS-CoV) – Qatar. Retrieved from: http://www.who.int/csr/don/11-february-2015-mers-qatar/en/. On: November 12, 2015.

World Heath Organization (2015). Middle East respiratory syndrome coronavirus (MERS-CoV) – Republic of Korea. Retrieved from: http://www.who.int/csr/don/25-october-2015-mers-korea/en/. On: November 12, 2015.

The presented work falls within one of Qatar's Research Grand Challenges, namely the area of Cyber Security. We have designed a new public-key cryptosystem that can improve the security of communication networks. This new cryptosystem combines two important ideas. The first idea is the difficulty of finding an invariant of infinite diagonalizable group. More specifically, for the coding purposes, we build an infinite diagonalizable group that has a given polynomial invariant of high degree. One possible attack on this cryptosystem is to find an invariant of this group. However, during the design of the system we guarantee that the minimal degree of invariants of this group is very high which makes the direct attempt to find any invariant using linear algebra techniques computationally expensive. The second idea is based on our discovery that when working over the ring Z of integers, another attack to break the cryptosystem is possible. This attack is based on replacing the prime factorization of integers by finding a factorization of “atoms” and can be implemented using the Euclidean algorithm. Similar algorithm works for rings that are unique factorization domains. To prevent this type of attack, we work over number fields that are not unique factorization domains (there are many such suitable number fields of small degrees). By doing so we invoke the well-known problem of prime factorization (used in commercial cryptosystems like RSA) which becomes principally more complicated over number fields that are not unique factorization domains. We have also showed that similar system based on finite diagonalizable groups are not secure against attack because such a system can be broken in polynomial time using an algorithm that finds a root of every polynomial p(x) with complex coefficients such that all of its roots are roots of unity. All invariants considered for diagonalizable groups are linear combinations of monomial invariants. The situation is more complicated for diagonalizable supergroups. Since it could improve the safety of the cryptosystem, we also investigated the case of supergroups and derived theoretical results about the minimal degrees of invariants. Since the diagonalizable supergroups enjoy more complicated structural properties, a cryptosystem based on them would be even more secured. In order to move to the supergroups, a better understanding of general linear supergroups was desired. We have established theoretical results describing and proving the linkage principle for these supergroups and we gained an understanding how are the composition factors of highest weight modules related. For the future work, we plan to implement the algorithm for the public-key cryptosystem that we have designed and test the speed of coding and test the security of the system by determining the time and space complexities of known attacks of the system.

In order to improve the effectiveness and safety of control systems, the problem of integrated fault diagnosis and control (IFDC) design has attracted significant attention in the recent years, both in the research and in the application domains. The integrated design unifies the control and diagnosis units into a single unit which leads to less complexity as compared to the case of separate designs. Nowadays, the IFDC modules are implemented on digital platforms. However, in almost all of these implementations, the IFDC task is executed periodically with a constant sampling period, which is called “time-triggering” sampling. However, the time-triggering sampling scheme produces many useless messages if the current sampled signal has not significantly changed in contrast to the previous sampled signal, which leads to a conservative usage of the communication bandwidth. This is especially disadvantageous in applications where the measured outputs and/or the actuator signals have to be transmitted over a shared (and possibly wireless) communication network, where the bandwidth of the network (and power consumption of the wireless radios) should be constrained. To mitigate the unnecessary waste of computation and communication resources in conventional time-triggered IFDC design, the problem of event-triggered integrated fault diagnosis and control (E-IFDC) for discrete-time linear systems is considered in this paper. A single E-IFDC module based on a dynamic filter is proposed which produces two signals, namely the residual and the control signals. The parameters of the E-IFDC module should be designed such that the effects of disturbances on the residual signals are minimized (for accomplishing the fault detection objective) subject to the constraint that the mapping matrix function from the faults to the residuals is equal to a pre- assigned diagonal mapping matrix (for accomplishing the fault isolation objective), while the effects of disturbances and faults on the specified control output are minimized (for accomplishing the fault-tolerant control objective). Two event-triggered conditions are proposed and designed to reduce the transmissions from the sensor to the E- IFDC module and from the E-IFDC module to the actuator. These event-triggered conditions determine whether the newly measured data or control output, respectively, should be transmitted or not. Indeed, the sensor measurement (controller output) is sent to the E-IFDC module (actuator) only when the difference between the latest transmitted sensor (controller) value and the current sensor measurement (controller output) is sufficiently large as compared to the current sensor (controller) value. This property reduces the burden on the network communication and saves the communication bandwidth in the network. Consequently, it is possible to significantly reduce the usage of communication resources for diagnosis and control tasks as compared to a conventional time-triggered IFDC approach. A multi-objective formulation of the problem is presented based on the H∞ and H- performance indices. The sufficient conditions for solvability of the problem are obtained in terms of linear matrix inequality (LMI) feasibility conditions. Indeed, the filter parameters and the event-triggered conditions are simultaneously obtained using strict LMI conditions. The main advantage of the proposed LMI formulation is that it is convex, and is therefore solved effectively using interior-point methods. Application of our methodology to a linearized model of the Subzero III ROV is presented to illustrate the effectiveness and capabilities of our proposed methodology. Remotely operated vehicles (ROVs) are underwater robotic platforms that have become increasingly important tools in a wide range of applications including offshore oil operations, fisheries research, dam inspection, salvage operations, military applications, among others. Since transmission resources are limited under water, using an event-triggered scheme for communication is more efficient. Therefore, the results of this paper are applied for designing an event-triggered IFDC module for the Subzero III ROV.

This paper presents the blueprint for the design of a practical system that would promote sharing of ideas among researchers, to allow them to identify optimal partners, to protect their intellectual capital, to ensure attribution of their ideas and to create equitable sharing in the ownership and revenue of any eventual commercializable invention. The title, Crowd Inventing, reflects the fact that the signaling among researchers in search of best partners – the “crowd” – is itself an inventive element in their larger enterprise. The combination of legal and technological components that the Crowd Inventing system offers allows it to reduce the transaction costs of this search. It is an invention about the inventive process that promises theoretical and practical advantages that will hopefully attract research sponsors or private enterprise to invest in promising projects and to thereby better promote and reward innovation. Qatar's rich research environment and entrepreneurial aspirations make it an ideal forum to implement the Crowd Inventing system as a platform that will allow it to capitalize on its investments through commercialization of products and processes. Crowd Inventing is designed to help researchers and innovators:

• Find valuable complementary ideas and research collaborators that are missing from their research team and that threaten to impair or, worse still, cripple their project. The drive to commercialization of research, as well as the basic goal of ensuring attribution of one's research, confronts huge challenges when all the inventive elements are not part of one large enterprise that has designed its own proprietary signaling and invention protection system. The open community of researchers who publish in conferences and journals confronts these challenges, with the result that researchers engage in greater secrecy that limits communication and impairs collaboration and, if they do publish, of losing all attribution and commercial value to the inventor who builds a successful product on their ideas.

• Address the inability of intellectual property to protect against a downstream user's failure to attribute or share revenue. Intellectual property imposes little or no legal obligations on such users to attribute the source of the ideas they employ. It also focuses all reward on the last person to combine the inventive ideas into a final, commercializable product; there is no legal requirement of sharing revenues with contributors that fall outside its corporate or contractual network. Neither copyright nor trademark protect the functional ideas that a researcher discloses in his/her publications. These ideas are deemed to pass into the public domain to become free for competitors to use. Nor do they provide the researcher adequate protection against false attribution. As a result, a downstream user can pluck the idea from the public domain, use it without attributing its source, and even itself claim full attribution.

• Reach their patent goal. Patent law provides researchers with protection for their novel functional ideas, but its reduction-to-practice requirement means that the proprietary reward that it offers is very distant from many research projects. In many areas of innovation the authors lack the collaboration and capital to put together all of the pieces, with the result that the entity adding the last needed element can capture the full commercial benefit of the invention. In a world where ever-increasingly complex projects result in cost-prohibitive and prolonged research and the demanding search for collaborators to stay the course to eventual invention, the patent hurdle produces huge unintended consequences. Increased secrecy is one consequence and this has strong negative effects on publication and on the signaling required to find the missing elements for successful invention. Large enterprises whose rich financial and human capital is congregated in a single corporate silo often emerge as the winners in this environment – and when they do achieve a patent they have the financial resources to protect and defend their resulting property rights. However, academic or disbursed research communities do not typically have these resources or systems in place to compete. Even though their decentralized structure and flexibility mean they are increasingly the sites of path-breaking discovery, they are unable to successful achieve patenting and their ideas pass to others to commercialize them or to fade into obscurity. The proposed Crowd Inventing system crafts a legal and a technological solution that offers the following practical solutions to research and innovation problems:

• The signaling mechanism needed for successful collaboration; more effective sharing of ideas; full attribution to all contributors; equitable sharing in the rewards of patenting; and the enhanced ability to attract financial investment to projects. Researchers that subscribe to Crown Inventing would contractually enter the system through a master agreement that defines and protects member's attribution and revenue-sharing rights. Underlying this is a technological information-sharing platform whereby data is shared in standardized form and access is monitored and controlled using a system of digital management that would help secure and control information flows. The researcher submitting the information (the source) could track access to its information and ensure attribution, while the user could more easily verify the lineage of ideas and link it more closely to the reputation of its source. Thereby both sides could gain. The Crowd Inventing master agreement would also supply contractual templates to provide standardized resolution of the revenue sharing aspects of any resulting joint ventures and its trained intermediaries could facilitate agreements, either of which could be less expensive than employing the lawyers and the other professionals that typically exact heavy taxes on every venture or technology transfer transaction.

• The means to find out the conditions under which the research data was generated and to identify and approach the source through the clearing function of the information sharing system. Once the parties had identified themselves they could begin to work together to learn more about one another's work and address the terms of any relationship between them based on this information. The Crown Inventing System anticipates the contractual needs of their relationship facilitating an ensuing master agreement which avoids the potentially long delays of initial contracting. (If necessary the identity of the source could be held back until a formal approach is made by the interested party to the source).

• The apparatus to more successfully monitor and publish the reputations of the members of its user community. Crowd Inventing would facilitate a community where not only the reputation of products (academic or applied) could be charted by registering the number of transactions, but also the reputations of companies and academic labs as joint venture partners (their good faith and candor) could be logged thereby creating a system of accountability and verifiable reputation.

• The means to create a “market” based on failed experiments conducted by other researchers in related areas. While the Crown Inventing system is designed principally to promote maximum innovation and successful invention, it could also be adapted to create a “market” based on failed or stalled experiments conducted by other researchers in related areas. Currently there is a dearth of communication within the scientific community concerning unsuccessful experiments and failed hypotheses. Only successful experiments are published; scientists do not expose their failures perhaps out of fear that it will lower their prestige and because of a lack of an appropriate, widely-disseminated forum for this purpose. The Crowd Inventing system could be used to address sharing of information about failed or shelved experiments as readily as it could regarding successful experiments, and in the process it could create market value for such information.

• A useful complement to the internal governance structure of large corporations. While it is contemplated that the Crown Inventing system would be ideally suited to communities of scattered researchers or small independent companies, it could also be employed as a useful complement to the internal governance structure of large corporations. Such enterprises confront at the level of their inter-departmental relationships, problems of how to share information between departments, employee attribution, what budgets to set for each department, and the departments, compensations, which the Crown Inventing system could address. In summary, Crowd Inventing aspires to offer the research community a solution to the impediments to collaborative communication and the inequities of an intellectual property system that rewards the last contributor and that fails to protect attribution of prior inputs. In the process it promises to help researchers more easily find the collaborators and commercial funding and other resources they need to reach invention. It is itself an academic-conceived invention that with adequate community or commercial funding could become a reality that makes Qatar a leader in facilitating innovation. This proposal is led by Professor Clinton Francis, the Founding Dean of the Hamad bin Khalifa University, who is joined by HBKU Juris Doctorate students who will assist in conducting the research for, and design of, Crowd Inventing – an innovation about innovation.