Search results for: self efficacy

Authors: Catarina Ramos Pereira, Jorge Rodrigues, Natália Oliveira, Jorge Machado, Maria Begoña Criado, Jorge Machado, Henri J. Greten

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Background: Parkinson's disease is a multi-system neurodegenerative disorder characterized by motor and non-motor symptoms. To slow disorder progression, different treatment options are now available, but in most cases, these therapeutic strategies also involve the presence of important side effects. This has led many patients to pursue complementary therapies, such as acupuncture, to alleviate PD symptoms. Therefore, an update on the efficacy of this treatment for patients of PD is of great value. This work presents a systematic review of the efficacy of acupuncture treatments in relieving PD symptoms. Methods: EMBASE, Medline, Pubmed, Science Direct, The Cochrane Library, Cochrane Central Register of Controlled Trials (Central), and Scielo databases were systematically searched from January 2011 through July 2021. Randomized controlled trials (RCTs) published in English with all types of acupuncture treatment were included. The selection and analysis of the articles were conducted by two blinding authors through the Rayyan application. Results: 720 potentially relevant articles were identified; 52 RCTs met our inclusion criteria. After the exclusion of 35, we found 17 eligible. The included RCTs reported positive effects for acupuncture plus conventional treatment compared with conventional treatment alone in the UPDRS score. Conclusions: Additional evidence should be supported by rigorous methodological strategies. Although firm conclusions cannot be drawn, acupuncture treatment, in the framework of an interdisciplinary care team, appears to have positive effects on PD symptoms.

Keywords: systematic review, Parkinson disease, acupuncture, traditional Chinese medicine

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Authors: Janet Tolulope Olaseni

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Emotional well-being in adolescents is an important psychological factor that can enhance positive living, but if it is not well groomed, it can have adverse impacts on their development. Therefore, the present study examined the efficacy of psycho-education on the emotional well-being of adolescents who are visually impaired in Nigeria. A total of twenty-eight (28) participants, which comprisednineteen (19) males and nine (9) females (M=15.82, SD=2.23) from a Nigerian School for the Blind, participated in the quasi-experimental study. Randomized clinical trial designwas used to assigned the participants into three (Complete Psycho-education, Incomplete Psycho-education, and No Psycho-education) groups. Standardized scales were used to gather data from the respondents. The formulated hypotheses were tested using Dependent T-Test and Analysis of Co-Variance. The results showed that there was a significant effect of Psycho-education on the emotional well-being of the Visually Impaired Adolescents. Those who received complete Psycho-educationhad the highest level of emotional well-being compared to those in the other groups. In order to enhance the emotional well-being of the Visually Impaired Adolescents, the study recommended that complete Psycho-education programme should be incorporated into the school activities of the Visually Impaired Adolescents.

Keywords: emotional well-being, psycho-education, visually impaired adolescents, Nigeria

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Authors: Iveta Eimontaite, Sarah R. Fletcher, Michele Surico, Alfio Minissale, Fabio F. Abba

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Industry 4.0 offers possibilities for increased production volumes and greater efficiency whilst at the same time presenting new opportunities and challenges for the human workforce. Exoskeletons have been used in healthcare and are now starting to be adopted in manufacturing. The potential benefits of reducing fatigue and physical strain are attractive prospects of the technology for industry; however, the novelty of exoskeletons and surrounding ethical issues raise concerns amongst the stakeholders. The current case study investigated the introduction of an upper body exoskeleton designed to support posture but not increase physical strength in a factory over three time points: before the exoskeleton was introduced, and one and two months post-introduction once operators had experienced working with it. The main focus was to evaluate changes in operators' workload, situation awareness, technology self-efficacy, and physical discomfort following the introduction of the exoskeleton. After using the exoskeleton over two months, operators reported a decrease in temporal demand and an increase in performance of the NASA TLX instrument. Furthermore, over the second month, operators' self-reported technology self-efficacy scores increased, but at the same time, their situation awareness decreased. Interestingly, operators' physical discomfort after using the exoskeleton for two months increased from not uncomfortable to quite uncomfortable in the shoulder, arm, and middle back regions. The results suggest that self-perceived task efficiency improved; however, increased discomfort and decreased situation awareness scores indicate that two months might not be long enough for the exoskeleton to be integrated into operators’ mental body schema. The paper will discuss further implications and suggestions for exoskeleton introduction to manufacturing environments.

Keywords: exoskeleton, manufacturing, mental workload, physical discomfort, situation awareness, technology self-efficacy

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Authors: Sourav Ghosh, Antony Gomes

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Since 1894 anti-snake venom serum (ASVS) is the only available treatment against snake envenomation, although there are many side effects and limitations. The need for a supportive treatment was felt for a long time to overcome the side effects and limitations of ASVS. Andrographolide conjugated with gold nanoparticle (A-GNP) has been found to antagonize viper venom-induced local damages. The present study was aimed to study the protective efficacy of A-GNP against Viper venom-induced inflammatory response and organ toxicity in animal model. Ethical clearance was obtained from animal experiments. Physico-chemical characterization of A-GNP was done by DLS (diameter and zeta potential), FE-SEM and XRD. Swiss albino male mice were divided into 4 groups: Gr.1-Sham control, Gr.2- Russell’s Viper venom (RVV) control, Gr.3- andrographolide treated and Gr.4- A-GNP treated. The 1/5th minimum lethal dose of RVV (500µg/kg, s.c.) was induced in animals of group 2, 3 & 4 animals, followed by treatment with andrographolide (100mg/kg, i.p.) and A-GNP (100mg/kg, i.v.) in group 3 & 4 animals, respectively. Blood was collected after 18 h, serum was prepared, and inflammatory markers (IL 1β, 6, 17a, 10, TNF α) and biochemical markers (AST, ACP, LDH, urea, creatinine) were assessed. Values were expressed as mean±SEM (n=4), one way ANOVA was done, P<0.05 was considered as statistically significant. DLS size showed the hydrodynamic diameter of A-GNP to be 230-260nm with polydispersity index of 0.103 and zeta potential was -18.32mV. XRD data confirmed the presence of crystalline gold in A-GNP, and FESEM indicated the presence of nearly spherical particle with size18-24nm.Treatment with A-GNP significantly decreased viper venom-induced proinflammatory markers (IL 1β, 6, 17, TNF α) increased anti-inflammatory markers (IL 10) and decreased organ toxicity markers (AST, ACP, LDH, urea, creatinine) in animal model. Venom neutralization efficacy of A-GNP was > andrographolide, which confirmed the increased efficacy of andrographolide after gold nanoparticle conjugation. Venom neutralization by A-GNP was due to anti-oxidant/anti-inflammatory activity of andrographolide, which showed increased efficacy after gold nanoparticle tagging. Thus, A-GNP may serve as a supportive therapy in snake-bite (against inflammatory response and organ toxicity) subject to further detail studies.

Keywords: andrographolide, gold nanoparticle, inflammatory response, organ toxicity, snake venom, snake venom neutralization, viper venom

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Authors: A. Van Staden, N. Purcell

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Spelling development is complex and multifaceted and relies on several cognitive-linguistic processes. This paper explored the spelling difficulties of English second language learners with auditory processing delays. This empirical study aims to address these issues by means of an intervention design. Specifically, the objectives are: (a) to develop and implement a multi-sensory spelling program for second language learners with auditory processing difficulties (APD) for a period of 6 months; (b) to assess the efficacy of the multi-sensory spelling program and whether this intervention could significantly improve experimental learners' spelling, phonological awareness, and processing (PA), rapid automatized naming (RAN), working memory (WM), word reading and reading comprehension; and (c) to determine the relationship (or interplay) between these cognitive and linguistic skills (mentioned above), and how they influence spelling development. Forty-four English, second language learners with APD were sampled from one primary school in the Free State province. The learners were randomly assigned to either an experimental (n=22) or control group (n=22). During the implementation of the spelling program, several visual, tactile and kinesthetic exercises, including the utilization of fingerspelling were introduced to support the experimental learners’ (N = 22) spelling development. Post-test results showed the efficacy of the multi-sensory spelling program, with the experimental group who were trained in utilising multi-sensory coding and fingerspelling outperforming learners from the control group on the cognitive-linguistic, spelling and reading measures. The results and efficacy of this multi-sensory spelling program and the utilisation of fingerspelling for hearing second language learners with APD open up innovative perspectives for the prevention and targeted remediation of spelling difficulties.

Keywords: English second language spellers, auditory processing delays, spelling difficulties, multi-sensory intervention program

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Authors: Yasin Ibrahim, Hisham Almohandes, Chia Hsu, Regina Baronia, Jesse Worsham, Sara Abdelgawad, Mansour Shawky, Mohammed Abdelfattah, Nesif Alhemiary

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Background: The matrix model (MM) is an evidence-based program for treating substance use disorders. Since first translated into Arabic in 2010, the MM has been gaining popularity in Arabic countries. However, there is no published data as pertains to its efficacy and feasibility in Arabic communities. Here we aimed at exploring providers’ perspectives on its feasibility and efficacy. Methods: Eight addiction treatment centers from four Arabic countries, namely Egypt, Kingdom of Saudi Arabia, the United Arab Emirates, and Iraq, were contacted via email. They were asked to fill in a 21-item questionnaire. Results: Matrix model continues to be utilized in 6 out of the 8 contacted programs. One center in Egypt has discontinued the MM as the providers felt it was not suitable for substance disorders other than stimulants, which are not common in Egypt. Baghdad University Medical Center has substituted MM with Colombo Program as there have been more training opportunities available for it. Data showed wide variability in regards to number of clients treated with the MM (from 300 to 2500). The Arabic version was utilized for training providers in 5 out of the 8 centers while the providers of the other 3 have been trained in the United States. All providers reported that MM made their job significantly easier, and seven providers believed that MM has favorably affected the relapse rate. In all of the six centers, MM is being utilized for many substance use disorders in addition to stimulant use disorders. Reported challenges included the acceptability of patients and their families, difficulty understanding some concepts, and high drop rates in some centers. Conclusion: Matrix model seems to be a valuable modality for the treatment of substance use disorders in Arabic countries. It has its own challenges and limitations that call for more culturally adapted versions.

Keywords: addiction, Arabic countries, developing countries, matrix model

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Authors: Nadeem Munawar, David Galbraith, Tariq Mahmood

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Rodenticides are often included as part of an integrated pest management approach for managing rodent species since they are relatively quick and inexpensive to apply. The current field study was conducted to evaluate the effectiveness of formulated baits of zinc phosphide (2%) and the second generation anticoagulant brodifacoum (0.005%) against field rats inhabiting a wheat-groundnut cropping system. Burrow baiting was initiated at the early flowering stages of the respective crops, and continued through three growth stages (tillering / peg formation, flowering, and maturity). Three treatments were done at equal time intervals, with the final baiting being about 2 weeks before harvest. Treatment efficacy of the trials was assessed through counts of active rodent burrows before and after treatments at the three growth stages of these crops. The results indicated variable degrees of reduction in burrow activities following the three bait applications. The reductions in rodent activity in wheat were: 88.8% (at tillering), 92%, (at flowering/grain formation), and 95.5% (at maturity). In groundnut, the rodent activities were reduced by 91.8%, 93.5% and 95.8% at sowing, peg formation, and maturity stages, respectively. The estimated mortality at all three growth stages of both wheat and groundnut ranged between 60-85%. We recommend that a field efficacy study should be conducted with zinc phosphide and brodifacoum bait formulations to determine their field performance in the reduction of agricultural damage by rodent pest species. It is a promising alternative approach for use of the most potent second-generation anticoagulant (brodifacoum) in resistance management, particularly with respect to reducing environmental risks and secondary poisoning.

Keywords: brodifacoum, burrow baiting, second-generation anticoagulant, synergistic effect

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Authors: Peter Adly Hamdy Fahmy

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The aim of the study was to examine the effects of a physical education program on student learning by combining the teaching of personal and social responsibility (TPSR) with a physical education model and TPSR with a traditional teaching model, these learning outcomes involving self-learning. -Study. Athletic performance, enthusiasm for sport, group cohesion, sense of responsibility and game performance. The participants were 3 secondary school physical education teachers and 6 physical education classes, 133 participants with students from the experimental group with 75 students and the control group with 58 students, and each teacher taught the experimental group and the control group for 16 weeks. The research methods used surveys, interviews and focus group meetings. Research instruments included the Personal and Social Responsibility Questionnaire, Sports Enthusiasm Scale, Group Cohesion Scale, Sports Self-Efficacy Scale, and Game Performance Assessment Tool. Multivariate analyzes of covariance and repeated measures ANOVA were used to examine differences in student learning outcomes between combining the TPSR with a physical education model and the TPSR with a traditional teaching model. The research findings are as follows: 1) The TPSR sports education model can improve students' learning outcomes, including sports self-efficacy, game performance, sports enthusiasm, team cohesion, group awareness and responsibility. 2) A traditional teaching model with TPSR could improve student learning outcomes, including sports self-efficacy, responsibility, and game performance. 3) The sports education model with TPSR could improve learning outcomes more than the traditional teaching model with TPSR, including sports self-efficacy, sports enthusiasm, responsibility and game performance. 4) Based on qualitative data on teachers' and students' learning experience, the physical education model with TPSR significantly improves learning motivation, group interaction and sense of play. The results suggest that physical education with TPSR could further improve learning outcomes in the physical education program. On the other hand, the hybrid model curriculum projects TPSR - Physical Education and TPSR - Traditional Education are good curriculum projects for moral character education that can be used in school physics.

Keywords: approach competencies, physical, education, teachers employment, graduate, physical education and sport sciences, SWOT analysis character education, sport season, game performance, sport competence

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Authors: Pontsho E. Tseke, Phatu W. Mashela

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Cucurbitacin-containing phytonematicides had been consistent in suppressing root-knot (Meloidogyne species) when used in dried crude form, with limited evidence whether the efficacy could be affected when fresh fruits were used during fermentation. The objective of this study was to determine the influence of Nemafric-BL phytonematicide prepared using fermented crude extracts of fresh fruit from wild watermelon (Cucumis africanus) on the growth of tomato (Solanum lycopersicum) plants and suppression of Meloidogyne species. Seedlings of tomato cultivar ‘Floradade’ were inoculated with 3 000 eggs and second-stage juveniles (J2) of M. incognita race 2 in pot trials, with treatments comprising 0, 2, 4, 8, 16, 32 and 64 % Nemafric-BL phytonematicide. At 56 days after inoculation, the phytonematicide reduced eggs and J2 in roots by 84-97%, J2 in soil by 49-96% and total nematodes by 70-97%. Plant variables and concentrations of Nemafric-BL phytonematicide exhibited positive quadratic relations, with 74-98% associations. In conclusion, fresh fruit of C. africanus could be used for the preparation of Nemafric-BL phytonematicide, particularly in cases where the dry infrastructure is not available.

Keywords: Cucurbitacin B, density-dependent growth, effective microorganisms, quadratic relations

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Authors: Norbayah Mohd Suki, Norazah Mohd Suki

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This study aims to examine relationships between attitude, self-efficacy, and subjective norm with students’ behavioural intention to use public computing facilities at a library. Data was collected from 200 undergraduate students enrolled at a higher learning institution in the Federal Territory of Labuan, Malaysia via a structured questionnaire comprising closed-ended questions. Data was analyzed using multiple regression analysis. The results show that students’ behavioural intention to use public computing facilities at the library is widely affected by subjective norm factor i.e. influence of the support of family members, friends and neighbours. The findings of this study provide a better understanding of factors likely to influence students’ behavioural intention to use public computing facilities at a library. It also offers valuable insights into factors which university librarians need to focus on to improve students’ behavioural intention to actively use public computing facilities at a library for quality information retrieval. Direction for future research is also presented.

Keywords: attitude, self-efficacy, subjective norm, behavioural intention

Procedia PDF Downloads 446

Authors: Peter Adly Hamdy Fahmy

Abstract:

The aim of the study was to examine the effects of a physical education program on student learning by combining the teaching of personal and social responsibility (TPSR) with a physical education model and TPSR with a traditional teaching model, these learning outcomes involving self-learning. -Study. Athletic performance, enthusiasm for sport, group cohesion, sense of responsibility and game performance. The participants were 3 secondary school physical education teachers and 6 physical education classes, 133 participants with students from the experimental group with 75 students and the control group with 58 students, and each teacher taught the experimental group and the control group for 16 weeks. The research methods used surveys, interviews and focus group meetings. Research instruments included the Personal and Social Responsibility Questionnaire, Sports Enthusiasm Scale, Group Cohesion Scale, Sports Self-Efficacy Scale, and Game Performance Assessment Tool. Multivariate analyzes of covariance and repeated measures ANOVA were used to examine differences in student learning outcomes between combining the TPSR with a physical education model and the TPSR with a traditional teaching model. The research findings are as follows: 1) The TPSR sports education model can improve students' learning outcomes, including sports self-efficacy, game performance, sports enthusiasm, team cohesion, group awareness and responsibility. 2) A traditional teaching model with TPSR could improve student learning outcomes, including sports self-efficacy, responsibility, and game performance. 3) The sports education model with TPSR could improve learning outcomes more than the traditional teaching model with TPSR, including sports self-efficacy, sports enthusiasm, responsibility and game performance. 4) Based on qualitative data on teachers' and students' learning experience, the physical education model with TPSR significantly improves learning motivation, group interaction and sense of play. The results suggest that physical education with TPSR could further improve learning outcomes in the physical education program. On the other hand, the hybrid model curriculum projects TPSR - Physical Education and TPSR - Traditional Education are good curriculum projects for moral character education that can be used in school physics.

Keywords: approach competencies, physical, education, teachers employment, graduate, physical education and sport sciences, SWOT analysis character education, sport season, game performance, sport competence

Procedia PDF Downloads 59

Authors: Valentine Ayo Mebu

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The study examined the efficacy of a brief intervention programme in the treatment of post-traumatic stress disorder (PTSD) symptoms exhibited by secondary school students exposed to conflict in Kano metropolis. The study tested three hypotheses that there is no significant difference between post-test re-experiencing, hyper-arousal, and avoidance mean scores of students exposed to the intervention and those who were not exposed to the intervention. The design of the study was an experimental design, specifically the pre-test and post-test control group design. The purposive sampling technique was used to select 60 research participants (male=30, female=30, Mean Age=15.50) for the study. These participants met the Diagnostic Statistical Manual of Mental Disorders (DSM-5) criteria of PTSD symptoms and were randomly assigned to experimental and control groups, respectively. Instrument for data collection was the University of California Post-Traumatic Stress Disorder Reaction Index (UCLA PTSD Index). Findings from the study indicated that there was a significant effect of the intervention on post re-experiencing symptoms scores [ F (1, 57) = 85.97, p=.00, partial eta squared η²=.60], hyper-arousal symptoms scores[ F (1, 57) = 27.81, p=.00, partial eta squared η² =.33], and avoidance symptoms scores [ F (1, 57) = 59.56, p=.00, partial eta squared η² =.51]. The efficacy of this brief psycho-educational intervention as an effective treatment in reducing PTSD symptoms among secondary school students exposed to conflict is supported by the results of this study and this will also add to the existing literature on the effectiveness of psycho-educational intervention in treating PTSD symptoms among students exposed to conflict.

Keywords: avoidance symptoms, hyper-arousal symptoms, re-experiencing symptoms, post-traumatic stress disorder, psycho-education

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Authors: Eda Ozkara San

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Nurse educators have been charged by several nursing organizations and accrediting bodies to provide innovative and evidence-based educational experiences, both didactic and clinical, to help students to develop the knowledge, skills, and attitudes needed to provide culturally competent nursing care to patients. Clinical simulation, which offers the opportunity for students to practice nursing skills in a risk-free, controlled environment and helps develop self-efficacy (confidence) within the nursing role. As one simulation method, the standardized patients (SPs) simulation helps educators to teach nursing students variety of skills in nursing, medicine, and other health professions. It can be a helpful tool for nurse educators to enhance cultural competence of nursing students. An alarming gap exists within the literature concerning the effectiveness of SP strategy to enhance cultural competence development of diverse student groups, who must work with patients from various backgrounds. This grant-supported, longitudinal, one-group, pretest and post-test educational intervention study aimed to examine the effect of the Diverse Standardized Patient Simulation (DSPS) cultural competence education strategy on students’ (n = 53) transcultural self-efficacy (TSE). The researcher-developed multidimensional DSPS strategy involved careful integration of transcultural nursing skills guided by the Cultural Competence and Confidence (CCC) model. As a carefully orchestrated teaching and learning strategy by specifically utilizing the SP pedagogy, the DSPS also followed international guidelines and standards for the design, implementation, evaluation, and SP training; and had content validity review. The DSPS strategy involved two simulation scenarios targeting underrepresented patient populations (Muslim immigrant woman with limited English proficiency and Irish-Italian American gay man with his partner (Puerto Rican) to be utilized in a second-semester, nine-credit, 15-week medical-surgical nursing course at an urban public US university. Five doctorally prepared content experts reviewed the DSPS strategy for content validity. The item-level content validity index (I-CVI) score was calculated between .80-1.0 on the evaluation forms. Jeffreys’ Transcultural Self-Efficacy Tool (TSET) was administered as a pretest and post-test to assess students’ changes in cognitive, practical, and affective dimensions of TSE. Results gained from this study support that the DSPS cultural competence education strategy assisted students to develop cultural competence and caused statistically significant changes (increase) in students’ TSE perceptions. Results also supported that all students, regardless of their background, benefit (and require) well designed cultural competence education strategies. The multidimensional DSPS strategy is found to be an effective way to foster nursing students’ cultural competence development. Step-by-step description of the DSPS provides an easy adaptation of this strategy with different student populations and settings.

Keywords: cultural competence development, the cultural competence and confidence model, CCC model, educational intervention, transcultural self-efficacy, TSE, transcultural self-efficacy tool, TSET

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Authors: Ashit Syngle, Inderjit Verma, Pawan Krishan

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Therapeutic approaches used previously relied on disease-modifying antirheumatic drugs (DMARDs) that had only partial clinical benefit and were associated with significant toxicity. Spironolactone, an oral aldosterone antagonist, suppresses inflammatory mediators. Clinical efficacy of spironolactone compared with placebo in patients with active psoriatic arthritis despite treatment with prior traditional DMARDs. In the 24-week, placebo-controlled study patients (n=31) were randomized to placebo and spironolactone (2 m/kg/day). Patients on background concurrent DMARDs continued stable doses (methotrexate, leflunomide, and/or sulfasalazine). Primary outcome measures were the assessment of disease activity measures i.e. 28-joint disease activity score (DAS28) and diseases activity in psoriatic arthritis (DAPSA) at week 24. The key secondary endpoint was change from baseline in Health Assessment Questionnaire–Disability Index (HAQ-DI) at week 24. Additional efficacy outcome measures at week 24 included improvements in the markers of inflammation (ESR and CRP) and pro-inflammatory cytokines TNF-α, IL-6 and IL-1. At week 24, spironolactone significantly reduced disease activity measure DAS-28 (p<0.001) and DAPSA (p=0.001) compared with placebo. Significant improvements in key secondary measures HAQ-DI (disability index) were evident with spironolactone (p=0.02) versus placebo. After week 24, there was significant reduction in pro-inflammatory cytokines level TNF-α, IL-6 (p<0.01) as compared with placebo group. However, there was no significant improvement in IL-1 in both treatment and placebo groups. There were minor side effects which did not mandate stopping of spironolactone. No change in any biochemical profile was noted after spironolactone treatment. Spironolactone was effective in the treatment of PsA, improving disease activity, physical function and suppressing the level of pro-inflammatory cytokines. Spironolactone demonstrated an acceptable safety profile and was well tolerated.

Keywords: spironolactone, inflammation, inflammatory cytokine, psoriatic arthritis

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Authors: Chantel Snyman, Chrizanne van Eeden, Marita Heyns

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Autism spectrum disorder (ASD) is one of the most common disabilities in schools, with up to50% of children displaying behaviors that challenge, bringing about demanding teaching circumstances. The teachers and teaching assistants of such learners often experience a negative impact on their own quality of life. Research globally and in South Africa about the teachers of ASD learners and teaching interventions, especially positive psychology approaches aimed at supporting learners with ASD, is limited. The primary research aim of this study was to investigate the feasibility as well as the effect of a strength-based intervention for teachers on the behavior of their learners with ASD and on the wellbeing and self-efficacy of teachers and assistants over time. This quantitative study used a pre-experimental group design with a pre-test-post-test method for the proposed school-based intervention. Teachers and teaching assistants completed the Difficult Behavior Self-Efficacy Scale, the Mental Health Questionnaire, and the short Behaviors That Challenge Checklist for learners with ASD. The six-week intervention on character strengths was delivered by the researcher as part of Teacher Staff Development. Results were generally significant on a practical level (based on practical effect sizes), which indicate that the intervention had a visible effect on behaviors that challenge. Research scores over time suggested a positive effect of the intervention in the well-being of participants and an overall positive effect on behaviors that challenge of ASD learners. Results showed that the character strengths intervention shows promise as a simple but effective intervention for teachers and teaching assistants, with positive effects for learners and teaching staff in the ASD classroom. It is recommended that this intervention should be repeated over a longer period of time and with a larger sample to determine its validity.

Keywords: autism spectrum disorder (ASD), behavior that challenge, character strengths, disabilities, self-efficacy, teachers, teaching assistants, well-being

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Authors: Sancho-Esper Franco, Rodríguez Sánchez Carla, Sánchez Carolina, Orús-Sanclemente Carlos

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Water scarcity is a reality that affects many regions of the world and is aggravated by climate change and population growth. Saving water has become an urgent need to ensure the sustainability of the planet and the survival of many communities, where youth and social networks play a key role in promoting responsible practices and adopting habits that contribute to environmental preservation. This study analyzes the persuasion capacity of messages designed to promote pro-environmental behaviors among youth. Specifically, it studies how the efficacy (effectiveness) of the response (personal response efficacy/effectiveness) and the perception of distance from the source of the message influence the water-saving behavior of the audience. To do so, two communication frameworks are combined. First, the Construal Level Theory, which is based on the concept of "psychological distance", that is, people, objects or events can be perceived as psychologically near or far, and this subjective distance (i.e., social, temporal, or spatial) determines their attitudes, emotions, and actions. This perceived distance can be social, temporal, or spatial. This research focuses on studying the spatial distance and social distance generated by cultural differences between influencers and their audience to understand how cultural distance can influence the persuasiveness of a message. Research on the effects of psychological distance between influencers-followers in the pro-environmental field is very limited, being relevant because people could learn specific behaviors suggested by opinion leaders such as influencers in social networks. Second, different approaches to behavioral change suggest that the perceived efficacy of a behavior can explain individual pro-environmental actions. People will be more likely to adopt a new behavior if they perceive that they are capable of performing it (efficacy belief) and that their behavior will effectively contribute to solving that problem (personal response efficacy). It is also important to study the different actors (social and individual) that are perceived as responsible for addressing environmental problems. Specifically, we analyze to what extent the belief individual’s water-saving actions are effective in solving the problem can influence water-saving behavior since this individual effectiveness increases people's sense of obligation and responsibility with the problem. However, in this regard, empirical evidence presents mixed results. Our study addresses the call for experimental studies manipulating different subtypes of response effectiveness to generate robust causal evidence. Based on all the above, this research analyzes whether cultural distance (local vs. international influencer) and the perception of effectiveness of behavior (personal response efficacy) (personal/individual vs. collective) affect the actual behavior and the intention to conserve water of social network users. An experiment of 2 (local influencer vs. international influencer) x 2 (effectiveness of individual vs. collective response) is designed and estimated. The results show that a message from a local influencer appealing to individual responsibility exerts greater influence on intention and actual water-saving behavior, given the cultural closeness between influencer-follower, and the appeal to individual responsibility increases the feeling of obligation to participate in pro-environmental actions. These results offer important implications for social marketing campaigns that seek to promote water conservation.

Keywords: social marketing, influencer, message framing, experiment, personal response efficacy, water saving

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Authors: Bawa Inalegwu, Jacob A. Jato, Ovye Akyengo, John Akighir

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All humans will experience some type of wound in every lifetime. Most wounds heal quickly with little or no attention but, many people suffer from wounds that are complex and/or persistent therefore posing a burden. This study was designed to assess the efficacy of Mitrcarpus villous ointment against honey in diabetic rats. To achieve this, percentage wound closure and collagen assessments were used to express treatment efficacy. Results show that on day 21, rats treated with M. villosus ointment had the highest percentage closure (94.5%) while honey treated and non-treated recorded 90.0% and 83.3% respectively. Similarly, a significant difference (p < 0.05) was observed on day 21 in the total collagen deposited in wounds of diabetic rats (10.57 ± 0.7) and M. villous ointment treated wounds (11.77 ± 0.4) as compared with the non-treated diabetic rats. M. villosus ointment was efficacious in healing wounds in diabetic rats and heals wound faster than honey and may hold potential for wound healing in diabetes mellitus sufferers. However, the wound healing mechanism of this ointment

Keywords: collagen, diabetic rats, honey, Mitracarpus villosus, ointment, wound healing

Procedia PDF Downloads 199

Authors: Sharon Jackson White

Abstract:

Purpose: Nurse practitioners (NPs) practicing within hospital medicine play a significant role in caring for patients who might benefit from palliative care (PC) services. Using the Theory of Planned Behavior, the purpose of this study was to examine the relationships among facilitators to referral, barriers to referral, self-efficacy with end-of-life discussions, history of referral, and referring to PC among NPs in hospital medicine. Hypotheses: 1) Perceived facilitators to referral will be associated with a higher history of referral and a higher number of referrals to PC. 2) Perceived barriers to referral will be associated with a lower history of referral and a lower number of referrals to PC. 3) Increased self-efficacy with end-of-life discussions will be associated with a higher history of referral and a higher number of referrals to PC. 4) Perceived facilitators to referral, perceived barriers to referral, and self–efficacy with end-of-life discussions will contribute to a significant variance in the history of referral to PC. 5) Perceived facilitators to referral, perceived barriers to referral, and self–efficacy with end-of-life discussions will contribute to a significant variance in the number of referrals to PC. Significance: Previous studies of referring patients to PC within the hospital setting care have focused on physician practices. Identifying factors that influence NPs referring hospitalized patients to PC is essential to ensure that patients have access to these important services. This study incorporates the SNRS mission of advancing nursing research through the dissemination of research findings and the promotion of nursing science. Methods: A cross-sectional, predictive correlational study was conducted. History of referral to PC, facilitators to referring to PC, barriers to referring to PC, self-efficacy in end-of-life discussions, and referral to PC were measured using the PC referral case study survey, facilitators and barriers to PC referral survey, and self-assessment with end-of-life discussions survey. Data were analyzed descriptively and with Pearson’s Correlation, Spearman’s Rho, point-biserial correlation, multiple regression, logistic regression, Chi-Square test, and the Mann-Whitney U test. Results: Only one facilitator (PC team being helpful with establishing goals of care) was significantly associated with referral to PC. Three variables were statistically significant in relation to the history of referring to PC: “Inclined to refer: PC can help decrease the length of stay in hospital”, “Most inclined to refer: Patients with serious illnesses and/or poor prognoses”, and “Giving bad news to a patient or family member”. No predictor variables contributed a significant variance in the number of referrals to PC for all three case studies. There were no statistically significant results showing a relationship between the history of referral and referral to PC. All five hypotheses were partially supported. Discussion: Findings from this study emphasize the need for further research on NPs who work in hospital settings and what factors influence their behaviors of referring to PC. Since there is an increase in NPs practicing within hospital settings, future studies should use a larger sample size and incorporate hospital medicine NPs and other types of NPs that work in hospitals.

Keywords: palliative care, nurse practitioners, hospital medicine, referral

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Authors: Feras Darwish Elhajji, Alberto Berardi, Manal Ayyash, Iman Basheti

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The concept of the use of probiotics for humans now has been known for decades however, their intake by the Jordanian population seems to be less common when compared to population in the developed countries. Community pharmacy is the main supplier of probiotics, however, after conducting an extensive literature review, not any published research article could be found talking about the role, knowledge, and practice of the pharmacists in the area of probiotics. The main aim of this study was to evaluate the level of knowledge about probiotics and their dispensing practice in community pharmacies in Jordan. Community pharmacy staff (pharmacists and technicians) in Amman and north of Jordan were randomly selected to complete an anonymous questionnaire that had been pre-tested and validated. Ethical approval was obtained from the university ethics committee. The questionnaire included the following sections: demographics, knowledge and perceptions about probiotics, and role of the pharmacist Pharmacists and technicians were visited and interviewed in 281 community pharmacies. Asking about probiotics, 90.4% of them said that they know what probiotics are, although only 29.5% agreed that pharmacy staff in Jordan have good knowledge about probiotics, and 88.3% agreed that pharmacy staff in Jordan need more training and knowledge about probiotics. Variables that were significantly related to knowledge about probiotics were being a pharmacist (ρ= 0.012), area of the community pharmacy (ρ= 0.019), and female staff (ρ= 0.031) after conducting logistic regression statistical analysis. More than two-thirds of the participants thought that probiotics are classified as dietary supplements by Jordan Food and Drug Administration (JFDA). Of those who knew probiotics, the majority of them – 76.8% and 91.7% – agreed that probiotics are effective and safe, respectively. Believing in efficacy of the probiotics was significantly associated with answering their use to be with or after antibiotic administration and to increase normal flora gut population (ρ= 0.007). Efficacy was also significantly associated with recommending probiotics to consumers by the pharmacist (ρ< 0.001) and by the doctor (ρ= 0.041). At the same time, the concept of safety was mainly associated with their use for flatulence and gases (ρ= 0.048). Level of knowledge about probiotics and their uses, efficacy and safety amongst community pharmacy staff in Jordan is found to be good. However, this level can be raised in the future, especially knowledge about uses of probiotics.

Keywords: community pharmacy, Jordan, prebiotics, probiotics

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Authors: Naureen Naeem, M. S. Aslam

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Chia seeds found to be a rich source of dietary fiber contain oil which is high in omega 6 and omega 3 fatty acids and helpful in the control of cardiovascular diseases. Owing to its spectacular significance, present research had been designed to explore its effect on cholesterol level of the individuals after consumption of chia seed oil supplemented ice cream. The project was designed in such a manner that fat of ice cream was replaced with chia seed oil in different proportions i.e., 25%, 50%, 75%, 100%. After physico-chemical and sensory evaluation of ice cream, best treatment was selected and used for efficacy trials. After baseline line study and thorough inclusion criteria 10 individuals were selected and divided into two groups. One group treated as control and the other was given chia seed oil supplemented l(50%) ice cream. Significant decrease in cholesterol level was observed in the treated group. 18% decrease in cholesterol level was observed at 40th day followed by 8% at 20th day. Similarly 20% decrease in LDL cholesterol with 14% increase in HDL cholesterol. It was recommended that further trials be conducted with sophisticated techniques to completely replace saturated fat in ice cream with unsaturated fats and to study its effect in hyperglycemia and oxidative stress.

Keywords: hypercholesterolemia, chia seed oil, HDL, triglycerides

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Authors: Vivek Rangarajan, Kim G. Klarke

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With overpopulation threatening the world’s ability to feed itself, food production and protection has become a major issue, especially in developing countries. Almost one-third of the food produced for human consumption, around 1.3 billion tonnes, is either wasted or lost annually. Postharvest decay in particular constitutes a major cause of crop loss with about 20% of fruits and vegetables produced lost during postharvest storage, mainly due to fungal disease. Some of the major phytopathogenic fungi affecting postharvest fruit crops in South Africa include Aspergillus, Botrytis, Penicillium, Alternaria and Sclerotinia spp. To date control of fungal phytopathogens has primarily been dependent on synthetic chemical fungicides, but these chemicals pose a significant threat to the environment, mainly due to their xenobiotic properties and tendency to generate resistance in the phytopathogens. Here, an environmentally benign alternative approach to control postharvest fungal phytopathogens in perishable fruit crops has been presented, namely the application of a bio-fungicide in the form of lipopeptide molecules. Lipopeptides are biosurfactants produced by Bacillus spp. which have been established as green, nontoxic and biodegradable molecules with antimicrobial properties. However, since the Bacillus are capable of producing a large number of lipopeptide homologues with differing efficacies against distinct target organisms, the lipopeptide production conditions and strategy are critical to produce the maximum lipopeptide concentration with homologue ratios to specification for optimum bio-fungicide efficacy. Process conditions, and their impact on Bacillus lipopeptide production, were evaluated in fully instrumented laboratory scale bioreactors under well-regulated controlled and defined environments. Factors such as the oxygen availability and trace element and nitrate concentrations had profound influences on lipopeptide yield, productivity and selectivity. Lipopeptide yield and homologue selectivity were enhanced in cultures where the oxygen in the sparge gas was increased from 21 to 30 mole%. The addition of trace elements, particularly Fe2+, increased the total concentration of lipopeptides and a nitrate concentration equivalent to 8 g/L ammonium nitrate resulted in optimum lipopeptide yield and homologue selectivity. Efficacy studies of the culture supernatant containing the crude lipopeptide mixture were conducted using phytopathogens isolated from fruit in the field, identified using genetic sequencing. The supernatant exhibited antifungal activity against all the test-isolates, namely Lewia, Botrytis, Penicillium, Alternaria and Sclerotinia spp., even in this crude form. Thus the lipopeptide product efficacy has been confirmed to control the main diseases, even in the basic crude form. Future studies will be directed towards purification of the lipopeptide product and enhancement of efficacy.

Keywords: antifungal efficacy, biocontrol, lipopeptide production, perishable crops

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Authors: Radha Rajamma, Susheela Palanisamy

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The use of chemical fertilizers and pesticides has posed a serious threat to the environment, cause disturbance to the soil ecosystem, pollute the water causing serious health problems. The indigenous practices such as herbal spray, phyto-alternatives, etc. offer harmless alternatives in integrated pest management. The use of plant materials has become an integral part of insect pest management because of their cheap and non-toxic nature. Hence an investigation has been made to determine the bio-efficacy of vermiwash and two leaf extracts, Azadirachta indica and Vitex negundo against mealy bug, Paracoccus marginatus. The results on the effect of vermitechnologies on the activity of mealy bug indicated the effectiveness of vermiwash foliar application in suppressing the pest activity. Accumulative mortality of mealy bug increased gradually with the increase of exposure intervals. The combined treatment of vermiwash with Azadirachta indica reported the highest mortality percentage of 96% followed by the individual treatment of leaf extracts. Hence vermiwash was proved to be the most effective in enhancing the potency of mealy bug and decreased LC50 of the target insect.

Keywords: Azadirachta indica, Paracoccus marginatus, vermiwash, Vitex negundo

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Authors: Linda Saili, Amel Hanini, Chiraz Smirani, Iness Azzouz, Amina Azzouz, Hafedh Abdemelek, Zihad Bouslama

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Electrocardiogram and arterial pressure measurements were studied under acute exposures to WIFI (2.45 GHz) during one hour in adult male rabbits. Antennas of WIFI were placed at 25 cm at the right side near the heart. Acute exposure of rabbits to WIFI increased heart frequency (+ 22%) and arterial blood pressure (+14%). Moreover, analysis of ECG revealed that WIFI induced a combined increase of PR and QT intervals. By contrast, the same exposure failed to alter the maximum amplitude and P waves. After intravenously injection of dopamine (0.50 ml/kg) and epinephrine (0.50ml/kg) under acute exposure to RF we found that WIFI alter catecholamines(dopamine, epinephrine) action on heart variability and blood pressure compared to control. These results suggest for the first time, as far as we know, that exposure to WIFI affect heart rhythm, blood pressure, and catecholamines efficacy on cardiovascular system; indicating that radio frequency can act directly and/or indirectly on the cardiovascular system.

Keywords: heart rate (HR), arterial pressure (PA), electrocardiogram (ECG), the efficacy of catecholamines, dopamine, epinephrine

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Authors: F. Pal-Fam, R. Hoffmann, S. Keszthelyi

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Granary weevil, Sitophilus granarius (L.) (Col.: Curculionidae) is a typical cosmopolitan pest. It can cause significant damage to stored grains, and can drastically decrease yields. Damaged grain has reduced nutritional and market value, weaker germination, and reduced weight. The commonly used protectants against stored-product pests in Europe are residual insecticides, applied directly to the product. Unfortunately, these pesticides can be toxic to mammals, the residues can accumulate in the treated products, and many pest species could become resistant to the protectants. During recent years, alternative solutions of grain protection have received increased attention. These solutions are considered as the most promising alternatives to residual insecticides. The aims of our comparative study were to obtain information about the efficacies of the 1. diatomaceous earth, 2. sterile insect technology and 3. herbal oils against the S. granarius on grain (foremost maize), and to evaluate the influence of the dose rate on weevil mortality and progeny. The main results of our laboratory experiments are the followings: 1. Diatomaceous earth was especially efficacious against S. granarius, but its insecticidal properties depend on exposure time and applied dose. The efficacy on barley was better than on maize. Mortality value of the highest dose was 85% on the 21st day in the case of barley. It can be ascertained that complete elimination of progeny was evidenced on both gain types. To summarize, a satisfactory efficacy level was obtained only on barley at a rate of 4g/kg. Alteration of efficacy between grain types can be explained with differences in grain surface. 2. The mortality consequences of Roentgen irradiation on the S. granarius was highly influenced by the exposure time, and the dose applied. At doses of 50 and 70Gy, the efficacy accepted in plant protection (mortality: 95%) was recorded only on the 21st day. During the application of 100 and 200Gy doses, high mortality values (83.5% and 97.5%) were observed on the 14th day. Our results confirmed the complete sterilizing effect of the doses of 70Gy and above. The autocide effect of 50 and 70Gy doses were demonstrated when irradiated specimens were mixed into groups of fertile specimens. Consequently, these doses might be successfully applied to put sterile insect technique (SIT) into practice. 3. The results revealed that both studied essential oils (Callendula officinalis, Hippophae rhamnoides) exerted strong toxic effect on S. granarius, but C. officinalis triggered higher mortality. The efficacy (94.62 ± 2.63%) was reached after a 48 hours exposure to H. rhamnoides oil at 2ml/kg while the application of 2ml/kg of C. officinalis oil for 24 hours produced 98.94 ± 1.00% mortality rate. Mortality was 100% at 5 ml/kg of H. rhamnoides after 24 hours duration of its application, while with C. officinalis the same value could be reached after a 12 hour-exposure to the oil. Both essential oils applied were eliminated the progeny.

Keywords: Sitophilus granarius, stored product, protection, alternative solutions

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Authors: Anton Grobler

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Background: Psychological capital (PsyCap), consisting of Hope, Optimism, Resilience, and Self-efficacy, is a popular positive organisational behaviour construct utilised in the studying employee work and behavioral attitudes. Various scholars believe however that further validity research should be conducted on the PsyCap questionnaire (PCQ), outside of the founding research team and in more diverse settings, for the purpose of this paper, within the diverse South African (SA) context. Aim: The purpose of this study was to investigate the construct validity of the PCQ with specific reference to its psychometric properties within the diverse SA context. Setting: The sample includes a total of 1 749 respondents, ± 60 each from 30 organisations in South Africa. Method: This study utilised a cross-sectional design and quantitative analysis. The sample is relatively representative (in terms of race, gender) of the South African workforce. A multi-factorial model was statistically explored and confirmed (with exploratory factor analysis [EFA] and confirmatory factor analysis [CFA] respectively). Results: The study yielded a three-factor solution, with Hope and Optimism as a combined factor and Resilience and Self-efficacy made up of a reconfigured set of substantively justifiable items. Three items of the original 24 items were found not to be suitable. The three factors showed good psychometric properties, good fit (in support of construct validity) and acceptable levels of convergent and discriminant validity. Conclusion: The results support the original conceptualisation of PsyCap, although with a unique structural configuration. This resonates with the notion of scholars that further research should be conducted within diverse settings. This is necessary to ensure the valid measurement of the construct, which is considered to be one of the four criteria for a construct to be categorised as a positive organisational behaviour construct.

Keywords: positive organisational behaviour, psychological capital, hope, optimism, resilience, self-efficacy, construct validity

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Authors: Emily C. Shepard, Caroline Sweeney, Jessica Grimm, Sophie Jacobs, Lauren Thompson, Lisa L. Weyandt

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Adolescence is a critical phase of development in which individuals are prone to more risky behavior while also facing potentially life-changing decisions. The balance of increased behavioral risk and responsibility indicates the importance of executive functioning ability. In recent years, executive function training has emerged as a technique to enhance this cognitive ability. The aim of the present systematic review was to discuss the reported efficacy of executive functioning training techniques among adolescents. After reviewing 3110 articles, a total of 24 articles were identified which examined the role of executive functioning training techniques among adolescents (age 10-19). Articles retrieved demonstrated points of comparison across psychiatric and medical diagnosis, location of training, and stage of adolescence. Typically developing samples, as well as those with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), conduct disorder, and physical health concerns were found, allowing for the comparison of the efficacy of techniques considering physical and psychological heterogeneity. Among typically developing adolescents, executive functioning training yielded nonsignificant or low effect size improvements in executive functioning, and in some cases executive functioning ability was decreased following the training. In special populations, including those with ADHD, (ASD), conduct disorder, and physical health concerns significant differences and larger effect sizes in executive functioning were seen following treatment, particularly among individuals with ADHD. Future research is needed to identify the long-term efficacy of these treatments, as well as their generalizability to real-world conditions.

Keywords: adolescence, attention-deficit hyperactivity disorder, executive function, executive function training, traumatic brain injury

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Authors: Parastoo Parhizkar, Jaber Yaghini, Omid Fakheran

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Background: Third molar surgery is often associated with postoperative problems which cause serious impediments on daily activities and quality of life. Steroidal anti-inflammatory drugs may decrease these common post-operative complications. The purpose of this review is evaluating the available evidence regarding the efficacy of corticosteroids used as adjunctive therapy for patients undergoing third molar surgery. Methods: PubMed, Google scholar, Scopus, web of science, clinicaltrials.gov, scirus.com, Cochrane central register for controlled trials, LILACS, OpenGrey, centerwatch, isrctn, who.int and ebsco were searched without restrictions regarding the year of publication. Randomized clinical trials assessing patient-reported outcomes in patients undergoing surgical therapy, were eligible for inclusion. Study quality was assessed using the CONSORT-checklist. No meta-analysis was performed. Results: A total of twelve Randomized Clinical Trials were included in this study. Methylprednisolone and Dexamethasone may decrease postoperative side effects such as pain, trismus and edema. Based on the results both of them could improve patients’ satisfaction, and there is no significant difference between these two types of corticosteroids regarding the patient centered outcomes (p > 0.05). Intralesional and intravenous injection of Dexamethasone showed an equivalent result, with statistically significant better results (P < 0.05) in comparison with the oral treatment. Conclusion: various types of corticosteroids can enhance the patient’s satisfaction following third molar surgery. However, there is no significant difference between Dexamethasone, Prednisolone and Methylprednisolone groups in this regard. Comparing the various administration routs, local injection of Dexamethasone is quite simple, painless and cost-effective adjunctive therapy with better drug efficacy.

Keywords: third molar surgery, corticosteroids, patient-reported outcomes, health related quality of life

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Authors: Vishal Bhatnagar

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The objective of this study is to compare the efficacy of epidural analgesia of two amide local anesthetics, ropivacaine and levobupivacaine, with fentanyl for postoperative analgesia in major abdominal surgery CRS+HIPEC. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) are done for primary peritoneal malignancies or peritoneal spread of malignant neoplasm. CRS and HIPEC are considered one of the most painful surgery among all major abdominal surgeries. Poorly managed postoperative pain elevates stress, increases anxiety, causes prolonged Hospital stay, increases opioid requirement and side effects, increases the cost of treatment and psychological effects on patient and family. It affects the quality of life of patients. The epidural technique provides better postoperative analgesia, earlier recovery of bowel function, fewer side effects, higher patient satisfaction, and an improvement in life quality in the postoperative days after abdominal surgery than other analgesic techniques.

Keywords: HIPEC, postoperative analgesia, cytoreductive surgery, VAS score, rescue analgesia

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Authors: Muhammad Asif Qayyoum, Bilal Saeed Khan

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Poultry red mites (Dermanyssus gallinae De Geer) are economically deleterious parasite of hens in poultry industry in all over the world. Due to lack of proper control managements and result of poor application of commercial products, D. gallinae get resistance and severe infestation in poultry birds. Laboratory experiment was planned for the control of D. gallinae by using different mushroom and plant extracts. We used control treatment (100 ml distilled water) and nine treatments (10 gr Lentinula adobas, Ganoderma lucidum and Pleurotus aryngii with 100 ml methanol, 1% and 2% Neemazal, 1.5% Gamma-T-ol, Echinacea Leaf , 1.5% Fungatol with neem spray and Methanol) with five replication having five mites each. Data collected after 12 and 24 hours every day till mites found dead in every treatment. The significant differences among the mean values were compared with the DUNCAN multiple range test. The efficacy (%) of each treatment was determined with the Abbott formula. All statistical analyses were conducted with the SPSS Version 12 program. Lentinula edodes (80%), Ganoderma lucidum (76%) and Fungatol+Neem spray (1.5%) (80%) were significant against D. gallinae within 3 days.

Keywords: mushroom extracts, plant extracts, D. gallinae, control

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Authors: Zhipeng Yan, Janice Wing-Tung Kwong, Ching-Lung Lai

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Background: Advanced melanoma accounts for the majority of skin cancer death due to its poor prognosis. Nivolumab and ipilimumab are monoclonal antibodies targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocytes antigen 4 (CTLA-4). Nivolumab and ipilimumab combination therapy has been proven to be effective for advanced melanoma. This systematic review and meta-analysis are to evaluate its clinical efficacy and adverse events. Method: A systematic search was done on databases (Pubmed, Embase, Medline, Cochrane) on 21 June 2020. Search keywords were nivolumab, ipilimumab, melanoma, and randomised controlled trials. Clinical trials fulfilling the inclusion criteria were selected to evaluate the efficacy of combination therapy in terms of prolongation of progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The odd ratios and distributions of grade 3 or above adverse events were documented. Subgroup analysis was performed based on PD-L1 expression-status and BRAF-mutation status. Results: Compared with nivolumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR in combination therapy were 0.64 (95% CI, 0.48-0.85; p=0.002), 0.84 (95% CI, 0.74-0.95; p=0.007) and 1.76 (95% CI, 1.51-2.06; p < 0.001), respectively. Compared with ipilimumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR were 0.46 (95% CI, 0.37-0.57; p < 0.001), 0.54 (95% CI, 0.48-0.61; p < 0.001) and 6.18 (95% CI, 5.19-7.36; p < 0.001), respectively. In combination therapy, the odds ratios of grade 3 or above adverse events were 4.71 (95% CI, 3.57-6.22; p < 0.001) compared with nivolumab monotherapy, and 3.44 (95% CI, 2.49-4.74; p < 0.001) compared with ipilimumab monotherapy, respectively. High PD-L1 expression level and BRAF mutation were associated with better clinical outcomes in patients receiving combination therapy. Conclusion: Combination therapy is effective for the treatment of advanced melanoma. Adverse events were common but manageable. Better clinical outcomes were observed in patients with high PD-L1 expression levels and positive BRAF-mutation.

Keywords: nivolumab, ipilimumab, advanced melanoma, systematic review, meta-analysis

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