Search results for: cardiovascular outcomes

Authors: Ma'in Abushaikha

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Memorials are usually a landmark could be either an object, sculpture or a statue. They are built for a specific group or person who has died with historical contribution, or it could refer to an important hub, event or a specific culture, therefore to keep past events alive in the common memory through this kind of physical representation in public areas, or even to satisfy the desire to honour something either it is a person who suffered or died during a conflict or just to honour a group of people or even a whole society in a specific character they used to possess during a specific period of time. The aim behind the research is to look more deeply about the importance of memorials placement and environment for more successful outcomes towards people's psychology, therefore, behavior, manners and characteristics, knowing that in the main, they are usually set for function able purposes so people could be involved meaningfully therefore psychologically more than aesthetically. What contribution either positive or negative does memorialization through its physical/urban elements has towards people? Is it towards locals social reconstruction over time including either their understanding to the current conflicts or is it toward their general behavior, manners and characteristics in terms of psychology? And how important Memorial's placement is for the observer? Moreover, how does that either reduces or increases its value, attractiveness, and its effectiveness? This paper considers taking north Cyprus memorials as the main case study, is good enough as a choice to support the research hypothesis where a comparison between deferent memorials is going to be done as the main approach in trying to address the mentioned questions, by that, the research requires field survey in terms of interviewing both dwellers and general observers as well as library survey by viewing similar studies. As a significant result, this research is about to come up assesses how important memorials placements are, in order to apply its impact to the observers, whereas the most successful placed ones have its more effectiveness on observers psychology by time by introducing several mental reflects by this kind of physical representation.

Keywords: memorials, placement, environment, impact, psychology, characteristics, manners, behavior

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Authors: Pedro Cabrales, Scott Caroen, Tony R. Reid, Bryan Oronsky

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Introduction and Purpose RRx-001 is an NLRP3 inhibitor and Nrf2 agonist in Phase 3 trials for the treatment of cancer. The purpose of this study was to examine whether treatment with RRx-001, given itsanti-inflammatory and antioxidant properties, improvedexercise and skeletal muscle oxidative capacity in mice on the generalpremiss that better health outcomes correlatewith more activity. Material and Methods Male and female adult mice (n=6 per group) were subjected to an endurance exercise capacity (EEC)test until exhaustion on a motorized treadmill after 3 once weekly doses of either RRx-001 5 mg/kg, RRx-001 2 mg/kg, or vehicle. The EEC protocol consisted of a treadmill velocity of 30meters per min at an uphill inclination (slope of 10%) until the mice reached fatigue, which was defined as the inability of the mice to maintain the appropriate pace despitecontinuous hand stimulation for 1 min. The concentration of malondialdehyde (MDA), an indicator of lipid peroxidation, and creatine kinase (CK), an indicator of muscle damage, in the blood samples collected immediately after the acute exercise was determined with a commercial ELISA assay kit. ResultsThe exhaustive exercise times of the RRx-001 groups were significantly longer than that of the vehicle group (p<0.05) by weeks 2 and 3. In addition, MDA levels in the gastrocnemius, soleus, and extensor digitorum longus muscles were significantly lower than those of the vehicle group were (p<0.05), as were the serum CK levels(p<0.05). ConclusionsIn conclusion, this study found that RRx-001 has anti-fatigue properties, as evidenced by an increase in exercise capacity with RRx-001 treatment, and protects against strenuous exercise-induced muscle damage and lipid peroxidation. This data potentially supports the use of RRx-001 in the clinic to improve exercise performance and reduce physical fatigue.

Keywords: RRx-001, anti-fatigue, muscle protection, increased exercise tolerance, lipid peroxidation

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Authors: Chanda Burrage

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The past half-century has revealed massive structural, geographic, and technological changes in livestock production. The move, for instance, toward expanding export markets, massive feedlots for the fattening of cattle and improved veterinary standards is a global trend in food animal agribusiness and is apparent in both developed and developing regions. In the Horn of Africa, various breeds of cattle that previously were not considered in economic terms are now treated as commodities and branded for numerous export markets. Formerly a culturally significant exchange good within the subsistence pastoral livelihoods, cattle are now identified as a key economic resource and fully connected to global markets. This study incorporates an ethnographic-commodity chain approach to examine critical issues surrounding regional trade, harmonization of standards, import & export legislation, the role of the private sector, and infrastructure development relative to the Boran cattle breed and Borana pastoralists. The specific sites assessed include the cattle production region of Moyale in southern Ethiopia, feedlots and export abattoirs in Adama, Ethiopia, and quarantines and ports in Djibouti and Somaliland. The goal is to evaluate innovation and modernization outcomes and narratives around Boran cattle production and development and the associate livelihood changes for cattle producers in southern Ethiopia and how the smallholder pastoralists are coping with the multitude of global changes. Inevitably, the inherent pressures related to such changes alter, and may even promote the reconfiguration of identity, while inadvertently contribute to the capacity of smallholder cattle producers to act independently and make their own free choices in sustainability. It is through these processes that local Borana groups may appropriate, bypass, or put to new use available and innovative material resources.

Keywords: globalization, global change, commodification, pastoralism, vulnerability, adaptive capacity

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Authors: Marine Hascoet, Valentina Giaconi, Ludivine Jamain

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The aim of our study is to examine if the family socio-economic status (SES) has an influence on students’ academic achievement. We first make the hypothesis that the more their families have financial and social resources, the more students succeed at school. We second make the hypothesis that this family SES has also an impact on parents’ expectations about their children educational outcomes. Moreover, we want to study if that parents’ expectations play the role of mediator between parents’ socio-economic status and the student’ self-concept and academic outcome. We test this model with a longitudinal design thanks to the census-based assessment from the System of Measurement of the Quality of Education (SIMCE). The SIMCE tests aim to assess all the students attending to regular education in a defined level. The sample used in this study came from the SIMCE assessments done three times: in 4th, 8th and 11th grade during the years 2007, 2011 and 2014 respectively. It includes 156.619 students (75.084 boys and 81.535 girls) that had valid responses for the three years. The family socio-economic status was measured at the first assessment (in 4th grade). The parents’ educational expectations and the students’ self-concept were measured at the second assessment (in 8th grade). The achievement score was measured twice; once when children were in 4th grade and a second time when they were in 11th grade. To test our hypothesis, we have defined a structural equation model. We found that our model fit well the data (CFI = 0.96, TLI = 0.95, RMSEA = 0.05, SRMR = 0.05). Both family SES and prior achievements predict parents’ educational expectations and effect of SES is important in comparison to the other coefficients. These expectations predict students’ achievement three years later (with prior achievement controlled) but not their self-concept. Our model explains 51.9% of the achievement in the 11th grade. Our results confirm the importance of the parents’ expectations and the significant role of socio-economic status in students’ academic achievement in Chile.

Keywords: Chilean context, parent’s expectations, school achievement, self-concept, socio-economic status

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Authors: Anastasia Papachristou, Anastasia Ntikoudi, Vasileios Saridakis

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The safety and health care needs of refugees have become an increasingly important issue all over the world especially during last few decades. Wars are the primary reason for refugees to leave their countries. Moreover, refugees are frequently exposed to a variety of stressors such as socioeconomic disadvantages, poverty, changes in family structure and functioning, losing social support, difficulty to access education, living in very crowded places, experiencing racism and isolation. This systematic review included research studies published between 2007-2017 from the search databases Medline, Scopus, Cinahl and PubMed, with keywords 'war survivors', 'war trauma', 'psychiatric disorders', 'refugees'. In order to meet the purpose of the systematic review, further research for complementary studies was conducted into the literature references of the research articles included in this study that would meet the criteria. Overall, 14 studies were reviewed and evaluated. The majority of them demonstrated that the most common psychiatric disorders observed among war refugees are post-traumatic stress disorder (PTSD), depression, anxiety and multiple somatic complaints. Moreover, significant relationship was shown between the number of traumatic events experienced by the refugees and sociodemographic features such as gender, age and previous family history of any psychological disorder. War violence is highly traumatic, causing multiple, long-term negative outcomes such as the aforementioned psychiatric disorders. The number of the studies reviewed in this systematic review is not representative of the problem and its significance. The need for care of the survivors and their families is vital. Further research is necessary in order to clarify the role of predictive factors in the development and maintenance of post-traumatic stress and the rest psychiatric disorders following war trauma. In conclusion, it is necessary to have large multicenter studies in the future in order to be able to draw reliable conclusions about the effects of war.

Keywords: psychiatric disorders, refugees, war survivors, war trauma

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Authors: Rukhsana Kausar, Issam Malki

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The integration and assimilation of ethnic minority immigrants (EMIs) and their subsequent generations remains a serious unsettled issue in most of the host countries. This study conducts the labour market gender analysis to investigate specifically whether second generation of ethnic minority immigrants in the UK is gaining access to professional and managerial employment and advantaged occupational positions on par with their native counterparts. The data used to examine the labour market achievements of EMIs is taken from Labour Force Survey (LFS) for the period 2014-2018. We apply a multivalued treatment under ignorability as proposed by Cattaneo (2010), which refers to treatment effects under the assumptions of (i) selection – on – observables and (ii) common support. We report estimates of Average Treatment Effect (ATE), Average Treatment Effect on the Treated (ATET), and Potential Outcomes Means (POM) using three estimators, including the Regression Adjustment (RA), Augmented Inverse Probability Weighting (AIPW) and Inverse Probability Weighting- Regression Adjustment (IPWRA). We consider two cases: the case with four categories where the first-generation natives are the base category, the second case combine all natives as a base group. Our findings suggest the following. Under Case 1, the estimated probabilities and differences across groups are consistently similar and highly significant. As expected, first generation natives have the highest probability for higher career attainment among both men and women. The findings also suggest that first generation immigrants perform better than the remaining two groups, including the second-generation natives and immigrants. Furthermore, second generation immigrants have higher probability to attain higher professional career, while this is lower for a managerial career. Similar conclusions are reached under Case 2. That is to say that both first – generation and second – generation immigrants have a lower probability for higher career and managerial attainment. First – generation immigrants are found to perform better than second – generation immigrants.

Keywords: immigrnats, second generation, occupational attainment, ethnicity

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Authors: Amalia Ardeljan, Lexi Frankel, Divesh Manjani, Gabriela Santizo, Maximillian Guerra, Omar Rashid

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Introduction: Cytomegalovirus (CMV) infection is a widespread infection affecting between 60-70% of people in industrialized countries. CMV has been previously correlated with a higher incidence of Hodgkin Lymphoma compared to noninfected persons. Research regarding prior CMV infection and subsequent lymphoma development is still controversial. With limited evidence, further research is needed in order to understand the relationship between previous CMV infection and subsequent lymphoma development. This study assessed the effect of CMV infection and the incidence of lymphoma afterward. Methods: A retrospective cohort study (2010-2019) was conducted through a Health Insurance Portability and Accountability Act (HIPAA) compliant national database and conducted using International Classification of Disease (ICD) 9th,10th codes, and Current Procedural Terminology (CPT) codes. These were used to identify lymphoma diagnosis in a previously CMV infected population. Patients were matched for age range and Charlson Comorbidity Index (CCI). A chi-squared test was used to assess statistical significance. Results: A total number of 14,303 patients was obtained in the CMV infected group as well as in the control population (matched by age range and CCI score). Subsequent lymphoma development was seen at a rate of 11.44% (1,637) in the CMV group and 5.74% (822) in the control group, respectively. The difference was statistically significant by p= 2.2x10-16, odds ratio = 2.696 (95% CI 2.483- 2.927). In an attempt to stratify the population by antiviral medication exposure, the outcomes were limited by the decreased number of members exposed to antiviral medication in the control population. Conclusion: This study shows a statistically significant correlation between prior CMV infection and an increased incidence of lymphoma afterward. Further exploration is needed to identify the potential carcinogenic mechanism of CMV and whether the results are attributed to a confounding bias.

Keywords: cytomegalovirus, lymphoma, cancer, microbiology

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Authors: Yuliya Markava

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The laser in situ keratomileusis (LASIK) is widely common surgical procedure, which has become an alternative for patients who are not satisfied with the performance of other correction methods. A high level of patient satisfaction functional outcomes after refractive surgery confirms the high reliability and safety of LASIK and provides a significant improvement in the quality of life and social adaptation. Purpose: To perform clinical analysis of the results of correction made to the excimer laser system SCHWIND AMARIS 500E in patients with different types of refractive anomalies. Materials and Methods: This was a retrospective analysis of 1581 operations (812 patients): 413 males (50.86%) and 399 females (49.14%) at the age from 18 to 47 years with different types of ametropia. All operations were performed on excimer laser SCHWIND AMARIS 500E in the LASIK procedure. Formation of the corneal flap was made by mechanical microkeratome SCHWIND. Results: Analyzing the structure of refractive anomalies: The largest number of interventions accounted for myopia: 1505 eyes (95.2%), of which about a low myopia: 706 eyes (44.7%), moderate myopia: 562 eyes (35.5 %), high myopia: eyes 217 (13.7%) and supermyopia: 20 eyes (1.3%). Hyperopia was 0.7% (11 eyes), mixed astigmatism: 4.1% (65 eyes). The efficiency was 80% (in patients with supermyopia) to 91.6% and 95.4% (in groups with myopia low and moderate, respectively). Uncorrected visual acuity average values before and after laser operation was in groups: a low myopia 0.18 (up 0.05 to 0.31) and 0.80 (up 0.60 to 1.0); moderate myopia 0.08 (up 0.03 to 0.13) and 0.87 ( up 0.74 to 1.0); high myopia 0.05 (up 0.02 to 0.08) and 0.83 (up 0.66 to 1.0); supermyopia 0.03 (up 0.02 to 0.04) and 0.59 ( up 0.34 to 0.84); hyperopia 0.27 (up 0.16 to 0.38) and 0.57 (up 0.27 to 0.87); mixed astigmatism of 0.35 (up 0.19 to 0.51) and 0.69 (up 0.44 to 0.94). In all cases, after LASIK indicators uncorrected visual acuity significantly increased. Reoperation was 4.43%. Significance: Clinical results of refractive surgery at the excimer laser system SCHWIND AMARIS 500E in different ametropia correction is characterized by high efficiency.

Keywords: effectiveness of laser correction, LASIK, refractive anomalies, surgical treatment

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Authors: Seyedeh Mozhgan Seyed Talebi, Chih -Hao Lee

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With an abrupt rise in the power conservation efficiency (PCE) of perovskite solar cells (PSCs) within a short span of time, the toxicity of lead was raised as a major hurdle in the path toward their commercialization. In the present research, a systematic investigation of the electrical and optical characteristics of the all-inorganic CsSnI₃ perovskite absorber layer was performed with the Vienna Ab Initio Simulation Package (VASP) using the projector-augmented wave method. The presence of inorganic halide perovskite offers the advantages of enhancing the degradation resistance of the device, reducing the cost of cells, and minimizing the recombination of generated carriers. The simulated standard device using a 1D simulator like solar cell capacitance simulator (SCAPS) version 3308 involves FTO/n-TiO₂/CsSnI₃ Perovskite absorber/Spiro OmeTAD HTL/Au contact layer. The variation in the device design key parameters such as the thickness and defect density of perovskite absorber, hole transport layer and electron transport layer and interfacial defects are examined with their impact on the photovoltaic characteristic parameters. The effect of an increase in operating temperature from 300 K to 400 K on the performance of CsSnI3-based perovskite devices is also investigated. The optimized standard device at room temperature shows the highest PCE of 25.18 % with FF of 75.71 %, Voc of 0.96 V, and Jsc of 34.67 mA/cm². The outcomes and interpretation of different inorganic Cu-based HTLs presence, such as CuSCN, Cu₂O, CuO, CuI, SrCu₂O₂, and CuSbS₂, here represent a critical avenue for the possibility of fabricating high PCE perovskite devices made of stable, low-cost, efficient, safe, and eco-friendly all-inorganic materials like CsSnI₃ perovskite light absorber.

Keywords: CsSnI₃, hole transporting layer (HTL), lead-free perovskite solar cell, SCAPS-1D software

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Authors: Abebe Tibebu

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This study investigates the quality of training factors in Ethiopian Technical and Vocational Education and Training (TVET) colleges and their impact on declining enrollment rates. Employing a descriptive survey design, both quantitative and qualitative data were collected from diverse stakeholders, including Grade 12 graduates, current TVET trainees, trainers, college deans, community members, high school directors, teachers, and officials from TVET government agencies. The sample included 20 TVET centers from various Ethiopian regions. Secondary data were obtained from college and government documents, while primary data were gathered through questionnaires, interviews, focus group discussions, and observations. Analysis was conducted using descriptive statistics with SPSS, capturing response frequencies and percentages. The study's findings highlight several key factors affecting TVET enrollment: limited infrastructure capacity, insufficient trainer competency, misaligned curriculum, low-quality training delivery particularly in cooperative training implementation and industry partnership and low success rates on Certification of Competency (CoC) exams. Many TVET institutions lack qualified trainers, adequate machinery, and timely provision of materials for practical skills training. Based on these findings, the study recommends enhanced infrastructure investment, professional development for trainers, curriculum adjustments to better align with industry needs, and standardized assessment practices. Addressing these areas through collaborative efforts with government bodies and industry stakeholders is essential to improving the quality and appeal of Ethiopian TVET programs, ultimately strengthening enrollment and outcomes.

Keywords: TVET, quality factors, enrollment, potentially enrolled

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Authors: Folasade R. Sulaiman

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Pupils’ health and nutrition are basically important to their schooling. The preponderance of avoidable deaths among children in Africa (WHO, 2000) may not be unconnected with the nutritional and health education status of families and communities that have their children as school clients. This study adopted a descriptive survey design focusing on the assessment of the level of nutritional and health education of families and community members in the rural riverine areas of Ogun State. Two research questions were raised. The Nutritional and Health Education of Families and Communities Inventory (NHEFCI) was used to collect data from 250 rural child-bearing aged women, and 0.73 test-retest reliability coefficient was established to determine the strength of the instrument. Data collected were analysed using descriptive statistics of frequency counts, percentages and mean in accordance with research questions raised in the study. The findings revealed amongst others: that 65% of the respondents had low level of nutritional and health education among the families and community members; while 72% had low level of awareness of the possible influence of nutritional and health education on the learning outcomes of the children. Based on the findings, it was recommended among others that government should intensify efforts on sensitization, mass literacy campaign etc.; also improve upon the already existing School Feeding Programme in Nigerian primary schools to provide at least one balanced diet for children while in school; community health workers, social workers, Non-Governmental Organizations (NGO) should collaborate with international Organizations like UNICEF, UNESCO, WHO etc. to organize sensitization programmes for members of the rural riverine communities on the importance of meeting the health and nutritional needs of their children in order to attain their educational potentials.

Keywords: nutritional and health education, learning capacities, school-age children, universal basic education, rural riverine areas

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Authors: Maatouk Mohamed, Nouira Mariem, Hamdi Kbir Gh, Mahjoubi M. F., Ben Moussa M.

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Background and aim: Preoperative biliary drainage (PBD) has been introduced to lower bilirubin levels and to control the negative effects of obstructive jaundice in patients with malignant obstructive jaundice undergoing pancreaticoduodenectomy (PD). The optimal time interval between PBD and PD is still not clear. Delaying surgery by 4 to 6 weeks is the commonly accepted practice. However, delayed PD has been shown to decrease the rate of resection and adversely affect the tumor grading and prognosis. Thus, the purpose of our systematic review and meta-analysis was to evaluate the optimal period for PBD prior to PD: short or prolonged in terms of postoperative morbidity and survival outcomes. Methods: Trials were searched in PubMed, Science Direct, Google Scholar, and Cochrane Library until November 2022. Studies using PBD in patients with malignant obstructive jaundice that compared short duration group (SDG) (surgery performed within 3-4 weeks) with prolonged duration group (PDG) (at least 3-4 weeks after PBD) were included in this study. The risk of bias was assessed using the Rob v2 and Robins-I tools. The priori protocol was published in PROSPERO (ID: CRD42022381405). Results: Seven studies comprising 1625 patients (SDG 870, PDG 882) were included. All studies were non-randomized, and only one was prospective. No significant differences were observed between the SDG and PDG in mortality (OR= 0.59; 95% CI [0.30, 1.17], p=0.13), major morbidity (Chi² = 30.28, p <0.00001; I² = 87%), pancreatic fistula (Chi² = 6.61, p = 0.25); I² = 24%), post pancreatectomy haemorrhage (OR= 1.16; 95% CI [0.67, 2.01], p=0.59), positive drainage culture (OR= 0.36; 95% CI [0.10, 1.32], p=0.12), septic complications (OR= 0.78; 95% CI [0.23, 2.72], p=0.70), wound infection (OR= 0.08, p=0.07), operative time (MD= 0.21; p=0.21). Conclusion: Early surgery within 3 or 4 weeks after biliary drainage is both safe and effective. Thus, it is reasonable to suggest early surgery following PBD for patients having resectable periampullary cancers.

Keywords: preoperative biliary drainage, pancreatic cancer, pancreatic surgery, complication

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Authors: Natividad Natalia Angeles Manuel

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In the Dominican Republic, American-Dominican veterans face unique challenges due to their dual identities and wartime experiences. This case study examines an 85-year-old veteran with memory impairments and emotional distress linked to military service. A neuropsychological assessment using standardized tools evaluated cognitive domains and functional abilities. Significant deficits in memory, orientation, semantic memory, and executive functions, alongside symptoms of Post-Traumatic Stress Disorder and depression, were identified. A six-month cognitive stimulation program included tailored interventions to enhance memory, attention, and executive skills through weekly sessions and group activities. Medical and physical therapy support aimed to improve overall cognitive, functional, and emotional outcomes. Follow-up evaluations showed improvements in memory retention, attention, task proficiency, and reduced depressive symptoms, highlighting the program's effectiveness in promoting emotional well-being and quality of life. Despite ongoing memory challenges and military-related nightmares, the veteran responded positively to interventions, demonstrating resilience and motivation. This study emphasizes the importance of personalized neuropsychological interventions for American-Dominican veterans in the Dominican Republic. Through assessment tools and focused cognitive stimulation strategies, healthcare providers can successfully alleviate cognitive and emotional challenges stemming from traumatic experiences in elderly veterans. Overall, integrated neuropsychological assessment and stimulation programs are shown to enhance cognitive resilience and emotional well-being, thus contributing to an enhanced quality of life for aging American-Dominican veterans.

Keywords: neuropsychology, cognitive stimulation, American-Dominican veterans, Dominican Republic, PTSD, memory deficits

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Authors: Melkamu Tadesse Getachew

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Intelligent control systems have revolutionized biomedical engineering, advancing research and enhancing medical practice. This review paper examines the impact of intelligent control on various aspects of biomedical engineering. It analyzes how these systems enhance precision and accuracy in biomedical instrumentation, improving diagnostics, monitoring, and treatment. Integration challenges are addressed, and potential solutions are proposed. The paper also investigates the optimization of drug delivery systems through intelligent control. It explores how intelligent systems contribute to precise dosing, targeted drug release, and personalized medicine. Challenges related to controlled drug release and patient variability are discussed, along with potential avenues for overcoming them. The comparison of algorithms used in intelligent control systems in biomedical control is also reviewed. The implications of intelligent control in computational and systems biology are explored, showcasing how these systems enable enhanced analysis and prediction of complex biological processes. Challenges such as interpretability, human-machine interaction, and machine reliability are examined, along with potential solutions. Intelligent control in biomedical engineering also plays a crucial role in risk management during surgical operations. This section demonstrates how intelligent systems improve patient safety and surgical outcomes when integrated into surgical robots, augmented reality, and preoperative planning. The challenges associated with these implementations and potential solutions are discussed in detail. In summary, this review paper comprehensively explores the widespread impact of intelligent control on biomedical engineering, showing the future of human health issues promising. It discusses application areas, challenges, and potential solutions, highlighting the transformative potential of these systems in advancing research and improving medical practice.

Keywords: Intelligent control systems, biomedical instrumentation, drug delivery systems, robotic surgical instruments, Computational monitoring and modeling

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Authors: Monica Dantas

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At what socio-economic costs can the food industry offer products at low prices? This research seeks to understand and to explore how we attribute competence and meaning, what enables the outcomes of agriculture and what institutions provides validation regarding food production. This study objective is to explain and interpret conditions of the present state of agriculture in Brazil centring on two distinct segments, agribusiness and family farming, as the Brazilian, rapidly changing political environment unfolds. The approach is grounded in multidisciplinary literature drawing from the politics of development, the sociology of food, the sustainability framework and the conceptual differences between agribusiness and family farming regarding the innate purpose of the two segments. In addition, a quantitative portion of the research includes secondary data analysis from statistical measurements, economic indicators, federal budget information, and census data to compare the two segments, conveying a general snapshot of the conditions investigated. The results raised questions about the perceived image of the success of agribusiness, against some contradicting economic checks and balances. Analyzing how public funds are invested in agriculture shed light on what can enable or undermine the development of food systems in Brazil. It also revealed how politics, ideology, and corporations might influence the Brazilian Federal. In the 2000-2018 observed timeline of annual federal spending on agriculture in Brazil, there is variation in the amount invested in family farming that seems to 'coincide' with the ideological direction of the federal government in power. It was also observed that significant changes in the institutional framework and financial support either promoted or purposely undermined family farming importance using public institutions to validate support for agribusiness.

Keywords: food politics, sustainability, family farming, food system, public budget

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Authors: Wei Wang, Yaohua Zhao, Yanhua Diao

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The exponential growth of the lighting industry has rendered traditional thermal technologies inadequate for addressing the thermal management challenges inherent to high-power light-emitting diode (LED) technology. To enhance the thermal management of LEDs, this study proposes a heat sink configuration that integrates a miniature heat pipe array based on phase change technology with rectangular channels. The thermal performance of the heat sink was evaluated through experimental testing, and the results demonstrated that when the input power was 100W, 150W, and 200W, the temperatures of the LED substrate were 47.64℃, 56.78℃, and 69.06℃, respectively. Additionally, the maximum temperature difference of the MHPA in the vertical direction was observed to be 0.32℃, 0.30℃, and 0.30℃, respectively. The results demonstrate that the heat sink not only effectively dissipates the heat generated by the LEDs, but also exhibits excellent temperature uniformity. In consideration of the experimental measurement outcomes, a corresponding numerical model was developed as part of this study. Following the model validation, the effect of the structural parameters of the heat sink on its heat dissipation efficacy was examined through the use of response surface methodology (RSM) analysis. The rectangular channel width, channel height, channel length, number of channel cross-sections, and channel cross-section spacing were selected as the input parameters, while the LED substrate temperature and the total mass of the heat sink were regarded as the response variables. Subsequently, the response was subjected to an analysis of variance (ANOVA), which yielded a regression model that predicted the response based on the input variables. This offers some direction for the design of the radiator.

Keywords: light-emitting diodes, heat transfer, heat pipe, natural convection, response surface methodology

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Authors: Akshay Patil

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Objective: Mediation analysis identifies causal pathways by testing the relationships between the NCR, the OS, and an intermediate variable that mediates the relationship between the Nimotuzumab-cisplatin-radiation (NCR) and OS. Introduction: In randomized controlled trials, the primary interest is in the mechanisms by which an intervention exerts its effects on the outcomes. Clinicians are often interested in how the intervention works (or why it does not work) through hypothesized causal mechanisms. In this work, we highlight the value of understanding causal mechanisms in randomized trial by applying causal mediation analysis in a randomized trial in oncology. Methods: Data was obtained from a phase III randomized trial (Subgroup of HPVNOCP). NCR is reported to significantly improve the OS of patients locally advanced head and neck cancer patients undergoing definitive chemoradiation. Here, based on trial data, the mediating effect of NCR on patient overall survival was systematically quantified through progression-free survival(PFS), disease free survival (DFS), Loco-regional failure (LRF), and the disease control rate (DCR), Overall response rate (ORR). Effects of potential mediators on the HR for OS with NCR versus cisplatin-radiation (CR) were analyzed by Cox regression models. Statistical analyses were performed using R software Version 3.6.3 (The R Foundation for Statistical Computing) Results: Effects of potential mediator PFS was an association between NCR treatment and OS, with an indirect-effect (IE) 0.76(0.62 – 0.95), which mediated 60.69% of the treatment effect. Taking into account baseline confounders, the overall adjusted hazard ratio of death was 0.64 (95% CI: 0.43 – 0.96; P=0.03). The DFS was also a significant mediator and had an IE 0.77 (95% CI; 0.62-0.93), 58% mediated). Smaller mediation effects (maximum 27%) were observed for LRF with IE 0.88(0.74 – 1.06). Both DCR and ORR mediated 10% and 15%, respectively, of the effect of NCR vs. CR on the OS with IE 0.65 (95% CI; 0.81 – 1.08) and 0.94(95% CI; 0.79 – 1.04). Conclusion: Our findings suggest that PFS and DFS were the most important mediators of the OS with nimotuzumab to weekly cisplatin-radiation in HPVNOCP.

Keywords: mediation analysis, cancer data, survival, NCR, HPV negative oropharyngeal

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Authors: Shanti Faridah Salleh, Azzahrah Anuar, Hamimah Ujir, Rohana Sapawi, Wan Hashim Wan Ibrahim, Noraziah Abdul Wahab, Majina Sulaiman, Raudhah Ahmadi, Al-Khalid Othman, Johari Abdullah

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Integrated Cumulative Grade Point Average or iCGPA is an evaluation and reporting system that represents a comprehensive development of students’ achievement in their academic programs. Universiti Malaysia Sarawak, UNIMAS has started its implementation of iCGPA in 2016. iCGPA is driven by the Outcome-Based Education (OBE) system that has been long integrated into the higher education in Malaysia. iCGPA is not only a tool to enhance the OBE concept through constructive alignment but it is also an integrated mechanism to assist various stakeholders in making decisions or planning for program improvement. The outcome of this integrated system is the reporting of students’ academic performance in terms of cognitive (knowledge), psychomotor (skills), and affective (attitude) of which the students acquire throughout the duration of their study. The iCGPA reporting illustrates the attainment of student’s attribute in the eight domains of learning outcomes listed in the Malaysian Qualifications Framework (MQF). This paper discusses on the implementation of iCGPA in UNIMAS on the policy and strategy to direct the whole university to implement the iCGPA. The steps and challenges in integrating the exsting Outcome-Based Education and utilising iCGPA as a tool to quantify the students’ achievement are also highlighted in this paper. Finally, the ACADEMIA system, which is a dedicated centralised program ensure the implementation of iCGPA is a success has been developed. This paper discusses the structure and the analysis of ACADEMIA program and concludes the analysis made on the improvement made on the implementation of constructive alignment in all 40 programs involves in iCGPA implementation.

Keywords: constructive alignment, holistic graduates, mapping of assessment, programme outcome

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Authors: M. Shokry Rashwan

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This study follows a number of experiments conducted at Red River College (RRC) to investigate the short term properties of tire derived aggregate (TDA) produced from shredding off-the-road (OTR) wasted tires in a proposed new application. The application targets replacing natural material used under concrete slabs and as backfills for residential homes’ basement slabs and walls, respectively, with TDA. The experimental work included determining: compressibility, gradation distribution, unit weight, hydraulic conductivity and lateral pressure. Based on the results of those short term properties; it was decided to move forward to study the long-term performance of this otherwise waste material through on-site demonstration. A full-scale basement replicating a typical Manitoba home was therefore built at RRC where both TDA and Natural Materials (NM) were used side-by-side. A large number of sensing and measuring systems are used to compare between the performances of each material when exposed to the typical ground and weather conditions. Parameters monitored and measured include heat losses, moisture migration, drainage ability, lateral pressure, relative movements of slabs and walls, an integrity of ground water and radon emissions. Up-to-date results have confirmed part of the conclusions reached from the earlier laboratory experiments. However, other results have shown that construction practices; such as placing and compaction, may need some adjustments to achieve more desirable outcomes. This presentation provides a review of both short-term tests as well as up-to-date analysis of the on-site demonstration.

Keywords: tire derived aggregate (TDA), basement construction, TDA material properties, lateral pressure of TDA, hydraulic conductivity of TDA

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Authors: Anne Klimesch, Alejandra Martinez, Martin HäRter, Isabelle Scholl, Paulina Bravo

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Patient-centered care (PCC) is a key principle of high-quality healthcare. In Latin America, research on and promotion of PCC have taken place in the past. However, thorough implementation of PCC in practice is still missing. In Germany, an integrative model of patient-centeredness has been developed by synthesis of diverse concepts of PCC. The model could serve as a point of reference for further research on the implementation of PCC. However, it is predominantly based on research from Europe and North America. This scoping review, therefore, aims to accumulate research on PCC in Latin America in the past 15 years and analyse how PCC has been conceptualized. The resulting overview of PCC in Latin America will be a foundation for a subsequent study aiming at the adaptation of the integrative model of patient-centeredness to the Latin American health care context. Scientific databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Web of Science, SCIELO, Redalyc.) will be searched, and reference and citation tracking will be performed. Studies will be included if they were carried out in Latin America, investigated PCC in any clinical and community setting (public and private), and were published in English, Spanish, French, or Portuguese since 2006. Furthermore, any theoretical framework or conceptual model to guide how PCC is conceptualized in Latin America will be included. Two reviewers will be responsible for the identification of articles, screening of records, and full-text assessment. The results of the scoping review will be used in the development of a mixed-methods study with the aim to understand the needs for PCC, as well as barriers and facilitators in Latin America. Based on the outcomes, the integrative model of PCC will be translated to Spanish and adapted to the Latin American context. The integrative model will enable the dissemination of the concept of PCC in Latin America and will provide a common ground for further research on the topic. The project will thereby make an important contribution to an evidence-based implementation of PCC in Latin America.

Keywords: conceptual framework, integrative model of PCC, Latin America, patient-centered care

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Authors: F. Fatoye, C. E. Mbada, T. Gebrye, A. O. Ogunsola, C. Fatoye, O. Oyewole

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Musculoskeletal disorders (MSDs) are a major cause of pain and disability. It is likely to become a greater economic and public health burden that is unnecessary. Thus, reliable prevalence figures are important for both clinicians and policy-makers to plan health care needs for those affected with the disease. This study estimated hospital based real-world prevalence of MSDs in Nigeria. A review of medical charts for adult patients attending Physiotherapy Outpatient Clinic at the Obafemi Awolowo University Teaching Hospitals Complex, Osun State, Nigeria between 2009 and 2018 was carried out to identify common MSDs including low back pain (LBP), cervical spondylosis (CSD), post immobilization stiffness (PIS), sprain, osteoarthritis (OA), and other conditions. Occupational class of the patients was determined using the International Labour Classification (ILO). Data were analysed using descriptive statistics of frequency and percentages. Overall, medical charts of 3,340 patients were reviewed within the span of ten years (2009 to 2018). Majority of the patients (62.8%) were in the middle class, and the remaining were in low class (25.1%) and high class (10.5%) category. An overall prevalence of 47.35% of MSD was found within the span of ten years. Of this, the prevalence of LBP, CSD, PIS, sprain, OA, and other conditions was 21.6%, 10%, 18.9%, 2%, 6.3%, and 41.3%, respectively. The highest (14.2%) and lowest (10.5%) prevalence of MSDs was recorded in the year of 2012 and 2018, respectively. The prevalence of MSDs is considerably high among Nigerian patients attending outpatient a physiotherapy clinic. The high prevalence of MSDs underscores the need for clinicians and decision makers to put in place appropriate strategies to reduce the prevalence of these conditions. In addition, they should plan and evaluate healthcare services to improve the health outcomes of patients with MSDs. Further studies are required to determine the economic burden of the condition and examine the clinical and cost-effectiveness of physiotherapy interventions for patients with MSDs.

Keywords: musculoskeletal disorders, Nigeria, prevalence, real world

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Authors: Nurunnahar Akter, Elena Kulinskaya, Nicholas Steel, Ilyas Bakbergenuly

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Although Hormone Replacement Therapy (HRT) is an effective treatment in ameliorating menopausal symptoms, it has mixed effects on different health outcomes, increasing, for instance, the risk of breast cancer. Because of this, many symptomatic women are left untreated. Untreated menopausal symptoms may result in other health issues, which eventually put an extra burden and costs to the health care system. All-cause mortality analysis may explain the net benefits and risks of the HRT therapy. However, it received far less attention in HRT studies. This study investigated the impact of HRT on all-cause mortality using electronically recorded primary care data from The Health Improvement Network (THIN) that broadly represents the female population in the United Kingdom (UK). The study entry date for this study was the record of the first HRT prescription from 1984, and patients were followed up until death or transfer to another GP practice or study end date, which was January 2017. 112,354 HRT users (cases) were matched with 245,320 non-users by age at HRT initiation and general practice (GP). The hazards of all-cause mortality associated with HRT were estimated by a parametric Weibull-Cox model adjusting for a wide range of important medical, lifestyle, and socio-demographic factors. The multilevel multiple imputation techniques were used to deal with missing data. This study found that during 32 years of follow-up, combined HRT reduced the hazard ratio (HR) of all-cause mortality by 9% (HR: 0.91; 95% Confidence Interval, 0.88-0.94) in women of age between 46 to 65 at first treatment compared to the non-users of the same age. Age-specific mortality analyses found that combined HRT decreased mortality by 13% (HR: 0.87; 95% CI, 0.82-0.92), 12% (HR: 0.88; 95% CI, 0.82-0.93), and 8% (HR: 0.92; 95% CI, 0.85-0.98), in 51 to 55, 56 to 60, and 61 to 65 age group at first treatment, respectively. There was no association between estrogen-only HRT and women’s all-cause mortality. The findings from this study may help to inform the choices of women at menopause and to further educate the clinicians and resource planners.

Keywords: hormone replacement therapy, multiple imputations, primary care data, the health improvement network (THIN)

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Authors: Babak Mirzashahi, Arvin Najafi, Pejman Mansouri, Mahmoud Farzan

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Background: The most effective treatment of posterior cruciate ligament (PCL) tears and the consequence of untreated PCL injuries remain controversial. Objectives: The aim of this study is to assess outcomes of fixation of tibial posterior cruciate ligament (PCL) avulsion fractures via a modified technique. Patients and Methods: From January, 2009 to March, 2012, there were 45 cases of PCL tibial avulsion fractures that were referred to our hospital and were managed through a modified open posterior approach. Fixation of Tibial PCL avulsion fractures were fixed by means of a lag screw and washer placed through our modified open posterior approach. Range of motion was begun on the first postoperative day. Clinical stability, range of motion, gastrocnemius muscle strength, radiographic investigation, and patient’s overall quality of life was analyzed at final follow up visit. Results: The average of overall musculoskeletal functional evaluation scores was 15 (range 3–35). All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. The mean preoperative Lysholm score for 15 knees was 62 ± 8 (range, 50-75); the mean postoperative Lysholm score was 92± 7 (range, 75-101). A significant difference in Lysholm scores between preoperative and final follow-up evaluations was found (P < .05). At first-year follow-up, 42 (93%) patients revealed a difference of less than 10 mm in thigh circumference between their injured and healthy knees. Conclusions: The management of displaced large PCL avulsion fractures with placement of a cancellous lag screw with washer by means of the modified open posterior approach leads to satisfactory clinical, radiographic, and functional results and reduces the operation time and less blood loss. Level of evidence: IV.

Keywords: posterior cruciate ligament, tibial fracture, lysholm knee score, patient outcome assessment

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Authors: Rorick Daniel Tovar Galvan

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The existence of different legal systems represents an important barrier for married couples that attempt to reside in another country. Each movement can cause important changes in the rights and obligations derived from the marriage since a different law could be used by the courts to solve legal disputes arising from their relationship. In a context in which it is increasingly common to move from one country to another, people cannot be certain about the outcomes of proceedings dealing with i.e., the dissolution of property regime, maintenance payments or time to wait to initiate divorce because a foreign – and in most cases unknown – law could apply every time they move. At first glance, the answer to this issue seems to be the harmonization of the legal systems: the greater the mobility of individuals inside a group of countries, the higher the similarities of their laws should be. Such a solution could be positive for spouses because a higher degree of legal certainty would be reached in case the same legal rules applied regardless of the place where the couple lives. However, the legal pluralism brings with it also advantages that could be appreciated when one looks closely at the economic rationale behind the legal institution of marriage. This contribution carries out an economic analysis of the existence of different legal systems in the area of marriage law and proposes another strategy to cope with the problems arising from legal pluralism. Far from eliminating the diversity of legal systems, one wishes to foster it, since significant advantages could arise from such diversity in case couples are permitted to choose the applicable law themselves. Based on the idea that the law could be seem as a product offered in the market as well as states and spouses as suppliers and consumers of this product, the paper shows the advantages of designing a legal framework that allows spouses to determine freely the law governing the legal effects of their marriage. Instead of promoting the harmonization of the substantive law, one explores the benefits of encouraging the regulatory competition at international level in the area of marriage law.

Keywords: conflict of laws, harmonization, international marriage law, law and economics, regulatory competition

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Authors: Sani AbdulRahman Bala

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This empirical study delves into the realm of forensic accounting practices within the Nigerian Public Sector, seeking to quantitatively analyze their efficacy in addressing the persistent challenges of fraud and financial irregularities. With a focus on empirical data, this research employs a robust methodology to assess the current state of fraud in the Nigerian Public Sector and evaluate the performance of existing forensic accounting measures. Through quantitative analyses, including statistical models and data-driven insights, the study aims to identify patterns, trends, and correlations associated with fraudulent activities. The research objectives include scrutinizing documented fraud cases, examining the effectiveness of established forensic accounting practices, and proposing data-driven strategies for enhancing fraud detection and prevention. Leveraging quantitative methodologies, the study seeks to measure the impact of technological advancements on forensic accounting accuracy and efficiency. Additionally, the research explores collaborative mechanisms among government agencies, regulatory bodies, and the private sector by quantifying the effects of information sharing on fraud prevention. The empirical findings from this study are expected to provide a nuanced understanding of the challenges and opportunities in combating fraud within the Nigerian Public Sector. The quantitative insights derived from real-world data will contribute to the refinement of forensic accounting strategies, ensuring their effectiveness in addressing the unique complexities of financial irregularities in the public sector. The study's outcomes aim to inform policymakers, practitioners, and stakeholders, fostering evidence-based decision-making and proactive measures for a more resilient and fraud-resistant financial governance system in Nigeria.

Keywords: fraud, financial irregularities, nigerian public sector, quantitative investigation

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Authors: Michael Naderhirn, Marco Pavone

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Problem statement, motivation, and aim of work: So far, the development of control algorithms was done by control engineers in a way that the controller would fit a specification by testing. When it comes to the certification of an autonomous car in highly complex scenarios, the challenge is much higher since such a controller must mathematically guarantee to implement the rules of the road while on the other side guarantee aspects like safety and real time executability. What if it becomes reality to solve this demanding problem by combining Formal Verification and System Theory? The aim of this work is to present a workflow to solve the above mentioned problem. Summary of the presented results / main outcomes: We show the usage of an English like language to transform the rules of the road into system specification for an autonomous car. The language based specifications are used to define system functions and interfaces. Based on that a formal model is developed which formally correctly models the specifications. On the other side, a mathematical model describing the systems dynamics is used to calculate the systems reachability set which is further used to determine the system input boundaries. Then a motion planning algorithm is applied inside the system boundaries to find an optimized trajectory in combination with the formal specification model while satisfying the specifications. The result is a control strategy which can be applied in real time independent of the scenario with a mathematical guarantee to satisfy a predefined specification. We demonstrate the applicability of the method in simulation driving scenarios and a potential certification. Originality, significance, and benefit: To the authors’ best knowledge, it is the first time that it is possible to show an automated workflow which combines a specification in an English like language and a mathematical model in a mathematical formal verified way to synthesizes a controller for potential real time applications like autonomous driving.

Keywords: formal system verification, reachability, real time controller, hybrid system

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Authors: Min Liu, Thanapauge Chamaratana

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Integrating ecotourism into urban borderlands holds significant potential for promoting sustainable development, enhancing cross-border cooperation, and preserving cultural and natural heritage. This study aims to evaluate the current status and strategic measures for sustainable ecotourism development in the border urban areas of Xishuangbanna, leveraging the unique opportunities and challenges presented by its policy and geographical location. Employing a qualitative research approach, the exploratory study utilizes documentary research, observation, and in-depth interviews with 20 key stakeholders, including local government officials, tourism operators, community members, and tourists. Content analysis is conducted to interpret the collected data. The findings reveal that Xishuangbanna holds significant potential for ecotourism due to its rich biodiversity, cultural heritage, and strategic location along the Belt and Road Initiative route. The integration of ecotourism can drive economic growth, create employment opportunities, and foster a deeper appreciation for conservation efforts. By promoting ecotourism practices, the region can attract environmentally conscious travelers, thereby contributing to global sustainability goals. However, challenges such as inadequate infrastructure, limited community involvement, and environmental concerns are also identified. The study recommends enhancing ecotourism development in urban borderlands through integrated planning, stakeholder collaboration, and sustainable practices. These measures are essential to ensure long-term benefits for both the local community and the environment. Moreover, the study underscores the importance of a holistic approach to ecotourism development, which balances economic, social, and environmental priorities to achieve sustainable outcomes for urban borderlands.

Keywords: ecotourism, sustainable tourism, urban, borderland

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Authors: Deepanwita Deka, Dhruva Kumar Jha

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Endophytes are the microbes that colonize living, internal tissues of plants without causing any immediate, overt negative effects. Endophytes are rich source of therapeutic substances like antimicrobial, anticancerous, herbicidal, insecticidal, immunomodulatory compounds. Brucea mollis, commonly known as Quinine in Assam, belonging to the family Simaroubaceae, is a shrub or small tree, recorded as endangered species in North East India by CAMP survey in 2003. It is traditionally being used as antimalarial and antimicrobial agent and has antiplasmodial, cytotoxic, anticancer, diuretic, cardiovascular effect etc. Being endangered and medicinal; this plant may host certain noble endophytes which need to be studied in depth. The aim of the present study was isolation and identification of potent endophytic fungi from Brucea mollis, an endangered medicinal plant, to protect it from extinction due to over use for medicinal purposes. Aseptically collected leaves, barks and roots samples of healthy plants were washed and cut into a total of 648 segments of about 2 cm long and 0.5 cm broad with sterile knife, comprising 216 segments each from leaves, barks and roots. These segments were surface sterilized using ethanol, mercuric chloride (HgCl2) and aqueous solution of sodium hypochlorite (NaClO). Different media viz., Czapeck-Dox-Agar (CDA, Himedia), Potato-Dextrose-Agar (PDA, Himedia), Malt Extract Agar (MEA, Himedia), Sabourad Dextrose Agar (SDA, Himedia), V8 juice agar, nutrient agar and water agar media and media amended with plant extracts were used separately for the isolation of the endophytic fungi. A total of 11 fungal species were recovered from leaf, bark and root tissues of B. mollis. The isolates were screened for antimicrobial, antioxidant and enzymatic activities using certain protocols. Cochliobolus geniculatus was identified as the most dominant species. The mycelia sterilia (creamy white) showing highest inhibitory activity against Candida albicans (MTCC 183) was induced to sporulate using modified PDA media. The isolate was identified as Geosmithia pallida. The internal transcribed spacer of rDNA was sequenced for confirmation of the taxonomic identity of the sterile mycelia (creamy white). The internal transcribed spacer r-DNA sequence was submitted to the NCBI (KU693285) for the first time from India. G. pallida and Penicillium showed highest antioxidant activity among all the isolates. The antioxidant activity of G. pallida and Penicillium didn’t show statistically significant difference (P˃0.05). G. pallida, Cochliobolus geniculatus and P. purpurogenum respectively showed highest cellulase, amylase and protease activities. Thus, endopytic fungal isolates may be used as potential natural resource of pharmaceutical importance. The endophytic fungi, Geosmithia pallida, may be used for synthesis of pharmaceutically important natural products and consequently can replace plants hitherto used for the same purpose. This study suggests that endophytes should be investigated more aggressively to better understand the endophyte biology of B. mollis.

Keywords: Antimicrobial activity, antioxidant activity, Brucea mollis, endophytic fungi, enzyme activity, Geosmithia pallida

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Authors: Anthony Quansah, Tresor Ntaryamira, Shula Mushota

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Models for geotechnical centrifuge testing are usually made from re-formed soil, allowing for comparisons with naturally occurring soil deposits. However, there is a fundamental omission in this process because the natural soil is deposited in layers creating a unique structure. Nonlinear dynamics of clay material deposit is an essential part of changing the attributes of ground movements when subjected to solid seismic loading, particularly when diverse intensification conduct of speeding up and relocation are considered. The paper portrays a review of axis shaking table tests and numerical recreations to explore the offshore clay deposits subjected to seismic loadings. These perceptions are accurately reenacted by DEEPSOIL with appropriate soil models and parameters reviewed from noteworthy centrifuge modeling researches. At that point, precise 1-D site reaction investigations are performed on both time and recurrence spaces. The outcomes uncover that for profound delicate clay is subjected to expansive quakes, noteworthy increasing speed lessening may happen close to the highest point of store because of soil nonlinearity and even neighborhood shear disappointment; nonetheless, huge enhancement of removal at low frequencies are normal in any case the forces of base movements, which proposes that for dislodging touchy seaward establishments and structures, such intensified low-recurrence relocation reaction will assume an essential part in seismic outline. This research shows centrifuge as a tool for creating a layered sample important for modelling true soil behaviour (such as permeability) which is not identical in all directions. Currently, there are limited methods for creating layered soil samples.

Keywords: seismic analysis, layered modeling, terotechnology, finite element modeling

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Authors: Mbuso Siwela

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Background: The Sub-Saharan Africa region has the greatest number of people eligible to receive antiretroviral treatment (ART). Multi-month Drug dispensing (MMD) of antiretroviral treatment (ART) aims to reduce patient-related barriers to access long-term treatment and improve health system efficiency. In Eswatini, however, few children and adolescents are on MMD. Young Heroes is implementing an HIV program that aims to avert new HIV infections in children and youth and improve treatment outcomes for children and adolescents living with HIV (C/ALHIV: 0-19 Years) and OVC caregivers with HIV prevention and impact mitigation interventions that prevent new HIV infections and reduce vulnerability. Aim of the study: The study aimed to ascertain factors that are associated with the assignment of the MMD model on C/ALHIVs. Methodology: The project provides treatment adherence support through well-trained community cadres (Home Visitors - HVs) at both community and health facility levels. During door-to-door visits, HVs track all C/ALHIV enrolled in the project monthly and refer any who might have stopped or interrupted treatment. C/ALHIV with unsuppressed viral load is supported through case conferencing and teen clubs. A quantitative cross-sectional analysis was conducted using STATA for children and adolescents living with HIV enrolled in the project. Bivariate analysis was conducted, and the Logistic Regression model was used to ascertain the effects of duration on ART on the choice of MMD model. Results: Data for 544 C/ALHIV (0-19 Years) was analyzed in STATA. Results show a strong association between (duration on ART, Age, being in teen club) and enrolment in an MMD model. Duration on ART is a major predictor for the choice of MMD model at (95% CI: 0.0012905 – 0.0039812; P = <0.0001). C/ALHIV who have been on ART for less than a year are less likely to be on MMD. C/ALHIVs who are 1 or more years on ART are more likely to be in 3 months dispensing, while those who are 5 years or more are most likely to be in 6 months model.

Keywords: C/ALHIV, OVC, HIV, treatment

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