Search results for: modal assurance criteria

Authors: Benoit Atge, Alice Dhersin, Oscar Da Silva Cacao, Beatrice Martinez, Dominique Ducint, Catherine Verdun-Esquer, Isabelle Baldi, Mathieu Molimard, Antoine Villa, Mireille Canal-Raffin

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Introduction: Healthcare workers' exposure to antineoplastic drugs (AD) is a burning issue for occupational medicine practitioners. Biological monitoring of occupational exposure (BMOE) is an essential tool for assessing AD contamination of healthcare workers. In addition to BMOE, surface sampling is a useful tool in order to understand how workers get contaminated, to identify sources of environmental contamination, to verify the effectiveness of surface decontamination way and to ensure monitoring of these surfaces. The objective of this work was to develop a complete tool including a kit for surface sampling and a quantification analytical method for AD traces detection. The development was realized with the three following criteria: the kit capacity to sample in every professional environment (healthcare services, veterinaries, etc.), the detection of very low AD traces with a validated analytical method and the easiness of the sampling kit use regardless of the person in charge of sampling. Material and method: AD mostly used in term of quantity and frequency have been identified by an analysis of the literature and consumptions of different hospitals, veterinary services, and home care settings. The kind of adsorbent device, surface moistening solution and mix of solvents for the extraction of AD from the adsorbent device have been tested for a maximal yield. The AD quantification was achieved by an ultra high-performance liquid chromatography method coupled with tandem mass spectrometry (UHPLC-MS/MS). Results: With their high frequencies of use and their good reflect of the diverse activities through healthcare, 15 AD (cyclophosphamide, ifosfamide, doxorubicin, daunorubicin, epirubicin, 5-FU, dacarbazin, etoposide, pemetrexed, vincristine, cytarabine, methothrexate, paclitaxel, gemcitabine, mitomycin C) were selected. The analytical method was optimized and adapted to obtain high sensitivity with very low limits of quantification (25 to 5000ng/mL), equivalent or lowest that those previously published (for 13/15 AD). The sampling kit is easy to use, provided with a didactic support (online video and protocol paper). It showed its effectiveness without inter-individual variation (n=5/person; n= 5 persons; p=0,85; ANOVA) regardless of the person in charge of sampling. Conclusion: This validated tool (sampling kit + analytical method) is very sensitive, easy to use and very didactic in order to control the chemical risk brought by AD. Moreover, BMOE permits a focal prevention. Used in routine, this tool is available for every intervention of occupational health.

Keywords: surface contamination, sampling kit, analytical method, sensitivity

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Authors: Adisorn Banhan, Toansakul Santiboon, Prasong Saihong

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Using the Socio-Scientific Issues-Based Learning Method is to compare of the blended instruction of STEM education with a sample consisted of 84 students in 2 classes at the 11th grade level in Sarakham Pittayakhom School. The 2-instructional models were managed of five instructional lesson plans in the context of electronic wave issue. These research procedures were designed of each instructional method through two groups, the 40-experimental student group was designed for the instructional STEM education (STEMe) and 40-controlling student group was administered with the Socio-Scientific Issues-Based Learning (SSIBL) methods. Associations between students’ learning achievements of each instructional method and their science attitudes of their predictions to their exploring activities toward physics with the STEMe and SSIBL methods were compared. The Measuring Reasonable Ethics Test (MRET) was assessed students’ reasonable ethics with the STEMe and SSIBL instructional design methods on two each group. Using the pretest and posttest technique to monitor and evaluate students’ performances of their reasonable ethics on electromagnetic wave issue in the STEMe and SSIBL instructional classes were examined. Students were observed and gained experience with the phenomena being studied with the Socio-Scientific Issues-Based Learning method Model. To support with the STEM that it was not just teaching about Science, Technology, Engineering, and Mathematics; it is a culture that needs to be cultivated to help create a problem solving, creative, critical thinking workforce for tomorrow in physics. Students’ attitudes were assessed with the Test Of Physics-Related Attitude (TOPRA) modified from the original Test Of Science-Related Attitude (TOSRA). Comparisons between students’ learning achievements of their different instructional methods on the STEMe and SSIBL were analyzed. Associations between students’ performances the STEMe and SSIBL instructional design methods of their reasonable ethics and their science attitudes toward physics were associated. These findings have found that the efficiency of the SSIBL and the STEMe innovations were based on criteria of the IOC value higher than evidence as 80/80 standard level. Statistically significant of students’ learning achievements to their later outcomes on the controlling and experimental groups with the SSIBL and STEMe were differentiated between students’ learning achievements at the .05 level. To compare between students’ reasonable ethics with the SSIBL and STEMe of students’ responses to their instructional activities in the STEMe is higher than the SSIBL instructional methods. Associations between students’ later learning achievements with the SSIBL and STEMe, the predictive efficiency values of the R2 indicate that 67% and 75% for the SSIBL, and indicate that 74% and 81% for the STEMe of the variances were attributable to their developing reasonable ethics and science attitudes toward physics, consequently.

Keywords: socio-scientific issues-based learning method, STEM education, science attitudes, measurement, reasonable ethics, physics classes

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Authors: Esraa A. Khalil, Mohamed N. AbouZeid

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Building materials selection is critical for the sustainability of any project. The choice of building materials has a huge impact on the built environment and cost of projects. Building materials emit huge amount of carbon dioxide (CO₂) due to the use of cement as a basic component in the manufacturing process and as a binder, which harms our environment. Energy consumption from buildings has increased in the last few years; a huge amount of energy is being wasted from using unsustainable building and finishing materials, as well as from the process of heating and cooling of buildings. In addition, the construction sector in Egypt is taking a good portion of the economy; however, there is a lack of awareness of buildings environmental impacts on the built environment. Using advanced building materials and different wall systems can help in reducing heat consumption, the project’s initial and long-term costs, and minimizing the environmental impacts. Red Bricks is one of the materials that are being used widely in Egypt. There are many other types of bricks such as Autoclaved Aerated Concrete (AAC); however, the use of Red Bricks is dominating the construction industry due to its affordability and availability. This research focuses on the New Egyptian Administrative Capital as a case study to investigate the potential of the influence of using different wall systems such as AAC on the project’s cost and the environment. The aim of this research is to conduct a comparative analysis between the traditional and most commonly used bricks in Egypt, which is Red Bricks, and AAC wall systems. Through an economic and environmental study, the difference between the two wall systems will be justified to encourage the utilization of uncommon techniques in the construction industry to build more affordable, energy efficient and sustainable buildings. The significance of this research is to show the potential of using AAC in the construction industry and its positive influences. The study analyzes the factors associated with choosing suitable building materials for different projects according to the need and criteria of each project and its nature without harming the environment and wasting materials that could be saved or recycled. The New Egyptian Administrative Capital is considered as the country’s new heart, where ideas regarding energy savings and environmental benefits are taken into consideration. Meaning that, Egypt is taking good steps to move towards more sustainable construction. According to the analysis and site visits, there is a potential in reducing the initial costs of buildings by 12.1% and saving energy by using different techniques up to 25%. Interviews with the mega structures project engineers and managers reveal that they are more open to introducing sustainable building materials that will help in saving the environment and moving towards green construction as well as to studying more effective techniques for energy conservation.

Keywords: AAC blocks, building material, environmental impact, modern construction, new Egyptian administrative capital

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Authors: S. V. Kuznetsov, M. N. Mayakova, V. Yu. Proydakova, V. V. Pavlov, A. S. Nizamutdinov, O. A. Morozov, V. V. Voronov, P. P. Fedorov

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Increase in the share of electricity received by conversion of solar energy results in the reduction of the industrial impact on the environment from the use of the hydrocarbon energy sources. One way to increase said share is to improve the efficiency of solar energy conversion in silicon-based solar panels. Such efficiency increase can be achieved by transferring energy from sunlight-insensitive areas of work of silicon solar panels to the area of their photoresistivity. To achieve this goal, a transition to new luminescent materials with the high quantum yield of luminescence is necessary. Improvement in the quantum yield can be achieved by quantum cutting, which allows obtaining a quantum yield of down conversion of more than 150% due to the splitting of high-energy photons of the UV spectral range into lower-energy photons of the visible and near infrared spectral ranges. The goal of present work is to test approach of excitation through sensibilization of 4f-4f fluorescence of Yb3+ by various RE ions absorbing in UV and Vis spectral ranges. One of promising materials for quantum cutting luminophores are fluorides. In our investigation we have developed synthesis of nano- and submicron powders of calcium fluoride and strontium doped with rare-earth elements (Yb: Ce, Yb: Pr, Yb: Eu) of controlled dimensions and shape by co-precipitation from water solution technique. We have used Ca(NO3)2*4H2O, Sr(NO3)2, HF, NH4F as precursors. After initial solutions of nitrates were prepared they have been mixed with fluorine containing solution by dropwise manner. According to XRD data, the synthesis resulted in single phase samples with fluorite structure. By means of SEM measurements, we have confirmed spherical morphology and have determined sizes of particles (50-100 nm after synthesis and 150-300 nm after calcination). Temperature of calcination appeared to be 600°C. We have investigated the spectral-kinetic characteristics of above mentioned compounds. Here the diffuse reflection and laser induced fluorescence spectra of Yb3+ ions excited at around 4f-4f and 4f-5d transitions of Pr3+, Eu3+ and Ce3+ ions in the synthesized powders are reported. The investigation of down conversion luminescence capability of synthesized compounds included measurements of fluorescence decays and quantum yield of 2F5/2-2F7/2 fluorescence of Yb3+ ions as function of Yb3+ and sensitizer contents. An optimal chemical composition of CaF2-YbF3- LnF3 (Ln=Ce, Eu, Pr), SrF2-YbF3-LnF3 (Ln=Ce, Eu, Pr) micro- and nano- powders according to criteria of maximal IR fluorescence yield is proposed. We suppose that investigated materials are prospective in solar panels improvement applications. Work was supported by Russian Science Foundation grant #17-73- 20352.

Keywords: solar cell, fluorides, down-conversion luminescence, maximum quantum yield

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Authors: Getachew Weldemichael, Sentayehu Alamerew, Leta Tulu, Gezahegn Berecha

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Coffee quality improvement program is becoming the focus of coffee research, as the world coffee consumption pattern shifted to high-quality coffee. However, there is limited information on the genetic variation of C. Arabica for quality improvement in potential specialty coffee growing areas of Ethiopia. Therefore, this experiment was conducted with the objectives of determining the magnitude of variation among 105 coffee accessions collected from east Wollega coffee growing areas and assessing correlations between the different coffee qualities attributes. It was conducted in RCRD with three replications. Data on green bean physical characters (shape and make, bean color and odor) and organoleptic cup quality traits (aromatic intensity, aromatic quality, acidity, astringency, bitterness, body, flavor, and overall standard of the liquor) were recorded. Analysis of variance, clustering, genetic divergence, principal component and correlation analysis was performed using SAS software. The result revealed that there were highly significant differences (P<0.01) among the accessions for all quality attributes except for odor and bitterness. Among the tested accessions, EW104 /09, EW101 /09, EW58/09, EW77/09, EW35/09, EW71/09, EW68/09, EW96 /09, EW83/09 and EW72/09 had the highest total coffee quality values (the sum of bean physical and cup quality attributes). These genotypes could serve as a source of genes for green bean physical characters and cup quality improvement in Arabica coffee. Furthermore, cluster analysis grouped the coffee accessions into five clusters with significant inter-cluster distances implying that there is moderate diversity among the accessions and crossing accessions from these divergent inter-clusters would result in hetrosis and recombinants in segregating generations. The principal component analysis revealed that the first three principal components with eigenvalues greater than unity accounted for 83.1% of the total variability due to the variation of nine quality attributes considered for PC analysis, indicating that all quality attributes equally contribute to a grouping of the accessions in different clusters. Organoleptic cup quality attributes showed positive and significant correlations both at the genotypic and phenotypic levels, demonstrating the possibility of simultaneous improvement of the traits. Path coefficient analysis revealed that acidity, flavor, and body had a high positive direct effect on overall cup quality, implying that these traits can be used as indirect criteria to improve overall coffee quality. Therefore, it was concluded that there is considerable variation among the accessions, which need to be properly conserved for future improvement of the coffee quality. However, the variability observed for quality attributes must be further verified using biochemical and molecular analysis.

Keywords: accessions, Coffea arabica, cluster analysis, correlation, principal component

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Authors: Angela T. H. Kwan, Wenjun Liang, Jack Wellington, Mohammad Mofatteh, Thanh N. Nguyen, Pingzhong Fu, Juanmei Chen, Zile Yan, Weijuan Wu, Yongting Zhou, Shuiquan Yang, Sijie Zhou, Yimin Chen

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Background: Endovascular Therapy (EVT)—in the form of mechanical thrombectomy—following intravenous thrombolysis is the standard gold treatment for patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). It is well established that an ASPECTS ≥ 7 is associated with an increased likelihood of positive post-EVT outcomes, as compared to an ASPECTS < 7. There is also prognostic utility in coupling posterior circulation ASPECTS (pc-ASPECTS) with magnetic resonance imaging for evaluating the post-EVT functional outcome. However, the value of pc-ASPECTS applied to CT must be explored further to determine its usefulness in predicting functional outcomes following EVT. Objective: In this study, we aimed to determine whether pc-ASPECTS on CT can predict post-EVT functional outcomes among patients with AIS due to LVO. Methods: A total of 247 consecutive patients aged 18 and over receiving EVT for LVO-related AIS were recruited into a prospective database. The data were retrospectively analyzed between March 2019 to February 2022 from two comprehensive tertiary care stroke centers: Foshan Sanshui District People’s Hospital and First People's Hospital of Foshan in China. Patient parameters included EVT within 24hrs of symptom onset, premorbid modified Rankin Scale (mRS) ≤ 2, presence of distal and terminal cerebral blood vessel occlusion, and subsequent 24–72-hour post-stroke onset CT scan. Univariate comparisons were performed using the Fisher exact test or χ2 test for categorical variables and the Mann–Whitney U test for continuous variables. A p-value of ≤ 0.05 was statistically significant. Results: A total of 247 patients met the inclusion criteria; however, 3 were excluded due to the absence of post-CTs and 8 for pre-EVT ASPECTS < 7. Overall, 236 individuals were examined: 196 anterior circulation ischemic strokes and 40 posterior strokes of basilar artery occlusion. We found that both baseline post- and pc-ASPECTS ≥ 7 serve as strong positive markers of favorable outcomes at 90 days post-EVT. Moreover, lower rates of inpatient mortality/hospice discharge, 90-day mortality, and 90-day poor outcome were observed. Moreover, patients in the post-ASPECTS ≥ 7 anterior circulation group had shorter door-to-recanalization time (DRT), puncture-to-recanalization time (PRT), and last known normal-to-puncture-time (LKNPT). Conclusion: Patients of anterior and posterior circulation ischemic strokes with baseline post- and pc-ASPECTS ≥ 7 may benefit from EVT.

Keywords: endovascular therapy, thrombectomy, large vessel occlusion, cerebral ischemic stroke, ASPECTS

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Authors: Preetinder Kaur Randhawa

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The rural areas can be differentiated from urban areas in terms of their economic activities as rural areas are primarily involved in agricultural sector and provide natural resources whereas, urban areas are primarily involved in infrastructure sector and provide manufacturing services. Census of India defines a Census Town as an area which satisfies the following three criteria i.e. population exceeds 5000, at least 75 percent of male population engaged in non-agricultural sector and minimum population density of 400 persons per square kilometers. Urban areas can be attributed to the improvement of transport facilities, the massive decline in agricultural, especially male workers and workers shift to non-agricultural activities. This study examines the pattern, process of rural areas transformed into urban areas/ census town. The study has analyzed the various factors which are responsible for land transformation as well as the socio-economic transformation of the village population. Nilpur (CT) which belongs to Rajpura Tehsil in Patiala district, Punjab has been selected for the present study. The methodology adopted includes qualitative and quantitative research design, methods based on secondary data. Secondary data has been collected from unpublished revenue record office of Rajpura Tehsil and Primary Census Abstract of Patiala district, Census of India 2011. The results have showed that rate of transformation of a village to census town in Rajpura Tehsil has been one of highest among other villages. The census town has evolved through the evolutionary process of human settlement which grows in size, population and physical development. There must be a complete economic transformation and attainment of high level of technological development. Urban design and construction of buildings and infrastructure can be carried out better and faster and can be used to aid human habitation with the enhancement of quality of life. The study has concluded that in the selected area i.e Nilpur (CT) literacy rate has increased to 72.1 percent in year 2011 from 67.6 percent in year 2001. Similarly non-agricultural work force has increased to 95.2 percent in year 2011 from 81.1 percent in year 2001. It is very much clear that the increased literacy rate has put a positive impact on the involvement of non-agricultural workers have enhanced. The study has concluded that rural-urban linkages are important tools for understanding complexities of people livelihood and their strategies which involve mobility migration and the diversification of income sources and occupations.

Keywords: Census Town, India, Nilpur, Punjab

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Authors: Itee Chowdhury, Shikha Modi

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Introduction: Cancer is beginning to outpace cardiovascular disease as a cause of death affecting every major organ system with profound implications for perioperative management. Breast cancer is the most common cancer in women in India, accounting for 27% of all cancers. The small changes in analgesic management of cancer patients can greatly improve prognosis and reduce the risk of postsurgical cancer recurrence as opioid-based analgesia has a deleterious effect on cancer outcomes. Shortened postsurgical recovery time facilitates earlier return to intended oncological therapy maximising the chance of successful treatment. Literature reveals that the role of BIS since FDA approval has been assessed in various types of surgeries, but clinical data on its use in oncosurgical patients are scanty. Our study focuses on the role of BIS-guided anaesthesia for breast cancer surgery patients. Methods: A prospective randomized controlled study in patients aged 36-55years scheduled for modified radical mastectomy was conducted in 51 patients in each group who met the inclusion and exclusion criteria, and randomization was done by sealed envelope technique. In BIS guided anaesthesia group (B), sevoflurane was titrated to keep the BIS value 45-60, and thereafter if the patient showed hypertension/tachycardia, an opioid was given. In standard anaesthesia care (group C), sevoflurane was titrated to keep MAC in the range of 0.8-1, and fentanyl was given if the patient showed hypertension/tachycardia. Intraoperative opioid consumption was calculated. Postsurgery recovery characteristics, including Aldrete score, were assessed. Patients were questioned for pain, PONV, and recall of the intraoperative event. A comparison of age, BMI, ASA, recovery characteristics, opioid, and VAS score was made using the non-parametric Mann-Whitney U test. Categorical data like intraoperative awareness of surgery and PONV was studied using the Chi-square test. A comparison of heart rate and MAP was made by an independent sample t-test. #ggplot2 package was used to show the trend of the BIS index for all intraoperative time points for each patient. For a statistical test of significance, the cut-off p-value was set as <0.05. Conclusions: BIS monitoring led to reduced opioid consumption and early recovery from anaesthesia in breast cancer patients undergoing MRM resulting in less postoperative nausea and vomiting and less pain intensity in the immediate postoperative period without any recall of the intraoperative event. Thus, the use of a Bispectral index monitor allows for tailoring of anaesthesia administration with a good outcome.

Keywords: bispectral index, depth of anaesthesia, recovery, opioid consumption

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Authors: Hamid Abbasi, Neda Jourabchi, Ranasadat Abedi, Kiarash Tajernarenj, Mehdi Farhoudi, Sarvin Sanaie

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Background: Alpha lipoic acid (ALA), fat- and water-soluble, coenzyme with sulfuret content, has received considerable attention for its potential therapeutic role in diabetes, cardiovascular diseases, cancers, and central nervous disease. This investigation aims to evaluate the probable protective effects of ALA in stroke patients. Methods: Based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, This meta-analysis was performed. The PICO criteria for this meta-analysis were as follows: Population/Patients (P: stroke patients); Intervention (I: ALA); Comparison (C: control); Outcome (O: blood glucose, lipid profile, oxidative stress, inflammatory factors).In addition, Studies that were excluded from the analysis consisted of in vitro, in vivo, and ex vivo studies, case reports, quasi-experimental studies. Scopus, PubMed, Web of Science, EMBASE databases were searched until August 2023. Results: Of 496 records that were screened in the title/abstract stage, 9 studies were included in this meta-analysis. The sample sizes in the included studies vary between 28 and 90. The result of risk of bias was performed via risk of bias (RoB) in randomized-controlled trials (RCTs) based on the second version of the Cochrane RoB assessment tool. 8 studies had a definitely high risk of bias. Discussion: To the best of our knowledge, The present meta-analysis is the first study addressing the effectiveness of ALA supplementation in enhancing post-stroke metabolic markers, including lipid profile, oxidative stress, and inflammatory indices. It is imperative to acknowledge certain potential limitations inherent in this study. First of all, type of treatment (oral or intravenous infusion) could alter the bioavailability of ALA. Our study had restricted evidence regarding the impact of ALA supplementation on included outcomes. Therefore, further research is warranted to develop into the effects of ALA specifically on inflammation and oxidative stress. Funding: The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 72825). Registration: This study was registered in the International prospective register of systematic reviews (PROSPERO ID: CR42023461612).

Keywords: alpha-lipoic acid, lipid profile, blood glucose, inflammatory factors, oxidative stress, meta-analysis, post-stroke

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Authors: Nursyafiq Ali Shibramulisi, Nor Farah Fauzi, Nur Azniza Zawin Anuar, Nurul Atikah Azmi, Janice Hew Pei Fang

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Background: Work related musculoskeletal disorders (WRMD) among dental personnel have been underestimated and under-reported worldwide and specifically in Malaysia. The problem will arise and progress slowly over time, as it results from accumulated injury throughout the period of work. Several risk factors, such as repetitive movement, static posture, vibration, and adapting poor working postures, have been identified to be contributing to WRMSD in dental practices. Dental personnel is at higher risk of getting this problem as it is their working nature and core business. This would cause pain and dysfunction syndrome among them and result in absence from work and substandard services to their patients. Methodology: A cross-sectional study involving 19 government dental clinics in Perak was done over the period of 3 months. Those who met the criteria were selected to participate in this study. Malay version of the Self-Reported Nordic Musculoskeletal Discomfort Form was used to identify the prevalence of WRMSD, while the intensity of pain in the respective regions was evaluated using a 10-point scale according to ‘Pain as The 5ᵗʰ Vital Sign’ by MOH Malaysia and later on were analyzed using SPSS version 25. Descriptive statistics, including mean and SD and median and IQR, were used for numerical data. Categorical data were described by percentage. Pearson’s Chi-Square Test and Spearman’s Correlation were used to find the association between the prevalence of WRMSD and other socio-demographic data. Results: 159 dentists, 73 dental therapists, 26 dental lab technicians, 81 dental surgery assistants, and 23 dental attendants participated in this study. The mean age for the participants was 34.9±7.4 and their mean years of service was 9.97±7.5. Most of them were female (78.5%), Malay (71.3%), married (69.6%) and right-handed (90.1%). The highest prevalence of WRMSD was neck (58.0%), followed by shoulder (48.1%), upper back (42.0%), lower back (40.6%), hand/wrist (31.5%), feet (21.3%), knee (12.2%), thigh 7.7%) and lastly elbow (6.9%). Most of those who reported having neck pain scaled their pain experiences at 2 out of 10 (19.5%), while for those who suffered upper back discomfort, most of them scaled their pain experience at 6 out of 10 (17.8%). It was found that there was a significant relationship between age and pain at neck (p=0.007), elbow (p=0.027), lower back (p=0.032), thigh (p=0.039), knee (p=0.001) and feet (p=0.000) regions. Job position also had been found to be having a significant relationship with pain experienced at the lower back (p=0.018), thigh (p=0.011), knee, and feet (p=0.000). Conclusion: The prevalence of WRMSD among dental personnel in Perak was found to be high. Age and job position were found to be having a significant relationship with pain experienced in several regions. Intervention programs should be planned and conducted to prevent and reduce the occurrence of WRMSD, as all harmful or unergonomic practices should be avoided at all costs.

Keywords: WRMSD, ergonomic, dentistry, dental

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Authors: Revaz Gvelesiani

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The problem of compliance between the state economic policy and entrepreneurial policy of businesses is primarily manifested in the contradictions related to the congruence between entrepreneurship development and self-development strategies. Among various types (financial, monetary, social, etc.) of the state economic policy aiming at the development of entrepreneurship, economic order policy is of special importance. Its goal is to set the framework for both public and private economic activities and achieve coherence between the societal value system and the formation of the economic order framework. Economic order policy, in its turn, involves intrinsic contradiction between the social and the competitive order. Competitive order is oriented on the principle of success, while social order _ on the criteria of need satisfaction, which contradicts, at least partly, to the principles of success. Thus within the economic order policy, on the one hand, the state makes efforts to form social order and expand its frontiers, while, on the other hand, market is determined to establish functioning competitive order and ensure its realization. Locating the adequate spaces for and setting the rational border between the state (social order) and the private (competitive order) activities, represents the phenomenon of the decisive importance from the entrepreneurship development strategy standpoint. In the countries where the above mentioned spaces and borders are “set” correctly, entrepreneurship agents (small, medium-sized and large businesses) achieve great success by means of seizing the respective segments and maintaining the leading positions in the internal, the European and the world markets for a long time. As for the entrepreneurship self-development strategy, above all, it involves: •market identification; •interactions with consumers; •continuous innovations; •competition strategy; •relationships with partners; •new management philosophy, etc. The analysis of compliance between the entrepreneurship strategy and entrepreneurship culture should be the reference point for any kind of internationalization in order to avoid shocks of cultural nature and the economic backwardness. Stabilization can be achieved only when the employee actions reflect the existing culture and the new contents of culture (targeted culture) is turned into the implicit consciousness of the personnel. The future leaders should learn how to manage different cultures. Entrepreneurship can be managed successfully if its strategy and culture are coherent. However, not rarely enterprises (organizations) show various forms of violation of both personal and team actions. If personal and team non-observances appear as the form of influence upon the culture, it will lead to global destruction of the system and structure. This is the entrepreneurship culture pathology that complicates to achieve compliance between the entrepreneurship strategy and entrepreneurship culture. Thus, the intrinsic contradictions of entrepreneurship development and self-development strategies complicate the task of reaching compliance between the state economic policy and the company entrepreneurship policy: on the one hand, there is a contradiction between the social and the competitive order within economic order policy and on the other hand, the contradiction exists between entrepreneurship strategy and entrepreneurship culture within entrepreneurship policy.

Keywords: economic order policy, entrepreneurship, development contradictions, self-development contradictions

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Authors: Belaynesh Tefera, Ahmed Mohammed, Zelalem Bayisa

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This study focuses on the issue of underage internal migration from rural to urban areas in Ethiopia, specifically in the context of child labor. It addresses the significant disparities in living standards between rural and urban areas, which motivate individuals from rural areas to migrate to urban areas in search of better economic opportunities. The study was conducted in Addis Ababa, where there is a high prevalence of underage internal migrants engaged in child labor due to extreme poverty in rural parts of the country. The aim of this study is to explore the life experiences of shoe-makers who have migrated from rural areas of Ethiopia to Addis Ababa. The focus is on understanding the factors that push these underage individuals to migrate, the challenges they face, and the implications for child labor. This study adopts a qualitative approach, using semistructured face-to-face interviews with underage migrants. A total of 27 interviews were conducted in Addis Ababa, Ethiopia, until the point of data saturation. The criteria for selecting interviewees include working as shoemakers and migrating to Addis Ababa underage, below 16 years old. The interviews were audio-taped, transcribed into Amharic, and then translated into English for analysis. The study reveals that the major push factors for underage internal migration are socioeconomic and environmental factors. Despite improvements in living standards for underage migrants and their families, there is a high prevalence of child labor and lack of access to education among them. Most interviewees migrated without the accompaniment of their family members and faced various challenges, including sleeping on the streets. This study highlights the role of social marketing in addressing the issues of underage internal migration and child labor. It suggests that social marketing can be an effective strategy to protect children from abuse, loneliness, and harassment during their migration process. The data collection involved conducting in-depth interviews with the underage migrants. The interviews were transcribed and translated for analysis. The analysis focused on identifying common themes and patterns within the interview data. The study addresses the factors contributing to underage internal migration, the challenges faced by underage migrants, the prevalence of child labor, and the potential role of social marketing in addressing these issues. The study concludes that although Ethiopia has policies against child internal migration, it is difficult to protect underage laborers who migrate from rural to urban areas due to the voluntary nature of their migration. The study suggests that social marketing can serve as a solution to protect children from abuse and other challenges faced during migration.

Keywords: underage, internal migration, social marketing, child labor, Ethiopia

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Authors: Ana Breda, Catarina Cruz

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Daily, we face unpredictable events, often attributed to chance, as there is no justification for such an occurrence. Chance, understood as a source of uncertainty, is present in several aspects of human life, such as weather forecasts, dice rolling, and lottery. Surprisingly, humans and some animals can quickly adjust their behavior to handle efficiently doubly stochastic processes (random events with two layers of randomness, like unpredictable weather affecting dice rolling). This adjustment ability suggests that the human brain has built-in mechanisms for perceiving, understanding, and responding to simple probabilities. It also explains why current trends in mathematics education include probability concepts in official curriculum programs, starting from the third year of primary education onwards. In the first years of schooling, children learn to use a certain type of (specific) vocabulary, such as never, always, rarely, perhaps, likely, and unlikely, to help them to perceive and understand the probability of some events. These are keywords of crucial importance for their perception and understanding of probabilities. The development of the probabilistic concepts comes from facts and cause-effect sequences resulting from the subject's actions, as well as the notion of chance and intuitive estimates based on everyday experiences. As part of a junior summer school program, which took place at a Portuguese university, a non-formal learning experiment was carried out with 18 children in the 5th and 6th grades. This experience was designed to be implemented in a dynamic of a serious ice-breaking game, to assess their levels of probabilistic, critical, and creative thinking in understanding impossible, certain, equally probable, likely, and unlikely events, and also to gain insight into how the non-formal learning context influenced their achievements. The criteria used to evaluate probabilistic thinking included the creative ability to conceive events classified in the specified categories, the ability to properly justify the categorization, the ability to critically assess the events classified by other children, and the ability to make predictions based on a given probability. The data analysis employs a qualitative, descriptive, and interpretative-methods approach based on students' written productions, audio recordings, and researchers' field notes. This methodology allowed us to conclude that such an approach is an appropriate and helpful formative assessment tool. The promising results of this initial exploratory study require a future research study with children from these levels of education, from different regions, attending public or private schools, to validate and expand our findings.

Keywords: critical and creative thinking, non-formal mathematics learning, probabilistic thinking, serious game

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Authors: S. Chowdhury, A. Corlett

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Large tsunamis strike the British Columbia coast every few hundred years. The Cascadia Subduction Zone, which extends along the Pacific coast from Vancouver Island to Northern California is one of the most seismically active regions in Canada. Significant earthquakes have occurred in this region, including the 1700 Cascade Earthquake with an estimated magnitude of 9.2. Based on geological records, experts have predicted a 'great earthquake' of a similar magnitude within this region may happen any time. This earthquake is expected to generate a large tsunami that could impact the coastal communities on Vancouver Island. Since many of these communities are in remote locations, they are more likely to be vulnerable, as the post-earthquake relief efforts would be impacted by the damage to critical road infrastructures. To assess the coastal vulnerability within these communities, a hydrodynamic model has been developed using MIKE-21 software. We have considered a 500 year probabilistic earthquake design criteria including the subsidence in this model. The bathymetry information was collected from Canadian Hydrographic Services (CHS), and National Oceanic Atmospheric and Administration (NOAA). The arial survey was conducted using a Cessna-172 aircraft for the communities, and then the information was converted to generate a topographic digital elevation map. Both survey information was incorporated into the model, and the domain size of the model was about 1000km x 1300km. This model was calibrated with the tsunami occurred off the west coast of Moresby Island on October 28, 2012. The water levels from the model were compared with two tide gauge stations close to the Vancouver Island and the output from the model indicates the satisfactory result. For this study, the design water level was considered as High Water Level plus the Sea Level Rise for 2100 year. The hourly wind speeds from eight directions were collected from different wind stations and used a 200-year return period wind speed in the model for storm events. The regional model was set for 12 hrs simulation period, which takes more than 16 hrs to complete one simulation using double Xeon-E7 CPU computer plus a K-80 GPU. The boundary information for the local model was generated from the regional model. The local model was developed using a high resolution mesh to estimate the coastal flooding for the communities. It was observed from this study that many communities will be effected by the Cascadia tsunami and the inundation maps were developed for the communities. The infrastructures inside the coastal inundation area were identified. Coastal vulnerability planning and resilient design solutions will be implemented to significantly reduce the risk.

Keywords: tsunami, coastal flooding, coastal vulnerable, earthquake, Vancouver, wave propagation

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Authors: Malab Sana Balouch, Meenakshi Nayar

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Hemispatial Neglect is a common disorder primarily associated with right hemispheric stroke, in the acute phase of which it can occur up to 82% of the time. Such individuals fail to acknowledge or respond to people and objects in their left field of vision due to deficits in attention and awareness. Persistent hemispatial neglect significantly impedes post-stroke recovery, leading to longer hospital stays post-stroke, increased functional dependency, longer-term disability in ADLs and increased risk of falls. Recently, evidence has emerged for the use of dopamine agonist Rotigotine in neglect. The aim of our Quality Improvement Project (QIP) is to evaluate and better the current protocols and practice in assessment, documentation and management of neglect and rotigotine use at the Neurorehabilitation unit at Charing Cross Hospital (CNRU). In addition, it brings light to rotigotine use in the management of hemispatial neglect and paves the way for future research in the field. Our QIP was based in the CNRU. All patients admitted to the CNRU suffering from a right-sided stroke from 2nd of February 2018 to the 2nd of February 2021 were included in the project. Each patient’s multidisciplinary team report and hospital notes were searched for information, including bio-data, fulfilment of the inclusion criteria (having hemispatial neglect) and data related to rotigotine use. This includes whether or not the drug was administered, any contraindications to drug in patients that did not receive it, and any therapeutic benefits(subjective or objective improvement in neglect) in those that did receive the rotigotine. Data was simultaneously entered into excel sheet and further statistical analysis was done on SPSS 20.0. Out of 80 patients suffering from right sided strokes, 72.5% were infarcts and 27.5% were hemorrhagic strokes, with vast majority of both types of strokes were in the middle cerebral artery territory (MCA). A total of 31 (38.8%) of our patients were noted to have hemispatial neglect, with the highest number of cases being associated with MCA strokes. Almost half of our patients with MCA strokes suffered from neglect. Neglect was more common in male patients. Out of the 31 patients suffering from visuospatial neglect, only 16% actually received rotigotine and 80% of them were noted to have an objective improvement in their neglect tests and 20% revealed subjective improvement. After thoroughly going through neglect-associated documentation, the following recommendations/plans were put in place for the future. We plan to liaise with the occupational therapy team at our rehab unit to set a battery of tests that would be done on all patients presenting with neglect and recommend clear documentation of outcomes of each neglect screen under it. Also to create two proformas; one for the therapy team to aid in systematic documentation of neglect screens done prior to and after rotigotine administration and a second proforma for the medical team with clear documentation of rotigotine use, its benefits and any contraindications if not administered.

Keywords: hemispatial Neglect, right hemispheric stroke, rotigotine, neglect, dopamine agonist

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Authors: Vanessa Bennemann, Gabriela Laste, Márcia Inês Goettert

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The gestational period is a phase in which the pregnant woman undergoes constant physiological and hormonal changes, which are part of the woman’s biological cycle, the development of the fetus, childbirth, and lactation. These are factors of response to the immunological adaptation of the human reproductive process that is directly related to the pregnancy’s well-being and development. Although most pregnancies occur without complications, about 15% of pregnant women will develop potentially fatal complications, implying maternal and fetal risk. Therefore, requiring specialized care for high-risk pregnant women (HRPW) with obstetric interventions for the survival of the mother and/or fetus. Among the risk factors that characterize HRPW are the women's age, gestational diabetes mellitus (GDM), autoimmune diseases, infectious diseases such as syphilis and HIV, hypertension (SAH), preeclampsia, eclampsia, HELLP syndrome, uterine contraction abnormalities, and premature placental detachment (PPD), thyroid disorders, among others. Thus, pregnancy has an impact on the thyroid gland causing changes in the functioning of the mother's thyroid gland, altering the thyroid hormone (TH) profiles and production as pregnancy progresses. Considering, throughout the gestational period, the interpretation of the results of the tests to evaluate the thyroid functioning depends on the stage in which the pregnancy is. Thyroid disorders are directly related to adverse obstetric outcomes and in child development. Therefore, the adequate release of TH is important for a pregnancy without complications and optimal fetal growth and development. Objective: Investigate the physiological effects caused by thyroid disorders in the gestational period. Methods: A search for articles indexed in PubMed, Scielo, and MDPI databases, was performed using the term “AND”, with the descriptors: Pregnancy, Thyroid. With several combinations that included: Melatonin, Thyroidopathy, Inflammatory processes, Cytokines, Anti-inflammatory, Antioxidant, High-risk pregnancy. Subsequently, the screening was performed through the analysis of titles and/or abstracts. The criteria were: including clinical studies in general, randomized or not, in the period of 10 years prior to the research, in the English literature; excluded: experimental studies, case reports, research in the development phase. Results: In the preliminary results, a total of studies (n=183) were found, (n=57) excluded, such as studies of cancer, diabetes, obesity, and skin diseases. Conclusion: To date, it has been identified that thyroid diseases can impair the fetus’s brain development. Further research is suggested on this matter to identify new substances that may have a potential therapeutic effect to aid the gestational period with thyroid diseases.

Keywords: pregnancy, thyroid, melatonin, high-risk pregnancy

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Authors: Shofiayuningtyas Luftiani

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Some private schools in Indonesia started integrating the online program Gizmos in the teaching-learning process. Gizmos was developed to supplement the existing curriculum by integrating it into the instructional programs. The program has some features using an inquiry-based simulation, in which students conduct exploration by using a worksheet while teachers use the teacher guidelines to direct and assess students’ performance In this study, the discussion about Gizmos highlights its features as the assessment media of mathematics learning for secondary school students. The discussion is based on the case study and literature review from the Indonesian context. The purpose of applying Gizmos as an assessment media refers to the diagnostic assessment. As a part of the diagnostic assessment, the teachers review the student exploration sheet, analyze particularly in the students’ difficulties and consider findings in planning future learning process. This assessment becomes important since the teacher needs the data about students’ persistent weaknesses. Additionally, this program also helps to build student’ understanding by its interactive simulation. Currently, the assessment over-emphasizes the students’ answers in the worksheet based on the provided answer keys while students perform their skill in translating the question, doing the simulation and answering the question. Whereas, the assessment should involve the multiple perspectives and sources of students’ performance since teacher should adjust the instructional programs with the complexity of students’ learning needs and styles. Consequently, the approach to improving the assessment components is selected to challenge the current assessment. The purpose of this challenge is to involve not only the cognitive diagnosis but also the analysis of skills and error. Concerning the selected setting for this diagnostic assessment that develops the combination of cognitive diagnosis, skills analysis and error analysis, the teachers should create an assessment rubric. The rubric plays the important role as the guide to provide a set of criteria for the assessment. Without the precise rubric, the teacher potentially ineffectively documents and follows up the data about students at risk of failure. Furthermore, the teachers who employ the program of Gizmos as the diagnostic assessment might encounter some obstacles. Based on the condition of assessment in the selected setting, the obstacles involve the time constrain, the reluctance of higher teaching burden and the students’ behavior. Consequently, the teacher who chooses the Gizmos with those approaches has to plan, implement and evaluate the assessment. The main point of this assessment is not in the result of students’ worksheet. However, the diagnostic assessment has the two-stage process; the process to prompt and effectively follow-up both individual weaknesses and those of the learning process. Ultimately, the discussion of Gizmos as the media of the diagnostic assessment refers to the effort to improve the mathematical learning process.

Keywords: diagnostic assessment, error analysis, Gizmos online program, skills analysis

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Authors: O. Adjoul, A. Feugier, K. Benfriha, A. Aoussat

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In general, issues related to design and maintenance are considered in an independent manner. However, the decisions made in these two sets influence each other. The design for maintenance is considered an opportunity to optimize the life cycle cost of a product, particularly in the nuclear or aeronautical field, where maintenance expenses represent more than 60% of life cycle costs. The design of large-scale systems starts with product architecture, a choice of components in terms of cost, reliability, weight and other attributes, corresponding to the specifications. On the other hand, the design must take into account maintenance by improving, in particular, real-time monitoring of equipment through the integration of new technologies such as connected sensors and intelligent actuators. We noticed that different approaches used in the Design For Maintenance (DFM) methods are limited to the simultaneous characterization of the reliability and maintainability of a multi-component system. This article proposes a method of DFM that assists designers to propose dynamic maintenance for multi-component industrial systems. The term "dynamic" refers to the ability to integrate available monitoring data to adapt the maintenance decision in real time. The goal is to maximize the availability of the system at a given life cycle cost. This paper presents an approach for simultaneous optimization of the design and maintenance of multi-component systems. Here the design is characterized by four decision variables for each component (reliability level, maintainability level, redundancy level, and level of monitoring data). The maintenance is characterized by two decision variables (the dates of the maintenance stops and the maintenance operations to be performed on the system during these stops). The DFM model helps the designers choose technical solutions for the large-scale industrial products. Large-scale refers to the complex multi-component industrial systems and long life-cycle, such as trains, aircraft, etc. The method is based on a two-level hybrid algorithm for simultaneous optimization of design and maintenance, using genetic algorithms. The first level is to select a design solution for a given system that considers the life cycle cost and the reliability. The second level consists of determining a dynamic and optimal maintenance plan to be deployed for a design solution. This level is based on the Maintenance Free Operating Period (MFOP) concept, which takes into account the decision criteria such as, total reliability, maintenance cost and maintenance time. Depending on the life cycle duration, the desired availability, and the desired business model (sales or rental), this tool provides visibility of overall costs and optimal product architecture.

Keywords: availability, design for maintenance (DFM), dynamic maintenance, life cycle cost (LCC), maintenance free operating period (MFOP), simultaneous optimization

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Authors: Aziza Barnawi

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Background: Regular exercise reduces risk factors associated with cardiovascular diseases. Over the past decade, exercise interventions have been introduced to reduce the risk of and prevent coronary artery disease (CAD). Elevated low-density lipoproteins (LDL) contribute to the formation of atherosclerosis, its manifestations on the endothelial narrow the coronary artery and affect the endothelial function. Therefore, flow-mediated dilation (FMD) technique is used to assess the function. The results of previous studies have been inconsistent and difficult to interpret across different types of exercise programs. The relationship between exercise therapy and lipid levels has been extensively studied, and it is known to improve the lipid profile and endothelial function. However, the effectiveness of exercise in altering LDL levels and improving blood flow is controversial. Objective: This review aims to explore the evidence and quantify the impact of exercise training on LDL levels and vascular function by FMD. Methods: Electronic databases were searched PubMed, Google Scholar, Web of Science, the Cochrane Library, and EBSCO using the keywords: “low and/or moderate aerobic training”, “blood flow”, “atherosclerosis”, “LDL mediated blood flow”, “Cardiac Rehabilitation”, “low-density lipoproteins”, “flow-mediated dilation”, “endothelial function”, “brachial artery flow-mediated dilation”, “oxidized low-density lipoproteins” and “coronary artery disease”. The studies were conducted for 6 weeks or more and influenced LDL levels and/or FMD. Studies with different intensity training and endurance training in healthy or CAD individuals were included. Results: Twenty-one randomized controlled trials (RCTs) (14 FMD and 7 LDL studies) with 776 participants (605 exercise participants and 171 control participants) met eligibility criteria and were included in the systematic review. Endurance training resulted in a greater reduction in LDL levels and their subfractions and a better FMD response. Overall, the training groups showed improved physical fitness status compared with the control groups. Participants whose exercise duration was ≥150 minutes /week had significant improvement in FMD and LDL levels compared with those with <150 minutes/week.Conclusion: In conclusion, although the relationship between physical training, LDL levels, and blood flow in CAD is complex and multifaceted, there are promising results for controlling primary and secondary prevention of CAD by exercise. Exercise training, including resistance, aerobic, and interval training, is positively correlated with improved FMD. However, the small body of evidence for LDL studies (resistance and interval training) did not prove to be significantly associated with improved blood flow. Increasing evidence suggests that exercise training is a promising adjunctive therapy to improve cardiovascular health, potentially improving blood flow and contributing to the overall management of CAD.

Keywords: exercise training, low density lipoprotein, flow mediated dilation, coronary artery disease

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Authors: Abubakar Dikko

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The research investigates the causes of unemployment in Namibia, Nigeria and South Africa, and the role of Capital Accumulation in reducing the unemployment profile of these economies as proposed by the post-Keynesian economics. This is conducted through extensive review of literature on the NAIRU models and focused on the post-Keynesian view of unemployment within the NAIRU framework. The NAIRU (non-accelerating inflation rate of unemployment) model has become a dominant framework used in macroeconomic analysis of unemployment. The study views the post-Keynesian economics arguments that capital accumulation is a major determinant of unemployment. Unemployment remains the fundamental socio-economic challenge facing African economies. It has been a burden to citizens of those economies. Namibia, Nigeria and South Africa are great African nations battling with high unemployment rates. In 2013, the countries recorded high unemployment rates of 16.9%, 23.9% and 24.9% respectively. Most of the unemployed in these economies comprises of youth. Roughly about 40% working age South Africans has jobs, whereas in Nigeria and Namibia is less than that. Unemployment in Africa has wide implications on households which has led to extensive poverty and inequality, and created a rampant criminality. Recently in South Africa there has been a case of xenophobic attacks which were caused by the citizens of the country as a result of unemployment. The high unemployment rate in the country led the citizens to chase away foreigners in the country claiming that they have taken away their jobs. The study proposes that there is a strong relationship between capital accumulation and unemployment in Namibia, Nigeria and South Africa, and capital accumulation is responsible for high unemployment rates in these countries. For the economies to achieve steady state level of employment and satisfactory level of economic growth and development there is need for capital accumulation to take place. The countries in the study have been selected after a critical research and investigations. They are selected based on the following criteria; African economies with high unemployment rates above 15% and have about 40% of their workforce unemployed. This level of unemployment is the critical level of unemployment in Africa as expressed by International Labour Organization (ILO). The African countries with low level of capital accumulation. Adequate statistical measures have been employed using a time-series analysis in the study and the results revealed that capital accumulation is the main driver of unemployment performance in the chosen African countries. An increase in the accumulation of capital causes unemployment to reduce significantly. The results of the research work will be useful and relevant to federal governments and ministries, departments and agencies (MDAs) of Namibia, Nigeria and South Africa to resolve the issue of high and persistent unemployment rates in their economies which are great burden that slows growth and development of developing economies. Also, the result can be useful to World Bank, African Development Bank and International Labour Organization (ILO) in their further research and studies on how to tackle unemployment in developing and emerging economies.

Keywords: capital accumulation, unemployment, NAIRU, Post-Keynesian economics

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Authors: Gainiya Tazhina

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Higher education systems of many countries have increased diversity and ensured equal rights and opportunities for inclusive students in the last decades. Issues of diversity-equity-inclusion (DEI) in Kazakhstani higher education began to be considered in legislation in 2021-2023. The adoption of the Road Map of the Ministry of Education and Science for universities’ inclusivity indicated strategies for change. The paper traces how this government initiative is being implemented in universities across the country. Content analysis of legislative documents, media publications, surveys of students, staff and interviews with leaders have demonstrated the inconsistency of these strategic decisions. Thus, the Road Map required that by 2023 conditions for promoting and ensuring inclusive education and barrier-free environments should be created in 60% -100% of Kazakhstani universities, including spaces inside academic buildings and dormitories in a short period of time. (March 2023-August 2025). Educational programs and curricula have not been adapted to the needs of students with special education needs (SEN); teachers do not have the skills and methods to work with students with SEN, students from minority groups, and international students. 60% of universities have not created a barrier-free environment on campuses due to the high cost of elevators, tactile tiles and assistive devices. Only 1% of school-disabled graduates enter universities due to the unwillingness of universities to educate people with disabilities. At the same time, universities do not adapt their educational programs and services to the needs of inclusive students; their needs are not identified; they study under the same conditions as regular students. Accordingly, teaching staff does not have the knowledge and skills to teach inclusive students; university lecturers misunderstand or oversimplify the social phenomena of ‘inclusion’ and ‘diversity’. The situation is more acute with the creation of a barrier-free architectural environment on university campuses. Recent reports indicate that these reforms have not been implemented to date, proven controversial in practice due to the inconsistency of national research on inclusion in higher education. Widely announced reforms have not produced the expected results leading to distortions at the local level. Inconsistent policies, contradictory legislative acts without expertise of needs and developing specific implementation criteria, without training specialists and indicators for achieving reforms are doomed to failure and mistrust of society. Based on the results of this research, recommendations have been developed: (1) to overcome inconsistencies in legislation regarding DEI in higher education; (2) to encourage initiatives in universities' inclusive environments; (3) to develop projects that will promote public awareness of DEI.

Keywords: diversity-equity-inclusion, Kazakhstani universities, reforms, legislation, accessibility

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Authors: C. S. Chen, F. Y. Hui, B. S. Farhana, J. De Leon

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Introduction: Stroke can lead to long-term disability, affecting one’s quality of life. Providing stroke education to patient and family members is essential to optimize stroke recovery and prevent recurrent stroke. Currently, nurses conduct stroke education by handing out pamphlets and explaining their contents to patients. However, this is not always effective as nurses have varying levels of knowledge and depth of content discussed with the patient may not be consistent. With the advancement of information technology, health education is increasingly being disseminated via electronic software and studies have shown this to have benefitted patients. Hence, a multi-disciplinary team consisting of doctors, nurses and allied health professionals was formed to create the stroke journey map software to deliver consistent and concise stroke education. Research Objectives: To evaluate the effectiveness of using a stroke journey map software in improving patients’ perceived knowledge in the acute stroke unit during hospitalization. Methods: Patients admitted to the acute stroke unit were given stroke journey map software during patient education. The software consists of 31 interactive slides that are brightly coloured and 4 videos, based on input provided by the multi-disciplinary team. Participants were then assessed with pre-and-post survey questionnaires before and after viewing the software. The questionnaire consists of 10 questions with a 5-point Likert scale which sums up to a total score of 50. The inclusion criteria are patients diagnosed with ischemic stroke and are cognitively alert and oriented. This study was conducted between May 2017 to October 2017. Participation was voluntary. Results: A total of 33 participants participated in the study. The results demonstrated that the use of a stroke journey map as a stroke education medium was effective in improving patients’ perceived knowledge. A comparison of pre- and post-implementation data of stroke journey map revealed an overall mean increase in patients’ perceived knowledge from 24.06 to 40.06. The data is further broken down to evaluate patients’ perceived knowledge in 3 domains: (1) Understanding of disease process; (2) Management and treatment plans; (3) Post-discharge care. Each domain saw an increase in mean score from 10.7 to 16.2, 6.9 to 11.9 and 6.6 to 11.7 respectively. Project Impact: The implementation of stroke journey map has a positive impact in terms of (1) Increasing patient’s perceived knowledge which could contribute to greater empowerment of health; (2) Reducing need for stroke education material printouts making it environmentally friendly; (3) Decreasing time nurses spent on giving education resulting in more time to attend to patients’ needs. Conclusion: This study has demonstrated the benefit of using stroke journey map as a platform for stroke education. Overall, it has increased patients’ perceived knowledge in understanding their disease process, the management and treatment plans as well as the discharge process.

Keywords: acute stroke, education, ischemic stroke, knowledge, stroke

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Authors: Dorsa Pourmojib, Marc J. Boutin

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Urban space is used everyday by a diverse range of urban dwellers, each with different expectations. In this space, opportunities and resources are not distributed equitably among urban dwellers, despite the importance of inclusivity. In addition, some marginalized groups may not be considered. These include people with low incomes, immigrants from diverse cultures, various age groups, and those with special needs. To this end, this research aims to enhance social equity in urban space by bridging the gap between social equity and spatial equity in the urban context. This gap in the knowledge base related to urban design may be present for several reasons; lack of studies on relationship between social equity and spatial equity in urban open space, lack of practical design strategies for promoting social equity in urban open space, lack of proper site analysis in terms of context and users of the site both for designing new urban open spaces and developing the existing ones, and lack of researchers that are designers and finally it could be related to priorities of the city’s policies in addressing such issues, since it is time, money and energy consuming. The main objective of this project is addressing the aforementioned gap in the knowledge by exploring the relationship between social equity and spatial equity in urban open space. Answering the main question of this research is a promising step to this end; 'What are the considerations towards providing social equity through the design of urban elements that offer spatial equity?' To answer the main question of this research there are several secondary questions which should be addressed. Such as; how can the characteristics of social equity be translated to spatial equity? What are the diverse user’s needs and which of their needs are not considered in that site? What are the specific elements in the site which should be designed in order to promote social equity? What is the current situation of social and spatial equity in the proposed site? To answer the research questions and achieve the proposed objectives, a three-step methodology has been implemented. Firstly, a comprehensive research framework based on the available literature has been presented. Afterwards, three different urban spaces have been analyzed in terms of specific key research questions as the precedent studies; Naqsh-e Jahan Square (Iran), Superkilen Park (Denmark) and Campo Dei Fiori (Italy). In this regard, a proper gap analysis of the current situation and the proposed situation of these sites has been conducted. Finally, by combining the extracted design considerations from the precedent studies and the literature review, practical design strategies have been introduced as a result of this research. The presented guidelines enable the designers to create socially equitable urban spaces. To conclude, this research proposes a spatial approach to social inclusion and equity in urban space by presenting a practical framework and criteria for translating social equity to spatial equity in urban areas.

Keywords: inclusive urban design, social equity, social inclusion, spatial equity

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Authors: Adonis Menezes, J. C. Passos

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The current panorama of technology in heat transfer and the scarcity of information about the convective boiling of CO₂ and hydrocarbon in small diameter channels motivated the development of this work. Among non-halogenated refrigerants, CO₂/ R744 has distinct thermodynamic properties compared to other fluids. The R744 presents significant differences in operating pressures and temperatures, operating at higher values compared to other refrigerants, and this represents a challenge for the design of new evaporators, as the original systems must normally be resized to meet the specific characteristics of the R744, which creates the need for a new design and optimization criteria. To carry out the convective boiling tests of CO₂, an experimental apparatus capable of storing (m= 10kg) of saturated CO₂ at (T = -30 ° C) in an accumulator tank was used, later this fluid was pumped using a positive displacement pump with three pistons, and the outlet pressure was controlled and could reach up to (P = 110bar). This high-pressure saturated fluid passed through a Coriolis type flow meter, and the mass velocities varied between (G = 20 kg/m².s) up to (G = 1000 kg/m².s). After that, the fluid was sent to the first test section of circular cross-section in diameter (D = 4.57mm), where the inlet and outlet temperatures and pressures, were controlled and the heating was promoted by the Joule effect using a source of direct current with a maximum heat flow of (q = 100 kW/m²). The second test section used a cross-section with multi-channels (seven parallel channels) with a square cross-section of (D = 2mm) each; this second test section has also control of temperature and pressure at the inlet and outlet as well as for heating a direct current source was used, with a maximum heat flow of (q = 20 kW/m²). The fluid in a biphasic situation was directed to a parallel plate heat exchanger so that it returns to the liquid state, thus being able to return to the accumulator tank, continuing the cycle. The multi-channel test section has a viewing section; a high-speed CMOS camera was used for image acquisition, where it was possible to view the flow patterns. The experiments carried out and presented in this report were conducted in a rigorous manner, enabling the development of a database on the convective boiling of the R744 in macro and micro channels. The analysis prioritized the processes from the beginning of the convective boiling until the drying of the wall in a subcritical regime. The R744 resurfaces as an excellent alternative to chlorofluorocarbon refrigerants due to its negligible ODP (Ozone Depletion Potential) and GWP (Global Warming Potential) rates, among other advantages. The results found in the experimental tests were very promising for the use of CO₂ in micro-channels in convective boiling and served as a basis for determining the flow pattern map and correlation for determining the heat transfer coefficient in the convective boiling of CO₂.

Keywords: convective boiling, CO₂/R744, macro-channels, micro-channels

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Authors: Valentina Adduci

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The developing research aims to define in general the criteria of environmental sustainability of rural buildings in Puglia and particularly in the manor farm. The main part of the study analyzes the relationship / dependence between the rural building and the landscape which, after many stratifications, results clearly identified and sometimes also characterized in a positive way. The location of the manor farm, in fact, is often conditioned by the infrastructural network and by the structure of the agricultural landscape. The manor farm, without the constraints due to the urban pattern’s density, was developed in accordance with a logical settlement that gives priority to the environmental aspects. These vernacular architectures are the most valuable example of how our ancestors have planned their dwellings according to nature. The 237 farms, analysis’ object, have been reported in cartography through the GIS system; a symbol has been assigned to each of them to identify the architectural typology and a different color for the historical period of construction. A datasheet template has been drawn up, and it has made possible a deeper understanding of each manor farm. This method provides a faster comparison of the most recurring characters in all the considered buildings, except for those farms which benefited from special geographical conditions, such as proximity to the road network or waterways. Below there are some of the most frequently constants derived from the statistical study of the examined buildings: southeast orientation of the main facade; placement of the sheep pen on the ground tilted and exposed to the south side; larger windowed surface on the south elevation; smaller windowed surface on the north elevation; presence of shielding vegetation near the more exposed elevations to the solar radiation; food storage’s rooms located on the ground floor or in the basement; animal shelter located in north side of the farm; presence of tanks and wells, sometimes combined with a very accurate channeling storm water system; thick layers of masonry walls, inside of which were often obtained hollow spaces to house stairwells or depots for the food storage; exclusive use of local building materials. The research aims to trace the ancient use of bioclimatic constructive techniques in the Apulian rural architecture and to define those that derive from an empirical knowledge and those that respond to an already encoded design. These constructive expedients are especially useful to obtain an effective passive cooling, to promote the natural ventilation and to built ingenious systems for the recovery and the preservation of rainwater and are still found in some of the manor farms analyzed, most of them are, today, in a serious state of neglect.

Keywords: bioclimatic devices, farmstead, rural landscape, sustainability

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Authors: Carmen Noheda

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This text provides a reflection on the way of thinking about the study of the history of music by examining the production of historiography in Spain at the turn of the century. Based on concepts developed by the historical theorist Jörn Rüsen, the article focuses on the following aspects: the theoretical artifacts that structure the interpretation of the limits of writing the history of music, the narrative patterns used to give meaning to the discourse of history, and the orientation context that functions as a source of criteria of significance for both interpretation and representation. This analysis intends to show that historical music theory is not only a means to abstractly explore the complex questions connected to the production of historical knowledge, but also a tool for obtaining concrete images about the intellectual practice of professional musicologists. Writing about the historiography of contemporary Spanish music is a task that requires both a knowledge of the history that is being written and investigated, as well as a familiarity with current theoretical trends and methodologies that allow for the recognition and definition of the different tendencies that have arisen in recent decades. With the objective of carrying out these premises, this project takes as its point of departure the 'immediate historiography' in relation to Spanish music at the beginning of the 21st century. The hesitation that Spanish musicology has shown in opening itself to new anthropological and sociological approaches, along with its rigidity in the face of the multiple shifts in dynamic forms of thinking about history, have produced a standstill whose consequences can be seen in the delayed reception of the historiographical revolutions that have emerged in the last century. Methodologically, this essay is underpinned by Rüsen’s notion of the disciplinary matrix, which is an important contribution to the understanding of historiography. Combined with his parallel conception of differing paradigms of historiography, it is useful for analyzing the present-day forms of thinking about the history of music. Following these theories, the article will in the first place address the characteristics and identification of present historiographical currents in Spanish musicology to thereby carry out an analysis based on the theories of Rüsen. Finally, it will establish some considerations for the future of musical historiography, whose atrophy has not only fostered the maintenance of an ingrained positivist tradition, but has also implied, in the case of Spain, an absence of methodological schools and an insufficient participation in international theoretical debates. An update of fundamental concepts has become necessary in order to understand that thinking historically about music demands that we remember that subjects are always linked by reciprocal interdependencies that structure and define what it is possible to create. In this sense, the fundamental aim of this research departs from the recognition that the history of music is embedded in the conditions that make it conceivable, communicable and comprehensible within a society.

Keywords: historiography, Jörn Rüssen, Spanish musicology, theory of history of music

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Authors: Vasiliki Markantoni, Eftychia Platsidaki, Georgios Chaidemenos, Georgios Kontochristopoulos

Abstract:

Introduction: Bromhidrosis, also known as osmidrosis, is a common distressing condition with a significant negative effect on patient’s quality of life. Its etiology is multifactorial. It usually affects axilla, genital skin, breasts and soles, areas where apocrine glands are mostly distributed. Therapeutic treatments include topical antibacterial agents, antiperspirants and neuromuscular blocker agents-toxins. In this study, we aimed to evaluate the efficacy and possible complications of topical glycopyrrolate, an anticholinergic agent, for treatment of bromhidrosis. Glycopyrrolate, applied topically as a cream, solution or spray at concentrations between 0,5% and 4%, has been successfully used to treat different forms of focal hyperhidrosis. Materials and Methods: Twenty patients, six males and fourteen females, meeting the criteria for bromhidrosis were treated with topical glycopyrrolate for two months. The average age was 36. Eleven patients had bromhidrosis located to the axillae, four to the soles, four to both axillae and soles and one to the genital folds. Glycopyrrolate was applied topically as a cream at concentration 2%, formulated in Fitalite. During the first month, patients were using the cream every night and thereafter twice daily. The degree of malodor was assessed subjectively by patients and scaled averagely as ‘none’, ‘mild’, ‘moderate’, and ‘severe’ with corresponding scores of 0, 1, 2, and 3, respectively. The modified Dermatology Life Quality Index (DLQI) was used to assess the quality of life. The clinical efficacy was graded by the patient scale of excellent, good, fair and poor. In the end, patients were given the power to evaluate whether they were totally satisfied with, partially satisfied or unsatisfied and possible side effects during the treatment were recorded. Results: All patients were satisfied at the end of the treatment. No patient defined the response as no improvement. The subjectively assessed score level of bromhidrosis was remarkably improved after the first month of treatment and improved slightly more after the second month. DLQI score was also improved to all patients. Adverse effects were reported in 2 patients. In the first case, topical irritation was reported. This was classed as mild (erythema and desquamation), appeared during the second month of treatment and was treated with low-potency topical corticosteroids. In the second case, mydriasis was reported, that recovered without specific treatment, as soon as we insisted to the importance of careful hygiene after cream application so as not to contaminate the periocular skin or ocular surface. Conclusions: Dermatologists often encounter patients with bromhidrosis, therefore should be aware of treatment options. To the best of our knowledge, this is the first study to evaluate the use of topical glycopyrrolate as a therapeutic approach for bromhidrosis. Our findings suggest that topical glycopyrrolate has an excellent safety profile and demonstrate encouraging results for the management of this distressful condition.

Keywords: Bromhidrosis, glycopyrrolate, topical treatment, osmidrosis

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Authors: Anchal Rana

Abstract:

Indian Himalayas with their diverse climatic conditions are home to many rare and endangered medicinal flora. One such species is Polygonatum verticillatum Linn., popularly known as King Solomon’s Seal or Solomon’s Seal. Its mention as an incredible medicinal herb comes from 5000 years ago in Indian Materia Medica as a component of Ashtavarga, a poly-herbal formulation comprising of eight herbs illustrated as world’s first ever revitalizing and rejuvenating nutraceutical food, which is now commercialised in the name ‘Chaywanprash’. It is an erect tall (60 to 120 cm) perennial herb with sessile, linear leaves and white pendulous flowers. The species grows well in an altitude range of 1600 to 3600 m amsl, and propagates mostly through rhizomes. The rhizomes are potential source for significant phytochemicals like flavonoids, phenolics, lectins, terpenoids, allantoin, diosgenin, β-Sitosterol and quinine. The presence of such phytochemicals makes the species an asset for antioxidant, cardiotonic, demulcent, diuretic, energizer, emollient, aphrodisiac, appetizer, glactagogue, etc. properties. Having profound concentrations of macro and micronutrients, species has fine prospects of being used as a diet supplement. However, due to unscientific and gregarious uprooting, it has been assigned a status of ‘vulnerable’ and ‘endangered’ in the Conservation Assessment and Management Plan (CAMP) process conducted by Foundation for Revitalisation of Local Health Traditions (FRLHT) during 2010, according to IUCN Red-List Criteria. Further, destructive harvesting, land use disturbances, heavy livestock grazing, climatic changes and habitat fragmentation have substantially contributed towards anomaly of the species. It, therefore, became imperative to conserve the diversity of the species and make judicious use in future research and commercial programme and schemes. A Gene Bank was therefore established at High Altitude Herbal Garden of the Forest Research Institute, Dehradun, India situated at Chakarata (30042’52.99’’N, 77051’36.77’’E, 2205 m amsl) consisting 149 accessions collected from thirty-one geographical locations spread over three Himalayan States of Jammu and Kashmir, Himachal Pradesh, and Uttarakhand. The present investigations purport towards sampling and collection of divergent germplasm followed by planting and cultivation techniques. The ultimate aim is thereby focussed on analysing genetic diversity of the species and capturing promising genotypes for carrying out further genetic improvement programme so to contribute towards sustainable development and healthcare.

Keywords: Polygonatum verticillatum Linn., phytochemicals, genetic diversity, conservation, gene bank

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Authors: Tatjana Pekmezovic, Milica Jecmenica-Lukic, Igor Petrovic, Vladimir Kostic

Abstract:

Background: A group of atypical parkinsonian syndromes (APS) includes a variety of rare neurodegenerative disorders characterized by reduced life expectancy, increasing disability, and considerable impact on health-related quality of life (HRQoL). Aim: In this study we wanted to answer two questions: a) which demographic and clinical factors are main contributors of HRQoL in our cohort of patients with APS, and b) how does quality of life of these patients change over 1-year follow-up period. Patients and Methods: We conducted a prospective cohort study in hospital settings. The initial study comprised all consecutive patients who were referred to the Department of Movement Disorders, Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade (Serbia), from January 31, 2000 to July 31, 2013, with the initial diagnoses of ‘Parkinson’s disease’, ‘parkinsonism’, ‘atypical parkinsonism’ and ‘parkinsonism plus’ during the first 8 months from the appearance of first symptom(s). The patients were afterwards regularly followed in 4-6 month intervals and eventually the diagnoses were established for 46 patients fulfilling the criteria for clinically probable progressive supranuclear palsy (PSP) and 36 patients for probable multiple system atrophy (MSA). The health-related quality of life was assessed by using the SF-36 questionnaire (Serbian translation). Hierarchical multiple regression analysis was conducted to identify predictors of composite scores of SF-36. The importance of changes in quality of life scores of patients with APS between baseline and follow-up time-point were quantified using Wilcoxon Signed Ranks Test. The magnitude of any differences for the quality of life changes was calculated as an effect size (ES). Results: The final models of hierarchical regression analysis showed that apathy measured by the Apathy evaluation scale (AES) score accounted for 59% of the variance in the Physical Health Composite Score of SF-36 and 14% of the variance in the Mental Health Composite Score of SF-36 (p<0.01). The changes in HRQoL were assessed in 52 patients with APS who completed 1-year follow-up period. The analysis of magnitude for changes in HRQoL during one-year follow-up period have shown sustained medium ES (0.50-0.79) for both Physical and Mental health composite scores, total quality of life as well as for the Physical Health, Vitality, Role Emotional and Social Functioning. Conclusion: This study provides insight into new potential predictors of HRQoL and its changes over time in patients with APS. Additionally, identification of both prognostic markers of a poor HRQoL and magnitude of its changes should be considered when developing comprehensive treatment-related strategies and health care programs aimed at improving HRQoL and well-being in patients with APS.

Keywords: atypical parkinsonian syndromes, follow-up study, quality of life, APS

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Authors: Kathrina Aseanne Acapulco-Gomez, Shayne Julieane Morales, Tzar Francis Verame

Abstract:

Mean platelet volume (MPV) is the most accurate measure of the size of platelets and is routinely measured by most automated hematological analyzers. Several studies have shown associations between MPV and cardiovascular risks and outcomes. Although its measurement may provide useful data, MPV remains to be a diagnostic tool that is yet to be included in routine clinical decision making. The aim of this systematic review and meta-analysis is to determine summary estimates of the diagnostic accuracy of mean platelet volume for the diagnosis of myocardial infarction among adult patients with angina and/or its equivalents in terms of sensitivity, specificity, diagnostic odds ratio, and likelihood ratios, and to determine the difference of the mean MPV values between those with MI and those in the non-MI controls. The primary search was done through search in electronic databases PubMed, Cochrane Review CENTRAL, HERDIN (Health Research and Development Information Network), Google Scholar, Philippine Journal of Pathology, and Philippine College of Physicians Philippine Journal of Internal Medicine. The reference list of original reports was also searched. Cross-sectional, cohort, and case-control articles studying the diagnostic performance of mean platelet volume in the diagnosis of acute myocardial infarction in adult patients were included in the study. Studies were included if: (1) CBC was taken upon presentation to the ER or upon admission (within 24 hours of symptom onset); (2) myocardial infarction was diagnosed with serum markers, ECG, or according to accepted guidelines by the Cardiology societies (American Heart Association (AHA), American College of Cardiology (ACC), European Society of Cardiology (ESC); and, (3) if outcomes were measured as significant difference AND/OR sensitivity and specificity. The authors independently screened for inclusion of all the identified potential studies as a result of the search. Eligible studies were appraised using well-defined criteria. Any disagreement between the reviewers was resolved through discussion and consensus. The overall mean MPV value of those with MI (9.702 fl; 95% CI 9.07 – 10.33) was higher than in those of the non-MI control group (8.85 fl; 95% CI 8.23 – 9.46). Interpretation of the calculated t-value of 2.0827 showed that there was a significant difference in the mean MPV values of those with MI and those of the non-MI controls. The summary sensitivity (Se) and specificity (Sp) for MPV were 0.66 (95% CI; 0.59 - 0.73) and 0.60 (95% CI; 0.43 – 0.75), respectively. The pooled diagnostic odds ratio (DOR) was 2.92 (95% CI; 1.90 – 4.50). The positive likelihood ratio of MPV in the diagnosis of myocardial infarction was 1.65 (95% CI; 1.20 – 22.27), and the negative likelihood ratio was 0.56 (95% CI; 0.50 – 0.64). The intended role for MPV in the diagnostic pathway of myocardial infarction would perhaps be best as a triage tool. With a DOR of 2.92, MPV values can discriminate between those who have MI and those without. For a patient with angina presenting with elevated MPV values, it is 1.65 times more likely that he has MI. Thus, it is implied that the decision to treat a patient with angina or its equivalents as a case of MI could be supported by an elevated MPV value.

Keywords: mean platelet volume, MPV, myocardial infarction, angina, chest pain

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