Search results for: factors of collaboration

Authors: Mohamed Abdelrahman Abdalla

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Apart from their function in producing CSF, the brain ventricles have been recognized as the mere remnant of the embryological neural tube with no clear role. The lack of proper definition of the function of the brain ventricles and the central spinal canal has made it difficult to ascertain the pathophysiology of its different disease conditions or to treat them. This study aims to review the simple physics that could explain the basic function of the CNS ventricular system and to suggest new ways of approaching its pathology. There are probably more physical factors to consider than only the pressure. Monro-Killie hypothesis focuses on volume and subsequently pressure to direct our surgical management in different disease conditions. However, the enlarged volume of the ventricles in normal pressure hydrocephalus does not move any blood or brain outside the skull. Also, in idiopathic intracranial hypertension, the very high intracranial pressure rarely causes brain herniation. On this note, the continuum of the intracranial cavity with the spinal canal makes it a whole unit and hence the defect in the theory. In this study, adding different factors to the equation like brain and CSF density and positions of the brain in space, in addition to the volume and pressure, aims to identify how the ventricles are important in the CNS homeostasis. In addition, increasing the variables that we analyze to treat different CSF pathological conditions should increase our understanding and hence accuracy of treatment of such conditions.

Keywords: communicating hydrocephalus, functions of the ventricles, idiopathic intracranial hypertension physics of CSF

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Authors: Choumous Mannoubi, Dahlia Kairy, Brigitte Vachon

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The use of technology allows clinicians to provide an individualized approach in a cost-effective manner and to reach a broader client base more easily. Such interventions can be effective in ensuring self-management and follow-up of people with diabetes, reducing the risk of complications by improving accessibility to care services, and better adherence to health recommendations. Consideration of users' opinions and fears to inform the design and implementation stages of these telehealth services seems to be essential to improve their acceptance and usability. The objective of this study is to describe the telepractice of nutritionists supporting the therapeutic management of diabetic patients and document the functional requirements of nutritionists for the design of a tele-nutrition platform. To best identify the requirements and constraints of nutritionists, we conducted individual semi-structured interviews with 10 nutritionists who offered tele-nutrition services. Using a qualitative design with a descriptive approach based on the Nutrition Care Process Model (mNCP) framework, we explored in depth the state of nutritionists' telepractice in public and private health care settings, as well as their requirements for teleconsultation. Qualitative analyses revealed that nutritionists primarily used telephone calls during the COVID 19 pandemic to provide teleconsultations. Nutritionists identified the following important features for the design of a tele-nutrition platform: it should support interprofessional collaboration, allow for the development and monitoring of a care plan, integrate with the existing IT environment, be easy to use, accommodate different levels of patient literacy, and allow for easy sharing of educational materials to support nutrition education.

Keywords: telehealth, nutrition, diabetes, telenutrition, teleconsultation, telemonitoring

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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A core challenge of physician assistant education is preparing professionals for lifelong learning. While this conventionally has encompassed scientific advances, students must also embrace new care delivery models and technologies. Telemedicine, the provision of care via two-way audio and video, is an example of a technological advance reforming health care. During a three-semester sequence of Hospital Community Experiences, physician assistant students were assigned experiences with Answer Health on Demand, a telemedicine collaborative. Preceding the experiences, the agency lectured on the application of telemedicine. Students were then introduced to the technology and partnered with a provider. Prior to observing the patient-provider interaction, patient consent was obtained. Afterwards, students completed a reflection paper on lessons learned and the potential impact of telemedicine on their careers. Thematic analysis was completed on the students’ reflection papers (n=13). Preceding the lecture and experience, over 75% of students (10/13) were unaware of telemedicine. Several stated they were 'skeptical' about the effectiveness of 'impersonal' health care appointments. After the experience, all students remarked that telemedicine will play a large role in the future of healthcare and will provide benefits by improving access in rural areas, decreasing wait time, and saving cost. More importantly, 30% of students (4/13) commented that telemedicine is a technology they can see themselves using in their future practice. Initial results indicate that collaborative interaction between students and telemedicine providers enhanced student learning and exposed students to technological advances in the delivery of care. Further, results indicate that students perceived telemedicine more favorably as a viable delivery method after the experience.

Keywords: collaboration, physician assistant education, teaching innovative health care delivery method, telemedicine

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Authors: Sulaiman Yunus

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The need for modeling response to urban fire disaster cannot be over emphasized, as recurrent fire outbreaks have gutted most cities of the world. This necessitated the need for a prompt and efficient response system in order to mitigate the impact of the disaster. Promptness, as a function of time, is seen to be the fundamental determinant for efficiency of a response system and magnitude of a fire disaster. Delay, as a result of several factors, is one of the major determinants of promptgness of a response system and also the magnitude of a fire disaster. Response Delay Model (RDM) intends to bridge the gap in urban fire disaster response system through incorporating and synchronizing the delay moments in measuring the overall efficiency of a response system and determining the magnitude of a fire disaster. The model identified two delay moments (pre-notification and Intra-reflex sequence delay) that can be elastic and collectively plays a significant role in influencing the efficiency of a response system. Due to variation in the elasticity of the delay moments, the model provides for measuring the length of delays in order to arrive at a standard average delay moment for different parts of the world, putting into consideration geographic location, level of preparedness and awareness, technological advancement, socio-economic and environmental factors. It is recommended that participatory researches should be embarked on locally and globally to determine standard average delay moments within each phase of the system so as to enable determining the efficiency of response systems and predicting fire disaster magnitudes.

Keywords: delay moment, fire disaster, reflex sequence, response, response delay moment

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Authors: Osama Shakeel

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The objective of the paper is to study the clinic-pathological factors, survival analyses, recurrence rate, metastatic rate, risk factors and the management of cutaneous malignant melanoma at Shaukat Khanum Memorial Cancer Hospital and Research Center. Methodology: From 2014 to 2017, all patients with a diagnosis of cutaneous malignant melanoma (CMM) were included in the study. Demographic variables were collected. Short and long term oncological outcomes were recorded. All data were entered and analyzed in SPSS version 21. Results: A total of 28 patients were included in the study. Median age was 46.5 +/-15.9 years. There were 16 male and 12 female patients. The family history of melanoma was present in 7.1% (n=2) of the patients. All patients had a mean survival of 13.43+/- 9.09 months. Lower limb was the commonest site among all which constitutes 46.4%(n=13). On histopathological analyses, ulceration was seen in 53.6% (n=15) patients. Unclassified tumor type was present in 75%(n=21) of the patients followed by nodular 21.4% (n=6) and superficial spreading 3.5%(n=1). Clark level IV was the commonest presentation constituting 46.4%(n=13). Metastases were seen in 50%(n=14) of the patients. Local recurrence was observed in 60.7%(n=17). 64.3%(n=18) lived after one year of treatment. Conclusion: CMM is a fatal disease. Although its disease of fair skin individuals, however, the incidence of CMM is also rising in this part of the world. Management includes early diagnoses and prompt management. However, mortality associated with this disease is still not favorable.

Keywords: malignant cancer of skin, cutaneous malignant melanoma, skin cancer, survival analyses

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Authors: Meshal Alsaiari

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Fused Deposition Modeling is one of the additive manufacturing technologies the industry is shifting to nowadays due to its simplicity and low affordable cost. The fabrication processing parameters predominantly influence FDM part strength and mechanical properties. This presentation will demonstrate the influences of the two manufacturing parameters on the tensile testing evaluation indexes, infill density, and Printing Orientation, which were analyzed to create a piping spacer suitable for oil and gas applications. The tensile specimens are made of two polymers, Acrylonitrile Styrene Acrylate (ASA) and High high-impact polystyrene (HIPS), to characterize the mechanical properties performance for creating the final product. The mechanical testing was carried out per the ASTM D638 testing standard, following Type IV requirements. Taguchi's experiment design using an L-9 orthogonal array was used to evaluate the performance output and identify the optimal manufacturing factors. The experimental results demonstrate that the tensile test is more pronounced with 100% infill for ASA and HIPS samples. However, the printing orientations varied in reactions; ASA is maximum at 0 degrees while HIPS shows almost similar percentages between 45 and 90 degrees. Taguchi-Gray integrated methodology was adopted to minimize the response and recognize optimal fabrication factors combinations.

Keywords: FDM, ASTM D638, tensile testing, acrylonitrile styrene acrylate

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Authors: Onyinyechi Joy Kingdom

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Mergers and Acquisitions (M&A) have been proposed as a mechanism through which, problems associated with inefficiency or poor performance in financial institution could be addressed. The aim of this study is to examine the proposition that recapitalization of banks, which encouraged Mergers and Acquisitions in Nigeria banking system, would strengthen the domestic banks, improve financial deepening and the confidence of depositors. Hence, this study examines the impact of the 2005 M&A in the Nigerian-banking sector on financial deepening using mixed method (quantitative and qualitative approach). The quantitative process of this study utilised annual time series for financial deepening indicator for the period of 1997 to 2012. While, the qualitative aspect adopted semi-structured interview to collate data from three merged banks and three stand-alone banks to explore, understand and complement the quantitative results. Furthermore, a framework thematic analysis is employed to analyse the themes developed using NVivo 11 software. Using the quantitative approach, findings from the equality of mean test (EMT) used suggests that M&A have significant impact on financial deepening. However, this method is not robust enough given its weak validity as it does not control for other potential factors that may determine financial deepening. Thus, to control for other factors that may affect the level of financial deepening, a Multiple Regression Model (MRM) and Interrupted Times Series Analysis (ITSA) were applied. The coefficient for M&A dummy turned negative and insignificant using MRM. In addition, the estimated linear trend of the post intervention when ITSA was applied suggests that after M&A, the level of financial deepening decreased annually; however, this was statistically insignificant. Similarly, using the qualitative approach, the results from the interview supported the quantitative results from ITSA and MRM. The result suggests that interest rate should fall when capital base is increased to improve financial deepening. Hence, this study contributes to the existing literature the importance of other factors that may affect financial deepening and the economy when policies that will enhance bank performance and the economy are made. In addition, this study will enable the use of valuable policy instruments relevant to monetary authorities when formulating policies that will strengthen the Nigerian banking sector and the economy.

Keywords: mergers and acquisitions, recapitalization, financial deepening, efficiency, financial crisis

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Authors: Luciana Brandao Ferreira, Janaina de Moura Engracia Giraldi, Fabiana Gondim Mariutti, Marina Toledo de Arruda Lourencao

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Developing countries, such as BRICS (Brazil, Russia, India, China and South Africa) are hosting sports mega-events to promote socio-economic development and image enhancement. Thus, this paper aims to verify the image of Rio de Janeiro, in Brazil, as the host city of 2016 Olympic Games, considering the main cognitive and affective image dimensions. The research design uses exploratory factorial analysis to find the most important factors highlighted in the city image dimensions. The data were collected by structured questionnaires with an international respondents sample (n=274) with high international travel experience. The results show that Rio’s image as a sport mega-event host city has two main factors in each dimension: Cognitive ('General Infrastructure'; 'Services and Attractions') and Affective ('Positive Feelings'; 'Negative Feelings'). The most important factor related to cognitive dimension was 'Services and Attractions' which is more related to tourism activities. In the affective dimension 'Positive Feelings' was the most important factor, which means a good result considering that is a city in an emerging country with many unmet social demands.

Keywords: Rio de Janeiro, 2016 olympic games, host city image, cognitive image dimension, affective image dimension

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Authors: Pornwipa Daoduong, Jairak Loysongkroa, Napaphan Viriyautsahakul, Wachira Pengjuntr

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Obesity is on of serious health problem in many countries including Thailand where the prevalence of childhood obesity has increased from 8.8 % in 2014 to 9.5 % in 2015 and 12.9 % in 2016. The Ministry of Public Health’s objective is to reduce prevalence of childhood Obesity to 10% or lower in 2017, by implementing the measure in relation to nutrition, physical activity (PA) and environment in 6,405 targeted school with proportion of school children with obesity is higher than 10 %. Smart Kids Coacher (SKC)” is a new innovative intervention created by Department of Health and consists of 252 regional and provincial officers. The SKC aims to train the super trainers about food and nutrition.PA and emotional control through implementing three learning activities including 1) Food for Fun is about Nutrition flag, Nutrition label, food portion and Nutrition surveillance; 2) Fun for Fit includes intermediated- and advanced level workouts within 60 minutes such as kangaroo dance, Chair stretching; and 3) Control emotional is about to prevent probability of access to unhealthy food, to ensure for having meal in appropriate time, and to recruit peers and family member to increase awareness among target groups. Apart from providing SKC lesson for 3,828 officers at district level, a number of students (2,176) as role model are selected through implementing “Smart Kids Leader: (SKL)”.Consequently. The SKC lowers proportion of childhood obesity from 17% in 2012 to 12.9% in 2016. Further, the SKC coverage should be expanded to other setting. Policy maker should be aware of the important of reduction of the prevalence of childhood obesity, and it’s related risk. Network and Collaboration between stakeholders are essential as well as an improvement of holistic intervention and knowledge “NuPETHS” for kids in the future.

Keywords: childhood obesity, model, obesity, smart kids coacher

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Authors: Tania Breton, Dorina Simeonov, Shauna MacEachern

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Ontario’s 10 Year Mental Health and Addictions Strategy has included the establishment of 18 Service Collaborative across the province; cross-sector tables in a specific region coming together to explore mental health and addiction system needs and adopting an intervention to address that need. The process is community led and supported by implementation teams from the Centre for Addiction and Mental Health (CAMH), using the framework of implementation science (IS) to enable evidence-based and sustained change. These justice initiatives are focused on the intersection of the justice system and the mental health and addiction systems. In this presentation, we will share the learnings, achievements and challenges of implementing innovative practices to the mental health and addictions needs of Ontarians within the justice system. Specifically, we will focus on the key points across the justice system - from early intervention and trauma-informed, culturally appropriate services to post-sentence support and community reintegration. Our approach to this work involves external implementation support from the CAMH team including coaching, knowledge exchange, evaluation, Aboriginal engagement and health equity expertise. Agencies supported the implementation of tools and processes which changed practice at the local level. These practices are being scaled up across Ontario and community agencies have come together in an unprecedented collaboration and there is a shared vision of the issues overlapping between the mental health, addictions and justice systems. Working with ministry partners has allowed space for innovation and created an environment where better approaches can be nurtured and spread.

Keywords: implementation, innovation, early identification, mental health and addictions, prevention, systems

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Authors: Neena Kanojia, R. K. Kanojia

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Background: Osteoarthritis OA of the knee is one of the leading causes of disability characterized by degeneration of hyaline cartilage combined with reparative processes. Its strong association with metabolic syndrome is postulated to be due to both mechanical and biochemical factors. Our study aims to study differential effect of metabolic risk factors on cartilage degeneration and regeneration at biomarker level. Design: After screening 281 patients presenting with knee pain, 41 patients who met the selection criteria were included and were divided into metabolic MetS OA and non-metabolic Non-MetS OA phenotypes using National Cholesterol Education Programme-Adult Treatment Panel-III NCEP ATP III criteria for metabolic syndrome. Serum Cartilage Oligomeric Matrix Protein COMP and Procollagen type IIA N terminal Propeptide PIIANP levels were used as tools to assess cartilage degeneration and regeneration, respectively. Results: 22 among 41 patients 53.66% had metabolic syndrome. Covariates like age, gender, Kellgren Lawrence KL grades were comparable in both groups. MetS OA group showed significant increase in serum COMP levels (p 0.03 with no significant effect on serum PIIANP levels (p 0.46. Hypertriglyceridemia showed independent association with both cartilage anabolism (p 0.03 and catabolism (p 0.03. Conclusion: Metabolic syndrome, though has no effect on cartilage regeneration tends to shift cartilage homeostasis towards degeneration with hypertriglyceridemia showing significant independent effect on cartilage metabolism.

Keywords: metabolic, syndrome, cartilage, degernation

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Authors: Cornelius Michael Ekenta

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The study determined institutional and technological factors that influence the adoption of tenera oil palm production practices with a gender dimension among smallholder farmers in Edo State, Nigeria. Primary data were generated with use of questionnaire administered to 155 males and 137 female respondents. Results show that the level of adoption of tenera oil palm production practices was low for both male and females. Tobi regression result shows that land ownership structure and affordability at 1% significance influenced male adoption of tenera oil palm production practices while age and level of income at 1% significance influenced female in the adoption. The major roles of male as reported in adopting process were purchase of seedlings, clearing of bush for planting and selling of cut bunches while the major roles of female were periodic weeding, gathering of cut bunches and mulching of palm field. The major constraint faced by male in adoption process were high cost of labour while for females is drudgery nature of the work. The study recommended that the Land Use Act of 1978 should be enforced to help women and non-indigenes to have sizeable farm lands, Government should empower Agricultural Development Programme (ADP) by employing more extension personnel to increase their contacts with the farmers.

Keywords: gender, adoption, variety, oil, tenera, Edo

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Authors: Raquel Balon Quintana

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This study aims to help the Students-At-Risk of Dropping Out to finish their studies in their grade/year level category for this school year by finding out students’ behavior in and out the school, community involvement in the learning process and the causes or reasons behind drop-out rate that affect the performance level of the school. This study also looked for the intervention measures to reduce the drop-out rate of the school. The Normative Survey Method of research was used to achieve its purpose and objective of conducting interview with students and their parents, subject teachers, classmates and friends; undertaking observation and monitoring to find out the whereabouts of SARDO’s on and off classes hours; using questionnaires; and conducting home visitation to be able to link the community involvement into dropping-out of student. Results of the study revealed that out of 32 Students-At-Risk of Dropping Out, 50% were over age for high school (16 years old to 21 years old) while the other 50% came from the regular high school students. These 16 students came from the 41 students who dropped-out from their classes last school year. All Students-At-Risk of Dropping-Out are single and seventy-eight percent of them are male. Top five (5) among the factors that affect their school performance were peer pressure, self-drive, malnutrition, family problem/support and truancy. The five (5) least factors that affect their schooling were problems within their community, school-administration factor, harassment, teacher factor and distance from the school.

Keywords: students-at-risk of dropping-out, drop-out rate, Leocadio Alejo Entienza High School, Philippines

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Authors: Arzyana Sunkar, Yanto Santosa, Siti Badriyah Rushayati

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Indonesia has experienced annual forest fires that have rapidly destroyed and degraded its forests. Fires in the peat swamp forests of Riau Province, have set the stage for problems to worsen, this being the ecosystem most prone to fires (which are also the most difficult, to extinguish). Despite various efforts to curb deforestation, and forest degradation processes, severe forest fires are still occurring. To find an effective solution, the basic causes of the problems must be identified. It is therefore critical to have an in-depth understanding of the underlying causal factors that have contributed to deforestation and forest degradation as a whole, in order to attain reductions in their rates. An assessment of the drivers of deforestation and forest degradation was carried out, in order to design and implement measures that could slow these destructive processes. Research was conducted in Giam Siak Kecil–Bukit Batu Biosphere Reserve (GSKBB BR), in the Riau Province of Sumatera, Indonesia. A biosphere reserve was selected as the study site because such reserves aim to reconcile conservation with sustainable development. A biosphere reserve should promote a range of local human activities, together with development values that are in line spatially and economically with the area conservation values, through use of a zoning system. Moreover, GSKBB BR is an area with vast peatlands, and is experiencing forest fires annually. Various factors were analysed to assess the drivers of deforestation and forest degradation in GSKBB BR; data were collected from focus group discussions with stakeholders, key informant interviews with key stakeholders, field observation and a literature review. Landsat satellite imagery was used to map forest-cover changes for various periods. Analysis of landsat images, taken during the period 2010-2014, revealed that within the non-protected area of core zone, there was a trend towards decreasing peat swamp forest areas, increasing land clearance, and increasing areas of community oil-palm and rubber plantations. Fire was used for land clearing and most of the forest fires occurred in the most populous area (the transition area). The study found a relationship between the deforested/ degraded areas, and certain distance variables, i.e. distance from roads, villages and the borders between the core area and the buffer zone. The further the distance from the core area of the reserve, the higher was the degree of deforestation and forest degradation. Research findings suggested that agricultural expansion may be the direct cause of deforestation and forest degradation in the reserve, whereas socio-economic factors were the underlying driver of forest cover changes; such factors consisting of a combination of socio-cultural, infrastructural, technological, institutional (policy and governance), demographic (population pressure) and economic (market demand) considerations. These findings indicated that local factors/problems were the critical causes of deforestation and degradation in GSKBB BR. This research therefore concluded that reductions in deforestation and forest degradation in GSKBB BR could be achieved through ‘local actor’-tailored approaches such as community empowerment

Keywords: Actor-led solution, community empowerment, drivers of deforestation and forest degradation, Giam Siak Kecil – Bukit Batu Biosphere Reserve

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Authors: Nattabhorn Leamcharaskul

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This study aims to examine determining factors of the dynamics of poverty in Thailand by using panel data of 3,567 households in 2007-2017. Four techniques of estimation are employed to analyze the situation of poverty across households and time periods: the multinomial logit model, the sequential logit model, the quantile regression model, and the difference in difference model. Households are categorized based on their experiences into 5 groups, namely chronically poor, falling into poverty, re-entering into poverty, exiting from poverty and never poor households. Estimation results emphasize the effects of demographic and socioeconomic factors as well as unexpected events on the economic status of a household. It is found that remittances have positive impact on household’s economic status in that they are likely to lower the probability of falling into poverty or trapping in poverty while they tend to increase the probability of exiting from poverty. In addition, not only receiving a secondary source of household income can raise the probability of being a never poor household, but it also significantly increases household income per capita of the chronically poor and falling into poverty households. Public work programs are recommended as an important tool to relieve household financial burden and uncertainty and thus consequently increase a chance for households to escape from poverty.

Keywords: difference in difference, dynamic, multinomial logit model, panel data, poverty, quantile regression, remittance, sequential logit model, Thailand, transfer

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Authors: Sajid Aman

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Jobs in the banking sector in Pakistan are perceived as very tough, due to which employee turnover is very high. However, the managerial role is very important in influencing employees’ attitudes toward their turnout. This paper explores the manager’s role in influencing employees’ effectiveness on the job. The paper adopted a pragmatic approach by combining both qualitative and quantitative data. The study employed an exploratory sequential strategy under a mixed-method research design. Qualitative data was analyzed using thematic analysis. Five major themes, such as the manager’s attitude towards employees, his leadership style, listening to employee’s personal problems, provision of personal loans without interest and future career prospects, emerged as key factors increasing employee’s effectiveness in the banking sector. The quantitative data revealed that a manager’s attitude, leadership style, availability to listen to employees’ personal problems, and future career prospects and listening to employee’s personal problems are strongly associated with employees’ effectiveness at the job. However, personal loan without interest was noted as having no significant association with employee’s effectiveness at the job. The study concludes manager’s role is more important in the effectiveness of the employees at their job in the banking sector. It is suggested that managers should have a positive attitude towards employees and give time to listening to employee’s problems, even personal ones.

Keywords: banking sector, employee’s effectiveness, manager’s role, leadership style

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Authors: Zafar Iqbal

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This article aims at analyzing the U.S.-Taliban peace deal considering the cross- pressures that both parties (U.S. and Taliban) faced and eventually paved the way for a negotiated settlement to the two-decade-long war. The paper first discusses the peace process initiated by President Obama in 2009 and then explores the factors that compelled both the parties to sign this deal. The study is based on secondary data and interviews done with the leading experts on Afghanistan along with the Taliban Qatar office spokesperson’s interview. The theoretical framework is based on the interplay of diplomacy and domestic politics: two-level games logic proposed by Robert D. Putnam. The two-level games suggest that actors involved in negotiations face cross-pressures and are constrained both by the expectations of the domestic audience and their counterpart’s zone of possible agreement. This paper will take the cross pressures for both sides as the permissive factors for the entire process of negotiations. However, there will be a slight aberration in the application of Putnam’s two-level games. In this case, it is not inter-state negotiations but between an all-powerful state and the unyielding non-state actors. The study concludes that both the parties faced domestic as well as international pressure which compelled them to sign a deal that could lead to an end of the two-decade-long war. Furthermore, it looks at the potential prospects and challenges of the deal following the U.S. withdrawal.

Keywords: neo-Taliban insurgency, negotiations, two-level game, U.S.-Taliban peace deal, U.S. withdrawal

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Authors: Oluwayemisi D. Ishola, Lekan Ajijola

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Nigeria faces a demographic challenge characterized by a burgeoning youth population and an escalating fertility rate. A notable decline in the use of modern contraceptives among adolescent girls and young women compounds the challenge. The youthful demographic stands at a critical juncture in the nation's pursuit to fulfill its pledge of achieving a 27% modern contraceptive rate by 2030, embodying the potential to translate this ambitious commitment into a tangible reality. This research undertook a multi-dimensional examination to scrutinize contraceptive ideational disparities among adolescents and young women in Nigeria, with a particular emphasis on ideational factors. The data underpinning this study were drawn from a cross-sectional household survey carried out in the Nigerian states of Edo, Ogun, Plateau, and Niger between October 2019 and January 2020. The survey encompassed 2,857 sexually active women aged 15-24 years. Employing an ideational framework focusing on behavior that accentuates psychosocial factors, the study dissected nine unique ideational variables into three principal domains: social, cognitive, and emotional. Multivariate logistics regression analyses were used to assess associations between ideational elements and contraceptive use within the total sample and specific age brackets (adolescents of 15-19 years and youth of 20-24 years). For this study, a p-value less than 0.05 was considered indicative of statistical significance. The study's results revealed significant associations between the ideational variables and contraceptive use in total sample and among adolescent and youth, ranging from p < .05 to p < .001. The influence of each domain's predictors on Family Planning (FP) manifested variations when assessed separately and across the different age groups. Notably, cognitive and emotional domains were found to be the strongest predictor of contraceptive use when compared with social domains in the general sample and among youth. This study’s findings highlight the complex interplay of social, cognitive, and emotional factors in contraceptive use among young individuals. Understanding these dynamics is crucial in developing effective strategies to overcome barriers and improve access to contraceptive services among young women in Nigeria.

Keywords: adolescents, contraception, ideation, youth

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Authors: Kalayanee Senasu

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This research investigates Thai people’s happiness based on socioeconomic factors, i.e. region, municipality, gender, age, and occupation. The research data were collected from survey data using interviewed questionnaires. The primary data were from stratified multi-stage sampling in each region, province, district, and enumeration area; and simple random sampling in each enumeration area. These data were collected in 13 provinces: Bangkok and three provinces in each of all four regions. The data were collected over two consecutive years. There were 3,217 usable responses from the 2017 sampling, and 3,280 usable responses from the 2018 sampling. The Senasu’s Thai Happiness Index (THaI) was used to calculate the happiness level of Thai people in 2017 and 2018. This Thai Happiness Index comprises five dimensions: subjective well-being, quality of life, philosophy of living, governance, and standard of living. The result reveals that the 2017 happiness value is 0.506, while Thai people are happier in 2018 (THaI = 0.556). For 2017 happiness, people in the Central region have the highest happiness (THaI = 0.532), which is followed closely by people in the Bangkok Metropolitan Area (THaI = 0.530). People in the North have the lowest happiness (THaI = 0.476) which is close to the level for people in the Northeast (THaI = 0.479). Comparing age groups, it is found that people in the age range 25-29 years old are the happiest (THaI = 0.529), followed by people in the age range 55-59 and 35-39 years old (THaI = 0.526 and 0.523, respectively). Additionally, people who live in municipal areas are happier than those who live in non-municipal areas (THaI = 0.533 vs. 0.475). Males are happier than females (THaI = 0.530 vs. 0.482), and retired people, entrepreneurs, and government employees are all in the high happiness groups (THaI =0.614, 0.608, and 0.593, respectively). For 2018 happiness, people in the Northern region have the highest happiness (THaI = 0.590), which is followed closely by people in the South and Bangkok Metropolitan Area (THaI = 0.578 and 0.577, respectively). People in the Central have the lowest happiness (THaI = 0.530), which is close to the level for people in the Northeast (THaI = 0.533). Comparing age groups, it is found that people in the age range 35-39 years old are the happiest (THaI = 0.572), followed by people in the age range 40-44 and 60-64 years old (THaI = 0.569 and 0.568, respectively). Similar to 2017 happiness, people who live in municipal areas are happier than those who live in non-municipal areas (THaI = 0.567 vs. 0. 552). However, males and females are happy at about the same levels (THaI = 0.561 vs. 0.560), and government employees, retired people, and state enterprise employees are all in the high happiness groups (THaI =0.667, 0.639, and 0.661, respectively).

Keywords: happiness, quality of life, Thai happiness index, socio-economic factors

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Authors: C. Soh, S. Muktar, C. M. Malata, J. R. Benson

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Introduction Reasons for requesting CPM include prevention of recurrence, peace of mind and moving on after breast cancer. Some women seek CPM as a delayed procedure but factors influencing this are poorly understood. Methods A retrospective analysis examined patients undergoing CPM as either an immediate or delayed procedure with or without breast reconstruction (BR) between January 2009 and December 2019. A cross-sectional survey based on validated questionnaires (5 point Likert scale) explored patients’ decision-making process in terms of timing of CPM and any BR. Results A total of 123 patients with unilateral breast cancer underwent CPM with 39 (32.5%) delayed procedures with or without BR. The response rate amongst patients receiving questionnaires (n=33) was 22/33 (66%). Within this delayed CPM cohort were three reconstructive scenarios 1) unilateral immediate BR with CPM (n=12); 2) delayed CPM with concomitant bilateral BR (n=22); 3) delayed bilateral BR after delayed CPM (n=3). Two patients had delayed CPM without BR. The most common reason for delayed CPM was to complete all cancer treatments (including radiotherapy) before surgery on the unaffected breast (score 2.91). The second reason was unavailability of genetic test results at the time of therapeutic mastectomy (score 2.64) whilst the third most cited reason was a subsequent change in family cancer history. Conclusion Factors for delayed CPM are patient-driven with few women spontaneously changing their mind having initially decided against immediate CPM for reasons also including surgical duration. CPM should be offered as a potentially delayed option with informed discussion of risks and benefits.

Keywords: Breast Cancer, CPM, Prophylactic, Rationale

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Authors: Winnie Kung, Xinhua Liu, Debbie Huang, Patricia Kim, Keon Kim, Xiaoran Wang, Lawrence Yang

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Considerable Asian Americans were exposed to the World Trade Center attack due to the proximity of the site to Chinatown and a sizeable number of South Asians working in the collapsed and damaged buildings nearby. Few studies focused on Asians in examining the disaster’s mental health impact, and even less longitudinal studies were reported beyond the first couple of years after the event. Based on the World Trade Center Health Registry, this study examined the trajectory of PTSD of individuals directly exposed to the attack from 2-3 to 5-6 years after the attack, comparing Asians against the non-Hispanic White group. Participants included 2,431 Asians and 31,455 Whites. Trajectories were delineated into the resilient, chronic, delayed-onset and remitted groups using PTSD checklist cut-off score at 44 at the 2 waves. Logistic regression analyses were conducted to compare the poorer trajectories against the resilient as a reference group, using predictors of baseline sociodemographic, exposure to the disaster, lower respiratory symptoms and previous depression/anxiety disorder diagnosis, and recruitment source as the control variable. Asians had significant lower socioeconomic status in terms of income, education and employment status compared to Whites. Over 3/4 of participants from both races were resilient, though slightly less for Asians than Whites (76.5% vs 79.8%). Asians had a higher proportion with chronic PTSD (8.6% vs 7.4%) and remission (5.9% vs 3.4%) than Whites. A considerable proportion of participants had delayed-onset in both races (9.1% Asians vs 9.4% Whites). The distribution of trajectories differed significantly by race (p<0.0001) with Asians faring poorer. For Asians, in the chronic vs resilient group, significant protective factors included age >65, annual household income >$50,000, and never married vs married/cohabiting; risk factors were direct disaster exposure, job loss due to 9/11, lost someone, and tangible loss; lower respiratory symptoms and previous mental disorder diagnoses. Similar protective and risk factors were noted for the delayed-onset group, except education being protective; and being an immigrant a risk. Between the 2 comparisons, the chronic group was more vulnerable than the delayed-onset as expected. It should also be noted that in both comparisons, Asians’ current employment status had no significant impact on their PTSD trajectory. Comparing between Asians against Whites, the direction of the relationships between the predictors and the PTSD trajectories were mostly the same, although more factors were significant for Whites than for Asians. A few factors showed significant racial difference: Higher risk for lower respiratory symptoms for Whites than Asians, higher risk for pre-9/11 mental disorder diagnosis for Asians than Whites, and immigrant a risk factor for the remitted vs resilient groups for Whites but not for Asians. Over 17% Asians still suffered from PTSD 5-6 years after the WTC attack signified its persistent impact which incurred substantial human, social and economic costs. The more disadvantaged socioeconomic status of Asians rendered them more vulnerable in their mental health trajectories relative to Whites. Together with their well-documented low tendency to seek mental health help, outreach effort to this population is needed to ensure follow-up treatment and prevention.

Keywords: PTSD, Asian Americans, World Trade Center Attack, racial differences

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Authors: Einat Waizbard, Emilio Ferrer, Meghan Miller, Brianna Heath, Derek S. Andrews, Sally J. Rogers, Christine Wu Nordahl, Marjorie Solomon, David G. Amaral

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Background: Autism symptoms are comprised of social-communication deficits and restricted/repetitive behaviors (RRB). The severity of these symptoms can change during childhood, with differences between boys and girls. From the literature, it was found that young autistic girls show a stronger tendency to decrease and a weaker tendency to increase their overall autism symptom severity levels compared to young autistic boys. It is not clear, however, which symptoms are driving these sex differences across childhood. In the current study, we evaluated the trajectories of independent autism symptoms across childhood and compared the patterns of change in such symptoms between boys and girls. Method: The study included 183 children diagnosed with autism (55 girls) evaluated three times across childhood, at ages 3, 6 and 11. We analyzed 22 independent items from the Autism Diagnostic Observation Scheudule-2 (ADOS-2), the gold-standard assessment tool for autism symptoms, each item representing a specific autism symptom. First, we used latent growth curve models to estimate the trajectories for the 22 ADOS-2 items for each child in the study. Second, we extracted the factor scores representing the individual slopes for each ADOS-2 item (i.e., slope representing that child’s change in that specific item). Third, we used factor analysis to identify common patterns of change among the ADOS-2 items, separately for boys and girls, i.e., which autism symptoms tend to change together and which change independently across childhood. Results: The best-emerging patterns for both boys and girls identified four common factors: three factors representative of changes in social-communication symptoms and one factor describing changes in RRB. Boys and girls showed the same pattern of change in RRB, with four items (e.g., speech abnormalities) changing together across childhood and three items (e.g., mannerisms) changing independently of other items. For social-communication deficits in boys, three factors were identified: the first factor included six items representing initiating and engaging in social-communication (e.g., quality of social overtures, conversation), the second factor included five items describing responsive social-communication (e.g., response to name) and the third factor included three items related to different aspects of social-communication (e.g., level of language). Girls’ social-communications deficits also loaded onto three factors: the first factor included five items (e.g., unusual eye contact), the second factor included six items (e.g., quality of social response), and the third factor included four items (e.g., showing). Some items showed similar patterns of change for both sexes (e.g., responsive joint attention), while other items showed differences (e.g., shared enjoyment). Conclusions: Girls and boys had different patterns of change in autism symptom severity across childhood. For RRB, both sexes showed similar patterns. For social-communication symptoms, however, there were both similarities and differences between boys and girls in the way symptoms changed over time. The strongest patterns of change were identified for initiating and engaging in social communication for boys and responsive social communication for girls.

Keywords: autism spectrum disorder, autism symptom severity, symptom trajectories, sex differences

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Authors: Taruna Katyal Arora, Geeta Kumari, Hari Shankar, Neelima Mishra

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Substandard and counterfeit antimalarials is a major problem in malaria endemic areas. The availability of counterfeit/ substandard medicines is not only decreasing the efficacy in patients, but it is also one of the contributing factors for developing antimalarial drug resistance. Owing to this, a pilot study was conducted to survey quality of drugs collected from different malaria endemic areas of India. Artesunate+Sulphadoxine-Pyrimethamine (AS+SP), Artemether-Lumefantrine (AL), Chloroquine (CQ) tablets were randomly picked from public health facilities in selected states of India. The quality of antimalarial drugs from these areas was assessed by using Global Pharma Health Fund Minilab test kit. This includes physical/visual inspection and disintegration test. Thin-layer chromatography (TLC) was carried out for semi-quantitative assessment of active pharmaceutical ingredients. A total of 45 brands, out of which 21 were for CQ, 14 for AL and 10 for AS+SP were tested from Uttar Pradesh (U.P.), Mizoram, Meghalaya and Gujrat states. One out of 45 samples showed variable disintegration and retension factor. The variable disintegration and retention factor which would have been due to substandard quality or other factors including storage. However, HPLC analysis confirms standard active pharmaceutical ingredient, but may be due to humid temperature and moisture in storage may account for the observed result.

Keywords: antimalarial medicines, counterfeit, substandard, TLC

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Authors: Bin Mu, Site Li, Shijin Yuan

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Under the circumstance of environment deterioration, people are increasingly concerned about the quality of the environment, especially air quality. As a result, it is of great value to give accurate and timely forecast of AQI (air quality index). In order to simplify influencing factors of air quality in a city, and forecast the city’s AQI tomorrow, this study used MATLAB software and adopted the method of constructing a mathematic model of PCA-GABP to provide a solution. To be specific, this study firstly made principal component analysis (PCA) of influencing factors of AQI tomorrow including aspects of weather, industry waste gas and IAQI data today. Then, we used the back propagation neural network model (BP), which is optimized by genetic algorithm (GA), to give forecast of AQI tomorrow. In order to verify validity and accuracy of PCA-GABP model’s forecast capability. The study uses two statistical indices to evaluate AQI forecast results (normalized mean square error and fractional bias). Eventually, this study reduces mean square error by optimizing individual gene structure in genetic algorithm and adjusting the parameters of back propagation model. To conclude, the performance of the model to forecast AQI is comparatively convincing and the model is expected to take positive effect in AQI forecast in the future.

Keywords: AQI forecast, principal component analysis, genetic algorithm, back propagation neural network model

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Authors: Adnan Sahin, Ufuk Uylas, Ercument Pasaoglu, Tarik Caga, Enver Ihtiyar, Serdar Erkasap, Ersin Ates, Fatih Yasar

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Background: In this study, it was evaluated the demographic features, etiological factors and the management of acute pancreatitis. Methods: 106 patient hospitalized due to acute pancreatitis were retrospectively examined from 1 January 2015 to 31 December 2015 in Department of General Surgery of ESOGUMF. The data of gender, signs and symptoms, etiological factors, WBC, AST, ALT, Amilase, USG and CT findings treatment options ERCP, and complications, mortality rate were analysed. Results: The mean age of patients were 58.8 (53 men and 53 women). The causes of acute pancreatitis were as follows: gallbladder stone was 89, hyperlipidemia was 5 and idiopathic were 16 patients. Severe pancreatitis was developed in 16 patients in the biliary pancreatitis group and ERCP was performed. Cholecystectomy was performed to all biliary pancreatitis group patients after acute pancreatitis subside. The mean hospital stay period was 9.33 (2-37) day. Discussion and conclusion: Severe acute pancreatitis is a mortal disease. The most common etiological cause of acute pancreatitis is biliary origin. The first line treatment modality of acute pancreatitis is medical. Cholecystectomy should be planned to the all-biliary caused acute pancreatitis patients after the attack subside. ERCP is a useful treatment modality in the case of clinical worsening and suspicion of acute cholangitis. ERCP procedure used 16 patients in our series and these patients have a good morbidity and mean hospital period is lower than the others. We suppose that ERCP procedure should be planned selectively and conservatively.

Keywords: acute pancreatitis, ERCP, morbidity, treatment

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Authors: Tahir Khaleeq, Patrick Lancaster, Keji Fakoya, Pedro Ferreira, Usman Ahmed

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Introduction: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Materials and Methods: A protocol was developed by the clinical team in collaboration with Advanced Physiotherapy Practitioners (APP) on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes. Results: In total 2489 patients were referred to VFC from internal and external sources. 734 patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. 87 patients were triaged into subspecialty clinics. 37 patients were felt to have been referred inappropriately. Discussion: BOA guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.

Keywords: virtual fracture clinic, lockdown, trauma and orthopaedics, Covid- 19

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Authors: Abdul Walid Ali

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The trend of publishing political musicals in Istana Budaya has been popular since 2007 when Malaysia celebrated its 50th anniversary of independence. Istana Budaya has at least one musical of any politician since then. Normally, the politicians are former Prime Ministers and renowned ministers prior to Malaysia's independence in 1957. The first performance in Istana Budaya which represented a politician as a theme was Muzikal Cheng Lock (2007) followed by Muzikal Tun Abdul Razak (2009), Muzikal Tun Mahathir (2010), and Muzikal Tun Mahathir 2 (2011). In 2012, Lawak Ke Der has changed the trend with comic performance and put an end to politician musical. Tun Siti Hasmah the Musical (2012) is not listed in the research because she did not hold any position as a minister. This qualitative research focuses on musicals of political figures as a theme. Some factors of making this type of performance are analyzed based on Istana Budaya’s decisions during that time in Malaysia between 2007 and 2011. This research aims to document these musical themed performances in Istana Budaya for further research in the future. Political performances are listed and analyzed from 2007 to 2012 based on reports and previous research. The declination of audiences in 2012 and a new theme in theatre performances in Istana Budaya are important factors for the downfall of the political theatres' theme.

Keywords: musical, politician, Istana Budaya, theatre

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Authors: Pushpavathi M., Kavya V., Akshatha V.

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Introduction: Cleft lip and palate (CLP) is a congenital condition which hinders effectual communication due to associated speech and language difficulties. Expressive language delay (ELD) is a feature seen in this population which is influenced by factors such as type and severity of CLP, age at surgical and linguistic intervention and also the type and intensity of speech and language therapy (SLT). Since CLP is the most common congenital abnormality seen in Indian children, early intervention is a necessity which plays a critical role in enhancing their speech and language skills. The interaction between the timing of intervention and factors which contribute to effective intervention by caregivers is an area which needs to be explored. Objectives: The present study attempts to determine the effect of timing of intervention on the contributing maternal factors for effective linguistic intervention in toddlers with repaired CLP with respect to the awareness, home training patterns, speech and non-speech behaviors of the mothers. Participants: Thirty six toddlers in the age range of 1 to 4 years diagnosed as ELD secondary to repaired CLP, along with their mothers served as participants. Group I (Early Intervention Group, EIG) included 19 mother-child pairs who came to seek SLT soon after corrective surgery and group II (Delayed Intervention Group, DIG) included 16 mother-child pairs who received SLT after the age of 3 years. Further, the groups were divided into group A, and group B. Group ‘A’ received SLT for 60 sessions by Speech Language Pathologist (SLP), while Group B received SLT for 30 sessions by SLP and 30 sessions only by mother without supervision of SLP. Method: The mothers were enrolled for the Early Language Intervention Program and following this, their awareness about CLP was assessed through the Parental awareness questionnaire. The quality of home training was assessed through Mohite’s Inventory. Subsequently, the speech and non-speech behaviors of the mothers were assessed using a Mother’s behavioral checklist. Detailed counseling and orientation was done to the mothers, and SLT was initiated for toddlers. After 60 sessions of intensive SLT, the questionnaire and checklists were re-administered to find out the changes in scores between the pre- and posttest measurements. Results: The scores obtained under different domains in the awareness questionnaire, Mohite’s inventory and Mothers behavior checklist were tabulated and subjected to statistical analysis. Since the data did not follow normal distribution (i.e. p > 0.05), Mann-Whitney U test was conducted which revealed that there was no significant difference between groups I and II as well as groups A and B. Further, Wilcoxon Signed Rank test revealed that mothers had better awareness regarding issues related to CLP and improved home-training abilities post-orientation (p ≤ 0.05). A statistically significant difference was also noted for speech and non-speech behaviors of the mothers (p ≤ 0.05). Conclusions: Extensive orientation and counseling helped mothers of both EI and DI groups to improve their knowledge about CLP. Intensive SLT using focused stimulation and a parent-implemented approach enabled them to carry out the intervention in an effectual manner.

Keywords: awareness, cleft lip and palate, early language intervention program, home training, orientation, timing of intervention

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Authors: Saeed Musaid H. Alzahrani

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The role of middle leaders, especially in primary schools, is a multi-faced role that has been subject to changes in nature over recent decades, with claims for more distributed leadership practices. This research examines the way 18 middle leaders in Saudi and English primary schools conceptualise their roles and responsibilities, and different factors influencing those roles and responsibilities. It begins from the premise that both the power of the role and the values of middle leaders are grounded in cultural and political bases, a belief held by the researcher as an 'insider' within the Saudi educational leadership context. The study consisted of a comparative analysis of the role and the responsibilities of middle leaders in Saudi primary schools and their equivalents in English primary schools. A purely qualitative methodological stance was adopted, using in-depth face-to-face semi-structured interviews, observations and document analysis. Middle leaders were asked to reflect deeply on their perceptions and understanding of their roles and explain what they thought influenced their daily practices and responsibilities. The findings suggest that the concept of middle leadership has been influenced by power imposed from above by political authority, via internal and external hierarchical structures, which shapes the nature of the role of the middle leaders and forces them to comply. Middle leaders seem to believe they have the power to make decisions and promote change, but these findings suggest that this is illusory. The power that keeps middle leaders performing is the power of their cultural and religious values. Those values are the resource to which they turn in their search for more energy when they lack support and are short of time taken. Middle leaders in Saudi, just like their equivalents in English schools must comply with the requirements of their role. However, Saudi middle leaders are given no leeway to make decisions or implement change, neither do they have the culture of collegiality that seems to give middle leaders in England more power over their resources and decisions. However, in neither educational setting have middle leaders been given the power to lead, so they remain managers rather than leaders. The findings of this research suggest that there are more similarities between the educational settings of Saudi and England than differences; and in the light of different factors identified in the study, suggest the establishment of a framework for middle leadership, in the hope of enhancing the way the role is practiced.

Keywords: middle leader, primary school, power, educational leadership, value, culture, model, Saudi Arabia, England

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Authors: B. Ratchaneepun, N.S. Bardell

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It is recognized that people are the main drivers in almost all the processes that affect airworthiness assurance. This is especially true in the area of aircraft maintenance, which is an essential part of continuing airworthiness. This work investigates what impact English language proficiency, the intersection of the military and Thai cultures, and the lack of initial and continuing human factors training have on the work performance of maintenance personnel in the Royal Thai Air Force (RTAF). A quantitative research method based on a cross-sectional survey was used to gather data about these three key aspects of “people” in a military airworthiness environment. 30 questions were developed addressing the crucial topics of English language proficiency, impact of culture, and human factors training. The officers and the non-commissioned officers (NCOs) who work for the Aeronautical Engineering Divisions in the RTAF comprised the survey participants. The survey data were analysed to support various hypotheses by using a t-test method. English competency in the RTAF is very important since all of the service manuals for Thai military aircraft are written in English. Without such competency, it is difficult for maintenance staff to perform tasks and correctly interpret the relevant maintenance manual instructions; any misunderstandings could lead to potential accidents. The survey results showed that the officers appreciated the importance of this more than the NCOs, who are the people actually doing the hands-on maintenance work. Military culture focuses on the success of a given mission, and leverages the power distance between the lower and higher ranks. In Thai society, a power distance also exists between younger and older citizens. In the RTAF, such a combination tends to inhibit a just reporting culture and hence hinders safety. The survey results confirmed this, showing that the older people and higher ranks involved with RTAF aircraft maintenance believe that the workplace has a positive safety culture and climate, whereas the younger people and lower ranks think the opposite. The final area of consideration concerned human factors training and non-technical skills training. The survey revealed that those participants who had previously attended such courses appreciated its value and were aware of its benefits in daily life. However, currently there is no regulation in the RTAF to mandate recurrent training to maintain such knowledge and skills. The findings from this work suggest that the people involved in assuring the continuing airworthiness of the RTAF would benefit from: (i) more rigorous requirements and standards in the recruitment, initial training and continuation training regarding English competence; (ii) the development of a strong safety culture that exploits the uniqueness of both the military culture and the Thai culture; and (iii) providing more initial and recurrent training in human factors and non-technical skills.

Keywords: aircraft maintenance, continuing airworthiness, military culture, people, Royal Thai Air Force

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