Search results for: double burden
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1962

Search results for: double burden

1662 Electrochemiluminescent Detection of DNA Damage Induced by Tetrachloro-1,4- Benzoquinone Using DNA Sensor

Authors: Tian-Fang Kang, Xue Sun

Abstract:

DNA damage induced by tetrachloro-1,4-benzoquinone (TCBQ), a reactive metabolite of pentachloro-phenol (PCP), was investigated using a glassy carbon electrode (GCE) modified with calf thymus double-stranded DNA (ds-DNA) in this work. DNA modified films were constructed by layer-by-layer adsorption of polycationic poly(diallyldimethyl- ammonium chloride) (PDDA) and negatively charged ds-DNA on the surface of a glassy carbon electrode. The DNA intercalator [Ru(bpy)2(dppz)]2+ (bpy=2, 2′-bipyridine, dppz0dipyrido [3, 2-a: 2′,3′-c] phenazine) was chosen as an electrochemical probe to detect DNA damage. After the sensor was incubated in 0.1 M pH 7.3 phosphate buffer solution (PBS) for 30min, the intact PDDA/DNA film produced a sensitive electrochemiluminescent (ECL) signal. However, after the sensor was incubated in 100 μM TCBQ or a mixed solution of 100 μM TCBQ and 2 mM H2O2, ECL signal decreased significantly. During the incubation of DNA in TCBQ or TCBQ-H2O2 solution, the double-helix of DNA was damaged, which resulted in the decrease of Ru-dppz bound to DNA. Additionally, the results were verified independently by fluorescence experiments. This paper provides a sensitive method to directly screen DNA damage induced by chemicals in the environment.

Keywords: DNA damage, detection, electrochemiluminescence, sensor

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1661 Epstein, Barr Virus Alters ATM-Dependent DNA Damage Responses in Germinal Centre B-Cells during Early Infection

Authors: Esther N. Maina, Anna Skowronska, Sridhar Chaganti, Malcolm A. Taylor, Paul G. Murray, Tatjana Stankovic

Abstract:

Epstein-Barr virus (EBV) has been implicated in the pathogenesis of human tumours of B-cell origin. The demonstration that a proportion of Hodgkin lymphomas and all Burkitt’s lymphomas harbour EBV suggests that the virus contributes to the development of these malignancies. However, the mechanisms of lymphomagenesis remain largely unknown. To determine whether EBV causes DNA damage and alters DNA damage response in cells of EBV-driven lymphoma origin, Germinal Centre (GC) B cells were infected with EBV and DNA damage responses to gamma ionising radiation (IR) assessed at early time points (12hr – 72hr) after infection and prior to establishment of lymphoblastoid (LCL) cell lines. In the presence of EBV, we observed induction of spontaneous DNA DSBs and downregulation of ATM-dependent phosphorylation in response to IR. This downregulation coincided with reduced ability of infected cells to repair IR-induced DNA double-strand breaks, as measured by the kinetics of gamma H2AX, a marker of double-strand breaks, and by the tail moment of the comet assay. Furthermore, we found that alteration of DNA damage responses coincided with the expression of LMP-1 protein. The presence of the EBV virus did not affect the localization of the ATM-dependent DNA repair proteins to sites of damage but instead lead to an increased expression of PP5, a phosphatase that regulates ATM function. The impact of the virus on DNA repair was most prominent 24h after infection, suggesting that this time point is crucial for the viral establishment in B cells. Our results suggest that during an early infection EBV virus dampens crucial cellular responses to DNA double-strand breaks which facilitate successful viral infection, but at the same time might provide the mechanism for tumor development.

Keywords: EBV, ATM, DNA damage, germinal center cells

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1660 Rising of Single and Double Bubbles during Boiling and Effect of Electric Field in This Process

Authors: Masoud Gholam Ale Mohammad, Mojtaba Hafezi Birgani

Abstract:

An experimental study of saturated pool boiling on a single artificial nucleation site without and with the application of an electric field on the boiling surface has been conducted. N-pentane is boiling on a copper surface and is recorded with a high speed camera providing high quality pictures and movies. The accuracy of the visualization allowed establishing an experimental bubble growth law from a large number of experiments. This law shows that the evaporation rate is decreasing during the bubble growth, and underlines the importance of liquid motion induced by the preceding bubble. Bubble rise is therefore studied: once detached, bubbles accelerate vertically until reaching a maximum velocity in good agreement with a correlation from literature. The bubbles then turn to another direction. The effect of applying an electric field on the boiling surface in finally studied. In addition to changes in the bubble shape, changes are also shown in the liquid plume and the convective structures above the surface. Lower maximum rising velocities were measured in the presence of electric fields, especially with a negative polarity.

Keywords: single and double bubbles, electric field, boiling, rising

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1659 Fabrication of Glucose/O₂ Microfluidic Biofuel Cell with Double Layer of Electrodes

Authors: Haroon Khan, Chul Min Kim, Sung Yeol Kim, Sanket Goel, Prabhat K. Dwivedi, Ashutosh Sharma, Gyu Man Kim

Abstract:

Enzymatic biofuel cells (EBFCs) have drawn the attention of researchers due to its demanding application in medical implants. In EBFCs, electricity is produced with the help of redox enzymes. In this study, we report the fabrication of membraneless EBFC with new design of electrodes to overcome microchannel related limitations. The device consists of double layer of electrodes on both sides of Y-shaped microchannel to reduce the effect of oxygen depletion layer and diffusion of fuel and oxidant at the end of microchannel. Moreover, the length of microchannel was reduced by half keeping the same area of multiwalled carbon nanotubes (MWCNT) electrodes. Polydimethylsiloxane (PDMS) stencils were used to pattern MWCNT electrodes on etched Indium Tin Oxide (ITO) glass. PDMS casting was used to fabricate microchannel of the device. Both anode and cathode were modified with glucose oxidase and laccase. Furthermore, these enzymes were covalently bound to carboxyl MWCNTs with the help of EDC/NHS. Glucose used as fuel was oxidized by glucose oxidase at anode while oxygen was reduced to water at the cathode side. The resulted devices were investigated with the help of polarization curves obtained from Chronopotentiometry technique by using potentiostat. From results, we conclude that the performance of double layer EBFC is improved 15 % as compared to single layer EBFC delivering maximum power density of 71.25 µW cm-2 at a cell potential of 0.3 V and current density of 250 µA cm-2 at micro channel height of 450-µm and flow rate of 25 ml hr-1. However, the new device was stable only for three days after which its power output was rapidly dropped by 75 %. This work demonstrates that the power output of membraneless EBFC is improved comparatively, but still efforts will be needed to make the device stable over long period of time.

Keywords: EBFC, glucose, MWCNT, microfluidic

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1658 Salt Tolerance of Potato: Genetically Engineered with Atriplex canescens BADH Gene Driven by 3 Copies of CAMV35s Promoter

Authors: Arfan Ali, Muhammad Shahzad Iqbal, Idrees Ahmad Nasir

Abstract:

Potato (Solanum tuberosum L.) is ranked among the top leading staple foods in the world. Salinity adversely affects potato crop yield and quality. Therefore, increased level of salt tolerance is a key factor to ensure high yield. The present study focused on the Agrobacterium-mediated transformation of Atriplex canescens betaine aldehyde dehydrogenase (BADH) gene, using single, double and triple CAMV35s promoter to improve salt tolerance in potato. Detection of seven potato lines harboring BADH gene, followed by identification of T-DNA insertions, determination of transgenes copies no through Southern Hybridization and quantification of BADH protein through Enzyme Linked Immunosorbent Assay were considered in this study. The results clearly depict that the salt tolerance of potato was found to be promoter-dependent, as the potato transgenic lines with triple promoter showed 4.4 times more glycine betaine production which consequently leads towards high resistance to salt stress as compared to transgenic potato lines with single and double promoters having least production of glycine betaine. Moreover, triple promoter transgenic potato lines have also shown lower levels of H2O2, malondialdehyde (MDA), relative electrical conductivity, high proline and chlorophyll content as compared other two lines having a single and double promoter. Insilco analysis also confirmed that Atriplex canescens BADH has the tendency to interact with sodium ions and water molecules. Taken together these facts it can be concluded that over-expression of BADH under triple CAMV35s promoter with more glycine betaine, chlorophyll & MDA contents, high relative quantities of other metabolites results in an enhanced level of salt tolerance in potato.

Keywords: Atriplex canescens, BADH, CAMV35s promotor, potato, Solanum tubersum

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1657 Temperature Rises Characteristics of Distinct Double-Sided Flat Permanent Magnet Linear Generator for Free Piston Engines for Hybrid Vehicles

Authors: Ismail Rahama Adam Hamid

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This paper presents the development of a thermal model for a flat, double-sided linear generator designed for use in free-piston engines. The study conducted in this paper examines the influence of temperature on the performance of the permeant magnet linear generator, an integral and pivotal component within the system. This research places particular emphasis on the Neodymium Iron Boron (NdFeB) permanent magnet, which serves as a source of magnetic field for the linear generator. In this study, an internal combustion engine that tends to produce heat is connected to a generator. Considering the temperatures rise from both the combustion process and the thermal contributions of current-carrying conductors and frictional forces. Utilizing Computational Fluid Dynamics (CFD) method, a thermal model of the (NdFeB) magnet within the linear generator is constructed and analyzed. Furthermore, the temperature field is examined to ensure that the linear generator operates under stable conditions without the risk of demagnetization.

Keywords: free piston engine, permanent magnet, linear generator, demagnetization, simulation

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1656 Big Classes, Bigger Ambitions: A Participatory Approach to the Multiple-Choice Exam

Authors: Melanie Adrian, Elspeth McCulloch, Emily-Jean Gallant

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Resources -financial, physical, and human- are increasingly constrained in higher education. University classes are getting bigger, and the concomitant grading burden on faculty is growing rapidly. Multiple-choice exams are seen by some as one solution to these changes. How much students retain, however, and what their testing experience is, continues to be debated. Are multiple-choice exams serving students well, or are they bearing the burden of these developments? Is there a way to address both the resource constraints and make these types of exams more meaningful? In short, how do we engender evaluation methods for large-scale classes that provide opportunities for heightened student learning and enrichment? The following article lays out a testing approach we have employed in four iterations of the same third-year law class. We base our comments in this paper on our initial observations as well as data gathered from an ethics-approved study looking at student experiences. This testing approach provides students with multiple opportunities for revision (thus increasing chances for long term retention), is both individually and collaboratively driven (thus reflecting the individual effort and group effort) and is automatically graded (thus draining limited institutional resources). We found that overall students appreciated the approach and found it more ‘humane’, that it notably reduced pre-exam and intra-exam stress levels, increased ease, and lowered nervousness.

Keywords: exam, higher education, multiple-choice, law

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1655 Debt Relief for Emerging Economies: An Empirical Investigation

Authors: Hummad Ch. Umar

Abstract:

Most of the developing economies, including Pakistan, are confronted with high level of external debt which is adversely affecting their economic performance. The hypothesis of debt overhang is often used to assess the negative relationship between foreign debt and the economic growth of the indebted country. As first objective of the present study, this hypothesis is tested by using Pooled OLS (POLS), Generalized Method of Moment (GMM), Random Effect (RE), and Fixed effect (FE) techniques. As second objective, the study uses the concept of debt Laffer Curve to determine the eligibility condition of the indebted countries for the relief programs. According to this approach, countries lying on the right side of the Laffer Curve are stated to be trapped in the strong debt overhang making them unable to come out of the vicious circle of low growth and high foreign debt. The empirical analysis confirms that only two countries out of twenty two completely fulfill the conditions of being eligible for the debt relief. All other countries continue to face debt burden of different magnitudes. The study further confirms that the debt relief alone is not sufficient for overcoming the debt problem. Instead, sound economic policies and conducive investment decisions are required to lay the foundations of long-term growth and development. Debt relief should be the option for only those countries that meet a minimum measurable criterion of good governance, economic freedom, and consistency of policies.

Keywords: external debt, debt burden, debt overhang, debt laffer curve, debt relief, investment decisions

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1654 NiAl-Layered Double Hydroxide: Preparation, Characterization and Applications in Photo-Catalysis and Hydrogen Storage

Authors: Ahmed Farghali, Heba Amar, Mohamed Khedr

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NiAl-Layered Double Hydroxide (NiAl-LDH), one of anionic functional layered materials, has been prepared by a simple co-precipitation process. X-ray diffraction patterns confirm the formation of the desired compounds of NiAl hydroxide single phase and the crystallite size was found to be about 4.6 nm. The morphology of the prepared samples was investigated using scanning electron microscopy and the layered structure was appeared under the transmission electron microscope. The thermal stability and the function groups of NiAl-LDH were investigated using thermal gravimetric analysis (TGA) and Fourier transform infrared (FTIR) respectively. NiAl-LDH was investigated as a photo-catalyst for the degradation of some toxic dyes such as toluidine blue and bromopyrogallol red. It shows good catalytic efficiency in visible light and even in dark. For the first time NiAl-LDH was used for hydrogen storage application. NiAl-LDH samples were exposed to 20 bar applied hydrogen pressure at room temperature, 100 and -193 oC. NiAl-LDH samples appear to have feasible hydrogen storage capacity. It was capable to adsorb 0.1wt% at room temperature, 0.15 wt% at 100oC and storage capacity reached 0.3 wt% at -193 oC.

Keywords: NiAl-LDH, preparation, characterization, photo-catalysis, hydrogen storage

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1653 Change of Epidemiological Characteristics and Disease Burden of Varicella Due to Implementation of Mass Immunization Program in Taiwan from 2000 to 2012

Authors: En-Tzu Wang, Ting-Ann Wang, Yi-Hui Shen, Yu-Min Chou, Chi-Tai Fang, Chin-Hui Yang

Abstract:

Background and purpose: A mass varicella immunization program was established to provide free 1-dose vaccination for all 1-year-old children throughout Taiwan since 2004. The epidemiological characteristics and disease burden of varicella from 2000 to 2012 was investigated and the results will be essential to refine the national immunization policy. Method: We included patients (n = 17,838–164,245) with ICD-9-CM codes 052 (chickenpox) from the 2000 to 2012 National Health Insurance Database. The age, period, and cohort-specific incidence of varicella were calculated. The hospital admission rate, medical costs and indirect costs from the societal perspective of varicella including travel costs to the medical facility, registration fee, productivity losses of the patients and caregivers were also estimated. Result: There were 979,252 patients for medical treatment due to varicella from 2000 to 2012 in Taiwan. The implementation of a routine childhood varicella vaccination program has resulted in 87% decline in morbidity (881.49 to 115.17 per 100,000). The average age of patients increased from 7.9 years to 16.3 years. The overall varicella-related hospital admission rate was 15.5 per 1000 patients, and peaked in the groups of infants younger than 1 year, adults aged from 20 to 39 years and elders over 70 years. Among patients admitted to hospital, 33.5% of them had one or more complications. Patients with underlying diseases had higher admission rate (241.6 per 1,000) and longer duration of hospital stay (6.61 days vs. 4.76 days). The annual varicella-related medical expense declined after 2002 and the proportion of medical costs for admission has increased to 42%. The annual indirect costs from the societal perspective of varicella were 5.29 to 9.63 times higher than varicella-related medical costs. Every one dollar invested in the varicella immunization program, 2.97 dollars of medical and social costs were saved on average. Conclusion: The dramatic decline in morbidity, hospitalization, medical and social costs of varicella can be directly attributed to the implementation of the mass immunization program. Two-dose vaccination is recommended for both children with underlying diseases and susceptible adults to prevent serious complications and hospitalizations.

Keywords: disease burden, epidemiology, medical and social costs, varicella, varicella vaccine

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1652 Educational Attainment Inequalities in Depressive Symptoms in More Than 100 000 Individuals in Europe

Authors: Adam Chlapecka, Anna Kagstrom, Pavla Cermakova

Abstract:

Background: Increasing educational attainment (EA) could decrease the occurrence of depression. We investigated the relationship between EA and depressive symptoms in older individuals across four European regions. Methods: We studied 108 315 Europeans (54 % women, median age 63 years old) from the Survey on Health, Ageing and Retirement in Europe assessing EA (7 educational levels based on ISCED classification); and depressive symptoms (≥ 4 points on EURO-D scale). Logistic regression estimated the association between EA and depressive symptoms, adjusting for sociodemographic and health-related factors; testing for sex/age/region and education interactions. Results: Higher EA was associated with lower odds of depressive symptoms, independent of sociodemographic and health-related factors. A threshold of the lowest odds of depressive symptoms was detected at the first stage of tertiary education (OR 0.60; 95% CI 0.55-0.65; p<0.001; relative to no education). Central and Eastern Europe showed the strongest association (OR for high vs. low education 0.37; 95% CI 0.33-0.40; p<0.001) and Scandinavia the weakest (OR for high vs. low education 0.69; 95% CI 0.60-0.80; p<0.001). The association was strongest amongst younger individuals. There was a sex and education interaction only within Central and Eastern Europe. Conclusion: The level of EA is reflected in later-life depressive symptoms, suggesting that supporting individuals in achieving EA, and considering those with lower EA at increased risk for depression, could lead to the decreased burden of depression across the life course. Further educational support in Central and Eastern Europe may decrease the higher burden of depressive symptoms in women.

Keywords: depression, education, epidemiology, Europe

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1651 Infernal Affairs (Hong Kong) versus Double Face (Japan): Remaking and Context

Authors: Roman Kusaiko

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For decades, remaking was one of the film industry’s main practices but has become vivid in recent years. The latest geopolitical developments, though, are becoming a new challenge for filmmakers regarding cultural landscapes and contextual differences. Deglobalization may also affect transnational remaking practices. Thus, these upcoming challenges can be addressed through the analysis of contemporary academic thought, primarily from adaptation and film studies and their understanding of the issues of transmediality and how it affects film remaking. However, the analysis would be insufficient without conducting case studies. This paper is part of broader research about transnational remaking practices and their cultural and contextual specifics. This paper aims to understand whether shifting medium affects remaking as a critical category and present case studies of the popular Hong Kong motion picture Infernal Affairs and its transition into the Japanese remake Double Face. Consequently, the analysis of their contextual distinctions will lead to the correct categorization of the transnational remakes allowing scholars and filmmakers to better understand the existing remaking practices and whether they affect the final result.

Keywords: cinema, context, culture, films, remaking, transmediality

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1650 Investigation of Distortion and Impact Strength of 304 L Butt Joint Using Different Weld Groove

Authors: A. Sharma, S. S. Sandhu, A.Shahi, A. Kumar

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In this study, the effects of geometric configurations of butt joints i.e. double V groove, double U groove and UV groove of AISI 304L of thickness 12 mm by using Gas Tungsten Arc Welding (GTAW) are investigated. The magnitude of transverse shrinkage stress and distortion generated during welding under the unrestrained conditions of butt joints is the main objective of the study. The effect of groove design on impact strength and metallurgical properties are also studied. The Finite element analysis for the groove design is done and compared the actual experimentation. The experimental results and the FEM results were compared and reveal a very good correlation for distortion and weld groove design for multipass joint with a standard analogy of 80%. In the case of VV groove design it was found that the transverse stress and cumulative deflection have the lowest value. It was found that the UV groove design had the maximum ultimate and yield tensile strength, VV groove had the highest impact strength. Vicker’s hardness value of all the groove design was measured. Micro structural studies were carried out using conventional microscopic tools which revealed a lot of useful information for correlating the microstructure with mechanical properties.

Keywords: weld groove design, distortion, AISI 304 L, butt joint, FEM, GTAW

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1649 Parental Awareness and Willingness to Vaccinate Adolescent Daughters against Human Papilloma Virus for Cervical Cancer Prevention in Eastern Region of Kenya: Towards Affirmative Action

Authors: Jacinta Musyoka, Wesley Too

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Cervical cancer is the second leading cause of cancer-related deaths in Kenya and the second most common cancer among women, yet preventable following prevention strategies put in place, which includes vaccination with Human Papilloma Virus Vaccine (HPPV) among the young adolescent girls. Kenya has the highest burden of cervical cancer and the leading cause of death among women of reproductive age and is a known frequent type of cancer amongst women. This is expected to double by 2025 if the necessary steps are not taken, which include vaccinating girls between the ages of 9 and 14 and screening women. Parental decision is critical in ensuring that their daughters receive this vaccine. Hence this study sought to establish parental willingness and factors associate with the acceptability to vaccine adolescent daughters against the human papilloma virus for cervical cancer prevention in Machakos County, Eastern Region of Kenya. Method: Cross-sectional study design utilizing a mixed methods approach was used to collect data from Nguluni Health Centre in Machakos County; Matungulu sub-county, Kenya. This study targeted all parents of adolescent girls seeking health care services in the Matungulu sub-county area who were aged 18 years and above. A total of 220 parents with adolescent girls aged 10-14 years were enrolled into the study after informed consent were sought. All ethical considerations were observed. Quantitative data were analyzed using Multivariate regression analysis, and thematic analysis was used for qualitative data related to perceptions of parents on HPVV. Results, conclusions, and recommendations- ongoing. We expect to report findings and articulate contributions based on the study findings in due course before October 2022

Keywords: adolescents, human papilloma virus, kenya, parents

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1648 Calling Persons with Disability as Divine: Exploring and Critiquing Meanings of Divyang (The One with a Divine Limb) in the Indian Context

Authors: Vinay Suhalka

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In India, the official nomenclature used by the State for persons with disability is divyang (literally, the one with a divine limb), a word coming from the Sanskrit language. Disability thus gets portrayed as divine, at least in the welfare sector from where it flows down even to the popular imagination where it gets equated to divinity. This paper looks at reference to persons with disabilities as divyangs and goes on to discusses what such usage for an already marginalized group achieves and misses out. The issue of nomenclature and language has always been a contested one when it comes to disability. At the same time, there is also an issue of who determines these labels for the persons with disability. Nomenclature and language used for disability can have real consequences for the population of persons with disability as it may empower or disempower them. Thus, this paper looks at the issue of what it means for persons with disabilities as ‘exceptionally gifted’ and hence divyang. Language can be a powerful tool to communicate meanings and messages associated with a term. When the persons with disabilities as a group are described as ‘exceptionally gifted, talented and the source of inspiration’, it essentially stereotypes and marginalizes them by putting a burden of performance that all of them ought to be achievers, and it is only then that they would be assimilated in the larger society. This paper also argues that such a situation creates a ‘double bind’ where the person is always trying to match up to the labels (the disabled as ‘achiever, overcomer, inspirational’) created by somebody else and looks at self through the eyes of others. This conceptual paper also presents an overview of disability labels while simultaneously looking at projecting disability as divinity which has the potential to wrongly portray the lives of persons with disability in India due to the official usage of the term. It also explores the question of visibility of disability since the idea of divyang implicitly assumes that all disabilities are visible. In reality, however, it may not be the case simply because all forms of disabilities are not visible, people may choose not to visibilize their disabilities if they can and pass as able-bodied, fearing the stigma that surrounds disability. Finally, it argues for an increased focus on understanding the everyday lived realities of those with disability in order to regard it as an important form of difference which could be a potential resource for the society.

Keywords: persons with disability, labels, language use, divinity

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1647 The Silent Tuberculosis: A Case Study to Highlight Awareness of a Global Health Disease and Difficulties in Diagnosis

Authors: Susan Scott, Dina Hanna, Bassel Zebian, Gary Ruiz, Sreena Das

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Although the number of cases of TB in England has fallen over the last 4 years, it remains an important public health burden with 1 in 20 cases dying annually. The vast majority of cases present in non-UK born individuals with social risk factors. We present a case of non-pulmonary TB presenting in a healthy child born in the UK to professional parents. We present a case of a healthy 10 year old boy who developed acute back pain during school PE. Over the next 5 months, he was seen by various health and allied professionals with worsening back pain and kyphosis. He became increasing unsteady and for the 10 days prior to admission to our hospital, he developed fevers. He was admitted to his local hospital for tonsillitis where he suffered two falls on account of his leg weakness. A spinal X-ray revealed a pathological fracture and gibbus formation. He was transferred to our unit for further management. On arrival, the patient had lower motor neurone signs of his left leg. He underwent spinal fixture, laminectomy and decompression. Microbiology samples taken intra-operatively confirmed Mycobacterium Tuberculosis. He had a positive Mantoux and T-spot and treatment were commenced. There was no evidence of immune compromise. The patient was born in the UK, had a BCG scar and his only travel history had been two years prior to presentation when he travelled to the Phillipines for a short holiday. The patient continues to have issues around neuropathic pain, mobility, pill burden and mild liver side effects from treatment. Discussion: There is a paucity of case reports on spinal TB in paediatrics and diagnosis is often difficult due to the non-specific symptomatology. Although prognosis on treatment is good, a delayed diagnosis can have devastating consequences. This case highlights the continued need for higher index of suspicion and diagnosis in a world with changing patterns of migration and increase global travel. Surgical intervention is limited to the most serious cases to minimise further neurological damage and improve prognosis. There remains the need for a multi-disciplinary approach to deal with challenges of treatment and rehabilitation.

Keywords: tuberculosis, non-pulmonary TB, public health burden, diagnostic challenge

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1646 Health as an Agenda in Indian Politics: A Study of Election Manifestos in 16th General Elections

Authors: Kiran Bala

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Health, education and employment opportunities available for a common citizen reflect the development status of a country. Health of an individual affects the growth of a country in every aspect. According to a study by WHO, India is estimated to lose more than $237 billion of its GDP over the period 2006-15 on account of premature death and morbidity from Non-communicable diseases alone. Each year 37 million people fall below poverty line due to high expenditure on health services they have to incur. Falling sick puts a double burden on them in terms of loss of income and expenditure on health care which pushes them further into debt and poverty. Adding to the gravity of situation, public spending on health in India has itself declined after liberalization from 1.3% of GDP in 1990 to 0.9% in 1999. The Approach Paper of the Government of India to the Twelfth Five Year Plan indicated that health expenditure alone as a per cent of GDP was about 1.4 per cent (B.E.) in 2011-12. It also mentioned that if one included expenditure on rural water supply and sanitation, the figure would be about 1.8 per cent. Given the abysmally low level of priority accorded to health in Indian economic policy, it becomes rather important to study the representation of health in the Indian public sphere. To this end, this study examines the prioritization of health in the public policy agenda of the national/regional political parties as evidenced in their election manifestos at a time when the nation is poised to go for the General Elections. The paper also focuses attention on the prioritization of health in the public perception as evidenced in their reasons for their preferences for a particular party or individual contestant. To arrive at the reasons for the priority level accorded by the political actors and the citizens, the study uses Focus groups of health policy makers, media persons, medical practitioners and voters. Collected data will be analysed in the theoretical framework of spiral of silence and agenda setting theory.

Keywords: health, election manifestos, public perception, policies

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1645 A Qualitative Meta-Synthesis of the Caregiving Experiences of Family Caregivers for Elderly Cancer Patients in China: Implications for Health Social Work

Authors: Longtao He, Han Wu

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Summary: As the need for elder care increases in China due to a growing aging population and, in particular, rising cancer rates, it becomes increasingly important to also support family caregivers, who are often the main source of care. We used a qualitative meta-synthesis to systematically evaluate and integrate the caregiving experiences of family caregivers of elderly cancer patients as revealed by articles published in Chinese journals. Findings: Nine studies are included in the final analysis. The caregiver experiences they describe are synthesized into three primary themes: care needs, care burden, and care gains, with numerous secondary themes. Besides the findings that seem to align with other findings across cultures, we have highlighted three main discoveries from the synthesis that may be quite specific to the Chinese context: 1. more sub-themes related to specific caregiving skills caregivers of cancer patients; 2. a call for health professionals to improve their communication skills with family caregivers; 3. the important role of filial piety. Applications: Our findings can be used to help health social workers and relevant policymakers in China support family caregivers by identifying the education and training required for caregivers, ways to make the most of potential care gains, and ways to ease care burdens.

Keywords: cancer, Chinese family caregivers, caregiving skills, care burden, care gains, health social work

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1644 Tuberculosis and Associated Transient Hyperglycaemia in Peri-Urban South Africa: Implications for Diabetes Screening in High Tuberculosis/HIV Burden Settings

Authors: Mmamapudi Kubjane, Natacha Berkowitz, Rene Goliath, Naomi S. Levitt, Robert J. Wilkinson, Tolu Oni

Abstract:

Background: South Africa remains a high tuberculosis (TB) burden country globally and the burden of diabetes – a TB risk factor is growing rapidly. As an infectious disease, TB also induces transient hyperglycaemia. Therefore, screening for diabetes in newly diagnosed tuberculosis patients may result in misclassification of transient hyperglycaemia as diabetes. Objective: The objective of this study was to determine and compare the prevalence of hyperglycaemia (diabetes and impaired glucose regulation (IGR)) in TB patients and to assess the cross-sectional association between TB and hyperglycaemia at enrolment and after three months of follow-up. Methods: Consecutive adult TB and non-TB participants presenting at a TB clinic in Cape Town were enrolled in this cross-sectional study and follow-up between July 2013 and August 2015. Diabetes was defined as self-reported diabetes, fasting plasma glucose (FPG) ≥ 7.0 mmol·L⁻¹ or glycated haemoglobin (HbA1c) ≥ 6.5%. IGR was defined as FPG 5.5– < 7.0 mmol·L⁻¹ or HbA1c 5.7– < 6.5%. TB patients initiated treatment. After three months, all participants were followed up and screened for diabetes again. The association between TB and hyperglycaemia was assessed using logistic regression adjusting for potential confounders including sex, age, income, hypertension, waist circumference, previous prisoner, marital status, work status, HIV status. Results: Diabetes screening was performed in 852 participants (414 TB and 438 non-TB) at enrolment and in 639 (304 TB and 335 non-TB) at three-month follow-up. The prevalence of HIV-1 infection was 69.6% (95% confidence interval (CI), 64.9–73.8 %) among TB patients, and 58.2% (95% CI, 53.5–62.8 %) among the non-TB participants. Glycaemic levels were much higher in TB patients than in the non-TB participants but decreased over time. Among TB patients, the prevalence of IGR was 65.2% (95% CI 60.1 - 69.9) at enrollment and 21.5% (95% CI 17.2-26.5) at follow-up; and was 50% (45.1 - 54.94) and 32% (95% CI 27.9 - 38.0) respectively, among non-TB participants. The prevalence of diabetes in TB patients was 12.5% (95% CI 9.69 – 16.12%) at enrolment and 9.2% (95% CI, 6.43–13.03%) at follow-up; and was 10.04% (95% CI, 7.55–13.24%) and 8.06% (95% CI, 5.58–11.51) respectively, among non-TB participants. The association between TB and IGT was significant at enrolment (adjusted odds ratio (OR) 2.26 (95% CI, 1.55-3.31) but disappeared at follow-up 0.84 (0.53 - 1.36). However, the TB-diabetes association remained positive and significant both at enrolment (2.41 (95% CI, 1.3-4.34)) and follow-up (OR 3.31 (95% CI, 1.5 - 7.25)). Conclusion: Transient hyperglycaemia exists during tuberculosis. This has implications on diabetes screening in TB patients and suggests a need for diabetes confirmation tests during or after TB treatment. Nonetheless, the association between TB and diabetes noted at enrolment persists at 3 months highlighting the importance of diabetes control and prevention for TB control. Further research is required to investigate the impact of hyperglycaemia (transient or otherwise) on TB outcomes to ascertain the clinical significance of hyperglycemia at enrolment.

Keywords: diabetes, impaired glucose regulation, transient hyperglycaemia, tuberculosis

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1643 Zn-, Mg- and Ni-Al-NO₃ Layered Double Hydroxides Intercalated by Nitrate Anions for Treatment of Textile Wastewater

Authors: Fatima Zahra Mahjoubi, Abderrahim Khalidi, Mohamed Abdennouri, Omar Cherkaoui, Noureddine Barka

Abstract:

Industrial effluents are one of the major causes of environmental pollution, especially effluents discharged from various dyestuff manufactures, plastic, and paper making industries. These effluents can give rise to certain hazards and environmental problems for their highly colored suspended organic solid. Dye effluents are not only aesthetic pollutants, but coloration of water by the dyes may affect photochemical activities in aquatic systems by reducing light penetration. It has been also reported that several commonly used dyes are carcinogenic and mutagenic for aquatic organisms. Therefore, removing dyes from effluents is of significant importance. Many adsorbent materials have been prepared in the removal of dyes from wastewater, including anionic clay or layered double hydroxyde. The zinc/aluminium (Zn-AlNO₃), magnesium/aluminium (Mg-AlNO₃) and nickel/aluminium (Ni-AlNO₃) layered double hydroxides (LDHs) were successfully synthesized via coprecipitation method. Samples were characterized by XRD, FTIR, TGA/DTA, TEM and pHPZC analysis. XRD patterns showed a basal spacing increase in the order of Zn-AlNO₃ (8.85Å)> Mg-AlNO₃ (7.95Å)> Ni-AlNO₃ (7.82Å). FTIR spectrum confirmed the presence of nitrate anions in the LDHs interlayer. The TEM images indicated that the Zn-AlNO3 presents circular to shaped particles with an average particle size of approximately 30 to 40 nm. Small plates assigned to sheets with hexagonal form were observed in the case of Mg-AlNO₃. Ni-AlNO₃ display nanostructured sphere in diameter between 5 and 10 nm. The LDHs were used as adsorbents for the removal of methyl orange (MO), as a model dye and for the treatment of an effluent generated by a textile factory. Adsorption experiments for MO were carried out as function of solution pH, contact time and initial dye concentration. Maximum adsorption was occurred at acidic solution pH. Kinetic data were tested using pseudo-first-order and pseudo-second-order kinetic models. The best fit was obtained with the pseudo-second-order kinetic model. Equilibrium data were correlated to Langmuir and Freundlich isotherm models. The best conditions for color and COD removal from textile effluent sample were obtained at lower values of pH. Total color removal was obtained with Mg-AlNO₃ and Ni-AlNO₃ LDHs. Reduction of COD to limits authorized by Moroccan standards was obtained with 0.5g/l LDHs dose.

Keywords: chemical oxygen demand, color removal, layered double hydroxides, textile wastewater treatment

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1642 Risk Mapping of Road Traffic Incidents in Greater Kampala Metropolitan Area for Planning of Emergency Medical Services

Authors: Joseph Kimuli Balikuddembe

Abstract:

Road traffic incidents (RTIs) continue to be a serious public health and development burden around the globe. Compared to high-income countries (HICs), the low and middle-income countries (LMICs) bear the heaviest brunt of RTIs. Like other LMICs, Uganda, a country located in Eastern Africa, has been experiencing a worryingly high burden of RTIs and their associated impacts. Over the years, the highest number of all the total registered RTIs in Uganda has taken place in the Greater Kampala Metropolitan Area (GKMA). This places a tremendous demand on the few existing emergency medical services (EMS) to adequately respond to those affected. In this regard, the overall objective of the study was to risk map RTIs in the GKMA so as to help in the better planning of EMS for the victims of RTIs. Other objectives included: (i) identifying the factors affecting the exposure, vulnerability and EMS capacity for the victims of RTIs; (ii) identifying the RTI prone-areas and estimating their associated risk factors; (iii) identifying the weaknesses and capacities which affect the EMS systems for RTIs; and (iv) determining the strategies and priority actions that can help to improve the EMS response for RTI victims in the GKMA. To achieve these objectives, a mixed methodological approach was used in four phrases for approximately 15 months. It employed a systematic review based on the preferred reporting items for systematic reviews and meta-data analysis guidelines; a Delphi panel technique; retrospective data analysis; and a cross-sectional method. With Uganda progressing forward as envisaged in its 'Vision 2040', the GKMA, which is the country’s political and socioeconomic epicenter, is experiencing significant changes in terms of population growth, urbanization, infrastructure development, rapid motorization and other factors. Unless appropriate actions are taken, these changes are likely to worsen the already alarming rate of RTIs in Uganda, and in turn also to put pressure on the few existing EMS and facilities to render care for those affected. Therefore, road safety vis-à-vis injury prevention measures, which are needed to reduce the burden of RTIs, should be multifaceted in nature so that they closely correlate with the ongoing dynamics that contribute to RTIs, particularly in the GKMA and Uganda as a whole.

Keywords: emergency medical services, Kampala, risk mapping, road traffic incidents

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1641 Characterization of AlOOH Film Containing Mg-Al Layered Double Hydroxide Prepared on Al Alloy by Steam Coating

Authors: Ai Serizawa, Kotaro Mori, Takahiro Ishizaki

Abstract:

Al alloys have been used as advanced structural materials in automobile and railway industries because of excellent physical and mechanical properties such as low density, good heat conductivity, and high specific strength. Their low corrosion resistance, however, limits their use in the corrosive environment. To improve the corrosion resistance of the Al alloys, the development of a novel coating technology has been highly desirable. Chemical conversion methods using layered double hydroxide (LDH) have attracted much attention because the LDH can suppress corrosion reaction due to their trapping ability of corrosive anions such as Cl- between layers. In this presentation, we report on a novel preparation method of AlOOH film containing Mg-Al layered double hydroxide (LDH) on Al alloy by steam coating. The corrosion resistance of the composite film including LDH was especially focused. Al-Mg-Si alloy was used as the substrate. The substrates were ultrasonically cleaned in ethanol for 10 min. The cleaned substrates were set in the autoclave with a 100 mL capacity. 20 ml of ultrapure water was located at the bottom of the autoclave to produce steam. The autoclave was heated up to a temperature of 100 to 200 °C, and then held at this temperature for up to 48 h, and was subsequently cooled naturally to room temperature, resulting in the formation of anticorrosive films on Al alloys. The resultant films were characterized by XRD, FT-IR, FE-SEM and electrochemical measurements. FE-SEM image of film surface treated at 180 °C for 48 h demonstrated that needle-like nanostructure was densely formed on the surface. XRD patterns revealed that the film formed on the Al alloys by steam coating was composed of crystal AlOOH and Mg-Al LDH. The corrosion resistance of the film was evaluated using electrochemical measurements. The potentiodynamic polarization curves of the film coated and uncoated substrates of Al-Mg-Si alloy after immersion in the 5 wt% NaCl aqueous solution for 30 min revealed that the corrosion current density, jcorr, of the film coated sample decreased by more than two orders of magnitude as compared to the uncoated sample, indicating that the corrosion resistance of the substrates of Al-Mg-Si alloy were improved by the formation of the anticorrosive film via steam coating.

Keywords: aluminum alloy, boehmite, corrosion resistance, steam process

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1640 Thermodynamic Approach of Lanthanide-Iron Double Oxides Formation

Authors: Vera Varazashvili, Murman Tsarakhov, Tamar Mirianashvili, Teimuraz Pavlenishvili, Tengiz Machaladze, Mzia Khundadze

Abstract:

Standard Gibbs energy of formation ΔGfor(298.15) of lanthanide-iron double oxides of garnet-type crystal structure R3Fe5O12 - RIG (R – are rare earth ions) from initial oxides are evaluated. The calculation is based on the data of standard entropies S298.15 and standard enthalpies ΔH298.15 of formation of compounds which are involved in the process of garnets synthesis. Gibbs energy of formation is presented as temperature function ΔGfor(T) for the range 300-1600K. The necessary starting thermodynamic data were obtained from calorimetric study of heat capacity – temperature functions and by using the semi-empirical method for calculation of ΔH298.15 of formation. Thermodynamic functions for standard temperature – enthalpy, entropy and Gibbs energy - are recommended as reference data for technological evaluations. Through the isostructural series of rare earth-iron garnets the correlation between thermodynamic properties and characteristics of lanthanide ions are elucidated.

Keywords: calorimetry, entropy, enthalpy, heat capacity, gibbs energy of formation, rare earth iron garnets

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1639 The Possible Double-Edged Sword Effects of Online Learning on Academic Performance: A Quantitative Study of Preclinical Medical Students

Authors: Atiwit Sinyoo, Sekh Thanprasertsuk, Sithiporn Agthong, Pasakorn Watanatada, Shaun Peter Qureshi, Saknan Bongsebandhu-Phubhakdi

Abstract:

Background: Since the SARS-CoV-2 virus became extensively disseminated throughout the world, online learning has become one of the most hotly debated topics in educational reform. While some studies have already shown the advantage of online learning, there are still questions concerning how online learning affects students’ learning behavior and academic achievement when each student learns in a different way. Hence, we aimed to develop a guide for preclinical medical students to avoid drawbacks and get benefits from online learning that possibly a double-edged sword. Methods: We used a multiple-choice questionnaire to evaluate the learning behavior of second-year Thai medical students in the neuroscience course. All traditional face-to-face lecture classes were video-recorded and promptly posted to the online learning platform throughout this course. Students could pick and choose whatever classes they wanted to attend, and they may use online learning as often as they wished. Academic performance was evaluated as summative score, spot exam score and pre-post-test improvement. Results: More frequently students used online learning platform, the less they attended lecture classes (P = 0.035). High proactive online learners (High PO) who were irregular attendee (IrA) had significantly lower summative scores (P = 0.026), spot exam score (P = 0.012) and pre-post-test improvement (P = 0.036). In the meanwhile, conditional attendees (CoA) who only attended classes with attendance check had significantly higher summative score (P = 0.025) and spot exam score (P = 0.001) if they were in the High PO group. Conclusions: The benefit and drawbacks edges of using an online learning platform were demonstrated in our research. Based on this double-edged sword effect, we believe that online learning is a valuable learning strategy, but students must carefully plan their study schedule to gain the “benefit edge” meanwhile avoiding its “drawback edge”.

Keywords: academic performance, assessment, attendance, online learning, preclinical medical students

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1638 The International Legal Protection of Foreign Investment Through Bilateral Investment Treaties and Double Taxation Treaties in the Context of International Investment Law and International Tax Law

Authors: Abdulmajeed Abdullah Alqarni

Abstract:

This paper is devoted a study of the current frameworks applicable to foreign investments at the levels of domestic and international law, with a particular focus on the legitimate balance to be achieved between the rights of the host state and the legal protections owed to foreign investors. At the wider level of analysis, the paper attempts to map and critically examine the relationship between foreign investment and economic development. In doing so, the paper offers a study in how current discourses and practices on investment law can reconcile the competing interests of developing and developed countries. The study draws on the growing economic imperative for developing nations to create a favorable investment climate capable of attracting private foreign investment. It notes that that over the past decades, an abundance of legal standards that establish substantive and procedural protections for legal forms of foreign investments in the host countries have evolved and crystalized. The study then goes on to offer a substantive analysis of legal reforms at the domestic level in countries such as Saudi Arabia before going on to provide an in- depth and substantive examination of the most important instruments developed at the levels of international law: bilateral investment agreements and double taxation agreements. As to its methods, the study draws on case studies and from data assessing the link between double taxation and economic development. Drawing from the extant literature and doctrinal research, and international and comparative jurisprudence, the paper excavates and critically examines contemporary definitions and norms of international investment law, many of which have been given concrete form and specificity in an ever-expanding number of bilateral and multilateral investment treaties. By reconsidering the wider challenges of conflicts of law and jurisdiction, and the competing aims of the modern investment law regime, the study reflects on how bilateral investment treaties might succeed in achieving the dual aims of rights protection and economic sovereignty. Through its examination of the double taxation phenomena, the study goes on to identify key practical challenges raised by the implementation of bilateral treaties whilst also assessing the sufficiency of the domestic and international legal solutions that are proposed in response. In its final analysis, the study aims to contribute to existing scholarship by assessing contemporary legal and economic barriers to the free flow of investment with due regard for the legitimate concerns and diversity of developing nations. It does by situating its analysis of the domestic enforcement of international investment instrument in its wider historical and normative context. By focusing on the economic and legal dimensions of foreign investment, the paper also aims to offer an interdisciplinary and holistic perspective on contemporary issues and developments in investment law while offering practical reform proposals that can be used to be achieve a more equitable balance between the rights and interests of states and private entities in an increasingly trans nationalized sphere of investment regulation and treaty arbitration.

Keywords: foreign investment, bilateral investment treaties, international tax law, double taxation treaties

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1637 The Influence of the Geogrid Layers on the Bearing Capacity of Layered Soils

Authors: S. A. Naeini, H. R. Rahmani, M. Hossein Zade

Abstract:

Many classical bearing capacity theories assume that the natural soil's layers are homogenous for determining the bearing capacity of the soil. But, in many practical projects, we encounter multi-layer soils. Geosynthetic as reinforcement materials have been extensively used in the construction of various structures. In this paper, numerical analysis of the Plate Load Test (PLT) using of ABAQUS software in double-layered soils with different thicknesses of sandy and gravelly layers reinforced with geogrid was considered. The PLT is one of the common filed methods to calculate parameters such as soil bearing capacity, the evaluation of the compressibility and the determination of the Subgrade Reaction module. In fact, the influence of the geogrid layers on the bearing capacity of the layered soils is investigated. Finally, the most appropriate mode for the distance and number of reinforcement layers is determined. Results show that using three layers of geogrid with a distance of 0.3 times the width of the loading plate has the highest efficiency in bearing capacity of double-layer (sand and gravel) soils. Also, the significant increase in bearing capacity between unreinforced and reinforced soil with three layers of geogrid is caused by the condition that the upper layer (gravel) thickness is equal to the loading plate width.

Keywords: bearing capacity, reinforcement, geogrid, plate load test, layered soils

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1636 Developing Thai-UK Double Degree Programmes: An Exploratory Study Identifying Challenges, Competing Interests and Risks

Authors: Joy Tweed, Jon Pike

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In Thailand, a 4.0 policy has been initiated that is designed to prepare and train an appropriate workforce to support the move to a value-based economy. One aspect of support for this policy is a project to encourage the creation of double degree programmes, specifically between Thai and UK universities. This research into the project, conducted with its key players, explores the factors that can either enable or hinder the development of such programmes. It is an area that has received little research attention to date. Key findings focus on differences in quality assurance requirements, attitudes to benefits, risks, and committed levels of institutional support, thus providing valuable input into future policy making. The Transnational Education (TNE) Development Project was initiated in 2015 by the British Council, in conjunction with the Office for Higher Education Commission (OHEC), Thailand. The purpose of the project was to facilitate opportunities for Thai Universities to partner with UK Universities so as to develop double degree programme models. In this arrangement, the student gains both a UK and a Thai qualification, spending time studying in both countries. Twenty-two partnerships were initiated via the project. Utilizing a qualitative approach, data sources included participation in TNE project workshops, peer reviews, and over 20 semi-structured interviews conducted with key informants within the participating UK and Thai universities. Interviews were recorded, transcribed, and analysed for key themes. The research has revealed that the strength of the relationship between the two partner institutions is critical. Successful partnerships are often built on previous personal contact, have senior-level involvement and are strengthened by partnership on different levels, such as research, student exchange, and other forms of mobility. The support of the British Council was regarded as a key enabler in developing these types of projects for those universities that had not been involved in TNE previously. The involvement of industry is apparent in programmes that have high scientific content but not well developed in other subject areas. Factors that hinder the development of partnership programmes include the approval processes and quality requirements of each institution. Significant differences in fee levels between Thai and UK universities provide a challenge and attempts to bridge them require goodwill on the part of the latter that may be difficult to realise. This research indicates the key factors to which attention needs to be given when developing a TNE programme. Early attention to these factors can reduce the likelihood that the partnership will fail to develop. Representatives in both partner universities need to understand their respective processes of development and approval. The research has important practical implications for policy-makers and planners involved with TNE, not only in relation to the specific TNE project but also more widely in relation to the development of TNE programmes in other countries and other subject areas. Future research will focus on assessing the success of the double degree programmes generated by the TNE Development Project from the perspective of universities, policy makers, and industry partners.

Keywords: double-degree, internationalization, partnerships, Thai-UK

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1635 Older Adult Grandparents' Voices as a Principle Care Giver in a Skipped-Generation Family

Authors: Kerdsiri Hongthai, Darunee Jongudomkarn, Rutja Phuphaibul

Abstract:

In Thailand, many adults in rural areas migrate to seek employ¬ment resulting in skipped-generation family where grandparents care for grandchildren with no other adults present. This is a preliminary study using qualitative case study methods, aimed to explore the situations of older adult grandparents' experiences in skipped-generation family in North-East of Thailand. Data were collected by in-depth inter¬views with 6 grandparents living in skipped-generation families; 5 females and 1 males grandparents, aged 62-75, some of them have diabetes mellitus, hypertension, during November to December, 2017. The finding themes are: ‘Caught up in the middle’: the older adults were pleased to have grandchildren but, at the same time, acknowledge the burden that this placed on them, especially when the migrant children failed to send enough money back to support the family. ‘Getting bad health’: they reported to be fatigued and stressed due to burden of caring for their grandchildren without support. This situation can aggravate problems of poor health status and be worsening economic status of the grandparents. In some cases of deprivation, the grandparents feel that having to be the sole care providers of their grandchildren can negative adversely affect their mental status. It is important to find out in other sectors similar to Thailand and lead to more in-depth research to answer the research questions about policy and social support in skipped-generation family in the future.

Keywords: older adult grandparents, experiences, principle care giver, skipped-generation family

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1634 Health Burden of Disease Assessment for Minimizing Aflatoxin Exposure in Peanuts

Authors: Min-Pei Ling

Abstract:

Aflatoxin is a fungal secondary metabolite with high toxicity capable of contaminating various types of food crops. It has been identified as a Group 1 human carcinogen by the International Agency for Research on Cancer. Chronic aflatoxin exposure has caused a worldwide public food safety concern. Peanuts and peanut products are the major sources of aflatoxin exposure. Therefore, some reduction interventions have been developed to minimize contamination through the peanut production chain. The purpose of this study is to estimate the efficacy of interventions in reducing the health impact of hepatocellular carcinoma caused by aflatoxin contamination in peanuts. The estimated total disability-adjusted life-years (DALYs) was calculated using FDA-iRISK online software. Six aflatoxin reduction strategies were evaluated, including good agricultural practice (GAP), biocontrol, Purdue Improved Crop Storage packaging, basic processing, ozonolysis, and ultraviolet irradiation. The results indicated that basic processing could prevent huge public health loss of 4,079.7–21,833 total DALYs per year, which accounted for 39.6% of all decreased total DALYs. GAP and biocontrol were both effective strategies in the farm field, while the other three interventions were limited in reducing total DALYs. In conclusion, this study could help farmers, processing plants, and government policymakers to alleviate aflatoxin contamination issues in the peanut production chain.

Keywords: aflatoxin, health burden, disability-adjusted life-years, peanuts

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1633 The Risk of Hyperglycemia Associated with Use of Dolutegravir among Adults Living with HIV in Kampala, Uganda: A Case Control Study

Authors: Daphine Namara, Jeremy I. Schwartz, Andrew K. Tusubira, Willi McFarland, Caroline Birungi, Fred C. Semitala, Martin Muddu

Abstract:

Emerging evidence suggests a possible association between hyperglycemia and dolutegravir (DTG), a preferred first-line antiretroviral agent in sub-Saharan Africa (SSA). There is a need for rigorous studies to validate this association in the face of increasing DTG use and the burden of non-communicable diseases among people living with HIV (PLHIV). We conducted a case-control study to assess the risk of hyperglycemia associated with the use of DTG among PLHIV attending Mulago ISS Clinic in Kampala. Cases had hyperglycemia, while controls had no hyperglycemia, as confirmed by fasting plasma glucose and oral glucose tolerance tests. Demographic, laboratory, and clinical data were collected using interviewer-administered questionnaires and medical record abstraction. The analysis compared cases and controls on DTG use prior to diagnosis of hyperglycemia while controlling for potential confounders using multivariable logistic regression. We included 204 cases and 231 controls. In multivariable analysis, patients with prior DTG use had seven times greater odds of subsequent diagnosis of hyperglycemia compared to those who had non-DTG-based regimens (adjusted odds ratio [aOR] 7.01, 95% CI 1.96-25.09). The odds of hyperglycemia also increased with age (56 years and above vs. 18-35, aOR 12.38, 95% CI 3.79-40.50) and hypertension (aOR 5.78, 95% CI 2.53-13.21). Our study demonstrates a strong association between prior DTG exposure and subsequent diagnosis of hyperglycemia. Given the benefits of DTG, wide-scale use, and the growing burden of diabetes mellitus (DM) in SSA, there is a need for systematic screening for hyperglycemia and consideration of alternate regimens for those at risk for DM.

Keywords: HIV, hyperglycemia, doluteravir, diabetes

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