Search results for: reflecting on social work teaching methods

Authors: Jelena Kovačević Vorgučin, Sibila Petenji Arbutina

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The postmodern age brings a rapid development of technology which inevitably leads to man's need to adapt to modern lifestyle. On the one hand, technological achievements have made human life easier, but there are numerous risks involved. Moreover, man's awareness and perception is changing and adapting unconsciously to the world we live in, while communication in the 21st century is predominantly based on the consumption of images. This paper presents sociological aspects of a community which is confined due to turbulent political-economic circumstances and its impact on the development of media literacy in Serbia. Previous researches led to the conclusion that the media culture is on an extremely low level, and that it can have a strong influence on the general development of the society, starting from the youngest segment of the population. Our aim is to use the conceptual authorial photographs inspired by the obtained research results to emphasize the importance that the impact of visual art has in delivering the message, its role in education and in raising awareness of universal social problems. The paper presents a number of stages involved in the conceptual project which is designed to last over a longer period of time in order to facilitate dissemination of information. First, a survey was carried out in several preschool institutions. This resulted in obtaining the necessary information on the habitual use of the medium of television in children and their carers-parents. The second stage focused on the relationship between the parent and the child in TV consumption. Further, an overview of the visual part of the project was made, which consisted of photographs in various dimensions, ranging from miniature to large dimensions, and following various exhibition principles in both gallery and alternative spaces. This stage of the project placed particular emphasis on the non-standard exhibiting formats and alternative exhibition principles which are increasingly present in all kinds of visual art aimed at achieving a higher level of information noticing and memorizing. The motif on the authorial photographs is children's portraits taken while they are watching different television contents, with emphasis on their emotional response. The importance of the medium of TV is particularly emphasized due to the fact that its consumption is the highest, even though there are newer and more advanced information-technological achievements. The already realized part of the project was used for an analysis of the results in the last stage of the project, which led to the conclusion that the response to the entire visual expression campaign was extremely positive, and action as such very useful indeed. The results obtained speak in favour of widening and continuation of the project, both on a greater number of sites locally as well as in other communities in Serbia with the aim of guiding people towards meaningful consumption of the television medium.

Keywords: alternative space exhibiting, children and TV, conceptual portrait photography, media literacy

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Authors: Maria Cardova

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Aim and objectives: The purpose of this studywas to explore to what extent the deprivation statusinfluenced children’s physical activity, dietary behaviour, and health outcomes such as weight status. Background: The United Kingdom’s childhood obesity rates are currently ranked among the highest in Europe. North West England deals with highest rates of childhood obesity. Data from the UK Millennium Cohort Study suggested a deprivation gradient to childhood obesity in England, with obesity rates being the highest in the most deprived areas. Traditionally, it has been individual conception of health, but the contemporary stance is that health behaviours affecting obesity are influenced by a broad range of factors operating at multiple levels. According to socio-ecological model of health behaviour, differences in obesity rates and health outcomes are likely explained by differences in lifestyle behaviours including physical activity and diet behaviours. However, higher rates of obesity among deprived children are not due to physical inactivity, in fact, most socially disadvantaged children are the most physically active. Poor diet including high consumption of fast food and sugar-sweetened beverages and low consumption of fruit and vegetables was found to be the most prevalent among adolescents living in poverty. Methods: This study adopted quantitative approach. It consisted of combination of basic demographic data, anthropometry, and questionnaires. Children (N = 165, mean age = 10.04 years; 53.33% female; 46.66% male) completed survey packs during school day including KIDSCREEN, Youth Activity Profile, Beverage and Snack Questionnaire, and Child Body Image Scale questionnaires as well as had anthropometric measurements taken including Body mass index, waist circumference, weight, and height. Children’s deprivation status was based on the English Indices of Multiple Deprivation scores of the school they attended. Results: Children from more deprived areas had higher weight status, waist circumference. Deprivation status had also effect on some dimensions of the KIDSCREEN questionnaire, such as that those from more deprived areas felt less socially accepted and bullied by their peers, had worse feelings about themselves such as body image, and more difficulty with school and learning. Children from more deprived areas reported higher rates of physical activity and also differences in snack and fruit and vegetable intake than their more affluent peers. Conclusion: Results demonstrated that, children living in the most-deprived areas appear to be at greater risk of unfavourable health-related variables and behaviours and are exposed to home and neighbourhood environments that are less conducive to health-promoting behaviours compared to their peers from less deprived areas. These findings indicate that children living in highly deprived areas represent an important group for future interventions designed to promote health-behaviours that would impact on the quality of life of the child and other health variables such as weight status.

Keywords: children, dietary behaviour, health, obesity, physical Activity, weight Status

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Authors: Sahar Nasr, Lin Li, Edwin Wang

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Bladder cancer (BLCA) is known as the 13th cause of death among cancer patients worldwide, and ~575,000 new BLCA cases are diagnosed each year. Urothelial carcinoma (UC) is the most prevalent subtype among BLCA patients, which can be categorized into muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC). Currently, various therapeutic options are available for UC patients, including (1) transurethral resection followed by intravesical instillation of chemotherapeutics or Bacillus Calmette-Guérin for NMIBC patients, (2) neoadjuvant platinum-based chemotherapy (NAC) plus radical cystectomy is the standard of care for localized MIBC patients, and (3) systematic chemotherapy for metastatic UC. However, conventional treatments may lead to several challenges for treating patients. As an illustration, some patients may suffer from recurrence of the disease after the first line of treatment. Recently, immune checkpoint therapy (ICT) has been introduced as an alternative treatment strategy for the first or second line of treatment in advanced or metastatic BLCA patients. Although ICT showed lucrative results for a fraction of BLCA patients, ~80% of patients were not responsive to it. Therefore, novel treatment methods are required to augment the ICI response rate within BLCA patients. It has been shown that the infiltration of T-cells into the tumor microenvironment (TME) is positively correlated with the response to ICT within cancerous patients. Therefore, the goal of this study is to enhance the infiltration of cytotoxic T-cells into TME through the identification of target genes within the tumor that are responsible for the non-T-cell inflamed TME and their inhibition. BLCA bulk RNA-sequencing data from The Cancer Genome Atlas (TCGA) and immune score for TCGA samples were used to determine the Pearson correlation score between the expression of different genes and immune score for each sample. The genes with strong negative correlations were selected (r < -0.2). Thereafter, the correlation between the expression of each gene and survival in BLCA patients was calculated using the TCGA data and Cox regression method. The genes that are common in both selected gene lists were chosen for further analysis. Afterward, BLCA bulk and single-cell RNA-sequencing data were ranked based on the expression of each selected gene and the top and bottom 25% samples were used for pathway enrichment analysis. If the pathways related to the T-cell infiltration (e.g., antigen presentation, interferon, or chemokine pathways) were enriched within the low-expression group, the gene was included for downstream analysis. Finally, the selected genes will be used to calculate the correlation between their expression and the infiltration rate of the activated CD+8 T-cells, natural killer cells and the activated dendric cells. A list of potential target genes has been identified and ranked based on the above-mentioned analysis and criteria. SUN-1 got the highest score within the gene list and other identified genes in the literature as benchmarks. In conclusion, inhibition of SUN1 may increase the tumor-infiltrating lymphocytes and the efficacy of ICI in BLCA patients. BLCA tumor cells with and without SUN-1 CRISPR/Cas9 knockout will be injected into the syngeneic mouse model to validate the predicted SUN-1 effect on increasing tumor-infiltrating lymphocytes.

Keywords: data analysis, gene expression analysis, gene identification, immunoinformatic, functional genomics, transcriptomics

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Authors: Robert Miller, Fred Soltero, Sandra Allan, Denise Bonilla

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The Tropical Bont Tick (TBT), Amblyomma variegatum, was introduced to the Caribbean in the mid-1700s. Since it has spread throughout the Caribbean dispersed by cattle egrets (Bubulcus ibis). Tropical Bont Ticks vector many pathogens to livestock and humans. However, only the livestock diseases heartwater, Ehrlichia (Cowdria) ruminantium, and dermatophilosis, Dermatophilus congolensis, are associated with TBT in the Caribbean. African tick bite fever (Rickettsia africae) is widespread in Caribbean TBT but human cases are rare. The Caribbean Amblyomma Programme (CAP) was an effort led by the Food and Agricultural Organization to eradicate TBTs from participating islands. This 10-year effort successfully eradicated TBT from many islands. However, most are reinfested since its termination. Pheromone technology has been developed to aid in TBT control. Although not part of the CAP treatment scheme, this research established that pheromones in combination with pesticide greatly improves treatment efficiencies. Additionally, pheromone combined with CO₂ traps greatly improves active surveillance success. St. Croix has a history of TBT outbreaks. Passive surveillance detected outbreaks in 2016 and in May of 2021. Surveillance efforts are underway to determine the extent of TBT on St Croix. Puerto Rico is the next island in the archipelago and is at a greater risk of re-infestation due to active outbreaks in St Croix. Tropical Bont Ticks were last detected in Puerto Rico in the 1980s. The infestation started on the small Puerto Rican island of Vieques, the closest landmass to St Croix, and spread to the main island through cattle movements. This infestation was eradicated with the help of the Tropical Cattle Tick (TCT), Rhipicephalus (Boophilus) microplus, eradication program. At the time, large percentages of Puerto Rican cattle were treated for ticks along with the necessary material and manpower mobilized for the effort. Therefore, a shift of focus from the TCT to TBT prevented its establishment in Puerto Rico. Currently, no large-scale treatment of TCTs occurs in Puerto Rico. Therefore, the risk of TBT establishment is now greater than it was in the 1980s. From Puerto Rico, the risk of TBT movement to the American continent increases significantly. The establishment of TBTs in the Americas would cause $1.2 billion USD in losses to the livestock industry per year. The USDA Agricultural Research Service recently worked with the USDA Animal Health Inspection Service and the Puerto Rican Department of Agriculture to modernize the management of the TCT. This modernized program uses safer pesticides and has successfully been used to eradicate pesticide-susceptible and -resistant ticks throughout the island. The objective of this work is to prevent the infestation of Puerto Rico by TBTs by combining the current TCT management efforts with TBT surveillance in Vieques. The combined effort is designed to eradicate TCT from Vieques while using the treated cattle as trap animals for TBT using pheromone impregnated tail tags attached to treated animals. Additionally, active surveillance using CO₂-baited traps combined with pheromone will be used to actively survey the environment for free-living TBT. Knowledge gained will inform TBT control efforts in St. Croix.

Keywords: Amblyomma variegatum, caribbean, eradication, Rhipicephalus (boophilus) microplus, pheromone

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Authors: Neelofar, Khursheed Alam, Jamal Ahmad

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Protein modification in diabetes mellitus may lead to early glycation products (EGPs) or amadori product as well as advanced glycation end products (AGEs). Early glycation involves the reaction of glucose with N-terminal and lysyl side chain amino groups to form Schiff’s base which undergoes rearrangements to form more stable early glycation product known as Amadori product. After Amadori, the reactions become more complicated leading to the formation of advanced glycation end products (AGEs) that interact with various AGE receptors, thereby playing an important role in the long-term complications of diabetes. Millard reaction or nonenzymatic glycation reaction accelerate in diabetes due to hyperglycation and alter serum protein’s structure, their normal functions that lead micro and macro vascular complications in diabetic patients. In this study, Human Serum Albumin (HSA) with a constant concentration was incubated with different concentrations of glucose at 370C for a week. At 4th day, Amadori product was formed that was confirmed by colorimetric method NBT assay and TBA assay which both are authenticate early glycation product. Conformational changes in native as well as all samples of Amadori albumin with different concentrations of glucose were investigated by various biophysical and biochemical techniques. Main biophysical techniques hyperchromacity, quenching of fluorescence intensity, FTIR, CD and SDS-PAGE were used. Further conformational changes were observed by biochemical assays mainly HMF formation, fructoseamine, reduction of fructoseamine with NaBH4, carbonyl content estimation, lysine and arginine residues estimation, ANS binding property and thiol group estimation. This study find structural and biochemical changes in Amadori modified HSA with normal to hyperchronic range of glucose with respect to native HSA. When glucose concentration was increased from normal to chronic range biochemical and structural changes also increased. Highest alteration in secondary and tertiary structure and conformation in glycated HSA was observed at the hyperchronic concentration (75mM) of glucose. Although it has been found that Amadori modified proteins is also involved in secondary complications of diabetes as AGEs but very few studies have been done to analyze the conformational changes in Amadori modified proteins due to early glycation. Most of the studies were found on the structural changes in Amadori protein at a particular glucose concentration but no study was found to compare the biophysical and biochemical changes in HSA due to early glycation with a range of glucose concentration at a constant incubation time. So this study provide the information about the biochemical and biophysical changes occur in Amadori modified albumin at a range of glucose normal to chronic in diabetes. Although many implicates currently in use i.e. glycaemic control, insulin treatment and other chemical therapies that can control many aspects of diabetes. However, even with intensive use of current antidiabetic agents more than 50 % of diabetic patient’s type 2 suffers poor glycaemic control and 18 % develop serious complications within six years of diagnosis. Experimental evidence related to diabetes suggests that preventing the nonenzymatic glycation of relevant proteins or blocking their biological effects might beneficially influence the evolution of vascular complications in diabetic patients or quantization of amadori adduct of HSA by authentic antibodies against HSA-EGPs can be used as marker for early detection of the initiation/progression of secondary complications of diabetes. So this research work may be helpful for the same.

Keywords: diabetes mellitus, glycation, albumin, amadori, biophysical and biochemical techniques

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Authors: Bar Y. Ainuz, Harry M. Salinas, Aleeza Ali, Eli B. Levitt, Austin J. Pourmoussa, Antoun Bouz, Miguel A. Medina

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Introduction: Breast conservation therapy remains the mainstay surgical treatment for early breast cancer. Oncoplastic techniques, in conjunction with lumpectomy and adjuvant radiotherapy, have been demonstrated to achieve good aesthetic results without adversely affecting cancer outcomes in the treatment of patients with macromastia or significant ptosis. In our patient population, many women present for breast conservation with pre-existing cosmetic implants or with breast volumes too small for soft tissue, only oncoplastic techniques. Our study evaluated a consecutive series of patients presenting for breast conservation undergoing concomitant oncoplastic-augmentation-mastopexy (OAM) with a contralateral augmentation-mastopexy for symmetry. Methods: OAM surgical technique involves simultaneous lumpectomy with exchange or placement of implants, oncoplastic mastopexy, and concomitant contralateral augmentation mastopexy for symmetry. Patients undergoing lumpectomy for breast conservation as outpatients were identified via retrospective chart review at a high volume private academic affiliated community-based cancer center. Patients with ptosis and either pre-existing breast implants or insufficient breast volume undergoing oncoplastic implant placement (or exchange) and mastopexy were included in the study. Operative details, aesthetic outcomes, and complications were assessed. Results: Over a continuous three-year period, with a two-surgeon cohort, 30 consecutive patients (56 breasts, 4 unilateral procedures) were identified. Patients had an average age of 52.5 years and an average BMI of 27.5, with 40% smokers or former smokers. The average operative time was 2.5 hours, the average implant size removed was 352 cc, and the average implant size placed was 300 cc. All new implants were smooth silicone, with the majority (92%) placed in a retropectoral fashion. 40% of patients received chemotherapy, and 80% of patients received whole breast adjuvant photon radiotherapy with a total radiation dose of either 42.56 or 52.56 Gy. The average and median length of follow-up were both 8.2 months. Of the 24 patients that received radiotherapy, 21% had asymmetry due to capsular contracture. A total of 7 patients (29.2%) underwent revisions for either positive margins (12.5%), capsular contracture (8.3%), implant loss (4.2%), or cosmetic concerns (4.2%). One patient developed a pulmonary embolism in the acute postoperative period and was treated with anticoagulant therapy. Conclusion: Oncoplastic augmentation mastopexy is a safe technique with good aesthetic outcomes and acceptable complication rates for ptotic patients with breast cancer and a paucity of breast volume or pre-existing implants who wish to pursue breast-conserving therapy. The revision rates compare favorably with single-stage cosmetic augmentation procedures as well as other oncoplastic techniques described in the literature. The short-term capsular contracture rates seem lower than the rates in patients undergoing radiation after mastectomy and implant-based reconstruction. Long term capsular contractures and revision rates are too early to know in this cohort.

Keywords: breast conserving therapy, oncoplastic augmentation mastopexy, capsular contracture, breast reconstruction

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Authors: Omolola Ojetayo, Emmanuel Garuba, Obinna Ajunwa, Abiodun A. Onilude

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Introduction: Biofilm is a functional community of microorganisms that are associated with a surface or an interface. These adherent cells become embedded within an extracellular matrix composed of polymeric substances, i.e., biofilms refer to biological deposits consisting of both microbes and their extracellular products on biotic and abiotic surfaces. Despite their detrimental effects in medicine, biofilms as natural cell immobilization have found several applications in biotechnology, such as in the treatment of wastewater, bioremediation and biodegradation, desulfurization of gas, and conversion of agro-derived materials into alcohols and organic acids. The means of enhancing immobilized cells have been chemical-inductive, and this affects the medium composition and final product. Physical factors including electrical, magnetic, and electromagnetic flux have shown potential for enhancing biofilms depending on the bacterial species, nature, and intensity of emitted signals, the duration of exposure, and substratum used. However, the concept of cell immobilisation by electrical and magnetic induction is still underexplored. Methods: To assess the effects of physical factors on biofilm formation, six American typed culture collection (Acetobacter aceti ATCC15973, Pseudomonas aeruginosa ATCC9027, Serratia marcescens ATCC14756, Gluconobacter oxydans ATCC19357, Rhodobacter sphaeroides ATCC17023, and Bacillus subtilis ATCC6633) were used. Standard culture techniques for bacterial cells were adopted. Natural autoimmobilisation potentials of test bacteria were carried out by simple biofilms ring formation on tubes, while crystal violet binding assay techniques were adopted in the characterisation of biofilm quantity. Electroinduction of bacterial cells by direct current (DC) application in cell broth, static magnetic field exposure, and electromagnetic flux were carried out, and autoimmobilisation of cells in a biofilm pattern was determined on various substrata tested, including wood, glass, steel, polyvinylchloride (PVC) and polyethylene terephthalate. Biot Savart law was used in quantifying magnetic field intensity, and statistical analyses of data obtained were carried out using the analyses of variance (ANOVA) as well as other statistical tools. Results: Biofilm formation by the selected test bacteria was enhanced by the physical factors applied. Electromagnetic induction had the greatest effect on biofilm formation, with magnetic induction producing the least effect across all substrata used. Microbial cell-cell communication could be a possible means via which physical signals affected the cells in a polarisable manner. Conclusion: The enhancement of biofilm formation by bacteria using physical factors has shown that their inherent capability as a cell immobilization method can be further optimised for industrial applications. A possible relationship between the presence of voltage-dependent channels, mechanosensitive channels, and bacterial biofilms could shed more light on this phenomenon.

Keywords: bacteria, biofilm, cell immobilization, electromagnetic induction, substrata

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Authors: Olatokunbo Yakeem

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Human trafficking is a crime against gross violations of human rights. Trafficking in persons is a severe socio-economic dilemma that affects the national and international dimensions. Human trafficking or modern-day-slavery emanated from slavery, and it has been in existence before the 6ᵗʰ century. Today, no country is exempted from dehumanizing human beings, and as a result, it has been an international issue. The United Nations (UN) presented the International Protocol to fight human trafficking worldwide, which brought about the international definition of human trafficking. The protocol is to prevent, suppress, and punish trafficking in persons, especially women and children. The trafficking protocol has a link with transnational organised crime rather than migration. Over a hundred and fifty countries nationwide have enacted their criminal and panel code trafficking legislation from the UN trafficking protocol. Sex trafficking is the most common type of exploitation of women and children. Other forms of this crime involve exploiting vulnerable victims through forced labour, child involvement in warfare, domestic servitude, debt bondage, and organ removal for transplantation. Trafficking of women and children into sexual exploitation represents the highest form of human trafficking than other types of exploitation. Trafficking of women and children can either happen internally or across the border. It affects all kinds of people, regardless of their race, social class, culture, religion, and education levels. However, it is more of a gender-based issue against females. Furthermore, human trafficking can lead to life-threatening infections, mental disorders, lifetime trauma, and even the victim's death. The study's significance is to explore why the root causes of women and children trafficking in Nigeria are based around poverty, entrusting children in the hands of relatives and friends, corruption, globalization, weak legislation, and ignorance. The importance of this study is to establish how the national, regional, and international organisations are using the 3P’s Protection, Prevention, and Prosecution) to tackle human trafficking. The methodology approach for this study will be a qualitative paradigm. The rationale behind this selection is that the qualitative method will identify the phenomenon and interpret the findings comprehensively. The data collection will take the form of semi-structured in-depth interviews through telephone and email. The researcher will use a descriptive thematic analysis to analyse the data by using complete coding. In summary, this study aims to recommend to the Nigerian federal government to include human trafficking as a subject in their educational curriculum for early intervention to prevent children from been coerced by criminal gangs. And the research aims to find the root causes of women and children trafficking. Also, to look into the effectiveness of the strategies in place to eradicate human trafficking globally. In the same vein, the research objective is to investigate how the anti-trafficking bodies such as law enforcement and NGOs collaborate to tackle the upsurge in human trafficking.

Keywords: children, Nigeria, trafficking, women

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Authors: Saqib Aziz, Brad Alexander, Christoph Gengnagel, Stefan Weinzierl

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This paper explores a generative design, simulation, and optimization workflow for the integration of acoustical diffuser and/or absorber geometry with embedded coupled Helmholtz-resonators for full-scale 3D printed building components. Large-scale additive manufacturing in conjunction with algorithmic CAD design tools enables a vast amount of control when creating geometry. This is advantageous regarding the increasing demands of comfort standards for indoor spaces and the use of more resourceful and sustainable construction methods and materials. The presented methodology highlights these new technological advancements and offers a multimodal and integrative design solution with the potential for an immediate application in the AEC-Industry. In principle, the methodology can be applied to a wide range of structural elements that can be manufactured by additive manufacturing processes. The current paper focuses on a case study of an application for a biaxial load-bearing beam grillage made of reinforced concrete, which allows for a variety of applications through the combination of additive prefabricated semi-finished parts and in-situ concrete supplementation. The semi-prefabricated parts or formwork bodies form the basic framework of the supporting structure and at the same time have acoustic absorption and diffusion properties that are precisely acoustically programmed for the space underneath the structure. To this end, a hybrid validation strategy is being explored using a digital and cross-platform simulation environment, verified with physical prototyping. The iterative workflow starts with the generation of a parametric design model for the acoustical geometry using the algorithmic visual scripting editor Grasshopper3D inside the building information modeling (BIM) software Revit. Various geometric attributes (i.e., bottleneck and cavity dimensions) of the resonator are parameterized and fed to a numerical optimization algorithm which can modify the geometry with the goal of increasing absorption at resonance and increasing the bandwidth of the effective absorption range. Using Rhino.Inside and LiveLink for Revit, the generative model was imported directly into the Multiphysics simulation environment COMSOL. The geometry was further modified and prepared for simulation in a semi-automated process. The incident and scattered pressure fields were simulated from which the surface normal absorption coefficients were calculated. This reciprocal process was repeated to further optimize the geometric parameters. Subsequently the numerical models were compared to a set of 3D concrete printed physical twin models, which were tested in a .25 m x .25 m impedance tube. The empirical results served to improve the starting parameter settings of the initial numerical model. The geometry resulting from the numerical optimization was finally returned to grasshopper for further implementation in an interdisciplinary study.

Keywords: acoustical design, additive manufacturing, computational design, multimodal optimization

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Authors: Masoume Pourmohamadreza-Tajrishi, Parviz Azadfallah

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Autism spectrum disorders (ASD) involve myriad aberrant perceptual, cognitive, linguistic, and social behaviors. The term spectrum emphasizes that the disabilities associated with ASD fall on a continuum from relatively mild to severe. People with ASD may display stereotyped behaviors such as twirling, spinning objects, flapping the hands, and rocking. The individuals with ASD exhibit communication problems due to repetitive/restricted behaviors. Children with ASD who lack the motivation to learn, who do not enjoy physical challenges, or whose sensory perception results in confusing or unpleasant feedback from movement may not become sufficiently motivated to practice motor activities. As a result, they may show both a delay in developing certain motor skills. Additionally, attention is an important component of learning. As far as children with ASD have problems in joint attention, many education-based programs are needed to consider some aspects of attention and motor activities development for students with ASD. These programs focus on the basic movement skills that are crucial for the future development of the more complex skills needed in games, dance, sports, gymnastics, active play, and recreational physical activities. The purpose of the present research was to determine the effectiveness of therapeutic exercise on motor skills and attention of male students with ASD. This was an experimental study with a control group. The population consisted of 8-10 year-old male students with ASD and 30 subjects were selected randomly from an available center suitable for the children with ASD. They were evaluated by the Basic Motor Ability Test (BMAT) and Persian version of computerized Stroop color-word test and randomly assigned to an experimental and control group (15 students in per group). The experimental group participated in 16 therapeutic exercise sessions and received therapeutic exercise program (twice a week; each lasting for 45 minutes) designed based on the Spark motor program while the control group did not. All subjects were evaluated by BMAT and Stroop color-word test after the last session again. The collected data were analyzed by using multivariate analysis of covariance (MANCOVA). The results of MANCOVA showed that experimental and control groups had a significant difference in motor skills and at least one of the components of attention (correct responses, incorrect responses, no responses, the reaction time of congruent words and reaction time of incongruent words in the Stroop test). The findings showed that the therapeutic exercise had a significant effect on motor skills and all components of attention in students with ASD. We can conclude that the therapeutic exercise led to promote the motor skills and attention of students with ASD, so it is necessary to design or plan such programs for ASD students to prevent their communication or academic problems.

Keywords: Attention, autism spectrum disorder, motor skills, therapeutic exercise

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Authors: Clemens Bulitta, Sasan Sadrizadeh, Sebastian Buhl

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Introduction: Ventilation technology in operating theatres (OT)is internationally regulated by dif-ferent standards, which define basic specifications for technical equipment and many times also the necessary operating and performance parameters. This confronts the operators of healthcare facilities with the question of finding the best ventilation and air conditioning system for the OT in order to achieve the goal of a large and robust surgicalworkzone with appropriate air quality and climate for patient safety and occupational health. Additionally, energy consumption and the potential need for clothing that limits transmission of bacteria must be considered as well as the total life cycle cost. However, the evaluation methodology of ventilation systems regarding these matters are still a topic of discussion. To date, there are neither any uniform standardized specifications nor any common validation criteria established. Thus, this study aimed to review data in the literature and add ourown research results to compare and assess the performance of different ventilations systems regarding infection preventive effects, energy efficiency, and staff comfort. Methods: We have conducted a comprehensive literature review on OT ventilation-related topics to understand the strengths and limitations of different ventilation systems. Furthermore, data from experimental assessments on OT ventilation systems at the University of Amberg-Weidenin Germany were in-cluded to comparatively assess the performance of Laminar Airflow (LAF), Turbulent Mixing Air-flow(TMA), and Temperature-controlled Airflow (TcAF) with regards to patient and occupational safety as well as staff comfort including indoor climate.CFD simulations from the Royal Institute of Technology in Sweden (KTH) were also studied to visualize the differences between these three kinds of ventilation systems in terms of the size of the surgical workzone, resilience to obstacles in the airflow, and energy use. Results: A variety of ventilation concepts are in use in the OT today. Each has its advantages and disadvantages, and thus one may be better suited than another depend-ing on the built environment and clinical workflow. Moreover, the proper functioning of OT venti-lation is also affected by multiple external and internal interfering factors. Based on the available data TcAF and LAF seem to provide the greatest effects regarding infection control and minimizing airborne risks for surgical site infections without the need for very tight surgical clothing systems. Resilience to obstacles, staff comfort, and energy efficiency seem to be favourable with TcAF. Conclusion: Based on literature data in current publications and our studies at the Technical Uni-versity of Applied Sciences Amberg-Weidenand the Royal Institute of Technoclogy, LAF and TcAF are more suitable for minimizing the risk for surgical site infections leading to improved clin-ical outcomes. Nevertheless, regarding the best management of thermal loads, atmosphere, energy efficiency, and occupational safety, overall results and data suggest that TcAF systems could pro-vide the economically most efficient and clinically most effective solution under routine clinical conditions.

Keywords: ventilation systems, infection control, energy efficiency, operating theatre, airborne infection risks

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Authors: Nadia Obaed, Lexi Frankel, Amalia Ardeljan, Denis Nigel, Anniki Witter, Omar Rashid

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Breast cancer is the most common cancer among women, with a lifetime risk of one in eight of all women in the United States. Although breast cancer is prevalent throughout the world, the uneven distribution in incidence and mortality rates is shaped by the variation in population structure, environment, genetics and known lifestyle risk factors. Furthermore, the bacterial profile in healthy and cancerous breast tissue differs with a higher relative abundance of bacteria capable of causing DNA damage in breast cancer patients. Previous bacterial infections may change the composition of the microbiome and partially account for the environmental factors promoting breast cancer. One study found that higher amounts of Staphylococcus, Bacillus, and Enterobacteriaceae, of which Escherichia coli (E. coli) is a part, were present in breast tumor tissue. Based on E. coli’s ability to damage DNA, it is hypothesized that there is an increased risk of breast cancer associated with previous E. coli infection. Therefore, the purpose of this study was to evaluate the correlation between E. coli infection and the incidence of breast cancer. Holy Cross Health, Fort Lauderdale, provided access to the Health Insurance Portability and Accountability (HIPAA) compliant national database for the purpose of academic research. International Classification of Disease 9th and 10th Codes (ICD-9, ICD-10) was then used to conduct a retrospective analysis using data from January 2010 to December 2019. All breast cancer diagnoses and all patients infected versus not infected with E. coli that underwent typical E. coli treatment were investigated. The obtained data were matched for age, Charlson Comorbidity Score (CCI score), and antibiotic treatment. Standard statistical methods were applied to determine statistical significance and an odds ratio was used to estimate the relative risk. A total of 81286 patients were identified and analyzed from the initial query and then reduced to 31894 antibiotic-specific treated patients in both the infected and control group, respectively. The incidence of breast cancer was 2.51% and present in 2043 patients in the E. coli group compared to 5.996% and present in 4874 patients in the control group. The incidence of breast cancer was 3.84% and present in 1223 patients in the treated E. coli group compared to 6.38% and present in 2034 patients in the treated control group. The decreased incidence of breast cancer in the E. coli and treated E. coli groups was statistically significant with a p-value of 2.2x10-16 and 2.264x10-16, respectively. The odds ratio in the E. coli and treated E. coli groups was 0.784 and 0.787 with a 95% confidence interval, respectively (0.756-0.813; 0.743-0.833). The current study shows a statistically significant decrease in breast cancer incidence in association with previous Escherichia coli infection. Researching the relationship between single bacterial species is important as only up to 10% of breast cancer risk is attributable to genetics, while the contribution of environmental factors including previous infections potentially accounts for a majority of the preventable risk. Further evaluation is recommended to assess the potential and mechanism of E. coli in decreasing the risk of breast cancer.

Keywords: breast cancer, escherichia coli, incidence, infection, microbiome, risk

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Authors: Matthew Arnaouti, Michael Baird, Gabrielle Cahill, Tamara Worlton, Michelle Joseph

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Introduction: Over ten years after the 7.0 magnitude Earthquake struck the capital of Haiti, impacting over three million people and leading to the deaths of over two hundred thousand, the multinational humanitarian response remains the largest disaster relief effort to date. This study critically evaluates the multi-sector and multinational disaster response to the Earthquake, looking at how the lessons learned from this analysis can be applied to future disaster response efforts. We put particular emphasis on assessing the interaction between civilian and military sectors during this humanitarian relief effort, with the hopes of highlighting how concrete guidelines are essential to improve future responses. Methods: An extensive scoping review of the relevant literature was conducted - where library scientists conducted reproducible, verified systematic searches of multiple databases. Grey literature and hand searches were utilised to identify additional unclassified military documents, for inclusion in the study. More than 100 documents were included for data extraction and analysis. Key domains were identified, these included: Humanitarian and Military Response, Communication, Coordination, Resources, Needs Assessment and Pre-Existing Policy. Corresponding information and lessons-learned pertaining to these domains was then extracted - detailing the barriers and facilitators to an effective response. Results: Multiple themes were noted which stratified all identified domains - including the lack of adequate pre-existing policy, as well as extensive ambiguity of actors’ roles. This ambiguity was continually influenced by the complex role the United States military played in the disaster response. At a deeper level, the effects of neo-colonialism and concern about infringements on Haitian sovereignty played a substantial role at all levels: setting the pre-existing conditions and determining the redevelopment efforts that followed. Furthermore, external factors significantly impacted the response, particularly the loss of life within the political and security sectors. This was compounded by the destruction of important infrastructure systems - particularly electricity supplies and telecommunication networks, as well as air and seaport capabilities. Conclusions: This study stands as one of the first and most comprehensive evaluations, systematically analysing the civilian and military response - including their collaborative efforts. This study offers vital information for improving future combined responses and provides a significant opportunity for advancing knowledge in disaster relief efforts - which remains a more pressing issue than ever. The categories and domains formulated serve to highlight interdependent factors that should be applied in future disaster responses, with significant potential to aid the effective performance of humanitarian actors. Further studies will be grounded in these findings, particularly the need for greater inclusion of the Haitian perspective in the literature, through additional qualitative research studies.

Keywords: civilian and military collaboration, combined response, disaster, disaster response, earthquake, Haiti, humanitarian response

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Authors: Dipanwita Chakravortty

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Officially, the Israel Defence Forces (IDF) follows a policy of 'gender equality and partnership' which institutionalises norms regarding equal duty towards the nation. It reiterates the equality in unbiased opportunities and resources for Jewish men and women to participate in the military as equal citizens. At the same time, as a military institution, the IDF supports gender biases and crystallises the same through various interactions among women soldiers, male soldiers and the institution. These biases are expressed through various stages and processes in the military institution like biased training, discriminatory postings of women soldiers, lack of combat training and acceptance of sexual harassment. The gender-military debates in Israel is largely devoted to female emancipation and converting the militarised women’s experiences into mainstream debates. This critical scholarship, largely female-based and located in Israel, has been consistently critical of the structural policies of the IDF that have led to continued discriminatory practices against women soldiers. This has compelled the military to increase its intake of women soldiers and make its structural policies more gender-friendly. Nonetheless, the continued thriving of gender discrimination in the IDF resulted in scholars looking deep into the failure of these policies in bringing about a change. This article looks into two research objectives, firstly to analyse existing gender relations in the IDF which impact the practices and prejudices in the institution and secondly to look beyond the structural discrimination as part of the gender debates in the IDF. The proposed research uses the structural-functional model as a framework to study the discourses and norms emerging out of the interaction between gender and military as two distinct social institutions. Changing gender-military debates will be discussed in great detail to understanding the in-depth relation between the Israeli society and the military due to the conscription model. The main arguments of the paper deal with the functional aspect of the military service rather than the structural component of the institution. Traditional stereotypes of military institutions along with cultural notions of a female body restrict the complete integration of women soldiers despite favourable legislations and policies. These result in functional discriminations like uneven promotion, sexual violence, restructuring gender identities and creating militarised bodies. The existing prejudices encourage younger women recruits to choose from within the accepted pink-collared jobs in the military rather than ‘breaking the barriers.’ Some women recruits do try to explore new avenues and make a mark for themselves. Most of them face stiff discrimination but they accept it as part of military life. The cyclical logic behind structural norms leading to functional discrimination which then emphasises traditional stereotypes and hampers change in the institutional norms compels the IDF to continue to strive towards gender equality within the institution without practical realisation.

Keywords: women soldiers, Israel Defence Forces, gender-military debates, security studies

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Authors: Junqi Zou

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As one of the world’s most tech-ready countries, Singapore has initiated the Smart Nation plan to harness the full power and potential of digital technologies to transform the way people live and work, through the more efficient government and business processes, to make the economy more productive. The key evolutions of digital technology transformation in healthcare and the increasing deployment of Internet of Things (IoTs), Big Data, AI/cognitive, Robotic Process Automation (RPA), Electronic Health Record Systems (EHR), Electronic Medical Record Systems (EMR), Warehouse Management System (WMS in the most recent decade have significantly stepped up the move towards an information-driven healthcare ecosystem. The advances in information technology not only bring benefits to patients but also act as a key force in changing management accounting in healthcare sector. The aim of this study is to investigate the impacts of digital technology transformation on Singapore’s healthcare sector from a management accounting perspective. Adopting a Balanced Scorecard (BSC) analysis approach, this paper conducted an exploratory case study of a newly launched Singapore public hospital, which has been recognized as amongst the most digitally advanced healthcare facilities in Asia-Pacific region. Specifically, this study gains insights on how the new technology is changing healthcare organizations’ management accounting from four perspectives under the Balanced Scorecard approach, 1) Financial Perspective, 2) Customer (Patient) Perspective, 3) Internal Processes Perspective, and 4) Learning and Growth Perspective. Based on a thorough review of archival records from the government and public, and the interview reports with the hospital’s CIO, this study finds the improvements from all the four perspectives under the Balanced Scorecard framework as follows: 1) Learning and Growth Perspective: The Government (Ministry of Health) works with the hospital to open up multiple training pathways to health professionals that upgrade and develops new IT skills among the healthcare workforce to support the transformation of healthcare services. 2) Internal Process Perspective: The hospital achieved digital transformation through Project OneCare to integrate clinical, operational, and administrative information systems (e.g., EHR, EMR, WMS, EPIB, RTLS) that enable the seamless flow of data and the implementation of JIT system to help the hospital operate more effectively and efficiently. 3) Customer Perspective: The fully integrated EMR suite enhances the patient’s experiences by achieving the 5 Rights (Right Patient, Right Data, Right Device, Right Entry and Right Time). 4) Financial Perspective: Cost savings are achieved from improved inventory management and effective supply chain management. The use of process automation also results in a reduction of manpower costs and logistics cost. To summarize, these improvements identified under the Balanced Scorecard framework confirm the success of utilizing the integration of advanced ICT to enhance healthcare organization’s customer service, productivity efficiency, and cost savings. Moreover, the Big Data generated from this integrated EMR system can be particularly useful in aiding management control system to optimize decision making and strategic planning. To conclude, the new digital technology transformation has moved the usefulness of management accounting to both financial and non-financial dimensions with new heights in the area of healthcare management.

Keywords: balanced scorecard, digital technology transformation, healthcare ecosystem, integrated information system

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Authors: Lillian M. Seo, Curtis L. Petersen, Ryan J. Halter, David Kotz, John A. Batsis

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Background: Resistance-based exercises effectively enhance muscle strength, which is especially important in older populations as it reduces the risk of disability. Our group developed a Bluetooth-enabled handle for resistance exercise bands that wirelessly transmits relative force data through low-energy Bluetooth to a local smartphone or similar device. The system has the potential to measure home-based exercise interventions, allowing health professionals to monitor compliance. Its feasibility has already been demonstrated in both clinical and field-based settings, but it remained unclear whether the system’s usability persisted upon repeated use. The current study sought to assess the usability of this system and its users’ satisfaction with repeated use by deploying the device among younger adults to gather formative information that can ultimately improve the device’s design for older adults. Methods: A usability study was conducted in which 32 participants used the above system. Participants executed 10 repetitions of four commonly performed exercises: bicep flexion, shoulder abduction, elbow extension, and triceps extension. Each completed three exercise sessions, separated by at least 24 hours to minimize muscle fatigue. At its conclusion, subjects completed an adapted version of the usefulness, satisfaction, and ease (USE) questionnaire – assessing the system across four domains: usability, satisfaction, ease of use, and ease of learning. The 20-item questionnaire examined how strongly a participant agrees with positive statements about the device on a seven-point Likert scale, with one representing ‘strongly disagree’ and seven representing ‘strongly agree.’ Participants’ data were aggregated to calculate mean response values for each question and domain, effectively assessing the device’s performance across different facets of the user experience. Summary force data were visualized using a custom web application. Finally, an optional prompt at the end of the questionnaire allowed for written comments and feedback from participants to elicit qualitative indicators of usability. Results: Of the n=32 participants, 13 (41%) were female; their mean age was 32.4 ± 11.8 years, and no participants had a physical impairment. No usability questions received a mean score < 5 of seven. The four domains’ mean scores were: usefulness 5.66 ± 0.35; satisfaction 6.23 ± 0.06; ease of use 6.25 ± 0.43; and ease of learning 6.50 ± 0.19. Representative quotes of the open-ended feedback include: ‘A non-rigid strap-style handle might be useful for some exercises,’ and, ‘Would need different bands for each exercise as they use different muscle groups with different strength levels.’ General impressions were favorable, supporting the expectation that the device would be a useful tool in exercise interventions. Conclusions: A simple usability assessment of a Bluetooth-enabled resistance exercise band supports a consistent and positive user experience among young adults. This study provides adequate formative data, assuring the next steps can be taken to continue testing and development for the target population of older adults.

Keywords: Bluetooth, exercise, mobile health, mHealth, usability

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Authors: Ana Flavia Belchior De Andrade

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Forensic laboratories all over the world face a great challenge to overcame waiting time and backlog in many different areas. Many aspects contribute to this situation, such as an increase in drug complexity, increment in the number of exams requested and cuts in funding limiting laboratories hiring capacity. Altogether, those facts pose an essential challenge for forensic chemistry laboratories to keep both quality and time of response within an acceptable period. In this paper we will analyze how the backlog affects test results and, in the end, the whole judicial system. In this study data from marijuana samples seized by the Federal District Civil Police in Brazil between the years 2013 and 2017 were tabulated and the results analyzed and discussed. In the last five years, the number of petitioned exams increased from 822 in February 2013 to 1358 in March 2018, representing an increase of 32% in 5 years, a rise of more than 6% per year. Meanwhile, our data shows that the number of performed exams did not grow at the same rate. Product numbers are stationed as using the actual technology scenario and analyses routine the laboratory is running in full capacity. Marijuana detection is the most prevalence exam required, representing almost 70% of all exams. In this study, data from 7,110 (seven thousand one hundred and ten) marijuana samples were analyzed. Regarding waiting time, most of the exams were performed not later than 60 days after receipt (77%). Although some samples waited up to 30 months before being examined (0,65%). When marijuana´s exam is delayed we notice the enlargement of inconclusive results using thin-layer chromatography (TLC). Our data shows that if a marijuana sample is stored for more than 18 months, inconclusive results rise from 2% to 7% and when if storage exceeds 30 months, inconclusive rates increase to 13%. This is probably because Cannabis plants and preparations undergo oxidation under storage resulting in a decrease in the content of Δ9-tetrahydrocannabinol ( Δ9-THC). An inconclusive result triggers other procedures that require at least two more working hours of our analysts (e.g., GC/MS analysis) and the report would be delayed at least one day. Those new procedures increase considerably the running cost of a forensic drug laboratory especially when the backlog is significant as inconclusive results tend to increase with waiting time. Financial aspects are not the only ones to be observed regarding backlog cases; there are also social issues as legal procedures can be delayed and prosecution of serious crimes can be unsuccessful. Delays may slow investigations and endanger public safety by giving criminals more time on the street to re-offend. This situation also implies a considerable cost to society as at some point, if the exam takes a long time to be performed, an inconclusive can turn into a negative result and a criminal can be absolved by flawed expert evidence.

Keywords: backlog, forensic laboratory, quality management, accreditation

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Authors: Young Ik Suh, Sanghak Lee, Tae Wook Chung

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In recent year, cultural diversity has acquired increasing attentions in our society due to the cultural pluralism and globalization. With the emphasis of diversity in our society, higher education has played a significant role in preparing people to be successful in a diverse world. A number of colleges and universities provide various diversity-related courses that enhance students to recognize the importance of diversity and multiculturalism. However, little research has been conducted with diversity environments in physical activity and sports-related courses to appreciate students’ attitudes toward multiculturalism. Physical activity courses can be regarded as an essential and complementary part of general education. As well, playing and watching certain sports plays a critical role to foster mutual understanding between different races and to help social integration for minority communities. Therefore, it is expected that the appropriate diverse environments in physical activity courses may have a positive impact to the understandings of different cultures and races. The primary purpose of this study is to examine attitudes toward cultural diversity in a physical activity course among undergraduate students. In building on the scholarly foundation in this area, this study applies the established survey scale (e.g., Pluralism and Diversity Attitude Assessment [PADAA]) developed by Stanley (1996) and previous literature related to cultural diversity. The PADAA includes 19 questions. The following two research hypotheses were proposed. H1: Students who take a diversity-related physical course (i.e., Taekwondo) will provide positive attitude changes toward their cultural diversity. H2: Students who take a general physical activity course (i.e., Weight Training) will provide no significant attitude changes toward their cultural diversity. To test the research hypotheses, subjects will be selected from the both Taekwondo and Weight Training class at University of West Georgia. In the Taekwondo class, students will learn the history, meaning, basic terminology, and physical skills, which is a Korean martial art and the national sport of Korea. In the Weight Training class, students will not be exposed to any cultural diversity topics. Regarding data analysis, Doubly Multivariate Analysis of Covariance (Doubly MANCOVA), 2 (time period: pre and after) X 2 (diversity-related content exposure: Taekwondo and Weight Training), will be conducted on attitudes toward the cultural diversity with control variables such as gender and age. The findings of this study will add to the body of literature in cultural diversity because this will be the first known attempt to explain the college students’ attitudes toward cultural diversity in a physical activity courses. The expected results will state that the physical activity course focusing on diversity issues will have a positive impact on college students’ attitude toward cultural diversity. This finding will indicate that Universities need to create diverse programs (e.g., study abroad, exchange program, second language courses) and environments so that students can have positive interactions with other groups of races and different cultures. It is also expected that the positive perceptions and attitudes toward cultural diversity will break down cultural barriers and make students be ready for meeting several challenges in a multicultural and global society.

Keywords: cultural diversity, physical activity course, attitude, Taekwondo

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Authors: Maari Sugawara

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This arts-based research is about "self-torture": the interplay of seemingly opposing elements of pain, pleasure, submission, and power. It asserts that "self-torture" can be considered a nontrivial mediation between the aesthetic and the sociopolitical. It explores what the author calls queered self-torture; "self-torture" marked by an ambivalence that allows the oppressed to resist, and their counter-valorization occasionally functions as therapeutic solutions to the problems they highlight and condense. The research goal is to deconstruct normative self-torture and propose queered self-torture as a fertile ground for considering the complexities of desire that allow the oppressed to practice freedom. While “self-torture” manifests in many societies, this research focuses on cultural and national identity in post-WWII Japan using this lens of self-torture, as masochism functions as the very basis for Japanese cultural and national identity to ensure self-preservation. This masochism is defined as an impulse to realize a sense of pride and construct an identity through the acceptance of subordination, shame, and humiliation in the face of an all-powerful Other; the dominant Euro-America. It could be argued that this self-torture is a result of Japanese cultural annihilation and the trauma of the nation's defeat to the US. This is the definition of "self-torturous thresholds," the author’s post-WWII Japan psycho-historical diagnosis; when this threshold is crossed, the oppressed begin to torture themselves; the oppressors no longer need to do anything to maintain their power. The oppressed are already oppressing themselves. The term "oppressed" here refers to Japanese individuals and residents of Japan who are subjected to oppressive “white” heteropatriarchal supremacist structures and values that serve colonialist interests. There are three stages in "self-torturous thresholds": (1) the oppressors no longer need to oppress because the oppressed voluntarily commit to self-torture; (2) the oppressed find pleasure in self-torture; and (3) the oppressed achieve queered self-torture, to achieve alternative futures. Using the conceptualization of "self-torture," this research examines and critiques pleasure, desire, capital, and power in postwar Japan, which enables the discussion of the data-colonizing “Moonshot Research and Development program”. If the oppressed want to divest from the habits of normative self-torture, which shape what is possible in both our present and future, we need methods to feel and know that the alternative results of self-torture are possible. Phase three will be enacted using Sarah Ahmed's queer methodology to reorient national and cultural identity away from heteronormativity. Through theoretical analysis, textual analysis, archival research, ethnographic interviews, and digital art projects, including experimental documentary as a method to capture the realities of the individuals who are practicing self-torture, this research seeks to reveal how self-torture may become not just a vehicle of pleasure but also a mode of critiquing power and achieving freedom. It seeks to encourage the imaginings of queer Japanese futures, where the marginalized survive Japan’s natural and man-made disasters and Japan’s Imperialist past and present rather than submitting to the country’s continued violence.

Keywords: arts-based research, Japanese studies, interdisciplinary arts, queer studies, cultural studies, popular culture, BDSM, sadomasochism, sexuality, VR, AR, digital art, visual arts, speculative fiction

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Authors: Ine Huybrechts, Anja Declercq, Emily Verté, Peter Raeymaeckers, Sibyl Anthierens

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Goal-oriented care is a concept gaining increased interest as an approach to go towards more coordinated and integrated primary care. It places patients’ personal life goals at the core of health care support, hereby shifting the focus from “what’s the matter with this patient” to “what matters to this patient.” In Flanders/Belgium, various primary care providers, health and social care organizations and governmental bodies have picked up this concept and have initiated actions to facilitate this approach. The implementation of goal-oriented care not only happens on the micro-level, but it also requires efforts on the meso- and macro-level. Within implementation research, there is a growing recognition that the context in which an intervention takes place strongly relates to its implementation outcomes. However, when investigating contextual variables, the external context and its impact on implementation processes is often overlooked. This study aims to explore how we can better identify and understand the external context and how it relates to the mechanism of change within the implementation process of goal-oriented care in Flanders/Belgium. Results can be used to support and guide initiatives to introduce innovative approaches such as goal-oriented care inside an organization or in the broader primary care landscape. We have conducted qualitative research, performing in-depth interviews with n=23 respondents who have affinity with the implementation of goal-oriented care within their professional function. This lead to in-depth insights from a wide range of actors, with meso-level and/or macro-level perspectives on the implementation of goal-oriented care. This means that we have interviewed actors that are not only involved with initiatives to implement goal-oriented care, but also actors that actively give form to the external context in which goal-oriented care is implemented. Data were collected using a semi-structured interview guide, audio recorded, and analyzed first inductively and then deductively using various theories and concepts that derive from organizational research. Our preliminary findings suggest t Our findings can contribute to further define actions needed for sustainable implementation of goal-oriented primary care. It gives insights in the dynamics between contextual variables and implementation efforts, hereby indicating towards those contextual variables that can be further shaped to facilitate the implementation of an innovation such as goal-oriented care. hat organizational theories can help understand the mechanism of change of implementation processes with a macro-level perspective. Institutional theories, contingency theories, resources dependency theories and others can expose the mechanism of change for an innovation such as goal-oriented care. Our findings can contribute to further define actions needed for sustainable implementation of goal-oriented primary care. It gives insights in the dynamics between contextual variables and implementation efforts, hereby indicating towards those contextual variables that can be further shaped to facilitate the implementation of an innovation such as goal-oriented care.

Keywords: goal-oriented care, implementation processes, organizational theories, person-centered care, implementation research

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Authors: Allison Herlene Du Plessis, Dalena (R.M.) Van Rooyen, Wilma Ten Ham-Baloyi, Sihaam Jardien-Baboo

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Introduction: Women die in pregnancy and childbirth for five main reasons—severe bleeding, infections, unsafe abortions, hypertensive disorders (pre-eclampsia and eclampsia), and medical complications including cardiac disease, diabetes, or HIV/AIDS complicated by pregnancy. In 2015, WHO classified sepsis as the third highest cause for maternal mortalities in the world. Chorioamnionitis is a clinical syndrome of intrauterine infection during any stage of the pregnancy and it refers to ascending bacteria from the vaginal canal up into the uterus, causing infection. While the incidence rates for chorioamnionitis are not well documented, complications related to chorioamnionitis are well documented and midwives still struggle to identify this condition in time due to its complex nature. Few diagnostic methods are available in public health services, due to escalated laboratory costs. Often the affordable biomarkers, such as C-reactive protein CRP, full blood count (FBC) and WBC, have low significance in diagnosing chorioamnionitis. A lack of screening impacts on effective and timeous management of chorioamnionitis, and early identification and management of risks could help to prevent neonatal complications and reduce the subsequent series of morbidities and healthcare costs of infants who are health foci of perinatal infections. Objective: This integrative literature review provides an overview of current best research evidence on the screening of women at risk for chorioamnionitis. Design: An integrative literature review was conducted using a systematic electronic literature search through EBSCOhost, Cochrane Online, Wiley Online, PubMed, Scopus and Google. Guidelines, research studies, and reports in English related to chorioamnionitis from 2008 up until 2020 were included in the study. Findings: After critical appraisal, 31 articles were included. More than one third (67%) of the literature included ranked on the three highest levels of evidence (Level I, II and III). Data extracted regarding screening for chorioamnionitis was synthesized into four themes, namely: screening by clinical signs and symptoms, screening by causative factors of chorioamnionitis, screening of obstetric history, and essential biomarkers to diagnose chorioamnionitis. Key conclusions: There are factors that can be used by midwives to identify women at risk for chorioamnionitis. However, there are a paucity of established sociological, epidemiological and behavioral factors to screen this population. Several biomarkers are available to diagnose chorioamnionitis. Increased Interleukin-6 in amniotic fluid is the better indicator and strongest predictor of histological chorioamnionitis, whereas the available rapid matrix-metalloproteinase-8 test requires further testing. Maternal white blood cells count (WBC) has shown poor selectivity and sensitivity, and C-reactive protein (CRP) thresholds varied among studies and are not ideal for conclusive diagnosis of subclinical chorioamnionitis. Implications for practice: Screening of women at risk for chorioamnionitis by health care providers providing care for pregnant women, including midwives, is important for diagnosis and management before complications arise, particularly in resource-constraint settings.

Keywords: chorioamnionitis, guidelines, best evidence, screening, diagnosis, pregnant women

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Authors: A. Sottomayor, M. Perez Duque, M. C. Henriques

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Introduction: Migration is not a new phenomenon; nomads often traveled, seeking better living conditions, including food and water. The increase of migrations affects all countries, rising health-related challenges. In Portugal, we have had migrant movements in the last decades, pairing with economic behavior. Irregular immigrants are detained in Santo António detention center from Portuguese Immigration and Borders Service (USHA-SEF) in Porto until court decision for a maximum of 60 days. It is the only long stay officially designated detention center for immigrants in Portugal. Immigrant health is important for public health (PH). It affects and is affected by the community. The XXVII Portuguese Government considered immigrant integration, including access to health, health promotion, protection and reduction of inequities a political priority. Many curative, psychological and legal services are provided for detainees, but until 2015, no structured health promotion or prevention actions were being held at USHA-SEF. That year, Porto Occidental PH Local Unit started to provide vaccination and health literacy on this theme for detainees and SEF workers. Our activities include a vaccine lecture, a medical consultation with vaccine prescription and administration, along with documented proof of vaccination. All vaccines are volunteer and free of charge. This action reduces the risk of importation and transmission of diseases, contributing to world eradication and elimination programs. We aimed to characterize the demography of irregular immigrant detained at UHSA-SEF and describe our activity. Methods: All data was provided by Porto Occidental Public Health Unit. All paper registers of vaccination were uploaded to MicrosoftExcel®. We included all registers and collected demographic variables, nationality, vaccination date, category, and administered vaccines. Descriptive analysis was performed using MicrosoftExcel®. Results: From 2015 to 2018, we delivered care to 256 individuals (179 immigrants; 77 workers). Considering immigrants, 72% were male, and 8 (16%) women were pregnant. 85% were between 20-54 years (ᵡ=30,8y; 2-71y), and 11 didn’t report any age. Migrants came from 48 countries, and India had the highest number (9%). MMR and Tetanus vaccines had > 90% vaccination rate and Poliomyelitis, hepatitis B and flu vaccines had around 85% vaccination rates. We had a consistent number of refusals. Conclusion: Our irregular migrant population comes from many different countries, which increases the risk of disease importation. Pregnant women are present as a particular subset of irregular migrants, and vaccination protects them and the baby. Vaccination of migrant is valuable for them and for the countries in which they pass. It contributes to universal health coverage, for eradication programmes and accomplishment of the Sustainable Development Goals. Peer influence may present as a determinant of refusals so we must consistently educate migrants before vaccination. More studies would be valuable, particularly on the migrant trajectory, duration of stay, destiny after court decision and health impact.

Keywords: migrants, public health, universal health coverage, vaccination

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Authors: V. Saccà, A. Sarica, F. Novellino, S. Barone, T. Tallarico, E. Filippelli, A. Granata, P. Valentino, A. Quattrone

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The work aim was to evaluate how well Random Forest (RF) and Support Vector Machine (SVM) algorithms could support the early diagnosis of Multiple Sclerosis (MS) from resting-state functional connectivity data. In particular, we wanted to explore the ability in distinguishing between controls and patients of mean signals extracted from ICA components corresponding to 15 well-known networks. Eighteen patients with early-MS (mean-age 37.42±8.11, 9 females) were recruited according to McDonald and Polman, and matched for demographic variables with 19 healthy controls (mean-age 37.55±14.76, 10 females). MRI was acquired by a 3T scanner with 8-channel head coil: (a)whole-brain T1-weighted; (b)conventional T2-weighted; (c)resting-state functional MRI (rsFMRI), 200 volumes. Estimated total lesion load (ml) and number of lesions were calculated using LST-toolbox from the corrected T1 and FLAIR. All rsFMRIs were pre-processed using tools from the FMRIB's Software Library as follows: (1) discarding of the first 5 volumes to remove T1 equilibrium effects, (2) skull-stripping of images, (3) motion and slice-time correction, (4) denoising with high-pass temporal filter (128s), (5) spatial smoothing with a Gaussian kernel of FWHM 8mm. No statistical significant differences (t-test, p < 0.05) were found between the two groups in the mean Euclidian distance and the mean Euler angle. WM and CSF signal together with 6 motion parameters were regressed out from the time series. We applied an independent component analysis (ICA) with the GIFT-toolbox using the Infomax approach with number of components=21. Fifteen mean components were visually identified by two experts. The resulting z-score maps were thresholded and binarized to extract the mean signal of the 15 networks for each subject. Statistical and machine learning analysis were then conducted on this dataset composed of 37 rows (subjects) and 15 features (mean signal in the network) with R language. The dataset was randomly splitted into training (75%) and test sets and two different classifiers were trained: RF and RBF-SVM. We used the intrinsic feature selection of RF, based on the Gini index, and recursive feature elimination (rfe) for the SVM, to obtain a rank of the most predictive variables. Thus, we built two new classifiers only on the most important features and we evaluated the accuracies (with and without feature selection) on test-set. The classifiers, trained on all the features, showed very poor accuracies on training (RF:58.62%, SVM:65.52%) and test sets (RF:62.5%, SVM:50%). Interestingly, when feature selection by RF and rfe-SVM were performed, the most important variable was the sensori-motor network I in both cases. Indeed, with only this network, RF and SVM classifiers reached an accuracy of 87.5% on test-set. More interestingly, the only misclassified patient resulted to have the lowest value of lesion volume. We showed that, with two different classification algorithms and feature selection approaches, the best discriminant network between controls and early MS, was the sensori-motor I. Similar importance values were obtained for the sensori-motor II, cerebellum and working memory networks. These findings, in according to the early manifestation of motor/sensorial deficits in MS, could represent an encouraging step toward the translation to the clinical diagnosis and prognosis.

Keywords: feature selection, machine learning, multiple sclerosis, random forest, support vector machine

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Authors: Marcin Zieliński, Marcin Dębowski, Mirosław Krzemieniewski

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The anaerobic degradation of substrates is limited especially by the rate and effectiveness of the first (hydrolytic) stage of fermentation. This stage may be intensified through pre-treatment of substrate aimed at disintegration of the solid phase and destruction of substrate tissues and cells. The most frequently applied criterion of disintegration outcomes evaluation is the increase in biogas recovery owing to the possibility of its use for energetic purposes and, simultaneously, recovery of input energy consumed for the pre-treatment of substrate before fermentation. Hydrodynamic cavitation is one of the methods for organic substrate disintegration that has a high implementation potential. Cavitation is explained as the phenomenon of the formation of discontinuity cavities filled with vapor or gas in a liquid induced by pressure drop to the critical value. It is induced by a varying field of pressures. A void needs to occur in the flow in which the pressure first drops to the value close to the pressure of saturated vapor and then increases. The process of cavitation conducted under controlled conditions was found to significantly improve the effectiveness of anaerobic conversion of organic substrates having various characteristics. This phenomenon allows effective damage and disintegration of cellular and tissue structures. Disintegration of structures and release of organic compounds to the dissolved phase has a direct effect on the intensification of biogas production in the process of anaerobic fermentation, on reduced dry matter content in the post-fermentation sludge as well as a high degree of its hygienization and its increased susceptibility to dehydration. A device the efficiency of which was confirmed both in laboratory conditions and in systems operating in the technical scale is a hydrodynamic generator of cavitation. Cavitators, agitators and emulsifiers constructed and tested worldwide so far have been characterized by low efficiency and high energy demand. Many of them proved effective under laboratory conditions but failed under industrial ones. The only task successfully realized by these appliances and utilized on a wider scale is the heating of liquids. For this reason, their usability was limited to the function of heating installations. Design of the presented cavitation generator allows achieving satisfactory energy efficiency and enables its use under industrial conditions in depolymerization processes of biomass with various characteristics. Investigations conducted on the laboratory and industrial scale confirmed the effectiveness of applying cavitation in the process of biomass destruction. The use of the cavitation generator in laboratory studies for disintegration of sewage sludge allowed increasing biogas production by ca. 30% and shortening the treatment process by ca. 20 - 25%. The shortening of the technological process and increase of wastewater treatment plant effectiveness may delay investments aimed at increasing system output. The use of a mechanical cavitator and application of repeated cavitation process (4-6 times) enables significant acceleration of the biogassing process. In addition, mechanical cavitation accelerates increases in COD and VFA levels.

Keywords: hydrodynamic cavitation, pretreatment, biomass, methane fermentation, Virginia fanpetals

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Authors: Simone Raimondi De Souza, Glaucia Maria Moraes De Oliveira, Ronir Raggio Luiz, Glorimar Rosa

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Introduction: Obesity is among the main risk factors for cardiovascular disease (CVD). Genesis is multifactorial, including genetic, hormonal and environmental factors disorders, among which inadequate feeding pattern, for which nutritional counseling strategies have proven effective. The consumption of beta-glucans (soluble fibers that reportedly promote satiety) present in oat bran can be an effective strategy for preventing and treating obesity. Other benefits have been observed with oat bran consumption, such as reduction of hypercholesterolemia and hyperglycemia, two other risk factors for CVD. Objectives: To analyze the effect of oat bran consumption associated with nutritional counseling in reducing body mass index (BMI), blood cholesterol, glucose profile, waist and neck circumference in obese individuals, and to evaluate the change in eating pattern. Methods: clinical trial, randomized, double-blind, placebo-controlled, lasting 90 days with adults of both genders, with BMI ≥30kg/m2. The study was approved by the Ethics in Research involving human beings in a public institute of cardiology, in Rio de Janeiro, Brazil. Individuals were invited to participate and accepted formally by signing the Terms of Consent. Participants were randomized into oat bran group (gOB) or placebo group (gPCB) and received, respectively: morning prepared consisting of 40g oat bran, 30g of skimmed milk powder and 1g sweetener sucralose; refined flour 40g rice, 30g of milk powder and 1g sweetener sucralose. The Ten Steps to Healthy Eating, of Brazilian Ministry of Health were used to support the nutritional counseling. Variables analyzed: gender; age; BMI, waist circumference (WC) neck circumference (NC); systolic blood pressure (SBP); diastolic blood pressure (DBP); food consumption, total cholesterol (TC), LDL-cholesterol (LDL-c), HDL-cholesterol (HDL-c), non-HDL cholesterol (nHDLc), triglycerides (TG), fasting glucose (FG), fasting insulin (FI) and HOMA-IR. Dietary intake was assessed by 24-hour dietary recall. The Diet Quality Index revised for the Brazilian population (IQD-R) assessed quality of feeding pattern. Statistical analyzes were performed using SPSS version 21, considering statistically significant p-value less than 0.05. Results: A total of 38 participants were included, age = 50 ± 7,6years, 63% women. 19 subjects were placed in gOB and 19 in gPCB. After intervention, statistically significant reductions were observed in the following parameters: in gOB: IQD-R, TC, LDL-c, nHDL-c, FI, SBP, DBP, BMI, WC, NC; in gPCB: IQD-R, LDL-c, SBP, DBP, BMI, WC, NC. No statistically significant differences were observed in the results between groups. Conclusion: Our results reinforce nutritional counseling as important strategy for prevention and treatment of obesity and suggest that inclusion of oat bran in daily diet can bring additional benefits controlling risk factors for CVD. More studies are needed to establish all benefits of oat bran to human health as well as the ideal daily dose for consumption.

Keywords: oat bran, cardiovascular disease, nutritional counseling, obesity

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Authors: Isabelle Gobatto

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Based on an anthropological approach, this paper explores the medical profession and the construction of medical practices by considering the multiform articulations between structural poverty and the production of care from a low-resource francophone West African country, Burkina Faso. This country is considered in its exemplary dimension of culturally differentiated countries of the African continent that share the same situation of structural poverty. The objective is to expose the effects of structural poverty on the ways of constructing professional knowledge and thinking about the sense of the medical profession. If doctors are trained to have the same capacities in South and West countries, which are to treat and save lives whatever the cultural contexts of the practice of medicine, the ways of investing their role and of dealing with this context of action fracture the homogenization of the medical profession. In the line of anthropology of biomedicine, this paper outlines the complex effects of structural poverty on health care, care relations, and the moral economy of doctors. The materials analyzed are based on an ethnography including two temporalities located thirty years apart (1990-1994 and 2020-2021), based on long-term observations of care practices conducted in healthcare institutions, interviews coupled with the life histories of physicians. The findings reveal that disabilities faced by doctors to deliver care are interpreted as policy gaps, but they are also considered by physicians as constitutive of the social and cultural characteristics of patients, making their capacities and incapacities in terms of accompanying caregivers in the production of care. These perceptions have effects on know-how, structured around the need to act even when diagnoses are not made so as not to see patients desert health structures if the costs of care are too high for them. But these interpretations of highly individualizing dimensions of these difficulties place part of the blame on patients for the difficulties in using learned knowledge and delivering effective care. These situations challenge the ethics of caregivers but also of ethnologists. Firstly because the interpretations of disabilities prevent caregivers from considering vulnerabilities of care as constituting a common condition shared with their patients in these health systems, affecting them in an identical way although in different places in the production of care. Correlatively, these results underline that these professional conceptions prevent the emergence of a figure of victim, which could be shared between patients and caregivers who, together, undergo working and care conditions at the limit of the acceptable. This dimension directly involves politics. Secondly, structural poverty and its effects on care challenge the ethics of the anthropologist who observes caregivers producing, without intent to arm, experiences of care marked by an ordinary violence, by not giving them the care they need. It is worth asking how anthropologists could get doctors to think in this light in west-African societies.

Keywords: Africa, care, ethics, poverty

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Authors: Bhojan Dhakal, Naba Raj Devkota, Chet Raj Upreti, Maheshwar Sapkota

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A study was conducted to find out the production potential, nutrient composition, and the variability of the most commonly available fodder trees along with the varying altitude to help optimize the dry matter requirement during winter lean period. The study was carried out from March to June, 2012 in Lho and Prok Village Development Committee of Manaslu Conservation Area (MCA), located in Gorkha district of Nepal. The other objective of the research was to learn the impact of climate change on livestock production linking it with feed availability. The study was conducted in two parts: social and biological. Accordingly, a households (HHs) survey was conducted to collect primary data from 70 HHs, focusing on the perception of respondents on impacts of climatic variability on the feeding management. The next part consisted of understanding yield potential and nutrient composition of the four most commonly available fodder trees (M. azedirach, M. alba, F. roxburghii, F. nemoralis), within two altitudes range: (1500-2000 masl and 2000-2500 masl) by using a RCB design in 2*4 factorial combination of treatments, each replicated four times. Results revealed that majority of the farmers perceived the change in climatic phenomenon more severely within the past five years. Farmers were using different adaptation technologies such as collection of forage from jungle, reducing unproductive animals, fodder trees utilization, and crop by product feeding at feed scarcity period. Ranking of the different fodder trees on the basis of indigenous knowledge and experiences revealed that F. roxburghii was the best-preferred fodder tree species (index value 0.72) in terms overall preferability whereas M. azedirach had highest growth and productivity (index value 0.77), F. roxburghii had highest adoptability (index value 0.69) and palatability (index value 0.69) as well. Similarly, fresh yield and dry matter yield of the each fodder trees was significant (P < 0.01) between the altitude and within species. Fodder trees yield analysis revealed that the highest dry matter (DM) yield (28 kg/tree) was obtained for F. roxburghii but that remained statistically similar (P > 0.05) to the other treatment. On the other hand, most of the parameters: ether extract (EE), acid detergent lignin (ADL), acid detergent fibre (ADF), cell wall digestibility (CWD), relative digestibility (RD), digestible nutrient (TDN), and Calcium (Ca) among the treatments were highly significant (P < 0.01). This indicates the scope of introducing productive and nutritive fodder trees species even at the high altitude to help reduce fodder scarcity problem during winter. The finding also revealed the scope of promoting all available local fodder trees species as crude protein content of these species were similar.

Keywords: fodder trees, yield potential, climate change, nutrient composition

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Authors: Truong H. Le, Ngoc M. To, Quang N. Tran, Luu T. Cao, Chi V. Le

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Introduction: In Vietnam, the current monitoring and treatment for ordinary diabetic patient mostly based on glucose monitoring with HbA1c test for every three months (recommended goal is HbA1c < 6.5%~7%). For diabetes in pregnant women or Gestational diabetes mellitus (GDM), glycemic control until the time of delivery is extremly important because it could reduce significantly medical implications for both the mother and the child. Besides, GDM requires continuos glucose monitoring at least every two weeks and therefore an alternative marker of glycemia for short-term control is considering a potential tool for the healthcare providers. There are published studies have indicated that the glycosylated serum protein is a better indicator than glycosylated hemoglobin in GDM monitoring. Based on the actual practice in Vietnam, this study was designed to evaluate the role of serum fructosamine as a monitoring tool in GDM treament and its correlations with fasting blood glucose (G0), 2-hour postprandial glucose (G2) and glycosylated hemoglobin (HbA1c). Methods: A cohort study on pregnant women diagnosed with GDM by the 75-gram oralglucose tolerance test was conducted at Endocrinology Department, Cho Ray hospital, Vietnam from June 2014 to March 2015. Cho Ray hospital is the final destination for GDM patient in the southern of Vietnam, the study population has many sources from other pronvinces and therefore researchers belive that this demographic characteristic can help to provide the study result as a reflection for the whole area. In this study, diabetic patients received a continuos glucose monitoring method which consists of bi-weekly on-site visit every 2 weeks with glycosylated serum protein test, fasting blood glucose test and 2-hour postprandial glucose test; HbA1c test for every 3 months; and nutritious consultance for daily diet program. The subjects still received routine treatment at the hospital, with tight follow-up from their healthcare providers. Researchers recorded bi-weekly health conditions, serum fructosamine level and delivery outcome from the pregnant women, using Stata 13 programme for the analysis. Results: A total of 500 pregnant women was enrolled and follow-up in this study. Serum fructosamine level was found to have a light correlation with G0 ( r=0.3458, p < 0.001) and HbA1c ( r=0.3544, p < 0.001), and moderately correlated with G2 ( r=0.4379, p < 0.001). During study timeline, the delivery outcome of 287 women were recorded with the average age of 38.5 ± 1.5 weeks, 9% of them have macrosomia, 2.8% have premature birth before week 35th and 9.8% have premature birth before week 37th; 64.8% of cesarean section and none of them have perinatal or neonatal mortality. The study provides a reference interval of serum fructosamine for GDM patient was 112.9 ± 20.7 μmol/dL. Conclusion: The present results suggests that serum fructosamine is as effective as HbA1c as a reflection of blood glucose control in GDM patient, with a positive result in delivery outcome (0% perinatal or neonatal mortality). The reference value of serum fructosamine measurement provided a potential monitoring utility in GDM treatment for hospitals in Vietnam. Healthcare providers in Cho Ray hospital is considering to conduct more studies to test this reference as a target value in their GDM treatment and monitoring.

Keywords: gestational diabetes mellitus, monitoring tool, serum fructosamine, Vietnam

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Authors: Oscar Bareiro, Johannes Sackmann, Thomas Gries

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Carbon fiber reinforced polymer composites (CFRP) are used in a wide variety of applications due to its advantageous properties and design versatility. The braiding process enables the manufacture of components with good toughness and fatigue strength. However, failure mechanisms of CFRPs are complex and still present challenges associated with their maintenance and repair. Within the broad scope of structural health monitoring (SHM), strain monitoring can be applied to composite materials to improve reliability, reduce maintenance costs and safely exhaust service life. Traditional SHM systems employ e.g. fiber optics, piezoelectrics as sensors, which are often expensive, time consuming and complicated to implement. A cost-efficient alternative can be the exploitation of the conductive properties of fiber-based sensors such as carbon, copper, or constantan - a copper-nickel alloy – that can be utilized as sensors within composite structures to achieve strain monitoring. This allows the structure to provide feedback via electrical signals to a user which are essential for evaluating the structural condition of the structure. This work presents a strategy for the in-process integration of resistance-based sensors (Elektrisola Feindraht AG, CuNi23Mn, Ø = 0.05 mm) into textile preforms during its manufacture via the braiding process (Herzog RF-64/120) to achieve strain monitoring of braided composites. For this, flat samples of instrumented composite laminates of carbon fibers (Toho Tenax HTS40 F13 24K, 1600 tex) and epoxy resin (Epikote RIMR 426) were manufactured via vacuum-assisted resin infusion. These flat samples were later cut out into test specimens and the integrated sensors were wired to the measurement equipment (National Instruments, VB-8012) for data acquisition during the execution of mechanical tests. Quasi-static tests were performed (tensile, 3-point bending tests) following standard protocols (DIN EN ISO 527-1 & 4, DIN EN ISO 14132); additionally, dynamic tensile tests were executed. These tests were executed to assess the sensor response under different loading conditions and to evaluate the influence of the sensor presence on the mechanical properties of the material. Several orientations of the sensor with regards to the applied loading and sensor placements inside the laminate were tested. Strain measurements from the integrated sensors were made by programming a data acquisition code (LabView) written for the measurement equipment. Strain measurements from the integrated sensors were then correlated to the strain/stress state for the tested samples. From the assessment of the sensor integration approach it can be concluded that it allows for a seamless sensor integration into the textile preform. No damage to the sensor or negative effect on its electrical properties was detected during inspection after integration. From the assessment of the mechanical tests of instrumented samples it can be concluded that the presence of the sensors does not alter significantly the mechanical properties of the material. It was found that there is a good correlation between resistance measurements from the integrated sensors and the applied strain. It can be concluded that the correlation is of sufficient accuracy to determinate the strain state of a composite laminate based solely on the resistance measurements from the integrated sensors.

Keywords: braiding process, in-process sensor integration, instrumented composite material, resistance-based sensor, strain monitoring

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Authors: L. Kashyap, S. Jha, D. Shende, V. K. Mohan, P. Khanna, A. Aravindan, S. Kashyap, L. Singh, S. Aggarwal

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Obesity is associated with a chronic inflammatory state. During surgery, there is an interplay between anaesthetic and surgical stress vis-a-vis the already present complex immune state. Moreover, the postoperative period is dictated by inflammation, which is crucial for wound healing and regeneration. An excess of inflammatory response might hamper recovery besides increasing the risk for infection and complications. There is definite evidence of the immunosuppressive role of inhaled anaesthetic agents. This immune modulation may be brought into effect directly by influencing the innate and adaptive immunity cells. The effects of propofol on immune mechanisms in has been widely elucidated because of its popularity. It reduces superoxide generation, elastase release, and chemotaxis. However, there is no unequivocal proof of one’s superiority over the other. Hence, an anaesthetic regimen with lesser inflammatory potential and specific to the obese patient is needed. OBESITA trial protocol (2019) by Sousa and co-workers in progress aims to test the hypothesis that anaesthesia with sevoflurane results in a weaker proinflammatory response compared to propofol, as evidenced by lower IL-6 and other biomarkers and an increased macrophage differentiation into M2 phenotype in adipose tissue. IL-6 was used as the objective parameter to evaluate inflammation as it is regulated by both surgery and anesthesia. It is the most sensitive marker of the inflammatory response to tissue damage since it is released within minutes by blood leukocytes. We hypothesized that maintenance of anaesthesia with propofol would lead to less inflammation than that with desflurane. Aims: The effect of two anaesthetic techniques, total intravenous anaesthesia (TIVA) with propofol and desflurane, on surgical stress response was evaluated. The primary objective was to compare serum interleukin-6 (IL-6) levels before and after surgery. Methods: In this prospective single-blinded randomized controlled trial undertaken, 30 obese patients (BMI>30 kg/m2) undergoing laparoscopic bariatric surgery under general anaesthesia were recruited. Patients were randomized to receive desflurane or TIVA using a target-controlled infusion for maintenance of anaesthesia. As a marker of inflammation, pre-and post-surgery IL-6 levels were compared. Results: After surgery, IL-6 levels increased significantly in both groups. The rise in IL-6 was less with TIVA than with desflurane; however, it did not reach significance. IL-6 rise post-surgery correlated positively with the complexity of procedure and duration of surgery and anaesthesia, rather than anaesthetic technique. Both groups did not differ in terms of intra-operative hemodynamic and respiratory variables, time to awakening, postoperative pulmonary complications, and duration of hospital stay. The incidence of nausea was significantly higher with desflurane than with TIVA. Conclusion: Inflammatory response did not differ as a function of anaesthetic technique when propofol and desflurane were compared. Also, patient and surgical variables dictated post-operative inflammation more than the anaesthetic factors. Further, larger sample size is needed to confirm or refute these findings.

Keywords: bariatric, biomarkers, inflammation, laparoscopy

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