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Authors: Alefsi D. Sanchez-Reinoso, Leonardo Lombardini, Hermann Restrepo

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Colombian coffee is recognized worldwide for its mild flavor and aroma. Its cultivation generates a large amount of waste, such as fresh pulp, which leads to environmental, health, and economic problems. Obtaining biochar (BC) by pyrolysis of coffee pulp and its incorporation to the soil can be a complement to the crop mineral nutrition. The objective was to evaluate the effect of the application of BC obtained from coffee pulp on the physiology and agronomic performance of the Castillo variety coffee crop (Coffea arabica L.). The research was developed in field condition experiment, using a three-year-old commercial coffee crop, carried out in Tolima. Four doses of BC (0, 4, 8 and 16 t ha-1) and four levels of chemical fertilization (CF) (0%, 33%, 66% and 100% of the nutritional requirements) were evaluated. Three groups of variables were recorded during the experiment: i) physiological parameters such as Gas exchange, the maximum quantum yield of PSII (Fv/Fm), biomass, and water status were measured; ii) physical and chemical characteristics of the soil in a commercial coffee crop, and iii) physiochemical and sensorial parameters of roasted beans and coffee beverages. The results indicated that a positive effect was found in plants with 8 t ha-1 BC and fertilization levels of 66 and 100%. Also, a positive effect was observed in coffee trees treated with 8 t ha-1 BC and 100%. In addition, the application of 16 t ha-1 BC increased the soil pHand microbial respiration; reduced the apparent density and state of aggregation of the soil compared to 0 t ha-1 BC. Applications of 8 and 16 t ha-1 BC and 66%-100% chemical fertilization registered greater sensitivity to the aromatic compounds of roasted coffee beans in the electronic nose. Amendments of BC between 8 and 16 t ha-1 and CF between 66% and 100% increased the content of total soluble solids (TSS), reduced the pH, and increased the titratable acidity in beverages of roasted coffee beans. In conclusion, 8 t ha-1 BC of the coffee pulp can be an alternative to supplement the nutrition of coffee seedlings and trees. Applications between 8 and 16 t ha-1 BC support coffee soil management strategies and help the use of solid waste. BC as a complement to chemical fertilization showed a positive effect on the aromatic profile obtained for roasted coffee beans and cup quality attributes.

Keywords: crop yield, cup quality, mineral nutrition, pyrolysis, soil amendment

Procedia PDF Downloads 99

Authors: Mathieu Bere

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Al-Qaeda and Islamic State-affiliated groups such as Ja’amat Nusra al Islam Wal Muslimim (JNIM) and the Islamic State-Greater Sahara Faction, which is now part of the Boko Haram splinter group, Islamic State in West Africa, were responsible, between 2018 and 2020, for at least 1.333 violent incidents against both military and civilian targets, including the assassination and kidnapping for ransom of Western citizens in Mali, Burkina Faso and Niger, the Central Sahel. Protecting civilians from the terrorist violence that is now spreading from the Sahel to the coastal countries of West Africa has been very challenging, mainly because of the many unknowns that surround the perpetrators. To contribute to a better protection of civilians in the region, this paper aims to shed light on the motivations and targeting logic of jihadist perpetrators of terrorist violence against civilians in the central Sahel region. To that end, it draws on relevant secondary data retrieved from datasets, the media, and the existing literature, but also on primary data collected through interviews and surveys in Burkina Faso. An analysis of the data with the support of qualitative and statistical analysis software shows that military and rational strategic motives, more than purely ideological or religious motives, have been the main drivers of terrorist violence that strategically targeted government symbols and representatives as well as local leaders in the central Sahel. Behind this targeting logic, the jihadist grand strategy emerges: wiping out the Western-inspired legal, education and governance system in order to replace it with an Islamic, sharia-based political, legal, and educational system.

Keywords: terrorism, jihadism, Sahel, targeting logic

Procedia PDF Downloads 81

Authors: Rose Lastovicka, Bernard Guy, Diana Burton

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Greek myth and art acted as tools to think with, and a lens through which to explore complex topics as a form of social media. In particular, coins were a form of propaganda to communicate the wealth and power of the city-states they originated from as they circulated from person to person. From this, how can the application of 3D printing technologies explore the infusion of ancient forms with contemporary commentaries to promote discussion? The digital reconstruction of artifacts is a topic that has been researched by various groups all over the globe. Yet, the exploration of Greek myth through artifacts infused with contemporary issues is currently unexplored in this medium. Using the Stratasys J750 3D printer - a multi-material, full-colour 3D printer - a series of coins inspired by ancient Greek currency and myth was created to present commentaries on the adversities surrounding individuals in the LGBT+ community. Using the J750 as the medium for expression allows for complete control and precision of the models to create complex high-resolution iconography. The coins are printed with a hard, translucent material with coloured 3D visuals embedded into the coin to then be viewed in close contact by the audience. These coins as commentaries present an avenue for wider understanding by drawing perspectives not only from sources concerned with the contemporary LGBT+ community but also from sources exploring ancient homosexuality and the perception and regulation of it in antiquity. By displaying what are usually points of contention between anti- and pro-LGBT+ parties, this visual medium opens up a discussion to both parties, suggesting heritage can play a vital interpretative role in the contemporary world.

Keywords: 3D printing, design, Greek mythology, LGBT+ community

Procedia PDF Downloads 111

Authors: H. Scholz, P. Kuehne, G. Heckenberger

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Problems during the calving period (December until May) often are results in a high body condition score (BCS) at this time. At the end of the grazing period (frequently after early weaning), however, an increase of BCS can often be observed under German conditions. In the last eight weeks before calving, the body condition should be reduced or at least not increased. Rations with a higher amount of crude fiber can be used (rations with straw or late mowed grass silage). Fermentative digestion of fiber is slow and incomplete; that’s why the fermentative process in the rumen can be reduced over a long feeding time. Viewed in this context, feed intake of suckler cows (8 weeks before calving) in different rations and fermentation in the rumen should be checked by taking rumen fluid. Eight suckler cows (Charolais) were feeding a Total Mixed Ration (TMR) in the last eight weeks before calving and grass silage after calving. By the addition of straw (30 % [TMR1] vs. 60 % [TMR2] of dry matter) was varied the amount of crude fiber in the TMR (grass silage, straw, mineral) before calving. After calving of the cow's grass, silage [GS] was fed ad libitum, and the last measurement of rumen fluid took place on the pasture [PS]. Rumen fluid, plasma, body weight, and backfat thickness were collected. Rumen fluid pH was assessed using an electronic pH meter. Volatile fatty acids (VFA), sedimentation, methylene-blue, and amount of infusorians were measured. From these 4 parameters, an “index of rumen fermentation” [IRF] in the rumen was formed. Fixed effects of treatment (TMR1, TMR2, GS, and PS) and a number of lactations (3-7 lactations) were analyzed by ANOVA using SPSS Version 25.0 (significant by p ≤ 5 %). Rumen fluid pH was significantly influenced by variants (TMR 1 by 6.6; TMR 2 by 6.9; GS by 6.6 and PS by 6.9) but was not affected by other effects. The IRF showed disturbed fermentation in the rumen by feeding the TMR 1+2 with a high amount of crude fiber (Score: > 10.0 points) and a very good environment for fermentation during grazing the pasture (Score: 6.9 points). Furthermore, significant differences were found for VFA, methylene blue, and the number of infusorians. The use of rations with a high amount of crude fiber from weaning to calving may cause deviations from undisturbed fermentation in the rumen and adversely affect the utilization of the feed in the rumen.

Keywords: rumen fermentation, suckler cow, digestibility organic matter, crude fiber

Procedia PDF Downloads 133

Authors: S. Potgieter-Vermaak, N. Bain, A. Brown, K. Shaw

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It is well-known from public news media that air pollution is a health hazard and is responsible for early deaths. The quantification of the relationship between air quality and health is a probing question not easily answered. It is known that airborne particulate matter (APM) <2.5µm deposits in the tracheal and alveoli zones and our research probes the possibility of quantifying pulmonary injury by linking reactive oxygen species (ROS) in these particles to DNA damage. Currently, APM mass concentration is linked to early deaths and limited studies probe the influence of other properties on human health. To predict the full extent and type of impact, particles need to be characterised for chemical composition and structure. APMs are routinely analysed for their bulk composition, but of late analysis on a micro level probing single particle character, using micro-analytical techniques, are considered. The latter, single particle analysis (SPA), permits one to obtain detailed information on chemical character from nano- to micron-sized particles. This paper aims to provide a snapshot of studies using data obtained from chemical characterisation and its link with in-vitro studies to inform on personal health risks. For this purpose, two studies will be compared, namely, the bioaccessibility of the inhalable fraction of urban road dust versus total suspended solids (TSP) collected in the same urban environment. The significant influence of metals such as Cu and Fe in TSP on DNA damage is illustrated. The speciation of Hg (determined by SPA) in different urban environments proved to dictate its bioaccessibility in artificial lung fluids rather than its concentration.

Keywords: air pollution, human health, in-vitro studies, particulate matter

Procedia PDF Downloads 221

Authors: Anjana Aggarwal, Sheilja Walia

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Prevalence of obesity and overweight is increasing due to sedentary lifestyles and busy schedules of people that spend less time on physical exercise. To reduce weight, people are finding easier and more convenient ways. The easiest solution is the use of dietary supplements and fat burners. These are products that decrease body weight by increasing the basal metabolic rate. Various reports have been published on the consumption of fat burners leading to heart palpitations, seizures, anxiety, depression, psychosis, bradycardia, insomnia, muscle contractions, hepatotoxicity, and even liver failure. Case reports and series are reporting that the ingredients present in the fat burners caused acute liver failure (ALF) and hepatic toxicity in many cases. Another contributing factor is the absence of regulations from the Food and Drug Administration on these products, leading to increased consumption and a higher risk of liver diseases among the population. This systematic review aims to attain a better understanding of the dietary supplements used globally to reduce weight and document the case reports/series of acute liver failure caused by the consumption of fat burners. Electronic databases like PubMed, Cochrane, Google Scholar, etc., will be systematically searched for relevant articles. Various websites of dietary products and brands that sell such supplements, Journals of Hepatology, National and international projects launched for ALF, and their reports, along with the review of grey literature, will also be done to get a better understanding of the topic. After discussing with the co-author, the selection and screening of the articles will be performed by the author. The studies will be selected based on the predefined inclusion and exclusion criteria. The case reports and case series that will be included in the final list of the studies will be assessed for methodological quality using the CARE guidelines. The results from this study will provide insights and a better understanding of fat burners. Since the supplements are easily available in the market without any restrictions on their sale, people are unaware of their adverse effects. The consumption of these supplements causes acute liver failure. Thus, this review will provide a platform for future larger studies to be conducted.

Keywords: acute liver failure, dietary supplements, fat burners, weight loss supplements

Procedia PDF Downloads 76

Authors: Priyanwada I. Singhapathirana

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The public land ownership is a common phenomenon in many countries in the world however, the development approaches and the institutional structures are greatly diverse. The existing scholarship around public land development has been greatly limited to Europe and advanced Asian economies. Inferences of such studies seem to be inadequate and inappropriate to comprehend the peculiarities of public land development in developing Asian economies. The absence of critical inquiry on the public land ownership and the long-established institutional structures which govern the development has restrained these countries from institutional innovations. In this context, this research investigates the issues related to public land development and the institutional responses in Sri Lanka. This study introduces the concept of ‘Institutional Responsiveness’ in Public land development, which is conceptualized as the ability of the institutions to respond to the spatial, market and fiscal stimulus. The inquiry was carried out through in-depth interviews with five key informants from apex public agencies in order to explore the responsiveness of land institutions form decision-makers' perspectives. Further, the analysis of grey literature and recent media reports are used to supplement the analysis. As per the findings, long term abandonment of public lands and high transaction costs are some of the key issues in relation to public land development. The inability of the institutions to respond to the market and fiscal stimulus has left many potential public lands underutilized. As a result, the public sector itself and urban citizens have not been able to relish the benefits of the public lands in cities. Spatial analysis at the local scale is suggested for future studies in order to capture the multiple dimensions of the responsiveness of institutions to the development stimulus.

Keywords: institutions, public land, responsiveness, under-utilization

Procedia PDF Downloads 123

Authors: Rose Chapman Rodriguez

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Problem: Evidence-based practice (EBP) attributes are significantly associated with EBP implementation science, which improves patient care outcomes. Nurses influence EBP, yet little is known of the specific EBP attributes of pediatric nurses in their clinical sub-specialties. Aim: This study aims to investigate the relationship between nursing academic degree, years of experience, and clinical specialty, with mean survey scores on EBP belief, organizational culture, and implementation scales across all levels of nursing in a Children’s Hospital. Methods: A convenience sample of nurses (n=185) participated in a descriptive, cross-sectional, correlational study in May 2023. The electronic surveys comprised 11 demographic questions and nine survey items from the short-version EBP Beliefs Scale (Cronbach α = 0.81), Organizational Culture and Readiness Scale for System-wide Integration Scale (Cronbach α = 0.87), and EBP Implementation Scale (Cronbach α = 0.89). Findings: EBP belief scores were notably higher in nurses working in neonatology (m=4.33), critical care (m=4.47), and among nurse leaders (m=4.50). There was a statistically significant difference in EBP organizational culture among nurse leaders (m = 3.95, p=0.039) compared to clinical nurses (m = 3.34) and advanced practice nurses (m = 3.34). EBP implementation was favorable in neonatology (m=4.20), acute care (m=4.05), and nurse leaders (m=4.33). No significant difference or correlation was found in EBP belief, organizational culture, or implementation mean scores related to nurses' age, academic nursing degree, or years of experience in our cohort (EBP beliefs (r = -.06, p = .400), organizational readiness (r = .02, p = .770), and implementation scales (r = .01, p = .867). Conclusions: This study identified nurse’s EBP attributes in a Children’s Hospital using key variables studied in EBP social cognitive theory and learning theory. Magnet status, shared governance structure, specialty certification, and nurse leaders play a significant role in favorable EBP culture and implementation. Nurses’ unit level ‘group culture’ may vary depending on the EBP attributes and collaborative efforts of local teams. Opportunities for mentoring were identified, which may continue to enhance EBP implementation science across all nursing roles in our pediatric organization.

Keywords: evidence-based practice, peditrics, nursing roles, implementation

Procedia PDF Downloads 64

Authors: Chong Zhang

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There is widespread debate about the nationalistic top-down approach to citizenship education. Employing the notion of cultural citizenship as a useful theoretical lens, citizenship education research tends to focus on the process of subjectivity construction among students’ citizenship learning process. As the Communist Party of China (CPC) plays a dominant role in cultivating citizens through ideological and political education (IaPE) in Chinese universities, the research problem herein focuses on the dynamics and complexity of how Chinese university students construct their subjectivities regarding citizenship learning through IaPE, mediated by the interaction between the state and university teachers. Drawing on questionnaire data from 212 students and interview data from 25 students in one university in China, this paper examines the ways in which students understand and respond to dominant discourses. Its findings reveal there is a deficit of citizenship learning in IaPE, and that students feel ideologically pressurized. From its analysis of social contexts’ influence, the article suggests Chinese higher education students act as either mild changemakers or active self-motivators to enact complex subjectivities, in that they must involve themselves in IaPE for personal academic and career development, yet adopt covert strategies to realise their self-conscious citizenship learning expectations. These strategies take the form of passive and active freedoms, ranging from obediently completing basic curriculum requirements and distancing themselves by studying abroad, to actively searching for learning opportunities from other courses and social media. This paper contributes to the research on citizenship education by recognizing the complexities of how subjectivities are formed in formal university settings.

Keywords: university students, citizenship learning, cultural citizenship, subjectivity, Chinese higher education

Procedia PDF Downloads 114

Authors: Ginevra Addis

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The possibility of reproducing physical artifacts in a digital format is one of the opportunities offered by the technological advancements in information and communication most frequently promoted by museums. Indeed, the study and conservation of our cultural heritage have seen significant advancement due to the three-dimensional acquisition and modeling technology. A variety of laser scanning systems has been developed, based either on optical triangulation or on time-of-flight measurement, capable of producing digital 3D images of complex structures with high resolution and accuracy. It is necessary, however, to explore the challenges and opportunities that this practice brings within museums. The purpose of this paper is to understand what change is introduced by digital techniques in those museums that are hosting digital masterpieces. The methodology used will investigate three distinguished Italian exhibitions, related to the territory of Milan, trying to analyze the following issues about museum practices: 1) how digitizing art masterpieces increases the number of visitors; 2) what the need that calls for the digitization of artworks; 3) which techniques are most used; 4) what the setting is; 5) the consequences of a non-publication of hard copies of catalogues; 6) envision of these practices in the future. Findings will show how interconnection plays an important role in rebuilding a collection spread all over the world. Secondly how digital artwork duplication and extension of reality entail new forms of accessibility. Thirdly, that collection and preservation through digitization of images have both a social and educational mission. Fourthly, that convergence of the properties of different media (such as web, radio) is key to encourage people to get actively involved in digital exhibitions. The present analysis will suggest further research that should create museum models and interaction spaces that act as catalysts for innovation.

Keywords: digital masterpieces, education, interconnection, Italian museums, preservation

Procedia PDF Downloads 172

Authors: Farzad Doostishoar, Abdolreza Hasanzadeh, Seyed Amin Ayatolahi Mousavi

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Introduction and Goals: Deuterium has different action from its isotopes hydrogen in chemical reactions and biochemical processes. It is not a significant difference in heavier atoms between the behavior of heavier isotope and the lighter One but for very lighter atoms it is significant . According to that most of the weight of all creatures body is water natural rate can be significant. In this article we want to study the effect of reduced deuterium on the fungus cell. If we saw the dependence of deuterium concentration of environment on the cells growth we can test this in invivo models too. Methods: First we measured deuterium concentration of the distillated water this analyze was operated by Arak’s heavy water company. Then the deuterium was diluted to ½ ¼ 1/8 1/16 by adding water free of deuterium for making media. In tree of samples the deuterium concentration was increased by adding D2O up to 10,50,100 times more concentrated. For candida albicans growth we used sabor medium and for aspergillus fomigatis growth we used sabor medium containing chloramphenicol. After culturing the funguses species we put the mediums for each species in the shaker incubator for 10 days in 25 centigrade. In different days and times the plates were studied morphologically and some microscopic characteristics were studied too. This experiments and cultures were repeated 3 times. Results: Statistical analyzes by paired-sample T test showed that aspergilus fomigatoos growth was decreased in concentration of 72 ppm( half deuterium concentration of negative control) significantly. In deuterium concentration reduction the growth reduce into the negative control significantly. The project results showed that candida albicans was sensitive to reduce and decrease of the deuterium in all concentrations.

Keywords: deuterium, cancer cell, growth, candida albicans

Procedia PDF Downloads 396

Authors: Bartlomiej S. Witkowski, Lukasz Wachnicki, Sylwia Gieraltowska, Rafal Pietruszka, Marek Godlewski

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Zinc oxide is extensively studied II-VI semiconductor with a direct energy gap of about 3.37 eV at room temperature and high transparency in visible light spectral region. Due to these properties, ZnO is an attractive material for applications in photovoltaic, electronic and optoelectronic devices. ZnO nanorods, due to a well-developed surface, have potential of applications in sensor technology and photovoltaics. In this work we present a new inexpensive method of the ultra-fast growth of ZnO nanorods from the aqueous solution. This environment friendly and fully reproducible method allows growth of nanorods in few minutes time on various substrates, without any catalyst or complexing agent. Growth temperature does not exceed 50ºC and growth can be performed at atmospheric pressure. The method is characterized by simplicity and allows regulation of size of the ZnO nanorods in a large extent. Moreover the method is also very safe, it requires organic, non-toxic and low-price precursors. The growth can be performed on almost any type of substrate through the homo-nucleation as well as hetero-nucleation. Moreover, received nanorods are characterized by a very high quality - they are monocrystalline as confirmed by XRD and transmission electron microscopy. Importantly oxygen vacancies are not found in the photoluminescence measurements. First results for obtained by us ZnO nanorods in sensor applications are very promising. Resistance UV sensor, based on ZnO nanorods grown on a quartz substrates shows high sensitivity of 20 mW/m2 (2 μW/cm2) for point contacts, especially that the results are obtained for the nanorods array, not for a single nanorod. UV light (below 400 nm of wavelength) generates electron-hole pairs, which results in a removal from the surfaces of the water vapor and hydroxyl groups. This reduces the depletion layer in nanorods, and thus lowers the resistance of the structure. The so-obtained sensor works at room temperature and does not need the annealing to reset to initial state. Details of the technology and the first sensors results will be presented. The obtained ZnO nanorods are also applied in simple-architecture photovoltaic cells (efficiency over 12%) in conjunction with low-price Si substrates and high-sensitive photoresistors. Details informations about technology and applications will be presented.

Keywords: hydrothermal method, photoresistor, photovoltaic cells, ZnO nanorods

Procedia PDF Downloads 430

Authors: S. Kershaw, P. J. Barry, K. Webb

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Background: Cystic Fibrosis (CF) is a chronic lung disease where patients have chronic lung infection punctuated by acute exacerbations that require intermittent intravenous (IV) antibiotics during their lives. With time, peripheral venous access can become difficult and limited. Accessing these veins can become arduous, traumatic, painful and unworkable. A permanent intravascular access device or Port is a small device that is inserted into the central venous system that allows the delivery of medicine eliminating the need for peripheral venous access. Ports represent a convenient and efficient method when venous access is required on a permanent basis however they are also associated with significant vascular complications. Superior Vena Cava Obstruction (SVCO) is a rare but significant vascular complication of ports in this setting. Objective: We aimed to look at a single CF centre’s experience of port-related SVCO over a thirty year period. Methods: Retrospective data was extracted using patient’s notes, electronic radiological reports and local databases over a period in excess of 30 years from 1982 to 2014. Results: 13 patients were identified with SVCO as a result of their port. 11 patients had CF (9 female, 2 male), one male patient had Primary Ciliary Dyskinesia and one female patient had severe Asthma. The mean port function was 1532 days (range 110 – 4049) and the mean age at SVCO was 24 years (range 11.1 to 36.5 years). The most common symptoms were facial oedema (n=8, 61.5%) and dilated veins (n=6, 46.2%). 7 patients had their Ports removed after SVCO. 6 patients underwent attempted stenting (46.2%) and 6 did not. 4 out of the 6 who underwent stenting required/had re-intervention. 3 of the 6 patients who underwent stenting had symptom resolution, however, 4 of the 6 patients who were not stented had symptom resolution also. Symptom resolution was not guaranteed with stenting and required re-intervention in two-thirds. Conclusion: This case series represents the experience of one of the longest established CF units in the UK and represents the largest cohort ever reported in the literature.

Keywords: ports, Superior Vena Cava Obstruction, cystic fibrosis, access devices

Procedia PDF Downloads 314

Authors: Bandi Aruna

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The increase of multidrug-resistant pathogens and the restriction on the use of antibiotics due to its side effects have drawn attention to the search for possible alternatives. Bacteriocins are ribosomally synthesized antimicrobial peptides that are active against Gram-positive and Gram-negative bacteria. The bacteriocins from lactic acid bacteria represent an important application of these peptides as clinical drugs or as food biopreservatives. The present study describes the isolation of bacteriocin producing lactic acid bacteria (LAB) from fermented batter of green gram and bengal gram using Man, Rogosa and Sharpe (MRS) media. The bacteriocin produced by these organisms inhibited the growth of Staphylococcus aureus, Escherichia coli, Klebsiella species, Pseudomonas aeruginosa, The isolates G1, G2 were isolated from green gram; B1 and B2 were isolated from fermented bengal gram batter. G1 and G2 were identified as Lactobacillus casie and B1 and B2 were identified as Streptococcus species. Antimicrobial activity of the bacteriocin produced by these strains was studied by agar well diffusion method. Bacteriocins produced by the Lactobacillus casie and Streptococcus secies retained their antagonistic property at pH of 5 and pH of 7. Exposure of bacteriocin to UV light for 4 min showed antibacterial activity. The antagonistic property was observed even at 100°C demonstrating stability at higher temperatures of the bacteriocin. The bacteriocins were stable for a period of 15 days at 27°C. The bacteriocins of G1, G2, and B2 exhibited highest antagonistic activity at pH of 5 and B1 at pH of 7. Therefore, the bacteriocins of the isolates may find important application in controlling the food-borne pathogens.

Keywords: Keywords: Antibacterial activity, Lactic acid bacteria, Bacteriocin

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Authors: Hasan AL-Khshemawee, Manjree Agarwal, Xin Du, Yonglin Ren

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The possibility use of stable isotopes to study Medfly mating and life history were investigated in these experiments. 13C6 glucose was incorporated in the diet of the Mediterranean fruit fly Ceratitis capitata (Diptera: Tephidae). Treatments included labelling and unlabelled of either the media or adult sugar water. The measured started from egg hatching till the adults have died. After mating, the adults were analysed for 13C6 glucose ratio using Liquid chromatography-mass spectrometry LC-MS in two periods of time immediately and after three days of mating. Results showed that stable isotopes were used successfully for labelling Medfly in laboratory conditions, and there were significant differences between labelled and unlabelled treatment in eggs hatching, larval development, pupae emergence, survival of adults and mating behaviour. Labelling during larval development and combined labelling of larvae and adults resulted in detectable values. The label glucose in larvae stage did not effect on mating behaviour, however, the label glucose in adults’ stage was affected by mating behaviour. We recommended that it is possible to label adults of Mediterranean fruit fly C. capitata and detected the label after mating. This method offers good tools to study mating behaviour in Medfly and other types of insects and could be providing useful tools in genetic studies, sterile insect technique (SIT) or agricultural pest management. Also, we recommended using this technique in the field.

Keywords: stable isotope, sterile insect technique (SIT), medfly, mating behaviour

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Authors: Ashit Syngle, Inderjit Verma, Pawan Krishan

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Objective: Endothelial progenitor cells (EPCs) have reparative potential in overcoming the endothelial dysfunction and reducing cardiovascular risk. EPC depletion has been demonstrated in the setting of established atherosclerotic diseases. With this background, we evaluated whether reduced EPCs population are associated with endothelial dysfunction, subclinical atherosclerosis and inflammatory markers in ankylosing spondylitis (AS) patients without any known traditional cardiovascular risk factor in AS patients. Methods: Levels of circulating EPCs (CD34+/CD133+), brachial artery flow-mediated dilatation, carotid intima-media thickness (CIMT) and inflammatory markers i.e erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tissue necrosis factor (TNF)–α, interleukin (IL)-6, IL-1 were assessed in 30 AS patients (mean age33.41 ± 10.25; 11 female and 19 male) who fulfilled the modified New York diagnostic criteria with 25 healthy volunteers (mean age 29.36± 8.64; 9 female and 16 male) matched for age and sex. Results: EPCs (CD34+/CD133+) cells were significantly (0.020 ± 0.001% versus 0.040 ± 0.010%, p<0.001) reduced in patients with AS compared to healthy controls. Endothelial function (7.35 ± 2.54 versus 10.27 ±1.73, p=0.002), CIMT (0.63 ± 0.01 versus 0.35 ± 0.02, p < 0.001) and inflammatory markers were also significantly (p < 0.01) altered as compared to healthy controls. Specifically, CD34+CD133+cells were inversely multivariate correlated with CRP and TNF-α and endothelial dysfunction was positively correlated with reduced number of EPC. Conclusion: Depletion of EPCs population is an independent predictor of endothelial dysfunction and early atherosclerosis in AS patients and may provide additional information beyond conventional risk factors and inflammatory markers.

Keywords: endothelial progenitor cells, atherosclerosis, ankylosing spondylitis, cardiovascular

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Authors: Oleg Redkin, Olga Bernikova

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It is commonly accepted that every language is both pure linguistic phenomenon as well as socially significant communicative system, which exists on the basis of certain society - its collective 'native speaker'. Therefore the language evolution and features besides its own linguistic rules and regulations are also defined by the influence of a number of extra-linguistic factors. The above mentioned statement may be illustrated by the example of the Arabic language which may be characterized by the following peculiarities: - the inner logic of the Arabic language - the 'algebraicity' of its morphological paradigms and grammar rules; - association of the Arabic language with the sacred texts of Islam, its close ties with the pre-Islamic and Islamic cultural heritage - the pre-Islamic poetry and Islamic literature and science; - territorial distribution, which in recent years went far beyond the boundaries of its traditional realm due to the development of new technologies and the spread of mass media, and what is more important, migration processes; - association of the Arabic language with the so called 'Renaissance of Islam'. These peculiarities should be remembered while considering the status of the Modern Standard Arabic (MSA) language or the Classical Arabic (CA) language as well as the Modern Arabic (MA) dialects in synchrony or from the diachronic point of view. Continuity of any system in diachrony on the one hand depends on the level of its ability to adapt itself to changing environment and by its internal ties on the other. Structural durability of language is characterized by its inner logic, hierarchy of paradigms and its grammar rules, as well as continuity of their implementation in acts of everyday communication. Since the Arabic language is both linguistic and social phenomenon the process of the Arabic language acquisition and study should not be focused only on the knowledge about linguistic features or development of communicative skills alone, but must be supplied with the information related to culture, history and religion of peoples of certain region that will expand and enrich competences of the target audience.

Keywords: Arabic, culture, Islam, language

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Authors: Guram Adamashvili

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Surface plasmon polariton is a surface optical wave which undergoes a strong enhancement and spatial confinement of its wave amplitude near an interface of two-dimensional layered structures. Phosphorene (single-layer black phosphorus) and other two-dimensional anisotropic phosphorene-like materials are recognized as promising materials for potential future applications of surface plasmon polariton. A theory of an optical breather of self-induced transparency for surface plasmon polariton propagating in monolayer or few-layer phosphorene is developed. A theory of an optical soliton of self-induced transparency for surface plasmon polariton propagating in monolayer or few-layer phosphorene have been investigated earlier Starting from the optical nonlinear wave equation for surface TM-modes interacting with a two-dimensional layer of atomic systems or semiconductor quantum dots and a phosphorene monolayer (or other two-dimensional anisotropic material), we have obtained the evolution equations for the electric field of the breather. In this case, one finds that the evolution of these pulses become described by the damped Bloch-Maxwell equations. For surface plasmon polariton fields, breathers are found to occur. Explicit relations of the dependence of breathers on the local media, phosphorene anisotropic conductivity, transition layer properties and transverse structures of the SPP, are obtained and will be given. It is shown that the phosphorene conductivity reduces exponentially the amplitude of the surface breather of SIT in the process of propagation. The direction of propagation corresponding to the maximum and minimum damping of the amplitude are assigned along the armchair and zigzag directions of black phosphorus nano-film, respectively. The most rapid damping of the intensity occurs when the polarization of breather is along the armchair direction.

Keywords: breathers, nonlinear waves, solitons, surface plasmon polaritons

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Authors: Farhaz Amyn Rajabali, Collins Odour

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Mathematics has been there for over 4000 years and has been one of the very first educational topics explored by human civilization. Throughout the years, it has become a complex study and has derived so many other subjects. With advancements in ICT, most of the computation in mathematics is done using powerful computers. In many different countries, the children in primary and secondary schools face difficulties in learning mathematics, and this has many reasons behind it, one being the students don’t engage much with the mathematical concepts hence failing to understand them deeply. The objective of this system is to help the students understand this mathematical concept interactively, which in return will encourage the love for learning and increase thorough understanding of many concepts. Research was conducted among a group of samples and about 50% of respondents replied that they had never used an augmented reality application before. This means that the chances for this system to be accepted in the market are high due to its innovative idea. Around 60% of people did recommend the use of this system to learn mathematics. The study also showed several challenges in an educational system, including but not limited to lack of resources which was chosen by 30% of respondents, the challenge to read from textbooks (34.6%) and how hard it is to visualize concepts (46.2%). The survey question asked what benefits the users see using augmented reality to learn mathematics. The responses that were picked the most were increased student engagement and using real-world examples to understand concepts, both being 65.4% and followed by easy access to learning material at 61.5%, and increased knowledge retention at 50%. This shows that there are plenty of issues with an education system that can be addressed by software applications; now that the newer generation is so enthusiastic about electronic devices, it can actually be used to deliver good knowledge and skills to the upcoming students and mitigate most of the challenges faced currently. The study concludes that the implementation of the system is a best practice for the educational system especially leveraging a new technology that has the ability to attract the attention of many young students and use it to deliver information. It will also give rise to awareness of new technology and on multiple ways it can be implemented. Addressing the educational sector in developing countries using information technology is an imperative task since these kids studying now is the future of the country and will use what they learn and understand during their childhood will help them to make decisions about their lives in the future which will not only affect them personally but also affect the whole society in general.

Keywords: AR, mathematics, system development, augmented reality

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Authors: Fatima Faraz

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BACKGROUND: While Artificial intelligence (AI) provides new opportunities across a wide variety of industries, healthcare is no exception. AI can lead to advancements in how the healthcare system functions and improves the quality of patient care. Developing countries like Pakistan are lagging in the implementation of AI-based solutions in healthcare. This demands increased knowledge and AI literacy among health care professionals. OBJECTIVES: To assess the level of awareness among medical students and faculty about AI in preparation for teaching AI basics and data science applications in clinical practice in an integrated medical curriculum. METHODS: An online 15-question semi-structured questionnaire, previously tested and validated, was delivered among participants through convenience sampling. The questionnaire composed of 3 parts: participant’s background knowledge, AI awareness, and attitudes toward AI applications in medicine. RESULTS: A total of 182 students and 39 faculty members from Rawalpindi Medical University, Pakistan, participated in the study. Only 26% of students and 46.2% of faculty members responded that they were aware of AI topics in clinical medicine. The major source of AI knowledge was social media (35.7%) for students and professional talks and colleagues (43.6%) for faculty members. 23.5% of participants answered that they personally had a basic understanding of AI. Students and faculty (60.1%) were interested in AI in patient care and teaching domain. These findings parallel similar published AI survey results. CONCLUSION: This survey concludes interest among students and faculty in AI developments and technology applications in healthcare. Further studies are required in order to correctly fit AI in the integrated modular curriculum of medical education.

Keywords: medical education, data science, artificial intelligence, curriculum

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Authors: Anish Shah, Steve A. Wakelin, Derrick Moot, Aurélie Laugraud, Hayley J. Ridgway

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A mixed pasture system of ryegrass-clover is used in New Zealand, where clovers are generally inoculated with commercially available strains of rhizobia. The community of rhizobia living in the soil and the way in which they interact with the plant are affected by different biotic and abiotic factors. In general, bacterial richness and diversity in soil varies by soil pH. pH also affects cell physiology and acts as a master variable that controls the wider soil physiochemical conditions such as P availability, Al release and micronutrient availability. As such, pH can have both primary and secondary effects on soil biology and processes. The aim of this work was to investigate the effect of soil pH on the genetic diversity and metabolic profile of Rhizobium leguminosarum strains nodulating clover. Soils were collected from 12 farms across New Zealand which had a pH(water) range of between 4.9 and 7.5, with four acidic (pH 4.9 – 5.5), four ‘neutral’ (5.8 – 6.1) and four alkaline (6.5 – 7.5) soils. Bacteria were recovered from nodules of Trifolium repens (white clover) and T. subterraneum (subterranean clover) grown in the soils. The strains were cultured and screened against a range of pH-amended media to demonstrate whether they were adapted to pH levels similar to their native soils. The strains which showed high relative growth at a given pH (~20% of those isolated) were selected for metabolic and taxonomic profiling. The Omnilog (Biolog Inc., Hayward, CA) phenotype array was used to perform assays on carbon (C) utilisation for selected strains. DNA was extracted from the strains which had differing C utilisation profiles and PCR products for both forward and reverse primers were sequenced for the following genes: 16S rRNA, recA, nodC, nodD and nifH (symbiotic).

Keywords: bacterial diversity, clover, metabolic and taxonomic profiling, pH adaptation, rhizobia

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Authors: Wu Peiqin

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Flexible thermoelectric devices are light and flexible, which can be in close contact with any shape of heat source surfaces to minimize heat loss and achieve efficient energy conversion. Among the wide application fields, energy harvesting via flexible thermoelectric generators can adapt to a variety of curved heat sources (such as human body, circular tubes, and surfaces of different shapes) and can drive low-power electronic devices, exhibiting one of the most promising technologies in self-powered systems. The heat flux along the cross-section of the flexible thin-film generator is limited by the thickness, so the temperature difference decreases during the generation process, and the output power is low. At present, most of the heat flow directions of the thin film thermoelectric generator are along the thin-film plane; however, this method is not suitable for attaching to the human body surface to generate electricity. In order to make the film generator more suitable for thermoelectric generation, it is necessary to apply a flexible heatsink on the air sides with the film to maintain the temperature difference. In this paper, Bismuth telluride thermoelectric paste was deposited on polyimide flexible substrate by a screen printing method, and the flexible thermoelectric film was formed after drying. There are ten pairs of thermoelectric legs. The size of the thermoelectric leg is 20 x 2 x 0.1 mm, and adjacent thermoelectric legs are spaced 2 mm apart. A phase change material-based flexible heatsink was designed and fabricated. The flexible heatsink consists of n-octadecane, polystyrene, and expanded graphite. N-octadecane was used as the thermal storage material, polystyrene as the supporting material, and expanded graphite as the thermally conductive additive. The thickness of the flexible phase change material-based heatsink is 2mm. A thermoelectric performance testing platform was built, and its output performance was tested. The results show that the system can generate an open-circuit output voltage of 3.89 mV at a temperature difference of 10K, which is higher than the generator without a heatsink. Therefore, the flexible heatsink can increase the temperature difference between the two ends of the film and improve the output performance of the flexible film generator. This result promotes the application of the film thermoelectric generator in collecting human heat for power generation.

Keywords: flexible thermoelectric generator, screen printing, PCM, flexible heatsink

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Authors: Lucas Berrini

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Academic libraries have always struggled with engaging with students and faculty. Striking the balance between what the community needs and what the library can afford has also been a point of contention for libraries. As academia begins to return to a new normal after COVID, library staff are rethinking how remind patrons that the library is open and ready for business. NC Wesleyan, a small liberal arts school in eastern North Carolina, decided to be proactive and reach out to the academic community. After shutting down in 2020 for COVID, the campus library saw a marked decrease in in-person attendance. For a small school whose operational budget was tied directly to tuition payments, it was imperative for the library to remind faculty and staff that they were open for business. At the beginning of the Summer 2022 term and continuing into the fall, the reference team created a marketing plan using email, physical meetings, and virtual events targeted at students and faculty as well as community members who utilized the facilities prior to COVID. The email blasts were gentle reminders that the building was open and available for use The target audiences were the community at large. Several of the emails contained reminders of previous events in the library that were student centered. The next phase of the email campaign centers on reminding the community about the libraries physical and electronic resources, including the makerspace lab. Language will indicate that student voices are needed, and a QR code is included for students to leave feedback as to what they want to see in the library. The final phase of the email blasts were faculty focused and invited them to connect with library reference staff for an in-person consultation on their research needs. While this phase is ongoing, the response has been positive, and staff are compiling data in hopes of working with administration to implement some of the requested services and materials. These email blasts will be followed up by in-person meetings with faculty and students who responded to the QR codes. This research is ongoing. This type of targeted outreach is new for Wesleyan. It is the hope of the library that by the end of Fall 2022, there will be a plan in place to address the needs and concerns of the students and faculty. Furthermore, the staff hopes to create a new sense of community for the students and staff of the university.

Keywords: academic, education, libraries, outreach

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Authors: Gebeyaw Molla Wondim, Damen Haile Mariam, Wubegzier Mekonnen, Catherine Arsenault

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Introduction: Maternal depression is a common psychological disorder that mostly occurs during pregnancy and after childbirth. It affects approximately one in four women worldwide. There is inconsistent evidence regarding the association between anemia and maternal depression. The objective of this systematic review was to examine the association between anemia and depression during pregnancy. Method: A comprehensive search of articles published before March 8, 2024, was conducted in seven databases such as PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cochrane Library, and Google Scholar. The Boolean operators “AND” or “OR” and “NOT” were used to connect the MeSH terms and keywords. Rayyan software was used to screen articles for final retrieval, and the PRISMA diagram was used to show the article selection process. Data extraction and risk bias assessment were done by two reviewers independently. JBI critical appraisal tool was used to assess the methodological quality of the retrieved articles. Heterogenicity was assessed through visual inspection of the extracted result, and narrative analysis was used to synthesize the result. Result: A total of 2,413 articles were obtained from seven electronic databases. Among these articles, a total of 2,398 were removed due to duplication (702 articles), by title and abstract selection criteria (1,678 articles), and by full-text review (18 articles). Finally, in this systematic review, 15 articles with a total of 628,781 pregnant women were included: seven articles were cohort studies, two were case-control, and six studies were cross-sectional. All included studies were published between 2013 and 2022. Studies conducted in the United States, South Korea, Finland, and one in South India found no significant association between anemia and maternal depression during pregnancy. On the other hand, studies conducted in Australia, Canada, Finland, Israel, Turkey, Vietnam, Ethiopia, and South India showed a significant association between anemia and depression during pregnancy. Conclusion: The overall finding of the systematic review shows the burden of anemia and antenatal depression is much higher among pregnant women in developing countries. Around three-fourths of the studies show that anemia is positively associated with antenatal depression. Almost all studies conducted in LMICs show anemia positively associated with antenatal depression.

Keywords: pregnant, women, anemia, depression

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Authors: Werner Roux Uys

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The Commissioner for the South African Revenue Service (SARS) holds a high position of trust in South African society and a lack of trust by taxpayers in the Commissioner’s actions or conduct could compromise SARS’ management of public finances. Tax morality – which is implicit in the social contract between taxpayers and the state – includes distinct phenomena that can cause a breakdown if there is a perceived lack of action on the part of the Commissioner to ensure public finances are kept safe. To promote tax morality, the Commissioner must support the judiciary in the exercise of its discretion to punish fraudulent tax activities and corrupt tax practices. For several years the political meddling in the Commissioner’s actions and conduct have caused perceived abuse of power at SARS, and taxpayers believed their hard-earned income paid over to SARS would be fruitless and wasteful expenditure. The purpose of this article is to identify and analyse previous decisions held by the South African judiciary regarding the Commissioner’s actions and conduct in tax matters, as well as consider important political statements and newspaper bulletins for the purpose of this research. The study applies a qualitative research approach and exploratory case study technique. Keywords were selected and inserted in the LexisNexis electronic database to systematically identify applicable case law where the ratio decidendi of the court referred to the actions and/or conduct of the Commissioner. Specific real-life statements, including political statements and newspaper bulletins, were selected to support the topic at hand. The purpose of the study is to educate the public about the perceptions that have transformed taxpayers’ behaviour towards the Commissioner for SARS since South Africa’s fledgling constitutional democracy was inaugurated in 1994. The study adds to the literature by identifying key characteristics or distinct phenomena regarding the actions and conduct of the Commissioner affecting taxpayers’ behaviour, including discretionary decision-making. From the findings, it emerged that SARS must abide by its (own) laws and that there is a need to educate not only South African taxpayers about tax morality, but also the public in general.

Keywords: commissioner, SARS, action and conduct, judiciary, discretionry, decsion-making

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Authors: Shady S. Hassan, Brijesh K. Tiwari, Gwilym A. Williams, Amit K. Jaiswal

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EU is known as the destination with the highest rate of the coffee consumption per capita in the world. Spent coffee grounds (SCG) are the main by-product of coffee brewing. SCG is either disposed as a solid waste or employed as compost, although the polysaccharides from such lignocellulosic biomass might be used as feedstock for fermentation processes. However, SCG as a lignocellulose have a complex structure and pretreatment process is required to facilitate an efficient enzymatic hydrolysis of carbohydrates. However, commonly used pretreatment methods, such as chemical, physico-chemical and biological techniques are still insufficient to meet optimal industrial production requirements in a sustainable way. Ultrasound is a promising candidate as a sustainable green pretreatment solution for lignocellulosic biomass utilization in a large scale biorefinery. Thus, ultrasound pretreatment of SCG without adding harsh chemicals investigated as a green technology to enhance enzyme hydrolysis. In the present work, ultrasound pretreatment experiments were conducted on SCG using different ultrasound frequencies (25, 35, 45, 130, and 950 kHz) for 60 min. Regardless of ultrasound power, low ultrasound frequency is more effective than high ultrasound frequency in pretreatment of biomass. Ultrasound pretreatment of SCG (at ultrasound frequency of 25 kHz for 60 min) followed by enzymatic hydrolysis resulted in total reducing sugars of 56.1 ± 2.8 mg/g of biomass. Fourier transform Infrared Spectroscopy (FTIR) was employed to investigate changes in functional groups of biomass after pretreatment, while high-performance liquid chromatography (HPLC) was employed for determination of glucose. Pretreatment of lignocellulose by low frequency ultrasound in water only was found to be an effective green approach for SCG to improve saccharification and glucose yield compared to native biomass. Pretreatment conditions will be optimized, and the enzyme hydrolysate will be used as media component substitute for the production of ethanol.

Keywords: lignocellulose, ultrasound, pretreatment, spent coffee grounds

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Authors: Alicia Carranza, Hildemar Dos Santos, W. Lawrence Beeson, R. Patti Herring, Kimberly R. Freeman, Adam Arechiga

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Early exposure to trauma can impact health-related behaviors later in life, which poses a considerable challenge for young adults transitioning into independence when they are lacking the necessary skills and support to live a healthy life. The study will be a non-experimental, mixed methods pre- and post-test (where subjects will serve as their own controls) to determine the impact of an eight-week trauma-informed healthy lifestyle program on self-efficacy for adopting health-promoting behaviors and health outcomes among young adults. Forty-two adults, ages 18-24 who are living in Orange County, CA will be recruited to participate in the eight-week trauma-informed healthy living program. Baseline and post-intervention assessments will be conducted to assess changes in self-efficacy for nutrition and physical exercise, sleep quality and quantity, body mass index (kg/m2), and coping skills used by comparing pre- to post-intervention. Some of the planned activities include cooking demonstrations, mindful eating activities and media literacy using Instagram. Frequencies analyses, paired t-test, and multiple regression will be used to determine if there was a change in coping skills. The results of this study can serve to assess the potential for mitigating the effects of Adverse Childhood Experiences (ACEs), or other toxic stress, experienced during adolescence across the lifespan. Young adults who learn how to cope with stress in a healthy way and engage in a healthy lifestyle can be better prepared to role model that behavior to their children.

Keywords: nutrition, healthy lifestyle, trauma-informed, stress management

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Authors: Reine Suci Wulandari, Rosa Suryantini

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Albizia (Paraserianthes falcataria) is a woody plant species that has a high economic value and multifunctional. Albizia is important timber, medicinal plants and can also be used as a plant to rehabilitate critical lands. The demand value of Albizia is increased so that the large quantities and high quality of seeds are required. In vitro propagation techniques are seed propagation that can produce more seeds and quality in a short time. In vitro cultures require growth regulators that can be obtained from biological agents such as endophytic fungi. Endophytic fungi are micro fungi that colonize live plant tissue without producing symptoms or other negative effects on host plants and increase plant growth. The purposes of this research were to isolate and identify endophytic fungi isolated from the root of Albizia and to study the effect of endophytic fungus on the growth of Albizia in vitro. The methods were root isolation, endophytic fungal identification, and inoculation of endophytic fungi to Albizia plants in vitro. Endophytic fungus isolates were grown on PDA media before being inoculated with Albizia sprouts. Incubation is done for 4 (four) weeks. The observed growth parameters were live explant percentage, percentage of explant shoot, and percentage of explant rooted. The results of the research showed that 6 (six) endophytic fungal isolates obtained from the root of Albizia, namely Aspergillus sp., Verticillium sp, Penicillium sp., Trichoderma sp., Fusarium sp., and Acremonium sp. Statistical analysis found that Trichoderma sp. and Fusarium sp. affect in vitro growth of Albizia. Endophytic fungi from the results of this research were potential as plant growth promoting. It can be applied to increase productivity either through increased plant growth and increased endurance of Albizia seedlings to pests and diseases.

Keywords: Albizia, endophytic fungi, propagation, in vitro

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Authors: Asim Majeed, Anwar Ul Haq, Ayesha Asim, Mike Lloyd-Williams, Arshad Jamal, Usman Butt

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This study aims to investigate the impact of data leak of M&S customers on digital communities. Modern businesses are using digital communities as an important public relations tool for marketing purposes. This form of communication helps companies to build better relationship with their customers which also act as another source of information. The communication between the customers and the organizations is not regulated so users may post positive and negative comments. There are new platforms being developed on a daily basis and it is very crucial for the businesses to not only get themselves familiar with those but also know how to reach their existing and perspective consumers. The driving force of marketing and communication in modern businesses is the digital communities and these are continuously increasing and developing. This phenomenon is changing the way marketing is conducted. The current research has discussed the implications on M&S business performance since the data was exploited on digital communities; users contacted M&S and raised the security concerns. M&S closed down its website for few hours to try to resolve the issue. The next day M&S made a public apology about this incidence. This information was proliferated on various digital communities and it has impacted negatively on M&S brand name, sales and customers. The content analysis approach is being used to collect qualitative data from 100 digital bloggers including social media communities such as Facebook and Twitter. The results and finding provide useful new insights into the nature and form of security concerns of digital users. Findings have theoretical and practical implications. This research will showcase a large corporation utilizing various digital community platforms and can serve as a model for future organizations.

Keywords: Digital, communities, performance, dissemination, implications, data, exploitation

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Authors: Shraddha Acharya, Sharad Kumar Sharma, Ratna Bhattarai, Bhagwan Maharjan, Deepak Dahal, Serpahine Kaminsa

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Background: Drug-resistant (DR) tuberculosis (TB) continues to be a threat in Nepal, with an estimated 2800 new cases every year. The treatment of DR-TB with second line TB drugs is complex and takes longer time with comparatively lower treatment success rate than drug-susceptible TB. Delay in treatment initiation for DR-TB patients might further result in unfavorable treatment outcomes and increased transmission. This study thus aims to determine median time taken to initiate second-line treatment among Rifampicin Resistant (RR) diagnosed TB patients and to assess the proportion of treatment delays among various type of DR-TB cases. Method: A retrospective cohort study was done using national routine electronic data (DRTB and TB Laboratory Patient Tracking System-DHIS2) on drug resistant tuberculosis patients between January 2020 and December 2022. The time taken for treatment initiation was computed as– days from first diagnosis as RR TB through Xpert MTB/Rif test to enrollment on second-line treatment. The treatment delay (>7 days after diagnosis) was calculated. Results: Among total RR TB cases (N=954) diagnosed via Xpert nationwide, 61.4% were enrolled under shorter-treatment regimen (STR), 33.0% under longer treatment regimen (LTR), 5.1% for Pre-extensively drug resistant TB (Pre-XDR) and 0.4% for Extensively drug resistant TB (XDR) treatment. Among these cases, it was found that the median time from diagnosis to treatment initiation was 6 days (IQR:2-15.8). The median time was 5 days (IQR:2.0-13.3) among STR, 6 days (IQR:3.0-15.0) among LTR, 30 days (IQR:5.5-66.8) among Pre-XDR and 4 days (IQR:2.5-9.0) among XDR TB cases. The overall treatment delay (>7 days after diagnosis) was observed in 42.4% of the patients, among which, cases enrolled under Pre-XDR contributed substantially to treatment delay (72.0%), followed by LTR (43.6%), STR (39.1%) and XDR (33.3%). Conclusion: Timely diagnosis and prompt treatment initiation remain fundamental focus of the National TB program. The findings of the study, however suggest gaps in timeliness of treatment initiation for the drug-resistant TB patients, which could bring adverse treatment outcomes. Moreover, there is an alarming delay in second line treatment initiation for the Pre-XDR TB patients. Therefore, this study generates evidence to identify existing gaps in treatment initiation and highlights need for formulating specific policies and intervention in creating effective linkage between the RR TB diagnosis and enrollment on second line TB treatment with intensified efforts from health providers for follow-ups and expansion of more decentralized, adequate, and accessible diagnostic and treatment services for DR-TB, especially Pre-XDR TB cases, due to the observed long treatment delays.

Keywords: drug-resistant, tuberculosis, treatment initiation, Nepal, treatment delay

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