Search results for: twin therapeutic approach
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 14792

Search results for: twin therapeutic approach

11192 The Role of DNA Evidence in Determining Paternity in India: A Study of Cases from the Legal and Scientific Perspective

Authors: Pratyusha Das

Abstract:

A paradigm shift has been noticed in the interpretation of DNA evidence for determining paternity. Sometimes DNA evidence has been accepted while sometimes it was rejected by the Indian Courts. Courts have forwarded various justifications for acceptance and rejection of such evidence through legal and scientific means. Laws have also been changed to accommodate the necessities of society. Balances between both the legal and scientific approaches are required, to make the best possible use of DNA evidence for the well-being of the society. Specifications are to be framed as to when such evidence can be used in the future by pointing out the pros and cons. Judicial trend is to be formulated to find out the present situation. The study of cases of superior courts of India using an analytical and theoretical approach is driving the questions regarding the shared identity of the legal and scientific approaches. To assimilate the differences between the two approaches, the basic differences between them have to be formulated. Revelations are required to access the favorable decisions using the DNA evidence. Reasons are to be forwarded for the unfavorable decisions and the approach preferred in such cases. The outcome of the two methods has to be assessed in relation to the parties to the dispute, the society at large, the researcher and from the judicial point of view. The dependability of the two methods is to be studied in relation to the justice delivery system. A highlight of the chronological study of cases along with the changes in the laws with the aid of presumptions will address the questions of necessity of a method according to the facts and situations. Address is required in this respect whether the legal and scientific forces converge somewhere pushing the traditional identification of paternity towards a fundamental change.

Keywords: cases, evidence, legal, scientific

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11191 Integrating One Health Approach with National Policies to Improve Health Security post-COVID-19 in Vietnam

Authors: Yasser Sanad, Thu Trang Dao

Abstract:

Introduction: Implementing the One Health (OH) approach requires an integrated, interdisciplinary, and cross-sectoral methodology. OH is a key tool for developing and implementing programs and projects and includes developing ambitious policies that consider the common needs and benefits of human, animal, plant, and ecosystem health. OH helps humanity readjust its path to environmentally friendly and impartial sustainability. As co-leader of the Global Health Security Agenda’s Zoonotic Disease Action Package, Vietnam pioneered a strong OH approach to effectively address early waves of the COVID-19 outbreak in-country. Context and Aim: The repeated surges in COVID-19 in Vietnam challenged the capabilities of the national system and disclosed the gaps in multi-sectoral coordination and resilience. To address this, FHI 360 advocated for the standardization of the OH platform by government actors to increase the resiliency of the system during and post COVID-19. Methods: FHI 360 coordinated technical resources to develop and implement evidence-based OH policies, promoting high-level policy dialogue between the Ministries of Health, Agriculture, and the Environment, and policy research to inform developed policies and frameworks. Through discussions, an OH-building Partnership (OHP) was formed, linking climate change, the environment, and human and animal health. Findings: The OHP Framework created a favorable policy environment within and between sectors, as well as between governments and international health security partners. It also promoted strategic dialogue, resource mobilization, policy advocacy, and integration of international systems with National Steering Committees to ensure accountability and emphasize national ownership. Innovative contribution to policy, practice and/or research: OHP was an effective evidence-based research-to-policy platform linking to the National One Health Strategic Plan (2021-2025). Collectively they serve as a national framework for the implementation and monitoring of OH activities. Through the adoption of policies and plans, the risk of zoonotic pathogens, environmental agent spillover, and antimicrobial resistance can be minimized through strengthening multi-sectoral OH collaboration for health security.

Keywords: one health, national policies, health security, COVID-19, Vietnam

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11190 Biosensor Design through Molecular Dynamics Simulation

Authors: Wenjun Zhang, Yunqing Du, Steven W. Cranford, Ming L. Wang

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The beginning of 21st century has witnessed new advancements in the design and use of new materials for biosensing applications, from nano to macro, protein to tissue. Traditional analytical methods lack a complete toolset to describe the complexities introduced by living systems, pathological relations, discrete hierarchical materials, cross-phase interactions, and structure-property dependencies. Materiomics – via systematic molecular dynamics (MD) simulation – can provide structure-process-property relations by using a materials science approach linking mechanisms across scales and enables oriented biosensor design. With this approach, DNA biosensors can be utilized to detect disease biomarkers present in individuals’ breath such as acetone for diabetes. Our wireless sensor array based on single-stranded DNA (ssDNA)-decorated single-walled carbon nanotubes (SWNT) has successfully detected trace amount of various chemicals in vapor differentiated by pattern recognition. Here, we present how MD simulation can revolutionize the way of design and screening of DNA aptamers for targeting biomarkers related to oral diseases and oral health monitoring. It demonstrates great potential to be utilized to build a library of DNDA sequences for reliable detection of several biomarkers of one specific disease, and as well provides a new methodology of creating, designing, and applying of biosensors.

Keywords: biosensor, DNA, biomarker, molecular dynamics simulation

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11189 A Monte Carlo Fuzzy Logistic Regression Framework against Imbalance and Separation

Authors: Georgios Charizanos, Haydar Demirhan, Duygu Icen

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Two of the most impactful issues in classical logistic regression are class imbalance and complete separation. These can result in model predictions heavily leaning towards the imbalanced class on the binary response variable or over-fitting issues. Fuzzy methodology offers key solutions for handling these problems. However, most studies propose the transformation of the binary responses into a continuous format limited within [0,1]. This is called the possibilistic approach within fuzzy logistic regression. Following this approach is more aligned with straightforward regression since a logit-link function is not utilized, and fuzzy probabilities are not generated. In contrast, we propose a method of fuzzifying binary response variables that allows for the use of the logit-link function; hence, a probabilistic fuzzy logistic regression model with the Monte Carlo method. The fuzzy probabilities are then classified by selecting a fuzzy threshold. Different combinations of fuzzy and crisp input, output, and coefficients are explored, aiming to understand which of these perform better under different conditions of imbalance and separation. We conduct numerical experiments using both synthetic and real datasets to demonstrate the performance of the fuzzy logistic regression framework against seven crisp machine learning methods. The proposed framework shows better performance irrespective of the degree of imbalance and presence of separation in the data, while the considered machine learning methods are significantly impacted.

Keywords: fuzzy logistic regression, fuzzy, logistic, machine learning

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11188 Synchronized Vehicle Routing for Equitable Resource Allocation in Food Banks

Authors: Rabiatu Bonku, Faisal Alkaabneh

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Inspired by a food banks distribution operation for non-profit organization, we study a variant synchronized vehicle routing problem for equitable resource allocation. This research paper introduces a Mixed Integer Programming (MIP) model aimed at addressing the complex challenge of efficiently distributing vital resources, particularly for food banks serving vulnerable populations in urban areas. Our optimization approach places a strong emphasis on social equity, ensuring a fair allocation of food to partner agencies while minimizing wastage. The primary objective is to enhance operational efficiency while guaranteeing fair distribution and timely deliveries to prevent food spoilage. Furthermore, we assess four distinct models that consider various aspects of sustainability, including social and economic factors. We conduct a comprehensive numerical analysis using real-world data to gain insights into the trade-offs that arise, while also demonstrating the models’ performance in terms of fairness, effectiveness, and the percentage of food waste. This provides valuable managerial insights for food bank managers. We show that our proposed approach makes a significant contribution to the field of logistics optimization and social responsibility, offering valuable insights for improving the operations of food banks.

Keywords: food banks, humanitarian logistics, equitable resource allocation, synchronized vehicle routing

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11187 Enhancement in Antimicrobial and Antioxidant Activity of Cuminum cyminum L. through Niosome Nanocarries

Authors: Fatemeh Haghiralsadat, Mohadese Hashemi, Elham Akhoundi Kharanaghi, Mojgan Yazdani, Mahboobe Sharafodini, Omid Javani

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Niosomes are colloidal particles formed from the self-assembly of non-ionic surfactants in aqueous medium resulting in closed bilayer structures. As a consequence of this hydrophilic and hydrophobic structure, niosomes have the capacity to entrap compounds of different solubilities. Niosomes are promising vehicle for drug delivery which protect sensitive drugs and improve the therapeutic index of drugs by restricting their action to target cells. Essential oils are complex mixtures of volatile compounds such as terpenoids, phenol-derived aromatic components that have been used for many biological properties including bactericidal, fungicidal, insecticidal, antioxidant, anti-tyrosinase and other medicinal properties. Encapsulation of essential oils in niosomes can be an attractive method to overcome their limitation such as volatility, easily decomposition by heat, humidity, light, or oxygen. Cuminum cyminum L. (Cumin) is an aromatic plant included in the Apiaceae family and is used to flavor foods, added to fragrances, and for medical preparations which is indigenous to Egypt, the Mediterranean region, Iran and India. The major components of the Cumin oil were reported as cuminaldehyde, γ -terpinene, β-pinene, p-cymene, p-mentha-1, 3-dien-7-al, and p-mentha-1, 4-dien-7-al which provide the antimicrobial and antioxidant activity. The aim of this work was to formulate Cumin essential oil-loaded niosomes to improve water solubility of natural product and evaluate its physico-chemical features and stability. Cumin oil was obtained through steam distillation using a clevenger-type apparatus and GC/MS was applied to identify the main components of the essential oil. Niosomes were prepared by using thin film hydration method and nanoparticles were characterized for particle size, dispersity index, zeta potential, encapsulation efficiency, in vitro release, and morphology.

Keywords: Cuminum cyminum L., Cumin, niosome, essential oil, encapsulation

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11186 Amelioration of Lipopolysaccharide Induced Murine Colitis by Cell Wall Contents of Probiotic Lactobacillus Casei: Targeting Immuno-Inflammation and Oxidative Stress

Authors: Vishvas N. Patel, Mehul Chorawala

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Currently, according to the authors best knowledge there are less effective therapeutic agents to limit intestinal mucosa damage associated with inflammatory bowel disease (IBD). Clinical studies have shown beneficial effects of several probiotics in patients of IBD. Probiotics are live organisms; confer a health benefit to the host by modulating immunoinflammation and oxidative stress. Although probiotics in murine and human improve disease severity, very little is known about the specific contribution of cell wall contents of probiotics in IBD. Herein, we investigated the ameliorative potential of cell wall contents of Lactobacillus casei (LC) in lipopolysaccharide (LPS)-induced murine colitis. Methods: Colitis was induced in LPS-sensitized rats by intracolonic instillation of LPS (50 µg/rat) for consecutive 14 days. Concurrently, cell wall contents isolated from 103, 106 and 109 CFU of LC was given subcutaneously to each rat for 21 days, considering sulfasalazine (100 mg/kg, p.o.) as standard. The severity of colitis was assessed by body weight loss, food intake, stool consistency, rectal bleeding, colon weight/length, spleen weight and histological analysis. Colonic inflammatory markers (myeloperoxidase (MPO) activity, C-reactive protein and proinflammatory cytokines) and oxidative stress markers (malondialdehyde, reduced glutathione and nitric oxide) were also assayed. Results: Cell wall contents of isolated from 106 and 109 CFU of LC significantly improved the severity of colitis by reducing body weight loss and diarrhea & bleeding incidence, improving food intake, colon weight/length, spleen weight and microscopic damage to the colonic mucosa. The treatment also reduced levels of inflammatory and oxidative stress markers and boosted antioxidant molecule. However, cell wall contents of isolated from 103 were ineffective. Conclusion: In conclusion, cell wall contents of LC attenuate LPS-induced colitis by modulating immuno-inflammation and oxidative stress.

Keywords: probiotics, Lactobacillus casei, immuno-inflammation, oxidative stress, lipopolysaccharide, colitis

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11185 Development of a General Purpose Computer Programme Based on Differential Evolution Algorithm: An Application towards Predicting Elastic Properties of Pavement

Authors: Sai Sankalp Vemavarapu

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This paper discusses the application of machine learning in the field of transportation engineering for predicting engineering properties of pavement more accurately and efficiently. Predicting the elastic properties aid us in assessing the current road conditions and taking appropriate measures to avoid any inconvenience to commuters. This improves the longevity and sustainability of the pavement layer while reducing its overall life-cycle cost. As an example, we have implemented differential evolution (DE) in the back-calculation of the elastic modulus of multi-layered pavement. The proposed DE global optimization back-calculation approach is integrated with a forward response model. This approach treats back-calculation as a global optimization problem where the cost function to be minimized is defined as the root mean square error in measured and computed deflections. The optimal solution which is elastic modulus, in this case, is searched for in the solution space by the DE algorithm. The best DE parameter combinations and the most optimum value is predicted so that the results are reproducible whenever the need arises. The algorithm’s performance in varied scenarios was analyzed by changing the input parameters. The prediction was well within the permissible error, establishing the supremacy of DE.

Keywords: cost function, differential evolution, falling weight deflectometer, genetic algorithm, global optimization, metaheuristic algorithm, multilayered pavement, pavement condition assessment, pavement layer moduli back calculation

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11184 In vitro Modeling of Aniridia-Related Keratopathy by the Use of Crispr/Cas9 on Limbal Epithelial Cells and Rescue

Authors: Daniel Aberdam

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Haploinsufficiency of PAX6 in humans is the main cause of congenital aniridia, a rare eye disease characterized by reduced visual acuity. Patients have also progressive disorders including cataract, glaucoma and corneal abnormalities making their condition very challenging to manage. Aniridia-related keratopathy (ARK), caused by a combination of factors including limbal stem-cell deficiency, impaired healing response, abnormal differentiation, and infiltration of conjunctival cells onto the corneal surface, affects up to 95% of patients. It usually begins in the first decade of life resulting in recurrent corneal erosions, sub-epithelial fibrosis with corneal decompensation and opacification. Unfortunately, current treatment options for aniridia patients are currently limited. Although animal models partially recapitulate this disease, there is no in vitro cellular model of AKT needed for drug/therapeutic tools screening and validation. We used genome editing (CRISPR/Cas9 technology) to introduce a nonsense mutation found in patients into one allele of the PAX6 gene into limbal stem cells. Resulting mutated clones, expressing half of the amount of PAX6 protein and thus representative of haploinsufficiency were further characterized. Sequencing analysis showed that no off-target mutations were induced. The mutated cells displayed reduced cell proliferation and cell migration but enhanced cell adhesion. Known PAX6 targets expression was also reduced. Remarkably, addition of soluble recombinant PAX6 protein into the culture medium was sufficient to activate endogenous PAX6 gene and, as a consequence, rescue the phenotype. It strongly suggests that our in vitro model recapitulates well the epithelial defect and becomes a powerful tool to identify drugs that could rescue the corneal defect in patients. Furthermore, we demonstrate that the homeotic transcription factor Pax6 is able to be uptake naturally by recipient cells to function into the nucleus.

Keywords: Pax6, crispr/cas9, limbal stem cells, aniridia, gene therapy

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11183 Long Run Estimates of Population, Consumption and Economic Development of India: An ARDL Bounds Testing Approach of Cointegration

Authors: Sanjay Kumar, Arumugam Sankaran, Arjun K., Mousumi Das

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The amount of domestic consumption and population growth is having a positive impact on economic growth and development as observed by the Harrod-Domar and endogenous growth models. The paper negates the Solow growth model which argues the population growth has a detrimental impact on per capita and steady-state growth. Unlike the Solow model, the paper observes, the per capita income growth never falls zero, and it sustains as positive. Hence, our goal here is to investigate the relationship among population, domestic consumption and economic growth of India. For this estimation, annual data from 1980-2016 has been collected from World Development Indicator and Reserve Bank of India. To know the long run as well as short-run dynamics among the variables, we have employed the ARDL bounds testing approach of cointegration followed by modified Wald causality test to know the direction of causality. The conclusion from cointegration and ARDL estimates reveal that there is a long run positive and statistically significant relationship among the variables under study. At the same time, the causality test shows that there is a causal relationship that exists among the variables. Hence, this calls for policies which have a long run perspective in strengthening the capabilities and entitlements of people and stabilizing domestic demand so as to serve long run and short run growth and stability of the economy.

Keywords: cointegration, consumption, economic development, population growth

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11182 The Image of Cultural Tourism in the Tourists’ Point of View

Authors: Wanida Suwunniponth

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The purposes of this research were to investigate the perceived of a cultural image and loyalty of tourists toward the attraction at Banglumphu neighborhood in Bangkok and to study the relationship of the cultural image of Banglumphu community and loyalty to visit this area of the tourists. This study employed both quantitative approach and qualitative approach. In a quantitative research, a questionnaire was used to collect data from 300 systematic sampled tourists who visited Banglumphu area and the correlation analysis were used to analyze data. The results revealed that the overall tourists’ point of view toward Banglumphu cultural image was at a good level which lifestyle had the best image, followed by value and belief, physical dimension, community identity, tradition, and local wisdom. In addition, the overall aspect of tourists’ loyalty including satisfaction, word of mouths, and revisiting were at good levels which word of mouths received the highest value, followed by revisiting, and satisfaction, respectively. In addition, the relationship between cultural image in aspect on lifestyle, tradition, local wisdom, belief, community identity and loyalty to visit Banglumphu in each aspect on satisfaction, word of mouths, and revisiting were moderately correlated at the significant level of 0.05, except physical dimension was not correlated with each aspect of tourists’ loyalty.

Keywords: cultural tourism, image, loyalty, revisit

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11181 A Case-Series Analysis of Tuberculosis in Patients at Internal Medicine Department

Authors: Cherif Y., Ghariani R., Derbal S., Farhati S., Ben Dahmen F., Abdallah M.

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Introduction: Tuberculosis (TBC) is a frequent infection and is still a major public health problem in Tunisia. The aim of this work is to focus on diagnostic and therapeutic characteristics of TBC in patients referred to our internal medicine department. Patients and Methods: The study was retrospective and descriptive of a cohort of consecutive cases treated from January 2016 to December 2019, collecting patients with latent or patent TBC. Twenty-eight medical records of adults diagnosed with TBC were reviewed. Results: Twenty-eight patients, including 18 women and 10 men, were diagnosed with TBC. Their mean age is 48 years (range: 22-78 years). Five patients have a medical history of diabetes mellitus, 1 patient was followed for systemic lupus erythematosus treated with corticosteroids and immunosuppressant drugs, and another was treated with corticosteroids for Mac Duffy syndrome. The TBC is latent in 12 cases and patent in 16 cases. The most common symptoms were fever and weight loss and were found in 10 cases, a cough in 2 cases, sputum in 3 cases, lymph nodes in 4 cases, erythema nodosum in 2 cases, and neurological signs in 3 cases. Lymphopenia is noticed in 3 cases and a biological inflammatory syndrome in 18 of the cases. The purified protein derivate reaction was positive in 17 cases, anergic in 3 cases, negative in 5 cases, and not done in 3 cases. The acid-fast bacilli stain culture was strongly positive in one patient. The histopathological study was conclusive in 11 patients and showed granulomatosis with caseous necrosis. TBC was pulmonary in 7 patients, lymph node in 7 cases, peritoneal in 7 cases, digestive in 1 case, neuromeningeal in 3 cases, and thyroïd in 1 case. Seven patients had multifocal TBC. All the patients received anti-tuberculosis treatment with a mean duration of 8 months with no failure or relapse with an average follow-up time of 10.58 months. Conclusion: Diagnosis and management of TBC remain essential to avoid serious complications. The survey is necessary to ensure timely detection and treatment of infected adults to decrease its incidence. The best treatment remains preventive through vaccination and improving social and economic conditions.

Keywords: tuberculosis, infection, autoimmune disease, granulomatosis

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11180 Current Aspects of 21st Century Primary School Music Education in South Korea: Zoltán Kodály Concept

Authors: Kyung Hwa Shin

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Primary school music education plays a crucial role in nurturing students' musical abilities and fostering a lifelong appreciation for music. As we embark on the 21st century, it becomes imperative to explore advanced approaches that can effectively engage and empower students in the realm of music. This study aims to shed light on the aspects of primary school music education in South Korea, with a specific focus on the incorporation of the Zoltán Kodály Concept. The Zoltán Kodály Concept, developed by Hungarian composer and educator Zoltán Kodály (Kodály, 1974) advocates for a holistic music education that integrates singing, movement, and music literacy. This concept has gained recognition worldwide for its effectiveness in developing musicianship and enhancing music learning experiences. This study will delve into the ways in which the Zoltán Kodály Concept has been adapted and implemented in the context of South Korean primary school music education. It will highlight the benefits of this approach in nurturing students' musical skills, fostering creativity, and promoting cultural understanding through music. Furthermore, it will enhance the delivery of the Kodály-based curriculum challenges posed by the 21st-century digital age. Drawing on this research, pedagogical practices, and case studies, this study will provide valuable insights into the practical applications of the Zoltán Kodály Concept in South Korean primary school music education. It will discuss the impact of this approach on student engagement, motivation, and achievement, as well as the role of teachers in facilitating effective implementation. Additionally, it will address the professional development opportunities available to music educators to enhance their pedagogical skills in line with the Kodály philosophy. Ultimately, it aims to inspire and empower educators, policymakers, and researchers to embrace the Zoltán Kodály Concept as a transformative and forward-thinking approach to primary school music education in the 21st century. By embracing current aspects and progressive methodologies, South Korea can continue to strengthen its music education system and cultivate a generation of musically literate and culturally enriched individuals.

Keywords: primary school music education, Zoltán Kodály concept, 21st century, South Korea, music literacy, pedagogy, curriculum

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11179 Building a Transformative Continuing Professional Development Experience for Educators through a Principle-Based, Technological-Driven Knowledge Building Approach: A Case Study of a Professional Learning Team in Secondary Education

Authors: Melvin Chan, Chew Lee Teo

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There has been a growing emphasis in elevating the teachers’ proficiency and competencies through continuing professional development (CPD) opportunities. In this era of a Volatile, Uncertain, Complex, Ambiguous (VUCA) world, teachers are expected to be collaborative designers, critical thinkers and creative builders. However, many of the CPD structures are still revolving in the model of transmission, which stands in contradiction to the cultivation of future-ready teachers for the innovative world of emerging technologies. This article puts forward the framing of CPD through a Principle-Based, Technological-Driven Knowledge Building Approach grounded in the essence of andragogy and progressive learning theories where growth is best exemplified through an authentic immersion in a social/community experience-based setting. Putting this Knowledge Building Professional Development Model (KBPDM) in operation via a Professional Learning Team (PLT) situated in a Secondary School in Singapore, research findings reveal that the intervention has led to a fundamental change in the learning paradigm of the teachers, henceforth equipping and empowering them successfully in their pedagogical design and practices for a 21st century classroom experience. This article concludes with the possibility in leveraging the Learning Analytics to deepen the CPD experiences for educators.

Keywords: continual professional development, knowledge building, learning paradigm, principle-based

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11178 Dermatomyositis: It is Not Always an Allergic Reaction

Authors: Irfan Abdulrahman Sheth, Sohil Pothiawala

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Dermatomyositis is an idiopathic inflammatory myopathy, traditionally characterized by a progressive, symmetrical proximal muscle weakness and pathognomonic or characteristic cutaneous manifestations. We report a case of a 60-year old Chinese female who was referred from polyclinic for allergic rash over the body after applying hair dye 3 weeks ago. It was associated with puffiness of face, shortness of breath and hoarse voice since last 2 weeks with decrease effort tolerance. She also complained of dysphagia/ myalgia with progressive weakness of proximal muscles and palpitations. She denied chest pain, loss of appetite, weight loss, orthopnea or fever. She had stable vital signs and appeared cushingoid. She was noted to have rash over the scalp/ face and ecchymosis over the right arm with puffiness of face and periorbital oedema. There was symmetrical muscle weakness and other neurological examination was normal. Initial impression was of allergic reaction and underlying nephrotic syndrome and Cushing’s syndrome from TCM use. Diagnostic tests showed high Creatinine kinase (CK) of 1463 u/l, CK–MB of 18.7 ug/l and Troponin –T of 0.09 ug/l. The Full blood count and renal panel was normal. EMG showed inflammatory myositis. Patient was managed by rheumatologist and discharged on oral prednisolone with methotrexate/ ergocalciferol capsule and calcium carb, vitamin D tablets and outpatient follow up. In some patients, cutaneous disease exists in the absence of objective evidence of muscle inflammation. Management of dermatomyositis begins with careful investigation for the presence of muscle disease or of additional systemic involvement, particularly of the pulmonary, cardiac or gastrointestinal systems, and for the possibility of an accompanying malignancy. Muscle disease and systemic involvement can be refractory and may require multiple sequential therapeutic interventions or, at times, combinations of therapies. Thus, we want to highlight to the physicians that the cutaneous disease of dermatomyositis should not be confused with allergic reaction. It can be particularly challenging to diagnose. Early recognition aids appropriate management of this group of patients.

Keywords: dermatomyositis, myopathy, allergy, cutaneous disease

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11177 Employee Whistleblower Protection: An Analysis of Malaysian Law and Islamic Law

Authors: Ashgar Ali Ali Mohamed, Farheen Baig Sardar Baig

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In Malaysia, the Whistle-blower Protection Act 2010 provides protection to a person in an organization who exposes misconduct, alleged dishonest or illegal activity that violates the existing laws, among others. For example, alleged fraud, health and safety violations, and corruption, to name but a few. Undeniable, most whistle-blowers are internal to an organisation who report misconduct of a fellow employee or superior within their company and they frequently face reprisal at the hands of the organisation which they have accused. In fact, many people do not consider blowing the whistle because of fear of retaliation and losing their relationships at workplace. Although whistle-blowers are protected under law from employer retaliation, there have been many cases where punishment for whistleblowing has occurred, such as suspension, demotion, termination, or harsh mistreatment by other employees. Hence, this paper will analyse the adequacy of the legal protection available to employees who whistle-blow on their employers with reference to the Whistle-blower Protection Act 2010. Reference will also be made to the approach taken in other selected jurisdiction with a view of highlighting the adequacy of the Malaysian legislation on this subject besides strengthen employee whistle-blower protection. Further, reference is also made to the Islamic approach on this subject with particular reference to the concept of amr-bil-Ma’roof (ordering for acknowledged virtues) and nahi anil munkar (forbidding from sin). Allah (SWT) says: “And there should be a group amongst you who invite towards good, order for acknowledged virtues, forbid from sin and these it is that are the successful ones” (Al Imran(Chp 3), verse 104).

Keywords: whistleblower protection, employee whistleblower, detrimental and reprisal, Malaysian law

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11176 Role of Empirical Evidence in Law-Making: Case Study from India

Authors: Kaushiki Sanyal, Rajesh Chakrabarti

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In India, on average, about 60 Bills are passed every year in both Houses of Parliament – Lok Sabha and Rajya Sabha (calculated from information on websites of both Houses). These are debated in both Lok Sabha (House of Commons) and Rajya Sabha (Council of States) before they are passed. However, lawmakers rarely use empirical evidence to make a case for a law. Most of the time, they support a law on the basis of anecdote, intuition, and common sense. While these do play a role in law-making, without the necessary empirical evidence, laws often fail to achieve their desired results. The quality of legislative debates is an indicator of the efficacy of the legislative process through which a Bill is enacted. However, the study of legislative debates has not received much attention either in India or worldwide due to the difficulty of objectively measuring the quality of a debate. Broadly, three approaches have emerged in the study of legislative debates. The rational-choice or formal approach shows that speeches vary based on different institutional arrangements, intra-party politics, and the political culture of a country. The discourse approach focuses on the underlying rules and conventions and how they impact the content of the debates. The deliberative approach posits that legislative speech can be reasoned, respectful, and informed. This paper aims to (a) develop a framework to judge the quality of debates by using the deliberative approach; (b) examine the legislative debates of three Bills passed in different periods as a demonstration of the framework, and (c) examine the broader structural issues that disincentive MPs from scrutinizing Bills. The framework would include qualitative and quantitative indicators to judge a debate. The idea is that the framework would provide useful insights into the legislators’ knowledge of the subject, the depth of their scrutiny of Bills, and their inclination toward evidence-based research. The three Bills that the paper plans to examine are as follows: 1. The Narcotics Drugs and Psychotropic Substances Act, 1985: This act was passed to curb drug trafficking and abuse. However, it mostly failed to fulfill its purpose. Consequently, it was amended thrice but without much impact on the ground. 2. The Criminal Laws (Amendment) Act, 2013: This act amended the Indian Penal Code to add a section on human trafficking. The purpose was to curb trafficking and penalise traffickers, pimps, and middlemen. However, the crime rate remains high while the conviction rate is low. 3. The Surrogacy (Regulation) Act, 2021: This act bans commercial surrogacy allowing only relatives to act as surrogates as long as there is no monetary payment. Experts fear that instead of preventing commercial surrogacy, it would drive the activity underground. The consequences would be borne by the surrogate, who would not be protected by law. The purpose of the paper is to objectively analyse the quality of parliamentary debates, get insights into how MPs understand the evidence and deliberate on steps to incentivise them to use empirical evidence.

Keywords: legislature, debates, empirical, India

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11175 Estimating the Receiver Operating Characteristic Curve from Clustered Data and Case-Control Studies

Authors: Yalda Zarnegarnia, Shari Messinger

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Receiver operating characteristic (ROC) curves have been widely used in medical research to illustrate the performance of the biomarker in correctly distinguishing the diseased and non-diseased groups. Correlated biomarker data arises in study designs that include subjects that contain same genetic or environmental factors. The information about correlation might help to identify family members at increased risk of disease development, and may lead to initiating treatment to slow or stop the progression to disease. Approaches appropriate to a case-control design matched by family identification, must be able to accommodate both the correlation inherent in the design in correctly estimating the biomarker’s ability to differentiate between cases and controls, as well as to handle estimation from a matched case control design. This talk will review some developed methods for ROC curve estimation in settings with correlated data from case control design and will discuss the limitations of current methods for analyzing correlated familial paired data. An alternative approach using Conditional ROC curves will be demonstrated, to provide appropriate ROC curves for correlated paired data. The proposed approach will use the information about the correlation among biomarker values, producing conditional ROC curves that evaluate the ability of a biomarker to discriminate between diseased and non-diseased subjects in a familial paired design.

Keywords: biomarker, correlation, familial paired design, ROC curve

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11174 A Multidisciplinary Team Approach for Limb Salvage in a Rare Case of Pyoderma Gangrenosum in a Significant Circumferential Lower Extremity Wound Complicated by Diabetes and End-stage Renal Disease

Authors: Jenee Gooden, Kevin Vasquez-monterroso, Lady Paula Dejesus, Sandra Wainwright, Daniel Kim, Mackenzie Walker

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Introduction: Pyoderma gangrenosum (PG) is a rare, rapidly progressive, neutrophilic ulcerative colitis condition with an incidence of 3 to 10 cases per year ¹ ². Due to the similar appearance, PG is often misdiagnosed as a diabetic ulcer in diabetic patients. Though they may clinically appear similar in appearance, the treatment protocol and diagnostic criteria differ. Also, end-stage renal disease (ESRD) is often a condition seen in diabetic patients, which can have a significant impact on wound healing due to the wide range of uremic toxins³. This case study demonstrates a multidisciplinary team and multimodal treatment approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine for an uncontrolled diabetic with pyoderma gangrenosum of a significant circumferential wound, covering almost the entire right lower extremity. Methods:56 y.o male presents with multiple PG ulcerations, including the chest, right posterior lower extremity and sacrum. All ulcerations were previously managed by the same wound care specialist. His chief complaint was worsening PG ulcerations accompanied by a fever of 103 °F . This case study focuses on the wound to his RLE. Past medical history significant for diabetes mellitus type 2 with hemoglobin A1c of 10% and end stage renal disease (ESRD) on hemodialysis. A multidisciplinary team approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine was successfully used to perform right lower extremity limb salvage. The patient was managed by rheumatology for the continuation of prior medication, as well as the mutual agreement with wound care for the addition of dapsone. A coronary CT angiogram was performed by interventional cardiology, but no significant disease was noted, and no further vascular workup was necessary. Multiple surgical sharp wide excisional debridements with application of allografts and split thickness skin grafts for the circumferential ulceration that encompassed almost the entire right lower extremity were performed by both podiatric surgery and general surgery. Wound cultures and soft tissue biopsies were performed, and infectious disease managed antibiotic therapy. Hyperbaric oxygen therapy and wound vac therapy by wound care were also completed as adjunct management. Results: Prevention of leg amputation by limb salvage of the RLE was accomplished by a multidisciplinary team approach, with the wound size decreasing over a total of 29 weeks from 600 cm² to 12.0 x 3.5 x 0.2 cm. Our multidisciplinary team included podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine. Discussion: Wound healing, in general, can have its challenges, and those challenges are only magnified when accompanied by multiple systemic illnesses. Though the negative impact of diabetes on wound healing is well known, the compound impact of being a diabetic with ESRD and having pyoderma gangrenosum is not. This case demonstrates the necessity for a multidisciplinary team approach with a wide array of treatment modalities to optimize wound healing and perform limb salvage with prevention of lower extremity amputation.

Keywords: diabetes, podiatry, pyoderma gangrenosum, end stage renal disease

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11173 Consequential Investigations on the Impact of Zakat Towards the Promotion of Socio-Economic Development in Morocco: A Theoretical Framework

Authors: Mennani Maha, Attak El Houssain

Abstract:

Under the massive effect of the Covid-19 health crisis, marked by a loss of competitiveness, a slowdown in growth and an accumulation of the repercussions of socio-economic inequalities, a considerable effort must be combined, in Morocco, to put into perspective macro-political, macro-economic and social opportunities. The development of a new economic and social approach is essential in order to respond to the authenticity of the new development model that will be used by the country. The appropriation of strategies of solidarity and social cohesion constitutes a participatory, competitive and inclusive approach to support the functionalities of the economic, social and political system. Therefore, the search for alternative financial resources has become a necessity to achieve the objectives of sustainable socio-economic growth on the one hand; and to promote, on the other hands, the dynamics, of large scale, social investments. The zakat remains a site of the Islamic economy dedicated to stimulating the bases of a collective adhesion of the population on the economic, as well as on the social level, thanks to a fair and equitable distribution of the zakat funds. However, Morocco is one of the few Muslim countries that has not yet had an institution for collecting and distributing this Islamic duty, which makes it difficult to measure the socio-economic impact of zakat. This theoretical document essentially ensures the development of the crucial utility of institutionalizing zakat in order to reinforce the objectives of social solidarity in Morocco in line with the process of conceptualizing a new development model.

Keywords: zakat, socio-economic development, solidarity, social investment

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11172 Data-Driven Performance Evaluation of Surgical Doctors Based on Fuzzy Analytic Hierarchy Processes

Authors: Yuguang Gao, Qiang Yang, Yanpeng Zhang, Mingtao Deng

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To enhance the safety, quality and efficiency of healthcare services provided by surgical doctors, we propose a comprehensive approach to the performance evaluation of individual doctors by incorporating insights from performance data as well as views of different stakeholders in the hospital. Exploratory factor analysis was first performed on collective multidimensional performance data of surgical doctors, where key factors were extracted that encompass assessment of professional experience and service performance. A two-level indicator system was then constructed, for which we developed a weighted interval-valued spherical fuzzy analytic hierarchy process to analyze the relative importance of the indicators while handling subjectivity and disparity in the decision-making of multiple parties involved. Our analytical results reveal that, for the key factors identified as instrumental for evaluating surgical doctors’ performance, the overall importance of clinical workload and complexity of service are valued more than capacity of service and professional experience, while the efficiency of resource consumption ranks comparatively the lowest in importance. We also provide a retrospective case study to illustrate the effectiveness and robustness of our quantitative evaluation model by assigning meaningful performance ratings to individual doctors based on the weights developed through our approach.

Keywords: analytic hierarchy processes, factor analysis, fuzzy logic, performance evaluation

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11171 Gan Nanowire-Based Sensor Array for the Detection of Cross-Sensitive Gases Using Principal Component Analysis

Authors: Ashfaque Hossain Khan, Brian Thomson, Ratan Debnath, Abhishek Motayed, Mulpuri V. Rao

Abstract:

Though the efforts had been made, the problem of cross-sensitivity for a single metal oxide-based sensor can’t be fully eliminated. In this work, a sensor array has been designed and fabricated comprising of platinum (Pt), copper (Cu), and silver (Ag) decorated TiO2 and ZnO functionalized GaN nanowires using industry-standard top-down fabrication approach. The metal/metal-oxide combinations within the array have been determined from prior molecular simulation study using first principle calculations based on density functional theory (DFT). The gas responses were obtained for both single and mixture of NO2, SO2, ethanol, and H2 in the presence of H2O and O2 gases under UV light at room temperature. Each gas leaves a unique response footprint across the array sensors by which precise discrimination of cross-sensitive gases has been achieved. An unsupervised principal component analysis (PCA) technique has been implemented on the array response. Results indicate that each gas forms a distinct cluster in the score plot for all the target gases and their mixtures, indicating a clear separation among them. In addition, the developed array device consumes very low power because of ultra-violet (UV) assisted sensing as compared to commercially available metal-oxide sensors. The nanowire sensor array, in combination with PCA, is a potential approach for precise real-time gas monitoring applications.

Keywords: cross-sensitivity, gas sensor, principle component analysis (PCA), sensor array

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11170 A Goal-Oriented Approach for Supporting Input/Output Factor Determination in the Regulation of Brazilian Electricity Transmission

Authors: Bruno de Almeida Vilela, Heinz Ahn, Ana Lúcia Miranda Lopes, Marcelo Azevedo Costa

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Benchmarking public utilities such as transmission system operators (TSOs) is one of the main strategies employed by regulators in order to fix monopolistic companies’ revenues. Since 2007 the Brazilian regulator has been utilizing Data Envelopment Analysis (DEA) to benchmark TSOs. Despite the application of DEA to improve the transmission sector’s efficiency, some problems can be pointed out, such as the high price of electricity in Brazil; the limitation of the benchmarking only to operational expenses (OPEX); the absence of variables that represent the outcomes of the transmission service; and the presence of extremely low and high efficiencies. As an alternative to the current concept of benchmarking the Brazilian regulator uses, we propose a goal-oriented approach. Our proposal supports input/output selection by taking traditional organizational goals and measures as a basis for the selection of factors for benchmarking purposes. As the main advantage, it resolves the classical DEA problems of input/output selection, undesirable and dual-role factors. We also provide a demonstration of our goal-oriented concept regarding service quality. As a result, most TSOs’ efficiencies in Brazil might improve when considering quality as important in their efficiency estimation.

Keywords: decision making, goal-oriented benchmarking, input/output factor determination, TSO regulation

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11169 A Next Generation Multi-Scale Modeling Theatre for in silico Oncology

Authors: Safee Chaudhary, Mahnoor Naseer Gondal, Hira Anees Awan, Abdul Rehman, Ammar Arif, Risham Hussain, Huma Khawar, Zainab Arshad, Muhammad Faizyab Ali Chaudhary, Waleed Ahmed, Muhammad Umer Sultan, Bibi Amina, Salaar Khan, Muhammad Moaz Ahmad, Osama Shiraz Shah, Hadia Hameed, Muhammad Farooq Ahmad Butt, Muhammad Ahmad, Sameer Ahmed, Fayyaz Ahmed, Omer Ishaq, Waqar Nabi, Wim Vanderbauwhede, Bilal Wajid, Huma Shehwana, Muhammad Tariq, Amir Faisal

Abstract:

Cancer is a manifestation of multifactorial deregulations in biomolecular pathways. These deregulations arise from the complex multi-scale interplay between cellular and extracellular factors. Such multifactorial aberrations at gene, protein, and extracellular scales need to be investigated systematically towards decoding the underlying mechanisms and orchestrating therapeutic interventions for patient treatment. In this work, we propose ‘TISON’, a next-generation web-based multiscale modeling platform for clinical systems oncology. TISON’s unique modeling abstraction allows a seamless coupling of information from biomolecular networks, cell decision circuits, extra-cellular environments, and tissue geometries. The platform can undertake multiscale sensitivity analysis towards in silico biomarker identification and drug evaluation on cellular phenotypes in user-defined tissue geometries. Furthermore, integration of cancer expression databases such as The Cancer Genome Atlas (TCGA) and Human Proteome Atlas (HPA) facilitates in the development of personalized therapeutics. TISON is the next-evolution of multiscale cancer modeling and simulation platforms and provides a ‘zero-code’ model development, simulation, and analysis environment for application in clinical settings.

Keywords: systems oncology, cancer systems biology, cancer therapeutics, personalized therapeutics, cancer modelling

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11168 Dynamic Modeling of the Exchange Rate in Tunisia: Theoretical and Empirical Study

Authors: Chokri Slim

Abstract:

The relative failure of simultaneous equation models in the seventies has led researchers to turn to other approaches that take into account the dynamics of economic and financial systems. In this paper, we use an approach based on vector autoregressive model that is widely used in recent years. Their popularity is due to their flexible nature and ease of use to produce models with useful descriptive characteristics. It is also easy to use them to test economic hypotheses. The standard econometric techniques assume that the series studied are stable over time (stationary hypothesis). Most economic series do not verify this hypothesis, which assumes, when one wishes to study the relationships that bind them to implement specific techniques. This is cointegration which characterizes non-stationary series (integrated) with a linear combination is stationary, will also be presented in this paper. Since the work of Johansen, this approach is generally presented as part of a multivariate analysis and to specify long-term stable relationships while at the same time analyzing the short-term dynamics of the variables considered. In the empirical part, we have applied these concepts to study the dynamics of of the exchange rate in Tunisia, which is one of the most important economic policy of a country open to the outside. According to the results of the empirical study by the cointegration method, there is a cointegration relationship between the exchange rate and its determinants. This relationship shows that the variables have a significant influence in determining the exchange rate in Tunisia.

Keywords: stationarity, cointegration, dynamic models, causality, VECM models

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11167 The h3r Antagonist E159 Alleviates Neuroinflammation and Autistic-Like Phenotypes in BTBR T+ tf/J Mouse Model of Autism

Authors: Shilu Deepa Thomas, P. Jayaprakash, Dorota Łazewska, Katarzyna Kieć-Kononowicz, B. Sadek

Abstract:

A large body of evidence suggests the involvement of cognitive impairment, increased levels of inflammation and oxidative stress in the pathogenesis of autism spectrum disorder (ASD). ASD commonly coexists with psychiatric conditions like anxiety and cognitive challenges, and individuals with ASD exhibit significant levels of inflammation and immune system dysregulation. Previous Studies have identified elevated levels of pro-inflammatory markers such as IL-1β, IL-6, IL-2 and TNF-α, particularly in young children with ASD. The current therapeutic options for ASD show limited effectiveness, signifying the importance of exploring an efficient drugs to address the core symptoms. The role of histamine H3 receptors (H3Rs) in memory and the prospective role of H3R antagonists in pharmacological control of neurodegenerative disorders, e.g., ASD, is well-accepted. Hence, the effects of chronic systemic administration of H3R antagonist E159 on autistic-like repetitive behaviors, social deficits, memory and anxiety parameters, as well as neuroinflammation in Black and Tan BRachyury (BTBR) mice, were evaluated using Y maze, Barnes maze, self-grooming, open field and three chamber social test. E159 (2.5, 5 and 10 mg/kg, i.p.) dose-dependently ameliorated repetitive and compulsive behaviors by reducing the increased time spent in self-grooming and improved reduced spontaneous alternation in BTBR mice. Moreover, treatment with E159 attenuated disturbed anxiety levels and social deficits in tested male BTBR mice. Furthermore, E159 attenuated oxidative stress by significantly increasing GSH, CAT, and SOD and decreasing the increased levels of MDA in the cerebellum as well as the hippocampus. In addition, E159 decreased the elevated levels of proinflammatory cytokines (tumor necrosis factor (TNF-α), interleukin-1β (IL-1β), and IL-6). The observed results show that H3R antagonists like E159 may represent a promising novel pharmacological strategy for the future treatment of ASD.

Keywords: histamine H3 receptors, antagonist E159, autism, behaviors, mice

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11166 Traffic Prediction with Raw Data Utilization and Context Building

Authors: Zhou Yang, Heli Sun, Jianbin Huang, Jizhong Zhao, Shaojie Qiao

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Traffic prediction is essential in a multitude of ways in modern urban life. The researchers of earlier work in this domain carry out the investigation chiefly with two major focuses: (1) the accurate forecast of future values in multiple time series and (2) knowledge extraction from spatial-temporal correlations. However, two key considerations for traffic prediction are often missed: the completeness of raw data and the full context of the prediction timestamp. Concentrating on the two drawbacks of earlier work, we devise an approach that can address these issues in a two-phase framework. First, we utilize the raw trajectories to a greater extent through building a VLA table and data compression. We obtain the intra-trajectory features with graph-based encoding and the intertrajectory ones with a grid-based model and the technique of back projection that restore their surrounding high-resolution spatial-temporal environment. To the best of our knowledge, we are the first to study direct feature extraction from raw trajectories for traffic prediction and attempt the use of raw data with the least degree of reduction. In the prediction phase, we provide a broader context for the prediction timestamp by taking into account the information that are around it in the training dataset. Extensive experiments on several well-known datasets have verified the effectiveness of our solution that combines the strength of raw trajectory data and prediction context. In terms of performance, our approach surpasses several state-of-the-art methods for traffic prediction.

Keywords: traffic prediction, raw data utilization, context building, data reduction

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11165 A Triple Win: Linking Students, Academics, and External Organisations to Provide Real-World Learning Experiences with Real-World Benefits

Authors: Anne E. Goodenough

Abstract:

Students often learn best ‘on the job’ through holistic real-world projects. They need real-world experiences to make classroom learning applicable and to increase their employability. Academics typically value working on projects where new knowledge is created and have a genuine desire to help students engage with learning and develop new skills. They might also have institutional pressure to enhance student engagement, retention, and satisfaction. External organizations - especially non-governmental bodies, charities, and small enterprises - often have fundamental and pressing questions, but lack the manpower and academic expertise to answer them effectively. They might also be on the lookout for talented potential employees. This study examines ways in which these diverse requirements can be met simultaneously by creating three-way projects that provide excellent academic and real-world outcomes for all involved. It studied a range of innovative projects across natural sciences (biology, ecology, physical geography and social sciences (human geography, sociology, criminology, and community engagement) to establish how to best harness the potential of this powerful approach. Focal collaborations included: (1) development of practitioner-linked modules; (2) frameworks where students collected/analyzed data for link organizations in research methods modules; (3) placement-based internships and dissertations; and (4) immersive fieldwork projects in novel locations to allow students engage first-hand with contemporary issues as diverse as rhino poaching in South Africa, segregation in Ireland, and gun crime in Florida. Although there was no ‘magic formula’ for success, the approach was found to work best when small projects were developed that were achievable in a short time-frame, both to tie into modular curricula and meet the immediacy expectations of many link organizations. Bigger projects were found to work well in some cases, especially when they were essentially a series of linked smaller projects, either running concurrently or successively with each building on previous work. Opportunities were maximized when there were tangible benefits to the link organization as this generally increased organization investment in the project and motivated students too. The importance of finding the right approach for a given project was found to be key: it was vital to ensure that something that could work effectively as an independent research project for one student, for example, was not shoehorned into being a project for multiple students within a taught module. In general, students were very positive about collaboration projects. They identified benefits to confidence, time-keeping and communication, as well as conveying their enthusiasm when their work was of benefit to the wider community. Several students have gone on to do further work with the link organization in a voluntary capacity or as paid staff, or used the experiences to help them break into the ever-more competitive job market in other ways. Although this approach involves a substantial time investment, especially from academics, the benefits can be profound. The approach has strong potential to engage students, help retention, improve student satisfaction, and teach new skills; keep the knowledge of academics fresh and current; and provide valuable tangible benefits for link organizations: a real triple win.

Keywords: authentic learning, curriculum development, effective education, employability, higher education, innovative pedagogy, link organizations, student experience

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11164 Fabrication and Characterization of Cu50 (Zr50-xNix) 50 Nanocrystalline Coating by Cold Spray Technique for Potential Antibiofilm Application

Authors: Ahmad Alazemi, M. Sherif El-Eskandrany, Mohamad Kishk, Thanyan AlOnaizi, Ahmad Alduweesh, Shorouq Abdullaleel

Abstract:

Arc melting technique followed by top-down approach, using a high-energy ball milling technique were employed to synthesize nanocrystalline of Cu50(Zr50-xNix)50 (x = 0, 10, 20 and 30 at.%) powder particles. The end-products of the alloy powders obtained after 50 h of the ball milling time were uniform in composition and had spherical-like morphology with an average particle size of 0.75 µm in diameter. The powders, which consisted of nanocrystalline grains with an average grain size of 10 nm in diameter, were used as feedstock materials for double face coating of stainless (SUS304) sheets, using cold spraying process. The coating materials enjoyed nanocrystalline structure and uniform composition. Biofilms were grown on 20-mm2 SUS304 sheets coated coupons inoculated with 1.5 × 108 CFU ml−1 E. coli. Significant biofilm inhibition was recorded in the nanoparticles coated coupons in comparison to non-coated SUS304 coupon. In conclusion, this study demonstrates that formation of biofilms can be significantly inhibited by Cu-based alloys especially in case of high (Ni) content. The inhibition of biofilm formation by nanocrystalline powders of Cu-based provides a practical approach to achieve the inhibition of biofilms formed by an emerging pathogen.

Keywords: biofilm, Cu, E.coli, FE-HRTEM/EDS, nanomaterials, nanocrystalline

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11163 Links between Moral Distress of Registered Nurses and Factors Related to Patient Care at the End of Their Life: A Cross Sectional Survey

Authors: L. Laurs, A. Blazeviciene, D. Milonas

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Introduction: Nursing as a profession is grounded in moral obligation. Nursing practice is grounded in ethical standards: to not harm, to promote justice, to be accountable, and to provide safe and competent care. The nature of the nurse-patient therapeutic relationship requires acting on the patient's behalf. Moral distress consists of negative stress symptoms that occur in situations that involve ethical situations that the nurse perceives as discordant with their professional values. Aim of the Study: The purpose of this study was to assess links between moral distress of registered nurses and factors related to patient care at the end of their life. Methods and Sample: A descriptive, cross-sectional, correlational design was applied in this study. Registered nurses were recruited from seven municipal multi-profile hospitals providing both general and specialized healthcare services in Lithuania (N=1055). Research instruments included two questionnaires: Obstacles and Facilitating at the End of Life Care and Moral Distress Scale (revised). Results: Spearman’s correlation analysis was performed to assess the relationship between nurses' attitudes towards patient care at the end of life and the experienced moral distress. A statistically significant correlation between moral distress and the following factors related to patient end-of-life care has been identified: conversations with physicians on patient end-of-life problems have a positive impact on job satisfaction; some patients may be excluded from decisions about their treatment and nursing because they are questioned about their ability to assess the situation. These situations increased moral distress. Patient consciousness should not be permanently suppressed by calming medications, and the patient should be provided with all nursing care services and moral distress. Conclusions: The moral distress of nurses is significantly related to the end-of-life care of patients and their determinants: moral distress increased due to lack of discussion with doctors about problem-solving and exclusion of patients from decision-making. And it diminished by refusing calming medications to permanently suppress a patient's consciousness and providing good care for patients.

Keywords: moral distress, registered nurses, end of life, care

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