Search results for: evidence presentation
Commenced in January 2007
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Edition: International
Paper Count: 4929

Search results for: evidence presentation

1299 Innovative Strategies for Chest Wall Reconstruction Following Resection of Recurrent Breast Carcinoma

Authors: Sean Yao Zu Kong, Khong Yik Chew

Abstract:

Introduction: We described a case report of the successful use of advanced surgical techniques in a patient with recurrent breast cancer who underwent a wide resection including the hemi-sternum, clavicle, multiple ribs, and a lobe of the lung due to tumor involvement. This extensive resection exposed critical structures, requiring a creative approach to reconstruction. To address this complex chest wall reconstruction, a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap were successfully utilized. The use of a free vascularized bone flap allowed for rapid osteointegration and resistance against osteoradionecrosis after adjuvant radiation, while a four-zone tram flap allowed for reconstruction of both the chest wall and breast mound. Although limited recipient vessels made free flaps challenging, the free fibula flap served as both a bony reconstruction and vascular conduit, supercharged with the distal peroneal artery and veins of the peroneal artery from the fibula graft. Our approach highlights the potential of advanced surgical techniques to improve outcomes in complex cases of chest wall reconstruction in patients with recurrent breast cancer, which is becoming increasingly relevant as breast cancer incidence rates increases. Case presentation: This report describes a successful reconstruction of a patient with recurrent breast cancer who required extensive resection, including the anterior chest wall, clavicle, and sternoclavicular joint. Challenges arose due to the loss of accessory muscles and the non-rigid rib cage, which could lead to compromised ventilation and instability. A free fibula osteocutaneous flap and a four-zone TRAM flap with vascular supercharging were utilized to achieve long-term stability and function. The patient has since fully recovered, and during the review, both flaps remained viable, and chest mound reconstruction was satisfactory. A planned nipple/areolar reconstruction was offered pending the patient’s decision after adjuvant radiotherapy. Conclusion: In conclusion, this case report highlights the successful use of innovative surgical techniques in addressing a complex case of recurrent breast cancer requiring extensive resection and radical reconstruction. Our approach, utilized a combination of a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap, demonstrates the potential for advanced techniques in chest wall reconstruction to minimize complications and ensure long-term stability and function. As the incidence of breast cancer continues to rise, it is crucial that healthcare professionals explore and utilize innovative techniques to improve patient outcomes and quality of life.

Keywords: free fibula flap, rectus abdominis musculocutaneous flap, post-adjuvant radiotherapy, reconstructive surgery, malignancy

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1298 The Bioequivalent: A Medical Drug Search Tool Based on a Collaborative Database

Authors: Rosa L. Figueroa, Joselyn A. Hernández

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During the last couple of years, the Ministry of Health have been developing new health policies in order to regulate and improve in benefit of the patient the pharmaceutical system in our country. However, there are still some deficiencies in how medicines have been accessed, distributed, and sold. Therefore, it is necessary to empower the patient by offering new instances to improve access to drug information. This work introduces ‘the bioequivalent’ a medical drug search tool created to increase both diffusion and getting information about the therapeutic equivalence of medicines for the patient. The development of the search tool started with a study on the availability of sources of drug information accessible to the patient where advantages and disadvantages were analyzed. The information obtained was used to feed the functional design of the new tool. The design of the new tool shows an external interface that includes a header, body, sidebar and footer. The header has a menu containing ‘Home,’ ‘Who we are,’ and ‘Mission and vision.’ The Body contains the medical drug search tool, and the Sidebar is for the user logging in. It could be anonym, registered user, as well as, administrator. Anonym user could only use the tool. Registered users could add some information on existing medicines in the database; however, adding information will be restricted and limited to specific items and subject to administrator approval because the information added must be endorsed by the Chilean Public Health Institute. On the other hand, the administrator will have all the privileges, including creating or deleting drugs or information about them. The Bioequivalent was tested on different mobile devices, and no fails have been found. Moreover, a small survey was answered by ten people who tested the tool, and all of them agree that the tool was useful to get information about bioequivalent drugs, and they would recommend the tool to others. Nevertheless, an 80% of people who tested the tool says it was easy to use, and a 70% indicates that additional help is not required. These results are evidence that ‘the Bioequivalent’ may contribute to the knowledge about the therapeutic bioequivalence and bioequivalent drugs existing in Chile. As future work, the tool will be developed to make it available to the public for a first testing stage in a more massive scenario.

Keywords: collaborative database, bioequivalent drugs, search tool, web platform

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1297 Effective Survey Designing for Conducting Opinion Survey to Follow Participatory Approach in a Study of Transport Infrastructure Projects: A Case Study of the City of Kolkata

Authors: Jayanti De

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Users of any urban road infrastructure may be classified into various categories. The current paper intends to see whether the opinions on different environmental and transportation criteria vary significantly among different types of road users or not. The paper addresses this issue by using a unique survey data that has been collected from Kolkata, a highly populated city in India. Multiple criteria should be taken into account while planning on infrastructure development programs. Given limited resources, a welfare maximizing government typically resorts to public opinion by designing surveys for prioritization of one project over another. Designing such surveys can be challenging and costly. Deciding upon whom to include in a survey and how to represent each group of consumers/road-users depend crucially on how opinion for different criteria vary across consumer groups. A unique dataset has been collected from various parts of Kolkata to statistically test (using Kolmogorov-Smirnov test) whether assigning of weights to rank the transportation criteria like congestion, air pollution, noise pollution, and morning/evening delay vary significantly across the various groups of users of such infrastructure. The different consumer/user groups in the dataset include pedestrian, private car owner, para-transit (taxi /auto rickshaw) user, public transport (bus) user and freight transporter among others. Very little evidence has been found that ranking of different criteria among these groups vary significantly. This also supports the hypothesis that road- users/consumers form their opinion by using their long-run rather than immediate experience. As a policy prescription, this implies that under-representation or over-representation of a specific consumer group in a survey may not necessarily distort the overall opinion, since opinions across different consumer groups are highly correlated as evident from this particular case study.

Keywords: multi criteria analysis, project-prioritization, road- users, survey designing

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1296 The TarMed Reform of 2014: A Causal Analysis of the Effects on the Behavior of Swiss Physicians

Authors: Camila Plaza, Stefan Felder

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In October 2014, the TARMED reform was implemented in Switzerland. In an effort to even out the financial standing of general practitioners (including pediatricians) relative to that of specialists in the outpatient sector, the reform tackled two aspects: on the one hand, GPs would be able to bill an additional 9 CHF per patient, once per consult per day. This is referred to as the surcharge position. As a second measure, it reduced the fees for certain technical services targeted to specialists (e.g., imaging, surgical technical procedures, etc.). Given the fee-for-service reimbursement system in Switzerland, we predict that physicians reacted to the economic incentives of the reform by increasing the consults per patient and decreasing the average amount of time per consult. Within this framework, our treatment group is formed by GPs and our control group by those specialists who were not affected by the reform. Using monthly insurance claims panel data aggregated at the physician praxis level (provided by SASIS AG), for the period of January 2013-December 2015, we run difference in difference panel data models with physician and time fixed effects in order to test for the causal effects of the reform. We account for seasonality, and control for physician characteristics such as age, gender, specialty, and physician experience. Furthermore, we run the models on subgroups of physicians within our sample so as to account for heterogeneity and treatment intensities. Preliminary results support our hypothesis. We find evidence of an increase in consults per patients and a decrease in time per consult. Robustness checks do not significantly alter the results for our outcome variable of consults per patient. However, we do find a smaller effect of the reform for time per consult. Thus, the results of this paper could provide policymakers a better understanding of physician behavior and their sensitivity to financial incentives of reforms (both past and future) under the current reimbursement system.

Keywords: difference in differences, financial incentives, health reform, physician behavior

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1295 Systematic Identification and Quantification of Substrate Specificity Determinants in Human Protein Kinases

Authors: Manuel A. Alonso-Tarajano, Roberto Mosca, Patrick Aloy

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Protein kinases participate in a myriad of cellular processes of major biomedical interest. The in vivo substrate specificity of these enzymes is a process determined by several factors, and despite several years of research on the topic, is still far from being totally understood. In the present work, we have quantified the contributions to the kinase substrate specificity of i) the phosphorylation sites and their surrounding residues in the sequence and of ii) the association of kinases to adaptor or scaffold proteins. We have used position-specific scoring matrices (PSSMs), to represent the stretches of sequences phosphorylated by 93 families of kinases. We have found negative correlations between the number of sequences from which a PSSM is generated and the statistical significance and the performance of that PSSM. Using a subset of 22 statistically significant PSSMs, we have identified specificity determinant residues (SDRs) for 86% of the corresponding kinase families. Our results suggest that different SDRs can function as positive or negative elements of substrate recognition by the different families of kinases. Additionally, we have found that human proteins with known function as adaptors or scaffolds (kAS) tend to interact with a significantly large fraction of the substrates of the kinases to which they associate. Based on this characteristic we have identified a set of 279 potential adaptors/scaffolds (pAS) for human kinases, which is enriched in Pfam domains and functional terms tightly related to the proposed function. Moreover, our results show that for 74.6% of the kinase– pAS association found, the pAS colocalize with the substrates of the kinases they are associated to. Finally, we have found evidence suggesting that the association of kinases to adaptors and scaffolds, may contribute significantly to diminish the in vivo substrate crossed- specificity of protein kinases. In general, our results indicate the relevance of several SDRs for both the positive and negative selection of phosphorylation sites by kinase families and also suggest that the association of kinases to pAS proteins may be an important factor for the localization of the enzymes with their set of substrates.

Keywords: kinase, phosphorylation, substrate specificity, adaptors, scaffolds, cellular colocalization

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1294 Entry, Descent and Landing System Design and Analysis of a Small Platform in Mars Environment

Authors: Daniele Calvi, Loris Franchi, Sabrina Corpino

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Thanks to the latest Mars mission, the planetary exploration has made enormous strides over the past ten years increasing the interest of the scientific community and beyond. These missions aim to fulfill many complex operations which are of paramount importance to mission success. Among these, a special mention goes to the Entry, Descent and Landing (EDL) functions which require a dedicated system to overcome all the obstacles of these critical phases. The general objective of the system is to safely bring the spacecraft from orbital conditions to rest on the planet surface, following the designed mission profile. For this reason, this work aims to develop a simulation tool integrating the re-entry trajectory algorithm in order to support the EDL design during the preliminary phase of the mission. This tool was used on a reference unmanned mission, whose objective is finding bio-evidence and bio-hazards on Martian (sub)surface in order to support the future manned mission. Regarding the concept of operations (CONOPS) of the mission, it concerns the use of Space Penetrator Systems (SPS) that will descend on Mars surface following a ballistic fall and will penetrate the ground after the impact with the surface (around 50 and 300 cm of depth). Each SPS shall contain all the instrumentation required to sample and make the required analyses. Respecting the low-cost and low-mass requirements, as result of the tool, an Entry Descent and Impact (EDI) system based on inflatable structure has been designed. Hence, a solution could be the one chosen by Finnish Meteorological Institute in the Mars Met-Net mission, using an inflatable Thermal Protection System (TPS) called Inflatable Braking Unit (IBU) and an additional inflatable decelerator. Consequently, there are three configurations during the EDI: at altitude of 125 km the IBU is inflated at speed 5.5 km/s; at altitude of 16 km the IBU is jettisoned and an Additional Inflatable Braking Unit (AIBU) is inflated; Lastly at about 13 km, the SPS is ejected from AIBU and it impacts on the Martian surface. Since all parameters are evaluated, it is possible to confirm that the chosen EDI system and strategy verify the requirements of the mission.

Keywords: EDL, Mars, mission, SPS, TPS

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1293 Consumer’s Behavioral Responses to Corporate Social Responsibility Marketing: Mediating Impact of Customer Trust, Emotions, Brand Image, and Brand Attitude

Authors: Yasir Ali Soomro

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Companies that demonstrate corporate social responsibilities (CSR) are more likely to withstand any downturn or crises because of the trust built with stakeholders. Many firms are utilizing CSR marketing to improve the interactions with their various stakeholders, mainly the consumers. Most previous research on CSR has focused on the impact of CSR on customer responses and behaviors toward a company. As online food ordering and grocery shopping remains inevitable. This study will investigate structural relationships among consumer positive emotions (CPE) and negative emotions (CNE), Corporate Reputation (CR), Customer Trust (CT), Brand Image (BI), and Brand attitude (BA) on behavioral outcomes such as Online purchase intention (OPI) and Word of mouth (WOM) in retail grocery and food restaurants setting. Hierarchy of Effects Model will be used as theoretical, conceptual framework. The model describes three stages of consumer behavior: (i) cognitive, (ii) affective, and (iii) conative. The study will apply a quantitative method to test the hypotheses; a self-developed questionnaire with non-probability sampling will be utilized to collect data from 500 consumers belonging to generation X, Y, and Z residing in KSA. The study will contribute by providing empirical evidence to support the link between CSR and customer affective and conative experiences in Saudi Arabia. The theoretical contribution of this study will be empirically tested comprehensive model where CPE, CNE, CR, CT, BI, and BA act as mediating variables between the perceived CSR & Online purchase intention (OPI) and Word of mouth (WOM). Further, the study will add more to how the emotional/ psychological process mediates in the CSR literature, especially in the Middle Eastern context. The proposed study will also explain the effect of perceived CSR marketing initiatives directly and indirectly on customer behavioral responses.

Keywords: corporate social responsibility, corporate reputation, consumer emotions, loyalty, online purchase intention, word-of-mouth, structural equation modeling

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1292 Communication Anxiety in Nigerian Students Studying English as a Foreign Language: Evidence from Colleges of Education Sector

Authors: Yasàlu Haruna

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In every transaction, the use of language is central regardless of form or complexity if any meaning is expected to be harvested therefrom. Students constituting a population group in the learning landscape of Nigeria occupy a central position with a propensity to excel or otherwise in the context of communication, especially in the learning process and social interaction. The nature or quantum of anxiety or confidence in speaking a second language is not only peculiar to societies where the second language is not an official language but to a degree, the linguistic gap created by adoption and adaptation syndrome manifests in created anxiety or lack of confidence especially where mastery of a spoken language becomes a major challenge. This paper explores the manner in which linguistic complexity and cultural barriers combine to widen the adaptation and adoption gap. In much the same way, typical issues of pronouncement, intonation and accent difficulties are vital variables that explain the root cause of anxiety. Using a combination of primary and secondary sources of data expressed in questionnaires, key informant interviews and other available data, the paper concludes that the non-integration of anxiety possibility into the education delivery framework has left a lot to be needed in cultivating second language speakers among students of Nigerian Colleges of Education. In addition, cultural barriers and the absence of integration interfaces in the course of learning within and outside the classroom contribute to further widening the gap. Again, colleagues/mates/conversation partners' mastery of a second language remains a contributory factor largely due to the quality of the preparatory school system in many parts of the country. The paper recommends that national policies and frameworks must be reviewed to consider integration windows where culture and conversation partner deficiencies can be remedied through educational events such as debates, quizzes and symposia; improvements can be attained while commercial advertisements are tailored towards seeking for adoption of second language in commerce and major cultural activities.

Keywords: cultural barriers, integration, college of education and adaptation, second language

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1291 Tsunami Wave Height and Flow Velocity Calculations Based on Density Measurements of Boulders: Case Studies from Anegada and Pakarang Cape

Authors: Zakiul Fuady, Michaela Spiske

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Inundation events, such as storms and tsunamis can leave onshore sedimentary evidence like sand deposits or large boulders. These deposits store indirect information on the related inundation parameters (e.g., flow velocity, flow depth, wave height). One tool to reveal these parameters are inverse models that use the physical characteristics of the deposits to refer to the magnitude of inundation. This study used boulders of the 2004 Indian Ocean Tsunami from Thailand (Pakarang Cape) and form a historical tsunami event that inundated the outer British Virgin Islands (Anegada). For the largest boulder found in Pakarang Cape with a volume of 26.48 m³ the required tsunami wave height is 0.44 m and storm wave height are 1.75 m (for a bulk density of 1.74 g/cm³. In Pakarang Cape the highest tsunami wave height is 0.45 m and storm wave height are 1.8 m for transporting a 20.07 m³ boulder. On Anegada, the largest boulder with a diameter of 2.7 m is the asingle coral head (species Diploria sp.) with a bulk density of 1.61 g/cm³, and requires a minimum tsunami wave height of 0.31 m and storm wave height of 1.25 m. The highest required tsunami wave height on Anegada is 2.12 m for a boulder with a bulk density of 2.46 g/cm³ (volume 0.0819 m³) and the highest storm wave height is 5.48 m (volume 0.216 m³) from the same bulk density and the coral type is limestone. Generally, the higher the bulk density, volume, and weight of the boulders, the higher the minimum tsunami and storm wave heights required to initiate transport. It requires 4.05 m/s flow velocity by Nott’s equation (2003) and 3.57 m/s by Nandasena et al. (2011) to transport the largest boulder in Pakarang Cape, whereas on Anegada, it requires 3.41 m/s to transport a boulder with diameter 2.7 m for both equations. Thus, boulder equations need to be handled with caution because they make many assumptions and simplifications. Second, the physical boulder parameters, such as density and volume need to be determined carefully to minimize any errors.

Keywords: tsunami wave height, storm wave height, flow velocity, boulders, Anegada, Pakarang Cape

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1290 Issues and Influences in Academic Choices among Communication Students in Oman

Authors: Bernard Nnamdi Emenyeonu

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The study of communication as a fully-fledged discipline in institutions of higher education in the Sultanate of Oman is relatively young. Its evolution is associated with Oman's Renaissance beginning from 1970, which ushered in an era of modernization in which education, industrialization, expansion, and liberalization of the mass media, provision of infrastructure, and promotion of multilateral commercial ventures were considered among the top priorities of national development plans. Communication studies were pioneered by the sole government university, Sultan Qaboos University, in the 1990s, but so far, the program is taught in Arabic only. In recognition of the need to produce professionals suitably equipped to fit into the expanding media establishments in the Sultanate as well as the widening global market, the government decided to establish programs in which communication would be taught in English language. Under the supervision of the Ministry of Higher Education, six Colleges of Applied Sciences were established in Oman in 2007. These colleges offer a 4-year Bachelor degree program in communication studies that comprises six areas of specialization: Advertising, Digital Media, International Communication, Journalism, Media Management and Public Relations. Over the years, a trend has emerged where students tend to flock to particular specializations such as Public Relations and Digital Media, while others, such as Advertising and Journalism, continue to draw the least number of students. In some instances, some specializations have had to be frozen due to the dire lack of interest among new students. It has also been observed that female students are more likely to be more biased in choice of specializations. It was therefore the task of this paper to establish, through a survey and focus group interviews, the factors that influence choice of communication studies as well as particular specializations, among Omani Communication Studies undergraduates. Results of the study show that prior to entering into the communication studies program, the majority of students had no idea of what the field entailed. Whatever information they had about communication studies was sourced from friends and relatives rather than more reliable sources such as career fairs or guidance counselors. For the most part, the choice of communication studies as a major was also influenced by factors such as family, friends and prospects for jobs. Another significant finding is the strong association between gender and choice of specializations within the program, with females flocking to digital media while males tended to prefer public relations. Reasons for specialization preferences dwelt strongly on expectations of a good GPA and the promise of a good salary after graduation. Regardless of gender, most students identified careers in news reporting, public relations and advertising as unsuitable for females. Teaching and program presentation were identified as the most suitable for females. Based on these and other results, the paper not only examined the social and cultural factors that are likely to have influenced the respondent's attitude to communication studies, but also discussed the implication for curriculum development and career development in a developing society such as Oman.

Keywords: career choice, communication specialization, media education, Oman

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1289 Studying Language of Immediacy and Language of Distance from a Corpus Linguistic Perspective: A Pilot Study of Evaluation Markers in French Television Weather Reports

Authors: Vince Liégeois

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Language of immediacy and distance: Within their discourse theory, Koch & Oesterreicher establish a distinction between a language of immediacy and a language of distance. The former refers to those discourses which are oriented more towards a spoken norm, whereas the latter entails discourses oriented towards a written norm, regardless of whether they are realised phonically or graphically. This means that an utterance can be realised phonically but oriented more towards the written language norm (e.g., a scientific presentation or eulogy) or realised graphically but oriented towards a spoken norm (e.g., a scribble or chat messages). Research desiderata: The methodological approach from Koch & Oesterreicher has often been criticised for not providing a corpus-linguistic methodology, which makes it difficult to work with quantitative data or address large text collections within this research paradigm. Consequently, the Koch & Oesterreicher approach has difficulties gaining ground in those research areas which rely more on corpus linguistic research models, like text linguistics and LSP-research. A combinatory approach: Accordingly, we want to establish a combinatory approach with corpus-based linguistic methodology. To this end, we propose to (i) include data about the context of an utterance (e.g., monologicity/dialogicity, familiarity with the speaker) – which were called “conditions of communication” in the original work of Koch & Oesterreicher – and (ii) correlate the linguistic phenomenon at the centre of the inquiry (e.g., evaluation markers) to a group of linguistic phenomena deemed typical for either distance- or immediacy-language. Based on these two parameters, linguistic phenomena and texts could then be mapped on an immediacy-distance continuum. Pilot study: To illustrate the benefits of this approach, we will conduct a pilot study on evaluation phenomena in French television weather reports, a form of domain-sensitive discourse which has often been cited as an example of a “text genre”. Within this text genre, we will look at so-called “evaluation markers,” e.g., fixed strings like bad weather, stifling hot, and “no luck today!”. These evaluation markers help to communicate the coming weather situation towards the lay audience but have not yet been studied within the Koch & Oesterreicher research paradigm. Accordingly, we want to figure out whether said evaluation markers are more typical for those weather reports which tend more towards immediacy or those which tend more towards distance. To this aim, we collected a corpus with different kinds of television weather reports,e.g., as part of the news broadcast, including dialogue. The evaluation markers themselves will be studied according to the explained methodology, by correlating them to (i) metadata about the context and (ii) linguistic phenomena characterising immediacy-language: repetition, deixis (personal, spatial, and temporal), a freer choice of tense and right- /left-dislocation. Results: Our results indicate that evaluation markers are more dominantly present in those weather reports inclining towards immediacy-language. Based on the methodology established above, we have gained more insight into the working of evaluation markers in the domain-sensitive text genre of (television) weather reports. For future research, it will be interesting to determine whether said evaluation markers are also typical for immediacy-language-oriented in other domain-sensitive discourses.

Keywords: corpus-based linguistics, evaluation markers, language of immediacy and distance, weather reports

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1288 Smallholder Participation in Organized Retail Markets: Evidence from India

Authors: Kedar Vishnu, Parmod Kumar

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India is becoming most favored retail destination in the world. The organized retail has presented many opportunities to farmers to increase income by shifting cropping pattern from food grains to commercial crops. Previous research revealed potential benefits for farmers by supplying fruits and vegetables to organized retail channels. However the supply of fruits and vegetables from small and marginal farmers remain low than expected. The main objective of this paper is to identify the factors determining market participation of smallholder farmers in modern organized retail chains. Attempt is also made to find out factors influencing the choice of participation in particular organized retail collection centers as compared to other organized retail. The paper was based on primary survey of 40 Beans and Tomato farmers who supply to organized retail collection centers from Karnataka, India. Multiple regression technique is used to identify the factors determining quantity sold at collection centers. The regression result, show that area under vegetables, yield, and price from modern collection center and having access to technical help were found significantly affecting quantity sold into modern organized retail channels. On the opposite, increased rejection rates and vegetable prices at APMC were found influencing farmers decision into the reverse side. Empirical result of the multinomial logit model show that Reliance fresh has tendency to prefer large farmers who can supply more quality and better quantity compared with TESCO and More collection centers. The negative sign of area, having access to technical help, transportation cost, and number of bore wells led to higher probability of farmers to participate in Reliance Fresh collection centers as compared with More and TESCO.

Keywords: fruits, vegetables, organized retail markets, multinomial logit model

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1287 A Comparative, Epidemiological Study of Acute Renal Colic Presentations to Major Academic Emergency Departments in Doha, Qatar and Melbourne, Australia

Authors: Sameer A. Pathan, Biswadev Mitra, Zain A. Bhutta, Isma Qureshi, Elle Spencer, Asmaa A. Hameed, Sana Nadeem, Ramsha Tahir, Shahzad Anjum, Peter A. Cameron

Abstract:

Background: This study aimed to compare epidemiology, clinical presentations, management and outcomes of renal colic presentations in two major academic centers and discuss potential implications of these results for the applicability of current evidence in the management of renal colic. Methods: We undertook a retrospective cohort study of patients with renal colic who presented to the Hamad General Hospital Emergency Department (HGH-ED), Qatar, and The Alfred ED, Melbourne, Australia, during a period of one year from August 1, 2012, to July 3, 2013. Cases were identified using ICD-9-CM codes, and an electronic template was used to record the data on predefined clinical variables. Results: A total of 12,223 from the HGH-ED and 384 from The Alfred ED were identified as renal colic presentations during the study period. The rate of renal colic presentations at the HGH-ED was 27.9 per 1000 ED visits compared to 6.7 per 1000 ED visits at The Alfred ED. Patients presenting to the HGH-ED were significantly younger [34.9 years (29.0- 43.4) than The Alfred ED [48 years (37-60); P < 0.001]. The median stone size was larger in the HGH-ED group [6 (4-8) mm] versus The Alfred ED group [4 (3-6) mm, P < 0.001]. The intervention rate in the stone-positive population was significantly higher in the HGH-ED group as opposed to The Alfred ED group (38.7% versus 11.9%, p<0.001). At the time of discharge, The Alfred ED group received less analgesic prescriptions (55.8% versus 83.5%, P < 0.001) and more tamsulosin prescriptions (25.3% versus 11.7%, P < 0.001). Conclusions: Renal colic presentations to the HGH-ED, Qatar, were younger, with larger stone size, compared to The Alfred ED, whereas, medical expulsion therapy use was higher at the Alfred ED. Differences in epidemiology should be considered while tailoring strategies for effective management of patients with renal colic in the given setting.

Keywords: kidney stones, urolithiasis, nephrolithiasis, renal colic, epidemiology

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1286 Subdued Electrodermal Response to Empathic Induction Task in Intimate Partner Violence (IPV) Perpetrators

Authors: Javier Comes Fayos, Isabel Rodríguez Moreno, Sara Bressanutti, Marisol Lila, Angel Romero Martínez, Luis Moya Albiol

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Empathy is a cognitive-affective capacity whose deterioration is associated with aggressive behaviour. Deficient affective processing is one of the predominant risk factors in men convicted of intimate partner violence (IPV perpetrators), since it makes their capacity to empathize very difficult. The objective of this study is to compare the response of electrodermal activity (EDA), as an indicator of emotionality, to an empathic induction task, between IPV perpetrators and men without a history of violence. The sample was composed of 51 men who attended the CONTEXTO program, with penalties for gender violence under two years, and 47 men with no history of violence. Empathic induction was achieved through the visualization of 4 negative emotional-eliciting videos taken from an emotional induction battery of videos validated for the Spanish population. The participants were asked to actively empathize with the video characters (previously pointed out). The psychophysiological recording of the EDA was accomplished by the "Vrije Universiteit Ambulatory Monitoring System (VU-AMS)." An analysis of repeated measurements was carried out with 10 intra-subject measurements (time) and "group" (IPV perpetrators and non-violent perpetrators) as the inter-subject factor. First, there were no significant differences between groups in the baseline AED levels. Yet, a significant interaction between the “time” and “group” was found with IPV perpetrators exhibiting lower EDA response than controls after the empathic induction task. These findings provide evidence of a subdued EDA response after an empathic induction task in IPV perpetrators with respect to men without a history of violence. Therefore, the lower psychophysiological activation would be indicative of difficulties in the emotional processing and response, functions that are necessary for the empathic function. Consequently, the importance of addressing possible empathic difficulties in IPV perpetrator psycho-educational programs is reinforced, putting special emphasis on the affective dimension that could hinder the empathic function.

Keywords: electrodermal activity, emotional induction, empathy, intimate partner violence

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1285 Women and Food Security: Evidence from Bangladesh Demographic Health Survey 2011

Authors: Abdullah Al. Morshed, Mohammad Nahid Mia

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Introduction: Food security refers to the availability of food and a person’s access to it. It is a complex sustainable development issue, which is closely related to under-nutrition. Food security, in turn, can widely affect the living standard, and is rooted in poverty and leads to poor health, low productivity, low income, food shortage, and hunger. The study's aim was to identify the most vulnerable women who are in insecure positions. Method: 17,842 married women were selected for analysis from the Bangladesh Demographic and Health Survey 2011. Food security defined as dichotomous variables of skipped meals and eaten less food at least once in the last year. The outcome variables were cross-tabulated with women's socio-demographic characteristics and chi2 test was applied to see the significance. Logistic regression models were applied to identify the most vulnerable groups in terms of food security. Result: Only 18.5% of women said that they ever had to skip meals in the last year. 45.7% women from low socioeconomic status had skip meal for at least once whereas only 3.6% were from women with highest socioeconomic status. Women meal skipping was ranged from 1.4% to 34.2% by their educational status. 22% of women were eaten less food during the last year. The rate was higher among the poorest (51.6%), illiterate (39.9%) and household have no electricity connection (38.1) in compared with richest (4.4%), higher educated (2.0%), and household has electricity connection (14.0%). The logistic regression analysis indicated that household socioeconomic status, and women education show strong gradients to skip meals. Poorest have had higher odds (20.9) than richest and illiterate women had 7.7 higher odds than higher educated. In terms of religion, Christianity was 2.3 times more likely to skip their meals than Islam. On the other hand, a similar trend was observed in our other outcome variable eat less food. Conclusion: In this study we able to identify women with lower economics status and women with no education were mostly suffered group from starvation.

Keywords: food security, hunger, under-nutrition, women

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1284 Forced Migrants in Israel and Their Impact on the Urban Structure of Southern Neighborhoods of Tel Aviv

Authors: Arnon Medzini, Lilach Lev Ari

Abstract:

Migration, the driving force behind increased urbanization, has made cities much more diverse places to live in. Nearly one-fifth of all migrants live in the world’s 20 largest cities. In many of these global cities, migrants constitute over a third of the population. Many of contemporary migrants are in fact ‘forced migrants,’ pushed from their countries of origin due to political or ethnic violence and persecution or natural disasters. During the past decade, massive numbers of labor migrants and asylum seekers have migrated from African countries to Israel via Egypt. Their motives for leaving their countries of origin include ongoing and bloody wars in the African continent as well as corruption, severe conditions of poverty and hunger, and economic and political disintegration. Most of the African migrants came to Israel from Eritrea and Sudan as they saw Israel the closest natural geographic asylum to Africa; soon they found their way to the metropolitan Tel-Aviv area. There they concentrated in poor neighborhoods located in the southern part of the city, where they live under conditions of crowding, poverty, and poor sanitation. Today around 45,000 African migrants reside in these neighborhoods, and yet there is no legal option for expelling them due to dangers they might face upon returning to their native lands. Migration of such magnitude to the weakened neighborhoods of south Tel-Aviv can lead to the destruction of physical, social and human infrastructures. The character of the neighborhoods is changing, and the local population is the main victim. These local residents must bear the brunt of the failure of both authorities and the government to handle the illegal inhabitants. The extremely crowded living conditions place a heavy burden on the dilapidated infrastructures in the weakened areas where the refugees live and increase the distress of the veteran residents of the neighborhoods. Some problems are economic and some stem from damage to the services the residents are entitled to, others from a drastic decline in their standard of living. Even the public parks no longer serve the purpose for which they were originally established—the well-being of the public and the neighborhood residents; they have become the main gathering place for the infiltrators and a center of crime and violence. Based on secondary data analysis (for example: The Israel’s Population, Immigration and Border Authority, the hotline for refugees and migrants), the objective of this presentation is to discuss the effects of forced migration to Tel Aviv on the following tensions: between the local population and the immigrants; between the local population and the state authorities, and between human rights groups vis-a-vis nationalist local organizations. We will also describe the changes which have taken place in the urban infrastructure of the city of Tel Aviv, and discuss the efficacy of various Israeli strategic trajectories when handling human problems arising in the marginal urban regions where the forced migrant population is concentrated.

Keywords: African asylum seekers, forced migrants, marginal urban regions, urban infrastructure

Procedia PDF Downloads 238
1283 Resting-State Functional Connectivity Analysis Using an Independent Component Approach

Authors: Eric Jacob Bacon, Chaoyang Jin, Dianning He, Shuaishuai Hu, Lanbo Wang, Han Li, Shouliang Qi

Abstract:

Objective: Refractory epilepsy is a complicated type of epilepsy that can be difficult to diagnose. Recent technological advancements have made resting-state functional magnetic resonance (rsfMRI) a vital technique for studying brain activity. However, there is still much to learn about rsfMRI. Investigating rsfMRI connectivity may aid in the detection of abnormal activities. In this paper, we propose studying the functional connectivity of rsfMRI candidates to diagnose epilepsy. Methods: 45 rsfMRI candidates, comprising 26 with refractory epilepsy and 19 healthy controls, were enrolled in this study. A data-driven approach known as independent component analysis (ICA) was used to achieve our goal. First, rsfMRI data from both patients and healthy controls were analyzed using group ICA. The components that were obtained were then spatially sorted to find and select meaningful ones. A two-sample t-test was also used to identify abnormal networks in patients and healthy controls. Finally, based on the fractional amplitude of low-frequency fluctuations (fALFF), a chi-square statistic test was used to distinguish the network properties of the patient and healthy control groups. Results: The two-sample t-test analysis yielded abnormal in the default mode network, including the left superior temporal lobe and the left supramarginal. The right precuneus was found to be abnormal in the dorsal attention network. In addition, the frontal cortex showed an abnormal cluster in the medial temporal gyrus. In contrast, the temporal cortex showed an abnormal cluster in the right middle temporal gyrus and the right fronto-operculum gyrus. Finally, the chi-square statistic test was significant, producing a p-value of 0.001 for the analysis. Conclusion: This study offers evidence that investigating rsfMRI connectivity provides an excellent diagnosis option for refractory epilepsy.

Keywords: ICA, RSN, refractory epilepsy, rsfMRI

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1282 Operating Characteristics of Point-of-Care Ultrasound in Identifying Skin and Soft Tissue Abscesses in the Emergency Department

Authors: Sathyaseelan Subramaniam, Jacqueline Bober, Jennifer Chao, Shahriar Zehtabchi

Abstract:

Background: Emergency physicians frequently evaluate skin and soft tissue infections in order to differentiate abscess from cellulitis. This helps determine which patients will benefit from incision and drainage. Our objective was to determine the operating characteristics of point-of-care ultrasound (POCUS) compared to clinical examination in identifying abscesses in emergency department (ED) patients with features of skin and soft tissue infections. Methods: We performed a comprehensive search in the following databases: Medline, Web of Science, EMBASE, CINAHL and Cochrane Library. Trials were included if they compared the operating characteristics of POCUS with clinical examination in identifying skin and soft tissue abscesses. Trials that included patients with oropharyngeal abscesses or that requiring abscess drainage in the operating room were excluded. The presence of an abscess was determined by pus drainage. No pus seen on incision or resolution of symptoms without pus drainage at follow up, determined the absence of an abscess. Quality of included trials was assessed using GRADE criteria. Operating characteristics of POCUS are reported as sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios and the respective 95% confidence intervals (CI). Summary measures were calculated by generating a hierarchical summary receiver operating characteristic model (HSROC). Results: Out of 3203 references identified, 5 observational studies with 615 patients in aggregate were included (2 adults and 3 pediatrics). We rated the quality of 3 trials as low and 2 as very low. The operating characteristics of POCUS and clinical examination in identifying soft tissue abscesses are presented in the table. The HSROC for POCUS revealed a sensitivity of 96% (95% CI = 89-98%), specificity of 79% (95% CI = 71-86), LR+ of 4.6 (95% CI = 3.2-6.8), and LR- of 0.06 (95% CI = 0.02-0.2). Conclusion: Existing evidence indicates that POCUS is useful in identifying abscesses in ED patients with skin or soft tissue infections.

Keywords: abscess, point-of-care ultrasound, pocus, skin and soft tissue infection

Procedia PDF Downloads 357
1281 Development of a Social Assistive Robot for Elderly Care

Authors: Edwin Foo, Woei Wen, Lui, Meijun Zhao, Shigeru Kuchii, Chin Sai Wong, Chung Sern Goh, Yi Hao He

Abstract:

This presentation presents an elderly care and assistive social robot development work. We named this robot JOS and he is restricted to table top operation. JOS is designed to have a maximum volume of 3600 cm3 with its base restricted to 250 mm and his mission is to provide companion, assist and help the elderly. In order for JOS to accomplish his mission, he will be equipped with perception, reaction and cognition capability. His appearance will be not human like but more towards cute and approachable type. JOS will also be designed to be neutral gender. However, the robot will still have eyes, eyelid and a mouth. For his eyes and eyelids, they will be built entirely with Robotis Dynamixel AX18 motor. To realize this complex task, JOS will be also be equipped with micro-phone array, vision camera and Intel i5 NUC computer and a powered by a 12 V lithium battery that will be self-charging. His face is constructed using 1 motor each for the eyelid, 2 motors for the eyeballs, 3 motors for the neck mechanism and 1 motor for the lips movement. The vision senor will be house on JOS forehead and the microphone array will be somewhere below the mouth. For the vision system, Omron latest OKAO vision sensor is used. It is a compact and versatile sensor that is only 60mm by 40mm in size and operates with only 5V supply. In addition, OKAO vision sensor is capable of identifying the user and recognizing the expression of the user. With these functions, JOS is able to track and identify the user. If he cannot recognize the user, JOS will ask the user if he would want him to remember the user. If yes, JOS will store the user information together with the capture face image into a database. This will allow JOS to recognize the user the next time the user is with JOS. In addition, JOS is also able to interpret the mood of the user through the facial expression of the user. This will allow the robot to understand the user mood and behavior and react according. Machine learning will be later incorporated to learn the behavior of the user so as to understand the mood of the user and requirement better. For the speech system, Microsoft speech and grammar engine is used for the speech recognition. In order to use the speech engine, we need to build up a speech grammar database that captures the commonly used words by the elderly. This database is built from research journals and literature on elderly speech and also interviewing elderly what do they want to robot to assist them with. Using the result from the interview and research from journal, we are able to derive a set of common words the elderly frequently used to request for the help. It is from this set that we build up our grammar database. In situation where there is more than one person near JOS, he is able to identify the person who is talking to him through an in-house developed microphone array structure. In order to make the robot more interacting, we have also included the capability for the robot to express his emotion to the user through the facial expressions by changing the position and movement of the eyelids and mouth. All robot emotions will be in response to the user mood and request. Lastly, we are expecting to complete this phase of project and test it with elderly and also delirium patient by Feb 2015.

Keywords: social robot, vision, elderly care, machine learning

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1280 The Impact of Corporate Governance Mechanisms on Earnings Management Practices: Evidence from Jordan

Authors: Lara Al-Haddad, Mark Whittington

Abstract:

This paper aims to examine the impact of two influential internal corporate governance mechanisms, namely board characteristics and ownership structure on the use of real activities-based and accrual-based earnings management by Jordanian public firms. Using panel data from Jordanian public firms after the introduction of the Jordanian Corporate Governance Code (JCGC) in 2009, the study finds both institutional ownership and managerial ownership constrain the use of real and accrual earnings manipulations. On the other side, both independent directors and largest shareholders are found to exaggerate the incidence of using real and accrual earnings management. The study also examines the trade-off between real and accrual earnings management and found that Jordanian firms use a combination of real and accrual-based earnings management to obtain the greatest effect on earnings reporting strategies. For the purpose of this study, three types of real earnings management are considered: sales manipulation, overproduction, and the abnormal reduction of discretionary expenditures. The abnormal discretionary accrual is considered for accruals management. While for the internal corporate governance mechanisms; board characteristics are examined by using board independence, board size, and CEO-duality; and ownership structure is examined by using managerial ownership, institutional ownership, foreign ownership and largest shareholder ownership. To the best knowledge of the researchers, this study is the first to examine the relationship between board characteristics and real earnings management in Jordan. Further, it is the first to examine the relationship between corporate governance mechanisms and discretionary accruals after the introduction of the Jordanian Corporate Governance Code in 2009. Thus, the findings of this study have important policy implications for policymakers, regulators, standard setters, audit professional, and investors in their attempts to constrain the practice of earnings management, whether real or accrual, and to improve the financial reporting quality in Jordan.

Keywords: board characteristics, Jordan, ownership structure, real earnings management

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1279 A Review: Role of Chromium in Broiler

Authors: Naveed Zahra, Zahid Kamran, Shakeel Ahmad

Abstract:

Heat stress is one of the most important environmental stressors challenging poultry production worldwide. The detrimental effect of heat stress results in reduction in the productive performance of poultry with high incidences of mortality. Researchers have made efforts to prevent such damage to poultry production through dietary manipulation. Supplementation with Chromium (Cr) might have some positive effects on some aspect of blood parameters and broilers performance. Chromium (Cr) the element whose trivalent Cr (III) organic state is present in trace amounts in animal feed and water is found to be a key element in evading heat stress and thus cutting down the heavy expenditure on air conditioning in broiler sheds. Chromium, along with other essential minerals is lost due to increased excretion during heat stress and thus its inclusion in broiler diet is kind of mandatory in areas of hot climate. Chromium picolinate in broiler diet has shown a hike in growth rate including muscle gain with body fat reduction under environmental stress. Fat reduction is probably linked to the ability of chromium to increase the sensitivity of the insulin receptors on tissues and thus the uptake of sugar from blood increases which decreases the amount of glucose to be converted to amino acids and stored in adipose tissue as triglycerides. Organic chromium has also shown to increase lymphocyte proliferation rate and antioxidant levels. So, the immune competency, muscle gain and fat reduction along with evasion of heat stress are good enough signs that indicate the fruitful inclusion of dietary chromium for broiler. This promising element may bring the much needed break in the local poultry industry. The task is now to set the exact dose of the element in the diet that would be useful enough and still not toxic to broiler. In conclusion there is a growing body of evidence which suggest that chromium may be an essential trace element for livestock and poultry. The nutritional requirement for chromium may vary with different species and physiological state within a species.

Keywords: broiler, chromium, heat stress, performance

Procedia PDF Downloads 259
1278 Analysis of Cell Cycle Status in Radiation Non-Targeted Hepatoma Cells Using Flow Cytometry: Evidence of Dose Dependent Response

Authors: Sharmi Mukherjee, Anindita Chakraborty

Abstract:

Cellular irradiation incites complex responses including arrest of cell cycle progression. This article accentuates the effects of radiation on cell cycle status of radiation non-targeted cells. Human Hepatoma HepG2 cells were exposed to increasing doses of γ radiations (1, 2, 4, 6 Gy) and their cell culture media was transferred to non-targeted HepG2 cells cultured in other Petri plates. These radiation non-targeted cells cultured in the ICCM (Irradiated cell conditioned media) were the bystander cells on which cell cycle analysis was performed using flow cytometry. An apparent decrease in the distribution of bystander cells at G0/G1 phase was observed with increased radiation doses upto 4 Gy representing a linear relationship. This was accompanied by a gradual increase in cellular distribution at G2/M phase. Interestingly the number of cells in G2/M phase at 1 and 2 Gy irradiation was not significantly different from each other. However, the percentage of G2 phase cells at 4 and 6 Gy doses were significantly higher than 2 Gy dose indicating the IC50 dose to be between 2 and 4 Gy. Cell cycle arrest is an indirect indicator of genotoxic damage in cells. In this study, bystander stress signals through the cell culture media of irradiated cells disseminated the radiation induced DNA damages in the non-targeted cells which resulted in arrest of the cell cycle progression at G2/M phase checkpoint. This implies that actual radiation biological effects represent a penumbra with effects encompassing a larger area than the actual beam. This article highlights the existence of genotoxic damages as bystander effects of γ rays in human Hepatoma cells by cell cycle analysis and opens up avenues for appraisal of bystander stress communications between tumor cells. Contemplation of underlying signaling mechanisms can be manipulated to maximize damaging effects of radiation with minimum dose and thus has therapeutic applications.

Keywords: bystander effect, cell cycle, genotoxic damage, hepatoma

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1277 Reduplication In Urdu-Hindi Nonsensical Words: An OT Analysis

Authors: Riaz Ahmed Mangrio

Abstract:

Reduplication in Urdu-Hindi affects all major word categories, particles, and even nonsensical words. It conveys a variety of meanings, including distribution, emphasis, iteration, adjectival and adverbial. This study will primarily discuss reduplicative structures of nonsensical words in Urdu-Hindi and then briefly look at some examples from other Indo-Aryan languages to introduce the debate regarding the same structures in them. The goal of this study is to present counter-evidence against Keane (2005: 241), who claims “the base in the cases of lexical and phrasal echo reduplication is always independently meaningful”. However, Urdu-Hindi reduplication derives meaningful compounds from nonsensical words e.g. gũ mgũ (A) ‘silent and confused’ and d̪əb d̪əb-a (N) ‘one’s fear over others’. This needs a comprehensive examination to see whether and how the various structures form patterns of a base-reduplicant relationship or, rather, they are merely sub lexical items joining together to form a word pattern of any grammatical category in content words. Another interesting theoretical question arises within the Optimality framework: in an OT analysis, is it necessary to identify one of the two constituents as the base and the other as reduplicant? Or is it best to consider this a pattern, but then how does this fit in with an OT analysis? This may be an even more interesting theoretical question. Looking for the solution to such questions can serve to make an important contribution. In the case at hand, each of the two constituents is an independent nonsensical word, but their echo reduplication is nonetheless meaningful. This casts significant doubt upon Keane’s (2005: 241) observation of some examples from Hindi and Tamil reduplication that “the base in cases of lexical and phrasal echo reduplication is always independently meaningful”. The debate on the point becomes further interesting when the triplication of nonsensical words in Urdu-Hindi e.g. aẽ baẽ ʃaẽ (N) ‘useless talk’ is also seen, which is equally important to discuss. The example is challenging to Harrison’s (1973) claim that only the monosyllabic verbs in their progressive forms reduplicate twice to result in triplication, which is not the case with the example presented. The study will consist of a thorough descriptive analysis of the data for the purpose of documentation, and then there will be OT analysis.

Keywords: reduplication, urdu-hindi, nonsensical, optimality theory

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1276 Phylogenetic Analysis Based On the Internal Transcribed Spacer-2 (ITS2) Sequences of Diadegma semiclausum (Hymenoptera: Ichneumonidae) Populations Reveals Significant Adaptive Evolution

Authors: Ebraheem Al-Jouri, Youssef Abu-Ahmad, Ramasamy Srinivasan

Abstract:

The parasitoid, Diadegma semiclausum (Hymenoptera: Ichneumonidae) is one of the most effective exotic parasitoids of diamondback moth (DBM), Plutella xylostella in the lowland areas of Homs, Syria. Molecular evolution studies are useful tools to shed light on the molecular bases of insect geographical spread and adaptation to new hosts and environment and for designing better control strategies. In this study, molecular evolution analysis was performed based on the 42 nuclear internal transcribed spacer-2 (ITS2) sequences representing the D. semiclausum and eight other Diadegma spp. from Syria and worldwide. Possible recombination events were identified by RDP4 program. Four potential recombinants of the American D. insulare and D. fenestrale (Jeju) were detected. After detecting and removing recombinant sequences, the ratio of non-synonymous (dN) to synonymous (dS) substitutions per site (dN/dS=ɷ) has been used to identify codon positions involved in adaptive processes. Bayesian techniques were applied to detect selective pressures at a codon level by using five different approaches including: fixed effects likelihood (FEL), internal fixed effects likelihood (IFEL), random effects method (REL), mixed effects model of evolution (MEME) and Program analysis of maximum liklehood (PAML). Among the 40 positively selected amino acids (aa) that differed significantly between clades of Diadegma species, three aa under positive selection were only identified in D. semiclausum. Additionally, all D. semiclausum branches tree were highly found under episodic diversifying selection (EDS) at p≤0.05. Our study provide evidence that both recombination and positive selection have contributed to the molecular diversity of Diadegma spp. and highlights the significant contribution of D. semiclausum in adaptive evolution and influence the fitness in the DBM parasitoid.

Keywords: diadegma sp, DBM, ITS2, phylogeny, recombination, dN/dS, evolution, positive selection

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1275 Effectiveness of Exercise and TENS in the Treatment of Temporomandibular Joint Disorders

Authors: Arben Murtezani, Shefqet Mrasori, Vančo Spirov, Bukurije Rama, Oliver Dimitrovski, Visar Bunjaku

Abstract:

Overview: Temporomandibular disorders (TMDs) are chronic musculoskeletal pain conditions. Clinical indicators of discomfort are related to the use of the joint stiffness during first motions after extended rest and restricted joint range of motion can cause substantial pain and disability. There is little evidence that physical therapy methods of management cause long-lasting reduction in signs and symptoms. Exercise programs premeditated to improve physical fitness have beneficial effects on chronic pain and disability of the musculoskeletal system. Objective: The aim of this study was to assess the effectiveness of physical therapy interventions in the management of temporomandibular disorders. Materials and Methods: A prospective comparative study with a 2-month follow-up period was conducted between April 2016 and June 2016 at the Physical Medicine and Rehabilitation Clinic in Prishtina. Forty six patients with TMDs, (more than three months duration of symptoms) were randomized into two groups: the TENS therapy group (n=24) and combination of active exercise and manual therapy group (n=22). The TENS therapy group patients were treated with twelve sessions of TENS. The treatment period of both groups was 3 weeks at an outpatient clinic. Following main outcome measures were evaluated: (1) pain at rest (2) pain at stress (3) impairment (4) mouth opening at base-line, before and after treatment and at 3 month follow-up. Results: Significant reduction in pain was observed in both treatment groups. In the TENS group 73% (16/22) achieved at least 80% improvement from baseline in TMJ pain at 2 months compared with 54% (13/24) in the exercise group (difference of 19%; 95% confidence interval 220 to 30%). Active and passive maximum mouth opening has been greater in the TENS group (p < 0.05). Conclusion: Exercise therapy in combination with TENS seems to be useful in the treatment of temporomandibular disorders.

Keywords: temporomandibular joint disorders, TENS, manual therapy, exercise

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1274 Effects of Self-Management Programs on Blood Pressure Control, Self-Efficacy, Medication Adherence, and Body Mass Index among Older Adult Patients with Hypertension: Meta-Analysis of Randomized Controlled Trials

Authors: Van Truong Pham

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Background: Self-management was described as a potential strategy for blood pressure control in patients with hypertension. However, the effects of self-management interventions on blood pressure, self-efficacy, medication adherence, and body mass index (BMI) in older adults with hypertension have not been systematically evaluated. We evaluated the effects of self-management interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP), self-efficacy, medication adherence, and BMI in hypertensive older adults. Methods: We followed the recommended guidelines of preferred reporting items for systematic reviews and meta-analyses. Searches in electronic databases including CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science, and other sources were performed to include all relevant studies up to April 2019. Studies selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized intervention effects as Hedges' g values and 95% confidence intervals (CI) using a random-effects model. Data were analyzed using Comprehensive Meta-Analysis software 2.0. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly improved blood pressure control, self-efficacy, medication adherence, whereas the effect of self-management on BMI was not significant in older adult patients with hypertension. The following Hedges' g (effect size) values were obtained: SBP, -0.34 (95% CI, -0.51 to -0.17, p < 0.001); DBP, -0.18 (95% CI, -0.30 to -0.05, p < 0.001); self-efficacy, 0.93 (95%CI, 0.50 to 1.36, p < 0.001); medication adherence, 1.72 (95%CI, 0.44 to 3.00, p=0.008); and BMI, -0.57 (95%CI, -1.62 to 0.48, p = 0.286). Conclusions: Self-management interventions significantly improved blood pressure control, self-efficacy, and medication adherence. However, the effects of self-management on obesity control were not supported by the evidence. Healthcare providers should implement self-management interventions to strengthen patients' role in managing their health care.

Keywords: self-management, meta-analysis, blood pressure control, self-efficacy, medication adherence, body mass index

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1273 Thermal Energy Storage Based on Molten Salts Containing Nano-Particles: Dispersion Stability and Thermal Conductivity Using Multi-Scale Computational Modelling

Authors: Bashar Mahmoud, Lee Mortimer, Michael Fairweather

Abstract:

New methods have recently been introduced to improve the thermal property values of molten nitrate salts (a binary mixture of NaNO3:KNO3in 60:40 wt. %), by doping them with minute concentration of nanoparticles in the range of 0.5 to 1.5 wt. % to form the so-called: Nano-heat-transfer-fluid, apt for thermal energy transfer and storage applications. The present study aims to assess the stability of these nanofluids using the advanced computational modelling technique, Lagrangian particle tracking. A multi-phase solid-liquid model is used, where the motion of embedded nanoparticles in the suspended fluid is treated by an Euler-Lagrange hybrid scheme with fixed time stepping. This technique enables measurements of various multi-scale forces whose characteristic (length and timescales) are quite different. Two systems are considered, both consisting of 50 nm Al2O3 ceramic nanoparticles suspended in fluids of different density ratios. This includes both water (5 to 95 °C) and molten nitrate salt (220 to 500 °C) at various volume fractions ranging between 1% to 5%. Dynamic properties of both phases are coupled to the ambient temperature of the fluid suspension. The three-dimensional computational region consists of a 1μm cube and particles are homogeneously distributed across the domain. Periodic boundary conditions are enforced. The particle equations of motion are integrated using the fourth order Runge-Kutta algorithm with a very small time-step, Δts, set at 10-11 s. The implemented technique demonstrates the key dynamics of aggregated nanoparticles and this involves: Brownian motion, soft-sphere particle-particle collisions, and Derjaguin, Landau, Vervey, and Overbeek (DLVO) forces. These mechanisms are responsible for the predictive model of aggregation of nano-suspensions. An energy transport-based method of predicting the thermal conductivity of the nanofluids is also used to determine thermal properties of the suspension. The simulation results confirms the effectiveness of the technique. The values are in excellent agreement with the theoretical and experimental data obtained from similar studies. The predictions indicates the role of Brownian motion and DLVO force (represented by both the repulsive electric double layer and an attractive Van der Waals) and its influence in the level of nanoparticles agglomeration. As to the nano-aggregates formed that was found to play a key role in governing the thermal behavior of nanofluids at various particle concentration. The presentation will include a quantitative assessment of these forces and mechanisms, which would lead to conclusions about nanofluids, heat transfer performance and thermal characteristics and its potential application in solar thermal energy plants.

Keywords: thermal energy storage, molten salt, nano-fluids, multi-scale computational modelling

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1272 The Impact of Nutrition Education Intervention in Improving the Nutritional Status of Sickle Cell Patients

Authors: Lindy Adoma Dampare, Marina Aferiba Tandoh

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Sickle cell disease (SCD) is an inherited blood disorder that mostly affects individuals in sub-Saharan Africa. Nutritional deficiencies have been well established in SCD patients. In Ghana, studies have revealed the prevalence of malnutrition, especially amongst children with SCD and hence the need to develop an evidence-based comprehensive nutritional therapy for SCD to improve their nutritional status. The aim of the study was to develop and assess the effect of a nutrition education material on the nutritional status of SCD patients in Ghana. This was a pre-post interventional study. Patients between the ages of 2 to 60 years were recruited from the Tema General Hospital. Following a baseline nutrition knowledge (NK), beliefs, sanitary practice and dietary consumption pattern assessment, a twice-monthly nutrition education was carried out for 3 months, followed by a post-intervention assessment. Nutritional status of SCD patients was assessed using a 3-days dietary recall and anthropometric measurements. Nutrition education (NE) was given to SCD adults and caregivers of SCD children. Majority of the caregivers (69%) and SCD adult (82%) at baseline had low NK. The level of NK improved significantly in SCD adults (4.18±1.83 vs. 10.00±1.00, p<0.001) and caregivers (5.58 ± 2.25 vs.10.44± 0.846, p<0.001) after NE. Increase in NK improved dietary intake and dietary consumption pattern of SCD patients. Significant increase in weight (23.2±11.6 vs. 25.9±12.1, p=0.036) and height (118.5±21.9 vs. 123.5±22.2, p=0.011) was observed in SCD children at post intervention. Stunting (10.5% vs. 8.6%, p=0.62) and wasting (22.1% vs. 14.4%, p=0.30) reduced in SCD children after NE although not statistically significant. Reduction (18.2% vs. 9.1%) in underweight and an increase (18.2% vs. 27.3%) in overweight SCD adults was recorded at post intervention. Fat mass remained the same while high muscle mass increased (18.2% vs. 27.3%) at post intervention in SCD adult. Anaemic status of SCD patients improved at post intervention and the improvement was statistically significant amongst SCD children. Nutrition education improved the NK of SCD caregivers and adults hence, improving the dietary consumption pattern and nutrient intake of SCD patients. Overall, NE improved the nutritional status of SCD patients. This study shows the potential of nutrition education in improving the nutritional knowledge, dietary consumption pattern, dietary intake and nutritional status of SCD patients, and should be further explored.

Keywords: sickle cell disease, nutrition education, dietary intake, nutritional status

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1271 Job Satisfaction and Associated factors of Urban Health Extension Professionals in Addis Ababa City, Ethiopia

Authors: Metkel Gebremedhin, Biruk Kebede, Guash Abay

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Job satisfaction largely determines the productivity and efficiency of human resources for health. There is scanty evidence on factors influencing the job satisfaction of health extension professionals (HEPs) in Addis Ababa. The objective of this study was to determine the level of and factors influencing job satisfaction among extension health workers in Addis Ababa city. This was a cross-sectional study conducted in Addis Ababa, Ethiopia. Among all public health centers found in the Addis Ababa city administration health bureau that would be included in the study, a multistage sampling technique was employed. Then we selected the study health centers randomly and urban health extension professionals from the selected health centers. In-depth interview data collection methods were carried out for a comprehensive understanding of factors affecting job satisfaction among Health extension professionals (HEPs) in Addis Ababa. HEPs working in Addis Ababa areas are the primary study population. Multivariate logistic regression with 95% CI at P ≤ 0.05 was used to assess associated factors to job satisfaction. The overall satisfaction rate was 10.7% only, while 89.3%% were dissatisfied with their jobs. The findings revealed that variables such as marital status, staff relations, community support, supervision, and rewards have a significant influence on the level of job satisfaction. For those who were not satisfied, the working environment, job description, low salary, poor leadership and training opportunities were the major causes. Other factors influencing the level of satisfaction were lack of medical equipment, lack of transport facilities, lack of training opportunities, and poor support from woreda experts. Our study documented a very low level of overall satisfaction among health extension professionals in Addis Ababa city public health centers. Considering the factors responsible for this state of affairs, urgent and concrete strategies must be developed to address the concerns of extension health professionals as they represent a sensitive domain of the health system of Addis Ababa city. Improving the overall work environment, review of job descriptions and better salaries might bring about a positive change.

Keywords: job satisfaction, extension health professionals, Addis Ababa

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1270 Technical Efficiency in Organic and Conventional Wheat Farms: Evidence from a Primary Survey from Two Districts of Ganga River Basin, India

Authors: S. P. Singh, Priya, Komal Sajwan

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With the increasing spread of organic farming in India, costs, returns, efficiency, and social and environmental sustainability of organic vis-a-vis conventional farming systems have become topics of interest among agriculture scientists, economists, and policy analysts. A study on technical efficiency estimation under these farming systems, particularly in the Ganga River Basin, where the promotion of organic farming is incentivized, can help to understand whether the inputs are utilized to their maximum possible level and what measures can be taken to improve the efficiency. This paper, therefore, analyses the technical efficiency of wheat farms operating under organic and conventional farming systems. The study is based on a primary survey of 600 farms (300 organic ad 300 conventional) conducted in 2021 in two districts located in the Middle Ganga River Basin, India. Technical, managerial, and scale efficiencies of individual farms are estimated by applying the data envelopment analysis (DEA) methodology. The per hectare value of wheat production is taken as an output variable, and values of seeds, human labour, machine cost, plant nutrients, farm yard manure (FYM), plant protection, and irrigation charges are considered input variables for estimating the farm-level efficiencies. The post-DEA analysis is conducted using the Tobit regression model to know the efficiency determining factors. The results show that technical efficiency is significantly higher in conventional than organic farming systems due to a higher gap in scale efficiency than managerial efficiency. Further, 9.8% conventional and only 1.0% organic farms are found operating at the most productive scale size (MPSS), and 99% organic and 81% conventional farms at IRS. Organic farms perform well in managerial efficiency, but their technical efficiency is lower than conventional farms, mainly due to their relatively lower scale size. The paper suggests that technical efficiency in organic wheat can be increased by upscaling the farm size by incentivizing group/collective farming in clusters.

Keywords: organic, conventional, technical efficiency, determinants, DEA, Tobit regression

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