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Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern

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Introduction: Head and neck cancers (HNC) are often associated with the development of non-HNC primaries, as the risk factors that predispose patients to HNC are often risk factors for other cancers. Aim: We sought to evaluate whether there was an increased risk of smoking and alcohol-related cancers and also other cancers in HNC patients and to evaluate whether there is a difference between the rates of non-HNC primaries in Aboriginal compared with non-Aboriginal HNC patients. Methods: We performed a retrospective cohort analysis of 320 HNC patients from a single center in Western Australia, identifying 80 Aboriginal and 240 non-Aboriginal patients matched on a 1:3 ratio by sites, histology, rurality, and age. We collected data on the patient characteristics, tumour features, treatments, outcomes, and past and subsequent HNCs and non-HNC primaries. Results: In the overall study population, there were 86 patients (26.9%) with a metachronous or synchronous non-HNC primary. Non-HNC primaries were actually significantly more common in the non-Aboriginal population compared with the Aboriginal population (30% vs. 17.5%, p=0.02); however, half of these were patients with cutaneous squamous or basal cell carcinomas (cSCC/BCC) only. When cSCC/BCCs were excluded, non-Aboriginal patients had a similar rate as Aboriginal patients (16.7% vs. 15%, p=0.73). There were clearly more cSCC/BCCs in non-Aboriginal patients compared with Aboriginal patients (16.7% vs. 2.5%, p=0.001) and more patients with melanoma (2.5% vs. 0%, p value not significant (p=NS). Rates of most cancers were similar between non-Aboriginal and Aboriginal patients, including prostate (2.9% vs. 3.8%), colorectal (2.9% vs. 2.5%), kidney (1.2% vs. 1.2%), and these rates appeared comparable to Australian Age Standardised Incidence Rates (ASIR) in the general community. Oesophageal cancer occurred at double the rate in Aboriginal patients (3.8%) compared with non-Aboriginal patients (1.7%), which was far in excess of ASIRs which estimated a lifetime risk of 0.59% in the general population. Interestingly lung cancer rates did not appear to be significantly increased in our cohort, with 2.5% of Aboriginal patients and 3.3% of non-Aboriginal patients having lung cancer, which is in line with ASIRs which estimates a lifetime risk of 5% (by age 85yo). Interestingly the rate of Glioma in the non-Aboriginal population was higher than the ASIR, with 0.8% of non-Aboriginal patients developing Glioma, with Australian averages predicting a 0.6% lifetime risk in the general population. As these are small numbers, this finding may well be due to chance. Unsurprisingly, second HNCs occurred at an increased incidence in our cohort, in 12.5% of Aboriginal patients and 11.2% of non-Aboriginal patients, compared to an ASIR of 17 cases per 100,000 persons, estimating a lifetime risk of 1.70%. Conclusions: Overall, 26.9% of patients had a non-HNC primary. When cSCC/BCCs were excluded, Aboriginal and non-Aboriginal patients had similar rates of non-HNC primaries, although non-Aboriginal patients had a significantly higher rate of cSCC/BCCs. Aboriginal patients had double the rate of oesophageal primaries; however, this was not statistically significant, possibly due to small case numbers.

Keywords: head and neck cancer, synchronous and metachronous primaries, other primaries, Aboriginal

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Authors: Takuya Suzuki, Atsushi Shirai, Takashi Seki

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Acupuncture therapy is one of the treatments in traditional Chinese medicine. Recently, some reports have shown the effectiveness of acupuncture. However, its full acceptance has been hindered by the lack of understanding on mechanism of the therapy. Acupuncture applied to Zusanli (ST-36) enhances blood flow volume in superior mesenteric artery (SMA), yielding peripheral vascular resistance – regulated blood flow of SMA dominated by the parasympathetic system and inhibition of sympathetic system. In this study, a lumped-parameter approximation model of blood flow in the systemic arteries was developed. This model was extremely simple, consisting of the aorta, carotid arteries, arteries of the four limbs and SMA, and their peripheral vascular resistances. Here, the individual artery was simplified to a tapered tube and the resistances were modelled by a linear resistance. We numerically investigated contribution of the peripheral vascular resistance of SMA to the systemic blood distribution using this model. In addition to the upstream end of the model, which correlates with the left ventricle, two types of boundary condition were applied; mean left ventricular pressure which correlates with blood pressure (BP) and mean cardiac output which corresponds to cardiac index (CI). We examined it to reproduce the experimentally obtained hemodynamic change, in terms of the ratio of the aforementioned hemodynamic parameters from their initial values before the acupuncture, by regulating the peripheral vascular resistances and the upstream boundary condition. First, only the peripheral vascular resistance of SMA was changed to show contribution of the resistance to the change in blood flow volume in SMA, expecting reproduction of the experimentally obtained change. It was found, however, this was not enough to reproduce the experimental result. Then, we also changed the resistances of the other arteries together with the value given at upstream boundary. Here, the resistances of the other arteries were changed simultaneously in the same amount. Consequently, we successfully reproduced the hemodynamic change to find that regulation of the upstream boundary condition to the value experimentally obtained after the stimulation is necessary for the reproduction, though statistically significant changes in BP and CI were not observed in the experiment. It is generally known that sympathetic and parasympathetic tones take part in regulation of whole the systemic circulation including the cardiac function. The present result indicates that stimulation to ST-36 could induce vasodilation of peripheral circulation of SMA and vasoconstriction of that of other arteries. In addition, it implies that experimentally obtained small changes in BP and CI induced by the acupuncture may be involved in the therapeutic response.

Keywords: acupuncture, hemodynamics, lumped-parameter approximation, modeling, systemic vascular resistance

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Authors: Hanin Suleiman Alqam

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The knowledge-based economy, as its name implies relies on knowledge, information and high levels of skills made available for all economic agents. Delving a bit more deeply, the concept of a knowledge-based economy is showcasing four main pillars, which are: Education and Training, Information and Communication Technology, Economic incentives and Institutional regimes, and Research and Development (R&D) and Innovation system. A good number of researches are showing its positive contribution to economic diversification underpinning sustainable development and growth. The present paper aimed at assessing the role of SMEs in moving Oman’s economy from a traditional economy to a knowledge-based economy. To lay down a groundwork that should lead to future studies, the methodology selected is based on exploratory research. Hence, the interview was conducted as a data collection tool. Based on a purposive sampling technique, seven handpicked experts have partaken in the study as they are working in different key organizations considered to be directly or indirectly the backbone of the Omani national economy. A thematic approach is employed for the purpose of data analysis. Results of the study showed that SMEs are not really contributing in the knowledge-based economy due to a lack of awareness about its importance to the country and to the enterprise within SMEs in Oman. However, it was shown that SMEs owners are interested in innovation and are trying to support innovative individuals by attracting them to their enterprises. On the other hand, the results revealed that SMEs' performance in e-solution is still not up to the level as 32% of SMEs only are using e-solutions in their internal processes and procedures like accounting systems. It is recommended to SMEs owners to use new and modern technologies in marketing and customer relation, encourage creativity, research and development, and allow the youth to have opportunities and facilitate the procedure in terms of innovation so that their role in contributing to the knowledge-based economy could be improved.

Keywords: knowledge-based economy, SMEs, ICT pillars, research and innovation

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Authors: Rakibul Islam Sagor, Sadia Ibnat Raisa

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Many nations across the globe, including Dhaka, are facing challenges in meeting the needs for a satisfactory quality of life due to the combination of a growing population and limited land resources. As a result, maximum spaces in modern cities are engulfed by concrete infrastructure, and there are hardly any open spaces in the urban neighborhoods. Although vertical movement has predominantly been employed for residential and commercial applications, the notion of vertical recreational and sports facilities remains unsettled. The primary objective of this study is to explore the feasibility of implementing vertical adaptations in urban recreational spaces, drawing upon the principles of high-rise theory. This article presents an analysis of the open spaces in Gulshan, Dhaka, focusing on the evaluation of the demand for open recreational and sports facilities that adequately cater to the existing population of the region. Initially, the study tried to identify and examine all potential open spaces within the designated area. Following that, an acceptable place is selected utilizing space syntax analysis, which takes into account the most conveniently accessible space for social interactions in the neighborhood. In addition, socioeconomic conditions of the area have been studied in order to determine the feasibility of the area. Finally, the study presented viable options for vertical urban sports facilities in the context of Dhaka, Bangladesh. Additionally, it seeks to develop strategies for maximizing the use of vertical expansions, thereby promoting a healthier and more active lifestyle among the city's residents. This approach aims to effectively handle the issue of limited land availability and enhance the efficiency of recreational areas around the globe.

Keywords: vertical sports, urban open spaces, social interaction, recreational activities

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Authors: Chih-Ping Chen

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Today, technology does not necessitate change; rather, social media has afforded a new arena and digital tools for users/individuals to be symbolized and marketed in meaningful exchanges of digital identities. We argue that these symbolic interactions may afford individuals the ability to create and present less restricted Line person-to-person (P2P) chats than would be possible in face-to-face communications. Individuals can select flexible influence strategies to market themselves, which enables them to create and present their digital identities and impressions in alternative ways within a dynamic sociocultural context. Therefore, this paper aims to explore the novel phenomenon of how individuals market themselves to manage their digital identities and impressions to connect with other users through the symbolic interactions created by new digital tools (e.g., stickers). A netnographic approach was developed by applying a triangulated methodology consisting of user self-diary reports, in-depth interviews, and observations. Totally, 20 participants (10 females and 10 males) were of Taiwanese origin, and their ages ranged from 20–47 years old. The findings of this research showed that individuals on Line P2P social media where traditional cultural gender norms have shifted. Both male and female participants market their modern digital identities by adopting a combination of flexible influence tactics/strategies when using digital stickers. Some findings showed that their influence tactics/strategies often flouted Taiwanese cultural gender norms or skirted traditional rules to fit individual or P2P needs. Finally, these findings potentially contributed to the literature regarding the consumer culture theory and symbolic interaction theory in digital marketing and social media fields.

Keywords: Consumer culture theory, Digital sticker, Self-marketing, Impression, Symbolic interaciton

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Authors: Kuate Tueguem William Norbert, Ngoh Dooh Jules Patrice, Kone Sangou Abdou Nourou, Mboussi Serge Bertrand, Chewachang Godwill Mih, Essome Sale Charles, Djuissi Tohoto Doriane, Ambang Zachee

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The objectives of this study were to evaluate the effects of foliar application of 24-epibrassinolide (EBR) on the development of rice helminthosporiosis caused by Bipolaris oryzae and its influence on the improvement of growth parameters and induction of the synthesis of defense substances in the rice plants. The experimental asset up involved a multifactorial split-plot with two varieties (NERICA 3 and local variety KAMKOU) and five treatments (T0: control, T1: EBR, T2: BANKO PLUS (fungicide), T3: NPK (chemical fertilizer), T4: mixture: NPK + BANKO PLUS + EBR) with three repetitions. Agro-morphological and epidemiological parameters, as well as substances for plant resistance, were evaluated over two growing seasons. The application of the EBR induced significant growth of the rice plants for the 2015 and 2016 growing seasons on the two varieties tested compared to the T0 treatment. At 74 days after sowing (DAS), NERICA 3 showed plant heights of 58.9 ± 5.4; 83.1 ± 10.4; 86.01 ± 9.4; 69.4 ± 11.1 and 87.12 ± 7.4 cm at T0; T1; T2; T3, and T4, respectively. Plant height for the variety KAMKOU varied from 87,12 ± 8,1; 88.1 ± 8.1 and 92.02 ± 6.3 cm in T1, T2, and T3 to 74.1 ± 8.6 and 74.21 ± 11.4 cm in T0 and T3. In accordance with the low rate of expansion of helminthosporiosis in experimental plots, EBR (T1) significantly reduced the development of the disease with severities of 0.0; 1.29, and 2.04%, respectively at 78; 92, and 111 DAS on the variety NERICA 3 compared with1; 3.15 and 3.79% in the control T0. The reduction of disease development/severity as a result of the application of EBR is due to the induction of acquired resistance of rice varieties through increased phenol (13.73 eqAG/mg/PMF) and total protein (117.89 eqBSA/mg/PMF) in the T1 treatment against 5.37 eqAG/mg/PMF and 104.97 eqBSA/mg/PMF in T0 for the NERICA 3 variety. Similarly, on the KAMKOU variety, 148.53 eqBSA/mg/PMF were protein and 6.10 eqAG/mg/PMF of phenol in T1. In summary, the results show the significant effect of EBR on plant growth, yield, synthesis of secondary metabolites and defense proteins, and disease resistance. The EBR significantly reduced losses of rice grains by causing an average gain of about 1.55 t/ha compared to the control and 1.00 t/ha compared to the NPK-based treatment for the two varieties studied. Further, the enzymatic activities of PPOs, POXs, and PR2s were higher in leaves from treated EBR-based plants. These results show that 24-epibrassinolide can be used in the control of helminthosporiosis of rice to reduce disease and increase yields.

Keywords: Oryza sativa, 24-epibrassinolide, helminthosporiosis, secondary metabolites, PR proteins, acquired resistance

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Authors: Elizalde D. Bana

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Healing restores continuity and form through cell replication; hence, conserving structural integrity. In response to the worldwide pressing problem of chronic wounds in the healthcare delivery system, the researcher aims to provide effective intervention to preserve the structural integrity of the person. The wound healing effects of cryopreserved and lyophilized amniotic membrane (AM) of a term fetus embedded into two (2) concentrations (1.5 % and 1.0 %) of absorption-based ointment has been evaluated in vivo using the excision wound healing model 1x1 cm size. The total protein concentration in full term fetus was determined by the Biuret and Bradford methods, which are based on UV-visible spectroscopy. The percentages of protein presence in 9.5 mg (Mass total sample) of Amniotic membrane ranges between 14.77 – 14.46 % in Bradford method, while slightly lower to 13.78 – 13.80 % concentration in Biuret method, respectively. Bradford method evidently showed higher sensitivity for proteins than Biuret test. Overall, the amniotic membrane is composed principally of proteins in which a copious amount of literature substantially proved its healing abilities. After which, an area of 1 cm by 1 cm skin tissue was excised to its full thickness from the dorsolateral aspect of the isogenic mice and was applied twice a day with the ointment formulation having two (2) concentrations for the diabetic group and non-diabetic group. The wounds of each animal were left undressed and its area was measured every other day by a standard measurement formula from day 2,4,6,8,10,12 and 14. By the 14th day, the ointment containing 1.5 % of AM in absorption-based ointment applied to non-diabetic and diabetic group showed 100 % healing. The wound areas in the animals treated with the standard antibiotic, Mupirocin Ointment (Brand X) showed a 100% healing by the 14th day but with traces of scars, indicating that AM prepared from cryopreservation and lyophilization, at that given concentration, had a better wound healing property than the standard antibiotic. Four (4) multivariate tests were used which showed a significant interaction between days and treatments, meaning that the ointments prepared in two differing concentrations and induced in different groups of the mice had a significant effect on the percent of contraction over time. Furthermore, the evaluations of its effectiveness to wound healing were all significant although in differing degrees. It is observed that the higher the concentrations of amniotic membrane, the more effective are the results.

Keywords: wounds, healing, amniotic membrane ointments, biomedical, stem cell

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Authors: Khizar Z. Choudhrya, Richard Coles, Salman Qureshi, Robert Ashford, Salim Khan, Rabia R. Mir

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Abstract: The majority of existing landscape research has been derived by conducting heuristic evaluations, without having empirical insight of real participant visual response. In this research, a modern multimodal measurement approach (using narratives and eye tracking) was applied to investigate visual behaviour in perceiving naturalistic and urban environments. This research is unique in exploring gaze behaviour on environmental images possessing different levels of saliency. Eye behaviour is predominantly attracted by salient locations. The concept of methodology of this research on naturalistic and urban environments is drawn from the approaches in market research. Borrowing methodologies from market research that examine visual responses and qualities provided a critical and hitherto unexplored approach. This research has been conducted by using mixed methodological quantitative and qualitative approaches. On the whole, the results of this research corroborated existing landscape research findings, but they also identified potential refinements. The research contributes both methodologically and empirically to human-environment interaction (HEI). This study focused on initial impressions of environmental images with the help of eye tracking. Taking under consideration the importance of the image, this study explored the factors that influence initial fixations in relation to expectations and preferences. In terms of key findings of this research it is noticed that each participant has his own unique navigation style while surfing through different elements of landscape images. This individual navigation style is given the name of ‘visual signature’. This study adds the necessary clarity that would complete the picture and bring an insight for future landscape researchers.

Keywords: human-environment interaction (HEI), multimodal measurement, narratives, eye tracking

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Authors: A. Gokulram

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Industrial waste is often categorized as commercial and non-commercial waste by market value. In many Indian industries and other industrialized countries, the commercial value waste is capitalized and non-commercial waste is dumped to landfill. A lack of adequate research on industrial waste leads to the failure of effective resource management and the non-commercial waste are being considered as commercially non-viable residues. The term Industrial symbiosis refers to the direct inter-firm reuse or exchange of material and energy resource. The resource efficiency of commercial waste is mainly followed by an informal symbiosis in our research area. Some Industrial residues are reused within the facility where they are generated, others are reused directly nearby industrial facilities and some are recycled via the formal and informal market. The act of using industrial waste as a resource for another product faces challenges in India. This research study has observed a major negligence of trust and communication among several bodies to implement effective circular economy in India. This study applies interviewing process across researchers, government bodies, industrialist and designers to understand the challenges of circular economy in India. The study area encompasses an industrial estate in Ahmedabad in the state of Gujarat which comprises of 1200 industries. The research study primarily focuses on making industrial waste as commercial ready resource and implementing Indigenous sustainable practice in modern context to improve resource efficiency. This study attempted to initiate waste exchange platform among several industrialist and used varied methodologies from mail questionnaire to telephone survey. This study makes key suggestions to policy change and sustainable finance to improve circular economy in India.

Keywords: effective resource management, environmental policy, indigenous technique, industrial symbiosis, sustainable finance

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Authors: Nelya Babynets

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Shakespeare and Mexican theatregoers have enjoyed quite a complex relationship. Shakespearean plays have appeared on the Mexican stage with remarkable perseverance, yet with mixed success. Although Shakespeare has long been a part of the global cultural marketplace and his works are celebrated all around the world, the adaptation of his plays on the contemporary Mexican stage is always an adventure, since the works of this early modern author are frequently seen as the legacy of a ‘high’, but obsolete, culture, one that is quite distant from the present-day viewers’ daily experiences and concerns. Moreover, Mexican productions of Shakespeare are presented mostly in Peninsular Spanish, a language similar yet alien to the language spoken in Mexico, one that does not wholly fit into the viewers’ cultural praxis. This is the reason why Mexican dramatic adaptations of Shakespearean plays tend to replace the cultural references of the original piece with ones that are more significant and innate to Latin American spectators. This paper analyses the new Mexican production of Richard III adapted and directed by Mauricio Garcia Lozano, which employs onstage violence - a cultural force that is inherent to all human beings regardless of their beliefs, ethnic background or nationality - as the means to make this play more relevant to a present-day audience. Thus, this paper addresses how the bloody bombast of staged murders helps to avoid the tyranny of a rigid framework of fixed meanings that denies the possibility of an intercultural appropriation of this European play written over four hundred years ago. The impact of violence displayed in Garcia Lozano’s adaptation of Richard III on Mexican audiences will also be examined. This study is particularly relevant in Mexico where the term ‘tragedy’ has become a commonplace and where drug wars and state-sanctioned violence have already taken the lives of many people.

Keywords: audience, dramatic adaptation, Shakespeare, viewer

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Authors: Lisa Robins, Jill Newby, Kay Wilhelm, Therese Fletcher, Jessica Smith, Trevor Ma, Adam Finch, Lesley Campbell, Jerry Greenfield, Gavin Andrews

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Background:Depression treatment for people living with depression comorbid with diabetes is of critical importance for improving quality of life and diabetes self-management, however depression remains under-recognised and under-treated in this population. Cost—effective and accessible forms of depression treatment that can enhance the delivery of mental health services in routine diabetes care are needed. Provision of internet-delivered Cognitive Behaviour Therapy (iCBT) provides a promising way to deliver effective depression treatment to people with diabetes. Aims:To explore the outcomes of the clinician assisted iCBT program for people with comorbid Major Depressive Disorder (MDD) and diabetes compared to those who remain under usual care. The main hypotheses are that: (1) Participants in the treatment group would show a significant improvement on disorder specific measures (Patient Health Questionnaire; PHQ-9) relative to those in the control group; (2) Participants in the treatment group will show a decrease in diabetes-related distress relative to those in the control group. This study will also examine: (1) the effect of iCBT for MDD on disability (as measured by the SF-12 and SDS), general distress (as measured by the K10), (2) the feasibility of these treatments in terms of acceptability to diabetes patients and practicality for clinicians (as measured by the Credibility/Expectancy Questionnaire; CEQ). We hypothesise that associated disability, and general distress will reduce, and that patients with comorbid MDD and diabetes will rate the program as acceptable. Method:Recruit 100 people with MDD comorbid with diabetes (either Type 1 or Type 2), and randomly allocate to: iCBT (over 10 weeks) or treatment as usual (TAU) for 10 weeks, then iCBT. Measure pre- and post-intervention MDD severity, anxiety, diabetes-related distress, distress, disability, HbA1c, lifestyle, adherence, satisfaction with clinicians input and the treatment. Results:Preliminary results comparing MDD symptom levels, anxiety, diabetes-specific distress, distress, disability, HbA1c levels, and lifestyle factors from baseline to conclusion of treatment will be presented, as well as data on adherence to the lessons, homework downloads, satisfaction with the clinician's input and satisfaction with the mode of treatment generally.

Keywords: cognitive behaviour therapy, depression, diabetes, internet

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Authors: Girish Chandran, Milu Tigi

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Brian O'Doherty's seminal essay, Inside the white Cube theorized and named the dominant mode of display and exhibition of Modern Art museums. Ever since the advent of Biennales and other site-specific public art projects we have seen a departure from the white cube mode of exhibition. The physicality, materiality and context within which an artwork is framed has a role in the production of meaning of public art. Equally, artworks contribute to the meaning and identity of a place. This to and fro relationship between the site and artwork and its influence on the sense of place and production of meaning is being explored in this paper in the context of Kochi Muziris Biennale (KMB). Known as the Peoples biennale with over 5 lakh visitors, it is India's first Biennale and its largest art exhibition of contemporary art. The paper employs place theory and contemporary curatorial theories to present the case. The KMB has an interesting mix of exhibition spaces which includes existing galleries and halls, site-specific projects in public spaces, infill developments and adaptive reuse of heritage and other unused architecture. The biennale was envisioned as an event connecting to the history, socio-political peculiarities of the cultural landscape of Kerala and more specifically Kochi. The paper explains the role of spatial elements in forming a curatorial narrative connected to the above mentioned ambitions.The site-specific nature of exhibition and its use of unused architecture helps in the formation of exhibition spaces unique in type and materiality. The paper argues how this helps in the creation of an 'archeology of the place'. The research elucidates how a composite nature of experience helps connect with the thematic ambitions of the Biennale and how it brings about an aesthetics distinct to KMB.

Keywords: public art, curatorial practice, architecture, place, contemporary art, site specificity

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Authors: Zarah M. Bello, Nathan Baddoo, Mariana Lilley, Paul Wernick

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In this paper, we present findings from a multi-part study to evaluate candidate elements reflecting the level of digital capability maturity (DCM) in higher education and the relationship between these elements. We will use these findings to propose a model of DCM for educational institutions. We suggest that the success of learning in higher education is dependent in part on the level of maturity of digital capabilities of institutions as well as the abilities of learners and those who support the learning process. It is therefore important to have a good understanding of the elements that underpin this maturity as well as their impact and interactions in order to better exploit the benefits that technology presents to the modern learning environment and support its continued improvement. Having identified ten candidate elements of digital capability that we believe support the level of a University’s maturity in this area as well as a number of relevant stakeholder roles, we conducted two studies utilizing both quantitative and qualitative research methods. In the first of these studies, 85 electronic questionnaires were completed by various stakeholders in a UK university, with a 100% response rate. We also undertook five in-depth interviews with management stakeholders in the same university. We then utilized statistical analysis to process the survey data and conducted a textual analysis of the interview transcripts. Our findings support our initial identification of candidate elements and support our contention that these elements interact in a multidimensional manner. This multidimensional dynamic suggests that any proposal for improvement in digital capability must reflect the interdependency and cross-sectional relationship of the elements that contribute to DCM. Our results also indicate that the notion of DCM is strongly data-centric and that any proposed maturity model must reflect the role of data in driving maturity and improvement. We present these findings as a key step towards the design of an operationalisable DCM maturity model for universities.

Keywords: digital capability, elements, maturity, maturity framework, university

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Authors: Claudia Seabra, Elisabeth Kastenholz, José Luís Abrantes, Manuel Reis

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In a world of increasing mobility and global risks, terrorism has, in a perverse way, capitalized on contemporaneous society’s growing interest in travel to explore a world whose national boundaries and distances have decreased. Terrorists have identified the modern tourist flows originated from the economically more developed countries as new appealing targets so as to: i) call attention to the causes they defend and ii) destroy a country’s foundations of tourism, with the final aim of disrupting the economic and consequently social fabric of the affected countries. The present study analyses sensitivity towards risk and travel behaviors in international travel amongst a sample of 600 international tourists from 49 countries travelling by air. Specifically, the sample was segmented according to the Global Peace Index. This index defines country profiles regarding the levels of peace. The indicators used are established over three broad themes: i) ongoing domestic and international conflict; ii) societal safety and security; and iii) militarisation. Tourists were segmented, according to their country of origin, in different levels of peacefulness. Several facets of travel behavior were evaluated, namely motivations, attitude towards trip planning, quality perception and perceived value of the trip. Also factors related with risk perception were evaluated, specifically terrorism risk perception during the trip, unsafety sensation as well as importance attributed to safety in travel. Results contribute to our understanding of the role of previous exposure to the lack of peace and safety at home in the international tourists behaviors, which is further discussed in terms of tourism management and marketing implications which should particularly interest tourism services and destinations more affected by terrorism, war, political turmoil, crime and other safety risks.

Keywords: terrorism, tourism, safety, risk perception

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Authors: Veerle Van Hoeck, Ingrid Somers, Dany Morisset

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Anti-nutritional factors such as non-starch polysaccharides (NSP) are present in viscous cereals used to feed poultry. Therefore, exogenous carbohydrases are commonly added to monogastric feed to degrade these NSP. Our hypothesis is that xylanase not only improves laying hen performance and digestibility but also induces a significant shift in microbial composition within the intestinal tract and, thereby, can cause a prebiotic effect. In this context, a better understanding of whether and how the chicken gut flora can be modulated by xylanase is needed. To do so, in the herein laying hen study, the effects of dietary supplementation of xylanase on performance, digestibility, and cecal microbiome were evaluated. A total of 96 HiSex laying hens was used in this experiment (3 diets and 16 replicates of 2 hens). Xylanase was added to the diets at concentrations of 0, 45,000 (15 g/t XygestTM HT) and 90,000 U/kg (30 g/t Xygest HT). The diets were based on wheat (~55 %), soybean, and sunflower meal. The lowest dosage, 45,000 U/kg, significantly increased average egg weight and improved feed efficiency compared to the control treatment (p < 0.05). Egg quality parameters were significantly improved in the experiment in response to the xylanase addition. For example, during the last 28 days of the trial, the 45,000 U/kg and the 90,000 U/kg treatments exhibited an increase in Haugh units and albumin heights (p < 0.05). Compared with the control, organic matter digestibility and N retention were drastically improved in the 45,000 U/kg treatment group, which implies better nutrient digestibility at this lowest recommended dosage compared to the control (p < 0.05). Furthermore, gross energy and crude fat digestibility were improved significantly for birds fed 90,000 U/kg group compared to the control. Importantly, 16S rRNA gene analysis revealed that xylanase at 45,000 U/kg dosages can exert a prebiotic effect. This conclusion was drawn based on studying the sequence variation in the 16S rRNA gene in order to characterize diverse microbial communities of the cecal content. A significant increase in beneficial bacteria (Lactobacilli spp and Enterococcus casseliflavus) was documented when adding 45,000 U/kg xylanase to the diet of laying hens. In conclusion, dietary supplementation of xylanase, even at the lowest dose of (45,000 U/kg), significantly improved laying hen performance and digestibility. Furthermore, it is generally accepted that a proper bacterial balance between the number of beneficial bacteria and pathogenic bacteria in the intestine is vital for the host. It seems that the xylanase enzyme is able to modulate the laying hen microbiome beneficially and thus exerts a prebiotic effect. This microbiome plasticity in response to the xylanase provides an attractive target for stimulating intestinal health.

Keywords: laying hen, prebiotic, XygestTM HT, xylanase

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Authors: Anne Prip, Kirsten Alling Møller, Dorte Lisbet Nielsen, Mary Jarden, Marie-Helene Olsen, Anne Kjaergaard Danielsen

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Background: The development in cancer care has shifted towards shorter hospital stays and more outpatient treatment. Today, cancer care and treatment predominantly takes place in outpatient settings where encounters between patients and health care professionals are often brief. This development will probably continue internationally as the global cancer burden seems to be growing significantly. Furthermore, the number of patients who require ambulatory treatments such as chemotherapy is increasing. Focusing on the encounters between health care professionals and patients during oncology treatment has thus become increasingly important due to a growing trend in outpatient cancer management. Objective: The aim of the systematic review was to summarize the literature from the perspective of the patient, on experiences of and the need for communication and relationships with the health care professional during chemotherapy treatment in an outpatient setting. Method: The review was designed and carried out according to the PRISMA guidelines and PICO framework. The systematic search was conducted in Medline, CINAHL, The Cochrane Library and Joanna Briggs Institute Evidence Based Practice Database. Results: In all, 1174 studies were identified by literature search. After duplicates were removed, the remaining studies (n = 1053) were screened for inclusion. Nine studies were included; qualitative (n = 5) and quantitative (n = 4) as they met the inclusions criteria. The review identified that communication and relationships between health care professionals and patients were important for the patients’ ability to cope with cancer and also had an impact on patients’ satisfaction with care in the outpatient clinic. Furthermore, the review showed that hope and positivity was a need and strategy for patients with cancer and was facilitated by health care professionals. Finally, it revealed that outpatient clinic visits framed and influenced communication and relationships. Conclusions: This review identified the significance of communication and the relationships between patients and health care professionals in the outpatient setting as it supports patients’ ability to cope with cancer. The review showed the need for health care professionals to pay attention to the relational aspects of communication in an outpatient clinic as encounters are often brief. Furthermore, the review helps to specify which elements of the communication are central in the patient-health care professional interaction from the patients' perspective. Finally, it shows a need for more research to investigate which type of interaction and intervention would be the most effective in supporting patients’ coping during chemotherapy in an outpatient clinic.

Keywords: ambulatory chemotherapy, communication, health care professional-patient relation, nurse-patient relation, outpatient care, systematic review

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Authors: Yijie Wang, Hanwei Cheng

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Under the Chinese educational context, the materials for patriotic education typically take the form of grand narratives. However, in post-modern times the younger members of society tend to welcome elements of more micro and personal nature. It is therefore important to explore how patriotism can be integrated into an ‘everyday’, private narrative that holds more attraction for the young. Based on semi-structured interviews of eight Chinese graduate students, this research examines how Chinese young people draw materials to establish national identity and develop love for the country from everyday-life details, as well as how they perceive, interpret and articulate their patriotism through private narratives. And implications for patriotic education are proposed accordingly. Several conclusions are drawn from the pre-interviews. Firstly, sensory experiences that remind people of their country—such as the taste of Chinese delicacies and the sound of a traditional instrument—are a major source of patriotic feelings. Secondly, the love for the country often stems from and is continued to be mediated by the emotional attachment with other people, typically significant others, and patriotism is articulated (or acknowledged) by the young as a kind of ‘sentiment’ rather than ‘faith’ or ‘belief’. Thirdly, for young people who are currently studying abroad, their birth country represents a kind of familiar, well-accustomed life or lifestyle, and any nostalgic realization of it leads to increased national belonging and sense of identity. Fourthly, the awareness of the country’s transformations—positive ones and neutral ones alike—triggers young people affections towards the country, and even negative transformations may result in promoted sense of self-involvement and therefore consolidate national identity. Implications for patriotic education can be drawn accordingly, and although the research is conducted under the Chinese context, it will hopefully contribute to the understanding of relevant fields.

Keywords: national identity, patriotic education, private narrative, young people

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Authors: Sridhar A. Malkaram, Tamer E. Fandy

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Purpose: 5-Azacytidine (5AC) and decitabine (DC) are DNA hypomethylating agents. We recently demonstrated that both drugs increase the enzymatic activity of the histone deacetylase enzyme SIRT6. Accordingly, we are comparing the changes H3K9 acetylation changes in the whole genome induced by both drugs using leukemia cells. Description of Methods & Materials: Mononuclear cells from the bone marrow of six de-identified naive acute myeloid leukemia (AML) patients were cultured with either 500 nM of DC or 5AC for 72 h followed by ChIP-Seq analysis using a ChIP-validated acetylated-H3K9 (H3K9ac) antibody. Chip-Seq libraries were prepared from treated and untreated cells using SMARTer ThruPLEX DNA- seq kit (Takara Bio, USA) according to the manufacturer’s instructions. Libraries were purified and size-selected with AMPure XP beads at 1:1 (v/v) ratio. All libraries were pooled prior to sequencing on an Illumina HiSeq 1500. The dual-indexed single-read Rapid Run was performed with 1x120 cycles at 5 pM final concentration of the library pool. Sequence reads with average Phred quality < 20, with length < 35bp, PCR duplicates, and those aligning to blacklisted regions of the genome were filtered out using Trim Galore v0.4.4 and cutadapt v1.18. Reads were aligned to the reference human genome (hg38) using Bowtie v2.3.4.1 in end-to-end alignment mode. H3K9ac enriched (peak) regions were identified using diffReps v1.55.4 software using input samples for background correction. The statistical significance of differential peak counts was assessed using a negative binomial test using all individuals as replicates. Data & Results: The data from the six patients showed significant (Padj<0.05) acetylation changes at 925 loci after 5AC treatment versus 182 loci after DC treatment. Both drugs induced H3K9 acetylation changes at different chromosomal regions, including promoters, coding exons, introns, and distal intergenic regions. Ten common genes showed H3K9 acetylation changes by both drugs. Approximately 84% of the genes showed an H3K9 acetylation decrease by 5AC versus 54% only by DC. Figures 1 and 2 show the heatmaps for the top 100 genes and the 99 genes showing H3K9 acetylation decrease after 5AC treatment and DC treatment, respectively. Conclusion: Despite the similarity in hypomethylating activity and chemical structure, the effect of both drugs on H3K9 acetylation change was significantly different. More changes in H3K9 acetylation were observed after 5 AC treatments compared to DC. The impact of these changes on gene expression and the clinical efficacy of these drugs requires further investigation.

Keywords: DNA methylation, leukemia, decitabine, 5-Azacytidine, epigenetics

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Authors: Binod C. Agrawal

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In modern history, industrial and media merchandising in South Asia from East Asia, Europe, United States and other countries of the West is over 200 years old. Hence, continued external technology and media exposure is not a new experience in multi-lingual and multi religious South Asia which evolved cultural means to withstand structural change. In the post-World War II phase, media exposure especially of telecommunication, film, Internet, radio, print media and television have increased manifold. South Asia did not lose any time in acquiring and adopting digital media accelerated by chip revolution, computer and satellite communication. The penetration of digital media and utilization are exceptionally high though the spread has an unequal intensity, use and effects. The author argues that industrial and media products are “cultural products” apart from being “technological products”; hence their influences are most felt in the cultural domain which may lead to blunting of unique cultural specifics in the multi-cultural, multi-lingual and multi religious South Asia. Social scientists, political leaders and parents have voiced concern of “Cultural domination”, “Digital media colonization” and “Westernization”. Increased digital media access has also opened up doors of pornography and other harmful information that have sparked fresh debates and discussions about serious negative, harmful, and undesirable social effects especially among youth. Within ‘techno-social’ perspective, based on recent research studies, the paper aims to describe and analyse possible socio-economic change due to digital media penetration. Further, analysis supports the view that the ancient multi-lingual and multi-religious cultures of South Asia due to inner cultural strength may sustain without setting in a process of irreversible structural changes in South Asia.

Keywords: cultural sustainability, digital media effects, digital media impact in South Asia, social change in South Asia

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Authors: W. Mohammedsaeed, A. J. Mcbain, S. M. Cruickshank, C. A. O’Neill

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Many studies have demonstrated the importance of probiotics and their potential therapeutic effects within the gut. Recently, the possible therapeutic effects of probiotics in other tissues have also begun to be investigated. Comparatively few studies have evaluated the use of topical probiotics in relation to the skin. In this study, we have conducted preliminary investigations into whether a well-known probiotic, Lactobacillus rhamnosus GG (LGG), can increase the rate of re-epithelialization in a model wound. Full-thickness skin was obtained from individuals undergoing elective cosmetic surgery. This skin was wounded using excisional punch and cultured using a serum-free medium, either in the presence or absence of L. rhamnosus GG lysate. Histological staining of the sections was performed with Haematoxylin& Eosin E to quantify “epithelial tongue length”. This is the length of the new epithelial ‘tongue’ that grows and covers the exposed dermis at the inner wound edges. The length of the new epithelial ‘tongue’ was compared in untreated section and section treated with and L. rhamnosus GG made using108CFU/ml bacterial cells. L. rhamnosus GG lysate enhanced significantly the re-epithelialisation of treated wounds compared with that of untreated wounds (P=0.005, n=3). Tongue length, at day 1 was 7.55μm 0.15, at day 3 it was 18.5μm 0.25 and at day 7 was 22.9μm 0.35. These results can be compared with untreated cultures in which tongue length was 3.25μm 0.35, day 3 was 9.65μm 0.25 and day 7 was 13.5μm 0.15 post-wounding. In ex-vivo proliferation and migration cells were measured by determining the expression of nuclear proliferation marker Ki-67 and the expression of Phosphorylated cortactin respectively demonstrated that L. rhamnosus GG significantly increased NHEK proliferation and migration rates relative to controls. However, the dominant mechanism was migration because in ex-vivo skin treated with the L. rhamnosus GG up-regulated the gene expression of the chemokine receptor and ligands CXCR2 and CXCL2 comparing with controls (P=0.02, P=0.03 respectively, n=3). High levels of CXCL2/CXCL2 have already been implicated in multiple aspects of stimulation of wound healing through activation of keratinocyte migration. These data demonstrate that lysates from Lactobacillus rhamnosus GG increase re-epithelialization by stimulation of keratinocyte migration. The current study identifies the partial mechanism that contribute to stimulating the wound-healing process ex vivo in response to L. rhamnosus GG lysate is an increase in the production of CXCL2/ CXCR2 in ex vivo models. The use of probiotic lysates potentially offers new options to develop treatments that could improve wound healing.

Keywords: Lactobacillus rhamnosus GG, wounds, migration, lysate

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Authors: A. Rostampouryasouri, A. Maghoul, S. Tahersima

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The rapid growth of urbanization and the subsequent increase in population in cities have resulted in the destruction of the environment to cater to the needs of citizens. The industrialization of urban life has led to the production of pollutants, which has significantly contributed to the rise of air pollution. Infrastructure can have both positive and negative effects on air pollution. The effects of infrastructure on air pollution are complex and depend on various factors such as the type of infrastructure, location, and context. This study examines the effects of infrastructure on air pollution, drawing on a range of empirical evidence from Iran and China. Our paper focus for analyzing the data is on the following concepts: 1. Urban design and planning principles and practices 2. Infrastructure efficiency and optimization strategies 3. Public transportation systems and their environmental impact 4. GHG emissions reduction strategies in urban areas 5. Case studies and best practices in sustainable urban development This paper employs a mixed methodology approach with a focus on developmental and applicative purposes. The mixed methods approach combines both quantitative and qualitative research methods to provide a more comprehensive understanding of the research topic. A group of 20 architectural specialists and experts who are proficient in the field of research, design, and implementation of green architecture projects were interviewed in a systematic and purposeful manner. The research method was based on content analysis using MAXQDA2020 software. The findings suggest that policymakers and urban planners should consider the potential impacts of infrastructure on air pollution and take measures to mitigate negative effects while maximizing positive ones. This includes adopting a nature-based approach to urban planning and infrastructure development, investing in information infrastructure, and promoting modern logistic transport infrastructure.

Keywords: GHG emissions, infrastructure efficiency, urban development, urban design

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Authors: Jihane Saad, Thomas Lendormi, Caroline Le Marechal, Anne-marie Pourcher, Céline Druilhe, Jean-louis Lanoiselle

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Agricultural anaerobic digestion consists in the conversion of animal slurry and manure into biogas and digestate. They need, however, to be treated at 70 ºC during 60 min before anaerobic digestion according to the European regulation (EC n°1069/2009 & EU n°142/2011). The impact of such heat treatment on the outcome of bacteria has been poorly studied up to now. Moreover, a recent study¹ has shown that enterococci and clostridia are still detected despite the application of such thermal treatment, questioning the relevance of this approach for the hygienisation of digestate. The aim of this study is to establish the heat inactivation kinetics of two species of enterococci (Enterococcus faecalis and Enterococcus faecium) and two species of clostridia (Clostridioides difficile and Clostridium novyi as a non-toxic model for Clostridium botulinum of group III). A pure culture of each strain was prepared in a specific sterile medium at concentration of 10⁴ – 10⁷ MPN / mL (Most Probable number), depending on the bacterial species. Bacterial suspensions were then filled in sterilized capillary tubes and placed in a water or oil bath at desired temperature for a specific period of time. Each bacterial suspension was enumerated using a MPN approach, and tests were repeated three times for each temperature/time couple. The inactivation kinetics of the four indicator bacteria is described using the Weibull model and the classical Bigelow model of first-order kinetics. The Weibull model takes biological variation, with respect to thermal inactivation, into account and is basically a statistical model of distribution of inactivation times as the classical first-order approach is a special case of the Weibull model. The heat treatment at 70 ºC / 60 min contributes to a reduction greater than 5 log10 for E. faecium and E. faecalis. However, it results only in a reduction of about 0.7 log10 for C. difficile and an increase of 0.5 log10 for C. novyi. Application of treatments at higher temperatures is required to reach a reduction greater or equal to 3 log10 for C. novyi (such as 30 min / 100 ºC, 13 min / 105 ºC, 3 min / 110 ºC, and 1 min / 115 ºC), raising the question of the relevance of the application of heat treatment at 70 ºC / 60 min for these spore-forming bacteria. To conclude, the heat treatment (70 ºC / 60 min) defined by the European regulation is sufficient to inactivate non-sporulating bacteria. Higher temperatures (> 100 ºC) are required as far as spore-forming bacteria concerns to reach a 3 log10 reduction (sporicidal activity).

Keywords: heat treatment, enterococci, clostridia, inactivation kinetics

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Authors: Nelson R. Osungbemiro, O. A. Bello-Olusoji, M. Oladipupo

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This study was carried out to determine the effects of probiotics Pseudomonas fluorescens on the growth performance, histology examination and immune modulation of African Catfish, (Clarias gariepinus) challenged with Clostridium botulinum. P. fluorescens, and C. botulinum isolates were removed from the gut, gill and skin organs of procured adult samples of Clarias gariepinus from commercial fish farms in Akure, Ondo State, Nigeria. The physical and biochemical tests were performed on the bacterial isolates using standard microbiological techniques for their identification. Antibacterial activity tests on P. fluorescens showed inhibition zone with mean value of 3.7 mm which indicates high level of antagonism. The experimental diets were prepared at different probiotics bacterial concentration comprises of five treatments of different bacterial suspension, including the control (T1), T2 (10³), T3 (10⁵), T4 (10⁷) and T5 (10⁹). Three replicates for each treatment type were prepared. Growth performance and nutrients utilization indices were calculated. The proximate analysis of fish carcass and experimental diet was carried out using standard methods. After feeding for 70 days, haematological values and histological test were done following standard methods; also a subgroup from each experimental treatment was challenged by inoculating Intraperitonieally (I/P) with different concentration of pathogenic C. botulinum. Statistically, there were significant differences (P < 0.05) in the growth performance and nutrient utilization of C. gariepinus. Best weight gain and feed conversion ratio were recorded in fish fed T4 (10⁷) and poorest value obtained in the control. Haematological analyses of C. gariepinus fed the experimental diets indicated that all the fish fed diets with P. fluorescens had marked significantly (p < 0.05) higher White Blood Cell than the control diet. The results of the challenge test showed that fish fed the control diet had the highest mortality rate. Histological examination of the gill, intestine, and liver of fish in this study showed several histopathological alterations in fish fed the control diets compared with those fed the P. fluorescens diets. The study indicated that the optimum level of P. fluorescens required for C. gariepinus growth and white blood cells formation is 10⁷ CFU g⁻¹, while carcass protein deposition required 10⁵ CFU g⁻¹ of P. fluorescens concentration. The study also confirmed P. fluorescens as efficient probiotics that is capable of improving the immune response of C. gariepinus against the attack of a virulent fish pathogen, C. botulinum.

Keywords: Clarias gariepinus, Clostridium botulinum, probiotics, Pseudomonas fluorescens

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Authors: Misheck Musokwa, Paramu Mafongoya, Simon Lorentz

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Seasonal shortages of fodder during the dry season is a major constraint to smallholder livestock farmers in South Africa. To mitigate the shortage of fodder, legume trees can be intercropped with pastures which can diversify the sources of feed and increase the amount of protein for grazing animals. The objective was to evaluate dry matter yield of Panicum maximum and land productivity under different fodder production systems during 2016/17-2017/18 seasons at Empangeni (28.6391° S and 31.9400° E). A randomized complete block design, replicated three times was used, the treatments were sole Panicum maximum, Panicum maximum + Sesbania sesban, Panicum maximum + pigeonpea, sole Sesbania sesban, Sole pigeonpea. Three months S.sesbania seedlings were transplanted whilst pigeonpea was direct seeded at spacing of 1m x 1m. P. maximum seeds were drilled at a respective rate of 7.5 kg/ha having an inter-row spacing of 0.25 m apart. In between rows of trees P. maximum seeds were drilled. The dry matter yield harvesting times were separated by six months’ timeframe. A 0.25 m² quadrant randomly placed on 3 points on the plot was used as sampling area during harvesting P. maximum. There was significant difference P < 0.05 across 3 harvests and total dry matter. P. maximum had higher dry matter yield as compared to both intercrops at first harvest and total. The second and third harvest had no significant difference with pigeonpea intercrop. The results was in this order for all 3 harvest: P. maximum (541.2c, 1209.3b and 1557b) kg ha¹ ≥ P. maximum + pigeonpea (157.2b, 926.7b and 1129b) kg ha¹ > P. maximum + S. sesban (36.3a, 282a and 555a) kg ha¹. Total accumulation of dry matter yield of P. maximum (3307c kg ha¹) > P. maximum + pigeonpea (2212 kg ha¹) ≥ P. maximum + S. sesban (874 kg ha¹). There was a significant difference (P< 0.05) on seed yield for trees. Pigeonpea (1240.3 kg ha¹) ≥ Pigeonpea + P. maximum (862.7 kg ha¹) > S.sesbania (391.9 kg ha¹) ≥ S.sesbania + P. maximum. The Land Equivalent Ratio (LER) was in the following order P. maximum + pigeonpea (1.37) > P. maximum + S. sesban (0.84) > Pigeonpea (0.59) ≥ S. Sesbania (0.57) > P. maximum (0.26). Results indicates that it is beneficial to have P. maximum intercropped with pigeonpea because of higher land productivity. Planting grass with pigeonpea was more beneficial than S. sesban with grass or sole cropping in terms of saving the shortage of arable land. P. maximum + pigeonpea saves a substantial (37%) land which can be subsequently be used for other crop production. Pigeonpea is recommended as an intercrop with P. maximum due to its higher LER and combined production of livestock feed, human food, and firewood. Panicum grass is low in crude protein though high in carbohydrates, there is a need for intercropping it with legume trees. A farmer who buys concentrates can reduce costs by combining P. maximum with pigeonpea this will provide a balanced diet at low cost.

Keywords: fodder, livestock, productivity, smallholder farmers

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Authors: Herlin Vallejo, Jhon Osorio

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Quality is a concept that has gained importance in different scenarios over time, especially in the area of health. The nursing staff is one of the actors that contributes most to the care process and the satisfaction of the users in the evaluation of quality. However, until now, there are few tools to measure the quality of care in specialized performance scenarios. Patients receiving ambulatory cancer treatments can face various problems, which can increase their level of distress, so improving the quality of outpatient care for cancer patients should be a priority for oncology nursing. The experience of the patient in relation to the care in these services has been little investigated. The purpose of this study was to understand the perception that patients have about quality care in outpatient chemotherapy services. A qualitative, exploratory, descriptive study was carried out in 9 patients older than 18 years, diagnosed with cancer, who were treated at the Institute of Cancerology, in outpatient chemotherapy rooms, with a minimum of three months of treatment with curative intention and which had given your informed consent. The total of participants was determined by the theoretical saturation, and the selection of these was for convenience. Unstructured interviews were conducted, recorded and transcribed. The analysis of the information was done under the technique of content analysis. Three categories emerged that reflect the perception that patients have regarding quality care: patient-centered care, care with love and effects of care. Patients highlighted situations that show that care is centered on them, incorporating elements of patient-centered care from the institutional, infrastructure, qualities of care and what for them, in contrast, means inappropriate care. Care with love as a perception of quality care means for patients that the nursing staff must have certain qualities, perceive caring with love as a family affair, limits on care with love and the nurse-patient relationship. Quality care has effects on both the patient and the nursing staff. One of the most relevant effects was the confidence that the patient develops towards the nurse, besides to transform the unreal images about cancer treatment with chemotherapy. On the other hand, care with quality generates a commitment to self-care and is a facilitator in the transit of oncological disease and chemotherapeutic treatment, but from the perception of a healing transit. It is concluded that care with quality from the perception of patients, is a construction that goes beyond the structural issues and is related to an institutional culture of quality that is reflected in the attitude of the nursing staff and in the acts of Care that have positive effects on the experience of chemotherapy and disease. With the results, it contributes to better understand how quality care is built from the perception of patients and to open a range of possibilities for the future development of an individualized instrument that allows evaluating the quality of care from the perception of patients with cancer.

Keywords: nursing care, oncology service hospital, quality management, qualitative studies

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Authors: Ashok K. Gupta

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Over the past few decades, since the bio-engineering revolution, autologous cell therapy (ACT) has become a rapidly evolving field. Currently, this form of therapy has broad applications in modern medicine and plastic surgery, ranging from the treatment/improvement of wound healing to life-saving operations. A study was conducted on 50 patients having to disfigure, and deform post burn scars and was treated by injection of extracted, refined adipose tissue grafts with their unique stem cell properties. To compare the outcome, a control of 20 such patients was treated with conventional skin or soft-tissue flaps or skin grafting, and a control of 10 was treated with more advanced microsurgical techniques such as Pre-fabricated flaps/pre laminated flaps / free flaps. Assessment of fat volume and survival post- follow up period was done by radiological aid, using MRI and clinically (Survival of the autograft and objective parameters for scar elasticity were evaluated skin elasticity parameters 3 to 9 months postoperatively). Recently, an enzyme that is involved in collagen crosslinking in fibrotic tissue, lysyl hydroxylase (LH2), was identified. This enzyme is normally active in bone and cartilage but hardly in the skin. It has been found that this enzyme is highly expressed in scar tissue and subcutaneous fat; this is in contrast to the dermis, where the enzyme is hardly expressed. Adipose tissue-derived stem cell injections are an effective method in the treatment of various extensive post-burn scar deformities that makes it possible to re-create the lost sub-dermal tissue for improvement in the function of involved joint movements.

Keywords: adipose tissue-derived stem cell injections, treatment of various extensive post-burn scar deformities, re-create the lost sub-dermal tissue, improvement in function of involved joint movements

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Authors: Puneet Goyal, Aarti Agarwal

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Background and Objective: Nutritional support is an integral part of palliative care of advanced non-resectable abdominal malignancy patients, though is frequently neglected aspect. Non-Healing high output Entero-cutaneous fistulas sometimes require long term parenteral nutrition, to take care of catabolism and replacement of nutrients. We present a case of inoperable pancreatic malignancy with high output entero-cutaneous fistula, which was provided parenteral nutritional support with the use of Totally Implantable Venous Access Device (TIVAD). Method and Results: 55 year old man diagnosed with carcinoma pancreas had developed high entero-cutaneous fistula. His tumor was found to be inoperable and was on total parenteral nutrition through routine central line. This line was difficult to maintain as he required it for a long term TPN. He was planned to undergo Totally Implantable Venous Access Device (TIVAD) implantation. 8Fr single lumen catheter with Groshong non-return Valve (Bard Access Systems, Inc. USA) was inserted through right internal jugular vein, under fluoroscopic guidance. The catheter was tunneled subcutaneously and brought towards infraclavicular pocket, cut at appropriate length and connected to port and locked. Port was sutured in floor of pocket. Free flow of blood aspirated, flushed with heparinized saline. There was no kink observed in entire length of catheter under fluoroscopy. Skin over infraclavicular pocket was sutured. Long term catheter care and associated risks were explained to patient and relatives. Patient continued to receive total parenteral nutrition as well as other supportive therapy though TIVAD for next 6 weeks, till his demise. Conclusion: TIVADs are standard of care for long term venous access solutions in cancer patients requiring chemotherapy. In this case, we extended its use for providing parenteral nutrition and other supportive therapy. TIVADs can be implanted in advanced cancer patients for providing venous access solution required for various palliative treatments and medications. This will help in improving quality of life and satisfaction amongst terminally ill cancer patients.

Keywords: parenteral nutrition, totally implantable venous access device, long term venous access, interventions in anesthesiology

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Authors: Changaiz Khan

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Pakistan has the highest rates of maternal mortality in South Asia. From the year 2000 to 2017 the global rate of maternal mortality has decreased up to 39 %. In the context of South Asia, it has decreased by 59% since 2000s. Pakistan has also reduced the rate of maternal mortality, but there is a difference on the provincial level. According to the report of the National Institute of Population Studies (NIPS) conducted in 2020, the MMR in Balochistan has crossed the ratio of most of the South Asian countries, i.e., 298 maternal deaths per 100,000 live births. In comparison, the province of Punjab has the lowest maternal mortality rate i.e. 157 deaths (per 100,000 live births). The rate of maternal mortality is much higher in Balochistan as compared to the other provinces. This research is aimed to discuss the supply side barriers and utilization of maternal healthcare services in the District Gwadar. Likert scale survey method has been used to collect data from the Healthcare Professionals from hospitals -private and government- and the maternal healthcare receiver, that is patient. Semi-structured interviews of healthcare professionals such as doctors, nurses, and Lab technicians have also been conducted. It has been found in this research study that the hospitals in Gwadar district are lagging behind in providing modern maternal healthcare to women due to the lack of staff training, medicine supply, and Laboratories. Moreover, the system of the lady health worker is also not catering to the needs of the women in District Gwadar. It has been recommended in the study that first of all the government should fulfill the supply of the medicine in the hospital. Secondly, the government should open laboratories in the hospitals. Thirdly, the government should increase the funding of the government hospital and the allocation of lady health workers in District Gwadar, Balochistan should be increased.

Keywords: maternal mortality, neonatal, postnatal, supply barriers, patients, healthcare professionals, laboratory, medical supply, training

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Authors: Yonwaba Atyosi, Moses Cho, Abel Ramoelo, Nobuhle Majozi, Cecilia Masemola, Yoliswa Mkhize

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Spectroscopy has been widely used to understand the hyperspectral remote sensing of soils. Accurate and efficient measurement of soil moisture is essential for precision agriculture. The aim of this study was to understand the spectral behavior of soil at different soil water content levels and identify the significant spectral bands for soil moisture content retrieval at field-scale. The study consisted of 60 soil samples from a maize farm, divided into four different treatments representing different moisture levels. Spectral signatures were measured for each sample in laboratory under artificial light using an Analytical Spectral Device (ASD) spectrometer, covering a wavelength range from 350 nm to 2500 nm, with a spectral resolution of 1 nm. The results showed that the absorption features at 1450 nm, 1900 nm, and 2200 nm were particularly sensitive to soil moisture content and exhibited strong correlations with the water content levels. Continuum removal was developed in the R programming language to enhance the absorption features of soil moisture and to precisely understand its spectral behavior at different water content levels. Statistical analysis using partial least squares regression (PLSR) models were performed to quantify the correlation between the spectral bands and soil moisture content. This study provides insights into the spectral behavior of soil at different water content levels and identifies the significant spectral bands for soil moisture content retrieval. The findings highlight the potential of spectroscopy for non-destructive and rapid soil moisture measurement, which can be applied to various fields such as precision agriculture, hydrology, and environmental monitoring. However, it is important to note that the spectral behavior of soil can be influenced by various factors such as soil type, texture, and organic matter content, and caution should be taken when applying the results to other soil systems. The results of this study showed a good agreement between measured and predicted values of Soil Moisture Content with high R2 and low root mean square error (RMSE) values. Model validation using independent data was satisfactory for all the studied soil samples. The results has significant implications for developing high-resolution and precise field-scale soil moisture retrieval models. These models can be used to understand the spatial and temporal variation of soil moisture content in agricultural fields, which is essential for managing irrigation and optimizing crop yield.

Keywords: soil moisture content retrieval, precision agriculture, continuum removal, remote sensing, machine learning, spectroscopy

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Authors: Shilpa Avarebeel

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Background: India is one of the seven identified countries in South-East Asia region, regularly reporting dengue infection and may soon transform into a major niche for dengue epidemics. Objective: To study the clinical profile of dengue in our setting with special reference to respiratory complication. Study design: Descriptive and exploratory study, for one year in 2014. All patients confirmed as dengue infection were followed and their clinical profile, along with outcome was determined. Study proforma was designed based on the objective of the study and it was pretested and used after modification. Data was analyzed using statistical software SPSS-Version 16. Data were expressed as mean ±S .D for parametric variables and actual frequencies or percentage for non-parametric data. Comparison between groups was done using students’ t-test for independent groups, Chie square test, one-way ANOVA test, Karl Pearson’s correlation test. Statistical significance is taken at P < 0.05. Results: Study included 134 dengue positive cases. 81% had dengue fever, 18% had dengue hemorrhagic fever, and one had dengue shock syndrome. Most of the cases reported were during the month of June. Maximum number of cases was in the age group of 26-35 years. Average duration of hospital stay was less than seven days. Fever and myalgia was present in all the 134 patients, 16 had bleeding manifestation. 38 had respiratory symptoms, 24 had breathlessness, and 14 had breathlessness and dry cough. On clinical examination of patients with respiratory symptoms, all twenty-eight had hypoxia features, twenty-four had signs of pleural effusion, and four had ARDS features. Chest x-ray confirmed the same. Among the patients with respiratory symptoms, the mean platelet count was 26,537 c/cmm. There was no statistical significant difference in the platelet count in those with ARDS and other dengue complications. Average four units of platelets were transfused to all those who had ARDS in view of bleeding tendency. Mechanical ventilator support was provided for ARDS patients. Those with pleural effusion and pulmonary oedema were given NIV (non-invasive ventilation) support along with supportive care. However, steroids were given to patients with ARDS and 10 patients with signs of respiratory distress. 100%. Mortality was seen in patients with ARDS. Conclusion: Dengue has to be checked for those presenting with fever and breathlessness. Supportive treatments remain the cornerstone of treatment. Platelet transfusion has to be given only by clinical judgment. Steroids have no role except in early ARDS, which is controversial. Early NIV support helps in speedy recovery of dengue patients with respiratory distress.

Keywords: adult respiratory distress syndrome, dengue fever, non-invasive ventilation, pulmonary complication

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