Search results for: high frequency data

Authors: Carmit Noa Shpigelman, Michal Isaacson

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Over the last decades, the improvement in welfare and health services and the increase in awareness of the needs of people with intellectual disability has led to an increase in their life expectancy, and many of them enter into old age. Furthermore, many older adults with intellectual disability live in out-of-home residence. This situation, in addition to the parents' aging process as the main caregivers, may lead to a reduction in contact with the family and, as a result, decreased level of the residents' (older adults with intellectual disability) well-being. A plausible solution for this condition may be using communication technologies. Previous studies indicate that using communication technologies among older adults contributes to maintaining the relationship with others, decreasing the older adult's sense of loneliness, and increasing their level of well-being. Using communication technologies may be especially valuable for older adults in the current global pandemic of COVID-19 and the associated restrictions of social distancing. However, to date, research on using communication technologies among people with intellectual disability has focused on younger cohorts. Moreover, research on the adoption of technologies among older adults with intellectual disability has focused more on assistive technologies and less on communication technologies. To address these practice and research gaps, the present study focuses on the adoption process of communication technology among older adults with intellectual disability (over the age of 45 years) who live in supported accommodation. Fifteen residents participated in an intervention program where they received a tablet with a video communication application and through which they were able to contact their families. A multiple-case study methodology was applied to capture the experiences, including barriers and needs, of the residents from three perspectives: the resident, the family member, and a staff member from the residential setting. The data was collected via quantitative and qualitative measures at different time points over the intervention. The findings demonstrate the contribution of using communication technology for the well-being of older adults with intellectual disability in supported accommodation. The findings also map the adoption process among this population, including pitfalls. The present study contributes to developing best practices on how to accommodate communication technologies to older adults with intellectual disability for maintaining contact with others.

Keywords: adoption, aging, communication, intellectual disability, technology

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Authors: Kousay Abid

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The aim of this paper is to better understand talent and talent management (TM) in small French companies as well as in medium-sized ones (SME). While previous empirical investigations have largely focused on multinationals and big companies and concentrated on the Anglo-Saxon context, we focus on the pressing need for implementing TM strategies and practices, not only on a new ground of SME but also within a new European context related to France and the French context. This study also aims at understanding strategies adopted by those firms as means to attract, retain, maintain and to develop talents. We contribute to TM issues by adopting a multilevel approach, holding the goal of reaching a global holistic vision of interactions between various levels while applying TM, to make it more and more familiar to us. A qualitative research methodology based on a multiple-case study design, bottomed firstly on a qualitative survey and secondly on two in-depth case study, both built on interviews, will be used in order to develop an ideal analysis for TM strategies and practices. The findings will be based on data collected from more than 15 French SMEs. Our theoretical contributions are the fruit of context considerations and the dynamic of multilevel approach. Theoretically, we attempt first to clarify how talents and TM are seen and defined in French SMEs and consequently to enrich the literature on TM in SMEs out of the Anglo-Saxon context. Moreover, we seek to understand how SMEs manage jointly their talents and their TM strategies by setting up this contextualized pilot study. As well, we focus on the systematic TM model issue from French SMEs. Our prior managerial goal is to shed light on the need for TM to achieve a better management of these organizations by directing leaders to better identify the talented people whom they hold at all levels. In addition, our TM systematic model strengthens our analysis grid as recommendations for CEO and Human Resource Development (HRD) to make them rethink about the companies’ HR business strategies. Therefore, our outputs present a multiple lever of action that should be taken into consideration while reviewing HR strategies and systems, as well as their impact beyond organizational boundaries.

Keywords: french context, multilevel approach, small and medium-sized enterprises, talent management

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Authors: Beverly Wang

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Background: Rosai-Dorfman disease (RDD), aka sinus histiocytosis with massive lymphadenopathy, is a rare, idiopathic histiocytic proliferative disorder. Although RDD can be seen involving the head and neck lymph nodes, rarely it can affect other extranodal sites. It present 3 unique cases of RDD affecting the nasal cavity, paranasal sinuses, and ear canal. The initial clinical presentation on two cases mimicked a malignant neoplasm. The 3rd case of RDD co-existed with a cholesteatoma of the ear canal. The clinical presentation, histology and immunohistochemical stains, and radiographic findings are discussed. Design: An overview of 3 cases of RDD affected sinonasal cavity and ear canal from UCI Medical Center was conducted. Case 1: A 61 year old male complaining of breathing difficulty presented with bilateral polypoid sinonasal masses and severe nasal obstruction. The masses elevated the nasal floor, and involved the anterior nasal septum to lateral wall. It was endoscopically excised. At intraoperative consultation, frozen section reported a pleomorphic spindle cell neoplasm with scattered large atypical spindle cells, resembling a high grade sarcoma. Case 2: A 46 year old male presented with recurrent bilateral maxillary chronic sinusitis with mass formation, clinically suspicious for malignant lymphoma. Excisional tissue sample showed large irregular spindled histiocytes with abundant granular and vacuolated cytoplasm. Case 3: A 36 year old female with a history of asthma initially presented with left-sided chronic otalgia, occasional nausea, vertigo, and fluctuating pain exacerbated by head movement and temperature changes. CT scan revealed an external auditory canal mass extending to the middle ear, coexisting with a small cholesteatoma. Results: The morphology of all cases revealed large atypical spindled histiocytes resembling fibrohistiocytic or myofibroblastic proliferative neoplasms. Scattered emperipolesis was seen. All 3 cases were confirmed as extranodal sinus RDD, confirmed by immunohistochemistry. The large atypical cells were positive for S100, CD68, and CD163. No evidence for malignancy was identified. Case 3 showed concurrent RDD co-existing with a cholesteatoma. Conclusion: Due to its rarity and variable clinical presentations, the diagnosis of RDD is seldom clinically considered. Extranodal sinus RDD morphologically can be pitfall as mimicker of spindly neoplasm, especially at intraoperative consultation. It can create diagnostic and therapeutic challenges. Correlation of radiological findings with histologic features will help to reach the diagnosis.

Keywords: head and neck, extranodal, rosai-dorfman disease, mimicker, immunohistochemistry

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Authors: Ahilya Singh, Brad Carte, Ramesh Subramani, William Aalbersberg

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A total of 37 actinomycete strains were purified from 25 Solomon Islands marine sediments using four different types of isolation media. Among them, 54% of the strains had obligate requirement of seawater for growth. The ethyl acetate extract of 100 ml fermentation product of each strain was screened for antimicrobial activity against multidrug resistant human pathogens and cytotoxic activity against brine shrimps. A total of 67% of the ethyl acetate extracts showed antimicrobial and/or cytotoxic activities. A strain F-1915 was selected for isolation and evaluation of bioactive compound(s) based on its bioactive properties and chemical profile analysis using the LC-MS. The strain F-1915 was identified to have 96% sequence similarity to Streptomyces violaceusniger on the basis of 16S rDNA sequences using BLAST analysis. The 16S rDNA revealed that the strain F-1915 is a new member of MAR4 clade of actinomycetes. The MAR4 clade is an interesting clade of actinomycetes known for the production of pharmaceutically important hybrid isoprenoid compounds. The ethyl acetate extract of the fermentation product of this strain was purified by silica gel column chromatography and afforded the isolation of one bioactive pure compound. Based on the 1D and 2D NMR spectral data of compound 1 it was identified as a new mono-brominated phenazinone, Marinophenazimycin A, a structure which has already been studied by external collaborators at Scripps Institution of Oceanography but is yet to be published. Compound 1 displayed significant antimicrobial activity against drug resistant human pathogens. The minimum inhibitory concentration (MIC) of compound 1 was against Methicillin Resistant Staphylococcus aureus (MRSA) was about 1.9 μg/ml and MIC recorded against Amphotericin Resistant Candida albicans (ARCA) was about 0.24 μg/ml. The bioactivity of compound 1 against ARCA was found to be better than the standard antifungal agent amphotericin B. Compound 1 however did not show any cytotoxic activity against brine shrimps.

Keywords: actinomycetes, antimicrobial activity, brominated phenazine, MAR4 clade, marine natural products, multidrug resistent, 1D and 2D NMR

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Authors: M. Zareh, H. Mohammadi, B. Naser

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Atherosclerotic plaque rupture is the main trigger of heart attack and brain stroke which are the leading cause of death in developed countries. Better understanding of rupture-prone plaque can help clinicians detect vulnerable plaques- rupture prone or instable plaques- and apply immediate medical treatment to prevent these life-threatening cardiovascular events. Therefore, there are plenty of studies addressing disclosure of vulnerable plaques properties. Necrotic core and fibrous tissue are two major tissues constituting atherosclerotic plaque; using histopathological and numerical approaches, many studies have demonstrated that plaque rupture is strongly associated with a large necrotic core and a thin fibrous cap, two morphological characteristic which can be acquired by two-dimensional imaging of atherosclerotic plaque present in coronary and carotid arteries. Plaque rupture is widely considered as a mechanical failure inside plaque tissue; this failure occurs when the stress within plaque excesses the strength of tissue material; hence, finite element method, a strong numerical approach, has been extensively applied to estimate stress distribution within plaques with different compositions which is then used for assessment of various vulnerability characteristics including plaque morphology, material properties and blood pressure. This study aims to evaluate significance of three-dimensional morphology on vulnerability degree of atherosclerotic plaque. To reach this end, different two-dimensional geometrical models of atherosclerotic plaques are considered based on available data and named Main 2D Models (M2M). Then, for each of these M2Ms, two three-dimensional idealistic models are created. These two 3D models represent two possible three-dimensional morphologies which might exist for a plaque with similar 2D morphology to one of M2Ms. Finite element method is employed to estimate stress, von-Mises stress, within each 3D models. Results indicate that for each M2Ms stress can significantly varies due to possible 3D morphological changes in that plaque. Also, our results show that an atherosclerotic plaque with thick cap may experience rupture if it has a critical 3D morphology. This study highlights the effect of 3D geometry of plaque on its instability degree and suggests that 3D morphology of plaque might be necessary to more effectively and accurately assess atherosclerotic plaque vulnerability.

Keywords: atherosclerotic plaque, plaque rupture, finite element method, 3D model

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Authors: Anna M. N. Shifotoka, Richard Walker, Katie Haighton, Richard McNally

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An analysis of trends in Case Notification Rates (CNR) can be used to monitor the impact of Tuberculosis (TB) control interventions over time in order to inform the implementation of current and future TB interventions. A retrospective analysis of trends in TB CNR for two urban regions in Namibia, namely Khomas and Erongo regions, was conducted. TB case notification data were obtained from annual TB reports of the national TB programme, Ministry of Health and Social Services, covering the period from 1997 to 2015. Joinpoint regression was used to analyse trends in CNR for different types of TB groups. A trend was considered to be statistically significant when a p-value was less than 0.05. During the period under review, the crude CNR for all forms of TB declined from 808 to 400 per 100 000 population in Khomas, and from 1051 to 611 per 100 000 population in Erongo. In both regions, significant change points in trends were observed for all types of TB groups examined. In Khomas region, the trend for new smear positive pulmonary TB increased significantly by an annual rate of 4.1% (95% Confidence Interval (CI): 0.3% to 8.2%) during the period 1997 to 2004, and thereafter declined significantly by -6.2% (95%CI: -7.7% to -4.3%) per year until 2015. Similarly, the trend for smear negative pulmonary TB increased significantly by 23.7% (95%CI: 9.7 to 39.5) per year from 1997 to 2004 and thereafter declined significantly by an annual change of -26.4% (95%CI: -33.1% to -19.8%). The trend for all forms of TB CNR in Khomas region increased significantly by 8.1% (95%CI: 3.7 to 12.7) per year from 1997 to 2004 and thereafter declined significantly a rate of -8.7% (95%CI: -10.6 to -6.8). In Erongo region, the trend for smear positive pulmonary TB increased at a rate of 1.2% (95%CI: -1.2% to 3.6%) annually during the earlier years (1997 to 2008), and thereafter declined significantly by -9.3% (95%CI: -13.3% to -5.0%) per year from 2008 to 2015. Also in Erongo, the trend for all forms of TB CNR increased significantly by an annual rate of 4.0% (95%CI: 1.4% to 6.6%) during the years between 1997 to 2006 and thereafter declined significantly by -10.4% (95%CI: -12.7% to -8.0%) per year during 2006 to 2015. The trend for extra-pulmonary TB CNR declined but did not reach statistical significance in both regions. In conclusion, CNRs declined for all types of TB examined in both regions. Further research is needed to study trends for other TB dimensions such as treatment outcomes and notification of drug resistant TB cases.

Keywords: epidemiology, Namibia, temporal trends, tuberculosis

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Authors: Elena Carcano, James Ball, Betty Tiko

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Carrying capacity refers to the maximum population that a given level of resources can sustain over a specific period. In undisturbed environments, the maximum population is determined by the availability and distribution of resources, as well as the competition for their utilization. This information is typically obtained through long-term data collection. In regulated environments, where resources are artificially modified, populations must adapt to changing conditions, which can lead to additional challenges due to fluctuations in resource availability over time and throughout development. An example of this is observed in hydropower plants, which alter water flow and impact fish migration patterns and behaviors. To assess how fish species can adapt to these changes, specialized surveys are conducted, which provide valuable information on fish populations, sample sizes, and density before and after flow modifications. In such situations, it is highly recommended to conduct hydrological and biological monitoring to gain insight into how flow reductions affect species adaptability and to prevent unfavorable exploitation conditions. This analysis involves several planned steps that help design appropriate hydropower production while simultaneously addressing environmental needs. Consequently, the study aims to strike a balance between technical assessment, biological requirements, and societal expectations. Beginning with a small hydro project that requires restoration, this analysis focuses on the lower tail of the Flow Duration Curve (FDC), where both hydrological and environmental goals can be met. The proposed approach involves determining the threshold condition that is tolerable for the most vulnerable species sampled (Telestes Muticellus) by identifying a low flow value from the long-term FDC. The results establish a practical connection between hydrological and environmental information and simplify the process by establishing a single reference flow value that represents the minimum environmental flow that should be maintained.

Keywords: carrying capacity, fish bypass ladder, long-term streamflow duration curve, eta-beta method, environmental flow

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Authors: Matthew Cameron, Stephen Yang, Latifa Al Kharusi, Adam Gosselin, Anissa Chirico, Pouya Gholipour Baradari

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Background: Iron supplementation has been evaluated in several randomized controlled trials (RCTs) for the potential to increase baseline hemoglobin and decrease the incidence of red blood cell (RBC) transfusion during cardiac surgery. This study's main objective was to evaluate the evidence for iron administration in cardiac surgery patients for its effect on the incidence of perioperative RBC transfusion. Methods: This systematic review protocol was registered with PROSPERO (CRD42020161927) on Dec. 19th, 2019, and was prepared as per the PRISMA guidelines. MEDLINE, EMBASE, CENTRAL, Web of Science databases, and Google Scholar were searched for RCTs evaluating perioperative iron administration in adult patients undergoing cardiac surgery. Each abstract was independently reviewed by two reviewers using predefined eligibility criteria. The primary outcome was perioperative RBC transfusion, with secondary outcomes of the number of RBC units transfused, change in ferritin level, reticulocyte count, hemoglobin, and adverse events, after iron administration. The risk of bias was assessed with the Cochrane Collaboration Risk of Bias Tool, and the primary and secondary outcomes were analyzed with a random-effects model. Results: Out of 1556 citations reviewed, five studies (n = 554 patients) met the inclusion criteria. The use of iron demonstrated no difference in transfusion incidence (RR 0.86; 95% CI 0.65 to 1.13). There was a low heterogeneity between studies (I²=0%). The trial sequential analysis suggested an optimal information size of 1132 participants, which the accrued information size did not reach. Conclusion: The current literature does not support the routine use of iron supplementation before cardiac surgery; however, insufficient data is available to draw a definite conclusion. A critical knowledge gap has been identified, and more robust RCTs are required on this topic.

Keywords: cardiac surgery, iron, iron supplementation, perioperative medicine, meta-analysis, systematic review, randomized controlled trial

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Authors: Fatemeh Dehghan Khangahi, Hakan Gunes

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Transforming a public necessity into a commercial commodity becomes more and more evident as time goes on, and it is one of the issues of water shortage. Development projects of countries, consume the water and waterbeds in various forms, ignoring the concepts such as sustainability and the negative effects they place on the environment, pollute and change the ways of waterways. Throughout these processes, the water basins and all the vital environments sometimes can suffer damage to the irreparable level. In this context, the issue of Lake Urmia that is located in the North West of Iran left alone by drought, has been researched. The lake, which is on the list of UNESCO's biosphere reserves, is now exposed to the danger of desiccation. If the desiccation is fully realized, more than 5.000.000 people that they are living around the lake, will have to migrate as a result of negative living conditions. As a matter of fact, along with the recent years of increasing drought level, regional migrations have begun. In addition to migration issues, it is also necessary to specify the negative effects on human and all-round’s life that depend on the formation of salt storms, mixing of salt into the air and soil, which threaten human health seriously because the lake is salty. The main aim of this work is to raise national and international awareness of this problem, which is an environment and a human tragedy at the same time. This research has two basic questions: 1) In the case of Lake Urmia, what are environmental problems and how they have emerged and what is the role of governments? 2) What is the social consequence of this problem in relation to the first question? In response, after the literature search, having a comparative view of the situation of the Aral Sea and the Great Salt Lake (Utah, USA), which involved the two major international examples. The first, one is related to the terms of population and migration, the second is about biological properties. Then, data and status information that provided after 3 years area research has been evaluated. Towards the end, with the support of qualitative and quantitative methods, the study of social mobilization in the region has been carried out. An example of it is using the public space of TRAXTOR matches like a protests area.

Keywords: environment problems, water, social mobilization, Lake Urmia, migration

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Authors: Ayhan Cinici, Mustafa Ozden, Umit Duruk, Gulden Akdag

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The purpose of this study was to investigate how feedbacks left from two different sources (mentors and peers) during microteaching sessions effecting preservice teachers’ teaching skills and views on science teaching. Sampling process is twofold in the study. As part of qualitative research, among other counterparts, case study method was chosen and respectively, constructed six working groups in which there were six preservice teachers, totally from thirty six preservice teachers enrolled in the third grade of Elementary Education Department by random assignment. Subsequently, one preservice teacher from all groups was appointed as the moderator of those groups (totally six moderators). Rest of them taking part remained as audience in all groups. At the beginning of the instructional process, all participants were asked to watch some videos by which someone already recorded. After watching these videos, they were also given a chance to discuss their ideas and impressions regarding microteaching in the classroom atmosphere. Both academic staff as mentors and participants as preservice teachers took role in the process of determining which teaching skills would be taken into consideration as part of microteaching sessions. Each group were gathered at regular intervals throughout twelve weeks together with their mentor who guided them and performed their microteaching. Data was collected using reflective diaries by which researchers constructed for both preservice teachers playing role as teacher of the group and preservice teachers playing role as audience during these microteaching sessions. Semi structured interviews were also carried out with only preservice teachers playing role as teachers of the groups. Findings from these reflective diaries and semi structured interviews were analysed by descriptive statistics and content analysis method. With regard to these findings, explanatory themes and subthemes were categorized and supported by direct citations. The results reveal that preservice teachers playing role as the teachers of the each group consider “content knowledge” as the most important aspect among other teaching skills. Furthermore, preservice teachers also point out that the more they get feedback on any teaching skill, the more they get motivated to develop it.

Keywords: teacher education, microteaching, mentor, peer feedback

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Authors: Bastien Sanglard, Simon Cayez, Guillaume Viau, Thomas Blon, Julian Carrey, Sébastien Lachaize

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The need to develop clean production processes is a key challenge of any industry. Steel and iron industries are particularly concerned since they emit 6.8% of global anthropogenic greenhouse gas emissions. One key step of the process is the high-temperature reduction of iron ore using coke, leading to large amounts of CO2 emissions. One route to decrease impacts is to get rid of fossil fuels by changing both the heat source and the reducer. The present work aims at investigating experimentally the possibility to use concentrated solar energy and carbon-free reducing agents. Two sets of experimentations were realized. First, in situ X-ray diffraction on pure and industrial powder of hematite was realized to study the phase evolution as a function of temperature during reduction under hydrogen and ammonia. Secondly, experiments were performed on industrial iron ore pellets, which were reduced by NH3 or H2 into a “solar furnace” composed of a controllable 1600W Xenon lamp to simulate and control the solar concentrated irradiation of a glass reactor and of a diaphragm to control light flux. Temperature and pressure were recorded during each experiment via thermocouples and pressure sensors. The percentage of iron oxide converted to iron (called thereafter “reduction ratio”) was found through Rietveld refinement. The power of the light source and the reduction time were varied. Results obtained in the diffractometer reaction chamber show that iron begins to form at 300°C with pure Fe2O3 powder and 400°C with industrial iron ore when maintained at this temperature for 60 minutes and 80 minutes, respectively. Magnetite and wuestite are detected on both powders during the reduction under hydrogen; under ammonia, iron nitride is also detected for temperatures between400°C and 600°C. All the iron oxide was converted to iron for a reaction of 60 min at 500°C, whereas a conversion ratio of 96% was reached with industrial powder for a reaction of 240 min at 600°C under hydrogen. Under ammonia, full conversion was also reached after 240 min of reduction at 600 °C. For experimentations into the solar furnace with iron ore pellets, the lamp power and the shutter opening were varied. An 83.2% conversion ratio was obtained with a light power of 67 W/cm2 without turning over the pellets. Nevertheless, under the same conditions, turning over the pellets in the middle of the experiment permits to reach a conversion ratio of 86.4%. A reduction ratio of 95% was reached with an exposure of 16 min by turning over pellets at half time with a flux of 169W/cm2. Similar or slightly better results were obtained under an ammonia reducing atmosphere. Under the same flux, the highest reduction yield of 97.3% was obtained under ammonia after 28 minutes of exposure. The chemical reaction itself, including the solar heat source, does not produce any greenhouse gases, so solar metallurgy represents a serious way to reduce greenhouse gas emission of metallurgy industry. Nevertheless, the ecological impact of the reducers must be investigated, which will be done in future work.

Keywords: solar concentration, metallurgy, ammonia, hydrogen, sustainability

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Authors: Rofida Gamal, Mostafa Mohammed, Mariam Adel, Marwa Gamal, Marwa kamal, Ayat Saber, Maha Mamdouh, Amira Emad, Mai Ramadan

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Lynch Syndrome is an inherited genetic condition associated with an increased risk of colorectal and other cancers. Detecting Lynch Syndrome in individuals is crucial for early intervention and preventive measures. This study proposes a computational pipeline for Lynch Syndrome detection by integrating alignment, variant calling, and annotation. The pipeline leverages popular tools such as FastQC, Trimmomatic, BWA, bcftools, and ANNOVAR to process the input FASTQ file, perform quality trimming, align reads to the reference genome, call variants, and annotate them. It is believed that the computational pipeline was applied to a dataset of Lynch Syndrome cases, and its performance was evaluated. It is believed that the quality check step ensured the integrity of the sequencing data, while the trimming process is thought to have removed low-quality bases and adaptors. In the alignment step, it is believed that the reads were accurately mapped to the reference genome, and the subsequent variant calling step is believed to have identified potential genetic variants. The annotation step is believed to have provided functional insights into the detected variants, including their effects on known Lynch Syndrome-associated genes. The results obtained from the pipeline revealed Lynch Syndrome-related positions in the genome, providing valuable information for further investigation and clinical decision-making. The pipeline's effectiveness was demonstrated through its ability to streamline the analysis workflow and identify potential genetic markers associated with Lynch Syndrome. It is believed that the computational pipeline presents a comprehensive and efficient approach to Lynch Syndrome detection, contributing to early diagnosis and intervention. The modularity and flexibility of the pipeline are believed to enable customization and adaptation to various datasets and research settings. Further optimization and validation are believed to be necessary to enhance performance and applicability across diverse populations.

Keywords: Lynch Syndrome, computational pipeline, alignment, variant calling, annotation, genetic markers

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Authors: Chih-Rong Shyr, Chi-Ping Huang

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Intravesical BCG is the gold-standard therapy for high risk non-muscle invasive bladder cancer (NMIBC) after TURBT, but if not responsive to BCG, these BCG unresponsive patients face cystectomy that causes morbidity and comes with a morality risk. To provide the bladder sparing options for patients with BCG-unresponsive NMIBC, several new treatments have been developed to salvage the bladders and prevent progression to muscle invasive or metastatic, but however, most approved or developed treatments still fail in a significant proportion of patients without long term success. Thus more treatment options and the combination of different therapeutic modalities are urgently needed to change the outcomes. Xenogeneic rejection has been proposed to a mechanism of action to induce anti-tumor immunity for the treatment of cancers due to the similarities between rejection mechanism to xenoantigens (proteins, glycans and lipids) and anti-tumor immunities to tumor specific antigens (neoantigens, tumor associated carbohydrates and lipids). Xenogeneic urothelial cells (XUC) of porcine origin have been shown to induce anti-tumor immune responses to inhibit bladder tumor progression in mouse bladder cancer models. To further demonstrate the efficacy of the distinct intravesical XUC treatment in NMIBC, and the combined effects with chemotherapy and immune checkpoint inhibitors (ICIs) as a alternate therapeutic option, this study investigated the therapeutic effects and mechanisms of intravesical XUC immunotherapy in an orthotopic mouse immune competent model of NMIBC, generated from a mouse bladder cancer cell line. We found that the tumor progression was inhibited by intravescial XUC treatment and there was a synergy between intravesical XUC with intravesical chemotherapeutic agent, gemcitabine or systemic ICI, anti-PD1 antibody treatment. The cancer cell proliferation was decreased but the cell death was increased by the intravecisal XUC treatment. Most importantly, the mechanisms of action of intravesical XUC immunotherapy were found to be linked to enhanced infiltration of CD4+ and CD8+ T-cell as well as NK cells, but decreased presence of myeloid immunosuppressive cells in XUC treated tumors. The increased stimulation of immune cells of XUC treated mice to xenogeneic urothelial cells and mouse bladder cancer cells in immune cell proliferation and cytokine secretion were observed both as a monotherapy and in combination with intravesical gemcitabine or systemic anti PD-L1 treatment. In sum, we identified the effects of intravesical XUC treatment in monotherapy and combined therapy on tumor progression and its cellular and molecular events related to immune activation to understand the anti-tumoral mechanisms behind intravesical XUC immunotherapy for NMIBC. These results contribute to the understanding of the mechanisms behind successful xenogeneic cell immunotherapy against NMIBC and characterize a novel therapeutic approach with a new xenogeneic cell modality for BCG-unresponsive NMIBC.

Keywords: xenoantigen, neoantigen, rejection, immunity

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Authors: Piyush Sharma, Laltu Chandra, P. S. Ghoshdastidar, Rajiv Shekhar

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Metals processing operations such as melting and heat treatment of metals are energy-intensive, requiring temperatures greater than 500oC. The desired temperature in these industrial furnaces is attained by circulating electrically-heated air. In most of these furnaces, electricity produced from captive coal-based thermal power plants is used. Solar thermal energy could be a viable heat source in these furnaces. A retrofitted solar convective furnace (SCF) concept, which uses solar thermal generated hot air, has been proposed. Critical to the success of a SCF is the design of an open volumetric air receiver (OVAR), which can heat air in excess of 800oC. The OVAR is placed on top of a tower and receives concentrated solar radiation from a heliostat field. Absorbers, mixer assembly, and the return air flow chamber (RAFC) are the major components of an OVAR. The absorber is a porous structure that transfers heat from concentrated solar radiation to ambient air, referred to as primary air. The mixer ensures uniform air temperature at the receiver exit. Flow of the relatively cooler return air in the RAFC ensures that the absorbers do not fail by overheating. In an earlier publication, the detailed design basis, fabrication, and characterization of a 2 kWth open volumetric air receiver (OVAR) based laboratory solar air tower simulator was presented. Development of an experimentally-validated, CFD based mathematical model which can ultimately be used for the design and scale-up of an OVAR has been the major objective of this investigation. In contrast to the published literature, where flow and heat transfer have been modeled primarily in a single absorber module, the present study has modeled the entire receiver assembly, including the RAFC. Flow and heat transfer calculations have been carried out in ANSYS using the LTNE model. The complex return air flow pattern in the RAFC requires complicated meshes and is computational and time intensive. Hence a simple, realistic 1-D mathematical model, which circumvents the need for carrying out detailed flow and heat transfer calculations, has also been proposed. Several important results have emerged from this investigation. Circumferential electrical heating of absorbers can mimic frontal heating by concentrated solar radiation reasonably well in testing and characterizing the performance of an OVAR. Circumferential heating, therefore, obviates the need for expensive high solar concentration simulators. Predictions suggest that the ratio of power on aperture (POA) and mass flow rate of air (MFR) is a normalizing parameter for characterizing the thermal performance of an OVAR. Increasing POA/MFR increases the maximum temperature of air, but decreases the thermal efficiency of an OVAR. Predictions of the 1-D mathematical are within 5% of ANSYS predictions and computation time is reduced from ~ 5 hours to a few seconds.

Keywords: absorbers, mixer assembly, open volumetric air receiver, return air flow chamber, solar thermal energy

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Authors: Kunkanit Sutamchai, Kate E. Rowlands

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Recent public ethical scandals in many organizations around the world have raised concern about organizational ethics, which have, in turn, made ethical behaviors and conducts on the part of leaders become more critical topics in organizational studies. However, current research on the benefits of mindfulness within the workplace contexts has predominantly focused on stress reduction and work performance enhancement, while the aspects of ethical behavior development have been far less investigated in mindfulness research in the organizational and management fields. Only recently has there been an emerging call for organizational researchers and practitioners to study mindfulness concepts and practices from the original Buddhist perspectives given that ethics is regarded as a foundation for Buddhist mindfulness. Yet little, if any, empirical research on the contributions of mindfulness practices to ethical leadership has been done in Eastern Buddhist contexts. Therefore, this study aims to explore the extent to which and how Buddhist-based mindfulness practices can influence organizational leaders’ ethical values and practices. On this basis, Thailand was selected as a context of study due to a predominantly Buddhist society and culture. Qualitative data were gathered through in-depth semi-structured interviews with twenty executive leaders from various private organizations in Thailand, who practice Buddhist-based mindfulness meditation regularly. The findings from this study shed light on the role Buddhist-based mindfulness practices can play in promoting ethical behavior among executive leaders in Thailand. The results also suggest that ethical values and practices influenced by Buddhist-based mindfulness practices are well aligned with the elements appeared in the inter-disciplinary and cross-cultural ethical leadership framework, namely: humane, justice, sustainability and responsibility, and moderation. This study concludes that the integration of ethical dimensions to mindfulness practices may provide promising opportunities for ethical leadership development, particularly in the context of Thailand. This could contribute significantly to the future development of both organizations and society at large. The study also suggests that mindfulness interventions in organizational contexts should place more explicit emphasis on ethics. This may be done by relating the ethical principles underlying Buddhist-based mindfulness to other ethical systems in different contexts and cultures where they can be aligned.

Keywords: Buddhism, ethical leadership, leadership development, mindfulness, Thailand, training

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Authors: Uraib Sharaha, Ahmad Salman, Eladio Rodriguez-Diaz, Elad Shufan, Klaris Riesenberg, Irving J. Bigio, Mahmoud Huleihel

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Antimicrobial drugs have played an indispensable role in controlling illness and death associated with infectious diseases in animals and humans. However, the increasing resistance of bacteria to a broad spectrum of commonly used antibiotics has become a global healthcare problem. Many antibiotics had lost their effectiveness since the beginning of the antibiotic era because many bacteria have adapted defenses against these antibiotics. Rapid determination of antimicrobial susceptibility of a clinical isolate is often crucial for the optimal antimicrobial therapy of infected patients and in many cases can save lives. The conventional methods for susceptibility testing require the isolation of the pathogen from a clinical specimen by culturing on the appropriate media (this culturing stage lasts 24 h-first culturing). Then, chosen colonies are grown on media containing antibiotic(s), using micro-diffusion discs (second culturing time is also 24 h) in order to determine its bacterial susceptibility. Other methods, genotyping methods, E-test and automated methods were also developed for testing antimicrobial susceptibility. Most of these methods are expensive and time-consuming. Fourier transform infrared (FTIR) microscopy is rapid, safe, effective and low cost method that was widely and successfully used in different studies for the identification of various biological samples including bacteria; nonetheless, its true potential in routine clinical diagnosis has not yet been established. The new modern infrared (IR) spectrometers with high spectral resolution enable measuring unprecedented biochemical information from cells at the molecular level. Moreover, the development of new bioinformatics analyses combined with IR spectroscopy becomes a powerful technique, which enables the detection of structural changes associated with resistivity. The main goal of this study is to evaluate the potential of the FTIR microscopy in tandem with machine learning algorithms for rapid and reliable identification of bacterial susceptibility to antibiotics in time span of few minutes. The UTI E.coli bacterial samples, which were identified at the species level by MALDI-TOF and examined for their susceptibility by the routine assay (micro-diffusion discs), are obtained from the bacteriology laboratories in Soroka University Medical Center (SUMC). These samples were examined by FTIR microscopy and analyzed by advanced statistical methods. Our results, based on 700 E.coli samples, were promising and showed that by using infrared spectroscopic technique together with multivariate analysis, it is possible to classify the tested bacteria into sensitive and resistant with success rate higher than 90% for eight different antibiotics. Based on these preliminary results, it is worthwhile to continue developing the FTIR microscopy technique as a rapid and reliable method for identification antibiotic susceptibility.

Keywords: antibiotics, E.coli, FTIR, multivariate analysis, susceptibility, UTI

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Authors: Migena Mana, Ahmed Khalid Syed, Abdul Malik, Nikhil Cherian

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In recent years, advancements in deep learning enabled researchers to tackle the problem of self-driving cars. Car companies use huge datasets to train their deep learning models to make autonomous cars a reality. However, this approach has certain drawbacks in that the state space of possible actions for a car is so huge that there cannot be a dataset for every possible road scenario. To overcome this problem, the concept of reinforcement learning (RL) is being investigated in this research. Since the problem of autonomous driving can be modeled in a simulation, it lends itself naturally to the domain of reinforcement learning. The advantage of this approach is that we can model different and complex road scenarios in a simulation without having to deploy in the real world. The autonomous agent can learn to drive by finding the optimal policy. This learned model can then be easily deployed in a real-world setting. In this project, we focus on three RL algorithms: Q-learning, Deep Deterministic Policy Gradient (DDPG), and Proximal Policy Optimization (PPO). To model the environment, we have used TORCS (The Open Racing Car Simulator), which provides us with a strong foundation to test our model. The inputs to the algorithms are the sensor data provided by the simulator such as velocity, distance from side pavement, etc. The outcome of this research project is a comparative analysis of these algorithms. Based on the comparison, the PPO algorithm gives the best results. When using PPO algorithm, the reward is greater, and the acceleration, steering angle and braking are more stable compared to the other algorithms, which means that the agent learns to drive in a better and more efficient way in this case. Additionally, we have come up with a dataset taken from the training of the agent with DDPG and PPO algorithms. It contains all the steps of the agent during one full training in the form: (all input values, acceleration, steering angle, break, loss, reward). This study can serve as a base for further complex road scenarios. Furthermore, it can be enlarged in the field of computer vision, using the images to find the best policy.

Keywords: autonomous driving, DDPG (deep deterministic policy gradient), PPO (proximal policy optimization), reinforcement learning

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Authors: Antonio Lopez-Villegas, Rafael Bautista-Mesa, Emilio Robles-Musso, Daniel Catalan-Matamoros, Cesar Leal-Costa

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Objectives: The purpose of this trial was to evaluate the burden borne by and the costs to informal caregivers of users with telemonitoring of pacemakers. Methods: This is a controlled, non-randomised clinical trial, with data collected from informal caregivers, five years after implantation of pacemakers. The Spanish version of the Survey on Disabilities, Personal Autonomy, and Dependency Situations was used to get information on clinical and social characteristics, levels of professionalism, duration and types of care, difficulties in providing care, health status, economic and job aspects, impact on the family or leisure due to informal caregiving for patients with pacemakers. Results: After five years of follow-up, 55 users with pacemakers finished the study. Of which, 50 were helped by a caregiver, 18 were included in the telemonitoring group (TM) and 32 in the conventional follow-up group (HM). Overall, females represented 96.0% of the informal caregivers (88.89% in TM and 100.0% in HM group). The mean ages were 63.17 ± 15.92 and 63.13 ± 14.56 years, respectively (p = 0.83) in the groups. The majority (88.0%) of the caregivers declared that they had to provide their services between 6 and 7 days per week (83.33% in TM group versus 90.63% in HM group), without significant differences between both groups. The costs related to care provided by the informal caregivers were 47.04% higher in the conventional follow-up group than in the TM group. Conclusions: The results of this trial confirm that there were no significant differences between the informal caregivers regarding to baseline characteristics, workload and time worked in both groups of follow-up. The costs incurred by the informal caregivers providing care for users with pacemakers included in telemonitoring group are significantly lower than those in the conventional follow-up group. Trial registration: ClinicalTrials.gov NCT02234245. Funding: The PONIENTE study, has been funded by the General Secretariat for Research, Development and Innovation, Regional Government of Andalusia (Spain), project reference number PI/0256/2017, under the research call 'Development and Innovation Projects in the Field of Biomedicine and Health Sciences', 2017.

Keywords: costs, disease burden, informal caregiving, pacemaker follow-up, remote monitoring, telemedicine

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Authors: Shailendra M. Pradhan, Upendra M. Pradhan

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Disasters are perennial features of human civilization. The recurring earthquakes, floods, cyclones, among others, that result in massive loss of lives and devastation, is a grim reminder of the fact that, despite all our success stories of development, and progress in science and technology, human society is perennially at risk to disasters. The apparent threat of climate change and global warming only severe our disaster risks. Darjeeling hills, situated along Eastern Himalayan region of India, and famous for its three Ts – tea, tourism and toy-train – is also equally notorious for its disasters. The recurring landslides and earthquakes, the cyclone Aila, and the Ambootia landslides, considered as the largest landslide in Asia, are strong evidence of the vulnerability of Darjeeling hills to natural disasters. Given its geographical location along the Hindu-Kush Himalayas, the region is marked by rugged topography, geo-physically unstable structure, high-seismicity, and fragile landscape, making it prone to disasters of different kinds and magnitudes. Most of the studies on disasters in Darjeeling hills are, however, scientific and geographical in orientation that focuses on the underlying geological and physical processes to the neglect of social and political conditions. This has created a tendency among the researchers and policy-makers to endorse and promote a particular type of discourse that does not consider the social and political aspects of disasters in Darjeeling hills. Disaster, this paper argues, is a complex phenomenon, and a result of diverse factors, both physical and human. The hazards caused by the physical and geological agents, and the vulnerabilities produced and rooted in political, economic, social and cultural structures of a society, together result in disasters. In this sense, disasters are as much a result of political and economic conditions as it is of physical environment. The human aspect of disasters, therefore, compels us to address intricating social and political challenges that ultimately determine our resilience and vulnerability to disasters. Set within the above milieu, the aims of the paper are twofold: a) to provide a political and sociological account of disasters in Darjeeling hills; and, b) to identify and address the root causes of its vulnerabilities to disasters. In situating disasters in Darjeeling Hills, the paper adopts the Pressure and Release Model (PAR) that provides a theoretical insight into the study of social and political aspects of disasters, and to examine myriads of other related issues therein. The PAR model conceptualises risk as a complex combination of vulnerabilities, on the one hand, and hazards, on the other. Disasters, within the PAR framework, occur when hazards interact with vulnerabilities. The root causes of vulnerability, in turn, could be traced to social and political structures such as legal definitions of rights, gender relations, and other ideological structures and processes. In this way, the PAR model helps the present study to identify and unpack the root causes of vulnerabilities and disasters in Darjeeling hills that have largely remained neglected in dominant discourses, thereby providing a more nuanced and sociologically sensitive understanding of disasters.

Keywords: Darjeeling, disasters, PAR, vulnerabilities

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Authors: Chang Liu, Hanwen Zhang, Vikash Sharma, Don Eliseo Lucerno-Prisno III, Emmanuel Yujuico, Maulik Chokshi, Prashanthi Krishnakumar, Bach Xuan Tran, Giang Thu Vu, Kamilla Anna Pinter, Shenglan Tang

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Background and Aims: Globally, many health systems focus on hospital-based healthcare models targeting acute care and disease treatment, which are not effective in addressing the challenges of ageing populations, chronic conditions, multi-morbidities, and increasingly unhealthy lifestyles. Recently, integrated care programs on chronic diseases have been developed, piloted, and implemented to meet such challenges. However, integrated care programs in the Asia-Pacific region vary in the levels of integration from linkage to coordination to full integration. This study aims to identify and analyze existing cases of integrated care in the Asia-Pacific region and identify the facilitators and barriers in order to improve existing cases and inform future cases. Methods: The study is a comparative study, with a combination approach of desk-based research and key informant interviews. The selected countries included in this study represent a good mix of lower-middle income countries (the Philippines, India, Vietnam, and Fiji), upper-middle income country (China), and high-income country (Singapore) in the Asia-Pacific region. Existing integrated care programs were identified through the scoping review approach. Trigger, history, general design, beneficiaries, and objectors were summarized with barriers and facilitators of integrated care based on key informant interviews. Representative case(s) in each country were selected and comprehensively analyzed through deep-dive case studies. Results: A total of 87 existing integrated care programs on chronic diseases were found in all countries, with 44 in China, 21 in Singapore, 12 in India, 5 in Vietnam, 4 in the Philippines, and 1 in Fiji. 9 representative cases of integrated care were selected for in-depth description and analysis, with 2 in China, the Philippines, and Vietnam, and 1 in Singapore, India, and Fiji. Population aging and the rising chronic disease burden have been identified as key drivers for almost all the six countries. Among the six countries, Singapore has the longest history of integrated care, followed by Fiji, the Philippines, and China, while India and Vietnam have a shorter history of integrated care. Incentives, technologies, education, and performance evaluation would be crucial for developing strategies for implementing future programs and improve already existing programs. Conclusion: Integrated care is important for addressing challenges surrounding the delivery of long-term care. To date, there is an increasing trend of integrated care programs on chronic diseases in the Asia-Pacific region, and all six countries in our study set integrated care as a direction for their health systems transformation.

Keywords: integrated healthcare, integrated care delivery, chronic diseases, Asia-Pacific region

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Authors: David Maina Muthegethi

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For decades, archaeological work of Swahili Civilization has mainly concentrated on exploration of economic and political dynamics of City states. This paper moves further and explore how gender roles were formed, maintained, negotiated and re-negotiated through time and space in Gede City. Unlike other Swahili city states, Gede was located around two miles away from the shores of Indian Ocean. Nonetheless, the city was characterized by security walls, stone houses, mosques and tombs typical of Swahili City states such as Kilwa. The study employed several methods of data collection namely: archival research, survey, re-examination of collected materials and excavation of Gede archaeological site. Since, the study aimed to examine gender roles across different social class, a total of three houses were excavated based on their social hierarchy. Thus, the houses were roughly categorized as belonging to elites, middle class and lower class. The house were located in the inner wall, second inner wall and the outer wall of Gede City respectively. Key findings shows that gender roles differed considerably along classes in Gede archaeological site. For instance, the women of the elite and middle class were active participants in Gede international trade through production and consumption of imported goods. This participation corresponded with commercialization of Gede households especially in elite’ areas where they hosted international traders. On the other hand, the middle class houses, women concentrated on running of light industries aimed at supplying goods for the urban community. Thus, they were able to afford exotic goods as their elites counterparts. Lastly, the gender roles of lower class entailed subsistence gender roles with little participation in Gede formal commerce. Interestingly, gender roles in Gede were dynamic in nature and response to cultural diffusion, spread of Islam, intensification of trade, diversification of subsistence patterns and urbanization. Therefore, this findings, demonstrate centrality of gender in reconstruction of social lives of Swahili Civilization.

Keywords: gender roles, Islam, Swahili civilization, urbanization

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Authors: Anum Rafiq

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Adolescence is a vulnerable period for youth across the world. It is a period of new learning with opportunities to understand and develop perspectives on health and well-being. With youth beginning to engage in intimate relationships at an earlier age in the 21st century, concentrating on the learning opportunity they have in school is paramount. The nature of what has been deemed important to teach in schools has changed throughout history, and the focus has shifted from home/family skills to teaching youth how to be competitive in the job market. Amidst this emphasis, opportunities for them exist to learn about building healthy intimate relationships, one of the foundational elements of most people’s lives. Using an Institutional Ethnography (IE), the lived experiences of youth in how they understand intimate relationships and how their learning experience is organized through the high school Health and Physical Education (H&PE) course is explored. An empirical inquiry into how the actual work of teachers and youth are socially organized by a biomedical, employment-related, and efficiency-based discourse is provided. Through thirty-two qualitative interviews with teachers and youth, a control of ruling relations such as institutional accountability circuits, performance reports, and timetabling over the experience of teachers and youth is found. One of the facets of the institutional accountability circuit is through the social organization of teaching and learning about healthy intimate relationships being framed through a biomedical discourse. In addition, the role of a hyper-focus on performance and evaluation is found as paramount in situating healthy intimacy discussions as inferior to neoliberally charged productivity measures such as employment skills. Lastly, due to the nature of institutional policies such as regulatory guidelines, teachers are largely influenced to avoid diving into discussions deemed risky or taboo by society, such as healthy intimacy in adolescence. The findings show how texts such as the H&PE curriculum, the Ontario College of Teachers (OCT) guidelines, Ministry of Education Performance Reports, and the timetable organize the day-to-day activities of teachers and students and reproduce different disjunctures for youth. This disjuncture includes some of their experiences being subordinated, difficulty relating to curriculum, and an experience of healthy living discussions being skimmed over across sites. The findings detail that the experience of youth in learning about healthy intimate relationships is not akin to the espoused vision outlined in policy documents such as the H&PE (2015) curriculum policy. These findings have implications for policymakers, activists, and school administration alike, which call for an investigation into who is in power when it comes to youth’s learning needs, as a pivotal period where youth can be equipped with life-changing knowledge is largely underutilized. A restructuring of existing institutional practices that allow for the social and institutional flexibility required to broach the topic of healthy intimacy in a comprehensive manner is required.

Keywords: health policy, intimate relationships, youth, education, ruling relations, sexual education, violence prevention

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Authors: E. Gouya Bozorg

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The issue of ranking of sports teams, in particular soccer teams is of primary importance in the professional sports. However, it is still based on classical statistics and models outside of area of mathematics. Rigorous mathematics and then statistics despite the expectation held of them have not been able to effectively engage in the issue of ranking. It is something that requires serious pathology. The purpose of this study is to change the approach to get closer to mathematics proper for using in the ranking. We recommend using theoretical mathematics as a good option because it can hermeneutically obtain the theoretical concepts and criteria needful for the ranking from everyday language of a League. We have proposed a framework that puts the issue of ranking into a new space that we have applied in soccer as a case study. This is an experimental and theoretical study on the issue of ranking in a professional soccer league based on theoretical mathematics, followed by theoretical statistics. First, we showed the theoretical definition of constant number Є = 1.33 or ‘golden number’ of a soccer league. Then, we have defined the ‘efficiency of a team’ by this number and formula of μ = (Pts / (k.Є)) – 1, in which Pts is a point obtained by a team in k number of games played. Moreover, K.Є index has been used to show the theoretical median line in the league table and to compare top teams and bottom teams. Theoretical coefficient of σ= 1 / (1+ (Ptx / Ptxn)) has also been defined that in every match between the teams x, xn, with respect to the ability of a team and the points of both of them Ptx, Ptxn, and it gives a performance point resulting in a special ranking for the League. And it has been useful particularly in evaluating the performance of weaker teams. The current theory has been examined for the statistical data of 4 major European Leagues during the period of 1998-2014. Results of this study showed that the issue of ranking is dependent on appropriate theoretical indicators of a League. These indicators allowed us to find different forms of ranking of teams in a league including the ‘special table’ of a league. Furthermore, on this basis the issue of a record of team has been revised and amended. In addition, the theory of ranking can be used to compare and classify the different leagues and tournaments. Experimental results obtained from archival statistics of major professional leagues in the world in the past two decades have confirmed the theory. This topic introduces a new theory for ranking of a soccer league. Moreover, this theory can be used to compare different leagues and tournaments.

Keywords: efficiency of a team, ranking, special table, theoretical mathematic

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Authors: Emily Jin, Harry Sharples, Anne Weist

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Introduction: NICE Evidence Search Student Champion Scheme is a peer-assisted learning scheme that aims to improve the routine use of evidence-based information by future health and social care staff. The focus is on the NICE evidence search portal that provides selected information from more than 800 reliable health, social care, and medicines sources, including up-to-date guidelines and information for the public. This paper aims to evaluate the effectiveness of the scheme when implemented in Liverpool School of Medicine and to understand the experiences of those attending. Methods: Twelve student champions were recruited and trained in February 2020 as peer tutors during a workshop facilitated by NICE. Cascade sessions were then organised and delivered on an optional basis for students, in small groups of < 10 to approximately 70 attendees. Surveys were acquired immediately before and 8-12 weeks after cascade sessions (n=47 and 45 respectively). Data from these surveys facilitated the analysis of the scheme. Results: Surveys demonstrated 74% of all attendees frequently searched for health and social care information online as a part of their studies. However, only 15% of attendees reported having prior formal training on searching for health information, despite receiving such training earlier on in the curriculum. After attending cascade sessions, students reported a 58% increase in confidence when searching for information using evidence search, from a pre-session a baseline of 36%. Conclusion: NICE Evidence Search Student Champion Scheme provided clear benefits for attending students, increasing confidence in searching for peer-reviewed, mainly secondary sources of health information. The lack of reported training represents the unmet need that the champion scheme satisfies, and this likely benefits student champions as well as attendees. Increasing confidence in searching for healthcare information online may support future evidence-based decision-making.

Keywords: evidence-based medicine, NICE, medical education, medical school, peer-assisted learning

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Authors: Mukhamad Fatkhullah, Arfan Fadli, Marini Kristina Situmeang, Siti Hazar Sitorus

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The emergence of a community of people with disabilities along with the various works produced has made great progress to open the public eye to their existence in society. This study focuses attention on a community that is suspected to be one of the pioneers in pursuing the movement. It is Deaf Art Community (DAC), a community of persons with disabilities based in Yogyakarta, with deaf and speech-impaired members who use sign language in everyday communication. Knowing the movement of disabled communities is a good thing, the description of the things behind it then important to know as the basis for initiating similar movements. This research focuses on the question of how community of people with disabilities begin to take shape in different regions and interact with collaborative events. Qualitative method with in-depth interview as data collection techniques was used to describe the process of formation and the emergence of community. The analytical unit in the study initially focuses on the subject in the community, but in the process, it develops to institutional analysis. Therefore some informants were determined purposively and expanded using the snowball technique. The theory used in this research is Phenomenology of Alfred Schutz to be able to see reality from the subject and institutional point of view. The results of this study found that the community is formed because the existing educational institutions (both SLB and inclusion) are less able to empower and make children with disabilities become equal with the society. Through the SLB, the presence of children with disabilities becomes isolated from the society, especially in children of his or her age. Therefore, discrimination and labeling will never be separated from society's view. Meanwhile, facilities for the basic needs of children with disabilities can not be fully provided. Besides that, the guarantee of discrimination, glances, and unpleasant behavior from children without disability does not exist, which then indicates that the existing inclusion schools offer only symbolic acceptance. Thus, both in SLB and Inclusive Schools can not empower children with disabilities. Community-based assistance, in this case, has become an alternative to actually empowering children with disabilities. Not only giving them a place to interact, through the same community, children with disabilities will be guided to discover their talents and develop their potential to be self-reliant in the future.

Keywords: children with disabilities, community-based assessment, community empowerment, social equity

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Authors: Emni Omar Daw Hussin, Pathmawathi Subramanian, Wong Li Ping

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Background: To provide quality care at the end of life, nurses should possess knowledge and skills to provide effective end-of-life care, as well as develop the attitudes and interpersonal competence to provide compassionate care. Aim: This study aimed to assess nurses’ knowledge and attitude towards end of life care and caring for terminal ill patients and to examine relationships among demographic variables and nurse’s knowledge and attitudes toward end of life care and caring for terminal ill patients. Method: a cross-sectional study was conducted at 1 tertiary hospital located in Kuala Lumpur, Malaysia. Self-administrative questionnaire was used to collect data from 553 nurses from over all departments except emergency department, operation theater and outpatient clinic. Two tools were used in this study, the Frommelt’s Attitude Toward Care of the Dying (FATCOD) Scale to assess the nurses’ attitude and End of Life Knowledge Assessment to assess the nurses’ knowledge. Result: the result of this study yielded that, the majority of participants (54.8%) and (54.4%) have less positive attitude and knowledge towards end of life care and caring for terminal ill patients respectively. As well as there is no significant relationship were found between nurses’ ethnicity, religion, and the total score of FATCOD scale; End of Life Knowledge Assessment score. On other hand there is significant relationship among nurses’ age, working experience, level of education, attending any post basic courses and the total score of both FATCOD scale and End of Life Knowledge Assessment. Conclusion: A lack of education and experience and post basic course about end of life care and palliative care may contribute to the negative attitudes and poor knowledge regarding end of life care. Providing sufficient courses about end of life care could enhance the nurses’ knowledge towards end of life care, as well as providing a reflective narrative environment in which nurses can express their personal feelings about death and dying could be a potentially effective approach. Implication for Practice: This study elaborates the need for further research to develop an effective educational programs to enhance nurses’ knowledge and to promote positive attitude towards death and dying, as well as enhance communication skills, and coping strategies.

Keywords: knowledge, attitude, nurse, end of life care

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Authors: Moses Pinto, Ana Paula Monte

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The present research analyses the interactions between various categories of corporate social responsibility (CSR) that mediate the relationship between CSR and financial performance in Multinational Enterprises (MNE) in light of the present socio-political factors prevalent in the countries under observation. In the research it has been hypothesized that the absence of consensus in the empirical literature on the CSR–financial performance relationship may be explained by the existence of synergies (Complementarities) between the different CSR components. Upon investigation about whether such relationships exist, a final unbalanced panel sample of 1000 observations taken from 100 Multinational Enterprises per year functioning in the Schengen countries and one south east Asian country namely: India, over the span of 10 years i.e. from the year 2008 to 2018 has been analyzed. The empirical analysis used in the research methodology employs dynamic Panel Data in time series specifically, the system Generalized Method of Moments (GMM) which had been used to detect the varying degrees of relationships between the CSR and financial performance parameters in the background of the socio-political factors prevailing in the countries at the time and also taking into account the bilateral treaty obligations between the countries under observation. The econometric model has employed the financial ratio namely the Return on Assets (ROA) as an indicator of financial performance in order to gauge the internal performance and valuation of a firm as opposed to the Tobin’s Q that provides for the external evaluation of a firm’s financial performance which may not always be accurate. The various CSR dimensions have demonstrated significant correlations to the ‘ROA’ which include some negatively associated correlations and one positively associated correlation that is highly significant throughout the analysis of the observations, namely the correlation between the ‘ROA’ and the CSR dimension: ‘Environment’. The results provide a deeper insight in the synergistic CSR activities that managers could adapt into their Firm’s CSR strategy in order to enhance the ‘ROA’ and also to understand which interactions between the CSR dimensions can be adapted together due to their positively correlated association with each other and the ROA. The future lines of research would be inclined to investigate the effects of socio-political factors on the ROA of the MNEs through better designed econometric models.

Keywords: CSR, financial performance, complementarity, sociopolitical factors

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Authors: Dinara Ikramova, Karin A. Hing, Simon C. F. Rawlinson

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Silicate-substituted hydroxyapatite (SiHA) has been shown to enhance bone regeneration in vivo compared with phase pure stoichiometric hydroxyapatite. Evidence suggests that substrate chemistry dependent formation of a permissive protein layer on the surface of synthetic bone graft substitute materials is key for bioactivity and cell attachment. However, little information is available on whether the substrate chemistry may affect cell migration and recruitment. The aim of this study is to investigate whether or not human Mesenchymal Stem Cells (hMSCs) exhibit a chemotactic response to SiHA porous granules and if it can be linked to either the ion exchange or protein sequestering and enrichment on the surface of the material. 150mg of SiHA granules with 80% total porosity and 20% strut porosity were incubated in 1ml of either Serum Free Media (SFM) or 10% Serum Containing Media (SCM) under static cell culture conditions (37°C, 5% CO2) in absence of cells. Protein sequestering and exchange of calcium, phosphate and silicate ions were analysed at 0.5, 1, 2, 4, 8, 16 and 24 hours with n=12 per time point. Migration of hMSCs in the presence of 150mg of SiHA granules was assessed over 24 hours using a modified transwell migration system in either SFM or SCM (n=6) with 30% serum containing media acting as a positive control. At 24 hours protein sequestering and ionic exchange were analysed, and the number of cells was quantified using a high throughput confocal microscope (IN Cell Analyser 6000). In acellular condition, both calcium and phosphate ion concentrations in media showed a decrease at 24 hours which was greater in SFM than in SCM. This suggests possible formation and precipitation of a bone like apatite on the surface of SiHA. Reduction in this activity observed in SCM indicates that the presence of serum proteins is interfering with the ion exchange at the material and media interface. Adsorbed protein levels showed fluctuation over time followed by sharp decrease at 24 hours, suggesting a possible protein rearrangement on the surface of the material. The ion analysis performed on SFM and SCM after 24-hour incubation with cells in the presence of granules showed a greater reduction in phosphate concentration in both SFM and SCM compared to phosphate levels in acellular condition. Silicate concentration in SCM increased from 1.6mM (absence of cells) to 5.1mM (presence of cells). This indicates that the cells are promoting the uptake of phosphate and release of silicate ions. No significant change was seen in levels of adsorbed proteins in the presence and absence of cells. Further analysis is required to determine whether the species of these proteins change over time. The analysis of cell migration after 24-hour incubation showed more cells migrating towards the granules, 12.7% in SFM and 8.3% in SCM, than in positive control, 4.5% in SFM and 3.6% in SCM respectively. These results suggest that SiHA has a chemotactic activity independent of serum proteins. A property which has not previously been demonstrated for a synthetic bone graft material.

Keywords: cell migration, hMSCs, SiHA, transwell migration system

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Authors: Niraimathi Kesavan, Sangeeta Sharma, Deepa Jagan, Sridhar Sukumar, Mohan Ramachandran, Vidhubala Elangovan

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Background: Childhood is a dynamic period for growth and development. Optimum nutrition during this period forms a strong foundation for growth, development, resistance to infections, long-term good health, cognition, educational achievements, and work productivity in a later phase of life. Underprivileged children living in a resource constraint settings like shelter homes are at high risk of malnutrition due to poor quality diet and nutritional inadequacy. In low-income countries, underprivileged children are vulnerable to being deprived of nutritious food, which stands as a major challenge in the health sector. The present aims to assess the dietary intake, nutritional status, and nutritional inadequacy and their association with malnutrition among children residing in shelter homes in rural Tamil Nadu. Methods: The study was a descriptive survey conducted among all the children aged between 8-18 years residing in two selected shelter homes (Anbu illam, a home for female children, and Amaidhi illam, a home for male children), rural Tirunelveli, Tamil Nadu, India. A total of 57 children were recruited, including 18 boys and 39 girls, for the study. Dietary intake was measured using seven days 24 hours recall. The average nutrient intake was considered for further analysis. Results: Of the 57 children, about 60% (n=35) were undernutrition. The mean daily energy intake was 1298 (SD 180) kcal for boys and 952 (SD155) kcal for girls. The total calorie intake was 55-60% below the estimated average requirement (EAR) for adolescent boys and girls in the age group 13-15 years and 16-18 years. Carbohydrates were the major source of energy (boys 53% and girls 51%), followed by fat (boys 31.5% and girls 34.5%) and protein (boys 14% and girls 12.9%). Dairy intake (<200ml/day) was less than the recommendation (500ml/day). Micro-nutrient-rich foods such as fruits, vegetables, and green leafy vegetables in the diet were <200g/day, which was far less than the recommended dietary guidelines of 400g- 600g/day for the age group of 7-18 years. Nearly 26% of girls reported experiencing menstrual problems. The majority (76.9%) of the children exhibited nutrient deficiency-related signs and symptoms. Conclusion: The total energy, minerals, and micro-nutrient intake were inadequate and below the Recommended Dietary Allowance for children and adolescents. The diet predominantly consists of refined cereals, rice, semolina, and vermicelli. Consumption of whole grains, milk, fruits, vegetables, and leafy vegetables was far below the recommended dietary guidelines. Dietary inadequacies among these children pose a serious concern for their overall health status and its consequences in the later phase of life.

Keywords: adolescents, children, dietary intake, malnutrition, nutritional inadequacy, shelter home

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Authors: Noor F. Ilias, Mazlifah Omar, Hashbullah Ismail

Abstract:

Exercise training has been shown to improve functional capacity and is recommended as a therapy for management of blood pressure. Our purpose was to establish whether different exercise capacity produces different effect size for Cardiorespiratory Fitness (CRF), systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension. Exercise characteristic is required in order to have optimal benefit from the training, but optimal exercise capacity is still unwarranted. A MEDLINE search (1985 to 2015) was conducted for exercise based rehabilitation trials in hypertensive patients. Thirty-seven studies met the selection criteria. Of these, 31 (83.7%) were aerobic exercise and 6 (16.3%) aerobic with additional resistance exercise, providing a total of 1318 exercise subjects and 819 control, the total of subjects was 2137. We calculated exercise volume and energy expenditure through the description of exercise characteristics. 4 studies (18.2%) were 451kcal - 900 kcal, 12 (54.5%) were 900 kcal – 1350 kcal and 6 (27.3%) >1351kcal per week. Peak oxygen consumption (peak VO2) increased by mean difference of 1.44 ml/kg/min (95% confidence interval [CI]: 1.08 to 1.79 ml/kg/min; p = 0.00001) with weighted mean 21.2% for aerobic exercise compare to aerobic with additional resistance exercise 4.50 ml/kg/min (95% confidence interval [CI]: 3.57 to 5.42 ml/kg/min; p = 0.00001) with weighted mean 14.5%. SBP was clinically reduce for both aerobic and aerobic with resistance training by mean difference of -4.66 mmHg (95% confidence interval [CI]: -5.68 to -3.63 mmHg; p = 0.00001) weighted mean 6% reduction and -5.06 mmHg (95% confidence interval [CI]: -7.32 to -2.8 mmHg; p = 0.0001) weighted mean 5% reduction respectively. Result for DBP was clinically reduce for aerobic by mean difference of -1.62 mmHg (95% confidence interval [CI]: -2.09 to -1.15 mmHg; p = 0.00001) weighted mean 4% reduction and aerobic with resistance training reduce by mean difference of -3.26 mmHg (95% confidence interval [CI]: -4.87 to -1.65 mmHg; p = 0.0001) weighted mean 6% reduction. Optimum exercise capacity for 451 kcal – 900 kcal showed greater improvement in peak VO2 and SBP by 2.76 ml/kg/min (95% confidence interval [CI]: 1.47 to 4.05 ml/kg/min; p = 0.0001) with weighted mean 40.6% and -16.66 mmHg (95% confidence interval [CI]: -21.72 to -11.60 mmHg; p = 0.00001) weighted mean 9.8% respectively. Our data demonstrated that aerobic exercise with total volume of 451 kcal – 900 kcal/ week energy expenditure may elicit greater changes in cardiorespiratory fitness and blood pressure in hypertensive patients. Higher exercise capacity weekly does not seem better result in management hypertensive patients.

Keywords: blood Pressure, exercise, hypertension, peak VO2

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