Search results for: growing patient

Authors: Ibrahim Ahmed, Richard Amoateng, Akhil Jain, Mohamed Ahmed

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Alcoholic cardiomyopathy (ACM) is a type of acquired cardiomyopathy caused by chronic alcohol consumption. Frequently ACM is associated with arrhythmias such as atrial flutter. Our aim was to characterize the patient demographics and investigate the effect of atrial flutter (AF) on ACM. This was a retrospective cohort study using the Nationwide Inpatient Sample database to identify admissions in adults with principal and secondary diagnoses of alcoholic cardiomyopathy and atrial flutter from 2019. Multivariate linear and logistic regression models were adjusted for age, gender, race, household income, insurance status, Elixhauser comorbidity score, hospital location, bed size, and teaching status. The primary outcome was all-cause mortality, and secondary outcomes were the length of stay (LOS) and total charge in USD. There was a total of 21,855 admissions with alcoholic cardiomyopathy, of which 1,635 had atrial flutter (AF-ACM). Compared to Non-AF-ACM cohort, AF-ACM cohort had fewer females (4.89% vs 14.54%, p<0.001), were older (58.66 vs 56.13 years, p<0.001), fewer Native Americans (0.61% vs2.67%, p<0.01), had fewer smaller (19.27% vs 22.45%, p<0.01) & medium-sized hospitals (23.24% vs28.98%, p<0.01), but more large-sized hospitals (57.49% vs 48.57%, p<0.01), more Medicare (40.37% vs 34.08%, p<0.05) and fewer Medicaid insured (23.55% vs 33.70%, p=<0.001), fewer hypertension (10.7% vs 15.01%, p<0.05), and more obesity (24.77% vs 16.35%, p<0.001). Compared to Non-AF-ACM cohort, there was no difference in AF-ACM cohort mortality rate (6.13% vs 4.20%, p=0.0998), unadjusted mortality OR 1.49 (95% CI 0.92-2.40, p=0.102), adjusted mortality OR 1.36 (95% CI 0.83-2.24, p=0.221), but there was a difference in LOS 1.23 days (95% CI 0.34-2.13, p<0.01), total charge $28,860.30 (95% CI 11,883.96-45,836.60, p<0.01). In patients admitted with ACM, the presence of AF was not associated with a higher all-cause mortality rate or odds of all-cause mortality; however, it was associated with 1.23 days increase in LOS and a $28,860.30 increase in total hospitalization charge. Native Americans, older age and obesity were risk factors for the presence of AF in ACM.

Keywords: alcoholic cardiomyopathy, atrial flutter, cardiomyopathy, arrhythmia

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Authors: Muhammad nor Farhan Sa'At, Xin Y. Lim, Terence Y. C. Tan, Siti Hajar M. Rosli, Syazwani S. Ali, Ami F. Syed Mohamed

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INTRODUCTION: Hemp (Cannabis sativa subsp. sativa), commonly used for industrial purposes, differs from marijuana by containing lower levels of delta-9-tetrahydronannabidiol- the principal psychoactive constituent in cannabis. Due to its non-psychoactive nature, there has been growing interest in hemp’s therapeutic potential, which has been investigated through pre-clinical and clinical study modalities. OBJECTIVE: To provide an overview of the current landscape of hemp research, through recent scientific findings specific to the pharmacological effects of the medicinal hemp plant and its derived compounds. METHODS: This review was conducted through a systematic search strategy according to the preferred reporting items for systematic review and meta-analysis-ScR (PRISMA-ScR) checklist on electronic databases including MEDLINE, OVID (OVFT, APC Journal Club, EBM Reviews), Cochrane Library Central and Clinicaltrials.gov. RESULTS: From 65 primary articles reviewed, there were 47 pre-clinical studies related to medicinal hemp. Interestingly, the hemp derivatives showed several potential activities such as anti-oxidative, anti-hypertensive, anti-inflammatory, anti-diabetic, anti-neuroinflammatory, anti-arthritic, anti-acne, and anti-microbial activities. Renal protective effects and estrogenic properties were also exhibited in vitro. CONCLUSION: Medicinal hemp possesses various pharmacological effects tested in vitro and in vivo. Information provided in this review could be used as tool to strengthen the study design of future clinical trial research.

Keywords: Preclinical, Herbal Medicine, Hemp, Cannabis

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Authors: Dorit Olenik-Shemesh, Tali Heiman

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The rapid increase in the massive use of the internet in recent yearshas led to an increase in the prevalence of a phenomenon called 'Problematic Internet use' (PIU), an emerging, growing health problem, especially during adolescents, that poses a challenge for mental health research and practitioners. Problematic Internet use (PIU) is defined as an excessive overuse of the internet, including an inability to control time spent on the internet, cognitivepreoccupation with the Internet, and continued use in spite of the adverse consequences, which may lead to psychological, social, and academic difficulties in one's life and daily functioning. However, little is known about the nature of the nexusbetween PIU and subjective well-being among adolescents. The main purpose of the current study was to explore in depth the network of connections between PIU, sense of well-being, and fourpersonal-emotional factors (resilience, self-control, depressive mood, and loneliness) that may mediate these relationships. A total sample of 433 adolescents, 214 (49.4%) girls and 219 (50.6%) boys between the ages of 12–17 (mean = 14.9, SD = 2.16), completed self-reportquestionnaires relating to the study variables. In line with the hypothesis, analysis of a Structural Equation modeling (SEM) revealed the main following results: high levels of PIU predicted low levels of well-being among adolescents. In addition, low levels of resilience and high levels of depressivemood (together), as well as low levels of self control and high levels of depressivemood (together), as well as low levels of resilience and high levels of loneliness, mediated the relationships between PIU and well-being. In general, girls were found to be higher in PIU and inresilience than boys. The study results revealed specific implications for developing intervention programs for adolescents in the context of PIU; aiming at more balanced adjusted use of the Internet along withpreventingthe decrease in well being.

Keywords: probelmatic inetrent Use, well-being, adolescents, SEM model

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Authors: Ammani K., Glory M.

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Demands of traditional herbal medicines are increasing day by day over the world. Considering the growing demand of medicinal plants in curative treatments and the role of VAM fungi in augmentation of the production of active secondary metabolites by the medicinal plants, the present work has been undertaken to survey the mycorrhizal status in 30 different medicinal plants belonging to various families from Krishna district, Andhra Pradesh. The roots were collected carefully and stained by the Phillips & Hayman technique. Basing on the occurrence of vesicles and arbuscules, categorized into four grades; Excellent: mycelia, vesicles or arbuscules present more than 75% of root bits, Good: mycelia, vesicles or arbuscules present 50-75% in surface of root bits, moderate: mycelia, vesicles or arbuscules present 25-50% in surface of root bits, and poor: mycelia, vesicles or arbuscules present 1-25% in surface of root bits. The study reveals that the roots of all plants were colonized by AM fungi. Percentage of root colonization by AM fungi was more in Aloe vera, Phylanthus emblica, Azadiracta indica and least in plants such as Aerva lanata, Vinca rosea, Crotalaria verrucosa among the 30 medicinal plants in present study. The enhancement of growth and vigour and increased production of bioactive compounds of the medicinal plants is desirable which may be achieved by inoculation of the roots with Arbuscular mycorrhizal fungi. There is a steady increase in the cultivation of medicinal plants to maintain a steady supply to support the increasing demand but corresponding researches of VAM fungi and their association in medicinal plants have received very little attention as compared to the studies on forest species and field crops. So a vast research on this field is necessary for a better tomorrow.

Keywords: Arbuscular mycorrhizae, colonization, categories, medicinal plants

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Authors: Sterling C. DeVerter

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In recent decades, there has been continually growing concern amongst scholars and political leaders towards the global resurgence of nationalism, particularly in Europe, the United States, and China. However, very few studies have attempted to empirically examine the relationship between religion and nationalism at the level of the individual, and none are known to have done so quantitatively. Building on Tajfel's and Turner's (1978) Social Identity Theory (SIT), and Anderson (1991) and Marx (2003), this study will employ SIT and regression analysis to compare the sources and patterns of nationalistic sentiment among European respondents in eight countries to the average levels of self-reported religiosity, religious participation, age, education, and income levels. Survey reports from the International Social Survey Programme were the primary quantitative data sources. It was hypothesized that the increase in nationalism across Europe follows this same evolution as first identified by Anderson, and is positively correlated to the reduction in reported religiosity. However, this study failed to reject the null, there was no substantial ( < .035) correlation between nationalistic sentiment and any of the measures of religiosity, nor were there any substantial correlations between nationalistic sentiment and either of the three control variables ( < .008). Across all countries examined, it was discovered that inclusionary nationalism has slightly declined (-5.08%), while exclusionary nationalism had increased substantially (+17.25%). The combined trend reflected an overall rise in nationalism across the time period and a forecast that suggests the current levels are also elevated. The primary implications include the demand to readdress the notion of religion and nationalism, and the correlation between the two, as well as the current nationalism trends in terms of support or non-support for future political and social movements.

Keywords: European Union, secularization, nationalism, social identity theory

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Authors: Akida Mulyaningtyas, Wahyudi Budi Sediawan

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One decisive stage in bioethanol production from plant biomass is the hydrolysis of lignocellulosic materials into simple sugars such as glucose. The produced glucose is then fermented into ethanol. This stage is popularly done in biological method by using cellulase that is produced by certain fungi. As it is known, glucose is the main source of nutrition for most microorganisms. Therefore, cutting cellulose into glucose is actually an attempt of microorganism to provide nutrition for itself. So far, this phenomenon has received less attention while it is necessary to identify the quantity of sugar consumed by the microorganism. In this study, we examined the phenomenon of sugar consumption by microorganism on lignocellulosic hydrolysis. We used oil palm empty fruit bunch (OPEFB) as the source of lignocellulose and Aspergillus niger as cellulase-producing fungus. In Indonesia, OPEFB is plantation waste that is difficult to decompose in nature and causes environmental problems. First, OPEFB was pretreated with 1% of NaOH at 170 oC to destroy lignin that hindered A.niger from accessing cellulose. The hydrolysis was performed by growing A.niger on pretreated OPEFB in solid state to minimize the possibility of contamination. The produced glucose was measured every 24 hours for 9 days. We analyzed the kinetics of both reactions, i.e., hydrolysis and glucose consumption, simultaneously. The constants for both reactions were assumed to follow the Monod equation. The results showed that the reaction constant of glucose consumption (μC) was higher than of cellulose hydrolysis (μH), i.e., 11.8 g/L and 0.62 g/L for glucose consumption and hydrolysis respectively. However, in general, the reaction rate of hydrolysis is greater than of glucose consumption since the cellulose concentration as substrate in hydrolysis is much higher than glucose as substrate in the consumption reaction.

Keywords: Aspergillus niger, bioethanol, hydrolysis, kinetics

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Authors: Pragya Pandey

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A major discussion in the 21st -century international affairs has been around the shifting economic and political center of gravity to Asia. In the maritime realm, it translates into a shift in focus from the Atlantic to the Pacific-Indian Ocean region or what is now popularly called the Indo-Pacific region. The Indo-Pacific is rapidly eclipsing once dominant Asia-Pacific as center of trade, investment, competition and cooperation. The growing inter-connectivity between the Indian Ocean and the Pacific Ocean is bringing forth the ‘confluence of the two seas’. Therefore, the Indo-Pacific strategic arc is acquiring greater salience in consonance with the changing realities of the time. The region is undergoing unprecedented transformation in its security outlook. At present, the region is at an interesting historic epoch- witnessing the simultaneous rise India and China, their economic growth, naval modernization and power projection capabilities, alongside the continued presence of the United States, particularly with its rebalancing strategy. Besides the interplay among the three major stakeholders, other regional players like Japan, Australia, and Indonesia, would play a crucial role in the geopolitical re-arrangement of the Indo-Pacific region. The region will be the future theater of activities to determine the shifts and distribution of sea power, by the virtue of its strategic location, intrinsic value of the energy resources and significant maritime trade routes of the region. Therefore, the central theme of the paper would be to scrutinize the maritime security environment of the region against the backdrop of the tricky geopolitical landscape, contributing to the change in the regional and global balance of power.

Keywords: China, geopolitics, India, United States

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Authors: Peng Hao Wang, Garam Kim, Ronald Sterkenburg

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In composite manufacturing, the fabrication of tooling and tooling maintenance contributes to a large portion of the total cost. However, as the applications of composite materials continue to increase, there is also a growing demand for more tooling. The demand for more tooling places heavy emphasis on the industry’s ability to fabricate high quality tools while maintaining the tool’s cost effectiveness. One of the popular techniques of tool fabrication currently being developed utilizes additive manufacturing technology known as 3D printing. The popularity of 3D printing is due to 3D printing’s ability to maintain low material waste, low cost, and quick fabrication time. In this study, a team of Purdue University School of Aviation and Transportation Technology (SATT) faculty and students investigated the effectiveness of a 3D printed composite mold. A steel valve cover from an aircraft reciprocating engine was modeled utilizing 3D scanning and computer-aided design (CAD) to create a 3D printed composite mold. The mold was used to fabricate carbon fiber versions of the aircraft reciprocating engine valve cover. The carbon fiber valve covers were evaluated for dimensional accuracy and quality while the 3D printed composite mold was evaluated for durability and dimensional stability. The data collected from this study provided valuable information in the understanding of 3D printed composite molds, potential improvements for the molds, and considerations for future tooling design.

Keywords: additive manufacturing, carbon fiber, composite tooling, molds

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Authors: Michael Fusi Ligaliga

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Peace and Conflict Studies (PACS), despite being a new pedagogical discipline, is a growing interdisciplinary academic field that has expanded its presence from the traditional lens of war, conflict, and violence to addressing various social issues impacting society. Family and domestic violence (FDV) has seldom been explored through the PACS lens despite some studies showing that “on average, nearly 20 people per minute are physically abused by an intimate partner in the United States. Over one year, this equates to more than 10 million women and men.” In the Pacific, FDV rates are some of the highest in the world. The friction caused by cultural practices reinforcing patriarchy and male impunity, compounded by historical colonial experiences, as well as the impact of Christianity on the Pacific region, creates a complex social landscape when thinking about and addressing FDV in the Pacific. This paper seeks to re-examine Johan Galtung’s violence triangle (GVT) theory and its application to understanding FDV in the Pacific. Galtung argues that there are three forms of violence – direct, structural, and cultural. Direct violence (DV) is behaviors that threaten life itself or diminishes the ability of a person to meet his or her basic needs. This form of violence is visible because it is manifested in behaviors such as killing, maiming, sexual assault, etc. Structural violence (SV) exists when people do not get equal access to goods and services (health, education, justice) that enable them to reach their full potential. When ideologies embedded in cultural norms and practices are used to justify and advocate acts of violence by shifting the moral parameters from being wrong to right or acceptable, this, according to Galtung, is referred to as Cultural violence (CV).

Keywords: direct violence, cultural violence, structural violence, indigenous peacebuilding, samoa

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Authors: Rafsan Al Mamun, Md. Motaharul Islam, Rabana Tajrin, Nabiha Noor, Shafinaz Qader

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In an attempt to enrich the lives of billions of people by providing proper information, security and a way of communicating with others, the need for efficient and improved satellites is constantly growing. Thus, there is an increasing demand for better error detection and correction (EDAC) schemes, which are capable of protecting the data onboard the satellites. The paper is aimed towards detecting and correcting such errors using a special algorithm called the Hamming Code, which uses the concept of parity and parity bits to prevent single-bit errors onboard a satellite in Low Earth Orbit. This paper focuses on the study of Low Earth Orbit satellites and the process of generating the Hamming Code matrix to be used for EDAC using computer programs. The most effective version of Hamming Code generated was the Hamming (16, 11, 4) version using MATLAB, and the paper compares this particular scheme with other EDAC mechanisms, including other versions of Hamming Codes and Cyclic Redundancy Check (CRC), and the limitations of this scheme. This particular version of the Hamming Code guarantees single-bit error corrections as well as double-bit error detections. Furthermore, this version of Hamming Code has proved to be fast with a checking time of 5.669 nanoseconds, that has a relatively higher code rate and lower bit overhead compared to the other versions and can detect a greater percentage of errors per length of code than other EDAC schemes with similar capabilities. In conclusion, with the proper implementation of the system, it is quite possible to ensure a relatively uncorrupted satellite storage system.

Keywords: bit-flips, Hamming code, low earth orbit, parity bits, satellite, single error upset

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Authors: Adebayo A. Abimbola, Anifowose O. Joseph, Olanrewaju S. Taiwo

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Green building (GB) practices have the potential to save energy, save money, and improve the quality of human habitat. They can also contribute to water conservation, more efficient use of raw materials, and ecosystem health around the globe. The Intergovernmental Panel on Climate Change (IPCC) singled out the building sector as having the most cost-effective opportunities for reducing carbon emissions—in fact, many building-related opportunities are cost-neutral, or even cost-positive, to the building owner. These benefits have made green building practices the fastest-growing trend in the building industry, but they still represent only a fraction of new construction, and the enormous stock of existing buildings has barely been touched at all. To effectively deliver the kind of (GB) that can become a force for positive change at global, regional and local scales, all workforce sectors need new skills that are both technical and interpersonal in nature. A prominent bottleneck is seen to be education and training. This paper investigates the major gaps in current GB education and training offerings in Nigeria. A questionnaire survey was developed to capture the perception of construction professionals and academics in relevant professions regarding the significance of the identified gaps as it affects GB education and training. Based on Likert scale ranking, research result shows that perception of training in specific technical fields and financial benefits and evaluation are identified as the top gaps in GB training and education offerings. The paper concludes with suggestions and actions that can enhance capabilities of the GB workforce in Nigeria.

Keywords: education and training, gaps, green building, workforce

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Authors: Rkia Lbouhmadi, Mir Youssef

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Fatty acids such as DocosaHexaenoic Acid (DHA) and EicosaPentaenoic Acid (EPA) are of growing interest for their positive impact on human health. Oils rich in omega-3 are in high demand, particularly for incorporation into infant milk. Generally omega-3 fatty acids are extracted from oily fish, putting additional pressure on global fish stocks that is experiencing an over exploitation. Therefore, this present work aimed to study the capacity of tree different strains of microalgae for producing lipids rich on Omega-3 fatty acids such as EPA and DHA that can be used to enrich infantile milk. Three different strains were selected for this study; Parachlorella kessleri (GEPEA UMR-CNRS6144, University of Nantes) and Cyclotella spp and Scenedesmus spp (collected from different water bodies that are located in the region of Agadir, Morocco). it examined the impact of various culture conditions on EPA and DHA accumulation in three strains. Lipid composition was analyzed using GC-MS and FTIR. Following a comparative analysis between regular and microalgal oil-supplemented formula milk was carried out by incorporating large droplets of fat containing microalgal fatty acids coated with added phospholipids into the formula milk. Results indicated that culture conditions such as light intensity affected fatty acides production. With 40% increase in Polyunsaturated Fatty Acids (PUFA) compared to Saturated Fatty Acids (SFA). In conclusion, it exploratory study indicates that incorporating large milk phospholipid-coated lipid droplets enriched with microalgae lipids into infant formula may offer improved nutritional benefits for newborns, resembling human milk.

Keywords: microalgae oil, INFANT MILK, EPA, DHA

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Authors: Shan-Yu Hsu, Hsin-Shu Huang

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The main purpose of this teaching research is to design an interdisciplinary team-assisted teaching method for trainees and interns and review the effectiveness of this teaching method on trainees' understanding of peritoneal dialysis. The teaching research object is the fifth and sixth-grade trainees in a medical center's medical school. The teaching methods include media teaching, demonstration of technical operation, face-to-face communication with patients, special case discussions, and field visits to the peritoneal dialysis room. Evaluate learning effectiveness before, after, and verbally. Statistical analysis was performed using the SPSS paired-sample t-test to analyze whether there is a difference in peritoneal dialysis professional cognition before and after teaching intervention. Descriptive statistics show that the average score of the previous test is 74.44, the standard deviation is 9.34, the average score of the post-test is 95.56, and the standard deviation is 5.06. The results of the t-test of the paired samples are shown as p-value = 0.006, showing the peritoneal dialysis professional cognitive test. Significant differences were observed before and after. The interdisciplinary team-assisted teaching method helps trainees and interns to improve their professional awareness of peritoneal dialysis. At the same time, trainee physicians have positive feedback on the inter-professional team-assisted teaching method. This teaching research finds that the clinical ability development education of trainees and interns can provide cross-professional team-assisted teaching methods to assist clinical teaching guidance.

Keywords: monitor quality, patient safety, health promotion objective, cross-professional team-assisted teaching methods

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Authors: Abdullah A. Al Qurashi, Hattan A. Hassani, Bader K. Alaslap

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Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) is an uncommon, inheritable cardiac disorder characterized by the progressive substitution of cardiac myocytes by fibro-fatty tissues. This pathologic substitution predisposes patients to ventricular arrhythmias and right ventricular failure. The underlying genetic defect predominantly involves genes encoding for desmosome proteins, particularly plakophilin-2 (PKP2). These aberrations lead to impaired cell adhesion, heightening the susceptibility to fibrofatty scarring under conditions of mechanical stress. Primarily, ARVD/C affects the right ventricle, but it can also compromise the left ventricle, potentially leading to biventricular heart failure. Clinical presentations can vary, spanning from asymptomatic individuals to those experiencing palpitations, syncopal episodes, and, in severe instances, sudden cardiac death. The establishment of a diagnostic criterion specifically tailored for ARVD/C significantly aids in its accurate diagnosis. Nevertheless, the task of early diagnosis is complicated by the disease's frequently asymptomatic initial stages, and the overall rarity of ARVD/C cases reported globally. In some cases, as exemplified by the adult female patient in this report, the disease may advance to terminal stages, rendering therapies like Ventricular Tachycardia (VT) ablation ineffective. This case underlines the necessity for increased awareness and understanding of ARVD/C to aid in its early detection and management. Through such efforts, we aim to decrease morbidity and mortality associated with this challenging cardiac disorder.

Keywords: arrhythmogenic right ventricular dysplasia, cardiac disease, interventional cardiology, cardiac electrophysiology

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Authors: Shahanaz Aboobacker Ahmed, P. Ajilal

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We live in the ‘age of migration’ where global migration and repatriation is the stark reality of human lives in the contemporary world. With increasing number of people migrating and repatriating for education, work, or crisis situations, there is an ever-growing need for active research into the effects of repatriation and migration on the psychological well-being of the migrants and expatriates. Moving across borders has resulted in individual developing a third culture and hence such individual are known as Third Culture Kids (TCKs). The aim of the study was to understand the difference in the resilience between Third Culture Kids and Non- Third Culture Kids and gain an insight into how resilience is shaped by migratory experience. The sample comprised of 200 participants that included 100 TCKs and 100 Non-TCKs. The participants were in the age range group of 17-26 years and were pursuing their college education in various parts of the world. The variable of Resilience was measured using the Resilience scale developed and standardized on TCK population which included subtests; Emotional Regulation, Impulse Control, Causal Analysis, Self Efficacy, Realistic Optimism, Empathy and Reaching Out. The data was obtained from in-person sessions and over Skype. The data was analyzed using independent sample t-tests. Results indicated that there is a significant difference between TCKs and Non-TCKs on Impulse Control, Causal Analysis, Realistic Optimism, Empathy and Reaching Out. However, no significant difference was found on the sub-variables of Self Efficacy and Emotional Regulation.

Keywords: third culture kids, resilience, immigration, cross-cultural psychology, repatriation, emotional maturity, emotional regulation, impulse control, causal analysis, self-efficacy, realistic optimism, empathy, reaching out

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Authors: Ching-Ling Lin, Li-Chi Huang, Yao-Tsung Chang, Ruey-Yu Chen, Shwu-Huey Yang

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Introduction & Purpose: Diabetes and its related complications always been a major part of medical cost in Taiwan. To patient with diabetes, self-management blood sugar, improving a healthy lifestyle are the most important thing to avoid getting worse. The aim of this study was to explore the trend of the changing in blood glucose within intervention and followed-up periods of patients who participated in the health coaching program between 2017 and 2020. Design & Methods: The data was combined from two diabetes health coaching program. The intervention group had health coaching and usual care for 6 months, whereas the control had usual care only. The main outcome variables were HbA1c level at baseline, 3, 6, 9, and 12 months. Results: In total, the data were available for 99 patients in the coaching intervention group and for 88 patients in the control group, the dropout rate during the follow-up period is about 18%. Of 187 participants, 54% were female, mean age was 61.5 years (SD=10.19), only 32.1% had a bachelor’s degree or higher, and the mean duration of diabetes treatment at Cathay General Hospital was 9.9 years. Within 12 months, the intervention group had a significant decrease of 0.65% (SD=1.05) in HbA1c level, and a non-significant decrease of 0.13%(SD=0.96) was observed in the control group. The figure showed the effect was the most significant in the first three months of the intervention and can be maintained for up to six months after the intervention was over. The HbA1c values of the two groups at each follow-up point are significantly different. In addition, there were non-significant correlation between HbA1c and gender, age, and educational level. Conclusion: Health coaching might be an effective way to enhance self-management for patients with diabetes and improving their blood sugar control in Taiwan.

Keywords: diabetes, health coaching, HbA1c, self-management

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Authors: Katie-Beth Webster

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Mucormycosis is a rare opportunistic fungal infection that, if left untreated, can cause large scale tissue necrosis and death. There are a number of cases of this in the literature, most commonly in the head and neck region arising from sinuses. It is also usually found in immunocompromised patient subgroups. This study reviewed a number of cases of mucormycosis in previously fit and healthy young trauma patients to assess predisposing factors for infection and adequacy of current treatment paradigms. These trauma patients likely contracted the fungal infection from the soil at the site of the incident. Despite early washout and debridement of the wounds at the scene of the injury and on arrival in hospital, both these patients contracted mucormycosis. It was suspected that inadequate early debridement of soil contaminated limbs was one of the major factors that can lead to catastrophic tissue necrosis. In both cases, this resulted in the patients having a higher level of amputation than would have initially been required based on the level of their injury. This was secondary to cutaneous and soft tissue necrosis secondary to the fungal infiltration leading to osteomyelitis and systemic sepsis. In the literature, it appears diagnosis is often protracted in this condition secondary to inadequate early treatment and long processing times for fungal cultures. If fungal cultures were sent at the time of first assessment and adequate debridements are performed aggressively early, it could lead to these critically unwell trauma patients receiving appropriate antifungal and surgical treatment earlier in their episode of care. This is likely to improve long term outcomes for these patients.

Keywords: mucormycosis, plastic surgery, osteomyelitis, trauma

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Authors: Muhammad Imran, Iqra Basit, Mobushir Riaz Khan, Sajid Rasheed Ahmad

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The present study investigates the space-time impact of climate change on the rice crop calendar in tropical Gujranwala, Pakistan. The climate change impact was quantified through the climatic variables, whereas the existing calendar of the rice crop was compared with the phonological stages of the crop, depicted through the time series of the Normalized Difference Vegetation Index (NDVI) derived from Landsat data for the decade 2005-2015. Local maxima were applied on the time series of NDVI to compute the rice phonological stages. Panel models with fixed and cross-section fixed effects were used to establish the relation between the climatic parameters and the time-series of NDVI across villages and across rice growing periods. Results show that the climatic parameters have significant impact on the rice crop calendar. Moreover, the fixed effect model is a significant improvement over cross-sectional fixed effect models (R-squared equal to 0.673 vs. 0.0338). We conclude that high inter-annual variability of climatic variables cause high variability of NDVI, and thus, a shift in the rice crop calendar. Moreover, inter-annual (temporal) variability of the rice crop calendar is high compared to the inter-village (spatial) variability. We suggest the local rice farmers to adapt this change in the rice crop calendar.

Keywords: Landsat NDVI, panel models, temperature, rainfall

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Authors: Adriana C. Panayi, Riaz A. Agha, Brady A. Sieber, Dennis P. Orgill

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Background: Increased rates of both breast cancer and obesity have resulted in more women seeking breast reconstruction. These women may be at increased risk for perioperative complications. A systematic review was conducted to assess the outcomes in obese women who have undergone breast reconstruction following mastectomy. Methods: Cochrane, PUBMED and EMBASE electronic databases were screened and data was extracted from included studies. The clinical outcomes assessed were surgical complications, medical complications, length of postoperative hospital stay, reoperation rate and patient satisfaction. Results: 33 studies met the inclusion criteria for the review and 29 provided enough data to be included in the meta-analysis (71368 patients, 20061 of which were obese). Obese women were 2.3 times more likely to experience surgical complications (95 percent CI 2.19 to 2.39; P < 0.00001), 2.8 times more likely to have medical complications (95 percent CI 2.41 to 3.26; P < 0.00001) and had a 1.9 times higher risk of reoperation (95 percent CI 1.75 to 2.07; P < 0.00001). The most common complication, wound dehiscence, was 2.5 times more likely in obese women (95 percent CI 1.80 to 3.52; P < 0.00001). Sensitivity analysis confirmed that obese women were more likely to experience surgical complications (RR 2.36, 95% CI 2.22–2.52; P < 0.00001). Conclusions: This study provides evidence that obesity increases the risk of complications in both implant and autologous reconstruction. Additional prospective and observational studies are needed to determine if weight reduction prior to reconstruction reduces the perioperative risks associated with obesity.

Keywords: autologous reconstruction, breast cancer, breast reconstruction, literature review, obesity, oncology, prosthetic reconstruction

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Authors: Nanyombi Lubimbi, Josette Niyokindi

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Background: As in many other developing countries in Africa, Rwanda suffers from a chronic shortage of skilled Health Care professionals including Clinical Instructors. This shortage negatively affects the clinical instruction quality therefore impacting student-learning outcomes. Due to poor clinical supervision, it is often noted that students have no structure or consistent guidance in their learning process. The Clinical Educators and the Rwandan counterparts identified the need to create a favorable environment for learning. Description: During orientation the expectations of the student learning process, collaboration of the clinical instructors with the nurses and Clinical Educators is outlined. The ward managers facilitate structured learning by helping the students identify a maximum of two patients using the school’s objectives to guide the appropriate selection of patients. Throughout the day, Clinical Educators with collaboration of Clinical Instructors when present conduct an ongoing assessment of learning and provide feedback to the students. Post-conference is provided once or twice a week to practice critical thinking skills of patient cases that they have been taking care of during the day. Lessons Learned: The students are found to be more confident with knowledge and skills gained during rotations. Clinical facility evaluations completed by students at the end of their rotations highlight the student’s satisfaction and recommendation for continuation of structured learning. Conclusion: Based on the satisfaction of both students and Clinical Instructors, we have identified need for structured learning during clinical rotations. We acknowledge that more evidence-based practice is necessary to effectively address the needs of nursing and midwifery students throughout the country.

Keywords: Rwanda, clinical rotation, structured learning, critical thinking skills, post-conference

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Authors: Rosa Suryantini, Reine S. Wulandari, Slamet Rifanjani

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Acacia (Acacia mangium) is a forest plant species which is produced to pulp and paper. The high demand for pulp and paper increase the acacia plantation forest area. However, the outbreak of Ganoderma (root rot pathogen) infection becomes obstacles for the development of acacia plantations. This is due to the extent of host range and species of Ganoderma. Ganoderma has also the ability to survive the long-term without hosts. The diversity of the host and Ganoderma species affects its virulence. Therefore, this study aimed to determine the virulence of Ganoderma from different hosts (acacia, palm oil (Elaeis guineensis) and rubber (Hevea brasiliensis)). The methods were isolation and morphology identification of Ganoderma, and inoculation of Ganoderma isolates on acacia seedlings. The results showed that the three isolates of Ganoderma from different hosts had a morphological similarity with G. Lucidum (according to Ganoderma isolated from acacia or G1), G. boninense (according to Ganoderma isolated from palm oil or G2) and G. applanatum (according to Ganoderma isolated from rubber or G3). Symptoms of infection in acacia were seen at 3 months of age. The symptoms were begun with chlorosis, necrosis and death of seedlings (such as burning). Necrosis was started from the tip of the leaf. Based on this visible symptoms, G1 was moderate virulence isolate and G2 was low virulence isolate while G3 was avirulen isolate. The symptoms were still growing in accordance with the development of plant so it affected the value of diseases severity index. Ganoderma infection decreased the dry weight of seedlings, ie. 3.82 g (seedlings that were inoculated by G1), 4.01 g (seedlings that were inoculated by G2); and 5.02 g (seedlings that were inoculated by G3) when the dry weight of seedlings control was 10,02 g. These results provide information for early control of Ganoderma diseases on acacia especially those planted near rubber and oil palm crops.

Keywords: Acacia, Ganoderma, infection, virulence

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Authors: Magdy Al Shourbagi

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Diabetes mellitus is the commonest cause of neuropathy. The common pattern is a distal symmetrical sensory polyneuropathy, associated with autonomic disturbances. Less often, Diabetes mellitus is responsible for a focal or multifocal neuropathy. Common causes for non-healing of diabetic foot are the infection and ischemia. Diabetes mellitus is associated with a defective cellular and humoral immunity. Particularly, decreased phagocytosis, decreased chemotaxis, impaired bacterial killing and abnormal lymphocytic function resulting in a reduced inflammatory reaction and defective wound healing. Hyperbaric oxygen therapy is defined by the Undersea and Hyperbaric Medical Society as a treatment in which a patient intermittently breathes 100% oxygen and the treatment chamber is pressurized to a pressure greater than sea level (1 atmosphere absolute). The pressure increase may be applied in mono-place (single person) or multi-place chambers. Multi-place chambers are pressurized with air, with oxygen given via face mask or endotracheal tube; while mono-place chambers are pressurized with oxygen. Oxygen gas plays an important role in the physiology of wound healing. Hyperbaric oxygen therapy can raise tissue oxygen tensions to levels where wound healing can be expected. HBOT increases the killing ability of leucocytes also it is lethal for certain anaerobic bacteria and inhibits toxin formation in many other anaerobes. Multiple anecdotal reports and studies in HBO therapy in diabetic patients report that HBO can be an effective adjunct therapy in the management of diabetic foot wounds and is associated with better functional outcomes.

Keywords: hyperbari oxygen therapy, diabetic foot, neuropathy, multiplace chambers

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Authors: Robin L. Rohrer

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Introduction: Pre-natal or early childhood exposure to the medical radiation used in diagnosis or treatment is an identified risk for childhood cancers but can be difficult to document. The author developed a family questionnaire/interview form to identify possible exposures. Aims: This retrospective study examines pre-natal and early childhood medical radiation exposure in a cohort of children diagnosed with a solid tumor including brain tumors from 1985-2015 at the Children’s Hospital of Pittsburgh (CHP). The hospital is a tri-state regional referral center which treats about 150-180 new cases of cancer in children per year. About 70% are diagnosed with a solid tumor. Methods: Each consented family so far (approximately 50% of the cohort) has been interviewed in person or by the phone call. Medical staff and psycho- social staff referred patient families for the interview with the author. Results: Among the families interviewed to date at least one medical radiation exposure has been identified (pre-conception, pre-natal or early childhood) in over 70% of diagnosed children. These exposures have included pre-conception sinus or chest CT or X-ray in either parent, sinus CT or X-ray in the mother or diagnostic radiation of chest or abdomen in children. Conclusions: Exposures to medical radiation for a child later diagnosed with cancer may occur at several critical junctures. These exposures may well contribute to a ‘perfect storm’ in the still elusive causes of childhood cancer. The author plans to expand the study from 1975 to present to hopefully further document these junctures.

Keywords: pediatric, solid tumors, medical radiation, cancer

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Authors: Kldiashvili Ekaterina, Burduli Archil, Ghortlishvili Gocha

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Introduction – Medical information system (MIS) is at the heart of information technology (IT) implementation policies in healthcare systems around the world. Different architecture and application models of MIS are developed. Despite of obvious advantages and benefits, application of MIS in everyday practice is slow. Objective - On the background of analysis of the existing models of MIS in Georgia has been created a multi-user web-based approach. This presentation will present the architecture of the system and its application for image based second opinion consultations. Methods – The MIS has been created with .Net technology and SQL database architecture. It realizes local (intranet) and remote (internet) access to the system and management of databases. The MIS is fully operational approach, which is successfully used for medical data registration and management as well as for creation, editing and maintenance of the electronic medical records (EMR). Five hundred Georgian language electronic medical records from the cervical screening activity illustrated by images were selected for second opinion consultations. Results – The primary goal of the MIS is patient management. However, the system can be successfully applied for image based second opinion consultations. Discussion – The ideal of healthcare in the information age must be to create a situation where healthcare professionals spend more time creating knowledge from medical information and less time managing medical information. The application of easily available and adaptable technology and improvement of the infrastructure conditions is the basis for eHealth applications. Conclusion - The MIS is perspective and actual technology solution. It can be successfully and effectively used for image based second opinion consultations.

Keywords: digital images, medical information system, second opinion consultations, electronic medical record

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Authors: Mariusz Hofman

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The paper ‘Theoretical framework for value creation in Project-Oriented Companies’ is designed to determine, how organisations create value and whether this allows them to achieve market success. An assumption has been made that there are two routes to achieving this value. The first one is to create intangible assets (i.e. the resources of human, structural and relational capital), while the other one is to create added value (understood as the surplus of revenue over costs). It has also been assumed that the combination of the achieved added value and unique intangible assets translates to the success of a project-oriented company. The purpose of the paper is to present hypothetical and deductive model which describing the modus operandi of such companies and approach to model operationalisation. All the latent variables included in the model are theoretical constructs with observational indicators (measures). The existence of a latent variable (construct) and also submodels will be confirmed based on a covariance matrix which in turn is based on empirical data, being a set of observational indicators (measures). This will be achieved with a confirmatory factor analysis (CFA). Due to this statistical procedure, it will be verified whether the matrix arising from the adopted theoretical model differs statistically from the empirical matrix of covariance arising from the system of equations. The fit of the model with the empirical data will be evaluated using χ2, RMSEA and CFI (Comparative Fit Index). How well the theoretical model fits the empirical data is assessed through a number of indicators. If the theoretical conjectures are confirmed, an interesting development path can be defined for project-oriented companies. This will let such organisations perform efficiently in the face of the growing competition and pressure on innovation.

Keywords: value creation, project-oriented company, structural equation modelling

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Authors: Shramana Mondal

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As a city is growing in population, sprawl, and complexity, use of public spaces increases variably and thus ensuring safety for the people becomes an utmost priority. While active monitoring measures may be necessary in some places, urban design can play a major role in devising self-policing and encourage active public life. This paper aims to explore the various spatial and psychological reasons for the occurrence of crime and the role of ‘urban design’ to address this issue. In this research, the principles of urban design are examined, as well as projected on actual site by addressing the issue with urban design principles. In this review the sociological, psychological, typological and morphological factors are addressed which affect the safety of a space and the possible framing guidelines, controls and urban design strategies are explored to address a safe neighborhood. On the basis of statistical survey, the residential and street network of Malviya Nagar in Delhi is chosen as the area of demonstration. The programs inhibit a safe neighborhood and a movement network that are addressed based on the four principles of natural surveillance, territoriality, community building, and connectivity. The paper concludes with a discussion of the urban design as an effective tool by creating an intense active zone with mixed use feature to ensure throughout activity and also ensuring safe pedestrian zone by introducing sense of community feeling and territoriality thus achieving active, useful and public friendly space.

Keywords: crime, public life, safety, urban design

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Authors: Ravi Kiran Pothamsetty, Radha Rani Ghosh, Baby Paul Thaliath

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Radiation therapy has undergone many advancements and evloved from 2D to 3D. Recently, with rapid pace of drug discoveries, cutting edge technology, and clinical trials has made innovative advancements in computer technology and treatment planning and upgraded to intensity modulated radiotherapy (IMRT) which delivers in homogenous dose to tumor and normal tissues. The present study was a hospital-based experience comparing two different conformal radiotherapy techniques for brain tumors. This analytical study design has been conducted at Regional Cancer Centre, India from January 2014 to January 2015. Ten patients have been selected after inclusion and exclusion criteria. All the patients were treated on Artiste Siemens Linac Accelerator. The tolerance level for maximum dose was 6.0 Gyfor lenses and 54.0 Gy for brain stem, optic chiasm and optical nerves as per RTOG criteria. Mean and standard deviation values of PTV98%, PTV 95% and PTV 2% in IMRT were 93.16±2.9, 95.01±3.4 and 103.1±1.1 respectively; for 3DCRT were 91.4±4.7, 94.17±2.6 and 102.7±0.39 respectively. PTV max dose (%) in IMRT and 3D-CRT were 104.7±0.96 and 103.9±1.0 respectively. Maximum dose to the tumor can be delivered with IMRT with acceptable toxicity limits. Variables such as expertise, location of tumor, patient condition, and TPS influence the outcome of the treatment.

Keywords: brain tumors, intensity modulated radiotherapy (IMRT), three dimensional conformal radiotherapy (3D-CRT), radiation therapy oncology group (RTOG)

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Authors: Nunuy Nuraeni, Vera Amalia Lestari, Atri Laranova, Viena Nissa Mien Fadhillah, Mutia, Muhammad Ikhlas Abdian Putra

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Introduction: Obesity is a common disease with high prevalence especially in developing countries including Indonesia. The obesitygenic lifestyle such as excessive intake of food, sedentary lifestyle is the major environmental etiologies of obesity. Obesity is also as one of burden disease with high morbidity due to its complication, such as diabetes mellitus and hypertension. The objective of this literature review is to know how the Epigallocathecin-3-Gallate of Green tea or Camellia sinensis effect as anti-obesity agent and reduce the complication of obesity. Material and Methods: This study based on the secondary data analysis complemented by primary data collection from several journal and textbook. We identified the effect of Epigallocathecin-3-Gallate of Green tea or Camellia sinensis as adjuvant therapy for management obesity and to prevent the complications of obesity. Results: Based on the result, Green tea or Camellia sinensis contain Epigallocathecin-3-Gallate (EGCG) that has anti-obesity effect such as induce apoptosis, inhibit adipogenesis, increasing lipolytic activity, increasing fat oxidation and thermogenesis. Discussion: EGCG are naturally distributed in green tea, that contains a biological activity that has a potential effect to treat obesity. Conclusion: EGCG are capable to treat obesity. By consuming EGCG can prevent obesity in normal health person and prevent complication in patient with obesity.

Keywords: adjuvant therapy, anti-obesity effect, complication, epigallocathecin-3-gallate, obesity

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Authors: Rajib Husain, Mezbah Uddin, Mohammad Shamsal Islam, Rabeya Siddiquee

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Purpose: To determine the improvement of visual acuity in patients undergoing occlusion therapy. Methods: This was a prospective hospital-based study of newly diagnosed of amblyopia seen at the pediatric clinic of Chittagong Eye Infirmary & Training Complex. There were 32 refractive amblyopia subjects were examined & questionnaire was piloted. Included were all patients diagnosed with refractive amblyopia between 5 to 8 years, without previous amblyopia treatment, and whose parents were interested to participate in the study. Patients diagnosed with strabismic amblyopia were excluded. Patients were first corrected with the best correction for a month. When the VA in the amblyopic eye did not improve over a month, then occlusion treatment was started. Occlusion was done daily for 6-8 h together with vision therapy. The occlusion was carried out for three months. Results: Out of study 32 children, 31 of them have a good compliance of amblyopic treatment whereas one child has poor compliance. About 6% Children have amblyopia from Myopia, 7% Hyperopia, 32% from myopic astigmatism, 42% from hyperopic astigmatism and 13% have mixed astigmatism. The mean and Standard deviation of present average VA was 0.452±0.275 Log MAR and after an intervention of amblyopia therapy with vision therapy mean and Standard deviation VA was 0.155±0.157 Log MAR. Out of total respondent 21.85% have BCVA in range from (0-.2) log MAR, 37.5% have BCVA in range from (0.22-0.5) log MAR, 35.95% have in range from (0.52-0.8) log MAR, 4.7% have in range from (0.82-1) log MAR and after intervention of occlusion therapy with vision therapy 76.6% have VA in range from (0-.2) log MAR, 21.85% have VA in range from (0.22-0.5) log MAR, 1.5% have in range from (0.52-0.8) log MAR. Conclusion: Amblyopia is a most important factor in pediatric age group because it can lead to visual impairment. Thus, this study concludes that occlusion therapy with vision therapy is probably one of the best treatment methods for amblyopic patients (age 5-8 years), and compliance and age were the most critical factor predicting a successful outcome.

Keywords: amblyopia, occlusion therapy, vision therapy, eccentric fixation, visuoscopy

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Authors: Ann Vibert, Heather Hemming

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This paper presentation summarizes the findings and implications of research on the plight and practices of women educational leaders in public school systems and in one university. The authors, both women university administrators, are also scholars and researchers of education. The research project on which this paper presentation is based proposed to examine how women educational leaders imagined, experienced, and carried out their leadership roles in the context of a growing local and global accountability-based performativity discourse which is reshaping educational work especially for women, we argue, in both public school and post-secondary sites. The research employed critical ethnographic interviews with 20 women educational leaders in P-12 school systems and three women university level educational leaders. Data were collected on women educational leaders’ perceptions of the effects of accountability and performativity discourses on the nature of their work. Specifically, leaders were asked to speak to whether they experienced a growth in managerial work as a consequence of increased accountability demands; how they experienced their work changing as a consequence of accountability and performativity demands; how these changes impacted the central values they enacted in their work as women educational leaders changes; and how they responded to/negotiated/accommodated changes in the nature of their work developing as a consequence of accountability and performativity frameworks. Findings from the research data and analyses confirm and extend recent scholarly work on the gendered nature of performativity and accountability discourses and frameworks, and their differential effects across differing genders. The oral presentation we propose here focusses on those findings in terms of similarities for women educational leaders across different educational contexts.

Keywords: women in educational leadership, gender and educational performativity, accountability and women leaders, gender and educational leadership

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