Search results for: nursing interventions classification

Authors: Yosep Chong, Yejin Kim, Jingyun Choi, Hwanjo Yu, Eun Jung Lee, Chang Suk Kang

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For the past decades, immunohistochemistry (IHC) has been playing an important role in the diagnosis of human neoplasms, by helping pathologists to make a clearer decision on differential diagnosis, subtyping, personalized treatment plan, and finally prognosis prediction. However, the IHC performed in various tumors of daily practice often shows conflicting and very challenging results to interpret. Even comprehensive diagnosis synthesizing clinical, histologic and immunohistochemical findings can be helpless in some twisted cases. Another important issue is that the IHC data is increasing exponentially and more and more information have to be taken into account. For this reason, we reached an idea to develop an expert supporting system to help pathologists to make a better decision in diagnosing human neoplasms with IHC results. We gave probabilistic decision tree algorithm and tested the algorithm with real case data of lymphoid neoplasms, in which the IHC profile is more important to make a proper diagnosis than other human neoplasms. We designed probabilistic decision tree based on Bayesian theorem, program computational process using MATLAB (The MathWorks, Inc., USA) and prepared IHC profile database (about 104 disease category and 88 IHC antibodies) based on WHO classification by reviewing the literature. The initial probability of each neoplasm was set with the epidemiologic data of lymphoid neoplasm in Korea. With the IHC results of 131 patients sequentially selected, top three presumptive diagnoses for each case were made and compared with the original diagnoses. After the review of the data, 124 out of 131 were used for final analysis. As a result, the presumptive diagnoses were concordant with the original diagnoses in 118 cases (93.7%). The major reason of discordant cases was that the similarity of the IHC profile between two or three different neoplasms. The expert supporting system algorithm presented in this study is in its elementary stage and need more optimization using more advanced technology such as deep-learning with data of real cases, especially in differentiating T-cell lymphomas. Although it needs more refinement, it may be used to aid pathological decision making in future. A further application to determine IHC antibodies for a certain subset of differential diagnoses might be possible in near future.

Keywords: database, expert supporting system, immunohistochemistry, probabilistic decision tree

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Authors: Yael Wolff Sagy, Yiska Loewenberg Weisband, Vered Kaufman Shriqui, Michal Krieger, Arie Ben Yehuda, Ronit Calderon Margalit

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Background: Obesity is both a risk factor and common comorbidity of diabetes. Obesity impedes the achievement of glycemic control, and enhances damage caused by hyperglycemia to blood vessels; thus it increases diabetes-related complications. This study assessed the prevalence of obesity and morbid obesity among Israeli adults with diabetes, and estimated disparities associated with sex and socioeconomic position (SEP). Methods: A cross-sectional study was conducted in the setting of the Israeli National Program for Quality Indicators in Community Healthcare. Data on all the Israeli population is retrieved from electronic medical records of the four health maintenance organizations (HMOs). The study population included all Israeli patients with diabetes aged 20-64 with documented body mass index (BMI) in 2016 (N=180,451). Diabetes was defined as the existence of one or more of the following criteria: (a) Plasma glucose level >200 mg% in at least two tests conducted at least one month apart in the previous year; (b) HbA1c>6.5% at least once in the previous year (c) at least three prescriptions of diabetes medications were dispensed during the previous year. Two measures were included: the prevalence of obesity (defined as last BMI≥ 30 kg/m2 and <35 kg/m2) and the prevalence of morbid obesity (defined as last BMI≥ 35 kg/m2) in individuals aged 20-64 with diabetes. The cut-off value for morbid obesity was set in accordance with the eligibility criteria for bariatric surgery in diabetics. Data were collected by the HMOs and aggregated by age, sex and SEP. SEP was based on statistical areas ranking by the Israeli Central Bureau of Statistics and divided into 4 categories, ranking from 1 (lowest) to 4 (highest). Results: BMI documentation among adults with diabetes was 84.9% in 2016. The prevalence of obesity in the study population was 30.5%. Although the overall rate was similar in both sexes (30.8% in females, 30.3% in males), SEP disparities were stronger in females (32.7% in SEP level 1 vs. 27.7% in SEP level 4; 18.1% relative difference) compared to males (30.6% in SEP level 1 vs. 29.3% in SEP level 4; 4.4% relative difference). The overall prevalence of morbid obesity in this population was 20.8% in 2016. The rate among females was almost double compared to the rate in males (28.1% and 14.6%, respectively). In both sexes, the prevalence of morbid obesity was strongly associated with lower SEP. However, in females, disparities between SEP levels were much stronger (34.3% in SEP level 1 vs. 18.7% in SEP level 4; 83.4% relative difference) compared to SEP-disparities in males (15.7% in SEP level 1 vs. 12.3% in SEP level 4; 27.6% relative difference). Conclusions: The overall prevalence of BMI≥ 30 kg/m2 among adults with diabetes in Israel exceeds 50%; and the prevalence of morbid obesity suggests that 20% meet the BMI-criteria for bariatric surgery. Prevalence rates show major SEP- and sex-disparities; especially strong SEP disparities in morbid obesity among females. These findings highlight the need for greater consideration of different population groups when implementing interventions.

Keywords: diabetes, health disparities, health policy, obesity, socio-economic position

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Authors: Deanne McArthur, Melinda Wall, Claire Hanlon, Dana Agnolin, Krista Davis, Melanie Dennis, Elizabeth Glidden, Anne Marie Smith, Claudette Thomson

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In Canada, as prevalence rates and severity of illness have increased among patients suffering from eating disorders, wait times have grown substantially. Patients in Canada often face wait times in excess of 12 months. It is known that delaying treatment for eating disorders contributes to poor patient outcomes and higher rates of symptom relapse. Improving interim services for adult patients awaiting outpatient treatment is a priority for an outpatient eating disorders clinic in Ontario, Canada. The clinical setting currently provides care for adults diagnosed with anorexia nervosa, bulimia nervosa and binge eating disorder. At present, the only support provided while patients are on the waitlist consists of communication with primary care providers regarding parameters for medical monitoring. The significance of this study will be to test the feasibility, acceptability and efficacy of an intervention to support adult patients awaiting outpatient eating disorder treatment for anorexia nervosa, bulimia nervosa and binge eating disorder. Methods: An intervention including psychoeducation, supportive resources, self-monitoring, and auxiliary referral will be pilot-tested with a group of patients in the summer of 2022 and detailed using a prospective cohort case study research design. The team will host patient focus groups in May 2022 to gather input informing the content of the intervention. The intervention will be pilot tested with newly-referred patients in June and July 2022. Patients who participate in the intervention will be asked to complete a survey evaluating the utility of the intervention and for suggestions, they may have for improvement. Preliminary findings describing the existing literature pertaining to waitlist interventions for patients with eating disorders, data gathered from the focus groups and early pilot testing results will be presented. Data analysis will continue throughout 2022 and early 2023 for follow-up publication and presentation in the summer of 2023. The aim of this study is to contribute to the body of knowledge pertaining to providing interim support to those patients waiting for treatment for eating disorders and, by extension, to improve outcomes for this population.

Keywords: eating disorders, waitlist management, intervention study, pilot test

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Authors: Rebecca Keyte, Helen Egan, Michail Mantzios

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It is well acknowledged that ongoing adherence is a major concern within CF. However recently literature has indicated that non-adherence should not be viewed just in terms of medical regimens. There are other damaging behaviours that some chronically ill patients engage in which can be viewed as a form of non-adherence, such as risky behaviours. Risky behaviours are a major concern within CF, as they can have adverse health effects on patients regardless of patients adherence to medical regimens. The risky behaviours this research is predominantly focusing on are smoking, excessive alcohol consumption, illicit drug use and risky sexual behaviour. This research investigates patient’s beliefs about their CF and the impact their CF has upon their life, exploring rationales for why some patients engage in risky behaviours. This research utilises qualitative semi-structured interviews taking an interpretive perspective. Twenty-four adult participants have been recruited (16 male, age range 19–66 yrs) from two UK regional CF centres, with a median FEV1 61.77% predicted. Participants were recruited via clinician guidance, with 13 participants identified by clinicians as partaking in risky behaviours. However, during the interviews 17 participants were identified as partaking in risky behaviours, illustrating that not all patients offer full disclosure of engagement in such behaviours to their clinicians. Preliminary findings illustrate a variety of reasons as to why some CF patients engage in risky behaviours, with many participants stating that one challenge in terms of living with CF is accepting their illness. Disclosure of illness was also an issue, the desire to be seen as ‘normal’ was important to many. It is often possible for CF patients to hide their illness as they do not always appear to be unwell. However, literature indicates a desire for normalcy can be accompanied with the engagement of normalised risky behaviours, enabling patients to retaliate against their illness identity. There was also evidence of a life-orientated perspective amongst participants, with some reporting that their desire for fun and enjoyment was the reason for why they were engaging in risky behaviours. Some participants did not acknowledge the impact their risky behaviours could have upon their CF, and others rationalised their continuation with the behaviours by suggesting that they were in fact beneficial to their health. There was an apparent lack of knowledge around the implications of risky behaviours, with participants indicating that they had not been informed of such potential consequences by their clinicians. Given the adverse health effects of risky behaviours within CF, more effective health promotion measures are needed to both reduce and more importantly prevent these behaviours. Due to the initiation of risky behaviours within the CF population commonly occurring during adolescence, the researcher now proposes to conduct semi-structured interviews with paediatric patients to investigate their awareness and beliefs towards risky behaviours. Overall, this research will highlight reasons why some CF patients engage in risky behaviours, in order to inform interventions aimed to prevent the initiation in risky behaviours by increasing patient awareness.

Keywords: cystic fibrosis, health beliefs, preliminary findings, risky health behaviours

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Authors: Crystal Hoole

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Employee well-being has become an area of concern for top executives and organizations worldwide. In developing countries such as South Africa, and especially in the educational sector, employees have to deal with anxiety, stress, fear, student protests, political and economic turmoil and excessive work demands on a daily basis. Research has shown that workplaces with higher resilience and better well-being strategies also report higher productivity, increased innovation, better employee retention and better employee engagement. Many organisations offer standard employee assistance programs and once-off short interventions. However, most of these well-being initiatives are perceived as ineffective. Some of the criticism centers around a lack of holistic well-being approaches, no proof of the success of well-being initiatives, not being part of the organization’s strategies and a lack of genuine leadership support. This study attempts to illustrate how a holistic well-being intervention, over a period of 100 days, is far more effective in impacting organizational outcomes. A quasi-experimental design, with a pre-test and pro-test design with a randomization strategy, will be used. Measurements of organizational outcomes are taken at three-time points throughout the study, before, middle and after. The constructs that will be measured are employee engagement, psychological well-being, organizational culture and trust, and perceived stress. The well-being is imitative follows a salutogenesis approach and is aimed at building resilience through focusing on six focal areas, namely sleep, mindful eating, exercise, love, gratitude and appreciation, breath work and mindfulness, and finally, purpose. Certain organizational constructs, including employee engagement, psychological well-being, organizational culture and trust and perceived stress, will be measured at three-time points during the study, namely before, middle and after. A quasi-experimental, pre-test and post-test design will be applied, also using a randomization strategy to limit potential bias. Repeated measure ANCOVA will be used to determine whether any change occurred over the period of 100 days. The study will take place in a Higher Education institution in South Africa. The sample will consist of academic and administrative staff. Participants will be assigned to a test and control group. All participants will complete a survey measuring employee engagement, psychological well-being, organizational culture and trust, and perceived stress. Only the test group will undergo the well-being intervention. The study envisages contributing on several levels: Firstly, the study hopes to find a positive increase in the various well-being indicators of the participants who participated in the study and secondly to illustrate that a longer more holistic approach is successful in improving organisational success (as measured in the various organizational outcomes).

Keywords: wellbeing, resilience, organizational success, intervention

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Authors: Leslie M. Gutman

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Conduct problems (CP) represent a major dilemma, with wide-ranging and long-lasting individual and societal impacts. Children experience heterogeneous patterns of conduct problems; based on the age of onset, developmental course and related risk factors from around age 3. Early childhood represents a potential window for intervention efforts aimed at changing the trajectory of early starting conduct problems. Using the UK Millennium Cohort Study (n = 17,206 children), this study (a) identifies trajectories of conduct problems from ages 3 to 14 years and (b) assesses the cumulative and interactive effects of individual, family and socioeconomic risk factors from ages 9 months to 14 years. The same factors according to three domains were assessed, including child (i.e., low verbal ability, hyperactivity/inattention, peer problems, emotional problems), family (i.e., single families, parental poor physical and mental health, large family size) and socioeconomic (i.e., low family income, low parental education, unemployment, social housing). A cumulative risk score for the child, family, and socioeconomic domains at each age was calculated. It was then examined how the cumulative risk scores explain variation in the trajectories of conduct problems. Lastly, interactive effects among the different domains of cumulative risk were tested. Using group-based trajectory modeling, four distinct trajectories were found including a ‘low’ problem group and three groups showing childhood-onset conduct problems: ‘school-age onset’; ‘early-onset, desisting’; and ‘early-onset, persisting’. The ‘low’ group (57% of the sample) showed a low probability of conducts problems, close to zero, from 3 to 14 years. The ‘early-onset, desisting’ group (23% of the sample) demonstrated a moderate probability of CP in early childhood, with a decline from 3 to 5 years and a low probability thereafter. The ‘early-onset, persistent’ group (8%) followed a high probability of conduct problems, which declined from 11 years but was close to 70% at 14 years. In the ‘school-age onset’ group, 12% of the sample showed a moderate probability of conduct problems from 3 and 5 years, with a sharp increase by 7 years, increasing to 50% at 14 years. In terms of individual risk, all factors increased the likelihood of being in the childhood-onset groups compared to the ‘low’ group. For cumulative risk, the socioeconomic domain at 9 months and 3 years, the family domain at all ages except 14 years and child domain at all ages were found to differentiate childhood-onset groups from the ‘low’ group. Cumulative risk at 9 months and 3 years did not differentiate between the ‘school-onset’ group and ‘low’ group. Significant interactions were found between the domains for the ‘early-onset, desisting group’ suggesting that low levels of risk in one domain may buffer the effects of high risk in another domain. The implications of these findings for preventive interventions will be highlighted.

Keywords: conduct problems, cumulative risk, developmental trajectories, early childhood, adolescence

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Authors: Aiman Mazhar Qureshi, Ahmed Rachid

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Extreme heat events are emerging human environmental health concerns in dense urban areas due to anthropogenic activities. High spatial and temporal resolution heat maps are important for urban heat adaptation and mitigation, helping to indicate hotspots that are required for the attention of city planners. The Heat Vulnerability Index (HVI) is the important approach used by decision-makers and urban planners to identify heat-vulnerable communities and areas that require heat stress mitigation strategies. Amiens is a medium-sized French city, where the average temperature has been increasing since the year 2000 by +1°C. Extreme heat events are recorded in the month of July for the last three consecutive years, 2018, 2019 and 2020. Poor air quality, especially ground-level ozone, has been observed mainly during the same hot period. In this study, we evaluated the HVI in Amiens during extreme heat days recorded last three years (2018,2019,2020). The Principal Component Analysis (PCA) technique is used for fine-scale vulnerability mapping. The main data we considered for this study to develop the HVI model are (a) socio-economic and demographic data; (b) Air pollution; (c) Land use and cover; (d) Elderly heat-illness; (e) socially vulnerable; (f) Remote sensing data (Land surface temperature (LST), mean elevation, NDVI and NDWI). The output maps identified the hot zones through comprehensive GIS analysis. The resultant map shows that high HVI exists in three typical areas: (1) where the population density is quite high and the vegetation cover is small (2) the artificial surfaces (built-in areas) (3) industrial zones that release thermal energy and ground-level ozone while those with low HVI are located in natural landscapes such as rivers and grasslands. The study also illustrates the system theory with a causal diagram after data analysis where anthropogenic activities and air pollution appear in correspondence with extreme heat events in the city. Our suggested index can be a useful tool to guide urban planners and municipalities, decision-makers and public health professionals in targeting areas at high risk of extreme heat and air pollution for future interventions adaptation and mitigation measures.

Keywords: heat vulnerability index, heat mapping, heat health-illness, remote sensing, urban heat mitigation

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Authors: Khadija Al-Hosni, Moon Fai Chan, Mohammed Al-Azri

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Background: Several studies suggest that most school-age adolescents are poorly informed on cancer warning signs and risk factors. Providing adolescents with sufficient knowledge would increase their awareness in adulthood and improve seeking behaviors later. Significant: The results will provide a clear vision in assisting key decision-makers in formulating policies on the students' awareness programs towards cancer. So, the likelihood of avoiding cancer in the future will be increased or even promote early diagnosis. Objectives: to evaluate the effectiveness of an education program designed to increase awareness of cancer signs and symptoms risk factors, improve the behavior of seeking help among school students in Oman, and address the barriers to obtaining medical help. Methods: A randomized controlled trial with two groups was conducted in Oman. A total of 1716 students (n=886/control, n= 830/education), aged 15-17 years, at 10th and 11th grade from 12 governmental schools 3 in governorates from 20-February-2022 to 12-May-2022. Basic demographic data were collected, and the Cancer Awareness Measure (CAM) was used as the primary outcome. Data were collected at baseline (T0) and 4 weeks after (T1). The intervention group received an education program about cancer's cause and its signs and symptoms. In contrast, the control group did not receive any education related to this issue during the study period. Non-parametric tests were used to compare the outcomes between groups. Results: At T0, the lamp was the most recognized cancer warning sign in control (55.0%) and intervention (55.2%) groups. However, there were no significant changes at T1 for all signs in the control group. In contrast, all sign outcomes were improved significantly (p<0.001) in the intervention group, the highest response was unexplained pain (93.3%). Smoking was the most recognized risk factor in both groups: (82.8% for control; 84.1% for intervention) at T0. However, there was no significant change in T1 for the control group, but there was for the intervention group (p<0.001), the highest identification was smoking cigarettes (96.5%). Too scared was the largest barrier to seeking medical help by students in the control group at T0 (63.0%) and T1 (62.8%). However, there were no significant changes in all barriers in this group. Otherwise, being too embarrassed (60.2%) was the largest barrier to seeking medical help for students in the intervention group at T0 and too scared (58.6%) at T1. Although there were reductions in all barriers, significant differences were found in six of ten only (p<0.001). Conclusion: The intervention was effective in improving students' awareness of cancer symptoms, warning signs (p<0.001), and risk factors (p<0.001 reduced the most addressed barriers to seeking medical help (p<0.001) in comparison to the control group. The Ministry of Education in Oman could integrate awareness of cancer within the curriculum, and more interventions are needed on the sociological part to overcome the barriers that interfere with seeking medical help.

Keywords: adolescents, awareness, cancer, education, intervention, student

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Authors: Tania Lisboa, Angela Voyajolu, Adam Ockelford

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The positive impact of music on the development of children with autism is widely acknowledged: music offers a unique channel for communication, wellbeing and self-regulation, as well as access to culture and a means of creative engagement. Yet, no coherent program exists for parents, carers and teachers to follow with their children in the early years, when the need for interventions is often most acute. Hence, research and the development of resources is urgently required. Autism is a project with children on the autism spectrum. The project aims at promoting the participants’ engagement with music through involvement in specially-designed musical activities with parents and carers. The main goal of the research is to verify the effectiveness of newly designed resources and strategies, which are based on the Sounds of Intent in the Early Years (SoI-EY) framework of musical development. This is a pilot study, comprising case studies of five children with autism in the early years. The data comprises semi-structured interviews, observations of videos, and feedback from parents on resources. Interpretative Phenomenological Analysis was chosen to analyze the interviews. The video data was coded in relation to the SoI-EY framework. The feedback from parents was used to evaluate the resources (i.e. musical activity cards). The participants’ wider development was also assessed through selected elements of the Early Years Foundation Stage (EYFS), a national assessment framework used in England: specifically, communication, language and social-emotional development. Five families of children on the autism spectrum (aged between 4-8 years) participated in the pilot. The research team visited each family 4 times over a 3-month period, during which the children were observed, and musical activities were suggested based on the child’s assessed level of musical development. Parents then trialed the activities, providing feedback and gathering further video observations of their child’s musical engagement between visits. The results of one case study will be featured in this paper, in which the evidence suggests that specifically tailored musical activity may promote communication and social engagement for a child with language difficulties on the autism spectrum. The resources were appropriate for the children’s involvement in musical activities. Findings suggest that non-specialist musical engagement with family and carers can be a powerful means to foster communication. The case study featured in this paper illustrates this with a child of limited verbal ability. There is a need for further research and development of resources that can be made available to all those working with children on the autism spectrum.

Keywords: autism, development, music education, resources

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Authors: Mohammad Ali Al Qatawneh, Bespalchuk Pavel Ivanovich

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Computer navigation has been introduced in total knee arthroplasty to improve the accuracy of the procedure. Computer navigation improves the accuracy of bone resection in the coronal and sagittal planes. It was also noted that it normalizes the rotational alignment of the femoral component and fully assesses and balances the deformation of soft tissues in the coronal plane. The work is devoted to the advantages of using computer navigation technology in total knee arthroplasty in 62 patients (11 men and 51 women) suffering from gonarthrosis, aged 51 to 83 years, operated using a computer navigation system, followed up to 3 years from the moment of surgery. During the examination, the deformity variant was determined, and radiometric parameters of the knee joints were measured using the Knee Society Score (KSS), Functional Knee Society Score (FKSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scales. Also, functional stress tests were performed to assess the stability of the knee joint in the frontal plane and functional indicators of the range of motion. After surgery, improvement was observed in all scales; firstly, the WOMAC values decreased by 5.90 times, and the median value to 11 points (p < 0.001), secondly KSS increased by 3.91 times and reached 86 points (p < 0.001), and the third one is that FKSS data increased by 2.08 times and reached 94 points (p < 0.001). After TKA, the axis deviation of the lower limbs of more than 3 degrees was observed in 4 patients at 6.5% and frontal instability of the knee joint just in 2 cases at 3.2%., The lower incidence of sagittal instability of the knee joint after the operation was 9.6%. The range of motion increased by 1.25 times; the volume of movement averaged 125 degrees (p < 0.001). Computer navigation increases the accuracy of the spatial orientation of the endoprosthesis components in all planes, reduces the variability of the axis of the lower limbs within ± 3 °, allows you to achieve the best results of surgical interventions, and can be used to solve most basic tasks, allowing you to achieve excellent and good outcomes of operations in 100% of cases according to the WOMAC scale. With diaphyseal deformities of the femur and/or tibia, as well as with obstruction of their medullary canal, the use of computer navigation is the method of choice. The use of computer navigation prevents the occurrence of flexion contracture and hyperextension of the knee joint during the distal sawing of the femur. Using the navigation system achieves high-precision implantation for the endoprosthesis; in addition, it achieves an adequate balance of the ligaments, which contributes to the stability of the joint, reduces pain, and allows for the achievement of a good functional result of the treatment.

Keywords: knee joint, arthroplasty, computer navigation, advantages

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Authors: Lisa Tragbar

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In post-war scenarios, reconstruction is a principle towards creating a Just Peace in order to restore a stable post-war society. Just peace theorists explore normative behaviour after war, including the duties and responsibilities of different actors and peacebuilding strategies to achieve a lasting, positive peace. Environmental peace ethicists have argued for including the role of nature in the Ethics of War and Peace. This text explores the question of why and how to rethink the value of nature in post-war scenarios. The aim is to include the rights of nature within a maximalist account of reconstruction by highlighting sumak kawsay in the post-war period. Destruction of nature is usually considered collateral damage in war scenarios. Common universal standards for post-war reconstruction are restitution, compensation and reparation programmes, which is mostly anthropocentric approach. The problem of reconstruction in the aftermath of war is the instrumental value of nature. The responsibility to rebuild needs to be revisited within a non-anthropocentric context. There is an ongoing debate about a minimalist or maximalist approach to post-war reconstruction. While Michael Walzer argues for minimalist in-and-out interventions, Alex Bellamy argues for maximalist strategies such as the responsibility to protect, a UN-concept on how face mass atrocity crimes and how to reconstruct peace. While supporting the tradition of maximalist responsibility to rebuild, these normative post-Bellum concepts do not yet sufficiently consider the rights of nature in the aftermath of war. While reconstruction of infrastructures seems important and necessary, concepts that strengthen the intrinsic value of nature in post-bellum measures must also be included. Peace is not Just Peace without a thriving nature that provides the conditions and resources to live and guarantee human rights. Ecuador's indigenous philosophy of life can contribute to the restoration of nature after war by changing the perspective on the value of nature. The sumak kawsay includes the de-hierarchisation of humans and nature and the principle of reciprocity towards nature. Transferring this idea of life and interconnectedness to post-war reconstruction practices, post bellum perpetrators have restorative obligations not only to people but also to nature. This maximalist approach would include both a restitutive principle, by restoring the balance between humans and nature, and a retributive principle, by punishing the perpetrators through compensatory duties to nature. A maximalist approach to post-war reconstruction that takes into account the rights of nature expands the normative post-war questions to include a more complex field of responsibilities. After a war, Just Peace is restored once not only human rights but also the rights of nature are secured. A minimalist post-bellum approach to reconstruction does not locate future problems at their source and does not offer a solution for the inclusion of obligations to nature. There is a lack of obligations towards nature after a war, which can be changed through a different perspective: The indigenous philosophy of life provides the necessary principles for a comprehensive reconstruction of Just Peace.

Keywords: normative ethics, peace, post-war, sumak kawsay, applied ethics

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Authors: Lilian Bambirra De Assis, Patricia Albuquerque Gomes, Kamila Pagel De Oliveira, Deborah Oliveira Santos, Marcelo Esteves Chaves Campos

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This paper aimed to analyze how performance management occurs in the context of the modernization of the federal public sector in Chile and Portugal. To do so, the study was based on a theoretical framework that covers the modernization of public administration to performance management, passing on people management. The work consisted of qualitative-descriptive research in which 16 semi-structured interviews were applied in the countries of study and documents and legislation were used referring to the subject. Performance management, as well as other people management subsystems, is criticized for using private sector management tools, based on a results-driven logic. From this point of view, it is understood that certain practices of the private sector, regarding the measurement of performance, can not be simply inserted in the scenario of the public administration. Beyond this criticism, performance management can contribute to the achievement of the strategic objectives of the countries and its focus is upward, a trend that can be verified through the manuals produced; by the interest of consultants and professional organizations, both public and private; and OECD (Organization for Economic Cooperation and Development) evaluations. In Portugal, public administration reform was implemented during the Constitutional Government (2005-2009) and had as its objective the restructuring of human resources management, with an emphasis on its integration with budget management, which is an inclination of the OECD, while in Chile HRM (Human Resource Management) practices are directed to ministries to a lesser extent than the OECD average. The central human resources management sector, for the most part, coordinates policy but is also responsible for other issues, including payment and classification systems. Chile makes less use of strategic Human Resource Management practices than the average of OECD countries, and its prominence lies in the decentralization of public bodies, which may grant autonomy, but fragments the implementation of policies and practices in that country since they are not adopted by all organs. Through the analysis, it was possible to identify that Chile and Portugal have practices and personnel management policies that make reference to performance management, which is similar to other OECD countries. The study countries also have limitations to implement performance management and the results indicate that there are still processes to be perfected, such as performance appraisal and compensation.

Keywords: management of people in the public sector, modernization of public administration, performance management in the public sector, HRM, OECD

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Authors: Lily Farris, Chantel E. Canessa, Rena Heathcote, Susan Shumay, Suzanna V. McRae, Alissa Collingridge, Minna K. Miller

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Objective: To describe how the Lean approach can be applied to improve access, quality and safety of care in an ambulatory pediatric primary care setting. Background: Lean was originally developed by Toyota manufacturing in Japan, and subsequently adapted for use in the healthcare sector. Lean is a systematic approach, focused on identifying and reducing waste within organizational processes, improving patient-centered care and efficiency. Limited literature is available on the implementation of the Lean methodologies in a pediatric ambulatory care setting. Methods: A strategic continuous improvement event or Rapid Process Improvement Workshop (RPIW) was launched with the aim evaluating and structurally supporting clinic workflow, capacity building, sustainability, and ultimately improving access to care and enhancing the patient experience. The Lean process consists of five specific activities: Current state/process assessment (value stream map); development of a future state map (value stream map after waste reduction); identification, quantification and prioritization of the process improvement opportunities; implementation and evaluation of process changes; and audits to sustain the gains. Staff engagement is a critical component of the Lean process. Results: Through the implementation of the RPIW and shifting workload among the administrative team, four hours of wasted time moving between desks and doing work was eliminated from the Administrative Clerks role. To streamline clinic flow, the Nursing Assistants completed patient measurements and vitals for Nurse Practitioners, reducing patient wait times and adding value to the patients visit with the Nurse Practitioners. Additionally, through the Nurse Practitioners engagement in the Lean processes a need was recognized to articulate clinic vision, mission and the alignment of NP role and scope of practice with the agency and Ministry of Health strategic plan. Conclusions: Continuous improvement work in the Pediatric Primary Care NP Clinic has provided a unique opportunity to improve the quality of care delivered and has facilitated further alignment of the daily continuous improvement work with the strategic priorities of the Ministry of Health.

Keywords: ambulatory care, lean, pediatric primary care, system efficiency

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Authors: Jemma Porrett

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Background: We present a literature review examining the research surrounding tick paralysis resulting in facial nerve palsy. A case of an intra-aural paralysis tick bite resulting in unilateral facial nerve palsy is also discussed. Methods: A novel case of otoacariasis with associated ipsilateral facial nerve involvement is presented. Additionally, we conducted a review of the literature, and we searched the MEDLINE and EMBASE databases for relevant literature published between 1915 and 2020. Utilising the following keywords; 'Ixodes', 'Facial paralysis', 'Tick bite', and 'Australia', 18 articles were deemed relevant to this study. Results: Eighteen articles included in the review comprised a total of 48 patients. Patients' ages ranged from one year to 84 years of age. Ten studies estimated the possible duration between a tick bite and facial nerve palsy, averaging 8.9 days. Forty-one patients presented with a single tick within the external auditory canal, three had a single tick located on the temple or forehead region, three had post-auricular ticks, and one patient had a remarkable 44 ticks removed from the face, scalp, neck, back, and limbs. A complete ipsilateral facial nerve palsy was present in 45 patients, notably, in 16 patients, this occurred following tick removal. House-Brackmann classification was utilised in 7 patients; four patients with grade 4, one patient with grade three, and two patients with grade 2 facial nerve palsy. Thirty-eight patients had complete recovery of facial palsy. Thirteen studies were analysed for time to recovery, with an average time of 19 days. Six patients had partial recovery at the time of follow-up. One article reported improvement in facial nerve palsy at 24 hours, but no further follow-up was reported. One patient was lost to follow up, and one article failed to mention any resolution of facial nerve palsy. One patient died from respiratory arrest following generalized paralysis. Conclusions: Tick paralysis is a severe but preventable disease. Careful examination of the face, scalp, and external auditory canal should be conducted in patients presenting with otalgia and facial nerve palsy, particularly in tropical areas, to exclude the possibility of tick infestation.

Keywords: facial nerve palsy, tick bite, intra-aural, Australia

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Authors: Mitakshara Sharma, S. K. Nema, Sanjeev Narang

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Diabetes mellitus (DM) is a group of metabolic disorders characterized by metabolic abnormalities, chronic hyperglycaemia and long term macrovascular & microvascular complications. Vascular complications are due to platelet hyperactivity and dysfunction, increased inflammation, altered coagulation and endothelial dysfunction. Large proportion of patients with Type II DM suffers from preventable vascular angiopathies, and there is need to develop risk factor modifications and interventions to reduce impact of complications. These complications are attributed to platelet activation, recognised by increase in Platelet Volume Indices (PVI) including Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW). The current study is prospective analytical study conducted over 2 years. Out of 1100 individuals, 930 individuals fulfilled inclusion criteria and were segregated into three groups on basis of glycosylated haemoglobin (HbA1C): - (a) Diabetic, (b) Non-Diabetic and (c) Subjects with Impaired fasting glucose (IFG) with 300 individuals in IFG and non-diabetic groups & 330 individuals in diabetic group. Further, diabetic group was divided into two groups on the basis of presence or absence of known diabetes related vascular complications. Samples for HbA1c and PVI were collected using Ethylene diamine tetraacetic acid (EDTA) as anticoagulant and processed on SYSMEX-X-800i autoanalyser. The study revealed gradual increase in PVI from non-diabetics to IFG to diabetics. PVI were markedly increased in diabetic patients. MPV and PDW of diabetics, IFG and non diabetics were (17.60 ± 2.04)fl, (11.76 ± 0.73)fl, (9.93 ± 0.64)fl and (19.17 ± 1.48)fl, (15.49 ± 0.67)fl, (10.59 ± 0.67)fl respectively with a significant p value 0.00 and a significant positive correlation (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). MPV & PDW of subjects with diabetes related complications were higher as compared to those without them and were (17.51±0.39)fl & (15.14 ± 1.04)fl and (20.09 ± 0.98) fl & (18.96 ± 0.83)fl respectively with a significant p value 0.00. There was a significant positive correlation between PVI and duration of diabetes across the groups (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). However, a significant negative correlation was found between glycaemic levels and total platelet count (PC- HbA1c r =-0.164). This is multi-parameter and comprehensive study with an adequately powered study design. It can be concluded from our study that PVI are extremely useful and important indicators of impending vascular complications in all patients with deranged glycaemic control. Introduction of automated cell counters has facilitated the availability of PVI as routine parameters. PVI is a useful means for identifying larger & active platelets which play important role in development of micro and macro angiopathic complications of diabetes leading to mortality and morbidity. PVI can be used as cost effective markers to predict and prevent impending vascular events in patients with Diabetes mellitus especially in developing countries like India. PVI, if incorporated into protocols for management of diabetes, could revolutionize care and curtail the ever increasing cost of patient management.

Keywords: diabetes, IFG, HbA1C, MPV, PDW, PVI

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Authors: Murray Matarab Konzang

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Lae Port Development Project, Four Lane Highway and other development in the extraction industry which have direct road link to Lae City are predicted to have significant impact on its road network system. This paper evaluates Lae roads improvement program with forecast on planning, economic and the installation of bypasses to ease congestion, effective and convenient transport service for bulk goods and reduce travel time. Land-use transportation study and plans for local area traffic management scheme will be considered. City roads are faced with increased number of traffic and some inadequate road pavement width, poor transport plans, and facilities to meet this transportation demand. Lae also has drainage system which might not hold a 100 year flood. Proper evaluation, plan, design and intersection analysis is needed to evaluate road network system thus recommend improvement and estimate future growth. Repetitive and cyclic loading by heavy commercial vehicles with different axle configurations apply on the flexible pavement which weakens and tear the pavement surface thus small cracks occur. Rain water seeps through and overtime it creates potholes. Effective planning starts from experimental research and appropriate design standards to enable firm embankment, proper drains and quality pavement material. This paper will address traffic problems as well as road pavement, capacities of intersections, and pedestrian flow during peak hours. The outcome of this research will be to identify heavily trafficked road sections and recommend treatments to reduce traffic congestions, road classification, and proposal for bypass routes and improvement. First part of this study will describe transport or traffic related problems within the city. Second part would be to identify challenges imposed by traffic and road related problems and thirdly to recommend solutions after the analyzing traffic data that will indicate current capacities of road intersections and finally recommended treatment for improvement and future growth.

Keywords: Lae, road network, highway, vehicle traffic, planning

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Authors: Ella Tyuryumina, Alexey Neznanov

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This paper is devoted to mathematical modelling of the progression and stages of breast cancer. We propose Consolidated mathematical growth model of primary tumor and secondary distant metastases growth in patients with lymph nodes metastases (CoM-III) as a new research tool. We are interested in: 1) modelling the whole natural history of primary tumor and secondary distant metastases growth in patients with lymph nodes metastases; 2) developing adequate and precise CoM-III which reflects relations between primary tumor and secondary distant metastases; 3) analyzing the CoM-III scope of application; 4) implementing the model as a software tool. Firstly, the CoM-III includes exponential tumor growth model as a system of determinate nonlinear and linear equations. Secondly, mathematical model corresponds to TNM classification. It allows to calculate different growth periods of primary tumor and secondary distant metastases growth in patients with lymph nodes metastases: 1) ‘non-visible period’ for primary tumor; 2) ‘non-visible period’ for secondary distant metastases growth in patients with lymph nodes metastases; 3) ‘visible period’ for secondary distant metastases growth in patients with lymph nodes metastases. The new predictive tool: 1) is a solid foundation to develop future studies of breast cancer models; 2) does not require any expensive diagnostic tests; 3) is the first predictor which makes forecast using only current patient data, the others are based on the additional statistical data. Thus, the CoM-III model and predictive software: a) detect different growth periods of primary tumor and secondary distant metastases growth in patients with lymph nodes metastases; b) make forecast of the period of the distant metastases appearance in patients with lymph nodes metastases; c) have higher average prediction accuracy than the other tools; d) can improve forecasts on survival of breast cancer and facilitate optimization of diagnostic tests. The following are calculated by CoM-III: the number of doublings for ‘non-visible’ and ‘visible’ growth period of secondary distant metastases; tumor volume doubling time (days) for ‘non-visible’ and ‘visible’ growth period of secondary distant metastases. The CoM-III enables, for the first time, to predict the whole natural history of primary tumor and secondary distant metastases growth on each stage (pT1, pT2, pT3, pT4) relying only on primary tumor sizes. Summarizing: a) CoM-III describes correctly primary tumor and secondary distant metastases growth of IA, IIA, IIB, IIIB (T1-4N1-3M0) stages in patients with lymph nodes metastases (N1-3); b) facilitates the understanding of the appearance period and inception of secondary distant metastases.

Keywords: breast cancer, exponential growth model, mathematical model, primary tumor, secondary metastases, survival

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Authors: Hilal Keklicek, Fatih Erbahceci, Elif Kirdi, Ali Yalcin, Semra Topuz, Ozlem Ulger, Gul Sener

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Objectives and Goals: The stride-to-stride fluctuations in gait is a determinant of qualified locomotion as known as gait variability. Gait variability is an important predictive factor of fall risk and useful for monitoring the effects of therapeutic interventions and rehabilitation. Comparison of gait variability in individuals with trans-tibial lower limb loss and trans femoral lower limb loss was the aim of the study. Methods: Ten individuals with traumatic unilateral trans femoral limb loss(TF), 12 individuals with traumatic transtibial lower limb loss(TT) and 12 healthy individuals(HI) were the participants of the study. All participants were evaluated with treadmill. Gait characteristics including mean step length, step length variability, ambulation index, time on each foot of participants were evaluated with treadmill. Participants were walked at their preferred speed for six minutes. Data from 4th minutes to 6th minutes were selected for statistical analyses to eliminate learning effect. Results: There were differences between the groups in intact limb step length variation, time on each foot, ambulation index and mean age (p < .05) according to the Kruskal Wallis Test. Pairwise analyses showed that there were differences between the TT and TF in residual limb variation (p=.041), time on intact foot (p=.024), time on prosthetic foot(p=.024), ambulation index(p = .003) in favor of TT group. There were differences between the TT and HI group in intact limb variation (p = .002), time on intact foot (p<.001), time on prosthetic foot (p < .001), ambulation index result (p < .001) in favor of HI group. There were differences between the TF and HI group in intact limb variation (p = .001), time on intact foot (p=.01) ambulation index result (p < .001) in favor of HI group. There was difference between the groups in mean age result from HI group were younger (p < .05).There were similarity between the groups in step lengths (p>.05) and time of prosthesis using in individuals with lower limb loss (p > .05). Conclusions: The pilot study provided basic data about gait stability in individuals with traumatic lower limb loss. Results of the study showed that to evaluate the gait differences between in different amputation level, long-range gait analyses methods may be useful to get more valuable information. On the other hand, similarity in step length may be resulted from effective prosthetic using or effective gait rehabilitation, in conclusion, all participants with lower limb loss were already trained. The differences between the TT and HI; TF and HI may be resulted from the age related features, therefore, age matched population in HI were recommended future studies. Increasing the number of participants and comparison of age-matched groups also recommended to generalize these result.

Keywords: lower limb loss, amputee, gait variability, gait analyses

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Authors: Olga Maksakova

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A work with unconscious patients after acute brain damages besides special knowledge and practical skills of all the participants requires a very specific organization. A lot of said about team approach in neurorehabilitation, usually as for outpatient mode. Rehabilitologists deal with fixed patient problems or deficits (motion, speech, cognitive or emotional disorder). Team-building means superficial paradigm of management psychology. Linear mode of teamwork fits casual relationships there. Cases with deep altered states of consciousness (vegetative states, coma, and confusion) require non-linear mode of teamwork: recovery of consciousness might not be the goal due to phenomenon uncertainty. Rehabilitation team as Semi-open Complex System includes the patient as a part. Patient's response pattern becomes formed not only with brain deficits but questions-stimuli, context, and inquiring person. Teamwork is sourcing of phenomenology knowledge of patient's processes as Third-person approach is replaced with Second- and after First-person approaches. Here is a chance for real-time change. Patient’s contacts with his own body and outward things create a basement for restoration of consciousness. The most important condition is systematic feedbacks to any minimal movement or vegetative signal of the patient. Up to now, recovery work with the most severe contingent is carried out in the mode of passive physical interventions, while an effective rehabilitation team should include specially trained psychologists and psychotherapists. It is they who are able to create a network of feedbacks with the patient and inter-professional ones building up the team. Characteristics of ‘Team-Patient’ system (TPS) are energy, entropy, and complexity. Impairment of consciousness as the absence of linear contact appears together with a loss of essential functions (low energy), vegetative-visceral fits (excessive energy and low order), motor agitation (excessive energy and excessive order), etc. Techniques of teamwork are different in these cases for resulting optimization of the system condition. Directed regulation of the system complexity is one of the recovery tools. Different signs of awareness appear as a result of system self-organization. Joint meetings are an important part of teamwork. Regular or event-related discussions form the language of inter-professional communication, as well as the patient's shared mental model. Analysis of complex communication process in TPS may be useful for creation of the general theory of consciousness.

Keywords: rehabilitation team, urgent rehabilitation, severe brain damage, consciousness disorders, complex system theory

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Authors: Shosh Kazaz, Shmuel Banai, Vered Zilberberg

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Optimizing high business performance and employee's well-being simultaneously often challenges organizations. 'TIP' intervention enables achieving them both as the given project demonstrates. Increasing outcomes and improving performance were the initial motivators for this explorative project, followed by a request of the head of the Cardiology department: 'I know we are the best at our clinical practice, but we need to take it further and break our own glass ceiling.' Two guided interventions were conducted in two different units within the department, designed to implement advanced managerial and business-oriented tools, along with 'soft tools' based on coaching psychology and particularly wellness coaching. The organ department multi-disciplinary teams were assembled, aiming to manage and lead the process: mapping the patients' flow, creating solutions, implementing, assessing, improving and assimilating them. Approximately four months later, without additional external resources, meaningful results emerged by the teams in terms of business and performance: shortening the hospitalization length at a given procedure (from 7 to 2.1 days); increasing the availability of Catheterization laboratory by 16% daily – resulting profitability raise; improving patients' journey and experience. A year later, those results are maintained. Furthermore, interviews with the participants revealed positive perceptions regarding the department; a higher sense of joyfulness, connectedness, belonging and a better department climate were reported. Additionally, participants reported a higher sense of fulfillment as opposed to their earliest skepticism and cynicism about their ability to enhance outcomes without more resources (budget and/or manpower), experiencing a mindset change toward the possibility of leading personal and professional growth processes. These reports were supported by analyzing a set of questionnaires that the participants completed, parallel to a control group of non-participating colleagues. Although the assessment was taken a year after the completion of the project and during 'covid-19th-3rd national quarantine, the results indicated a significant impact on several personal parameters associated with wellness, compared to the control group. The participants were higher in self-efficacy and organizational commitment; men were higher in resilience and optimism and women were higher in well-being. In conclusion, the 'TIP' relatively short intervention integrates advanced managerial and wellness coaching tools, empowers organizational resources: Team, Individual and Process and by that generates multi-impact measurable results in terms of employee's wellness parameters along with business performance and patient care.

Keywords: coaching, health and wellness, health management, leadership and well-being

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Authors: S. Mamoucha, J. Rahul, N. Christodoulakis

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Introduction: Nature has been the source of medicinal agents since the dawn of the human existence on Earth. Currently, millions of people, in the developing world, rely on medicinal plants for primary health care, income generation and lifespan improvement. In Greece, more than 5500 plant taxa are reported while about 250 of them are considered to be of great pharmaceutical importance. Among the plants used for medical purposes, Vitex agnus-castus L. (Verbenaceae) is known since ancient times. It is a small tree or shrub, widely distributed in the Mediterranean basin up to the Central Asia. It is also known as chaste tree or monks pepper. Theophrastus mentioned the shrub several times, as ‘agnos’ in his ‘Enquiry into Plants’. Dioscorides mentioned the use of V. agnus-castus for the stimulation of lactation in nursing mothers and the treatment of several female disorders. The plant has important medicinal properties and a long tradition in folk medicine as an antimicrobial, diuretic, digestive and insecticidal agent. Materials and methods: Leaves were cleaned, detached, fixed, sectioned and investigated with light and Scanning Electron Microscopy (SEM). Histochemical tests were executed as well. Specific histochemical reagents (osmium tetroxide, H2SO4, vanillin/HCl, antimony trichloride, Wagner’ s reagent, Dittmar’ s reagent, potassium bichromate, nitroso reaction, ferric chloride and di methoxy benzaldehyde) were used for the sub cellular localization of secondary metabolites. Results: Light microscopical investigations of the elongated leaves of V. agnus-castus revealed three layers of palisade parenchyma, just below the single layered adaxial epidermis. The spongy parenchyma is rather loose. Adaxial epidermal cells are larger in magnitude, compared to those of the abaxial epidermis. Four different types of capitate, secreting trichomes, were localized among the abaxial epidermal cells. Stomata were observed at the abaxial epidermis as well. SEM revealed the interesting arrangement of trichomes. Histochemical treatment on fresh and plastic embedded tissue sections revealed the nature and the sites of secondary metabolites accumulation (flavonoids, steroids, terpenes). Acknowledgment: This work was supported by IKY - State Scholarship Foundation, Athens, Greece.

Keywords: Vitex agnus-castus, leaf anatomy, histochemical reagents, secondary metabolites

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Authors: Ibitoye Olabode Clement

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The huge amount of grants for infrastructures development in Tertiary Institutions in Nigeria calls for transparency and accountability in the procurement process. However, questions have been raised concerning the judicious and appropriate use of the funds, and it was doubtful if the institutions complied with due process. This paper examined the causes of non-compliance with the Public Procurement Act (2007) in the procurement of Goods, Works, and Services through either direct or indirect processes of procurement, mostly in Tertiary Institutions of State government subvention institutions in Nigeria. Nigeria has over 120 public universities, polytechnics, and colleges of Education. This paper will take samples of some selected Institutions in southwest Nigeria. The institutions comprise 5 Universities, 5 Polytechnics, and 5 Colleges of Education / Health and Technology. The opinions of the institutions’ Procurement Officers on the tremendous investment through grants and interventions for infrastructure development in Tertiary Education Institutions (TEI) in Nigeria call for transparency and accountability in the procurement process. However, there are a lot of questions have been raised as to the judicious use of the funds, and it was doubtful if the institutions complied with due process. This study examined the causes of non-compliance with the Public Procurement Act (2007) in the procurement of Goods, Works, and Services in most State Government Public Institutions in Southwest Nigeria. Over, 120 public institutions comprising 5 Universities, 5 Polytechnics, and 5 Colleges of Education / Health and Technology were used for the study. The opinions of the institutions’ Procurement Officers on the causes of non-compliance with the Act in their procurement process were sought using a structured questionnaire. The results revealed that non-independent of Procurement Officers, non-compliance with the Act by some at the managerial level, claiming inadequate knowledge of the Act, non-employment of qualified and experienced Procurement officers, insufficient publicity of the Act, and non-existence of corporate governance led to poor management of procurement record and non-provision of incentive, Inability to separate the duties of Internal Auditors and Procurement Officers, Inability to translate procurement entity at large which makes nearly all at departmental level believe they procurement officers. Conclusively, on taking the Procurement Officers through interviewing having it that: the right educational and professional qualifications, understanding of the Act, sufficient cognate working experience, recruiting most professionals needed if not all, and occupying management position will enhance compliance. Hence, in addition, adopting an external empowered department from the Bureau should raise for monitoring the compliance mostly in State Government Tertiary Education Institution. Also, an organizational culture with a corporate governance structure that supports the engagement of the right and qualified personnel to handle procurement, encourages them to perform at their best and rewards excellent service by giving incentives, and operates within an administrative environment devoid of corruption.

Keywords: non compliance of procurement act, tertiary education institution, university, polytechnic and college of education/ health science and technology, Nigeria

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Authors: Desalegn Feyissa Desu

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Drug therapy problem is a significant challenge to provide high quality health care service for the patients. It is associated with morbidity, mortality, increased hospital stay, and reduced quality of life. Moreover, pediatric patients are quite susceptible to drug therapy problems. Thus this study aimed to assess drug therapy problem and its contributing factors among pediatric patients diagnosed with infectious disease admitted to pediatric ward of Jimma university medical center, from April 1 to June 30, 2018. Prospective observational study was conducted among pediatric patients with infectious disease admitted from April 01 to June 30, 2018. Drug therapy problems were identified by using Cipolle’s and strand’s drug related problem classification method. Patient’s written informed consent was obtained after explaining the purpose of the study. Patient’s specific data were collected using structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug therapy problems occurrence, multiple stepwise backward logistic regression analysis was done. The 95% CI was used to show the accuracy of data analysis and statistical significance was considered at p-value < 0.05. A total of 304 pediatric patients were included in the study. Of these, 226(74.3%) patients had at least one drug therapy problem during their hospital stay. A total of 356 drug therapy problems were identified among two hundred twenty six patients. Non-compliance (28.65%) and dose too low (27.53%) were the most common type of drug related problems while disease comorbidity [AOR=3.39, 95% CI= (1.89-6.08)], Polypharmacy [AOR=3.16, 95% CI= (1.61-6.20)] and more than six days stay in hospital [AOR=3.37, 95% CI= (1.71-6.64) were independent predictors of drug therapy problem occurrence. Drug therapy problems were common in pediatric patients with infectious disease in the study area. Presence of comorbidity, polypharmacy and prolonged hospital stay were the predictors of drug therapy problem in study area. Therefore, to overcome the significant gaps in pediatric pharmaceutical care, clinical pharmacists, Pediatricians, and other health care professionals have to work in collaboration.

Keywords: drug therapy problem, pediatric, infectious disease, Ethiopia

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Authors: Toslim Uddin Khan, Jesmin Akter, Mohiuddin Ahmed

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Menstrual hygiene management (MHM) and personal health-care practice is a critical issue to prevent morbidity and other reproductive health complications among adolescent girls in Bangladesh. Inadequate access to water, sanitation and hygiene (WASH) facilities lead to unhealthy MHM practices that resulted in poor reproductive health outcomes. It is evident from different studies that superstitions and misconception are more common in rural communities that limit young girls’ access to and understanding of the menstrual hygiene and self care practices. The state-of-the-art approach of Social Marketing Company (SMC) is proved to be instrumental in delivering reinforcing health messages, making public health and hygiene products available at the door steps of the community through community mobilization programs in rural Bangladesh. School health program is one of the flagship interventions of SMC to equip adolescent girls and boys with correct knowledge of health and hygiene practices among themselves, their families and peers. In Bangladeshi culture, adolescent girls often feel shy to ask fathers or male family members about buying sanitary napkin from local pharmacy and they seem to be reluctant to seek help regarding their menstrual problems. A recent study reveals that 48% adolescent girls are using sanitary napkins while majority of them are unaware of menstrual hygiene practices in Bangladesh. Under school adolescent program, SMC organizes health education sessions for adolescent girls from grade seven to ten using enter-educate approach with special focus on sexual and reproductive health and menstrual hygiene issues including delaying marriage and first pregnancy. In addition, 2500 rural women entrepreneurs branded as community sales agents are also involved in disseminating health messages and selling priority health products including sanitary napkin at the household level. These women entrepreneurs are serving as a source of sustainable supply of the sanitary napkins for the rural adolescent girls and thereby they are earning profit margins on the sales they make. A recent study on the impact of adolescent program activities reveals that majority (71%) of the school adolescent girls are currently using sanitary napkins. Health education equips and empowers adolescent girls with accurate knowledge about menstrual hygiene practices and self-care as well. Therefore, engagement of female entrepreneurs in school adolescent health program at the community level is one of the promising ways to improve menstrual hygiene practices leading to increased use of sanitary napkin in rural and semi-rural communities in Bangladesh.

Keywords: school adolescent program, social marketing, women entrepreneurs, menstrual hygiene management

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Authors: Dor Oppenheim, Yael Edan, Guy Shani

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This paper presents an image analysis algorithm to detect and count yellow tomato flowers in a greenhouse with uneven illumination conditions, complex growth conditions and different flower sizes. The algorithm is designed to be employed on a drone that flies in greenhouses to accomplish several tasks such as pollination and yield estimation. Detecting the flowers can provide useful information for the farmer, such as the number of flowers in a row, and the number of flowers that were pollinated since the last visit to the row. The developed algorithm is designed to handle the real world difficulties in a greenhouse which include varying lighting conditions, shadowing, and occlusion, while considering the computational limitations of the simple processor in the drone. The algorithm identifies flowers using an adaptive global threshold, segmentation over the HSV color space, and morphological cues. The adaptive threshold divides the images into darker and lighter images. Then, segmentation on the hue, saturation and volume is performed accordingly, and classification is done according to size and location of the flowers. 1069 images of greenhouse tomato flowers were acquired in a commercial greenhouse in Israel, using two different RGB Cameras – an LG G4 smartphone and a Canon PowerShot A590. The images were acquired from multiple angles and distances and were sampled manually at various periods along the day to obtain varying lighting conditions. Ground truth was created by manually tagging approximately 25,000 individual flowers in the images. Sensitivity analyses on the acquisition angle of the images, periods throughout the day, different cameras and thresholding types were performed. Precision, recall and their derived F1 score were calculated. Results indicate better performance for the view angle facing the flowers than any other angle. Acquiring images in the afternoon resulted with the best precision and recall results. Applying a global adaptive threshold improved the median F1 score by 3%. Results showed no difference between the two cameras used. Using hue values of 0.12-0.18 in the segmentation process provided the best results in precision and recall, and the best F1 score. The precision and recall average for all the images when using these values was 74% and 75% respectively with an F1 score of 0.73. Further analysis showed a 5% increase in precision and recall when analyzing images acquired in the afternoon and from the front viewpoint.

Keywords: agricultural engineering, image processing, computer vision, flower detection

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Authors: Suzanne Strauss, Leandi Steenkamp

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The Finnish symphonic metal band Nightwish is the brainchild of songwriter and lyricist TuomasHolopainen and the band recorded their first demonstration recording in 1996. The band has since produced nine full-length studio albums, the most recent being the 2020 album Human. :||: Nature., and has reached massive international success. The band is well known for songs about fantasy and escapism and employs many sonic, visual and branding tools and techniques to communicate these constructs to the audience. Among these, is the band’s creation of the so-called “Nightwish world and mythology” with a set of recurring characters and narratives which, in turn, creates a psychological anchor and safe space for Nightwish fans around the globe. Nature and the reverence of nature are central themes in Nightwish’s self-created mythology.Swiss psychologist Carl Jung’s theory of the collective unconscious identified a mysterious reservoir of psychological constructs common to all people, being derived from ancestral memory and experience, common to all humankind, and distinct from the individual’s personal unconscious. Furthermore, he defined archetypes as timeless collective patterns and images that springs forth from the collective unconscious. Archetypes can be actualized when they enter consciousness as images in interaction with the outside world. Archetypal patterns or images can manifest in different ways across world cultures, but follow common patterns, also known as archetypal themes and symbols. The Jungian approach to the psyche places great emphasis on nature, positing a direct link betweenthe concept of wholeness and responsible care for nature and the environment.In our proposed paper, we examine, by means of thematic content analysis, how Nightwish makes use of archetypal themes and symbols referring to nature and the environment in selected songs from their ninth full-length album Human. II Nature. Furthermore, we argue that the longing for and reverence of nature in selected Nightwish songs may serve as a type of “social intervention” and social critique on modern capitalist society. The type of social critique that the band offers is generally connoted intertextually and is not equally explicit in their songs. The band uses a unique combination of escapism, fantasy, and nature narratives to inspire a sense of wonder, enchantment, and magic in the listener. In this way, escapism, fantasy, and nature serve as postmodern frames of reference that aim to “re-enchant” the disenchanted and de-spiritualized. In this way, re-enchantment could also refer to spiritual and/or psychological healing and rebirth.

Keywords: archetypes, metal music, nature, Nightwish, social interventions

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Authors: Mariko Nishikawa, Masaaki Yamanaka, Ayami Kondo

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Background: International visitors to Japan are at a risk of travel-related illnesses or injury that could result in hospitalization in a country where the language and customs are unique. Over twelve million international visitors came to Japan in 2015, and more are expected leading up to the Tokyo Olympics. One aspect of this is the potentially greater demand on healthcare services by foreign visitors. Nurses who take care of them have anxieties and concerns of their knowledge of the Japanese health system. Objectives: An effective distribution of travel-health information is vital for facilitating care for international visitors. Our research investigates whether a four-minute digital animation (Mari Info Japan), designed and developed by the authors and applied to a survey of 513 nurses who take care of foreigners daily, could clarify travel health procedures, reduce anxieties, while making it enjoyable to learn. Methodology: Respondents to a survey were divided into two groups. The intervention group watched Mari Info Japan. The control group read a standard guidebook. The participants were requested to fill a two-page questionnaire called Mari Meter-X, STAI-Y in English and mark a face scale, before and after the interventions. The questions dealt with knowledge of health promotion, the Japanese healthcare system, cultural concerns, anxieties, and attitudes in Japan. Data were collected from an intervention group (n=83) and control group (n=83) of nurses in a hospital, Japan for foreigners from February to March, 2016. We analyzed the data using Text Mining Studio for open-ended questions and JMP for statistical significance. Results: We found that the intervention group displayed more confidence and less anxiety to take care of foreign patients compared to the control group. The intervention group indicated a greater comfort after watching the animation. However, both groups were most likely to be concerned about language, the cost of medical expenses, informed consent, and choice of hospital. Conclusions: From the viewpoint of nurses, the provision of travel-health information by digital animation to international visitors to Japan was more effective than traditional methods as it helped them be better prepared to treat travel-related diseases and injury among international visitors. This study was registered number UMIN000020867. Funding: Grant–in-Aid for Challenging Exploratory Research 2010-2012 & 2014-16, Japanese Government.

Keywords: digital animation, health promotion, international visitor, Japan, nurse

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Authors: Khadija Al-Hosni, Moon Fai Chan, Mohammed Al-Azri

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Background: Several studies suggest that most school-age adolescents are poorly informed on cancer warning signs and risk factors. Providing adolescents with sufficient knowledge would increase their awareness in adulthood and improve seeking behaviors later. Significant: The results will provide a clear vision in assisting key decision-makers in formulating policies on the students' awareness programs towards cancer. So, the likelihood of avoiding cancer in the future will be increased or even promote early diagnosis. Objectives: to evaluate the effectiveness of an education program designed to increase awareness of cancer signs and symptoms risk factors, improve the behavior of seeking help among school students in Oman, and address the barriers to obtaining medical help. Methods: A randomized controlled trial with two groups was conducted in Oman. A total of 1716 students (n=886/control, n= 830/education), aged 15-17 years, at 10th and 11th grade from 12 governmental schools 3 in governorates from 20-February-2022 to 12-May-2022. Basic demographic data were collected, and the Cancer Awareness Measure (CAM) was used as the primary outcome. Data were collected at baseline (T0) and 4 weeks after (T1). The intervention group received an education program about cancer's cause and its signs and symptoms. In contrast, the control group did not receive any education related to this issue during the study period. Non-parametric tests were used to compare the outcomes between groups. Results: At T0, the lamp was the most recognized cancer warning sign in the control (55.0%) and intervention (55.2%) groups. However, there were no significant changes at T1 for all signs in the control group. In contrast, all sign outcomes were improved significantly (p<0.001) in the intervention group, and the highest response was unexplained pain (93.3%). Smoking was the most recognized risk factor in both groups: (82.8% for control; 84.1% for intervention) at T0. However, there was no significant change in T1 for the control group, but there was for the intervention group (p<0.001), the highest identification was smoking cigarettes (96.5%). Too scared was the largest barrier to seeking medical help by students in the control group at T0 (63.0%) and T1 (62.8%). However, there were no significant changes in all barriers in this group. Otherwise, being too embarrassed (60.2%) was the largest barrier to seeking medical help for students in the intervention group at T0 and too scared (58.6%) at T1. Although there were reductions in all barriers, significant differences were found in six of ten only (p<0.001). Conclusion: The intervention was effective in improving students' awareness of cancer symptoms, warning signs (p<0.001), and risk factors (p<0.001 reduced the most addressed barriers to seeking medical help (p<0.001) in comparison to the control group. The Ministry of Education in Oman could integrate awareness of cancer within the curriculum, and more interventions are needed on the sociological part to overcome the barriers that interfere with seeking medical help.

Keywords: adolescents, awareness, cancer, education, intervention, student

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Authors: Roberto Rosenhaim, Marcos Antonio Crus Moreira, Robson da Cunha, Gerson Gomes Cunha

Abstract:

This work provides details on the wind speed behavior within cities of Arraial do Cabo and São Pedro da Aldeia located in the Lakes Region of the State of Rio de Janeiro, Brazil. This region has one of the best potentials for wind power generation. In interurban layer, wind conditions are very complex and depend on physical geography, size and orientation of buildings and constructions around, population density, and land use. In the same context, the fundamental surface parameter that governs the production of flow turbulence in urban canyons is the surface roughness. Such factors can influence the potential for power generation from the wind within the cities. Moreover, the use of wind on a small scale is not fully utilized due to complexity of wind flow measurement inside the cities. It is difficult to accurately predict this type of resource. This study demonstrates how fuzzy logic can facilitate the assessment of the complexity of the wind potential inside the cities. It presents a decision support tool and its ability to deal with inaccurate information using linguistic variables created by the heuristic method. It relies on the already published studies about the variables that influence the wind speed in the urban environment. These variables were turned into the verbal expressions that are used in computer system, which facilitated the establishment of rules for fuzzy inference and integration with an application for smartphones used in the research. In the first part of the study, challenges of the sustainable development which are described are followed by incentive policies to the use of renewable energy in Brazil. The next chapter follows the study area characteristics and the concepts of fuzzy logic. Data were collected in field experiment by using qualitative and quantitative methods for assessment. As a result, a map of the various points is presented within the cities studied with its wind viability evaluated by a system of decision support using the method multivariate classification based on fuzzy logic.

Keywords: behavior of winds, wind power, fuzzy logic, sustainable development

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Authors: Giorgia Carratta

Abstract:

Since the beginning of mass production, plastic items have been crucial in our daily lives. Thanks to their physical and chemical properties, plastic materials have proven almost irreplaceable in a number of economic sectors such as packaging, automotive, building and construction, textile, and many others. At the same time, the disruptive consequences of plastic pollution have been progressively brought to light in all environmental compartments. The overaccumulation of plastics in the environment, and its adverse effects on habitats, wildlife, and (most likely) human health, represents a call for action to decision-makers around the globe. From a regulatory perspective, plastic production is an unprecedented challenge at all levels of governance. At the international level, the design of new legal instruments, the amendment of existing ones, and the coordination among the several relevant policy areas requires considerable effort. Under the pressure of both increasing scientific evidence and a concerned public opinion, countries seem to slowly move towards the discussion of a new international ‘plastic treaty.’ However, whether, how, and with which scopes such instrument would be adopted is still to be seen. Additionally, governments are establishing regional-basedstrategies, prone to consider the specificities of the plastic issue in a certain geographical area. Thanks to the new Circular Economy Action Plan, approved in March 2020 by the European Commission, EU countries are slowly but steadily shifting to a carbon neutral, circular economy in the attempt to reduce the pressure on natural resources and, parallelly, facilitate sustainable economic growth. In this context, the EU Plastic Strategy is promising to change the way plastic is designed, produced, used, and treated after consumption. In fact, only in the EU27 Member States, almost 26 million tons of plastic waste are generated herein every year, whose 24,9% is still destined to landfill. Positive effects of the Strategy also include a more effective protection of our environment, especially the marine one, the reduction of greenhouse gas emissions, a reduced need for imported fossil energy sources, more sustainable production and consumption patterns. As promising as it may sound, the road ahead is still long. The need to implement these measures in domestic legislations makes their outcome difficult to predict at the moment. An analysis of the current international and European Union legal framework on plastic pollution, binding, and voluntary instruments included, could serve to detect ‘blind spots’ in the current governance as well as to facilitate the development of policy interventions along the plastic value chain, where it appears more needed.

Keywords: environmental law, European union, governance, plastic pollution, sustainability

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