Search results for: exchange index
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4920

Search results for: exchange index

1020 Combined Cervical Headache Snag with Cervical Snag Half Rotation Techniques on Cervicogenic Headache Patients

Authors: Wael Salah Shendy, Moataz Mohamed EL Semary, Hosam Salah Murad, Adham A. Mohamed

Abstract:

Background: Cervicogenic headache is a major problem in many people suffering from upper cervical dysfunction with a great conflict in its physical therapy management. Objectives: To determine the effect of C1-C2 Mulligan SNAGs mobilizations on cervicogenic headache and associated dizziness symptoms. Methods: Forty-eight patients with cervicogenic headache included in the study; from the outpatient clinic of Faculty of Physical Therapy, Cairo University, and New Cairo outpatient clinics, were randomly assigned into three equal groups; group A ( Headache SNAG), group B (C1-C2 SNAG rotation) and group C (combined). Their mean age was (29.37 ± 2.6), (29.31 ± 2.54) and (29.68 ± 2.65). Neck Disability Index used to examine neck pain intensity and CEH symptoms. 6 Items Headache Impact test '6-HIT' scale used to examine headache severity and its adverse effects on social life and functions. Flexion-Rotation Test 'FRT' also used to assess rotation ROM at the level of C1-C2 by 'CROM' device. Dizziness Handicap Inventory 'DHI' scale was used to evaluate dizziness symptoms. Evaluation is done pre and post treatment, and comparison between groups was quantified. Correlations between the examined parameters were also measured. Headache SNAG and C1-C2 Rotation SNAGs were done separately in group (A- B) and combined in group C as a treatment intervention. Results: Group C has Significant improvement in whole parameters compared to group A and B, positive correlation was found between NDI and 6-HIT scores compared to negative correlation between NDI and DHI scores. Conclusion: SNAGs mobilizations used in the study were effective in reducing cervicogenic headache and dizziness symptoms in all groups with a noticeable improvement in the combined group.

Keywords: cervicogenic headache, cervical headache snag, cervical snag half rotation, cervical dizziness

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1019 Erectile Function and Heart Rate Variability in Men under 40 Years Old

Authors: Rui Miguel Costa, Jose Pestana, David Costa, Paula Mangia, Catarina Correia, Mafalda Pinto Coelho

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There is lack of studies examining the relation of different heart rate variability (HRV) parameters with the risk of erectile dysfunction (ED) in younger men. Thus, the present study aimed at examining, in a nonclinical sample of men aged 19-39 years old (mean age = 23.98 years, SD = 4.90), the relations of risk of ED with the standard deviation of the heart rate (SD of HR), high and low frequency power of HRV, and low-to-high frequency HRV ratio. Eighty-three heterosexual Portuguese men completed the 5-item version of the International Index of Erectile Function (IIEF-5) and HRV parameters were calculated from a 5-minute resting period. Risk of ED was determined by IIEF-5 scores of 21 or less. Fifteen men (18.1%) reported symptoms of ED (14 with mild and one with mild to moderate symptoms). Univariate analyses of variance revealed that risk of ED was related to lesser SD of HR and lesser low-frequency power, the two HRV parameters that express a coupling of higher vagal and sympathetic tone. Risk of ED was unrelated to high-frequency power and low-to-high frequency HRV ratio. Further, in a logistic regression, the risk of ED was independently predicted by older age and lower SD of HR, but not by low-frequency power, having a regular sexual partner, and cohabiting. The results provide preliminary evidence that, in younger men, a coupling of higher vagal and sympathetic tone, as indexed by the SD of HR, is important for erections. Greater resting SD of HR might reflect better vascular and interpersonal function via vagal tone coupled with greater motor mobilization to pursue sexual intercourse via sympathetic tone. Many interventions can elevate HRV; future research is warranted on how they can be tailored to treat ED in younger men.

Keywords: erectile dysfunction, heart rate variability, standard deviation of the heart rate, younger men

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1018 The Usefulness and Usability of a Linkedin Group for the Maintenance of a Community of Practice among Hand Surgeons Worldwide

Authors: Vaikunthan Rajaratnam

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Maintaining continuous professional development among clinicians has been a challenge. Hand surgery is a unique speciality with the coming together of orthopaedics, plastics and trauma surgeons. The requirements for a team-based approach to care with the inclusion of other experts such as occupational, physiotherapist and orthotic and prosthetist provide the impetus for the creation of communities of practice. This study analysed the community of practice in hand surgery that was created through a social networking website for professionals. The main objectives were to discover the usefulness of this community of practice created in the platform of the group function of LinkedIn. The second objective was to determine the usability of this platform for the purposes of continuing professional development among members of this community of practice. The methodology used was one of mixed methods which included a quantitative analysis on the usefulness of the social network website as a community of practice, using the analytics provided by the LinkedIn platform. Further qualitative analysis was performed on the various postings that were generated by the community of practice within the social network website. This was augmented by a respondent driven survey conducted online to assess the usefulness of the platform for continuous professional development. A total of 31 respondents were involved in this study. This study has shown that it is possible to create an engaging and interactive community of practice among hand surgeons using the group function of this professional social networking website LinkedIn. Over three years the group has grown significantly with members from multiple regions and has produced engaging and interactive conversations online. From the results of the respondents’ survey, it can be concluded that there was satisfaction of the functionality and that it was an excellent platform for discussions and collaboration in the community of practice with a 69 % of satisfaction. Case-based discussions were the most useful functions of the community of practice. This platform usability was graded as excellent using the validated usability tool. This study has shown that the social networking site LinkedIn’s group function can be easily used as a community of practice effectively and provides convenience to professionals and has made an impact on their practice and better care for patients. It has also shown that this platform was easy to use and has a high level of usability for the average healthcare professional. This platform provided the improved connectivity among professionals involved in hand surgery care which allowed for the community to grow and with proper support and contribution of relevant material by members allowed for a safe environment for the exchange of knowledge and sharing of experience that is the foundation of a community practice.

Keywords: community of practice, online community, hand surgery, lifelong learning, LinkedIn, social media, continuing professional development

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1017 Multiple-Channel Piezoelectric Actuated Tunable Optical Filter for WDM Application

Authors: Hailu Dessalegn, T. Srinivas

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We propose new multiple-channel piezoelectric (PZT) actuated tunable optical filter based on racetrack multi-ring resonators for wavelength de-multiplexing network applications. We design tunable eight-channel wavelength de-multiplexer consisting of eight cascaded PZT actuated tunable multi-ring resonator filter with a channel spacing of 1.6 nm. The filter for each channel is basically structured on a suspended beam, sandwiched with piezoelectric material and built in integrated ring resonators which are placed on the middle of the beam to gain uniform stress and linearly varying longitudinal strain. A reference single mode serially coupled multi stage racetrack ring resonator with the same radii and coupling length is designed with a line width of 0.8974 nm with a flat top pass band at 1dB of 0.5205 nm and free spectral range of about 14.9 nm. In each channel, a small change in the perimeter of the rings is introduced to establish the shift in resonance wavelength as per the defined channel spacing. As a result, when a DC voltage is applied, the beams will elongate, which involves mechanical deformation of the ring resonators that induces a stress and a strain, which brings a change in refractive index and perimeter of the rings leading to change in the output spectrum shift providing the tunability of central wavelength in each channel. Simultaneous wave length shift as high as 45.54 pm/V has been achieved with negligible tunability variation in the eight channel tunable optical filter proportional to the DC voltage applied in the structure, and it is capable of tuning up to 3.45 nm in each channel with a maximum loss difference of 0.22 dB in the tuning range and out of band rejection ratio of 35 dB, with a low channel crosstalk ≤ 30 dB.

Keywords: optical MEMS, piezoelectric (PZT) actuation, tunable optical filter, wavelength de-multiplexer

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1016 Social Aspect of Energy Transition in Frankfurt

Authors: Aly Ahmed, Aber Kay Obwona, Mokrzecka Martyna, Piotrowska Małgorzata, Richardson Stephen

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Frankfurt am Main, the fifth largest city in Germany, ranked at 15th place by the Global Financial Centers Index in 2014, and a finalist of European Green Capital, 214 is a crucial player in German Environmental Policy. Since 2012 the city Authorities have been working on implementing the plan, which assumed to reduce the energy consumption by 50%, and fully switch to renewable energy by the year 2050. To achieve this goal, the Municipality of Frankfurt has begun preparing the Master plan, which will be introduced to public by the end of 2015. A significant question when facing the starting of Master Plan public’s introduction was deciding which method should be used to increase the public engagement. In order to answer this question, the city and region authorities in the cooperation with Frankfurt’s Universities and Climate KIC, organized a two-week PhD scientific workshops, in which participated more than 30 students from numerous countries. The paper presented the outcome of the research and solution proposal of the winning team. Transitions theory tells, that to address challenges as complex as Climate Change and the Energiewende, using of new technologies and system to the public is not sufficient. Transition –by definition is a process, and in such a large scale (city and region transition) can be fulfilled only, when operates within a broad socio – technical system. Authors believe that only by close cooperation with city dwellers, as well as different stakeholders, the Transition in Frankfurt can be successful. The vital part is the strategy which will ensure the engagement, sense of ownership and broad support within Frankfurt society. Author proposal based therefore, on fostering the citizens engagement through a comprehensive, innovative communication strategy.

Keywords: city development, communication strategies, social transition, sustainability

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1015 The Associations of Pes Planus Plantaris (Flat Foot) to the Postural Stability of Basketball Student-Athletes Through the Ground Reaction Force Vector (vGRF)

Authors: Def Primal, Sasanty Kusumaningtyas, Ermita I. Ibrahim

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Purpose: The main objective of this study is to determine the pes planus plantaris (flat foot) condition can contribute to the disturbance of postural stability in basketball athletes in static and dynamic activities. Methods: This cross-sectional quantitative analytical retrospective study on 47 subjects of basketball student-athletes identified the foot arch index by extensive footprint area and AMTI (Advanced Mechanical Technology Inc.) Force flat-form (force plate) determined their postural stability. Subjects were conducted in three activities (static, dynamic vertical jump, and dynamic loading response) for ground reaction force (GRF) resultant vectors towards the vertical plane of body mass (W). Results Analytical results obtained that 80.9% of subjects had pes planus plantaris. It shows no significant differences in pes planus plantaris incidence in both sexes subject (p>0.005); however, there are differences in athlete’s exercise period aspect. Athlete students who have practiced strictly for more than four years’ experience over 50% of pes planus plantaris; furthermore, a long period of exercise was believed to stimulate pes planus. The average value of GRF vectors of pes planus plantaris subjects on three different basketball movements shows a significant correlation to postural stability. Conclusions Pes planus plantaris affected almost basketball athletes regarding the length and intensity of exercise performed. The condition significantly contributes to postural stability disturbance on a static condition, dynamic vertical jump, and dynamic vertical jump loading response.

Keywords: pes planus plantaris, flatfoot, ground reaction force, static and dynamic stability

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1014 The Effect of Vitamin D Supplements and Aerobic Exercise on Hunger and Serum Insulin Levels in Adolescents With Metabolic Syndrome

Authors: Vahab Behmanesh

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Metabolic syndrome is defined as having at least three of the five metabolic risk factors, including abdominal obesity, high blood pressure, high triglycerides, low HDL, and insulin resistance. Lifestyle changes towards reducing physical activity, unhealthy eating habits Especially the high-fat and high-carbohydrate diet is directly related to metabolic syndrome, and due to the epidemic of overweight and sedentary life, metabolic syndrome is a serious problem worldwide. On the other hand, vitamin D deficiency is considered as one of the most common problems in the world, which is related to the dysfunction of beta cells and insulin resistance, and therefore, vitamin D deficiency is considered as a factor in the occurrence of metabolic syndrome. 40 subjects (age: 16.12 ± 4.4 years and body mass index 25.61 ± 4.4 kg/m2) were randomly assigned to groups of aerobic exercise and placebo, aerobic exercise and vitamin D and placebo (no exercise) were divided. Vitamin D was taken at a dose of 50,000 units per week in a double-blind format for eight weeks, and the daily aerobic exercise program was performed for 50 to 60 minutes, three doses per week, with an intensity of 50-60% of the maximum heart rate. From one-way analysis of variance, Factorial variance analysis (2x2) repeated measurement and correlated t-test were used for data analysis. Aerobic exercise and vitamin D intake reduced all metabolic risk indicators and blood insulin (P < 0.05). However, the subjective feeling of hunger did not change significantly (P < 0.05). Regarding waist circumference and blood glucose, the effect of exercise combined with vitamin D consumption was greater than the corresponding effect in the vitamin D group (P < 0.05). Aerobic exercises and vitamin D intake are safe and effective for improving cardiometabolic health, Imam adds vitamin D to the exercise program has more benefits for weight and blood sugar control, which suggests prescribing it for patients with metabolic syndrome.

Keywords: vitamin D, aerobic exercise, metabolic control, adolescents

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1013 Combination of Work and Family Demands Correlated with the Severity of Wrist Musculoskeletal Disorders among Nurses

Authors: Hsien Hwa Kuo, Lin Wen Chun, Lin Wen Chun, Hsien Wen Kuo

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Objective: Nurses represent an important occupational group frequently affected by wrist musculoskeletal disorders (WMSDs) due to a heavy workload, working shifts, poor posture, giving shots, making beds, lifting patients, bending their waist and insufficient rest time every day. However, lack of research reported nurses whether workload in household correlated with the severity of WMSDs. Methods: 550 nurses from a hospital in Taoyuan were interviewed using a modified standardized Nordic Musculoskeletal (NMQ) questionnaire including the demographic information, workplace condition and nine body parts of musculoskeletal disorders. Results: 17.9% and 23.9% of severity and symptoms in WMSDs among nurses with children were significant higher than among nurses without children (1​2.4% and 15.9%). Based on multiple logistic regression models adjusted for age, work duration, job title and body mass index (BMI), we found that heavy workload in hospital had higher odds ratio (OR) of the severity and symptoms of WMSD among nurses with children (OR= 8.67 and OR= 4.30, p<0.05) compared to nurses without children (OR= 1.94 and OR= 1.70). Conclusion: The severity and symptoms of WMSDs among nurses significantly correlated with workload in hospital among nurses with children. If women are at greater risk because of the combination of their work and family demands, synergistic effect of WMSDs was found among nurses. Comment: Women's domestic work, especially once they become mothers, they invest more time and energy caring for children, helping others, and doing housework. Thus domestic work, per se, may be a risk factor for wrist musculoskeletal problems, and, more importantly, it may constrain women's ability to protect themselves from the effects of their paid work. If nurses with more domestic work periodically make efforts to physical activity or modify inappropriate posture, their WMSDs symptoms will be alleviated.

Keywords: musculoskeletal disorders, nurse, NMQ, WMSDs

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1012 Clinical Parameters Response to Low Level Laser Versus Monochromatic Near Infrared Photo Energy in Diabetic Patient with Peripheral Neuropathy

Authors: Abeer Ahmed Abdehameed

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Background: Diabetic sensorimotor polyneuropathy (DSP) is one of the most common micro vascular complications of type 2 diabetes. Loss of sensation is thought to contribute to lake of static and dynamic stability and increased risk of falling. Purpose: The purpose of this study was to compare the effects of low level laser (LLL) and monochromatic near infrared photo energy (MIRE) on pain , cutaneous sensation, static stability and index of lower limb blood flow in diabetic with peripheral neuropathy. Methods: Forty subjects with diabetic peripheral neuropathy were recruited for study. They were divided into two groups: The ( MIRE) group that included (20) patients and (LLL) group included (20) patients. All patients in the study had been subjected to various physical assessment procedures including pain, cutaneous sensation, Doppler flow meter and static stability assessments. The baseline measurements were followed by treatment sessions that conducted twice a week for 6 successive weeks. Results: The statistical analysis of the data had revealed significant improvement of the pain in both groups, with significant improvement in cutaneous sensation and static balance in (MIRE) group compared to (LLL) group; on the other hand results showed no significant differences on lower limb blood flow in both groups. Conclusion: Low level laser and monochromatic near infrared therapy can improve painful symptoms in patients with diabetic neuropathy. On the other hand (MIRE) is useful in improving cutaneous sensation and static stability in patients with diabetic neuropathy.

Keywords: diabetic neuropathy, doppler flow meter, low level laser, monochromatic near infrared photo energy

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1011 Musculoskeletal Disorders among Employees of an Assembly Industrial Workshop: Biomechanical Constrain’s Semi-Quantitative Analysis

Authors: Lamia Bouzgarrou, Amira Omrane, Haithem Kalel, Salma Kammoun

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Background: During recent decades, mechanical and electrical industrial sector has greatly expanded with a significant employability potential. However, this sector faces the increasing prevalence of musculoskeletal disorders with heavy consequences associated with direct and indirect costs. Objective: The current intervention was motivated by large musculoskeletal upper limbs and back disorders frequency among the operators of an assembly workshop in a leader company specialized in sanitary equipment and water and gas connections. We aimed to identify biomechanical constraints among these operators through activity and biomechanical exposures semi-quantitative analysis based on video recordings and MUSKA-TMS software. Methods: We conducted, open observations and exploratory interviews at first, in order to overall understand work situation. Then, we analyzed operator’s activity through systematic observations and interviews. Finally, we conducted a semi-quantitative biomechanical constraints analysis with MUSKA-TMS software after representative activity period video recording. The assessment of biomechanical constrains was based on different criteria; biomechanical characteristics (work positions), aggravating factor (cold, vibration, stress, etc.) and exposure time (duration and frequency of solicitations, recovery phase); with a synthetic score of risk level variable from 1 to 4 (1: low risk of developing MSD and 4: high risk). Results: Semi-quantitative analysis objective many elementary operations with higher biomechanical constrains like high repetitiveness, insufficient recovery time and constraining angulation of shoulders, wrists and cervical spine. Among these risky elementary operations we sited the assembly of sleeve with the body, the assembly of axis, and the control on testing table of gas valves. Transformation of work situations were recommended, covering both the redevelopment of industrial areas and the integration of new tools and equipment of mechanical handling that reduces operator exposure to vibration. Conclusion: Musculoskeletal disorders are complex and costly disorders. Moreover, an approach centered on the observation of the work can promote the interdisciplinary dialogue and exchange between actors with the objective to maximize the performance of a company and improve the quality of life of operators.

Keywords: musculoskeletal disorders, biomechanical constrains, semi-quantitative analysis, ergonomics

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1010 Jabodebek Light Rail Transit with Grade of Automation (GoA) No.3 (Driverless) Technology towards Jakarta Net-Zero Emissions (NZE) 2050

Authors: Nadilla Saskia, Octoria Nur, Assegaf Zareeva

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Mass transport infrastructures are essential to enhance the connectivity between regions and regional equity in Indonesia. Indonesia’s capital city, Jakarta, ranked the 10th highest congestion rate in the world based on the 2019 traffic index, contributing to air pollution and energy consumption. Other than that, the World Air Quality Report in 2019 depicted Jakarta’s air pollutant concentration at 49.4 mg, the 5th highest in the world. Issues of severe traffic congestion, lack of sufficient urban infrastructure in Jakarta, and greenhouse gas emissions have to be addressed through mass transportation. Indonesia’s government is currently constructing The Greater Jakarta LRT (Light Rapid Transit) as convenient, efficient, and environmentally friendly transportation connecting Jakarta with Bekasi and Cibubur areas and plans to serve the passengers in August 2023. Greater Jakarta LRT is operated with Grade of Automation (GoA) No.3, Driverless Train Operation (DTO). Hence, the automated technology used in rail infrastructure is anticipated to address these issues with greater results. The paper will be validated and establish the extent to which the automation system would increase energy efficiency, help reduce carbon emissions, and benefit the environment. Based on the calculated CO2 emissions and fuel consumption for the existing condition (2015) during the feasibility study of the LRT Project and the predicted condition in 2030, it is obtained that Greater Jakarta LRT with GoA3 operation will reduce the CO2 emissions and fuel consumption by more than 50% in 2030. In the bigger picture, Greater Jakarta LRT supports the government's goal of achieving Jakarta Net-Zero Emissions (NZE) 2050.

Keywords: LRT, Grade of Automation (GoA), energy efficiency, carbon emissions, railway infrastructure, DKI Jakarta

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1009 Magnitude of Transactional Sex and Its Determinant Factors Among Women in Sub-Saharan Africa: Systematic Review and Meat Analysis

Authors: Gedefaye Nibret Mihretie

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Background: Transactional sex is casual sex between two people to receive material incentives in exchange for sexual favors. Transactional sex is associated with negative consequences, which increase the risk of sexually transmitted diseases, including HIV/AIDS, unintended pregnancy, unsafe abortion, and physiological trauma. Many primary studies in Sub-Saharan Africa have been conducted to assess the prevalence and associated factors of transactional sex among women. These studies had great discrepancies and inconsistent results. Hence, this systematic review and meta-analysis aimed to synthesize the pooled prevalence of the practice of transactional sex among women and its associated factors in Sub-Saharan Africa. Method: Cross-sectional studies were systematically searched from March 6, 2022, to April 24, 2022, using PubMed, Google Scholar, HINARI, Cochrane Library, and grey literature. The pooled prevalence of transactional sex and associated factors was estimated using DerSemonial-Laird Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic was used to assess the studies' heterogeneity. A funnel plot and Egger's test were used to check for publication bias. A subgroup analysis was performed to minimize the underline heterogeneity depending on the study years, source of data, sample sizes and geographical location. Results: Four thousand one hundred thirty articles were extracted from various databases. The final thirty-two studies were included in this systematic review, including 108,075 participants. The pooled prevalence of transactional sex among women in Sub-Saharan Africa was 12.55%, with a confidence interval of 9.59% to 15.52%. Educational status (OR = .48, 95%CI, 0.27, 0.69) was the protective factors of transactional sex whereas, alcohol use (OR = 1.85, 95% CI: 1.19, 2.52), early sex debut (OR = 2.57, 95%CI, 1.17, 3.98), substance abuse (OR = 4.21, 95% CI: 2.05, 6.37), having history of sexual experience abuse (OR = 4.08, 95% CI: 1.38, 6.78), physical violence abuse (OR = 6.59, 95% CI: 1.17, 12.02), and sexual violence abuse (OR = 3.56, 95% CI: 1.15, 8.27) were the risk factors of transactional sex. Conclusion: The prevalence of transactional sex among women in Sub-Saharan Africa was high. Educational status, alcohol use, substance abuse, early sex debut, having a history of sexual experiences, physical violence, and sexual violence were predictors of transaction sex. Governmental and other stakeholders are designed to reduce alcohol utilization, provide health information about the negative consequences of early sex debut, substance abuse, and reduce sexual violence, ensuring gender equality through mass media, which should be included in state policy.

Keywords: women’s health, child health, reproductive health, midwifery

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1008 An Informative Marketing Platform: Methodology and Architecture

Authors: Martina Marinelli, Samanta Vellante, Francesco Pilotti, Daniele Di Valerio, Gaetanino Paolone

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Any development in web marketing technology requires changes in information engineering to identify instruments and techniques suitable for the production of software applications for informative marketing. Moreover, for large web solutions, designing an interface that enables human interactions is a complex process that must bridge between informative marketing requirements and the developed solution. A user-friendly interface in web marketing applications is crucial for a successful business. The paper introduces mkInfo - a software platform that implements informative marketing. Informative marketing is a new interpretation of marketing which places the information at the center of every marketing action. The creative team includes software engineering researchers who have recently authored an article on automatic code generation. The authors have created the mkInfo software platform to generate informative marketing web applications. For each web application, it is possible to automatically implement an opt in page, a landing page, a sales page, and a thank you page: one only needs to insert the content. mkInfo implements an autoresponder to send mail according to a predetermined schedule. The mkInfo platform also includes e-commerce for a product or service. The stakeholder can access any opt-in page and get basic information about a product or service. If he wants to know more, he will need to provide an e-mail address to access a landing page that will generate an e-mail sequence. It will provide him with complete information about the product or the service. From this point on, the stakeholder becomes a user and is now able to purchase the product or related services through the mkInfo platform. This paper suggests a possible definition for Informative Marketing, illustrates its basic principles, and finally details the mkInfo platform that implements it. This paper also offers some Informative Marketing models, which are implemented in the mkInfo platform. Informative marketing can be applied to products or services. It is necessary to realize a web application for each product or service. The mkInfo platform enables the product or the service producer to send information concerning a specific product or service to all stakeholders. In conclusion, the technical contributions of this paper are: a different interpretation of marketing based on information; a modular architecture for web applications, particularly for one with standard features such as information storage, exchange, and delivery; multiple models to implement informative marketing; a software platform enabling the implementation of such models in a web application. Future research aims to enable stakeholders to provide information about a product or a service so that the information gathered about a product or a service includes both the producer’s and the stakeholders' point of view. The purpose is to create an all-inclusive management system of the knowledge regarding a specific product or service: a system that includes everything about the product or service and is able to address even unexpected questions.

Keywords: informative marketing, opt in page, software platform, web application

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1007 The Role of Transport Investment and Enhanced Railway Accessibility in Regional Efficiency Improvement in Saudi Arabia: Data Envelopment Analysis

Authors: Saleh Alotaibi, Mohammed Quddus, Craig Morton, Jobair Bin Alam

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This paper explores the role of large-scale investment in transport sectors and the impact of increased railway accessibility on the efficiency of the regional economic productivity in the Kingdom of Saudi Arabia (KSA). There are considerable differences among the KSA regions in terms of their levels of investment and productivity due to their geographical scale and location, which in turn greatly affect their relative efficiency. The study used a non-parametric linear programming technique - Data Envelopment Analysis (DEA) - to measure the regional efficiency change over time and determine the drivers of inefficiency and their scope of improvement. In addition, Window DEA analysis is carried out to compare the efficiency performance change for various time periods. Malmquist index (MI) is also analyzed to identify the sources of productivity change between two subsequent years. The analysis involves spatial and temporal panel data collected from 1999 to 2018 for the 13 regions of the country. Outcomes reveal that transport investment and improved railway accessibility, in general, have significantly contributed to regional economic development. Moreover, the endowment of the new railway stations has spill-over effects. The DEA Window analysis confirmed the dynamic improvement in the average regional efficiency over the study periods. MI showed that the technical efficiency change was the main source of regional productivity improvement. However, there is evidence of investment allocation discrepancy among regions which could limit the achievement of development goals in the long term. These relevant findings will assist the Saudi government in developing better strategic decisions for future transport investments and their allocation at the regional level.

Keywords: data envelopment analysis, transport investment, railway accessibility, efficiency

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1006 Early Childhood Developmental Delay in 63 Low- and Middle-Income Countries: Prevalence and Inequalities Estimated from National Health Surveys

Authors: Jesus D. Cortes Gil, Fernanda Ewerling, Leonardo Ferreira, Aluisio J. D. Barros

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Background: The sustainable development goals call for inclusive, equitable, and quality learning opportunities for all. This is especially important for children, to ensure they all develop to their full potential. We studied the prevalence and inequalities of suspected delay in child development in 63 low- and middle-income countries. Methods and Findings: We used the early child development module from national health surveys, which covers four developmental domains (physical, social-emotional, learning, literacy-numeracy) and provides a combined indicator (early child development index, ECDI) of whether children are on track. We calculated the age-adjusted prevalence of suspected delay at the country level and stratifying by wealth, urban/rural residence, sex of the child, and maternal education. We also calculated measures of absolute and relative inequality. We studied 330.613 children from 63 countries. The prevalence of suspected delay for the ECDI ranged from 3% in Barbados to 67% in Chad. For all countries together, 25% of the children were suspected of developmental delay. At regional level, the prevalence of delay ranged from 10% in Europe and Central Asia to 42% in West and Central Africa. The literacy-numeracy domain was by far the most challenging, with the highest proportions of delay. We observed very large inequalities, and most markedly for the literacy-numeracy domain. Conclusions: To date, our study presents the most comprehensive analysis of child development using an instrument especially developed for national health surveys. With a quarter of the children globally suspected of developmental delay, we face an immense challenge. The multifactorial aspect of early child development and the large gaps we found only add to the challenge of not leaving these children behind.

Keywords: child development, inequalities, global health, equity

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1005 Shoulder-Arm Mobility and Upper and Lower Extremity Muscle Function are Impaired in Patients with Systemic Sclerosis

Authors: F. Bringby, A. Nordin, L. Björnådal, E. Svenungsson, C. Boström, H Alexanderson

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Patients with systemic sclerosis (SSc) have reduced hand function and self-reported limitations in daily activities. Few studies have explored limitations in shoulder-arm mobility and muscle function, or if there are differences in physical function between diffuse cutaneous (dcSSc) and limited cutaneous (lcSSc) SSc. The purpose of this study was to describe objectively assessed shoulder-arm mobility, lower extremity muscle function and muscle endurance in SSc and evaluate possible differences between lcSSc and dcSSc. 121 patients with SSc were included in this cross sectional study. Shoulder-arm mobility were examined using the Shoulder Function Assessment Scale (SFA) including 5 tasks ,lower extremity muscle function was measured by Timed stands test (TST) and muscle endurance in shoulder- and hip flexors were assessed by the Functional Index 2 (FI-2). Patients with dcSSc had median SFA hand to back score 5 (4-6) and median “hand to seat” score of 5 (4-6) compared to patients with lcSSc with corresponding median values of 6 (4-6) and 6 (5-6) respectively (p<0.01-p<0.05). 50% of both patientsgroups had lower muscle function assessed by the TST compared to age- and gender matched reference values but there were no differences in TST between the two patient groups. There was no difference in FI-2 scores between dcSSc and lcSSc. The whole group had 40 (28-83) % and 38 (32-72) % of maximal FI-2 shoulder flexion score on the right and left sides, and 40 (23-63) % and 37 (23-62) % of maximal FI-2 hip flexion score on the right and left sides. Reference values for the FI-2 indicate that healthy individuals perform in mean 100 % of maximal score. Patients with dcSSc were more limited than patients with lcSSc. Patients with SSc have reduced muscle function compared to reference values. These results highlights the importance of assessing shoulder-arm mobility and muscle function as well as a need for further research to identify exercise interventions to target these limitations.

Keywords: diffuse, limited, mobility, muscle function, physical therapy, systemic sclerosis

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1004 Monitoring the Change of Padma River Bank at Faridpur, Bangladesh Using Remote Sensing Approach

Authors: Ilme Faridatul, Bo Wu

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Bangladesh is often called as a motherland of rivers. It contains about 700 rivers among all these the Padma River is one of the largest rivers of Bangladesh. The change of river bank and erosion has become a common environmental natural hazard in Bangladesh. The river banks are under intense pressure from natural processes such as erosion and accretion as well as anthropogenic processes such as urban growth and pollution. The Padma River is flowing along ten districts of Bangladesh among all these Faridpur district is most vulnerable to river bank erosion. The severity of the river erosion is so high that each year a thousand of populations become homeless and lose their agricultural lands. Though the Faridpur district is most vulnerable to river bank erosion no specific research has been conducted to identify the changing pattern of river bank along this district. The outcome of the research may serve as guidance to prepare river bank monitoring program and management. This research has utilized integrated techniques of remote sensing and geographic information system to monitor the changes from 1995 to 2015 at Faridpur district. To discriminate the land water interface Modified Normalized Difference Water Index (MNDWI) algorithm is applied and on screen digitization approach is used over MNDWI images of 1995, 2002 and 2015 for river bank line extraction. The extent of changes in the river bank along Faridpur district is estimated through overlaying the digitized maps of all three years. The river bank lines are highlighted to infer the erosion and accretion and the changes are calculated. The result shows that the middle of the river is gaining land through sedimentation and the both side river bank is shifting causing severe erosion that consequently resulting the loss of farmland and homestead. Over the study period from 1995 to 2015 it witnessed huge erosion and accretion that played an active role in the changes of the river bank.

Keywords: river bank, erosion and accretion, change monitoring, remote sensing

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1003 The Effect of Costus igneus Extract on Learning and Memory in Normal and Diabetic Rats

Authors: Shalini Adiga, Shashikant Chetty, Jisha, Shobha Kamath

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Background: Moderate impairment of learning and memory has been observed in both type 1 and 2 diabetes mellitus in humans and experimental animals. A Change in glucose utilization and oxidative stress that occur in diabetes are considered the main reasons for cognitive dysfunction. Objective: Costus igneus (CI) which is known to possess hypoglycemic activity was evaluated in this study for its effect on learning and memory in normal and diabetic rats. Methods: Wistar rats were divided into control, CI-alcoholic extract treated normal (250 and 500mg/kg), diabetic control and CI-treated diabetic groups. CI treatment was continued for 4 weeks. For induction of diabetes, a single dose of streptozotocin was injected (30 mg/kg i.p). Entrance latency and time spent in the dark room during acquisition and at 24 and 48h after an aversive shock in a passive avoidance model was used as an index of learning and memory. Glutathione and malondialdehyde levels in brain and blood glucose were measured. Data was analysed using ANOVA. Results: During the three trials in exploration test, the diabetic control rats exhibited no significant change in entrance latency or in the total time spent in the dark compartment. During retention testing, the entrance latency of the diabetic treated groups was two times less at 24h and three times less at 48h after aversive stimulus as compared to diabetic rats. The normal drug-treated rats showed similar behaviour as the saline control. Treatment with CI significantly reduced the raised blood sugar and MDA levels of diabetic rats. Conclusion: Costus igneus prevented the cognitive dysfunction in diabetic rats which can be attributed to its antioxidant and antihyperglycemic activities.

Keywords: Costus igneous, diabetes, learning and memory, cognitive dysfunction

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1002 Transformational Leadership Style of Principal and Conflict Management in Public Secondary Schools in North Central Nigeria

Authors: Odeh Regina Comfort, Angelina Okewu Ogwuche

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The study investigated transformational leadership style of principal and conflict management in secondary schools in North Central Nigeria. A descriptive survey design was adopted. The population of the study comprised 34,473 teachers in 1949 public secondary schools in the study area. Proportionate stratified random sampling and simple random sampling techniques were used to select 39 public secondary schools and 689 respondents, respectively, for the study. The researcher utilized a self-structured questionnaire titled 'Influence of Transformational Leadership Style Questionnaire (ITLSQ)'. Face and content validity were ensured. The reliability index of 0.86 was obtained through Cronbach alpha statistics. The instrument was a modified Likert rating scale of Very High Extent (4), High Extent (3), Low Extent (2) and Very Low Extent (1). Mean, and standard deviation were used to answer 2 research questions, while chi-square goodness of fit was used to test the 2 hypotheses at 0.05 level of significance. The results among others indicate: that intellectual stimulation and individualized components of transformational leadership style of principal in public secondary schools in the study area have significant influence on conflict management in secondary schools. Based on the results, it was recommended that principals of secondary schools should be encouraged to practice the intellectual stimulation component of transformational leadership style that would help to consider teachers' levels of knowledge to decide what suits them to reach high levels of attainment thereby minimizing conflict in school settings; also transformational leadership should be taught to all people at all levels of secondary school especially that which pertains to individualized consideration to have a positive impact on the overall performance of teachers and this would help to minimize conflict in schools.

Keywords: conflict management, individualized consideration, intellectual stimulation, transformational leadership style

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1001 Comparative Correlation Investigation of Polynuclear Aromatic Hydrocarbons (PAHs) in Soils of Different Land Uses: Sources Evaluation Perspective

Authors: O. Onoriode Emoyan, E. Eyitemi Akporhonor, Charles Otobrise

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Polycyclic Aromatic Hydrocarbons (PAHs) are formed mainly as a result of incomplete combustion of organic materials during industrial, domestic activities or natural occurrence. Their toxicity and contamination of terrestrial and aquatic ecosystem have been established. Though with limited validity index, previous research has focused on PAHs isomer pair ratios of variable physicochemical properties in source identification. The objective of this investigation was to determine the empirical validity of Pearson correlation coefficient (PCC) and cluster analysis (CA) in PAHs source identification along soil samples of different land uses. Therefore, 16 PAHs grouped as endocrine disruption substances (EDSs) were determined in 10 sample stations in top and sub soils seasonally. PAHs was determined the use of Varian 300 gas chromatograph interfaced with flame ionization detector. Instruments and reagents used are of standard and chromatographic grades respectively. PCC and CA results showed that the classification of PAHs along kinetically and thermodyanamically-favoured and those derived directly from plants product through biologically mediated processes used in source signature is about the predominance PAHs are likely to be. Therefore the observed PAHs in the studied stations have trace quantities of the vast majority of the sixteen un-substituted PAHs which may ultimately inhabit the actual source signature authentication. Type and extent of bacterial metabolism, transformation products/substrates, and environmental factors such as: salinity, pH, oxygen concentration, nutrients, light intensity, temperature, co-substrates and environmental medium are hereby recommended as factors to be considered when evaluating possible sources of PAHs.

Keywords: comparative correlation, kinetically and thermodynamically-favored PAHs, pearson correlation coefficient, cluster analysis, sources evaluation

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1000 Symmetry of Performance across Lower Limb Tests between the Dominant and Non-Dominant Legs

Authors: Ghulam Hussain, Herrington Lee, Comfort Paul, Jones Richard

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Background: To determine the functional limitations of the lower limbs or readiness to return to sport, most rehabilitation programs use some form of testing; however, it is still unknown what the pass criteria is. This study aims to investigate the differences between the dominant and non-dominant leg performances across several lower limb tasks, which are hop tests, two-dimensional (2D) frontal plane projection angle (FPPA) tests, and isokinetic muscle tests. This study also provides the reference values for the limb symmetry index (LSI) for the hop and isokinetic muscle strength tests. Twenty recreationally active participants were recruited, 11 males and 9 females (age 23.65±2.79 years; height 169.9±3.74 cm; and body mass 74.72±5.81 kg. All tests were undertaken on the dominant and non-dominant legs. These tests are (1) Hop tests, which include horizontal hop for distance and crossover hop tests, (2) Frontal plane projection angle (FPPA): 2D capturing from two different tasks, which are forward hop landing and squatting, and (3) Isokinetic muscle strength tests: four different muscles were tested: quadriceps, hamstring, ankle plantar flexor, and hip extensor muscles. The main outcome measurements were, for the (1) hop tests: maximum distance was taken when undertaking single/crossover hop for distance using a standard tape measure, (2) for the FPPA: the knee valgus angle was measured from the maximum knee flexion position using a single 2D camera, and (3) for the isokinetic muscle strength tests: three different variables were measured: peak torque, peak torque to body weight, and the total work to body weight. All the muscle strength tests have been applied in both concentric and eccentric muscle actions at a speed of 60°/sec. This study revealed no differences between the dominant and non-dominant leg performance, and 85% of LSI was achieved by the majority of the subjects in both hop and isokinetic muscle tests, and; therefore, one leg’s hop performance can define the other.

Keywords: 2D FPPA, hop tests, isokinetic testing, LSI

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999 Navigating the Case-Based Learning Multimodal Learning Environment: A Qualitative Study Across the First-Year Medical Students

Authors: Bhavani Veasuvalingam

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Case-based learning (CBL) is a popular instructional method aimed to bridge theory to clinical practice. This study aims to explore CBL mixed modality curriculum in influencing students’ learning styles and strategies that support learning. An explanatory sequential mixed method study was employed with initial phase, 44-itemed Felderman’s Index of Learning Style (ILS) questionnaire employed across year one medical students (n=142) using convenience sampling to describe the preferred learning styles. The qualitative phase utilised three focus group discussions (FGD) to explore in depth on the multimodal learning style exhibited by the students. Most students preferred combination of learning stylesthat is reflective, sensing, visual and sequential i.e.: RSVISeq style (24.64%) from the ILS analysis. The frequency of learning preference from processing to understanding were well balanced, with sequential-global domain (66.2%); sensing-intuitive (59.86%), active- reflective (57%), and visual-verbal (51.41%). The qualitative data reported three major themes, namely Theme 1: CBL mixed modalities navigates learners’ learning style; Theme 2: Multimodal learners active learning strategies supports learning. Theme 3: CBL modalities facilitating theory into clinical knowledge. Both quantitative and qualitative study strongly reports the multimodal learning style of the year one medical students. Medical students utilise multimodal learning styles to attain the clinical knowledge when learning with CBL mixed modalities. Educators’ awareness of the multimodal learning style is crucial in delivering the CBL mixed modalities effectively, considering strategic pedagogical support students to engage and learn CBL in bridging the theoretical knowledge into clinical practice.

Keywords: case-based learning, learnign style, medical students, learning

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998 The Crossroads of Corruption and Terrorism in the Global South

Authors: Stephen M. Magu

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The 9/11 and Christmas bombing attacks in the United States are mostly associated with the inability of intelligence agencies to connect dots based on intelligence that was already available. The 1998, 2002, 2013 and several 2014 terrorist attacks in Kenya, on the other hand, are probably driven by a completely different dynamic: the invisible hand of corruption. The World Bank and Transparency International annually compute the Worldwide Governance Indicators and the Corruption Perception Index respectively. What perhaps is not adequately captured in the corruption metrics is the impact of corruption on terrorism. The World Bank data includes variables such as the control of corruption, (estimates of) government effectiveness, political stability and absence of violence/terrorism, regulatory quality, rule of law and voice and accountability. TI's CPI does not include measures related to terrorism, but it is plausible that there is an expectation of some terrorism impact arising from corruption. This paper, by examining the incidence, frequency and total number of terrorist attacks that have occurred especially since 1990, and further examining the specific cases of Kenya and Nigeria, argues that in addition to having major effects on governance, corruption has an even more frightening impact: that of facilitating and/or violating security mechanisms to the extent that foreign nationals can easily obtain identification that enables them to perpetuate major events, targeting powerful countries' interests in countries with weak corruption-fighting mechanisms. The paper aims to model interactions that demonstrate the cost/benefit analysis and agents' rational calculations as being non-rational calculations, given the ultimate impact. It argues that eradication of corruption is not just a matter of a better business environment, but that it is implicit in national security, and that for anti-corruption crusaders, this is an argument more potent than the economic cost / cost of doing business argument.

Keywords: corruption, global south, identification, passports, terrorism

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997 Phytoplankton Assemblage and Physicochemical Parameters of a Perturbed Tropical Manmade Lake, Southwestern Nigeria

Authors: Adedolapo Ayoade, John the Beloved Dada

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This study identified the phytoplankton assemblage of the Dandaru Lake (that received effluents from a zoological garden and hospital) as bioindicators of water quality. Physicochemical parameters including Dissolved Oxygen (DO), biochemical oxygen demand, nitrate, phosphate and heavy metals were also determined. Samples of water and plankton were collected once monthly from April to September, 2015 at five stations (I – V). The mean physicochemical parameters were within the limits of National Environmental Standards and Regulations Enforcement Agency (NESREA) and USEPA except Lead, 0.02 ± 0.08 mg/ L; Manganese, 0.46 ± 1.00 mg/ L and Zinc, 0.05 ± 0.17 mg/ L. Means of DO, alkalinity, and phosphate were significantly different between the stations at p < 0.05. While highest mean DO (6.88 ± 1.34 mg/L) was recorded in station I with less anthropogenic activities, highest phosphate concentration (0.28 ± 0.28 mg/L) occurred in station II, the entry point of wastewater from hospital and zoological garden. The 147 phytoplankton species found in the lake belonged to six classes: Chlorophyceae (50), Euglenophyceae (40), Bacillariophyceae (37), Cyanophyceae (17), Xanthophyceae and Chrysophyceae (3). The order of abundance for phytoplankton was Euglenophyceae (49.77%) > Bacillariophyceae (18.00%) > Cyanophyceae (17.39%) > Chlorophyceae (13.7%) > Xanthophyceae (1.06%) > Chrysophyceae (0.02%). The stations impacted with effluents were dominated by members of Euglenophyceae (Station III, 77.09%; IV, 50.55%) and Cyanophyceae (Station II, 27.7%; V, 32.57%). While station I was dominated by diatoms (57.98%). The species richness recorded was 0.32 – 4.49. Evenness index was highest in station I and least in station III. Generally, pollution tolerant species (Microcystis, Oscillatoria, Scenedesmus, Anabaena, and Euglena) showed greater density in areas impacted by human activities. The phytoplankton assemblage and comparatively low biotic diversity in Dandaru Lake could be attributed to perturbations in the water column that exerted selective effects on the biological assemblage.

Keywords: manmade lake, Nigeria, phytoplankton, water quality

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996 The Impact of Geophagia on the Iron Status of Black South African Women

Authors: A van Onselen, C. M. Walsh, F. J. Veldman, C. Brand

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Objectives: To determine the nutritional status and risk factors associated with women practicing geophagia in QwaQwa, South Africa. Materials and Methods: An observational epidemiological study design was adopted which included an exposed (geophagia) and non-exposed (control) group. A food frequency questionnaire, anthropometric measurements and blood sampling were applied to determine nutritional status of participants. Logistic regression analysis was performed in order to identify factors that were likely to be associated with the practice of geophagia. Results: The mean total energy intake for the geophagia group (G) and control group(C) were 10324.31 ± 2755.00 kJ and 10763.94 ± 2556.30 kJ respectively. Both groups fell within the overweight category according to the mean body mass index (BMI) of each group (G= 25.59 kg/m2; C= 25.14 kg/m2). The mean serum iron levels of the geophagia group (6.929 μmol/l) were significantly lower than that of the control group (13.75 μmol/l) (p = 0.000). Serum transferrin (G=3.23g/l; C=2.7054g/l) and serum transferrin saturation (G=8.05%; C=18.74%) levels also differed significantly between groups (p=0.00). Factors that were associated with the practice of geophagia included haemoglobin (Odds ratio (OR):14.50), serum-iron (OR: 9.80), serum-ferritin (OR: 3.75), serum-transferrin (OR: 6.92) and transferrin saturation (OR: 14.50). A significant negative association (p=0.014) was found between women who were wage-earners and those who were not wage-earners and the practice of geophagia (OR: 0.143; CI: 0.027; 0.755). These findings seem to indicate that a permanent income may decrease the likelihood of practising geophagia. Key findings: Geophagia was confirmed to be a risk factor for iron deficiency in this community. The significantly strong association between geophagia and iron deficiency emphasizes the importance of identifying the practice of geophagia in women, especially during their child bearing years. Further research to establish whether the practice of geophagia is a cause of iron-deficiency, or whether it is the consequence thereof, would give a clearer view on how to recognise and treat the condition.

Keywords: geophagia, iron deficiency anaemia, dietary intake, anthropometry

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995 How Virtualization, Decentralization, and Network-Building Change the Manufacturing Landscape: An Industry 4.0 Perspective

Authors: Malte Brettel, Niklas Friederichsen, Michael Keller, Marius Rosenberg

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The German manufacturing industry has to withstand an increasing global competition on product quality and production costs. As labor costs are high, several industries have suffered severely under the relocation of production facilities towards aspiring countries, which have managed to close the productivity and quality gap substantially. Established manufacturing companies have recognized that customers are not willing to pay large price premiums for incremental quality improvements. As a consequence, many companies from the German manufacturing industry adjust their production focusing on customized products and fast time to market. Leveraging the advantages of novel production strategies such as Agile Manufacturing and Mass Customization, manufacturing companies transform into integrated networks, in which companies unite their core competencies. Hereby, virtualization of the process- and supply-chain ensures smooth inter-company operations providing real-time access to relevant product and production information for all participating entities. Boundaries of companies deteriorate, as autonomous systems exchange data, gained by embedded systems throughout the entire value chain. By including Cyber-Physical-Systems, advanced communication between machines is tantamount to their dialogue with humans. The increasing utilization of information and communication technology allows digital engineering of products and production processes alike. Modular simulation and modeling techniques allow decentralized units to flexibly alter products and thereby enable rapid product innovation. The present article describes the developments of Industry 4.0 within the literature and reviews the associated research streams. Hereby, we analyze eight scientific journals with regards to the following research fields: Individualized production, end-to-end engineering in a virtual process chain and production networks. We employ cluster analysis to assign sub-topics into the respective research field. To assess the practical implications, we conducted face-to-face interviews with managers from the industry as well as from the consulting business using a structured interview guideline. The results reveal reasons for the adaption and refusal of Industry 4.0 practices from a managerial point of view. Our findings contribute to the upcoming research stream of Industry 4.0 and support decision-makers to assess their need for transformation towards Industry 4.0 practices.

Keywords: Industry 4.0., mass customization, production networks, virtual process-chain

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994 A Quality Improvement Approach for Reducing Stigma and Discrimination against Young Key Populations in the Delivery of Sexual Reproductive Health and Rights Services

Authors: Atucungwiire Rwebiita

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Introduction: In Uganda, provision of adolescent sexual reproductive health and rights (SRHR) services for key population is still hindered by negative attitudes, stigma and discrimination (S&D) at both the community and facility levels. To address this barrier, Integrated Community Based Initiatives (ICOBI) with support from SIDA is currently implementing a quality improvement (QI) innovative approach for strengthening the capacity of key population (KP) peer leaders and health workers to deliver friendly SRHR services without S&D. Methods: Our innovative approach involves continuous mentorship and coaching of 8 QI teams at 8 health facilities and their catchment areas. Each of the 8 teams (comprised of 5 health workers and 5 KP peer leaders) are facilitated twice a month by two QI Mentors in a 2-hour mentorship session over a period of 4 months. The QI mentors were provided a 2-weeks training on QI approaches for reducing S&D against young key populations in the delivery of SRHR Services. The mentorship sessions are guided by a manual where teams base to analyse root causes of S&D and develop key performance indicators (KPIs) in the 1st and 2nd second sessions respectively. The teams then develop action plans in the 3rd session and review implementation progress on KPIs at the end of subsequent sessions. The KPIs capture information on the attitude of health workers and peer leaders and the general service delivery setting as well as clients’ experience. A dashboard is developed to routinely track the KPIs for S&D across all the supported health facilities and catchment areas. After 4 months, QI teams share documented QI best practices and tested change packages on S&D in a learning and exchange session involving all the teams. Findings: The implementation of this approach is showing positive results. So far, QI teams have already identified the root causes of S&D against key populations including: poor information among health workers, fear of a perceived risk of infection, perceived links between HIV and disreputable behaviour. Others are perceptions that HIV & STIs are divine punishment, sex work and homosexuality are against religion and cultural values. They have also noted the perception that MSM are mentally sick and a danger to everyone. Eight QI teams have developed action plans to address the root causes of S&D. Conclusion: This approach is promising, offers a novel and scalable means to implement stigma-reduction interventions in facility and community settings.

Keywords: key populations, sexual reproductive health and rights, stigma and discrimination , quality improvement approach

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993 Clinical Prediction Rules for Using Open Kinetic Chain Exercise in Treatment of Knee Osteoarthritis

Authors: Mohamed Aly, Aliaa Rehan Youssef, Emad Sawerees, Mounir Guirgis

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Relevance: Osteoarthritis (OA) is the most common degenerative disease seen in all populations. It causes disability and substantial socioeconomic burden. Evidence supports that exercise are the most effective conservative treatment for patients with OA. Therapists experience and clinical judgment play major role in exercise prescription and scientific evidence for this regard is lacking. The development of clinical prediction rules to identify patients who are most likely benefit from exercise may help solving this dilemma. Purpose: This study investigated whether body mass index and functional ability at baseline can predict patients’ response to a selected exercise program. Approach: Fifty-six patients, aged 35 to 65 years, completed an exercise program consisting of open kinetic chain strengthening and passive stretching exercises. The program was given for 3 sessions per week, 45 minutes per session, for 6 weeks Evaluation: At baseline and post treatment, pain severity was assessed using the numerical pain rating scale, whereas functional ability was being assessed by step test (ST), time up and go test (TUG) and 50 feet time walk test (50 FTW). After completing the program, global rate of change (GROC) score of greater than 4 was used to categorize patients as successful and non-successful. Thirty-eight patients (68%) had successful response to the intervention. Logistic regression showed that BMI and 50 FTW test were the only significant predictors. Based on the results, patients with BMI less than 34.71 kg/m2 and 50 FTW test less than 25.64 sec are 68% to 89% more likely to benefit from the exercise program. Conclusions: Clinicians should consider the described strengthening and flexibility exercise program for patents with BMI less than 34.7 Kg/m2 and 50 FTW faster than 25.6 seconds. The validity of these predictors should be investigated for other exercise.

Keywords: clinical prediction rule, knee osteoarthritis, physical therapy exercises, validity

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992 Encouraging Collaboration and Innovation: The New Engineering Oriented Educational Reform in Urban Planning, Tianjin University, China

Authors: Tianjie Zhang, Bingqian Cheng, Peng Zeng

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Engineering science and technology progress and innovation have become an important engine to promote social development. The reform exploration of "new engineering" in China has drawn extensive attention around the world, with its connotation as "to cultivate future diversified, innovative and outstanding engineering talents by taking ‘fostering character and civic virtue’ as the guide, responding to changes and shaping the future as the construction concept, and inheritance and innovation, crossover and fusion, coordination and sharing as the principal approach". In this context, Tianjin University, as a traditional Chinese university with advantages in engineering, further launched the CCII (Coherent-Collaborative-Interdisciplinary-Innovation) program, raising the cultivation idea of integrating new liberal arts education, multidisciplinary engineering education and personalized professional education. As urban planning practice in China has undergone the evolution of "physical planning -- comprehensive strategic planning -- resource management-oriented planning", planning education has also experienced the transmutation process of "building foundation -- urban scientific foundation -- multi-disciplinary integration". As a characteristic and advantageous discipline of Tianjin University, the major of Urban and Rural Planning, in accordance with the "CCII Program of Tianjin University", aims to build China's top and world-class major, and implements the following educational reform measures: 1. Adding corresponding English courses, such as advanced course on GIS Analysis, courses on comparative studies in international planning involving ecological resources and the sociology of the humanities, etc. 2. Holding "Academician Forum", inviting international academicians to give lectures or seminars to track international frontier scientific research issues. 3. Organizing "International Joint Workshop" to provide students with international exchange and design practice platform. 4. Setting up a business practice base, so that students can find problems from practice and solve them in an innovative way. Through these measures, the Urban and Rural Planning major of Tianjin University has formed a talent training system with multi-disciplinary cross integration and orienting to the future science and technology.

Keywords: China, higher education reform, innovation, new engineering education, rural and urban planning, Tianjin University

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991 Water Management Scheme: Panacea to Development Using Nigeria’s University of Ibadan Water Supply Scheme as a Case Study

Authors: Sunday Olufemi Adesogan

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The supply of potable water at least is a very important index in national development. Water tariffs depend on the treatment cost which carries the highest percentage of the total operation cost in any water supply scheme. In order to keep water tariffs as low as possible, treatment costs have to be minimized. The University of Ibadan, Nigeria, water supply scheme consists of a treatment plant with three distribution stations (Amina way, Kurumi and Lander) and two raw water supply sources (Awba dam and Eleyele dam). An operational study of the scheme was carried out to ascertain the efficiency of the supply of potable water on the campus to justify the need for water supply schemes in tertiary institutions. The study involved regular collection, processing and analysis of periodic operational data. Data collected include supply reading (water production on daily basis) and consumers metered reading for a period of 22 months (October 2013 - July 2015), and also collected, were the operating hours of both plants and human beings. Applying the required mathematical equations, total loss was determined for the distribution system, which was translated into monetary terms. Adequacies of the operational functions were also determined. The study revealed that water supply scheme is justified in tertiary institutions. It was also found that approximately 10.7 million Nigerian naira (N) is lost to leakages during the 22-month study period; the system’s storage capacity is no longer adequate, especially for peak water production. The capacity of the system as a whole is insufficient for the present university population and that the existing water supply system is not being operated in an optimal manner especially due to personnel, power and system ageing constraints.

Keywords: development, panacea, supply, water

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