Search results for: obesity prevention programs

Authors: Mohammad Ali Hasanzadeh, Thierry Van Elslander, Eddy Van De Voorde

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About 90 percent of world merchandise trade by volume being carried by sea. Maritime transport remains as back bone behind the international trade and globalization meanwhile all seaborne goods need using at least two ports as origin and destination. Amid seaborne traded cargos, container traffic is a prosperous market with about 16% in terms of volume. Albeit containerized cargos are less in terms of tonnage but, containers carry the highest value cargos amongst all. That is why efficient handling of containers in ports is very important. Accidents are the foremost causes that lead to port inefficiency and a surge in total transport cost. Having different port safety management systems (PSMS) in place, statistics on port accidents show that numerous accidents occur in ports. Some of them claim peoples’ life; others damage goods, vessels, port equipment and/or the environment. Several accident investigation illustrate that the most common accidents take place throughout transport operation, it sometimes accounts for 68.6% of all events, therefore providing a safer workplace depends on reducing collision risk. In order to quantify risks at the port area different variables can be used as exposure measurement. One of the main motives for defining and using exposure in studies related to infrastructure is to account for the differences in intensity of use, so as to make comparisons meaningful. In various researches related to handling containers in ports and intermodal terminals, different risk exposures and also the likelihood of each event have been selected. Vehicle collision within the port area (10-7 per kilometer of vehicle distance travelled) and dropping containers from cranes, forklift trucks, or rail mounted gantries (1 x 10-5 per lift) are some examples. According to the objective of the current research, three categories of accidents selected for collision risk assessment; fall of container during ship to shore operation, dropping container during transfer operation and collision between vehicles and objects within terminal area. Later on various consequences, exposure and probability identified for each accident. Hence, reducing collision risks profoundly rely on picking the right risk exposures and probability of selected accidents, to prevent collision accidents in container terminals and in the framework of risk calculations, such risk exposures and probabilities can be useful in assessing the effectiveness of safety programs in ports.

Keywords: container terminal, collision, seaborne trade, risk exposure, risk probability

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Authors: Halima Sadia Qureshi, Urooj Sadiq, Noshi Eram Zaman

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The goal of this study was to see how cognitive behavior hypnotherapy affected nonsuicidal self-injury. DSM 5 invites the researchers to explore the newly added condition under the chapter of conditions under further study named Nonsuicidal self-injury disorder. To date, no empirical sound intervention has been proven effective for NSSI as given in DSM 5. Nonsuicidal self-injury is defined by DSM 5 as harming one's self physically, without suicidal intention. Around 7.6% of teenagers are expected to fulfill the NSSI disorder criteria. 3 Adolescents, particularly university students, account for around 87 percent of self-harm studies. Furthermore, one of the risks associated with NSSI is an increased chance of suicide attempts, and in most cases, the cycle repeats again. 6 The emotional and psychological components of the illness might lead to suicide, either intentionally or unintentionally. 7 According to a research done at a Pakistani military hospital, over 80% of participants had no intention of committing suicide. Furthermore, it has been determined that improvements in NSSI prevention and intervention are necessary as a stand-alone strategy. The quasi-experimental study took place in Islamabad and Rawalpindi, Pakistan, from May 2019 to April 2020 and included students aged 18 to 25 years old from several institutions and colleges in the twin cities. According to the Diagnostic and Statistical Manual of Mental Disorders 5th edition, the individuals were assessed for >2 episodes without suicidal intent using the intentional self-harm questionnaire. The Clinician Administered Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess the individual for NSSI condition. Symptom checklist-90 (SCL-90) was used to screen the participants for differential diagnosis. Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to rule out the BPD cases. The selected participants, n=106 from the screening sample of 600, were selected. They were further screened to meet the inclusion and exclusion criteria, and the total of n=71 were split into two groups: intervention and control. The intervention group received cognitive behavior hypnotherapy for the next three months, whereas the control group received no treatment. After the period of three months, both the groups went through the post assessment, and after the three months’ period, follow-up assessment was conducted. The groups were evaluated, and SPSS 25 was used to analyse the data. The results showed that each of the two groups had 30 (50 percent) of the 60 participants. There were 41 males (68 percent) and 19 girls (32 percent) in all. The bulk of the participants were between the ages of 21 and 23. (48 percent). Self-harm events were reported by 48 (80 percent) of the pupils, and suicide ideation was found in 6 (ten percent). In terms of pre- and post-intervention values (d=4.90), post-intervention and follow-up assessment values (d=0.32), and pre-intervention and follow-up values (d=5.42), the study's effect size was good. The comparison of treatment and no-treatment groups revealed that treatment was more successful than no-treatment, F (1, 58) = 53.16, p.001. The results reveal that the treatment manual of CBH is effective for Nonsuicidal self-injury disorder.

Keywords: NSSI, nonsuicidal self injury disorder, self-harm, self-injury, Cognitive behaviour hypnotherapy, CBH

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Authors: Josiane Yaguibou, Ngoy Kishimba, Issiaka V. Coulibaly, Sabrina Pestilli, Falinirina Razanalison, Hantanirina V. Andremanisa

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Background In Madagascar modern contraceptive prevalence rate increased from 18% in 2003 to 43% in 2021. Anecdotal evidence suggests that increased use and frequent stock out in public health facilities of male condoms and medroxyprogesterone acetate (MPA) can be related to diverted use of these products. This study analyzed the use of contraceptives and mode of utilization (correct or diverted) at the community level in the period 2019-2023 in Madagascar. Methodology: The study included a literature review, a quantitative survey combined with a qualitative study. It was carried out in 10 regions out of the 23 of the country. Eight regions (Bongolava, Vakinakaratra, Italy, Hautre Matsiatra, Betsiboka, Diana, Sofia and Anosy) were selected based on a study that showed existence of medroxyprogesterone acetate in pigs (MPA). The remaining 2 regions were selected due to high mCPR (Atsimo Andrefana) and to ensure coverage of all geographical zones in the country (Alaotra Mangoro). Sample random method was used, and the sample size was identified at 300 individuals per region. Zonal distribution is based on the urbanization rate for the region. 6 focus group discussions were organized in 3 regions, equally distributed between rural and urban areas. Key findings: Overall, 67% of those surveyed or their partner are currently using contraception. Injectables (MPA) are the most popular choice (33%), followed by implants and male condoms, 12% and 9%, respectively. The majority of respondents use condoms to prevent unwanted pregnancy but also to prevent STDs. Still, 43% of respondents use condoms for other purposes, reaching 52% of respondents in urban areas and 71,2% in the age group 15-18. Diverted use includes hair growth (18.9%), as a toy (18.8%), cleaning the screen of electronic devices (10 %), cleaning shoes (3.1%) and for skincare (1.6%). Injectables are the preferred method of contraception both in rural areas (35%) and urban areas (21.2%). However, diverted use of injectables was confirmed by 4% of the respondents, ranging from 3 % in rural areas to 12% in urban. The diverted use of injectables in pig rearing was to avoid pregnancy and facilitate pig’s growth. Program Implications: The study confirmed the diverted use of some contraceptives. The misuse of male condoms is among the causes of stockouts of products in public health facilities, limiting their availability for pregnancy and STDs prevention. The misuse of injectables in pigs rearing needs to be further studied to learn the full extent of the misuse and eventual implications for meat consumption. The study highlights the importance of including messages on the correct use of products during sensibilization activities. In particular, messages need to address the anecdotal and false effects of male condoms, especially amongst young people. For misuse of injectables is critical to sensibilize farmers and veterinaries on possible negative effects for humans.

Keywords: diverted use, injectables, male condoms, sensibilization

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Authors: Rutcher M. Lacaza, Stephen Jun V. Villejo

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This paper investigated the patterns of private transfers in the Philippines using the Family Income Expenditure Survey (FIES) 2009, conducted by the Philippine government’s National Statistics Office (NSO) every three years. The paper performed bivariate analysis on net transfers, using the identified determinants for a household to be either a net receiver or a net giver. The household characteristics considered are the following: age, sex, marital status, employment status and educational attainment of the household head, and also size, location, pre-transfer income and the number of employed members of the household. The variables net receiver and net giver are determined by computing the net transfer, subtracting total gifts from total receipts. The receipts are defined as the sum of cash received from abroad, cash received from domestic sources, total gifts received and inheritance. While gifts are defined as the sum of contributions and donations to church and other religious institutions, contributions and donations to other institutions, gifts and contributions to others, and gifts and assistance to private individuals outside the family. Both in kind and in cash transfers are considered in the analysis. It also performed a multiple regression analysis on transfers received and income including other household characteristics to examine the motives for giving transfers – whether altruism or exchanged. It also used the binary logistic regression to estimate the probability of being a net receiver or net giver given the household characteristics. The study revealed that receiving tends to be universal – both the non-poor and the poor benefit although the poor receive substantially less than the non-poor. Regardless of whether households are net receivers or net givers, households in the upper deciles generally give and receive more than those in the lower deciles. It also appears that private transfers may just flow within economic groups. Big amounts of transfers are, therefore, directed to the non-poor and the small amounts go to the poor. This was also supported by the increasing function of gross transfers received and the income of households – the poor receiving less and the non-poor receiving more. This is contrary to the theory that private transfers can help equalize the distribution of income. This suggested that private transfers in the Philippines are not altruistically motivated but exchanged. However, bilateral data on transfers received or given is needed to test this theory directly. The results showed that transfers are much needed by the poor and it is important to understand the nature of private transfers, to ensure that government transfer programs are properly designed and targeted so as to prevent the duplication of private safety nets already present among the non-poor.

Keywords: private transfers, net receiver, net giver, altruism, exchanged.

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Authors: Fatema Akram, Mohammad G. Rasul, M. Masud K. Khan, M. Sharif I. I. Amir

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Australia is a country of some 7,700 million square kilometres with a population of about 22.6 million. At present water security is a major challenge for Australia. In some areas the use of water resources is approaching and in some parts it is exceeding the limits of sustainability. A focal point of proposed national water conservation programs is the recycling of both urban storm-water and treated wastewater. But till now it is not widely practiced in Australia, and particularly storm-water is neglected. In Australia, only 4% of storm-water and rainwater is recycled, whereas less than 1% of reclaimed wastewater is reused within urban areas. Therefore, accurately monitoring, assessing and predicting the availability, quality and use of this precious resource are required for better management. As storm-water is usually of better quality than untreated sewage or industrial discharge, it has better public acceptance for recycling and reuse, particularly for non-potable use such as irrigation, watering lawns, gardens, etc. Existing storm-water recycling practice is far behind of research and no robust technologies developed for this purpose. Therefore, there is a clear need for using modern technologies for assessing feasibility of storm-water harvesting and reuse. Numerical modelling has, in recent times, become a popular tool for doing this job. It includes complex hydrological and hydraulic processes of the study area. The hydrologic model computes storm-water quantity to design the system components, and the hydraulic model helps to route the flow through storm-water infrastructures. Nowadays water quality module is incorporated with these models. Integration of Geographic Information System (GIS) with these models provides extra advantage of managing spatial information. However for the overall management of a storm-water harvesting project, Decision Support System (DSS) plays an important role incorporating database with model and GIS for the proper management of temporal information. Additionally DSS includes evaluation tools and Graphical user interface. This research aims to critically review and discuss all the aspects of storm-water harvesting and reuse such as available guidelines of storm-water harvesting and reuse, public acceptance of water reuse, the scopes and recommendation for future studies. In addition to these, this paper identifies, understand and address the importance of modern technologies capable of proper management of storm-water harvesting and reuse.

Keywords: storm-water management, storm-water harvesting and reuse, numerical modelling, geographic information system, decision support system, database

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Authors: Mehrab Karimian

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This study investigates the intricate relationships among Iranian EFL teachers’ motivation, creativity, and job stress in Shiraz and Fasa institutes. The primary aim is to explore these links using quantitative methods, providing a comprehensive understanding of how these factors interact within the educational context. The research employed convenient sampling, gathering data from 101 EFL teachers through three specific questionnaires: the Motivation to Teach Questionnaire, Teacher Creativity Questionnaire, and Job Stress Questionnaire. The methodology involved rigorous statistical analyses, including Pearson correlation and multiple regression, to interpret the collected data. The findings revealed positive relationships between motivation and creativity, as well as between motivation and job stress. However, no significant link was observed between creativity and job stress. Notably, creativity emerged as a strong predictor of motivation, highlighting its crucial role in the motivational dynamics of EFL teachers. The theoretical importance of this study lies in its contribution to understanding how motivation can influence both creativity and job stress among EFL teachers. By emphasizing the complex interplay of these factors, the study provides valuable insights that can inform future research and educational practices. The data collection process was thorough, utilizing well-established questionnaires to ensure the reliability and validity of the findings. Statistical analyses such as Pearson correlation and multiple regression were employed to interpret the relationships between motivation, creativity, and job stress. These analyses provided a detailed understanding of how these variables interact, offering a nuanced view of the motivational and stress dynamics in the teaching profession. The study addressed key questions regarding the influence of motivation on creativity and job stress, underscoring the predictive power of creativity on motivation. The conclusion drawn from the study suggests that motivated EFL teachers may experience higher levels of job stress. This finding highlights the need for targeted interventions to support teacher well-being and maintain their motivation. Such interventions could include professional development programs, stress management workshops, and creative teaching strategies to help teachers manage stress while fostering their motivation and creativity. Reviewers have commended the study for its contribution to the field, particularly in revealing the intricate dynamics between motivation, creativity, and job stress in EFL teachers. They recommend enhancing the methodology by considering potential confounding variables and incorporating qualitative approaches to complement the quantitative findings. These suggestions aim to provide a more comprehensive understanding of the factors influencing EFL teachers’ motivation, creativity, and job stress.

Keywords: creativity, Job stress, gender, years of teaching experience

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Authors: Massimiliano Panella, Sara Bortoluzzi, Sophia Russotto, Daniele Nicolini, Carmela Rinaldi

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Osteoporosis affects more than 200 million people worldwide. About 75% of osteoporosis cases are undiagnosed or diagnosed only when a bone fracture occurs. Since osteoporosis related fractures are significant determinants of the burden of disease and health and social costs of aging populations, we believe that this is the early identification and treatment of high-risk patients should be a priority in actual healthcare systems. Screening for osteoporosis by dual energy x-ray absorptiometry (DEXA) is not cost-effective for general population. An alternative is pulse-echo ultrasound (PEUS) because of the minor costs. To this end, we developed an early detection program for osteoporosis with PEUS, and we evaluated is possible impact and sustainability. We conducted a cross-sectional study including 1,050 people in Italy. Subjects with >1 major or >2 minor risk factors for osteoporosis were invited to PEUS bone mass density (BMD) measurement at the proximal tibia. Based on BMD values, subjects were classified as healthy subjects (BMD>0.783 g/cm²) and pathological including subjects with suspected osteopenia (0.783≤BMD>0.719 g/cm²) or osteoporosis (BMD ≤ 0.719 g/cm²). The responder rate was 60.4% (634/1050). According to the risk, PEUS scan was recommended to 436 people, of whom 300 (mean age 45.2, 81% women) accepted to participate. We identified 240 (80%) healthy and 60 (20%) pathological subjects (47 osteopenic and 13 osteoporotic). We observed a significant association between high risk people and reduced bone density (p=0.043) with increased risks for female gender, older ages, and menopause (p<0.01). The yearly cost of the screening program was 8,242 euros. With actual Italian fracture incidence rates in osteoporotic patients, we can reasonably expect in 20 years that at least 6 fractures will occur in our sample. If we consider that the mean costs per fracture in Italy is today 16,785 euros, we can estimate a theoretical cost of 100,710 euros. According to literature, we can assume that the early treatment of osteoporosis could avoid 24,170 euros of such costs. If we add the actual yearly cost of the treatments to the cost of our program and we compare this final amount of 11,682 euros to the avoidable costs of fractures (24,170 euros) we can measure a possible positive benefits/costs ratio of 2.07. As a major outcome, our study let us to early identify 60 people with a significant bone loss that were not aware of their condition. This diagnostic anticipation constitutes an important element of value for the project, both for the patients, for the preventable negative outcomes caused by the fractures, and for the society in general, because of the related avoidable costs. Therefore, based on our finding, we believe that the PEUS based screening performed could be a cost-effective approach to early identify osteoporosis. However, our study has some major limitations. In fact, in our study the economic analysis is based on theoretical scenarios, thus specific studies are needed for a better estimation of the possible benefits and costs of our program.

Keywords: osteoporosis, prevention, public health, screening

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Authors: Ammar Asma, Bouafia Nabiha, Ben Cheikh Asma, Ezzi Olfa, Mahjoub Mohamed, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Ventilator-associated pneumonia (VAP) is currently recognized as one of the most relevant causes of morbidity and mortality among intensive care unit (ICU) patients worldwide. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP. The purposes of this study were to determine the incidence and risk factors for VAP in in a Tunisian medical ICU. Materials / Methods: A retrospective case-control study design based on the prospective database collected over a 14-month period from September 15th, 2015 through November 15th, 2016 in an 8-bed medical ICU. Patients under ventilation for over 48 h were included. The number of cases was estimated by Epi-info Software with the power of statistical test equal to 90 %. Each case patient was successfully matched to two controls according to the length of mechanical ventilation (MV) before VAP for cases and the total length of MV in controls. VAP in the ICU was defined according to American Thoracic Society; Infectious Diseases Society of America guidelines. Early onset or late-onset VAP were defined whether the infectious process occurred within or after 96 h of ICU admission. Patients’ risk factors, causes of admission, comorbidities and respiratory specimens collected were reviewed. Univariate and multivariate analyses were performed to determine variables associated with VAP with a p-value < 0.05. Results: During the period study, a total of 169 patients under mechanical ventilation were considered, 34 patients (20.11%) developed at least one episode of VAP in the ICU. The incidence rate for VAP was 14.88/1000 ventilation days. Among these cases, 9 (26.5 %) were early-onset VAP and 25 (73.5 %) were late-onset VAP. It was a certain diagnosis in 66.7% of cases. Tracheal aspiration was positive in 80% of cases. Multi-drug resistant Acinerobacter baumanii was the most common species detected in cases; 67.64% (n=23). The rate of mortality out of cases was 88.23% (n= 30). In univariate analysis, the patients with VAP were statistically more likely to suffer from cardiovascular diseases (p=0.035) and prolonged duration of sedation (p=0.009) and tracheostomy (p=0.001), they also had a higher number of re-intubation (p=0.017) and a longer total time of intubation (p=0.012). Multivariate analysis showed that cardiovascular diseases (OR= 4.44; 95% IC= [1.3 - 14]; p=0.016), tracheostomy (OR= 4.2; 95% IC= [1.16 -15.12]; p= 0.028) and prolonged duration of sedation (OR=1.21; 95% IC= [1.07, 1.36]; p=0.002) were independent risk factors for the development of VAP. Conclusion: VAP constitutes a therapeutic challenge in an ICU setting, therefore; strategies that effectively prevent VAP are needed. An infection control-training program intended to all professional heath care in this unit insisting on bundles and elaboration of procedures are planned to reduce effectively incidence rate of VAP.

Keywords: case control study, intensive care unit, risk factors, ventilator associated pneumonia

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Authors: Rocio Murad, Juan Carlos Rivillas, Nury Alejandra Rodriguez, Daniela Roldán

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In Colombia, around 5 million women have suffered forced displacement and all forms of gender-based violence, mostly adolescents and young women, single mothers, or widows with children affected by the war. After the signing of the peace agreements, the department of Antioquia has been one of the most affected by the armed conflict, from a territorial and gender perspective in the period. The objective of the research was to analyze the situation of sexual and reproductive rights in the department of Antioquia from a territorial and gender perspective in the period after the signing of the Peace Agreement. A mixed methodology was developed. The quantitative component conducted a cross-sectional descriptive study of barriers to access to contraceptive methods, safe abortion and gender-based violence based on microdata from the 2015 National Demographic and Health Survey. In the qualitative component, a case study was developed in Dabeiba, a municipality of Antioquia prioritized in order to deepen the experiences before, during and after the armed conflict in sexual and reproductive rights; using three research techniques: Focused observation, Semi-structured interviews, and Documentary review. The results showed that there is a gradient of greater vulnerability to greater effects of the conflict and that the subregion of Urabá Antioqueño, to which Dabeiba belongs, has the highest levels of vulnerability in relation to departmental data. In this subregion, the percentage of women with an unmet need for contraceptive methods (9%), women with unintended pregnancies (31%), of women between 15 and 19 years of age who are already mothers or are pregnant with their first child (32%) and the percentage of women victims of physical violence (42%) and sexual violence (13%) by their partners are significantly higher. Women, particularly rural and indigenous women, were doubly affected due to the existence of violence that is specifically directed at them or that has a greater impact on their life projects. There was evidence of insufficient, fragmented and disjointed social and institutional action in relation to women's rights and the existence of androcentric and patriarchal social imaginaries through which women and the feminine are undervalued. These results provide evidence of violations of sexual and reproductive rights in contexts of armed conflict and make it possible to identify mechanisms to guarantee the re-establishment of the rights of the victims, particularly women and girls. Among the mechanisms evidenced are: working for the elimination of gender stereotypes; supporting the formation and strengthening of women's social organizations; working for the concerted definition and articulated implementation of actions necessary to respond to sexual and reproductive health needs; and working for the recognition of reproductive violence as specific and different from sexual violence in the context of armed conflict. Also, it was evidenced that it is necessary to implement prevention, attention and reparation actions.

Keywords: sexual and reproductive rights, Colombia, armed conflict, violence against women

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Authors: B. Vadiraj, S. N. Omkar, B. Kapil Bharadwaj, Yash Vardhan Gupta

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During manned exploration of space, missions will require astronaut crewmembers to perform Extra Vehicular Activities (EVAs) for a variety of tasks. These EVAs take place after long periods of operations in space, and in and around unique vehicles, space structures and systems. Considering the remoteness and time spans in which these vehicles will operate, EVA system operations should utilize common worksites, tools and procedures as much as possible to increase the efficiency of training and proficiency in operations. All of the preparations need to be carried out based on studies of astronaut motions. Until now, development and training activities associated with the planned EVAs in Russian and U.S. space programs have relied almost exclusively on physical simulators. These experimental tests are expensive and time consuming. During the past few years a strong increase has been observed in the use of computer simulations due to the fast developments in computer hardware and simulation software. Based on this idea, an effort to develop a computational simulation system to model human dynamic motion for EVA is initiated. This study focuses on the simulation of an astronaut moving the orbital replaceable units into the worksites or removing them from the worksites. Our physics-based methodology helps fill the gap in quantitative analysis of astronaut EVA by providing a multisegment human arm model. Simulation work described in the study improves on the realism of previous efforts, incorporating joint stops to account for the physiological limits of range of motion. To demonstrate the utility of this approach human arm model is simulated virtually using ADAMS/LifeMOD® software. Kinematic mechanism for the astronaut’s task is studied from joint angles and torques. Simulation results obtained is validated with numerical simulation based on the principles of Newton-Euler method. Torques determined using mathematical model are compared among the subjects to know the grace and consistency of the task performed. We conclude that due to uncertain nature of exploration-class EVA, a virtual model developed using multibody dynamics approach offers significant advantages over traditional human modeling approaches.

Keywords: extra vehicular activity, biomechanics, inverse kinematics, human body modeling

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Authors: Agnieszka Markowska-Radomska, Ewa Dluska

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Maintaining a bioactive substances dense diet is important for the elderly, especially to prevent diseases and to support healthy ageing. Adequate bioactive substances intake can reduce the risk of developing chronic diseases (e.g. cardiovascular, osteoporosis, neurodegenerative syndromes, diseases of the oral cavity, gastrointestinal (GI) disorders, diabetes, and cancer). This can be achieved by introducing a comprehensive supplementation of components necessary for the proper functioning of the ageing body. The paper proposes the multiple emulsions of the W1/O/W2 (water-in-oil-in-water) type as carriers for effective co-encapsulation and co-delivery of bioactive substances in supplementation of the elderly. Multiple emulsions are complex structured systems ("drops in drops"). The functional structure of the W1/O/W2 emulsion enables (i) incorporation of one or more bioactive components (lipophilic and hydrophilic); (ii) enhancement of stability and bioavailability of encapsulated substances; (iii) prevention of interactions between substances, as well as with the external environment, delivery to a specific location; and (iv) release in a controlled manner. The multiple emulsions were prepared by a one-step method in the Couette-Taylor flow (CTF) contactor in a continuous manner. In general, a two-step emulsification process is used to obtain multiple emulsions. The paper contains a proposal of emulsion functionalization by introducing pH-responsive biopolymer—carboxymethylcellulose sodium salt (CMC-Na) to the external phase, which made it possible to achieve a release of components controlled by the pH of the gastrointestinal environment. The membrane phase of emulsions was soybean oil. The W1/O/W2 emulsions were evaluated for their characteristics (drops size/drop size distribution, volume packing fraction), encapsulation efficiency and stability during storage (to 30 days) at 4ºC and 25ºC. Also, the in vitro multi-substance co-release process were investigated in a simulated gastrointestinal environment (different pH and composition of release medium). Three groups of stable multiple emulsions were obtained: emulsions I with co-encapsulated vitamins B12, B6 and resveratrol; emulsions II with vitamin A and β-carotene; and emulsions III with vitamins C, E and D3. The substances were encapsulated in the appropriate emulsion phases depending on the solubility. For all emulsions, high encapsulation efficience (over 95%) and high volume packing fraction of internal droplets (0.54-0.76) were reached. In addition, due to the presence of a polymer (CMC-Na) with adhesive properties, high encapsulation stability during emulsions storage were achieved. The co-release study of encapsulated bioactive substances confirmed the possibility to modify the release profiles. It was found that the releasing process can be controlled through the composition, structure, physicochemical parameters of emulsions and pH of the release medium. The results showed that the obtained multiple emulsions might be used as potential liquid complex carriers for controlled/modified/site-specific co-delivery of bioactive substances in dietary supplementation in the elderly.

Keywords: bioactive substance co-release, co-encapsulation, elderly supplementation, multiple emulsion

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Authors: Ilana Singer, Anastasia Lučić, Julie Leclerc

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Introduction: Tics, characterized by repetitive, sudden, non-voluntary motor movements or vocalizations, are prevalent in chronic tic disorder (CT) and Tourette Syndrome (TS). These neurodevelopmental disorders often coexist with various psychiatric conditions, leading to challenges and reduced quality of life. While medication in conjunction with behavioral interventions, such as Habit Reversal Training (HRT), Exposure Response Prevention (ERP), and Comprehensive Behavioral Intervention for Tics (CBIT), has shown efficacy, a significant proportion of patients experience persistent tics. Thus, innovative treatment approaches are necessary to improve therapeutic outcomes, such as mindfulness-based approaches. Nonetheless, the effectiveness of mindfulness-based interventions in the context of CT and TS remains understudied. Objective: The objective of this scoping review is to provide an overview of the current state of research on mindfulness-based interventions for CT and TS, identify knowledge and evidence gaps, discuss the effectiveness of mindfulness-based interventions with other treatment options, and discuss implications for clinical practice and policy development. Method: Using guidelines from Peters (2020) and the PRISMA-ScR, a scoping review was conducted. Multiple electronic databases were searched from inception until June 2023, including MEDLINE, EMBASE, PsychInfo, Global Health, PubMed, Web of Science, and Érudit. Inclusion criteria were applied to select relevant studies, and data extraction was independently performed by two reviewers. Results: Five papers were included in the study. Firstly, we found that mindfulness interventions were found to be effective in reducing anxiety and depression while enhancing overall well-being in individuals with tics. Furthermore, the review highlighted the potential role of mindfulness in enhancing functional connectivity within the Default Mode Network (DMN) as a compensatory function in TS patients. This suggests that mindfulness interventions may complement and support traditional therapeutic approaches, particularly HRT, by positively influencing brain networks associated with tic regulation and control. Conclusion: This scoping review contributes to the understanding of the effectiveness of mindfulness-based interventions in managing CT and TS. By identifying research gaps, this review can guide future investigations and interventions to improve outcomes for individuals with CT or TS. Overall, these findings emphasize the potential benefits of incorporating mindfulness-based interventions as a smaller subset within comprehensive treatment strategies. However, it is essential to acknowledge the limitations of this scoping review, such as the exclusion of a pre-established protocol and the limited number of studies available for inclusion. Further research and clinical exploration are necessary to better understand the specific mechanisms and optimal integration of mindfulness-based interventions with existing behavioral interventions for this population.

Keywords: scoping reviews, Tourette Syndrome, tics, mindfulness-based, therapy, intervention

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Authors: Getahun Lemma

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Introduction Guinea Worm Disease (GWD), also known as dracunculiasisis, is one of the oldest diseases in the history of mankind. Dracunculiasis is caused by a parasitic nematode, Dracunculus medinensis. Infection is acquired by drinking contaminated water with copepods containing infective Guinea Worm (GW) larvae). Almost one year after the infection, the worm usually emerges out through the skin on a lower, causing severe pain and disabilities. Although there is no effective drug or vaccine against the disease, the chain of transmission can be effectively prevented with simple and cost effective public health measures. Death due to dracunculiasis is very rare. However, it results in a wide range of physical, social and economic sequels. The disease is usually common in the rural, remote places of Sub-Saharan African countries among the marginalized societies. Currently, GWD is one of the neglected tropical diseases, which is on the verge of eradication. The global Guinea Worm Eradication Program (GWEP) was started in 1980. Since then, the program has achieved a tremendous success in reducing the global burden and number of GW case from 3.5 million to only 28 human cases at the end of 2018. However, it has recently been shown that not only humans can become infected, with a total of 1,105 animal infections have been reported at the end of 2018. Therefore, the objective of this study was to identify the existing challenges in the last mile of the GWEP in order To inform Policy makers and stakeholders on potential measures to finally achieve eradication. Method Systematic literature review on articles published from January 1, 2000 until May 30, 2019. Papers listed in Cochrane Library, Google Scholar, ProQuest PubMed and Web of Science databases were searched and reviewed. Results Twenty-five articles met inclusion criteria of the study and were selected for analysis. Hence, relevant data were extracted, grouped and descriptively analyzed. Results showed the main challenges complicating the last mile of global GWEP: 1. Unusual mode of transmission; 2. Rising animal Guinea Worm infection; 3. Suboptimal surveillance; 4. Insecurity; 5. Inaccessibility; 6. Inadequate safe water points; 7. Migration; 8. Poor case containment measures, 9. Ecological changes; and 10. New geographic foci of the disease. Conclusion This systematic review identified that most of the current challenges in the GWEP have been present since the start of the campaign. However, the recent change in epidemiological patterns and nature of GWD in the last remaining endemic countries illustrates a new twist in the global GWEP. Considering the complex nature of the current challenges, there seems to be a need for a more coordinated and multidisciplinary approach of GWD prevention and control measures in the last mile of the campaign. These new strategies would help to make history by eradicating dracunculiasis as the first ever parasitic disease.

Keywords: dracunculiasis, eradication program, guinea worm, last mile

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Authors: Housein Deli, Loui Al-Shrouf, Hammoud Al Joumaa, Mohieddine Jelali

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When forming metallic materials, fluctuations in material properties, process conditions, and wear lead to deviations in the component geometry. Several hundred features sometimes need to be measured, especially in the case of functional and safety-relevant components. These can only be measured offline due to the large number of features and the accuracy requirements. The risk of producing components outside the tolerances is minimized but not eliminated by the statistical evaluation of process capability and control measurements. The inspection intervals are based on the acceptable risk and are at the expense of productivity but remain reactive and, in some cases, considerably delayed. Due to the considerable progress made in the field of condition monitoring and measurement technology, permanently installed sensor systems in combination with machine learning and artificial intelligence, in particular, offer the potential to independently derive forecasts for component geometry and thus eliminate the risk of defective products - actively and preventively. The reliability of forecasts depends on the quality, completeness, and timeliness of the data. Measuring all geometric characteristics is neither sensible nor technically possible. This paper, therefore, uses the example of car seat rail production to discuss the necessary first step of feature selection and reduction by correlation analysis, as otherwise, it would not be possible to forecast components in real-time and inline. Four different car seat rails with an average of 130 features were selected and measured using a coordinate measuring machine (CMM). The run of such measuring programs alone takes up to 20 minutes. In practice, this results in the risk of faulty production of at least 2000 components that have to be sorted or scrapped if the measurement results are negative. Over a period of 2 months, all measurement data (> 200 measurements/ variant) was collected and evaluated using correlation analysis. As part of this study, the number of characteristics to be measured for all 6 car seat rail variants was reduced by over 80%. Specifically, direct correlations for almost 100 characteristics were proven for an average of 125 characteristics for 4 different products. A further 10 features correlate via indirect relationships so that the number of features required for a prediction could be reduced to less than 20. A correlation factor >0.8 was assumed for all correlations.

Keywords: long-term SHM, condition monitoring, machine learning, correlation analysis, component prediction, wear prediction, regressions analysis

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Authors: Ryan B. Simpson, Margaret A. Waskow, Aishwarya Venkat, Elena N. Naumova

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The Centers for Disease Control and Prevention (CDC) estimate that 31 known foodborne pathogens cause 9.4 million cases of these illnesses annually in US. Over 90% of these illnesses are associated with exposure to Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shigella, Shiga-Toxin Producing E.Coli (STEC), Vibrio, and Yersinia. Contaminated products contain parasites typically causing an intestinal illness manifested by diarrhea, stomach cramping, nausea, weight loss, fatigue and may result in deaths in fragile populations. Since 1998, the National Outbreak Reporting System (NORS) has allowed for routine collection of suspected and laboratory-confirmed cases of food poisoning. While retrospective analyses have revealed common pathogen-specific seasonal patterns, little is known concerning the stability of those patterns over time and whether they can be used for preventative forecasting. The objective of this study is to construct a calendar of foodborne outbreaks of nine infections based on the peak timing of outbreak incidence in the US from 1996 to 2017. Reported cases were abstracted from FoodNet for Salmonella (135115), Campylobacter (121099), Shigella (48520), Cryptosporidium (21701), STEC (18022), Yersinia (3602), Vibrio (3000), Listeria (2543), and Cyclospora (758). Monthly counts were compiled for each agent, seasonal peak timing and peak intensity were estimated, and the stability of seasonal peaks and synchronization of infections was examined. Negative Binomial harmonic regression models with the delta-method were applied to derive confidence intervals for the peak timing for each year and overall study period estimates. Preliminary results indicate that five infections continue to lead as major causes of outbreaks, exhibiting steady upward trends with annual increases in cases ranging from 2.71% (95%CI: [2.38, 3.05]) in Campylobacter, 4.78% (95%CI: [4.14, 5.41]) in Salmonella, 7.09% (95%CI: [6.38, 7.82]) in E.Coli, 7.71% (95%CI: [6.94, 8.49]) in Cryptosporidium, and 8.67% (95%CI: [7.55, 9.80]) in Vibrio. Strong synchronization of summer outbreaks were observed, caused by Campylobacter, Vibrio, E.Coli and Salmonella, peaking at 7.57 ± 0.33, 7.84 ± 0.47, 7.85 ± 0.37, and 7.82 ± 0.14 calendar months, respectively, with the serial cross-correlation ranging 0.81-0.88 (p < 0.001). Over 21 years, Listeria and Cryptosporidium peaks (8.43 ± 0.77 and 8.52 ± 0.45 months, respectively) have a tendency to arrive 1-2 weeks earlier, while Vibrio peaks (7.8 ± 0.47) delay by 2-3 weeks. These findings will be incorporated in the forecast models to predict common paths of the spread, long-term trends, and the synchronization of outbreaks across etiological agents. The predictive modeling of foodborne outbreaks should consider long-term changes in seasonal timing, spatiotemporal trends, and sources of contamination.

Keywords: foodborne outbreak, national outbreak reporting system, predictive modeling, seasonality

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Authors: Jonix Owino, Heather Fuller

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Refugees flee from their home countries due to civil unrest, war, persecution and migrate to Western countries such as the United States in search of a safe haven. Transitioning into a new society and culture can be challenging, thereby affecting refugee’s quality of life and well-being in the host communities. Moreover, as individuals age, they experience physical, cognitive and socioemotional changes that may impact their quality of life. However, little is known about the predictors of quality of life among aging refugees. It is not clear how quality of life varies by age, that is, between midlife refugees in comparison to their older counterparts. In addition to age, other sociodemographic factors such as gender, socioeconomic status, or country of origin are likely to have differential associations to quality of life, yet research on such variations among older refugees is sparse. Thus the present study seeks to explore factors associated with quality of life by asking the following research questions: 1) Do sociodemographic factors (such as age and gender) predict quality of life among older refugees, 2) Is there an association between social integration and quality of life, and 3) Is there an association between migratory related experiences (such as post migratory adjustments) and quality of life. The present study recruited 90 refugees (primarily originating from Bhutan, Somalia, Burundi, and Sudan) aged 50 or older living in the US. The participants completed a structured questionnaire which assessed factors such as participant’s sociodemographic attributes (e.g., age, gender, length of residence in the US, country of origin, employment, level of education, and marital status), and validated measures of social integration, post-migration living difficulties, and quality of life. Preliminary results suggest sociodemographic variability in quality of life among these refugees. Further analyses will be conducted using hierarchical regression analyses to address the following hypotheses: first, it is hypothesized that quality of life will vary by age and gender such that younger refugees and men will report higher quality of life. Second, it is expected that refugees with greater levels of social integration will also report better quality of life. Finally, post-migration factors such as language barriers and family stress are hypothesized to predict poorer quality of life. Further results will be analyzed, including potential moderating effects of age and gender, and resulting findings will be interpreted and discussed. The findings from this study have potential implications for communities on how they can better support older refugees as well as develop social programs that can effectively cater to their well-being. Conclusions will be drawn and discussed in light of policies related to both aging and refugee migration within the context of the US.

Keywords: aging out of place, migration, older refugees, quality of life, social integration

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Authors: Daniel O. Kleinsman

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The 2019 terrorist attack on two masjidain in Christchurch, New Zealand, was a shocking demonstration of the harm that can be caused by hate crime. As legal and governmental responses to the attack struggle to provide effective remedies to its victims, restorative justice has emerged as a tool that can assist, in terms of both meeting victims’ needs and discharging the obligations of the state under the International Covenant on Civil and Political Rights (ICCPR), arts 2(3), 26, 27. Restorative justice is a model that emphasizes the repair of harm caused or revealed by unjust behavior. It also prioritises the facilitation of dialogue, the restoration of equitable relationships, and the prevention of future harm. Returning to the case study, in the remarks of the sentencing judge, the terrorist’s actions were described as a hate crime of vicious malevolence that the Court was required to decisively reject, as anathema to the values of acceptance, tolerance and mutual respect upon which New Zealand’s inclusive society is based and which the country strives to maintain. This was one of the reasons for which the terrorist received a life sentence with no possibility of parole. However, in the report of the Royal Commission of Inquiry into the Attack, it was found that victims felt the attack occurred within the context of widespread racism, discrimination and Islamophobia, where hostile behaviors, including hate-based threats and attacks, were rarely recorded, analysed or acted on. It was also found that the Government had inappropriately concentrated intelligence resources on the risk of ‘Islamist’ terrorism and had failed to adequately respond to concerns raised about threats against the Muslim community. In this light, the remarks of the sentencing judge can be seen to reflect a criminal justice system that, in the absence of other remedies, denies systemic accountability and renders hate crime an isolated incident rather than an expression of more widespread discrimination and hate to be holistically addressed. One of the recommendations of the Royal Commission was to explore with victims the desirability and design of restorative justice processes. This presents an opportunity for victims to meet with state representatives and pursue effective remedies (ICCPR art 2(3)) not only for the harm caused by the terrorist but the harm revealed by a system that has exposed the minority Muslim community in New Zealand to hate in all forms, including but not limited to violent extremism. In this sense, restorative justice can also assist the state in discharging its wider obligations to protect all persons from discrimination (art 26) and allow ethnic and religious minorities to enjoy their own culture and profess and practice their own religion (art 27). It can also help give effect to the law and its purpose as a remedy to hate crime, as expressed in this case study by the sentencing judge.

Keywords: hate crime, restorative justice, minorities, victims' rights

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Authors: Ireen Manase Kabembo, Patrick Chanda

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Background: Substance use disorders are among the chronic conditions that affect all age groups. Worldwide, there is an increase in young people affected by SUDs, which implies that more family members are transitioning into the caregiver role. Family caregivers play a buffering role in the formal healthcare system due to their involvement in caring for persons with acute and chronic conditions in the home setting. Family carers of youth with problematic alcohol and marijuana use experience myriad challenges in managing daily care for this medically vulnerable group. In addition, the poor health-seeking behaviours of youth with SUDs characterized by eluding treatment and runaway tendencies coupled with the effects of the pandemic made caregiving a daunting task for most family caregivers. Issues such as limited and unavailable psychotropic medications, social stigma and discrimination, financial hurdles, systemic barriers in adolescent and young adult mental healthcare services, and the lack of a perceived vulnerability to Covid-19 by youth with SUDs are experiences of family caretakers. Methods: A qualitative study with 30 family caregivers of youth aged 16-24 explored their lived experiences and subjective meanings using two in-depth semi-structured interviews, a caregiving timeline, and participant observation. Findings: Results indicate that most family caregivers had challenges managing care for treatment elusive youth, let alone having them adhere to Covid-19 regulations. However, youth who utilized healthcare services and adhered to treatment regimens had positive outcomes and sustained recovery. The effects of the pandemic, such as job losses and the closure of businesses, further exacerbated the financial challenges experienced by family caregivers, making it difficult to purchase needed medications and daily necessities for the youth. The unabated stigma and discrimination of families of substance-dependent youth in Zambian communities further isolated family caregivers, leaving them with limited support. Conclusion: Since young people with SUDs have a compromised mental capacity due to the cognitive impairments that come with continued substance abuse, they often have difficulties making sound judgements, including the need to utilize SUD recovery services. Also, their tendency to not adhere to the Covid-19 pandemic requirements places them at a higher risk for adverse health outcomes in the (post) pandemic era. This calls for urgent implementation of robust youth mental health services that address prevention and recovery for these emerging adults grappling with substance use disorders. Support for their family caregivers, often overlooked, cannot be overemphasized.

Keywords: chronic care management, Covid-19 pandemic, family caregivers, youth with substance use disorders

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Authors: Emilio Galdeano-Gómez, Ángeles Godoy-Durán, Juan C. Pérez-Mesa, Laura Piedra-Muñoz

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Eco-efficiency is receiving ever-increasing interest as an indicator of sustainability, as it links environmental and economic performances in productive activities. In agriculture, these indicators and their determinants prove relevant due to the close relationships in this activity between the use of natural resources, which is generally limited, and the provision of basic goods to society. In this context, various analyses have focused on eco-efficiency by considering individual family farms as the basic production unit. However, not only must the measure of efficiency be taken into account, but also the existence of a series of factors which constitute socio-economic, political-institutional, and environmental determinants. Said factors have been studied to a lesser extent in the literature. The present work analyzes eco-efficiency at a micro level, focusing on small-scale family farms as the main decision-making units in horticulture in southeast Spain, a sector which represents about 30% of the fresh vegetables produced in the country and about 20% of those consumed in Europe. The objectives of this study are a) to obtain a series of eco-efficiency indicators by estimating several pressure ratios and economic value added in farming, b) to analyze the influence of specific social, economic and environmental variables on the aforementioned eco-efficiency indicators. The present work applies the method of Data Envelopment Analysis (DEA), which calculates different combinations of environmental pressures (water usage, phytosanitary contamination, waste management, etc.) and aggregate economic value. In a second stage, an analysis is conducted on the influence of the socio-economic and environmental characteristics of family farms on the eco-efficiency indicators, as endogeneous variables, through the use of truncated regression and bootstrapping techniques, following Simar-Wilson methodology. The results reveal considerable inefficiency in aspects such as waste management, while there is relatively little inefficiency in water usage and nitrogen balance. On the other hand, characteristics, such as product specialization, the adoption of quality certifications and belonging to a cooperative do have a positive impact on eco-efficiency. These results are deemed to be of interest to agri-food systems structured on small-scale producers, and they may prove useful to policy-makers as regards managing public environmental programs in agriculture.

Keywords: data envelopment analysis, eco-efficiency, family farms, horticulture, socioeconomic features

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Authors: Norbert Magyar, Jozsef Kovacs, Peter Tanos, Balazs Trasy, Tamas Garamhegyi, Istvan Gabor Hatvani

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Water is one of the most important common resources, and as a result of urbanization, agriculture, and industry it is becoming more and more exposed to potential pollutants. The prevention of the deterioration of water quality is a crucial role for environmental scientist. To achieve this aim, the operation of monitoring networks is necessary. In general, these networks have to meet many important requirements, such as representativeness and cost efficiency. However, existing monitoring networks often include sampling sites which are unnecessary. With the elimination of these sites the monitoring network can be optimized, and it can operate more economically. The aim of this study is to illustrate the applicability of the CCDA (Combined Cluster and Discriminant Analysis) to the field of water quality monitoring and optimize the monitoring networks of a river (the Danube), a wetland-lake system (Kis-Balaton & Lake Balaton), and two surface-subsurface water systems on the watershed of Lake Neusiedl/Lake Fertő and on the Szigetköz area over a period of approximately two decades. CCDA combines two multivariate data analysis methods: hierarchical cluster analysis and linear discriminant analysis. Its goal is to determine homogeneous groups of observations, in our case sampling sites, by comparing the goodness of preconceived classifications obtained from hierarchical cluster analysis with random classifications. The main idea behind CCDA is that if the ratio of correctly classified cases for a grouping is higher than at least 95% of the ratios for the random classifications, then at the level of significance (α=0.05) the given sampling sites don’t form a homogeneous group. Due to the fact that the sampling on the Lake Neusiedl/Lake Fertő was conducted at the same time at all sampling sites, it was possible to visualize the differences between the sampling sites belonging to the same or different groups on scatterplots. Based on the results, the monitoring network of the Danube yields redundant information over certain sections, so that of 12 sampling sites, 3 could be eliminated without loss of information. In the case of the wetland (Kis-Balaton) one pair of sampling sites out of 12, and in the case of Lake Balaton, 5 out of 10 could be discarded. For the groundwater system of the catchment area of Lake Neusiedl/Lake Fertő all 50 monitoring wells are necessary, there is no redundant information in the system. The number of the sampling sites on the Lake Neusiedl/Lake Fertő can decrease to approximately the half of the original number of the sites. Furthermore, neighbouring sampling sites were compared pairwise using CCDA and the results were plotted on diagrams or isoline maps showing the location of the greatest differences. These results can help researchers decide where to place new sampling sites. The application of CCDA proved to be a useful tool in the optimization of the monitoring networks regarding different types of water bodies. Based on the results obtained, the monitoring networks can be operated more economically.

Keywords: combined cluster and discriminant analysis, cost efficiency, monitoring network optimization, water quality

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Authors: Kinneret Segal

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Background: The work of a midwife is emotionally challenging, both positively and negatively. Midwives share moments of joy when a baby is welcomed into the world and also attend difficult events of loss and trauma. The relationship that develops with the maternity is the essence of the midwife's care, and it is a fundamental source of motivation and professional satisfaction. This close relationship with the maternity may be used as a double-edged sword in cases of exposure to traumatic events at birth. Birth problems, exposure to emergencies and traumatic events, and loss can affect the professional quality of life and the Compassion satisfaction of the midwife. It seems that the issue of traumatic experiences in the work of midwives has not been sufficiently explored. Aim: The present study examined the associations between exposure to traumatic events, personal resilience and post-traumatic symptoms, professional quality of life, and organizational commitment among midwifery nurses in Israeli hospitals. Methods: 131 midwives from three hospitals in the country's center in Israel participated in this study. The data were collected during 2021 using a self-report questionnaire that examined sociodemographic characteristics, the degree of exposure to traumatic events in the delivery room, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment. Results: The three most difficult traumatic events for the midwives were death or fear of death of a newborn, death or fear of the death of a mother, and a quiet birth. The higher the frequency of exposure to traumatic events, the more numerous and intense the onset of post-trauma symptoms. The more numerous and powerful the post-trauma symptoms, the higher the level of professional burnout and/or compassion fatigue, and the lower the level of compassion satisfaction. High levels of compassion satisfaction and/or low professional burnout were expressed in a heightened sense of organizational commitment. Personal resilience, country of birth, traumatic symptoms, and organizational commitment predicted satisfaction from compassion. Conclusions: Midwives are exposed to traumatic events associated with dissatisfaction and impairment of the professional quality of life that accompanies burnout and compassion fatigue. Exposure to traumatic events leads to the appearance of traumatic symptoms, a decrease in organizational commitment, and psychological and mental well-being. The issue needs to be addressed by implementing training programs, organizational support, and policies to improving well-being and quality of care among midwives.

Keywords: organizational commitment, traumatic experiences, personal resilience, quality of life

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Authors: Yuki Matsumoto, Yuma Ishimoto

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Cognitive Behavior Therapy (CBT) with children has shown effective application to various problems such as anxiety and depression. Although there are barriers to access to mental health services including lack of professional services in communities and parental concerns about stigma, school has a significant role to address children’s health problems. Schools are regarded as a suitable arena for prevention and early intervention of mental health problems. In this line, CBT can be adaptable to school education and useful to enhance students’ social and emotional skills. However, Japanese school curriculum is rigorous so as to limit available time for implementation of CBT in schools. This paper describes Brief Cognitive Behavior Therapy (BCBT) with children in a Japanese school setting. The program has been developed in order to facilitate acceptability of CBT in schools and aimed to enhance students’ skills to manage anxiety and difficult behaviors. The present research used a single arm design in which 30 students aged 9-10 years old participated. The authors provided teachers a CBT training workshop (two hours) at two primary schools in Tokyo metropolitan area and recruited participants in the research. A homeroom teacher voluntarily delivered a 6-session BCBT program (15 minutes each) in classroom periods which is called as Kaerinokai, a meeting before leaving school. Students completed a questionnaire sheet at pre- and post-periods under the supervision of the teacher. The sheet included the Spence Child Anxiety Scale (SCAS), the Depression Self-Rating Scale for Children (DSRS), and the Strengths and Difficulties Questionnaire (SDQ). The teacher was asked for feedback after the completion. Significant positive changes were found in the total and five of six sub-scales of the SCAS and the total difficulty scale of the SDQ. However, no significant changes were seen in Physical Injury Fear sub-scale of the SCAS, in the DSRS or the Prosocial sub-scale of the SDQ. The effect sizes are mostly between small and medium. The teacher commented that the program was easy to use and found positive changes in classroom activities and personal relationships. This preliminary research showed the feasibility of the BCBT in a school setting. The results suggest that the BCBT offers effective treatment for reduction in anxiety and in difficult behaviors. There is a good prospect of the BCBT suggesting that BCBT may be easier to be delivered than CBT by Japanese teachers to promote child mental health. The study has limitations including no control group, small sample size, or a short teacher training. Future research should address these limitations.

Keywords: brief cognitive behavior therapy, cognitive behavior therapy, mental health services in schools, teacher training workshop

Procedia PDF Downloads 336

Authors: Ditsapelo M. McFarland

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Background: Despite the availability of the Pap smear services in urban areas in Botswana, most women in such areas do not seem to screen regular for prevention of the cervical cancer disease. Reasons for non-use of the available Pap smear services are not well understood. Beliefs about cancer may influence participation in cancer screening in these women. The purpose of this study was to develop an instrument to measure beliefs about cervical cancer and Pap smear screening among Black women in Botswana, and evaluate the psychometric properties of the instrument. Significance: Instruments that are designed to measure beliefs about cervical cancer and screening among black women in Botswana, as well as in the surrounding region, are presently not available. Valid and reliable instruments are needed for exploration of the women’s beliefs about cervical cancer. Conceptual Framework: The Health Belief Model (HBM) provided a conceptual framework for the study. Methodology: The study was done in four phases: Phase 1: item generation: 15 items were generated from literature review and qualitative data for each of four conceptually defined HBM constructs: Perceived susceptibility, severity, benefits, and barriers (Version 1). Phase 2: content validity: Four experts who were advanced practice nurses of African descent and were familiar with the content and the HBM evaluated the content. Experts rated the items on a 4-point Likert scale ranging from: 1=not relevant, 2=somewhat relevant, 3=relevant and 4=very relevant. Fifty-five items were retained for instrument development: perceived susceptibility - 11, severity - 14, benefits - 15 and barriers - 15, all measuring on a 4-point Likert scale ranging from strongly disagree (1) to strongly agree (4). (Version 2). Phase 3: pilot testing: The instrument was pilot tested on a convenient sample of 30 women in Botswana and revised as needed. Phase 4: reliability: the revised instrument (Version 3) was submitted to a larger sample of women in Botswana (n=300) for reliability testing. The sample included women who were Batswana by birth and decent, were aged 30 years and above and could complete an English questionnaire. Data were collected with the assistance of trained research assistants. Major findings: confirmatory factor analysis of the 55 items found that a number of items did not adequately load in a four-factor solution. Items that exhibited reasonable reliability and had low frequency of missing values (n=36) were retained: perceived barriers (14 items), perceived benefits (8 items), perceived severity (4 items), and perceived susceptibility (10 items). confirmatory factor analysis (principle components) for a four factor solution using varimax rotation demonstrated that these four factors explained 43% of the variation in these 36 items. Conclusion: reliability analysis using Cronbach’s Alpha gave generally satisfactory results with values from 0.53 to 0.89.

Keywords: cervical cancer, factor analysis, psychometric evaluation, varimax rotation

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Authors: Hala M. Abdel Mageed, Ahmed I. Omar, Shady H. E. Abdel Aleem

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This paper describes in details a commercial green building that has been designed and constructed in Marsa Matrouh, Egypt. The balance between homebuilding and the sustainable environment has been taken into consideration in the design and construction of this building. The building consists of one floor with 3 m height and 2810 m² area while the envelope area is 1400 m². The building construction fulfills the natural ventilation requirements. The glass curtain walls are about 50% of the building and the windows area is 300 m². 6 mm greenish gray tinted temper glass as outer board lite, 6 mm safety glass as inner board lite and 16 mm thick dehydrated air spaces are used in the building. Visible light with 50% transmission, 0.26 solar factor, 0.67 shading coefficient and 1.3 W/m².K thermal insulation U-value are implemented to realize the performance requirements. Optimum electrical distribution for lighting system, air conditions and other electrical loads has been carried out. Power and quantity of each type of the lighting system lamps and the energy consumption of the lighting system are investigated. The design of the air conditions system is based on summer and winter outdoor conditions. Ventilated, air conditioned spaces and fresh air rates are determined. Variable Refrigerant Flow (VRF) is the air conditioning system used in this building. The VRF outdoor units are located on the roof of the building and connected to indoor units through refrigerant piping. Indoor units are distributed in all building zones through ducts and air outlets to ensure efficient air distribution. The green building energy consumption is evaluated monthly all over one year and compared with the consumed energy in the non-green conditions using the Hourly Analysis Program (HAP) model. The comparison results show that the total energy consumed per year in the green building is about 1,103,221 kWh while the non-green energy consumption is about 1,692,057 kWh. In other words, the green building total annual energy cost is reduced from 136,581 $ to 89,051 $. This means that, the energy saving and consequently the money-saving of this green construction is about 35%. In addition, 13 points are awarded by applying one of the most popular worldwide green energy certification programs (Leadership in Energy and Environmental Design “LEED”) as a rating system for the green construction. It is concluded that this green building ensures sustainability, saves energy and offers an optimum energy performance with minimum cost.

Keywords: energy consumption, energy saving, green building, leadership in energy and environmental design, sustainability

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Authors: Mary Farrell, Maria Soubra, Sandra Vega, Dorothy Kakraba, Joanne Fontanilla, Moira Kendra, Danielle Tonzola, Stephanie Chiu

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Pneumonia is the most common infectious cause of hospitalizations in the United States, with more than one million admissions annually and costs of $10 billion every year, making it the 8th leading cause of death. Aspiration pneumonia is an aggressive type of pneumonia that results from inhalation of oropharyngeal secretions and/or gastric contents and is preventable. The authors hypothesized that an evidence-based aspiration pneumonia clinical care pathway could reduce 30-day hospital readmissions and mortality rates, while improving the overall care of patients. We conducted a retrospective chart review on 979 patients discharged with aspiration pneumonia from January 2021 to December 2022 at Overlook Medical Center. The authors identified patients who were coded with aspiration pneumonia and/or stable sepsis. Secondarily, we identified 30-day readmission rates for aspiration pneumonia from a SNF. The Aspiration Pneumonia Clinical Care Pathway starts in the emergency department (ED) with the initiation of antimicrobials within 4 hours of admission and early recognition of aspiration. Once this is identified, a swallow test is initiated by the bedside nurse, and if the patient demonstrates dysphagia, they are maintained on strict nothing by mouth (NPO) followed by a speech and language pathologist (SLP) referral for an appropriate modified diet recommendation. Aspiration prevention techniques included the avoidance of straws, 45-degree positioning, no talking during meals, taking small bites, placement of the aspiration wrist band, and consuming meals out of the bed in a chair. Nursing education was conducted with a newly created online learning module about aspiration pneumonia. The authors identified 979 patients, with an average age of 73.5 years old, who were diagnosed with aspiration pneumonia on the index hospitalization. These patients were reviewed for a 30-day readmission for aspiration pneumonia or stable sepsis, and mortality rates from January 2021 to December 2022 at Overlook Medical Center (OMC). The 30-day readmission rates were significantly lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011). When evaluating the mortality rates in the pre and post intervention cohort the authors discovered the mortality rates were lower in the post intervention cohort (23.7% vs 22.4%, p = 0.61) Mortality among non-white (self-reported as non-white) patients were lower in the post intervention cohort (34.4% vs. 21.0% , p = 0.05). Patients who reported as a current smoker/vaper in the pre and post cohorts had increased mortality rates (5.9% vs 22%). There was a decrease in mortality for the male population but an increase in mortality for women in the pre and post cohorts (19% vs. 25%). The authors attributed this increase in mortality in the post intervention cohort to more active smokers, more former smokers, and more being admitted from a SNF. This research identified that implementation of an Aspiration Pneumonia Clinical Care Pathway showed a statistically significant decrease in readmission rates and mortality rates in non-whites. The 30-day readmission rates were lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011).

Keywords: aspiration pneumonia, mortality, quality improvement, 30-day pneumonia readmissions

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Authors: Mohammad Khoshini, Arman Khoshghalb, Meghdad Payan, Nasser Khalili

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Most of the Earth’s crust surface rocks are technically categorized as weak rocks or weakly bonded geomaterials. Deeply weathered, weakly cemented, friable and easily erodible, they demonstrate complex material behaviour and understanding the overlooked mechanical behaviour of such materials is of particular importance in geotechnical engineering practice. Weakly bonded geomaterials are so susceptible to surface shear and moisture that conventional methods of core drilling fail to extract high-quality undisturbed samples out of them. Moreover, most of these geomaterials are of high heterogeneity rendering less reliable and feasible material characterization. In order to compensate for the unpredictability of the material response, either numerous experiments are needed to be conducted or large factors of safety must be implemented in the design process. However, none of these approaches is sustainable. In this study, a method for dry core drilling of such materials is introduced to take high-quality undisturbed core samples. By freezing the material at certain moisture content, a secondary structure is developed throughout the material which helps the whole structure to remain intact during the core drilling process. Moreover, to address the heterogeneity issue, the natural material was reconstructed artificially to obtain a homogeneous material with very high similarity to the natural one in both micro and macro-mechanical perspectives. The method is verified for both micro and macro scale. In terms of micro-scale analysis, using Scanning Electron Microscopy (SEM), pore spaces and inter-particle bonds were investigated and compared between natural and artificial materials. X-Ray Diffraction, XRD, analyses are also performed to control the chemical composition. At the macro scale, several uniaxial compressive strength tests, as well as triaxial tests, were performed to verify the similar mechanical response of the materials. A high level of agreement is observed between micro and macro results of natural and artificially bonded geomaterials. The proposed methods can play an important role to cut down the costs of experimental programs for material characterization and also to promote the accuracy of the numerical modellings based on the experimental results.

Keywords: Artificial geomaterial, core drilling, macro-mechanical behavior, micro-scale, sample preparation, SEM photography, weakly bonded geomaterials

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Authors: Seyda Can, Meryem Unulu

Abstract:

Objective: Breast milk is the most fundamental nutritional element for the healthy growth and development of newborns as they supply all the necessary components. Various obstacles such as diseases of mother and child, allergies of the baby, and insufficient breastmilk affect breast-feeding adversely. The wet nursery or breast milk banking is the most important source in providing the nutrients closest to the ideal for the newborn. Despite increasing opinions about its benefits, breast milk banking practice is controversial because of reasons such as ethical problems, traditional beliefs and attitudes, security concerns of families and lack of knowledge. It is thought that the results of this study will create the data for studies to raise the awareness of the society regarding wet nursery, and milk banks. Method: The study was planned and performed in descriptive type. The population of the study consists of mothers that gave birth between October-November 2017 in a public hospital in Turkey, and the sample consisted of 205 mothers chosen by improbable sampling method from the population and accepted to participate in the study. While gathering data, a survey consisting of 33 questions designed to determine the socio-demographic characteristics and their views on wet nursery and breast milk banking. Written ethical committee and institution permit was taken. Before the interview, participants were informed about the purpose and content of the study and oral permit was taken. Result: When the distribution of 205 mothers according to their individual characteristics, it was detected that their age average was 28,16±5,23 and 63,4 of mothers (n=130) had normal delivery. It was determined that clear majority of mothers, 75,6% (n=155) had no breast-feeding problems and 75,1% (n=154) fed the baby only with breast milk. It was detected that 18,5% (n=38) would accept a stranger to be a wet nurse and 60% (n=123) would donate milk if there is a breast milk bank. It was detected 33,2 % (n=68) of participant mothers want to make use of breast milk bank if there is a situation that prevents breast feeding, 38,5 % (n=79) of mothers think breast milk bank would be problematic religiously. Statistical difference was detected between the educational status of women and the rate of wanting breast milk bank practice. As the educational status of mothers increased, their rate of wanting breast milk bank practice increased. Conclusion: It is essential that every baby is breastfed by its mother primarily. However, when this is not possible, in order to implement wet nursery and breast milk banking as an extension of national breast-feeding policy, regulations need to be made and worries should be eased. Also, organizing training programs are also really important to raise awareness of the society and mothers.

Keywords: breast feeding, breast milk, milk banks, wet nursery

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Authors: Demmiele Matu Kiiza, Constantine Steven Labongo Loum, Julaina Obika Asinasi

Abstract:

Background: The use of traditional medicine in Uganda forms the preliminary therapeutic approaches among many people. Traditional medicines have been used in Uganda for many years, not only for the management of pregnancy-related complications but also for the management of other physical and psychological illnesses. Traditional medicines are always considered the first line of treatment by a considerable number of people. This study, therefore, sought to explore the lived experiences of pregnant women by assessing their perceptions of the transitional use of traditional medicine. Methods: Ethnography was used to capture data from an emic perspective. The ethnographic approach involved visiting a few selected pregnant women to observe and participate in the identification of traditional medicines. The ethnographic fieldwork was carried out within a period of three months. In-depth interviews were carried out and audio recorded and later transcribed verbatim. Data was thereafter analyzed thematically. The thematic analysis involved identifying statements made by research participants by transcribing audio and reading through field notes, coding was done, and themes were generated according to commonly mentioned experiences of using traditional medicine. Results: The findings revealed that women performed a ritual of ‘cutting the cord’ by making a small horizontal incision on the belly across the linea Nigra (also known as a pregnancy line) at around six months of pregnancy to avoid producing a baby with an umbilical cord tied around the baby’s neck. They also used crushed egg shells, crushed snail shells and herbs such as pawpaw roots, Entarahompo (crassocephalum vitelline), Ekyoganyanja (Erlangea tomentose), to manage Omushohokye (a term used by the study participants to refer to a situation where women pass out too much water when giving birth, producing a child with mold and oozing out of a milky liquid through the breasts before giving births); prepare for safe delivery and also to manage pregnancy-related complications. The study recommends the implementation of a traditional medicine use policy using a bottom-up approach. Designing and implementing of culturally sensitive maternal healthcare intervention programs and involving village health teams and the elderly in health education.

Keywords: traditional medicine, pregnant women, uganda, perceptions

Procedia PDF Downloads 98

Authors: Nabeeha Hassan Abdel Jalil, Lulwa Saeed Al Badi, Mouza Ghafan Alkhyeli, Khaja Mohteshamuddin, Ahmad Al Aiyan, Mohamed Elfatih Hamad, Robert Barigye

Abstract:

The present study was done to elucidate the prevalence of enzootic bovine leucosis (EBL) in the UAE, the seroprevalence rates of EBL in dairy herds from the Al Ain area, Abu Dhabi (AD) and indigenous cattle at the Al Ain livestock market (AALM) were assessed. Of the 949 sera tested by ELISA, 657 were from adult Holstein-Friesians from three farms and 292 from indigenous cattle at the AALM. The level of significance between the proportions of seropositive cattle were analyzed by the Marascuilo procedure and questionnaire data on husbandry and biosecurity practices evaluated. Overall, the aggregated farm and AALM data demonstrated a seroprevalence of 25.9%, compared to 37.0% for the study farms, and 1.0% for the indigenous cattle. Additionally, the seroprevalence rates at farms #1, #2 and #3 were 54.7%, 0.0%, and 26.3% respectively. Except for farm #2 and the AALM, statistically significant differences were noted between the proportions of seropositive cattle for farms #1 and #2 (Critical Range or CR=0.0803), farms #1 and #3 (p=0.1069), and farms #2 and #3 (CR=0.0707), farm #1 and the AALM (CR=0.0819), and farm #3 and the AALM (CR=0.0726). Also, the proportions of seropositive animals on farm #1 were 9.8%, 59.8%, 29.3%, and 1.2% in the 12-36, 37-72, 73-108, and 109-144-mo-old age groups respectively compared to 21.5%, 60.8%, 15.2%, and 2.5% in the respective age groups for farm #2. On both farms and the AALM, the 37-72-mo-old age group showed the highest EBL seroprevalence rate while all the 57 cattle on farm #2 were seronegative. Additionally, farms #1 and #3 had 3,130 and 2,828 intensively managed Holstein-Friesian cattle respectively, and all animals were routinely immunized against several diseases except EBL. On both farms #1 and #3, artificial breeding was practiced using semen sourced from the USA, and USA and Canada respectively, all farms routinely quarantined new stock, and farm #1 previously imported dairy cattle from an unspecified country, and farm #3 from the Netherlands, Australia and South Africa. While farm #1 provided no information on animal nutrition, farm #3 cited using hay, concentrates, and ad lib water. To the authors’ best knowledge, this is the first serological evidence of EBL in the UAE and as previously reported, the seroprevalence rates are comparatively higher in the intensively managed dairy herds than in indigenous cattle. As two of the study farms previously sourced cattle and semen from overseas, biosecurity protocols need to be revisited to avoid inadvertent EBL incursion and the possibility of regional transboundary disease spread also needs to be assessed. After the proposed molecular studies have adduced additional data, the relevant UAE animal health authorities may need to develop evidence-based EBL control policies and programs.

Keywords: cattle, enzootic bovine leukosis, seroprevalence, UAE

Procedia PDF Downloads 146

Authors: Mirka Januszkiewicz

Abstract:

The Regional Municipality of Durham is the upper level of a two-tier municipal and regional structure comprised of eight lower-tier municipalities. With a population of 655,000 in both urban and rural settings, the Region is approximately 2,537 square kilometers neighboring the City of Toronto, Ontario Canada to the east. The Region has been focused on diverting waste from disposal since the development of its Long Term Waste Management Strategy Plan for 2000-2020. With a 54 percent solid waste diversion rate, the focus now is on achieving 70 percent diversion on the path to zero waste using local waste management options whenever feasible. The Region has an Integrated Waste Management System that consists of a weekly curbside collection of recyclable printed paper and packaging and source separated organics; a seasonal collection of leaf and yard waste; a bi-weekly collection of residual garbage; and twice annual collection of intact, sealed household batteries. The Region also maintains three Waste Management Facilities for residential drop-off of household hazardous waste, polystyrene, construction and demolition debris and electronics. Special collection events are scheduled in the spring, summer and fall months for reusable items, household hazardous waste, and electronics. The Region is in the final commissioning stages of an energy from the waste facility for residual waste disposal that will recover energy from non-recyclable wastes. This facility is state of the art and is equipped for installation of carbon capture technology in the future. Despite all of these diversion programs and efforts, there is still room for improvement. Recent residential waste studies revealed that over 50% of the residual waste placed at the curb that is destined for incineration could be recycled. To move towards a zero waste community, the Region is looking to more advanced technologies for extracting the maximum recycling value from residential waste. Plans are underway to develop a pre-sort facility to remove organics and recyclables from the residual waste stream, including the growing multi-residential sector. Organics would then be treated anaerobically to generate biogas and fertilizer products for beneficial use within the Region. This project could increase the Region’s diversion rate beyond 70 percent and enhance the Region’s climate change mitigation goals. Zero waste is an ambitious goal in a changing regulatory and economic environment. Decision makers must be willing to consider new and emerging technologies and embrace change to succeed.

Keywords: municipal waste, residential, waste diversion, zero waste

Procedia PDF Downloads 219