Search results for: european banks risk
3904 Planning and Design Criteria to Make Urban Transport More Sustainable: The Case of Baku
Authors: Gülnar Bayramoğlu Barman
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Since the industrial revolution, technological developments and increased population have caused environmental damages. To protect the nature and architectural environment, firstly, green architecture, ecological architecture and then sustainability occurred. This term has been proposed not to be a new term but a response to environmental disturbances caused by human activities and it is re-conceptualization of architecture. Sustainable architecture or sustainability is lot more extensive than ecological and green architecture. It contains the imbalance between environmental problems that is natural environment and consumption that occurred all around the world. An important part of sustainability debate focused on urban planning and design for more sustainable forms and patterns. In particular, it is discussed that planning and design of urban areas have a major effect on transport and therefore can help reduce car usage, emissions, global warming and climate change. There are many planning and design approaches and movement that introduce certain criteria and strategies to prevent car dependency and encourage people to use public transportation and walking. However, when review the literature, it is seen that planning movements, such as New Urbanism and Transit Oriented Development originated and were implemented mostly in West European and North American Cities. The purpose of this study is to find out whether all those criteria, principles and strategies are also relevant planning approaches for more non-western cities like Baku, which has a very different planning background and therefore possibly different urban form and transport issues. In order to answer the above mentioned question, planning and design approaches in the literature and these recent planning movements were studied and a check list was formed which indicate planning and design approaches that can help attain a more sustainable transport outcome. The checklist was then applied to the case of Baku.Keywords: sustainability, sustainable development, sustainable transportation, transport, urban design
Procedia PDF Downloads 4383903 Monitoring Key Biomarkers Related to the Risk of Low Breastmilk Production in Women, Leading to a Positive Impact in Infant’s Health
Authors: R. Sanchez-Salcedo, N. H. Voelcker
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Currently, low breast milk production in women is one of the leading health complications in infants. Recently, It has been demonstrated that exclusive breastfeeding, especially up to a minimum of 6 months, significantly reduces respiratory and gastrointestinal infections, which are the main causes of death in infants. However, the current data shows that a high percentage of women stop breastfeeding their children because they perceive an inadequate supply of milk, and only 45% of children are breastfeeding under 6 months. It is, therefore, clear the necessity to design and develop a biosensor that is sensitive and selective enough to identify and validate a panel of milk biomarkers that allow the early diagnosis of this condition. In this context, electrochemical biosensors could be a powerful tool for assessing all the requirements in terms of reliability, selectivity, sensitivity, cost efficiency and potential for multiplex detection. Moreover, they are suitable for the development of POC devices and wearable sensors. In this work, we report the development of two types of sensing platforms towards several biomarkers, including miRNAs and hormones present in breast milk and dysregulated in this pathological condition. The first type of sensing platform consists of an enzymatic sensor for the detection of lactose, one of the main components in milk. In this design, we used gold surface as an electrochemical transducer due to the several advantages, such as the variety of strategies available for its rapid and efficient functionalization with bioreceptors or capture molecules. For the second type of sensing platform, nanoporous silicon film (pSi) was chosen as the electrode material for the design of DNA sensors and aptasensors targeting miRNAs and hormones, respectively. pSi matrix offers a large superficial area with an abundance of active sites for the immobilization of bioreceptors and tunable characteristics, which increase the selectivity and specificity, making it an ideal alternative material. The analytical performance of the designed biosensors was not only characterized in buffer but also validated in minimally treated breastmilk samples. We have demonstrated the potential of an electrochemical transducer on pSi and gold surface for monitoring clinically relevant biomarkers associated with the heightened risk of low milk production in women. This approach, in which the nanofabrication techniques and the functionalization methods were optimized to increase the efficacy of the biosensor highly provided a foundation for further research and development of targeted diagnosis strategies.Keywords: biosensors, electrochemistry, early diagnosis, clinical markers, miRNAs
Procedia PDF Downloads 193902 Association between Maternal Personality and Postnatal Mother-to-Infant Bonding
Authors: Tessa Sellis, Marike A. Wierda, Elke Tichelman, Mirjam T. Van Lohuizen, Marjolein Berger, François Schellevis, Claudi Bockting, Lilian Peters, Huib Burger
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Introduction: Most women develop a healthy bond with their children, however, adequate mother-to-infant bonding cannot be taken for granted. Mother-to-infant bonding refers to the feelings and emotions experienced by the mother towards her child. It is an ongoing process that starts during pregnancy and develops during the first year postpartum and likely throughout early childhood. The prevalence of inadequate bonding ranges from 7 to 11% in the first weeks postpartum. An impaired mother-to-infant bond can cause long-term complications for both mother and child. Very little research has been conducted on the direct relationship between the personality of the mother and mother-to-infant bonding. This study explores the associations between maternal personality and postnatal mother-to-infant bonding. The main hypothesis is that there is a relationship between neuroticism and mother-to-infant bonding. Methods: Data for this study were used from the Pregnancy Anxiety and Depression Study (2010-2014), which examined symptoms of and risk factors for anxiety or depression during pregnancy and the first year postpartum of 6220 pregnant women who received primary, secondary or tertiary care in the Netherlands. The study was expanded in 2015 to investigate postnatal mother-to-infant bonding. For the current research 3836 participants were included. During the first trimester of gestation, baseline characteristics, as well as personality, were measured through online questionnaires. Personality was measured by the NEO Five Factor Inventory (NEO-FFI), which covers the big five of personality (neuroticism, extraversion, openness, altruism and conscientiousness). Mother-to-infant bonding was measured postpartum by the Postpartum Bonding Questionnaire (PBQ). Univariate linear regression analysis was performed to estimate the associations. Results: 5% of the PBQ-respondents reported impaired bonding. A statistically significant association was found between neuroticism and mother-to-infant bonding (p < .001): mothers scoring higher on neuroticism, reported a lower score on mother-to-infant bonding. In addition, a positive correlation was found between the personality traits extraversion (b: -.081), openness (b: -.014), altruism (b: -.067), conscientiousness (b: -.060) and mother-to-infant bonding. Discussion: This study is one of the first to demonstrate a direct association between the personality of the mother and mother-to-infant bonding. A statistically significant relationship has been found between neuroticism and mother-to-infant bonding, however, the percentage of variance predictable by a personality dimension is very small. This study has examined one part of the multi-factorial topic of mother-to-infant bonding and offers more insight into the rarely investigated and complex matter of mother-to-infant bonding. For midwives, it is important recognize the risks for impaired bonding and subsequently improve policy for women at risk.Keywords: mother-to-infant bonding, personality, postpartum, pregnancy
Procedia PDF Downloads 3643901 Well-being at Work in the Sports Sector: Systematic Review and Perspectives
Authors: Ouazoul Abdelouahd, Jemjami Nadia
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The concept of well-being at work is one of today's significant challenges in maintaining quality of life and managing psycho-social risks at work. Indeed, work in the sports sector has evolved, and this exponential evolution, marked by increasing demands and psychological, physical, and social challenges, which sometimes exceed the resources of sports actors, influences their sense of well-being at work. Well-being and burnout as antagonists provide information on the quality of working life in sports. The Basic aim of this literature review is to analyze the scientific corpus dealing with the subject of well-being at work in the sports sector while exploring the link between sports burnout and well-being. The results reveal the richness of the conceptual approaches and the difficulties of implementing them. Prospects for future research have, therefore, been put forward.Keywords: Well-being, quality of life, Burnout, ; psycho-social risk, Sports sector
Procedia PDF Downloads 863900 Cost-Benefit Analysis for the Optimization of Noise Abatement Treatments at the Workplace
Authors: Paolo Lenzuni
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Cost-effectiveness of noise abatement treatments at the workplace has not yet received adequate consideration. Furthermore, most of the published work is focused on productivity, despite the poor correlation of this quantity with noise levels. There is currently no tool to estimate the social benefit associated to a specific noise abatement treatment, and no comparison among different options is accordingly possible. In this paper, we present an algorithm which has been developed to predict the cost-effectiveness of any planned noise control treatment in a workplace. This algorithm is based the estimates of hearing threshold shifts included in ISO 1999, and on compensations that workers are entitled to once their work-related hearing impairments have been certified. The benefits of a noise abatement treatment are estimated by means of the lower compensation costs which are paid to the impaired workers. Although such benefits have no real meaning in strictly monetary terms, they allow a reliable comparison between different treatments, since actual social costs can be assumed to be proportional to compensation costs. The existing European legislation on occupational exposure to noise it mandates that the noise exposure level be reduced below the upper action limit (85 dBA). There is accordingly little or no motivation for employers to sustain the extra costs required to lower the noise exposure below the lower action limit (80 dBA). In order to make this goal more appealing for employers, the algorithm proposed in this work also includes an ad-hoc element that promotes actions which bring the noise exposure down below 80 dBA. The algorithm has a twofold potential: 1) it can be used as a quality index to promote cost-effective practices; 2) it can be added to the existing criteria used by workers’ compensation authorities to evaluate the cost-effectiveness of technical actions, and support dedicated employers.Keywords: cost-effectiveness, noise, occupational exposure, treatment
Procedia PDF Downloads 3223899 Predictors of Glycaemic Variability and Its Association with Mortality in Critically Ill Patients with or without Diabetes
Authors: Haoming Ma, Guo Yu, Peiru Zhou
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Background: Previous studies show that dysglycemia, mostly hyperglycemia, hypoglycemia and glycemic variability(GV), are associated with excess mortality in critically ill patients, especially those without diabetes. Glycemic variability is an increasingly important measure of glucose control in the intensive care unit (ICU) due to this association. However, there is limited data pertaining to the relationship between different clinical factors and glycemic variability and clinical outcomes categorized by their DM status. This retrospective study of 958 intensive care unit(ICU) patients was conducted to investigate the relationship between GV and outcome in critically ill patients and further to determine the significant factors that contribute to the glycemic variability. Aim: We hypothesize that the factors contributing to mortality and the glycemic variability are different from critically ill patients with or without diabetes. And the primary aim of this study was to determine which dysglycemia (hyperglycemia\hypoglycemia\glycemic variability) is independently associated with an increase in mortality among critically ill patients in different groups (DM/Non-DM). Secondary objectives were to further investigate any factors affecting the glycemic variability in two groups. Method: A total of 958 diabetic and non-diabetic patients with severe diseases in the ICU were selected for this retrospective analysis. The glycemic variability was defined as the coefficient of variation (CV) of blood glucose. The main outcome was death during hospitalization. The secondary outcome was GV. The logistic regression model was used to identify factors associated with mortality. The relationships between GV and other variables were investigated using linear regression analysis. Results: Information on age, APACHE II score, GV, gender, in-ICU treatment and nutrition was available for 958 subjects. Predictors remaining in the final logistic regression model for mortality were significantly different in DM/Non-DM groups. Glycemic variability was associated with an increase in mortality in both DM(odds ratio 1.05; 95%CI:1.03-1.08,p<0.001) or Non-DM group(odds ratio 1.07; 95%CI:1.03-1.11,p=0.002). For critically ill patients without diabetes, factors associated with glycemic variability included APACHE II score(regression coefficient, 95%CI:0.29,0.22-0.36,p<0.001), Mean BG(0.73,0.46-1.01,p<0.001), total parenteral nutrition(2.87,1.57-4.17,p<0.001), serum albumin(-0.18,-0.271 to -0.082,p<0.001), insulin treatment(2.18,0.81-3.55,p=0.002) and duration of ventilation(0.006,0.002-1.010,p=0.003).However, for diabetes patients, APACHE II score(0.203,0.096-0.310,p<0.001), mean BG(0.503,0.138-0.869,p=0.007) and duration of diabetes(0.167,0.033-0.301,p=0.015) remained as independent risk factors of GV. Conclusion: We found that the relation between dysglycemia and mortality is different in the diabetes and non-diabetes groups. And we confirm that GV was associated with excess mortality in DM or Non-DM patients. Furthermore, APACHE II score, Mean BG, total parenteral nutrition, serum albumin, insulin treatment and duration of ventilation were significantly associated with an increase in GV in Non-DM patients. While APACHE II score, mean BG and duration of diabetes (years) remained as independent risk factors of increased GV in DM patients. These findings provide important context for further prospective trials investigating the effect of different clinical factors in critically ill patients with or without diabetes.Keywords: diabetes, glycemic variability, predictors, severe disease
Procedia PDF Downloads 1893898 Health-Related Problems of International Migrant Groups in Eskisehir, Turkey
Authors: Temmuz Gönç Şavran
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Migration is a multidimensional and health-related concept that has important consequences for both migrants and the host society. Due to past conflicts and poor living conditions that lead to migration, the dangerous and difficult journey, and the problems they face upon arrival in the destination country, migrants are at higher risk for poor health. Health is a human right, and all societies and communities, including migrant groups, must receive adequate health care. In addition, the health of migrants must be improved to protect the health of the host society and ensure social integration. The main determinants of health are employment, income, education, good housing, and adequate nutrition. It can be said that migrants are among the most vulnerable groups in society in these respects, and migrant health is negatively affected by this situation. Rigid immigration policies or financial constraints in destination countries, the complexity and bureaucracy of health systems, the low health literacy of migrant groups, and the inadequate provision of translation services in health facilities are among the other main factors affecting migrant health. Migrants are also at risk of stigma, exclusion, detection, and deportation when seeking medical care. Based on data from a qualitative study with a descriptive case study design, this paper aims to highlight and sociologically assess the health-related problems of international migrants in Eskisehir, Turkey. The sample consists of 30 international migrants living in Eskisehir, two-thirds of whom are from Syria, Iraq, Afghanistan, and Pakistan. Those who are citizens of the Republic of Turkey are excluded from the study; otherwise, the legal status of the participants is not considered in the selection of the sample. This makes it possible to distinguish the different needs and problems of subgroups and to consider migrant health as a comprehensive concept. The research is supported by Anadolu University in Eskisehir, and data will be collected through semi-structured interviews between November 2022 and February 2023. With holistic sociology of health approach, this study considers migrant health as a comprehensive sociological concept. It aims to reveal the health-related resources and needs of the international migrant groups living in the center of Eskisehir, the problems they encounter in meeting these needs, and the strategies they use to solve these problems. The results are expected to show that the health of migrants is not only influenced by legislation but is shaped by many processes, from housing conditions to cultural habits. It is expected that the results will also raise awareness of discrimination, exclusion, marginalization, and hate speech in migrants’ access to health services.Keywords: migrant health, sociology of health, sociology of migration, Turkey, refugees
Procedia PDF Downloads 793897 Valorization of Lignocellulosic Wastes– Evaluation of Its Toxicity When Used in Adsorption Systems
Authors: Isabel Brás, Artur Figueirinha, Bruno Esteves, Luísa P. Cruz-Lopes
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The agriculture lignocellulosic by-products are receiving increased attention, namely in the search for filter materials that retain contaminants from water. These by-products, specifically almond and hazelnut shells are abundant in Portugal once almond and hazelnuts production is a local important activity. Hazelnut and almond shells have as main constituents lignin, cellulose and hemicelluloses, water soluble extractives and tannins. Along the adsorption of heavy metals from contaminated waters, water soluble compounds can leach from shells and have a negative impact in the environment. Usually, the chemical characterization of treated water by itself may not show environmental impact caused by the discharges when parameters obey to legal quality standards for water. Only biological systems can detect the toxic effects of the water constituents. Therefore, the evaluation of toxicity by biological tests is very important when deciding the suitability for safe water discharge or for irrigation applications. The main purpose of the present work was to assess the potential impacts of waters after been treated for heavy metal removal by hazelnut and almond shells adsorption systems, with short term acute toxicity tests. To conduct the study, water at pH 6 with 25 mg.L-1 of lead, was treated with 10 g of shell per litre of wastewater, for 24 hours. This procedure was followed for each bark. Afterwards the water was collected for toxicological assays; namely bacterial resistance, seed germination, Lemna minor L. test and plant grow. The effect in isolated bacteria strains was determined by disc diffusion method and the germination index of seed was evaluated using lettuce, with temperature and humidity germination control for 7 days. For aquatic higher organism, Lemnas were used with 4 days contact time with shell solutions, in controlled light and temperature. For terrestrial higher plants, biomass production was evaluated after 14 days of tomato germination had occurred in soil, with controlled humidity, light and temperature. Toxicity tests of water treated with shells revealed in some extent effects in the tested organisms, with the test assays showing a close behaviour as the control, leading to the conclusion that its further utilization may not be considered to create a serious risk to the environment.Keywords: lignocellulosic wastes, adsorption, acute toxicity tests, risk assessment
Procedia PDF Downloads 3673896 Marosok Tradition in the Process of Buying and Selling Cattle in Payakumbuh: A Comparative Study between Adat Law and Positive Law of Indonesia
Authors: Mhd. Zakiul Fikri, M. Agus Maulidi
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Indonesia is a constitutional state. As the constitutional state, Indonesia is not only using a single legal system, but also adopting three legal systems consist of: The European continental legal system or positive law of Indonesia, adat law system, and legal system of religion. This study will discuss Marosok tradition in the process of buying and selling cattle in Payakumbuh: a comparative study between adat law and positive law of Indonesia. The objectives of this research are: First, to find the meaning of the philosophical of Marosok tradition in Payakumbuh. Second, to find the legal implications of the Marosok tradition reviewed aspects of adat law and positive law of Indonesia. Third, to find legal procedure in arbitrating the dispute wich is potentially appear in the post-process of buying and selling cattle based on positive law and adat law adopted in Indonesia. This research is empirical legal research that using two model approaches which are statute approach and conceptual approach. Data was obtained through interviews, observations, and documents or books. Then a method of data analysis used is inductive analysis. Finally, this study found that: First, tradition of Marosok contains the meaning of harmonization of social life that keep people from negative debate, envy, and arrogant. Second, Marosok tradition is one of the adat law in Indonesia; it is one of contract law in the process of buying and selling. If the comparison between the practice Marosok tradition as adat law with the provisions of Article 1320 book of civil code about the terms of the validity of a contract, the elements contained in the provisions of these regulations are met in practice Marosok. Thus, the practice of Marosok in buying and selling cattle process in Payakumbuh justified in view of the positive law of Indonesia. Last of all, all kinds of disputes arising due to contracts made by Marosok tradition can be resolved by positive law and adat law of Indonesia.Keywords: Adat law, contract, Indonesia, Marosok
Procedia PDF Downloads 3233895 Intellectual Property and SMEs in the Baltic Sea Region: A Comparative Study on the Use of the Utility Model Protection
Authors: Christina Wainikka, Besrat Tesfaye
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Several of the countries in the Baltic Sea region are ranked high in international innovations rankings, such as the Global Innovation Index and European Innovation Scoreboard. There are however some concerns in the performance of different countries. For example, there is a widely spread notion about “The Swedish Paradox”. Sweden is ranked high due to investments in R&D and patent activity, but the outcome is not as high as could be expected. SMEs in Sweden are also below EU average when it comes to registering intellectual property rights such as patents and trademarks. This study is concentrating on the protection of utility model. This intellectual property right does not exist in Sweden, but in for example Finland and Germany. The utility model protection is sometimes referred to as a “patent light” since it is easier to obtain than the patent protection but at the same time does cover technical solutions. In examining statistics on patent activities and activities in registering utility models it is clear that utility model protection is scarcely used in the countries that have the protection. In Germany 10 577 applications were made in 2021. In Finland there were 259 applications made in 2021. This can be compared with patent applications that were 58 568 in Germany in 2021 and 1 662 in Finland in 2021. In Sweden there has never been a protection for utility models. The only protection for technical solutions is patents and business secrets. The threshold for obtaining a patent is high, due to the legal requirements and the costs. The patent protection is there for often not chosen by SMEs in Sweden. This study examines whether the protection of utility models in other countries in the Baltic region provide SMEs in these countries with better options to protect their innovations. The legal methodology is comparative law. In order to study the effects of the legal differences statistics are examined and interviews done with SMEs from different industries.Keywords: baltic sea region, comparative law, SME, utility model
Procedia PDF Downloads 1143894 Perceptions and Spatial Realities: Women and the City of Limassol
Authors: Anna Papadopoulou
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Women’s relationship to the post-industrial city has been defined by a reciprocal relationship between women’s identity and urban form. Women’s place within the social structure has been influenced by often limiting conditions set by the built environment, and, concurrently, women’s active role in social processes has definitively impacted urban development. Cities in Cyprus present unique locations for urban investigations pertaining to gender because of the country’s particular urban history: unlike most prominent European cities that have experienced approximately five hundred years of urban growth spurred by industrial development, Cypriot cities did not begin to form until the end of the Ottoman occupation that occurred in the last quarter of the nineteenth century. Consequently, Cyprus’ urban history is distinctive in that it coincides with international awakenings towards gender equality. This paper is drawn from a study of a contemporary urban narrative of Limassolian women and aims to elucidate spatial and perceptual boundaries that are inherent, constructed and implied. Within the context of this study, gender - in its socially constructed form - becomes a tool for reading and understanding the urban landscape, as well as a vehicle to impact the production and consumption of space. The investigation evaluates urban changes through the lens of women’s entry into the workforce which is a profound event in the social process and consequently explores issues of space and time, connectivity, and access, perceptions and awareness. A narrative of gendered urbanism has been derived from semi-structured interviews where the findings are studied, organised, analysed and synthesised through a grounded theory approach. These qualitative findings have been complemented and specialised by a series of informal observations and mappings.Keywords: boundaries, gender, Limassol, urbanism
Procedia PDF Downloads 2353893 Analysis of the Savings Behaviour of Rice Farmers in Tiaong, Quezon, Philippines
Authors: Angelika Kris D. Dalangin, Cesar B. Quicoy
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Rice farming is a major source of livelihood and employment in the Philippines, but it requires a substantial amount of capital. Capital may come from income (farm, non-farm, and off-farm), savings and credit. However, rice farmers suffer from lack of capital due to high costs of inputs and low productivity. Capital insufficiency, coupled with low productivity, hindered them to meet their basic household and production needs. Hence, they resorted to borrowing money, mostly from informal lenders who charge very high interest rates. As another source of capital, savings can help rice farmers meet their basic needs for both the household and the farm. However, information is inadequate whether the farmers save or not, as well as, why they do not depend on savings to augment their lack of capital. Thus, it is worth analyzing how rice farmers saved. The study revealed, using the actual savings which is the difference between the household income and expenditure, that about three-fourths (72%) of the total number of farmers interviewed are savers. However, when they were asked whether they are savers or not, more than half of them considered themselves as non-savers. This gap shows that there are many farmers who think that they do not have savings at all; hence they continue to borrow money and do not depend on savings to augment their lack of capital. The study also identified the forms of savings, saving motives, and savings utilization among rice farmers. Results revealed that, for the past 12 months, most of the farmers saved cash at home for liquidity purposes while others deposited cash in banks and/or saved their money in the form of livestock. Among the most important reasons of farmers for saving are for daily household expenses, for building a house, for emergency purposes, for retirement, and for their next production. Furthermore, the study assessed the factors affecting the rice farmers’ savings behaviour using logistic regression. Results showed that the factors found to be significant were presence of non-farm income, per capita net farm income, and per capita household expense. The presence of non-farm income and per capita net farm income positively affects the farmers’ savings behaviour. On the other hand, per capita household expenses have negative effect. The effect, however, of per capita net farm income and household expenses is very negligible because of the very small chance that the farmer is a saver. Generally, income and expenditure were proved to be significant factors that affect the savings behaviour of the rice farmers. However, most farmers could not save regularly due to low farm income and high household and farm expenditures. Thus, it is highly recommended that government should develop programs or implement policies that will create more jobs for the farmers and their family members. In addition, programs and policies should be implemented to increase farm productivity and income.Keywords: agricultural economics, agricultural finance, binary logistic regression, logit, Philippines, Quezon, rice farmers, savings, savings behaviour
Procedia PDF Downloads 2283892 Well-being at Work in the Sports Sector: Systematic Review and Perspectives
Authors: Ouazoul Abdeloauhd, Jemjami Nadia
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The concept of well-being at work is one of today's significant challenges in maintaining quality of life and managing psycho-social risks at work. Indeed, work in the sports sector has evolved, and this exponential evolution, marked by increasing demands and psychological, physical, and social challenges, which sometimes exceed the resources of sports actors, influences their sense of well-being at work. Well-being and burnout as antagonists provide information on the quality of working life in sports. The Basic aim of this literature review is to analyze the scientific corpus dealing with the subject of well-being at work in the sports sector while exploring the link between sports burnout and well-being. The results reveal the richness of the conceptual approaches and the difficulties of implementing them. Prospects for future research have, therefore, been put forward.Keywords: well-being, burnout, quality of life, psycho-social risk, work on sports sector
Procedia PDF Downloads 923891 Angiotensin Converting Enzyme Gene Polymorphism Studies: A Case-Control Study
Authors: Salina Y. Saddick
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Mild gestational hyperglycemia (MGH) is a very common complication of pregnancy that is characterized by intolerance to glucose. The association of angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism to MGH has been previously reported. In this study, we evaluated the association between ACE polymorphism and the risk of MGH in a Saudi population. We conducted a case-control study in a population of 100 MGH patients and 100 control subjects. ACE gene polymorphism was analyzed by the novel approach of tetraprimer amplification refractory mutation system (ARMS)-polymerase chain reaction (PCR). The frequency of ACE polymorphism was not associated with either alleles or genotypes in MGH patients. Glucose concentration was found to be significantly associated with the MGH group. Our study suggests that ACE genotypes were not associated with ACE polymorphism in a Saudi population.Keywords: MGH, ACE, insertion polymorphism, deletion polymorphism
Procedia PDF Downloads 3193890 On Board Measurement of Real Exhaust Emission of Light-Duty Vehicles in Algeria
Authors: R. Kerbachi, S. Chikhi, M. Boughedaoui
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The study presents an analysis of the Algerian vehicle fleet and resultant emissions. The emission measurement of air pollutants emitted by road transportation (CO, THC, NOX and CO2) was conducted on 17 light duty vehicles in real traffic. This sample is representative of the Algerian light vehicles in terms of fuel quality (gasoline, diesel and liquefied petroleum gas) and the technology quality (injection system and emission control). The experimental measurement methodology of unit emission of vehicles in real traffic situation is based on the use of the mini-Constant Volume Sampler for gas sampling and a set of gas analyzers for CO2, CO, NOx and THC, with an instrumentation to measure kinematics, gas temperature and pressure. The apparatus is also equipped with data logging instrument and data transfer. The results were compared with the database of the European light vehicles (Artemis). It was shown that the technological injection liquefied petroleum gas (LPG) has significant impact on air pollutants emission. Therefore, with the exception of nitrogen oxide compounds, uncatalyzed LPG vehicles are more effective in reducing emissions unit of air pollutants compared to uncatalyzed gasoline vehicles. LPG performance seems to be lower under real driving conditions than expected on chassis dynamometer. On the other hand, the results show that uncatalyzed gasoline vehicles emit high levels of carbon monoxide, and nitrogen oxides. Overall, and in the absence of standards in Algeria, unit emissions are much higher than Euro 3. The enforcement of pollutant emission standard in developing countries is an important step towards introducing cleaner technology and reducing vehicular emissions.Keywords: on-board measurements of unit emissions of CO, HC, NOx and CO2, light vehicles, mini-CVS, LPG-fuel, artemis, Algeria
Procedia PDF Downloads 2753889 The Religious Economic Behavior of People in Dusit Province
Authors: Sivilai Jayankura
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This research aims to study the religious economic behavior that effect the lifestyle of the people in Dusit area. The result shows that religious identity salience makes people increase contributions to public goods. Most of the Buddhism decrease contributions to public goods, expect others to contribute less to public goods, and become less risk averse. We find no evidence of religious identity salience effects on disutility of work effort, discount rates or generosity in life spending. Mostly the people like to make merit in the temple during special day of religion. The atmosphere in the temple leads the people like to travel and merit at the temple near their home.Keywords: Dusit province, identity, lifestyle, religious economic behavior
Procedia PDF Downloads 3283888 Lee-Carter Mortality Forecasting Method with Dynamic Normal Inverse Gaussian Mortality Index
Authors: Funda Kul, İsmail Gür
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Pension scheme providers have to price mortality risk by accurate mortality forecasting method. There are many mortality-forecasting methods constructed and used in literature. The Lee-Carter model is the first model to consider stochastic improvement trends in life expectancy. It is still precisely used. Mortality forecasting is done by mortality index in the Lee-Carter model. It is assumed that mortality index fits ARIMA time series model. In this paper, we propose and use dynamic normal inverse gaussian distribution to modeling mortality indes in the Lee-Carter model. Using population mortality data for Italy, France, and Turkey, the model is forecasting capability is investigated, and a comparative analysis with other models is ensured by some well-known benchmarking criterions.Keywords: mortality, forecasting, lee-carter model, normal inverse gaussian distribution
Procedia PDF Downloads 3603887 An Analytical Metric and Process for Critical Infrastructure Architecture System Availability Determination in Distributed Computing Environments under Infrastructure Attack
Authors: Vincent Andrew Cappellano
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In the early phases of critical infrastructure system design, translating distributed computing requirements to an architecture has risk given the multitude of approaches (e.g., cloud, edge, fog). In many systems, a single requirement for system uptime / availability is used to encompass the system’s intended operations. However, when architected systems may perform to those availability requirements only during normal operations and not during component failure, or during outages caused by adversary attacks on critical infrastructure (e.g., physical, cyber). System designers lack a structured method to evaluate availability requirements against candidate system architectures through deep degradation scenarios (i.e., normal ops all the way down to significant damage of communications or physical nodes). This increases risk of poor selection of a candidate architecture due to the absence of insight into true performance for systems that must operate as a piece of critical infrastructure. This research effort proposes a process to analyze critical infrastructure system availability requirements and a candidate set of systems architectures, producing a metric assessing these architectures over a spectrum of degradations to aid in selecting appropriate resilient architectures. To accomplish this effort, a set of simulation and evaluation efforts are undertaken that will process, in an automated way, a set of sample requirements into a set of potential architectures where system functions and capabilities are distributed across nodes. Nodes and links will have specific characteristics and based on sampled requirements, contribute to the overall system functionality, such that as they are impacted/degraded, the impacted functional availability of a system can be determined. A machine learning reinforcement-based agent will structurally impact the nodes, links, and characteristics (e.g., bandwidth, latency) of a given architecture to provide an assessment of system functional uptime/availability under these scenarios. By varying the intensity of the attack and related aspects, we can create a structured method of evaluating the performance of candidate architectures against each other to create a metric rating its resilience to these attack types/strategies. Through multiple simulation iterations, sufficient data will exist to compare this availability metric, and an architectural recommendation against the baseline requirements, in comparison to existing multi-factor computing architectural selection processes. It is intended that this additional data will create an improvement in the matching of resilient critical infrastructure system requirements to the correct architectures and implementations that will support improved operation during times of system degradation due to failures and infrastructure attacks.Keywords: architecture, resiliency, availability, cyber-attack
Procedia PDF Downloads 1093886 Hedging and Corporate Governance: Lessons from the Financial Crisis
Authors: Rodrigo Zeidan
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The paper identifies failures of decision making and corporate governance that allow non-financial companies around the world to develop hedging strategies that lead to hefty losses in the aftermath of the financial crisis. The sample is comprised of 346 companies from 10 international markets, of which 49 companies (and a subsample of 13 distressed companies) lose a combined US$18.9 billion. An event study shows that most companies that present losses in derivatives experience negative abnormal returns, including a number of companies in which the effect is persistent after a year. The results of a probit model indicate that the lack of a formal hedging policy, no monitoring to the CFOs, and considerations of hubris and remuneration contribute to the mismanagement of hedging policies.Keywords: risk management, hedging, derivatives, monitoring, corporate governance structure, event study, hubris
Procedia PDF Downloads 4423885 Machine Learning Prediction of Diabetes Prevalence in the U.S. Using Demographic, Physical, and Lifestyle Indicators: A Study Based on NHANES 2009-2018
Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei
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To develop a machine learning model to predict diabetes (DM) prevalence in the U.S. population using demographic characteristics, physical indicators, and lifestyle habits, and to analyze how these factors contribute to the likelihood of diabetes. We analyzed data from 23,546 participants aged 20 and older, who were non-pregnant, from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). The dataset included key demographic (age, sex, ethnicity), physical (BMI, leg length, total cholesterol [TCHOL], fasting plasma glucose), and lifestyle indicators (smoking habits). A weighted sample was used to account for NHANES survey design features such as stratification and clustering. A classification machine learning model was trained to predict diabetes status. The target variable was binary (diabetes or non-diabetes) based on fasting plasma glucose measurements. The following models were evaluated: Logistic Regression (baseline), Random Forest Classifier, Gradient Boosting Machine (GBM), Support Vector Machine (SVM). Model performance was assessed using accuracy, F1-score, AUC-ROC, and precision-recall metrics. Feature importance was analyzed using SHAP values to interpret the contributions of variables such as age, BMI, ethnicity, and smoking status. The Gradient Boosting Machine (GBM) model outperformed other classifiers with an AUC-ROC score of 0.85. Feature importance analysis revealed the following key predictors: Age: The most significant predictor, with diabetes prevalence increasing with age, peaking around the 60s for males and 70s for females. BMI: Higher BMI was strongly associated with a higher risk of diabetes. Ethnicity: Black participants had the highest predicted prevalence of diabetes (14.6%), followed by Mexican-Americans (13.5%) and Whites (10.6%). TCHOL: Diabetics had lower total cholesterol levels, particularly among White participants (mean decline of 23.6 mg/dL). Smoking: Smoking showed a slight increase in diabetes risk among Whites (0.2%) but had a limited effect in other ethnic groups. Using machine learning models, we identified key demographic, physical, and lifestyle predictors of diabetes in the U.S. population. The results confirm that diabetes prevalence varies significantly across age, BMI, and ethnic groups, with lifestyle factors such as smoking contributing differently by ethnicity. These findings provide a basis for more targeted public health interventions and resource allocation for diabetes management.Keywords: diabetes, NHANES, random forest, gradient boosting machine, support vector machine
Procedia PDF Downloads 93884 The Role of Gastric Decompression on Postoperative Nausea and Vomiting in Orthognathic Surgery
Authors: Minna Salim, James Brady
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Postoperative nausea and pain (PONV) are adverse effects following surgical procedures. It is especially pronounced in patients undergoing orthognathic surgery, as their mouth is closed postoperatively using wires or rubber bands. Postoperative mouth closure increases the discomfort and risk of complications associated with nausea and vomiting. Many surgeons and institutions apply gastric decompression in hopes of aspirating stomach contents and, therefore, decreasing PONV incidence. This review observed that PONV incidence was not affected by gastric decompression overall. However, the effect of gastric decompression on PONV in orthognathic surgery was variable. This paper aims to summarize the findings of gastric decompression on PONV and to determine the need for it in orthognathic surgery.Keywords: gastric decompression, nasogastric tube, orthognathic surgery, postoperative nausea, vomiting
Procedia PDF Downloads 873883 A Review on Benzo(a)pyrene Emission Factors from Biomass Combustion
Authors: Franziska Klauser, Manuel Schwabl, Alexander Weissinger, Christoph Schmidl, Walter Haslinger, Anne Kasper-Giebl
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Benzo(a)pyrene (BaP) is the most widely investigated representative of Polycyclic Aromatic Hydrocarbons (PAH) as well as one of the most toxic compounds in this group. Since 2013 in the European Union a limit value for BaP concentration in the ambient air is applied, which was set to a yearly average value of 1 ng m-3. Several reports show that in some regions, even where industry and traffic are of minor impact this threshold is regularly exceeded. This is taken as proof that biomass combustion for heating purposes contributes significantly to BaP pollution. Several investigations have been already carried out on the BaP emission behavior of biomass combustion furnaces, mostly focusing on a certain aspect like the influences from wood type, of operation type or of technology type. However, a superior view on emission patterns of BaP from biomass combustion and the aggregation of determined values also from recent studies is not presented so far. The combination of determined values allows a better understanding of the BaP emission behavior from biomass combustion. In this work the review conclusions are driven from the combination of outcomes from different publication. In two examples it was shown that technical progress leads to 10 to 100 fold lower BaP emission from modern furnaces compared to old technologies of equivalent type. It was also indicated that the operation with pellets or wood chips exhibits clearly lower BaP emission factors compared to operation with log wood. Although, the BaP emission level from automatic furnaces is strongly impacted by the kind of operation. This work delivers an overview on BaP emission factors from different biomass combustion appliances, from different operation modes and from the combustion of different fuel and wood types. The main impact factors are depicted, and suggestions for low BaP emission biomass combustion are derived. As one result possible investigation fields concerning BaP emissions from biomass combustion that seem to be most important to be clarified are suggested.Keywords: benzo(a)pyrene, biomass, combustion, emission, pollution
Procedia PDF Downloads 3553882 Serum Neurotrophins in Different Metabolic Types of Obesity
Authors: Irina M. Kolesnikova, Andrey M. Gaponov, Sergey A. Roumiantsev, Tatiana V. Grigoryeva, Alexander V. Laikov, Alexander V. Shestopalov
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Background. Neuropathy is a common complication of obesity. In this regard, the content of neurotrophins in such patients is of particular interest. Neurotrophins are the proteins that regulate neuron survival and neuroplasticity and include brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF). However, the risk of complications depends on the metabolic type of obesity. Metabolically unhealthy obesity (MUHO) is associated with a high risk of complications, while this is not the case with metabolically healthy obesity (MHO). Therefore, the aim of our work was to study the effect of the obesity metabolic type on serum neurotrophins levels. Patients, materials, methods. The study included 134 healthy donors and 104 obese patients. Depending on the metabolic type of obesity, the obese patients were divided into subgroups with MHO (n=40) and MUHO (n=55). In the blood serum, the concentration of BDNF and NGF was determined. In addition, the content of adipokines (leptin, asprosin, resistin, adiponectin), myokines (irisin, myostatin, osteocrin), indicators of carbohydrate, and lipid metabolism were measured. Correlation analysis revealed the relationship between the studied parameters. Results. We found that serum BDNF concentration was not different between obese patients and healthy donors, regardless of obesity metabolic type. At the same time, in obese patients, there was a decrease in serum NGF level versus control. A similar trend was characteristic of both MHO and MUHO. However, MUHO patients had a higher NGF level than MHO patients. The literature indicates that obesity is associated with an increase in the plasma concentration of NGF. It can be assumed that in obesity, there is a violation of NGF storage in platelets, which accelerates neurotrophin degradation. We found that BDNF concentration correlated with irisin levels in MUHO patients. Healthy donors had a weak association between NGF and VEGF levels. No such association was found in obese patients, but there was an association between NGF and leptin concentrations. In MHO, the concentration of NHF correlated with the content of leptin, irisin, osteocrin, insulin, and the HOMA-IR index. But in MUHO patients, we found only the relationship between NGF and adipokines (leptin, asprosin). It can be assumed that in patients with MHO, the replenishment of serum NGF occurs under the influence of muscle and adipose tissue. In the MUHO patients only the effect of adipose tissue on NGF was observed. Conclusion. Obesity, regardless of metabolic type, is associated with a decrease in serum NGF concentration. We showed that muscle and adipose tissues make a significant contribution to the serum NGF pool in the MHO patients. In MUHO there is no effect of muscle on the NGF level, but the effect of adipose tissue remains.Keywords: neurotrophins, nerve growth factor, NGF, brain-derived neurotrophic factor, BDNF, obesity, metabolically healthy obesity, metabolically unhealthy obesity
Procedia PDF Downloads 1003881 Prenatal Genetic Screening and Counselling Competency Challenges of Nurse-Midwife
Authors: Girija Madhavanprabhakaran, Frincy Franacis, Sheeba Elizabeth John
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Introduction: A wide range of prenatal genetic screening is introduced with increasing incidences of congenital anomalies even in low-risk pregnancies and is an emerging standard of care. Being frontline caretakers, the role and responsibilities of nurses and midwives are critical as they are working along with couples to provide evidence-based supportive educative care. The increasing genetic disorders and advances in prenatal genetic screening with limited genetic counselling facilities urge nurses and midwifery nurses with essential competencies to help couples to take informed decision. Objective: This integrative literature review aimed to explore nurse midwives’ knowledge and role in prenatal screening and genetic counselling competency and the challenges faced by them to cater to all pregnant women to empower their autonomy in decision making and ensuring psychological comfort. Method: An electronic search using keywords prenatal screening, genetic counselling, prenatal counselling, nurse midwife, nursing education, genetics, and genomics were done in the PUBMED, SCOPUS and Medline, Google Scholar. Finally, based on inclusion criteria, 8 relevant articles were included. Results: The main review results suggest that nurses and midwives lack essential support, knowledge, or confidence to be able to provide genetic counselling and help the couples ethically to ensure client autonomy and decision making. The majority of nurses and midwives reported inadequate levels of knowledge on genetic screening and their roles in obtaining family history, pedigrees, and providing genetic information for an affected client or high-risk families. The deficiency of well-recognized and influential clinical academic midwives in midwifery practice is also reported. Evidence recommended to update and provide sound educational training to improve nurse-midwife competence and confidence. Conclusion: Overcoming the challenges to achieving informed choices about fetal anomaly screening globally is a major concern. Lack of adequate knowledge and counselling competency, communication insufficiency, need for education and policy are major areas to address. Prenatal nurses' and midwives’ knowledge on prenatal genetic screening and essential counselling competencies can ensure services to the majority of pregnant women around the globe to be better-informed decision-makers and enhances their autonomy, and reduces ethical dilemmas.Keywords: challenges, genetic counselling, prenatal screening, prenatal counselling
Procedia PDF Downloads 2003880 The Interaction and Relations Between Civil and Military Logistics
Authors: Cumhur Cansever, Selcuk Er
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There is an increasing cooperation and interaction between the military logistic systems and civil organizations operating in today's market. While the scope and functions of civilian logistics have different characteristics, military logistics tries to import some applications that are conducted by private sectors successfully. Also, at this point, the determination of the optimal point of integration and interaction between civilian and military logistics has emerged as a key issue. In this study, the mutual effects between military and civilian logistics and their most common integration areas, (Supply Chain Management (SCM), Integrated Logistics Support (ILS) and Outsourcing) will be examined with risk analysis and determination of basic skills evaluation methods for determining the optimum point in the integration.Keywords: core competency, integrated logistics support, outsourcing, supply chain management
Procedia PDF Downloads 5273879 Findings: Impact of a Sustained Health Promoting Workplace on Stock Price Performance and Beta; A Singapore Case
Authors: Wee Tong Liaw, Elaine Wong Yee Sing
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The main objective and focus of this study are to establish the significance of a sustained health promoting workplace on stock and portfolio returns focusing on companies listed on the Singapore stock exchange, using a two-factor model comprising of the single factor CAPM and a 'health promoting workplace' factor. The 'health promoting workplace' factor represents the excess returns derived between two portfolios of component stocks that, when combined, would represent a top tier stock market index in Singapore, namely the STI index. The first portfolio represents companies that are independently assessed by the Singapore’s Health Award, SHA, to have a sustained and comprehensive health promoting workplace (SHA-STI portfolio) and the second portfolio represents companies that had not been independently assessed (Non-SHA STI portfolio). Since 2001, many companies in Singapore have voluntarily participated in the bi-annual Singapore HEALTH Award initiated by the Health Promotion Board of Singapore (HPB). The Singapore HEALTH Award (SHA), is an industry-wide award and assessment process. SHA assesses and recognizes employers in Singapore for implementing a comprehensive and sustainable health promotion programme at their workplaces. When using a ten year holding period instead of a one year holding period, excess returns in the SHA-STI portfolio over Non-SHA STI portfolio were consistently being observed over all test periods, during 2001 to 2013. In addition, when applied to the SHA-STI portfolio, results from the Two Factor Model consistently revealed higher explanatory powers across all test periods for the portfolio as well as all the individual component stocks in SHA-STI portfolio, than the single factor CAPM model. However, with respect to attaining higher level of achievement in the Singapore Health Award, this study did not show any incentive for selecting listed companies that have achieved a higher level of award. Results from this study would give further insights to investors and fund managers alike who intend to consider health promoting workplace as a risk factor in their stock or portfolio selection process, in particular for investors who have a preference for STI’s component stocks and with a longer investment horizon. Key micro factors like management abilities, business development strategies and production capabilities that meet the needs of market would create the demand for a company’s product(s) or service(s) and consequently contribute to its top line and profitability. Thereafter, the existence of a sustainable health promoting workplace would be a key catalytic factor in sustaining a productive workforce needed to support the continued success of a profitable business.Keywords: asset pricing model, company's performance, stock returns, financial risk factor, sustained health promoting workplace
Procedia PDF Downloads 1693878 Mechanisms Underlying the Effects of School-Based Internet Intervention for Alcohol Drinking Behaviours among Chinese Adolescent
Authors: Keith T. S. Tung, Frederick K. Ho, Rosa S. Wong, Camilla K. M. Lo, Wilfred H. S. Wong, C. B. Chow, Patrick Ip
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Objectives: Underage drinking is an important public health problem both locally and globally. Conventional prevention/intervention relies on unidirectional knowledge transfer such as mail leaflets or health talks which showed mixed results in changing the target behaviour. Previously, we conducted a school internet-based intervention which was found to be effective in reducing alcohol use among adolescents, yet the underlying mechanisms have not been properly investigated. This study, therefore, examined the mechanisms that explain how the intervention produced a change in alcohol drinking behaviours among Chinese adolescent as observed in our previous clustered randomised controlled trial (RCT) study. Methods: This is a cluster randomised controlled trial with parallel group design. Participating schools were randomised to the Internet intervention or the conventional health education group (control) with a 1:1 allocation ratio. Secondary 1–3 students of the participating schools were enrolled in this study. The Internet intervention was a web-based quiz game competition, in which participating students would answer 1,000 alcohol-related multiple-choice quiz questions. Conventional health education group received a promotional package on equivalent alcohol-related knowledge. The participants’ alcohol-related attitude, knowledge, and perceived behavioural control were self-reported before the intervention (baseline) and one month and three months after the intervention. Results: Our RCT results showed that participants in the Internet group were less likely to drink (risk ratio [RR] 0.79, p < 0.01) as well as in lesser amount (β -0.06, p < 0.05) compared to those in the control group at both post-intervention follow-ups. Within the intervention group, regression analyses showed that high quiz scorer had greater improvement in alcohol-related knowledge (β 0.28, p < 0.01) and attitude (β -0.26, p < 0.01) at 1 month after intervention, which in turn increased their perceived behavioural control against alcohol use (β 0.10 and -0.26, both p < 0.01). Attitude, compared to knowledge, was found to be a stronger contributor to the intervention effect on perceived behavioural control. Conclusions: Our internet-based intervention has demonstrated effectiveness in reducing the risk of underage drinking when compared with conventional health education. Our study results further showed an attitude to be a more important factor than knowledge in changing health-related behaviour. This has an important implication for future prevention/intervention on an underage drinking problem.Keywords: adolescents, internet-based intervention, randomized controlled trial, underage drinking
Procedia PDF Downloads 1643877 Conservative and Surgical Treatment of Antiresorptive Drug-Related Osteonecrosis of the Jaw with Ultrasonic Piezoelectric Bone Surgery under Polyvinylpyrrolidone Iodine Irrigation: A Case Series of 13 Treated Sites
Authors: Esra Yuce, Isil D. S. Yamaner, Murude Yazan
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Aims and objective: Antiresorptive agents including bisphosphonates and denosumab as strong suppressors of osteoclasts are the most commonly used antiresorptive medications for the treatment of osteoporosis which counteract the negative quantitative alteration of trabecular and cortical bone by inhibition of bone turnover. Oral bisphosphonate therapy for the treatment of osteopenia, osteoporosis or Paget's disease is associated with the low-grade risk of osteonecrosis of the jaw, while higher-grade risk is associated with receiving intravenous bisphosphonates therapy in the treatment of multiple myeloma and bone metastases. On the other hand, there has been a remarkable increase in incidences of antiresorptive related osteonecrosis of the jaw (ARONJ) in oral bisphosphonate users. This clinical presentation will evaluate the healing outcomes via piezoelectric bone surgery under the irrigation of PVP-I solution irrigation in patients received bisphosphonate therapy. Material-Method: The study involved 8 female and 5 male patients that have been treated for ARONJ. Among 13 necrotic sites, 9 were in the mandible and 4 were in the maxilla. All of these 13 patients treated with surgical debridement via piezoelectric bone surgery under irrigation by solution with 3% PVP-I concentration in combination with long-term antibiotic therapy and 5 also underwent removal of mobile segments of bony sequestrum. All removable prosthesis in 8 patients were relined with soft liners during the healing periods in order to eliminate chronic minor traumas. Results: All patients were on oral bisphosphonate therapy for at least 2 years and 5 of which had received intravenous bisphosphonates up to 1 year before therapy with oral bisphosphonates was started. According to the AAOMS staging system, four cases were stage II, eight cases were stage I, and one case was stage III. The majority of lesions were identified at sites of dental prostheses (38%) and dental extractions (62%). All patients diagnosed with ARONJ stage I had used unadjusted removable prostheses. No recurrence of the symptoms was observed during the present follow-up (9–37 months). Conclusion: Despite their confirmed effectiveness, the prevention and treatment of osteonecrosis of the jaw secondary to oral bisphosphonate therapy remain major medical challenges. Treatment with piezoelectric bone surgery with irrigation of povidone-iodine solution was effective for management of bisphosphonate-related osteonecrosis of the jaw. Taking precautions for patients treated with oral bisphosphonates, especially also denture users, may allow for a reduction in the rate of developing osteonecrosis of the maxillofacial region.Keywords: antiresorptive drug related osteonecrosis, bisphosphonate therapy, piezoelectric bone surgery, povidone iodine
Procedia PDF Downloads 2673876 Catastrophic Health Expenditures: Evaluating the Effectiveness of Nepal's National Health Insurance Program Using Propensity Score Matching and Doubly Robust Methodology
Authors: Simrin Kafle, Ulrika Enemark
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Catastrophic health expenditure (CHE) is a critical issue in low- and middle-income countries like Nepal, exacerbating financial hardship among vulnerable households. This study assesses the effectiveness of Nepal’s National Health Insurance Program (NHIP), launched in 2015, to reduce out-of-pocket (OOP) healthcare costs and mitigate CHE. Conducted in Pokhara Metropolitan City, the study used an analytical cross-sectional design, sampling 1276 households through a two-stage random sampling method. Data was collected via face-to-face interviews between May and October 2023. The analysis was conducted using SPSS version 29, incorporating propensity score matching to minimize biases and create comparable groups of enrolled and non-enrolled households in the NHIP. PSM helped reduce confounding effects by matching households with similar baseline characteristics. Additionally, a doubly robust methodology was employed, combining propensity score adjustment with regression modeling to enhance the reliability of the results. This comprehensive approach ensured a more accurate estimation of the impact of NHIP enrollment on CHE. Among the 1276 samples, 534 households (41.8%) were enrolled in NHIP. Of them, 84.3% of households renewed their insurance card, though some cited long waiting times, lack of medications, and complex procedures as barriers to renewal. Approximately 57.3% of households reported known diseases before enrollment, with 49.8% attending routine health check-ups in the past year. The primary motivation for enrollment was encouragement from insurance employees (50.2%). The data indicates that 12.5% of enrolled households experienced CHE versus 7.5% among non-enrolled. Enrollment into NHIP does not contribute to lower CHE (AOR: 1.98, 95% CI: 1.21-3.24). Key factors associated with increased CHE risk were presence of non-communicable diseases (NCDs) (AOR: 3.94, 95% CI: 2.10-7.39), acute illnesses/injuries (AOR: 6.70, 95% CI: 3.97-11.30), larger household size (AOR: 3.09, 95% CI: 1.81-5.28), and households below the poverty line (AOR: 5.82, 95% CI: 3.05-11.09). Other factors such as gender, education level, caste/ethnicity, presence of elderly members, and under-five children also showed varying associations with CHE, though not all were statistically significant. The study concludes that enrollment in the NHIP does not significantly reduce the risk of CHE. The reason for this could be inadequate coverage, where high-cost medicines, treatments, and transportation costs are not fully included in the insurance package, leading to significant out-of-pocket expenses. We also considered the long waiting time, lack of medicines, and complex procedures for the utilization of NHIP benefits, which might result in the underuse of covered services. Finally, gaps in enrollment and retention might leave certain households vulnerable to CHE despite the existence of NHIP. Key factors contributing to increased CHE include NCDs, acute illnesses, larger household sizes, and poverty. To improve the program’s effectiveness, it is recommended that NHIP benefits and coverage be expanded to better protect against high healthcare costs. Additionally, simplifying the renewal process, addressing long waiting times, and enhancing the availability of services could improve member satisfaction and retention. Targeted financial protection measures should be implemented for high-risk groups, and efforts should be made to increase awareness and encourage routine health check-ups to prevent severe health issues that contribute to CHE.Keywords: catastrophic health expenditure, effectiveness, national health insurance program, Nepal
Procedia PDF Downloads 253875 Preservation of Endocrine Function after Central Pancreatectomy without Anastomoses for a Mid Gland Pancreatic Insulinoma: A Case Report
Authors: Karthikeyan M., Paul M. J.
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This abstract describes a case of central pancreatectomy (CP) for a 50-year-old woman with a neuroendocrine tumor in the mid-body of the pancreas. CP, a parenchyma-sparing surgical option, preserves the distal pancreas and spleen, reducing the risk of pancreatic endocrine and exocrine insufficiency compared to traditional resections. The patient, initially misdiagnosed with transient ischemic attack, presented with hypoglycemic symptoms and was found to have a pancreatic lesion. Post-operative results were positive, with a reduction in pancreatic drain volume and normalization of blood sugar levels. This case highlights CP's efficacy in treating centrally located pancreatic lesions while maintaining pancreatic function.Keywords: central pancreatectomy without anastomosis, no endocrine deficiency on follow-op, less post-op hospital stay, less post-op complications
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