Search results for: strategies and guidelines
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6385

Search results for: strategies and guidelines

2245 The Effect of Blood Flow Restriction on the Knee Rehabilitation

Authors: O. Casasayas, M. Vigo, R. Navarro, P. Ragazzi, P. Alvarez, A. Perez-Bellmunt

Abstract:

Introduction: The blood flow restriction training (BFR) is a method of muscle training that allows increasing the stress of muscle tissue to enhance the muscle cross-section and strength. This type of training has clear benefits in the rehabilitation field since it can improve muscle strength using low mechanical loads. The aim of this study is to know in which knee pathologies BFR has been used, what methodology was used and what were the obtained results. Study design: We performed a systematic literature search using strategies for the concepts of “blood flow restriction OR blood flow restriction training AND knee” in Medline. Articles were screened by authors and included if they used the blood flow restriction training in pathology of the knee. Results: The pathology more frequently treated by BFR was knee osteoarthritis and the variables most analyzed were strength and pain. The vascular occlusion used was 80% in the major part of studies. The groups of BFR obtained an increase of strength with less pain but not always the results are statistically significant. The evidence levels are poor in the high number of studies because in some cases there is not a control group or the evaluators were not blinded. Conclusion: The use of BFR is useful to improve muscle strength in knee pathology since it does not increase the pain, but more studies are needed to see (comprehend) if this type of treatment obtains better results than a conventional therapy. No studies have been found that compare the different occlusion effects in both the strength improvement and the pain reduction. Neither studies that analyse the effects of BFR on the muscle contractile parameters have been found.

Keywords: blood flow restriction training, knee, arthroscopy knee, physical therapy

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2244 Development and Validation of a Rapid Turbidimetric Assay to Determine the Potency of Cefepime Hydrochloride in Powder Injectable Solution

Authors: Danilo F. Rodrigues, Hérida Regina N. Salgado

Abstract:

Introduction: The emergence of resistant microorganisms to a large number of clinically approved antimicrobials has been increasing, which restrict the options for the treatment of bacterial infections. As a strategy, drugs with high antimicrobial activities are in evidence. Stands out a class of antimicrobial, the cephalosporins, having as fourth generation cefepime (CEF) a semi-synthetic product which has activity against various Gram-positive bacteria (e.g. oxacillin resistant Staphylococcus aureus) and Gram-negative (e.g. Pseudomonas aeruginosa) aerobic. There are few studies in the literature regarding the development of microbiological methodologies for the analysis of this antimicrobial, so researches in this area are highly relevant to optimize the analysis of this drug in the industry and ensure the quality of the marketed product. The development of microbiological methods for the analysis of antimicrobials has gained strength in recent years and has been highlighted in relation to physicochemical methods, especially because they make possible to determine the bioactivity of the drug against a microorganism. In this context, the aim of this work was the development and validation of a microbiological method for quantitative analysis of CEF in powder lyophilized for injectable solution by turbidimetric assay. Method: For performing the method, Staphylococcus aureus ATCC 6538 IAL 2082 was used as the test microorganism and the culture medium chosen was the Casoy broth. The test was performed using temperature control (35.0 °C ± 2.0 °C) and incubated for 4 hours in shaker. The readings of the results were made at a wavelength of 530 nm through a spectrophotometer. The turbidimetric microbiological method was validated by determining the following parameters: linearity, precision (repeatability and intermediate precision), accuracy and robustness, according to ICH guidelines. Results and discussion: Among the parameters evaluated for method validation, the linearity showed results suitable for both statistical analyses as the correlation coefficients (r) that went 0.9990 for CEF reference standard and 0.9997 for CEF sample. The precision presented the following values 1.86% (intraday), 0.84% (interday) and 0.71% (between analyst). The accuracy of the method has been proven through the recovery test where the mean value obtained was 99.92%. The robustness was verified by the parameters changing volume of culture medium, brand of culture medium, incubation time in shaker and wavelength. The potency of CEF present in the samples of lyophilized powder for injectable solution was 102.46%. Conclusion: The turbidimetric microbiological method proposed for quantification of CEF in lyophilized powder for solution for injectable showed being fast, linear, precise, accurate and robust, being in accordance with all the requirements, which can be used in routine analysis of quality control in the pharmaceutical industry as an option for microbiological analysis.

Keywords: cefepime hydrochloride, quality control, turbidimetric assay, validation

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2243 Effect of Perioperative Multimodal Analgesia on Postoperative Opioid Consumption and Complications in Elderly Traumatic Hip Fracture Patients: A Systematic Review of Randomised Controlled Trials

Authors: Raheel Shakoor Siddiqui, Shahbaz Malik, Manikandar Srinivas Cheruvu, Sanjay Narayana Murthy, Livio DiMascio

Abstract:

Background: elderly traumatic hip fracture patients frequently present to trauma services globally. Rising low energy falls amongst an osteoporotic aging population is the commonest cause for injury. Hip fractures in this population are a major cause for severe pain, morbidity and mortality. The term hip fracture is interchangeable with neck of femur fracture, fractured neck of femur or proximal femur fracture. Hip fracture pain management protocols and guidelines suggest conventional analgesia, nerve block and opioid based treatment as rescue analgesia. There is a current global opioid crisis with overuse, abuse and dependence. Adverse opioid related complications in vulnerable elderly patients further adds to morbidity and mortality. Systematic reviews in literature have evidenced superiority of multimodal analgesia in osteoarthritic primary joint replacements compared to opioids however, this has not yet been conducted for elderly traumatic hip fracture patients. Aims: The primary aim of this systematic review is to provide standardised evidence following Cochrane and PRISMA guidance in determining advantages of perioperative multimodal analgesia over conventional opioid based treatments in elderly traumatic hip fractures. Methods: 5 databases were searched from January 2000-2023 which identified 8 randomised controlled trials and 446 total participants. These trials met defined PICOS eligibility criteria of patient mean age ≥ 65 years presenting with a unilateral traumatic fractured neck of femur for operative intervention. Analgesic intervention with perioperative multimodal analgesia has been compared to conventional opioid based analgesia. Outcomes of interest include, primarily, the change in postoperative opioid consumption within a 0-30 postoperative period and secondarily, the change in postoperative adverse events and complications. A qualitative synthesis has been performed due to clinical heterogenicity and variance amongst trials. Results: GRADE evidence of moderate quality supports perioperative multimodal analgesia leads to a reduction in postoperative opioid consumption however, low quality evidence supports a reduction of adverse effects and complications. Conclusion: Perioperative multimodal analgesia whether used preoperative, intraoperative and/or postoperative leads to a reduction in postoperative opioid consumption for elderly traumatic hip fracture patients. This review recommends the use of perioperative multimodal analgesia as part of hip fracture pain protocols however, caution and clinical judgement should be used as the risk of adverse effects may not be lower.

Keywords: trauma, orthopaedics, hip, fracture, neck of femur fracture, analgesia, multimodal analgesia, opioid

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2242 Revolutionizing Higher Education: AI-Powered Gamification for Enhanced Learning

Authors: Gina L. Solano

Abstract:

This project endeavors to enhance learning experiences for undergraduate pre-service teachers and graduate K-12 educators by leveraging artificial intelligence (AI). Firstly, the initiative delves into integrating AI within undergraduate education courses, fostering traditional literacy skills essential for academic success and extending their applicability beyond the classroom. Education students will explore AI tools to design literacy-focused activities aligned with their curriculum. Secondly, the project investigates the utilization of AI to craft instructional materials employing gamification strategies (e.g., digital and classic games, badges, quests) to amplify student engagement and motivation in mastering course content. Lastly, it aims to create a professional repertoire that can be applied by pre-service and current teachers in P-12 classrooms, promoting seamless integration for those already in teaching positions. The project's impact extends to benefiting college students, including pre-service and graduate teachers, as they enhance literacy and digital skills through AI. It also benefits current P-12 educators who can integrate AI into their classrooms, fostering innovative teaching practices. Moreover, the project contributes to faculty development, allowing them to cultivate low-risk and engaging classroom environments, ultimately enriching the learning journey. The insights gained from this project can be shared within and beyond the discipline to advance the broader field of study.

Keywords: artificial intelligence, gamification, learning experiences, literacy skills, engagement

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2241 Modeling of Full Range Flow Boiling Phenomenon in 23m Long Vertical Steam Generator Tube

Authors: Chaitanya R. Mali, V. Vinod, Ashwin W. Patwardhan

Abstract:

Design of long vertical steam generator (SG) tubes in nuclear power plant involves an understanding of different aspects of flow boiling phenomenon such as flow instabilities, flow regimes, dry out, critical heat flux, pressure drop, etc. The knowledge of the prediction of local thermal hydraulic characteristics is necessary to understand these aspects. For this purpose, the methodology has been developed which covers all the flow boiling regimes to model full range flow boiling phenomenon. In this methodology, the vertical tube is divided into four sections based on vapor fraction value at the end of each section. Different modeling strategies have been applied to the different sections of the vertical tube. Computational fluid dynamics simulations have been performed on a vertical SG tube of 0.0126 m inner diameter and 23 m length. The thermal hydraulic parameters such as vapor fraction, liquid temperature, heat transfer coefficient, pressure drop, heat flux distribution have been analyzed for different designed heat duties (1.1 MW (20%) to 3.3 MW (60%)) and flow conditions (10 % to 80 %). The sensitivity of different boiling parameters such as bubble departure diameter, nucleation site density, bubble departure frequency on the thermal hydraulic parameters was also studied. Flow instability has been observed at 20 % designed heat duty and 20 % flow conditions.

Keywords: thermal hydraulics, boiling, vapor fraction, sensitivity

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2240 A Conundrum of Teachability and Learnability of Deaf Adult English as Second Language Learners in Pakistani Mainstream Classrooms: Integration or Elimination

Authors: Amnah Moghees, Saima Abbas Dar, Muniba Saeed

Abstract:

Teaching a second language to deaf learners has always been a challenge in Pakistan. Different approaches and strategies have been followed, but they have been resulted into partial or complete failure. The study aims to investigate the language problems faced by adult deaf learners of English as second language in mainstream classrooms. Moreover, the study also determines the factors which are very much involved in language teaching and learning in mainstream classes. To investigate the language problems, data will be collected through writing samples of ten deaf adult learners and ten normal ESL learners of the same class; whereas, observation in inclusive language teaching classrooms and interviews from five ESL teachers in inclusive classes will be conducted to know the factors which are directly or indirectly involved in inclusive language education. Keeping in view this study, qualitative research paradigm will be applied to analyse the corpus. The study figures out that deaf ESL learners face severe language issues such as; odd sentence structures, subject and verb agreement violation, misappropriation of verb forms and tenses as compared to normal ESL learners. The study also predicts that in mainstream classrooms there are multiple factors which are affecting the smoothness of teaching and learning procedure; role of mediator, level of deaf learners, empathy of normal learners towards deaf learners and language teacher’s training.

Keywords: deaf English language learner, empathy, mainstream classrooms, previous language knowledge of learners, role of mediator, language teachers' training

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2239 The Impact of the Corona Virus Outbreak Crisis on Startups

Authors: Mohammad Mehdizadeh, Sara Miri

Abstract:

Due to the recent events surrounding the global health crisis and the spread of the coronavirus (COVID-19), the activities of many businesses and start-up companies have been disrupted. It solves many economic problems and can reduce unemployment in countries because governments can take advantage of their potential without direct investment. However, with the help of their innovative ideas and new technologies, these companies can develop and grow the economy. But it is essential to consider that there will be no guarantee of their success in the event of unforeseen events, as the coronavirus outbreak in the last two years has seriously damaged these companies and, like other businesses, challenges and stagnation have started. The startup companies' challenge in the face of coronavirus begins with its impact on customers. Changing customer behavior can affect their products and distribution channels. On the other hand, to prevent countless losses in this crisis, startup companies require creative solutions to address challenges in various areas of human capital, supply chain management, sales and marketing, and so on. Therefore, all business leaders must consider and plan for the current crisis and the future; after overcoming these conditions and returning to regular business routines, it will no longer be an option, and new situations will prevail in a competitive environment. The essential strategies for developing and growing startups during the Coronavirus outbreak can be connecting with the global startup ecosystem, hosting webinars, providing podcasts and free question and answer sessions, mentoring services to growing teams, and consulting pointed out this to firms for digitalization.

Keywords: business, COVID-19, digitalization, startups

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2238 Blockchain Based Hydrogen Market (BBH₂): A Paradigm-Shifting Innovative Solution for Climate-Friendly and Sustainable Structural Change

Authors: Volker Wannack

Abstract:

Regional, national, and international strategies focusing on hydrogen (H₂) and blockchain are driving significant advancements in hydrogen and blockchain technology worldwide. These strategies lay the foundation for the groundbreaking "Blockchain Based Hydrogen Market (BBH₂)" project. The primary goal of this project is to develop a functional Blockchain Minimum Viable Product (B-MVP) for the hydrogen market. The B-MVP will leverage blockchain as an enabling technology with a common database and platform, facilitating secure and automated transactions through smart contracts. This innovation will revolutionize logistics, trading, and transactions within the hydrogen market. The B-MVP has transformative potential across various sectors. It benefits renewable energy producers, surplus energy-based hydrogen producers, hydrogen transport and distribution grid operators, and hydrogen consumers. By implementing standardized, automated, and tamper-proof processes, the B-MVP enhances cost efficiency and enables transparent and traceable transactions. Its key objective is to establish the verifiable integrity of climate-friendly "green" hydrogen by tracing its supply chain from renewable energy producers to end users. This emphasis on transparency and accountability promotes economic, ecological, and social sustainability while fostering a secure and transparent market environment. A notable feature of the B-MVP is its cross-border operability, eliminating the need for country-specific data storage and expanding its global applicability. This flexibility not only broadens its reach but also creates opportunities for long-term job creation through the establishment of a dedicated blockchain operating company. By attracting skilled workers and supporting their training, the B-MVP strengthens the workforce in the growing hydrogen sector. Moreover, it drives the emergence of innovative business models that attract additional company establishments and startups and contributes to long-term job creation. For instance, data evaluation can be utilized to develop customized tariffs and provide demand-oriented network capacities to producers and network operators, benefitting redistributors and end customers with tamper-proof pricing options. The B-MVP not only brings technological and economic advancements but also enhances the visibility of national and international standard-setting efforts. Regions implementing the B-MVP become pioneers in climate-friendly, sustainable, and forward-thinking practices, generating interest beyond their geographic boundaries. Additionally, the B-MVP serves as a catalyst for research and development, facilitating knowledge transfer between universities and companies. This collaborative environment fosters scientific progress, aligns with strategic innovation management, and cultivates an innovation culture within the hydrogen market. Through the integration of blockchain and hydrogen technologies, the B-MVP promotes holistic innovation and contributes to a sustainable future in the hydrogen industry. The implementation process involves evaluating and mapping suitable blockchain technology and architecture, developing and implementing the blockchain, smart contracts, and depositing certificates of origin. It also includes creating interfaces to existing systems such as nomination, portfolio management, trading, and billing systems, testing the scalability of the B-MVP to other markets and user groups, developing data formats for process-relevant data exchange, and conducting field studies to validate the B-MVP. BBH₂ is part of the "Technology Offensive Hydrogen" funding call within the research funding of the Federal Ministry of Economics and Climate Protection in the 7th Energy Research Programme of the Federal Government.

Keywords: hydrogen, blockchain, sustainability, innovation, structural change

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2237 Evaluation of Energy Efficiency Development Perspectives in Lithuanian Furniture Industry

Authors: J. Vasauskaite

Abstract:

From the perspective of Lithuanian furniture enterprises, the role of energy efficiency is significant as it leads to direct economic benefits, increased competitiveness and higher productivity. There are various possible improvements in energy efficiency in industry: changes in the production process, investment in R&D, implementation of energy-saving technologies or energy management systems. The research aims to contribute the understanding of energy efficiency importance in industry by presenting possible improvements of energy use in different manufacturing process of enterprises. The evaluation methodology included quantitative and qualitative research methods: the comparative and statistical analysis of primary and secondary sources of information. This paper provides the detailed analysis of the energy efficiency development opportunities and challenges in Lithuanian furniture industry. The results of the study show the importance of technological innovations, energy efficiency policies and environmental management strategies in developing energy efficiency within the wood and furniture industry. The analysis of energy efficiency development in Lithuanian furniture industry showed that the industrial activities are influenced by various internal and external factors such as increasing flows of products, human resources and overall management decisions; dynamic growth and increasing competition; emerging need for environmental information. In the light of these factors, Lithuanian furniture industry has undergone significant changes – restructuring, technological advances and business model innovations, allowing it to be more export-oriented and focus on upgrading quality, design and innovation.

Keywords: energy efficiency, energy policy, furniture industry, technological innovation

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2236 Using Building Information Modeling in Green Building Design and Performance Optimization

Authors: Moataz M. Hamed, Khalid S. M. Al Hagla, Zeyad El Sayad

Abstract:

Thinking in design energy-efficiency and high-performance green buildings require a different design mechanism and design approach than conventional buildings to achieve more sustainable result. By reasoning about specific issues at the correct time in the design process, the design team can minimize negative impacts, maximize building performance and keep both first and operation costs low. This paper attempts to investigate and exploit the sustainable dimension of building information modeling (BIM) in designing high-performance green buildings that require less energy for operation, emit less carbon dioxide and provide a conducive indoor environment for occupants through early phases of the design process. This objective was attained by a critical and extensive literature review that covers the following issues: the value of considering green strategies in the early design stage, green design workflow, and BIM-based performance analysis. Then the research proceeds with a case study that provides an in-depth comparative analysis of building performance evaluation between an office building in Alexandria, Egypt that was designed by the conventional design process with the same building if taking into account sustainability consideration and BIM-based sustainable analysis integration early through the design process. Results prove that using sustainable capabilities of building information modeling (BIM) in early stages of the design process side by side with green design workflow promote buildings performance and sustainability outcome.

Keywords: BIM, building performance analysis, BIM-based sustainable analysis, green building design

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2235 Assessing the Implementation of Community Driven Development through Social Capital in Migrant and Indigenous Informal Settlements in Accra, Ghana

Authors: Beatrice Eyram Afi Ziorklui, Norihisa Shima

Abstract:

Community Driven Development (CDD) is now a widely recommended and accepted development strategy for informal communities across the continent. Centered on the utilization of social capital through community structures, different informal settlements have different structures and different levels of social capital, which affect the implementation and ability to overcome CDD challenges. Although known to be very successful, there are few perspectives on the implementation of CDD initiatives in different informal settlements. This study assesses the implementation of CDD initiatives in migrant and indigenous informal settlements and their ability to navigate challenges. The case study research design was adopted in this research, and respondents were chosen through simple random sampling. Using the Statistical Package for social scientists (SPSS) for data analysis, the study found that migrant informal settlements implement CDD projects through the network of hierarchical structures based on government systems, whereas indigenous informal settlements implement through the hierarchical social structure based on traditions and culture. The study also found that, with the exception of the challenge of land accessibility in migrant informal settlements, all other challenges, such as participation, resource mobilization, and maintenance, have a significant relationship with social capital, although indigenous informal settlements have higher levels of social capital than migrant informal settlements. The study recommends a framework that incorporates community characteristics and the underlying social capital to facilitate upgrading strategies in informal in Ghana.

Keywords: community driven development, informal settlements, social capital, upgrading

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2234 The Effectiveness of Spatial Planning And Land Use Management Act, 2013 in Fetakgomo Tubatse Local Municipality: Case Study of Apel Nodal Point

Authors: Hlabishi Peter Ntloana

Abstract:

This paper aims to present the effectiveness of the Spatial Planning and Land Use Management Act, 2013, in addressing key spatial challenges in Fetakgomo Tubatse Local Municipality, mainly focusing on Apel nodal point. Spatial Planning and Land Use Management Act, 2013, popularly known as SPLUMA, aimed at addressing emerging and existing spatial planning and land use management challenges in South Africa. There are critical key spatial challenges that are continuously encountered in Apel Nodal Point, which include dispersed rural settlement mainly in a communal settlement. The spatial patterns and rural settlements development patterns are a challenge, and such results in uncoordinated human settlements. The objective of this research paper is to analyze the spatial planning of Apel nodal points and determine the effectiveness of the SPLUMA policy. Key Informant interviews were conducted with 20 participants, and also the municipal Spatial Development Framework was considered to explore more challenges and proposed recommendations. The results divulged that there is a huge gap in addressing spatial planning, mainly in rural areas, and correlation with the findings of the Municipal Spatial Development framework. In conclusion, spatial planning remains a critical dilemma in most rural settlements, and there must be programmes and strategies to balance the effectiveness of spatial planning in urban and rural settlements.

Keywords: land use management, rural settlement, spatial development framework, spatial planning

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2233 Lessons Learned in Developing a Clinical Information System and Electronic Health Record (EHR) System That Meet the End User Needs and State of Qatar's Emerging Regulations

Authors: Darshani Premaratne, Afshin Kandampath Puthiyadath

Abstract:

The Government of Qatar is taking active steps in improving quality of health care industry in the state of Qatar. In this initiative development and market introduction of Clinical Information System and Electronic Health Record (EHR) system are proved to be a highly challenging process. Along with an organization specialized on EHR system development and with the blessing of Health Ministry of Qatar the process of introduction of EHR system in Qatar healthcare industry was undertaken. Initially a market survey was carried out to understand the requirements. Secondly, the available government regulations, needs and possible upcoming regulations were carefully studied before deployment of resources for software development. Sufficient flexibility was allowed to cater for both the changes in the market and the regulations. As the first initiative a system that enables integration of referral network where referral clinic and laboratory system for all single doctor (and small scale) clinics was developed. Setting of isolated single doctor clinics all over the state to bring in to an integrated referral network along with a referral hospital need a coherent steering force and a solid top down framework. This paper discusses about the lessons learned in developing, in obtaining approval of the health ministry and in introduction to the industry of the single doctor referral network along with an EHR system. It was concluded that development of this nature required continues balance between the market requirements and upcoming regulations. Further accelerating the development based on the emerging needs, implementation based on the end user needs while tallying with the regulations, diffusion, and uptake of demand-driven and evidence-based products, tools, strategies, and proper utilization of findings were equally found paramount in successful development of end product. Development of full scale Clinical Information System and EHR system are underway based on the lessons learned. The Government of Qatar is taking active steps in improving quality of health care industry in the state of Qatar. In this initiative development and market introduction of Clinical Information System and Electronic Health Record (EHR) system are proved to be a highly challenging process. Along with an organization specialized on EHR system development and with the blessing of Health Ministry of Qatar the process of introduction of EHR system in Qatar healthcare industry was undertaken. Initially a market survey was carried out to understand the requirements. Secondly the available government regulations, needs and possible upcoming regulations were carefully studied before deployment of resources for software development. Sufficient flexibility was allowed to cater for both the changes in the market and the regulations. As the first initiative a system that enables integration of referral network where referral clinic and laboratory system for all single doctor (and small scale) clinics was developed. Setting of isolated single doctor clinics all over the state to bring in to an integrated referral network along with a referral hospital need a coherent steering force and a solid top down framework. This paper discusses about the lessons learned in developing, in obtaining approval of the health ministry and in introduction to the industry of the single doctor referral network along with an EHR system. It was concluded that development of this nature required continues balance between the market requirements and upcoming regulations. Further accelerating the development based on the emerging needs, implementation based on the end user needs while tallying with the regulations, diffusion, and uptake of demand-driven and evidence-based products, tools, strategies, and proper utilization of findings were equally found paramount in successful development of end product. Development of full scale Clinical Information System and EHR system are underway based on the lessons learned.

Keywords: clinical information system, electronic health record, state regulations, integrated referral network of clinics

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2232 Distribution and Ecological Risk Assessment of Trace Elements in Sediments along the Ganges River Estuary, India

Authors: Priyanka Mondal, Santosh K. Sarkar

Abstract:

The present study investigated the spatiotemporal distribution and ecological risk assessment of trace elements of surface sediments (top 0 - 5 cm; grain size ≤ 0.63 µm) in relevance to sediment quality characteristics along the Ganges River Estuary, India. Sediment samples were collected during ebb tide from intertidal regions covering seven sampling sites of diverse environmental stresses. The elements were analyzed with the help of ICPAES. This positive, mixohaline, macro-tidal estuary has global significance contributing ecological and economic services. Presence of fine-clayey particle (47.03%) enhances the adsorption as well as transportation of trace elements. There is a remarkable inter-metallic variation (mg kg-1 dry weight) in the distribution pattern in the following manner: Al (31801± 15943) > Fe (23337± 7584) > Mn (461±147) > S(381±235) > Zn(54 ±18) > V(43 ±14) > Cr(39 ±15) > As (34±15) > Cu(27 ±11) > Ni (24 ±9) > Se (17 ±8) > Co(11 ±3) > Mo(10 ± 2) > Hg(0.02 ±0.01). An overall trend of enrichment of majority of trace elements was very much pronounced at the site Lot 8, ~ 35km upstream of the estuarine mouth. In contrast, the minimum concentration was recorded at site Gangasagar, mouth of the estuary, with high energy profile. The prevalent variations in trace element distribution are being liable for a set of cumulative factors such as hydrodynamic conditions, sediment dispersion pattern and textural variations as well as non-homogenous input of contaminants from point and non-point sources. In order to gain insight into the trace elements distribution, accumulation, and their pollution status, geoaccumulation index (Igeo) and enrichment factor (EF) were used. The Igeo indicated that surface sediments were moderately polluted with As (0.60) and Mo (1.30) and strongly contaminated with Se (4.0). The EF indicated severe pollution of Se (53.82) and significant pollution of As (4.05) and Mo (6.0) and indicated the influx of As, Mo and Se in sediments from anthropogenic sources (such as industrial and municipal sewage, atmospheric deposition, agricultural run-off, etc.). The significant role of the megacity Calcutta in relevance to the untreated sewage discharge, atmospheric inputs and other anthropogenic activities is worthwhile to mention. The ecological risk for different trace elements was evaluated using sediment quality guidelines, effects range low (ERL), and effect range median (ERM). The concentration of As, Cu and Ni at 100%, 43% and 86% of the sampling sites has exceeded the ERL value while none of the element concentration exceeded ERM. The potential ecological risk index values revealed that As at 14.3% of the sampling sites would pose relatively moderate risk to benthic organisms. The effective role of finer clay particles for trace element distribution was revealed by multivariate analysis. The authors strongly recommend regular monitoring emphasizing on accurate appraisal of the potential risk of trace elements for effective and sustainable management of this estuarine environment.

Keywords: pollution assessment, sediment contamination, sediment quality, trace elements

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2231 Development of Mineral Carbonation Process from Ultramafic Tailings, Enhancing the Reactivity of Feedstocks

Authors: Sara Gardideh, Mansoor Barati

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The mineral carbonation approach for reducing global warming has garnered interest on a worldwide scale. Due to the benefits of permanent storage and abundant mineral resources, mineral carbonation (MC) is one of the most effective strategies for sequestering CO₂. The combination of mineral processing for primary metal recovery and mineral carbonation for carbon sequestration is an emerging field of study with the potential to minimize capital costs. A detailed study of low-pressures–solid carbonation of ultramafic tailings in a dry environment has been accomplished. In order to track the changing structure of serpentine minerals and their reactivity as a function of temperature (300-900 ᵒC), CO₂ partial pressure (25-90 mol %), and thermal preconditioning, thermogravimetry has been utilized. The incongruent CO₂ van der Waals molecular diameters with the octahedral-tetrahedral lattice constants of serpentine were used to explain the mild carbonation reactivity. Serpentine requires additional thermal-treatment to remove hydroxyl groups, resulting in the chemical transformation to pseudo-forsterite, which is a mineral composed of isolated SiO₄ tetrahedra linked by octahedrally coordinated magnesium ions. The heating treatment above 850 ᵒC is adequate to remove chemically bound water from the lattice. Particles with a diameter < 34 (μm) are desirable, and thermally treated serpentine at 850 ᵒC for 2.30 hours reached 65% CO₂ storage capacity. The decrease in particle size, increase in temperature, and magnetic separation can dramatically enhance carbonation.

Keywords: particle size, thermogravimetry, thermal-treatment, serpentine

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2230 Genetic Diversity of Mycobacterium bovis and Its Zoonotic Potential in Ethiopia: A Systematic Review

Authors: Begna Tulu, Gobena Ameni

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Understanding the types of Mycobacterium bovis (M. bovis) strains circulating in a country and exploring its zoonotic potential has significant contribution in the effort to design control strategies. The main aim of this study was to review and compile the results of studies conducted on M. bovis genotyping and its zoonotic potential of M. bovis in Ethiopia. A systematic search and review of articles published on M. bovis strains in Ethiopia were made. PubMed and Google Scholar databases were considered for the search while the keywords used were 'Mycobacteria,' 'Mycobacterium bovis,' 'Bovine Tuberculosis' and 'Ethiopia.' Fourteen studies were considered in this review and a total of 31 distinct strains of M. bovis (N=211) were obtained; the most dominant strains were SB0133 (N=62, 29.4%), SB1176 (N=61, 28.9%), and followed by SB0134 and SB1476 each (N=18, 8.5%). The clustering rate of M. bovis strains was found to be 42.0%. On the other hand, 6 strains of M. bovis were reported from human namely; SB0665 (N=4), SB0303 (N=2), SB0982 (N=2), SB0133 (N=1), SB1176 (N=1), and 1 new strain. Similarly, a total of 8 strains (N=13) of M. tuberculosis bacteria were also identified from animal subjects; namely SIT149 (N=3), SIT1 (N=2), SIT1688 (n=2), SIT262 (N=2), SIT53 (N=1), SIT59 (N=1), and one new-Ethiopian strain. The result showed that the genetic diversity of M. bovis strains reported from Ethiopia are less diversified and highly clustered. And also the result underlines that there is an ongoing active transmission of M. bovis and M. tuberculosis between human and animals in Ethiopia because a significant number strains of both type of bacteria were reported from human and animals.

Keywords: mycobacterium bovis, Mycobacterium tuberculosis, zoonotic potential, genetic diversity, Ethiopia

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2229 Digital Marketing Maturity Models: Overview and Comparison

Authors: Elina Bakhtieva

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The variety of available digital tools, strategies and activities might confuse and disorient even an experienced marketer. This applies in particular to B2B companies, which are usually less flexible in uptaking of digital technology than B2C companies. B2B companies are lacking a framework that corresponds to the specifics of the B2B business, and which helps to evaluate a company’s capabilities and to choose an appropriate path. A B2B digital marketing maturity model helps to fill this gap. However, modern marketing offers no widely approved digital marketing maturity model, and thus, some marketing institutions provide their own tools. The purpose of this paper is building an optimized B2B digital marketing maturity model based on a SWOT (strengths, weaknesses, opportunities, and threats) analysis of existing models. The current study provides an analytical review of the existing digital marketing maturity models with open access. The results of the research are twofold. First, the provided SWOT analysis outlines the main advantages and disadvantages of existing models. Secondly, the strengths of existing digital marketing maturity models, helps to identify the main characteristics and the structure of an optimized B2B digital marketing maturity model. The research findings indicate that only one out of three analyzed models could be used as a separate tool. This study is among the first examining the use of maturity models in digital marketing. It helps businesses to choose between the existing digital marketing models, the most effective one. Moreover, it creates a base for future research on digital marketing maturity models. This study contributes to the emerging B2B digital marketing literature by providing a SWOT analysis of the existing digital marketing maturity models and suggesting a structure and main characteristics of an optimized B2B digital marketing maturity model.

Keywords: B2B digital marketing strategy, digital marketing, digital marketing maturity model, SWOT analysis

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2228 The Impact of Stigma on the Course of Mental Illness: A Brief Review

Authors: Mariana Mangas, Yaroslava Martins, Ana Matos Pires

Abstract:

Introduction: Stigmatization is a common problem to overcome for people suffering from chronic diseases. It usually follows mental disorders and complicates the course of illness and reduces quality of life for people with mental illness. Objective: unsystematic review concerning stigma and mental illness, its impact on psychiatric disease and strategies to eradicate stigma. Methods: A search was conducted on PubMed, using keywords 'stigma' and 'mental illness'. Results and Discussion: Stigma is a psychosocial process that identifies individuals by the negative label of their differences. Stigma often brings a loss of occupational success and social support, reduced functioning and lower quality of life. The sense of stigma is common in individuals with mental illness and has considerable negative repercussions: delays treatment achievement, promotes social isolation, stress and maladaptive coping behaviors and it is associated with higher symptom levels, placing these individuals at higher risk for a poorer outcome and prognoses. Conclusion: Given the interrelation between stigma, symptoms, treatment seeking and disease management, stigma is a key construct in mental illness upon which anti-stigma initiatives may have considerable therapeutic potential. It will take multidisciplinary interventions to overcome mental illness stigma, including changes in social policy, attitudes and practices among mental health professionals, liaison between general public and people with a mental illness under conditions of equity and parity, family support, and easy access to evidence-based treatments.

Keywords: discrimination, stigma, mental illness, quality of life

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2227 A Study on the Strategy of Pocket Park in the Renewal of Old City in China

Authors: Xian Chen

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In recent years, the tendency that the decline of material and social vitality of old city in China becomes more and more serious. Nowadays, transformation and renewal of the old city have become a hot topic in urban research. The traditional mode of large-scale promotion has been criticized. Thus, exploration of new ways to update the city turns to be a necessity on the way of sustainable urban development. Pocket Park is a small city open space, its location choose is based on abandoned or idle lands on urban structure, is scattered or hidden in corner of the urban. It has a great significance on improving the old city environment. Based on the theory of ‘pocket park’, this paper summarizes the successful experience of domestic and foreign practice, and discusses the update strategies which are suitable for China's national conditions according to the characteristics and predicament of the old city in China. The main methods and results are as follows: 1)Based on the conception of ‘pocket park’, though describing the research status in domestic and foreign, summarizing the experience which is worth learning and existing problems. 2) From the analysis of ‘pocket park’ function, general design principles and types of the deep-seated difficulties in renewal the old city and the possibility of the application of ‘pocket park’,the varied implementation of ‘pocket park’ form are established, and application value in the old city renewal are summed up. 3) It can’t be denied that pocket park plays an irreplaceable role in solving the recession and renewing the vitality of the old city. Anymore, It is recommended to develop corresponding supportive development policies.

Keywords: sustainable development, strategy, old city renewal, pocket park

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2226 Educational Reforms in Algeria: Dilemmas of Globalization, Equity, and Decolonization

Authors: Fella Lahmar

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This chapter investigates the educational reforms in Algeria, highlighting the challenges and complexities that arise in the context of globalization, equity, and decolonization. While Algeria’s education system historically had a socialist-economic model grounded in Islamic values, contemporary reforms reflect global influences and aspirations for cultural authenticity. The study employed a qualitative approach, utilizing semi-structured interviews with a diverse sample of 15 participants intimately involved in the Algerian education system. Analysis of the data reveals a discrepancy between the educational system’s pedagogical practices and students’ diverse learning needs, implying ramifications for educational equity and social justice. Furthermore, a critical tension was evident between global influences, local cultural authenticity, and the endeavor to decolonize education. In conclusion, the chapter advocates for reforms that prioritize the students’ holistic development and well-being while fostering intrinsic motivation and engagement. This entails re-evaluating curriculum frameworks, assessment strategies, and pedagogies in light of Algeria’s cultural and religious heritage. The chapter also calls for future research to explore methods for innovatively integrating cultural heritage into education in ways to cultivate learners who are both locally grounded and globally aware.

Keywords: impact of globalization on education, parental involvement in education, marketization of education, policy enactment and reform, curriculum overload, holistic approach, shadow education

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2225 Comprehensive Multi-Omics Study Highlights Osteopontin/SPP1 in Ovarian Aging Control

Authors: Chia-Jung Li, Li-Te Lin, Kuan-Hao Tsui

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The study identifies SPP1 as a potential gene associated with ovarian aging, revealing a significant decline in its expression in aged ovaries. SPP1, also known as osteopontin (OPN), is a multifunctional glycoprotein involved with regulatory proteins and pro-inflammatory immune chemokines. However, its genetic links to ovarian aging have not been extensively explored. Spatial transcriptomic analyses were conducted on ovaries from young and aged female mice, along with a sample from a 73-year-old individual. Additionally, single-cell RNA sequencing analysis was performed to identify associations between SPP1 and key genes. The study focused on crucial genes, including ITGAV, ITGB1, CD44, MMP3, and FN1, with a particular emphasis on the correlation between SPP1 and ITGB1. The findings indicate a significant decline in SPP1 expression in aged ovaries, which was consistent in the 73-year-old sample. Single-cell RNA sequencing unveiled associations between SPP1 and key genes, emphasizing a strong co-expression correlation between SPP1 and ITGB1. While the study provides valuable insights, further research is necessary to understand the broader implications and potential applications of SPP1 in ovarian aging. Translating these findings to clinical settings requires careful consideration. The identification of SPP1 as a gene implicated in ovarian aging opens new avenues for advancing precision medicine and refining treatment strategies for conditions related to ovarian aging.

Keywords: SPP1, ovarian aging, spatial transcriptomic, single-cell RNA sequencing

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2224 Impact of Economic Crisis on Secondary Education in Anambra State

Authors: Stella Nkechi Ezeaku, Ifunanya Nkechi Ohamobi

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This study investigated the impact of economic crisis on education in Anambra state. The population of the study comprised of all principals and teachers in Anambra state numbering 5,887 (253 principles and 5,634 teachers). To guide the study, three research questions and one hypothesis were formulated correlational design was adopted. Stratified random sampling technique was used to select 200 principals and 300 teachers as respondents for the study. A researcher-developed instrument tagged Impact of Economic Crisis on Education questionnaire (IECEQ) was used to collect data needed for the study. The instrument was validated by experts in measurement and evaluation. The reliability of the instrument was established using randomly selected members of the population who did not take part in the study. The data obtained was analyzed using Cronbach alpha technique and reliability co-efficient of .801 and .803 was obtained. The data were analyzed using simple and Multiple Regression Analysis. The formulated hypothesis was tested at .05 level of significance. Findings revealed that: there is a significant relationship between economic crisis and realization of goals of secondary education. The result also shows that economic crisis affect students' academic performance, teachers' morale and productivity and principals' administrative capability. This study therefore concludes that certain strategies must be devised to minimize the impact of economic crisis on secondary education. It is recommended that all stakeholders to education should be more resourceful and self-sufficient in order to cushion the effects of economic crisis currently gripping most world economies Nigeria inclusive.

Keywords: impact, economic, crisis, education

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2223 Influence of Branding and Consultancy Services on the Performance of Coaches, Athletes and Sports Managers in Nigeria

Authors: Yakubu Nkom Bityong, A. I. Kabido, K. Venkateswarlu

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The influence of branding and consultancy services on sports development and marketing mix has been a matter of interest among coaches athletes and sports managers in Nigeria. Marketers use sports as a promotional vehicle towards attracting customers to their products and services. The use of images, names, and photographs of sports personalities to advertise beverages, cars, and a whole range of other products and services as it is clearly noticed all over the television, radio and print media has generated a lot of argument among consumers who have vested interest and are more drawn to their favorite teams and sports personalities than they are to many company products This paper examines the influence of branding and consultancy services on sports Performance of coaches, athletes and sports managers in Nigeria. From a population of 7,441 made up of coaches, athletes and sports managers, 372 respondents were sampled for the study. A self developed and standardized questionnaire was the instrument used for data collection. One-tailed t-test was used to test the hypothesis. Results revealed that branding and consultancy services influence the performances of coaches, athletes and sports managers in Nigeria. It was concluded that the establishment of the National Institute of Sports (NIS) in Lagos with affiliated sports training programmes in Nigerian Universities is responsible for boosting the performance of sports personalities in Nigeria. It was recommended that National Policy on Sports should be reviewed in order to inculcate new methods and strategies towards enhancing sports development initiatives in the country while stakeholders should intensify regular training and retraining programmes for coaches, athletes and sports managers to update their knowledge and skills.

Keywords: branding, consultancy, sports performance, sports development

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2222 Adaptive Strategies of Maize in Leaf Traits to N Deficiency

Authors: Panpan Fan, Bo Ming, Niels Anten, Jochem Evers, Yaoyao Li, Shaokun Li, Ruizhi xie

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Nitrogen (N) utilization for crop production under N deficiency conditions is subject to a trade-off between maintaining specific leaf N content (SLN), important for radiation-use efficiency (RUE), versus maintaining leaf area (LA) development, important for light capture. This paper aims to explore how maize deals with this trade-off through responses in SLN, LA and their underlying traits during the vegetative and reproductive growth stages. In a ten-year N fertilization trial in Jilin province, Northeast China, three N fertilizer levels have been maintained: N-deficiency (N0), low N supply (N1), and high N supply (N2). We analyzed data from years 8 and 10 of this experiment for two common hybrids. Under N deficiency, maize plants maintained LA and decreased SLN during vegetative stages, while both LA and SLN decreased comparably during reproductive stages. Canopy-average specific leaf area (SLA) decreased sharply during vegetative stages and slightly during reproductive stages, mainly because senesced leaves in the lower canopy had a higher SLA. In the vegetative stage, maize maintained leaf area at low N by maintaining leaf biomass (albeit hence having N content/mass) and slightly increasing SLA. These responses to N deficiency were stronger in maize hybrid XY335 than in ZD958. We conclude the main strategy of maize to cope with low N is to maintain plant growth, mainly by increasing SLA throughout the plant during early growth. N was too limiting for either strategy to be followed during later growth stages.

Keywords: leaf N content per unit leaf area, N deficiency, specific leaf area, maize strateg

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2221 NprRX Regulation on Surface Spreading Motility in Bacillus cereus

Authors: Yan-Shiang Chiou, Yi-Huang Hsueh

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Bacillus cereus is a foodborne pathogen that causes two types of foodborne illness, the emetic and diarrheal syndromes. B. cereus consistently ranks among the top three among bacterial foodborne outbreaks in the ten years of 2001 to 2010 in Taiwan. Foodborne outbreak caused by B. cereus has been increased, and recently it ranks second foodborne pathogen after Vibrio parahaemolyticus. This pathogen is difficult to control due to its ubiquitousness in the environment, the psychrotrophic nature of many strains, and the heat resistance of their spores. Because complete elimination of biofilms is difficult, a better understanding of the molecular mechanisms of biofilm formation by B. cereus will help to develop better strategies to control this pathogen. Surface translocation can be an important factor in biofilm formation. In B. cereus, NprR is a quorum sensor, and its apo NprR is a dimer and changes to a tetramer in the presence of NprX. The small peptide NprX may induce conformational change allowing the apo dimer to switch to an active tetramer specifically recognizing target DNA sequences. Our result showed that mutation of nprRX causes surface spreading deficiency. Mutation of flagella, pili and surfactant genes (flgAB, bcpAB, krsABC), did not abolish spreading motility. Under nprRX mutant, mutation of spo0A restored the spreading deficiency. This suggests that spreading motility is not related surfactant, pili and flagella but other unknown mechanism and Spo0A, a sporulation initiation protein, inhibits spreading motility.

Keywords: Bacillus cereus, nprRX, spo0A, spreading motility

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2220 Governance of Energy Transitions in Developing States

Authors: Robert Lindner

Abstract:

In recent years a multitude of international efforts, including the United Nations’ aspirational 2030 Agenda for Sustainable Development, provided a new momentum to facilitate energy access and rural electrification projects to combat energy poverty in developing states in Asia. Rural electrification projects promise to facilitate other sustainable development aims, such as the empowerment of local communities through the creation of economic opportunities or increased disaster resilience. This study applies a multi-governance research framework to study the cases of the ongoing energy system transition in Myanmar and Cambodia. It explores what impact the international aid community, especially multilateral development banks and international development agencies, has on the governance of the transitions and how diverging aid donor interest shape policy making and project planning. The study is based on policy analysis and expert interviews, as well as extensive field research. It critically examines the current development trajectories and the strategies of the stakeholders involved. It concludes that institutional and technological competition between donors, as well as a lack of transparency and inclusion in the project planning and implementation phases, contributes to insufficient coordination in national energy policy making and project implementation at the local level. The study further discusses possible alternative approaches that might help to promote the spread of sustainable energy technologies.

Keywords: energy governance, developing countries, multi-level governance, energy transitions

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2219 The Role of the Corporate Social Responsibility in Poverty Reduction

Authors: M. Verde, G. Falzarano

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The paper examines the connection between corporate social responsibility (CSR), capability approach and poverty reduction; in particular, the local employment development (LED) by way of CSR initiatives. The joint action of LED/CSR results in a win-win situation, not only for the enterprises but also for all the stakeholders involved; in this regard, subsidiarity and coordination between national and regional/local authorities are central to a socially-oriented market economy. In the first section, the CSR is analysed on the basis of its social function in the fight against poverty, as a 'capabilities deprivation'. In the central part, the attention is focused on the relationship between CSR and LED; ergo, on the role of the enterprises in fostering capabilities development (the employment). Besides, all the potential solutions are presented, stressing the possible combinations, in the last part. The benchmark is the enterprise as an economic and a social institution: the business should not be combined with profit merely, paying more attention to its sustainable impact and social contribution. In which way could it be possible? The answer is the CSR. The impact of CSR on poverty reduction is still little explored. The companies help to reduce poverty through economic contribution, human rights and social inclusion; hence, the business becomes an 'agent of development' in order to fight against 'inequality'. The starting point is the pyramid of social responsibility, where ethic and philanthropic responsibilities involve programmes and actions aimed at personal development of the individuals, improving human standard of living in all forms, including poverty, when people do not have a choice between different 'life options', ranging from level of education to employment. At this point, CSR comes into play and works on two dimensions: poverty reduction and poverty prevention, by means of a series of initiatives: first of all, job creation and precarious work reduction. Empowerment of the local actors, financial support and combination of top down and bottom up initiatives are some of CSR areas of activity. Several positive effects occur on individual levels of educations, access to capital, individual health status, empowerment of youth and woman, access to social networks and it was observed that these effects depend on the type of CSR strategy. Indeed, CSR programmes should take into account fundamental criteria, such as the transparency, the information about benefits, a coordination unit among institutions and more clear guidelines. In this way, the advantages to the corporate reputation and to the community translate into a better job matching on the labour market, inter alia. It is important to underline that the success depends on the specific measures of the areas in question, by adapting them to the local needs, in light of general principles and index; therefore, the concrete commitment of the all stakeholders involved is decisive in order to achieve the goals. The enterprise would represent a concrete contribution for the pursuit of sustainable development and for the dissemination of a social and well being awareness.

Keywords: capability approach, local employment development, poverty, social inclusion

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2218 Efficacy of Carvacrol as an Antimicrobial Wash Treatment for Reducing Both Campylobacter jejuni and Aerobic Bacterial Counts on Chicken Skin

Authors: Sandip Shrestha, Ann M. Donoghue, Komala Arsi, Basanta R. Wagle, Abhinav Upadhyay, Dan J. Donoghue

Abstract:

Campylobacter, one of the major cause of foodborne illness worldwide, is commonly present in the intestinal tract of poultry. Many strategies are currently being investigated to reduce Campylobacter counts on commercial poultry during processing with limited success. This study investigated the efficacy of the generally recognized as safe compound, carvacrol (CR), a component of wild oregano oil as a wash treatment for reducing C. jejuni and aerobic bacteria on chicken skin. A total of two trials were conducted, and in each trial, a total of 75 skin samples (4cm × 4cm each) were randomly allocated into 5 treatment groups (0%, 0.25%, 0.5%, 1% and 2% CR). Skin samples were inoculated with a cocktail of four wild strains of C. jejuni (~ 8 log10 CFU/skin). After 30 min of attachment, inoculated skin samples were dipped in the respective treatment solution for 1 min, allowed to drip dry for 2 min and processed at 0, 8, 24 h post treatment for enumeration of C. jejuni and aerobic bacterial counts (n=5/treatment/time point). The data were analyzed by ANOVA using PROC GLM procedure of SAS 9.3. All the tested doses of CR suspension consistently reduced C. jejuni counts across all time points. The 2% CR wash was the most effective treatment and reduced C. jejuni counts by ~4 log₁₀ CFU/sample (P < 0.05). Aerobic counts were reduced for the 0.5% CR dose at 0 and 24h in Trial 1 and at 0, 8 and 24h in Trial 2. The 1 and 2% CR doses consistently reduced aerobic counts in both trials up to 2 log₁₀ CFU/skin.

Keywords: Campylobacter jejuni, carvcrol, chicken skin, postharvest

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2217 Patients' Interpretation of Prescribed Medication Instructions: A Pilot Study among Diabetes Mellitus Patients at Makanye Clinic in Limpopo Province, South Africa

Authors: Charity Ngoatle, Tebogo M. Mothiba, Mahlapahlapana J. Themane

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Misapprehension of medications instructions due to poor health literacy is common in diabetic patients, predominantly leading to suboptimal medication therapy caused by taking less than expected, or getting inadequate medication concentration. Globally, 50% of adults have been reported to have misunderstood medication instructions which could be the cause of not using medication as prescribed. Reading material has been found not to improve people’s knowledge to the extent where they would be informed and knowledgeable about their health. This, therefore, depicts that instructive materials alone cannot improve health literacy but further patient education is still needed to explain what the information really mean. The aim of this study was to investigate patients’ interpretation of prescribed medication instructions at Makanye Clinic in Limpopo Province, South Africa. The study used a mixed method approach. A non-probability purposive and simple random sampling strategies will be used to select ten (10) participants for the pilot study. Semi-structured interviews with a guide and self- administered structured questionnaires will be used to collect data. Tesch’s eight steps for qualitative data analysis and SPSS version 24 with descriptive statistics will be adopted. The preliminary findings from other studies show that: (a) poor health literacy negatively affect medication adherence, (b) general literacy influence health literacy, and (c) there are poor health outcomes and medication adverse effects due to poor medication comprehension.

Keywords: instructions, diabetes mellitus, patients, prescribed medication

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2216 Determinants of Walking among Middle-Aged and Older Overweight and Obese Adults: Demographic, Health, and Socio-Environmental Factors

Authors: Samuel N. Forjuoh, Marcia G. Ory, Jaewoong Won, Samuel D. Towne, Suojin Wang, Chanam Lee

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The public health burden of obesity is well established as is the influence of physical activity (PA) on the health and wellness of individuals who are obese. This study examined the influence of selected demographic, health, and socioenvironmental factors on the walking behaviors of middle-aged and older overweight and obese adults. Online and paper surveys were administered to community-dwelling overweight and obese adults aged ≥ 50 years residing in four cities in central Texas and seen by a family physician in the primary care clinic from October 2013 to June 2014. Descriptive statistics were used to characterize participants’ anthropometric and demographic data as well as their health conditions and walking, socioenvironmental, and more broadly defined PA behaviors. Then Pearson chi-square tests were used to assess differences between participants who reported walking the recommended ≥ 150 minutes for any purpose in a typical week as a proxy to meeting the U.S. Centers for Disease Control and Prevention’s PA guidelines and those who did not. Finally, logistic regression was used to predict walking the recommended ≥ 150 minutes for any purpose, controlling for covariates. The analysis was conducted in 2016. Of the total sample (n=253, survey response rate of 6.8%), the majority were non-Hispanic white (81.7%), married (74.5%), male (53.5%), and reported an annual household income of ≥ $50,000 (65.7%). Approximately, half were employed (49.6%), or had at least a college degree (51.8%). Slightly more than 1 in 5 (n=57, 22.5%) reported walking the recommended ≥150 minutes for any purpose in a typical week. The strongest predictors of walking the recommended ≥ 150 minutes for any purpose in a typical week in adjusted analysis were related to education and a high favorable perception of the neighborhood environment. Compared to those with a high school diploma or some college, participants with at least a college degree were five times as likely to walk the recommended ≥ 150 minutes for any purpose (OR=5.55, 95% CI=1.79-17.25). Walking the recommended ≥ 150 minutes for any purpose was significantly associated with participants who disagreed that there were many distracted drivers (e.g., on the cell phone while driving) in their neighborhood (OR=4.08, 95% CI=1.47-11.36) and those who agreed that there are sidewalks or protected walkways (e.g., walking trails) in their neighborhood (OR=3.55, 95% CI=1.10-11.49). Those employed were less likely to walk the recommended ≥ 150 minutes for any purpose compared to those unemployed (OR=0.31, 95% CI=0.11-0.85) as were those who reported some difficulty walking for a quarter of a mile (OR=0.19, 95% CI=0.05-0.77). Other socio-environmental factors such as having care-giver responsibilities for elders, someone to walk with, or a dog in the household as well as Walk Score™ were not significantly associated with walking the recommended ≥ 150 minutes for any purpose in a typical week. Neighborhood perception appears to be an important factor associated with the walking behaviors of middle-aged and older overweight and obese individuals. Enhancing the neighborhood environment (e.g., providing walking trails) may promote walking among these individuals.

Keywords: determinants of walking, obesity, older adults, physical activity

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