Search results for: food and nutritional recommendations

Authors: Shweh Fern Loo, Jun Yin Ong, Than Zaw Oo

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Acute respiratory distress syndrome (ARDS) is a common serious condition of bilateral lung infiltrates that develops secondary to various underlying conditions such as diseases or injuries. ARDS with severe hypercapnia is associated with higher ICU mortality and morbidity. Venovenous Extracorporeal membrane oxygenation (VV-ECMO) support has been established to avert life-threatening hypoxemia and hypercapnic respiratory failure despite optimal conventional mechanical ventilation. However, VV-ECMO is relatively not advisable in particular groups of patients, especially in multi-organ failure, advanced age, hemorrhagic complications and irreversible central nervous system pathology. We presented a case of a 79-year-old Chinese lady without any pre-existing lung disease admitted to our hospital intensive care unit (ICU) after acute presentation of breathlessness and chest pain. After extensive workup, she was diagnosed with rapidly progressing acute interstitial pneumonia with ARDS and hypercapnia respiratory failure. The patient received lung protective strategies of mechanical ventilation and neuromuscular blockage therapy as per clinical guidelines. However, hypercapnia respiratory failure was refractory, and she was deemed not a good candidate for VV-ECMO support given her advanced age and high vasopressor requirements from shock. Alternative therapy with extracorporeal CO2 removal (ECCO2R) was considered and implemented. The patient received 12 days of ECCO2R paired with muscle paralysis, optimization of lung-protective mechanical ventilation and dialysis. Unfortunately, the patient still had refractory hypercapnic respiratory failure with dual vasopressor support despite prolonged therapy. Given failed and futile medical treatment, the family opted for withdrawal of care, a conservative approach, and comfort care, which led to her demise. The effectivity of extracorporeal CO2 removal may depend on disease burden, involvement and severity of the disease. There is insufficient data to make strong recommendations about its benefit-risk ratio for ECCO2R devices, and further studies and data would be required. Nonetheless, ECCO2R can be considered an alternative treatment for refractory hypercapnic respiratory failure patients who are unsuitable for initiating venovenous ECMO.

Keywords: extracorporeal CO2 removal (ECCO2R), acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), hypercapnic respiratory failure

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Authors: Shehzad Khan, Jehangir Khan, Shah Babar, Rashid Mahmood, Rizwan Khan, Sanya Hadi

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Ascaris lumbricoides are familiar with the roundworm that causes biliary infections in humans. Nevertheless, ascariasis is primarily found in the jejunum and transferred in numerous body parts with the intake of Ascaris lumbricoides present in food and water. These study methods were implemented at the Saidu Teaching Hospital Radiology Department from December 2021 to January 2023. This study includes the participants suffering from biliary ascariasis admitted or visited Saidu Teaching Hospital in that time frame. Clinical assessment of the participants was done based on the appearance of signs and symptoms present in them. The participant's laboratory test was done to determine the level of basic body parameters. After that ultrasonography was used to diagnose the presence and appearance of worms. Endoscopic retrograde cholangiopancreatography (ERCP) was used to extract worms from biliary channels, and the incidence of post-ERCP biliary ascariasis was accessed with ultrasonography. This study's results show the presence of numerous types of worms in the biliary channels of patients. Also, the level of body parameters, for instance, neutrophil, hemoglobin, and others, were compared at the time of admission and at the time of discharge from the hospital. Furthermore, the incidence of post-ERCP biliary ascariasis was reported as 4% in females, and 1% in males, respectively.

Keywords: Ascaris, biliary, ERCP, ultrasound

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Authors: Akanit Pisalwadcharin, Komate Satayawut, Virachnee Lohachoompol

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Green tea, mangosteen and pomegranate contain high levels of bioactive compounds which have antioxidant effects and great potential in food applications. The aim of this study was to produce and determine catechin contents, total phenolic contents, antioxidant activity and phenolic compounds of two instant fruit green tea powders which were green tea fortified with mangosteen juice and green tea fortified with pomegranate juice. Seventy percent of hot water extract of green tea was mixed with 30% of mangosteen juice or pomegranate juice, and then spray-dried using a spray dryer. The results showed that the drying conditions optimized for the highest total phenolic contents, catechin contents and antioxidant activity of both powders were the inlet air temperature of 170°C, outlet air temperatures of 90°C and maltodextrin concentration of 30%. The instant green tea with mangosteen powder had total phenolic contents, catechin contents and antioxidant activity of 19.18 (mg gallic acid/kg), 85.44 (mg/kg) and 4,334 (µmoles TE/100 g), respectively. The instant green tea with pomegranate powder had total phenolic contents, catechin contents and antioxidant activity of 32.72 (mg gallic acid/kg), 156.36 (mg/kg) and 6,283 (µmoles TE/100 g), respectively. The phenolic compounds in instant green tea with mangosteen powder comprised of tannic acid (2,156.87 mg/kg), epigallocatechin-3-gallate (898.23 mg/kg) and rutin (13.74 mg/kg). Also, the phenolic compounds in instant green tea with pomegranate powder comprised of tannic acid (2,275.82 mg/kg), epigallocatechin-3-gallate (981.23 mg/kg), rutin (14.97 mg/kg) and i-quercetin (5.86 mg/kg).

Keywords: green tea, mangosteen, pomegranate, antioxidant activity

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Authors: Reuben Mugisha, Stella Bakibinga

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The cervical cancer burden is a global threat, but more so in low income settings where more than 85% of mortality cases occur due to lack of sufficient screening programs. There is consequently a lack of early detection of cancer and precancerous cells among women. Studies show that 3% to 35% of deaths could have been avoided through early screening depending on prognosis, disease progression, environmental and lifestyle factors. In this study, a systematic literature review is undertaken to understand potential barriers and facilitators as documented in previous studies that focus on the application of telehealth in cervical cancer screening programs for early detection of cancer and precancerous cells. The study informs future studies especially those from low income settings about lessons learned from previous studies and how to be best prepared while planning to implement telehealth for cervical cancer screening. It further identifies the knowledge gaps in the research area and makes recommendations. Using a specified selection criterion, 15 different articles are analyzed based on the study’s aim, theory or conceptual framework used, method applied, study findings and conclusion. Results are then tabulated and presented thematically to better inform readers about emerging facts on barriers and facilitators to telehealth implementation as documented in the reviewed articles, and how they consequently lead to evidence informed conclusions that are relevant to telehealth implementation for cervical cancer screening. Preliminary findings of this study underscore that use of low cost mobile colposcope is an appealing option in cervical cancer screening, particularly when coupled with onsite treatment of suspicious lesions. These tools relay cervical images to the online databases for storage and retrieval, they permit integration of connected devices at the point of care to rapidly collect clinical data for further analysis of the prevalence of cervical dysplasia and cervical cancer. Results however reveal the need for population sensitization prior to use of mobile colposcopies among patients, standardization of mobile colposcopy programs across screening partners, sufficient logistics and good connectivity, experienced experts to review image cases at the point-of-care as important facilitators to the implementation of mobile colposcope as a telehealth cervical cancer screening mechanism.

Keywords: cervical cancer screening, digital technology, hand-held colposcopy, knowledge-sharing

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Authors: Jaleh Mohammad Aliha, Rezvan Razazi, Nasim Naderi

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Introduction: Despite the progress in new effective drugs in the treatment of heart failure, the disease still accompanied with frequent hospitalization, impaired quality of life, early mortality and significant economic burden. Patients with chronic disease and consequently patients with heart failure need the knowledge and optimal health literacy to improve the quality of life and minimize the rate of rehopitalizatio. So, considering to importance of knowledge and health literacy in this patients as well as contradictory literature, this study conducted to investigate the relationship between health literacy and Knowledge of heart failure with rehospitalization in patients with heart failure admitted to heart failure clinic in Rajai Heart center in 1394. Methods: The cross-sectional method with convenience sampling method was used in this study. After obtaining the necessary permissions from the ethics committee and the Shahid Rajai Heart center, 238 patients who were older than 18 years and had ejection fraction 35% or less with the ability to read and write and lack of psychiatric, neurological and cognitive disorders and signed the informed consent were recruited. Data collection were perfomed through demographic data questionnaire, short standard health literacy questionnaire 'Short-TOFHLA-16' and Vanderwall (2005) knowledge of heart failure questionnaire. Reliability was assessed by internal consistency method and Cronbach's alpha for both questionnaires was more than 0.7. Then data were analysed by SPSS-20 with descriptive statistic and analytical statistic such as T-test, Chi-square and ANOVA. Results: The majority of patients were male (66%), married (80%) and had age between 50 to 70 years old (42%). The majority of studied men and women have good health literacy and About half of them have adequate knowledge about heart failure. Fisher's exact test showed that there was a significant statistical correlation between health literacy and knowlegh about heart failure. In other words, higher health literacy associated with more knowledge about their condition. Also findings showed that there was no significant statistical correlation between health literacy and knowledge about heart failure and frequency of CCU and emergency admissions. Conclusion: The study results showed that the higher health literacy, associated with the greater knowledge about heart failure and patients' perception about caring recommendations and disease outcomes. Therefore, the knowledge about heart failure and factors which related to severity of the disease, is the important issue to problem identification and treatment and reduction of rehospitalization.

Keywords: health literacy, heart failure, knowlegde, rehospitalization

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Authors: Deenadayalan Govender

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In South Africa, similar to nations globally, the prevailing tangible link between people and the state is public infrastructure. Services delivered through infrastructure to the people and to the state form a critical enabler for social development in communities and economic development in the country. In this regard, infrastructure, being the backbone to a nation’s prosperity, ideally should be effectively maintained for seamless delivery of services. South African infrastructure is in a state of deterioration, which is leading to infrastructure dysfunction and collapse and is negatively affecting development of the economy. This infrastructure deterioration stems from deficiencies in maintenance practices and strategies. From the birth of South African democracy, government has pursued socio-economic transformation and the delivery of critical basic services to decrease the broadening boundaries of disparity. In this regard, the National Infrastructure Plan borne from strategies encompassed in the National Development Plan is given priority by government in delivering strategic catalytic infrastructure projects. The National Infrastructure Plan is perceived to be the key in unlocking opportunities that generate economic growth, kerb joblessness, alleviate poverty, create new entrepreneurial prospects, and mitigate population expansion and rapid urbanisation. Socio-economic transformation benefits from new infrastructure spend is not being realised as initially anticipated. In this context, South Africa is currently in a state of weakening economic growth, with further amassed levels of joblessness, unremitting poverty and inequality. Due to investor reluctance, solicitation of strategic infrastructure funding is progressively becoming a debilitating challenge in all government institutions. Exacerbating these circumstances further, is substandard functionality of existing infrastructure subsequent to inadequate maintenance practices. This in-depth multi-sectoral study into the state of infrastructure is to understand the principal reasons for infrastructure functionality regression better; furthermore, prioritised investigations into progressive maintenance strategies is focused upon. Resultant recommendations reveal enhanced maintenance strategies, with a vision to capitalize on infrastructure design life, and also give special emphasis to socio-economic development imperatives in the long-term. The research method is principally based on descriptive methods (survey, historical, content analysis, qualitative).

Keywords: infrastructure, maintenance, socio-economic, strategies

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Authors: Alvine Sandrine Ndinchout, D. P. Chattopadhyay, Moundipa Fewou Paul, Nyegue Maximilienne Ascension, Varinder Kaur, Sukhraj Kaur, B. H. Patel

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Dacryodes macrophylla is a species of the Burseraceae family that is widespread in Cameroon, Equatorial Guinea, and Gabon. The only part of D. macrophylla known to use is the pulp contained in the fruit. This very juicy pulp is consumed directly and used in making juices. During consumption, these fruit leaves a dark blackish colour on fingers and garment. This observation means that D. macrophylla fruits must be a good source of natural dye with probably good fastness properties on textile materials. But D. macrophylla has not yet been investigated with reference as a potential source of natural dye to our best knowledge. Natural dye has been extracted using water as solvent by soxhlet extraction method. The extracted color was characterized by spectroscopic studies like UV/Visible and further tested for antimicrobial activity against gram-negative (Vibrio cholerae, Escherichia coli, Salmonella enterica serotype Typhi, Shigella flexneri) and gram-positive (Listeria monocytogenes, Staphylococcus aureus) bacteria. It was observed that the water extract of D. macrophylla showed antimicrobial activities against S. enterica. The results of fastness properties of the dyed fabrics were fair to good. Taken together, these results indicate that D. macrophylla can be used as natural dye not only in textile but also in other domains like food coloring.

Keywords: antimicrobial activity, natural dye, silk, wash fastness, wool

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Authors: Anuradha Chug, Sunali Gandhi

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Regression Testing is a very expensive and time-consuming process carried out to ensure the validity of modified software. Due to the availability of insufficient resources to re-execute all the test cases in time constrained environment, efforts are going on to generate test data automatically without human efforts. Many search based techniques have been proposed to generate efficient, effective as well as optimized test data, so that the overall cost of the software testing can be minimized. The generated test data should be able to uncover all potential lapses that exist in the software or product. Inspired from the natural behavior of bat for searching her food sources, current study employed a meta-heuristic, search-based bat algorithm for optimizing the test data on the basis certain parameters without compromising their effectiveness. Mathematical functions are also applied that can effectively filter out the redundant test data. As many as 50 Java programs are used to check the effectiveness of proposed test data generation and it has been found that 86% saving in testing efforts can be achieved using bat algorithm while covering 100% of the software code for testing. Bat algorithm was found to be more efficient in terms of simplicity and flexibility when the results were compared with another nature inspired algorithms such as Firefly Algorithm (FA), Hill Climbing Algorithm (HC) and Ant Colony Optimization (ACO). The output of this study would be useful to testers as they can achieve 100% path coverage for testing with minimum number of test cases.

Keywords: regression testing, test case selection, test case prioritization, genetic algorithm, bat algorithm

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Authors: Abdreheman Seid Abdella

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This study examined instructors willingness, self-efficacy beliefs, attitudes and knowledge about provisions of instructional accommodations for students with disabilities in universities. Major concepts used in this study operationally defined and some models of disability were reviewed. Questionnaires were distributed to a total of 181 instructors from four universities and quantitative data was generated. Then to analyze the data, appropriate methods of data analysis were employed. The result indicated that on average instructors had positive willingness, strong self-efficacy beliefs and positive attitudes towards providing instructional accommodations. In addition, the result showed that the majority of participants had moderate level of knowledge about provision of instructional accommodations. Concerning the relationship between instructors background variables and dependent variables, the result revealed that location of university and awareness raising training about Inclusive Education showed statistically significant relationship with all dependent variables (willingness, self-efficacy beliefs, attitudes and knowledge). On the other hand, gender and college/faculty did not show a statistically significant relationship. In addition, it was found that among the inter-correlation of dependent variables, the correlation between attitudes and willingness to provide accommodations was the strongest. Furthermore, using multiple linear regression analysis, this study also indicated that predictor variables like self-efficacy beliefs, attitudes, knowledge and teaching methodology training made statistically significant contribution to predicting the criterion willingness. Predictor variables like willingness and attitudes made statistically significant contribution to predicting self-efficacy beliefs. Predictor variables like willingness, Special Needs Education course and self-efficacy beliefs made statistically significant contribution to predict attitudes. Predictor variables like Special Needs Education courses, the location of university and willingness made statistically significant contribution to predicting knowledge. Finally, using exploratory factor analysis, this study showed that there were four components or factors each that represent the underlying constructs of willingness and self-efficacy beliefs to provide instructional accommodations items, five components for attitudes towards providing accommodations items and three components represent the underlying constructs for knowledge about provisions of instructional accommodations items. Based on the findings, recommendations were made for improving the situation of instructional accommodations in Ethiopian universities.

Keywords: willingness, self-efficacy belief, attitude, knowledge

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Authors: Ali Alahmari

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Saudi Arabia is facing increasing challenges in managing urban drainage, due to a combination of factors including climate change and urban expansion. Traditional drainage systems are unable to cope with demand, resulting in flooding and damage to property. Consequently, new ways of dealing with this issue need to be found and Sustainable Urban Drainage Systems (SUDS) appear to be a possible solution. This paper suggests that knowledge is a central issue in the adoption of Sustainable Urban Drainage approaches, as revealed through qualitative research with representative officials and professionals from key government departments and organisations in Riyadh. Semi-structured interviews were conducted with twenty-six participants. The interviews explored the challenges of adopting sustainable drainage approaches, and grounded theory analysis was used to examine the role of knowledge. However, a number of barriers have been identified with regard to the adoption of sustainable drainage approaches, such as the marginal status of sustainability in drainage decisions; lack of technical standards for other unconventional drainage solutions, and lack of consideration by decision makers of contributions from environmental and geographical studies. Due to centralisation, decision-making processes are complex and time-consuming, resulting in the discouragement of the adoption of new knowledge and approaches. Stakeholders with knowledge of sustainable approaches are often excluded from the hierarchical system of urban planning and drainage management. In addition, the multiplicity of actors involved in the implementation of the drainage system, as well as the different technical standards involved, often causes problems around coordination and cooperation. Although those with procedural and explicit knowledge have revealed a range of opportunities, such as a significant increase in government support for rainwater drainage in urban areas, they also identified a number of obstacles. These are mainly related to the lack of specialists in sustainable approaches, and a reluctance to involve external experts. Therefore, recommendations for overcoming some of these challenges are presented, which include enhancing the decision-making process through applying decentralisation and promoting awareness of sustainability through establishing educational and outreach programmes. This may serve to increase knowledge and facilitate the adoption of sustainable drainage approaches to promote sustainable development in the context of Saudi Arabia.

Keywords: climate change, decision-making processes, new knowledge and approaches, resistance to change, Saudi Arabia, SUDS, urban expansion

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Authors: Reda Moussa Massoud Embark

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Tourism and hospitality graduate development is key to the future state of the tourism and hospitality industry. Meanwhile, Information and Communication Technology is increasingly becoming the engine for improving productivity and business opportunities in the travel and hospitality industry. Given the challenges and fierce global competition that have arisen in today's hospitality industry, it was important to shed light on strategic management. In addition, five-star hotels play a key role in supporting the tourism industry and investments in Egypt. Therefore, this study aims to examine the extent to which strategic management practices are implemented in five-star hotels in Egypt and to examine the differences between resort and inner-city hotels in terms of the implementation of strategic management processes. The influence of different hotel types on the implementation of the strategic management process is examined. A simple random sampling technique is used to select a sample of the target population, including hotels in the cities of Sharm el-Sheikh, Cairo and Hurghada. The data collection tool used in this study is an interviewer-administered questionnaire. Finally, combining the study results with the literature review allowed to present a set of recommendations to be addressed to hoteliers in the area of strategic management practices. Education and training in tourism and hospitality must take these changes into account in order to improve the ability of future managers to use a variety of tools and strategies to make their organizations more efficient and competitive. Therefore, this study aims to examine the types and effectiveness of training courses offered by tourism and hospitality departments in Egypt and to assess the importance of these training courses from the perspective of the graduate. The survey is aimed at graduates who have completed three different majors in the past decade: tourism and hospitality. Findings discussed the nature, level and effectiveness of the training provided at these faculties and the extent to which the training programs were valued by graduates working in different fields, and finally recommended specific practices to improve learning effectiveness increase and increase perceived employee benefits in the tourism and hospitality industry.

Keywords: marketing channels, crisis, hotel, international, tour, operators, online travel agencies, e-tourism, hotel websites, tourism, web-tourism, strategic-management, strategic tools, five-star hotels, resorts, downtown hotels, Egyptian Markets.

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Authors: Thaminda Liyanage, Chamila Shamika Kurukulasuriya

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Introduction: Morbid obesity has been successfully treated with bariatric surgery for over 60 years. Although operative procedures have improved and associated complications have reduced substantially, surgery still carries the risk of post-operative malabsorption, malnutrition and a range of gastrointestinal disorders. Overweight by itself can impair libido in both sexes and cause erectile dysfunction in males by inducing a state of hypogonadotropic hypogonadism, proportional to the degree of obesity. Impact of weight reduction on libido and sexual activity remains controversial, however it is broadly accepted that weight loss improves sexual drive. Zinc deficiency, subsequent to malabsorption, may lead to impaired testosterone synthesis in men while excessive and/or rapid weight loss in females may result in reversible amenorrhoea leading to sub-fertility. Methods: We describe a 37 year old male, 6 years post Roux-en-Y gastric bypass surgery, who presented with erectile dysfunction, loss of libido, worsening fatigue and generalized weakness for 4 months. He also complained of constipation and frequent muscle cramps but denied having headache, vomiting or visual disturbances. Patient had lost 38 kg of body weight post gastric bypass surgery over four years {135kg (BMI 42.6 kg/m2) to 97 kg (BMI 30.6 kg/m2)} and the weight had been stable for past two years. He had no recognised co-morbidities at the time of the surgery and noted marked improvement in general wellbeing, physical fitness and psychological confident post surgery, up until four months before presentation. Clinical examination revealed dry pale skin with normal body hair distribution, no thyroid nodules or goitre, normal size testicles and normal neurological examination with no visual field defects or diplopia. He had low serum testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), T3, T4, thyroid stimulating hormone (TSH), insulin like growth factor 1 (IGF-1) and 24-hour urine cortisol levels. Serum cortisol demonstrated an appropriate rise to ACTH stimulation test but growth hormone (GH) failed increase on insulin tolerance test. Other biochemical and haematological studies were normal, except for low zinc and folate with minimally raised liver enzymes. MRI scan of the head confirmed a solid pituitary mass with no mass effect on optic chiasm. Results: In this patient clinical, biochemical and radiological findings were consistent with anterior pituitary dysfunction. However, there were no features of raised intracranial pressure or neurological compromise. He was commenced on appropriate home replacement therapy and referred for neurosurgical evaluation. Patient reported marked improvement in his symptoms, specially libido and erectile dysfunction, on subsequent follow up visits. Conclusion: Sexual dysfunction coupled with non specific constitutional symptoms has multiple aetiologies. Clinical symptoms out of proportion to nutritional deficiencies post bariatric surgery should be thoroughly investigated. Close long term follow up is crucial for overall success.

Keywords: obesity, bariatric surgery, erectile dysfunction, loss of libido

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Authors: Marek Gancarz, Agnieszka Nawrocka, Robert Rusinek, Marcin Tadla

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Volatile organic compounds (VOCs) are the fungi metabolites in the gaseous form produced during improper storage of agricultural commodities (e.g. grain, food). The spoilt commodities produce a wide range of VOCs including alcohols, esters, aldehydes, ketones, alkanes, alkenes, furans, phenols etc. The characteristic VOCs and odours can be determined by using electronic nose (e-Nose) which contains a matrix of different kinds of sensors e.g. resistive sensors. The aim of the present studies was to determine relationship between response of the resistive sensors on the chosen volatiles and their concentration. According to the literature, it was chosen volatiles characteristic for the cereals: ethanol, 3-methyl-1-butanol and hexanal. Analysis of the sensor signals shows that a signal shape is different for the different substances. Moreover, each VOC signal gives information about a maximum of the normalized sensor response (R/Rmax), an impregnation time (tIM) and a cleaning time at half maximum of R/Rmax (tCL). These three parameters can be regarded as a ‘VOC fingerprint’. Seven resistive sensors (TGS2600-B00, TGS2602-B00, TGS2610-C00, TGS2611-C00, TGS2611-E00, TGS2612-D00, TGS2620-C00) produced by Figaro USA Inc., and one (AS-MLV-P2) produced by AMS AG, Austria were used. Two out of seven sensors (TGS2611-E00, TGS2612-D00) did not react to the chosen VOCs. The most responsive sensor was AS-MLV-P2. The research was supported by the National Centre for Research and Development (NCBR), Grant No. PBS2/A8/22/2013.

Keywords: agricultural commodities, organic compounds, resistive sensors, volatile

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Authors: Oris Tom-Lawyer, Michael Thomas

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This paper seeks to analyse the hegemony of the English language in Western Africa through the lens of educational policies and the socio-economic functions of the language. It is based on the premise that there is a positive link between the English language and development contexts. The study aims to fill a gap in the research literature by examining the usefulness of hegemony as a concept to explain the role of English language in the region, thus countering the negative connotations that often accompany it. The study identified four main research questions: i. What are the socio-economic functions of English in Francophone/lusophone countries? ii. What factors promote the hegemony of English in anglophone countries? iii. To what extent is the hegemony of English in West Africa? iv. What are the implications of the non-hegemony of English in Western Africa? Based on a meta-analysis of the research literature between 2003 and 2018, the findings of the study revealed that in francophone/lusophone countries, English functions in the following socio-economic domains; they are peace keeping missions, regional organisations, commercial and industrial sectors, as an unofficial international language and as a foreign language. The factors that promote linguistic hegemony of English in anglophone countries are English as an official language, a medium of instruction, lingua franca, cultural language, language of politics, language of commerce, channel of development and English for media and entertainment. In addition, the extent of the hegemony of English in West Africa can be viewed from the factors that contribute to the non-hegemony of English in the region; they are French language, Portuguese language, the French culture, neo-colonialism, level of poverty, and economic ties of French to its former colonies. Finally, the implications of the non-hegemony of English language in West Africa are industrial backwardness, poverty rate, lack of social mobility, drop out of school rate, growing interest in English, access to limited internet information and lack of extensive career opportunities. The paper concludes that the hegemony of English has resulted in the development of anglophone countries in Western Africa, while in the francophone/lusophone regions of the continent, industrial backwardness and low literacy rates have been consequences of English language marginalisation. In conclusion, the paper makes several recommendations, including the need for the early introduction of English into French curricula as part of a potential solution.

Keywords: developmental tool, English language, linguistic hegemony, West Africa

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Authors: Abdulrahman Fahim M. Alsulami

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This paper is dedicated to a detailed investigation of the interaction between the agreement on trade-related aspects of intellectual property rights (TRIPS) and bilateral investment treaties (BITs) in the regulation of health-related intellectual property rights in Australia and the Kingdom of Saudi Arabia. The chosen research object is complex and requires a thorough examination of a set of factors influencing the problem under investigation. At the moment, to the author’s best knowledge’ there is no academic research that would conceptualize and critically compare the regulation of health-related intellectual property rights in these two countries. While there is a substantial amount of information in the literature on certain aspects of the problem, the existing knowledge about certain aspects of the health-related regulatory frameworks in Australia and Saudi Arabia barely explains in detail the specifics of the ways in which the TRIPS agreement interacts with (BITs) in the regulation of health-related intellectual property rights. Therefore, this paper will address an evident research gap by studying an intriguing yet under-researched problem. The paper comprises five subsections. The first subsection provides an overview of the investment climate in Saudi Arabia and Australia with an emphasis on the health care industry. It will cover political, economic, and social factors influencing the investment climate in these countries, the systems of intellectual property rights protection, recent patterns relevant to the investment climate’s development, and key characteristics of the investment climate in the health care industry. The second subsection analyses BITs in Saudi Arabia and Australia in light of the countries’ responsibilities under the TRIPS Agreement. The third subsection provides a critical examination of the interaction between the TRIPS Agreement and BITs in Saudi Arabia on the basis of data collected and analyzed in previous subsections. It will investigate key discrepancies concerning the regulation of health-related intellectual property rights in Saudi Arabia and Australia from the position of BITs’ interaction with the TRIPS Agreement and explore the existing procedures for clarifying priorities between them in regulating health-related intellectual property rights. The fourth subsection of the paper provides recommendations concerning the transformation of BITS into a TRIPS+ dimension in regulating health-related intellectual property rights in Saudi Arabia and Australia. The final subsection provides a summary of differences between the Australian and Saudi BITs from the perspective of the regulation of health-related intellectual property rights under the TRIPS agreement and bilateral investment treaties.

Keywords: Australia, bilateral investment treaties, IP law, public health sector, Saudi Arabia

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Authors: Omaimah Algohary

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Kaolin is one of the principle intestinal adsorbents, has traditionally been used internally in the treatment of various enteric disorders, colitis, enteritis, dysentery, and diarrhea associated with food and alkaloidal poisoning and in traveler’s diarrhea. It binds to and traps bacteria and its toxins and gases in the gut. It also binds to water in the gut, which helps to make the stools firmer, hence giving symptomatic relief. Metronidazole is a synthetic antibacterial agent that is used primarily in the treatment of various anaerobic infections such as intra-abdominal infections, antiprotozoal, and as amebicidal. The need for safe, therapeutically effective antidiarrheal combination continuously lead to effective treatment. Metronidazol used for treatment of anaerobic bacteria and kaolin , when administered simultaneously, Metronidazole–Kaolin interactions have been reported by FDA but not studied. This project is the first to study the effect of Metronidazole–Kaolin interactions on the antimicrobial activity of metronidazole. Agar diffusion method performed to test the antimicrobial activity of metronidazole–kaolin antidiarrheal combination from aqueous solutions at an in-vivo simulated pHs conditions that obtained at 37+0.5 °C on Helicobacter pylori as anaerobic bacteria and E.coli as aerobic bacteria and used as a control for the technique. The antimicrobial activity of metronidazole combination as 1:1 and 1:2 with kaolin was abolished in acidic media as no zones of inhibition shown compared to only metronidazole that used as a control. In alkaline media metronidazole combination as 1:1 and 1:2 with kaolin showed diminutive activity compared to the control. These results proved that the kaolin adsorb metronidazole and abolish its antimicrobial activity and such combination should be avoided.

Keywords: kaolin, metronidazole, interaction, Helicobacter pylori. E. coli, antimicrobial activity

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Authors: Mahadehe Hassan

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Transport system and industries which are the main basis of industrial and socio-economic development of any country. It is mainly dependent on fossil fuels. Bangladesh has fossil fuel reserves of 9.51 TCF as of July 2023, and if no new gas fields are discovered in the next 7-9 years and if the existing gas consumption rate continues, the fossil fuel reserves will be exhausted. The demand for petroleum products in Bangladesh is increasing steadily, with 63% imported by BPC and 37% imported by private companies. 61.61% of BPC imported products are used in the transport sector and 5.49% in the industrial sector, which is expensive and harmful to the environment. Liquefied Petroleum Gas (LPG) should be considered as an alternative energy for Bangladesh based on Sustainable Development Goals (SDGs) criteria for sustainable, clean and affordable energy. This will not only lead to the much desired mitigation of energy famine in the country but also contribute favorably to the macroeconomic indicators. Considering the environmental and economic issues, the government has referred to CNG (compressed natural gas) as the fuel carrier since 2000, but currently due to the decline mode of gas reserves, the government of Bangladesh is thinking of new energy sources for transport and industrial sectors which will be sustainable, environmentally friendly and economically viable. Liquefied Petroleum Gas (LPG) is the best choice for fueling transport and industrial sectors in Bangladesh. At present, a total of 1.54 million metric tons of liquefied petroleum gas (LPG) is marketed in Bangladesh by the public and private sectors. 83% of it is used by households, 12% by industry and commerce and 5% by transportation. Industrial and transport sector consumption is negligible compared to household consumption. So the purpose of the research is to find out the challenges of LPG market development in transport and industrial sectors in Bangladesh and make recommendations to reduce the challenges. Secure supply chain, inadequate infrastructure, insufficient investment, lack of government monitoring and consumer awareness in the transport sector and industrial sector are major challenges for LPG market development in Bangladesh. Bangladesh government as well as private owners should come forward in the development of liquefied petroleum gas (LPG) industry to reduce the challenges of secure energy sector for sustainable development. Furthermore, ensuring adequate Liquefied Petroleum Gas (LPG) supply in Bangladesh requires government regulations, infrastructure improvements in port areas, awareness raising and most importantly proper pricing of Liquefied Petroleum Gas (LPG) to address the energy crisis in Bangladesh.

Keywords: transportand industries fuel, LPG consumption, challenges, economical sustainability

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Authors: Mst. Tuhina-Khatun, Mohamed Hanafi Musa, Mohd Rafii Yosup, Wong Mui Yun, Md. Aktar-Uz-Zaman, Mahbod Sahebi

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Rice is a staple crop of economic importance of most Asian people, and blast is the major constraints for its higher yield. Heritability of plants traits helps plant breeders to make an appropriate selection and to assess the magnitude of genetic improvement through hybridization. Diversity of crop plants is necessary to manage the continuing genetic erosion and address the issues of genetic conservation for successfully meet the future food requirements. Therefore, an experiment was conducted to estimate heritability and to determine the diversity of 27 blast resistant upland rice genotypes based on 18 quantitative traits using randomized complete block design. Heritability value was found to vary from 38 to 93%. The lowest heritability belonged to the character total number of tillers/plant (38%). In contrast, number of filled grains/panicle, and yield/plant (g) was recorded for their highest heritability value viz. 93 and 91% correspondingly. Cluster analysis based on 18 traits grouped 27 rice genotypes into six clusters. Cluster I was the biggest, which comprised 17 genotypes, accounted for about 62.96% of total population. The multivariate analysis suggested that the genotype ‘Chokoto 14’ could be hybridized with ‘IR 5533-55-1-11’ and ‘IR 5533-PP 854-1’ for broadening the gene pool of blast resistant upland rice germplasms for yield and other favorable characters.

Keywords: blast resistant, diversity analysis, heritability, upland rice

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Authors: Hayet El Kolli, Hocine Laouer

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Bunium in the world comprises about 50 to 100 species, mostly distributed in: Algeria, Italy, Pakistan, Iran, and South Africa. Bunium species have several uses like: Bunium persicum which is commonly used as antispasmodic, carminative, anti-obesity and lactogage. This plant have been widely used as an additive in food stuff such as in bread cooking, rice and yoghurt for its carminative, anti-dyspepsia and antispasmodic effect. The B. paucifolium oil has a wide spectrum of action against moulds, yeast and bacteria. The chemical compositions of Bunium incrassatum and Bunium alpinum essential oils were carry out by GC and GC/MS. Therefore, antibacterial activity of two oils was investigated by disk diffusion method against Pseudomonas aeruginosa ATCC 27853, Escherichia coli ATCC 25922, Salmonella typhimurium ATCC 1331, Staphylococcus aureus ATCC 25923, Klebsiella pneumoniae ATCC 700603, Bacillus cereus ATCC 10876, Enterococcus faecalis ATCC 49452, Lysteria monocytogenes ATCC 15313, Citrobacter freundii ATCC 8090, Proteus mirabilis ATCC 35659. A moderate antibacterial activity was found. In conclusion, it is found that essential oils of the two species are rich in sesquiterpens and other oxygenated compounds. These compounds have been reported to show bactericidal activity and the presence of phenolic compounds makes them useful antioxidants so that results confirm some ethnopharmacologique applications of these two oils of Bunium.

Keywords: Bunium alpinum, Bunium incrassatum, apiaceae, essential oil, sesquiterpens, phenols, antibacterial, antioxidant activities

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Authors: Pradip Kumar Das

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As the entire world continues its rapid move towards industrialization, it has seriously threatened mankind’s ability to maintain an ecological balance. Geographical and natural forces have a significant influence on the location of industries. Industrialization is the foundation stone of the development of any country, while the unplanned industrialization and discharge of waste by industries is the cause of environmental pollution. There is growing degree of awareness and concern globally among nations about environmental degradation or pollution. Environmental resources endowed by the gift of nature and not manmade are invaluable natural resources of a country like India. Any developmental activity is directly related to natural and environmental resources. Economic development without environmental considerations brings about environmental crises and damages the quality of life of present, as well as future generation. As corporate sectors in the global market, especially in India, are becoming anxious about environmental degradation, naturally more and more emphasis will be ascribed to how environment-friendly the outcomes are. Maintaining accounts of such environmental and natural resources in the country has become more urgent. Moreover, international awareness and acceptance of the importance of environmental issues has motivated the development of a branch of accounting called “Environmental Accounting”. Environmental accounting attempts to detect and focus the resources consumed and the costs rendered by an industrial unit to the environment. For the sustainable development of mankind, a healthy environment is indispensable. Gradually, therefore, in many countries including India, environment matters are being given top most priority. Accounting and disclosure of environmental matters have been increasingly manifesting as an important dimension of corporate accounting and reporting practices. But, as conventional accounting deals with mainly non-living things, the formulation of valuation, and measurement and accounting techniques for incorporating environment-related matters in the corporate financial statement sometimes creates problems for the accountant. In the light of this situation, the conceptual analysis of the study is concerned with the rationale of environmental accounting on the economy and society as a whole, and focuses the failures of the traditional accounting system. A modest attempt has been made to throw light on the environmental awareness in developing nations like India and discuss the problems associated with the implementation of environmental accounting. The conceptual study also reflects that despite different anomalies, environmental accounting is becoming an increasing important aspect of the accounting agenda within the corporate sector in India. Lastly, a conclusion, along with recommendations, has been given to overcome the situation.

Keywords: environmental accounting, environmental degradation, environmental management, environmental resources

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Authors: Mimoza Canga, Irene Malagnino, Vergjini Mulo, Alketa Qafmolla, Vito Antonio Malagnino

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Background: Dental caries is the most common dental disease and pregnancy represents a special process of physical, hormonal and metabolic changes in pregnant women, which is accompanied by an imbalance in the oral cavity. Objective: The objective of this study is to evaluate caries reduction after dental visits, the scaling of teeth, fluoridated water, brushing of the teeth and using fluoride toothpaste before and during pregnancy. Materials and methods: This study was conducted in the time period March 2018- September 2021, the age range of the participants was: 18-41 years old. The sample taken under observation was composed of 84 pregnant women. The questionnaire included the demographic characteristics of the sample, such as age, women's education level was primary, secondary, and higher education. Based on women's education level, our analysis found that 25.9% of pregnant women had completed primary education, 35.2% of them had secondary education and 38.9% of pregnant women had higher education. The descriptive and analytical research analysis is formulated as a longitudinal study. Statistical analysis was performed using IBM SPSS Statistics 23.0. The significance level (α) was set at 0.05, whereas P-value and analysis of variance (ANOVA) were used to analyze the data. Results: In the present study, it was observed that there is a strong relationship between dental visits and the scaling of the teeth with the value of P˂ .0001. While the number of teeth with caries before pregnancy and fluoridated water have a P-value=0.002. If we compare the same factor with the number of teeth with dental caries during pregnancy, the correlation is P-value = 0.0001. The number of teeth with caries before pregnancy and carbohydrates consumption has a strong relation with P-value=0.05. According to the present research, the number of teeth with dental caries before pregnancy in relation to brushing the teeth has a P-value ˂ 0.05. Furthermore, in the actual research, it was established that using fluoride toothpaste doesn’t affect the number of teeth with caries before pregnancy with a P-value= .314. Conclusion: According to the results of the present study performed in Albania, it was found out that the periodical dental visits, scaling of the teeth, fluoridated water, brushing of the teeth influenced caries reduction before and during pregnancy. In comparison, the usage of fluoride toothpaste did not have any effect on dental caries reduction in the same time period. The recommendations are as follows: maintaining oral hygiene, using fluoridated water and brushing the teeth regularly. Healthcare providers should inform pregnant women about the importance of oral health and the implementation of measures to manage dental caries.

Keywords: brushing of the teeth, dental visits, dental scaling, fluoridated water, pregnancy

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Authors: Adela Mariana Vadastreanu, Adrian Bot, Andreea Maier, Dorin Maier

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This paper approaches the need for innovation management in the context of an existing integrated management system implemented in an organization. The road to success for companies in today’s economic environment is more demanding than ever and the capacity of adapting to the rapid changes is compensatory in order to resist on the market. The managers struggle, daily, with increasingly complex problems, caused by fierce competition in the market but also from the rising demands of customers. Innovation seems to be the solution for these problems. During the last decade almost all companies have been certificated according to various management systems, like quality management system, environmental management system, health and safety management system and others; furthermore many companies have implemented an integrated management system, by integrating two or more management systems. The problem rising today is how to integrate innovation in this integrated management systems. The challenge of the problem is that the development of an innovation management system is in the early phase. In this paper we have studied the possibility of integrating some of the innovation request in an existing management system, we have identify the innovation performance request and we proposed some recommendations regarding innovation management and its implementation as a part of an integrated management system. This paper lies down the bases for developing an model of integration management systems that include innovation as a main part of it. Organizations are becoming more aware of the importance of Integrated Management Systems (IMS). Integrating two or more management systems into an integrated management system can have much advantages.This paper examines various models of management systems integration in accordance with professional references ISO 9001, ISO 18001 and OHSAS 18001, highlighting strengths and weaknesses, creating a basis for future development of integrated management systems, and their involvement in various other processes within the organization, such as innovation management. The more and more demanding economic context emphasizes the awareness of the importance of innovation for organizations. This paper highlights the importance of the innovation for an organization and also gives some practical solution in order to improve the overall success of the business through a better approach of innovation. Various standards have been developed in order to certificate organizations that they respect the requirements. Applying an integrated standards model is shown to be a more effective way then applying the standards independently. The problem that arises is that in order to adopt the integrated version of standards there have to be made some changes at the organizational level. Every change that needs to be done has an effect on its activity, and in this sense the paper tries to deal with the changes needed for adopting an integrated management system and if those changes have an influence over the performance. After the analysis of the results, we can conclude that in order to improve the performance a necessary step is the implementation of innovation in the existing integrated management system.

Keywords: innovation, integrated management systems, innovation management, quality

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Authors: Dessie Fisseha, Derbew Belew, Ambecha Olika

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Potato is a high-potential food security crop in Ethiopia. However, the yield and productivity of the crop have been far below the world average. This is due to several factors, including appropriate agronomic practices, such as time of earthing-up and inflorescence management. A field experiment was conducted at Jimma, Southwest Ethiopia, during 2016/17 under irrigation to determine the effect of time of earthing-up and inflorescence removal on the growth, yield, and quality of potatoes. The treatments consisted of a time of earthing-up (no earthing-up, earthing-up at 15, 30, and 45 days after complete plant emergence) and inflorescence removal (inflorescence removed and not removed). Potato variety (Belete) was used for this experiment. A 2x4 factorial experiment was laid out with three replications. Data collected on the growth, yield, and quality components of potatoes were analyzed using SAS Version 9.3 statistical software. Inflorescence removal affected the majority of the growth and yield parameters, while the time of earthing-up affected all growth, yield, and quality (green tuber number) parameters. Earthing-up at 15 days in combination with inflorescence removal (at 60 days after complete plant emergence) gave better plant growth and maximum tuber yield of the Belete potato variety under irrigated conditions. Since the current research was conducted at one location, in one season, and with one potato cultivar (Belete), it would be advisable to repeat the experiment so as to arrive at a final conclusion and subsequent recommendation.

Keywords: Belete, earthing-up, inflorescence, yield

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Authors: Kamal Ahmed, Othman Ayman, Refat Mostafa

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The post-construction phase represents a critical milestone in the project lifecycle. This is because design errors and omissions, as well as construction defects, are examined during this phase. The traditional procurement approaches that are commonly adopted in construction projects separate design from construction, which ultimately inhibits contractors, suppliers and other parties from providing the design team with constructive comments and feedback to improve the project design. As a result, a lack of considering maintainability aspects during the design process results in increasing maintenance and operation costs as well as reducing building performance. This research aims to investigate the role of Early Supplier Involvement (ESI) in the design process as an approach to enhancing building maintainability. In order to achieve this aim, a research methodology consisting of a literature review, case studies and a survey questionnaire was designed to accomplish four objectives. Firstly, a literature review was used to examine the concepts of building maintenance, maintainability, the design process and ESI. Secondly, three case studies were presented and analyzed to investigate the role of ESI in enhancing building maintainability during the design process. Thirdly, a survey questionnaire was conducted with a representative sample of Architectural Design Firms (ADFs) in Egypt to investigate their perception and application of ESI towards enhancing building maintainability during the design process. Finally, the research developed a framework to facilitate ESI in the design process in ADFs in Egypt. Data analysis showed that the ‘Difficulty of trusting external parties and sharing information with transparency’ was ranked the highest challenge of ESI in ADFs in Egypt, followed by ‘Legal competitive advantage restrictions’. Moreover, ‘Better estimation for operation and maintenance costs’ was ranked the highest contribution of ESI towards enhancing building maintainability, followed by ‘Reduce the number of operation and maintenance problems or reworks’. Finally, ‘Innovation, technical expertise, and competence’ was ranked the highest supplier’s selection criteria, while ‘paying consultation fees for offering advice and recommendations to the design team’ was ranked the highest form of supplier’s remuneration. The proposed framework represents a synthesis that is creative in thought and adds value to the knowledge in a manner that has not previously occurred.

Keywords: maintenance, building maintainability, building life cycle cost (ICC), material supplier

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Authors: Mohammad Tayefeh Norooz, Amirhossein Kargarzadeh

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Overweight and obesity as an abnormality are health threatening factors. Body mass index (BMI) above 25 is referred to as overweight and above 30 as obese. Apollo Endosurgery, Inc., a pioneering company in endoscopy surgeries, is poised to revolutionize patient care with its minimally invasive treatment options. Some product solutions are designed to improve patient outcomes and redefine the future of healthcare. Weight gain post-weight-loss surgery may stem from an enlarged stomach opening, reducing fullness and increasing food intake. Apollo Endosurgery's OverStitch system, a minimally invasive approach, addresses this by using sutures to reduce stomach opening size. This reflects Apollo's commitment to transformative improvements in healing endoscopy, emphasizing a shift towards minimally invasive options. The system's versatility and precision in full-thickness suturing offer treatment alternatives, exemplified in applications like Endoscopic Sleeve Gastroplasty for reshaping obesity management. Apollo’s dedication to pioneering advancements suggests ongoing breakthroughs in minimally invasive surgery, positioning the OverStitch systems as a testament to innovation in patient care.

Keywords: apollo endosurgery, endoscopic sleeve gastroplasty, weight loss system, overstitch endoscopic suturing system, therapeutic, perforations, fistula

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Authors: Tirimisiyu Olaide Gbadamosi

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Individuals go into business for the sake of obtaining regular income, becoming self-employed. Although, there different kinds of business enterprises that female and male can go into, often times, some businesses are regarded more suitable for a particular sex and not the other. This means that there is some gender discrimination in the choice of business one goes into and by extension in entrepreneurship development. Apparently, gender attitudes and behaviors will have positive or negative effects on entrepreneurship development in a society or economy. This research work therefore intends to take a critical look at gender discrimination as they affect entrepreneurship development with particular reference to northern Nigeria in general, using Exceptional Production Services Limited Kaduna, Kaduna North Local Government area as a case study, and also to suggest the possible solution to unidentified problems and give recommendation where necessary. Statement of research problem: Entrepreneurship has generally been recognised as a good medium or strategy for economic development of an individual, a community and a nation. It is also a known a known fact that some gender discrimination are often used in the choice of business or even the decision to go into business. For example, some businesses are regarded as more suitable to men than women. The question here is, is this the right approach to economic development through entrepreneurship? Of what effect is this approach to entrepreneurship development? These and the other questions are what this research intends to find answers to and if possible make recommendations. Significance of the study: The findings of this study will provide a guide for anyone for the establishment of a business in Nigeria. The study will help any prospective entrepreneur to make the right decision of which business to go into and how to contend with gender related issues that might influence its success in business. Furthermore, it is hoped that the study will assist the government and her agencies in the process in developing entrepreneurship development programs. Conclusion: There has been growing recognition that various types of discrimination do not always affect women and men in the same way. Moreover, gender discrimination may be intensified and facilitated by all other forms of discrimination. It has been increasingly recognized that without gender analysis of all forms of discrimination in business, including multiple forms of discrimination, and, in particular, in this context, related intolerance, violations of the human rights of women might escape detection and remedies to address racism may also fail to meet the needs of women and girls. It is also important that efforts to address gender discrimination incorporate approaches to the elimination of all forms of discrimination. Recommendation: Campaigning and raising awareness among young men and women, parents, teachers and employers about gender stereotypical attitudes towards academic performances and the likely consequences of overall educational choices for employment and entrepreneurship opportunities, career progression and earnings.

Keywords: entrepreneurship, economic development, small medium enterprises, gender discrimination

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Authors: Krisztina Bohacs, Klaudia Markus

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To author’s best knowledge we are in absence of studies on cognitive program evaluation and we are certainly short of programs that prove to have high effect sizes with strong retention results. The purpose of our study was to investigate the effectiveness of a comprehensive cognitive training program, namely BrainRx. This cognitive rehabilitation program target and remediate seven core cognitive skills and related systems of sub-skills through repeated engagement in game-like mental procedures delivered one-on-one by a clinician, supplemented by digital training. A larger sample of children with learning disability were given pretest and post-test cognitive assessments. The experimental group completed a twenty-week cognitive training program in a BrainRx center. A matched control group received another twenty-week intervention with Feuerstein’s Instrumental Enrichment programs. A second matched control group did not receive training. As for pre- and post-test, we used a general intelligence test to assess IQ and a computer-based test battery for assessing cognition across the lifespan. Multiple regression analyses indicated that the experimental BrainRx treatment group had statistically significant higher outcomes in attention, working memory, processing speed, logic and reasoning, auditory processing, visual processing and long-term memory compared to the non-treatment control group with very large effect sizes. With the exception of logic and reasoning, the BrainRx treatment group realized significantly greater gains in six of the above given seven cognitive measures compared to the Feuerstein control group. Our one-year retention measures showed that all the cognitive training gains were above ninety percent with the greatest retention skills in visual processing, auditory processing, logic, and reasoning. The BrainRx program may be an effective tool to establish long-term cognitive changes in case of students with learning disabilities. Recommendations are made for treatment centers and special education institutions on the cognitive training of students with special needs. The importance of our study is that targeted, systematic, progressively loaded and intensive brain training approach may significantly change learning disabilities.

Keywords: cognitive rehabilitation training, cognitive skills, learning disability, permanent structural cognitive changes

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Authors: Jeewantha Ranawaka, Gunawardane Kapila, Wijethunaga Mudiyanselage B. G. Jayathilake

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Introduction: Sweeping of the membranes is a fairly simple technique that may positively influence the shift from maintenance of pregnancy to the beginning of labor. Objective: To assess the effectiveness and acceptability of twice versus once-only membrane sweeping in uncomplicated primi gravid at 40 weeks of gestational age in a tertiary care hospital in Sri Lanka. Methods: A randomized controlled clinical trial was done in Ward 05 of Teaching Hospital, Kandy. The participants were primi-gravida with a singleton live fetus who was at 40 weeks of gestation with intact fetal membranes and with a Modified Bishop’s score <5. After randomization both groups received membrane sweeping at 40 weeks of gestation and the experimental group received membrane sweeping after 48 hours (40+2 days). The modified Bishop Score was assessed at 40+5 days. In two groups who did not go into natural labor at 40+5 days were managed according to the ward policy of cervical ripening and with labor induction at 40+5 days. Two different methods were used to assess discomfort and pain. Patient acceptability was assessed using recommendation to another patient and acceptance during next pregnancy. Perinatal, maternal and labour outcomes were assessed. Results: A change of the Bishops score was 67.3% (n= 31 of 46) in experimental group whereas in control group it was 57.5% (n= 38 of 66). (p = 0.21, OR-1.52, CI = 0.6 -3.34). Mean (SD) of Modified Bishop score was 6.36 (1.94) in experimental group and 6.03 (.84) in control group (p = 0.354). The probability of having the spontaneous onset of labour in experimental group was 61.6% (n=74 of 120) whereas in control group it was 45% (n= 54 of 120) (p=0.01, OR-1.966, CI = 1.17 – 3.28 NNT = 5.99). Recommending the method to another among experimental group was 75% (n= 90 of 120) whereas in control group it was 79.2% (n= 95 of 120) (p= 0.443). Accepting membrane Sweeping for subsequent pregnancy among experimental was 72.5% (n=87 of 120) whereas in control group was 72.5% (n=87 of 120) (p= 1.00) Need of formal induction of labour at 40+ 5 days in experimental group was 38.4% (n=46 of 120) whereas in control group was 61.6% (n=66 of 120) (p=0.01, OR=0.5, CI= 0.3 – 0.8, NNT=6). Neonatal outcome, labour outcome such as Cesarean -section rate, need for augmentation and maternal complications such as fever, Premature rupture of membrane, bleeding were comparable in two groups. Conclusions and Recommendations: It can be concluded that twice sweeping of membrane was effective to reduce the need of formal induction of labour and increase the chances of having spontaneous onset of labour (SOL) at 40+5 days without increasing maternal or fetal morbidity. Acceptability of twice sweeping is not different from sweeping once. Hence we recommend consideration of multiple membranes sweeping as first line for women at 40 weeks of gestation.

Keywords: acceptability, induction, labour, membrane sweeping

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Authors: Elif N. Coban

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With the political instability that has prevailed in Lebanon since October 2019, followed by a global pandemic and a deepening concurrent economic crisis after the Beirut Port explosion on August 4, 2020, Syrian refugees in Lebanon have struggled to survive what the World Bank has described as one of the worst economic crises in decades. This study aims to assess the vulnerability of Syrian refugee women. It will present a comparative analysis of refugee and Lebanese households using data from Lebanon’s Labour Force and Household Conditions Survey (LFHLCS) and from VASyr surveys, which are comprehensive annual surveys conducted jointly by the United Nations High Commissioner for Refugees (UNHCR), the United Nations Children’s Fund (UNICEF), and the United Nations World Food Programme (WFP). The study adopts an intersectionality-based method, which deals with gender and marginalized communities from many different perspectives, to put forward a gender-oriented approach. Examining the distribution of socioeconomic status among Syrian and Lebanese households might help to understand the disproportionate burdens borne by women. In this context, multidimensional poverty (MP) helps depict fragile communities’ socioeconomic status and allows a fuller grasp the multiple aspects of deprivation. Finally, this understanding may pave the way to more inclusive policy for decision-makers and practitioners working on refugee issues.

Keywords: multidimensional poverty, gender studies, intersectionality, Syrian refugees, Lebanon

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Authors: Mercia I. Van Der Walt, Suzan Sayegh, Izzeldin E. L. J. Ibrahim, Mohamed G. Al-Kuwari, Manaf Kamil

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Background: Increased physical activity is associated with improvements in health conditions. Walking is recognized as an easy form of physical activity and a strategy used in health promotion. Step into Health (SIH), a national community program, was established in Qatar to support physical activity promotion through the monitoring of step counts. This study aims to assess the physical activity levels of the adult population in Qatar through a pedometer-based community program over a three-year-period. Methodology: This cross-sectional longitudinal study was conducted between from January 2013 and December 2015 based on daily step counts. A total of 15,947 adults (8,551 males and 7,396 females), from different nationalities enrolled in the program and aged 18 to 64, are included. The program involves free distribution of pedometers to members who voluntarily choose to register. It is also supported by a self-monitoring online account and linked to a web-database. All members are informed about the 10,000 steps/day target and automated emails as well as text messages are sent as reminders to upload data. Daily step counts were measured through the Omron HJ-324U pedometer (Omron Healthcare Co., Ltd., Japan). Analyses are done on the data extracted from the web-database. Results: Daily average step count for the overall community increased from 4,830 steps/day (2013) to 6,124 steps /day (2015). This increase was also observed within the three age categories (18–30), (31-45) and (>45) years. Average steps per day were found to be more among males compared with females in each of the aforementioned age groups. Moreover, males and females in the age group (>45 years) show the highest average step count with 7,010 steps/day and 5,564 steps/day respectively. The 21% increase in overall step count throughout the study period is associated with well-resourced program and ongoing impact in smaller communities such as workplaces and universities, a step in the right direction. However, the average step count of 6,124 steps/day in the third year is still classified as the low active category. Although the program showed an increase step count we found, 33% of the study population are low active, 35 % are sedentary with only 32% being active. Conclusion: This study indicates that the pedometer-based intervention was effective in increasing the daily physical activity of participants. However, alternative approaches need to be incorporated within the program to educate and encourage the community to meet the physical activity recommendations in relation to step count.

Keywords: pedometer, physical activity, Qatar, step count

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