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Authors: Rosario Carmona

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This article aims to discuss the importance of indigenous people participation in climate change mitigation and adaptation. Specifically, it analyses different understandings of climate vulnerability among diverse actors involved in climate change policies in Chile: indigenous people, state officials, and academics. These data were collected through participant observation and interviews conducted during October 2017 and January 2019 in Chile. Following Karen O’Brien, there are two types of vulnerability, outcome vulnerability and contextual vulnerability. How vulnerability to climate change is understood determines the approach, which actors are involved and which knowledge is considered to address it. Because climate change is a very complex phenomenon, it is necessary to transform the institutions and their responses. To do so, it is fundamental to consider these two perspectives and different types of knowledge, particularly those of the most vulnerable, such as indigenous people. For centuries and thanks to a long coexistence with the environment, indigenous societies have elaborated coping strategies, and some of them are already adapting to climate change. Indigenous people from Chile are not an exception. But, indigenous people tend to be excluded from decision-making processes. And indigenous knowledge is frequently seen as subjective and arbitrary in relation to science. Nevertheless, last years indigenous knowledge has gained particular relevance in the academic world, and indigenous actors are getting prominence in international negotiations. There are some mechanisms that promote their participation (e.g., Cancun safeguards, World Bank operational policies, REDD+), which are not absent from difficulties. And since 2016 parties are working on a Local Communities and Indigenous Peoples Platform. This paper also explores the incidence of this process in Chile. Although there is progress in the participation of indigenous people, this participation responds to the operational policies of the funding agencies and not to a real commitment of the state with this sector. The State of Chile omits a review of the structure that promotes inequality and the exclusion of indigenous people. In this way, climate change policies could be configured as a new mechanism of coloniality that validates a single type of knowledge and leads to new territorial control strategies, which increases vulnerability.

Keywords: indigenous knowledge, climate change, vulnerability, Chile

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Authors: T. Nishimura, K. Doi, H. Fujimoto, Y. Hoshikawa, T. Wada

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In Japan, it is expected that reasonable accommodation for persons with disabilities will progress further. In particular, there is an urgent need to enhance information support for visually impaired persons who have difficulty accessing information. Recently, tactile symbols have been attached to various surfaces, such as the content labels of containers and packaging of various everyday products. The advantage of tactile symbols is that they are useful for visually impaired persons who cannot read Braille. The method of displaying tactile symbols is prescribed by the International Organization for Standardization (ISO). However, the quantitative data on the shapes and dimensions of tactile symbols is insufficient. In this study, through an evaluation experiments, we examine the easy-to-distinguish shapes and dimensions of tactile symbols used for various applications, including the content labels on containers and packaging. Visually impaired persons participated in the experiments. They used tactile symbols on a daily basis. The details and processes of the experiments were orally explained to the participants prior to the experiments, and the informed consent of the participants was obtained. They were instructed to touch the test pieces of tactile symbols freely with both hands. These tactile symbols were selected because they were likely to be easily distinguishable symbols on the content labels of top surfaces of containers and packaging based on a hearing survey that involved employees of an organization of visually impaired and a social welfare corporation, as well as academic experts of support technology for visually impaired. The participants then answered questions related to ease of distinguishing of tactile symbols on a scale of 5 (where 1 corresponded to ‘difficult to distinguish’ and 5 corresponded to ‘easy to distinguish’). Hearing surveys were also performed in an oral free answer manner with the participants after the experiments. This study revealed the shapes and dimensions regarding easily distinguishable tactile symbols attached to containers and packaging. We expect that this knowledge contributes to improvement of the quality of life of visually impaired persons.

Keywords: visual impairment, accessible design, tactile symbol, containers and packaging

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Authors: Amalia Ardeljan, Lexi Frankel, Divesh Manjani, Gabriela Santizo, Maximillian Guerra, Omar Rashid

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Introduction: Cytomegalovirus (CMV) infection is a widespread infection affecting between 60-70% of people in industrialized countries. CMV has been previously correlated with a higher incidence of Hodgkin Lymphoma compared to noninfected persons. Research regarding prior CMV infection and subsequent lymphoma development is still controversial. With limited evidence, further research is needed in order to understand the relationship between previous CMV infection and subsequent lymphoma development. This study assessed the effect of CMV infection and the incidence of lymphoma afterward. Methods: A retrospective cohort study (2010-2019) was conducted through a Health Insurance Portability and Accountability Act (HIPAA) compliant national database and conducted using International Classification of Disease (ICD) 9th,10th codes, and Current Procedural Terminology (CPT) codes. These were used to identify lymphoma diagnosis in a previously CMV infected population. Patients were matched for age range and Charlson Comorbidity Index (CCI). A chi-squared test was used to assess statistical significance. Results: A total number of 14,303 patients was obtained in the CMV infected group as well as in the control population (matched by age range and CCI score). Subsequent lymphoma development was seen at a rate of 11.44% (1,637) in the CMV group and 5.74% (822) in the control group, respectively. The difference was statistically significant by p= 2.2x10-16, odds ratio = 2.696 (95% CI 2.483- 2.927). In an attempt to stratify the population by antiviral medication exposure, the outcomes were limited by the decreased number of members exposed to antiviral medication in the control population. Conclusion: This study shows a statistically significant correlation between prior CMV infection and an increased incidence of lymphoma afterward. Further exploration is needed to identify the potential carcinogenic mechanism of CMV and whether the results are attributed to a confounding bias.

Keywords: cytomegalovirus, lymphoma, cancer, microbiology

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Authors: Renga Rao Krishnamoorthy, Raihan Tahir

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The quality of classroom learning and teaching delivery has been and will continue to be debated at various levels worldwide. The regional cooperation programme to improve the quality and labour market orientation of the Technical and Vocational Education and Training (RECOTVET), ‘Deutsche Gesellschaft für Internationale Zusammenarbeit’ (GIZ), in line with the sustainable development goals (SDG), has taken the initiative in the development of quality TVET in the ASEAN region by developing the Quality Toolbox for Better TVET Delivery (Quality Toolbox). This initiative aims to provide quick and practical materials to trainers, instructors, and personnel involved in education and training at an institute to shape the quality of classroom learning and teaching. The Quality Toolbox for Better TVET Delivery was developed in three stages: literature review and development, validation, and finalization. Thematic areas in the Quality Toolbox were derived from collective input of concerns and challenges raised from experts’ workshops through moderated sessions involving representatives of TVET institutes from 9 ASEAN Member States (AMS). The sessions were facilitated by professional moderators and international experts. TVET practitioners representing AMS further analysed and discussed the structure of the Quality Toolbox and content of thematic areas and outlined a set of specific requirements and recommendations. The application exercise of the Quality Toolbox was carried out by TVET institutes among ASM. Experience sharing sessions from participating ASEAN countries were conducted virtually. The findings revealed that TVET institutes use two types of approaches in shaping the quality of learning and teaching, which is ascribed to inductive or deductive, shaping of quality in learning and teaching is a non-linear process and finally, Q-tools can be adopted and adapted to shape the quality of learning and teaching at TVET institutes in the following: improvement of the institutional quality, improvement of teaching quality and improvement on the organisation of learning and teaching for students and trainers. The Quality Toolbox has good potential to be used at education and training institutes to shape quality in learning and teaching.

Keywords: AMS, GIZ, RECOTVET, quality tools

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Authors: Mehmet Akköse

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Concern about seismic safety of concrete dams have been growing around the world, partly because the population at risk in locations downstream of major dams continues to expand and also because it is increasingly evident that the seismic design concepts in use at the time most existing dams were built were inadequate. Most of the investigations in the past have been conducted on large dams, typically above 100m high. A large number of concrete dams in our country and in other parts of the world are less than 50m high. Most of these dams were usually designed using pseudo-static methods, ignoring the dynamic characteristics of the structure as well as the characteristics of the ground motion. Therefore, it is important to carry out investigations on seismic behavior this category of dam in order to assess and evaluate the safety of existing dams and improve the knowledge for different high dams to be constructed in the future. In this study, size effects on structural performance of concrete gravity dams subjected to near and far-fault ground motions are investigated including dam-water-foundation interaction. For this purpose, a benchmark problem proposed by ICOLD (International Committee on Large Dams) is chosen as a numerical application. Structural performance of the dam having five different heights is evaluated according to damage criterions in USACE (U.S. Army Corps of Engineers). It is decided according to their structural performance if non-linear analysis of the dams requires or not. The linear elastic dynamic analyses of the dams to near and far-fault ground motions are performed using the step-by-step integration technique. The integration time step is 0.0025 sec. The Rayleigh damping constants are calculated assuming 5% damping ratio. The program NONSAP modified for fluid-structure systems with the Lagrangian fluid finite element is employed in the response calculations.

Keywords: concrete gravity dams, Lagrangian approach, near and far-fault ground motion, USACE damage criterions

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Authors: Arnold Missiame

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In Ghana, rural dwellers who depend primarily on agriculture for their livelihood constitute about 60% of the country’s population. This shows the critical role and potentials of the agricultural sector in helping to achieve Ghana’s vision 2030. With the current threat of climate change and advancements in technology, agricultural extension is not just about technology transfer and improvements in productivity, but it is also about improving the managerial and technical skills of farmers. In Ghana, the government of Ghana as well as other players in the sector like; non-governmental organizations, NGOs, local and international funding agencies, for decades now, have made capacity-building-investments in smallholder farmers by way of extension services delivery. This study sought to compare the technical efficiency of farmers who have access to agricultural extension and farmers who do not in Ghana. The study employed the stochastic meta-frontier model to analyze household survey data comprising 300 smallholder cassava farmers from the Fanteakwa district of Ghana. The farmers were selected through a two-stage sampling technique where 5 communities were purposively selected in the first stage and then 60 smallholder cassava farmers were randomly selected from each of the 5 communities. Semi-structured questionnaires were used to collect data on farmers’ socioeconomic and farm-level characteristics. The results showed that farmers who have access to agricultural extensions services have higher technical efficiencies (TE) and produce much closer to their meta-production frontiers (higher technology gap ratios (TGR) than farmers who do not have access to such extension services. Furthermore, experience in cassava cultivation and formal education significantly improves the technical efficiencies of farmers. The study recommends that the mode and scope of agricultural extension service delivery in the country should be enhanced to ensure that smallholder farmers have easy access to extension agents.

Keywords: agricultural extension, Ghana, smallholder farmers, stochastic meta-frontier model, technical efficiency

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Authors: Folasade R. Sulaiman

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Pupils’ health and nutrition are basically important to their schooling. The preponderance of avoidable deaths among children in Africa (WHO, 2000) may not be unconnected with the nutritional and health education status of families and communities that have their children as school clients. This study adopted a descriptive survey design focusing on the assessment of the level of nutritional and health education of families and community members in the rural riverine areas of Ogun State. Two research questions were raised. The Nutritional and Health Education of Families and Communities Inventory (NHEFCI) was used to collect data from 250 rural child-bearing aged women, and 0.73 test-retest reliability coefficient was established to determine the strength of the instrument. Data collected were analysed using descriptive statistics of frequency counts, percentages and mean in accordance with research questions raised in the study. The findings revealed amongst others: that 65% of the respondents had low level of nutritional and health education among the families and community members; while 72% had low level of awareness of the possible influence of nutritional and health education on the learning outcomes of the children. Based on the findings, it was recommended among others that government should intensify efforts on sensitization, mass literacy campaign etc.; also improve upon the already existing School Feeding Programme in Nigerian primary schools to provide at least one balanced diet for children while in school; community health workers, social workers, Non-Governmental Organizations (NGO) should collaborate with international Organizations like UNICEF, UNESCO, WHO etc. to organize sensitization programmes for members of the rural riverine communities on the importance of meeting the health and nutritional needs of their children in order to attain their educational potentials.

Keywords: nutritional and health education, learning capacities, school-age children, universal basic education, rural riverine areas

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Authors: Paulina Clara Appiah, Kofi Issah, Timothy Letsa, Kennedy Nartey, Amanua Chinbuah, Adoma Dwomo-Fokuo, Jacqeline G. Asibey

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Background: The Every Newborn Action Plan provides evidence–based interventions to end preventable deaths in high burden countries. Brong Ahafo Region is one of ten regions in Ghana with less than half of its district hospitals having sick newborn units. Facility-based neonatal care is not prioritized and under-funded, and there is also inadequate knowledge and competence to manage the sick. The aim of this intervention was to make available in–patient care for sick newborns in all 19 district hospitals through the strengthening of facility-based systems. Methods: With the development and dissemination of the National Newborn Strategy and Action Plan 2014-2018, the country was able to attract PATH which provided the region with basic resuscitation equipment, supported hospital providers’ capacity building in Helping Babies Breathe, Essential Care of Every Baby, Infection Prevention and Management and held a symposia on managing the sick newborn. Newborn advocacy was promoted through newborn champions at the facility and community levels. Hospital management was then able to mobilize resources from communities, corporate organizations and from internally generated funds; created or expanded sick newborn care units and provided essential medicines and equipment. Kangaroo Mother Care was initiated in 6 hospitals. Pediatric specialist outreach services initiated comprised telephone consultations, teaching ward rounds and participating in perinatal death audits meetings. Newborn data capture and management was improved through the provision and training on the use of standard registers provided from the national level. Results: From February 2015 to November 2017, hospitals with sick newborn units increased from 7 to 19 (37%-100%). 180 pieces each of newborn ventilation bags and masks size 0, 1 and penguin suction bulbs were distributed to the hospitals, in addition to 20 newborn mannequin sets and 90 small clinical reminder posters. 802 providers (96.9%) were trained in resuscitation, of which 96% were successfully followed up in 6 weeks, 91% in 6 months and 80% in 12 months post-training. 53 clinicians (65%) were trained and mentored to manage sick newborns. 56 specialist teaching ward rounds were conducted. Data completeness improved from 92.6% - 99.9%. Availability of essential medicines improved from 11% to 100%. Number of hospital cots increased from 116 to 248 (214%). Cot occupancy rate increased from 57.4% to 92.5%. Hospitals with phototherapy equipment increased from 0 to 12 (63%). Hospitals with incubators increased from 1 to 12 (5%-63%). Newborn deaths among admissions reduced from 6.3% to 5.4%. Conclusion: Access to in-patient care increased significantly. Newborn advocacy successfully mobilized resources required for strengthening facility –based systems.

Keywords: facility-based systems, Ghana, in-patient care, newborn advocacy

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Authors: Isaac Kofi Mensah

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E-government has been adopted and used by many governments/countries around the world including Ghana to provide citizens and businesses with more accurate, real-time, and high quality services and information. The objective of this paper is to present an overview of the Government of Ghana’s (GoG) adoption and implement of e-government and its usage by the Ministries, Departments and its agencies (MDAs) as well as other public sector institutions to deliver efficient public service to the general public i.e. citizens, business etc. Government implementation of e-government focused on facilitating effective delivery of government service to the public and ultimately to provide efficient government-wide electronic means of sharing information and knowledge through a network infrastructure developed to connect all major towns and cities, Ministries, Departments and Agencies and other public sector organizations in Ghana. One aim for the Government of Ghana use of ICT in public administration is to improve productivity in government administration and service by facilitating the exchange of information to enable better interaction and coordination of work among MDAs, citizens and private businesses. The study was prepared using secondary sources of data from government policy documents, national and international published reports, journal articles, and web sources. This study indicates that through the e-government initiative, currently citizens and businesses can access and pay for services such as renewal of driving license, business registration, payment of taxes, acquisition of marriage and birth certificates as well as application for passport through the GoG electronic service (eservice) and electronic payment (epay) portal. Further, this study shows that there is an enormous commitment from GoG to adopt and implement e-government as a tool not only to transform the business of government but also to bring efficiency in public services delivered by the MDAs. To ascertain this, a further study need to be carried out to determine if the use of e-government has brought about the anticipated improvements and efficiency in service delivery of MDAs and other state institutions in Ghana.

Keywords: electronic government, electronic services, electronic pay, MDAs

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Authors: F. V. Matta, C. M. Donnelly, M. B. Jaafar, N. I. Ward

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‘Yerba Mate’ (Ilex paraguariensis) is a native plant from South America with the main producers being Argentina and Brazil. ‘Mate’ is widely consumed in Argentina, Brazil, Uruguay and Paraguay. The most popular format is as an infusion made from dried leaves of a traditional cup, roasted material in tea bags or iced tea infusions. There are many alleged health benefits resulted from mate consumption, even though there is a lack of conclusive research published in the international literature. The main objective of this study was to develop and evaluate the sample preparation and instrumental analysis stages involved in the determination of trace elements in yerba mate using inductively coupled plasma mass spectrometry (ICP-MS). Specific details on the methods of sample digestion, validation of the ICP-MS analysis especially for polyatomic ion correction and matrix effects associated with the complex medium of mate will be presented. More importantly, mate produced in Brazil and Argentina, is subject to different soil conditions, methods of cultivation and production, especially for loose leaves and tea bags. The highest concentrations for loose mate leaf were for (mg/kg, dry weight): aluminium (253.6 – 506.9 for Brazil (Bra), 230.0 – 541.8 for Argentina (Arg), respectively), manganese (378.3 – 762.6 Bra; 440.8 – 879.9 Arg), iron (32.5 – 85.7 Bra; 28.2 – 132.9 Arg), zinc (28.2 – 91.1 Bra; 39.1 – 92.3 Arg), nickel (2.2 – 4.3 Bra; 2.9 – 10.8 Arg) and copper (4.8 – 9.1 Bra; 4.3 – 9.2 Arg), with lower levels of chromium, cobalt, selenium, molybdenum, cadmium, lead and arsenic. Elemental levels of mate leaf consumed in tea bags were found to be higher, mainly due to only using leaf material (as opposed to leaf and twig for loose packed product). Further implications of the way of consuming yerba mate will be presented, including different infusion methods in Brazil and Argentina. This research provides for the first time an extensive evaluation of mate products from both countries and the possible implications of specific trace elements, especially Mn, Fe, Se, Cu and Zn and the various health claims of consuming yerba mate.

Keywords: beverage analysis, ICP-MS, trace elements, yerba mate

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Authors: Chetna Dhand, Venkatesh Mayandi, Silvia Marrero Diaz, Roger W. Beuerman, Seeram Ramakrishna, Rajamani Lakshminarayanan

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Sturdy Insect Cuticle Sclerotization, Incredible Substrate independent Mussel’s bioadhesion, Tanning of Leather are some of catechol(amine)s mediated natural processes. Chemical contemplation spots toward a mechanism instigated with the formation of the quinone moieties from the respective catechol(amine)s, via oxidation, followed by the nucleophilic addition of the amino acids/proteins/peptides to this quinone leads to the development of highly strong, cross-linked and water-resistant proteinacious structures. Inspired with this remarkable catechol(amine)s chemistry towards amino acids/proteins/peptides, we attempted to design highly stable and water-resistant antifungal wound dressing mats with exceptional durability using collagen (protein), dopamine (catecholamine) and antifungal drugs (Amphotericin B and Caspofungin) as the key materials. Electrospinning technique has been used to fabricate desired nanofibrous mat including Collagen (COLL), COLL/Dopamine (COLL/DP) and calcium incorporated COLL/DP (COLL-DP-Ca2+). The prepared protein-based scaffolds have been studied for their microscopic investigations (SEM, TEM, and AFM), structural analysis (FT-IR), mechanical properties, water wettability characteristics and aqueous stability. Biocompatibility of these scaffolds has been analyzed for dermal fibroblast cells using MTS assay, Cell TrackerTM Green CMFDA and confocal imaging. Being the winner sample, COLL-DP-Ca2+ scaffold has been selected for incorporating two antifungal drugs namely Caspofungin (Peptide based) and Amphotericin B (Non-Peptide based). Antifungal efficiency of the designed mats has been evaluated for eight diverse fungal strains employing different microbial assays including disc diffusion, cell-viability assay, time kill kinetics etc. To confirm the durability of these mats, in term of their antifungal activity, drug leaching studies has been performed and monitored using disc diffusion assay each day. Ex-vivo fungal infection model has also been developed and utilized to validate the antifungal efficacy of the designed wound dressings. Results clearly reveal dopamine mediated crosslinking within COLL-antifungal scaffolds that leads to the generation of highly stable, mechanical tough, biocompatible wound dressings having the zone of inhabitation of ≥ 2 cm for almost all the investigated fungal strains. Leaching studies and Ex-vivo model has confirmed the durability of these wound dressing for more than 3 weeks and certified their suitability for commercialization. A model has also been proposed to enlighten the chemical mechanism involved for the development of these antifungal wound dressings with exceptional robustness.

Keywords: catecholamine chemistry, electrospinning technique, antifungals, wound dressings, collagen

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Authors: Jaci Marie Mastrandrea, Rosario Haro

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Background: The National Comprehensive Cancer Network (NCCN) recommends that healthcare institutions have established processes for integrating palliative care (PC) into cancer treatment and that all cancer patients be screened for PC needs upon initial diagnosis as well as throughout the entire continuum of care (National Comprehensive Cancer Network, 2021). Early PC screening and intervention is directly associated with improved patient outcomes. The Sky Lakes Cancer Treatment Center (SLCTC) is an institution that has access to PC services yet does not have protocols in place for identifying patients with palliative needs or a standardized referral process. The aim of this quality improvement project was to improve early access to PC services by establishing a standardized screening and referral process for outpatient oncology patients. Method: The sample population included all adult patients with an oncology diagnosis who presented to the SLCTC for treatment during the project timeline. The “Palliative and Supportive Needs Assessment'' (PSNA) screening tool was developed from validated, evidence-based PC referral criteria. The tool was initially implemented using paper forms, and data was collected over a period of eight weeks. Patients were screened by nurses on the SLCTC oncology treatment team. Nurses responsible for screening patients received an educational inservice prior to implementation. Patients with a PSNA score of three or higher received an educational handout on the topic of PC and education about PC and symptom management. A score of five or higher indicates that PC referral is strongly recommended, and the patient’s EHR is flagged for the oncology provider to review orders for PC referral. The PSNA tool was approved by Sky Lakes administration for full integration into Epic-Beacon. The project lead collaborated with the Sky Lakes’ information systems team and representatives from Epic on the tool’s aesthetic and functionality within the Epic system. SLCTC nurses and physicians were educated on how to document the PSNA within Epic and where to view results. Results: Prior to the implementation of the PSNA screening tool, the SLCTC had zero referrals to PC in the past year, excluding referrals to hospice. Data was collected from the completed screening assessments of 100 patients under active treatment at the SLCTC. Seventy-three percent of patients met criteria for PC referral with a score greater than or equal to three. Of those patients who met referral criteria, 53.4% (39 patients) were referred for a palliative and supportive care consultation. Patients that were not referred to PC upon meeting criteria were flagged in EPIC for re-screening within one to three months. Patients with lung cancer, chronic hematologic malignancies, breast cancer, and gastrointestinal malignancy most frequently met the criteria for PC referral and scored highest overall on the scale of 0-12. Conclusion: The implementation of a standardized PC screening tool at the SLCTC significantly increased awareness of PC needs among cancer patients in the outpatient setting. Additionally, data derived from this quality improvement project supports the national recommendation for PC to be an integral component of cancer treatment across the entire continuum of care.

Keywords: oncology, palliative and supportive care, symptom management, outpatient oncology, palliative screening tool

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Authors: A. R. Shakura, A. B. Elistina, M. S. Aini, S. Norhasmah, A. Fakhru’l-Razi

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Tsunami 2004 was an unforeseeable event that caught Malaysia of guard resulting with 68 losses of lives and with an estimated economic loss of about 55.15billion US dollar. Scientists predict that if the earthquake epicentre originates from the Andaman-Nicobar region, the coastal population of Penang will have about 30 minutes to evacuate to safety. Thus, a study was conducted to enhance resiliency of Penang community as the area was the worst affected region during 2004 tsunami disaster. This paper is intended to examine the factors that influence intention to prepare for future tsunami among the coastal residence in Penang. The differences in the level of intention to prepare were also examined between those who experience and did not experience the 2004 tsunami. This study utilized a cross-sectional research design using a survey method. A total of 503 respondents were chosen systematically and data gathered were analysed using SPSS. Both genders, male and female were equally represented with a mean age of 44 years. Data indicated that the level of intention to prepare for tsunami disaster was moderate (M=3.72) with no significant difference in intention to prepare between those who had experienced or had not experienced the 2004 tsunami. Subsequently, results from a multiple regression analysis found that sense of community to be the most influential factor followed by subjective norm, trust, positive outcome expectancy and risk perception, explaining the 57% variance in intention to prepare. These factors reflect the influence of the collectivistic culture in Malaysia whereby households plus communities have a central role in encouraging each other. Therefore, the findings highlights the potential of adopting a community based disaster risk management as recommended by the United Nations International Strategy Disaster Reduction (UNISDR) which encompasses the cooperation between the local community and relevant stakeholders in preparing for future tsunami disaster.

Keywords: disaster management, experience, intention to prepare, tsunami

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Authors: F. Fatoye, C. E. Mbada, T. Gebrye, A. O. Ogunsola, C. Fatoye, O. Oyewole

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Musculoskeletal disorders (MSDs) are a major cause of pain and disability. It is likely to become a greater economic and public health burden that is unnecessary. Thus, reliable prevalence figures are important for both clinicians and policy-makers to plan health care needs for those affected with the disease. This study estimated hospital based real-world prevalence of MSDs in Nigeria. A review of medical charts for adult patients attending Physiotherapy Outpatient Clinic at the Obafemi Awolowo University Teaching Hospitals Complex, Osun State, Nigeria between 2009 and 2018 was carried out to identify common MSDs including low back pain (LBP), cervical spondylosis (CSD), post immobilization stiffness (PIS), sprain, osteoarthritis (OA), and other conditions. Occupational class of the patients was determined using the International Labour Classification (ILO). Data were analysed using descriptive statistics of frequency and percentages. Overall, medical charts of 3,340 patients were reviewed within the span of ten years (2009 to 2018). Majority of the patients (62.8%) were in the middle class, and the remaining were in low class (25.1%) and high class (10.5%) category. An overall prevalence of 47.35% of MSD was found within the span of ten years. Of this, the prevalence of LBP, CSD, PIS, sprain, OA, and other conditions was 21.6%, 10%, 18.9%, 2%, 6.3%, and 41.3%, respectively. The highest (14.2%) and lowest (10.5%) prevalence of MSDs was recorded in the year of 2012 and 2018, respectively. The prevalence of MSDs is considerably high among Nigerian patients attending outpatient a physiotherapy clinic. The high prevalence of MSDs underscores the need for clinicians and decision makers to put in place appropriate strategies to reduce the prevalence of these conditions. In addition, they should plan and evaluate healthcare services to improve the health outcomes of patients with MSDs. Further studies are required to determine the economic burden of the condition and examine the clinical and cost-effectiveness of physiotherapy interventions for patients with MSDs.

Keywords: musculoskeletal disorders, Nigeria, prevalence, real world

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Authors: Alberto Piatto, Zaza Nadja Lee Hansen, Peter Jacobsen

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This paper examines the quantitative and qualitative factors influencing the buyer-supplier relationship. Understanding and acting on the right factors influencing supplier relationship management is crucial when a company outsource an important part of its business as it can be for engineering to order (ETO) company executing only the designing part in-house. Acting on these factors increase the quality of the relationship obtaining for both parties what they want and expect from an improved relationship. Best practices in supplier relationship management are considered and a case study of a large global company, called Cement A/S, operating in the cement business is carried out. One study is conducted including a large international company and hundreds of its suppliers. Data from the company is collected using semi-structured interviews and data from the suppliers is collected using a survey. Based on these inputs and an extensive literature review a classification of factors influencing the relationship buyer-supplier is presented and discussed. The results show that different managers among the company are assessing supplier from various perspectives, a standard approach to measure the performance of suppliers does not exist. The factors used nowadays in the company to measure performances of the suppliers are mostly related to time and cost. Quality is a key factor, but it has not been addressed properly since no data are available in the system. From a practical perspective, managers can learn from this paper which factors to consider when applying best practices of Supplier Relationship Management. Furthermore, from a theoretical perspective, this paper contributes with new knowledge in the area as limited research in collaboration with the company has been conducted. For this reason, a company, its suppliers and few studies for this type of industry have been conducted. For further research, it is suggested to define the correlation of factors to the profitability of the company and calculate its impact. When conducting this analysis it is important to focus on the efficient and effective use of factors that can be measurable and accepted from the supplier.

Keywords: buyer-supplier relationship, cement industry, classification of factors, ETO

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Authors: Reem Alsager, James Milton

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Coxhead’s (2000) Academic Word List (AWL) believed to be essential for students pursuing higher education and helps differentiate English for Academic Purposes (EAP) from General English as a course of study, and it is thought to be important for comprehending English academic texts. It has been described that AWL is an infrequent, discrete set of vocabulary items unreachable from general language. On the other hand, it has been known for a period of time that general vocabulary knowledge is a good predictor of academic achievement. This study, however, is an attempt to measure and compare the contribution of academic knowledge and general vocabulary knowledge to learners’ GPA and examine what knowledge is a better predictor of academic achievement and investigate whether AWL as a specialised list of infrequent words relates to the frequency effect. The participants were comprised of 44 international postgraduate students in Swansea University, all from the School of Management, following the taught MSc (Master of Science). The study employed the Academic Vocabulary Size Test (AVST) and the XK_Lex vocabulary size test. The findings indicate that AWL is a list based on word frequency rather than a discrete and unique word list and that the AWL performs the same function as general vocabulary, with tests of each found to measure largely the same quality of knowledge. The findings also suggest that the contribution that AWL knowledge provides for academic success is not sufficient and that general vocabulary knowledge is better in predicting academic achievement. Furthermore, the contribution that academic knowledge added above the contribution of general vocabulary knowledge when combined is really small and noteworthy. This study’s results are in line with the argument and suggest that it is the development of general vocabulary size is an essential quality for academic success and acquiring the words of the AWL will form part of this process. The AWL by itself does not provide sufficient coverage, and is probably not specialised enough, for knowledge of this list to influence this general process. It can be concluded that AWL as an academic word list epitomizes only a fraction of words that are actually needed for academic success in English and that knowledge of academic vocabulary combined with general vocabulary knowledge above the most frequent 3000 words is what matters most to ultimate academic success.

Keywords: academic achievement, academic vocabulary, general vocabulary, vocabulary size

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Authors: Matthew Edmunds, Andrew Hunter, Clare Littlewood, Wisha Gul, Gabriel Heppenstall-Harris, Thomas Humphries

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Background: Revision courses for medical students undertaking their final examinations are commonplace throughout the UK. Traditionally these take the form of a series of lectures over multiple weeks or a single day of intensive lectures. The COVID-19 pandemic, however, has required medical educators to create new teaching formats to ensure they adhere to social distancing requirements. It has provided an unexpected opportunity to accelerate the development of students proficiency in the use of ‘technology-enabled communication platforms’, as mandated in the 2018 GMC Outcomes of Graduates. Recent advances in technology have made distance learning possible, whilst also providing novel and more engaging learning opportunities for students. Foundation Year 2 doctors at Aintree University Hospital developed an online series of videos to help prepare medical students in the North West and byond for their final medical school examinations. Method: Eight hour-long videos covering the key topics in medicine and surgery were posted on the Peer Learning Liverpool Youtube channel. These videos were created using new technology such as the screen and audio recording platform, Loom. Each video compromised at least 20 single best answer (SBA) questions, in keeping with the format in most medical school finals. Explanations of the answers were provided, and additional important material was covered. Students were able to ask questions by commenting on the videos, with the authors replying as soon as possible. Feedback was collated using an online Google form. Results: An average of 327 people viewed each video, with 113 students filling in the feedback form. 65.5% of respondents were within one month of their final medical school examinations. The average rating for how well prepared the students felt for their finals was 6.21/10 prior to the course and 8.01/10 after the course. A paired t-test demonstrated a mean increase of 1.80 (95% CI 1.66-1.93). Overall, 98.2% said the online format worked well or very well, and 99.1% would recommend the course to a peer. Conclusions: Based on the feedback received, the online revision course was successful both in terms of preparing students for their final examinations, and with regards to how well the online format worked. Free-text qualitative feedback highlighted advantages such as; students could learn at their own pace, revisit key concepts important to them, and practice exam style questions via the case-based format. Limitations identified included inconsistent audiovisual quality, and requests for a live online Q&A session following the conclusion of the course. This course will be relaunched later in the year with increased opportunities for students to access live feedback. The success of this online course has shown the roll that technology can play in medical education. As well as providing novel teaching modes, online learning allows students to access resources that otherwise would not be available locally, and ensure that they do not miss out on teaching that was previously provided face to face, in the current climate of social distancing.

Keywords: COVID-19 pandemic, Medical School, Online learning, Revision course

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Authors: Targba Aondowase

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Undocumented migration along Nigeria’s boarder with Cameroon, Chad and Niger is a key issue in tackling the human security challenges in the region as the security situation cannot be contained without proper boarder control. The paper adopts migration systems theory which asserts that migration alters the social, cultural, economic, and institutional conditions at both the sending and receiving ends to explain the influence of unregistered migrants on institutional changes as it affects the security situation in Northern Nigeria. It was found that undocumented migration is majorly influenced by poverty, illegal trade, wars and asylum. The study also discovers that Nigerian boarders are porous with over 250 footpaths that link directly to Cameroon, Chad and Niger, making the proliferation of small arms and light weapons a transnational organized crime in the region. These porous borders are unmanned by security operatives with limited government presence in the boarder communities. The study also found that undocumented immigrants are easily integrated into the northern communities due to common religious beliefs and race where they carry out normal and civic functions without obstruction. The paper concluded that the level of undocumented migration in Northern Nigeria is high due to unmanned and porous borders. The paper therefore recommended that the security agencies should be strengthened through adequate funding, innovative technology, sound policies and proficient processes that will help protect the country’s borders. The National Populations Commission and the National Identity Management Commission should be strengthened to have a good data base of the country’s citizens and there should be international cooperation between the neighbouring countries to tackle illegal migration and illegal trade along the borders. The findings and recommendations of this paper will serve as a guide towards curtailing the impact of undocumented migration on human security in Northern Nigeria.

Keywords: human security, impact, migration, undocumented

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Authors: Yollande Sènan Djivoh, Dominique de Jaeger

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Background: Abdominal exercises are commonly practised nowadays. Specific techniques of abdominal muscles strengthening like hypopressive exercises have recently emerged and their practice is encouraged against the practice of Curl-up especially in postpartum. The acute and the training effects of these exercises did not allow to advise one exercise to the detriment of another. However, physiotherapists remain reluctant to perform Curl-up with postpartum women because of its potential harmful effect on the pelvic floor. Design: This study was a randomized control trial registered under the number PACTR202110679363984. Objective: to observe the training effect of two experimental protocols (Curl-up versus Drawing-in+Diaphragmatic aspiration) on the abdominal wall (interrecti distance, rectus and transversus abdominis thickness, abdominal strength) in Beninese postpartum women. Pelvic floor function (tone, endurance, urinary incontinence) will be assessed to evaluate potential side effects of exercises on the pelvic floor. Method: Postpartum women diagnosed with diastasis recti were randomly assigned to one of three groups (Curl-up, Drawingin+Diaphragmatic aspiration and control). Abdominal and pelvic floor parameters were assessed before and at the end of the 6-week protocol. The interrecti distance and the abdominal muscles thickness were assessed by ultrasound and abdominal strength by dynamometer. Pelvic floor tone and strength were assessed with Biofeedback and urinary incontinence was quantified by pad test. To compare the results between the three groups and the two measurements, a two-way Anova test with repeated measures was used (p<0.05). When interaction was significant, a posthoc using Student t test, with Bonferroni correction, was used to compare the three groups regarding the difference (end value minus initial value). To complete these results, a paired Student t test was used to compare in each group the initial and end values. Results: Fifty-eight women participated in this study, divided in three groups with similar characteristics regarding their age (29±5 years), parity (2±1 children), BMI (26±4 kg/m2 ), time since the last birth (10±2 weeks), weight of their baby at birth (330±50 grams). Time effect and interaction were significant (p<0.001) for all abdominal parameters. Experimental groups improved more than control group. Curl-up group improved more (p=0.001) than Drawing-in+Diaphragmatic aspiration group regarding the interrecti distance (9.3±4.2 mm versus 6.6±4.6 mm) and abdominal strength (20.4±16.4 Newton versus 11.4±12.8 Newton). Drawingin+Diaphragmatic aspiration group improved (0.8±0.7 mm) more than Curl-up group (0.5±0.7 mm) regarding the transversus abdominis thickness (p=0.001). Only Curl-up group improved (p<0.001) the rectus abdominis thickness (1.5±1.2 mm). For pelvic floor parameters, both experimental groups improved (p=0.01) except for tone which improved (p=0.03) only in Drawing-in+Diaphragmatic aspiration group from 19.9±4.1 cmH2O to 22.2±4.5 cmH2O. Conclusion: Curl-up was more efficient to improve abdominal function than Drawingin+Diaphragmatic aspiration. However, these exercises are complementary. None of them degraded the pelvic floor, but Drawing-in+Diaphragmatic aspiration improved further the pelvic floor function. Clinical implications: Curl-up, Drawing-in and Diaphragmatic aspiration can be used for the management of abdominal function in postpartum women. Exercises must be chosen considering the specific needs of each woman’s abdominal and pelvic floor function.

Keywords: curl-up, drawing-in, diaphragmatic aspiration, hypopressive exercise, postpartum women

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Authors: Tina Sleiman

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In the early 1970s, a graphics revolution - in quantity and quality - marked the youth publications sector in France. The increased interest in youth publications was supported with the emergence of youth libraries and major publishing houses. In parallel, the 'Agence de Cooperation Culturelle et Technique' (currently the International Organization of the Francophonie) was created, and several Arab countries had joined as members. In spite of political turmoil in the Middle East, French schools in Arab countries were still functioning and some even flourishing. This is a testament that French culture was, and still is, a major export to the region. This study focuses on the aesthetic value of the graphic styles that characterize French children’s books from the 1970s, and their personal value to Francophone people who have consumed these artifacts, in the Middle East. The first part of the study looks at the artifact itself: starting from the context of creation and consumption of these books, and continuing to the preservation and remaining collections. The aesthetic value is studied and compared to similar types of visuals of juxtaposed time periods. The second part examines the audience’s response to the visuals in terms of style recognition or identification, along with emotional significance or associations, and the personal value the artifacts might hold to their consumers. The methods of investigation consist of a literature review, a survey of book collections, and a visual questionnaire, supported by personal interviews. As an outcome, visual patterns will be identified: elements from 1970s children’s books reborn in contemporary youth-based publications. Results of the study shall inform us directly on the aesthetic and personal value of illustrated French children’s books in the Middle East, and indirectly on the capacity of youth-targeted design to create a long-term emotional response from its audience.

Keywords: children’s books, French visual culture, graphic style, publication design, revival

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Authors: Mohammad Javaherian, Siamak Bashardoust Tajali, Monavvar Hadizadeh

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Objective: This systematic review study was conducted to evaluate the effects of Pulsed Electromagnetic (PEMF) and Static Magnetic Fields (SMG) on pain relief and functional improvement in patients with musculoskeletal Low Back Pain (LBP). Methods: Seven electronic databases were searched by two researchers independently to identify the published Randomized Controlled Trials (RCTs) on the efficacy of pulsed electromagnetic, static magnetic, and therapeutic nuclear magnetic fields. The identified databases for systematic search were Ovid Medline®, Ovid Cochrane RCTs and Reviews, PubMed, Web of Science, Cochrane Library, CINAHL, and EMBASE from 1968 to February 2016. The relevant keywords were selected by Mesh. After initial search and finding relevant manuscripts, all references in selected studies were searched to identify second hand possible manuscripts. The published RCTs in English would be included to the study if they reported changes on pain and/or functional disability following application of magnetic fields on chronic musculoskeletal low back pain. All studies with surgical patients, patients with pelvic pain, and combination of other treatment techniques such as acupuncture or diathermy were excluded. The identified studies were critically appraised and the data were extracted independently by two raters (M.J and S.B.T). Probable disagreements were resolved through discussion between raters. Results: In total, 1505 abstracts were found following the initial electronic search. The abstracts were reviewed to identify potentially relevant manuscripts. Seventeen possibly appropriate studies were retrieved in full-text of which 48 were excluded after reviewing their full-texts. Ten selected articles were categorized into three subgroups: PEMF (6 articles), SMF (3 articles), and therapeutic nuclear magnetic fields (tNMF) (1 article). Since one study evaluated tNMF, we had to exclude it. In the PEMF group, one study of acute LBP did not show significant positive results and the majority of the other five studies on Chronic Low Back Pain (CLBP) indicated its efficacy on pain relief and functional improvement, but one study with the lowest sessions (6 sessions during 2 weeks) did not report a significant difference between treatment and control groups. In the SMF subgroup, two articles reported near significant pain reduction without any functional improvement although more studies are needed. Conclusion: The PEMFs with a strength of 5 to 150 G or 0.1 to 0.3 G and a frequency of 5 to 64 Hz or sweep 7 to 7KHz can be considered as an effective modality in pain relief and functional improvement in patients with chronic low back pain, but there is not enough evidence to confirm their effectiveness in acute low back pain. To achieve the appropriate effectiveness, it is suggested to perform this treatment modality 20 minutes per day for at least 9 sessions. SMFs have not been reported to be substantially effective in decreasing pain or improving the function in chronic low back pain. More studies are necessary to achieve more reliable results.

Keywords: pulsed electromagnetic field, static magnetic field, magnetotherapy, low back pain

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Authors: Viktoriia Burkina, Vladimir Zlabek, Galia Zamaratskaia

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Cytochromes P450 (CYP) are important family of enzymes in Phase I metabolism. Environmental pollutants often act as inducers of the gene expression and activities CYP1A1 and CYP3A-like isoforms in fish. The activities are generally measured in the fish liver or gills, and less is known about tissue distribution of expression. In present study, the CYP1A1 and CYP3A-like activities were measured in rainbow trout liver, gill, intestine, heart, brain and gonads. The activities of CYP1A1 and CYP3A-like proteins were estimated as the rates of 7-ethoxyresorufin-O-deethylation (EROD) and benzyloxy-4-trifluoromethylcoumarin-O-debenzyloxylation (BFCOD), respectively. The CYP1A1 and CYP3A-like activities were detectable in all investigated fish tissues, with the highest activity in hepatic tissue followed by heart > brain > gill > intestine > gonads. To confirm the presence of CYP1A1 in different tissues, EROD activity was measured in presence of the selective inhibitors ellipticine (CYP1A1), ketoconazole (CYP3A), 8-methoxypsoralen (human CYP2A) and diallyl sulphide (CYP2E1). It was found that ellipticine, ketoconazole and 8-methoxypsoralen inhibited hepatic EROD activity by 88-98%. Ellipticine inhibited gill, intestine, and gonad EROD activity by 50%. In conclusion, EROD and BFCOD activities were detected in rainbow trout liver, gill, intestine, heart, brain and gonads. Further studies are needed to fully identify all CYP450 isoforms responsible for these activities. Acknowledgement: The study was financially supported by the Ministry of Education, Youth and Sports of the Czech Republic - projects „CENAKVA “(No. CZ.1.05/2.1.00/01.0024), “CENAKVA Center Development “(No. CZ.1.05/2.1.00/19.0380), “CENAKVA II “(No. LO1205 under the NPU I program), and "Development of USB - International mobility (No. CZ.02.2.69/0.0/0.0/16_027/0008364).

Keywords: BFCOD, EROD, fish, phase I metabolism, selective inhibitors

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Authors: Ana Asratashvili

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One of the main issues of state’s economic policy is the environmental problems. The development of society is implementing by the connection with nature. A human being needs different material resources which must be got by the influence on the nature. This relationship between nature and society is complicated and controversial and it was changing from time to time according to human’s evolution. The imprudent and unreasonable usage of natural resources, scientific-technological revolution and the hard pollution of nature related to it caused the disruption of environmental balance between nature and society which has been made for ages and destructively acted on society and environment. Environmental protection is one of the major issues of the European Union all over the world. The aim of EU environmental policy is to improve ecological conditions. Besides, it aims encouraging of careful and rational usage of natural resources. At the same time, the union tries to raise problems related to environmental protection at the international level. After that when scientists concluded anthropogenic impact of human on the nature causes climate changes, the special attention was paid to the environmental protection by developed countries. Global warming will cause floods, storms, draughts and desertification and to solve these results presumably will cost 20% of World GDP by 2050 for developed countries, if, of course, it does not make strict environmental policy. EU member countries have pretty strict environmental standards. Their defense is observed by different state institutions. According to impacts on nature throughout the world the most polluted fumes are made by electricity facilities (44%), transport (20%), industry (18%), domestic and service sector (17%). The special concern to the issues related to the importance of environment by environmentalists is caused by low self-esteem of population about the problems of environment. According to their mind, population is engaged with daily difficulties so that they don’t react much on environmental problems. Correspondingly, the main task for environmental organizations is to inform population and raise self-esteem about environmental issues.

Keywords: economic policy, environment, technological revolution, pollution, environmental, standards, self-esteem

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Authors: Louise Elizabeth Bolton

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Statement of the problem: There are an estimated 328 million cases of COPD worldwide. It is likely to become the third biggest cause of death by 2030. The impact of living with palliative care needs arising from COPD disrupts an individual’s existential situation. Understandings of individuals' existential situations within COPD are limited within the research literature and are rarely addressed within clinical practice, yet existential suffering has been linked to poor health-related quality of life for those living with other chronic conditions. The purpose of this integrative review is to provide a synthesis of existing evidence on existential suffering for those living with palliative care needs arising from COPD. Methods: This is an integrative review undertaken in accordance with PRISMA guidelines. Nine electronic databases were searched from April 2019 to January 2021. Thirty-five empirical research papers of both qualitative and quantitative methodologies, alongside systematic literature reviews, were included. Data analysis was undertaken using an integrative thematic analysis approach. Findings: Identified themes of existential suffering when living with palliative care needs arising from COPD are as follows: Liminality, Lamented Life, Loss of Personal Liberty, Life Meaning and Existential isolation. The absence of life meaning and purpose was of most importance to patients. Conclusion and Significance: This integrative review provides a synthesis of international evidence upon the presence of existential suffering. It is present and of significant impact within the daily lives of those living with palliative care needs arising from COPD. The absence of life meaning has the most significant impact, requiring further exploration of both its physical and psychological impact. Rediscovery of life meaning diminishes feelings of worthlessness and hopelessness in daily life and facilitates feelings of inner peace. For those with COPD living with such a relentless symptom burden, a positive existential situation is desirable.

Keywords: palliative care, COPD, existential suffering, end of life care

Procedia PDF Downloads 135

Authors: Iahtasham Khan, Vania Lucia De Assis Santana, Marcilia Maria Alves De Souza, Mabel Hanna Vance Harrop, Fernando Leandro Dos Santos, Cecília Maria Souza Leão E. Silva, Pedro Paulo Silveira, Marcelo Brasil, Marcus Vinícius, Hélio Cordeiro Manso Filho, Muhammad Younus, Aman Ullah Khan

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Glanders ranks high on clinical lists in some regions of Brazil as a cause of respiratory and lymphatic disease in equids. Glanders is caused by Burkolderia mallei (B. mallei) Gram-negative bacterium. B. mallei was first biological agent used in World War I in 20th century. The complement fixation test (CFT) is a serodiagnostic tool prescribed by the World Organization for Animal Health (OIE)for the diagnosis of glanders in the international trade of equids. The aim of the present study was to monitor the serological responses in equines naturally infected with B. mallei using the CFT. A total of 574 equids were tested with CFT, 30 days apart in a total of 12 samplings. One hundred thirty-four sera tested negative in all samplings; 192 sera tested positive in one sampling and 125 sera tested positive in two or more samplings. Remaining 123 samples showed uncertain results. Thus, CFT results can vary over a period of time. These variations could be the consequence of the effects of the natural immune response in each animal. The findings of the present study demonstrate difficulties regarding the simultaneous implementation of CFT and test and slaughter policies to eradicate glanders. Another constraint to control this disease is the presence of carrier/transitory CFT-negative animals, which are a potential source of disease in glanders-free areas. Serodiagnostic tests of higher sensitivity and specificity like immunobloat should be implemented to achieve success in the eradication of glanders.

Keywords: glanders, equids, horses, immunological, mules

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Authors: Awotidebe Taofeek, Oyinsuyi Oluwafunmbi

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Psychosocial factors play a significant role in physical activity participation in diseased conditions and the general population. However, little is known about the role of exercise self-efficacy (ESE), exercise perceived barriers (EPB), and social support (SOS) in patients with asthma. This study investigated the influence of psychosocial factors on physical activity participation in patients with asthma in ile-ife. This cross-sectional study involved 130 patients with asthma. They were recruited from the Chest Clinic of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-ife using purposive sampling technique. Ethical approval was obtained from the Ethics and Research Committee of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-ife, Nigeria. Socio-demographic characteristics of respondents were recorded. Information on ESE, EPB, and SOS were obtained using Exercise Self-Efficacy, Exercise Benefit, and Barrier and Medical Outcome Social Support Scales respectively. Physical activity level was assessed in the last 7 days using international physical activity questionnaire. Descriptive and inferential statistics were used to analyze the data. Alpha level was set at p<0.5. The mean age of the respondents was 25.15 ± 9.38, and a majority, 110 (84.60%), engaged in low physical activity, 69(53%) had low exercise self-efficacy. However, less than two-third 80 (62.20%) reported high social support, with the majority of 95 (73.10%) reported high exercise perceived barriers. The means of ESE for male and femalerespondents were 29.01 ± 20.62 and 24.35 ± 17.36, respectively. The means of SOS formale and female respondents were 49.52 ± 22.22 and 61.87 ± 22.66, respectively. Themeans of EPB for male and female respondents were 53.37 ± 10.23 and 57.43 ± 9.65, respectively. The respondents were comparable in exercise self-efficacy and physicalactivity level (p>0.05). However, there were significant differences in social support (t=-2.791; p=0.006) and exercise perceived barriers (t=-2.108, p=0.037).Theresultsshowthattherewasasignificantrelationshipbetweenexerciseperceivedbarriersandlowphysicalactivitylevel(r=-0.216;p=0.023).TherewasasignificantassociationbetweenExerciseself-efficacyandmarried individuals(OR=0.967;95%CI=0.936-0.998;p= 0.037). Similarly, However,thereweresignificantassociationsbetweensocialsupport Andagegroup35-54years(OR=1.036;95%CI=1.007-1.067;p=0.014),females(OR= 1.024;95%CI=1.006;p=0.009)andmarriedindividuals(OR=1.049;95%CI=1.020-1.079. p=0.001).Therewasasignificantassociationbetweenexerciseperceivedbarriersand females(OR=1.043;95%CI=1.002-1.085;p=0.040).However, thereweresignificant associationsbetweenexerciseperceivedbarriersandoccupationgroup;civilservants (OR=1.092;95%CI=1.009-1.182;p=0.028),retiree(OR=1.092;95%CI=1.040-1.469;p= 0.016)andstudents(OR=1.110;95%CI=1.040;p=0.002). Inconclusion,agreaterpercentageofpatientswithasthmahadlowphysicalactivityleveland it was associatedwithhighexerciseperceivedbarriers,whileexerciseself-efficacyandsocialsupportwerenot.

Keywords: asthma, psychosocial factors, physical activity, physical fitness

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Authors: Induja R. Nimma, Anand Reddy Maligireddy, Artur Schneider, Melissa Lyle

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Background: Although heart failure is one of the most common causes of hospitalization in adult patients, there is limited knowledge on outcomes following initial hospitalization for COVID-19 with heart failure (HCF-19). We felt it pertinent to analyze 30-day readmission causes and outcomes among patients with HCF-19 using the United States using real-world big data via the National readmission database. Objective: The aim is to describe the rate and causes of readmissions and morbidity of heart failure with coinciding COVID-19 (HFC-19) in the United States, using the 2020 National Readmission Database (NRD). Methods: A descriptive, retrospective study was conducted on the 2020 NRD, a nationally representative sample of all US hospitalizations. Adult (>18 years) inpatient admissions with COVID-19 with HF and readmissions in 30 days were selected based on the International Classification of Diseases-Tenth Revision, Procedure Code. Results: In 2020, 2,60,372 adult patients were hospitalized with COVID-19 and HF. The median age was 74 (IQR: 64-83), and 47% were female. The median length of stay was 7(4-13) days, and the total cost of stay was 62,025 (31,956 – 130,670) United States dollars, respectively. Among the index hospital admissions, 61,527 (23.6%) died, and 22,794 (11.5%) were readmitted within 30 days. The median age of patients readmitted in 30 days was 73 (63-82), 45% were female, and 1,962 (16%) died. The most common principal diagnosis for readmission in these patients was COVID-19= 34.8%, Sepsis= 16.5%, HF = 7.1%, AKI = 2.2%, respiratory failure with hypoxia =1.7%, and Pneumonia = 1%. Conclusion: The rate of readmission in patients with heart failure exacerbations is increasing yearly. COVID-19 was observed to be the most common principal diagnosis in patients readmitted within 30 days. Complicated hypertension, chronic pulmonary disease, complicated diabetes, renal failure, alcohol use, drug use, and peripheral vascular disorders are risk factors associated with readmission. Familiarity with the most common causes and predictors for readmission helps guide the development of initiatives to minimize adverse outcomes and the cost of medical care.

Keywords: Covid-19, heart failure, national readmission database, readmission outcomes

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Authors: Mengying Wang, Dongjing Liu, Holger Schwender, Ping Wang, Hongping Zhu, Tao Wu, Terri H Beaty

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Background: Maternal smoking is a recognized risk factor for nonsyndromic cleft lip with or without cleft palate (NSCL/P). It has been reported that the effect of maternal smoking on oral clefts is mediated through genes that influence nicotine dependence. The polymorphisms of cholinergic receptor nicotinic alpha (CHRNA) and beta (CHRNB) subunits genes have previously shown strong associations with nicotine dependence. Here, we attempted to investigate whether the above genes are associated with clefting risk through testing for potential gene-gene (G×G) and gene-environment (G×E) interaction. Methods: We selected 120 markers in 14 genes associated with nicotine dependence to conduct transmission disequilibrium tests among 806 Chinese NSCL/P case-parent trios ascertained in an international consortium which conducted a genome-wide association study (GWAS) of oral clefts. We applied Cordell’s method using “TRIO” package in R to explore G×G as well as G×E interaction involving environmental tobacco smoke (ETS) based on conditional logistic regression model. Results: while no SNP showed significant association with NSCL/P after Bonferroni correction, we found signals for G×G interaction between 10 pairs of SNPs in CHRNA3, CHRNA5, and CHRNB4 (p<10-8), among which the most significant interaction was found between RS3743077 (CHRNA3) and RS11636753 (CHRNB4, p<8.2×10-12). Linkage disequilibrium (LD) analysis revealed only low level of LD between these markers. However, there were no significant results for G×ETS interaction. Conclusion: This study fails to detect association between nicotine dependence genes and NSCL/P, but illustrates the importance of taking into account potential G×G interaction for genetic association analysis in NSCL/P. This study also suggests nicotine dependence genes should be considered as important candidate genes for NSCL/P in future studies.

Keywords: Gene-Gene Interaction, Maternal Smoking, Nicotine Dependence, Non-Syndromic Cleft Lip with or without Cleft Palate

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Authors: Gülcan Taşkıran, Ayla Bayık Temel

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Background: Florence Nightingale, the modern founder of the nursing, is most famous for her role as a nurse. But not so much known about her contributions as a mathematician and statistician. Aim: In this conceptual article it is aimed to examine Florence Nightingale's statistics education, how she used her passion for statistics and applied statistical data in nursing care and her scientific contributions to statistical science. Design: Literature review method was used in the study. The databases of Istanbul University Library Search Engine, Turkish Medical Directory, Thesis Scanning Center of Higher Education Council, PubMed, Google Scholar, EBSCO Host, Web of Science were scanned to reach the studies. The keywords 'statistics' and 'Florence Nightingale' have been used in Turkish and English while being screened. As a result of the screening, totally 41 studies were examined from the national and international literature. Results: Florence Nightingale has interested in mathematics and statistics at her early ages and has received various training in these subjects. Lessons learned by Nightingale in a cultured family environment, her talent in mathematics and numbers, and her religious beliefs played a crucial role in the direction of the statistics. She was influenced by Quetelet's ideas in the formation of the statistical philosophy and received support from William Farr in her statistical studies. During the Crimean War, she applied statistical knowledge to nursing care, developed many statistical methods and graphics, so that she made revolutionary reforms in the health field. Conclusions: Nightingale's interest in statistics, her broad vision, the statistical ideas fused with religious beliefs, the innovative graphics she has developed and the extraordinary statistical projects that she carried out has been influential on the basis of her professional achievements. Florence Nightingale has also become a model for women in statistics. Today, using and teaching of statistics and research in nursing care practices and education programs continues with the light she gave.

Keywords: Crimean war, Florence Nightingale, nursing, statistics

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Authors: Fei Peng, Jun Yuan, Chen Fan, Fan Jiang, Qian Sun, Yudi Liu

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Although Earth Station in Motion (ESIM) services are widely used and there is a huge market demand around the world, International Telecommunication Union (ITU) does not have unified conclusion for the use of ESIM yet. ESIM are Mobile Satellite Services (MSS) due to its mobile-based attributes, while multiple administrations want to use ESIM in Fixed Satellite Service (FSS). However, Radio Regulations (RR) have strict distinction between MSS and FSS. In this case, ITU has been very controversial because this kind of application will violate the RR Article and the conflict will bring risks to the global deployment. Thus, this paper illustrates the development of rules, regulations, standards concerning ESIM and the radio spectrum usage of ESIM in different regions around the world. Firstly, the basic rules, standard and definition of ITU’s Radiocommunication Sector (ITU-R) is introduced. Secondly, the World Radiocommunication Conference (WRC) agenda item on radio spectrum allocation for ESIM, e.g. in C/Ku/Ka band, is introduced and multi-view on the radio spectrum allocation is elaborated, especially on 19.7-20.2 GHz & 29.5-30.0 GHz. Then, some ITU-R Recommendations and Reports are analyzed on the specific technique to enable these ESIM to communicate with Geostationary Earth Orbit Satellite (GSO) space stations in the FSS without causing interference at levels in excess of that caused by conventional FSS earth stations. Meanwhile, the opposite opinion on not allocating EISM service in FSS frequency band is also elaborated. Finally, based on the ESIM’s future application, the ITU-R standards development trend is forecasted. In conclusion, using radio spectrum resource in an equitable, rational and efficient manner is the basic guideline of ITU. Although it is not a good approach to obstruct the revise of RR when there is a large demand for radio spectrum resource in satellite industry, still the propulsion and global demand of the whole industry may face difficulties on the unclear application in modify rules of RR.

Keywords: earth station in motion, ITU standards, radio regulations, radio spectrum, satellite communication

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