Search results for: Helikx Open School

Authors: Abdelhalim. N. Mohammed, Mohammed. Y. Esmail

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In the course of recent decades, medical imaging has been dominated by the use of costly film media for review and archival of medical investigation, however due to developments in networks technologies and common acceptance of a standard digital imaging and communication in medicine (DICOM) another approach in light of World Wide Web was produced. Web technologies successfully used in telemedicine applications, the combination of web technologies together with DICOM used to design a web-based and open source DICOM viewer. The Web server allowance to inquiry and recovery of images and the images viewed/manipulated inside a Web browser without need for any preinstalling software. The dynamic site page for medical images visualization and processing created by using JavaScript and HTML5 advancements. The XAMPP ‘apache server’ is used to create a local web server for testing and deployment of the dynamic site. The web-based viewer connected to multiples devices through local area network (LAN) to distribute the images inside healthcare facilities. The system offers a few focal points over ordinary picture archiving and communication systems (PACS): easy to introduce, maintain and independently platforms that allow images to display and manipulated efficiently, the system also user-friendly and easy to integrate with an existing system that have already been making use of web technologies. The wavelet-based image compression technique on which 2-D discrete wavelet transform used to decompose the image then wavelet coefficients are transmitted by entropy encoding after threshold to decrease transmission time, stockpiling cost and capacity. The performance of compression was estimated by using images quality metrics such as mean square error ‘MSE’, peak signal to noise ratio ‘PSNR’ and compression ratio ‘CR’ that achieved (83.86%) when ‘coif3’ wavelet filter is used.

Keywords: DICOM, discrete wavelet transform, PACS, HIS, LAN

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Authors: Alexandra P. Alexandropoulou, Andreas Fousteris, Eleni Didaskalou, Dimitrios A. Georgakellos

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As urbanization is becoming a major stress factor not only for the urban environment but also for the wellbeing of city dwellers, incorporating the issues of urban health in strategic city planning and policy-making has never been more relevant. The impact of urbanization can vary from low to severe and relates to all non-communicable diseases caused by the different functions of cities. Air pollution, noise pollution, water and soil pollution, availability of open green spaces, and urban heat island are the major factors that can compromise citizens' health. Urban health describes the effects of the social environment, the physical environment, and the availability and accessibility to health and social services. To assess the quality of urban wellbeing, all urban characteristics that might have an effect on citizens' health must be considered, evaluated, and introduced in integrated local planning. A series of indices and indicators can be used to better describe these effects and set the target values in policy making. Local strategic planning is one of the most valuable development tools a local city administration can possess; thus, it has become mandatory under Greek law for all municipalities. It involves a two-stage procedure; the first aims to collect, analyse and evaluate data on the current situation of the city (administrative data, population data, environmental data, social data, swot analysis), while the second aims to introduce a policy vision described and supported by distinct (nevertheless integrated) actions, plans and measures to be implemented with the aim of city development and citizen wellbeing. In this procedure, the element of health is often neglected or under-evaluated. A relative survey was conducted among all Greek local authorities in order to shed light on the current situation. Evidence shows that the rate of incorporation of health in strategic planning is lacking behind. The survey also highlights key hindrances and concerns raised by local officials and suggests a path for the way forward.

Keywords: urban health, strategic planning, local authorities, integrated development

Procedia PDF Downloads 72

Authors: T. Iakovleva

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Present paper suggests a theoretical model that describes the process of the development of responsible innovations on the firm level in health and welfare sectors. There is a need to develop new firm strategies in these sectors. This paper suggests to look on the concept of responsible innovation that was originally developed on the social level and to apply this new concept to the new area of firm strategy. The rapid global diffusion of information and communication technologies has greatly improved access to knowledge. At the same time, communication is cheap, information is a commodity, and global trade increases technological diffusion. As a result, firms and users, including those outside of industrialized nations, get early exposure to the latest technologies and information. General-purpose technologies such as mobile phones and 3D printers enable individuals to solve local needs and customize products. The combined effect of these changes is having a profound impact on the innovation landscape. Meanwhile, the healthcare sector is facing unprecedented challenges, which are magnified by budgetary constraints, an aging population and the desire to provide care for all. On the other hand, patients themselves are changing. They are savvier about their diseases, they expect their relation with the healthcare professionals to be open and interactive, but above all they want to be part of the decision process. All of this is a reflection of what is already happening in other industries where customers have access to large amount of information and became educated buyers. This article addresses the question of how ICT research and innovation may contribute to developing solutions to grand societal challenges in a responsible way. A broad definition of the concept of responsibility in the context of innovation is adopted in this paper. Responsibility is thus seen as a collective, uncertain and future-oriented activity. This opens the questions of how responsibilities are perceived and distributed and how innovation and science can be governed and stewarded towards socially desirable and acceptable ends. This article addresses a central question confronting politicians, business leaders, and regional planners.

Keywords: responsible innovation, ICT, healthcare, welfare sector

Procedia PDF Downloads 196

Authors: McKenna Halverson, Allison Karpyn

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Introduction: The COVID-19 pandemic posed unprecedented challenges for families with young children in the United States. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a federal nutrition assistance program that provides low-income mothers and young children with access to healthy foods (e.g., infant formula, milk, and peanut butter), mitigated some financial challenges for families. However, the U.S. experienced a national infant formula shortage and rising inflation rates during the pandemic, which likely impacted WIC participants’ shopping experiences and well-being. As such, this study aimed to characterize how the COVID-19 pandemic and related events impacted Delaware WIC participants’ in-store benefit redemption experiences and overall well-being. Method: The authors conducted semi-structured interviews with 51 WIC participants in Wilmington, Delaware. Survey measures included demographic questions and open-ended questions regarding participants’ experiences with WIC benefit redemption during the COVID-19 pandemic. Data were analyzed using a hybrid inductive and deductive coding approach. Findings: The COVID-19 pandemic significantly impacted WIC participants’ shopping experiences and well-being. Specifically, participants were forced to alter their shopping behaviors to account for rising food prices (e.g., used coupons, bought less food, used food banks). Additionally, WIC participants experienced significant distress during the national infant formula shortage resulting from difficulty finding formula to feed their children. Participants also struggled with in-store benefit redemption due to inconsistencies in shelf labelling, the WIC app, and low stock of WIC foods. These findings highlight the need to reexamine WIC operations and emergency food response policy in the United States during times of crisis to optimize public health and ensure federal nutrition assistance programs meeting the needs of low-income families with young children.

Keywords: benefit redemption, COVID-19 pandemic, infant formula shortage, inflation, shopping, WIC

Procedia PDF Downloads 75

Authors: Waddah Abdullah, Saleh Al-Sarem

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Electrokinetic remediation was undoubtedly proven to be one of the most efficient techniques used to clean up soils contaminated with polar charged contaminants (such as heavy metals) and non-polar organic contaminants. It can be efficiently used to clean up low permeability mud, wastewater, electroplating wastes, sludge, and marine dredging. This study presented and discussed the results of electrokinetic remediation processes to clean up soils contaminated with nickel. Two types of electrokinetics cells were used: an open cell and an advanced cylindrical cell. Two types of soils were used for this investigation; the Azraq green clay which has very low permeability taken from the eastern part of Jordan (city of Azraq) and a sandy soil having, relatively, very high permeability. The clayey soil was spiked with 500 ppm of nickel, and the sandy soil was spiked with 1500 ppm of nickel. Fully saturated and partially saturated clayey soils were used for the clean-up process. Clayey soils were tested under a direct current of 80 mA and 50 mA to study the effect of the electrical current on the remediation process. Chelating agent (Na-EDTA), disodium ethylene diamine tetraacetatic acid, was used in both types of soils to enhance the electroremediation process. The effect of carbonates presence in the contaminated soils, also, was investigated by use of sodium carbonate and calcium carbonate. pH changes in the anode and the cathode compartments were controlled by use of buffer solutions. The results of the investigation showed that for the fully saturated clayey soil spiked with nickel had an average removal efficiency of 64%, and the average removal efficiency was 46% for the unsaturated clayey soil. For the sandy soil, the average removal efficiency of Nickel was 90%. Test results showed that presence of carbonates in the remediated soils retarded the clean-up process of nickel-contaminated soils (removal efficiency was reduced from 90% to 60%). EDTA enhanced decontamination of nickel contaminated clayey and sandy soils with carbonates was studied. The average removal efficiency increased from 60% (prior to using EDTA) to more than 90% after using EDTA.

Keywords: buffer solution, EDTA, electroremediation, nickel removal efficiency

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Authors: Leo Laine, Morgan Johansson

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To meet the civilizations future needs for safe living and low environmental footprint, the engineers designing the complex systems of tomorrow will need efficient ways to model and optimize these systems for their intended purpose. For example, a civil defence shelter and its subsystem components needs to withstand, e.g. airblast and ground shock from decided design level explosion which detonates with a certain distance from the structure. In addition, the complex civil defence shelter needs to have functioning air filter systems to protect from toxic gases and provide clean air, clean water, heat, and electricity needs to also be available through shock and vibration safe fixtures and connections. Similar complex building systems can be found in any concentrated living or office area. In this paper, the authors use a multidomain modelling language called Modelica to model a concrete wall as a single degree of freedom (SDOF) system with elastoplastic properties with the implemented option of plastic hardening. The elastoplastic model was developed and implemented in the open source tool OpenModelica. The simulation model was tested on the case with a transient equivalent reflected pressure time history representing an airblast from 100 kg TNT detonating 15 meters from the wall. The concrete wall is approximately regarded as a concrete strip of 1.0 m width. This load represents a realistic threat on any building in a city like area. The OpenModelica model results were compared with an Excel implementation of a SDOF model with an elastic-plastic spring using simple fixed timestep central difference solver. The structural displacement results agreed very well with each other when it comes to plastic displacement magnitude, elastic oscillation displacement, and response times.

Keywords: airblast from explosives, elastoplastic spring model, Modelica modelling language, SDOF, structural response of concrete structure

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Authors: Sadeq Al Yaari, Muhammad Alkhunayn, Aayah Al Yaari, Ayman Al Yaari, Montaha Al Yaari, Sajedah Al Yaari, Fatehi Eissa

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The recent rise of smart educational aids and the move away from traditional listening aids are leading to a fundamental shift in the way in which individuals with attention and listening problems (ALP) manipulate listening inputs and/or act appropriately to the spoken information presented to them. A total sample of twenty-six ALP pupils (m=20 and f=6) between 7-12 years old was selected from different strata based on gender, region and school. In the sample size, thirteen (10 males and 3 females) received the treatment in terms of smart classes provided with smart educational aids in a listening course that lasted for four month-semester while others did not (they studied the same course by the same instructor but in ordinary class). A pretest was administered to assess participants’ levels, and a posttest was given to evaluate their attention and listening comprehension performance, namely in phonetic and phonological tests with sociolinguistic themes that have been designed for this purpose. Test results were analyzed both psychoneurolinguistically and statistically. Results reveal a remarkable change in pupils’ behavioral listening where scores witnessed a significant difference in the performance of the experimental ALP group in the pretest compared to the posttest (Pupils performed better at the pretest-posttest on phonetics than at the two tests on phonology). It is concluded that smart educational aids designed for listening skills help not only increase the listening command of pupils with ALP to understand what they listen to but also develop their interactive listening capability and, at the same rate, are responsible for increasing concentrated and in-depth listening capacity. Plus, ALP pupils become able to grasp the audio content of text recordings, including educational audio recordings, news, oral stories and tales, views, spiritual/religious text and general knowledge. However, the pupils have not experienced individual smart audio-visual aids that connect listening to other language receptive and productive skills, which could be the future area of research.

Keywords: language skills, implementing, listening skill, attention, smart aids

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Authors: A. Aulinger, A. M. Backes, J. Bieser, V. Matthias, M. Quante

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High concentrations of particles pose a threat to human health. Thus, legal maximum concentrations of PM10 and PM2.5 in ambient air have been steadily decreased over the years. In central Europe, the inorganic species ammonium sulphate and ammonium nitrate make up a large fraction of fine particles. Many studies investigate the influence of emission reductions of sulfur- and nitrogen oxides on aerosol concentration. Here, we focus on the influence of ammonia (NH3) emissions. While emissions of sulphate and nitrogen oxides are quite well known, ammonia emissions are subject to high uncertainty. This is due to the uncertainty of location, amount, time of fertilizer application in agriculture, and the storage and treatment of manure from animal husbandry. For this study, we implemented a crop growth model into the SMOKE emission model. Depending on temperature, local legislation, and crop type individual temporal profiles for fertilizer and manure application are calculated for each model grid cell. Additionally, the diffusion from soils and plants and the direct release from open and closed barns are determined. The emission data was used as input for the Community Multiscale Air Quality (CMAQ) model. Comparisons to observations from the EMEP measurement network indicate that the new ammonia emission module leads to a better agreement of model and observation (for both ammonia and ammonium). Finally, the ammonia emission model was used to create emission scenarios. This includes emissions based on future European legislation, as well as a dynamic evaluation of the influence of different agricultural sectors on particle formation. It was found that a reduction of ammonia emissions by 50% lead to a 24% reduction of total PM2.5 concentrations during winter time in the model domain. The observed reduction was mainly driven by reduced formation of ammonium nitrate. Moreover, emission reductions during winter had a larger impact than during the rest of the year.

Keywords: ammonia, ammonia abatement strategies, ctm, seasonal impact, secondary aerosol formation

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Authors: Mulligan T., Barker-Collo S., Gobson K., Jones K.

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There is a relatively scarce body of literature regarding adolescent experiences of traumatic brain injury (TBI). This qualitative study explored how sustaining a TBI at this unique stage of development might impact a young person as they navigate the challenges of adolescence and transition to adulthood, and what might support recovery. Thirteen young adults who sustained a mild-moderate TBI as an adolescent (aged 13 – 17 years), approximately 7.7 years (range = 6.7 – 8.0 years) prior, participated in the research. Semi-structured individual interviews were conducted to explore participants’ experiences surrounding and following their TBIs. Thematic analysis of interview data produced five key categories of findings: (1) Following their TBIs, many participants experienced problems with cognitive (e.g., forgetfulness, concentration difficulties), physical (e.g., migraines, fatigue) and emotional (e.g., depression, anxiety) functioning, which were often endured into adulthood. (2) TBI-related problems often adversely affected important areas of life for the participant, including school, work and friendships. (3) Changes following TBI commonly impacted identity formation. (4) Recovery processes evolved over time as the participants coped initially by just ‘getting on with it’, before learning to accept new limitations and, ultimately, growing from their TBI experiences. (5) While the presence of friends and family assisted recovery, struggles were often exacerbated by a lack of emotional support from others, in addition to the absence of any assistance or information-provision from professionals regarding what to expect following TBI. The findings suggest that even mild TBI sustained during adolescence can have consequences for an individual’s functioning, engagement in life and identity development, whilst also giving rise to post-traumatic growth. Recovery following adolescent TBI might be maximised by facilitating greater understanding of the injury and acknowledging its impacts on important areas of life, as well as the provision of emotional support and facilitating self-reflection and meaning-making.

Keywords: adolescent, brain Injury, qualitative, post-traumatic growth

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Authors: Tamunotonye Mayowa Braide, Isaac Oluwatayo

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This study investigates multidimensional poverty, and its correlates among rural households in Sekhukhune and Capricorn District municipalities (SDM & CDM) in Limpopo Province, South Africa. Primary data were collected from 407 rural households selected through purposive and simple random sampling techniques. Analytical techniques employed include descriptive statistics, principal component analysis (PCA), and the Alkire Foster (A-F) methodology. The results of the descriptive statistics showed there are more females (66%) than males (34%) in rural areas of Limpopo Province, with about 45% of them having secondary school education as the highest educational level attained and only about 3% do not have formal education. In the analysis of deprivation, eight dimensions of deprivation, constructed from 21 variables, were identified using the PCA. These dimensions include type and condition of dwelling water and sanitation, educational attainment and income, type of fuel for cooking and heating, access to clothing and cell phone, assets and fuel for light, health condition, crowding, and child health. In identifying the poor with poverty cut-off (0.13) of all indicators, about 75.9% of the rural households are deprived in 25% of the total dimensions, with the adjusted headcount ratio (M0) being 0.19. Multidimensional poverty estimates showed higher estimates of poor rural households with 71%, compared to 29%, which fall below the income poverty line. The study conducted poverty decomposition, using sub-groups within the area by examining regions and household characteristics. In SDM, there are more multidimensionally poor households than in CDM. The water and sanitation dimension is the largest contributor to the multidimensional poverty index (MPI) in rural areas of Limpopo Province. The findings can, therefore, assist in better design of welfare policy and target poverty alleviation programs and as well help in efficient resource allocation at the provincial and local municipality levels.

Keywords: Alkire-Foster methodology, Limpopo province, multidimensional poverty, principal component analysis, South Africa

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Authors: Babajide Olufemi Diyaolu

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The opportunity provided by advances in technology as regards sports betting is so numerous that even at one's comfort, with the use of a phone, Nigerian youth are found engaging in all kinds of betting. Today it is more difficult to differentiate a true fan as there are quite a number of them that became fans as a result of betting on live games. This study investigated the influence of online sports events on betting among Nigerian youth. A descriptive survey research design was used, and the population consists of all Nigerian youth that engages in betting and live within the southwest zone of Nigeria. A simple random sampling technique was used to pick three states from the southwest zone of Nigeria. Two thousand five hundred respondents comprising males and female were sampled from the three states. A structured questionnaire on online sports event contribution to sports betting (OSECSB) was used. The Instrument consists of three sections. Section A seeks information on the demographic data of the respondents. Section B seeks information on online sports events, while section C is used to extract information on sports betting. The modified instrument, which consists of 14 items, has a reliability coefficient of 0.74. The hypothesis was tested at 0.05 significance level. The completed questionnaire was collated, coded, and analyzed using descriptive statistics of frequency counts, percentage and pie chart, and inferential statistics of multiple regressions. The findings of this study revealed that online sports betting is a significant predictor of an increase in sports betting among Nigerian youth. The media and television, as well as globalization and the internet coupled with social media and various online platforms, have all contributed to the immense increase in sports betting. The increase in the advertisement of the betting platform during live matches, especially football, is becoming more alarming. In most organized international events, the media attention, as well as sponsorship right, are now been given to one or two betting platforms. There is a need for all stakeholders to put in place school-based intervention programs to reorientate our youth about the consequences of addiction to betting. Such programs must include meta-analyses and emotional control towards sports betting.

Keywords: betting platform, Nigerian fans, Nigerian youth, sports betting

Procedia PDF Downloads 73

Authors: Yoni Elviandri, Vivi Fitriyanti, Agung Surya Wijaya, Suryani Humayyah, Muhammad Alif Azizi

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The massive development of computing power and internet access nowadays is marked by audiovisual games and computers which are known as electronic games, one of the examples is online games. This kind of game can be found everywhere in Indonesia, both in the cities and even the villages. In the present time, online games are becoming a popular games in various layers of the community, one of them does happen to elementary school students. As the online games spread over, the traditional games gradually fade away and even thought as an old-fashioned game. Contrary, traditional games actually have the better and higher educational values such as patience, honesty, integrity and togetherness value which cannot be found in online games which are more to individualist. A brand new set of education tools is necessary to provide a convenience, safe and fun place for children to play around but still contains educational values. One interesting example goes to Cilulaba is an agricultural-based playground. It is a good place for children to play and learn as it was planned to entertain children to play around as well as introducing agriculture to them. One of the games is a 1990’s well-known traditional game which its name is Congklak. Congklak is an agricultural-based traditional game and it also introduces the home garden to the children. Some of the Cilulaba’s aims are to protect the existence of nation’s cultural inheritance through Congklak traditional game, as a tool to introduce the agriculture to the children through the methods of Congklak traditional game and giving explanation related to the advantages of a “healthy home garden” to the children. The expected output from this place is to deliver a good understanding about agriculture to the children and make them begin to love it to make an aesthetic home garden and enhance the optimalisation usage of home garden that will support the availability of various edible plants in productive and health households. The proposed method in this Student Creative Program in Society Service is Participatory Rural Appraisal (PRA) method.

Keywords: Cilubaba, Congklak, traditional game, agricultural-based playground

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Authors: Dalya Markovich

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In the last decade art-educators strive to integrate critical pedagogy within the art classroom. Critical pedagogy aims to deconstruct the oppressive social reality and the false consciousness in which learners from both privileged and underprivileged groups are caught. Understanding oppression as a product of socio-political conditions seeks to instigate processes of change anchored in the student's views. Yet, growing empirical evidence show that these efforts often has resulted in art projects in which art teachers play an active role in the process of critical teaching, while the students remain passive listeners. In this common scenario, the teachers/artists become authoritarian moral guides of critical thinking and acting, while the students are often found to be indifferent or play along to satisfy the teachers'/artists aspirations. These responses indicate that the message of critical pedagogy – transforming the students' way of thinking and acting – mostly do not fulfill its emancipation goals. The study analyses the critical praxis embedded in new art projects and their influence on the participants. This type of projects replaces the individual producer with a collaborative work; switch the finite work with an ongoing project; and transforms the passive learner to an engaged co-producer. The research delves into the pedagogical framework of two of these art projects by using qualitative methods. In-depth interviews were conducted with 4 of the projects' initiator and managers, in order to access understandings of the art projects goals and pedagogical methods. Field work included 4 participant observation (two in each project) during social encounters in the project's settings, focusing on how critical thinking is enacted (or not) by the participants. The analysis exposes how the new art projects avoid the prepackaged "critical" assumptions and praxis, thus turning the participants from passive carriers of critical thinking to agents that actively use criticism. Findings invite researchers to explore new avenues for understanding critical pedagogy and developing various ways to implement critical pedagogy during art education, in view of the growing need of critical thinking and acting in school/society.

Keywords: critical pedagogy, education through art, collaborative work, agency

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Authors: Angeli Marie P. Lagman, Nephtali M. Gorgonio

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Catamenial pneumothorax is defined as a recurrent accumulation of air in the pleural cavity, which occurs in the period of 72 hours before or after menses. In a menstruating woman presenting with the difficulty of breathing and chest pain with concomitant radiographic evidence of pneumothorax, a diagnosis of catamenial pneumothorax should be entertained. Two cases of catamenial pneumothorax were reported in our local literature. This report added two more cases. The first case is 45 years old G1P1, while the second case is 46 years old G2P2. These two patients had a history of pelvic endometriosis in the past. All other signs and symptoms were similar to the previously reported cases. All patients presented with difficulty of breathing associated with chest pain. Imaging studies showed right-sided pneumothorax in all patients. Intraoperatively, subpleural bleb, diaphragmatic fenestrations, and endometriotic implants were found. Three patients underwent video-assisted thoracosurgery (VATS), while one patient underwent open thoracotomy with pleurodesis. Histopathology revealed endometriosis in only two patients. All patients received postoperative hormonal therapy, and there were no recurrences noted in all patients. Endometriosis-related catamenial pneumothorax is a rare condition that needs early recognition of the symptoms. Several theories may be involved to explain the pathogenesis of catamenial pneumothorax. Two cases show a strong significant association between a history of pelvic endometriosis and the development of catamenial pneumothorax, while one case can be explained by the hormonal theory. The difficulty of breathing and chest pain in relation to menses may prompt early diagnosis. One case has shown that pneumothorax may occur even after menstruation. A biopsy of the endometrial implants may not always show endometrial glands and stroma, nor will immunostaining, which will not always show estrogen and progesterone receptors. Video-assisted thoracoscopic surgery is the gold standard in the diagnosis and treatment of catamenial pneumothorax. Postoperative hormonal suppression will further reduce the disease recurrence and facilitate the effectiveness of the surgical treatment.

Keywords: catamenial pneumothorax, endometriosis, menstruation, video assisted thoracosurgery

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Authors: Yuko Hiramatsu, Fumihiro Sato, Atsushi Ito, Hiroyuki Hatano, Mie Sato, Yu Watanabe, Akira Sasaki

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This paper presents a mobile phone application developed for sightseeing in Nikko, one of the cultural world heritages in Japan, using the BLE (Bluetooth Low Energy) beacon. Based on our pre-research, we decided to design our application for young people who walk around the area actively, but know little about the tradition and culture of Nikko. One solution is to construct many information boards to explain; however, it is difficult to construct new guide plates in cultural world heritage sites. The smartphone is a good solution to send such information to such visitors. This application was designed using a combination of the smartphone and beacons, set in the area, so that when a tourist passes near a beacon, the application displays information about the area including a map, historical or cultural information about the temples and shrines, and local shops nearby as well as a bus timetable. It is useful for foreigners, too. In addition, we developed quizzes relating to the culture and tradition of Nikko to provide information based on the Zeigarnik effect, a psychological effect. According to the results of our trials, tourists positively evaluated the basic information and young people who used the quiz function were able to learn the historical and cultural points. This application helped young visitors at Nikko to understand the cultural elements of the site. In addition, this application has a function to send notifications. This function is designed to provide information about the local community such as shops, local transportation companies and information office. The application hopes to also encourage people living in the area, and such cooperation from the local people will make this application vivid and inspire young visitors to feel that the cultural heritage site is still alive today. This is a gateway for young people to learn about a traditional place and understand the gravity of preserving such areas.

Keywords: BLE beacon, smartphone application, Zeigarnik effect, world heritage site, school trip

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Authors: N. Nalini, Bhanu Prakash Gopularam

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The term data security refers to the degree of resistance or protection given to information from unintended or unauthorized access. The core principles of information security are the confidentiality, integrity and availability, also referred as CIA triad. Cloud computing services are classified as SaaS, IaaS and PaaS services. With cloud adoption the confidential enterprise data are moved from organization premises to untrusted public network and due to this the attack surface has increased manifold. Several cloud computing platforms like OpenStack, Eucalyptus, Amazon EC2 offer users to build and configure public, hybrid and private clouds. While the traditional encryption based on PKI infrastructure still works in cloud scenario, the management of public-private keys and trust certificates is difficult. The Identity based Public Key Cryptography (also referred as ID-PKC) overcomes this problem by using publicly identifiable information for generating the keys and works well with decentralized systems. The users can exchange information securely without having to manage any trust information. Another advantage is that access control (role based access control policy) information can be embedded into data unlike in PKI where it is handled by separate component or system. In OpenStack cloud platform the keystone service acts as identity service for authentication and authorization and has support for public key infrastructure for auto services. In this paper, we explain OpenStack security architecture and evaluate the PKI infrastructure piece for data confidentiality. We provide method to integrate ID-PKC schemes for securing data while in transit and stored and explain the key measures for safe guarding data against security attacks. The proposed approach uses JPBC crypto library for key-pair generation based on IEEE P1636.3 standard and secure communication to other cloud services.

Keywords: data confidentiality, identity based cryptography, secure communication, open stack key stone, token scoping

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Authors: Bianca W. O. Silva, Adriana C. M. Andrade, Gustavo C. M. Lucena, Virna M. S. Lima

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Introduction: Basic life support (BLS) involves the immediate recognition of cardiopulmonary arrest. Each year, 359.400 and 275.000 individuals with cardiac arrest are attended in emergency departments in USA and Europe. Brazilian data shows that 200.000 cardiac arrests occur every year, and half of them out of the hospital. Medical schools around the world teach BLS in the first years of the course, but studies show that there is a decline of the knowledge as the years go by, affecting the chain of survival. The objective was to analyze the knowledge of medical students about BLS and the retention of this learning throughout the course. Methods: This study included 150 students who were at the second and third year of a medical school in Salvador, Bahia, Brazil. The instrument of data collection was a structured questionnaire composed of 20 questions based on the 2015 American Heart Association guideline. The Pearson Chi-square test was used in order to study the association between previous training, sex and semester with the degree of knowledge of the students. The Kruskal-Wallis test was used to evaluate the different yields obtained between the various semesters. The number of correct answers was described by average and quartiles. Results: Regarding the degree of knowledge, 19.6% of the female students reached the optimal classification, a better outcome than the achieved by the male participants. Of those with previous training, 33.33% were classified as good and optimal, none of the students reached the optimal classification and only 2.2% of them were classified as bad (those who did not have 52.6% of correct answers). The analysis of the degree of knowledge related to each semester revealed that the 5th semester had the highest outcome: 30.5%. However, the acquaintance presented by the semesters was generally unsatisfactory, since 50% of the students, or more, demonstrated knowledge levels classified as bad or regular. When confronting the different semesters and the achieved scores, the value of p was 0.831. Conclusion: It is important to focus on the training of medical professionals that are capable of facing emergency situations, improving the systematization of care, and thereby increasing the victims' possibility of survival.

Keywords: basic life support, cardiopulmonary ressucitacion, education, medical students

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Authors: Mai Hussein

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'Littoral' is an original voice in Québécois theatre, spanning the cultural gaps that can exist between the playwrights’ native Lebanon, North America, Quebec, and Europe. Littoral is a 'crossroad' of cultures and themes, a 'bridge' connecting cultures and languages. It represents a new form of theatrical writing that combines the verbal, the vocal and the pantomimic, calling upon the stage to question the real, to engage characters in a quest, in a journey of mourning, of reconstructing identity and a collective memory despite ruins and wars. A theatre of witness, a theatre denouncing irrationality of racism and war, a theatre 'performing' the symptoms of the stress disorders of characters passing from resistance and anger to reconciliation and giving voice to the silenced victims, these are some of the pillars that this play has to offer. In this corrida between life and death, the identity seems like a work-in-progress that is shaped in the presence of the Self and the Other. This trajectory will lead to re-open widely the door to questions, interrogations, and reflections to show how this play is at the nexus of contemporary preoccupations of the 21st century: the importance of memory, the search for meaning, the pursuit of the infinite. It also shows how a play can create bridges between languages, cultures, societies, and movements. To what extent does it mediate between the words and the silence, and how does it burn the bridges or the gaps between the textual and the performative while investigating the power of intermediality to confront racism and segregation. It also underlines the centrality of confrontation between cultures, languages, writing and representation techniques to challenge the characters in their quest to restructure their shattered, but yet intertwined identities. The goal of this theatre would then be to invite everyone involved in the process of a journey of self-discovery away from their comfort zone. Everyone will have to explore the liminal space, to read in between the lines of the written text as well as in between the text and the performance to explore the gaps and the tensions that exist between what is said, and what is played, between the 'parole' and the performative body.

Keywords: identity, memory, performance, testimony, trauma

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Authors: Folong Tchoffo Marlyse Fabiola, Anaba Onana Achille Basile

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Located in the western region of Cameroon, in the BAMBOUTOS department, the city of Mbouda belongs to the Pan-African basement. The water resources exploited in this region consist of surface water and groundwater from weathered and fractured aquifers within the same basement. To study the factors determining the productivity of aquifers in the Mbouda area, we adopted a methodology based on collecting data from boreholes drilled in the region, identifying different types of rocks, analyzing structures, and conducting geophysical surveys in the field. The results obtained allowed us to distinguish two main types of rocks: metamorphic rocks composed of amphibolites and migmatitic gneisses and igneous rocks, namely granodiorites and granites. Several types of structures were also observed, including planar structures (foliation and schistosity), folded structures (folds), and brittle structures (fractures and lineaments). A structural synthesis combines all these elements into three major phases of deformation. Phase D1 is characterized by foliation and schistosity, phase D2 is marked by shear planes and phase D3 is characterized by open and sealed fractures. The analysis of structures (fractures in outcrops, Landsat lineaments, subsurface structures) shows a predominance of ENE-WSW and WNW-ESE directions. Through electrical surveys and borehole data, we were able to identify the sequence of different geological formations. Four geo-electric layers were identified, each with a different electrical conductivity: conductive, semi-resistive, or resistive. The last conductive layer is considered a potentially aquiferous zone. The flow rates of the boreholes ranged from 2.6 to 12 m3/h, classified as moderate to high according to the CIEH classification. The boreholes were mainly located in basalts, which are mineralogically rich in ferromagnesian minerals. This mineral composition contributes to their high productivity as they are more likely to be weathered. The boreholes were positioned along linear structures or at their intersections.

Keywords: Mbouda, Pan-African basement, productivity, west-Cameroon

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Authors: M. J. Alcedo, K. Ito, K. Maeda

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A stockperson has a significant influence on the productivity and welfare of their animals. This influence may be good or bad depending on their stockmanship competence. In this study, stockmanship competence (SC) is defined as the capacity of the stockperson to ensure the welfare of their animals by providing their animal’s needs. The study was conducted to evaluate the stockmanship competence of backyard goat raisers and to examine its relationship to productivity and economic profitability. This was made possible by interviewing 101 backyard goat raisers who have undergone farmer livestock school on integrated goat management (FLS IGM) in Region I, Philippines on September 3-30, 2012 and March 4-17, 2013. Secondary data needed were gathered from the local government agencies involved. Data on stockmanship, goat productivity and farmer’s income before and after attending FLS-IGM were gathered through a semi-structured interview. Questions for stockamnship were based on the Philippine recommends on goat production, tips on goat raising and other scientific literature. Stockmanship competence index score (SCIS) was computed by summing the raw scores derived from each components of SC divided by the total number of components. Pearson correlation through SPSS was used to see the relationship between SC, productivity and income. Result showed that majority raised native and upgraded goats. The computed mean SCIS before and after undergoing FLS-IGM was 38.53% and 75.81%, respectively, an improvement of 49.17%. Both index scores resulted in significant differences in productivity and income. The median mature weight and mortality rate of goats before FLS-IGM, where SC was low, was 14 kg and 50% respectively. On the other hand, after stockmanship had improved, the median mature weight increased to 19 kgs and mortality rate decreased to 11.11%. Likewise, fewer goat diseases were observed by farmers as compared before. With regards to income, there was 127.34% difference on the median net income derived by farmers. Result implies that improved stockmanship competence can lead not only to increased productivity and income of backyard goat raisers but also welfare of the animal.

Keywords: stockmanship, backyard goat production, animal welfare, Philippines

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Authors: Jing-Jing Wang, Yang Gao, Heather H. M. Kwok, Wendy Y. J. Huang

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Objectives: Intellectual disability (ID) ranks among the top 20 most costly disorders. A child with ID creates a wide set of challenges to the individual, family, and society, and overweight and obesity aggravate those challenges. People with ID have the right to attain optimal health like the rest of the population. They should be given priority to eliminate existing health inequities. Childhood obesity epidemic and associated factors among children, in general, has been well documented, while knowledge about overweight and obesity in children with ID is scarce. Methods: A cross-sectional study was conducted among 524 Chinese children with ID (males: 68.9%, mean age: 12.2 years) in Hong Kong in 2015. Children’s height and weight were measured at school. Parents, in the presence of their children, completed a self-administered questionnaire at home about the children’s physical activity (PA), eating habits, and sleep duration in a typical week as well as parenting practices regarding children’s eating and PA, and their socio-demographic characteristics. Multivariate logistic regression estimated the potential risk factors for children being overweight. Results: The prevalence of overweight and obesity in children with ID was 31.3%, which was higher than their general counterparts (18.7%-19.9%). Multivariate analyses revealed that the risk factors of overweight and obese in children with ID included: comorbidity with autism, the maternal side being overweight or obese, parenting practices with less pressure to eat more, children having shorter sleep duration, longer periods of sedentary behavior, and higher intake frequencies of sweetened food, fried food, and meats, fish, and eggs. Children born in other places, having snacks more frequently, and having irregular meals were also more likely to be overweight or obese, with marginal significance. Conclusions: Children with ID are more vulnerable to being overweight or obese than their typically developing counterparts. Identified risk factors in this study highlight a multifaceted approach to the involvement of parents as well as the modification of some children’s questionable behaviors to help them achieve a healthy weight.

Keywords: prevalence, risk factors, obesity, children with disability

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Authors: Nizika Sorokhaibam

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With the collapse of the Soviet Union in 1989, that marked the end of the prolonged struggle of ideologies between capitalism of the United States of America and communism of the Soviet Union, the world entered a new era of free markets, trade and economic liberalization. Through analysis of various literatures on North Korea, this study focuses on the impact of Globalization on North Korea- its people, economy and the regime. The study also takes a glance at the Juche ideology, which was crafted by the Supreme Leader Kim Il Sung, for the people of DPRK and its role and influence in shaping the North Korean economy. The new buzz word being Globalization, as businesses started to expand on international scale, demanding the need for co-operation, connectivity and interdependence of countries around the world. States tilted their focus towards industrialization, production of raw materials, production of goods to meet the growing demands and grabbing markets for the manufactured products. This became the norm as many newly independent countries adopted democracy and aligned their views with globalization processes. Socialist and communist regimes either fell one after the other to join the globalization trend or reformed their economic system to meet the globalization trends. However, even after staying isolated for more than six decades, Democratic People’s Republic of Korea, the Hermit Kingdom, refuses to open up its economy to the globalised world. North Korean regime still controls all the sectors of the country and no trade and investment freedom is given to the people. North Korea vigorously makes efforts to emphasize on its Juche ideology of self-sustenance and self-reliance to keep away from actively engaging in global trade and process of globalization, which they refer to as “Americanization” of the world. Nevertheless, the reality is that North Korea’s economy is not self sustained and is collapsing from within, which led them to solicit foreign aid from the United States of America, South Korea (Republic of Korea) and People’s Republic of China. The regime needs to implement reforms and make adjustments for the economy to survive in the competing world.

Keywords: economic globalization, economic isolation, Juche, North Korea

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Authors: Najeeb Hassan, Mahmudur Rahman

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Arial Khan River is one of the main south-eastward outlets of the River Padma. This river maintains a meander channel through its course and is erosional in nature. The specific objective of the research is to study and evaluate the hydrological characteristics in the form of assessing changes of cross-sections, discharge, water level and velocity profile in different stations and to create a hydrodynamic model of the Arial Khan River. Necessary data have been collected from Bangladesh Water Development Board (BWDB) and Center for Environment and Geographic Information Services (CEGIS). Satellite images have been observed from Google earth. In this study, hydrodynamic model of Arial Khan River has been developed using well known steady open channel flow code Hydrologic Engineering Centers and River Analysis System (HEC-RAS) using field surveyed geometric data. Cross-section properties at 22 locations of River Arial Khan for the years 2011, 2013 and 2015 were also analysed. 1-D HEC-RAS model has been developed using the cross sectional data of 2015 and appropriate boundary condition is being used to run the model. This Arial Khan River model is calibrated using the pick discharge of 2015. The applicable value of Mannings roughness coefficient (n) is adjusted through the process of calibration. The value of water level which ties with the observed data to an acceptable accuracy is taken as calibrated model. The 1-D HEC-RAS model then validated by using the pick discharges from 2009-2018. Variation in observed water level in the model and collected water level data is being compared to validate the model. It is observed that due to seasonal variation, discharge of the river changes rapidly and Mannings roughness coefficient (n) also changes due to the vegetation growth along the river banks. This river model may act as a tool to measure flood area in future. By considering the past pick flow discharge, it is strongly recommended to improve the carrying capacity of Arial Khan River to protect the surrounding areas from flash flood.

Keywords: BWDB, CEGIS, HEC-RAS

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Authors: Oscar E. Cariceo, Claudia V. Casal

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Machine learning offers a set of techniques to promote social work interventions and can lead to support decisions of practitioners in order to predict new behaviors based on data produced by the organizations, services agencies, users, clients or individuals. Machine learning techniques include a set of generalizable algorithms that are data-driven, which means that rules and solutions are derived by examining data, based on the patterns that are present within any data set. In other words, the goal of machine learning is teaching computers through 'examples', by training data to test specifics hypothesis and predict what would be a certain outcome, based on a current scenario and improve that experience. Machine learning can be classified into two general categories depending on the nature of the problem that this technique needs to tackle. First, supervised learning involves a dataset that is already known in terms of their output. Supervising learning problems are categorized, into regression problems, which involve a prediction from quantitative variables, using a continuous function; and classification problems, which seek predict results from discrete qualitative variables. For social work research, machine learning generates predictions as a key element to improving social interventions on complex social issues by providing better inference from data and establishing more precise estimated effects, for example in services that seek to improve their outcomes. This paper exposes the results of a classification algorithm to predict cyberbullying among adolescents. Data were retrieved from the National Polyvictimization Survey conducted by the government of Chile in 2017. A logistic regression model was created to predict if an adolescent would experience cyberbullying based on the interaction and behavior of gender, age, grade, type of school, and self-esteem sentiments. The model can predict with an accuracy of 59.8% if an adolescent will suffer cyberbullying. These results can help to promote programs to avoid cyberbullying at schools and improve evidence based practice.

Keywords: cyberbullying, evidence based practice, machine learning, social work research

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Authors: Karen Fang

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Investigative genetic genealogy has attracted much interest in both the field of ethics and the public eye due to its global application in criminal cases. Arguments have been made regarding privacy and informed consent, especially with law enforcement using consumer genetic testing results to convict individuals. In the case of public interest, DNA databases have the strong potential to significantly reduce crime, which in turn leads to safer communities and better futures. With the advancement of genetic technologies, the integration of a universal forensic DNA database in violent crimes, crimes against children, and missing person cases is expected to deter crime while protecting one’s privacy. Rather than collecting whole genomes from the whole population, STR profiles can be used to identify unrelated individuals without compromising personal information such as physical appearance, disease risk, and geographical origin, and additionally, reduce cost and storage space. STR DNA profiling is already used in the forensic science field and going a step further benefits several areas, including the reduction in recidivism, improved criminal court case turnaround time, and just punishment. Furthermore, adding individuals to the database as early as possible prevents young offenders and first-time offenders from participating in criminal activity. It is important to highlight that DNA databases should be inclusive and tightly governed, and the misconception on the use of DNA based on crime television series and other media sources should be addressed. Nonetheless, deterrent effects have been observed in countries like the US and Denmark with DNA databases that consist of serious violent offenders. Fewer crimes were reported, and fewer people were convicted of those crimes- a favorable outcome, not even the death penalty could provide. Currently, there is no better alternative than a universal forensic DNA database made up of STR profiles. It can open doors for investigative genetic genealogy and fostering better communities. Expanding the appropriate use of DNA databases is ethically acceptable and positively impacts the public.

Keywords: bioethics, deterrent effects, DNA database, investigative genetic genealogy, privacy, public interest

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Authors: Takaharu Hirai, Yuta Mitobe, Hiromi Hirai

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Introduction: Eating disorders (ED) are serious psychiatric disorders that affect individuals, especially adolescents. It has been suggested that nonclinical ED-like characteristics are related to sleep problems. However, studies exploring the association between potential ED and sleep disorders have primarily been conducted in Europe and the United States. We conducted a survey of Japanese adolescents to investigate this claim. Method: In this cross-sectional study, 398 school-aged adolescents, aged 12–18 years old, matched for gender ratio, responded to a self-administered questionnaire survey. We used the Eating Attitudes Test-26 (EAT-26) and the Athens Insomnia Scale (AIS) to measure potential ED and sleep problems, respectively. In this study, participants with an EAT-26 total score of 0–19 points were classified as non-ED, while those with scores of 20 points or higher were classified as potential ED. Result: Of the 398 participants, 17 (4.3%) had an EAT-26 total score of 20 or higher. Among boys, the rate was 6 of 199 participants (3%), and among girls, the rate was 11 of 182 participants (6%). There were 89 participants (22.4%) with an AIS score of 6 points or higher, of which 36 (17.6%) were boys, and 53 (27.5%) were girls. Adolescents with potential ED had significantly higher rates of daytime sleep problems than those without ED. Further, while examining the types of sleep problems, adolescents with potential ED had greater problems with a sense of well-being and physical and mental functioning during the day. In contrast, no significant associations were found between potential ED and sleep initiation, awakenings during the night, early morning awakening, total sleep duration, or overall quality of sleep. Finally, nocturnal and daytime sleep scores were significantly associated with dieting, bulimia, and oral control EAT-26 sub-scores. Discussion: While Japanese adolescents with possible ED do not experience nighttime sleep problems, they do experience problems related to well-being and mental and physical functioning, which are indicators of daytime sleep problems. This may assist with early detection of disordered eating in adolescents. The study suggested that professionals working towards adolescent mental health issues need an approach that comprehensively integrates both sleep problems and potential ED.

Keywords: adolescents, potential eating disorders, sleep problems, eating attitudes test-26

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Authors: Lima Antony

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In G. M. Hopkins’s poetics and aesthetics there is scope for a comparative study with Indian discourses on aesthetics, an area not adequately explored so far. This exploration will enrich the field of comparative study of diverse cultural expressions and their areas of similarity. A comparative study of aesthetic and religious experiences in diverse cultures will open up avenues for the discovery of similarities in self-experiences and their transcendence. Such explorations will reveal similar patterns in aesthetic and religious experiences. The present paper intends to prove this in the theories of Hopkins and Indian aesthetics. From the time of the Vedas Indian sages have believed that aesthetic enjoyment could develop into a spiritual realm. From the Natyasastra of Bharata, Indian aesthetics develops and reaches its culmination in later centuries into a consciousness of union with the mystery of the Ultimate Being, especially in Dhvanaāloka of Anandavardhana and Locana of Abhinavagupta. Dhvanyaloka elaborates the original ideas of rasa (mood or flavor) and dhvani (power of suggestion) in Indian literary theory and aesthetics. Hopkins was successful, like the ancient Indian alankarikas, in creating aesthetically superb patterns at various levels of sound and sense for which he coined the term ‘inscape’. So Hopkins’s aesthetic theory becomes suitable for transcultural comparative study with Indian aesthetics especially the dhvani theories of Anandavardhana and Abhinavagupta. Hopkins’s innovative approach to poetics and his selection of themes are quite suitable for analysis in the light of Indian literary theories. Indian philosophy views the ultimate reality called Brahman, as the 'soul,' or inner essence, of all reality. We see in Hopkins also a search for the essence of things and the chiming of their individuality with the Ultimate Being in multidimensional patterns of sound, sense and ecstatic experience. This search culminates in the realization of a synthesis of the individual self with the Ultimate Being. This is achieved through an act of surrender of the individuality of the self before the Supreme Being. Attempts to reconcile the immanent and transcendent aspects of the Ultimate Being can be traced in the Indian as well as Hopkins’s aesthetics which can contribute to greater understanding and harmony between cultures.

Keywords: Dhvani, Indian aesthetics, transcultural studies, Rasa

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Authors: Afshin Zahedi, Keivan Jamshidi

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This study was conducted to determine the neurotoxic effects of different doses of ACR on the thoracic axons of the spinal cord of rat. To evaluate this hypothesis in the thoracic axons, amino-cupric silver staining technique of the de Olmos was conducted to define the histopathologic characteristic (argyrophilia) of axonal damage following ACR exposure. For this purpose 60 adult male rats (Wistar, approximately 250 g) were selected. Rats were hosed in polycarbonate boxes as two per each. Randomly assigned groups of rats (10 rats per exposure group, total 5 exposure groups as A, B, C, D and E) were exposed to 0.5, 5, 50, 100 and 500 mg/kg per day×11days intraperitoneal injection (IP injection) respectively. The remaining 10 rats were housed in group (F) as control group. Control rats received daily injections of 0.9% saline (3ml/kg). As indices of developing neurotoxicity, weight gain, gait scores and landing hindlimb foot splay (LHF) were determined. Weight gains were measured daily prior to injection. Gait scoring involved observation of spontaneous open field locomotion, included evaluations of ataxia, hopping, rearing and hind foot placement, and hindlimb foot splay were determined 3-4 times per week. Gait score was assigned from 1-4. After 11 days, two rats for silver stain, were randomly selected, dissected and proper samples were collected from thoracic portion of the spinal cord of rat. Results did show no neurological behavior in groups A, B and F, whereas severe neurotoxicity was observed in groups C and D. Rats in groups E died within 1-2 hours due to severe toxemia. In histopathological studies based on the de Olmos technique no argyrophilic neurons or processes were observed in stained sections obtained from the thoracic portion of the spinal cord of rats belong to groups A, B and F, while moderate to severe argyrophilic changes were observed in different stained sections obtained from the thoracic portion of the spinal cord of rats belong to groups C and D.

Keywords: acrylamide, rat, axonopathy, argyrophily, de Olmos

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Authors: Gift Chidi-Onwuta, Iwe Nkem Nkechinyere, Chikamadu Christabelle Chinyere

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The teaching of English is a resource-driven activity that requires rich resource-classroom settings for the delivery of effective lessons and the acquisition of interpersonal skills for integration in a target-language environment. However, throughout the world, English is often taught in low-resource classrooms. This paper is aimed to reveal the common problems associated with teaching English in low-resource environments and the prospects for teachers who found themselves in such undefined teaching settings. Self-structured and validated questionnaire in a closed-ended format, open question format and scaling format was administered to teachers across five countries: Nigeria, Cameroun, Iraq, Turkey, and Sudan. The study adopts situational language teaching theory (SLTT), which emphasizes a performance improvement imperative. This study inclines to this model because it maintains that learning must be fun and enjoyable like playing a favorite sport, just as in real life. Since teaching resources make learning engaging, we found this model apt for the current study. The perceptions of teachers about accessibility and functionality of teaching material resources, the nature of teaching outcomes in resource-less environments, their levels of involvement in improvisation and the prospects associated with resource limitations were sourced. Data were analysed using percentages and presented in frequency tables. Results: showed that a greater number of teachers across these nations do not have access to sufficient productive resource materials that can aid effective English language teaching. Teaching outcomes, from the findings, are affected by low material resources; however, results show certain advantages to teaching English with limited resources: flexibility and autonomy with students and creativity and innovation amongst teachers. Results further revealed group work, story, critical thinking strategy, flex, cardboards and flashcards, dictation and dramatization as common teaching strategies, as well as materials adopted by teachers to overcome low resource-related challenges in classrooms.

Keywords: teaching materials, low-resource environments, English language teaching, situational language theory

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Authors: Mohd Asharf Ganie, Aafia Rashid, Mohd Afzal Zargar, Showkat Ali Zargar, Syed Mudasar, Tabasum Parvaiz, Zafar Amin Shah

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Accumulating evidence suggests that Vitamin D deficiency (VDD) might at least contribute to the metabolic co-morbidities in PCOS. Hence, we aimed to study the effect of vitamin D supplementation in co-prescription with insulin sensitizers like metformin and pioglitazone on clinical, hormonal and metabolic parameters in women with PCOS. In this open label randomized, controlled trial a total of 120 women with PCOS diagnosis (AE-PCOS 2009 Criteria) were assigned to four treatment groups (n= 30 in each): group I (metformin 1 gm/day in combination with cholecalciferol 4000 IU/day), group II (pioglitazone 30 mg/day in combination with cholecalciferol 4000 IU/day), group III (metformin 1 gm /day) and group IV (pioglitazone 30 mg/day). Vitamin D supplementation was given as 60,000 units every two weeks for 24 weeks. All the subjects were routinely evaluated for clinical, biochemical, hormonal and insulin sensitivity parameters in addition to various safety parameters especially serum calcium levels at baseline and after 24 weeks of the treatment. Our results indicate that 95.5% of PCOS women were vitamin D deficient at baseline. Serum 25 (OH) D levels increased significantly (p < 0.001) in groups I and II without any adverse effects after 24 weeks of oral administration of 4000 IU cholecalciferol daily. However, serum 25 (OH) D levels remained unchanged in group III and IV. By six months, number of menstrual cycles per year increased whereas Ferriman-Gallwey score, serum total testosterone and HOMA-IR decreased significantly (P < 0.001) in the treatment groups supplemented with cholecalciferol as compared to those treated either drug alone. No significant beneficial changes were observed on weight, BMI, blood pressure, glucose tolerance and serum lipids in any of the groups supplemented with cholecalciferol. We conclude that daily dose of 4000 IU cholecalciferol might be a useful adjunct in complex treatment of PCOS with fewer adverse events. Furthermore, pioglitazone and cholecalciferol combination seems to be marginally better although there was no statistical significance.

Keywords: PCOS, vitamin D supplementation, insulin resistance, spironolactone, metformin, pioglitazone

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