Search results for: objective realism

Authors: Ubaid Ullah Kamgar, Ajaz Ahmed Suhaff, Mohammad Maqbool Dar

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Objective: The aim is to study the association of MRI findings of T₂/FLAIR white matter hyperintensities among patients with psychiatric disorders. Background and Rationale: MRI findings in psychiatric disorders can vary widely depending on specific disorders and individual differences. However, some general patterns have been observed, such as, in Depression - reduced volume in areas such as the prefrontal cortex and hippocampus; in Schizophrenia - enlarged ventricles, abnormalities in frontal and temporal lobes, as well as hippocampus and thalamus; in Bipolar Disorder – reduced volume in the prefrontal cortex and hippocampus and abnormalities in the amygdala; in OCD – abnormalities in the orbitofrontal cortex, anterior cingulate cortex and striatum. However, many patients show findings of white-matter hyper-intensities, which are usually considered non-specific in psychiatry. These hyperintensities are low attenuation in the deep and white matter. The pathogenic mechanisms of white matter hyperintensities are not well-understood and have been attributed to cerebral small vessel disease. The aim of the study is to study the association of the above MRI findings in patients with psychiatric disorders after ruling out neurological disorders (if any are found). Methodology: Patients admitted to psychiatric hospitals or presenting to OPDs with underlying psychiatric disorders, having undergone MRI Brain as part of investigations, and having T₂/FLAIR white-matter hyperintensities on MRI were taken to study the association of the above MRI findings with different psychiatric disorders. Results: Out of the 22 patients having MRI findings of T₂/FLAIR white-matter hyper-intensities, the underlying psychiatric comorbidities were: Major Depressive Disorder in 7 pts; Obsessive Compulsive Disorder in 5 pts; Bipolar Disorder in 5 pts; Dementia (vascular type) in 5pts. Discussion and conclusion: In our study, the white matter hyper-intensities were found mostly in MDD (32%), OCD (22.7%), Bipolar Disorder (22.7%) and Dementia in 22.7% of patients. In conclusion, the presence of white-matter hyperintensities in psychiatric disorders underscores the complex interplay between vascular, neurobiological and psychosocial factors. Further research with a large sample size is needed to fully elucidate their clinical significance.

Keywords: white-matter hyperintensities, OCD, MDD, dementia, bipolar disorder.

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Authors: Javier Comes Fayos, Isabel Rodríguez Moreno, Sara Bressanutti, Marisol Lila, Angel Romero Martínez, Luis Moya Albiol

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Empathy is a cognitive-affective capacity whose deterioration is associated with aggressive behaviour. Deficient affective processing is one of the predominant risk factors in men convicted of intimate partner violence (IPV perpetrators), since it makes their capacity to empathize very difficult. The objective of this study is to compare the response of electrodermal activity (EDA), as an indicator of emotionality, to an empathic induction task, between IPV perpetrators and men without a history of violence. The sample was composed of 51 men who attended the CONTEXTO program, with penalties for gender violence under two years, and 47 men with no history of violence. Empathic induction was achieved through the visualization of 4 negative emotional-eliciting videos taken from an emotional induction battery of videos validated for the Spanish population. The participants were asked to actively empathize with the video characters (previously pointed out). The psychophysiological recording of the EDA was accomplished by the "Vrije Universiteit Ambulatory Monitoring System (VU-AMS)." An analysis of repeated measurements was carried out with 10 intra-subject measurements (time) and "group" (IPV perpetrators and non-violent perpetrators) as the inter-subject factor. First, there were no significant differences between groups in the baseline AED levels. Yet, a significant interaction between the “time” and “group” was found with IPV perpetrators exhibiting lower EDA response than controls after the empathic induction task. These findings provide evidence of a subdued EDA response after an empathic induction task in IPV perpetrators with respect to men without a history of violence. Therefore, the lower psychophysiological activation would be indicative of difficulties in the emotional processing and response, functions that are necessary for the empathic function. Consequently, the importance of addressing possible empathic difficulties in IPV perpetrator psycho-educational programs is reinforced, putting special emphasis on the affective dimension that could hinder the empathic function.

Keywords: electrodermal activity, emotional induction, empathy, intimate partner violence

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Authors: Shawna Staud, Mary Kaye Scaramucci

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Objective: Rubber cup polishing has been a traditional method of preventative therapy in dental hygiene treatment. Newer methods such as air polishing have changed the way dental hygiene care is provided, yet this technique has not been embraced by students in the program nor by practitioners in the workforce. Students entering the workforce tend to follow office protocol and are limited in confidence to introduce technologies learned in the curriculum. This project was designed to help students gain confidence in newer skills and encourage private practice settings to adopt newer technologies for patient care. Our program recently introduced air polishing earlier in the program before the rubber cup technique to determine if students would embrace the technology to become leading-edge professionals when they enter the marketplace. Methods: The class of 2022 was taught the traditional method of polishing in the first-year curriculum and air polishing in the second-year curriculum. The class of 2023 will be taught the air polishing method in the first-year curriculum and the traditional method of polishing in the second-year curriculum. Pre- and post-graduation survey data will be collected from both cohorts. Descriptive statistics and pre and post-paired t-tests with alpha set at .05 to compare pre and post-survey results will be used to assess data. Results: This study is currently in progress, with a completion date of October 2023. The class of 2022 completed the pre-graduation survey in the spring of 2022. The post-gradation survey will be sent out in October 2022. The class of 2023 cohort will be surveyed in the spring of 2023 and October 2023. Conclusion: Our hypothesis is students who are taught air polishing first will be more inclined to adopt that skill in private practice, thereby embracing newer technology and improving oral health care.

Keywords: luggage handling system at world’s largest pilgrimage center

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Authors: Vivianne Aggestam

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Purpose: Organic dairy products have steadily increased with consumer popularity in recent years in Sweden, permitting more transport activities. The main aim of this study was to compare the transport costs and the environmental emissions made by the organic and conventional dairy production in Sweden. The objective was to evaluate differences and environmental impacts of transport between the two different production systems, allowing a more transparent understanding of the real impact of transport within the supply chain. Methods: A partial attributional Life Cycle Assessment has been conducted based on a comprehensive survey of Swedish farmers, dairies and consumers regarding their transport needs and costs. Interviews addressed the farmers and dairies. Consumers were targeted through an online survey. Results: Higher transport inputs from conventional dairy transportation are mainly via feed and soil management on farm level. The regional organic milk brand illustrate less initial transport burdens on farm level, however, after leaving the farm, it had equal or higher transportation requirements. This was mainly due to the location of the dairy farm and shorter product expiry dates, which requires more frequent retail deliveries. Organic consumers tend to use public transport more than private vehicles. Consumers using private vehicles for shopping trips primarily bought conventional products for which price was the main deciding factor. Conclusions: Organic dairy products that emphasise its regional attributes do not ensure less transportation and may therefore not be a more “climate smart” option for the consumer. This suggests that the idea of localism needs to be analysed from a more systemic perspective. Fuel and regional feed efficiency can be further implemented, mainly via fuel type and the types of vehicles used for transport.

Keywords: supply chains, distribution, transportation, organic food productions, conventional food production, agricultural fossil fuel use

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Authors: Amna Ali Al-Saadi, Riken Homma, Kazuhisa Iki

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Despite the fact that many places have successes in achieving some aspects of sustainable urban development, there are no scientific facts to convince decision makers. Also, each of them was developed to fulfill the need of specific city only. Therefore, objective method to generate the solutions from a successful case is the aim of this research. The questions were: how to learn the lesson from each case study; how to distinguish the potential criteria and negative one; snd how to quantify their effects in the future development. Walkability has been selected as a goal. This is because it has been found as a solution to achieve healthy life style as well as social, environmental and economic sustainability. Moreover, it has complication as every aspect of sustainable development. This research is stand on quantitative- comparative methodology in order to assess pedestrian oriented development. Three analyzed area (AAs) were selected. One site is located in Oman in which hypotheses as motorized oriented development, while two sites are in Japan where the development is pedestrian friendly. The study used Multi- criteria evaluation method (MCEM). Initially, MCEM stands on analytic hierarchy process (AHP). The later was structured into main goal (walkability), objectives (functions and layout) and attributes (the urban form criteria). Secondly, the GIS were used to evaluate the attributes in multi-criteria maps. Since each criterion has different scale of measurement, all results were standardized by z-score and used to measure the co-relations among criteria. As results, different scenario was generated from each AA. MCEM (AHP-OWA)-GIS measured the walkability score and determined the priority of criteria development in the non-walker friendly environment. The comparison criteria for z-score presented a measurable distinguished orientation of development. This result has been used to prove that Oman is motorized environment while Japan is walkable. Also, it defined the powerful criteria and week criteria regardless to the AA. This result has been used to generalize the priority for walkable development. In conclusion, the method was found successful in generate scientific base for policy decisions.

Keywords: walkability, policy decisions, sustainable development, GIS

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Authors: Eric Jacob Bacon, Chaoyang Jin, Dianning He, Shuaishuai Hu, Lanbo Wang, Han Li, Shouliang Qi

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Objective: Refractory epilepsy is a complicated type of epilepsy that can be difficult to diagnose. Recent technological advancements have made resting-state functional magnetic resonance (rsfMRI) a vital technique for studying brain activity. However, there is still much to learn about rsfMRI. Investigating rsfMRI connectivity may aid in the detection of abnormal activities. In this paper, we propose studying the functional connectivity of rsfMRI candidates to diagnose epilepsy. Methods: 45 rsfMRI candidates, comprising 26 with refractory epilepsy and 19 healthy controls, were enrolled in this study. A data-driven approach known as independent component analysis (ICA) was used to achieve our goal. First, rsfMRI data from both patients and healthy controls were analyzed using group ICA. The components that were obtained were then spatially sorted to find and select meaningful ones. A two-sample t-test was also used to identify abnormal networks in patients and healthy controls. Finally, based on the fractional amplitude of low-frequency fluctuations (fALFF), a chi-square statistic test was used to distinguish the network properties of the patient and healthy control groups. Results: The two-sample t-test analysis yielded abnormal in the default mode network, including the left superior temporal lobe and the left supramarginal. The right precuneus was found to be abnormal in the dorsal attention network. In addition, the frontal cortex showed an abnormal cluster in the medial temporal gyrus. In contrast, the temporal cortex showed an abnormal cluster in the right middle temporal gyrus and the right fronto-operculum gyrus. Finally, the chi-square statistic test was significant, producing a p-value of 0.001 for the analysis. Conclusion: This study offers evidence that investigating rsfMRI connectivity provides an excellent diagnosis option for refractory epilepsy.

Keywords: ICA, RSN, refractory epilepsy, rsfMRI

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Authors: Chalermsri Sorasit, Siriporn Mongkhonthawornchai, Darawan Augsornwan, Sudthanom Kamollirt

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Background: Although knowledge of pain and pain management is improving, they are still inadequate to patients. The Nursing Division of Srinagarind Hospital is responsible for setting the pain management system, including work instruction development and pain management indicators. We have developed an information technology program for monitoring pain quality indicators, which was implemented to all nursing departments in April 2013. Objective: To study outcomes of acute pain management in process and outcome indicators. Method: This is a retrospective descriptive study. The sample population was patients who had acute pain 24-48 hours after receiving a procedure, while admitted to Srinagarind Hospital in 2014. Data were collected from the information technology program. 2709 patients with acute pain from 10 Nursing Departments were recruited in the study. The research tools in this study were 1) the demographic questionnaire 2) the pain management questionnaire for process indicators, and 3) the pain management questionnaire for outcome indicators. Data were analyzed and presented by percentages and means. Results: The process indicators show that nurses used pain assessment tool and recorded 99.19%. The pain reassessment after the intervention was 96.09%. The 80.15% of the patients received opioid for pain medication and the most frequency of non-pharmacological intervention used was positioning (76.72%). For the outcome indicators, nearly half of them (49.90%) had moderate–severe pain, mean scores of worst pain was 6.48 and overall pain was 4.08. Patient satisfaction level with pain management was good (49.17%) and very good (46.62%). Conclusion: Nurses used pain assessment tools and pain documents which met the goal of the pain management process. Patient satisfaction with pain management was at high level. However the patients had still moderate to severe pain. Nurses should adhere more strictly to the guidelines of pain management, by using acute pain guidelines especially when pain intensity is particularly moderate-high. Nurses should also develop and practice a non-pharmacological pain management program to continually improve the quality of pain management. The information technology program should have more details about non-pharmacological pain techniques.

Keywords: outcome, pain management, acute pain, Srinagarind Hospital

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Authors: S. P. Rana

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Objectives: For the manufacture of a very thin strip or a strip with a high-quality finish, the stainless steel sheet that is called billet is re-rolled in re-rolling mill to make stainless steel sheet of 18 gauges. The rolls of re-rolling mill exert tremendous pressure over the sheet and there is likely chance of breaking of stainless steel strip from the sheet. The objective of the study was to minimise the number of accidents in steel re-rolling mills due to ejection of stainless steel strip and to minimize the pollution caused by the pickling process used in these units. Methods: Looking into the high rate of frequency and severity of accidents as well as pollution hazard in re-rolling and pickling mills, it becomes essential to make necessary arrangements for prevention of accidents in such type of industry. The author carried out survey/inspections of a large number of re-rolling and pickling mills and allied units. During the course of inspection, the working of these steel re-rolling and pickling mills was closely studied and monitored. A number of accidents involving re-rolling mills were investigated and subsequently remedial measures to prevent the occurrence of such accidents were suggested. Assessment of occupational safety and health system of these units was carried out and compliance level of the statutory requirements was checked. The workers were medically examined and monitored to ascertain their health conditions. Results: Proper use of safety gadgets by workers, machine guarding and regular training brought down the risk to an acceptable level and discharged effluent pollution was brought down to permissible limits. The fatal accidents have been reduced by 83%. Conclusions: Effective enforcement and implementation of the directions/suggestions given to the managements of such units brought down the no. of accidents to a rational level. The number of fatal accidents has reduced by 83% during the study period. The effective implementation of pollution control device curtailed the pollution level to an acceptable level.

Keywords: re-rolling mill, hazard, accident, health hazards

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Authors: Nagwa E. Abd Elazim, Maha S. El-naggar, Rania H. Mohamed, Sara M. Awad

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Background: Radiodermatitis is a common side effect of radiation therapy for breast cancer. However, there is no current consensus about effective standard therapy for the prevention and management of radiation dermatitis. Topical ectoine has demonstrated efficacy in the treatment of atopic dermatitis owing to its anti-inflammatory activity. Objective: To evaluate the efficacy of topical ectoine in comparison to traditional topical dexpanthenol treatment in the management of acute radiodermatitis in breast cancer patients undergoing adjuvant radiotherapy. Methods: Fifty patients were randomized to use either dexpanthenol 0.5% cream (25 patients), or ectoin 7% cream (25 patients), applied twice daily to the irradiated area during the radiation period and continued for 2 weeks after cessation of radiotherapy. Assessment of radiation skin toxicity using Common Terminology Criteria of Adverse Events (CTCAE) v4.0, radiation-associated symptoms, and adverse events were undertaken weekly during radiotherapy and 2 weeks after the end of radiotherapy. Results: Topical ectoine showed some clinical benefit over dexpanthenol, as shown by delayed time to onset (at week 3 versus week 2, respectively) and larger number of patients who reached grade 0 at the end of treatment (64% vs. 48%, respectively). The clinical symptoms of pain (p = 0.003) and itching (p = 0.001) attributable to radiation were less pronounced with ectoine than with dexpanthenol. Burning and hyperpigmentation were the most common side effects with ectoine. However, no significant difference between dexpanthenol and ectoine treatments was found in any of the side effects (p = 0.1). Conclusion: Ectoin was overall more effective in improving radiation dermatitis than topical dexpanthenol in breast cancer patients. Ectoin could be proposed as a preventive or curative treatment for patients undergoing postoperative irradiation for breast cancer. Further clinical studies with a larger number of patients are recommended for the confirmation of these preliminary results.

Keywords: breast cancer, dexapanthenol, ectoin, radiation dermatitis

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Authors: Sathyaseelan Subramaniam, Jacqueline Bober, Jennifer Chao, Shahriar Zehtabchi

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Background: Emergency physicians frequently evaluate skin and soft tissue infections in order to differentiate abscess from cellulitis. This helps determine which patients will benefit from incision and drainage. Our objective was to determine the operating characteristics of point-of-care ultrasound (POCUS) compared to clinical examination in identifying abscesses in emergency department (ED) patients with features of skin and soft tissue infections. Methods: We performed a comprehensive search in the following databases: Medline, Web of Science, EMBASE, CINAHL and Cochrane Library. Trials were included if they compared the operating characteristics of POCUS with clinical examination in identifying skin and soft tissue abscesses. Trials that included patients with oropharyngeal abscesses or that requiring abscess drainage in the operating room were excluded. The presence of an abscess was determined by pus drainage. No pus seen on incision or resolution of symptoms without pus drainage at follow up, determined the absence of an abscess. Quality of included trials was assessed using GRADE criteria. Operating characteristics of POCUS are reported as sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios and the respective 95% confidence intervals (CI). Summary measures were calculated by generating a hierarchical summary receiver operating characteristic model (HSROC). Results: Out of 3203 references identified, 5 observational studies with 615 patients in aggregate were included (2 adults and 3 pediatrics). We rated the quality of 3 trials as low and 2 as very low. The operating characteristics of POCUS and clinical examination in identifying soft tissue abscesses are presented in the table. The HSROC for POCUS revealed a sensitivity of 96% (95% CI = 89-98%), specificity of 79% (95% CI = 71-86), LR+ of 4.6 (95% CI = 3.2-6.8), and LR- of 0.06 (95% CI = 0.02-0.2). Conclusion: Existing evidence indicates that POCUS is useful in identifying abscesses in ED patients with skin or soft tissue infections.

Keywords: abscess, point-of-care ultrasound, pocus, skin and soft tissue infection

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Authors: Alexey Yu. Martynov, Sulejman Bayramov

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Introduction: The myocardial bridging is the most common anomaly of the coronary arteries (CA). Depending on the examination method, the frequency of detected myocardial bridges (MB) varies in a rather wide range. The typical clinical manifestations of MB are angina pectoris, arrhythmias, sudden cardiac death. Objective: To study the incidence of MB in patients hospitalized with coronary artery disease (CAD). To assess clinical manifestations of MB in patients admitted with CAD. Materials and methods: A retrospective analysis of 19159 case histories of patients admitted at clinical city hospital in Moscow from 01.01.2018 to 31.12 2019 with CAD was performed. 9384 patients’ coronary angiographies (CAG) were examined for MB. The localization of MB, the degree of coronary contraction by MB, the number of MB, isolated MB and combined with CAD were assessed. The clinical manifestations of MB were determined. Results: MB was detected in 52 patients all with one myocardial bridge. 20 patients with MB have intact CA, and 32 patients have MB combined with CAD. Among 20 patients with intact CA: I degree of MB contraction (up to 50%) was detected in 9 patients. Clinical manifestations in five cases were angina pectoris, in 3 myocardial infarction (MI) - 1 patients with ST segment elevation MI (STEMI), 2 without ST segment elevation MI (NSTEMI), 1 post-infarction cardiosclerosis (PICS). Stable angina II FC in 3, III FC in 1, vasospastic angina (VSA) in 1 patient. II degree of MB contraction (up to 50-70%) was determined in 9 patients: in seven cases angina pectoris was detected, 1 NSTEMI, 1 PICS. Stable angina II FC in 3, III FC in 1, VSA in 3 patients. III degree of MB contraction (> 70%) detected in 2 patients. II FC stable angina in one case, PICS in another. Among 32 patients having MB combined with CAD I degree of MB contraction was observed in 20 patients. Clinical manifestations in 12 cases were angina pectoris in 8 II FC and in 4 III FC, 7 MI 6 with STEMI and 1 NSTEMI, 1 PICS. II degree of MB contraction was detected in 7 patients, 4 of them had angina pectoris, 3 MI 2 with STEMI and 1 NSTEMI. Stable angina II FC in 3, VSA in 1 patients. III degree of MB contraction was diagnosed in five patients. In two cases, II FC and III FC stable angina were observed, 2 MI with STEMI and NSTEMI, 1 PICS. Conclusions: MB incidence is one in 368 patients with CAD. The most common involvement (68%) is MB combined with CA atherosclerotic lesions. MB with intact CA are detected in one-third (32%) of patients. The first-degree MB contraction is most frequent condition. MI is more often detected in intact CA with first degree MB than in the second degree. The degree of MB contraction was not correlated with the severity of the clinical manifestations.

Keywords: clinical manifestations, coronary angiography, coronary artery disease, myocardial bridging, myocardial infarction, stable angina

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Authors: N. Casado-Sanz, B. Guirao

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The population aged 65 and over is projected to double in the coming decades. Due to this increase, driver population is expected to grow and in the near future, all countries will be faced with population aging of varying intensity and in unique time frames. This is the greatest challenge facing industrialized nations and due to this fact, the study of the relationships of dependency between population aging and road safety is becoming increasingly relevant. Although the deterioration of driving skills in the elderly has been analyzed in depth, to our knowledge few research studies have focused on the road infrastructure and the mobility of this particular group of users. In Spain, crosstown roads have one of the highest fatality rates. These rural routes have a higher percentage of elderly people who are more dependent on driving due to the absence or limitations of urban public transportation. Analysing road safety in these routes is very complex because of the variety of the features, the dispersion of the data and the complete lack of related literature. The objective of this paper is to identify key factors that cause traffic accidents. The individuals under study were the accidents with killed or seriously injured in Spanish crosstown roads during the period 2006-2015. Latent cluster analysis was applied as a preliminary tool for segmentation of accidents, considering population aging as the main input among other socioeconomic indicators. Subsequently, a linear regression analysis was carried out to estimate the degree of dependence between the accident rate and the variables that define each group. The results show that segmenting the data is very interesting and provides further information. Additionally, the results revealed the clear influence of the aging variable in the clusters obtained. Other variables related to infrastructure and mobility levels, such as the crosstown roads layout and the traffic intensity aimed to be one of the key factors in the causality of road accidents.

Keywords: cluster analysis, population ageing, rural roads, road safety

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Authors: Gianpaolo Ghiani, Emanuela Guerriero, Emanuele Manni, Alessandro Romano

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In this article, we deal with a variant of the classical course timetabling problem that has a practical application in many areas of education. In particular, in this paper we are interested in high schools remedial courses. The purpose of such courses is to provide under-prepared students with the skills necessary to succeed in their studies. In particular, a student might be under prepared in an entire course, or only in a part of it. The limited availability of funds, as well as the limited amount of time and teachers at disposal, often requires schools to choose which courses and/or which teaching units to activate. Thus, schools need to model the training offer and the related timetabling, with the goal of ensuring the highest possible teaching quality, by meeting the above-mentioned financial, time and resources constraints. Moreover, there are some prerequisites between the teaching units that must be satisfied. We first present a Mixed-Integer Programming (MIP) model to solve this problem to optimality. However, the presence of many peculiar constraints contributes inevitably in increasing the complexity of the mathematical model. Thus, solving it through a general purpose solver may be performed for small instances only, while solving real-life-sized instances of such model requires specific techniques or heuristic approaches. For this purpose, we also propose a heuristic approach, in which we make use of a fast constructive procedure to obtain a feasible solution. To assess our exact and heuristic approaches we perform extensive computational results on both real-life instances (obtained from a high school in Lecce, Italy) and randomly generated instances. Our tests show that the MIP model is never solved to optimality, with an average optimality gap of 57%. On the other hand, the heuristic algorithm is much faster (in about the 50% of the considered instances it converges in approximately half of the time limit) and in many cases allows achieving an improvement on the objective function value obtained by the MIP model. Such an improvement ranges between 18% and 66%.

Keywords: heuristic, MIP model, remedial course, school, timetabling

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Authors: Randa M. Ali, Naguiba F. Loutfy, Osama M. Awad

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Background: Leishmaniasis is a worldwide disease, affecting 88 countries, it is estimated that about 350 million people are at risk of leishmaniasis. Overall prevalence is 12 million people with annual mortality of about 60,000. Annual incidence is 1,500,000 cases of cutaneous leishmaniasis (CL) worldwide and half million cases of visceral Leishmaniasis (VL). Objectives: The objective of this study was to assess primary health care physicians knowledge (PHP) and attitude about leishmaniasis and to assess awareness of local inhabitants about the disease and its vector in four areas in west Alexandria, Egypt. Methods: This study was a cross sectional survey that was conducted in four PHC units in west Alexandria. All physicians currently working in these units during the study period were invited to participate in the study, only 20 PHP completed the questionnaire. 60 local inhabitant were selected randomly from the four areas of the study, 15 from each area; Data was collected through two different specially designed questionnaires. Results: 11(55%) percent of the physicians had satisfactory knowledge, they answered more than 9 (60%) questions out of a total 14 questions about leishmaniasis and sandfly. The second part of the questionnaire is concerned with attitude of the primary health care physicians about leishmaniasis, 17 (85%) had good attitude and 3 (15%) had poor attitude. The second questionnaire showed that the awareness of local inhabitants about leishmaniasis and sandly as a vector of the disease is poor and needs to be corrected. Most of the respondents (90%) had not heard about leishmaniasis, Only 3 (5%) of the interviewed inhabitants said they know sandfly and its role in transmission of leishmaniasis. Conclusions: knowledge and attitudes of physicians are acceptable. However, there is, room for improvement and could be done through formal training courses and distribution of guidelines. In addition to raising the awareness of primary health care physicians about the importance of early detection and notification of cases of lesihmaniasis. Moreover, health education for raising awareness of the public regarding the vector and the disease is necessary because related studies have demonstrated that if the inhabitants do not perceive mosquitoes to be responsible for diseases such as malaria they do not take enough measures to protect themselves against the vector.

Keywords: leishmaniasis, PHP, knowledge, attitude, local inhabitants

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Authors: Recep Kesli, Onur Turkyilmaz, Cengiz Demir

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Objective: Autoimmune collagen diseases occur with the immune reactions against the body’s own cell or tissues which cause inflammation and damage the tissues and organs. In this study, it was aimed to compare seropositivity rates and patterns of the anti-nuclear antibodies (ANA) in the diagnosis of four different autoimmune collagen tissue diseases (Rheumatoid Arthritis-RA, Systemic Lupus Erythematous-SLE, Scleroderma-SSc and Sjogren Syndrome-SS) with each other. Methods: One hundred eighty-eight patients applied to different clinics in Afyon Kocatepe University ANS Practice and Research Hospital between 11.07.2014 and 14.07.2015 that thought the different collagen disease such as RA, SLE, SSc and SS have participated in the study retrospectively. All the data obtained from the patients participated in the study were evaluated according to the included criteria. The historical archives belonging to the patients have been screened, assessed in terms of ANA positivity. The obtained data was analysed by using the descriptive statistics; chi-squared, Fischer's exact test. The evaluations were performed by SPSS 20.0 version and p < 0.05 level was considered as significant. Results: Distribution rates of the totally one hundred eighty-eight patients according to the diagnosis were found as follows: 82 (43.6%) were RA, 38 (20.2%) were SLE, 22 (11.7%) were SSc, and 46 (24.5%) were SS. Distribution of ANA positivity rates according to the collagen tissue diseases were found as follows; for RA were 54 (65,9 %), for SLE were 36 (94,7 %), for SSc were 18 (81,8 %), and for SS were 43 (93,5 %). Rheumatoid arthritis should be evaluated and classified as a different class among all the other investigated three autoimmune illnesses. ANA positivity rates were found as differently higher (91.5 %) in the SLE, SSc, and SS, from the RA (65.9 %). Differences at ANA positivity rates for RA and the other three diseases were found as statistically significant (p=0.015). Conclusions: Systemic autoimmune illnesses show broad spectrum. ANA positivity was found as an important predictor marker in the diagnosis of the rheumatologic illnesses. ANA positivity should be evaluated as more valuable and sensitive a predictor diagnostic marker in the laboratory findings of the SLE, SSc, and SS according to RA.

Keywords: antinuclear antibody (ANA), rheumatoid arthritis, scleroderma, Sjogren syndrome, systemic lupus Erythemotosus

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Authors: Yakubu Adamu

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The aim of this research was to assess the factors contributing to the need for optimisation of the gastric emptying protocols in nuclear medicine and molecular imaging (SNMMI) procedures. The objective is to suggest whether optimisation is possible and provide supporting evidence for the current imaging protocols of gastric emptying examination used in nuclear medicine. The research involved the use of some selected patients with 30 dynamic series for the image processing using ImageJ, and by so doing, the calculated half-time, retention fraction to the 60 x1 minute, 5 minute and 10-minute protocol, and other sampling intervals were obtained. Results from the study IDs for the gastric emptying clearance half-time were classified into normal, abnormal fast, and abnormal slow categories. In the normal category, which represents 50% of the total gastric emptying image IDs processed, their clearance half-time was within the range of 49.5 to 86.6 minutes of the mean counts. Also, under the abnormal fast category, their clearance half-time fell between 21 to 43.3 minutes of the mean counts, representing 30% of the total gastric emptying image IDs processed, and the abnormal slow category had clearance half-time within the range of 138.6 to 138.6 minutes of the mean counts, representing 20%. The results indicated that the calculated retention fraction values from the 1, 5, and 10-minute sampling curves and the measured values of gastric emptying retention fraction from sampling curves of the study IDs had a normal retention fraction of <60% and decreased exponentially with an increase in time and it was evident with low percentages of retention fraction ratios of < 10% after the 4 hours. Thus, this study does not change categories suggesting that these values could feasibly be used instead of having to acquire actual images. Findings from the study suggest that the current gastric emptying protocol can be optimized by acquiring fewer images. The study recommended that the gastric emptying studies should be performed with imaging at a minimum of 0, 1, 2, and 4 hours after meal ingestion.

Keywords: gastric emptying, retention fraction, clearance halftime, optimisation, protocol

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Authors: Bisi Olawoyin

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The idea of knowledge sharing facilitated by the internet and complemented by a collaborative offline process in form of shared workshops called Makerspaces has become an attractive economic development agenda worldwide. Towards this end, Nigeria has established a number of Technology Incubation Centers (TICs) across the country with a view to using them as institutional mechanisms for commercializing Research and Development results; thus helping to promote venture creation and economic development. This study thus examines the impact of the nurturing by the TICs, on the performance of selected incubated enterprises that have grown into medium scale businesses in different sectors of the economy. The objective is to determine the extent to which the process of incubation has contributed to their growth in relation to similar businesses that developed outside the TICs. Six enterprises nurtured by TICs and six others outside, these were selected for the study. Data were collected in respect of the twelve enterprises covering their first five years of operation. Performances in terms of annual turnover, market share, and product range were analysed by scatter diagram plotted to show these variables against time and on comparative basis between TIC and non-TIC enterprises. Results showed an initial decline in performance for most of the incubatees in the first two years due to sluggish adjustment to withdrawal of subsidies enjoyed at the TICs. However, four of them were able to catch up with improved performance and surpass their non–TIC counterparts consistently from the third year. Analysis of year on year performance also showed average growth rate of 7% and 5 % respectively for TIC and non–TIC enterprises. The study, therefore, concludes that TICs have great role to play in nurturing new, innovative businesses but sees the need for government to address the provision of critical facilities especially electricity and utilities that constitute critical cost components for businesses. It must also address the issue of investment grants, loans including the development of technology/industrial parks that will serve to boost business survival.

Keywords: entrepreneurship, incubation, innovation, makerspaces

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Authors: Sanjiv Kumar Soni, Chetna Janveja

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The approach of utilizing zero cost kitchen waste residues for growing suitable strains of fungi for the induction of a cocktail of hydrolytic enzymes and ethanol generation has been validated in the present study with the objective of developing an indigenous biorefinery for low cost bioethanol production with the generation of zero waste. Solid state fermentation has been carried out to evaluate the potential of various steam pretreated kitchen waste residues as substrates for the co-production of multiple carbohydrases including cellulases, hemicellulases, pectinase and amylases by a locally isolated strain of Aspergillus niger C-5. Of all the residues, potato peels induced the maximum yields of all the enzyme components corresponding to 64.0±1.92 IU of CMCase, 17.0±0.54 IU of FPase , 42.8±1.28 IU of β-glucosidase, 990.0±28.90 IU of xylanase, 53.2±2.12 IU of mannanase, 126.0±3.72 IU of pectinase, 31500.0±375.78 IU of α-amylase and 488.8±9.82 IU of glucoamylase/g dry substrate respectively. Saccharification of various kitchen refuse residues using inhouse produced crude enzyme cocktail resulted in the release of 610±10.56, 570±8.89, 435±6.54, 475±4.56, 445±4.27, 385±4.49, 370±6.89, 490±10.45 mg of total reducing sugars/g of dried potato peels, orange peels, pineapple peels, mausami peels, onion peels, banana stalks, pea pods and composite mixture respectively revealing carbohydrate conversion efficiencies in the range of 97.0-99.4%. After fermentation of released hexoses by Saccharomyces cerevisae, ethanol yields ranging from 80-262 mL/ kg of dry residues were obtained. The study has successfully evaluated the valorization of kitchen garbage, a highly biodegradable component in Municipal Solid Waste by using it as a substrate for the in-house co-production of multiple carbohydrases and employing the steam treated residues as a feed stock for bioethanol production. Such valorization of kitchen garbage may reduce the level of Municipal Solid Waste going into land-fills thus lowering the emissions of greenhouse gases. Moreover, the solid residue left after the bioconversion may be used as a biofertilizer for improving the fertility of the soils.

Keywords: kitchen waste, bioethanol, solid waste, bioconversion, waste management

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Authors: Shahindokht Bassiri-Jahromi, Mohammad Reza Pourshafie, Farzad Katiraee, Mannan Hajimahmoodi, Ehsan Mostafavi, Malihe Talebi

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Objective: Resistance of Candida species to antifungal agents has potentially serious implications for management of infections. Candida species are now fourth common organisms isolated from hospitalized patients. It is important to increase effective therapy. In the past decade, numerous reports of treatment failures were reported. Prevention and control of these infections will require new antimicrobial agents. Plant-derived antifungal have always been a source of novel therapeutics. The aim of this study was to investigate the antifungal effect of methanolic extract of pomegranate peel and pulp against Candida species. Material and Methods: Eight cultivars of Punica granatum L. were collected from Saveh Agricultural Investigation Center in Iran. Both pomegranate pulp and peel were dried and powdered separately. The dried powders were extracted by using a soxhlet extractor. The antifungal effect of methanolic extract of pomegranate peel and pulp were determined in vitro by minimum inhibitory concentration (MIC) against five standard species of (ATCC 10231), C. parapsilosis (ATCC 22019), C. tropicalis (ATCC 750), C. glabrata (PTCC 5297), and C. kroseii (PTCC 5295). Results: Maximum inhibitions of antifungal effect were attributed to peel extract pomegranate cultivar and Candida species. The most potential antifungal inhibition among 8 different cultivars observed by sour malas, sour white peel, and sour summer extracts respectively, against five Candida strains. The antifungal activity of pulp extracts against Candida species was approximately negative. Conclusion: The use of Punica granatum peel extract has been shown to possess antifungal activities. The phytochemistry and pharmacological actions of Punica granatum peel components suggest a wide range of clinical applications for the treatment and prevention of candidiasis.

Keywords: antifungal activity, Candida species, Punica granatum L., pharmacognosy

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Authors: M. Meddi, A. Boufekane

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The Mitidja coastal groundwater which extends over an area of 1450 km2 is a strategic resource in the Algiers region. The high dependence of the regional economy on the use of this groundwater forces us to have recourse to its artificial recharge from the Wadi El Harrach in its upstream part. This system of artificial recharge has shown its effectiveness in the development of water resource mentioned in the succeeding works in several regions of the world. The objective of this study is to: Increase the reserves of water inputs by infiltration, raise the water level and its good quality in wells and boreholes, reduce losses to the sea, and address seawater intrusion by maintaining balance in the freshwater-saltwater interface in the downstream part of the groundwater basin. After analyzing the situation, it was noticed that a qualitative monitoring of the Wadi water for the groundwater recharge has to be done. For this purpose, we proceeded during three successive years (2010, 2011, and 2012) to the monthly sampling of water in the upstream part of the Wadi El Harrach for chemical analysis. The variation of the sediment transport concentration will be also measured. This monitoring aims to characterize the water quality and avoid clogging in the proposed recharge area. The results of these analyses showed the good chemical quality according to the analyses we performed in the laboratory during the three years, but they are too loaded with suspended matters. We noticed that these fine particles come from the grinding of limestone of sandpit located upstream of the area of the proposed recharge system. This problem can be solved by a water supply upstream of sandpit. For the recharge, we propose the method of using two wells for dual use, which means that it can be used for water supply and extraction. This solution is inexpensive in our case and could easily be used as wells are already drilled in the upstream part. This solution increases over time the piezometric level and also reduce groundwater contamination by saltwater in the downstream part.

Keywords: water quality, artificial groundwater recharge, Mitidja, North Algeria

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Authors: Michael Zaidman, Naum Simanovsky

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Introduction. Symptomatic tarsal coalition with rigid flat foot often demands operative solution. An isolated coalition resection does not guarantee pain relief; correction of co-existing foot deformity may be required. The objective of the study was to analyze the results of combination of tarsal coalition resection and arthroereisis. Patients and methods. We retrospectively reviewed medical records and radiographs of children operatively treated in our institution for symptomatic calcaneonavicular or talocalcaneal coalition between the years 2019 and 2022. Eight patients (twelve feet), 4 boys and 4 girls with mean age 11.2 years, were included in the study. In six patients (10 feet) calcaneonavicular coalition was diagnosed, two patients (two feet) sustained talonavicular coalition. To quantify degrees of foot deformity, we used calcaneal pitch angle, lateral talar-first metatarsal (Meary's) angle, and talonavicular coverage angle. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Score. Results. The mean follow-up was 28 month. The preoperative mean talonavicular coverage angle was 17,75º as compared with postoperative mean angle of 5.4º. The calcaneal pitch angle improved from mean 6,8º to 16,4º. The mean preoperative Meary’s angle of -11.3º improved to mean 2.8º. The preoperative mean AOFAS score improved from 54.7 to 93.1 points post-operatively. In nine of twelve feet, overall clinical outcome judged by AOFAS scale was excellent (90-100 points), in three feet was good (80-90 points). Six patients (ten feet) obviously improved their subtalar range of motion. Conclusion. For symptomatic stiff or rigid flat feet associated with tarsal coalition, the combination of coalition resection and arthroereisis leads to normalization of radiographic parameters, clinical and functional improvement with good patient’s satisfaction and likely to be more effective than the isolated procedures.

Keywords: rigid flat foot, tarsal coalition resection, arthroereisis, outcome

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Authors: Sónia Ribeiro, Diana Farinha, Elsa Pereira, Hélia Sales, Filipa Figueiredo, Rita Pontes, João Nunes

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Conventional plastic impacts on Planet, natural resources contamination, human health as well as animals are the most attractive environmental and health attention. The lack of treatment in the end-of-life (EOL) phase and uncontrolled discard allows plastic to be found everywhere in the world. Food waste is increasing significantly, with a final destination to landfills. To face these difficulties, new packaging solutions are needed with the objective of prolonging the shelf-life of products as well as equipment solutions for the development of the mentioned packaging. FLUI project thus presents relevance and innovation to reach a new level of knowledge and industrial development focused in Ecodesign. Industrial equipment field for the manufacture of new packaging solutions based on biodegradable plastics films to apply in the food sector. With lesser environmental impacts and new solutions that make it possible to prevent food waste, reduce the production e consequent poor disposal of plastic of fossil origin. It will be a paradigm shift at different levels, from industry to waste treatment stations, passing through commercial agents and consumers. It can be achieved through the life cycle assessment (LCA) and ecodesign of the products, which integrates the environmental concerns in the design of the product as well as through the entire life cycle. The FLUI project aims to build a piece of new bio-PLA extrusion equipment with the incorporation of bioactive extracts through the production of flexible mono- and multi-layer functional films (FLUI systems). The biofunctional and biodegradable films will prompt the extension of packaged products’ shelf-life, reduce food waste and contribute to reducing the consumption of non-degradable fossil plastics, as well as the use of raw material from renewable sources.

Keywords: food packing, bioplastics, ecodesign, circular economy

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Authors: Arben Murtezani, Shefqet Mrasori, Vančo Spirov, Bukurije Rama, Oliver Dimitrovski, Visar Bunjaku

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Overview: Temporomandibular disorders (TMDs) are chronic musculoskeletal pain conditions. Clinical indicators of discomfort are related to the use of the joint stiffness during first motions after extended rest and restricted joint range of motion can cause substantial pain and disability. There is little evidence that physical therapy methods of management cause long-lasting reduction in signs and symptoms. Exercise programs premeditated to improve physical fitness have beneficial effects on chronic pain and disability of the musculoskeletal system. Objective: The aim of this study was to assess the effectiveness of physical therapy interventions in the management of temporomandibular disorders. Materials and Methods: A prospective comparative study with a 2-month follow-up period was conducted between April 2016 and June 2016 at the Physical Medicine and Rehabilitation Clinic in Prishtina. Forty six patients with TMDs, (more than three months duration of symptoms) were randomized into two groups: the TENS therapy group (n=24) and combination of active exercise and manual therapy group (n=22). The TENS therapy group patients were treated with twelve sessions of TENS. The treatment period of both groups was 3 weeks at an outpatient clinic. Following main outcome measures were evaluated: (1) pain at rest (2) pain at stress (3) impairment (4) mouth opening at base-line, before and after treatment and at 3 month follow-up. Results: Significant reduction in pain was observed in both treatment groups. In the TENS group 73% (16/22) achieved at least 80% improvement from baseline in TMJ pain at 2 months compared with 54% (13/24) in the exercise group (difference of 19%; 95% confidence interval 220 to 30%). Active and passive maximum mouth opening has been greater in the TENS group (p < 0.05). Conclusion: Exercise therapy in combination with TENS seems to be useful in the treatment of temporomandibular disorders.

Keywords: temporomandibular joint disorders, TENS, manual therapy, exercise

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Authors: Mouna Baassi, Mohamed Moussaoui, Sanchaita Rajkhowa, Hatim Soufi, Said Belaaouad

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The objective of this paper is to address the challenging task of targeting Human Immunodeficiency Virus type 1 Reverse Transcriptase (HIV-1 RT) in the treatment of AIDS. Reverse Transcriptase inhibitors (RTIs) have limitations due to the development of Reverse Transcriptase mutations that lead to treatment resistance. In this study, a combination of statistical analysis and bioinformatics tools was adopted to develop a mathematical model that relates the structure of compounds to their inhibitory activities against HIV-1 Reverse Transcriptase. Our approach was based on a series of compounds recognized for their HIV-1 RT enzymatic inhibitory activities. These compounds were designed via software, with their descriptors computed using multiple tools. The most statistically promising model was chosen, and its domain of application was ascertained. Furthermore, compounds exhibiting comparable biological activity to existing drugs were identified as potential inhibitors of HIV-1 RT. The compounds underwent evaluation based on their chemical absorption, distribution, metabolism, excretion, toxicity properties, and adherence to Lipinski's rule. Molecular docking techniques were employed to examine the interaction between the Reverse Transcriptase (Wild Type and Mutant Type) and the ligands, including a known drug available in the market. Molecular dynamics simulations were also conducted to assess the stability of the RT-ligand complexes. Our results reveal some of the new compounds as promising candidates for effectively inhibiting HIV-1 Reverse Transcriptase, matching the potency of the established drug. This necessitates further experimental validation. This study, beyond its immediate results, provides a methodological foundation for future endeavors aiming to discover and design new inhibitors targeting HIV-1 Reverse Transcriptase.

Keywords: QSAR, ADMET properties, molecular docking, molecular dynamics simulation, reverse transcriptase inhibitors, HIV type 1

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Authors: Ruqayya Naheed Khan, Romaisa Shamim, Awais Amjad Malik, Awais Naeem, Amina Iqbal Khan, Asad Parvaiz

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Objective: Patients undergoing axillary lymph node dissection (ALND) for metastatic lymph nodes in our hospital usually have drains placed in their axilla for a period of 6-10 days. We evaluated the post-op course of patients who underwent breast conservation surgery (BCS) along with ALND. Methods: A prospective cohort study was conducted at Shaukat Khanam Memorial Cancer Hospital from April 2017 to August 2017 including all lymph node positive breast cancer patients undergoing BCS with ALND. Patients were divided into two groups. Group A had no axillary drain while in Group B a drain was placed in axilla. Results: A total of 76 patients were included. 41 patients were included in group A and 35 patients in Group B. Median number of LNs dissected in group A was 17 and in group B was 15 (p value 0.443). Median operative time in group A was 84 min and in group B was 79 min (p value 0.223). Median hospital stay in both groups was 1 day (p value 0.78). At 2 weeks all patients in group A developed seroma as compared to none in group B (p value < 0.001). 3 of these patients in group A required aspiration of seroma due to pressure effects. Rest were managed conservatively. At 6 weeks only 50% patients had a seroma radiologically in Group A as compared to 33% in group B (p value 0.023). No intervention was required in any patients at week 6. QOL at 2 weeks was much better in Group A (7/41 patients had unsatisfactory response) as compared to group B (10/31 had unsatisfactory response). Results were statistically significant (p value 0.045). However, there wasn’t much difference in QOL at 6 weeks. Only 1 patient in group A had an unsatisfactory response. Average pain score at 2 weeks was similar in both groups (4.2 v/s 4.1 p value 0.73). Infection was seen in 1 patient in each group at 2 weeks (p value 0.668) and in only 1 patient in group A at 6 weeks (p value 0.067). Conclusion: We conclude from our study that there isn’t much difference in drain and no drain group in terms of wound infection and pain scores. No drain group is however associated with a better QOL in early post-op period.

Keywords: axillary drainage, axillary lymph node dissection, breast cancer, no drain in axilla

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Authors: Sheikh Omar Sillah

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Introduction: Monitoring is an important means of ensuring the smooth implementation and quality of clinical trials. For many years, traditional site monitoring approaches have been critical in detecting data errors but not optimal in identifying fabricated and implanted data as well as non-random data distributions that may significantly invalidate study results. The objective of this paper was to provide recommendations based on best statistical monitoring practices for detecting data-integrity issues suggestive of fabrication and implantation early in the study conduct to allow implementation of meaningful corrective and preventive actions. Methodology: Electronic bibliographic databases (Medline, Embase, PubMed, Scopus, and Web of Science) were used for the literature search, and both qualitative and quantitative studies were sought. Search results were uploaded into Eppi-Reviewer Software, and only publications written in the English language from 2012 were included in the review. Gray literature not considered to present reproducible methods was excluded. Results: A total of 18 peer-reviewed publications were included in the review. The publications demonstrated that traditional site monitoring techniques are not efficient in detecting data anomalies. By specifying project-specific parameters such as laboratory reference range values, visit schedules, etc., with appropriate interactive data monitoring, statistical monitoring can offer early signals of data anomalies to study teams. The review further revealed that statistical monitoring is useful to identify unusual data patterns that might be revealing issues that could impact data integrity or may potentially impact study participants' safety. However, subjective measures may not be good candidates for statistical monitoring. Conclusion: The statistical monitoring approach requires a combination of education, training, and experience sufficient to implement its principles in detecting data anomalies for the statistical aspects of a clinical trial.

Keywords: statistical monitoring, data anomalies, clinical trials, traditional monitoring

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Authors: Deepak Nathiya1, Ramesh Roop Rai, Pratima Singh1, Preeti Raj1, Supriya Suman, Balvir Singh Tomar

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Background: Sarcopenia is a catabolic state in liver cirrhosis (LC), accelerated with a breakdown of skeletal muscle to release amino acids which adversely affects survival, health-related quality of life, and response to any underlying disease. The primary objective of the study was to investigate the long-term effect of branched-chain amino acids (BCAA) supplementations on parameters associated with improved prognosis in sarcopenic patients with LC, as well as to evaluate its impact on cirrhotic-related events. Methods: We carried out a 24 week, single-center, randomized, open-label, controlled, two cohort parallel-group intervention trial comparing the efficacy of BCAA against lactoalbumin (L-ALB) on 106 sarcopenic liver cirrhotics. The BCAA (intervention) group was treated with 7.2 g BCAA per whereas, the lactoalbumin group was also given 6.3 g of L-Albumin. The primary outcome was to assess the impact of BCAA on parameters of sarcopenia: muscle mass, muscle strength, and physical performance. The secondary outcomes were to study combined survival and maintenance of liver function changes in laboratory and clinical markers in the duration of six months. Results: Treatment with BCAA leads to significant improvement in sarcopenic parameters: muscle strength, muscle function, and muscle mass. The total cirrhotic-related complications and cumulative event-free survival occurred fewer in the BCAA group than in the L-ALB group. Prognostic markers also improved significantly in the study. Conclusion: The current clinical trial demonstrated that long-term BCAAs supplementation improved sarcopenia and prognostic markers in patients with advanced liver cirrhosis.

Keywords: sarcopenia, liver cirrhosis, BCAA, quality of life

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Authors: Metkel Gebremedhin, Biruk Kebede, Guash Abay

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Job satisfaction largely determines the productivity and efficiency of human resources for health. There is scanty evidence on factors influencing the job satisfaction of health extension professionals (HEPs) in Addis Ababa. The objective of this study was to determine the level of and factors influencing job satisfaction among extension health workers in Addis Ababa city. This was a cross-sectional study conducted in Addis Ababa, Ethiopia. Among all public health centers found in the Addis Ababa city administration health bureau that would be included in the study, a multistage sampling technique was employed. Then we selected the study health centers randomly and urban health extension professionals from the selected health centers. In-depth interview data collection methods were carried out for a comprehensive understanding of factors affecting job satisfaction among Health extension professionals (HEPs) in Addis Ababa. HEPs working in Addis Ababa areas are the primary study population. Multivariate logistic regression with 95% CI at P ≤ 0.05 was used to assess associated factors to job satisfaction. The overall satisfaction rate was 10.7% only, while 89.3%% were dissatisfied with their jobs. The findings revealed that variables such as marital status, staff relations, community support, supervision, and rewards have a significant influence on the level of job satisfaction. For those who were not satisfied, the working environment, job description, low salary, poor leadership and training opportunities were the major causes. Other factors influencing the level of satisfaction were lack of medical equipment, lack of transport facilities, lack of training opportunities, and poor support from woreda experts. Our study documented a very low level of overall satisfaction among health extension professionals in Addis Ababa city public health centers. Considering the factors responsible for this state of affairs, urgent and concrete strategies must be developed to address the concerns of extension health professionals as they represent a sensitive domain of the health system of Addis Ababa city. Improving the overall work environment, review of job descriptions and better salaries might bring about a positive change.

Keywords: job satisfaction, extension health professionals, Addis Ababa

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Authors: S. L. Tulasi Devi, Shivam Azad

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The primary objective of this study is to analyze the impact of green bond issuance on the stock prices of respective Indian companies. An event study methodology has been employed to study the effect of green bond issuance. For in-depth study and analysis, this paper used different window frames, including 15-15 days, 10-10 days, 7-7days, 6-6 days, and 5-5 days. Further, for better clarity, this paper also used an uneven window period of 7-5 days. The period of study covered all the companies which issued green bonds during the period of 2017-2022; Adani Green Energy, State Bank of India, Power Finance Corporation, Jain Irrigation, and Rural Electrification Corporation, except Indian Renewable Energy Development Agency and Indian Railway Finance Corporation, because of data unavailability. The paper used all three event study methods as discussed in earlier literature; 1) constant return model, 2) market-adjusted model, and 3) capital asset pricing model. For the fruitful comparison between results, the study considered cumulative average return (CAR) and buy and hold average return (BHAR) methodology. For checking the statistical significance, a two-tailed t-statistic has been used. All the statistical calculations have been performed in Microsoft Excel 2016. The study found that all other companies have shown positive returns on the event day except for the State Bank of India. The results demonstrated that constant return model outperformed compared to the market-adjusted model and CAPM. The p-value derived from all the methods has shown an almost insignificant impact of the issuance of green bonds on the stock prices of respective companies. The overall analysis states that there’s not much improvement in the market efficiency of the Indian Stock Markets.

Keywords: green bonds, event study methodology, constant return model, market-adjusted model, CAPM

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Authors: M. Baratieri, M. Beccali, S. Corradino, B. Di Pietra, C. La Grassa, F. Monteleone, G. Morosinotto, G. Puglisi

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The energy renovation of existing buildings represents an important opportunity to increase the decarbonization and the sustainability of urban environments. In this context, the work carried out has the objective of demonstrating the technical and economic feasibility of an energy renovate of a public building destined for offices located on the island of Lampedusa in the Mediterranean Sea. By applying the Italian transpositions of European Directives 2010/31/EU and 2009/28/EC, the building has been renovated from the current energy requirements of 111.7 kWh/m² to 16.4 kWh/m². The result achieved classifies the building as nZEB (nearly Zero Energy Building) according to the Italian national definition. The analysis was carried out using in parallel a quasi-stationary software, normally used in the professional field, and a dynamic simulation model often used in the academic world. The proposed interventions cover the components of the building’s envelope, the heating-cooling system and the supply of energy from renewable sources. In these latter points, the analysis has focused more on assessing two aspects that affect the supply of renewable energy. The first concerns the use of advanced logic control systems for air conditioning units in order to increase photovoltaic self-consumption. With these adjustments, a considerable increase in photovoltaic self-consumption and a decrease in the electricity exported to the Island's electricity grid have been obtained. The second point concerned the evaluation of the building's energy classification considering the real efficiency of the heating-cooling plant. Normally the energy plants have lower operational efficiency than the designed one due to multiple reasons; the decrease in the energy classification of the building for this factor has been quantified. This study represents an important example for the evaluation of the best interventions for the energy renovation of buildings in the Mediterranean Climate and a good description of the correct methodology to evaluate the resulting improvements.

Keywords: heat pumps, HVAC systems, nZEB renovation, renewable energy sources

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