Search results for: comprehensive care
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6173

Search results for: comprehensive care

1223 Strategies by a Teaching Assistant to Support the Classroom Talk of a Child with Communication and Interaction Difficulties in Italy: A Case for Promoting Social Scaffolding Training

Authors: Lorenzo Ciletti, Ed Baines, Matt Somerville

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Internationally, supporting staff with limited training (Teaching Assistants (TA)) has played a critical role in the education of children with special educational needs and/or disabilities (SEND). Researchers have notably illustrated that TAs support the children’s classroom tasks while teachers manage the whole class. Rarely have researchers investigated the TAs’ support for children’s participation in whole-class or peer-group talk, despite this type of “social support” playing a significant role in children’s whole-class integration and engagement with the classroom curriculum and learning. Social support seems particularly crucial for a large proportion of children with SEND, namely those with communication and interaction difficulties (e.g., autism spectrum conditions and speech impairments). This study explored TA practice and, particularly, TA social support in a rarely examined context (Italy). The Italian case was also selected as it provides TAs, known nationally as “support teachers,” with the most comprehensive training worldwide, thus potentially echoing (effective) nuanced practice internationally. Twelve hours of video recordings of a single TA and a child with communication and interaction difficulties (CID) were made. Video data was converted into frequencies of TA multidimensional support strategies, including TA social support and pedagogical assistance. TA-pupil talk oriented to children’s participation in classroom talk was also analysed into thematic patterns. These multi-method analyses were informed by social scaffolding principles: in particular, the extent to which the TA designs instruction contingently to the child’s communication and interaction difficulties and how their social support fosters the child’s highest responsibility in dealing with whole-class or peer-group talk by supplying the least help. The findings showed that the TA rarely supported the group or whole class participation of the child with CID. When doing so, the TA seemed to highly control the content and the timing of the child’s contributions to the classroom talk by a) interrupting the teacher’s whole class or group conversation to start an interaction between themselves and the child and b) reassuring the child about the correctness of their talk in private conversations and prompting them to raise their hand and intervene in the whole-class talk or c) stopping the child from contributing to the whole-class or peer-group talk when incorrect. The findings are interpreted in terms of their theoretical relation to scaffolding. They have significant implications for promoting social scaffolding in TA training in Italy and elsewhere.

Keywords: children with communication and interaction difficulties, children with special educational needs and/or disabilities, social scaffolding, teaching assistants, teaching practice, whole-class talk participation

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1222 Evaluation of Complications Observed in Porcelain Fused to Metal Crowns Placed at a Teaching Institution

Authors: Shizrah Jamal, Robia Ghafoor, Farhan Raza

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Porcelain fused to metal crown is the most versatile variety of crown that is commonly placed worldwide. Various complications have been reported in the PFM crowns with use over the period of time. These include chipping of the porcelain, recurrent caries, loss of retention, open contacts, and tooth fracture. The objective of the present study was to determine the frequency of these complications in crowns cemented over a period of five years in a tertiary care hospital and also to report the survival of these crowns. A retrospective study was conducted in Dental clinics, Aga Khan University Hospital in which 150 PFM crowns cemented over a period of five years were evaluated. Patient demographics, oral hygiene habits, para-functional habits, crown insertion and follow-up dates were recorded in a specially designed proforma. All PFM crowns fulfilling the inclusion criteria were assessed both clinically and radiographically for the presence of any complication. SPSS version 22.0 was used for statistical analysis. Frequency distribution and proportion of complications were determined. Chi-square test was used to determine the association of complications of PFM crowns with multiple variables including tooth wear, opposing dentition and betel nut chewing. Kaplan- meier survival analysis was used to determine the survival of PFM crowns over the period of five years. Level of significance was kept at 0.05. A total of 107 patients, with a mean age of 43.51 + 12.4 years, having 150 PFM crowns were evaluated. The most common complication observed was open proximal contacts (8.7%) followed by porcelain chipping (6%), decementation (5.3%), and abutment fracture (1.3%). Chi square test showed that there was no statistically significant association of PFM crown complication with tooth wear, betel nut and opposing dentition (p-value <0.05). The overall success and survival rates of PFM crowns turned out to be 78.7 and 84.7% respectively. Within the limitations of the study, it can be concluded that PFM crowns are an effective treatment modality with high success and survival rates. Since it was a single centered study; the results should be generalized with caution.

Keywords: chipping, complication, crown, survival rate

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1221 Team-Theatre as a Tool of Occupational Safety Awareness

Authors: Fiorenza Misale

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The painful phenomenon of so-called white deaths and accidents at work, unfortunately, is always current. The key is to act on the culture of security through effective measures of attitudes and behaviors that go far beyond the knowledge and the know-how. It is necessary that there is an ‘introjection’ of safety culture through the conscious involvement of all workers. The legislation on work safety identifies the main tool to promote the culture of safety at work and prevention within the workplace. In law the term education is used to distinguish itself from the information with which they will simply theoretically transmit, and from the training with which they will provide the practical skills. The new decree fact fills several gaps in previous legislation and stresses the importance of training in the workplace, that is, the main activity through which it is possible to achieve the active participation of all workers in the company’s prevention system. This system is built only through the dissemination of risk information, the circulation of information, comparison and dialogue between all actors involved that are the necessary elements for a correct transmission of the culture of worker safety. Training activity should put the focus on work experience in order to bring out all the knowledge needed to identify and assess the risks in the work place, and especially the action to eliminate or control them, integrating, when necessary, the missing knowledge. In addition to traditional training and information systems can be utilized for the purpose of training that are able to affect both one emotionally and aesthetically, team-theatre is one of them. Among the methods of company theater that can be used in work safety we have: Lesson show, theater workshop, improvised theater, forum theater, theater playback. The theater can represent a complementary approach to traditional training and give information on safety measures, demonstrating that there are more engaging outreach tools. Team-theatre allows identification with the characters, a transmission of emotions and moods and it is through the staging of a story that the individual processes new information. It’ also s a means of experiential training that allows you to work with your mind, body, emotions.The aim of one work is the use of corporate theater on the personnel working in the health sector. Through a questionnaire we are able to analyze the knowledge of occupational safety and current risks; in particular in health care which is to be administered before and after the play.

Keywords: theater, training, occupational health, safety

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1220 Digitalize or Die-Responsible Innovations in Healthcare and Welfare Sectors

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

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1219 Voluntary Water Intake of Flavored Water in Euhydrated Horses

Authors: Brianna M. Soule, Jesslyn A. Bryk-Lucy, Linda M. Ritchie

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Colic, defined as abdominal pain in the horse, has several known predisposing factors. Decreased water intake has been shown to predispose equines to impaction colic. The objective of this study was to determine if offering flavored water (sweet feed or banana extract) would increase voluntary water intake in horses to serve as an assessable, noninvasive method for farm managers, veterinarians, or owners to decrease the risk of impaction colic. An a priori power analysis, which was conducted using G*Power version 3.1.9.7, indicated that the minimum sample size required to achieve 80% power for detecting a large effect at a significance level of α = .05 was 19 horses for a one-way repeated measures ANOVA with three treatment levels and assuming a non-sphericity correction of ε=0.5. After a three-day control period, 21 horses were randomly divided into two sequences and offered either banana or sweet feed flavored water. Horses always had a bucket of unflavored water available. A repeated measure study design was used to measure water consumption of each horse over a 62-hour period. A one-way repeated measures ANOVA was conducted to determine whether there were statistically significant differences among the means for the three-day average water intake (ml/kg). Although not statistically significant (F(2, 38) = 1.28, p = .290, partial η2 = .063), the three-day average water intake was largest for banana flavored water (M = 53.51, SD = 9.25 ml/kg), followed by sweet feed (M = 52.93, SD = 11.99 ml/kg), and, finally, unflavored water (M = 50.40, SD = 10.82 ml/kg). Paired-samples t-tests were used to determine whether there was a statistically significant difference between the three-day average water intake (ml/kg) for flavored versus unflavored water. The average unflavored water intake (M = 29.3 ml/kg, SD = 8.9) over the measurement period was greater than the banana flavored water (M = 27.7 ml/kg, SD = 9.8), but the average consumption of the sweet feed flavored water (M = 30.4 ml/kg, SD = 14.6) was greater than unflavored water (M = 24.3 ml/kg, SD = 11.4). None of these differences in average intake were statistically significant (p > .244). Future research is warranted to determine if other flavors significantly increase voluntary water intake in horses.

Keywords: colic, equine, equine science, water intake, flavored water, horses, equine management, equine health, horse health, horse health care management, colic prevention

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1218 Platelet Volume Indices: Emerging Markers of Diabetic Thrombocytopathy

Authors: Mitakshara Sharma, S. K. Nema

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Diabetes mellitus (DM) is metabolic disorder prevalent in pandemic proportions, incurring significant morbidity and mortality due to associated vascular angiopathies. Platelet related thrombogenesis plays key role in pathogenesis of these complications. Most patients with type II DM suffer from preventable vascular complications and early diagnosis can help manage these successfully. These complications are attributed to platelet activation which can be recognised by the increase in Platelet Volume Indices(PVI) viz. Mean Platelet Volume(MPV) and Platelet Distribution Width(PDW). This study was undertaken with the aim of finding a relationship between PVI and vascular complications of Diabetes mellitus, their importance as a causal factor in these complications and use as markers for early detection of impending vascular complications in patients with poor glycaemic status. This is a cross-sectional study conducted for 2 years with total 930 subjects. The subjects were segregated in 03 groups on basis of glycosylated haemoglobin (HbA1C) as: - (a) Diabetic, (b) Non-Diabetic and (c) Subjects with Impaired fasting glucose(IFG) with 300 individuals in IFG and non-diabetic group & 330 individuals in diabetic group. The diabetic group was further divided into two groups: - (a) Diabetic subjects with diabetes related vascular complications (b) Diabetic subjects without diabetes related vascular complications. Samples for HbA1C and platelet indices were collected using Ethylene diamine tetracetic acid(EDTA) as anticoagulant and processed on SYSMEX-XS-800i autoanalyser. The study revealed stepwise increase in PVI from non-diabetics to IFG to diabetics. MPV and PDW of diabetics, IFG and non diabetics were 17.60 ± 2.04, 11.76 ± 0.73, 9.93 ± 0.64 and 19.17 ± 1.48, 15.49 ± 0.67, 10.59 ± 0.67 respectively with a significant p value 0.00 and a significant positive correlation (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). However, significant negative correlation was found between glycaemic levels and total platelet count (PC- HbA1c r =-0.164). MPV & PDW of subjects with and without diabetes related complications were (15.14 ± 1.04) fl & (17.51±0.39) fl and (18.96 ± 0.83) fl & (20.09 ± 0.98) fl respectively with a significant p value 0.00.The current study demonstrates raised platelet indices & reduced platelet counts in association with rising glycaemic levels and diabetes related vascular complications across various study groups & showed that platelet morphology is altered with increasing glycaemic levels. These changes can be known by measurements of PVI which are important, simple, cost effective, effortless tool & indicators of impending vascular complications in patients with deranged glycaemic control. PVI should be researched and explored further as surrogate markers to develop a clinical tool for early recognition of vascular changes related to diabetes and thereby help prevent them. They can prove to be more useful in developing countries with limited resources. This study is multi-parameter, comprehensive with adequately powered study design and represents pioneering effort in India on account of the fact that both Platelet indices (MPV & PDW) along with platelet count have been evaluated together for the first time in Diabetics, non diabetics, patients with IFG and also in the diabetic patients with and without diabetes related vascular complications.

Keywords: diabetes, HbA1C, IFG, MPV, PDW, PVI

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1217 Female Entrepreneurship in Transitional Economies: An In-Depth Comparative Study about Challenges Facing Female Entrepreneurs in Nigeria and Egypt

Authors: Dina Mohamed Ayman, Rafieu Akin

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In an attempt to increase the female total entrepreneurial activities (TEA) within Egypt and Nigeria, this paper aims to investigate the challenges facing female entrepreneurs operating in Egypt, in relative to Nigeria. In this regard, both researchers undertook a qualitative approach due to the scarcity of the literature reviewed on the topic; in those particular countries, and as an in-depth comparative mode. Therefore, ten Egyptian entrepreneurs in relative to ten Nigerian entrepreneurs were in-depth investigated. The research findings prove that female entrepreneurs face complex problems for being both gender and country-specific. Regarding the gender-specific obstacles, the work/life imbalance due to the scarcity of child-care nurseries and the prevalence of the gender-role division while performing the house chores rather than the concept of co-operation, acted as a main source of cultural challenge because women are considered mostly as 'housewives'. However, interestingly, this specific gender-discrimination challenge is proven to have no grounded effect in terms of the business-establishment and daily dealings neither in Egypt nor Nigeria, as one of the sample exclaimed 'as long as you pay, then no gender difference is set on the table'. Other country-specific challenges facing female entrepreneurs, lied in, the aggregate weak entrepreneurial framework governing both countries, also, women faced the difficulty of access to financial institutions with collateral requirements that are usually "hardly to be met", besides, the absence of the "micro-credit-Grameen-banks" concept. As well, the scarcity of incubators and business training centers providing network, consultancy and well-trained workforce to female entrepreneurs constitute a major hurdle for women entrepreneurs operating in both countries. Finally, this paper will conclude the research by offering a set of public-policy recommendations to pave the way for females to choose self-employment as a career path.

Keywords: entrepreneurship, female entrepreneurship, obstacles, framework conditions, culture, micro-credit

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1216 Life Cycle Carbon Dioxide Emissions from the Construction Phase of Highway Sector in China

Authors: Yuanyuan Liu, Yuanqing Wang, Di Li

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Carbon dioxide (CO2) emissions mitigation from road construction activities is one of the potential pathways to deal with climate change due to its higher use of materials, machinery energy consumption, and high quantity of vehicle and equipment fuels for transportation and on-site construction activities. Aiming to assess the environmental impact of the road infrastructure construction activities and to identify hotspots of emissions sources, this study developed a life-cycle CO2 emissions assessment framework covering three stages of material production, to-site and on-site transportation under the guidance of the principle of LCA ISO14040. Then streamlined inventory analysis on sub-processes of each stage was conducted based on the budget files from cases of highway projects in China. The calculation results were normalized into functional unit represented as ton per km per lane. Then a comparison between the amount of emissions from each stage, and sub-process was made to identify the major contributor in the whole highway lifecycle. In addition, the calculating results were used to be compared with results in other countries for understanding the level of CO2 emissions associated with Chinese road infrastructure in the world. The results showed that materials production stage produces the most of the CO2 emissions (for more than 80%), and the production of cement and steel accounts for large quantities of carbon emissions. Life cycle CO2 emissions of fuel and electric energy associated with to-site and on-site transportation vehicle and equipment are a minor component of total life cycle CO2 emissions from highway project construction activities. Bridges and tunnels are dominant large carbon contributor compared to the road segments. The life cycle CO2 emissions of road segment in highway project in China are slightly higher than the estimation results of highways in European countries and USA, about 1500 ton per km per lane. In particularly, the life cycle CO2 emissions of road pavement in majority cities all over the world are about 500 ton per km per lane. However, there is obvious difference between the cities when the estimation on life cycle CO2 emissions of highway projects included bridge and tunnel. The findings of the study could offer decision makers a more comprehensive reference to understand the contribution of road infrastructure to climate change, especially understand the contribution from road infrastructure construction activities in China. In addition, the identified hotspots of emissions sources provide the insights of how to reduce road carbon emissions for development of sustainable transportation.

Keywords: carbon dioxide emissions, construction activities, highway, life cycle assessment

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1215 Epidemiological Correlates of Adherence to Anti-Hypertensive Treatment in Primary Health Care Setting of Ludhiana, Punjab

Authors: Sangeeta Girdhar, Amanat Grewal, Nahush Bansal

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Introduction: There is an increasing burden of hypertension in India. The morbidity and mortality arising from complications are mainly due to non-adherence to medication, unhealthy dietary habits, and lack of physical activity. Non-adherence is a well-recognised factor contributing to inadequate control of high blood pressure. Adherence to pharmacotherapy for hypertension varies from 43% to 88%. Non-adherence is influenced by various socio-demographic factors. Understanding these factors is useful in managing non-adherence. Therefore, the study was planned to determine adherence among hypertensives and factors associated with non-adherence to treatment. Methodology: A cross-sectional study was conducted at Urban Health Training Centre of Dayanand Medical College and Hospital Ludhiana. Patients attending the OPD over a period of 3 months were included in the study. Prior ethical approval was obtained, and informed consent was taken from subjects. A predesigned semi-structured questionnaire was applied, which included socio-demographic profile, treatment-seeking behaviour, adherence to the antihypertensive medication, lifestyle factors (intake of alcohol, smoking, consumption of junk food, high salt intake) contributing to the development of the disease. Reasons for non-adherence to the therapy were also explored. Data was entered into excel, and SPSS 26 version was used for analysis. Results: A total of 186 individuals were interviewed. Out of these, 113 females (60.8%) and 73 males (39.2%) participated in the study. Mean age of participants was 60.9 ± 10.7 years. Adherence to anti-hypertensive treatment was found in 68.3% of the participants. It was observed that adherence was more in literate individuals as compared to illiterate (p value- 0.78). Adherence was lower among smokers (33.3%) and alcohol consumers (53.8%) as compared to non-users (69.4% and 70.6%, respectively). The predominant reasons for skipping medications were discontinuing medication when feeling well, forgetfulness and unawareness. Conclusion: There is a need to generate awareness regarding the importance of adherence to therapy among patients. Intensive health education and counselling of the patients is the need of the hour.

Keywords: hypertension, anti-hypertensive, adherence, counselling

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1214 Work-Life Balance: A Landscape Mapping of Two Decades of Scholarly Research

Authors: Gertrude I Hewapathirana, Mohamed M. Moustafa, Michel G. Zaitouni

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The purposes of this research are: (a) to provide an epistemological and ontological understanding of the WLB theory, practice, and research to illuminate how the WLB evolved between 2000 to 2020 and (b) to analyze peer-reviewed research to identify the gaps, hotspots, underlying dynamics, theoretical and thematic trends, influential authors, research collaborations, geographic networks, and the multidisciplinary nature of the WLB theory to guide future researchers. The research used four-step bibliometric network analysis to explore five research questions. Using keywords such as WLB and associated variants, 1190 peer-reviewed articles were extracted from the Scopus database and transformed to a plain text format for filtering. The analysis was conducted using the R version 4.1 software (R Development Core Team, 2021) and several libraries such as bibliometrics, word cloud, and ggplot2. We used the VOSviewer software (van Eck & Waltman, 2019) for network visualization. The WLB theory has grown into a multifaceted, multidisciplinary field of research. There is a paucity of research between 2000 to 2005 and an exponential growth from 2006 to 2015. The rapid increase of WLB research in the USA, UK, and Australia reflects the increasing workplace stresses due to hyper competitive workplaces, inflexible work systems, and increasing diversity and the emergence of WLB support mechanisms, legal and constitutional mandates to enhance employee and family wellbeing at multilevel social systems. A severe knowledge gap exists due to inadequate publications disseminating the "core" WLB research. "Locally-centralized-globally-discrete" collaboration among researchers indicates a "North-South" divide between developed and developing nations. A shortage in WLB research in developing nations and a lack of research collaboration hinder a global understanding of the WLB as a universal phenomenon. Policymakers and practitioners can use the findings to initiate supporting policies, and innovative work systems. The boundary expansion of the WLB concepts, categories, relations, and properties would facilitate researchers/theoreticians to test a variety of new dimensions. This is the most comprehensive WLB landscape analysis that reveals emerging trends, concepts, networks, underlying dynamics, gaps, and growing theoretical and disciplinary boundaries. It portrays the WLB as a universal theory.

Keywords: work-life balance, co-citation networks; keyword co-occurrence network, bibliometric analysis

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1213 Implementing a Structured, yet Flexible Tool for Critical Information Handover

Authors: Racheli Magnezi, Inbal Gazit, Michal Rassin, Joseph Barr, Orna Tal

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An effective process for transmitting patient critical information is essential for patient safety and for improving communication among healthcare staff. Previous studies have discussed handover tools such as SBAR (Situation, Background, Assessment, Recommendation) or SOFI (Short Observational Framework for Inspection). Yet, these formats lack flexibility, and require special training. In addition, nurses and physicians have different procedures for handing over information. The objectives of this study were to establish a universal, structured tool for handover, for both physicians and nurses, based on parameters that were defined as ‘important’ and ‘appropriate’ by the medical team, and to implement this tool in various hospital departments, with flexibility for each ward. A questionnaire, based on established procedures and on the literature, was developed to assess attitudes towards the most important information for effective handover between shifts (Cronbach's alpha 0.78). It was distributed to 150 senior physicians and nurses in 62 departments. Among senior medical staff, 12 physicians and 66 nurses responded to the questionnaire (52% response rate). Based on the responses, a handover form suitable for all hospital departments was designed and implemented. Important information for all staff included: Patient demographics (full name and age); Health information (diagnosis or patient complaint, changes in hemodynamic status, new medical treatment or equipment required); and Social Information (suspicion of violence, mental or behavioral changes, and guardianship). Additional information relevant to each unit included treatment provided, laboratory or imaging required, and change in scheduled surgery in surgical departments. ICU required information on background illnesses, Pediatrics required information on diet and food provided and Obstetrics required the number of days after cesarean section. Based on the model described, a flexible tool was developed that enables handover of both common and unique information. In addition, it includes general logistic information that must be transmitted to the next shift, such as planned disruptions in service or operations, staff training, etc. Development of a simple, clear, comprehensive, universal, yet flexible tool designed for all medical staff for transmitting critical information between shifts was challenging. Physicians and nurses found it useful and it was widely implemented. Ongoing research is needed to examine the efficiency of this tool, and whether the enthusiasm that accompanied its initial use is maintained.

Keywords: handover, nurses, hospital, critical information

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1212 Unveiling Comorbidities in Irritable Bowel Syndrome: A UK BioBank Study utilizing Supervised Machine Learning

Authors: Uswah Ahmad Khan, Muhammad Moazam Fraz, Humayoon Shafique Satti, Qasim Aziz

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Approximately 10-14% of the global population experiences a functional disorder known as irritable bowel syndrome (IBS). The disorder is defined by persistent abdominal pain and an irregular bowel pattern. IBS significantly impairs work productivity and disrupts patients' daily lives and activities. Although IBS is widespread, there is still an incomplete understanding of its underlying pathophysiology. This study aims to help characterize the phenotype of IBS patients by differentiating the comorbidities found in IBS patients from those in non-IBS patients using machine learning algorithms. In this study, we extracted samples coding for IBS from the UK BioBank cohort and randomly selected patients without a code for IBS to create a total sample size of 18,000. We selected the codes for comorbidities of these cases from 2 years before and after their IBS diagnosis and compared them to the comorbidities in the non-IBS cohort. Machine learning models, including Decision Trees, Gradient Boosting, Support Vector Machine (SVM), AdaBoost, Logistic Regression, and XGBoost, were employed to assess their accuracy in predicting IBS. The most accurate model was then chosen to identify the features associated with IBS. In our case, we used XGBoost feature importance as a feature selection method. We applied different models to the top 10% of features, which numbered 50. Gradient Boosting, Logistic Regression and XGBoost algorithms yielded a diagnosis of IBS with an optimal accuracy of 71.08%, 71.427%, and 71.53%, respectively. Among the comorbidities most closely associated with IBS included gut diseases (Haemorrhoids, diverticular diseases), atopic conditions(asthma), and psychiatric comorbidities (depressive episodes or disorder, anxiety). This finding emphasizes the need for a comprehensive approach when evaluating the phenotype of IBS, suggesting the possibility of identifying new subsets of IBS rather than relying solely on the conventional classification based on stool type. Additionally, our study demonstrates the potential of machine learning algorithms in predicting the development of IBS based on comorbidities, which may enhance diagnosis and facilitate better management of modifiable risk factors for IBS. Further research is necessary to confirm our findings and establish cause and effect. Alternative feature selection methods and even larger and more diverse datasets may lead to more accurate classification models. Despite these limitations, our findings highlight the effectiveness of Logistic Regression and XGBoost in predicting IBS diagnosis.

Keywords: comorbidities, disease association, irritable bowel syndrome (IBS), predictive analytics

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1211 Turkey at the End of the Second Decade of the 21st Century: A Secular or Religious Country?

Authors: Francesco Pisano

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Islam has been an important topic in Turkey’s institutional identity. Since the dawn of the Turkish Republic, at the end of the First World War, the new Turkish leadership was urged to deal with the religious heritage of the Sultanate. Mustafa Kemal Ataturk, Turkey’s first President, led the country in a process of internal change, substantially modifying not merely the democratic stance of it, but also the way politics was addressing the Muslim faith. Islam was banned from the public sector of the society and was drastically marginalized to the mere private sphere of citizens’ lives. Headscarves were banned from institutional buildings together with any other religious practice, while the country was proceeding down a path of secularism and Westernization. This issue is demonstrated by the fact that even a new elected Prime Minister, Recep Tayyip Erdoğan, was initially barred from taking the institutional position, because of allegations that he had read a religious text while campaigning. Over the years, thanks to this initial internal shift, Turkey has often been seen by Western partners as one of the few countries that had managed to find a perfect balance between a democratic stance and an Islamic inherent nature. In the early 2000s, this led many academics to believe that Ankara could eventually have become the next European capital. Since then, the internal and external landscape of Turkey has drastically changed. Today, religion has returned to be an important point of reference for Turkish politics, considering also the failure of the European negotiations and the always more unstable external environment of the country. This paper wants to address this issue, looking at the important role religion has covered in the Turkish society and the way it has been politicized since the early years of the Republic. It will evolve from a more theoretical debate on secularism and the path of political westernization of Turkey under Ataturk’s rule to a more practical analysis of today’s situation, passing through the failure of Ankara’s accession into the EU and the current tense political relation with its traditional NATO allies. The final objective of this research, therefore, is not to offer a meticulous opinion on Turkey’s current international stance. This issue will be left entirely to the personal consideration of the reader. Rather, it will supplement the existing literature with a comprehensive and more structured analysis on the role Islam has played on Turkish politics since the early 1920s up until the political domestic revolution of the early 2000s, after the first electoral win of the Justice and Development Party (AKP).

Keywords: democracy, Islam, Mustafa Kemal Atatürk, Recep Tayyip Erdoğan, Turkey

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1210 Improving Photocatalytic Efficiency of TiO2 Films Incorporated with Natural Geopolymer for Sunlight-Driven Water Purification

Authors: Satam Alotibi, Haya A. Al-Sunaidi, Almaymunah M. AlRoibah, Zahraa H. Al-Omaran, Mohammed Alyami, Fatehia S. Alhakami, Abdellah Kaiba, Mazen Alshaaer, Talal F. Qahtan

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This research study presents a novel approach to harnessing the potential of natural geopolymer in conjunction with TiO₂ nanoparticles (TiO₂ NPs) for the development of highly efficient photocatalytic materials for water decontamination. The study begins with the formulation of a geopolymer paste derived from natural sources, which is subsequently applied as a coating on glass substrates and allowed to air-dry at room temperature. The result is a series of geopolymer-coated glass films, serving as the foundation for further experimentation. To enhance the photocatalytic capabilities of these films, a critical step involves immersing them in a suspension of TiO₂ nanoparticles (TiO₂ NPs) in water for varying durations. This immersion process yields geopolymer-loaded TiO₂ NPs films with varying concentrations, setting the stage for comprehensive characterization and analysis. A range of advanced analytical techniques, including UV-Vis spectroscopy, Fourier-transform infrared spectroscopy (FTIR), Raman spectroscopy, scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM), were meticulously employed to assess the structural, morphological, and chemical properties of the geopolymer-based TiO₂ films. These analyses provided invaluable insights into the materials' composition and surface characteristics. The culmination of this research effort sees the geopolymer-based TiO₂ films being repurposed as immobilized photocatalytic reactors for water decontamination under natural sunlight irradiation. Remarkably, the results revealed exceptional photocatalytic performance that exceeded the capabilities of conventional TiO₂-based photocatalysts. This breakthrough underscores the significant potential of natural geopolymer as a versatile and highly effective matrix for enhancing the photocatalytic efficiency of TiO₂ nanoparticles in water treatment applications. In summary, this study represents a significant advancement in the quest for sustainable and efficient photocatalytic materials for environmental remediation. By harnessing the synergistic effects of natural geopolymer and TiO₂ nanoparticles, these geopolymer-based films exhibit outstanding promise in addressing water decontamination challenges and contribute to the development of eco-friendly solutions for a cleaner and healthier environment.

Keywords: geopolymer, TiO2 nanoparticles, photocatalytic materials, water decontamination, sustainable remediation

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1209 Ethnobotanical Medicines for Treating Snakebites among the Indigenous Maya Populations of Belize

Authors: Kerry Hull, Mark Wright

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This paper brings light to ethnobotanical medicines used by the Maya of Belize to treat snake bites. The varying ecological zones of Belize boast over fifty species of snakes, nine of which are poisonous and dangerous to humans. Two distinct Maya groups occupy neighboring regions of Belize, the Q’eqchi’ and the Mopan. With Western medical care often far from their villages, what traditional methods are used to treat poisonous snake bites? Based primarily on data gathered with native consultants during the authors’ fieldwork with both groups, this paper details the ethnobotanical resources used by the Q’eqchi’ and Mopan traditional healers. The Q’eqchi’ and Mopan most commonly rely on traditional ‘bush doctors’ (ilmaj in Mopan), both male and female, and specialized ‘snake doctors’ to heal bites from venomous snakes. First, this paper presents each plant employed by healers for bites for the nine poisonous snakes in Belize along with the specific botanical recipes and methods of application for each remedy. Individual chemical and therapeutic qualities of some of those plants are investigated in an effort to explain their possible medicinal value for different toxins or the symptoms caused by those toxins. In addition, this paper explores mythological associations with certain snakes that inform local understanding regarding which plants are considered efficacious in each case, arguing that numerous oral traditions (recorded by the authors) help to link botanical medicines to episodes within their mythic traditions. Finally, the use of plants to counteract snakebites brought about through sorcery is discussed inasmuch as some snakes are seen as ‘helpers’ of sorcerers. Snake bites given under these circumstances can only be cured by those who know both the proper corresponding plant(s) and ritual prayer(s). This paper provides detailed documentation of traditional ethnomedicines and practices from the dying art of traditional Maya healers and argues for multi-faceted diagnostic techniques to determine toxin severity, the presence or absence of sorcery, and the appropriate botanical remedy.

Keywords: ethnobotany, Maya, medicine, snake bites

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1208 Assessment of Environmental Risk Factors of Railway Using Integrated ANP-DEMATEL Approach in Fuzzy Conditions

Authors: Mehrdad Abkenari, Mehmet Kunt, Mahdi Nourollahi

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Evaluating the environmental risk factors is a combination of analysis of transportation effects. Various definitions for risk can be found in different scientific sources. Each definition depends on a specific and particular perspective or dimension. The effects of potential risks present along the new proposed routes and existing infrastructures of large transportation projects like railways should be studied under comprehensive engineering frameworks. Despite various definitions provided for ‘risk’, all include a uniform concept. Two obvious aspects, loss and unreliability, have always been pointed in all definitions of this term. But, selection as the third aspect is usually implied and means how one notices it. Currently, conducting engineering studies on the environmental effects of railway projects have become obligatory according to the Environmental Assessment Act in developing countries. Considering the longitudinal nature of these projects and probable passage of railways through various ecosystems, scientific research on the environmental risk of these projects have become of great interest. Although many areas of expertise such as road construction in developing countries have not seriously committed to these studies yet, attention to these subjects in establishment or implementation of different systems have become an inseparable part of this wave of research. The present study used environmental risks identified and existing in previous studies and stations to use in next step. The second step proposes a new hybrid approach of analytical network process (ANP) and DEMATEL in fuzzy conditions for assessment of determined risks. Since evaluation of identified risks was not an easy touch, mesh structure was an appropriate approach for analyzing complex systems which were accordingly employed for problem description and modeling. Researchers faced the shortage of real space data and also due to the ambiguity of experts’ opinions and judgments, they were declared in language variables instead of numerical ones. Since fuzzy logic is appropriate for ambiguity and uncertainty, formulation of experts’ opinions in the form of fuzzy numbers seemed an appropriate approach. Fuzzy DEMATEL method was used to extract the relations between major and minor risk factors. Considering the internal relations of risk major factors and its sub-factors in the analysis of fuzzy network, the weight of risk’s main factors and sub-factors were determined. In general, findings of the present study, in which effective railway environmental risk indicators were theoretically identified and rated through the first usage of combined model of DEMATEL and fuzzy network analysis, indicate that environmental risks can be evaluated more accurately and also employed in railway projects.

Keywords: DEMATEL, ANP, fuzzy, risk

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1207 Association between Caries Status of First Permanent Molar with Oral Health Care Practice in Children Aged 9-12 Years in Lubuk Kilangan, Padang City

Authors: Cytha Nilam Chairani, Ditha Noviantika, Hidayati Amir, Nurul Khairiyah, Siti Rahmadita, Fadila Khairani

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Background: Dental caries is one of the most common diseases with high prevalence in children. The first permanent molar (FPM) has an essential role in establishing the occlusion. Nevertheless, FPM is very prone to caries because of various factors, such as their anatomical structure and early emergence in oral cavity. It is due to the little knowledge from parents and children regarding the timing of emergence of FPM in oral cavity which is still considered as primary teeth. Furthermore, the lack of knowledge from parents and children may affect their oral hygiene practice resulting to carious process. Objective: The aim of this study was to assess the status of FPM caries and its association with children’s oral hygiene practice in 9-12-year-old school children in Lubuk Kilangan Community Health Centre, Padang City. Methods: A cross-sectional study was performed in 50 school children (9-12 years old) using random sampling technique from two randomly selected schools in Lubuk Kilangan Community Health Centre, Padang City. A questionnaire was developed from other studies consisting of four closed ended questions regarding oral health practice. The data obtained were analyzed statistically using Mann-Whitney Test to assess the status of FPM caries and its association with children’s oral hygiene practice. Results: The results showed that 32% of children had FPMs sound and the remaining 68% had FPMs carious which were grouped into 1-2 FPMs carious (60%) and 3-4 FPMs carious (8%). The caries status of mandibular FPM (64%) was higher compared to maxillary FPM (10%). Conclusion: There was significant association in subject who did not visit dentist in the last 6 months which had more carious FPMs compared to subject who visited dentist (p < 0.05). There was no significant association between the status of FPM caries and knowledge of the timing eruption of FPM, oral hygiene instruction from parents and tooth brushing (p > 0.05).

Keywords: dental caries, children, first permanent molar, oral hygiene practice

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1206 A Comprehensive Study on Freshwater Aquatic Life Health Quality Assessment Using Physicochemical Parameters and Planktons as Bio Indicator in a Selected Region of Mahaweli River in Kandy District, Sri Lanka

Authors: S. M. D. Y. S. A. Wijayarathna, A. C. A. Jayasundera

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Mahaweli River is the longest and largest river in Sri Lanka and it is the major drinking water source for a large portion of 2.5 million inhabitants in the Central Province. The aim of this study was to the determination of water quality and aquatic life health quality in a selected region of Mahaweli River. Six sampling locations (Site 1: 7° 16' 50" N, 80° 40' 00" E; Site 2: 7° 16' 34" N, 80° 40' 27" E; Site 3: 7° 16' 15" N, 80° 41' 28" E; Site 4: 7° 14' 06" N, 80° 44' 36" E; Site 5: 7° 14' 18" N, 80° 44' 39" E; Site 6: 7° 13' 32" N, 80° 46' 11" E) with various anthropogenic activities at bank of the river were selected for a period of three months from Tennekumbura Bridge to Victoria Reservoir. Temperature, pH, Electrical Conductivity (EC), Total Dissolved Solids (TDS), Dissolved Oxygen (DO), 5-day Biological Oxygen Demand (BOD5), Total Suspended Solids (TSS), hardness, the concentration of anions, and metal concentration were measured according to the standard methods, as physicochemical parameters. Planktons were considered as biological parameters. Using a plankton net (20 µm mesh size), surface water samples were collected into acid washed dried vials and were stored in an ice box during transportation. Diversity and abundance of planktons were identified within 4 days of sample collection using standard manuals of plankton identification under the light microscope. Almost all the measured physicochemical parameters were within the CEA standards limits for aquatic life, Sri Lanka Standards (SLS) or World Health Organization’s Guideline for drinking water. Concentration of orthophosphate ranged between 0.232 to 0.708 mg L-1, and it has exceeded the standard limit of aquatic life according to CEA guidelines (0.400 mg L-1) at Site 1 and Site 2, where there is high disturbance by cultivations and close households. According to the Pearson correlation (significant correlation at p < 0.05), it is obvious that some physicochemical parameters (temperature, DO, TDS, TSS, phosphate, sulphate, chloride fluoride, and sodium) were significantly correlated to the distribution of some plankton species such as Aulocoseira, Navicula, Synedra, Pediastrum, Fragilaria, Selenastrum, Oscillataria, Tribonema and Microcystis. Furthermore, species that appear in blooms (Aulocoseira), organic pollutants (Navicula), and phosphate high eutrophic water (Microcystis) were found, indicating deteriorated water quality in Mahaweli River due to agricultural activities, solid waste disposal, and release of domestic effluents. Therefore, it is necessary to improve environmental monitoring and management to control the further deterioration of water quality of the river.

Keywords: bio indicator, environmental variables, planktons, physicochemical parameters, water quality

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1205 Off-Body Sub-GHz Wireless Channel Characterization for Dairy Cows in Barns

Authors: Said Benaissa, David Plets, Emmeric Tanghe, Jens Trogh, Luc Martens, Leen Vandaele, Annelies Van Nuffel, Frank A. M. Tuyttens, Bart Sonck, Wout Joseph

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The herd monitoring and managing - in particular the detection of ‘attention animals’ that require care, treatment or assistance is crucial for effective reproduction status, health, and overall well-being of dairy cows. In large sized farms, traditional methods based on direct observation or analysis of video recordings become labour-intensive and time-consuming. Thus, automatic monitoring systems using sensors have become increasingly important to continuously and accurately track the health status of dairy cows. Wireless sensor networks (WSNs) and internet-of-things (IoT) can be effectively used in health tracking of dairy cows to facilitate herd management and enhance the cow welfare. Since on-cow measuring devices are energy-constrained, a proper characterization of the off-body wireless channel between the on-cow sensor nodes and the back-end base station is required for a power-optimized deployment of these networks in barns. The aim of this study was to characterize the off-body wireless channel in indoor (barns) environment at 868 MHz using LoRa nodes. LoRa is an emerging wireless technology mainly targeted at WSNs and IoT networks. Both large scale fading (i.e., path loss) and temporal fading were investigated. The obtained path loss values as a function of the transmitter-receiver separation were well fitted by a lognormal path loss model. The path loss showed an additional increase of 4 dB when the wireless node was actually worn by the cow. The temporal fading due to movement of other cows was well described by Rician distributions with a K-factor of 8.5 dB. Based on this characterization, network planning and energy consumption optimization of the on-body wireless nodes could be performed, which enables the deployment of reliable dairy cow monitoring systems.

Keywords: channel, channel modelling, cow monitoring, dairy cows, health monitoring, IoT, LoRa, off-body propagation, PLF, propagation

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1204 Outcome of Bowel Management Program in Patient with Spinal Cord Injury

Authors: Roongtiwa Chobchuen, Angkana Srikhan, Pattra Wattanapan

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Background: Neurogenic bowel is common condition after spinal cord injury. Most of spinal cord injured patients have motor weakness, mobility impairment which leads to constipation. Moreover, the neural pathway involving bowel function is interrupted. Therefore, the bowel management program should be implemented in nursing care in the earliest time after the onset of the disease to prevent the morbidity and mortality. Objective: To study the outcome of bowel management program of the patients with spinal cord injury who admitted for rehabilitation program. Study design: Descriptive study. Setting: Rehabilitation ward in Srinagarind Hospital. Populations: patients with subacute to chronic spinal cord injury who admitted at rehabilitation ward, Srinagarind hospital, aged over 18 years old. Instrument: The neurogenic bowel dysfunction score (NBDS) was used to determine the severity of neurogenic bowel. Procedure and statistical analysis: All participants were asked to complete the demographic data; age gender, duration of disease, diagnosis. The individual bowel function was assessed using NBDS at admission. The patients and caregivers were trained by nurses about the bowel management program which consisted of diet modification, abdominal massage, digital stimulation, stool evacuation including medication and physical activity. The outcome of the bowel management program was assessed by NBDS at discharge. The chi-square test was used to detect the difference in severity of neurogenic bowel at admission and discharge. Results: Sixteen spinal cord injured patients were enrolled in the study (age 45 ± 17 years old, 69% were male). Most of them (50%) were tetraplegia. On the admission, 12.5%, 12.5%, 43.75% and 31.25% were categorized as very minor (NBDS 0-6), minor (NBDS 7-9), moderate (NBDS 10-13) and severe (NBDS 14+) respectively. The severity of neurogenic bowel was decreased significantly at discharge (56.25%, 18.755%, 18.75% and 6.25% for very minor, minor, moderate and severe group respectively; p < 0.001) compared with NBDS at admission. Conclusions: Implementation of the effective bowel program decrease the severity of the neurogenic bowel in patient with spinal cord injury.

Keywords: neurogenic bowel, NBDS, spinal cord injury, bowel program

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1203 Using a Train-the-Trainer Model to Deliver Post-Partum Haemorrhage Simulation in Rural Uganda

Authors: Michael Campbell, Malaz Elsaddig, Kevin Jones

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Background: Despite encouraging progress, global maternal mortality has remained stubbornly high since the declaration of the Millennium development goals. Sub-Saharan Africa accounts for well over half of maternal deaths with Post-Partum Haemorrhage (PPH) being the lead cause. ‘In house’ simulation training delivered by local doctors may be a sustainable approach for improving emergency obstetric care. The aim of this study was to evaluate the use of a Train-the-Trainer (TtT) model in a rural Ugandan hospital to ascertain whether it can feasibly improve practitioners’ management of PPH. Methods: Three Ugandan doctors underwent a training course to enable them to design and deliver simulation training. These doctors used MamaNatalie® models to simulate PPH scenarios for midwives, nurses and medical students. The main outcome was improvement in participants’ knowledge and confidence, assessed using self-reported scores on a 10-point scale. Results: The TtT model produced significant improvements in the confidence and knowledge scores of the ten participants. The mean confidence score rose significantly (p=0.0005) from 6.4 to 8.6 following the simulation training. There was also a significant increase in the mean knowledge score from 7.2 to 9.0 (p=0.04). Medical students demonstrated the greatest overall increase in confidence scores whilst increases in knowledge scores were largest amongst nurses. Conclusions: This study demonstrates that a TtT model can be used in a low resource setting to improve healthcare professionals’ confidence and knowledge in managing obstetric emergencies. This Train-the-Trainer model represents a sustainable approach to addressing skill deficits in low resource settings. We believe that its expansion across healthcare institutions in Sub-Saharan Africa will help to reduce the region’s high maternal mortality rate and step closer to achieving the ambitions of the Millennium development goals.

Keywords: low resource setting, post-partum haemorrhage, simulation training, train the trainer

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1202 Brand Positioning in Iran: A Case Study of the Professional Soccer League

Authors: Homeira Asadi Kavan, Seyed Nasrollah Sajjadi, Mehrzade Hamidi, Hossein Rajabi, Mahdi Bigdely

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Positioning strategies of a sports brand can create a unique impression in the minds of the fans, sponsors, and other stakeholders. In order to influence potential customer's perception in an effective and positive way, a brands positioning strategy must be unique, credible, and relevant. Many sports clubs in Iran have been struggling to implement and achieve brand positioning accomplishments, due to different reasons such as lack of experience, scarcity of experts in the sports branding, and lack of related researches in this field. This study will provide a comprehensive theoretical framework and action plan for sport managers and marketers to design and implement effective brand positioning and to enable them to be distinguishable from competing brands and sports clubs. The study instrument is interviews with sports marketing and brand experts who have been working in this industry for a minimum of 20 years. Qualitative data analysis was performed using Atlast.ti text mining software version 7 and Open, axial and selective coding were employed to uncover and systematically analyze important and complex phenomena and elements. The findings show 199 effective elements in positioning strategies in Iran Professional Soccer League. These elements are categorized into 23 concepts and sub-categories as follows: Structural prerequisites, Strategic management prerequisites, Commercial prerequisites, Major external prerequisites, Brand personality, Club symbols, Emotional aspects, Event aspects, Fans’ strategies, Marketing information strategies, Marketing management strategies, Empowerment strategies, Executive management strategies, League context, Fans’ background, Market context, Club’s organizational context, Support context, Major contexts, Political-Legal elements, Economic factors, Social factors, and Technological factors. Eventually, the study model was developed by 6 main dimensions of Causal prerequisites, Axial Phenomenon (brand position), Strategies, Context Factors, Interfering Factors, and Consequences. Based on the findings, practical recommendations and strategies are suggested that can help club managers and marketers in developing and improving their respective sport clubs, brand positioning, and activities.

Keywords: brand positioning, soccer club, sport marketing, Iran professional soccer league, brand strategy

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1201 Exploring the Perspective of Service Quality in mHealth Services during the COVID-19 Pandemic

Authors: Wan-I Lee, Nelio Mendoza Figueredo

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The impact of COVID-19 has a significant effect on all sectors of society globally. Health information technology (HIT) has become an effective health strategy in this age of distancing. In this regard, Mobile Health (mHealth) plays a critical role in managing patient and provider workflows during the COVID-19 pandemic. Therefore, the users' perception of service quality about mHealth services plays a significant role in shaping confidence and subsequent behaviors regarding the mHealth users' intention of use. This study's objective was to explore levels of user attributes analyzed by a qualitative method of how health practitioners and patients are satisfied or dissatisfied with using mHealth services; and analyzed the users' intention in the context of Taiwan during the COVID-19 pandemic. This research explores the experienced usability of a mHealth services during the Covid-19 pandemic. This study uses qualitative methods that include in-depth and semi-structured interviews that investigate participants' perceptions and experiences and the meanings they attribute to them. The five cases consisted of health practitioners, clinic staff, and patients' experiences using mHealth services. This study encourages participants to discuss issues related to the research question by asking open-ended questions, usually in one-to-one interviews. The findings show the positive and negative attributes of mHealth service quality. Hence, the significant importance of patients' and health practitioners' issues on several dimensions of perceived service quality is system quality, information quality, and interaction quality. A concept map for perceptions regards to emergency uses' intention of mHealth services process is depicted. The findings revealed that users pay more attention to "Medical care", "ease of use" and "utilitarian benefits" and have less importance for "Admissions and Convenience" and "Social influence". To improve mHealth services, the mHealth providers and health practitioners should better manage users' experiences to enhance mHealth services. This research contributes to the understanding of service quality issues in mHealth services during the COVID-19 pandemic.

Keywords: COVID-19, mobile health, service quality, use intention

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1200 Genetics, Law and Society: Regulating New Genetic Technologies

Authors: Aisling De Paor

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Scientific and technological developments are driving genetics and genetic technologies into the public sphere. Scientists are making genetic discoveries as to the make up of the human body and the cause and effect of disease, diversity and disability amongst individuals. Technological innovation in the field of genetics is also advancing, with the development of genetic testing, and other emerging genetic technologies, including gene editing (which offers the potential for genetic modification). In addition to the benefits for medicine, health care and humanity, these genetic advances raise a range of ethical, legal and societal concerns. From an ethical perspective, such advances may, for example, change the concept of humans and what it means to be human. Science may take over in conceptualising human beings, which may push the boundaries of existing human rights. New genetic technologies, particularly gene editing techniques create the potential to stigmatise disability, by highlighting disability or genetic difference as something that should be eliminated or anticipated. From a disability perspective, use (and misuse) of genetic technologies raise concerns about discrimination and violations to the dignity and integrity of the individual. With an acknowledgement of the likely future orientation of genetic science, and in consideration of the intersection of genetics and disability, this paper highlights the main concerns raised as genetic science and technology advances (particularly with gene editing developments), and the consequences for disability and human rights. Through the use of traditional doctrinal legal methodologies, it investigates the use (and potential misuse) of gene editing as creating the potential for a unique form of discrimination and stigmatization to develop, as well as a potential gateway to a form of new, subtle eugenics. This article highlights the need to maintain caution as to the use, application and the consequences of genetic technologies. With a focus on the law and policy position in Europe, it examines the need to control and regulate these new technologies, particularly gene editing. In addition to considering the need for regulation, this paper highlights non-normative approaches to address this area, including awareness raising and education, public discussion and engagement with key stakeholders in the field and the development of a multifaceted genetics advisory network.

Keywords: disability, gene-editing, genetics, law, regulation

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1199 Adoption of Electronic Logistics Management Information System for Life-Saving Maternal, Neonatal and Child Health Medicines: A Bangladesh Perspective

Authors: Mohammad Julhas Sujan, Md. Ferdous Alam

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Maternal, neonatal, and child health (MNCH) holds one of the prime focuses in Bangladesh’s national healthcare system. To save the lives of mothers and children, knowing the stock of MNCH medicines in different healthcare facilities and when to replenish them are essential. A robust information system not only facilitates efficient management of the essential MNCH medicines but also helps effective allocation of scarce resources. In Bangladesh, Supply chain management of the 25-essential life-saving medicines are currently tracked and monitored via an electronic logistics management information system (eLMIS). Our aim was to conduct a cross-sectional study with a year (2020) worth of data from 24 districts of Bangladesh to evaluate how eLMIS is helping the Government and other stakeholders in efficient supply chain management. Data were collected from 4711 healthcare facilities ranging from primary to secondary levels within a district. About 90% (4143) are community clinics which are considered primary health care facilities in Bangladesh. After eLMIS implementation, the average reporting rate across the districts has been increased (> 97%). The month of stock (MOS) of zinc is an average 6 months compared to Inj. Magnesium Sulphate which will take 2.5 years to consume according to the current average monthly consumption (AMC). Due to first approaching expiry, Tab. Misoprostol, 7.1% Chlorhexidine and Inj. Oxytocin may become unusable. Moreover, Inj. Oxytocin is temperature sensitive and may reduce its efficacy if it is stocked for a longer period. In contrast, Zinc should be sufficiently stocked to prevent sporadic stockouts. To understand how data are collected, transmitted, processed, and aggregated for MNCH medicines in a faster and timely manner, an electronic logistics management information system (eLMIS) is necessary. We recommend the use of such a system in developing countries like Bangladesh for efficient supply chain management of essential MNCH medicines.

Keywords: adaption, eLMIS, MNCH, live-saving medicines

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1198 First Rank Symptoms in Mania: An Indistinct Diagnostic Strand

Authors: Afshan Channa, Sameeha Aleem, Harim Mohsin

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First rank symptoms (FRS) are considered to be pathognomic for Schizophrenia. However, FRS is not a distinctive feature of Schizophrenia. It has also been noticed in affective disorder, albeit not inclusive in diagnostic criteria. The presence of FRS in Mania leads to misdiagnosis of psychotic illness, further complicating the management and delay of appropriate treatment. FRS in Mania is associated with poor clinical and functional outcome. Its existence in the first episode of bipolar disorder may be a predictor of poor short-term outcome and decompensating course of illness. FRS in Mania is studied in west. However, the cultural divergence and detriments make it pertinent to study the frequency of FRS in affective disorder independently in Pakistan. Objective: The frequency of first rank symptoms in manic patients, who were under treatment at psychiatric services of tertiary care hospital. Method: The cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. One hundred and twenty manic patients were recruited from November 2014 to May 2015. The patients who were unable to comprehend Urdu or had comorbid psychiatric or organic disorder were excluded. FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool. Result: The mean age of the patients was 37.62 + 12.51. The mean number of previous manic episode was 2.17 + 2.23. 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a p-value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness. 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity. 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception. Conclusion: The study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders. Being married had no protective effect on the presence of FRS.

Keywords: first rank symptoms, Mania, psychosis, present state examination

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1197 Pediatric Health Nursing Research in Jordan: Evaluating the State of Knowledge and Determining Future Research Direction

Authors: Inaam Khalaf, Nadin M. Abdel Razeq, Hamza Alduraidi, Suhaila Halasa, Omayyah S. Nassar, Eman Al-Horani, Jumana Shehadeh, Anna Talal

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Background: Nursing researchers are responsible for generating knowledge that corresponds to national and global research priorities in order to promote, restore, and maintain the health of individuals and societies. The objectives of this scoping review of Jordanian literature are to assess the existing research on pediatric nursing in terms of evolution, authorship and collaborations, funding sources, methodologies, topics of research, and pediatric subjects' age groups so as to identify gaps in research. Methodology: A search was conducted using related keywords obtained from national and international databases. The reviewed literature included pediatric health articles published through December 2019 in English and Arabic, authored by nursing researchers. The investigators assessed the retrieved studies and extracted data using a data-mining checklist. Results: The review included 265 articles authored by Jordanian nursing researchers concerning children's health, published between 1987 and 2019; 95% were published between 2009 and 2019. The most commonly applied research methodology was the descriptive non-experimental method (76%). The main generic topics were health promotion and disease prevention (23%), chronic physical conditions (19%), mental health, behavioral disorders, and forensic issues (16%). Conclusion: The review findings identified a grave shortage of evidence concerning nursing care issues for children below five years of age, especially those between ages two and five years. The research priorities identified in this review resonate with those identified in international reports. Implications: Nursing researchers are encouraged to conduct more research targeting topics of national-level importance in collaboration with clinically involved nurses and international scholars.

Keywords: Jordan, scoping review, children health nursing, pediatric, adolescents

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1196 Policy Recommendations for Reducing CO2 Emissions in Kenya's Electricity Generation, 2015-2030

Authors: Paul Kipchumba

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Kenya is an East African Country lying at the Equator. It had a population of 46 million in 2015 with an annual growth rate of 2.7%, making a population of at least 65 million in 2030. Kenya’s GDP in 2015 was about 63 billion USD with per capita GDP of about 1400 USD. The rural population is 74%, whereas urban population is 26%. Kenya grapples with not only access to energy but also with energy security. There is direct correlation between economic growth, population growth, and energy consumption. Kenya’s energy composition is at least 74.5% from renewable energy with hydro power and geothermal forming the bulk of it; 68% from wood fuel; 22% from petroleum; 9% from electricity; and 1% from coal and other sources. Wood fuel is used by majority of rural and poor urban population. Electricity is mostly used for lighting. As of March 2015 Kenya had installed electricity capacity of 2295 MW, making a per capital electricity consumption of 0.0499 KW. The overall retail cost of electricity in 2015 was 0.009915 USD/ KWh (KES 19.85/ KWh), for installed capacity over 10MW. The actual demand for electricity in 2015 was 3400 MW and the projected demand in 2030 is 18000 MW. Kenya is working on vision 2030 that aims at making it a prosperous middle income economy and targets 23 GW of generated electricity. However, cost and non-cost factors affect generation and consumption of electricity in Kenya. Kenya does not care more about CO2 emissions than on economic growth. Carbon emissions are most likely to be paid by future costs of carbon emissions and penalties imposed on local generating companies by sheer disregard of international law on C02 emissions and climate change. The study methodology was a simulated application of carbon tax on all carbon emitting sources of electricity generation. It should cost only USD 30/tCO2 tax on all emitting sources of electricity generation to have solar as the only source of electricity generation in Kenya. The country has the best evenly distributed global horizontal irradiation. Solar potential after accounting for technology efficiencies such as 14-16% for solar PV and 15-22% for solar thermal is 143.94 GW. Therefore, the paper recommends adoption of solar power for generating all electricity in Kenya in order to attain zero carbon electricity generation in the country.

Keywords: co2 emissions, cost factors, electricity generation, non-cost factors

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1195 Transport Mode Selection under Lead Time Variability and Emissions Constraint

Authors: Chiranjit Das, Sanjay Jharkharia

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This study is focused on transport mode selection under lead time variability and emissions constraint. In order to reduce the carbon emissions generation due to transportation, organization has often faced a dilemmatic choice of transport mode selection since logistic cost and emissions reduction are complementary with each other. Another important aspect of transportation decision is lead-time variability which is least considered in transport mode selection problem. Thus, in this study, we provide a comprehensive mathematical based analytical model to decide transport mode selection under emissions constraint. We also extend our work through analysing the effect of lead time variability in the transport mode selection by a sensitivity analysis. In order to account lead time variability into the model, two identically normally distributed random variables are incorporated in this study including unit lead time variability and lead time demand variability. Therefore, in this study, we are addressing following questions: How the decisions of transport mode selection will be affected by lead time variability? How lead time variability will impact on total supply chain cost under carbon emissions? To accomplish these objectives, a total transportation cost function is developed including unit purchasing cost, unit transportation cost, emissions cost, holding cost during lead time, and penalty cost for stock out due to lead time variability. A set of modes is available to transport each node, in this paper, we consider only four transport modes such as air, road, rail, and water. Transportation cost, distance, emissions level for each transport mode is considered as deterministic and static in this paper. Each mode is having different emissions level depending on the distance and product characteristics. Emissions cost is indirectly affected by the lead time variability if there is any switching of transport mode from lower emissions prone transport mode to higher emissions prone transport mode in order to reduce penalty cost. We provide a numerical analysis in order to study the effectiveness of the mathematical model. We found that chances of stock out during lead time will be higher due to the higher variability of lead time and lad time demand. Numerical results show that penalty cost of air transport mode is negative that means chances of stock out zero, but, having higher holding and emissions cost. Therefore, air transport mode is only selected when there is any emergency order to reduce penalty cost, otherwise, rail and road transport is the most preferred mode of transportation. Thus, this paper is contributing to the literature by a novel approach to decide transport mode under emissions cost and lead time variability. This model can be extended by studying the effect of lead time variability under some other strategic transportation issues such as modal split option, full truck load strategy, and demand consolidation strategy etc.

Keywords: carbon emissions, inventory theoretic model, lead time variability, transport mode selection

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1194 Green Synthesis of Nanosilver-Loaded Hydrogel Nanocomposites for Antibacterial Application

Authors: D. Berdous, H. Ferfera-Harrar

Abstract:

Superabsorbent polymers (SAPs) or hydrogels with three-dimensional hydrophilic network structure are high-performance water absorbent and retention materials. The in situ synthesis of metal nanoparticles within polymeric network as antibacterial agents for bio-applications is an approach that takes advantage of the existing free-space into networks, which not only acts as a template for nucleation of nanoparticles, but also provides long term stability and reduces their toxicity by delaying their oxidation and release. In this work, SAP/nanosilver nanocomposites were successfully developed by a unique green process at room temperature, which involves in situ formation of silver nanoparticles (AgNPs) within hydrogels as a template. The aim of this study is to investigate whether these AgNPs-loaded hydrogels are potential candidates for antimicrobial applications. Firstly, the superabsorbents were prepared through radical copolymerization via grafting and crosslinking of acrylamide (AAm) onto chitosan backbone (Cs) using potassium persulfate as initiator and N,N’-methylenebisacrylamide as the crosslinker. Then, they were hydrolyzed to achieve superabsorbents with ampholytic properties and uppermost swelling capacity. Lastly, the AgNPs were biosynthesized and entrapped into hydrogels through a simple, eco-friendly and cost-effective method using aqueous silver nitrate as a silver precursor and curcuma longa tuber-powder extracts as both reducing and stabilizing agent. The formed superabsorbents nanocomposites (Cs-g-PAAm)/AgNPs were characterized by X-ray Diffraction (XRD), UV-visible Spectroscopy, Attenuated Total reflectance Fourier Transform Infrared Spectroscopy (ATR-FTIR), Inductively Coupled Plasma (ICP), and Thermogravimetric Analysis (TGA). Microscopic surface structure analyzed by Transmission Electron Microscopy (TEM) has showed spherical shapes of AgNPs with size in the range of 3-15 nm. The extent of nanosilver loading was decreased by increasing Cs content into network. The silver-loaded hydrogel was thermally more stable than the unloaded dry hydrogel counterpart. The swelling equilibrium degree (Q) and centrifuge retention capacity (CRC) in deionized water were affected by both contents of Cs and the entrapped AgNPs. The nanosilver-embedded hydrogels exhibited antibacterial activity against Escherichia coli and Staphylococcus aureus bacteria. These comprehensive results suggest that the elaborated AgNPs-loaded nanomaterials could be used to produce valuable wound dressing.

Keywords: antibacterial activity, nanocomposites, silver nanoparticles, superabsorbent Hydrogel

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