Search results for: group decision

Authors: Hassan Almoslim

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Background: The machine resistance training is an exercise that uses the equipment as loads to strengthen and condition the musculoskeletal system and improving muscle tone. The machine resistance training is easy to use, allow the individual to train with heavier weights without assistance, useful for beginners and elderly populations and specific muscle groups. Purpose: The purpose of this study was to examine the impact of nine weeks of machine resistance training on maximum strength among lean and normal weight male college students. Method: Thirty-six male college students aged between 19 and 21 years from King Fahd University of petroleum & minerals participated in the study. The subjects were divided into two an equal groups called Lean Group (LG, n = 18) and Normal Weight Group (NWG, n = 18). The subjects whose body mass index (BMI) is less than 18.5 kg / m2 is considered lean and who is between 18.5 to 24.9 kg / m2 is normal weight. Both groups performed machine resistance training nine weeks, twice per week for 40 min per training session. The strength measurements, chest press, leg press and abdomen exercises were performed before and after the training period. 1RM test was used to determine the maximum strength of all subjects. The training program consisted of several resistance machines such as leg press, abdomen, chest press, pulldown, seated row, calf raises, leg extension, leg curls and back extension. The data were analyzed using independent t-test (to compare mean differences) and paired t-test. The level of significance was set at 0.05. Results: No change was (P ˃ 0.05) observed in all body composition variables between groups after training. In chest press, the NWG recorded a significantly greater mean different value than the LG (19.33 ± 7.78 vs. 13.88 ± 5.77 kg, respectively, P ˂ 0.023). In leg press and abdomen exercises, both groups revealed similar mean different values (P ˃ 0.05). When the post-test was compared with the pre-test, the NWG showed significant increases in the chest press by 47% (from 41.16 ± 12.41 to 60.49 ± 11.58 kg, P ˂ 001), abdomen by 34% (from 45.46 ± 6.97 to 61.06 ± 6.45 kg, P ˂ 0.001) and leg press by 23.6% (from 85.27 ± 15.94 to 105.48 ± 21.59 kg, P ˂ 0.001). The LG also illustrated significant increases by 42.6% in the chest press (from 32.58 ± 7.36 to 46.47 ± 8.93 kg, P ˂ 0.001), the abdomen by 28.5% (from 38.50 ± 7.84 to 49.50 ± 7.88 kg, P ˂ 0.001) and the leg press by 30.8% (from 70.2 ± 20.57 to 92.01 ± 22.83 kg, P ˂ 0.001). Conclusion: It was concluded that the lean and the normal weight male college students can benefit from the machine resistance-training program remarkably.

Keywords: body composition, lean, machine resistance training, normal weight

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Authors: H. Al-Jabli

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The research on the presence of heavy metals and bromate in drinking water is of immense scientific significance due to the potential risks these substances pose to public health. These contaminants are subject to regulatory limits outlined by the National Primary Drinking Water Regulations. Through a comprehensive analysis involving the compilation of existing data and the collection of new data via water sampling in residential areas of Kuwait, the aim is to create detailed maps illustrating the spatial distribution of these substances. Furthermore, the investigation will utilize GRAPHER software to explore correlations among different chemical parameters. By implementing rigorous scientific methodologies, the research will provide valuable insights for the Ministry of Electricity and Water and the Ministry of Health. These insights can inform evidence-based decision-making, facilitate the implementation of corrective measures, and support strategic planning for future infrastructure activities.

Keywords: heavy metals, bromate, ozonation, GIS

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Authors: Kujhin Jeong, Sungjoo Lee

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In the past, cross-licensing was made up of various application or commercial patents. Today, cross-licensing is restricted to essential patents, which has emphasized their importance significantly. Literature has shown that patent portfolio provides information for patent protection or strategy decision-making, but little empirical research has found strategic tool of essential patents. This paper will highlight four types of essential patent portfolio and analysis about each strategy in the field of LTE-A. Specifically we collected essential patents of mobile communication company through ETSI (European Telecommunication Standards Institute) and build-up portfolio activity, concentration, diversity, and quality. Using these portfolios, we can understand each company’s strategic character about the technology of LTE-A and comparison analysis of financial results. Essential patents portfolio displays a mobile communication company’s strategy and its strategy’s impact on the performance of a company.

Keywords: essential patent, portfolio, patent portfolio, essential patent portfolio

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Authors: Marzieh Nojomi, Azadeh Mottaghi, Arghavan Haj-Sheykholeslami, Narjes Khalili, Arash Tehrani Banihashemi

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Background and objectives: Domestic violence is a global problem with severe consequences throughout the life of the victims. Iran’s Ministry of Health has launched an intimate partner violence (IPV) prevention program, integrated in the primary health care services since 2016. The present study is a part of this national program’s evaluation. In this section, we aimed to examine spousal abuse victims’ knowledge and attitude towards domestic violence before and after receivingthese services. Methods: To assess the knowledge and attitudes of victims, a questionnaire designed by Ahmadzadand colleagues in 2013 was used. This questionnaire includes 15 questions regarding knowledge in the fields of definition, epidemiology, and effects on children, outcomes, and prevention of domestic violence. To assess the attitudes, this questionnaire has 10 questions regarding the attitudes toward the causes, effects, and legal or protective support services of domestic violence. To assess the satisfaction and the effect of the program on prevention or reduction of spousal violence episodes, two more questions were also added. Since domestic violence prevalence differs in different parts of the country, we chose nine areas with the highest, the lowest, and moderate prevalence of IPVfor the study. The link to final electronic version of the questionnaire was sent to the randomly selected public rural or urban health centers in the nine chosen areas. Since the study had to be completed in one month, we used newly identified victims as pre-intervention group and people who had at least received one related service from the program (like psychiatric consultation, education about safety measures, supporting organizations and etc.) during the previous year, as our post- intervention group. Results: A hundred and ninety-two newly identified IPV victims and 267 victims who had at least received one related program service during the previous year entered the study. All of the victims were female. Basic characteristics of the two groups, including age, education, occupation, addiction, spouses’ age, spouses’ addiction, duration of the current marriage, and number of children, were not statistically different. In knowledge questions, post- intervention group had statistically better scores in the fields of domestic violence outcomes and its effects on children; however, in the remaining areas, the scores of both groups were similar. The only significant difference in the attitude across the two groups was in the field of legal or protective support services. From the 267 women who had ever received a service from the program, 91.8% were satisfied with the services, and 74% reported a decrease in the number of violent episodes. Conclusion: National IPV prevention program integrated in the primary health care services in Iran is effective in improving the knowledge of victims about domestic violence outcomes and its effects on children. Improving the attitude and knowledge of domestic violence victims about its causes and preventive measures needs more effective interventions. This program can reduce the number of IPV episodes between the spouses, and satisfaction among the service users is high.

Keywords: intimate partner violence, assessment, health services, efficacy

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Authors: Sunil K. Jena, Sanjaya K. Samal, Mahesh Chand, Abhay T. Sangamwar

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Tamoxifen (TMX) and its analogues are approved as a first line therapy for the treatment of estrogen receptor-positive tumors. However, clinical development of TMX has been hampered by its low bioavailability and severe hepatotoxicity. Herein, we attempt to design a new drug delivery vehicle that could enhance the pharmacokinetic performance of TMX. Initially, high-molecular weight carboxymethyl chitosan was hydrolyzed to low-molecular weight carboxymethyl chitosan (LMW CMC) with hydrogen peroxide under the catalysis of phosphotungstic acid. Amphiphilic block copolymers of LMW CMC were synthesized via amidation reaction between the carboxyl group of α-tocopherol succinate (TS) and an amine group of LMW CMC. These amphiphilic block copolymers were self-assembled to nanosize core-shell-structural micelles in the aqueous medium. The critical micelle concentration (CMC) decreased with the increasing substitution of TS on LMW CMC, which ranged from 1.58 × 10-6 to 7.94 × 10-8 g/mL. Maximum TMX loading up to 8.08 ± 0.98% was achieved with Cmc-TS4.5 (TMX/Cmc-TS4.5 with 1:8 weight ratio). Both blank and TMX-loaded polymeric micelles (TMX-PM) of Cmc-TS4.5 exhibits spherical shape with the particle size below 200 nm. TMX-PM has been found to be stable in the gastrointestinal conditions and released only 44.5% of the total drug content by the first 72 h in simulated gastric fluid (SGF), pH 1.2. However, the presence of pepsin does not significantly increased the TMX release in SGF, pH 1.2, released only about 46.2% by the first 72 h suggesting its inability to cleave the peptide bond. In contrast, the release of TMX from TMX-PM4.5 in SIF, pH 6.8 (without pancreatin) was slow and sustained, released only about 10.43% of the total drug content within the first 30 min and nearly about 12.41% by the first 72 h. The presence of pancreatin in SIF, pH 6.8 led to an improvement in drug release. About 28.09% of incorporated TMX was released in the presence of pancreatin in 72 h. A cytotoxicity study demonstrated that TMX-PM exhibited time-delayed cytotoxicity in human MCF-7 breast cancer cells. Pharmacokinetic studies on Sprague-Dawley rats revealed a remarkable increase in oral bioavailability (1.87-fold) with significant (p < 0.0001) enhancement in AUC0-72 h, t1/2 and MRT of TMX-PM4.5 than that of TMX-suspension. Thus, the results suggested that CMC-TS micelles are a promising carrier for TMX delivery.

Keywords: carboxymethyl chitosan, d-α-tocopherol succinate, pharmacokinetic, polymeric micelles, tamoxifen

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Authors: Chengli Liu, C. K. M. Lee

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The tradition competitive newsvendor game assumes decision makers are rational. However, there are behavioral biases when people make decisions, such as loss aversion, mental accounting and overconfidence. Overestimation of a subject’s own performance is one type of overconfidence. The objective of this research is to analyze the impact of the overestimated demand in the newsvendor competitive game with two players. This study builds a competitive newsvendor game model where newsvendors have private information of their demands, which is overestimated. At the same time, demands of each newsvendor forecasted by a third party institution are available. This research shows that the overestimation leads to demand steal effect, which reduces the competitor’s order quantity. However, the overall supply of the product increases due to overestimation. This study illustrates the boundary condition for the overestimated newsvendor to have the equilibrium order drop due to the demand steal effect from the other newsvendor. A newsvendor who has higher critical fractile will see its equilibrium order decrease with the drop of estimation level from the other newsvendor.

Keywords: bias, competing newsvendor, Nash equilibrium, overestimation

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Authors: Ismail Becenen

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Air pollution, a consequence of urbanization brought about by modern life, is as global as it is local and regional. Because of the adverse effects of air pollution on human health, air quality is given importance all over the world. According to the decision of the World Health Organization, clean air is the basic necessity for human health and well-being. It poses a very high risk especially for heart diseases and stroke cases. In this study, the positive effects of natural gas usage on air pollution in cities are explained by using literature scans and air pollution measurement values. Natural gas is cleaner than other types of fuel. It contains less sulfur and organic sulfur compounds. When natural gas burns, it does not leave ashes, it does not cause problems in the rubbish mountains. It's a clean fuel, it easily burns and shines. It is a burning gas that is easy and efficient. In addition, there is not a toxic effect for people in case of inhalation. As a result, the use of natural gas needs to be widespread to reduce air pollution around the world in order to provide a healthier life for people and the environment.

Keywords: natural gas, air pollution, sulfur dioxide, particulate matter, energy

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Authors: Grace Omowunmi Soyebi

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A computerized medical record system is a collection of medical information about a person that is stored on a computer. One principal problem of most hospitals in rural areas is using the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved, this may cause an unexpected to happen to the patient. This Data Mining application is to be designed using a Structured System Analysis and design method which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the Design and Implementation of a Computerized medical record system. This Computerized system will replace the file management system and help to quickly retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: programming, computing, data, innovation

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Authors: Imessaoudene Y., Mouhouche B., Sengouga A., Kadir M.

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The objective of this work is to determine the virtual water of main crops grown in the province of Djelfa and water use efficiency (W.U.E.), Which is essential to approach the application and better integration with the offer in the region. In the case of agricultural production, virtual water is the volume of water evapo-transpired by crops. It depends on particular on the expertise of its producers and its global production area, warm and dry climates induce higher consumption. At the scale of the province, the determination of the quantities of virtual water is done by calculating the unit water requirements related to water irrigated hectare and total rainfall over the crop using the Cropwat 8.0 F.A.O. software. Quantifying the volume of agricultural virtual water of crops practiced in the study area demonstrates the quantitative importance of these volumes of water in terms of available water resources in the province, so the advantages which can be the concept of virtual water as an analysis tool and decision support for the management and distribution of water in scarcity situation.

Keywords: virtual water, water use efficiency, water requirements, Djelfa

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Authors: O. Ahmed Apampa, Yinusa, A. Jimoh

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The aim of this study was to develop an appropriate model for predicting the compaction behavior of lateritic soils and corn cob ash (CCA) stabilized lateritic soils. This was done by first adopting an equation earlier developed for fine-grained soils and subsequent adaptation by others and extending it to modified lateritic soil through the introduction of alpha and beta parameters which are polynomial functions of the CCA binder input. The polynomial equations were determined with MATLAB R2011 curve fitting tool, while the alpha and beta parameters were determined by standard linear programming techniques using the Solver function of Microsoft Excel 2010. The model so developed was a good fit with a correlation coefficient R2 value of 0.86. The paper concludes that it is possible to determine the optimum moisture content and the maximum dry density of CCA stabilized soils from the compaction test of the unmodified soil, and recommends that this procedure is extended to other binder stabilized lateritic soils to facilitate quick decision making in roadworks.

Keywords: compaction, corn cob ash, lateritic soil, stabilization

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Authors: Narong Anurak

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This study aimed to find out the hair-care purchasing behavior at hypermarkets and to investigate two factors, package design and advertising channels, that influenced hair-care purchasing behavior. The subjects of the study consisted of 100 housewives aged between 20-60 who usually shopped at Big C Tiwanon. They were selected by accidental sampling, and were asked to complete a questionnaire. The main findings of the survey were that the majority of respondents regarding their brand selection of hair-care products, they gave priority to the product quality followed by a reasonable price, and fragrance, respectively. Besides, more than half of the respondents had brand loyalty while the rest were attracted by an attractive package design and advertising promotion campaigns. The respondents who were attracted by the package design said that the information on the labels influenced their purchasing decision the most, and television was a medium that best reached them as well.

Keywords: advertising channels, consumer purchasing decisions, hair-care market, package design

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Authors: I. Stathopoulos, V. Syrgiamiotis, E. Karavasilis, A. Ploussi, I. Nikas, C. Hatzigiorgi, K. Platoni, E. P. Efstathopoulos

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Introduction: Brain and central nervous system (CNS) tumors form the second most common group of cancer in children, accounting for 30% of all childhood cancers. MRI is the key imaging technique used for the visualization and management of pediatric brain tumors. Initial characterization of tumors from MRI scans is usually performed via a radiologist’s visual assessment. However, different brain tumor types do not always demonstrate clear differences in visual appearance. Using only conventional MRI to provide a definite diagnosis could potentially lead to inaccurate results, and so histopathological examination of biopsy samples is currently considered to be the gold standard for obtaining definite diagnoses. Machine learning is defined as the study of computational algorithms that can use, complex or not, mathematical relationships and patterns from empirical and scientific data to make reliable decisions. Concerning the above, machine learning techniques could provide effective and accurate ways to automate and speed up the analysis and diagnosis for medical images. Machine learning applications in radiology are or could potentially be useful in practice for medical image segmentation and registration, computer-aided detection and diagnosis systems for CT, MR or radiography images and functional MR (fMRI) images for brain activity analysis and neurological disease diagnosis. Purpose: The objective of this study is to provide an automated tool, which may assist in the imaging evaluation and classification of brain neoplasms in pediatric patients by determining the glioma type, grade and differentiating between different brain tissue types. Moreover, a future purpose is to present an alternative way of quick and accurate diagnosis in order to save time and resources in the daily medical workflow. Materials and Methods: A cohort, of 80 pediatric patients with a diagnosis of posterior fossa tumor, was used: 20 ependymomas, 20 astrocytomas, 20 medulloblastomas and 20 healthy children. The MR sequences used, for every single patient, were the following: axial T1-weighted (T1), axial T2-weighted (T2), FluidAttenuated Inversion Recovery (FLAIR), axial diffusion weighted images (DWI), axial contrast-enhanced T1-weighted (T1ce). From every sequence only a principal slice was used that manually traced by two expert radiologists. Image acquisition was carried out on a GE HDxt 1.5-T scanner. The images were preprocessed following a number of steps including noise reduction, bias-field correction, thresholding, coregistration of all sequences (T1, T2, T1ce, FLAIR, DWI), skull stripping, and histogram matching. A large number of features for investigation were chosen, which included age, tumor shape characteristics, image intensity characteristics and texture features. After selecting the features for achieving the highest accuracy using the least number of variables, four machine learning classification algorithms were used: k-Nearest Neighbour, Support-Vector Machines, C4.5 Decision Tree and Convolutional Neural Network. The machine learning schemes and the image analysis are implemented in the WEKA platform and MatLab platform respectively. Results-Conclusions: The results and the accuracy of images classification for each type of glioma by the four different algorithms are still on process.

Keywords: image classification, machine learning algorithms, pediatric MRI, pediatric oncology

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Authors: Cynthia Adlerstein-Grimberg, Andrea Bralic-Echeverría

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An extensive and controversial research debate discusses pedagogical documentation (PD) within early childhood education (ECE) as integral to ECE teachers' professional development. The literature converges in acknowledging that ICT integration in PD can be fundamental for children's and teachers' collaborative learning by making their processes visible and open to reflection. Controversial issues about PD emerge around ICT integration and the use of multimedia applications and platforms, displacing the physical experience involved in this pedagogical practice. Authors argue that online platforms make PD become a passive device to demonstrate accountability and performance. Furthermore, ICT integration would make educators inform children and families of pedagogical processes, positioning them more as consumers instead of involving them in collective thinking and pedagogical decision-making. This article analyses how pedagogical documentation mediated by a multimedia application (MAFApp) allows for the positive strengthening of an ECE pedagogical online community that thinks collectively about learning environments. In doing so, the paper shows how ICT integration supports ECE teachers' collective online thinking, enabling them to move from the controversial version of online PD, where they only act as informers of children's learning and assume a voyeuristic perspective, towards a collective online thinking that builds professional development and supports pedagogical decision-making about learning environments. This article answers How ECE teachers' pedagogical documentation evolves with ICT integration using the MAFApp multimedia application in a national ECE online community. From a posthumanist stance, this paper draws on an 18-month collaborative ethnographic immersion in Chile's unique public ECE online PD community. It develops a unique case study of an online ECE pedagogical community mediated by a multimedia application called MAFApp. This ECE online community includes 32 Chilean public kindergartens, 45 ECE teachers, and 72 assistants, who produced 534 pedagogical documentation. Fieldwork included 35 in-depth interviews, 13 discussion groups, and the constant comparison method for the PD coding. Findings show ICT integration in PD builds collective online thinking that evolves through four moments of growing complexity: 1) teachernalism of built environments, 2) onlookerism of children's anecdotes in learning environments; 3) storytelling of children's place-making, and 4) empowering pedagogies for co-creating learning environments. ICT integration through the MAFApp multimedia application enabled ECE teachers to build collective online thinking, making pedagogies of place visible and engaging children in co-constructing learning environments. This online PD is a continuous professional learning space for ECE teachers, empowering pedagogies of place. In conclusion, ICT integration into PD progressively empowers pedagogies of place in Chilean public ECE. Strengthening collective online thinking using the MAFApp multimedia application sharply contrasts with some recent PD research findings. ICT integration to PD enabled strong collective online thinking. Doing so makes PD operate as a place of professional development, pedagogical reflective encounters, and experimentation while inhabiting their own learning environments with children.

Keywords: early childhood education, ICT integration, multimedia application, online collective thinking, pedagogical documentation, professional development

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Authors: Maria Valeria De Bonis, Gianpaolo Ruocco

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Nowadays, computational modeling is paving new design and verification ways in a number of industrial sectors. The technology is ripe to challenge some case in the Bioengineering and Medicine frameworks: for example, looking at the strategical and ethical importance of oncology research, efforts should be made to yield new and powerful resources to tumor knowledge and understanding. With these driving motivations, we approach this gigantic problem by using some standard engineering tools such as the mathematics behind the biomass transfer. We present here some bacterial colonization studies in complex structures. As strong analogies hold with some tumor proliferation, we extend our study to a benchmark case of solid tumor. By means of a commercial software, we model biomass and energy evolution in arbitrary media. The approach will be useful to cast virtualization cases of cancer growth in human organs, while augmented reality tools will be used to yield for a realistic aid to informed decision in treatment and surgery.

Keywords: bacteria, simulation, tumor, precision medicine

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Authors: Sudkhanoung Ritruechai, Somrak Choovanichwong, Kruawon Tiengtom, Peanchanan Leeudomwong

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The purposes of this qualitative research were to study the recovery experience of people with bipolar disorder and also to propose a development approach to the Bipolar Friends Club. The participants were eight people with bipolar disorder for six to twenty years (four women and four men). They have been members of the Bipolar Friends Club for two to ten years. They have no mental symptoms in order to provide sufficient information about their recovery experiences and have returned to everyday life with their family, community, and work. The data were collected by doing an in-depth interview. Two interviews were done, each from 45-90 minutes and four to five weeks apart. The researcher sent the results of the preliminary data analysis to the participants two to three days beforehand. Confirmation of the results of the preliminary data analysis from the first interview was done at the second interview. The research study found that the participants had a positive experience of being a Bipolar Club member. The club continued its activities following Recovery Oriented Service: ROS to the participants. As a result, they recovered in eight areas as follows. 1) Intellectual: The wisdom of joining the group has brought knowledge and experiences from an exchange with others in self-care as well as a positive thinking in life. 2) Social: The participants have set up a group to take care of each other and to do activities which have brought warmth. Their social network which was normally little has also been increased. 3) Spiritual: The concept of religion has been used to lead the life of the participants. 4) Occupational: One participant is a student while the others do work. All of them have done well. 5) Environmental: The participants would be able to adapt to the environment and cope with their problems better. 6) Physical: Most female participants have difficulties with losing weight which leads them saying that they are ‘not fully recovered’. 7) Emotional: The participants feel calmer than before entering the club. They have also developed more tolerance to problems. 8) Financial: The participants would be able to control their spending by themselves and with the help of their family members. The people with bipolar disorder have suggested that the services of the club are perfect and should be continued. The results of the study encourage the Bipolar Friends Club, as well as other clubs/associations that support the recovery of patients. Consideration of the recovery has highlighted the need for ongoing and various life-enhancing programs for the caregivers and their loved ones with bipolar disorder. Then, they would be able to choose the program that suits their needs to improve their life.

Keywords: people with bipolar disorder, recovery, club, experience

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Authors: Thiago R. Pereira

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The philosophical hermeneutics is able to change the Brazilian Judiciary because of the understanding of the characteristics of the human being. It is impossible for humans, to be invested in the function of being a judge, making absolutely neutral decisions, but the philosophical hermeneutics can assist the judge making impartial decisions, based on the federal constitution. The normative legal positivism imagined a neutral judge, a judge able to try without any preconceived ideas, without allowing his/her background to influence him/her. When a judge arbitrates based on legal rules, the problem is smaller, but when there are no clear legal rules, and the judge must try based on principles, the risk of the decision is based on what they believe in. Solipsistically, this issue gains a huge dimension. Today, the Brazilian judiciary is independent, but there must be a greater knowledge of philosophy and the philosophy of law, partially because the bigger problem is the unpredictability of decisions made by the judiciary. Actually, when a lawsuit is filed, the result of this judgment is absolutely unpredictable. It is almost a gamble. There must be the slightest legal certainty and predictability of judicial decisions, so that people, with similar cases, may not receive opposite sentences. The relativism, since classical antiquity, believes in the possibility of multiple answers. Since the Greeks in in the sixth century before Christ, through the Germans in the eighteenth century, and even today, it has been established the constitution as the great law, the Groundnorm, and thus, the relativism of life can be greatly reduced when a hermeneut uses the Constitution as North interpretational, where all interpretation must act as the hermeneutic constitutional filter. For a current philosophy of law, that inside a legal system with a Federal Constitution, there is a single correct answer to a specific case. The challenge is how to find this right answer. The only answer to this question will be that we should use the constitutional principles. But in many cases, a collision between principles will take place, and to resolve this issue, the judge or the hermeneut will choose a solipsism way, using what they personally believe to be the right one. For obvious reasons, that conduct is not safe. Thus, a theory of decision is necessary to seek justice, and the hermeneutic philosophy and the linguistic turn will be necessary for one to find the right answer. In order to help this difficult mission, it will be necessary to use philosophical hermeneutics in order to find the right answer, which is the constitutionally most appropriate response. The constitutionally appropriate response will not always be the answer that individuals agree to, but we must put aside our preferences and defend the answer that the Constitution gives us. Therefore, the hermeneutics applied to Law, in search constitutionally appropriate response, should be the safest way to avoid judicial individual decisions. The aim of this paper is to present the science of law starting from the linguistic turn, the philosophical hermeneutics, moving away from legal positivism. The methodology used in this paper is qualitative, academic and theoretical, philosophical hermeneutics with the mission to conduct research proposing a new way of thinking about the science of law. The research sought to demonstrate the difficulty of the Brazilian courts to depart from the secular influence of legal positivism. Moreover, the research sought to demonstrate the need to think science of law within a contemporary perspective, where the linguistic turn, philosophical hermeneutics, will be the surest way to conduct the science of law in the present century.

Keywords: hermeneutic, right answer, solipsism, Brazilian judiciary

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Authors: Amanina Iymia Jeffree, Reena Thriumani, Mohammad Iqbal Omar, Ammar Zakaria, Yumi Zuhanis Has-Yun Hashim, Ali Yeon Md Shakaff

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Metabolite profiling is a strategy to be approached in the pattern recognition method focused on three types of cancer cell line that driving the most to death specifically lung, breast, and colon cancer. The purpose of this study was to discriminate the VOCs pattern among cancerous and control group based on metabolite profiling. The sampling was executed utilizing the cell culture technique. All culture flasks were incubated till 72 hours and data collection started after 24 hours. Every running sample took 24 minutes to be completed accordingly. The comparative metabolite patterns were identified by the implementation of headspace-solid phase micro-extraction (HS-SPME) sampling coupled with gas chromatography-mass spectrometry (GCMS). The optimizations of the main experimental variables such as oven temperature and time were evaluated by response surface methodology (RSM) to get the optimal condition. Volatiles were acknowledged through the National Institute of Standards and Technology (NIST) mass spectral database and retention time libraries. To improve the reliability of significance, it is of crucial importance to eliminate background noise which data from 3rd minutes to 17th minutes were selected for statistical analysis. Targeted metabolites, of which were annotated as known compounds with the peak area greater than 0.5 percent were highlighted and subsequently treated statistically. Volatiles produced contain hundreds to thousands of compounds; therefore, it will be optimized by chemometric analysis, such as principal component analysis (PCA) as a preliminary analysis before subjected to a pattern classifier for identification of VOC samples. The volatile organic compound profiling has shown to be significantly distinguished among cancerous and control group based on metabolite profiling.

Keywords: in vitro cancer cell line, metabolite profiling, pattern recognition, volatile organic compounds

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Authors: Majid Gharaipour Abbasabad

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This research is studying the effects that various densities of Zeatin, and BA hormones may have on the scale of transformation of plant nodes to new shoots, among seedlings produced by seed germination, and also surveys the amount of produced shoots and their lengths, inside the specific Olive seed lab medium (OM). It is also concerned with the effects that various densities of IBA hormone, and inoculating the shoots with Agrobacterium Rhizogenez A4 can have on shoots' root production. This is a totally random research, and each attendance group has had three occurrences, and ten samples per a hectare. The average amounts have been compared using Duncan's test method, which was done in 5% level. The results indicated that the highest rate of transformation of micro samples to shoots happened in the seed germination environments, containing Zetain with 5 mg, and also 15 mg per a liter densities. (respectively, 95% and 94%), while the highest rate of plants' stem production ,in micro samples, happened in the lab medium environments with 5mg per a liter Zetain density (4.5). In lab medium environments with 15 mg Zetain per liter, a decrease was observed in the number of produced stems (3.88). According to the produced stems' lenght, the longest stem length was observed in environments with 5 mg and also 15 mg per a liter Zetain, and 25 mg per a liter BA densities (respectively, 8.45 cm, 45.66 cm, 8.53 cm). Meanwhile, the lowest amount of transformation of micro samples to shoots, the lowest number of produced shoots, and the shortest shoots were observed in the environments without any hormones (respectively, 3.32 cm, 1.13, 19.66%). The results of root production in Olive indicated that attendance groups which were exposed to different hormones did not vary, and Agrobacterium Rhizogenez A4 had no effect on them, as well. The lowest root's growth rate (22%) happened in environments without any hormones and also, in environment with Agrobacterium Rhizogenez A4 (19.66%). The largest number of roots was observed in the environments, containing Agrobacterium Rhizogenez A4 plus IBA (10 mg/l) and Agrobacterium Rhizogenez A4 plus IBA (10 mg/l), (respectively, 8.46 and 8.70), which had a significant difference with environments merely containing 10 mg and 20 mg of IBA per a litre (respectively, 3.06 and 3.2). So it can be concluded that even though Agrobacterium Rhizogenez A4 had no impact on root's growth among shoots, it had an impact on the number of produced roots. It should be noted that even when the environment contained merely Agrobacterium Rhizogenez A4 without any hormones, only (1.16) roots were produced, which is significantly different from the attendance group with hormones (1.06).

Keywords: olive-effect of hormones-germination of seed, densities of zeatin, BA hormones, agriculture

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Authors: Anusha De, Bjorn Van Campenhout

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Faced with imperfect information, economic actors use judgment and perceptions in decision-making. Inaccurate perceptions or false beliefs may result in inefficient value chains, and systematic bias in perceptions may affect inclusiveness. In this paper, perceptions in Ugandan maize supply chains are studied. A random sample of maize farmers where they were asked to rate other value chain actors—agro-input dealers, assembly traders and maize millers—on a set of important attributes such as service quality, price competitiveness, ease of access, and overall reputation. These other value chain actors are tracked and asked to assess themselves on the same attributes. It is observed that input dealers, traders and millers assess themselves more favorably than farmers do. Zooming in on heterogeneity in perceptions related to gender, it is evident that women rate higher than men. The sex of the actor being rated does not affect the rating.

Keywords: gender, input dealers, maize supply chain, perceptions, processors

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Authors: Sara S. Fouad, Omneya Messallam

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Egypt has countless prestigious buildings and diversity of cultural heritage which are located in many cities. Most of the researchers, archaeologists, stakeholders and governmental bodies are paying more attention to the big cities such as Cairo and Alexandria, due to the country’s centralization nature. However, there are other historic cities that are grossly neglected and in need of emergency conservation. For instance, Port Said which is a former colonial city that was established in nineteenth century located at the edge of the northeast Egyptian coast between the Mediterranean Sea and the Suez Canal. This city is chosen because it presents one of the important Egyptian archaeological sites that archive Egyptian architecture of the 19^th and 20^th centuries. The historic urban fabric is divided into three main districts; the Arab, the European (Al-Afrang), and Port Fouad. The European district is selected to be the research case study as it has culture diversity, significant buildings, and includes the largest number of the listed heritage buildings in Port Said. Based on questionnaires and interviews, since 2003 several initiative trials have been taken by Alliance Francaise, the National Organization for Urban Harmony (NOUH), some Non-Governmental Organizations (NGOs), and few number of community residents to highlight the important city legacy and protect it from being demolished. Unfortunately, the limitation of their participation in decision-making policies is considered a crucial threat facing sustainable heritage conservation. Therefore, encouraging the local community to participate in their architecture heritage conservation would create a self-confident one, capable of making decisions for the city’s future development. This paper aims to investigate the role of the local inhabitants in protecting their buildings heritage through listing the community level of participations twice (2012 and 2018) in preserving their heritage based on the ladder citizen participation approach. Also, it is to encourage community participation in order to promote city architecture conservation, heritage management, and sustainable development. The methodology followed in this empirical research involves using several data assembly methods such as structural observations, questionnaires, interviews, and mental mapping. The questionnaire was distributed among 92 local inhabitants aged 18-60 years. However, the outset of this research at the beginning demonstrated the majority negative attitude, motivation, and confidence of the local inhabitants’ role to safeguard their architectural heritage. Over time, there was a change in the negative attitudes. Therefore, raising public awareness and encouraging community participation by providing them with a real opportunity to take part in the decision-making. This may lead to a positive relationship between the community residents and the built heritage, which is essential for promoting its preservation and sustainable development.

Keywords: buildings preservation, community participation, heritage conservation, local inhabitant, ladder of citizen participation

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Authors: Priyanka Tiwari, Uma Devi Ranjit, Ritesh Thapa

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Background and Significance: Cerebral Palsy (CP) influences not only the child's everyday functioning but also the functioning of whole family. Application of study findings can be used in clinical or community setting to screen the parents of children with cerebral palsy in order to identify the compromised domain of stress which in turn will help to improve the interaction between parent and child with disability and thus ultimately affect the progress that a child makes in his or her therapeutic or educational programs. Objective: The objective of the study was to assess the level of stress in mothers of children with CP by adopting mixed method design. Methodology: Cross-sectional descriptive design was adopted in the quantitative design where Parental Stress Scale (PSS) was utilized to collect data from a convenient sample of 40 mothers of children with CP who were under regular follow-up by home visitor of Self-help Group for Cerebral Palsy while embedded qualitative design was used to explore the stress of mothers of CP affected children. From the parent population of quantitative sample 4 mothers were chosen for in-depth exploration, regarding their stress by means of case study method. Descriptive statistics like frequency, percentage, mean, median, standard deviation, correlation and inferential statistics like Mann-Whitney U test and Kruskal-Wallis H test were used to describe and assess relationship between variables. Findings: The mean stress experienced by mothers of children with cerebral palsy was 53.62±9.53 with 15% percent of the mothers experiencing severe stress. There was significant association between age group of mother and total stress score and negative themes of stress. Similarly, signification association was found between educational status of the mother and positive themes of stress which was convergent with the qualitative finding as well, where literate mothers had more positive view of their child's disability which could be attributed to their educational level as education provides us with a broad perspective to look at a situation. Conclusions: Still one-sixth of the mothers experienced severe stress so if we want to ensure the well-being of the children affected by cerebral palsy, then parents caring for them need to be looked after as well.

Keywords: stress, cerebral palsy, mothers, mixed method

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Authors: Pegah Eshraghi, Zahra Sadat Zomorodian, Mohammad Tahsildoost

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Over the past decade, energy consumption in educational buildings has steadily increased. The purpose of this research is to provide a method to quickly predict the energy consumption of buildings using separate evaluation of zones and decomposing the building to eliminate the complexity of geometry at the early design stage. To produce this framework, machine learning algorithms such as Support vector regression (SVR) and Artificial neural network (ANN) are used to predict energy consumption and thermal comfort metrics in a school as a case. The database consists of more than 55000 samples in three climates of Iran. Cross-validation evaluation and unseen data have been used for validation. In a specific label, cooling energy, it can be said the accuracy of prediction is at least 84% and 89% in SVR and ANN, respectively. The results show that the SVR performed much better than the ANN.

Keywords: early stage of design, energy, thermal comfort, validation, machine learning

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Authors: Sharon Millen, Sarah Miller, Laura Dunne, Clare McGeady, Laura Neeson

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This paper presents the findings from a randomised controlled trial (RCT) and process evaluation of the Lifestart parenting programme. Lifestart is a structured child-centred programme of information and practical activity for parents of children aged from birth to five years of age. It is delivered to parents in their own homes by trained, paid family visitors and it is offered to parents regardless of their social, economic or other circumstances. The RCT evaluated the effectiveness of the programme and the process evaluation documented programme delivery and included a qualitative exploration of parent and child outcomes. 424 parents and children participated in the RCT: 216 in the intervention group and 208 in the control group across the island of Ireland. Parent outcomes included: parental knowledge of child development, parental efficacy, stress, social support, parenting skills and embeddedness in the community. Child outcomes included cognitive, language and motor development and social-emotional and behavioural development. Both groups were tested at baseline (when children were less than 1 year old), mid-point (aged 3) and at post-test (aged 5). Data were collected during a home visit, which took two hours. The process evaluation consisted of interviews with parents (n=16 at baseline and end-point), and focus groups with Lifestart Coordinators (n=9) and Family Visitors (n=24). Quantitative findings from the RCT indicated that, compared to the control group, parents who received the Lifestart programme reported reduced parenting-related stress, increased knowledge of their child’s development, and improved confidence in their parenting role. These changes were statistically significant and consistent with the hypothesised pathway of change depicted in the logic model. There was no evidence of any change in parents’ embeddedness in the community. Although four of the five child outcomes showed small positive change for children who took part in the programme, these were not statistically significant and there is no evidence that the programme improves child cognitive and non-cognitive skills by immediate post-test. The qualitative process evaluation highlighted important challenges related to conducting trials of this magnitude and design in the general population. Parents reported that a key incentive to take part in study was receiving feedback from the developmental assessment, which formed part of the data collection. This highlights the potential importance of appropriate incentives in relation to recruitment and retention of participants. The interviews with intervention parents indicated that one of the first changes they experienced as a result of the Lifestart programme was increased knowledge and confidence in their parenting ability. The outcomes and pathways perceived by parents and described in the interviews are also consistent with the findings of the RCT and the theory of change underpinning the programme. This hypothesises that improvement in parental outcomes, arising as a consequence of the programme, mediate the change in child outcomes. Parents receiving the Lifestart programme reported great satisfaction with and commitment to the programme, with the role of the Family Visitor being identified as one of the key components of the programme.

Keywords: parent-child relationship, parental self-efficacy, parental stress, school readiness

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Authors: Beom-Ryeol Choi, Won-Poong Lee, Jin-Young Choi, Young-Hak Shin, Dong-Jun Won

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A Microgrid (MG) has a major role in power system. There are numerous benefits, such as ability to reduce environmental impact and enhance the reliability of a power system. Hence, Multi-MG (MMG) consisted of multiple MGs is being studied intensively. This paper proposes the optimal power exchange of MMG with hierarchical coordination. The whole system architecture consists of two layers: 1) upper layer including MG of MG Center (MoMC) which is in charge of the overall management and coordination and 2) lower layer comprised of several Microgrid-Energy Management Systems (MG-EMSs) which make a decision for own schedule. In order to accomplish the optimal power exchange, the proposed coordination algorithm is applied to MMG system. The objective of this process is to achieve optimal operation for improving economics under the grid-connected operation. The simulation results show how the output of each MG can be changed through coordination algorithm.

Keywords: microgrids, multi-microgrids, power exchange, hierarchical coordination

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Authors: Abidullah, Basharat Hussain, Jong Seok Kim

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Polymer electrolyte membrane fuel cell (PEMFC) is an electrochemical cell, which undergoes an oxygen reduction reaction to produce electrical energy. Platinum (Pt) metal has been used as a catalyst since its inception, but expensiveness is the major obstacle in the commercialization of fuel cells. Herein a non-precious group metal (NPGM) is employed instead of Pt to reduce the cost of PEMFCs. Manganese dioxide impregnated carbon nanotubes (MnO₂-CNTs composite) is a catalyst having excellent electrochemical properties and offers a better alternative to the Platinum-based PEMFC. The catalyst is synthesized by impregnating the transition metal on large surface carbonaceous CNTs by hydrothermal synthesis techniques. To enhance the catalytic activity and increase the volumetric current density, the sample was pyrolyzed at 800ᵒC under a nitrogen atmosphere. During pyrolysis, the nitrogen was doped in the framework of CNTs. Then the material was treated with acid for removing the unreacted metals and adding oxygen functional group to the CNT framework. This process ameliorates the catalytic activity of the manganese-based catalyst. The catalyst has been characterized by scanning electron microscope (SEM), X-ray diffraction (XRD), and the catalyst activity has been examined by rotating disc electrode (RDE) experiment. The catalyst was strong enough to withstand an austere alkaline environment in experimental conditions and had a high electrocatalytic activity for oxygen reduction reaction (ORR). Linear Sweep Voltammetry (LSV) depicts an excellent current density of -4.0 mA/cm² and an overpotential of -0.3V vs. standard calomel electrode (SCE) in 0.1M KOH electrolyte. Rotating disk electrode (RDE) was conducted at 400, 800, 1200, and 1600 rpm. The catalyst exhibited a higher methanol tolerance and long term durability with respect to commercial Pt/C. The results for MnO₂-CNT show that the low-cost catalyst will supplant the expensive Pt/C catalyst in the fuel cell.

Keywords: carbon nanotubes, methanol fuel cell, oxygen reduction reaction, MnO₂-CNTs

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Authors: Fergal Fouhy, Alan O’Keeffe, Sean Costelloe, Michael Clarkson

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Background: Sarcoidosis is a systemic, non-infectious disease of unknown aetiology, characterized by non-caseating granulomatous inflammation. The lung is most often affected (90%); however, the condition can affect all organs, including the kidneys. There is limited evidence describing the incidence and characteristics of renal involvement in sarcoidosis. Serum angiotensin-converting enzyme (ACE) is a recognised biomarker used in the diagnosis and monitoring of sarcoidosis. Methods: A single-centre, retrospective cohort study of patients presenting to Cork University Hospital (CUH) in 2015 with first-time elevations of serum ACE was performed. This included an initial database review of ACE and other biochemistry results, followed by a medical chart review to confirm the presence or absence of sarcoidosis and management thereof. Acute kidney injury (AKI) was staged using the AKIN criteria, and chronic kidney disease (CKD) was staged using the KDIGO criteria. Follow-up was assessed over five years tracking serum creatinine, serum calcium, and estimated glomerular filtration rates (eGFR). Results: 119 patients were identified as having a first raised serum ACE in 2015. Seventy-nine male patients and forty female patients were identified. The mean age of patients identified was 47 years old. 11% had CKD at baseline. 18% developed an AKI at least once within the next five years. A further 6% developed CKD during this time period. 13% developed hypercalcemia. The patients within the lowest quartile of serums ACE had an incidence of sarcoidosis of 5%. None of this group developed hypercalcemia, 23% developed AKI, and 7% developed CKD. Of the patients with a serum ACE in the highest quartile, almost all had documented diagnoses of sarcoidosis with an incidence of 96%. 3% of this group developed hypercalcemia, 13% AKI and 3% developed CKD. Conclusions: There was an unexpectedly high incidence of AKI in patients who had a raised serum ACE. Not all patients with a raised serum ACE had a confirmed diagnosis of sarcoidosis. There does not appear to be a relationship between increased serum ACE levels and increased incidence of hypercalcaemia, AKI, and CKD. Ideally, all patients should have biopsy-proven sarcoidosis. This is an initial study that should be replicated with larger numbers and including multiple centres.

Keywords: sarcoidosis, acute kidney injury, chronic kidney disease, hypercalcemia

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Authors: Brajesh

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Introduction: It is generally believed that women's lack power to making decision may restrict their use of modern contraceptives practices. However, few studies have examined the different dimensions of women's empowerment and contraceptive use in Asian content. Pervasive gendered inequities and norms regarding the subordination of women give Asian men disproportionately more power than women, particularly in relation to the sex. We hypothesize that lack of sexual empowerment may pose an important barrier to reproductive health and adoption of family planning methods. Using the Demographic Health Survey, we examine the association between women’s sexual empowerment and contraceptive use in Nepal, Bangladesh and Pakistan. Objectives: To understand the trend and pattern of contraceptive choices and use among women due to sexual empowerment in selected south Asian countries. To examine the association between women’s sexual empowerment and contraceptive practices among non-pregnant married and partnered women in Nepal, Bangladesh and Pakistan. Methods: Data came from the latest round of Demographic and Health Surveys conducted between 2010-12 in and during deacde1990 -92 in Nepal, Bangladesh and Pakistan. Responses from married or cohabiting women aged 15-49 years were analyzed for six dimensions of empowerment and the current use of female-only methods or couple of methods. Bi-variate and multivariate multinomial regressions were used to identify associations between the empowerment dimensions and method use. Results: Positive associations were found between the overall empowerment score and method use in all countries (relative risk ratios, 1.1-1.3). In multivariate analysis, household economic decision-making was associated with the use of either female-only or couple methods (relative risk ratios -1. 1 for all), as was agreement on fertility preferences (RRR-1.3-1.6) and the ability to negotiate sexual activity (RRR -1. 1-1.2). In Bangladesh, women's negative attitudes toward domestic violence were correlated with the use of couple of methods (RRR -1. 1). Increasing levels of sexual empowerment were found to be associated with use of contraceptives, even after adjusting for demographic predictors of contraceptive use. This association is moderated by the wealth. Formal education, increasing wealth, and being in an unmarried partnership are associated with contraceptive use, whereas women who identify as being Muslim are less likely to use contraceptives than those who identify as being Hindus or other. These findings suggest that to achieve universal access to reproductive health services, gendered disparities in sexual empowerment, particularly among economically disadvantaged women, need to be better addressed. Conclusions: Intervention programs aimed at increasing contraceptive use may need to involve different approaches, including promoting couples' discussion of fertility preferences and family planning, improving women's self-efficacy in negotiating sexual activity and increasing their economic independence. Policies are needed to encourage the rural families to give their girls a chance of attending higher level education and professional course so that can get a better job opportunity and can economically support their family as son are expected to do.

Keywords: reproductive and child health (RCH), relative risk ratios (RRR), demographic and health survey (DHS), women’s sexual empowerment (WSE)

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Authors: Drishti Sharma, Mona Duggal

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Background: WhatsApp can serve as a cost-effective, scalable, convenient, and popular medium for public health management related communication in the developing world where the existing system of communication is top-down and slow. The product supports sending and receiving a variety of media: text, photos, videos, documents, and location, as well as voice/video calls. With growing number of users of smartphones and improving access and penetration of internet, the scope of information technology remains immense in resolving the hurdles faced by traditional public health system. Poor infrastructure, gap in digital literacy, faulty documentation, strict organizational hierarchy and slow movement of information across desks and offices- all these, make WhatsApp an efficient prospect to complement the existing system for communication, feedback and leadership for public health system in India. Objective: This study investigates the benefits, challenges and limitations associated with WhatsApp usage as a public health management tool. Methods: The study was conducted within the Chandigarh Union Territory. We used a qualitative approach and conducted individual semi-structured interviews and group interviews (n = 10). Participants included medical officers (n 20), Program managers (n = 4), academicians (n=2) and administrators (n=2). Thematic and content qualitative analyses were conducted. Message log of the WhatsApp group of one of the health program was assessed. Results: Medical Officers said that WhatsApp helped them remain in touch with the program officer. They could easily give feedback and highlight those challenges which needed immediate intervention from the program managers, hence they felt supported. Also, the application helped them share pictures of their activities (meetings and field activities) with the group which they thought inspired others and gave themselves immense satisfaction. Also, it helped build stronger relationships and better coordination among themselves, the same being important in team events. For program managers, it had become a portal for coordinating large scale campaigns. Its reach and the fact that the feedback is real-time make WhatsApp ideal for district level events. Though the easy informal connectivity made them answerable to their staff but it also provided them with flexibility in operations. It turned out to be an important portal for sharing outcome and goals related feedback (both positive and negative) to the team. To be sure, using WhatsApp for the purpose of public health program presents considerable challenges, including technological barriers, organizational challenges, gender issues, confidentiality concerns and unplanned aftereffects. Nevertheless, its advantages in a low-cost setting make it an efficient alternative. Conclusion: WhatsApp has become an integral part of our lives. Use of this app for public health program management within closed groups looks promising and useful. At the same time, addressing the challenges involved would make its usage safer.

Keywords: communication, mobile technology, public health management, WhatsApp

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Authors: Milagros S. Salibad, Levita B. Grana

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The presence and role of Indigenous Peoples residing in key biodiversity, protected, and watershed areas within the ancestral domain in the Caraga Region hold immense significance. This study aimed to determine the level of biodiversity conservation practices among the Mamanwas, Manobos, and Higaonons, and identify facilitating or hindering factors. Employing a mixed-method research design, 421 respondents participated through a researcher-made questionnaire. Focus group discussions, key informant interviews, researcher field notes, community immersions, and secondary sources were done. The three groups have demonstrated a high level of biodiversity conservation practices manifesting their commitment to conserving their natural resources and ecosystems. Evidently, selecting and cutting only mature trees for shelter and tribal usage, and preservation of large trees that harbor ancestors’ spirits and worship through rituals (Mambabaja). Each group exhibited unique environmental practices shaped by their distinct cultures, traditions, customary knowledge, and access to information. The Mamanwa practiced traditional hunting and gathering by using traps while Manobo practiced shifting cultivation to maintain soil fertility and biodiversity, and Higaonon managed forest resources through traditional forest management (establishment of sacred forests and conservation areas). Various facilitating and hindering factors influenced their conservation efforts. Their traditional knowledge and practices, partnership and collaboration, legal recognition and support, access to information, and biodiversity monitoring system facilitate practices. Insufficient government assistance, political and social issues, scarce financial support, inadequate policy enforcement, lack of livelihood opportunities, and land use conflicts hinder them. Monitoring the sustainability of IPs' local biodiversity conservation practices is essential as they contribute to conservation endeavors.

Keywords: biodiversity, conservation, indigenous peoples, traditional knowledge

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Authors: Mustafa Metin Donma, Orkide Donma

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Childhood obesity is an important clinical problem because it may lead to chronic diseases during the adulthood period of the individual. Obesity is a metabolic disease associated with low-grade inflammation. The liver occurs at the center of metabolic pathways. Adropin, fibroblast growth factor-21 (FGF-21), and fetuin-A are hepatokines. Due to the immense participation of the liver in glucose metabolism, these liver-derived factors may be associated with insulin resistance (IR), which is a phenomenon discussed within the scope of obesity problems. The aim of this study is to determine the concentrations of adropin, FGF-21, and fetuin-A in childhood obesity, to point out possible differences between the obesity groups, and to investigate possible associations among these three hepatokines in obese and morbidly obese children. A total of one hundred and thirty-two children were included in the study. Two obese groups were constituted. The groups were matched in terms of mean ± SD values of ages. Body mass index values of obese and morbidly obese groups were 25.0 ± 3.5 kg/m² and 29.8 ± 5.7 kg/m², respectively. Anthropometric measurements including waist circumference, hip circumference, head circumference, and neck circumference were recorded. Informed consent forms were taken from the parents of the participants. The ethics committee of the institution approved the study protocol. Blood samples were obtained after overnight fasting. Routine biochemical tests, including glucose- and lipid-related parameters, were performed. Concentrations of the hepatokines (adropin, FGF-21, fetuin A) were determined by enzyme-linked immunosorbent assay. Insulin resistance indices such as homeostasis model assessment for IR (HOMA-IR), alanine transaminase-to aspartate transaminase ratio (ALT/AST), diagnostic obesity notation model assessment laboratory index, diagnostic obesity notation model assessment metabolic syndrome index as well as obesity indices such as diagnostic obesity notation model assessment-II index, and fat mass index were calculated using the previously derived formulas. Statistical evaluation of the study data as well as findings of the study was performed by SPSS for Windows. Statistical difference was accepted significant when p is smaller than 0.05. Statistically significant differences were found for insulin, triglyceride, high-density lipoprotein cholesterol levels of the groups. A significant increase was observed for FGF-21 concentrations in the morbidly obese group. Higher adropin and fetuin-A concentrations were observed in the same group in comparison with the values detected in the obese group (p > 0.05). There was no statistically significant difference between the ALT/AST values of the groups. In all of the remaining IR and obesity indices, significantly increased values were calculated for morbidly obese children. Significant correlations were detected between HOMA-IR and each of the hepatokines. The highest one was the association with fetuin-A (r=0.373, p=0.001). In conclusion, increased levels observed in adropin, FGF-21, and fetuin-A have shown that these hepatokines possess increasing potential going from obese to morbid obese state. Out of the correlations found with the IR index, the most affected hepatokine was fetuin-A, the parameter possibly used as the indicator of the advanced obesity stage.

Keywords: adropin, fetuin A, fibroblast growth factor-21, insulin resistance, pediatric obesity

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