Search results for: outpatient housing options for children and teenagers with disabilities

Authors: Noreen Pulte

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Prior to the 'Back to Sleep' Campaign in 1992, 1 of every 300 infants seen by Advanced Practice Providers had plagiocephaly. Insufficient attention is given to plagiocephaly and brachycephaly diagnoses in practice and pediatric education. In this talk, Nurse Practitioners and Pediatric Providers will be able to: (1) identify red flags associated with head shape abnormalities, (2) learn techniques they can teach parents to prevent head shape abnormalities, and (3) differentiate between plagiocephaly, brachycephaly, and craniosynostosis. The presenter is a Primary Care Pediatric Nurse Practitioner at Ann & Robert H. Lurie Children's Hospital of Chicago and the primary provider for its head shape abnormality clinics. She will help participants translate key information obtained from birth history, review of systems, and developmental history to understand risk factors for head shape abnormalities and progression of deformities. Synostotic and non-synostotic head shapes will be explained to help participants differentiate plagiocephaly and brachycephaly from synostotic head shapes. This knowledge is critical for the prompt referral of infants with craniosynostosis for surgical evaluation and correction. Rapid referral for craniosynostosis can possibly direct the patient to a minimally invasive surgical procedure versus a craniectomy. As for plagiocephaly and brachycephaly, this timely referral can also aid in a physical therapy referral if necessitated, which treats torticollis and aids in improving head shape. A well-timed referral to a head shape clinic can possibly eliminate the need for a helmet and/or minimize the time in a helmet. Practitioners will learn the importance of obtaining head measurements using calipers. The presenter will explain head calculations and how the calculations are interpreted to determine the severity of the head shape abnormalities. Severity defines the treatment plan. Participants will learn when to refer patients to a head shape abnormality clinic and techniques they should teach parents to perform while waiting for the referral appointment. The purpose, mechanics, and logistics of helmet therapy, including optimal time to initiate helmet therapy, recommended helmet wear-time, and tips for helmet therapy compliance, will be described. Case scenarios will be incorporated into the presenter's presentation to support learning. The salient points of the case studies will be explained and discussed. Practitioners will be able to immediately translate the knowledge and skills gained in this presentation into their clinical practice.

Keywords: plagiocephaly, brachycephaly, craniosynostosis, red flags

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Authors: Danielle G. Saique

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Introduction: Promoting Gender Equality, Equity and Empowerment of Women (GEE&EW) can be attained by practicing thereby exercising Sexual and Reproductive Health and Rights (SRHR). Gender Inequality is manifested thru Violence Against Women (VAW). Objectives: This study presents causes, prevalence, effects of Gender Inequality for not practicing and violating SRHR. This proposes Action Plan by promoting, integrating SRHR in the “holistic approach” of Social Work education, practice and service-delivery in any work-set-ups. Limitations: VAW cases showed victim and violator are known, related and living together. Cases transpired at home, reported, investigated in the police and filed in the legal court of law for the year 2013. Methods: Data from blotters, reports, filed cases, case studies gathered by the Social Worker (SWr). Qualitative analysis identified cause, prevalence of VAW related in violating SRHR. SWr serves innovative interventions in any work settings by applying SRHR background, skills in educating, counseling client-victims. Results: 65 VAW cases on non-negotiation or refusal of practicing SRHR. Non-acceptance of Family Planning yielded unwanted, unplanned pregnancies, abandoned children, battered women. Neglected pre-post natal maternal care caused complications or death. Rape, incest led trauma or death. Unsafe, unprotected sex transmitted STDs. Conclusions: Non-availing SRHR from health facilities, from Medical Health SWr concluded to non-practicing or violating rights to life, health care, protection, rights to information, education, rights to plan family, rights from torture, ill-treatment. VAW brings undesirable effects to the well-being, wellness and humaneness of the victim. Recommendations: The innovative intervention services on SRHR of a SWr and the findings, results in violating SRHR are recommendations in Action Planning by adding “The SRHR Concepts” in Social Work thereby preventing VAW; empowering women’s rights to development, gender equality, equity liberty, security, freedom; resilience and involvement in promoting, practicing, exercising SRHR at home. Recommended therefore to duplicate this innovative practice and experience on SRHR as implemented by the SWr in any work setting.

Keywords: women development, promoting gender equality, equity, empowerment of women

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Authors: Comsun Thongchai, Vorapoj Promasatayaprot

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Background: Child development center is a day care center that gathers large numbers of children in the same areas. As a result, it provides high opportunity for infection, especially gastrointestinal and respiratory infections. Ubon Ratchathani has been a province with an increasing number of cases of Hand foot and mouth disease each year reported between 2014 and 2016. Accorded to a recent investigation reported, HFMD occurred in the Child Development Center and kindergartens, this was a place where HFMD spreads. This research was aimed to investigate the knowledge, attitude and behavior about hand foot and mouth disease preventing of child caregivers in child development centers, Ubon Ratchathani Province. Method: Descriptive study was conducted between April and July, 2017. The study instruments used questionnaires and in-depth interviews on their practices of prevention and environment management of HFMD. The samples of survey questionnaires were caregivers who are working in 160 child development centers of the 160 parishes in Ubon Ratchathani province. The data was analyzed by percentages, means and standard deviations and Pearson Product Moment Correlation Coefficient. Result: The results showed that the majority were female (96.3%), average age 41 years (68.3%), marital status were couples (85.7%) and studied in undergraduate (75.2%). with a period of performance as teachers in child development centers range from 10 to 14 years were percentage 58.7 and 71.8 percent of them had been trained by health worker about the control HFMD. The knowledge for preventive in hand foot mouth disease on child caregivers was at high level. The mean score was 2.76 (S.D. = 0.114). The attitude of child caregivers was at a moderate level. Its mean score was 2.28 (S.D. = 0.247). On the other hand, the level of environmental management to prevent HFMD was low. The mean score was 1.34 (S.D. = 0.215). The factor of personal characteristics as gender, age, educational level, duration at work, knowledge and attitude of preventive HFMD was associated with Preventive of Behaviors to a statistically significant level (p<0.05 respectively). Conclusion: These results should be concerned to develop knowledge and improving practice for preventive hand foot mouth disease of child caregivers in child development centers by training. Preparation of media education, Surveillance of hand foot mouth disease and health behaviors promotion with community participation need to be supported continuously.

Keywords: preventive behavior, child development center, hand foot mouth disease, Thailand

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Authors: V. L. M. F. Capellini, A. P. P. M. Maturana, N. C. M. Brondino, M. B. C. L. B. M. Peixoto, A. J. Broughton

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A paradigm shift is a process. The process of implementing inclusive education, a system constructed to support all learners, requires planning, identification, experimentation, and evaluation. In this vein, the purpose of the present study was to evaluate the capacity of one Brazilian state school systems to provide special education students with a quality inclusive education. This study originated at the behest of concerned families of students with special needs who filed complaints with the Municipality of Bauru, São Paulo. These families claimed, 1) children with learning differences and educational needs had not been identified for services, and 2) those who had been identified had not received sufficient specialized educational assistance (SEA) in schools across the City of Bauru. Hence, the Office of Civil Rights for the state of São Paulo (Ministério Público de São Paulo) summoned the local higher education institution, UNESP, to design a research study to investigate these allegations. In this exploratory study, descriptive data were gathered from all elementary and middle schools including 58 state schools and 17 city schools, for a total of 75 schools overall. Data collection consisted of each school's annual strategic action plan, surveys and interviews with all school stakeholders to determine their perceptions of the inclusive education available to students with Special Education Needs (SEN). The data were collected as one of four stages in a larger study which also included field observations of a focal students' experience and a continuing education course for all teachers and administrators in both state and city schools. For the purposes of this study, the researchers were interested in understanding the perceptions of school staff, parents, and students across all schools. Therefore, documents and surveys from 75 schools were analyzed for adherence to federal legislation guaranteeing students with SEN the right to special education assistance within the regular school setting. Results shows that while some schools recognized the legal rights of SEN students to receive special education, the plans to actually deliver services were absent. In conclusion, the results of this study revealed both school staff and families have insufficient planning and accessibility resources, and the schools have inadequate infrastructure for full-time support to SEN students, i.e., structures and systems to support the identification of SEN and delivery of services within schools of Bauru, SP. Having identified the areas of need, the city is now prepared to take next steps in the process toward preparing all schools to be inclusive.

Keywords: inclusion, school, special education, special needs

Procedia PDF Downloads 136

Authors: Sitira Williams, Georgina Cherry, Andrea Wright, Kevin Wells, Taran Rai, Richard Brown, Travis Street, Alasdair Cook

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Social media sources (50) were identified, keywords defined by veterinarians and organised into 6 topics known to be indicative of feline pruritus: body areas, behaviors, symptoms, diagnosis, and treatments. These were augmented using academic literature, a cat owner survey, synonyms, and Google Trends. The content was collected using a social intelligence solution, with keywords tagged and filtered. Data were aggregated and de-duplicated. SL content matching body areas, behaviors and symptoms were reviewed manually, and posts were marked relevant if: posted by a pet owner, identifying an itchy cat and not duplicated. A sub-set of 493 posts published from 2009-2022 was used for reflexive thematic analysis in NVIVO (Burlington, MA) to identify themes. Five themes were identified: allergy, pruritus, additional behaviors, unusual or undesirable behaviors, diagnosis, and treatment. Most (258) posts reported the cat was excessively licking, itching, and scratching. The majority were indoor cats and were less playful and friendly when itchy. Half of these posts did not indicate a known cause of pruritus. Bald spots and scabs (123) were reported, often causing swelling and fur loss, and 56 reported bumps, lumps, and dry patches. Other impacts on the cat’s quality of life were ear mites, cat self-trauma and stress. Seven posts reported their cats’ symptoms caused them ongoing anxiety and depression. Cats with food allergies to poultry (often chicken and beef) causing bald spots featured in 23 posts. Veterinarians advised switching to a raw food diet and/or changing their bowls. Some cats got worse after switching, leaving owners’ needs unmet. Allergic reactions to flea bites causing excessive itching, red spots, scabs, and fur loss were reported in 13 posts. Some (3) posts indicated allergic reactions to medication. Cats with seasonal and skin allergies, causing sneezing, scratching, headshaking, watery eyes, and nasal discharge, were reported 17 times. Eighty-five posts identified additional behaviors. Of these, 13 reported their cat’s burst pimple or insect bite. Common behaviors were headshaking, rubbing, pawing at their ears, and aggressively chewing. In some cases, bites or pimples triggered previously unseen itchiness, making the cat irritable. Twenty-four reported their cat had anxiety: overgrooming, itching, losing fur, hiding, freaking out, breathing quickly, sleeplessness, hissing and vocalising. Most reported these cats as having itchy skin, fleas, and bumps. Cats were commonly diagnosed with an ear infection, ringworm, acne, or kidney disease. Acne was diagnosed in cats with an allergy flare-up or overgrooming. Ear infections were diagnosed in itchy cats with mites or other parasites. Of the treatments mentioned, steroids were most frequently used, then anti-parasitics, including flea treatments and oral medication (steroids, antibiotics). Forty-six posts reported distress following poor outcomes after medication or additional vet consultations. SL provides veterinarians with unique insights. Verbatim comments highlight the detrimental effects of pruritus on pets and owner quality of life. This study demonstrates the need for veterinarians to communicate management and treatment options more effectively to relieve owner frustrations. Data analysis could be scaled up using machine learning for topic modeling.

Keywords: content analysis, feline, itch, pruritus, social media, thematic analysis, veterinary dermatology

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Authors: Muzaffer Topgul, Hasan Atac

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In case of explaining the migration concept, although it is not a new phenomenon, it is easy to understand that communities have migrated for variety of reasons such as natural disasters, famine, wars, economic problems, and several theories have been put forth to define and find solution for migration within its changing nature. Examining of migration theories denotes that the circumstances under which they appear reflect political, social, and economic conditions of the age they appear. In this day and time, security is considered not only from military perspective but also from economic, political, sociological dimensions. Based on the changing security environment new impacts of migration has occurred; the migration is proceed to be conferred as a type of war, qualified as a transnational crime because of its outcomes and interpreted in a different dimension owing to its effects on the health and education areas. Social security dimension in the context of expanding concept of security; when dealing with the safety of people and social groups with the assumption that national unity and identity are threatened, it sees immigrants as a source of threat. The human security assesses the safety of individuals in terms of survival and quality of life. Changes in the standard of living under the influence of immigrants and possible terrorist acts can be seen as a threat source in this type of security. Economic security of the individuals and the regional changes at the micro level created by the immigrants are covered issues of economic security. Due to the factors such as terrorism and civil war, the increasing numbers of displaced people who have taken refugee status affect the countries, whether it is near or far to the crisis areas, in the new and different dimensions of security day by day. In this study, the term of immigration through the eyes of national and international law will be evaluated, the place of the irregular and illegal immigration in the changing security sphere will be revealed and the effects of the irregular migration to short-term, mid-term and long-term security issues will be assessed through human and social security aspects. In order to analyze the threats for the human security; the parameters such as living conditions of the immigrants, the ratio of the genders, birth rate occasions, the education circumstances of the immigrant children and the effects of the illegal passing on the public order will be evaluated. The outcomes of the problem areas for the human security and the demographic alteration resulting from the human flow of displaced people will be discussed thorough social security extent. The fizzling economic diversity, which has shown up by irregular migration, will be presented within the scope of economic dimension of security.

Keywords: irregular migration, the changing dimensions of security, human security, social security

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Authors: Moshiur Rahman, Tahmida Jakia

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Bangladesh, a densely populated South Asian country is home to more than 160 million people. In two decades ago, the people of this developing nation drank heavily contaminated surface water. Over the past thirty years, the country, and its development partners, has undertaken extensive efforts to provide microbiologically safe groundwater based drinking water through the use of tube-wells. About 85% of the people now drink tube-well water from about 11 million tube-wells/hand pumps. However, diarrhoeal and other water-related diseases are still reported among the major causes of morbidity and mortality among Bangladeshi children. This implies that the mode of transmission of pathogens through water and/or other modes continue. In addition, massive scale arsenic contamination has been recently reported in the ground water. Thirty five million people may be at risk of consuming arsenic contaminated water exceeding 0.05 mg/l in Bangladesh. Drinking of arsenic contaminated water has been linked with skin problems, cancer, cardiovascular diseases, neurological diseases, eye problems, cancer of the internal organs, and other diseases. In the study area, Narail district, recent investigations about existing water quality situations indicated presence of low to high levels of arsenic, salinity, iron, manganese and bacteriological contamination risks. As challenges for safe water exist; it is likely that sanitation and food hygiene practices are poor which lead threat to ensure food security.The main attempt of this study is to find out the challenges to ensure food security andprovide probable solutions to ensure food safety towards 0.7 million of people in study area. A survey has been conducted at Lohagara and Kalia sub district of Narail district with a pretested questionnaire. Primary data are collected through a questionnaire, while secondary data are collected from pertinent offices as well as academic journals. FGD has also been done to know the knowledge regarding water, sanitation as well as food preparation and consumption practice of community people in study area. The major focus of this study is to assess the state of sanitation and food hygiene condition of rural people. It is found that most of the villagers have lack of knowledge about food safety. Open defecation rate is high which lead threat to ensure food security.

Keywords: food safety, challenges, hygiene, Bangladesh

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Authors: Mahya Saffarinia

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The family has existed as a natural unit of human relations from the beginning of creation and life of human society until now and has been the core of the relationship between women, men, and children. However, in the field of human relations, the definition of family, related rights and duties, principles governing the family, the impact of the family on other individual or social phenomena and various other areas have changed over time, especially in recent decades, and the subject has now become one of the important categories of studies including interdisciplinary studies. It is difficult to provide an accurate and comprehensive definition of the family, and in the context of different cultures, customs, and legal systems, different definitions of family are presented. The meaning of legal principles governing the family is the general rules of law that determine the organization of different dimensions of the family, and dozens of partial rules are inferred from it or defined in the light of these general rules. How each of these principles was formed has left its own detailed history. In international human rights standards, which have been gradually developed over the past 72 years, numerous data can be found that in some way represent a rule in the field of family law or provide an interpretation of existing international rules which also address obligations of governments in the field of family. Based on a descriptive-analytical method and by examining human rights instruments, the present study seeks to explain the effective elements in defining and the principles governing the family. This article makes it clear that international instruments do not provide a clear definition of the family and that governments are empowered to define the family in terms of the cultural context of their community. But at the same time, it has been stipulated that governments do not have the exclusive authority to provide this definition, and certain principles should be considered as essential elements. Also, 7 principles have been identified as general legal rules governing all international human rights instruments related to the family, such as the principle of voluntary family formation and the prohibition of forced marriage, and the principle of respecting human dignity for all family members. Each of these 7 principles has led to different debates, and the acceptance or non-acceptance of each of them has different consequences in the rights and duties related to the family and the relations between its members and even the family's interactions with others and society. One of the consequences of the validity of these principles in family-related human rights standards is that many of the existing legal systems of countries in some cases need to be amended and their regulations revised, and some established cultural traditions in societies that are considered inhumane in terms of these principles need to be modified and changed. Of course, this process of governing the principles derived from human rights standards over the family also has vulnerabilities and misinterpretations that should not be neglected.

Keywords: family, human rights, international instruments, principles

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Authors: Teesta Dey

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Integrated Transport development with proper traffic management leads to sustainable growth of any urban sphere. Appropriate mass transport planning is essential for the populous cities in third world countries like India. The exponential growth of motor vehicles with unplanned road network is now the common feature of major urban centres in India. Kolkata, the third largest mega city in India, is not an exception of it. The imbalance between demand and supply of unplanned transport services in this city is manifested in the high economic and environmental costs borne by the associated society. With the passage of time, the growth and extent of passenger demand for rapid urban transport has outstripped proper infrastructural planning and causes severe transport problems in the overall urban realm. Hence Kolkata stands out in the world as one of the most crisis-ridden metropolises. The urban transport crisis of this city involves severe traffic congestion, the disparity in mass transport services on changing peripheral land uses, route overlapping, lowering of travel speed and faulty implementation of governmental plans as mostly induced by rapid growth of private vehicles on limited road space with huge carbon footprint. Therefore the paper will critically analyze the extant road network pattern for improving regional connectivity and accessibility, assess the degree of congestion, identify the deviation from demand and supply balance and finally evaluate the emerging alternate transport options as promoted by the government. For this purpose, linear, nodal and spatial transport network have been assessed based on certain selected indices viz. Road Degree, Traffic Volume, Shimbel Index, Direct Bus Connectivity, Average Travel and Waiting Tine Indices, Route Variety, Service Frequency, Bus Intensity, Concentration Analysis, Delay Rate, Quality of Traffic Transmission, Lane Length Duration Index and Modal Mix. Total 20 Traffic Intersection Points (TIPs) have been selected for the measurement of nodal accessibility. Critical Congestion Zones (CCZs) are delineated based on one km buffer zones of each TIP for congestion pattern analysis. A total of 480 bus routes are assessed for identifying the deficiency in network planning. Apart from bus services, the combined effects of other mass and para transit modes, containing metro rail, auto, cab and ferry services, are also analyzed. Based on systematic random sampling method, a total of 1500 daily urban passengers’ perceptions were studied for checking the ground realities. The outcome of this research identifies the spatial disparity among the 15 boroughs of the city with severe route overlapping and congestion problem. North and Central Kolkata-based mass transport services exceed the transport strength of south and peripheral Kolkata. Faulty infrastructural condition, service inadequacy, economic loss and workers’ inefficiency are the most dominant reasons behind the defective mass transport network plan. Hence there is an urgent need to revive the extant road based mass transport system of this city by implementing a holistic management approach by upgrading traffic infrastructure, designing new roads, better cooperation among different mass transport agencies, better coordination of transport and changing land use policies, large increase in funding and finally general passengers’ awareness.

Keywords: carbon footprint, critical congestion zones, direct bus connectivity, integrated transport development

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Authors: Marietta Kékes Szabó

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The patterns of personality (mal)function and the individuals’ psychosocial environment influence the healthy status collectively and may lie in the background of psychosomatic disorders. Although the patients with their diversified symptoms usually do not have any organic problems, the experienced complaint, the fear of serious illness and the lack of social support often lead to increased anxiety and further enigmatic symptoms. The role of the family system and its atmosphere seem to be very important in this process. More studies explored the characteristics of dysfunctional family organization: inflexible family structure, hidden conflicts that are not spoken about by the family members during their daily interactions, undefined role boundaries, neglect or overprotection of the children by the parents and coalition between generations. However, questionnaires that are used to measure the properties of the family system are able to explore only its unit and cannot pay attention to the dyadic interactions, while the representation of the family structure by a figure placing test gives us a new perspective to better understand the organization of the (sub)system(s). Furthermore, its dynamic form opens new perspectives to explore the family members’ joint representations, which gives us the opportunity to know more about the flexibility of cohesion and hierarchy of the given family system. In this way, the communication among the family members can be also examined. The aim of my study was to collect a great number of information about the organization of psychosomatic families. In our research we used Gehring’s Family System Test (FAST) both in static and dynamic forms to mobilize the family members’ mental representations about their family and to get data in connection with their individual representations as well as cooperation. There were four families in our study, all of them with a young adult person. Two families with healthy participants and two families with asthmatic patient(s) were involved in our research. The family members’ behavior that could be observed during the dynamic situation was recorded on video for further data analysis with Noldus Observer XT 8.0 program software. In accordance with the previous studies, our results show that the family structure of the families with at least one psychosomatic patient is more rigid than it was found in the control group and the certain (typical, ideal, and conflict) dynamic representations reflected mainly the most dominant family member’s individual concept. The behavior analysis also confirmed the intensified role of the dominant person(s) in the family life, thereby influencing the family decisions, the place of the other family members, as well as the atmosphere of the interactions, which could also be grasped well by the applied methods. However, further research is needed to learn more about the phenomenon that can open the door for new therapeutic approaches.

Keywords: psychosomatic families, family structure, family system test (FAST), static and dynamic representations, behavior analysis

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Authors: Eish Sharma

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Literature around Mathematics education suggests that democratic attitudes can be strengthened through teaching and learning Mathematics. Furthermore, connections between critical education and Mathematics education are observed in the light of critical pedagogy to locate Critical Mathematics Education (CME) as the theoretical framework. Critical pedagogy applied to Mathematics education is identified as one of the key themes subsumed under Critical Mathematics Education. Through the application of critical pedagogy in mathematics, unequal power relations and social injustice can be identified, analyzed, and challenged. The research question is: have educational policies in India viewed the role of critical pedagogy applied to mathematics education (i.e., critical mathematics education) to ensure social justice as an educational aim? The National Curriculum Framework (NCF), 2005 upholds education for democracy and the role of mathematics education in facilitating the same. More than this, NCF 2005 rests on Critical Pedagogy Framework and it recommends that critical pedagogy must be practiced in all dimensions of school education. NCF 2005 visualizes critical pedagogy for social sciences as well as sciences, stating that the science curriculum, including mathematics, must be used as an “instrument for achieving social change to reduce the divide based on economic class, gender, caste, religion, and the region”. Furthermore, the implementation of NCF 2005 led to a reform in the syllabus and textbooks in school mathematics at the national level, and critical pedagogy was applied to mathematics textbooks at the primary level. This intervention led to ethnomathematics and critical mathematics education in the school curriculum in India for the first time at the national level. In October 2022, the Ministry of Education launched the National Curriculum Framework for Foundational Stage (NCF-FS), developed in light of the National Education Policy, 2020, for children in the three to eight years age group. I want to find out whether critical pedagogy-based education and critical pedagogy-based mathematics education are carried forward in NCF 2022. To find this, an argument analysis of specific sections of the National Curriculum Framework 2022 document needs to be executed. Des Gasper suggests two tables: The first table contains four columns, namely, text component, comments on meanings, possible reformulation of the same text, and identified conclusions and assumptions (both stated and unstated). This table is for understanding the components and meanings of the text and is based on Scriven’s model for understanding the components and meanings of words in the text. The second table contains four columns i.e., claim identified, given data, warrant, and stated qualifier/rebuttal. This table is for describing the structure of the argument, how and how well the components fit together and is called ‘George Table diagram based on Toulmin-Bunn Model’.

Keywords: critical mathematics education, critical pedagogy, social justice, etnomathematics

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Authors: R. Prinsloo

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Amniotic fluid stem cells (AFSC) have been shown to contribute towards the amelioration of Acute Renal Failure (ARF), but the mechanisms underlying the renoprotective effect are largely unknown. Therefore, the main goal of the current study was to evaluate the therapeutic efficacy of AFSC in a cisplatin-induced rat model of ARF and to investigate the underlying mechanisms responsible for its renoprotective effect. To study the therapeutic efficacy of AFSC, ARF was induced in Wistar rats by an intra-peritoneal injection of cisplatin, and five days after administration, the rats were randomized into two groups and injected with either AFSC or normal saline intravenously. On day 8 and 12 after cisplatin injection, i.e., day 3 and day7 post-therapy respectively, the blood biochemical parameters, histopathological changes, apoptosis, and expression of pro-apoptotic, anti-apoptotic and autophagy-related proteins in renal tissues were studied in both groups of rats. Administration of AFSC in ARF rats resulted in improvement of renal function and attenuation of renal damage as reflected by significant decrease in blood urea nitrogen, serum creatinine levels, tubular cell apoptosis as assessed by Bax/Bcl2 ratio, and expression of the pro-apoptotic proteins viz. PUMA, Bax, cleaved caspase-3 and cleaved caspase-9 as compared to saline-treated group. Furthermore, in the AFSC-treated group as compared to saline-treated group, there was a significant increase in the activation of autophagy as evident by increased expression of LC3-II, ATG5, ATG7, Beclin1 and phospho-AMPK levels with a concomitant decrease in phospho-p70S6K and p62 expression levels. To further confirm whether the protective effects of AFSC on cisplatin-induced apoptosis were dependent on autophagy, chloroquine, an autophagy inhibitor was administered by the intra-peritoneal route. Chloroquine administration led to significant reduction in the anti-apoptotic effects of the AFSC therapy and further deterioration in the renal structure and function caused by cisplatin. Collectively, our results put forth that AFSC ameliorates cisplatin-induced ARF through induction of autophagy and inhibition of apoptosis. Furthermore, the protective effects of AFSC were blunted by chloroquine, highlighting that activation of autophagy is an important mechanism of action for the protective role of AFSC in cisplatin-induced renal injury.

Keywords: best interest of the child, children's rights, parent and child relationship, parental responsibilities and rights

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Authors: Sarah A. Alotaibi, Mohammed A. Almutairi, Abdullah A. Alsayari, Adibah M. Almutairi, Somaiah K. Almubayedh

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Concerns over the presence of acrylamide in food date back to 2002, when Swedish scientists stated that, in carbohydrate-rich foods, amounts of acrylamide were formed when cooked at high temperatures. Similar findings were reported by other researchers which, consequently, caused major international efforts to investigate dietary exposure and the subsequent health complications in order to properly manage this issue. Due to this issue, in this work, we aim to determine the acrylamide level in different foods (coffee, potato chips, biscuits, and baby food) commonly consumed by the Saudi population. In a total of forty-three samples, acrylamide was detected in twenty-three samples at levels of 12.3 to 2850 µg/kg. In reference to the food groups, the highest concentration of acrylamide was found in coffee samples (<12.3-2850 μg/kg), followed by potato chips (655-1310 μg/kg), then biscuits (23.5-449 μg/kg), whereas the lowest acrylamide level was observed in baby food (<14.75 – 126 μg/kg). Most coffee, biscuits and potato chips products contain high amount of acrylamide content and also the most commonly consumed product. Saudi adults had a mean exposure of acrylamide for coffee, potato, biscuit, and cereal (0.07439, 0.04794, 0.01125, 0.003371 µg/kg-b.w/day), respectively. On the other hand, exposure to acrylamide in Saudi infants and children to the same types of food was (0.1701, 0.1096, 0.02572, 0.00771 µg/kg-b.w/day), respectively. Most groups have a percentile that exceeds the tolerable daily intake (TDI) cancer value (2.6 µg/kg-b.w/day). Overall, the MOE results show that the Saudi population is at high risk of acrylamide-related disease in all food types, and there is a chance of cancer risk in all age groups (all values ˂10,000). Furthermore, it was found that in non-cancer risks, the acrylamide in all tested foods was within the safe limit (˃125), except for potato chips, in which there is a risk for diseases in the population. With potato and coffee as raw materials, additional studies were conducted to assess different factors, including temperature, cocking time, and additives affecting the acrylamide formation in fried potato and roasted coffee, by systematically varying processing temperatures and time values, a mitigation of acrylamide content was achieved when lowering the temperature and decreasing the cooking time. Furthermore, it was shown that the combination of the addition of chitosan and NaCl had a large impact on the formation.

Keywords: risk assessment, dietary exposure, MOA, acrylamide, hazard

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Authors: Aisha Giwa, Mohammed-Faosy Adeniran, Olufunke Femi-Ojo

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Four decades ago, the World Health Organization (WHO) launched the Expanded Programme on Immunization (EPI). The EPI blueprint laid out the technical and managerial functions necessary to routinely vaccinate children with a limited number of vaccines, providing protection against diphtheria, tetanus, whooping cough, measles, polio, and tuberculosis, and to prevent maternal and neonatal tetanus by vaccinating women of childbearing age with tetanus toxoid. Despite global efforts, the Routine Immunization (RI) coverage in two of the World Health Organization (WHO) regions; the African Region and the South-East Asia Region, still remains short of its targets. As a result, the WHO Regional Director for Africa declared 2012 as the year for intensifying RI in these regions and this also coincided with the declaration of polio as a programmatic emergency by the WHO Executive Board. In order to intensify routine immunization, the National Routine Immunization Strategic Plan (2013-2015) stated that its core priority is to ensure 100% adequacy and availability of vaccines for safe immunization. To achieve 100% availability, the “PUSH System” and then “Push-Plus” were adopted for vaccine distribution, which replaced the inefficient “PULL” method. The NPHCDA plays the key role in coordinating activities in area advocacy, capacity building, engagement of 3PL for the state as well as monitoring and evaluation of the vaccine delivery process. eHealth Africa (eHA) is a player as a 3PL service provider engaged by State Primary Health Care Boards (SPHCDB) to ensure vaccine availability through Vaccine Direct Delivery (VDD) project which is essential to successful routine immunization services. The VDD project ensures the availability and adequate supply of high-quality vaccines and immunization-related materials to last-mile facilities. eHA’s commitment to the VDD project saw the need for an assessment of the project vis-a-vis the overall project performance, evaluation of a process for necessary improvement suggestions as well as general impact across Kano State (Where eHA had transitioned to the state), Bauchi State (currently manage delivery to all LGAs except 3 LGAs currently being managed by the state), Sokoto State (eHA currently covers all LGAs) and Zamfara State (Currently, in-sourced and managed solely by the state).

Keywords: cold chain logistics, health supply chain system strengthening, logistics management information system, vaccine delivery traceability and accountability

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Authors: Arto Grasten

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Given the rising trend in obesity in children and youth, age-related decline in moderate- to- vigorous-intensity physical activity (MVPA) in several Western, African, and Asian countries in addition to limited evidence of behavioral, affective, cognitive outcomes in physical education, it is important to clarify the motivational processes in physical education classes behind total MVPA engagement. The present study examined the full sequence of the Hierarchical Model of Motivation in physical education including motivational climate, basic psychological needs, intrinsic motivation, contextual behavior, affect, cognition, total MVPA, and associated links to body mass index (BMI) and gender differences. A cross-sectional data comprised self-reports and objective assessments of 770 middle school students (Mage = 13.99 ± .81 years, 52% of girls) in North-East Finland. In order to test the associations between motivational climate, psychological needs, intrinsic motivation, cognition, behavior, affect, and total MVPA, a path model was implemented. Indirect effects between motivational climate and cognition, behavior, affect and total MVPA were tested by setting basic needs and intrinsic motivation as mediators into the model. The findings showed that direct and indirect paths for girls and boys associated with different contextual outcomes and girls’ indirect paths were not related with total MVPA. Precisely, task-involving climate-mediated by physical competence and intrinsic motivation related to enjoyment, importance, and graded assessments within girls, whereas task-involving climate associated with enjoyment and importance via competence and autonomy, and total MVPA via autonomy, intrinsic motivation, and importance within boys. Physical education assessments appeared to be essential in motivating students to participate in greater total MVPA. BMI was negatively linked with competence and relatedness only among girls. Although, the current and previous empirical findings supported task-involving teaching methods in physical education, in some cases, ego-involving climate should not be totally avoided. This may indicate that girls and boys perceive physical education classes in a different way. Therefore, both task- and ego-involving teaching practices can be useful ways of driving behavior in physical education classes.

Keywords: achievement goal theory, assessment, enjoyment, hierarchical model of motivation, physical activity, self-determination theory

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Authors: Natchaphon Auampradit, Patama Vapattanawong, Sureeporn Punpuing, Malee Sunpuwan, Tawanchai Jirapramukpitak

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Longitudinal studies related to cognitive impairment in elderly are necessary for health promotion and development. The purposes of this study were (1) to examine changes in cognition of elderly over time and (2) to examine the impacts of changes in social determinants of health (SDH) toward changes in cognition of elderly by using the secondary data derived from the Kanchanaburi Demographic Surveillance System (KDSS) by the Institute for Population and Social Research (IPSR) which contained longitudinal data on individuals, households, and villages. Two selected projects included the Health and Social Support for Elderly in KDSS in 2007 and the Population, Economic, Social, Cultural, and Long-term Care Surveillance for Thai Elderly People’s Health Promotion in 2011. The samples were 586 elderly participated in both projects. SDH included living arrangement, social relationships with children, relatives, and friends, household asset-based wealth index, household monthly income, loans for livings, loans for investment, and working status. Cognitive impairment was measured by category fluency and delayed recall. This study employed Generalized Estimating Equation (GEE) model to investigate changes in cognition by taking SDH and other variables such as age, gender, marital status, education, and depression into the model. The unstructured correlation structure was selected to use for analysis. The results revealed that 24 percent of elderly had cognitive impairment at baseline. About 13 percent of elderly still had cognitive impairment during 2007 until 2011. About 21 percent and 11 percent of elderly had cognitive decline and cognitive improvement, respectively. The cross-sectional analysis showed that household asset-based wealth index, social relationship with friends, working status, age, marital status, education, and depression were significantly associated with cognitive impairment. The GEE model revealed longitudinal effects of household asset-based wealth index and working status against cognition during 2007 until 2011. There was no longitudinal effect of social conditions against cognition. Elderly living with richer household asset-based wealth index, still being employed, and being younger were less likely to have cognitive impairment. The results strongly suggested that poorer household asset-based wealth index and being unemployed were served as a risk factor for cognitive impairment over time. Increasing age was still the major risk for cognitive impairment as well.

Keywords: changes in cognition, cognitive impairment, elderly, KDSS, longitudinal study

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Authors: Ioana Simina Frincu

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As institutional initiatives often fail to provide good practices when it comes to heritage management or to adapt to the changing environment in which they function and to the audiences they address, private actions represent viable strategies for sustainable knowledge acquisition. Information dissemination to future generations is one of the key aspects in preserving cultural heritage and is successfully feasible even in the absence of original artifacts. Combined with the (re)discovery of natural landscape, open-air exploratory approaches (archeoparks) versus an enclosed monodisciplinary rigid framework (traditional museums) are more likely to 'speak the language' of a larger number of people, belonging to a variety of categories, ages, and professions. Interactive sites are efficient ways of stimulating heritage awareness and increasing the number of visitors of non-interactive/static cultural institutions owning original pieces of history, delivering specialized information, and making continuous efforts to preserve historical evidence (relics, manuscripts, etc.). It is high time entrepreneurs took over the role of promoting cultural heritage, bet it under a more commercial yet more attractive form (business). Inclusive, participatory type of activities conceived by experts from different domains/fields (history, anthropology, tourism, sociology, business management, integrative sustainability, etc.) have better chances to ensure long term cultural benefits for both adults and children, especially when and where the educational discourse fails. These unique self-experience leisure activities, which offer everyone the opportunity to recreate history by him-/her-self, to relive the ancestors’ way of living, surviving and exploring should be regarded not as pseudo-scientific approaches but as important pre-steps to museum experiences. In order to support this theory, focus will be laid on two different examples: one dynamic, in the outdoors (the Boario Terme Archeopark from Italy) and one experimental, held indoor (the reconstruction of the Neolithic sanctuary of Parta, Romania as part of a transdisciplinary academic course) and their impact on young generations. The conclusion of this study shows that the increasingly lower engagement of youth (students) in discovering and understanding history, archaeology, and heritage can be revived by entrepreneurial projects.

Keywords: archeopark, educational tourism, open air museum, Parta sanctuary, prehistory

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Authors: Irina Belozerova

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In the recent years, the number of crimes against peace and humanity has constantly been increasing. The development of the international community is inseparably connected to the compliance with the law which protects the rights and interests of citizens in all of their manifestations. The provisions of the law of criminal procedure are no exception. The rights of the victims of genocide, of the war crimes and the crimes against humanity, require particular attention. These crimes fall within the jurisdiction of the International Criminal Court governed by the Rome Statute of the International Criminal Court. These crimes have the following features. First, any such crime has a mass character and therefore requires specific regulation in the international criminal law and procedure and the national criminal law and procedure of different countries. Second, the victims of such crimes are usually children, women and old people; the entire national, ethnic, racial or religious groups are destroyed. These features influence the classification of victims by the age criterion. Article 68 of the Rome Statute provides for protection of the safety, physical and psychological well-being, dignity and privacy of victims and witnesses and thus determines the procedural status of these persons. However, not all the persons whose rights have been violated by the commission of these crimes acquire the status of victims. This is due to the fact that such crimes affect a huge number of persons and it is impossible to mention them all by name. It is also difficult to assess the entire damage suffered by the victims. While assessing the amount of damages it is essential to take into account physical and moral harm, as well as property damage. The procedural status of victims thus gains an exclusive character. In order to determine the full extent of the damage suffered by the victims it is necessary to collect sufficient evidence. However, it is extremely difficult to collect the evidence that would ensure the full and objective protection of the victims’ rights. While making requests for the collection of evidence, the International Criminal Court faces the problem of protection of national security information. Religious beliefs and the family life of victims are of great importance. In some Islamic countries, it is impossible to question a woman without her husband’s consent which affects the objectivity of her testimony. Finally, the number of victims is quantified by hundreds and thousands. The assessment of these elements demands time and highly qualified work. These factors justify the creation of a mechanism that would help to collect the evidence and establish the truth in the international criminal proceedings. This mechanism will help to impose a just and appropriate punishment for the persons accused of having committed a crime, since, committing the crime, criminals could not misunderstand the outcome of their criminal intent.

Keywords: crimes against humanity, evidence in international criminal proceedings, international criminal proceedings, protection of victims

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Authors: Friman Hen, Banner Ifaa, Shalom-Tuchin Bosmat, Einav Yulia

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The action learning course is an academic course which involves academic learning and social activities. The courses deal with processes and social challenges, reveal different ideologies, and develop critical thinking and pragmatic ideas. Students receive course credits and a grade for being part of such courses. Participating students enroll in courses that involve action and activities to engage in the experiential learning process, thereby creating a dialogue and cross-fertilization between being taught in the classroom and experiencing the reality in the real world. A learning experience includes meeting with social organizations, institutions, and state authorities and carrying out practical work with diverse populations. Through experience, students strengthen their academic skills, formulate ethical attitudes toward reality, develop professional and civilian perspectives, and realize how they can influence their surrounding in the present and the hereafter. Under the guidance and supervision of Dr. Hen Friman, H.I.T. has built an innovative course that combines action and activities to increase the awareness and accessibility of the community in an experiential way. The end goal is to create Green Ambassadors—children with a high level of environmental awareness. This course is divided into two parts. The first part, focused on frontal teaching, delivers knowledge from extensive environmental fields to students. These areas include introduction to ecology, the process of electricity generation, air pollution, renewable energy, water economy, waste and recycling, and energy efficiency (first stage). In addition to the professional content in the environment field, students learn the method of effective and experiential teaching to younger learners (4 to 8 years old). With the attainment of knowledge, students are divided into operating groups. The second part of the course shows how the theory becomes practical and concrete. At this stage, students are asked to introduce to the first- and second-graders of ‘Revivim’ School in Holon a lesson of 90 minutes focused on presenting the issues and their importance during the course (second stage). This course is the beginning of a paradigm shift regarding energy usage in the modern society in Israel. The objective of the course is to expand worldwide and train the first and second-graders, and even pre-schoolers, in a wide scope to increase population awareness rate, both in Israel and all over the world, for a green future.

Keywords: air pollution, green ambassador, recycling, renewable energy

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Authors: Nino Kupatadze, Tamar Memanishvili, Natia Ochkhikidze, David Tugushi, Zaal Kokaia, Ramaz Katsarava

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Amino acid-based Biodegradable poly(ester-amide)s (PEAs) have gained considerable interest as a promising materials for numerous biomedical applications. These polymers reveal a high biocompatibility and easily form small particles suitable for delivery various biological, as well as elastic bio-erodible films serving as matrices for constructing antibacterial coatings. In the present work we have demonstrated a potential of the PEAs for two applications: 1. cell therapy for stroke as vehicles for delivery and sustained release of growth factors, 2. bactericidal coating as prevention biofilm and applicable in infected wound management. Stroke remains the main cause of adult disability with limited treatment options. Although stem cell therapy is a promising strategy, it still requires improvement of cell survival, differentiation and tissue modulation. .Recently, microspheres (MPs) made of biodegradable polymers have gained significant attention for providing necessary support of transplanted cells. To investigate this strategy in the cell therapy of stroke, MPs loaded with transcription factors Wnt3A/BMP4 were prepared. These proteins have been shown to mediate the maturation of the cortical neurons. We have suggested that implantation of these materials could create a suitable microenvironment for implanted cells. Particles with spherical shape, porous surface, and 5-40 m in size (monitored by scanning electron microscopy) were made on the basis of the original PEA composed of adipic acid, L-phenylalanine and 1,4-butanediol. After 4 months transplantation of MPs in rodent brain, no inflammation was observed. Additionally, factors were successfully released from MPs and affected neuronal cell differentiation in in vitro. The in vivo study using loaded MPs is in progress. Another severe problem in biomedicine is prevention of surgical devices from biofilm formation. Antimicrobial polymeric coatings are most effective “shields” to protect surfaces/devices from biofilm formation. Among matrices for constructing the coatings preference should be given to bio-erodible polymers. Such types of coatings will play a role of “unstable seating” that will not allow bacteria to occupy the surface. In other words, bio-erodible coatings would be discomfort shelter for bacteria that along with releasing “killers of bacteria” should prevent the formation of biofilm. For this purpose, we selected an original biodegradable PEA composed of L-leucine, 1,6-hexanediol and sebacic acid as a bio-erodible matrix, and nanosilver (AgNPs) as a bactericidal agent (“killer of bacteria”). Such nanocomposite material is also promising in treatment of superficial wound and ulcer. The solubility of the PEA in ethanol allows to reduce AgNO3 to NPs directly in the solution, where the solvent served as a reductive agent, and the PEA served as NPs stabilizer. The photochemical reduction was selected as a basic method to form NPs. The obtained AgNPs were characterized by UV-spectroscopy, transmission electron microscope (TEM), and dynamic light scattering (DLS). According to the UV-data and TEM data the photochemical reduction resulted in spherical AgNPs with wide particle size distribution with a high contribution of the particles below 10 nm that are known as responsible for bactericidal activity of AgNPs. DLS study showed that average size of nanoparticles formed after photo-reduction in ethanol solution ranged within ca. 50 nm.

Keywords: biodegradable polymers, microparticles, nanocomposites, stem cell therapy, stroke

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Authors: Papali Elizabeth Maqalika

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Introduction: Dress is used daily and can be used to define culture, and through it, individuals form a sense of self and identity. One of the characteristics of culture is that it evolves; Basotho culture is no exception to this. It has evolved through rites of entry, significant ceremonies, daily living, and an approach to others. Most of these affect and have been affected by the local/traditional dress. The study focused on the evolution of culture, and the role played by dress as it is one of the major contributors to non-verbal communication. Methodology: Secondary data were used since most of the original cultural practices are no longer held dear in the value system and so no longer practiced. Interviews were conducted to get some insights from the senior citizens and their responses compared to those of the present adults. Content analysis was used for the interview data. Results: The nature of governance in Lesotho has clearly contributed to the current cultural state of confusion. The Basotho culture has indeed shifted, and the difference in dress code explains it. Acculturation, the alteration in environments, and the type of occasions Basotho attended lately contributed to the shift. Technology brought about a difference in the mode of transport, sports, household activities, and gender roles. Conclusion and Recommendations: It was concluded that since culture is imparted through socialisation, a change in availability of most Basotho women leaves little time left for socialisation with children and resorts to other upbringing patterns, most of which are not cultural; this has brought a cultural shift. In addition, acculturation has contributed massively to the value system of Basotho. The type of dress worn by Basotho presently shifts the culture, and the shifting culture also shifts the dress required to suit the present culture. Because of the type of mindset Basotho has now, it is recommended that cultural days be observed in schools, including the multi-racial ones, and media should assist in this information transmission. The campaigns regarding the value of traditional dress and what it represents are recommended. The local dressmakers manufacturing the Seshoeshoe and any other traditional dress need to be educated about the fabric history, fiber content, and consequent care to be in a position to guide ultimate consumers of the products. Awareness campaigns that the culture shifts and may not necessarily result in negative should be ventured. Cultural exhibitions should also be held ideally at places that hold some cultural heritage. The ministry of sports and culture, together with that of tourism, should run with cultural awareness and enriching vision with a focus on education as opposed to revenue collection.

Keywords: Basotho, culture, dress, acculturation, influence, cultural heritage, socialization, non-verbal communication, Seshoeshoe

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Authors: Orkide Donma, Mustafa M. Donma

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Basal metabolic rate is questioned as a risk factor for weight gain. The relations between basal metabolic rate and body composition have not been cleared yet. The impact of fat mass on basal metabolic rate is also uncertain. Within this context, indices based upon total body mass as well as total body fat mass are available. In this study, the aim is to investigate the potential clinical utility of these indices in the adult population. 287 individuals, aged from 18 to 79 years, were included into the scope of the study. Based upon body mass index values, 10 underweight, 88 normal, 88 overweight, 81 obese, and 20 morbid obese individuals participated. Anthropometric measurements including height (m), and weight (kg) were performed. Body mass index, diagnostic obesity notation model assessment index I, diagnostic obesity notation model assessment index II, basal metabolic rate-to-weight ratio were calculated. Total body fat mass (kg), fat percent (%), basal metabolic rate, metabolic age, visceral adiposity, fat mass of upper as well as lower extremities and trunk, obesity degree were measured by TANITA body composition monitor using bioelectrical impedance analysis technology. Statistical evaluations were performed by statistical package (SPSS) for Windows Version 16.0. Scatterplots of individual measurements for the parameters concerning correlations were drawn. Linear regression lines were displayed. The statistical significance degree was accepted as p < 0.05. The strong correlations between body mass index and diagnostic obesity notation model assessment index I as well as diagnostic obesity notation model assessment index II were obtained (p < 0.001). A much stronger correlation was detected between basal metabolic rate and diagnostic obesity notation model assessment index I in comparison with that calculated for basal metabolic rate and body mass index (p < 0.001). Upon consideration of the associations between basal metabolic rate-to-weight ratio and these three indices, the best association was observed between basal metabolic rate-to-weight and diagnostic obesity notation model assessment index II. In a similar manner, this index was highly correlated with fat percent (p < 0.001). Being independent of the indices, a strong correlation was found between fat percent and basal metabolic rate-to-weight ratio (p < 0.001). Visceral adiposity was much strongly correlated with metabolic age when compared to that with chronological age (p < 0.001). In conclusion, all three indices were associated with metabolic age, but not with chronological age. Diagnostic obesity notation model assessment index II values were highly correlated with body mass index values throughout all ranges starting with underweight going towards morbid obesity. This index is the best in terms of its association with basal metabolic rate-to-weight ratio, which can be interpreted as basal metabolic rate unit.

Keywords: basal metabolic rate, body mass index, children, diagnostic obesity notation model assessment index, obesity

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Authors: E. Isaac, I. Jalo, Y. Alkali, A. Ajani, A. Rasaki, Y. Jibrin, K. Mustapha, A. Ayuba, S. Charanchi, H. Danlami

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Introduction: Hepatitis B infection continues to be a serious global health problem with about 2 billion people infected worldwide, many of these in sub-Saharan Africa. Nigeria is one of the countries with the highest incidence, with a prevalence of 10-15%. Methods: Records of Hepatitis B surface and envelope antigen test results in adults in Federal Teaching Hospital, Gombe between May 2000 and May 2015 were retrieved and analyzed. Findings: Adult out-patient consultations and in-patient admissions were 343,083 and 67,761 respectively, accounting for 87% of total. Hepatitis B surface antigenaemia was tested for in 23,888 adults and children. 88.9% (21240) were adults. Males constituted 56% (11902/21240) and females 44% (9211/21240). 5104 (24.0%) of tested individuals were 19-25years; 12,039 (56.7%) 26-45years; 21119 (9.0%) 46-55years; 2.8% (590/21240) and 766 (3.6%) >65years. Among adult males, 17% (2133/11902) was contributed by ages 19-25. 58% (7017/11902), 11.9% (1421/11902), 6.4% (765/11902) and 4.7% (563/11902) of males were 26-45 years old, 46-55 years old and 56-65 years and >65year old respectively. Adults aged 19-25years, 26-45 years, 46-55years, 56-65 and > 65years each constituted 32% (2966/9211); 54.4% (5009/9211); 7.4% (684/9211), 3.8% (350/9211) and 2.2% (201/9211) of females respectively. 16.2% (3431/21,240) demonstrated Hepatitis B surface antigenaemia. The sero-positivity rate was 16.9% (865//5104) between 19-25years, 21.2% (2559/12,039) among 26-45year old individuals. 17.9% (377/2111); 14.1% (83/590) and 7.3% (56/766) of 46-55year old, 56-65year old and >65year old individuals screened were seropositive. The highest sero-positivity rate was found in male young adults aged 19-25years 27.9% (398/1426) and lowest in elderly males 7.4% (28/377). HBe antigen testing rate among HbSAg seropositive individuals was 97.3% (3338/3431). Males constituted 59.7% (1992/3338) and females 40.3% (1345/3338). 25.3% (844/3338) were aged 19-25years; 61.1% (2039/3338) 26-45years; 10.2% (340/3338) 46-55years; 2.7% (90/3338) 56-65years and 0.7% >65years old. HB e antigenaemia was positive in 8.2% (275/3338) of those tested. 41% (113/275); 50.2% (138/275); 5.4% (15/275); 1.8% (5/275) and 1.1 (3/275) of HB e sero-positivity was among age groups 19-25, 26-45, 46-55, 56-65 and > 65year old individuals. Dual sero-positivity rate was highest 13% (113/844) in young adults 19-25years and lowest between 46-55years; 15/340 (4.4%). 4.2% (15/360); 13.5% (69/512); 6.7% (90/1348); 4.6% (10/214); 5% (2/40) and 6.7% (1/15) of males aged 19-25; 26-45; 46-55; 56-65; and >65years had HB e antigenaemia respectively. Among females - 27/293 (9.2%) aged 19-25; 26/500 (5.2%) 26-45; 2/84 (2.4%) 46-55; 1/12 (8.3%) 56-65 and 1/9(11.1%) >65years had dual antigenaemia. In women of childbearing age, 6.9% (53/793) had a dual carriage. Conclusion: Dual hepatitis B surface and envelope antigenaemia are highest in young adult males. This will have significant implications for the development of chronic liver disease and hepatocellular carcinoma.

Keywords: adult, Hepatitis B, Nigeria, dual carriage

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Authors: Kayliegh Richardson, Ana Speed

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The international campaign, '16 Days of Activism against Gender Based Violence', seeks to raise awareness and understanding of gender based violence in a variety of settings. The campaign requires its participants to join in for advancing the right to education and challenging violence, discrimination, and inequality and take into account intersections such as gender, race, ethnicity, religion, sexual orientation, socio-economic status and other social identifiers. The authors of this paper are both clinic supervisors at Northumbria University in Newcastle Upon Tyne, England. As part of their research project, the authors are going to ask final year students on the MLaw degree at Northumbria University to become involved in the campaign by participating in a variety of awareness-raising activities during the course of the 16 days, which runs from 27 November 2017 until 10 December 2017. As part of the campaign, the authors will be running the following activities for students to participate in 1. Documentary showing of Banaz, a love story followed by discussion group. 2. 16 blogs for 16 days. Students will contribute to our family law blog over the 16 days, with articles about gender based violence. 3. Guest lecture on domestic violence (potentially run by a domestic violence organisation) 4. Workshop by Professor Ruth Lewis who will be presenting her innovative research in gender based violence and online abuse. 5. Poster competition - the students are asked to submit a poster about the different forms of gender based violence or proposals for ending violence against women and girls. The research aims are to identify whether participation in the project: 1. increases the students' engagement with issues of gender justice 2. is an effective educational tool for raising the students' awareness and understanding of gender based violence in its many forms. 3. increases the students' understanding of the domestic and international framework for protecting victims (in particular women and children) of gender based violence. After the activities, an impartial, experienced researcher will be holding a focus group with volunteering students to discuss their experiences of participating in the activities and whether they felt that participation in the project achieved the aims set out above. This paper will discuss the activities undertaken by the students and will address the data gathered during the focus group. Finally, the authors will discuss their thoughts on whether awareness of gender-based violence and other international family law issues can be appropriately raised in an educational setting.

Keywords: gender based violence, clinical legal education, international family law, domestic abuse

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Authors: Yingyi Luo

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Cross-border surrogacy is seen by many as a market in which women are bought and sold commodities at risk of trafficking. A surrogate can be framed as either a fully acknowledged subject, with whom intended parents engage in cross-border surrogacy—or as a tool utilized by intended parents and surrogacy facilitators in the furtherance of their own objectives. In order to identify which frame prevails, this paper applies subjectivity theory to an empirical study of cross-border surrogacy facilitated by facilitators in Australia analysing interviews with surrogate agents, counsellors and lawyers, and observations at trade show. The aim of the paper is to advance understanding of the dynamics of the relationship between intended parents, surrogates, and surrogacy facilitators by collecting new data and applying unique framework. As dominant players, surrogacy facilitators have a significant impact on determining the nature of cross-border surrogacy. However, little is known concerning the manner in which facilitators influence the inter-subjectivity between surrogate mothers and intended parents. Thus, this paper intends to identify how facilitators depict surrogate mothers, the degree to which their perspectives bear upon both the subjectivity of the surrogate mother and the relationship of intended parents with surrogate mothers. For the purpose of introducing and developing this framework in the context of cross-border surrogacy, this paper borrows from the work of theorists not often mentioned in bioethics, including Jacques Lacan, Marco Cavallaro, Michel Foucault, and others. It also applies the concept of 'the gaze' along with the dynamic of 'self' and 'other' to the cross-border surrogacy arrangement. Applying the concept of the gaze can provide a new way to interpret the power dynamic that plays out among surrogacy facilitators, intended parents, and surrogates within the commercial surrogacy arrangement and how the subjectivity is produced through the power. Viewing the relationships between the players in cross-border surrogacy through the lens of gaze theory, this paper finds that, in cross-border surrogacy, due to the structural power imbalance, affluent intended parents and surrogacy facilitators are possessors of the gaze, while surrogate mothers are under the thrall of the gaze. Specifically, facilitators frame surrogate mothers' reproductive abilities as commodities that intended parents can purchase to fulfil their urgent need to have children and experience full subjectivity, and they take a cut of the money that paid by intended parents. Therefore, commodification of the body results in degrading a surrogate mother (the object), reifying her as no more than a walking womb (the other), a process which is highly detrimental to the self of surrogate mothers. This relationship, formalized through contractual means, allows intended parents and facilitators to take advantage of surrogate mothers in the furtherance of their own objectives. This argument is enriched by new data from interviews and observations that provide nuance to this understanding of inter-subjectivity.

Keywords: cross-border surrogacy, facilitators, self, surrogate mothers

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Authors: Gunjan Razdan, Priyanka Sreenath, Jagannath Behera, S. K. Mishra, Sunil Mehra

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Uttar Pradesh is one of the poor performing states with high Malnutrition and Anaemia among adolescent girls resulting in high MMR, IMR and low birth weight rate. The rate of anaemia among adolescent girls has doubled in the past decade. Adolescents gain around 15-20% of their optimum height, 25-50% of the ideal adult weight and 45% of the skeletal mass by the age of 19. Poor intake of energy, protein and other nutrients is one of the factors for malnutrition and anaemia. METHODS: The cross-sectional survey using a mixed method (quantitative and qualitative) was adopted in this study. The respondents (adolescents, parents and frontline health workers) were selected randomly from 30 villages and surveyed through a semi-structured questionnaire for qualitative information and FGDs and IDIs for qualitative information. A 24 hours dietary recall method was adopted to estimate their dietary practices. A total of 1069 adolescent girls, 1067 boys, 1774 parents and 69 frontline functionaries were covered under the study. Percentages and mean were calculated for quantitative variable, and content analysis was carried out for qualitative data. RESULTS: Over 80 % of parents provided assertions that they understood the term balanced diet and strongly felt that their children were having balanced diet. However, only negligible 1.5 % of parents could correctly recount essential eight food groups and 22% could tell about four groups which was the minimum response expected to say respondents had fair knowledge on a balanced diet. Only 10 percent of parents could tell that balanced diet helps in physical and mental growth and only 2% said it has a protective role. Besides, qualitative data shows that the perception regarding balanced diet is having costly food items like nuts and fruits. The dietary intake of adolescents is very low despite the increased iron needs associated with physical growth and puberty.The consumption of green leafy vegetables (less than 35 %) and citrus fruits (less than 50%) was found to be low. CONCLUSIONS: The assertions on an understanding of term balanced diet are contradictory to the actual knowledge and practices. Knowledge on essential food groups and nutrients is crucial to inculcate healthy eating practices among adolescents. This calls for comprehensive communication efforts to improve the knowledge and dietary practices among adolescents.

Keywords: anemia, knowledge, malnutrition, perceptions

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Authors: Celine Jaspers

Abstract:

The Belgian legal system is slowly evolving to mandatory mediation to promote ADR. One of the reasons for this evolution is the lack of use of alternative methods in relation to their possible benefits. Especially in divorce cases, ADR can play a beneficial role in resolving disputes, since the emotional component is very much present. When children are involved, a solution provided by the parent may be more adapted to the child’s best interest than a court order. In the first part, the lack of use of voluntary ADR and the evolution toward mandatory ADR in Belgium will be indicated by sources of legislation, jurisprudence and social-scientific sources, with special attention to divorce cases. One of the reasons is lack of knowledge on ADR, despite the continuing efforts of the Belgian legislator to promote ADR. One of the last acts of ADR-promotion, was the implementation of an Act in 2018 which gives the judge the possibility to refer parties to mediation if at least one party wants to during the judicial procedure. This referral is subject to some conditions. The parties will be sent to a private mediator, recognized by the Federal Mediation Commission, to try to resolve their conflict. This means that at least one party can be mandated to try mediation (indicated as “semi-mandatory mediation”). The main goal is to establish the factors and elements that Belgium has to take into account in their further development of mandatory ADR, with consideration of the human rights perspective and the EU perspective. Furthermore it is also essential to detect some dangerous pitfalls other systems have encountered with their process design. Therefore, the second part, the comparative component, will discuss the existing framework in California, USA to establish the necessary elements, possible pitfalls and considerations the Belgian legislator can take into account when further developing the framework of mandatory ADR. The contrasting and functional method will be used to create key elements and possible pitfalls, to help Belgium improve its existing framework. The existing mandatory system in California has been in place since 1981 and is still up and running, and can thus provide valuable lessons and considerations for the Belgian system. Thirdly, the key elements from a human rights perspective and from a European Union perspective (e.g. the right to access to a judge, the right to privacy) will be discussed too, since the basic human rights and European legislation and jurisprudence play a significant part in Belgian legislation as well. The main sources for this part will be the international and European treaties, legislation, jurisprudence and soft law. In the last and concluding part, the paper will list the most important elements of a mandatory ADR-system design with special attention to the dangers of these elements (e.g. to include or exclude domestic violence cases in the mandatory ADR-framework and the consequences thereof), and with special attention for the necessary the international and European rights, prohibitions and guidelines.

Keywords: Belgium, divorce, framework, mandatory ADR

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Authors: Kamal Kithsiri Karunadasa Hewawasam Revulge

Abstract:

This paper is an interpretative historical analysis of Australian migration laws that examines asylum and refugee policies and attitudes in Australia. It looks at major turning points in Australian migration history, and in doing so, the researcher reviewed relevant literature on the aspects crucial to highlighting the current trend of Australian migration policies. The data was collected using secondary data from official government sources, including annual reports, media releases on immigration, inquiry reports, statistical information, and other available literature to identify critical historical events that significantly affected the systematic developments of asylum seekers and refugee policies in Australia and to look at the historical trends of official thinking. A reliance on using these official sources is justified as those are the most convincing sources to analyse the historical events in Australia. Additional literature provides us with critical analyses of the behaviour and culture of the Australian immigration administration. The analytical framework reviewed key Australian Government immigration policies since British colonization and the settlement era of 1787–the 1850s and to the present. The fundamental basis for doing so is that past events and incidents offer us clues and lessons relevant to the present day. Therefore, providing a perspective on migration history in Australia helps analyse how current policymakers' strategies developed and changed over time. Attention is also explicitly focused on Australian asylum and refugee policy internationally, as it helped to broaden the analysis. The finding proved a link between past events and adverse current Australian government policies towards asylum seekers and refugees. It highlighted that Australia's current migration policies are part of a carefully and deliberately planned pattern that arose from the occupation of Australia by early British settlers. In this context, the remarkable point is that the historical events of taking away children from their Australian indigenous parents, widely known as the 'stolen generation' reflected a model of assimilation, or a desire to absorb other cultures into Australian society by fully adopting the settlers' language, their culture, and losing indigenous people's traditions. Current Australian policies towards migrants reflect the same attitude. Hence, it could be argued that policies and attitudes towards asylum seekers and refugees, particularly so-called 'boat people' to some extent, still reflect Australia's earlier colonial and 'white Australia' history.

Keywords: migration law, refugee law, international law, administrative law

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Authors: Brooke Sweeney, David White, Felix Amparano, Nick A. Clark, Amy R. Beck, Mathew Lindquist, Lora Edwards, Julie Vandal, Jennifer Lisondra, Katie Cox, Renee Arensberg, Allen Cummins, Jazmine Cedeno, Jason D. Fraser, Kelsey Dean, Helena H. Laroche, Cristina Fernandez

Abstract:

Background: National organizations call for standardized pre-surgical requirements and education to optimize postoperative outcomes. Since 2017 our surgery program has used defined protocols and educational curricula pre- and post-surgery. In response to patient outcomes, our educational content was refined to include quizzes to assess patient knowledge and surgical preparedness. We aim to optimize adolescent pre-bariatric surgery preparedness by improving overall aggregate pre-surgical assessment performance from 68% to 80% within 12 months. Methods: A multidisciplinary improvement team was developed within the weight management clinic (WMC) of our tertiary care, free-standing children’s hospital. A manual has been utilized since 2017, with limitations in consistent delivery and patient uptake of information. The curriculum has been improved to include quizzes administered during WMC visits prior to bariatric surgery. The initial outcome measure is the pre-surgical quiz score of adolescents preparing for bariatric surgery. Process measure was the number of questions answered correctly to test the questions. Baseline performance was determined by a patient assessment survey of pre-surgical preparedness at patient visits. Plan-Do-Study-Act cycles (PDSA) included: 1) creation and implementation of a refined curriculum, 2) development of 5 new quizzes based upon learning objectives, and 3) improving provider-lead teaching and quiz administration within clinic workflow. Run charts assessed impact over time. Results: A total of 346 quiz questions were administered to 34 adolescents. The outcome measure improved from a baseline mean of 68% to 86% following PDSA 2 cycles, and it was sustained. Conclusion/Implication: Patient/family comprehension of surgical preparedness improved with standardized education via team member-led teaching and assessment using quizzes during pre-surgical clinic visits. The next steps include launching redesigned teaching materials with modules correlated to quizzes and assessment of comprehension and outcomes post-surgically.

Keywords: bariatric surgery, adolescent, clinic, pre-bariatric training

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Authors: Michael Vieth, Aric Schadler, Hubert Ballard, J. A. Bauer, Pratibha Thakkar

Abstract:

Introduction: Congenital diaphragmatic hernia (CDH) is a condition characterized by the herniation of abdominal contents into the thoracic cavity requiring postnatal surgical repair. Previous literature suggests improved CDH outcomes at high-volume regional referral centers compared to low-volume centers. The purpose of this study was to examine CDH outcomes at Kentucky Children’s Hospital (KCH), a low-volume center, compared to the Congenital Diaphragmatic Hernia Study Group (CDHSG). Methods: A retrospective chart review was performed at KCH from 2007-2019 for neonates with CDH, and then subdivided into two cohorts: those requiring ECMO therapy and those not requiring ECMO therapy. Basic demographic data and measures of mortality and morbidity including ventilator days and length of stay were compared to the CDHSG. Measures of morbidity for the ECMO cohort including duration of ECMO, clinical bleeding, intracranial hemorrhage, sepsis, need for continuous renal replacement therapy (CRRT), need for sildenafil at discharge, timing of surgical repair, and total ventilator days were collected. Statistical analysis was performed using IBM SPSS Statistics version 28. One-sample t-tests and one-sample Wilcoxon Signed Rank test were utilized as appropriate.Results: There were a total of 27 neonatal patients with CDH at KCH from 2007-2019; 9 of the 27 required ECMO therapy. The birth weight and gestational age were similar between KCH and the CDHSG (2.99 kg vs 2.92 kg, p =0.655; 37.0 weeks vs 37.4 weeks, p =0.51). About half of the patients were inborn in both cohorts (52% vs 56%, p =0.676). KCH cohort had significantly more Caucasian patients (96% vs 55%, p=<0.001). Unadjusted mortality was similar in both groups (KCH 70% vs CDHSG 72%, p =0.857). Using ECMO utilization (KCH 78% vs CDHSG 52%, p =0.118) and need for surgical repair (KCH 95% vs CDHSG 85%, p =0.060) as proxy for severity, both groups’ mortality were comparable. No significant difference was noted for pulmonary outcomes such as average ventilator days (KCH 43.2 vs. CDHSG 17.3, p =0.078) and home oxygen dependency (KCH 44% vs. CDHSG 24%, p =0.108). Average length of hospital stay for patients treated at KCH was similar to CDHSG (64.4 vs 49.2, p=1.000). Conclusion: Our study demonstrates that outcome in CDH patients is independent of center’s case volume status. Management of CDH with a standardized approach in a low-volume center can yield similar outcomes. This data supports the treatment of patients with CDH at low-volume centers as opposed to transferring to higher-volume centers.

Keywords: ECMO, case volume, congenital diaphragmatic hernia, congenital diaphragmatic hernia study group, neonate

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