Search results for: major adverse cardiac events

Authors: Muskan Jain, Baiju Gopal

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Objectives: Intimacy in interpersonal relationships is integral to psychological health and everyday wellbeing; the focus is on intimacy, which can be described as feelings of closeness, connection, and belonging within relationships, which is influenced by an individual's gender identity as well as life experiences. The study aims to explore the experiences of intimacy of the non-binary gender; this marginalized community has increased risks of developing the imposter phenomenon. The study explores the influence of IP on the development and sustenance of intimacy in relationships. Methods: The present study accumulates detailed narratives from 10 non-binary young adults ages 18 to 25 in metropolitan cities of India. Thematic analysis was used for the data analysis. Results: Seven major themes have emerged revolving around internalized criticism and self-depreciating behavior, which causes distance between partners. The four themes that result in the internalization of criticism are lack of social stability, invalidation by social units, adverse life experiences, and estrangement due to gender identity. Three themes that encapsulate major difficulties in relationships are limited self-disclosure, inhibition of physical needs, and fear of taking space. The findings have been critically compared and contrasted with the existing body of literature in the domain, which sets the agenda for further inquiry. Conclusion: It is important for future studies to capture the experiences of non-binary genders in India to provide better therapeutic support in order to assist them in forming meaningful and authentic relationships, thus increasing overall wellbeing.

Keywords: imposter phenomenon, intimacy, internalized criticism, marginalized community

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Authors: Shivam Adhikary

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Sports stadiums are not merely public amenities for entertainment and recreation for a city. They are buildings with extremely high construction investment and running costs which holds the supreme responsibility of social integration, nation building and financial upliftment of the community apart from its primary motive of conducting and promotion of the sports. But the present scenario of sports performances at international events and growing physical inactivity among the youth in India show that the sports facilities are far behind in achieving these goals. A pilot study of Indira Gandhi Sports complex in Vijayawada, Andhra Pradesh gave an indication of underutilization of sports stadia in India. This probed a crying need for the assessment of the present usage and functioning of the major sports (non-cricketing) facilities within the country. This paper assesses the sustainability of stadiums built for national and international sporting (non-cricket) events in terms of sporting, socio-cultural and financial sustainability by mainly focusing on their usage in non-event days. The criteria for the assessment and comparison of the stadiums within the nation is done using World Stadium Index and GDI (Gross Domestic Income) while with international counterparts using WSI and GNI (Gross National Income). The pilot case of India Gandhi Sports complex in Vijayawada is further investigated for a deeper understanding of the present usage, the existing issues for its underutilization and the way-forward (at least a few) to reach its sustainable potential. The paper finally concludes with the discussion on whether sports stadiums are being utilized to its financial potential and if it is at par with its international counterparts.

Keywords: economic sustainability, social sustainability, sports infrastructure, stadium efficiency

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Authors: Mandy W. M. Chan, Samantha Y. N. Shek, Chi K. Yeung, Taro Kono, Henry H. L. Chan

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Fractional radiofrequency devices have shown to improve skin texture such as smoothness, rhytides, brightness as well as atrophic acne scars by increasing dermal thickness, dermal collagen content and dermal fibrillin content. The objective of the study is to assess the efficacy and adverse effects of this device on Asian patients with skin textural changes. In this study, 20 Chinese patients (ranging from 21-60 years old) with irregularities of skin texture, rhytides and acne scars were recruited. Patients received six treatments at 2-4 week intervals. Treatment was initiated with maximum energy tolerated and was adjustable during treatment if patients felt excessive discomfort. A total of two passes were delivered at each session. Physician assessment and standardized photographs were taken at baseline, all treatment visits and at one, two, and six month after final treatment. As a result, 17 patients were recruited and completed the study according to the study protocol. One patient withdrew after the first treatment due to reaction to local anesthesia and two patients were lost to follow-up. At six months follow-up, 71% of the patients were satisfied and 24% were very satisfied, while treatment physician reported various degrees of improvement based on the global assessment scale in 60% of the subjects. Anticipated side effects including erythema, edema, pinpoint bleeding, scabs formation and flare of acne were recorded, but there were no serious adverse effects noted. Conclude up, the use of fractional radiofrequency improves skin texture and appears to be safe in Asian patients. No long-term serious adverse effect was noted.

Keywords: Asian, fractional radiogrequency, skin, texture

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Authors: Antonis Skouloudis, Konstantinos Evangelinos, Walter Leal-Filho, Panagiotis Vouros, Ioannis Nikolaou

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Organizational resilience capacity to extreme weather events (EWEs) has sparked a growth in scholarly attention over the past decade as an essential aspect in business continuity management, with supporting evidence for this claim to suggest that it retains a key role in successful responses to adverse situations, crises and shocks. Small and medium-sized enterprises (SMEs) are more vulnerable to face floods compared to their larger counterparts, so they are disproportionately affected by such extreme weather events. The limited resources at their disposal, the lack of time and skills all conduce to inadequate preparedness to challenges posed by floods. SMEs tend to plan in the short-term, reacting to circumstances as they arise and focussing on their very survival. Likewise, they share less formalised structures and codified policies while they are most usually owner-managed, resulting in a command-and-control management culture. Such characteristics result in them having limited opportunities to recover from flooding and quickly turnaround their operation from a loss making to a profit making one. Scholars frame the capacity of business entities to be resilient upon an EWE disturbance (such as flash floods) as the rate of recovery and restoration of organizational performance to pre-disturbance conditions, the amount of disturbance (i.e. threshold level) a business can absorb before losing structural and/or functional components that will alter or cease operation, as well as the extent to which the organization maintains its function (i.e. impact resistance) before performance levels are driven to zero. Nevertheless, while it seems to be accepted as an essential trait of firms effectively transcending uncertain conditions, research deconstructing the enabling conditions and/or inhibitory factors of SMEs resilience capacity to natural hazards is still sparse, fragmentary and mostly fuelled by anecdotal evidence or normative assumptions. Focusing on the individual level of analysis, i.e. the individual enterprise and its endeavours to succeed, the emergent picture from this relatively new research strand delineates the specification of variables, conceptual relationships or dynamic boundaries of resilience capacity components in an attempt to provide prescriptions for policy-making as well as business management. This study will present the development of a flood resilience capacity index (FRCI) and its application to Greek SMEs. The proposed composite indicator pertains to cognitive, behavioral/managerial and contextual factors that influence an enterprise’s ability to shape effective responses to meet flood challenges. Through the proposed indicator-based approach, an analytical framework is set forth that will help standardize such assessments with the overarching aim of reducing the vulnerability of SMEs to flooding. This will be achieved by identifying major internal and external attributes explaining resilience capacity which is particularly important given the limited resources these enterprises have and that they tend to be primary sources of vulnerabilities in supply chain networks, generating Single Points of Failure (SPOF).

Keywords: Floods, Small & Medium-Sized enterprises, organizational resilience capacity, index development

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Authors: Chau-Kuang Chen, Juanita Buford, Colette Davis, Raisha Allen, John Hughes, James Tyus, Dexter Samuels

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During the post-Civil War era, the city of Nashville, Tennessee, had the highest mortality rate in the country. The elevated death and disease among ex-slaves were attributable to the unavailability of healthcare. To address the paucity of healthcare services, the College, an institution with the mission of educating minority professionals and serving the under served population, was established in 1876. This study was designed to assess if the College has accomplished its mission of serving under served communities and contributed to the elimination of health disparities in the United States. The study objective was to quantify the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities, which, in turn, was significantly associated with a health professional shortage score partly designated by the U.S. Department of Health and Human Services. Various statistical methods were used to analyze the alumni data in years 1975 – 2013. K-means cluster analysis was utilized to identify individual medical and dental graduates into the cluster groups of the practice communities (Disadvantaged or Non-disadvantaged Communities). Discriminant analysis was implemented to verify the classification accuracy of cluster analysis. The independent t test was performed to detect the significant mean differences for clustering and criterion variables between Disadvantaged and Non-disadvantaged Communities, which confirms the “content” validity of cluster analysis model. Chi-square test was used to assess if the proportion of cluster groups (Disadvantaged vs Non-disadvantaged Communities) were consistent with that of practicing specialties (primary care vs. non-primary care). Finally, the partial least squares (PLS) path model was constructed to explore the “construct” validity of analytics model by providing the magnitude effects of socioeconomic status and adverse health outcome on primary care professionals serving disadvantaged community. The social ecological theory along with statistical models mentioned was used to establish the relationship between medical and dental graduates (primary care professionals serving disadvantaged communities) and their social environments (socioeconomic status, adverse health outcome, health professional shortage score). Based on social ecological framework, it was hypothesized that the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities could be quantified. Also, primary care professionals serving disadvantaged communities related to a health professional shortage score can be measured. Adverse health outcome (adult obesity rate, age-adjusted premature mortality rate, and percent of people diagnosed with diabetes) could be affected by the latent variable, namely socioeconomic status (unemployment rate, poverty rate, percent of children who were in free lunch programs, and percent of uninsured adults). The study results indicated that approximately 83% (3,192/3,864) of the College’s medical and dental graduates from 1975 to 2013 were practicing in disadvantaged communities. In addition, the PLS path modeling demonstrated that primary care professionals serving disadvantaged community was significantly associated with socioeconomic status and adverse health outcome (p < .001). In summary, the majority of medical and dental graduates from the College provide primary care services to disadvantaged communities with low socioeconomic status and high adverse health outcomes, which demonstrate that the College has fulfilled its mission.

Keywords: disadvantaged community, K-means cluster analysis, PLS path modeling, primary care

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Authors: Emre Bayamlıoğlu

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Apart from being the subject of neighboring rights when broadcasted on TV or of cinematographic work when fixed to a tangible medium including a hard drive, the copyright eligibility of a sports performance, and eventually the sporting event has once again given rise to controversy following the CJEU judgment in the Murphy case. Most of the arguments which deny copyright protection for sports performances focus on the fact that unlike movies, plays, television programs, or operas, athletic events are competitive and have no underlying script. The first part of the paper aims to explain that such rhetoric is rather weak simply for the fact that, several types of performances such as improvised musical or dramatic shows are still protected by copyright despite the fact that they are not based on a script. The second part argues that the core reason for the denial copyright protection was the functionality aiming certain practical results such as winning the game, scoring, eliminating an opponent, obstructing a shot and etc., but no scientific or artistic expression in whatsoever form. The paper further argues that expanding copyright protection to functional performances would give rise to unintended copyright claims by the athletes on tackles, shoots, passes, crosses etc. resulting with further restrictions on reporting and photographing of sporting events. The final part provides a policy analysis of the trend to broaden the scope of copyright to cover sports performances. It is argued that such expansion will clearly undermine the ratio legis of copyright laws since it will give rise to excessive commodification of information beyond the needs of a viable market economy. Therefore, remedies other than copyright protection such as unfair competition and unjust enrichment provides sufficient redress for the damages to be sustained by the investors of sporting events.

Keywords: copyright eligibility, idea-expression dichotomy, sports performance

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Authors: Achiron Anat, Mathilda Mandel, Mayust Sue, Achiron Reuven, Gurevich Michael

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Introduction: As coronavirus disease 2019 (COVID-19) vaccination is currently spreading around the world, it is of importance to assess the ability of multiple sclerosis (MS) patients to mount an appropriate immune response to the vaccine in the context of disease-modifying treatments (DMT’s). Objectives: Evaluate immunity generated following COVID-19 vaccination in MS patients, and assess factors contributing to protective humoral and cellular immune responses in MS patients vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus infection. Methods: Review our recent data related to (1) the safety of PfizerBNT162b2 COVID-19 mRNA vaccine in adult MS patients; (2) the humoral post-vaccination SARS-CoV2 IgG response in MS vaccinees using anti-spike protein-based serology; and (3) the cellular immune response of memory B-cells specific for SARS-CoV-2 receptor-binding domain (RBD) and memory T-cells secreting IFN-g and/or IL-2 in response to SARS-CoV2 peptides using ELISpot/Fluorospot assays in MS patients either untreated or under treatment with fingolimod, cladribine, or ocrelizumab; (4) covariate parameters related to mounting protective immune responses. Results: COVID-19 vaccine proved safe in MS patients, and the adverse event profile was mainly characterised by pain at the injection site, fatigue, and headache. Not any increased risk of relapse activity was noted and the rate of patients with acute relapse was comparable to the relapse rate in non-vaccinated patients during the corresponding follow-up period. A mild increase in the rate of adverse events was noted in younger MS patients, among patients with lower disability, and in patients treated with DMTs. Following COVID-19 vaccination protective humoral immune response was significantly decreased in fingolimod- and ocrelizumab- treated MS patients. SARS-CoV2 specific B-cell and T-cell cellular responses were respectively decreased. Untreated MS patients and patients treated with cladribine demonstrated protective humoral and cellular immune responses, similar to healthy vaccinated subjects. Conclusions: COVID-19 BNT162b2 vaccine proved as safe for MS patients. No increased risk of relapse activity was noted post-vaccination. Although COVID-19 vaccination is new, accumulated data demonstrate differences in immune responses under various DMT’s. This knowledge can help to construct appropriate COVID-19 vaccine guidelines to ensure proper immune responses for MS patients.

Keywords: covid-19, vaccination, multiple sclerosis, IgG

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Authors: Amira Kaddour

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To curb the problem of liquidity in times of financial crises, two cases arise; the Bailout or Bailin, two opposite choices that elicit the analysis of their effect on moral hazard. This paper attempts to empirically analyze the effect of these two types of events on the behavior of investors. For this end, we use the Emerging Market Bonds Index (EMBI-JP Morgan), and its excess of return, to detect the change in the risk premia through a Markov switching model. The results showed the transition to two types of regime and an effect on moral hazard; Bailout is an incentive of moral hazard, Bailin effectiveness remains subject of credibility.

Keywords: Bailout, Bailin, Moral hazard, financial crisis, Markov switching

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Authors: Ghassen Kharroubi, Ines Cherif, Leila Bouabid, Adel Gharbi, Aicha Boukthir, Margaret McCarron, Nissaf Ben Alaya, Afif Ben Salah, Jihene Bettaieb

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Influenza vaccination (IV) is recommended for elderly persons, especially those with underlying conditions. In countries where IV rates in the elderly remain unsatisfactory, exploring attitudes of older persons toward the flu vaccine could be useful to identify barriers and facilitators to IV. The aim of this study was to determine the reasons for IV acceptance or decline in the Tunisian elderly. A national cross-sectional study was conducted in 2019, among persons aged 60 years and over with chronic disease. Data were collected using a standard administered questionnaire. Of the 1191 older persons included, 19.4% received the influenza vaccine in the 2018-2019 flu season. The two main reasons that may lead to refusal of vaccination were concerns that the vaccine could cause side effects (71.5%) and a belief that the vaccine was ineffective (33.9%). The main reason that may lead to accepting vaccination was a doctor’s recommendation (41.1%). Doctors were by far the most trusted source for information regarding influenza vaccine (91.5%) followed by pharmacists (17.6%). Our results highlighted the important role that doctors could play in promoting IV among the Tunisian elderly. Physicians should correct misconceptions about adverse events and the efficiency of the vaccine. In fact, influenza vaccines are generally effective and safe among older persons.

Keywords: attitudes, influenza vaccination, older persons, Tunisia

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Authors: Guebli Abdelkader, Reguieg Madani, Belkadi Adel, Sbaa Bouabdellah

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The identification of mechanical variables in the motor performance trajectory has a prominent role in improving skill performance, error-exceeding, it contributes seriously to solving some problems of learning and training. The study aims to highlight the indicators of motor performance for Paralympic athletes during the practicing sports between modelling and between excellence in motor performance, this by taking into account the distinction of athlete practicing with special behavioral skills for the Paralympic athletes. In the study, we relied on the analysis of some previous research of biomechanical performance indicators during some of the events sports (shooting activities in the Paralympic athletics, shooting skill in the wheelchair basketball). The results of the study highlight the distinction of disabled practitioners of sporting events identified in motor performance during practice, by overcoming some physics indicators in human movement, as a lower center of body weight, increase in offset distance, such resistance which requires them to redouble their efforts. However, the results of the study highlighted the strength of the correlation between biomechanical variables of motor performance and the digital level achievement similar to the other practitioners normal.

Keywords: sports, the disabled, motor performance, Paralympic

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Authors: Bruno Tassin, Robin Treilles, Cleo Stratmann, Minh Trang Nguyen, Sam Azimi, Vincent Rocher, Rachid Dris, Johnny Gasperi

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Microplastics (<5mm) in the environment and in hydro systems is one of the major present environmental issues. Over the last five years a research programme was conducted in order to assess the behavior of microplastics in the Seine river catchment, in a Man-Land-Sea continuum approach. Results show that microplastic concentration varies at the seasonal scale, but also at much smaller scales, during flood events and with tides in the estuary for instance. Moreover, microplastic sampling and characterization issues emerged throughout this work. The Seine river is a 750km long river flowing in Northwestern France. It crosses the Paris megacity (12 millions inhabitants) and reaches the English Channel after a 170 km long estuary. This site is a very relevant one to assess the effect of anthropogenic pollution as the mean river flow is low (mean flow around 350m³/s) while the human presence and activities are very intense. Monthly monitoring of the microplastic concentration took place over a 19-month period and showed significant temporal variations at all sampling stations but no significant upstream-downstream increase, indicating a possible major sink to the sediment. At the scale of a major flood event (winter and spring 2018), microplastic concentration shows an evolution similar to the well-known suspended solids concentration, with an increase during the increase of the flow and a decrease during the decrease of the flow. Assessing the position of the concentration peak in relation to the flow peak was unfortunately impossible. In the estuary, concentrations vary with time in connection with tides movements and in the water column in relation to the salinity and the turbidity. Although major gains of knowledge on the microplastic dynamics in the Seine river have been obtained over the last years, major gaps remain to deal mostly with the interaction with the dynamics of the suspended solids, the selling processes in the water column and the resuspension by navigation or shear stress increase. Moreover, the development of efficient chemical characterization techniques during the 5 year period of this pluriannual research programme led to the improvement of the sampling techniques in order to access smaller microplastics (>10µm) as well as larger but rare ones (>500µm).

Keywords: microplastics, Paris megacity, seine river, suspended solids

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Authors: Andhiani Sharfina Arnellya, Mochammad Indra Permana, Dika Pramita Destiani, Ellin Febrina

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Health Research Data, Ministry of Health of Indonesia in 2007, showed coronary heart disease (CHD) or coronary artery disease (CAD) was the third leading cause of death in Indonesia after hypertension and stroke with 7.2% incidence rate. Antiplatelet is one of the important therapy in management of patients with CHD. In addition to therapeutic effect on patients, quality of life is one aspect of another assessment to see the success of antiplatelet therapy. The purpose of this study was to determine the quality of life of patients on oral antiplatelet therapy in outpatient cardiac department Dr. Hasan Sadikin central general hospital, Bandung, Indonesia. This research is a cross sectional by collecting data through quality of life questionnaire of patients which performed prospectively as primary data and secondary data from medical record of patients. The results of this study showed that 54.3% of patients had a good quality of life, 45% had a moderate quality of life, and 0.7% had a poor quality of life. There are no significant differences in quality of life-based on age, gender, diagnosis, and duration of drug use.

Keywords: antiplatelet, quality of life, coronary artery disease, coronary heart disease

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Authors: N. Kotabin, Y. Tahara, K. Issakul, O. Chunhachart

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Cadmium (II) (Cd) is one of the major toxic elemental pollutants which is hazardous for humans, animals and plants. γ-Polyglutamic acid (γ-PGA) is an extracellular biopolymer produced by several species of Bacillus which has been reported to be an effective biosorbent for metal ions. The effect of γ-PGA on growth of rice grown under laboratory conditions was investigated. Rice seeds were germinated and then grown at 30±1°C on filter paper soaked with Cd solution and γ-PGA for 7 days. The result showed that Cd significantly inhibited the growth of roots and shoots by reducing root and shoot lengths. Fresh and dry weights also decreased compared with control; however, the addition of 500 mg•L-1 γ-PGA alleviated rice seedlings from the adverse effects of Cd. The analysis of physiological traits revealed that Cd caused a decrease in the total chlorophyll and soluble protein contents and amylase activities in all treatments. The Cd content in seedling tissues increased for the Cd 250 μM treatment (P < 0.05) but the addition of 500 mg•L-1 γ-PGA resulted in a noticeable decrease in Cd (P < 0.05).

Keywords: polyglutamic acid, cadmium, rice, bacillus subtilis

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Authors: Vidhya Venugopal, Jeremiah Chinnadurai, Rebekah A. I. Lucas, Tord Kjellstrom, Bruno Lemke

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Introduction: The effects of climate change (CC) are largely discussed across the globe in terms of impacts on the environment and the general population, but the impacts on workers remain largely unexplored. The predicted rise in temperatures and heat events in the CC scenario have health implications on millions of workers in physically exerting jobs. The current health and productivity risks associated with heat exposures are characterized, future risk estimates as temperature rises and recommendations towards developing protective and preventive occupational health and safety guidelines for India are discussed. Methodology: Cross-sectional studies were conducted in several occupational sectors with workers engaged in moderate to heavy labor (n=1580). Quantitative data on heat exposures (WBGT°C), physiological heat strain indicators viz., Core temperature (CBT), Urine specific gravity (USG), Sweat rate (SwR) and qualitative data on heat-related health symptoms and productivity losses were collected. Data were analyzed for associations between heat exposures, health and productivity outcomes related to heat stress. Findings: Heat conditions exceeded the Threshold Limit Value (TLV) for safe manual work in 66% of the workers across several sectors (Avg.WBGT of 28.7°C±3.1°C). Widespread concerns about heat-related health outcomes (86%) were prevalent among workers exposed to high TLVs, with excessive sweating, fatigue and tiredness being commonly reported by workers. The heat stress indicators, core temperature (14%), Sweat rate (8%) and USG (9%), were above normal levels in the study population. A significant association was found between rise in Core Temperatures and WBGT exposures (p=0.000179) Elevated USG and SwR in the worker population indicate moderate dehydration, with potential risks of developing heat-related illnesses. In a steel industry with high heat exposures, an alarming 9% prevalence of kidney/urogenital anomalies was observed in a young workforce. Heat exposures above TLVs were associated with significantly increased odds of various adverse health outcomes (OR=2.43, 95% CI 1.88 to 3.13, p-value = <0.0001) and productivity losses (OR=1.79, 95% CI 1.32 to 2.4, p-value = 0.0002). Rough estimates for the number of workers who would be subjected to higher than TLV levels in the various RCP scenarios are RCP2.6 =79%, RCP4.5 & RCP6 = 81% and at RCP 8.5 = 85%. Rising temperatures due to CC has the capacity to further reduce already compromised health and productivity by subjecting the workers to increased heat exposures in the RCP scenarios are of concern for the country’s occupational health and economy. Conclusion: The findings of this study clearly identify that health protection from hot weather will become increasingly necessary in the Indian subcontinent and understanding the various adaptation techniques needs urgent attention. Further research with a multi-targeted approach to develop strategies for implementing interventions to protect the millions of workers is imperative. Approaches to include health aspects of climate change within sectoral and climate change specific policies should be encouraged, via a number of mechanisms, such as the “Health in All Policies” approach to avert adverse health and productivity consequences as climate change proceeds.

Keywords: heat stress, occupational health, productivity loss, heat strain, adverse health outcomes

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Authors: Sara Patricia Ibarra-Zavaleta, Rabindranarth Romero-Lopez, Rosario Langrave, Annie Poulin, Gerald Corzo, Mathias Glaus, Ricardo Vega-Azamar, Norma Angelica Oropeza

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The progressive change in climatic conditions worldwide has increased frequency and severity of extreme hydrometeorological events (EHE). Mexico is an example; this has been affected by the presence of EHE leaving economic, social and environmental losses. The objective of this research was to apply a Canadian distributed hydrological model (DHM) to tropical conditions and to evaluate its capacity to predict flows in a basin in the central Gulf of Mexico. In addition, the DHM (once calibrated and validated) was used to calculate the theoretical hydraulic power and the performance to predict streamflow before the presence of an EHE. The results of the DHM show that the goodness of fit indicators between the observed and simulated flows in the calibration process (NSE=0.83, RSR=0.021 and BIAS=-4.3) and validation: temporal was assessed at two points: point one (NSE=0.78, RSR=0.113 and BIAS=0.054) and point two (NSE=0.825, RSR=0.103 and BIAS=0.063) are satisfactory. The DHM showed its applicability in tropical environments and its ability to characterize the rainfall-runoff relationship in the study area. This work can serve as a tool for identifying vulnerabilities before floods and for the rational and sustainable management of water resources.

Keywords: HYDROTEL, hydraulic power, extreme hydrometeorological events, streamflow

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Authors: Masoud Swalehe, Semra Günay

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Developed countries are losing many lives to non-communicable diseases as compared to their developing counterparts. The effects of these diseases are mostly sudden and manifest at a very short time prior to death or a dangerous attack and this has consolidated the significance of emergency medical system (EMS) as one of the vital areas of healthcare service delivery. The primary objective of this research is to reduce ambulance response times (RT) of Eskişehir province EMS since a number of studies have established a relationship between ambulance response times and survival chances of patients especially out of hospital cardiac arrest (OHCA) victims. It has been found out that patients who receive out of hospital medical attention in few (4) minutes after cardiac arrest because of low ambulance response times stand higher chances of survival than their counterparts who take longer times (more than 12 minutes) to receive out of hospital medical care because of higher ambulance response times. The study will make use of geographic information systems (GIS) technology to dynamically reallocate ambulance resources according to demand and time so as to reduce ambulance response times. Geospatial-time distribution of ambulance calls (demand) will be used as a basis for optimal ambulance deployment using system status management (SSM) strategy to achieve much demand coverage with the same number of ambulance resources to cause response time reduction. Drive-time polygons will be used to come up with time specific facility coverage areas and suggesting additional facility candidate sites where ambulance resources can be moved to serve higher demands making use of network analysis techniques. Emergency Ambulance calls’ data from 1st January 2014 to 31st December 2014 obtained from Eskişehir province health directorate will be used in this study. This study will focus on the reduction of ambulance response times which is a key Emergency Medical Services performance indicator.

Keywords: emergency medical services, system status management, ambulance response times, geographic information system, geospatial-time distribution, out of hospital cardiac arrest

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Authors: Saule Balmagambetova, Zhenisgul Tlegenova, Saule Madinova

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Cardiotoxicity associated with anticancer treatment, now defined as cancer therapy-related cardiac dysfunction (CTRCD), accompanies cancer patients and negatively impacts their survivorship. Currently, a cardio-oncological service is being created in Kazakhstan based on the provisions of the European Society of Cardio-oncology (ESC) Guidelines. In the frames of a pilot project, a cohort study on CTRCD conditions was initiated at the Aktobe Cancer center. One hundred twenty-eight newly diagnosed breast cancer patients started on doxorubicin and/or trastuzumab were recruited. Echocardiography with global longitudinal strain (GLS) assessment, biomarkers panel (cardiac troponin (cTnI), brain natriuretic peptide (BNP), myeloperoxidase (MPO), galectin-3 (Gal-3), D-dimers, C-reactive protein (CRP)), and other tests were performed at baseline and every three months. Patients were stratified by the cardiovascular risks according to the ESC recommendations and allocated into the risk groups during the pre-treatment visit. Of them, 10 (7.8%) patients were assigned to the high-risk group, 48 (37.5%) to the medium-risk group, and 70 (54.7%) to the low-risk group, respectively. High-risk patients have been receiving their cardioprotective treatment from the outset. Patients were also divided by treatment - in the anthracycline-based 83 (64.8%), in trastuzumab- only 13 (10.2%), and in the mixed anthracycline/trastuzumab group 32 individuals (25%), respectively. Mild symptomatic CTRCD was revealed and treated in 2 (1.6%) participants, and a mild asymptomatic variant in 26 (20.5%). Mild asymptomatic conditions are defined as left ventricular ejection fraction (LVEF) ≥50% and further relative reduction in GLS by >15% from baseline and/or a further rise in cardiac biomarkers. The listed biomarkers were assessed longitudinally in repeated-measures linear regression models during 12 months of observation. The associations between changes in biomarkers and CTRCD and between changes in biomarkers and LVEF were evaluated. Analysis by risk groups revealed statistically significant differences in baseline LVEF scores (p 0.001), BNP (p 0.0075), and Gal-3 (p 0.0073). Treatment groups found no statistically significant differences at baseline. After 12 months of follow-up, only LVEF values showed a statistically significant difference by risk groups (p 0.0011). When assessing the temporal changes in the studied parameters for all treatment groups, there were statistically significant changes from visit to visit for LVEF (p 0.003); GLS (p 0.0001); BNP (p<0.00001); MPO (p<0.0001); and Gal-3 (p<0.0001). No moderate or strong correlations were found between the biomarkers values and LVEF, between biomarkers and GLS. Between the biomarkers themselves, a moderate, close to strong correlation was established between cTnI and D-dimer (r 0.65, p<0.05). The dose-dependent effect of anthracyclines has been confirmed: the summary dose has a moderate negative impact on GLS values: -r 0.31 for all treatment groups (p<0.05). The present study found myeloperoxidase as a promising biomarker of cardiac dysfunction in the mixed anthracycline/trastuzumab treatment group. The hazard of CTRCD increased by 24% (HR 1.21; 95% CI 1.01;1.73) per doubling in baseline MPO value (p 0.041). Increases in BNP were also associated with CTRCD (HR per doubling, 1.22; 95% CI 1.12;1.69). No cases of chemotherapy discontinuation due to cardiotoxic complications have been recorded. Further observations are needed to gain insight into the ability of biomarkers to predict CTRCD onset.

Keywords: breast cancer, chemotherapy, cardiotoxicity, Kazakhstan

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Authors: Swanand Pathak, Kiran R. Giri, Reena R. Giri, Kamlesh Palandurkar, Sangita Totade, Rajesh Jha, S. S. Patel

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Background: Population burden, illiteracy, availability of few doctors for larger group of population leads to many unanswered questions left in a patient’s mind. Incomplete information results into noncompliance, therapeutic failure, and adverse drug reactions (ADR). It is very important to establish a system which will provide noncommercial, independent, unbiased source of medicine information. Medicines Info OPD is a concept and step towards safe and appropriate use of medicines. Objective: (1) to assess the present status of knowledge about the medicines in the patients and its correlation with education; (2) to assess the medicine information dispensing modalities, their use and sufficiency from the patients view point; (3) to assess the overall need for Medicines Information OPD in present scenario. Materials and Methods: A pre-validated questionnaire based study was conducted amongst 500 patients of tertiary health care hospital. The questionnaire consisted of specific questions regarding understanding of prescription, knowledge about adverse drug reaction, view about self-medication and opinion regarding the need of Medicines Info OPD. Results: Significantly large proportion of patients opined that doctors do not have sufficient time in current Indian healthcare to explain the prescription and they are not aware of adverse drug reactions, expiry date or use the package inserts etc. Conclusion: Clinically relevant, up to date, user specific, independent, objective and unbiased Medicines Info OPD is essential for appropriate drug use and can help in a big way to common public to address many problems faced by them.

Keywords: information, prescription, unbiased, clinically relevant

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Authors: Soo Hyung Kim

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Two different learning approaches were suggested: focusing on factual knowledge or focusing on the embedded meaning in the statements. Each way of learning has positive effects on different question categories, where factual knowledge helps more with simple fact questions, and searching for meaning in given information helps learn causal relationship and the embedded meaning. To test this belief, two groups of learners (12 male and 39 female adults aged 18-37) watched a ten-minute long Youtube video about various factual events of American history, their meaning, and the causal relations of the events. The fact group was asked to focus on factual knowledge in the video, and the meaning group was asked to focus on the embedded meaning in the video. After watching the video, both groups took multiple-choice questions, which consisted of 10 questions asking the factual knowledge addressed in the video and 10 questions asking embedded meaning in the video, such as the causal relationship between historical events and the significance of the event. From ANCOVA analysis, it was found that the factual knowledge showed higher performance on the factual questions than the meaning group, although there was no group difference on the questions about the meaning between the two groups. The finding suggests that teacher instruction plays an important role in learners constructing a different type of knowledge in online learning.

Keywords: factual knowledge, instruction, meaning-based knowledge, online learning

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Authors: Szu-Hua Wang

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Urban ecosystems, as complex coupled human-environment systems, contain abundant natural resources for breeding natural assets and, at the same time, attract urban assets and consume natural resources, triggered by urban development. Land use change illustrates the interaction between human activities and environments factually. However, IPCC (2014) announces that land use change and urbanization due to human activities are the major cause of climate change, leading to serious impacts on urban ecosystem resilience and risk. For this reason, risk assessment and resilience analysis are the keys for responding to climate change on urban ecosystems. Urban spatial planning can guide urban development by land use planning, transportation planning, and environmental planning and affect land use allocation and human activities by building major constructions and protecting important national land resources simultaneously. Urban spatial planning can aggravate climate change and, on the other hand, mitigate and adapt climate change. Research on effects of spatial planning on land use change and climate change is one of intense issues currently. Therefore, this research focuses on developing frameworks for risk assessment and resilience analysis from the aspect of ecosystem based on typhoon precipitation in Taipei area. The integrated method of risk assessment and resilience analysis will be also addressed for applying spatial planning practice and sustainable development.

Keywords: ecosystem, land use change, risk analysis, resilience

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Authors: Hidayah bt Rahmalan, Marhazli Kipli, Muhammad Suffian Sikandar Ghani, Maisarah Abu, Muhammad Faisal Ashaari, Norlizam Md Sukiban

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This study presents an example of activity management system for e-Masjid implementing elements of usability and sociability. It is expected to resolve the shortcomings of the most e-Masjid that provide lot of activities to their community. However, the data on handling a lot of activities or events in which involve a lot of people will be difficult to manipulate. Thus, this paper presents the usability and sociability element on an activity management system that not only eases the job for the user but being practical for future when the community join any events. For the time being, this activity management system was only applied for Sayyidina Abu Bakar Mosque in Utem, Malacca.

Keywords: e-masjid, usability, sociability, activity management system

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Authors: Ow Tze Weng, Suhaila Isaak, Yusmeeraz Yusof

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The trend of health care screening devices in the world is increasingly towards the favor of portability and wearability, especially in the most common electrocardiogram (ECG) monitoring system. This is because these wearable screening devices are not restricting the patient’s freedom and daily activities. While the demand of low power and low cost biomedical system on chip (SoC) is increasing in exponential way, the front end ECG sensors are still suffering from flicker noise for low frequency cardiac signal acquisition, 50 Hz power line electromagnetic interference, and the large unstable input offsets due to the electrode-skin interface is not attached properly. In this paper, a high performance CMOS amplifier for ECG sensors that suitable for low power wearable cardiac screening is proposed. The amplifier adopts the highly stable folded cascode topology and later being implemented into RC feedback circuit for low frequency DC offset cancellation. By using 0.13 µm CMOS technology from Silterra, the simulation results show that this front end circuit can achieve a very low input referred noise of 1 pV/√Hz and high common mode rejection ratio (CMRR) of 174.05 dB. It also gives voltage gain of 75.45 dB with good power supply rejection ratio (PSSR) of 92.12 dB. The total power consumption is only 3 µW and thus suitable to be implemented with further signal processing and classification back end for low power biomedical SoC.

Keywords: CMOS, ECG, amplifier, low power

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Authors: Mustapha Kamel Mihoubi, Reda Madi

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The problem of natural disasters in general and flooding in particular is a topic which marks a memorable action in the world and specifically in cities and large urban areas. Torrential floods and faster flows pose a major problem in urban area. Indeed, a better management of risks of floods becomes a growing necessity that must mobilize technical and scientific means to curb the adverse consequences of this phenomenon, especially in the Saharan cities in arid climate. The aim of this study is to deploy a basic calculation approach based on a hydrologic and hydraulic quantification for locating the black spots in urban areas generated by the flooding and to locate the areas that are vulnerable to flooding. The principle of flooding method is applied to the city of Ghardaia to identify vulnerable areas to inundation and to establish maps management and prevention against the risks of flooding.

Keywords: Alea, Beni Mzab, cartography, HEC-RAS, inundation, torrential, vulnerability, wadi

Procedia PDF Downloads 282

Authors: Somayeh Khanjani, Samaneh Nabavi, Shirin Jalili

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Aluminum phosphide (ALP) is an inorganic phosphide used to control insects and is a highly effective insecticide and rodenticide used frequently to protect stored grain. Acute poisoning with this compound is common in some countries including India and Iran, and is a serious health problem. In Iran it was known as "rice tablet", for its use to preserve rice. Two kinds of rice tablets one being herbal while other containing 3g aluminum phosphide (AlP) are available for use in Iranian households to protect stored food grains from pests and rodents. The toxicity of Aluminum phosphide is attributed to the liberation of phosphine gas in contact with water or weak acid and is the major cause of poisoning and deaths. Rice tablet (Aluminum Phosphid) poisoning may be associated with serious and sometimes incurable complications. In 61.3% of patients were shown uniform ingestion. Vomiting was the most common symptoms reported by 96.4% patients. Agitation was reported in 36.9% and felling of thirsty in 27.9 %. Although many complications such as Hypotension, Adult Respiratory Distress Syndrome (ARDS), Acute Renal Failure (ARF) AND Multi Organ Failure (MOF) were the common complications observed in these patients, but the most lethal complication was Cardiac Arrhythmias occurred in 36.9% of cases. Abdominal pain in 31.4% of the patients, nausea in 79.4% of the patients and 41.1% of the patients showed metabolic acidosis. Suicidal intention was the most common cause of poisoning leading to deaths in 18.6% of the patients. Aluminum phosphide can cause either elevation, decrease or no change in electrolytes, bicarbonate and blood glucose level. The possible mechanism for changes in blood glucose levels are complex and depend on the balance of factors which increase its concentration and those which reduce it. AlP poisoning has been postulated to stimulate cortisol which leads to increasing blood level of cortisol, also it may cause stimulation of glucagon, and Adrenaline secretion; in addition, it can inhibit insulin synthesis which may lead to hyperglycemia. Another suggested mechanism of hyperglycemia is rennin activity in some cases, an increase in magnesium level of plasma and that of tissues, and high phosphate level. Although hyperglycemia is most frequent in this poisoning and also is known as a marker of poor prognostic, hypoglycemia in aluminum phosphide poisoning is a rare finding which may be so dangerous. Patients showed sever hypotension and sever acidosis in addition to sever hypoglycemia. The presenting features of AlP intoxication are rapid onset of shock, severe metabolic acidosis, cardiac dysrhythmias and adult respiratory distress syndrome (ARDS).

Keywords: aluminum phosphide (ALP), rice tablet, poisoning, phosphine gas

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Authors: Fatimazahrae Elbakri, Azeddine Ibrahimi, Meryem Lemrani, Dris Belghyti

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Leishmaniasis represents a major public health problem because of the number of cases recorded each year and the wide distribution of the disease. It is a parasitic disease of flagellated protozoa transmitted by the bite of certain species of sandfly, causing a spectrum of clinical pathology in humans ranging from disfiguring skin lesions to fatal visceral leishmaniasis. Cutaneous leishmaniasis due to Leishmania major is a polymorphic disease; in fact, the infection can be asymptomatic, localized, or disseminated. The objective of this work is to determine the genomic diversity that contributes to clinical variability by trying to identify the variation in chromosome number and to extract SNPs and SNPs and InDels; it is based on four sequences (WGS) of Leishmania major available on NCBI in Fastq form, from three countries: Tunisia, Algeria, and Israel, the analysis is set up from a pipeline to facilitate the discovery of genetic diversity, in particular SNP and chromosomal somy.

Keywords: Leshmania major, cutaneous Leishmania, NGS, genomic, somy, variant calling

Procedia PDF Downloads 59

Authors: Miroslav Dumbrovsky

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The paper deals with impacts of climate change with the main emphasis on land degradation, agriculture and forestry management in the landscape. Land degradation, due to adverse effect of farmers activities, as a result of inappropriate conventional technologies, was a major issue in the Czech Republic during the 20th century and will remain for solving in the 21st century. The importance of land degradation is very high because of its impact on crop productivity and many other adverse effects. Land degradation through soil degradation is causing losses on crop productivity and quality of the environment, through decreasing quality of soil and water (especially water resources). Negative effects of conventional farming practices are increased water erosion, as well as crusting and compaction of the topsoil and subsoil. Soil erosion caused by water destructs the soil’s structure, reduces crop productivity due to deterioration in soil physical and chemical properties such as infiltration rate, water-holding capacity, loss of nutrients needed for crop production, and loss of soil carbon. Water erosion occurs on fields with row crops (maize, sunflower), especially during the rainfall period from April to October. Recently there is a serious problem of greatly expanded production of biofuels and bioenergy from field crops. The result is accelerated soil degradation. The damages (on and off- site) are greater than the benefits. An effective soil conservation requires an appropriate complex system of measures in the landscape. They are also important to continue to develop new sophisticated methods and technologies for decreasing land degradation. The system of soil conservation solving land degradation depend on the ability and the willingness of land users to apply them. When we talk about land degradation, it is not just a technical issue but also an economic and political issue. From a technical point of view, we have already made many positive steps, but for successful solving the problem of land degradation is necessary to develop suitable economic and political tools to increase the willingness and ability of land users to adopt conservation measures.

Keywords: land degradation, soil erosion, soil conservation, climate change

Procedia PDF Downloads 357

Authors: Tao Zhang

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As the competition of all kinds of festival events becomes more and more fierce, more and more event organizers try to design a blended festivalscape by integrating multifaceted environmental cues in order to raise the service quality of festival events and then raise visitors’ satisfaction. As the main type of festival events, food festivals are popular in all over the world. The organizers’ of food festivals also try to mix food with multifaceted environmental cues (e.g., music, stage, light, dance) to design a blended festivalscape. However, until now little studies explore the environmental cues of food festivals and their relationship with visitors’ satisfaction. Therefore, the aim of this study is to ascertain the environmental cues of food festival and their relationship with visitors’ satisfaction by using the blended festivalscape theory. Using convenient sampling method, this study investigated 1,000 food festival visitors in Macau. Factor analysis showed there are mainly six environmental cues (i.e., food, atmosphere, program, staff, facility, and information). All six environmental cues are positively related with visitors’ satisfaction, while the most influential factors are food, atmosphere, and program. This study showed that festival event organizers’ should focus on the topic of their festival event, build festival atmosphere, and create interesting programs in order to design a blended festivalscape and then raise visitors’ satisfaction.

Keywords: environmental cue, event, festival, satisfaction

Procedia PDF Downloads 344

Authors: Majid Bayatian, Mohammadreza Ashouri

Abstract:

Releasing hazardous chemicals is one of the major problems for office buildings in the chemical industry and, therefore, environmental risks are inherent to these environments. The adverse health effects of the airborne concentration of benzene have been a matter of significant concern, especially in oil refineries. The chronic and acute adverse health effects caused by benzene exposure have attracted wide attention. Acute exposure to benzene through inhalation could cause headaches, dizziness, drowsiness, and irritation of the skin. Chronic exposures have reported causing aplastic anemia and leukemia at the occupational settings. Association between chronic occupational exposure to benzene and the development of aplastic anemia and leukemia were documented by several epidemiological studies. Numerous research works have investigated benzene emissions and determined benzene concentration at different locations of the refinery plant and stated considerable health risks. The high cost of industrial control measures requires justification through lifetime health risk assessment of exposed workers and the public. In the present study, a Computational Fluid Dynamics (CFD) model has been proposed to assess the exposure risk of office building around a refinery due to its release of benzene. For simulation, GAMBIT, FLUENT, and CFD Post software were used as pre-processor, processor, and post-processor, and the model was validated based on comparison with experimental results of benzene concentration and wind speed. Model validation results showed that the model is highly validated, and this model can be used for health risk assessment. The simulation and risk assessment results showed that benzene could be dispersion to an office building nearby, and the exposure risk has been unacceptable. According to the results of this study, a validated CFD model, could be very useful for decision-makers for control measures and possibly support them for emergency planning of probable accidents. Also, this model can be used to assess exposure to various types of accidents as well as other pollutants such as toluene, xylene, and ethylbenzene in different atmospheric conditions.

Keywords: health risk assessment, office building, Benzene, numerical simulation, CFD

Procedia PDF Downloads 106

Authors: Roya Vakili, Lekaa Elhajjmoussa, Barzin Omidi-Shal, Kim Blake

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Objective: The purpose of this case report is to highlight the successful treatment of a patient with Coloboma, Heart defect, Atresia choanae, Retarded growth and development, Genital hypoplasia, Ear anomalies/deafness, (CHARGE syndrome) using a vagal nerve stimulator (VNS). Background: This is the first documented case report, to the authors' best knowledge, for a patient with CHARGE syndrome, epilepsy, autism, and postural orthostatic tachycardia syndrome (POTS) that was successfully treated with an implanted VNS therapeutic device. Methodology: The study is a case report. Results: This is the case of a 24-year-old female patient with CHARGE syndrome (non-random association of anomalies Coloboma, Heart defect, Atresia choanae, Retarded growth and development, Genital hypoplasia, Ear anomalies/deafness) and several other comorbidities including refractory epilepsy, Patent Ductus Arteriosus (PDA) and POTS who had significant improvement of her symptoms after VNS implantation. She was a VNS candidate given her longstanding history of drug-resistant epilepsy and current disposition secondary to CHARGE syndrome. Prior to VNS implantation, she experienced three generalized seizures a year and daily POTS-related symptoms. She was having frequent lightheadedness and syncope spells due to a rapid heart rate and low blood pressure. The VNS device was set to detect a rapid heart rate and send appropriate stimulation anytime the heart rate exceeded 20% of the patient’s normal baseline. The VNS device demonstrated frequent elevated heart rates and concurrent VNS release every 8 minutes in addition to the programmed events. Following VNS installation, the patient became more active, alert, and communicative and was able to verbally communicate with words she was unable to say prior. Her GI symptoms also improved, as she was able to tolerate food better orally in addition to her G and J tube, likely another result of the vagal nerve stimulation. Additionally, the patient’s seizures and POTS-related cardiac events appeared to be well controlled. She had prolonged electroencephalogram (EEG) testing, showing no significant change in epileptiform activity. Improvements in the patient’s disposition are believed to be secondary to parasympathetic stimulation, adequate heart rate control, and GI stimulation, in addition to behavioral changes and other benefits via her implanted VNS. Conclusion: VNS showed promising results in improving the patient's quality of life and managing her diverse symptoms, including dysautonomia, POTs, gastrointestinal mobility, cognitive functioning as well seizure control.

Keywords: autism, POTs, CHARGE, VNS

Procedia PDF Downloads 62

Authors: Pawan Kumar, Dhananjoy Shaw, Manoj Kumar Rathi

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Purpose of the study were to compare between (a) frequencies among the four quartiles of percentile norms of autonomic variables from power events and (b) frequencies among the four quartiles percentile norms of autonomic variables from aerobic events of Indian sportspersons withdrawn from competitive games and sports in regard to number of samples falling in each quartile. The study was conducted on 430 males of 30 to 35 years of age. Based on the nature of game/sports the retired sportspersons were classified into power events (throwers, judo players, wrestlers, short distance swimmers, cricket fast bowlers and power lifters) and aerobic events (long distance runners, long distance swimmers, water polo players). Date was collected using ECG polygraphs. Data were processed and extracted using frequency domain analysis and time domain analysis. Collected data were computed with frequency, percentage of each quartile and finally the frequencies were compared with the chi square analysis. The finding pertaining to norm reference comparison of frequencies among the four quartiles of Indian sportspersons withdrawn from competitive games and sports from (a) power events suggests that frequency distribution in four quartile namely Q1, Q2, Q3, and Q4 are significantly different at .05 level in regard to variables namely, SDNN, Total Power (Absolute Power), HF (Absolute Power), LF (Normalized Power), HF (Normalized Power), LF/HF ratio, deep breathing test, expiratory respiratory ratio, valsalva manoeuvre, hand grip test, cold pressor test and lying to standing test, whereas, insignificantly different at .05 level in regard to variables namely, SDSD, RMSSD, SDANN, NN50 Count, pNN50 Count, LF (Absolute Power) and 30: 15 Ratio (b) aerobic events suggests that frequency distribution in four quartile are significantly different at .05 level in regard to variables namely, SDNN, LF (Normalized Power), HF (Normalized Power), LF/HF ratio, deep breathing test, expiratory respiratory ratio, hand grip test, cold pressor test, lying to standing test and 30: 15 ratio, whereas, insignificantly different at .05 level in regard to variables namely, SDSD, RMSSD. SDANN, NN50 count, pNN50 count, Total Power (Absolute Power), LF(Absolute Power) HF(Absolute Power), and valsalva manoeuvre. The study concluded that comparison of frequencies among the four quartiles of Indian retired sportspersons from power events and aerobic events are different in four quartiles in regard to selected autonomic functions, hence the developed percentile norms are not homogenously distributed across the percentile scale; hence strengthen the percentage distribution towards normal distribution.

Keywords: power, aerobic, absolute power, normalized power

Procedia PDF Downloads 334