Search results for: general hospital

Authors: P. van Tonder, U. Bagdadi, B. M. D. Lario, Z. Masina, T. R. Motshwari

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This paper analyses how concrete reinforcing steel bars corrode and how it can be minimised through the use of various protection methods against corrosion, such as metal-based paint, alloying, cathodic protection and electroplating. Samples of carbon steel bars were protected, using these four methods. Tests performed on the samples included durability, electrical resistivity and bond strength. Durability results indicated relatively low corrosion rates for alloying, cathodic protection, electroplating and metal-based paint. The resistivity results indicate all samples experienced a downward trend, despite erratic fluctuations in the data, indicating an inverse relationship between electrical resistivity and corrosion rate. The results indicated lowered bond strengths when the reinforced concrete was cured in seawater compared to being cured in normal water. It also showed that higher design compressive strengths lead to higher bond strengths which can be used to compensate for the loss of bond strength due to corrosion in a real-world application. In terms of implications, all protection methods have the potential to be effective at resisting corrosion in real-world applications, especially the alloying, cathodic protection and electroplating methods. The metal-based paint underperformed by comparison, most likely due to the nature of paint in general which can fade and chip away, revealing the steel samples and exposing them to corrosion. For alloying, stainless steel is the suggested material of choice, where Y-bars are highly recommended as smooth bars have a much-lowered bond strength. Cathodic protection performed the best of all in protecting the sample from corrosion, however, its real-world application would require significant evaluation into the feasibility of such a method.

Keywords: protection methods, corrosion, concrete, reinforcing steel bars

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Authors: Davies Obaromi, Qin Yongsong, James Ndege

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To interpolate scattered or regularly distributed data, there are imprecise or exact methods. However, there are some of these methods that could be used for interpolating data in a regular grid and others in an irregular grid. In spatial epidemiology, it is important to examine how a disease prevalence rates are distributed in space, and how they relate with each other within a defined distance and direction. In this study, for the geographic and graphic representation of the disease prevalence, linear and biharmonic spline methods were implemented in MATLAB, and used to identify, localize and compare for smoothing in the distribution patterns of tuberculosis (TB) in Eastern Cape Province. The aim of this study is to produce a more “smooth” graphical disease map for TB prevalence patterns by a 3-D curve fitting techniques, especially the biharmonic splines that can suppress noise easily, by seeking a least-squares fit rather than exact interpolation. The datasets are represented generally as a 3D or XYZ triplets, where X and Y are the spatial coordinates and Z is the variable of interest and in this case, TB counts in the province. This smoothing spline is a method of fitting a smooth curve to a set of noisy observations using a spline function, and it has also become the conventional method for its high precision, simplicity and flexibility. Surface and contour plots are produced for the TB prevalence at the provincial level for 2012 – 2015. From the results, the general outlook of all the fittings showed a systematic pattern in the distribution of TB cases in the province and this is consistent with some spatial statistical analyses carried out in the province. This new method is rarely used in disease mapping applications, but it has a superior advantage to be assessed at subjective locations rather than only on a rectangular grid as seen in most traditional GIS methods of geospatial analyses.

Keywords: linear, biharmonic splines, tuberculosis, South Africa

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Authors: Asibor Godwin, Adeniyi Funsho

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This study was carried out to investigate the impact of biological treated effluent on the physico-chemical properties of receiving waterbodies and also to establish its suitability for other purposes. It focused on the changes of some physic-chemical variables as one move away from the point of discharge downstream of the waterbodies. Water samples were collected from 14 sampling stations made up of the untreated effluent, treated effluent and receiving streams (before and after treated effluent discharge) over a period of 6 months spanning the dry and rainy seasons. Analyses were carried out on the following: temperature, turbidity, pH, conductivity, major anions and cation, dissolved oxygen, percentage oxygen Saturation, biological oxygen demand (BOD), solids (total solids, suspended solids and dissolved solids), nitrates, phosphates, organic matter and flow discharge using standard analytical methods. The relationships between investigated sites with regards to their physico-chemical properties were analyzed using student-t statistics. Also changes in the treated effluent receiving streams after treated effluent outfall was discussed fully. The physico-chemical water quality of the receiving water bodies meets most of the general water requirements for both domestic and industrial uses. The untreated effluent quality was shown to be of biological origin based on the biological oxygen demand, chloride, dissolved oxygen, total solids, pH and organic matter. The treated effluent showed significant improvement over the raw untreated effluent based on most parameters assessed. There was a significant difference (p<0.05) between the physico-chemical quality of untreated effluent and the treated effluent for the most of the investigated physico-chemical quality. The difference between the discharged treated effluent and the unimpacted section of the receiving waterbodies was also significant (p<0.05) for the most of the physico-chemical parameters.

Keywords: eflluent, Opa River, physico-chemical, waterbody

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Authors: Seung-Min Ko, Seung-Jai Choi, Gun Jung, Jang-Ho Jay Kim

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Although extensive explosion-related research has been performed in the past several decades, almost no research has focused on internal blasts. However, internal blast research is needed to understand about the behavior of a containment structure or building under internal blast loading, as in the case of the Chornobyl and Fukushima nuclear accidents. Therefore, the internal blast study concentrated on RC and PSC structures is performed. The test data obtained from reinforced concrete (RC) and prestressed concrete (PSC) tubular structures applied with an internal explosion using ammonium nitrate/fuel oil (ANFO) charge are used to assess their deformation resistance and ultimate failure load based on the structural stiffness change under various charge weight. For the internal blast charge weight, ANFO explosive charge weights of 15.88, 20.41, 22.68 and 24.95 kg were selected for the RC tubular structures, and 22.68, 24.95, 27.22, 29.48, and 31.75 kg were selected for PSC tubular structures, which were detonated at the center of cross section at the mid-span with a standoff distance of 1,000mm to the inner wall surface. Then, the test data were used to predict the internal charge weight required to fail a real scale reinforced concrete containment vessels (RCCV) and prestressed concrete containment vessel (PCCV). Then, the analytical results based on the experimental data were derived using the simple assumptions of the models, and another approach using the stiffness, deformation and explosion weight relationship was used to formulate a general method for analyzing internal blasted tubular structures. A model of the internal explosion of a steel tube was used as an example for validation. The proposed method can be used generically, using factors according to the material characteristics of the target structures. The results of the study are discussed in detail in the paper.

Keywords: internal blast, reinforced concrete, RCCV, PCCV, stiffness, blast safety

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Authors: Madhur Verma, Meena Rajput, Kamal Kishore

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Background: The general view that obesity is a problem of prosperous Western countries has been repealed with substantial evidence showing that middle-income countries like India are now at the heart of a fat explosion. Neck circumference has evolved as a promising index to measure obesity, because of the convenience of its use, even in culture sensitive population. Objectives: To determine whether neck circumference (NC) was associated with overweight and obesity and contributed to the prediction like other classical anthropometric indices. Methodology: Cross-sectional study consisting of 1080 adults (> 19 years) selected through Multi-stage random sampling between August 2013 and September 2014 using the pretested semi-structured questionnaire. After recruitment, the demographic and anthropometric parameters [BMI, Waist & Hip Circumference (WC, HC), Waist to hip ratio (WHR), waist to height ratio (WHtR), body fat percentage (BF %), neck circumference (NC)] were recorded & calculated as per standard procedures. Analysis was done using appropriate statistical tests. (SPSS, version 21.) Results: Mean age of study participants was 44.55+15.65 years. Overall prevalence of overweight & obesity as per modified criteria for Asian Indians (BMI ≥ 23 kg/m2) was 49.62% (Females-51.48%; Males-47.77%). Also, number of participants having high WHR, WHtR, BF%, WC & NC was 827(76.57%), 530(49.07%), 513(47.5%), 537(49.72%) & 376(34.81%) respectively. Variation of NC, BMI & BF% with age was non- significant. In both the genders, as per the Pearson’s correlational analysis, neck circumference was positively correlated with BMI (men, r=0.670 {p < 0.05}; women, r=0.564 {p < 0.05}), BF% (men, r=0.407 {p < 0.05}; women, r= 0.283 {p < 0.05}), WC (men, r=0.598{p < 0.05}; women, r=0.615 {p < 0.05}), HC (men, r=0.512{p < 0.05}; women, r=0.523{p < 0.05}), WHR (men, r= 0.380{p > 0.05}; women, r=0.022{p > 0.05}) & WHtR (men, r=0.318 {p < 0.05}; women, r=0.396{p < 0.05}). On ROC analysis, NC showed good discriminatory power to identify obesity with AUC (AUC for males: 0.822 & females: 0.873; p- value < 0.001) with maximum sensitivity and specificity at a cut-off value of 36.55 cms for males & 34.05cms for females. Conclusion: NC has fair validity as a community-based screener for overweight and obese individuals in the study context and has also correlated well with other classical indices.

Keywords: neck circumference, obesity, anthropometric indices, body fat percentage

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Authors: P. Nafisi Poor, P. Javid

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Religion and divinity have always held important meaning to humans, and therefore it affects different aspects of life including art and architecture. Numerous works of art are related to religion whether supporting or denying it. Religion and religious scholars have influenced and changed art throughout history. This paper focuses on Islam and Christianity because these two religions have been the most discussed and most popular of all time, starting from the birth of Jesus to the arrival of Mohammad. Based on this popularity, these religions have influenced the arts and especially architecture. Islam on one hand changed Iranian and Arabian architecture and they applied it in different places around the world. From the appearance of Islam at 622 AD to this day, Islamic architecture has been evolving; however, one of the most important periods for this style was between 1501 AD and 1736 AD in Iran. Christianity, on the other hand, changed European architecture especially between 1150 AD and 1450 AD or the so-called "Gothic" era, which begins at medieval time and reaches its peak at International Gothic ages. At both of these periods, designing buildings based on spiritual concepts and divine statements reached its peak, and architects were considering God and religion as their center of attention. This article studies the focus on the religions of Islam and Christianity in terms of architecture and presents a general philosophy of both styles to comprehend the idea behind each one, followed by an analysis of their geometry and architectural aspects derived from the best examples, all to understand the purpose of each style and to realize, which one was more successful in reaching their purpose. Subsequently, a comprehensive review of each building is provided including 3D visualizations to help achieve the goal of the article. These studies can support diverse inquiries about both Islamic and Gothic architecture and can be used as a resource to support studies and research towards designing based on religion or for divine purposes.

Keywords: architecture, Gothic, Islamic, religion

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Authors: M. M. S. Prahastomi, M. Muhajir Saputra, Axel Derian

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Lapindo mud (LUSI ) phenomenon which occurred in Sidoarjo 2006 is a national scale of the geological phenomenon. This mudflow forms a mud volcano that spreads by time is in the need of serious treatment. Some further research has been conducted either by the application method of geodesy, geophysics, and subsurface geology, but still remains a mystery to this phenomenon. Sidoarjo Physiographic regions are included in the Kendeng zone flanked by Rembang zones in northern and Solo zones in southern. In this region revealed Kabuh formation, Jombang formation, and alluvium. In general, in the northern part of the area is composed of sedimentary rocks Sidoarjo klastika, epiklastic, pyroclastics, and older alluvium of the Early Pleistocene to Resen. The study was conducted with the literature study of the stratigraphy and regional geology as well as secondary data from observations coupled gravity method (Anomaly Bouger). The aim of the study is to reveal the subsurface geology structure pattern and the changes in mass flow. Gravity anomaly data were obtained from the calculation of the value of gravity and altitude, then processed into gravity anomaly contours which reflect changes in density of each group observed gravity. The gravity data could indicate a bottom surface which deformation occur the stronger or more intense to the south. Deformation in the form of gravity impairment was associated with a decrease in future density which is indicated by the presence of gas, water and gas bursts. Sectional analysis of changes in the measured value of gravity at different times indicates a change in the value of gravity caused by the presence of subsurface subsidence. While the gravity anomaly section describes the fault zone causes the zone to be unstable.

Keywords: mud volcano, Lumpur Sidoarjo, Bouger anomaly, Indonesia

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Authors: Made Kurnia Widiastuti Giri, Nyoman Kanca, Arie Swastini, Bambang Purwanto

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Aim: Waria transgenders are a phenomenon whose existence is undeniable. The sexual behaviours of waria transgenders belong to the groups of high-risk STDs infections, especially HIV/AIDS. The present study was aimed at finding out the general idea of the existence of waria transgenders in Singaraja, their sexual transactions, their sexual behaviours, and at exploring the factors affecting their sexual behaviours along with their participation in regular reproduction health control. Methods: The subjects of the present research were male-to-female transgenders living in the town of Singaraja. The research applied a qualitative approach. Data collection in this research was conducted through in-depth interview and observation. Results: The results of the study exposed 1) the existence of waria transgender community in Singaraja observed from their active participation in social events such as taking the roles of counsellors in the campaign of prevention and control of HIV/AIDS with the Local Commission of AIDS Control and other foundations; 2) the sexual services provided by waria transgenders which were performed in squeeze method, oral and anal sex which could be categorized as HIV/AIDS high-risk sexual behaviours, while the consistency in doing safe sex among the trangenders in Singaraja showed that most of the waria transgenders (80%) were aware of the urgency of using condoms during sexual intercourse; and 3) the low participation of the waria transgenders in Singaraja in regular reproduction health check up at the local Centre of Public Health Service was caused by their negative perception about being examined by female doctors. Conclucions: Waria in singaraja categorized as HIV/AIDS high-risk sexual behaviours but they do have consistency in doing safe sex by using condoms. They have a negative psychological perception about being examined by female doctors.

Keywords: waria transgenders, sexual behaviours, reproduction health, hiv/aids

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Authors: Kimberly Joyce A. Roguis, Mica Lorraine L. Fernando, Alan Vito B. Macadangdang, Jennina Mari C. Mijares, Maria Carinnes A. Gonzalez

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The paper showcases the vulnerability of the tourism industry especially the inevitable occurrence of natural disasters, implicating the necessity for post-disaster analysis on tourist attractions. This study discusses the aftermath of the super typhoon ‘Yolanda’ incident in the locality of Coron Island, Palawan, assessing its general effect on the community and its tourism livelihood through the analysis of responses from key role-players in the tourism industry of the area gathered through semi-structured interviews and direct observation. The local government’s instigation of recovery programs to their locality has been a pivotal factor in reviving the vitality of their tourism industry and the involvement of the community has been the determining condition that shifted the industry towards revival a year after the incidence. The study illuminates the disaster mitigation processes in the local tourism livelihood perspective, predominantly the diving industry. It did not suffer physical damage to a great extent but was affected because of the public imagery the disaster brought upon. Collaboration between the local government and the community is the highlight of the research for they maneuvered recovery revealing that cooperation between these two parties bridged the correlation of recovery to tourism development. The disaster paved way to a stance towards promoting progressive tourism outlooks, raising awareness among the public and private sectors and re-assessment of the tourism vitality in their locality. The mayhem and destruction proved to be a liberating creative process to give way to progression and was deemed to be of high significance in the over-all tourism system process despite its impediments in the case of the tourism industry in Coron, Palawan.

Keywords: disaster recovery, tourism development, diving, Palawan

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Authors: Jingqian Xiao

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The rapid wave of urbanization triggered by China’s economic growth over the past few decades has inevitably impacted the country’s educational landscape. Educational spaces in China shifted during the 1990s when, due to the government’s tax reforms, large numbers of rural schools were abolished or merged with urban schools, resulting in an “urbanization” of school content and values. While urbanized education is now the status quo, there is as yet no literature review, to our best knowledge, that comprehensively summarizes academic work on this phenomenon. Besides, most research on Chinese educational urbanization relies on basic policy deductions, and there is room for improvement in both the quality and quantity of empirical research on this topic. This paper, therefore, reviews relevant literature on educational urbanization in China from three interrelated factors that shape educational inequality between urban and rural China, namely the urbanization in educational space, school content, and educational values. Results find that the main discussion on Chinese educational urbanization often addresses how Chinese rural education can be improved by reforming the urbanization model to revitalize rural society. While the complete urbanization of Chinese education does not seem feasible, the rapidly changing nature of China’s development patterns and political landscape means the course of Chinese education may shift at any time. When the government does decide to fulfill its intentions to improve the countryside, many formerly dilapidated rural schools may be revived, but for the moment, both rural and urban education in China suffers from governmental neglect. In addition, the breakout of COVID-19, which led to a sudden spread of online education that reopened the gap between the educational conditions and the cultural capital of families in rural and urban areas, has also posed new challenges for China’s attempts to resolve conflicting interests between urban and rural schools and promote educational equality.

Keywords: Chinese education, educational inequality, rural and urban education, urbanization in education

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Authors: Arezoo Assarian, Reza Javaherdashti

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Microbiologically influenced corrosion (MIC) is an electrochemical process that can affect both metals and non-metals. The cost of MIC can amount to 40% of the cost of corrosion. MIC is enhanced via factors such as but not limited to the presence of certain bacteria and archaea as well as mechanisms such as external electron transfer. There are five methods by which electrochemical corrosion, including MIC, can be prevented, of which coatings are an effective method due to blinding anode, cathode and, electrolyte from each other. Conventional ordinary coatings may themselves become nutrient sources for the bacteria and therefore show low efficiency in dealing with MIC. Recently our works on polyaspartic coating (DTM) have shown promising results, therefore nominating DTM as the most appropriate coating material to manage both MIC and general electrochemical corrosion very efficiently. Nanosilver particles are known for their antimicrobial properties that make them of desirable distractive impacts on any germs. This coating will be formulated based on Nanosilver phosphate and copper II oxide in the resin network and co-reactant. The nanoparticles are light and heat-sensitive agents. The method which is used to keep nanoparticles in the film coating is the encapsulation of active ingredients. By this method, it will prevent incompatibility between different particles. For producing microcapsules, the interfacial cross-linking method will be used. This is achieved by adding an active ingredient to an aqueous solution of the cross-linkable polymer. In this paper, we will first explain the role of coating materials in controlling and preventing electrochemical corrosion. We will explain MIC and some of its fundamental principles, such as bacteria establishment (biofilm) and the role they play in enhancing corrosion via mechanisms such as the establishment of differential aeration cells. Later we will explain features of DTM coatings that highly contribute to preventing biofilm formation and thus microbial corrosion.

Keywords: biofilm, corrosion, microbiologically influenced corrosion(MIC), nanosilver particles, polyaspartic coating (DTM)

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Authors: Siamak Yaghoubi, Mohammad Reza Abootorabi, Hamid Kayalha

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Objective: The study was aimed to evaluate the applicability of the Cobra Perilaryngeal Airway (Cobra PLATM) for patients under general anesthesia and also compare result with the Laryngeal Mask Airway (LMA). Methods: Seventy three obese and overweight patients were included in the study. The patients were randomly assigned to either LMA or Cobra PLATM. Time required for intubation, successful intubation attempt, airway sealing pressure, the incidences of complications including blood staining, sore throat and dysphagia were assessed and noted. Results: Thirty six and thirty seven patients were allocated randomly to either LMA or Cobra PLATM, respectively. Most of the patients were male and were in Mallampati Class II airway in both groups. The first attempt and overall insertion success for the Cobra PLATM was significantly more frequent compared to the LMA (p<0.05). Tube insertion was more successful (Cobra PLATM, 94%; LMA™, 77%; P = 0.027) with the Cobra PLATM. The insertion times were similar with the Cobra PLATM and LMA™ (Cobra PLATM, 29.94±16.35s; LMA™, 27.00±7.88s). The airway sealing pressure in the Cobra PLATM (24.80±0.90 H2O) was significantly more than LMA™ (19.13 ±0.58 H2O, p<0.001). Sore throat was more frequent in the LMA™ groups that did not reach statistical significance (Fisher’s exact test, P = 0.33). Incidences of blood staining on airway tube were seen for both groups that was higher in the Cobra PLATM group (Fisher’s exact test, P = 0.02). Incidence of dysphagia was not different between the two groups. Conclusion: The CobraPLA™ was found to be safe and low complications, better airway sealing and high rate of the first insertion success for suing in obese and overweight patients. The study recommended using the CobraPLA™ as a rescue device in an emergency situation among obese and overweight patients.

Keywords: CobraPLA™, flexible laryngeal mask airway, obese patients, perilaryngeal airway

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Authors: Chan Eang Teng, Tang Mui Joo

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With the viral factor on social media, the sense of persuasion is generated by repetition and popularity. When users’ interest is captured, political awareness increases to spark political enthusiasm, but, the level of user’s political participation and political attitude of those active users is still questionable. An online survey on 250 youth and in-depth interview on two politicians are conducted to answer the main question in this paper. The result shows that Facebook significantly increases political awareness among youths. Social media may not be the major trigger to political activism among youths as most respondents opined that they would still vote without Facebook. Other factors could be political campaigning, political climate, age, peer pressure or others. Finding also shows that majority of respondents did not participate in online political debates or political groups. Many also wondered if the social media was the main power switch that triggers the political influx among young voters. The research finding is significant to understand how the new media, Facebook, has reshaped the political landscape in Malaysia, creating the Social Media Election that changed the rules of the political game. However, research finding does not support the ideal notion that the social media is the major trigger to youth’s political activism. This research outcome has exposed the flaws of the Social Media Election. It has revealed the less optimistic side of youth political activism. Unfortunately, results fall short of the idealistic belief that the social media have given rise to political activism among youths in the 13^th General Election in Malaysia. The research outcome also highlights an important lesson for the democratic discourse of Malaysia which is making informed and educated decisions takes more commitment, proactive and objective attitude.

Keywords: social media, political participation, political activism, democracy, political communication

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Authors: Sh. Heidari, A. J. Andrews, A. Oberoi

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Electrochemical storage of hydrogen in activated carbon electrodes as part of a reversible fuel cell offers a potentially attractive option for storing surplus electrical energy from inherently variable solar and wind energy resources. Such a system – which we have called a proton flow battery – promises to have a roundtrip energy efficiency comparable to lithium ion batteries, while having higher gravimetric and volumetric energy densities. In this paper, a theoretical model is presented of the process of H+ ion (proton) conduction through an acid electrolyte into a highly porous activated carbon electrode where it is neutralised and absorbed on the inner surfaces of pores. A Butler-Volmer type equation relates the rate of adsorption to the potential difference between the activated carbon surface and the electrolyte. This model for the hydrogen storage electrode is then incorporated into a more general computer model based on MATLAB software of the entire electrochemical cell including the oxygen electrode. Hence a theoretical voltage-current curve is generated for given input parameters for a particular activated carbon electrode. It is shown that theoretical VI curves produced by the model can be fitted accurately to experimental data from an actual electrochemical cell with the same characteristics. By obtaining the best-fit values of input parameters, such as the exchange current density and charge transfer coefficient for the hydrogen adsorption reaction, an improved understanding of the adsorption reaction is obtained. This new model will assist in designing improved proton flow batteries for storing solar and wind energy.

Keywords: electrochemical hydrogen storage, proton flow battery, butler-volmer equation, activated carbon

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Authors: Aarti M. Shetty, Estela Davoodi, Subrata Gangooly, Anita Rao-Coppisetty

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Background: Testing Patency of Fallopian Tubes is among one of the several protocols for investigating Subfertile Couples. Both, Hysterosalpingogram (HSG) and Laparoscopy and dye test have been used as Tubal patency test for several years, with well-known limitation. Hysterosalpingo Contrast Sonography (HyCoSy) can be used as an alternative tool to HSG, to screen patency of Fallopian tubes, with an advantage of being non-ionising, and also, use of transvaginal scan to diagnose pelvic pathology. Aim: To determine the indication and analyse the performance of transvaginal scan and HyCoSy in Broomfield Hospital. Methods: We retrospectively analysed fertility workup of 282 women, who attended HyCoSy clinic at our institution from January 2015 to June 2016. An Audit proforma was designed, to aid data collection. Data was collected from patient notes and electronic records, which included patient demographics; age, parity, type of subfertility (primary or secondary), duration of subfertility, past medical history and base line investigation (hormone profile and semen analysis). Findings of the transvaginal scan, HyCoSy and Laparoscopy were also noted. Results: The most common indication for referral were as a part of primary fertility workup on couples who had failure to conceive despite intercourse for a year, other indication for referral were recurrent miscarriage, history of ectopic pregnancy, post reversal of sterilization(vasectomy and tuboplasty), Post Gynaecology surgery(Loop excision, cone biopsy) and amenorrhea. Basic Fertility workup showed 34% men had abnormal semen analysis. HyCoSy was successfully completed in 270 (95%) women using ExEm foam and Transvaginal Scan. Of the 270 patients, 535 tubes were examined in total. 495/535 (93%) tubes were reported as patent, 40/535 (7.5%) tubes were reported as blocked. A total of 17 (6.3%) patients required laparoscopy and dye test after HyCoSy. In these 17 patients, 32 tubes were examined under laparoscopy, and 21 tubes had findings similar to HyCoSy, with a concordance rate of 65%. In addition to this, 41 patients had some form of pelvic pathology (endometrial polyp, fibroid, cervical polyp, fibroid, bicornuate uterus) detected during transvaginal scan, who referred to corrective surgeries after attending HyCoSy Clinic. Conclusion: Our audit shows that HyCoSy and Transvaginal scan can be a reliable screening test for low risk women. Furthermore, it has competitive diagnostic accuracy to HSG in identifying tubal patency, with an additional advantage of screening for pelvic pathology. With addition of 3D Scan, pulse Doppler and other non-invasive imaging modality, HyCoSy may potentially replace Laparoscopy and chromopertubation in near future.

Keywords: hysterosalpingo contrast sonography (HyCoSy), transvaginal scan, tubal infertility, tubal patency test

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Authors: Raymond E. Raguindin

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Objective: This research studied the teaching improvement of daycare workers in imitation, joint attention, and language activities using the play-based early intervention training program in Cabanatuan City, Nueva Ecija. Methods: Focus group discussions were developed to explore the attitude, beliefs, and practices of daycare workers. Results: Findings of the study revealed that daycare workers have existing knowledge and experience in teaching children with autism. Their workshops on managing inappropriate behaviors of children with autism resulting in a general positive perception of accepting and teaching children with autism in daycare centers. Play based activities were modelled and participated in by daycare workers. These include demonstration, modelling, prompting and providing social reinforcers as reward. Five lectures and five training days were done to implement the training program. Daycare workers’ levels of skill in teaching imitation, joint attention and language were gathered before and after the participation in the training program. Findings suggest significant differences between pre-test and post test scores. They have shown significant improvement in facilitating imitation, joint attention, and language children with autism after the play-based early intervention training. They were able to initiate and sustain imitation, joint attention, and language activities with adequate knowledge and confidence. Conclusions: 1. Existing attitudes and beliefs greatly influenced the positive delivery mode of instruction. 2. Teacher-directed approach to improve attention, imitation, joint attention, and language of children with autism can be acquired by daycare workers. 3. Teaching skills and experience can be used as reference and basis for identifying future training needs.

Keywords: early intervention, imitation, joint attention, language

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Authors: Peaceman Sopazi, Mabila Mathebula, John Smallwood

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Recent health and safety (H&S) concerns and their resultant impact on railway operations, namely, the severe acute respiratory syndrome (SARS) or collectively known as SARS-CoV-2 (Covid-19) pandemic and the Fourth Industrial Revolution (4IR), which have dominated public discourse, brought into question as to whether, or not, some aspects of how we have so far managed safety oversight as railway regulatory bodies and operators will remain relevant in a changing railway environment. Railway practitioners have generally found themselves between a proverbial rock and a hard place by being confronted by emerging challenges which have brought along great opportunities for sustainability. As witnesses and participants to the progressively introduced railway safety management, and transformation regimes, this paper attempts to share gathered field experience on adaptable regulatory oversight and safety awareness. The discourse is approached from a South African context but also with an informed perspective of what seems to work and what usually does not. The authors share their own multi and transdisciplinary experience coupled with insights they have gained as researchers of global trends in general safety management and specific aspects of railway safety management, for sustainability. In addition to sharing a largely experience-based methodology for survival, suggestions are offered for consideration as a way of keeping the railway safety management discourse alive as practitioners navigate a new path which is shrouded in a cloud of untold uncertainty. The authors further believe that the right timing for the implementation of the proposed suggestions in this paper will produce beneficial outcomes. Finally, the paper will identify areas that are still open for further investigation for and by researchers and practitioners alike.

Keywords: health & safety management, safety awareness, railway safety management, railway systems sustainability

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Authors: S. Shakibaei, P. Alpkokin

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The railway network is one of the major components of a transportation system in a country which may be an indicator of the country’s level of economic improvement. Since 2000s on, revival of national railways and development of High Speed Rail (HSR) lines are one of the most remarkable policies of Turkish government in railway sector. Within this trend, the railway age is to be revived and coming decades will be a golden opportunity. Indubitably, major infrastructures such as road and railway networks require sizeable investment capital, precise maintenance and reparation. Traditionally, governments are held responsible for funding, operating and maintaining these infrastructures. However, lack or shortage of financial resources, risk responsibilities (particularly cost and time overrun), and in some cases inefficacy in constructional, operational and management phases persuade governments to find alternative options. Financial power, efficient experiences and background of private sector are the factors convincing the governments to make a collaboration with private parties to develop infrastructures. Public-Private Partnerships (PPP or 3P or P3) and related regulatory issues are born considering these collaborations. In Turkey, PPP approaches have attracted attention particularly during last decade and these types of investments have been accelerated by government to overcome budget limitations and cope with inefficacy of public sector in improving transportation network and its operation. This study mainly tends to present a comprehensive overview of PPP concept, evaluate the regulatory procedure in Europe and propose a general framework for Turkish State Railways (TCDD) as an outlook on privatization, liberalization and deregulation of railway network.

Keywords: deregulation, high-speed railway, liberalization, privatization, public-private partnership

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Authors: Ningning Liu, Gaoding Jia, Yinshan Wang, Haimei Li, Xinian Zuo, Yufeng Wang, Lu Liu, Qiujin Qian

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Background: There has been speculation that a high IQ may not necessarily provide protection against attention deficit hyperactivity disorder (ADHD), and there may be a U-shaped correlation between IQ and ADHD symptoms. However, this speculation has not been validated in the ADHD population in any study so far. Method: We conducted a study with 5,138 children who have been professionally diagnosed with ADHD and have a wide range of IQ levels. General Linear Models were used to determine the optimal model between IQ and ADHD core symptoms with sex and age as covariates. The ADHD symptoms we looked at included the total scores (TO), inattention (IA) and hyperactivity/impulsivity (HI). Wechsler Intelligence scale were used to assess IQ [Full-Scale IQ (FSIQ), Verbal IQ (VIQ), and Performance IQ (PIQ)]. Furthermore, we examined the correlation between IQ and the execution function [Behavior Rating Inventory of Executive Function (BRIEF)], as well as between IQ and brain surface area, to determine if the associations between IQ and ADHD symptoms are reflected in executive functions and brain structure. Results: Consistent with previous research, the results indicated that FSIQ and VIQ both showed a linear negative correlation with the TO and IA scores of ADHD. However, PIQ showed an inverted U-shaped relationship with the TO and HI scores of ADHD, with 103 as the peak point. These findings were also partially reflected in the relationship between IQ and executive functions, as well as IQ and brain surface area. Conclusion: To sum up, the relationship between IQ and ADHD symptoms is not straightforward. Our study confirms long-standing academic hypotheses and finds that PIQ exhibits an inverted U-shaped relationship with ADHD symptoms. This study enhances our understanding of symptoms and behaviors of ADHD with varying IQ characteristics and provides some evidence for targeted clinical intervention.

Keywords: ADHD, IQ, execution function, brain imaging

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Authors: Amine Alaoui Sanae, Tagjdid Reda, Loutfi Chafiqa, Melloul Merouane, Laloui Aziz, Touil Nadia, El Fahim, E. Mostafa

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Background: Rotavirus group A (RVA) strains with G8P[14] specificities are usually detected in calves and goats. However, these strains have been reported globally in humans and have often been characterized as originating from zoonotic transmissions, particularly in area where ruminants and humans live side-by-side. Whether human P[14] genotypes are two-way and can be transmitted to animal species remains to be established. Here we describe VP4 deduced amino-acid relationships of three Moroccan P[14] genotypes originating from different species and the receptiveness of an alpine goat to a human G8P[14] through an experimental infection. Material/methods: the human MA31 RVA strain was originally identified in a four years old girl presenting an acute gastroenteritis hospitalized at the pediatric care unit in Rabat Hospital in 2011. The virus was isolated and propagated in MA104 cells in the presence of trypsin. Ch_10S and 8045_S animal RVA strains were identified in fecal samples of a 2-week-old native goat and 3-week-old calf with diarrhea in 2011 in Bouaarfa and My Bousselham respectively. Genomic RNAs of all strains were subjected to a two-step RT-PCR and sequenced using the consensus primers VP4. The phylogenetic tree for MA31, Ch_10S and 8045_S VP4 and a set of published P[14] genotypes was constructed using MEGA6 software. The receptivity of MA31 strain by an eight month-old alpine goat was assayed. The animal was orally and intraperitonally inoculated with a dose of 8.5 TCID50 of virus stock at passage level 3. The shedding of the virus was tested by a real time RT-PCR assay. Results: The phylogenetic tree showed that the three Moroccan strains MA31, Ch_10S and 8045_S VP4 were highly related to each other (100% similar at the nucleotide level). They were clustered together with the B10925, Sp813, PA77 and P169 strains isolated in Belgium, Spain and Italy respectively. The Belgian strain B10925 was the most closely related to the Moroccan strains. In contrast, the 8045_S and Ch_10S strains were clustered distantly from the Tunisian calf strain B137 and the goat strain cap455 isolated in South Africa respectively. The human MA31 RVA strain was able to induce bloody diarrhea at 2 days post infection (dpi) in the alpine goat kid. RVA virus shedding started by 2 dpi (Ct value of 28) and continued until 5 dpi (Ct value of 25) with a concomitant elevation in the body temperature. Conclusions: Our study while limited to one animal, is the first study proving experimentally that a human P[14] genotype causes diarrhea and virus shedding in the goat. This result reinforce the potential role of inter- species transmission in generating novel and rare rotavirus strains such G8P[14] which infect humans.

Keywords: interspecies transmission, rotavirus, goat, human

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Authors: Sergey Kholodkevich, Tatiana Kuznetsova

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The objective assessment of ecological state of water ecosystems is impossible without the use of biological methods of the environmental monitoring capable in the integrated look to reveal negative for biota changes of quality of water as habitats. Considerable interest for the development of such methods of environmental quality control represents biomarker approach. Measuring systems, by means of which register cardiac activity characteristics, received the name of bioelectronic. Bioelectronic systems are information and measuring systems in which animals (namely, benthic invertebrates) are directly included in structure of primary converters, being an integral part of electronic system of registration of these or those physiological or behavioural biomarkers. As physiological biomarkers various characteristics of cardiac activity of selected invertebrates have been used in bioelectronic system.lChanges in cardiac activity are considered as integrative measures of the physiological condition of organisms, which reflect the state of the environment of their dwelling. Greatest successes in the development of tools of biological methods and technologies of an assessment of surface water quality in real time. Essential advantage of bioindication of water quality by such tool is a possibility of an integrated assessment of biological effects of pollution on biota and also the expressness of such method and used approaches. In the report the practical experience of authors in biomonitoring and bioindication of an ecological condition of sea, brackish- and freshwater areas is discussed. Authors note that the method of non-invasive cardiac activity monitoring of selected invertebrates can be used not only for the advancement of biomonitoring, but also is useful in decision of general problems of comparative physiology of the invertebrates.

Keywords: benthic invertebrates, physiological state, heart rate monitoring, water quality assessment

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Authors: G. A. Kuanaliyeva, G. T. Aigarinova, G. K. Shulanbekova

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This article is devoted to judicial control in criminal legal proceedings of the Republic of Kazakhstan in the light of the new Concept of legal policy till 2020. In article the general characteristic and concept of judicial control, and also its signs and types are considered. Different views of scientists are analyzed. Foreign experiment on application of judicial control is given. The author states also the point sight on this problem and gives the definition to concept of judicial control. The code of criminal procedure of the Republic of Kazakhstan (RK Criminal Procedure Code) doesn't consolidate concept of judicial control. The author in article suggests making change and addition to the existing Code of criminal procedure of the Republic of Kazakhstan by definition of judicial control. The decree of the President of the Republic of Kazakhstan of August 24, 2009 No. 858 approved the Concept of legal policy of the Republic for the period from 2010 to 2020. The new Concept of legal policy of the Republic of Kazakhstan, defines prospects of development of national legal system of the country on the following decade. The concept of legal policy completely mentions also institute of judicial control. Since finding of the independence by Kazakhstan the set of laws, including the rights directed on providing, freedoms and a legitimate interest of citizens was accepted. Certainly, in any country, whatever democratic it was, there are problems to human rights. However, it is obvious that Kazakhstan strongly intends to guarantee all Republic of Kazakhstan proclaimed in the Constitution the rights and freedoms of the citizens. Our country seeks for creation of the constitutional state, tries to provide a guarantee from various arbitrariness in activity of competent government bodies, officials. In the concept of legal policy of the Republic of Kazakhstan it is specified: "...priority of development of the criminal procedure right there is a further consecutive realization of the fundamental principles of the criminal legal proceedings directed on protection of the rights and freedoms of the person". Judicial control just also is such guarantee.

Keywords: rights and freedoms of the person, concept, legal policy, court, judicial control

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Authors: Abeer K. Jameel, Harry Evdorides

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Iraq is a middle income country where the road safety issue is considered one of the leading causes of deaths. To control the road risk issue, the Iraqi Ministry of Planning, General Statistical Organization started to organise a collection system of traffic accidents data with details related to their causes and severity. These data are published as an annual report. In this paper, a review of the available crash data in Iraq will be presented. The available data represent the rate of accidents in aggregated level and classified according to their types, road users’ details, and crash severity, type of vehicles, causes and number of causalities. The review is according to the types of models used in road safety studies and research, and according to the required road safety data in the road constructions tasks. The available data are also compared with the road safety dataset published in the United Kingdom as an example of developed country. It is concluded that the data in Iraq are suitable for descriptive and exploratory models, aggregated level comparison analysis, and evaluation and monitoring the progress of the overall traffic safety performance. However, important traffic safety studies require disaggregated level of data and details related to the factors of the likelihood of traffic crashes. Some studies require spatial geographic details such as the location of the accidents which is essential in ranking the roads according to their level of safety, and name the most dangerous roads in Iraq which requires tactic plan to control this issue. Global Road safety agencies interested in solve this problem in low and middle-income countries have designed road safety assessment methodologies which are basing on the road attributes data only. Therefore, in this research it is recommended to use one of these methodologies.

Keywords: road safety, Iraq, crash data, road risk assessment, The International Road Assessment Program (iRAP)

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Authors: Rajender Singh, Nidhi Sharma, Aastha Chauhan, Meenakshi Barsaul, Jyoti Deswal, Chetan Chhikara

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Introduction: Pre-eclampsia and eclampsia are hypertensive disorders of pregnancy with multisystem involvement and are common causes of morbidity and mortality in obstetrics. It is believed that changes in retinal arterioles may indicate similar changes in the placenta. Therefore, this study was undertaken to evaluate the ocular manifestations in cases of pre-eclampsia and eclampsia and to deduce any association between the retinal changes and blood pressure, the severity of disease, gravidity, proteinuria, and other lab parameters so that a better approach could be devised to ensure maternal and fetal well-being. Materials and Methods: This was a hospital-based cross-sectional study conducted over a period of one year, from April 2021 to May 2022. 350 admitted patients with diagnosed pre-eclampsia, eclampsia, and pre-eclampsia superimposed on chronic hypertension were included in the study. A pre-structured proforma was used. After taking consent and ocular history, a bedside examination to record visual acuity, pupillary size, corneal curvature, field of vision, and intraocular pressure was done. Dilated fundus examination was done with a direct and indirect ophthalmoscope. Age, parity, BP, proteinuria, platelet count, liver and kidney function tests were noted down. The patients with positive findings only were followed up after 72 hours and 6 weeks of termination of pregnancy. Results: The mean age of patients was 26.18±4.33 years (range 18-39 years).157 (44.9%) were primigravida while 193(55.1%) were multigravida.53 (15.1%) patients had eclampsia, 128(36.5%) had mild pre-eclampsia,128(36.5%) had severe pre-eclampsia and 41(11.7%) had chronic hypertension with superimposed pre-eclampsia. Retinal changes were found in 208 patients (59.42%), and grade I changes were the most common. 82(23.14%) patients had grade I changes, 75 (21.4%) had grade II changes, 41(11.71%) had grade III changes, and 11(3.14%) had serous retinal detachment/grade IV changes. 36 patients had unaided visual acuity <6/9, of these 17 had refractive error and 19(5.4%) had varying degrees of retinal changes. 3(0.85%) out of 350 patients had an abnormal field of vision in both eyes. All 3 of them had eclampsia and bilateral exudative retinal detachment. At day 4, retinopathy in 10 patients resolved, and 3 patients had improvement in visual acuity. At 6 weeks, retinopathy in all the patients resolved spontaneously except persistence of grade II changes in 23 patients with chronic hypertension with superimposed pre-eclampsia, while visual acuity and field of vision returned to normal in all patients. Pupillary size, intraocular pressure, and corneal curvature were found to be within normal limits at all times of examination. There was a statistically significant positive association between retinal changes and mean arterial pressure. The study showed a positive correlation between fundus findings and severity of disease (p value<0.05) and mean arterial pressure (p value<0.005). Primigravida had more retinal changes than multigravida patients. A significant association was found between fundus changes and thrombocytopenia and deranged liver and kidney function tests (p value<0.005). Conclusion: As the severity of pre-eclampsia and eclampsia increases, the incidence of retinopathy also increases, and it affects visual acuity and visual fields of the patients. Thus, timely ocular examination should be done in all such cases to prevent complications.

Keywords: eclampsia, hypertensive, ocular, pre-eclampsia

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Authors: Montserrat Crespi-Vallbona; Oscar Mascarilla-Miró

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Mature destinations have different challenges trying to attract tourism and please its citizens. Hence, they have to maintain their touristic interest to standard demand and also not to undeceive those tourists with more advanced experiences. Second, they have to be concerned for the daily life of citizens and avoid the negative effects of touristification. This balance is quite delicate and often has to do with the sensitivity and commitment of the party in the local government. However, what is a general consensus is the need for destinations to differentiate from the homogeneous rest of regions and create new content, consumable resources or marketing events to guarantee their positioning. In this sense, the main responsibility of destinations is to satisfy users, tourists and citizens. Hence, its aim has to do with holistic experiences, which collect these wide approaches. Specifically, this research aims to analyze the volume and growth of tourist houses in the central touristic neighborhoods of Barcelona (this is Ciutat Vella) as the starting point to identify the behavior of tourists regarding their interests in searching for local heritage attractiveness and community atmosphere. Then, different cases are analyzed in order to show how Barcelona struggles to keep its attractive brand for the visitors, as well as for its inhabitants. Methodologically, secondary data used in this research comes from official registered tourist houses (Catalunya Government), Open Data (Barcelona municipality), the Airbnb tourist platform, from the Incasol Data and Municipal Register of Inhabitants. Primary data are collected through in-depth interviews with neighbors, social movement managers and political representatives from Turisme de Barcelona (local DMO, Destination Management Organization). Results show what the opportunities and priorities are for key actors to design policies to find a balance between all different interests.

Keywords: touristification, tourist houses, governance, tourism demand, airbnbfication

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Authors: Bradley Fevrier

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Background: Type 2 diabetes mellitus, a non-communicable metabolic disorder, is a fast-growing problem for health, as it presents numerous complications and death worldwide. St. Lucia, much like most other emerging nation in the Caribbean, struggles with the management of type 2 diabetes mellitus (T2DM) among its populace. Good knowledge, attitude, and practices [KAP] of T2DM are essential in the prevention and management of this disease.Lifestyle adaptation, including increased knowledge, positive attitude, and efficient practice towards lifestyle modifications, can avert the advancement of difficulties associated with diabetes. Methods: An institutional-based cross-sectional study was conducted during the period June 15, 2022, to July15 2022. Data were collected by using the self-administered questionnaire designed to collect the required information from participants, and the data wasanalyzed using the statistical package for social science (SPSS) version 26. Knowledge, attitude, and practice of lifestyle modification among participants were determined using descriptive statistics. Results: A total of 402 participants completed the study, fully yielding an 84% response rate. Overall, the assessed levels of KAP relating to the life-threatening complications of T2DM were moderate. Results further indicated that women outnumbered men 68.4% to 31.6%, respectively. Significant positive correlation (r= 0.244, p<0.001) and (r=.203, p<0.001) were found between the knowledge level as well as the attitude level of study respondents. Conclusion: The overall study findings regarding the level of knowledge and attitude concerning lifestyle modifications among study participants were interpreted as generally high. However, the practice of healthy lifestyle modification habits was poor. The current findings suggest a need for structured educational campaigns prioritizing the importance of lifestyle modifications (weight loss, smoking cessation, physical exercise) to the general population.

Keywords: Diabetes, knowledge, lifestyle, survey

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Authors: Halima Sadia Qureshi, Urooj Sadiq, Noshi Eram Zaman

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The goal of this study was to see how cognitive behavior hypnotherapy affected nonsuicidal self-injury. DSM 5 invites the researchers to explore the newly added condition under the chapter of conditions under further study named Nonsuicidal self-injury disorder. To date, no empirical sound intervention has been proven effective for NSSI as given in DSM 5. Nonsuicidal self-injury is defined by DSM 5 as harming one's self physically, without suicidal intention. Around 7.6% of teenagers are expected to fulfill the NSSI disorder criteria. 3 Adolescents, particularly university students, account for around 87 percent of self-harm studies. Furthermore, one of the risks associated with NSSI is an increased chance of suicide attempts, and in most cases, the cycle repeats again. 6 The emotional and psychological components of the illness might lead to suicide, either intentionally or unintentionally. 7 According to a research done at a Pakistani military hospital, over 80% of participants had no intention of committing suicide. Furthermore, it has been determined that improvements in NSSI prevention and intervention are necessary as a stand-alone strategy. The quasi-experimental study took place in Islamabad and Rawalpindi, Pakistan, from May 2019 to April 2020 and included students aged 18 to 25 years old from several institutions and colleges in the twin cities. According to the Diagnostic and Statistical Manual of Mental Disorders 5th edition, the individuals were assessed for >2 episodes without suicidal intent using the intentional self-harm questionnaire. The Clinician Administered Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess the individual for NSSI condition. Symptom checklist-90 (SCL-90) was used to screen the participants for differential diagnosis. Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to rule out the BPD cases. The selected participants, n=106 from the screening sample of 600, were selected. They were further screened to meet the inclusion and exclusion criteria, and the total of n=71 were split into two groups: intervention and control. The intervention group received cognitive behavior hypnotherapy for the next three months, whereas the control group received no treatment. After the period of three months, both the groups went through the post assessment, and after the three months’ period, follow-up assessment was conducted. The groups were evaluated, and SPSS 25 was used to analyse the data. The results showed that each of the two groups had 30 (50 percent) of the 60 participants. There were 41 males (68 percent) and 19 girls (32 percent) in all. The bulk of the participants were between the ages of 21 and 23. (48 percent). Self-harm events were reported by 48 (80 percent) of the pupils, and suicide ideation was found in 6 (ten percent). In terms of pre- and post-intervention values (d=4.90), post-intervention and follow-up assessment values (d=0.32), and pre-intervention and follow-up values (d=5.42), the study's effect size was good. The comparison of treatment and no-treatment groups revealed that treatment was more successful than no-treatment, F (1, 58) = 53.16, p.001. The results reveal that the treatment manual of CBH is effective for Nonsuicidal self-injury disorder.

Keywords: NSSI, nonsuicidal self injury disorder, self-harm, self-injury, Cognitive behaviour hypnotherapy, CBH

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Authors: R. Tariq, R. Lee

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Background: Heywood, Middleton & Rochdale Urgent Community Care Team (UCCT)1 is a great example of using a multidisciplinary team to cope with demand. The service reduces unnecessary admissions to hospitals and ensures that patients can leave the hospital quicker by making care more readily available within the community and patient’s homes. The team comprises nurses, community practitioners, and allied health professions, including physiotherapy, occupational therapy, pharmacy, and GPs. The main challenge for a team with a range of experiences and skill sets is to maintain consistency of care, which technology can help address. Allied healthcare professionals (HCPs) are often used in expanded roles with duties mainly involving patient consultations and decision making to ease pressure on doctors. The Clinical Reasoning Platform (CRP) Dem Dx is used to support new as well as experienced professionals in the decision making process. By guiding HCPs through diagnosing patients from an expansive directory of differential diagnoses, patients can receive quality care in the community. Actions on the platform are determined using NICE guidelines along with local guidance influencing the assessment and management of a patient. Objective: To compare the clinical assessment, decisions, and actions taken by the UCCT multidisciplinary team in the community and Dem Dx, using retrospective clinical cases. Methodology: Dem Dx was used to analyse 192 anonymised cases provided by the HMR UCCT. The team’s performance was compared with Dem Dx regarding the quality of the documentation of the clinical assessment and the next steps on the patient’s journey, including the initial management, actions, and any onward referrals made. The cases were audited by two medical doctors. Results: The study found that the actions outlined by the Dem Dx platform were appropriate in almost 87% of cases. When in a direct comparison between DemDX and the actions taken by the clinical team, it was found that the platform was suitable 83% (p<0.001) of the time and could lead to a potential improvement of 66% in the assessment and management of cases. Dem Dx also served to highlight the importance of comprehensive and high quality clinical documentation. The quality of documentation of cases by UCCT can be improved to provide a detailed account of the assessment and management process. By providing step-by-step guidance and documentation at every stage, Dem Dx may ensure that legal accountability has been fulfilled. Conclusion: With the ever expanding workforce in the NHS, technology has become a key component in driving healthcare outcomes. To improve healthcare provision and clinical reasoning, a decision support platform can be integrated into HCPs’ clinical practice. Potential assistance with clinical assessments, the most appropriate next step and actions in a patient’s care, and improvements in the documentation was highlighted by this retrospective study. A further study has been planned to ascertain the effectiveness of improving outcomes using the clinical reasoning platform within the clinical setting by clinicians.

Keywords: allied health professional, assessment, clinical reasoning, clinical records, clinical decision-making, ocumentation

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Authors: Sarika Gupta, Harshika Khanna, Ajay K Verma, Surya Kant

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Background: Drug-resistant tuberculosis (DR-TB) is a growing health challenge to global TB control efforts. Pediatric DR-TB is one of the neglected infectious diseases. In our previously published report, we have notified an increased prevalence of DR-TB in the pediatric population at a tertiary health care centre in North India which was estimated as 17.4%, 15.1%, 18.4%, and 20.3% in (%) in the year 2018, 2019, 2020, and 2021. Limited evidence exists about a pattern of drug resistance, side effect profile and programmatic outcomes of Paediatric DR-TB treatment. Therefore, this study was done to find out the pattern of resistance, side effect profile and treatment outcome. Methodology: This was a prospective cohort study conducted at the nodal drug-resistant tuberculosis centre of a tertiary care hospital in North India from January 2021 to December 2022. Subjects included children aged between 0-18 years of age with a diagnosis of DR-TB, on the basis of GeneXpert (rifampicin [RIF] resistance detected), line probe assay and drug sensitivity testing (DST) of M. tuberculosis (MTB) grown on a culture of body fluids. Children were classified as monoresistant TB, polyresistant TB (resistance to more than 1 first-line anti-TB drug, other than both INH and RIF), MDR-TB, pre-XDR-TB and XDR-TB, as per the WHO classification. All the patients were prescribed DR TB treatment as per the standard guidelines, either shorter oral DR-TB regimen or a longer all-oral MDR/XDR-TB regimen (age below five years needed modification). All the patients were followed up for side effects of treatment once per month. The patient outcomes were categorized as good outcomes if they had completed treatment and cured or were improving during the course of treatment, while bad outcomes included death or not improving during the course of treatment. Results: Of the 50 pediatric patients included in the study, 34 were females (66.7%) and 16 were male (31.4%). Around 33 patients (64.7%) were suffering from pulmonary TB, while 17 (33.3%) were suffering from extrapulmonary TB. The proportions of monoresistant TB, polyresistant TB, MDR-TB, pre-XDR-TB and XDR-TB were 2.0%, 0%, 50.0%, 30.0% and 18.0%, respectively. Good outcome was reported in 40 patients (80.0%). The 10 bad outcomes were 7 deaths (14%) and 3 (6.0%) children who were not improving. Adverse events (single or multiple) were reported in all the patients, most of which were mild in nature. The most common adverse events were metallic taste 16(31.4%), rash and allergic reaction 15(29.4%), nausea and vomiting 13(26.0%), arthralgia 11 (21.6%) and alopecia 11 (21.6%). Serious adverse event of QTc prolongation was reported in 4 cases (7.8%), but neither arrhythmias nor symptomatic cardiac side effects occurred. Vestibular toxicity was reported in 2(3.9%), and psychotic symptoms in 4(7.8%). Hepatotoxicity, hypothyroidism, peripheral neuropathy, gynaecomastia, and amenorrhea were reported in 2 (4.0%), 4 (7.8%), 2 (3.9%), 1(2.0%), and 2 (3.9%) respectively. None of the drugs needed to be withdrawn due to uncontrolled adverse events. Conclusion: Paediatric DR TB treatment achieved favorable outcomes in a large proportion of children. DR TB treatment regimen drugs were overall well tolerated in this cohort.

Keywords: pediatric, drug-resistant, tuberculosis, adverse events, treatment

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Authors: Isaac Kofi Mensah

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Governments around the world are adopting Information and Communication Technologies (ICTs) because of the important opportunities it provides through E-government (EG) to modernize government public administration processes and delivery of quality and efficient public services. Almost every country in the world is adopting ICT in its public sector administration (EG) to modernize and change the traditional process of government, increase citizen engagement and participation in governance, as well as the provision of timely information to citizens. This paper, therefore, seeks to present the adoption, development and implementation of EG in regions globally, as well as the ICT indicators around the world, which are making EG initiatives successful. Europe leads the world in its EG adoption and development index, followed by the Americas, Asia, Oceania and Africa. There is a gradual growth in ICT indicators in terms of the increase in Internet access and usage, increase in broadband penetration, an increase of individuals using the Internet at home and a decline in fixed telephone use, while the mobile cellular phone has been on the increase year-on-year. Though the lack of ICT infrastructure is a major challenge to EG adoption and implementation around the world, in Africa it is very pervasive, hampering the expansion of Internet access and provision of broadband, and hence is a barrier to the successful adoption, development, and implementation of EG initiatives in countries on the continent. But with the general improvement and increase in ICT indicators around the world, it provides countries in Europe, Americas, Asia, Arab States, Oceania and Africa with the huge opportunity to enhance public service delivery through the adoption of EG. Countries within these regions cannot fail their citizens who desire to enjoy an enhanced and efficient public service delivery from government and its many state institutions.

Keywords: e-government development index, e-government, indicators, information and communication technologies (ICTs)

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