Search results for: Educational background

Authors: Shafaq Rubab

Abstract:

One of the biggest reasons of dropouts from schools is lack of motivation and interest among the students, particularly in mathematics. Many developing countries are facing this problem and this issue is lowering the literacy rate in these developing countries. The best solution for increasing motivation level and interest among the students is using tablet game-based learning. However, a pedagogically sound game required a well-planned instructional design model to enhance learner’s attention and confidence otherwise effectiveness of the learning games suffers badly. This research aims to evaluate the impact of the pedagogically sound instructional design model on students’ motivation by using tablet game-based learning. This research was conducted among the out-of-school-students having an age range from 7 to 12 years and the sample size of two hundred students was purposively selected without any gender discrimination. Qualitative research was conducted by using a survey tool named Instructional Material Motivational Survey (IMMS) adapted from Keller Arcs model. A comparison of results from both groups’ i.e. experimental group and control group revealed that motivation level of the students taught by the game was higher than the students instructed by using conventional methodologies. Experimental group’s students were more attentive, confident and satisfied as compared to the control group’s students. This research work not only promoted the trend of digital game-based learning in developing countries but also supported that a pedagogically sound instructional design model utilized in an educational game can increase the motivation level of the students and can make the learning process a totally immersive and interactive fun loving activity.

Keywords: digital game-based learning, student’s motivation, instructional design model, learning process

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Authors: Soodabeh Shahid Sales, Azam Rastgar Moghadam, Mehrane Mehramiz, Malihe Entezari, Kazem Anvari, Mohammad Sadegh Khorrami, Saeideh Ahmadi Simab, Ali Moradi, Seyed Mahdi Hassanian, Majid Ghayour-Mobarhan, Gordon A. Ferns, Amir Avan

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Background Esophageal cancer has been reported as the eighth most common cancer universal and the seventh cause of cancer-related death in men .recent studies have revealed that cytochrome P450, family 1, subfamily B, polypeptide 1, which plays a role in metabolizing xenobiotics, is associated with different cancers. Therefore in the present study, we investigated the impact of CYP1B1-rs1056836 on esophagus squamous cell carcinoma (ESCC) patients. Method: 317 subjects, with and without ESCC were recruited. DNA was extracted and genotyped via Real-time PCR-Based Taq Man. Kaplan Meier curves were utilized to assess overall and progression-free survival. To evaluate the relationship between patients clinicopathological data, genotypic frequencies, disease prognosis, and patients survival, Pearson chi-square and t-test were used. Logistic regression was utilized to assess the association between the risk of ESCC and genotypes. Results: the genotypic frequency for GG, GC, and CC are respectively 58.6% , 29.8%, 11.5% in the healthy group and 51.8%, 36.14% and 12% in ESCC group. With respect to the recessive genetic inheritance model, an association between the GG genotype and stage of ESCC were found. Also, statistically significant results were not found for this variation and risk of ESCC. Patients with GG genotype had a decreased risk of nodal metastasis in comparison with patients with CC/CG genotype, although this link was not statistically significant. Conclusion: Our findings illustrated the correlation of CYP1B1-rs1056836 as a potential biomarker for ESCC patients, supporting further studies in larger populations in different ethnic groups. Moreover, further investigations are warranted to evaluate the association of emerging marker with dietary intake and lifestyle.

Keywords: Cytochrome P450, esophagus squamous cell carcinoma, dietary intake, lifestyle

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Authors: Bela Siska Afrida, Wisnu Barlianto, Desy Wulandari, Ery Olivianto

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Background: Allergic asthma, caused by IgE-mediated allergic reactions, remains a global health issue with high morbidity and mortality rates. Immunotherapy is the only etiology-based approach to treating asthma, but no standard biomarkers have been established to evaluate the therapy’s effectiveness. This study aims to determine the correlation between the ratios of serum levels of HDM-specific IgE/total IgE and Asthma Control Test (ACT) score as a biomarker of the response to immunotherapy in pediatric allergic asthma patients. Patient and Methods: This retrospective cohort study involved 26 pediatric allergic asthma patients who underwent HDM-specific subcutaneous immunotherapy for 14 weeks at the Pediatric Allergy Immunology Outpatient Clinic at Saiful Anwar General Hospital, Malang. Serum levels of HDM-Specific IgE and Total IgE were measured before and after immunotherapy using Chemiluminescence Immunoassay and Enzyme-linked Immunosorbent Assay (ELISA) method. Changes in asthma control were assessed using the ACT score. The Wilcoxon Signed Ranked Test and Spearman correlation test were used for data analysis. Results: There were 14 boys and 12 girls with a mean age of 6.48 ± 2.54 years. The study showed a significant decrease in serum HMD-specific levels before immunotherapy [9.88 ± 5.74 kuA/L] compared to those of 14 weeks after immunotherapy [4.51 ± 3.98 kuA/L], p = 0.000. Serum Total IgE levels significant decrease before immunotherapy [207.6 ± 120.8IU/ml] compared to those of 14 weeks after immunotherapy [109.83 ± 189.39 IU/mL], p = 0.000. The ratios of serum HDM-specific IgE/total IgE levels significant decrease before immunotherapy [0.063 ± 0.05] compared to those of 14 weeks after immunotherapy [0.041 ± 0.039], p = 0.012. There was also a significant increase in ACT scores before and after immunotherapy (each 15.5 ± 1.79 and 20.96 ± 2.049, p = 0.000). The correlation test showed a weak negative correlation between the ratios of HDM-specific IgE/total IgE levels and ACT score (p = 0.034 and r = -0.29). Conclusion: In conclusion, this study showed that a decrease in HDM-specific IgE levels, total IgE levels, and HDM-specific IgE/total IgE ratios, and an increase in ACT score, was observed after 14 weeks of HDM-specific subcutaneous immunotherapy. The weak negative correlation between the HDM-specific IgE/total IgE ratio and the ACT score suggests that this ratio can serve as a potential biomarker of the effectiveness of immunotherapy in treating pediatric allergic asthma patients.

Keywords: HDM-specific IgE/total IgE ratio, ACT score, immunotherapy, allergic asthma

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Authors: Tian Yi Du, Guan Rong Fan, Dong Dong Zou, Di Xue

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Background: The patient satisfaction survey is becoming of increasing importance for hospitals or other providers to get more reimbursement and/or more governmental subsidies. However, when the results of patient satisfaction survey are compared among medical institutions, there are some concerns. The primary objectives of this study were to evaluate patient satisfaction in tertiary hospitals of Shanghai and to compare the satisfaction rating on physician services between patients and observers. Methods: Two hundred outpatients were randomly selected for patient satisfaction survey in each of 28 public tertiary hospitals of Shanghai. Four or five volunteers were selected to observe 5 physicians’ practice in each of above hospitals and rated observed physicians’ practice. The outpatients that the volunteers observed their physician practice also filled in the satisfaction questionnaires. The rating scale for outpatient survey and volunteers’ observation was: 1 (very dissatisfied) to 6 (very satisfied). If the rating was equal to or greater than 5, we considered the outpatients and volunteers were satisfied with the services. The validity and reliability of the measure were assessed. Multivariate regressions for each of the 4 dimensions and overall of patient satisfaction were used in analyses. Paired t tests were applied to analyze the rating agreement on physician services between outpatients and volunteers. Results: Overall, 90% of surveyed outpatients were satisfied with outpatient care in the tertiary public hospitals of Shanghai. The lowest three satisfaction rates were seen in the items of ‘Restrooms were sanitary and not crowded’ (81%), ‘It was convenient for the patient to pay medical bills’ (82%), and ‘Medical cost in the hospital was reasonable’ (84%). After adjusting the characteristics of patients, the patient satisfaction in general hospitals was higher than that in specialty hospitals. In addition, after controlling the patient characteristics and number of hospital visits, the hospitals with higher outpatient cost per visit had lower patient satisfaction. Paired t tests showed that the rating on 6 items in the dimension of physician services (total 14 items) was significantly different between outpatients and observers, in which 5 were rated lower by the observers than by the outpatients. Conclusions: The hospital managers and physicians should use patient satisfaction and observers’ evaluation to detect the room for improvement in areas such as social skills cost control, and medical ethics.

Keywords: patient satisfaction, observation, quality, hospital

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Authors: Karima Abdel Aty Hassan Mohamed, Manal Mohamed Ismail, Mona Hassan Gamal Eldein, Ahmed Hassan Hussein, Abdel Aziz Mohamed Elsingerg

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Background: Patellofemoral pain (PFP) is a common musculoskeletal pain condition, especially in females. Decreased hip muscle strength has been implicated as a contributing factor, yet the relationships between pain, hip muscle strength and function are not known. Objective: The purpose of this study is to investigate the effects of strengthening hip abductors and lateral rotators on pain intensity, function and hip abductor and hip lateral rotator eccentric and concentric torques in patients with PFPS. Methods: Thirty patients had participated in this study; they were assigned into two experimental groups. With age ranged for eighty to thirty five years. Group A consisted of 15 patients (11females and 4 males) with mean age 20.8 (±2.73) years, received closed kinetic chain exercises program, stretching exercises for tight lower extremity soft tissues, and hip strengthening exercises .Group B consisted of 15 patients (12 females and 3 males) with mean age 21.2(±3.27) years, received closed kinetic chain exercises program and stretching exercises for tight lower extremity soft tissues. Treatment was given 2-3times/week, for 6 weeks. Patients were evaluated pre and post treatment for their pain severity, function of knee joint, hip abductors and external rotators concentric/eccentric peak torque. Result: the results revealed that there were significant differences in pain and function between both groups, while there was improvement for all values for both group. Conclusion: Six weeks rehabilitation program focusing on knee strengthening exercises either supplemented by hip strengthening exercises or not effective in improving function, reducing pain and improving hip muscles torque in patients with PFPS. However, adding hip abduction and lateral rotation strengthening exercises seem to reduce pain and improve function more efficiently.

Keywords: patellofemoral pain syndrome, hip muscles, rehabilitation, isokinetic

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Authors: Tamara Matevosyan

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In this globalized world, intercultural communication is becoming essential for understanding communication among people, for developing understanding of cultures, to appreciate the opportunities and challenges that each culture presents to people. Moreover, it plays an important role in developing an ideal personification to understand different behaviors in different cultures. Native speakers assimilate sociolinguistic knowledge in natural conditions, while it is a great problem for language learners, and in this context feature films reveal cultural peculiarities and involve students in real communication. As we know nowadays the key role of language learning is the development of intercultural competence as communicating with someone from a different cultural background can be exciting and scary, frustrating and enlightening. Intercultural competence is important in FL learning classroom and here feature films can perform as essential tools to develop this competence and overcome the intercultural gap that foreign students face. Current proposal attempts to reveal the correlation of the given culture and language through feature films. To ensure qualified, well-organized and practical classes on Intercultural Communication for language learners a number of methods connected with movie watching have been implemented. All the pre-watching, while watching and post-watching methods and techniques are aimed at developing students’ communicative competence. The application of such activities as Climax, Role-play, Interactive Language, Daily Life helps to reveal and overcome mistakes of cultural and pragmatic character. All the above-mentioned activities are directed at the assimilation of the language vocabulary with special reference to the given culture. The study dwells into the essence of culture as one of the core concepts of intercultural communication. Sometimes culture is not a priority in the process of language learning which leads to further misunderstandings in real life communication. The application of various methods and techniques with feature films aims at developing students’ cultural competence, their understanding of norms and values of individual cultures. Thus, feature film activities will enable learners to enlarge their knowledge of the particular culture and develop a fundamental insight into intercultural communication.

Keywords: climax, intercultural competence, interactive language, role-play

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Authors: Chiedu C. Ifekandu, Olusegun Sangowawa, Jean E. Njab

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Background: Health care providers (HCPs) in Nigeria receive little or no training of the healthcare needs of men who have sex with men (MSM) limiting the quality and effectiveness of comprehensive HIV prevention and treatment services. Consequently, most MSM disguise themselves to access services which limit the quality of care provided partly due to challenges related to stigma and discrimination, and breach of confidentiality. Objective: To assess the knowledge of healthcare providers on effective intervention for MSM. Methods: We trained 122 HIV focal persons drawn from 60 health facilities from twelve Nigerian states. , the participants were requested to complete a pre-training questionnaire to assess their level of working experience with key populations as a baseline. Participants included male and female doctors, nurses and counselors/testers. A test was administered to measure their knowledge on MSM sexual risk practices, HIV prevention and healthcare needs and also to assess their attitudes (including homophobia) and beliefs and how it affects service uptake by key populations particularly MSM prior and immediately after the training to ascertain the impact of the training. Results: The mean age of the HCP was 38 years +/- SD Of the 122 HCPs (45 % female, 55 % male; 85 % counsellor/testers; 15 % doctors and nurses; 92 % working in government facilities) from 42 health facilities were trained, of which 105 attempted the test questions. At the baseline, few HCPs reported any prior sensitivity training on MSM. Most of the HCPs had limited knowledge of MSM sexual health needs. Over 90% of the HCPs believed that homosexuality is a mental illness. 8 % do not consider MSM, FSW and PWID as key populations for HIV infection. 45 % lacked knowledge on MSM anal sexual practices. The post-test showed that homophobic attitudes had decreased significantly by the end of the training; the health care providers have acquired basic knowledge compared to the pre-test. Conclusions: Scaling up MSM sensitivity training for Nigerian HCPs is likely to be a timely and effective means to improve their understanding of MSM-related health issues, reduce homophobic sentiments and enhance their capacity to provide responsive HIV prevention, treatment and care services in a supportive and non-stigmatizing environment.

Keywords: healthcare providers, key population, men who have sex with men, HCT

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Authors: N. Khanyile, P. Dlamini, M. Masenya

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Background: Most of the population in Africa is still dependent on indigenous medicinal knowledge for treating and managing ailments. Indigenous traditional knowledge owners/practitioners who own this knowledge are consulted by communities, but their knowledge is not known how they get it. The question of how knowledge is acquired and preserved remains one of the biggest challenges in traditional healing and treatment with herbal medicines. It is regrettable that despite the importance and recognition of indigenous medicinal knowledge globally, the details of acquirement, storing and transmission, and preservation techniques are not known. Hence this study intends to unveil the process of acquirement and transmission, and preservation techniques of indigenous medical knowledge by its owners. Objectives: This study aims to assess the process of acquiring and preservation of traditional medicinal knowledge by traditional medicinal knowledge owners/practitioners in uMhlathuze Municipality, in the province of KwaZulu-Natal, South Africa. The study was guided by four research objectives which were to: identify the types of traditional medicinal knowledge owners who possess this knowledge, establish the approach used by indigenous medicinal knowledge owners/healers for acquiring medicinal knowledge, identify the process of preservation of medicinal knowledge by indigenous medicinal knowledge owners/healers, and determine the challenges encountered in transferring the knowledge. Method: The study adopted a qualitative research approach, and a snowball sampling technique was used to identify the study population. Data was collected through semi-structured interviews with indigenous medicinal knowledge owners. Results: The findings suggested that uMhlathuze municipality had different types of indigenous medicinal knowledge owners who possess valuable knowledge. These are diviners (Izangoma), faith healers (Abathandazi), and herbalists (Izinyanga). The study demonstrated that indigenous medicinal knowledge is acquired in many different ways, including visions, dreams, and vigorous training. The study also revealed the acquired knowledge is preserved or shared with specially chosen children and trainees. Conclusion: The study concluded that this knowledge is gotten through vigorous training, which requires the learner to be attentive and eager to learn. It was recommended that a study of this nature be conducted but at a broader level to enhance an informed conclusion and recommendations.

Keywords: preserving, indigenous medicinal knowledge, indigenous knowledge, indigenous medicinal knowledge owners/practitioners, acquiring

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Authors: Z. Dedovets, M. Rodionov

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The goal of the modern education system is to prepare students to be able to adapt to ever-changing life situations. They must be able to acquire required knowledge independently; apply such knowledge in practice to solve various problems by using modern technologies; think critically and creatively; competently use information; be communicative, work in a team; and develop their own moral values, intellect and cultural awareness. As a result, the status of education significantly increases; new requirements to its quality have been formed. In recent years, the competency-based approach in education has become of significant interest. This approach is a strengthening of applied and practical characteristics of a school education and leads to the forming of the key students’ competencies which define their success in future life. In this article, the authors’ attention focuses on a range of key competencies, educational, informational and communicative and on the possibility to develop such competencies via STEM education. This research shows the change in students’ attitude towards scientific disciplines such as mathematics, general science, technology and engineering as a result of STEM education. Two-staged analyzes questionnaires completed by students of forms II to IV in the republic of Trinidad and Tobago allowed the authors to categorize students between two levels that represent students’ attitude to various disciplines. The significance of differences between selected levels was confirmed with the use of Pearsons’ chi-squared test. In summary, the analysis of obtained data makes it possible to conclude that STEM education has a great potential for development of core students’ competencies and encourages the development of positive student attitude towards the above mentioned above scientific disciplines.

Keywords: STEM, science, technology, engineering, mathematics, students’ competency, Pearson's chi-squared test

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Authors: Peder O. Laugen Heggdal, Oyvind Nordvik, Jonas Brannstrom, Flemming Vassbotn, Anne Kari Aarstad, Hans Jorgen Aarstad

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Background: Hearing loss (HL) affect people of all ages and stages in life. To author's best knowledge, if patients with an HL have reduced Generic Quality of life (QoL), has yet not been answered. Aim: The aim of the present study was to investigate the relationship between HL and generic and disease-specific Health Related Quality of Life (HRQoL) in adult patients (aged 18–78 years) with an HL, seeking Hearing Aid (HA). Material and Methods: 158 adult (aged 18-78 years) patients with HL, referred for HA fitting at Haukeland University Hospital in western Norway, participated in the study. Both first-time users, as well as patients referred for HA renewals, were included. First-time users had been pre-examined by an Ear Nose and Throat specialist. The questionnaires were answered before the actual HA fitting procedure. The pure-tone average (PTA; frequencies 0.5, 1, 2 and 4 kHz) was determined for each ear. The generic European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire general part and a shortened version of the Abbreviated Profile of Hearing Aid Benefit (APHAB) were answered. In addition, EORTC HRQoL answers from a general population and patients with former head and neck cancer served as comparison. Results: In general, no lowered HRQoL scores were determined among HL patients compared to the general population. Patients with unilateral HL to some extent showed lower HRQoL than those with bilateral HL (social function and fatigue). The APHAB scores correlated significantly with the EORTC HRQoL scores. By stepwise linear regression analysis, the APHAB scores were scored secondary to PTA (best ear), cognitive and physical function. Conclusion: HRQoL scores in HL patients, in general, seems to be at the population level, but the unilateral HL patients scored to some extent lower than the bilateral HI patients. APHAB and generic QoL scores levels are associated. Both HRQoL and APHAB scores are generated more complexly than anticipated.

Keywords: quality of life, hearing loss, hearing impairment, distress, depression, anxiety, hearing aid

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Authors: Firouz Amani, Adalat Hoseinian, Sajjad Hakimian

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Background: The mortality due to Myocardial Infarction (MI) is often occur during the first hours after onset of symptom. So, for taking the necessary treatment and decreasing the mortality rate, timely visited of the hospital could be effective in this regard. The aim of this study was to investigate the impact of effective factors in mortality of MI patients by using Linear Logistic Regression. Materials and Methods: In this case-control study, all patients with Acute MI who referred to the Ardabil city hospital were studied. All of died patients were considered as the case group (n=27) and we select 27 matched patients without Acute MI as a control group. Data collected for all patients in two groups by a same checklist and then analyzed by SPSS version 24 software using statistical methods. We used the linear logistic regression model to determine the effective factors on mortality of MI patients. Results: The mean age of patients in case group was significantly higher than control group (75.1±11.7 vs. 63.1±11.6, p=0.001).The history of non-cardinal diseases in case group with 44.4% significantly higher than control group with 7.4% (p=0.002).The number of performed PCIs in case group with 40.7% significantly lower than control group with 74.1% (P=0.013). The time distance between hospital admission and performed PCI in case group with 110.9 min was significantly upper than control group with 56 min (P=0.001). The mean of delay time from Onset of symptom to hospital admission (patient delay) and the mean of delay time from hospital admissions to receive treatment (system delay) was similar between two groups. By using logistic regression model we revealed that history of non-cardinal diseases (OR=283) and the number of performed PCIs (OR=24.5) had significant impact on mortality of MI patients in compare to other factors. Conclusion: Results of this study showed that of all studied factors, the number of performed PCIs, history of non-cardinal illness and the interval between onset of symptoms and performed PCI have significant relation with morality of MI patients and other factors were not meaningful. So, doing more studies with a large sample and investigated other involved factors such as smoking, weather and etc. is recommended in future.

Keywords: acute MI, mortality, heart failure, arrhythmia

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Authors: Raquel Mateo Mendaza, Carmen Novo Urraca

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The current paper presents the elaboration of a corpus database that aligns two different corpora in order to simplify the search of information both for researchers and students of Old English. This database comprises the information contained in two main reference corpora, namely the Dictionary of Old English Corpus (DOEC), compiled at the University of Toronto, and the York-Toronto-Helsinki Parsed Corpus of Old English (YCOE). The first one provides information on all surviving texts written in the Old English language. The latter offers the syntactical and morphological annotation of several texts included in the DOEC. Although both corpora are closely related, as the YCOE includes the DOE source text identifier, the main problem detected is that there is not an alignment of texts that allows for the search of whole fragments to be further analysed in terms of morphology and syntax. The database proposed in this paper gathers all this information and presents it in a simple, more accessible, visual, and educational way. The alignment of fragments has been done in an automatized way. However, some problems have emerged during the creating process particularly related to the lack of correspondence in the division of fragments. For this reason, it has been necessary to revise the whole entries manually to obtain a truthful high-quality product and to carefully indicate the gaps encountered in these corpora. All in all, this database contains more than 60,000 entries corresponding with the DOE fragments annotated by the YCOE. The main strength of the resulting product is its research and teaching implications in the study of Old English. The use of this database will help researchers and students in the study of different aspects of the language, such as inflectional morphology, syntactic behaviour of given words, or translation studies, among others. By means of the search of words or fragments, the annotated information on morphology and syntax will be automatically displayed, automatizing, and speeding up the search of data.

Keywords: alignment, corpus database, morphosyntactic analysis, Old English

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Authors: Natasha Yasmin Felles, Gerard Riley

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Background and Aims: Relationship breakdown is typical when one partner lives with an acquired brain injury caused by issues like a stroke. Research has found that the perception of relationship satisfaction decreases following such an injury among non-injured partners. Non-injured partners also are found to experience caregiver stress/burden as they immediately have to take the role of a caregiver along with being a partner of the injured. Research has also found that the perception of a continuous relationship, i.e. the perception of the relationship to be essentially the same as it was before the injury, also changes among those caregiving partners. However, there is a lack of available intervention strategies that can help those partners with both individual and relationship difficulties. The aim of this case study was to conduct a pilot test of an intervention aimed to explore whether it is possible to support a partner to experience greater continuity within the relationship poststroke, and what benefits such a change might have. Method: A couple, where one partner experienced an acquired brain injury poststroke were provided with Integrated Behavioural Couples Therapy for 3-months. The intervention addressed goals identified as necessary by the couple and by the formulation of their individual and relationship difficulties, alongside the goal of promoting relationship continuity. Before and after measures were taken using a battery of six questionnaires to evaluate changes in perceptions of continuity, stress, and other aspects of the relationship. Results: Both quantitative and qualitative data showed that relationship continuity was improved after the therapy, as were the measures of stress and other aspects of the relationship. The stress felt by the person with the acquired brain injury also showed some evidence of improvement. Conclusion: The study found that perceptions of relationship continuity can be improved by therapy and that improving these might have a beneficial impact on the stress felt by the carer, their satisfaction with the relationship and overall levels of conflict and closeness within the relationship. The study suggested the value of further research on enhancing perceptions of continuity in the relationship after an acquired brain injury. Currently, the findings of the study have been used to develop a pilot feasibility study to collect substantive evidence on the impact of the intervention on the couples and assess its feasibility and acceptability, which will help in further developing a specific generalized relationship continuity intervention, that will be beneficial in preventing relationship breakdown in the future.

Keywords: acquired brain injury, couples therapy, relationship continuity, stroke

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Authors: Kai Pai Huang

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Background: There are several types of plasma cell neoplasms including multiple myeloma, plasmacytoma, lymphoplasmacytic lymphoma, and monoclonal gammopathy of undetermined significance (MGUS) are found in our lab. Today, we want to compare with two cases using the method of capillary electrophoresis. Method: Serum is prepared and electrophoresis is performed at alkaline PH in a capillary using the Sebia® Capillary 2. Albumin and globulins are detected by the detector which is located in the cathode of the capillary and the signals are transformed to peaks. Serum was treated with beta-mercaptoethanol which reducing the polymerized immunoglobulin to monomer immunoglobulin to clarify two M-protein are secreted from the same plasma cell clone in bone marrow. Result: Case 1: A 78-year-old female presenting dysuria, oliguria and leg edema for several months. Laboratory data showed proteinuria, leukocytosis, results of high serum IgA and lambda light chain. A renal biopsy found amyloid fibrils in the glomerular mesangial area. Serum protein electrophoresis shows a major monoclonal peak in the β region and minor small peak in gamma region, and the immunotyping studies for serum showed two IgA/λ type. Case 2: A 55-year-old male presenting abdominal distension and low back pain for more than one month. Laboratory data showed T12 T8 compression fracture, results of high serum IgM and kappa light chain. Bone marrow aspiration showed the cells from the bone marrow are B cells with monotypic kappa chain expression. Bone marrow biopsy found this is lymphoplasmacytic lymphoma (Waldenstrom macroglobulin). Serum protein electrophoresis shows a monoclonal peak in the β region and the immunotyping studies for serum showed IgM/κ type. Conclusion: Plasma cell neoplasm can be diagnosed by many examinations. Among them, using capillary electrophoresis by a lab can separate several types of gammopathy and the quantification of a monoclonal peak can be used to evaluate the patients’ prognosis or treatment.

Keywords: plasma cell neoplasm, capillary electrophoresis, serum protein electrophoresis, immunotyping

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

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Healthcare workers' flu vaccination prevents influenza disease among both patients and caregivers. We aimed in this study to assess influenza vaccine (IV) coverage in 2018-2019 among Tunisian physicians and to determine factors associated with IV receipt. A cross sectional study was carried out in Tunisian primary and secondary health care facilities in the 2018-2019 influenza season. Physicians with direct patient contact were recruited according to a self-weighted multistage sampling. Data were collected through a face to face questionnaire containing questions on knowledge, attitudes, and practices regarding IV. Bivariate analysis was used in order to determine factors associated with IV receipt. A total of 167 physicians were included in the study with a mean age of 48.2 ± 7.7 years and a sex-ratio (M: F) of 0.37. Among participants, 15.1% (95% CI: [9.7%-20.3%]) were vaccinated against influenza in the 2018-2019 influenza season. Bivariate analysis revealed that previous flu immunization in the four years preceding the 2018-2019 influenza season (OR=32.3; p < 10-3), belief that vaccinating healthcare workers may reduce work absenteeism (OR=4.7, p=0.028), belief that flu vaccine should be mandatory to healthcare workers (OR=3.3, p=0.01) and high confidence towards IV efficacy in preventing influenza among caregivers (OR= 4.5, p=0.01) were associated with a higher IV receipt in 2018-2019 among physicians. Less than one fifth of Tunisian physicians were vaccinated against influenza in 2018-2019. Higher vaccine uptake was related to a higher belief in vaccine efficacy in preventing influenza disease among both patients and caregivers. This underscores the need for periodic educational campaigns to raise physicians' awareness about IV efficacy. The switch to an IV mandatory policy should also be considered.

Keywords: influenza vaccine, physicians, Tunisia, vaccination uptake

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Authors: Anastasios Rodis

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Background: Case studies of walkers, climbers, and campers exposed to cold and wet conditions without limb water/windproof protection revealed experiences of muscle weakness and fatigue. It is reasonable to assume that a part of the fatigue could occur due to an alteration in substrate utilization, since reduction of performance in extreme cold conditions, may partially be explained by higher anaerobic glycolysis, reflecting higher carbohydrate oxidation and an increase accumulation rate of blood lactate. The aim of this study was to assess the effects of pre-exercise lower limb cooling on substrate utilization rate during sub-maximal exercise. Method: Six male university students (mean (SD): age, 21.3 (1.0) yr; maximal oxygen uptake (V0₂ max), 49.6 (3.6) ml.min⁻¹; and percentage of body fat, 13.6 (2.5) % were examined in random order after either 30min cold water (12°C) immersion utilized as the cooling strategy up to the gluteal fold, or under control conditions (no precooling), with tests separated by minimum of 7 days. Exercise consisted of 60min cycling at 50% V0₂ max, in a thermoneutral environment of 20°C. Subjects were also required to record a diet diary over the 24hrs prior to the each trial. Means (SD) for the three macronutrients during the 1 day prior to each trial (expressed as a percentage of total energy) 52 (3) % carbohydrate, 31 (4) % fat, and 17 (± 2) % protein. Results: The following responses to lower limb cooling relative to control trial during exercise were: 1) Carbohydrate (CHO) oxidation, and blood lactate (Bₗₐc) concentration were significantly higher (P < 0.05); 2) rectal temperature (Tᵣₑc) was significantly higher (P < 0.05), but skin temperature was significantly lower (P < 0.05); no significant differences were found in blood glucose (Bg), heart rate (HR) and oxygen consumption (V0₂). Discussion: These data suggested that lower limb cooling prior to submaximal exercise will shift metabolic processes from Fat oxidation to CHO oxidation. This shift from Fat to CHO oxidation will probably have important implications in the surviving scenario, since people facing accidental localized cooling of their limbs either through wading/falling in cold water or snow even if they do not perform high intensity activity, they have to rely on CHO availability.

Keywords: exercise in wet conditions, leg cooling, outdoors exercise, substrate utilization

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Authors: Felix E. Gbenoba, Opeyemi Dahunsi

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Self-instructional materials are at the heart of instructional delivery in Open and Distance Learning (ODL). The success of any ODL institution depends on the availability of instructional materials in quality and quantity. An ODL study material is expected to fully play the teacher plays in the face-to-face learning environment. In Nigeria, efforts to deliver ODL learning materials have been peculiarly challenging. Although researchers are unrelenting in hewing out ways to make ODL delivery in Africa generally and Nigeria in particular, meet the learners’ needs and acceptable global practices, the prospects of integrating instructional media into distance learning courses are largely unexplored. In the present study, we critically examine the prospects of integration of instructional media into ODL courses for pedagogic and other benefits it portends for delivery via the distance learning mode. Although efforts to integrate media in ODL have been recorded before now, the reality has not matched the expectation so far in Nigeria. This does not mean that the existing instructional materials have not produced any significant positive results in improving the overall learning (and teaching) experience in its institutions; it implies that increased integration as suggested here will further improve the experience as well as bring up the new challenges. Obstacles and problems of instructional materials and media development that could have affected the open educational resource initiatives are well established. The first aspect of this paper recalls the revolutionary strides that ODL brought to delivery of education in Nigeria particularly. The other aspect is on what instructional media are, their role, prospects and challenges for ODL in Nigeria; these are examined vis a vis the challenges of development, production and distribution of print instructional materials as the major format of instructional delivery at Nigeria’s only single mode ODL institution, NOUN. In the third aspect, we justify the need and benefits of integrating instructional media into the courses and make recommendations.

Keywords: instructional delivery, instructional media, ODL, media integration, Nigeria, self-instructional materials

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Authors: Nadia Naseem, Farwa Batool, Nasir Mehmood, AbdulHannan Nagi

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Background: The incidence and mortality of breast cancer vary significantly in geographically distinct populations. In Pakistan, breast cancer has shown an increase in incidence in young females and is characterized by more aggressive behavior. The tumor suppressor TP53 gene is a crucial genetic factor that plays a significant role in breast carcinogenesis. This study investigated the TP53 mutations in molecular subtypes of both nodes negative and positive breast cancer in young Pakistani patients. Material and Methods: p53, Estrogen Receptor (ER), Progesterone Receptor (PR), Her-2 neu and Ki 67 expressions were analyzed immunohistochemically in a series of 75 node negative (A) and 75 node positive (B) young (aged: 19-40 years) breast cancer patients diagnosed between 2014 to 2017 at two leading hospitals of Punjab, Pakistan. Tumor tissue specimens and peripheral blood samples were examined for TP53 mutations by direct sequencing of the gene (exons 4-9). The relation of TP53 mutations to these markers and clinicopathological data was investigated. Results: Mean age of the patients was 32.4 + 9.1 SD. Invasive breast carcinoma was the most frequent histological variant (A=92%, B=94.6%). Grade 3 carcinoma was the commonest grade (A=72%, B=81.3%). Triple negative cases (ER-, PR-, Her-2) formed most of the molecular subtypes (A=44%, B=50.6%). A total of 17.2% (A: 6.6%, B: 10.6%) patients showed TP53 mutations. Mutations were significantly more frequent in triple negative cases (A: 74.8%, B: 62.2%) compared to HER2-positive patients (P < 0.0001). In the multivariate analysis of the whole patient group, the independent prognosticator were triple negative cases (P=0.021), TP53 overexpression by IHC (P=0.001) and advanced-stage disease (P=0.007). No statistically significant correlation between TP53 mutations and clinicopathological parameters was found (P < 0.05). Conclusions: It is concluded that TP53 mutations are infrequently present in breast carcinoma of young Pakistani population and there was no significant correlation between p53 mutation and early onset disease. Immunohistochemically detected TP53 expression in our resource-constrained to set up can be beneficial in predicting mutations at the younger age in our population.

Keywords: immunohistochemistry (IHC), invasive breast carcinoma (IBC), Pakistan, TP53

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Authors: Sopit Tubtimhin, Chaliya Wamaloon, Anchalee Supattagorn

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Background and Significance: Breast cancer is the most frequently diagnosed and leading cause of cancer death among women. This study aims to determine factors potentially predicting recurrence and long-term survival after the first recurrence in surgically treated patients between postmenopausal and younger women. Methods and Analysis: A retrospective cohort study was performed on 498 Thai women with invasive breast cancer, who had undergone mastectomy and been followed-up at Ubon Ratchathani Cancer Hospital, Thailand. We collected based on a systematic chart audit from medical records and pathology reports between January 1, 2002, and December 31, 2011. The last follow-up time point for surviving patients was December 31, 2016. A Cox regression model was used to calculate hazard ratios of recurrence and death. Findings: The median age was 49 (SD ± 9.66) at the time of diagnosis, 47% was post-menopausal women ( ≥ 51years and not experienced any menstrual flow for a minimum of 12 months), and 53 % was younger women ( ˂ 51 years and have menstrual period). Median time from the diagnosis to the last follow-up or death was 10.81 [95% CI = 9.53-12.07] years in younger cases and 8.20 [95% CI = 6.57-9.82] years in postmenopausal cases. The recurrence-free survival (RFS) for younger estimates at 1, 5 and 10 years of 95.0 %, 64.0% and 58.93% respectively, appeared slightly better than the 92.7%, 58.1% and 53.1% for postmenopausal women [HRadj = 1.25, 95% CI = 0.95-1.64]. Regarding overall survival (OS) for younger at 1, 5 and 10 years were 97.7%, 72.7 % and 52.7% respectively, for postmenopausal patients, OS at 1, 5 and 10 years were 95.7%, 70.0% and 44.5 respectively, there were no significant differences in survival [HRadj = 1.23, 95% CI = 0.94 -1.64]. Multivariate analysis identified five risk factors for negatively impacting on survival were triple negative [HR= 2.76, 95% CI = 1.47-5.19], Her2-enriched [HR = 2.59, 95% CI = 1.37-4.91], luminal B [HR = 2.29, 95 % CI=1.35-3.89], not free margin [HR = 1.98, 95%CI=1.00-3.96] and patients who received only adjuvant chemotherapy [HR= 3.75, 95% CI = 2.00-7.04]. Statistically significant risks of overall cancer recurrence were Her2-enriched [HR = 5.20, 95% CI = 2.75-9.80], triple negative [HR = 3.87, 95% CI = 1.98-7.59], luminal B [HR= 2.59, 95% CI = 1.48-4.54,] and patients who received only adjuvant chemotherapy [HR= 2.59, 95% CI = 1.48-5.66]. Discussion and Implications: Outcomes from this studies have shown that postmenopausal women have been associated with increased risk of recurrence and mortality. As the results, it provides useful information for planning the screening and treatment of early-stage breast cancer in the future.

Keywords: breast cancer, menopause status, recurrence-free survival, overall survival

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Authors: D. Szinay, O. Perski, A. Jones, T. Chadborn, J. Brown, F. Naughton

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Background: The uptake of health and wellbeing smartphone apps is largely influenced by popularity indicators (e.g., rankings), rather than evidence-based content. Rapid disengagement is common. This study aims to explore how and why potential users 1) select and 2) engage with such apps, and 3) how increased engagement could be promoted. Methods: Semi-structured interviews and a think-aloud approach were used to allow participants to verbalise their thoughts whilst searching for a health or wellbeing app online, followed by a guided search in the UK National Health Service (NHS) 'Apps Library' and Public Health England’s (PHE) 'One You' website. Recruitment took place between June and August 2019. Adults interested in using an app for behaviour change were recruited through social media. Data were analysed using the framework approach. The analysis is both inductive and deductive, with the coding framework being informed by the Theoretical Domains Framework. The results are further mapped onto the COM-B (Capability, Opportunity, Motivation - Behaviour) model. The study protocol is registered on the Open Science Framework (https://osf.io/jrkd3/). Results: The following targets were identified as playing a key role in increasing the uptake of and engagement with health and wellbeing apps: 1) psychological capability (e.g., reduced cognitive load); 2) physical opportunity (e.g., low financial cost); 3) social opportunity (e.g., embedded social media); 4) automatic motivation (e.g., positive feedback). Participants believed that the promotion of evidence-based apps on NHS-related websites could be enhanced through active promotion on social media, adverts on the internet, and in general practitioner practices. Future Implications: These results can inform the development of interventions aiming to promote the uptake of and engagement with evidence-based health and wellbeing apps, a priority within the UK NHS Long Term Plan ('digital first'). The targets identified across the COM-B domains could help organisations that provide platforms for such apps to increase impact through better selection of apps.

Keywords: behaviour change, COM-B model, digital health, mhealth

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Authors: Farzad Shidfar, Najmeh Rostami, Ziaodin Mazhari, Fatemeh Hosseini Baharanchi

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Background and Aim: The rate of failure to maintain a reduced weight has been increased. By definition, people who regain about one-third to two-thirds of their lost weight after one year from the end of the dietary treatment and return all the lost weight after 5 years it is called weight regain. This study was performed to find the causes of weight regain and its relationship with biochemical and psychological factors. Materials and Methods: This cross-sectional study was performed by reviewing the files of people who followed the dietary treatment in 1397-1398.seventy-three persons was in the weight regain group, and seventy-three people were in the weight maintenance group. Psychological factors such as depression, anxiety, quality of life, physical activity, and dietary frequency were assessed through a questionnaire, and biochemical factors such as serum insulin and fasting blood sugar were measured. The mean basal energy in the weight regain group was significantly higher than the weight maintenance group (p = 0.004). There was no significant difference between the two groups in terms of food intake and inflammatory index of food. There was no significant difference between the two groups in terms of food intake and inflammatory index of food. Mean serum insulin concentration (p = 0.023), mean fasting blood sugar (p = 0.04) and insulin resistance (p = 0.013) in the weight regain group were higher than the weight maintenance group. The weight maintenance group showed higher insulin sensitivity than the weight regain group (p = 0.005). There was no significant difference between the two groups in terms of psychological indicators. Conclusion: The only body mass index after one year from the end of the treatment period, insulin sensitivity, serum insulin concentration, fasting blood sugar, insulin resistance, selenium intake, and basal energy expenditure Specific and significant with weight regain. However, the significance of insulin resistance, basal energy expenditure, and body mass index after one year from the end of the treatment period was higher than other variables in the weight regain group.

Keywords: body weight maintenance, weight regain, insulin resistance, insulin sensitivity

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Authors: Radim Sip, Denisa Denglerova

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It’s impossible to capture complex phenomena, such as inclusion, with reductionism. The most common form of reductionism is the objectivist approach, where processes and relationships are reduced to entities and clearly outlined phases, with a consequent search for relationships between them. Constructivism as a paradigm and situational analysis as a methodological research portfolio represent a way to avoid the dominant objectivist approach. They work with a situation, i.e. with the essential blending of actors and their environment. Primary transactions are taking place between actors and their surroundings. Researchers create constructs based on their need to solve a problem. Concepts therefore do not describe reality, but rather a complex of real needs in relation to the available options how such needs can be met. For examination of a complex problem, corresponding methodological tools and overall design of the research are necessary. Using an original research on inclusion in the Czech Republic as an example, this contribution demonstrates that inclusion is not a substance easily described, but rather a relationship field changing its forms in response to its actors’ behaviour and current circumstances. Inclusion consists of dynamic relationship between an ideal, real circumstances and ways to achieve such ideal under the given circumstances. Such achievement has many shapes and thus cannot be captured by description of objects. It can be expressed in relationships in the situation defined by time and space. Situational analysis offers tools to examine such phenomena. It understands a situation as a complex of dynamically changing aspects and prefers relationships and positions in the given situation over a clear and final definition of actors, entities, etc. Situational analysis assumes creation of constructs as a tool for solving a problem at hand. It emphasizes the meanings that arise in the process of coordinating human actions, and the discourses through which these meanings are negotiated. Finally, it offers “cartographic tools” (situational maps, socials worlds / arenas maps, positional maps) that are able to capture the complexity in other than linear-analytical ways. This approach allows for inclusion to be described as a complex of phenomena taking place with a certain historical preference, a complex that can be overlooked if analyzed with a more traditional approach.

Keywords: constructivism, situational analysis, objective realism, reductionism, inclusion

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Authors: John Tarus, Zhendong Niu, Bakhti Khadidja

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In recent years, e-learning recommender systems has attracted great attention as a solution towards addressing the problem of information overload in e-learning environments and providing relevant recommendations to online learners. E-learning recommenders continue to play an increasing educational role in aiding learners to find appropriate learning materials to support the achievement of their learning goals. Although general recommender systems have recorded significant success in solving the problem of information overload in e-commerce domains and providing accurate recommendations, e-learning recommender systems on the other hand still face some issues arising from differences in learner characteristics such as learning style, skill level and study level. Conventional recommendation techniques such as collaborative filtering and content-based deal with only two types of entities namely users and items with their ratings. These conventional recommender systems do not take into account the learner characteristics in their recommendation process. Therefore, conventional recommendation techniques cannot make accurate and personalized recommendations in e-learning environment. In this paper, we propose a recommendation technique combining collaborative filtering and ontology to recommend personalized learning materials to online learners. Ontology is used to incorporate the learner characteristics into the recommendation process alongside the ratings while collaborate filtering predicts ratings and generate recommendations. Furthermore, ontological knowledge is used by the recommender system at the initial stages in the absence of ratings to alleviate the cold-start problem. Evaluation results show that our proposed recommendation technique outperforms collaborative filtering on its own in terms of personalization and recommendation accuracy.

Keywords: collaborative filtering, e-learning, ontology, recommender system

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Authors: Tingting Huang, Sha Li, Geoffrey Griffiths, Martin Lukac, Jianning Zhu

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Territorial landscapes have experienced a gradual loss of their typical characteristics during long-term human activities. In order to protect the integrity of regional landscapes, it is necessary to characterize, evaluate and protect them in a graded manner. The study takes Fujian, China, as an example and classifies the landscape characters of the site at the regional scale, middle scale, and detailed scale. A multi-scale approach combining parametric and holistic approaches is used to classify and partition the landscape character types (LCTs) and landscape character areas (LCAs) at different scales, and a multi-element landscape assessment approach is adopted to explore the conservation strategies of the landscape character. Firstly, multiple fields and multiple elements of geography, nature and humanities were selected as the basis of assessment according to the scales. Secondly, the study takes a parametric approach to the classification and partitioning of landscape character, Principal Component Analysis, and two-stage cluster analysis (K-means and GMM) in MATLAB software to obtain LCTs, combines with Canny Operator Edge Detection Algorithm to obtain landscape character contours and corrects LCTs and LCAs by field survey and manual identification methods. Finally, the study adopts the Landscape Sensitivity Assessment method to perform landscape character conservation analysis and formulates five strategies for different LCAs: conservation, enhancement, restoration, creation, and combination. This multi-scale identification approach can efficiently integrate multiple types of landscape character elements, reduce the difficulty of broad-scale operations in the process of landscape character conservation, and provide a basis for landscape character conservation strategies. Based on the natural background and the restoration of regional characteristics, the results of landscape character assessment are scientific and objective and can provide a strong reference in regional and national scale territorial spatial planning.

Keywords: parameterization, multi-scale, landscape character identify, landscape character assessment

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Authors: Mohamed Salaheldien Mohamed Alayat, Ahmed Mohamed Elsoudany, Roaa Abdulghani Sroge, Bayan Muteb Aldhahwani

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Background: Neck pain is a common illness that could affect individual’s daily activities. Class IV laser with longer wavelength can stimulate tissues and penetrate more than the classic low-level laser therapy. Objectives: The aim of the study was to investigate the efficacy of class IV diode laser in the treatment of patients with chronic neck pain (CNP). Methods: Fifty-two patients participated and completed the study. Their mean age (SD) was 50.7 (6.2). Patients were randomized into two groups and treated with laser plus exercise (laser + EX) group and placebo laser plus exercise (PL+EX) group. Treatment was performed by Class IV laser in two phases; scanning and trigger point phases. Scanning to the posterior neck and shoulder girdle region with 4 J/cm2 with a total energy of 300 J applied to 75 cm2 in 4 minutes and 16 seconds. Eight trigger points on the posterior neck area were treated by 4 J/cm2 and the time of application was in 30 seconds. Both groups received exercise two times per week for 4 weeks. Exercises included range of motion, isometric, stretching, isotonic resisted exercises to the cervical extensors, lateral bending and rotators muscles with postural correction exercises. The measured variables were pain level using visual analogue scale (VAS), and neck functional activity using neck disability index (NDI) score. Measurements were taken at baseline and after 4 weeks of treatment. The level of statistical significance was set as p < 0.05. Results: There were significant decreases in post-treatment VAS and NDI in both groups as compared to baseline values. Laser + EX effectively decreased VAS (mean difference -6.5, p = 0.01) and NDI scores after (mean difference -41.3, p = 0.01) 4 weeks of treatment compared to PL + EX. Conclusion: Class IV laser combined with exercise is effective treatment for patients with CNP as compared to PL + EX therapy. The combination of laser + EX effectively increased functional activity and reduced pain after 4 weeks of treatment.

Keywords: chronic neck pain, class IV laser, exercises, neck disability index, visual analogue scale

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Authors: Chijindu D. Mgbemere

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Mass killing also known as genocide is the systematic killing of people from national, ethnic, or religious group, or an attempt to do so. The act has been there before 1948, when it was officially recognized for what it is. From then, the world has continued to witness genocide in diverse forms- negating different measures by the United Nations and its agencies to curb it. So far, all the studies and documentations on this subject are biased in favor of radio and the print. This paper therefore extended the interrogation of genocide, drumming its devastating effects, using the film medium; and in doing so devised innovative and pragmatic approach to genocide scholarship. It further centered attention on the factors and impacts of genocide, with a view to determine how effective film can be in such a study. The study is anchored on Bateson’s Framing Theory. Four films- Hotel Rwanda, Half of a Yellow Sun, Attack on Darfur, and sarafina, were analyzed, based on background, factors/causes, impacts, and development of genocide, via Content Analysis. The study discovered that: as other continents strive towards peace, acts of genocide are on the increase in African. Bloodletting stereotypes give Africa negative image in the global society. Difficult political frameworks, the trauma of postcolonial state, aggravated by ethnic and religious intolerance, and limited access to resources are responsible for high cases of genocide in Africa. The media, international communities, and peace agencies often abet other than prevent genocide or mass killings in Africa. High human casualty and displacement, children soldering, looting, hunger, rape, sex-slavery and abuse, mental and psychosomatic stress disorders are some of the impacts of genocide. Genocidaires are either condemned or killed. Grievances can be vented using civil resistance, negotiation, adjudication, arbitration, and mediation. The cinema is an effective means of studying and documenting genocide. Africans must factor the image laundering of their continent into consideration. Punishment of genocidaires without an attempt to de-radicalize them is counterproductive.

Keywords: African film, genocide, framing theory, mass murder

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Authors: Buhari Samaila, Sabiu Abdullahi, Buhari Maidamma

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Background: Contrast-enhanced computed tomography (CE-CT) is a technique that uses contrast media to improve image quality and diagnostic accuracy. It is a widely used imaging modality in medical diagnostics, offering high-resolution images for accurate diagnosis. However, concerns regarding the potential adverse effects of contrast media and radiation dose exposure have prompted ongoing investigation and assessment. It is important to assess the effects of contrast media and radiation dose in CE-CT procedures. Objective: This study aims to assess the effects of contrast media and radiation dose in contrast-enhanced computed tomography (CECT) procedures. Methods: A comprehensive review of the literature was conducted to identify studies related to contrast media effects and radiation dose assessment in CECT. Relevant data, including location, type of research, objective, method, findings, conclusion, authors, and year of publications, were extracted, analyzed, and reported. Results: The findings revealed that several studies have investigated the impacts of contrast media and radiation doses in CECT procedures, with iodinated contrast agents being the most commonly employed. Adverse effects associated with contrast media administration were reported, including allergic reactions, nephrotoxicity, and thyroid dysfunction, albeit at relatively low incidence rates. Additionally, radiation dose levels varied depending on the imaging protocol and anatomical region scanned. Efforts to minimize radiation exposure through optimization techniques were evident across studies. Conclusion: Contrast-enhanced computed tomography (CECT) remains an invaluable tool in medical imaging; however, careful consideration of contrast media effects and radiation dose exposure is imperative. Healthcare practitioners should weigh the diagnostic benefits against potential risks, employing strategies to mitigate adverse effects and optimize radiation dose levels for patient safety and effective diagnosis. Further research is warranted to enhance the understanding and management of contrast media effects and radiation dose optimization in CECT procedures.

Keywords: CT, contrast media, radiation dose, effect of radiation

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Authors: Ammar Asma, Bouafia Nabiha, Ghammam Rim, Ezzi Olfa, Ben Cheikh Asma, Mahjoub Mohamed, Helali Radhia, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Central venous catheter associated infections (CVC-AI) are among the serious hospital-acquired infections. The aims of this study are to determine the incidence of CVC-AI, and their risk factors among patients followed in a Tunisian medical intensive care unit (ICU). Materials / Methods: A prospective cohort study conducted between September 15th, 2015 and November 15th, 2016 in an 8-bed medical ICU including all patients admitted for more than 48h. CVC-AI were defined according to CDC of ATLANTA criteria. The enrollment was based on clinical and laboratory diagnosis of CVC-AI. For all subjects, age, sex, underlying diseases, SAPS II score, ICU length of stay, exposure to CVC (number of CVC placed, site of insertion and duration catheterization) were recorded. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: Among 192 eligible patients, 144 patients (75%) had a central venous catheter. Twenty-eight patients (19.4%) had developed CVC-AI with density rate incidence 20.02/1000 CVC-days. Among these infections, 60.7% (n=17) were systemic CVC-AI (with negative blood culture), and 35.7% (n=10) were bloodstream CVC-AI. The mean SAPS II of patients with CVC-AI was 32.76 14.48; their mean Charlson index was 1.77 1.55, their mean duration of catheterization was 15.46 10.81 days and the mean duration of one central line was 5.8+/-3.72 days. Gram-negative bacteria was determined in 53.5 % of CVC-AI (n= 15) dominated by multi-drug resistant Acinetobacter baumani (n=7). Staphylococci were isolated in 3 CVC-AI. Fourteen (50%) patients with CVC-AI died. Univariate analysis identified men (p=0.034), the referral from another hospital department (p=0.03), tobacco (p=0.006), duration of sedation (p=0.003) and the duration of catheterization (p=0), as possible risk factors of CVC-AI. Multivariate analysis showed that independent factors of CVC-AI were, male sex; OR= 5.73, IC 95% [2; 16.46], p=0.001, Ramsay score; OR= 1.57, IC 95% [1.036; 2.38], p=0.033, and duration of catheterization; OR=1.093, IC 95% [1.035; 1.15], p=0.001. Conclusion: In a monocenter cohort, CVC-AI had a high density and is associated with poor outcome. Identifying the risk factors is necessary to find solutions for this major health problem.

Keywords: central venous catheter associated infection, intensive care unit, prospective cohort studies, risk factors

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Authors: Auwal Abubakar, Shazril Imran Shaukat, Noor Khairiah A. Karim, Mohammed Zakir Kassim, Gokula Kumar Appalanaido, Hafiz Mohd Zin

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Background: Voluntary deep inspiration breath-hold radiotherapy (vDIBH-RT) is an effective cardiac dose reduction technique during left breast radiotherapy. This study aimed to assess the accuracy of the implementation of the vDIBH technique among left breast cancer patients without the use of a special device such as a surface-guided imaging system. Methods: The vDIBH-RT technique was implemented among thirteen (13) left breast cancer patients at the Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia. Breath-hold monitoring was performed based on breath-hold skin marks and laser light congruence observed on zoomed CCTV images from the control console during each delivery. The initial setup was verified using cone beam computed tomography (CBCT) during breath-hold. Each field was delivered using multiple beam segments to allow a delivery time of 20 seconds, which can be tolerated by patients in breath-hold. The data were analysed using an in-house developed MATLAB algorithm. PTV margin was computed based on van Herk's margin recipe. Results: The setup error analysed from CBCT shows that the population systematic error in lateral (x), longitudinal (y), and vertical (z) axes was 2.28 mm, 3.35 mm, and 3.10 mm, respectively. Based on the CBCT image guidance, the Planning target volume (PTV) margin that would be required for vDIBH-RT using CCTV/Laser monitoring technique is 7.77 mm, 10.85 mm, and 10.93 mm in x, y, and z axes, respectively. Conclusion: It is feasible to safely implement vDIBH-RT among left breast cancer patients without special equipment. The breath-hold monitoring technique is cost-effective, radiation-free, easy to implement, and allows real-time breath-hold monitoring.

Keywords: vDIBH, cone beam computed tomography, radiotherapy, left breast cancer

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Authors: Piluntana Panpluem, Monticha Putsakum

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The objectives of this study were to investigate 1) consumers’ behaviors in buying organic products; and 2) the relationships between personal factors, cultural factors, social factors, psychological factors and marketing mix factors, and the behavior in buying organic products of consumers in the greater Bangkok metropolitan area. The sample group was 400 consumers at the age of 15 and older, who bought organic agricultural products from green markets and green shops in Bangkok, including its suburbs. The data were collected by using a questionnaire, which were analyzed by descriptive statistics and chi-square test. The results showed that the consumers bought 3 – 4 types of fresh vegetables with a total expenditure of less than 499 Baht each time. They purchased organic products mainly at a supermarket, 2 – 4 times per month, most frequently on Sundays, which took less than 30 minutes of shopping each time. The purpose of the purchase was for self-consuming. Gaining or retaining good health was the reason for the consumption of the products. Additionally, the first considered factor in the organic product selection was the quality. The decisions in purchasing the products were made directly by consumers, who were influenced mainly by advertising media on television. For the relationships among personal, cultural, social, psychological and marketing mix factors, and consumers’ behavior in buying organic products, the results showed the following: 1) personal factors, which were gender, age and educational level, were related to the behavior in terms of “What”, “Why”, and “Where” the consumers bought organic products (p<0.05); 2) cultural factors were related to “Why” the consumers bought organic products (p<0.05); 3) social factors were related to “Where” and “How” the consumers bought organic products (p<0.05); 4) psychological factors were related to “When” the consumers bought organic products (p<0.05). 5) For the marketing mix factors, “Product” was related to “Who participated” in buying, “What” and “Where” the consumers bought organic products (p<0.05), while “Price” was related to “What” and “When” the consumers bought organic products (p<0.05). “Place” was related to “What” and “How” the consumers bought organic products (p<0.05). Furthermore, “Promotion” was related to “What” and “Where” the consumers bought organic products (p<0.05).

Keywords: consumer behavior, organic products, Bangkok Metropolis and Vicinity

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