Search results for: Arba Minch general hospital

Authors: Sinarwati Mohamad Suhaili, Naomie Salim, Mohamad Nazim Jambli

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Sequence-to-sequence (seq2seq) models augmented with attention mechanisms are playing an increasingly important role in automated customer service. These models, which are able to recognize complex relationships between input and output sequences, are crucial for optimizing chatbot responses. Central to these mechanisms are neural attention weights that determine the focus of the model during sequence generation. Despite their widespread use, there remains a gap in the comparative analysis of different attention weighting functions within seq2seq models, particularly in the domain of chatbots using the Customer Support Twitter (CST) dataset. This study addresses this gap by evaluating four distinct attention-scoring functions—dot, multiplicative/general, additive, and an extended multiplicative function with a tanh activation parameter — in neural generative seq2seq models. Utilizing the CST dataset, these models were trained and evaluated over 10 epochs with the AdamW optimizer. Evaluation criteria included validation loss and BLEU scores implemented under both greedy and beam search strategies with a beam size of k=3. Results indicate that the model with the tanh-augmented multiplicative function significantly outperforms its counterparts, achieving the lowest validation loss (1.136484) and the highest BLEU scores (0.438926 under greedy search, 0.443000 under beam search, k=3). These results emphasize the crucial influence of selecting an appropriate attention-scoring function in improving the performance of seq2seq models for chatbots. Particularly, the model that integrates tanh activation proves to be a promising approach to improve the quality of chatbots in the customer support context.

Keywords: attention weight, chatbot, encoder-decoder, neural generative attention, score function, sequence-to-sequence

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Authors: Ragi Poyyara, Vijaya Patnana, Mohammed Alam

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When acid is pumped into damaged reservoirs for damage removal/stimulation, distorted inflow of acid into the formation occurs caused by acid preferentially traveling into highly permeable regions over low permeable regions, or (in general) into the path of least resistance. This can lead to poor zonal coverage and hence warrants diversion to carry out an effective placement of acid. Diversion is desirably a reversible technique of temporarily reducing the permeability of high perm zones, thereby forcing the acid into lower perm zones. The uniqueness of each reservoir can pose several challenges to engineers attempting to devise optimum and effective diversion strategies. Diversion techniques include mechanical placement and/or chemical diversion of treatment fluids, further sub-classified into ball sealers, bridge plugs, packers, particulate diverters, viscous gels, crosslinked gels, relative permeability modifiers (RPMs), foams, and/or the use of placement techniques, such as coiled tubing (CT) and the maximum pressure difference and injection rate (MAPDIR) methodology. It is not always realized that the effectiveness of diverters greatly depends on reservoir properties, such as formation type, temperature, reservoir permeability, heterogeneity, and physical well characteristics (e.g., completion type, well deviation, length of treatment interval, multiple intervals, etc.). This paper reviews the mechanisms by which each variety of diverter functions and discusses the effect of various reservoir properties on the efficiency of diversion techniques. Guidelines are recommended to help enhance productivity from zones of interest by choosing the best methods of diversion while pumping an optimized amount of treatment fluid. The success of an overall acid treatment often depends on the effectiveness of the diverting agents.

Keywords: diversion, reservoir, zonal coverage, carbonate, sandstone

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Authors: Manasa Kalla, Narasimha Raju Chebrolu, Ashok Chatterjee

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We have studied the quantum transport properties of a single molecular transistor in the presence of an external magnetic field using the Keldysh Green function technique. We also used the Anderson-Holstein-Caldeira-Leggett Model to describe the single molecular transistor that consists of a molecular quantum dot (QD) coupled to two metallic leads and placed on a substrate that acts as a heat bath. The phonons are eliminated by the Lang-Firsov transformation and the effective Hamiltonian is used to study the effect of an external magnetic field on the spectral density function, Tunneling Current, Differential Conductance and Spin polarization. A peak in the spectral function corresponds to a possible excitation. In the presence of a magnetic field, the spin-up and spin-down states are degenerate and this degeneracy is lifted by the magnetic field leading to the splitting of the central peak of the spectral function. The tunneling current decreases with increasing magnetic field. We have observed that even the differential conductance peak in the zero magnetic field curve is split in the presence electron-phonon interaction. As the magnetic field is increased, each peak splits into two peaks. And each peak indicates the existence of an energy level. Thus the number of energy levels for transport in the bias window increases with the magnetic field. In the presence of the electron-phonon interaction, Differential Conductance in general gets reduced and decreases faster with the magnetic field. As magnetic field strength increases, the spin polarization of the current is increasing. Our results show that a strongly interacting QD coupled to metallic leads in the presence of external magnetic field parallel to the plane of QD acts as a spin filter at zero temperature.

Keywords: Anderson-Holstein model, Caldeira-Leggett model, spin-polarization, quantum dots

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Authors: Alonge Isaac Olusola

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Taking a cue from countries such as China and Japan, there is no doubt that the teaching and learning of Mother Tongue ( MT) or Language of Immediate Environment (LIE) is a potential source of development in every country. The engine of economic, scientific, technological and political advancement would be more functional when the language of instruction for teaching and learning in schools is in the child’s mother tongue. The purpose of this paper therefore, is to delve into the genesis of the official recognition given to the teaching and learning of Nigerian languages at national level with special focus on Yoruba language. Yoruba language and other Nigerian languages were placed on a national pedestal by a Nigerian Educational Minister, Late Professor Babatunde Fafunwa, who served under the government of General Ibrahim Babangida (1985 – 1993). Through his laudable effort, the teaching and learning of Nigerian languages in schools all over the nation was incorporated officially in the national policy of education. Among all the Nigerian languages, Hausa, Igbo and Yoruba were given foremost priorities because of the large population of their speakers. Since the Fafunwa era, Yoruba language has become a national subject taught in primary, secondary and tertiary institutions in Nigeria. However, like every new policy, its implementation has suffered several forms of criticisms and impediments from governments, policy makers, curriculum developers, school administrators, teachers and learners. This paper has been able to arrive at certain findings through oral interviews, questionnaires and evaluation of pupils/students enrolment and performances in Yoruba language with special focus on the South-west and North central regions of Nigeria. From the research carried out, some factors have been found to be responsible for the successful implementation or otherwise of Yoruba language instruction policy in some schools, colleges and higher institutions in Nigeria. In conclusion, the paper made recommendations on how the National Policy of Education would be implemented to enhance the teaching and learning of Yoruba language in all Nigerian schools.

Keywords: language of immediate environment, mother tongue, national policy of education, yoruba language

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Authors: Anna Demian, Levi Howard, L. Ng, Leslie Simon, Mark Dragon, A. Desai, Timothy Devlantes, W. David Freeman

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Introduction: Out-of-hospital cardiac arrest (OHCA) can carry a high mortality. For survivors, the most common complication is hypoxic-ischemic brain injury (HIBI). Rarely, lumbosacral spinal cord and/or other spinal cord artery ischemia can occur due to anatomic variation and variable mean arterial pressure after the return of spontaneous circulation. We present a case of an OHCA survivor who later woke up with bilateral leg weakness with preserved sensation (ASIA grade B, L2 level). Methods: We describe a clinical, radiographic, and laboratory presentation, as well as a National Library of Medicine (NLM) search engine methodology, characterizing incidence/prevalence of this entity is discussed. A 70-year-old male, a longtime smoker, and alcohol user, suddenly collapsed at a bar surrounded by friends. He had complained of chest pain before collapsing. 911 was called. EMS arrived, and the patient was in pulseless electrical activity (PEA), cardiopulmonary resuscitation (CPR) was initiated, and the patient was intubated, and a LUCAS device was applied for continuous, high-quality CPR in the field by EMS. In the ED, central lines were placed, and thrombolysis was administered for a suspected Pulmonary Embolism (PE). It was a prolonged code that lasted 90 minutes. The code continued with the eventual return of spontaneous circulation. The patient was placed on an epinephrine and norepinephrine drip to maintain blood pressure. ECHO was performed and showed a “D-shaped” ventricle worrisome for PE as well as an ejection fraction around 30%. A CT with PE protocol was performed and confirmed bilateral PE. Results: The patient woke up 24 hours later, following commands, and was extubated. He was found paraplegic below L2 with preserved sensation, with hypotonia and areflexia consistent with “spinal shock” or anterior spinal cord syndrome. MRI thoracic and lumbar spine showed a conus medullaris level spinal cord infarction. The patient was given IV steroids upon initial discovery of cord infarct. NLM search using “cardiac arrest” and “spinal cord infarction” revealed 57 results, with only 8 review articles. Risk factors include age, atherosclerotic disease, and intraaortic balloon pump placement. AoA (Artery of Adamkiewicz) anatomic variation along with existing atherosclerotic factors and low perfusion were also known risk factors. Conclusion: Acute paraplegia from anterior spinal cord infarction of the AoA territory after cardiac arrest is rare. Larger prospective, multicenter trials are needed to examine potential interventions of hypothermia, lumbar drains, which are sometimes used in aortic surgery to reduce ischemia and/or other neuroprotectants.

Keywords: cardiac arrest, spinal cord infarction, artery of Adamkiewicz, paraplegia

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Authors: Siddhant Yadav, Ann Vincent, Sanjeev Nanda, Karen M. Fischer, Jessica A. Wright

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Statement of the Problem: Despite the growing popularity of cannabis in the general population, there are several unknowns regarding its use, specific reasons for use, patient’s choice of products, health benefits, and adverse effects. The aim of our study was to evaluate patient-reported information related to cannabis use that was recorded in the electronic medical records. Methodology & Theoretical Orientation: We manually reviewed the electronic medical records of cannabis users who were part of a large pharmacogenomic study. Data abstracted included demographics, level of education, concurrent alcohol and tobacco use, type of cannabis utilized, formulation, indication, symptomatic improvement, or adverse effects reported. Following this, we did a descriptive statistical analysis. Findings: Our sample of 164 cannabis users were predominantly female (73.2%); 66% of users reported using cannabis for medical indications. Of the 109 patients who recorded information pertaining to alcohol/tobacco use, two-thirds of cannabis users reported concurrent use of alcohol, and about half of them were former or current tobacco users. The mean age of cannabis use was 66 years. Regarding the type of cannabis, 34.1% reported using marijuana, 32.3% reported CBD use, 1.8% reported using THC, and 1.2% reported using Marinol. Oral formulations (capsules, oils, suspensions, brownies, cakes, and tea) were the most common route (44 %). Indications for use included chronic pain (n=76), anxiety (n=9), counteracting side effects of chemotherapy (n=4), and palliative reasons (n=2). Fifty-eight of the 76 users endorsed improvement in chronic pain (80%), 5 users reported improvement in anxiety, and 2 reported improvement in side effects of chemotherapy. Conclusion & Significance: The majority of our cannabis users were Caucasian females, and there was a high likelihood of coinciding use of alcohol/tobacco in patients using cannabis. Most of our patients used the oral formulation for chronic pain. Importantly, a considerable number of patients reported improvements in chronic pain, anxiety, and side effects of chemotherapy.

Keywords: cannabis use, adverse effects, medical practice, indications

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Authors: Tamirat Solomon, Aberash Yohannis, Efrem Gulfo

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The plantation of trees, which harmonizes the agroecology of the environment, has been implemented in Ethiopia with great concern for a noticeably degraded environment. This study was designed to evaluate the effectiveness of green legacy, species selection and, the rate of survival, and the management status in the study areas. A systematic sampling method was employed to collect the required data from 144 quadrants measuring a 15m radius with an interval of 40m apart. Additionally, 244 sample households were selected for the socioeconomic study in addition to secondary data collected from office recordings. The data collected was analyzed using multivariate analysis, considering exposure and outcome variables. The findings of this study indicated that four exotic tree species, namely; A. salgina, C. fistula, A. indica, and G. robusta, were commonly selected tree species for degraded land restoration in the study areas. Among the seedlings planted at the four study sites, a total of 79.9% survived, and A. salgina was the dominant and best performed species, A. indica was the least survived species in the entire study area. The age of the seedling before planting significantly (p = 0.05) affected the survival potential of most seedlings of species, and the majority (82%) of local communities expressed their positive attitudes and willingness to manage the restoration works in the study areas. It was recommended to consider the inclusion of native species in the restoration effort and evaluate the co-existence of native flora with exotic and its competition for nutrients, water, and light in addition to the invading potentials in the ecosystem. In general, before embarking on degraded land restoration, species selection, adequate preparation of seedlings, and species diversity composition that exactly fit the socioeconomic and ecological demands of the areas must get the attention for the success of the restoration.

Keywords: plantation forest, degraded land, forest restoration, plantation survival, species selection

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Authors: Lixin Tian, Wei Xue

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Many jobs in society go underground, such as mine mining, tunnel construction and subways, which are vital to the development of society. Once accidents occur in these places, the interruption of traditional wired communication is not conducive to the development of rescue work. In order to realize the positioning, early warning and command functions of underground personnel and improve rescue efficiency, it is necessary to develop and design an emergency ground communication system. It is easy to be subjected to narrowband interference when performing conventional underground communication. Spreading communication can be used for this problem. However, general spread spectrum methods such as direct spread communication are inefficient, so it is proposed to use parallel combined spread spectrum (PCSS) communication to improve efficiency. The PCSS communication not only has the anti-interference ability and the good concealment of the traditional spread spectrum system, but also has a relatively high frequency band utilization rate and a strong information transmission capability. So, this technology has been widely used in practice. This paper presents a PCSS communication model-multiple detection parallel combined spread spectrum (MDPCSS) communication system. In this paper, the principle of MDPCSS communication system is described, that is, the sequence at the transmitting end is processed in blocks and cyclically shifted to facilitate multiple detection at the receiving end. The block diagrams of the transmitter and receiver of the MDPCSS communication system are introduced. At the same time, the calculation formula of the system bit error rate (BER) is introduced, and the simulation and analysis of the BER of the system are completed. By comparing with the common parallel PCSS communication, we can draw a conclusion that it is indeed possible to reduce the BER and improve the system performance. Furthermore, the influence of different pseudo-code lengths selected on the system BER is simulated and analyzed, and the conclusion is that the larger the pseudo-code length is, the smaller the system error rate is.

Keywords: cyclic shift, multiple detection, parallel combined spread spectrum, PN code

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Authors: Jia-Jane Shuai

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Purpose of this research aims to improve understanding of the nature of online religion by examining the religious social websites. What motivates individual users to use the online religious social websites, and which factors affect those motivations. We survey various online religious social websites provided by different religions, especially the Taiwanese folk religion. Based on the theory of the Content Analysis and Social Network Analysis, religious social websites and religious web activities are examined. This research examined the folk religion websites’ presentation and contents that promote the religious use of the Internet in Taiwan. The difference among different religions and religious websites also be compared. First, this study used keywords to examine what types of messages gained the most clicks of “Like”, “Share” and comments on Facebook. Dividing the messages into four media types, namely, text, link, video, and photo, reveal which category receive more likes and comments than the others. Meanwhile, this study analyzed the five dialogic principles of religious websites accessed from mobile phones and also assessed their mobile readiness. Using the five principles of dialogic theory as a basis, do a general survey on the websites with elements of online religion. Second, the project analyzed the characteristics of Taiwanese participants for online religious activities. Grounded by social network analysis and text mining, this study comparatively explores the network structure, interaction pattern, and geographic distribution of users involved in communication networks of the folk religion in social websites and mobile sites. We studied the linkage preference of different religious groups. The difference among different religions and religious websites also be compared. We examined the reasons for the success of these websites, as well as reasons why young users accept new religious media. The outcome of the research will be useful for online religious service providers and non-profit organizations to manage social websites and internet marketing.

Keywords: content analysis, online religion, social network analysis, social websites

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Authors: Nurunnahar Akter, Elena Kulinskaya, Nicholas Steel, Ilyas Bakbergenuly

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Although Hormone Replacement Therapy (HRT) is an effective treatment in ameliorating menopausal symptoms, it has mixed effects on different health outcomes, increasing, for instance, the risk of breast cancer. Because of this, many symptomatic women are left untreated. Untreated menopausal symptoms may result in other health issues, which eventually put an extra burden and costs to the health care system. All-cause mortality analysis may explain the net benefits and risks of the HRT therapy. However, it received far less attention in HRT studies. This study investigated the impact of HRT on all-cause mortality using electronically recorded primary care data from The Health Improvement Network (THIN) that broadly represents the female population in the United Kingdom (UK). The study entry date for this study was the record of the first HRT prescription from 1984, and patients were followed up until death or transfer to another GP practice or study end date, which was January 2017. 112,354 HRT users (cases) were matched with 245,320 non-users by age at HRT initiation and general practice (GP). The hazards of all-cause mortality associated with HRT were estimated by a parametric Weibull-Cox model adjusting for a wide range of important medical, lifestyle, and socio-demographic factors. The multilevel multiple imputation techniques were used to deal with missing data. This study found that during 32 years of follow-up, combined HRT reduced the hazard ratio (HR) of all-cause mortality by 9% (HR: 0.91; 95% Confidence Interval, 0.88-0.94) in women of age between 46 to 65 at first treatment compared to the non-users of the same age. Age-specific mortality analyses found that combined HRT decreased mortality by 13% (HR: 0.87; 95% CI, 0.82-0.92), 12% (HR: 0.88; 95% CI, 0.82-0.93), and 8% (HR: 0.92; 95% CI, 0.85-0.98), in 51 to 55, 56 to 60, and 61 to 65 age group at first treatment, respectively. There was no association between estrogen-only HRT and women’s all-cause mortality. The findings from this study may help to inform the choices of women at menopause and to further educate the clinicians and resource planners.

Keywords: hormone replacement therapy, multiple imputations, primary care data, the health improvement network (THIN)

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Authors: Brian Bilich

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A typical global learning program is a two-week project based, culturally immersive and academically relevant experience built around a project with purpose and catered to student and business groups. Global Learning in Continuing Education at Austin Community College promotes global readiness through projects with purpose with special attention given to balancing learning, hospitality and travel. A recent project involved CommunityFirst! Village; a 51-acre planned community which provides affordable, permanent housing for men and women coming out of chronic homelessness. Global Learning students collaborated with residents and staff at the Community First! Village on a project to produce two-dimensional remodeling plans of residents’ tiny homes with a focus on but not limited to design improvements on elements related to accessibility, increased usability of living and storage space and esthetic upgrades to boost psychological and emotional appeal. The goal of project-based learning in the context of global learning in Continuing Educaiton at Austin Community Collegen general is two fold. One, in rapid fashion we develop a project which gives the learner a hands-on opportunity to exercise soft and technical skills, like creativity and communication and analytical thinking. Two, by basing projects on global social conflict issues, the project of purpose promotes the development of empathy for other people and fosters a sense of corporate social responsibility in future generations of business leadership. In the example provide above the project informed the student group on the topic of chronic homelessness and promoted awareness and empathy for this underserved segment of the community. Project-based global learning based on projects with purpose has the potential to cultivate global readiness by developing empathy and strengthening emotional intelligence for future generations.

Keywords: project-based learning, global learning, global readiness, globalization, international exchange, collaboration

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Authors: Tristan R. Fraser, Christopher D. Steadman, Christopher J. Boos

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Myopericarditis is an inflammation syndrome characterised by clinical diagnostic criteria for pericarditis, such as chest pain, combined with evidence of myocardial involvement, such as elevation of biomarkers of myocardial damage, e.g., troponins. It can rarely be a complication of therapeutics used for dysregulated immune-mediated diseases such as inflammatory bowel disease (IBD), for example, mesalazine. The infrequency of mesalazine-induced myopericarditis adds to the challenge in its recognition. Rapid diagnosis and the early introduction of treatment are crucial. This case report follows a 24-year-old professional footballer with a past medical history of ulcerative colitis, recently started on mesalazine for disease control. Three weeks after mesalazine was initiated, he was admitted with fever, shortness of breath, and chest pain worse whilst supine and on deep inspiration, as well as elevated venous blood cardiac troponin T level (cTnT, 288ng/L; normal: <13ng/L). Myocarditis was confirmed on initial inpatient cardiac MRI, revealing the presence of florid myocarditis with preserved left ventricular systolic function and an ejection fraction of 67%. This was a longitudinal case study following the progress of a single individual with myopericarditis over four acute hospital admissions over nine weeks, with admissions ranging from two to five days. Parameters examined included clinical signs and symptoms, serum troponin, transthoracic echocardiogram, and cardiac MRI. Serial measurements of cardiac function, including cardiac MRI and transthoracic echocardiogram, showed progressive deterioration of cardiac function whilst mesalazine was continued. Prior to cessation of mesalazine, transthoracic echocardiography revealed a small global pericardial effusion of < 1cm and worsening left ventricular systolic function with an ejection fraction of 45%. After recognition of mesalazine as a potential cause and consequent cessation of the drug, symptoms resolved, with cardiac MRI performed as an outpatient showing resolution of myocardial oedema. The patient plans to make a return to competitive sport. Patients suffering from myopericarditis are advised to refrain from competitive sport for at least six months in order to reduce the risk of cardiac remodelling and sudden cardiac death. Additional considerations must be taken in individuals for whom competitive sport is an essential component of their livelihood, such as professional athletes. Myopericarditis is an uncommon, however potentially serious medical condition with a wide variety of aetiologies, including viral, autoimmune, and drug-related causes. Management is mainly supportive and relies on prompt recognition and removal of the aetiological process. Mesalazine-induced myopericarditis is a rare condition; as such increasing awareness of mesalazine as a precipitant of myopericarditis is vital for optimising the management of these patients.

Keywords: myopericarditis, mesalazine, inflammatory bowel disease, professional athlete

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Authors: Sarekha Woranuch, Rangrong Yoksan

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Chitosan is a derivative of chitin, which is a second most naturally abundant polysaccharide found in crab shells, shrimp shells, and squid pens. The applications of chitosan in pharmaceutical, cosmetics, food and packaging industries have been reported owing to its general recognition as safe, excellent biodegradability and biocompatibility, as well as ability to form films, membranes, gels, beads, fibers and particles. Nevertheless, chitosan is an amino polysaccharide consisting of strong inter- and intramolecular hydrogen bonds which limit its solubility in neutral pH water resulting in restricted utilization. Chemical modification is an alternative way to impede hydrogen bond formation. The objective of the present research is to improve water solubility and antioxidant activity of chitosan by grafting with ferulic acid. Ferulic acid was grafted onto chitosan at the C-2 position via a carbodiimide-mediated coupling reaction. Different mole ratios of chitosan to ferulic acid (i.e. 1.0:0.0, 1.0:0.5, 1.0:1.0, 1.0:1.5, 1.0:2.0, and 1.0:2.5) and various reaction temperatures (i.e. 40, 60, and 80 °C) were used. The reaction was performed at different times (i.e. 1.5, 3.0, 4.5, and 6.0 h). The obtained ferulic acid-grafted chitosan was characterized by FTIR and 1H NMR technique. The influences of ferulic acid on crystallinity, solubility and radical scavenging activity of chitosan were also investigated. Ferulic acid grafted chitosan was successfully synthesized as confirmed from (i) the appearance of FTIR absorption band at 1517 cm-1 belonging to C=C aromatic ring of ferulic acid and the increased C–H stretching band intensity and (ii) the appearance of proton signals at δ = 6.31-7.67 ppm ascribing to methine protons of ferulic acid. The condition in which the reaction temperature of 60°C, reaction time of 3 h and the mole ratio of chitosan to ferulic acid of 1:1 gave the highest ferulic acid substitution degree, i.e. 0.37. The resulting ferulic acid grafted chitosan was soluble in water (1.3 mg/mL) due to its reduced crystallinity as compared with chitosan and also exhibited 90% greater radical scavenging activity than chitosan. The result suggested the utilization of ferulic acid grafted chitosan as an antioxidant material.

Keywords: antioxidant property, chitosan, ferulic acid, grafting

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Authors: S. O. Ayansina, O. A. Adekunle

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There is an increasing demand for a functional extension delivery services in Nigeria with a view to meet up with the food and fiber needs of the ever growing population of human and animal respectively. The study was therefore designed to examine the farmers’ preference for public and private extension services in Southwestern Nigeria, specifically to determine the farmers’ level of participation in the two types of organizations involved and also to evaluate the Performance level of personnel in the two organizations in order to ascertain the beneficiaries’ satisfaction. A multi-stage random sampling technique was used to samples 30 respondents from each of the three selected organizations in each of the three states sampled in Southwestern Nigeria. Hence, 270 respondents were sampled for the study. Data collected were analyzed with Kruskal Wallis one-way Analysis of variance to test the difference between the participation of beneficiaries in the public and private extension services and the level of benefit accrued from the two organizations involved in the study. Results generally revealed that private organizations were performing better and were more preferred by the beneficiaries. Results of the tested hypotheses as shown by Kruskal Wallis test of difference (x2=0.709) indicates no significant difference between farmers’ participation in the extension services of public and private organizations but however shows significant difference (X2=12.074) in the benefits achieved by respondents in the two organizations, such benefits include: increased quantity of Crop produced, farm income, skill acquisition, and improved Education in private extension organizations. Based on this result, it could be inferred that beneficiaries generally preferred private extension organizations because of their effectiveness and vibrancy in programme administration. Public extension is therefore recommended for general overhauling and possibly “merging” of public and private sectors in order to cater for teeming population of farmers demanding for efficient and functional extension services to better their lots both in production and processing.

Keywords: public and private involvement, extension services, farmers’ preferences, Kruskal Wallis Test

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Authors: Tuba Senel Zor, Oktay Aslan

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With current trends in nanoscience and nanotechnology (NST), scientists have paid much attention to education and nanoliteracy in parallel with the developments on these fields. To understand the advances in NST research requires a population with a high degree of science literacy. All citizens should soon need nanoliteracy in order to navigate some of the important science-based issues faced to their everyday lives. While the fields of NST are advancing rapidly and raising their societal significance, general public’s awareness of these fields has remained at a low level. Moreover, students enrolled different education levels and teachers don’t have awareness at expected level. This problem may be stemmed from inadequate education and training. To remove the inadequacy, teachers have greatest duties and responsibilities. Especially science teachers at all levels need to be made aware of these developments and adequately prepared so that they are able to teach about these advances in a developmentally appropriate manner. If the teachers develop understanding and awareness of NST, they can also discuss the topic with their students. Therefore, the awareness and conceptual understandings of both the teachers who will teach science to students and the students who will be introduced about NST should be increased, and the necessary training should be provided. The aim of this study was to examine the effect of NST education on preservice science teachers’ awareness of NST. The study was designed in one group pre-test post-test quasi-experimental pattern. The study was conducted with 32 preservice science teachers attending the Elementary Science Education Program at a large Turkish university in central Anatolia. NST education was given during five weeks as two hours per week. Nanoscience and Nanotechnology Awareness Questionnaire was used as data collected tool and was implemented for pre-test and post-test. The collected data were analyzed using Statistical package for the Social Science (SPSS). The results of data analysis showed that there was a significant difference (z=6.25, p< .05) on NST awareness of preservice science teachers after implemented NST education. The results of the study indicate that NST education has an important effect for improving awareness of preservice science teachers on NST.

Keywords: awareness level, nanoliteracy, nanoscience and nanotechnology education, preservice science teachers

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Authors: Koteswara Rao Pagolu, Raghava Rao Tamanam

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The present study was aimed to find out the prevalence of DD's in Visakhapatnam, one of the north coastal districts of Andhra Pradesh, India during a span of five years. A cross-sectional investigation was held at District early intervention center (DEIC), Visakhapatnam from 2016 to 2020. To identify the pattern and trend of different DD's including seasonal variations, a retrospective analysis of the health center's inpatient database for the past 5 years was done. Male and female children aged 2 months-18 years are included in the study with the prior permission of the concerned medical officer. The screening tool developed by the Ministry of health and family welfare, India, was used for the study. Among 26,423 cases, children with birth defects are 962, 2229 with deficiencies, 7516 with diseases, and 15716 with disabilities were admitted during the study period. From birth defects, congenital deafness occurred in large numbers with 22.66%, and neural tube defect observed in a small number of cases with 0.83% during the period. From the side of deficiencies, severe acute malnutrition has mostly occurred (66.80 %) and a small number of children were affected with goiter (1.70%). Among the diseases, dental carriers (67.97%) are mostly found and these cases were at peak during the years 2016 and 2019. From disabilities, children with vision impairment (20.55%) have mostly approached the center. Over the past 5 years, the admission rate of down's syndrome and congenital deafness cases showed a rising trend up to 2019 and then declined. Hearing impairment, motor delay, and learning disorder showed a steep rise and gradual decline trend, whereas severe anemia, vitamin-D deficiency, otitis media, reactive airway disease, and attention deficit hyperactivity disorder showed a declining trend. However, congenital heart diseases, dental caries, and vision impairment admission rates showed a zigzag pattern over the past 5 years. This center had inadequate diagnostic facilities related to genetic disease management. For advanced confirmation, the cases are referred to a district government hospital or private diagnostic laboratories in the city for genetic tests. Information regarding the overall burden and pattern of admissions in the health center is obtained by the review of DEIC records. Through this study, it is observed that the incidence of birth defects, as well as genetic disease burden, is high in the Visakhapatnam district. Hence there is a need for strengthening of management services for these diseases in this region.

Keywords: child health screening, developmental delays, district early intervention center, genetic disease management, infrastructural facility, Visakhapatnam district

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Authors: Mark Kaahwa, Chang Zhu, Moses Muhumuza

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This study investigates the satisfaction of distance education university students (DEUS) with the use of audio media as a medium of instruction. Studying students’ satisfaction is vital because it shows whether learners are comfortable with a certain instructional strategy or not. Although previous studies have investigated the use of audio media, the satisfaction of students with an instructional strategy that combines radio teaching and podcasts as an independent teaching strategy has not been fully investigated. In this study, all lectures were delivered through the radio and students had no direct contact with their instructors. No modules or any other material in form of text were given to the students. They instead, revised the taught content by listening to podcasts saved on their mobile electronic gadgets. Prior to data collection, DEUS received orientation through workshops on how to use audio media in distance education. To achieve objectives of the study, a survey, naturalistic observations and face-to-face interviews were used to collect data from a sample of 211 undergraduate and graduate students. Findings indicate that there was no statistically significant difference in the levels of satisfaction between male and female students. The results from post hoc analysis show that there is a statistically significant difference in the levels of satisfaction regarding the use of audio media between diploma and graduate students. Diploma students are more satisfied compared to their graduate counterparts. T-test results reveal that there was no statistically significant difference in the general satisfaction with audio media between rural and urban-based students. And ANOVA results indicate that there is no statistically significant difference in the levels of satisfaction with the use of audio media across age groups. Furthermore, results from observations and interviews reveal that DEUS found learning using audio media a pleasurable medium of instruction. This is an indication that audio media can be considered as an instructional strategy on its own merit.

Keywords: audio media, distance education, distance education university students, medium of instruction, satisfaction

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Authors: Berkas Khaoula

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Based on selection characteristics, high-density polyethylene (HDPE) extruded pipes are among the most economical and durable materials as well-designed solutions for water and gas transmission systems. The main reasons for such a choice are the high quality-performance ratio and the long-term service durability under aggressive conditions. Due to inevitable interactions with soils of different chemical compositions and transported fluids, aggressiveness becomes a key factor in studying resilient strength and life prediction limits. This phenomenon is known as environmental stress cracking resistance (ESCR). In this work, the effect of 3 acidic environments (5% acetic, 20% hydrochloric and 20% sulfuric) on HDPE-100 samples (~10x11x24 mm3). The results presented in the form (Δm/m0, %) as a function of √t indicate that the absorption, in the case of strong acids (HCl and H2SO4), evolves towards negative values involving material losses such as antioxidants and some additives. On the other hand, acetic acid and deionized water (DW) give a form of linear Fickean (LF) and B types, respectively. In general, the acids cause a slow but irreversible alteration of the chemical structure, composition and physical integrity of the polymer. The DW absorption is not significant (~0.02%) for an immersion duration of 69 days. Such results are well accepted in actual applications, while changes caused by acidic environments are serious and must be subjected to particular monitoring of the OIT factor (Oxidation Induction Time). After 55 days of aging, the H2SO4 and HCl media showed particular values with a loss of % mass in the interval [0.025-0.038] associated with irreversible chemical reactions as well as physical degradations. This state is usually explained by hydrolysis of the polymer, causing the loss of functions and causing chain scissions. These results are useful for designing and estimating the lifetime of the tube in service and in contact with adverse environments.

Keywords: HDPE, environmental stress cracking, absorption, acid media, chemical aging

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Authors: Mohamed Naser Zainol, P. P. Angeline Song

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Over the years, the profile of end-stage renal patients placed under The National Kidney Foundation Singapore (NKFS) dialysis program has evolved, with a gradual incline in the number of patients with behavior-related issues. With these challenging profiles, social workers and counsellors are often expected to oversee behavior management, through referrals from its partnering colleagues. Due to the segregation of tasks usually found in many hospital-based multi-disciplinary settings, social workers’ and counsellors’ interventions are often seen as an endpoint, limiting other stakeholders’ involvement that could otherwise be potentially crucial in managing such patients. While patients’ contact in local hospitals often leads to eventual discharge, NKFS patients are mostly long term. It is interesting to note that these patients are regularly seen by a team of professionals that includes doctors, nurses, dietitians, exercise specialists in NKFS. The dynamism of relationships presents an opportunity for any of these professionals to take ownership of their potentials in leading interventions that can be helpful to patients. As such, it is important to have a framework that incorporates the strength of these professionals and also channels empowerment across the multi-disciplinary team in working towards wholistic patient care. This paper would like to suggest a new framework for NKFS’s multi-disciplinary team, where the group synergy and dynamics are used to encourage ownership and promote empowerment. The social worker and counsellor use group work skills and his/her knowledge of its members’ strengths, to generate constructive solutions that are centered towards patient’s growth. Using key ideas from Karl’s Tomm Interpersonal Communications, the Communication Management of Meaning and Motivational Interviewing, the social worker and counsellor through a series of guided meeting with other colleagues, facilitates the transmission of understanding, responsibility sharing and tapping on team resources for patient care. As a result, the patient can experience personal and concerted approach and begins to flow in a direction that is helpful for him. Using seven case studies of identified patients with behavioral issues, the social worker and counsellor apply this framework for a period of six months. Patient’s overall improvement through interventions as a result of this framework are recorded using the AB single case design, with baseline measured three months before referral. Interviews with patients and their families, as well as other colleagues that are not part of the multi-disciplinary team are solicited at mid and end points to gather their experiences about patient’s progress as a by-product of this framework. Expert interviews will be conducted on each member of the multi-disciplinary team to study their observations and experience in using this new framework. Hence, this exploratory framework hopes to identify the inherent usefulness in managing patients with behavior related issues. Moreover, it would provide indicators in improving aspects of the framework when applied to a larger population.

Keywords: behavior management, end-stage renal failure, satellite dialysis, multi-disciplinary team

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Authors: Xincheng Jiang, Yanyan An, Yaoyao Huang, Wei Ding, Manli Sun, Hong Li, Huaili Zheng

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The residual antibiotics in the environment will pose a threat to the environment and human health. Thus, efficient removal and rapid detection of norfloxacin (NOR) in wastewater is very important. The main sources of NOR pollution are the agricultural, pharmaceutical industry and hospital wastewater. The total consumption of NOR in China can reach 5440 tons per year. It is found that neither animals nor humans can totally absorb and metabolize NOR, resulting in the excretion of NOR into the environment. Therefore, residual NOR has been detected in water bodies. The hazards of NOR in wastewater lie in three aspects: (1) the removal capacity of the wastewater treatment plant for NOR is limited (it is reported that the average removal efficiency of NOR in the wastewater treatment plant is only 68%); (2) NOR entering the environment will lead to the emergence of drug-resistant strains; (3) NOR is toxic to many aquatic species. At present, the removal and detection technologies of NOR are applied separately, which leads to a cumbersome operation process. The development of simultaneous adsorption-flocculation removal and FTIR detection of pollutants has three advantages: (1) Adsorption-flocculation technology promotes the detection technology (the enrichment effect on the material surface improves the detection ability); (2) The integration of adsorption-flocculation technology and detection technology reduces the material cost and makes the operation easier; (3) FTIR detection technology endows the water treatment agent with the ability of molecular recognition and semi-quantitative detection for pollutants. Thus, it is of great significance to develop a smart water treatment material with high removal capacity and detection ability for pollutants. This study explored the feasibility of combining NOR removal method with the semi-quantitative detection method. A magnetic Cu-Ni-S/Ni foam was synthesized by in-situ loading Cu-Ni-S nanostructures on the surface of Ni foam. The novelty of this material is the combination of adsorption-flocculation technology and semi-quantitative detection technology. Batch experiments showed that Cu-Ni-S/Ni foam has a high removal rate of NOR (96.92%), wide pH adaptability (pH=4.0-10.0) and strong ion interference resistance (0.1-100 mmol/L). According to the Langmuir fitting model, the removal capacity can reach 417.4 mg/g at 25 °C, which is much higher than that of other water treatment agents reported in most studies. Characterization analysis indicated that the main removal mechanisms are surface complexation, cation bridging, electrostatic attraction, precipitation and flocculation. Transmission FTIR detection experiments showed that NOR on Cu-Ni-S/Ni foam has easily recognizable FTIR fingerprints; the intensity of characteristic peaks roughly reflects the concentration information to some extent. This semi-quantitative detection method has a wide linear range (5-100 mg/L) and a low limit of detection (4.6 mg/L). These results show that Cu-Ni-S/Ni foam has excellent removal performance and semi-quantitative detection ability of NOR molecules. This paper provides a new idea for designing and preparing multi-functional water treatment materials to achieve simultaneous removal and semi-quantitative detection of organic pollutants in water.

Keywords: adsorption-flocculation, antibiotics detection, Cu-Ni-S/Ni foam, norfloxacin

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Authors: Orkide Donma, Mustafa M. Donma

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Childhood obesity, which may lead to increased risk for heart diseases in children as well as adults, is one of the most important health problems throughout the world. Prevalences of morbid obesity and metabolic syndrome (MetS) are being increased during childhood age group. MetS is a cluster of metabolic and vascular abnormalities including hypercoagulability and an increased risk of cardiovascular diseases (CVDs). There are also some relations between some components of MetS and leukocytes. The aim of this study is to investigate complete blood cell count parameters that differ between morbidly obese boys and girls with MetS diagnosis. A total of 117 morbid obese children with MetS consulted to Department of Pediatrics in Faculty of Medicine Hospital at Namik Kemal University were included into the scope of the study. The study population was classified based upon their genders (60 girls and 57 boys). Their heights and weights were measured and body mass index (BMI) values were calculated. WHO BMI-for age and sex percentiles were used. The values above 99 percentile were defined as morbid obesity. Anthropometric measurements were performed. Waist-to-hip and head-to-neck ratios as well as homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Components of MetS (central obesity, glucose intolerance, high blood pressure, high triacylglycerol levels, low levels of high density lipoprotein cholesterol) were determined. Hematological variables were measured. Statistical analyses were performed using SPSS. The degree for statistical significance was p ≤ 0.05. There was no statistically significant difference between the ages (11.2±2.6 years vs 11.2±3.0 years) and BMIs (28.6±5.2 kg/m² vs 29.3±5.2 kg/m²) of boys and girls (p ≥ 0.05), respectively. Significantly increased waist-to-hip ratios were obtained for boys (0.94±0.08 vs 0.91±0.06; p=0.023). Significantly elevated values of hemoglobin (13.55±0.98 vs 13.06±0.82; p=0.004), mean corpuscular hemoglobin concentration (33.79±0.91 vs 33.21±1.14; p=0.003), eosinophils (0.300±0.253 vs 0.196±0.197; p=0.014), and platelet (347.1±81.7 vs 319.0±65.9; p=0.042) were detected for boys. There was no statistically significant difference between the groups in terms of neutrophil/lymphocyte ratios as well as HOMA-IR values (p ≥ 0.05). Statistically significant gender-based differences were found for hemoglobin as well as mean corpuscular hemoglobin concentration and hence, separate reference intervals for two genders should be considered for these parameters. Eosinophils may contribute to the development of thrombus in acute coronary syndrome. Eosinophils are also known to make an important contribution to mechanisms related to thrombosis pathogenesis in acute myocardial infarction. Increased platelet activity is observed in patients with MetS and these individuals are more susceptible to CVDs. In our study, elevated platelets described as dominant contributors to hypercoagulability and elevated eosinophil counts suggested to be related to the development of CVDs observed in boys may be the early indicators of the future cardiometabolic complications in this gender.

Keywords: children, complete blood count, gender, metabolic syndrome

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Authors: Akkasit Jongjareonrak, Supansa Namchaiya

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Unripe green coffee cherry (UGCC) accounting about 5 % of total raw material weight receiving to the coffee bean production process and is, in general, sorting out and dump as waste. The UGCC is known to rich in phenolic compounds such as caffeoylquinic acids, feruloylquinic acids, chlorogenic acid (CGA), etc. CGA is one of the potent bioactive compounds using in the nutraceutical and functional food industry. Therefore, this study aimed at optimization the extraction condition of CGA from UGCC using Accelerated Solvent Extractor (ASE). The ethanol/water mixture at various ethanol concentrations (50, 60 and 70 % (v/v)) was used as an extraction solvent at elevated pressure (10.34 MPa) and temperatures (90, 120 and 150 °C). The recovery yield of UGCC crude extract, total phenolic content, CGA content and some bioactivities of UGCC extract were investigated. Using of ASE at lower temperature with higher ethanol concentration provided higher CGA content in the UGCC crude extract. The maximum CGA content was observed at the ethanol concentration of 70% ethanol and 90 °C. The further purification of UGCC crude extract gave a higher purity of CGA with a purified CGA yield of 4.28 % (w/w, of dried UGCC sample) containing 72.52 % CGA equivalent. The antioxidant activity and antimicrobial activity of purified CGA extract were determined. The purified CGA exhibited the 2,2-Diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity at 0.88 mg Trolox equivalent/mg purified CGA sample. The antibacterial activity against Escherichia coli was observed with the minimum inhibitory concentration (MIC) at 3.12 mg/ml and minimum bactericidal concentration (MBC) at 12.5 mg/ml. These results suggested that using of high concentration of ethanol and low temperature under elevated pressure of ASE condition could accelerate the extraction of CGA from UGCC. The purified CGA extract could be a promising alternative source of bioactive compound using for nutraceutical and functional food industry.

Keywords: bioactive, chlorogenic acid, coffee, extraction

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Authors: Antonello Durante, James Duff, Kevin Kelly

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The visual needs of people in modern work based buildings are changing. Self-illuminated screens of computers, televisions, tablets and smart phones have changed the relationship between people and the lit environment. In the past, lighting design practice was primarily based on providing uniform horizontal illuminance on the working plane, but this has failed to ensure good quality lit environments. Lighting standards of today continue to be set based upon a 100 year old approach that at its core, considers the task illuminance of the utmost importance, with this task typically being located on a horizontal plane. An alternative method focused on appearance has been proposed, as opposed to the traditional performance based approach. Mean Room Surface Exitance (MRSE) and Target-Ambient Illuminance Ratio (TAIR) are two new metrics proposed to assess illumination adequacy in interiors. The hypothesis is that these factors will be superior to the existing metrics used, which are horizontal illuminance led. For the six past years, research has examined this, within the Dublin Institute of Technology, with a view to determining the suitability of this approach for application to general lighting practice. Since the start of this research, a number of key findings have been produced that centered on how occupants will react to various levels of MRSE. This paper provides a broad update on how this research has progressed. More specifically, this paper will: i) Demonstrate how MRSE can be measured using HDR images technology, ii) Illustrate how MRSE can be calculated using scripting and an open source lighting computation engine, iii) Describe experimental results that demonstrate how occupants have reacted to various levels of MRSE within experimental office environments.

Keywords: illumination hierarchy (IH), mean room surface exitance (MRSE), perceived adequacy of illumination (PAI), target-ambient illumination ratio (TAIR)

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Authors: Kristina Nikolovska

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Social movements have become common in the Post Yugoslav cities. Consequently, the wave of activism has been considerably present in Skopje. Starting from 2009 the activist wave in Skopje emerged with the notion of the city. Diversity of initiatives appeared in the city in order to defend places that have been contested by the urban development project SK2014. The activist wave diffused into many different initiatives and diversity of issues. The result was unification in one massive movement in 2016, called 'The Colourful Revolution'. The paper explores the scope of activism in Skopje, with taking into consideration the influence of the spatial transformation, the project SK2014. Moreover, it examines the processes of spatiality into shaping the contention in Skopje, focusing on interdisciplinary and comprehensive approaches. Except the diversity of theoretical framework mainly founded on contentious politics theory and space elaboration from different perspectives, the study is founded on field work based on conducted interviews. Using an interdisciplinary approach and focusing on three main dimensions, the research contributes to understand the dynamics of the activist wave and importance of spatial processes in the creation of the contention in Skopje. Moreover, it elaborates the characteristics, possible effects, and reflections of the cycles of protests in Skopje. The main results of the research showed that dynamics of space is important in the creation of the activist wave in Skopje, moreover space context can give explanation about how opportunities diffuse and transformative power is created. The study contributed into deeper understanding of the importance of spatiality in contentious politics, it showed that in general contentions politics can benefit from deeper analyses of place specificity. Finally, the thesis opposes the traditional linear understanding of social movements, and proposes more dynamic, comprehensive, and sensitive elaboration.

Keywords: contentious politics, place, Skopje, SK2014, social movements, space

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Authors: Michael Lekan-Kehinde, Abimbola Asojo, Bonnie Sanborn

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Good acoustic performance has been identified as one of the critical Indoor Environmental Quality (IEQ) factors for student learning and development by the National Research Council. Childhood presents the opportunity for children to develop lifelong skills that will support them throughout their adult lives. Acoustic performance of a space has been identified as a factor that can impact language acquisition, concentration, information retention, and general comfort within the environment. Increasingly, students learn by communication between both teachers and fellow students, making speaking and listening crucial. Neurodiversity - while initially coined to describe individuals with autism spectrum disorder (ASD) - widely describes anyone with a different brain process. As the understanding from cognitive and neurosciences increases, the number of people identified as neurodiversity is nearly 30% of the population. This research looks at guidelines and standard for spaces with good acoustical quality and relates it with the experiences of students with autism spectrum disorder (ASD), their parents, teachers, and educators through a mixed methods approach, including selected case studies interviews, and mixed surveys. The information obtained from these sources is used to determine if selected materials, especially properties relating to sound absorption and reverberation reduction, are equally useful in small, medium sized, and large learning spaces and methodologically approaching. The results describe the potential impact of acoustics on Neurodiverse students, considering factors that determine the complexity of sound in relation to the auditory processing capabilities of ASD students. In conclusion, this research extends the knowledge of how materials selection influences the better development of acoustical environments for autism students.

Keywords: acoustics, autism spectrum disorder (ASD), children, education, learning, learning spaces, materials, neurodiversity, sound

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Authors: Sachil Kumar, Anoop Kumar Verma, Wahid Ali, Uma Shankar Singh

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Globally approximately 55.3 million people die each year. In the India there were 95 lakh annual deaths in 2013. The number of deaths resulted from homicides, suicides and unintentional injuries in the same period was about 5.7 lakh. The ever-increasing crime rate necessitated the development of methods for determining time since death. An erroneous time of death window can lead investigators down the wrong path or possibly focus a case on an innocent suspect. In this regard a research was carried out by analyzing the temperature dependent degradation of a Cardiac Troponin-T protein (cTnT) in the myocardium postmortem as a marker for time since death. Cardiac tissue samples were collected from (n=6) medico-legal autopsies, (in the Department of Forensic Medicine and Toxicology, King George’s Medical University, Lucknow India) after informed consent from the relatives and studied post-mortem degradation by incubation of the cardiac tissue at room temperature (20±2 OC), 12 0C, 25 0C and 37 0C for different time periods ((~5, 26, 50, 84, 132, 157, 180, 205, and 230 hours). The cases included were the subjects of road traffic accidents (RTA) without any prior history of disease who died in the hospital and their exact time of death was known. The analysis involved extraction of the protein, separation by denaturing gel electrophoresis (SDS-PAGE) and visualization by Western blot using cTnT specific monoclonal antibodies. The area of the bands within a lane was quantified by scanning and digitizing the image using Gel Doc. The data shows a distinct temporal profile corresponding to the degradation of cTnT by proteases found in cardiac muscle. The disappearance of intact cTnT and the appearance of lower molecular weight bands are easily observed. Western blot data clearly showed the intact protein at 42 kDa, two major (27 kDa, 10kDa) fragments, two additional minor fragments (32 kDa) and formation of low molecular weight fragments as time increases. At 12 0C the intensity of band (intact cTnT) decreased steadily as compared to RT, 25 0C and 37 0C. Overall, both PMI and temperature had a statistically significant effect where the greatest amount of protein breakdown was observed within the first 38 h and at the highest temperature, 37 0C. The combination of high temperature (37 0C) and long Postmortem interval (105.15 hrs) had the most drastic effect on the breakdown of cTnT. If the percent intact cTnT is calculated from the total area integrated within a Western blot lane, then the percent intact cTnT shows a pseudo-first order relationship when plotted against the log of the time postmortem. These plots show a good coefficient of correlation of r = 0.95 (p=0.003) for the regression of the human heart at different temperature conditions. The data presented demonstrates that this technique can provide an extended time range during which Postmortem interval can be more accurately estimated.

Keywords: degradation, postmortem interval, proteolysis, temperature, troponin

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Siqin Wang, Jonathan Corcoran, Yan Liu, Thomas Sigler

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Australia is a quintessentially immigrant nation with 28 percent of its residents being foreign-born. By 2011, People’s Republic of China (PRC) overtook the United Kingdom to become the largest source country in Australia. Significantly, the profile of PRC-born migrants has changed to mirror broader global shifts towards high-skilled labour, education-related, and investment-focussed migration, all of which reflect an increasing trend in the mobility of wealthy and/or educated cohorts. Together, these coalesce to form a more complex pattern of migrant settlement –both spatially and socio-economically. This paper focuses on the PRC-born migration, redresses these lacunae, with regard to the settlement outcomes of PRC migrants to Australia, with a particular focus on spatial evolution and residential mobility at both the metropolitan and national scales. By drawing on Census Data and migration Micro Datasets, the aim of this paper is to examine the shifting dynamics of PRC-born migrants in Australian capital cities to unveil their socioeconomic characteristics, residential patterns and change of spatial concentrations during their transition into the new host society. This paper finds out three general patterns in the residential evolution of PRC-born migrants depending on the size of capital cities where they settle down, as well as the association of socio-economic characters with the formation of enclaves. It also examines the residential mobility across states and cities from 2001 to 2011 indicating the rising status of median-size Australian capital cities for receiving PRC-born migrants. The paper concludes with a discussion of evidences for policy formation, facilitates the effective transition of PRC-born populations into the mainstream of host society and enhances social harmony to help Australia become a more successful multicultural nation.

Keywords: Australia, Chinese migrants, residential mobility, spatial evolution

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Authors: Conchita Martin de Bustamante, Christopher S. Kung, Brianne Lacy, Eunsol Park, Hien Piotrowski, Mustafa Husain, Waseem Ahmed

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Objective: To explore the comorbidity of mental health conditions (major depressive disorder, borderline personality disorder, generalized anxiety disorder, and schizophrenia) with opioid use disorder in people incarcerated at a large urban jail. Background Schizophrenia, depression, bipolar disorder, and anxiety are all serious mental health conditions that are highly prevalent amongst incarcerated patients. However, it is seldom the only disorder these patients are suffering from. According to the US Department of Justice, about half of US prisoners, both at the state and federal level, suffer from substance use disorders. Although the opioid epidemic has been studied greatly in the recent years amongst the general population, little has been explored on how the opioid crisis has affected incarcerated patients in local jails, particularly regarding which of these patients are most susceptible. Method The cohort consisted of 507 people incarcerated at a large county jail who were evaluated by mental health providers in December 2020. A retrospective review was performed to evaluate associations between mental health diagnoses, substance use disorder, and other demographic variables. Results Participants had been diagnosed with various mental health conditions, including MDD (22.6%, n = 115), GAD (33.7%, n = 171), Schizophrenia (15.2%, n = 77) and BPD (27%, n = 137). Preliminary Chi square tests were conducted for these conditions against marijuana, alcohol, cocaine, opioid, methamphetamine, benzodiazepines, and sedative use disorders. The results showed significant associations between Schizophrenia (p = 0.013), GAD (p M 0.001), and MDD (p = 0.029) with opioid use disorders. Conclusions Determining the extent of these comorbid substance use and mental health disorders within an incarcerated population can help influence treatment plans for future incarcerated patients. Many federal and state jail systems lack pharmacological substance use intervention and the prevalence of these co-morbid conditions can shed light on the importance of treating conditions concurrently upon intake.

Keywords: mental health conditions, opioids, substance use disorder, comorbidity

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Authors: Mona Almanasef, Dalia Almaghaslah, Geetha Kandasamy, Rajalakshimi Vasudevan, Sadia Batool

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Background: Community pharmacists are one of the most accessible healthcare practitioners worldwide and their services are used by a large proportion of the population. Expanding the roles of community pharmacists could contribute to reducing pressure on general health practice and other areas of health services. This research aimed to evaluate the contribution of community pharmacists in the provision of public health services and to investigate the perceived barriers to the provision of these services in Saudi Arabia. Materials and Methods: This study followed a cross-sectional design using an online anonymous self-administered questionnaire. The study took place in the Asir region, Saudi Arabia, between September 2019 and February 2020. A convenience sampling strategy was used to select and recruit the study participants. The questionnaire was adapted from previous research and involved three sections: demographics, involvement in public health services and barriers to practicing public health roles. Results: The total number of respondents was 193. The proportion of respondents who reported that they were “very involved” or “involved” in each service was 61.7% for weight management, 60.6% for sexual health, 57.5% for healthy eating, 53.4% for physical activity promotion, 51.3% for dental health, 46.1% for smoking cessation, 39.4% for screening for diabetes, 35.7% for screening for hypertension, 31.1% for alcohol dependence and drug misuse counseling, 30.6% for screening for dyslipidaemia, and 21.8% for vaccination and immunization. Most of the barriers in the current research were rated as having low relevance to the provision of public health services. Conclusion: Findings in the current research suggest that community pharmacists in the Asir region have varying levels of involvement in public health roles. Further research needs to be undertaken to understand the barriers to the provision of public health services and what strategies would be beneficial for enhancing the public health role of community pharmacists in Saudi Arabia.

Keywords: community pharmacist, public health, Asir region, Saudi Arabia

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