Search results for: geriatric population

Authors: Aarif Hussain, Afnan Tariq

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In recent years, microfinance has emerged as a critical tool for promoting financial inclusion and empowering marginalized communities, particularly women. In India, where poverty and lack of access to financial services continue to be significant challenges for many, microfinance has the potential to provide much-needed support to women with disabled children. These women face unique challenges, including discrimination, lack of access to education and employment, and limited support systems, making it even more difficult for them to break out of poverty and provide for their families. Microfinance, by providing small loans, savings products, and other financial services, can help these women to start or grow businesses, build assets, and achieve financial independence. India has adhered to an SHG-bank linkage model of microfinance since 1980, and programs like IRDP and SGSY were initiatives in the same direction. In the year 2011, India launched DAY-NRLM, a restructured version of SGSY. DAY-NRLM is an SHG-based microfinance program targeting the rural women of India. It aims to organise these poor women into SHGs and link them to banking institutions for creating sustainable livelihoods. The program has a reservation for disabled women but has no special status for mothers with disabled children. The impact of microfinance on women with disabilities and their families has been well documented. Studies have shown that women participating in microfinance programs are more likely to start businesses, increase their income, and improve their standard of living. Furthermore, these women are more likely to invest in their children's education and health, which can have long-term positive effects on their family’s well-being. In the Union territory of Jammu and Kashmir, the programme started in 2013 and is running smoothly to date. Women with children having a disability have not been documented as a category within the programme. The core aspect of this study is to delve into these women’s lives and analyse the impact of SHG membership on their lives and their children. The participants were selected purposively. For data collection, in-depth interviews were conducted. The findings of the paper show that microfinance has the potential to play a significant role in promoting financial inclusion and empowering women with children having disabilities in Kashmir. By providing access to small loans, savings products, and other financial services, microfinance can help these women to start or grow businesses, build assets, and achieve financial independence. However, more work is needed to ensure that these women have equal access to financial services and opportunities and that microfinance institutions are equipped to effectively serve this population. Working together to address these challenges can create a brighter future for women with children having disabilities and their families in India.

Keywords: DAY-NRLM, microfinance, SHGs, women, disabled children

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Authors: Sadeem Aljamaan, Reem Hariri, Rahaf Alghamdi, Batool Alotaibi, Batool Alsenan, Lama Althunayyan, Areej Alnemer

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The aim of this study is to correlate between radiological findings and histopathological results in regard to the breast imaging-reporting and data system scores, size of breast masses, molecular subtypes and suspicious radiological features, as well as to assess the concordance rate in histological grade between core biopsy and surgical excision among breast cancer patients, followed by analyzing the change of concordance rate in relation to neoadjuvant chemotherapy in a Saudi population. A retrospective review was conducted over 6-year period (2017-2022) on all breast core biopsies of women preceded by radiological investigation. Chi-squared test (χ2) was performed on qualitative data, the Mann-Whitney test for quantitative non-parametric variables, and the Kappa test for grade agreement. A total of 641 cases were included. Ultrasound, mammography, and magnetic resonance imaging demonstrated diagnostic accuracies of 85%, 77.9% and 86.9%; respectively. magnetic resonance imaging manifested the highest sensitivity (72.2%), and the lowest was for ultrasound (61%). Concordance in tumor size with final excisions was best in magnetic resonance imaging, while mammography demonstrated a higher tendency of overestimation (41.9%), and ultrasound showed the highest underestimation (67.7%). The association between basal-like molecular subtypes and the breast imaging-reporting and data system score 5 classifications was statistically significant only for magnetic resonance imaging (p=0.04). Luminal subtypes demonstrated a significantly higher percentage of speculation in mammography. Breast imaging-reporting and data system score 4 manifested a substantial number of benign pathologies in all the 3 modalities. A fair concordance rate (k= 0.212 & 0.379) was demonstrated between excision and the preceding core biopsy grading with and without neoadjuvant therapy, respectively. The results demonstrated a down-grading in cases post-neoadjuvant therapy. In cases who did not receive neoadjuvant therapy, underestimation of tumor grade in biopsy was evident. In summary, magnetic resonance imaging had the highest sensitivity, specificity, positive predictive value and accuracy of both diagnosis and estimation of tumor size. Mammography demonstrated better sensitivity than ultrasound and had the highest negative predictive value, but ultrasound had better specificity, positive predictive value and accuracy. Therefore, the combination of different modalities is advantageous. The concordance rate of core biopsy grading with excision was not impacted by neoadjuvant therapy.

Keywords: breast cancer, mammography, MRI, neoadjuvant, pathology, US

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Authors: Mareike Dornhoefer, Madjid Fathi

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Water supply and water quality are key problems of mankind at the moment and - due to increasing population - in the future. Management disciplines like water, environment and quality management therefore need to closely interact, to establish a high level of water quality and to guarantee water supply in all parts of the world. Groundwater remediation is one aspect in this process. From a knowledge management perspective it is only possible to solve complex ecological or environmental problems if different factors, expert knowledge of various stakeholders and formal regulations regarding water, waste or chemical management are interconnected in form of a knowledge base. In general knowledge management focuses the processes of gathering and representing existing and new knowledge in a way, which allows for inference or deduction of knowledge for e.g. a situation where a problem solution or decision support are required. A knowledge base is no sole data repository, but a key element in a knowledge based system, thus providing or allowing for inference mechanisms to deduct further knowledge from existing facts. In consequence this knowledge provides decision support. The given paper introduces an environmental knowledge system in water management. The proposed environmental knowledge system is part of a research concept called Green Knowledge Management. It applies semantic technologies or concepts such as ontology or linked open data to interconnect different data and information sources about environmental aspects, in this case, water quality, as well as background material enriching an established knowledge base. Examples for the aforementioned ecological or environmental factors threatening water quality are among others industrial pollution (e.g. leakage of chemicals), environmental changes (e.g. rise in temperature) or floods, where all kinds of waste are merged and transferred into natural water environments. Water quality is usually determined with the help of measuring different indicators (e.g. chemical or biological), which are gathered with the help of laboratory testing, continuous monitoring equipment or other measuring processes. During all of these processes data are gathered and stored in different databases. Meanwhile the knowledge base needs to be established through interconnecting data of these different data sources and enriching its semantics. Experts may add their knowledge or experiences of previous incidents or influencing factors. In consequence querying or inference mechanisms are applied for the deduction of coherence between indicators, predictive developments or environmental threats. Relevant processes or steps of action may be modeled in form of a rule based approach. Overall the environmental knowledge system supports the interconnection of information and adding semantics to create environmental knowledge about water environment, supply chain as well as quality. The proposed concept itself is a holistic approach, which links to associated disciplines like environmental and quality management. Quality indicators and quality management steps need to be considered e.g. for the process and inference layers of the environmental knowledge system, thus integrating the aforementioned management disciplines in one water management application.

Keywords: water quality, environmental knowledge system, green knowledge management, semantic technologies, quality management

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Authors: Richa Sharma, Uma Nahar, Sadhna Sharma, Indu Verma

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Counteracting the deadly pathogen Mycobacterium tuberculosis (M. tb) effectively is still a global challenge. Scrutinizing alternative weapons like antimicrobial peptides to strengthen existing tuberculosis artillery is urgently required. Considering the antimycobacterial potential of Human Beta Defensin 1 (HBD-1) along with isoniazid, the present study was designed to explore the ability of HBD-1 to act against active and dormant M. tb. HBD-1 was screened in silico using antimicrobial peptide prediction servers to identify its short antimicrobial motif. The activity of both HBD-1 and its selected motif (Pep B) was determined at different concentrations against actively growing M. tb in vitro and ex vivo in monocyte derived macrophages (MDMs). Log phase M. tb was grown along with HBD-1 and Pep B for 7 days. M. tb infected MDMs were treated with HBD-1 and Pep B for 72 hours. Thereafter, colony forming unit (CFU) enumeration was performed to determine activity of both peptides against actively growing in vitro and intracellular M. tb. The dormant M. tb models were prepared by following two approaches and treated with different concentrations of HBD-1 and Pep B. Firstly, 20-22 days old M. tbH37Rv was grown in potassium deficient Sauton media for 35 days. The presence of dormant bacilli was confirmed by Nile red staining. Dormant bacilli were further treated with rifampicin, isoniazid, HBD-1 and its motif for 7 days. The effect of both peptides on latent bacilli was assessed by colony forming units (CFU) and most probable number (MPN) enumeration. Secondly, human PBMC granuloma model was prepared by infecting PBMCs seeded on collagen matrix with M. tb(MOI 0.1) for 10 days. Histopathology was done to confirm granuloma formation. The granuloma thus formed was incubated for 72 hours with rifampicin, HBD-1 and Pep B individually. Difference in bacillary load was determined by CFU enumeration. The minimum inhibitory concentrations of HBD-1 and Pep B restricting growth of mycobacteria in vitro were 2μg/ml and 20μg/ml respectively. The intracellular mycobacterial load was reduced significantly by HBD-1 and Pep B at 1μg/ml and 5μg/ml respectively. Nile red positive bacterial population, high MPN/ low CFU count and tolerance to isoniazid, confirmed the formation of potassium deficienybaseddormancy model. HBD-1 (8μg/ml) showed 96% and 99% killing and Pep B (40μg/ml) lowered dormant bacillary load by 68.89% and 92.49% based on CFU and MPN enumeration respectively. Further, H&E stained aggregates of macrophages and lymphocytes, acid fast bacilli surrounded by cellular aggregates and rifampicin resistance, indicated the formation of human granuloma dormancy model. HBD-1 (8μg/ml) led to 81.3% reduction in CFU whereas its motif Pep B (40μg/ml) showed only 54.66% decrease in bacterial load inside granuloma. Thus, the present study indicated that HBD-1 and its motif are effective antimicrobial players against both actively growing and dormant M. tb. They should be further explored to tap their potential to design a powerful weapon for combating tuberculosis.

Keywords: antimicrobial peptides, dormant, human beta defensin 1, tuberculosis

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Authors: Kenny Chi Man Chui

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Background: In Chinese culture, the traditional equivalent term for English dementia is chi dai zheng, which, whether translated as ‘insanity’ or ‘idiocy’ carries a sharply negative connotation. In fact, even though the traditional name for dementia has evolved, from chi dai zheng to shi zhi zheng, nao tui hua zheng or ren zhi zhang ai zheng, educating the population about more respectful terms for the condition and promoting a positive understanding about people with dementia in society have proven to be time-intensive endeavors. By extension, the use of such terms promotes the perception that people with dementia undergo a ‘total loss of self’ or experience a ‘living death’ or ‘social death’. Both in Asia and elsewhere, the appropriate nomenclature for dementia remains controversial, and different medical and healthcare professionals in Hong Kong have taken various stances on how to refer to the condition there. Indeed, how this negative perception affects the interaction between people with dementia and the surrounding others? Methodology: Qualitative research with the concept of postmodernism, interpretivism, and Foucauldian theory was adopted as frameworks in applying participatory observations, in-depth interviews, and other qualitative methods. First, ten people with dementia—one man and nine women—living in two residential care homes in Hong Kong were interviewed, as were ten members of the care staff, all of whom were women. Next, to coach the staff in understanding the feelings and self-perceptions of people with dementia, two reflective training sessions were provided. Afterward, to assess the impact of the training sessions on the staff, two focus groups were held. Findings: The findings revealed that residents with dementia did not perceive themselves as being ‘demented’ and were confused by not getting responses from the others. From the understanding of care staff, they perceived the residents as being ‘demented’, desolate troublemakers. They described people with dementia as ‘naughty children’ who should be controlled and be punished while treated them as ‘psychiatric patients’ who could be ignored and be mute. “Psychosocial restraint” happened regarding the discrepancy of perception between people with dementia and the care staff. People with dementia did not think that their confusion of memory was related to dementia or, frankly speaking, they did not know what dementia was. When others treated them as ‘demented patients, the residents with mild to moderate dementia fiercely rejected that designation and reported a host of negative feelings, hence the fluctuations of mood and emotion noted by the care staff. Conclusion: As the findings revealed, the people with dementia were also discontent with the care arrangements in the care homes, felt abandoned by others and worried about bothering others. Their shifting emotional states and moods were treated as the Behavioral and Psychological symptoms of Dementia (BPSD), which nothing can do reported by the care staff in the residential care homes. People with dementia become social withdrawal or isolated in daily living, which should be alert and be changed by the social work professionals about the occurrence of “psychosocial restraint” in dementia care.

Keywords: psychosocial restraint, qualitative research, social work with dementitude, voice of people with dementia

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Authors: Ngwa Lodence Njwe

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This study investigated the response of hemodialysis patients to an established nutrition therapy guide accompanied by a 7-day menu plan administered for a month. End Stage Renal Disease (ESRD), also known as End Stage Kidney Disease (ESKD), is a non-communicable disease primarily caused by hypertension and diabetes, posing significant challenges in both developed and developing nations. Hemodialysis is a key treatment for these patients. In this experimental study, 100 hemodialysis patients from Douala General Hospital in Cameroon participated. A questionnaire was used to collect data on sociodemographic and anthropometric characteristics, health status, and dietary intake, while medical records provided biomedical data. The levels of the biochemical parameters (Phosphorus, calcium and hemoglobin) were determined before and one month after the distribution of the nutrition education guide and the use of a 7-day menu plan. The Phosphorus and Calcium levels were measured using an LTCC03 semi-automatic chemistry analyzer. Blood was collected from each patient into a test tube, allowed to clot and centrifuged. 50µl of the serum was aspirated by the analyzer for Ca and P level analysis, and results were read from the display. The hemoglobin level was measured using the URIT–12 hemoglobin Meter. The blood sample was collected by hand prick and placed in a strip, and the results were read from the screen. The means of the biochemical parameters were then computed. The most prevalent age group was 40-49 years, with males constituting 70% and females 30% of respondents. Among these patients, 80% were hypertensive, 3% had both hypertension and diabetes, 9% were hypertensive, diabetic, and obese, and 1% suffered from hypertension and heart failure. Analysis of anthropometric parameters revealed a high prevalence of underweight, overweight, and obesity, highlighting the urgent need for targeted nutrition interventions to modify cooking methods, enhance food choices, and increase dietary variety for improved quality of life. Before the nutrition therapy guide was implemented, average calcium levels were 73.05 mg/L for males and 89.44 mg/L for females; post-implementation, these values increased to 77.55 mg/L and 91.44 mg/L, respectively. Conversely, average phosphorus levels decreased from 42.05 mg/L for males and 43.55 mg/L for females to 41.05 mg/L and 39.3 mg/L, respectively, after the intervention. Additionally, average hemoglobin levels increased from 8.35 g/dL for males and 8.5 g/dL for females to 9.2 g/dL and 8.95 g/dL, respectively. The findings confirm that the nutrition therapy guide and the 7-day menu significantly impacted the biomedical parameters of hemodialysis patients, underscoring the need for ongoing nutrition education and counseling for this population.

Keywords: end stage kidney disease, nutrition therapy guide, nutritional status, anthropometric parameters, food frequency, biomedical data

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Authors: Vicki R. Voskuil, Jorgie M. Watson

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Despite the well-established health benefits of physical activity (PA), most adolescents do not meet guidelines recommending 60 minutes of moderate to vigorous physical activity (MVPA) each day. Adolescent girls engage in less PA than boys, a difference that increases with age. By the 9th grade, only 20% of girls report meeting recommendations for PA with lower percentages for black and Hispanic girls compared to white girls. The purpose of the study was to explore the physical activity (PA) behavior and needs of adolescent girls. Study aims included assessment of adolescent girls’ PA behavior; facilitators of and barriers to PA, PA needs, and acceptability of the Fitbit-Flex 2 activity tracker. This exploratory study used a qualitative and quantitative approach. The qualitative approach involved a focus group using a semi-structured interview technique. PA was measured using the Fitbit-Flex 2 activity tracker. Steps, distance, and active minutes were recorded for one week. A Fitbit survey was also administered to assess acceptability. SPSS Version 22.0 and ATLAS.ti Version 8 were used to analyze data. Girls in the ninth grade were recruited from a high school in the Midwest (n=11). Girls were excluded if they were involved in sports or other organized PA ≥ 3 days per week, had a health condition that prevented or limited PA, or could not read and write English. Participants received a Fitbit-Flex 2 activity tracker to wear for one week. At the end of the week, girls returned the Fitbit and participated in a focus group. Girls responded to open-ended questions regarding their PA behavior and shared their ideas for future intervention efforts aimed at increasing PA among adolescents. Girls completed a survey assessing their perceptions of the Fitbit. Mean age of the girls was 15.3 years (SD=0.44). On average girls took 6,520 steps and walked 2.73 miles each day. Girls stated their favorite types of PA were walking, riding bike, and running. Most girls stated they did PA for 30 minutes or more at a time once a day or every other day. The top 3 facilitators of PA reported by girls were friends, family, and transportation. The top 3 barriers included health issues, lack of motivation, and weather. Top intervention ideas were community service projects, camps, and using a Fitbit activity tracker. Girls felt the best timing of a PA program would be in the summer. Fitbit survey results showed 100% of girls would use a Fitbit on most days if they had one. Ten (91%) girls wore the Fitbit on all days. Seven (64%) girls used the Fitbit app and all reported they liked it. Findings indicate that PA participation for this sample is consistent with previous studies. Adolescent girls are not meeting recommended daily guidelines for PA. Fitbit activity trackers were positively received by all participants and could be used in future interventions aimed at increasing PA for adolescent girls. PA interventions that take place in the summer with friends and include community service projects may increase PA and be well received by this population.

Keywords: adolescents, girls, interventions, physical activity

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Authors: Farouq Sule Garo, Yahaya Yusuf

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The purpose of this study is to investigate why there is a general lack of successful adoption of sustainable energy in Nigeria. This is particularly important given the current global campaign for net-zero emissions. The 26th United Nations Conference of the Parties (COP26), held in 2021, was hosted by the UK, in Glasgow, where, amongst other things, countries including Nigeria agreed to a zero emissions pact. There is, therefore, an obligation on the part of Nigeria for transition from fossil fuel-based economy to a sustainable net-zero emissions economy. The adoption of renewable energy is fundamental to achieving this ambitious target if decarbonisation of economic activities were to become a reality. Nigeria has an abundance of sources of renewable energy and yet there has been poor uptake and where attempts have been made to develop and harness renewable energy resources, there has been limited success. It is not entirely clear why this is the case. When analysts allude to corruption as the reason for failure for successful adoption of renewable energy or project implementation, it is arguable that corruption alone cannot explain the situation. Therefore, there is the need for a thorough investigation into the underlying issues surrounding poor uptake of renewable energy in Nigeria. This pilot study, drawing upon stakeholders’ theory, adopts a multi-stakeholder’ perspectives to investigate the influence and impacts of economic, political, technological, social factors in adoption of renewable energy in Nigeria. The research will also investigate how these factors shape (or fail to shape) strategies for achieving successful adoption of renewable energy in the country. A qualitative research methodology has been adopted given the nature of the research requiring in-depth studies in specific settings rather than a general population survey. There will be a number of interviews and each interview will allow thorough probing of sources. This, in addition to the six interviews that have already been conducted, primarily focused on economic dimensions of the challenges in adoption of renewable energy. The six participants in these initial interviews were all connected to the Katsina Wind Farm Project that was conceived and built with the view to diversifying Nigeria's energy mix and capitalise on the vast wind energy resources in the northern region. The findings from the six interviews provide insights into how the economic factors impacts on the wind farm project. Some key drivers have been identified, including strong governmental support and the recognition of the need for energy diversification. These drivers have played crucial roles in initiating and advancing the Katsina Wind Farm Project. In addition, the initial analysis has highlighted various challenges encountered during the project's implementation, including financial, regulatory, and environmental aspects. These challenges provide valuable lessons that can inform strategies to mitigate risks and improve future wind energy projects.

Keywords: challenges in adoption of renewable energy, economic factors, net-zero emission, political factors

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Authors: Sadandaula Rose Muheriwa Matemba, Alexander Glazier, Natalie M. LeBlanc

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In the United States, up to 10% of girls and 22 % of boys 10-14 years have had sex, 5% of them had their first sex before 11 years, and the age of first sexual encounter is reported to be 8 years. Over 4,000 adolescent girls, 10-14 years, become pregnant every year, and 2.6% of the abortions in 2019 were among adolescents below 15 years. Despite these negative outcomes, little research has been conducted to understand the sexual health education offered to young adolescents ages 10-14. Early sexual health education is one of the most effective strategies to help lower the rate of early pregnancies, HIV infections, and other sexually transmitted. Such knowledge is necessary to inform best practices for supporting the healthy sexual development of young adolescents and prevent adverse outcomes. This qualitative descriptive study was conducted to explore the community stakeholders’ experiences in sexual health education for young adolescents ages 10-14 and ascertain the young adolescents’ sexual health support needs. Maximum variation purposive sampling was used to recruit a total sample of 13 community stakeholders, including health education teachers, members of youth-based organizations, and Adolescent Clinic providers in Rochester, New York State, in the United States of America from April to June 2022. Data were collected through semi-structured individual in-depth interviews and were analyzed using MAXQDA following a conventional content analysis approach. Triangulation, team analysis, and respondent validation to enhance rigor were also employed to enhance study rigor. The participants were predominantly female (92.3%) and comprised of Caucasians (53.8%), Black/African Americans (38.5%), and Indian-American (7.7%), with ages ranging from 23-59. Four themes emerged: the perceived need for early sexual health education, preferred timing to initiate sexual health conversations, perceived age-appropriate content for young adolescents, and initiating sexual health conversations with young adolescents. The participants described encouraging and concerning experiences. Most participants were concerned that young adolescents are living in a sexually driven environment and are not given the sexual health education they need, even though they are open to learning sexual health materials. There was consensus on the need to initiate sexual health conversations early at 4 years or younger, standardize sexual health education in schools and make age-appropriate sexual health education progressive. These results show that early sexual health education is essential if young adolescents are to delay sexual debut, prevent early pregnancies, and if the goal of ending the HIV epidemic is to be achieved. However, research is needed on a larger scale to understand how best to implement sexual health education among young adolescents and to inform interventions for implementing contextually-relevant sexuality education for this population. These findings call for increased multidisciplinary efforts in promoting early sexual health education for young adolescents.

Keywords: community stakeholders’ perspectives, sexual development, sexual health education, young adolescents

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Authors: Aziz Ikhlef

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Most of multi-slices Computed Tomography (CT) scanners are built with detectors composed of scintillator - photodiodes arrays. The photodiodes arrays are mainly based on front-illuminated technology for detectors under 64 slices and on back-illuminated photodiode for systems of 64 slices or more. The designs based on back-illuminated photodiodes were being investigated for CT machines to overcome the challenge of the higher number of runs and connection required in front-illuminated diodes. In backlit diodes, the electronic noise has already been improved because of the reduction of the load capacitance due to the routing reduction. This is translated by a better image quality in low signal application, improving low dose imaging in large patient population. With the fast development of multi-detector-rows CT (MDCT) scanners and the increasing number of examinations, the clinical community has raised significant concerns on radiation dose received by the patient in both medical and regulatory community. In order to reduce individual exposure and in response to the recommendations of the International Commission on Radiological Protection (ICRP) which suggests that all exposures should be kept as low as reasonably achievable (ALARA), every manufacturer is trying to implement strategies and solutions to optimize dose efficiency and image quality based on x-ray emission and scanning parameters. The added demands on the CT detector performance also comes from the increased utilization of spectral CT or dual-energy CT in which projection data of two different tube potentials are collected. One of the approaches utilizes a technology called fast-kVp switching in which the tube voltage is switched between 80 kVp and 140 kVp in fraction of a millisecond. To reduce the cross-contamination of signals, the scintillator based detector temporal response has to be extremely fast to minimize the residual signal from previous samples. In addition, this paper will present an overview of detector technologies and image chain improvement which have been investigated in the last few years to improve the signal-noise ratio and the dose efficiency CT scanners in regular examinations and in energy discrimination techniques. Several parameters of the image chain in general and in the detector technology contribute in the optimization of the final image quality. We will go through the properties of the post-patient collimation to improve the scatter-to-primary ratio, the scintillator material properties such as light output, afterglow, primary speed, crosstalk to improve the spectral imaging, the photodiode design characteristics and the data acquisition system (DAS) to optimize for crosstalk, noise and temporal/spatial resolution.

Keywords: computed tomography, X-ray detector, medical imaging, image quality, artifacts

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Authors: Mustafa Metin Donma, Orkide Donma

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Vitamin deficiencies are common in obese individuals. Particularly, the status of vitamin B12 and its association with vitamin B9 (folate) and vitamin D is under investigation in recent time. Vitamin B12 is closely related to many vital processes in the body. In clinical studies, its involvement in fat metabolism draws attention from the obesity point of view. Obesity, in its advanced stages and in combination with metabolic syndrome (MetS) findings, may be a life-threatening health problem. Pediatric obesity is particularly important because it may be a predictor of severe chronic diseases during the adulthood period of the child. Due to its role in fat metabolism, vitamin B12 deficiency may disrupt metabolic pathways of the lipid and energy metabolisms in the body. The association of low B12 levels with obesity degree may be an interesting topic to be investigated. Obesity indices may be helpful at this point. Weight- and fat-based indices are available. Of them, body mass index (BMI) is in the first group. Fat mass index (FMI), fat-free mass index (FFMI) and diagnostic obesity notation model assessment-II (D2I) index lie in the latter group. The aim of this study is to clarify possible associations between vitamin B12 status and obesity indices in the pediatric population. The study comprises a total of one hundred and twenty-two children. Thirty-two children were included in the normal body mass index (N-BMI) group. Forty-six and forty-four children constitute groups with morbid obese children without MetS and with MetS, respectively. Informed consent forms and the approval of the institutional ethics committee were obtained. Tables prepared for obesity classification by World Health Organization were used. Metabolic syndrome criteria were defined. Anthropometric and blood pressure measurements were taken. Body mass index, FMI, FFMI, D2I were calculated. Routine laboratory tests were performed. Vitamin B9, B12, D concentrations were determined. Statistical evaluation of the study data was performed. Vitamin B9 and vitamin D levels were reduced in MetS group compared to children with N-BMI (p>0.05). Significantly lower values were observed in vitamin B12 concentrations of MetS group (p<0.01). Upon evaluation of blood pressure as well as triglyceride levels, there exist significant increases in morbid obese children. Significantly decreased concentrations of high density lipoprotein cholesterol were observed. All of the obesity indices and insulin resistance index exhibit increasing tendency with the severity of obesity. Inverse correlations were calculated between vitamin D and insulin resistance index as well as vitamin B12 and D2I in morbid obese groups. In conclusion, a fat-based index, D2I, was the most prominent body index, which shows a strong correlation with vitamin B12 concentrations in the late stage of obesity in children. A negative correlation between these two parameters was a confirmative finding related to the association between vitamin B12 and obesity degree.

Keywords: body mass index, children, D2I index, fat mass index, obesity

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Authors: Nur Fareza Mustapha

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Solutions to policy problems need to be curated to the local context, taking into account the trajectory of the local development path to ensure its efficacy. For Kuala Lumpur, rapid urbanization and migration into the city for the past few decades have increased the demand for housing to accommodate a growing urban population. As a critical factor affecting housing affordability, land supply constraints have been attributed to intensifying market pressures, which grew in tandem with the demands of urban development, along with existing institutional constraints in the governance of land. While demand-side pressures are inevitable given the fixed supply of land, supply-side constraints in regulations distort markets and if addressed inappropriately, may lead to mistargeted policy interventions. Given Malaysia’s historical development, regulatory barriers for land may originate from the British colonial period, when many aspects of the current laws governing tenure were introduced and formalized, and henceforth, became engrained in the system. This research undertakes a postcolonial institutional analysis approach to uncover the causal mechanism driving the evolution of land tenure systems in post-colonial Kuala Lumpur. It seeks to determine the sources of these shifts, focusing on the incentives and bargaining positions of actors during periods of institutional flux/change. It aims to construct a conceptual framework to further this understanding and to elucidate how this historical trajectory affects current access to urban land markets for housing. Archival analysis is used to outline and analyse the evolution of land tenure systems in Kuala Lumpur while stakeholder interviews are used to analyse its impact on the current urban land market, with a particular focus on the provision of and access to affordable housing in the city. Preliminary findings indicate that many aspects of the laws governing tenure that were introduced and formalized during the British colonial period have endured until the present day. Customary rules of tenure were displaced by rules following a European tradition, which found legitimacy through a misguided interpretation of local laws regarding the ownership of land. Colonial notions of race and its binary view of native vs. non-natives have also persisted in the construction and implementation of current legislation regarding land tenure. More concrete findings from this study will generate a more nuanced understanding of the regulatory land supply constraints in Kuala Lumpur, taking into account both the long and short term spatial and temporal processes that affect how these rules are created, implemented and enforced.

Keywords: colonial discourse, historical institutionalism, housing, land policy, post-colonial city

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Authors: Vivian Caroline Koerbel Dombrowski

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Armed conflicts have always meant the ultimate expression of power and at the same time, lack of understanding among nations. Cities were destroyed, people were killed, assets were devastated. But these are not only the loss of a war: the environmental damage comes to be considered immeasurable losses in the short, medium and long term. And this is because no nation wants to bear that cost. They invest in military equipment, training, technical equipment but the environmental account yet finds gaps in international law. Considering such a generalization in rights protection, many nations are at imminent danger in a conflict if the water will be used as a mass weapon, especially if we consider important rivers such as Jordan, Euphrates and Nile. The top three international documents were analyzed on the subject: the Stockholm Convention (1972), Additional Protocol I to the Geneva Convention (1977) and the Rome Statute (1998). Indeed, some references are researched in doctrine, especially scientific articles, to substantiate with consistent data about the extent of the damage, historical factors and decisions which have been successful. However, due to the lack of literature about this subject, the research tends to be exhaustive. From the study of the indicated material, it was noted that international law - humanitarian and environmental - calls in some of its instruments the environmental protection in war conflicts, but they are generic and vague rules that do not define exactly what is the environmental damage , nor sets standards for measure them. Taking into account the mains conflicts of the century XX: World War II, the Vietnam War and the Gulf War, one must realize that the environmental consequences were of great rides - never deactivated landmines, buried nuclear weapons, armaments and munitions destroyed in the soil, chemical weapons, not to mention the effects of some weapons when used (uranium, agent Orange, etc). Extending the search for more recent conflicts such as Afghanistan, it is proven that the effects on health of the civilian population were catastrophic: cancer, birth defects, and deformities in newborns. There are few reports of nations that, somehow, repaired the damage caused to the environment as a result of the conflict. In the pitch of contemporary conflicts, many nations fear that water resources are used as weapons of mass destruction, because once contaminated - directly or indirectly - can become a means of disguised genocide side effect of military objective. In conclusion, it appears that the main international treaties governing the subject mention the concern for environmental protection, however leave the normative specifications vacancies necessary to effectively there is a prevention of environmental damage in armed conflict and, should they occur, the repair of the same. Still, it appears that there is no protection mechanism to safeguard natural resources and avoid them to become a mass destruction weapon.

Keywords: armed conflicts, criminal liability, environmental damages, humanitarian law, mass weapon

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Authors: Aakriti Chetan Shah, Elle Sein

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Background/purpose: Group B Streptococcus(GBS) is the leading cause of severe early onset infection in newborns, with the incidence of Early Onset Group B Streptococcus (EOGBS) in the UK and Ireland rising from 0.48 to 0.57 per 1000 births from 2000 to 2015. A WHO study conducted in 2017, has shown that 38.5% of cases can result in stillbirth and infant deaths. This is an important problem to consider as 20% of women worldwide have GBS colonisation and can suffer from these detrimental effects. Current Royal College of Obstetricians and Midwives (RCOG) guidelines do not recommend bacteriological screening for pregnant women due to its low sensitivity in antenatal screening correlating with the neonate having GBS but advise a patient information leaflet be given to pregnant women. However, a Healthcare Safety Investigation Branch (HSIB) 2019 learning report found that only 50% of trusts and health boards reported giving GBS information leaflets to all pregnant mothers. Therefore, this audit aimed to assess current practices of information dissemination about GBS at Chelsea & Westminster (C&W) Hospital. Methodology: A quantitative cross-sectional study was carried out using a questionnaire based on the RCOG GBS guidelines and the HSIB Learning report. The study was conducted in antenatal clinics at Chelsea & Westminster Hospital, from 29th January 2021 to 14th February 2021, with twenty-two practicing obstetricians and midwives participating in the survey. The main outcome measure was the proportion of obstetricians and midwives who disseminate information about GBS to pregnant women, and the reasons behind why they do or do not. Results: 22 obstetricians and midwives responded with 18 complete responses. Of which 12 were obstetricians and 6 were midwives. Only 17% of clinical staff routinely inform all pregnant women about GBS, and do so at varying timeframes of the pregnancy, with an equal split in the first, second and third trimester. The primary reason for not informing women about GBS was influenced by three key factors: Deemed relevant only for patients at high risk of GBS, lack of time in clinic appointments and no routine NHS screening available. Interestingly 58% of staff in the antenatal clinic believe it is necessary to inform all women about GBS and its importance. Conclusion: It is vital for obstetricians and midwives to inform all pregnant women about GBS due to the high prevalence of incidental carriers in the population, and the harmful effects it can cause for neonates. Even though most clinicians believe it is important to inform all pregnant women about GBS, most do not. To ensure that RCOG and HSIB recommendations are followed, we recommend that women should be given this information at 28 weeks gestation in the antenatal clinic. Proposed implementations include an information leaflet to be incorporated into the Mum and Baby app, an informative video and end-to-end digital clinic documentation to include this information sharing prompt.

Keywords: group B Streptococcus, early onset sepsis, Antenatal care, Neonatal morbidity, GBS

Procedia PDF Downloads 179

Authors: Alessandra Pardu, Elena Curti, Marco Caredda, Alessio Dedola, Margherita Addis, Massimo Pes, Antonio Pirisi, Tonina Roggio, Sergio Uzzau, Roberto Anedda

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Some of the artisanal cheeses products of European Countries certificated as PDO (Protected Designation of Origin) are made from raw milk. To recognise potential frauds (e.g. pasteurisation or thermisation of milk aimed at raw milk cheese production), the alkaline phosphatase (ALP) assay is currently applied only for pasteurisation, although it is known to have notable limitations for the validation of ALP enzymatic state in nonbovine milk. It is known that frauds considerably impact on customers and certificating institutions, sometimes resulting in a damage of the product image and potential economic losses for cheesemaking producers. Robust, validated, and univocal analytical methods are therefore needed to allow Food Control and Security Organisms, to recognise a potential fraud. In an attempt to develop a new reliable method to overcome this issue, Time-Domain Nuclear Magnetic Resonance (TD-NMR) spectroscopy has been applied in the described work. Daily fresh milk was analysed raw (680.00 µL in each 10-mm NMR glass tube) at least in triplicate. Thermally treated samples were also produced, by putting each NMR tube of fresh raw milk in water pre-heated at temperatures from 68°C up to 72°C and for up to 3 min, with continuous agitation, and quench-cooled to 25°C in a water and ice solution. Raw and thermally treated samples were analysed in terms of 1H T2 transverse relaxation times with a CPMG sequence (Recycle Delay: 6 s, interpulse spacing: 0.05 ms, 8000 data points) and quasi-continuous distributions of T2 relaxation times were obtained by CONTIN analysis. In line with previous data collected by high field NMR techniques, a decrease in the spin-spin relaxation constant T2 of the predominant 1H population was detected in heat-treated milk as compared to raw milk. The decrease of T2 parameter is consistent with changes in chemical exchange and diffusive phenomena, likely associated to changes in milk protein (i.e. whey proteins and casein) arrangement promoted by heat treatment. Furthermore, experimental data suggest that molecular alterations are strictly dependent on the specific heat treatment conditions (temperature/time). Such molecular variations in milk, which are likely transferred to cheese during cheesemaking, highlight the possibility to extend the TD-NMR technique directly on cheese to develop a method for assessing a fraud related to the use of a milk thermal treatment in PDO raw milk cheese. Results suggest that TDNMR assays might pave a new way to the detailed characterisation of heat treatments of milk.

Keywords: cheese fraud, milk, pasteurisation, TD-NMR

Procedia PDF Downloads 242

Authors: S. Grinnell

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A PhD Research Project exploring the Social Health and Well-Being Impacts associated with Hydraulic Fracturing, with an aim to produce a Best Practice Support Guidance for those anticipating dealing with planning applications or submitting Environmental Impact Assessments (EIAs). Amid a possible global energy crisis, founded upon a number of factors, including unstable political situations, increasing world population growth, people living longer, it is perhaps inevitable that Hydraulic Fracturing (commonly referred to as ‘fracking’) will become a major player within the global long-term energy and sustainability agenda. As there is currently no best practice guidance for governing bodies the Best Practice Support Document will be targeted at a number of audiences including, consultants undertaking EIAs, Planning Officers, those commissioning EIAs Industry and interested public stakeholders. It will offer a robust, evidence-based criteria and recommendations which provide a clear narrative and consistent and shared approach to the language used along with containing an understanding of the issues identified. It is proposed that the Best Practice Support Document will also support the mitigation of health impacts identified. The Best Practice Support Document will support the newly amended Environmental Impact Assessment Directive (2011/92/EU), to be transposed into UK law by 2017. A significant amendment introduced focuses on, ‘higher level of protection to the environment and health.’ Methodology: A qualitative research methods approach is being taken with this research. It will have a number of key stages. A literature review has been undertaken and been critically reviewed and analysed. This was followed by a descriptive content analysis of a selection of international and national policies, programmes and strategies along with published Environmental Impact Assessments and associated planning guidance. In terms of data collection, a number of stakeholders were interviewed as well as a number of focus groups of local community groups potentially affected by fracking. These were determined from across the UK. A theme analysis of all the data collected and the literature review will be undertaken, using NVivo. Best Practice Supporting Document will be developed based on the outcomes of the analysis and be tested and piloted in the professional fields, before a live launch. Concluding statement: Whilst fracking is not a new concept, the technology is now driving a new force behind the use of this engineering to supply fuels. A number of countries have pledged moratoria on fracking until further investigation from the impacts on health have been explored, whilst other countries including Poland and the UK are pushing to support the use of fracking. If this should be the case, it will be important that the public’s concerns, perceptions, fears and objections regarding the wider social health and well-being impacts are considered along with the more traditional biomedical health impacts.

Keywords: fracking, hydraulic fracturing, socio-economic health, well-being

Procedia PDF Downloads 243

Authors: Oluseun A. Akinsorotan, Louise K. Gentle, Md. Mofakkarul Islam, Richard W. Yarnell

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High levels of anthropogenic activity such as habitat destruction, poaching and encroachment into natural habitat have resulted in significant global wildlife declines. In order to protect wildlife, many protected areas such as national parks have been created. However, it is argued that many protected areas are only protected in name and are often exposed to continued, and often illegal, anthropogenic pressure. In West African protected areas, declines of large mammals have been documented between 1962 and 2008. This study aimed to produce occupancy estimates of the remaining large mammal fauna in the third largest National Park in Nigeria, Old Oyo, and to compare the estimates with historic estimates while also attempting to quantify levels of illegal anthropogenic activity using a multi-disciplinary approach. Large mammal populations and levels of illegal anthropogenic activity were assessed using empirical field data (camera trapping and transect surveys) in combination with data from questionnaires completed by local villagers and park rangers. Four of the historically recorded species in the park, lion (Panthera leo), hunting dog (Lycaon pictus), elephant (Loxodonta africana) and buffalo (Syncerus caffer) were not detected during field studies nor were they reported by respondents. In addition, occupancy estimates of hunters and illegal grazers were higher than the majority of large mammal species inside the park. This finding was reinforced by responses from the villagers and rangers who’s perception was that large mammal densities in the park were declining, and that a large proportion of the local people were entering the park to hunt wild animals and graze their domestic livestock. Our findings also suggest that widespread poverty and a lack of alternative livelihood opportunities, culture of consuming bushmeat, lack of education and awareness of the value of protected areas, and weak law enforcement are some of the reasons for the illegal activity. Law enforcement authorities were often constrained by insufficient on-site personnel and a lack of modern equipment and infrastructure to deter illegal activities. We conclude that there is a need to address the issue of illegal hunting and livestock grazing, via provision of alternative livelihoods, in combination with community outreach programmes that aim to improve conservation education and awareness and develop the capacity of the conservation authorities in order to achieve conservation goals. Our findings have implications for the conservation management of all protected areas that are available for exploitation by local communities.

Keywords: camera trapping, conservation, extirpation, illegal grazing, large mammals, national park, occupancy estimates, poaching

Procedia PDF Downloads 295

Authors: Apurva Singh, S. P. Jaiswar, Apala Priyadarshini, Akancha Pandey

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Objective: The aim of this study is to find the association of PON1 gene polymorphism with pesticides In RPL subjects. Background: Recurrent pregnancy loss (RPL) is defined as three or more sequential abortions before the 20th week of gestation. Pesticides and its derivatives (organochlorine and organophosphate) are proposed to accommodate a ruler chemical for RPL in the sub-humid region of India. The paraoxonase-1 enzyme (PON1) plays an important role in the toxicity of some organophosphate pesticides, with low PON1 activity being associated with higher pesticide sensitivity Methodology: This is a case-control study done in Department of Obstetrics & Gynaecology & Department of Biochemistry, K.G.M.U, Lucknow, India. The subjects were enrolled after fulfilling the inclusion & exclusion criteria. Inclusion criteria: Cases- Subject having two or more spontaneous abortions & Control- Healthy female having one or more alive child was selected. Exclusion criteria: Cases & Control- Subject having the following disease will be excluded from the study Diabetes mellitus, Hypertension, Tuberculosis, Immunocompromised patients, any endocrine disorder and genital, colon or breast cancer any other malignancies. Blood samples were collected in EDTA tubes from cases & healthy control women & genomic DNA was extracted by phenol-chloroform method. The estimation of pesticides residue from blood was done by HPLC. Biochemical estimation was also performed. Genotyping of PON1 gene polymorphism was performed by RFLP. Statistical analysis of the data was performed using the SPSS16.3 software. Results: A sum of total 14 pesticides (12 organochlorine and 2 organophosphate) selected on the basis of their persistent nature and consumption rate. The significant level of pesticide (ppb) estimated by the Mann whiney test and it was found to be significant at higher level of β-HCH (p:0.04), γ-HCH (p:0.001), δ-HCH (p: 0.002), chloropyrifos (p:0.001), pp-DDD (p:0.001) and fenvalrate (p: 0.001) in case group compare to its control. The level of antioxidant enzymes were found to be significantly decreased among the cases. Wild homozygous TT was more frequent and prevalent among control groups. However, heterozygous group (Tt) was more in cases than control groups (CI-0.3-1.3) (p=0.06). Conclusion: Higher levels of pesticides with endocrine disrupting potential in cases indicate the possible role of these compounds as one of the causes of recurrent pregnancy loss. Possibly, increased pesticide level appears to indicate increased levels of oxidative damage that has been associated with the possible cause of Recurrent Miscarriage, it may reflect indirect evidence of toxicity rather than the direct cause. Since both factors are reported to increase risk, individuals with higher levels of these 'Toxic compounds' especially in 'high-risk genotypes' might be more susceptible to recurrent pregnancy loss.

Keywords: paraoxonase, pesticides, PON1, RPL

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Authors: Feiyu Yang, Chunfang Ni, Rong Wang, Yun Zou, Wenbin Liu, Chenggong Zhang, Fenjin Sun, Chun Wang

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Cocaine is the most frequently used illegal drug globally, with the global annual prevalence of cocaine used ranging from 0.3% to 0.4 % of the adult population aged 15–64 years. Growing consumption trend of abused cocaine and drug crimes are a great concern, therefore urine sample testing has become an important noninvasive sampling whereas cocaine and its metabolites (COCs) are usually present in high concentrations and relatively long detection windows. However, direct analysis of urine samples is not feasible because urine complex medium often causes low sensitivity and selectivity of the determination. On the other hand, presence of low doses of analytes in urine makes an extraction and pretreatment step important before determination. Especially, in gathered taking drug cases, the pretreatment step becomes more tedious and time-consuming. So developing a sensitive, rapid and high-throughput method for detection of COCs in human body is indispensable for law enforcement officers, treatment specialists and health officials. In this work, a new automated magnetic dispersive solid-phase extraction (MDSPE) sampling method followed by high performance liquid chromatography-mass spectrometry (HPLC-MS) was developed for quantitative enrichment of COCs from human urine, using prepared magnetic nanoparticles as absorbants. The nanoparticles were prepared by silanizing magnetic Fe3O4 nanoparticles and modifying them with divinyl benzene and vinyl pyrrolidone, which possesses the ability for specific adsorption of COCs. And this kind of magnetic particle facilitated the pretreatment steps by electromagnetically controlled extraction to achieve full automation. The proposed device significantly improved the sampling preparation efficiency with 32 samples in one batch within 40mins. Optimization of the preparation procedure for the magnetic nanoparticles was explored and the performances of magnetic nanoparticles were characterized by scanning electron microscopy, vibrating sample magnetometer and infrared spectra measurements. Several analytical experimental parameters were studied, including amount of particles, adsorption time, elution solvent, extraction and desorption kinetics, and the verification of the proposed method was accomplished. The limits of detection for the cocaine and cocaine metabolites were 0.09-1.1 ng·mL-1 with recoveries ranging from 75.1 to 105.7%. Compared to traditional sampling method, this method is time-saving and environmentally friendly. It was confirmed that the proposed automated method was a kind of highly effective way for the trace cocaine and cocaine metabolites analyses in human urine.

Keywords: automatic magnetic dispersive solid-phase extraction, cocaine detection, magnetic nanoparticles, urine sample testing

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Authors: Rajesh Ranjan, Marimuthu Palaniswami, A. A. Hashmi

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With the changing lifestyle and environment around us, the prevalence of the critical and incurable disease has proliferated. One such condition is the neurological disorder which is rampant among the old age population and is increasing at an unstoppable rate. Most of the neurological disorder patients suffer from some movement disorder affecting the movement of their body parts. Tremor is the most common movement disorder which is prevalent in such patients that infect the upper or lower limbs or both extremities. The tremor symptoms are commonly visible in Parkinson’s disease patient, and it can also be a pure tremor (essential tremor). The patients suffering from tremor face enormous trouble in performing the daily activity, and they always need a caretaker for assistance. In the clinics, the assessment of tremor is done through a manual clinical rating task such as Unified Parkinson’s disease rating scale which is time taking and cumbersome. Neurologists have also affirmed a challenge in differentiating a Parkinsonian tremor with the pure tremor which is essential in providing an accurate diagnosis. Therefore, there is a need to develop a monitoring and assistive tool for the tremor patient that keep on checking their health condition by coordinating them with the clinicians and caretakers for early diagnosis and assistance in performing the daily activity. In our research, we focus on developing a system for automatic classification of tremor which can accurately differentiate the pure tremor from the Parkinsonian tremor using a wearable accelerometer-based device, so that adequate diagnosis can be provided to the correct patient. In this research, a study was conducted in the neuro-clinic to assess the upper wrist movement of the patient suffering from Pure (Essential) tremor and Parkinsonian tremor using a wearable accelerometer-based device. Four tasks were designed in accordance with Unified Parkinson’s disease motor rating scale which is used to assess the rest, postural, intentional and action tremor in such patient. Various features such as time-frequency domain, wavelet-based and fast-Fourier transform based cross-correlation were extracted from the tri-axial signal which was used as input feature vector space for the different supervised and unsupervised learning tools for quantification of severity of tremor. A minimum covariance maximum correlation energy comparison index was also developed which was used as the input feature for various classification tools for distinguishing the PT and ET tremor types. An automatic system for efficient classification of tremor was developed using feature extraction methods, and superior performance was achieved using K-nearest neighbors and Support Vector Machine classifiers respectively.

Keywords: machine learning approach for neurological disorder assessment, automatic classification of tremor types, feature extraction method for tremor classification, neurological movement disorder, parkinsonian tremor, essential tremor

Procedia PDF Downloads 154

Authors: Ana Julia Acevedo Urquiaga, Jose A. Acevedo Suarez, Ana Julia Urquiaga Rodriguez, Neyfe Sablon Cossio

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Despite the progress made in logistics and supply chains fields, it is unavoidable the development of business models that use efficiently information to facilitate the integrated logistics flows management between partners. Collaborative management is an important tool for materializing the cooperation between companies, as a way to achieve the supply chain efficiency and effectiveness. The first face of this research was a comprehensive analysis of the collaborative planning on the Cuban companies. It is evident that they have difficulties in supply chains planning where production, supplies and replenishment planning are independent tasks, as well as logistics and distribution operations. Large inventories generate serious financial and organizational problems for entities, demanding increasing levels of working capital that cannot be financed. Problems were found in the efficient application of Information and Communication Technology on business management. The general objective of this work is to develop a methodology that allows the deployment of a planning and control system in a coordinated way on the medicine’s logistics system in Cuba. To achieve these objectives, several mechanisms of supply chain coordination, mathematical programming models, and other management techniques were analyzed to meet the requirements of collaborative logistics management in Cuba. One of the findings is the practical and theoretical inadequacies of the studied models to solve the current situation of the Cuban logistics systems management. To contribute to the tactical-operative management of logistics, the Collaborative Logistics Flow Management Model (CLFMM) is proposed as a tool for the balance of cycles, capacities, and inventories, always to meet the final customers’ demands in correspondence with the service level expected by these. The CLFMM has as center the supply chain planning and control system as a unique information system, which acts on the processes network. The development of the model is based on the empirical methods of analysis-synthesis and the study cases. Other finding is the demonstration of the use of a single information system to support the supply chain logistics management, allows determining the deadlines and quantities required in each process. This ensures that medications are always available to patients and there are no faults that put the population's health at risk. The simulation of planning and control with the CLFMM in medicines such as dipyrone and chlordiazepoxide, during 5 months of 2017, permitted to take measures to adjust the logistic flow, eliminate delayed processes and avoid shortages of the medicines studied. As a result, the logistics cycle efficiency can be increased to 91%, the inventory rotation would increase, and this results in a release of financial resources.

Keywords: collaborative management, medicine logistic system, supply chain planning, tactical-operative planning

Procedia PDF Downloads 176

Authors: F. O’Dowd, G. Murphy, M. Roche, E. Shudell, F. Keane, M. O’Kane

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Intoduction: Apremilast (Otezla®) is an oral phosphodiesterase-4 (PDE4) inhibitor indicated for treatment of adult patients with moderate to severe plaque psoriasis who have contraindications to have failed or intolerant of standard systemic therapy and/or phototherapy; and adult patients with active psoriatic arthritis. Apremilast influences intracellular regulation of inflammatory mediators. Two randomized, placebo-controlled trials evaluating apremilast in 1426 patients with moderate to severe plague psoriasis (ESTEEM 1 and 2) demonstrated that the commonest adverse reactions (AE’s) leading to discontinuation were nausea (1.6%), diarrhoea (1.0%), and headaches (0.8%). The overall proportion of subjects discontinuing due to adverse reactions was 6.1%. At week 16 these trials demonstrated significant more apremilast-treated patients (33.1%) achieved the primary end point PASI-75 than placebo (5.3%). We began prescribing apremilast in July 2015. Aim: To evaluate efficacy and tolerability of apremilast in an Irish teaching hospital psoriasis population. Methods: A proforma documenting clinical evaluation parameters, prior treatment experience and AE’s; was completed prospectively on all patients commenced on apremilast since July 2015 – July 2017. Data was collected at week 0,6,12,24,36 and week 52 with 20/71 patients having passed week 52. Efficacy was assessed using Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). AE’s documented included GI effects, infections, changes in weight and mood. Retrospective chart review and telephone review was utilised for missing data. Results: A total of 71 adult subjects (38 male, 33 female; age range 23-57), with moderate to severe psoriasis, were evaluated. Prior treatment: 37/71 (52%) were systemic/biologic/phototherapy naïve; 14/71 (20%) has prior phototherapy alone;20/71 (28%) had previous systemic/biologic exposure; 12/71 (17%) had both psoriasis and psoriatic arthritis. PASI responses: mean baseline PASI was 10.1 and DLQI was 15.Week 6: N=71, n=15 (21%) achieved PASI 75. Week 12: N= 48, n=6 (13%) achieved a PASI 100%; n=16 (34.5%) achieved a PASI 75. Week 24: N=40, n=10 (25%) achieved a PASI 100; n=15 (37.5%) achieved a PASI 75. Week 52: N= 20, n=4 (20%) achieved a PASI 100; n= 16 (80%) achieved a PASI 75. (N= number of pts having passed the time point indicated, n= number of pts (out of N) achieving PASI or DLQI responses at that time). DLQI responses: week 24: N= 40, n=30 (75%) achieved a DLQI score of 0; n=5 (12.5%) achieved a DLQI score of 1; n=1 (2.5%) achieved a DLQI score of 10 (due to lack of efficacy). Adverse Events: The proportion of patients that discontinued treatment due to AE’s was n=7 (9.8%). One patient experienced nausea alleviated by dose reduction; another developed significant dysgeusia for certain foods, both continued therapy. Two patients lost 2-3 kg. Conclusion: Initial Irish patient experience of Apremilast appears comparable to that observed in trials with good efficacy and tolerability.

Keywords: Apremilast, introduction, Ireland, clinical audit

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Authors: Ani Demetrashvili

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As online learning continues to reshape the landscape of education, questions arise regarding its efficacy for diverse learning styles, particularly for visual learners. This abstract delves into the impact of online learning on visual learners, exploring how digital mediums influence their educational experience and how educational platforms can be optimized to cater to their needs. Visual learners comprise a significant portion of the student population, characterized by their preference for visual aids such as diagrams, charts, and videos to comprehend and retain information. Traditional classroom settings often struggle to accommodate these learners adequately, relying heavily on auditory and written forms of instruction. The advent of online learning presents both opportunities and challenges in addressing the needs of visual learners. Online learning platforms offer a plethora of multimedia resources, including interactive simulations, virtual labs, and video lectures, which align closely with the preferences of visual learners. These platforms have the potential to enhance engagement, comprehension, and retention by presenting information in visually stimulating formats. However, the effectiveness of online learning for visual learners hinges on various factors, including the design of learning materials, user interface, and instructional strategies. Research into the impact of online learning on visual learners encompasses a multidisciplinary approach, drawing from fields such as cognitive psychology, education, and human-computer interaction. Studies employ qualitative and quantitative methods to assess visual learners' preferences, cognitive processes, and learning outcomes in online environments. Surveys, interviews, and observational studies provide insights into learners' preferences for specific types of multimedia content and interactive features. Cognitive tasks, such as memory recall and concept mapping, shed light on the cognitive mechanisms underlying learning in digital settings. Eye-tracking studies offer valuable data on attentional patterns and information processing during online learning activities. The findings from research on the impact of online learning on visual learners have significant implications for educational practice and technology design. Educators and instructional designers can use insights from this research to create more engaging and effective learning materials for visual learners. Strategies such as incorporating visual cues, providing interactive activities, and scaffolding complex concepts with multimedia resources can enhance the learning experience for visual learners in online environments. Moreover, online learning platforms can leverage the findings to improve their user interface and features, making them more accessible and inclusive for visual learners. Customization options, adaptive learning algorithms, and personalized recommendations based on learners' preferences and performance can enhance the usability and effectiveness of online platforms for visual learners.

Keywords: online learning, visual learners, digital education, technology in learning

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Authors: Jayashree And Gajjam

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Intellectual humility (IH) is defined as a virtuous mean between intellectual arrogance and intellectual self-diffidence by the ‘Doxastic Account of IH’ studied, researched and developed by western scholars not earlier than 2015 at the University of Edinburgh. Ancient Indian philosophical texts or the Upanisads written in the Sanskrit language during the later Vedic period (circa 600-300 BCE) have long addressed the virtue of being humble in several stories and narratives. The current research paper questions and revisits these character traits in an Indian context following an experimental method. Based on the subjective reports of more than 400 Indian teenagers and adults, it argues that while a few traits of IH (such as trustworthiness, respectfulness, intelligence, politeness, etc.) are panhuman and pancultural, a few are not. Some attributes of IH (such as proper pride, open-mindedness, awareness of own strength, etc.) may be taken for arrogance by the Indian population, while other qualities of Intellectual Diffidence such as agreeableness, surrendering can be regarded as the characteristic of IH. The paper then gives the reasoning for this discrepancy that can be traced back to the ancient Indian (Upaniṣadic) teachings that are still prevalent in many Indian families and still anchor their views on IH. The name Upanisad itself means ‘sitting down near’ (to the Guru to gain the Supreme knowledge of the Self and the Universe and setting to rest ignorance) which is equivalent to the three traits among the BIG SEVEN characterized as IH by the western scholars viz. ‘being a good listener’, ‘curious to learn’, and ‘respect to other’s opinion’. The story of Satyakama Jabala (Chandogya Upanisad 4.4-8) who seeks the truth for several years even from the bull, the fire, the swan and waterfowl, suggests nothing but the ‘need for cognition’ or ‘desire for knowledge’. Nachiketa (Katha Upanisad), a boy with a pure mind and heart, follows his father’s words and offers himself to Yama (the God of Death) where after waiting for Yama for three days and nights, he seeks the knowledge of the mysteries of life and death. Although the main aim of these Upaniṣadic stories is to give the knowledge of life and death, the Supreme reality which can be identical with traits such as ‘curious to learn’, one cannot deny that they have a lot more to offer than mere information about true knowledge e.g., ‘politeness’, ‘good listener’, ‘awareness of own limitations’, etc. The possible future scope of this research includes (1) finding other socio-cultural factors that affect the ideas on IH such as age, gender, caste, type of education, highest qualification, place of residence and source of income, etc. which may be predominant in current Indian society despite our great teachings of the Upaniṣads, and (2) to devise different measures to impart IH in Indian children, teenagers, and younger adults for the harmonious future. The current experimental research can be considered as the first step towards these goals.

Keywords: ethics and virtue epistemology, Indian philosophy, intellectual humility, upaniṣadic texts in ancient India

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Authors: Jamil Lane, Jason Freeman

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Background: The role of interpersonal relationships is vital predictors of adolescents’ eating habits, exercise activity, and health problems including obesity. The effect of interpersonal relationships (i.e. family, friends, and intimate partners) on individual health behaviors and development have gained considerable attention during the past 10 years. Teenagers eating habits and exercise activities are established through a dynamic course involving internal and external factors such as food preferences, body weight perception, and parental and peer influence. When conceptualizing one’s interpersonal relationships, it is important to understand that how one relates to others is shaped by their culture. East-Asian culture has been characterized as collectivistic, which describes the significant role intergroup relationships play in their construction of the self. Cultures found in North America, on the other hand, can be characterized as individualistic, meaning that these cultures encourage individuals to prioritize their interest over the needs and want of their compatriots. Individuals from collectivistic cultures typically have stronger boundaries between in-group and out-group membership, whereas those from individualistic cultures see themselves as distinct and separate from strangers as well as family or friends. Objective: The purpose of this study is to examine the effect of collectivism and individualism on interpersonal relationships that shapes eating patterns and physical activity among Asian-American and European-American adolescents. Design/Methods: Analyses were based on data from the National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents in the United States who were surveyed from 1994 through 2008. This data will be used to examine interpersonal relationship factors that shape dietary intake and physical activity patterns within the Asian-American and European-American population in the United States. Factors relating to relationship strength, eating, and exercise behaviors were reported by participants in this first wave of data collection (1995). We plan to analyze our data using intragroup comparisons among those who identified as 'Asian-American' (n = 270) and 'White or European American' (n = 4,294) among the domains of positivity of peer influence and level of physical activity / healthy eating. Further, intergroup comparisons of these relationships will be made to extricate how the role positive peer influence in maintaining healthy eating and exercise habits differs with cultural variation. Results: We hypothesize that East-Asian participants with a higher degree of positivity in their peer and family relationships will experience a significantly greater rise in healthy eating and exercise behaviors than European-American participants with similar degrees of relationship positivity.

Keywords: interpersonal relationships, eating patterns, physical activity, adolescent health

Procedia PDF Downloads 198

Authors: Abdirahman Barre, Abdihamid Salad Hassan, Iftin Abdi Mohamud, Abdirahman Mohamed Mohamud, Ahmed Adan Mohamed, Mukhtaar Mohamed Idow

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Pasteurellosis (Hemorrhagic septicemia) is a common respiratory disease of camel that is an acutely fatal disease caused by Pasteurella multocida type A or several serotypes of Mannheimia hemolytic, which also affect other animals. The disease had shown to spread between animals, across herds and to humans. Meaning that the disease is Zoonosis. The study aimed at establishment of sero-prevalence of Pasteurellosis in some selected Districts of camel rearing in the Benadir Region. It was a cross-sectional study, where the study population was purposively chosen to consist of animals taken within three sub-Districts of Benadir Region, namely Sub-District (Daynile Township), Sub-District (Yaaqshid) Sub-District (kaxda). This was because they normally handle many camels in a day, thus making it easy for the investigator to access the required number conveniently; it was also assumed that data collected from these for-slaughter camels was representative of the situation in the sub-District/county. A total of one hundred and sixty camels were tested using four serological tests: Rose Bengal Plate Test (RBPT),) and Complex Fixation Test (CFT). The serological tests were purposively chosen to increase the chances of picking positive cases and also to compare their sensitivities with respect to camel serum since they were originally meant for use on bovine serum. Blood samples (15 ml) were collected for serum harvesting from the jugular veins of the animals as they were waiting to be examined. Rose Bengal plate test and CFT were run at a laboratory within the Department of Veterinary Medicine, University of Horsed, 21 October campus; serum samples having been transported in a cool box. On average, out of an overall total of 300 serum samples tested, 180 samples were selected as sample procedures and were given eleven (11) positive results, amounting to a prevalence of 6.67%. For the three Districts, respective prevalence (averaged from the two (2) serological tests run) were: 7% (3/50) for Yaqshiid; 8% (3/60) for Deyniile and 10% (3/70) for Kaxda. When sensitivities of the two (2) serological tests were compared, there was no significant difference between them with respect to the picking of positive cases (p=0.05). The study has demonstrated presence of Pasterolosis in camels in Benadir Region and the authors are recommending the usage of RBPT and CFT as screening tests, since they are cheap, quick, and easy to carry out. Any of the other three involving tests can then be used if one wants to establish respective titers. Therefore, further detailed investigation needs to be conducted so as to understand specific etiological agents causing pasteurollosis in camel and can be instituted to optimize the benefit obtained from the camel sector.

Keywords: hemorrhagic septicemia, camel, prevalence, Benadir region, Somalia

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Authors: Felicite Ann Fairer-Wessels

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There has always been a disparity between mining and tourism mainly due to the socio-economic and environmental impacts of mines on both the adjacent resident communities and the areas taken up by the mining operation. Although heritage mining tourism has been actively and successfully pursued and developed in the UK, largely Wales, and Scandinavian countries, the debate whether active mining and tourism can have a mutually beneficial relationship remains imminent. This pilot study explores the relationship between the ‘to be developed’ future Nokeng Mine and its adjacent community, the rural community of Moloto, will be investigated in terms of whether sustainable tourism and livelihood activities can potentially be developed with the support of the mine. Concepts such as social entrepreneur, corporate social responsibility, sustainable development and triple bottom line are discussed. Within the South African context as a mineral rich developing country, the government has a statutory obligation to empower disenfranchised communities through social and labour plans and policies. All South African mines must preside over a Social and Labour Plan according to the Mineral and Petroleum Resources Development Act, No 28 of 2002. The ‘social’ component refers to the ‘social upliftment’ of communities within or adjacent to any mine; whereas the ‘labour’ component refers to the mine workers sourced from the specific community. A qualitative methodology is followed using the case study as research instrument for the Nokeng Mine and Moloto community with interviews and focus group discussions. The target population comprised of the Moloto Tribal Council members (8 in-depth interviews), the Moloto community members (17: focus groups); and the Nokeng Mine representatives (4 in-depth interviews). In this pilot study two disparate ‘worlds’ are potentially linked: on the one hand, the mine as social entrepreneur that is searching for feasible and sustainable ideas; and on the other hand, the community adjacent to the mine, with potentially sustainable tourism entrepreneurs that can tap into the resources of the mine should their ideas be feasible to build their businesses. Being an exploratory study the findings are limited but indicate that the possible success of tourism and sustainable livelihood activities lies in the fact that both the Mine and Community are keen to work together – the mine in terms of obtaining labour and profit; and the community in terms of improved and sustainable social and economic conditions; with both parties realizing the importance to mitigate negative environmental impacts. In conclusion, a relationship of trust is imperative between a mine and a community before a long term liaison is possible. However whether tourism is a viable solution for the community to engage in is debatable. The community could initially rather pursue the sustainable livelihoods approach and focus on life-supporting activities such as building, gardening, etc. that once established could feed into possible sustainable tourism activities.

Keywords: community development, mining tourism, sustainability, South Africa

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Authors: G. Yanay-Ventura, H. Desivilya Syna, K. Michael

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Social businesses are based on the idea that an enterprise can be established for the sake of profit and, at the same time, with the aim of fulfilling social goals. Yet, the question of how these goals can be integrated in practice to derive parallel benefit in both realms still needs to be examined. Particularly notable in this context is the ‘governance challenge’ of social businesses, meaning the danger of the mission drifts from the social goal in the pursuit of good business. This study is based on an evaluation study of a social business that operates as a restaurant providing professional training to at-risk youth. The evaluation was based on the collection of a variety of data through interviews with stakeholders in the enterprise (directors and managers, business partners, social partners, and position holders in the restaurant and the social enterprise), a focus group consisting of the youth receiving the professional training, observations of the restaurant’s operation, and analysis of the social enterprise’s primary documents. The evaluation highlighted significant strengths of the social enterprise, including reaching relatively fast business sustainability, effective management of the restaurant, stable employment of the restaurant staff, and effective management of the social project. The social enterprise and business management have both enjoyed positive evaluations from a variety of stakeholders. Clearly, the restaurant was deemed by all a promising young business. However, the social project suffered from a 90% dropout rate among the youth entering its ranks, extreme monthly fluctuation in the number of youths participating, and a distinct minority of the youth who have succeeded in completing their training period. Possible explanations of the high dropout rate included the small number of cooks, which impeded the effectiveness of the training process and the provision of advanced cooking skills; lack of clarity regarding the essence and the elements of training; and lack of a meaningful peer group for the youth engaged in the program. Paradoxically, despite the stakeholders’ great appreciation for the social enterprise, the challenge of governability was also formidable, revealing a tangible risk of mission drift in the reduction of the social enterprise’s target population and a breach of the commitment made to the youth with regard to practical training. The risk of mission drifts emerged as a hidden and evasive issue for the stakeholders, who revealed a deep appreciation for the management and the outcomes of the social enterprise. The challenge of integration, therefore, requires an in-depth examination of how to maintain a successful business without hindering the achievement of the social goal. The study concludes that clear conceptualization of the training process and its aims, increased cooks’ participation in the social project, and novel conceptions with regard to the evaluation of success could serve to benefit the youth and impede mission drift.

Keywords: evaluation study, management, mission drift, social business

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Authors: Mohamed Bualhamam

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Due to the complex nature of tourism resources of the Northern part of the United Arab Emirates (UAE), the potential of Geographical Information Systems (GIS) and Remote Sensing (RS) in resolving these issues was used. The study was an attempt to use existing GIS data layers to identify sensitive natural environment and archaeological heritage resources that may be threatened by increased urban growth and give some specific recommendations to protect the area. By identifying sensitive natural environment and archaeological heritage resources, public agencies and citizens are in a better position to successfully protect important natural lands and direct growth away from environmentally sensitive areas. The paper concludes that applications of GIS and RS in study of urban growth impact in tourism resources are a strong and effective tool that can aid in tourism planning and decision-making. The study area is one of the fastest growing regions in the country. The increase in population along the region, as well as rapid growth of towns, has increased the threat to natural resources and archeological sites. Satellite remote sensing data have been proven useful in assessing the natural resources and in monitoring the changes. The study used GIS and RS to identify sensitive natural environment and archaeological heritage resources that may be threatened by increased urban growth. The result of GIS analyses shows that the Northern part of the UAE has variety for tourism resources, which can use for future tourism development. Rapid urban development in the form of small towns and different economic activities are showing in different places in the study area. The urban development extended out of old towns and have negative affected of sensitive tourism resources in some areas. Tourism resources for the Northern part of the UAE is a highly complex resources, and thus requires tools that aid in effective decision making to come to terms with the competing economic, social, and environmental demands of sustainable development. The UAE government should prepare a tourism databases and a GIS system, so that planners can be accessed for archaeological heritage information as part of development planning processes. Applications of GIS in urban planning, tourism and recreation planning illustrate that GIS is a strong and effective tool that can aid in tourism planning and decision- making. The power of GIS lies not only in the ability to visualize spatial relationships, but also beyond the space to a holistic view of the world with its many interconnected components and complex relationships. The worst of the damage could have been avoided by recognizing suitable limits and adhering to some simple environmental guidelines and standards will successfully develop tourism in sustainable manner. By identifying sensitive natural environment and archaeological heritage resources of the Northern part of the UAE, public agencies and private citizens are in a better position to successfully protect important natural lands and direct growth away from environmentally sensitive areas.

Keywords: GIS, natural environment, UAE, urban growth

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Authors: Swapnil Kumar Singh

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Gamma-ray bursts (GRB's), short and intense pulses of low-energy γ rays, have fascinated astronomers and astrophysicists since their unexpected discovery in the late sixties. GRB'sare accompanied by long-lasting afterglows, and they are associated with core-collapse supernovae. The detection of delayed emission in X-ray, optical, and radio wavelength, or "afterglow," following a γ-ray burst can be described as the emission of a relativistic shell decelerating upon collision with the interstellar medium. While it is fair to say that there is strong diversity amongst the afterglow population, probably reflecting diversity in the energy, luminosity, shock efficiency, baryon loading, progenitor properties, circumstellar medium, and more, the afterglows of GRBs do appear more similar than the bursts themselves, and it is possible to identify common features within afterglows that lead to some canonical expectations. After an initial flash of gamma rays, a longer-lived "afterglow" is usually emitted at longer wavelengths (X-ray, ultraviolet, optical, infrared, microwave, and radio). It is a slowly fading emission at longer wavelengths created by collisions between the burst ejecta and interstellar gas. In X-ray wavelengths, the GRB afterglow fades quickly at first, then transitions to a less-steep drop-off (it does other stuff after that, but we'll ignore that for now). During these early phases, the X-ray afterglow has a spectrum that looks like a power law: flux F∝ E^β, where E is energy and beta is some number called the spectral index. This kind of spectrum is characteristic of synchrotron emission, which is produced when charged particles spiral around magnetic field lines at close to the speed of light. In addition to the outgoing forward shock that ploughs into the interstellar medium, there is also a so-called reverse shock, which propagates backward through the ejecta. In many ways," reverse" shock can be misleading; this shock is still moving outward from the restframe of the star at relativistic velocity but is ploughing backward through the ejecta in their frame and is slowing the expansion. This reverse shock can be dynamically important, as it can carry comparable energy to the forward shock. The early phases of the GRB afterglow still provide a good description even if the GRB is highly collimated since the individual emitting regions of the outflow are not in causal contact at large angles and so behave as though they are expanding isotropically. The majority of afterglows, at times typically observed, fall in the slow cooling regime, and the cooling break lies between the optical and the X-ray. Numerous observations support this broad picture for afterglows in the spectral energy distribution of the afterglow of the very bright GRB. The bluer light (optical and X-ray) appears to follow a typical synchrotron forward shock expectation (note that the apparent features in the X-ray and optical spectrum are due to the presence of dust within the host galaxy). We need more research in GRB and Particle Physics in order to unfold the mysteries of afterglow.

Keywords: GRB, synchrotron, X-ray, isotropic energy

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