Search results for: occupational health and safety in Turkey

Authors: Domenico Chizzoniti, Monica Moscatelli, Letizia Cattani, Luca Preis

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A primary healthcare facility in developing countries should be a multifunctional space able to respond to different requirements: Flexibility, modularity, aggregation and reversibility. These basic features could be better satisfied if applied to an architectural artifact that complies with the typological, figurative and constructive aspects of the context in which it is located. Therefore, the purpose of this paper is to identify a procedure that can define the figurative aspects of the architectural structure of the health prototype for the marginal areas of developing countries through a critical approach. The application context is the rural areas of the Northeast of Bahia in Brazil. The prototype should be located in the rural district of Quingoma, in the municipality of Lauro de Freitas, a particular place where there is still a cultural fusion of black and indigenous populations. Based on the historical analysis of settlement strategies and architectural structures in spaces of public interest or collective use, this paper aims to provide a procedure able to identify the categories and rules underlying typological and figurative aspects, in order to detect significant and generalizable elements, as well as materials and constructive techniques typically adopted in the rural areas of Brazil. The object of this work is therefore not only the recovery of certain constructive approaches but also the development of a procedure that integrates the requirements of the primary healthcare prototype with its surrounding economic, social, cultural, settlement and figurative conditions.

Keywords: architectural typology, developing countries, local construction techniques, primary health care.

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Authors: Seyedvahid Najafi, Viliam Makis

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In recent years, maintenance optimization has attracted special attention due to the growth of industrial systems complexity. Maintenance costs are high for many systems, and preventive maintenance is effective when it increases operations' reliability and safety at a reduced cost. The novelty of this research is to consider general repair in the modeling of multi-unit series systems and solve the maintenance problem for such systems using the semi-Markov decision process (SMDP) framework. We propose an opportunistic maintenance policy for a series system composed of two main units. Unit 1, which is more expensive than unit 2, is subjected to condition monitoring, and its deterioration is modeled using a gamma process. Unit 1 hazard rate is estimated by the proportional hazards model (PHM), and two hazard rate control limits are considered as the thresholds of maintenance interventions for unit 1. Maintenance is performed on unit 2, considering an age control limit. The objective is to find the optimal control limits and minimize the long-run expected average cost per unit time. The proposed algorithm is applied to a numerical example to compare the effectiveness of the proposed policy (policy Ⅰ) with policy Ⅱ, which is similar to policy Ⅰ, but instead of general repair, replacement is performed. Results show that policy Ⅰ leads to lower average cost compared with policy Ⅱ. 

Keywords: condition-based maintenance, proportional hazards model, semi-Markov decision process, two-unit series systems

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Authors: Cely D. Magpantay, Geolynne Marie Adel, Cire-rine Mae Concepcion, Dessa Jean Orcajada, Jorgette Andrea Santos, Orian Laurace Canaman

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Mental illness initiative is very relevant in promoting the Mental Health Bill act of 2017. In the Philippines alone, the public is more open and receptive to people at risks with a mental condition. Although it is uncommon that parents can become more psychologically unfit compared to their children, research shows that parents who are suffering from mental illness have a more significant negative effect than another family member. The impact of parent’s mental health can put their children more susceptible to acquire the same disorder. The aim of the study is to explore the lived experiences of children whose parents suffered from mental illness. It discusses how their parent's mental condition in, anyway, affects their psychological development. Using Phenomenological Qualitative Research, an in-depth, interview was conducted to five (5) consenting adults who lived with their parents diagnosed with a mental disorder. Results are clustered into four themes. The first theme is the negative emotion towards parents, the second theme is the psychosocial dynamics in caring for the patient, third is accepting the disease, and fourth is a general perspective on the family. Each themes is validated by experts and the participants. This theme generates subcomponent like isolation, shallow relationship and debt of gratitude. Along with these themes comes the fear of having a family emerged. There is a growing need to strengthen the family ties even more because of parent’s mental illness. Therefore, parental mental illness has an effect on the children’s psychological and social development.

Keywords: lived experience in Philippines, mental health, parental mental illness, psychosocial dynamics

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Authors: Ben Mansour Mouin, Elloumi Abdelkarim

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We will discuss the problem of routing a fleet of different vehicles from a central depot to different types of infrastructure-defaults with dynamic maintenance requests, modified time windows, and control of default maintained. For this reason, we propose a modified metaheuristicto to solve our mathematical model. SVRDP-CMTW is a variant VRP of an optimal vehicle plan that facilitates the maintenance task of different types of infrastructure-defaults. This task will be monitored after the maintenance, based on its priorities, the degree of danger associated with each default, and the neighborhood at the black-spots. We will present, in this paper, a multidimensional genetic algorithm “MGA” by detailing its characteristics, proposed mechanisms, and roles in our work. The coding of this algorithm represents the necessary parameters that characterize each infrastructure-default with the objective of minimizing a combination of cost, distance and maintenance times while satisfying the priority levels of the most urgent defaults. The developed algorithm will allow the dynamic integration of newly detected defaults at the execution time. This result will be displayed in our programmed interactive system at the routing time. This multidimensional genetic algorithm replaces N genetic algorithm to solve P different type problems of infrastructure defaults (instead of N algorithm for P problem we can solve in one multidimensional algorithm simultaneously who can solve all these problemsatonce).

Keywords: mathematical model, VRP, multidimensional genetic algorithm, metaheuristics

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Authors: Mehrnaz Mostafavi, Alireza Azani, Mahtab Shabani, Fatemeh Ghafari

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While filled with promise and wonder, space exploration also presents significant challenges, one of the foremost being the threat of cosmic radiation to astronaut health. Recent advancements in assessing these risks and developing protective strategies have shed new light on this issue. Cosmic radiation encompasses a variety of high-energy particles originating from sources like solar particle events, galactic cosmic rays, and cosmic rays from beyond the solar system. These particles, composed of protons, electrons, and heavy ions, pose a substantial threat to human health in space due to the lack of Earth's protective atmosphere and magnetic field. Researchers have made significant progress in assessing the risks associated with cosmic radiation exposure. By employing advanced dosimetry techniques and conducting biological studies, they have gained insights into how cosmic radiation affects astronauts' health, including increasing the risk of cancer and radiation sickness. This research has led to personalized risk assessment methods tailored to individual astronaut profiles. Distinctive protection strategies have been proposed to combat the dangers of cosmic radiation. These include developing spacecraft shielding materials and designs to enhance radiation protection. Additionally, researchers are exploring pharmacological interventions such as radioprotective drugs and antioxidant therapies to mitigate the biological effects of radiation exposure and preserve astronaut well-being. The findings from recent research have significant implications for the future of space exploration. By advancing our understanding of cosmic radiation risks and developing effective protection strategies, we pave the way for safer and more sustainable human missions beyond Earth's orbit. This is especially crucial for long-duration missions to destinations like Mars, where astronauts will face prolonged exposure to cosmic radiation. In conclusion, recent research has marked a milestone in addressing the challenges posed by cosmic radiation in space exploration. By delving into the complexities of cosmic radiation exposure and developing innovative protection strategies, scientists are ensuring the health and resilience of astronauts as they venture into the vast expanse of the cosmos. Continued research and collaboration in this area are essential for overcoming the cosmic radiation challenge and enabling humanity to embark on new frontiers of exploration and discovery in space.

Keywords: Space exploration, cosmic radiation, astronaut health, risk assessment, protective strategies

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Authors: Shaun G. Abbott, Rebecca C. Reynolds, James B. Etter, John B. F. de Wit

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The benefits of physical activity (PA) on health are well documented. Low socioeconomic status (SES) is associated with poor health, with PA a suggested mediator. Pedometers and accelerometers offer an effective behavior change tool to increase PA levels. While the role of pedometer and accelerometer use in increasing PA is recognized in many populations, little is known in low-SES groups. We are aiming to assess the effectiveness of pedometer- and accelerometer-based interventions for increasing PA step count and improving subsequent health outcomes among low-SES groups of high-income countries. Medline, Embase, PsycINFO, CENTRAL and SportDiscus databases were searched to identify articles published before 10th July, 2015; using search terms developed from previous systematic reviews. Inclusion criteria are: low-SES participants classified by income, geography, education, occupation or ethnicity; study duration minimum 4 weeks; an intervention and control group; wearing of an unsealed pedometer or accelerometer to objectively measure PA as step counts per day for the duration of the study. We retrieved 2,142 articles from our database searches, after removal of duplicates. Two investigators independently reviewed titles and abstracts of these articles (50% each) and a combined 20% sample were reviewed to account for inter-assessor variation. We are currently verifying the full texts of 430 articles. Included studies will be critically appraised for risk of bias using guidelines suggested by the Cochrane Public Health Group. Two investigators will extract data concerning the intervention; study design; comparators; steps per day; participants; context and presence or absence of obesity and/or chronic disease. Heterogeneity amongst studies is anticipated, thus a narrative synthesis of data will be conducted with the simplification of selected results into percentage increases from baseline to allow for between-study comparison. Results will be presented at the conference in December if selected.

Keywords: accelerometer, pedometer, physical activity, socioeconomic, step count

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Authors: Qudsiya Baig

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Empathy yields an unparalleled therapeutic value within patient physician interactions. Medical research is inundated with evidence to support that a physician’s ability to empathise with patients leads to a greater willingness to report symptoms, an improvement in diagnostic accuracy and safety, and a better adherence and satisfaction with treatment plans. Furthermore, the Institute of Medicine states that empathy leads to a more patient-centred care, which is one of the six main goals of a 21st century health system. However, there is a paradox between the theoretical significance of empathy and its presence, or lack thereof, in clinical practice. Recent studies have reported that empathy declines amongst students and physicians over time. The three most impactful contributors to this decline are: (1) disagreements over the definitions of empathy making it difficult to implement it into practice (2) poor consideration or regulation of empathy leading to burnout and thus, abandonment altogether, and (3) the lack of diversity in the curriculum and the influence of medical culture, which prioritises science over patient experience, limiting some physicians from using ‘too much’ empathy in the fear of losing clinical objectivity. These issues were investigated by conducting a fully inductive thematic narrative analysis of patient narratives in the UK to evaluate the behaviours and attitudes that patients associate with empathy. The principal enquiries underpinning this study included uncovering the factors that affected experience of empathy within provider-patient interactions and to analyse their effects on patient care. This research contributes uniquely to this discourse by examining the phenomenon of empathy directly from patients’ experiences, which were systematically extracted from a repository of online patient narratives of care titled ‘CareOpinion UK’. Narrative analysis was specifically chosen as the methodology to examine narratives from a phenomenological lens to focus on the particularity and context of each story. By enquiring beyond the superficial who-whatwhere, the study of narratives prescribed meaning to illness by highlighting the everyday reality of patients who face the exigent life circumstances created by suffering, disability, and the threat of life. The following six themes were found to be the most impactful in influencing the experience of empathy: dismissive behaviours, judgmental attitudes, undermining patients’ pain or concerns, holistic care and failures and successes of communication or language. For each theme there were overarching themes relating to either a failure to understand the patient’s perspective or a success in taking a person-centred approach. An in-depth analysis revealed that a lack of empathy was greatly associated with an emotive-cognitive imbalance, which disengaged physicians with their patients’ emotions. This study hereby concludes that competent providers require a combination of knowledge, skills, and more importantly empathic attitudes to help create a context for effective care. The crucial elements of that context involve (a) identifying empathy clues within interactions to engage with patients’ situations, (b) attributing a perspective to the patient through perspective-taking and (c) adapting behaviour and communication according to patient’s individual needs. Empathy underpins that context, as does an appreciation of narrative, and the two are interrelated.

Keywords: empathy, narratives, person-centred, perspective, perspective-taking

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Authors: Laura Ramona Nae

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The issue of risks faced by companies providing tourist and hotel services in the HoReCa field, related to the goods belonging to consumer tourists left in hotel storage, has acquired a new dimension in the context of the economic and geo-political influences that have recently intervened at the global level. Thus, hoteliers and not only had to create contractual mechanisms regarding the risks and to protect the businesses in this field of activity. This situation has led to a reassessment of the importance of insurance, in particular with regard to hotel liability insurance-premises liability, safety, and security of goods. Interpretation of clauses in contracts concluded between hoteliers and tourists consuming hotel services and products, all the more so in the current pandemic context of Covid 19, stressed the increase in the number of disputes generated by them. This article presents a general picture of the significance of the risks related to the activity carried out in the hospitality industry, tourism, respectively within the HoReCa field. The study mainly marks the specificities of the hotel deposit contract, as well as the related insurance specific to the field, as a way to cover these risks. The article also refers to alternative methods of out-of-court settlement of disputes (ADR) in the HoReCa domain, generally used in both Romania and the European Union.

Keywords: consumer tourist, disputes and ADR methods, deposit contract, hotel warehouse and hotelier insurance, hotel services and tourist products, HoReCa

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Authors: Umaiza Bashir, Ushna Farukh

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The present study examined the perspective of school students regarding teacher’s behavioral pattern during a teaching in classroom and its influence on the students’ socialization particularly forming peer relationships with the development of emotional, behavioral problems in school children. To study these dimension of teacher-student classroom relationship, 210 school children (105 girls and 105 boys) within the age range of 14 to 18 years were taken from the government, private schools. The cross-sectional research design was used in which stratified random sampling was done. Teacher-student interaction scale was used to assess the teacher-student relationship in the classroom, which had two factors such as positive and negative interaction. Peer relationship scale was administered to investigate the socialization of students, and School Children Problem Scale was also given to the participants to explore their emotional, behavioral issues. The analysis of Pearson correlation showed that there is a significant positive relationship between negative teacher-student interaction and student’s emotional-behavioral as well as social problems. Another analysis of t-test revealed that boys perceived more positive interaction with teachers than girls (p < 0.01). Girls showed more emotional behavioral problems than boys (p < 0.001) Linear regression explained that age, gender, negative teacher’s interaction with students and victimization in social gathering predicts mental health problems in school children. This study suggests and highlights the need for the school counselors for the better mental health of students and teachers.

Keywords: teacher-student interaction, school psychology, student’s emotional behavioral problems

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Authors: Whitehead-Clarke T., Beynon V., Banks J., Karanjia R., Mudera V., Windsor A., Kureshi A.

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Introduction: Mesh implants are regularly used to help repair both hiatus hernias (HH) and diaphragmatic hernias (DH). In vivo studies are used to test not only mesh safety but increasingly comparative efficacy. Our work examines the field of in vivo mesh testing for HH and DH models to establish current practices and standards. Method: This systematic review was registered with PROSPERO. Medline and Embase databases were searched for relevant in vivo studies. 44 articles were identified and underwent abstract review, where 22 were excluded. 4 further studies were excluded after full text review – leaving 18 to undergo data extraction. Results: Of 18 studies identified, 9 used an in vivo HH model and 9 a DH model. 5 studies undertook mechanical testing on tissue samples – all uniaxial in nature. Testing strip widths ranged from 1-20mm (median 3mm). Testing speeds varied from 1.5-60mm/minute. Upon histology, the most commonly assessed structural and cellular factors were neovascularization and macrophages, respectively (n=9 each). Structural analysis was mostly qualitative, where cellular analysis was equally likely to be quantitative. 11 studies assessed adhesion formation, of which 8 used one of four scoring systems. 8 studies measured mesh shrinkage. Discussion: In vivo studies assessing mesh for HH and DH repair are uncommon. Within this relatively young field, we encourage surgical and materials testing institutions to discuss its standardisation.

Keywords: hiatus, diaphragmatic, hernia, mesh, materials testing, in vivo

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Authors: Dongseok Cho, Mitchell Driedger, Sera Han, Noman Khan, Mohammed Elmorsy, Mohamad El-Hajj

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Since the approval of the COVID-19 vaccine in late 2020, vaccination rates have varied around the globe. Access to a vaccine supply, mandated vaccination policy, and vaccine hesitancy contribute to these rates. This study used COVID-19 vaccination data from Our World in Data and the Multilateral Leaders Task Force on COVID-19 to create two COVID-19 vaccination indices. The first index is the Vaccine Utilization Index (VUI), which measures how effectively each country has utilized its vaccine supply to doubly vaccinate its population. The second index is the Vaccination Acceleration Index (VAI), which evaluates how efficiently each country vaccinated its population within its first 150 days. Pearson correlations were created between these indices and country indicators obtained from the World Bank. The results of these correlations identify countries with stronger health indicators, such as lower mortality rates, lower age dependency ratios, and higher rates of immunization to other diseases, displaying higher VUI and VAI scores than countries with lesser values. VAI scores are also positively correlated to Governance and Economic indicators, such as regulatory quality, control of corruption, and GDP per capita. As represented by the VUI, proper utilization of the COVID-19 vaccine supply by country is observed in countries that display excellence in health practices. A country’s motivation to accelerate its vaccination rates within the first 150 days of vaccinating, as represented by the VAI, was largely a product of the governing body’s effectiveness and economic status, as well as overall excellence in health practises.

Keywords: data mining, Pearson correlation, COVID-19, vaccination rates and hesitancy

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Authors: Dongju Kim, Youngjoo Suh, Hyojin Kim, Gyeongyeong Kim

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Acoustic Emission Testing (AET) is widely used to test the structural integrity of an operational hydrogen storage container, and clustering algorithms are frequently used in pattern recognition methods to interpret AET results. However, the interpretation of AET results can vary from user to user as the tuning of the relevant parameters relies on the user's experience and knowledge of AET. Therefore, it is necessary to use a deep learning model to identify patterns in acoustic emission (AE) signal data that can be used to classify defects instead. In this paper, a deep learning-based model for classifying the types of defects in hydrogen storage tanks, using AE sensor waveforms, is proposed. As hydrogen storage tanks are commonly constructed using carbon fiber reinforced polymer composite (CFRP), a defect classification dataset is collected through a tensile test on a specimen of CFRP with an AE sensor attached. The performance of the classification model, using one-dimensional convolutional neural network (1-D CNN) and synthetic minority oversampling technique (SMOTE) data augmentation, achieved 91.09% accuracy for each defect. It is expected that the deep learning classification model in this paper, used with AET, will help in evaluating the operational safety of hydrogen storage containers.

Keywords: acoustic emission testing, carbon fiber reinforced polymer composite, one-dimensional convolutional neural network, smote data augmentation

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Authors: Tamara Roma, Emma Capulli

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Pregnancy and fertility, in other words, reproduction, has become, in the last half of the century, increasingly and globally controlled, medicalized, and regulated. The reflection proposed starts from the consequences of the inscription of reproduction into the neoliberal economic paradigm. The new biotechnologies developments have raised a new patriarchal justification for State’s control of uterus bodies and a new construction of knowledge about reproductive health. Moral discussion and juridification remove reproduction and non-reproduction from their personal and intimate context and frame them under words like “duties”, “rights”, “family planning”, “demography”, and “population policy”, reinvent them as “States business” and ultimately help to re/confirm a specific construct of fertility, motherhood, and family. Moreover, the interaction between the neoliberal economy and medical biotechnologies brought about a new formulation of the connection between feminine generative potential and value production. The widespread and contemporary debates on Medically Assisted Reproduction (MAR), surrogacy and abortion suggest the need for a “feminist/queer global bioethical discourse” capable of inserting itself into the official bioethical debate characterized by the traditional dichotomy of laic bioethics/Catholic bioethics. The contribution moves from a feminist bioethics perspective on reproductive technologies to introduce a feminist/queer global bioethics point of view on reproductive health. The comparison between reproduction and non-reproduction debates is useful to analyze and demonstrate how restrictive legislations, dichotomic bioethical discussion and medical control confirm and strengthens gender injustice in reproductive life. In fact, MAR, surrogacy, and abortion restrictions stem from a shared social and legal paradigm that depends on traditional gender roles revealing how the stratification of reproduction is based on multiple discrimination along the lines of gender, race, and class. In conclusion, the perspective of feminist/queer global bioethics tries to read the concept of universal reproductive justice, introducing an original point of view on reproductive health access.

Keywords: queer bioethics, reproductive health, reproductive justice, reproductive technologies

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Authors: Susan Evans, Janna Gordon-Elliott, Katarzyna Wyka, Virginia Mutch

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During the rise of the COVID-19 pandemic, healthcare workers needed an intervention that could address their profound acute stress. Mindfulness-based stress reduction (MBSR) is a program that has long established effectiveness for mental and physical health outcomes. In recent years, MBSR has been modified such that the duration of both class time and number of sessions has been abbreviated, and its delivery has been adapted for online dissemination, thus increasing the likelihood that individuals who could most benefit from the program would do so. We sought to investigate whether a brief, online version of MBSR could be feasible and acceptable for health care workers (HCW) in acute stress in response to the COVID-19 pandemic. Participants were recruited via an email sent to all hospital employees, which spans residents, physicians, nurses, housekeeping, lab technicians, administrators, and others. Participating HCW were asked about their previous experience with mindfulness and asked to commit to a minimum of 3 sessions. They were then provided with four weekly 1-hour sessions online that included the major mindfulness exercises taught during traditional MBSR programs (i.e., body scan, sitting meditation, mindful eating, and yoga). Participants were provided with supporting slides, videos, demonstrations and asked to track their practice. Hospital staff enrolled in the program; by the end of the first day of recruitment, 40 had applied; by the start date, about 100 were enrolled, and n attended a minimum of 3 sessions, supporting feasibility. Hospital staff also participated and practiced the mindfulness exercises (n=42), thus supporting acceptability. Participants reported that the program was logical, successful, and worth recommending both before starting the program and after completing it (M= 22.02 and M=21.76, respectively, possible range 0-27). There was a slight decline in the belief in improvement in health and well-being due to the program (ES=.37, p=.021). Secondary hypotheses regarding participants’ self-reported stress and levels of mindfulness were also supported, such that participants reported improvements in perceived stress (ES=.45, p=.006), compassion satisfaction, burnout, and secondary traumatic stress (ES=.41, ES=.31, ES=.35, respectively, p<.05). Participants reported significant improvements in the describing facet of mindfulness (ES=.49, p=.004), while all other facets (observing, acting with awareness, nonjudging of inner experience, nonreactivity to inner experience) remained unchanged pre- to post-program. Results from this study suggest that an abridged, online version of MBSR is feasible and accessible to health care workers in acute stress and provides benefits expected from traditional MBSR programs. The lack of a randomized control group limits generalizability. We intend to provide a structure, framework, and lessons learned to hospital administrators and clinical staff seeking to support their employees in acute stress.

Keywords: acute stress, health care workers, mindfulness, online interventions

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Authors: Ruwen Pei

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In the rapidly evolving landscape of the digital economy, platform employment has emerged as a transformative labor force, fundamentally altering the traditional paradigms of the employer-employee relationship. This paper provides a comprehensive analysis of the unique dynamics and intricate legal challenges associated with platform work, where workers often navigate precarious labor conditions without the robust safety nets typically afforded in traditional industries. It underscores the limitations of current labor regulations, particularly in addressing pressing concerns such as income volatility and disparate benefits. By drawing insights from diverse global case studies, this study emphasizes the compelling need for platform companies to shoulder their social welfare responsibilities, ensuring fair treatment and security for their workers. Moreover, it critically examines the profound influence of socio-cultural factors and educational awareness on the platform economy, shedding light on the complexities of this emerging labor landscape. Advocating for a harmonious equilibrium between flexibility and security, this paper calls for substantial legal reforms and innovative policy initiatives that can adapt to the evolving nature of work in the digital age. Finally, it anticipates forthcoming trends in the digital economy and platform labor relations, underscoring the significance of proactive adaptation to foster equitable and inclusive employment practices.

Keywords: platform employment, labor protections, social welfare, legal reforms, digital economy

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Authors: T. Keiller, E. Hindman, P. Hassmen, K. Radford, L. Lavrencic

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Background: Psychosocial disadvantage is associated with impaired cognitive abilities, with executive functioning (EF) abilities particularly vulnerable. EF abilities strongly predict general daily functioning, educational and career prospects, and health choices. A reliable and valid assessment of EF is important to support appropriate care and intervention strategies. However, evidence-based EF assessment tools for use with Aboriginal Australians are limited. Aim and Method: This research aims to develop and validate a culturally appropriate EF tool for use with indigenous Australians. To this end, Study One aims to review current literature examining the benefits and disadvantages of current EF assessment tools for use with Indigenous Australians. Study Two aims to collate expert opinion on the strengths and weaknesses of various current EF assessment tools for use with Indigenous Australians using Delphi methodology with experienced psychologists (n = 10). The initial two studies will inform the development of a culturally appropriate assessment tool. Study Three aims to evaluate the psychometric properties of the tool with an Indigenous sample living in the New South Wales Mid-North Coast. The study aims to quantify the predictive validity of this tool via comparison to functionality predictors and neuropsychological assessment scores. Study Four aims to collect qualitative data surrounding the feasibility and acceptability of the tool among indigenous Australians and health professionals. Expected Results: Findings from this research are likely to inform cognitive assessment practices and tool selection for health professionals conducting cognitive assessments with Indigenous Australians. Improved assessment of EF will inform appropriate care and intervention strategies for individuals with EF deficits.

Keywords: aboriginal Australians, assessment tool, cognition, executive functioning

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Authors: Maren J. Coffman, Victoria C. Scott, J. Claire Schuch, Ashley N. Kelley, Jeri L. Ryan

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Postpartum Depression (PPD) is a leading cause of postpartum morbidity. PPD affects 7.1% of postpartum women and 19.2% of postpartum women when including minor depression. Lower-income women and ethnic minorities are more at risk for developing PPD and face multiple attitudinal and institutional barriers to receiving care. This study aims to identify PPD among low-income women and connect them to appropriate services in order to reduce the illness burden and enhance access to care. Screenings were conducted in two Women, Infants, and Children (WIC) clinics in the city of Charlotte, North Carolina, USA, from April 2017 to April 2018. WIC is a supplemental nutrition program that provides healthcare and nutrition to low-income pregnant women, breastfeeding women, and children under the age of 5. Additionally, a qualitative study was conducted to better understand the PPD continuum of care in order to identify opportunities for improvement. Mothers with infants were screened for depression risk using the PHQ-2. Mothers who scored ≥ 2 completed two additional standardized screening tools (PHQ-7, to complete the PHQ-9, and the Edinburgh) to assess depressive symptomatology. If indicated they may be suffering from depression, women were referred for case management services. Open-ended questions were used to understand treatment barriers. Four weeks after the initial survey, a follow-up telephone call was made to see if women had received care. Seven focus groups with WIC staff and managers, referral agency staff, local behavioral health professionals, and students examining the screenings, are being conducted March - April, 2018 to gather information related to current screening practices, referrals, follow up and treatment. Mothers (n = 231 as of February, 2018) were screened in English (65%) or Spanish (35%). According to preliminary results, 29% of mothers screened were at risk for postpartum depression (PHQ-2 ≥ 2). There were significant differences in preliminary screening results based on survey language (

Keywords: health disparities, maternal health, mental health, postpartum depression

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Authors: Hamitri-Guerfi Fatiha, Mekimene Lekhder, Madani Khodir, Youyou Ahcene

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Virgin olive oil is appreciated by consumers, the quality of the oil is regulated by the international olive oil council depends on its chemical composition, so, the correct packing conditions are a prerequisite to preserve oil color, flavor, and nutriments, from production to consumption. The contact of food with various materials of packaging, since the production, until their consumption constitutes one of the essential aspects of food safety (directive 76/833/CEE). In Algeria, plastic bottles, although, they are economic and light are largely used at packaging olive oil but not used in other countries. This is due to migration phenomena that can occur from these materials. Thus, the goal of this work is to examine the physicochemical behavior of the couple packaging plastic-oil during their exposure to three temperatures corresponding to the conditions of storage applied in Algeria. Like, it is difficult to compare blowers of bottles which are heavy engineering, it comes out from this study that the effect of heat, the absorption of water, the constraints of storage of acidity, as well as the composition of oil, the PET bottles showed a remarkable structural instability, this defect of quality was confirmed by the analysis of morphology by electronic scan microscopy. These bottles present a total migration significantly higher than the threshold of acceptance. Moreover, a metal contamination of oil by its packaging was confirmed by the spectroscopy of atomic absorption and a microanalysis. The differences observed between the results of the microanalysis applied and the mechanical characterizations of the various bottles are reported, showing the reality of the container-contents exchanges.

Keywords: interaction, stability, pet, virgin olive oil

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Authors: Prakash Singh

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Schools throughout the world are facing increasing challenges in dealing with school violence and drug abuse by pupils. Therefore, the question of the fear of failure to meet the aims and objectives of education inevitably surfaces as it places increasing and challenging demands on educators and all other stakeholders to address this malaise. Multiple studies on the construct tobephobia (TBP) simply define TBP as the fear of failure in education. This study is a continuation of the exploratory studies on the manifestation of fear in education. The primary purpose of this study was to establish how TBP, caused by school violence and drug abuse affects teaching and learning in our schools. The qualitative research method was used for this study. Teachers admitted that they fear for their safety at school. Working in a fearful situation places a high rate of stress and anxiety on them. Tobephobic educators spend most of their time worrying about their fear of violence and drug abuse by pupils and are too frightened to carry out their normal duties. They prefer to stay in familiar surroundings for fear of being attacked by inebriated learners. This study, therefore, contributes to our understanding of the effects of TBP in our schools caused by school violence and drug abuse. Also, this study supplements the evidence accumulated over the past fifteen years that TBP is not a figment of someone’s imagination; it is a gruesome reality affecting the very foundation of our educational system globally to provide quality and equal education to all our learners in a harmonious, collegial school environment.

Keywords: tobephobia, tobephobic educators, fear of failure in education, school violence, drug abuse

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Authors: Piyush Hajela

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Public spaces within Indian markets are vibrant, colorful and contain dimensions that make them attractive and therefore act as popular gathering spaces. Most of these public spaces emerge as squares, plazas of varied shapes and sizes spread at different locations within the market. These public spaces grow organically and are discovered by the people themselves as they respond positively to the collective human senses. On the other hand, there are the planned and designed public spaces as well that are less active. This research evaluates both the planned and the organically transformed public spaces in Indian markets from an Urban Design point of view. The purpose of such research is to provide a basis for design solutions to ensure the success of designed public spaces. The evaluation is done for identified Attributes, namely Comfort, Protection, Familiarity, Activities, Form, Legibility, Engagement, Safety, Accessibility, Environment and Transformations by which a Public Space attains its recognition. The evaluation is based on a rating done for forty-four parameters falling under eleven attributes of public space. An opinion survey of professionals is conducted for their priorities of attributes while designing Public spaces. A comparison is made to rank these attributes between Planned and Organically transformed Public spaces and, opinion of the professionals. After dues analysis, the research suggests the learning from the organically transformed Public spaces for ensuring the success of designed public spaces. The suggestions may be in the form of Design decisions or administrative regulations, or both for achieving the desirables.

Keywords: assessment, attributes, engagement, interaction

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Authors: Innocent Atuhe, Babra Nalwadda, Grace Mulyowa, Annabella Habinka Ejiri

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Background: Atopic Dermatitis (AD) is one of the most prevalent and growing chronic inflammatory skin diseases in African prisons. AD care is limited in African due to a lack of information about the disease amongst primary care workers, limited access to dermatologists, lack of proper training of healthcare workers, and shortage of appropriate treatments. We designed and implemented the Prisons Telederma project based on the recommendations of the International Society of Atopic Dermatitis. We aimed at; i) increase awareness and understanding of teledermatology among prison health workers and ii) improve treatment outcomes of prisoners with atopic dermatitis through increased access to and utilization of consultant dermatologists through teledermatology in Uganda prisons. Approach: We used Store-and-forward Teledermatology (SAF-TD) to increase access to dermatologist-led care for prisoners and prison staff with AD. We conducted five days of training for prison health workers using an adapted WHO training guide on recognizing neglected tropical diseases through changes on the skin together with an adapted American Academy of Dermatology (AAD) Childhood AD Basic Dermatology Curriculum designed to help trainees develop a clinical approach to the evaluation and initial management of patients with AD. This training was followed by blended e-learning, webinars facilitated by consultant Dermatologists with local knowledge of medication and local practices, apps adjusted for pigmented skin, WhatsApp group discussions, and sharing pigmented skin AD pictures and treatment via zoom meetings. We hired a team of Ugandan Senior Consultant dermatologists to draft an iconographic atlas of the main dermatoses in pigmented African skin and shared this atlas with prison health staff for use as a job aid. We had planned to use MySkinSelfie mobile phone application to take and share skin pictures of prisoners with AD with Consultant Dermatologists, who would review the pictures and prescribe appropriate treatment. Unfortunately, the National Health Service withdrew the app from the market due to technical issues. We monitored and evaluated treatment outcomes using the Patient-Oriented Eczema Measure (POEM) tool. We held four advocacy meetings to persuade relevant stakeholders to increase supplies and availability of first-line AD treatments such as emollients in prison health facilities. Results: We have the very first iconographic atlas of the main dermatoses in pigmented African skin. We increased; i) the proportion of prison health staff with adequate knowledge of AD and teledermatology from 20% to 80%; ii) the proportion of prisoners with AD reporting improvement in disease severity (POEM scores) from 25% to 35% in one year; iii) increased proportion of prisoners with AD seen by consultant dermatologist through teledermatology from 0% to 20% in one year and iv)Increased the availability of AD recommended treatments in prisons health facilities from 5% to 10% in one year. Our study contributes to the use, evaluation, and verification of the use of teledermatology to increase access to specialist dermatology services to the most hard to reach areas and vulnerable populations such as that of prisoners.

Keywords: teledermatology, prisoners, reaching, un-reachable

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Authors: Mbuzeni Mathenjwa

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Upon their independence, most African countries adopted constitutions that proclaim respect for the rule of law. The decision to constitutionalise the rule of law is basically informed by the countries’ experience during the colonial era which was characterised by discrimination on various grounds including race, gender and religion. Despite the promise to be bound by and adhere to the rule of law, disrespect for the rule of law has become a norm in the African continent. This is evident from the reported incidence of abuse of power, failure to perform obligations imposed by law and flagrant disregard of the law by the Executive including the heads of states in the continent. In some African countries including South Africa, the courts of law have been approached to rule on the legality of the decisions of the executives, taken contrary to the prescripts of the law. South African Courts have laid down a number of decisions wherein they found that the conduct of the executive contravenes the rule of law. Consequently decisions of the executive have been declared invalid by courts. In this regard courts have become a safety net in preserving the rule of law in. Accordingly, this paper discusses the role of the courts in preserving the rule of law in Africa. This it does by explaining the notion of judicial independence and the doctrine of the rule of law. The explanation on the notion of judicial independence is relevant because only an independent judiciary can effectively review and set aside the decision of the executive including the president of a country. Furthermore, a comparative overview of the enforcement of the rule of law in African countries is done. The methods used for this research is literature review, and study of legislation and case law in selected African countries relating to the independence of the judiciary and the rule of law. Finally, a conclusion is drawn on the role of the independent judiciary to preserve the rule of law in Africa.

Keywords: Africa, constitutions, independence, judiciary

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Authors: Zeynep Tanrıverdi, Ş. Barihüda Tanrıkorur

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Mevlevihanes are the dervish lodges of the Mevlevi Sufi Order of dervishes, which was founded on the teachings of Mevlâna Jalaluddin Rumi (1207-1273) in the late 13th century in the Anatolian city of Konya, from which they were administered until 1925, when their activities together with all other sufi dervish orders, were legally prohibited after the founding of the Turkish Republic. On their closure in 1925 over 150 mevlevihane architectural complexes, which had functioned for over 600 years through the late Seljuk, Emirates, and Ottoman periods of Turkish history, were to be found in the geographic areas that had been once occupied by the Ottoman Empire. Unfortunately, because of the history of their prohibition and closure after 1925, the public developed confused negative reactions towards sufi dervish orders and their buildings occupied a nebulous political status so that their upkeep and restoration became neglected, they were used for different, inappropriate functions or were abandoned within the Turkish Republic, until a more socially objective, educated viewpoint developed in the late 1970’s and 80’s. The declaration of the Mevlevi Ayin-i Şerifi (the Ritual Whirling Ceremony of the Mevlevi Dervish Order) with its complex composed music and sema (whirling movements) performance, as a Masterpiece of the Intangible Heritage of Humanity in 2005 by UNESCO and 2007 as the International Year of Mevlâna, started an increase in studies about mevlevihanes and a wave of restorations, especially of their semahanes (the large assembly whirling halls where the Mevlevi Ritual Whirling Ceremony was performed). However, due to inadequacies in legal procedures, socio-cultural changes, economic incapacity, negative environmental factors, and faulty repair practices, the studies and applications for the protection of mevlevihanes have not reached the desired level. Within this historical perspective, this study aims to reveal the particular architectural conservation and restoration problems of mevlevihanes and propose solutions for them. Firstly, the categorization and components of mevlevihane architecture was evaluated through its historical process. Secondly, their basic architectural characteristics were explained. Thirdly, by examining recently restored examples like Manisa, Edirne, Bursa, Tokat, Gelibolu, and Çankırı Mevlevihanes, using archival documents, old maps, drawings, photos and reports, building survey method, mevlevihane architectural conservation and restoration application problems were analyzed. Finally, solution suggestions were proposed for the problems that threaten the proper restoration of mevlevihanes. It is hoped that this study will contribute to the preservation of Mevlevihanes which have played an important role in the architectural, cultural heritage of Turkey, and that their authentic values will be properly transmitted to future generations.

Keywords: conservation, cultural heritage, mevlevihane architecture, reastoration

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Authors: Uraib Sharaha, Guy Beck, Joseph Kapelushnik, Adam H. Agbaria, Itshak Lapidot, Shaul Mordechai, Ahmad Salman, Mahmoud Huleihel

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Infectious diseases cause a significant burden on the public health and the economic stability of societies all over the world for several centuries. A reliable detection of the causative agent of infection is not possible based on clinical features, since some of these infections have similar symptoms, including fever, sneezing, inflammation, vomiting, diarrhea, and fatigue. Moreover, physicians usually encounter difficulties in distinguishing between viral and bacterial infections based on symptoms. Therefore, there is an ongoing need for sensitive, specific, and rapid methods for identification of the etiology of the infection. This intricate issue perplex doctors and researchers since it has serious repercussions. In this study, we evaluated the potential of the mid-infrared spectroscopic method for rapid and reliable identification of bacterial and viral infections based on simple peripheral blood samples. Fourier transform infrared (FTIR) spectroscopy is considered a successful diagnostic method in the biological and medical fields. Many studies confirmed the great potential of the combination of FTIR spectroscopy and machine learning as a powerful diagnostic tool in medicine since it is a very sensitive method, which can detect and monitor the molecular and biochemical changes in biological samples. We believed that this method would play a major role in improving the health situation, raising the level of health in the community, and reducing the economic burdens in the health sector resulting from the indiscriminate use of antibiotics. We collected peripheral blood samples from young 364 patients, of which 93 were controls, 126 had bacterial infections, and 145 had viral infections, with ages lower than18 years old, limited to those who were diagnosed with fever-producing illness. Our preliminary results showed that it is possible to determine the infectious agent with high success rates of 82% for sensitivity and 80% for specificity, based on the WBC data.

Keywords: infectious diseases, (FTIR) spectroscopy, viral infections, bacterial infections.

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Authors: Niyada Naksuk, Thoetchai Peeraphatdit, Vitaly Herasevich, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham

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Introduction: Little is known about the safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. Methods: Pre-study Confusion Assessment Method-Intensive Care Unit (CAM–ICU) criteria were implemented in screening consecutive patients admitted to Mayo Clinic, Rochester, the USA from 2004 through 2013. Death status was prospectively ascertained. Results: Of 11,079 study patients, the incidence of delirium was 8.3% (n=925). Delirium was associated with an increased risk of in-hospital mortality (adjusted OR 1.49; 95% CI, 1.08-2.08; P=.02) and one-year mortality among patients who survived from CCU admission (adjusted HR 1.46; 95% CI, 1.12-1.87; P=.005). A total of 792 doses of haloperidol (5 IQR [3-10] mg/day) or quetiapine (25 IQR [13-50] mg/day) were given to 244 patients with delirium. The clinical characteristics of patients with delirium who did and did not receive antipsychotic therapy were not different (baseline corrected QT [QTc] interval 460±61 ms vs. 457±58 ms, respectively; P = 0.57). In comparison to baseline, mean QTc intervals after the first and third doses of the antipsychotics were not significantly prolonged in haloperidol (448±56, 458±57, and 450±50 ms, respectively) or quetiapine groups (459±54, 467±68, and 462±46 ms, respectively) (P > 0.05 for all). Additionally, in-hospital mortality (adjusted OR 0.67; 95% CI, 0.42-1.04; P=.07), ventricular arrhythmia (adjusted OR 0.87; 95% CI, 0.17-3.62; P=.85) and one-year mortality among the hospital survivors (adjusted HR 0.86; 95% CI 0.62-1.17; P = 0.34) were not different in patients with delirium irrespective of whether or not they received antipsychotics. Conclusions: In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.

Keywords: arrhythmias, haloperidol, mortality, qtc interval, quetiapine

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Authors: Despina Giannadaki, Jos Lelieveld, Andrea Pozzer, John Evans

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Outdoor air pollution by fine particles ranks among the top ten global health risk factors that can lead to premature mortality. Epidemiological cohort studies, mainly conducted in United States and Europe, have shown that the long-term exposure to PM2.5 (particles with an aerodynamic diameter less than 2.5μm) is associated with increased mortality from cardiovascular, respiratory diseases and lung cancer. Fine particulates can cause health impacts even at very low concentrations. Previously, no concentration level has been defined below which health damage can be fully prevented. The World Health Organization ambient air quality guidelines suggest an annual mean PM2.5 concentration limit of 10μg/m3. Populations in large parts of the world, especially in East and Southeast Asia, and in the Middle East, are exposed to high levels of fine particulate pollution that by far exceeds the World Health Organization guidelines. The aim of this work is to evaluate the implementation of recent air quality standards for PM2.5 in the EU, the US and other countries worldwide and estimate what measures will be needed to substantially reduce premature mortality. We investigated premature mortality attributed to fine particulate matter (PM2.5) under adults ≥ 30yrs and children < 5yrs, applying a high-resolution global atmospheric chemistry model combined with epidemiological concentration-response functions. The latter are based on the methodology of the Global Burden of Disease for 2010, assuming a ‘safe’ annual mean PM2.5 threshold of 7.3μg/m3. We estimate the global premature mortality by PM2.5 at 3.15 million/year in 2010. China is the leading country with about 1.33 million, followed by India with 575 thousand and Pakistan with 105 thousand. For the European Union (EU) we estimate 173 thousand and the United States (US) 52 thousand in 2010. Based on sensitivity calculations we tested the gains from PM2.5 control by applying the air quality guidelines (AQG) and standards of the World Health Organization (WHO), the EU, the US and other countries. To estimate potential reductions in mortality rates we take into consideration the deaths that cannot be avoided after the implementation of PM2.5 upper limits, due to the contribution of natural sources to total PM2.5 and therefore to mortality (mainly airborne desert dust). The annual mean EU limit of 25μg/m3 would reduce global premature mortality by 18%, while within the EU the effect is negligible, indicating that the standard is largely met and that stricter limits are needed. The new US standard of 12μg/m3 would reduce premature mortality by 46% worldwide, 4% in the US and 20% in the EU. Implementing the AQG by the WHO of 10μg/m3 would reduce global premature mortality by 54%, 76% in China and 59% in India. In the EU and US, the mortality would be reduced by 36% and 14%, respectively. Hence, following the WHO guideline will prevent 1.7 million premature deaths per year. Sensitivity calculations indicate that even small changes at the lower PM2.5 standards can have major impacts on global mortality rates.

Keywords: air quality guidelines, outdoor air pollution, particulate matter, premature mortality

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Authors: Mohammad Parvaresh, Mahdi Babaee, Bahareh Arghand, Davood Nourmohammadi

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Environmental degradation is caused by social inequalities and the inappropriate use of nature and a factor in the violation of human rights. Indeed, the right to a safe, healthy and ecologically-balanced environment is an independent human right. Therefore, the relationship between human rights and environmental protection is crucial for the study of social justice and sustainable development, and environmental problems are a result of the failure to realize social and economic justice. In this regard, 'article 50 of the constitution of the Islamic Republic of Iran as a general principle have many of the concepts of sustainable development, including: the growth and improvement of human life, the rights of present and future generations, and the integrity of the inner and outer generation, the prohibition of any environmental degradation'. Also, Charter on Citizen’s Rights, which was conveyed by the President of the Islamic Republic of Iran, Mr. Rouhani refers to the right to a healthy environment and sustainable development. In this regard in 2013, Tehran Province Water and Wastewater Co. defined a plan called 'Tehran’s Health Line' was includes Western and Eastern part by about 26 kilometers of water transferring pipelines varied 1000 to 2000 mm diameters. This project aims to: (1) Transfer water from the northwest water treatment plant to the southwest areas, which suffer from qualitative and quantitative water, in order to mix with the improper wells’ water; (2) Reducing the water consumption provided by harvesting from wells which results in improving the underground water resources, causing the large settlements and stopping the immigrating slums into the center or north side of the city. All of the financial resources accounted for 53,000,000 US$ which is mobilized by Tehran Province Water and Wastewater Co. to expedite the work. The present study examines the Tehran Health Line plan and the purpose of implementation of this plan to achieve environmental protection, environmental justice and citizenship rights for all people who live in Tehran.

Keywords: environmental justice, international environmental law, erga omnes, charter on citizen's rights, Tehran health line

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Authors: Imad M. Assali

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Recently, the world main problem is a global warming and climate change affecting both outdoor and indoor environments, especially the air quality (AQ) as a result of vast migration of people from rural areas to urban areas. Therefore, cities became more crowded and denser from an irregular population increase, along with increasing urbanization caused many problems for the environment such as increasing the land prices, changes in life style, and the new buildings are not adapted to the climate producing uncomfortable and unhealthy indoor building conditions. As interior environments are the places that create the most intimate relationship with the user. Consequently, the indoor environment quality (IEQ) for buildings became uncomfortable and unhealthy for its occupants. The symptoms commonly associated with poor indoor environment such as itchy, headache, fatigue, and respiratory complaints such as cough and congestion, etc. The symptoms tend to improve over time or even disappear when people are away from the building. Therefore, designing a healthy indoor environment to fulfill human needs is the main concern for architects and interior designer. However, this research explores how occupant expectations and environmental attitudes may influence occupant health and satisfaction within the context of the indoor environment. In doing so, it reviews and contributes to the methods and tools used to evaluate only the indoor environment quality (IEQ) components of building performance. Its main aim is to review the literature on indoor human comfort. This is followed by a review of previous papers published related to human comfort. Finally, this paper will provide possible approaches in design level of healthy buildings.

Keywords: sustainable building, indoor environment quality (IEQ), occupant's health, active system, sick building syndrome (SBS)

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Authors: Peter Smolianov, Jed Smith, Lisa Chen, Steven Dion, Christopher Schoen, Jaclyn Norberg

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This study evaluated the effectiveness of an experimental training program used to improve performance and health of competitive athletes and recreational sport participants. This holistic program integrated and advanced Eastern and Western methods of prolonging elite sports participation and enjoying lifelong fitness, particularly from China, India, Russia, and the United States. The program included outdoor, gym, and water training approaches focused on strengthening while stretching/decompressing and on full body activation-all in order to improve performance as well as treat and prevent common disorders and pains. The study observed and surveyed over 100 users of the program including recreational fitness and sports enthusiasts as well as elite athletes who competed for national teams of different countries and for Division I teams of National Collegiate Athletic Association in the United States. Different types of sport were studied, including territorial games (e.g., American football, basketball, volleyball), endurance/cyclical (athletics/track and field, swimming), and artistic (e.g., gymnastics and synchronized swimming). Results of the study showed positive effects on the participants’ performance and health, particularly for those who used the program for more than two years and especially in reducing spinal disorders and in enabling to perform new training tasks which previously caused back pain.

Keywords: lifelong fitness, injury prevention, prolonging sport participation, improving performance and health

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Authors: Yuri Teterin, Lomali Generdukaev, Dmitry Blagovestnov, Peter Yartcev

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Introduction: Under the definition "large biliary stones," we referred to stones over 1.5 cm, in which standard transpapillary litho extraction techniques were unsuccessful. Electrohydraulic and laser contact lithotripsy under SpyGlass control have been actively applied for the last decade in order to improve endoscopic treatment results. Aims and Methods: Between January 2019 and July 2022, the N.V. Sklifosovsky Research Institute of Emergency Care treated 706 patients diagnosed with choledocholithiasis who underwent biliary stones removed from the common bile duct. Of them, in 57 (8, 1%) patients, the use of a Dormia basket or Biliary stone extraction balloon was technically unsuccessful due to the size of the stones (more than 15 mm in diameter), which required their destruction. Mechanical lithotripsy was used in 35 patients, and electrohydraulic and laser lithotripsy under SpyGlass direct visualization system - in 26 patients. Results: The efficiency of mechanical lithotripsy was 72%. Complications in this group were observed in 2 patients. In both cases, on day one after lithotripsy, acute pancreatitis developed, which resolved on day three with conservative therapy (Clavin-Dindo type 2). The efficiency of contact lithotripsy was in 100% of patients. Complications were not observed in this group. Bilirubin level in this group normalized on the 3rd-4th day. Conclusion: Our study showed the efficacy and safety of electrohydraulic and laser lithotripsy under SpyGlass control in a well-defined group of patients with large bile duct stones.

Keywords: contact lithotripsy, choledocholithiasis, SpyGlass, cholangioscopy, laser, electrohydraulic system, ERCP

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