Search results for: pediatric physical therapy
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 7950

Search results for: pediatric physical therapy

2640 Characterization of Biosurfactants Produced by Bacteria Degrading Gasoline

Authors: Ikram Kamal, Mohamed Blaghen

Abstract:

Biosurfactants are amphiphilic biological compounds consisting of hydrophobic and hydrophilic domains produced extracellularly or as part of the cell membrane by a variety of yeast, bacteria and filamentous fungi. Biosurfactant applications in the environmental industries are promising due to their biodegradability, low toxicity, and effectiveness in enhancing biodegradation and solubilization of low solubility compounds. Currently, the main application is for enhancement of oil recovery and hydrocarbon bioremediation due to their biodegradability and low critical micelle concentration (CMC). The use of biosurfactants has also been proposed for various industrial applications, such as in food additives, cosmetics, detergent formulations and in combinations with enzymes for wastewater treatment. In this study, we have investigated the potential of bacterial strains: Mannheimia haemolytica, Burkholderia cepacia and Serratia ficaria were collected aseptically from the lagoon Marchika (water and soil) in Nador, Morocco; for the production of biosurfactants. This study also aimed to optimize the biosurfactant production process by changing the variables that influence the type and amount of biosurfactant produced by these microorganisms such as: carbon sources and also other physical and chemical parameters such as temperature and pH. Emulsification index, methylene blue test, and thin layer chromatography (TLC) revealed the ability of strains used in this study to produce compounds that could emulsify gasoline. In addition, a GC/MS was used to separate and identify different biosurfactants purified.

Keywords: biosurfactants, Mannheimia haemolytica, biodegradability, Burkholderia cepacia, Serratia ficaria

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2639 Investigation of Physical Properties of W-Doped CeO₂ and Mo-Doped CeO₂: A Density Functional Theory Study

Authors: Aicha Bouhlala, Sabah Chettibi

Abstract:

A systematic investigation on structural, electronic, and magnetic properties of Ce₀.₇₅A₀.₂₅O₂ (A = W, Mo) is performed using first-principles calculations within the framework Full-Potential Linear Augmented Plane Wave (FP-LAPW) method based on the Density Functional Theory (DFT). The exchange-correlation potential has been treated using the generalized gradient approximation (WC-GGA) developed by Wu-Cohen. The host compound CeO2 was doped with transition metal atoms W and Mo in the doping concentration of 25% to replace the Ce atom. In structural properties, the equilibrium lattice constant is observed for the W-doped CeO₂ compound which exists within the value of 5.314 A° and the value of 5.317 A° for Mo-doped CeO2. The present results show that Ce₀.₇₅A₀.₂₅O₂ (A=W, Mo) systems exhibit semiconducting behavior in both spin channels. Although undoped CeO₂ is a non-magnetic semiconductor. The band structure of these doped compounds was plotted and they exhibit direct band gap at the Fermi level (EF) in the majority and minority spin channels. In the magnetic properties, the doped atoms W and Mo play a vital role in increasing the magnetic moments of the supercell and the values of the total magnetic moment are found to be 1.998 μB for Ce₀.₇₅W₀.₂₅O₂ and to be 2.002 μB for Ce₀.₇₅Mo₀.₂₅O₂ compounds. Calculated results indicate that the magneto-electronic properties of the Ce₁₋ₓAₓO₂(A= W, Mo) oxides supply a new way to the experimentalist for the potential applications in spintronics devices.

Keywords: FP-LAPW, DFT, CeO₂, properties

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2638 Co-Composting of Poultry Manure with Different Organic Amendments

Authors: M. E. Silva, I. Brás

Abstract:

To study the influence of different organic amendments on the quality of poultry manure compost, three pilot composting trials were carried out with different mixes: poultry manure/carcasse meal/ashes/grape pomace (Pile 1), poultry manure/ cellulosic sludge (Pile 2) and poultry manure (Pile 3). For all piles, wood chips were applied as bulking agent. The process was monitored, over time, by evaluating standard physical and chemical parameters, such as, pH, electric conductivity, moisture, organic matter and ash content, total carbon and total nitrogen content, carbon/nitrogen ratio (C/N) and content in mineral elements. Piles 1 and 2 reached a thermophilic phase, however having different trends. Pile 1 reached this phase earlier than Pile 2. For both, the pH showed a slight alkaline character and the electric conductivity was lower than 2 mS/cm. Also, the initial C/N value was 22 and reached values lower than 15 at the end of composting process. The total N content of the Pile 1 increased slightly during composting, in contrast with the others piles. At the end of composting process, the phosphorus content ranged between 54 and 236 mg/kg dry matter, for Pile 2 and 3, respectively. Generally, the Piles 1 and 3 exhibited similar heavy metals content. This study showed that organic amendments can be used as carbon source, given that the final composts presented parameters within the range of those recommended in the 2nd Draft of EU regulation proposal (DG Env.A.2 2001) for compost quality.

Keywords: co-composting, compost quality, organic ammendment, poultry manure

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2637 Overview of Multi-Chip Alternatives for 2.5 and 3D Integrated Circuit Packagings

Authors: Ching-Feng Chen, Ching-Chih Tsai

Abstract:

With the size of the transistor gradually approaching the physical limit, it challenges the persistence of Moore’s Law due to the development of the high numerical aperture (high-NA) lithography equipment and other issues such as short channel effects. In the context of the ever-increasing technical requirements of portable devices and high-performance computing, relying on the law continuation to enhance the chip density will no longer support the prospects of the electronics industry. Weighing the chip’s power consumption-performance-area-cost-cycle time to market (PPACC) is an updated benchmark to drive the evolution of the advanced wafer nanometer (nm). The advent of two and half- and three-dimensional (2.5 and 3D)- Very-Large-Scale Integration (VLSI) packaging based on Through Silicon Via (TSV) technology has updated the traditional die assembly methods and provided the solution. This overview investigates the up-to-date and cutting-edge packaging technologies for 2.5D and 3D integrated circuits (ICs) based on the updated transistor structure and technology nodes. The author concludes that multi-chip solutions for 2.5D and 3D IC packagings are feasible to prolong Moore’s Law.

Keywords: moore’s law, high numerical aperture, power consumption-performance-area-cost-cycle time to market, 2.5 and 3D- very-large-scale integration, packaging, through silicon via

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2636 Acceptance towards Counselling Services among Flood Victims in Selangor

Authors: Husni Mohd Radzi, Lilie Zahara Ramly, Sapora Sipon, Salhah Abdullah

Abstract:

Malaysia have been experiencing series of huge floods all around the country for the past decades despide planned development done by local authorities. The floods incurred due to factors like natural climate change or man-made disaster. Floods have caused a lot of damages, destructions and losses in term of infrastructure, financial implications and physical health. However, other damaging aspect was not being given much attention are the psychological need of the flood victim. The traumatic impact from the natural disaster like floods may cause serious psychological and spiritual deterioration. Many flood relief shelters in the past did not provide counseling services for flood victims to consult, and as a result, it contributes to added stress among the flood victims, as the issue were not being addressed. Some studies indicates that flood victims did not look for counseling service being offered. A total of 257 flood victim was involved in this study. Main area of the study was Kg Bukit Changgang, Kg. Rancangan Tanah Belia, Kg. Labohan Dagang and Kg.Olak Lempit in Kuala Langat, Selangor. The flood victims have responded to the survey given and the data was analyze using SPSS for descriptive information and other measures. At least 13 victims were reported to have experienced moderate to severe level of stress and anxiety over the flood disaster incidents and a total of 88 respondents admitted to have at least thought and consider getting counseling service.

Keywords: perception, acceptance towards counseling, counseling service for flood victim, disaster

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2635 Inclusive Education in Jordanian Double-Shift Schools: Attitudes of Teacher and Students

Authors: David Ross Cameron

Abstract:

In an attempt to alleviate the educational planning problem, double-shift schools have been created throughout various regions in Jordan, namely communities closer to the Syrian border, where a large portion of the refugee population settled, allowing Jordanians to attend the morning-shift and Syrians to attend the afternoon-shift. Subsequently, overcrowded classrooms have added a significant amount of stress on school facilities and teacher capacities. Established national policies and the implementation of inclusive educational practices have been jeopardized. In particular, teachers’ and student’s attitudes of the importance of inclusive education provisions in the classroom have deteriorated. To have a more comprehensive understanding of the current situation and possible plan for intervention, a focus study was carried out at a double-shift Jordanian/Syrian girls’ public school in Irbid, Jordan. Interviews and surveys of 29 students with physical, learning, emotional and behavioral disabilities, 33 students without any special needs and nine teachers were included with a mixed-method social research approach to highlight the current attitudes that students and teachers held and factors that contributed to shaping their inclinations and beliefs of inclusive education.

Keywords: capacity building, development, double-shift, Irbid, inclusive education, Jordan, pedagogy, planning, policy, refugee, special education, special needs, vulnerable population

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2634 Surface Roughness of Al-Si/10% AlN MMC Material in Milling Operation Using the Taguchi Method

Authors: M. S. Said, J. A. Ghani, Izzati Osman, Z. A. Latiff, S. A .F. Syed Mohd

Abstract:

Metal matrix composites have demand for light-weight structural and functional materials. MMCs have been shown to offer improvements in strength, rigidity, temperature stability, wear resistance, reliability and control of physical properties such as density and coefficient of thermal expansion, thereby providing improved engineering performance in comparison to the un-reinforced matrix. Experiment were conducted at various cutting speed, feed rate and difference cutting tools according to Taguchi method using a standard orthogonal array L9. The volume of AlN reinforced particle was 10% in MMC. The milling process was carried out under dry cutting condition using uncoated carbide, TiN and TiCN tool insert. The parameters used were the cutting speed of (230,300,370 m/min) the federate used were (0.4, 0.6, 0.8 mm/tooth) while the depth of cut is constant (0.3 mm). The tool diameter is 20mm. From the project, the surface roughness mechanism was investigated in detail using Mitutoyo portable surface roughness measurements surftest SJ-310. This machining will be fabricated on MMC with 150mm length, 100mm width and 30mm thick. The results showed using S/N ratio, concluded that a combination of low cutting speed, medium feed rate and uncoated insert give a remarkable surface finish. From the ANOVA result showed the feed rate was major contributing factor (43.76%) following type of insert (40.89%).

Keywords: MMC, milling operation and surface roughness, Taguchi method

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2633 Addressing Urban Security Challenges in Nigeria through Neighborhood Renewal: A Reflection of Mokola World Bank Slum Upgrading Pilot Project

Authors: Tabiti S. Tabiti, A. M. Jinadu, Daramola Japheth

Abstract:

Urban insecurity is among the challenges militating against sustainable urban governance; in the first place it distorts the peace of urban areas making them unsafe. On the other hand it hinders the effective performance of urban functions. Urban security challenges manifest in different forms such as, street violence, theft and robbery, accidents of different types kidnapping, killings etc.. Efforts to address urban security challenges in Nigeria have been concentrated in legislative, law enforcement and the use of community vigilante groups. However in this study, the place of physical planning strategy through effective neighbourhood renewal as practiced in Mokola is presented as an effective complementary approach for addressing urban insecurity. On this backdrop, the paper recommends the need for gradual rehabilitation of urban slum neighborhoods by the state government in collaboration with World Bank and other development financiers. The local governments should be made autonomy in Nigeria so as to make them more responsible to the people. Other recommendations suggested in the paper include creating enabling environment that will promote economic empowerment and public enlightment on personal and community sanitation. It is certain that if these recommendations are adopted the challenge of urban insecurity will reduce significantly in Nigerian cities.

Keywords: neighbourhood renewal, pilot project, slum upgrading, urban security

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2632 Lower Cretaceous Clay in Anti-Lebanon Mountains, Syria and their Importance in Ceramic Manufacturing

Authors: Abdul Salam Turkmani

Abstract:

The Lower Cretaceous rocks are exposed only in the mountains regions of Syria, such as the Anti- Lebanon mountain on the western side of Damascus. The lower cretaceous sequences are made up of different rocks. The upper and middle parts of the section are composed mainly of carbonate sediments and, less frequently, gypsum and anhydrite. The lower beds are mainly composed of sandstone, conglomerate and clay. Clay samples were collected from the study area, which is located about 45 km west of the city of Damascus, near the border village of Kfer Yabous and to the left of the Damascus -Beirut International Road, within the lower Cretaceous upper Aptian deposits. The properties of clay were carried out by X-ray diffraction (XRD) and, X-ray fluorescence (XRF) and Thermal Analysis (DTA-TG-DSC) techniques. The studied samples of clay were mainly composed of kaolinite, quartz, illite. Chemical analysis shows the content of SiO₂ varied between 46.06 to 73 % Al₂O₃ 14.55-26.56%, about the staining oxides (Fe₂O₃ + TiO₂), the total content is about 4.3 to 12.5%. The physical properties were determined by studying the behavior of the body before and after firing, showed low bending strength values (22.5 kg/cm²) after drying, and (about 247 kg/cm²) after firing at 1180°C, water absorption value was about 10%. The cubic thermal expansion coefficient at 1140°C is 213.77 x 10-7 /°C. All of the presented results confirm the suitability of this clay for the ceramic industry.

Keywords: anti-Lebanon, Damascus, ceramic, clay, thermal analysis, thermal expansion coefficient

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2631 Comparison Between Bispectral Index Guided Anesthesia and Standard Anesthesia Care in Middle Age Adult Patients Undergoing Modified Radical Mastectomy

Authors: Itee Chowdhury, Shikha Modi

Abstract:

Introduction: Cancer is beginning to outpace cardiovascular disease as a cause of death affecting every major organ system with profound implications for perioperative management. Breast cancer is the most common cancer in women in India, accounting for 27% of all cancers. The small changes in analgesic management of cancer patients can greatly improve prognosis and reduce the risk of postsurgical cancer recurrence as opioid-based analgesia has a deleterious effect on cancer outcomes. Shortened postsurgical recovery time facilitates earlier return to intended oncological therapy maximising the chance of successful treatment. Literature reveals that the role of BIS since FDA approval has been assessed in various types of surgeries, but clinical data on its use in oncosurgical patients are scanty. Our study focuses on the role of BIS-guided anaesthesia for breast cancer surgery patients. Methods: A prospective randomized controlled study in patients aged 36-55years scheduled for modified radical mastectomy was conducted in 51 patients in each group who met the inclusion and exclusion criteria, and randomization was done by sealed envelope technique. In BIS guided anaesthesia group (B), sevoflurane was titrated to keep the BIS value 45-60, and thereafter if the patient showed hypertension/tachycardia, an opioid was given. In standard anaesthesia care (group C), sevoflurane was titrated to keep MAC in the range of 0.8-1, and fentanyl was given if the patient showed hypertension/tachycardia. Intraoperative opioid consumption was calculated. Postsurgery recovery characteristics, including Aldrete score, were assessed. Patients were questioned for pain, PONV, and recall of the intraoperative event. A comparison of age, BMI, ASA, recovery characteristics, opioid, and VAS score was made using the non-parametric Mann-Whitney U test. Categorical data like intraoperative awareness of surgery and PONV was studied using the Chi-square test. A comparison of heart rate and MAP was made by an independent sample t-test. #ggplot2 package was used to show the trend of the BIS index for all intraoperative time points for each patient. For a statistical test of significance, the cut-off p-value was set as <0.05. Conclusions: BIS monitoring led to reduced opioid consumption and early recovery from anaesthesia in breast cancer patients undergoing MRM resulting in less postoperative nausea and vomiting and less pain intensity in the immediate postoperative period without any recall of the intraoperative event. Thus, the use of a Bispectral index monitor allows for tailoring of anaesthesia administration with a good outcome.

Keywords: bispectral index, depth of anaesthesia, recovery, opioid consumption

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2630 Synthesizing an Artificial Loess for Geotechnical Investigations of Collapsible Soil Behavior

Authors: Hamed Sadeghi, Pouya A. Panahi, Hamed Nasiri, Mohammad Sadeghi

Abstract:

Collapsible soils like loess comprise an important category of problematic soils for construction purposes and sustainable development. As a result, research on both geological and geotechnical aspects of this type of soil have been in progress for decades. However, considerable natural variability in physical properties of in-situ loess strata even in a single block sample challenges the fundamental laboratory investigations. The reason behind this is that it is somehow impossible to remove the effect of a specific factor like void ratio from fair comparisons to come with a reliable conclusion. In order to cope with this limitation, two types of artificially made dispersive and calcareous loess are introduced which can be easily reproduced in any soil mechanics laboratory provided that all its compositions are known and controlled. The collapse potential is explored for a variety of soil water salinity and lime content and comparisons are made against the natural soil behavior. Trends are reported for the influence of pore water salinity on collapse potential under different osmotic flow conditions. The most important advantage of artificial loess is the ease of controlling cementing agent content like calcite or dispersive potential for studying their influence on mechanical soil behavior.

Keywords: artificial loess, unsaturated soils, collapse potential, dispersive clays, laboratory tests

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2629 Neonatal Sepsis in Dogs Attend in Veterinary Hospital of the Sao Paulo State University, Botucatu, Brazil – Incidence, Clinical Aspects and Mortality

Authors: Maria Lucia G. Lourenco, Keylla H. N. P. Pereira, Vivane Y. Hibaru, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

Abstract:

Neonatal sepsis is a systemic response to the acute generalized infection caused by one or more bacterial agents, representing the main infectious cause of neonatal mortality in dogs during the first three weeks of life. This study aims to describe the incidence of sepsis in neonate dogs, as well as the main clinical signs and mortality rates. The study included 735 neonates admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, between January 2018 and November 2019. Seven hundred thirty-five neonates, 14% (98/703) presented neonatal sepsis. The main sources of infection for the neonates were intrauterine (72.5%, 71/98), lactogenic (13.2%, 13/98), umbilical (5.1%, 5/98) and unidentified sources (9.2%, 9/98). The main non-specific clinical signs observed in the newborns were weakness, depression, impaired or absent reflexes, hypothermia, hypoglycemia, dehydration, reduced muscle tonus and diarrhea. The newborns also manifested clinical signs of severe infection, such as hyperemia in the abdominal and anal regions, omphalitis, hematuria, abdomen and extremities with purplish-blue coloration necrosing injuries in the pads, bradycardia, dyspnea, epistaxis, hypotension and evolution to septic shock. Infections acquired during intrauterine life led to the onset of the clinical signs at the time of birth, with fast evolution during the first hours of life. On the other hand, infections acquired via milk or umbilical cord presented clinical signs later. The total mortality rate was 5.4% (38/703) and the mortality rate among the neonates with sepsis was 38.7% (38/98). The early mortality rate (0 to 2 days) accounted for 86.9% (33/38) and the late mortality rate (3 to 30 days) for 13.1% (5/38) of the deaths among the newborns with sepsis. The main bacterial agents observed were Staphylococcus spp., Streptococcus spp., Proteus spp. Mannheimia spp. and Escherichia coli. Neonatal sepsis evolves quickly and may lead to high mortality in a litter. The prognosis is usually favorable if the diagnosis is reached early and the antibiotic therapy instituted as soon as possible, even before the results of blood cultures and antibiograms. The therapeutic recommendations should meet the special physiological conditions of a neonate in terms of metabolism and excretion of medication. Therefore, it is of utmost importance that the veterinarian is knowledgeable regarding neonatology to provide effective intervention and improve the survival rates of these patients.

Keywords: Neonatal infection , bacteria, puppies, newborn

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2628 Obstetric Violence Consequences And Coping Strategies: Insights Through The Voices Of Arab And Jewish Women In Israel

Authors: Dganit Sharon, Raghda Alnabilsy

Abstract:

The goal of this qualitative research was to sound the voices of Jewish and Arab women in Israel who had experienced obstetric violence, to learn the consequences of the violence to them on different levels and over time, and to present their coping strategies from their perspective. Another goal was to expand the research knowledge on an issue that has not been studied among Arab and Jewish women in Israel. The premise of this study is the feminist approach that aims to promote human rights, and to eradicate phenomena related to cultural, structural, gender and patriarchal structures of women, their bodies, and their health. The research was based on the qualitative-constructivist methodology, by means of thematic analysis of 20 in-depth semi-structured interviews. Two main themes emerged from the analysis. First, the physical and emotional consequences of obstetric violence, consequences to spousal relationships, and mistrust of the health system and service providers. Second, women’s coping strategies with obstetric violence that included repression and avoidance as a way of coping with the pain and trauma of the abuse; garnering inner strengths, resilience, knowledge and awareness of the delivery process; recruiting and relying on external help; sharing on social media, and discussions with other women who had similar experiences; or reaching out to therapists / legal aid / public complaints.

Keywords: obstetric violence, Jewish and arab women in israel, consequences, coping strategies, gender-related perspective

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2627 Development and Characterization of Topical 5-Fluorouracil Solid Lipid Nanoparticles for the Effective Treatment of Non-Melanoma Skin Cancer

Authors: Sudhir Kumar, V. R. Sinha

Abstract:

Background: The topical and systemic toxicity associated with present nonmelanoma skin cancer (NMSC) treatment therapy using 5-Fluorouracil (5-FU) make it necessary to develop a novel delivery system having lesser toxicity and better control over drug release. Solid lipid nanoparticles offer many advantages like: controlled and localized release of entrapped actives, nontoxicity, and better tolerance. Aim:-To investigate safety and efficacy of 5-FU loaded solid lipid nanoparticles as a topical delivery system for the treatment of nonmelanoma skin cancer. Method: Topical solid lipid nanoparticles of 5-FU were prepared using Compritol 888 ATO (Glyceryl behenate) as lipid component and pluronic F68 (Poloxamer 188), Tween 80 (Polysorbate 80), Tyloxapol (4-(1,1,3,3-Tetramethylbutyl) phenol polymer with formaldehyde and oxirane) as surfactants. The SLNs were prepared with emulsification method. Different formulation parameters viz. type and ratio of surfactant, ratio of lipid and ratio of surfactant:lipid were investigated on particle size and drug entrapment efficiency. Results: Characterization of SLNs like–Transmission Electron Microscopy (TEM), Differential Scannig calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), Particle size determination, Polydispersity index, Entrapment efficiency, Drug loading, ex vivo skin permeation and skin retention studies, skin irritation and histopathology studies were performed. TEM results showed that shape of SLNs was spherical with size range 200-500nm. Higher encapsulation efficiency was obtained for batches having higher concentration of surfactant and lipid. It was found maximum 64.3% for SLN-6 batch with size of 400.1±9.22 nm and PDI 0.221±0.031. Optimized SLN batches and marketed 5-FU cream were compared for flux across rat skin and skin drug retention. The lesser flux and higher skin retention was obtained for SLN formulation in comparison to topical 5-FU cream, which ensures less systemic toxicity and better control of drug release across skin. Chronic skin irritation studies lacks serious erythema or inflammation and histopathology studies showed no significant change in physiology of epidermal layers of rat skin. So, these studies suggest that the optimized SLN formulation is efficient then marketed cream and safer for long term NMSC treatment regimens. Conclusion: Topical and systemic toxicity associated with long-term use of 5-FU, in the treatment of NMSC, can be minimized with its controlled release with significant drug retention with minimal flux across skin. The study may provide a better alternate for effective NMSC treatment.

Keywords: 5-FU, topical formulation, solid lipid nanoparticles, non melanoma skin cancer

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2626 Enhancing Mental Health Services Through Strategic Planning: The East Tennessee State University Counseling Center’s 2024-2028 Plan

Authors: R. M. Kilonzo, S. Bedingfield, K. Smith, K. Hudgins Smith, K. Couper, R. Ratley, Z. Taylor, A. Engelman, M. Renne

Abstract:

Introduction: The mental health needs of university students continue to evolve, necessitating a strategic approach to service delivery. The East Tennessee State University (ETSU) Counseling Center developed its inaugural Strategic Plan (2024-2028) to enhance student mental health services. The plan focuses on improving access, quality of care, and service visibility, aligning with the university’s mission to support academic success and student well-being. Aim: This strategic plan aims to establish a comprehensive framework for delivering high-quality, evidence-based mental health services to ETSU students, addressing current challenges, and anticipating future needs. Methods: The development of the strategic plan was a collaborative effort involving the Counseling Center’s leadership, staff, with technical support from Doctor of Public Health-community and behavioral health intern. Multiple workshops, online/offline reviews, and stakeholder consultations were held to ensure a robust and inclusive process. A SWOT analysis and stakeholder mapping were conducted to identify strengths, weaknesses, opportunities, and challenges. Key performance indicators (KPIs) were set to measure service utilization, satisfaction, and outcomes. Results: The plan resulted in four strategic priorities: service application, visibility/accessibility, safety and satisfaction, and training programs. Key objectives include expanding counseling services, improving service access through outreach, reducing stigma, and increasing peer support programs. The plan also focuses on continuous quality improvement through data-driven assessments and research initiatives. Immediate outcomes include expanded group therapy, enhanced staff training, and increased mental health literacy across campus. Conclusion and Recommendation: The strategic plan provides a roadmap for addressing the mental health needs of ETSU students, with a clear focus on accessibility, inclusivity, and evidence-based practices. Implementing the plan will strengthen the Counseling Center’s capacity to meet the diverse needs of the student population. To ensure sustainability, it is recommended that the center continuously assess student needs, foster partnerships with university and external stakeholders, and advocate for increased funding to expand services and staff capacity.

Keywords: strategic plan, university counseling center, mental health, students

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2625 Youth and International Environmental Voluntary Initiatives: A Case Study of IGreen Project by AIESEC in Bandung

Authors: Yoel Agustheo Rinding

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Globalization has made physical borders between countries become more obscure. Due to the free flow of information between countries, issue for instance, environment has become global concern. The concern has grown as the result of endless campaign made by most of the non-governmental organizations (NGOs). By means of this situation, international voluntary initiatives on environmental issues have appeared to be popular among world’s society today especially for youth. AIESEC as international non-governmental organization (INGO) through IGreen Project has initiated environmental international voluntary initiatives concerning in environmental awareness of Bandung’s citizen. Bandung itself is still struggling on solving flood as one of its major problems regardless the fact that Bandung is one of the most developed cities in Indonesia. This paper would like to discuss on how globalization affects AIESEC as an INGO in order to spread its influence and also on how it could build international voluntary initiatives networks. Afterwards, author would like to elaborate how both AIESEC and youth perceive the importance of international voluntary initiatives by using cosmopolitanism approach. In order to get a deep understanding of how this activity works, this paper also would like to explain regarding the management, expected outcomes, and the real impacts of IGreen project towards Bandung. In the end of this paper, author would like to propose solutions on how to utilize international voluntary initiatives as a solution for environmental issues nowadays.

Keywords: AIESEC, cosmopolitanism, environmental issues, globalization, IGreen project, international environmental voluntary initiatives, INGO, youth

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2624 Use of Curcumin in Radiochemotherapy Induced Oral Mucositis Patients: A Control Trial Study

Authors: Shivayogi Charantimath

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Radiotherapy and chemotherapy are effective for treating malignancies but are associated with side effects like oral mucositis. Chlorhexidine gluconate is one of the most commonly used mouthwash in prevention of signs and symptoms of mucositis. Evidence shows that chlorhexidine gluconate has side effects in terms of colonization of bacteria, bad breadth and less healing properties. Thus, it is essential to find a suitable alternative therapy which is more effective with minimal side effects. Curcumin, an extract of turmeric is gradually being studied for its wide-ranging therapeutic properties such as antioxidant, analgesic, anti-inflammatory, antitumor, antimicrobial, antiseptic, chemo sensitizing and radio sensitizing properties. The present study was conducted to evaluate the efficacy and safety of topical curcumin gel on radio-chemotherapy induced oral mucositis in cancer patients. The aim of the study is to evaluate the efficacy and safety of curcumin gel in the management of oral mucositis in cancer patients undergoing radio chemotherapy and compare with chlorhexidine. The study was conducted in K.L.E. Society’s Belgaum cancer hospital. 40 oral cancer patients undergoing the radiochemotheraphy with oral mucositis was selected and randomly divided into two groups of 20 each. The study group A [20 patients] was advised Cure next gel for 2 weeks. The control group B [20 patients] was advised chlorhexidine gel for 2 weeks. The NRS, Oral Mucositis Assessment scale and WHO mucositis scale were used to determine the grading. The results obtained were calculated by using SPSS 20 software. The comparison of grading was done by applying Mann-Whitney U test and intergroup comparison was calculated by Wilcoxon matched pairs test. The NRS scores observed from baseline to 1st and 2nd week follow up in both the group showed significant difference. The percentage of change in erythema in respect to group A was 63.3% for first week and for second week, changes were 100.0% with p = 0.0003. The changes in Group A in respect to erythema was 34.6% for 1st week and 57.7% in second week. The intergroup comparison was significant with p value of 0.0048 and 0.0006 in relation to group A and group B respectively. The size of the ulcer score was measured which showed 35.5% [P=0.0010] of change in Group A for 1st and 2nd week showed totally reduction i.e. 103.4% [P=0.0001]. Group B showed 24.7% change from baseline to 1st week and 53.6% for 2nd week follow up. The intergroup comparison with Wilcoxon matched pair test was significant with p=0.0001 in group A. The result obtained by WHO mucositis score in respect to group A shows 29.6% [p=0.0004] change in first week and 75.0% [p=0.0180] change in second week which is highly significant in comparison to group B. Group B showed minimum changes i.e. 20.1% in 1st week and 33.3% in 2nd week. The p value with Wilcoxon was significant with 0.0025 in Group A for 1st week follow up and 0.000 for 2nd week follow up. Curcumin gel appears to an effective and safer alternative to chlorhexidine gel in treatment of oral mucositis.

Keywords: curcumin, chemotheraphy, mucositis, radiotheraphy

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2623 Contrastive Focus Marking in Brazilian Children under Typical and Atypical Phonological Development

Authors: Geovana Soncin, Larissa Berti

Abstract:

Some aspects of prosody acquisition remain still unclear, especially regarding atypical speech development processes. This work deals with prosody acquisition and its implications for clinical purposes. Therefore, we analyze speech samples produced by adult speakers, children in typical language development, and children with phonological disorders. Phonological disorder comprises deviating manifestations characterized by inconsistencies in the phonological representation of a linguistic system under acquisition. The clinical assessment is performed mostly based on contrasts whose manifestations occur in the segmental level of a phonological system. Prosodic organization of spoken utterances is not included in the standard assessment. However, assuming that prosody is part of the phonological system, it was hypothesized that children with Phonological Disorders could present inconsistencies that also occur at a prosodic level. Based on this hypothesis, the paper aims to analyze contrastive focus marking in the speech of children with Phonological Disorders in comparison with the speech of children under Typical Language Development and adults. The participants of all groups were native speakers of Brazilian Portuguese. The investigation was designed in such a way as to identify differences and similarities among the groups that could be interpreted as clues of normal or deviant processes of prosody acquisition. Contrastive focus in Brazilian Portuguese is marked by increasing duration, f0, and intensity on the focused element as well as by a particular type of pitch accent (L*+H). Thirty-nine subjects participated, thirteen from each group. Acoustic analysis was performed, considering duration, intensity, and intonation as parameters. Children with PD were recruited in sessions from a service provided by Speech-Language Pathology Therapy; children in TD, paired in age and sex with the first group, were recruited in a regular school; and 20-24 years old adults were recruited from a University class. In a game prepared to elicit focused sentences, all of them produced the sentence “Girls love red dress,” marking focus on different syntactic positions: subject, verb, and object. Results showed that adults, children in typical language development, and children with Phonological Disorders marked contrastive focus differently: typical children used all parameters like adults do; however, in comparison with them, they exaggerated duration and, in the opposite direction, they did not increase f0 in a sufficient magnitude as adults; children with Phonological Disorder presented inconsistencies in duration, not increasing it in some syntactic positions, and also in intonation, not producing the representative pitch accent of contrastive focus. The results suggest prosody is also affected by phonological disorder and give clues of developmental processes of prosody acquisition.

Keywords: Brazilian Portuguese, contrastive focus, phonological disorder, prosody acquisition

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2622 An Experimental Study on the Positive Streamer Leader Propagation under Slow Front Impulse Voltages in a 10m Rod-Plane Air Gap

Authors: Wahab Ali Shah, Junjia He

Abstract:

In this work, we performed a large-scale investigation into leader development in a 10 m rod-plane gap under a long front positive impulse. To describe the leader propagation under slow front impulse voltages, we recorded the leader propagation with a high-speed charge coupled device (CCD) camera. It is important to figure out this phenomenon to deepen our understanding of leader discharge. The observation results showed that the leader mechanism is a very complex physical phenomenon; it could be categorized into two types of leader process, namely, continuous and the discontinuous leader streamer-leader propagation. Furthermore, we studied the continuous leader development parameters, including two-dimensional (2-D) leader length, injected charge, and final jump stage, as well as leader velocity for rod–plane configuration. We observed that the discontinuous leader makes an important contribution to the appearance of channel re-illuminations of the positive leader. The comparative study shows better results in terms of standard switch impulse and long front positive impulse. Finally, the results are presented with a view toward improving our understanding of propagation mechanisms related to restrike phenomena, which are rarely reported. To clarify the above doubts under long front cases, we carried out extensive experiments in this study.

Keywords: continuous and discontinuous leader, high-speed photographs, long air gap, positive long front impulse, restrike phenomena

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2621 Depressive Trends in Children and Adolescents Suffering from Beta-Thalassemia

Authors: Sanober Khanum, Barerah Siddiqui, Asim Qidwai

Abstract:

Objective: To determine the risk factors and frequency of depressive trends in children and adolescents suffering from Beta-Thalassemia. Background: Thalassemia is a chronic disease affecting 10,000 people in 60 countries. Many studies show that prolonged medical conditions cause depression. Due to the invasive procedures and suffering, Beta-Thalassemia cause great psychological distress to both children and their caregivers. The study shows 14-24% prevalence of psychiatric problems in Thalassemic patients. Method: Sample consisted of 195 registered patients of A.M.T.F (Female=95 and Male=100). Based on age range the sample was divided into two groups, Group A = children (4-9 years) and Group B = adolescent (10-16 years). A detailed interview with a self-made screening measure was administered on parents to find out the level of depression in patients. Statistics: Chi-square and t-test was applied in order to analyze the data. Results show high prevalence of depression, depression n= 131(66.83%), no depression n=65(33.16%). Analyses reflect that age influences the level of depression Adolescent (71.05%) and Children (64.16%). The analysis also shows a difference in level of depression between both genders. (t=2.975, p < .05). Conclusion: There is a high possibility of developing depressive trend in children affected with Beta Thalassemia; especially females. Therefore, there is a dire need for psychological screening and appropriate treatment in order to improve physical; as well as mental health.

Keywords: childhood depression, chronic illness, psychopathology, Thalassemia

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2620 Intimate Partner Violence and Risk of Obesity among Women

Authors: Fatemeh Abdollahi, Munn-Sann Lye, Jamshid Yazdani Charati, Mehran Zarghami

Abstract:

Both obesity and intimate partner violence (IPV) are growing health threats. This study aimed to assess the prevalence and risk factors of both IPV and obesity and their association. In this cross-sectional study, 530 women aged 16-65 years attending Mazandaran primary health centers were recruited through the stratified random sampling method (2019-2020). Data were collected using the modified World Health Organization Domestic Violence questionnaire, Perceived Stress Scale, and socio-demographic, obstetric, and anthropometric questionnaires. The data were analyzed using descriptive statistics, the chi-square test, and multiple logistic regression. The prevalence of overweight, obesity and psychological, physical, and sexual IPV were 47.6%, 26.7%, 70.4%, 17.9%, and 6.4%, respectively. Increasing women’s educational level and exposure to violence during their lifespan increased the odds of any type of IPV while living in a nuclear family reduced it. In groups of women who were subjected to any type of IPV and only psychological IPV, experiencing violence during the lifespan was significant in predicting obesity. The alarming prevalence of IPV and obesity-overweight in this study points to the need for collaborative socio-political and health intervention. The link between experiencing violence during lifespan and obesity in some subgroups of women highlights the detrimental consequences of chronic violence and the urgent need for effective preventive programs.

Keywords: intimate partner violence, body mass index, obesity, risk factor, women

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2619 Challenges and Opportunities in Computing Logistics Cost in E-Commerce Supply Chain

Authors: Pramod Ghadge, Swadesh Srivastava

Abstract:

Revenue generation of a logistics company depends on how the logistics cost of a shipment is calculated. Logistics cost of a shipment is a function of distance & speed of the shipment travel in a particular network, its volumetric size and dead weight. Logistics billing is based mainly on the consumption of the scarce resource (space or weight carrying capacity of a carrier). Shipment’s size or deadweight is a function of product and packaging weight, dimensions and flexibility. Hence, to arrive at a standard methodology to compute accurate cost to bill the customer, the interplay among above mentioned physical attributes along with their measurement plays a key role. This becomes even more complex for an ecommerce company, like Flipkart, which caters to shipments from both warehouse and marketplace in an unorganized non-standard market like India. In this paper, we will explore various methodologies to define a standard way of billing the non-standard shipments across a wide range of size, shape and deadweight. Those will be, usage of historical volumetric/dead weight data to arrive at a factor which can be used to compute the logistics cost of a shipment, also calculating the real/contour volume of a shipment to address the problem of irregular shipment shapes which cannot be solved by conventional bounding box volume measurements. We will also discuss certain key business practices and operational quality considerations needed to bring standardization and drive appropriate ownership in the ecosystem.

Keywords: contour volume, logistics, real volume, volumetric weight

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2618 Antioxidant Effects of Regular Aerobic Exercise in Postmenopausal Women with Type 2 Diabetes Mellitus

Authors: Parvin Farzanegi

Abstract:

Background: Diabetes is a metabolic disorder associated with increased free radicals and oxidative stress. The evidence indicates that physical inactivity is a modifiable behavioral risk factor for a wide range of chronic disorders such as diabetes mellitus. We investigated the effects of eight-week aerobic exercise on some antioxidant enzyme activities in postmenopausal women with type 2 diabetes mellitus (T2DM). Methods: sixteen sedentary postmenopausal women with T2DM were randomly assigned to the control (n=8; CG) and exercise group (n=8; EG). The exercise consisted of progressive aerobic training at a moderate intensity (50-70% of the maximum heart rate), for 25-60 min/day, and 3 days/week for 8 weeks. Age, sex, and body mass index were similar in the two groups. Antioxidant status was evaluated by measuring the superoxide dismutase (SOD) and catalase (CAT) activity. Also levels of malondialdehyde (MDA) as an index of lipid peroxidation and glucose in the plasma were measured before and after the intervention. Results: Following the 8 weeks of exercise training, the plasma MDA and glucose levels were significantly reduced in EG compared to CG (P=0.001 and P=0.011 respectively). However, SOD (P=0.017) and CAT (P=0.011) activities were increased in EG compared to CG. Conclusion: The present study suggests regular aerobic exercise appears can exert protective effects against oxidative stress due to its ability to increase antioxidant defense and glucose control in postmenopausal women with T2DM.

Keywords: aerobic exercise, antioxidant, diabetes mellitus, type 2

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2617 The Construction of the Meaning of Beauty by the Representation of Wardah Halal Beauty

Authors: Indhie Febrianti Herlina, Riri Akadafi, Alna Hanana

Abstract:

This research describes the constructivism of the Halal beauty of Wardah commercials that present hijab women as the advertising models and shows the sign of Halal in each promotion. There are differences of the concept of beauty between wardah and other beauty ads. When today’s ads describe that beautiful women are who have bright skin, sharp nose and long hair, wardah describes that beautiful women are the hijab women and wear Halal beauty product. This research is interesting because it is so rare when the beauty is presented by hijab women. By using the constructivism paradigm and combining it with reception theory, the author wants to reveal whether women are constructed by these commercials. Reception theory is about how public accept the content of a media. The informants are the women who wear hijab, wear Wardah products and join ‘Wardah Goes to Campus’, a roadshow event conducted by Wardah in Universities all around Indonesia. By interviewing the informants, a statement can be inferred that informants A, B, C, and D assumed that beauty is a physical beauty. However, after they have learned about the true meaning of beauty and watched Wardah commercials, those informants understand that beauty is reflected by the women who wear hijab and wear Halal Cosmetics. Meanwhile, the informant E assumes that beauty is relative, inner, and good-looking. The conclusion of this research is that the informants are constructed by the halal beauty described by Wardah commercials. By presenting the models wearing hijab and wear natural-looking cosmetics, Wardah successfully influences the informants to be more confident to look good by wearing hijab.

Keywords: ad, commercial, construction, halal beauty, wardah

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2616 Neurotoxic Effects Assessment of Metformin in Danio rerio

Authors: Gustavo Axel Elizalde-Velázquez

Abstract:

Metformin is the first line of oral therapy to treat type II diabetes and is also employed as a treatment for other indications, such as polycystic ovary syndrome, cancer, and COVID-19. Recent data suggest it is the aspirin of the 21st century due to its antioxidant and anti-aging effects. However, increasingly current articles indicate its long-term consumption generates mitochondrial impairment. Up to date, it is known metformin increases the biogenesis of Alzheimer's amyloid peptides via up-regulating BACE1 transcription, but further information related to brain damage after its consumption is missing. Bearing in mind the above, this work aimed to establish whether or not chronic exposure to metformin may alter swimming behavior and induce neurotoxicity in Danio rerio adults. For this purpose, 250 Danio rerio grown-ups were assigned to six tanks of 50 L of capacity. Four of the six systems contained 50 fish, while the remaining two had 25 fish (≈1 male:1 female ratio). Every system with 50 fish was allocated one of the three metformin treatment concentrations (1, 20, and 40 μg/L), with one system as the control treatment. Systems with 25 fish, on the other hand, were used as positive controls for acetylcholinesterase (10 μg/L of Atrazine) and oxidative stress (3 μg/L of Atrazine). After four months of exposure, a mean of 32 fish (S.D. ± 2) per group of MET treatment survived, which were used for the evaluation of behavior with the Novel Tank test. Moreover, after the behavioral assessment, we aimed to collect the blood and brains of all fish from all treatment groups. For blood collection, fish were anesthetized with an MS-222 solution (150 mg/L), while for brain gathering, fish were euthanized using the hypothermic shock method (2–4 °C). Blood was employed to determine CASP3 activity and the percentage of apoptotic cells with the TUNEL assay, and brains were used to evaluate acetylcholinesterase activity, oxidative damage, and gene expression. After chronic exposure, MET-exposed fish exhibited less swimming activity when compared to control fish. Moreover, compared with the control group, MET significantly inhibited the activity of AChE and induced oxidative damage in the brain of fish. Concerning gene expression, MET significantly upregulated the expression of Nrf1, Nrf2, BAX, p53, BACE1, APP, PSEN1, and downregulated CASP3 and CASP9. Although MET did not overexpress the CASP3 gene, we saw a meaningful rise in the activity of this enzyme in the blood of fish exposed to MET compared to the control group, which we then confirmed by a high number of apoptotic cells in the TUNEL assay. To the best of our understanding, this is the first study that delivers evidence of oxidative impairment, apoptosis, AChE alteration, and overexpression of B- amyloid-related genes in the brain of fish exposed to metformin.

Keywords: AChE inhibition, CASP3 activity, NovelTank test, oxidative damage, TUNEL assay

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2615 The Effect of Radish (Raphanus Sativus L.) Leaves Ethanol Extract on Blood Glucose Levels in Streptozotocin-Nicotinamide-Induced Type-2 Diabetic Rats

Authors: Satria B. Mahathma, Asri Hendrawati

Abstract:

Background: Diabetes mellitus (DM) is a metabolic disorder syndrome characterized by chronic hyperglycemia. The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014. In general, almost 90% of the prevalence of DM is type 2 DM which marked by insulin resistance and decreased receptor sensitivity. Aside from conventional antidiabetic therapy, the utilization of medicinal plants as alternative medicine has beneficial effects in diabetic patients. Flavonoid contents in radish leaves such as quercetin, pelargonidin, and kaempferol are thought to have antidiabetic activity on decreasing blood glucose levels by tricyclic nucleotide modulation of pancreatic beta cells and ameliorating insulin resistance. This study aimed to determine the effect of variant concentration of radish leaves ethanol extract on blood glucose levels in diabetic rats. Method: This study used pretest-posttest control group design by using 16 male Wistar rats which were induced type-2 diabetic by streptozotocin 60 mg/kg BW-nicotinamide 120 mg/kg BW intraperitoneally. Rats who had developed type-2 DM later divided randomly into 4 groups; negative control received placebo, positive control received glibenclamide 5 mg/kg BW/day, rats intervention I and intervention II received 100% and 50% of radish leaves ethanol extract, respectively. Treatments were administered orally for four weeks. The blood glucose levels were measured using the Enzymatic Colorimetric Test “GOD-PAP”. Data were analyzed by the dependent t-test for pretest-posttest intervention difference and one-way ANOVA followed by post hoc test to determine the significant difference of each treatment to obtain the significant data. Result: The result revealed that intervention group had lower blood glucose levels mean than control group which the lowest was intervention II group (negative control: 540,9 ± 191,7 mg/dl, positive control: 494, 97 ± 64,91 mg/dl, intervention I: 301,92 ± 165,70 mg/dl, and intervention II group: 276,1 ± 139,02 mg/dl. Intervention II group had the highest antidiabetic activity, followed by the intervention I group with the amount of decrease in blood glucose levels were -151,85 ± 77,43 mg/dl and -11,08 ± 186,62 mg/dl, however negative and positive control group didn’t have antidiabetic activity. The dependent t-test result showed there is a significant difference in decreasing blood glucose levels in the intervention II pretest-posttest intervention (p=0,03) while the other group didn’t. Data analyzed by one-way ANOVA also revealed the intervention II group significantly declined blood glucose levels compared to the negative and positive control group (p = 0,033 and p=0,032, respectively). Conclusion: There is a significant effect of radish leaves ethanol extract on blood glucose levels in streptozotocin-nicotinamide-induced diabetic rats with the optimal therapeutic effect at a concentration of 50%.

Keywords: blood glucose levels, medicinal plant, radish leaves, type-2 diabetes mellitus

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2614 Intelligent Fishers Harness Aquatic Organisms and Climate Change

Authors: Shih-Fang Lo, Tzu-Wei Guo, Chih-Hsuan Lee

Abstract:

Tropical fisheries are vulnerable to the physical and biogeochemical oceanic changes associated with climate change. Warmer temperatures and extreme weather have beendamaging the abundance and growth patterns of aquatic organisms. In recent year, the shrinking of fish stock and labor shortage have increased the threat to global aquacultural production. Thus, building a climate-resilient and sustainable mechanism becomes an urgent, important task for global citizens. To tackle the problem, Taiwanese fishermen applies the artificial intelligence (AI) technology. In brief, the AI system (1) measures real-time water quality and chemical parameters infish ponds; (2) monitors fish stock through segmentation, detection, and classification; and (3) implements fishermen’sprevious experiences, perceptions, and real-life practices. Applying this system can stabilize the aquacultural production and potentially increase the labor force. Furthermore, this AI technology can build up a more resilient and sustainable system for the fishermen so that they can mitigate the influence of extreme weather while maintaining or even increasing their aquacultural production. In the future, when the AI system collected and analyzed more and more data, it can be applied to different regions of the world or even adapt to the future technological or societal changes, continuously providing the most relevant and useful information for fishermen in the world.

Keywords: aquaculture, artificial intelligence (AI), real-time system, sustainable fishery

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2613 A Coordinated School Health Program Effect on Cardiorespiratory Fitness in Preschool Children

Authors: Zasha Romero, Roberto Trevino, Lin Wang, Elizabeth Alanis, Jesus Cuellar

Abstract:

Background: There is a strong relationship between low cardiorespiratory fitness (CRF) and high adiposity levels. The purpose of this study was to assess the effects of the Bienestar/Neema Coordinated School Health Program (BN CSHP) on the CRF of preschool children. Methods: This is a randomized cluster trial conducted in preschools of two school districts located along the Texas-Mexico border. Of 48 eligible schools, 28 were randomly selected (intervention, n=14; control, n=14). Family demographics and household health characteristics were collected from parents. CRF, as measured by the Progressive Anaerobic Capacity Endurance Run (PACER) fitness test, was collected from the children. A generalized linear mixed model (GLMM) was used to analyze the data. Results: Family demographics, household health characteristics, and children’s weight, obesity prevalence, and sedentary activity were similar among both treatment groups. After adjusting for covariates, the number of laps run by children in the control group increased by 23% (CI: -5% to 60%) per each data collection period compared with 53% (CI: 7% to 119%) in the intervention group. Conclusions: Children in the BN CSHP, compared to those in the control group, had a significantly higher increase in their CRF. This finding is important because of the health benefits of CRF in children.

Keywords: coordinated school health program, cardiorespiratory fitness, obesity, border health, preschool, physical education, movement

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2612 Exploring Management Strategies Used by Grade 1 Educators in the Classroom Working with Learners Presenting with ADHD Symptoms in the Western Cape

Authors: Athena Pedro, Gina Stockingt

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This study aimed to explore current management strategies used by Grade 1 educators working with learners presenting with Attention Deficit Hyperactivity Disorder (ADHD) symptoms in mainstream schools in the Western Cape. A sample of grade 1 educators were selected for the study. The sample comprised of twelve grades 1 educators from four local schools in the Western Cape. All twelve educators were individually interviewed and discussed the management strategies used in the classroom when working with learner presenting with ADHD symptoms. The data was analysed qualitatively with a focus in identifying, sorting and analyse meaning according to the subjective perception, understanding and behaviour of the grade 1 educators within their context. Furthermore, the social, cultural, political and physical environment of the participants were taken into consideration to explore and interpret the link between these elements. The findings were as follows: many educators felt that they did not receive enough training on Attention Deficit Hyperactivity Disorder, therefore lacking knowledge on how to apply management strategies to address this. Managing a diverse range of learners, lack of resources, lack of parental involvement, lack of assistance in the classroom, as well as distracted and disorganised children posed as challenges for educators working with learners presenting with Attention Deficit Hyperactivity Disorder symptoms.

Keywords: ADHD, Grade 1 educators, Learners, Management strategies

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2611 Outcome of Naive SGLT2 Inhibitors Among ICU Admitted Acute Stroke with T2DM Patients a Prospective Cohort Study in NCMultispecialty Hospital, Biratnagar, Nepal

Authors: Birendra Kumar Bista, Rhitik Bista, Prafulla Koirala, Lokendra Mandal, Nikrsh Raj Shrestha, Vivek Kattel

Abstract:

Introduction: Poorly controlled diabetes is associated with cause and poor outcome of stroke. High blood sugar reduces cerebral blood flow, increases intracranial pressure, cerebral edema and neuronal death, especially among patients with poorly controlled diabetes.1 SGLT2 inhibitors are associated with 50% reduction in hemorrhagic stroke compared with placebo. SGLT2 inhibitors decrease cardiovascular events via reducing glucose, blood pressure, weight, arteriosclerosis, albuminuria and reduction of atrial fibrillation.2,3 No study has been documented in low income countries to see the role of post stroke SGLT2 inhibitors on diabetic patients at and after ICU admission. Aims: The aim of the study was to measure the 12 months outcome of diabetic patients with acute stroke admitted in ICU set up with naïve SGLT2 inhibitors add on therapy. Method: It was prospective cohort study carried out in a 250 bedded tertiary neurology care hospital at the province capital Biratnagar Nepal. Diabetic patient with acute stroke admitted in ICU from 1st January 2022 to 31st December 2022 who were not under SGLT2 inhibitors were included in the study. These patients were managed as per hospital protocol. Empagliflozin was added to the alternate enrolled patients. Empagliflozin was continued at the time of discharged and during follow up unless contraindicated. These patients were followed up for 12 months. Outcome measured were mortality, morbidity requiring readmission or hospital visit other than regular follow up, SGLT2 inhibitors related adverse events, neuropsychiatry comorbidity, functional status and biochemical parameters. Ethical permission was taken from hospital administration and ethical board. Results: Among 147 diabetic cases 68 were not treated with empagliflozin whereas 67 cases were started the SGLT2 inhibitors. HbA1c level and one year mortality was significantly low among patients on empaglifozin arm. Over a period of 12 months 427 acute stroke patients were admitted in the ICU. Out of them 44% were female, 61% hypertensive, 34% diabetic, 57% dyslipidemia, 26% smoker and with median age of 45 years. Among 427 cases 4% required neurosurgical interventions and 76% had hemorrhagic CVA. The most common reason for ICU admission was GCS<8 (51%). The median ICU stay was 5 days. ICU mortality was 21% whereas 1 year mortality was 41% with most common reason being pneumonia. Empaglifozin related adverse effect was seen in 11% most commonly lower urinary tract infection in 6%. Conclusion: Empagliflozin can safely be started among acute stroke with better Hba1C control and low mortality outcome compared to treatment without SGLT2 inhibitor.

Keywords: diabetes, ICU, mortality, SGLT2 inhibitors, stroke

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