Search results for: unplanned ER visit

Authors: Fabio L. Vieira, Micaelle F. C. Lemos, Luciano C. Lemos, Rafaela S. Oliveira, Ian A. Cunha

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Brazil has some challenges ahead related to population oral health, most of them associated with the need of expanding into the local level its promotion and prevention activities, offer equal access to services and promote changes in the lifestyle of the population. The program implemented an oral health initiative in public schools in the city of Salvador, Bahia. The mission was to improve oral health among students on primary and secondary education, from 2 to 15 years old, using the school as a pathway to increase access to healthcare. The main actions consisted of a team's visit to the schools with educational sessions for dental cavity prevention and individual assessment. The program incorporated a clinical surveillance component through a dental evaluation of every student searching for dental disease and caries, standardization of the dentists’ team to reach uniform classification on the assessments, and the use of an online platform to register data directly from the schools. Sequentially, the students with caries were referred for free clinical treatment on the program’s Health Centre. The primary purpose of this study was to analyze the effects and outcomes of this school-based oral health program. The study sample was composed by data of a period of 3 years - 2015 to 2017 - from 13 public schools on the suburb of the city of Salvador with a total number of assessments of 9,278 on this period. From the data collected the prevalence of children with decay on permanent teeth was chosen as the most reliable indicator. The prevalence was calculated for each one of the 13 schools using the number of children with 1 or more dental caries on permanent teeth divided by the total number of students assessed for school each year. Then the percentage change per year was calculated for each school. Some schools presented a higher variation on the total number of assessments in one of the three years, so for these, the percentage change calculation was done using the two years with less variation. The results show that 10 of the 13 schools presented significative improvements for the indicator of caries in permanent teeth. The mean for the number of students with caries percentage reduction on the 13 schools was 26.8%, and the median was 32.2% caries in permanent teeth institution. The highest percentage of improvement reached a decrease of 65.6% on the indicator. Three schools presented a rise in caries prevalence (8.9, 18.9 and 37.2% increase) that, on an initial analysis, seems to be explained with the students’ cohort rotation among other schools, as well as absenteeism on the treatment. In conclusion, the program shows a relevant impact on the reduction of caries in permanent teeth among students and the need for the continuity and expansion of this integrated healthcare approach. It has also been evident the significative of the articulation between health and educational systems representing a fundamental approach to improve healthcare access for children especially in scenarios such as presented in Brazil.

Keywords: primary care, public health, oral health, school-based oral health, data management

Procedia PDF Downloads 134

Authors: Hsin-Hung Lin, Janet Chang, Te-Yi Chang, You-Sheng Huang

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The natural and men-made disasters have become huge challenges for tourism destinations as well as emphasizing the fragility of the industry. Hot springs, among all destinations, are prone to disasters due to their dependence on natural resources and locations. After the COVID-19 outbreak, hot spring destinations have experienced not only the loss of businesses but also the psychological trauma. However, evidence has also shown that the impacts may not necessarily reduce the resilience for people but may be converted into posttraumatic growth. In Taiwan, a large proportion of hot springs are located in rural or indigenous areas. As a result, hot spring resources are associated with community cohesion for local residents. Yet prior research on hot spring destinations has mainly focused on visitors, whereas residents have been overlooked. More specifically, the relationship between hot springs resources and resident resilience in the face of the COVID-19 impacts remains unclear. To fulfill this knowledge gap, this paper aims to explore the COVID-19 impacts on residents’ hot spring experiences as well as individual and community resilience from the perspective of posttraumatic growth. A total of 315 residents of 13 hot spring destinations that are most popular in Taiwan were recruited. Online questionnaires were distributed over travel forums and social networks after the COVID-19. This paper subsequently used Partial Least Squares Structural Equation Modeling for data analysis as the technique offers significant advantages in addressing nonnormal data and small sample sizes. A preliminary test was conducted, and the results showed acceptable internal consistency and no serious common method variance. The path analysis demonstrated that the COVID-19 impacts strengthened residents’ perceptions of hot spring resources and experiences, implying that the pandemic had propelled the residents to visit hot springs for the healing benefits. In addition, the COVID-19 impacts significantly enhanced residents’ individual and community resilience, which indicates that the residents at hot springs are more resilient thanks to their awareness of external risks. Thirdly, residents’ individual resilience was positively associated with hot spring experiences, while community resilience was not affected by hot spring experiences. Such findings may suggest that hot spring experiences are more related to individual-level experiences and, consequently, have insignificant influence on community resilience. Finally, individual resilience was proved to be the most relevant factor that help foster community resilience. To conclude, the authorities may consider exploiting the hot spring resources so as to increase individual resilience for local residents. Such implications can be used as a reference for other post-disaster tourist destinations as well. As for future research, longitudinal studies with qualitative methods are suggested to better understand how the hot spring experiences have changed individuals and communities over the long term. It should be noted that the main subjects of this paper were focused on the hot spring communities in Taiwan. Therefore, the results cannot be generalized for all types of tourism destinations. That is, more diverse tourism destinations may be investigated to provide a broader perspective of post-disaster recovery.

Keywords: community resilience, hot spring destinations, individual resilience, posttraumatic growth

Procedia PDF Downloads 81

Authors: Rongrong Liu, Li Wang, Hui Xu, Jianpei Fang, Sixi Liu, Xiaolin Yin, Junbin Liang, Gaohui Yan, Yaoyun Li, Yali Zhou, Xinyu Li, Yue Li, Lei Shi, Yongrong Lai, Junjiu Huang, Xinhua Zhang

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Background: Beta-Thalassemia is caused by reduced (β+) or absent (β0) synthesis of the β-globin chains of hemoglobin. Transfusions and oral iron chelation therapy have improved the quality of life for patients with Transfusion-Dependent thalassemia (TDT). Recent advances in genome editing platforms of CRISPR-Cas9 have paved the way for induction of HbF by reactivating expression of γ-chain.Aims: We performed CRISPR-Cas9-mediated genome editing of hematopoietic stem cells to mutate HBG1/HBG2 promoter sequence, thereby representing a naturally occurring HPFH-liked mutation, producing RM-001. Here, we present an initial assessment of safety and efficacy of RM-001 in patients with TDT. Methods: Patients (6–35 y of age) with TDT receiving packed red blood cell (pRBC) transfusions of ≥100 mL/kg/y or ≥10 units/y in the previous 2 y were eligible. CD34+ cells were edited with CRISPR-Cas9 using a guide RNA specific for the binding site of BCL11A on the HBG1/2 promoter. Prior to RM-001 product infusion (day 0), patients received myeloablative conditioning with Busulfan from day-7 to day-4. Patients were monitored for AEs Hb expression.Results: Data cut as of 28 Feb 2024, 16 TDT patients have been treated with RM-001 and followed ≥3 months. 5 of these 16 patients had finished their 24 months follow up. Eleven patients have β0/β0 genotype and five patients have β0/β+ genotype. In addition to β-thalassemia, two patients had α- deletion with the genotype of --/αα. Efficacy:All patients received a single dose intravenous infusion of RM-001 cells. 5 of them had been followed 24 months or longer. All patients achieved transfusion-independent (TI, total Hb continued ≥ 9g/dL) (Figure1). Patients demonstrated sustained and clinically meaningful increases in HbF levels since 4 month post-RM-001 infusion (Figure.2). Total hemoglobin in all patients was stable at 10-12g/dL during the follow-up period. Safety:The adverse events observed after RM-001 infusion were consistent with those that are typical of Busulfan-based myeloablation. The allelic editing analysis at 6-month visit showed that the on-target allelic editing frequency in bone marrow cells was 73.44% (64.65% to 84.6%, n=13).Summary/Conclusion: This interim analysis, in which all the 19 patients age from 7.9 to 25yo met the success criteria for the trial with respect to transfusion independence, showed that autologous HBG1/2 promoter-modified CD34+ HSPCs gene therapy resulted in an adequate amount of HbF as early as 2 months after infusion led to near-normal hemoglobin levels, remained transfusion-free through the reported period without product related SAE. After RM-001 infusion, high levels of HbF proportion and on-target editing in bone marrow cells were maintained. Submitted on behalf of the RM-001 Investigators.

Keywords: thalassemian, genetherapy, CRISPR/Cas9, HbF

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Authors: Hsin-Hung Lin, Janet Chang, Te-Yi Chang, You-Sheng Huang

Abstract:

The natural and men-made disasters have become huge challenges for tourism destinations as well as emphasizing the fragility of the industry. Hot springs, among all destinations, are prone to disasters due to their dependence on natural resources and locations. After the COVID-19 outbreak, hot spring destinations have experienced not only the loss of businesses but also the psychological trauma. However, evidence has also shown that the impacts may not necessarily reduce the resilience for people but may be converted into posttraumatic growth. In Taiwan, a large proportion of hot springs are located in rural or indigenous areas. As a result, hot spring resources are associated with community cohesion for local residents. Yet prior research on hot spring destinations has mainly focused on visitors, whereas residents have been overlooked. More specifically, the relationship between hot springs resources and resident resilience in the face of the COVID-19 impacts remains unclear. To fulfill this knowledge gap, this paper aims to explore the COVID-19 impacts on residents’ hot spring experiences as well as individual and community resilience from the perspective of posttraumatic growth. A total of 315 residents of 13 hot spring destinations that are most popular in Taiwan were recruited. Online questionnaires were distributed over travel forums and social networks after the COVID-19. This paper subsequently used Partial Least Squares Structural Equation Modeling for data analysis as the technique offers significant advantages in addressing nonnormal data and small sample sizes. A preliminary test was conducted, and the results showed acceptable internal consistency and no serious common method variance. The path analysis demonstrated that the COVID-19 impacts strengthened residents’ perceptions of hot spring resources and experiences, implying that the pandemic had propelled the residents to visit hot springs for the healing benefits. In addition, the COVID-19 impacts significantly enhanced residents’ individual and community resilience, which indicates that the residents at hot springs are more resilient thanks to their awareness of external risks. Thirdly, residents’ individual resilience was positively associated with hot spring experiences, while community resilience was not affected by hot spring experiences. Such findings may suggest that hot spring experiences are more related to individual-level experiences and, consequently, have insignificant influence on community resilience. Finally, individual resilience was proved to be the most relevant factor that help foster community resilience. To conclude, the authorities may consider exploiting the hot spring resources so as to increase individual resilience for local residents. Such implications can be used as a reference for other post-disaster tourist destinations as well.As for future research, longitudinal studies with qualitative methods are suggested to better understand how the hot spring experiences have changed individuals and communities over the long term. It should be noted that the main subjects of this paper were focused on the hot spring communities in Taiwan. Therefore, the results cannot be generalized for all types of tourism destinations. That is, more diverse tourism destinations may be investigated to provide a broader perspective of post-disaster recovery.

Keywords: community resilience, hot spring destinations, individual resilience, posttraumatic growth (PTG)

Procedia PDF Downloads 74

Authors: Prajwal Paudel, Shreeprasad Adhikari, Shailendra Bir Karmacharya, Kalpana Upadhyaya

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Background: Human milk banks have been recommended by the World Health Organization (WHO) for newborn and child nourishment in the provision of optimum nutrition as an alternative to breastfeeding in circumstances when direct breastfeeding is inaccessible. The vulnerable group of babies, mainly preterm, low birth weight, and sick newborns, are at a greater risk of mortality and possibly benefit from the safe use of donated human milk through milk banks. In this study, we aimed to shed light on the process involved during the setting up of the nation’s first milk bank and its vitality in small and sick newborn nutrition and care. Methods: The study was conducted in Paropakar Maternity and Women’s Hospital, where the first human milk (HMB) was established. The establishment involved a stepwise process of need assessment meeting, formation of the HMB committee, learning visit to HMB in India, studying the strengths and weaknesses of promoting breastfeeding and HMB system integration, procurement, installation, and setting up the infrastructure, and developing technical competency, launching of the HMB. After the initiation of HMB services, information regarding the recruited donor mothers and the volume of milk pasteurized and consumed by the needy recipient babies were recorded. Descriptive statistics with frequencies and percentages were used to describe the utilization of HMB services. Results: During the study period, a total of 506113 ml of milk was collected, while 49930 ml of milk was pasteurized. Of the pasteurized milk, 381248 ml of milk was dispensed. The total volume of milk received was from a total of 883 after proper routine screening tests. Similarly, the total number of babies who received the donated human milk (DHM) was 912 with different neonatal conditions. Among the babies who received DHM, 527(57.7%) were born via CS, and 385 (42.21%) were delivered normally. In the birth weight category,9 (1%) of the babies were less than 1000 grams, 75 (8.2%) were less than 1500 grams, 405 (44.4%) were between 1500 to less than 2500 grams whereas, 423 (46.4%) of the babies who received DHM were normal weight babies. Among the sick newborns, perinatal asphyxia accounted for 166 (18.2%), preterm with other complications 372 (40.7%), preterm 23 (2.02%), respiratory distress 140 (15.35%), neonatal jaundice 150 (16.44%), sepsis 94 (10.30%), meconium aspiration syndrome 9(1%), seizure disorder 28 (3.07%), congenital anomalies 13 (1.42%) and others 33(3. 61%). The neonatal mortality rate dropped to 6.2/1000 live births from 7.5/1000 live births in the first year of establishment as compared to the previous year. Conclusion: The establishment of the first HMB in Nepal involved a comprehensive approach to integrate a new system with the existing newborn care in the provision of safe DHM. Premature babies with complication, babies born via CS, perinatal asphyxia and babies with sepsis consumed the greater proportion of DHM. Rigorous research is warranted to assess the impact of DHM in small and sick newborn who otherwise would be fed formula milk.

Keywords: human milk bank, sick-newborn, mortality, neonatal nutrition

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Authors: Kaveri Dutta, Ratna Sharma

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Indian traditional textile is a synthesis of various cultures. Art and crafts of a country showcases the rich cultural and artistic history of that nation. Prehistorically Indian handicrafts were basically made for day to day use; the yearning for aesthetic application soon saw the development of flooding designs and motifs. Similarly, Bagh print a traditional hand block Print with natural colours an Indian handicraft practiced in Bagh, Madhya Pradesh(India). Bagh print has its roots in Sindh, which is now a part of Pakistan. The present form of Bagh printing actually started in 1962 when the craftsmen migrated from Manavar to the neighboring town of Bagh situated in Madhya Pradesh and hence Bagh has always been associated with this printing style. Bagh printing basically involved blocks that are carved onto motifs that represent flora such as Jasmine, Mushroom leheriya and so on. There are some prints that were inspired by the jaali work that embellished the Taj Mahal and various other forts. Inspiration is also drawn from the landscapes and geometrical figures. The motifs evoke various moods in the serenity of the prints and that is the catchy element of Bagh prints. The development in this traditional textile is as essential as in another field. Nowadays fashion trends are fragile and innovative changes over existing fashion field in the short span is the demand of times. We must make efforts to preserve this cultural heritage of arts and crafts and this is done either by documenting the various ancient traditions or by making a blend of it. Since this craft is well known over the world, but the need is to document the original motif, fabric, technology and colors used in contemporary fashion. Hence keeping above points in mind this study on bagh print textiles of Madhya Pradesh work has been formulated. The information incorporated in the paper was based on secondary data taken from relevant books, journals, museum visit and articles. Besides for the demographic details and working profile of the artisans dealt with printing, an interview schedule was carried out in three regions of Madhya Pradesh. This work of art was expressed in Cotton fabric. For this study selected traditional motifs for Bang printing was used. Some of the popular traditional Bagh motifs are Jasmine, Mushroom leheriya, geometrical figures and jaali work. The Bagh printed cotton fabrics were developed into a range of men’s ethic wear in combination with embroideries from Rajasthan. Products developed were bandhgala jackets, kurtas, serwani and dupattas. From the present study, it can be observed that the embellished traditional Bang printed range of ethnic men’s wear resulted in the fresh and colourful pattern. The embroidered Bagh printed cotton fabric also created a huge change in a positive way among artisans of the three regions.

Keywords: art and craft of Madhya Pradesh, evolution of printing in India, history of Bagh printing, sources of inspiration

Procedia PDF Downloads 353

Authors: Jennifer Zelmer

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The debate regarding the morality, and therefore legality, of abortion has many social, political, and medical ramifications worldwide. In a developing country like Bolivia, carrying a pregnancy to delivery is incredibly risky. Given the very high maternal mortality rate in Bolivia, greater consideration has been given to the (de)criminalization of abortion – a contributing cause of maternal death. In the spring of 2017, the Bolivian government proposed to loosen restrictions on women’s access to receiving a safe abortion, which was met with harsh criticism from 'pro-vida' (pro-life) factions. Although the current Bolivian government Movimiento al Socialismo (Movement Toward Socialism) portrays an agenda of decolonization, or to seek a 'traditionally-modern' society, nevertheless, Bolivia still has one of the highest maternal mortality rates in the Americas, because of centuries of colonial and patriarchal order. Applying a feminist critique and using the abortion debate as the central point, this paper argues that the 'traditionally-modern' society Bolivia strives towards is a paradox, and in fact only contributes to the reciprocal process of the death of 'mother tongues' and the unnecessary death of women. This claim is supported by a critical analysis of historical texts about Spanish Colonialism in Bolivia; the linguistic reality of reproductive educational strategies, and the philosophical framework which the Bolivian government and its citizens implement. This analysis is demonstrated in the current state of women’s access to reproductive healthcare in Cochabamba, Bolivia based on recent fieldwork which included audits of clinics and hospitals, interviews, and participant observation. This paper has two major findings: 1) the language used by opponents of abortion in Bolivia is not consistent with the claim of being 'pro-life' but more accurately with being 'pro-potential'; 2) when the topic of reproductive health appears in Cochabamba, Bolivia, it is often found written in the Spanish language, and does not cater to the many indigenous communities that inhabit or visit this city. Finally, this paper considers the crucial role of public health documentation to better inform the abortion debate, as well as the necessity of expanding reproductive health information to more than text-based materials in Cochabamba. This may include more culturally appropriate messages and mediums that cater to the oral tradition of the indigenous communities, who historically and currently have some of the highest fertility rates. If the objective of one who opposes abortion is to save human lives, then preventing the death of women should equally be of paramount importance. But rather, the 'pro-life' movement in Bolivia is willing to risk the lives of to-be mothers, by judicial punishment or death, for the chance of a potential baby. Until abortion is fully legal, safe, and accessible, there will always be the vestiges of colonial and patriarchal order in Bolivia which only perpetuates the needless death of women.

Keywords: abortion, feminist theory, Quechua, reproductive health education

Procedia PDF Downloads 166

Authors: Debarpita Pande

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On 22nd May 2013 Chinese Premier Li Keqiang on his visit to Pakistan tabled a proposal for connecting Kashgar in China’s Xinjiang Uygur Autonomous Region with the south-western Pakistani seaport of Gwadar via the China Pakistan Economic Corridor (hereinafter referred to as CPEC). The project, popularly termed as 'One Belt One Road' will encompass within it a connectivity component including a 3000-kilometre road, railways and oil pipeline from Kashgar to Gwadar port along with an international airport and a deep sea port. Superficially, this may look like a 'game changer' for Pakistan and other countries of South Asia but this article by doctrinal method of research will unearth some serious flaws in it, which may change the entire economic system of this region heavily affecting the socio-economic conditions of South Asia, further complicating the complete geopolitical situation of the region disturbing the world economic stability. The paper besets with a logical analyzation of the socio-economic issues arising out of this project with an emphasis on its impact on the Pakistani and Indian economy due to Chinese dominance, serious tension in international relations, security issues, arms race, political and provincial concerns. The research paper further aims to study the impact of huge burden of loan given by China towards this project where Pakistan already suffers from persistent debts in the face of declining foreign currency reserves along with that the sovereignty of Pakistan will also be at stake as the entire economy of the country will be held hostage by China. The author compares this situation with the fallout from projects in Sri Lanka, Tajikistan, and several countries of Africa, all of which are now facing huge debt risks brought by Chinese investments. The entire economic balance will be muddled by the increment in Pakistan’s demand of raw materials resulting to the import of the same from China, which will lead to exorbitant price-hike and limited availability. CPEC will also create Chinese dominance over the international movement of goods that will take place between the Atlantic and the Pacific oceans and hence jeopardising the entire economic balance of South Asia along with Middle Eastern countries like Dubai. Moreover, the paper also analyses the impact of CPEC in the context of international unrest and arms race between Pakistan and India as well as India and China due to border disputes and Chinese surveillance. The paper also examines the global change in economic dynamics in international trade that CPEC will create in the light of U.S.-China relationship. The article thus reflects the grave consequences of CPEC on the international economy, security and bilateral relations, which surpasses the positive impacts of it. The author lastly suggests for more transparency and proper diplomatic planning in the execution of this mega project, which can be a cause of economic complexity in international trade in near future.

Keywords: China, CPEC, international trade, Pakistan

Procedia PDF Downloads 174

Authors: Andrea Ghermandi

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Natural treatment systems such as constructed wetlands and waste stabilization ponds are increasingly used to treat water and wastewater from a variety of sources, including stormwater and polluted surface water. The provision of ancillary benefits in the form of cultural ecosystem services makes these systems unique among water and wastewater treatment technologies and greatly contributes to determine their potential role in promoting sustainable water management practices. A quantitative analysis of these benefits, however, has been lacking in the literature. Here, a critical assessment of the recreational and educational benefits in natural treatment systems is provided, which combines observed public use from a survey of managers and operators with estimated public use as obtained using geotagged photos from social media as a proxy for visitation rates. Geographic Information Systems (GIS) are used to characterize the spatial boundaries of 273 natural treatment systems worldwide. Such boundaries are used as input for the Application Program Interfaces (APIs) of two popular photo-sharing websites (Flickr and Panoramio) in order to derive the number of photo-user-days, i.e., the number of yearly visits by individual photo users in each site. The adequateness and predictive power of four univariate calibration models using the crowdsourced data as a proxy for visitation are evaluated. A high correlation is found between photo-user-days and observed annual visitors (Pearson's r = 0.811; p-value < 0.001; N = 62). Standardized Major Axis (SMA) regression is found to outperform Ordinary Least Squares regression and count data models in terms of predictive power insofar as standard verification statistics – such as the root mean square error of prediction (RMSEP), the mean absolute error of prediction (MAEP), the reduction of error (RE), and the coefficient of efficiency (CE) – are concerned. The SMA regression model is used to estimate the intensity of public use in all 273 natural treatment systems. System type, influent water quality, and area are found to statistically affect public use, consistently with a priori expectations. Publicly available information regarding the home location of the sampled visitors is derived from their social media profiles and used to infer the distance they are willing to travel to visit the natural treatment systems in the database. Such information is analyzed using the travel cost method to derive monetary estimates of the recreational benefits of the investigated natural treatment systems. Overall, the findings confirm the opportunities arising from an integrated design and management of natural treatment systems, which combines the objectives of water quality enhancement and provision of cultural ecosystem services through public use in a multi-functional approach and compatibly with the need to protect public health.

Keywords: constructed wetlands, cultural ecosystem services, ecological engineering, waste stabilization ponds

Procedia PDF Downloads 180

Authors: Aritra Das, Tanmay Mahapatra, Prabir Maharana, Sridhar Srikantiah

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In the absence of adequate well-equipped neonatal-care facilities serving rural Bihar, India, the practice of essential home-based newborn-care remains critically important for reduction of neonatal and infant mortality, especially among pre-term and small-for-gestational-age (Low-birth-weight) newborns. To improve the child health parameters in Bihar, ‘Very-Low-Birth-Weight (vLBW) Tracking’ intervention is being conducted by CARE India, since 2015, targeting public facility-delivered newborns weighing ≤2000g at birth, to improve their identification and provision of immediate post-natal care. To assess the effectiveness of the intervention, 200 public health facilities were randomly selected from all functional public-sector delivery points in Bihar and various outcomes were tracked among the neonates born there. Thus far, one pre-intervention (Feb-Apr’2015-born neonates) and three post-intervention (for Sep-Oct’2015, Sep-Oct’2016 and Sep-Oct’2017-born children) follow-up studies were conducted. In each round, interviews were conducted with the mothers/caregivers of successfully-tracked children to understand outcome, service-coverage and care-seeking during the neonatal period. Data from 171 matched facilities common across all rounds were analyzed using SAS-9.4. Identification of neonates with birth-weight ≤ 2000g improved from 2% at baseline to 3.3%-4% during post-intervention. All indicators pertaining to post-natal home-visits by frontline-workers (FLWs) improved. Significant improvements between baseline and post-intervention rounds were also noted regarding mothers being informed about ‘weak’ child – at the facility (R1 = 25 to R4 = 50%) and at home by FLW (R1 = 19%, to R4 = 30%). Practice of ‘Kangaroo-Mother-Care (KMC)’– an important component of essential newborn care – showed significant improvement in postintervention period compared to baseline in both facility (R1 = 15% to R4 = 31%) and home (R1 = 10% to R4=29%). Increasing trend was noted regarding detection and birth weight-recording of the extremely low-birth-weight newborns (< 1500 g) showed an increasing trend. Moreover, there was a downward trend in mortality across rounds, in each birth-weight strata (< 1500g, 1500-1799g and >= 1800g). After adjustment for the differential distribution of birth-weights, mortality was found to decline significantly from R1 (22.11%) to R4 (11.87%). Significantly declining trend was also observed for both early and late neonatal mortality and morbidities. Multiple regression analysis identified - birth during immediate post-intervention phase as well as that during the maintenance phase, birth weight > 1500g, children of low-parity mothers, receiving visit from FLW in the first week and/or receiving advice on extra care from FLW as predictors of survival during neonatal period among vLBW newborns. vLBW tracking was found to be a successful and sustainable intervention and has already been handed over to the Government.

Keywords: weak newborn tracking, very low birth weight babies, newborn care, community response

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Authors: Areej Al-Khabbaz, Swapna Goerge, Majedah Abdul-Rasoul

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Introduction: The most prevalent periodontal disease among children is gingivitis, and it usually becomes more severe in adolescence. A number of intervention studies suggested that resolution of periodontal inflammation can improve metabolic control in patients diagnosed with diabetes mellitus. Aim: to assess the effect of non-surgical periodontal therapy on glycemic control of children diagnosed with diabetes mellitus. Method: Twenty-eight children diagnosed with diabetes mellitus were recruited with established diagnosis diabetes for at least 1 year. Informed consent and child assent form were obtained from children and parents prior to enrolment. The dental examination for the participants was performed on the same week directly following their annual medical assessment. All patients had their glycosylated hemoglobin (HbA1c%) test one week prior to their annual medical and dental visit and 3 months following non-surgical periodontal therapy. All patients received a comprehensive periodontal examination The periodontal assessment included clinical attachment loss, bleeding on probing, plaque score, plaque index and gingival index. All patients were referred for non-surgical periodontal therapy, which included oral hygiene instruction and motivation followed by supra-gingival and subg-ingival scaling using ultrasonic and hand instruments. Statistical Analysis: Data were entered and analyzed using the Statistical Package for Social Science software (SPSS, Chicago, USA), version 18. Statistical analysis of clinical findings was performed to detect differences between the two groups in term of periodontal findings and HbA1c%. Binary logistic regression analysis was performed in order to examine which factors were significant in multivariate analysis after adjusting for confounding between effects. The regression model used the dependent variable ‘Improved glycemic control’, and the independent variables entered in the model were plaque index, gingival index, bleeding %, plaque Statistical significance was set at p < 0.05. Result: A total of 28 children. The mean age of the participants was 13.3±1.92 years. The study participants were divided into two groups; Compliant group (received dental scaling) and non-complaints group (received oral hygiene instructions only). No statistical difference was found between compliant and non-compliant group in age, gender distribution, oral hygiene practice and the level of diabetes control. There was a significant difference between compliant and non-compliant group in term of improvement of HBa1c before and after periodontal therapy. Mean gingival index was the only significant variable associated with improved glycemic control level. In conclusion, this study has demonstrated that non-surgical mechanical periodontal therapy can improve HbA1c% control. The result of this study confirmed that children with diabetes mellitus who are compliant to dental care and have routine professional scaling may have better metabolic control compared to diabetic children who are erratic with dental care.

Keywords: children, diabetes, metabolic control, periodontal therapy

Procedia PDF Downloads 161

Authors: Mathula Thangarajh

Abstract:

Duchenne muscular dystrophy (DMD) is a severe form of X-linked muscular dystrophy caused by mutations in the dystrophin gene resulting in progressive skeletal muscle weakness. Boys with DMD also have significant cognitive disabilities. The intelligence quotient of boys with DMD, compared to peers, is approximately one standard deviation below average. Detailed neuropsychological testing has demonstrated that boys with DMD have a global developmental impairment, with verbal memory and visuospatial skills most significantly affected. Furthermore, the total brain volume and gray matter volume are lower in children with DMD compared to age-matched controls. These results are suggestive of a significant structural and functional compromise to the developing brain as a result of absent dystrophin protein expression. There is also some genetic evidence to suggest that mutations in the 3’ end of the DMD gene are associated with more severe neurocognitive problems. Our working hypothesis is that (i) boys with DMD do not make gains in neurodevelopmental skills compared to typically developing children and (ii) women carriers of DMD mutations may have subclinical cognitive deficits. We also hypothesize that there may be an intergenerational vulnerability of cognition, with boys of DMD-carrier mothers being more affected cognitively than boys of non-DMD-carrier mothers. The objectives of this study are: 1. Assess the neurodevelopment in boys with DMD at 4-time points and perform baseline neuroradiological assessment, 2. Assess cognition in biological mothers of DMD participants at baseline, 3. Assess possible correlation between DMD mutation and cognitive measures. This study also explores functional brain abnormalities in people with DMD by exploring how regional and global connectivity of the brain underlies executive function deficits in DMD. Such research can contribute to a better holistic understanding of the cognition alterations due to DMD and could potentially allow clinicians to create better-tailored treatment plans for the DMD population. There are four study visits for each participant (baseline, 2-4 weeks, 1 year, 18 months). At each visit, the participant completes the NIH Toolbox Cognition Battery, a validated psychometric measure that is recommended by NIH Common Data Elements for use in DMD. Visits 1, 3, and 4 also involve the administration of the BRIEF-2, ABAS-3, PROMIS/NeuroQoL, PedsQL Neuromuscular module 3.0, Draw a Clock Test, and an optional fMRI scan with the N-back matching task. We expect to enroll 52 children with DMD, 52 mothers of children with DMD, and 30 healthy control boys. This study began in 2020 during the height of the COVID-19 pandemic. Due to this, there were subsequent delays in recruitment because of travel restrictions. However, we have persevered and continued to recruit new participants for the study. We partnered with the Muscular Dystrophy Association (MDA) and helped advertise the study to interested families. Since then, we have had families from across the country contact us about their interest in the study. We plan to continue to enroll a diverse population of DMD participants to contribute toward a better understanding of Duchenne Muscular Dystrophy.

Keywords: neurology, Duchenne muscular dystrophy, muscular dystrophy, cognition, neurodevelopment, x-linked disorder, DMD, DMD gene

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Authors: Amy Williamson, Kerry Armstrong, Jason Edwards, Patricia Obst

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Australian national policy endorses a responsive approach to work health and safety (WHS) regulation, combining positive motivators (education and guidance), with compliance monitoring and enforcement to encourage and secure compliance with legislation. Despite theoretical support for responsive regulation, there is limited evidence regarding how to achieve best results in practice. Using positive psychology as a novel paradigm, this study aims to investigate how non-punitive regulatory interactions can be improved to further encourage regulatory compliance in the construction industry. As part of a larger project, semi-structured interviews were conducted with 35 inspectorate staff and 11 managers in the Australian (Queensland) construction industry. Using an inductive, grounded approach, an in-depth qualitative investigation was conducted to identify the positive psychological principles which underpin effective use of the non-punitive aspects of responsive regulation. Results highlighted the importance of effective engagement between inspectors and industry managers. This involved the need to interact cooperatively and encourage compliance with WHS legislation. Several strategies were identified that assisted regulatory interactions and the ability of inspectors to engage. The importance of communication and interpersonal skills was reported to be critical to any interaction, regardless of the nature of the visit and regulatory tools used. In particular, the use of clear and open communication fostered trust and rapport which facilitated more positive interactions. The importance of respect and empathy was also highlighted. The need for provision of guidance and direction on how to achieve compliance was also reported. This related to ensuring companies understand their WHS obligations, providing specific advice regarding how to rectify a breach and meet compliance requirements, and ensuring sufficient follow up to confirm that compliance is successfully achieved. In the absence of imminent risk, allowing companies the opportunity to comply before further action is taken was also highlighted. Increased proactive engagement with industry to educate and promote the vision of safety at work was also reported. Finally, provision of praise and positive feedback was reported to assist interactions and encourage the continuation of good practices. Evidence from positive psychology and organisational psychology was obtained to support the use of each strategy in practice. In particular, the area of positive leadership provided a useful framework to consider the factors and conditions that drive positive interactions within the context of work health and safety and the specific relationship between inspectors and industry managers. This study provides fresh insight into key psychological principles which support non-punitive regulatory interactions in the area of workplace health and safety. The findings of this research contribute to a better understanding of how inspectors can enhance the efficacy of their regulatory interactions to improve compliance with legislation. Encouraging and assisting compliance through effective non-punitive activity offers a sustainable pathway for promoting safety and preventing fatalities and injuries in the construction industry.

Keywords: engagement, non-punitive approaches to compliance, positive interactions in the workplace, work health and safety compliance

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Authors: Naniek Widayati Priyomarsono

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Introduction: In beginning of Karaton formation, namely, era of Javanese kingdom town had the power region outside castle town (called as Mancanegara), settlement of karaton can function as “the space-between” and “space-defense”, besides it was one of components from governmental structure and karaton power at that time (internal servant/abdi dalem and sentana dalem). Upon the Independence of Indonesia in 1945 “Kingdom-City” converted its political status into part of democratic town managed by statutes based on the classification. The latter affects local culture hierarchy alteration due to the physical development and events. Dynamics of social economy activities in Kampung Karaton surrounded by buildings of Complex of Karaton Kasunanan ini, have impact on the urban system disturbed into the región. Also cultural region image fades away with the weak visual access from existant cultural artefacts. That development lacks of giving appreciation to the established region image providing identity of Karaton Kasunanan particularly and identity of Surakarta city in general. Method used is strategy of grounded theory research (research providing strong base of a theory). Research is focused on actors active and passive relevantly getting involved in change process of Karaton settlement. Data accumulated is “Investigation Focus” oriented on actors affecting that change either internal or external. Investigation results are coupled with field observation data, documentation, literature study, thus it takes accurate findings. Findings: Karaton village has potential products as attraction, possessing human resource support, strong motivation from society still living in that settlement, possessing facilities and means supports, tourism event-supporting facilities, cultural art institution, available fields or development area. Data analyzed: To get the expected result it takes restoration in social cultural development direction, and economy, with ways of: Doing social cultural development strategy, economy, and politics. To-do steps are program socialization of Karaton village as Tourism Village, economical development of local society, regeneration pattern, filtering, and selection of tourism development, integrated planning system development, development with persuasive approach, regulation, market mechanism, social cultural event sector development, political development for region activity sector. Summary: In case the restoration is done by getting society involved as subject of that settlement (active participation in the field), managed and packed interestingly and naturally with tourism-supporting facilities development, village of Karaton Kasunanan Surakarta is ready to receive visit of domestic and foreign tourists.

Keywords: karaton village, finding, restoration, economy, Indonesia

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Authors: Benachour Karima

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Pollination is a key factor in crop production and the presence of insect pollinators, mainly wild bees, is essential for improving yields. In this work, visiting apoids of two vegetable crops, the turnip (Brassica rapa L.) and the radish (Raphanus sativus L.) (Brassicaceae) were recorded during flowering times of 2003 and 2004 in Constantine area (36°22’N 06°37’E, 660 m). The observations were conducted in a plot of approximately 308 m2 of the Institute of Nutrition, Food and Food Technology (University of Mentouri Brothers). To estimate the density of bees (per 100 flowers or m2), 07 plots (01m2 for each one) are defined from the edge of the culture and in the first two rows. From flowering and every two days, foraging insects are recorded from 09 am until 17 pm (Gmt+1).The purpose of visit (collecting nectar, pollen or both) and pollinating efficiency (estimated by the number of flowers visited per minute and the number of positive visits) were noted for the most abundant bees on flowers. The action of pollinating insects is measured by comparing seed yields of 07 plots covered with tulle with 07 other accessible to pollinators. 04 families of Apoidea: Apidae, Halictidae, Andrenidae and Megachilidae were observed on the two plants. On turnip, the honeybee is the most common visitor (on average 214visites/ m2), it is followed by the Halictidae Lasioglossum mediterraneum whose visits are less intense (20 individuals/m2). Visits by Andrenidae, represented by several species such as Andrena lagopus, A.flavipes, A.agilissima and A.rhypara were episodic. The honeybee collected mainly nectar, its visits were all potentially fertilizing (contact with stigma) and more frequent (on average 14 flowers/min. L.mediterraneum visited only 05 flrs/min, it collected mostly the two products together and all its visits were also positive. On radish, the wild bee Ceratina cucurbitina recorded the highest number of visits (on average 06 individuals/100flo wers), the Halictidae represented mainly by L.mediterraneum, and L.malachurum, L.pauxillum were less abundant. C.cucurbitina visited on average 10 flowers /min and all its visits are positive. Visits of Halictidae were less frequent (05-06 flowers/min) and not all fertilizing. Seed yield of Brassica rapa (average number of pods /plant, seeds/ pods and average weight of 1000 seeds) was significantly higher in the presence of pollinators. Similarly, the pods of caged plants gave a percentage of aborted seeds (10.3%) significantly higher than that obtained on free plants (4.12%), the pods of caged plants also gave a percentage of malformed seeds (1.9%) significantly higher than that of the free plants (0.9%). For radish, the seed yield in the presence and absence of insects are almost similar. Only the percentage of malformed seeds (3.8%) obtained from the pods of caged plants was significantly higher in comparison with pods of free plants (1.9%). Following these results, it is clear that pollinators especially bees are essential for the production and improvement of crop yields and therefore it is necessary to protect this fauna increasingly threatened.

Keywords: foraging behavior, honey bee, radish, seed yield, turnip, wild bee

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Authors: Richard Levy, Peter Dawson

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Ft. Conger, located in the Canadian Arctic was one of the most remote 19th-century scientific stations. Established in 1881 on Ellesmere Island, a wood framed structure established a permanent base from which to conduct scientific research. Under the charge of Lt. Greely, Ft. Conger was one of 14 expeditions conducted during the First International Polar Year (FIPY). Our research project “From Science to Survival: Using Virtual Exhibits to Communicate the Significance of Polar Heritage Sites in the Canadian Arctic” focused on the creation of a virtual museum website dedicated to one of the most important polar heritage site in the Canadian Arctic. This website was developed under a grant from Virtual Museum of Canada and enables visitors to explore the fort’s site from 1875 to the present, http://fortconger.org. Heritage sites are often viewed as static places. A goal of this project was to present the change that occurred over time as each new group of explorers adapted the site to their needs. The site was first visited by British explorer George Nares in 1875 – 76. Only later did the United States government select this site for the Lady Franklin Bay Expedition (1881-84) with research to be conducted under the FIPY (1882 – 83). Still later Robert Peary and Matthew Henson attempted to reach the North Pole from Ft. Conger in 1899, 1905 and 1908. A central focus of this research is on the virtual reconstruction of the Ft. Conger. In the summer of 2010, a Zoller+Fröhlich Imager 5006i and Minolta Vivid 910 laser scanner were used to scan terrain and artifacts. Once the scanning was completed, the point clouds were registered and edited to form the basis of a virtual reconstruction. A goal of this project has been to allow visitors to step back in time and explore the interior of these buildings with all of its artifacts. Links to text, historic documents, animations, panorama images, computer games and virtual labs provide explanations of how science was conducted during the 19th century. A major feature of this virtual world is the timeline. Visitors to the website can begin to explore the site when George Nares, in his ship the HMS Discovery, appeared in the harbor in 1875. With the emergence of Lt Greely’s expedition in 1881, we can track the progress made in establishing a scientific outpost. Still later in 1901, with Peary’s presence, the site is transformed again, with the huts having been built from materials salvaged from Greely’s main building. Still later in 2010, we can visit the site during its present state of deterioration and learn about the laser scanning technology which was used to document the site. The Science and Survival at Fort Conger project represents one of the first attempts to use virtual worlds to communicate the historical and scientific significance of polar heritage sites where opportunities for first-hand visitor experiences are not possible because of remote location.

Keywords: 3D imaging, multimedia, virtual reality, arctic

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Authors: Joao Ferreira Do Rosario, Maria De Lurdes Calisto, Ana Teresa Machado, Nuno Gustavo, Rui Gonçalves

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The tourism sector is increasingly important to the economic performance of countries and a relevant theme to academic research, increasing the importance of understanding how and why tourists evaluate tourism locations. The city of Lisbon is currently a tourist destination of excellence in the European and world-wide panorama, registering a significant growth of the economic weight of its tourist activities in the Gross Added Value of the region. Although there is research on the feedback of those who visit tourist sites and different methodologies for studying tourist sites have been applied, this research seeks to be innovative in the objective of obtaining insights on the competitiveness in terms of attractiveness of the city of Lisbon as a tourist destination, based the feedback of tourists in the Facebook pages of the most visited museums and monuments of Lisbon, an interpretation that is relevant in the development of strategies of tourist attraction. The intangible dimension of the tourism offer, due to its unique condition of simultaneous production and consumption, makes eWOM particularly relevant. The testimony of consumers is thus a decisive factor in the decision-making and buying process in tourism. Online social networks are one of the most used platforms for tourists to evaluate the attractiveness's points of a tourism destination (e.g. cultural and historical heritage), with this user-generated feedback enabling relevant information about the customer-tourists. This information is related to the tourist experience representing the true voice of the customer. Furthermore, this voice perceived by others as genuine, opposite to marketing messages, may have a powerful word-of-mouth influence on other potential tourists. The relevance of online reviews sharing, however, becomes particularly complex, considering social media users’ different profiles or the possible and different sources of information available, as well as their associated reputation associated with each source. In the light of these trends, our research focuses on the tourists’ feedback on Facebook pages of the most visited museums and monuments of Lisbon that contribute to its attractiveness as a tourism destination. Sentiment Analysis is the methodology selected for this research, using public available information in the online context, which was deemed as an appropriate non-participatory observation method. Data will be collected from two museums (Museu dos Coches and Museu de Arte Antiga) and three monuments ((Mosteiro dos Jerónimos, Torre de Belém and Panteão Nacional) Facebook pages during a period of one year. The research results will help in the evaluation of the considered places by the tourists, their contribution to the city attractiveness and present insights helpful for the management decisions regarding this museums and monuments. The results of this study will also contribute to a better knowledge of the tourism sector, namely the identification of attributes in the evaluation and choice of the city of Lisbon as a tourist destination. Further research will evaluate the Lisbon attraction points for tourists in different categories beyond museums and monuments, will also evaluate the tourist feedback from other sources like TripAdvisor and apply the same methodology in other cities and country regions.

Keywords: Lisbon tourism, opinion mining, sentiment analysis, tourism location attractiveness evaluation

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Authors: Sharon Millen, Sarah Miller, Laura Dunne, Clare McGeady, Laura Neeson

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This paper presents the findings from a randomised controlled trial (RCT) and process evaluation of the Lifestart parenting programme. Lifestart is a structured child-centred programme of information and practical activity for parents of children aged from birth to five years of age. It is delivered to parents in their own homes by trained, paid family visitors and it is offered to parents regardless of their social, economic or other circumstances. The RCT evaluated the effectiveness of the programme and the process evaluation documented programme delivery and included a qualitative exploration of parent and child outcomes. 424 parents and children participated in the RCT: 216 in the intervention group and 208 in the control group across the island of Ireland. Parent outcomes included: parental knowledge of child development, parental efficacy, stress, social support, parenting skills and embeddedness in the community. Child outcomes included cognitive, language and motor development and social-emotional and behavioural development. Both groups were tested at baseline (when children were less than 1 year old), mid-point (aged 3) and at post-test (aged 5). Data were collected during a home visit, which took two hours. The process evaluation consisted of interviews with parents (n=16 at baseline and end-point), and focus groups with Lifestart Coordinators (n=9) and Family Visitors (n=24). Quantitative findings from the RCT indicated that, compared to the control group, parents who received the Lifestart programme reported reduced parenting-related stress, increased knowledge of their child’s development, and improved confidence in their parenting role. These changes were statistically significant and consistent with the hypothesised pathway of change depicted in the logic model. There was no evidence of any change in parents’ embeddedness in the community. Although four of the five child outcomes showed small positive change for children who took part in the programme, these were not statistically significant and there is no evidence that the programme improves child cognitive and non-cognitive skills by immediate post-test. The qualitative process evaluation highlighted important challenges related to conducting trials of this magnitude and design in the general population. Parents reported that a key incentive to take part in study was receiving feedback from the developmental assessment, which formed part of the data collection. This highlights the potential importance of appropriate incentives in relation to recruitment and retention of participants. The interviews with intervention parents indicated that one of the first changes they experienced as a result of the Lifestart programme was increased knowledge and confidence in their parenting ability. The outcomes and pathways perceived by parents and described in the interviews are also consistent with the findings of the RCT and the theory of change underpinning the programme. This hypothesises that improvement in parental outcomes, arising as a consequence of the programme, mediate the change in child outcomes. Parents receiving the Lifestart programme reported great satisfaction with and commitment to the programme, with the role of the Family Visitor being identified as one of the key components of the programme.

Keywords: parent-child relationship, parental self-efficacy, parental stress, school readiness

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Authors: Abdalla Ahmed Abdrabou Emam Eldeib

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For more than a century, the Hague Conference has tackled issues in the most challenging areas of private international law, including family law. Its actions in the realm of international child abduction have been remarkable in two ways during the last two decades. First, on October 25, 1980, the Hague Convention on the Civil Aspects of International Child Abduction (the Convention) was promulgated as an unusually inventive and powerful tool. Second, the Convention is rapidly becoming more prominent in the development of international child law. By that time, overseas travel had grown more convenient, and more couples were marrying or travelling across national lines. At the same time, parental separation and divorce have increased, leading to an increase in international child custody battles. The convention they drafted avoids legal quagmires and addresses extra-legal issues well. It literally restores the kid to its place of usual residence by establishing that the youngster was unlawfully abducted from that position or, alternatively, was wrongfully kept abroad after an allowed visit. Legal custody of a child of a contested parent is usually followed by the child's abduction or unlawful relocation to another country by the non-custodial parent or other persons. If a child's custodial parent lives outside of Egypt, the youngster may be kidnapped and brought to Egypt. It's natural to ask what laws should apply and what legal norms should be followed while hearing individual instances. This study comprehensively evaluates and estimates the relevant Hague Child Abduction Convention and the current situation in Egypt and which law is applicable for child custody. In addition, this research emphasis, detail, and focus on the position of Cross-border parental child abductions in Egypt. Moreover, examine the Islamic law compared to the Hague Convention on Child Custody in detail, as well as mentioning the treatment of Islamic countries in this matter in general and Egypt's treatment of this matter in particular, as well as the criticism directed at Egypt regarding the application and implementation of child custody issues. The present research backs up this method by using non-doctrinal techniques, including surveys, interviews, and dialogues. An important objective of this research is to examine the factors that contribute to parental child abduction. In this case, family court attorneys and other interested parties serve as the target audience from whom data is collected. A survey questionnaire was developed and sent to the target population in order to collect data for future empirical testing to validate the identified critical factors on Parental Child Abduction. The main finding in this study is breaking the reservations of many Muslim countries to join the Hague Convention with regard to child custody., Likewise, clarify the problems of implementation in practice in cases of kidnapping a child from one of the parents and traveling with him outside the borders of the country. Finally, this study is to provide suggestions for reforming the current Egyptian Family Law to make it an effective and efficient for all dispute's resolution mechanism and the possibility of joining The Hague Convention.

Keywords: egyptian family law, Hague child abduction convention, child custody, cross-border parental child abductions in egypt

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Authors: Wanvipa Thongborisute, Punyaphat Sirithanabadeekul, Pichit Suvanprakorn, Anan Jiraviroon

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Background: Acne vulgaris is one of the most common dermatologic problems, and can have a significant psychological and physical effect on patients. Propionibacterium acnes' roles in acne vulgaris involve the activation of toll-like receptor 4 (TLR4), and toll-like receptor 2 (TLR2) pathways. By activating these pathways, inflammatory events of acne lesions, comedogenesis and sebaceous lipogenesis can occur. Currently, there are several topical agents commonly use in treating acne vulgaris that are known to have an effect on TLRs, such as retinoic acid and adapalene, but these drugs still have some irritating effects. At present, there is an alarming increase in rate of bacterial resistance due to irrational used of antibiotics both orally and topically. For this reason, acne treatments should contain bioactive molecules targeting at the site of action for the most effective therapeutic effect with the least side effects. Sparganium stoloniferumis a Chinese aquatic herb containing a compound called Sparstolonin B (SsnB), which has been reported to selectively blocks Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4)-mediated inflammatory signals. Therefore, this topical TLR2 and TLR4 antagonist, in a form of Sparganium stoloniferum-derived compound containing SsnB, should give a benefit in reducing inflammation of acne vulgaris lesions and providing an alternative treatments for patients with this condition. Materials and Methods: The objectives of this randomized double blinded split faced placebo controlled trial is to study the safety and efficacy of the Sparganium stoloniferum-derived compound. 32 volunteered patients with mild to moderate degree of acne vulgaris according to global acne grading system were included in the study. After being informed and consented the subjects were given 2 topical treatments for acne vulgaris, one being topical 2.40% Sparganium stoloniferum extraction (containing Sparstolonin B) and the other, placebo. The subjects were asked to apply each treatment to either half of the face daily morning and night by randomization for 8 weeks, and come in for a weekly follow up. For each visit, the patients went through a procedure of lesion counting, including comedones, papules, nodules, pustules, and cystic lesions. Results: During 8 weeks of experimentation, the result shows a reduction in total lesions number between the placebo and the treatment side show statistical significance starting at week 4, where the 95% confidence interval begin to no longer overlap, and shows a trend of continuing to be further apart. The decrease in the amount of total lesions between week 0 and week 8 of the placebo side shows no statistical significant at P value >0.05. While the decrease in the amount of total lesions of acne vulgaris of the treatment side comparing between week 0 and week 8 shows statistical significant at P value <0.001. Conclusion: The data demonstrates that 2.40% Sparganium stoloniferum extraction (containing Sparstolonin B) is more effective in treating acne vulgaris comparing to topical placebo in treating acne vulgaris, by showing significant reduction in the total numbers of acne lesions. Therefore, this topical Sparganium stoloniferum extraction could become a potential alternative treatment for acne vulgaris.

Keywords: acne vulgaris, sparganium stoloniferum, sparstolonin B, toll-like receptor 2, toll-like receptor 4

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Authors: Salima Bijapuri, Shweta Bhatbolan, Sejalben Patel

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Ergonomics concerns the fitting of the environment and the equipment to the worker. Ergonomic principles can be employed in different dimensions of the industrial sector. Participation of all the stakeholders is the key to the formulation of a multifaceted and comprehensive approach to lessen the burden of occupational hazards. Taking responsibility for one’s own work activities by acquiring sufficient knowledge and potential to influence the practices and outcomes is the basis of participatory ergonomics and even hastens the process to identify workplace hazards. The study was aimed to check how participatory ergonomics can be effective in the management of work-related musculoskeletal disorders. Method: A mega kitchen was identified in a twin city of Karnataka, India. Consent was taken, and the screening of workers was done using observation methods. Kitchen work was structured to include different tasks, which included preparation, cooking, distributing, and serving food, packing food to be delivered to schools, dishwashing, cleaning and maintenance of kitchen and equipment, and receiving and storing raw material. Total 100 workers attended the education session on participatory ergonomics and its role in implementing the correct ergonomic practices, thus preventing WRMSDs. Demographic details and baseline data on related musculoskeletal pain and discomfort were collected using the Nordic pain questionnaire and VAS score pre- and post-study. Monthly visits were made, and the education sessions were reiterated on each visit, thus reminding, correcting, and problem-solving of each worker. After 9 months with a total of 4 such education session, the post education data was collected. The software SPSS 20 was used to analyse the collected data. Results: The majority of them (78%), depending on the availability and feasibility, participated in the intervention workshops were arranged four times. The average age of the participants was 39 years. The percentage of female participants was 79.49%, and 20.51% of participants comprised of males. The Nordic Musculoskeletal Questionnaire (NMQ) showed that knee pain was the most commonly reported complaint (62%) from the last 12 months with a mean VAS of 6.27, followed by low back pain. Post intervention, the mean VAS Score was reduced significantly to 2.38. The comparison of pre-post scores was made using Wilcoxon matched pairs test. Upon enquiring, it was found that, the participants learned the importance of applying ergonomics at their workplace which inturn was beneficial for them to handle any problems arising at their workplace on their own with self confidence. Conclusion: The participatory ergonomics proved effective with workers of mega kitchen, and it is a feasible and practical approach. The advantage of the given study area was that it had a sophisticated and ergonomically designed workstation; thus it was the lack of education and practical knowledge to use these stations was of utmost need. There was a significant reduction in VAS scores with the implementation of changes in the working style, and the knowledge of ergonomics helped to decrease physical load and improve musculoskeletal health.

Keywords: ergonomic awareness session, mega kitchen, participatory ergonomics, work related musculoskeletal disorders

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Authors: Truong H. Le, Ngoc M. To, Quang N. Tran, Luu T. Cao, Chi V. Le

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Introduction: In Vietnam, the current monitoring and treatment for ordinary diabetic patient mostly based on glucose monitoring with HbA1c test for every three months (recommended goal is HbA1c < 6.5%~7%). For diabetes in pregnant women or Gestational diabetes mellitus (GDM), glycemic control until the time of delivery is extremly important because it could reduce significantly medical implications for both the mother and the child. Besides, GDM requires continuos glucose monitoring at least every two weeks and therefore an alternative marker of glycemia for short-term control is considering a potential tool for the healthcare providers. There are published studies have indicated that the glycosylated serum protein is a better indicator than glycosylated hemoglobin in GDM monitoring. Based on the actual practice in Vietnam, this study was designed to evaluate the role of serum fructosamine as a monitoring tool in GDM treament and its correlations with fasting blood glucose (G0), 2-hour postprandial glucose (G2) and glycosylated hemoglobin (HbA1c). Methods: A cohort study on pregnant women diagnosed with GDM by the 75-gram oralglucose tolerance test was conducted at Endocrinology Department, Cho Ray hospital, Vietnam from June 2014 to March 2015. Cho Ray hospital is the final destination for GDM patient in the southern of Vietnam, the study population has many sources from other pronvinces and therefore researchers belive that this demographic characteristic can help to provide the study result as a reflection for the whole area. In this study, diabetic patients received a continuos glucose monitoring method which consists of bi-weekly on-site visit every 2 weeks with glycosylated serum protein test, fasting blood glucose test and 2-hour postprandial glucose test; HbA1c test for every 3 months; and nutritious consultance for daily diet program. The subjects still received routine treatment at the hospital, with tight follow-up from their healthcare providers. Researchers recorded bi-weekly health conditions, serum fructosamine level and delivery outcome from the pregnant women, using Stata 13 programme for the analysis. Results: A total of 500 pregnant women was enrolled and follow-up in this study. Serum fructosamine level was found to have a light correlation with G0 ( r=0.3458, p < 0.001) and HbA1c ( r=0.3544, p < 0.001), and moderately correlated with G2 ( r=0.4379, p < 0.001). During study timeline, the delivery outcome of 287 women were recorded with the average age of 38.5 ± 1.5 weeks, 9% of them have macrosomia, 2.8% have premature birth before week 35th and 9.8% have premature birth before week 37th; 64.8% of cesarean section and none of them have perinatal or neonatal mortality. The study provides a reference interval of serum fructosamine for GDM patient was 112.9 ± 20.7 μmol/dL. Conclusion: The present results suggests that serum fructosamine is as effective as HbA1c as a reflection of blood glucose control in GDM patient, with a positive result in delivery outcome (0% perinatal or neonatal mortality). The reference value of serum fructosamine measurement provided a potential monitoring utility in GDM treatment for hospitals in Vietnam. Healthcare providers in Cho Ray hospital is considering to conduct more studies to test this reference as a target value in their GDM treatment and monitoring.

Keywords: gestational diabetes mellitus, monitoring tool, serum fructosamine, Vietnam

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Authors: Bill Wason

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143 Crude Palm Oil Coop mills on Sumatra Island are participating in a program to transfer land from defaulted estates to small farmers while improving the sustainability of palm production to allow for biofuel & food production. GCarbon will be working with farmers to transfer technology, fertilizer, and trees to double the yield from the current baseline of 3.5 tons to at least 7 tons of oil per ha (25 tons of fruit bunches). This will be measured via evaluation of yield comparisons between participant and non-participant farms. We will also capture methane from Palm Oil Mill Effluent (POME)throughbelt press filtering. Residues will be weighed and a formula used to estimate methane emission reductions based on methodologies developed by other researchers. GCarbon will also cover mill ponds with a non-permeable membrane and collect methane for energy or steam production. A system for accelerating methane production involving ozone and electro-flocculation will be tested to intensifymethane generation and reduce the time for wastewater treatment. A meta-analysis of research on sweet potatoes and sorghum as rotation crops will look at work in the Rio Grande do Sul, Brazil where5 ha. oftest plots of industrial sweet potato have achieved yields of 60 tons and 40 tons per ha. from 2 harvests in one year (100 MT/ha./year). Field trials will be duplicated in Bom Jesus Das Selvas, Maranhaothat will test varieties of sweet potatoes to measure yields and evaluate disease risks in a very different soil and climate of NE Brazil. Hog methane will also be captured. GCarbon Brazil, Coop Sisal, and an Australian research partner will plant several varieties of agave and use agronomic procedures to get yields of 880 MT per ha. over 5 years. They will also plant new varieties expected to get 3500 MT of biomass after 5 years (176-700 MT per ha. per year). The goal is to show that the agave can adapt to Brazil’s climate without disease problems. The study will include a field visit to growing sites in Australia where agave is being grown commercially for biofuels production. Researchers will measure the biomass per hectare at various stages in the growing cycle, sugar content at harvest, and other metrics to confirm the yield of sugar per ha. is up to 10 times greater than sugar cane. The study will look at sequestration rates from measuring soil carbon and root accumulation in various plots in Australia to confirm carbon sequestered from 5 years of production. The agave developer estimates that 60-80 MT of sequestration per ha. per year occurs from agave. The three study efforts in 3 different countries will define a feedstock pathway for jet fuel that involves very high yield crops that can produce 2 to 10 times more biomass than current assumptions. This cost-effective and less land intensive strategy will meet global jet fuel demand and produce huge quantities of food for net zero aviation and feeding 9-10 billion people by 2050

Keywords: zero emission SAF, methane capture, food-fuel integrated refining, new crops for SAF

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Authors: Prashant Gupta

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Throughout India, temples have served as cultural centers, commerce hubs, art galleries, educational institutions, and social centers in addition to being places of worship since centuries. Across the country, there are over two million temples, which are crucial economic hubs, attracting devotees and tourists worldwide. In India, we have 53 temples per each 100,000 Indians. As per NSSO survey, the temple economy is worth about $40 billion and 2.32 per cent of GDP based on major temple’s survey, which only includes formal sector. It could be much larger as an actual estimation has not been done yet. In India, 43.1% of total economy represents informal sector. Over 10 billion domestic tourists visit to new destinations every year within India. Even 20 per cent of the 90 million foreign tourists visited Madurai and Mahabalipuram temples which became the most visited tourist spot in 2022. Recently the current central government in power have started revitalizing the ancient Indian civilization by reconstructing and beautifying the major temples of India i.e., Kashi Vishwanath Corridor, Mahakaleshwara Temple, Kedarnath, Ayodhya etc. The reason researcher chose Kashi as a case study because it is known as a Spiritual Capital of India, which is also the abode for the spread of Hinduism, Buddhism, Jainism and Sikkism, which are core Sanatan Dharmic practices. 17,800 Million INR Amount was spend to redevelop Kashi Vishwanath Corridor since 2019. RESEARCH OBJECTIVES 1. To assess historical contribution of temples in socio economic development and revival of Indic Civilization. 2. To examine the role of temples redevelopment for informal sector businesses. 3. To identify the sub-sectors of informal sector businesses 4. To identify products and services of informal businesses for investigation of marketing strategies and business development. PROPOSED METHODS AND PROCEDURES This study will follow a mixed approach, employing both qualitative and quantitative methods of research. To conduct the study, data will be collected from 500 informal business owners through structured questionnaire and interview instruments. The informal business owners will be selected using a systematic random sampling technique. In addition, documents from government offices of the last 10 years of tax collection will be reviewed to substantiate the study. To analyze the study, descriptive and econometric analysis techniques will be employed. EXPECTED CONTRIBUTION OF THE PROPOSED STUDY By studying the contribution of temple re-development on informal business creation and growth, the study will be beneficial to the informal business owners and the government. For the government, scientific and empirical evidence on the contribution of temple re-development for informal business creation and growth to give evidence the study will give based infrastructural development and boosting tax collection. For informal businesses, the study will give them a detailed insight on the nature of their business and the possible future growth potential of their business, and the alternative products and services supplying to their customers in the future. Studying informal businesses will help to identify the key products and services which are majorly profitable and possess potential to multiply and grow through correct product marketing strategies and business development.

Keywords: business development, informal sector businesses, services and products marketing, temple economics

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Authors: Rakesh Tiwary, D. M. Diwakar, Sandhya Mahapatro

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Agro-forestry offers huge opportunities for diversification of agriculture in middle Gangetic Basin of India, particularly in the state of Bihar as the region is identified with traditional & stagnant agriculture, low productivity, high population pressure, rural poverty and lack of agro- industrial development. The region is endowed with favourable agro-climatic, soil & drainage conditions; interestingly, there has been an age old tradition of agro-forestry in the state. However, due to demographic pressures, declining land holdings and other socio- economic factors, agro forestry practices have declined in recent decades. The government of Bihar has initiated a special program for expansion of agro-forestry based on modern practices with an aim to raise income level of farmers, make available raw material for wood based industries and increase green cover in the state. The Agro-forestry Schemes – Poplar & Other Species are the key components of the program being implemented by Department of Environment & Forest, Govt. of Bihar. The paper is based on fieldwork based evaluation study on experiences of implementation of the agro-forestry schemes. Understanding adoption patterns, identification of key motives for practising agro-forestry, experiences of farmers well analysing the barriers in expansion constituted the major themes of the research study. This paper is based on primary as well as secondary data. The primary data consists of beneficiary household survey, Focus Group Discussions among beneficiary communities, dialogue and multi stakeholder meetings and field visit to the sites. The secondary data information was collected and analysed from official records, policy documents and reports. Primary data was collected from about 500 beneficiary households of Muzaffarpur & Saharsa- two populous, large and agriculture dominated districts of middle Gangetic basin of North Bihar. Survey also covers 100 households of non-beneficiaries. Probability Proportionate to Size method was used to determine the number of samples to be covered in different blocks of two districts. Qualitative tools were also implemented to have better insights about key research questions. Present paper discusses socio-economic background of farmers practising agro-forestry; the adoption patterns of agro- forestry (choice of plants, methods of plantation and others); and motivation behind adoption of agro-forestry and the comparative benefits of agro-forestry (vis-a-vis traditional agriculture). Experience of beneficiary farmers with agro-forestry based on government programs & promotional campaigns (in terms of awareness, ease of access, knowhow and others) have been covered in the paper. Different aspects of survival of plants have been closely examined. Non beneficiaries but potential adopters were also interviewed to understand barriers of adoption of agro- forestry. Paper provides policy recommendations and interventions required for effective expansion of the agro- forestry and realisation of its future prospects for agricultural diversification in the region.

Keywords: agro-forestry adoption patterns, farmers’ motivations & experiences, Indian middle Gangetic plains, strategies for expansion

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Authors: Andrea Bertocchi, Alessio Barnaba Di Fonzo, Davide Talarico, Simone Rivaroli, Jeff Konin

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The patient is a 89 years old male (180cm/85kg) retired notary former golfer with no past medical history. He describes a progressive ideomotor slowdown for 14 months. The disorder is characterized by short-term memory deficits and, for some months, also by unstable walking with a broad base with skidding and risk of falling at directional changes and urinary urgency. There were also episodes of aggression towards his wife and staff. At the time, the patient takes no prescribed medications. He has difficulty eating, dressing, and some problems with personal hygiene. In the initial visit, the patient was alert, cooperating, and performed simple tasks; however, he has a hearing impairment, slowed spontaneous speech, and amnestic deficit to the short story. Ideomotor apraxia is not present. He scored 20 points in the MMSE. From a motor function, he has deficits using Medical Research Council (MRC) 3-/5 in bilateral lower limbs and requires maximum assistance from sit to stand with existing premature fatigue. He’s unable to walk for about 1 month. Tremors and hypertonia are absent. BERG was unable to be administered, and BARTHEL was obtained 45/100. An Amyloid Angiopathy is suspected and then confirmed at the neurological examination. Therehabilitation objectives were the recovery of mobility and reinforcement of the UE/LE, especially legs, for recovery of standing and walking. The cognitive aspect was also an essential factor for the patient's recovery. The literature doesn’t demonstrate any particular studies regarding motor and cognitive rehabilitation on this pathology. Failing to manage his attention on exercise and tending to be disinterested and falling asleep constantly, we used golf-specific gestures to stimulate his mind to work and get results because the patient has memory recall of golf related movement. We worked for 4 months with a frequency of 3 sessions per week. Every session lasted for 45 minutes. After 4 months of work, the patient walked independently with the use of a stick for about 120 meters without stopping. MRC 4/5 AI bilaterally andpostural steps performed independently with supervision. BERG 36/56. BARTHEL 65/100. 6 Minutes Walking Test (6MWT), at the beginning, it wasn’t measurable, now, he performs 151,5m with Numeric Rating Scale 4 at the beginning and 7 at the end. Cognitively, he no longer has episodes of aggression, although the short-term memory and concentration deficit remains. Amyloid Angiopathy is a mix of motor and cognitive disorder. It is worth the thought that cerebral amyloid angiopathy manifests with functional deficits due to strokes and bleedings and, as such, has an important rehabilitation indication, as classical stroke is not associated with amyloidosis. Exploring the motor patterns learned at a young age and remained in the implicit and explicit memory of the patient allowed us to set up effective work and to obtain significant results in the short-middle term. Surely many studies will still be done regarding this pathology and its rehabilitation, but the importance of the cognitive sphere applied to the motor sphere could represent an important starting point.

Keywords: amyloid angiopathy, cognitive rehabilitation, golf, motor disorder

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Authors: Zofija Tupikovskaja-Omovie, David Tyler, Sam Dhanapala, Steve Hayes

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The UK is leading in online retail and mobile adoption. However, there is a dearth of information relating to mobile apparel retail, and developing an understanding about consumer browsing and purchase behavior in m-retail channel would provide apparel marketers, mobile website and app developers with the necessary understanding of consumers’ needs. Despite the rapid growth of mobile retail businesses, no published study has examined shopping behaviour on fashion mobile websites and apps. A mixed method approach helped to understand why fashion consumers prefer websites on mobile devices, when mobile apps are also available. The following research methods were employed: survey, eye-tracking experiments, observation, and interview with retrospective think aloud. The mobile gaze tracking device by SensoMotoric Instruments was used to understand frustrations in navigation and other issues facing consumers in mobile channel. This method helped to validate and compliment other traditional user-testing approaches in order to optimize user experience and enhance the development of mobile retail channel. The study involved eight participants - females aged 18 to 35 years old, who are existing mobile shoppers. The participants used the Topshop mobile app and website on a smart phone to complete a task according to a specified scenario leading to a purchase. The comparative study was based on: duration and time spent at different stages of the shopping journey, number of steps involved and product pages visited, search approaches used, layout and visual clues, as well as consumer perceptions and expectations. The results from the data analysis show significant differences in consumer behaviour when using a mobile app or website on a smart phone. Moreover, two types of problems were identified, namely technical issues and human errors. Having a mobile app does not guarantee success in satisfying mobile fashion consumers. The differences in the layout and visual clues seem to influence the overall shopping experience on a smart phone. The layout of search results on the website was different from the mobile app. Therefore, participants, in most cases, behaved differently on different platforms. The number of product pages visited on the mobile app was triple the number visited on the website due to a limited visibility of products in the search results. Although, the data on traffic trends held by retailers to date, including retail sector breakdowns for visits and views, data on device splits and duration, might seem a valuable source of information, it cannot explain why consumers visit many product pages, stay longer on the website or mobile app, or abandon the basket. A comprehensive list of pros and cons was developed by highlighting issues for website and mobile app, and recommendations provided. The findings suggest that fashion retailers need to be aware of actual consumers’ behaviour on the mobile channel and their expectations in order to offer a seamless shopping experience. Added to which is the challenge of retaining existing and acquiring new customers. There seem to be differences in the way fashion consumers search and shop on mobile, which need to be explored in further studies.

Keywords: consumer behavior, eye-tracking technology, fashion retail, mobile app, m-retail, smart phones, topshop, user experience, website

Procedia PDF Downloads 459

Authors: Sum Lau, Wing Chung Cleo Lau, Wing Yan Chu, Long Ching Ip, Wan Yin Lo, Jo Long Sam Yau, Ka Ho Hui, Sze Yi Mak

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Biomedical engineering (BME) is an interdisciplinary subject where knowledge about biology and medicine is applied to novel applications, solving clinical problems. This subject is crucial for cities such as Hong Kong, where the burden on the medical system is rising due to reasons like the ageing population. Hong Kong, who is actively boosting technological advancements in recent years, sets BME, or biotechnology, as a major category, as reflected in the 2018-19 Budget, where biotechnology was one of the four pillars for development. Over the years, while resources in terms of money and space have been provided, there has been a lack of talents expressed by both the academia and industry. While exogenous factors, such as COVID, may have hindered talents from outside Hong Kong to come, endogenous factors should also be considered. In particular, since there are already a few local universities offering BME programmes, their curriculum or style of education requires to be reviewed to intensify the network of the BME community and support post-academic career development. It was observed that while undergraduate (UG) studies focus on knowledge teaching with some technical training and postgraduate (PG) programmes concentrate on upstream research, the programmes are generally confined to the academic sector and lack connections to the industry. In light of that, a “Biomedical Innovation and Outreach Programme 2022” (“B.I.O.2022”) was held to connect students and professors from academia with clinicians and engineers from the industry, serving as a comparative approach to conventional education methods (UG and PG programmes from tertiary institutions). Over 100 participants, including undergraduates, postgraduates, secondary school students, researchers, engineers, and clinicians, took part in various outreach events such as conference and site visits, all held from June to July 2022. As a case study, this programme aimed to tackle the aforementioned problems with the theme of “4Cs” (connection, communication, collaboration, and commercialisation). The effectiveness of the programme is investigated by its ability to serve as an adult and continuing education and the effectiveness of causing social change to tackle current societal challenges, with the focus on tackling the lack of talents engaging in biomedical engineering. In this study, B.I.O.2022 is found to be able to complement the traditional educational methods, particularly in terms of knowledge exchange between the academia and the industry. With enhanced communications between participants from different career stages, there were students who followed up to visit or even work with the professionals after the programme. Furthermore, connections between the academia and industry could foster the generation of new knowledge, which ultimately pointed to commercialisation, adding value to the BME industry while filling the gap in terms of human resources. With the continuation of events like B.I.O.2022, it provides a promising starting point for the development and relationship strengthening of a BME community in Hong Kong, and shows potential as an alternative way of adult education or learning with societal benefits.

Keywords: biomedical engineering, adult education for social change, comparative methods and principles, lifelong learning, faced problems, promises, challenges and pitfalls

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Authors: Anastasia Constantinou, Stephen Morris

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Background: The adoption of synchronous and asynchronous telemedicine modalities for primary care consultations has exponentially increased since the COVID-19 pandemic. However, there is limited understanding of how virtual consultations influence healthcare resource utilization and other quality measures including safety, timeliness, efficiency, patient and provider satisfaction, cost-effectiveness and environmental impact. Aim: Quantify the rate of follow-up visits, emergency department visits, hospitalizations, request for investigations and prescriptions and comment on the effect on different quality measures associated with different telemedicine modalities used for primary care services and primary care referrals to secondary care Design and setting: Systematic review in primary care Methods: A systematic search was carried out across three databases (Medline, PubMed and Scopus) between August and November 2023, using terms related to telemedicine, general practice, electronic referrals, follow-up, use and efficiency and supported by citation searching. This was followed by screening according to pre-defined criteria, data extraction and critical appraisal. Narrative synthesis and metanalysis of quantitative data was used to summarize findings. Results: The search identified 2230 studies; 50 studies are included in this review. There was a prevalence of asynchronous modalities in both primary care services (68%) and referrals from primary care to secondary care (83%), and most of the study participants were females (63.3%), with mean age of 48.2. The average follow-up for virtual consultations in primary care was 28.4% (eVisits: 36.8%, secure messages 18.7%, videoconference 23.5%) with no significant difference between them or F2F consultations. There was an average annual reduction of primary care visits by 0.09/patient, an increase in telephone visits by 0.20/patient, an increase in ED encounters by 0.011/patient, an increase in hospitalizations by 0.02/patient and an increase in out of hours visits by 0.019/patient. Laboratory testing was requested on average for 10.9% of telemedicine patients, imaging or procedures for 5.6% and prescriptions for 58.7% of patients. When looking at referrals to secondary care, on average 36.7% of virtual referrals required follow-up visit, with the average rate of follow-up for electronic referrals being higher than for videoconferencing (39.2% vs 23%, p=0.167). Technical failures were reported on average for 1.4% of virtual consultations to primary care. When using carbon footprint estimates, we calculate that the use of telemedicine in primary care services can potentially provide a net decrease in carbon footprint by 0.592kgCO2/patient/year. When follow-up rates are taken into account, we estimate that virtual consultations reduce carbon footprint for primary care services by 2.3 times, and for secondary care referrals by 2.2 times. No major concerns regarding quality of care, or patient satisfaction were identified. 5/7 studies that addressed cost-effectiveness, reported increased savings. Conclusions: Telemedicine provides quality, cost-effective, and environmentally sustainable care for patients in primary care with inconclusive evidence regarding the rates of subsequent healthcare utilization. The evidence is limited by heterogeneous, small-scale studies and lack of prospective comparative studies. Further research to identify the most appropriate telemedicine modality for different patient populations, clinical presentations, service provision (e.g. used to follow-up patients instead of initial diagnosis) as well as further education for patients and providers alike on how to make best use of this service is expected to improve outcomes and influence practice.

Keywords: telemedicine, healthcare utilisation, digital interventions, environmental impact, sustainable healthcare

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Authors: Neil Singla, Derek Muse, Karen DiDonato, Pamela Palmer

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Introduction: Pain is the most common reason people visit emergency rooms. Studies indicate however, that Emergency Department (ED) physicians often do not provide adequate analgesia to their patients as a result of gender and age bias, opiophobia and insufficient knowledge of and formal training in acute pain management. Novel classes of analgesics have recently been introduced, but many patients suffer from acute pain in settings where the availability of intravenous (IV) access may be limited, so there remains a clinical need for rapid-acting, potent analgesics that do not require an invasive route of delivery. A sublingual sufentanil tablet (SST), dispensed using a single-dose applicator, is in development for treatment of moderate-to-severe acute pain in a medically-supervised setting. Objective: The primary objective of this study was to demonstrate the repeat-dose efficacy, safety and tolerability of sufentanil 20 mcg and 30 mcg sublingual tablets compared to placebo for the management of acute pain as determined by the time-weighted sum of pain intensity differences (SPID) to baseline over the 12-hour study period (SPID12). Key secondary efficacy variables included SPID over the first hour (SPID1), Total pain relief over the 12-hour study period (TOTPAR12), time to perceived pain relief (PR) and time to meaningful PR. Safety variables consisted of adverse events (AE), vital signs, oxygen saturation and early termination. Methods: In this Phase 2, double-blind, dose-finding study, an equal number of male and female patients were randomly assigned in a 2:2:1 ratio to SST 20 mcg, SS 30 mcg or placebo, respectively, following bunionectomy. Study drug was dosed as needed, but not more frequently than hourly. Rescue medication was available as needed. The primary endpoint was the Summed Pain Intensity Difference to baseline over 12h (SPIDI2). Safety was assessed by continuous oxygen saturation monitoring and adverse event reporting. Results: 101 patients (51 Male/50 Female) were randomized, 100 received study treatment (intent-to-treat [ITT] population), and 91 completed the study. Reasons for early discontinuation were lack of efficacy (6), adverse events (2) and drug-dosing error (1). Mean age was 42.5 years. For the ITT population, SST 30 mcg was superior to placebo (p=0.003) for the SPID12. SPID12 scores in the active groups were superior for both male (ANOVA overall p-value =0.038) and female (ANOVA overall p-value=0.005) patients. Statistically significant differences in favour of sublingual sufentanil were also observed between the SST 30mcg and placebo group for SPID1(p<0.001), TOTPAR12(p=0.002), time to perceived PR (p=0.023) and time to meaningful PR (p=0.010). Nausea, vomiting and somnolence were more frequent in the sufentanil groups but there were no significant differences between treatment arms for the proportion of patients who prematurely terminated due to AE or inadequate analgesia. Conclusions: Sufentanil tablets dispensed sublingually using a single-dose applicator is in development for treatment of patients with moderate-to-severe acute pain in a medically-supervised setting where immediate IV access is limited. When administered sublingually, sufentanil’s pharmacokinetic profile and non-invasive delivery makes it a useful alternative to IM or IV dosing.

Keywords: acute pain, pain management, sublingual, sufentanil

Procedia PDF Downloads 356