Search results for: period poverty

Authors: Aishwarya Pothula

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Euthanasia in India is a politically dormant policy issue in the sense that discussions around it are sporadic in nature (usually with developments in specific cases) and it stays as a dominant issue in the public domain for a fleeting period. In other words, it is a non-political issue that has been unable to successfully get on the policy agenda. This paper studies how the Supreme Court of India (SC) plays a role in euthanasia’s policy making. In 2011, the SC independently put a law in place that legalized passive euthanasia through its judgement in the Aruna Shanbaug v. Union of India case. According to this, it is no longer illegal to withhold/withdraw a patient’s medical treatment in certain cases. This judgement, therefore, is the empirical focus of this paper. The paper essentially employs two techniques of discourse analysis to study the SC’s system of argumentation. The two methods, Text Analysis using Gasper’s Analysis Table and Frame Analysis – are complemented by two discourse techniques called metaphor analysis and lexical analysis. The framework within which the analysis is conducted lies in 1) the judicial process of India, i.e. the SC procedures and the Constitutional rules and provisions, and 2) John W. Kingdon’s theory of policy windows and policy entrepreneurs. The results of this paper are three-fold: first, the SC dismiss the petitioner’s request for passive euthanasia on inadequate and weak grounds, thereby setting no precedent for the historic law they put in place. In other words, they leave the decision open for the Parliament to act upon. Hence the judgement, as opposed to arguments by many, is by no means an instance of judicial activism/overreach. Second, they define euthanasia in a way that resonates with existing broader societal themes. They combine this with a remarkable use of authoritative and protective tones/stances to settle at an intermediate position that balances the possible opposition to their role in the process and what they (perhaps) perceive to be an optimal solution. Third, they soften up the policy community (including the public) to the idea of passive euthanasia leading it towards a Parliamentarian legislation. They achieve this by shaping prevalent principles, provisions and worldviews through an astute use of the legal instruments at their disposal. This paper refers to this unconventional role of the SC as ‘judicial entrepreneurship’ which is also the first scholarly contribution towards research on euthanasia as a policy issue in India.

Keywords: argumentation analysis, Aruna Ramachandra Shanbaug, discourse analysis, euthanasia, judicial entrepreneurship, policy-making process, supreme court of India

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Authors: Hanbyul Kim, Hye-Jin Kin, Taehun Park, Woo Jun Sul, Susun An

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Skin is the largest organ of the human body and can provide the diverse habitat for various microorganisms. The ecology of the skin surface selects distinctive sets of microorganisms and is influenced by both endogenous intrinsic factors and exogenous environmental factors. The diversity of the bacterial community in the skin also depends on multiple host factors: gender, age, health status, location. Among them, age-related changes in skin structure and function are attributable to combinations of endogenous intrinsic factors and exogenous environmental factors. Skin aging is characterized by a decrease in sweat, sebum and the immune functions thus resulting in significant alterations in skin surface physiology including pH, lipid composition, and sebum secretion. The present study gives a comprehensive clue on the variation of skin microbiota and the correlations between ages by analyzing and comparing the metagenome of skin microbiome using Next Generation Sequencing method. Skin bacterial diversity and composition were characterized and compared between two different age groups: younger (20 – 30y) and older (60 - 70y) Xian, Chinese women. A total of 73 healthy women meet two conditions: (I) living in Xian, China; (II) maintaining healthy skin status during the period of this study. Based on Ribosomal Database Project (RDP) database, skin samples of 73 participants were enclosed with ten most abundant genera: Chryseobacterium, Propionibacterium, Enhydrobacter, Staphylococcus and so on. Although these genera are the most predominant genus overall, each genus showed different proportion in each group. The most dominant genus, Chryseobacterium was more present relatively in Young group than in an old group. Similarly, Propionibacterium and Enhydrobacter occupied a higher proportion of skin bacterial composition of the young group. Staphylococcus, in contrast, inhabited more in the old group. The beta diversity that represents the ratio between regional and local species diversity showed significantly different between two age groups. Likewise, The Principal Coordinate Analysis (PCoA) values representing each phylogenetic distance in the two-dimensional framework using the OTU (Operational taxonomic unit) values of the samples also showed differences between the two groups. Thus, our data suggested that the composition and diversification of skin microbiomes in adult women were largely affected by chronological and physiological skin aging.

Keywords: next generation sequencing, age, Xian, skin microbiome

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Authors: S. Ben Fredj, H. Ghali, M. Ben Rejeb, S. Layouni, S. Khefacha, L. Dhidah, H. Said

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Background: The Intensive Care Unit (ICU) provides continuous care and uses a high level of treatment technologies. Although developed country hospitals allocate only 5–10% of beds in critical care areas, approximately 20% of nosocomial infections (NI) occur among patients treated in ICUs. Whereas in the developing countries the situation is still less accurate. The aim of our study is to assess mortality rates in ICUs and to determine its predictive factors. Methods: We carried out a nested case-control study in a 630-beds public tertiary care hospital in Eastern Tunisia. We included in the study all patients hospitalized for more than two days in the surgical or medical ICU during the entire period of the surveillance. Cases were patients who died before ICU discharge, whereas controls were patients who survived to discharge. NIs were diagnosed according to the definitions of ‘Comité Technique des Infections Nosocomiales et les Infections Liées aux Soins’ (CTINLIS, France). Data collection was based on the protocol of Rea-RAISIN 2009 of the National Institute for Health Watch (InVS, France). Results: Overall, 301 patients were enrolled from medical and surgical ICUs. The mean age was 44.8 ± 21.3 years. The crude ICU mortality rate was 20.6% (62/301). It was 35.8% for patients who acquired at least one NI during their stay in ICU and 16.2% for those without any NI, yielding an overall crude excess mortality rate of 19.6% (OR= 2.9, 95% CI, 1.6 to 5.3). The population-attributable fraction due to ICU-NI in patients who died before ICU discharge was 23.46% (95% CI, 13.43%–29.04%). Overall, 62 case-patients were compared to 239 control patients for the final analysis. Case patients and control patients differed by age (p=0,003), simplified acute physiology score II (p < 10-3), NI (p < 10-3), nosocomial pneumonia (p=0.008), infection upon admission (p=0.002), immunosuppression (p=0.006), days of intubation (p < 10-3), tracheostomy (p=0.004), days with urinary catheterization (p < 10-3), days with CVC ( p=0.03), and length of stay in ICU (p=0.003). Multivariate analysis demonstrated 3 factors: age older than 65 years (OR, 5.78 [95% CI, 2.03-16.05] p=0.001), duration of intubation 1-10 days (OR, 6.82 [95% CI, [1.90-24.45] p=0.003), duration of intubation > 10 days (OR, 11.11 [95% CI, [2.85-43.28] p=0.001), duration of CVC 1-7 days (OR, 6.85[95% CI, [1.71-27.45] p=0.007) and duration of CVC > 7 days (OR, 5.55[95% CI, [1.70-18.04] p=0.004). Conclusion: While surveillance provides important baseline data, successful trials with more active intervention protocols, adopting multimodal approach for the prevention of nosocomial infection incited us to think about the feasibility of similar trial in our context. Therefore, the implementation of an efficient infection control strategy is a crucial step to improve the quality of care.

Keywords: intensive care unit, mortality, nosocomial infection, risk factors

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Authors: Alireza Nikbakht Shahbazi, Emadeddin Shirali

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Since optimization issues of water resources are complicated due to the variety of decision making criteria and objective functions, it is sometimes impossible to resolve them through regular optimization methods or, it is time or money consuming. Therefore, the use of modern tools and methods is inevitable in resolving such problems. An accurate and essential utilization policy has to be determined in order to use natural resources such as water reservoirs optimally. Water reservoir programming studies aim to determine the final cultivated land area based on predefined agricultural models and water requirements. Dam utilization rule curve is also provided in such studies. The basic information applied in water reservoir programming studies generally include meteorological, hydrological, agricultural and water reservoir related data, and the geometric characteristics of the reservoir. The system of Dez dam water resources was simulated applying the basic information in order to determine the capability of its reservoir to provide the objectives of the performed plan. As a meta-exploratory method, genetic algorithm was applied in order to provide utilization rule curves (intersecting the reservoir volume). MATLAB software was used in order to resolve the foresaid model. Rule curves were firstly obtained through genetic algorithm. Then the significance of using rule curves and the decrease in decision making variables in the system was determined through system simulation and comparing the results with optimization results (Standard Operating Procedure). One of the most essential issues in optimization of a complicated water resource system is the increasing number of variables. Therefore a lot of time is required to find an optimum answer and in some cases, no desirable result is obtained. In this research, intersecting the reservoir volume has been applied as a modern model in order to reduce the number of variables. Water reservoir programming studies has been performed based on basic information, general hypotheses and standards and applying monthly simulation technique for a statistical period of 30 years. Results indicated that application of rule curve prevents the extreme shortages and decrease the monthly shortages.

Keywords: optimization, rule curve, genetic algorithm method, Dez dam reservoir

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Authors: Gheorghe Braniste

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Gender gap has always been in dispute when comparing records and has been a major factor influencing best performances in various sports. Consequently, our study registers the evolution of the difference between men's and women’s best performances within either cyclic or acyclic sports, considering the fact that the training sessions of high performance athletes prove both similarities and differences in long-term adaptation of their body to stress and effort in breaking limits and records. Firstly, for a correct interpretation of the data and tables included in this paper, we must point out that the intense muscular activity has a considerable impact on the structural organization of the organs and systems of the performer's body through the mechanism of motor-visceral reflexes, forming a high working capacity suitable for intense muscular activity. The opportunity to obtaine high sports results during the official competitions is due, on the one hand, to the genetic characteristics of the athlete's body, and on the other hand, to the fact that playing professional sports leaves its mark on the vital morphological and functional parameters. The aim of our research is to study the landmarking differences between male and female athletes and their physical development, together with their growing capacity to stand up to the functional training during the competitive period of their annual training cycle. In order to evaluate the physical development of the athletes, the data of the anthropometric screenings obtained at the Olympic Training Center of the selected teams of the Republic of Moldova were interpreted and rated. During the study of physical development in terms of body height and weight, vital capacity, thoracic excursion, maximum force (Fmax), dynamometry of the hand and back, a further evaluation of the physical development indices that allow an evaluation of complex physical development were registered. The interdependence of the results obtained in performance sports with the morphological and functional particularities of the athletes' body is firmly determined and cannot be disputed. Nevertheless, registered data proved that with the increase of the training capacity, the morphological and functional abilities of the female body increase and, in some respects, approach and even slightly surpass the men in certain sports.

Keywords: physical development, indices, parameters, active body weight, morphological maturity, physical performance

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Authors: Venkata Srikanth Meka, Nur Arthirah Binti Ahmad Tarmizi Tan, Muhammad Syahmi Bin Md Nazir, Adinarayana Gorajana, Senthil Rajan Dharmalingam

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Biphasic drug delivery systems are designed to release drug at two different rates, either fast/prolonged or prolonged/fast. A fast/prolonged release system provides a burst drug release at initial stage followed by a slow release over a prolonged period of time and in case of prolonged/fast release system, the release pattern is vice versa. Terminalia catappa gum (TCG) is a natural polymer and was successfully proven as a novel pharmaceutical excipient. The main objective of the present research is to investigate the applicability of natural polymer, Terminalia catappa gum in the design of oral biphasic drug delivery system in the form of mini tablets by using a model drug, buspirone HCl. This investigation aims to produce a biphasic release drug delivery system of buspirone by combining immediate release and prolonged release mini tablets into a capsule. For immediate release mini tablets, a dose of 4.5 mg buspirone was prepared by varying the concentration of superdisintegrant; crospovidone. On the other hand, prolonged release mini tablets were produced by using different concentrations of the natural polymer; TCG with a buspirone dose of 3mg. All mini tablets were characterized for weight variation, hardness, friability, disintegration, content uniformity and dissolution studies. The optimized formulations of immediate and prolonged release mini tablets were finally combined in a capsule and was evaluated for release studies. FTIR and DSC studies were conducted to study the drug-polymer interaction. All formulations of immediate release and prolonged release mini tablets were passed all the in-process quality control tests according to US Pharmacopoeia. The disintegration time of immediate release mini tablets of different formulations was varied from 2-6 min, and maximum drug release was achieved in lesser than 60 min. Whereas prolonged release mini tablets made with TCG have shown good drug retarding properties. Formulations were controlled for about 4-10 hrs with varying concentration of TCG. As the concentration of TCG increased, the drug release retarding property also increased. The optimised mini tablets were packed in capsules and were evaluated for the release mechanism. The capsule dosage form has clearly exhibited the biphasic release of buspirone, indicating that TCG is a suitable natural polymer for this study. FTIR and DSC studies proved that there was no interaction between the drug and polymer. Based on the above positive results, it can be concluded that TCG is a suitable polymer for the biphasic drug delivery systems.

Keywords: Terminalia catappa gum, biphasic release, mini tablets, tablet in capsule, natural polymers

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Authors: Vuiswa Lucia Sethunya, Tonderayi Matambo, Diane Hildebrandt

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South African’s informal settlements produce tonnes of kitchen waste (KW) per year which is dumped into the landfill. These landfill sites are normally located in close proximity to the household of the poor communities; this is a problem in which the young children from those communities end up playing in these landfill sites which may result in some health hazards because of methane, carbon dioxide and sulphur gases which are produced. To reduce this large amount of organic materials being deposited into landfills and to provide a cleaner place for those within the community especially the children, an energy conversion process such as anaerobic digestion of the organic waste to produce biogas was implemented. In this study, the digestion of various kitchen waste was investigated in order to understand and develop a system that is suitable for household use to produce biogas for cooking. Three sets of waste of different nutritional compositions were digested as per acquired in the waste streams of a household at mesophilic temperature (35ᵒC). These sets of KW were co-digested with cow dung (CW) at different ratios to observe the microbial behaviour and the system’s stability in a laboratory scale system. The gas chromatography-flame ionization detector analyses have been performed to identify and quantify the presence of organic compounds in the liquid samples from co-digested and mono-digested food waste. Acetic acid, propionic acid, butyric acid and valeric acid are the fatty acids which were studied. Acetic acid (1.98 g/L), propionic acid (0.75 g/L) and butyric acid (2.16g/L) were the most prevailing fatty acids. The results obtained from organic acids analysis suggest that the KW can be an innovative substituent to animal manure for biogas production. The faster degradation period in which the microbes break down the organic compound to produce the fatty acids during the anaerobic process of KW also makes it a better feedstock during high energy demand periods. The C/N ratio analysis showed that from the three waste streams the first stream containing vegetables (55%), fruits (16%), meat (25%) and pap (4%) yielded more methane-based biogas of 317mL/g of volatile solids (VS) at C/N of 21.06. Generally, this shows that a household will require a heterogeneous composition of nutrient-based waste to be fed into the digester to acquire the best biogas yield to sustain a households cooking needs.

Keywords: anaerobic digestion, biogas, kitchen waste, household

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Authors: Byung Lee, Charles Perschau

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This study analyzes the development of a communication journal, the Journal of Advertising Education (JAE) over the past 20 years by examining citations of all research articles there. The purpose of a journal is to offer a stable and transparent forum for the presentation, scrutiny, and discussion of research in a targeted domain. This study asks whether JAE has fulfilled this purpose. The authors and readers who are involved in a journal need to have common research topics of their interest. In the case of the discipline of communication, scholars have a variety of backgrounds beyond communication itself since the social scientific study of communication is a relatively recent development, one that emerged after World War II, and the discipline has been heavily indebted to other social sciences, such as psychology, sociology, social psychology, and political science. When authors impart their findings and knowledge to others, their work is not done in isolation. They have to stand on previous studies, which are listed as sources in the bibliography. Since communication has heavily piggybacked on other disciplines, cited sources should be as diverse as the resources it taps into. This paper analyzes 4,244 articles that were cited by JAE articles in the past 36 issues. Since journal article authors reveal their intellectual linkage by using bibliographic citations, the analysis of citations in journal articles will reveal various networks of relationships among authors, journal types, and fields in an objective and quantitative manner. The study found that an easier access to information sources because of the development of electronic databases and the growing competition among scholars for publication seemed to influence authors to increase the number of articles cited even though some variations existed during the examined period. The types of articles cited have also changed. Authors have more often cited journal articles, periodicals (most of them available online), and web site sources, while decreased their dependence on books, conference papers, and reports. To provide a forum for discussion, a journal needs a common topic or theme. This can be realized when an author writes an article about a topic, and that article is cited and discussed in another article. Thus, the citation of articles in the same journal is vital for a journal to form a forum for discussion. JAE has gradually increased the citations of in-house articles with a few fluctuations over the years. The study also examines not only specific articles that are often cited, but also specific authors often cited. The analysis of citations in journal articles shows how JAE has developed into a full academic journal while offering a communal forum even though the speed of its formation is not as fast as desired probably because of its interdisciplinary nature.

Keywords: citation, co-citation, the Journal of Advertising Education, development of a journal

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Authors: Kristy Howells, Catherine Meehan

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This position paper presents current research findings into the proposed gap between teachers’ and practitioners’ thinking and acting about physical activity health and well-being in childhood. Within the new Primary curriculum, there is a focus on sustained physical activity within a Physical Education and healthy lifestyles in Personal, Health, Social and Emotional lessons, but there is no curriculum guidance about what sustained physical activity is and how it is defined. The current health guidance on birth to five suggests that children should not be inactive for long periods and specify light and energetic activities, however there is the a suggested period of time per day for young children to achieve, but the guidance does not specify how this should be measured. The challenge therefore for teachers and practitioners is their own confidence and understanding of what “good / moderate intensity” physical activity and healthy living looks like for children and the children understanding what they are doing. There is limited research about children from birth to eight years and also the perceptions and attitudes of those who work with this age group of children, however it was found that children at times can identify different levels of activity and it has been found that children can identify healthy foods and good choices for healthy living at a basic level. Authors have also explored teachers’ beliefs about teaching and learning and found that teachers could act in accordance to their beliefs about their subject area only when their subject knowledge, understanding and confidence of that area is high. It has been proposed that confidence and competence of practitioners and teachers to integrate ‘well-being’ within the learning settings has been reported as being low. This may be due to them not having high subject knowledge. It has been suggested that children’s life chances are improved by focusing on well-being in their earliest years. This includes working with parents and families, and being aware of the environmental contexts that may impact on children’s wellbeing. The key is for practitioners and teachers to know how to implement these ideas effectively as these key workers have a profound effect on young children as role models and due to the time of waking hours spent with them. The position paper is part of a longitudinal study at Canterbury Christ Church University and currently we will share the research findings from the initial questionnaire (online, postal, and in person) that explored and evaluated the knowledge, competence and confidence levels of practitioners and teachers as to the structure and planning of sustained physical activity and healthy lifestyles and how this progresses with the children’s age.

Keywords: health, perceptions, physical activity, well-being

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Authors: Beloulou Mohamed Lamine, Bouhouf Attef, Meliani Walid, Sellami Dalila, Lamara Abdelhak

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Introduction: Post-surgical chronic pain (PSCP) is a pathological condition with a rather complex etiopathogenesis that extensively involves sensitization processes and neuronal damage. The neuropathic component of these pains is almost always present, with variable expression depending on the type of surgery. Objective: To assess the presumed beneficial effect of Regional Anesthesia-Analgesia Techniques (RAAT) on the development of post-surgical chronic neuropathic pain (PSCNP) in various surgical procedures. Patients and Methods: A comparative study involving 510 patients distributed across five surgical models (mastectomy, thoracotomy, hernioplasty, cholecystectomy, and major abdominal-pelvic surgery) and randomized into two groups: Group A (240) receiving conventional postoperative analgesia and Group B (270) receiving balanced analgesia, including the implementation of a Regional Anesthesia-Analgesia Technique (RAAT). These patients were longitudinally followed over a 6-month period, with post-surgical chronic neuropathic pain (PSCNP) defined by a Neuropathic Pain Score DN2≥ 3. Comparative measurements through univariate and multivariate analyses were performed to identify associations between the development of PSCNP and certain predictive factors, including the presumed preventive impact (protective effect) of RAAT. Results: At the 6th month post-surgery, 419 patients were analyzed (Group A= 196 and Group B= 223). The incidence of PSCNP was 32.2% (n=135). Among these patients with chronic pain, the prevalence of neuropathic pain was 37.8% (95% CI: [29.6; 46.5]), with n=51/135. It was significantly lower in Group B compared to Group A, with respective percentages of 31.4% vs. 48.8% (p-value = 0.035). The most significant differences were observed in breast and thoracopulmonary surgeries. In a multiple regression analysis, two predictors of PSCNP were identified: the presence of preoperative pain at the surgical site as a risk factor (OR: 3.198; 95% CI [1.326; 7.714]) and RAAT as a protective factor (OR: 0.408; 95% CI [0.173; 0.961]). Conclusion: The neuropathic component of PSCNP can be observed in different types of surgeries. Regional analgesia included in a multimodal approach to postoperative pain management has proven to be effective for acute pain and seems to have a preventive impact on the development of PSCNP and its neuropathic nature or component, particularly in surgeries that are more prone to chronicization.

Keywords: chronic postsurgical pain, postsurgical chronic neuropathic pain, regional anesthesia and analgesia techniques (RAAT), neuropathic pain score dn2, preventive impact

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Authors: B. Nair, S. Singh

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Oral health behaviors such as dietary preferences and tooth brushing are acquired during a child’s primary socialization period yet many oral health promotion interventions are implemented without taking into account the role and impact of parental influence in supporting healthy oral health behaviors. The aim and objective of this study was to determine the relationship between parental income and level of education with knowledge, attitudes and perceptions of oral health care practices. Methods: The study design was cross-sectional and exploratory, and data collection occurred in two phases. Phase 1 comprised of a self-administered questionnaire. The sample consisted of parents of 313 Grade 1 learners aged between 5-6 years old attending one of twelve selected public primary schools in the Chatsworth Circuit, Durban, South Africa. Phase 2 comprised of focus group discussions held at 5 purposively selected schools. Data collection comprised of a semi-structured face-to-face group interview with the objective of obtaining a deeper understanding of parental knowledge, attitudes and perceptions of dental caries. Results and Discussion: Almost 56% of participants earned a monthly income of less than R6000 (600 US dollars). Nearly three quarters (77.5%) of participants indicated that they did not have medical aid/insurance scheme. More than three-quarters of the participants (76.6%) identified diet as being the primary cause of decayed teeth. More than half of the study sample (56.1%) indicated that milk teeth were important and that rotten teeth (74.6%) could affect the child’s health. Almost half (49.8%) of participants reported that “bad teeth” were inherited. With more than two-thirds of the participants (77.7%), having at most a high school education, there was a correlation between the level of the caregiver’s education and the oral health care of the child. The analysis of the correlation between a child having decayed teeth and income (p=.007); and the manner in which the income is received (p=.003) was statistically significant. The results indicate that more effort needs to be placed in understanding parental knowledge, perceptions and attitudes towards dental caries. Parental level of education, income and oral health literacy is shown to be related to attitudes, and perceptions towards dental caries and its subsequent preventive measures. These findings have important implications for oral health planning at community and facility-based levels.

Keywords: oral health prevention, parental education, dental caries, attitudes and perceptions

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Authors: John Yahng, Hansraj Riteesh Bookun

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Objective: This was a retrospective cross-sectional study evaluating the safety of discharge on the first postoperative day following carotid surgery - principally carotid endarterectomy. Methods: Between January 2010 to October 2017, 252 patients with mean age of 72 years, underwent carotid surgery by seven surgeons. Their medical records were consulted and their operative as well as complication timelines were databased. Descriptive statistics were used to analyse pooled responses and our indicator variables. The statistical package used was STATA 13. Results: There were 183 males (73%) and the comorbid burden was as follows: ischaemic heart disease (54%), diabetes (38%), hypertension (92%), stage 4 kidney impairment (5%) and current or ex-smoking (77%). The main indications were transient ischaemic attacks (42%), stroke (31%), asymptomatic carotid disease (16%) and amaurosis fugax (8%). 247 carotid endarterectomies (109 with patch arterioplasty, 88 with eversion and transection technique, 50 with endarterectomy only) were performed. 2 carotid bypasses, 1 embolectomy, 1 thrombectomy with patch arterioplasty and 1 excision of a carotid body tumour were also performed. 92% of the cases were performed under general anaesthesia. A shunt was used in 29% of cases. The mean length of stay was 5.1 ± 3.7days with the range of 2 to 22 days. No patient was discharged on day 1. The mean time from admission to surgery was 1.4 ± 2.8 days, ranging from 0 to 19 days. The mean time from surgery to discharge was 2.7 ± 2.0 days with the of range 0 to 14 days. 36 complications were encountered over this period, with 12 failed repairs (5 major strokes, 2 minor strokes, 3 transient ischaemic attacks, 1 cerebral bleed, 1 occluded graft), 11 bleeding episodes requiring a return to the operating theatre, 5 adverse cardiac events, 3 cranial nerve injuries, 2 respiratory complications, 2 wound complications and 1 acute kidney injury. There were no deaths. 17 complications occurred on postoperative day 0, 11 on postoperative day 1, 6 on postoperative day 2 and 2 on postoperative day 3. 78% of all complications happened before the second postoperative day. Out of the complications which occurred on the second or third postoperative day, 4 (1.6%) were bleeding episodes, 1 (0.4%) failed repair , 1 respiratory complication (0.4%) and 1 wound complication (0.4%). Conclusion: Although it has been common practice to discharge patients on the second postoperative day following carotid endarterectomy, we find here that discharge on the first operative day is safe. The overall complication rate is low and most complications are captured before the second postoperative day. We suggest that patients having an uneventful first 24 hours post surgery be discharged on the first day. This should reduce hospital length of stay and the health economic burden.

Keywords: carotid, complication, discharge, surgery

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Authors: Natalia Kalinowska

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The adoption of the General Data Protection Regulation, (GDPR) finished the four-year work of the European Commission in this area in the European Union. Considering far-reaching changes, which will be applied by GDPR, the European legislator envisaged two-year transitional period. Member states and companies have to prepare for a new regulation until 25 of May 2018. The idea, which becomes a new look at an attitude to data protection in the European Union is risk-based approach. So far, as a result of implementation of Directive 95/46/WE, in many European countries (including Poland) there have been adopted very particular regulations, specifying technical and organisational security measures e.g. Polish implementing rules indicate even how long password should be. According to the new approach from May 2018, controllers and processors will be obliged to apply security measures adequate to level of risk associated with specific data processing. The risk in GDPR should be interpreted as the likelihood of a breach of the rights and freedoms of the data subject. According to Recital 76, the likelihood and severity of the risk to the rights and freedoms of the data subject should be determined by reference to the nature, scope, context and purposes of the processing. GDPR does not indicate security measures which should be applied – in recitals there are only examples such as anonymization or encryption. It depends on a controller’s decision what type of security measures controller considered as sufficient and he will be responsible if these measures are not sufficient or if his identification of risk level is incorrect. Data protection regulation indicates few levels of risk. Recital 76 indicates risk and high risk, but some lawyers think, that there is one more category – low risk/now risk. Low risk/now risk data processing is a situation when it is unlikely to result in a risk to the rights and freedoms of natural persons. GDPR mentions types of data processing when a controller does not have to evaluate level of risk because it has been classified as „high risk” processing e.g. processing on a large scale of special categories of data, processing with using new technologies. The methodology will include analysis of legal regulations e.g. GDPR, the Polish Act on the Protection of personal data. Moreover: ICO Guidelines and articles concerning risk based approach in GDPR. The main conclusion is that an appropriate risk assessment is a key to keeping data safe and avoiding financial penalties. On the one hand, this approach seems to be more equitable, not only for controllers or processors but also for data subjects, but on the other hand, it increases controllers’ uncertainties in the assessment which could have a direct impact on incorrect data protection and potential responsibility for infringement of regulation.

Keywords: general data protection regulation, personal data protection, privacy protection, risk based approach

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Authors: Jamila Fakchich, Mostafa Jamila Lazaar Elachouri, Lakhder Fakchich, Fatna Ouali, Abd Errazzak Belkacem

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Diabetes is a chronic metabolic disease that has a significant impact on the health, quality of life, and life expectancy of patients as well as the health care system. By its nature diabetes, is a multisystem disease with wide-ranging complication that span nearly all region of the body. This epidemic problem, however, is not unique to the industrialized society, but has also hardly struck the developing countries. In Morocco, as developing country, there is an epidemic rise in diabetes, with ensuing concern about the management and control of this disease; it began a chronic burdensome disease of largely middle-aged and elderly people, with a long course and serious complications often resulting in high death-rate, the treatment of diabetes spent vast amount of resources including medicines, diets, physical training. Treatment of this disease is considered problematic due to the lack of effective and safe drugs capable of inducing sustained clinical, biochemical, and histological cure. In Moroccan society, the phytoremedies are some times the only affordable sources of healthcare, particularly for the people in remote areas. In this paper, we present a synthesis work obtained from the ethnobotanical data reported in different specialized journals. A Synthesis of four published ethnobotanical studies that have been carried out in different region of Morocco by different team seekers during the period from 1997 to 2015. Medicinal plants inventoried by different seekers in four Moroccan’s areas have been regrouped and codified, then, Factorial Analysis (FA) and Principal Components Analysis (PCA) are used to analyse the aggregated data from the four studies and plants are classified according to their frequency of use by population. Our work deals with an attempt to gather information on some traditional uses of medicinal plants from different regions of Morocco, also, it was designed to give a set of medicinal plants commonly used by Moroccan people in the treatment of diabetes; In this paper, we intended to provide a basic knowledge about plant species used by Moroccan society for treatment of diabetes. One of the most interesting aspects of this type of works is to assess the relative cultural importance of medicinal plants for specific illnesses and exploring its usefulness in the context of diabetes.

Keywords: Morocco, medicinal plants, ethnobotanical, diabetes, phytoremedies

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Authors: Keneilwe Matlhaku

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Crosslinguistic studies (theoretical and clinical) have shown delays and significant misarticulation in the acquisition of the rhotics. This article provides a detailed analysis of the early development of the rhotic phoneme, an apical trill /r/, by monolingual Setswana (Tswana S30) children of age ranges between 1 and 4 years. The data display the following trends: (1) late acquisition of /r/; (2) a wide range of substitution patterns involving this phoneme (i.e., gliding, coronal stopping, affrication, deletion, lateralization, as well as, substitution to a dental and uvular fricative). The primary focus of the article is on the potential origins of these variations of /r/, even within the same language. Our data comprises naturalistic longitudinal audio recordings of 6 children (2 males and 4 females) whose speech was recorded in their homes over a period of 4 months with no or only minimal disruptions in their daily environments. Phon software (Rose et al. 2013; Rose & MacWhinney 2014) was used to carry out the orthographic and phonetic transcriptions of the children’s data. Phon also enabled the generation of the children’s phonological inventories for comparison with adult target IPA forms. We explain the children’s patterns through current models of phonological emergence (MacWhinney 2015) as well as McAllister Byun, Inkelas & Rose (2016); Rose et al., (2022), which highlight the perceptual and articulatory factors influencing the development of sounds and sound classes. We highlight how the substitution patterns observed in the data can be captured through a consideration of the auditory properties of the target speech sounds, combined with an understanding of the types of articulatory gestures involved in the production of these sounds. These considerations, in turn, highlight some of the most central aspects of the challenges faced by the child toward learning these auditory-articulatory mappings. We provide a cross-linguistic survey of the acquisition of rhotic consonants in a sample of related and unrelated languages in which we show that the variability and volatility in the substitution patterns of /r/ is also brought about by the properties of the children’s ambient languages. Beyond theoretical issues, this article sets an initial foundation for developing speech-language pathology materials and services for Setswana learning children, an emerging area of public service in Botswana.

Keywords: rhotic, apical trill, Phon, phonological emergence, auditory, articulatory, mapping

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Authors: Abhishek Ranka

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Rock-cut Architecture is a manifestation of human endurance in constructing magnificent structures by sculpting and cutting entire hills. Cave Architecture in India form an important part of rock-cut development and is among the most prolific examples of rock-cut architecture in the world. There are more than 1500 rock-cut caves in various regions of India. Among them mostly are located in western India, more particularly in the state of Maharashtra. Some of the rock-cut caves are located in the central region of India, which is presently known as Malawa (Madhya Pradesh). The region is dominated by the vidhyachal hill ranges toward the west, dotted with the coarse laterite rock. Dhamnar Caves have been excavated in the central region of Mandsaur Dist. With a combination of shared sacred faiths. The earliest rock-cut activity began in the north, in Bihar, where caves were excavated in the Barabar and the Nagarjuni hills during the Mauryan period (3rd century BCE). The rock-cut activity then shifts to the central part of India in Madhya Pradesh, where the caves at Dhamnar, Bagh, Udayagiri, Poldungar, etc. excavated between 3rdto 9ᵗʰ CE. The rock-cut excavation continued to flourish in Madhya Pradesh till 10ᵗʰ century CE, simultaneously with monolithic Hindu temples. Dhamnar caves fall into four architectural typologies: the Lena caves, Chaitya caves, Viharas & Lena-Chaityagriha caves. The Buddhist rock-cutting activity in central India is divisible into two phases. In the first phase (2ndBCE-3rd CE), the Buddha image is conspicuously absent. After a lapse of about three centuries, activity begins again, and the Buddha images this time are carved. The former group belongs to the Hinayana (Lesser Vehicle) phase and the latter to the Mahayana (Greater Vehicle). Dhamnar caves has an elaborate facades, pillar capitals, and many more creative sculptures in various postures. These caves were excavated against the background of invigorating trade activities and varied socio-religious or Socio Cultural contexts. These caves also highlights the wealthy and varied patronage provided by the dynasties of the past. This paper speaks about the appraisal of the rock cut mechanisms, design strategies, and approaches while promoting a scope for further research in conservation practices. Rock-cut sites, with their physical setting and various functional spaces as a sustainable habitat for centuries, has a heritage footprint with a researchquotient.

Keywords: rock-cut architecture, buddhism, hinduism, Iconography, and architectural typologies, Jainism

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Authors: R. Rajeswari

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An investigation was carried out to know the SOC stock and its change over time in benchmark soils of different agroclimatic zones of Tamil Nadu. Roth.C model was used to assess SOC stock under existing and alternate cropping pattern. Soil map prepared on 1:50,000 scale from Natural Resources Information System (NRIS) employed under satellite data (IRS-1C/1D-PAN sharpened LISS-III image) was used to estimate SOC stock in different agroclimatic zones of Tamil Nadu. Fifteen benchmark soils were selected in different agroclimatic zones of Tamil Nadu based on their land use and the areal extent to assess SOC level and its change overtime. This revealed that, between eleven years of period (1997 - 2007). SOC buildup was higher in soils under horticulture system, followed by soils under rice cultivation. Among different agroclimatic zones of Tamil Nadu hilly zone have the highest SOC stock, followed by north eastern, southern, western, cauvery delta, north western, and high rainfall zone. Although organic carbon content in the soils of North eastern, southern, western, North western, Cauvery delta were less than high rainfall zone, the SOC stock was high. SOC density was higher in high rainfall and hilly zone than other agroclimatic zones of Tamil Nadu. Among low rainfall regions of Tamil Nadu cauvery delta zone recorded higher SOC density. Roth.C model was used to assess SOC stock under existing and alternate cropping pattern in viz., Periyanaickenpalayam series (western zone), Peelamedu series (southern zone), Vallam series (north eastern zone), Vannappatti series (north western zone) and Padugai series (cauvery delta zone). Padugai series recorded higher TOC, BIO, and HUM, followed by Periyanaickenpalayam series, Peelamedu series, Vallam series, and Vannappatti series. Vannappatti and Padugai series develop high TOC, BIO, and HUM under existing cropping pattern. Periyanaickenpalayam, Peelamedu, and Vallam series develop high TOC, BIO, and HUM under alternate cropping pattern. Among five selected soil series, Periyanaickenpalayam, Peelamedu, and Padugai series recorded 0.75 per cent TOC during 2025 and 2018, 2100 and 2035, 2013 and 2014 under existing and alternate cropping pattern, respectively.

Keywords: agro climatic zones, benchmark soil, land use, soil organic carbon

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Authors: Ibrahim O. Abdulmalik, Michael C. Amonye, Mahdi Makoyo

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Manual knapsack sprayer is the most popular means of farm spraying in Nigeria. It has its limitations. Apart from the human fatigue, which leads to unsteady walking steps, their field capacities are small. They barely cover about 0.2hectare per hour. Their small swath implies that a sizeable farm would take several days to cover. Weather changes are erratic and often it is desired to spray a large farm within hours or few days for even effect, uniformity and to avoid adverse weather interference. It is also often required that a large farm be covered within a short period to avoid re-emergence of weeds before crop emergence. Deployment of many knapsack operators to large farms has not been successful. Human error in taking equally spaced swaths usually result in over dosage of overlaps and in unapplied areas due to error at edges overlaps. Large farm spraying require boom equipment with larger swath. Reduced error in swath overlaps and spraying within the shortest possible time are then assured. Tractor boom sprayers would readily overcome these problems and achieve greater coverage, but they are not available in the country. Tractor hire for cultivation is very costly with the attendant lack of spare parts and specialized technicians for maintenance wherefore farmers find it difficult to engage tractors for cultivation and would avoid considering the employment of a tractor boom sprayer. Animal traction in farming is predominant in Nigeria, especially in the Northern part of the country. Development of boom sprayers drawn by work animals surely implies the maximization of animal utilization in farming. The Hydraulic Equipment Development Institute, Kano, in keeping to its mandate of targeted R&D in hydraulic and pneumatic systems, has developed an Animal Drawn Knapsack Boom Sprayer with four nozzles using the axle mechanism of a two wheeled cart to actuate the piston pump of two knapsack sprayers in line with appropriate technology demand of the country. It is hoped that the introduction of this novel contrivance shall enhance crop protection practice and lead to greater crop and food production in Nigeria.

Keywords: boom, knapsack, farm, sprayer, wheel axle

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Authors: Kurt Maxwell Kusterer, Sylvain Mignot, Annick Vignes

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To our best knowledge YouTube is the largest video hosting platform in the world. A high number of creators, viewers, subscribers and commentators act in this specific eco-system which generates huge sums of money. Views, subscribers, and comments help to increase the popularity of content creators. The most popular creators are sponsored by brands and participate in marketing campaigns. For a few of them, this becomes a financially rewarding profession. This is made possible through the YouTube Partner Program, which shares revenue among creators based on their popularity. We believe that the role of comments in increasing the popularity is to be emphasized. In what follows, YouTube is considered as a bilateral network between the videos and the commentators. Analyzing a detailed data set focused on French YouTubers, we consider each comment as a link between a commentator and a video. Our research question asks what are the predominant features of a video which give it the highest probability to be commented on. Following on from this question, how can we use these features to predict the action of the agent in commenting one video instead of another, considering the characteristics of the commentators, videos, topics, channels, and recommendations. We expect to see that the videos of more popular channels generate higher viewer engagement and thus are more frequently commented. The interest lies in discovering features which have not classically been considered as markers for popularity on the platform. A quick view of our data set shows that 96% of the commentators comment only once on a certain video. Thus, we study a non-weighted bipartite network between commentators and videos built on the sub-sample of 96% of unique comments. A link exists between two nodes when a commentator makes a comment on a video. We run an Exponential Random Graph Model (ERGM) approach to evaluate which characteristics influence the probability of commenting a video. The creation of a link will be explained in terms of common video features, such as duration, quality, number of likes, number of views, etc. Our data is relevant for the period of 2020-2021 and focuses on the French YouTube environment. From this set of 391 588 videos, we extract the channels which can be monetized according to YouTube regulations (channels with at least 1000 subscribers and more than 4000 hours of viewing time during the last twelve months).In the end, we have a data set of 128 462 videos which consist of 4093 channels. Based on these videos, we have a data set of 1 032 771 unique commentators, with a mean of 2 comments per a commentator, a minimum of 1 comment each, and a maximum of 584 comments.

Keywords: YouTube, social networks, economics, consumer behaviour

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Authors: Magda Gorczyca, Zofia Nocoń

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Past and current studies from different countries showed that river engineering leads to environmental degradation and extinction of many species - often those protected by local and international wildlife conservation laws. Through the years, the main focus of rivers utilization has shifted from industrial applications to recreation and wildlife preservation with a focus on keeping the biodiversity which plays a significant role in preventing climate changes. Thus an opportunity appeared to recreate flooding areas and natural habitats, which are very rare in the scale of Europe. Additionally, river restoration helps to avoid floodings and periodic droughts, which are usually very damaging to the economy. In this research, the biodiversity of dragonflies and ground beetles was analyzed in the context of plant communities and forest stands structure. Results were enriched with data from past and current literature. A comparison was made between two parts of the Odra river. A part where oxbow lake and riparian forest were separated from the river bed by embankment and a part of the river with floodplains left intact. Validity assessment of embankments relocation was made based on the research results. In the period between May and September, insects were collected, phytosociological analysis were taken, and forest stand structure properties were specified. In the part of the river not separated by the embankments, rare and protected species of plants were spotted (e.g., Trapanatans, Salvinianatans) as well as greater species and quantitive diversity of dragonfly. Ground beetles fauna, though, was richer in the area separated by the embankment. Even though the research was done during only one season and in a limited area, the results can be a starting point for further extended research and may contribute to acquiring legal wildlife protection and restoration of the researched area. During the research, the presence of invasive species Impatiens parviflora, Echinocystislobata, and Procyonlotor were observed, which may lead to loss of the natural values of the researched areas.

Keywords: carabidae, floodplains, middle Odra river, Odonata, oxbow lakes, riparian forests

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Authors: Maha Atout, Pippa Hemingway, Jane Seymour

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Background: A mixed method systematic review was undertaken in order to explore issues related to the experiences of health care providers and parents in the care of children with palliative care needs. The aims of this systematic review were to identify existing evidence about the experiences of communication in the care of children with palliative care needs, to appraise the research conducted in this area and to identify gaps in the literature in order to recommend for future related studies. Method: A mixed method systematic review of research on the experience of communication in the care of children with palliative care needs, conducted with parents and health professionals was undertaken. The electronic databases of CINAHL, Cochrane, PubMed, OVID, Social Care Online, Web of Science, Scopus, and ProQuest were searched for the period of 2000-2016. Inclusion was limited to studies of communication experience in the care of children with palliative care needs. Result: Thirty-eight studies were found. The studies were conducted in a variety of countries: Uganda, Jordan, USA, UK, Taiwan, Turkey, Ireland, Poland, Brazil, Australia, Switzerland, Sweden, Netherland, Lebanon, Spain, Greece, and China. The current review shows that parents tend to protect their children when they are discussing their illnesses with them, particularly where they have a life-threatening or life-limiting condition. The approach of parents towards the discussion of sensitive issues concerning death with their children is significantly affected by the cultural background of the families. Conservative cultures encourage collusion behaviours which tend to keep children unaware of the incurable nature of the disease. The major communication challenges reported by health professionals are facing difficulties in judging how much information should be given to parents, responding to difficult questions, conflicts with families and inadequate skills to support grieving families. Conclusion: It is probably significant for the future studies to consider the change of parent-child communication experience over time in order to understand how the parents could change their interaction styles with their children according to the different stages of their children’s disease. Moreover, further studies are required to investigate the experience of communication of parents of children with non-malignant life-threatening and life-limiting illnesses.

Keywords: children with life-threatening or life- limiting illnesses, end of life, experience of communication, healthcare care providers, paediatric palliative care

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Authors: Mikhail V. Khachaturyan, Inga A. Koryagina, Eugenia V. Klicheva

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In modern conditions, scientific judgment of problems in developing mechanisms of value creation and risk management acquires special relevance. Formation of economic knowledge has resulted in the constant analysis of consumer behavior for all players from national and world markets. Effective mechanisms development of the demand analysis, crucial for consumer's characteristics of future production, and the risks connected with the development of this production are the main objectives of control systems in modern conditions. The modern period of economic development is characterized by a high level of globalization of business and rigidity of competition. At the same time, the considerable share of new products and services costs has a non-material intellectual nature. The most successful in Russia is the contemporary development of small innovative firms. Such firms, through their unique technologies and new approaches to process management, which form the basis of their intellectual capital, can show flexibility and succeed in the market. As a rule, such enterprises should have very variable structure excluding the tough scheme of submission and demanding essentially new incentives for inclusion of personnel in innovative activity. Realization of similar structures, as well as a new approach to management, can be constructed based on value-oriented management which is directed to gradual change of consciousness of personnel and formation from groups of adherents included in the solution of the general innovative tasks. At the same time, valuable changes can gradually capture not only innovative firm staff, but also the structure of its corporate partners. Introduction of new technologies is the significant factor contributing to the development of new valuable imperatives and acceleration of the changing values systems of the organization. It relates to the fact that new technologies change the internal environment of the organization in a way that the old system of values becomes inefficient in new conditions. Introduction of new technologies often demands change in the structure of employee’s interaction and training in their new principles of work. During the introduction of new technologies and the accompanying change in the value system, the structure of the management of the values of the organization is changing. This is due to the need to attract more staff to justify and consolidate the new value system and bring their view into the motivational potential of the new value system of the organization.

Keywords: value, risk, creation, problems, organization

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Authors: Muhammad Younas, Zimal Naveed

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Introduction : TB is caused by the bacillus Mycobacterium tuberculosis, which is spread when people who are sick with TB expel bacteria into the air (e.g. by coughing). The 30 high TB burden countries accounted for 87% of all estimated incident cases worldwide, and eight of these countries accounted for more than two thirds of the global total: India (27%), Indonesia (10%), China (7.1%), the Philippines (7.0%), Pakistan (5.7%), Nigeria (4.5%), Bangladesh (3.6%) and the Democratic Republic of the Congo (3.0%). Objective : To analyze prevalence of tuberculosis among the people who presented at THQ hospital Bhalwal between April 2024 to June 2024. Method : Total of 9200 patients presented in the OPD of THQ hospital Bhalwal were included in the study. These presumed cases underwent diagnostic testing by sputum for AFB, Gene expert and chest x rays. The data was then classified based Pulmonary and Extra-pulmonary TB disease and further classified on the basis of bacteriology positive and clinically diagnosed TB. The registered TB cases were then classified in 8 age groups in years and according to the gender. All the registered TB cases were then tested for HIV to observe the relation between Tuberculosis and HIV. Results : The total of 9200 patients presented to OPD during the period of 3 months between April 2024 to June 2024. Total registered cases of Tuberculosis were 161 (comprising 153 new cases and 8 cases after treatment failure). Out of the new cases 83 were males and 70 female cases were identified. The majority of males that were identified lies between age 55-64 and 65 and above while the majority of females that were diagnosed lies in the age group of 5-14 and 15-24. All the registered cases were then tested for HIV but none of them were found to be positive. Conclusion : According to World Health Organisation Global Tuberculosis Report, the incidence of Tubeculosis per 100000 people was 258, equivalent to 0.258 %. However, the study reveals an exceptionally high frequency of TB cases. The prevalence of Tuberculosis per 100000 people was found to be 1750 which is equivalent to 1.75 %. The study revealed that larger proportion of the population is currently affected by TB compared to the global average incidence reported by the WHO. The findings of the study indicates that the prevalence of tuberculosis (TB) among females is most common in the younger population, specifically between the ages of 5 to 24, and particularly within the peak fertility age group of 15 to 24 years. The health of women in their peak fertility years is crucial for maternal and child health outcomes. This highlights the need for targeted public health interventions in this area to manage and reduce the burden of TB.

Keywords: AGE, AFB, female, male

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Authors: Michalis Michael, Mauro Overend

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Buildings, in which we spend 87-90% of our time, act as a shelter protecting us from environmental conditions and weather phenomena. The building's overall performance is significantly dependent on the envelope’s glazing part, which is particularly critical as it is the most vulnerable part to heat gain and heat loss. However, conventional glazing technologies have relatively low-performance thermo-optical characteristics. In this regard, during winter, the heat losses due to the glazing part of a building envelope are significantly increased as well as the heat gains during the summer period. In this study, the contribution of an innovative glazing technology, namely Closed Cavity Façade (CCF) in improving energy efficiency and IEQ in office buildings is examined, aiming to optimize various design configurations of CCF. Using Energy Plus and IDA ICE packages, the performance of several CCF configurations and geometries for various climate types were investigated, aiming to identify the optimum solution. The model used for the simulations and optimization process was MATELab, a recently constructed outdoor test facility at the University of Cambridge (UK). The model was previously experimentally calibrated. The study revealed that the use of CCF technology instead of conventional double or triple glazing leads to important benefits. Particularly, the replacement of the traditional glazing units, used as the baseline, with the optimal configuration of CCF led to a decrease in energy consumption in the range of 18-37% (depending on the location). This mainly occurs due to integrating shading devices in the cavity and applying proper glass coatings and control strategies, which lead to improvement of thermal transmittance and g-value of the glazing. Since the solar gain through the façade is the main contributor to energy consumption during cooling periods, it was observed that a higher energy improvement is achieved in cooling-dominated locations. Furthermore, it was shown that a suitable selection of the constituents of a closed cavity façade, such as the colour and type of shading devices and the type of coatings, leads to an additional improvement of its thermal performance, avoiding overheating phenomena and consequently ensuring temperatures in the glass cavity below the critical value, and reducing the radiant discomfort providing extra benefits in terms of Indoor Environmental Quality (IEQ).

Keywords: building energy efficiency, closed cavity façade, optimization, occupants comfort

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Authors: Elissavet Feloni, Ioannis Kourtis, Konstantinos Kotsifakis, Evangelos Baltas

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Water inadequacy in small dry islands scattered in the Aegean Sea (Greece) is a major problem regarding Water Resources Management (WRM), especially during the summer period due to tourism. In the present work, various WRM schemes are designed and presented. The WRM schemes take into account current infrastructure and include Rainwater Harvesting tanks and Reverse Osmosis Desalination Units. The energy requirements are covered mainly by wind turbines and/or a seawater pumped storage system. Sizing is based on the available data for population and tourism per island, after taking into account a slight increase in the population (up to 1.5% per year), and it guarantees at least 80% reliability for the energy supply and 99.9% for potable water. Evaluation of scenarios is carried out from a financial perspective, after calculating the Life Cycle Cost (LCC) of each investment for a lifespan of 30 years. The wind-powered desalination plant was found to be the most cost-effective practice, from an economic point of view. Finally, in order to estimate the Climate Change (CC) impact, six different CC scenarios were investigated. The corresponding rate of on-grid versus off-grid energy required for ensuring the targeted reliability for the zero and each climatic scenario was investigated per island. The results revealed that under CC the grid-on energy required would increase and as a result, the reduction in wind turbines and seawater pumped storage systems’ reliability will be in the range of 4 to 44%. However, the range of this percentage change does not exceed 22% per island for all examined CC scenarios. Overall, CC is proposed to be incorporated into the design process for WRM-related projects. Acknowledgements: This research is co-financed by Greece and the European Union (European Social Fund - ESF) through the Operational Program «Human Resources Development, Education and Lifelong Learning 2014-2020» in the context of the project “Development of a combined rain harvesting and renewable energy-based system for covering domestic and agricultural water requirements in small dry Greek Islands” (MIS 5004775).

Keywords: small dry islands, water resources management, climate change, desalination, RES, seawater pumped storage system, rainwater harvesting

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Authors: Ioannis N. Sergentanis, Stavroula Papadodima, Maria Tsellou, Dimitrios Vlachodimitropoulos, Sotirios Athanaselis, Chara Spiliopoulou

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Introduction: The aim of this study is the investigation of characteristics of suicide, as documented in autopsies during a five-year interval in the greater area of Attica, including the city of Athens. This could reveal possible protective or aggravating factors for suicide risk during a period strongly associated with the Greek debt crisis. Materials and Methods: Data was obtained following registration of suicide cases among autopsies performed in the Forensic Medicine and Toxicology Department, School of Medicine, National and Kapodistrian University of Athens, Greece, during the time interval from January 2011 to December 2015. Anonymity and medical secret were respected. A series of demographic and social factors in addition to special characteristics of suicide were entered into a specially established pre-coded database. These factors include social data as well as psychiatric background and certain autopsy characteristics. Data analysis was performed using descriptive statistics and Fisher’s exact test. The software used was STATA/SE 13 (Stata Corp., College Station, TX, USA). Results: A total of 162 cases were studied, 128 men and 34 women. Age ranged from 14 to 97 years old with an average of 53 years, presenting two peaks around 40 and 60 years. A 56% of cases were single/ divorced/ widowed. 25% of cases occurred during the weekend, and 66% of cases occurred in the house. A predominance of hanging as the leading method of suicide (41.4%) followed by jumping from a height (22.8%) and firearms (19.1%) was noted. Statistical analysis showed an association was found between suicide method and gender (P < 0.001, Fisher’s exact test); specifically, no woman used a firearm while only one man used medication overdose (against four women). Discussion: Greece has historically been one of the countries with the lowest suicide rates in Europe. Given a possible change in suicide trends during the financial crisis, further research seems necessary in order to establish risk factors. According to our study, suicide is more frequent in men who are not married, inside their house. Gender seems to be a factor affecting the method of suicide. These results seem in accordance with the international literature. Stronger than expected predominance in male suicide can be associated with failure to live up to social and family expectations for financial reasons.

Keywords: autopsy, Greece, risk factors, suicide

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Authors: Mai Alharthy, Agnes Shiel, Hynes Sinead

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Objectives: The objectives of the study are to translate and culturally adapt the RBMT-3 to be appropriate for use within an Arabic-speaking population and to achieve maximum equivalency between the translated and original versions and to evaluate the psychometric properties of the Arabic version of the RBMT-3. Participants' numbers are 16 (10 females and 6 males). All participants are bilingual speakers of Arabic and English, above 18 years old and with no current nor past memory impairment. Methods: The study was conducted in two stages: Translation and cultural adaptation stage: Forward and backward translations were completed by professional translators. Five out of the 14 RBMT-3 subtests required cultural adaptations. Half of the faces in the face recognition subtests were replaced with Arabic faces by a professional photographer. Pictures that are irrelevant to the Arabic culture in the picture recognition subtests were replaced. Names, story and orientations subtests were also adapted to suit the Arabic culture. An expert committee was formed to compare the translated and original versions and to advise on further changes required for test materials. Validation of the Arabic RBMT-3- pilot: 16 Participants were tested on version 1 of the English version and the two versions of the Arabic RBMT-3 ( counterbalanced ). The assessment period was 6 weeks long, with two weeks gap between tests. All assessments took place in a quiet room in the National University of Ireland Galway. Two qualified occupational therapists completed the assessments. Results: Wilcox signed-rank test was used to compare between subtest scores. Significant differences were found in the story, orientation and names subtests between the English and Arabic versions. No significant differences were found in subtests from both Arabic versions except for the story subtest. Conclusion: The story and orientation subtests should be revised by the expert committee members to make further adaptations. The rest of the Arabic RBMT-3 subtests are equivalent to the subtests of the English version. The psychometric properties of the Arabic RBMT-3 will be investigated in a larger Arabic-speaking sample in Saudi Arabia. The outcome of this research is to provide clinicians and researchers with a reliable tool to assess memory problems in Arabic speaking population.

Keywords: memory impairment, neuropsychological assessment, cultural adaptation, cognitive assessment

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Authors: Jelka Pleadin, Nina Kudumija, Ana Vulic, Manuela Zadravec, Tina Lesic, Mario Skrivanko, Irena Perkovic, Nada Vahcic

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Products of animal origin, such as meat and meat products, can contribute to human mycotoxins’ intake coming as a result of either indirect transfer from farm animals exposed to naturally contaminated grains and feed (carry-over effects) or direct contamination with moulds or naturally contaminated spice mixtures used in meat production. Ochratoxin A (OTA) is mycotoxin considered to be of the outermost importance from the public health standpoint in connection with meat products. The aim of this study was to investigate the occurrence of OTA in different traditional meat products circulating on Croatian markets during 2018, produced by a large number of households situated in eastern and north Croatian regions using a variety of technologies. Concentrations of OTA were determined in traditional meat products (n = 70), including dry fermented sausages (Slavonian kulen, Slavonian sausage, Istrian sausage and domestic sausage; n = 28), dry-cured meat products (pancetta, pork rack and ham; n = 22) and cooked sausages (liver sausages, black pudding sausages and pate; n = 20). OTA was analyzed by use of quantitative screening immunoassay method (ELISA) and confirmed for positive samples (higher than the limit of detection) by liquid chromatography tandem mass spectrometry (LC-MS/MS) method. Whereas the bacon samples contaminated with OTA were not found, its level in dry fermented sausages ranged from 0.22 to 2.17 µg/kg and in dry-cured meat products from 0.47 to 5.35 µg/kg, with in total 9% of positive samples. Besides possible primary contamination of these products arising due to improper manufacturing or/and storage conditions, observed OTA contamination could also be the consequence of secondary contamination that comes as a result of contaminated feed the animals were fed on. OTA levels obtained in cooked sausages ranged from 0.32 to 4.12 µg/kg (5% of positives) and could probably be linked to the contaminated raw materials (liver, kidney and spices) used in the sausages production. The results showed an occasional OTA contamination of traditional meat products, pointing that to avoid such contamination on households these products should be produced and processed under standardized and well-controlled conditions. Further investigations should be performed in order to identify mycotoxin-producing moulds on the surface of the products and to define preventative measures that can reduce the contamination of traditional meat products during their production on households and period of storage.

Keywords: Croatian households, ochratoxin-A, traditional cooked sausages, traditional dry-cured meat products

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Authors: Ashwini Patil

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Caudal block is one of the most commonly used regional anesthetic techniques in children. Currently, fentanyl is used as an adjuvant to bupivacaine to prolong analgesia but fentanyl is a narcotic. Dexamethasone, a glucocorticoid with strong anti-inflammatory effects provides improvement in post-operative analgesia and post-operative side effects. However, its analgesic efficacy and safety in comparison with fentanyl has not been extensively studied. So the objective of this randomized controlled study is to compare dexamethasone with fentanyl as an adjuvant to bupivacaine for caudal block in children in relation to the duration of caudal analgesia, post-operative analgesic requirement and incidence of post-operative nausea and vomiting. This study included 100 children, aged 1–6 years, undergoing lower abdominal surgeries. Patients were randomized into two groups, 50 each to receive a combination of dexamethasone 0.2 mg/kg along with 1 ml/kg bupivacaine 0.25% (group A) or combination of fentanyl (1 ug/kg) along with 1ml/kg bupivacaine 0.25% (group B). In the post-operative period, pain was assessed using a Modified Objective Pain Scale (MOPS) until 12 hr after surgery and rescue analgesia is administered when MOPS score 4 or more is recorded. Residual motor block, number of analgesic doses required within 24 hr after surgery, sedation scores, intra-operative and post-operative hemodynamic variables, post-operative nausea and vomiting (PONV), and other adverse effects were recorded. Data is analysed using unpaired t test and Significance level of P< 0.05 is considered statistically significant. Group A showed a significantly longer time to first analgesic requirement than group B (p<0.05). The number of rescue analgesic doses required in the first 24 h was significantly less in group A (p<0.05). Group A showed significantly lower MOPS scores than group B(p<0.05). Intra-operative and post-operative hemodynamic variables, Modified Bromage Scale scores, and sedation scores were comparable in both the groups. Group A showed significantly fewer incidences of PONV compared with group B(p<0.05). This study reveals that adding dexamethasone to bupivacaine prolongs the duration of postoperative analgesia and decreases the incidence of PONV as compared to combination of fentanyl to bupivacaine after a caudal block in pediatric patients.

Keywords: bupivacaine, caudal analgesia, dexamethasone, pediatric

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Authors: Choon Seong Ng, P. Petrick, C. L. Lau

Abstract:

Background: Carbapenem-resistant isolates have been increasingly reported recently. Carbapenem stewardship is designed to optimize its usage particularly among medical wards with high prevalence of carbapenem prescriptions to combat such emerging resistance. Carbapenem stewardship programmes (CSP) can reduce antibiotic use but clinical outcome of such measures needs further evaluation. We examined this in a prospective manner using feedback mechanism. Methods: Our single-center prospective cohort study involved all carbapenem prescriptions across the medical wards (including medical patients admitted to intensive care unit) in a tertiary university hospital setting. The impact of such stewardship was analysed according to the accepted and the rejected groups. The primary endpoint was safety. Safety measure applied in this study was the death at 1 month. Secondary endpoints included length of hospitalisation and readmission. Results: Over the 19 months’ period, input from 144 carbapenem prescriptions was analysed on the basis of acceptance of our CSP recommendations on the use of carbapenems. Recommendations made were as follows : de-escalation of carbapenem; stopping the carbapenem; use for a short duration of 5-7 days; required prolonged duration in the case of carbapenem-sensitive Extended Spectrum Beta-Lactamases bacteremia; dose adjustment; and surgical intervention for removal of septic foci. De-escalation, shorten duration of carbapenem and carbapenem cessation comprised 79% of the recommendations. Acceptance rate was 57%. Those who accepted CSP recommendations had no increase in mortality (p = 0.92), had a shorter length of hospital stay (LOS) and had cost-saving. Infection-related deaths were found to be higher among those in the rejected group. Moreover, three rejected cases (6%) among all non-indicated cases (n = 50) were found to have developed carbapenem-resistant isolates. Lastly, Pitt’s bacteremia score appeared to be a key element affecting the carbapenem prescription’s behaviour in this trial. Conclusions: Carbapenem stewardship program in the medical wards not only saves money, but most importantly it is safe and does not harm the patients with added benefits of reducing the length of hospital stay. However, more time is needed to engage the primary clinical teams by formal clinical presentation and immediate personal feedback by senior Infectious Disease (ID) personnel to increase its acceptance.

Keywords: audit and feedback, carbapenem stewardship, medical wards, university hospital

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