Search results for: Rohingya population

Authors: Minjung Maing, Sibei Liu

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This research discusses the results of a study of window opening behavior of large housing developments in the high-density megacity of Hong Kong. The methods used for the study involved field observations using photo documentation of the four cardinal elevations (north, south-east, and west) of two large housing developments in a very dense urban area of approx. 46,000 persons per square meter within the city of Hong Kong. The targeted housing developments (A and B) are large public housing with a population of about 13,000 in each development of lower income. However, the mean income level in development A is about 40% higher than development B and home ownership is 60% in development A and 0% in development B. Mapping of the surrounding amenities and layout of the developments were also studied to understand the available activities to the residents. The photo documentation of the elevations was taken from November 2016 to February 2018 to gather a full spectrum of different seasons and both in the morning and afternoon (am/pm) times. From the photograph, the window opening behavior was measured by counting the amount of windows opened as a percentage of all the windows on that façade. For each date of survey data collected, weather data was recorded from weather stations located in the same region to collect temperature, humidity and wind speed. To further understand the behavior, simulation studies of microclimate conditions of the housing development was conducted using the software ENVI-met, a widely used simulation tool by researchers studying urban climate. Four major conclusions can be drawn from the data analysis and simulation results. Firstly, there is little change in the amount of window opening during the different seasons within a temperature range of 10 to 35 degrees Celsius. This means that people who tend to open their windows have consistent window opening behavior throughout the year and high tolerance of indoor thermal conditions. Secondly, for all four elevations the lower-income development B opened more windows (almost two times more units) than higher-income development A meaning window opening behavior had strong correlations with income level. Thirdly, there is a lack of correlation between outdoor horizontal wind speed and window opening behavior, as the changes of wind speed do not seem to affect the action of opening windows in most conditions. Similar to the low correlation between horizontal wind speed and window opening percentage, it is found that vertical wind speed also cannot explain the window opening behavior of occupants. Fourthly, there is a slightly higher average of window opening on the south elevation than the north elevation, which may be due to the south elevation being well shaded from high angle sun during the summer and allowing heat into units from lower angle sun during the winter season. These findings are important to providing insight into how to better design urban environments and indoor thermal environments for a liveable high density city.

Keywords: high-density housing, subtropical climate, urban behavior, window opening

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Authors: A. Delimitsou, C. Gouedard, E. Konstanta, A. Koletis, S. Patera, E. Manou, K. Spaho, S. Murray

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Background: There remains a lack of International Standard Control Reference materials for Next Generation Sequencing-based approaches or device calibration. We have designed and validated dsDNA biomimetic reference materials for targeted such approaches incorporating proprietary motifs (patent pending) for device/test calibration. They enable internal single-sample calibration, alleviating sample comparisons to pooled historical population-based data assembly or statistical modelling approaches. We have validated such an approach for BRCA Copy Number Variation analytics using iQRS™-CNVSUITE versus Mixed Ligation-dependent Probe Amplification. Methods: Standard BRCA Copy Number Variation analysis was compared between mixed ligation-dependent probe amplification and next generation sequencing using a cohort of 198 breast/ovarian cancer patients. Next generation sequencing based copy number variation analysis of samples spiked with iQRS™ dsDNA biomimetics were analysed using proprietary CNVSUITE software. Mixed ligation-dependent probe amplification analyses were performed on an ABI-3130 Sequencer and analysed with Coffalyser software. Results: Concordance of BRCA – copy number variation events for mixed ligation-dependent probe amplification and CNVSUITE indicated an overall sensitivity of 99.88% and specificity of 100% for iQRS™-CNVSUITE. The negative predictive value of iQRS-CNVSUITE™ for BRCA was 100%, allowing for accurate exclusion of any event. The positive predictive value was 99.88%, with no discrepancy between mixed ligation-dependent probe amplification and iQRS™-CNVSUITE. For device calibration purposes, precision was 100%, spiking of patient DNA demonstrated linearity to 1% (±2.5%) and range from 100 copies. Traditional training was supplemented by predefining the calibrator to sample cut-off (lock-down) for amplicon gain or loss based upon a relative ratio threshold, following training of iQRS™-CNVSUITE using spiked iQRS™ calibrator and control mocks. BRCA copy number variation analysis using iQRS™-CNVSUITE™ was successfully validated and ISO15189 accredited and now enters CE-IVD performance evaluation. Conclusions: The inclusion of a reference control competitor (iQRS™ dsDNA mimetic) to next generation sequencing-based sequencing offers a more robust sample-independent approach for the assessment of copy number variation events compared to mixed ligation-dependent probe amplification. The approach simplifies data analyses, improves independent sample data analyses, and allows for direct comparison to an internal reference control for sample-specific quantification. Our iQRS™ biomimetic reference materials allow for single sample copy number variation analytics and further decentralisation of diagnostics to single patient sample assessment.

Keywords: validation, diagnostics, oncology, copy number variation, reference material, calibration

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Authors: Flavia Oliveira de A. M. Cruz, Edison Tostes Faria, Paula Elaine D. Reis

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When the breast is submitted to radiation therapy (RT), the most common effects are pain, skin changes, mobility restrictions, local sensory alteration, and fatigue. These effects, if not managed properly, may reduce the quality of life of cancer patients and may lead to the treatment discontinuation. Therefore, promoting knowledge and guidelines for symptom management remain a high priority for patients and a challenge for health professionals, due to the need to handle side effects in a population with a life-threatening disease. Printed materials are important strategies for supporting educative activities since they help the individual to assimilate and understand the amount of information transmitted. Nurses' behavior can be systematized through the use of an educative manual, which may be effective in promoting information regarding the treatment, self-care and how to control the effects of RT at home. In view of the importance of guaranteeing the validity of the material before its use, the objective of this research was to validate the content and appearance of an educative manual for breast cancer patients undergoing RT. The Theory of Psychometrics was used for the validation process in this descriptive methodological research. A minimum agreement rate (AR) of 80% was considered to guarantee the validity of the material. The data were collected from October to December 2017, by means of two assessments tools, constructed in the form of a Likert scale, with five levels of understanding. These instruments addressed different aspects of the evaluation, in view of two different groups of participants; 17 experts in the theme area of the educative manual, and 12 women that received RT previously to treat breast cancer. The manual was titled 'Orientation Manual: radiation therapy in breast', and was focused on breast cancer patients attended at the Department of Oncology of the Brasília University Hospital (UNACON/HUB). The research project was submitted to the Research Ethics Committee at the School of Health Sciences of the University of Brasília (CAAE: 24592213.1.0000.0030). Only two items of the assessment tool for the experts, one related to the manual's ability to promote behavioral and attitude changes and the other related to the extent of its use for other health services, obtained AR < 80% and were reformulated based on the participants' suggestions and in the literature. All other items were considered appropriate and/or complete appropriate in the three blocks proposed for the experts: objectives - 89%, structure and form - 93%, and relevance - 93%; and good and/or very good in the five blocks of analysis proposed for patients: objectives - 100%, organization - 100%, writing style - 100%, appearance - 100%, and motivation. The appearance and content validation of the educative manual proposed were attended to. The educative manual was considered relevant and pertinent and may contribute to the understanding of the therapeutic process by breast cancer patients during RT, as well as support clinical practice through the nursing consultation.

Keywords: oncology nursing, nursing care, validation studies, educational technology

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Authors: Budur Almutairi

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Introduction: There is an alarming increase in the number of diabetic patients in Saudi Arabia during the last twenty years. The World Health Organization (WHO) reports that the country ranks seventh in the world for the rate of diabetes. It is also estimated that around 7 million of the population are diabetic and almost around 3 million have pre-diabetes. The prevalence is more in urban area than in rural and more in women than in men and it is closely associated with the parallel rise in obesity rates. Diabetes is found to be contributing to the increasing mortality, morbidity and vascular complications and becoming a significant cause of medical complications and even death. The trends shown by the numbers are worrying as the prevalence is steadily doubling every two decades and particularly in Saudi Arabia, this could soon reach 50% in those over 50 years of age. The economic growth and prosperity have shown notable changes in the lifestyle of the people. Most importantly, along with an increased consumption of fast foods and sugar-rich carbonated soft drinks, eating habits became less healthy and the level of physical activity is decreased. The simultaneous technological advancement and the introduction of new mechanical devices like, elevators, escalators, remotes and vehicles pushed people to a situation of leading a more sedentary life. This study is attempting to evaluate the success of the campaign that introduced through popular social media in the country. Methodology: The Ministry of Health (MoH) has initiated a novel method of campaign activity to generate discussion among public about diabetes. There were mythical monsters introduced through popular social media with disguised messages about the condition of diabetes has generated widespread discussions about the disease among the general public. The characters that started appearing in social media About 600 retweets of the original post was testimonial for the success of the Twitter campaign. The second most successful form of campaign was a video that adopted a very popular approach of using Dark Comedy in which, the diabetes was represented through a twisted negative character that talks about his meticulous plans of how he is going to take the common people into his clutches. This fictional character gained more popularity when introduced into twitter and people started interacting with him raising various questions and challenging his anti-social activities. Major findings: The video generated more than 3,200,000 views ranking 9th in You Tube’s most popular video in Saudi Arabia and was shared 7000 times in a single week. Also, the hashtag got over 4,500,000impressions and over one million visits. Conclusion: Diabetes mellitus in Saudi Arabia is emerging as an epidemic of massive proportions, threatening to negate the benefits of modernization and economic revival. It is highly possible that healthy practices connected with the prevention and management of DM can easily be implemented in a manner that does not conflict with the cultural milieu of Saudi Arabia.

Keywords: campaign, diabetes, Saudi, social media

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Authors: Giulia Colonna, Jocelyn Hoye, Bart de Laat, Gelsina Stanley, Jose Key, Alaaddin Ibrahimy, Sule Tinaz, Evan D. Morris

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Parkinson’s disease (PD) is the second most common neurodegenerative disease and affects approximately 1% of the world’s population. Increasing evidence suggests that aerobic physical exercise can be beneficial in mitigating both motor and non-motor symptoms of the disease. In a recent pilot study of the role of exercise on PD, we sought to confirm exercise intensity by monitoring heart rate (HR). For this purpose, we asked participants to wear a chest strap heart rate monitor (Polar Electro Oy, Kempele). The device sometimes proved uncomfortable. Looking forward to larger clinical trials, it would be convenient to employ a more comfortable and user friendly device. The Fitbit Charge 4 (Fitbit Inc) is a potentially comfortable, user-friendly solution since it is a wrist-worn heart rate monitor. Polar H10 has been used in large trials, and for our purposes, we treated it as the gold standard for the beat-to-beat period (R-R interval) assessment. In previous literature, it has been shown that Fitbit Charge 4 has comparable accuracy to Polar H10 in healthy subjects. It has yet to be determined if the Fitbit is as accurate as the Polar H10 in subjects with PD or in clinical populations, generally. Goal: To compare the Fitbit Charge 4 to the Polar H10 for monitoring HR in PD subjects engaging in an intensive exercise program. Methods: A total of 596 exercise sessions from 11 subjects (6 males) were collected simultaneously by both devices. Subjects with early-stage PD (Hoehn & Yahr <=2) were enrolled in a 6 months exercise training program designed for PD patients. Subjects participated in 3 one-hour exercise sessions per week. They wore both Fitbit and Polar H10 during each session. Sessions included rest, warm-up, intensive exercise, and cool-down periods. We calculated the bias in the HR via Fitbit under rest (5min) and intensive exercise (20min) by comparing the mean HR during each of the periods to the respective means measured by the Polar (HRFitbit – HRPolar). We also measured the sensitivity and specificity of Fitbit for detecting HRs that exceed the threshold for intensive exercise, defined as 70% of an individual’s theoretical maximum HR. Different types of correlation between the two devices were investigated. Results: The mean bias was 1.68 bpm at rest and 6.29 bpm during high intensity exercise, with an overestimation by Fitbit in both conditions. The mean bias of Fitbit across both rest and intensive exercise periods was 3.98 bpm. The sensitivity of the device in identifying high intensity exercise sessions was 97.14 %. The correlation between the two devices was non-linear, suggesting a saturation tendency of Fitbit to saturate at high values of HR. Conclusion: The performance of Fitbit Charge 4 is comparable to Polar H10 for assessing exercise intensity in a cohort of PD subjects. The device should be considered a reasonable replacement for the more cumbersome chest strap technology in future similar studies of clinical populations.

Keywords: fitbit, heart rate measurements, parkinson’s disease, wrist-wearable devices

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Authors: Peninah Agaba, Monica Magadi, Bev Orton

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Uganda is one of the countries with high maternal mortality (336/100,000) where adolescents account for 24 percent of the total maternal deaths. Research shows that use of maternal health services may prevent some of these deaths and good provider attitudes attract adolescents to use the services. However, poor health provider’s attitudes discourage adolescents from seeking the services during the maternity period. This study explores the experiences of unmarried female adolescents at the health facilities during the maternity period. The study population is unmarried adolescent girls aged 10-19 years who were pregnant or had given birth within three years before the interview. This is a special interest group that requires attention throughout this period. Most of the pregnancies among unmarried adolescents are unwanted; as a result, many of them have been abused and neglected by parents and close family members including partners who deny fatherhood of the pregnancy/child. These adolescents hope to find comfort from health providers like being listened to during counseling, not abused and judged; unfortunately this is not the case always. The research was approved by the University of Hull, School of Education and Social Sciences ethics review committee, Mildmay Uganda Research Ethics Committee and Uganda National Council of Science and Technology. The study was carried out in Bushenyi and Kibale districts in Western Uganda. Fourteen in-depth interviews and seven focus group discussions were completed in the local languages and later transcribed to English language. Thematic analysis to identify the themes was done. Adolescents were aged 16-19 years, two had become pregnant before 15 years. Most had not completed secondary education; none had tertiary education and three of the 14 IDI adolescent participants wanted to get pregnant. Analysis shows varied experiences; most adolescents were abused verbally and physically by the health providers due to their young age of pregnancy, lack of essential items during this period (maternity dresses, children clothes, delivery kit) and fear of labour pains. Another cause for abuse was these adolescents coming for antenatal care with no partners yet the implementation of a policy on increasing male involvement in reproductive health in Uganda requires them to attend antenatal care with their partners and most of these unmarried adolescents have no partners to accompany them. Despite the above challenges, the study also identified the care some of these unmarried adolescents received during the maternity visits for example they were not abused, were provided with appropriate information and supported with child care. The study identified abuse and support the unmarried adolescents received during the maternity period. Efforts to provide adolescents with adequate information including what to expect during labour by providers and provision of basic needs are essential. Health providers should have trainings on client care especially how to embrace unmarried adolescents when they come to access maternity services. More so, the policy on improving male involvement in RH issues need to be considerate of unmarried adolescents who in most cases do not have the partners to go with to access maternity care.

Keywords: abuse, maternity care, Uganda, unmarried, adolescents

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Authors: Ichiro Takahashi

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One conundrum that macroeconomic theory faces is to explain how an economy can revive from depression, in which the aggregate demand has fallen substantially below its productive capacity. This paper examines an autonomous stabilizing mechanism using an agent-based Wicksell-Keynes macroeconomic model. This paper focuses on the effects of the number of firms and the length of the gestation period for investment that are often assumed to be one in a mainstream macroeconomic model. The simulations found the virtual economy was highly unstable, or more precisely, collapsing when these parameters are fixed at one. This finding may even suggest us to question the legitimacy of these common assumptions. A perpetual decline in capital stock will eventually encourage investment if the capital stock is short-lived because an inactive investment will result in insufficient productive capacity. However, for an economy characterized by a roundabout production method, a gradual decline in productive capacity may not be able to fall below the aggregate demand that is also shrinking. Naturally, one would then ask if our economy cannot rely on an external stimulus such as population growth and technological progress to revive investment, what factors would provide such a buoyancy for stimulating investments? The current paper attempts to answer this question by employing the artificial macroeconomic model mentioned above. The baseline model has the following three features: (1) the multi-period gestation for investment, (2) a large number of heterogeneous firms, (3) demand-constrained firms. The instability is a consequence of the following dynamic interactions. (a) A multiple-period gestation period means that once a firm starts a new investment, it continues to invest over some subsequent periods. During these gestation periods, the excess demand created by the investing firm will spill over to ignite new investment of other firms that are supplying investment goods: the presence of multi-period gestation for investment provides a field for investment interactions. Conversely, the excess demand for investment goods tends to fade away before it develops into a full-fledged boom if the gestation period of investment is short. (b) A strong demand in the goods market tends to raise the price level, thereby lowering real wages. This reduction of real wages creates two opposing effects on the aggregate demand through the following two channels: (1) a reduction in the real labor income, and (2) an increase in the labor demand due to the principle of equality between the marginal labor productivity and real wage (referred as the Walrasian labor demand). If there is only a single firm, a lower real wage will increase its Walrasian labor demand, thereby an actual labor demand tends to be determined by the derived labor demand. Thus, the second positive effect would not work effectively. In contrast, for an economy with a large number of firms, Walrasian firms will increase employment. This interaction among heterogeneous firms is a key for stability. A single firm cannot expect the benefit of such an increased aggregate demand from other firms.

Keywords: agent-based macroeconomic model, business cycle, demand constraint, gestation period, representative agent model, stability

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Authors: C. Silveira, A. Ascenso, J. Ferreira, A. I. Miranda, P. Tuccella, G. Curci

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Poor air quality is one of the main environmental causes of premature deaths worldwide, and mainly in cities, where the majority of the population lives. It is a consequence of successive land cover (LC) and use changes, as a result of the intensification of human activities. Knowing these landscape modifications in a comprehensive spatiotemporal dimension is, therefore, essential for understanding variations in air pollutant concentrations. In this sense, the use of air quality models is very useful to simulate the physical and chemical processes that affect the dispersion and reaction of chemical species into the atmosphere. However, the modelling performance should always be evaluated since the resolution of the input datasets largely dictates the reliability of the air quality outcomes. Among these data, the updated LC is an important parameter to be considered in atmospheric models, since it takes into account the Earth’s surface changes due to natural and anthropic actions, and regulates the exchanges of fluxes (emissions, heat, moisture, etc.) between the soil and the air. This work aims to evaluate the performance of the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem), when different LC classifications are used as an input. The influence of two LC classifications was tested: i) the 24-classes USGS (United States Geological Survey) LC database included by default in the model, and the ii) CLC (Corine Land Cover) and specific high-resolution LC data for Portugal, reclassified according to the new USGS nomenclature (33-classes). Two distinct WRF-Chem simulations were carried out to assess the influence of the LC on air quality over Europe and Portugal, as a case study, for the year 2015, using the nesting technique over three simulation domains (25 km², 5 km² and 1 km² horizontal resolution). Based on the 33-classes LC approach, particular emphasis was attributed to Portugal, given the detail and higher LC spatial resolution (100 m x 100 m) than the CLC data (5000 m x 5000 m). As regards to the air quality, only the LC impacts on tropospheric ozone concentrations were evaluated, because ozone pollution episodes typically occur in Portugal, in particular during the spring/summer, and there are few research works relating to this pollutant with LC changes. The WRF-Chem results were validated by season and station typology using background measurements from the Portuguese air quality monitoring network. As expected, a better model performance was achieved in rural stations: moderate correlation (0.4 – 0.7), BIAS (10 – 21µg.m^-3) and RMSE (20 – 30 µg.m^-3), and where higher average ozone concentrations were estimated. Comparing both simulations, small differences grounded on the Leaf Area Index and air temperature values were found, although the high-resolution LC approach shows a slight enhancement in the model evaluation. This highlights the role of the LC on the exchange of atmospheric fluxes, and stresses the need to consider a high-resolution LC characterization combined with other detailed model inputs, such as the emission inventory, to improve air quality assessment.

Keywords: land use, spatial resolution, WRF-Chem, air quality assessment

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Authors: Mustafa Metin Donma

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Metabolic syndrome (MetS) is characterized by a series of biochemical, physiological and anthropometric indicators and is a life-threatening health problem due to its close association with chronic diseases such as diabetes mellitus, hypertension, cancer and cardiovascular diseases. The syndrome deserves great interest both in adults and children. Central obesity is the indispensable component of MetS. Particularly, children, who are morbidly obese have a great tendency to develop the disease, because they are under the threat in their future lives. Preventive measures at this stage should be considered. For this, investigators seek for an informative scale or an index for the purpose. So far, several, but not many suggestions come into the stage. However, the diagnostic decision is not so easy and may not be complete particularly in the pediatric population. The aim of the study was to develop a MetS index capable of predicting MetS, while children are at the morbid obesity stage. This study was performed on morbid obese (MO) children, which were divided into two groups. Morbid obese children, who do not possess MetS criteria comprised the first group (n=44). The second group was composed of children (n=42) with MetS diagnosis. Parents were informed about the signed consent forms, which are required for the participation of their children in the study. The approval of the study protocol was taken from the institutional ethics committee of Tekirdag Namik Kemal University. Helsinki Declaration was accepted prior to and during the study. Anthropometric measurements including weight, height, waist circumference (WC), hip C, head C, neck C, biochemical tests including fasting blood glucose (FBG), insulin (INS), triglycerides (TRG), high density lipoprotein cholesterol (HDL-C) and blood pressure measurements (systolic (SBP) and diastolic (DBP)) were performed. Body fat percentage (BFP) values were determined by TANITA’s Bioelectrical Impedance Analysis technology. Body mass index and MetS indices were calculated. The equations for MetS index (MetSI) and advanced Donma MetS index (ADMI) were [(INS/FBG)/(HDL-C/TRG)]*100 and MetSI*[(SBP+DBP/Height)], respectively. Descriptive statistics including median values, compare means tests, correlation-regression analysis were performed within the scope of data evaluation using the statistical package program, SPSS. Statistically significant mean differences were determined by a p value smaller than 0.05. Median values for MetSI and ADMI in MO (MetS-) and MO (MetS+) groups were calculated as (25.9 and 36.5) and (74.0 and 106.1), respectively. Corresponding mean±SD values for BFPs were 35.9±7.1 and 38.2±7.7 in groups. Correlation analysis of these two indices with corresponding general BFP values exhibited significant association with ADMI, close to significance with MetSI in MO group. Any significant correlation was found with neither of the indices in MetS group. In conclusion, important associations observed with MetS indices in MO group were quite meaningful. The presence of these associations in MO group was important for showing the tendency towards the development of MetS in MO (MetS-) participants. The other index, ADMI, was more helpful for predictive purpose.

Keywords: body fat percentage, child, index, metabolic syndrome, obesity

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Authors: Mohamed Naser Zainol, P. P. Angeline Song

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Over the years, the profile of end-stage renal patients placed under The National Kidney Foundation Singapore (NKFS) dialysis program has evolved, with a gradual incline in the number of patients with behavior-related issues. With these challenging profiles, social workers and counsellors are often expected to oversee behavior management, through referrals from its partnering colleagues. Due to the segregation of tasks usually found in many hospital-based multi-disciplinary settings, social workers’ and counsellors’ interventions are often seen as an endpoint, limiting other stakeholders’ involvement that could otherwise be potentially crucial in managing such patients. While patients’ contact in local hospitals often leads to eventual discharge, NKFS patients are mostly long term. It is interesting to note that these patients are regularly seen by a team of professionals that includes doctors, nurses, dietitians, exercise specialists in NKFS. The dynamism of relationships presents an opportunity for any of these professionals to take ownership of their potentials in leading interventions that can be helpful to patients. As such, it is important to have a framework that incorporates the strength of these professionals and also channels empowerment across the multi-disciplinary team in working towards wholistic patient care. This paper would like to suggest a new framework for NKFS’s multi-disciplinary team, where the group synergy and dynamics are used to encourage ownership and promote empowerment. The social worker and counsellor use group work skills and his/her knowledge of its members’ strengths, to generate constructive solutions that are centered towards patient’s growth. Using key ideas from Karl’s Tomm Interpersonal Communications, the Communication Management of Meaning and Motivational Interviewing, the social worker and counsellor through a series of guided meeting with other colleagues, facilitates the transmission of understanding, responsibility sharing and tapping on team resources for patient care. As a result, the patient can experience personal and concerted approach and begins to flow in a direction that is helpful for him. Using seven case studies of identified patients with behavioral issues, the social worker and counsellor apply this framework for a period of six months. Patient’s overall improvement through interventions as a result of this framework are recorded using the AB single case design, with baseline measured three months before referral. Interviews with patients and their families, as well as other colleagues that are not part of the multi-disciplinary team are solicited at mid and end points to gather their experiences about patient’s progress as a by-product of this framework. Expert interviews will be conducted on each member of the multi-disciplinary team to study their observations and experience in using this new framework. Hence, this exploratory framework hopes to identify the inherent usefulness in managing patients with behavior related issues. Moreover, it would provide indicators in improving aspects of the framework when applied to a larger population.

Keywords: behavior management, end-stage renal failure, satellite dialysis, multi-disciplinary team

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Authors: Orkide Donma, Mustafa M. Donma

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Childhood obesity, which may lead to increased risk for heart diseases in children as well as adults, is one of the most important health problems throughout the world. Prevalences of morbid obesity and metabolic syndrome (MetS) are being increased during childhood age group. MetS is a cluster of metabolic and vascular abnormalities including hypercoagulability and an increased risk of cardiovascular diseases (CVDs). There are also some relations between some components of MetS and leukocytes. The aim of this study is to investigate complete blood cell count parameters that differ between morbidly obese boys and girls with MetS diagnosis. A total of 117 morbid obese children with MetS consulted to Department of Pediatrics in Faculty of Medicine Hospital at Namik Kemal University were included into the scope of the study. The study population was classified based upon their genders (60 girls and 57 boys). Their heights and weights were measured and body mass index (BMI) values were calculated. WHO BMI-for age and sex percentiles were used. The values above 99 percentile were defined as morbid obesity. Anthropometric measurements were performed. Waist-to-hip and head-to-neck ratios as well as homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Components of MetS (central obesity, glucose intolerance, high blood pressure, high triacylglycerol levels, low levels of high density lipoprotein cholesterol) were determined. Hematological variables were measured. Statistical analyses were performed using SPSS. The degree for statistical significance was p ≤ 0.05. There was no statistically significant difference between the ages (11.2±2.6 years vs 11.2±3.0 years) and BMIs (28.6±5.2 kg/m² vs 29.3±5.2 kg/m²) of boys and girls (p ≥ 0.05), respectively. Significantly increased waist-to-hip ratios were obtained for boys (0.94±0.08 vs 0.91±0.06; p=0.023). Significantly elevated values of hemoglobin (13.55±0.98 vs 13.06±0.82; p=0.004), mean corpuscular hemoglobin concentration (33.79±0.91 vs 33.21±1.14; p=0.003), eosinophils (0.300±0.253 vs 0.196±0.197; p=0.014), and platelet (347.1±81.7 vs 319.0±65.9; p=0.042) were detected for boys. There was no statistically significant difference between the groups in terms of neutrophil/lymphocyte ratios as well as HOMA-IR values (p ≥ 0.05). Statistically significant gender-based differences were found for hemoglobin as well as mean corpuscular hemoglobin concentration and hence, separate reference intervals for two genders should be considered for these parameters. Eosinophils may contribute to the development of thrombus in acute coronary syndrome. Eosinophils are also known to make an important contribution to mechanisms related to thrombosis pathogenesis in acute myocardial infarction. Increased platelet activity is observed in patients with MetS and these individuals are more susceptible to CVDs. In our study, elevated platelets described as dominant contributors to hypercoagulability and elevated eosinophil counts suggested to be related to the development of CVDs observed in boys may be the early indicators of the future cardiometabolic complications in this gender.

Keywords: children, complete blood count, gender, metabolic syndrome

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Authors: Christa Fricke, Sibylle Meyer, Gert G. Wagner

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Our research focuses on the question of whether assistive and social robotics could pose a promising strategy to support the independent living of elderly people and potentially relieve relatives of any anxieties. To answer the question of how elderly people perceive the potential of robotics, we analysed the data from the Berlin Aging Study BASE-II (https://www.base2.mpg.de/de) (N=1463) and data from the German SYMPARTNER study (http://www.sympartner.de) (N=120) and compared those to a control group made up of people younger than 30 years (BASE II: N=241; SYMPARTNER: N=30). BASE-II is a cohort study of people living in Berlin, Germany. The sample covers more than 2200 cases; a questionnaire on the use and acceptance of assistive and social robots was carried out with a sub-sample of 1463 respondents in 2015. The SYMPARTNER study was done by SIBIS institute of Social Research, Berlin and included a total of 120 persons between the ages of 60 and 87 in Berlin and the rural German federal state of Thuringia. Both studies included a control group of persons between the ages of 20 and 35 (BASE II: N=241; SYMPARTNER: N=30). Additional data, representative for the whole population in Germany, will be surveyed in fall 2017 (Survey “Technikradar” [technology radar] by the National Academy of Science and Engineering). Since this survey is including some identical questions as BASE-II/SYMPARTNER, comparative results can be presented at 20th International Conference on Social Robotics in New York 2018. The complexity of the data gathered in BASE-II and SYMPARTNER, encompassing detailed socio-economic background characteristics as well as personality traits such as the personal attitude to risk taking, locus of control and Big Five, proves highly valuable and beneficial. Results show that participants’ expressions of resentment against robots are comparatively low. Participants’ personality traits play a role, however the effect sizes are small. Only 15 percent of participants received domestic robots with great scepticism. Participants aged older than 70 years expressed greatest rejection of the robotic assistant. The effect sizes however account for only a few percentage points. Overall, participants were surprisingly open to the robot and its usefulness. The analysis also shows that men’s acceptance of the robot is generally greater than that of women (with odds ratios of about 0.6 to 0.7). This applies to both assistive robots in the private household and in care environments. Men expect greater benefits of the robot than women. Women tend to be more sceptical of their technical feasibility than men. Interview results prove our hypothesis that men, in particular of the age group 60+, are more accustomed to delegate household chores to women. A delegation to machines instead of humans, therefore, seems palpable. The answer to the title question of this planned presentation is: social and assistive robots at home robots are not only accepted by men – but by fewer women than men.

Keywords: acceptance, care, gender, household

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Authors: Alberto Mora-Vazquez, Nelly Paulina Trejo Guzmán

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This study examines the learning trajectories of twelve language teachers who were former students of a BA in applied linguistics at a Mexican state university. In particular, the study compares the social, academic and professional trajectories of two groups of teachers, six locally raised and educated ones and six repatriated ones from the U.S. Our interest in undertaking this research lies in the wide variety of students’ backgrounds we as professors in the BA program have witnessed throughout the years it has been around. Ever since the academic program started back in 2006, the student population has been made up of students whose backgrounds are highly diverse in terms of English language proficiency level, professional orientations and degree of cross-cultural awareness. Such diversity is further evidenced by the ongoing incorporation of some transnational students who have lived and studied in the United States for a significant period of time before their enrolment in the BA program. This, however, is not an isolated event as other researchers have reported this phenomenon in other TESOL-related programs of Mexican universities in the literature. Therefore, this suggests that their social and educational experiences are quite different from those of their Mexican born and educated counterparts. In addition, an informal comparison of the participation in formal teaching activities of the two groups at the beginning of their careers also suggested that significant differences in teacher training and development needs could also be identified. This issue raised questions about the need to examine the life and learning trajectories of these two groups of student teachers so as to develop an intervention plan aimed at supporting and encouraging their academic and professional advancement based on their particular needs. To achieve this goal, the study makes use of a combination of retrospective life-history research and the analysis of academic documents. The first approach uses interviews for data-collection. Through the use of a narrative life-history interview protocol, teachers were asked about their childhood home context, their language learning and teaching experiences, their stories of studying applied linguistics, and self-description. For the analysis of participants’ educational outcomes, a wide range of academic records, including reports of language proficiency exams results and language teacher training certificates, were used. The analysis revealed marked differences between the two groups of teachers in terms of academic and professional orientations. The locally educated teachers tended to graduate first, to look for further educational opportunities after graduation, to enter the language teaching profession earlier, and to expand their professional development options more than their peers. It is argued that these differences can be explained by their identities, which are made up of the interplay of influences such as their home context, their previous educational experiences and their cultural background. Implications for language teacher trainers and applied linguistics academic program administrators are provided.

Keywords: beginning language teachers, life-history research, Mexican context, transnational students

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Authors: Katharina Lapin, Debashis Sanyal

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Worldwide urban areas are growing. Urbanization has a great impact on social and economic development and ecosystem services. This global trend of urbanization also has significant impact on habitat and biodiversity. The impact of urbanization on the biodiversity of cities in Europe and North America is well studied, while there is a lack of data from cities in currently fast growing urban areas. Indian cities are expanding. The scientific community and the governmental authorities are facing the ongoing urbanization process as an opportunity for the environment. This case study supports the evaluation of urban biodiversity of the city Raipur in the North-West of India. The aim of this study is to assess the overview of the environmental and ecological implications of urbanization. The collected data and analysis was used to discuss the challenges for the sustainable city development. Vascular plants were chosen as an appropriate indicator for the assessment of local biodiversity changes. On the one hand, the vegetation cover is sensible to anthropogenic influence, and in the other hand, the local species composition is comparable to changes at the regional and national scale, using the plant index of India. Further information of abiotic situation can be gathered with the determination of indicator species. In order to calculate the influence of urbanization on the native plant diversity, the Shannon diversity index H´ was chosen. The Pielou`s pooled quadrate method was used for estimating diversity when a random sample is not expected. It was used to calculate the Pilou´s index of evenness. The estimated species coverage was used for calculating the H´ and J. Pearson correlation was performed to test the relationship between urbanization pattern and plant diversity. Further, a SWOT analysis was used in for analyzing internal and external factors impinging on a decision making process. The city of Raipur (21.25°N 81.63°E) has a population of 1,010,087 inhabitants living in an urban area of 226km², in the district of the Indian state of Chhattisgarh. Within the last decade, the urban area of Raipur increased. The results show that various novel ecosystems exist in the urban area of Raipur. The high amount of native flora is mainly to find at the shore of urban lakes and along the river Karun. These areas of high Biodiversity Index are to protect as urban biodiversity hot spots. The governmental authorities are well informed about the environmental challenges for the sustainable development of the city. Together with the scientific community of the Technical University of Raipur many engineering solutions are discussed for implementation of the future. The case study helped to point out the importance environmental measures that support the ecosystem services of green infrastructure. The fast process of urbanization is difficult to control. Uncontrolled creation of urban housing leads to difficulties in unsustainable use of natural resources. This is the major threat for the urban biodiversity.

Keywords: India, novel ecosystems, plant diversity, urban ecology

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Authors: Elena Chernyak, Ryan Ceresola

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Intimate partner violence is a serious social problem that affects a million women worldwide and impacts their health and wellbeing. Some risk factors for intimate partner violence against women (e.g., disobeying or arguing with a partner, women’s age, education, and employment) are similar in many countries, both developed and developing. However, one of the principal and most significant contributors to women’s vulnerability to violence perpetrated by their intimate partners is the witnessing of interparental aggression in the family of origin. Witnessing interparental violence may lead to acceptance of intimate partner violence as a normal way to resolve conflicts. Thus, utilization of violence becomes the behavioral model: men who witnessed the parental violence are more likely to employ physical violence against their female partners whereas women who observed their fathers beating their mothers learn to tolerate aggressive behavior and become victims of domestic violence themselves. Taking into consideration the importance of this subject matter, the association between witnessing intimate partner violence in family-of-origin and experience of intimate partner violence in adulthood requires further attention. The objective of this research is to analyze and compare the prevalence of intimate partner violence in ten developing countries in different regions, namely: Mali, Haiti, Jordan, Peru, the Philippines, Pakistan, Cambodia, Egypt, the Dominican Republic and Nigeria. Specifically, this research asks whether witnessing interparental violence in a family of origin is associated with the woman’s experience of intimate partner violence during adulthood and to what extent this factor varies among the countries under investigation. This study contributes to the literature on domestic violence against women, prevalence and experience of intimate partner violence against women in developing countries, and the risk factors, using recently collected, nationally representative population-based data from above-mentioned countries. The data used in this research are derived from the demographic and health surveys conducted in the ten mentioned above countries from 2013-2016. These surveys are cross-sectional, nationally representative surveys of ever-married or cohabitating women of reproductive age and the good source of high quality and comprehensive information about women, their children, partners, and households. To complete this analysis, multivariate logistic regression was run for each of the countries, and the results are presented with odds ratios, in order to highlight the effect of witnessing intimate partner violence controlling for other factors. The results of this study indicated that having witnessed partner violence in a family of origin significantly (by 50-500%) increases the likelihood of experiencing later abuse for respondents in all countries. This finding provides robust support for the intergenerational transmission of violence theory that explains the link between interparental aggression and intimate partner violence in subsequent relationships in adulthood as a result of a learned model of behavior observed in childhood. Furthermore, it was found that some of the control variables (e.g., education, number of children, and wealth) are associated with intimate partner violence in some countries under investigation while are not associated with male partner’s abusive behavior in some other, which may be explained by specific cultural and economic factors.

Keywords: intimate partner violence, domestic violence against women, developing countries, demographic and health surveys, risk factors

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Authors: Pawel Kiper, Alfonc Baba, Mahmoud Alhelou, Giorgia Pregnolato, Michela Agostini, Andrea Turolla

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Impairment of cervical spine mobility is often related to pain triggered by musculoskeletal disorders or direct traumatic injuries of the spine. To date, these disorders are assessed with goniometers and inclinometers, which are the most popular devices used in clinical settings. Nevertheless, these technologies usually allow measurement of no more than two-dimensional range of motion (ROM) quotes in static conditions. Conversely, the wide use of motion tracking systems able to measure 3 to 6 degrees of freedom dynamically, while performing standard ROM assessment, are limited due to technical complexities in preparing the setup and high costs. Thus, motion tracking systems are primarily used in research. These systems are an integral part of virtual reality (VR) technologies, which can be used for measuring spine mobility. To our knowledge, the accuracy of VR measure has not yet been studied within virtual environments. Thus, the aim of this study was to test the reliability of a protocol for the assessment of sensorimotor function of the cervical spine in a population of healthy subjects and to compare whether using immersive or non-immersive VR for visualization affects the performance. Both VR assessments consisted of the same five exercises and random sequence determined which of the environments (i.e. immersive or non-immersive) was used as first assessment. Subjects were asked to perform head rotation (right and left), flexion, extension and lateral flexion (right and left side bending). Each movement was executed five times. Moreover, the participants were invited to perform head reaching movements i.e. head movements toward 8 targets placed along a circular perimeter each 45°, visualized one-by-one in random order. Finally, head repositioning movement was obtained by head movement toward the same 8 targets as for reaching and following reposition to the start point. Thus, each participant performed 46 tasks during assessment. Main measures were: ROM of rotation, flexion, extension, lateral flexion and complete kinematics of the cervical spine (i.e. number of completed targets, time of execution (seconds), spatial length (cm), angle distance (°), jerk). Thirty-five healthy participants (i.e. 14 males and 21 females, mean age 28.4±6.47) were recruited for the cervical spine assessment with immersive and non-immersive VR environments. Comparison analysis demonstrated that: head right rotation (p=0.027), extension (p=0.047), flexion (p=0.000), time (p=0.001), spatial length (p=0.004), jerk target (p=0.032), trajectory repositioning (p=0.003), and jerk target repositioning (p=0.007) were significantly better in immersive than non-immersive VR. A regression model showed that assessment in immersive VR was influenced by height, trajectory repositioning (p<0.05), and handedness (p<0.05), whereas in non-immersive VR performance was influenced by height, jerk target (p=0.002), head extension, jerk target repositioning (p=0.002), and by age, head flex/ext, trajectory repositioning, and weight (p=0.040). The results of this study showed higher accuracy of cervical spine assessment when executed in immersive VR. The assessment of ROM and kinematics of the cervical spine can be affected by independent and dependent variables in both immersive and non-immersive VR settings.

Keywords: virtual reality, cervical spine, motion analysis, range of motion, measurement validity

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Authors: K. C. Sharda

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Introduction: In the world, almost half of the population are lacking proper access to improved sanitation services. In Nepal, large number of people are living without access to any sanitation facility. Ecological sanitation toilet which is defined as water conserving and nutrient recycling system for use of human urine and excreta in agriculture would count a lot to utilize locally available resources, to regenerate soil fertility, to save national currency and to achieve the goal of elimination open defecation in country like Nepal. The objectives of the research were to test the efficacy of human urine for improving crop performance and to evaluate the feasibility of ecological sanitation in rural area of Central Nepal. Materials and Methods: The field investigation was carried out at Palung Village Development Committee (VDC) of Makawanpur District, Nepal from March – August, 2016. Five eco-san toilets in two villages (Angare and Bhot Khoriya) were constructed and questionnaire survey was carried out. During the questionnaire survey, respondents were asked about socio-economic parameters, farming practices, awareness of ecological sanitation and fertilizer value of human urine and excreta in agriculture. In prior to a field experiment, soil was sampled for analysis of basic characteristics. In the field experiment, cauliflower was cultivated for a month in the two sites to compare the fertilizer value of urine with chemical fertilizer and no fertilizer with three replications. The harvested plant samples were analyzed to understand the nutrient content in plant with different treatments. Results and Discussion: Eighty three percent respondents were engaged in agriculture growing mainly vegetables, which may raise the feasibility of ecological sanitation. In the study area, water deficiencies in dry season, high demand of chemical fertilizer, lack of sanitation awareness were found to be solved. The soil at Angare has sandier texture and lower nitrogen content compared to that in Bhot Khoriya. While the field experiment in Angare showed that the aboveground biomass of cauliflower in the urine fertilized plot were similar with that in the chemically fertilized plot and higher than those in the non-fertilized plots, no significant difference among the treatments were found in Bhot Khoriya. The more distinctive response of crop growth to the three treatments in the former might be attributed to the poorer soil productivity, which in turn could be caused by the poorer inherent soil fertility and the poorer past management by the farmer in Angare. Thus, use of urine as fertilizer could help poor farmers with low quality soil. The significantly different content of nitrogen and potassium in the plant samples among three treatments in Bhot Khoriya would require further investigation. When urine is utilized as a fertilizer, the productivity could be increased and the money to buy chemical fertilizer would be utilized in other livelihood activities. Ecological sanitation is feasible in the area with similar socio-economic parameter.

Keywords: cauliflower, chemical fertilizer, ecological sanitation, Nepal, urine

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Authors: Vanessa G. P. Severino, Eliangela Cristina Candida Costa, Nubia Alves Mariano Teixeira Pires Gomides, Lucilia Kato, Afif Felix Monteiro, Maria Anita Lemos Vasconcelos Ambrosio, Carlos Henrique Gomes Martins

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One of the biomes present in Brazil is known as Cerrado, which is a vast tropical savanna ecoregion, particularly in the states of Goiás, Mato Grosso do Sul, Mato Grosso, Tocantins and Minas Gerais. Many species of plants are characterized as endemic and they have therapeutic value for a large part of the population, especially to the rural communities. Given that, the southeastern region of the state of Goiás contains about 21 rural communities, which present a form of organization based on the use of natural resources available. One of these rural communities is named of Coqueiros, where the knowledge about the medicinal plants was very important to this research. Thus, this study focuses on the ethnobotanical survey of this community on the use of Kielmeyera coriacea to treat diseases. From the 37 members interviewed, 76% indicated this species for the treatment of intestinal infection, leukemia, anemia, gastritis, gum pain, toothache, cavity, arthritis, arthrosis, healing, vermifuge, rheumatism, antibiotic, skin problems, mycoses and all kinds of infections. The medicinal properties attributed during the interviews were framed in the body system (disease categories), adapted from ICD 10; thus, 20 indications of use were obtained, among five body systems. Therefore, the root of this species was select to chemical and biological (antioxidant and antimicrobial) studies. From the liquid-liquid extraction of ethanolic extract of root (EER), the hexane (FH), ethyl acetate (FAE), and hydro alcoholic (FHA) fractions were obtained. The chemical profile study of these fractions was performed by LC-MS, identifying major compounds such as δ-tocotrienol, prenylated acylphoroglucinol, 2-hydroxy-1-methoxyxanthone and quercitrin. EER, FH, FAE and FHA were submitted to biological tests. FHA presented the best antioxidant action (EC50 201.53 μg mL-1). EER inhibited the bacterial growth of Streptococcus pyogenes and Pseudomonas aeruginosa, microorganisms associated with rheumatism, at Minimum Inhibitory Concentration (MIC) of 6.25 μg mL-1. In addition, the FH-10 subfraction, obtained from FH fractionation, presented MIC of 1.56 μg mL-1 against S. pneumoniae; EER also inhibited the fungus Candida glabrata (MIC 7.81 μg mL- 1). The FAE-4.7.3 fraction, from the fractionation of FAE, presented MIC of 200 μg mL-1 against Lactobacillus casei, which is one of the causes of caries and oral infections. By the correlation of the chemical and biological data, it is possible to note that the FAE-4.7.3 and FH-10 are constituted 4-hydroxy-2,3-methylenedioxy xanthone, 3-hydroxy-1,2-dimethoxy xanthone, lupeol, prenylated acylphoroglucinol and quercitrin, which could be associated with the biological potential found. Therefore, this study provides an important basis for further investigations regarding the compounds present in the active fractions of K. coriacea, which will permit the establishment of a correlation between ethnobotanical survey and bioactivity.

Keywords: biological activity, ethnobotanical survey, Kielmeyera coriacea Mart., LC-MS profile

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Authors: Rabab Makki

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Bone mineral density and bone metabolism are affected by various factors such as genetic, endocrine, mechanical and nutritional. Our understanding of nutritional influences on bone health is limited because most studies have focused on calcium. This study investigated the dietary factors which are likely t contribute to Osteoporosis in Saudi post-menopausal women, and correlated it with BMD. This is a case controlled study involved 36 postmenopausal Saudi females selected from the Orthopedics and osteoporosis outpatient clinics, and 25 postmenopausal Saudi females as controls from the primary clinic of Military Hospital in Riyadh. The women were diagnosed as osteoporotic based on the BMD measurement at any site (left femur neck, right femur neck, left total hip or right total hip or spine). Both the controls and the Osteoporotics were over 50 years of age and BMI between 31-34 kg/m2 had 2nd degree obesity, and were not free from other problems such as diabetes, hypertension, etc. Subjects (osteoporotics and controls) were interviewed to called data on demographic characterstics, medical history, dietary intake anthropometry (height and weight) bone mineral density. Blood samples were collected from subjects (Osteoporotics and controls). Analysis of serum calcium, vitamin D, phosphate were done at the main laboratory at Military Hospital Riyadh, by the laboratory technician while BMD was determined at the department of Nuclear Medicine by an expert technician and results were interpreted by radiologist.Data on frequency of consumption of animal food (meat, eggs, poultry and fish) and diary foods (milk, yogurt, cheese) of osteoporotic was less than control. In spite of the low intake there was no association with BMD.In general, the vegetables and fruits were consumed less by the osteoporotics than control. The only fruit which had shown a significant positive correlation is banana with right and left hip BMD total probably due to high potassium and minerals content which likely to prevent bone resorption. Mataziz vegetables combination of wheat showed a significant positive correlation with the same site (total right and left hip). Both osteoporotics abd controls were consuming table sugar. (But the sweet intake showed a significant negative correlation with left neck femur BMD, suggesting sucrose increase urinary calcium loss. Both osteoporotic and controls were consuming Arabic coffee. A negative significant correlation between intake of Arabic coffee and BMD of right neck femur of osteoporosis patient was observed. It could be suggested that increased intake of fruits and vegetables, might promote bone density while high intake of coffee and sugars might affect bone density, no significant correlation was observed between BMD at any site and diary product. We can say the major risk factors are inadequate nutrition. Further studies are needed among Saudi population to confirm these results.

Keywords: osteoporosi, Saudia Arabia, Riyadh Armed Forces, postmenopausal women

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Authors: Sara Rejeb, Catherine Duveau, Tabea Rebafka

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To monitor the production process of turbofan aircraft engines, multiple measurements of various geometrical parameters are systematically recorded on manufactured parts. Engine parts are subject to extremely high standards as they can impact the performance of the engine. Therefore, it is essential to analyze these databases to better understand the influence of the different parameters on the engine's performance. Self-organizing maps are unsupervised neural networks which achieve two tasks simultaneously: they visualize high-dimensional data by projection onto a 2-dimensional map and provide clustering of the data. This technique has become very popular for data exploration since it provides easily interpretable results and a meaningful global view of the data. As such, self-organizing maps are usually applied to aircraft engine condition monitoring. As databases in this field are huge and complex, they naturally contain multiple missing entries for various reasons. The classical Kohonen algorithm to compute self-organizing maps is conceived for complete data only. A naive approach to deal with partially observed data consists in deleting items or variables with missing entries. However, this requires a sufficient number of complete individuals to be fairly representative of the population; otherwise, deletion leads to a considerable loss of information. Moreover, deletion can also induce bias in the analysis results. Alternatively, one can first apply a common imputation method to create a complete dataset and then apply the Kohonen algorithm. However, the choice of the imputation method may have a strong impact on the resulting self-organizing map. Our approach is to address simultaneously the two problems of computing a self-organizing map and imputing missing values, as these tasks are not independent. In this work, we propose an extension of self-organizing maps for partially observed data, referred to as missSOM. First, we introduce a criterion to be optimized, that aims at defining simultaneously the best self-organizing map and the best imputations for the missing entries. As such, missSOM is also an imputation method for missing values. To minimize the criterion, we propose an iterative algorithm that alternates the learning of a self-organizing map and the imputation of missing values. Moreover, we develop an accelerated version of the algorithm by entwining the iterations of the Kohonen algorithm with the updates of the imputed values. This method is efficiently implemented in R and will soon be released on CRAN. Compared to the standard Kohonen algorithm, it does not come with any additional cost in terms of computing time. Numerical experiments illustrate that missSOM performs well in terms of both clustering and imputation compared to the state of the art. In particular, it turns out that missSOM is robust to the missingness mechanism, which is in contrast to many imputation methods that are appropriate for only a single mechanism. This is an important property of missSOM as, in practice, the missingness mechanism is often unknown. An application to measurements on one type of part is also provided and shows the practical interest of missSOM.

Keywords: imputation method of missing data, partially observed data, robustness to missingness mechanism, self-organizing maps

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Authors: Bing Chen, Xiang Ni, Eric Li

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With the population ageing, the number of patients suffering from chronic diseases is increasing, among which stroke is a high incidence for the elderly. In addition, there is a gradual increase in the number of patients with orthopedic or neurological conditions such as spinal cord injuries, nerve injuries, and other knee injuries. These diseases are chronic, with high recurrence and complications, and normal walking is difficult for such patients. Nowadays, robotic knee exoskeletons have been developed for individuals with knee impairments. However, the currently available robotic knee exoskeletons are generally developed with heavyweight, which makes the patients uncomfortable to wear, prone to wearing fatigue, shortening the wearing time, and reducing the efficiency of exoskeletons. Some lightweight materials, such as carbon fiber and titanium alloy, have been used for the development of robotic knee exoskeletons. However, this increases the cost of the exoskeletons. This paper illustrates the design of a new ultra-light and ultra-stiff truss type of lattice structure. The lattice structures are arranged in a fan shape, which can fit well with circular arc surfaces such as circular holes, and it can be utilized in the design of rods, brackets, and other parts of a robotic knee exoskeleton to reduce the weight. The metamaterial is formed by continuous arrangement and combination of small truss structure unit cells, which changes the diameter of the pillar section, geometrical size, and relative density of each unit cell. It can be made quickly through additive manufacturing techniques such as metal 3D printing. The unit cell of the truss structure is small, and the machined parts of the robotic knee exoskeleton, such as connectors, rods, and bearing brackets, can be filled and replaced by gradient arrangement and non-uniform distribution. Under the condition of satisfying the mechanical properties of the robotic knee exoskeleton, the weight of the exoskeleton is reduced, and hence, the patient’s wearing fatigue is relaxed, and the wearing time of the exoskeleton is increased. Thus, the efficiency and wearing comfort, and safety of the exoskeleton can be improved. In this paper, a brief description of the hardware design of the prototype of the robotic knee exoskeleton is first presented. Next, the design of the ultra-light and ultra-stiff truss type of lattice structures is proposed, and the mechanical analysis of the single-cell unit is performed by establishing the theoretical model. Additionally, simulations are performed to evaluate the maximum stress-bearing capacity and compressive performance of the uniform arrangement and gradient arrangement of the cells. Finally, the static analysis is performed for the cell-filled rod and the unmodified rod, respectively, and the simulation results demonstrate the effectiveness and feasibility of the designed ultra-light and ultra-stiff truss type of lattice structures. In future studies, experiments will be conducted to further evaluate the performance of the designed lattice structures.

Keywords: additive manufacturing, lattice structures, metamaterial, robotic knee exoskeleton

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Authors: Lilian Nantume Wampande

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Group-based strategies in the delivery of HIV care have opened up new avenues not only for meaningful participation for HIV positive people but also platforms for deconstruction and reconstruction of knowledge about living with the virus. Yet the contributions of such strategies among patients who live in high risk areas are still not explored. This case study research assessed the impact of HIV support networks on sexual health outcomes of HIV positive out-of-school adolescents residing in fishing islands of Kalangala in Uganda. The study population was out-of-school adolescents living with HIV and their sexual partners (n=269), members of their households (n=80) and their health service providers (n=15). Data were collected via structured interviews, observations and focus group discussions between August 2016 and March 2017. Data was then analyzed inductively to extract key themes related to the approaches and outcomes of the groups’ activities. The study findings indicate that support groups unite HIV positive adolescents in a bid for social renegotiation to achieve change but individual constraints surpass the groups’ intentions. Some adolescents for example reported increased fear which led to failure to cope, sexual violence, self-harm and denial of status as a result of the high expectations placed on them as members of the support groups. Further investigations around this phenomenon show that HIV networks play a monotonous role as information sources for HIV positive out-of-school adolescents which limit their creativity to seek information elsewhere. Results still indicate that HIV adolescent groups recognize the complexity of long-term treatment and stay in care leading to improved immunity for the majority yet; there is still scattered evidence about how effective they are among adolescents at different phases in the disease trajectory. Nevertheless, the primary focus of developing adolescent self-efficacy and coping skills significantly address a range of disclosure difficulties and supports autonomy. Moreover, the peer techniques utilized in addition to the almost homogeneous group characteristics accelerates positive confidence, hope and belongingness. Adolescent HIV-support groups therefore have the capacity to both improve and/or worsen sexual health outcomes for a young adolescent who is out-of-school. Communication interventions that seek to increase awareness about ‘self’ should therefore be emphasized more than just fostering collective action. Such interventions should be sensitive to context and gender. In addition, facilitative support supervision done by close and trusted health care providers, most preferably Village Health Teams (who are often community elected volunteers) would help to follow-up, mentor, encourage and advise this young adolescent in matters involving sexuality and health outcomes. HIV/AIDS prevention programs have extended their efforts beyond individual focus to those that foster collective action, but programs should rekindle interpersonal level strategies to address the complexity of individual behavior.

Keywords: adolescent, HIV, support groups, Uganda

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Authors: Kamelia Hamza

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Background: Proton pump inhibitors (PPIs) are the most prescribed drug classes for pediatric gastroesophageal reflux disease (GERD).Many patients are treated with these drugs for atypical manifestations attributed to gastroesophageal reflux (GER), even in the absence of proved causal relationship. There is an impression of increase use of PPI's treatment for reflux in "clalit health services," the largest health organization in Israel. In the recent years, the medicine is given without restriction, it's not limited to pediatric gastroenterologists only, but pediatricians and family doctors. The objective of this study is to evaluate the hypothesis that exposure to PPIs during the first year of life is associated with an increased risk of developing late adverse diseases: pneumonia, asthma, AGE, IBD, celiac disease, allergic disorders, obesity, attention deficit hyperactivity disorders (ADHD), autism spectrum disorders (ASD). Methods: The study is a retrospective case-control cohort study based on a computerized database of Clalit Health Services (CHS). It includes 9844 children born between 2002-2018 and reported to complain of at least one of the symptoms (reflux/ spitting up, irritability, feeding difficulties, colics). The study population included the study group (n=4922) of children exposed to PPIs at any time prior to the first year of life and a control group (n=4922) child not exposed to PPIs who were matched to each case of the study group on age, race, socioeconomic status, and year of birth. The prevalence of late complications/diseases in the study group was compared with the prevalence of late complications/diseases diagnosis between 2002-2020 in the control group. Odds ratios and 95% confidence intervals were calculated by using logistic regression models. Results: We found that compared to the control group, children exposed to PPIs in the first year of life had an increased risk of developing several late complications/ disorders: pneumonia, asthma, various allergies (urticaria, allergic rhinitis, or allergic conjunctivitis) OR, inhalant allergies, and food allergies. In addition, they showed an increased risk of being diagnosed with ADHD or ASD, but children exposed to PPIs in the first year of life had decrease the risk of obesity by 17% (OR 0.825, 95%CI 0.697-0.976). Conclusions: We found significant associations between the use of PPIs during the first year of life and subsequent development of late complications/diseases such as respiratory diseases, allergy diseases, ADHD, and ASD. More studies are needed to prove causality and determine the mechanism behind the effect of PPIs and the development of late complications.

Keywords: acid suppressing medications, proton pump inhibitors, histamine 2 blocker, late complications, gastroesophageal reflux, gastroesophageal reflux disease, acute gastroenteritis, community acquired pneumonia, asthma, allergic diseases, obesity, inflammatory bowel diseases, ulcerative colitis, crohn disease, attention deficit hyperactivity disorders, autism spectrum disorders

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Authors: Muhammad Umer Mehmood, Muhammad Luqman, Muhammad Yaseen, Imtiaz Hussain

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Climate change is an arduous fact, which could not be unheeded easily. It is a phenomenon which has brought a collection of challenges for the mankind. Scientists have found many of its negative impacts on the life of human being and the resources on which the life of humanity is dependent. There are many issues which are associated with the factor of prime importance in this study, 'climate change'. Whenever changes happen in nature, they strike the whole globe. Effects of these changes vary from region to region. Climate of every region of this globe is different from the other. Even within a state, country or the province has different climatic conditions. So it is mandatory that the response in that specific region and the coping strategy of this specific region should be according to the prevailing risk. In the present study, the objective was to assess the coping strategies and vulnerability of small landholders. So that a professional suggestion could be made to cope with the vulnerability factor of small farmers. The cross-sectional research design was used with the intervention of quantitative approach. The study was conducted in the Khanewal district, of Punjab, Pakistan. 120 small farmers were interviewed after randomized sampling from the population of respective area. All respondents were above the age of 15 years. A questionnaire was developed after keen observation of facts in the respective area. Content and face validity of the instrument was assessed with SPSS and experts in the field. Data were analyzed through SPSS using descriptive statistics. From the sample of 120, 81.67% of the respondents claimed that the environment is getting warmer and not fit for their present agricultural practices. 84.17% of the sample expressed serious concern that they are disturbed due to change in rainfall pattern and vulnerability towards the climatic effects. On the other hand, they expressed that they are not good at tackling the effects of climate change. Adaptation of coping strategies like change in cropping pattern, use of resistant varieties, varieties with minimum water requirement, intercropping and tree planting was low by more than half of the sample. From the sample 63.33% small farmers said that the coping strategies they adopt are not effective enough. The present study showed that subsistence farming, lack of marketing and overall infrastructure, lack of access to social security networks, limited access to agriculture extension services, inappropriate access to agrometeorological system, unawareness and access to scientific development and low crop yield are the prominent factors which are responsible for the vulnerability of small farmers. A comprehensive study should be conducted at national level so that a national policy could be formulated to cope with the dilemma in future with relevance to climate change. Mainstreaming and collaboration among the researchers and academicians could prove beneficiary in this regard the interest of national leaders’ does matter. Proper policies to avoid the vulnerability factors should be the top priority. The world is taking up this issue with full responsibility as should we, keeping in view the local situation.

Keywords: adaptation, coping strategies, climate change, Pakistan, small farmers, vulnerability

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Authors: Anna-Maria Ramezanzadeh

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Demand for Arabic language is growing worldwide, driven by increased interest in the multifarious purposes the language serves, both for the population of heritage learners and those studying Arabic as a foreign language. The diglossic, or indeed multiglossic nature of the language as used in Arabic speaking communities however, is seldom represented in the content of classroom courses. This disjoint between the nature of provision and students’ expectations can severely impact their engagement with course material, and their motivation to either commence or continue learning the language. The nature of motivation and its relationship to multiglossia is sparsely explored in current literature on Arabic. The theoretical framework here proposed aims to address this gap by presenting a model and instruments for the measurement of Arabic learners’ motivation in relation to the multiple strands of the language. It adopts and develops the Second Language Motivation Self-System model (L2MSS), originally proposed by Zoltan Dörnyei, which measures motivation as the desire to reduce the discrepancy between leaners’ current and future self-concepts in terms of the second language (L2). The tripartite structure incorporates measures of the Current L2 Self, Future L2 Self (consisting of an Ideal L2 Self, and an Ought-To Self), and the L2 Learning Experience. The strength of the self-concepts is measured across three different domains of Arabic: Classical, Modern Standard and Colloquial. The focus on learners’ self-concepts allows for an exploration of the effect of multiple factors on motivation towards Arabic, including religion. The relationship between Islam and Arabic is often given as a prominent reason behind some students’ desire to learn the language. Exactly how and why this factor features in learners’ L2 self-concepts has not yet been explored. Specifically designed surveys and interview protocols are proposed to facilitate the exploration of these constructs. The L2 Learning Experience component of the model is operationalized as learners’ task-based engagement. Engagement is conceptualised as multi-dimensional and malleable. In this model, situation-specific measures of cognitive, behavioural, and affective components of engagement are collected via specially designed repeated post-task self-report surveys on Personal Digital Assistant over multiple Arabic lessons. Tasks are categorised according to language learning skill. Given the domain-specific uses of the different varieties of Arabic, the relationship between learners’ engagement with different types of tasks and their overall motivational profiles will be examined to determine the extent of the interaction between the two constructs. A framework for this data analysis is proposed and hypotheses discussed. The unique combination of situation-specific measures of engagement and a person-oriented approach to measuring motivation allows for a macro- and micro-analysis of the interaction between learners and the Arabic learning process. By combining cross-sectional and longitudinal elements with a mixed-methods design, the model proposed offers the potential for capturing a comprehensive and detailed picture of the motivation and engagement of Arabic learners. The application of this framework offers a number of numerous potential pedagogical and research implications which will also be discussed.

Keywords: Arabic, diglossia, engagement, motivation, multiglossia, sociolinguistics

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Authors: Jovina Concepcion Bachynski, Lenora Duhn, Idevania G. Costa, Pilar Camargo-Plazas

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Kidney failure is a life-limiting condition for which treatment, such as dialysis (hemodialysis and peritoneal dialysis), can exact a tremendously high physical and psychosocial symptom burden. Kidney failure can be severe enough to require a palliative approach to care. The term supportive care can be used in lieu of palliative care to avoid the misunderstanding that palliative care is synonymous with end-of-life or hospice care. Kidney supportive care, encompassing advance care planning, is an approach to care that improves the quality of life for people receiving dialysis through early identification and treatment of symptoms throughout the disease trajectory. Advanced care planning involves ongoing conversations about the values, goals, and preferences for future care between individuals and their healthcare teams. Kidney supportive care is underutilized and often initiated late in this population. There is evidence to indicate nurses are not providing the necessary elements of supportive kidney care. Dialysis nurses’ delay or lack of engagement in supportive care until close to the end of life may result in people dying without receiving optimal palliative care services. Using Charmaz’s constructivist grounded theory, the purpose of this doctoral study is to develop a substantive theory that explains the process of engagement in supportive care by nurses working in dialysis settings in Canada. Through initial purposeful and subsequent theoretical sampling, 23 nurses with current or recent work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings drawn from across Canada were recruited to participate in two intensive interviews using the Zoom© teleconferencing platform. Concurrent data collection and data analysis, constant comparative analysis of initial and focused codes until the attainment of theoretical saturation, and memo-writing, as well as researcher reflexivity, have been undertaken to aid the emergence of concepts, categories, and, ultimately, the constructed theory. At the time of abstract submission, data analysis is currently at the second level of coding (i.e., focused coding stage) of the research study. Preliminary categories include: (a) focusing on biomedical care; (b) multi-dimensional challenges to having the conversation; (c) connecting and setting boundaries with patients; (d) difficulty articulating kidney-supportive care; and (e) unwittingly practising kidney-supportive care. For the conference, the resulting theory will be presented. Nurses working in dialysis are well-positioned to ensure the delivery of quality kidney-supportive care. This study will help to determine the process and the factors enabling and impeding nurse engagement in supportive care in dialysis to effect change for normalizing advance care planning conversations in the clinical setting. This improved practice will have substantive beneficial implications for the many individuals living with kidney failure and their supporting loved ones.

Keywords: dialysis, kidney failure, nursing, supportive care

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Authors: Georgios Samaras

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New media such as Facebook, YouTube and Twitter introduced the world to a new era of instant communication. An era where online interactions could replace a lot of offline actions. Technology can create a mediated environment in which participants can communicate (one-to-one, one-to-many, and many-to-many) both synchronously and asynchronously and participate in reciprocal message exchanges. Currently, social networks are attracting similar academic attention to that of the internet after its mainstream implementation into public life. Websites and platforms are seen as the forefront of a new political change. There is a significant backdrop of previous methodologies employed to research the effects of social networks. New approaches are being developed to be able to adapt to the growth of social networks and the invention of new platforms. Golden Dawn was the first openly neo-Nazi party post World War II to win seats in the parliament of a European country. Its racist rhetoric and violent tactics on social networks were rewarded by their supporters, who in the face of Golden Dawn’s leaders saw a ‘new dawn’ in Greek politics. Mainstream media banned its leaders and members of the party indefinitely after Ilias Kasidiaris attacked Liana Kanelli, a member of the Greek Communist Party, on live television. This media ban was seen as a treasonous move by a significant percentage of voters, who believed that the system was desperately trying to censor Golden Dawn to favor mainstream parties. The shocking attack on live television received international coverage and while European countries were condemning this newly emerged neo-Nazi rhetoric, almost 7 percent of the Greek population rewarded Golden Dawn with 18 seats in the Greek parliament. Many seem to think that Golden Dawn mobilised its voters online and this approach played a significant role in spreading their message and appealing to wider audiences. No strict online censorship existed back in 2012 and although Golden Dawn was openly used neo-Nazi symbolism, it was allowed to use social networks without serious restrictions until 2017. This paper used qualitative methods to investigate Golden Dawn’s rise in social networks from 2012 to 2019. The focus of the content analysis was set on three social networking platforms: Facebook, Twitter and YouTube, while the existence of Golden Dawn’s website, which was used as a news sharing hub, was also taken into account. The content analysis included text and visual analyses that sampled content from their social networking pages to translate their political messaging through an ideological lens focused on extreme-right populism. The absence of hate speech regulations on social network platforms in 2012 allowed the free expression of those heavily ultranationalist and populist views, as they were employed by Golden Dawn in the Greek political scene. On YouTube, Facebook and Twitter, the influence of their rhetoric was particularly strong. Official channels and MPs profiles were investigated to explore the messaging in-depth and understand its ideological elements.

Keywords: populism, far-right, social media, Greece, golden dawn

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Authors: Katarzyna Drela, Miroslaw Wielgos, Mikolaj Wrobel, Barbara Lukomska

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Mesenchymal stem cells (MSCs) have a great potential in regenerative medicine. Since the initial number of isolated MSCs is limited, in vitro propagation is often required to reach sufficient numbers of cells for therapeutic applications. During long-term culture MSCs may undergo genetic or epigenetic alterations that subsequently increase the probability of spontaneous malignant transformation. Thus, factors that influence genomic stability of MSCs following long-term expansions need to be clarified before cultured MSCs are employed for clinical application. The aim of our study was to investigate the potential for spontaneous transformation of human neonatal cord blood (HUCB-MSCs) and adult bone marrow (BM-MSCs) derived MSCs. Materials and Methods: HUCB-MSCs and BM-MSCs were isolated by standard Ficoll gradient centrifugations method. Isolated cells were initially plated in high density 106 cells per cm2. After 48 h medium were changed and non-adherent cells were removed. The malignant transformation of MSCs in vitro was evaluated by morphological changes, proliferation rate, ability to enter cell senescence, the telomerase expression and chromosomal abnormality. Proliferation of MSCs was analyzed with WST-1 reduction method and population doubling time (PDT) was calculated at different culture stages. Then the expression pattern of genes characteristic for mesenchymal or epithelial cells, as well as transcriptions factors were examined by RT-PCR. Concomitantly, immunocytochemical analysis of gene-related proteins was employed. Results: Our studies showed that MSCs from all bone marrow isolations ultimately entered senescence and did not undergo spontaneous malignant transformation. However, HUCB-MSCs from one of the 15 donors displayed an increased proliferation rate, failed to enter senescence, and exhibited an altered cell morphology. In this sample we observed two different cell phenotypes: one mesenchymal-like exhibited spindle shaped morphology and express specific mesenchymal surface markers (CD73, CD90, CD105, CD166) with low proliferation rate, and the second one with round, densely package epithelial-like cells with significantly increased proliferation rate. The PDT of epithelial-like populations was around 1day and 100% of cells were positive for proliferation marker Ki-67. Moreover, HUCB-MSCs showed a positive expression of human telomerase reverse transcriptase (hTERT), cMYC and exhibit increased number of CFU during the long-term culture in vitro. Furthermore, karyotype analysis revealed chromosomal abnormalities including duplications. Conclusions: Our studies demonstrate that HUCB-MSCs are susceptible to spontaneous malignant transformation during long-term culture. Spontaneous malignant transformation process following in vitro culture has enormous effect on the biosafety issues of future cell-based therapies and regenerative medicine regimens.

Keywords: mesenchymal stem cells, spontaneous, transformation, long-term culture

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Authors: Sidra Jawed

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The accessibility constructs and the body privilege discourse has been a major problem while dealing with health inequities and inaccessibility. The inherent problem in this arbitrary view of disability is that disability would never be the productive way of living. For past thirty years, disability activists have been working to differentiate ‘impairment’ from ‘disability’ and probing for more understanding of limitation imposed by society, this notion is ultimately known as the Social Model of Disability. The vulnerable population as disability community remains marginalized and seen relentlessly fighting to highlight the importance of social factors. It does not only constitute physical architectural barriers and famous blue symbol of access to the healthcare but also invisible, intangible barriers as attitudes and behaviours. Conventionally the idea of ‘disability’ has been laden with prejudiced perception amalgamating with biased attitude. Equity in contemporary setup necessitates the restructuring of organizational structure. Apparently simple, the complex interplay of disability and contemporary healthcare set up often ends up at negotiating vital components of basic healthcare needs. The role of society is indispensable when it comes to people with disability (PWD), everything from the access to healthcare to timely interventions are strongly related to the set up in place and the attitude of healthcare providers. It is vital to understand the association between assumptions and the quality of healthcare PWD receives in our global healthcare setup. Most of time the crucial physician-patient relationship with PWD is governed by the negative assumptions of the physicians. The multifaceted, troubled patient-physicians’ relationship has been neglected in past. To compound it, insufficient work has been done to explore physicians’ perspective about the disability and access to healthcare PWD have currently. This research project is directed towards physicians’ perspective on the intersection of health and access of healthcare for PWD. The principal aim of the study is to explore the perception of disability in family medicine physicians, highlighting the underpinning of medical perspective in healthcare institution. In the quest of removing barriers, the first step must be to identify the barriers and formulate a plan for future policies, involving all the stakeholders. There would be semi-structured interviews to explore themes as accessibility, medical training, construct of social model and medical model of disability, time limitations, financial constraints. The main research interest is to identify the obstacles to inclusion and marginalization continuing from the basic living necessities to wide health inequity in present society. Physicians point of view is largely missing from the research landscape and the current forum of knowledge with regards to physicians’ standpoint. This research will provide policy makers with a starting point and comprehensive background knowledge that can be a stepping stone for future researches and furthering the knowledge translation process to strengthen healthcare. Additionally, it would facilitate the process of knowledge translation between the much needed medical and disability community.

Keywords: disability, physicians, social model, accessibility

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Authors: N. Uaphongsathorn, C. Worawong, S. Thaewpia

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Background and significance: The population is aging in Thai society, the elderly dependent is at great risk of various functional, psychological, and socio-economic problems as well as less access to health care. They may require long term care at home to maximize their functional abilities and activities of daily living and to improve their quality of life during their own age. Therefore, there is a need to develop a home-based long term care to meet the long term care needs of elders dependent. Methods: The research purpose was to develop long term care model among the elderly dependent in Chaiyaphum province in Northeast region of Thailand. Action Research which is composing of planning, action, observation, and reflection phases was used. Research was carried out for 12 months in all sub-districts of 6 districts in Chaiyaphum province. Participants (N = 1,010) participating in the processes of model development were comprised of 3 groups: a) a total of 110 health care professionals, b) a total of 600 health volunteers and family caregivers and c) a total of 300 the elderly dependent with chronically medical illnesses or disabilities. Descriptive statistics and content analysis were used to analyze data. Findings: Results have shown that the most common health problems among elders dependent with physical disabilities to function independently were cardiovascular disease, dementia, and traffic injuries. The development of home-based long term care model among elders dependent in Chaiyaphum province was composed of six key steps. They are: a) initiating policies supporting formal and informal caregivers for the elder dependent in all sub-districts, b) building network and multidisciplinary team, c) developing 3-day care manager training program and 3-day care provider training program d) training case managers and care providers for the elderly dependent through team and action learning, e) assessing, planning and providing care based on care individual’s needs of the elderly dependent, and f) sharing experiences for good practice and innovation for long term care at homes in district urban and rural areas. Among all care managers and care providers, the satisfaction level for training programs was high with a mean score of 3.98 out of 5. The elders dependent and family caregivers addressed that long term care at home could contribute to improving life’s daily activities, family relationship, health status, and quality of life. Family caregivers and volunteers have feeling a sense of personal satisfaction and experiencing providing meaningful care and support for elders dependent. Conclusion: In conclusion, a home-based long term care is important to Thai elders dependent. Care managers and care providers play a large role and responsibility to provide appropriate care to meet the elders’ needs in both urban and rural areas in Thai society. Further research could be rigorously studied with a larger group of populations in similar socio-economic and cultural contexts.

Keywords: elderly people, care manager, care provider, long term care

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