Search results for: bridge health monitoring

Authors: Mathew Wakefield, Matthew Mitchell, Lisa Wise, Christopher McCarthy

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The properties of memory representations in artificial neural networks have cognitive implications. Distributed representations that encode instances as a pattern of activity across layers of nodes afford memory compression and enforce the selection of a single point in instance space. These encoding schemes also appear to distort the representational space, as well as trading off the ability to validate that input information is within the bounds of past experience. In contrast, a localist representation which encodes some meaningful information into individual nodes in a network layer affords less memory compression while retaining the integrity of the representational space. This allows the validity of an input to be determined. The validity (or familiarity) of input along with the capacity of localist representation for multiple instance selections affords a memory sampling approach that dynamically balances the bias-variance trade-off. When the input is familiar, bias may be high by referring only to the most similar instances in memory. When the input is less familiar, variance can be increased by referring to more instances that capture a broader range of features. Using this approach in a localist instance memory network, an experiment demonstrates a relationship between representational conflict, generalization performance, and memorization demand. Relatively small sampling ranges produce the best performance on a classic machine learning dataset of visual objects. Combining memory validity with conflict detection produces a reliable confidence judgement that can separate responses with high and low error rates. Confidence can also be used to signal the need for supervisory input. Using this judgement, the need for supervised learning as well as memory encoding can be substantially reduced with only a trivial detriment to classification performance.

Keywords: artificial neural networks, representation, memory, conflict monitoring, confidence

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Authors: Bar Shapira-Youngster, Sima Amram-Vaknin, Yuliya Lipshits-Braziler

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The study examined how 811 Israelis experienced and coped with the COVID-19 lockdown. Stress, uncertainty, and loss of control were reported as common emotional experiences. Two main difficulties were reported: Loneliness and health and emotional concerns. Frequent explanations for the virus's emergence were: scientific or faith reasoning. The most prevalent coping strategies were distraction activities and acceptance. Reducing the use of maladaptive coping strategies has important implications for mental health outcomes. Objectives: COVID-19 has been recognized as a collective, continuous traumatic stressor. The present study examined how individuals experienced, perceived, and coped with this traumatic event during the lockdown in Israel in April 2020. Method: 811 Israelis (71.3% were women; mean age 43.7, SD=13.3)completed an online semi-structured questionnaire consisting two sections: In the first section, participants were asked to report background information. In the second section, they were asked to answer 8 open-ended questions about their experience, perception, and coping with the covid-19 lockdown. Participation was voluntary, and anonymity was assured, they were not offered compensation of any kind. The data were subjected to qualitative content analysis that seeks to classify the participants` answers into an effective number of categories that represent similar meanings. Our content analysis of participants’ answers extended far beyond simple word counts; our objective was to try to identify recurrent categories that characterized participants’ responses to each question. We sought to ensure that the categories regarding the different questions are as mutually exclusive and exhaustive as possible. To ensure robust analysis, the data were initially analyzed by the first author, and a second opinion was then sought from research colleagues. Contribution: The present research expands our knowledge of individuals' experiences, perceptions, and coping mechanisms with continuous traumatic events. Reducing the use of maladaptive coping strategies has important implications for mental health outcomes.

Keywords: Covid-19, emotional distress, coping, continuous traumatic event

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Authors: Mohd Aslam Aslam

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Chronic renal failure is a debilitating condition responsible for high morbidity and mortality. Because of its costs and the complexity of its treatment, proper care is available to very few patients in India. According to researchers, the number of adults aged 30 or older who have chronic kidney disease is projected to increase from 13.2 percent currently, to 14.4 percent in 2020 and 16.7 percent in 2030. The aerial part of Aerva lanata (Busehri booti) have been used in kidney disorders by the Unani physicians. In the present study, the effect of extract of Aerva lanata was investigated on cisplatin-induced nephrotoxicity in rats. The renal effects of this drug was evaluated by monitoring levels of blood urea nitrogen (BUN), serum creatinine, serum uric acid in blood and histopathological examination of kidney. Aerva lanata was evaluated at two different doses (1400 mg/kg and 2800 mg/kg). The effect of higher dose was more pronounced in terms of inhibition in the rise of BUN, serum creatinine and uric acid. Higher dose show greater prevention in the rise of BUN, serum creatinine, and uric acid. The histopathological examination of the kidney tissue of the rats treated with aqueous methanolic extract of Aerva lanata (Higher dose-2800 mg/kg) showed marked inhibition of glomerular congestion, tubular casts, peritubular congestion, epithelial desquamation, blood vessel congestion, interstitial edema and inflammatory cells produced by the cisplatin-induced nephrotoxicity. This finding clearly indicates the protective role of Aerva lanata at higher dose. Present investigation validates the use of Aerva lanata in kidney disorders by Unani physicians.

Keywords: Aerva lanata, Busehri booti, nephroprotective, unani medicine

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Authors: Mumtaz Mooncey, Alexander Jolly, Megan Fisher, Kerry Robinson, Robert Lloyd, Dave Fielding

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Introduction: The integration of the WingFactors in-situ simulation programme has transformed the education landscape at the Whittington Health NHS Trust. To date, there have been a total of 90 simulations - 19 aimed at Paediatric trainees, including 2 Child and Adolescent Mental Health (CAMHS) scenarios. The opportunity for joint debriefs provided by clinical faculty and airline pilots, has created a new exciting avenue to explore human factors within psychiatry. Through the use of real clinical environments and primed actors; the benefits of high fidelity simulation, interdisciplinary and interprofessional learning has been highlighted. The use of in-situ simulation within Psychiatry is a newly emerging concept and its success here has been recognised by unanimously positive feedback from participants and acknowledgement through nomination for the Health Service Journal (HSJ) Award (Best Education Programme 2021). Methodology: The first CAMHS simulation featured a collapsed patient in the toilet with a ligature tied around her neck, accompanied by a distressed parent. This required participants to consider:; emergency physical management of the case, alongside helping to contain the mother and maintaining situational awareness when transferring the patient to an appropriate clinical area. The second simulation was based on a 17- year- old girl attempting to leave the ward after presenting with an overdose, posing potential risk to herself. The safe learning environment enabled participants to explore techniques to engage the young person and understand their concerns, and consider the involvement of other members of the multidisciplinary team. The scenarios were followed by an immediate ‘hot’ debrief, combining technical feedback with Human Factors feedback from uniformed airline pilots and clinicians. The importance of psychological safety was paramount, encouraging open and honest contributions from all participants. Key learning points were summarized into written documents and circulated. Findings: The in-situ simulations demonstrated the need for practical changes both in the Emergency Department and on the Paediatric ward. The presence of airline pilots provided a novel way to debrief on Human Factors. The following key themes were identified: -Team-briefing (‘Golden 5 minutes’) - Taking a few moments to establish experience, initial roles and strategies amongst the team can reduce the need for conversations in front of a distressed patient or anxious relative. -Use of checklists / guidelines - Principles associated with checklist usage (control of pace, rigor, team situational awareness), instead of reliance on accurate memory recall when under pressure. -Read-back - Immediate repetition of safety critical instructions (e.g. drug / dosage) to mitigate the risks associated with miscommunication. -Distraction management - Balancing the risk of losing a team member to manage a distressed relative, versus it impacting on the care of the young person. -Task allocation - The value of the implementation of ‘The 5A’s’ (Availability, Address, Allocate, Ask, Advise), for effective task allocation. Conclusion: 100% of participants have requested more simulation training. Involvement of airline pilots has led to a shift in hospital culture, bringing to the forefront the value of Human Factors focused training and multidisciplinary simulation. This has been of significant value in not only physical health, but also mental health simulation.

Keywords: human factors, in-situ simulation, inter-professional, multidisciplinary

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Authors: Jose Manuel Rodriguez-Dominguez, Rodrigo Barba-Gonzalez, Ernesto Tapia-Campos

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Sprekelia formosissima (L.) Herbert is a bulbous ornamental species of the monocotyledonous Amaryllidaceae family, and it is a perennial, herbaceous monotypic plant commonly known as ‘Aztec Lily’ or ‘Jacobean Lily’; it is distributed through Mexico and Guatemala. Its scarlet flowers with curved petals have made it an exceptional ornamental pot plant. Cytogenetic studies in this species have shown differences in chromosome number (2n=60, 120, 150, 180) with a basic number x=30. Different reports have shown a variable ploidy level (diploid, tetraploid, pentaploid and hexaploid); however, triploid plants have not been reported. In this work, triploid plants of S. formosissima were obtained by crossing tetraploid (2n=4x=120) with diploid (2n=2x=60) genotypes of this species; the seeds obtained from the crosses were placed in pots with a moist substrate made of Peat Moss: Vermiculite (7:3) for germination. Root tips were collected, and metaphasic chromosome preparations were performed. For chromosome counting, the best five metaphases obtained were photographed with a Leica DMRA2 microscope (Leica Microsystems, Germany) microscopy coupled to an Evolution QEI camera under phase contrast (Media-Cybernetics). Chromosomes counting in root-tip cells showed that 100% of the plants were triploid (2n=3x=90). Although tetraploid or pentaploid plants of S. formosissima are highly appreciated, they usually have lower growth rates than related diploid ones. For this reason, it is important to obtain triploid plants, which have advantages such as higher growth rates than tetraploid and pentaploid, larger flowers than those of the diploid plants and they are expected to not be able to produce seeds because their gametes are aneuploids. Furthermore, triploids may become very important for genomic research in the future, creating opportunities for discovering and monitoring genomic and transcriptomic changes in unbalanced genomes, hence the importance of this work.

Keywords: Amaryllidaceae, cytogenetics, ornamental, ploidy level

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Authors: Mahmoud Y. M. Ahmed, Ahmed Konsowa, Mostafa Sami, Ayman Mosallam

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Fukushima nuclear accident (Japan 2011) has drawn attention to the issue of gas leakage from hazardous facilities through building boundaries. The rapidly increasing investments in nuclear stations have made the ability to predict, and prevent, gas leakage a rather crucial issue both environmentally and economically. Leakage monitoring for underground facilities is rather complicated due to the combination of Reinforced Concrete Shear Wall (RCSW) and soil. In the framework of a recent research conducted by the authors, the gas insulation capabilities of RCSW-soil combination have been investigated via a lab-scale experimental work. Despite their accuracy, experimental investigations are expensive, time-consuming, hazardous, and lack for flexibility. Numerically simulating the gas leakage as a fluid flow problem based on Computational Fluid Dynamics (CFD) modeling approach can provide a potential alternative. This novel implementation of CFD approach is the topic of the present paper. The paper discusses the aspects of modeling the gas flow through porous media that resemble the RCSW both isolated and combined with the normal soil. A commercial CFD package is utilized in simulating this fluid flow problem. A fixed RCSW layer thickness is proposed, air is taken as the leaking gas, whereas the soil layer is represented as clean sand with variable properties. The variable sand properties include sand layer thickness, fine fraction ratio, and moisture content. The CFD simulation results almost demonstrate what has been found experimentally. A soil layer attached next to a cracked reinforced concrete section plays a significant role in reducing the gas leakage from that cracked section. This role is found to be strongly dependent on the soil specifications.

Keywords: RCSW, gas leakage, Pressure Decay Method, hazardous underground facilities, CFD

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Authors: Yi Yau, Chia-Huei Hsiao

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The elderly society is already a problem of globalization, and Taiwan will enter a super-aged society in 2025. Therefore, how to improve the health of the elderly and reduce the government's social burden is an important issue at present. Exercise is the best medical care, and it is also a healthy activity for people to live a healthy life. Facing the super-aged society in the future, it is necessary to attract them to participate in sports voluntarily through sports promotion so that they can live healthy and independent lives and continue to participate in society to enhance the well-being of the elderly. Experiential marketing and sports participation are closely related. In the past, it was mainly aimed at consumer behavior at the commercial level. At present, there are not many study objects focusing on participant behavior and middle-aged and elderly people. Therefore, this study takes the news emerged sport-Pickleball that has been loved by silver-haired people in recent years as the research sport. It uses questionnaire surveys and intentional sampling methods. The purpose of the group is to understand the middle-aged and elderly people’s experience and behavior patterns of Pickleball, explore the relationship between experiential marketing and participants' intentional behaviors, and predict which aspects of experiential marketing will affect their intentional behaviors. The findings showed that experience marketing is highly positively correlated with behavioral intentions, and experience marketing has a positive predictive power for behavioral intentions. Among them, "ACT" and "SENSE" are predictive variables that effectively predict behavioral intentions. This study proves the feasibility of pickleball for middle-aged and senior sports. It is recommended that in the future curriculum planning, try to simplify the exercise steps, increase the chances of contact with the sphere, and enhance the sensory experience to enhance the sense of success during exercise, and then generate exercise motivation, and ultimately change the exercise mode or habits and promote health.

Keywords: newly emerged sports, middle age and elderly, health promotion, ACT, SENSE

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Authors: E. Farg, M. M. El-Sharkawy, M. S. Mostafa, S. M. Arafat

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Mapping water stress provides important baseline data for sustainable agriculture. Recent developments in the new Sentinel-1 data which allow the acquisition of high resolution images and varied polarization capabilities. This study was conducted to detect and quantify vegetation water content from canopy backscatter for extracting spatial information to encourage drought mapping activities throughout new reclaimed sandy soils in western Nile delta, Egypt. The performance of radar imagery in agriculture strongly depends on the sensor polarization capability. The dual mode capabilities of Sentinel-1 improve the ability to detect water stress and the backscatter from the structure components improves the identification and separation of vegetation types with various canopy structures from other features. The fieldwork data allowed identifying of water stress zones based on land cover structure; those classes were used for producing harmonious water stress map. The used analysis techniques and results show high capability of active sensors data in water stress mapping and monitoring especially when integrated with multi-spectral medium resolution images. Also sub soil drip irrigation systems cropped areas have lower drought and water stress than center pivot sprinkler irrigation systems. That refers to high level of evaporation from soil surface in initial growth stages. Results show that high relationship between vegetation indices such as Normalized Difference Vegetation Index NDVI the observed radar backscattering. In addition to observational evidence showed that the radar backscatter is highly sensitive to vegetation water stress, and essentially potential to monitor and detect vegetative cover drought.

Keywords: canopy backscatter, drought, polarization, NDVI

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Authors: Celestine Odigwe, Epoke Lincoln, Rhoda-Dara Ephraim

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Background; Immunization against the childhood killer diseases is the cardinal strategy for the prevention of these diseases all over the world in under five children, these diseases include; Tuberculosis, Measles, Polio, Tetanus, Diphthria, Pertusis, Yellow Fever, Hepatitis B, Haemophilus Influenza type B. 6.9 million children die before their fifth birthday , 80% of the worlds death in children under 5 years occur in 25 countries most in Africa and Asia and 2 million children can be saved each year with routine immunization Therefore failure to achieve total immunization coverage puts several children at risk. Aim; The aim of the study was to ascertain the prevalence, Investigate the various reasons and causes why several under five children in a suburb of calabar municipal county fail to get the required immunizations as at and when due and possibly the consequences, so that efforts can be re-directed towards the solution of the problems so identified. Methods; the study was a community based cross sectional study. The respondents were the mothers/guardians of the sampled children who were all aged 0-59 months. To be eligible for recruitment into the study, the parent or guardian was required to give an informed consent, reside within the Calabar South County with his/her children aged 0-59 months. We calculated our sample size using the Leslie-Kish formula and we used a two-staged sampling method, first to ballot for the wards to be involved and then to select four of the most populated ones in the wards chosen. Data collection was by interviewer administered structured questionnaire (Appendix I), Data collected was entered and analyzed using Statistical Package for the Social Sciences (SPSS) Version 20. Percentages were calculated and represented using charts and tables Results; The number of children sampled was 159. We found that 150 were fully immunized and 9 were not, the prevalence of missed opportunity was 32% from the study. The reasons for missed opportunities were varied, ranging from false contraindications, logistical problems resulting in very poor access roads to health facilities and poor organization of health centers together with negative health worker attitudes. Some of the consequences of these missed opportunities were increased susceptibility to vaccine preventable diseases, resurgence of the above diseases and increased morbidity and mortality of children aged less than 5 years. Conclusion; We found that ignorance on the part of both parents/guardians and health care staff together with infrastructural inadequacies in the county such as- roads, poor electric power supply for storage of vaccines were hugely responsible for most missed opportunities for immunization. The details of these and suggestions for improvement and the way forward are discussed.

Keywords: missed opportunity, immunization, under five, Calabar south

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Authors: H. Salonen, E. Castagnoli, C. Vornanen-Winqvist, R. Mikkola, C. Duchaine, L. Morawska, J. Kurnitski

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A wide range of health effects among occupants are associated with the exposure to bioaerosols from fungal sources. Although the accurate role of these aerosols in causing the symptoms and diseases is poorly understood, the important effect of bioaerosol exposure on human health is well recognized. Thus, there is a need to determine all of the contributing factors related to the concentration of fungi in indoor air. In this study, we reviewed and summarized the different factors affecting the concentrations of viable fungi in school buildings. The literature research was conducted using Pubmed and Google Scholar. In addition, we searched the lists of references of selected articles. According to the literature, the main factors influencing the concentration of viable fungi in the school buildings are moisture damage in building structures, the season (temperature and humidity conditions), the type and rate of ventilation, the number and activities of occupants and diurnal variations. This study offers valuable information that can be used in the interpretation of the fungal analysis and to decrease microbial exposure by reducing known sources and/or contributing factors. However, more studies of different local factors contributing to the human microbial exposure in school buildings—as well as other type of buildings and different indoor environments—are needed.

Keywords: fungi, concentration, indoor, school, contributing factor

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Authors: Joella Mukashyaka, Rose Mukarubayiza, Emmanuel Habumugisha, Francois-Xavier Sunday, Kellen Muganwa, Valens Mbarushimana, Pamela Meharry

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Background: Breastfeeding in the first hour post-birth can decrease neonatal morbidity and mortality. Disease prevention and health outcomes differ immensely between newborns who receive human milk and those who do not. Rwanda has high breastfeeding rates, though factors associated with early initiation of breastfeeding (EIBF) are unknown. Objective: To assess factors associated with EIBF among mothers in immediate postpartum units at two hospitals. Methods: A cross-sectional study design and a convenience sample of 187 mothers were used. An interviewer-administered questionnaire was used for data collection. A Chi-square test showed the relationship between EIBF and sociodemographic factors. Results: The findings showed less than one quarter (20.5%) breastfed within the first hour after birth. The majority was < 25 years (52.4%), had some primary education (27.7%) employed (66.7%), urban dweller (58.1%), attendance of one ANC visit or more (81.3%), vaginal birth (58.8%), and did not receive EIBF health education (92.0%). The majority (78.5%) was too tired to initiate breastfeeding, and many supplemented (41.9%) due to perceived insufficient breastmilk. Conclusion: Most mothers did not initiate breastfeeding within the first hour after birth. Sociodemographic factors were associated with EIBF. A program to promote, protect, and support EIBF is urgently needed the community.

Keywords: breastfeeding, early initiation, neonates, morbidity, mortality, sub-Saharan Africa

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Authors: Rehana Akhter, Sajad A. Rather, F. A. Masoodi, Adil Gani, S. M. Wani

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During recent years probiotic food products receive market interest as health-promoting, functional foods, which are believed to contribute health benefits. In order to deliver the health benefits by probiotic bacteria, it has been recommended that they must be present at a minimum level of 106 CFU/g to 107 CFU/g at point of delivery or be eaten in sufficient amounts to yield a daily intake of 108 CFU. However a major challenge in relation to the application of probiotic cultures in food matrix is the maintenance of viability during processing which might lead to important losses in viability as probiotic cultures are very often thermally labile and sensitive to acidity, oxygen or other food constituents for example, salts. In this study Lactobacillus plantarum and Lactobacillus casei were encapsulated in calcium alginate beads with the objective of enhancing their survivability and preventing exposure to the adverse conditions of the gastrointestinal tract and where then inoculated in mutton nuggets. Micro encapsulated Lactobacillus plantarum and Lactobacillus casei were resistant to simulated gastric conditions (pH 2, 2h) and bile solution (3%, 2 h) resulting in significantly (p ≤ 0.05) improved survivability when compared with free cell counterparts. A high encapsulation yield was found due to the encapsulation procedure. After incubation at low pH-values, micro encapsulation yielded higher survival rates compared to non-encapsulated probiotic cells. The viable cell numbers of encapsulated Lactobacillus plantarum and Lactobacillus casei were 107-108 CFU/g higher compared to free cells after 90 min incubation at pH 2.5. The viable encapsulated cells were inoculated into mutton nuggets at the rate of 108 to 1010 CFU/g. The micro encapsulated Lactobacillus plantarum and Lactobacillus casei achieved higher survival counts (105-107 CFU/g) than the free cell counterparts (102-104 CFU/g). Thus micro encapsulation offers an effective means of delivery of viable probiotic bacterial cells to the colon and maintaining their survival during simulated gastric, intestinal juice and processing conditions during nugget preparation.

Keywords: survival, Lactobacillus plantarum, Lactobacillus casei, micro-encapsulation, nugget

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Authors: Abhimanyu Kumar

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The relationship between religion and medicine is much evident in the context of Buddhism. This paper is an attempt to look at the processes of social and cultural evolution of scientific creativity in the field of medicine and institutionalization of medical practices. The objective of the paper is to understand the Buddhist responses towards health as understood from the Vinaya Piṭaka and the Jātaka. This work is a result of the analysis of two important Buddhist texts: the Vinaya Piṭaka and the Jātaka. Broadly the Vinaya Piṭaka is concerned with the growth of Buddhist monasticism. The Vinaya Piṭaka is considered one of the most important sacred texts of the Buddhists, and contains rules for monastic life. These rules deal with such aspects as formal meetings of the saṃgha (monastery), expiation, confession, training, and legal questions. The Jātaka stories, on the other hand, are in the form of folk narratives, and provide a major source of medical consultation for all classes. These texts help us to ascertain the ‘proficiency and perceptions’ of the prevailing medical traditions. The Jātakas are a collection of 547 stories about the past lives of the Buddha, who is represented in anthropomorphic and animal form. The Jātaka connects itself between existing cognitive environments related to ethics and Buddhist didacticism. These stories are a reflection of the connection between the past and contemporary times (in the sense of time of creation of the story) as well. This is visible through the narrative strategy of the text, where every story is sub-divided into the story of the past and story of the present, and there is a significant identification element or connection that established at the end of each story. The minimal presence of philosophical content and the adoption of a narrative strategy make it possible for more of everyday life. This study gives me an opportunity to raise questions about how far were the body and mind closely interrelated in the Buddhist perceptions, and also did the society act like a laboratory for the Buddhists to practice healing activities? How far did religious responses to afflictions, be they leprosy or plague or anger, influence medical care; what impact did medical practitioners, religious authorities and the regulation of medical activity and practice have on healing the body and the mind; and, how has the healing environment been viewed. This paper is working with the idea that medical science in early India was not only for the curative purpose of diseases, but it fulfilled a greater cause of promoting, maintaining and restoring human health. In this regard, studying these texts gives an insight regarding religious responses to epidemics, from leprosy to plague, as well as to behavioral disorder such as anger. In other words, it deals with the idea about healing the body and healing the soul from a religious perspective.

Keywords: food for health, folk narratives, human body, materia medica, social sickness

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Authors: Y. Jin, N. Zhang, X. Luo, W. Zhang

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China with annual increasing 0.5-0.6 billion squares city residence has brought in enormous energy consumption by HVAC facilities and other appliances. In this regard, governments and researchers are encouraging renewable energy like solar energy, geothermal energy using in houses. However, high cost of equipment and low energy conversion result in a very low acceptable to residents. So what’s the equilibrium point of eco-feedback to reach economic benefit and thermal comfort? That is the main question should be answered. In this paper, the objective is an on-site solar PV and heater house, which has been evaluated as a low energy building. Since HVAC system is considered as main energy consumption equipment, the residence with 24-hour monitoring system set to measure temperature, wind velocity and energy in-out value with no HVAC system for one month of summer and winter. Thermal comfort time period will be analyzed and confirmed; then the air-conditioner will be started within thermal discomfort time for the following one summer and winter month. The same data will be recorded to calculate the average energy consumption monthly for a purpose of whole day thermal comfort. Finally, two analysis work will be done: 1) Original building thermal simulation by computer at design stage with actual measured temperature after construction will be contrastive analyzed; 2) The cost of renewable energy facilities and power consumption converted to cost efficient rate to assess the feasibility of renewable energy input for residence. The results of the experiment showed that a certain deviation exists between actual measured data and simulated one for human thermal comfort, especially in summer period. Moreover, the cost-effectiveness is high for a house in targeting city Guilin now with at least 11 years of cost-covering. The conclusion proves that an eco-feedback of a low energy residence is never only consideration of its energy net value, but also the cost efficiency that is the critical factor to push renewable energy acceptable by the public.

Keywords: cost efficiency, eco-feedback, low energy residence, thermal comfort

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Authors: Elaine Wong

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Introduction: The Singapore Physical Activity and Nutrition Study (SPANS) aimed to assess the effects of a community-based intervention on physical activity (PA) and nutrition behaviours as well as chronic disease risk factors for Singaporean women aged above 50 years. This article examines the participation, dose, fidelity, reach, satisfaction and reasons for completion and non-completion of the SPANS. Methods: The SPANS program integrated constructs of Social Cognitive Theory (SCT) and is composed of PA activities; nutrition workshops; dietary counselling coupled with motivational interviewing (MI) through phone calls; and text messages promoting healthy behaviours. Printed educational resources and health incentives were provided to participants. Data were collected via a mixed-method design strategy from a sample of 295 intervention participants. Quantitative data were collected using self-completed survey (n = 209); qualitative data were collected via research assistants’ notes, post feedback sessions and exit interviews with program completers (n = 13) and non-completers (n = 12). Results: Majority of participants reported high ‘satisfactory to excellent’ ratings for the program pace, suitability of interest and overall program (96.2-99.5%). Likewise, similar ratings for clarity of presentation; presentation skills, approachability, knowledge; and overall rating of trainers and program ambassadors were achieved (98.6-100%). Phone dietary counselling had the highest level of participation (72%) at less than or equal to 75% attendance rate followed by nutrition workshops (65%) and PA classes (60%). Attrition rate of the program was 19%; major reasons for withdrawal were personal commitments, relocation and health issues. All participants found the program resources to be colourful, informative and practical for their own reference. Reasons for program completion and maintenance were: desired health benefits; social bonding opportunities and to learn more about PA and nutrition. Conclusions: Process evaluation serves as an appropriate tool to identify recruitment challenges, effective intervention strategies and to ensure program fidelity. Program participants were satisfied with the educational resources, program components and delivery strategies implemented by the trainers and program ambassadors. The combination of printed materials and intervention components, when guided by the SCT and MI, were supportive in encouraging and reinforcing lifestyle behavioural changes. Mixed method evaluation approaches are integral processes to pinpoint barriers, motivators, improvements and effective program components in optimising the health status of Singaporean women.

Keywords: process evaluation, Singapore, older adults, lifestyle changes, program challenges

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Authors: Mamoon Mousa Atout

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The industries of construction are in continuous growth not only in Middle East rejoin but almost all over the world. For the last fifteen years, big expansion and increase of different types of projects has been observed. Many infrastructural projects have been developed, high rise buildings, big shopping malls, power sub-stations, roads, bridges, schools, universities and developing many of new cities with full and complete facilities. The growth and enlargement of the mentioned developed projects has been accomplished through many international and local contracting organizations. Senior management of these organizations depend on their qualified and experienced team whom are aware of the implications of project management, construction management, engineering management and resource management during tendering till final completion of the project. This research aims to find out why reasons of principles of construction engineering and management are necessary for contracting firms and their managers. Principles of construction management help contracting organizations to accomplish and deliver projects without delay. This can be maintained by establishing guidelines’ details for updating the adopted system of construction management that they have through qualified and experienced project managers. The research focuses on benefits of other essential skills of projects planning, monitoring and control. Defining roles and responsibilities of contractor project managers during tendering and execution is a part of the investigated factors that will be analyzed. Other skills like optimizing and utilizing the obtainable project resources to deliver the project within time, cost and quality will be also investigated to find out how these factors are affecting the performance of contracting firms, projects managers and projects. The conclusion of the research will help senior management team and the contractors project managers about the benefits of implications and benefits construction management system and its effect upon the performance and knowledge of contract values that they have, and the optimal profit margin of the firm it.

Keywords: construction management, contracting firms, project managers, planning processes, roles and responsibilities

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Authors: Alemayehu Agizew Woldeamanuel, Mekonnen Maschal Tarekegn, Raj Mohan Balakrishina

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Composting is one of the conventional techniques adopted for organic waste management, but the practice is very limited in emerging cities despite the most of the waste generated is organic. This paper aims to examine the viability of composting for organic waste management in the emerging city of Addis Ababa, Ethiopia, by addressing the composting practice, quality of compost, and application of compost in urban agriculture. The study collects data using compost laboratory testing and urban farm households’ survey and uses descriptive analysis on the state of compost production and application, physicochemical analysis of the compost samples, and regression analysis on the urban farmer’s willingness to pay for compost. The findings of the study indicated that there is composting practice at a small scale, most of the producers use unsorted feedstock materials, aerobic composting is dominantly used, and the maturation period ranged from four to ten weeks. The carbon content of the compost ranges from 30.8 to 277.1 due to the type of feedstock applied, and this surpasses the ideal proportions for C:N ratio. The total nitrogen, pH, organic matter, and moisture content are relatively optimal. The levels of heavy metals measured for Mn, Cu, Pb, Cd and Cr⁶⁺ in the compost samples are also insignificant. In the urban agriculture sector, chemical fertilizer is the dominant type of soil input in crop productions but vegetable producers use a combination of both fertilizer and other organic inputs, including compost. The willingness to pay for compost depends on income, household size, gender, type of soil inputs, monitoring soil fertility, the main product of the farm, farming method and farm ownership. Finally, this study recommends the need for collaboration among stakeholders’ along the value chain of waste, awareness creation on the benefits of composting and addressing challenges faced by both compost producers and users.

Keywords: composting, emerging city, organic waste management, urban agriculture

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Authors: Wei Yaming

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Objective: In order to compare the stress of employees sent overseas with (GRAS) before and after, we used the resource-oriented music listening intervention in this study. We also collected pertinent experimental data. Methods: The experiment involved 47 employees who were sent abroad by the Chinese side. They completed the stress scale test and documented it before the intervention. They tested for stress after five interventions and performed one-on-one interviews. Quantitative data and SPSS software were used to analyze relationships between stress reduction and resource-oriented music listening, as well as Pearson's correlation, multiple regression levels, and ANOVA. For the qualitative analysis, content analysis of one-on-one interviews was performed. Results: A comparison of data from before and after demonstrates how resource-focused music listening activities can lessen and relieve stress in remote workers. In the qualitative study, stress is broken down into six categories: relationship stress, health stress, emotional stress, and frustration stress. External pressures include work pressure and cultural stress. And it has been determined that listening to music that is resource-oriented can better ease internal stress (health, emotion, and dissatisfaction). Conclusion: The Guide Resource-oriented Music Listening (GROML) Program appears to have had some effect on the participants' stress levels. The resources that the participants encountered while listening to music are bravery, calm, letting go, and relaxing.

Keywords: resource-oriented, music listening, oversea dispatch employees, work stress

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Authors: Mugabe Nzarama Gabriel

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In Rwanda, many healthcare organizations are still using a paper based patients’ data record system although it still present weaknesses to share health patients’ information across different services when necessary. In developed countries, the EHR has been put in place to revolutionize the paper based record system but still the EHR has some challenges related to privacy, security, or interoperability. The purpose of this research was to assess the existing patients’ data record system in healthcare sector in Rwanda, see what an EHR can improve to the system in place and assess the acceptance of EHR as system which is interoperable, very secure and interoperable and see whether stakeholders are ready to adopt the system. The case based methodology was used and TAM theoretical framework to design the questionnaire for the survey. A judgmental sample across two cases, CHUB and Hopital de Nemba, has been selected and SPSS has been used for descriptive statistics. After a qualitative analysis, the findings showed that the paper based record is useful, gives complete information about the patient, protects the privacy of patients but it is still less secure and less interoperable. The respondents shown that they are ready to use the proposed EHR System and want it secure, capable of enforcing the privacy but still they are not all ready for the interoperability. A conclusion has been formulated; recommendations and further research have been proposed.

Keywords: EHR system, healthcare service, TAM, privacy, interoperability

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Authors: Hakim Herbane

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Efforts to achieve sustainability in architecture must prove their effectiveness despite various methods attempted. Biomimicry, which looks to successful natural models to promote sustainability and innovation, faces obstacles in implementing sustainability despite its restorative approach to the relationship between humans and nature. In Nunavik, Inuit communities are exploring a sustainable production system that aligns with their aspirations and meets their demands of human, technological, technical, economic, and ecological factors. Biomimicry holds promise in line with Inuit philosophy, but its failure to implement sustainability requires further investigations to remedy its deficiencies. Our literature review underscores the importance of involving the community in defining sustainability and determining the best methods for its implementation. Additionally, vernacular architecture shows valuable orientations for achieving sustainability. Moreover, reintegrating Inuit communities and their traditional architectural practices, which have successfully balanced their built environment's diverse needs and constraints, could pave the way for a sustainable Inuit-built environment in Nunavik and advance architectural biomimicry principles simultaneously. This research aims at establishing a sustainability monitoring tool for Nordic architectural process by analyzing Inuit vernacular and biomimetic architecture, in addition to the input of stakeholders involved in Inuit architecture production in Nunavik, especially Inuit. The goal is to create a practical tool (an index) to aid in designing sustainable architecture, taking into account environmental, social, and economic perspectives. Furthermore, the study seeks to authenticate strong, sustainable design principles of vernacular and biomimetic architectures. The literature review uncovered challenges and identified new opportunities. The forthcoming discourse will focus on the careful and considerate incorporation of Inuit communities’ perceptions and indigenous building practices into our methodology and the latest findings of our research.

Keywords: sustainability, biomimicry, vernacular architecture, community involvement

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Authors: C. Bolakis, I. S. Karanasiou, D. Grbovic, G. Karunasiri, N. Uzunoglu

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A new approach for efficient detection of THz radiation in biomedical imaging applications is proposed. A double-layered absorber consisting of a 32 nm thick aluminum (Al) metallic layer, located on a glass medium (SiO2) of 1 mm thickness, was fabricated and used to design a fine-tuned absorber through a theoretical and finite element modeling process. The results indicate that the proposed low-cost, double-layered absorber can be tuned based on the metal layer sheet resistance and the thickness of various glass media taking advantage of the diversity of the absorption of the metal films in the desired THz domain (6 to 10 THz). It was found that the composite absorber could absorb up to 86% (a percentage exceeding the 50%, previously shown to be the highest achievable when using single thin metal layer) and reflect less than 1% of the incident THz power. This approach will enable monitoring of the transmission coefficient (THz transmission ‘’fingerprint’’) of the biosample with high accuracy, while also making the proposed double-layered absorber a good candidate for a microbolometer pixel’s active element. Based on the aforementioned promising results, a more sophisticated and effective double-layered absorber is under development. The glass medium has been substituted by diluted poly-si and the results were twofold: An absorption factor of 96% was reached and high TCR properties acquired. In addition, a generalization of these results and properties over the active frequency spectrum was achieved. Specifically, through the development of a theoretical equation having as input any arbitrary frequency in the IR spectrum (0.3 to 405.4 THz) and as output the appropriate thickness of the poly-si medium, the double-layered absorber retains the ability to absorb the 96% and reflects less than 1% of the incident power. As a result, through that post-optimization process and the spread spectrum frequency adjustment, the microbolometer detector efficiency could be further improved.

Keywords: bio-imaging, fine-tuned absorber, fingerprint, microbolometer

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Authors: Temesgen Geremew

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The excessive emission of heavy metal ions from industrial processes poses a serious threat to both the environment and human health. This study presents a distinct approach utilizing (PTh-MnS/CoS NPs) for the highly selective and sensitive detection of Hg²⁺ ions in water. Such detection is crucial for safeguarding human health, protecting the environment, and accurately assessing toxicity. The fabrication method employs a simple and efficient chemical precipitation technique, harmoniously combining polythiophene, MnS, and CoS NPs to create highly active substrates for SERS. The MnS@Hg²⁺ exhibits a distinct Raman shift at 1666 cm⁻¹, enabling specific identification and demonstrating the highest responsiveness among the studied semiconductor substrates with a detection limit of only 1 nM. This investigation demonstrates reliable and practical SERS detection for Hg²⁺ ions. Relative standard deviation (RSD) ranged from 0.49% to 9.8%, and recovery rates varied from 96% to 102%, indicating selective adsorption of Hg²⁺ ions on the synthesized substrate. Furthermore, this research led to the development of a remarkable set of substrates, including (MnS, CoS, MnS/CoS, and PTh-MnS/CoS) nanoparticles were created right there on SiO₂/Si substrate, all exhibiting sensitive, robust, and selective SERS for Hg²⁺ ion detection. These platforms effectively monitor Hg²⁺ concentrations in real environmental samples.

Keywords: surface-enhanced raman spectroscopy (SERS), sensor, mercury ions, nanoparticles, and polythiophene.

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Authors: Ravinder Singh, Pratima Syal

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Background: The rising prevalence and incidence of Acute Pancreatitis (AP) and its associated metabolic variables known as metabolic syndrome (MetS) are common medical conditions with catastrophic consequences and substantial treatment costs. The correlation between MetS and AP, as well as their impact on Health Related Quality of Life (HRQoL) is uncertain, and because there are so few published studies, further research is needed. As a result, we planned this study to determine the relationship between MetS components impact on HRQoL in AP patients. Patients and Methods: A prospective, observational study involving the recruitment of patients with AP with and without MetS was carried out in tertiary care hospital of North India. Patients were classified with AP if they were diagnosed with two or more components of the following criteria, abdominal pain, serum amylase and lipase levels two or more times normal, imaging trans-abdominal ultrasound, computed tomography, or magnetic resonance. The National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) criterion was used to diagnose the MetS. The various socio-demographic variables were also taken into consideration for the calculation of statistical significance (P≤.05) in AP patients. Finally, the correlation between AP and MetS, along with their impact on HRQoL was assessed using Student's t test, Pearson Correlation Coefficient, and Short Form-36 (SF-36). Results: AP with MetS (n = 100) and AP without MetS (n = 100) patients were divided into two groups. Gender, Age, Educational Status, Tobacco use, Body Mass Index (B.M.I), and Waist Hip Ratio (W.H.R) were the socio-demographic parameters found to be statistically significant (P≤.05) in AP patients with MetS. Also, all the metabolic variables were also found to statistically significant (P≤.05) and found to be increased in patients with AP with MetS as compared to AP without MetS except HDL levels. Using the SF-36 form, a greater significant decline was observed in physical component summary (PCS) and mental component summary (MCS) in patients with AP with MetS as compared to patients without MetS (P≤.05). Furthermore, a negative association between all metabolic variables with the exception of HDL, and AP was found to be producing deterioration in PCS and MCS. Conclusion: The study demonstrated that patients with AP with MetS had a worse overall HRQOL than patients with AP without MetS due to number of socio-demographic and metabolic variables having direct correlation impacting physical and mental health of patients.

Keywords: metabolic disorers, QOL, cost effectiveness, pancreatitis

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Authors: Manuela Amorim, Cláudia S. Marques, Maria Conceição Calhau, Hélder J. Pinheiro, Maria Manuela Pintado

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Recently it has been recognized peptides from different food sources with biological activities. However, no relevant study has proven the potential of brewer yeast peptides in the modulation of gut microbiota. The importance of human intestinal microbiota in maintaining host health is well known. Probiotics, prebiotics and the combination of these two components, can contribute to support an adequate balance of the bacterial population in the human large intestine. The survival of many bacterial species inhabiting the large bowel depends essentially on the substrates made available to them, most of which come directly from the diet. Some of these substrates can be selectively considered as prebiotics, which are food ingredients that can stimulate beneficial bacteria such as Lactobacilli or Bifidobacteria growth in the colon. Moreover, conventional food can be used as vehicle to intake bioactive compounds that provide those health benefits and increase people well-being. In this way, the main objective of this work was to study the potential prebiotic activity of brewer yeast peptide extract (BYP) obtained via hydrolysis of yeast proteins by cardosins present in Cynara cardunculus extract for possible use as a functional ingredient. To evaluate the effect of BYP on the modulation of gut microbiota in diet-induced obesity model, Wistar rats were fed either with a standard or a high-fat diet. Quantified via 16S ribosomal RNA (rRNA) expression by quantitative PCR (qPCR), genera of beneficial bacteria (Lactobacillus spp. and Bifidobacterium spp.) and three main phyla (Firmicutes, Bacteroidetes and Actinobacteria) were assessed. Results showed relative abundance of Lactobacillus spp., Bifidobacterium spp. and Bacteroidetes was significantly increased (P < 0.05) by BYP. Consequently, the potential health-promoting effects of WPE through modulation of gut microbiota were demonstrated in vivo. Altogether, these findings highlight the possible intervention of BYP as gut microbiota enhancer, promoting healthy life style, and the incorporation in new food products, leads them bringing associated benefits endorsing a new trend in the improvement of new value-added food products.

Keywords: functional ingredients, gut microbiota, prebiotics, brewer yeast peptide extract

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Authors: Harley Stephens

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Although fiducial marker insertion is regarded as the ‘gold standard’ in terms of image guided radiotherapy (IGRT), its application must be considered carefully as the procedure can be invasive, time-consuming, and reliant on consultant expertise. Precision of the fiducials is dependent on these markers remaining in the same location and on the prostate not changing shape during the course treatment. To facilitate the acquirement of non-ionising IGRT and intra-fractional prostate tracking, Clarity TPUS was developed as an alternative imaging system. The main benefits of Clarity TPUS are that it is non-invasive, non-ionising and cost-effective. Other studies have compared fiducials to transabdominal ultrasound, which has since been proven to not be as accurate as trans-perineal imaging, as included in this study. CBCT fiducial translations and Clarity TPUS translations for 120 images as part of the PACE-C prostate SABR trial were retrospectively evaluated by three imaging specialists. Differences were analysed using correlation and Bland-Altman plots. Inter-observer matches agreed within 3mm 88.3 % of the time in left/right direction, 86.7 % of the time in in superior/inferior direction, and 91.7% of the time in ant/post direction. They agreed within 5mm more than 98.3 % of the time in all directions. The intra-class correlation co-efficient was calculated for each direction to show agreement between imaging specialist for inter-observer variability. Each was 0.95 or above, with 1 indicating perfect reliability. Agreement between observers was slightly higher for CBCT and fiducials at 98.7% agreement within 5 mm, compared to clarity TPUS where 96.7% agreement was seen within 5mm. Clarity TPUS has the benefit of no additional dose and intra-fractional monitoring, and results show a good correlation between the different modalities. Inter-observer variability is to be considered, and further research with a larger population would be of benefit.

Keywords: oncology, prostate radiotherapy, image guided radiotherapy, IGRT

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Authors: Rhiannon Barker, Gregory Hartwell, Matt Egan, Karen Lock

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Background: Evidence suggests that mental health (MH) issues in children and young people (CYP) in the UK are on the rise. Of particular concern is data that indicates that the pandemic, together with the impact of school closures, have accentuated already pronounced inequalities; children from families on low incomes or from black and minority ethnic groups are reportedly more likely to have been adversely impacted. This study aimed to help identify specific support which may facilitate the building of a positive school climate and protect student mental health, particularly in the wake of school closures following the pandemic. It has important implications for integrated working between schools and statutory health services. Methods: The research comprised of three parts; scoping, case studies, and a stakeholder workshop to explore and consolidate results. The scoping phase included a literature review alongside interviews with a range of stakeholders from government, academia, and the third sector. Case studies were then conducted in two London state schools. Results: Our research identified how student MH was being impacted by a range of factors located at different system levels, both internal to the school and in the wider community. School climate, relating both to a shared system of beliefs and values, as well as broader factors including style of leadership, teaching, discipline, safety, and relationships -all played a role in the experience of school life and, consequently, the MH of both students and staff. Participants highlighted the importance of a whole school approach and ensuring that support for student MH was not separated from academic achievement, as well as the importance of identifying and applying universal measuring systems to establish levels of MH need. Our findings suggest that a school’s climate is influenced by the style and strength of its leadership, while this school climate - together with mechanisms put in place to respond to MH needs (both statutory and non-statutory) - plays a key role in supporting student MH. Implications: Schools in England have a responsibility to decide on the nature of MH support provided for their students, and there is no requirement for them to report centrally on the form this provision takes. The reality on the ground, as our study suggests, is that MH provision varies significantly between schools, particularly in relation to ‘lower’ levels of need which are not covered by statutory requirements. A valid concern may be that in the huge raft of possible options schools have to support CYP wellbeing, too much is left to chance. Work to support schools in rebuilding their cultures post-lockdowns must include the means to identify and promote appropriate tools and techniques to facilitate regular measurement of student MH. This will help establish both the scale of the problem and monitor the effectiveness of the response. A strong vision from a school’s leadership team that emphasises the importance of student wellbeing, running alongside (but not overshadowed by) academic attainment, should help shape a school climate to promote beneficial MH outcomes. The sector should also be provided with support to improve the consistency and efficacy of MH provision in schools across the country.

Keywords: mental health, schools, young people, whole-school culture

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Authors: B. Fazekas, I. Korolov, K. Kutasi

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Plasma medicine, which involves the use of gas discharge plasmas for medical applications is a rapidly growing research field. The use of non-thermal atmospheric pressure plasmas in dermatology to assist tissue regeneration by improving the healing of infected and/or chronic wounds is a promising application. It is believed that plasma can activate cells, which are involved in the wound closure. Non-thermal atmospheric plasmas are rich in chemically active species (such as O and N-atoms, O2(a) molecules) and radiative species such as the NO, N2+ and N2 excited molecules, which dominantly radiate in the 200-500 nm spectral range. In order to understand the effect of plasma species, both of chemically active and radiative species on wound healing process, the interaction of physical plasma with the human skin cells is necessary. In order to clarify the effect of plasma radiation on the wound healing process we treated keratinocyte cells – that are one of the main cell types in human skin epidermis – covered with a layer of phosphate-buffered saline (PBS) with a low power atmospheric pressure plasma. For the generation of such plasma we have applied a plasma needle. Here, the plasma is ignited at the tip of the needle in flowing helium gas in contact with the ambient air. To study the effect of plasma radiation we used a plasma needle configuration, where the plasma species – chemically active radicals and charged species – could not reach the treated cells, but only the radiation. For the comparison purposes, we also irradiated the cells using a UV-B light source (FS20 lamp) with a 20 and 40 mJ cm-2 dose of 312 nm. After treatment the viability and the proliferation of the cells have been examined. The proliferation of cells has been studied with a real time monitoring system called Xcelligence. The results have indicated, that the 20 mJ cm-2 dose did not affect cell viability, whereas the 40 mJ cm-2 dose resulted a decrease in cell viability. The results have shown that the plasma radiation have no quantifiable effect on the cell proliferation as compared to the non-treated cells.

Keywords: UV radiation, non-equilibrium gas discharges (non-thermal plasmas), plasma emission, keratinocyte cells

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Authors: Josephine Emebiziogo Anene-Okeakwa

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This study investigates the challenges and opportunities for gender equality in vocational education in Awka South, Anambra State, Nigeria. Recognizing the critical role of vocational education in economic development, the research aims to evaluate the current state of gender equality, identify key barriers faced by female students, assess the impact of government policies, and explore opportunities for enhancing gender equality in this sector. Ten vocational schools within Awka South were randomly selected, and a total of 1,000 questionnaires were distributed among students, with 991 completed and returned, yielding a high response rate of 99.1%, and the retrieved data were analyzed using SPSS. The findings indicate significant gender disparities in vocational education enrollment and participation, with male students overwhelmingly outnumbering female students in most technical and engineering-related programs. Key barriers identified include cultural norms discouraging females from pursuing technical fields, economic constraints, lack of female role models, and social stereotypes regarding gender roles. Despite various government policies aimed at promoting gender equality, their implementation and effectiveness remain inadequate, as reflected in persistent gender disparities. However, opportunities for improving gender equality were identified, such as implementing gender-sensitive curricula, expanding mentorship programs for female students, and adopting best practices from other countries. The study recommends enhancing access to vocational training resources, implementing gender-sensitive curricula, expanding mentorship programs, and strengthening the implementation and monitoring of government policies. Addressing these challenges through targeted interventions is essential for achieving gender parity in vocational education, thereby empowering female students and contributing to Nigeria's socio-economic development.

Keywords: vocational education, gender equality, barriers, government policies

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Authors: Wedad Azhar

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Vitamin D is an essential fat-soluble vitamin that is required for the maintenance of good health. It is obtained either through exposure to sunlight (ultraviolet B radiation) or through dietary sources. The role of vitamin D is beyond bone health. Indeed, it plays a critical role in the immune system and a broad range of organ functions such as the cardiovascular system. Moreover, vitamin D plays a critical role in the endothelial function, which is one of the main indicators of atherosclerosis. This study is investigating the correlation between vitamin D status and endothelial function in preventing and treating atherosclerosis especially in country that has ample of sunshine but yet, Saudis from suffering from this issue vitamin D deficiency and insufficiency. Ninety participants from both genders and aged 40 to 60will be involved. The participants will be categorised into three groups: the control group will be healthy persons, patients at risk of developing atherosclerosis, patients formally diagnosed atherosclerosis. Half of the participants in each group should already have been taking vitamin D supplementations. Fasting blood samples will be taken from the participants for biochemical assays. Endothelial function will be assist by flow-mediated dilation of the brachial artery. Participants will be asked to complete a questionnaire on their social and economic status, education level, daily exposure to sunlight, smoking status, consumption of supplements and medication, and a food frequency of vitamin D intake. The data will be analysed using SPSS.

Keywords: atherosclerosis, endothelial function, nutrition, vitamin D

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Authors: A. Kumar, D. Himanshu, Ak Vaish, K. Usman , A. Singh, R. Misra, V. Atam, S. P. Verma, S. Singhal

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Introduction: Resistant and uncontrolled hypertension offer great challenge, in terms of higher risk of morbidity, mortality and not the least, difficulty in diagnosis and management. Our study tries to identify the importance of two crucial aspects of hypertension management, i.e. drug compliance and optimum dosing and also the effect of spironolactone on blood pressure in cases of resistant hypertension. Methodology: A prospective study was carried out among patients, who were referred as case of resistant hypertension to Hypertension Clinic at Gandhi memorial and associated hospital, Lucknow, India from August, 2013 to July 2014. A total of 122 Subjects having uncontrolled BP with ≥3 antihypertensives were selected. After ruling out secondary resistance and with appropriate lifestyle modifications, effect of adherence and optimum doses was seen with monitoring of BP. Only those having blood pressure still uncontrolled were true resistant. These patients were given spironolactone to see its effect on BP over next 12 weeks. Results: Mean baseline BP of all (n=122) patients was 150.4±7.2 mmHg systolic and 92.1±5.7 mmHg diastolic. After promoting adherence to the regimen, there was reduction of 4.20±3.65 mmHg systolic and 2.08±4.74 mmHg Diastolic blood pressure, with 26 patients achieving target blood pressure goal. Further reduction of 6.66±5.99 mmHg in systolic and 2.59±3.67 mmHg in diastolic BP was observed after optimizing the drug doses with another 66 patients achieving target blood pressure goal. Only 30 patients were true resistant hypertensive and prescribed spironolactone. Over 12 weeks, mean reduction of 20.62±3.65 mmHg in systolic and 10.08 ± 6.46 mmHg in diastolic BP was observed. Out of these 30, BP was controlled in 24 patients. Side effects observed were hyperkalemia in 2 patients and breast tenderness in 2 patients. Conclusion: Improper adherence and suboptimal regimen appear to be the important reasons for uncontrolled hypertension. By virtue of maintaining proper adherence to an optimum regimen, target BP goal can be reached in many without adding much to the regimen. Spironolactone is effective in patients with resistant hypertension, in terms of blood pressure reduction with minimal side effects.

Keywords: resistant, hypertension, spironolactone, blood pressure

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