Search results for: Nigel Q. Kelly

Authors: Theresa MacNeil-Kelly

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Blue Zones are particular regions of the world with a high prevalence of centenarians who share common characteristics, lifestyles and environments. There are currently only five recognized Blue Zones, two of which include Okinawa, Japan and the Nicoya Peninsula in Costa Rica. Individuals living in these areas tend to have positive outlooks on life, utilize daily movement, rely on strong social support groups, and eat little to no processed foods. The current research sought to further understand how centenarians living in Okinawa and in the Nicoya Peninsula utilize Blue Zone lifestyle elements in their daily living habits. To accomplish this, the author traveled to both Okinawa and the Nicoya Peninsula, Costa Rica, and interviewed several centenarians, paying particular attention to lifestyle choices and their effects on the aging process. Thematic analysis was used to analyze interview responses, and several themes emerged, such as the importance of family, friends, faith/spirituality, mindfulness, nutrition and daily movement as key foundations to aging in healthy and productive ways. Suggestions for ways to implement these habits globally was also discussed.

Keywords: aging, blue zones, centenarians, nicoya peninsula, okinawa

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Authors: Angeliki Vassila, Dimitrios Kalogeropoulos, Rania Rawashdeh, Nigel Hall, Najiha Rahman, Mark Fabian, Suresh Thulasidharan, Hossain Parwez

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Introduction: Necrotising scleritis is a severe form of scleritis and poses a significant threat to vision. It can manifest in various systemic autoimmune disorders, systemic vasculitis, or as a consequence of microbial infections. The objective of this study is to present a case of necrotizing scleritis associated with scleroderma, which was further complicated by a secondary Staphylococcus epidermidis infection. Methods: This is a retrospective analysis that examines the medical records of a patient who was hospitalised in the Eye Unit at University Hospital Southampton. Results: A 78-year-old woman presented at the eye casualty department of our unit with a two-week history of progressively worsening pain in her left eye. She received a diagnosis of necrotising scleritis and was admitted to the hospital for further treatment. It was decided to commence a three-day course of intravenous methylprednisolone followed by a tapering regimen of oral steroids. Additionally, a conjunctival swab was taken, and two days later, it revealed the presence of S. epidermidis, indicating a potential secondary infection. Given this finding, she was also prescribed topical (Ofloxacin 0.3% - four times daily) and oral (Ciprofloxacin 750mg – twice daily) antibiotics. The inflammation and symptoms gradually improved, leading to the patient being scheduled for a scleral graft and applying an amniotic membrane to cover the area of scleral thinning. Conclusions: Rheumatoid arthritis and granulomatosis with polyangiitis are the most commonly identifiable systemic diseases associated with necrotising scleritis. Although association with scleroderma is extremely rare, early identification and treatment are necessary to prevent scleritis-related complications.

Keywords: scleritis, necrotizing scleritis, scleroderma, autoimmune disease

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Authors: Heather Clark, Jon Kelly

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Burnout among healthcare professionals has been elevated to a high level of concern. The descriptions of the healthcare workplace often include language such as, stressful, long hours, rotating shifts, weekends and holidays, and exhausting. New graduate healthcare professionals are being sent into the workplace with little to no coping skills, knowledge of signs and symptoms of burnout, or resources that are available. The authors of this study created a university course entitled 'coping in your profession' that enrolled registered nurses, licensed practical nurses, EMTs, nurse assistants, and medical assistants. The course addresses burnout, self-analysis, incivility, coping mechanisms, and organizational responsibilities for employee well-being. The students were surveyed using QualtricsXM that included a pre-course and post-course analysis. Pre-course results showed high levels of individual experiences with burnout and limited knowledge of resources to combat burnout. Post-course results included personal growth and that students’ perception of burnout can be prevented at both the individual and the organization levels. Students also indicated that few to no resources to combat burnout existed at their place of employment. Addressing burnout at the educational level helps prepare graduates with the knowledge and tools to combat burnout at the individual and organization level.

Keywords: burnout, coping, healthcare workers, incivility, resilience

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Authors: Moses Oghenenyoreme Eyankware, Christian Ogubuchi Ede

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Groundwater is the principal source for various uses in this study area. The quality and availability of groundwater depend on rock formation within the study area. To effectively study the quality of groundwater, 24 groundwater samples were collected. The study was aimed at investigating the hydrogeochemistry of groundwater, and additionally its suitability for drinking and irrigation purposes. The following parameters were analyzed using the American Public Health Association standard method: pH, turbidity, Ec, TDS, Mg2+, SO42-, NO3¯, Cl-, HCO3¯, K+, Na2+ and Ca2+. Results obtained from Water Quality Index revealed that the groundwater sample fell within good water quality that implies that groundwater is considered fit for drinking purposes. Deduced results obtained from irrigation indices revealed that Permeability Index (PI), Soluble Sodium Percentage (SSP), Sodium Percentage (Na %), Sodium Absorption Ratio (SAR), Kelly Ratio (KR), Magnesium Hazard (MH) ranges from 0.00 to 0.01, 4.04 to 412.9, 0.63 to 257.7, 0.15 to 2.34, 0.09 to 2.57 and 6.84 to 84.55 respectively. Findings from Total hardness revealed that groundwater fell within soft, moderately hard and hard categories. Estimated results obtained from CSMR, RI and LSI showed that groundwater showed corrosion tendency, salinization influenced groundwater at certain sampling points and chloride and sulfate unlikely to interfere with natural formation film.

Keywords: water, quality, suitability, anthropogenic, Nigeria

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Authors: Moses Oghnennyoreme Eyankware, Christian Ogubuchi Ede

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Groundwater is the principal source for various uses in this study area. The quality and availability of groundwater depend on rock formation within the study area. To effectively study the quality of groundwater, 24 groundwater samples were collected. The study was aimed at investigating the hydrogeochemistry of groundwater, and additionally its suitability for drinking and irrigation purposes. The following parameters were analyzed using the American Public Health Association standard method: pH, turbidity, Ec, TDS, Mg2+, SO42-, NO3¯, Cl-, HCO3¯, K+, Na2+ and Ca2+. Results obtained from Water Quality Index revealed that the groundwater sample fell within good water quality that implies that groundwater is considered fit for drinking purposes. Deduced results obtained from irrigation indices revealed that Permeability Index (PI), Soluble Sodium Percentage (SSP), Sodium Percentage (Na %), Sodium Absorption Ratio (SAR), Kelly Ratio (KR), Magnesium Hazard (MH) ranges from 0.00 to 0.01, 4.04 to 412.9, 0.63 to 257.7, 0.15 to 2.34, 0.09 to 2.57 and 6.84 to 84.55 respectively. Findings from Total hardness revealed that groundwater fell within soft, moderately hard and hard categories. Estimated results obtained from CSMR, RI and LSI showed that groundwater showed corrosion tendency, salinization influenced groundwater at certain sampling points and chloride and sulfate unlikely to interfere with natural formation film.

Keywords: water, quality, suitability, anthropogenic, Nigeria

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Authors: Ke Guek Nee, Wong Siew Fan, Nigel V. Marsh

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Excessive use of the Internet has become a cause for concern in many countries, including Malaysia. Such behaviour is reported to be more prevalent amongst young adults who are reported to be spending large amount of time on the Internet. The present study has three objectives. First one is designing a manual-based Cognitive Behavioural Therapy (CBT) programme to reduce problematic Internet use among young adults in Malaysia. Second one is examining the effectiveness of a manual-based CBT programme at the pilot study stage. Thirdly, the programme focuses on reducing the level of stress and anxiety in problematic Internet users. We adopted CBT with single subject experimental design method. A total of six participants completed the entire program. They were asked to report their daily Internet use and software was installed on their devices to record actual use. The data collection involved three time frame measurements: T1 (baseline), T2 (immediately during the last session of the intervention sessions), and T3 (follow-up). Three scales were used to measure the effectiveness of the program: Depression, Anxiety, Stress Scales (DASS), Social Interaction Anxiety Scale (SIAS), and Problematic Internet Use Questionnaire (PIUQ). The results revealed that the intervention programme has significantly improved two dimensions of problematic Internet use which were obsession and control disorder. The participants’ mental health also showed a deduction in means scores for depression, anxiety and stress with depression showing the greatest improvement after the intervention programme. The participants’ social anxiety showed a slight deduction in means scores. We concluded that the intervention programme designed was effective. However, its limitations need to be addressed in future research.

Keywords: excessive internet use, cognitive behavioral thearapy (CBT), psychological well-being, young adults

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Authors: Zafar Iqbal, Nigel P. Grigg, K. Govindaraju, Nicola M. Campbell-Allen

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Quality Function Deployment (QFD) is structured approach. It has been used to improve the quality of products and process in a wide range of fields. Using this systematic tool, practitioners normally rank Voice of Customer ratings (VoCs) in order to produce Improvement Ratios (IRs) which become the basis for prioritising process / product design or improvement activities. In one matrix of the House of Quality (HOQ) competitors are rated. The method of obtaining improvement ratios (IRs) does not always integrate the competitors’ rating in a systematic way that fully utilises competitor rating information. This can have the effect of diverting QFD practitioners’ attention from a potentially important VOC to less important VOC. In order to enhance QFD analysis, we present a more systematic method for integrating competitor ratings, utilising the geometric mean of the customer rating matrix. In this paper we develop a new approach, based on the Analytic Hierarchy Process (AHP), in which we generating a matrix of multiple comparisons of all competitors, and derive a geometric mean for each competitor. For each VOC an improved IR is derived which-we argue herein - enhances the initial VOC importance ratings by integrating more information about competitor performance. In this way, our method can help overcome one of the possible shortcomings of QFD. We then use a published QFD example from literature as a case study to demonstrate the use of the new AHP-based IRs, and show how these can be used to re-rank existing VOCs to -arguably- better achieve the goal of customer satisfaction in relation VOC ratings and competitors’ rankings. We demonstrate how two dimensional AHP-based geometric mean derived from the multiple competitor comparisons matrix can be useful for analysing competitors’ rankings. Our method utilises an established methodology (AHP) applied within an established application (QFD), but in an original way (through the competitor analysis matrix), to achieve a novel improvement.

Keywords: quality function deployment, geometric mean, improvement ratio, AHP, competitors ratings

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Authors: Vignesh Ratnaraj, Daniel Marascia, Kelly Ruecker

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Purpose: Pulmonary embolism (PE) is a major cause of morbidity and mortality in trauma patients. Data suggests PE is occurring earlier in trauma patients, with attention being turned to possible de novo events. Here, we examine the incidence of early PE at a level 1 trauma center and examine the relationship with a chest injury. Method: A retrospective analysis was performed from a prospective trauma registry at a level 1 trauma center. All patients admitted from 1 January 2010 to 30 June 2019 diagnosed with PE following trauma were included. Early PE was considered a diagnosis within 72 hours of admission. The severity of the chest injury was determined by the Abbreviated Injury Score (AIS). Analysis of severe chest injury and incidence of early PE was performed using chi-square analysis. Sub-analysis on the timing of PE and PE location was also performed using chi-square analysis. Results: Chest injury was present in 125 of 184 patients diagnosed with PE. Early PE occurred in 28% (n=35) of patients with a chest injury, including 24.39% (n=10) with a severe chest injury. Neither chest injury nor severe chest injury determined the presence of early PE (p= > 0.05). Sub-analysis showed a trend toward central clots in early PE (37.14%, n=13) compared to late (27.78%, n=25); however, this was not found to be significant (p= > 0.05). Conclusion: PE occurs early in trauma patients, with almost one-third being diagnosed before 72 hours. This analysis does not support the paradigm that chest injury, nor severe chest injury, results in statistically significant higher rates of early PE. Interestingly, a trend toward early central PE was noted in those suffering chest trauma.

Keywords: trauma, PE, chest injury, anticoagulation

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Authors: Kelly La Venture

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Destination promotion has become increasingly important to economic development in the United States. Key stakeholders of the First City on the Mississippi recognizes the importance of the visitor economy and decided to invest in destination promotion of the city as ‘True North’. The purpose of the study was to analyze the economic impact and stakeholder perceptions of destination promotion of the First City on the Mississippi as ‘True North’ using the case study method. Using a semi-structured guide consisting of 8 questions and additional probing questions, investigators engaged in 30-90 minute interviews with 20 key stakeholders. Data captured was then subjected to thematic analysis and interpretation. Through a review of literature and interview analysis, data indicate(1) there is increasing value in the visitor economy of the First City on the Mississippi,(2) the visitor economy warrants investments in destination promotion,(3) economic development can be more effective through coordination of destination promotion of as ‘True North’ and,(4) destination promotion fuels development across the entire economic spectrum. As a result, the First City on the Mississippi should prioritize marketing efforts of as ‘True North’ and coordinate these efforts with economic development initiatives. The destination promotion of the First City on the Mississippi as ‘True North’ may raise the communities profile and open doors to increased tourism, business relocation, business expansion, and entrepreneurs ready to start up a new organization.

Keywords: case study method, destination promotion, economic development, leisure and business travel

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Authors: Robert C. Pritchett, Elizabeth Broad, Kelly L. Pritchett

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Individuals a with spinal cord injuries have been suggested to be at risk for a 25(OH)D insufficiency. However, little is known regarding the relationship between seasonal Vitamin D status and performance in a spinally injured athletic population. Purpose: The purpose of this study was: 1) to examine the seasonal change in 25(OH)D concentrations and 2) to determine whether 25(OH)D status impacts athletic performance in US Paralympic athletes. Methods: 25 (OH)D concentrations were measured in 11 outdoor track athletes ( 5 men/6 females), between fall (October/November) and winter(February). Dietary intake and lifestyle habits were assessed via questionnaire, and performance measurements were assessed using a 20meter sprint test. 25(OH)D concentrations were assessed using a blood spot method (ZRT Laboratory). Results: There was no significant change in 25 (OH) D concentrations across seasons (P=0.505; 31 + 6.35 ng/mL, 29 + 8.72 ng/mL (mean + SD) for Fall and Winter, respectively. In the Fall,42% of the athletes had sufficient levels (>32ng/mL), and 58% were insufficient. (20ng/mL -31ng/mL) where as the winter levels dropped with 33% being sufficient and 58% being insufficient and 1% being deficient (<20ng/mL). There was a weak but significant correlation between a change in 25(OH)D concentrations, and change in 20m sprint time (p<0.05; r=0.408). Conclusion: A substantial proportion of elite athletes with an SCI have low vitamin D status. However, results suggest there was little seasonal variation in 25(OH)D status in elite track athletes with an SCI. Furthermore, any change that was observed demonstrated a very weak relationship with a change in performance.

Keywords: 25(oh)d, performance, spinal cord injuries, elite, sprint, concentration

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Authors: Gregory Kelly, Gary Chai, Sittampalam Manoharan, Deborah Delaney

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A Structural Number (SN) can be calculated for a road pavement from the properties and thicknesses of the surface, base course, sub-base, and subgrade. Historically, the cost of collecting structural data has been very high. Data were initially collected using Benkelman Beams and now by Falling Weight Deflectometer (FWD). The structural strength of pavements weakens over time due to environmental and traffic loading factors, but due to a lack of data, no structural deterioration curve for pavements has been implemented in a Pavement Management System (PMS). International Roughness Index (IRI) is a measure of the road longitudinal profile and has been used as a proxy for a pavement’s structural integrity. This paper offers two conceptual methods to develop Pavement Structural Deterioration Curves (PSDC). Firstly, structural data are grouped in sets by design Equivalent Standard Axles (ESA). An ‘Initial’ SN (ISN), Intermediate SN’s (SNI) and a Terminal SN (TSN), are used to develop the curves. Using FWD data, the ISN is the SN after the pavement is rehabilitated (Financial Accounting ‘Modern Equivalent’). Intermediate SNIs, are SNs other than the ISN and TSN. The TSN was defined as the SN of the pavement when it was approved for pavement rehabilitation. The second method is to use Traffic Speed Deflectometer data (TSD). The road network already divided into road blocks, is grouped by traffic loading. For each traffic loading group, road blocks that have had a recent pavement rehabilitation, are used to calculate the ISN and those planned for pavement rehabilitation to calculate the TSN. The remaining SNs are used to complete the age-based or if available, historical traffic loading-based SNI’s.

Keywords: conceptual, pavement structural number, pavement structural deterioration curve, pavement management system

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Authors: Alpha Bolinao, Francine Rose De Castro, Jessie Kate Lumba, Raztine Mae Paeste, Hannah Grace Tosio

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The present study aimed to know the role of verbal bullying in the lives of obese teenagers exposed to it. The study employed a qualitative design specifically the phenomenological approach that focuses on the obese teenagers’ verbal bullying experiences. The study also used the social constructivism approach wherein it described the obese teenagers’ verbal bullying experiences as they interact with the social world. Through purposive and referral sampling technique, the researchers were able to choose twelve (12) respondents from different schools around the City of Manila, enrolled in the School Year 2015-2016, ages 16-21 years old, has experienced verbal bullying for the last ten (10) years and with the Body Mass Index (BMI) of equal to or greater than 30. Upon the consent of the respondents, ethical considerations were ensured. In-depth one (1) hour interviews were guided by the researchers’ aide memoir. The recorded interviews were transcribed into a field text and the responses were thoroughly analyzed through Thematic Analysis and Kelly’s Repertory Grid. It was found that the role of verbal bullying in the lives of obese teenagers exposed to it is a process and is best described through a syringe, or the 5S Responses of Obese Teenagers in Bullying, with five conceptual themes which also signify the experiences and the process that obese teenagers have gone through after experiencing verbal bullying. The themes conceptualized were: Suffering, self-doubt, suppression, self-acceptance and sanguineness. This paper may serve as a basis for a counseling program to help the obese teenagers cope with their bullying experiences.

Keywords: obesity, obese teenagers, bullying, experiences

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Authors: Adel Alblihy, Reem Ali, Mashael Algethami, Ahmed Shoqafi, Michael S. Toss, Juliette Brownlie, Natalie J. Tatum, Ian Hickson, Paloma Ordonez Moran, Anna Grabowska, Jennie N. Jeyapalan, Nigel P. Mongan, Emad A. Rakha, Srinivasan Madhusudan

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Platinum resistance is a clinical challenge in ovarian cancer. Platinating agents induce DNA damage which activate Mre11 nuclease directed DNA damage signalling and response (DDR). Upregulation of DDR may promote chemotherapy resistance. Here we have comprehensively evaluated Mre11 in epithelial ovarian cancers. In clinical cohort that received platinum- based chemotherapy (n=331), Mre11 protein overexpression was associated with aggressive phenotype and poor progression free survival (PFS) (p=0.002). In the ovarian cancer genome atlas (TCGA) cohort (n=498), Mre11 gene amplification was observed in a subset of serous tumours (5%) which correlated highly with Mre11 mRNA levels (p<0.0001). Altered Mre11 levels was linked with genome wide alterations that can influence platinum sensitivity. At the transcriptomic level (n=1259), Mre11 overexpression was associated with poor PFS (p=0.003). ROC analysis showed an area under the curve (AUC) of 0.642 for response to platinum-based chemotherapy. Pre-clinically, Mre11 depletion by gene knock down or blockade by small molecule inhibitor (Mirin) reversed platinum resistance in ovarian cancer cells and in 3D spheroid models. Importantly, Mre11 inhibition was synthetically lethal in platinum sensitive XRCC1 deficient ovarian cancer cells and 3D-spheroids. Selective cytotoxicity was associated with DNA double strand break (DSB) accumulation, S-phase cell cycle arrest and increased apoptosis. We conclude that pharmaceutical development of Mre11 inhibitors is a viable clinical strategy for platinum sensitization and synthetic lethality in ovarian cancer.

Keywords: MRE11; XRCC1, ovarian cancer, platinum sensitization, synthetic lethality

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Authors: Helen Pushkarskaya, David Tolin, Lital Ruderman, Ariel Kirshenbaum, J. MacLaren Kelly, Christopher Pittenger, Ifat Levy

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Obsessive-Compulsive Disorder (OCD) produces profound morbidity. Difficulties with decision making and intolerance of uncertainty are prominent clinical features of OCD. The nature and etiology of these deficits are poorly understood. We used a well-validated choice task, grounded in behavioral economic theory, to investigate differences in valuation and value-based choice during decision making under uncertainty in 20 unmedicated participants with OCD and 20 matched healthy controls. Participants’ choices were used to assess individual decision-making characteristics. Compared to controls, individuals with OCD were less consistent in their choices and less able to identify options that were unambiguously preferable. These differences correlated with symptom severity. OCD participants did not differ from controls in how they valued uncertain options when outcome probabilities were known (risk) but were more likely than controls to avoid uncertain options when these probabilities were imprecisely specified (ambiguity). These results suggest that the underlying neural mechanisms of valuation and value-based choices during decision-making are abnormal in OCD. Individuals with OCD show elevated intolerance of uncertainty, but only when outcome probabilities are themselves uncertain. Future research focused on the neural valuation network, which is implicated in value-based computations, may provide new neurocognitive insights into the pathophysiology of OCD. Deficits in decision-making processes may represent a target for therapeutic intervention.

Keywords: obsessive compulsive disorder, decision-making, uncertainty intolerance, risk aversion, ambiguity aversion, valuation

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Authors: Hercules Argyropoulos, Thomas F. Johnson, Nigel B Jackson, Kalliopi Zourna, Daniel G. Bracewell

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Lipid encapsulation has become essential in drug delivery, notably for mRNA vaccines during the COVID-19 pandemic. However, their sterile filtration poses challenges due to the risk of deformation, filter fouling and product loss from adsorption onto the membrane. Choosing the right filtration membrane is crucial to maintain sterility and integrity while minimizing product loss. The objective of this study is to develop a rigorous analytical framework utilizing confocal microscopy and filtration blocking models to elucidate the fouling mechanisms of liposomes as a model system for this class of delivery vehicle during sterile filtration, particularly in response to variations in transmembrane pressure (TMP) during the filtration process. Experiments were conducted using fluorescent Lipoid S100 PC liposomes formulated by micro fluidization and characterized by Multi-Angle Dynamic Light Scattering. Dual-layer PES/PES and PES/PVDF membranes with 0.2 μm pores were used for filtration under constant pressure, cycling from 30 psi to 5 psi and back to 30 psi, with 5, 6, and 5-minute intervals. Cross-sectional membrane samples were prepared by microtome slicing and analyzed with confocal microscopy. Liposome characterization revealed a particle size range of 100-140 nm and an average concentration of 2.93x10¹¹ particles/mL. Goodness-of-fit analysis of flux decline data at varying TMPs identified the intermediate blocking model as most accurate at 30 psi and the cake filtration model at 5 psi. Membrane resistance analysis showed atypical behavior compared to therapeutic proteins, with resistance remaining below 1.38×10¹¹ m⁻¹ at 30 psi, increasing over fourfold at 5 psi, and then decreasing to 1-1.3-fold when pressure was returned to 30 psi. This suggests that increased flow/shear deforms liposomes enabling them to more effectively navigate membrane pores. Confocal microscopy indicated that liposome fouling mainly occurred in the upper parts of the dual-layer membrane.

Keywords: sterile filtration, membrane resistance, microfluidization, confocal microscopy, liposomes, filtration blocking models

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Authors: Kelly F. Delgado-De Agrela, Sonia E. Ruiz, Marco A. Santos-Santiago

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An approach is proposed for the design of regular buildings equipped with non-linear viscous dissipating devices. The approach is based on a direct-displacement seismic design method which satisfies seismic performance objectives. The global system involved is formed by structural regular moment frames capable of supporting gravity and lateral loads with elastic response behavior plus a set of non-linear viscous dissipating devices which reduce the structural seismic response. The dampers are characterized by two design parameters: (1) a positive real exponent α which represents the non-linearity of the damper, and (2) the damping coefficient C of the device, whose constitutive force-velocity law is given by F=Cvᵃ, where v is the velocity between the ends of the damper. The procedure is carried out using a substitute structure. Two limits states are verified: serviceability and near collapse. The reduction of the spectral ordinates by the additional damping assumed in the design process and introduced to the structure by the viscous non-linear dampers is performed according to a damping reduction factor. For the design of the non-linear damper system, the real velocity is considered instead of the pseudo-velocity. The proposed design methodology is applied to an 8-story steel moment frame building equipped with non-linear viscous dampers, located in intermediate soil zone of Mexico City, with a dominant period Tₛ = 1s. In order to validate the approach, nonlinear static analyses and nonlinear time history analyses are performed.

Keywords: based design, direct-displacement based design, non-linear viscous dampers, performance design

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Authors: Kelly Grani Yuen

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Accounting scandals and auditing frauds are perceived to be driven by aggressive companies and misrepresentation of audit reports. However, local legal systems and law enforcements may affect the services auditors provide to their ‘important’ clients. Under the civil law and common law jurisdictions, the standard setters, the government, and the regulatory bodies treat cases differently. As such, whether or not different forms of legal systems and extent of law enforcement plays an important role in auditor’s Audit Quality is a question this paper attempts to explore. The paper focuses on the investigation in Asia, where Hong Kong represents the common-law jurisdiction, while Taiwan and China represent the civil law jurisdiction. Only the ten reputable accounting firms are used in this study due to the differences in rankings and establishments of some of the small local audit firms. This will also contribute to the data collected between the years 2007-2013. By focusing on the use of multiple regression based on the dependent (Audit Quality) and independent variables (Client Importance, Law Enforcement, and Press Freedom), six different models are established. Results demonstrate that since different jurisdictions have different legal systems and market regulations, auditor’s treatment on ‘important’ clients will vary. However, with the moderators in place (law enforcement and press freedom), the relationship between client importance and audit quality may be smoothed out. With that in mind, this study contributes to local governments and standard setters’ consideration on legal reform and proper law enforcement in the market. Perhaps, with such modifications on the economic systems, collusion between companies and auditors can finally be put to a halt.

Keywords: audit quality, client importance, jurisdiction, modified audit opinions

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Authors: Fasil Wagnew, Kerri Viney, Kefyalew Addis Alene, Matthew Kelly, Darren Gray

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Background: Undernutrition is a risk factor for tuberculosis (TB), including poor treatment outcomes. However, evidence regarding the effect of undernutrition on TB treatment outcomes is not well understood. We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multi-drug resistance (MDR)-TB. Methods: We searched for publications in the Medline, Embase, Scopus, and Web of Science databases without restrictions on geography or year of publication. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Two reviewers independently assessed the study eligibility, extracted the necessary information, and assessed the risk of bias. Depending on the nature of the data, odds ratio (OR) and hazard ratio (HR) with 95% confidence intervals (CIs) were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger’s tests. Results: Of 2358 records screened, 59 studies comprising a total of 31,254 people with MDR-TB were included. Undernutrition was significantly associated with a lower sputum culture conversion rate (HR 0·7, 95% CI 0·6–0·9, I2=67·1%) and a higher rate of mortality (OR 2·9, 95%CI 2·1–3·8, I2=23·7%) and unfavourable treatment outcomes (OR 1·8, 95%CI 1·5–2·0, I2=72·7%). There was no statistically significant publication bias in the included studies. Three studies were low, forty-two studies were moderate, and fourteen studies were high quality. Interpretations: Undernutrition was significantly associated with unfavourable treatment outcomes, including mortality and lower sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardised second-line TB drugs.

Keywords: undernutrition, MDR-TB, sputum culture conversion, treatment outcomes, meta-analysis

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Authors: Jo Angouri, Charlotte Kennedy, Shawnea Ting, David Rawlinson, Matthew Booker, Nigel Rees

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Ambulance services need to balance the large volume of emergency (999 in the UK) calls they receive (e.g., West Midlands Ambulance Service reports per day about 4,000 999 calls; about 679,000 calls per year are received in Wales), with dispatching limited resource for on-site intervention to the most critical cases. The process by which Emergency Medical Dispatch (EMD) decisions are made is related to risk assessment and involves the caller and call-taker as well as clinical teams negotiating risk levels on a case-by-case basis. Medical Priority Dispatch System (MPDS – also referred to as Advanced Medical Priority Dispatch System AMPDS) are used in the UK by NHS Trusts (e.,g WAST) to process and prioritise 999 calls. MPDS / AMPDS provide structured protocols for call prioritisation and call management. Protocols/policy frameworks have not been examined before in the way we propose in our project. In more detail, the risk factors that play a role in the EMD negotiation between the caller and call-taker have been analysed in both medical and social science research. Research has focused on the structural, morphological and phonological aspects that could improve, and train, human-to-human interaction or automate risk detection, as well as the medical factors that need to be captured from the caller to inform the dispatch decision. There are two significant gaps in our knowledge that we address in our work: 1. the role of backstage clinical teams in translating the caller/call-taker interaction in their internal risk negotiation and, 2. the role of policy frameworks, protocols and regulations in the framing of institutional priorities and resource allocation. We take a multi method approach and combine the analysis of 999 calls with the analysis of policy documents. We draw on interaction analysis, corpus methodologies and thematic analysis. In this paper, we report on our preliminary findings and focus in particular on the risk factors we have identified and the relationship with the regulations that create the frame within which teams operate. We close the paper with implications of our study for providing evidence-based policy intervention and recommendations for further research.

Keywords: emergency (999) call, interaction analysis, discourse analysis, ambulance dispatch, medical discourse

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Authors: Fasil Wagnew, Kefyalew Addis Alene, Setegn Eshetie, Tom Wingfield, Matthew Kelly, Darren Gray

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Introduction: Undernutrition is a major and under-appreciated risk factor for TB, which is estimated to be responsible for 1.9 million TB cases per year globally. The effectiveness of micronutrient supplementation on TB treatment outcomes and its prognostic markers such as sputum conversion and serum zinc, retinol, and hemoglobin levels has been poorly understood. This systematic review and meta-analysis aimed to determine the association between zinc and vitamin A supplementation and TB treatment outcomes and its prognostic markers. Methods: A systematic literature search for randomized controlled trials (RCTs) was performed in PubMed, Embase, and Scopus databases. Meta-analysis with a random effect model was performed to estimate risk ratio (RR) and mean difference (MD), with a 95% confidence interval (CI), for dichotomous and continuous outcomes, respectively. Results: Our search identified 2,195 records. Of these, nine RCTs consisting of 1,375 participants were included in the final analyses. Among adults with pulmonary TB, zinc (RR: 0.94, 95%CI: 0.86, 1.03), vitamin A (RR: 0.90, 95%CI: 0.80, 1.01), and combined zinc and vitamin A (RR: 0.98, 95%CI: 0.89, 1.08) supplementation were not significantly associated with TB treatment success. Combined zinc and vitamin A supplementation was significantly associated with increased sputum smear conversion at 2 months (RR: 1.16, 95%CI: 1.03, 1.32), serum zinc levels at 2 months (MD of 0.86umol/l, 95% CI: 0.14, 1.57), serum retinol levels at 2 months (MD: 0.06umol/l, 95 % CI: 0.04, 0.08) and 6 months (MD: 0.12umol/l, 95 % CI: 0.10, 0.14), and serum hemoglobin level at 6 months (MD: 0.29 ug/dl, 95% CI: 0.08 to 0.51), among adults with TB. Conclusions: Providing zinc and vitamin A supplementation to adults with pulmonary TB during treatment may increase early sputum smear conversion, serum zinc, retinol, and hemoglobin levels. However, the use of zinc, vitamin A, or both were not associated with TB treatment success.

Keywords: zinc and vitamin A supplementation, tuberculosis, treatment outcomes, meta-analysis, RCT

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Authors: Jeremy Schultz, Kelly Bricker

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Ecotourism has proven itself to be a forerunner in the advancement of environmental conservation all the while supporting cultural tradition, uniqueness, and pride among indigenous communities. Successful private-community partnerships associated with ecotourism operations are vital to the overall prosperity of both the businesses and the local communities. Such accomplishments can be seen through numerous livelihood goals including income, food security, health, reduced vulnerability, governance, and empowerment. Private-community partnerships also support global initiatives such as the sustainable development goals and sustainable development frameworks including those proposed by the United Nations World Tourism Organization (WTO). Understanding such partnerships assists not only large organizations such as the WTO, but it also benefits smaller ecotourism operators and entrepreneurs who are trying to achieve their sustainable tourism development goals. This study examined the partnership between an ecotourism company (Rivers Fiji) and two rural villages located in Fiji’s Upper Navua Conservation Area. Focus groups were conducted in each village. Observation journals were also used to record conversations outside of the focus groups. Data were thematically organized and analyzed to offer researcher interpretations and understandings. This research supported the notion that respectful and emboldening partnerships between communities and private enterprise are vital to the composition of successful ecotourism operations that support sustainable development protocol. Understanding these partnerships can assist in shaping future ecotourism development and re-molding existing businesses. This study has offered an example of a thriving partnership through community input and critical researcher analysis. Research has identified six contributing factors to successful ecotourism partnerships, and this study provides additional support to that framework.

Keywords: community partnerships, conservation areas, ecotourism, Fiji, sustainability

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Authors: Erin V. Kelly, Nicola C. Newton, Lexine A. Stapinski, Maree Teesson

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Introduction: There is a lack of targeted prevention programs for reducing bullying and distress among adolescents involved in bullying. The current study aimed to examine the impact of a personality-targeted intervention (Preventure) on bullying (victimization and perpetration) and distress among adolescent victims/bullies with high-risk personality types. Method: A cluster randomized trial (RCT) was conducted in 26 secondary schools (2190 students) in NSW and Victoria, Australia, as part of the Climate Schools and Preventure trial. The schools were randomly allocated to Preventure (13 schools received Preventure, 13 did not). Students were followed up at 4 time points (6, 12, 24 and 36 months post-baseline). Preventure involves two group sessions, based on cognitive behavioral therapy, and tailored to four personality types shown to increase risk of substance misuse and other emotional and behavioural problems, including impulsivity, sensation-seeking, anxiety sensitivity and hopelessness. Students were allocated to the personality-targeted groups based on their scores on the Substance Use Risk Profile Scale. Bullying was measured using an amended version of the Revised Olweus Bully/Victim Scale. Psychological distress was measured using the Kessler Psychological Distress Scale. Results: Among high-risk students classified as victims at baseline, those in Preventure schools reported significantly less victimization and distress over time than those in control schools. Among high-risk students classified as bullies at baseline, those in Preventure schools reported significantly less distress over time than those in control schools (no difference for perpetration). Conclusion: Preventure is a promising intervention for reducing bullying victimization and psychological distress among adolescents involved in bullying.

Keywords: adolescents, bullying, personality, prevention

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Authors: Garry Gorman, Nigel McKelvey, James Connolly

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This study will evaluate a growth mindset intervention with Junior Cycle Coding and Senior Cycle Computer Science students in Ireland, where gamification will be used to incentivise growth mindset behaviour. An artificial intelligence (AI) driven personalised learning system will be developed to present computer programming learning tasks in a manner that is best suited to the individuals’ own learning preferences while incentivising and rewarding growth mindset behaviour of persistence, mastery response to challenge, and challenge seeking. This research endeavours to measure mindset with before and after surveys (conducted nationally) and by recording growth mindset behaviour whilst playing a digital game. This study will harness the capabilities of AI and aims to determine how a personalised learning (PL) experience can impact the mindset of a broad range of students. The focus of this study will be to determine how personalising the learning experience influences female and disadvantaged students' sense of belonging in the computer science classroom when tasks are presented in a manner that is best suited to the individual. Whole Brain Learning will underpin this research and will be used as a framework to guide the research in identifying key areas such as thinking and learning styles, cognitive potential, motivators and fears, and emotional intelligence. This research will be conducted in multiple school types over one academic year. Digital games will be played multiple times over this period, and the data gathered will be used to inform the AI algorithm. The three data sets are described as follows: (i) Before and after survey data to determine the grit scores and mindsets of the participants, (ii) The Growth Mind-Set data from the game, which will measure multiple growth mindset behaviours, such as persistence, response to challenge and use of strategy, (iii) The AI data to guide PL. This study will highlight the effectiveness of an AI-driven personalised learning experience. The data will position AI within the Irish educational landscape, with a specific focus on the teaching of CS. These findings will benefit coding and computer science teachers by providing a clear pedagogy for the effective delivery of personalised learning strategies for computer science education. This pedagogy will help prevent students from developing a fixed mindset while helping pupils to exhibit persistence of effort, use of strategy, and a mastery response to challenges.

Keywords: computer science education, artificial intelligence, growth mindset, pedagogy

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Authors: Antonello Durante, James Duff, Kevin Kelly

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The visual needs of people in modern work based buildings are changing. Self-illuminated screens of computers, televisions, tablets and smart phones have changed the relationship between people and the lit environment. In the past, lighting design practice was primarily based on providing uniform horizontal illuminance on the working plane, but this has failed to ensure good quality lit environments. Lighting standards of today continue to be set based upon a 100 year old approach that at its core, considers the task illuminance of the utmost importance, with this task typically being located on a horizontal plane. An alternative method focused on appearance has been proposed, as opposed to the traditional performance based approach. Mean Room Surface Exitance (MRSE) and Target-Ambient Illuminance Ratio (TAIR) are two new metrics proposed to assess illumination adequacy in interiors. The hypothesis is that these factors will be superior to the existing metrics used, which are horizontal illuminance led. For the six past years, research has examined this, within the Dublin Institute of Technology, with a view to determining the suitability of this approach for application to general lighting practice. Since the start of this research, a number of key findings have been produced that centered on how occupants will react to various levels of MRSE. This paper provides a broad update on how this research has progressed. More specifically, this paper will: i) Demonstrate how MRSE can be measured using HDR images technology, ii) Illustrate how MRSE can be calculated using scripting and an open source lighting computation engine, iii) Describe experimental results that demonstrate how occupants have reacted to various levels of MRSE within experimental office environments.

Keywords: illumination hierarchy (IH), mean room surface exitance (MRSE), perceived adequacy of illumination (PAI), target-ambient illumination ratio (TAIR)

Procedia PDF Downloads 187

Authors: Kelly E. Tow, Peter Caputi, Claudia Rogge, Thomas Lee, Simon R. Knowles

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Inflammatory Bowel Disease (IBD) is a serious chronic health condition, characterised by inflammation of the gastrointestinal tract. Individuals with active IBD experience severe abdominal symptoms, which can adversely impact their physical and mental health, as well as their quality of life (QoL). Given that stress may exacerbate IBD symptoms and is frequently highlighted as a contributing factor for the development of psychological difficulties and poorer QoL, it is vital to investigate stress-management strategies aimed at improving the lives of those with IBD. The present study extends on the limited research in IBD cohorts by exploring the role of dispositional mindfulness and its impact on psychological well-being and QoL. The study examined how disease activity and dispositional mindfulness were related to psychological distress and QoL in a cohort of IBD patients. The potential role of dispositional mindfulness as a moderator between stress and anxiety, depression and QoL in these individuals was also examined. Participants included 47 patients with a clinical diagnosis of IBD. Each patient completed a series of psychological questionnaires and was assessed by a gastroenterologist to determine their disease activity levels. Correlation analyses indicated that disease activity was not significantly related to psychological distress or QoL in the sample of IBD patients. However, dispositional mindfulness was inversely related to psychological distress and positively related to QoL. Furthermore, moderation analyses demonstrated a significant interaction between stress and dispositional mindfulness on anxiety. These findings demonstrate that increased levels of dispositional mindfulness may be beneficial for individuals with IBD. Specifically, the results indicate positive links between dispositional mindfulness, general psychological well-being and QoL, and suggest that dispositional mindfulness may attenuate the negative impacts of stress on levels of anxiety in IBD patients. While further research is required to validate and expand on these findings, the current study highlights the importance of addressing psychological factors in IBD and indicates support for the use of mindfulness-based interventions for patients with the disease.

Keywords: anxiety, depression, dispositional mindfulness, inflammatory bowel disease, quality of life, stress

Procedia PDF Downloads 159

Authors: Aarthi Sridhar, Henri Gavin, Karah Kelly

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Rolling Isolation Systems (RISs) are simple and effective means to mitigate earthquake hazards to equipment in critical and precious facilities, such as hospitals, network collocation facilities, supercomputer centers, and museums. The RIS works by isolating components acceleration the inertial forces felt by the subsystem. The RIS consists of two platforms with counter-facing concave surfaces (dishes) in each corner. Steel balls lie inside the dishes and allow the relative motion between the top and bottom platform. Formerly, a mathematical model for the dynamics of RISs was developed using Lagrange’s equations (LE) and experimentally validated. A new mathematical model was developed using Gauss’s Principle of Least Constraint (GPLC) and verified by comparing impulse response trajectories of the GPLC model and the LE model in terms of the peak displacements and accelerations of the top platform. Mathematical models for the RIS are tedious to derive because of the non-holonomic rolling constraints imposed on the system. However, using Gauss’s Principle of Least constraint to find the equations of motion removes some of the obscurity and yields a system that can be easily extended. Though the GPLC model requires more state variables, the equations of motion are far simpler. The non-holonomic constraint is enforced in terms of accelerations and therefore requires additional constraint stabilization methods in order to avoid the possibility that numerical integration methods can cause the system to go unstable. The GPLC model allows the incorporation of more physical aspects related to the RIS, such as contribution of the vertical velocity of the platform to the kinetic energy and the mass of the balls. This mathematical model for the RIS is a tool to predict the motion of the isolation platform. The ability to statistically quantify the expected responses of the RIS is critical in the implementation of earthquake hazard mitigation.

Keywords: earthquake hazard mitigation, earthquake isolation, Gauss’s Principle of Least Constraint, nonlinear dynamics, rolling isolation system

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Authors: Robert Prohaska, Arnaud Konan, Kenneth Kelly, Adam Ragatz, Adam Duran

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In an effort to evaluate the in-use performance of electrified Power Take-off (PTO) usage on bucket utility trucks operating under real-world conditions, data from 20 medium- and heavy-duty vehicles operating in California, USA were collected, compiled, and analyzed by the National Renewable Energy Laboratory's (NREL) Fleet Test and Evaluation team. In this paper, duty-cycle statistical analyses of class 5, medium-duty quick response trucks and class 8, heavy-duty material handler trucks are performed to examine and characterize vehicle dynamics trends and relationships based on collected in-use field data. With more than 100,000 kilometers of driving data collected over 880+ operating days, researchers have developed a robust methodology for identifying PTO operation from in-field vehicle data. Researchers apply this unique methodology to evaluate the performance and utilization of the conventional and electric PTO systems. Researchers also created custom representative drive-cycles for each vehicle configuration and performed modeling and simulation activities to evaluate the potential fuel and emissions savings for hybridization of the tractive driveline on these vehicles. The results of these analyses statistically and objectively define the vehicle dynamic and kinematic requirements for each vehicle configuration as well as show the potential for further system optimization through driveline hybridization. Results are presented in both graphical and tabular formats illustrating a number of key relationships between parameters observed within the data set that relates specifically to medium- and heavy-duty utility vehicles operating under real-world conditions.

Keywords: drive cycle, heavy-duty (HD), hybrid, medium-duty (MD), PTO, utility

Procedia PDF Downloads 396

Authors: Lívia Pimentel Sant'ana Dourado, Raquel Das Neves Almeida, Luís Henrique Costa Corrêa Neto, Nayara Soares, Kelly Grace Magalhães

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Introduction: Obesity and high-fat diet intake have a crucial impact on immune cells and inflammatory profile, highlighting an emerging realization that obesity is an inflammatory disease. In the present work, we aimed to characterize the role of caspase-1/11 and NLRP3 inflammasome in the establishment of mice obesity and modulation of inflammatory lipid metabolism induced by high fat diet intake. Methods and results: Wild type, caspase-1/11 and NLRP3 knockout mice were fed with standard fat diet (SFD) or high fat diet (HFD) for 90 days. The weight of animals was measured weekly to monitor the weight gain. After 90 days, the blood, peritoneal lavage cells, heart and liver were collected from mice studied here. Cytokines were measured in serum by ELISA and analyzed in spectrophotometry. Lipid antigen presentation molecule CD1d expression, reactive oxygen species (ROS) generation and lipid droplets biogenesis were analyzed in cells from mice peritoneal cavity by flow cytometry. Liver histopathology was performed for morphological evaluation of the organ. The absence of caspase-1/11, but not NLRP3, in mice fed with HFD favored the mice weight gain, increased liver size, induced development of hepatic steatosis and IL-12 secretion in mice compared to mice fed with SFD. In addition, caspase-1/11 knockout mice fed with HFD presented an increased CD1d molecule expression, as well as higher levels of lipid droplets biogenesis and ROS generation compared to wild type mice also fed with HFD. Conclusion: Our data suggest that caspase-1/11 knockout mice have greater susceptibility to obesity as well as increased activation of lipid metabolism and inflammatory markers.

Keywords: caspase 1, caspase 11, inflamassome, obesity, lipids

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Authors: S. M. C. Kelly, A. Hargreaves, S. Hargreaves

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Introduction: The Can’t intubate, Can’t ventilate emergency scenario is one which has been shown to be managed badly in the past. Reasons identified included gaps in knowledge of the procedure and the emergency equipment used. We aimed to show an increase in confidence amongst anesthetists and operating department practitioners in the technique following a short tea trolley style teaching intervention. Methods: We carried out the teaching on a one-to-one basis. Two Anaesthetists visited each operating theatre during normal working days. One carried out the teaching session and one took over the intra‐operative care of the patient, releasing the listed anaesthetist for a short teaching session. The teaching was delivered to mixture of students and healthcare professionals, both anaesthetists and anaesthetic practitioners. The equipment includes a trolley, an airway manikin, size 10 scalpel, bougie and size 6.0 tracheal tube. The educator discussed the equipment, performed a demonstration and observed the participants performing the procedure. We asked each person to fill out a pre and post teaching questionnaire, stating their confidence with the procedure. Results: The teaching was delivered to 63 participants in total, which included 21 consultant anaesthetists, 23 trainee doctors and 19 anaesthetic practitioners. The teaching sessions lasted on average 9 minutes (range 5– 15 minutes). All participants reported an increase in confidence in both the equipment and technique in front of neck access. Anaesthetic practitioners reported the greatest increase in confidence (53%), with trainee anaesthetists reporting 27% increase and consultant anaesthetists 22%. Overall, confidence in the performance of emergency front of neck access increased by 31% after the teaching session. Discussion: Short ‘Trolley style’ teaching improves confidence in the equipment and technique used for the emergency front of neck access. This is true for students and for consultant anaesthetists. This teaching style is quick with minimal running costs and is relevant for all anesthetic departments.

Keywords: airway teaching, can't intubate can't ventilate, cricothyroidotomy, front-of-neck

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Authors: Maria Karidakis, Barbara Kelly

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The challenges precipitated by the advent of COVID-19 have brought to the fore the task governments and key stakeholders are faced with; ensuring public health communication is readily accessible to vulnerable populations. COVID-19 has presented challenges for the provision and reception of timely, accessible, and accurate health information pertaining to vaccine health messaging to Aboriginal and Torres Strait Islander peoples. The aim of this qualitative study was to explore strategies used by Aboriginal-led organisations to improve communication about COVID-19 and vaccination for their communities and to explore how these mediation and outreach strategies were received by community members. We interviewed 6 Aboriginal-led organisations and 15 community members from several states across Australian, and these interviews were analysed thematically. The findings suggest that effective public health communication is enhanced when aFirst nations-led response defines the governance that happens in First Nations communities. Pro-active and self-determining Aboriginal leadership and decision-making helps drive the response to counter a growing trend towards vaccine hesitancy. Other strategies include establishing partnerships with government departments and relevant non-governmental organisations to ensure services are implemented and culturally appropriate. The outcomes of this research will afford policymakers, stakeholders in healthcare, and cultural mediators the capacity to identify strengths and potential problems associated with pandemic health information and to subsequently implement creative and culturally specific solutions that go beyond the provision of written documentation via translation or interpreting. It will also enable governing bodies to adjust multilingual polices and to adopt mediation strategies that will improve information delivery and intercultural services on a national and international level.

Keywords: intercultural communication, qualitative, public health communication, COVID-19, pandemic, mediated communication, first nations people

Procedia PDF Downloads 160