Search results for: panel data analysis

Authors: Isaura Esther Solano Núñez, David Suarez

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The main purpose of this research is to discover what causes death in children of the Wayuu community, and deeply analyze those results in order to take corrective measures to properly control infant mortality. We consider important to determine the reasons that are producing early death in this specific type of population, since they are the most vulnerable to high risk environmental conditions. In this way, the government, through competent authorities, may develop prevention policies and the right measures to avoid an increase of this tragic fact. The methodology used to develop this investigation is data mining, which consists in gaining and examining large amounts of data to produce new and valuable information. Through this technique it has been possible to determine that the child population is dying mostly from malnutrition. In short, this technique has been very useful to develop this study; it has allowed us to transform large amounts of information into a conclusive and important statement, which has made it easier to take appropriate steps to resolve a particular situation.

Keywords: malnutrition, data mining, analytical, descriptive, population, Wayuu, indigenous

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Authors: Saule Balmagambetova, Zhenisgul Tlegenova, Saule Madinova

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Cardiotoxicity associated with anticancer treatment, now defined as cancer therapy-related cardiac dysfunction (CTRCD), accompanies cancer patients and negatively impacts their survivorship. Currently, a cardio-oncological service is being created in Kazakhstan based on the provisions of the European Society of Cardio-oncology (ESC) Guidelines. In the frames of a pilot project, a cohort study on CTRCD conditions was initiated at the Aktobe Cancer center. One hundred twenty-eight newly diagnosed breast cancer patients started on doxorubicin and/or trastuzumab were recruited. Echocardiography with global longitudinal strain (GLS) assessment, biomarkers panel (cardiac troponin (cTnI), brain natriuretic peptide (BNP), myeloperoxidase (MPO), galectin-3 (Gal-3), D-dimers, C-reactive protein (CRP)), and other tests were performed at baseline and every three months. Patients were stratified by the cardiovascular risks according to the ESC recommendations and allocated into the risk groups during the pre-treatment visit. Of them, 10 (7.8%) patients were assigned to the high-risk group, 48 (37.5%) to the medium-risk group, and 70 (54.7%) to the low-risk group, respectively. High-risk patients have been receiving their cardioprotective treatment from the outset. Patients were also divided by treatment - in the anthracycline-based 83 (64.8%), in trastuzumab- only 13 (10.2%), and in the mixed anthracycline/trastuzumab group 32 individuals (25%), respectively. Mild symptomatic CTRCD was revealed and treated in 2 (1.6%) participants, and a mild asymptomatic variant in 26 (20.5%). Mild asymptomatic conditions are defined as left ventricular ejection fraction (LVEF) ≥50% and further relative reduction in GLS by >15% from baseline and/or a further rise in cardiac biomarkers. The listed biomarkers were assessed longitudinally in repeated-measures linear regression models during 12 months of observation. The associations between changes in biomarkers and CTRCD and between changes in biomarkers and LVEF were evaluated. Analysis by risk groups revealed statistically significant differences in baseline LVEF scores (p 0.001), BNP (p 0.0075), and Gal-3 (p 0.0073). Treatment groups found no statistically significant differences at baseline. After 12 months of follow-up, only LVEF values showed a statistically significant difference by risk groups (p 0.0011). When assessing the temporal changes in the studied parameters for all treatment groups, there were statistically significant changes from visit to visit for LVEF (p 0.003); GLS (p 0.0001); BNP (p<0.00001); MPO (p<0.0001); and Gal-3 (p<0.0001). No moderate or strong correlations were found between the biomarkers values and LVEF, between biomarkers and GLS. Between the biomarkers themselves, a moderate, close to strong correlation was established between cTnI and D-dimer (r 0.65, p<0.05). The dose-dependent effect of anthracyclines has been confirmed: the summary dose has a moderate negative impact on GLS values: -r 0.31 for all treatment groups (p<0.05). The present study found myeloperoxidase as a promising biomarker of cardiac dysfunction in the mixed anthracycline/trastuzumab treatment group. The hazard of CTRCD increased by 24% (HR 1.21; 95% CI 1.01;1.73) per doubling in baseline MPO value (p 0.041). Increases in BNP were also associated with CTRCD (HR per doubling, 1.22; 95% CI 1.12;1.69). No cases of chemotherapy discontinuation due to cardiotoxic complications have been recorded. Further observations are needed to gain insight into the ability of biomarkers to predict CTRCD onset.

Keywords: breast cancer, chemotherapy, cardiotoxicity, Kazakhstan

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Authors: Fatemeh Torfi

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Estimation of stochastic demand in physical distribution in general and efficient transport routs management in particular is emerging as a crucial factor in urban planning domain. It is particularly important in some municipalities such as Tehran where a sound demand management calls for a realistic analysis of the routing system. The methodology involved critically investigating a fuzzy least-squares linear regression approach (FLLRs) to estimate the stochastic demands in the vehicle routing problem (VRP) bearing in mind the customer's preferences order. A FLLR method is proposed in solving the VRP with stochastic demands. Approximate-distance fuzzy least-squares (ADFL) estimator ADFL estimator is applied to original data taken from a case study. The SSR values of the ADFL estimator and real demand are obtained and then compared to SSR values of the nominal demand and real demand. Empirical results showed that the proposed methods can be viable in solving problems under circumstances of having vague and imprecise performance ratings. The results further proved that application of the ADFL was realistic and efficient estimator to face the stochastic demand challenges in vehicle routing system management and solve relevant problems.

Keywords: fuzzy least-squares, stochastic, location, routing problems

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Authors: Irene H. Maralit

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Warning labels have been found to inform smokers about the health hazards of smoking, encourage smokers to quit, and prevent nonsmokers from starting to smoke. Warning labels on tobacco products are an ideal way of communicating with smokers. Since the intervention is delivered at the time of smoking, nearly all smokers are exposed to warning labels and pack-a-day smokers could be exposed to the warnings more than 7,000 times per year. Given the reach and frequency of exposure, the proponents want to know the effect of warning labels on smoking behavior. Its aims to identify the profile of the smokers associated with its behavioral variables that best describe the users’ perception. The behavioral variables are AVOID, THINK RISK and FORGO. This research study aims to determine if there is significant relationship between the effect of warning labels on cigarette package on Consumer behavior when grouped according to profile variable. The researcher used quota sampling to gather representative data through purposive means to determine the accurate representation of data needed in the study. Furthermore, the data was gathered through the use of a self-constructed questionnaire. The statistical method used were Frequency count, Chi square, multi regression, weighted mean and ANOVA to determine the scale and percentage of the three variables. After the analysis of data, results shows that most of the respondents belongs to age range 22–28 years old with percentage of 25.3%, majority are male with a total number of 134 with percentage of 89.3% and single with total number of 79 and percentage of 52.7%, mostly are high school graduates with total number of 59 and percentage of 39.3, with regards to occupation, skilled workers have the highest frequency of 37 with 24.7%, Majority of the income of the respondents falls under the range of Php 5,001-Php10,000 with 50.7%. And also with regards to the number of sticks consumed per day falls under 6–10 got the highest frequency with 33.3%. The respondents THINK RISK factor got the highest composite mean which is 2.79 with verbal interpretation of agree. It is followed by FORGO with 2.78 composite mean and a verbal interpretation of agree and AVOID variable with composite mean of 2.77 with agree as its verbal interpretation. In terms of significant relationship on the effects of cigarette label to consumer behavior when grouped according to profile variable, sex and occupation found to be significant.

Keywords: consumer behavior, smokers, warning labels, think risk avoid forgo

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Authors: P. Kazymbet, G. Abildinova, K.Makhambetov, M. Bakhtin, D. Rybalkina, K. Zhumadilov

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Conducted cytogenetic research in workers Stepnogorsk Mining-Chemical Combine (Akmola region) with the study of 26341 chromosomal metaphase. Using a regression analysis with program DataFit, version 5.0, dependence between exposure dose and the following cytogenetic exponents has been studied: frequency of aberrant cells, frequency of chromosomal aberrations, frequency of the amounts of dicentric chromosomes, and centric rings. Experimental data on calibration curves "dose-effect" enabled the development of a mathematical model, allowing on data of the frequency of aberrant cells, chromosome aberrations, the amounts of dicentric chromosomes and centric rings calculate the absorbed dose at the time of the study. In the dose range of 0.1 Gy to 5.0 Gy dependence cytogenetic parameters on the dose had the following equation: Y = 0,0067е^0,3307х (R2 = 0,8206) – for frequency of chromosomal aberrations; Y = 0,0057е^0,3161х (R2 = 0,8832) –for frequency of cells with chromosomal aberrations; Y =5 Е-0,5е^0,6383 (R2 = 0,6321) – or frequency of the amounts of dicentric chromosomes and centric rings on cells. On the basis of cytogenetic parameters and regression equations calculated absorbed dose in workers of uranium production at the time of the study did not exceed 0.3 Gy.

Keywords: Stepnogorsk, mathematical modeling, cytogenetic, dicentric chromosomes

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Authors: Nepton Kiani

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Dental decay is one of the most common chronic diseases worldwide and imposes significant costs annually on people and healthcare systems. Addressing this issue is among the important programs of the World Health Organization in the field of oral and dental disease prevention and health promotion. In this context, oral and dental health in vulnerable groups, especially pregnant women, is of greater importance due to the health maintenance of the mother and fetus. The aim of this study is to investigate the DMFT index and various factors affecting it in order to identify different factors influencing the process of dental decay and to take an effective step in reducing the progression of this disease, control, and prevention. In this cross-sectional descriptive study, 120 pregnant women attending Nepton Policlinica clinic in Malaga, Spain, were evaluated for the DMFT index and oral and dental hygiene. In this regard, interviews, precise observations, and data collection were used. Subsequently, data analysis was performed using SPSS software and employing correlation tests, Kruskal-Wallis, and Mann-Whitney tests. The DMFT index for pregnant women in three age groups 22-26, 27- 31, and 32-36 years was respectively 2.8, 4.5, and 5.6. The results of logistic regression analysis showed that demographic variables (age, education, job, economic status) and the frequency of brushing and flossing lead to preventive behavior up to 49.58 percent (P<0.05). Generally, the results indicated that oral and dental care during pregnancy is poor. Only a small number of pregnant women regularly used toothbrush and dental floss or visited the dentist regularly. On the other hand, poor performance in adopting oral and dental care was more observed in pregnant women with lower economic and educational status. The present study showed that raising the level of awareness and education on oral and dental health in pregnant women is essential. In this field, it is necessary to focus on conducting educational-care courses at the level of healthcare centers for midwives, healthcare personnel, and at the community level for families, to prevent and perform dental treatments before the pregnancy period

Keywords: Malaga, oral and dental health, pregnant women, Spain

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Authors: Abdul Wahab Rahimi

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This research examines the role of discursive strategies in the politics of self-censorship in Afghanistan, where political pressure, press freedom, and independent media work together, and language plays a vital role in implementing these strategies. Critical Discourse Analysis was conducted to describe the connection between language usage and the exercise of power by analyzing news stories related to women’s rights. This research focuses on 11 months of chronologically collected data from two mainstream television channels in Afghanistan: Tolo News and Ariana News. The findings show that Tolo News sustains and justifies juxtaposition and political critics’ discursive strategies to address women’s rights issues, criticize government policies, and deal with political pressure. At the same time, Ariana News follows the factual narrative strategy, practices self-censorship, and skips or partially focuses on the objective reporting of sensitive issues. The research concludes that the domestic media in Afghanistan follows the media policy of the Islamic Emirate of Afghanistan by covering sensitive issues and marginalizing women's rights issues in the media discourse.

Keywords: discursive strategies, Taliban, TV Channel, news stories, self-censorship, women's rights.

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Authors: Yuhan Wu, CTB (Kees) Ahaus, Martina Buljac-Samardzic

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Patient aggression and violence is a complex occupational hazards for physicians working in hospitals, and it can have multiple severe negative effects for physicians and hospitals. Although there is a range of interventions in the healthcare sector applied in various countries, China lacks a comprehensive set of interventions at the hospital level in this area. Therefore, due to cultural differences, this study investigates whether international interventions are important and feasible in the Chinese cultural context by conducting a Delphi study. Based on a literature search, a list of 47 hospital interventions to prevent and manage patient aggression and violence was constructed, including 8 categories: hospital environment design, access and entrance, staffing and work practice, training and education, leadership and culture, support, during/after-the-event actions, and hospital policy. The list of interventions will be refined, extended and brought back during a three-round Delphi study. The panel consists of 17 Chinese experts, including physicians experiencing patient aggression and violence, hospital management team members, scientists working in this research area, and policymakers in the healthcare sector. In each round, experts will receive the possible interventions with the instruction to indicate the importance and feasibility of each intervention for preventing and managing patient violence and aggression in Chinese hospitals. Experts will be asked about the importance and feasibility of interventions for patient violence and aggression at the same time. This study will exclude or include interventions based on the score of importance. More specifically, an intervention will be included after each round if >80% of the experts judged it as important or very important and excluded if >50% judged an intervention as not or moderately important. The three-round Delphi study will provide a list of included interventions and assess which of the 8 categories of interventions are considered as important. It is expected that this study can bring new ideas and inspiration to Chinese hospitals in the prevention and management of patient aggression and violence.

Keywords: patient aggression and violence, hospital interventions, feasibility, importance

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Authors: Petra Hofmann, Dana Koniel, Jussi Luukkanen, Walter Nieminen, Lea Hannola, Ilkka Donoghue

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The Covid-19 pandemic forced people to isolate and become physically less connected. The pandemic has not only reshaped people’s behaviours and needs but also accelerated digital transformation (DT). DT of cities has become an imperative with the outlook of converting them into smart cities in the future. Embedding digital infrastructure and smart city initiatives as part of normal design, construction, and operation of cities provides a unique opportunity to improve the connection between people. The Internet of Things (IoT) is an emerging technology and one of the drivers in DT. It has disrupted many industries by introducing different services and business models, and IoT solutions are being applied in multiple fields, including smart cities. As IoT and data are fundamentally linked together, IoT solutions can only create value if the data generated by the IoT devices is analysed properly. Extracting relevant conclusions and actionable insights by using established techniques, data analytics contributes significantly to the growth and success of IoT applications and investments. Companies must grasp DT and be prepared to redesign their offerings and business models to remain competitive in today’s marketplace. As there are many IoT solutions available today, the amount of data is tremendous. The challenge for companies is to understand what solutions to focus on and how to prioritise and which data to differentiate from the competition. This paper explains how IoT and data analytics can impact competitive advantage and how companies should approach IoT and data analytics to translate them into concrete offerings and solutions in the smart city context. The study was carried out as a qualitative, literature-based research. A case study is provided to validate the preservation of company’s competitive advantage through smart city solutions. The results of the research contribution provide insights into the different factors and considerations related to creating competitive advantage through IoT and data analytics deployment in the smart city context. Furthermore, this paper proposes a framework that merges the factors and considerations with examples of offerings and solutions in smart cities. The data collected through IoT devices, and the intelligent use of it, can create competitive advantage to companies operating in smart city business. Companies should take into consideration the five forces of competition that shape industries and pay attention to the technological, organisational, and external contexts which define factors for consideration of competitive advantages in the field of IoT and data analytics. Companies that can utilise these key assets in their businesses will most likely conquer the markets and have a strong foothold in the smart city business.

Keywords: data analytics, smart cities, competitive advantage, internet of things

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Authors: Tejaswi Agarwal, Amritansh Agarwal

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Forest ecosystem plays very important role in the global carbon cycle. It stores about 80% of all above ground and 40% of all below ground terrestrial organic carbon. There is much interest in the extent of tropical forests and their rates of deforestation for two reasons: greenhouse gas contributions and the impact of profoundly negative biodiversity. Deforestation has many ecological, social and economic consequences, one of which is the loss of biological diversity. The rapid deployment of remote sensing (RS) satellites and development of RS analysis techniques in the past three decades have provided a reliable, effective, and practical way to characterize terrestrial ecosystem properties. Global estimates of tropical deforestation vary widely and range from 50,000 to 170,000km2 /yr Recent FAO tropical deforestation estimates for 1990–1995 cite 116,756km2 / yr globally. Remote Sensing can prove to be a very useful tool in monitoring of forests and associated deforestation to a sufficient level of accuracy without the need of physically surveying the forest areas as many of them are physically inaccessible. The methodology for the assessment of forest cover using digital image processing (ERDAS) has been followed. The satellite data for the study was procured from Indian institute of remote Sensing (IIRS), Dehradoon in the digital format. While procuring the satellite data, care was taken to ensure that the data was cloud free and did not belong to dry and leafless season. The Normalized Difference Vegetation Index (NDVI) has been used as a numerical indicator of the reduction in ground biomass. NDVI = (near I.R - Red)/ (near I.R + Red). After calculating the NDVI variations and associated mean, we have analysed the change in ground biomass. Through this paper, we have tried to indicate the rate of deforestation over a given period of time by comparing the forest cover at different time intervals. With the help of remote sensing and GIS techniques, it is clearly shown that the total forest cover is continuously degrading and transforming into various land use/land cover category.

Keywords: remote sensing, deforestation, supervised classification, NDVI, change detection

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Authors: Mark Joseph Quinto, Roan Beronilla, Guiller Damian, Eliza Camaso, Ronaldo Alberto

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Forest inventories are essential to assess the composition, structure and distribution of forest vegetation that can be used as baseline information for management decisions. Classical forest inventory is labor intensive and time-consuming and sometimes even dangerous. The use of Light Detection and Ranging (LiDAR) in forest inventory would improve and overcome these restrictions. This study was conducted to determine the possibility of using LiDAR derived data in extracting high accuracy forest biophysical parameters and as a non-destructive method for forest status analysis of San Manual, Pangasinan. Forest resources extraction was carried out using LAS tools, GIS, Envi and .bat scripts with the available LiDAR data. The process includes the generation of derivatives such as Digital Terrain Model (DTM), Canopy Height Model (CHM) and Canopy Cover Model (CCM) in .bat scripts followed by the generation of 17 composite bands to be used in the extraction of forest classification covers using ENVI 4.8 and GIS software. The Diameter in Breast Height (DBH), Above Ground Biomass (AGB) and Carbon Stock (CS) were estimated for each classified forest cover and Tree Count Extraction was carried out using GIS. Subsequently, field validation was conducted for accuracy assessment. Results showed that the forest of San Manuel has 73% Forest Cover, which is relatively much higher as compared to the 10% canopy cover requirement. On the extracted canopy height, 80% of the tree’s height ranges from 12 m to 17 m. CS of the three forest covers based on the AGB were: 20819.59 kg/20x20 m for closed broadleaf, 8609.82 kg/20x20 m for broadleaf plantation and 15545.57 kg/20x20m for open broadleaf. Average tree counts for the tree forest plantation was 413 trees/ha. As such, the forest of San Manuel has high percent forest cover and high CS.

Keywords: carbon stock, forest inventory, LiDAR, tree count

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Authors: Ibe O. Stephen, Egwuonwu N. Gabriel

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Variations in seismic P-wave velocity and depth resolution resulting from variations in subsurface water saturation were investigated in this study in order to determine the season of the year that gives the most reliable P-wave velocity and depth resolution of the subsurface in Zaria Area, Nigeria. A 2D seismic refraction tomography technique involving an ABEM Terraloc MK6 Seismograph was used to collect data across a borehole of standard log with the centre of the spread situated at the borehole site. Using the same parameters this procedure was repeated along the same spread for at least once in a month for at least eight months in a year for four years. The choice for each survey time depended on when there was significant variation in rainfall data. The seismic data collected were tomographically inverted. The results suggested that the average P-wave velocity ranges of the subsurface in the area are generally higher when the ground was wet than when it was dry. The results also suggested that the overburden of about 9.0 m in thickness, the weathered basement of about 14.0 m in thickness and the fractured basement at a depth of about 23.0 m best fitted the borehole log. This best fit was consistently obtained in the months between March and May when the average total rainfall was about 44.8 mm in the area. The results had also shown that the velocity ranges in both dry and wet formations fall within the standard ranges as provided in literature. In terms of velocity, this study has not in any way clearly distinguished the quality of the results of the seismic data obtained when the subsurface was dry from the results of the data collected when the subsurface was wet. It was concluded that for more detailed and reliable seismic studies in Zaria Area and its environs with similar climatic condition, the surveys are best conducted between March and May. The most reliable seismic data for depth resolution are most likely obtainable in the area between March and May.

Keywords: best season, variations in depth resolution, variations in P-wave velocity, variations in subsurface water saturation, Zaria area

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Authors: Mohammed M. Siddeq, Mohammed H. Rasheed, Omar M. Salih, Marcos A. Rodrigues

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This research proposes a data encoding and decoding method based on the Matrix Minimization algorithm. This algorithm is applied to high-frequency coefficients for compression/encoding. The algorithm starts by converting every three coefficients to a single value; this is accomplished based on three different keys. The decoding/decompression uses a search method called QSS (Quick Sequential Search) Decoding Algorithm presented in this research based on the sequential search to recover the exact coefficients. In the next step, the decoded data are saved in an auxiliary array. The basic idea behind the auxiliary array is to save all possible decoded coefficients; this is because another algorithm, such as conventional sequential search, could retrieve encoded/compressed data independently from the proposed algorithm. The experimental results showed that our proposed decoding algorithm retrieves original data faster than conventional sequential search algorithms.

Keywords: matrix minimization algorithm, decoding sequential search algorithm, image compression, DCT, DWT

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Authors: Hassan Younis

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Purpose: The objective of this study is to review influential papers in the sustainability and supply chain studies domain, leveraging insights from this review to develop a structured framework for academics and researchers. This framework aims to assist scholars in identifying the most impactful publications for their scholarly pursuits. Subsequently, the study will apply and trial the developed framework on selected scholarly articles within the sustainability and supply chain studies domain to evaluate its efficacy, practicality, and reliability. Design/Methodology/Approach: Utilizing the "Publish or Perish" tool, a search was conducted to locate papers incorporating "sustainability" and "supply chain" in their titles. After rigorous filtering steps, a panel of university professors identified five crucial criteria for evaluating research robustness: average yearly citation counts (25%), scholarly contribution (25%), alignment of findings with objectives (15%), methodological rigor (20%), and journal impact factor (15%). These five evaluation criteria are abbreviated as “ACMAJ" framework. Each paper then received a tiered score (1-3) for each criterion, normalized within its category, and summed using weighted averages to calculate a Final Normalized Score (FNS). This systematic approach allows for objective comparison and ranking of the research based on its impact, novelty, rigor, and publication venue. Findings: The study's findings highlight the lack of structured frameworks for assessing influential sustainability research in supply chain management, which often results in a dependence on citation counts. A complete model that incorporates five essential criteria has been suggested as a response. By conducting a methodical trial on specific academic articles in the field of sustainability and supply chain studies, the model demonstrated its effectiveness as a tool for identifying and selecting influential research papers that warrant additional attention. This work aims to fill a significant deficiency in existing techniques by providing a more comprehensive approach to identifying and ranking influential papers in the field. Practical Implications: The developed framework helps scholars identify the most influential sustainability and supply chain publications. Its validation serves the academic community by offering a credible tool and helping researchers, students, and practitioners find and choose influential papers. This approach aids field literature reviews and study suggestions. Analysis of major trends and topics deepens our grasp of this critical study area's changing terrain. Originality/Value: The framework stands as a unique contribution to academia, offering scholars an important and new tool to identify and validate influential publications. Its distinctive capacity to efficiently guide scholars, learners, and professionals in selecting noteworthy publications, coupled with the examination of key patterns and themes, adds depth to our understanding of the evolving landscape in this critical field of study.

Keywords: supply chain management, sustainability, framework, model

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Authors: Ishaq Kashif, Muhammad Younas, Muhammad Riaz, Mubarak Ali

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Poor feeding management during pre-weaning period is one of the factors resulting in compromised growth of Beetal kids fattened for meat purpose. The main reason for this anomaly may be less milk offered to kids and non-serious efforts for its management. This study was planned to find the most appropriate protein level suiting the age of the weaning while shifting animals to high input feeding system. Total of 42 Beetal male kids having 30 (±10), 60 (±10) and 90 (±10) days of age were selected with 16 in each age group. They were designated as G30, G60 and G90, respectively. The weights of animals were; 8±2 kg (G30), 12±2 kg (G60) and 16±2 kg (G90), respectively. All animals were weaned by introducing the total mix feed gradually and withdrawing the milk during the adjustment period of two weeks. The pelleted starter ration (total mix feed) with three various dietary protein levels designated as R1 (16% CP), R2 (20% CP) and R3 (26% CP) were introduced. The control group was reared on the fodder (Maize). The starter rations were iso-caloric and were offered for six-week duration. All animals were exposed to treatment using two-factor factorial (3×3) plus control treatment arrangement under completely randomized design. The data were collected on average daily feed intake (ADFI), average daily gain (ADG), gain to intake ratio, Klieber ratio (KR), body measurements and blood metabolites of kids. The data was analyzed using aov function of R-software. The statistical analysis showed that starter feed protein levels and age of weaning had significant interaction for ADG (P < 0.001), KR (P < 0.001), ADFI (P < 0.05) and blood urea nitrogen (P < 0.05) while serum creatinine and feed conversion had non-significant interaction. The trend analysis revealed that ADG had significant quadratic interaction (P < 0.05) within protein levels and age of weaning. It was found that animals weaned at 30 or 60 days, on R2 diet had better ADG (46.8 gm/day and 87.06 gm/day, respectively) weaned at 60 days of age. The animals weaned at 90 days had best ADG (127 gm/day) with R1. It is concluded that animal weaned at 30 or 40 days required 20% CP for better growth performance while animal at 90 days showed better performance with 16% CP.

Keywords: average daily gain, starter protein levels, weaning age, gain to intake ratio

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Authors: Wahab Abdul Ghafar, Tao Zhong, Baba Kalan Enamullah

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Steel plate shear walls (SPSWs) are a robust lateral load resistance structure because of their high flexibility and efficient energy dissipation when subjected to seismic loads. This research investigates the seismic Performance of an innovative infill web strip (IWS-SPSW) and a typical unstiffened steel plate shear wall (USPSW). As a result, two 1:3 scale specimens of an IWS-SPSW and USPSW with a single story and a single bay were built and subjected to a cyclic lateral loading methodology. In the prototype, the beam-to-column connections were accomplished with the assistance of semi-rigid end-plate connectors. IWS-SPSW demonstrated exceptional ductility and shear load-bearing capacity during the testing process, with no cracks or other damage occurring. In addition, the IWS-SPSW could effectively dissipate energy without causing a significant amount of beam-column connection distortion. The shear load-bearing capacity of the USPSW was exceptional. However, it exhibited low ductility, severe infill plate corner ripping, and huge infill web plate cracks. The FE models were created and then confirmed using the experimental data. It has been demonstrated that the infill web strips of an SPSW system can affect the system's high Performance and total energy dissipation. In addition, a parametric analysis was carried out to evaluate the material qualities of the IWS, which can considerably improve the system's seismic performances. These properties include the steel's strength as well as its thickness.

Keywords: steel shear walls, seismic performance, failure mode, hysteresis response, nonlinear finite element analysis, parametric study.

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Authors: Inas S. Khayal, Weiping Zhou, Jonathan Skinner

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Healthcare delivery systems around the world are in crisis. The need to improve health outcomes while decreasing healthcare costs have led to an imminent call to action to transform the healthcare delivery system. While Bioinformatics and Biomedical Engineering have primarily focused on biological level data and biomedical technology, there is clear evidence of the importance of the delivery of care on patient outcomes. Classic singular decomposition approaches from reductionist science are not capable of explaining complex systems. Approaches and methods from systems science and systems engineering are utilized to structure healthcare delivery system data. Specifically, systems architecture is used to develop a multi-scale and multi-dimensional characterization of the healthcare delivery system, defined here as the Healthcare Delivery System Knowledge Base. This paper is the first to contribute a new method of structuring and visualizing a multi-dimensional and multi-scale healthcare delivery system using systems architecture in order to better understand healthcare delivery.

Keywords: health informatics, systems thinking, systems architecture, healthcare delivery system, data analytics

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Authors: Abiola O. Temitayo-Oboh, Olugbenga L. Abodunrin, Wasiu O. Adebimpe, Micheal C. Asuzu

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Introduction: Many women who are sexually active would prefer to avoid becoming pregnant but are not using any method of contraception. These women are considered to have an unmet need for contraception. In an ideal situation, all women who want to space or limit their births and are exposed to the risk of conception would use some kind of conception; in practice, however, some women fail to use contraception which put them at risk of having mistimed or unwanted births, induced abortion, or maternal death. This study, therefore, aimed to assess the determinants of unmet need for contraception among currently married women in rural and urban communities of Osun State, South-West Nigeria. Methods: This was an analytical cross-sectional comparative study, which was carried out among currently married women. Three hundred and twenty respondents each were selected for the rural and urban groups from four Local Government Areas using multi-stage sampling technique. Data were collected using a pre-tested semi-structured interviewer-administered questionnaire and focus group discussion (FGD) guide; data analysis was done with Statistical Package for Social Sciences (SPSS) version 17.0 and detailed content analysis method respectively. Statistical analysis of the difference between proportions was done by the use of the Chi-square test and T-test was used to compare the means of the continuous variables. The study also utilized descriptive, bivariate and multivariate analytical techniques to examine the effect of some variables on unmet need. Level of statistical significance was set at p-value < 0.05 for all values. Results: Two hundred and ninety-six (92.5%) of the rural and 306 (95.6%) of the urban study population had heard of contraception, 365 (57.0 %) of the total respondents had good knowledge [162 (50.6 %) for rural respondents and 203 (63.4 %) for urban respondents]. This difference was statistically significant (p < 0.001). Five hundred and twenty-one (81.4%) respondents had a positive attitude towards contraception [243 (75.9%) in the rural and 278 (86.9%) in the urban area], and the difference was also statistically significant (p < 0.001). Only 47 (14.7%) and 59 (18.4%) of rural and urban women were current contraceptive users respectively. The total unmet need for contraception among rural women was 138 (43.1%) of which 82 (25.6%) was for spacing and 56 (17.5%), for limiting. While the total unmet need for contraception among urban women was 145 (45.3%) of which 96 (30.0%) was for spacing and 49 (15.3%) for limiting. Number of living children, knowledge of contraceptive methods, discussion with health workers about family planning, couples discussion about family planning and availability of family planning services were found to be predictors of women’s unmet need for contraception (p < 0.05). Conclusion: It is, therefore, recommended that there is need to intensify reproductive health education in bridging the knowledge gap, improving attitude and modifying practices regarding use of contraception in Nigeria. Hence, this will help to enhance the utilization of family planning services among Nigerian women.

Keywords: contraception, married women, Nigeria, rural, urban, unmet need

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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: Elsa Marta Soares, Ana Rita Valente, Cristiana Rodrigues, Filipa Gonçalves

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Background: The assessment of feelings and attitudes of preschool children in relation to stuttering is crucial. Negative experiences can lead to anxiety, worry or frustration. To avoid the worsening of attitudes and feelings related to stuttering, it is important the early detection in order to intervene as soon as possible through an individualized intervention plan. Then it is important to have Portuguese instruments that allow this assessment. Aims: The aim of the present study is to realize the translation and adaptation of the Communication Attitude Test for Children in Preschool Age and Kindergarten (KiddyCat) for EP. Methodology: For the translation and adaptation process, a methodological study was carried out with the following steps: translation, back translation, assessment by a committee of experts and pre-test. This abstract describes the results of the first two phases of this process. The translation was accomplished by two bilingual individuals without experience in health and any knowledge about the instrument. One of them was an English teacher and the other one a Translator. The back-translation was conducted by two Senior Class Teachers that live in United Kingdom without any knowledge in health and about the instrument. Results and Discussion: In translation there were differences in semantic equivalences of various expressions and concepts. A discussion between the two translators, mediated by the researchers, allowed to achieve the consensus version of the translated instrument. Taking into account the original version of KiddyCAT the results demonstrated that back-translation versions were similar to the original version of this assessment instrument. Although the back-translators used different words, they were synonymous, maintaining semantic and idiomatic equivalences of the instrument’s items. Conclusion: This project contributes with an important resource that can be used in the assessment of feelings and attitudes of preschool children who stutter. This was the first phase of the research; expert panel and pretest are being developed. Therefore, it is expected that this instrument contributes to an holistic therapeutic intervention, taking into account the individual characteristics of each child.

Keywords: assessment, feelings and attitudes, preschool children, stuttering

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Authors: Sandra Smieszek, Jonathan Haines

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Introduction: Numerous research efforts have focused on searching for ‘longevity genes’. However, attempting to decipher the genetic component of the longevous phenotype have resulted in limited success and the mechanisms governing longevity remain to be explained. We conducted a genome-wide homozygosity analysis (GWHA) of the founder population of the Amish community in central Ohio. While genome-wide association studies using unrelated individuals have revealed many interesting longevity associated variants, these variants are typically of small effect and cannot explain the observed patterns of heritability for this complex trait. The Amish provide a large cohort of extended kinships allowing for in depth analysis via family-based approach excellent population due to its. Heritability of longevity increases with age with significant genetic contribution being seen in individuals living beyond 60 years of age. In our present analysis we show that the heritability of longevity is estimated to be increasing with age particularly on the paternal side. Methods: The present analysis integrated both phenotypic and genotypic data and led to the discovery of a series of variants, distinct for stratified populations across ages and distinct for paternal and maternal cohorts. Specifically 5437 subjects were analyzed and a subset of 893 successfully genotyped individuals was used to assess CHIP heritability. We have conducted the homozygosity analysis to examine if homozygosity is associated with increased risk of living beyond 90. We analyzed AMISH cohort genotyped for 614,957 SNPs. Results: We delineated 10 significant regions of homozygosity (ROH) specific for the age group of interest (>90). Of particular interest was ROH on chromosome 13, P < 0.0001. The lead SNPs rs7318486 and rs9645914 point to COL4A2 and our lead SNP. COL25A1 encodes one of the six subunits of type IV collagen, the C-terminal portion of the protein, known as canstatin, is an inhibitor of angiogenesis and tumor growth. COL4A2 mutations have been reported with a broader spectrum of cerebrovascular, renal, ophthalmological, cardiac, and muscular abnormalities. The second region of interest points to IRS2. Furthermore we built a classifier using the obtained SNPs from the significant ROH region with 0.945 AUC giving ability to discriminate between those living beyond to 90 years of age and beyond. Conclusion: In conclusion our results suggest that a history of longevity does indeed contribute to increasing the odds of individual longevity. Preliminary results are consistent with conjecture that heritability of longevity is substantial when we start looking at oldest fifth and smaller percentiles of survival specifically in males. We will validate all the candidate variants in independent cohorts of centenarians, to test whether they are robustly associated with human longevity. The identified regions of interest via ROH analysis could be of profound importance for the understanding of genetic underpinnings of longevity.

Keywords: regions of homozygosity, longevity, SNP, Amish

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Authors: Seher Arslankaya, Bahar Uludağ

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Meeting the needs and demands of customers and pleasing the customers are important requirements for companies in food sectors where the growth of competition is significantly unpredictable. Customer satisfaction is also one of the key concepts which is mainly driven by wide range of customer preference and expectation upon products and services introduced and delivered to them. In order to meet the customer demands, the companies that engage in food sectors are expected to have a well-managed set of Total Quality Management (TQM), which sets out to improve quality of products and services; to reduce costs and to increase customer satisfaction by restructuring traditional management practices. It aims to increase customer satisfaction by meeting (their) customer expectations and requirements. The achievement would be determined with the help of customer satisfaction surveys, which is done to obtain immediate feedback and to provide quick responses. In addition, the surveys would also assist the making of strategic planning which helps to anticipate customer future needs and expectations. Meanwhile, periodic measurement of customer satisfaction would be a must because with the better understanding of customers perceptions from the surveys (done by questioners), the companies would have a clear idea to identify their own strengths and weaknesses that help the companies keep their loyal customers; to stand in comparison toward their competitors and map out their future progress and improvement. In this study, we propose a survey based on customer satisfaction measurement method and its statistical analysis for sales and logistic activities of food firms. Customer satisfaction would be discussed in details. Furthermore, after analysing the data derived from the questionnaire that applied to customers by using the SPSS software, various results obtained from the application would be presented. By also applying ANOVA test, the study would analysis the existence of meaningful differences between customer demographic proportion and their perceptions. The purpose of this study is also to find out requirements which help to remove the effects that decrease customer satisfaction and produce loyal customers in food industry. For this purpose, the customer complaints are collected. Additionally, comments and suggestions are done according to the obtained results of surveys, which would be useful for the making-process of strategic planning in food industry.

Keywords: customer satisfaction measurement and analysis, food industry, SPSS, TQM

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Authors: Amritansh Agarwal, Tejaswi Agarwal

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Forest ecosystem plays very important role in the global carbon cycle. It stores about 80% of all above ground and 40% of all below ground terrestrial organic carbon. There is much interest in the extent of tropical forests and their rates of deforestation for two reasons: greenhouse gas contributions and the impact of profoundly negative biodiversity. Deforestation has many ecological, social and economic consequences, one of which is the loss of biological diversity. The rapid deployment of remote sensing (RS) satellites and development of RS analysis techniques in the past three decades have provided a reliable, effective, and practical way to characterize terrestrial ecosystem properties. Global estimates of tropical deforestation vary widely and range from 50,000 to 170,000 km2 /yr Recent FAO tropical deforestation estimates for 1990–1995 cite 116,756km2 / yr globally. Remote Sensing can prove to be a very useful tool in monitoring of forests and associated deforestation to a sufficient level of accuracy without the need of physically surveying the forest areas as many of them are physically inaccessible. The methodology for the assessment of forest cover using digital image processing (ERDAS) has been followed. The satellite data for the study was procured from USGS website in the digital format. While procuring the satellite data, care was taken to ensure that the data was cloud and aerosol free by making using of FLAASH atmospheric correction technique. The Normalized Difference Vegetation Index (NDVI) has been used as a numerical indicator of the reduction in ground biomass. NDVI = (near I.R - Red)/ (near I.R + Red). After calculating the NDVI variations and associated mean we have analysed the change in ground biomass. Through this paper we have tried to indicate the rate of deforestation over a given period of time by comparing the forest cover at different time intervals. With the help of remote sensing and GIS techniques it is clearly shows that the total forest cover is continuously degrading and transforming into various land use/land cover category.

Keywords: remote sensing, deforestation, supervised classification, NDVI change detection

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Authors: S. M. Ali, A. Salam Khan, A. U. Khan, M. Tariq, M. S. Hussain, B. A. Abbasi, I. Hussain, U. Farid

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Environment and surrounding plays a pivotal rule in structuring life-style of the consumers. Living standards intern effect the energy consumption of the consumers. In smart grid paradigm, climate drifts, weather parameter and green environmental directly relates to the energy profiles of the various consumers, such as residential, commercial and industrial. Considering above factors helps policy in shaping utility load curves and optimal management of demand and supply. Thus, there is a pressing need to develop correlation models of load and weather parameters and critical analysis of the factors effecting energy profiles of smart grid consumers. In this paper, we elaborated various environment and weather parameter factors effecting demand of consumers. Moreover, we developed correlation models, such as Pearson, Spearman, and Kendall, an inter-relation between dependent (load) parameter and independent (weather) parameters. Furthermore, we validated our discussion with real-time data of Texas State. The numerical simulations proved the effective relation of climatic drifts with energy consumption of smart grid consumers.

Keywords: climatic drifts, correlation analysis, energy consumption, smart grid, weather parameter

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Authors: Qasem Qananwah, Ahmad Dagamseh, Hiam AlQuran, Khalid Shaker Ibrahim

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Blood pressure helps the physicians greatly to have a deep insight into the cardiovascular system. The determination of individual blood pressure is a standard clinical procedure considered for cardiovascular system problems. The conventional techniques to measure blood pressure (e.g. cuff method) allows a limited number of readings for a certain period (e.g. every 5-10 minutes). Additionally, these systems cause turbulence to blood flow; impeding continuous blood pressure monitoring, especially in emergency cases or critically ill persons. In this paper, the most important statistical features in the photoplethysmogram (PPG) signals were extracted to estimate the blood pressure noninvasively. PPG signals from more than 40 subjects were measured and analyzed and 12 features were extracted. The features were fed to principal component analysis (PCA) to find the most important independent features that have the highest correlation with blood pressure. The results show that the stiffness index means and standard deviation for the beat-to-beat heart rate were the most important features. A model representing both features for Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) was obtained using a statistical regression technique. Surface fitting is used to best fit the series of data and the results show that the error value in estimating the SBP is 4.95% and in estimating the DBP is 3.99%.

Keywords: blood pressure, noninvasive optical system, principal component analysis, PCA, continuous monitoring

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Authors: Folajinmi Oluwasina, Towolawi Adetayo, Kate Ssamula, Penninah Iutung, Daniel Reijer

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Objective: Routine HIV screening has been promoted as an essential component of efforts to reduce incidence, morbidity, and mortality. The objectives of this study were to identify the optimal annual volume needed to realize the public health goals of HIV screening in the AIDS Healthcare Foundation supported hospitals and establish an implementation process to realize that optimal annual volume. Methods: Starting in 2011 a program was established to routinize HIV screening within communities and government hospitals. In 2016 Five-years of HIV screening data were reviewed to identify the optimal annual proportions of age-eligible patients screened to realize the public health goals of reducing new diagnoses and ending late-stage diagnosis (tracked as concurrent HIV/AIDS diagnosis). Analysis demonstrated that rates of new diagnoses level off when 42% of age-eligible patients were screened, providing a baseline for routine screening efforts; and concurrent HIV/AIDS diagnoses reached statistical zero at screening rates of 70%. Annual facility based targets were re-structured to meet these new target volumes. Restructuring efforts focused on right-sizing HIV screening programs to align and transition programs to integrated HIV screening within standard medical care and treatment. Results: Over one million patients were screened for HIV during the five years; 16, 033 new HIV diagnoses and access to care and treatment made successfully for 82 % (13,206), and concurrent diagnosis rates went from 32.26% to 25.27%. While screening rates increased by 104.7% over the 5-years, volume analysis demonstrated that rates need to further increase by 62.52% to reach desired 20% baseline and more than double to reach optimal annual screening volume. In 2011 facility targets for HIV screening were increased to reflect volume analysis, and in that third year, 12 of the 19 facilities reached or exceeded new baseline targets. Conclusions and Recommendation: Quantifying targets against routine HIV screening goals identified optimal annual screening volume and allowed facilities to scale their program size and allocate resources accordingly. The program transitioned from utilizing non-evidence based annual volume increases to establishing annual targets based on optimal volume analysis. This has allowed efforts to be evaluated on the ability to realize quantified goals related to the public health value of HIV screening. Optimal volume analysis helps to determine the size of an HIV screening program. It is a public health tool, not a tool to determine if an individual patient should receive screening.

Keywords: HIV screening, optimal volume, HIV diagnosis, routine

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Authors: Mohammad W. Dewan, Jahangir Alam, Khurshida Sharmin

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Synthetic fibers (carbon, glass, aramid, etc.) are generally utilized to make composite materials for better mechanical and thermal properties. However, they are expensive and non-biodegradable. In the perspective of Bangladesh, jute fibers are available, inexpensive, and comprising good mechanical properties. The improved properties (i.e., low cost, low density, eco-friendly) of natural fibers have made them a promising reinforcement in hybrid composites without sacrificing mechanical properties. In this study, jute and e-glass fiber reinforced hybrid composite materials are fabricated utilizing hand lay-up followed by a compression molding technique. Room temperature cured two-part epoxy resin is used as a matrix. Approximate 6-7 mm thick composite panels are fabricated utilizing 17 layers of woven glass and jute fibers with different fiber layering sequences- only jute, only glass, glass, and jute alternatively (g/j/g/j---) and 4 glass - 9 jute – 4 glass (4g-9j-4g). The fabricated composite panels are analyzed through fiber volume calculation, tensile test, bending test, and water absorption test. The hybridization of jute and glass fiber results in better tensile, bending, and water absorption properties than only jute fiber-reinforced composites, but inferior properties as compared to only glass fiber reinforced composites. Among different fiber layering sequences, 4g-9j-4g fibers layering sequence resulted in better tensile, bending, and water absorption properties. The effect of chemical treatment on the woven jute fiber and chopped glass microfiber infusion are also investigated in this study. Chemically treated jute fiber and 2 wt. % chopped glass microfiber infused hybrid composite shows about 12% improvements in flexural strength as compared to untreated and no micro-fiber infused hybrid composite panel. However, fiber chemical treatment and micro-filler do not have a significant effect on tensile strength.

Keywords: compression molding, chemical treatment, hybrid composites, mechanical properties

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Authors: Melissa Langevin, Natalie Ward, Colleen Fitzgibbons, Christa Ramsey, Melanie Hogue, Anna Theresa Lobos

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Description: Root Cause Analysis (RCA) is used by health care teams to examine adverse events (AEs) to identify causes which then leads to recommendations for prevention Despite widespread use, RCA has limitations. Best practices have not been established for implementing recommendations or tracking the impact of interventions after AEs. During phase 1 of this study, we used simulation to analyze two fictionalized AEs that occurred in hospitalized paediatric patients to identify and understand how the errors occurred and generated recommendations to mitigate and prevent recurrences. Scenario A involved an error of commission (inpatient drug error), and Scenario B involved detecting an error that already occurred (critical care drug infusion error). Recommendations generated were: improved drug labeling, specialized drug kids, alert signs and clinical checklists. Aim: Use simulation to optimize interventions recommended post critical event analysis prior to implementation in the clinical environment. Methods: Suggested interventions from Phase 1 were designed and tested through scenario simulation in the clinical environment (medicine ward or pediatric intensive care unit). Each scenario was simulated 8 times. Recommendations were tested using different, voluntary teams and each scenario was debriefed to understand why the error was repeated despite interventions and how interventions could be improved. Interventions were modified with subsequent simulations until recommendations were felt to have an optimal effect and data saturation was achieved. Along with concrete suggestions for design and process change, qualitative data pertaining to employee communication and hospital standard work was collected and analyzed. Results: Each scenario had a total of three interventions to test. In, scenario 1, the error was reproduced in the initial two iterations and mitigated following key intervention changes. In scenario 2, the error was identified immediately in all cases where the intervention checklist was utilized properly. Independently of intervention changes and improvements, the simulation was beneficial to identify which of these should be prioritized for implementation and highlighted that even the potential solutions most frequently suggested by participants did not always translate into error prevention in the clinical environment. Conclusion: We conclude that interventions that help to change process (epinephrine kit or mandatory checklist) were more successful at preventing errors than passive interventions (signage, change in memory aids). Given that even the most successful interventions needed modifications and subsequent re-testing, simulation is key to optimizing suggested changes. Simulation is a safe, practice changing modality for institutions to use prior to implementing recommendations from RCA following AE reviews.

Keywords: adverse events, patient safety, pediatrics, root cause analysis, simulation

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Authors: Adeola Ibukunoluwa Samuel, Afsoon Kazerouni

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Industrial mineral kaolin has many favourable properties such as colour, shape, softness, non-abrasiveness, natural whiteness, as well as chemical stability. It occurs extensively in North of Bedford road Grahamstown, South Africa. The relationship between both the physical and chemical properties as lead to its application in the production of certain industrial products which are used by the public; this includes the prospect of production of paper, ceramics, rubber, paint, and plastics. Despite its interesting economic potentials, kaolinite clay mineral remains undermined, and this is threatening its sustainability in the mineral industry. This research study focuses on a detailed evaluation of the kaolinite mineral and possible ways to increase its lifespan in the industry. The methods employed for this study includes petrographic microscopy analysis, X-ray powder diffraction analysis (XRD), and proper field reconnaissance survey. Results emanating from this research include updated geological information on Grahamstown. Also, mineral transformation phases such as quartz, kaolinite, calcite and muscovite were identified in the clay samples. Petrographic analysis of the samples showed that the study area has been subjected to intense tectonic deformation and cement replacement. Also, different dissolution patterns were identified on the Grahamstown kaolinitic clay deposits. Hence incorporating analytical studies and data interpretations, possible ways such as the establishment of processing refinery near mining plants, which will, in turn, provide employment for the locals and land reclamation is suggested. In addition, possible future sustainable industrial applications of the clay minerals seem to be possible if additives, cellulosic wastes are used to alter the clay mineral.

Keywords: kaolinite, industrial use, sustainability, Grahamstown, clay minerals

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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

Procedia PDF Downloads 153