Search results for: delay discounting

Authors: Windy Rakhmawati, Suryani Suryani, Sri Hendrawati, Nenden Nur Asriyani Maryam

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Tuberculosis (TB) is one of the leading causes of death in the world. Fear of COVID-19 has made people reluctant to visit health facilities, leading to disruptions to childhood TB control programs, which may increase household transmission and delay diagnosis and treatment. This study aimed to describe parents' knowledge, attitudes, and health-seeking behaviour towards childhood TB during the COVID-19 pandemic. This cross-sectional study was performed on 392 parents with TB children in three provinces with the highest proportion of TB cases in Indonesia. This study was conducted from February to December 2022. The inclusion criteria of respondents were parents with a child aged 0-14 years old with TB diagnosis who live with their parents. Data were collected using the Knowledge, Attitude, and Practice (KAP) survey guidelines from the World Health Organization and analyzed descriptively, as well as Spearman’s correlation. Overall, 392 parents of children with TB had poor knowledge (51.8%) including about causes, risk factors, transmission, symptoms, treatment, and prevention, which about 52.3%, 55.1%, 61.2%, 69.6%, 100%, 59.2%, respectively. Parents' health service-seeking behaviour towards Child TB was not normally distributed (P < 0.05) with knowledge test results (.000) and Seeking Health Services (.000). Health-seeking behaviour of parents in pediatric TB care was self-medication or self-treatment (86.2%), Traditional health seeking behaviour (4.8%), and modern health seeking behaviour (8.9%). The correlation between knowledge and seeking health services (Sig= .609) means there is no correlation between knowledge about TB and parents' health-seeking behaviour. Furthermore, 60.2% of the respondents would be shocked if their child had TB. More than half of the families in this study have poor knowledge and did self-medication or self-treatment regarding health-seeking behaviour for TB disease. Therefore, health workers, especially nurses, must provide TB-related education and health promotion and emphasize the importance of early detection. Health workers can also optimize their role in caring for and providing care to patients by increasing their trust in health workers, which will impact health-seeking behaviour in the future.

Keywords: attitude, child, health seeking behaviour, knowledge, tuberculosis

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Authors: Hamide Azimi Lolaty, Fateme Alsadat Ghanipoor, Azar Ramzani, Reza Ali Mohammadpoor, Alireza Babaei

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Background and Objective: Despite the merits behind orthognathic surgery, self-care training in such patients seems logical. The current research was performed pursuing the goal of outlining the effect of training mindfulness-based self-care on Self-Esteem (SE) and Body Image Concern (BIC) of orthognathic surgery candidate patients. Material and Methods: The present study was performed using a semi-experimental method with pre-and post-design in the control and intervention groups. The eligible patients to enter the Babol-based Shahid Beheshti Orthognathic Surgery Clinic were conveniently divided into two 25-person groups. The variables of Self-Esteem and Body Image Concern were measured before and after executing the eight 90-minute training sessions and in the follow-up period done three months after executing the intervention using Cooper Smith’s Self-Esteem Inventory (CSEI) and Body Image Concern Inventory (BICI). The data were analyzed using ANOVA and the independent t-test and using SPSS-26, the data were analyzed at a 0.05 level. Results: As a result of the intervention, the intervention group’s SE score critically changed on average from 25.4±7.31 in the pre-intervention to 31.16±7.05 in the post-intervention and to 40.45±3.51 in the follow-up period (P=0.01), the intervention group’s BIC score changed on average from 60.28±16.47 in the pre-intervention to 47.15±80.47 in the post-intervention and to 32.20 ± 10.73 in the follow-up period. This difference was meaningful (P=0.001). But due to time and the intervention interaction, the control group underwent this significant reduction with a delay. The study revealed the scores of the SE as 32± 6.84 and that of the BIC as 43.32±10.64 in the control group didn’t result in any meaningful statistical difference (P<0.05). Conclusion: Training mindfulness-based self-care exerts an effect on the SE and BIC of the patients undergoing orthognathic surgery. Therefore, it’s recommended to train mindfulness-based self-care for orthognathic surgery candidate patients.

Keywords: self-care, mindfulness, self-esteem, body image concern, orthognathic surgery

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Authors: Carlos Riascos, Peter Thomson

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Real-time hybrid simulation (RTHS) is a modern cyber-physical technique used for the experimental evaluation of complex systems, that treats the system components with predictable behavior as a numerical substructure and the components that are difficult to model as an experimental substructure. Therefore it is an attractive method for evaluation of the response of civil structures under earthquake, wind and anthropic loads. Another practical application of RTHS is the evaluation of control systems, as these devices are often nonlinear and their characterization is an important step in the design of controllers with the desired performance. In this paper, the response of three-story shear frame controlled by a tuned liquid column damper (TLCD) and subject to base excitation is considered. Both passive and semi-active control strategies were implemented and are compared. While the passive TLCD achieved a reduction of 50% in the acceleration response of the main structure in comparison with the structure without control, the semi-active TLCD achieved a reduction of 70%, and was robust to variations in the dynamic properties of the main structure. In addition, a RTHS was implemented with the main structure modeled as a linear, time-invariant (LTI) system through a state space representation and the TLCD, with both control strategies, was evaluated on a shake table that reproduced the displacement of the virtual structure. Current assessment measures for RTHS were used to quantify the performance with parameters such as generalized amplitude, equivalent time delay between the target and measured displacement of the shake table, and energy error using the measured force, and prove that the RTHS described in this paper is an accurate method for the experimental evaluation of structural control systems.

Keywords: structural control, hybrid simulation, tuned liquid column damper, semi-active sontrol strategy

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Authors: Jayanti De

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Users of any urban road infrastructure may be classified into various categories. The current paper intends to see whether the opinions on different environmental and transportation criteria vary significantly among different types of road users or not. The paper addresses this issue by using a unique survey data that has been collected from Kolkata, a highly populated city in India. Multiple criteria should be taken into account while planning on infrastructure development programs. Given limited resources, a welfare maximizing government typically resorts to public opinion by designing surveys for prioritization of one project over another. Designing such surveys can be challenging and costly. Deciding upon whom to include in a survey and how to represent each group of consumers/road-users depend crucially on how opinion for different criteria vary across consumer groups. A unique dataset has been collected from various parts of Kolkata to statistically test (using Kolmogorov-Smirnov test) whether assigning of weights to rank the transportation criteria like congestion, air pollution, noise pollution, and morning/evening delay vary significantly across the various groups of users of such infrastructure. The different consumer/user groups in the dataset include pedestrian, private car owner, para-transit (taxi /auto rickshaw) user, public transport (bus) user and freight transporter among others. Very little evidence has been found that ranking of different criteria among these groups vary significantly. This also supports the hypothesis that road- users/consumers form their opinion by using their long-run rather than immediate experience. As a policy prescription, this implies that under-representation or over-representation of a specific consumer group in a survey may not necessarily distort the overall opinion, since opinions across different consumer groups are highly correlated as evident from this particular case study.

Keywords: multi criteria analysis, project-prioritization, road- users, survey designing

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Authors: Daniel F. Bohorquez, Luis M. Agudelo, Henry H. León

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Heart rate variability (HRV) is defined as the temporary variation between heartbeats or RR intervals (distance between R waves in an electrocardiographic signal). This distance is currently a recognized biomarker. With the analysis of the distance, it is possible to assess the sympathetic and parasympathetic nervous systems. These systems are responsible for the regulation of the cardiac muscle. The analysis allows health specialists and researchers to diagnose various pathologies based on this variation. For the acquisition and analysis of HRV taken from a cardiac electrical signal, electronic equipment and analysis software that work independently are currently used. This complicates and delays the process of interpretation and diagnosis. With this delay, the health condition of patients can be put at greater risk. This can lead to an untimely treatment. This document presents a single portable device capable of acquiring electrocardiographic signals and calculating a total of 19 HRV metrics. This reduces the time required, resulting in a timelier intervention. The device has an electrocardiographic signal acquisition card attached to a microcontroller capable of transmitting the cardiac signal wirelessly to a mobile device. In addition, a mobile application was designed to analyze the cardiac waveform. The device calculates the RR and different metrics. The application allows a user to visualize in real-time the cardiac signal and the 19 metrics. The information is exported to a cloud database for remote analysis. The study was performed under controlled conditions in the simulated hospital of the Universidad de la Sabana, Colombia. A total of 60 signals were acquired and analyzed. The device was compared against two reference systems. The results show a strong level of correlation (r > 0.95, p < 0.05) between the 19 metrics compared. Therefore, the use of the portable system evaluated in clinical scenarios controlled by medical specialists and researchers is recommended for the evaluation of the condition of the cardiac system.

Keywords: biological signal análisis, heart rate variability (HRV), HRV metrics, mobile app, portable device.

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Authors: Hsiao-Yung Wang

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This essay aims to examine how the transgender imagery has been constructed in the Taiwanese news media and its evolution from 1953 to 2016. It also explores the discourse patterns and rhetorical strategies in the transgender-related issues which contributed to levels of evaluation in forming ‘social deviance.’ Samples for analysis were selected from mainstream newspapers, including China Times, United Daily and Apple Daily. The time frame for sample selection is from August 1953 (when the first transgender case was reported in Taiwan) to June 2016. To enhance understanding of media representation as nominalistic-based, the author refers to the representative of critical rhetoric Raymie McKerrow for his study on remembrance and forgetfulness in public discourse (especially in his model of ‘critique of domination’); thereby categorizing the 64 years of transgender discourse into five periods: (1) transgender as ‘intersex’ of surgical-reparative medical treatment; (2) transgender as ‘freak gender-bender’ with criminal behaviors; (3) transgender as ‘ladyboy’ (‘katoey in a Thai term) of bar girls or sex workers; (4) transgender as ‘cross dresser’ of transvestite performance; and (5) transgender as ‘life-style or human right’ of spontaneous gender identification. Based on the research findings, this essay argues that the characterization of transgender reporting as a site for the production of compulsory sexism and gender stereotype by the specific forms of name-calling. Besides, the evolution of word-image addressing to transgender issues also pinpoints media as a reflection of fashion of the day. While the transgender imagery might be crystallized as ‘still social problems’ or ‘gender transgression’ in insidious rhetoric; and while the so-called ‘phobia’ persistently embodies in media discourse to exercise name-calling in an ambiguous (rather than in a bullying) way or under the cover of humanist-liberalist rationales, these emergent rhetorical dilemma should be resolved without any delay.

Keywords: critical rhetoric, media representation, McKerrow, nominalistic, social deviance, transgender

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Authors: Wisit Wichitkosoom

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Objective:The majority of the hisk-risk patients (ST-elevation myocardial infarction (STEMI), Acute cerebrovascular accident, Sepsis, Acute Traumatic patient ) are admitted to district or lacal hospitals (average 1-1.30 hr. from Udonthani general hospital, Northeastern province, Thailand) without proper facilities. The referral system was support to early care and early management at pre-hospital stage and prepare for the patient data to higher hospital. This study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to Udonthani General Hospital. Methods and results: Four district or local hospitals without proper facilities for treatment the very high-risk patient were serving the study region. Pre-hospital diagnoses were established with the simple technology such as LINE, SMS, telephone and Fax for concept of LEAN process and then the telemedicine, by ambulance monitoring (ECG, SpO2, BT, BP) in both real time and snapshot mode was administrated during the period of transfer for safety transfer concept (inter-hospital stage). The standard treatment for patients with STEMI, Intracranial injury and acute cerebrovascular accident were done. From 1 October 2012 to 30 September 2013, the 892 high-risk patients transported by ambulance and transferred to Udonthani general hospital were registered. Patients with STEMI diagnosed pre-hospitally and referred directly to the Udonthani general hospital with telemedicine closed monitor (n=248). The mortality rate decreased from 11.69% in 2011 to 6.92 in 2012. The 34 patients were arrested on the way and successful to CPR during transfer with the telemedicine consultation were 79.41%. Conclusion: The proper innovation could apply for health care system. The very high-risk patients must had the closed monitoring with two-way communication for the “safety transfer period”. It could modified to another high-risk group too.

Keywords: safety transfer, telemedicine, critical patients, medical and health sciences

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Authors: Ahmad AlAbdullah, Ali AlQallaf, Mahdi Hussain, Mohammed AlAttar, Salman Ashknani, Magdy Helal

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We study the effectiveness of the parking service provided at Kuwaiti commercial malls and explore potential problems and feasible improvements. Commercial malls are important to Kuwaitis as the entertainment and shopping centers due to the lack of other alternatives. The difficulty and relatively long times wasted in finding a parking spot at the mall are real annoyances. We applied queuing analysis to one of the major malls that offer paid-parking (1040 parking spots) in addition to free parking. Patrons of the mall usually complained of the traffic jams and delays at entering the paid parking (average delay to park exceeds 15 min for about 62% of the patrons, while average time spent in the mall is about 2.6 hours). However, the analysis showed acceptable service levels at the check-in gates of the parking garage. Detailed review of the vehicle movement at the gateways indicated that arriving and departing cars both had to share parts of the gateway to the garage, which caused the traffic jams and delays. A simple comparison we made indicated that the largest commercial mall in Kuwait does not suffer such parking issues, while other smaller, yet important malls do, including the one we studied. It was suggested that well-designed inlets and outlets of that gigantic mall permitted smooth parking despite being totally free and mall is the first choice for most people for entertainment and shopping. A simulation model is being developed for further analysis and verification. Simulation can overcome the mathematical difficulty in using non-Poisson queuing models. The simulation model is used to explore potential changes to the parking garage entrance layout. And with the inclusion of the drivers’ behavior inside the parking, effectiveness indicators can be derived to address the economic feasibility of extending the parking capacity and increasing service levels. Outcomes of the study are planned to be generalized as appropriate to other commercial malls in Kuwait

Keywords: commercial malls, parking service, queuing analysis, simulation modeling

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Authors: Mohammed Khalil Ur Rahman, Khanita Aammatullh

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Rasayana is one of the eight clinical specialities of classical Ayurveda The disease preventive and health promotive approach of ‘Ayurveda’, which takes into consideration the whole body, mind and spirit while dealing with the maintenance of health, promotion of health and treating ailments is holistic and finds increasing acceptability in many regions of the world. Ancient Ayurvedic physicians had developed certain dietary and therapeutic measures to arrest/delay ageing and rejuvenating whole functional dynamics of the body system. This revitalization and rejuvenation is known as the ‘Rasayan chikitsa’ (rejuvenation therapy). Traditionally, Rasayana drugs are used against a plethora of seemingly diverse disorders with no pathophysiological connections according to modern medicine. Though, this group of plants generally possesses strong antioxidant activity, only a few have been investigated in detail. Over about 100 disorders like rheumatoid arthritis, hemorrhagic shock, CVS disorders, cystic fibrosis, metabolic disorders, neurodegenerative diseases, gastrointestinal ulcerogenesis and AIDS have been reported as reactive oxygen species mediated. In this review, the role of free radicals in these diseases has been briefly reviewed. ‘Rasayana’ plants with potent antioxidant activity have been reviewed for their traditional uses, and mechanism of antioxidant action. Fifteen such plants have been dealt with in detail and some more plants with less work have also been reviewed briefly The Rasayanas are rejuvenators, nutritional supplements and possess strong antioxidant activity. They also have antagonistic actions on the oxidative stressors, which give rise to the formation of different free radicals. Ocimum sanctum, Tinospora cordifolia, Emblica officinalis, Convolvulus pluricaulis, Centella asiatica, Bacopa monniera, Withania somnifera, Triphala rasayana, Chyawanprash, Brahma rasayana are very important rasayanas which are described in ayurveda and proved by new researches.

Keywords: rasayana, antioxidant activity, Bacopa monniera, Withania somnifera Triphala, chyawanprash

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Authors: Marja A. Bernardo, Coreena A. Bueser, Cybele Lara R. Abad, Raul V. Destura

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Pneumocystis jirovecii pneumonia (PCP) is the most common opportunistic infection among people with HIV. Early consideration of PCP should be made even in patients whose HIV status is unknown as delay in treatment may be fatal. The use of absolute lymphocyte count (ALC) has been suggested as an alternative predictor of PCP especially in resource limited settings where PCR testing is costly or delayed. Objective: To determine whether the absolute lymphocyte count (ALC) can be used as a screening tool to predict Pneumocystis pneumonia in patients with unknown HIV status admitted at a private tertiary hospital. Methods: A retrospective cross-sectional study was conducted at a private tertiary medical center. Inpatient medical records of patients aged 18 years old and above from January 2012 to May 2014, in whom a clinical diagnosis of Pneumocystis jirovecii pneumonia was made were reviewed for inclusion. Demographic data, clinical features, hospital course, PCP PCR and HIV results were recorded. Independent t-test and chi-square analysis was used to determine any statistical difference between PCP-positive and PCP-negative groups. Mann-Whitney U-test was used for comparison of hospital stay. Results: There were no statistically significant differences in baseline characteristics between PCP positive and negative groups. While both the percent lymphocyte count (0.14 ± 0.13 vs 0.21 ± 0.16) and ALC (1160 ± 528.67 vs 1493.70 ± 988.61) were lower for the PCP-positive group, only the percent lymphocyte count reached a statistically significant difference (p= 0.067 vs p= 0.042). Conclusion: A quick determination of the ALC may be useful as an additional parameter to help screen for and diagnose pneumocystis pneumonia. In our study, the ALC of patients with PCP appear to be lower than in patients without PCP. A low ALC (e.g. below 1200) may help with the decision regarding empiric treatment. However, it should be used in conjunction with the patient’s clinical presentation, as well as other diagnostic tests. Larger, prospective studies incorporating the ALC with other clinical predictors are necessary to optimally predict those who would benefit from empiric or expedited management for potential PCP.

Keywords: Pneumocystis carinii pneumonia, Absolute Lymphocyte Count, infection, PCP

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Authors: Peifang Hsieh

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New Taipei city faces increasing number of migrant families, in which the needs of children are sometimes neglected due to insufficient support from communities. Moreover, the traditional mindset of disengagement discourages citizens from preemptively identifying families in need in their communities, resulting in delay of prompt intervention from authorities concerned. To safeguard these vulnerable families, New Taipei city develops the 'Integrated Safety-Net Program for High-Risk Families' from 2011 by implementing the following measures: (A) New attitude and action: Instead of passively receiving reported case of high-risk families, the program takes proactive and preemptive approach to detect and respond at early stage, so the cases are prevented from worsening. In addition, cross-departmental integration mechanism is established to meet multiple needs of high-risk families. The children number added to the government care network is greatly increased to over 10,000, which is around 4.4 times the original number before the program. (B) New service points: 2000 city-wide convenience stores are added as service stations so that children in less privileged families can go to any of 24-hour convenience stores across the city to pick up free meals. This greatly increases the approachability to high-risk families. Moreover, the social welfare institutes will be notified with information left in convenience stores by children and follow up with further assistance, greatly enhancing chances of less privileged families being identified. (C) New Key Figures: Mobilize community officers and volunteers to detect and offer on-site assistance. Volunteer organizations within communities are connected to report and offer follow-up services in a more active manner. In total, from 2011 to 2015, 54,789 cases are identified through active care, benefiting 82,124 children. In addition, 87.49% family-cases in the program receiving comprehensive social assistance are no longer at high risk.

Keywords: cross department, high-risk families, public-private partnership, integrated safety net

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Authors: Qianhui Li, Christoph H. Bruecker

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Atherosclerotic plaques are typically found where flow separation and variations of shear stress occur. Although helical flow patterns and flow separations have been recorded in the aorta, their relation has not been clearly clarified and especially in the condition of artificial heart valve prostheses. Therefore, an experimental study is performed to investigate the hemodynamic performance of different mechanical heart valves (MHVs), i.e. the SJM Regent bileaflet mechanical heart valve (BMHV) and the Lapeyre-Triflo FURTIVA trileaflet mechanical heart valve (TMHV), in a transparent model of the human aorta under a physiological pulsatile right-hand helical flow condition. A typical systolic flow profile is applied in the pulse-duplicator to generate a physiological pulsatile flow which thereafter flows past an axial turbine blade structure to imitate the right-hand helical flow induced in the left ventricle. High-speed particle image velocimetry (PIV) measurements are used to map the flow evolution. A circular open orifice nozzle inserted in the valve plane as the reference configuration initially replaces the valve under investigation to understand the hemodynamic effects of the entered helical flow structure on the flow evolution in the aortic arch. Flow field analysis of the open orifice nozzle configuration illuminates the helical flow effectively delays the flow separation at the inner radius wall of the aortic arch. The comparison of the flow evolution for different MHVs shows that the BMHV works like a flow straightener which re-configures the helical flow pattern into three parallel jets (two side-orifice jets and the central orifice jet) while the TMHV preserves the helical flow structure and therefore prevent the flow separation at the inner radius wall of the aortic arch. Therefore the TMHV is of better hemodynamic performance and reduces the pressure loss.

Keywords: flow separation, helical aortic flow, mechanical heart valve, particle image velocimetry

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Authors: Taghi-Zada T. G., Hajiyeva U. K.

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Recent years, due to the development of tourism, migration and globalization, brucellosis has spread to non-endemic regions of the country in Azerbaijan and this disease has become one of the main priority areas of medicine. In our daily practice, we face patients with specific symptoms of brucellosis and also infected with this disease but misdiagnosed. It should also be noted that the symptoms and signs of brucellosis are very diverse, and since none of these signs are specific enough to confirm the diagnosis, it creates difficulties in its timely detection and diagnosis. The main purpose of the work. Therefore, the main goal of the work is to investigate the cases of delay in making the correct diagnosis in children with brucellosis and the mistakes in this matter. Material and method. 50 children with brucellosis between the ages of 6 months and 17 years were examined. The medical history and anamnesis of these children were collected, clinical-instrumental examination, and serological tests for brucellosis were performed. Patients were divided into 2 groups, taking into account the specificity of symptoms and the timely diagnosis Results. Group I included 15 (40%) children aged 3-17 years. The main specific symptoms of brucellosis in these patients; persistent or long-term fever, night sweats, arthralgia were observed. In addition to specific symptoms, anamnesis and a specific serological test confirmed the diagnosis of brucellosis. 30 (60%) patients included in group II were misdiagnosed. 3 patients (up to 1 year) were diagnosed with sepsis, 6 with acute rheumatic fever, 10 with systemic diseases, 2 with tuberculosis, 5 with Covid 19, and 4 with unspecified fever. However, we included serological tests. detailed examination revealed the presence of brucellosis in them. As can be seen, compared to group I (40%) children included in group II (60%) In modern times, brucellosis manifests itself with its own characteristics, that is, imitating a number of other diseases, which has led to wrong diagnosis. Conclusion. Thus, the lack of specificity of clinical symptoms during brucellosis in children makes diagnosis difficult, causes mistakes and non-recognition of the disease. With this in mind, physicians in predominantly endemic and even sub-endemic areas should remain vigilant about this disease and consider brucellosis in the differential diagnosis of almost every unexplained medical problem until proven otherwise.

Keywords: brucellosis, pediatrics, diagnostics, serological tests

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Authors: Suleyman Kizil, Tahsin Sogut, Khalid M. Khawar

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Genus Allium includes 600 to 750 species and most of these including Allium tuncelianum (Kollman) N. Ozhatay, B. Mathew & Siraneci; Syn; A. macrochaetum Boiss. and Hausskn. subsp. tuncelianum Kollman] or Tunceli garlic is endemic to Eastern Turkish Province of Tunceli and Munzur mountains. They are edible, bear attractive white-to-purple flowers and fertile black seeds with deep seed dormancy. This study aimed to break seed dormancy of Tunceli garlic and determine the conditions for induction of bulblets on these seeds and increase their diameter by culturing them on MS medium supplemented different strengths of KNO3. Tunceli garlic seeds were collected from field grown plants. They were germinated on MS medium with or without 20 g/l sucrose followed by their culture on 1 × 1900 mg/l, 2 × 1900 mg/l, 4 ×1900 mg/l and 6 × 1900 mg/l mg/l KNO3 supplemented with 20 g/l sucrose to increase bulb diameter. Improved seeds germination was noted on MS medium with and without sucrose but with variation compared to previous reports. The bulb development percentage on each of the sprouted seeds was not parallel to the percentage of seed germination. The results showed 34% and 28.5% bulb induction was noted on germinated seeds after 150 and 158 days on MS medium containing 20 g l-1 sucrose and no sucrose respectively showing a delay of 8 days on the latter compared to the former. The results emphatically noted role of cold stratification on agar solidified MS medium supplemented with sucrose to improve seed germination. The best increase in bulb diameter was noted on MS medium containing 1 × 1900 mg/l KNO3 after 178 days with bulblet diameter and bulblet weight of 0.54 cm and 0.048 g, respectively. Consequently, the bulbs induced on sucrose containing MS medium could be transferred to pots earlier. Increased (>1 × 1900 mg/l KNO3) strengths of KNO3 induced negative effect on growth and development of Tunceli garlic bulbs. The strategy of seed germination and bulblet induction reported in this study could be positively used for conservation of this endemic plant species.

Keywords: Tunceli garlic, seed, dormancy, bulblets, bulb growth

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Authors: Babatunde Dosumu, Obuks Ejohwomu, Akilu Yunusa-Kaltungo

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Cost estimation in construction is often difficult, particularly when dealing with risks and uncertainties, which are inevitable and peculiar to developing countries like Nigeria. Direct consequences of these are major deviations in cost, duration, and quality. The fundamental aim of this study is to develop a framework for assessing the impacts of risk on cost estimation, which in turn causes variabilities between contract sum and final account. This is very important, as initial estimates given to clients should reflect the certain magnitude of consistency and accuracy, which the client builds other planning-related activities upon, and also enhance the capabilities of construction industry professionals by enabling better prediction of the final account from the contract sum. In achieving this, a systematic literature review was conducted with cost variability and construction projects as search string within three databases: Scopus, Web of science, and Ebsco (Business source premium), which are further analyzed and gap(s) in knowledge or research discovered. From the extensive review, it was found that factors causing deviation between final accounts and contract sum ranged between 1 and 45. Besides, it was discovered that a cost estimation framework similar to Building Cost Information Services (BCIS) is unavailable in Nigeria, which is a major reason why initial estimates are very often inconsistent, leading to project delay, abandonment, or determination at the expense of the huge sum of money invested. It was concluded that the development of a cost estimation framework that is adjudged an important tool in risk shedding rather than risk-sharing in project risk management would be a panacea to cost estimation problems, leading to cost variability in the Nigerian construction industry by the time this ongoing Ph.D. research is completed. It was recommended that practitioners in the construction industry should always take into account risk in order to facilitate the rapid development of the construction industry in Nigeria, which should give stakeholders a more in-depth understanding of the estimation effectiveness and efficiency to be adopted by stakeholders in both the private and public sectors.

Keywords: cost variability, construction projects, future studies, Nigeria

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Authors: Ali Al Orf, Khawaja Bilal Waheed

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Background and objective: Joubert syndrome (JS) is a rare, autosomal-recessive condition. Early recognition is important for management and counseling. Magnetic resonance imaging (MRI) can help in diagnosis. Therefore, we sought to evaluate clinical presentation and MRI findings in Joubert syndrome and related disorders. Method: A retrospective review of genetically proven cases of Joubert syndromes and related disorders was reviewed for their clinical presentation, demographic information, and magnetic resonance imaging findings in a period of the last 10 years. Two radiologists documented magnetic resonance imaging (MRI) findings. The presence of hypoplasia of the cerebellar vermis with hypoplasia of the superior cerebellar peduncle resembling the “Molar Tooth Sign” in the mid-brain was documented. Genetic testing results were collected to label genes linked to the diagnoses. Results: Out of 12 genetically proven JS cases, most were females (9/12), and nearly all presented with hypotonia, ataxia, developmental delay, intellectual impairment, and speech disorders. 5/12 children presented at age of 1 or below. The molar tooth sign was seen in 10/12 cases. Two cases were associated with other brain findings. Most of the cases were found associated with consanguineous marriage Conclusion and discussion: The molar tooth sign is a frequent and reliable sign of JS and related disorders. Genes related to defective cilia result in malfunctioning in the retina, renal tubule, and neural cell migration, thus producing heterogeneous syndrome complexes known as “ciliopathies.” Other ciliopathies like Senior-Loken syndrome, Bardet Biedl syndrome, and isolated nephronophthisis must be considered as the differential diagnosis of JS. The main imaging findings are the partial or complete absence of the cerebellar vermis, hypoplastic cerebellar peduncles (giving MTS), and (bat-wing appearance) fourth ventricular deformity. LimitationsSingle-center, small sample size, and retrospective nature of the study were a few of the study limitations.

Keywords: Joubart syndrome, magnetic resonance imaging, molar tooth sign, hypotonia

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Authors: Max Plotnikov, Arkadius Schier

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To counteract climate change, the European Commission adopted the European Green Deal (EDG) in 2019. Some of the main objectives of the EDG are climate neutrality by 2050, decarbonization, sustainable mobility, and the shift from a linear economy to a circular economy in the European Union. The mobility turnaround envisages, among other things, the switch from classic internal combustion vehicles to electromobility. The aforementioned goals are therefore accompanied by increased demand for lithium-ion batteries (LIBs) and the associated logistics. However, this inevitably gives rise to challenges that need to be addressed. Depending on whether the LIB is transported by road, rail, air, or sea, there are different regulatory frameworks in the European Union that relevant players in the value chain must adhere to. LIBs are classified as Dangerous Goods Class 9, and against this backdrop, there are various restrictions that need to be adhered to when transporting them for various actors. Currently, the exchange of information in the value chain between the various actors is almost entirely paper-based. Especially in the transport of dangerous goods, this often leads to a delay in the transport or to incorrect data. The exchange of information with the authorities is particularly essential in this context. A solution for the digital exchange of information is currently being developed. Electronic freight transport information (eFTI) enables fast and secure exchange of information between the players in the freight transport process. This concept is to be used within the supply chain from 2025. Another initiative that is expected to improve the monitoring of LIB in this context, among other things, is the battery pass. In July 2023, the latest battery regulation was adopted in the Official Journal of the European Union. This battery pass gives different actors static as well as dynamic information about the batteries depending on their access rights. This includes master data such as battery weight or battery category or information on the state of health or the number of negative events that the battery has experienced. The integration of the battery pass with the eFTI platform will be investigated for synergy effects in favor of the actors for battery transport.

Keywords: battery logistics, battery passport, data sharing, eFTI, sustainability

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Authors: O. Wright, N. Perkins, M. Donn, M. Halstead

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This research responded to anecdotal evidence that suggested inefficiencies within the Architect and Acoustician relationship may lead to ineffective acoustic design decisions.  The acoustician spoken to believed that he was approached too late in the design phase. The approached architect valued acoustical qualities, yet, struggled to interpret common measurement parameters. The preliminary investigation of these opinions indicated a gap in the current New Zealand Architectural discourse and currently informs the creation of a 2016 Master of Architecture (Prof) thesis research. Little meaningful information about acoustic intervention in the early design phase could be found from past literature. In the information that was sourced, authors focus on software as an incorporation tool without investigating why the flaws in the relationship originally exist. To further explore this relationship, a survey was designed. It underwent three phases to ensure its consistency, and was delivered to a group of 51 acousticians from one international Acoustics company. The results were then separated between New Zealand and off-shore to identify trends. The survey results suggest that 75% of acousticians meet the architect less than 5 times per project. Instead of regular contact, a mediated method is adopted though a mix of telecommunication and written reports. Acousticians tend to be introduced later into New Zealand building project than the corresponding off-shore building. This delay corresponds to an increase in remedial action for each of the building types in the survey except Auditoria and Office Buildings. 31 participants have had their specifications challenged by an architect. Furthermore, 71% of the acousticians believe that architects do not have the knowledge to understand why the acoustic specifications are in place. The issues raised in this investigation align to the colloquial evidence expressed by the two consultants. It identifies a larger gap in the industry were acoustics is remedially treated rather than identified as a possible design driver. Further research through design is suggested to understand the role of acoustics within architectural design and potential tools for its inclusion during, not after, the design process.

Keywords: architectural acoustics, early-design, interdisciplinary communication, remedial response

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Authors: Afshan Channa, Sameeha Aleem, Harim Mohsin

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First rank symptoms (FRS) are considered to be pathognomic for Schizophrenia. However, FRS is not a distinctive feature of Schizophrenia. It has also been noticed in affective disorder, albeit not inclusive in diagnostic criteria. The presence of FRS in Mania leads to misdiagnosis of psychotic illness, further complicating the management and delay of appropriate treatment. FRS in Mania is associated with poor clinical and functional outcome. Its existence in the first episode of bipolar disorder may be a predictor of poor short-term outcome and decompensating course of illness. FRS in Mania is studied in west. However, the cultural divergence and detriments make it pertinent to study the frequency of FRS in affective disorder independently in Pakistan. Objective: The frequency of first rank symptoms in manic patients, who were under treatment at psychiatric services of tertiary care hospital. Method: The cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. One hundred and twenty manic patients were recruited from November 2014 to May 2015. The patients who were unable to comprehend Urdu or had comorbid psychiatric or organic disorder were excluded. FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool. Result: The mean age of the patients was 37.62 + 12.51. The mean number of previous manic episode was 2.17 + 2.23. 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a p-value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness. 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity. 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception. Conclusion: The study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders. Being married had no protective effect on the presence of FRS.

Keywords: first rank symptoms, Mania, psychosis, present state examination

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Authors: P. S. Percin, O. Inanli, S. Karakaya

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Bitter melon (Momordica charantia) is a medicinal vegetable, which is used traditionally to remedy diabetes. Bitter melon contains several classes of primary and secondary metabolites. In traditional Turkish medicine bitter melon is used for wound healing and treatment of peptic ulcers. Nowadays, bitter melon is used for the treatment of diabetes and ulcerative colitis in many countries. The main constituents of bitter melon, which are responsible for the anti-diabetic effects, are triterpene, protein, steroid, alkaloid and phenolic compounds. In this study total phenolics, total carotenoids and β-carotene contents of mature and immature bitter melons were determined. In addition, in vitro α-amylase and α-glucosidase activities of mature and immature bitter melons were studied. Total phenolic contents of immature and mature bitter melon were 74 and 123 mg CE/g bitter melon respectively. Although total phenolics of mature bitter melon was higher than that of immature bitter melon, this difference was not found statistically significant (p > 0.05). Carotenoids, a diverse group of more than 600 naturally occurring red, orange and yellow pigments, play important roles in many physiological processes both in plants and humans. The total carotenoid content of mature bitter melon was 4.36 fold higher than the total carotenoid content of immature bitter melon. The compounds that have hypoglycaemic effect of bitter melon are steroidal saponins known as charantin, insulin-like peptides and alkaloids. α-Amylase is one of the main enzymes in human that is responsible for the breakdown of starch to more simple sugars. Therefore, the inhibitors of this enzyme can delay the carbohydrate digestion and reduce the rate of glucose absorption. The immature bitter melon extract showed α-amylase and α-glucosidase inhibitory activities in vitro. α-Amylase inhibitory activity was higher than that of α-glucosidase inhibitory activity when IC50 values were compared. In conclusion, the present results provide evidence that aqueous extract of bitter melon may have an inhibitory effect on carbohydrate breakdown enzymes.

Keywords: bitter melon, in vitro antidiabetic activity, total carotenoids, total phenols

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Authors: Soumaya Mrabet, Taieb Ach, Imen Akkari, Amira Atig, Neirouz Ghannouchi, Koussay Ach, Elhem Ben Jazia

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Introduction: Celiac disease (CD) is an immune-mediated small intestinal disorder that occurs in genetically susceptible people. It is significantly associated with other autoimmune disorders represented mainly by type 1 diabetes and autoimmune dysthyroidism. The aim of our study is to determine the prevalence and the type of the various autoimmune diseases associated with CD in adult patients. Material and methods: This is a retrospective study including patients diagnosed with CD, explored in Internal Medicine, Gastroenterology and Endocrinology and Diabetology Departments of the Farhat Hached University Hospital, between January 2005 and January 2016. The diagnosis of CD was confirmed by serological tests and duodenal biopsy. The screening of autoimmune diseases was based on physical examination, biological and serological tests. Results: Sixty five patients with a female predominance were included, 48women (73.8%) and 17 men (26.2%). The mean age was 31.8 years (17-75). A family history of CD or other autoimmune diseases was present in 5 and 10 patients respectively. Clinical presentation of CD was made by recurrent abdominal pain in 49 cases, diarrhea in 29 cases, bloating in 17 cases, constipation in 25 cases and vomiting in 8 cases. Autoimmune diseases associated with CD were found in 30 cases (46.1%): type 1 diabetes in 15 patients attested by the positivity of anti-GAD antibodies in 11 cases and anti-IA2 in 4 cases, Hashimoto thyroiditis in 8 cases confirmed by the positivity of anti-TPO antibodies, Addison's disease in 2 patients, Anemia of Biermer in 2 patients, autoimmune hepatitis, Systemic erythematosus lupus, Gougerot Sjögren syndrome, rheumatoid arthritis, Vitiligo and antiphospholipid syndrome in one patient each. CD was associated with more than one autoimmune disease defining multiple autoimmune syndrome in 2 female patients. The first patient had Basedow disease, Addison disease and type 1 diabetes. The second patient had systemic erythematosus lupus and Gougerot Sjögren syndrome. Conclusion: In our study autoimmune diseases were associated with CD in 46.1% of cases and were dominated by diabetes and dysthroidism. After establishing the diagnosis of CD the search of associated autoimmune diseases is necessary in order to avoid any therapeutic delay which can alter the prognosis of the patient.

Keywords: association, autoimmune thyroiditis, celiac disease, diabetes

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Authors: M. Kumpugdee-Vollrath, M. Tabatabaeifar, M. Helmis

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Shellac is a natural polyester resin secreted by insects. Pectins are natural, non-toxic and water-soluble polysaccharides extracted from the peels of citrus fruits or the leftovers of apples. Both polymers are allowed for the use in the pharmaceutical industry and as a food additive. SSB Aquagold® is the aqueous solution of shellac and can be used for a coating process as an enteric or controlled drug release polymer. In this study, tablets containing 10 mg methylene blue as a model drug were prepared with a rotary press. Those tablets were coated with mixtures of shellac and one of the pectin different types (i.e. CU 201, CU 501, CU 701 and CU 020) mostly in a 2:1 ratio or with pure shellac in a small scale fluidized bed apparatus. A stable, simple and reproducible three-stage coating process was successfully developed. The drug contents of the coated tablets were determined using UV-VIS spectrophotometer. The characterization of the surface and the film thickness were performed with the scanning electron microscopy (SEM) and the light microscopy. Release studies were performed in a dissolution apparatus with a basket. Most of the formulations were enteric coated. The dissolution profiles showed a delayed or sustained release with a lagtime of at least 4 h. Dissolution profiles of coated tablets with pure shellac had a very long lagtime ranging from 13 to 17.5 h and the slopes were quite high. The duration of the lagtime and the slope of the dissolution profiles could be adjusted by adding the proper type of pectin to the shellac formulation and by variation of the coating amount. In order to apply a coating formulation as a colon delivery system, the prepared film should be resistant against gastric fluid for at least 2 h and against intestinal fluid for 4-6 h. The required delay time was gained with most of the shellac-pectin polymer mixtures. The release profiles were fitted with the modified model of the Korsmeyer-Peppas equation and the Hixson-Crowell model. A correlation coefficient (R²) > 0.99 was obtained by Korsmeyer-Peppas equation.

Keywords: shellac, pectin, coating, fluidized bed, release, colon delivery system, kinetic, SEM, methylene blue

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Authors: Pablo Cid Galache, Laura Zamorano Bonilla

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Mauriac syndrome (MS) is a rare complication of type 1 diabetes mellitus (DM1). It is rela-ted to low insulin concentrations. Therefore is a complication mainly found in developing countries. The main clinical features are hepatomegaly, edema, growth and puberty delay, and the presence of elevated transaminases and serum lipids. The MS incidence is de-creasing due to the new types of insulin and intensive glycemic control. Therefore is a rare diagnosis in Europe nowadays, being described mainly in developing countries or with so-cioeconomic limitations to guarantee an adequate management of diabetes. Edema secondary to fluid retention is a rare complication of insulin treatment, especially in young patients. Its severity is variable and is mainly related to the start of a proper treatment and the improvement in glycemic control after diagnosis or after periods of poor metabolic control. Edema resolves spontaneously without requiring treatment in most cases. The Pediatric Endocrinology Unit of Hospital Motril could diagnose a 14-year-old girl who presented very poor metabolic control during the last 3 years as a consequence of the socioeconomic conditions of the country of origin during the last years. Presents up to 4 admissions for ketoacidosis during the last 12 months. After the family moved to Spain our patient began to be followed up in our Hospital. Initially presented glycated hemoglobin figures of 11%. One week after the start of treatment, the patient was admitted in the emergency room due to the appearance of generalized edema and pain in the limbs. The main laboratory abnormalities include: blood glucose 225mg/dl; HbA1C 10.8% triglycerides 543 mg/dl, total cholesterol 339 mg/dl (LDL 225) GOT 124 U/l, GPT 89U/l. Abdominal ultrasound shows mild hepatomegaly and no signs of ascites were shown. The patient presented a progressive improvement with resolution of the edema and analitical abnormalities during the next two weeks. During admission, the family received diabetes education, achieving adequate glycemic control at discharge. Nowadays the patient has a good glycemic control having glycated hemoglobin levels around 7%.

Keywords: Mauriac, diabetes, complication, developing countries

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Authors: Yunbin Deng

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Most existing applications of automatic speech recognition relies on cooperative subjects at a short distance to a microphone. Standoff speech recognition using microphone arrays can extend the subject to sensor distance somewhat, but it is still limited to only a few feet. As such, most deployed applications of standoff speech recognitions are limited to indoor use at short range. Moreover, these applications require air passway between the subject and the sensor to achieve reasonable signal to noise ratio. This study reports long range (50 feet) automatic speech recognition experiments using a Laser Doppler Vibrometer (LDV) sensor. This study shows that the LDV sensor modality can extend the speech acquisition standoff distance far beyond microphone arrays to hundreds of feet. In addition, LDV enables 'listening' through the windows for uncooperative subjects. This enables new capabilities in automatic audio and speech intelligence, surveillance, and reconnaissance (ISR) for law enforcement, homeland security and counter terrorism applications. The Polytec LDV model OFV-505 is used in this study. To investigate the impact of different vibrating materials, five parallel LDV speech corpora, each consisting of 630 speakers, are collected from the vibrations of a glass window, a metal plate, a plastic box, a wood slate, and a concrete wall. These are the common materials the application could encounter in a daily life. These data were compared with the microphone counterpart to manifest the impact of various materials on the spectrum of the LDV speech signal. State of the art deep neural network modeling approaches is used to conduct continuous speaker independent speech recognition on these LDV speech datasets. Preliminary phoneme recognition results using time-delay neural network, bi-directional long short term memory, and model fusion shows great promise of using LDV for long range speech recognition. To author’s best knowledge, this is the first time an LDV is reported for long distance speech recognition application.

Keywords: covert speech acquisition, distant speech recognition, DSR, laser Doppler vibrometer, LDV, speech intelligence surveillance and reconnaissance, ISR

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Authors: Elyce Cardonick, Shistri Dhar, Linsdey Seidman

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Background: When breast cancer is diagnosed during pregnancy, the prognosis is comparable to non-pregnant women matched for prognostic indicators when pregnant women receive treatment without delay. Chemotherapy, including taxanes, can be given during pregnancy with normal neonatal development in exposed fetuses. Methods: Cases of primary breast cancer were extracted from the Cancer and Pregnancy Registry and longitudinal study at Cooper Medical School, which collects cases of pregnant women diagnosed and treated for cancer into a single database. Obstetrical, oncology and pediatric records were reviewed, including annual neonatal developmental, behavioral and medical assessments. Results: 270 pregnant women were diagnosed with primary breast cancer at a mean gestational age of 14.7+9weeks. Mean maternal age at diagnosis 34.5+4.5 years. Receptor status is comparable to non-pregnant women of reproductive age. Forty-nine women were advised to terminate. Two hundred two women underwent surgery;244 women received chemotherapy in pregnancy after the first trimester; the majority of Doxorubucin/Cytoxan; 81 of the cases included a taxane. At a mean of 90 months, follow up obtained on 255 newborns.192/255 newborns are meeting developmental milestones. Respiratory illnesses, including asthma, and bronchiolitis, were reported in 64 newborns, the most common medical condition reported. Thirty-one children are undergoing treatment for GERD, 11 for urinary tract infections, and 7 are undergoing treatment for anemia. Twenty-six children with expressive or articulation language delays, 21/26 are mild. Eleven children with gross/ 7 with fine motor delays. Eight children are treated for ADHD, 4 for anxiety and 4 have social skill impairment. The majority of children with developmental, language or motor delays were born preterm. Conclusion: After chemotherapy exposure in utero for breast cancer, the majority of newborns are meeting developmental milestones and are medically healthy. The goal for treating pregnant women with breast cancer is to aim for delivery close to the term.

Keywords: breast cancer, pregnancy, chemotherapy, newborn

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Authors: Zemenu Yohannes

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Introduction: The pandemic overstretched the weak health systems in developing countries, including Ethiopia. This study aims to assess and explore the effect of COVID-19 on antenatal care (ANC) provision. Methods: A concurrent mixed methods study was applied. An interrupted time series design was applied for the quantitative study, and in-depth interviews were implemented for the qualitative research to explore maternity care providers' perceptions of ANC provision during COVID-19. We used routine monthly collected data from the health management information system (HMIS) in fifteen hospitals in the Sidama region, Ethiopia, from March 2019 to February 2020 (12 months) before COVID-19 and from March to August 2020 (6 months) during COVID-19. We imported data into STATA V.17 for analysis. ANC provision's mean monthly incidence rate ratio (IRR) was calculated using Poisson regression with a 95% confidence interval. The qualitative data were analysed using thematic analysis. Findings from quantitative and qualitative elements were integrated with a contiguous approach. Results: Our findings indicate the rate of ANC provision significantly decreased in the first six months of COVID-19. This study has three identified main themes: barriers to ANC provision, inadequate COVID-19 prevention approach, and delay in providing ANC. Conclusion and recommendation: Based on our findings, the pandemic affected ANC provision in the study area. The health bureau and stakeholders should take a novel and sustainable approach to prevent future pandemics. The health bureau and hospital administrators should establish a task force that relies on financial self-reliance to close gaps in future pandemics of medical supply shortages. Pregnant women should receive their care promptly from maternity care providers. In order to foster contact and avoid discrimination the future pandemics, hospital administrators should set up a platform for community members and maternity care providers.

Keywords: ANC provision, COVID-19, mixed methods study, Ethiopia

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Authors: Nyimas Annissa Mutiara Andini

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There are 325,000 children younger than age 15 in the U.S. have epilepsy. In Indonesia, 40% of 3,5 millions cases of epilepsy happens in children. The most common type of epilepsy, which affects 6 out of 10 people with the disorder, is called idiopathic epilepsy and which has no identifiable cause. One of the most commonly used medications in the treatment of this childhood epilepsy is sodium valproate. Administration of sodium valproat in children has a problem to fail. Nearly 60% of pediatric patients known were mildly, moderately, or severely non-adherent with therapy during the first six months of treatment. Many parents or caregiver took far less medication than prescribed, and the treatment-adherence pattern for the majority of patients was established during the first month of treatment. 42% of the patients were almost always given their medications as prescribed but 13% had very poor adherence even in the early weeks and months of treatment. About 7% of patients initially gave the medication correctly 90% of the time, but adherence dropped to around 20% within six months of starting treatment. Over the six months of observation, the total missing of administration is about four out of 14 doses in any given week. This fail can cause the epilepsy to relapse. Whereas, current reported epilepsy disorder were significantly more likely than those never diagnosed to experience depression (8% vs 2%), anxiety (17% vs 3%), attention-deficit/hyperactivity disorder (23% vs 6%), developmental delay (51% vs 3%), autism/autism spectrum disorder (16% vs 1%), and headaches (14% vs 5%) (all P< 0.05). They had a greater risk of limitation in the ability to do things (relative risk: 9.22; 95% CI: 7.56–11.24), repeating a school grade (relative risk: 2.59; CI: 1.52–4.40), and potentially having unmet medical and mental health needs. In the other side, technology can help to make our life easier. One of the technology, that we can use is a mobile application. A mobile app is a software program we can download and access directly using our phone. Indonesians are highly mobile centric. They use, on average, 6.7 applications over a 30 day period. This paper is aimed to describe an application that could help to control a sodium valproat administration in children; we call it as D-Epi app. D-Epi app is a downloadable application that can help parents or caregiver alert by a timer-related application to warn whether it is the time to administer the sodium valproat. It works not only as a standard alarm, but also inform important information about the drug and emergency stuffs to do to children with epilepsy. This application could help parents and caregiver to take care a child with epilepsy in Indonesia.

Keywords: application, children, D-Epi, epilepsy

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Authors: Benjamin Osei-Tutu, Henrietta Awewole Kolson

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Background: Acute gastroenteritis is one of the frequently reported Out-Patient Department (OPD) cases. However, the causative pathogens of these cases are rarely identified at the OPD due to delay in laboratory results or failure to obtain specimens before antibiotics is administered. Method: A retrospective review of surveillance data from the Adentan Municipality, Accra, Ghana that were recorded in the National foodborne disease surveillance system of Ghana, was conducted with the main aim of describing the epidemiology and food practice of cases reported from the Adentan Municipality. The study involved a retrospective review of surveillance data kept on patients who visited health facilities that are involved in foodborne disease surveillance in Ghana, from January 2015 to December 2016. Results: A total of 375 cases were reviewed and these were classified as viral hepatitis (hepatitis A and E), cholera (Vibrio cholerae), dysentery (Shigella sp.), typhoid fever (Salmonella sp.) or gastroenteritis. Cases recorded were all suspected case and the average cases recorded per week was 3. Typhoid fever and dysentery were the two main clinically diagnosed foodborne illnesses. The highest number of cases were observed during the late dry season (Feb to April), which marks the end of the dry season and the beginning of the rainy season. Relatively high number of cases was also observed during the late wet seasons (Jul to Oct) when the rainfall is the heaviest. Home-made food and street vended food were the major sources of suspected etiological food, recording 49.01% and 34.87% of the cases respectively. Conclusion: Majority of cases recorded were classified as gastroenteritis due to the absence of laboratory confirmation. Few cases were classified as typhoid fever and dysentery based on clinical symptoms presented. Patients reporting with foodborne diseases were found to consume home meal and street vended foods as their predominant source of food.

Keywords: accra, etiologic food, food poisoning, gastroenteritis, illness, surveillance

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Authors: Grace McCambridge, Alanna Keady, Madhur Agrawal, Dequina Nicholas Alvarado, Barbara Nikolajczyk, Leena Panneerseelan-Bharath

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Age is a non-modifiable risk factor for the inflammation that underlies pathologies such as type 2 diabetes mellitus (T2DM). Inflammation, as indicated by circulating cytokines, rises in aging, but mechanisms that promote this ‘inflammaging’ remain poorly defined. Furthermore, downstream consequences of inflammaging, including the development of an inflammatory profile that predicts comorbidities like T2DM, remain speculative. We tested the possibility that natural aging-associated changes in autophagy, a process that is compromised in both aging and T2DM, regulates inflammatory profiles in older subjects. Our data showed that circulating CD4⁺ T cells from older compared to younger subjects have (i) defects in autophagy; (ii) higher mitochondria accumulation; (iii) a failure to metabolically shift from oxidative phosphorylation to anaerobic glycolysis upon αCD3/CD28 activation; (iv) more reactive oxygen species (ROS) accumulation; and (v) a cytokine profile that recapitulates the Th17 profile that predicts T2DM. ROS scavenging in cells from older subjects restored mitochondrial mass and membrane potential (indicators of improved autophagy) and reduced Th17 cytokines to amounts made by T cells from younger subjects. Knock-down of the autophagy protein Atg3 in T cells from younger subjects increased mitochondrial accumulation and Th17 cytokines. To begin translating these findings to clinical practice, we showed that physiological concentrations of the diabetes drug metformin (100 µM) added in vitro enhanced autophagy, prevented mitochondria and ROS accumulation, increased anaerobic glycolysis, and decreased Th17 cytokines in activated CD4⁺ T cells from older subjects. Metformin therefore improves autophagy and multiple downstream pro-inflammatory mechanisms CD4⁺ T cells from older subjects. We conclude that autophagy improvement ameliorates the development of a T2DM-predictive Th17 profile in aging, and thus holds promise for delay or prevention of aging-associated metabolic decline.

Keywords: autophagy, mitochondrial turnover, ROS, glycolysis

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Authors: Umamaheswari Shanmugam, Silvia Ronchi

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Software, artificial intelligence, and machine learning can improve healthcare through innovative and advanced technologies that can use the large amount and variety of data generated during healthcare services every day; one of the significant advantages of these new technologies is the ability to get experience and knowledge from real-world use and to improve their performance continuously. Healthcare systems and institutions can significantly benefit because the use of advanced technologies improves the efficiency and efficacy of healthcare. Software-defined as a medical device, is stand-alone software that is intended to be used for patients for one or more of these specific medical intended uses: - diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of a disease, any other health conditions, replacing or modifying any part of a physiological or pathological process–manage the received information from in vitro specimens derived from the human samples (body) and without principal main action of its principal intended use by pharmacological, immunological or metabolic definition. Software qualified as medical devices must comply with the general safety and performance requirements applicable to medical devices. These requirements are necessary to ensure high performance and quality and protect patients' safety. The evolution and the continuous improvement of software used in healthcare must consider the increase in regulatory requirements, which are becoming more complex in each market. The gap between these advanced technologies and the new regulations is the biggest challenge for medical device manufacturers. Regulatory requirements can be considered a market barrier, as they can delay or obstacle the device's approval. Still, they are necessary to ensure performance, quality, and safety. At the same time, they can be a business opportunity if the manufacturer can define the appropriate regulatory strategy in advance. The abstract will provide an overview of the current regulatory framework, the evolution of the international requirements, and the standards applicable to medical device software in the potential market all over the world.

Keywords: artificial intelligence, machine learning, SaMD, regulatory, clinical evaluation, classification, international requirements, MDR, 510k, PMA, IMDRF, cyber security, health care systems

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