Search results for: rural medicine

Authors: Panpan Feng

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The concept of green infrastructure originated in Europe and the United States. It aims to ensure smart growth of urban and rural ecosystems and achieve sustainable urban and rural ecological, social, and economic development by combining it with gray infrastructure in traditional planning. Based on the literature review of the theoretical origin, value connotation, and measurement methods of green infrastructure, this study summarizes the research content of green infrastructure at different scales from the three spatial levels of region, city, and block and divides it into functional dimensions, spatial dimension, and strategic dimension. The results show that in the functional dimension, from region-city-block, the research on green infrastructure gradually shifts from ecological function to social function. In the spatial dimension, from region-city-block, the research on the spatial form of green infrastructure has shifted from two-dimensional to three-dimensional, and the spatial structure of green infrastructure has shifted from single ecological elements to multiple composite elements. From a strategic perspective, green infrastructure research is more of a spatial planning tool based on land management, environmental livability and ecological psychology, providing certain decision-making support.

Keywords: green infrastructure, multi-scale, social and ecological functions, spatial strategic decision-making tools

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Authors: Christopher Coley, Srividya Sheshadri, Rao R. Bhavani

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Empowering marginalized populations, especially women, with greater economic, social, and other leadership roles has been shown to have a profound effect on entire communities. There are discernible links between sustainable development, poverty reduction, and skill training for empowerment; however, one of the major challenges with implementing empowerment programs is to establish an understanding within the community that investing in women’s education carries the potential of high return for everyone. Effective strategies that can both empower women, and overcome the complex social issues normally faced, need to be developed and shared across stakeholders. Amrita University’s AMMACHI Labs, a research lab engaged in women empowerment through Technical Vocational Education and Training (TVET), has launched a new initiative, WE: Sanitation, a project aiming to train women to build their own toilets and promote healthy sanitation practices in rural villages across India. While in some cases, the community has come together and toilets are being built, there has been resistance by the community, especially men, in many places. This paper will explore the experiences of field workers and the initial results of the WE: Sanitation project, including observations on the trends of community dynamics, raise important questions for the direction of development work in general, and especially for sanitation projects in rural India.

Keywords: community-based development, gender dynamics, Indian sanitation, women empowerment, TVET

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Authors: Yeliz Sarı Nayim, B. Niyami Nayim

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Biotopes such as forest areas rich in biodiversity, wetlands, hedgerows and woodlands play important ecological roles in agricultural landscapes. Of these semi-natural areas and features, hedgerows are the most common landscape elements. Their most significant features are that they serve as a barrier between the agricultural lands, serve as shelter, add aesthetical value to the landscape and contribute significantly to the wildlife and biodiversity. Hedgerows surrounding agricultural landscapes also provide an important habitat for pollinators which are important for agricultural production. This study looks into the identification of hedgerows in agricultural lands in the Mugada rural area within Bartın province, Turkey. From field data and-and satellite images, it is clear that in this area, especially around rural settlements, large forest areas have been cleared for settlement and agriculture. A network of hedgerows is also apparent, which might potentially play an important role in the otherwise open agricultural landscape. We found that these hedgerows serve as an ecological and biological corridor, linking forest ecosystems. Forest patches of different sizes and creating a habitat network across the landscape. Some examples of this will be presented. The overall conclusion from the study is that ecologically, biologically and aesthetically important hedge biotopes should be maintained in the long term in agricultural landscapes such as this. Some suggestions are given for how they could be managed sustainably into the future.

Keywords: agricultural biotopes, Hedgerows, landscape ecology, Turkey

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Authors: Vijay Kumar Kutala, Addepalli Pavani, M. Amresh Rao, Naushad Sm

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In this study, we evaluated the impact of CYP2C9*2 and CYP2C9*3 variants on binding and hydroxylation of warfarin. In silico data revealed that warfarin forms two hydrogen bonds with protein backbone i.e. I205 and S209, one hydrogen bond with protein side chain i.e. T301 and stacking interaction with F100 in CYP2C9*1. In CYP2C9*2 and CYP2C9*3 variants, two hydrogen bonds with protein backbone are disrupted. In double variant, all the hydrogen bonds are disrupted. The distances between C7 of S-warfarin and Fe-O in CYP2C9*1, CYP2C9*2, CYP2C9*3 and CYP2C9*2/*3 were 5.81A°, 7.02A°, 7.43° and 10.07°, respectively. The glide scores (Kcal/mol) were -7.698, -7.380, -6.821 and -6.986, respectively. Increase in warfarin/7-hydroxy warfarin ratio was observed with increase in variant alleles. To conclude, CYP2C9*2 and CYP2C9*3 variants result in disruption of hydrogen bonding interactions with warfarin and longer distance between C7 and Fe-O thus impairing warfarin 7-hydroxylation due to lower binding affinity of warfarin.

Keywords: warfarin, CYP2C9 polymorphism, personalized medicine, in Silico

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Authors: V. Krishna, Shashikumar

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Edible Bananas (Musa spp.) are the major staple food for rural and urban consumers in India and an important source of rural income. The cultivar Musa paradisiaca cv. Karibale Monthan is an endemic cultivar of Malnad region of Karnataka and used as a glomolueroprotective neutraceutical to solve kidney problems. The protocol for mass multiplication of plantlets for this indigenous banana cultivar Karibale Monthan has not yet been standardized so far. In the present study, an attempt has been made to develop high frequency in vitro regeneration protocol and evaluation of morphoagronomic characteristics in the farmyard. The high frequency shoot initiation (93.33 %) was recorded at the synergetic effect of BAP (2 to 8mg/L), TDZ (0.1 to 1.2mg/L) and coconut water (0.1 to 1.2ml/L). It was optimized at the concentration 5 mg/l BAP, 0.5 mg/l TDZ and 0.5 ml/l coconut water with 15.90 ± 1.66 frequency of shoots per propagule. Supplementation of 1.0 mg/l IBA induces 5.33 ± 1.21 numbers of roots with a mean root length of 7.50 ± 1.87 roots. 99% of plantlets with distinct roots and shoots were successfully acclimatized in the green house and transferred to the field to evaluate the agro-morphological variations. The micropropagated plants showed significantly higher morphometric values for height of the plant (16.80±2.17), number of leaves (12.40±1.14), length of the bunch (56.20±2.17), weight of the bunch (13.60±1.14), number of hands in a bunch (11.40±1.14) and girth of the pseudostem (49.80±1.48) when compared with in vivo plants.

Keywords: banana cv. Karibale Monthan, neutraceutical, high-frequency regeneration, morphometric evaluation

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Authors: E. O. Aluta, C. A. Booth, D. G. Proverbs, T. Appleby

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Challenges in the effective management of potable water have attracted global attention in recent years and remain many world regions’ major priorities. Scarcity and unavailability of potable water may potentially escalate poverty, obviate democratic expression of views and militate against inter-sectoral development. These challenges contra-indicate the inherent potentials of the resource. Thus, while creation of poverty may be regarded as a broad-based problem, it is capable of reflecting life-span reduction diseases, the friction of interests manifesting in threats and warfare, the relegation of democratic principles for authoritarian definitions and Human Rights abuse. The challenges may be identified as manifestations of ineffective management of potable water resource and therefore, regarded as major problems in environmental protection. In reaction, some nations have re-examined their laws and policies, while others have developed innovative projects, which seek to ameliorate difficulties of providing sustainable potable water. The problems resonate in Nigeria, where the legal framework supporting the supply and management of potable water has been criticized as ineffective. This has impacted more on rural community members, often regarded as ‘voiceless’. At that level, the participation of non-state actors has been identified as an effective strategy, which can improve water supply. However, there are indications that there is no pragmatic application of this, resulting in over-centralization and top-down management. Thus, this study focuses on how the participatory process may enable the development of participatory water governance framework, for use in Nigeria rural communities. The Rural Advisory Board (RAB) is proposed as a governing body to promote proximal relationships, institute democratisation borne out of participation, while enabling effective accountability and information. The RAB establishes mechanisms for effectiveness, taking into consideration Transparency, Accountability and Participation (TAP), advocated as guiding principles of decision-makers. Other tools, which may be explored in achieving these are, Laws and Policies supporting the water sector, under the direction of the Ministries and Law Courts, which ensure non-violation of laws. Community norms and values, consisting of Nigerian traditional belief system, perceptions, attitude and reality (often undermined in favour of legislations), are relied on to pave the way for enforcement. While the Task Forces consist of community members with specific designation of duties, which ensure compliance and enforceability, a cross-section of community members are assigned duties. Thus, the principle of participation is pragmatically reflected. A review of the literature provided information on the potentials of the participatory process, in potable water governance. Qualitative methodology was explored by using the semi-structured interview as strategy for inquiry. The purposive sampling strategy, consisting of homogeneous, heterogeneous and criterion techniques was applied to enable sampling. The samples, sourced from diverse positions of life, were from the study area of Delta State of Nigeria, involving three local governments of Oshimili South, Uvwie and Warri South. From the findings, there are indications that the application of the participatory process is inhered with empowerment of the rural community members to make legitimate demands for TAP. This includes the obviation of mono-decision making for the supply and management of potable water. This is capable of restructuring the top-down management to a top-down/bottom-up system.

Keywords: participation, participatory process, participatory water governance, rural advisory board

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Authors: Ifeoma C. Afiaenyi, Elizabeth K. Ngwu, Rufina N. B. Ayogu

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Diabetes has crept into the rural areas of Nigeria, causing devastating effects on its sufferers; most of them could not afford diabetic medications. Moringa oleifera has been used extensively in animal models to demonstrate its antilipidaemic and haematinic qualities; however, there is a scarcity of data on the effect of graded levels of Moringa oleifera leaves on the lipid profile and hematological parameters in human diabetic subjects. The study determined the effect of Moringa oleifera leaves on the lipid profile and hematological parameters of type 2 diabetic subjects in Ukehe, a rural Nigerian community. Twenty-four adult male and female diabetic subjects were purposively selected for the study. These subjects were shared into four groups of six subjects each. The diets used in the study were isocaloric. A control group (diabetics, group 1) was fed diets without Moringa oleifera leaves. Experimental groups 2, 3 and 4 received 20g, 40g and 60g of Moringa oleifera leaves daily, respectively, in addition to the diets. The subjects' lipid profile and hematological parameters were measured prior to the feeding trial and at the end of the feeding trial. The feeding trial lasted for fourteen days. The data obtained were analyzed using the computer program Statistical Product for Service Solution (SPSS) for windows version 21. A Paired-samples t-test was used to compare the means of values collected before and after the feeding trial within the groups and significance was accepted at p < 0.05. There was a non-significant (p > 0.05) decrease in the mean total cholesterol of the subjects in groups 1, 2 and 3 after the feeding trial. There was a non-significant (p > 0.05) decrease in the mean triglyceride levels of the subjects in group 1 after the feeding trial. Groups 1 and 3 subjects had a non-significant (p > 0.05) decrease in their mean low-density lipoprotein (LDL) cholesterol after the feeding trial. Groups 1, 2 and 4 had a significant (p < 0.05) increase in their mean high-density lipoprotein (HDL) cholesterol after the feeding trial. A significant (p < 0.05) decrease in the mean hemoglobin level was observed only in group 4 subjects. Similarly, there was a significant (p < 0.05) decrease in the mean packed cell volume of group 4 subjects. It was only in group 4 that a significant (p < 0.05) decrease in the mean white blood cells of the subjects was also observed. The changes observed in the parameters assessed were not dose-dependent. Therefore, a similar study of longer duration and more samples is imperative to authenticate these results.

Keywords: anemia, diabetic subjects, lipid profile, moringa oleifera

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Authors: Nusrat Ali, Muhammad Saleem Khan

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Education is the process of bringing individuals aware of their own reality in a manner that leads them to the effective adjustment with the environment. Females’ participation is vital to reducing hunger and poverty and promoting the family welfare. Education is the right of men and women both. Female education is more needed rural areas as compared to urban areas. Without educating the women of the country we cannot think of developing our nation. It is a fact that women are the first teachers of their children. Hence, if mothers are well educated, they can play an important role in shaping and molding of their sons and daughters. The main purpose of study was to identify the barriers of female education and the attitude among the parents. The present study researchers selected a quantitative study to explore the highlighting problem in the particular areas. Through the stratified random sampling selected a sample size from each stratum and generalized whole population. Chi-square test was used to test the validity of the data. The conclusion shows attitudes of parents somehow influence their daughters’ education, particularly those who are living in countryside. Another a big challenge of female education is co-education system in our society is higher which directly subjected to parents unfavorable attitude towards their daughters’ education. In this modern era various organizations are working for female education in rural areas where females are considered as house working ladies, now it’s time to work more to change parent’s attitude towards their daughter’s education.

Keywords: parental attitude, professional education, daughter, unfavorable attitude

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Authors: Sofiya An, Akbota Kanderzhanova, Assel Akhmetova, Faye Foster, Chee K. Chan

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Healthcare, education and social support for children with autism in Kazakhstan has been evolving and transforming over the last three decades. There is still limited knowledge of the use of complementary and alternative medicine by families caring for autistic children in this post-Soviet region. An exploratory qualitative focus group study of Kazakhstani families was carried out to capture and understand their experiences of using complementary and alternative (CAM) medicine. A total of six focus groups were conducted in five cities across the country including Nur-Sultan, Almaty, Kyzylorda, Karaganda and Taraz. The perceived factors driving the availability, choice, and use of complementary and alternative medicine by families of autistic children in the country were distilled and evaluated. The data collected was analyzed using a framework analysis and themes and subthemes were developed. Two major themes stood out. The first was the “unmet needs”, which relates to the predisposing factors that motivate parents to CAM uptake, and the second was the “chasing hope”, which relates to the enabling factors that facilitate parents’ uptake of CAM. Fear of missing out (FOMO) is a latent underlying motivation underscoring these two themes as well. Parents of autism spectrum disorder (ASD) children in Kazakhstan have to deal with many challenges when seeking treatment for their children with ASD. They are prepared and resort to try out whatever CAM interventions available. The motivation and rationale of choice of use is driven by the lack of options and the hope of any potential positive outcome rather than from rational decisions based on efficacy or the evidence-based data of CAM. Parents get desperate and are willing to try CAM regardless of and independent of their cultural and belief systems and they do not want to miss out just in case it might work. This study also gives an international and cross-cultural perspective on the motives, choice and practice of parents with ASD children using CAM in Kazakhstan, a Central Asian country.

Keywords: autism spectrum disorder, Central Asia, complementary and alternative medicine, cross-cultural perspective, qualitative research

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Authors: J. Niyitegeka, G. Nshimirimana, A. Silverstein, J. Odhiambo, Y. Lin, T. Nkurunziza, R. Riviello, S. Rulisa, P. Banguti, H. Magge, M. Macharia, J. P. Dushime, R. Habimana, B. Hedt-Gauthier

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In low-resource settings, women needing an emergency cesarean section experiences various delays in both reaching and receiving care that is often linked to poor neonatal outcomes. In this study, we quantified different measures of delays and assessed the association between these delays and neonatal outcomes at three rural district hospitals in Rwanda. This retrospective study included 441 neonates and their mothers who underwent emergency cesarean sections in 2015 at Butaro, Kirehe and Rwinkwavu District Hospitals. Four possible delays were measured: Time from start of labor to district hospital admission, travel time from a health center to the district hospital, time from admission to surgical incision, and time from the decision for the emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR < 7 or death) and favorable (APGAR ≥ 7). We assessed the relationship between each type of delay and neonatal outcomes using multivariate logistic regression. In our study, 38.7% (108 out of 279) of neonates’ mothers labored for 12 to 24 hours before hospital admission and 44.7% (159 of 356) of mothers were transferred from health centers that required 30 to 60 minutes of travel time to reach the district hospital. 48.1% (178 of 370) of caesarean sections started within five hours after admission and 85.2% (288 of 338) started more than thirty minutes after the decision for the emergency cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 minutes of travel time from the health center to the district hospital compared to health centers attached to the hospital (OR = 5.12, p = 0.02). Neonatal outcomes were also significantly different depending on decision to incision intervals; neonates with cesarean deliveries starting more than thirty minutes after decision had better outcomes than those started immediately (OR = 0.32, p = 0.04). Interventions that decrease barriers to access to maternal health care services can improve neonatal outcome after emergency cesarean section. Triaging could explain the inverse relationship between time from decision to incision and neonatal outcome; this must be studied more in the future.

Keywords: Africa, emergency obstetric care, rural health delivery, maternal and child health

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Authors: Yu-Hsin Tsai

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A new, mandated county regional plan system has been initiated since 2010 nationwide in Taiwan, with its role situated in-between the policy-led cross-county regional plan and the blueprint-led city plan. This new regional plan contain both urban and rural areas in one single plan, which provides a more complete planning territory, i.e., city region within the county’s jurisdiction, and to be executed and managed effectively by the county government. However, the full picture of its functions and characteristics seems still not totally clear, compared with other levels of plans; either are planning goals and issues that can be most appropriately dealt with at this spatial scale. In addition, the extent to which the inclusion of sustainability ideal and measures to cope with climate change are unclear. Based on the above issues, this study aims to clarify the roles of county regional plan, to analyze the extent to which the measures cope with sustainability, climate change, and forecasted declining population, and the success factors and issues faced in the planning process. The methodology applied includes literature review, plan quality evaluation, and interview with officials of the central and local governments and urban planners involved for all the 23 counties in Taiwan. The preliminary research results show, first, growth management related policies have been widely implemented and expected to have effective impact, including incorporating resources capacity to determine maximum population for the city region as a whole, developing overall vision of urban growth boundary for all the whole city region, prioritizing infill development, and use of architectural land within urbanized area over rural area to cope with urban growth. Secondly, planning-oriented zoning is adopted in urban areas, while demand-oriented planning permission is applied in the rural areas with designated plans. Then, public participation has been evolved to the next level to oversee all of government’s planning and review processes due to the decreasing trust in the government, and development of public forum on the internet etc. Next, fertile agricultural land is preserved to maintain food self-supplied goal for national security concern. More adoption-based methods than mitigation-based methods have been applied to cope with global climate change. Finally, better land use and transportation planning in terms of avoiding developing rail transit stations and corridor in rural area is promoted. Even though many promising, prompt measures have been adopted, however, challenges exist to surround: first, overall urban density, likely affecting success of UGB, or use of rural agricultural land, has not been incorporated, possibly due to implementation difficulties. Second, land-use related measures to mitigating climate change seem less clear and hence less employed. Smart decline has not drawn enough attention to cope with predicted population decrease in the next decade. Then, some reluctance from county’s government to implement county regional plan can be observed vaguely possibly since limits have be set on further development on agricultural land and sensitive areas. Finally, resolving issue on existing illegal factories on agricultural land remains the most challenging dilemma.

Keywords: city region plan, sustainability, global climate change, growth management

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Authors: Sandeep Reddy, Sonia Allan, Simon Coghlan, Paul Cooper

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Artificial Intelligence (AI) and its application in medicine has generated ample interest amongst policymakers and clinicians. Successes with AI in medical imaging interpretation and clinical decision support are paving the way for its incorporation into routine healthcare delivery. While there has been a focus on the development of ethical principles to guide its application in healthcare, challenges of this application go beyond what ethics principles can address thus requiring robust governance frameworks. Also, while ethical challenges of medical artificial intelligence are being discussed, the ethics of deploying AI in lower-income countries receive less attention than in other developed economies. This creates an imperative not only for sound ethical guidelines but also for robust governance frameworks to regulate AI in medicine around the world. In this article, we discuss what components need to be considered in developing these governance frameworks and who should lead this worldwide effort.

Keywords: artificial intelligence, global health, governance, ethics

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Authors: Elena Cangelosi, Wayne Beyea

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This research expands the resilience planning literature by exploring the barriers and enablers to climate and health adaptation planning for small urban, coastal Great Lakes communities. With funding from the United States Centers for Disease Control and Prevention (CDC) Climate Ready City and States Initiative, this research took place during a 3-year pilot intervention project which integrates urban planning and public health. The project used the CDC’s Building Resilience Against Climate Effects (BRACE) framework to prevent or reduce the human health impacts from climate change in Marquette County, Michigan. Using a deliberation with the analysis planning process, interviews, focus groups, and community meetings with over 25 stakeholder groups and over 100 participants identified the area’s climate-related health concerns and adaptation interventions to address those concerns. Marquette County, on the shores of Lake Superior, the largest of the Great Lakes, was selected for the project based on their existing adaptive capacity and proactive approach to climate adaptation planning. With Marquette County as the context, this study fills a gap in the adaptation literature, which currently heavily emphasizes large-urban or agriculturally-based rural areas, and largely neglects small urban areas. This research builds on the qualitative case-study, survey, and interview approach established by previous researchers on contextual barriers and enablers for adaptation planning. This research uses a case study approach, including surveys and interviews of public officials, to identify the barriers and enablers for climate and health adaptation planning for small-urban areas within a large, non-agricultural, Great Lakes county. The researchers hypothesize that the barriers and enablers will, in some cases, overlap those found in other contexts, but in many cases, will be unique to a rural setting. The study reveals that funding, staff capacity, and communication across a large, rural geography act as the main barriers, while strong networks and collaboration, interested leaders, and community interest through a strong human-land connection act as the primary enablers. Challenges unique to rural areas are revealed, including weak opportunities for grant funding, large geographical distances, communication challenges with an aging and remote population, and the out-migration of education residents. Enablers that may be unique to rural contexts include strong collaborative relationships across jurisdictions for regional work and strong connections between residents and the land. As the factors that enable and prevent climate change planning are highly contextual, understanding, and appropriately addressing the unique factors at play for small-urban communities is key for effective planning in those areas. By identifying and addressing the barriers and enablers to climate and health adaptation planning for small-urban, coastal areas, this study can help Great Lakes communities appropriately build resilience to the adverse impacts of climate change. In addition, this research expands the breadth of research and understanding of the challenges and opportunities planners confront in the face of climate change.

Keywords: climate adaptation and resilience, climate change adaptation, climate change and urban resilience, governance and urban resilience

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Authors: Pedro Ferraz-Gameiro

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Introduction: The Pellegrini-Stieda lesion is the result of post-traumatic calcification and/or ossification on the medial collateral ligament (MCL) of the knee. When this calcification is accompanied by gonalgia and limitation of knee flexion, it is called Pellegrini-Stieda syndrome. The pathogenesis is probably the calcification of a post-traumatic hematoma at least three weeks after the initial trauma or secondary to repetitive microtrauma. On anteroposterior radiographs, a Pellegrini-Stieda lesion is a linear vertical ossification or calcification of the proximal portion of the MCL and usually near the medial femoral condyle. Patients with Pellegrini-Stieda syndrome present knee pain associated with loss of range of motion. The treatment is usually conservative with analgesic and anti-inflammatory drugs, either systemic or intra-articular. Physical medicine and rehabilitation techniques associated with shock wave therapy can be a way of reduction of pain/inflammation. Patients who maintain instability with significant limitation of knee mobility may require surgical excision. Methods: Research was done using PubMed central using the terms Pellegrini-Stieda syndrome. Discussion/conclusion: Medical treatment is the rule, with initial rest, anti-inflammatory, and physiotherapy. If left untreated, this ossification can potentially form a significant bone mass, which can compromise the range of motion of the knee. Physical medicine and rehabilitation techniques associated with shock wave therapy are a way of reduction of pain/inflammation.

Keywords: knee, Pellegrini-Stieda syndrome, rehabilitation, shock waves therapy

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Authors: Sarayu Agarwal

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This paper aims to teach English (secondary language) by bridging the understanding between the Regional language (primary language) and the English Language (secondary language). Here primary language is the one a person has learned from birth or within the critical period, while secondary language would be any other language one learns or speaks. The paper also focuses on evolving old teaching methods to a contemporary participatory model of learning and teaching. Pilot studies were conducted to gauge an understanding of student’s knowledge of the English language. Teachers and students were interviewed and their academic curriculum was assessed as a part of the initial study. Extensive literature study and design thinking principles were used to devise a solution to the problem. The objective is met using a holistic learning kit/card game to teach children word recognition, word pronunciation, word spelling and writing words. Implication of the paper is a noticeable improvement in the understanding and grasping of English language. With increasing usage and applicability of English as a second language (ESL) world over, the paper becomes relevant due to its easy replicability to any other primary or secondary language. Future scope of this paper would be transforming the idea of participatory learning into self-regulated learning methods. With the upcoming govt. learning centres in rural areas and provision of smart devices such as tablets, the development of the card games into digital applications seems very feasible.

Keywords: English as a second language, vocabulary-building card games, learning through gamification, rural education

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Authors: Ayesha Murtza

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Controlling images develop misinformed behaviors about impoverished Muslim Pakistani women that add to the oppression these Pakistani women endure their whole lives. Meanwhile, patriarchal and stereotypical societies provide an ideological justification for gender, class, and racial oppression, especially for women. Cojoining the concepts of controlling images by Patricia Hill Collins (1990) and binary thinking by Barbara Christian (1987), this paper discusses the ways in which various controlling images of urban and rural women are being presented in Pakistani dramas. These images reinforce an interlocking system of oppression for women in Pakistan. This paper further explores how these controlling images of intersecting components like class, gender, religion, ethnicity, physical appearance, color, and caste normalize hegemonic gendered oppression in society and how men have the same attitude towards women of their family whether they belong to the rural or urban class since they are the product of the same society. It further sheds light on how these matrixes of domination are an inevitable part of Pakistani women’s everyday lives and how these women reinforce survival strategies for coping with all these forms of oppression. By employing the feminist interactional framework, this paper elucidates the role of masculinity, femininity, feminist activism, and traditional knowledge against a monolithic image of Pakistani women. By highlighting these, this paper complicates the role of descriptive and visual images, religion, women’s rights, and the stereotypical role of women in Pakistani dramas.

Keywords: controlling images, oppression, women, Pakistan

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Authors: Selin Küçük

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Pre-industrial architecture is integration of natural and subsequent properties by intelligence and experience. Since various settlements relatively industrialized or non-industrialized at any time, ‘pre-industrial’ term does not refer to a definite time. Natural properties, which are existent conditions and materials in natural local environment, are climate, geomorphology and local materials. Subsequent properties, which are all anthropological comparatives, are culture of societies, requirements of people and construction techniques that people use. Yet, after industrialization, technology took technique’s place, cultural effects are manipulated, requirements are changed and local/natural properties are almost disappeared in architecture. Technology is universal, global and expands simply; conversely technique is time and experience dependent and should has a considerable cultural background. This research is about construction techniques according to natural properties of a region and classification of these techniques. Understanding local architecture is only possible by searching its background which is hard to reach. There are always changes in positive and negative in architectural techniques through the time. Archaeological layers of a region sometimes give more accurate information about transformation of architecture. However, natural properties of any region are the most helpful elements to perceive construction techniques. Many international sources from different cultures are interested in local architecture by mentioning natural properties separately. Unfortunately, there is no literature deals with this subject as far as systematically in the correct way. This research aims to improve a clear perspective of local architecture existence by categorizing archetypes according to natural properties. The ultimate goal of this research is generating a clear classification of local architecture independent from subsequent (anthropological) properties over the world such like a handbook. Since local architecture is the most sustainable architecture with refer to its economic, ecologic and sociological properties, there should be an excessive information about construction techniques to be learned from. Constructing the same buildings in all over the world is one of the main criticism of modern architectural system. While this critics going on, the same buildings without identity increase incrementally. In post-industrial term, technology widely took technique’s place, yet cultural effects are manipulated, requirements are changed and natural local properties are almost disappeared in architecture. These study does not offer architects to use local techniques, but it indicates the progress of pre-industrial architectural evolution which is healthier, cheaper and natural. Immigration from rural areas to developing/developed cities should be prohibited, thus culture and construction techniques can be preserved. Since big cities have psychological, sensational and sociological impact on people, rural settlers can be convinced to not to immigrate by providing new buildings designed according to natural properties and maintaining their settlements. Improving rural conditions would remove the economical and sociological gulf between cities and rural. What result desired to arrived in, is if there is no deformation (adaptation process of another traditional buildings because of immigration) or assimilation in a climatic region, there should be very similar solutions in the same climatic regions of the world even if there is no relationship (trade, communication etc.) among them.

Keywords: climate zones, geomorphology, local architecture, local materials

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Authors: Emilia K. H. Danielsson-Waters, Malaz Elsaddig, Kevin Jones

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Unfortunately, it is well known that neonatal deaths are a common and potentially preventable occurrence across the world. Neonatal resuscitation is a simple and inexpensive intervention that can effectively reduce this rate, and can be taught and implemented globally. This project is a follow-on from one in 2012, which found that neonatal resuscitation simulation was valuable for education, but would be better improved by being delivered by local staff. Methods: This study involved auditing the neonatal admission and death records within a rural Ugandan hospital, alongside implementing a Train-The-Trainer teaching scheme to teach Neonatal Resuscitation. One local doctor was trained for simulating neonatal resuscitation, whom subsequently taught an additional 14 staff members in one-afternoon session. Participants were asked to complete questionnaires to assess their knowledge and confidence pre- and post-simulation, and a survey to identify barriers and drivers to simulation. Results: The results found that the neonatal mortality rate in this hospital was 25% between July 2016- July 2017, with birth asphyxia, prematurity and sepsis being the most common causes. Barriers to simulation that were identified predominantly included a lack of time, facilities and opportunity, yet all members stated simulation was beneficial for improving skills and confidence. The simulation session received incredibly positive qualitative feedback, and also a 0.58-point increase in knowledge (p=0.197) and 0.73-point increase in confidence (0.079). Conclusion: This research shows that it is possible to create a teaching scheme in a rural hospital, however, many barriers are in place for its sustainability, and a larger sample size with a more sensitive scale is required to achieve statistical significance. This is undeniably important, because teaching neonatal resuscitation can have a direct impact on neonatal mortality. Subsequently, recommendations include that efforts should be put in place to create a sustainable training scheme, for example, by employing a resuscitation officer. Moreover, neonatal resuscitation teaching should be conducted more frequently in hospitals, and conducted in a wider geographical context, including within the community, in order to achieve its full effect.

Keywords: neonatal resuscitation, sustainable medical education, train-the-trainer, Uganda

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Authors: Lewis Mehl-Madrona, Josephine Conte, Barbara Mainguy

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We explore the historical connection of Andrew Taylor Still with the aboriginal nations placed in Missouri, notably the Shawnee, Pawnee, Kickapoo, Cherokee, and the Pottowattomy. Still was fluent in Shawnee and himself was part Native American (Lumbee). These nations had well-developed forms of hands-on healing as well as practicing lightning bone setting. They were more sophisticated than their European-derived neighbors in treating fractures and discolocations. We trace Still’s writings as evidence for his connectedness with these people and respect for their traditions. We explore the traditional hands-on therapies of these nations and discover that they are quite similar to osteopathy. We propose that Still was a translator of traditional manual medicine of the nations into the mainstream of American society. While, surely, he made his own personal contributions to manual medicine, he did not invent osteopathy de novo but relied on methods that were well-developed across centuries for his inspiration.

Keywords: indigenous healing, indigenous bodywork, American osteopathy, Andrew Taylor Still, Cherokee, Shawnee

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Authors: Ivan M. Taremwa, Scholastic Ashaba, Harriet O. Adrama, Carlrona Ayebazibwe, Daniel Omoding, Imelda Kemeza, Jane Yatuha, Thadeus Turuho, Noni E. MacDonald, Robert Hilliard

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Background: The burden of malaria in Uganda remains unacceptably high, especially among children and pregnant women. To prevent malaria related complications, household possession and use of Insecticide Treated mosquito Nets (ITNs) has become a common practice in the country. Despite the availability of ITNs, the number of malaria cases has not gone down. We sought to explore knowledge, attitude, and behaviour towards the use of ITNs as a nightly malaria prevention strategy among pregnant women and children under five years of age in rural southwest Uganda. Materials and Methods: This was a community based, descriptive cross-sectional study, in which households with children under 5 years, and/or pregnant women were enrolled. We used a structured questionnaire to collect data on participants’ understanding of the causes, signs and symptoms of malaria; use of ITNs to prevent malaria; attitudes and behaviours towards the use of ITNs. We also conducted key informant interviews (KIIs) to get in-depth understanding of responses from the participants. We analysed quantitative data using STATA version 12. Qualitative findings from the KIIs were transcribed and translated, and manually analysed using thematic content analysis. Results: Of the 369 households enrolled, 98.6% (N=363) households had children under five. Most participants (41.2%, N=152) were in the 21-30 years of age category (mean age; 32.2). 98.6% (N=362) of the respondents considered ITNs a key malaria prevention strategy. The ITN possession rate was 84.0% (N=310), of these, 67.0% (N=205) consistently used them. 39% of the respondents did not have a positive attitude towards ITNs, as they considered more the perceived effects of ITNs. Conclusions: Although 84.0% of the respondents possessed ITNs, many were not consistently using them. There is need to engage all stakeholders (including cultural leaders, community health workers, religious leaders and the government) in the malaria prevention campaigns using ITNs through: a) government’s concerted effort to ensure universal access of good quality ITNs, b) end-user directed education to correct false beliefs and misinformation, c) telling the ITN success stories to improve on the usage.

Keywords: ITNs use, malaria, pregnant women, rural Uganda

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Authors: Shilpa Vasavada

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One of the 17 SustainableDevelopmentGoals focuses on gender equality. The paper is based on the learning derived from working with two Corporate Social Responsibility cases in India: one, CSR of an International Corporate and the other, CSR of a multi state national level corporate -on their efforts to integrate gender perspective in their agriculture and livestock based rural livelihood programs. The author tries to dissect how ‘gender equality’ is seen by these two CSRs, where the goals are different. The implications of a CSR’sunderstandingon ‘gender equality’ as a goal; versus CSR’s understanding of working 'with women for enhancing quantity or quality of production’ gets reflected in their orientation to staff, resource allocation, strategic level and in processes followed at the rural grassroots level. The paper comes up with examples of changes made at programmatic front when CSR understands and works with the focus on gender equality as a goal. On the other hand, the paper also explores the differential, at times, the negative impact on women and the programmes;- when the goals differ. The paper concludes with recommendations for CSRs to take up at their resource allocation and strategic level if gender equality is the goal- which has direct implication at their grassroots programmatic work. The author argues that if gender equality has to be implemented actually in spirit by a CSR, it requires change in mindset and thus an openness to changes in strategies and resource allocation pattern of the CSR and not simply adding on women in the way intervention has been going on.

Keywords: gender equality, approaches, differential impact, resource allocation

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Authors: M. S. M. Anjalee Umesha Bandara

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Hela Veda Shastra is a science that is an endowment from generation to generation. There is also an individualistic science and indigenous practice of traditional herbs. There are many effective cures for snakes, fractures, head cancer, cuts, lunatics, reflexology, etc. Hela physicians who rescued them from infections caused by snakes have recognized poems to remember the medicines they used to cure the patients. Due to the harmony of the Hela Osu and Hela Knowledge poetry collection, it has become easy for the juniors of the Hela Veda generation to gain medical knowledge. It is a research problem whether it is possible to arrive at a correct conclusion about the patient form of the snake information thread through the existing Dhuta characteristics of Hela Serpa Vedakam. This research was done with the assumption that snake venom can be successfully treated according to its characteristics. In this research, two generations related to the Ratmalavatiya Vedaparamparava and the Vannihatpattu of the Kalla Veda generation have been identified as Veda Paramparas who treat and created Dutha Kavya, including the form of the Serpent Dasthana. They have collected ancient books, documents and interviews related to qualitative research on snake disease treatment. In addition, collecting data by referring to books related to Hela medicine. The ancient indigenous lineage methods that are superior to modern Western science's snake therapy should save the Hela's amazing wealth of wisdom for the future, leaving aside the selfishness of keeping the teaching to themselves.

Keywords: snake venom medicine, vedic genealogy, Dhuta characteristic, snake

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Authors: Nahla H. Alaswadko, Rayya A. Hassan, Bayar N. Mohammed

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Empirical deterministic models have been developed to predict roughness progression of heavy duty spray sealed pavements for a dataset representing rural arterial roads. The dataset provides a good representation of the relevant network and covers a wide range of operating and environmental conditions. A sample with a large size of historical time series data for many pavement sections has been collected and prepared for use in multilevel regression analysis. The modelling parameters include road roughness as performance parameter and traffic loading, time, initial pavement strength, reactivity level of subgrade soil, climate condition, and condition of drainage system as predictor parameters. The purpose of this paper is to report the approaches adopted for models development and validation. The study presents multilevel models that can account for the correlation among time series data of the same section and to capture the effect of unobserved variables. Study results show that the models fit the data very well. The contribution and significance of relevant influencing factors in predicting roughness progression are presented and explained. The paper concludes that the analysis approach used for developing the models confirmed their accuracy and reliability by well-fitting to the validation data.

Keywords: roughness progression, empirical model, pavement performance, heavy duty pavement

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Authors: Chang-Hwan Oh, Young-Jong Lee

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In April, 2015, the Ministry of Food and Drug Safety’s announcement that only 10 of the 207 products that list Cynanchum Wilfordii Radix among their ingredients were confirmed to actually contain “iyeobupiso” the counterfeit version of the “baeksuo” raised a fog to consumers who purchased health/functional foods supposedly containing the herbal medicinal material, “baeksuo” in Korean. Baeksuo is the main ingredient of the product “EstroG-100” that contain Phlomis umbrosa and Angelica gigas too (NaturalEndoTech, S.Korea). The hot water extract of the herbal medicinal materials (HMM) was approved as a product specific Health/Functional Food (HFF) having a helpful function to women reaching menopause by Korea Food & Drug Administration (Ministry of Food & Drug Safety at present). The origin of “baeksuo” is the root of Cynanchum wilfordii Hemsley in Korea (But “iyeobupiso, the root of Cynanchum auriculatum Royle ex Wight is considered as the origin of “baeksuo” in China). In Korea, about 116 HMMs are listed as the food materials in Korea Food Code among the total 187 HMMs could be used for food and medicine purpose simultaneously. But there are some chances of the HMMs (shared use for food and medicine purpose) could be misused by the part and HMMs not permitted for HFF such as the “baeksuo” case. In this study, some of HMMs (shared use for food and medicine purpose) are examined to alleviate the misuse chance of HMMs for HFFs in Korea. For the purpose of this study, the origin, shape, edible parts, efficacy and the side effects of the similar HMMs to be misused for HFF are investigated.

Keywords: herbal medicinal materials, healthy/functional foods, misuse, shared use

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Authors: Peter R. Reuter

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Health professionals play important roles in helping patients use Complementary and Alternative Medicine (CAM) practices safely and accurately. Consequently, it is important for future health professionals to learn about CAM practices during their time in undergraduate and graduate programs. To satisfy this need for education, teaching CAM in nursing and medical schools and other health professions programs is becoming more prevalent. Our study was the first to look specifically at the knowledge of, and attitude toward CAM of undergraduate health professions students at a university in the U.S. Students were invited to participate in one of two anonymous online surveys depending on whether they were pre-health professions students or graduating health professions seniors. Of the 763 responses analyzed, 71.7% were from pre-health professions students, and 28.3% came from graduating seniors. The overall attitude of participants toward and interest in learning about CAM practices was generally fairly positive with graduating seniors being more positive than pre-health professions students. Yoga, meditation, massage therapy, aromatherapy, and chiropractic care were the practices most respondents had personal experience with. Massage therapy, yoga, chiropractic care, meditation, music therapy, and diet-based therapy received the highest ratings from respondents. Three-quarters of respondents planned on including aspects of holistic medicine in their future career as a health professional. The top five practices named were yoga, meditation, massage therapy, diet-based therapy, and music therapy. The study confirms the need to educate health professions students about CAM practices to give them the background information they need to select or recommend the best practices for their patients' needs.

Keywords: CAM education, health professions, health professions students, pre-health professions students

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Authors: Rajkumar Ghosh, Ananya Mukhopadhyay

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This scientific paper presents a thorough investigation into the integration of roof-mounted photovoltaic (PV) array systems and home rooftop rainwater collection systems in a remote community in Himachal Pradesh, India, with the goal of optimum utilization of natural resources for attaining sustainable living conditions by 2030. The study looks into the technical feasibility, environmental benefits, and socioeconomic impacts of this integrated method, emphasizing its ability to handle energy and water concerns in remote rural regions. This comprehensive method not only provides a sustainable source of electricity but also ensures a steady supply of clean water, promoting resilience and improving the quality of life for the village's residents. This research highlights the potential of such integrated systems in supporting sustainable conditions in rural areas through a combination of technical feasibility studies, economic analysis, and community interaction. There would be 20690 villages and 1.48 million homes (23.79% annual growth rate) in Himachal Pradesh if all residential buildings in the state had roof-mounted photovoltaic arrays to capture solar energy for power generation. The energy produced is utilized to power homes, lessening dependency on traditional fossil fuels. The same residential buildings housed domestic rooftop rainwater collection systems. Rainwater runoff from rooftops is collected and stored in tanks for use in a number of residential purposes, such as drinking, cooking, and irrigation. The gathered rainfall enhances the region's limited groundwater resources, easing the strain on local wells and aquifers. Although Himachal Pradesh of India is a Power state, the PV arrays have reduced the reliance of village on grid power and diesel generators by providing a steady source of electricity. Rooftop rainwater gathering has not only increased residential water supply but it has also lessened the burden on local groundwater resources. This helps to replenish groundwater and offers a more sustainable water supply for the town. The neighbourhood has saved money by utilizing renewable energy and rainwater gathering. Furthermore, lower fossil fuel consumption reduces greenhouse gas emissions, which helps to mitigate the effects of climate change. The integrated strategy of installing grid connected rooftop photovoltaic arrays and home rooftop rainwater collecting systems in Himachal Pradesh rural community demonstrates a feasible model for sustainable development. According to “Swaran Jayanti Energy Policy of Himachal Pradesh”, Himachal Pradesh is planned 10 GW from rooftop mode from Solar Power. Government of India provides 40% subsidy on solar panel of 1-3 kw and subsidy of Rs 6,000 per kw per year to encourage domestic consumers of Himachal Pradesh. This effort solves energy and water concerns, improves economic well-being, and helps to conserve the environment. Such integrated systems can serve as a model for sustainable development in rural areas not only in Himachal Pradesh, but also in other parts of the world where resource scarcity is a major concern. Long-term performance and scalability of such integrated systems should be the focus of future study. Efforts should also be made to duplicate this approach in other rural areas and examine its socioeconomic and environmental implications over time.

Keywords: renewable energy, photovoltaic arrays, rainwater harvesting, sustainability, rural development, Himachal Pradesh, India

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Authors: Carmen Avilés Palacios, Camilo Muñoz Arenas, Joaquín García Alfonso, Jesús González Arteaga, Alberto Alcalde Calonge

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There is a need for review of the consumption and production models of industrialized states in accordance with the Paris Agreement and the Sustainable Development Goals (1) (OECD, 2016). This constitutes the basis of the bioeconomy (2) that is focused on striking a balance between economic development, social development and environmental protection. Bioeconomy promotes the adequate use and consumption of renewable natural resources (3) and involves developing new products and services adapted to the principles of circular economy: more sustainable (reusable, biodegradable, renewable and recyclable) and with a lower carbon footprint (4). In this context, Urban Forest Innovation Lab (UFIL) grows, an Urban Laboratory for experimentation focused on promoting entrepreneurship in forest bioeconomy (www.uiacuenca.es). UFIL generates local wellness taking sustainable advantage of an endogenous asset, forests. UFIL boosts forest bioeconomy opening its doors of knowledge to pioneers in this field, giving the opportunity to be an active part of a change in the way of understanding the exploitation of natural resources, discovering business, learning strategies and techniques and incubating business ideas So far now, 100 entrepreneurs are incubating their nearly 30 new business plans. UFIL has promoted an ecosystem to connect the rural-urban world that promotes sustainable rural development around the forest.

Keywords: bioeconomy, forestry, innovation, entrepreneurship

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Authors: Xue Wu

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Since the 1980s, a series of policies and practices have been implemented in China in response to the unprecedented rate of ageing population. The paper provides a detailed narrative of what later-life learning policy discourses have been advocated and gives a description on relevant practical issues during the past three decades. The research process based on the discourse approach with a systematic review of the government-issued documents. It finds that the main practices taken by central government at various levels were making University of the Aged (UA) available in all urban and rural regions to consolidate the newly student enrollments; focusing social-recreational, leisure and cultural activities on 55-75 age group; and utilizing various methods including voluntary works and tourism to improve older adults’ physical and mental wellness. Although there were greater achievements with 30 years of development, many problems still exist. Finding reveals that the curriculum should be modified to meet the needs of the local development, to promote older adults’ contact and contribution to the community, and to enhance technical competences of those in rural areas involving in agricultural production. Central government should also integrate resources from all sectors of the society for further developing later-life learning in China. The result of this paper highlights the value to promote community-based later-life learning for building a society for active ageing and ageing in place.

Keywords: ageing population, China, later-life learning, policy, University of the Aged

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Authors: Sarah Gounden, Mukesh Dheda, Boikhutso Tlou, Elizabeth Ojewole, Frasia Oosthuizen

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Background: Antiretroviral therapy (ART) has been effective in the reduction of mortality and resulted in an improvement in the prognosis of HIV-infected patients. However, treatment with antiretrovirals (ARVs) has led to the development of many adverse drug reactions (ADRs). It is, therefore, necessary to determine the safety profile of these medicines in a South African population in order to ensure safe and optimal medicine use. Objectives: The aim of this study was to quantify ADRs experienced with the different ARVs currently used in South Africa, to determine the safety profile of ARV medicine in South Africa based on reported ADRs, and to determine the ARVs with the lowest risk profile based on specific patient populations. Methodology: This was a quantitative study. Individual case safety reports for the period January 2010 – December 2013 were obtained from the National Pharmacovigilance Center; these reports contained information on ADRs, ARV medicine, and patient demographics. Data was analysed to find associations that may exist between ADRs experienced, ARV medicines used and patient demographics. Results: A total of 1916 patient reports were received of which 1534 met the inclusion criteria for the study. The ARV with the lowest risk of ADRs were found to be lamivudine (0.51%, n=12), followed by lopinavir/ritonavir combination (0.8%, n=19) and abacavir (0.64%, n=15). A higher incidence of ADRs was observed in females compared to males. The age group 31–50 years and the weight group 61–80 kg had the highest incidence of ADRs reported. Conclusion: This study found that the safest ARVs to be used in a South African population are lamivudine, abacavir, and the lopinavir/ritonavir combination. Gender differences play a significant role in the occurrence of ADRs and both anatomical and physiological differences account for this. An increased BMI (body mass index) in both men and women showed an increase in the incidence of ADRs associated with ARV therapy.

Keywords: adverse drug reaction, antiretrovirals, HIV/AIDS, pharmacovigilance, South Africa

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Authors: Anthara Vivek, Manisha Shukla, Mahesh Narayan, Prakash Narayan

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Sickle cell disease disproportionately affects sub-Saharan Africa and certain tribal populaces in India and has consequently drawn little intertest from Pharma. In sickle cell patients, adhesion of erythrocytes or reticulocytes to one another and the vessel wall results in painful ischemic episodes with few, if any, effective treatments for vaso-occlusive crises. Identification of disease-associated adhesion markers on erythrocytes or reticulocytes might inform the use of more effective therapies against vaso-occlusive crises. Increased expression of one or more of bcam, itga4, cd44, cd47, rap1a, vcam1, or icam4 has been reported in sickle cell subjects. Using the miRNet ontology knowledgebase, peripheral blood interactomes were generated by seeding various combinations of the afore-referenced mRNA. These interactomes yielded an array of miR targets. As examples, targeting hsa-miR-155-5p can potentially neutralize the rap1a-bcam-cd44-itga4-vcam1 erythrocyte/reticulocyte adhesion interactome whereas targeting hsa-miRs-103a-3p or 107 can potentially neutralize adhesion in cells overexpressing icam4-cd47-bcam-itga4-cd36. AM3380 (MIRacle™) is an off-the shelf hsa-miR-155-5p agomiR that can potentially neutralize the rap1a-bcam-cd44-itga4-vcam1 signaling axis. Phlebotomy coupled with transcriptomics represents a potentially feasible and effective precision medicine strategy to mitigate vaso-occlusive crises in sickle cell patients.

Keywords: adhesion, interactome, precision, medicine

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