Search results for: multiple linear regression

Authors: Iris W. A. Boot, Anke Wesselius, Maurice P. Zeegers

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Diet may play an essential role in the aetiology of bladder cancer (BC). Vitamin D is involved in various biological functions which have the potential to prevent BC development. Besides, vitamin D also influences the uptake of calcium and phosphorus , thereby possibly indirectly influencing the risk of BC. The aim of the present study was to investigate the relation between vitamin D intake and BC risk. Individual dietary data were pooled from three cohort studies. Food item intake was converted to daily intakes of vitamin D, calcium and phosphorus. Pooled multivariate hazard ratios (HRs), with corresponding 95% confidence intervals (CIs) were obtained using Cox-regression models. Analyses were adjusted for gender, age and smoking status (Model 1), and additionally for the food groups fruit, vegetables and meat (Model 2). Dose–response relationships (Model 1) were examined using a nonparametric test for trend. In total, 2,871 cases and 522,364 non-cases were included in the analyses. The present study showed an overall increased BC risk for high dietary vitamin D intake (HR: 1.14, 95% CI: 1.03-1.26). A similar increase BC risk with high vitamin D intake was observed among women and for the non-muscle invasive BC subtype, (HR: 1.41, 95% CI: 1.15-1.72, HR: 1.13, 95% CI: 1.01-1.27, respectively). High calcium intake decreased the BC risk among women (HR: 0.81, 95% CI: 0.67-0.97). A combined inverse effect on BC risk was observed for low vitamin D intake and high calcium intake (HR: 0.67, 95% CI: 0.48-0.93), while a positive effect was observed for high vitamin D intake in combination with low, moderate and high phosphorus (HR: 1.31, 95% CI: 1.09-1.59, HR: 1.17, 95% CI: 1.01-1.36, HR: 1.16, 95% CI: 1.03-1.31, respectively). Combining all nutrients showed a decreased BC risk for low vitamin D intake, high calcium and moderate phosphor intake (HR: 0.37, 95% CI: 0.18-0.75), and an increased BC risk for moderate intake of all the nutrients (HR: 1.18, 95% CI: 1.02-1.38), for high vitamin D and low calcium and phosphor intake (HR: 1.28, 95% CI: 1.01-1.62), and for moderate vitamin D and calcium and high phosphorus intake (HR: 1.27, 95% CI: 1.01-1.59). No significant dose-response analyses were observed. The findings of this study show an increased BC risk for high dietary vitamin D intake and a decreased risk for high calcium intake. Besides, the study highlights the importance of examining the effect of a nutrient in combination with complementary nutrients for risk assessment. Future research should focus on nutrients in a wider context and in nutritional patterns.

Keywords: bladder cancer, nutritional oncology, pooled cohort analysis, vitamin D

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Authors: Mahmoud Nabilu

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The present study explored the effect of using Mobile listening applications on developing listening skills by Iranian intermediate EFL learners. Fifty male intermediate English learners whose age range was between 15 and 20, participated in the study. The participants were placed in two groups on the basis of their scores on a placement test. Therefore, the participants of the study were homogenized in terms of general proficiency, and groups were assigned as one experimental group and one control group. The experimental group was instructed by the treatment which was using mobile applications to develop their listening skills while the control group received traditional methods. The research data were obtained from the 40-item multiple-choice tests as a pre-test and a post-test. The results of the t-test clearly revealed that the learners in the experimental group performed better in the post-test than the pre-test. This implies that using a mobile application for developing listening skills as a treatment was effective in helping the language learners perform better on post-test. However, a statistically significant difference was found between the post-tests scores of the two groups. The mean of the experimental group was greater compared to the control group. The participants were Iranian and from an Iranian Language Institute, so care should be taken while generalizing the results to the learners of other nationalities. However, in the researcher's view, the findings of this study have valuable implications for teachers and learners, methodologists and syllabus designers, linguists and MALL/CALL (mobile/computer-assisted language learning) experts. Using the result of the present paper is an aim of raising the consciousness of a better technique of developing listening skills in order to make language learning more efficient for the learners.

Keywords: Mobile listening applications, intermediate EFL learners, MALL, CALL

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Authors: Bilgen Özlük, Ülkü Baykal

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The study was conducted with the aim of determining the evaluations of nurses directed at the restructuring process carried out in the nursing services of a private hospital, and reveal how they have been affected by this process, in an integrated manner between a prospective approach and methods of quantitative and qualitative research, and as a comparative study, comparing the changes over a period of three years. The sample for the study is comprised of all of the nurses employed at a private hospital, and data has been collected from 17 nurses (a total of 30 interviews) for the qualitative part 377 nurses in 2013 and 429 nurses in 2014 for the quantitative part. As vehicles of data collection, the study used a form directed at identifying the changes in the organisational and management structure of the hospital, a nurses' interview form, a questionnaire identifying the personal and occupational characteristics of the nurses, the "Minnesota Job Satisfaction Scale", the "Organisational Citizenship Behaviour Scale" and the "Organisational Trust Scale". Qualitative data by researchers, quantitative data was analysed using number and percentage tests, a t-test, and ANOVA, progressive analysis Tukey and regression tests. While in the qualitative part of the study the nurses stated in the first year of the restructuring that they were satisfied with their relationship with top level management, the increases in salaries and changes in the working environment such as the increase in the number of staff, in later years, they stated that there had been a fall in their satisfaction levels due to reasons such as nursing services instead of nurse practitioners in a position they are not satisfied that the director, nursing services outside the nursing profession appointment of persons to positions of management and the lack of appropriate training and competence of these persons, increases in the burden of work, insufficient salaries and the lack of a difference in the salaries of senior and more junior staff. On the other hand, in the quantitative part, it was found that there was no difference in the levels of job satisfaction and organisational trust in any of the two years, that as the level of organisational trust increased the level of job satisfaction also increased, and that as the levels of job satisfaction and organisational trust a positive impact on organisational citizenship behaviour also increased.

Keywords: services, nursing management, re-structuring, job satisfaction, organisational citizenship behaviour, organisational trust

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Authors: Prakriti Chand, Binayak Prasad Rajbhandari, Ram Prasad Mainali

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Local indigenous community in Lalitpur, Nepal, use Ignored, Underutilized and Uncommercialized Horticultural Species (IUUHS) for medicine, food, spice, pickles, and religious purposes. But, research and exploration about usage, status, potentialities, and importance of these future sustainable crops are inadequately documented and have been ignored for a positive food transformation system. The study aimed to assess the use and diversity of NUWHS in terms of current status investigation, documentation, management, and future potentialities of IUUHS. A wide range of participatory tools through the household survey ( 100 respondents), 8 focus group discussions, 20 key informant interviews was followed by individual assessment, participatory rural assessments and supplemented by literature review. This study recorded 95 IUUHS belonging to 43 families, of which 92 were angiosperms, 2 pteridophytes, and 1 gymnosperm. Twenty seven species had multiple uses. The IUUHS observed during the study were 31 vegetables, 20 fruits, 14 wild species, 7 spices, 7 pulses, 7 pickle, 7 medicine, and 2 religious species. Vegetables and fruits were the most observed category of IUUHS. Eighty nine species were observed as medicinally valued species, and 86% of the women had taken over all the agricultural activities. 84% of respondents used these species during food deficient period. IUUHS have future potential as an alternative food to major staple crops due to its remarkable ability to be adapted in marginal soil and thrive harsh climatic condition. There are various constraints regarding the utilization and development of IUUHS, which needs initiation of promotion, utilization, management, and conservation of species from the grass root level.

Keywords: agrobiodiversity, Ignored and underutilized species, uncultivated horticultural species, diversity use

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Authors: C. F. Glover, J. Marinaccio, A. Barnes, I. Mabbett, G. Williams

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The aim of the current study is to optimise formulations, in terms of charging efficiency, of a printed Ni(OH)2 precursor coating of a battery anode. Through the assessment of the current densities during charging, the efficiency of a range of formulations are compared. The Scanning vibrating electrode technique (SVET) is used extensively in the field of corrosion to measure area-averaged current densities of freely-corroding metal surfaces when fully immersed in electrolyte. Here, a Ni(OH)2 electrode is immersed in potassium hydroxide (30% w/v solution) electrolyte and charged using a range of applied currents. Samples are prepared whereby multiple coatings are applied to one substrate, separated by a non-conducting barrier, and charged using a constant current. With a known applied external current, electrode efficiencies can be calculated based on the current density outputs measured using SVET. When fully charged, a green Ni(OH)2 is oxidised to a black NiOOH surface. Distinct regions displaying high current density, and hence a faster oxidising reaction rate, are located using the SVET. This is confirmed by a darkening of the region upon transition to NiOOH. SVET is a highly effective tool for assessing homogeneity of electrodes during charge/discharge. This could prove particularly useful for electrodes where there are no visible surface appearance changes. Furthermore, a scanning Kelvin probe technique, traditionally used to assess underfilm delamination of organic coatings for the protection of metallic surfaces, is employed to study the change in phase of oxides, pre and post charging.

Keywords: battery, electrode, nickel hydroxide, SVET, printed

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Authors: Maulik L. Sisodia, Tirth K. Raval, Aarsh S. Mistry

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This paper summarizes the ongoing researches about the defects in both flexible and rigid pavement and the maintenance in both flexible and rigid pavements. Various defects in pavements have been identified since the existence of both flexible and rigid pavement. Flexible Pavement failure is defined in terms of decreasing serviceability caused by the development of cracks, ruts, potholes etc. Flexible Pavement structure can be destroyed in a single season due to water penetration. Defects in flexible pavements is a problem of multiple dimensions, phenomenal growth of vehicular traffic (in terms of no. of axle loading of commercial vehicles), the rapid expansion in the road network, non-availability of suitable technology, material, equipment, skilled labor and poor funds allocation have all added complexities to the problem of flexible pavements. In rigid pavements due to different type of destress the failure like joint spalling, faulting, shrinkage cracking, punch out, corner break etc. Application of correction in the existing surface will enhance the life of maintenance works as well as that of strengthening layer. Maintenance of a road network involves a variety of operations, i.e., identification of deficiencies and planning, programming and scheduling for actual implementation in the field and monitoring. The essential objective should be to keep the road surface and appurtenances in good condition and to extend the life of the road assets to its design life. The paper describes lessons learnt from pavement failures and problems experienced during the last few years on a number of projects in India. Broadly, the activities include identification of defects and the possible cause there off, determination of appropriate remedial measures; implement these in the field and monitoring of the results.

Keywords: Flexible Pavements, Rigid Pavements, Defects, Maintenance

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Authors: Sopit Tubtimhin, Chaliya Wamaloon, Anchalee Supattagorn

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Background and Significance: Breast cancer is the most frequently diagnosed and leading cause of cancer death among women. This study aims to determine factors potentially predicting recurrence and long-term survival after the first recurrence in surgically treated patients between postmenopausal and younger women. Methods and Analysis: A retrospective cohort study was performed on 498 Thai women with invasive breast cancer, who had undergone mastectomy and been followed-up at Ubon Ratchathani Cancer Hospital, Thailand. We collected based on a systematic chart audit from medical records and pathology reports between January 1, 2002, and December 31, 2011. The last follow-up time point for surviving patients was December 31, 2016. A Cox regression model was used to calculate hazard ratios of recurrence and death. Findings: The median age was 49 (SD ± 9.66) at the time of diagnosis, 47% was post-menopausal women ( ≥ 51years and not experienced any menstrual flow for a minimum of 12 months), and 53 % was younger women ( ˂ 51 years and have menstrual period). Median time from the diagnosis to the last follow-up or death was 10.81 [95% CI = 9.53-12.07] years in younger cases and 8.20 [95% CI = 6.57-9.82] years in postmenopausal cases. The recurrence-free survival (RFS) for younger estimates at 1, 5 and 10 years of 95.0 %, 64.0% and 58.93% respectively, appeared slightly better than the 92.7%, 58.1% and 53.1% for postmenopausal women [HRadj = 1.25, 95% CI = 0.95-1.64]. Regarding overall survival (OS) for younger at 1, 5 and 10 years were 97.7%, 72.7 % and 52.7% respectively, for postmenopausal patients, OS at 1, 5 and 10 years were 95.7%, 70.0% and 44.5 respectively, there were no significant differences in survival [HRadj = 1.23, 95% CI = 0.94 -1.64]. Multivariate analysis identified five risk factors for negatively impacting on survival were triple negative [HR= 2.76, 95% CI = 1.47-5.19], Her2-enriched [HR = 2.59, 95% CI = 1.37-4.91], luminal B [HR = 2.29, 95 % CI=1.35-3.89], not free margin [HR = 1.98, 95%CI=1.00-3.96] and patients who received only adjuvant chemotherapy [HR= 3.75, 95% CI = 2.00-7.04]. Statistically significant risks of overall cancer recurrence were Her2-enriched [HR = 5.20, 95% CI = 2.75-9.80], triple negative [HR = 3.87, 95% CI = 1.98-7.59], luminal B [HR= 2.59, 95% CI = 1.48-4.54,] and patients who received only adjuvant chemotherapy [HR= 2.59, 95% CI = 1.48-5.66]. Discussion and Implications: Outcomes from this studies have shown that postmenopausal women have been associated with increased risk of recurrence and mortality. As the results, it provides useful information for planning the screening and treatment of early-stage breast cancer in the future.

Keywords: breast cancer, menopause status, recurrence-free survival, overall survival

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Authors: Tarali Kalita, Karabi Dutta

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The North Eastern Region of India, with diverse climatic conditions and a wide range of ecological habitats, makes an ideal natural abode for a good number of silk-producing insects. Cocoon is the economically important life stage from where silk of economic importance is obtained. In recent years, silk-based biomaterials have gained considerable attention, which is dependent on the structure and properties of the silkworm cocoons as well as silk yarn. The present investigation deals with the morphological study of cocoons, including cocoon color, cocoon size, shell weight and shell ratio of eleven different species of silk insects collected from different regions of North East India. The Scanning Electron Microscopic study and X-ray photoelectron spectroscopy were performed to know the arrangement of silk threads in cocoons and the atomic elemental analysis, respectively. Further, collected cocoons were degummed and reeled/spun on a reeling machine or spinning wheel to know the filament length, linear density and tensile strength by using Universal Testing Machine. The study showed significant variation in terms of cocoon color, cocoon shape, cocoon weight and filament packaging. XPS analysis revealed the presence of elements (Mass %) C, N, O, Si and Ca in varying amounts. The wild cocoons showed the presence of Calcium oxalate crystals which makes the cocoons hard and needs further treatment to reel. In the present investigation, the highest percentage of strain (%) and toughness (g/den) were observed in Antheraea assamensis, which implies that the muga silk is a more compact packing of molecules. It is expected that this study will be the basis for further biomimetic studies to design and manufacture artificial fiber composites with novel morphologies and associated material properties.

Keywords: cocoon characterization, north-east India, prospects, silk characterization

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Authors: Natcha Wattanaprapa, Alongkorn Taengtong, Phachaya Chaiwchan

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This study investigates and promotes the distribution of community enterprise products of Samut Songkhram province by using e-commerce web technology to help distribute the products. This study also aims to develop the information system to be able to operate on multiple platforms and promote the easy usability on smartphones to increase the efficiency and promote the distribution of community enterprise products of Samut Songkhram province in three areas including Baan Saraphi learning center, the learning center of Bang Noi Floating market as well as Bang Nang Li learning center. The main structure consists of spreading the knowledge regarding the tourist attraction in the area of community enterprise, e-commerce system of community enterprise products, and Chatbot. The researcher developed the system into an application form using the software package to create and manage the content on the internet. Connect management system (CMS) word press was used for managing web pages. Add-on CMS word press was used for creating the system of Chatbot, and the database of PHP My Admin was used as the database management system. The evaluation by the experts and users in 5 aspects, including the system efficiency, the accuracy in the operation of the system, the convenience and ease of use of the system, the design, and the promotion of product distribution in Samut Songkhram province by using questionnaires revealed that the result of evaluation in the promotion of product distribution in Samut Songkhram province was the highest with the mean of 4.20. When evaluating the efficiency of the developed system, it was found that the result of system efficiency was the highest level with a mean of 4.10.

Keywords: community enterprise, digital commerce, promotion of product distribution, Samut Songkhram province

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Authors: P. Gil Del Álamo, J. García Pereda, A. Castañeda De La Paz, D. Arazola Lopez, M. D. Cubiles De La Vega, A. Enguíx González, J. M. Muñoz Pichardo

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In the last decades, obesity has more than doubled and is, with overweight, the second leading cause of preventable death. Despite multiple strategies against obesity, no country to date has reduced the number of obese people. To achieve World Health Organization’s target to reverse this tendency we need dramatic and different actions to engage the civil society in creating demand for a healthy style of life. The objective of this study is to demonstrate that a social media as the television can be used to convince the civil society that a healthy nutrition and physical activity are affordable, effective and necessary to prevent and to treat the obesity. Methodology: 61 individuals (34 women and 27 men) with obesity (mean BMI 45,51) were recruited to follow during 22 weeks an intensive lifestyle intervention in order to lose weight in a healthy manner. They were not isolated or moved from their usual environment. This program included endocrinological and nutritional assessment, promotion of physical activity and psychological support. BMI was measured every week. Time to leave obesity between men and women was analyzed with a survival analysis. Results: BMI decreased in all the cases. Analysing Time to leave obesity, around the week 30, 25% of men leave the obesity and around the week 39, 25% of women leave the obesity too. Conclusion: We demonstrate the audience that improving the quality of the diet and increasing the physical activity is a realistic way to lose weight. This evidence can encourage the people to act in their own self-interest changing their style of life in order to prevent or to reduce their overweight.

Keywords: obesity epidemic, obesity prevention, obesity strategies, social media

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Authors: Dina Tareq Ismail, Alexandria A. Proff

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The United Arab Emirates (UAE) is a nation seeking to advance in all fields, particularly education. One area of focus for UAE 2021 agenda is to restructure UAE schools and universities by equipping them with highly developed technology. The agenda also advises educational institutions to prepare students with applicable and transferrable Information and Communication Technology (ICT) skills. Despite the emphasis on ICT and computer literacy skills, there exists limited empirical data on the use of M-Learning in the literature. This qualitative study explores the motivation of higher primary Arabic teachers in private schools toward implementing and integrating M-Learning apps in their classrooms. This research employs a phenomenological approach through the use of semistructured interviews with nine purposefully selected Arabic teachers. The data were analyzed using a content analysis via multiple stages of coding: open, axial, and thematic. Findings reveal three primary themes: (1) Arabic teachers with high levels of procedural knowledge in ICT are more motivated to implement M-Learning; (2) Arabic teachers' perceptions of self-efficacy influence their motivation toward implementation of M-Learning; (3) Arabic teachers implement M-Learning when they possess high utility and/or intrinsic value in these applications. These findings indicate a strong need for further training, equipping, and creating buy-in among Arabic teachers to enhance their ICT skills in implementing M-Learning. Further, given the limited availability of M-Learning apps designed for use in the Arabic language on the market, it is imperative that developers consider designing M-Learning tools that Arabic teachers, and Arabic-speaking students, can use and access more readily. This study contributes to closing the knowledge gap on teacher-motivation for implementing M-Learning in their classrooms in the UAE.

Keywords: ICT skills, m-learning, self-efficacy, teacher-motivation

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Authors: B. Wattanakul, G. Ngamwongwan, S. Ngamkham

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Exposure to different learning experiences contributes to changing in learning style. Addressing students’ learning preference could help teachers provide different learning activities that encourage the student to learn effectively. Purpose: The purpose of this descriptive study was to describe learning styles of nursing students at Boromarajonani College of Nursing Chon Buri. Sample: The purposive sample was 463 nursing students who were enrolled in a nursing program at different academic levels. The 16-item VARK questionnaire with 4 multiple choices was administered at one time data collection. Choices have consisted with modalities of Visual, Aural, Read/write, and Kinesthetic measured by VARK. Results: Majority of learning preference of students at different levels was visual and read/write learning preference. Almost 67% of students have a multimodal preference, which is visual learning preference associated with read/write or kinesthetic preference. At different academic levels, multimodalities are greater than single preference. Over 30% of students have one dominant learning preference, including visual preference, read/write preference and kinesthetic preference. Analysis of Variance (ANOVA) with Bonferroni adjustment revealed a significant difference between students based on their academic level (p < 0.001). Learning style of the first-grade nursing students differed from the second-grade nursing students (p < 0.001). While learning style of nursing students in the second-grade has significantly varied from the 1st, 3rd, and 4th grade (p < 0.001), learning preference of the 3rd grade has significantly differed from the 4th grade of nursing students (p > 0.05). Conclusions: Nursing students have varied learning styles based on their different academic levels. Learning preference is not fixed attributes. This should help nursing teachers assess the types of changes in students’ learning preferences while developing teaching plans to optimize students’ learning environment and achieve the needs of the courses and help students develop learning preference to meet the need of the course.

Keywords: learning preference, VARK, learning style, nursing

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Authors: Ammar Asma, Bouafia Nabiha, Ghammam Rim, Ezzi Olfa, Ben Cheikh Asma, Mahjoub Mohamed, Helali Radhia, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Central venous catheter associated infections (CVC-AI) are among the serious hospital-acquired infections. The aims of this study are to determine the incidence of CVC-AI, and their risk factors among patients followed in a Tunisian medical intensive care unit (ICU). Materials / Methods: A prospective cohort study conducted between September 15th, 2015 and November 15th, 2016 in an 8-bed medical ICU including all patients admitted for more than 48h. CVC-AI were defined according to CDC of ATLANTA criteria. The enrollment was based on clinical and laboratory diagnosis of CVC-AI. For all subjects, age, sex, underlying diseases, SAPS II score, ICU length of stay, exposure to CVC (number of CVC placed, site of insertion and duration catheterization) were recorded. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: Among 192 eligible patients, 144 patients (75%) had a central venous catheter. Twenty-eight patients (19.4%) had developed CVC-AI with density rate incidence 20.02/1000 CVC-days. Among these infections, 60.7% (n=17) were systemic CVC-AI (with negative blood culture), and 35.7% (n=10) were bloodstream CVC-AI. The mean SAPS II of patients with CVC-AI was 32.76 14.48; their mean Charlson index was 1.77 1.55, their mean duration of catheterization was 15.46 10.81 days and the mean duration of one central line was 5.8+/-3.72 days. Gram-negative bacteria was determined in 53.5 % of CVC-AI (n= 15) dominated by multi-drug resistant Acinetobacter baumani (n=7). Staphylococci were isolated in 3 CVC-AI. Fourteen (50%) patients with CVC-AI died. Univariate analysis identified men (p=0.034), the referral from another hospital department (p=0.03), tobacco (p=0.006), duration of sedation (p=0.003) and the duration of catheterization (p=0), as possible risk factors of CVC-AI. Multivariate analysis showed that independent factors of CVC-AI were, male sex; OR= 5.73, IC 95% [2; 16.46], p=0.001, Ramsay score; OR= 1.57, IC 95% [1.036; 2.38], p=0.033, and duration of catheterization; OR=1.093, IC 95% [1.035; 1.15], p=0.001. Conclusion: In a monocenter cohort, CVC-AI had a high density and is associated with poor outcome. Identifying the risk factors is necessary to find solutions for this major health problem.

Keywords: central venous catheter associated infection, intensive care unit, prospective cohort studies, risk factors

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Authors: Juliana Altavista Sagretti Gallo, Susy Frey Sabato

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Despite the poverty in the world, a third of all food produced in the world is wasted. FAO, the United Nations Organization of Agriculture and Food, points out the need to combine actions and new technologies to combat hunger and waste in contrast to the high production of food in the world. The energy of ionizing radiation in food brought many positive results, such as increased validity and insect infestation control. The food banks are organizations that act at various points of the food chain to collect and distribute food to the needy. So, the aim of this study was to initiate a partnership between irradiation and the food bank through the development of a questionnaire to evaluate and disseminate the knowledge and acceptance of individuals in the food bank in Brazil. Also, this study aimed to standardize a basis questionnaire for future research assessment of irradiated foods. For the construction of the questionnaire as a measuring instrument, a comprehensive and rigorous literature review was made. It's covered qualitative research, questionnaires, sensory evaluation, and food irradiated. Three stages of pre - tests were necessary, and related fields of experts were consulted. As a result, the questionnaire has three parts, personal issues, assertive issues and questions of multiple choices and finally an informative question. The questionnaire was applied in Ceagesp food bank in the biggest center of food in Brazil. Conclusions. 30 % of participants of Ceagesp bank had already heard of the Food irradiation but did not know about the mechanism, so they rejected the idea to associate with radioactivity and danger. The video showed in the last question and application of the questionnaire disseminated the idea of security. All individuals declare understand the goal of treatment and accept buy and consume irradiated food after them.

Keywords: bank of food, questionary, irradiated food, acceptance of irradiated food

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Authors: Phill-Seung Jung, Dae-Yeon Kim

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Objectives: In young, especially nulliparous women, it is not easy to decide on excisional therapy for cervical intraepithelial neoplasia (CIN). We aimed to evaluate how effective topical imiquimod is in the treatment of high-grade CIN so that excisional therapy can be avoided in young women. Methods: Patients with CIN were allocated to this pilot study. They did not want excisional therapy and agreed with topical imiquimod therapy, which required once-a-week hospital visit for 8 weeks for the application of imiquimod to the cervix by a gynecologic oncologist. If the lesion got worse during treatment, it was decided to convert imiquimod therapy to excisional therapy. Results: A total of 36 patients with a median age of 29 years (range, 22–41 years) agreed to receive topical imiquimod therapy. Of these, 32 patients (88.9%) were positive for high-risk human papillomavirus (HR HPV). Twenty-five patients (69.4%) had low-grade squamous intraepithelial lesion (LSIL), and 11 (30.6%) had high-grade squamous intraepithelial lesion (HSIL) on their initial LBC. Twenty-eight patients underwent punch biopsy, which showed CIN 1 in 7 (19.4%), CIN 2 in 11 (30.6%), and CIN 3 in 10 (27.8%) patients. Twenty patients finished the 8-week imiquimod therapy. Among them, 14 patients had CIN 2 or 3, and 6 patients had CIN 1. HR HPV was positive in 12 patients. On the last examination, 14 patients (70.0%) had negative intraepithelial lesions, 3 (15.0%) had atypical squamous cells of undetermined significance, and 1 (5.0%) had LSIL. Two patients had persistent HSIL: 1 patient underwent loop electrosurgical excision procedure, resulting in CIN 3 with positive resection margin, and the other patient underwent punch biopsy, resulting in intermediate cells and restarted imiquimod therapy. Only 7 patients were negative for HR HPV. Conclusions: This study showed that topical imiquimod therapy was effective for the treatment of high-grade CIN, with a histologic regression rate of 85.7% (14/20) and HPV eradication rate of 25.0% (8/32). Based on our findings, topical imiquimod therapy might have a successful therapeutic effect in young women with CIN 2-3 so that they can avoid excisional therapy. In addition, it could be a more reassuring treatment option for CIN 1 than just follow-up after few months. To confirm its efficacy, a phase II study with larger cohort would be needed.

Keywords: Imiquimod, Cervical Intraepthelial Neoplasia, Cervical Dysplasia, Human Papillomavirus

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Authors: Sellidj Abdelaziz, Lebaili Soltane

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A cobalt-based alloy type Co-Cr-Ni-WC was deposited by plasma transferred arc projection (PTA) on a stainless steel valve. The alloy is characterized at the equilibrium by a solid solution Co (γ) mainly dendritic, and eutectic carbides M₇C₃ and ηM₆C. At the deposit/substrate interface, this microstructure is modified by the fast cooling mode of the alloy when applied in the liquid state on the relatively cold steel substrate. The structure formed in this case is heterogeneous and metastable phases can occur and evolve over temperature service. Coating properties and reliability are directly related to microstructures formed during deposition. We were interested more particularly in this microstructure formed during the solidification of the deposit in the region of the interface joining the soldered couple and its evolution during cyclic heat treatments at temperatures similar to those of the thermal environment of the valve. The characterization was carried out by SEM-EDS microprobe CAMECA, XRD, and micro hardness profiles. The deposit obtained has a linear and regular appearance that is free of cracks and with little porosity. The morphology of the microstructure represents solidification stages that are relatively fast with a temperature gradient high at the beginning of the interface by forming a plane front solid solution Co (γ). It gradually changes with the decreasing temperature gradient by getting farther from the junction towards the outer limit of the deposit. The matrix takes the forms: cellular, mixed (cells and dendrites) and dendritic. Dendritic growth is done according to primary ramifications in the direction of the heat removal which takes place in the direction perpendicular to the interface, towards the external surface of the deposit, following secondary and tertiary undeveloped arms. The eutectic carbides M₇C₃ and ηM₆C formed are very thin and are located in the intercellular and interdendritic spaces of the solid solution Co (γ).

Keywords: Co-Ni-Cr-W-C alloy, solid deposit, microstructure, carbides, cyclic heat treatment

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Authors: Yasin I. Tayem, Jamil Ahmed, Mahmood Bahzad, Abdullah Alnama, Fahad Al Asfoor, Mahmood A. Jalil, Mohammed Radhi, Ahmed Alenezi, Khalid A. J. Al-Khaja

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Drug-drug interactions (DDIs) represent a significant cause of patient’s morbidity and mortality. The rate of DDIs is rapidly increasing worldwide with the increasing proportion of ageing population and frequent requirement of polypharmacy-prescription of multiple drugs to treat comorbidities. Prescribing physicians are responsible for checking their prescriptions for the presence and severity of DDIs. However, since a large number of new drugs are approved and marketed every year, new interactions between medications are increasingly reported. Consequently, it is no longer practical for physicians to rely only upon their previous knowledge of medicine to avoid potential DDIs. The aim of this study was to explore the perceptions of physicians working at primary healthcare centers in Bahrain towards DDIs and how they manage them during their practice. Methodology: In this cross-sectional study, physicians working at all governmental primary healthcare centers in Bahrain were invited to voluntarily, privately and anonymously respond to a self-administered questionnaire. The questionnaire aims to assess their self-reported knowledge of DDIs and how they check for them in their practice. The participants were requested to provide socio demographic data and information related to their attitudes towards DDIs including strategies they employ for detecting and managing them, and their awareness of drugs which commonly cause DDIs. At the end of the questionnaire, an open-ended item was added to allow participants to further add any comment. Findings and Conclusions: The study is going on currently, and the results and conclusions will be presented at the conference.

Keywords: awareness, drug interactions, health centres, physicians

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Authors: Thapa M., J.P. Dutta, K.R. Pandey, R.R. Kattel

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Nepal is extremely vulnerable to the impact of climate change. To mitigate the climate change effects on agricultural production and productivity a range of adaptive strategies needs to be considered. The study was conducted to assess organic paddy production as a coping strategy to the adverse impact of climate change in Phulbari, VDC of Chitwan district. Altogether, 120 respondents (60 adopters of organic farming and 60 from non adopter) were selected using snowball technique of sampling. Pre- tested interview schedule, direct observation, focus group discussion, key informant interview as well as secondary data were used to collect the required information. Factors determining the adoption of organic farming were found to be age, year of schooling, training, frequency of extension contact, perception about climate change, economically active members and poor. A unit increase in these factors except poor would increase the probability of adoption by 4.1%, 7.5%, 7.8%, 43.1%, 41.8% and 7% respectively. However, for poor, it would decrease the probability of adoption of organic farming by 5.1%. Average organic matter content in the adopters' field was higher (2.7%) than the non-adopters' field (2.5%). The regression result showed that type of farmer, price and area under rice cultivation had positive and significant relationship with income; however dependency ratio had negative relationship. As the year of adoption of organic farming increases, the production of rice decline in the first two years then after goes on increasing but the cost of production goes on decreasing with the year of adoption. The respondents adapted to the changing climate through diversification of crops, use of resistance varieties and following good cropping pattern. Gradually growing consumers' awareness about health, preference towards quality food products are the strong points behind organic farming, whereas lacks of bio-fertilizers, lack of effective extension services, no price differentiation between organic and inorganic products were the weak points. There is need for more training and education to change the attitude of farmers and enhance their confidence about the role of organic farming to cope with climate change impact.

Keywords: Organic farming, climate change, sustainable development

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Authors: Sani M. Lawal, Idris Musa, Aliyu D. Usman

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The Pareto approach of optimal solutions in a search space that evolved in multi-objective optimization problems is adopted in this paper, which stands for a set of solutions in the search space. This paper aims at presenting an optimal placement of Distributed Generation (DG) in radial distribution networks with an optimal size for minimization of power loss and voltage deviation as well as maximizing voltage profile of the networks. And these problems are formulated using particle swarm optimization (PSO) as a constraint nonlinear optimization problem with both locations and sizes of DG being continuous. The objective functions adopted are the total active power loss function and voltage deviation function. The multiple nature of the problem, made it necessary to form a multi-objective function in search of the solution that consists of both the DG location and size. The proposed PSO algorithm is used to determine optimal placement and size of DG in a distribution network. The output indicates that PSO algorithm technique shows an edge over other types of search methods due to its effectiveness and computational efficiency. The proposed method is tested on the standard IEEE 34-bus and validated with 33-bus test systems distribution networks. Results indicate that the sizing and location of DG are system dependent and should be optimally selected before installing the distributed generators in the system and also an improvement in the voltage profile and power loss reduction have been achieved.

Keywords: distributed generation, pareto, particle swarm optimization, power loss, voltage deviation

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Authors: Adedayo Jeremiah Adeyekun, Samuel Oluwagbemiga Ishola

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This paper aimed to identify the significance of sustainability in the built environment, the economic and environmental importance to building and construction projects. Sustainability in the built environment has been a key objective of research over the past several decades. Sustainability in the built environment requires reconciliation between economic, environmental and social impacts of design and planning decisions made during the life cycle of a project from inception to termination. Planning for sustainability in the built environment needs us to go beyond our individual disciplines to consider the variety of economic, social and environmental impacts of our decisions in the long term. A decision to build a green residential development in an isolated location may pass some of the test of sustainability through its reduction in stormwater runoff, energy efficiency, and ecological sustainability in the building, but it may fail to be sustainable from a transportation perspective. Sustainability is important to the planning, design, construction, and preservation of the built environment; because it helps these activities reflect multiple values and considerations. In fact, the arts and sciences of the built environment have traditionally integrated values and fostered creative expression, capabilities that can and should lead the sustainability movement as society seeks ways to live in dynamic balance with its own diverse needs and the natural world. This research aimed to capture the state-of-the-art in the development of innovative sustainable design and planning strategies for building and construction projects. Therefore, there is a need for a holistic selection and implication approach for identifying potential sustainable strategies applicable to a particular project and evaluating the overall life cycle impact of each alternative by accounting for different applicable impacts and making the final selection among various viable alternatives.

Keywords: sustainability, built environment, planning, design, construction

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Authors: Farah Naja, Mohamad Alameddine

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Background: The difficulty of compliance to therapeutic and lifestyle management of type 2 diabetes mellitus (T2DM) encourages patients to use complementary and alternative medicine (CAM) therapies. Little is known about the prevalence and mode of CAM use among diabetics in the Eastern Mediterranean Region in general and Lebanon in particular. Objective: To assess the prevalence and modes of CAM use among patients with T2DM residing in Beirut, Lebanon. Methods: A cross-sectional survey of T2DM patients was conducted on patients recruited from two major referral centers - a public hospital and a private academic medical center in Beirut. In a face-to-face interview, participants completed a survey questionnaire comprised of three sections: socio-demographic, diabetes characteristics and types and modes of CAM use. Descriptive statistics, univariate and multivariate logistic regression analyses were utilized to assess the prevalence, mode and correlates of CAM use in the study population. The main outcome in this study (CAM use) was defined as using CAM at least once since diagnosis with T2DM. Results: A total of 333 T2DM patients completed the survey (response rate: 94.6%). Prevalence of CAM use in the study population was 38%, 95% CI (33.1-43.5). After adjustment, CAM use was significantly associated with a “married” status, a longer duration of T2DM, the presence of disease complications, and a positive family history of the disease. Folk foods and herbs were the most commonly used CAM followed by natural health products. One in five patients used CAM as an alternative to conventional treatment. Only 7 % of CAM users disclosed the CAM use to their treating physician. Health care practitioners were the least cited (7%) as influencing the choice of CAM among users. Conclusion: The use of CAM therapies among T2DM patients in Lebanon is prevalent. Decision makers and care providers must fully understand the potential risks and benefits of CAM therapies to appropriately advise their patients. Attention must be dedicated to educating T2DM patients on the importance of disclosing CAM use to their physicians especially patients with a family history of diabetes, and those using conventional therapy for a long time.

Keywords: nutritional supplements, type 2 diabetes mellitus, complementary and alternative medicine (CAM), conventional therapy

Procedia PDF Downloads 324

Authors: Feleke Terefe Fanta

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Background: The existence of heavy metals and coliform bacteria contaminants in aquatic system of Akaki river basin, a sub city of Addis Ababa, Ethiopia has become a public concern as human population increases and land development continues. Hence, it is the right time to design treatment technologies that can handle multiple pollutants. Results: In this study, we prepared a synthetic zeolites and copper doped zeolite composite adsorbents as cost effective and simple approach to simultaneously remove heavy metals and total coliforms from wastewater of Akaki river. The synthesized copper–zeolite X composite was obtained by ion exchange method of copper ions into zeolites frameworks. Iodine test, XRD, FTIR and autosorb IQ automated gas sorption analyzer were used to characterize the adsorbents. The mean concentrations of Cd, Cr, and Pb in untreated sample were 0.795, 0.654 and 0.7025 mg/L respectively. These concentrations decreased to Cd (0.005 mg/L), Cr (0.052 mg/L) and Pb (bellow detection limit, BDL) for sample treated with bare zeolite X while a further decrease in concentration of Cd (0.005 mg/L), Cr (BDL) and Pb (BDL) was observed for the sample treated with copper–zeolite composite. Zeolite X and copper-modified zeolite X showed complete elimination of total coliforms after 90 and 50 min contact time respectively. Conclusion: The results obtained in this study showed high antimicrobial disinfection and heavy metal removal efficiencies of the synthesized adsorbents. Furthermore, these sorbents are efficient in significantly reducing physical parameters such as electrical conductivity, turbidity, BOD and COD.

Keywords: WASTE WATER, COPPER DOPED ZEOITE X, ADSORPITION, HEAVY METAL, DISINFECTION, AKAKI RIVER

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Authors: Jixiang Lei, Alexander Fuchs, Franz Pernkopf, Katrin Ellermann

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Within the Space@Sea project, funded by the Horizon 2020 program, an island consisting of multiple platforms was designed. The platforms are connected by ropes and fenders. The connection is critical with respect to the safety of the whole system. Therefore, fault detection systems are investigated, which could detect early warning signs for a possible failure in the connection elements. Previously, a model-based method called Extended Kalman Filter was developed to detect the reduction of rope stiffness. This method detected several types of faults reliably, but some types of faults were much more difficult to detect. Furthermore, the model-based method is sensitive to environmental noise. When the wave height is low, a long time is needed to detect a fault and the accuracy is not always satisfactory. In this sense, it is necessary to develop a more accurate and robust technique that can detect all rope faults under a wide range of operational conditions. Inspired by this work on the Space at Sea design, we introduce a fault diagnosis method based on deep neural networks. Our method cannot only detect rope degradation by using the acceleration data from each platform but also estimate the contributions of the specific acceleration sensors using methods from explainable AI. In order to adapt to different operational conditions, the domain adaptation technique DANN is applied. The proposed model can accurately estimate rope degradation under a wide range of environmental conditions and help users understand the relationship between the output and the contributions of each acceleration sensor.

Keywords: fault diagnosis, deep learning, domain adaptation, explainable AI

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Authors: Emmanuel Abayomi Rotimi

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Context: Rabbits production plays important role in increasing animal protein supply in Nigeria. Rabbit production provides a cheap, affordable, and healthy source of meat. The growth of animals involves an increase in body weight, which can change the conformation of various parts of the body. Live weight and linear measurements are indicators of growth rate in rabbits and other farm animals. Aims: This study aimed to define the body dimensions of New Zealand rabbits and also to investigate the morphometric traits variables that contribute to body conformation by the use of principal component analysis (PCA). Methods: Data were obtained from 80 New Zealand rabbits (40 bucks and 40 does) raised in Livestock Teaching and Research Farm, Federal University Dutsinma. Data were taken on body weight (BWT), body length (BL), ear length (EL), tail length (TL), heart girth (HG) and abdominal circumference (AC). Data collected were subjected to multivariate analysis using SPSS 20.0 statistical package. Key results: The descriptive statistics showed that the mean BWT, BL, EL, TL, HG, and AC were 0.91kg, 27.34cm, 10.24cm, 8.35cm, 19.55cm and 21.30cm respectively. Sex showed significant (P<0.05) effect on all the variables examined, with higher values recorded for does. The phenotypic correlation coefficient values (r) between the morphometric traits were all positive and ranged from r = 0.406 (between EL and BL) to r = 0.909 (between AC and HG). HG is the most correlated with BWT (r = 0.786). The principal component analysis with variance maximizing orthogonal rotation was used to extract the components. Two principal components (PCs) from the factor analysis of morphometric traits explained about 80.42% of the total variance. PC1 accounted for 64.46% while PC2 accounted for 15.97% of the total variances. Three variables, representing body conformation, loaded highest in PC1. PC1 had the highest contribution (64.46%) to the total variance, and it is regarded as body conformation traits. Conclusions: This component could be used as selection criteria for improving body weight of rabbits.

Keywords: conformation, multicollinearity, multivariate, rabbits and principal component analysis

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Authors: Reni Francis

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Learning has transcended the classroom boundaries to create a learner centric, interactive, and integrative teaching learning environment. This study analysed the impact of iLearn on the teaching, learning, and evaluation among 100 teacher trainees. The objectives were to cater to the different learning styles of the teacher trainees, to incorporate innovative teaching learning activities, to assist in peer tutoring, to implement different evaluation processes. i: Identifying the learning styles among the teacher trainees through VARK Learning style checklist was followed by planning the teaching-learning process to meet the learning styles of the teacher trainees. L: Leveraging innovations in teaching- learning by planning and creating modules incorporating innovative teaching learning and hence the concept based year plan was prepared. E: Engage learning through constructivism using different teaching methodology to engage the teacher trainees in the learning process through Workshop, Round Robin, Gallery walk, Co-Operative learning, Think-Pair-Share, EDMODO, Course Networking, Concept Map, Brainstorming Sessions, Video Clippings. A: Assessing the learning through an Open Book assignment, Closed book assignment, and Multiple Choice Questions and Seminar presentation. R: Remediation through peer tutoring through Mentor-mentee approach in the tutorial groups, Group work, Library Hours. N: Norming new standards. This was done in the form of extended remediation and tutorials to understand the need of the teacher trainee and support them for further achievements in learning through Face to face interaction, Supervised Study Circle, Mobile (Device) learning. The findings of the study revealed the positive impact of iLearn towards student achievement and enhanced social skills.

Keywords: academic achievement, innovative strategy, learning styles, social skills

Procedia PDF Downloads 332

Authors: Lovesh Goyal, Pushkar Dave, Prajyot Jadhav, GonnaYaswanth, Sakshi Giri, Sahil Dharme, Rushika Joshi, Rishabh Verma, Shital Chiddarwar

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With the rising need for human-robot interaction, researchers have proposed and tested multiple models with varying degrees of success. A few of these models performed on aerial platforms are commonly known as Tethered Aerial Systems. These aerial vehicles may be powered continuously by a tether cable, which addresses the predicament of the short battery life of quadcopters. This system finds applications to minimize humanitarian efforts for industrial, medical, agricultural, and service uses. However, a significant challenge in employing such systems is that it necessities attaining smooth and secure robot-human interaction while ensuring that the forces from the tether remain within the standard comfortable range for the humans. To tackle this problem, a hybrid control method that could switch between two control techniques: constant control input and the steady-state solution, is implemented. The constant control approach is implemented when a person is far from the target location, and error is thought to be eventually constant. The controller switches to the steady-state approach when the person reaches within a specific range of the goal position. Both strategies take into account human velocity feedback. This hybrid technique enhances the outcomes by assisting the person to reach the desired location while decreasing the human's unwanted disturbance throughout the process, thereby keeping the interaction between the robot and the subject smooth.

Keywords: unmanned aerial vehicle, tethered system, physical human-robot interaction, hybrid control

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Authors: Lizel Bertie, Kim Johnston

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Parental emotion regulation plays a central role in the socialisation of emotion, especially when teaching young children to cope with negative emotions. Despite evidence which shows non-supportive parental responses to children’s expression of negative emotions has implications for the social and emotional development of the child, few studies have investigated risk factors which impact parental emotion socialisation processes. The current study aimed to explore the extent to which parental stress contributes to both difficulties in parental emotion regulation and non-supportive parental responses to children’s expression of negative emotions. In addition, the study examined whether parental use of expressive suppression as an emotion regulation strategy facilitates the influence of parental stress on non-supportive responses by testing the relations in a mediation model. A sample of 140 Australian adults, who identified as parents with children aged 5 to 10 years, completed an online questionnaire. The measures explored recent symptoms of depression, anxiety, and stress, the use of expressive suppression as an emotion regulation strategy, and hypothetical parental responses to scenarios related to children’s expression of negative emotions. A mediated regression indicated that parents who reported higher levels of stress also reported higher levels of expressive suppression as an emotion regulation strategy and increased use of non-supportive responses in relation to young children’s expression of negative emotions. These findings suggest that parents who experience heightened symptoms of stress are more likely to both suppress their emotions in parent-child interaction and engage in non-supportive responses. Furthermore, higher use of expressive suppression strongly predicted the use of non-supportive responses, despite the presence of parental stress. Contrary to expectation, no indirect effect of stress on non-supportive responses was observed via expressive suppression. The findings from the study suggest that parental stress may become a more salient manifestation of psychological distress in a sub-clinical population of parents while contributing to impaired parental responses. As such, the study offers support for targeting overarching factors such as difficulties in parental emotion regulation and stress management, not only as an intervention for parental psychological distress, but also the detection and prevention of maladaptive parenting practices.

Keywords: emotion regulation, emotion socialisation, expressive suppression, non-supportive responses, parental stress

Procedia PDF Downloads 139

Authors: Rajeev Kumar, Angad Singh Kushwaha, Amritanshu Pandey, S. K. Srivastava

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Photonic crystals (PCs) have attracted much attention due to its electromagnetic properties and potential applications. In PCs, there is certain range of wavelength where electromagnetic waves are not allowed to pass are called photonic band gap (PBG). A localized defect mode will appear within PBG, due to change in the interference behavior of light, when we create a defect in the periodic structure. We can also create different types of defect structures by inserting or removing a layer from the periodic layered structure in two and three-dimensional PCs. We can design microcavity, waveguide, and perfect mirror by creating a point defect, line defect, and palanar defect in two and three- dimensional PC structure. One-dimensional and two-dimensional PCs with defects were reported theoretically and experimentally by Smith et al.. in conventional photonic band gap structure. In the present paper, we have presented the defect mode tunability in tilted non-graded photonic crystal (NGPC) and linearly graded photonic crystal (LGPC) using lead sulphide (PbS) and titanium dioxide (TiO2) in the infrared region. A birefringent defect layer is created in NGPC and LGPC using potassium titany phosphate (KTP). With the help of transfer matrix method, the transmission properties of proposed structure is investigated for transverse electric (TE) and transverse magnetic (TM) polarization. NGPC and LGPC without defect layer is also investigated. We have found that a photonic band gap (PBG) arises in the infrared region. An additional defect layer of KTP is created in NGPC and LGPC structure. We have seen that an additional transmission mode appers in PBG region. It is due to the addition of defect layer. We have also seen the effect, linear gradation in thickness, angle of incidence, tilt angle, and thickness of defect layer, on PBG and additional transmission mode. We have observed that the additional transmission mode and PBG can be tuned by changing the above parameters. The proposed structure may be used as channeled filter, optical switches, monochromator, and broadband optical reflector.

Keywords: defect modes, graded photonic crystal, photonic crystal, tilt angle

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Authors: R. Geetha, J. Arunkumar, P. Gopal, D. Loganathan, K. Pavithra, C. Vikashini

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Mobile Number Portability is an attempt to switch over from one network to another network facility for mobile based on applications. This facility is currently not available for mobile handsets. This application is intended to assist the mobile network and its service customers in understanding the criteria; this will serve as a universal set of requirements which must be met by the customers. This application helps the user's network portability. Accessing permission from the network provider to enable services to the user and utilizing the available network signals. It is enabling the user to make a temporary switch over to other network. The main aim of this research work is to adapt multiple networks at the time of no network coverage. It can be accessed at rural and geographical areas. This can be achieved by this mobile application. The application is capable of temporary switch over between various networks. With this application both the service provider and the network user are benefited. The service provider is benefited by charging a minimum cost for utilizing other network. It provides security in terms of password that is unique to avoid unauthorized users and to prevent loss of balance. The goal intended to be attained is a complete utilization of available network at significant situations and to provide feature that satisfy the customer needs. The temporary switch over is done to manage emergency calls when user is in rural or geographical area, where there will be a very low network coverage. Since people find it trend in using Android mobile, this application is designed as an Android applications, which can be freely downloaded and installed from Play store. In the current scenario, the service provider enables the user to change their network without shifting their mobile network. This application affords a clarification for users while they are jammed in a critical situation. This application is designed by using Android 4.2 and SQLite Version3.

Keywords: mobile number, random number, alarm, imei number, call

Procedia PDF Downloads 331

Authors: Jonathan Soliman, Thomas Cavasino, Virginie Pommelet, Lahouari Amor, Pierre Mornand, Simon Escoda, Nina Droz, Soraya Matczak, Julie Toubiana, François Angoulvant, Etienne Carbonnelle, Albert Faye, Loic de Pontual, Luu-Ly Pham

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Background: Typhoid and paratyphoid fever are systemic infections caused by Salmonella enterica serovar Typhi or paratyphi (A, B, C). Children traveling to tropical areas are at risk to contract these diseases which can be complicated. Methods: Clinical, biological and bacteriological data were collected from 78 pediatric cases reported between 2000 and 2017 in six Parisian hospitals. Children aged 0 to 18 years old, with a diagnosis of typhoid or paratyphoid fever confirmed by bacteriological exams, were included. Epidemiologic, clinical, biological features and presence of multidrug-resistant (MDR) bacteria or intermediate susceptibility to ciprofloxacin (nalidixic acid resistant) were examined by univariate analysis and by logistic regression analysis to identify risk factors of severe typhoid in children. Results: 84,6% of the children were imported cases of typhoid fever (n=66/78) and 15,4% were autochthonous cases (n=12/78). 89,7% were caused by S.typhi (n=70/78) and 12,8% by S.paratyphi (n=10/78) including 2 co-infections. 19,2% were intrafamilial cases (n=15/78). Median age at diagnosis was 6,4 years-old [6 months-17,9 years]. 28,2% of the cases were complicated forms (n=22/78): digestive (n=8; 10,3%), neurological (n=7; 9%), pulmonary complications (n=4; 5,1%) and hemophagocytic syndrome (n=4; 5,1%). Only 5% of the children had prior immunization with typhoid non-conjugated vaccine (n=4/78). 28% of the cases (n=22/78) were caused by resistant bacteria. Thrombocytopenia and diagnosis delay was significantly associated with severe infection (p= 0.029 and p=0,01). Complicated forms were more common with MDR (p=0,1) and not statistically associated with a young age or sex in this study. Conclusions: Typhoid and paratyphoid fever are not rare in children back from tropical areas. This multicentric pediatric study seems to show that thrombocytopenia, diagnosis delay, and multidrug resistant bacteria are associated with severe typhoid fever and complicated forms in children.

Keywords: antimicrobial resistance, children, Salmonella enterica typhi and paratyphi, severe typhoid

Procedia PDF Downloads 152