Search results for: rare disease policy

Authors: Ese Urhie, Olabisi Popoola, Obindah Gershon

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Several policies and programs initiated to address the challenge of unemployment in Nigeria seem to be inadequate. The desired structural transformation which is expected to absorb the excess labour in the economy is yet to be achieved. The agricultural sector accounts for almost half of the labour force with very low productivity. This could partly explain why the much anticipated structural transformation has not been achieved. A major reason for the low productivity is the fact that the production process is predominantly based on the use of traditional tools. In view of the underdeveloped nature of the agricultural sector, Nigeria still has huge potentials for productivity enhancement through modern technology. Aside from productivity enhancement, modern agriculture also stimulates both backward and forward linkages that promote investment and thus generate employment. Contrary to the apprehension usually expressed by many stake-holders about the adoption of modern technology by labour-abundant less-developed countries, this study showed that though there will be job loss initially, the reverse will be the case in the long-run. The outcome of this study will enhance the understanding of all stakeholders in the sector and also encourage them to adopt modern techniques of farming. It will also aid policy formulation at both sectoral and national levels. The recursive model and analysis adopted in the study is useful because it exhibits a unilateral cause-and-effect relationship which most simultaneous equation models do not. It enables the structural equations to be ordered in such a way that the first equation includes only predetermined variables on the right-hand side, while the solution for the final endogenous variable is completely determined by all equations of the system. The study examines the transmission channels and effect of modern agriculture on agricultural productivity and employment growth in Nigeria, via its forward and backward linkages. Using time series data spanning 1980 to 2014, the result of the analyses shows that: (i) a significant and positive relationship between agricultural productivity growth and modern agriculture; (ii) a significant and negative relationship between export price index and agricultural productivity growth; (iii) a significant and positive relationship between export and investment; and (iv) a significant and positive relationship between investment and employment growth. The unbalanced growth theory will be a good strategy to adopt by developing countries such as Nigeria.

Keywords: employment, modern agriculture, productivity, recursive model

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Authors: Sushil Kumar Singh, Kumar Rahul, Vivek Tewarson, Sarvesh Kumar, Shobhit Kumar

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Objective: Rheumatic mitral stenosis continues to be a major public health problem in developing countries. When the left atrium (LA) is unable to fill the left ventricle (LV) at normal LA pressures due to impaired relaxation and impaired compliance, diastolic dysfunction occurs. The assessment of left ventricular (LV) diastolic function and filling pressures is of clinical importance to identify underlying cardiac disease, its treatment, and to assess prognosis. 2D echocardiography can detect diastolic dysfunction with excellent sensitivity and minimal risk when compared to the gold standard of invasive pressure-volume measurements. Material and Method: This was a one-year study consisting of twenty-nine patients of isolated rheumatic severe mitral stenosis. Data was analyzed preoperative and post operative (at one month follow-up). Transthoracic 2D echocardiographic parameters of the diastolic function are transmitral flow, pulmonary venous flow, mitral annular tissue doppler, and color M-mode doppler. In our study, mitral valve orifice area, ejection fraction, deceleration time, E/A-wave, E/E’-wave, myocardial performance index of left ventricle (Tei index ), and Mitral inflow propagation velocity were included for echocardiographic evaluation. The statistical analysis was performed on SPSS Version 15.0 statistical analysis software. Result: Twenty-nine patients underwent successful closed mitral commissurotomy for isolated mitral stenosis. The outcome measures were observed pre-operatively and at one-month follow-up. The majority of patients were in NYHA grade III (69.0%) in the preoperative period, which improved to NYHA grade I (48.3%) after closed mitral commissurotomy. Post-surgery mitral valve area increased from 0.77 ± 0.13 to 2.32 ± 0.26 cm, ejection fraction increased from 61.38 ± 4.61 to 64.79 ± 3.22. There was a decrease in deceleration time from 231.55 ± 49.31 to 168.28 ± 14.30 ms, E/A ratio from 1.70 ± 0.54 from 0.89 ± 0.39, E/E’ ratio from 14.59 ± 3.34 to 8.86 ± 3.03. In addition, there was improvement in TIE index from 0.50 ± 0.03 to 0.39 ± 0.06 and mitral inflow propagation velocity from 47.28 ± 3.71 to 57.86 ± 3.19 cm/sec. In peri-operative and follow-up, there was no incidence of severe mitral regurgitation (MR). There was no thromboembolic incident and no mortality.

Keywords: closed mitral valvotomy, mitral stenosis, open mitral commissurotomy, balloon mitral valvotomy

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Authors: Kim Jin-OK, Lee Jin-Eui, Han Seung-Hoon, Kim Nam-Jo

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This study aimed to analyze the effect of the motivation of Chinese tourists to visit North Korea on their decision making process. Chinese tourists account for a considerable portion of foreign tourists in the world, while North Korea is the favorite tourist attraction of Chinese tourists. The motivation to visit North Korea was divided into three factors: the redness, which is the modern cultural heritage of Communism based on the red tourism accounting for the significant portion of domestic tourism, the novelty of the special environment of North Korean society, and the convenience of tour to North Korea in terms of geographical distance and policy of China. Red tourism refers to visiting the places of revolutionary events, monuments, artifacts and the residences of previous communist leaders, and other places related to the past Chinese Communist Party. As a revolutionary tourism, red tourism has recently been taking place in the old communist countries to recall their memories on the revolutionary places in China, as well as in North Korea, Vietnam, Cambodia, Russia, Bulgaria, Cuba, etc. In order to examine the effect of the segmented motivations on the revisit intention of Chinese tourists who have experienced a tour to North Korea, this study employed the model of goal-directed behavior, a model developed by adding a variable of emotion to the theory of planned behavior, which has a strong explanatory power on the decision making process of people in social science. For achieving the aim of the study, the data was collected through the survey in Dandong, China against Chinese tourists who have visited North Korea. The results of this study found that not only the novelty of North Korea, but also the redness, which accounts for the largest proportion in the domestic tourism, are significantly affecting overseas tour of Chinese tourists at this time point where overseas tour of Chinese tourists continue to increase. The results, therefore, suggest that the old communist countries, including those in Asia, need an emotional promotion strategy that stimulates nostalgia by focusing on the redness of the modern cultural heritage of Communism to attract Chinese tourists.

Keywords: model of goal-directed behavior, modern cultural heritage, North Korea, red tourism

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Authors: Seba Mohanty, Jitendra Mahakud

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Capital ratio is one of the major indicators of the stability of the commercial banks. Pertinent to its pervasive importance, over the years the regulators, policy makers focus on the maintenance of the particular level of capital ratio to minimize the solvency and liquidation risk. In this context, it is very much important to identify the relationship between capital and risk and find out the factors which determine the capital ratios of commercial banks. The study examines the relationship between capital and risk of the commercial banks operating in India. Other bank specific variables like bank size, deposit, profitability, non-performing assets, bank liquidity, net interest margin, loan loss reserves, deposits variability and regulatory pressure are also considered for the analysis. The period of study is 1997-2015 i.e. the period of post liberalization. To identify the impact of financial crisis and implementation of Basel II on capital ratio, we have divided the whole period into two sub-periods i.e. 1997-2008 and 2008-2015. This study considers all the three types of commercial banks, i.e. public sector, the private sector and foreign banks, which have continuous data for the whole period. The main sources of data are Prowess data base maintained by centre for monitoring Indian economy (CMIE) and Reserve Bank of India publications. We use simultaneous equation model and more specifically Two Stage Least Square method to find out the relationship between capital and risk. From the econometric analysis, we find that capital and risk affect each other simultaneously, and this is consistent across the time period and across the type of banks. Moreover, regulation has a positive significant impact on the ratio of capital to risk-weighted assets, but no significant impact on the banks risk taking behaviour. Our empirical findings also suggest that size has a negative impact on capital and risk, indicating that larger banks increase their capital less than the other banks supported by the too-big-to-fail hypothesis. This study contributes to the existing body of literature by predicting a strong relationship between capital and risk in an emerging economy, where banking sector plays a majority role for financial development. Further this study may be considered as a primary study to find out the macro economic factors which affecting risk and capital in India.

Keywords: capital, commercial bank, risk, simultaneous equation model

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Authors: Lisa Bennett, Cynthia Walters, Cynthia Argani, Andy Satin, Geeta Sood, Kerri Huber, Lisa Grubb, Woodrow Noble, Melissa Eichelberger, Darlene Zinalabedini, Eric Ausby, Jeffrey Snyder, Kevin Kirchoff

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Background: Surgical site infections (SSIs) within the obstetric population pose a variety of complications, creating clinical and personal challenges for the new mother and her neonate during the postpartum period. Our journey to achieve compliance with the SSI core measure for cesarean sections revealed many opportunities to improve these outcomes. Objective: Achieve and sustain core measure compliance keeping surgical site infection rates below the national benchmark pooled mean of 1.8% in post-operative patients, who delivered via cesarean section at the Johns Hopkins Bayview Medical Center. Methods: A root cause analysis was performed and revealed several environmental, pharmacologic, and clinical practice opportunities for improvement. A multidisciplinary approach led by the OB Safety Nurse, OB Medical Director, and Infectious Disease Department resulted in the implementation of fourteen interventions over a twenty-month period. Interventions included: post-operative dressing changes, standardizing operating room attire, broadening pre-operative antibiotics, initiating vaginal preps, improving operating room terminal cleaning, testing air quality, and re-educating scrub technicians on technique. Results: Prior to the implementation of our interventions, the SSI quarterly rate in Obstetrics peaked at 6.10%. Although no single intervention resulted in dramatic improvement, after implementation of all fourteen interventions, the quarterly SSI rate has subsequently ranged from to 0.0% to 2.70%. Significance: Taking an introspective look at current practices can reveal opportunities for improvement which previously were not considered. Collectively the benefit of these interventions has shown a significant decrease in surgical site infection rates. The impact of this quality improvement project highlights the synergy created when members of the multidisciplinary team work in collaboration to improve patient safety, and achieve a high quality of care.

Keywords: cesarean section, surgical site infection, collaboration and teamwork, patient safety, quality improvement

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Authors: Mark Morgan, Christine Li, Shuangyu Xu, Jenny McCarty

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The National Wild and Scenic Rivers System was created by the U.S. Congress in 1968 (Public Law 90-542; 16 U.S.C. 1271 et seq.) to preserve outstanding natural, cultural, and recreational values of some U.S. rivers in a free-flowing condition for the enjoyment of present and future generations. This Act is notable for safeguarding the special character of these rivers while supporting management action that encourages public participation for co-creating river protection goals and strategies. This is not an easy task. To meet the challenges of modern ecosystem management, federal resource agencies must address many legal, environmental, economic, political, and social issues. The U.S. Forest Service manages a 44-mile section of the Eleven Point National Scenic River (EPR) in southern Missouri, mainly for outdoor recreation purposes. About half of the acreage is in private lands, while the remainder flows through the Mark Twain National Forest. Private land along the river is managed by scenic easements to ensure protection of scenic values and natural resources, without public access. A portion of the EPR lies adjacent to a 16,500-acre tract known as the Irish Wilderness. The spring-fed river has steep bluffs, deep pools, clear water, and a slow current, making it an ideal setting for outdoor enthusiasts. A 10-month visitor study was conducted at five access points along the EPR during 2019 so the US Forest Service could update their river management plan. A mail-back survey was administered to 560 on-site visitors, yielding a response rate of 53%. Although different types of visitors use the EPR, boating and fishing were the predominant forms of outdoor recreation. Some river use was from locals, but other visitors came from farther away. Formulating unbiased policies for outdoor recreation is difficult because managers must assign relative values to recreational activities and travel distance. Because policymaking is a subjective process, management decisions can affect user groups in different ways (i.e., boaters vs. fishers; proximate vs. distal visitors), as seen through a GIS analysis.

Keywords: activity selection, forest recreation, policy, travel distance

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Authors: Nabeeha Hassan Abdel Jalil, Lulwa Saeed Al Badi, Mouza Ghafan Alkhyeli, Khaja Mohteshamuddin, Ahmad Al Aiyan, Mohamed Elfatih Hamad, Robert Barigye

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The present study was done to elucidate the prevalence of enzootic bovine leucosis (EBL) in the UAE, the seroprevalence rates of EBL in dairy herds from the Al Ain area, Abu Dhabi (AD) and indigenous cattle at the Al Ain livestock market (AALM) were assessed. Of the 949 sera tested by ELISA, 657 were from adult Holstein-Friesians from three farms and 292 from indigenous cattle at the AALM. The level of significance between the proportions of seropositive cattle were analyzed by the Marascuilo procedure and questionnaire data on husbandry and biosecurity practices evaluated. Overall, the aggregated farm and AALM data demonstrated a seroprevalence of 25.9%, compared to 37.0% for the study farms, and 1.0% for the indigenous cattle. Additionally, the seroprevalence rates at farms #1, #2 and #3 were 54.7%, 0.0%, and 26.3% respectively. Except for farm #2 and the AALM, statistically significant differences were noted between the proportions of seropositive cattle for farms #1 and #2 (Critical Range or CR=0.0803), farms #1 and #3 (p=0.1069), and farms #2 and #3 (CR=0.0707), farm #1 and the AALM (CR=0.0819), and farm #3 and the AALM (CR=0.0726). Also, the proportions of seropositive animals on farm #1 were 9.8%, 59.8%, 29.3%, and 1.2% in the 12-36, 37-72, 73-108, and 109-144-mo-old age groups respectively compared to 21.5%, 60.8%, 15.2%, and 2.5% in the respective age groups for farm #2. On both farms and the AALM, the 37-72-mo-old age group showed the highest EBL seroprevalence rate while all the 57 cattle on farm #2 were seronegative. Additionally, farms #1 and #3 had 3,130 and 2,828 intensively managed Holstein-Friesian cattle respectively, and all animals were routinely immunized against several diseases except EBL. On both farms #1 and #3, artificial breeding was practiced using semen sourced from the USA, and USA and Canada respectively, all farms routinely quarantined new stock, and farm #1 previously imported dairy cattle from an unspecified country, and farm #3 from the Netherlands, Australia and South Africa. While farm #1 provided no information on animal nutrition, farm #3 cited using hay, concentrates, and ad lib water. To the authors’ best knowledge, this is the first serological evidence of EBL in the UAE and as previously reported, the seroprevalence rates are comparatively higher in the intensively managed dairy herds than in indigenous cattle. As two of the study farms previously sourced cattle and semen from overseas, biosecurity protocols need to be revisited to avoid inadvertent EBL incursion and the possibility of regional transboundary disease spread also needs to be assessed. After the proposed molecular studies have adduced additional data, the relevant UAE animal health authorities may need to develop evidence-based EBL control policies and programs.

Keywords: cattle, enzootic bovine leukosis, seroprevalence, UAE

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Authors: Cleto J. Sauer Jr., Rita C. Sauer, Chaider G. Andrade, Doris F. Rabelo

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Introduction: Endotracheal Intubation (ETI) is a procedure for clinical management of patients with severe clinical presentation of COVID-19 disease. Realistic simulation (RS) is an active learning methodology utilized for clinical skill's improvement. To improve ETI skills of public health network's physicians from Recôncavo da Bahia region in Brazil, during COVID-19 outbreak, RS training was planned and carried out. Training scenario included the Nasco Lifeform realistic simulator, and three actions were simulated: ETI procedure, sedative drugs management, and bougie guide utilization. Training intervention occurred between May and June 2020, as an interinstitutional cooperation between the Health's Department of Bahia State and the Federal University from Recôncavo da Bahia. Objective: The main objective is to report the effects on participants' self-confidence perception for ETI procedure after RS based training. Methods: This is a descriptive study, with secondary data extracted from questionnaires applied throughout RS training. Priority workplace, time from last intubation, and knowledge about bougie were reported on a preparticipation questionnaire. Additionally, participants completed pre- and post-training qualitative self-assessment (10-point Likert scale) regarding self-confidence perception in performing each of simulated actions. Distribution analysis for qualitative data was performed with Wilcoxon Signed Rank Test, and self-confidence increase analysis in frequency contingency tables with Fisher's Exact Test. Results: 36 physicians participated of training, 25 (69%) from primary care setting, 25 (69%) performed ETI over a year ago, and only 4 (11%) had previous knowledge about the bougie guide utilization. There was an increase in self-confidence medians for all three simulated actions. Medians (variation) for self-confidence before and after training, for each simulated action were as follows: ETI [5 (1-9) vs. 8 (6-10) (p < 0.0001)]; Sedative drug management [5 (1-9) vs. 8 (4-10) (p < 0.0001)]; Bougie guide utilization [2.5 (1-7) vs. 8 (4-10) (p < 0.0001)]. Among those who performed ETI over a year ago (n = 25), an increase in self-confidence greater than 3 points for ETI was reported by 23 vs. 2 physicians (p = 0.0002), and by 21 vs. 4 (p = 0.03) for sedative drugs management. Conclusions: RS training contributed to self-confidence increase in performing ETI. Among participants who performed ETI over a year, there was a significant association between RS training and increase of more than 3 points in self-confidence, both for ETI and sedative drug management. Training with RS methodology is suitable for ETI confidence enhancement during COVID-19 outbreak.

Keywords: confidence, COVID-19, endotracheal intubation, realistic simulation

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Authors: Zahra Mila Elmi, Mahsa Khanekheshi

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Almost half of the population and potential manpower in the country and rural areas are women. Manpower especially educated people, plays an important role in the production and economic growth. Also, the potential of rural areas to create employment should not be overlooked. In this research, the effects of socio-economic and demographic factors on women's economic participation in rural areas of Iran's provinces will be studied. Therefore, this study was performed by using the results of the rural households income and expenditure surveys -has been taken in 2016- in the framework of pseudo panel data. This study used the logit model and the maximum likelihood method to study the rural women's participation, with 28,265 observations. Results show the inverted U-shaped relationship between age and the probability of female participation; In other words, young women are more likely to participate in labor markets more than the other groups. Divorced and single woman has more chance of participation in comparison with who was being married. With increasing the divorce rate and singleness in Iran, economic policymakers must provide appropriate solutions for this challenge in the coming years. On the base of the results, being a student and the presence of an infant under the age of 6 in the household has a negative effect on the possibility of women's participation in the labor market. The women's education level has a U-shaped relationship with their participation rate. Illiteracy and high education have a strong positive effect on the economic participation of rural women. This shows the dual labor market for women in Iran. Illiterate women are attracted to service jobs, and educated woman are more attracted to education and health jobs. Increasing household income has a small but positive and significant effect on the probability of rural female participation. In the overlook, due to the frequency of the women population in the age group of 25 to 35 years, and more willingness of women in the age 35 to 44 years to participate in the labor market, and studying ofa significant portion of the rural women, the increase of rural female participation is expected in the years ahead. Thus, it is expected policy maker to create new job opportunities for the employment of educated women and take the necessary plan to improve the current situation for women.

Keywords: female participation rate, rural area, provincial data, pseudo-panel data method

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Authors: Sidong Zhao, Xingping Wang

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Recently, the government of China has provided strong support the developments of overseas industrial parks. The global distribution of China overseas industrial parks has gradually moved from the 'sparks of fire' to the 'prairie fires.' The support and distribution have promoted developing overseas industrial parks to a strategy of constructing a China's new open economic system and a typical representative of the 'Chinese wisdom' and the 'China's plans' that China has contributed to the globalization of the new era under the initiative of the Belt and Road. As the industrial parks are the basis of 'work/employment', a basic function of a city (Athens Constitution), planning for developments of industrial parks has become a long-term focus of urban planning. Based on the research of the planning and the analysis of the present developments of some typical China overseas industrial parks, we found some interesting rules: First, large numbers of the China overseas industrial parks are located in less developed countries. These industrial parks have become significant drives of the developments of the host cities and even the regions in those countries, especially in investment, employment and paid tax fee for the local, etc. so, the planning and development of overseas industrial parks have received extensive attention. Second, there are some problems in the small part of the overseas Park, such as the planning of the park not following the planning of the host city and lack of implementation of the park planning, etc. These problems have led to the difficulties of the implementation of the planning and the sustainable developments of the parks. Third, a unique pattern of space development has been formed. in the dimension of the patterns of regional spatial distribution, there are five characteristics - along with the coast, along the river, along with the main traffic lines and hubs, along with the central urban area and along the connections of regions economic. In the dimension of the spatial relationships between the industrial park and the city, there is a growing and evolving trend as 'separation – integration - union'. In the dimension of spatial mode of the industrial parks, there are different patterns of development, such as a specialized industrial park, complex industrial park, characteristic town and new urban area of industry, etc. From the perspective of the trends of the developments and spatial modes, in the future, the planning of China overseas industrial parks should emphasize the idea of 'building a city based on the industrial park'. In other words, it's making the developments of China overseas industrial parks move from 'driven by policy' to 'driven by the functions of the city', accelerating forming the system of China overseas industrial parks and integrating the industrial parks and the cities.

Keywords: overseas industrial park, spatial mode, planning, China

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Authors: José Ramón López-Mínguez, Estrella Suárez-Corchuelo, Sergio López-Tejero, Luis Nombela-Franco, Xavier Freixa-Rofastes, Guillermo Bastos-Fernández, Xavier Millán-Álvarez, Raúl Moreno-Gómez, José Antonio Fernández-Díaz, Ignacio Amat-Santos, Tomás Benito-González, Fernando Alfonso-Manterola, Pablo Salinas-Sanguino, Pedro Cepas-Guillén, Dabit Arzamendi, Ignacio Cruz-González, Juan Manuel Nogales-Asensio

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Background and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P = .008) and 6.37% vs 1.91% (HR, 3.34; P = .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group.

Keywords: stents, atrial fibrillation, anticoagulants, left atrial appendage occlusion

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Authors: Olanrewaju Kafayat, O., Salman Kabir, K.

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The role of organic agriculture in providing food and income is now gaining wider recognition (Van Elzakker et al 2007). The increasing public concerns about food safety issues on the use of fertilizers, pesticide residues, growth hormones, GM organisms, and increasing awareness of environmental quality issues have led to an expanding demand for environmentally friendly products (Thompson, 1998; Rimal et al., 2005). As a result national governments are concerned about diet and health, and there has been renewed recognition of the role of public policy in promoting healthy diets, thus to provide healthier, safer, more confident citizens (Poole et al., 2007), With these benefits, a study into organic vegetables is very vital to all the major stakeholders. This study analyzed the willingness of consumers to pay for organic vegetables in Oyo state, Nigeria. Primary data was collected with the aid of structured questionnaire administered to 168 respondents. These were selected using multistage random sampling. The first stage involved the selection two (2) ADP zones out of the three (3) ADP zones in Oyo state, The second stage involved the random selection of two (2) local government areas each out of the two (2) ADP zones which are; Ibadan South West and Ogbomoso North and random selection of 4 wards each from the local government areas. The third stage involved random selection of 42 household each from of the local government areas. Descriptive statistics, the principal component analysis, and the logistic regression were used to analyze the data. Results showed 55 percent of the respondents were female while 80 percent were  50 years. 74 percent of the respondents agreed that organic vegetables are of better quality. 31 percent of the respondents were aware of organic vegetables as against 69 percent who were not aware. From the logistic model, educational attainment, amount spent on organic vegetables monthly, better quality of organic vegetables and accessibility to organic vegetables were significant and had a positive relationship on willingness to pay for organic vegetable. The variables that were significant and had a negative relationship with WTP are less attractiveness of organic vegetables and household size of the respondents. This study concludes that consumers with higher level of education were more likely to be aware and willing to pay for organic vegetables than those with low levels of education, the study therefore recommends creation of awareness on the relevance of consuming organic vegetables through effective marketing and educational campaigns.

Keywords: consumers awareness, willingness to pay, organic vegetables, Oyo State

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Authors: Minu Bharati, Priyanka Rai, Satarupa Dutta, Dhiraj Saha

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Culex quinquefasciatus Say, is a mosquito of immense public health concern due to its role in transmission of filariasis, which is an endemic disease in 20 states and union territories of India, putting about 600 million people at the risk of infection. The main strategies to control filaria in India include anti-larval measures in urban areas, Indoor Residual Spray (IRS) in rural areas and mass diethylcarbamazine citrate (DEC) administration. Larval destruction measures and IRS are done with the use of insecticides. In this study, Susceptibility/ Resistance to insecticides were assessed in Culex quinquefasciatus mosquitoes collected from eight densely populated areas of Siliguri subdivision, which has a high rate of filarial infection. To unveil the insecticide susceptibility status of Culex quinquefasciatus, bioassays were performed on field-caught mosquitoes against two major groups of insecticides, i.e. Synthetic Pyrethroids (SPs): 0.05% deltamethrin and 0.05% lambda-cyhalothrin and Organophosphates (OPs): 5% malathion and temephos using World Health Organisation (WHO) discriminating doses. The knockdown rates and knockdown times (KDT50) were also noted against deltamethrin, lambda-cyhalothrin and malathion. Also, activities of major detoxifying enzymes, i.e. α-carboxylesterases, β-carboxylesterases and cytochrome P450 (CYP450) monooxygenases were determined to find the involvement of biochemical mechanisms in resistance phenomenon (if any). The results obtained showed that, majority of the mosquito populations were moderately to severely resistant against both the SPs and one OP, i.e. temephos. Whereas, most of the populations showed 100% susceptibility to malathion. The knockdown rates and KDT50 in response to above-mentioned insecticides showed significant variation among different populations. Variability in activities of carboxylesterases and CYP450 monooxygenases were also observed with hints of their involvement in contribution towards insecticide resistance in some of the tested populations. It may be concluded that, Culex quinquefasciatus has started developing resistance against deltamethrin, lambda-cyhalothrin and temephos in Siliguri subdivision. Malathion seems to hold the greatest potentiality for control of these mosquitoes in this area as revealed through this study. Adoption of Integrated mosquito management (IMM) strategy should be the prime objective of the concerned authorities to delimit the insecticide resistance phenomenon and filariasis infections.

Keywords: Culex quinquefasciatus, detoxifying enzymes, insecticide resistance, knockdown rate

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Authors: Vicki Cameron

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Background: Rheumatoid Arthritis (RA) typically effects the feet and about 20% of patients present initially with foot and ankle symptoms. Custom moulded foot orthoses (FO) in the management of foot and ankle problems in RA is well documented in the literature. Off-the-shelf FO are thought to provide an effective alternative to custom moulded FO in patients with RA, however they are not evidence based. Objectives: To determine the effects of off-the-shelf FO on; 1. quality of life (QOL) 2. walking speed 4. peak plantar pressure in the forefoot (PPPft) Methods: Thirty-five patients (six male and 29 female) participated in the study from 11/2006 to 07/2008. The age of the patients ranged from 26 to 80 years (mean 52.4 years; standard deviation [SD] 13.3 years). A repeated measures design was used, with patients presenting at baseline, three months and six months. Patients were tested walking barefoot, shod and shod with FO. The type of orthoses used was the Slimflex Plastic ® (Algeos). The Leeds Foot Impact Scale (LFIS) was used to investigate QOL. The Vicon 612 motion analysis system was used to determine the effect of FO on walking speed. The F-scan walkway and in-shoe systems provided information of the effect on PPPft. Ethical approval was obtained on 07/2006. Data was analysed using SPSS version 15.0. Results/Discussion: The LFIS data was analysed with a repeated measures ANOVA. There was a significant improvement in the LFIS score with the use of the FO over the six months (p<0.01). A significant increase in walking speed with the orthoses was observed (p<0.01). Peak plantar pressure in the forefoot was reduced with the FO, as shown by a non-parametric Friedman’s test (chi-square = 55.314, df=2, p<0.05). Conclusion: The results show that off-the-shelf FO are effective in managing foot problems in patients with RA. Patients reported an improved QOL with the orthoses, and further objective measurements were quantified to provide a rationale for this change. Patients demonstrated an increased walking speed, which has been shown to be associated with reduced pain. The FO decreased PPPft which have been reported as a site of pain and ulceration in patients with RA. Salient Clinical Points: Off-the-shelf FO offer an effective alternative to custom moulded FO, and can be dispensed at the chair side. This is crucial in the management of foot problems associated with RA as early intervention is advocated due to the chronic and progressive nature of the disease.

Keywords: podiatry, rheumatoid arthritis, foot orthoses, gait analysis

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Authors: Germans Natuhwera, Peter Ellis, Acuda Wilson, Anne Merriman, Martha Rabwoni

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Objective: The aim of the study was to diagnose the socio-economic burden and impact of a diagnosis of cervical cancer (CC) in rural women in the context of low-resourced country Uganda, using a phenomenological enquiry. Methods: This was a multi-site phenomenological inquiry, conducted at three hospice settings; Mobile Hospice Mbarara in southwestern, Little Hospice Hoima in Western, and Hospice Africa Uganda Kampala in central Uganda. A purposive sample of women with a histologically confirmed diagnosis of CC was recruited. Data was collected using open-ended audio-recorded interviews conducted in the native languages of participants. Interviews were transcribed verbatim in English, and Braun and Clarke’s (2019) framework of thematic analysis was used. Results: 13 women with a mean age of 49.2 and age range 29-71 participated in the study. All participants were of low socioeconomic status. The majority (84.6%) had advanced disease at diagnosis. A fuller reading of transcripts produced four major themes clustered under; (1) socioeconomic characteristics of women, (2) impact of CC on women’s relationships, (3) disrupted and impaired activities of daily living (ADLs), and (4) economic disruptions. Conclusions: A diagnosis of CC introduces significant socio-economic disruptions in a woman’s and her family’s life. CC causes disability, impairs the woman and her family’s productivity hence exacerbating levels of poverty in the home. High and expensive out-of-pocket expenditure on treatment, investigations, and transport costs further compound the socio-economic burden. Decentralizing cancer care services to regional centers, scaling up screening services, subsidizing costs of cancer care services, or making cervical cancer care treatment free of charge, strengthening monitoring mechanisms in public facilities to curb the vice of healthcare workers soliciting bribes from patients, increased mass awareness campaigns about cancer, training more healthcare professionals in cancer investigation and management, and palliative care, and introducing an introductory course on gynecologic cancers into all health training institutions are recommended.

Keywords: activities of daily living, cervical cancer, out-of-pocket, expenditure, phenomenology, socioeconomic

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Authors: Min-Chih Yang, Shih-Jen Feng, Bo-Tsang Li

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The concept of “Brownfield” has been developed for nearly 35 years since it was put forward in 《Comprehensive Environmental Response, Compensation, and Liability Act, CERCLA》of USA in 1980 for solving the problem of soil contamination of those old industrial lands, and later, many countries have put forward relevant policies and researches continuously. But the related concept in Taiwan, a country has developed its industry for 60 years, is still in its infancy. This leads to the slow development of Brownfield related research and policy in Taiwan. When it comes to build the foundation of Brownfield development, we have to depend on the related experience and research of other countries. They are four aspects about Brownfield: 1. Contaminated Land; 2. Derelict Land; 3. Vacant Land; 4. Previously Development Land. This study will focus on and deeply investigate the Vacant land and contaminated land. The subject of this study is Formosa Chemicals & Fibre Corporation, Changhua branch in Taiwan. It has been operating for nearly 50 years and contributing a lot to the local economy. But under the influence of the toxic waste and sewage which was drained regularly or occasionally out from the factory, the environment has been destroyed seriously. There are three factors of pollution: 1. environmental toxicants, carbon disulfide, released from producing processes and volatile gases which is hard to monitor; 2. Waste and exhaust gas leakage caused by outdated equipment; 3. the wastewater discharge has seriously damage the ecological environment of the Dadu river estuary. Because of all these bad influences, the factory has been closed nowadays and moved to other places to spare the opportunities for the contaminated lands to re-develop. So we collect information about related Brownfield management experience and policies in different countries as background information to investigate the current Taiwanese Brownfield redevelopment issues and built the environmental assessment framework for it. We hope that we can set the environmental assessment indexes for Formosa Chemicals & Fibre Corporation, Changhua branch according to the framework. By investigating the theory and environmental pollution factors, we will carry out deep analysis and expert questionnaire to set those indexes and prove a sample in Taiwan for Brownfield redevelopment and remediation in the future.

Keywords: brownfield, industrial land, redevelopment, assessment index

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Authors: Bayarmaa Enkhbold, Kenichi Matsui

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Urban parks are important assets to every community in terms of providing space for health, cultural and leisure activities. However, Ulaanbaatar, the capital of Mongolia, faces a shortage of green spaces, particularly urban parks, due to overpopulation and haphazard growth. Therefore, in order to increase green space per person, the city government has planned to increase green space per person up to 20m² by 2020 and 30m² by 2030 by establishing more urban parks throughout the city. But this plan was estimated that it is highly unlikely to reach those goals according to the analysis of the present status of plan implementation because the current amount of green space per person is still 4m². In the past studies globally, city planners and scientists agree that it is highly improbable to develop urban parks and keep maintenance sustainably without reflecting community perceptions and their involvement in the park establishment. Therefore, this research aims to find the challenges which stymie urban park development in Ulaanbaatar city and recommend dealing with the problems. In order to reach the goal, communities’ perceptions about the current challenges and their necessity for urban parks were identified and determined whether they differentiated depending on two different types of residential areas (urban and suburban areas). It also attempted to investigate international good practices on how they deal with similar problems. The research methodology was based on a questionnaire survey among city residents, a document review regarding the involvement of stakeholders, and a literature review of relevant past studies. According to the residents’ perceptions, the biggest challenge was a lack of land availability and followed by a lack of proper policy, planning, management, and maintenance out of seven key challenges identified. The biggest community demand from the urban park was a playground for children and followed by recreation and relaxation out of six types of needs. Based on research findings, the study proposed several recommendations for enhancements as institutional and legal framework, park plan and management, supportive environment and monitoring, evaluation, and reporting.

Keywords: challenges of urban park planning and maintenance, community-based urban park establishment, community perceptions and participation, urban parks in Ulaanbaatar, Mongolia

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Authors: Tshegofatso Galekgathege

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Poor water quality is of great concern to human health as it can cause disease outbreaks. A standard practice today, in developed countries, is that people should be provided with safe-reliable drinking water, as safe drinking water is recognized as a basic human right and a cost effective measure of reducing diseases. Over 1.1 billion people worldwide lack access to a safe water supply and as a result, the majority are forced to use polluted surface or groundwater. It is widely accepted that our water supply systems are susceptible to the intentional or accidental contamination .Water quality degradation may occur anywhere in the path that water takes from the water source to the consumer. Chlorine is believed to be an effective tool in disinfecting water, but its concentration may decrease with time due to consumption by chemical reactions. This shows that we are at the risk of being infected by waterborne diseases if chlorine in water falls below the required level of 0.2-1mg/liter which should be maintained in water and some contaminants enter into the water distribution system. It is believed that the lack of adequate sanitation also contributes to the contamination of water globally. This study therefore, assesses drinking water contamination from the source to the consumer by identifying the point vulnerable to contamination from the source to the consumer in the study area .To identify the point vulnerable to contamination, water was sampled monthly from boreholes, water treatment plant, water distribution system (WDS), service reservoirs and consumer taps from all the twenty (20) villages of Palapye region. Sampled water was then taken to the laboratory for testing and analysis of microbiological and chemical parameters. Water quality analysis were then compared with Botswana drinking water quality standards (BOS32:2009) to see if they comply. Major sources of water contamination identified during site visits were the livestock which were found drinking stagnant water from leaking pipes in 90 percent of the villages. Soils structure around the area was negatively affected because of livestock movement even vegetation in the area. In conclusion microbiological parameters of water in the study area do not comply with drinking water standards, some microbiological parameters in water indicated that livestock do not only affect land degradation but also the quality of water. Chlorine has been applied to water over some years but it is not effective enough thus preventative measures have to be developed, to prevent contaminants from reaching water. Remember: Prevention is better than cure.

Keywords: land degradation, leaking systems, livestock, water contamination

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Authors: Amela Ajanovic, Reinhard Haas

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Electric vehicles (EVs) are considered as an important means to cope with current environmental problems in transport. However, their high capital costs and limited driving ranges state major barriers to a broader market penetration. The core objective of this paper is to investigate the future market prospects of various types of EVs from an economic and ecological point of view. Our method of approach is based on the calculation of total cost of ownership of EVs in comparison to conventional cars and a life-cycle approach to assess the environmental benignity. The most crucial parameters in this context are km driven per year, depreciation time of the car and interest rate. The analysis of future prospects it is based on technological learning regarding investment costs of batteries. The major results are the major disadvantages of battery electric vehicles (BEVs) are the high capital costs, mainly due to the battery, and a low driving range in comparison to conventional vehicles. These problems could be reduced with plug-in hybrids (PHEV) and range extenders (REXs). However, these technologies have lower CO₂ emissions in the whole energy supply chain than conventional vehicles, but unlike BEV they are not zero-emission vehicles at the point of use. The number of km driven has a higher impact on total mobility costs than the learning rate. Hence, the use of EVs as taxis and in car-sharing leads to the best economic performance. The most popular EVs are currently full hybrid EVs. They have only slightly higher costs and similar operating ranges as conventional vehicles. But since they are dependent on fossil fuels, they can only be seen as energy efficiency measure. However, they can serve as a bridging technology, as long as BEVs and fuel cell vehicle do not gain high popularity, and together with PHEVs and REX contribute to faster technological learning and reduction in battery costs. Regarding the promotion of EVs, the best results could be reached with a combination of monetary and non-monetary incentives, as in Norway for example. The major conclusion is that to harvest the full environmental benefits of EVs a very important aspect is the introduction of CO₂-based fuel taxes. This should ensure that the electricity for EVs is generated from renewable energy sources; otherwise, total CO₂ emissions are likely higher than those of conventional cars.

Keywords: costs, mobility, policy, sustainability,

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Authors: Scott Cavinder

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Surgical site infections (SSI) are a known complication to any surgical procedure and are one of the most common nosocomial infections. Globally it is estimated 300 million surgical procedures take place annually, with an incidence of SSI’s estimated to be 11 of 100 surgical patients developing an infection within 30 days after surgery. The specific purpose of the project is to address the PICOT (Problem, Intervention, Comparison, Outcome, Time) question: In patients who have undergone cardiothoracic or vascular surgery (P), does implementation of a post-operative care bundle based on current EBP (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period (T)? Synthesis of Supporting Evidence: A literature search of five databases, including citation chasing, was performed, which yielded fourteen pieces of evidence ranging from high to good quality. Four common themes were identified for the prevention of SSI’s including use and removal of surgical dressings; use of topical antibiotics and antiseptics; implementation of evidence-based care bundles, and implementation of surveillance through auditing and feedback. The Iowa Model was selected as the framework to help guide this project as it is a multiphase change process which encourages clinicians to recognize opportunities for improvement in healthcare practice. Practice/Implementation: The process for this project will include recruiting postsurgical participants who have undergone cardiovascular or thoracic surgery prior to discharge at a Northwest Indiana Hospital. The patients will receive education, verbal instruction, and return demonstration. The patients will be followed for 12 weeks, and wounds assessed utilizing the National Healthcare Safety Network//Centers for Disease Control (NHSN/CDC) assessment tool and compared to the SSI rate of 2021. Key stakeholders will include two cardiovascular surgeons, four physician assistants, two advance practice nurses, medical assistant and patients. Method of Evaluation: Chi Square analysis will be utilized to establish statistical significance and similarities between the two groups. Main Results/Outcomes: The proposed outcome is the prevention of SSIs in the post-op cardiothoracic and vascular patient. Implication/Recommendation(s): Implementation of standardized post operative care bundles in the prevention of SSI in cardiovascular and thoracic surgical patients.

Keywords: cardiovascular, evidence based practice, infection, post-operative, prevention, thoracic, surgery

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Authors: Anum Obaid, Iman Fatima, Wanisha Feroz, Haleema Imran, Hammad Tariq

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Unmarried women over thirty years of age as a health issue is a relatively young phenomenon, but it is rapidly growing in Pakistan; therefore, it is a public health issue. The challenges affecting nutrition and public health are some of the indispensable components that need to be met to achieve sustainable development goals (SDGs). This research intends to explain these goals in the context of nutrition and public health, especially analyzing the issues related to unmarried women above the age of thirty in Faisalabad, Pakistan. Still, this research is not feasible in Pakistan. In Pakistan alone, 10 million women over the age of 35 are unmarried, based on a recent United Nations report. The United Nations, in cooperation with the World Health Organization, has identified health as a state of being healthy, free from illness or disease, and not just a condition where there are no diseases or bodily disabilities. The current generation of women is unmarried and living a life under constant pressure from society to deliver changes like the diet these women take, and hence, their nutritional status defines their comprehensive health triangle, a mix of physical, mental, and social well-being. The research was carried out under the qualitative research paradigm, specifically through interviews with the participants who were unmarried women and married women above the age of thirty. This qualitative study explores how marriage affects the intake of nutrients, nutritional health, psychological and social well-being and their effects. The realization of well-being consisted of factors like physical health, mental and emotional health, pressure from society, social health, economic independence, and decision-making power to reveal the impact of singleness on well-being. The findings disclosed that marital status had a notable impact on the diet habits and nutritional behaviors of women in Faisalabad. Also, it was found that single women suffer from more stress and are not as positive as married women because they are lonely, as their husbands are absent from their lives. The findings established that nutritional understanding is differentially affected by marital status as a determinant of the health triangle consisting of physical, mental, and social health. Awareness of these factors is significant in designing specific goal-directed interventions that can enhance the nutritional well-being and general health status of unmarried women in Faisalabad. Hence, this study underscores the necessity of maintaining supportive environments and increasing the regard concerning the health state of single ladies beyond thirty.

Keywords: health triangle, over thirty, singleness, age barriers, unmarried women, women’s health, well-being

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Authors: Alice Nwanyioma Ohuoba, Rose Erdoo Kukwa, Ukpabi Joseph Ukpabi

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Cassava root (Manihot esculenta) is one of the important carbohydrates containing crops in Nigeria. It is a staple food, mostly in the southern part of the country, and a source of income to farmers and processors. Cassava gari processing methods result to residue fiber (solid waste) from the sieving operation, these residue fibers ( solid wastes) can be dried and milled into flour and used to prepare cakes, cookies, crackers and chin-chin instead of being thrown away mostly on farmland or near the residential area. Flour for baking or frying may contain carbohydrates and protein (wheat flour) or rich in only carbohydrates (cassava flour). Cake, cookies, crackers, and chin-chin were prepared using the residue flour obtained from the residue fiber of cassava variety NR87184 roots, processed into gari. This study is aimed at evaluating the proximate composition, mineral content and sensory attributes of these selected snacks produced. The proximate composition results obtained showed that crackers had the lowest value in moisture (2.3390%) and fat (1.7130%), but highest in carbohydrates (85.2310%). Amongst the food products, cakes recorded the highest value in protein (8.0910%). Crude fibre values ranges from 2.5265% (cookies) to 3.4165% (crackers). The result of the mineral contents showed cookies ranking the highest in Phosphorus (65.8535 ppm) and Iron (0.1150 mg/L), Calcium (1.3800mg/L) and Potassium (7.2850 mg/L) contents, while chin-chin and crackers were lowest in Sodium ( 2.7000 mg/L). The food products were also subjected to sensory attributes evaluation by thirty member panelists using 9-hedonic scale which ranged from 1 ( dislike extremely) to 9 (like extremely). The means score obtained shows all the food products having above 7.00 (above “like moderately”). This study has shown that food products that may be functional or nutraceuticals could be prepared from the residue flour. There is a call for the use of gluten-free flour in baking due to ciliac disease and other allergic causes by gluten. Therefore local carbohydrates food crops like cassava residue flour that are gluten-free, could be the solution. In addition, this could aid cassava gari processing waste management thereby reducing post-harvest losses of cassava root.

Keywords: allergy, flour, food-products, gluten-free

Procedia PDF Downloads 157

Authors: Ogunlesi Olufunso, John Ogunsola, Omolade Oladele, Benjamin Emikpe

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Context: Coccidiosis is a parasitic disease that affects poultry production, leading to economic losses. Garlic is known for medicinal properties and has been used as a natural remedy for various diseases. This study aims to investigate the prophylactic effect of garlic inclusion in the feed of commercial broilers with coccidiosis. Research Aim: The aim of this study is to determine the possible effect of garlic meal inclusion in poultry feed on the body weight gain of commercial broilers and to investigate it's therapeutic effect on broilers with coccidiosis. Methodology: The study conducted a case-control study for eight weeks with One hundred Arbor acre commercial broilers separated into five (5) groups from day-old, where 6,000 Eimeria oocysts were orally inoculated into each broiler in the different groups. Feed intake, body weight gain, feed conversion ratio, oocyt shedding rate, histopathology and erythrocyte indices were assessed. Findings: The inclusion of garlic meal in the broilers' diet resulted in an improved feed conversion ratio, decreased oocyst counts, reduced diarrhoeic fecal spots, decreased susceptibility to coccidial infection, and increased packed cell volume (PCV). Theoretical Importance: This study contributes to the understanding of the prophylactic effect of garlic supplementation, including its antiparasitic properties on commercial broilers with coccidiosis. It highlights the potential use of non-conventional feed additives or ayurvedic herb and spices in the treatment of poultry diseases. Data Collection and Analysis Procedures: The study collected data on feed intake, body weight gain, oocyst shedding rate, histopathological observations, and erythrocyte indices. Data were analyzed using Analysis of Variance and Duncan's Multiple range Test. Questions Addressed: The study addressed the possible effect of garlic meal inclusion in poultry feed on the body weight gain of broilers and its therapeutic effect on broilers with coccidiosis. Conclusion: The study concludes that garlic inclusion in the feed of broilers has a prophylactic effect, including antiparasitic properties, resulting in improved feed conversion ratio, reduced oocyst counts and increased PCV.

Keywords: broilers, eimeria spp, garlic, Ibadan

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Authors: Ayodele A. Otaiku

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Purpose: Nigeria has become the largest importer of rice in Africa and second in the world, 2015. Investigate interactions of organic rice farming on soil quality and health from bio-waste converted to biofertilizer and its environmental impact on rice crop. Methodology: Bio-wastes, poultry waste, organic agriculture wastes, wood ash mixed with microbial inoculant organisms called OBD-Plus microbes (broad spectrum) composted in anaerobic digester to OBD-biofertilizer (2010 - 2012) uses microbes to build humus and other stable carbons. Two field experiments were carried out at Badeggi, Niger state in 2011 and 2012 to evaluate the response of lowland rice production using biofertilizer. The experimental field was laid out in a strip-plot design with five treatments and three replications and at twenty-one day old seedlings of FARO 44 and FARO 52 rice varieties were transplanted. Plots without fertiliser application served as control. Findings: The highest rice grain yield increase of 4.4 t/ha over the control in 2012 against the Nigeria average of lowland rice grain yields of 1.5 t/ha. The utilization of OBD-Biofertilizer can decrease the use of chemical nitrogen fertilizer, prevent the depletion of soil organic matter and reduce environmental pollution. Increasing the floodwater productivity and optimizing the recycling of nutrients cum grazer populations and disease by biocontrols microbes present in the OBD-Biofertilizer. Organic matter in the soil improves by 58% and C/N 15 (2011) and 13.35 (2012). Implications: OBD- Biofertilizer produce plant growth hormones such as indole acetic acid (IAA), glomalin related soil protein and extracellular enzymes as phosphatases that promote soil health and quality. Conclusion: Microorganisms can enhance nutrients use efficiency by increasing root surface area e.g., mycorrhizal, fungi, promoting other beneficial symbioses of the host plant and microbial interactions resulting to increase in soil organic matter. By 2030, climate change is projected to depress cereal production in Africa by 2 to 3 percent. Improved seeds and increased fertilizer use should more than compensate, but this factor will still weigh heavily on efforts to make progress.

Keywords: OBD-plus microbial consortia, OBD-biofertilizer, rice production, soil quality, sustainable agriculture

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Authors: Natalia Carolina Encalada Castillo

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As part of an intended radical policy change compared to former administrations in Ecuador, the transformation of the institutionality of international cooperation during the period of President Rafael Correa was considered as a key element for the construction of the state of 'Good Living'. This intention led to several regulatory changes in the reception of cooperation for development, and even the departure of some foreign cooperation agencies. Moreover, Ecuador launched the initiative to become a donor of cooperation towards other developing countries through the ‘South-South Cooperation’ approach. All these changes were institutionalized through the Ecuadorian System of International Cooperation as a new framework to establish rules and policies that guarantee a sovereign management of foreign aid. Therefore, this research project has been guided by two questions: What were the factors that motivated the transformation of the institutionality of international cooperation in Ecuador from 2007 to 2017? and, what were the implications of this transformation in terms of the international role of the country? This paper seeks to answer these questions through Role Theory within a Constructivist meta-theoretical perspective, considering that in this case, changes at the institutional level in the field of cooperation, responded not only to material motivations but also to interests built on the basis of a specific state identity. The latter was only possible to affirm through specific roles such as ‘sovereign recipient of cooperation’ as well as ‘donor of international cooperation’. However, the performance of these roles was problematic as they were not easily accepted by the other actors in the international arena or in the domestic level. In terms of methodology, these dynamics are analyzed in a qualitative way mainly through interpretive analysis of the discourse of high-level decision-makers from Ecuador and other cooperation actors. Complementary to this, document-based research of relevant information as well as interviews have been conducted. Finally, it is concluded that even if material factors such as infrastructure needs, trade and investment interests, as well as reinforcement of state control and monitoring of cooperation flows, motivated the institutional transformation of international cooperation in Ecuador; the essential basis of these changes was the search for a new identity for the country to be projected in the international arena. This identity started to be built but continues to be unstable. Therefore, it is important to potentiate the achievements of the new international cooperation policies, and review their weaknesses, so that non-reimbursable cooperation funds received as well as ‘South-South cooperation’ actions, contribute effectively to national objectives.

Keywords: Ecuador, international cooperation, Role Theory, state identity

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Authors: Juan Facetti, Rocky McBride, Karina Loup

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The Chaco Region of Paraguay is a key biodiverse area for the conservation of jaguars (Panthera onca), the largest feline of the Americas. It comprises five eco-regions, which holds important but decreasing populations of this species. The last decades, the expansion of soybean over the Atlantic Forest, forced the translocation of cattle-ranches towards the Chaco. Few studies of Jaguar's population densities in the American hemisphere were done until now. In the region, the specie is listed as vulnerable or threatened and more information is needed to implement any conservation policy. Among the factors that threaten the populations are land-use change, habitat fragmentation, prey depletion and illegal hunting. Two largest eco-regions were studied: the Wet Chaco and the Dry Chaco. From 2002 more than 20 jaguars were captured and fitted with GPS-collar. Data collected from 11 GPS-collars were processed, transformed numerically and finally converted into maps for analyzing. 8.092 locations were determined for four adult females (AF) and one adult male (AM) in the Wet Chaco, and one AF, one juvenile male (JM) and four AM in the Dry Chaco, during 1,867 days. GIS and kernel methodology were used to calculate daily distance of movement, home range-HR (95% isopleth), and core area (considered as 50% isopleth). In the Wet Chaco HR were 56 Km2 and 238 km2 for females and males respectively; while in the Dry Chaco HR were 685 Km2 and 844.5 km2 for females and males respectively, and 172 Km2 for a juvenile. Core areas of individual activity for each jaguar, were on average 11.5 Km2 and 33.55 km2 for AF and AM respectively in the Wet Chaco, while in the Dry Chaco were larger: 115 km2 for five AM and 225 Km2 for an AF and 32.4 Km2 for a JM. In both ecoregions, only one relevant overlap of HR of adults was reported. During the reproduction season, the HR (95% K) of one AM overlapped 49.83% with that of one AF. At the Wet Chaco, the maximum daily distance moved by an AF was 14.5 Km and 11.6 Km for the AM, while the Maximum Mean Daily Moved (MMDM) distance was 5.6 km for an AF and 3.1 km for an AM. At the Dry Chaco, the maximum daily distance for an AF was 61.7Km., 50.9Km for the AM and 6.6 Km for the JM, while the MMDM distance was 13.2 km for an AM and 8.4 km for an AF. This study confirmed that, as the invasion to jaguar habitat increased, it resulted in fragmented landscapes that influence spacing patterns of jaguars. Males used largest HR that of the smaller females and males covers largest distances that of the females. There appeared to be important spatial segregation between not only females but also males. It is likely that the larger areas used by males are partly caused by the sexual dimorphism in body size that entails differences in prey requirements. These could explain the larger distances travelled daily by males.

Keywords: Chaco ecoregions, Jaguar, home range, Panthera onca, Paraguay

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Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski

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Transient ischaemic attacks (TIAs) are warning signs for future strokes. TIA patients are at increased risk of stroke and cardio-vascular events after a first episode. A majority of studies on TIA focused on the occurrence of these ancillary events after a TIA. Long-term mortality after TIA received only limited attention. We undertook this study to determine the long-term hazards of all-cause mortality following a first episode of a TIA using anonymised electronic health records (EHRs). We used a retrospective case-control study using electronic primary health care records from The Health Improvement Network (THIN) database. Patients born prior to or in year 1960, resident in England, with a first diagnosis of TIA between January 1986 and January 2017 were matched to three controls on age, sex and general medical practice. The primary outcome was all-cause mortality. The hazards of all-cause mortality were estimated using a time-varying Weibull-Cox survival model which included both scale and shape effects and a random frailty effect of GP practice. 20,633 cases and 58,634 controls were included. Cases aged 39 to 60 years at the first TIA event had the highest hazard ratio (HR) of mortality compared to matched controls (HR = 3.04, 95% CI (2.91 - 3.18)). The HRs for cases aged 61-70 years, 71-76 years and 77+ years were 1.98 (1.55 - 2.30), 1.79 (1.20 - 2.07) and 1.52 (1.15 - 1.97) compared to matched controls. Aspirin provided long-term survival benefits to cases. Cases aged 39-60 years on aspirin had HR of 0.93 (0.84 - 1.00), 0.90 (0.82 - 0.98) and 0.88 (0.80 - 0.96) at 5 years, 10 years and 15 years, respectively, compared to cases in the same age group who were not on antiplatelets. Similar beneficial effects of aspirin were observed in other age groups. There were no significant survival benefits with other antiplatelet options. No survival benefits of antiplatelet drugs were observed in controls. Our study highlights the excess long-term risk of death of TIA patients and cautions that TIA should not be treated as a benign condition. The study further recommends aspirin as the better option for secondary prevention for TIA patients compared to clopidogrel recommended by NICE guidelines. Management of risk factors and treatment strategies should be important challenges to reduce the burden of disease.

Keywords: dual antiplatelet therapy (DAPT), General Practice, Multiple Imputation, The Health Improvement Network(THIN), hazard ratio (HR), Weibull-Cox model

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Authors: Mary Ann L. Halliday, Zoengpari Gohain

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The stigma associated with HIV-AIDS negatively affect mental health and ability to effectively manage the disease. While the number of People living with HIV/AIDS (PLHIV) has been increasing day by day in Mizoram (a small north-eastern state in India), research on HIV/AIDS stigma has so far been limited. Despite the potential significance of Internalized HIV Stigma (IHS) in the lives of PLHIV, there has been very limited research in this area. It was therefore, felt necessary to explore the internalized HIV stigma, mental health, coping and perceived social support of PLHIV in Aizawl District, Mizoram. The present study was designed with the objectives to determine the degree of IHS, to study the relationship between the socio-demographic characteristics and level of IHS, to highlight the mental health status, coping strategies and perceived social support of PLHIV and to elucidate the relationship between these psychosocial variables. In order to achieve the objectives of the study, six hypotheses were formulated and statistical analyses conducted accordingly. The sample consisted of 300 PLWHA from Aizawl District, 150 males and 150 females, of the age group 20 to 70 years. Two- way classification of “Gender” (male and female) and three-way classification of “Level of IHS” (High IHS, Moderate IHS, Low IHS) on the dependent variables was employed, to elucidate the relationship between Internalized HIV Stigma, mental health, coping and perceived social support of PLHIV. The overall analysis revealed moderate level of IHS (67.3%) among PLHIV in Aizawl District, with a small proportion of subjects reporting high level of IHS. IHS was found to be significantly different on the basis of disclosure status, with the disclosure status of PLHIV accounting for 9% variability in IHS.  Results also revealed more or less good mental health among the participants, which was assessed by minimal depression (50.3%) and minimal anxiety (45%), with females with high IHS scoring significantly higher in both depression and anxiety (p<.01). Examination of the coping strategies of PLHIV found that the most frequently used coping styles were Acceptance (91%), Religion (84.3%), Planning (74.7%), Active Coping (66%) and Emotional Support (52.7%). High perception of perceived social support (48%) was found in the present study. Correlation analysis revealed significant positive relationships between IHS and depression as well as anxiety (p<.01), thus revealing that IHS negatively affects the mental health of PLHIV. Results however revealed that this effect may be lessened by the use of various coping strategies by PLHIV as well as their perception of social support.

Keywords: Aizawl, anxiety, depression, internalized HIV stigma, HIV/AIDS, mental health, mizoram, perceived social support

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Authors: J. Szpor, K. Witczak, M. Storman, A. Orchel, D. Hodorowicz-Zaniewska, K. Okoń, A. Klimkowska

Abstract:

Core needle biopsy (CNB) is well established as an important diagnostic tool in diagnosing breast cancer and it is now considered the initial method of choice for diagnosing breast disease. In comparison to fine needle aspiration (FNA), CNB provides more architectural information allowing for the evaluation of prognostic and predictive factors for breast cancer, including histological grade—one of three prognostic factors used to calculate the Nottingham Prognostic Index. Several studies have previously described the concordance rate between CNB and surgical excision specimen in determination of histological grade (HG). The concordance rate previously ascribed to overall grade varies widely across literature, ranging from 59-91%. The aim of this study is to see how the data looks like in material at authors’ institution and are the results as compared to those described in previous literature. The study population included 157 women with a breast tumor who underwent a core needle biopsy for breast carcinoma and a subsequent surgical excision of the tumor. Both materials were evaluated for the determination of histological grade (scale from 1 to 3). HG was assessed only in core needle biopsies containing at least 10 well preserved HPF with invasive tumor. The degree of concordance between CNB and surgical excision specimen for the determination of tumor grade was assessed by Cohen’s kappa coefficient. The level of agreement between core needle biopsy and surgical resection specimen for overall histologic grading was 73% (113 of 155 cases). CNB correctly predicted the grade of the surgical excision specimen in 21 cases for grade 1 tumors (Kappa coefficient κ = 0.525 95% CI (0.3634; 0.6818), 52 cases for grade 2 (Kappa coefficient κ = 0.5652 95% CI (0.458; 0.667) and 40 cases for stage 3 tumors (Kappa coefficient κ = 0.6154 95% CI (0.4862; 0.7309). The highest level of agreement was observed in grade 3 malignancies. In 9 of 42 (21%) discordant cases, the grade was higher in the CNB than in the surgical excision. This composed 6% of the overall discordance. These results correspond to the noted in the literature, showing that underestimation occurs more frequently than overestimation. This study shows that authors’ institution’s histologic grading of CNBs and surgical excisions shows a fairly good correlation and is consistent with findings in previous reports. Despite the inevitable limitations of CNB, CNB is an effective method for diagnosing breast cancer and managing treatment options. Assessment of tumour grade by CNB is useful for the planning of treatment, so in authors’ opinion it is worthy to implement it in daily practice.

Keywords: breast cancer, concordance, core needle biopsy, histological grade

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Authors: Adel Edwar Waheeb Louka

Abstract:

Purpose AI-driven solutions are at the forefront of many pathology and medical imaging methods. Using algorithms designed to better the experience of medical professionals within their respective fields, the efficiency and accuracy of diagnosis can improve. In particular, X-rays are a fast and relatively inexpensive test that can diagnose diseases. In recent years, X-rays have not been widely used to detect and diagnose COVID-19. The under use of Xrays is mainly due to the low diagnostic accuracy and confounding with pneumonia, another respiratory disease. However, research in this field has expressed a possibility that artificial neural networks can successfully diagnose COVID-19 with high accuracy. Models and Data The dataset used is the COVID-19 Radiography Database. This dataset includes images and masks of chest X-rays under the labels of COVID-19, normal, and pneumonia. The classification model developed uses an autoencoder and a pre-trained convolutional neural network (DenseNet201) to provide transfer learning to the model. The model then uses a deep neural network to finalize the feature extraction and predict the diagnosis for the input image. This model was trained on 4035 images and validated on 807 separate images from the ones used for training. The images used to train the classification model include an important feature: the pictures are cropped beforehand to eliminate distractions when training the model. The image segmentation model uses an improved U-Net architecture. This model is used to extract the lung mask from the chest X-ray image. The model is trained on 8577 images and validated on a validation split of 20%. These models are calculated using the external dataset for validation. The models’ accuracy, precision, recall, f1-score, IOU, and loss are calculated. Results The classification model achieved an accuracy of 97.65% and a loss of 0.1234 when differentiating COVID19-infected, pneumonia-infected, and normal lung X-rays. The segmentation model achieved an accuracy of 97.31% and an IOU of 0.928. Conclusion The models proposed can detect COVID-19, pneumonia, and normal lungs with high accuracy and derive the lung mask from a chest X-ray with similarly high accuracy. The hope is for these models to elevate the experience of medical professionals and provide insight into the future of the methods used.

Keywords: artificial intelligence, convolutional neural networks, deeplearning, image processing, machine learningSarapin, intraarticular, chronic knee pain, osteoarthritisFNS, trauma, hip, neck femur fracture, minimally invasive surgery

Procedia PDF Downloads 74