Search results for: local coronary artery disease

Authors: Arnold Missiame

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In Ghana, rural dwellers who depend primarily on agriculture for their livelihood constitute about 60% of the country’s population. This shows the critical role and potentials of the agricultural sector in helping to achieve Ghana’s vision 2030. With the current threat of climate change and advancements in technology, agricultural extension is not just about technology transfer and improvements in productivity, but it is also about improving the managerial and technical skills of farmers. In Ghana, the government of Ghana as well as other players in the sector like; non-governmental organizations, NGOs, local and international funding agencies, for decades now, have made capacity-building-investments in smallholder farmers by way of extension services delivery. This study sought to compare the technical efficiency of farmers who have access to agricultural extension and farmers who do not in Ghana. The study employed the stochastic meta-frontier model to analyze household survey data comprising 300 smallholder cassava farmers from the Fanteakwa district of Ghana. The farmers were selected through a two-stage sampling technique where 5 communities were purposively selected in the first stage and then 60 smallholder cassava farmers were randomly selected from each of the 5 communities. Semi-structured questionnaires were used to collect data on farmers’ socioeconomic and farm-level characteristics. The results showed that farmers who have access to agricultural extensions services have higher technical efficiencies (TE) and produce much closer to their meta-production frontiers (higher technology gap ratios (TGR) than farmers who do not have access to such extension services. Furthermore, experience in cassava cultivation and formal education significantly improves the technical efficiencies of farmers. The study recommends that the mode and scope of agricultural extension service delivery in the country should be enhanced to ensure that smallholder farmers have easy access to extension agents.

Keywords: agricultural extension, Ghana, smallholder farmers, stochastic meta-frontier model, technical efficiency

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Authors: Yan Ping Chen, Hau Yin Chung

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The Ideal Profile Method (IPM) is a newly developed descriptive sensory analysis conducted by consumers without previous training. To perform this test, both the perceived and the ideal intensities from the judgements of consumers on products’ attributes, as well as their hedonic ratings were collected for formulating an ideal product (the most liked one). In addition, Ideal Profile Analysis (IPA) was conducted to check the consistency of the ideal data at both the panel and consumer levels. In this test, 12 commercial plain sufus bought from Hong Kong local market were tested by 113 consumers according to the IPM, and rated on 22 attributes. Principal component analysis was used to profile the perceived and the ideal spaces of tested products. The consistency of ideal data was then checked by IPA. The result showed that most consumers shared a common ideal. It was observed that the sensory product space and the ideal product space were structurally similar. Their first dimensions all opposed products with intense fermented related aroma to products with less fermented related aroma. And the predicted ideal profile (the estimated liking score around 7.0 in a 9.0-point scale) got higher hedonic score than the tested products (the average liking score around 6.0 in a 9.0-point scale). For the majority of consumers (95.2%), the stated ideal product considered as a potential ideal through checking the R2 coefficient value. Among all the tested products, sample-6 was the most popular one with consumer liking percentage around 30%. This product with less fermented and moldy flavour but easier to melt in mouth texture possessed close sensory profile according to the ideal product. This experiment validated that data from untrained consumers could be guided as useful information. Appreciated sensory characteristics could be served as reference in the optimization of the commercial plain sufu.

Keywords: ideal profile method, product development, sensory evaluation, sufu (fermented soybean curd)

Procedia PDF Downloads 188

Authors: Chinyere Ori Elom, Ikechukwu Ogeze Ukeje, Chukwudum Collins Umoke

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This paper aims to stimulate scholarly interest in AI, ICT and the existing (complex) systems trajectory- theory, practice, and aspirations within the African continent and to shed fresh light on the shortcomings of the higher education sector (HEs) through the prism of AI-driven Solutions for enhancing Guidance and Counseling and sound governance framework (SGF) in higher education modeling. It further seeks to investigate existing prospects yet to be realized in Nigerian universities by probing innovation neglect in the localities, exploring practices in the global ICT spaces neglected by Nigeria universities’ governance regimes (UGRs), and suggesting area applicability, sustainability and solution modeling in response to peculiar ‘wicked ICT-driven problems’ and or issues facing the continent as well as other universities in emerging societies. This study will adopt a mixed-method approach to collect both qualitative and quantitative data. This paper argues that it will command great relevance in the local and global university system by developing ICT relevance sustainability policy initiatives (SPIs) powered by a multi-stakeholder engagement governance model (MSEGm) that is sufficiently dynamic, eclectic and innovative to surmount complex and constantly rising challenges of the modern-developing world. Hence, it will consider diverse actors both as producers and users alike as victims and beneficiaries of common concerns in the ICT world; thereby providing pathways on how AI’s integration into education governance can significantly reduce counseling gaps, ensuring more students are attended to especially when human counselors are unavailable.

Keywords: AI-counseling solution, stakeholder engagement, university governance, higher education

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Authors: Puthsodary Tat

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Democracy has been categorially accepted and used as foreign and domestic policy agendas for the hope of peace, economic growth and prosperity for more than 25 years in Cambodia. However, the country is now in the grip of dictatorship, human rights violations, and prospective economic sanctions. This paper examines different perceptions and experiences of democratic assistance. In this study, the author employs discourse theory, idealism and realism as a theory-based methodology for debating and assessing the implications of democratization. Discourse theory is used to establish a platform for understanding discursive formations, body of knowledge and the games of truth of democracy. Idealist approaches give rational arguments for adopting key tenets that work well on the ground. In contrast, realism allows for some sweeping critiques of utopian ideal and offers particular views on why Western hegemonic missions do not work well. From idealist views, the research finds that Cambodian people still believe that democracy is a prima facie universality for peace, growth and prosperity. From realism, democratization is on the brink of death in three reasons. Firstly, there are tensions between Western and local discourses about democratic values and norms. Secondly, democratic tenets have been undermined by the ruling party-controlled courts, corruption, structural oppression and political patronage-based institutions. The third pitfall is partly associated with foreign aid dependency and geopolitical power struggles in the region. Finally, the study offers a precise mosaic of democratic principles that may be used to avoid a future geopolitical and economic crisis.

Keywords: corruption, democracy, democratic principles, discourse theory, discursive formations, foreign aid dependency, games of truth, geopolitical and economic crisis, geopolitical power struggle, hegemonic mission, idealism, realism, utopian ideal

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Authors: Toshiki Ito, Takahiro Yamane, Yuki Adachi, Yoshiko Kato, Eiji Tsuda, Kousaku Nagasaka, Keigo Yoshida, Yoshiko Kawasaki, Naoki Aizawa, Kyouhei Nishi, Tetsuko Kato

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The epidemic of the coronavirus (COVID-19), first reported in Wuhan at the end of 2019, has drastically changed our daily lives. Under these circumstances, counseling, which provides psychological support to people, was also greatly affected. The structure of counseling, which had generally been implicitly common practice to be conducted in person, was greatly shaken. The author wondered how counseling can be conducted in situations where it is impossible to meet face-to-face. This is where telepsychological support (online counseling) came into use. The authors found that there were the following problems in telepsychological support: (1) anxiety about whether the communication is appropriate, (2) difficulty in understanding the client's situation and condition, (3) inability to perceive what was normally perceived in person, (4) difficulty in adjusting to severely ill clients, (5) difficulty in dealing with emergency situations, etc. In this study, we interviewed psychologists who had been accustomed to telepsychological support for more than two years after the Corona disaster began to clarify how they had or had not overcome the problems of telepsychological support identified in the above studies. We also aim to consider the unique possibilities of how telepsychological support, a new technique of psychological support, can be implemented to provide more effective and meaningful support in society after the end of the Corona disaster (post-Corona society). Thirteen psychologists who are currently providing telepsychological support in the Corona Disaster will be interviewed, and semi-structured interviews will be conducted for one hour per person. In order to empirically examine how the problems in telepsychological support had been overcome or not through the interview survey, the authors asked (1) how they overcame their anxiety about whether they were able to communicate appropriately, (2) how they devised ways to overcome it, (3) how they overcame the difficulty in adapting to heavy clients in terms of the level of the disease, (4) how they overcame the difficulty in dealing with emergency situations. The interviews were analyzed using Thematic Analysis, a qualitative analysis method commonly used in qualitative research overseas. The authors found that some devices and perspectives were newly discovered as a result of two years of practice of telepsychological support and that psychologists in this study considered face-to-face interviews and telepsychological support to be separate and were flexible enough to use them when available and to move to face-to-face interviews when not appropriate.

Keywords: telepsychology, COVID-19, Corona, psychologist

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Authors: Cuiyang Feng, Xu Tang, Yi Jin

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Coal is the most important primary energy source in China, which exerts a significant influence on the rapid economic growth. However, it makes the water resources to be a constraint on coal industry development, on account of the reverse geographical distribution between coal and water. To ease the pressure on water shortage, the ‘3 Red Lines’ water policies were announced by the Chinese government, and then ‘water for coal’ plan was added to that policies in 2013. This study utilized a structural path analysis (SPA) based on the multi-regional input-output table to quantify the virtual water flows caused by coal consumption in different stages. Results showed that the direct water input (the first stage) was the highest amount in all stages of coal consumption, accounting for approximately 30% of total virtual water content. Regional analysis demonstrated that virtual water trade alleviated the pressure on water use for coal consumption in water shortage areas, but the import of virtual water was not from the areas which are rich in water. Sectoral analysis indicated that the direct inputs from the sectors of ‘production and distribution of electric power and heat power’ and ‘Smelting and pressing of metals’ took up the major virtual water flows, while the sectors of ‘chemical industry’ and ‘manufacture of non-metallic mineral products’ importantly but indirectly consumed the water. With the population and economic growth in China, the water demand-and-supply gap in coal consumption would be more remarkable. In additional to water efficiency improvement measures, the central government should adjust the strategies of the virtual water trade to address local water scarcity issues. Water resource as the main constraints should be highly considered in coal policy to promote the sustainable development of the coal industry.

Keywords: coal consumption, multi-regional input-output model, structural path analysis, virtual water

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Authors: Klazina T. Havinga, Hilde R. H. de Geus

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Introduction: Pre-operative coagulation management of Apixaban prescribed patients, a new oral anticoagulant (a factor Xa inhibitor), is difficult, especially when chronic kidney disease (CKD) causes drug overdose. Apixaban is not dialyzable due to its high level of protein binding. An antidote, Andexanet α, is available but expensive and has an unfavorable short half-life. We report the successful extracorporeal removal of Apixaban prior to emergency surgery with the CytoSorb® Hemoadsorption device. Methods: A 89-year-old woman with CKD, with an Apixaban prescription for atrial fibrillation, was presented at the ER with traumatic rib fractures, a flail chest, and an unstable spinal fracture (T12) for which emergency surgery was indicated. However, due to very high Apixaban levels, this surgery had to be postponed. Based on the Apixaban-specific anti-factor Xa activity (AFXaA) measurements at admission and 10 hours later, complete clearance was expected after 48 hours. In order to enhance the Apixaban removal and reduce the time to operation, and therefore reduce pulmonary complications, CRRT with CytoSorb® cartridge was initiated. Apixaban-specific anti-factor Xa activity (AFXaA) was measured frequently as a substitute for Apixaban drug concentrations, pre- and post adsorber, in order to calculate the adsorber-related clearance. Results: The admission AFXaA concentration, as a substitute for Apixaban drug levels, was 218 ng/ml, which decreased to 157 ng/ml after ten hours. Due to sustained anticoagulation effects, surgery was again postponed. However, the AFXaA levels decreased quickly to sub-therapeutic levels after CRRT (Multifiltrate Pro, Fresenius Medical Care, Blood flow 200 ml/min, Dialysate Flow 4000 ml/h, Prescribed renal dose 51 ml-kg-h) with Cytosorb® connected in series into the circuit was initiated (within 5 hours). The adsorber-related (indirect) Apixaban clearance was calculated every half hour (Cl=Qe * (AFXaA pre- AFXaA post/ AFXaA pre) with Qe=plasma flow rate calculated with Ht=0.38 and system blood flow rate 200 ml-min): 100 ml/min, 72 ml/min and 57 ml/min. Although, as expected, the adsorber-related clearance decreased quickly due to saturation of the beads, still the reduction rate achieved resulted in a very rapid decrease in AFXaA levels. Surgery was ordered and possible within 5 hours after Cytosorb initiation. Conclusion: The CytoSorb® Hemoadsorption device enabled rapid correction of Apixaban associated anticoagulation.

Keywords: Apixaban, CytoSorb, emergency surgery, Hemoadsorption

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Authors: Abeer A. Kenawy, Usama Massoud, El-Said A. Ragab, Heba M. El-Kosery

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2-D Electrical Resistivity Tomography (ERT) and hydrochemical study have been conducted at El Sadat industrial city. The study aims to investigate the area around the wastewater ponds to determine the possibility of water percolation from the wastewater ponds to the Pleistocene aquifer and to inspect the effect of this seepage on the groundwater chemistry. Pleistocene aquifer is the main groundwater reservoir in this area, where El Sadat city and its vicinities depend totally on this aquifer for water supplies needed for drinking, agricultural, and industrial activities. In this concern, seven ERT profiles were measured around the wastewater ponds. Besides, 10 water samples were collected from the ponds and the nearby groundwater wells. The water samples have been chemically analyzed for major cations, anions, nutrients, and heavy elements. Also, the physical parameters (pH, Alkalinity, EC, TDS) of the water samples were measured. Inspection of the ERT sections shows that they exhibit lower resistivity values towards the water ponds and higher values in opposite sides. In addition, the water table was detected at shallower depths at the same sides of lower resistivity. This could indicate a wastewater infiltration to the groundwater aquifer near the oxidation ponds. Correlation of the physical parameters and ionic concentrations of the wastewater samples with those of the groundwater samples indicates that; the ionic levels are randomly varying and no specific trend could be obtained. In addition, the wastewater samples shows some ionic levels lower than those detected in other groundwater samples. Besides, the nitrate level is higher in samples taken from the cultivated land than the wastewater samples due to the over using of nitrogen fertilizers. Then, we can say that the infiltrated water from wastewater ponds are not the main controller of the groundwater chemistry in this area, but rather the variable ionic concentrations could be attributed to local, natural, and anthropogenic processes.

Keywords: El Sadat city, ERT, hydrochemistry, percolation, wastewater ponds

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Authors: A. Abdulla Khairi Mohamed, Mohamed Gamal Abdelmonem, Gehan Selim

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Walkability in civic and public spaces in Libyan cities is challenging due to the lack of accessibility design, informal merging into car traffic, and the general absence of adequate urban and space planning. The lack of accessible and pedestrian-friendly public spaces in Libyan cities has emerged as a major concern for the government if it is to develop smart and sustainable spaces for the 21st century. A walkable urban space has become a driver for urban development and redistribution of land use to ensure pedestrian and walkable routes between sites of living and workplaces. The characteristics of urban open space in the city centre play a main role in attracting people to walk when attending their daily needs, recreation and daily sports. There is significant gap in the understanding of perceptions, feasibility and capabilities of Libyan urban space to accommodate enhance or support the smart design of a walkable pedestrian-friendly environment that is safe and accessible to everyone. The paper aims to undertake observations of walkability and walkable space in the city of Tripoli as a benchmark for Libyan cities; assess the validity and consistency of the seven principal aspects of smart design, safety, accessibility and 51 factors that affect the walkability in open urban space in Tripoli, through the analysis of 10 local urban spaces experts (town planner, architect, transport engineer and urban designer); and explore user groups’ perceptions of accessibility in walkable spaces in Libyan cities through questionnaires. The study sampled 200 respondents in 2015-16. The results of this study are useful for urban planning, to classify the walkable urban space elements which affect to improve the level of walkability in the Libyan cities and create sustainable and liveable urban spaces.

Keywords: walkability, sustainability, liveability, accessibility

Procedia PDF Downloads 441

Authors: Syed Towseef Ahmad, Fatima Amin, Pritha Acharya, Anil K. Gupta, Pervez Ahmad

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Glaciers being the sentinels of climate change, are the most visible evidence of global warming. Given the unavailability of observed field-based data, this study has focussed on the use of geospatial techniques to obtain information about the glaciers of Pir-Panjal (PPJ) and the Great Himalayan Regions of Jhelum Basin (GHR). These glaciers need to be monitored in line with the variations in climatic conditions because they significantly contribute to various sectors in the region. The main aim of this study is to map the glaciers in the two adjacent regions (PPJ and GHR) in the north-western Himalayas with different topographies and compare the changes in various glacial attributes during two different time periods (1990-2020). During the last three decades, both PPJ as well as GHR regions have observed deglaciation of around 36 and 26 percent, respectively. The mean elevation of GHR glaciers has increased from 4312 to 4390 masl, while the same for PPJ glaciers has increased from 4085 to 4124 masl during the observation period. Using accumulation area ratio (AAR) method, mean mass balance of -34.52 and -37.6 cm.w.e was recorded for the glaciers of GHR and PPJ, respectively. The difference in areal and mass loss of glaciers in these regions may be due to (i) the smaller size of PPJ glaciers which are all smaller than 1 km² and are thus more responsive to climate change (ii) Higher mean elevation of GHR glaciers (iii) local variations in climatic variables in these glaciated regions. Time series analysis of climate variables indicates that both the mean maximum and minimum temperatures of Qazigund station (Tmax= 19.2, Tmin= 6.4) are comparatively higher than the Pahalgam station (Tmax= 18.8, Tmin= 3.2). Except for precipitation in Qazigund (Slope= - 0.3 mm a⁻¹), each climatic parameter has shown an increasing trend during these three decades, and with the slope of 0.04 and 0.03°c a⁻¹, the positive trend in Tmin (pahalgam) and Tmax (qazigund) are observed to be statistically significant (p≤0.05).

Keywords: glaciers, climate change, Pir-Panjal, greater Himalayas, mass balance

Procedia PDF Downloads 88

Authors: Yori Gidron, Maartje Mol, Norbert Foudraine, Frits Van Osch, Joop Van Den Bergh, Moshe Farchi, Maud Straus

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Background: The worldwide pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-COV2), which began in 2019, also known as Covid-19, has infected over 136 million people and tragically took the lives of over 2.9 million people worldwide. Many of the complications and deaths are predicted by the inflammatory “cytokine storm.” One way to progress in the prevention of death is by finding a predictive and protective factor that inhibits inflammation, on the one hand, and which also increases anti-viral immunity on the other hand. The vagal nerve does precisely both actions. This study examined whether vagal nerve activity, indexed by heart-rate variability (HRV), predicts survival in patients with Covid-19. Method: We performed a pseudo-prospective study, where we retroactively obtained ECGs of 271 Covid-19 patients arriving at a large regional hospital in The Netherlands. HRV was indexed by the standard deviation of the intervals between normal heartbeats (SDNN). We examined patients’ survival at 3 weeks and took into account multiple confounders and known prognostic factors (e.g., age, heart disease, diabetes, hypertension). Results: Patients’ mean age was 68 (range: 25-95) and nearly 22% of the patients had died by 3 weeks. Their mean SDNN (17.47msec) was far below the norm (50msec). Importantly, relatively higher HRV significantly predicted a higher chance of survival, after statistically controlling for patients’ age, cardiac diseases, hypertension and diabetes (relative risk, H.R, and 95% confidence interval (95%CI): H.R = 0.49, 95%CI: 0.26 – 0.95, p < 0.05). However, since HRV declines rapidly with age and since age is a profound predictor in Covid-19, we split the sample by median age (40). Subsequently, we found that higher HRV significantly predicted greater survival in patients older than 70 (H.R = 0.35, 95%CI: 0.16 – 0.78, p = 0.01), but HRV did not predict survival in patients below age 70 years (H.R = 1.11, 95%CI: 0.37 – 3.28, p > 0.05). Conclusions: To the best of our knowledge, this is the first study showing that higher vagal nerve activity, as indexed by HRV, is an independent predictor of higher chances for survival in Covid-19. The results are in line with the protective role of the vagal nerve in diseases and extend this to a severe infectious illness. Studies should replicate these findings and then test in controlled trials whether activating the vagus nerve may prevent mortality in Covid-19.

Keywords: Covid-19, heart-rate Variability, prognosis, survival, vagal nerve

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Authors: Umamaheswari Shanmugam, Silvia Ronchi, Radu Vornicu

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Software, artificial intelligence, and machine learning can improve healthcare through innovative and advanced technologies that are able to use the large amount and variety of data generated during healthcare services every day. As we read the news, over 500 machine learning or other artificial intelligence medical devices have now received FDA clearance or approval, the first ones even preceding the year 2000. One of the big advantages of these new technologies is the ability to get experience and knowledge from real-world use and to continuously improve their performance. Healthcare systems and institutions can have a great benefit because the use of advanced technologies improves the same time efficiency and efficacy of healthcare. Software-defined as a medical device, is stand-alone software that is intended to be used for patients for one or more of these specific medical intended uses: - diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of a disease, any other health conditions, replacing or modifying any part of a physiological or pathological process–manage the received information from in vitro specimens derived from the human samples (body) and without principal main action of its principal intended use by pharmacological, immunological or metabolic definition. Software qualified as medical devices must comply with the general safety and performance requirements applicable to medical devices. These requirements are necessary to ensure high performance and quality and also to protect patients’ safety. The evolution and the continuous improvement of software used in healthcare must take into consideration the increase in regulatory requirements, which are becoming more complex in each market. The gap between these advanced technologies and the new regulations is the biggest challenge for medical device manufacturers. Regulatory requirements can be considered a market barrier, as they can delay or obstacle the device approval, but they are necessary to ensure performance, quality, and safety, and at the same time, they can be a business opportunity if the manufacturer is able to define in advance the appropriate regulatory strategy. The abstract will provide an overview of the current regulatory framework, the evolution of the international requirements, and the standards applicable to medical device software in the potential market all over the world.

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

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Authors: Suganya Chandrababu, Dhundy Bastola

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Like in the gut, the subgingival microbiota plays a crucial role in oral hygiene, health, and cariogenic diseases. Human activities like diet, antibiotics, and periodontal treatments alter the bacterial communities, metabolism, and functions in the oral cavity, leading to a dysbiotic state and changes in the plaques of orthodontic patients. Fixed periodontal appliances hinder oral hygiene and cause changes in the dental plaques influencing the subgingival microbiota. However, the microbial species’ diversity and complexity pose a great challenge in understanding the taxa’s community distribution patterns and their role in oral health. In this research, we analyze the subgingival microbial samples from individuals with fixed dental appliances (metal/clear) using an in silico approach. We employ exploratory hypothesis-driven multivariate and regression analysis to shed light on the microbial community and its functional fluctuations due to dental appliances used and identify risks associated with complex disease phenotypes. Our findings confirm the changes in oral microbiota composition due to the presence and type of fixed orthodontal devices. We identified seven main periodontic pathogens, including Bacteroidetes, Actinobacteria, Proteobacteria, Fusobacteria, and Firmicutes, whose abundances were significantly altered due to the presence and type of fixed appliances used. In the case of metal braces, the abundances of Bacteroidetes, Proteobacteria, Fusobacteria, Candidatus saccharibacteria, and Spirochaetes significantly increased, while the abundance of Firmicutes and Actinobacteria decreased. However, in individuals With clear braces, the abundance of Bacteroidetes and Candidatus saccharibacteria increased. The highest abundance value (P-value=0.004 < 0.05) was observed with Bacteroidetes in individuals with the metal appliance, which is associated with gingivitis, periodontitis, endodontic infections, and odontogenic abscesses. Overall, the bacterial abundances decrease with clear type and increase with metal type of braces. Regression analysis further validated the multivariate analysis of variance (MANOVA) results, supporting the hypothesis that the presence and type of the fixed oral appliances significantly alter the bacterial abundance and composition.

Keywords: oral microbiota, statistical analysis, fixed or-thodontal appliances, bacterial abundance, multivariate analysis, regression analysis

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Authors: Magdalena Barbara Kaziuk

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Introduction: In December 2019, the first case of an acute infectious disease of the respiratory system caused by the SARS-CoV-2 virus was recorded in Wuhan in Central China. On March 11, 2020, the World Health Organization restrictions, among others, in the travel industry. Aim: The aim of the study was the assessment of the preparedness of European cultural institutions and catering establishments within the sanitary and epidemiological dimension during the COVID-19 pandemic by Polish tourists and their sense of safety in selected destinations. Material and methods: The study involved 300 Polish tourists (125 females, 175 males, age 46.5+/-12.9 years) who traveled during the COVID-19 pandemic to Southern European countries. 5 most popular travel destinations were selected: Italy, Austria, Greece, Croatia, and Mediterranean islands. The tourists assessed cultural institutions and catering establishments with the use of a proprietary questionnaire which concerned the preparedness regarding the sanitary and epidemiological requirements and the tourists' sense of safety. The number of respondents was deliberate - 60 persons per each country. Results: The more stringent sanitary regimes, the higher the sense of safety in the study group of females aged 45-50 (p<0.005), while the more stringent sanitary and epidemiological issues are implemented, the shorter the stay (p<0.001). Less stringent restrictions resulted in increased sense of freedom and mental rest in the group of studied males (p<0.005). Conclusions: The respondents' opinions revealed that the highest level of safety with regard to sanitary and epidemiological requirements (masks covering mouth and nose worn by both personnel and society, the necessity to present the COVID passport, the possibility to disinfect hands) was observed in Austria and Italy, while shorter length of the stay in these countries resulted from high prices, particularly in catering establishments. According to the respondents, less stringent restrictions, among others lack of the necessity to own the COVID passport, were linked to Croatia and Mediterranean islands. The sense of safety was satisfying, while the sense of freedom and mental rest was high. declared a string of COVID-19 cases a pandemic. Most countries implemented numerous sanitary and epidemiological

Keywords: sanitary and epidemiological regimes, tourist facilities, COVID-19 pandemic, sense of safety

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Authors: Pei-Chun Chen, Chi-Ting Tseng, Lih-Chi Chen, Kai-Hsiang Yang

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Introduction: The pharmacist is responsible for encouraging adverse drug reaction (ADR) reporting. In a local center in Northern Taiwan, promotion and rewarding of ADR reporting have continued for over six years but failed to bring significant changes. This study aims to find a solution to increase ADR reporting. Research question or hypothesis: We hypothesized that under-reporting is due to the inconvenience of the reporting system. Reports were made conventionally through printed sheets. We proposed that reports made per month will increase if they were computerized. Study design: An ADR reporting platform was established in April 2015, before which was defined as the first stage of this study (January-March, 2015) and after which the second stage. The third stage commenced in November, 2015, after adding a reporting module to physicians prescription system. ADRs could be reported simultaneously when documenting drug allergies. Methods: ADR report rates during the three stages of the study were compared. Effects of the information platform on reporting were also analyzed. Results: During the first stage, the number of ADR reports averaged 6 per month. In the second stage, the number of reports per month averaged 1.86. Introducing the information platform had little effect on the monthly number of ADR reports. The average number of reports each month during the third stage of the study was 11±3.06, with 70.43% made electronically. Reports per month increased significantly after installing the reporting module in November, 2015 (P<0.001, t-test). In the first two stages, 29.03% of ADR reports were made by physicians, as compared to 70.42% of cases in the third stage of the study. Increased physician reporting possibly account for these differences. Conclusion: Adding a reporting module to the prescription system significantly increased ADR reporting. Improved accessibility is likely the cause. The addition of similar modules to computer systems of other healthcare professions may be considered to encourage spontaneous ADR reporting.

Keywords: adverse drug reactions, adverse drug reaction reporting systems, regional hospital, prescription system

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Authors: Geoffrey Nwaka

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After many years of a border dispute between Nigeria and Cameroon over the ownership of the Bakassi Peninsula, the International Court of Justice ruled in 2002 that, based on the 1913 colonial boundary agreement between Britain and Germany, the oil-rich Peninsula, inhabited for generations by Nigerians, and hitherto administered as one of Nigeria’s 774 Local Government Areas, belongs to Cameroon, and not to Nigeria. Under pressure from the international community, Nigeria and Cameroon signed the Greentree Accord in 2006 to comply peacefully with the ICJ ruling and to protect the fundamental rights and freedoms of the Bakassi people, whether they opted to remain in the Peninsula under the authority of Cameroon or relocate to Nigeria. Sadly, the Nigerian government and the international community underestimated the scale of displacement that would follow the withdrawal of the Nigerian administration and military forces from the area and did not prepare adequately for the massive influx of tens of thousands of Bakassi people hurriedly dislodged by the reported hostility of the Cameroon authorities and their security services. The paper discusses the historical context and contemporary significance of the crisis, the chaotic resettlement schemes and appalling humanitarian relief camps in ‘New Bakassi’, and the prolonged hardship and disillusionment of the disaffected refugees/returnees. The lesson for African and Asian governments and peoples is to avoid needless conflicts over the 'imported' colonial boundaries, to remove unnecessary border restrictions, and take fully into account the development needs and well-being of borderland communities that sometimes rightly feel that distant central governments negotiate their political and international interests at the expense of the borderlands; and finally, to begin to see the boundaries more as links and bridges for the cooperation and integration of African and Asian states and peoples, rather than as barriers and static lines of demarcation on the map.

Keywords: Africa, forced displacement, resettlement, border conflict, Bakassi

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Authors: Parastoo Parhizkar, Jaber Yaghini, Omid Fakheran

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Background: Third molar surgery is often associated with postoperative problems which cause serious impediments on daily activities and quality of life. Steroidal anti-inflammatory drugs may decrease these common post-operative complications. The purpose of this review is evaluating the available evidence regarding the efficacy of corticosteroids used as adjunctive therapy for patients undergoing third molar surgery. Methods: PubMed, Google scholar, Scopus, web of science, clinicaltrials.gov, scirus.com, Cochrane central register for controlled trials, LILACS, OpenGrey, centerwatch, isrctn, who.int and ebsco were searched without restrictions regarding the year of publication. Randomized clinical trials assessing patient-reported outcomes in patients undergoing surgical therapy, were eligible for inclusion. Study quality was assessed using the CONSORT-checklist. No meta-analysis was performed. Results: A total of twelve Randomized Clinical Trials were included in this study. Methylprednisolone and Dexamethasone may decrease postoperative side effects such as pain, trismus and edema. Based on the results both of them could improve patients’ satisfaction, and there is no significant difference between these two types of corticosteroids regarding the patient centered outcomes (p > 0.05). Intralesional and intravenous injection of Dexamethasone showed an equivalent result, with statistically significant better results (P < 0.05) in comparison with the oral treatment. Conclusion: various types of corticosteroids can enhance the patient’s satisfaction following third molar surgery. However, there is no significant difference between Dexamethasone, Prednisolone and Methylprednisolone groups in this regard. Comparing the various administration routs, local injection of Dexamethasone is quite simple, painless and cost-effective adjunctive therapy with better drug efficacy.

Keywords: third molar surgery, corticosteroids, patient-reported outcomes, health related quality of life

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Authors: Vibha Venkataramu, B. V. Venkatarama Reddy

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Natural river sand is the most preferred choice as fine aggregate in masonry mortars. Uncontrolled mining of sand from riverbeds for several decades has had detrimental effects on the environment. Several countries across the world have put strict restrictions on sand mining from riverbeds. However, in countries like India, the huge infrastructural boom has made the local construction industry to look for alternative materials to sand. This study aims at understanding the suitability of granulated blast furnace slag (GBS) as fine aggregates in masonry mortars. Apart from characterising the material properties of GBS, such as particle size distribution, pH, chemical composition, etc., of GBS, tests were performed on the mortars with GBS as fine aggregate. Additionally, the properties of five brick tall, stack bonded masonry prisms with various types of GBS mortars were studied. The mortars with mix proportions 1: 0: 6 (cement: lime: fine aggregate), 1: 1: 6, and 1: 0: 3 were considered for the study. Fresh and hardened properties of mortar, such as flow and compressive strength, were studied. To understand the behaviour of GBS mortars on masonry, tests such as compressive strength and flexure bond strength were performed on masonry prisms made with a different type of GBS mortars. Furthermore, the elastic properties of masonry with GBS mortars were also studied under compression. For comparison purposes, the properties of corresponding control mortars with natural sand as fine aggregate and masonry prisms with sand mortars were also studied under similar testing conditions. From the study, it was observed the addition of GBS negatively influenced the flow of mortars and positively influenced the compressive strength. The GBS mortars showed 20 to 25 % higher compressive strength at 28 days of age, compared to corresponding control mortars. Furthermore, masonry made with GBS mortars showed nearly 10 % higher compressive strengths compared to control specimens. But, the impact of GBS on the flexural strength of masonry was marginal.

Keywords: building materials, fine aggregate, granulated blast furnace slag in mortars, masonry properties

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Authors: A. R. Shakura, A. B. Elistina, M. S. Aini, S. Norhasmah, A. Fakhru’l-Razi

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Tsunami 2004 was an unforeseeable event that caught Malaysia of guard resulting with 68 losses of lives and with an estimated economic loss of about 55.15billion US dollar. Scientists predict that if the earthquake epicentre originates from the Andaman-Nicobar region, the coastal population of Penang will have about 30 minutes to evacuate to safety. Thus, a study was conducted to enhance resiliency of Penang community as the area was the worst affected region during 2004 tsunami disaster. This paper is intended to examine the factors that influence intention to prepare for future tsunami among the coastal residence in Penang. The differences in the level of intention to prepare were also examined between those who experience and did not experience the 2004 tsunami. This study utilized a cross-sectional research design using a survey method. A total of 503 respondents were chosen systematically and data gathered were analysed using SPSS. Both genders, male and female were equally represented with a mean age of 44 years. Data indicated that the level of intention to prepare for tsunami disaster was moderate (M=3.72) with no significant difference in intention to prepare between those who had experienced or had not experienced the 2004 tsunami. Subsequently, results from a multiple regression analysis found that sense of community to be the most influential factor followed by subjective norm, trust, positive outcome expectancy and risk perception, explaining the 57% variance in intention to prepare. These factors reflect the influence of the collectivistic culture in Malaysia whereby households plus communities have a central role in encouraging each other. Therefore, the findings highlights the potential of adopting a community based disaster risk management as recommended by the United Nations International Strategy Disaster Reduction (UNISDR) which encompasses the cooperation between the local community and relevant stakeholders in preparing for future tsunami disaster.

Keywords: disaster management, experience, intention to prepare, tsunami

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Authors: Tamirat Solomon, Aberash Yohannis, Efrem Gulfo

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The plantation of trees, which harmonizes the agroecology of the environment, has been implemented in Ethiopia with great concern for a noticeably degraded environment. This study was designed to evaluate the effectiveness of green legacy, species selection and, the rate of survival, and the management status in the study areas. A systematic sampling method was employed to collect the required data from 144 quadrants measuring a 15m radius with an interval of 40m apart. Additionally, 244 sample households were selected for the socioeconomic study in addition to secondary data collected from office recordings. The data collected was analyzed using multivariate analysis, considering exposure and outcome variables. The findings of this study indicated that four exotic tree species, namely; A. salgina, C. fistula, A. indica, and G. robusta, were commonly selected tree species for degraded land restoration in the study areas. Among the seedlings planted at the four study sites, a total of 79.9% survived, and A. salgina was the dominant and best performed species, A. indica was the least survived species in the entire study area. The age of the seedling before planting significantly (p = 0.05) affected the survival potential of most seedlings of species, and the majority (82%) of local communities expressed their positive attitudes and willingness to manage the restoration works in the study areas. It was recommended to consider the inclusion of native species in the restoration effort and evaluate the co-existence of native flora with exotic and its competition for nutrients, water, and light in addition to the invading potentials in the ecosystem. In general, before embarking on degraded land restoration, species selection, adequate preparation of seedlings, and species diversity composition that exactly fit the socioeconomic and ecological demands of the areas must get the attention for the success of the restoration.

Keywords: plantation forest, degraded land, forest restoration, plantation survival, species selection

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Authors: M. Warburton

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Background: Case study examining hydrotherapy for a person with DSI. A 46 year-old lady completely deaf and blind post congenital rubella syndrome. Touch becomes the primary information gathering sense to optimise function in life. Communication is achieved via tactile finger spelling and signals onto her hand and skin. Hydrotherapy may provide a suitable mobility environment and somato-sensory input to people, and especially DSI persons. Buoyancy, warmth, hydrostatic pressure, viscosity and turbulence are elements of hydrotherapy that may offer a DSI person somato-sensory input to stimulate the mechanoreceptors, thermoreceptors and proprioceptors and offer a unique hydro-therapeutic environment. Purpose: The purpose of this case study was to establish what measurable benefits could be achieved from hydrotherapy with a DSI person. Methods: Hydrotherapy was provided for 8-weeks, 2 x week, 35-minute session duration. Pool temperature 32.5 degrees centigrade. Pool length 25-metres. Each session consisted of mobility encouragement and supervision, and activities to stimulate the somato-sensory system utilising aquatic properties of buoyancy, turbulence, viscosity, warmth and hydrostatic pressure. Somato-sensory activities focused on stimulating touch and tactile exploration including objects of various shape, size, weight, contour, texture, elasticity, pliability, softness and hardness. Outcomes were measured by the Goal Attainment Scale (GAS) and included mobility distance, attendance, and timed tactile responsiveness to varying objects. Results: Mobility distance and attendance exceeded baseline expectations. Timed tactile responsiveness to varying objects also changed positively from baseline. Average scale scores were 1.00 with an overall GAS t-score of 63.69. Conclusions: Hydrotherapy can be a quantifiable physio-therapeutic option for persons with DSI. It provides a relatively safe environment for mobility and allows the somato-sensory system to be fully engaged - important for the DSI population. Implications: Hydrotherapy can be a measurable therapeutic option for a DSI person. Physiotherapists should consider hydrotherapy for DSI people. Hydrotherapy can offer unique physical properties for the DSI population not available on land.

Keywords: chronic, disability, disease, rehabilitation

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Authors: William E. Bauta, Jennifer Rebeles, Reggie Jacob

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Porphyrins are noteworthy in biomedical science for their cancer tissue accumulation and photophysical properties. The preferential accumulation of some porphyrins in cancerous tissue has been known for many years. This, combined with their characteristic photophysical and photochemical properties, including their strong fluorescence and their ability to generate reactive oxygen species in vivo upon laser irradiation, has led to much research into the application of porphyrins as cancer diagnostic and therapeutic agents. Porphyrins have been used as dyes to detect cancer cells both in vivo and, less commonly, in vitro. In one example, human sputum samples from lung cancer patients and patients without the disease were dissociated and stained with the porphyrin TCPP (5,10,15,20-tetrakis-(4-carboxyphenyl)-porphine). Cells were analyzed by flow cytometry. Cancer samples were identified by their higher TCPP fluorescence intensity relative to the no-cancer controls. However, quantitative analysis of fluorescence in cell suspensions stained with multiple fluorophores requires particles stained with each of the individual fluorophores as controls. Fluorescent control particles must be compatible in size with flow cytometer fluidics and have favorable hydrodynamic properties in suspension. They must also display fluorescence comparable to the cells of interest and be stable upon storage amine-functionalized spherical polystyrene beads in the 5 to 20-micron diameter range that was reacted with TCPP and EDC in aqueous pH six buffer overnight to form amide bonds. Beads were isolated by centrifugation and tested by flow cytometry. The 10-micron amine-functionalized beads displayed the best combination of fluorescence intensity and hydrodynamic properties, such as lack of clumping and remaining in suspension during the experiment. These beads were further optimized by varying the stoichiometry of EDC and TCPP relative to the amine. The reaction was accompanied by the formation of a TCPP-related particulate, which was removed, after bead centrifugation, using a microfiltration process. The resultant TCPP-functionalized beads were compatible with flow cytometry conditions and displayed a fluorescence comparable to that of stained cells, which allowed their use as fluorescence standards. The beads were stable in refrigerated storage in the dark for more than eight months. This work demonstrates the first preparation of porphyrin-functionalized flow cytometry control beads.

Keywords: tetraaryl porphyrin, polystyrene beads, flow cytometry, peptide coupling

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Authors: Nancy Awuor Oduor, Nils Moosdorf

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Harmful Algal Blooms (HABs) are a threat to coastal water quality, marine biodiversity, and human health. The attention on HABs and associated phycotoxins is still very low in tropical coastal developing countries despite the high dependence of local communities on coastal and marine resources for food and livelihoods and the growing evidence of the global increase in HABs frequency, toxicity, and geographical expansion. Lack of HABs monitoring thus creates a high risk of exposure due to uncertainty. This study assessed the spatial and temporal variability and effects of potential HAB-forming species in Kenya’s coastal waters. The preliminary results from 463 sampled collected over a series of 10 coastal surveys conducted over 267 Km of Kenya’s coastline between August 2021 and July 2022 revealed the presence of 87 potential algal blooming species belonging to 47 genera dominated by species capable of producing toxins, causing physical harm and high biomass at 41, 31 and 21 % respectively. The taxonomic composition was also dominated by dinoflagellates at 47%, followed by diatoms, cyanobacteria, and silicoflagellates at 39, 12, and 2%, respectively. About 92 % of the toxin-producing species were established in the creek waters. However, there were no significant variations established in species richness between the dry and wet seasons. Paralytic Shellfish Poisoning (PSP) toxin-producing dinoflagellates Alexandrium spp., Aphanizomenon spp., Gonyaulax spp., Gymnodinium spp., and Brachydinium capitatum, and Amnesic Shellfish Poisoning (ASP) Toxin producing diatoms Amphora spp., Nitzschia spp. and Pseudo-nitzschia spp. Frequented the area in low cell densities ranging between 5 and 1500 cells/L. However, no domoic acid (DA) and saxitoxins (SXTs) were detected during the July surveys. This does not mean that the toxins are absent in the area, and longer studies are recommended.

Keywords: harmful algal blooms, phycotoxins, saxitoxin, domoic acid, Kenya

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Authors: Mohammed Jemal Ahmed

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Some anti-Islam attributes, such as alcoholism and voyeurism, have become de facto manifestations of the tourism sector. This eventually causes a paradoxical relationship between tourism and Islam. Hence, on the one hand, Islam inherently encourages Muslims to engage in tourism, the interest of Muslims to engage in tourism is steadily increasing. On the other hand, haram activities and products that are not allowed to Muslims as per the Islamic law and doctrine have surrounded tourism. Therefore, halal tourism has emerged as the best mediator to reconcile the conflicts between secular interests and religious values. Recent studies have confirmed that halal tourism is an emerging cultural phenomenon and secular rather than religious. The central aim of halal tourism is to have delighted customers irrespective of their religious and cultural backgrounds while promoting environmental conservation and social coexistence. This study appraises halal tourism development in Ethiopia from commercial, socio-cultural and diplomatic perspectives. Employing qualitative methodologies, the study, firstly, tried to clarify the existing terminological ambiguities between halal tourism and Islamic tourism and redefine both concepts. Then, it assessed perceptions of local communities and stakeholders towards halal tourism and identified halal tourism resources of Ethiopia. Accordingly, five clusters of halal visitor attractions and five potential halal tourism routes were identified and proposed. Furthermore, the comparative advantages of Ethiopia in terms of halal tourism development and potential barriers to halal tourism development in the country were rigorously appraised. The findings of this study reveal that halal tourism could inject hard currency into the national economy and create job opportunities for the locals. It could also support the mainstream tourism industry through product diversification and curving seasonality. Moreover, socially, halal tourism reinforces interreligious cohesion, relationship and coextensive in multi-religious, multicultural and multiethnic Ethiopia. Politically, it strengthens Ethiopia's foreign diplomatic relationship with the Islamic world and its near and distant neighbor Muslim Countries.

Keywords: halal-conscious travelers, halal tourism, Islamic tourism, tourism resources

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Authors: Sandra Maria Cerqueira Da Silva

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In Brazil, women are the majority of the country's population. They have advanced in terms of years of education and professional training. However, this has not prevented the differences in the labor market from being sustained, particularly the wage gap and inequalities concerning the access to command positions and promotions, i.e., in the gender relations and treatment. One of the conditions which constitute a barrier to career advancement is the necessary support chain to support women when they are in the labor market. Therefore, the purpose of this research is to demonstrate, describe, and criticize some of the current conformations of support chains and how these compete to promote the phenomenon known as glass ceiling in the country. However, this support may come even from inside a woman's own home, with a fairer division of household activities between men and women. Such behavior can free an entire network of women within the same family. In addition, it can serve as pressure to structure better conditions for women as a whole, improving the living conditions of the poor population. This can occur through programs and projects for qualification and retraining of adult women. In answer to the question that guides this study, it is concluded that a family support system is critical to the success of women in management positions. To meet this demand, one of the ways could be the development of specific gender policies by the public authorities, in accordance with the emerging global economic policies, in order to provide and structure the necessary support. This would respond to feminist manifestations - which should go on pointing needs – although the legislative assembly should also propose ideas to change this picture. This is a qualitative research, with a poststructuralist approach, featuring a cutout corpus of three interviews carried out with women holding leadership positions in the academia. Questions related to this very discussion are many. New studies could address points as the promotion of qualification and expansion of skills of women in subaltern condition. There is also need to investigate possible support systems, considering the inequalities and local economic conditions.

Keywords: gender and labor market, glass ceiling, post-structuralism, support chain

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Authors: Jose Melena, Rosa Santander, Tanya Gonzalez, Richard Duque, Juan Illanes

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Ecuador is one of the countries with the greatest aquatic biodiversity worldwide. In particular, there are at least a dozen native marine species with great aquaculture potential locally. This research concerns one of those species. It has proposed to implement experimental protocols in order to induce spawning and to generate the early larval development of the giant reef clam P. multicostata under controlled conditions. Bioassays were carried out with one adult batch (n= 8) with an average valvar length of 118,4 ± 5,8 mm, which were collected near of the Puerto Santa Rosa (2° 12' 30'' S, 80° 58' 28'' W), Santa Elena Province. During a short acclimation stage, the eight adults of giant reef clam P. multicostata were exposed to thermal stress. Briefly, the experimental protocol for spawning induction was based on the application of 20°C for 1 h and 30°C for 1 h on P. multicostata broodstock at least three consecutive times by one day. After spawning, collected sexual material was released for external fertilization process. After the delivery of gametes, it was achieved 3,25 × 10⁶ viable zygotes. As results, fertilized eggs had 56 µm diameter; while first and second cell divisions were observed to 2,5 h post-fertilization, with individual average length of 68 ± 5 µm and polar body. Latter cell divisions, including gastrula stage, appeared at 9 h post-fertilization, with individual average length of 73 ± 4 µm and trochophore stage at 15 h post-fertilization with individual average length of 75 ± 4 µm. In addition, veliger stage was registered at 20 h post-fertilization with individual average length of 82 ± 6 µm. Umboned larvae appeared at day 8 post-fertilization, with individual average length of 148 ± 6 µm. These pioneering results worldwide can strengthen the local conservation process of the overexploited P. multicostata and to encourage its production for commercial purposes.

Keywords: Ecuador, larval development, Periglypta multicostata, spawning induction

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Authors: Ana Bermudez de Castro Muela, Xiomara Santos Salas, Silvia Cayon Somacarrera

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The aim of this review is to explain what is the intracranial hypotension and its main causes, and also to approach to the diagnostic management in the different clinical situations, understanding radiological findings, and physiopathological substrate. An approach to the diagnostic management is presented: what are the guidelines to follow, the different tests available, and the typical findings. We review the myelo-CT and myelo-RM studies in patients with suspected CSF fistula or hypotension of unknown cause during the last 10 years in three centers. Signs of intracranial hypotension (subdural hygromas/hematomas, pachymeningeal enhancement, venous sinus engorgement, pituitary hyperemia, and lowering of the brain) that are evident in baseline CT and MRI are also sought. The intracranial hypotension is defined as a lower opening pressure of 6 cmH₂O. It is a relatively rare disorder with an annual incidence of 5 per 100.000, with a female to male ratio 2:1. The clinical features it’s an orthostatic headache, which is defined as development or aggravation of headache when patients move from a supine to an upright position and disappear or typically relieve after lay down. The etiology is a decrease in the amount of cerebrospinal fluid (CSF), usually by loss of it, either spontaneous or secondary (post-traumatic, post-surgical, systemic disease, post-lumbar puncture etc.) and rhinorrhea and/or otorrhea may exist. The pathophysiological mechanisms of hypotension and CSF hypertension are interrelated, as a situation of hypertension may lead to hypotension secondary to spontaneous CSF leakage. The diagnostic management of intracranial hypotension in our center includes, in the case of being spontaneous and without rhinorrhea and/or otorrhea and according to necessity, a range of available tests, which will be performed from less to more complex: cerebral CT, cerebral MRI and spine without contrast and CT/MRI with intrathecal contrast. If we are in a situation of intracranial hypotension with the presence of rhinorrhea/otorrhea, a sample can be obtained for the detection of b2-transferrin, which is found in the CSF physiologically, as well as sinus CT and cerebral MRI including constructive interference steady state (CISS) sequences. If necessary, cisternography studies are performed to locate the exact point of leakage. It is important to emphasize the significance of myelo-CT / MRI to establish the diagnosis and location of CSF leak, which is indispensable for therapeutic planning (whether surgical or not) in patients with more than one lesion or doubts in the baseline tests.

Keywords: cerebrospinal fluid, neuroradiology brain, magnetic resonance imaging, fistula

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Authors: H. Akhloufi, M. Hulscher, J. M. Prins, I. H. Van Der Sijs, D. Melles, A. Verbon

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Background: A timely switch from intravenous to oral antibiotic therapy has many advantages, such as reduced incidence of IV-line related infections, a decreased hospital length of stay and less workload for healthcare professionals with equivalent patient safety. Additionally, numerous studies have demonstrated significant decreases in costs of a timely intravenous to oral antibiotic therapy switch, while maintaining efficacy and safety. However, a considerable variation in iv to oral antibiotic switch therapy criteria has been described in literature. Here, we report the development of a set of iv to oral switch criteria that are generally applicable in all hospitals. Material/methods: A RAND-modified Delphi procedure, which was composed of 3 rounds, was used. This Delphi procedure is a widely used structured process to develop consensus using multiple rounds of questionnaires within a qualified panel of selected experts. The international expert panel was multidisciplinary and composed out of clinical microbiologists, infectious disease consultants and clinical pharmacists. This panel of 19 experts appraised 6 major intravenous to oral antibiotic switch therapy criteria and operationalized these criteria using 41 measurable conditions extracted from the literature. The procedure to select a concise set of iv to oral switch criteria included 2 questionnaire rounds and a face-to-face meeting. Results: The procedure resulted in the selection of 16 measurable conditions, which operationalize 6 major intravenous to oral antibiotic switch therapy criteria. The following 6 major switch therapy criteria were selected: (1) Vital signs should be good or improving when bad. (2) Signs and symptoms related to the infection have to be resolved or improved. (3) The gastrointestinal tract has to be intact and functioning. (4) The oral route should not be compromised. (5) Absence of contra-indicated infections. (6) An oral variant of the antibiotic with good bioavailability has to exist. Conclusions: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 major intravenous to oral antibiotic switch therapy criteria operationalized by 16 measurable conditions. This set of early antibiotic iv to oral switch criteria can be used in daily practice in all adult hospital patients. Future use in audits and as rules in computer assisted decision support systems will lead to improvement of antimicrobial steward ship programs.

Keywords: antibiotic resistance, antibiotic stewardship, intravenous to oral, switch therapy

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Authors: Emrehan Ozcan, Dilek Beyazlı

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The development of tourism depends on an accurate planning approach as well as on the right planning process. This dependency is also a key factor in ensuring sustainability of tourism. The types of tourism, social expectations, planning practice, the socio-economic and the cultural structure of the region are determinants of planning approaches for tourism development. The tourism plans prepared for the historic city centers are usually based on the revitalization of cultural and historical values. The preservation and development of the tourism potentials of the historic city centers are important for providing an economic contribution to the locality, creating livable solutions for local residents and also the sustainability of tourism. This research is about experiencing and discussing a planning approach that will provide tourism development based on historical and cultural values. Historical and cultural values in the historical city center of Trabzon -which has a settlement history of approximately 4000 years, is located on the Black Sea coast of Turkey- wear out over years and lose their tourism potential. A planning study has been experienced with strategic spatial planning approach for Trabzon, which has not done a tourism-oriented planning study until now. The stages of the planning process provided by strategic spatial planning approach are an assessment of the current situation; vision, strategies, and actions; action planning; designing and implementation of actions and monitoring-evaluation. In the discussion section, the advantages, planning process, methods and techniques of the approach are discussed for the possibilities and constraints in terms of tourism planning. In this context, it is aimed to put forth tourism planning process, stages, and implementation tools within the scope of strategic spatial planning approach by comparing approaches used in the tourism-oriented/priority planning of historical city centers. Suggestions on the position and effect of the preferred planning approach in the existing spatial planning practice are the outputs of the study.

Keywords: cultural heritage, tourism oriented planning, Trabzon, strategic spatial Planning

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Authors: Khanyisile Mnguni, Muthukrishnavellaisamy Kumarasamy, Jeff C. Smithers

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Umgeni Water is a water board that supplies most parts of KwaZulu Natal with bulk portable water. Currently, Umgeni Water is running its distribution system based on required reservoir levels and demands and does not consider the energy cost at different times of the day, number of pump switches, and background leakages. Including these constraints can reduce operational cost, energy usage, leakages, and increase performance. Optimising pump schedules can reduce energy usage and costs while adhering to hydraulic and operational constraints. Umgeni Water has installed an online hydraulic software, WaterNet Advisor, that allows running different operational scenarios prior to implementation in order to optimise the distribution system. This study will investigate operation scenarios using optimisation techniques and WaterNet Advisor for a local water distribution system. Based on studies reported in the literature, introducing pump scheduling optimisation can reduce energy usage by approximately 30% without any change in infrastructure. Including tariff structures in an optimisation problem can reduce pumping costs by 15%, while including leakages decreases cost by 10%, and pressure drop in the system can be up to 12 m. Genetical optimisation algorithms are widely used due to their ability to solve nonlinear, non-convex, and mixed-integer problems. Other methods such as branch and bound linear programming have also been successfully used. A suitable optimisation method will be chosen based on its efficiency. The objective of the study is to reduce energy usage, operational cost, and leakages, and the feasibility of optimal solution will be checked using the Waternet Advisor. This study will provide an overview of the optimisation of hydraulic networks and progress made to date in multi-objective optimisation for a selected sub-system operated by Umgeni Water.

Keywords: energy usage, pump scheduling, WaterNet Advisor, leakages

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