Search results for: community language
Commenced in January 2007
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Edition: International
Paper Count: 7930

Search results for: community language

370 Determination of Energy and Nutrients Composition of Potential Ready-to-Use Therapeutic Food Formulated from Locally Available Resources

Authors: Amina Sa'id Muhammad, Asmau Ishaq Alhassan, Beba Raymond, Fatima Bello

Abstract:

Severe acute malnutrition (SAM) remains a major killer of children under five years of age. Nigeria has the second highest burden of stunted children in the world, with a national prevalence rate of 32 percent of children under five. An estimated 2 million children in Nigeria suffer from severe acute malnutrition (SAM), and 3.9% of children in northwest Nigeria suffer from SAM, which is significantly higher than the national average of 2.1%. Community-Based Management of Acute Malnutrition (CMAM) has proven to be an effective intervention in the treatment of SAM in children using Ready-to-Use Therapeutic Food (RUTF). Ready-to-use therapeutic food (RUTF) is a key component for the treatment of Severe Acute Malnutrition. It contains all the energy and nutrients required for rapid catch-up growth and used particularly in the treatment of children over 6 months of age with SAM without medical complications. However, almost all RUTFs are currently imported to Nigeria from other countries. Shortages of RUTF due to logistics (shipping costs, delays, donor fatigue etc) and funding issues present a threat to the achievement of the 2030 World Health Assembly (WHA) targets for reducing malnutrition in addition to 2030 SDGs 2 (Zero Hunger), 3 (Good Health and Wellbeing), 12 (Responsible Consumption and Production), and 17 (Partnerships for the Goals), thus undermining its effectiveness in combating malnutrition On the other hand, the availability of human and material resources that will aid local production of RUTF presents an opportunity to fill in the gap in regular RUTF supply. About one thousand Nigerian children die of malnutrition-related causes every day, reaching a total of 361,000 each year. Owing to the high burden of malnutrition in Nigeria, the local production of RUTF is a logical step, that will ensure increased availability, acceptability, access, and efficiency in supply, and at lower costs. Objective(s): The objectives of this study were therefore, to formulate RUTF from locally available resources and to determine its energy and nutrients composition, incommensurate with the standard/commercial RUTF. Methods: Three samples of RUTF were formulated using locally available resources (soya beans, wheat, rice, baobab, brown-sugar, date palm and soya oil); which were subjected to various analysis to determine their energy/proximate composition, vitamin and mineral contents and organoleptic properties were also determined using sensory evaluation. Results: The energy values of the three samples of locally produced RUTF were found to be in conformity with WHO recommendation of ≥ 500 kcal per 100g. The energy values of the three RUTF samples produced in the current study were found to be 563.08, 503.67 and 528.98 kcal respectively. Sample A, B and C had protein content of 13.56% 16.71% and 14.62% respectively, which were higher than that of commercial RUTF (10.9%). Conclusions/recommendations: The locally formulated RUTF samples had energy value of more than 500 kcal per 100g; with an appreciable amount of macro and micro nutrients. The appearance, taste, flavor and general acceptability of the formulated RUTF samples were also commendable.

Keywords: energy, malnutrition, nutrients, RUTF

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369 School Accidents in Educational Establishment in Tunisia: A Five Years Retrospective Survey in the Governorate of Mahdia

Authors: Lamia Bouzgarrou, Amira Omrane, Leila Mrabet, Taoufik Khalfallah

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Background and aims: School accidents are one of the leading causes of morbidity and mortality among pupils and students. Indeed, they may induce an elevated number of lost school days, heavy emotional and physical disabilities, and financial costs on the victims and their families. This study aims to evaluate the annual incidence of school accidents in the central Tunisian governorate of Mahdia and to identify the epidemiological profile of victims and risk factors of these accidents. Methods: A retrospective study was conducted over the period of 5 school years, focusing on school accidents that occurred in public educational institutions (primary, basic, secondary and university) in the governorate of Mahdia (area = 2 966 km² and number of inhabitants in 2014 = 410 812). All accidents declared near the only official insurance of this type of injuries (MASU: Mutual School and University Accidents), and initially taken in charge at the University Hospital of Mahdia were included. Data was collected from the MASU reporting forms and the medical records of emergency and other specialized hospital departments. Results: With 3248 identified victims, the annual incidence of school accidents was equal to 0.69 per 100 pupils and students per year. The average age of victims was 14.51 ± 0.059 years and the sex ratio was 1.58. Pupils aged between 12 and 15 years, were concerned by 46.7% of the identified accidents. The practice of sports was the most relevant circumstances of these accidents (76.2 %). In 56.58 % of cases, falls were the leading mechanism. Bruises and fractures were the most frequent lesions (32.43 % and 30.51 %). Serious school accidents were noted in 28% of cases with hospitalization in 2.27 % of them. The average lost school days, was 12.23±1.73 days. Accidents occurring during sports or leisure activities were significantly more serious (p= 0.021). Furthermore, the frequency of hospitalization was significantly higher among boys (2.81% vs. 1.43%; p= 0.035), students ≤11 years (p= 0.008), and following crush trauma (p= 0.000). In addition, the surgical interventions were statistically more frequent among male victims (p=0.00), accidents occurring during physical education sessions (p=0.000); those associated to falls (p=0.000) and to crushes mechanisms (p=0.002), and injuries affecting lower limbs (p=0.000). Following this Multi-varied analysis concluded that the severity of school accident is correlated to the activity practiced during the trauma and the geographical location of the school. Conclusion: Children and adolescents are one of the most vulnerable groups against incidents with the risk of permanent disability, mainly related to the perturbation of the growth process and physiological limitations. Our five-year study, objectified a real elevate incidence of school accident among children and adolescents, with a considerable rate of severe injuries. In any community, the promotion of adolescents and children’s health is an important indicator of the public health level. Thus, it’s important to develop a multidisciplinary prevention strategy of school accident, based on safety and security rules and adapted to the specificity of our context.

Keywords: children and adolescents, children health, injuries and disability, school accident

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368 An Integrated Approach to Cultural Heritage Management in the Indian Context

Authors: T. Lakshmi Priya

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With the widening definition of heritage, the challenges of heritage management has become more complex . Today heritage not only includes significant monuments but comprises historic areas / sites, historic cities, cultural landscapes, and living heritage sites. There is a need for a comprehensive understanding of the values associated with these heritage resources, which will enable their protection and management. These diverse cultural resources are managed by multiple agencies having their own way of operating in the heritage sites. An Integrated approach to management of these cultural resources ensures its sustainability for the future generation. This paper outlines the importance of an integrated approach for the management and protection of complex heritage sites in India by examining four case studies. The methodology for this study is based on secondary research and primary surveys conducted during the preparation of the conservation management plansfor the various sites. The primary survey included basic documentation, inventorying, and community surveys. Red Fort located in the city of Delhi is one of the most significant forts built in 1639 by the Mughal Emperor Shahjahan. This fort is a national icon and stands testimony to the various historical events . It is on the ramparts of Red Fort that the national flag was unfurled on 15th August 1947, when India became independent, which continues even today. Management of this complex fort necessitated the need for an integrated approach, where in the needs of the official and non official stakeholders were addressed. The understanding of the inherent values and significance of this site was arrived through a systematic methodology of inventorying and mapping of information. Hampi, located in southern part of India, is a living heritage site inscribed in the World Heritage list in 1986. The site comprises of settlements, built heritage structures, traditional water systems, forest, agricultural fields and the remains of the metropolis of the 16th century Vijayanagar empire. As Hampi is a living heritage site having traditional systems of management and practices, the aim has been to include these practices in the current management so that there is continuity in belief, thought and practice. The existing national, regional and local planning instruments have been examined and the local concerns have been addressed.A comprehensive understanding of the site, achieved through an integrated model, is being translated to an action plan which safeguards the inherent values of the site. This paper also examines the case of the 20th century heritage building of National Archives of India, Delhi and protection of a 12th century Tomb of Sultan Ghari located in south Delhi. A comprehensive understanding of the site, lead to the delineation of the Archaeological Park of Sultan Ghari, in the current Master Plan for Delhi, for the protection of the tomb and the settlement around it. Through this study it is concluded that the approach of Integrated Conservation has enabled decision making that sustains the values of these complex heritage sites in Indian context.

Keywords: conservation, integrated, management, approach

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367 Transnational Solidarity and Philippine Society: A Probe on Trafficked Filipinos and Economic Inequality

Authors: Shierwin Agagen Cabunilas

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Countless Filipinos are reeling in dire economic inequality while many others are victims of human trafficking. Where there is extreme economic inequality, majority of the Filipinos are deprived of basic needs to have a good life, i.e., decent shelter, safe environment, food, quality education, social security, etc. The problem on human trafficking poses a scandal and threat in respect to human rights and dignity of a person on matters of sex, gender, ethnicity and race among others. The economic inequality and trafficking in persons are social pathologies that needed considerable amount of attention and visible solution both in the national and international level. However, the Philippine government seems falls short in terms of goals to lessen, if not altogether eradicate, the dire fate of many Filipinos. The lack of solidarity among Filipinos seems to further aggravate injustice and create hindrances to economic equity and protection of Filipinos from syndicated crimes, i.e., human trafficking. Indifference towards the welfare and well-being of the Filipino people trashes them into an unending cycle of marginalization and neglect. A transnational solidaristic action in response to these concerns is imperative. The subsequent sections will first discuss the notion of solidarity and the motivating factors for collective action. While solidarity has been previously thought of as stemming from and for one’s own community and people, it can be argued as a value that defies borders. Solidarity bridges peoples of diverse societies and cultures. Although there are limits to international interventions on another’s sovereignty, such as, internal political autonomy, transnational solidarity may not be an opposition to solidarity with people suffering injustices. Governments, nations and institutions can work together in securing justice. Solidarity thus is a positive political action that can best respond to issues of economic, class, racial and gender injustices. This is followed by a critical analysis of some data on Philippine economic inequality and human trafficking and link the place of transnational solidaristic arrangements. Here, the present work is interested on the normative aspect of the problem. It begins with the section on economic inequality and subsequently, human trafficking. It is argued that a transnational solidarity is vital in assisting the Philippine governing bodies and authorities to seriously execute innovative economic policies and developmental programs that are justice and egalitarian oriented. Transnational solidarity impacts a corrective measure in the economic practices, and activities of the Philippine government. Moreover, it is suggested that in order to mitigate Philippine economic inequality and human trafficking concerns it involves a (a) historical analysis of systems that brought about economic anomalies, (b) renewed and innovated economic policies, (c) mutual trust and relatively high transparency, and (d) grass-root and context-based approach. In conclusion, the findings are briefly sketched and integrated in an optimistic view that transnational solidarity is capable of influencing Philippine governing bodies towards socio-economic transformation and development of the lives of Filipinos.

Keywords: Philippines, Filipino, economic inequality, human trafficking, transnational solidarity

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366 Nurturing Scientific Minds: Enhancing Scientific Thinking in Children (Ages 5-9) through Experiential Learning in Kids Science Labs (STEM)

Authors: Aliya K. Salahova

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Scientific thinking, characterized by purposeful knowledge-seeking and the harmonization of theory and facts, holds a crucial role in preparing young minds for an increasingly complex and technologically advanced world. This abstract presents a research study aimed at fostering scientific thinking in early childhood, focusing on children aged 5 to 9 years, through experiential learning in Kids Science Labs (STEM). The study utilized a longitudinal exploration design, spanning 240 weeks from September 2018 to April 2023, to evaluate the effectiveness of the Kids Science Labs program in developing scientific thinking skills. Participants in the research comprised 72 children drawn from local schools and community organizations. Through a formative psychology-pedagogical experiment, the experimental group engaged in weekly STEM activities carefully designed to stimulate scientific thinking, while the control group participated in daily art classes for comparison. To assess the scientific thinking abilities of the participants, a registration table with evaluation criteria was developed. This table included indicators such as depth of questioning, resource utilization in research, logical reasoning in hypotheses, procedural accuracy in experiments, and reflection on research processes. The data analysis revealed dynamic fluctuations in the number of children at different levels of scientific thinking proficiency. While the development was not uniform across all participants, a main leading factor emerged, indicating that the Kids Science Labs program and formative experiment exerted a positive impact on enhancing scientific thinking skills in children within this age range. The study's findings support the hypothesis that systematic implementation of STEM activities effectively promotes and nurtures scientific thinking in children aged 5-9 years. Enriching education with a specially planned STEM program, tailoring scientific activities to children's psychological development, and implementing well-planned diagnostic and corrective measures emerged as essential pedagogical conditions for enhancing scientific thinking abilities in this age group. The results highlight the significant and positive impact of the systematic-activity approach in developing scientific thinking, leading to notable progress and growth in children's scientific thinking abilities over time. These findings have promising implications for educators and researchers, emphasizing the importance of incorporating STEM activities into educational curricula to foster scientific thinking from an early age. This study contributes valuable insights to the field of science education and underscores the potential of STEM-based interventions in shaping the future scientific minds of young children.

Keywords: Scientific thinking, education, STEM, intervention, Psychology, Pedagogy, collaborative learning, longitudinal study

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365 Recognition of Sanitation as a Human Right: An Overview of Unresolutions and Reports That Recognizes the Human Right to Sanitation in South-Asian Countries

Authors: Anju Vaidya

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Sanitation is concerned with proper disposal of human excreta, waste water and promotion of hygiene. Lack of sanitation impacts our environment affecting our finance, schooling, health, and thus exacerbating poverty, discrimination and exclusion of the marginalized group. Sanitation can be a route and one of the most important factor to reach the goals of all Millennium Development goals. This study aims at exploring what are the rights to sanitation of the people, how it is enacted and what challenges are being faced while implementing the right to sanitation in South-Asian countries (India, Nepal, Pakistan, Bangladesh, Srilanka) at government, non-government and international level. This study also aims at finding how right sanitation is interlinked with children rights. The available reports submitted by government and civil society organizations working in South-Asian countries from the website of the Office of High Commissioner for Human Rights that were submitted under International covenant on economic, social and cultural rights and Convention on rights of the child have been selected and analyzed. The study uses Literature review to analyze these UN documents submitted from 2000 to 2015 in the context of South-Asian countries. Preliminary insight reveals that sanitation is recognized as one of the important factor to attain adequate standard of living. It has been found that inadequate sanitation has been a major factor that affects all aspects of life and one of its devastating impacts is increased child mortality. Many efforts have been made at national and international level in South-Asian countries to improve the state of sanitation and sanitation services. Various approaches such as Community led Total Sanitation, School led Total Sanitation, establishing Open Defecation free zone, water supply services and other sanitation and hygiene awareness programs are being launched. Despite different efforts and programs being implemented, sanitation and hygiene practices and behavior change remains to be a big challenge. Disparity in access and imbalance between urban and rural services and geographical regions, inadequate financing, clear policy framework and fragile functionality are some of the significant challenges faced while implementing these programs. Children are one of the most vulnerable group that are affected to a large extent. The study brings into light varied approaches that are being made and challenges that are being faced by government, non-government and civil society organizations while implementing the programs and strategies related to sanitation. It also highlights the relation of sanitation as a human right with child rights. This can help the stakeholders and policymakers better understand that improving sanitation situation is a process that requires learning, planning and behavior change and achieving sanitation coverage targets and motivating behavior change requires additional tools based on participation, non-discrimination and process approaches for planning and feedback.

Keywords: challenges, child rights, open defecation, sanitation as a human right

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364 Influence of Urban Design on Pain and Disability in Women with Chronic Low Back Pain in Urban Cairo

Authors: Maha E. Ibrahim, Mona Abdel Aziz

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Background: Chronic low back pain (CLBP) in urban communities represents a challenge to healthcare systems worldwide. The traditional biomedical approach to back pain has been particularly inadequate. Failure of the biomedical model to explain the poor correlation between pain and disability on the one hand, and biological and physical factors that explain those symptoms on the other has led to the adoption of the biopsychosocial model, to recognize the reciprocal influence of physical, social and psychological factors implicated in CLBP, a condition that shows higher prevalence among women residing in urban areas. Urban design of the built community has been shown to exert a significant influence on physical and psychological health. However, little research has investigated the relationship between elements of the built environment, and the level of pain and disability of women with CLBP. As Egypt embarks on building a new capital city, and new settlements proliferate, better understanding of this relationship could greatly reduce the economic and human costs of this widespread medical problem for women. Methods: This study was designed as an exploratory mixed qualitative and quantitative study. Twenty-Six women with CLBP living in two neighborhoods in Cairo, different in their urban structure, but adjacent in their locations (Old Maadi and New Maadi) were interviewed using semi-structured interviews (8 from Old Maadi and 18 from New Maadi). Located in the South of Cairo, New Maadi is a neighborhood with the characteristic modern urban style (narrow streets and tall, adjacent buildings), while Old Maadi is known for being greener, quieter and more relaxed than the usual urban districts of Cairo. The interviews examined their perceptions of the built environment, including building shapes and colors and street light, as well as their sense of safety and comfort, and how it affects their physical and psychological health in general, and their back condition in particular. In addition, they were asked to rate their level of pain and to fill the Oswestry Disability Index (ODI), and the General Health Questionnaire (GHQ-12) to rate their level of disability and psychological status, respectively. Results: Women in both districts had moderate to severe pain and moderate disability with no significant differences between the two districts. However, those living in New Maadi had significantly worse scores on the GHQ-12 than those living in Old Maadi. Most women did not feel that specific elements of the built environment affected their back pain, however, they expressed distress of the elements that were ugly, distorted or damaged, especially where there were no ways of avoiding or fixing them. Furthermore, most women affirmed that the unsightly and uncomfortable elements of their neighborhoods affected their mood states and were a constant source of stress. Conclusion: This exploratory study concludes that elements of the urban built environment do not exert a direct effect on CLBP. However, the perception of women regarding these elements does affect their mood states, and their levels of stress, making them a possible indirect cause of increased suffering in these women.

Keywords: built environment, chronic back pain, disability, urban Cairo

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363 Role of HIV-Support Groups in Mitigating Adverse Sexual Health Outcomes among HIV Positive Adolescents in Uganda

Authors: Lilian Nantume Wampande

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Group-based strategies in the delivery of HIV care have opened up new avenues not only for meaningful participation for HIV positive people but also platforms for deconstruction and reconstruction of knowledge about living with the virus. Yet the contributions of such strategies among patients who live in high risk areas are still not explored. This case study research assessed the impact of HIV support networks on sexual health outcomes of HIV positive out-of-school adolescents residing in fishing islands of Kalangala in Uganda. The study population was out-of-school adolescents living with HIV and their sexual partners (n=269), members of their households (n=80) and their health service providers (n=15). Data were collected via structured interviews, observations and focus group discussions between August 2016 and March 2017. Data was then analyzed inductively to extract key themes related to the approaches and outcomes of the groups’ activities. The study findings indicate that support groups unite HIV positive adolescents in a bid for social renegotiation to achieve change but individual constraints surpass the groups’ intentions. Some adolescents for example reported increased fear which led to failure to cope, sexual violence, self-harm and denial of status as a result of the high expectations placed on them as members of the support groups. Further investigations around this phenomenon show that HIV networks play a monotonous role as information sources for HIV positive out-of-school adolescents which limit their creativity to seek information elsewhere. Results still indicate that HIV adolescent groups recognize the complexity of long-term treatment and stay in care leading to improved immunity for the majority yet; there is still scattered evidence about how effective they are among adolescents at different phases in the disease trajectory. Nevertheless, the primary focus of developing adolescent self-efficacy and coping skills significantly address a range of disclosure difficulties and supports autonomy. Moreover, the peer techniques utilized in addition to the almost homogeneous group characteristics accelerates positive confidence, hope and belongingness. Adolescent HIV-support groups therefore have the capacity to both improve and/or worsen sexual health outcomes for a young adolescent who is out-of-school. Communication interventions that seek to increase awareness about ‘self’ should therefore be emphasized more than just fostering collective action. Such interventions should be sensitive to context and gender. In addition, facilitative support supervision done by close and trusted health care providers, most preferably Village Health Teams (who are often community elected volunteers) would help to follow-up, mentor, encourage and advise this young adolescent in matters involving sexuality and health outcomes. HIV/AIDS prevention programs have extended their efforts beyond individual focus to those that foster collective action, but programs should rekindle interpersonal level strategies to address the complexity of individual behavior.

Keywords: adolescent, HIV, support groups, Uganda

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362 Use of Proton Pump Inhibitors Medications during the First Years of Life and Late Complications

Authors: Kamelia Hamza

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Background: Proton pump inhibitors (PPIs) are the most prescribed drug classes for pediatric gastroesophageal reflux disease (GERD).Many patients are treated with these drugs for atypical manifestations attributed to gastroesophageal reflux (GER), even in the absence of proved causal relationship. There is an impression of increase use of PPI's treatment for reflux in "clalit health services," the largest health organization in Israel. In the recent years, the medicine is given without restriction, it's not limited to pediatric gastroenterologists only, but pediatricians and family doctors. The objective of this study is to evaluate the hypothesis that exposure to PPIs during the first year of life is associated with an increased risk of developing late adverse diseases: pneumonia, asthma, AGE, IBD, celiac disease, allergic disorders, obesity, attention deficit hyperactivity disorders (ADHD), autism spectrum disorders (ASD). Methods: The study is a retrospective case-control cohort study based on a computerized database of Clalit Health Services (CHS). It includes 9844 children born between 2002-2018 and reported to complain of at least one of the symptoms (reflux/ spitting up, irritability, feeding difficulties, colics). The study population included the study group (n=4922) of children exposed to PPIs at any time prior to the first year of life and a control group (n=4922) child not exposed to PPIs who were matched to each case of the study group on age, race, socioeconomic status, and year of birth. The prevalence of late complications/diseases in the study group was compared with the prevalence of late complications/diseases diagnosis between 2002-2020 in the control group. Odds ratios and 95% confidence intervals were calculated by using logistic regression models. Results: We found that compared to the control group, children exposed to PPIs in the first year of life had an increased risk of developing several late complications/ disorders: pneumonia, asthma, various allergies (urticaria, allergic rhinitis, or allergic conjunctivitis) OR, inhalant allergies, and food allergies. In addition, they showed an increased risk of being diagnosed with ADHD or ASD, but children exposed to PPIs in the first year of life had decrease the risk of obesity by 17% (OR 0.825, 95%CI 0.697-0.976). Conclusions: We found significant associations between the use of PPIs during the first year of life and subsequent development of late complications/diseases such as respiratory diseases, allergy diseases, ADHD, and ASD. More studies are needed to prove causality and determine the mechanism behind the effect of PPIs and the development of late complications.

Keywords: acid suppressing medications, proton pump inhibitors, histamine 2 blocker, late complications, gastroesophageal reflux, gastroesophageal reflux disease, acute gastroenteritis, community acquired pneumonia, asthma, allergic diseases, obesity, inflammatory bowel diseases, ulcerative colitis, crohn disease, attention deficit hyperactivity disorders, autism spectrum disorders

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361 Adolescents’ Reports of Dating Abuse: Mothers’ Responses

Authors: Beverly Black

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Background: Adolescent dating abuse (ADA) is widespread throughout the world and negatively impacts many adolescents. ADA is associated with lower self-esteem, poorer school performance, lower employment opportunities, higher rates of depression, absenteeism from school, substance abuse, bullying, smoking, suicide, pregnancy, eating disorders, and risky sexual behaviors, and experiencing domestic violence later in life. ADA prevention is sometimes addressed through school programming; yet, parental responses to ADA can also be an important vehicle for its prevention. In this exploratory study, the author examined how mothers, including abused mothers, responded to scenarios of ADA involving their children. Methods: Six focus groups were conducted between December, 2013 and June, 2014 with mothers (n=31) in the southern part of the United States. Three of the focus groups were comprised of mothers (n=17) who had been abused by their partners. Mothers were recruited from local community family agencies. Participants were provided a series of four scenarios about ADA and they were asked to explain how they would respond. Focus groups lasted approximately 45 minutes. All participants were given a gift card to a major retailer as a ‘thank you’. Using QSR-N10, two researchers’ analyzed the focus group data first using open and axial coding techniques to find overarching themes. Researchers triangulated the coded data to ensure accurate interpretations of the participants’ messages and used the scenario questions to structure the coded results. Results: Almost 30% of 699 comments coded as mothers’ recommendations for responding to ADA focused on the importance of providing advice to their children. Advice included breaking up, going to police, ignoring or avoiding the abusive partner, and setting boundaries in relationships. About 22% of comments focused on the need for educating teens about healthy and unhealthy relationships and seeking additional information. About 13% of the comments reflected the view that parents should confront abuser and/or abusers’ parents, and less than 2% noted the need to take their child to counseling. Mothers who had been abused offered similar responses as parents who had not experienced abuse. However, their responses were more likely to focus on sharing their own experience exercising caution in their responses, as they knew from their own experiences that authoritarian responses were ineffective. Over half of the comments indicated that parents would react stronger, quicker, and angrier if a girl was being abused by a boy than vice versa; parents expressed greater fear for their daughters than their sons involved in ADA. Conclusions. Results suggest that mothers have ideas about how to respond to ADA. Mothers who have been abused draw from their experiences and are aware that responding in an authoritarian manner may not be helpful. Because parental influence on teens is critical in their development, it is important for all parents to respond to ADA in a helpful manner to break the cycle of violence. Understanding responses to ADA can inform prevention programming to work with parents in responding to ADA.

Keywords: abused mothers' responses to dating abuse, adolescent dating abuse, mothers' responses to dating abuse, teen dating violence

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360 The Impact of Speech Style on the Production of Spanish Vowels by Spanish-English Bilinguals and Spanish Monolinguals

Authors: Vivian Franco

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There has been a great deal of research about vowel production of second language learners of Spanish, vowel variation across Spanish dialects, and more recently, research related to Spanish heritage speakers’ vowel production based on speech style. However, there is little investigation reported on Spanish heritage speakers’ vowel production in regard to task modality by incorporating own comparison groups of monolinguals and late bilinguals. Thus, the present study investigates the influence of speech style on Spanish heritage speakers’ vowel production by comparing Spanish-English early and late bilinguals and Spanish monolinguals. The study was guided by the following research question: How do early bilinguals (heritage speakers) differ/relate to advanced L2 speakers of Spanish (late bilinguals) and Spanish monolinguals in their vowel quality (acoustic distribution) and quantity (duration) based on speech style? The participants were a total of 11 speakers of Spanish: 7 early Spanish-English bilinguals with a similar linguistic background (simultaneous bilinguals of the second generation); 2 advanced L2 speakers of Spanish; and 2 Spanish monolinguals from Mexico. The study consisted of two tasks. The first one adopted a semi-spontaneous style by a solicited narration of life experiences and a description of a favorite movie with the purpose to collect spontaneous speech. The second task was a reading activity in which the participants read two paragraphs of a Mexican literary essay 'La nuez.' This task aimed to obtain a more controlled speech style. From this study, it can be concluded that early bilinguals and monolinguals show a smaller formant vowel space overall compared to the late bilinguals in both speech styles. In terms of formant values by stress, the early bilinguals and the late bilinguals resembled in the semi-spontaneous speech style as their unstressed vowel space overlapped with that of the unstressed vowels different from the monolinguals who displayed a slightly reduced unstressed vowel space. For the controlled data, the early bilinguals were similar to the monolinguals as their stressed and unstressed vowel spaces overlapped in comparison to the late bilinguals who showed a more clear reduction of unstressed vowel space. In regard to stress, the monolinguals revealed longer vowel duration overall. However, findings of duration by stress showed that the early bilinguals and the monolinguals remained stable with shorter values of unstressed vowels in the semi-spontaneous data and longer duration in the controlled data when compared to the late bilinguals who displayed opposite results. These findings suggest an implication for Spanish heritage speakers and L2 Spanish vowels research as it has been frequently argued that Spanish bilinguals differ from the Spanish monolinguals by their vowel reduction and centralized vowel space influenced by English. However, some Spanish varieties are characterized by vowel reduction especially in certain phonetic contexts so that some vowels present more weakening than others. Consequently, it would not be conclusive to affirm an English influence on the Spanish of these bilinguals.

Keywords: Spanish-English bilinguals, Spanish monolinguals, spontaneous and controlled speech, vowel production.

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359 Metacognitive Processing in Early Readers: The Role of Metacognition in Monitoring Linguistic and Non-Linguistic Performance and Regulating Students' Learning

Authors: Ioanna Taouki, Marie Lallier, David Soto

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Metacognition refers to the capacity to reflect upon our own cognitive processes. Although there is an ongoing discussion in the literature on the role of metacognition in learning and academic achievement, little is known about its neurodevelopmental trajectories in early childhood, when children begin to receive formal education in reading. Here, we evaluate the metacognitive ability, estimated under a recently developed Signal Detection Theory model, of a cohort of children aged between 6 and 7 (N=60), who performed three two-alternative-forced-choice tasks (two linguistic: lexical decision task, visual attention span task, and one non-linguistic: emotion recognition task) including trial-by-trial confidence judgements. Our study has three aims. First, we investigated how metacognitive ability (i.e., how confidence ratings track accuracy in the task) relates to performance in general standardized tasks related to students' reading and general cognitive abilities using Spearman's and Bayesian correlation analysis. Second, we assessed whether or not young children recruit common mechanisms supporting metacognition across the different task domains or whether there is evidence for domain-specific metacognition at this early stage of development. This was done by examining correlations in metacognitive measures across different task domains and evaluating cross-task covariance by applying a hierarchical Bayesian model. Third, using robust linear regression and Bayesian regression models, we assessed whether metacognitive ability in this early stage is related to the longitudinal learning of children in a linguistic and a non-linguistic task. Notably, we did not observe any association between students’ reading skills and metacognitive processing in this early stage of reading acquisition. Some evidence consistent with domain-general metacognition was found, with significant positive correlations between metacognitive efficiency between lexical and emotion recognition tasks and substantial covariance indicated by the Bayesian model. However, no reliable correlations were found between metacognitive performance in the visual attention span and the remaining tasks. Remarkably, metacognitive ability significantly predicted children's learning in linguistic and non-linguistic domains a year later. These results suggest that metacognitive skill may be dissociated to some extent from general (i.e., language and attention) abilities and further stress the importance of creating educational programs that foster students’ metacognitive ability as a tool for long term learning. More research is crucial to understand whether these programs can enhance metacognitive ability as a transferable skill across distinct domains or whether unique domains should be targeted separately.

Keywords: confidence ratings, development, metacognitive efficiency, reading acquisition

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358 Microbiological and Physicochemical Evaluation of Traditional Greek Kopanisti Cheese Produced by Different Starter Cultures

Authors: M. Kazou, A. Gavriil, O. Kalagkatsi, T. Paschos, E. Tsakalidou

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Kopanisti cheese is a Greek soft Protected Designation of Origin (PDO) cheese made of raw cow, sheep or goat milk, or mixtures of them, with similar organoleptic characteristics to that of Roquefort cheese. Traditional manufacturing of Kopanisti cheese is limited in small-scale dairies, without the addition of starter cultures. Instead, an amount of over-mature Kopanisti cheese, called Mana Kopanisti, is used to initiate ripening. Therefore, the selection of proper starter cultures and the understanding of the contribution of various microbial groups to its overall quality is crucial for the production of a high-quality final product with standardized organoleptic and physicochemical characteristics. Taking the above into account, the aim of the present study was the investigation of Kopanisti cheese microbiota and its role in cheese quality. For this purpose, four different types of Kopanisti were produced in triplicates, all with pasteurized cow milk, with the addition of (A) the typical mesophilic species Lactococcus lactis and Lactobacillus paracasei used as starters in the production of soft spread cheeses, (B) strains of Lactobacillus acidipiscis and Lactobacillus rennini previously isolated from Kopanisti and Mana Kopanisti, (C) all the species from (A) and (B) as inoculum, and finally (D) the species from (A) and Mana Kopanisti. Physicochemical and microbiological analysis was performed for milk and cheese samples during ripening. Enumeration was performed for major groups of lactic acid bacteria (LAB), total mesophilic bacteria, yeasts as well as hygiene indicator microorganisms. Bacterial isolates from all the different LAB groups, apart from enterococci, alongside yeasts isolates, were initially grouped using repetitive sequence-based polymerase chain reaction (rep-PCR) and then identified at the species level using 16S rRNA gene and internal transcribed spacer (ITS) DNA region sequencing, respectively. Sensory evaluation was also performed for final cheese samples at the end of the ripening period (35 days). Based on the results of the classical microbiological analysis, the average counts of the total mesophilic bacteria and LAB, apart from enterococci, ranged between 7 and 10 log colony forming unit (CFU) g⁻¹, phychrotrophic bacteria, and yeast extract glucose chloramphenicol (YGC) isolates between 4 and 8 log CFU g⁻¹, while coliforms and enterococci up to 2 log CFU g⁻¹ throughout ripening in cheese samples A, C and D. In contrast, in cheese sample B, the average counts of the total mesophilic bacteria and LAB, apart from enterococci, phychrotrophic bacteria, and YGC isolates ranged between 0 and 10 log CFU g⁻¹ and coliforms and enterococci up to 2 log CFU g⁻¹. Although the microbial counts were not that different among samples, identification of the bacterial and yeasts isolates revealed the complex microbial community structure present in each cheese sample. Differences in the physicochemical characteristics among the cheese samples were also observed, with pH ranging from 4.3 to 5.3 and moisture from 49.6 to 58.0 % in the final cheese products. Interestingly, the sensory evaluation also revealed differences among samples, with cheese sample B ranking first based on the total score. Overall, the combination of these analyses highlighted the impact of different starter cultures on the Kopanisti microbiota as well as on the physicochemical and sensory characteristics of the final product.

Keywords: Kopanisti cheese, microbiota, classical microbiological analysis, physicochemical analysis

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357 Spectral Responses of the Laser Generated Coal Aerosol

Authors: Tibor Ajtai, Noémi Utry, Máté Pintér, Tomi Smausz, Zoltán Kónya, Béla Hopp, Gábor Szabó, Zoltán Bozóki

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Characterization of spectral responses of light absorbing carbonaceous particulate matter (LAC) is of great importance in both modelling its climate effect and interpreting remote sensing measurement data. The residential or domestic combustion of coal is one of the dominant LAC constituent. According to some related assessments the residential coal burning account for roughly half of anthropogenic BC emitted from fossil fuel burning. Despite of its significance in climate the comprehensive investigation of optical properties of residential coal aerosol is really limited in the literature. There are many reason of that starting from the difficulties associated with the controlled burning conditions of the fuel, through the lack of detailed supplementary proximate and ultimate chemical analysis enforced, the interpretation of the measured optical data, ending with many analytical and methodological difficulties regarding the in-situ measurement of coal aerosol spectral responses. Since the gas matrix of ambient can significantly mask the physicochemical characteristics of the generated coal aerosol the accurate and controlled generation of residential coal particulates is one of the most actual issues in this research area. Most of the laboratory imitation of residential coal combustion is simply based on coal burning in stove with ambient air support allowing one to measure only the apparent spectral feature of the particulates. However, the recently introduced methodology based on a laser ablation of solid coal target opens up novel possibilities to model the real combustion procedure under well controlled laboratory conditions and makes the investigation of the inherent optical properties also possible. Most of the methodology for spectral characterization of LAC is based on transmission measurement made of filter accumulated aerosol or deduced indirectly from parallel measurements of scattering and extinction coefficient using free floating sampling. In the former one the accuracy while in the latter one the sensitivity are liming the applicability of this approaches. Although the scientific community are at the common platform that aerosol-phase PhotoAcoustic Spectroscopy (PAS) is the only method for precise and accurate determination of light absorption by LAC, the PAS based instrumentation for spectral characterization of absorption has only been recently introduced. In this study, the investigation of the inherent, spectral features of laser generated and chemically characterized residential coal aerosols are demonstrated. The experimental set-up and its characteristic for residential coal aerosol generation are introduced here. The optical absorption and the scattering coefficients as well as their wavelength dependency are determined by our state-of-the-art multi wavelength PAS instrument (4λ-PAS) and multi wavelength cosinus sensor (Aurora 3000). The quantified wavelength dependency (AAE and SAE) are deduced from the measured data. Finally, some correlation between the proximate and ultimate chemical as well as the measured or deduced optical parameters are also revealed.

Keywords: absorption, scattering, residential coal, aerosol generation by laser ablation

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356 Gut Microbial Dynamics in a Mouse Model of Inflammation-Linked Carcinogenesis as a Result of Diet Supplementation with Specific Mushroom Extracts

Authors: Alvarez M., Chapela M. J., Balboa E., Rubianes D., Sinde E., Fernandez de Ana C., Rodríguez-Blanco A.

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The gut microbiota plays an important role as gut inflammation could contribute to colorectal cancer development; however, this role is still not fully understood, and tools able to prevent this progression are yet to be developed. The main objective of this study was to monitor the effects of a mushroom extracts formulation in gut microbial community composition of an Azoxymethane (AOM)/Dextran sodium sulfate (DSS) mice model of inflammation-linked carcinogenesis. For the in vivo study, 41 adult male mice of the C57BL / 6 strain were obtained. 36 of them have been induced in a state of colon carcinogenesis by a single intraperitoneal administration of AOM at a dose of 12.5 mg/kg; the control group animals received instead of the same volume of 0.9% saline. DSS is an extremely toxic polysaccharide sulfate that causes chronic inflammation of the colon mucosa, favoring the appearance of severe colitis and the production of tumors induced by AOM. Induction by AOM/DSS is an interesting platform for chemopreventive intervention studies. This time the model was used to monitor gut microbiota changes as a result of supplementation with a specific mushroom extracts formulation previously shown to have prebiotic activity. The animals have been divided into three groups: (i) Cancer + mushroom extracts formulation experimental group: to which the MicoDigest2.0 mushroom extracts formulation developed by Hifas da Terra S.L has been administered dissolved in drinking water at an estimated concentration of 100 mg / ml. (ii) Control group of animals with Cancer: to which normal water has been administered without any type of treatment. (iii) Control group of healthy animals: these are the animals that have not been induced cancer or have not received any treatment in drinking water. This treatment has been maintained for a period of 3 months, after which the animals were sacrificed to obtain tissues that were subsequently analyzed to verify the effects of the mushroom extract formulation. A microbiological analysis has been carried out to compare the microbial communities present in the intestines of the mice belonging to each of the study groups. For this, the methodology of massive sequencing by molecular analysis of the 16S gene has been used (Ion Torrent technology). Initially, DNA extraction and metagenomics libraries were prepared using the 16S Metagenomics kit, always following the manufacturer's instructions. This kit amplifies 7 of the 9 hypervariable regions of the 16S gene that will then be sequenced. Finally, the data obtained will be compared with a database that makes it possible to determine the degree of similarity of the sequences obtained with a wide range of bacterial genomes. Results obtained showed that, similarly to certain natural compounds preventing colorectal tumorigenesis, a mushroom formulation enriched the Firmicutes and Proteobacteria phyla and depleted Bacteroidetes. Therefore, it was demonstrated that the consumption of the mushroom extracts’ formulation developed could promote the recovery of the microbial balance that is disrupted in the mice model of carcinogenesis. More preclinical and clinical studies are needed to validate this promising approach.

Keywords: carcinogenesis, microbiota, mushroom extracts, inflammation

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355 Urban Security through Urban Transformation: Case of Saraycik District

Authors: Emir Sunguroglu, Merve Sunguroglu, Yesim Aliefendioglu, Harun Tanrivermis

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Basic human needs range from physiological needs such as food, water and shelter to safety needs such as security, protection from natural disasters and even urban terrorism which are extant and not fulfilled even in urban areas where people live civilly in large communities. These basic needs when arose in urban life lead to a different kind of crime set defined as urban crimes. Urban crimes mostly result from differences between socioeconomic conditions in society. Income inequality increases tendency towards urban crimes. Especially in slum areas and suburbs, urban crimes not only threaten public security but they also affect deliverance of public services. It is highlighted that, construction of urban security against problems caused by urban crimes is not only achieved by involvement of urban security in security of the community but also comprises juridical development and staying above a level of legal standards concurrently. The idea of urban transformation emerged as interventions to demolishment and rebuilding of built environment to solve the unhealthy urban environment, inadequate infrastructure and socioeconomic problems came up during the industrialization process. Considering the probability of urbanization process driving citizens to commit crimes, The United Nations Commission on Human Security’s focus on this theme is conferred to be a proper approach. In this study, the analysis and change in security before, through and after urban transformation, which is one of the tools related to urbanization process, is strived to be discussed through the case of Sincan County Saraycik District. The study also aims to suggest improvements to current legislation on public safety, urban resilience, and urban transformation. In spite of Saraycik District residing in a developing County in Ankara, Turkey, from urbanization perspective as well as socioeconomic and demographic indicators the District exhibits a negative view throughout the County and the country. When related to the county, rates of intentional harm reports, burglary reports, the offense of libel and threat reports and narcotic crime reports are higher. The District is defined as ‘crime hotspot’. Interviews with residents of Saraycik claim that the greatest issue of the neighborhood is Public Order and Security (82.44 %). The District becomes prominent with negative aspects, especially with the presence of unlicensed constructions, occurrence of important social issues such as crime and insecurity and complicated lives of inhabitants from poverty and low standard conditions of living. Additionally, the social structure and demographic properties and crime and insecurity of the field have been addressed in this study. Consequently, it is claimed that urban crime rates were related to level of education, employment and household income, poverty trap, physical condition of housing and structuration, accessibility of public services, security, migration, safety in terms of disasters and emphasized that urban transformation is one of the most important tools in order to provide urban security.

Keywords: urban security, urban crimes, urban transformation, Saraycik district

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354 Development and Evaluation of Economical Self-cleaning Cement

Authors: Anil Saini, Jatinder Kumar Ratan

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Now a day, the key issue for the scientific community is to devise the innovative technologies for sustainable control of urban pollution. In urban cities, a large surface area of the masonry structures, buildings, and pavements is exposed to the open environment, which may be utilized for the control of air pollution, if it is built from the photocatalytically active cement-based constructional materials such as concrete, mortars, paints, and blocks, etc. The photocatalytically active cement is formulated by incorporating a photocatalyst in the cement matrix, and such cement is generally known as self-cleaning cement In the literature, self-cleaning cement has been synthesized by incorporating nanosized-TiO₂ (n-TiO₂) as a photocatalyst in the formulation of the cement. However, the utilization of n-TiO₂ for the formulation of self-cleaning cement has the drawbacks of nano-toxicity, higher cost, and agglomeration as far as the commercial production and applications are concerned. The use of microsized-TiO₂ (m-TiO₂) in place of n-TiO₂ for the commercial manufacture of self-cleaning cement could avoid the above-mentioned problems. However, m-TiO₂ is less photocatalytically active as compared to n- TiO₂ due to smaller surface area, higher band gap, and increased recombination rate. As such, the use of m-TiO₂ in the formulation of self-cleaning cement may lead to a reduction in photocatalytic activity, thus, reducing the self-cleaning, depolluting, and antimicrobial abilities of the resultant cement material. So improvement in the photoactivity of m-TiO₂ based self-cleaning cement is the key issue for its practical applications in the present scenario. The current work proposes the use of surface-fluorinated m-TiO₂ for the formulation of self-cleaning cement to enhance its photocatalytic activity. The calcined dolomite, a constructional material, has also been utilized as co-adsorbent along with the surface-fluorinated m-TiO₂ in the formulation of self-cleaning cement to enhance the photocatalytic performance. The surface-fluorinated m-TiO₂, calcined dolomite, and the formulated self-cleaning cement were characterized using diffuse reflectance spectroscopy (DRS), X-ray diffraction analysis (XRD), field emission-scanning electron microscopy (FE-SEM), energy dispersive x-ray spectroscopy (EDS), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), BET (Brunauer–Emmett–Teller) surface area, and energy dispersive X-ray fluorescence spectrometry (EDXRF). The self-cleaning property of the as-prepared self-cleaning cement was evaluated using the methylene blue (MB) test. The depolluting ability of the formulated self-cleaning cement was assessed through a continuous NOX removal test. The antimicrobial activity of the self-cleaning cement was appraised using the method of the zone of inhibition. The as-prepared self-cleaning cement obtained by uniform mixing of 87% clinker, 10% calcined dolomite, and 3% surface-fluorinated m-TiO₂ showed a remarkable self-cleaning property by providing 53.9% degradation of the coated MB dye. The self-cleaning cement also depicted a noteworthy depolluting ability by removing 5.5% of NOx from the air. The inactivation of B. subtiltis bacteria in the presence of light confirmed the significant antimicrobial property of the formulated self-cleaning cement. The self-cleaning, depolluting, and antimicrobial results are attributed to the synergetic effect of surface-fluorinated m-TiO₂ and calcined dolomite in the cement matrix. The present study opens an idea and route for further research for acile and economical formulation of self-cleaning cement.

Keywords: microsized-titanium dioxide (m-TiO₂), self-cleaning cement, photocatalysis, surface-fluorination

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353 Assessment of Very Low Birth Weight Neonatal Tracking and a High-Risk Approach to Minimize Neonatal Mortality in Bihar, India

Authors: Aritra Das, Tanmay Mahapatra, Prabir Maharana, Sridhar Srikantiah

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In the absence of adequate well-equipped neonatal-care facilities serving rural Bihar, India, the practice of essential home-based newborn-care remains critically important for reduction of neonatal and infant mortality, especially among pre-term and small-for-gestational-age (Low-birth-weight) newborns. To improve the child health parameters in Bihar, ‘Very-Low-Birth-Weight (vLBW) Tracking’ intervention is being conducted by CARE India, since 2015, targeting public facility-delivered newborns weighing ≤2000g at birth, to improve their identification and provision of immediate post-natal care. To assess the effectiveness of the intervention, 200 public health facilities were randomly selected from all functional public-sector delivery points in Bihar and various outcomes were tracked among the neonates born there. Thus far, one pre-intervention (Feb-Apr’2015-born neonates) and three post-intervention (for Sep-Oct’2015, Sep-Oct’2016 and Sep-Oct’2017-born children) follow-up studies were conducted. In each round, interviews were conducted with the mothers/caregivers of successfully-tracked children to understand outcome, service-coverage and care-seeking during the neonatal period. Data from 171 matched facilities common across all rounds were analyzed using SAS-9.4. Identification of neonates with birth-weight ≤ 2000g improved from 2% at baseline to 3.3%-4% during post-intervention. All indicators pertaining to post-natal home-visits by frontline-workers (FLWs) improved. Significant improvements between baseline and post-intervention rounds were also noted regarding mothers being informed about ‘weak’ child – at the facility (R1 = 25 to R4 = 50%) and at home by FLW (R1 = 19%, to R4 = 30%). Practice of ‘Kangaroo-Mother-Care (KMC)’– an important component of essential newborn care – showed significant improvement in postintervention period compared to baseline in both facility (R1 = 15% to R4 = 31%) and home (R1 = 10% to R4=29%). Increasing trend was noted regarding detection and birth weight-recording of the extremely low-birth-weight newborns (< 1500 g) showed an increasing trend. Moreover, there was a downward trend in mortality across rounds, in each birth-weight strata (< 1500g, 1500-1799g and >= 1800g). After adjustment for the differential distribution of birth-weights, mortality was found to decline significantly from R1 (22.11%) to R4 (11.87%). Significantly declining trend was also observed for both early and late neonatal mortality and morbidities. Multiple regression analysis identified - birth during immediate post-intervention phase as well as that during the maintenance phase, birth weight > 1500g, children of low-parity mothers, receiving visit from FLW in the first week and/or receiving advice on extra care from FLW as predictors of survival during neonatal period among vLBW newborns. vLBW tracking was found to be a successful and sustainable intervention and has already been handed over to the Government.

Keywords: weak newborn tracking, very low birth weight babies, newborn care, community response

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352 Conceptualizing a Biomimetic Fablab Based on the Makerspace Concept and Biomimetics Design Research

Authors: Petra Gruber, Ariana Rupp, Peter Niewiarowski

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This paper presents a concept for a biomimetic fablab as a physical space for education, research and development of innovation inspired by nature. Biomimetics as a discipline finds increasing recognition in academia and has started to be institutionalized at universities in programs and centers. The Biomimicry Research and Innovation Center was founded in 2012 at the University of Akron as an interdisciplinary venture for the advancement of innovation inspired by nature and is part of a larger community fostering the approach of bioimimicry in the Great Lakes region of the US. With 30 faculty members the center has representatives from Colleges of Arts and Sciences (e.g., biology, chemistry, geoscience, and philosophy) Engineering (e.g., mechanical, civil, and biomedical), Polymer Science, and Myers School of Arts. A platform for training PhDs in Biomimicry (17 students currently enrolled) is co-funded by educational institutions and industry partners. Research at the center touches on many areas but is also currently biased towards materials and structures, with highlights being materials based on principles found in spider silk and gecko attachment mechanisms. As biomimetics is also a novel scientific discipline, there is little standardisation in programming and the equipment of research facilities. As a field targeting innovation, design and prototyping processes are fundamental parts of the developments. For experimental design and prototyping, MIT's maker space concept seems to fit well to the requirements, but facilities need to be more specialised in terms of accessing biological systems and knowledge, specific research, production or conservation requirements. For the education and research facility BRIC we conceptualize the concept of a biomimicry fablab, that ties into the existing maker space concept and creates the setting for interdisciplinary research and development carried out in the program. The concept takes on the process of biomimetics as a guideline to define core activities that shall be enhanced by the allocation of specific spaces and tools. The limitations of such a facility and the intersections to further specialised labs housed in the classical departments are of special interest. As a preliminary proof of concept two biomimetic design courses carried out in 2016 are investigated in terms of needed tools and infrastructure. The spring course was a problem based biomimetic design challenge in collaboration with an innovation company interested in product design for assisted living and medical devices. The fall course was a solution based biomimetic design course focusing on order and hierarchy in nature with the goal of finding meaningful translations into art and technology. The paper describes the background of the BRIC center, identifies and discusses the process of biomimetics, evaluates the classical maker space concept and explores how these elements can shape the proposed research facility of a biomimetic fablab by examining two examples of design courses held in 2016.

Keywords: biomimetics, biomimicry, design, biomimetic fablab

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351 The Confluence between Autism Spectrum Disorder and the Schizoid Personality

Authors: Murray David Schane

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Though years of clinical encounters with patients with autism spectrum disorders and those with a schizoid personality the many defining diagnostic features shared between these conditions have been explored and current neurobiological differences have been reviewed; and, critical and different treatment strategies for each have been devised. The paper compares and contrasts the apparent similarities between autism spectrum disorders and the schizoid personality are found in these DSM descriptive categories: restricted range of social-emotional reciprocity; poor non-verbal communicative behavior in social interactions; difficulty developing and maintaining relationships; detachment from social relationships; lack of the desire for or enjoyment of close relationships; and preference for solitary activities. In this paper autism, fundamentally a communicative disorder, is revealed to present clinically as a pervasive aversive response to efforts to engage with or be engaged by others. Autists with the Asperger presentation typically have language but have difficulty understanding humor, irony, sarcasm, metaphoric speech, and even narratives about social relationships. They also tend to seek sameness, possibly to avoid problems of social interpretation. Repetitive behaviors engage many autists as a screen against ambient noise, social activity, and challenging interactions. Also in this paper, the schizoid personality is revealed as a pattern of social avoidance, self-sufficiency and apparent indifference to others as a complex psychological defense against a deep, long-abiding fear of appropriation and perverse manipulation. Neither genetic nor MRI studies have yet located the explanatory data that identifies the cause or the neurobiology of autism. Similarly, studies of the schizoid have yet to group that condition with those found in schizophrenia. Through presentations of clinical examples, the treatment of autists of the Asperger type is revealed to address the autist’s extreme social aversion which also precludes the experience of empathy. Autists will be revealed as forming social attachments but without the capacity to interact with mutual concern. Empathy will be shown be teachable and, as social avoidance relents, understanding of the meaning and signs of empathic needs that autists can recognize and acknowledge. Treatment of schizoids will be shown to revolve around joining empathically with the schizoid’s apprehensions about interpersonal, interactive proximity. Models of both autism and schizoid personality traits have yet to be replicated in animals, thereby eliminating the role of translational research in providing the kind of clues to behavioral patterns that can be related to genetic, epigenetic and neurobiological measures. But as these clinical examples will attest, treatment strategies have significant impact.

Keywords: autism spectrum, schizoid personality traits, neurobiological implications, critical diagnostic distinctions

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350 A Public Health Perspective on Deradicalisation: Re-Conceptualising Deradicalisation Approaches

Authors: Erin Lawlor

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In 2008 Time magazine named terrorist rehabilitation as one of the best ideas of the year. The term deradicalisation has become synonymous with rehabilitation within security discourse. The allure for a “quick fix” when managing terrorist populations (particularly within prisons) has led to a focus on prescriptive programmes where there is a distinct lack of exploration into the drivers for a person to disengage or deradicalise from violence. It has been argued that to tackle a snowballing issue that interventions have moved too quickly for both theory development and methodological structure. This overly quick acceptance of a term that lacks rigorous testing, measuring, and monitoring means that there is distinct lack of evidence base for deradicalisation being a genuine process/phenomenon, leading to academics retrospectively attempting to design frameworks and interventions around a concept that is not truly understood. The UK Home Office has openly acknowledged the lack of empirical data on this subject. This lack of evidence has a direct impact on policy and intervention development. Extremism and deradicalisation are issues that affect public health outcomes on a global scale, to the point that terrorism has now been added to the list of causes of trauma, both in the direct form of being victim of an attack but also the indirect context of witnesses, children and ordinary citizens who live in daily fear. This study critiques current deradicalisation discourses to establish whether public health approaches offer opportunities for development. The research begins by exploring the theoretical constructs of both what deradicalisation, and public health issues are. Questioning: What does deradicalisation involve? Is there an evidential base on which deradicalisation theory has established itself? What theory are public health interventions devised from? What does success look like in both fields? From establishing this base, current deradicalisation practices will then be explored through examples of work already being carried out. Critiques can be broken into discussion points of: Language, the difficulties with conducting empirical studies and the issues around outcome measurements that deradicalisation interventions face. This study argues that a public health approach towards deradicalisation offers the opportunity to attempt to bring clarity to the definitions of radicalisation, identify what could be modified through intervention and offer insights into the evaluation of interventions. As opposed to simply focusing on an element of deradicalisation and analysing that in isolation, a public health approach allows for what the literature has pointed out is missing, a comprehensive analysis of current interventions and information on creating efficacy monitoring systems. Interventions, policies, guidance, and practices in both the UK and Australia will be compared and contrasted, due to the joint nature of this research between Sheffield Hallam University and La Trobe, Melbourne.

Keywords: radicalisation, deradicalisation, violent extremism, public health

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349 The Effects of Irregular Immigration Originating from Syria on Turkey's Security Issues

Authors: Muzaffer Topgul, Hasan Atac

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After the September 11 attacks, fight against terrorism has risen to higher levels in security concepts of the countries. The following reactions of some nation states have led to the formation of unstable areas in different parts of the World. Especially, in Iraq and Syria, the influences of radical groups have risen with the weakening of the central governments. Turkey (with the geographical proximity to the current crisis) has become a stop on the movement of people who were displaced because of terrorism. In the process, the policies of the Syrian regime resulted in a civil war which is still going on since 2011, and remain as an unresolved crisis. With the extension of the problem, changes occurred in foreign policies of the World Powers; moreover, the ongoing effects of the riots, conflicts of interests of foreign powers, conflicts in the region because of the activities of radical groups increased instability within the country. This case continues to affect the security of Turkey, particularly illegal immigration. It has exceeded the number of two million Syrians who took refuge in Turkey due to the civil war, while continuing uncertainty about the legal status of asylum seekers, besides the security problems of asylum-seekers themselves, there are problems in education, health and communication (language) as well. In this study, we will evaluate the term of immigration through the eyes of national and international law, place the disorganized and illegal immigration in security sphere, and define the elements/components of irregular migration within the changing security concept. Ultimately, this article will assess the effects of the Syrian refuges to Turkey’s short-term, mid-term, and long-term security in the light of the national and international data flows and solutions will be presented to the ongoing problem. While explaining the security problems the data and the donnees obtained from the nation and international corporations will be examined thorough the human security dimensions such as living conditions of the immigrants, the ratio of the genders, especially birth rate occasions, the education circumstances of the immigrant children, the effects of the illegal passing on the public order. In addition, the demographic change caused by the immigrants will be analyzed, the changing economical conditions where the immigrants mostly accumulate, and their participation in public life will be worked on and the economical obstacles sourcing due to irregular immigration will be clarified. By the entire datum gathered from the educational, cultural, social, economic, demographical extents, the regional factors affecting the migration and the role of irregular migration in Turkey’s future security will be revealed by implication to current knowledge sources.

Keywords: displaced people, human security, irregular migration, refugees

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348 Hunger and Health: The Acceptability and Development of Health Coaching in the Food Pantry Environment

Authors: Kelsey Fortin, Susan Harvey

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The intersection between hunger and health outcomes is beginning to gain traction among the research community. With new interventions focusing on collaborations between the medical and social service sectors, this study aimed to understand the acceptability and approach of a health coaching intervention within a county-wide Midwest food pantry. Through formative research, the study used mixed methods to review secondary data and conduct surveys and semi-structured interviews with food pantry clients (n=30), staff (n=7), and volunteers (n=10). Supplemental secondary data collected and provided by pantry staff were reviewed to understand the broader pantry context of clientele health and health behaviors, annual food donations, and current pantry programming. Results from secondary data showed that the broader pantry client population reported high rates of chronic disease, low consumption of fruits and vegetables, and poor self-reported health, while annual donation data showed increases in produce availability on pantry shelves. This disconnect between produce availability, client health status, and behaviors was supported in the current study, with pantry staff and volunteers reporting lack of knowledge in produce selection and preparation being amongst the most common client inquiries and barriers to healthy food selection. Additional supports to secondary data came from pantry clients in the current study through self-reported high rates of both individual (60%, n=18) and household (43%, n=13 ) disease diagnosis, low consumption of fruits and vegetables averaging zero to one servings of vegetables (67%, n=20) and fruits (47%, n=14) per day, and low levels of physical activity averaging zero to 120 minutes per week (67%, n=20). Further, pantry clients provided health coaching programmatic recommendations through interviews with feedback such as non-judgmental coaching, accountability measures, and providing participant incentives as considerations for future program design and approach. Volunteers and staff reported the need for client education in food preparation, basic nutrition and physical activity, and the need for additional health expertise to educate and respond to diet related nutrition recommendations. All three stakeholder groups supported hosting a health coach within the pantry to focused on nutrition, physical activity, and health programming, with one client stating, 'I am hoping it really works out [the health coaching program]. I think it would be great for something like this to be offered for someone that isn’t knowledgeable like me.' In conclusion, high rates of chronic disease, partnered with low food, nutrition, and physical activity literacy among pantry clients, demonstrates the need to address health behaviors. With all three stakeholder groups showing acceptability of a health coaching program, partnered with existing literature showing health coaching success as a behavior change intervention, further research should be conducted to pilot the design and implementation of such a program in the pantry setting.

Keywords: food insecurity, formative research, food pantries, health coaching, hunger and health

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347 Middle School as a Developmental Context for Emergent Citizenship

Authors: Casta Guillaume, Robert Jagers, Deborah Rivas-Drake

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Civically engaged youth are critical to maintaining and/or improving the functioning of local, national and global communities and their institutions. The present study investigated how school climate and academic beliefs (academic self-efficacy and school belonging) may inform emergent civic behaviors (emergent citizenship) among self-identified middle school youth of color (African American, Multiracial or Mixed, Latino, Asian American or Pacific Islander, Native American, and other). Study aims: 1) Understand whether and how school climate is associated with civic engagement behaviors, directly and indirectly, by fostering a positive sense of connection to the school and/or engendering feelings of self-efficacy in the academic domain. Accordingly, we examined 2) The association of youths’ sense of school connection and academic self-efficacy with their personally responsible and participatory civic behaviors in school and community contexts—both concurrently and longitudinally. Data from two subsamples of a larger study of social/emotional development among middle school students were used for longitudinal and cross sectional analysis. The cross-sectional sample included 324 6th-8th grade students, of which 43% identified as African American, 20% identified as Multiracial or Mixed, 18% identified as Latino, 12% identified as Asian American or Pacific Islander, 6% identified as Other, and 1% identified as Native American. The age of the sample ranged from 11 – 15 (M = 12.33, SD = .97). For the longitudinal test of our mediation model, we drew on data from the 6th and 7th grade cohorts only (n =232); the ethnic and racial diversity of this longitudinal subsample was virtually identical to that of the cross-sectional sample. For both the cross-sectional and longitudinal analyses, full information maximum likelihood was used to deal with missing data. Fit indices were inspected to determine if they met the recommended thresholds of RMSEA below .05 and CFI and TLI values of at least .90. To determine if particular mediation pathways were significant, the bias-corrected bootstrap confidence intervals for each indirect pathway were inspected. Fit indices for the latent variable mediation model using the cross-sectional data suggest that the hypothesized model fit the observed data well (CFI = .93; TLI =. 92; RMSEA = .05, 90% CI = [.04, .06]). In the model, students’ perceptions of school climate were significantly and positively associated with greater feelings of school connectedness, which were in turn significantly and positively associated with civic engagement. In addition, school climate was significantly and positively associated with greater academic self-efficacy, but academic self-efficacy was not significantly associated with civic engagement. Tests of mediation indicated there was one significant indirect pathway between school climate and civic engagement behavior. There was an indirect association between school climate and civic engagement via its association with sense of school connectedness, indirect association estimate = .17 [95% CI: .08, .32]. The aforementioned indirect association via school connectedness accounted for 50% (.17/.34) of the total effect. Partial support was found for the prediction that students’ perceptions of a positive school climate are linked to civic engagement in part through their role in students’ sense of connection to school.

Keywords: civic engagement, early adolescence, school climate, school belonging, developmental niche

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346 Autobiographical Memory Functions and Perceived Control in Depressive Symptoms among Young Adults

Authors: Meenu S. Babu, K. Jayasankara Reddy

Abstract:

Depression is a serious mental health concern that leads to significant distress and dysfunction in an individual. Due to the high physical, psychological, social, and economic burden it causes, it is important to study various bio-psycho-social factors that influence the onset, course, duration, intensity of depressive symptoms. The study aims to explore relationship between autobiographical memory (AM) functions, perceived control over stressful events and depressive symptoms. AM functions and perceived control were both found to be protective factors for individuals against depression and were both modifiable to predict better behavioral and affective outcomes. An extensive review of literatur, with a systematic search on Google Scholar, JSTOR, Science Direct and Springer Journals database, was conducted for the purpose of this review paper. These were used for all the aforementioned databases. The time frame used for the search was 2010-2021. An additional search was conducted with no time bar to map the development of the theoretical concepts. The relevant studies with quantitative, qualitative, experimental, and quasi- experimental research designs were included for the review. Studies including a sample with a DSM- 5 or ICD-10 diagnosis of depressive disorders were excluded from the study to focus on the behavioral patterns in a non-clinical population. The synthesis of the findings that were obtained from the review indicates there is a significant relationship between cognitive variables of AM functions and perceived control and depressive symptoms. AM functions were found to be have significant effects on once sense of self, interpersonal relationships, decision making, self- continuity and were related to better emotion regulation and lower depressive symptoms. Not all the components of AM function were equally significant in their relationships with various depressive symptoms. While self and directive functions were more related to emotion regulation, anhedonia, motivation and hence mood and affect, the social function was related to perceived social support and social engagement. Perceived control was found to be another protective cognitive factor that provides individuals a sense of agency and control over one’s life outcomes which was found to be low in individuals with depression. This was also associated to the locus of control, competency beliefs, contingency beliefs and subjective well being in individuals and acted as protective factors against depressive symptoms. AM and perceived control over stressful events serve adaptive functions, hence it is imperative to study these variables more extensively. They can be imperative in planning and implementing therapeutic interventions to foster these cognitive protective factors to mitigate or alleviate depressive symptoms. Exploring AM as a determining factor in depressive symptoms along with perceived control over stress creates a bridge between biological and cognitive factors underlying depression and increases the scope of developing a more eclectic and effective treatment plan for individuals. As culture plays a crucial role in AM functions as well as certain aspects of control such as locus of control, it is necessary to study these variables keeping in mind the cultural context to tailor culture/community specific interventions for depression.

Keywords: autobiographical memories, autobiographical memory functions, perceived control, depressive symptoms, depression, young adults

Procedia PDF Downloads 103
345 COVID-19: Potential Effects of Nutritional Factors on Inflammation Relief

Authors: Maryam Nazari

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COVID-19 is a respiratory disease triggered by the novel coronavirus, SARS-CoV-2, that has reached pandemic status today. Acute inflammation and immune cells infiltration into lung injuries result in multi-organ failure. The presence of other non-communicable diseases (NCDs) with systemic inflammation derived from COVID-19 may exacerbate the patient's situation and increase the risk for adverse effects and mortality. This pandemic is a novel situation and the scientific community at this time is looking for vaccines or drugs to treat the pathology. One of the biggest challenges is focused on reducing inflammation without compromising the correct immune response of the patient. In this regard, addressing the nutritional factors should not be overlooked not only as a matter of avoiding the presence of NCDs with severe infections but also as an adjunctive way to modulate the inflammatory status of the patients. Despite the pivotal role of nutrition in modifying immune response, due to the novelty of the COVID-19 disease, information about the effects of specific dietary agents is limited in this area. From the macronutrients point of view, protein deficiency (quantity or quality) has negative effects on the number of functional immunoglobulins and gut-associated lymphoid tissue (GALT). High biological value proteins or some amino acids like arginine and glutamine are well known for their ability to augment the immune system. Among lipids, fish oil has the ability to inactivate enveloped viruses, suppress pro-inflammatory prostaglandin production and block platelet-activating factors and their receptors. In addition, protectin D1, which is an Omega-3 PUFAs derivation, is a novel antiviral drug. So it seems that these fatty acids can reduce the severity and/or improve recovery of patients with COVID-19. Carbohydrates with lower glycemic index and fibers are associated with lower levels of inflammatory cytokines (CRP, TNF-α, and IL-6). Short-Chain Fatty acids not only exert a direct anti-inflammatory effect but also provide appropriate gut microbial, which is important in gastrointestinal issues related to COVID-19. From the micronutrients point of view, Vitamins A, C, D, E, iron, magnesium, zinc, selenium and copper play a vital role in the maintenance of immune function. Inadequate status in these nutrients may result in decreased resistance against COVID-19 infection. There are specific bioactive compounds in the diet that interact with the ACE2 receptor, which is the gateway for SARS and SARS-CoV-2, and thus controls the viral infection. Regarding this, the potential benefits of probiotics, resveratrol (a polyphenol found in grape), oleoylethanolamide (derived from oleic acid), and natural peroxisome proliferator-activated receptor γ agonists in foodstuffs (like curcumin, pomegranate, hot pepper) are suggested. Yet, it should be pointed out that most of these results have been reported in animal models and further human studies are needed to be verified.

Keywords: Covid-19, inflammation, nutrition, dietary agents

Procedia PDF Downloads 174
344 Musical Notation Reading versus Alphabet Reading-Comparison and Implications for Teaching Music Reading to Students with Dyslexia

Authors: Ora Geiger

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Reading is a cognitive process of deciphering visual signs to produce meaning. During the reading process, written information of symbols and signs is received in the person’s eye and processed in the brain. This definition is relevant to both the reading of letters and the reading of musical notation. But while the letters of the alphabet are signs determined arbitrarily, notes are recorded systematically on a staff, with the location of each note on the staff indicating its relative pitch. In this paper, the researcher specifies the characteristics of alphabet reading in comparison to musical notation reading, and discusses the question whether a person diagnosed with dyslexia will necessarily have difficulty in reading musical notes. Dyslexia is a learning disorder that makes it difficult to acquire alphabet-reading skills due to difficulties expressed in the identification of letters, spelling, and other language deciphering skills. In order to read, one must be able to connect a symbol with a sound and to join the sounds into words. A person who has dyslexia finds it difficult to translate a graphic symbol into the sound that it represents. When teaching reading to children diagnosed with dyslexia, the multi-sensory approach, supporting the activation and involvement of most of the senses in the learning process, has been found to be particularly effective. According to this approach, when most senses participate in the reading learning process, it becomes more effective. During years of experience, the researcher, who is a music specialist, has been following the music reading learning process of elementary school age students, some of them diagnosed with Dyslexia, while studying to play soprano (descant) recorder. She argues that learning music reading while studying to play a musical instrument is a multi-sensory experience by its nature. The senses involved are: sight, hearing, touch, and the kinesthetic sense (motion), which provides the brain with information on the relative positions of the body. In this way, the learner experiences simultaneously visual, auditory, tactile, and kinesthetic impressions. The researcher concludes that there should be no contra-indication for teaching standard music reading to children with dyslexia if an appropriate process is offered. This conclusion is based on two main characteristics of music reading: (1) musical notation system is a systematic, logical, relative set of symbols written on a staff; and (2) music reading learning connected with playing a musical instrument is by its nature a multi-sensory activity since it combines sight, hearing, touch, and movement. This paper describes music reading teaching procedures and provides unique teaching methods that have been found to be effective for students who were diagnosed with Dyslexia. It provides theoretical explanations in addition to guidelines for music education practices.

Keywords: alphabet reading, dyslexia, multisensory teaching method, music reading, recorder playing

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343 The Use of Social Stories and Digital Technology as Interventions for Autistic Children; A State-Of-The-Art Review and Qualitative Data Analysis

Authors: S. Hussain, C. Grieco, M. Brosnan

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Background and Aims: Autism is a complex neurobehavioural disorder, characterised by impairments in the development of language and communication skills. The study involved a state-of-art systematic review, in addition to qualitative data analysis, to establish the evidence for social stories as an intervention strategy for autistic children. An up-to-date review of the use of digital technologies in the delivery of interventions to autistic children was also carried out; to propose the efficacy of digital technologies and the use of social stories to improve intervention outcomes for autistic children. Methods: Two student researchers reviewed a range of randomised control trials and observational studies. The aim of the review was to establish if there was adequate evidence to justify recommending social stories to autistic patients. Students devised their own search strategies to be used across a range of search engines, including Ovid-Medline, Google Scholar and PubMed. Students then critically appraised the generated literature. Additionally, qualitative data obtained from a comprehensive online questionnaire on social stories was also thematically analysed. The thematic analysis was carried out independently by each researcher, using a ‘bottom-up’ approach, meaning contributors read and analysed responses to questions and devised semantic themes from reading the responses to a given question. The researchers then placed each response into a semantic theme or sub-theme. The students then joined to discuss the merging of their theme headings. The Inter-rater reliability (IRR) was calculated before and after theme headings were merged, giving IRR for pre- and post-discussion. Lastly, the thematic analysis was assessed by a third researcher, who is a professor of psychology and the director for the ‘Centre for Applied Autism Research’ at the University of Bath. Results: A review of the literature, as well as thematic analysis of qualitative data found supporting evidence for social story use. The thematic analysis uncovered some interesting themes from the questionnaire responses, relating to the reasons why social stories were used and the factors influencing their effectiveness in each case. However, overall, the evidence for digital technologies interventions was limited, and the literature could not prove a causal link between better intervention outcomes for autistic children and the use of technologies. However, they did offer valid proposed theories for the suitability of digital technologies for autistic children. Conclusions: Overall, the review concluded that there was adequate evidence to justify advising the use of social stories with autistic children. The role of digital technologies is clearly a fast-emerging field and appears to be a promising method of intervention for autistic children; however, it should not yet be considered an evidence-based approach. The students, using this research, developed ideas on social story interventions which aim to help autistic children.

Keywords: autistic children, digital technologies, intervention, social stories

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342 Mycophenolate-Induced Disseminated TB in a PPD-Negative Patient

Authors: Megan L. Srinivas

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Individuals with underlying rheumatologic diseases such as dermatomyositis may not adequately respond to tuberculin (PPD) skin tests, creating false negative results. These illnesses are frequently treated with immunosuppressive therapy making proper identification of TB infection imperative. A 59-year-old Filipino man was diagnosed with dermatomyositis on the basis of rash, electromyography, and muscle biopsy. He was initially treated with IVIG infusions and transitioned to oral prednisone and mycophenolate. The patient’s symptoms improved on this regimen. Six months after starting mycophenolate, the patient began having fevers, night sweats, and productive cough without hemoptysis. He moved from the Philippines 5 years prior to dermatomyositis diagnosis, denied sick contacts, and was PPD negative both at immigration and immediately prior to starting mycophenolate treatment. A third PPD was negative following the onset of these new symptoms. He was treated for community-acquired pneumonia, but symptoms worsened over 10 days and he developed watery diarrhea and a growing non-tender, non-mobile mass on the left side of his neck. A chest x-ray demonstrated a cavitary lesion in right upper lobe suspicious for TB that had not been present one month earlier. Chest CT corroborated this finding also exhibiting necrotic hilar and paratracheal lymphadenopathy. Neck CT demonstrated the left-sided mass as cervical chain lymphadenopathy. Expectorated sputum and stool samples contained acid-fast bacilli (AFB), cultures showing TB bacteria. Fine-needle biopsy of the neck mass (scrofula) also exhibited AFB. An MRI brain showed nodular enhancement suspected to be a tuberculoma. Mycophenolate was discontinued and dermatomyositis treatment was switched to oral prednisone with a 3-day course of IVIG. The patient’s infection showed sensitivity to standard RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) treatment. Within a week of starting RIPE, the patient’s diarrhea subsided, scrofula diminished, and symptoms significantly improved. By the end of treatment week 3, the patient’s sputum no longer contained AFB; he was removed from isolation, and was discharged to continue RIPE at home. He was discharged on oral prednisone, which effectively addressed his dermatomyositis. This case illustrates the unreliability of PPD tests in patients with long-term inflammatory diseases such as dermatomyositis. Other immunosuppressive therapies (adalimumab, etanercept, and infliximab) have been affiliated with conversion of latent TB to disseminated TB. Mycophenolate is another immunosuppressive agent with similar mechanistic properties. Thus, it is imperative that patients with long-term inflammatory diseases and high-risk TB factors initiating immunosuppressive therapy receive a TB blood test (such as a quantiferon gold assay) prior to the initiation of therapy to ensure that latent TB is unmasked before it can evolve into a disseminated form of the disease.

Keywords: dermatomyositis, immunosuppressant medications, mycophenolate, disseminated tuberculosis

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341 A Multifactorial Algorithm to Automate Screening of Drug-Induced Liver Injury Cases in Clinical and Post-Marketing Settings

Authors: Osman Turkoglu, Alvin Estilo, Ritu Gupta, Liliam Pineda-Salgado, Rajesh Pandey

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Background: Hepatotoxicity can be linked to a variety of clinical symptoms and histopathological signs, posing a great challenge in the surveillance of suspected drug-induced liver injury (DILI) cases in the safety database. Additionally, the majority of such cases are rare, idiosyncratic, highly unpredictable, and tend to demonstrate unique individual susceptibility; these qualities, in turn, lend to a pharmacovigilance monitoring process that is often tedious and time-consuming. Objective: Develop a multifactorial algorithm to assist pharmacovigilance physicians in identifying high-risk hepatotoxicity cases associated with DILI from the sponsor’s safety database (Argus). Methods: Multifactorial selection criteria were established using Structured Query Language (SQL) and the TIBCO Spotfire® visualization tool, via a combination of word fragments, wildcard strings, and mathematical constructs, based on Hy’s law criteria and pattern of injury (R-value). These criteria excluded non-eligible cases from monthly line listings mined from the Argus safety database. The capabilities and limitations of these criteria were verified by comparing a manual review of all monthly cases with system-generated monthly listings over six months. Results: On an average, over a period of six months, the algorithm accurately identified 92% of DILI cases meeting established criteria. The automated process easily compared liver enzyme elevations with baseline values, reducing the screening time to under 15 minutes as opposed to multiple hours exhausted using a cognitively laborious, manual process. Limitations of the algorithm include its inability to identify cases associated with non-standard laboratory tests, naming conventions, and/or incomplete/incorrectly entered laboratory values. Conclusions: The newly developed multifactorial algorithm proved to be extremely useful in detecting potential DILI cases, while heightening the vigilance of the drug safety department. Additionally, the application of this algorithm may be useful in identifying a potential signal for DILI in drugs not yet known to cause liver injury (e.g., drugs in the initial phases of development). This algorithm also carries the potential for universal application, due to its product-agnostic data and keyword mining features. Plans for the tool include improving it into a fully automated application, thereby completely eliminating a manual screening process.

Keywords: automation, drug-induced liver injury, pharmacovigilance, post-marketing

Procedia PDF Downloads 152