Search results for: Greek public hospital sector

Authors: Ambuja Raj

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This research will attempt to understand how documents are materially indispensable civic artifacts for migrants in their encounters with the state. Documents such as ID cards are sites of mediation and bureaucratic manifestation which reveal the inherent dynamics of power between the state and a delocalized people. While ID cards allow the holder to retain a different identity and articulate their demands as a citizen, they at the same time transform subjects into ‘objects’ in the exercise of governmental power. The research is based on the study of internal migrants in India, who are ‘visible’ to the state through its host of ID documents such as the ‘Aadhaar card’, electoral IDs, Ration cards, and a variety of region-specific documents, without the possession of which, not only are they unable to access jobs, public goods and services, and accommodation, but are liable to exploitation from state forces and mediators. Through semi-structured interviews with social actors in the processes of documentation and welfare of migrants, as well as with settlements of migrants themselves located in the state of Kerala in India, the thesis will attempt to understand the salience of documentary practices in the lives of inter-state migrants who move within Indian states in the hope of bettering their economic conditions. The research will trace the material and evolving significance of ID cards in the tenacity of states dealing with these ‘illegible’ populations. It will try to bring theories of governmentality, biopolitics and Weberian bureaucracy into the migrant issue while critically grounding itself on secondary literature by scholars who have worked on South Asian ‘governments of paper’.

Keywords: migration, historiography of documents, anthropology of state, documentary practices

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Authors: Marzieh Amiri, Zahra Iranpour Mobarakeh, Fatemeh Mehrbakhsh, Mehran Amiri

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Introduction: Early diagnosis and intervention of congenital hearing loss is necessary to minimize the adverse effects of hearing loss. The aim of the present study was to report the results of newborn hearing screening in a centerin the south part of Iran, Fasa. Material and methods: In this study, the data related to 6,144 newbornsduring September 2018 up to September2021, was analyzed. Hearing screening was performed using transient evoked otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR) tests. Results: From all 6144 newborns,3752 and 2392referred to the center from urban and rural part of Fasa, respectively. There were 2958 female and 3186 male in this study. Of 6144 newborns, 6098 ones passed the screening tests, and 46 neonates were referred to a diagnostic audiology clinic. Finally, nine neonates were diagnosed with congenital hearing loss (seven with sensorineural hearing loss and two with conductive hearing loss). The severity of all the hearing impaired neonates was moderate and above. The most important risk factors were family history of hearing loss, low gestational age, NICU hospitalization, and hyperbilirubinemia. Conclusion: Our results showed that the prevalence of hearing loss was 1.46 per 1000 infants. Boosting public knowledge by providing families with proper education appears to be helpful in preventing the negative effects of delayed implementation of health screening programs.

Keywords: newborn hearing screening, hearing loss, risk factor, prevalence

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Authors: Giovanni Matheus Rech, Gilberto Zan, Filipe P. Aguiar

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The current pandemic scenario raises questions that many times would have previously gone unnoticed. One of these issues is the quality of the air we breathe in the most diverse environments in which we are inserted in an everyday. It is plausible to suppose that, at times like this, there is apprehension regarding the possibility of contamination by pathological agents such as viruses and bacterias through the airways. However, the renewal of indoor air, combined with a properly sanitized air conditioning system, are important tools for the prevention of viral diseases, as is the case with COVID-19. The bus is an example of an environment where renovation is applied to improve the quality of indoor air, helping to reduce the possibility of spreading pathological agents. Together with other care, such as an alcohol gel dispenser, curtains to separate the passengers, cleaning the environment more frequently, and mandatory use of masks, help to reduce the transmission of pathologies, such as COVID-19. Knowing the reality of a large part of the population regarding the need for public transport, there are standards and devices dedicated to promoting air quality, ensuring greater comfort and safety for users. This paper seeks to present such standards and recommendations to improve the quality of indoor air, as well as the equipment responsible for the renewal of the air in the body of a bus. Experimental measurement of the flow rates of the renewal devices present in the bus body allows quantifying the average volume of external air admitted in each type of body. This way, it was possible to compare, in terms of airflow per person, the values of a bus in relation to a series of other environments, using recommendations for air renewal are described through the Brazilian standard ABNT NBR 16401.

Keywords: air quality, air renewal, buses, Covid-19

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Authors: Pushp Lata Sankhwar

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INTRODUCTION: Maternal Hypothyroidism is the most frequent endocrine disorder in pregnancy and varies from 2.5% in the west to 11.0% in India. Maternal Hypothyroidism can have detrimental maternal effects like increased risk of preterm labor, PPROM leading to increased maternal morbidity and also on the neonate in the form of prematurity and its complications, prolonged hospital stay, neurological developmental problems, delayed milestones and mental retardation etc. Henceforth, the study was planned to evaluate the role of Hypothyroidism in preterm labor and its effect on neonates. AIMS AND OBJECTIVES: To Correlate Overt Hypothyroidism, Subclinical Hypothyroidism and Isolated Hypothyroxinemia With Preterm Labor and the neonatal outcome. Material and Methods: A case-control study of singleton pregnancy was performed over a year, in which a total of 500 patients presenting in the emergency with preterm labor were enrolled. The thyroid profile of these patients was sent at the time of admission, on the basis of which they were divided into Cases – Hypothyroidic mothers and Controls – Euthyroid mothers. The cases were further divided into subclinical, overt Hypothyroidism and isolated hypothyroxinemia. The neonatal outcome of these groups was also compared on the basis of the incidence and severity of neonatal morbidity, neonatal respiratory distress, the incidence of neonatal Hypothyroidism and early complications. The feto-maternal data was collected and analysed. RESULTS: In the study, a total of 500 antenatal patients with a history of preterm labor were enrolled, out of which 67 (13.8%) patients were found to be hypothyroid. The majority of the mothers had Subclinical Hypothyroidism (12.2%), followed by Overt Hypothyroidism seen in 1% of the mothers and isolated hypothyroxinemia in 0.6% of cases. The neonates of hypothyroid mothers had higher levels of cord blood TSH, and the mean cord blood TSH levels were highest in the case of neonates of mothers with Overt Hypothyroidism. The need for resuscitation of the neonates at the time of birth was higher in the case of neonates of hypothyroid mothers, especially with Subclinical Hypothyroidism. Also, it was found that the requirement of oxygen therapy in the form of oxygen by nasal prongs, oxygen by a hood, CPAP, CPAP along with surfactant therapy and mechanical ventilation along with surfactant therapy was significantly higher in the case of neonates of hypothyroid mothers. CONCLUSION: The results of our study imply that uncontrolled and untreated maternal Hypothyroidism may also lead to preterm delivery. The neonates of mothers with Hypothyroidism have higher cord blood TSH levels. The study also shows that there is an increased incidence and severity of respiratory distress in the neonates of hypothyroid mothers with untreated subclinical Hypothyroidism. Hence, we propose that routine screening for thyroid dysfunction in pregnant women should be done to prevent thyroid-related feto-maternal complications.

Keywords: high-risk pregnancy, thyroid, dysfunction, hypothyroidism, Preterm labor

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Authors: Annie Ramanbhai Mecwan

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Cleaning validation in a pharmaceutical manufacturing facility is documented evidence that a cleaning process has effectively removed contaminants, residues from previous drug products and cleaning agents below a pre-defined threshold from the reusable tools and parts of equipment. In shared manufacturing facilities more than one drug product is prepared. After cleaning of reusable tools and parts of equipment after one drug product manufacturing, there are chances that some residues of drug substance from previously manufactured drug products may be retained on the equipment and can carried forward to the next drug product and thus cause cross-contamination. Health-based limits through the derivation of a safe threshold value called permitted daily exposure (PDE) for the residues of drug substances should be employed to identify the risks posed at these manufacturing facilities. The PDE represents a substance-specific dose that is unlikely to cause an adverse effect if an individual is exposed to or below this dose every day for a lifetime. There are different practices to calculate PDE. Data for all APIs in the public domain are considered to calculate PDE value though, company to company may vary the final PDE value based on different toxicologist’s perspective or their subjective evaluation. Hence, Regulatory agencies should take responsibility for publishing PDE values for all APIs as it is done for elemental PDEs. This will harmonize the PDE values all over the world and prevent the unnecessary load on manufacturers for cleaning validation

Keywords: active pharmaceutical ingredient, good manufacturing practice, NOAEL, no observed adverse effect level, permitted daily exposure

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Authors: Raman Sharma, Ashok Kumar, Vipin Koushal

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Healthcare facilities are always seen as places of haven and protection for managing the external incidents, but the situation becomes more difficult and challenging when such facilities themselves are affected from internal hazards. Such internal hazards are arguably more disruptive than external incidents affecting vulnerable ones, as patients are always dependent on supportive measures and are neither in a position to respond to such crisis situation nor do they know how to respond. The situation becomes more arduous and exigent to manage if, in case critical care areas like Intensive Care Units (ICUs) and Operating Rooms (OR) are convoluted. And, due to these complexities of patients’ in-housed there, it becomes difficult to move such critically ill patients on immediate basis. Healthcare organisations use different types of electrical equipment, inflammable liquids, and medical gases often at a single point of use, hence, any sort of error can spark the fire. Even though healthcare facilities face many fire hazards, damage caused by smoke rather than flames is often more severe. Besides burns, smoke inhalation is primary cause of fatality in fire-related incidents. The greatest cause of illness and mortality in fire victims, particularly in enclosed places, appears to be the inhalation of fire smoke, which contains a complex mixture of gases in addition to carbon monoxide. Therefore, healthcare organizations are required to have a well-planned disaster mitigation strategy, proactive and well prepared manpower to cater all types of exigencies resulting from internal as well as external hazards. This case report delineates a true OR fire incident in Emergency Operation Theatre (OT) of a tertiary care multispecialty hospital and details the real life evidence of the challenges encountered by OR staff in preserving both life and property. No adverse event was reported during or after this fire commotion, yet, this case report aimed to congregate the lessons identified of the incident in a sequential and logical manner. Also, timely smoke evacuation and preventing the spread of smoke to adjoining patient care areas by opting appropriate measures, viz. compartmentation, pressurisation, dilution, ventilation, buoyancy, and airflow, helped to reduce smoke-related fatalities. Henceforth, precautionary measures may be implemented to mitigate such incidents. Careful coordination, continuous training, and fire drill exercises can improve the overall outcomes and minimize the possibility of these potentially fatal problems, thereby making a safer healthcare environment for every worker and patient.

Keywords: healthcare, fires, smoke, management, strategies

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Authors: Tassana Boontong, Vilaivan Thongcharoen, Orapan Thosingha, Suphamon Chansakul, Anorut Jenwitheesuk, Chanin Chakkrapopyodhin, Isara Phiwchai, Mattika Chaichan, Rungnapha Khiewchaum

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According to Thailand health policy, subdistrict health promoting hospitals (SHPHs) serve as forefront facilities for inclusive health care service. Those services include health promotion, disease prevention, primary medical care and rehabilitation. However, SHPHs residing in some distant area, such as SHPHs residing on the islands, would deliver different services relevant to health needs of the local people and the tourists. This research aimed to study health care delivery services at SHPHs on the islands in Thailand. Data were collected using questionnaires. The result revealed that in Thailand, there are 58 SHPHs on the islands. During data collection process, the researchers were not allowed to collect data in 5 SHPHs in the southern part due to Covid-19 pandemic. The report is based on 53 SHPHs on the islands. Numbers of health care personnel were 201, 72.14 % were female, with the ages ranged from 22 to 60 years (mean = 35.56 years). About 53% were community health personnel, while 26.08% were professional nurses. In regard to work experiences, the range of year varied from less than 1 year to 30 years, with the mean of 8.36 years. The majority of their responsibilities focused on providing primary medical care (86.34%), caring of people with chronic illnesses (85.30%) and providing medical care procedures for patients with chronic illnesses at home (84.36%). Nurses were main health care personnel in performing primary medical care. Due to difficulty transportation from the islands to the mainland, nurses had to provide prompt emergency medical care while the patients arrived with emergency and critical illnesses such as severe head trauma, stroke or coronary artery disease. Although some medical procedures were complex and not covered by nursing and midwifery license, they decided to protect patients from life- threatening conditions and make them stable before transportation. In SHPHs, the workload exceeded manpower, health care personnel had to work overtime almost every day. In the famous tourist islands, health care personnel had to carry 3-4 folds of their workload during the holidays because of the large crowds of foreign and Thai tourists. It is recommended that SHPHs on the islands should scale up the level of services to cover advanced medical care. Health care personnel, in particular, professional nurses, should be equipped with emergency and critical care skills. The expected outcomes of the services should emphasize on rescuing patients with emergency and life-threatening illnesses and providing comprehensive care for people living on or visiting the islands.

Keywords: distant area, islands, sub district health promoting hospital, heath care services, Thailand

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Authors: Sanaa Abouras

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This research investigates the attitude of Egyptian Nubian University students towards the Arabic and the two Nubian languages, Nobiin, and Kenuzi-Dongola. The Nubian languages are called by Egyptian Nubians, Fadijja/Fadicca and Kenzi, respectively. Nubians are people who live in the Nubia area which lies between Egypt’s southern borders with the northern part of Sudan. Nubia is divided into two parts - one under the Egyptian regime, and the other under the Sudanese regime. The number of participants used in the study was forty - half male and half female. Twenty of these participants live in the Nubian region and are enrolled at the South Valley University in Aswan, Egypt. This number was compared with an additional twenty Egyptian-Nubian university students who live outside the Nubian region and attend various Egyptian universities located in Alexandria and Cairo. The hypothesis of this study is that Egyptian Nubian University students tend to have positive attitudes toward Arabic and also the Nubian languages. This research is a qualitative and partially quantitative one. Observations, questionnaires, and interviews were used to collect data in order to explore the following: (1) the language students prefer to speak at home and in public and if language preferences are gender-related, (2) the factors that influence the Egyptian Nubian university students' attitudes towards Arabic and Nubian languages, and (3) a look at the future of these ethnic Nubian languages. Results that answered the main question on the attitude of Egyptian Nubian University students toward Arabic and Nubian languages revealed that students who live inside and outside the Nubian region tend to have positive attitudes towards both the Arabic and the Nubian languages.

Keywords: language attitude, minority, Arabic language, Nubian Language

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Authors: Kunwar Paritosh, Vivekanand Vivekanand, Nidhi Pareek

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Presently, India depends primarily on fossil fuels for its acute energy demand. The swift in development of India in last two decades is accentuating its natural resources and compelling expenditures to cope energy security for the habitats. A total inhabitant of 1.2 billion, observing growing industrialization; is generating 68.8 million tonnes of municipal solid waste per year, 53.7 million tonnes is collected, and only trifling amount of 10.3 million tonnes of waste is treated per year that integrates to a massive amount of unimaginable land hill. In India, waste is mostly landfilled and/or incinerated with low technology and is poorly managed. Underutilization of this waste not only gulps resources but also stresses environment, public health and bionetwork thus affecting the bioeconomy negatively. It also creates conditions that invoke inevitable expenditures and loss of its renewable energy potential. The non-scientific approach to manage waste may lead to an economy downfall, underutilization and degradation of natural resources. Waste treatment technologies must be scientifically tailored and engineered as per the type of waste where it may be utilized as a source of energy (here biogas) and nutrients employing anaerobic digestion to the sorted waste. This paper presents a brief review on current practices, key achievements and forthcoming aspects of harnessing energy from municipal solid waste in Indian scenario.

Keywords: municipal discards, organic waste, anaerobic digestion, incineration, energy

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Authors: N. Dlamini, Mpumelelo G. Ndlela, Philisiwe Dlamini, Nicholus Kisyeri, Bhekizitha Sithole

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Accessing health services during the COVID-19 pandemic have exacerbated scarcity to routine medication. To ensure continuous accessibility to services, Eswatini launched Community Health Commodities Distribution (CHCD). Eligible Antiretroviral Therapy(ART) stable clients (VL<1,000) and patients on Non-Communicable Disease (NCD) medications were attended at community pick up points (PUP) based on distance between clients’ residence and the public health facility. Services provided includes ART and Pre-Exposure prophylaxis (PrEP) refills and NCD drug refills). The number of community PUP was 14% higher than health facility visits. Among all medications and commodities distributed between April and October 2020 at the PUP, 64% were HIV-related (HIV rapid test, HIVST, VL test, PrEP meds), and 36% were NCD related. The rapid roll out of CHCD during COVID-19 pandemic reduced the risk of COVID-19 transmission to clients as travel to health facilities was eliminated. It Additionally increased access to commodities during COVID-19-driven lockdown, decongested health facilities, integrated model of care, and increase service coverage. It was also noted that CHCD added different curative and HIV related services based on client specific needs and availability of the commodities.

Keywords: community health commodities distribution, pick up points, antiretroviral therapy, pre-exposure prophylaxis

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Authors: Z. Wang, F. Pashaei Kamali, J. A. Posada Duque, P. Osseweijer

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Globally, the aviation sector is seeking for sustainable solutions to comply with the pressure to reduce greenhouse gas emissions. Jet fuels derived from biomass are generally perceived as a sustainable alternative compared with their fossil counterparts. However, the establishment of jet biofuels supply chains will have impacts on environment, economy, and society. While existing studies predominantly evaluated environmental impacts and techno-economic feasibility of jet biofuels, very few studies took the social / socioeconomic aspect into consideration. Therefore, this study aims to provide a focused evaluation of social sustainability for aviation biofuels with a supply chain perspective. Three potential jet biofuel supply chains based on different feedstocks, i.e. sugarcane, eucalyptus, and macauba were analyzed in the context of Brazil. The assessment of social sustainability is performed with a process-based approach combined with input-output analysis. Over the supply chains, a set of social sustainability issues including employment, working condition (occupational accident and wage level), labour right, education, equity, social development (GDP and trade balance) and food security were evaluated in a (semi)quantitative manner. The selection of these social issues is based on two criteria: (1) the issues are highly relevant and important to jet biofuel production; (2) methodologies are available for assessing these issues. The results show that the three jet biofuel supply chains lead to a differentiated level of social effects. The sugarcane-based supply chain creates the highest number of jobs whereas the biggest contributor of GDP turns out to be the macauba-based supply chain. In comparison, the eucalyptus-based supply chain stands out regarding working condition. It is also worth noting that biojet fuel supply chain with high level of social benefits could result in high level of social concerns (such as occupational accident, violation of labour right and trade imbalance). Further research is suggested to investigate the possible interactions between different social issues. In addition, the exploration of a wider range of social effects is needed to expand the comprehension of social sustainability for biofuel supply chains.

Keywords: biobased supply chain, jet biofuel, social assessment, social sustainability, socio-economic impacts

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Authors: Husain Rajib, K. S. Kishor, D. G. Jewel

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Background: Uncorrected refractive error is a common cause of preventable visual impairment in pediatric age group which can be lead to blindness but early detection of visual impairment can reduce the problem that will have good effective in education and more involve in social activities. Glasses are the cheapest and commonest form of correction of refractive errors. To achieve this, patient must exhibit good compliance to spectacle wear. Patient’s attitude and perception of glasses and eye health could affect compliance. Material and method: A Prospective community based cross sectional study was designed in order to evaluate the knowledge, attitude and practices about refractive errors and eye health amongst the primary school going children. Result: Among 140 respondents, 72 were males and 68 were females. We found 50 children were myopic and out of them 26 were male and 24 were female, 27 children were hyperopic and out of them 14 were male and 13 were female. About 63 children were astigmatic and out of them 32 were male and 31 were female. The level of knowledge, attitude was satisfactory. The attitude of the students, teachers and parents was cooperative which helps to do cycloplegic refraction. Practice was not satisfactory due to social stigma and information gap. Conclusion: Knowledge of refractive error and acceptance of glasses for the correction of uncorrected refractive error. Public awareness program such as vision screening program, eye camp, and teachers training program are more beneficial for wearing and prescribing spectacle.

Keywords: refractive error, stigma, knowledge, attitude, practice

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Authors: Liaqat Ali, Ehsan, Muhammad Shahzad, Nasir Orakzai

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Introduction: Internal optical urethrotomy is the main stay treatment modality in management of urethral stricture. Being minimal invasive with less morbidity, it is commonly performed and favored procedure by urologists across the globe. Although short-term success rate of optical urethrotomy is promising but long-term efficacy of IOU is questionable with high recurrence rate in different studies. Numerous techniques had been adopted to reduce the recurrence after IOU like prolong catheterization and self-clean intermittent catheterization with varying success. Mitomycin C has anti-fibroblast and anti-collagen properties and has been used in trabeculectomy, myringotomy and after keloid scar excision in contemporary surgical practice. Present study according to the best of our knowledge is a pioneer pilot study in Pakistan to determine the efficacy of Mitomycin C in preventing recurrence of urethral stricture after internal optical urethrotomy. Objective: To determine the efficacy of Mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy. Methods: It is a randomized control trial conducted in department of urology, Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from March 2011 till December 2013. After approval of hospital ethical committee, we included maximum of 2 cm anterior urethral stricture irrespective of etiology. Total of 140 patients were equally divided into two groups by lottery method. Group A (Case) comprising of 70 patients in whom Mitomycin C 0.1% was injected sub mucosal in stricture area at 1,11,6 and 12 O clock position using straight working channel paediatric cystoscope after conventional optical urethrotomy. Group B (Control) 70 patients in whom only optical urethrotomy was performed. SCIC was not offered in both the groups. All the patients were regularly followed on a monthly basis for 3 months then three monthly for remaining 9 months. Recurrence was diagnosed by using diagnostic tools of retrograde urethrogram and flexible urethroscopy in selected cased. Data was collected on structured Proforma and was analyzed on SPSS. Result: The mean age in Group A was 33 ±1.5 years and Group B was 35 years. External trauma was leading cause of urethral stricture in both groups 46 (65%) Group A and 50 (71.4%) Group B. In Group A. Iatrogenic urethral trauma was 2nd etiological factor in both groups. 18(25%) Group A while 15( 21.4%) in Group B. At the end of 1 year, At the end of one year, recurrence of urethral stricture was recorded in 11 (15.71%) patient in Mitomycin C Group A and it was recorded in 27 (38.5 %) patients in group B. Significant difference p=0.001 was found in favour of group A Mitomycin group. Conclusion: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C is found highly effective in preventing recurrence of urethral stricture after IOU.

Keywords: urethral stricture, mitomycine, internal optical urethrotomy, medical and health sciences

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Authors: Özgür Emi̇nağaoğlu, Hayal Akyildirim Beğen, Şevval Sali̇oğlu

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In this study, the plant used for purification and aromatic purposes by the public in Adagül, Akpınar, Alaca, Ambarlı, Arkaköy, Avcılar, Balcı, Civan, Demirciler, Düzköy, İbrikli, Kale, Kaynarca and Taraklı villages in Borcka (Artvin) district between 2020-2022. The purpose of the study, determining the surgical common and local names, regions, botanical features, used parts of plants, purpose of use, local usage intensive, and giving literature data. The research area is located on the A8 square according to Davis's grid system; its phytogeographic extensions are in the Holarctic regions, and the Euro-Siberian flora settlement is in the Colchic subsection of the Euxine region. In the research area, 71 personal questionnaires were applied. As a result of the surveys, it was determined that 93 plant species belonging to 44 families were used by the local people for purification and aromatic purposes. The families that contain the most taxa in the research area are, respectively, Rosaceae (15 taxa), Astericaeae (9 taxa), Lamiaceae (7 taxa), Crassulaceae (4 taxa). As a result of the survey studies, Plantago major L. is known by almost all participants. The most used plants were Allium scorodoprasum, Helichrysum arenarium, Alnus glutinosa subsp. barbata, Juglans regia, Tilia rubra subsp. caucasica, Picea orientalis, Urtica dioica. These plants are used in the treatment of many diseases. Some of these plants that grow in Borçka are used in different countries for the treatment of the same diseases.

Keywords: artvin, borçka, medicinal, aromatic, plant

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Authors: Sibnath Sarkar

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Developing countries are facing many Social problems. In India, too there are several such problems. The problem of street children is one of them. No country or city anywhere in the world today is without the presence of street children, but the problem is most acute in developing countries. Thousands of street children can be seen in our populous cities like Mumbai, Kolkata, Delhi, and Chennai. Most of them are in the age group of 5-15 years. The number of street children is increasing gradually. Poverty, unemployment, rapid urbanization, rural-urban migrations are the root causes of street children. Being deprive from many of their, they have escaped to the street as a safe place for living. Street children always related with the urban spaces in the developing world and it represents a sad outcome of the rapid urbanization process. After coming to the streets, these children have to cope with the new situation every day. They also adopt or develop many complex survival strategies and a variety of different informal or even illegal activities in public space and form supportive social networks in order to survive in street life. Street children use the different suitable urban spaces as their earning, living, entertaining spot. Therefore, the livelihoods of young people on the street should analyze in relation to the spaces they use, as well as their age and length of stay on the streets. This paper tries to explore the livelihood strategies and copping situation of street children in Sealdah station area. One hundred seventy-five street living children are included in the study living in and around the railway station.

Keywords: strategies, street children, survive, urban-space

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Authors: Tae-Uk Yun, Pullip Chung, Kee-Young Kwahk, Hyunchul Ahn

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Fake news is defined as the news articles that are intentionally and verifiably false, and could mislead readers. Spread of fake news may provoke anxiety, chaos, fear, or irrational decisions of the public. Thus, detecting fake news and preventing its spread has become very important issue in our society. However, due to the huge amount of fake news produced every day, it is almost impossible to identify it by a human. Under this context, researchers have tried to develop automated fake news detection using machine learning techniques over the past years. But, there have been no prior studies proposed an automated fake news detection method for Korean news to our best knowledge. In this study, we aim to detect Korean fake news using text mining and machine learning techniques. Our proposed method consists of two steps. In the first step, the news contents to be analyzed is convert to quantified values using various text mining techniques (topic modeling, TF-IDF, and so on). After that, in step 2, classifiers are trained using the values produced in step 1. As the classifiers, machine learning techniques such as logistic regression, backpropagation network, support vector machine, and deep neural network can be applied. To validate the effectiveness of the proposed method, we collected about 200 short Korean news from Seoul National University’s FactCheck. which provides with detailed analysis reports from 20 media outlets and links to source documents for each case. Using this dataset, we will identify which text features are important as well as which classifiers are effective in detecting Korean fake news.

Keywords: fake news detection, Korean news, machine learning, text mining

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Authors: Innocent C. Abazie, Odukoya A. Olatunde, Ochuko Orakpoghenor, Bamidele J. Kolawole, Hannah L. Kolawole

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This study was carried out to obtain five-year retrospective data on dog bite cases and antirabies vaccination of dogs in relation to rabies control in Aba, Abia state, Nigeria. Data for retrospective studies (2016 - 2020) was collected from both government and private veterinary clinics in Aba. A total of 66 dog bite cases were reported between January 2016 and December 2020 with a majority of victims being adults (51.5%) within the ages of 18 – 50 years. On the prevalence of dog bite cases according to the gender of victims, males (75.8%) were mostly involved compared to female victims (24.2%). Anatomically, the majority of bite wounds (65.2%) were on the legs. The monthly distribution of bites indicates a higher frequency in the months of January and March (dry season). Local 28 (43.8%) and exotic breeds 30(46.8%) of dogs were mostly involved in the dog bite cases. The majority of the dogs (92.2%) involved in the bite cases were known dogs whose owners could be contacted, while a very few proportion (7.8%) were stray dogs. Results of this study indicated that only 16 (25%) of the offending dogs had a current antirabies vaccination record, 8 (12.5%) had an unknown vaccination record, while the largest proportion, 40 (62.5%) of the offending dogs had no current vaccination record. Public awareness of the danger of dog bites in relation to rabies and increased antirabies vaccination of dogs as a means of controlling the disease is recommended.

Keywords: Aba, dog bite, rabies, vaccination profile

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Authors: Ziyu Zhang, Xuanyu Ren, Fei Wu, Qinfei Lu, Yongmei Li, Xinyue Zhi

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Introduction: Adolescents experience a critical period of physical and psychological growth. Few studies focus on the influence of sleep hygiene on psychological health from the high school period to freshmen year. Also, the influence of the COVID-19 pandemic has public health significance. Methods: Totally 698 students from high school and college were included in the manuscript, and a cross-sectional procedure was conducted; the objective was to make the epidemiological comparison of the social phobia/depression prevalence and discuss the effects of potential determinants. Results: Psychological problems, including social phobia and depression, are prevalent, especially among high school students, with gender differences. The current results indicated that the association between sleep status and social phobia is most obvious among high school students, while the higher MMR risk was found both for high school social phobia students and college depressive freshmen. Moreover, the interaction between social phobia and depression was also obvious for both populations. Conclusions: Psychological problems, including social phobia and depression, are more prevalent among high school girls when compared with their male and freshmen peers. Important influenced factors for the risk of psychological problems among the two populations were different, but media multitasking status should be paid attention to for both.

Keywords: adolescence, psychological health, epidemiology, social culture

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Authors: Hirbaye Mokona, Abebaw Gebeyehu, Aemro Zerihun

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Introduction: Attention deficit hyperactivity disorder is serious public health problem affecting millions of children throughout the world. Method: A cross-sectional study conducted from May to June 2015 among children age 6 to 17 years living in rural area of Girja district. Multi-stage cluster sampling technique was used to select 1302 study participants. Disruptive Behavior Disorder rating scale was used to collect the data. Data were coded, entered and cleaned by Epi-Data version 3.1 and analyzed by SPSS version 20. Logistic regression analysis was used and Variables that have P-values less than 0.05 on multivariable logistic regression was considered as statistically significant. Results: Prevalence of Attention deficit hyperactivity disorder (ADHD) among children age 6 to 17 years was 7.3%. Being male [AOR=1.81, 95%CI: (1.13, 2.91)]; living with single parent [AOR=5.0, 95%CI: (2.35, 10.65)]; child birth order/rank [AOR=2.35, 95%CI: (1.30, 4.25)]; low family socio-economic status [AOR= 2.43, 95%CI: (1.29, 4.59)]; maternal alcohol/khat use during pregnancy [AOR=3.14, 95%CI: (1.37, 7.37)] and complication at delivery [AOR=3.56, 95%CI: (1.19, 10.64)] were more likely to develop Attention deficit hyperactivity disorder. Conclusion: In this study, the prevalence of Attention deficit hyperactivity disorder was similar with worldwide prevalence. Prevention and early management of its modifiable risk factors should be carryout alongside increasing community awareness.

Keywords: attention deficit hyperactivity disorder, ADHD, associated factors, children, prevalence

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Authors: Shadi Fathi, Moura Mehravar, Mujib Rahman

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Over the years,increased demands on railways, the emergence of high-speed trains and heavy axle loads, ageing, and deterioration of the existing tracks, is imposing costly maintenance actions on the railway sector. The need for developing a fast andcost-efficient non-destructive assessment method for the structural evaluation of railway tracksis therefore critically important. The layer modulus is the main parameter used in the structural design and evaluation of the railway track substructure (foundation). Among many recently developed NDTs, Falling Weight Deflectometer (FWD) test, widely used in pavement evaluation, has shown promising results for railway track substructure monitoring. The surface deflection data collected by FWD are used to estimate the modulus of substructure layers through the back-analysis technique. Although there are different commerciallyavailableback-analysis programs are used for pavement applications, there are onlya limited number of research-based techniques have been so far developed for railway track evaluation. In this paper, the suitability, accuracy, and reliability of the BAKFAAsoftware are investigated. The main rationale for selecting BAKFAA as it has a relatively straightforward user interfacethat is freely available and widely used in highway and airport pavement evaluation. As part of the study, a finite element (FE) model of a railway track section near Leominsterstation, Herefordshire, UK subjected to the FWD test, was developed and validated against available field data. Then, a virtual experimental database (including 218 sets of FWD testing data) was generated using theFE model and employed as the measured database for the BAKFAA software. This database was generated considering various layers’ moduli for each layer of track substructure over a predefined range. The BAKFAA predictions were compared against the cone penetration test (CPT) data (available from literature; conducted near to Leominster station same section as the FWD was performed). The results reveal that BAKFAA overestimatesthe layers’ moduli of each substructure layer. To adjust the BAKFA with the CPT data, this study introduces a correlation model to make the BAKFAA applicable in railway applications.

Keywords: back-analysis, bakfaa, railway track substructure, falling weight deflectometer (FWD), cone penetration test (CPT)

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Authors: Zhou Congling

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The integration of private tutoring has emerged as an indispensable facet in the acquisition of language proficiency beyond formal educational settings. Notably, there has been a discernible surge in the demand for private English tutoring, specifically geared towards the preparation for internationally recognized gatekeeping examinations, such as IELTS, TOEFL, GMAT, and GRE. This trajectory has engendered an escalating need for English Language Teaching Assistants (ELTAs) operating within the realm of Private Tutoring Schools (PTSs). The objective of this study is to unravel the intricate process by which these ELTAs formulate their professional identities in the nascent stages of their careers as English educators, as well as to delineate their perceptions regarding their professional trajectories. The construct of language teacher identity is inherently multifaceted, shaped by an amalgamation of individual, societal, and cultural determinants, exerting a profound influence on how language educators navigate their professional responsibilities. This investigation seeks to scrutinize the experiential and influential factors that mold the identities of ELTAs in PTSs, particularly post the culmination of their language-oriented academic programs. Employing a qualitative narrative inquiry approach, this study aims to delve into the nuanced understanding of how ELTAs conceptualize their professional identities and envision their future roles. The research methodology involves purposeful sampling and the conduct of in-depth, semi-structured interviews with ten participants. Data analysis will be conducted utilizing Barkhuizen’s Short Story Analysis, a method designed to explore a three-dimensional narrative space, elucidating the intricate interplay of personal experiences and societal contexts in shaping the identities of ELTAs. The anticipated outcomes of this study are poised to contribute substantively to a holistic comprehension of ELTA identity formation, holding practical implications for diverse stakeholders within the private tutoring sector. This research endeavors to furnish insights into strategies for the retention of ELTAs and the enhancement of overall service quality within PTSs.

Keywords: China, English language teacher, narrative inquiry, private tutoring school, teacher identity

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Authors: Rowena R. De Guzman

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Association of Southeast Asian Nations (ASEAN) integration requires that higher education institutions (HEIs) must adjust the quality of their educational services and develop a global mindset, through various quality assurance (QA) activities to a level producing global graduates and encouraging human resource mobility. For Philippine HEIs, QA involves enormous tasks and responsibilities, whereby the implementation of which involves various parties, agencies and stakeholders; and in that case innovations have to be installed to engage the whole system in the QA process. In this study, collaborative governance (CG), a concept from the field of public administration, is introduced in educational management, particularly in the area of QA management. The paper suggests that the exercise of and attitude toward CG in QA is relevant to the practice of activities across QA indicators in higher educational services among stakeholders from participating HEIs. Participants representing different interests are collectively empowered, and this compelled them to participate and support the QA activities of the HEIs. It is recommended to embed CG model in the system for HEIs undergoing or intending to undergo QA achieve their desired QA outcomes. The study supports the commitment of the Philippine government to the evolving policy and efforts to achieve comparable qualifications across the Asia-Pacific region under the auspices of the UNESCO.

Keywords: ASEAN integration, collaborative governance, global education, government policy, higher education, international demands, quality assurance

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Authors: Wanhyun Cho, Soonja Kang, Sangkyoon Kim, Soonyoung Park

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In this paper, we propose a novel inference algorithm for the multi-class Gaussian process classification model that can be used in the field of human behavior recognition. This algorithm can drive simultaneously both a posterior distribution of a latent function and estimators of hyper-parameters in a Gaussian process classification model with multi-class. Our algorithm is based on the Laplace approximation (LA) technique and variational EM framework. This is performed in two steps: called expectation and maximization steps. First, in the expectation step, using the Bayesian formula and LA technique, we derive approximately the posterior distribution of the latent function indicating the possibility that each observation belongs to a certain class in the Gaussian process classification model. Second, in the maximization step, using a derived posterior distribution of latent function, we compute the maximum likelihood estimator for hyper-parameters of a covariance matrix necessary to define prior distribution for latent function. These two steps iteratively repeat until a convergence condition satisfies. Moreover, we apply the proposed algorithm with human action classification problem using a public database, namely, the KTH human action data set. Experimental results reveal that the proposed algorithm shows good performance on this data set.

Keywords: bayesian rule, gaussian process classification model with multiclass, gaussian process prior, human action classification, laplace approximation, variational EM algorithm

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Authors: F. O Anugom

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The general functions of the university amongst other things include teaching, research and community service. Universities are recognized as the apex of learning, accumulating and imparting knowledge and skills of all kinds to students to enable them to be productive, earn their living and to make optimum contributions to national development. This is equivalent to the production of human capital in the form of high level manpower needed to administer the educational society, be useful to the society and manage the economy. Quality has become a matter of major importance for university education in Nigeria. Accreditation is the systematic review of educational programs to ensure that acceptable standards of education, scholarship and infrastructure are being maintained. Accreditation ensures that institution maintain quality. The process is designed to determine whether or not an institution has met or exceeded the published standards for accreditation, and whether it is achieving its mission and stated purposes. Ensuring quality assurance in accreditation process falls in the hands of university management which justified the need for this study. This study examined accreditation and quality assurance: the management imperative. Three research questions and three hypotheses guided the study. The design was a correlation survey with a population of 2,893 university administrators out of which 578 Heads of department and Dean of faculties were sampled. The instrument for data collection was titled Programme Accreditation Exercise scale with high levels of reliability. The research questions were answered with Pearson ‘r’ statistics. T-test statistics was used to test the hypotheses. It was found among others that the quality of accredited programme depends on the level of funding of universities in Nigeria. It was also indicated that quality of programme accreditation and physical facilities of universities in Nigeria have high relationship. But it was also revealed that programme accreditation is positively related to staffing in Nigerian universities. Based on the findings of the study, the researcher recommend that academic administrators should be included in the team of those who ensure quality programs in the universities. Private sector partnership should be encouraged to fund programs to ensure quality of programme in the universities. Independent agencies should be engaged to monitor the activities of accreditation teams to avoid bias.

Keywords: accreditation, quality assurance, national universities commission , physical facilities, staffing

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Authors: Chih-I. Tsai, Yu-Chien. Lin

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Through experiences of clinical practices, it is discovered that locations on the body at a level of four fingerbreadth above and below the joints are the points at which muscles connect to tendons, and since the muscles and tendons possess opposite characteristics, muscles are full of blood but lack qi, while tendons are full of qi but lack blood, these points on our body become easily blocked. It is proposed that through doing acupuncture or creating localized pressure to the areas four fingerbreadths above and below our joints, with an elastic bandage, we could help the energy, also known as qi, to flow smoothly in our body and further improve our health. Based on the Four Fingers Theory, we understand that human height is 22 four fingerbreadths. In addition, qi and blood travel through 24 meridians, 50 times each day, and they flow through 6 cun with every human breath. We can also understand the average number of human heartbeats is 75 times per minute. And the function of qi-blood circulation system in Traditional Chinese Medicine is the same as the blood circulation in Western Medical Science. Informed by Four Fingers Theory, this study further examined its applications in acupuncture practices. The research question is how Four Fingers Theory proves what has been mentioned in Nei Jing that there are 66 acupoints under a human’s elbow and knee. In responding to the research question, there are 66 acupoints under a human’s elbow and knee. Four Fingers Theory facilitated the creation of the acupuncture naming and teaching system. It is expected to serve as an approachable and effective way to deliver knowledge of acupuncture to the public worldwide.

Keywords: four fingers theory, meridians circulation, 66 acupoints under human elbow and knee, acupuncture

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Authors: Lilik Sudiajeng, Wiraga Wayan, Lanang Parwita I Gusti

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This is the ongoing research started in 2013 with the final aim is to design the recharge wells both for housing and industry for ground water conservation in Bali - Indonesia. The research started in Denpasar Regency, one of the strategic areas in Bali. The research showed that there is some critical area of ground water resources, especially in north and west part of Denpasar Regency. It driven by the rapid increase of the tourism industry which is followed by the high rate of population, change of land use that leads to the decreasing of rain water catchment areas, and less awareness on preserve natural resources, including ground water. Focus Group Discussion concluded that in order to solve the problem of groundwater crisis, requires the contribution of all parties, started from making simple recharge well for housing. Because of the availability of land is limited and expensive, it is necessary to present an ergonomic shallow recharge well in accordance with the ability of the family or community. The ergonomics shallow recharge well is designed based on the data of hydrology and the characteristics of soil. The design is very flexible depending on the availability of land, environmentally friendly, energy efficient, culture-based, and affordable. To meet the recommended standard of ground water quality, then it equipped with a filtration and sedimentation ponds. Before design recharge wells is disseminated to the public, it is necessary to analyze the effectiveness of the wells to harvest and absorb rainwater into the ground.

Keywords: ergonomics, ground water resources, recharge well, sustainable

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Authors: Beatriz Botella-Gil, Patricio Martínez-Barco, Lea Canales

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The Internet and ICT are an integral element of and omnipresent in our daily lives. Technologies have changed the way we see the world and relate to it. The number of companies in the ICT sector is increasing every year, and there has also been an increase in the work that occurs online, from sending e-mails to the way companies promote themselves. In social life, ICT’s have gained momentum. Social networks are useful for keeping in contact with family or friends that live far away. This change in how we manage our relationships using electronic devices and social media has been experienced differently depending on the age of the person. According to currently available data, people are increasingly connected to social media and other forms of online communication. Therefore, it is no surprise that violent content has also made its way to digital media. One of the important reasons for this is the anonymity provided by social media, which causes a sense of impunity in the victim. Moreover, it is not uncommon to find derogatory comments, attacking a person’s physical appearance, hobbies, or beliefs. This is why it is necessary to develop artificial intelligence tools that allow us to keep track of violent comments that relate to violent events so that this type of violent online behavior can be deterred. The objective of our research is to create a guide for detecting and recording violent messages. Our annotation guide begins with a study on the problem of violent messages. First, we consider the characteristics that a message should contain for it to be categorized as violent. Second, the possibility of establishing different levels of aggressiveness. To download the corpus, we chose the social network Twitter for its ease of obtaining free messages. We chose two recent, highly visible violent cases that occurred in Spain. Both of them experienced a high degree of social media coverage and user comments. Our corpus has a total of 633 messages, manually tagged, according to the characteristics we considered important, such as, for example, the verbs used, the presence of exclamations or insults, and the presence of negations. We consider it necessary to create wordlists that are present in violent messages as indicators of violence, such as lists of negative verbs, insults, negative phrases. As a final step, we will use automatic learning systems to check the data obtained and the effectiveness of our guide.

Keywords: human language technologies, language modelling, offensive language detection, violent online content

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Authors: Othman M. Hakami, Abdul Jabbar Al-Rajab

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Occurrence of heavy metals in water resources increased in the recent years albeit at low concentrations. Lead (PbII) is among the most important inorganic pollutants in ground and surface water. However, removal of this toxic metal efficiently from water is of public and scientific concern. In this study, we developed a rapid and efficient removal method of lead from water using chitosan/magnetite nanoparticles. A simple and effective process has been used to prepare chitosan/magnetite nanoparticles (NPs) (CS/Mag NPs) with effect on saturation magnetization value; the particles were strongly responsive to an external magnetic field making separation from solution possible in less than 2 minutes using a permanent magnet and the total Fe in solution was below the detection limit of ICP-OES (<0.19 mg L-1). The hydrodynamic particle size distribution increased from an average diameter of ~60 nm for Fe3O4 NPs to ~75 nm after chitosan coating. The feasibility of the prepared NPs for the adsorption and desorption of Pb(II) from water were evaluated using Chitosan/Magnetite NPs which showed a high removal efficiency for Pb(II) uptake, with 90% of Pb(II) removed during the first 5 minutes and equilibrium in less than 10 minutes. Maximum adsorption capacities for Pb(II) occurred at pH 6.0 and under room temperature were as high as 85.5 mg g-1, according to Langmuir isotherm model. Desorption of adsorbed Pb on CS/Mag NPs was evaluated using deionized water at different pH values ranged from 1 to 7 which was an effective eluent and did not result the destruction of NPs, then, they could subsequently be reused without any loss of their activity in further adsorption tests. Overall, our results showed the high efficiency of chitosan/magnetite nanoparticles (NPs) in lead removal from water in controlled conditions, and further studies should be realized in real field conditions.

Keywords: chitosan, magnetite, water, treatment

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Authors: Recep Kesli, Huseyin Bilgin, Yasar Unlu, Gokhan Gungor

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Aim: The aim of this study was to compare diagnostic values of two different molecular-based tests (GenoType® HelicoDR ve Seeplex® H. pylori-ClaR- ACE Detection) in detection presence of the H. pylori from gastric biopsy specimens. In addition to this also was aimed to determine resistance ratios of H. pylori strains against to clarytromycine and quinolone isolated from gastric biopsy material cultures by using both the genotypic (GenoType® HelicoDR, Seeplex ® H. pylori -ClaR- ACE Detection) and phenotypic (gradient strip, E-test) methods. Material and methods: A total of 266 patients who admitted to Konya Education and Research Hospital Department of Gastroenterology with dyspeptic complaints, between January 2011-June 2013, were included in the study. Microbiological and histopathological examinations of biopsy specimens taken from antrum and corpus regions were performed. The presence of H. pylori in all the biopsy samples was investigated by five differnt dignostic methods together: culture (C) (Portagerm pylori-PORT PYL, Pylori agar-PYL, GENbox microaer, bioMerieux, France), histology (H) (Giemsa, Hematoxylin and Eosin staining), rapid urease test (RUT) (CLOtest, Cimberly-Clark, USA), and two different molecular tests; GenoType® HelicoDR, Hain, Germany, based on DNA strip assay, and Seeplex ® H. pylori -ClaR- ACE Detection, Seegene, South Korea, based on multiplex PCR. Antimicrobial resistance of H. pylori isolates against clarithromycin and levofloxacin was determined by GenoType® HelicoDR, Seeplex ® H. pylori -ClaR- ACE Detection, and gradient strip (E-test, bioMerieux, France) methods. Culture positivity alone or positivities of both histology and RUT together was accepted as the gold standard for H. pylori positivity. Sensitivity and specificity rates of two molecular methods used in the study were calculated by taking the two gold standards previously mentioned. Results: A total of 266 patients between 16-83 years old who 144 (54.1 %) were female, 122 (45.9 %) were male were included in the study. 144 patients were found as culture positive, and 157 were H and RUT were positive together. 179 patients were found as positive with GenoType® HelicoDR and Seeplex ® H. pylori -ClaR- ACE Detection together. Sensitivity and specificity rates of studied five different methods were found as follows: C were 80.9 % and 84.4 %, H + RUT were 88.2 % and 75.4 %, GenoType® HelicoDR were 100 % and 71.3 %, and Seeplex ® H. pylori -ClaR- ACE Detection were, 100 % and 71.3 %. A strong correlation was found between C and H+RUT, C and GenoType® HelicoDR, and C and Seeplex ® H. pylori -ClaR- ACE Detection (r:0.644 and p:0.000, r:0.757 and p:0.000, r:0.757 and p:0.000, respectively). Of all the isolated 144 H. pylori strains 24 (16.6 %) were detected as resistant to claritromycine, and 18 (12.5 %) were levofloxacin. Genotypic claritromycine resistance was detected only in 15 cases with GenoType® HelicoDR, and 6 cases with Seeplex ® H. pylori -ClaR- ACE Detection. Conclusion: In our study, it was concluded that; GenoType® HelicoDR and Seeplex ® H. pylori -ClaR- ACE Detection was found as the most sensitive diagnostic methods when comparing all the investigated other ones (C, H, and RUT).

Keywords: Helicobacter pylori, GenoType® HelicoDR, Seeplex ® H. pylori -ClaR- ACE Detection, antimicrobial resistance

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Authors: Usha S. Adiga, Sachidanada Adiga

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Introduction: Diabetes Mellitus (DM) is one of the most common non-communicable diseases which imposes a large economic burden on the global health-care system. Cost of illness studies in India have assessed the health care cost of DM, but have certain limitations due to lack of standardization of the methods used, improper documentation of data, lack of follow up, etc. The objective of the study was to estimate the cost of illness of uncomplicated versus complicated type 2 diabetes mellitus in Coastal Karnataka, India. The study also aimed to find out the trend of cost of illness of the disease over a decade. Methodology: A prevalence based bottom-up approach study was carried out in two tertiary care hospitals located in Coastal Karnataka after ethical approval. Direct Medical costs like annual laboratory costs, pharmacy cost, consultation charges, hospital bed charges, surgical /intervention costs of 238 diabetics and 340 diabetic patients respectively from two hospitals were obtained from the medical record sections. Patients were divided into six groups, uncomplicated diabetes, diabetic retinopathy(DR), nephropathy(DN), neuropathy(DNeu), diabetic foot(DF), and ischemic heart disease (IHD). Different costs incurred in 2008 and 2017 in these groups were compared, to study the trend of cost of illness. Kruskal Wallis test followed by Dunn’s test were used to compare median costs between the groups and Spearman's correlation test was used for correlation studies. Results: Uncomplicated patients had significantly lower costs (p <0.0001) compared to other groups. Patients with IHD had highest Medical expenses (p < 0.0001), followed by DN and DF (p < 0.0001 ). Annual medical costs incurred were 1.8, 2.76, 2.77, 1.76, and 4.34 times higher in retinopathy, nephropathy, diabetic foot, neuropathy and IHD patients as compared to the cost incurred in managing uncomplicated diabetics. Other costs also showed a similar pattern of rising. A positive correlation was observed between the costs incurred and duration of diabetes, a negative correlation between the glycemic status and cost incurred. The cost incurred in the management of DM in 2017 was found to be elevated 1.4 - 2.7 times when compared to that in 2008. Conclusion: It is evident from the study that the economic burden due to diabetes mellitus is substantial. It poses a significant financial burden on the healthcare system, individual and society as a whole. There is a need for the strategies to achieve optimal glycemic control and operationalize regular and early screening methods for complications so as to reduce the burden of the disease.

Keywords: COI, diabetes mellitus, a bottom up approach, economics

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