Search results for: ESA guidelines

Authors: C. M. Williams, R. English, P. King, I. M. Brown

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Introduction: Pseudoangiomatous Stromal Hyperplasia (PASH) is a benign fibrous proliferation of breast stroma affecting predominantly premenopausal women with no significant increased risk of breast cancer. Informal recommendations for management have continued to evolve over recent years from surgical excision to observation, although there are no specific national guidelines. This study assesses the safety of a non-surgical approach to PASH management by review of cases at a single centre. Methods: Retrospective case series review (January 2011 – August 2016) was conducted on consecutive PASH cases. Diagnostic classification (clinical, radiological and histological), management outcomes, and breast cancer incidence were recorded. Results: 43 patients were followed up for median of 25 months (3-64) with 75% symptomatic at presentation. 12% of cases (n=5) had a radiological score (BIRADS MMG or US) ≥ 4 of which 3 were confirmed malignant. One further malignancy was detected and proven radiologically occult and contralateral. No patients were diagnosed with a malignancy during follow-up. Treatment evolved from 67% surgical in 2011 to 33% in 2016. Conclusions: The management of PASH has transitioned in line with other published experience. The preliminary findings suggest this appears safe with no evidence of missed malignancies; however, longer follow up is required to confirm long-term safety. Recommendations: PASH with suspicious radiological findings ( ≥ U4/R4) warrants multidisciplinary discussion for excision. In the absence of histological or radiological suspicion of malignancy, PASH can be safely managed without surgery.

Keywords: benign breast disease, conservative management, malignancy, pseudoangiomatous stromal hyperplasia, surgical excision

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Authors: Sophie Mills, Constantinos Aristotelous, Leila L. Touil, Richard C. W. James

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Objectives: Historical studies of the anatomy of the spinal accessory nerve (SAN) have reported conflicting results regarding its relationship with the internal jugular vein (IJV). A literature review was undertaken to establish the prevalence of anatomical variations of the SAN encountered during routine neck dissection surgery in order to increase awareness and reduce morbidity associated with iatrogenic SAN injury. Materials and Methods: The largest systematic review to date was performed using PRISMA-ScR guidelines, which yielded nine articles following the application of inclusion and exclusion criteria. A case report is also included, which demonstrates the rare anatomical relationship of the SAN traversing a fenestrated IJV, seen for the first time in the senior author’s career. Results: The mean number of dissections per study was 119, of which 55.6% (n=5) studies were performed on cadaver subjects, and 44.4% (n=4) were surgical dissections. Incidences of the SAN lateral to the IJV and medial to the IJV ranged from 38.9%-95.7% and 2.8%-57.4%, respectively. Over half of the studies reported incidences of the SAN traversing the IJV in 0.9%-2.8% of dissections. One study reported an isolated variant of the SAN dividing around the IJV with a prevalence of 0.5%. Conclusion: At the level of the posterior belly of the digastric muscle, the surgeon can anticipate the identification of the SAN lateral to the IJV in approximately three-quarters of cases, whilst around one-quarter are estimated to be medial. A mean of 1.6% of SANs traverses a fenestration of the vein. It is essential for surgeons to be aware of these anatomical variations and their prevalence to prevent injury to vital structures during surgery.

Keywords: anatomical variant, internal jugular vein, neck dissection, spinal accessory nerve

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Authors: Su Nandar Tin, Wutjanun Muttitanon

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The availability of free global and historical satellite imagery provides a valuable opportunity for mapping and monitoring the year by year for the built-up area, constantly and effectively. Land distribution guidelines and identification of changes are important in preparing and reviewing changes in the ground overview data. This study utilizes Landsat images for thirty years of information to acquire significant, and land spread data that are extremely valuable for urban arranging. This paper is mainly introducing to focus the basic of extracting built-up area for the city development area from the satellite images of LANDSAT 5,7,8 and Sentinel 2A from USGS in every five years. The purpose analyses the changing of the urban built-up area according to the year by year and to get the accuracy of mapping built-up and bare land areas in studying the trend of urban built-up changes the periods from 1990 to 2020. The GIS tools such as raster calculator and built-up area modelling are using in this study and then calculating the indices, which include enhanced built-up and bareness index (EBBI), Normalized difference Built-up index (NDBI), Urban index (UI), Built-up index (BUI) and Normalized difference bareness index (NDBAI) are used to get the high accuracy urban built-up area. Therefore, this study will point out a variable approach to automatically mapping typical enhanced built-up and bare land changes (EBBI) with simple indices and according to the outputs of indexes. Therefore, the percentage of the outputs of enhanced built-up and bareness index (EBBI) of the sentinel-2A can be realized with 48.4% of accuracy than the other index of Landsat images which are 15.6% in 1990 where there is increasing urban expansion area from 43.6% in 1990 to 92.5% in 2020 on the study area for last thirty years.

Keywords: built-up area, EBBI, NDBI, NDBAI, urban index

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Authors: Amel M. A. Osman, Roy Mahony, Lisa Dann, McKenna S.

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Background: Computed Tomography (CT) is a significant source of radiation in the pediatric population. A new head injury (HI) pathway was introduced in 2021, which altered the previous process of HI being jointly admitted with general pediatrics and surgery to admit these patients under the Emergency Medicine Team. Admitted patients included those with positive CT findings not requiring immediate neurosurgical intervention and those who did not meet current criteria for urgent CT brain as per NICE guidelines but were still symptomatic for prolonged observations. This approach aims to decrease the number of CT scans performed. The main aim is to assess the variation in CT scanning rates since the change in the admitting process. A retrospective review of patients presenting to CHI PECU with HI over 6-month period (01/01/19-31/05/19) compared to a 6-month period post introduction of the new pathway (01/06/2022-31/12/2022). Data was collected from the electronic record databases, symphony, and PACS. Results: In 2019, there were 869 presentations of HI, among which 32 (3.68%) had CT scans performed. 2 (6.25%) of those scanned had positive findings. In 2022, there were 1122 HI presentations, with 47 (4.19%) CT scans performed and positive findings in 5 (10.6%) cases. 57 patients were admitted under the new pathway for observation, with 1 having a CT scan following admission. Conclusion: Quantitative lifetime radiation risks for children are not negligible. While there was no statistically significant reduction in CTs performed amongst HIs presenting to our department, a significant group met the criteria for admission under the PECU consultant for prolonged monitoring. There was also a greater proportion of abnormalities on CT scans performed in 2022, demonstrating improved patient selection for imaging. Further data analysis is ongoing to determine if those who were admitted would have previously been scanned under the old pathway.

Keywords: head injury, CT, admission, guidline

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Authors: Endang Lukitaningsih, Fathul Jannah, Arief R. Hakim, Ratna D. Puspita, Zullies Ikawati

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Rifampicin is a semisynthetic antibiotic derivative of rifamycin B produced by Streptomyces mediterranei. RIF has been used worldwide as first line drug-prescribed throughout tuberculosis therapy. This study aims to develop and to validate an HPLC method couple with a UV detection for determination of rifampicin in spiked human plasma and its application for bioequivalence study. The chromatographic separation was achieved on an RP-C18 column (LachromHitachi, 250 x 4.6 mm., 5μm), utilizing a mobile phase of phosphate buffer/acetonitrile (55:45, v/v, pH 6.8 ± 0.1) at a flow of 1.5 mL/min. Detection was carried out at 337 nm by using spectrophotometer. The developed method was statistically validated for the linearity, accuracy, limit of detection, limit of quantitation, precise and specifity. The specifity of the method was ascertained by comparing chromatograms of blank plasma and plasma containing rifampicin; the matrix and rifampicin were well separated. The limit of detection and limit of quantification were 0.7 µg/mL and 2.3 µg/mL, respectively. The regression curve of standard was linear (r > 0.999) over a range concentration of 20.0 – 100.0 µg/mL. The mean recovery of the method was 96.68 ± 8.06 %. Both intraday and interday precision data showed reproducibility (R.S.D. 2.98% and 1.13 %, respectively). Therefore, the method can be used for routine analysis of rifampicin in human plasma and in bioequivalence study. The validated method was successfully applied in pharmacokinetic and bioequivalence study of rifampicin tablet in a limited number of subjects (under an Ethical Clearance No. KE/FK/6201/EC/2015). The mean values of Cmax, Tmax, AUC(0-24) and AUC(o-∞) for the test formulation of rifampicin were 5.81 ± 0.88 µg/mL, 1.25 hour, 29.16 ± 4.05 µg/mL. h. and 29.41 ± 4.07 µg/mL. h., respectively. Meanwhile for the reference formulation, the values were 5.04 ± 0.54 µg/mL, 1.31 hour, 27.20 ± 3.98 µg/mL.h. and 27.49 ± 4.01 µg/mL.h. From bioequivalence study, the 90% CIs for the test formulation/reference formulation ratio for the logarithmic transformations of Cmax and AUC(0-24) were 97.96-129.48% and 99.13-120.02%, respectively. According to the bioequivamence test guidelines of the European Commission-European Medicines Agency, it can be concluded that the test formulation of rifampicin is bioequivalence with the reference formulation.

Keywords: validation, HPLC, plasma, bioequivalence

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Authors: Ephrem Mebratu Dagnew, Mohammed Biset Ayalew, Gizework Alemnew Mekonnen, Alehegn Bishaw Geremew, Ousman Abubeker Abdela

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Objective: To assess the prevalence of drug-related problems and associated factors among adult psychiatric inpatients. Method: Hospital-based multicenter cross-sectional observational study was conducted from April to July 2021 at five randomly selected hospitals in North-west Ethiopia. A total of 325 consecutively sampled patients participated in the study. Clinical pharmacists assessed the DRPs based on clinical judgment supported by updated evidence-based diseases guidelines. A Medscape drug-interactions checker was used to check drug-drug interactions. The results were summarized using descriptive statistics, including frequency, mean, and standard deviation. Odds ratio (OR) with 95% confidence interval were also computed for each variable for the corresponding P-value. The value of P ≤ 0.05 was considered statistically significant. Result : From the total of 325 study participants, more than half of them (52.9%) were females and the mean age ± (standard deviation) was 30.8±11.3 years. At least one drug-related problem was recorded from 60.9%, 95% CI (55.7-65.8) of study participants with a mean of 0.6±0.49 per patient. Need additional drug therapy was the most common DRP (22.8%), followed by non-adherence to medicine (20.6%) and adverse drug reactions (11%), respectively. Factors independently associated with drug-related problems were rural residence [AOR=1.96,95%CI:1.01-2.84, P-value=0.046], self-employed [AOR=6.0 ,95% CI: 1.0-36.9, P-value=0.035] and alcohol drinkers [AOR=6.40,95%CI:1.12-37.5, p-value=0.034]. Conclusion: The prevalence of drug-related problems among adult psychiatric patients admitted to psychiatric wards was high. Healthcare providers give more attention to tackling these problems. Being a rural residence, self-employed, and Alcohol drinkers were associated with drug-related problems.

Keywords: psychiatric patients, drug-relatedproblems, multicenter, Ethiopia

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Authors: Silvija Šiljeg, Ivan Marić, Ante Šiljeg

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The accessibility of urban green spaces (UGS) is an integral element in the quality of life. Due to rapid urbanization, UGS studies have become a key element in urban planning. The potential benefits of space for its inhabitants are frequently analysed. A functional transport network system and the optimal spatial distribution of urban green surfaces are the prerequisites for maintaining the environmental equilibrium of the urban landscape. An accessibility analysis was conducted as part of the Urban Green Belts Project (UGB). The development of a GIS database for Zadar was the first step in generating the UGS accessibility indicator. Data were collected using the supervised classification method of multispectral LANDSAT images and manual vectorization of digital orthophoto images (DOF). An analysis of UGS accessibility according to the ANGst standard was conducted in the first phase of research. The accessibility indicator was generated on the basis of seven objective measurements, which included average UGS surface per capita and accessibility according to six functional levels of green surfaces. The generated indicator was compared with subjective measurements obtained by conducting a survey (718 respondents) within statistical units. The collected data reflected individual assessments and subjective evaluations of UGS accessibility. This study highlighted the importance of using objective and subjective measures in the process of understanding the accessibility of urban green surfaces. It may be concluded that when evaluating UGS accessibility, residents emphasize the immediate residential environment, ignoring higher UGS functional levels. It was also concluded that large areas of UGS within a city do not necessarily generate similar satisfaction with accessibility. The heterogeneity of output results may serve as guidelines for the further development of a functional UGS city network.

Keywords: urban green spaces (UGS), accessibility indicator, subjective and objective measurements, Zadar

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Authors: Kumar Kanudkuri, A. Sandhya

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Typically, in a MRI clinical setting, there are several protocols run, each indicated for a specific anatomy and disease condition. However, these protocols or parameters within them can change over time due to changes to the recommendations by the physician groups or updates in the software or by the availability of new technologies. Most of the time, the changes are performed by the MRI technologist to account for either time, coverage, physiological, or Specific Absorbtion Rate (SAR ) reasons. However, giving properly guidelines to MRI technologist is important so that they do not change the parameters that negatively impact the image quality. Typically a standard American College of Radiology (ACR) MRI phantom is used for Quality Control (QC) in order to guarantee that the primary objectives of MRI are met. The visual evaluation of quality depends on the operator/reviewer and might change amongst operators as well as for the same operator at various times. Therefore, overcoming these constraints is essential for a more impartial evaluation of quality. This makes quantitative estimation of image quality (IQ) metrics for MRI quality control is very important. So in order to solve this problem, we proposed that there is a need for a robust, open-source, and automated MRI image control tool. The Designed and developed an automatic analysis tool for measuring MRI image quality (IQ) metrics like Signal to Noise Ratio (SNR), Signal to Noise Ratio Uniformity (SNRU), Visual Information Fidelity (VIF), Feature Similarity (FSIM), Gray level co-occurrence matrix (GLCM), slice thickness accuracy, slice position accuracy, High contrast spatial resolution) provided good accuracy assessment. A standardized quality report has generated that incorporates metrics that impact diagnostic quality.

Keywords: ACR MRI phantom, MRI image quality metrics, SNRU, VIF, FSIM, GLCM, slice thickness accuracy, slice position accuracy

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Authors: Nabin Prasad Joshi

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A new variant of the coronavirus family found in the Wuhan city market of China is causing serious harm to human beings. After the WHO decided COVID-19 was a pandemic situation, everyone started to measure the prevention of infectious diseases according to WHO guidelines. It includes social distancing, isolation, quarantine, lockdown, sanitation, and masking, respectively. During this time, the researcher has observed the difficulties of cultivating the new normal in people in Nepal. People have perceived the single coronavirus differently; common populations and frontline workers have different perceptions of coronavirus. The researcher started to measure the psychosocial impact of the COVID-19 pandemic on frontline workers and general populations in Kathmandu valley. The total number of sample units for this research is 82; it includes 52 general populations and 30 frontline workers. These sample units are selected through convenient sampling and purposive sampling, respectively. This research is based on descriptive and exploratory design. DASS-21 of the Nepali version is a comprehensive data collection tool for depression, anxiety, and stress measurement in this research, and simultaneously the psychosocial checklist, key-informant interview, and case study have been done. Quantitative data are analyzed with the help of excel, and qualitative data are through thematic analysis. The study has shown that the occurrence of psychosocial issues among frontline workers is greater than in general populations. It is found that the informants with higher education status have greater psychosocial issues in comparison to low education status. In the context of a pandemic, family/friends’ support can function as a protective factor when at adequate levels.

Keywords: anxiety, depression, isolation, lockdown

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Authors: Inese Tenberga

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Undoubtedly, the focus of the present capitalist system of finance has shifted from the concept of productivity of money to the ‘cult of money’, which is characterized by such notions as speculative activity, squander, self-profit, vested interest, etc. The author is certain that a civilized society cannot follow this economic path any longer and therefore suggests that one solution would be to integrate the Islamic financial model in the banking sector of the EU to overcome its economic vulnerability and structurally transform its economies or build resilience against shocks and crisis. The researcher analyses the Islamic financial model, which is providing the basis for the concept of non-productivity of money, and proposes to consider it as a new paradigm of economic thinking. The author argues that it seeks to establish a broad-based economic well-being with an optimum rate of economic growth, socio-economic justice, equitable distribution of income and wealth. Furthermore, the author analyses and proposes to use the experience of member states of the Islamic Development Bank for the formation of a new EU interest free banking. It is offered to create within the EU banking system a credit sector and investment sector respectively. As a part of the latter, it is recommended to separate investment banks specializing in speculative investments and non­speculative investment banks. Meanwhile, understanding of the idea of Islamic banking exclusively from the perspective of the manner of yielding profit that differs from credit banking, without considering the legal, social, ethical guidelines of Islam impedes to value objectively the advantages of this type of financial activities at the non-Islamic jurisdictions. However, the author comes to the conclusion the imperative of justice and virtue, which is inherent to all of us, exists regardless of religion. The author concludes that the global community should adopt the experience of the Muslim countries and focus on the Islamic banking model.

Keywords: credit sector, EU banking system, investment sector, Islamic banking

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Authors: Pascal Rey, Anaïs Weber

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Many mining projects are being developed in Africa the last decades. Due to the economic opportunities they offer, these projects result in a massive and rapid influx of migrants to the surrounding area. In areas where central government representation is low and local administration lack financial resources, urban development is often anarchical, beyond all public control. It leads to socio-spatial segregation, insecurity and the risk of social conflicts rising. Aware that their economic development is very correlated with local situation, mining companies get more and more involved in regional planning in setting up tools and Strategic Directions document. One of the commonly used tools in this regard is the “Influx Management Plan”. It consists in looking at the region’s absorption capacities in order to ensure its coherent development and by developing several urban centers than one macrocephalic city. It includes many other measures such as urban governance support, skills transfer, creation of strategic guidelines, financial support (local taxes, mining taxes, development funds etc.) local development projects. Through various examples of mining projects in Guinea, A country that is host to many large mining projects, we will look at the implications of regional and urban planning of which mining companies are key playor as well as public authorities. While their investment capacity offers advantages and accelerates development, their actions raise questions of the unilaterality of interests and local governance. By interfering in public affairs are mining companies not increasing the risk of central and local government shirking their responsibilities in terms of regional development, or even calling their legitimacy into question? Is such public-private collaboration really sustainable for the region as a whole and for all stakeholders?

Keywords: Africa, guinea, mine, urban planning

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Authors: Omar Bouledroua, Djamel Zelmati, Zahreddine Hafsi, Milos B. Djukic

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Transporting hydrogen gas through the existing natural gas pipeline network offers an efficient solution for energy storage and conveyance. Hydrogen generated from excess renewable electricity can be conveyed through the API 5L steel-made pipelines that already exist. In recent years, there has been a growing demand for the transportation of hydrogen through existing gas pipelines. Therefore, numerical and experimental tests are required to verify and ensure the mechanical integrity of the API 5L steel pipelines that will be used for pressurized hydrogen transportation. Internal pressure loading is likely to accelerate hydrogen diffusion through the internal pipe wall and consequently accentuate the hydrogen embrittlement of steel pipelines. Furthermore, pre-cracked pipelines are susceptible to quick failure, mainly under a time-dependent cyclic pressure loading that drives fatigue crack propagation. Meanwhile, after several loading cycles, the initial cracks will propagate to a critical size. At this point, the remaining service life of the pipeline can be estimated, and inspection intervals can be determined. This paper focuses on the hydrogen embrittlement of API 5L steel-made pipeline under cyclic pressure loading. Pressurized hydrogen gas is transported through a network of pipelines where demands at consumption nodes vary periodically. The resulting pressure profile over time is considered a cyclic loading on the internal wall of a pre-cracked pipeline made of API 5L steel-grade material. Numerical modeling has allowed the prediction of fatigue crack evolution and estimation of the remaining service life of the pipeline. The developed methodology in this paper is based on the ASME B31.12 standard, which outlines the guidelines for hydrogen pipelines.

Keywords: hydrogen embrittlement, pipelines, transient flow, cyclic pressure, fatigue crack growth

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Authors: Abdul Haseeb Wani, Shruti Sharma, Rafat Siddique

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Self-compacting concrete is an engineered concrete that flows and de-airs without additional energy input. Such concrete requires a high slump which can be achieved by the addition of superplasticizers to the concrete mix. In the present work, bagasse ash is utilised as a replacement of cement in self-compacting concrete. This serves the purpose of both land disposal and environmental concerns related to the disposal of bagasse ash. Further, an experimental program was carried out to study the fresh, strength, and durability properties of self-compacting concrete made with bagasse ash. The mixes were prepared with four percentages (0, 5, 10 and 15) of bagasse ash as partial replacement of cement. Properties investigated were; Slump-flow, V-funnel and L-box, Compressive strength, Splitting tensile strength, Chloride-ion penetration resistance and Water absorption. Compressive and splitting tensile strength tests were conducted at the age of 7 and 28 days. Rapid chloride-ion permeability test was carried at the age of 28 days and water absorption test was carried out at the age of 7 days after initial curing of 28 days. Test results showed that there is an increase in the compressive strength and splitting tensile strength of the concrete specimens having up to 10% replacement level, however, there is a slight decrease at 15% level of replacement. Resistance to chloride-ion penetration of the specimens increased as the percentage of replacement was increased. The charge passed in all the specimens containing bagasse ash was lower than that of the specimen without bagasse ash. Water absorption of the specimens decreased up to 10% replacement level and increased at 15% level of replacement. Hence, it can be concluded that optimum level of replacement of cement with bagasse ash in self-compacting concrete comes out to be 10%; at which the self-compacting concrete has satisfactory flow characteristics (as per the European guidelines), improved compressive and splitting tensile strength and better durability properties as compared to the control mix.

Keywords: bagasse ash, compressive strength, self-compacting concrete, splitting tensile strength

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Authors: Laila Khawaja

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In recent years, an increasing emphasis has been placed on measuring program implementation, in part because of the great variability in how complex interventions are delivered in real-life settings. There is an increased awareness that while conducting process evaluations, one should aim to identify and understand the complexities of intervention if they are to be used for future intervention development or the strategies needed to implement the same intervention in a different setting. Complex interventions are public health interventions that are not drugs or surgical procedures but have many potential active aspects of intervention. In this paper, process evaluations are aligned with MRC guidelines to identify contextual factors related to outcomes to assess the quality of implementation. This paper briefly discusses the perceptions of research team on the implementation of the intervention of ‘Engaging Adolescents in Changing Behaviour’ (EACH-B), a school-based complex intervention study aiming to improve diet and physical activity among adolescents aged 12-13 years. Through qualitative interviews and focus groups with 10 staff members, we aimed to understand their experiences and reflections on implementing the EACH-B trial delivered in 49 Schools around Hampshire, England. Data were uploaded into NVivo, and analysis was conducted using thematic analysis. The investigation revealed two overarching themes: (a) how the communication patterns with teachers were impacted during the delivery of implementation and (b) what were the team’s strategies to keep logistics aligned with the research process that impacted the overall implementation of the trial. The paper informs adaptation strategies used by the research team to establish and maintain effective communication with the teachers as well as the thoughtfulness of the team’s logistic strategy for the successful delivery of the trial.

Keywords: complex interventions, process evaluation, adaptation strategies, randomised controlled trial

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Authors: Mei-Fang Wu, Shu-Li Wang, Feng-Tsung Cheng

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Highly developed technology and highly competitive global market highlight the important role of competitive advantages and operation performances in sustainable company operation. Activity-Based Costing (ABC) provides accurate operation cost and operation performance information. Rich literature provide relevant research with cases study on Activity-Based Costing application, and yet, there is no research studying on cause relationship between key success factors of applying Activity-Based Costing and its specific outcomes, such as profitability or share market. These relationships provide the ways to handle the key success factors to achieve the specific outcomes for ensuring to promote the competitive advantages and operation performances. The main purposes of this research are exploring the key success paths by Key Success Paths approach which will lead the ways to apply Activity-Base Costing. The Key Success Paths is the innovative method which is exploring the cause relationships and explaining what are the effects of key success factors to specific outcomes of Activity-Based Costing implementation. The cause relationships between key success factors and successful specific outcomes are Key Success Paths (KSPs). KSPs are the guidelines to lead the cost management strategies to achieve the goals of competitive advantages and operation performances. The research findings indicate that good management system design may impact the good outcomes of Activity-Based Costing application and achieve to outstanding competitive advantage, operating performance and profitability as well by KSPs exploration.

Keywords: activity-based costing, key success factors, key success paths approach, key success paths, key failure paths

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Authors: P. H. Tee, S. M. Zamri, K. M. Kasim, S. K. Tiew

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This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.

Keywords: awareness, knowledge, osteoporosis, practices

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Authors: Nunila Ferreira de Oliveira, Silvana Martins Mishima

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Diabetes mellitus type 2 (DM2) prevalence, is increasing on the world, in Brazil is considered a public health problem. Treatment focuses on glycemic control depending primarily of lifestyle changes - not drug treatment (NDT), may involve drug therapy (DT) and requires continuous health monitoring. In Brazil this monitoring is performed by the Unified Health System (SUS) through Primary Health Care (PHC), which stimulate people with DM2 empowerment for care management. SUS was approved in 1988 and the PHC operationalization was strengthened with the creation of the Family Health Strategy (FHS) in 1994. Our aim was to analyze the people with DM2 participation in front of the care management health monitoring in the FHS. Qualitative research was carried out through non-participant observation of attendance of 25 people with DM2 in the FHS and interviewed at home. Ethical guidelines were followed. It was found that people with DM2 only follow professionals’ recommendations that make sense according to their own conceptions of health/disease; most of them emphasize the importance of (DT) with little emphasis on the NDT, was found great difficulty in the NDT and lack of knowledge about the disease and care. As regards monitoring the FHS, were observed therapeutic practices based on the bio medical model, although the APS search for another care perspective; NDT is not systematically accompanied by the health team and takes place a few educational activities on the DM2 in the FHS, with low user adoption. The work of the FHS is done by multidisciplinary teams, but we see the need for greater participation of nurses in clinical-care follow-up of this population and may also act in adapting to the NDT. Finally we emphasize the need for professional practices that consider the difficulties to care management by people with DM2, especially because of the NDT. It is noticed that the measures recommended by the FHS professionals are not always developed by people with DM2. We must seek the empowerment of people with DM2 to manage the form of care associated with the FHS team, seeking to reduce the incidence of complications and higher quality of life.

Keywords: diabetes mellitus, primary health care, nursing, management of care

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Authors: Dimitra V. Peristeri, Hussameldin M. Nour, Amiya Ahsan, Sameh Abogabal, Krishna K. Singh, Muhammad Shafique Sajid

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Introduction: The use of optimal skin antiseptic agents for the prevention of surgical site infection (SSI) is of critical importance, especially during abdominal surgical procedures. Alcohol-based chlorhexidine gluconate (CHG) and aqueous-based povidone-iodine (PVI) are the two most common skin antiseptics used nowadays. The objective of this article is to evaluate the effectiveness of alcohol-based CHG versus aqueous-based PVI used for skin preparation before abdominal surgery to reduce SSIs. Methods: Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find randomised, controlled trials (RCTs) comparing alcohol-based CHG skin preparation versus aqueous-based PVI in patients undergoing abdominal surgery. The combined outcomes of SSIs were calculated using an odds ratio (OR) with 95% confidence intervals (95% CI). All data were analysed using Review Manager (RevMan) Software 5.4, and the meta-analysis was performed with a random effect model analysis. Results: A total of 11 studies, all RCTs, were included (n= 12072 participants), recruiting adult patients undergoing abdominal surgery. In the random effect model analysis, the use of alcohol-based CHG in patients undergoing abdominal surgery was associated with a reduced risk of SSI compared to aqueous-based PVI (OR: 0.84; 95% CI [0.74, 0.96], z= 2.61, p= 0.009). Conclusion: Alcohol-based CHG may be more effective for preventing the risk of SSI compared to aqueous-based PVI agents in abdominal surgery. The conclusion of this meta-analysis may add a guiding value to reinforce current clinical practice guidelines.

Keywords: skin preparation, surgical site infection, chlorhexidine, skin antiseptics

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Authors: Amrutha Kishor

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Today, with the rising global warming and depletion of resources every industry is moving toward sustainability and energy efficiency. As part of this movement, it is nowadays obligatory for architects to play their part by creating energy predictions for their designs. But in a lot of cases, these predictions do not reflect the real quantities of energy in newly built buildings when operating. These can be described as ‘Energy Performance Gaps’. This study aims to determine the underlying reasons for these gaps. Seven houses designed by Allan Joyce Architects, UK from 1998 until 2019 were considered for this study. The data from the residents’ energy bills were cross-referenced with the predictions made with the software SefairaPro and from energy reports. Results indicated that the predictions did not match the actual energy usage. An account of how energy was used in these seven houses was made by means of personal interviews. The main factors considered in the study were occupancy patterns, heating systems and usage, lighting profile and usage, and appliances’ profile and usage. The study found that the main reasons for the creation of energy gaps were the discrepancies in occupant usage and patterns of energy consumption that are predicted as opposed to the actual ones. This study is particularly useful for energy-conscious architectural firms to fine-tune the approach to designing houses and analysing their energy performance. As the findings reveal that energy usage in homes varies based on the way residents use the space, it helps deduce the most efficient technological combinations. This information can be used to set guidelines for future policies and regulations related to energy consumption in homes. This study can also be used by the developers of simulation software to understand how architects use their product and drive improvements in its future versions.

Keywords: architectural simulation, energy efficient design, energy performance gaps, environmental design

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Authors: J. Raub, H. Schillok, L. Kaupe, C. Jung-Sievers, G. Pitschel-Walz, M. Bühner, J. Gensichen, F. D. Pokal-Gruppe

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Introduction: In Germany, depression ranks among the top ten diseases with the highest disease burden and often occurs with comorbidities. Collaborative Care (CC), a concept developed in the United States for the primary care management of chronic diseases, has been identified as an efficient model for the treatment of depression in general medicine. A recent meta-analysis highlights research gaps regarding CC in patients with psychiatric multimorbidity. The highest prevalence of psychiatric comorbidities in depression is observed in anxiety disorders, post-traumatic stress disorder (PTSD), and substance use disorders. Methods: We conducted a literature search following the PRISMA guidelines with three components: Collaborative Care, Depression and randomized controlled trial on the common databases. We focused on the examination of psychiatric comorbidities in depression, specifically Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD). Results: During the screening process, we identified nine relevant articles related to PTSD, the number of articles related to Substance Use Disorder (SUD) was ten. We examined a total of 8,634 individuals. Our literature review did not reveal any overall significant superiority of the Collaborative Care model compared to Usual Care in patients with depression with comorbid Substance Use Disorder (SUD) or Posttraumatic Stress Disorder (PTSD). Discussion: Five studies demonstrate a faster and statistically significant improvement in depression outcomes among patients with Substance Use Disorder (SUD) and Posttraumatic Stress Disorder (PTSD). Currently, several randomized controlled trials on the topic of Collaborative Care in depression with psychiatric comorbidity are ongoing, such as miCare, Claro and COMET.

Keywords: Depression, primary care, collaborative care, PTSD, Substance use Disorder

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Authors: Alaa Alateeqi, Sara Aldhulaiee, Sara Alibraheem, Noura Alsaleh

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For the past few decades or so, Kuwait's local food industry has grown remarkably due to increase in demand for processed or semi processed food products in the market. It is important that the ever increasing food manufacturing/processing units maintain the required quality standards as per regional and to some extent international quality requirements. It has been realized that all Kuwait food manufacturing units should understand and follow the international standard practices, and moreover a set of guidelines must be set for quality assurance such that any new business in this area is aware of the minimum requirements. The current study has been undertaken to identify the gaps in Kuwait food industries in following the Good Manufacturing Practices (GMP) in terms of quality planning, control and quality assurance. GMP refers to Good Manufacturing Practices, which are a set of rules, laws or regulations that certify producing products within quality standards and ensuring that it is safe, pure and effective. The present study therefore reports about a ‘case study’ in a reputed food manufacturing unit in Kuwait; starting from assessment of the current practices followed by diagnosis, report of the diagnosis and road map and corrective measures for GMP implementation in the unit. The case study has also been able to identify the best practices and establish a benchmarking data for other companies to follow, through measuring the selected company's quality, policies, products and strategies and compare it with the established benchmarking data. A set of questionnaires and assessment mechanism has been established for companies to identify their ‘benchmarking score’ in relation to the number of non-conformities and conformities with the GMP standard requirements.

Keywords: good manufacturing practices, GMP, benchmarking, Kuwait Food Industries, food quality

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Authors: Yahia Massinissa, Henhouda Affaf, Yahia Mouloud

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The aim of this study was to investigate the toxicity; analgesic and anti-pyretic properties of standardized HA methanolic extract (HAMeOH) in vivo. The acute toxicity study was performed on rats while adopting the OECD-420 Guidelines (fixed dose procedure). Assessment of analgesic activity was performed in rats with two analgesic models. One was acetic acid induced writhing response and the other formalin-induced paw licking. The anti-pyretic effect was tested by brewer’s yeast induced fever in rats. For the acute toxicity test, the higher dose administration of 2000 mg/kg bw. of Hyoscyamus albus did not produce any toxic signs or deaths in rats. There were no significant differences (p>0.05) in the body and organ weights between control and treated groups. The (LD50) of Hyoscyamus albus was higher than 2000 g/kg bw. In subacute toxicity study, no mortality and toxic signs were observed with the doses of 100 and 200 mg/kg bw. of extracts of for 28 consecutive days. These analgesic experimental results indicated that HAMeOH (100 mg/kg and 200 mg/kg) decreased the acetic acid-induced writhing responses and HAMeOH (100 mg/kg and 200 mg/kg) decreased the licking time in the second phase of the formalin test. Moreover, in the model of yeast induced elevation of the body temperature HAMeOH showed dose-dependent lowering of the body temperature up to 3h at both the doses these results obtained, were comparable to that of paracetamol. The present findings indicate that the leaves of Hyoscyamus albus L. possess potent analgesic and antipyretic activity.

Keywords: Hyoscyamus albus, methanolic extract, toxicity, analgesic activity, antipyretic activity, formalin test

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Authors: Diptimayee Nayak

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Ecotourism has been recognised as a popular component of alternative tourism, which claims to guard host local environment and economy. This concept of ecological tourism (eco-tourism) has become more meaningful in evaluating the recreational function and services of any pristine ecosystem in context of ‘The Economics of Ecosystem and Biodiversity (TEEB)’. This ecotourism is said to be a local solution to the global problem of conserving ecosystems and optimising the utilisations of their services. This paper takes a case of recreational services of an Indian protected area ecosystems ‘Bhitarakanika mangrove protected area’ discussing how ecotourism is functioning taking the perspectives of different stakeholders. Specific stakeholders are taken for analysis, viz., tourists and local people, as they are believed to be the major beneficiaries of ecotourism. The stakeholders’ analysis is evaluated on the basis of travel cost techniques (by using truncated Poisson distribution model) for tourists and descriptive and analytical tools for local people. The evaluation of stakeholders’ analysis of ecotourism has gained its impetus after the formulation of Ecotourism guidelines by the Ministry of Environment and Forest (MoEF), Government of India. The paper concludes that ecotourism issues and challenges are site-specific and region-specific; without critically focussing challenges of ecotourism faced at local level the discourses of ecotourism at global level cannot be tackled. Mere integration and replication of policies at global level to be followed at local level will not be successful (top down policies). Rather mainstreaming the decision making process at local level with the global policy stature helps to solve global issues to a bigger extent (bottom up).

Keywords: ecosystem services, ecotourism, TEEB, economic valuation, stakeholders, travel cost techniques

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Authors: Asad Iqbal, Feixiang Zan, Xiaoming Liu, Guang-Hao Chen

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Water, food, and energy nexus is a vital subject to achieve sustainable development goals worldwide. Wastewater (WW) and food waste (FW) from municipal sources are primary contributors to their respective wastage sum from a country. Along with the loss of these invaluable natural resources, their treatment systems also consume a lot of abiotic energy and resources input with a perceptible contribution to global warming. Hence, the global paradigm has evolved from simple pollution mitigation to a resource recovery system (RRS). In this study, the prospects of six alternative FW treatment scenarios are quantitatively evaluated for Hong Kong in terms of energy use and greenhouse emissions (GHEs) potential, using life cycle assessment (LCA). Considered scenarios included: aerobic composting, anaerobic digestion (AD), combine AD and composting (ADC), co-disposal, and treatment with wastewater (CoD-WW), incineration, and conventional landfilling as base-case. Results revealed that in terms of GHEs saving, all-new scenarios performed significantly better than conventional landfilling, with ADC scenario as best-case and incineration, AD alone, CoD-WW ranked as second, third, and fourth best respectively. Whereas, composting was the worst-case scenario in terms of energy balance, while incineration ranked best and AD alone, ADC, and CoD-WW ranked as second, third, and fourth best, respectively. However, these results are highly sensitive to boundary settings, e.g., the inclusion of the impact of biogenic carbon emissions and waste collection and transportation, and several other influential parameters. The study provides valuable insights and policy guidelines for the decision-makers locally and a generic modelling template for environmental impact assessment.

Keywords: food waste, resource recovery, greenhouse emissions, energy balance

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Authors: Lingxia Li, Frédéric Schnell, Shuzhe Ding, Solène Le Douairon Lahaye

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Background: The risk of sudden cardiac arret/death (SCA/D) in athletes is controversial. There is a lack of meta-analyses assessing the sex differences in the risk of SCA/D in competitive athletes. Purpose: The aim of the present study was to evaluate sex differences in the incidence of SCA/D in competitive athletes using meta-analyses. Methods: The systematic review was registered in the PROSPERO database (registration ID: CRD42023432022) and was conducted according to the PRISMA guidelines. PubMed, Embase, Scopus, SPORT Discus and Cochrane Library were searched up to July 2023. To avoid systematic bias in data pooling, only studies with data for both sexes were included. Results: From the 18 included studies, 2028 cases of SCA/D were observed (males 1821 (89.79%), females 207 (10.21%)). The age ranges from the adolescents (<26 years) to the elderly (>45 years). The incidence in male athletes was 1.32/100,000 AY (95% CI: [0.90, 1.93]) and in females was 0.26/100,000 AY (95% CI: [0.16, 0.43]), the incidence rate ratio (IRR) was 6.43 (95% CI: [4.22, 9.79]). The subgroup synthesis showed a higher incidence in males than in females in both age groups <25 years and ≤35 years, the IRR was 5.86 (95% CI: [4.69, 7.32]) and 5.79 (95% CI: [4.73, 7.09]), respectively. When considering the events, the IRR was 6.73 (95%CI: [3.06, 14.78]) among studies involving both SCA/D events and 7.16 (95% CI: [4.93, 10.40]) among studies including only cases of SCD. The available clinical evidence showed that cardiac events were most frequently seen in long-distance running races (26, 35.1%), marathon (16, 21.6%) and soccer (10, 13.5%). Coronary artery disease (14, 18.9%), hypertrophic cardiomyopathy (8, 10.8%), and arrhythmogenic right ventricular cardiomyopathy (7, 9.5%) are the most common causes of SCA/D in competitive athletes. Conclusion: The meta-analysis provides evidence of sex differences in the incidence of SCA/D in competitive athletes. The incidence of SCA/D in male athletes was 6 to 7 times higher than in females. Identifying the reasons for this difference may have implications for targeted the prevention of fatal evets in athletes.

Keywords: incidence, sudden cardiac arrest, sudden cardiac death, sex difference, athletes

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Authors: Sumara Khanzada

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This research investigated how much stress is induced by various study-related factors, in undergraduate students belonging to a renowned university in Karachi along with the unhealthy coping strategy the students use to manage the stress. The study related factors considered for the purpose of the study were curriculum and instruction based stress, teacher-student relationship, assessment system and different components related to academic work. A survey in which questionnaires were administered to hundred students was conducted. The data were analyzed quantitatively to determine the percentages of stress induced by the various factors. The study found that student-teacher relationship is the strongest factor that causes stress in the undergraduate students specifically when teachers do not deliver the lectures effectively and give assignments and presentations to students without clear guidelines and instructions. The second important factor that causes stress was the different components of academic life, such as, parental expectations and pressures to achieve one's goals. Assessment system was found to be the third key factor inducing stress and affecting students' cognitive and psychological functioning. The most commonly used unhealthy coping strategy for stress management was procrastination. In light of the findings, it is recommended that importance be given to teacher training to ensure that instruction is proper and healthy teacher student relationship exists. Effective support programs, workshops, seminars, and different awareness programs should be arranged for promoting awareness regarding mental health in educational institutions. Moreover, additional zero credit courses should be offered to teach students how to learn stress management and healthy coping skills. Sumara Khanzada Clinical Psychologist [email protected]

Keywords: Stress, coping stretigies, acadamic stress, relationship

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Authors: Amber Shahi, Ayesha Tazeen, Abdus Samad, Shama Parveen

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Nanoparticles (NPs) are tiny particles. According to the International Organization for Standardization, the size range of NPs is in the nanometer range (1-100 nm). They show distinct properties that are not shown by larger particles of the same material. NPs are currently being used in different fields due to their unique physicochemical nature. NPs are a boon for medical sciences, environmental sciences, electronics, and textile industries. However, there is growing concern about their potential adverse effects on human health. This poster presents a comprehensive review of the current literature on the pros and cons of NPs on human health. The poster will discuss the various types of interactions of NPs with biological systems. There are a number of beneficial uses of NPs in the field of health and environmental welfare. NPs are very useful in disease diagnosis, antimicrobial action, and the treatment of diseases like Alzheimer’s. They can also cross the blood-brain barrier, making them capable of treating brain diseases. Additionally, NPs can target specific tumors and be used for cancer treatment. To treat environmental health, NPs also act as catalytic converters to reduce pollution from the environment. On the other hand, NPs also have some negative impacts on the human body, such as being cytotoxic and genotoxic. They can also affect the reproductive system, such as the testis and ovary, and sexual behavior. The poster will further discuss the routes of exposure of NPs. The poster will conclude with a discussion of the current regulations and guidelines on the use of NPs in various applications. It will highlight the need for further research and the development of standardized toxicity testing methods to ensure the safe use of NPs in various applications. When using NPs in diagnosis and treatment, we should also take into consideration their safe concentration in the body. Overall, this poster aims to provide a comprehensive overview of the pros and cons of NPs on human health and to promote awareness and understanding of the potential risks and benefits associated with their use.

Keywords: disease diagnosis, human health, nanoparticles, toxicity testing

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Authors: Javed Y. Uppal

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The background of this study is the great degree of stress that the world is experiencing today, internationally among the countries, within a community among people, and even individually within one’s own self. The significance of the study is the attempt to find a solution of this stress in the philosophy of the olden times of Jalaluddin Rumi and comparatively recently of that of Allama Iqbal. The methodology adopted in this paper is firstly exploration of the perspectives of these philosophers that are being consolidated by a number of psychic and spiritual experts of today, who are being widely read but less followed. This paper further goes on presenting brief life sketches of Rumi and Iqbal. It expounds the key concepts proposed by them and the social change that was resulted in the times of the two above mentioned metaphysical philosophers. It is further amplified that with the recent advancements, in both metaphysics and the physical sciences, the gap between the two is closing down. Both Rumi and Iqbal emphasized their common essence. The old time's concepts, postulates, and philosophies are hence once again becoming valid. The findings of this paper are that the existence of human empathy, affection and mutual social attraction among humans is still valid. The positive inner belief system that dictates our thoughts and actions is vital. As a conclusion, empathy should enable us solving our problems collectively. We need to strengthen our inner communication system, to listen to the messages that come to our inner-selves. We need to get guidance and strength from them. We need to value common needs and purposes collectively to achieve results. Spiritual energy among us is to be harnessed and utilized. Connectivity is to be recognized to unify and strengthen ties among people. Mutual bonding at small and large group levels is to be employed for the survival of the disadvantaged, and sustainability of the empowering trends. With the above guidelines, hopefully, we can define a framework towards a brave and happy new humane world.

Keywords: belief system, connectivity, human empathy, inner-self, mutual bonding, spiritual energy

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Authors: Elham Fariborzi, Hoda Anvari Kazemabad

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Today, ICT plays an important role in all matters and it affects the development of creative cities. According to virtual space in this technology, it use especially for expand terms like smart schools, Virtual University, web-based training and virtual classrooms that is in parallel with the traditional teaching. Nowadays, the educational systems in different countries such as Iran are changing and start increasing creativity in the learning environment. It will contribute to the development of innovative ideas and thinking of the people in this environment; such opportunities might be cause scientific discovery and development issues. The creativity means the ability to generate ideas and numerous, new and suitable solutions for solving the problems of real and virtual individuals and society, which can play a significant role in the development of creative current physical cities or virtual borders ones in the future. The purpose of this paper is to study strategies to increase creativity in a virtual learning to develop a creative city. In this paper, citation/ library study was used. The full description given in the text, including how to create and enhance learning creativity in a virtual classroom by reflecting on performance and progress; attention to self-directed learning guidelines, efficient use of social networks, systematic discussion groups and non-intuitive targeted controls them by involved factors and it may be effective in the teaching process regarding to creativity. Meanwhile, creating a virtual classroom the style of class recognizes formally the creativity. Also the use of a common model of creative thinking between student/teacher is effective to solve problems of virtual classroom. It is recommended to virtual education’ authorities in Iran to have a special review to the virtual curriculum for increasing creativity in educational content and such classes to be witnesses more creative in Iran's cities.

Keywords: virtual learning, creativity, e-learning, bioinformatics, biomedicine

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Authors: Xiaoxian Zhang

Abstract:

Guidelines of ecological risk assessment (ERA) and food safety assessment (FSA) used nowadays, based on an S-shaped threshold dose-response curve (SDR), fail to consider hormesis, a reproducible biphasic dose-response model represented as a J-shaped or an inverted U-shaped curve, that occurs in the real-life environment across multitudinous compounds on cells, organisms, populations, and even the ecosystem. Specifically, in SDR-based ERA and FSA practice, predicted no effect concentration (PNEC) is calculated separately for individual substances from no observed effect concentration (NOEC, usually equivalent to 10% effect concentration (EC10) of a contaminant or food condiment) over an assessment coefficient that is bigger than 1. Experienced researchers doubted that hormesis in the real-life environment might lead to a waste of limited human and material resources in ERA and FSA practice, but related data are scarce. In this study, hormetic effects on bioluminescence of Aliivibrio fischeri (A. f) induced by sulfachloropyridazine (SCP) under 40 conditions to simulate the real-life scenario were investigated, and hormetic effects on growth of human MCF-7 cells caused by brown sugar and mascavado sugar were found likewise. After comparison of related parameters, it has for the first time been proved that there is a 50% probability for safe concentration (SC) of contaminants and food condiments to fall within the hormetic-stimulatory range (HSR) or left to HSR, revealing the unreliability of traditional parameters in standardized (eco)toxicological studies, and supporting qualitatively and quantitatively the over-strictness of ERA and FSA resulted from misuse of SDR. This study provides a novel perspective for ERA and FSA practitioners that hormesis should dominate and conditions where SDR works should only be singled out on a specific basis.

Keywords: dose-response relationship, food safety, ecological risk assessment, hormesis

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