Search results for: total phosphorus
978 The Diagnostic Utility and Sensitivity of the Xpert® MTB/RIF Assay in Diagnosing Mycobacterium tuberculosis in Bone Marrow Aspirate Specimens
Authors: Nadhiya N. Subramony, Jenifer Vaughan, Lesley E. Scott
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In South Africa, the World Health Organisation estimated 454000 new cases of Mycobacterium tuberculosis (M.tb) infection (MTB) in 2015. Disseminated tuberculosis arises from the haematogenous spread and seeding of the bacilli in extrapulmonary sites. The gold standard for the detection of MTB in bone marrow is TB culture which has an average turnaround time of 6 weeks. Histological examinations of trephine biopsies to diagnose MTB also have a time delay owing mainly to the 5-7 day processing period prior to microscopic examination. Adding to the diagnostic delay is the non-specific nature of granulomatous inflammation which is the hallmark of MTB involvement of the bone marrow. A Ziehl-Neelson stain (which highlights acid-fast bacilli) is therefore mandatory to confirm the diagnosis but can take up to 3 days for processing and evaluation. Owing to this delay in diagnosis, many patients are lost to follow up or remain untreated whilst results are awaited, thus encouraging the spread of undiagnosed TB. The Xpert® MTB/RIF (Cepheid, Sunnyvale, CA) is the molecular test used in the South African national TB program as the initial diagnostic test for pulmonary TB. This study investigates the optimisation and performance of the Xpert® MTB/RIF on bone marrow aspirate specimens (BMA), a first since the introduction of the assay in the diagnosis of extrapulmonary TB. BMA received for immunophenotypic analysis as part of the investigation into disseminated MTB or in the evaluation of cytopenias in immunocompromised patients were used. Processing BMA on the Xpert® MTB/RIF was optimised to ensure bone marrow in EDTA and heparin did not inhibit the PCR reaction. Inactivated M.tb was spiked into the clinical bone marrow specimen and distilled water (as a control). A volume of 500mcl and an incubation time of 15 minutes with sample reagent were investigated as the processing protocol. A total of 135 BMA specimens had sufficient residual volume for Xpert® MTB/RIF testing however 22 specimens (16.3%) were not included in the final statistical analysis as an adequate trephine biopsy and/or TB culture was not available. Xpert® MTB/RIF testing was not affected by BMA material in the presence of heparin or EDTA, but the overall detection of MTB in BMA was low compared to histology and culture. Sensitivity of the Xpert® MTB/RIF compared to both histology and culture was 8.7% (95% confidence interval (CI): 1.07-28.04%) and sensitivity compared to histology only was 11.1% (95% CI: 1.38-34.7%). Specificity of the Xpert® MTB/RIF was 98.9% (95% CI: 93.9-99.7%). Although the Xpert® MTB/RIF generates a faster result than histology and TB culture and is less expensive than culture and drug susceptibility testing, the low sensitivity of the Xpert® MTB/RIF precludes its use for the diagnosis of MTB in bone marrow aspirate specimens and warrants alternative/additional testing to optimise the assay.Keywords: bone marrow aspirate , extrapulmonary TB, low sensitivity, Xpert® MTB/RIF
Procedia PDF Downloads 170977 MigrationR: An R Package for Analyzing Bird Migration Data Based on Satellite Tracking
Authors: Xinhai Li, Huidong Tian, Yumin Guo
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Bird migration is fantastic natural phenomenon. In recent years, the use of GPS transmitters has generated a vast amount of data, and the Movebank platform has made these data publicly accessible. For researchers, what they need are data analysis tools. Although there are approximately 90 R packages dedicated to animal movement analysis, the capacity for comprehensive processing of bird migration data remains limited. Hence, we introduce a novel package called migrationR. This package enables the calculation of movement speed, direction, changes in direction, flight duration, daily and annual movement distances. Furthermore, it can pinpoint the starting and ending dates of migration, estimate nest site locations and stopovers, and visualize movement trajectories at various time scales. migrationR distinguishes individuals through NMDS (non-metric multidimensional scaling) coordinates based on movement variables such as speed, flight duration, path tortuosity, and migration timing. A distinctive aspect of the package is the development of a hetero-occurrences species distribution model that takes into account the daily rhythm of individual birds across different landcover types. Habitat use for foraging and roosting differs significantly for many waterbirds. For example, White-naped Cranes at Poyang Lake in China typically forage in croplands and roost in shallow water areas. Both of these occurrence types are of equal importance. Optimal habitats consist of a combination of crop lands and shallow waters, whereas suboptimal habitats lack both, which necessitates birds to fly extensively. With migrationR, we conduct species distribution modeling for foraging and roosting separately and utilize the moving distance between crop lands and shallow water areas as an index of overall habitat suitability. This approach offers a more nuanced understanding of the habitat requirements for migratory birds and enhances our ability to analyze and interpret their movement patterns effectively. The functions of migrationR are demonstrated using our own tracking data of 78 White-naped Crane individuals from 2014 to 2023, comprising over one million valid locations in total. migrationR can be installed from a GitHub repository by executing the following command: remotes::install_github("Xinhai-Li/migrationR").Keywords: bird migration, hetero-occurrences species distribution model, migrationR, R package, satellite telemetry
Procedia PDF Downloads 63976 The Features of the Synergistic Approach in Marketing Management to Regional Level
Authors: Evgeni Baratashvili, Anzor Abralava, Rusudan Kutateladze, Nino Pailodze, Irma Makharashvili, Larisa Takalandze
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Sinergy as a neological term is reflected in modern sciences. It can be found in the various fields of science including the humanities and technical sciences. Among them are biology and medicine, philology, economy and etc. Synergy is the received surplus of marginal high total effect of the groups, consolidated by one common idea, received through endeavored applies of their combined tools, via obtained effect of the separate independent actions of the groups. In the conditions of market economy, according the terms of new communication terminology, synergy effects on management and marketing successfully as well as on purity defense of native language. The well-known scientist’s and public figure’s Academician I. Prangishvili’s works are especially valuable in this aspect. In our opinion the entropy research is linked to his name in our country. In modern economy, the current qualitative changes shows us that the most number of factors and issues have been regrouped. They have a great influence and even define the economic development. The declining abilities of traditional recourses of economic growth have been related on the use of their physical abilities and their moving closer to the edge. Also it is related on the reduced effectiveness, which at the same time increases the expenditures. This means that the leading must be the innovative process system of products and services in the economic growth model. In our opinion the above mentioned system is distinguished with the synergistic approach. It should be noted that the main components of the innovative system are technological, scientific and scientific-technical, social-organizational, managerial and cognitive changes. All of them are reflected on scientific works and inventions in the proper dosages, in know-how and material source. At any stage they create the reproduction cycle. The innovations are different from each other by technologies, origination, design, innovation and quality, subject-content structure, by the the spread of economic processes and the impact of the level of it’s distribution. We have presented a generalized statement of an innovative approach, which is not a single act of innovation but it is also targeted system of the development, implementation, reconciling-exploitation, production, diffusion and commercialization of news. The innovative approaches should be considered as the creation of news, in-depth process of creativity as an innovative alternative to the realization of innovative and entrepreneurial efforts and measures, in order to meet the requirements of the permanent process.Keywords: economic development, leading process, neological term, synergy
Procedia PDF Downloads 200975 Impact of UV on Toxicity of Zn²⁺ and ZnO Nanoparticles to Lemna minor
Authors: Gabriela Kalcikova, Gregor Marolt, Anita Jemec Kokalj, Andreja Zgajnar Gotvajn
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Since the 90’s, nanotechnology is one of the fastest growing fields of science. Nanomaterials are increasingly becoming part of many products and technologies. Metal oxide nanoparticles are among the most used nanomaterials. Zinc oxide nanoparticles (nZnO) is widely used due to its versatile properties; it has been used in products including plastics, paints, food, batteries, solar cells and cosmetic products. It is also a very effective photocatalyst used for water treatment. Such expanding application of nZnO increases their possible occurrence in the environment. In the aquatic ecosystem nZnO interact with natural environmental factors such as UV radiation, and thus it is essential to evaluate possible interaction between them. In this context, the aim of our study was to evaluate combined ecotoxicity of nZnO and Zn²⁺ on duckweed Lemna minor in presence or absence UV. Inhibition of vegetative growth of duckweed Lemna minor was monitored over a period of 7 days in multi-well plates. After the experiment, specific growth rate was determined. ZnO nanoparticles used were of primary size 13.6 ± 1.7 nm. The test was conducted with nominal nZnO and Zn²⁺ (in form of ZnCl₂) concentrations of 1, 10, 100 mg/L. Experiment was repeated with presence of natural intensity of UV (8h UV, 10 W/m² UVA, 0.5 W/m² UVB). Concentration of Zn during the test was determined by ICP-MS. In the regular experiment (absence of UV) the specific growth rate was slightly increased by low concentrations of nZnO and Zn²⁺ in comparison to control. However, 10 and 100 mg/L of Zn²⁺ resulted in 45% and 68% inhibition of the specific growth rate, respectively. In case of nZnO both concentrations (10 and 100 mg/L) resulted in similar ~ 30% inhibition and the response was not dose-dependent. The lack of the dose-response relationship is often observed in case of nanoparticles. The possible explanation is that the physical impact prevails instead of chemical ones. In the presence of UV the toxicity of Zn²⁺ was increased and 100 mg/L of Zn²⁺ caused total inhibition of the specific growth rate (100%). On the other hand, 100 mg/L of nZnO resulted in low inhibition (19%) in comparison to the experiment without UV (30%). It is thus expected, that tested nZnO is low photoactive, but could have a good UV absorption and/or reflective properties and thus protect duckweed against UV impacts. Measured concentration of Zn in the test suspension decreased only about 4% after 168h in the case of ZnCl₂. On the other hand concentration of Zn in nZnO test decreased by 80%. It is expected that nZnO were partially dissolved in the medium and at the same time agglomeration and sedimentation of particles took place and thus the concentration of Zn at the water level decreased. Results of our study indicated, that nZnO combined with UV of natural intensity does not increase toxicity of nZnO, but slightly protect the plant against UV negative effects. When Zn²⁺ and ZnO results are compared it seems that dissolved Zn plays a central role in the nZnO toxicity.Keywords: duckweed, environmental factors, nanoparticles, toxicity
Procedia PDF Downloads 333974 Nacre Deposition Rate in Japanese and Hybrid Mother Oysters, Pinctada Fucata, and Its Relationship with Their Respective Pearls
Authors: Gunawan Muhammad, Takashi Atsumi, Akira Komaru
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Pinctada fucata has been the most important pearl culture species in Japan and known as Japanese Akoya Pearl Oyster. However, during summer 1994, mass mortality devastated pearl culture in most parts of Japan. Therefore, pearl farmers started to import Chinese Pearl Oysters from Hainan Island that came from the same species because they are believed to be more resistant towards high water temperature, despite their lack of ability in producing high-quality pearls. The local farmers were then hybridized Japanese and Chinese pearl oysters and currently known as Hybrid pearl oysters, as an attempt to produce a new oyster's strain which is more resistant towards high temperature but also able to produce higher quality pearls. However, despite both strains were implanted by mantle tissues from the same group of donors, the thickness of pearl nacre produced by both strains was different, even though tablet thickness shows a rather similar pattern. Hence, this leads to a question of whether mother oysters play a major role in both nacre deposition rate and tablet thickness of pearls or not. This study first describes the nacre deposition rate of the shells of Japanese and Hybrid mother oysters towards the water temperature condition in Ago Bay, Mie Prefecture, Japan. Later, a comparative study was conducted among 4 shell positions that had been chosen according to the mantle tissue location and shell growth directions. A correlative study was then taken between shells and pearls nacre deposition rate to know whether mother oyster ability in depositing nacre on their shells is related to that of pearls. All the four shell positions were significantly different in shell nacre growth rate (Kruskal-Wallis, p-value < 0.05), and the third position have faster nacre growth among the other three both in Japanese and Hybrid strains, especially in warm temperature. The ability to deposit nacre between Japanese and Hybrid during warm water conditions (August and September) is also significantly different in almost all positions (Mann Whitney U, p-value < 0.01), Japanese oyster growth faster than Hybrid in all four positions. This leads to a different total growth among the two strains and a higher possibility of thicker nacre thickness in Japanese shell nacre. Tablet thickness is significantly different among all positions of shells (Kruskal-Wallis, p-value < 0.01), the 2nd position deposited rather thinner tablet thickness than the other three, including on the 6th month of culture which is more desirable in producing pearls with good luster. This result gives us new information that pearl growth rate is highly affected by the mother oysters; however, nacre tablet thickness might be the result of the shell matrix expressed by different mantle position from donor oysters.Keywords: nacre, deposition, biomineralization, pearl aquaculture, pearl oyster, Akoya pearl, pearl
Procedia PDF Downloads 138973 Comparison of Cardiometabolic Risk Factors in Lean Versus Overweight/Obese Peri-Urban Female Adolescent School Learners in Mthatha, South Africa: A Pilot Case Control Study
Authors: Benedicta N. Nkeh-Chungag, Constance R. Sewani-Rusike, Isaac M. Malema, Daniel T. Goon, Oladele V. Adeniyi, Idowu A. Ajayi
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Background: Childhood and adolescent obesity is an important predictor of adult cardiometabolic diseases. Current data on age- and gender-specific cardiometabolic risk factors are lacking in the peri-urban Eastern Cape Province, South Africa. However, such information is important in designing innovative strategies to promote healthy living among children and adolescents. The purpose of this pilot study was to compare and determine the extent of cardiometabolic risk factors between samples of lean and overweight/obese adolescent population in a peri-urban township of South Africa. Methods: In this case-control study, age-matched, non-pregnant and non-lactating female adolescents consisting of equal number of cases (50 overweight/obese) and control (50 lean) participated in the study. Fasting venous blood samples were obtained for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (Trig), highly sensitive C-reactive protein (hsCRP) and blood sugar. Anthropometric measurements included weight, height, waist and hip circumferences. Body mass index was calculated. Blood pressure was measured; and metabolic syndrome was assessed using appropriate diagnostic criteria for children and adolescents. Results: Of the 76 participants with complete data, 12/38 of the overweight/obese and 1/38 of the lean group met the criteria for adolescent metabolic syndrome. All cardiometabolic risk factors were elevated in the overweight/obese group compared with the lean group: low HDL-C (RR = 2.21), elevated TC (RR = 1.23), elevated LDL-C (RR = 1.42), elevated Trig (RR = 1.73), and elevated hsCRP (RR = 1.9). There were significant atherosclerotic indices among the overweight/obese group compared with the lean group: TC/HDL and LDL/HDL (2.99±0.91 vs 2.63±0.48; p=0.016 and 1.73±0.61 vs 1.41±0.46; p= 0.014, respectively). Conclusion: There are multiple cardiometabolic risk factors among the overweight/obese female adolescent group compared with lean adolescent group in the study. Female adolescent who are overweight and obese have higher relative risks of developing cardiometabolic diseases compared with their lean counterparts in the peri-urban Mthatha, South Africa. School health programme focusing on promoting physical exercise, healthy eating and keeping appropriate weight are needed in the country.Keywords: adolescents, cardiometabolic risk factors, obesity, peri-urban South Africa
Procedia PDF Downloads 474972 Microbiological Profile of UTI along with Their Antibiotic Sensitivity Pattern with Special Reference to Nitrofurantoin
Authors: Rupinder Bakshi, Geeta Walia, Anita Gupta
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Introduction: Urinary tract infections (UTI) are considered to be one of the most common bacterial infections with an estimated annual global incidence of 150 million. Antimicrobial drug resistance is one of the major threats due to widespread usage of uncontrolled antibiotics. Materials and Methods: A total number of 9149 urine samples were collected from R.H Patiala and processed in the Department of Microbiology G.M.C Patiala. Urine samples were inoculated on MacConkey’s and blood agar plates by using calibrated loop delivering 0.001 ml of sample and incubated at 37 °C for 24 hrs. The organisms were identified by colony characters, gram’s staining and biochemical reactions. Antimicrobial susceptibility of the isolates was determined against various antimicrobial agents (Hi – Media Mumbai India) by Kirby-Bauer disk diffusion method on Muller Hinton agar plates. Results: Maximum patients were in the age group of 21-30 yrs followed by 31-40 yrs. Males (34%) are less prone to urinary tract infections than females (66%). Out of 9149 urine sample, the culture was positive in 25% (2290) samples. Esch. coli was the most common isolate 60.3% (n = 1378) followed by Klebsiella pneumoniae 13.5% (n = 310), Proteus spp. 9% (n = 209), Staphylococcus aureus 7.6 % (n = 173), Pseudomonas aeruginosa 3.7% (n = 84), Citrobacter spp. 3.1 % (70), Staphylococcus saprophyticus 1.8 % (n = 142), Enterococcus faecalis 0.8%(n=19) and Acinetobacter spp. 0.2%(n=5). Gram negative isolates showed higher sensitivity towards, Piperacillin +Tazobactum (67%), Amikacin (80%), Nitrofurantoin (82%), Aztreonam (100%), Imipenem (100%) and Meropenam (100%) while gram positive showed good response towards Netilmicin (69%), Nitrofurantoin (79%), Linezolid (98%), Vancomycin (100%) and Teicoplanin (100%). 465 (23%) isolates were resistant to Penicillins, 1st generation and 2nd generation Cehalosporins which were further tested by double disk approximation test and combined disk method for ESBL production. Out of 465 isolates, 375 were ESBLs consisting of n 264 (70.6%) Esch.coli and 111 (29.4%) Klebsiella pneumoniae. Susceptibility of ESBL producers to Imipenem, Nitrofurantoin and Amikacin were found to be 100%, 76%, and 75% respectively. Conclusion: Uropathogens are increasingly showing resistance to many antibiotics making empiric management of outpatients UTIs challenging. Ampicillin, Cotrimoxazole, and Ciprofloxacin should not be used in empiric treatment. Nitrofurantoin could be used in lower urinary tract infection. Knowledge of uropathogens and their antimicrobial susceptibility pattern in a geographical region will help inappropriate and judicious antibiotic usage in a health care setup.Keywords: Urinary Tract Infection, UTI, antibiotic susceptibility pattern, ESBL
Procedia PDF Downloads 344971 Beneficial Effect of Autologous Endometrial Stromal Cell Co-Culture on Day 3 Embryo Quality
Authors: I. Bochev, A. Shterev, S. Kyurkchiev
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One of the factors associated with poor success rates in human in vitro fertilization (IVF) is the suboptimal culture conditions in which fertilization and early embryonic growth occur. Co-culture systems with helper cell lines appear to enhance the in vitro conditions and allow embryos to demonstrate improved in vitro development. The co-culture of human embryos with monolayers of autologous endometrial stromal cell (EnSCs) results in increased blastocyst development with a larger number of blastomeres, lower incidence of fragmentation and higher pregnancy rates in patients with recurrent implantation failure (RIF). The aim of the study was to examine the influence of autologous endometrial stromal cell (EnSC) co-culture on day 3 embryo quality by comparing the morphological status of the embryos from the same patients undergoing consecutive IVF/Intracytoplasmic sperm injection (ICSI) cycles without and with EnSC co-culture. This retrospective randomized study (2015-2017) includes 20 couples and a total of 46 IVF/ICSI cycles. Each patient couple included had at least two IVF/ICSI procedures – one with and one without autologous EnSC co-culture. Embryo quality was assessed at 68±1 hours in culture, according to Istanbul consensus criteria (2010). Day 3 embryos were classified into three groups: good – grade 1; fair – grade 2; poor – grade 3. Embryos from all cycles were divided into two groups (A – co-cultivated; B – not co-cultivated) and analyzed. Second, for each patient couple, embryos from matched IVF/ICSI cycles (with and without co-culture) were analyzed separately. When an analysis of co-cultivated day 3 embryos from all cycles was performed (n=137; group A), 43.1% of the embryos were graded as “good”, which was not significantly different from the respective embryo quality rate of 42.2% (p = NS) in group B (n=147) with non-co-cultivated embryos. The proportions of fair and poor quality embryos in group A and group B were similar as well – 11.7% vs 10.2% and 45.2% vs 47.6% (p=NS), respectively. Nevertheless, the separate embryo analysis by matched cycles for each couple revealed that in 65% of the cases the proportion of morphologically better embryos was increased in cycles with co-culture in comparison with those without co-culture. A decrease in this proportion after endometrial stromal cell co-cultivation was found in 30% of the cases, whereas no difference was observed in only one couple. The results demonstrated that there is no marked difference in the overall morphological quality between co-cultured and non-co-cultured embryos on day 3. However, in significantly greater percentage of couples the process of autologous EnSC co-culture could increase the proportion of morphologically improved day 3 embryos. By mimicking the in vivo relationship between embryo and maternal environment, co-culture in autologous EnSC system represents a perspective approach to improve the quality of embryos in cases with elevated risk for development of embryos with impaired morphology.Keywords: autologous endometrial stromal cells, co-culture, day 3 embryo, morphological quality
Procedia PDF Downloads 234970 An Ecological Grandeur: Environmental Ethics in Buddhist Perspective
Authors: Merina Islam
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There are many environmental problems. Various counter measures have been taken for environmental problems. Philosophy is an important contributor to environmental studies as it takes deep interest in meaning analysis of the concept environment and other related concepts. The Buddhist frame, which is virtue ethical, remains a better alternative to the traditional environmental outlook. Granting the unique role of man in immoral deliberations, the Buddhist approach, however, maintains a holistic concept of ecological harmony. Buddhist environmental ethics is more concerned about the complete moral community, the total ecosystem, than any particular species within the community. The moral reorientation proposed here has resemblance to the concept of 'deep ecology. Given the present day prominence of virtue ethics, we need to explore further into the Buddhist virtue theory, so that a better framework to treat the natural world would be ensured. Environment has turned out to be one of the most widely discussed issues in the recent times. Buddhist concepts such as Pratityasamutpadavada, Samvrit Satya, Paramartha Satya, Shunyata, Sanghatvada, Bodhisattva, Santanvada and others deal with interdependence in terms of both internal as well external ecology. The internal ecology aims at mental well-being whereas external ecology deals with physical well-being. The fundamental Buddhist concepts for dealing with environmental Problems are where the environment has the same value as humans as from the two Buddhist doctrines of the Non-duality of Life and its Environment and the Origination in Dependence; and the inevitability of overcoming environmental problems through the practice of the way of the Bodhisattva, because environmental problems are evil for people and nature. Buddhism establishes that there is a relationship among all the constituents of the world. There is nothing in the world which is independent from any other thing. Everything is dependent on others. The realization that everything in the universe is mutually interdependent also shows that the man cannot keep itself unaffected from ecology. This paper would like to focus how the Buddhist’s identification of nature and the Dhamma can contribute toward transforming our understanding, attitudes, and actions regarding the care of the earth. Environmental Ethics in Buddhism presents a logical and thorough examination of the metaphysical and ethical dimensions of early Buddhist literature. From the Buddhist viewpoint, humans are not in a category that is distinct and separate from other sentient beings, nor are they intrinsically superior. All sentient beings are considered to have the Buddha-nature, that is, the potential to become fully enlightened. Buddhists do not believe in treating of non-human sentient beings as objects for human consumption. The significance of Buddhist theory of interdependence can be understood from the fact that it shows that one’s happiness or suffering originates from ones realization or non-realization respectively of the dependent nature of everything. It is obvious, even without emphasis, which in the context of deep ecological crisis of today there is a need to infuse the consciousness of interdependence.Keywords: Buddhism, deep ecology, environmental problems, Pratityasamutpadavada
Procedia PDF Downloads 314969 The Effect of Information vs. Reasoning Gap Tasks on the Frequency of Conversational Strategies and Accuracy in Speaking among Iranian Intermediate EFL Learners
Authors: Hooriya Sadr Dadras, Shiva Seyed Erfani
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Speaking skills merit meticulous attention both on the side of the learners and the teachers. In particular, accuracy is a critical component to guarantee the messages to be conveyed through conversation because a wrongful change may adversely alter the content and purpose of the talk. Different types of tasks have served teachers to meet numerous educational objectives. Besides, negotiation of meaning and the use of different strategies have been areas of concern in socio-cultural theories of SLA. Negotiation of meaning is among the conversational processes which have a crucial role in facilitating the understanding and expression of meaning in a given second language. Conversational strategies are used during interaction when there is a breakdown in communication that leads to the interlocutor attempting to remedy the gap through talk. Therefore, this study was an attempt to investigate if there was any significant difference between the effect of reasoning gap tasks and information gap tasks on the frequency of conversational strategies used in negotiation of meaning in classrooms on one hand, and on the accuracy in speaking of Iranian intermediate EFL learners on the other. After a pilot study to check the practicality of the treatments, at the outset of the main study, the Preliminary English Test was administered to ensure the homogeneity of 87 out of 107 participants who attended the intact classes of a 15 session term in one control and two experimental groups. Also, speaking sections of PET were used as pretest and posttest to examine their speaking accuracy. The tests were recorded and transcribed to estimate the percentage of the number of the clauses with no grammatical errors in the total produced clauses to measure the speaking accuracy. In all groups, the grammatical points of accuracy were instructed and the use of conversational strategies was practiced. Then, different kinds of reasoning gap tasks (matchmaking, deciding on the course of action, and working out a time table) and information gap tasks (restoring an incomplete chart, spot the differences, arranging sentences into stories, and guessing game) were manipulated in experimental groups during treatment sessions, and the students were required to practice conversational strategies when doing speaking tasks. The conversations throughout the terms were recorded and transcribed to count the frequency of the conversational strategies used in all groups. The results of statistical analysis demonstrated that applying both the reasoning gap tasks and information gap tasks significantly affected the frequency of conversational strategies through negotiation. In the face of the improvements, the reasoning gap tasks had a more significant impact on encouraging the negotiation of meaning and increasing the number of conversational frequencies every session. The findings also indicated both task types could help learners significantly improve their speaking accuracy. Here, applying the reasoning gap tasks was more effective than the information gap tasks in improving the level of learners’ speaking accuracy.Keywords: accuracy in speaking, conversational strategies, information gap tasks, reasoning gap tasks
Procedia PDF Downloads 309968 Calcium Biochemical Indicators in a Group of Schoolchildren with Low Socioeconomic Status from Barranquilla, Colombia
Authors: Carmiña L. Vargas-Zapata, María A. Conde-Sarmiento, Maria Consuelo Maestre-Vargas
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Calcium is an essential element for good growth and development of the organism, and its requirement is increased at school age. Low socio-economic populations of developing countries such as Colombia may have food deficiency of this mineral in schoolchildren that could be reflected in calcium biochemical indicators, bone alterations and anthropometric indicators. The objective of this investigation was to evaluate some calcium biochemical indicators in a group of schoolchildren of low socioeconomic level from Barranquilla city and to correlate with body mass index. 60 schoolchildren aged 7 to 15 years were selected from Jesus’s Heart Educational Institution in Barranquilla-Atlántico, apparently healthy, without suffering from infectious or gastrointestinal diseases, without habits of drinking alcohol or smoking another hallucinogenic substance and without taking supplementation with calcium in the last six months or another substance that compromises bone metabolism. The research was approved by the ethics committee at Universidad del Atlántico. The selected children were invited to donate a blood and urine sample in a fasting time of 12 hours, the serum was separated by centrifugation and frozen at ˗20 ℃ until analyzed and the same was done with the urine sample. On the day of the biological collections, the weight and height of the students were measured to determine the nutritional status by BMI using the WHO tables. Calcium concentrations in serum and urine (SCa, UCa), alkaline phosphatase activity total and of bone origin (SAPT, SBAP) and urinary creatinine (UCr) were determined by spectrophotometric methods using commercial kits. Osteocalcin and Cross-linked N-telopeptides of type I collagen (NTx-1) in serum were measured with an enzyme-linked inmunosorbent assay. For statistical analysis the Statgraphics software Centurium XVII was used. 63% (n = 38) and 37% (n = 22) of the participants were male and female, respectively. 78% (n = 47), 5% (n = 3) and 17% (n = 10) had a normal, malnutrition and high nutritional status, respectively. The averages of evaluated indicators levels were (mean ± SD): 9.50 ± 1.06 mg/dL for SCa; 181.3 ± 64.3 U/L for SAPT, 143.8 ± 73.9 U/L for SBAP; 9.0 ± 3.48 ng/mL for osteocalcin and 101.3 ± 12.8 ng/mL for NTx-1. UCa level was 12.8 ± 7.7 mg/dL that adjusted with creatinine ranged from 0.005 to 0.395 mg/mg. Considering serum calcium values, approximately 7% of school children were hypocalcemic, 16% hypercalcemic and 77% normocalcemic. The indicators evaluated did not correlate with the BMI. Low values were observed in calcium urinary excretion and high in NTx-1, suggesting that mechanisms such as increase in renal retention of calcium and in bone remodeling may be contributing to calcium homeostasis.Keywords: calcium, calcium biochemical, indicators, school children, low socioeconomic status
Procedia PDF Downloads 112967 Intensive Care Unit Patient Self-Determination When Facing Cardiovascular Surgery for the First Time
Authors: Hsiao-Lin Fang
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The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive
Procedia PDF Downloads 176966 Assessment of Water Reuse Potential in a Metal Finishing Factory
Authors: Efe Gumuslu, Guclu Insel, Gülten Yuksek, Nilay Sayi Ucar, Emine Ubay Cokgor, Tuğba Olmez Hanci, Didem Okutman Tas, Fatoş Germirli Babuna, Derya Firat Ertem, Ökmen Yildirim, Özge Erturan, Betül Kirci
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Although water reclamation and reuse are inseparable parts of sustainable production concept all around the world, current levels of reuse constitute only a small fraction of the total volume of industrial effluents. Nowadays, within the perspective of serious climate change, wastewater reclamation and reuse practices should be considered as a requirement. Industrial sector is one of the largest users of water sources. The OECD Environmental Outlook to 2050 predicts that global water demand for manufacturing will increase by 400% from 2000 to 2050 which is much larger than any other sector. Metal finishing industry is one of the industries that requires high amount of water during the manufacturing. Therefore, actions regarding the improvement of wastewater treatment and reuse should be undertaken on both economic and environmental sustainability grounds. Process wastewater can be reused for more purposes if the appropriate treatment systems are installed to treat the wastewater to the required quality level. Recent studies showed that membrane separation techniques may help in solving the problem of attaining a suitable quality of water that allows being recycled back to the process. The metal finishing factory where this study is conducted is one of the biggest white-goods manufacturers in Turkey. The sheet metal parts used in the cookers production have to be exposed to surface pre-treatment processes composed of degreasing, rinsing, nanoceramics coating and deionization rinsing processes, consecutively. The wastewater generating processes in the factory are enamel coating, painting and styrofoam processes. In the factory, the main source of water is the well water. While some part of the well water is directly used in the processes after passing through resin treatment, some portion of it is directed to the reverse osmosis treatment to obtain required water quality for enamel coating and painting processes. In addition to these processes another important source of water that can be considered as a potential water source is rainwater (3660 tons/year). In this study, process profiles as well as pollution profiles were assessed by a detailed quantitative and qualitative characterization of the wastewater sources generated in the factory. Based on the preliminary results the main water sources that can be considered for reuse in the processes were determined as painting and styrofoam processes.Keywords: enamel coating, painting, reuse, wastewater
Procedia PDF Downloads 379965 The Importance of Country-of-Origin Information and Perceived Product Quality in Uzbekistan
Authors: Begzod Nishanov, Farhod Karimov
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Globalization and the internet have completely changed the way in which businesses operate as well as has equipped customers with endless potential. Today, consumers’ product choice is not only affected by branding, price and quality of the product, but also by the country-of-origin information. Precisely, ‘Made In’ label is considered as one of the driving factors which directly impact on consumers’ preferences. Generally, it is obvious that products manufactured in less developed countries are considered to be of lower quality and riskier compared to the products made in developed countries. In this regard, it is worth to note that this phenomenon is mainly applicable to western developed countries. However, there is a lack of empirical research on underlying the influence of country-of-origin phenomenon in emerging economies such as Uzbekistan. Today, Uzbek market is being dominated by growing number of foreign made products. Uzbek manufacturers are facing intense competition not only from local producers but also from the availability of foreign goods suppliers. Consequently, consumers are given wider choice of products than ever before. In this regard, it is important to define the importance of country-of-origin information in order to understand Uzbek consumers’ preference. The methodology of the research is formulated based on the methodology of previous papers. A total 527 online questionnaires were completed. Data analysis was conducted using factor analysis and analysis of variance test (ANOVA). Findings of the research support the view that Uzbek consumers attach great importance to the country-of-origin information of products. Precisely, it can be stated that Uzbek people perceive product quality by its ‘Made in...’ label, especially when buying high involvement goods such as car or refrigerator. Another findings of the paper show that products manufactured in developed countries including Germany, Japan and USA are found to be of high quality, while products manufactured in less developed countries are considered to be of lower quality. Marketers can use this information for segmentation purposes. For example, products manufactured in less developed countries can be targeted for low-to-middle income families while goods manufactured in developed countries can be targeted for higher income families. In conclusion, it can be stated that perceived product quality of products that are made in Uzbekistan has slightly increased since 18 years. It implies that nowadays products under ‘Made in Uzbekistan’ label is continually becoming available to many consumers in foreign markets, especially among Commonwealth of Independent States (CIS) countries. Therefore, conducting further research to explore the phenomenon of country-of-origin information and perceived product quality in emerging markets is of paramount importance.Keywords: country-of-origin, consumer behavior, product evaluation, perceived quality
Procedia PDF Downloads 261964 Structural Equation Modeling Approach: Modeling the Impact of Social Marketing Programs on Combating Female Genital Mutilation in the Sudanese Society
Authors: Nada Abdelsadig Moahamed Saied
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Female Genital Mutilation (FGM) and other similar traditional cultural practices pose a significant problem for Sudanese society. Such actions are severe and seriously detrimental to people's health since they are based on false social perceptions. To address these problems, numerous institutions and organizations were compelled to act rapidly. Female circumcision, or FGM, is one of the riskiest practices. It is referred to as the excision of the genitalia. Any surgeries involving the total or partial removal of the external female genitalia for non-medical reasons fall under this category. The results of FGM can vary depending on the kind and degree of the operation. These can be categorized as short-term, mid-term, or long-term issues. Infections, including the Human, blood, discomfort, and difficulty urinating are the immediate effects. FGM is defined by the World Health Organization (WHO) as practices that purposefully damage or modify female genital organs for non-medical purposes. It often takes place between the ages of one and fifteen. The girl's right to decide on important choices affecting her sexual and reproductive health is violated because the act is usually performed without her consent and frequently against her will. UNICEF, the United Nations International Children's Emergency Fund, aggressively combats the issue of FGM in Sudan. Numerous programs were started by NGOs to stop the practice. To our knowledge, no scientific study has been conducted to evaluate the effects of such social marketing techniques on simulating and comprehending society’s feelings surrounding FGM. This study proposes the development of a structural equation model aiming to determine the impact of awareness programs on people’s intentions to adopt the behavior of abandoning FGM based on theoretical models of behavior change. The model incorporates all the relevant factors that contribute to FGM and possible strategic actions to tackle this problem. The theoretical backdrop for FGM is presented in the next section, which also explains the practice's history, justifications, and potential treatments. The methodology section that follows describes the structural equation model. The proposed model, which compiles all the pertinent elements into a single image, is presented in the fourth part. Finally, conclusions are reached, and suggestions for further research are made.Keywords: social marketing, policy-making, behavioral change, female genital mutilation, culture
Procedia PDF Downloads 74963 Physicians’ Knowledge and Perception of Gene Profiling in Malaysia: A Pilot Study
Authors: Farahnaz Amini, Woo Yun Kin, Lazwani Kolandaiveloo
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Availability of different genetic tests after completion of Human Genome Project increases the physicians’ responsibility to keep themselves update on the potential implementation of these genetic tests in their daily practice. However, due to numbers of barriers, still many of physicians are not either aware of these tests or are not willing to offer or refer their patients for genetic tests. This study was conducted an anonymous, cross-sectional, mailed-based survey to develop a primary data of Malaysian physicians’ level of knowledge and perception of gene profiling. Questionnaire had 29 questions. Total scores on selected questions were used to assess the level of knowledge. The highest possible score was 11. Descriptive statistics, one way ANOVA and chi-squared test was used for statistical analysis. Sixty three completed questionnaires was returned by 27 general practitioners (GPs) and 36 medical specialists. Responders’ age range from 24 to 55 years old (mean 30.2 ± 6.4). About 40% of the participants rated themselves as having poor level of knowledge in genetics in general whilst 60% believed that they have fair level of knowledge. However, almost half (46%) of the respondents felt that they were not knowledgeable about available genetic tests. A majority (94%) of the responders were not aware of any lab or company which is offering gene profiling services in Malaysia. Only 4% of participants were aware of using gene profiling for detection of dosage of some drugs. Respondents perceived greater utility of gene profiling for breast cancer (38%) compared to the colorectal familial cancer (3%). The score of knowledge ranged from 2 to 8 (mean 4.38 ± 1.67). Non-significant differences between score of knowledge of GPs and specialists were observed, with score of 4.19 and 4.58 respectively. There was no significant association between any demographic factors and level of knowledge. However, those who graduated between years 2001 to 2005 had higher level of knowledge. Overall, 83% of participants showed relatively high level of perception on value of gene profiling to detect patient’s risk of disease. However, low perception was observed for both statements of using gene profiling for general population in order to alter their lifestyle (25%) as well as having the full sequence of a patient genome for the purpose of determining a patient’s best match for treatment (18%). The lack of clinical guidelines, limited provider knowledge and awareness, lack of time and resources to educate patients, lack of evidence-based clinical information and cost of tests were the most barriers of ordering gene profiling mentioned by physicians. In conclusion Malaysian physicians who participate in this study had mediocre level of knowledge and awareness in gene profiling. The low exposure to the genetic questions and problems might be a key predictor of lack of awareness and knowledge on available genetic tests. Educational and training workshop might be useful in helping Malaysian physicians incorporate genetic profiling into practice for eligible patients.Keywords: gene profiling, knowledge, Malaysia, physician
Procedia PDF Downloads 326962 Iranian English as Foreign Language Teachers' Psychological Well-Being across Gender: During the Pandemic
Authors: Fatemeh Asadi Farsad, Sima Modirkhameneh
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The purpose of this study was to explore the pattern of Psychological Well-Being (PWB) of Iranian male and female EFL teachers during the pandemic. It was intended to see if such a drastic change in the context and mode of teaching affects teachers' PWB. Furthermore, the possible difference between the six elements of PWB of Iranian EFL male vs. female teachers during the pandemic was investigated. The other purpose was to find out the EFL teachers’ perceptions of any modifications, and factors leading to such modifications in their PWB during pandemic. For the purpose of this investigation, a total of 81 EFL teachers (59 female, 22 male) with an age range of 25 to 35 were conveniently sampled from different cities in Iran. Ryff’s PWB questionnaire was sent to participant teachers through online platforms to elicit data on their PWB. As for their perceptions on the possible modifications and the factors involved in PWB during pandemic, a set of semi-structured interviews were run among both sample groups. The findings revealed that male EFL teachers had the highest mean on personal growth, followed by purpose of life, and self-acceptance and the lowest mean on environmental mastery. With a slightly similar pattern, female EFL teachers had the highest mean on personal growth, followed by purpose in life, and positive relationship with others with the lowest mean on environmental mastery. However, no significant difference was observed between the male and female groups’ overall means on elements of PWB. Additionally, participants perceived that their anxiety level in online classes altered due to factors like (1) Computer literacy skills, (2) Lack of social communications and interactions with colleagues and students, (3) Online class management, (4) Overwhelming workloads, and (5) Time management. The study ends with further suggestions as regards effective online teaching preparation considering teachers PWB, especially at severe situations such as covid-19 pandemic. The findings offer to determine the reformations of educational policies concerning enhancing EFL teachers’ PWB through computer literacy courses and stress management courses. It is also suggested that to proactively support teachers’ mental health, it is necessary to provide them with advisors and psychologists if possible for free. Limitations: One limitation is the small number of participants (81), suggesting that future replications should include more participants for reliable findings. Another limitation is the gender imbalance, which future studies should address to yield better outcomes. Furthermore, Limited data gathering tools suggest using observations, diaries, and narratives for more insights in future studies. The study focused on one model of PWB, calling for further research on other models in the literature. Considering the wide effect of the COVID-19 pandemic, future studies should consider additional variables (e.g., teaching experience, age, income) to understand Iranian EFL teachers’ vulnerabilities and strengths better.Keywords: online teaching, psychological well-being, female and male EFL teachers, pandemic
Procedia PDF Downloads 47961 Genetic Diversity Analysis in Ecological Populations of Persian Walnut
Authors: Masoud Sheidai, Fahimeh Koohdar, Hashem Sharifi
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Juglans regia (L.) commonly known as Persian walnut of the genus Juglans L. (Juglandaceae) is one of the most important cultivated plant species due to its high-quality wood and edible nuts. The genetic diversity analysis is essential for conservation and management of tree species. Persian walnut is native from South-Eastern Europe to North-Western China through Tibet, Nepal, Northern India, Pakistan, and Iran. The species like Persian walnut, which has a wide range of geographical distribution, should harbor extensive genetic variability to adapt to environmental fluctuations they face. We aimed to study the population genetic structure of seven Persian walnut populations including three wild and four cultivated populations by using ISSR (Inter simple sequence repeats) and SRAP (Sequence related amplified polymorphism) molecular markers. We also aimed to compare the genetic variability revealed by ISSR neutral multilocus marker and rDNA ITS sequences. The studied populations differed in morphological features as the samples in each population were clustered together and were separate from the other populations. Three wild populations studied were placed close to each other. The mantel test after 5000 times permutation performed between geographical distance and morphological distance in Persian walnut populations produced significant correlation (r = 0.48, P = 0.002). Therefore, as the populations become farther apart, they become more divergent in morphological features. ISSR analysis produced 47 bands/ loci, while we obtained 15 SRAP bands. Gst and other differentiation statistics determined for these loci revealed that most of the ISSR and SRAP loci have very good discrimination power and can differentiate the studied populations. AMOVA performed for these loci produced a significant difference (< 0.05) supporting the above-said result. AMOVA produced significant genetic difference based on ISSR data among the studied populations (PhiPT = 0.52, P = 0.001). AMOVA revealed that 53% of the total variability is due to among population genetic difference, while 47% is due to within population genetic variability. The results showed that both multilocus molecular markers and ITS sequences can differentiate Persian walnut populations. The studied populations differed genetically and showed isolation by distance (IBD). ITS sequence based MP and Bayesian phylogenetic trees revealed that Iranian walnut cultivars form a distinct clade separated from the cultivars studied from elsewhere. Almost all clades obtained have high bootstrap value. The results indicated that a combination of multilpcus and sequencing molecular markers can be used in genetic differentiation of Persian walnut.Keywords: genetic diversity, population, molecular markers, genetic difference
Procedia PDF Downloads 162960 Can Zirconia Wings of Resin Retained Cantilever Bridges Be Effectively Bonded To Tooth Tissue When Compared With Metal Wings In The Anterior Dentition in vivo? - A Systematic Review.
Authors: Ariyan S. Araghi, Guy C. Jackson, Stephen J. Bonsor
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Materials & Methods: A systematic literature search was undertaken using pre-determined inclusion and exclusion criteria. This review followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) statement. Several databases were used to search for randomised control trials and longitudinal cohort studies, which were published less than thirty years ago. A total of 54 studies met the predefined inclusion criteria. Four studies reviewed the success, survival, and failure characteristics of zirconia framework resin retained bridges, whilst two reviewed non-precious metal resin retained bridges. Results: The analysis of the studies revealed an overall survival rate of 95.9% for zirconia-based restorations compared to 90.7% for non-precious metal frameworks. Non-precious metal resin retained bridges displayed a higher overall failure rate of 11.9% compared to 4.6% for zirconia-based restorations in the analysed papers. The most frequent complications were wing debonding for the non-precious metal wing group, whereas substructure fracture and veneering ceramic fracture were more prevalent for the zirconia arm of the study. Conclusion: Both types of resin retained bridges provide effective medium to long-term survival. Zirconia-based frameworks will provide marginally increased success and survival and greatly improved aesthetics. However, catastrophic failure is more likely with zirconia-based restorations. Non-precious metal is time tested but performs worse than its zirconia counterpart with regards to longevity; it does not exhibit the same framework fractures as zirconia. Cement choice and attention to the adhesive bonding systems used appear to be paramount to restoration longevity with both restoration subtypes. Furthermore, improved longevity can be seen when air particle abrasion is incorporated into the adhesive protocol. Within the limitations of this study, it has been determined that zirconia-based resin retained bridges can be effectively used in anterior cantilever bridges. Clinical Significance: Zirconia-based resin retained bridges have been demonstrating promising results in terms of improved success and survival characteristics, together with improved aesthetics when compared to non-precious metal winged resin retained bridges. Their popularity is increasing in the age of digital dentistry as many restorations are manufactured using such technology. It is essential that clinicians understand the limitations of each material type and principles of adhesion to ensure restoration longevity.Keywords: resin retained bridge, fixed partial denture, zirconia bridge, adhesive bridge
Procedia PDF Downloads 81959 Molecular Detection of Staphylococcus aureus in the Pork Chain Supply and the Potential Anti-Staphylococcal Activity of Natural Compounds
Authors: Valeria Velasco, Ana M. Bonilla, José L. Vergara, Alcides Lofa, Jorge Campos, Pedro Rojas-García
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Staphylococcus aureus is both commensal bacterium and opportunistic pathogen that can cause different diseases in humans and can rapidly develop antimicrobial resistance. Since this bacterium has the ability to colonize the nares and skin of humans and animals, there is a risk of contamination of food in different steps of the food chain supply. Emerging strains have been detected in food-producing animals and meat, such as methicillin-resistant S. aureus (MRSA). The aim of this study was to determine the prevalence and oxacillin susceptibility of S. aureus in the pork chain supply in Chile and to suggest some natural antimicrobials for control. A total of 487 samples were collected from pigs (n=332), carcasses (n=85), and retail pork meat (n=70). Presumptive S. aureus colonies were isolated by selective enrichment and culture media. The confirmation was carried out by biochemical testing (Api® Staph) and molecular technique PCR (detection of nuc and mecA genes, associated with S. aureus and methicillin resistance, respectively). The oxacillin (β-lactam antibiotic that replaced methicillin) susceptibility was assessed by minimum inhibitory concentration (MIC) using the Epsilometer test (Etest). A preliminary assay was carried out to test thymol, carvacrol, oregano essential oil (Origanum vulgare L.), Maqui or Chilean wineberry extract (Aristotelia chilensis (Mol.) Stuntz) as anti-staphylococcal agents using the disc diffusion method at different concentrations. The overall prevalence of S. aureus in the pork chain supply reached 33.9%. A higher prevalence of S. aureus was determined in carcasses (56.5%) than in pigs (28.3%) and pork meat (32.9%) (P ≤ 0.05). The prevalence of S. aureus in pigs sampled at farms (40.6%) was higher than in pigs sampled at slaughterhouses (23.3%) (P ≤ 0.05). The contamination of no packaged meat with S. aureus (43.1%) was higher than in packaged meat (5.3%) (P ≤ 0.05). The mecA gene was not detected in S. aureus strains isolated in this study. Two S. aureus strains exhibited oxacillin resistance (MIC ≥ 4µg/mL). Anti-staphylococcal activity was detected in solutions of thymol, carvacrol, and oregano essential oil at all concentrations tested. No anti-staphylococcal activity was detected in Maqui extract. Finally, S. aureus is present in the pork chain supply in Chile. Although the mecA gene was not detected, oxacillin resistance was found in S. aureus and could be attributed to another resistance mechanism. Thymol, carvacrol, and oregano essential oil could be used as anti-staphylococcal agents at low concentrations. Research project Fondecyt No. 11140379.Keywords: antimicrobials, mecA gen, nuc gen, oxacillin susceptibility, pork meat
Procedia PDF Downloads 228958 Carbon Sequestration in Spatio-Temporal Vegetation Dynamics
Authors: Nothando Gwazani, K. R. Marembo
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An increase in the atmospheric concentration of carbon dioxide (CO₂) from fossil fuel and land use change necessitates identification of strategies for mitigating threats associated with global warming. Oceans are insufficient to offset the accelerating rate of carbon emission. However, the challenges of oceans as a source of reducing carbon footprint can be effectively overcome by the storage of carbon in terrestrial carbon sinks. The gases with special optical properties that are responsible for climate warming include carbon dioxide (CO₂), water vapors, methane (CH₄), nitrous oxide (N₂O), nitrogen oxides (NOₓ), stratospheric ozone (O₃), carbon monoxide (CO) and chlorofluorocarbons (CFC’s). Amongst these, CO₂ plays a crucial role as it contributes to 50% of the total greenhouse effect and has been linked to climate change. Because plants act as carbon sinks, interest in terrestrial carbon sequestration has increased in an effort to explore opportunities for climate change mitigation. Removal of carbon from the atmosphere is a topical issue that addresses one important aspect of an overall strategy for carbon management namely to help mitigate the increasing emissions of CO₂. Thus, terrestrial ecosystems have gained importance for their potential to sequester carbon and reduce carbon sink in oceans, which have a substantial impact on the ocean species. Field data and electromagnetic spectrum bands were analyzed using ArcGIS 10.2, QGIS 2.8 and ERDAS IMAGINE 2015 to examine the vegetation distribution. Satellite remote sensing data coupled with Normalized Difference Vegetation Index (NDVI) was employed to assess future potential changes in vegetation distributions in Eastern Cape Province of South Africa. The observed 5-year interval analysis examines the amount of carbon absorbed using vegetation distribution. In 2015, the numerical results showed low vegetation distribution, therefore increased the acidity of the oceans and gravely affected fish species and corals. The outcomes suggest that the study area could be effectively utilized for carbon sequestration so as to mitigate ocean acidification. The vegetation changes measured through this investigation suggest an environmental shift and reduced vegetation carbon sink, and that threatens biodiversity and ecosystem. In order to sustain the amount of carbon in the terrestrial ecosystems, the identified ecological factors should be enhanced through the application of good land and forest management practices. This will increase the carbon stock of terrestrial ecosystems thereby reducing direct loss to the atmosphere.Keywords: remote sensing, vegetation dynamics, carbon sequestration, terrestrial carbon sink
Procedia PDF Downloads 151957 Telepsychiatry for Asian Americans
Authors: Jami Wang, Brian Kao, Davin Agustines
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COVID-19 highlighted the active discrimination against the Asian American population easily seen through media, social tension, and increased crimes against the specific population. It is well known that long-term racism can also have a large impact on both emotional and psychological well-being. However, the healthcare disparity during this time also revealed how the Asian American community lacked the research data, political support, and medical infrastructure for this particular population. During a time when Asian American fear for safety with decreasing mental health, telepsychiatry is particularly promising. COVID-19 demonstrated how well psychiatry could integrate with telemedicine, with psychiatry being the second most utilized telemedicine visits. However, the Asian American community did not utilize the telepsychiatry resources as much as other groups. Because of this, we wanted to understand why the patient population who was affected the most by COVID-19 mentally did not seek out care. To do this, we decided to study the top top telepsychiatry platforms. The current top telepsychiatry companies in the United States include Teladoc and BetterHelp. In the Teladoc mental health sector, they only had 4 available languages (English, Spanish, French, and Danis,) with none of them being an Asian language. In a similar manner, Teladoc’s top competitor in the telepsychiatry space, BetterHelp, only listed a total of 3 Asian languages, including Mandarin, Japanese, and Malaysian. However, this is still a short list considering they have over 20 languages available. The shortage of available physicians that speak multiple languages is concerning, as it could be difficult for the Asian American community to relate with. There are limited mental health resources that cater to their likely cultural needs, further exacerbating the structural racism and institutional barriers to appropriate care. It is important to note that these companies do provide interpreters to comply with the nondiscrimination and language assistance federal law. However, interactions with an interpreter are not only more time-consuming but also less personal than talking directly with a physician. Psychiatry is the field that emphasizes interpersonal relationships. The trust between a physician and the patient is critical in developing patient rapport to guide in better understanding the clinical picture and treating the patient appropriately. The language barrier creates an additional barrier between the physician and patient. Because Asian Americans are one of the largest growing patient population bases, these telehealth companies have much to gain by catering to the Asian American market. Without providing adequate access to bilingual and bicultural physicians, the current system will only further exacerbate the growing disparity. The healthcare community and telehealth companies need to recognize that the Asian American population is a severely underserved population in mental health and has much to gain from telepsychiatry. The lack of language is one of many reasons why there is a disparity for Asian Americans in the mental health space.Keywords: telemedicine, psychiatry, Asian American, disparity
Procedia PDF Downloads 105956 Assessment of Agricultural Intervention on Ecosystem Services in the Central-South Zone of Chile
Authors: Steven Hidalgo, Patricio Neumann
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The growth of societies has increased the consumption of raw materials and food obtained from nature. This has influenced the services offered by ecosystems to humans, mainly supply and regulation services. One of the indicators used to evaluate these services is Net Primary Productivity (NPP), which is understood as the energy stored in the form of biomass by primary organisms through the process of photosynthesis and respiration. The variation of NPP by defined area produces changes in the properties of terrestrial and aquatic ecosystems, which alter factors such as biodiversity, nutrient cycling, carbon storage and water quality. The analysis of NPP to evaluate variations in ecosystem services includes harvested NPP (understood as provisioning services), which is the raw material from agricultural systems used by humans as a source of energy and food, and the remaining NPP (expressed as a regulating service) or the amount of biomass that remains in ecosystems after the harvesting process, which is mainly related to factors such as biodiversity. Given that agriculture is a fundamental pillar of Chile's integral development, the purpose of this study is to evaluate provisioning and regulating ecosystem services in the agricultural sector, specifically in cereal production, in the communes of the central-southern regions of Chile through a conceptual framework based on the quantification of the fraction of Human Appropriation of Net Primary Productivity (HANPP) and the fraction remaining in the ecosystems (NPP remaining). A total of 161 communes were analyzed in the regions of O'Higgins, Maule, Ñuble, Bio-Bío, La Araucanía and Los Lagos, which are characterized by having the largest areas planted with cereals. It was observed that the region of La Araucanía produces the greatest amount of dry matter, understood as provisioning service, where Victoria is the commune with the highest cereal production in the country. In addition, the maximum value of HANPP was in the O'Higgins region, highlighting the communes of Coltauco, Quinta de Tilcoco, Placilla and Rengo. On the other hand, the communes of Futrono, Pinto, Lago Ranco and Pemuco, whose cereal production was important during the study, had the highest values of remaining NPP as a regulating service. Finally, an inverse correlation was observed between the provisioning and regulating ecosystem services, i.e., the higher the cereal or dry matter production in a defined area, the lower the net primary production remaining in the ecosystems. Based on this study, future research will focus on the evaluation of ecosystem services associated with other crops, such as forestry plantations, whose activity is an important part of the country's productive sector.Keywords: provisioning services, regulating services, net primary productivity, agriculture
Procedia PDF Downloads 97955 A Study on Relationship between Firm Managers Environmental Attitudes and Environment-Friendly Practices for Textile Firms in India
Authors: Anupriya Sharma, Sapna Narula
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Over the past decade, sustainability has gone mainstream as more people are worried about environment-related issues than ever before. These issues are of even more concern for industries which leave a significant impact on the environment. Following these ecological issues, corporates are beginning to comprehend the impact on their business. Many such initiatives have been made to address these emerging issues in the consumer-driven textile industry. Demand from customers, local communities, government regulations, etc. are considered some of the major factors affecting environmental decision-making. Research also shows that motivations to go green are inevitably determined by the way top managers perceive environmental issues as managers personal values and ethical commitment act as a motivating factor towards corporate social responsibility. Little empirical research has been conducted to examine the relationship between top managers’ personal environmental attitudes and corporate environmental behaviors for the textile industry in the Indian context. The primary purpose of this study is to determine the current state of environmental management in textile industry and whether the attitude of textile firms’ top managers is significantly related to firm’s response to environmental issues and their perceived benefits of environmental management. To achieve the aforesaid objectives of the study, authors used structured questionnaire based on literature review. The questionnaire consisted of six sections with a total length of eight pages. The first section was based on background information on the position of the respondents in the organization, annual turnover, year of firm’s establishment and so on. The other five sections of the questionnaire were based upon (drivers, attitude, and awareness, sustainable business practices, barriers to implementation and benefits achieved). To test the questionnaire, a pretest was conducted with the professionals working in corporate sustainability and had knowledge about the textile industry and was then mailed to various stakeholders involved in textile production thereby covering firms top manufacturing officers, EHS managers, textile engineers, HR personnel and R&D managers. The results of the study showed that most of the textile firms were implementing some type of environmental management practice, even though the magnitude of firm’s involvement in environmental management practices varied. The results also show that textile firms with a higher level of involvement in environmental management were more involved in the process driven technical environmental practices. It also identified that firm’s top managers environmental attitudes were correlated with perceived advantages of environmental management as textile firm’s top managers are the ones who possess managerial discretion on formulating and deciding business policies such as environmental initiatives.Keywords: attitude and awareness, Environmental management, sustainability, textile industry
Procedia PDF Downloads 233954 Need for a Tailor Made HIV Prevention Services to the Migrants Community: Evidence from Implementing Migrant Service Delivery System (MSDS) among Migrant Workers, National AIDS Control Program, and India
Authors: Debasish Chowdhury, Sunil Mekale, Sarvanamurthy Sakthivel, Sukhvinder Kaur, Rambabu Khambampati, Ashok Agarwal
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Introduction: The migrant intervention in India was initiated during the National AIDS Control Program (NACP) Phase-2 (2002-2007). HIV Sentinel surveillance Studies (HSS) conducted in 2012-13 indicated higher HIV prevalence among migrants (0.99%) compared to general populations (0.35%). Migrants continue to bear a heightened risk of HIV infection which results from the condition and structure of the migration process. USAID PHFI-PIPPSE project in collaboration with the National AIDS Control Organization (NACO) developed a unique system called Migrant Service Delivery System (MSDS) to capture migrants profile with respect to their risk profile and to provide tailor made services to them. Description: MSDS is a web-based system, designed and implemented to increase service uptake among migrants through evidence based planning. 110 destination migrants Targeted Intervention (TI) from 11 states were selected for study with varied target populations in terms of occupations; to understand occupation related risk behaviors among the migrants. Occupation wise registration data of high risk vulnerable migrants were analyzed through MSDS for the period April 2014–June 2016. Analysis was made on specific indicators among these occupational groups to understand the risk behavior and their vulnerability to HIV and STIs. Findings: Out of total HIV positive migrant’s workers (N= 847) enrolled in MSDS HIV rate is found to be highest among Auto-Rickshaw (18.66%) followed by Daily wage laborers (14.46%), Loom workers (10.73%), Industrial workers (10.04%) and Construction worker 7.93%. With 45.14% positivity, industrial workers are found to be most vulnerable to Sexually Transmitted Infections (STIs) (N=10057) among all occupational categories followed by loom workers (16.28%), Skilled worker (Furniture, Jeweler)-7.14%, daily wage laborers (5.45%). Conclusion: MSDS is an effective tool to assess migrants’ risk and their vulnerability to HIV for designing evidence informed program. This system calls for a replication across all destination TIs by NACO for differential strategies for different occupation groups to ensure better yield through scientific planning of intervention among high risk and high vulnerable migrants.Keywords: migrants, migrant service delivery system, risk, vulnerability
Procedia PDF Downloads 271953 Identification of Candidate Gene for Root Development and Its Association With Plant Architecture and Yield in Cassava
Authors: Abiodun Olayinka, Daniel Dzidzienyo, Pangirayi Tongoona, Samuel Offei, Edwige Gaby Nkouaya Mbanjo, Chiedozie Egesi, Ismail Yusuf Rabbi
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Cassava (Manihot esculenta Crantz) is a major source of starch for various industrial applications. However, the traditional cultivation and harvesting methods of cassava are labour-intensive and inefficient, limiting the supply of fresh cassava roots for industrial starch production. To achieve improved productivity and quality of fresh cassava roots through mechanized cultivation, cassava cultivars with compact plant architecture and moderate plant height are needed. Plant architecture-related traits, such as plant height, harvest index, stem diameter, branching angle, and lodging tolerance, are critical for crop productivity and suitability for mechanized cultivation. However, the genetics of cassava plant architecture remain poorly understood. This study aimed to identify the genetic bases of the relationships between plant architecture traits and productivity-related traits, particularly starch content. A panel of 453 clones developed at the International Institute of Tropical Agriculture, Nigeria, was genotyped and phenotyped for 18 plant architecture and productivity-related traits at four locations in Nigeria. A genome-wide association study (GWAS) was conducted using the phenotypic data from a panel of 453 clones and 61,238 high-quality Diversity Arrays Technology sequencing (DArTseq) derived Single Nucleotide Polymorphism (SNP) markers that are evenly distributed across the cassava genome. Five significant associations between ten SNPs and three plant architecture component traits were identified through GWAS. We found five SNPs on chromosomes 6 and 16 that were significantly associated with shoot weight, harvest index, and total yield through genome-wide association mapping. We also discovered an essential candidate gene that is co-located with peak SNPs linked to these traits in M. esculenta. A review of the cassava reference genome v7.1 revealed that the SNP on chromosome 6 is in proximity to Manes.06G101600.1, a gene that regulates endodermal differentiation and root development in plants. The findings of this study provide insights into the genetic basis of plant architecture and yield in cassava. Cassava breeders could leverage this knowledge to optimize plant architecture and yield in cassava through marker-assisted selection and targeted manipulation of the candidate gene.Keywords: manihot esculenta crantz, plant architecture, dartseq, snp markers, genome-wide association study
Procedia PDF Downloads 95952 The Effectiveness of an Educational Program on Awareness of Cancer Signs, Symptoms, and Risk Factors among School Students in Oman
Authors: Khadija Al-Hosni, Moon Fai Chan, Mohammed Al-Azri
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Background: Several studies suggest that most school-age adolescents are poorly informed on cancer warning signs and risk factors. Providing adolescents with sufficient knowledge would increase their awareness in adulthood and improve seeking behaviors later. Significant: The results will provide a clear vision in assisting key decision-makers in formulating policies on the students' awareness programs towards cancer. So, the likelihood of avoiding cancer in the future will be increased or even promote early diagnosis. Objectives: to evaluate the effectiveness of an education program designed to increase awareness of cancer signs and symptoms risk factors, improve the behavior of seeking help among school students in Oman, and address the barriers to obtaining medical help. Methods: A randomized controlled trial with two groups was conducted in Oman. A total of 1716 students (n=886/control, n= 830/education), aged 15-17 years, at 10th and 11th grade from 12 governmental schools 3 in governorates from 20-February-2022 to 12-May-2022. Basic demographic data were collected, and the Cancer Awareness Measure (CAM) was used as the primary outcome. Data were collected at baseline (T0) and 4 weeks after (T1). The intervention group received an education program about cancer's cause and its signs and symptoms. In contrast, the control group did not receive any education related to this issue during the study period. Non-parametric tests were used to compare the outcomes between groups. Results: At T0, the lamp was the most recognized cancer warning sign in control (55.0%) and intervention (55.2%) groups. However, there were no significant changes at T1 for all signs in the control group. In contrast, all sign outcomes were improved significantly (p<0.001) in the intervention group, the highest response was unexplained pain (93.3%). Smoking was the most recognized risk factor in both groups: (82.8% for control; 84.1% for intervention) at T0. However, there was no significant change in T1 for the control group, but there was for the intervention group (p<0.001), the highest identification was smoking cigarettes (96.5%). Too scared was the largest barrier to seeking medical help by students in the control group at T0 (63.0%) and T1 (62.8%). However, there were no significant changes in all barriers in this group. Otherwise, being too embarrassed (60.2%) was the largest barrier to seeking medical help for students in the intervention group at T0 and too scared (58.6%) at T1. Although there were reductions in all barriers, significant differences were found in six of ten only (p<0.001). Conclusion: The intervention was effective in improving students' awareness of cancer symptoms, warning signs (p<0.001), and risk factors (p<0.001 reduced the most addressed barriers to seeking medical help (p<0.001) in comparison to the control group. The Ministry of Education in Oman could integrate awareness of cancer within the curriculum, and more interventions are needed on the sociological part to overcome the barriers that interfere with seeking medical help.Keywords: adolescents, awareness, cancer, education, intervention, student
Procedia PDF Downloads 86951 Insertion of Photovoltaic Energy at Residential Level at Tegucigalpa and Comayagüela, Honduras
Authors: Tannia Vindel, Angel Matute, Erik Elvir, Kelvin Santos
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Currently in Honduras, is been incentivized the generation of energy using renewable fonts, such as: hydroelectricity, wind power, biomass and, more recently with the strongest growth, photovoltaic energy. In July 2015 were installed 455.2 MW of photovoltaic energy, increasing by 24% the installed capacity of the national interconnected system existing in 2014, according the National Energy Company (NEC), that made possible reduce the thermoelectric dependency of the system. Given the good results of those large-scale photovoltaic plants, arises the question: is it interesting for the distribution utility and for the consumers the integration of photovoltaic systems in micro-scale in the urban and rural areas? To answer that question has been researched the insertion of photovoltaic energy in the residential sector in Tegucigalpa and Comayagüela (Central District), Honduras to determine the technical and economic viability. Francisco Morazán department, according the National Statistics Institute (NSI), in 2001 had more than 180,000 houses with power service. Tegucigalpa, department and Honduras capital, and Comayagüela, both, have the highest population density in the region, with 1,300,000 habitants in 2014 (NSI). The residential sector in the south-central region of Honduras represents a high percentage being 49% of total consumption, according with NEC in 2014; where 90% of this sector consumes in a range of 0 to 300 kWh / month. All this, in addition to the high level of losses in the transmission and distribution systems, 31.3% in 2014, and the availability of an annual average solar radiation of 5.20 kWh/(m2∙day) according to the NASA, suggests the feasibility of the implementation of photovoltaic systems as a solution to give a level of independency to the households, and besides could be capable of injecting the non-used energy to the grid. The capability of exchange of energy with the grid could make the photovoltaic systems acquisition more affordable to the consumers, because of the compensation energy programs or other kinds of incentives that could be created. Technical viability of the photovoltaic systems insertion has been analyzed, considering the solar radiation monthly average to determine the monthly average of energy that would be generated with the technology accessible locally and the effects of the injection of the energy locally generated on the grid. In addition, the economic viability has been analyzed too, considering the photovoltaic systems high costs, costs of the utility, location and monthly energy consumption requirements of the families. It was found that the inclusion of photovoltaic systems in Tegucigalpa and Comayagüela could decrease in 6 MW the demand for the region if 100% of the households use photovoltaic systems, which acquisition may be more accessible with the help of government incentives and/or the application of energy exchange programs.Keywords: grid connected, photovoltaic, residential, technical analysis
Procedia PDF Downloads 263950 Catalytic Pyrolysis of Sewage Sludge for Upgrading Bio-Oil Quality Using Sludge-Based Activated Char as an Alternative to HZSM5
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Due to the concerns about the depletion of fossil fuel sources and the deteriorating environment, the attempt to investigate the production of renewable energy will play a crucial role as a potential to alleviate the dependency on mineral fuels. One particular area of interest is the generation of bio-oil through sewage sludge (SS) pyrolysis. SS can be a potential candidate in contrast to other types of biomasses due to its availability and low cost. However, the presence of high molecular weight hydrocarbons and oxygenated compounds in the SS bio-oil hinders some of its fuel applications. In this context, catalytic pyrolysis is another attainable route to upgrade bio-oil quality. Among different catalysts (i.e., zeolites) studied for SS pyrolysis, activated chars (AC) are eco-friendly alternatives. The beneficial features of AC derived from SS comprise the comparatively large surface area, porosity, enriched surface functional groups, and presence of a high amount of metal species that can improve the catalytic activity. Hence, a sludge-based AC catalyst was fabricated in a single-step pyrolysis reaction with NaOH as the activation agent and was compared with HZSM5 zeolite in this study. The thermal decomposition and kinetics were invested via thermogravimetric analysis (TGA) for guidance and control of pyrolysis and catalytic pyrolysis and the design of the pyrolysis setup. The results indicated that the pyrolysis and catalytic pyrolysis contains four obvious stages, and the main decomposition reaction occurred in the range of 200-600°C. The Coats-Redfern method was applied in the 2nd and 3rd devolatilization stages to estimate the reaction order and activation energy (E) from the mass loss data. The average activation energy (Em) values for the reaction orders n = 1, 2, and 3 were in the range of 6.67-20.37 kJ for SS; 1.51-6.87 kJ for HZSM5; and 2.29-9.17 kJ for AC, respectively. According to the results, AC and HZSM5 both were able to improve the reaction rate of SS pyrolysis by abridging the Em value. Moreover, to generate and examine the effect of the catalysts on the quality of bio-oil, a fixed-bed pyrolysis system was designed and implemented. The composition analysis of the produced bio-oil was carried out via gas chromatography/mass spectrometry (GC/MS). The selected SS to catalyst ratios were 1:1, 2:1, and 4:1. The optimum ratio in terms of cracking the long-chain hydrocarbons and removing oxygen-containing compounds was 1:1 for both catalysts. The upgraded bio-oils with AC and HZSM5 were in the total range of C4-C17, with around 72% in the range of C4-C9. The bio-oil from pyrolysis of SS contained 49.27% oxygenated compounds, while with the presence of AC and HZSM5 dropped to 13.02% and 7.3%, respectively. Meanwhile, the generation of benzene, toluene, and xylene (BTX) compounds was significantly improved in the catalytic process. Furthermore, the fabricated AC catalyst was characterized by BET, SEM-EDX, FT-IR, and TGA techniques. Overall, this research demonstrated AC is an efficient catalyst in the pyrolysis of SS and can be used as a cost-competitive catalyst in contrast to HZSM5.Keywords: catalytic pyrolysis, sewage sludge, activated char, HZSM5, bio-oil
Procedia PDF Downloads 179949 Systematic Review of Digital Interventions to Reduce the Carbon Footprint of Primary Care
Authors: Anastasia Constantinou, Panayiotis Laouris, Stephen Morris
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Background: Climate change has been reported as one of the worst threats to healthcare. The healthcare sector is a significant contributor to greenhouse gas emissions with primary care being responsible for 23% of the NHS’ total carbon footprint. Digital interventions, primarily focusing on telemedicine, offer a route to change. This systematic review aims to quantify and characterize the carbon footprint savings associated with the implementation of digital interventions in the setting of primary care. Methods: A systematic review of published literature was conducted according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, PubMed, and Scopus databases as well as Google scholar were searched using key terms relating to “carbon footprint,” “environmental impact,” “sustainability”, “green care”, “primary care,”, and “general practice,” using citation tracking to identify additional articles. Data was extracted and analyzed in Microsoft Excel. Results: Eight studies were identified conducted in four different countries between 2010 and 2023. Four studies used interventions to address primary care services, three studies focused on the interface between primary and specialist care, and one study addressed both. Digital interventions included the use of mobile applications, online portals, access to electronic medical records, electronic referrals, electronic prescribing, video-consultations and use of autonomous artificial intelligence. Only one study carried out a complete life cycle assessment to determine the carbon footprint of the intervention. It estimate that digital interventions reduced the carbon footprint at primary care level by 5.1 kgCO2/visit, and at the interface with specialist care by 13.4 kg CO₂/visit. When assessing the relationship between travel-distance saved and savings in emissions, we identified a strong correlation, suggesting that most of the carbon footprint reduction is attributed to reduced travel. However, two studies also commented on environmental savings associated with reduced use of paper. Patient savings in the form of reduced fuel cost and reduced travel time were also identified. Conclusion: All studies identified significant reductions in carbon footprint following implementation of digital interventions. In the future, controlled, prospective studies incorporating complete life cycle assessments and accounting for double-consulting effects, use of additional resources, technical failures, quality of care and cost-effectiveness are needed to fully appreciate the sustainable benefit of these interventionsKeywords: carbon footprint, environmental impact, primary care, sustainable healthcare
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