Search results for: pharmacological management

Authors: Chamtouri I., Kechida M.

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Background: Evaluation has a prominent role in medical education and graduation. This evaluation has usually done in face-to-face, by written or oral questions. Simulation is increasingly taking a part as a method of evaluation. Due to the Covid-19 pandemic, which disrupted face-to-face evaluation, simulation using serious games (SG) is emerging in the field of training and assessment of medical students. The aim of our study is to compare the results of the evaluation of medical students by virtual simulation by online serious games versus clinical case-multiple choice questions (MCQ) and to assess the degree of satisfaction from these two evaluation methods. Methods: Medical students from the same study level were voluntarily participated in this study. Groupe 1 had an evaluation by SG dealing with “diagnosis and management of ST-segment elevationmyocardialinfarction (STEMI)alreadyprepared on the website www.Mediactiv.com. Groupe 2 were evaluated by clinical case-MCQ having thes same topic as SG. Results of the two groups were compared. Satisfaction questionnaire was filled by the two groups. Satisfaction degree was compared between the two groups. Results. In this study, 64 medical students (G1:31 and G2: 33) were enrolled. Obtaining complete notes in the "questioning" and "clinical examination" parts is significantly more important in-group 1 compared to group 2. No significant difference detected between the two groups in terms of “ECG interpretation” and “diagnosis of STEMI” parts. A greater number of students of group 1 obtained the full note compared to group 2 in “the initial treatment part” (54.8% vs. 39.4%; p = 0.04). Thirty learners (96.8%) in-group 1 obtained a total score ≥ 50% versus 69.7% in-group 2 (p = 0.004). The full score of 100% was obtained in three learners in-group1, while no student scored 100% in-group2 (p = 0.027). Medical evaluation using SG was reported as more innovative, fun, and realistic compared to evaluation by clinical case-MCQ. No significant difference detected between the two methods in terms of stress. Conclusion: Simulation by SG can be considered as an innovative and effective method in evaluating medical students with a higher degree of satisfaction.

Keywords: evaluation, serious games, medical students, satisfaction

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Authors: Eman. K. Ramadan, Abdelgawad. S. El-Tahawy

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The objective of this study was to evaluate the effects of calving season on the production and economic efficiency of dairy farms in Egypt. Our study was performed at dairy production farms in the Alexandria, Behera, and Kafr El-Sheikh provinces of Egypt from summer 2010 to winter 2013. The randomly selected dairy farms had herds consisting of Baladi, Holstein-Friesian, or cross-bred (Baladi × Holstein-Friesian) cows. The data were collected from production records and responses to a structured questionnaire. The average total return differed significantly (P < 0.05) between the different cattle breeds and calving seasons. The average total return was highest for the Holstein-Friesian cows that calved in the winter (29106.42 EGP/cow/year), and it was lowest for Baladi cows that calved in the summer (12489.79 EGP/cow/year). Differences in total returns between the cows that calved in the winter or summer or between the foreign and native breeds, as well as variations in calf prices, might have contributed to the differences in milk yield. The average net profit per cow differed significantly (P < 0.05) between the cattle breeds and calving seasons. The average net profit values for the Baladi cows that calved in the winter or summer were 2413 and 2994.96 EGP/cow/year, respectively, and those for the Holstein-Friesian cows were 10744.17 and 7860.56 EGP/cow/year, respectively, whereas those for the cross-bred cows were 10174.86 and 7571.33 EGP/cow/year, respectively. The variations in net profit might have resulted from variation in the availability or price of feed materials, milk prices, or sales volumes. Our results show that the breed and calving season of dairy cows significantly affected the economic efficiency of dairy farms in Egypt. The cows that calved in the winter produced more milk than those that calved in the summer, which may have been the result of seasonal influences, such as temperature, humidity, management practices, and the type of feed or green fodder available.

Keywords: calving season, economic, production, efficiency, dairy

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Authors: Sunho Seo, Younghwan Shin, Jong-Hong Park, Sooeun Song, Junsung Kim, Jusik Yun, Yongkyun Kim, Jong-Moon Chung

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In order to effectively cope with large and complex disasters, disaster response training is needed. Recently, disaster response training led by the ROK (Republic of Korea) government is being implemented through a 4 year R&D project, which has several similar functions as the HSEEP (Homeland Security Exercise and Evaluation Program) of the United States, but also has several different features as well. Due to the unpredictiveness and diversity of disasters, existing training methods have many limitations in providing experience in the efficient use of disaster incident response and recovery resources. Always, the challenge is to be as efficient and effective as possible using the limited human and material/physical resources available based on the given time and environmental circumstances. To enable repeated training under diverse scenarios, an AR (Augmented Reality) and VR (Virtual Reality) combined simulator is under development. Unlike existing disaster response training, simulator based training (that allows remote login simultaneous multi-user training) enables freedom from limitations in time and space constraints, and can be repeatedly trained with different combinations of functions and disaster situations. There are related systems such as ADMS (Advanced Disaster Management Simulator) developed by ETC simulation and HLS2 (Homeland Security Simulation System) developed by ELBIT system. However, the ROK government needs a simulator custom made to the country's environment and disaster types, and also combines the latest information and communication technologies, which include AR, VR, and MPEG-DASH (Moving Picture Experts Group - Dynamic Adaptive Streaming over HTTP) technology. In this paper, a new disaster response training simulator is proposed to overcome the limitation of existing training systems, and adapted to actual disaster situations in the ROK, where several technical features are described.

Keywords: augmented reality, emergency response training simulator, MPEG-DASH, virtual reality

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Authors: Shanza Akram, Samir Salah, Imran Saleem, Jassim Abdou, Ashraf Al Zaabi

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Estimated prevalence of asthma in UAE is around 10% (900,000 people). Patients with persistent symptoms despite using high dose ICS plus a second controller +/- Oral steroids are considered to have severe asthma. Omalizumab (Xolair) is an anti-IgE monoclonal antibody approved as add-on therapy for severe allergic asthma. The objective of our study was to obtain baseline characteristics of our local cohort, to determine the efficacy of omalizumab based on clinical outcomes pre and post 52 weeks of treatment and to assess safety and tolerability. Medical records of patients receiving omalizumab therapy for asthma at Zayed Military Hospital, Abu Dhabi were retrospectively reviewed. Patients fulfilling the criteria for severe allergic asthma as per GINA guidelines were included. Asthma control over 12 months pre and post omalizumab were analyzed by taking into account the number of exacerbations, hospitalizations, maintenance of medication dosages, the need for reliever therapy and PFT’s. 21 patients (5 females) with mean age 41 years were included. The mean duration of therapy was 22 months. 19 (91%) patients had Allergic Rhinitis/Sinusitis. Mean serum total IgE level was 648 IU/ml (65-1859). 11 (52%) patients were on oral maintenance steroids pre-treatment. 7 patients managed to stop steroids on treatment while 4 were able to decrease the dosage. Mean exacerbation rate decreased from 5 per year pre-treatment to 1.36 while on treatment. The number of hospitalizations decreased from a mean of 2 per year to 0.9 per year. Reliever inhaler usage decreased from mean of 40 to 15 puffs per week.2 patients discontinued therapy, 1 due to lack of benefit (2 doses) and 2nd due to severe persistent side effects. Patient compliance was poor in some cases. Treatment with omalizumab reduced the number of exacerbations, hospitalizations, maintenance and reliever medications, and is generally well tolerated. Our results show that there is room for improved documentation in terms of symptom recording and use of rescue medication at our institution. There is also need for better patient education and counseling in order to improve compliance.

Keywords: asthma, exacerbations, omalizumab, IgE

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Authors: Ryan Adams

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Introduction: Major trauma is the leading cause of death in 15-45 year olds and a significant human, social and economic costs. Resuscitation is a stalwart of trauma management, especially in the pre-hospital environment and packed red blood cells (pRBC) are being increasingly used with the advent of permissive hypotension. The evidence in this area is lacking and further research is required to determine its efficacy. Aim: The aim of this retrospective, matched cohort study was to determine if major trauma patients, who received pre-hospital pRBC, have a difference in their initial emergency department cardiovascular status; when compared with injury-profile matched controls. Methods: The trauma databases of the Royal Brisbane and Women's Hospital, Royal Children's Hospital (Herston) and Queensland Ambulance Service were accessed and major trauma patient (ISS>12) data, who received pre-hospital pRBC, from January 2011 to August 2014 was collected. Patients were then matched against control patients that had not received pRBC, by their injury profile. The primary outcomes was cardiovascular status; defined as shock index and Revised Trauma Score. Results: Data for 25 patients who received pre-hospital pRBC was accessed and the injury profiles matched against suitable controls. On admittance to the emergency department, a statistically significant difference was seen in the blood group (Blood = 1.42 and Control = 0.97, p-value = 0.0449). However, the same was not seen with the RTS (Blood = 4.15 and Control 5.56, p-value = 0.291). Discussion: A worsening shock index and revised trauma score was associated with pre-hospital administration of pRBC. However, due to the small sample size, limited matching protocol and associated confounding factors it is difficult to draw any solid conclusions. Further studies, with larger patient numbers, are required to enable adequate conclusions to be drawn on the efficacy of pre-hospital packed red blood cell transfusion.

Keywords: pre-hospital, packed red blood cells, severe trauma, emergency medicine

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Authors: Gul Jan

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It is the first quantitative ethno-botanical analysis and conservation issues of medicinal flora of Alpine and Sub-alpine, Hindikush region of Pakistan. The objective of the study aims to report, compare the uses and highlight the ethno-Botanical significance of medicinal plants for treatment of various diseases. A total of 250 (242 males and 8 females) local informants including 10 Local Traditional Healers were interviewed. Information was collected through semi-structured interviews, analyzed and compared by quantitative ethno-botanical indices such as Jaccard index (JI), Informant Consensus Factor (ICF), use value (UV) and Relative frequency of citation (RFC).Thorough survey indicated that 57 medicinal plants belongs to 43 families were investigated to treat various illnesses. The highest ICF is recorded for digestive system (0.69%), Circolatory system (0.61%), urinary tract system, (0.53%) and respiratory system (0.52%). Used value indicated that, Achillea mellefolium (UV = 0.68), Aconitum violaceum (UV = 0.69), Valeriana jatamansi (UV = 0.63), Berberis lyceum (UV = 0.65) and are exceedingly medicinal plant species used in the region. In comparison, highest similarity index is recorded in these studies with JI 17.72 followed by 16.41. According to DMR output, Pinus williciana ranked first due to multipurpose uses among all species and was found most threatened with higher market value. Unwise used of natural assets pooled with unsuitable harvesting practices have exaggerated pressure on plant species of the research region. The main issues causative to natural variety loss found were over grazing of animals, forest violation, wild animal hunting, fodder, plant collection as medicine, fuel wood, forest fire, and invasive species negatively affect the natural resources. For viable utilization, in situ and ex situ conservation, skillful collecting, and reforestation project may be the resolution. Further wide field management research is required.

Keywords: quantitative analysis, conservations issues, medicinal flora, alpine and sub-alpine, Hindukush region

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Authors: Awais Ahmed, Javed Iqbal

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Pakistan has been for many years facing extreme challenges in energy deficit due to the shortage of power generation compared to increasing demand. A part of this energy deficit is also contributed by the power lost in transmission and distribution network. Unfortunately, distribution companies are not equipped with modern technologies and methods to identify and eliminate these losses. According to estimate, total energy lost in early 2000 was between 20 to 26 percent. To address this issue the present research study was designed with the objectives of developing a standalone GIS application for distribution companies having the capability of loss calculation as well as identification of overloaded transformers. For this purpose, Hilal Road feeder in Faisalabad Electric Supply Company (FESCO) was selected as study area. An extensive GPS survey was conducted to identify each consumer, linking it to the secondary pole of the transformer, geo-referencing equipment and documenting conductor sizes. To identify overloaded transformer, accumulative kWH reading of consumer on transformer was compared with threshold kWH. Technical losses of 11kV and 220V lines were calculated using the data from substation and resistance of the network calculated from the geo-database. To automate the process a standalone GIS application was developed using ArcObjects with engineering analysis capabilities. The application uses GIS database developed for 11kV and 220V lines to display and query spatial data and present results in the form of graphs. The result shows that about 14% of the technical loss on both high tension (HT) and low tension (LT) network while about 4 out of 15 general duty transformers were found overloaded. The study shows that GIS can be a very effective tool for distribution companies in management and planning of their distribution network.

Keywords: geographical information system, GIS, power distribution, distribution transformers, technical losses, GPS, SDSS, spatial decision support system

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Authors: Murad Ali, Anderson Konan Seny Kan, Khalid A. Maimani

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Based on the theory of organizational design and the theory of knowledge, this study uses complexity theory to explain and better understand the causal impacts of various patterns of organizational structural factors stimulating absorptive capacity (ACAP). Organizational structure can be thought of as heterogeneous configurations where various components are often intertwined. This study argues that impact of the traditional variables which define a firm’s organizational structure (centralization, formalization, complexity and integration) on ACAP is better understood in terms of set-theoretic relations rather than correlations. This study uses a data sample of 347 from a multiple industrial sector in South Korea. The results from PLS-SEM support all the hypothetical relationships among the variables. However, fsQCA results suggest the possible configurations of centralization, formalization, complexity, integration, age, size, industry and revenue factors that contribute to high level of ACAP. The results from fsQCA demonstrate the usefulness of configurational approaches in helping understand equifinality in the field of knowledge management. A recent fsQCA procedure based on a modeling subsample and holdout subsample is use in this study to assess the predictive validity of the model under investigation. The same type predictive analysis is also made through PLS-SEM. These analyses reveal a good relevance of causal solutions leading to high level of ACAP. In overall, the results obtained from combining PLS-SEM and fsQCA are very insightful. In particular, they could help managers to link internal organizational structural with ACAP. In other words, managers may comprehend finely how different components of organizational structure can increase the level of ACAP. The configurational approach may trigger new insights that could help managers prioritize selection criteria and understand the interactions between organizational structure and ACAP. The paper also discusses theoretical and managerial implications arising from these findings.

Keywords: absorptive capacity, organizational structure, PLS-SEM, fsQCA, predictive analysis, modeling subsample, holdout subsample

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Authors: Adi Gielgun-Katz, Alina S. Rusu

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In the last two decades, education systems worldwide have integrated new pedagogical methods and strategies in lesson plans, such as innovative technologies, social-emotional learning (SEL), gamification, mixed learning, multiple literacies, and many others. Visual language, such as photographs, is known to transcend cultures and languages, and it is commonly used by youth to express positions and affective states in social networks. Therefore, visual language needs more educational attention as a linguistic and communicative component that can create connectedness among the students and their teachers. Nowadays, when SEL is gaining more and more space and meaning in the area of academic improvement in relation to social well-being, and taking and sharing pictures is part of the everyday life of the majority of people, it becomes natural to add the visual language to SEL approach as a reinforcement strategy for connecting education to the contemporary culture and language of the youth. This article presents a program conducted in a high school class in Israel, which combines the five SEL with photography techniques, i.e., Social-Emotional Learning Visual Empowerments (SELVEs) program (experimental group). Another class of students from the same institution represents the control group, which is participating in the SEL program without the photography component. The SEL component of the programs addresses skills such as: troubleshooting, uncertainty, personal strengths and collaboration, accepting others, control of impulses, communication, self-perception, and conflict resolution. The aim of the study is to examine the effects of programs on the level of the five SEL aspects in the two groups of high school students: Self-Awareness, Social Awareness, Self-Management, Responsible Decision Making, and Relationship Skills. The study presents a quantitative assessment of the SEL programs’ impact on the students. The main hypothesis is that the students’ questionnaires' analysis will reveal a better understanding and improvement of the five aspects of the SEL in the group of students involved in the photography-enhanced SEL program.

Keywords: social-emotional learning, photography, education program, adolescents

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Authors: Khemnath Kharel

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Forest itself is a factory as well as product. It supplies tangible and intangible goods and services. It supplies timber, fuel wood, fodder, grass leaf litter as well as non timber edible goods and medicinal and aromatic products additionally provides environmental services. These environmental services are of local, national, or even global importance. In Nepal more than 19 thousands community forests are providing environmental service in less economic benefit than actual efficiency. There is a risk of cost of management of those forest exceeds benefits and forests get converted to open access resources in future. Most of the environmental goods and services don’t have markets which mean no prices at which they are available to the consumers therefore the valuation of these services goods and services establishment of paying mechanism for such services and insure the benefit to community is more relevant in local as well as global scale. There are few examples of carbon trading in domestic level to meet the country wide emission goal. In this contest the study aims to explore the public attitude towards carbon offsetting and their responsibility over service providers. This study helps in promotion of environment service awareness among general people and service provider; community forest. The research helps to unveil the carbon pool scenario in community forest and willingness to pay for carbon offsetting of people who are consuming more energy than general people and emitting relatively more carbon in atmosphere. The study has assessed the carbon pool status in two community forest. In the study in two community forests carbon pools were assessed following the guideline “Forest Carbon Inventory Guideline 2010” prescribed by Ministry of Forest and soil Conservation, Nepal. Final out comes of analysis in intensively managed area of Hokse CF recorded as 103.58 tons C /ha with 6173.30 tons carbon stock. Similarly in Hariyali CF carbon density was recorded 251.72 mg C /ha. The total carbon stock of intensively managed blocks in Hariyali CF is 35839.62 tons carbon.

Keywords: carbon, offsetting, sequestration, valuation

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Authors: Olufunke O. Obanla, Oluseye O. Onabanjo, Silifat A. Sanni, Mojisola O. Adegunwa, Wasiu A. O. Afolabi, Omolola O. Oyawoye, Atinuke Titilola Lano-Maduagu

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Background: Dietary fat is implicated in the increasing development of chronic diseases in developing countries while dietary fibre plays a major role in the management of these diseases. Accurate nutrient composition data for composite dishes unique to a population is essential for the development of a nutrient database and the calculation of dietary intake. Methods: Representative samples of standardized Nigerian soups and dishes were analyzed for fatty acids using gas chromatography-mass spectrophotometry (GC-MS) and dietary fibre using an enzymatic-gravimetric standard method of AOAC. Results: The total Saturated Fatty acids (SFAs) ranged from 0.74+0.3g/100g to 73.82+0.07g/100g. The total monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) ranged from 2.16+1.13g/100g for Yam pottage to 22.25+0.58g/100g for Okazi soup and eba, and from 0.42+0.10g/100g for Yam pottage to 10.22+0.1g/100g for Pounded yam with egusi ball soup, respectively. Trans fat was observed in Alapafubu and Tuwo shinkafa (2.80+0.2g/100g), Yam pottage (0.20+0.15g/100g), Steamed bean pudding (1.28+0.53g/100g) and Ikokore (5.33+0.41g/100g). The Total Dietary Fibre (TDF) contents of the dishes ranged from 12.95+2.99g/100g in Jollof rice to 62.00+0.94g/100g in Melon seed and vegetable soup, the Soluble Dietary Fibre (SDF) ranged from 2.05+0.32g/100g in Steamed bean pudding to 7.81+0.74g/100g in Ikokore while the Insoluble Dietary Fibre (IDF) ranged from 8.20+0.43g/100g in Jollof rice to 57.91+4.69g/100g in melon seed and vegetable soup. Conclusions: The study has indicated that some Nigerian dishes are characterized by high SFAs, TFAs and dietary fibre, moderate MUFAs and very low levels of PUFAs. High levels of SFAs in some soups and dishes are a major public health concern.

Keywords: healthy diet, dietary fibre, fatty acid profile, chronic diseases, Nigerian dishes

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Authors: Mandana Karimi, Martha McMahon

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One of the most important consequences of water scarcity worldwide is the increase in conflicts over water issues, reduced access to clean water, food shortages, energy shortages, and reduced economic development. The extreme weather conditions in British Columbia are because of climate change, which is leading to water scarcity becoming a serious issue affecting British Columbians, aquatic ecosystems, the BC water policy, agriculture, and the economy. In light of climate change and water stress, the British Columbia government introduced a new water legislation in 2016 named the Water Sustainability Act to manage water resources in British Columbia. So, this study aimed to present a deep understanding emanating from the political and social dimensions of the new water policy in BC in the agriculture sector and which sociological paradigm governs the current water policy (WSA) in BC. Policy analysis based on the water problem representation approach was used to present the problem and solutions identified by the water policy in the agricultural sector in BC. The results of the policy analysis highlighted that the Water Sustainability Act is governed by a positivist and modernist approach because the groundwater license is the measurable situation to access the adequate quantity of water for the farmers. In addition, by the positivist paradigm water resources are conceptualized as a commodity to be bought and sold. Under the positivist approach, the measurable parameter of groundwater is also applied based on the top-down approach for water management to show the use of water resources for economic development. In addition, the findings of the policy analysis suggest that alternative paradigms, such as relational ontology, ecofeminism, and indigenous knowledge, could be applied in introducing water policies to shift from the positivist or modernist paradigm. These new paradigms present the potential for environmental policies like the Water Sustainability Act, based on partnership, and collaboration and with an explicit emphasis on protecting water for nature.

Keywords: water governance, Water Sustainability Act, water policy, small-scale farmer, policy analysis

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Authors: Fengqing Li, Petra Schneider

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Failure of tailings management facilities (TMF) of radioactive residues is an enormous challenge worldwide and can result in major catastrophes. Particularly in transboundary regions, such failure is most likely to lead to international conflict. This risk occurs in Kyrgyzstan and Uzbekistan, where the current major challenge is the quantification of impacts due to pollution from uranium legacy sites and especially the impact on river basins after natural hazards (i.e., landslides). By means of GoldSim, a probabilistic simulation model, the amount of tailing material that flows into the river networks of Mailuu Suu in Kyrgyzstan after pond failure was simulated for three scenarios, namely 10%, 20%, and 30% of material inputs. Based on Muskingum-Cunge flood routing procedure, the peak value of uranium flood wave along the river network was simulated. Among the 23 TMF, 19 ponds are close to the river networks. The spatiotemporal distributions of uranium along the river networks were then simulated for all the 19 ponds under three scenarios. Taking the TP7 which is 30 km far from the Kyrgyzstan-Uzbekistan border as one example, the uranium concentration decreased continuously along the longitudinal gradient of the river network, the concentration of uranium was observed at the border after 45 min of the pond failure and the highest value was detected after 69 min. The highest concentration of uranium at the border were 16.5, 33, and 47.5 mg/L under scenarios of 10%, 20%, and 30% of material inputs, respectively. In comparison to the guideline value of uranium in drinking water (i.e., 30 µg/L) provided by the World Health Organization, the observed concentrations of uranium at the border were 550‒1583 times higher. In order to mitigate the transboundary impact of a radioactive pollutant release, an integrated framework consisting of three major strategies were proposed. Among, the short-term strategy can be used in case of emergency event, the medium-term strategy allows both countries handling the TMF efficiently based on the benefit-sharing concept, and the long-term strategy intends to rehabilitate the site through the relocation of all TMF.

Keywords: Central Asia, contaminant transport modelling, radioactive residue, transboundary conflict

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Authors: Jakub Gren

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The recent transfer of banking supervision to the ECB has expanded its influence as of a non-majoritarian and technocratic policy-shaper in EU supervisory policies. To fulfil the main policy objectives of the Single Supervisory Mechanism, the ECB has been tasked with building a single supervisory approach to supervised banks across the euro area and is now exclusively responsible for direct supervision of the largest ‘significant’ euro area banks and the oversight of the remaining ‘less significant’ banks. This enhanced supranational position of the ECB significantly alters the EU institutional order and creates powerful incentives to actively pursue integrationist agenda by the ECB. However, this drastic shift has a little impact upon adapting the ECB’s new supervisory mandate to the requirements of democratic legitimacy. Whereas the ECB’s strong pre-crisis independence and limited accountability could be reconciled with democratic principles through a clearly articulated price stability mandate, independence and limited accountability in the context of a more complex supervisory mandate is problematic. Hence, in order to ensure the democratic legitimacy of the ECB/SSM’s supervisory policies, the ECB’s supervisory mandate requires both a lower scope of independence and higher accountability requirements. To address this situation, organizational separation (“Chinese Wall”) between the ECB monetary and supervisory arms was introduced. This separation includes different reporting lines and the relocation of the ECB’s monetary function to a new building complex while leaving its supervisory function at the Euro-tower (“Two Towers”). This paper argues that these measures are not sufficient to establish proper checks and balances on the ECB’s powers to pursue euro zone’s wide supervisory policies. As a remedy, this contribution suggests that the ECB’s Treaties-embedded independence, as set out by art. 130 TFEU, designed to carry out its monetary function shall not be fully applicable to its supervisory function. Indeed functional and conditional reading of this provision to ECB supervisory function could enhance the legitimacy of future ECB’s supervisory action.

Keywords: accountability and transparency, democratic governance, financial management, rule of law

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Authors: Rajashree Naik, Laxmi Kant Sharma

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Sambhar lake is the largest inland Salt Lake of India, declared as a Ramsar site on 23 March 1990. Due to high salinity and alkalinity condition its biodiversity richness is contributed by haloalkaliphilic flora and fauna along with the diverse land cover including waterbody, wetland, salt crust, saline soil, vegetation, scrub land and barren land which welcome large number of flamingos and other migratory birds for winter harboring. But with the gradual increase in the irrational salt extraction activities, the ecological diversity is at stake. There is an urgent need to assess the ecosystem. Advanced technology like remote sensing and GIS has enabled to look into the past, compare with the present for the future planning and management of the natural resources in a judicious way. This paper is a research work intended to present a vegetation in typical inland lake environment of Sambhar wetland using satellite data of NASA’s EO-1 Hyperion sensor launched in November 2000. With the spectral range of 0.4 to 2.5 micrometer at approximately 10nm spectral resolution with 242 bands 30m spatial resolution and 705km orbit was used to produce a vegetation map for a portion of the wetland. The vegetation map was tested for classification accuracy with a pre-existing detailed GIS wetland vegetation database. Though the accuracy varied greatly for different classes the algal communities were successfully identified which are the major sources of food for flamingo. The results from this study have practical implications for uses of spaceborne hyperspectral image data that are now becoming available. Practical limitations of using these satellite data for wetland vegetation mapping include inadequate spatial resolution, complexity of image processing procedures, and lack of stereo viewing.

Keywords: Algal community, NASA’s EO-1 Hyperion, salt-tolerant species, wetland vegetation mapping

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Authors: P. Phenpun, S. Wareewan

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This qualitative study aimed to describe the opinions in relation to humanized care emerging from the volunteer activities of nursing students at Boromarajonani College of Nursing, Chonburi, Thailand. One hundred and twenty-seven second-year nursing students participated in this study. The volunteer activity model was composed of preparation, implementation, and evaluation through a learning log, in which students were encouraged to write their daily activities after completing practical training at the healthcare center. The preparation content included three main categories: service minded, analytical thinking, and client participation. The preparation process took over three days that accumulates up to 20 hours only. The implementation process was held over 10 days, but with a total of 70 hours only, with participants taking part in volunteer work activities at a healthcare center. A learning log was used for evaluation and data were analyzed using content analysis. The findings were as follows. With service minded, there were two subcategories that emerged from volunteer activities, which were service minded towards patients and within themselves. There were three categories under service minded towards patients, which were rapport, compassion, and empathy service behaviors, and there were four categories under service minded within themselves, which were self-esteem, self-value, management potential, and preparedness in providing good healthcare services. In line with analytical thinking, there were two components of analytical thinking, which were analytical skill for their works and analytical thinking for themselves. There were four subcategories under analytical thinking for their works, which were evidence based thinking, real situational thinking, cause analysis thinking, and systematic thinking, respectively. There were four subcategories under analytical thinking for themselves, which were comparative between themselves, towards their clients that leads to the changing of their service behaviors, open-minded thinking, modernized thinking, and verifying both verbal and non-verbal cues. Lastly, there were three categories under participation, which were mutual rapport relationship; reconsidering client’s needs services and providing useful health care information.

Keywords: humanized care service, volunteer activity, nursing student, learning log

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Authors: K. R. Roopesh Bharatwaj, Avinash Maharana, Favour Tobi Aborisade, Roger Young

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Presently, there are few cases of complete automation of drones and its allied intelligence capabilities. In essence, the potential of the drone has not yet been fully utilized. This paper presents feasible methods to build an intelligent drone with smart capabilities such as self-driving, and obstacle avoidance. It does this through advanced Reinforcement Learning Techniques and performs object detection using latest advanced algorithms, which are capable of processing light weight models with fast training in real time instances. For the scope of this paper, after researching on the various algorithms and comparing them, we finally implemented the Deep-Q-Networks (DQN) algorithm in the AirSim Simulator. In future works, we plan to implement further advanced self-driving and object detection algorithms, we also plan to implement voice-based speech recognition for the entire drone operation which would provide an option of speech communication between users (People) and the drone in the time of unavoidable circumstances. Thus, making drones an interactive intelligent Robotic Voice Enabled Service Assistant. This proposed drone has a wide scope of usability and is applicable in scenarios such as Disaster management, Air Transport of essentials, Agriculture, Manufacturing, Monitoring people movements in public area, and Defense. Also discussed, is the entire drone communication based on the satellite broadband Internet technology for faster computation and seamless communication service for uninterrupted network during disasters and remote location operations. This paper will explain the feasible algorithms required to go about achieving this goal and is more of a reference paper for future researchers going down this path.

Keywords: convolution neural network, natural language processing, obstacle avoidance, satellite broadband technology, self-driving

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Authors: Abhaydeep Pandey, Shweta Shukla, Saptamita Goswami, Bhaswati Bandyopadhyay, Vishnampettai Ramachandran, Sudhanshu Vrati, Arup Banerjee

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Dengue virus infection is now considered as one of the most important mosquito-borne infection in human. The virus is known to promote vascular permeability, cerebral edema leading to Dengue hemorrhagic fever (DHF) or Dengue shock syndrome (DSS). Dengue infection has known to be endemic in India for over two centuries as a benign and self-limited disease. In the last couple of years, the disease symptoms have changed, manifesting severe secondary complication. So far, Delhi has experienced 12 outbreaks of dengue virus infection since 1997 with the last reported in 2014-15. Without specific antivirals, the case management of high-risk dengue patients entirely relies on supportive care, involving constant monitoring and timely fluid support to prevent hypovolemic shock. Nonetheless, the diverse clinical spectrum of dengue disease, as well as its initial similarity to other viral febrile illnesses, presents a challenge in the early identification of this high-risk group. WHO recommends the use of warning signs to identify high-risk patients, but warning signs generally appear during, or just one day before the development of severe illness, thus, providing only a narrow window for clinical intervention. The ability to predict which patient may develop DHF and DSS may improve the triage and treatment. With the recent discovery of high throughput RNA sequencing allows us to understand the disease progression at the genomic level. Here, we will collate the results of RNA-Sequencing data obtained recently from PBMC of different categories of dengue patients from India and will discuss the possible role of deregulated genes and long non-coding RNAs NEAT1 for development of disease progression.

Keywords: long non-coding RNA (lncRNA), dengue, peripheral blood mononuclear cell (PBMC), nuclear enriched abundant transcript 1 (NEAT1), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS)

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Authors: Ghulam Abbas, Ikramul Haq, Ghulam Ghouse

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Bread wheat Triticum aestivum L. (Poaceae) is the major source of the staple food for a number of countries of the world including Pakistan. Since it is the staple food of the country, it has been desired, and efforts have been made, that it does not undergo application of pesticides to ensure the food safety. Luckily, wheat does not face a serious threat of insect pests, in ecological conditions of Pakistan, except aphids and armyworm which infest the wheat prior to maturity. It has been observed that almost 5 species of aphid have been reported to attack wheat ie. Ropalosiphum maidi, R. Padi, Schizaphis graminum, Diuraphis noxia, and Sitibion miscanthi but due to natural rise in temperature in terminal season of wheat, the population of aphid gradually decreases and wheat has a safe escape from its infestation. In case, mild temperatures 15ºC to 30ºC prolong, the infestation of aphids also prolongs and it can severely damage wheat in patches, and it has potential to substantially reduce the yield of wheat in infested patch. In years 2013, 2014, and 2015 the studies were undertaken to determine the potential of damage caused by aphid complex in 10 fields in infested patches. The damage caused by aphid complex was calculated on the basis of 1000 grain weight of wheat grains taken from the infested patch and were compared with 1000 grain weight of the healthy plants of the same fields. It was observed that there was 26 to 42% decrease in the weight of grain in infested patches. This patch also escaped from general harvesting by combine harvester and enhanced the loss 13 to 46%. The quality of the wheat straw was also reduced and its acceptance to the animals was also affected up to 50 to 100%. Moreover, the population of naturally existing beneficial fauna was recorded and factors promoting establishment and manipulation of beneficial fauna were studied and analysed.

Keywords: Triticum aestivum, wheat, Pakistan, beneficial fauna, aphid complex

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Authors: Bassem Saleh, Hussam Nusair, Nariman Al Zubadi, Shams Al Shloul, Usama Saleh

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The nursing round system (NRS) means checking patients on an hourly basis during the A (0700–2200 h) shift and once every 2 h during the B (2200–0700 h) by the assigned nursing staff. The overall goal of this prospective study is to implement an NRS in a major rehabilitation centre—Sultan Bin Abdulaziz Humanitarian City—in the Riyadh area of the Kingdom of Saudi Arabia. The purposes of this study are to measure the effect of the NRS on: (i) the use of patient call light; (ii) the number of incidences of patients’ fall; (iii) the number of incidences of hospital-acquired bed sores; and (iv) the level of patients’ satisfaction. All patients hospitalized in the male stroke unit will be involved in this study. For the period of 8 weeks (17 December 2009–17 February 2010) All Nursing staff on the unit will record each call light and the patient’s need. Implementation of the NRS would start on 18 February 2010 and last for 8 weeks, until 18 April 2010. Data collected throughout this period will be compared with data collected during the 8 weeks period immediately preceding the implementation of the NRS (17 December 2009–17 February 2010) in order to measure the impact of the call light use. The following information were collected on all subjects involved in the study: (i) the Demographic Information Form; (ii) authors’ developed NRS Audit Form; (iii) Patient Call Light Audit Form; (iv) Patient Fall Audit Record; (v) Hospital-Acquired Bed Sores Audit Form; and (vi) hospital developed Patient Satisfaction Records. The findings suggested that a significant reduction on the use of call bell (P < 0.001), a significant reduction of fall incidence (P < 0.01) while pressure ulcer reduced by 50% before and after the implementation of NRS. In addition, the implementation of NRS increased patient satisfaction by 7/5 (P < 0.05).

Keywords: call light, patient-care management, patient safety, patient satisfaction, rounds

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Authors: Abduladim Maitieg, Mark Johnson

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Developing a coastal oil spill management plan for the Misratah coast is the motivating factor for building a database for coastal and marine systems and energy resources. Wind direction and speed, currents, bathymetry, coastal topography and offshore dynamics influence oil spill deposition in coastal water. Therefore, oceanographic and climatological data can be used to understand oil slick movement and potential oil deposits on shoreline area and the behaviour of oil spill trajectories on the sea surface. The purpose of this study is to investigate the effects of the coastal and marine physical factors under strong wave conditions and various bathymetric and coastal topography gradients in the western coastal area of Libya on the movement of oil slicks. The movement of oil slicks was computed using a GNOME simulation model based on current and wind speed/direction. The results in this paper show that (1) Oil slick might reach the Misratah shoreline area in two days in the summer and winter. Seasons. (2 ) The North coast of Misratah is the potential oil deposit area on the Misratah coast. (3) Tarball pollution was observed along the North coast of Misratah. (4) Two scenarios for the summer and the winter season were run, along the western coast of Libya . (5) The eastern coast is at a lower potential risk due to the influence of wind and current energy in the Gulf of Sidra. (6) The Misratah coastline is more vulnerable to oil spill movement in the summer than in winter seasons. (7) Oil slick takes from 2 to 5 days to reach the saltmarsh in the eastern Misratah coast. (8) Oil slick moves 300 km in 30 days from the spill resource location near the Libyan western border to the Misratah coast.(9) Bathymetric features have a profound effect on oil spill movement. (9)Oil dispersion simulations using GNOME are carried out taking into account high-resolution wind and current data.

Keywords: oil spill movement, coastal and marine physical factors, coast area, Libyan

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Authors: M. Shivakumar, S. R. Somashekhar, C. V. Raju

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Secondary salinization of agricultural lands in any command areas of the world is the major issue in the recent past. Currently, it is estimated that the 954 mh of saline and alkaline soil is present in the world. Thousands of hectares of land, getting added every year. Argentina, Bangladesh and Australia are most affected countries. In India, out of 142.80 million hectare (mh) cropped area, 56 mh is irrigated area. Of which, more than 9 mh (about 16.%) of land is found to be alkaline/saline. Due to continuous utilization of same land for same agricultural activities, excessive usage of fertilizers and water, most of the soils have become alkaline, saline or water logged. These lands are low productive and at times totally unfit for agricultural activities. These soils may or may not posses good physical condition, but plants may suffer from its inability to absorb water from salty solution. Plants suffer from dehydration and loose water to the soil, shrink, resulting death of plant. This process is called plasmolysis. It is the fact that soil is an independent, organic body of nature that acquires properties in accordance with forces which act upon it. Aquaculture is one of the solutions to utilize such problematic soils for food production. When the impoundments are constructed in an area 10-15% of the affected areas, the excess water along with the salts gets into impoundments and management of salt is easier in water than in the soil. Due to high organic input in aquaculture such as feed, manure and continuous deposition of fecal matter, pH of the soil gets reduced and over the period of time such soils can be put back into the original activity. Under National Agricultural Development Program (NADP), the project was implemented in 258 villages of Mandya District, Karnataka State, India and found that these lands can be effectively utilized for fish culture and increase the proteinacious food production by many folds while conserving the soils. The findings of the research can be adopted and up scaled in any country.

Keywords: saline and alkaline soils, Aquaculture, Problematic soils, Reclamation

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Authors: Christina Esti Susanti

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This study aimed to determine the effect Activities in marketing, Destination Marketing, and Environmental preservation loyalty through satisfaction at tourist destination in East Java, Indonesia. In this study population used is Surabaya citizens who had visited tourist destination in East Java, Indonesia. Characteristics of a sample of respondents in this study are: a minimum age of 17 years, and ever came in tourist destination in East Java, Indonesia with each destination more than 1 visits. Total sample 316 respondents. Data analysis tools which is used in this study is a structural equation modeling. Based on the analysis, the results of this study can be concluded that the hypothesis 1, 2, 5, and 6 are proposed in this study was rejected because not significant. The hypotheses are: (1) Activities in destination have influence which is positive effect on satisfaction in the tourist destination in East Java, Indonesia, (2) Destination marketing have influence which is positive effect on satisfaction in the tourist destination in East Java, Indonesia, (3) Activities in destination have influence which is positive effect towards loyalty through satisfaction in a tourist destination in East Java, Indonesia. (4) Destination marketing have influence which is positive effect on loyalty through satisfaction in a tourist destination in East Java, Indonesia. While the hypothesis 3, 4, and 7, is received. The hypotheses are: (1) Environmental preservation have influence which is positive effect and significant on satisfaction in the tourist destination in East Java, Indonesia. (2) Satisfaction have influence which is positive effect and significant on loyalty to the tourist destination in East Java, Indonesia. (3) Environmental preservation have influence which is positive effect and significant on loyalty through satisfaction in a tourist destination in East Java, Indonesia. Practical advice submitted to the management of tourist destinations, especially in the 10 areas where research was conducted for more attention to the condition of the physical environment to be around tourist spots / attractions, namely: the condition of roads, water supply conditions, the condition of drainage / sanitation, and the condition waste more seriously. Based on the proposal, the manager of a tourist destination seems to be working closely with the local municipal sanitation departments, local water companies local city and town local public works departments to jointly manage a tourist destination considering regional tourism is one of the region's assets and become one sources of local revenue (PAD) is vital.

Keywords: activities in marketing, destination amarketing, environmental preservation, satisfaction, loyalty

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Authors: Vistorina Amputu, Katja Tielboerger, Nichola Knox

Abstract:

Primary productivity in dry savannahs is constraint by moisture availability and under increasing anthropogenic pressure. Thus, considering climate change and the unprecedented pace and scale of rangeland deterioration, methods for assessing the status of such rangelands should be easy to apply, yield reliable and repeatable results that can be applied over large spatial scales. Global and local scale monitoring of rangelands through satellite data and labor-intensive field measurements respectively, are limited in accurately assessing the spatiotemporal heterogeneity of vegetation dynamics to provide crucial information that detects degradation in its early stages. Fortunately, newly emerging techniques such as unmanned aerial vehicles (UAVs), associated miniaturized sensors and improving digital photogrammetric software provide an opportunity to transcend these limitations. Yet, they have not been extensively calibrated in natural systems to encompass their complexities if they are to be integrated for long-term monitoring. Limited research using drone technology has been conducted in arid savannas, for example to assess the health status of this dynamic two-layer vegetation ecosystem. In our study, we fill this gap by testing the relationship between UAV-estimated cover of rangeland functional attributes and field data collected in discrete sample plots in a Namibian dryland savannah along a degradation gradient. The first results are based on a supervised classification performed on the ultra-high resolution multispectral imagery to distinguish between rangeland functional attributes (bare, non-woody, and woody), with a relatively good match to the field observations. Integrating UAV-based observations to improve rangeland monitoring could greatly assist in climate-adapted rangeland management.

Keywords: arid savannah, degradation gradient, field observations, narrow-band sensor, supervised classification

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Authors: Han Zheng

Abstract:

This research is being conducted to explore women's leadership in China's National Governing Bodies ( in order to identify the barriers to women's leadership and provide feasible solutions. Extensive research has been undertaken internationally, which has identified and acknowledged the underrepresentation of women in leadership positions across multiple industries and global contexts. According to these studies, leadership specifically within the sports industry was both historically and is still currently male-dominated. Within China, the underrepresentation of women in leadership positions is also evident, which women only occupy 16% of the leadership in business enterprises and 5.6% in scientific and technological research institutions, yet there is limited research that has looked to examine why this is the case regarding women's leadership in China, especially within in sports industry. Therefore, this research gap drives the purpose, which aims to explore the current situation of women's leadership in sports National Governing Bodies (NGBs) in China. By using both questionnaires and interviews, data from NGBs in China will be collected. This research will achieve the following three goals: 1, determine the representation level of women's leadership in the target organizations. 2, identify barriers to women's leadership and their causes. 3, provide feasible solutions. Based on the multi-level framework, this study develops a "barrier matrix" framework: according to the analysis of the previous literature, it concludes that there are eight main barriers that hinder the development of women's leadership. The research combines qualitative and quantitative analysis, using questionnaires and interviews. Key findings according to the analysis of the primary data collected: 1. The average proportion of female occupational leadership in China's sports NGBs is less than 17.5%. 2. 50.8% of China's sports NGBs have no equal employment opportunity policy. 3. According to the preliminary qualitative analysis of the interviews, it is found that the core barriers affecting women's leadership development are mainly in the following areas: male-dominated culture and gender stereotyping (macro-level), biased organizational policies and procedures (meso-level), work-family conflicts and self-limiting behaviors (micro-level).

Keywords: women leadership, sport management, gender equality, sport leadership, sport NGBs

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Authors: Viviana Letelier, Ester Tarela, Bianca Lopez, Pedro Muñoz, Giacomo Moriconi

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The environmental impact has become a global concern during the last decades. Several alternatives have been proposed and studied to minimize this impact in different areas. The reuse of aggregates from old concretes to manufacture new ones not only can reduce this impact but is also a way to optimize the resource management. The effect of the origin of the reused aggregates from two different origin materials in recycled concrete pavement is studied here. Using the dosing applied by a pavement company, coarse aggregates in the 6.3-25 mm fraction are replaced by recycled aggregates with two different origins: old concrete pavements with similar origin strength to the one of the control concrete, and precast concrete pipes with smaller strengths than the one of the control concrete. The replacement percentages tested are 30%, 40% and 50% in both cases. The compressive strength tests are performed after 7, 14, 28 and 90 curing days, the flexural strength tests and the elasticity modulus tests after 28 and 90 curing days. Results show that the influence of the quality of the origin concrete in the mechanical properties of recycled concretes is not despicable. Concretes with up to a 50% of recycled aggregates from the concrete pavement have similar compressive strengths to the ones of the control concrete and slightly smaller flexural strengths that, however, in all cases exceed the minimum of 5MPa after 28 curing days stablished by the Chilean regulation for pavement concretes. On the other hand, concretes with recycled aggregates from precast concrete pipes show significantly lower compressive strengths after 28 curing days. The differences with the compressive strength of the control concrete increase with the percentage of replacement, reaching a 13% reduction when 50% of the aggregates are replaced. The flexural strength also suffers significant reductions that increase with the percentage of replacement, only obeying the Chilean regulation when 30% of the aggregates are recycled after 28 curing days. Nevertheless, after 90 curing days, all series obey the regulation requirements. Results show, not only the importance of the quality of the origin concrete, but also the significance of the curing days, that may allow the use of less quality recycled material without important strength losses.

Keywords: flexural strength of recycled concrete., mechanical properties of recycled concrete, recycled aggregates, recycled concrete pavements

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Authors: Jeounghee Kim

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Objective: To describe the incidence of complication, according to the stage of Traumatic Spinal Cord Injury (TSCI) which was treated at Asan Medical Center (AMC), Korea. Hereafter, it should be developed in nursing management protocol of traumatic SCI. Methods. Retrospectively reviewed hospital records about the patients who were admitted AMC Patients with traumatic spinal cord injury until January 2005 and December 2016 were analyzed (n=97). AMC is a single institution of 2,700 beds where patients with trauma and severe trauma can be treated. Patients who were admitted to the emergency room due to spinal cord injury and who underwent intensive care unit, general ward, and rehabilitation ward. To identify long-term complications, we excluded patients who were operated on to other hospitals after surgery. Complications such as respiratory(pneumonia, atelectasis, pulmonary embolism, and others), cardiovascular (hypotension), urinary (autonomic dysreflexia, urinary tract infection (UTI), neurogenic bladder, and others), and skin systems (pressure ulcers) from the time of admission were examined through medical records and images. Results: SCI was graded according to ASIA scale. The initial grade was checked at admission. (grade A 55(56.7%), grade B 14(14.4)%, grade C 11(11.3%), grade D 15(15.5%), and grade E 2(2.1%). The grade was rechecked when the patient was discharged after treatment. (grade A 43(44.3%), grade B 15(15.5%), grade C 12(12.4%), grade D 21(21.6%), and grade E 6(6.2%). The most common complication after SCI was UTI 24cases (mean 36.5day), sore 24cases (40.5day), and Pneumonia which was 23 cases after 10days averagely. The other complications after SCI were neuropathic pain 19 cases, surgical site infection 4 cases. 53.6% of patient who had SCI were educated about intermittent catheterization at discharge from hospital. The mean hospital stay of all SCI patients was 61days. Conclusion: The Complications after traumatic SCI were developed at various stages from acute phase to chronic phase. Nurses need to understand fully the time-course of complication in traumatic SCI to provide evidence-based practice.

Keywords: spinal cord injury, complication, nursing, rehabilitation

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Authors: Si Jack Chong, Chew Theng Yap, Wan Loong James Mok

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Introduction: Regional burn centres face the spectra of introduced multi-drug resistant organisms (MDRO) from transfer patients resident in MDRO endemic countries. MDRO can cause severe nosocomial infection, which in massive burn patients, will lead to greater morbidity and mortality and strain the institution financially. We aim to highlight 4 key measures that have effectively prevented transmission of imported MDRO. Methods: A case of Candida auris (C. auris) from a massive burn patient transferred from an MDRO endemic country is used to illustrate the measures. C. auris is a globally emerging multi-drug resistant fungal pathogen causing nosocomial transmission. Results: Infection control measures used to mitigate the risk of outbreak from transfer cases are: (1) Multidisciplinary team approach involving Infection Control and Infectious Disease specialists early to ensure appropriate antibiotics use and implementation of barrier measures, (2) aseptic procedures for dressing change with strict isolation and donning of personal protective equipment in the ward, (3) early screening of massive burn patient from MDRO endemic region, (4) hydrogen peroxide vaporization terminal cleaning for operating theatres and rooms. Conclusion: The prevalence of air travel and international transfer to regional burn centres will need effective infection control measures to reduce the risk of transmission from imported massive burn patients. In our centre, we have effectively implemented 4 measures which have reduced the risks of local contamination. We share a recent case report to illustrate successful management of a potential MDRO outbreak resulting from transfer of massive burn patient resident in an MDRO endemic area.

Keywords: burns, burn unit, cross infection, infection control

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Authors: Abdul Nasir Zamir

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After the downfall of Ottoman Caliphate, it scattered into different small Muslim states. Muslim leaders, intellectuals, revivalists as well as modernists started trying to boost up their nation. Some Muslims are also trying to establish the caliphate. Every Muslim country has its own political system, i.e., kingship, dictatorship or democracy, etc. But these are not in their original forms as the historian or political science discussed in their studies. The laws and their practice are mixed, i.e., others with Islamic laws, e.g., Saudi Arabia (K.S.A) and the Islamic Republic of Pakistan, etc. There is great conflict among the revivalist Muslim parties (groups) and governments about political systems. The question is that the subject matter is Sharia or political system? Leaders of Modern Muslim states are alleged as disbelievers due to neglecting the revelation in their laws and decisions. There are two types of laws; Islamic laws and management laws. The conflict is that the non-Islamic laws are in practice in Muslim states. Non-Islamic laws can be gradually changed with Islamic laws with a legal and peaceful process according to the practice of former Muslim leaders and scholars. The bloodshed of Muslims is not allowed in any case. Weak Muslim state is a blessing than nothing. The political system after Muhammad and guided caliphs is considered as kingship. But during this period Muslims not only developed in science and technology but conquered many territories also. If the original aim is in practice, then the Modern Muslim states can be stabled with different political systems. Modern Muslim states are the hope of survival, stability, and development of Muslim Ummah. Islam does not allow arm clash with Muslim army or Muslim civilians. The caliphate is based on believing in one Allah Almighty and good deeds according to Quran and Sunnah. As faith became weak and good deeds became less from its standard level, caliphate automatically became weak and even ended. The last weak caliphate was Ottoman Caliphate which was a hope of all the Muslims of the world. There is no caliphate or caliph present in the world. But every Muslim country or state is like an Amarat (a part of caliphate or small and alternate form of the caliphate) of Muslims. It is the duty of all Muslims to stable these modern Muslim states with tolerance.

Keywords: caliphate, conflict resolution, modern Muslim state, political conflicts, political systems, tolerance

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Authors: Ekaterina Sánchez Romero, Emily Gabriela Aguirre Herrera, Sandra Luz Espinoza Esquerra, Jorge García Campos

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Female, 7 months old, daughter of a mother with anemia during pregnancy, with no history of atopy in the family, since birth she presents with recurrent dermatological and gastrointestinal infections, chronically treated for recurrent diaper dermatitis. At 6 months of age, she begins with generalized pallor, hyperpigmentation in hands and feet, smooth tongue, psychomotor retardation with lack of head support, sedation, and hypoactivity. She was referred to our hospital for a fever of 38°C, severe diaper rash, and pancytopenia with HB 9.3, platelets 38000, neutrophils 0.39 MCV: 86.80 high for her age. The approach was initiated to rule out myeloproliferative syndrome, with negative immunohistochemical results of bone marrow aspirate; during her stay, she presented neurological regression, lack of sucking, and focal seizures. CT scan showed cortical atrophy. The patient was diagnosed with primary immunodeficiency due to history; gamma globulin was administered without improvement with normal results of immunoglobulins and metabolic screening. When dermatological and neurological diagnoses were ruled out as the primary cause, a nutritional factor was evaluated, and a therapeutic trial was started with the administration of vitamin B12 and zinc, presenting clinical neurological improvement and resolution of pancytopenia in 2 months. It was decided to continue outpatient management. Discussion: We present a patient with neurological, dermatological involvement, and pancytopenia, so the most common differential diagnoses in this population were ruled out. Vitamin B12 deficiency is an uncommon entity. Due to maternal and clinical history, a therapeutic trial was started resulting in an improvement. Conclusion: VitaminB12 deficiency should be considered one of the differential diagnoses in the approach to pancytopenia with megaloblastic anemia associated with dermatologic and neurologic manifestations. Early treatment can reduce irreversible damage in these patients.

Keywords: vitamin B12 deficiency, pediatrics, pancytopenia, diaper dermatitis

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