Search results for: schedule risk management

Authors: I. Ramalho, S. Campos, M. Dias

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Introduction: Endometriosis may play a role in the pathogenesis of ovarian cancer (OC), however, the risk and prognosis have not been well established. The association between these two pathologies could have an important impact on prevention and early diagnosis of OC. Objective: To analyze the prevalence of endometriosis associated ovarian cancer and related clinical, epidemiological and histopathological issues. Design: We conducted a retrospective case series analysis of patients diagnosed with endometriosis and ovarian cancer in the Gynecology Department of Coimbra University Hospital Center since 2006 to 2015. Methods: We collected data from women diagnosed with ovarian cancer, with anatomopathology records reporting findings of endometriosis in ovarian cancer patients. Patients were retrieved from the pathological records and appropriate medical records were retrospectively reviewed. Statistical analysis was performed using SPSS 22.0. Results: Histological evidence of endometriosis was found in 17 out of 261 patients diagnosed with ovarian cancer (OC) (6.51%). The most usual symptoms were pelvic pain, abdominal distension, asthenia, ascites, weight loss and nausea. Mean age at diagnosis was 61.2 ± 15.1, 41-86 years old, 33.3% were pre-menopausal patients and cancer stage distribution was predominantly stage I (31.3%) and stage III (56.3%). OC occurred unilaterally in 14 patients and 2 patients were diagnosed with a synchronous ovarian and endometrial cancer. Regarding histological type, 10 OC were classified as clear cell carcinoma (CCC), 4 endometrioid carcinomas (EC) and 3 mixed type (clear cell and endometrioid). Four ovarian carcinomas presumably arose from endometriomas: 3 CCC and 1 EC. Conclusions: In accordance with previous studies, clear cell was the most common pathological type in endometriotic patients, followed by endometrioid carcinomas, and two rare synchronous ovarian and endometrial carcinomas were registered. Although endometriosis association to OC is uncommon, endometriosis should be managed with special care in order to early diagnosis.

Keywords: endometriosis, histology, observational study, ovarian cancer

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Authors: Herke Csongor

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The artificial intelligence (AI) has been used in the United States of America in the decisionmaking process of the criminal justice system for decades. In the field of law, including criminal law, AI can provide serious assistance in decision-making in many places. The paper reviews four main areas where AI still plays a role in the criminal justice system and where it is expected to play an increasingly important role. The first area is the predictive policing: a number of algorithms are used to prevent the commission of crimes (by predicting potential crime locations or perpetrators). This may include the so-called linking hot-spot analysis, crime linking and the predictive coding. The second area is the Big Data analysis: huge amounts of data sets are already opaque to human activity and therefore unprocessable. Law is one of the largest producers of digital documents (because not only decisions, but nowadays the entire document material is available digitally), and this volume can only and exclusively be handled with the help of computer programs, which the development of AI systems can have an increasing impact on. The third area is the criminal statistical data analysis. The collection of statistical data using traditional methods required enormous human resources. The AI is a huge step forward in that it can analyze the database itself, based on the requested aspects, a collection according to any aspect can be available in a few seconds, and the AI itself can analyze the database and indicate if it finds an important connection either from the point of view of crime prevention or crime detection. Finally, the use of AI during decision-making in both investigative and judicial fields is analyzed in detail. While some are skeptical about the future role of AI in decision-making, many believe that the question is not whether AI will participate in decision-making, but only when and to what extent it will transform the current decision-making system.

Keywords: artificial intelligence, international criminal cooperation, planning and organizing of the investigation, risk assessment

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Authors: Muhammad Dildar Gogi, Muhammad Jalal Arif, Muhammad Junaid Nisar, Mubashir Iqbal, Waleed Afzal Naveed, Muhammad Ahsan Khan, Ahmad Nawaz, Muhammad Sufian, Muhammad Arshad, Amna Jalal

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Fruit flies of Bactrocera genus cause heavy losses in fruits and vegetables globally and insecticide-application for their control creates issues of ecological backlash, environmental pollution, and food safety. There is need to explore alternatives and food-baits application is considered safe for the environment and effective for fruit fly management. Present experiment was carried out to assess the attractancy of five phagostimulant-Mixtures (PHS-Mix) prepared by mixing banana-squash, mulberry, protein-hydrolysate and molasses with some phagostimulant-lure sources including beef extract, fish extract, yeast, starch, rose oil, casein and cedar oil in five different ratios i.e., PHS-Mix-1 (1 part of all ingredients), PHS-Mix-2 (1 part of banana with 0.75 parts of all other ingredients), PHS-Mix-3 (1 part of banana with 0.5 parts of all other ingredients), PHS-Mix-4 (1 part of banana with 0.25 parts of all other ingredients) and PHS-Mix-5 (1 part of banana with 0.125 parts of all other ingredients). These were evaluated in comparison with a standard (GF-120). PHS-Mix-4 demonstrated 40.5±1.3-46.2±1.6% AI for satiated flies (class-II i.e., moderately attractive) and 59.5±2.0-68.6±3.0% AI for starved flies (class-III i.e., highly attractive) for both B. dorsalis and B. zonata in olfactometric study while the same exhibited 51.2±0.53% AI (class-III i.e., highly attractive) for B. zonata and 45.4±0.89% AI (class-II i.e., moderately attractive) for B. dorsalis in field study. PHS-Mix-1 proved non-attractive (class-I) and moderately attractive (class-II) phagostimulant in olfactometer and field studies, respectively. PHS-Mix-2 exhibited moderate attractiveness for starved lots in olfactometer and field-lot in field studies. PHS-Mix-5 proved non-attractive to starved and satiated lots of B. zonata and B. dorsalis females in olfactometer and field studies. Overall PHS-Mix-4 proved better phagostimulant-mixture followed by PHS-Mix-3 which was categorized as class-II (moderately attractive) phagostimulant for starved and satiated lots of female flies of both species in olfactometer and field studies; hence these can be exploited for fruit fly management.

Keywords: attractive index, field conditions, olfactometer, Tephritid flies

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Authors: A. Sadowska, R. Polaniak, P. Boczarski, E. Grochowska-Niedworok

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Working in a shopping center 12 hours a day as a shop assistant is a very demanding and stressful job, which is still underestimated. Proper eating habits, including recommended fruits, vegetables, products rich in fiber, omega-3 fatty acids, and proper hydration, can contribute to improvement in health and make shop assistants more resistant to stress. The aim of this study was to analyze the eating habits of shop assistants working in shopping centers 12 hours a day. Participant 101 sellers from Poland filled out authorial surveys. Nearly 50% of participants consumed the recommended number of 4 to 5 meals per day. There was a slight dependence between the number of meals consumed per day and the time that employers allowed for employee mealtimes. Respondents declared that they engaged in snacking, and they generally chose fruit, chocolates, and other sweets. Survey results indicated a low liquid intake, which was about 1,05 liters daily. Mineral water was chosen most often (63%) by participants. Participant fish consumption was very low in comparison with the norms, which can pose a risk of developing omega-3 fatty acids deficiency. Shop assistants stated that a change in their eating habits was necessary. Study findings suggest a moderate dependence between being on a diet and counting calories and macronutrients contained in meals. The number of meals eaten per day is correlated with the number of meals eaten at the worksite. The percentage of snacking by shop assistants was so high that it suggested a need for more nutrition education. The topic of eating habits among shop assistants should be examined using a larger group of participants. It is necessary to note a connection between nutrition and health problems.

Keywords: eating habits, work during 12 hours a day, shopping center, nutrition

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Authors: Felipe Osorio Ospina, Maria Adelaida Mejia Arango, Esteban Onésimo Vallejo Agudelo, Victoria Lucía Dávila Osorio, Natalia Vargas Grisales, Lina María Martínez Sanchez, Camilo Andrés Agudelo Vélez, Ángela Maria Londoño García, Isabel Cristina Ortiz Trujillo

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Excessive exposure to ultraviolet radiation, has shown to be a risk factor for photodamage, alteration of the immune mechanisms to recognize malignant cells and cutaneous pro-inflamatorios States and skin cancers. Objective: Identify the time of exposure to ultraviolet radiation for the production of chromosomal damage in human lymphocytes. Methodology: We conducted an in vitro study serial, in which samples were taken from heparinized blood of healthy people, who do not submit exposure to agents that could induce chromosomal alterations. The samples were cultured in RPMI-1640 medium containing 10% fetal bovine serum, penicillin and streptomycin antibiotic. Subsequently, they were grouped and exposed to ultraviolet light for 1 to 20 seconds. At the end of the treatments, cytology samples were prepared, and it was colored with Giemsa (5%). Reading was carried out in an optical microscope and 100 metaphases analysed by treatment for posting chromosomal alterations. Each treatment was conducted at three separate times and each became two replicas. Results: We only presented chromosomal alterations in lymphocytes exposed to UV for a groups 1 to 3 seconds (p<0.05). Conclusions: Exposure to ultraviolet radiation generates visible damage in chromosomes from human lymphocytes observed in light microscopy, the highest rates of injury was observed between two and three seconds, and above this value, the reduction in the number of mitotic cells was evident.

Keywords: ultraviolet rays, lymphocytes, chromosome breakpoints, photodamage

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Authors: Felipe Osorio Ospina, Maria Adelaida Mejia Arango, Esteban Onésimo Vallejo Agudelo, Victoria Lucía Dávila Osorio, Natalia Vargas Grisales, Lina María Martínez Sanchez, Camilo Andrés Agudelo Vélez, Ángela Maria Londoño García, Isabel Cristina Ortiz Trujillo

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Excessive exposure to ultraviolet radiation, has shown to be a risk factor for photodamage, alteration of the immune mechanisms to recognize malignant cells and cutaneous pro-inflamatorios states and skin cancers. Objective: To identify the time of exposure to ultraviolet radiation for the production of chromosomal damage in human lymphocytes. Methodology: We conducted an in vitro study serial, in which samples were taken from the heparinized blood of healthy people, who do not submit exposure to agents that could induce chromosomal alterations. The samples were cultured in RPMI-1640 medium containing 10% fetal bovine serum, penicillin, and streptomycin antibiotic. Subsequently, they were grouped and exposed to ultraviolet light for 1 to 20 seconds. At the end of the treatments, cytology samples were prepared, and it was colored with Giemsa (5%). Reading was carried out in an optical microscope and 100 metaphases analysed by treatment for posting chromosomal alterations. Each treatment was conducted at three separate times and each became two replicas. Results: We only presented chromosomal alterations in lymphocytes exposed to UV for groups 1 to 3 seconds (p < 0.05). Conclusions: Exposure to ultraviolet radiation generates visible damage in chromosomes from human lymphocytes observed in light microscopy, the highest rates of injury was observed between two and three seconds, and above this value, the reduction in the number of mitotic cells was evident.

Keywords: chromosome breakpoints, lymphocytes, photodamage, ultraviolet rays

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Authors: Getnet Gedefaw, Fentanesh Endalew, Bitewush Azmeraw, Bethelhem Walelign, Eyob Shitie

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Introduction: The issue of menstrual hygiene is often overlooked and has not been sufficiently addressed in the fields of reproductive health in low and middle-income countries. Inadequate menstrual hygiene practices can increase the risk of various infectious and chronic obstetric and gynaecological complications for girls and adolescents. Hence, this study seeks to investigate the knowledge, attitudes, and practices related to menstrual hygiene, along with the factors influencing them, among high school students. Methods: A facility based cross-sectional study was conducted involving a total of 423 study subjects. A systematic random sampling technique was utilized. Data was entered and analyzed through Epi data 3.1 and SPSS 22, respectively. Both univariable and multivariable logistic regression models were employed. A p-value of less than 0.05 was considered statistically significant. Results: This study revealed that 365(89.2%), 200(48.9%) and 196(47.9%) of the study participants have good knowledge, good practice, and good attitudes about menstrual hygiene, respectively. Being higher grade students (grade 10) [AOR=3.96, 95% CI =2.0-7.8] and having good practice of menstrual hygiene (AOR=2.52, 95% CI= 1.26-5) had a positive association with menstrual hygiene knowledge. Whereas maternal education level (AOR=1.86, 95% CI=1.18-2.9) and being a grade 10 student (AOR=2.3, 95% CI=1.48-3.56) were associated factors for practising menstrual hygiene. Additionally, being higher grade students (AOR=1.9, 95% CI=1.2-2.8), age ≥18 years (AOR=1.67, 95% CI=1.09-2.55) were statistically and positively associated with the attitude of menstrual hygiene. Conclusion: The study findings indicated that the knowledge of the study participants regarding menstrual hygiene was high, while their attitudes and practices towards menstrual hygiene were low. It is suggested that raising awareness among reproductive health groups and educating their families and parents could potentially lead to a positive change in their poor practices and attitudes towards menstrual hygiene.

Keywords: menstrual hygiene, menstruation, students, reproductive health

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Authors: Ilaha Rzayeva, Emin Alasgarov, Orkhan Karim-Zada

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This study attempts to consider the linkage between management and computer sciences in order to develop the software named “IntelSymb” as a demo application to prove data analysis of non-energy* fields’ diversification, which will positively influence on energy dependency mitigation of countries. Afterward, we analyzed 18 years of economic fields of development (5 sectors) of 13 countries by identifying which patterns mostly prevailed and which can be dominant in the near future. To make our analysis solid and plausible, as a future work, we suggest developing a gateway or interface, which will be connected to all available on-line data bases (WB, UN, OECD, U.S. EIA) for countries’ analysis by fields. Sample data consists of energy (TPES and energy import indicators) and non-energy industries’ (Main Science and Technology Indicator, Internet user index, and Sales and Production indicators) statistics from 13 OECD countries over 18 years (1995-2012). Our results show that the diversification of non-energy industries can have a positive effect on energy sector dependency (energy consumption and import dependence on crude oil) deceleration. These results can provide empirical and practical support for energy and non-energy industries diversification’ policies, such as the promoting of Information and Communication Technologies (ICTs), services and innovative technologies efficiency and management, in other OECD and non-OECD member states with similar energy utilization patterns and policies. Industries, including the ICT sector, generate around 4 percent of total GHG, but this is much higher — around 14 percent — if indirect energy use is included. The ICT sector itself (excluding the broadcasting sector) contributes approximately 2 percent of global GHG emissions, at just under 1 gigatonne of carbon dioxide equivalent (GtCO2eq). Ergo, this can be a good example and lesson for countries which are dependent and independent on energy, and mainly emerging oil-based economies, as well as to motivate non-energy industries diversification in order to be ready to energy crisis and to be able to face any economic crisis as well.

Keywords: energy policy, energy diversification, “IntelSymb” software, renewable energy

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Authors: Abubakar Mukhtar Yakasai, Muhammad Tahir Jan

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Purpose: This paper is aimed at exploring factors influencing online shopping intention among the young consumers in Nigeria. Design/Methodology/approach: The paper adopted and extended Technology Acceptance Model (TAM) as the basis for literature review. Additionally, the paper proposed a framework with the inclusion of culture as a moderating factor of consumer online shopping intention among consumers in Nigeria. Findings: Despite high rate of internet penetration in Nigerian, as well as the rapid advancement of online shopping in the world, little attention was paid to this important revolution specifically among Nigeria’s consumers. Based on the review of extant literature, the TAM extended to include perceived risk and enjoyment (PR and PE) was discovered to be a better alternative framework for predicting Nigeria’s young consumers’ online shopping intention. The moderating effect of culture in the proposed model is shown to help immensely in ascertaining differences, if any, between various cultural groups among online shoppers in Nigeria. Originality/ value: The critical analysis of different factors will assist practitioners (like online retailers, e-marketing managers, website developers, etc.) by signifying which combinations of factors can best predict consumer online shopping behaviour in particular instances, thereby resulting in effective value delivery. Online shopping is a newly adopted technology in Nigeria, hence the paper will give a clear focus for effective e-marketing strategy. In addition, the proposed framework in this paper will guide future researchers by providing a tool for systematic evaluation and testing of real empirical situation of online shopping in Nigeria.

Keywords: online shopping, perceived ease of use, perceived usefulness, perceived enjoyment, technology acceptance model, Nigeria

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Authors: Cher Rong Matthew Kong, Edmund Tian, Seng Poon Ong, Chee Sian Gan

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Gamma-aminobutyric acid (GABA) is a non-protein amino acid that is a functional constituent of certain rice varieties. When consumed, it decreases blood pressure and reduces the risk of hypertension-related diseases. This has led to more research dedicated towards the development of functional food products (e.g. germinated brown rice) with enhanced GABA content, and the development of these functional food products has led to increased demand for instrument-based methods that can efficiently and effectively determine GABA content. Current analytical methods require analyte derivatisation, and have significant disadvantages such as being labour intensive and time-consuming, and being subject to analyte loss due to the increased complexity of the sample preparation process. To address this, an LC-MS-MS method for the determination of GABA in rice products has been developed and validated. This developed method involves a relatively simple sample preparation process before analysis using HILIC LC-MS-MS. This method eliminates the need for derivatisation, thereby significantly reducing the labour and time associated with such an analysis. Using LC-MS-MS also allows for better differentiation of GABA from any potential co-eluting compounds in the sample matrix. Results obtained from the developed method demonstrated high linearity, accuracy, and precision for the determination of GABA (1ng/L to 8ng/L) in a variety of brown rice products. The method can significantly simplify sample preparation steps, improve the accuracy of quantitation, and increase the throughput of analyses, thereby providing a quick but effective alternative to established instrumental analysis methods for GABA in rice.

Keywords: functional food, gamma-aminobutyric acid, germinated brown rice, method development

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Authors: Sanjay Sinha, Mohd Umair Khan

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The level of income inequality in India has been worrisome as the World Inequality Report termed it as a “poor and unequal country, with an affluent elite”. As important as income is to understand inequality and deprivation, it is just one dimension. But the historical roots and current realities of inequality and deprivation in India lies in many of the non-income dimensions such as housing, nutrition, education, agency, sense of inclusion etc. which are often ignored, especially in solution-oriented research. The level of inequality and deprivation among the tribal is one such case. There is a corpus of literature establishing that the tribal communities in India are disadvantageous on various grounds. Given their rural geography, issues of access and quality of basic facilities such as education and healthcare are often unaddressed. COVID-19 has further exacerbated this challenge and climate change will make it even more worrying. With this background, a succinct measurement tool at the village level is necessary to design short to medium-term actions with reference to risk mitigation for tribal communities. This research paper examines the level of inequality and deprivation among the tribal communities in the rural areas of Andhra Pradesh state of India using a Multidimensional Inequality and Deprivation Index based on the Alkire-Foster methodology. The methodology is theoretically grounded in the capability approach propounded by Amartya Sen, emphasizing on achieving the “beings and doings” (functionings) an individual reason to value. In the index, the authors have five domains, including Livelihood, Food Security, Education, Health and Housing and these domains are divided into sixteen indicators. This assessment is followed by domain-wise short-term and long-term solutions.

Keywords: Andhra Pradesh, Alkire-Foster methodology, deprivation, inequality, multidimensionality, poverty, tribal

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Authors: Fatma Koksal Çakirlar, Si̇nem Ozdemir, Selcan Akyol, Revazi̇ye Gulesen, Murat Gunaydin, Nevri̇ye Gonullu, Belkis Levent, Nuri̇ Kiraz

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Vibrio cholerae O1 and O139 are the causative agent of epidemic or pandemic cholera. V. cholerae O1 is generally accepted as a non-invasive enterotoxigenic organism causing gastroenteritis of various severities. Non-O1 V. cholerae can cause small outbreaks of diarrhea due to consumption of contaminated food and water. Particularly, the patients with achlorydria have a risk for vibrio infections. There are numerous case reports of bacteremia caused by vibrio in patients with predisposing conditions like cirrhosis, nephrotic syndrome, diabetes, hematologic malignancy, gastrectomy, and AIDS. We described in this study the first case of nontoxigenic, non-01/non-O139 V. cholerae isolated from the blood culture of a 77-year-old female patient with hipertension, diabetes, coronary artery disease, gout and about 9 years ago migrated breast cancer history. The patient with complaints of shortness of breath, fever and malaise admitted to our emergency clinic were evaluated. There was no diarrhea or abdominal symptoms in the patient. No growth in her urine culture, but blood culture (BACTEC 9120 system, Becton Dickinson, USA) was positive for non-01/non-O139 V. cholerae that was identified by conventional methods and Phoenix automated system (BD Diagnostic Systems, Sparks, MD). It does not secrete the cholera toxin. The agglutination test was negative with polyvalent O1 antisera and O139 antiserum. Empirically ceftriaxone was administered to the patient and she was discharged with improvement in general condition. In this study we report bacteremia by non-01/non-O139 V. cholerae that is rare in the worldwide and first in Turkey.

Keywords: bacteremia, blood culture, immunocompromised patient, Non-O1 vibrio cholerae

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Authors: Eder Amayuelas, Begoña Bazán, M. Karmele Urtiaga, Gotzone Barandika, María I. Arriortua

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Metal Organic Frameworks (MOFs) have attracted great interest in recent years, taking a lead role in the field of catalysis, drug delivery, sensors and absorption. In the past decade, promising results have been reported specifically in the field of adsorption, based on the topology and chemical features of this type of porous material. Thus, its application in industry and environment for the adsorption of pollutants is presented as a response to an increasingly important need. In this area, organic dyes are nowadays widely used in many industries including medicine, textile, leather, printing and plastics. The consequence of this fact is that dyes are present as emerging pollutants in soils and water where they remain for long periods of time due to their high stability, with a potential risk of toxicity in wildlife and in humans. On the other hand, the presence of iodine in soils, water and gas as a nuclear activity pollutant product or its extended use as a germicide is still a problem in many countries, which indicates the imperative need for its removal. In this context, this work presents the characterization as an adsorbent of the activated compound αMOP@Ei2-1 obtained from the already reported [Cu₂₄(m-BDC)₂₄(DMF)₂₀(H₂O)₄]•24DMF•40H₂O (MOP@Ei2-1), where m-BDC is the 1,3-benzenedicarboxylic ligand and DMF is N,N′-dimethylformamide. The structure of MOP@Ei2-1 consists of Cu24 clusters arranged in such a way that 12 paddle-wheels are connected through m-BDC ligands. The clusters exhibit an internal cavity where crystallization molecules of DMF and water are located. Adsorption of dyes and iodine as pollutant examples has been carried out, focusing attention on the kinetics of the rapid process.

Keywords: adsorption, organic dyes, iodine, metal organic frameworks

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Authors: Pui Hong Chung, Wing Chi Ho, Jun Li, Cyrus Leung, Ek Yeoh

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Background: Cigarette smoking is associated with poor tuberculosis (TB) outcomes in terms of progression of active TB, relapse of TB and TB-related mortality, but the association with latent tuberculosis infection (LTBI) is unclear. The systematic review conducted aimed at studying the association between active smoking and LTBI, and likelihood of dose-response relationship. Methods: Two independent reviewers searched three electronic databases comprising PudMed, Medline by EBSCOHOST, ExcerptaMedica Database (EMBASE), from inception up to 31st Dec 2015 for studies reporting data on current smoking and the LTBI with tuberculin skin test (TST) or interferon-γ release assays (IGRAs) results, comparing the odds ratios (ORs) of outcome measure of TST or IGRAs among current smokers with 95% confidence intervals (CI). Results: Seven studies were identified, including six cross-sectional studies and one longitudinal cohort study. The outcome measures from three studies were in TST, three studies in IGRAs and one for both tests. For TST, OR ranging from 1.39 to 3.40 (95% CI) with all studies shown positive association between cigarette smoking and LTBI. For IGRAs, OR ranging from 0.47 to 1.89 (95% CI) with one study shown the negative association that might be related to impaired interferon-gamma production in immunosuppressive persons. One identified study demonstrated positive dose-response relationship in TST result. Conclusions: Cigarette smoking is likely to be a risk factor of LTBI. There is the important implication for TB and tobacco control program to halt TB by empowering public health policy. Further study is also needed to provide more evidence of the dose-response model/relationship.

Keywords: latent tuberculosis infection, systematic review, active smoking, model

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Authors: Hilal Al Shamsi, Abdullah Almutairi

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Introduction: As primary healthcare centres play an important role in implementing Saudi Arabia’s health strategy, this paper offers a review of publications on the quality of the country’s primary health care. With the aim of deciding on solutions for improvement, it provides an overview of healthcare quality in this context and indicates barriers to quality. Method: Using two databases, ProQuest and Scopus, data extracted from published articles were systematically analysed for determining the care quality in Saudi primary health centres and obstacles to achieving higher quality. Results: Twenty-six articles met the criteria for inclusion in this review. The components of healthcare quality were examined in terms of the access to and effectiveness of interpersonal and clinical care. Good access and effective care were identified in such areas as maternal health care and the control of epidemic diseases, whereas poor access and effectiveness of care were shown for chronic disease management programmes, referral patterns (in terms of referral letters and feedback reports), health education and interpersonal care (in terms of language barriers). Several factors were identified as barriers to high-quality care. These included problems with evidence-based practice implementation, professional development, the use of referrals to secondary care and organisational culture. Successful improvements have been implemented by other systems, such as mobile medical units, electronic referrals, online translation tools and mobile devices and their applications; these can be implemented in Saudi Arabia for improving the quality of the primary healthcare system in this country. Conclusion: The quality of primary health care in Saudi Arabia varies among the different services. To improve quality, management programmes and organisational culture must be promoted in primary health care. Professional development strategies are also needed for improving the skills and knowledge of healthcare professionals. Potential improvements can be implemented to improve the quality of the primary health system.

Keywords: quality, primary health care, Saudi Arabia, health centres, general medical

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Authors: Sa’idu A. Abdullah, Jafar Lawan, A. U. Adamu, Fowotade, S. A., Hamisu Abdu

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Scarcity of quality water in many communities compels inhabitants to use any available water resources for domestic, recreational, industrial and agricultural purposes. Global concern on the potential health hazards of anthropogenic inputs into our ecosystems imposes the need for constant monitoring of levels of pollutants in order to ensure compliance with internationally acceptable criteria. In this research, assessment of bioaccumulation of Cd, Co, Cu, Pb and Zn was carried out using tissues of Ipomoea batatas (sweet potato) and Manihot esculenta (cassava) irrigated with water from Muhammad Ayuba Dam in Kazaure, Jigawa State. The metal concentrations were determined using Flame Atomic Absorption Spectrophotometer (FAAS). The result of the analysis revealed the presence of the metals in varying concentrations. Cd and Co showed higher concentrations in the tubers of Manihot esculenta but all the other investigated metals were more concentrated in the leaves of the plant. Cd and Cu on the other hand showed higher concentration in the root of Ipomoea batatas while the remaining investigated metals were concentrated more in the leaves of the plant. The result of analysis of water samples from five sampling stations in the Dam showed the presence of the metals as follows: Cd, (0.063±0.02 mg/L), Co (0.086±0.03 mg/L), Cu (0.167±0.08 mg/L), Pb (0.22±0.01 mg/L) and Zn (0.047±0.01 mg/L) respectively. The results of bioaccumulation studies using the Bioaccumulation Factors (BAF) index indicated Ipomoea batatas to have higher bioaccumulation potential for Cd, Co and Cu while Pb and Zn were more accumulated in Manihot esculenta. The levels of the metals in both the water samples and plant tissues were all below the WHO permissible limit. This is indicative that the inhabitants of the community under investigation are not at any health risk.

Keywords: agriculture, bioaccumulation, heavy metal, plant tissues

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Authors: Saeed Poormoaied, Zumbul Atan

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Emergency shipments provide a powerful mechanism to alleviate the risk of imminent stock-outs and can result in substantial benefits in an inventory system. Customer satisfaction and high service level are immediate consequences of utilizing emergency shipments. In this paper, we consider a single-echelon periodic review inventory system consisting of a single local warehouse, being replenished from a central warehouse with ample capacity in an infinite horizon setting. Since the structure of the optimal policy appears to be complicated, we analyze this problem under an order-up-to-S inventory control policy framework, the (S, T) policy, with the emergency shipment consideration. In each period of the periodic review policy, there is a single opportunity at any point of time for the emergency shipment so that in case of stock-outs, an emergency shipment is requested. The goal is to determine the timing and amount of the emergency shipment during a period (emergency shipment policy) as well as the base stock periodic review policy parameters (replenishment policy). We show that how taking advantage of having an emergency shipment during periods improves the performance of the classical (S, T) policy, especially when fixed and unit emergency shipment costs are small. Investigating the structure of the objective function, we develop an exact algorithm for finding the optimal solution. We also provide a heuristic and an approximation algorithm for the periodic review inventory system problem. The experimental analyses indicate that the heuristic algorithm is computationally more efficient than the approximation algorithm, but in terms of the solution efficiency, the approximation algorithm performs very well. We achieve up to 13% cost savings in the (S, T) policy if we apply the proposed emergency shipment policy. Moreover, our computational results reveal that the approximated solution is often within 0.21% of the globally optimal solution.

Keywords: emergency shipment, inventory, periodic review policy, approximation algorithm.

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Authors: Irfan Abdulrahman Sheth, Sohil Pothiawala

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Dermatomyositis is an idiopathic inflammatory myopathy, traditionally characterized by a progressive, symmetrical proximal muscle weakness and pathognomonic or characteristic cutaneous manifestations. We report a case of a 60-year old Chinese female who was referred from polyclinic for allergic rash over the body after applying hair dye 3 weeks ago. It was associated with puffiness of face, shortness of breath and hoarse voice since last 2 weeks with decrease effort tolerance. She also complained of dysphagia/ myalgia with progressive weakness of proximal muscles and palpitations. She denied chest pain, loss of appetite, weight loss, orthopnea or fever. She had stable vital signs and appeared cushingoid. She was noted to have rash over the scalp/ face and ecchymosis over the right arm with puffiness of face and periorbital oedema. There was symmetrical muscle weakness and other neurological examination was normal. Initial impression was of allergic reaction and underlying nephrotic syndrome and Cushing’s syndrome from TCM use. Diagnostic tests showed high Creatinine kinase (CK) of 1463 u/l, CK–MB of 18.7 ug/l and Troponin –T of 0.09 ug/l. The Full blood count and renal panel was normal. EMG showed inflammatory myositis. Patient was managed by rheumatologist and discharged on oral prednisolone with methotrexate/ ergocalciferol capsule and calcium carb, vitamin D tablets and outpatient follow up. In some patients, cutaneous disease exists in the absence of objective evidence of muscle inflammation. Management of dermatomyositis begins with careful investigation for the presence of muscle disease or of additional systemic involvement, particularly of the pulmonary, cardiac or gastrointestinal systems, and for the possibility of an accompanying malignancy. Muscle disease and systemic involvement can be refractory and may require multiple sequential therapeutic interventions or, at times, combinations of therapies. Thus, we want to highlight to the physicians that the cutaneous disease of dermatomyositis should not be confused with allergic reaction. It can be particularly challenging to diagnose. Early recognition aids appropriate management of this group of patients.

Keywords: dermatomyositis, myopathy, allergy, cutaneous disease

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Authors: Nouira Mariem, Ennigrou Samir

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Background and aims: Healthcare-associated infections (HAI) represent a major public health problem worldwide. They represent one of the most serious adverse events in health care. The objectives of our study were to estimate the prevalence of HAI at the Charles Nicolle Hospital (CNH) and to identify the main associated factors as well as to estimate the frequency of antibiotic use. Methods: It was a cross-sectional study at the CNH with a unique passage per department (October-December 2018). All patients present at the wards for more than 48 hours were included. All patients from outpatient consultations, emergency, and dialysis departments were not included. The site definitions of infections proposed by the Centers for Disease Control and Prevention (CDC) were used. Only clinically and/or microbiologically confirmed active HAIs were included. Results: A total of 318 patients were included, with a mean age of 52 years and a sex ratio (female/male) of 1.05. A total of 41 patients had one or more active HAIs, corresponding to a prevalence of 13.1% (95% CI: 9.3%-16.9%). The most frequent site infections were urinary tract infections and pneumonia. Multivariate analysis among adult patients (>=18 years) (n=261) revealed that infection on admission (p=0.01), alcoholism (p=0.01), high blood pressure (p=0.008), having at least one invasive device inserted (p=0.004), and history of recent surgery (p=0.03), increased the risk of HAIs significantly. More than 1 of 3 patients (35.4%) were under antibiotics on the day of the survey, of which more than half (57.4%) were under two or more types of antibiotics. Conclusion: The prevalence of HAIs and antibiotic prescriptions at the CNH were considerably high. An infection prevention and control committee, as well as the development of an antibiotic stewardship program with continuous monitoring using repeated prevalence surveys, must be implemented to limit the frequency of these infections effectively.

Keywords: prevalence, healthcare associated infection, antibiotic, Tunisia

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Authors: Rishana Bilimoria, Selina Tang, Sajni Shah, Marianne Henien, Christopher Sproat

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Temporomandibular disorders (TMD) may affect up to a third of the general population, and there is evidence demonstrating the majority of Myofascial TMD cases improve after education and conservative measures. In 2015 our department implemented a modified care pathway for myofascial TMD patients in an attempt to improve the patient journey. This involved the use of an interactive group therapy approach to deliver education, reinforce conservative measures and promote self-management. Patient reported experience measures from the new group clinic revealed 71% patient satisfaction. This service is efficient in improving aspects of health status while reducing health-care costs and redistributing clinical time. Since its’ establishment, 52 hours of clinical time, resources and funding have been redirected effectively. This Quality Improvement Project was initiated because it was felt that this new service was being underutilised by our surgical teams. The ‘Plan-Do-Study-Act cycle’ (PDSA) framework was employed to analyse utilisation of the service: The ‘plan’ stage involved outlining our aims: to raise awareness amongst clinicians of the unified care pathway and to increase referral to this clinic. The ‘do’ stage involved collecting data from a sample of 96 patients over 4 month period to ascertain the proportion of Myofascial TMD patients who were correctly referred to the designated clinic. ‘Suitable’ patients who weren’t referred were identified. The ‘Study’ phase involved analysis of results, which revealed that 77% of suitable patients weren’t referred to the designated clinic. They were reviewed on other clinics, which are often overbooked, or managed by junior staff members. This correlated with our original prediction. Barriers to referral included: lack of awareness of the clinic, individual consultant treatment preferences and patient, reluctance to be referred to a ‘group’ clinic. The ‘Act’ stage involved presenting our findings to the team at a clinical governance meeting. This included demonstration of the clinical effectiveness of the care-pathway and explaining the referral route and criteria. In light of the evaluation results, it was decided to keep the group clinic and maximize utilisation. The second cycle of data collection following these changes revealed that of 66 Myofascial TMD patients over a 4 month period, only 9% of suitable patients were not seen via the designated pathway; therefore this QIP was successful in meeting the set objectives. Overall, employing the PDSA cycle in this QIP resulted in appropriate utilisation of the modified care pathway for patients with myofascial TMD in Guy’s Oral Surgery Department. In turn, this leads to high patient satisfaction with the service and effectively redirected 52 hours of clinical time. It permitted adoption of a collaborative working style with oral surgery colleagues to investigate problems, identify solutions, and collectively raise standards of clinical care to ensure we adopt a unified care pathway in secondary care management of Myofascial TMD patients.

Keywords: myofascial, quality Improvement, PDSA, TMD

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Authors: Omar Bataineh

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Total productive maintenance (TPM) is a principle-based method that aims to get a high-level production with no breakdowns, no slow running and no defects. Key principles of TPM were applied in this work to improve the performance of the glass production line at United Beverage Company in Kuwait, which is producing bottles of soft drinks. Principles such as 5S as a foundation for TPM implementation, developing a program for equipment management, Cause and Effect Analysis (CEA), quality improvement, training and education of employees were employed. After the completion of TPM implementation, it was possible to increase the Overall Equipment Effectiveness (OEE) from 23% to 40%.

Keywords: OEE, TPM, FMEA, CEA

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Authors: Baguma Charles Abwooli

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Whereas they profess to be comrades in the fight to save souls, Born Again Churches in Uganda are shooting each other in the foot over yet to be understood reasons. For a long time, churches have sustained a bitter divide among themselves. The country has witnessed pastoral scandals, including church leaders dragging each other to court, setting each other’s churches ablaze, and even plotting assassination against each her. The most dreadful was when one pastor called a chest-thumping press conference at the demise of another. There is even an emergence of church-owned radio stations purposed to fuel this conflict. Worse still, the division among pastors has been transferred to their congregations to extent that at the first meeting, congregants ask each other where they pray from perhaps to know how to deal with each other. This has caused the born-again to maintain factions among themselves and keeping ready to fight in case there is a battle. This is quite a risk to peace and stability in the country. This kind of belligerence not only defeats the very existence of churches but is a threat to national peace and security, especially as the churches mushroom across the country. It is feared that the vice could spread to the rest of Eastern Africa and beyond, given the connectivity. There is already evidence to this. One Pastor was heard to call the late Ghanaian Pastor T. B. Joshua, a witch who has been training witches in Uganda. He said this at his demise while referring to pastors that subscribe to T. B. Joshua’s approach to preaching the Gospel. This is an abomination, especially in Africa! There is, therefore, an urgent need to understand the roots of this conflict and design measures to decisively manageit. The present study employs tools based on conflict resolution theory to conduct a deep qualitative analysis of the origin and progression of the Born-Againconflict in Uganda with intend to make recommendations of appropriate measures to resolve it.

Keywords: uganda, shooting, pulpit, born again churches

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Authors: Zerubabel Mihret

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Background: Work-related stress is a pattern of reactions to work demands unmatched by worker’s knowledge, skills, or abilities. Healthcare institutions are considered high-risk and intensive work areas for work-related stress. However, there is the nonexistence of clear and strong data about the magnitude of work-related stress on sanitation workers in hospitals in Ethiopia. The aim of this study was to determine the magnitude of work-related stress among sanitation workers in public hospitals during COVID-19 in Addis Ababa, Ethiopia. Methods: Institution-based cross-sectional study was conducted from October 2021 to February 2022 among 494 sanitation workers who were selected from 4 hospitals. HSE (Health and Safety Executive of UK) standard data collection tool was used, and an interviewer-administered questionnaire was used to collect the data using KOBO collect application. The collected data were cleaned and analyzed using SPSS version 20.0. Both binary and multivariable logistic regression analyses were done to identify important factors having an association with work-related stress. Variables with p-value ≤ 0.25 in the bivariate analysis were entered into the multivariable logistic regression model. A statistically significant level was declared at a p-value ≤ 0.05. Results: This study revealed that the magnitude of work-related stress among sanitation workers was 49.2% (95% CI 45-54). Significant proportions (72.7%) of sanitation workers were dissatisfied with their current job. Sex, age, experience, and chewing khat were significantly associated with work-related stress. Conclusion: Work-related stress is significantly high among sanitation workers. Sex, age, experience, and chewing khat were identified as factors associated with work-related stress. Intervention program focusing on the prevention and control of stress is desired by hospitals.

Keywords: work-related stress, sanitation workers, Likert scale, public hospitals, Ethiopia

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Authors: Jolanta Jonak

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All students demonstrate various learning preferences and learning styles that range from visual, auditory to kinesthetic preferences. These learning preferences are further impacted by individual cognitive profiles hat characterizes itself in linguistic strengths, logical- special, inter-or intra- personal, just to name a few. Students from culturally and linguistically diverse backgrounds (CLD) have an increased risk of being misunderstood by many school systems and even medical personnel. Students with disability, specifically Autism, are faced with another layer of learning differences. Research indicates that large numbers of students are not provided the type of education and types of supports they need in order to be successful in an academic environment. Multiple research findings indicate that significant numbers of school staff self-reports that they do not feel adequately prepared to work with students with disability and different learing profiles. It is very important for the school staff to be educated about different learning needs of students with autism spectrum disorders. Having the knowledge, school staff can avoid unnecessary referrals for office referrals and avoid inaccurate decisions about restrictive learning environments. This presentation will illustrate the cognitive differences in students with autism, how to recognize them, and how to support them through Differentiated Instruction. One way to ensure successful education for students with disability is by providing Differentiated Instruction (DI). DI is quickly gaining its popularity in the Unites States as a scientific- research based instructional approach for all students. This form of support ensures that regardless of the students’ learning preferences and cognitive learning profiles, they have an opportunity to learn through approaches that are suitable to their needs. It is extremely important for the school staff, especially school psychologists who often are the first experts to be consulted by educators, to be educated about differences due to learning preference styles and differentiation needs.

Keywords: special education, autism, differentiation, differences, differentiated instruction

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Authors: Samipraj Mishra

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Despite the successful implementation of community forestry program, a number of pros and cons have been raised on Terai community forestry in the case of lowland locally called Terai region of Nepal, which is climatically belongs to tropical humid and possessed high quality forests in terms of ecology and economy. The study aims to investigate the local pricing strategy of forest products and its impacts on equitable forest benefit sharing, collection of community fund and carrying out livelihood improvement activities. The study was carried out on six community forests revealed that local people have substantially benefited from the community forests. However, being the region is heterogeneous by socio-economic conditions and forest resources have higher economical potential, the decision of low pricing strategy made by the local people have created inequality problems while sharing the forest benefits, and poorly contributed to community fund collection and consequently carrying out limited activities of livelihood improvement. The paper argued that the decision of low pricing strategy of forest products is counter-productive to promote the equitable benefit sharing in the areas of heterogeneous socio-economic conditions with high value forests. The low pricing strategy has been increasing accessibility of better off households at higher rate than poor; as such households always have higher affording capacity. It is also defective to increase the community fund and carry out activities of livelihood improvement effectively. The study concluded that unilateral decentralized forest policy and decision-making autonomy to the local people seems questionable unless their decision-making capacities are enriched sufficiently. Therefore, it is recommended that empowerment of decision-making capacity of local people and their respective institutions together with policy and program formulation are prerequisite for efficient and equitable community forest management and its long-term sustainability.

Keywords: community forest, livelihood, socio-economy, pricing system, Nepal

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Authors: Chia-Chen Hsieh, Fei-Hsiu Hsiao

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Objective: To examine the effects of supportive care interventions on depressive symptoms in patients with lung cancer. Methods: The databases of Cochrane Central Register of Controlled Trials (CENTRAL), Ovid EMBASE, PubMed, and Chinese Electronic Periodical Services (CEPS) were searched from their inception until September 2015. We included the studies with randomized controlled trial design that compared standard care with supportive care interventions using psychotherapeutic or exercises approach. The standardized mean differences (SMD) (Cohen’s d) were calculated to estimate the treatment effects. The Cochrane Risk of Bias Tool was used for quality assessment and subgroup analysis was conducted to identify possible sources of heterogeneity. Results: A total of 1472 patients with lung cancer were identified. Compared with standard care, the overall effects of all supportive care interventions significantly reduced depressive symptoms (SMD = -0.74 with 95% CI = -1.07 to -0.41), and the effect was maintained at the 4th, 8th, and 12th weeks of follow-up. Either psychotherapy combined with psychoeducation or exercise alone produced significant improvements in depressive symptoms, while psychoeducation alone did not. The greater improvements in depressive symptoms occurred in lung cancer patients with severe depressive symptoms at baseline, total duration of interventions of less than ten weeks, and intervention provided through face-to-face delivery. Conclusions: Psychotherapy combined with psychoeducation can help patients manage the causes of depressive symptoms, including both symptom distress and psychological trauma due to lung cancer. Exercise can target the impaired respiratory function that is a cause of depressive symptoms in lung cancer patients.

Keywords: supportive care intervention, depressive symptoms, lung cancer, meta-analysis

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Authors: Ionela-Daniela Carja, Diana Serbezeanu, Tachita Vlad-Bubulac, Corneliu Hamciuc

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Nowadays, epoxy materials are extensively used in ever more areas and under ever more demanding environmental conditions due to their remarkable combination of properties, light weight and ease of processing. However, these materials greatly increase the fire risk due to their flammability and possible release of toxic by-products as a result of their chemical composition which consists mainly from carbon and hydrogen atoms. Therefore, improving the fire retardant behaviour to prevent the loss of life and property is of particular concern among government regulatory bodies, consumers and manufacturers alike. Modification of epoxy resins with organophosphorus compounds, as reactive flame retardants or additives, is the key to achieving non-flammable advanced epoxy materials. Herein, a detailed characterization of fire behaviour for a series of phosphorus-containing epoxy thermosets is reported. A carefully designed phosphorus flame retardant additive was simply blended with a bifunctional bisphenol-A based epoxy resin. Further thermal cross-linking in the presence of various aminic hardeners led to eco-friendly flame retardant epoxy resins. The type of hardener, concentration of flame retardant additive, compatibility between the components of the mixture, char formation and morphology, thermal stability, flame retardant mechanisms were investigated. It was found that even a very low content of phosphorus introduced into the epoxy matrix increased the limiting oxygen index value to about 30%. In addition, the peak of the heat release rate value decreased up to 45% as compared to the one of the neat epoxy system. The main flame retardant mechanism was the condensed-phase one as revealed by SEM and XPS measurements.

Keywords: condensed-phase mechanism, eco-friendly phosphorus flame retardant, epoxy resin, thermal stability

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Authors: Almutazballlah Qablan, Jihan M. Muhaidat, Bana Abu Rajab

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Background: Acne vulgaris is the most common skin condition that general practitioners and dermatologists encounter. It represents a chronic inflammatory disease affecting the pilosebaceous unit. Although acne vulgaris is not a life-threatening condition, it has a considerable psychological impact on the affected person. Acne patients have poor body image, low self-esteem, social isolation, and restricted activities. As part of the emotional impact, increased levels of anxiety, anger, depression, and frustration have also been observed in acne patients. (1) In this study, we want to assess the association between two modifiable risk factors; BMI and smoking, regarding acne vulgaris. Methods: A case-control study was conducted at King Abdullah University Hospital in Irbid, north Jordan in 2019/2020. A total number of 163 Acne cases were collected and interviewed by the author; on the other hand, there were 162 control cases. Anthropometric measures for Acne patients and control individuals were taken, and BMI was calculated. Both groups were asked about smoking habits. Data on subjects between 14 and 33 years of age were extracted. The characteristics of people who reported acne were compared with those with no acne using univariate and multivariate analysis. The Statistical Package for Social Sciences (SPSS) was relied on to analyze the collected data. The crosstabs methods (chi-square) and odd ratios were relied on to test the study hypothesis. Results: Cigarette smoking was highly associated with no-acne, with an odds ratio of 0.4 (95% CI: 0.2–0.9), P-value = 0.018. BMI and waterpipe smoking were not significantly associated with acne in the multivariate analysis. Conclusion: Cigarette smoking was found to be protective from Acne. No significant relation between BMI nor waterpipe smoking and the development of Acne Vulgaris.

Keywords: acne, BMI, smoking, case-control

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Authors: Damayanti Sen

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The Fair and Equitable Treatment standard has emerged as a core tenet of a formulated legal structure aimed at encouraging investment through the granting of a secure and stable environment for the investor in the Host State. As an absolute, non-contingent standard, it constitutes an independent and reliable system for the protection of the investor and is frequently invoked and applied in investor-state dispute settlement under bilateral and multilateral investment treaties. Thus far, the standard has been examined principally as a measure for determining the responsibility of host countries towards investors and investments. The conduct of investor in applying the Fair and Equitable Treatment Standard is relatively unexplored. Such an assessment may be necessary in light of the development of new defenses to demands of host governments to confine the application of the standard in order to ensure a proper balance between the protection of investors and the inherent right of a State to regulate economic conduct within its borders. This paper explores the implications of including considerations of investor conduct in the determination of whether an act of the host country’s administrative and/or judicial authorities has breached the fair and equitable treatment principle. The need for such defenses are of special concern for governments of developing countries, whose limited resources can affect their ability to provide an effective evaluation of the nature of the proposed investment, and, subsequently, to ensure that the expected benefits are realized. On the basis of conceptual analysis, and emerging international judicial and arbitral case law, this paper suggests that investor duties such as, the avoidance of unconscionable conduct, the reasonable assessment of investment risk in the host country, and a duty to operate an investment reasonably are leading to a new limit upon the fair and equitable treatment standard- one that can be succinctly captured in the phrase “Caveat Investor”.

Keywords: BITs, FET Standard, investor behavior, arbitral case law

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Authors: Zineb Taidirt, Fathia Sebahi, Mohamed Karim Guarchani, Anissa Berkane, Noureddine Smail, Ouahiba Hadjoudj

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Cardiovascular diseases are one of the most important causes of death in Algeria. Several risk factors are responsible for this, including the consumption of foods containing saturated fat and trans fatty acids TFAs. This brief presents the results of a descriptive study of the lipid composition of 251 food products marketed in Algeria. The objective of the study is to describe the nature and composition of lipids and to verify the compliance of saturated and trans fatty acids intakes with the regulations. The study is based on data from the nutrition labelling of marketed food products. The results showed that the lipids in foodstuffs are diverse in nature and of varying amounts, but their nature is not specified on all products. In addition, the required content of saturated fatty acids is mentioned only in 29.48% of the products; 21.62% of them do not comply with the standard. Hydrogenation of fats, which produced Trans fatty acids, is common: 19.92% of products contain hydrogenated fats, and 74.89% may contain them according to the aspect of the lipid (solid fat). However, the trans fatty acid content is only mentioned in 5.18% of the products. The latter is above the limits set by Algerian regulations in 50% of the butter samples studied. The composition of lipids in mono- and polyunsaturated fatty acids essential for the body is insufficient: only 13.94% of the products inform their contents on their labels. It is necessary to adopt mandatory restriction of trans fatty acids, to ban the use of partially-hydrogenated oils, and to require required mandatory labeling of the TFAs and the other fatty acids on packaged foods, and to conduct more studies in order to appreciate the intake of TFAs and saturated fat and appreciate their effects on the Algerian population and to get more informed about the composition of the lipid in packaged foods.

Keywords: cardiovascular diseases, lipids, nutrition labelling, lipids, trans fatty acids

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