Search results for: health economy

Authors: Tadesse Melaku Abegaz

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Background: there was paucity of data on the self-reported adverse drug reactions (ADRs), level of adherence and clinical outcomes with antidepressants among major depressive disorder (MDD) patients in Ethiopia. Hence, the present study sought to determine the level of adherence for and clinical outcome with antidepressants and the magnitude of ADRs. Methods: A prospective cross-sectional study was employed on MDD patients from September 2016 to January 2017 at Gondar university hospital psychiatry clinic. All patients who were available during the study period were included under the study population. The Naranjo adverse drug reaction probability scale was employed to assess the adverse drug reaction. The rate of medication adherence was determined using morisky medication adherence measurement scale eight. Clinical Outcome of patients was measured by using patient health questionnaire. Multivariable logistic carried out to determine factors for adherence and patient outcome. Results: two hundred seventy patients were participated in the study. More than half of the respondents were males 122(56.2%). The mean age of the participants was 30.94 ± 8.853. More than one-half of the subjects had low adherence to their medications 124(57.1%). About 186(85.7%) of patients encountered ADR. The most common ADR was weight gain 29(13.2). Around 198(92.2%) ADRs were probable and 19(8.8%) were possible. Patients with long standing MDD had high risk of non-adherence COR: 2.458[4.413-4.227], AOR: 2.424[1.185-4.961]. More than one-half 125(57.6) of respondents showed improved outcome. Optimal level of medication adherence was found to be associated with reduced risk of progression of the diseases COR: 0.37[0.110-5.379] and AOR: 0.432[0.201-0.909]. Conclusion: Patient reported adverse drug reactions were more prevalent in major depressive disorder patients. Adherence to medications was very poor in the setup. However, the clinical outcome was relatively higher. Long standing depression was associated with non-adherence. In addition, clinical outcome of patients were affected by non-adherence. Therefore, adherence enhancing interventions should be provided to improve medication adherence and patient outcome.

Keywords: adverse drug reactions, clinical outcomes, Ethiopia, prospective study, medication adherence

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Authors: Shivalaxmi Arumugham

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Child sexual abuse (CSA) has taken several forms, particularly with the advent of internet technologies that provide pedophiles access to their targets anonymously at an affordable rate. To combat CSA which has far-reaching consequences on the physical and psychological health of the victims, a special act, the Protection of Children from Sexual Offences (POCSO) Act, was formulated amongst the existing laws. With its latest amendment criminalizing various online activities about child pornography also known as child sexual abuse materials in 2019, tremendous pressure is speculated on law enforcement to identify offenders online. Effective investigations of CSA cases help in not only to detect perpetrators but also in preventing the re-victimization of children. Understanding the vulnerability of the child population and that the offenders continue to develop stealthier strategies to operate, it is high time that traditional investigation, where the focus is on apprehending and prosecuting the offender, must make a paradigm shift to proactively investigate to prevent victimization at the first place. One of the proactive policing techniques involves understanding the psychology of the offenders and children and operating undercover to catch the criminals before a real child is victimized. With the fundamental descriptive approach to research, the article attempts to identify the multitude of issues associated with the investigation of child sexual abuse cases currently in practice in India. Then, the article contextualizes the various covert operations carried out by numerous law enforcement agencies across the globe. To provide this comprehensive overview, the paper examines various reports, websites, guidelines, protocols, judicial pronouncements, and research articles. Finally, the paper presents the challenges and ethical issues that are to be considered before getting into undercover operations either in the guise of a pedophile or as a child. The research hopes to contribute to the making of standard operating protocols for investigation officers and other relevant policymakers in this regard.

Keywords: child sexual abuse, cybercrime against children, covert police operations, investigation of CSA

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Authors: Cleto J. Sauer Jr., Rita C. Sauer, Chaider G. Andrade, Dóris F. Rabelo

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Some patients with COVID-19 disease and difficult airway characteristics undergo to endotracheal intubation (ETI) procedure. The tracheal introducer, known as the bougie guide, can aid ETI in patients with difficult airway pattern. Realistic simulation (RS) is a methodology utilized for healthcare professionals training. To improve skills in using the bougie guide of physicians from Recôncavo da Bahia region in Brazil, during COVID-19 outbreak, RS training was carried out. Simulated scenario included the Nasco Lifeform realistic simulator for ETI and a bougie guide introducer. Training was a capacitation program organized by the Health Department of Bahia State. Objective: To report effects in participants´ self-confidence perception for using bougie guide after a RS based training. Methods: Descriptive study, secondary data extracted from questionnaires. Priority workplace and previous knowledge about bougie were reported on a preparticipation formulary. Participants also completed pre- and post-training qualitative self-assessment (10-point Likert scale) regarding to self-confidence in using bougie guide. Distribution analysis for qualitative data was performed with Wilcoxon Signed Rank Test, and self-confidence increase analysis in frequency contingency tables with Fisher's exact test. Results: From May to June 2020 a total of 36 physicians participated of training, 25 (69%) from primary care setting, 32 (89%) with no previous knowledge about the bougie guide utilization. For those who had previous knowledge about bougie pre-training self-confidence median was 6,5, and 2 for participants who had not. In overall there was an increase in self-confidence median for bougie utilization. Median (variation) before and after training was 2.5 (1-7) vs. 8 (4-10) (p <0.0001). Among those who had no previous knowledge about bougie (n = 32) an increase in self-confidence greater than 3 points for bougie utilization was reported by 31 vs. 1 participants (p = 0.71). Conclusions: Most of participants had no previous knowledge about using the bougie guide. RS training contributed to self-confidence increase for using bougie for ETI procedure. RS methodology can contribute for training in using the bougie guide for ETI procedure during COVID-19 outbreak.

Keywords: bougie, confidence, COVID-19, endotracheal intubation, realistic simulation

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Authors: Muhammad Tayyab Afzal, Muhammad Arslan, Mirza Muhammad Waqar

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One of the key components of the water cycle is evapotranspiration (ET), which represents water consumption by vegetated and non-vegetated surfaces. Conventional techniques for measurements of ET are point based and representative of the local scale only. Satellite remote sensing data with large area coverage and high temporal frequency provide representative measurements of several relevant biophysical parameters required for estimation of ET at regional scales. The objective is of this research is to exploit satellite data in order to estimate evapotranspiration. This study uses Surface Energy Balance System (SEBS) model to calculate daily actual evapotranspiration (ETa) in Larkana District, Sindh Pakistan using Landsat TM data for clouds-free days. As there is no flux tower in the study area for direct measurement of latent heat flux or evapotranspiration and sensible heat flux, therefore, the model estimated values of ET were compared with reference evapotranspiration (ETo) computed by FAO-56 Penman Monteith Method using meteorological data. For a country like Pakistan, agriculture by irrigation in the river basins is the largest user of fresh water. For the better assessment and management of irrigation water requirement, the estimation of consumptive use of water for agriculture is very important because it is the main consumer of water. ET is yet an essential issue of water imbalance due to major loss of irrigation water and precipitation on cropland. As large amount of irrigated water is lost through ET, therefore its accurate estimation can be helpful for efficient management of irrigation water. Results of this study can be used to analyse surface conditions, i.e. temperature, energy budgets and relevant characteristics. Through this information we can monitor vegetation health and suitable agricultural conditions and can take controlling steps to increase agriculture production.

Keywords: SEBS, remote sensing, evapotranspiration, ETa

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Authors: Teguh R. Hakim, Frenny F. F. Kairupan, Alberta M. Mantiri

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The face of the coastal city is generally the same as other cities face showing the dualistic, traditional and modern, rural and urbanity, planned and unplanned, slum and high quality. Manado city is located on the northern coastal areas of the island of Sulawesi, Indonesia. Manado city is located on the northern coastal areas of the island of Sulawesi, Indonesia. Urban environmental problems ever occurred in this city, which is the impact of dualistic urban. Overcrowding, inadequate infrastructure, and limited human resources become the main cause of untidiness the coastal settlements in Malalayang. This has an impact on the activities of social, economic, public health level in the environment of coastal City of Manado, Malalayang. This is becoming a serious problem which must be tackled jointly by the government, private parties, and the community. Community-based settlement environment setup, into one solution to realize the city's coastal settlements livable. As for this research aims to analyze the involvement of local communities in arrangements of the settlement. The participatory approach of the model used in this study. Its application is mainly at macro and meso-scale (region, city, and environment) or community architecture. Model participatory approach leads more operational research approach to find a solution/answer to the problems of settlement. The participatory approach is a model for research that involves researchers and society as an object at the same time the subject of research, which in the process in addition to researching also developed other forms of participation in the design and build together. The expected results of this study were able to provide education to the community about environmental and set up a livable settlement for the sake of improving the quality of life. The study also becomes inputs to the government in applying the pattern of development that will be implemented in the future.

Keywords: arrangements the coastal environment, community participation, urban environmental problems, livable settlement

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Authors: Maria Ashitko

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The Constitution of the Republic of Belarus is based on the principle of the unity of rights and obligations, including those of the child. The constitutional status of the child is aspecific system of constitutional elements established and guaranteed by the state through the current legislation and regulatory acts that ensure the special legal status of the child, his or her constitutional legal capacity, implementation of the principles of the constitutional and legal status of the child, constitutional rights of the child and their safeguards. Under the principles of the constitutional status of the child, we consider the general, normative, social-volitional rules of behavior established by the Constitution of the Republic of Belarus, laws and other regulatory acts that determine the content and social purpose of the legal status of the child. The constitutional and legal status of the child is characterized by the following special principles, which form a feature of the state legal system:1) Ensuring the interests of the child means providing for the child in accordance with his or her age, state of health, characteristics of development, life experience, family life, cultural traditions, ethnicity. 2) The principle of equal responsibility of both parents or their substitutes characterized by caring for the next generation as one of the priority tasks of the state and society, and all issues related to the implementation of children’s rights should be addressed at the constitutional level. 3) We would like to highlight such a special principle as the subprinciple of safeguards, which is the principle of ensuring the safety of the child. It is also worth noting that in legal studies, there is no relationship between safety and constitutional rights as general safeguards of individual rights and freedoms, and as special safeguards for the right to life. 4) The principle of justice is expressed by the fact that in modern conditions, the quality of life is determined not only by material wealth but also by the ability of the state to ensure the harmonization of social relations and social harmony on the basis of humanism and justice. Thus, the specificity of the constitutional status of the child is the age boundary between adulthood and minority; therefore, we propose to highlight the age characteristics of the child as an additional element. It is advisable to highlight such a special principle as the subprinciple of safeguards, which is the principle of ensuring the safety of the child.

Keywords: children’s rights, constitutional status, constitutional principles, constitutional rights

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Authors: Aly Kassem, Eman Sapet, Eman Abdelbaset, Hosam Mahmoud

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Objective: Hypertension is an important public health challenge being one of the most common worldwide disease-affecting human. Our aim is to study the clinical characteristics, therapeutic regimens, treatment compliance, and risk factors in a sector of of hypertensive patients at Sohag City. Subject and Methods: A cross sectional study; conducted in Sohag city; it involved 520 patients; males (45.7 %) and females (54.3 %). Their ages ranged between 35-85 years. BP measurements, BMI, blood glucose, Serum creatinine, urine analysis, serum Lipids, blood picture and ECG were done all the studied patients. Results: Hypertension presented more between non-smokers (72.55%), females (54.3%), educated patients (50.99%) and patients with low SES (54.9%). CAD presented in (51.63%) of patients, while laboratory investigations showed hyperglycaemia in (28.7%), anemia in (18.3%), high serum creatinine level in (8.49%) and proteinuria in (10.45%) of patient. Adequate BP control was achieved in (49.67%); older patients had lower adequacy of BP control in spite of the extensive use of multiple-drug therapy. Most hypertensive patients had more than one coexistent CV risk factor. Aging, being a female (54.3%), DM (32.3%), family history of hypertension (28.7%), family history of CAD (25.4%), and obesity (10%) were the common contributing risk factors. ACE-inhibitors were prescribed in (58.16%), Beta-blockers in (34.64%) of the patients. Monotherapy was prescribed for (41.17%) of the patients. (75.81%) of patients had regular use of their drug regimens. (49.67%) only of patients had their condition under control, the number of drugs was inversely related to BP control. Conclusion: Hypertensive patients in Sohag city had a profile of high CV risks, and poor blood pressure control particularly in the elderly. A multidisciplinary approach for routine clinical check-up, follow-up, physicians and patients training, prescribing simple once-daily regimens and encouraging life style modifications are recommended. Anti hypertensives, hypertension, elderly patients, risk factors, treatment compliance.

Keywords: anti hypertensives, hypertension, elderly patients, risk factors, treatment compliance

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Authors: Jill Steel

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Introduction: Animal-assisted learning (AAL) interventions are increasing exponentially, yet a paucity of quality research in the field exists. The aim of this study was to evaluate how the promotion of emotional wellbeing, through AAL, in this case, a dog, may support children’s engagement with reading in a Primary 1 classroom. Research indicates that dogs can provide emotional support to children; by forming a trusting attachment with a non-critical ‘friend’ who confers unconditional positive regard on the child, confidence may be boosted and anxiety reduced. By promoting emotional wellbeing through interactions with the dog, it is hoped that children begin to associate reading with feelings of wellbeing, which then results in increased engagement with reading. Methodology: A review of the literature was conducted. The relationship between emotional wellbeing and learning was explored, followed by an examination of the literature relating to Animal-Assisted Therapy and AAL. Scottish educational policy and legislation were analysed to establish the extent to which AAL might be suitable for the Scottish pedagogical context. An empirical study was conducted in a mainstream Primary 1 classroom over a four-week period. An inclusive approach was adopted whereby all children that wanted to interact with the dog were given the opportunity to do so, and all 25 children subsequently chose to participate. Children were not withdrawn from the classroom. Primary methods included interviews, observations, and questionnaires. Three focus children were selected for closer study. Main Results: Results were remarkably close to previous research and literature. Children’s emotional wellbeing was boosted, and engagement in reading improved. Principal Conclusions and Implications for Field: It was concluded that AAL could support emotional wellbeing and, in turn, promote children’s engagement with reading. The main limitation of the study was its short-term nature, and a longer randomised controlled trial with a larger sample, currently being undertaken by the author, would provide a fuller answer to the research question. Barriers to AAL include health and safety concerns and steps to ensure the welfare of the dog.

Keywords: animal-assisted learning, emotional wellbeing, reading, reading to dogs

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Authors: Temosho Promise Chuene, T. Chitura

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Background: Foot and mouth disease is a real challenge in South Africa. The disease is a serious threat to the viability of livestock farming initiatives and affects local and international livestock trade. In Limpopo Province, the Kruger National Park and other game reserves are home to the African buffalo (Syncerus caffer), a notorious reservoir of the picornavirus, which causes foot and mouth disease. Out of the virus’s seven (7) distinct serotypes, Southern African Territories (SAT) 1, 2, and 3 are commonly endemic in South Africa. The broad objective of the study was to establish the trend of foot and mouth disease in Limpopo Province over a seven-year period (2014-2020), as well as the adoption and comprehensive reporting of the measures that are taken to contain disease outbreaks in the study area. Methods: The study used secondary data from the World Organization for Animal Health (WOAH) on reported cases of foot and mouth disease in South Africa. Descriptive analysis (frequencies and percentages) and Analysis of variance (ANOVA) were used to present and analyse the data. Result: The year 2020 had the highest prevalence of foot and mouth disease (3.72%), while 2016 had the lowest prevalence (0.05%). Serotype SAT 2 was the most endemic, followed by SAT 1. Findings from the study demonstrated the seasonal nature of foot and mouth disease in the study area, as most disease cases were reported in the summer seasons. Slaughter of diseased and at-risk animals was the only documented disease control strategy, and information was missing for some of the years. Conclusion: The study identified serious underreporting of the adopted control strategies following disease outbreaks. Adoption of comprehensive disease control strategies coupled with thorough reporting can help to reduce outbreaks of foot and mouth disease and prevent losses to the livestock farming sector of South Africa and Limpopo Province in particular.

Keywords: livestock farming, African buffalo, prevalence, serotype, slaughter

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Authors: Anjaly Joseph, Elezebeth Mathews

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Transportation and urban planning is the least recognised area for physical activity promotion in India, unlike developed regions. Identifying the preferred transportation modalities and factors associated with it is essential to address these lacunae. The objective of the study was to assess the prevalence of modes of transportation to work, and its correlates among working adults in Ernakulam District, Kerala. A cross sectional study was conducted among 350 working individuals in the age group of 18-60 years, selected through multi-staged stratified random sampling in Ernakulam district of Kerala. The inclusion criteria were working individuals 18-60 years, workplace at a distance of more than 1 km from the home and who worked five or more days a week. Pregnant women/women on maternity leave and drivers (taxi drivers, autorickshaw drivers, and lorry drivers) were excluded. An interview schedule was used to capture the modes of transportation namely, public, private and active transportation, socio demographic details, travel behaviour, anthropometric measurements and health status. Nearly two-thirds (64 percent) of them used private transportation to work, while active commuters were only 6.6 percent. The correlates identified for active commuting compared to other modes were low socio-economic status (OR=0.22, CI=0.5-0.85) and presence of a driving license (OR=4.95, CI= 1.59-15.45). The correlates identified for public transportation compared to private transportation were female gender (OR= 17.79, CI= 6.26-50.31), low income (OR=0.33, CI= 0.11-0.93), being unmarried (OR=5.19, CI=1.46-8.37), presence of no or only one private vehicle in the house (OR=4.23, CI=1.24-20.54) and presence of convenient public transportation facility to workplace (OR=3.97, CI= 1.66-9.47). The association between body mass index (BMI) and public transportation were explored and found that public transport users had lesser BMI than private commuters (OR=2.30, CI=1.23-4.29). Policies that encourage active and public transportation needs to be introduced such as discouraging private vehicle through taxes, introduction of convenient and safe public transportation facility, walking/cycling paths, and paid parking facility.

Keywords: active transportation, correlates, India, public transportation, transportation modes

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Authors: Hannah S. Elizabeth, D. Gnanasekaran, M. R. Manju Gowda, Antony George

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Phytoremediation a new technology of remediating the contaminated soil, water and air using plants and serves as a green technology with environmental friendly approach. The main aim of this technique is cleansing and detoxifying of organic compounds, organo-phosphorous pesticides, heavy metals like arsenic, iron, cadmium, gold, radioactive elements which cause teratogenic and life threatening diseases to mankind and animal kingdom when consume the food crops, vegetables, fruits, cerals, and millets obtained from the contaminated soil. Also, directly they may damage the genetic materials thereby alters the biosynthetic pathways of secondary metabolites and other phytoconstituents which may have different pharmacological activities which lead to lost their efficacy and potency as well. It would reflect in mutagenicity, drug resistance and affect other antagonistic properties of normal metabolism. Is the technology for real clean-up of contaminated soils and the contaminants which are potentially toxic. It reduces the risks produced by a contaminated soil by decreasing contaminants using plants as a source. The advantages are cost-effectiveness and less ecosystem disruption. Plants may also help to stabilize contaminants by accumulating and precipitating toxic trace elements in the roots. Organic pollutants can potentially be chemically degraded and ultimately mineralized into harmless biological compounds. Hence, the use of plants to revitalize contaminated sites is gaining more attention and preferred for its cost-effective when compared to other chemical methods. The introduction of harmful substances into the environment has been shown to have many adverse effects on human health, agricultural productivity, and natural ecosystems. Because the costs of growing a crop are minimal compared to those of soil removal and replacement, the use of plants to remediate hazardous soils is seen as having great promise.

Keywords: cost effective, eco-friendly, phytoremediation, secondary metabolites

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Authors: Lubna Azmi, Ila Shukla, Shyam Sundar Gupta, Padam Kant, Ch. V. Rao

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Gastric ulcer is a major global health threat, and it is the leading cause of stomach cancer death worldwide. Helicobacter pylori bacteriumis the most important etiologic factor for gastric ulcer. This infection is highly pervasive in South Asian developing countries, especially in India, Nepal, Srilanka etc. due to diversification in geographic area. Pathophysiology of gastric mucosal damage associated with non-invasive bacterium has not justified in detail, but it leads to change in histopathology, immunochemistry of the gastric and duodenal reason of host. The mechanism responsible for bacteria tissue tropism and mucosal damage in stomach variance during the disease is not clearly described and understood scientifically in treatment and control of pathogenic organisms. Polyphenols are secondary metabolites of plants and are generally involved in defense against aggression by pathogens. 2-(3,4-dihydroxyphenyl)-3,5,7-trihydroxychromen-4-one and 1-hydroxy-5,7-dimethoxy-2-naphthalene-carboxaldehyde are polyphenolic compound obtained from popular Indian medicinal plants ghavpatta (ArgeriaspeciosaLinn.f) andBael (Aeglemarmelos) have long been used in traditional Ayurvedic Indian medicine for various diseases. They have promising effects on ulcer, as detailed investigation has made in our laboratory. Therefore, the aim of present study is to explore membrane –dependent morphogenesis of H. pylori and associated apoptosis-mediated cell death. Based on this we analyzed immune gene expression in stomach of experimental animals with H. pylori, using quantitative reverse transcription polymerase chain reaction(q RT-PCR). This revealed rapid induction of prostaglandin, interferon I (INF-I), interferon II (INF-II) and INF-I associated genes in the infected animal. Ultrastructural changes associated with H. pylori will be taken for advanced studies. This investigation shows that the biomarkers eradicate H. pylori bacterium caused gastric ulcer which is a major risk factor for gastric cancer.

Keywords: gastric ulcer, Helicobacter pylori, immunochemistry, polyphenols

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Authors: Bouami Hind, Millot Patrick

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The implementation of automated devices in life-critical systems such as hospitals can bring a new set of challenges related to automation malfunctions. While automation has been identified as great leverage for the medication dispensing system’s security and efficiency, it also increases the complexity of the organization. In particular, the installation and operation stage of automated devices can be complex when malfunctions related to automated systems occur. This paper aims to document operators’ situation awareness about the malfunctions of automated drug delivery systems (ADCs) during their implementation through Saint Brieuc hospital’s feedback. Our evaluation approach has been deployed in Saint Brieuc hospital center’s pharmacy, which has been equipped with automated nominative drug dispensing systems since January of 2021. The analysis of Saint Brieuc hospital center pharmacy’s automation revealed numerous malfunctions related to the implementation of Automated Delivery Cabinets. It appears that the targeted performance is not reached in the first year of implementation in this case study. Also, errors have been collected in patients' automated treatments’ production such as lack of drugs in pill boxes or nominative carnets, excess of drugs, wrong location of the drug, drug blister damaged, non-compliant sachet, or ticket errors. Saint Brieuc hospital center’s pharmacy is doing a tremendous job of setting up and monitoring performance indicators from the beginning of automation and throughout ADC’s operation to control ADC’s malfunctions and meet the performance targeted by the hospital. Health professionals, including pharmacists, biomedical engineers and directors of work, technical services and safety, are heavily involved in an automation project. This study highlights the importance of the evaluation of ADCs’ performance throughout the implementation process and the hospital’s team involvement in automation supervision and management.

Keywords: life-critical systems, situation awareness, automated delivery cabinets, implementation, risks and malfunctions

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Authors: Shawna Staud, Mary Kaye Scaramucci

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Objective: Rubber cup polishing has been a traditional method of preventative therapy in dental hygiene treatment. Newer methods such as air polishing have changed the way dental hygiene care is provided, yet this technique has not been embraced by students in the program nor by practitioners in the workforce. Students entering the workforce tend to follow office protocol and are limited in confidence to introduce technologies learned in the curriculum. This project was designed to help students gain confidence in newer skills and encourage private practice settings to adopt newer technologies for patient care. Our program recently introduced air polishing earlier in the program before the rubber cup technique to determine if students would embrace the technology to become leading-edge professionals when they enter the marketplace. Methods: The class of 2022 was taught the traditional method of polishing in the first-year curriculum and air polishing in the second-year curriculum. The class of 2023 will be taught the air polishing method in the first-year curriculum and the traditional method of polishing in the second-year curriculum. Pre- and post-graduation survey data will be collected from both cohorts. Descriptive statistics and pre and post-paired t-tests with alpha set at .05 to compare pre and post-survey results will be used to assess data. Results: This study is currently in progress, with a completion date of October 2023. The class of 2022 completed the pre-graduation survey in the spring of 2022. The post-gradation survey will be sent out in October 2022. The class of 2023 cohort will be surveyed in the spring of 2023 and October 2023. Conclusion: Our hypothesis is students who are taught air polishing first will be more inclined to adopt that skill in private practice, thereby embracing newer technology and improving oral health care.

Keywords: luggage handling system at world’s largest pilgrimage center

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Authors: Young-Eun Jang, Mi-Hye Ma, Yemi Kim

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As the elderly population increases, the number of patients complaining of dry mouth is also increasing. Elderly people often use mouthwash to prevent periodontal disease. Mouthwash and saliva substitutes with low pH were reported to be able to cause enamel erosion. To the best of our knowledge, there have been no studies showing the effect of mouthwash on patients using saliva substitutes. Therefore, the purpose of this study was to evaluate the effect of the use of mouthwash in combination with saliva substitutes on tooth erosion using a quantitative light-induced fluorescence-digital (QLF-D) system. A total of 96 bovine specimens were embedded in putty blocks and randomly allocated to the following groups with n = 12 each: Group 1, application of mouthwash; Group 2, application of saliva substitutes; Group 3, application of saliva substitutes in combination with mouthwash; and control group, application of saline. The bovine samples were eroded using a demineralization solution and then saliva substitutes and mouthwash were applied according to the groups for 2 weeks. For saliva substitutes, three different products were used; Oasis (Oasis Consumer Health, Cleveland, OH, USA), Xeromia solution (Osstem Pharma Co., Seoul, Korea), and Drymund gel (Dong-A Pharma Co., Seoul, Korea). The pH values of the saliva substitutes were determined using a pH meter. Loss of enamel and root dentin was measured using the QLF-D system immediately after demineralization on the 3rd, 7th, and 14th days. The data were analyzed using repeated measures ANOVA followed by Tukey’s post hoc tests (p < 0.05). Mineral loss in enamel and root dentin was detected when mouthwash and saliva substitutes were used alone, respectively (p < 0.05). Also, when mouthwash was used with saliva substitutes, the mineral loss was observed in enamel and root dentin (p < 0.05). The use of Xeromia and Drymund gel increased mineral loss of enamel significantly compared to the use of Oasis (p < 0.05). However, when Drymund gel and Xeromia were used in combination with mouthwash, mineral loss of enamel was significantly reduced compared to when they were used alone (p < 0.05). The pH values of Drymund gel, Xeromia, Oasis, and mouthwash were 5.5, 5.52, 6.2, and 6.37, respectively. Based on these results, it can be concluded that the use of mouthwash with a higher pH value than that of saliva substitutes could help patients suffering from xerostomia avoid the risk of dental erosion.

Keywords: saliva substitute, mouthwash, tooth erosion, dry mouth

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Authors: P. Joshna, Souvik Kundu

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Detection of ultraviolet (UV) radiation is very important as it has exhibited a profound influence on humankind and other existences, including military equipment. In this work, a self-powered UV photodetector was reported based on oxides heterojunctions. The thin films of p-type nickel oxide (NiO) and n-type reduced graphene oxide (rGO) were used for the formation of p-n heterojunction. Low-Cost and low-temperature chemical synthesis was utilized to prepare the oxides, and the spin coating technique was employed to deposit those onto indium doped tin oxide (ITO) coated glass substrates. The top electrode platinum was deposited utilizing physical vapor evaporation technique. NiO offers strong UV absorption with high hole mobility, and rGO prevents the recombination rate by separating electrons out from the photogenerated carriers. Several structural characterizations such as x-ray diffraction, atomic force microscope, scanning electron microscope were used to study the materials crystallinity, microstructures, and surface roughness. On one side, the oxides were found to be polycrystalline in nature, and no secondary phases were present. On the other side, surface roughness was found to be low with no pit holes, which depicts the formation of high-quality oxides thin films. Whereas, x-ray photoelectron spectroscopy was employed to study the chemical compositions and oxidation structures. The electrical characterizations such as current-voltage and current response were also performed on the device to determine the responsivity, detectivity, and external quantum efficiency under dark and UV illumination. This p-n heterojunction device offered faster photoresponse and high on-off ratio under 365 nm UV light illumination of zero bias. The device based on the proposed architecture shows the efficacy of the oxides heterojunction for efficient UV photodetection under zero bias, which opens up a new path towards the development of self-powered photodetector for environment and health monitoring sector.

Keywords: chemical synthesis, oxides, photodetectors, spin coating

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Authors: Charlene Petersen, Herman Grobler, Karel Botha

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Restorative intervention with adolescents from a family violence context is a much needed resource given the limited access to mental health services in South Africa. In this research article the qualitative component which formed part of a mixed methods design of an overall research study, is discussed. A qualitative case study design was used. This article explores a psycho-education strategy, using a visual creative medium as a method for reconstructing identity in the context of family violence. The aim of this psycho-education strategy was to move away from interventions based on the biomedical model, but focused more on meaning-making about violent traumatic events adolescents have experienced, and to develop more positive, adaptive views about themselves in the present, and experience hope about the future. The research question that was asked was how the meaning, that adolescents from a specific community in South Africa give to family violence, contribute to defining their identity? Twelve participants were purposively selected for the study and included both male and female adolescents with ages ranging from 15 to 18 years from three secondary schools. The strategy was applied over five sessions with the intention to bring about awareness of different selves, identifying and naming the selves, and becoming aware of the configuration of identity that could lead to a redefined identity. The data were thematically and visually analyzed. Through the process of tailoring which forms the basis for reconstruction process, participants could identify the different selves, become aware of how they configure in the field. Through the process of tailoring the different self-parts, the sense of self became more self-cohesive and allowed the individual to become aware of the role of certain. Through identifying and naming the future self and resilient self the participants were able to accomplish some order and meaning in their lives. It provided them with a sense of predictability and an optimistic and hopefulness towards the future. The research findings indicated that this strategy can be used as a method for reconstructing identity in the context of family violence.

Keywords: identity, family violence, self-configuration, reconstructing identity, psycho-education strategy

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Authors: Kumaressan Ragunathan, Arisudhan Anantharachagan

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Gestational diabetes mellitus (GDM) is the subtype of diabetes that has been rapidly increasing in numbers in Australia. The annual percentage of GDM has increased more than 50 percent in the last decade. According to Diabetes Australia, more than five hundred thousand women in Australia will be diagnosed with GDM. Globally, the prevalence of GDM ranges from single-digit to more than 45%. The prevalence of GDM has increased significantly last five years after the introduction of new diagnostic criteria. Hence, we have decided to investigate the trend in GDM prevalence in a tertiary maternity unit at Western Australia and compare it to national prevalence. Data is derived from STORK Perinatal Database which has been used by Maternity services in Western Australia to populate information on pregnancy and labour. We have selected data from 2015 until 2020, which includes 17508 women. Among 17508 women, 3850 women were diagnosed with GDM. In 2015, we had a total of 2213 deliveries with 345 of them were complicated by GDM. GDM prevalence was 15.6% compared to the Australian national prevalence of 12%. In 2016, total deliveries increased to 2759 with 590 of were with GDM. GDM prevalence was 21.4% compared to the Australian national prevalence of 12%. In 2017, total deliveries further increased to 3049 with 675 with GDM. GDM prevalence was 22.1%, with an Australian national prevalence of 13%. In 2018, total deliveries continued to increase, with numbers reaching 3231 with 749 with GDM. GDM prevalence was 23.2%, with an Australian National prevalence of 14%. In 2019, total deliveries were 3110, with 712 complicated by GDM. GDM prevalence was 22.9%, with Australian national prevalence 14%. In 2020, total deliveries 3146 with 819 complicated by GDM. GDM prevalence increased to 26% and we were unable to compare this to national standard as national prevalence has not been released. Among 3890 women with GDM, 2482 (64%) of them required insulin. Apart from that, a total 1642(42%) from the GDM group were delivered via the Caesarean section. 2121 (55%) women with GDM required induction of labour. Overall, we demonstrated an increase in the prevalence of GDM in our unit from 2015 until 2020. Our prevalence is also higher compared to national prevalence. This could be contributed by the increasing number of obesity and in addition, our unit accepts referrals of women with a body mass index (BMI) of more than 40. Hence, further studies are required to look at other risk factors like ethnicity, socio-economic status, health literacy and age, which could contribute to this high prevalence.

Keywords: gestational diabetes mellitus, prevalence, Western Australia, Australia

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Authors: Pelin Yilmaz, Gizemnur Yildiz Uysal, Elcin Demirhan, Belma Ozbek

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The edible fig plant, Ficus carica Linn, belongs to the Moraceae family, and the leaves are mainly considered agricultural waste after harvesting. It has been demonstrated in the literature that fig leaves contain appealing properties such as high vitamins, fiber, amino acids, organic acids, and phenolic or flavonoid content. The extraction of these valuable products has gained importance. Microwave-assisted extraction (MAE) is a method using microwave energy to heat the solvents, thereby transferring the bioactive compounds from the sample to the solvent. The main advantage of the MAE is the rapid extraction of bioactive compounds. In the present study, the MAE was applied to extract the bioactive compounds from Ficus carica L. leaves, and the effect of microwave power (180-900 W), extraction time (60-180 s), and solvent to sample amount (mL/g) (10-30) on the antioxidant property of the leaves. Then, the volatile organic component profile was determined at the specified extraction point. Additionally, antimicrobial studies were carried out to determine the minimum inhibitory concentration of the microwave-extracted leaves. As a result, according to the data obtained from the experimental studies, the highest antimicrobial properties were obtained under the process parameters such as 540 W, 180 s, and 20 mL/g concentration. The volatile organic compound profile showed that isobergapten, which belongs to the furanocoumarins family exhibiting anticancer, antioxidant, and antimicrobial activity besides promoting bone health, was the main compound. Acknowledgments: This work has been supported by Yildiz Technical University Scientific Research Projects Coordination Unit under project number FBA-2021-4409. The authors would like to acknowledge the financial support from Tubitak 1515 - Frontier R&D Laboratory Support Programme.

Keywords: Ficus carica Linn leaves, volatile organic component, GC-MS, microwave extraction, isobergapten, antimicrobial

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Authors: Maryam Zahmatkesh

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Middle managers form a significant occupational category in organisations. They undertake a vital role, as they sit between the operational and strategic roles. Traditionally they were acting as diplomat administrators, and were only in power to meet the demands of professionals. Following the introduction of internal market, in line with the principles of New Public Management, middle managers have been considered as change agents. More recently, in the debates of middle managers, there is emphasis on entrepreneurialism and enacting strategic role. It was assumed that granting autonomy to the local organisations and the inception of semi-autonomous hospitals (Foundation Trusts in England and Board of Trustees in Iran) would give managers more autonomy to act proactively and innovatively. This thesis explores the hospital middle managers’ perception of and responses to public management reforms (in particular, hospital autonomy) in England and Iran. In order to meet the aims of the thesis, research was undertaken within the interpretative paradigm, in line with social constructivism. Data were collected from interviews with forty-five middle managers, observational fieldwork and documentary analysis across four teaching university hospitals in England and Iran. The findings show the different ways middle managers’ autonomy is constrained in the two countries. In England, middle managers have financial and human recourses, but their autonomy is constrained by government policy and targets. In Iran, middle managers are less constrained by government policy and targets, but they do not have financial and human resources to exercise autonomy. Unbalanced autonomy causes tension and frustration for middle managers. According to neo-institutional theory, organisations are deeply embedded within social, political, economic and normative settings that exert isomorphic and internal population-level pressures to conform to existing and established modes of operation. Health systems which are seeking to devolve autonomy to middle managers must appreciate the multidimensional nature of the autonomy, as well as the wider environment that organisations are embedded, if they are about to improve the performance of managers and their organisations.

Keywords: autonomy, healthcare organisations, middle managers, new public management

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Authors: Rima Almalla

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The purpose of the research project in Geography is to evaluate the applicability of urban green infrastructure approach in Finnish climate. The key focus will be on the operation and efficiency of green infrastructure on urban stormwater management. Green infrastructure approach refers to the employment of sufficient green covers as a modern and smart environmental solution to improve the quality of urban environments. Green infrastructure provides a wide variety of micro-scale ecosystem services, such as stormwater runoff management, regulation of extreme air temperatures, reduction of energy consumption, plus a variety of social benefits and human health and wellbeing. However, the cold climate of Finland with seasonal ground frost, snow cover and relatively short growing season bring about questions of whether green infrastructure works as efficiently as expected. To tackle this question, green infrastructure solutions will be studied and analyzed with manifold methods: stakeholder perspectives regarding existing and planned GI solutions will be collected by web based questionnaires, semi structured interviews and group discussions, and analyzed in both qualitative and quantitative methods. Targeted empirical field campaigns will be conducted on selected sites. A systematic literature review with global perspective will support the analyses. The findings will be collected, compiled and analyzed using geographic information systems (GIS). The findings of the research will improve our understanding of the functioning of green infrastructure in the Finnish environment in urban stormwater management, as a landscape element for citizens’ wellbeing, and in climate change mitigation and adaptation. The acquired information will be shared with stakeholders in interactive co-design workshops. As green covers have great demand and potential globally, the conclusions will have relevance in other cool climate regions and may support Finnish business in green infrastructure sector.

Keywords: climate change adaptation, climate change, green infrastructure, stormwater

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Authors: Sahar Fahmy Mehanna

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Wild fisheries and aquaculture offer excellent opportunities to decrease hunger and improve nutrition, relieve poverty, create economic growth and guarantee healthier use of natural resources. Employment in fisheries and aquaculture has grown continuously quicker than in the agriculture sector, providing up to 55 million jobs worldwide. Fisheries and aquaculture supplied Egypt with 2.1 million tons of fish in 2021, mostly used as food for people. Fish production in Egypt has grown dramatically in the last three decades, where fish production increased from about 346 thousand tons in 1990 to up to 2.1 million tons in 2021. In contrast to natural resources, which increased by only 30% in the period from 1990 to 2021, aquaculture production increased by 2502% during the same period. The majority of wild fisheries production in Egypt arises from coastal areas, where pollution is one of the main challenges severely affected both the productivity and quality of fish stocks. Our marine resources are at the risk of irreversible loss to habitats, ecological functions, and biodiversity because of overfishing, pollution, destructive fishing methods, climatic changes, unsustainable coastal area development and the competing demands from different industrial uses and human activities. Illegal, Unreported and Unregulated (IUU) Fishing continues to be a big challenge to achieve sustainable fisheries. Furthermore, poor governance, management and practices are a further challenge. Reducing overfishing, stimulating responsible and sustainable fisheries management, applying aquaculture new and friendly practices and conserving the marine environment health are among the government’s best opportunities to provide highly nutritious food to the increasing population in Egypt. The present presentation will discuss the fishery regulations in the Egyptian marine fisheries that taken to maintain, protect and promote the different Egyptian marine environments and to what extent these regulations were effective.

Keywords: egypt, marine fisheries, fishery regulations, fisheries management, Marine ecosystem conservation

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Authors: Xiao Wen Xu

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There exists a challenge of accommodating/integrating people at risk and those from various backgrounds in urban areas. The success of interdependence as a tool for survival largely rests on the mutually beneficial relationships amongst individuals within a given society. One approach to meeting this challenge has been written by Ivan Illich in his book, Tools for Conviviality, where he defines 'conviviality' as interactions that help individuals. With the goal of helping the community and applying conviviality as a principle to actors in both natural and social realms of Moss Park in Toronto, the proposal involves redesigning the park and buildings as a series of different health care, extended learning, employment support, armoury, and recreation facilities that integrate the exterior landscape as treatment, teaching, military, and recreation areas; in other words, the proposal links services with access to park space. While buildings are traditionally known to physically provide shelter, parks embody shelter and act as service, as people often find comfort and relief from being in nature, and Moss Park, in particular, is home to many people at risk. This landscape is not only an important space for the homeless community but also the rest of the neighborhood. The thesis proposes that the federal government rebuilds the current armoury, as it is an obsolete building while acknowledging the extensive future developments proposed by developers and its impact on public space. The neighbourhood is an underserved area, and the new design develops not just a new armoury, but also a complex of interrelated services, which are completely integrated into the park. The armoury is redesigned as an integral component of the community that not only serves as training facilities for reservists but also serves as an emergency shelter in sub-zero temperatures for the homeless community. This paper proposes a new design for Moss Park through examining how 'park buildings', interconnected buildings and parks, can foster empowering relationships that create a supportive public realm.

Keywords: conviviality, natural, social, Ivan Illich

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Authors: Van Truong Pham

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Background: Self-management was described as a potential strategy for blood pressure control in patients with hypertension. However, the effects of self-management interventions on blood pressure, self-efficacy, medication adherence, and body mass index (BMI) in older adults with hypertension have not been systematically evaluated. We evaluated the effects of self-management interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP), self-efficacy, medication adherence, and BMI in hypertensive older adults. Methods: We followed the recommended guidelines of preferred reporting items for systematic reviews and meta-analyses. Searches in electronic databases including CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science, and other sources were performed to include all relevant studies up to April 2019. Studies selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized intervention effects as Hedges' g values and 95% confidence intervals (CI) using a random-effects model. Data were analyzed using Comprehensive Meta-Analysis software 2.0. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly improved blood pressure control, self-efficacy, medication adherence, whereas the effect of self-management on BMI was not significant in older adult patients with hypertension. The following Hedges' g (effect size) values were obtained: SBP, -0.34 (95% CI, -0.51 to -0.17, p < 0.001); DBP, -0.18 (95% CI, -0.30 to -0.05, p < 0.001); self-efficacy, 0.93 (95%CI, 0.50 to 1.36, p < 0.001); medication adherence, 1.72 (95%CI, 0.44 to 3.00, p=0.008); and BMI, -0.57 (95%CI, -1.62 to 0.48, p = 0.286). Conclusions: Self-management interventions significantly improved blood pressure control, self-efficacy, and medication adherence. However, the effects of self-management on obesity control were not supported by the evidence. Healthcare providers should implement self-management interventions to strengthen patients' role in managing their health care.

Keywords: self-management, meta-analysis, blood pressure control, self-efficacy, medication adherence, body mass index

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Authors: Andra Vidyarini

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Adolescence is a transition period in which various changes occur, both biologically, intellectually and psychosocially. Changes in adolescents, one of which is a change in food consumption patterns that make adolescents vulnerable to nutritional problems that can affect their growth and health in the future. Nutritional problems in adolescents have increased from year to year and one of the causes is the low diversity and quality of consumption. The diversity and quality of consumption can be seen through the Individual Dietary Diversity Score and the Healthy Eating Index. Currently, in Indonesia, data on the diversity and quality of food consumption, especially among adolescents, are still scarce. In general, the purpose of this study is to describe the diversity and quality of adolescent food consumption and the relationship between the diversity and quality of food consumption with nutritional status. This study is a cross-sectional study by looking at the diversity and quality of consumption of adolescents aged 15-17 years. The total number of subjects in this study amounted to 70 teenagers. This research was conducted online via a google form. Data analysis in this study was univariate and bivariate. The results showed that the diversity of the subject's food consumption was in the diverse and very diverse category with an average of 6. However, the quality was still not good, whereas it was still in the bad and moderate categories with an average of 12.93. The nutritional status of the majority of the subjects was in the normal category and overweight to obese. The implementation of blended learning where there are still limited face-to-face meetings at school can be the reason why teenagers' food consumption is more diverse than when they are face-to-face schools. In addition, changes in people's diet during the pandemic also influenced the results of the study. The change in pattern is a change in eating habits to three times a day with menu choices ranging from rice, meat, fish, bean and vegetables. Analysis of the relationship between the diversity and quality of food consumption shows that the diversity of consumption has a significant relationship with the quality of food consumption with a p-value of 0.002 (p<0.05). Meanwhile, the diversity and quality of food consumption have no significant relationship with nutritional status, with p values 0.777 and 0.251 (>0.05), respectively. This shows that the diversity of food consumption is directly proportional to the quality of consumption, where if you have a variety of food consumption, the quality or in terms of portions and weight are also sufficient in accordance with the recommendations of PGRS.

Keywords: healthy eating index (HEI), food diversity, quality of consumption, adolescent

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Authors: Ilyes Athimni, Mouna Bouzazi, Mongi Boulehmi, Ahmed Ferchichi

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The principles of good governance, universal values, and digitization are among the tools to fight corruption and improve the quality of service delivery. In recent years, these tools have become one of the most controversial topics in the field of education and a concern of many international organizations and institutions against the problem of corruption. Corruption in the education sector, particularly in higher education, has negative impacts on the quality of education systems and on the quality of administrative or educational services. Currently, the health crisis due to the spread of the COVID-19 pandemic reveals the difficulties encountered by education systems in most countries of the world. Due to the poor governance of these systems, many educational institutions were unable to continue working remotely. To respond to these problems encountered by most education systems in many countries of the world, our initiative is to propose a methodology to reinvent education systems based on global values and digital technologies. This methodology includes a work strategy for educational institutions, whether in the provision of administrative services or in the teaching method, based on information and communication technologies (ICTs), intelligence artificial, and intelligent agents. In addition, we will propose a supervisory law that will be implemented and monitored by intelligent agents to improve accountability, transparency, and accountability in educational institutions. On the other hand, we will implement and evaluate a field experience by applying the proposed methodology in the operation of an educational institution and comparing it to the traditional methodology through the results of teaching an educational program. With these specifications, we can reinvent quality education systems. We also expect the results of our proposal to play an important role at local, regional, and international levels in motivating governments of countries around the world to change their university governance policies.

Keywords: artificial intelligence, corruption in education, distance learning, education systems, ICTs, intelligent agents, good governance

Procedia PDF Downloads 191

Authors: Deepak Nathiya1, Ramesh Roop Rai, Pratima Singh1, Preeti Raj1, Supriya Suman, Balvir Singh Tomar

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Background: Sarcopenia is a catabolic state in liver cirrhosis (LC), accelerated with a breakdown of skeletal muscle to release amino acids which adversely affects survival, health-related quality of life, and response to any underlying disease. The primary objective of the study was to investigate the long-term effect of branched-chain amino acids (BCAA) supplementations on parameters associated with improved prognosis in sarcopenic patients with LC, as well as to evaluate its impact on cirrhotic-related events. Methods: We carried out a 24 week, single-center, randomized, open-label, controlled, two cohort parallel-group intervention trial comparing the efficacy of BCAA against lactoalbumin (L-ALB) on 106 sarcopenic liver cirrhotics. The BCAA (intervention) group was treated with 7.2 g BCAA per whereas, the lactoalbumin group was also given 6.3 g of L-Albumin. The primary outcome was to assess the impact of BCAA on parameters of sarcopenia: muscle mass, muscle strength, and physical performance. The secondary outcomes were to study combined survival and maintenance of liver function changes in laboratory and clinical markers in the duration of six months. Results: Treatment with BCAA leads to significant improvement in sarcopenic parameters: muscle strength, muscle function, and muscle mass. The total cirrhotic-related complications and cumulative event-free survival occurred fewer in the BCAA group than in the L-ALB group. Prognostic markers also improved significantly in the study. Conclusion: The current clinical trial demonstrated that long-term BCAAs supplementation improved sarcopenia and prognostic markers in patients with advanced liver cirrhosis.

Keywords: sarcopenia, liver cirrhosis, BCAA, quality of life

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Authors: Adamu Muhammed Tukur

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Pulp and paper industry is one of the fastest growing industries due to an increased demand in paper products. For it to satisfy this ever increasing demand, it adopts new technological innovations some of which are proved to affect our environment negatively. Global consumption of paper has increased by 400% in the last four decades and this suggests that more research is required to assess the impact of industrial effluents to our environment and public health. Paper products are generally biodegradable, however, the processes involved in its production which involve the use of mainly bleaching agents and other non-biodegradable substances pose serious problem to the environment. There are more than 250 chemicals released in paper mill waste and some are xenobiotics. Different methods such as physical and chemical methods can be adopted for the remediation of the effluents but are proved to be costly and not safe to the environment. On the other hand, biological method is shown to be less costly and environmentally friendly. Microorganisms and their enzymes have shown a promising future for bioremediation of effluents related to paper mill. Many studies prove that one of the major pollutants in the paper mill effluent is phenol especially its chlorinated derivatives. Pentachlorophenol is extremely hazardous to living cells and therefore need to be removed from the environment. Microorganisms including bacteria and fungi have the potential to degrade phenolic compounds e.g. Bacillus stearothermiphilus, Pseudomonas putida, Coricus versicolor, Sphingomonas chlorophenolica, Fusarium sp, Bacillus subtilis and P. aeroginosa. Enzymes used for the degradation include phenol hydrooxylase, polyphenoloxylase, laccase, peroxidase among others. Lignin is another important pollutant and is resistant to microbial degradation but it has been proved that certain bacteria and fungi like can degrade it. Among the fungi white-rot fungi like Fomes lividus and Trametes vesicolor are the most important bioremediators. This review focused on use of microorganism to reduce or eradicate pollutants released from the paper industry. It can serve as a review for further research to be conducted especially in the field of Biotechnology.

Keywords: bioremediation, pulp and paper, pentachlorophenol, environment

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Authors: Pibool Waijittragum

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The purpose of this research is to analyze the marketing strategies of Thai Halal products which related to the way of life for Thai Muslims. The expected benefit is the marketing strategy for brand building process for Halal products in Thailand. 4 elements of marketing strategies which necessary for the brand identity creation is the research framework: Consists of Attributes, Benefits, Values and Personality. The research methodology was applied using qualitative and quantitative; 19 marketing experts with dynamic roles in Thai consumer products were interviewed. In addition, a field survey of 122 Thai Muslims selected from 175 Muslim communities in Bangkok was studied. Data analysis will be according to 5 categories of Thai Halal product: 1) Meat 2) Vegetable and Fruits 3) Instant foods and Garnishing ingredient 4) Beverages, desserts and snacks 5) Hygienic daily products; such as soap, shampoo and body lotion. The results will explain some suitable representation in the marketing strategies of Thai Halal products as are: 1) Benefit; the characteristics of the product with its benefit. Consumers will purchase this product with the reason of; it is beneficial nutrients product, there are no toxic or chemical residues. Fresh and clean materials 2) Attribute; the exterior images that attract to consumer. Consumers will purchase this product with the reason of; there is a standard proof mark, food and drug secure proof mark and Halal products mark. Packaging and its materials should be draw attention. Use an attractive graphic. Use outstanding images of product, material or ingredients. 3) Value; the value of products that affect to consumers perception; it is healthy products. Accumulate quality of life. It is a product of expertise, manufacturing of research result. Consumers are important. It’s sincere, honest and reliable to all. 4) Personality; reflection of consumers thought. The personality feedback to them after they were consumes this product; they are health care persons. They are the rational person, moral person, justice person and thoughtful person like a progressive thinking.

Keywords: marketing strategies, product identity, branding, Thai Halal products

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Authors: Sameer Masood, Lucas Chartier

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Head injuries are a commonly encountered presentation in emergency departments (ED) and the Choosing Wisely Canada (CWC) campaign was released in June 2015 in an attempt to decrease imaging utilization for patients with minor head injuries. The impact of the CWC campaign on imaging utilization for head injuries has not been explored in the ED setting. In our study, we describe the characteristics of patients with head injuries presenting to a tertiary care academic ED and the impact of the CWC campaign on CT head utilization. This retrospective cohort study used linked databases from the province of Ontario, Canada to assess emergency department visits with a primary diagnosis of head injury made between June 1, 2014 and Aug 31, 2016 at the University Health Network in Toronto, Canada. We examined the number of visits during the study period, the proportion of patients that had a CT head performed before and after the release of the CWC campaign, as well as mode of arrival, and disposition. There were 4,322 qualifying visits at our site during the study period. The median presenting age was 44.12 years (IQR 27.83,67.45), the median GCS was 15 (IQR 15,15) and the majority of patients presenting had intermediate acuity (CTAS 3). Overall, 43.17% of patients arrived via ambulance, 49.24 % of patients received a CT head and 10.46% of patients were admitted. Compared to patients presenting before the CWC campaign release, there was no significant difference in the rate of CT heads after the CWC (50.41% vs 47.68%, P = 0.07). There were also no significant differences between the two groups in mode of arrival (ambulance vs ambulatory) (42.94% vs 43.48%, P = 0.72) or admission rates (9.85% vs 11.26%, P = 0.15). However, more patients belonged to the high acuity groups (CTAS 1 or 2) in the post CWC campaign release group (12.98% vs 8.11% P <0.001). Visits for head injuries make up a significant proportion of total ED visits and approximately half of these patients receive CT imaging in the ED. The CWC campaign did not seem to impact imaging utilization for head injuries in the 14 months following its launch. Further efforts, including local quality improvement initiatives, are likely needed to increase adherence to its recommendation and reduce imaging utilization for head injuries.

Keywords: choosing wisely, emergency department, head injury, quality improvement

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