Search results for: patient care improvement

Authors: Neelam Taneja, Abhishek Mewara, Ajay Kumar

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Multidrug resistant shigellae have emerged as a therapeutic challenge in India. At our 2000 bed tertiary care referral centre in Chandigarh, North India, which caters to a large population of 7 neighboring states, antibiotic resistance in Shigella is being constantly monitored. Shigellae are isolated from 3 to 5% of all stool samples. In 1990 nalidixic acid was the drug of choice as 82%, and 63% of shigellae were resistant to ampicillin and cotrimoxazole respectively. Nalidixic acid resistance emerged in 1992 and rapidly increased from 6% during 1994-98 to 86% by the turn of 21st century. In the 1990s, the WHO recommended ciprofloxacin as the drug of choice for empiric treatment of shigellosis in view of the existing high level resistance to agents like chloramphenicol, ampicillin, cotrimoxazole and nalidixic acid. First resistance to ciprofloxacin in S. flexneri at our centre appeared in 2000 and rapidly rose to 46% in 2007 (MIC>4mg/L). In between we had an outbreak of ciprofloxacin resistant S.dysenteriae serotype 1 in 2003. Therapeutic failures with ciprofloxacin occurred with both ciprofloxacin-resistant S. dysenteriae and ciprofloxacin-resistant S. flexneri. The severity of illness was more with ciprofloxacin-resistant strains. Till 2000, elsewhere in the world ciprofloxacin resistance in S. flexneri was sporadic and uncommon, though resistance to co-trimoxazole and ampicillin was common and in some areas resistance to nalidixic acid had also emerged. Fluoroquinolones due to extensive use and misuse for many other illnesses in our region are thus no longer the preferred group of drugs for managing shigellosis in India. WHO presently recommends ceftriaxone and azithromycin as alternative drugs to fluoroquinolone-resistant shigellae, however, overreliance on this group of drugs also seems to soon become questionable considering the emerging cephalosporin-resistant shigellae. We found 15.1% of S. flexneri isolates collected over a period of 9 years (2000-2009) resistant to at least one of the third-generation cephalosporins (ceftriaxone/cefotaxime). The first isolate showing ceftriaxone resistance was obtained in 2001, and we have observed an increase in number of isolates resistant to third generation cephalosporins in S. flexneri 2005 onwards. This situation has now become a therapeutic challenge in our region. The MIC values for Shigella isolates revealed a worrisome rise for ceftriaxone (MIC90:12 mg/L) and cefepime (MIC90:8 mg/L). MIC values for S. dysenteriae remained below 1 mg/L for ceftriaxone, however for cefepime, the MIC90 has raised to 4 mg/L. These infections caused by ceftriaxone-resistant S. flexneri isolates were successfully treated by azithromycin at our center. Most worrisome development in the present has been the emergence of DSA(Decreased susceptibility to azithromycin) which surfaced in 2001 and has increased from 4.3% till 2011 to 34% thereafter. We suspect plasmid-mediated resistance as we detected qnrS1-positive Shigella for the first time from the Indian subcontinent in 2 strains from 2010, indicating a relatively new appearance of this PMQR determinant among Shigella in India. This calls for a continuous and strong surveillance of antibiotic resistance across the country. The prevention of shigellosis by developing cost-effective vaccines is desirable as it will substantially reduce the morbidity associated with diarrhoea in the country

Keywords: Shigella, antimicrobial, resistance, India

Procedia PDF Downloads 231

Authors: A. Almurshedi, M. Atherton, C. Mares, T. Stolarski, M. Miyatake

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Transportation and handling of delicate and lightweight objects is currently a significant issue in some industries. Two common contactless movement prototype designs, ultrasonic transducer design and vibrating plate design, are compared. Both designs are based on the method of squeeze-film levitation, and this study aims to identify the limitations, and challenges of each. The designs are evaluated in terms of levitation capabilities, and characteristics. To this end, theoretical and experimental explorations are made. It is demonstrated that the ultrasonic transducer prototype design is better suited to the terms of levitation capabilities. However, the design has some operating and mechanical designing difficulties. For making accurate industrial products in micro-fabrication and nanotechnology contexts, such as semiconductor silicon wafers, micro-components and integrated circuits, non-contact oil-free, ultra-precision and low wear transport along the production line is crucial for enabling. One of the designs (design A) is called the ultrasonic chuck, for which an ultrasonic transducer (Langevin, FBI 28452 HS) comprises the main part. Whereas the other (design B), is a vibrating plate design, which consists of a plain rectangular plate made of Aluminium firmly fastened at both ends. The size of the rectangular plate is 200x100x2 mm. In addition, four rounded piezoelectric actuators of size 28 mm diameter with 0.5 mm thickness are glued to the underside of the plate. The vibrating plate is clamped at both ends in the horizontal plane through a steel supporting structure. In addition, the dynamic of levitation using the designs (A and B) has been investigated based on the squeeze film levitation (SFL). The input apparatus that is used with designs consist of a sine wave signal generator connected to an amplifier type ENP-1-1U (Echo Electronics). The latter has to be utilised to magnify the sine wave voltage that is produced by the signal generator. The measurements of the maximum levitation for three different semiconductor wafers of weights 52, 70 and 88 [g] for design A are 240, 205 and 187 [um], respectively. Whereas the physical results show that the average separation distance for a disk of 5 [g] weight for design B reaches 70 [um]. By using the methodology of squeeze film levitation, it is possible to hold an object in a non-contact manner. The analyses of the investigation outcomes signify that the non-contact levitation of design A provides more improvement than design B. However, design A is more complicated than design B in terms of its manufacturing. In order to identify an adequate non-contact SFL design, a comparison between two common such designs has been adopted for the current investigation. Specifically, the study will involve making comparisons in terms of the following issues: floating component geometries and material type constraints; final created pressure distributions; dangerous interactions with the surrounding space; working environment constraints; and complication and compactness of the mechanical design. Considering all these matters is essential for proficiently distinguish the better SFL design.

Keywords: ANSYS, floating, piezoelectric, squeeze-film

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Authors: Aleksandra Czubek

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As AI systems increasingly shape content creation, existing copyright frameworks face significant challenges in determining liability for AI-generated outputs. Current legal discussions largely focus on who bears responsibility for infringing works, be it developers, users, or entities benefiting from AI outputs. This paper introduces a novel concept of algorithmic obligations, proposing that AI developers be subject to proactive duties that ensure their models prevent copyright infringement before it occurs. Building on principles of obligations law traditionally applied to human actors, the paper suggests a shift from reactive enforcement to proactive legal requirements. AI developers would be legally mandated to incorporate copyright-aware mechanisms within their systems, turning optional safeguards into enforceable standards. These obligations could vary in implementation across international, EU, UK, and U.S. legal frameworks, creating a multi-jurisdictional approach to copyright compliance. This paper explores how the EU’s existing copyright framework, exemplified by the Copyright Directive (2019/790), could evolve to impose a duty of foresight on AI developers, compelling them to embed mechanisms that prevent infringing outputs. By drawing parallels to GDPR’s “data protection by design,” a similar principle could be applied to copyright law, where AI models are designed to minimize copyright risks. In the UK, post-Brexit text and data mining exemptions are seen as pro-innovation but pose risks to copyright protections. This paper proposes a balanced approach, introducing algorithmic obligations to complement these exemptions. AI systems benefiting from text and data mining provisions should integrate safeguards that flag potential copyright violations in real time, ensuring both innovation and protection. In the U.S., where copyright law focuses on human-centric works, this paper suggests an evolution toward algorithmic due diligence. AI developers would have a duty similar to product liability, ensuring that their systems do not produce infringing outputs, even if the outputs themselves cannot be copyrighted. This framework introduces a shift from post-infringement remedies to preventive legal structures, where developers actively mitigate risks. The paper also breaks new ground by addressing obligations surrounding the training data of large language models (LLMs). Currently, training data is often treated under exceptions such as the EU’s text and data mining provisions or U.S. fair use. However, this paper proposes a proactive framework where developers are obligated to verify and document the legal status of their training data, ensuring it is licensed or otherwise cleared for use. In conclusion, this paper advocates for an obligations-centered model that shifts AI-related copyright law from reactive litigation to proactive design. By holding AI developers to a heightened standard of care, this approach aims to prevent infringement at its source, addressing both the outputs of AI systems and the training processes that underlie them.

Keywords: ip, technology, copyright, data, infringement, comparative analysis

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Authors: Heikki Ruohomaa, Vesa Salminen

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Regions are facing huge competition to attract companies, businesses, inhabitants, students, etc. This way to improve living and business environment, which is rapidly changing due to digitalization. On the other hand, from the industry's point of view, the availability of a skilled labor force and an innovative environment are crucial factors. In this context, qualified staff has been seen to utilize the opportunities of digitalization and respond to the needs of future skills. World Manufacturing Forum has stated in the year 2019- report that in next five years, 40% of workers have to change their core competencies. Through digital transformation, new technologies like cloud, mobile, big data, 5G- infrastructure, platform- technology, data- analysis, and social networks with increasing intelligence and automation, enterprises can capitalize on new opportunities and optimize existing operations to achieve significant business improvement. Digitalization will be an important part of the everyday life of citizens and present in the working day of the average citizen and employee in the future. For that reason, the education system and education programs on all levels of education from diaper age to doctorate have been directed to fulfill this ecosystem strategy. Goal: The Fourth Industrial Revolution will bring unprecedented change to societies, education organizations and business environments. This article aims to identify how education, education content, the way education has proceeded, and overall whole the education business is changing. Most important is how we should respond to this inevitable co- evolution. Methodology: The study aims to verify how the learning process is boosted by new digital content, new learning software and tools, and customer-oriented learning environments. The change of education programs and individual education modules can be supported by applied research projects. You can use them in making proof- of- the concept of new technology, new ways to teach and train, and through the experiences gathered change education content, way to educate and finally education business as a whole. Major findings: Applied research projects can prove the concept- phases on real environment field labs to test technology opportunities and new tools for training purposes. Customer-oriented applied research projects are also excellent for students to make assignments and use new knowledge and content and teachers to test new tools and create new ways to educate. New content and problem-based learning are used in future education modules. This article introduces some case study experiences on customer-oriented digital transformation projects and how gathered knowledge on new digital content and a new way to educate has influenced education. The case study is related to experiences of research projects, customer-oriented field labs/learning environments and education programs of Häme University of Applied Sciences.

Keywords: education process, digitalization content, digital tools for education, learning environments, transdisciplinary co-operation

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Authors: I. Derek Kaka’an, P. Smolianov, D. Koh Choon Lian, S. Dion, C. Schoen, J. Norberg

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This study was designed to examine mass participation and elite football performance in Nigeria with reference to advance international football management practices. Over 200 sources of literature on sport delivery systems were analyzed to construct a globally applicable model of elite football integrated with mass participation, comprising of the following three levels: macro- (socio-economic, cultural, legislative, and organizational), meso- (infrastructures, personnel, and services enabling sport programs) and micro-level (operations, processes, and methodologies for development of individual athletes). The model has received scholarly validation and showed to be a framework for program analysis that is not culturally bound. The Smolianov and Zakus model has been employed for further understanding of sport systems such as US soccer, US Rugby, swimming, tennis, and volleyball as well as Russian and Dutch swimming. A questionnaire was developed using the above-mentioned model. Survey questions were validated by 12 experts including academicians, executives from sport governing bodies, football coaches, and administrators. To identify best practices and determine areas for improvement of football in Nigeria, 120 coaches completed the questionnaire. Useful exemplars and possible improvements were further identified through semi-structured discussions with 10 Nigerian football administrators and experts. Finally, content analysis of Nigeria Football Federation’s website and organizational documentation was conducted. This paper focuses on the meso-level of Nigerian football delivery, particularly infrastructures, personnel, and services enabling sport programs. This includes training centers, competition systems, and intellectual services. Results identified remarkable achievements coupled with great potential to further develop football in different types of public and private organizations in Nigeria. These include: assimilating football competitions with other cultural and educational activities, providing favorable conditions for employees of all possible organizations to partake and help in managing football programs and events, providing football coaching integrated with counseling for prevention of antisocial conduct, and improving cooperation between football programs and organizations for peace-making and advancement of international relations, tourism, and socio-economic development. Accurate reporting of the sports programs from the media should be encouraged through staff training for better awareness of various events. The systematic integration of these meso-level practices into the balanced development of mass and high-performance football will contribute to international sport success as well as national health, education, and social harmony.

Keywords: football, high performance, mass participation, Nigeria, sport development

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Authors: S. Pradhan, V. Kumaran

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Centrifugal gas separation processes effect separation by utilizing the difference in the mole fraction in a high speed rotating cylinder caused by the difference in molecular mass, and consequently the centrifugal force density. These have been widely used in isotope separation because chemical separation methods cannot be used to separate isotopes of the same chemical species. More recently, centrifugal separation has also been explored for the separation of gases such as carbon dioxide and methane. The efficiency of separation is critically dependent on the secondary flow generated due to temperature gradients at the cylinder wall or due to inserts, and it is important to formulate accurate models for this secondary flow. The widely used Onsager model for secondary flow is restricted to very long cylinders where the length is large compared to the diameter, the limit of high stratification parameter, where the gas is restricted to a thin layer near the wall of the cylinder, and it assumes that there is no mass difference in the two species while calculating the secondary flow. There are two objectives of the present analysis of the rarefied gas flow in a rotating cylinder. The first is to remove the restriction of high stratification parameter, and to generalize the solutions to low rotation speeds where the stratification parameter may be O (1), and to apply for dissimilar gases considering the difference in molecular mass of the two species. Secondly, we would like to compare the predictions with molecular simulations based on the direct simulation Monte Carlo (DSMC) method for rarefied gas flows, in order to quantify the errors resulting from the approximations at different aspect ratios, Reynolds number and stratification parameter. In this study, we have obtained analytical and numerical solutions for the secondary flows generated at the cylinder curved surface and at the end-caps due to linear wall temperature gradient and external gas inflow/outflow at the axis of the cylinder. The effect of sources of mass, momentum and energy within the flow domain are also analyzed. The results of the analytical solutions are compared with the results of DSMC simulations for three types of forcing, a wall temperature gradient, inflow/outflow of gas along the axis, and mass/momentum input due to inserts within the flow. The comparison reveals that the boundary conditions in the simulations and analysis have to be matched with care. The commonly used diffuse reflection boundary conditions at solid walls in DSMC simulations result in a non-zero slip velocity as well as a temperature slip (gas temperature at the wall is different from wall temperature). These have to be incorporated in the analysis in order to make quantitative predictions. In the case of mass/momentum/energy sources within the flow, it is necessary to ensure that the homogeneous boundary conditions are accurately satisfied in the simulations. When these precautions are taken, there is excellent agreement between analysis and simulations, to within 10 %, even when the stratification parameter is as low as 0.707, the Reynolds number is as low as 100 and the aspect ratio (length/diameter) of the cylinder is as low as 2, and the secondary flow velocity is as high as 0.2 times the maximum base flow velocity.

Keywords: rotating flows, generalized onsager and carrier-Maslen model, DSMC simulations, rarefied gas flow

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Authors: R. B. B. Samantha Ramachandra, L. D. J. Upul Senarath, S. H. Padmal De Silva

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Dietary pattern largely differs over countries and even within a country, it shows cultural differences. The dietary pattern changes the energy consumption and micronutrient intake, directly affects the pregnancy outcome. The dietary diversity was used as an indirect measure to assess micronutrient adequacy for pregnant mothers in this study. The study was conducted as a baseline survey with the objective of designing an intervention to improve the dietary diversity of pregnant mothers in Sri Lanka. The survey was conducted in Kalutara district of Sri Lanka in 2015 among 769 pregnant mothers at different gestational ages. Dietary diversity questionnaire developed by Food and Agricultural Organization’s (FAO) Food and Nutrition technical Assistance (FANTA) II project, recommended for cross-country use with adaptations was used for data collection. Trained data collectors met pregnant mothers at field ante-natal clinic and questioned on last 24hr dietary recall with portion size and coded food items to identify the diversity. Pregnant mothers were identified from randomly selected 21 clusters of public health midwife areas. 81.5% mothers (n=627) in the sample had been registered at Public Health Midwife (PHM) before 8 weeks of gestation. 24.4% of mothers were with low starting BMI and 22.7% mothers were with high starting BMI. 47.6% (n=388) mothers had abstained from at least one food item during the pregnancy. The food group with the highest consumption was rice (98.4%) followed by sugar (89.9%). 76.1% mothers had consumed milk, 73% consumed fish and sea foods. Consumption of green leaves was 52% and Vit A rich foods consumed only by 49% mothers. Animal organs, flesh meat and egg all showed low prevalence as 4.7%, 21.6% and 20% respectively. Consumption of locally grown roots, nut, legumes all showed very low prevalence. Consumption of 6 or more food groups was considered as good dietary diversity (DD), 4 to 5 food groups as moderate diversity and 3 or less food groups as poor diversity by FAO FANTA II project. 42.1% mothers demonstrated good DD while another 42.1% recorded moderate diversity. Working mothers showed better DD (51.6%, n=82/159) compared to housewives in the sample (chi = 10.656a,. df=2, p=0.005). The good DD showed gradual improvement from 43.1% to 55.5% along the poorest to richest wealth index (Chi=48.045, df=8 and p=0.000). DD showed significant association with the ethnicity and Moors showed the lowest DD. DD showed no association with the home gardening even though where better diversity expected among those who have home gardening (p=0.548). Sri Lanka is a country where many food items can be grown in the garden and semi-urban setting have adequate space for gardening. Many Sri Lankan mothers do not add homegrown items in their meal. At the same time, their consumption of animal food shows low prevalence. The DD of most of the mothers being either moderate or low (58%) may result from inadequate micro nutrient intake during pregnancy. It is recommended that adding green leaves, locally grown vegetables, roots, nuts and legumes can help increasing the DD of Sri Lankan mothers at low cost.

Keywords: dietary diversity, pregnant mothers, micro-nutrient, food groups

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Authors: Douglas N. Simões, Michele Pittol, Vanda F. Ribeiro, Daiane Tomacheski, Ruth M. C. Santana

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The increasing demand of thermoplastic elastomers is related to the wide range of applications, such as automotive, footwear, wire and cable industries, adhesives and medical devices, cell phones, sporting goods, toys and others. These materials are susceptible to microbial attack. Moisture and organic matter present in some areas (such as shower area and sink), provide favorable conditions for microbial proliferation, which contributes to the spread of diseases and reduces the product life cycle. Compounds based on SEBS copolymers, poly(styrene-b-(ethylene-co-butylene)-b-styrene, are a class of thermoplastic elastomers (TPE), fully recyclable and largely used in domestic appliances like bath mats and tooth brushes (soft touch). Zinc oxide and zinc ions loaded in personal and home care products have become common in the last years due to its biocidal effect. In that sense, the aim of this study was to evaluate the effect of zinc as antimicrobial agent in compounds based on SEBS/polypropylene/oil/ calcite for use as refrigerator seals (gaskets), bath mats and sink squeegee. Two zinc oxides from different suppliers (ZnO-Pe and ZnO-WR) and one masterbatch of zinc ions (M-Zn-ion) were used in proportions of 0%, 1%, 3% and 5%. The compounds were prepared using a co-rotating double screw extruder (L/D ratio of 40/1 and 16 mm screw diameter). The extrusion parameters were kept constant for all materials. Tests specimens were prepared using the injection molding machine. A compound with no antimicrobial additive (standard) was also tested. Compounds were characterized by physical (density), mechanical (hardness and tensile properties) and rheological properties (melt flow rate - MFR). The Japan Industrial Standard (JIS) Z 2801:2010 was applied to evaluate antibacterial properties against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). The Brazilian Association of Technical Standards (ABNT) NBR 15275:2014 were used to evaluate antifungal properties against Aspergillus niger (A. niger), Aureobasidium pullulans (A. pullulans), Candida albicans (C. albicans), and Penicillium chrysogenum (P. chrysogenum). The microbiological assay showed a reduction over 42% in E. coli and over 49% in S. aureus population. The tests with fungi showed inconclusive results because the sample without zinc also demonstrated an inhibition of fungal development when tested against A. pullulans, C. albicans and P. chrysogenum. In addition, the zinc loaded samples showed worse results than the standard sample when tested against A. niger. The zinc addition did not show significant variation in mechanical properties. However, the density values increased with the rise in ZnO additives concentration, and had a little decrease in M-Zn-ion samples. Also, there were differences in the MFR results in all compounds compared to the standard.

Keywords: antimicrobial, home device, SEBS, zinc

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Authors: L. Le Priol, A. Nesterenko, K. El Kirat, K. Saleh

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Introduction and objectives: Polyunsaturated fatty acids (PUFAs) omega-3 and omega-6 are widely recognized as being beneficial to the health and normal growth. Unfortunately, due to their highly unsaturated nature, these molecules are sensitive to oxidation and thermic degradation leading to the production of toxic compounds and unpleasant flavors and smells. Hence, it is necessary to find out a suitable way to protect them. Microencapsulation by spray-drying is a low-cost encapsulation technology and most commonly used in the food industry. Many compounds can be used as wall materials, but there is a growing interest in the use of biopolymers, such as proteins and polysaccharides, over the last years. The objective of this study is to increase the oxidative stability of sunflower oil by microencapsulation in plant protein matrices using spray-drying technique. Material and methods: Sunflower oil was used as a model substance for oxidable food oils. Proteins from brown rice, hemp, pea, soy and sunflower seeds were used as emulsifiers and microencapsulation wall materials. First, the proteins were solubilized in distilled water. Then, the emulsions were pre-homogenized using a high-speed homogenizer (Ultra-Turrax) and stabilized by using a high-pressure homogenizer (HHP). Drying of the emulsion was performed in a Mini Spray Dryer. The oxidative stability of the encapsulated oil was determined by performing accelerated oxidation tests with a Rancimat. The size of the microparticles was measured using a laser diffraction analyzer. The morphology of the spray-dried microparticles was acquired using environmental scanning microscopy. Results: Pure sunflower oil was used as a reference material. Its induction time was 9.5 ± 0.1 h. The microencapsulation of sunflower oil in pea and soy protein matrices significantly improved its oxidative stability with induction times of 21.3 ± 0.4 h and 12.5 ± 0.4 h respectively. The encapsulation with hemp proteins did not significantly change the oxidative stability of the encapsulated oil. Sunflower and brown rice proteins were ineffective materials for this application, with induction times of 7.2 ± 0.2 h and 7.0 ± 0.1 h respectively. The volume mean diameter of the microparticles formulated with soy and pea proteins were 8.9 ± 0.1 µm and 16.3 ± 1.2 µm respectively. The values for hemp, sunflower and brown rice proteins could not be obtained due to the agglomeration of the microparticles. ESEM images showed smooth and round microparticles with soy and pea proteins. The surfaces of the microparticles obtained with sunflower and hemp proteins were porous. The surface was rough when brown rice proteins were used as the encapsulating agent. Conclusion: Soy and pea proteins appeared to be efficient wall materials for the microencapsulation of sunflower oil by spray drying. These results were partly explained by the higher solubility of soy and pea proteins in water compared to hemp, sunflower, and brown rice proteins. Acknowledgment: This work has been performed, in partnership with the SAS PIVERT, within the frame of the French Institute for the Energy Transition (Institut pour la Transition Energétique (ITE)) P.I.V.E.R.T. (www.institut-pivert.com) selected as an Investments for the Future (Investissements d’Avenir). This work was supported, as part of the Investments for the Future, by the French Government under the reference ANR-001-01.

Keywords: biopolymer, edible oil, microencapsulation, oxidative stability, release, spray-drying

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Authors: Fatima Meirkhankyzy Shaizadina, Alua Oralovna Omarova, Praskovya Mikhailovna Britskaya, Nessipkul Oryntayevna Alysheva

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In recent years in the Republic of Kazakhstan there have been registered outbreaks of measles among the population. The objective of work was the analysis of outbreak of measles in 2014 among the population of North-Kazakhstan region of the Republic of Kazakhstan. For the analysis of the measles outbreak descriptive and analytical research, techniques were used and threshold levels of morbidity were calculated. The increase of incidence was noted from March to July. The peak was registered in May and made 9.0 per 100000 population. High rates were registered in April – 5.7 per 100000 population, and in June and July they made 5.7 and 3.1 respectively. Duration of the period of increase made 5 months. The analysis of monthly incidence of measles revealed spring and summer seasonality. Across the territory it was established that 69.2% of cases were registered in the city, 29.1% in rural areas and 1.7% of cases were brought in from other regions of Kazakhstan. The registered cases and threshold values of measles during the outbreak revealed that from 12 to 24 week, and also during the 40th week the cases exceeding the threshold levels are registered. Thus, for example, for the analyzed 1 week the number of the revealed patients made 4, which exceeds the calculated threshold value (3) by 33.3%. The data exceeding the threshold values confirm the emergence of a disease outbreak or the beginning of epidemic rise in morbidity. Epidemic rise in incidence of the population of North-Kazakhstan region was observed throughout 2014. The risk group includes 0-4 year-old children, who made 22.7%, 15-19 year-olds – 25.6%, 20-24 year-olds – 20.9%. The analysis of measles cases registration by gender revealed that women are registered 1.1 times more often than men. The ratio of women to men made 1:0.87. In social and professional groups often ill are unorganized children – 23.3% and students – 19.8%. Studying clinical manifestations of measles in the hospitalized patients, the typical beginning of a disease with expressed intoxication symptoms – weakness, sickliness was established. In individual cases expressed intoxication symptoms, hemorrhagic and dyspeptic syndromes, complications in the form of overlay of a secondary bacterial infection, which defined high severity of the illness, were registered both in adults and in children. The average duration of stay of patients in the hospital made 6.9 days. The average duration of time between date of getting the disease and date of delivery of health care made 3.6 days. Thus, the analysis of monthly incidence of measles revealed spring and summer seasonality, the peak of which was registered in May. Urban dwellers are ill more often (69.2%), while in rural areas people are ill more rarely (29.1%). Throughout 2014 an epidemic rise in incidence of the population of North-Kazakhstan region was observed. Risk group includes: children under 4 – 22.7%, 15-19 year-olds – 25.6%, 20-24 year-olds – 20.9%. The ratio of women and men made 1:0.87. The typical beginning of a disease in all hospitalized with the expressed intoxication symptoms – weakness, sickliness was established.

Keywords: epidemiological analysis, measles, morbidity, outbreak

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Authors: Zo Hasina Rabemananjara

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The North-East of Madagascar is the pillar of Madagascar's foreign trade, providing 41% and 80% of world exports of cloves and vanilla, respectively, in 2016. For Madagascar, the north-eastern escarpment is home to the last massifs of humid forest in large scale of the island, surrounded by a small scale agricultural mosaic. In the sites where this study is taking place, located in the peripheral zones of protected areas, the production of rent aims to supply international markets. In fact, importers of the cash crops produced in these areas are located mainly in India, Singapore, France, Germany and the United States. Recently, the price of these products has increased significantly, especially from the year 2015. For vanilla, the price has skyrocketed, from an approximate price of 73 USD per kilo in 2015 to more than 250 USD per kilo in 2016. The value of clove exports increased sharply by 49.4% in 2017, largely to Singapore and India due to the sharp increase in exported volume (+47, 6%) in 2017. If the relationship between the rise in prices of rented products and the change in physical environments is known, the evolution of the behavior of land users linked to this aspect was not yet addressed by research. In fact, the consequence of this price increase in the organization of the use of space at the local level still raises questions. Hence, the research question is: to what extent does this improvement in the price of imported products affect user behavior linked to the local organization of access to the factor of soil production? To fully appreciate this change in behavior, surveys of 144 land user households were carried out, and group interviews were also carried out. The results of this research showed that the rise in the prices of annuity products from the year 2015 caused significant changes in the behavior of land users in the study sites. Young people, who have not been attracted to farming for a long time, have started to show interest in it since the period of rising vanilla and clove prices. They have set up their own fields of vanilla and clove cultivation. This revival of interest conferred an important value on the land and caused conflicts especially between family members because the acquisition of the cultivated land was done by inheritance or donation. This change in user behavior has also affected the farmers' life strategy since the latter have decided to abandon rain-fed rice farming, which has long been considered a guaranteed subsistence activity for cash crops. This research will contribute to nourishing scientific reflection on the management of land use and also to support political decision-makers in decision-making on spatial planning.

Keywords: behavior of land users, North-eastern Madagascar, price of export products, spatial planning

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Authors: Panaya Sudta, Wanchalerm Patanacharoenwong, Prachya Bumrungkun

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As With the evolution of smart grids, ensuring the reliability and efficiency of electrical systems in smart cities has become crucial. This paper proposes a distinct approach that combines advanced machine learning techniques to accurately predict electrical failures and address voltage reliability issues. This approach aims to improve the accuracy and efficiency of reliability evaluations in smart cities. The aim of this research is to develop a comprehensive predictive model that accurately predicts electrical failures and voltage reliability in smart cities. This model integrates RFM analysis, K-means clustering, and LSTM networks to achieve this objective. The research utilizes RFM analysis, traditionally used in customer value assessment, to categorize and analyze electrical components based on their failure recency, frequency, and monetary impact. K-means clustering is employed to segment electrical components into distinct groups with similar characteristics and failure patterns. LSTM networks are used to capture the temporal dependencies and patterns in customer data. This integration of RFM, K-means, and LSTM results in a robust predictive tool for electrical failures and voltage reliability. The proposed model has been tested and validated on diverse electrical utility datasets. The results show a significant improvement in prediction accuracy and reliability compared to traditional methods, achieving an accuracy of 92.78% and an F1-score of 0.83. This research contributes to the proactive maintenance and optimization of electrical infrastructures in smart cities. It also enhances overall energy management and sustainability. The integration of advanced machine learning techniques in the predictive model demonstrates the potential for transforming the landscape of electrical system management within smart cities. The research utilizes diverse electrical utility datasets to develop and validate the predictive model. RFM analysis, K-means clustering, and LSTM networks are applied to these datasets to analyze and predict electrical failures and voltage reliability. The research addresses the question of how accurately electrical failures and voltage reliability can be predicted in smart cities. It also investigates the effectiveness of integrating RFM analysis, K-means clustering, and LSTM networks in achieving this goal. The proposed approach presents a distinct, efficient, and effective solution for predicting and mitigating electrical failures and voltage issues in smart cities. It significantly improves prediction accuracy and reliability compared to traditional methods. This advancement contributes to the proactive maintenance and optimization of electrical infrastructures, overall energy management, and sustainability in smart cities.

Keywords: electrical state prediction, smart grids, data-driven method, long short-term memory, RFM, k-means, machine learning

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Authors: Quentin C.P. Bourgogne, Vanessa Bouchart, Pierre Chevrier, Emmanuel Dattoli

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This study presents an experimental and theoretical work conducted on a PolyPhenylene Sulfide reinforced with 40%wt of short glass fibers (PPS GF40) and its matrix. Thermoplastics are widely used in the automotive industry to lightweight automotive parts. The replacement of metallic parts by thermoplastics is reaching under-the-hood parts, near the engine. In this area, the parts are subjected to high temperatures and are immersed in cooling liquid. This liquid is composed of water and glycol and can affect the mechanical properties of the composite. The aim of this work was thus to quantify the evolution of mechanical properties of the thermoplastic composite, as a function of temperature and liquid aging effects, in order to develop a reliable design of parts. An experimental campaign in the tensile mode was carried out at different temperatures and for various glycol proportions in the cooling liquid, for monotonic and cyclic loadings on a neat and a reinforced PPS. The results of these tests allowed to highlight some of the main physical phenomena occurring during these solicitations under tough hydro-thermal conditions. Indeed, the performed tests showed that temperature and liquid cooling aging can affect the mechanical behavior of the material in several ways. The more the cooling liquid contains water, the more the mechanical behavior is affected. It was observed that PPS showed a higher sensitivity to absorption than to chemical aggressiveness of the cooling liquid, explaining this dominant sensitivity. Two kinds of behaviors were noted: an elasto-plastic type under the glass transition temperature and a visco-pseudo-plastic one above it. It was also shown that viscosity is the leading phenomenon above the glass transition temperature for the PPS and could also be important under this temperature, mostly under cyclic conditions and when the stress rate is low. Finally, it was observed that soliciting this composite at high temperatures is decreasing the advantages of the presence of fibers. A new phenomenological model was then built to take into account these experimental observations. This new model allowed the prediction of the evolution of mechanical properties as a function of the loading environment, with a reduced number of parameters compared to precedent studies. It was also shown that the presented approach enables the description and the prediction of the mechanical response with very good accuracy (2% of average error at worst), over a wide range of hydrothermal conditions. A temperature-humidity equivalence principle was underlined for the PPS, allowing the consideration of aging effects within the proposed model. Then, a limit of improvement of the reachable accuracy was determinate for all models using this set of data by the application of an artificial intelligence-based model allowing a comparison between artificial intelligence-based models and phenomenological based ones.

Keywords: aging, analytical modeling, mechanical testing, polymer matrix composites, sequential model, thermomechanical

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Authors: Shashikant Iyengar, Jasmeet Kaur, Anup Singh, Arun Kumar, Ira Sahay

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Insulin resistance (IR) is a condition that occurs when cells in the body become less responsive to insulin, leading to higher levels of both insulin and glucose in the blood. This condition is linked to metabolic syndromes, including diabetes. It is crucial to address IR promptly after diagnosis to prevent long-term complications associated with high insulin and high blood glucose. This four-month case study highlights the importance of treating the underlying condition to manage diabetes effectively. Insulin is essential for regulating blood sugar levels by facilitating the uptake of glucose into cells for energy or storage. In IR individuals, cells are less efficient at taking up glucose from the blood resulting in elevated blood glucose levels. As a result of IR, beta cells produce more insulin to make up for the body's inability to use insulin effectively. This leads to high insulin levels, a condition known as hyperinsulinemia, which further impairs glucose metabolism and can contribute to various chronic diseases. In addition to regulating blood glucose, insulin has anti-catabolic effects, preventing the breakdown of molecules in the body, such as inhibiting glycogen breakdown in the liver, inhibiting gluconeogenesis, and inhibiting lipolysis. If a person is insulin-sensitive or metabolically healthy, an optimal level of insulin prevents fat cells from releasing fat and promotes the storage of glucose and fat in the body. Thus optimal insulin levels are crucial for maintaining energy balance and plays a key role in metabolic processes. During the four-month study, researchers looked at the impact of a low-carb dietary (LCD) intervention on two male individuals (A & B) who had Type-2 diabetes. Althoughvneither of these individuals were obese, they were both slightly overweight and had abdominal fat deposits. Before the trial began, important markers such as fasting blood glucose (FBG), triglycerides (TG), high-density lipoprotein (HDL) cholesterol, and Hba1c were measured. These markers are essential in defining metabolic health, their individual values and variability are integral in deciphering metabolic health. The ratio of TG to HDL is used as a surrogate marker for IR. This ratio has a high correlation with the prevalence of metabolic syndrome and with IR itself. It is a convenient measure because it can be calculated from a standard lipid profile and does not require more complex tests. In this four-month trial, an improvement in insulin sensitivity was observed through the ratio of TG/HDL, which, in turn, improves fasting blood glucose levels and HbA1c. For subject A, HbA1c dropped from 13 to 6.28, and for subject B, it dropped from 9.4 to 5.7. During the trial, neither of the subjects were taking any diabetic medications. The significant improvements in their health markers, such as better glucose control, along with an increase in energy levels, demonstrate that incorporating LCD interventions can effectively manage diabetes.

Keywords: metabolic disorder, insulin resistance, type-2 diabetes, low-carb nutrition

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Authors: Paul Licina, Emma M. Johnston, David Lisle, Mark Young, Chris Brady

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Background: Lumbar pars pathology is a common cause of pain in the growing spine. It can be seen in young athletes participating in at-risk sports and can affect sporting performance and long-term health due to its resistance to traditional management. There is a current lack of consensus of classification and treatment for pars injuries. Previous systems used CT to stage pars defects but could not assess early stress reactions. A modified classification is proposed that considers findings on MRI, significantly improving early treatment guidance. The treatment protocol is designed for patients aged 5 to 19 years. Method: Clinical screening identifies patients with a low, medium, or high index of suspicion for lumbar pars injury using patient age, sport participation and pain characteristics. MRI of the at-risk cohort enables augmentation of existing CT-based classification while avoiding ionising radiation. Patients are classified into five categories based on MRI findings. A type 0 lesion (stress reaction) is present when CT is normal and MRI shows high signal change (HSC) in the pars/pedicle on T2 images. A type 1 lesion represents the ‘early defect’ CT classification. The group previously referred to as a 'progressive stage' defect on CT can be split into 2A and 2B categories. 2As have HSC on MRI, whereas 2Bs do not. This distinction is important with regard to healing potential. Type 3 lesions are terminal stage defects on CT, characterised by pseudarthrosis. MRI shows no HSC. Results: Stress reactions (type 0) and acute fractures (1 and 2a) can heal and are treated in a custom-made hard brace for 12 weeks. It is initially worn 23 hours per day. At three weeks, patients commence basic core rehabilitation. At six weeks, in the absence of pain, the brace is removed for sleeping. Exercises are progressed to positions of daily living. Patients with continued pain remain braced 23 hours per day without exercise progression until becoming symptom-free. At nine weeks, patients commence supervised exercises out of the brace for 30 minutes each day. This allows them to re-learn muscular control without rigid support of the brace. At 12 weeks, bracing ceases and MRI is repeated. For patients with near or complete resolution of bony oedema and healing of any cortical defect, rehabilitation is focused on strength and conditioning and sport-specific exercise for the full return to activity. The length of this final stage is approximately nine weeks but depends on factors such as development and level of sports participation. If significant HSC remains on MRI, CT scan is considered to definitively assess cortical defect healing. For these patients, return to high-risk sports is delayed for up to three months. Chronic defects (2b and 3) cannot heal and are not braced, and rehabilitation follows traditional protocols. Conclusion: Appropriate clinical screening and imaging with MRI can identify pars pathology early. In those with potential for healing, we propose hard bracing and appropriate rehabilitation as part of a multidisciplinary management protocol. The validity of this protocol will be tested in future studies.

Keywords: adolescents, MRI classification, pars interticularis, treatment protocol

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Authors: Oscar Nieto-Garzón, Angélica Lozano

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In urban areas, on-road freight transportation creates several social and environmental externalities. Then, it is crucial that freight transport considers not only economic aspects, like retailer distribution cost reduction and service improvement, but also environmental effects such as global CO2 and local emissions (e.g. Particulate Matter, NOX, CO) and noise. Inadequate infrastructure development, high rate of urbanization, the increase of motorization, and the lack of transportation planning are characteristics that urban areas from developing countries share. The Metropolitan Area of Mexico City (MAMC), the Metropolitan Area of São Paulo (MASP), and Bogota are three of the largest urban areas in Latin America where air pollution is often a problem associated with emissions from mobile sources. The effect of the lockdown due to COVID-19 was analyzedfor these urban areas, comparing the same period (January to August) of years 2016 – 2019 with 2020. A strong reduction in the concentration of primary criteria pollutants emitted by road traffic were observed at the beginning of 2020 and after the lockdown measures.Daily mean concentration of NOx decreased 40% in the MAMC, 34% in the MASP, and 62% in Bogota. Daily mean ozone levels increased after the lockdown measures in the three urban areas, 25% in MAMC, 30% in the MASP and 60% in Bogota. These changes in emission patterns from mobile sources drastically changed the ambient atmospheric concentrations of CO and NOX. The CO/NOX ratioat the morning hours is often used as an indicator of mobile sources emissions. In 2020, traffic from cars and light vehicles was significantly reduced due to the first lockdown, but buses and trucks had not restrictions. In theory, it implies a decrease in CO and NOX from cars or light vehicles, maintaining the levels of NOX by trucks(or lower levels due to the congestion reduction). At rush hours, traffic was reduced between 50% and 75%, so trucks could get higher speeds, which would reduce their emissions. By means an emission model, it was found that an increase in the average speed (75%) would reduce the emissions (CO, NOX, and PM) from diesel trucks by up to 30%. It was expected that the value of CO/NOXratio could change due to thelockdownrestrictions. However, although there was asignificant reduction of traffic, CO/NOX kept its trend, decreasing to 8-9 in 2020. Hence, traffic restrictions had no impact on the CO/NOX ratio, although they did reduce vehicle emissions of CO and NOX. Therefore, these emissions may not adequately represent the change in the vehicle emission patterns, or this ratio may not be a good indicator of emissions generated by vehicles. From the comparison of the theoretical data and those observed during the lockdown, results that the real NOX reduction was lower than the theoretical reduction. The reasons could be that there are other sources of NOX emissions, so there would be an over-representation of NOX emissions generated by diesel vehicles, or there is an underestimation of CO emissions. Further analysis needs to consider this ratioto evaluate the emission inventories and then to extend these results forthe determination of emission control policies to non-mobile sources.

Keywords: COVID-19, emissions, freight transport, latin American metropolis

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Authors: Violetta Cataldo, Renata Savy, Simona Sbranna

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Background: Foreign Language Learning (FLL) is characterised by prosodic transfer phenomena regarding pitch accents placement, intonation patterns, and pitch range excursion from the learners’ mother tongue to their Foreign Language (FL) which suggests that the gradual development of general linguistic competence in FL does not imply an equally correspondent improvement of the prosodic competence. Topic: The present study aims to monitor the development of prosodic competence of learners of Italian and German throughout the FLL process. The primary object of this study is to investigate the intonational features and the f₀ range excursion of Italian and German from a cross-linguistic perspective; analyses of native speakers’ productions point out the differences between this pair of languages and provide models for the Target Language (TL). A following crosscheck compares the L2 productions in Italian and German by non-native speakers to the Target Language models, in order to verify the occurrence of prosodic interference phenomena, i.e., type, degree, and modalities. Methodology: The subjects of the research are university students belonging to two groups: Italian native speakers learning German as FL and German native speakers learning Italian as FL. Both of them have been divided into three subgroups according to the FL proficiency level (beginners, intermediate, advanced). The dataset consists of wh-questions placed in situational contexts uttered in both speakers’ L1 and FL. Using a phonetic approach, analyses have considered three domains of intonational contours (Initial Profile, Nuclear Accent, and Terminal Contour) and two dimensions of the f₀ range parameter (span and level), which provide a basis for comparison between L1 and L2 productions. Findings: Results highlight a strong presence of prosodic transfer phenomena affecting L2 productions in the majority of both Italian and German learners, irrespective of their FL proficiency level; the transfer concerns all the three domains of the contour taken into account, although with different modalities and characteristics. Currently, L2 productions of German learners show a pitch span compression on the domain of the Terminal Contour compared to their L1 towards the TL; furthermore, German learners tend to use lower pitch range values in deviation from their L1 when improving their general linguistic competence in Italian FL proficiency level. Results regarding pitch range span and level in L2 productions by Italian learners are still in progress. At present, they show a similar tendency to expand the pitch span and to raise the pitch level, which also reveals a deviation from the L1 possibly in the direction of German TL. Conclusion: Intonational features seem to be 'resistant' parameters to which learners appear not to be particularly sensitive. By contrast, they show a certain sensitiveness to FL pitch range dimensions. Making clear which the most resistant and the most sensitive parameters are when learning FL prosody could lay groundwork for the development of prosodic trainings thanks to which learners could finally acquire a clear and natural pronunciation and intonation.

Keywords: foreign language learning, German, Italian, L2 prosody, pitch range, transfer

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Authors: I. Stathopoulos, V. Syrgiamiotis, E. Karavasilis, A. Ploussi, I. Nikas, C. Hatzigiorgi, K. Platoni, E. P. Efstathopoulos

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Introduction: Brain and central nervous system (CNS) tumors form the second most common group of cancer in children, accounting for 30% of all childhood cancers. MRI is the key imaging technique used for the visualization and management of pediatric brain tumors. Initial characterization of tumors from MRI scans is usually performed via a radiologist’s visual assessment. However, different brain tumor types do not always demonstrate clear differences in visual appearance. Using only conventional MRI to provide a definite diagnosis could potentially lead to inaccurate results, and so histopathological examination of biopsy samples is currently considered to be the gold standard for obtaining definite diagnoses. Machine learning is defined as the study of computational algorithms that can use, complex or not, mathematical relationships and patterns from empirical and scientific data to make reliable decisions. Concerning the above, machine learning techniques could provide effective and accurate ways to automate and speed up the analysis and diagnosis for medical images. Machine learning applications in radiology are or could potentially be useful in practice for medical image segmentation and registration, computer-aided detection and diagnosis systems for CT, MR or radiography images and functional MR (fMRI) images for brain activity analysis and neurological disease diagnosis. Purpose: The objective of this study is to provide an automated tool, which may assist in the imaging evaluation and classification of brain neoplasms in pediatric patients by determining the glioma type, grade and differentiating between different brain tissue types. Moreover, a future purpose is to present an alternative way of quick and accurate diagnosis in order to save time and resources in the daily medical workflow. Materials and Methods: A cohort, of 80 pediatric patients with a diagnosis of posterior fossa tumor, was used: 20 ependymomas, 20 astrocytomas, 20 medulloblastomas and 20 healthy children. The MR sequences used, for every single patient, were the following: axial T1-weighted (T1), axial T2-weighted (T2), FluidAttenuated Inversion Recovery (FLAIR), axial diffusion weighted images (DWI), axial contrast-enhanced T1-weighted (T1ce). From every sequence only a principal slice was used that manually traced by two expert radiologists. Image acquisition was carried out on a GE HDxt 1.5-T scanner. The images were preprocessed following a number of steps including noise reduction, bias-field correction, thresholding, coregistration of all sequences (T1, T2, T1ce, FLAIR, DWI), skull stripping, and histogram matching. A large number of features for investigation were chosen, which included age, tumor shape characteristics, image intensity characteristics and texture features. After selecting the features for achieving the highest accuracy using the least number of variables, four machine learning classification algorithms were used: k-Nearest Neighbour, Support-Vector Machines, C4.5 Decision Tree and Convolutional Neural Network. The machine learning schemes and the image analysis are implemented in the WEKA platform and MatLab platform respectively. Results-Conclusions: The results and the accuracy of images classification for each type of glioma by the four different algorithms are still on process.

Keywords: image classification, machine learning algorithms, pediatric MRI, pediatric oncology

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Authors: Hafid Smaili, Wilfred Rouwhorst, Paul Frost

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The trend of recent accident and incident cases worldwide show that the state-of-the-art automation and operations, for current and future demanding operational environments, does not provide the desired level of operational safety under crew peak workload conditions, specifically in complex situations such as loss-of-control in-flight (LOC-I). Today, the short term focus is on preparing crews to recognise and handle LOC-I situations through upset recovery training. This paper describes the cockpit integration aspects and piloted assessment of both a manually assisted and automatic upset detection and recovery system that has been developed and demonstrated within the European Advanced Cockpit for Reduction Of StreSs and workload (ACROSS) programme. The proposed system is a function that continuously monitors and intervenes when the aircraft enters an upset and provides either manually pilot-assisted guidance or takes over full control of the aircraft to recover from an upset. In order to mitigate the highly physical and psychological impact during aircraft upset events, the system provides new cockpit functionalities to support the pilot in recovering from any upset both manually assisted and automatically. A piloted simulator assessment was made in Oct-Nov 2015 using ten pilots in a representative civil large transport fly-by-wire aircraft in terms of the preference of the tested upset detection and recovery system configurations to reduce pilot workload, increase situational awareness and safe interaction with the manually assisted or automated modes. The piloted simulator evaluation of the upset detection and recovery system showed that the functionalities of the system are able to support pilots during an upset. The experiment showed that pilots are willing to rely on the guidance provided by the system during an upset. Thereby, it is important for pilots to see and understand what the aircraft is doing and trying to do especially in automatic modes. Comparing the manually assisted and the automatic recovery modes, the pilot’s opinion was that an automatic recovery reduces the workload so that they could perform a proper screening of the primary flight display. The results further show that the manually assisted recoveries, with recovery guidance cues on the cockpit primary flight display, reduced workload for severe upsets compared to today’s situation. The level of situation awareness was improved for automatic upset recoveries where the pilot could monitor what the system was trying to accomplish compared to automatic recovery modes without any guidance. An improvement in situation awareness was also noticeable with the manually assisted upset recovery functionalities as compared to the current non-assisted recovery procedures. This study shows that automatic upset detection and recovery functionalities are likely to positively impact the operational safety by means of reduced workload, improved situation awareness and crew stress reduction. It is thus believed that future developments for upset recovery guidance and loss-of-control prevention should focus on automatic recovery solutions.

Keywords: aircraft accidents, automatic flight control, loss-of-control, upset recovery

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Authors: Tamrat Girma Biru

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Multidrug-resistant tuberculosis (MDR-TB) is defined as resistant to at least Refampicin and Isoniazed: the most two power full TB drugs. It is a leading cause of high rates of morbidity and mortality, and increasing psychosocial challenges to patients, especially when co-infected with Human Immunodeficiency Virus (HIV). Ethiopia faces the highest rates of MDR-TB infection in the world. Objectives: The main objective of this study was to identify the psychosocial challenges of MDR-TB patients, to investigate the extent of the psychosocial challenges on (self-esteem, depression, and stigma) that MDR-TB patients encounter, to examine whether there is a sex difference in experiencing psychosocial challenges and assess the counseling needs of MDR-TB patients. Methodology: A cross-sectional study was conducted at St. Peter TB Specialized Hospital, Addis Ababa on 40 patients (25 males and 15 females) who are hospitalized for treatment. The patients were identified by using purposive sampling and made fill a questionnaire measuring their level of self-esteem, depression and stigma. Besides, data were collected from 16 participants, 28 care providers and 8 guardians, using semi-structured interview. The obtained data were analyzed using SPSS statistical program, descriptive statistics, independent t-test, and qualitative description. Results and Discussion: The results of the study showed that the majority (80%) of the respondents had suffered psychological challenges and social discriminations. Thus, the significance of MDR-TB and its association with HIV/AIDS problems is considered. Besides the psychosocial challenges, various aggravating factors such as length of treatment, drug burden and insecurity in economy together highly challenges the life of patients. In addition, 60% of participants showed low level of self-esteem. The patients also reported that they experienced high self-stigma and stigma by other members of the society. The majority of the participants (75%) showed moderate and severe level of depression. In terms of sex there is no difference between the mean scores of males and females in the level of depression and stigmatization by others and by themselves. But females showed lower level of self-esteem than males. The analysis of the t-test also shows that there were no statistically significant sex difference on the level of depression and stigma. Based on the qualitative data MDR-TB patients face various challenges in their life sphere such as: Psychological (depression, low self value, lowliness, anxiety), social (stigma, isolation from social relations, self-stigmatization,) and medical (drug side effect, drug toxicity, drug burden, treatment length, hospital stays). Recommendations: Based on the findings of this study possible recommendations were forwarded: develop and extend MDR-TB disease awareness creation through by media (printing and electronic), school net TB clubs, and door to door community education. Strengthen psychological wellbeing and social relationship of MDR-TB patients using proper and consistent psychosocial support and counseling. Responsible bodies like Ministry of Health (MOH) and its stakeholders and Non Governmental Organizations (NGOs) need to assess the challenges of patients and take measures on this pressing issue.

Keywords: psychosocial challenges, counseling, multi-drug resistant tuberculosis (MDR-TB), tuberculosis therapy

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Authors: Monkiz Khasreen

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In the context of the global trend towards reducing new buildings carbon footprint, the design team is required to make early decisions that have a major influence on embodied and operational carbon. Sustainability strategies should be clear during early stages of building design process, as changes made later can be extremely costly. Life-Cycle Assessment (LCA) could be used as the vehicle to carry other tools and processes towards achieving the requested improvement. Although LCA is the ‘golden standard’ to evaluate buildings from 'cradle to grave', lack of details available on the concept design makes LCA very difficult, if not impossible, to be used as an estimation tool at early stages. Issues related to transparency and accessibility of information in the building industry are affecting the credibility of LCA studies. A verified database derived from LCA case studies is required to be accessible to researchers, design professionals, and decision makers in order to offer guidance on specific areas of significant impact. This database could be the build-up of data from multiple sources within a pool of research held in this context. One of the most important factors that affects the reliability of such data is the temporal factor as building materials, components, and systems are rapidly changing with the advancement of technology making production more efficient and less environmentally harmful. Recent LCA studies on different building functions, types, and structures are always needed to update databases derived from research and to form case bases for comparison studies. There is also a need to make these studies transparent and accessible to designers. The work in this paper sets out to address this need. This paper also presents life-cycle case study of a new-build educational building in England. The building utilised very current construction methods and technologies and is rated as BREEAM excellent. Carbon emissions of different life-cycle stages and different building materials and components were modelled. Scenario and sensitivity analyses were used to estimate the future of new educational buildings in England. The study attempts to form an indicator during the early design stages of similar buildings. Carbon dioxide emissions of this case study building, when normalised according to floor area, lie towards the lower end of the range of worldwide data reported in the literature. Sensitivity analysis shows that life cycle assessment results are highly sensitive to future assumptions made at the design stage, such as future changes in electricity generation structure over time, refurbishment processes and recycling. The analyses also prove that large savings in carbon dioxide emissions can result from very small changes at the design stage.

Keywords: architecture, building, carbon dioxide, construction, educational buildings, England, environmental impact, life-cycle assessment

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Authors: Anush Patric, M. Jadeyegowda, M. N. Ramesh, M. Ravikumar, C. R. Ajay

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Kodagu district which is situated in Central Western Ghats regions falls in one of the hottest of hot spots of biodiversity which is recognised by UNESCO. The district has one of the highest densities of community managed sacred forests in the world with rich floral and faunal diversity. It is a habitat for more than ten different types of Ethnic Indigenous tribal groups commonly called ‘Girijanas’ (Soligas, Yarvas, Jenukuruba, Bettakuruba etc.), who are having the rich knowledge of medicinal value of the plants that are commonly available in the forest. The tribal men of this region are the treasure house of the traditional plant knowledge and health care practices. An ethnobotanical survey was undertaken in tribal areas of the district to collect information about some of the indigenous medicinal plant knowledge of tribal people by semi-structured interviews, ranking exercises and field observations on their native habitat in order to evaluate the potential medicinal uses of local plants. The study revealed that, the ethnobotanical information of 83 plant species belonging to 45 families, of the total 83 species documented, most plants used in the treatment were trees (11 species), shrubs (41 species), herbs (22 species) and rarely climbers (9 species) which are used in the treatment of Hyperacidity, Respiratory disorders, Snake bite Abortifacient, Anthelmintic, Paralysis, Antiseptic, Fever, Chest pain, Stomachic, Jaundice, Piles, Asthma, Malaria, Renal disorders, Malaria and many other diseases. Maximum of 6 plant species each of Acanthaceae, Apiaceae and were used for drug preparation, followed by Asclepiadaceae, Liliaceae, Fabaceae, Verbenaceae, Caesalpinaceae, Bombaceae, Papilonaceae, Solanaceae, Rubiaceae, Myrtaceae, Amaranthaceae, Asteraceae, Ascelepidaceae, Cucurbitaceae, Apocyanaceae, and Solanaceae etc. In our present study, only medicinal plants and their local medicinal uses are recorded and presented. Information was obtained by local informants having the knowledge about medicinal plants. About 23 local tribes were interviewed. For each plant, necessary information like botanical name, family of plant species, local name and uses are given. Recent trend shows a decline in the number of traditional herbal healers in the tribal areas since the younger generation is not interested to continue this tradition. Hence, there is an urgent need to record and preserve all information on plants used by different ethnic/tribal communities for various purposes before it reaches to verge of extinction. In addition, several wild medicinal plants are declining in numbers due to deforestation and forest fires. There is need for phytochemical analysis and conservation measures to be taken for conserving medicinal plant species which is far better than allopathic medicines and these do not cause any side effects as they are the natural disease healers. So, conservation strategies have to be practiced in all levels and sectors by creating awareness about the value of such medicinal plants, and it is necessary to save the disappearing plants to strengthen the document and to conserve them for future generation.

Keywords: diseases, ethnic groups, folk medicine, Kodagu, medicinal plants

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Authors: Evonne Kaplan-Liss, Val Lantz-Gefroh

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Arts and humanities are often incorporated into medical education to help deepen understanding of the human condition and the ability to communicate from a place of compassion. However, a gap remains in our knowledge of compassionate communication training for postgraduate medical professionals (as opposed to students and residents); how training opportunities include and impact the artists themselves, and how train-the-trainer models can support learners to become teachers. In this report, the authors present results from a pilot evaluation of the UC San Diego Health: Sanford Compassionate Communication Fellowship, a 60-hour experiential program that uses theater, narrative reflection, poetry, literature, and journalism techniques to train a multidisciplinary cohort of medical professionals and artists in compassionate communication. In the culminating project, fellows design and implement their own projects as teachers of compassionate communication in their respective workplaces. Qualitative methods, including field notes and 30-minute Zoom interviews with each fellow, were used to evaluate the impact of the fellowship. The cohort included both artists (n=2) and physicians representing a range of specialties (n=7), such as occupational medicine, palliative care, and pediatrics. The authors coded the data using thematic analysis for evidence of how the multidisciplinary nature of the fellowship impacted the fellows’ experiences. The findings show that the multidisciplinary cohort contributed to a greater appreciation of compassionate communication in general. Fellows expressed that the ability to witness how those in different fields approached compassionate communication enhanced their learning and helped them see how compassion can be expressed in various contexts, which was both “exhilarating” and “humbling.” One physician expressed that the fellowship has been “really helpful to broaden my perspective on the value of good communication.” Fellows shared how what they learned in the fellowship translated to increased compassionate communication, not only in their professional roles but in their personal lives as well. A second finding was the development of a supportive community. Because each fellow brought their own experiences and expertise, there was a sense of genuine ability to contribute as well as a desire to learn from others. A “brave space” was created by the fellowship facilitators and the inclusion of arts-based activities: a space that invited vulnerability and welcomed fellows to make their own meaning without prescribing any one answer or right way to approach compassionate communication. This brave space contributed to a strong connection among the fellows and reports of increased well-being, as well as multiple collaborations post-fellowship to carry forward compassionate communication training at their places of work. Results show initial evidence of the value of a multidisciplinary fellowship for promoting compassionate communication for both artists and physicians. The next steps include maintaining the supportive fellowship community and collaborations with a post-fellowship affiliate faculty program; scaling up the fellowship with non-physicians (e.g., nurses and physician assistants); and collecting data from family members, colleagues, and patients to understand how the fellowship may be creating a ripple effect outside of the fellowship through fellows’ compassionate communication.

Keywords: compassionate communication, communication in healthcare, multidisciplinary learning, arts in medicine

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Authors: Neelofar, Khursheed Alam, Jamal Ahmad

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Protein modification in diabetes mellitus may lead to early glycation products (EGPs) or amadori product as well as advanced glycation end products (AGEs). Early glycation involves the reaction of glucose with N-terminal and lysyl side chain amino groups to form Schiff’s base which undergoes rearrangements to form more stable early glycation product known as Amadori product. After Amadori, the reactions become more complicated leading to the formation of advanced glycation end products (AGEs) that interact with various AGE receptors, thereby playing an important role in the long-term complications of diabetes. Millard reaction or nonenzymatic glycation reaction accelerate in diabetes due to hyperglycation and alter serum protein’s structure, their normal functions that lead micro and macro vascular complications in diabetic patients. In this study, Human Serum Albumin (HSA) with a constant concentration was incubated with different concentrations of glucose at 370C for a week. At 4th day, Amadori product was formed that was confirmed by colorimetric method NBT assay and TBA assay which both are authenticate early glycation product. Conformational changes in native as well as all samples of Amadori albumin with different concentrations of glucose were investigated by various biophysical and biochemical techniques. Main biophysical techniques hyperchromacity, quenching of fluorescence intensity, FTIR, CD and SDS-PAGE were used. Further conformational changes were observed by biochemical assays mainly HMF formation, fructoseamine, reduction of fructoseamine with NaBH4, carbonyl content estimation, lysine and arginine residues estimation, ANS binding property and thiol group estimation. This study find structural and biochemical changes in Amadori modified HSA with normal to hyperchronic range of glucose with respect to native HSA. When glucose concentration was increased from normal to chronic range biochemical and structural changes also increased. Highest alteration in secondary and tertiary structure and conformation in glycated HSA was observed at the hyperchronic concentration (75mM) of glucose. Although it has been found that Amadori modified proteins is also involved in secondary complications of diabetes as AGEs but very few studies have been done to analyze the conformational changes in Amadori modified proteins due to early glycation. Most of the studies were found on the structural changes in Amadori protein at a particular glucose concentration but no study was found to compare the biophysical and biochemical changes in HSA due to early glycation with a range of glucose concentration at a constant incubation time. So this study provide the information about the biochemical and biophysical changes occur in Amadori modified albumin at a range of glucose normal to chronic in diabetes. Although many implicates currently in use i.e. glycaemic control, insulin treatment and other chemical therapies that can control many aspects of diabetes. However, even with intensive use of current antidiabetic agents more than 50 % of diabetic patient’s type 2 suffers poor glycaemic control and 18 % develop serious complications within six years of diagnosis. Experimental evidence related to diabetes suggests that preventing the nonenzymatic glycation of relevant proteins or blocking their biological effects might beneficially influence the evolution of vascular complications in diabetic patients or quantization of amadori adduct of HSA by authentic antibodies against HSA-EGPs can be used as marker for early detection of the initiation/progression of secondary complications of diabetes. So this research work may be helpful for the same.

Keywords: diabetes mellitus, glycation, albumin, amadori, biophysical and biochemical techniques

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Authors: Ben Otange, Wolfgang Parak, Florian Schulz, Michael Alexander Rubhausen

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The feasibility of extending the usage of molecular imprinting technique in complex biomolecules is demonstrated in this research. This technique is promising in diverse applications in areas such as drug delivery, diagnosis of diseases, catalysts, and impurities detection as well as treatment of various complications. While molecularly imprinted polymers MIP remain robust in the synthesis of molecules with remarkable binding sites that have high affinities to specific molecules of interest, extending the usage to complex biomolecules remains futile. This work reports on the successful synthesis of MIP from complex proteins: BSA, Transferrin, and MUC1. We show in this research that despite the heterogeneous binding sites and higher conformational flexibility of the chosen proteins, relying on their respective epitopes and motifs rather than the whole template produces highly sensitive and selective MIPs for specific molecular binding. Introduction: Proteins are vital in most biological processes, ranging from cell structure and structural integrity to complex functions such as transport and immunity in biological systems. Unlike other imprinting templates, proteins have heterogeneous binding sites in their complex long-chain structure, which makes their imprinting to be marred by challenges. In addressing this challenge, our attention is inclined toward the targeted delivery, which will use molecular imprinting on the particle surface so that these particles may recognize overexpressed proteins on the target cells. Our goal is thus to make surfaces of nanoparticles that specifically bind to the target cells. Results and Discussions: Using epitopes of BSA and MUC1 proteins and motifs with conserved receptors of transferrin as the respective templates for MIPs, significant improvement in the MIP sensitivity to the binding of complex protein templates was noted. Through the Fluorescence Correlation Spectroscopy FCS measurements on the size of protein corona after incubation of the synthesized nanoparticles with proteins, we noted a high affinity of MIPs to the binding of their respective complex proteins. In addition, quantitative analysis of hard corona using SDS-PAGE showed that only a specific protein was strongly bound on the respective MIPs when incubated with similar concentrations of the protein mixture. Conclusion: Our findings have shown that the merits of MIPs can be extended to complex molecules of higher biomolecular mass. As such, the unique merits of the technique, including high sensitivity and selectivity, relative ease of synthesis, production of materials with higher physical robustness, and higher stability, can be extended to more templates that were previously not suitable candidates despite their abundance and usage within the body.

Keywords: molecularly imprinted polymers, specific binding, drug delivery, high biomolecular mass-templates

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Authors: Ahmed D. Balami, Salmiah Md. Said, Nor Afiah Zulkefli, Norsa’adah Bachok, Bala Audu

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The World Health Organization prescribes that women living in malaria-endemic regions sleep under an insecticide-treated net (ITN) and comply with intermittent preventive treatment in pregnancy (IPTp). However, compliance with these measures is generally poor in Nigeria, despite the high burden of malaria and its complications in pregnancy, as well as the proven efficacy of these preventive measures. This study aimed to develop, implement, and evaluate the impacts of information-motivation-behavioral skills-based health education modules (IMB-HEMOD) on malaria prevention among pregnant women in Borno state, Nigeria. A parallel-group randomized controlled trial was conducted, enrolling 372 pregnant women (186 participants each in the intervention or control groups) at an antenatal clinic in Borno state, Nigeria. IMB-HEMOD on malaria prevention was delivered to the intervention group. This comprised four sessions and was conducted over four hours. Session one comprised lectures on malaria causative agents, transmission, symptoms, complications, and prevention. Session two was a facilitated interactive session, where participants brainstormed through the potential barriers to compliance with these preventive measures and collectively developed solutions to them. Sessions three and four entailed practical demonstrations of how to use these preventive measures. Participants in the control group received a dummy intervention in the form of health education on breastfeeding, delivered by the same facilitator, for a similar duration, and using a similar approach as the experimental intervention. Validated questionnaires were used to collect baseline and follow-up data (at two months and four months post-intervention) on the dependent variables – malaria prevention knowledge, motivation, behavioral skills, practices, and clinical outcomes. The generalized linear mixed-models analysis was used to test the effects of the intervention on the dependent variables. The total knowledge, motivation, and behavioral skills scores of the intervention group were significantly higher by 12.8% (95% Confidence Interval [CI]: 9.50 - 16.01), 8.6% (95% CI: 6.74 - 10.36), and 6.4% (95% CI: 4.41 – 8.29) respectively over the control group. The results also showed that 32% (95% CI: 6 – 59) and 37% (95% CI: 26 – 47) of participants in the intervention group slept at least one day more frequently under an insecticide-treated net (ITN), and took one dose more of intermittent preventive treatment in pregnancy (IPTp), compared to the control group. The intervention group also achieved 0.8% (95% CI: 0.53 – 1.07) higher hematocrit levels compared to the control group. Overall, the study results revealed the promising potential of the modules for not only boosting compliance with the prescribed malaria preventive measures but also improving clinical outcomes. It is thus recommended to adopt the modules into routine antenatal care health education. Future research evaluating the cost-effectiveness and feasibility of long-term implementation would help inform policy adoption.

Keywords: health education intervention, insecticide-treated net, intermittent preventive treatment, malaria, pregnant women

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Authors: Cassandra Branham, Danielle Farrar

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As writing instructors and writing center administrators at a large research university with a significant population of English language learners (ELLs), we are interested in how peer feedback pedagogy can be effectively translated for writing center purposes, as well as how various modes of peer feedback can enrich the learning experiences of L1 and L2 writers in these spaces. Although peer feedback is widely used in classrooms and centers, instructor, student, and researcher opinions vary in respect to its effectiveness. We argue that peer feedback - traditional and digital, synchronous and asynchronous - is an indispensable element for both classrooms and centers and emphasize that it should occur with both L1 and L2 students to further develop an array of reading and writing skills. We also believe that further understanding of the best practices of peer feedback in such cross-cultural spaces, like the classroom and center, can optimize the benefits of peer feedback. After a critical review of the literature, we implemented an embedded tutoring program in our university’s writing center in collaboration with its First-Year Composition (FYC) program and Language Institute. The embedded tutoring program matches a graduate writing consultant with L1 and L2 writers enrolled in controlled-matriculation composition courses where ELLs make up at least 50% of each class. Furthermore, this program is informed by what we argue to be some best practices of peer feedback for both classroom and center purposes, including expectation-based training through rubrics, modeling effective feedback, hybridizing traditional and digital modes of feedback, recognizing the significance the body in composition (what we call writer embodiment), and maximizing digital technologies to exploit extended cognition. After conducting surveys and follow-up interviews with students, instructors, and writing consultants in the embedded tutoring program, we found that not only did students see an increased value in peer feedback, but also instructors saw an improvement in both writing style and critical thinking skills. Our L2 participants noted improvements in language acquisition while our L1 students recognized a broadening of their worldviews. We believe that both L1 and L2 students developed self-efficacy and agency in their identities as writers because they gained confidence in their abilities to offer feedback, as well as in the legitimacy of feedback they received from peers. We also argue that these best practices situate novice writers as experts, as writers become a valued and integral part of the revision process with their own and their peers’ papers. Finally, the use of iPads in embedded tutoring recovered the importance of the body and its senses in writing; the highly sensory feedback from these multi-modal sessions that offer audio and visual input underscores the significant role both the body and mind play in compositional practices. After beginning with a brief review of the literature that sparked this research, this paper will discuss the embedded tutoring program in detail, report on the results of the pilot program, and will conclude with a discussion of the pedagogical implications that arise from this research for both classroom and center.

Keywords: English language learners, peer feedback, writing center, writing classroom

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Authors: V. Saccà, A. Sarica, F. Novellino, S. Barone, T. Tallarico, E. Filippelli, A. Granata, P. Valentino, A. Quattrone

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The work aim was to evaluate how well Random Forest (RF) and Support Vector Machine (SVM) algorithms could support the early diagnosis of Multiple Sclerosis (MS) from resting-state functional connectivity data. In particular, we wanted to explore the ability in distinguishing between controls and patients of mean signals extracted from ICA components corresponding to 15 well-known networks. Eighteen patients with early-MS (mean-age 37.42±8.11, 9 females) were recruited according to McDonald and Polman, and matched for demographic variables with 19 healthy controls (mean-age 37.55±14.76, 10 females). MRI was acquired by a 3T scanner with 8-channel head coil: (a)whole-brain T1-weighted; (b)conventional T2-weighted; (c)resting-state functional MRI (rsFMRI), 200 volumes. Estimated total lesion load (ml) and number of lesions were calculated using LST-toolbox from the corrected T1 and FLAIR. All rsFMRIs were pre-processed using tools from the FMRIB's Software Library as follows: (1) discarding of the first 5 volumes to remove T1 equilibrium effects, (2) skull-stripping of images, (3) motion and slice-time correction, (4) denoising with high-pass temporal filter (128s), (5) spatial smoothing with a Gaussian kernel of FWHM 8mm. No statistical significant differences (t-test, p < 0.05) were found between the two groups in the mean Euclidian distance and the mean Euler angle. WM and CSF signal together with 6 motion parameters were regressed out from the time series. We applied an independent component analysis (ICA) with the GIFT-toolbox using the Infomax approach with number of components=21. Fifteen mean components were visually identified by two experts. The resulting z-score maps were thresholded and binarized to extract the mean signal of the 15 networks for each subject. Statistical and machine learning analysis were then conducted on this dataset composed of 37 rows (subjects) and 15 features (mean signal in the network) with R language. The dataset was randomly splitted into training (75%) and test sets and two different classifiers were trained: RF and RBF-SVM. We used the intrinsic feature selection of RF, based on the Gini index, and recursive feature elimination (rfe) for the SVM, to obtain a rank of the most predictive variables. Thus, we built two new classifiers only on the most important features and we evaluated the accuracies (with and without feature selection) on test-set. The classifiers, trained on all the features, showed very poor accuracies on training (RF:58.62%, SVM:65.52%) and test sets (RF:62.5%, SVM:50%). Interestingly, when feature selection by RF and rfe-SVM were performed, the most important variable was the sensori-motor network I in both cases. Indeed, with only this network, RF and SVM classifiers reached an accuracy of 87.5% on test-set. More interestingly, the only misclassified patient resulted to have the lowest value of lesion volume. We showed that, with two different classification algorithms and feature selection approaches, the best discriminant network between controls and early MS, was the sensori-motor I. Similar importance values were obtained for the sensori-motor II, cerebellum and working memory networks. These findings, in according to the early manifestation of motor/sensorial deficits in MS, could represent an encouraging step toward the translation to the clinical diagnosis and prognosis.

Keywords: feature selection, machine learning, multiple sclerosis, random forest, support vector machine

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Authors: Sanari Chalin Moriri, Kwabena Kingsley Ayisi, Alina Mofokeng

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Dryland smallholder farmers in South Africa are vulnerable to all kinds of risks, and it negatively affects crop productivity and profit. Pigeonpea is a leguminous and multipurpose crop that provides food, fodder, and wood for smallholder farmers. The majority of these farmers are still growing pigeonpea from traditional unimproved seeds, which comprise a mixture of genotypes. The objectives of the study were to identify the key risk factors that affect pigeonpea productivity and to develop management strategies on how to alleviate the risk factors in pigeonpea production. The study was conducted in two provinces (Limpopo and Mpumalanga) of South Africa in six municipalities during the 2020/2021 growing seasons. The non-probability sampling method using purposive and snowball sampling techniques were used to collect data from the farmers through a structured questionnaire. A total of 114 pigeonpea producers were interviewed individually using a questionnaire. Key stakeholders in each municipality were also identified, invited, and interviewed to verify the information given by farmers. Data collected were subjected to SPSS statistical software 25 version. The findings of the study were that majority of farmers affected by risk factors were women, subsistence, and old farmers resulted in low food production. Drought, unavailability of improved pigeonpea seeds for planting, access to information, and processing equipment were found to be the main risk factors contributing to low crop productivity in farmer’s fields. Above 80% of farmers lack knowledge on the improvement of the crop and also on the processing techniques to secure high prices during the crop off-season. Market availability, pricing, and incidence of pests and diseases were found to be minor risk factors which were triggered by the major risk factors. The minor risk factors can be corrected only if the major risk factors are first given the necessary attention. About 10% of the farmers found to use the crop as a mulch to reduce soil temperatures and to improve soil fertility. The study revealed that most of the farmers were unaware of its utilisation as fodder, much, medicinal, nitrogen fixation, and many more. The risk of frequent drought in dry areas of South Africa where farmers solely depend on rainfall poses a serious threat to crop productivity. The majority of these risk factors are caused by climate change due to unrealistic, low rainfall with extreme temperatures poses a threat to food security, water, and the environment. The use of drought-tolerant, multipurpose legume crops such as pigeonpea, access to new information, provision of processing equipment, and support from all stakeholders will help in addressing food security for smallholder farmers. Policies should be revisited to address the prevailing risk factors faced by farmers and involve them in addressing the risk factors. Awareness should be prioritized in promoting the crop to improve its production and commercialization in the dryland farming system of South Africa.

Keywords: management strategies, pigeonpea, risk factors, smallholder farmers

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Authors: Theresa Bacon-Baguley, Martina Reinhold

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Introduction: The purpose of this paper is to discuss the importance of both formative and summative evaluation of a Physician Assistant (PA) program with a distant campus delivered through Interactive Television (ITV) to assure equity of educational experiences. Methodology: A needs assessment utilizing a case-control design determined the need and interest in expanding the existing PA program to northern Michigan. A federal grant was written and funded, which supported the hiring of two full-time faculty members and support staff at the distant site. The strengths and weaknesses of delivering a program through ITV were evaluated using weekly formative evaluation, and bi-semester summative evaluation. Formative evaluation involved discussion of lecture content to be delivered, special ITV needs, orientation of new lecturers to the system, student concerns, support staff updates, and scheduling of student/faculty traveling between the two campuses. The summative evaluation, designed from a literature review of barriers to ITV, included 19 statements designed to evaluate the following items: quality of technology (audio, video, etc.), confidence in the ITV system, quality of instruction and instructor interaction between the two locations, and availability of resources at each location. In addition, students were given the opportunity to write qualitative remarks for each course delivered between the two locations. This summative evaluation was given to all students at mid-semester and at the end of the semester. The goal of the summative evaluation was to have 80% or greater of the students respond favorably (‘Very Good’ or ‘Good’) to each of the 19 statements. Results: Prior to the start of the first cohort at the distant campus, the technology was tested. During this time period, the formative evaluations identified key components needing modification, which were rapidly addressed: ability to record lectures, lighting, sound, and content delivery. When the mid-semester summative survey was given to the first cohort of students, 18 of the 19 statements in the summative evaluation met the goal of 80% or greater in the favorable category. When the summative evaluation statements were stratified by the two cohorts, the summative evaluation identified that students at the home location responded that they did not have adequate access to printers, and students at the expansion location responded that they did not have adequate access to library resources. These results allowed the program to address the deficiencies through contacting informational technology for additional printers, and to provide students with knowledge on how to access library resources. Conclusion: Successful expansion of programs to a distant site utilizing ITV technology requires extensive monitoring using both formative and summative evaluation. The formative evaluation allowed for quick identification of issues that could immediately be addressed, both at the planning and developing stage, as well as during implementation. Through use of the summative evaluation the program is able to monitor the success/ effectiveness of the expansion and identify specific needs of students at each location.

Keywords: assessment, distance learning, formative feedback, interactive television (ITV), student experience, summative feedback, support

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