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Authors: Bhaskar Basu

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Universities and higher education institutes are finding it increasingly difficult to engage students fruitfully through traditional pedagogic tools. Web 2.0 technologies comprising social networking sites (SNSs) offer a platform for students to collaborate and share information, thereby enhancing their learning experience. Despite the potential and reach of SNSs, its use has been limited in academic settings promoting higher education. The purpose of this paper is to assess the perception of social networking sites among business school students in India and analyze its role in enhancing quality of student experiences in a business school leading to the proposal of an agenda for future research. In this study, more than 300 students of a reputed business school were involved in a survey of their preferences of different social networking sites and their perceptions and attitudes towards these sites. A questionnaire with three major sections was designed, validated and distributed among  a sample of students, the research method being descriptive in nature. Crucial questions were addressed to the students concerning time commitment, reasons for usage, nature of interaction on these sites, and the propensity to share information leading to direct and indirect modes of learning. It was further supplemented with focus group discussion to analyze the findings. The paper notes the resistance in the adoption of new technology by a section of business school faculty, who are staunch supporters of the classical “face-to-face” instruction. In conclusion, social networking sites like Facebook and LinkedIn provide new avenues for students to express themselves and to interact with one another. Universities could take advantage of the new ways  in which students are communicating with one another. Although interactive educational options such as Moodle exist, social networking sites are rarely used for academic purposes. Using this medium opens new ways of academically-oriented interactions where faculty could discover more about students' interests, and students, in turn, might express and develop more intellectual facets of their lives. hitherto unknown intellectual facets.  This study also throws up the enormous potential of mobile phones as a tool for “blended learning” in business schools going forward.

Keywords: business school, India, learning, social media, social networking, university

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Authors: James P. Takona

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In a world that is experiencing sharp digital transformations guided by digital technologies, the potential of technology to drive transformation and evolution in the higher is apparent. Higher education is facing a paradigm shift that exposes susceptibilities and threats to fully online programs in the face of post-Covid-19 trends of commodification. This historical moment is likely to be remembered as a critical turning point from analog to digital degree-focused learning modalities, where the default became the pivot point of competition between higher education institutions. Fall 2020 marks a significant inflection point in higher education as students, educators, and government leaders scrutinize higher education's price and value propositions through the new lens of traditional lecture halls versus multiple digitized delivery modes. Online education has since tiled the way for a pedagogical shift in how teachers teach and students learn. The incremental growth of online education in the west can now be attributed to the increasing patronage among students, faculty, and institution administrators. More often than not, college instructors assume paraclete roles in this learning mode, while students become active collaborators and no longer passive learners. This paper offers valuable discernments into the threats, challenges, and opportunities of a massive digital revolution in servicing degree programs. To view digital instruction and learning demands for instructional practices that revolve around collaborative work, engaging students in learning activities, and an engagement that promotes active efforts to solicit strong connections between course activities and expected learning pace for all students. Appropriate digital technologies demand instructors and students need prior solid skills. Need for the use of digital technology to support instruction and learning, intelligent tutoring offers great promise, and failures at implementing digital learning may not improve outcomes for specific student populations. Digital learning benefits students differently depending on their circumstances and background and those of the institution and/or program. Students have alternative options, access to the convenience of learning anytime and anywhere, and the possibility of acquiring and developing new skills leading to lifelong learning.

Keywords: digi̇tized learning, digital education, collaborative work, high education, online education, digitize delivery

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Authors: Folorunsho J. O., Umar M. A.

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Access to potable water supply in both the rural and urban regions of the world has been neglected, and this has severely affected man and the aesthetics of the natural environment of man. This has further worsened the issue of diseases prevalence. This study considered the effects of inadequate domestic water supply on human health in selected neighbourhoods of Lokoja. The study used descriptive statistics such as relative frequencies, percentages and inferential statistics to analyse the data obtained through the use of structured questionnaire. The results revealed that the females and male constituted 56% and 44% of the respondents respectively; 62% of the respondents married and 32% are unmarried; respondents between ages 31 and 40 years constitute majority of the study population, while respondents with tertiary education constituted 35%, and those with secondary education were 32% of the total respondents. Furthermore, civil servants constituted 40% and unemployed 16% of the total respondents. In terms of monthly income, 40% of the respondents was found to earn between ₦31,000 - 40,000 monthly. On the perception of households on the availability and adequacy of domestic water supply, the study revealed that 64.7% of the respondents have pipe-borne water as their main source of water supply, with only 28.5% out of the 64.7% have pipe-borne water supply daily. On the relationship between water supply characteristics and health status among households, the result shows that 76% of the respondents perceived a strong relationship between water supply and health status. Cumulatively, 67% of the respondents confirm that both the quality and quantity of water supplied play a critical role in determining health status of residents of the study area. The respondents also reported skin diseases (96%), diarrhoea (96%), malaria (91%), cholera (67%), dysentery (67%), and respiratory diseases (67%) as the most perceived and experienced in the area, the disease rate in the prevalence order of malaria (81%), diarrhoea (61%), skin diseases (58%), cholera (34%), dysentery (31%) and respiratory disease (14%) respectively. Finally, the results further showed how households cope with inadequate water supply with 52% of the respondents confirm that they regularly treat their water before it was deployed for domestic uses, while 35%, 26%, 25%, 10% and 4% of the 52% respectively, adopted boiling, addition of alums, filtering with fabrics, chlorination and bleaching as the preferred treatment methods. The study thus recommended policy options that will aggressively launch adequate potable water supply infrastructure in the study area.Keywords: Potable Water, Supply, Human Health, Perception, Chlorination

Keywords: potable water, human health, perception, chlorination

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Authors: Jayanta Bora, Sukhvinder Kaur, Ashok Agarwal, Sangeeta Kaul

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Background: It is important for targeted interventions to consider vulnerabilities of female sex workers (FSWs) such as poverty, work-related mobility and literacy for effective human immunodeficiency virus (HIV) prevention. This paper examines the association between vulnerability and behavioural outcomes among FSWs in Thane district, Maharashtra under USAID PHFI-PIPPSE project. Methods: Data were used from the Behavioural Tracking Survey, a cross-sectional behavioural study conducted in 2015 with 503 FSWs randomly selected from 12 TI-NGOs which were functioning and providing services to FSWs in Thane district prior to April 2014 in Thane district of Maharashtra. We have created the “vulnerability index”, a composite index of literacy, factors of dependence (alternative livelihood options, current debt), and aspects of sex work (mobility and duration in sex work) as a dependent variable. The key independent measures used were program exposure to intervention, service uptake, self-confidence, and self-identity. Bi-variate and multivariate logistic regressions were used to examine the study objectives. Results: A higher proportion of FSWs who were in the age-group 18–25 years from brothel/street /home/ lodge-based were categorized as highly vulnerable to HIV risk as compared to bar-based sex worker (74.1% versus 59.8%, P,0.002); regression analysis highlighted lower odds of vulnerability among FSWs who were aware of services and visited NGO clinic for medical check-up and counselling for STI [AOR= 0.092, 95% CI 0.018-0.460; P,0.004], However, lower odds of vulnerability on confident in supporting fellow sex worker in crisis [AOR= 0.601, 95% CI 0.476-0.758; P, 0.000] and were able to turn away clients when they refused to use a condom during sex [AOR= 0.524, 95% CI 0.342-0.802; P, 0.003]. Conclusion: The results highlight that FSWs associated with TIs and getting services are less vulnerable and highly empowered. As a result of behavioural change communication and other services provided by TIs, FSWs were able to successfully negotiate about condom use with their clients and manage solidarity in the crisis situation for fellow FSWs. Therefore, it is evident from study paper that TI prevention programs may transform the lives of masses considerably and may open a window of opportunity to infuse the information and awareness about HIV risk.

Keywords: female sex worker, HIV prevention, HIV service uptake, vulnerability

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Authors: Walid Al-Qerem, Ruba Zumot

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Background: The rise of obesity among children and adolescents remains a primary challenge for healthcare providers globally and in the Middle East. The aim of the present study is to determine the prevalence of obesity among 5-20 years old Jordanians based on CDC criteria. Method: A total of 5722 Jordanians (37% males; 63% females) aged 5-20 years data were retrieved from the Jordanian Ministry of Health electronic database (Hakeem). As per the CDC selection criteria, the chosen data pertains exclusively to healthy Jordanian children and adolescents who are medically sound, not suffering from health conditions, and not undergoing any treatments that could hinder normal growth patterns, such as severe infection, chronic kidney disease (CKD), Down’s syndrome, attention deficit hyperactivity disorder, cancer, heart disease, lung disease, cystic fibrosis, Crohn’s disease, type 1 diabetes, hormonal disturbances, any stress-related conditions, hormonal therapy such as corticosteroids, Growth hormones (GHS) or gonadotropin-releasing hormone agonists, insulin, and amphetamines or any other stimulants. In addition, participants with missing or invalid data values for anthropometric measurements were excluded from the study. Weight for age and body mass index for age were analyzed comparatively for Jordanian children and adolescents against the international growth standards. The Z-score for each record was computed based on CDC equations. As per CDC classifications, BMI for age percentiles, values ≥85th and < 95th are classified as overweight, and value at ≥ 95th is classified as obesity. Results: The average age of the evaluated sample was 12.33 ±4.39 years (10.79 ±3.39 for males and 13.23 ± 4.66 for females). The mean weight for males and females were 33.16±14.17 Kg and 133.54±17.17 cm for males, 43.86 ±18.82 Kg, and 142.19±18.35 for females, while for BMI the mean was for boys and girls 17.81±3.88 and 20.52±5.03 respectively. The results indicated that based on CDC criteria, 8.9% of males were classified as children/adolescents with overweight, and 9.7% were classified as children/adolescents with obesity, while in females, 17.8% were classified as children/adolescents with overweight and 10.2% were classified as children/adolescents with obesity. Discussion: The high prevalence of obesity reported in the present study emphasizes the importance of applying different strategies to prevent childhood obesity, including encouraging physical activity, promoting healthier food options, and behavioral changes. Conclusion: The results presented in this study indicated the high prevalence of overweight/obesity among Jordanian adolescents and children, which must be tagged by healthcare planners and providers.

Keywords: CDC, obesity, childhood, Jordan

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Authors: Elzbieta Sikorska-Simmons

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Dementia is a progressive terminal disease. Despite this recognition, research shows that most family caregivers do not know it, and it is unclear how this knowledge affects the quality of patient care. The aim of this qualitative study of 20 family caregivers for patients with advanced dementia is to examine how the caregiver's knowledge about dementia affects the quality of patient care in the context of healthcare decision-making, advanced care planning, and access to adequate support systems. Knowledge about dementia implies family caregivers' understanding of dementia trajectories, common symptoms/complications, and alternative treatment options (e.g., comfort feeding versus tube feeding). Data were collected in semi-structured interviews with 20 family caregivers. The interviews were conducted in person by the author and designed to elicit rich descriptions of family caregivers' experiences with healthcare decision-making and the management of common symptoms/complications of end-stage dementia as patient healthcare proxies. The study findings suggest that caregivers who recognize that dementia is a terminal disease are less likely to opt for life-extending treatments during the advanced stages. They are also more likely to seek palliative/hospice care, and consequently, they are better able to avoid unnecessary hospitalizations or medical procedures. For example, those who know that dementia is a terminal disease tend to opt for "comfort feeding" rather than "tube feeding" in managing the swallowing difficulties that accompany advanced dementia. In the context of advance care planning, family caregivers who know that dementia is a terminal disease tend to have more meaningful advance directives (e.g., Power of Attorney and Do Not Resuscitate orders). They are better prepared to anticipate common problems and pursue treatments that foster the best quality of patient life and care. Greater knowledge about advanced dementia helps them make more informed decisions that focus on enhancing the quality of patient life rather than just survival. In addition, those who know that dementia is a terminal disease are more likely to establish adequate support systems to help them cope with the complex demands of caregiving. For example, they are more likely to seek dementia-oriented primary care programs that offer house visits or respite services. Based on the study findings, knowledge about dementia as a terminal disease is critical in the optimal management of patient care needs and the establishment of adequate support systems. More research is needed to better understand what caregivers need to know to better prepare them for the complex demands of dementia caregiving.

Keywords: dementia education, family caregiver, management of dementia, quality of care

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Authors: Fereshteh Ganjavi, Rachel Schaffer, Varsha Jorawar

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Elena’s Light is a non-profit organization focused on building brighter futures for refugees, especially women and children. Our mission is to empower refugee women and children by addressing social, legal, and public health issues that predominantly concern them. Elena’s Light offers a range of services that support refugees from structural disadvantages, cultural and social stress, marginalization, and other stressors related to migration. Using a three-pronged approach, our programs focus on legal advocacy, English language acquisition, and health and wellness. Following the Afghan humanitarian crisis, Elena’s Light has developed and intensified advocacy efforts in the legal realm to address the influx of refugees who desperately need assistance. We developed and hosted a Know Your Rights presentation with local immigration lawyers and professionals in February 2022 on the Afghan Humanitarian Parole, which was very successful with over 100 attendees. Elena’s Light is hosting the second Know Your Rights session in early August 2022 on immigration options for Afghans, including Temporary Protected Status (TPS), asylum, Special Immigrant Visa (SIV), and humanitarian parole. Lastly, EL is also leading the local initiative to develop a pro-bono committee to respond to the overwhelming need for lawyers to work on legal cases for Afghan during this crisis. Furthermore, through our other services, we provide free, in-home customizable ESL tutoring sessions to refugee women with a focus on driver’s education, facilitating acculturation, and improving employment opportunities. We also provide in-home maternal, pediatric, and mental health education and wellness services that are aimed at addressing the explicit and implicit barriers to healthcare for refugee populations. Elena’s Light’s diverse community aims to counter the structural disadvantages and anxiety-inducing emotions and experiences related to being a refugee. We would like to join this International Conference on Refugee Law since protecting refugee rights is our mission. We would like to share what we have learned from our legal initiatives for refugee rights. We would also like to listen, learn from, and discuss with experts and researchers how to better understand and advocate for refugee rights. We hope to improve our understanding of how to provide better legal aid for our clients through this conference.

Keywords: legal, advocacy, Afghan humanitarian crisis, policy, pro-bono

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Authors: Elida M. R. Bonifacio

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English language proficiency has become an essential issue in aviation communication after aviation incidents, and accidents happened. Lack of proficiency or inappropriate use of the English language has been found as one of the factors that cause most of those incidents or accidents. Therefore, the International Civil Aviation Organization (ICAO) established the requirements for minimum English language proficiency of aviation personnel, especially pilots and air traffic controllers in the 192 member states. In Brazil, the discussions about this topic became patent after an accident that occurred in 2006, which was a mid-air collision and costed the life of 154 passengers and crew members. Thus, the number of schools and private practitioners willing to teach English for aviation purposes started to increase. Although the number of teaching materials internationally used for general purposes is relatively large, it would be inappropriate to adopt the same materials in classes that focus on communication in aviation contexts. On the contrary, the options of aviation English materials are scarce; moreover, they are internationally used and may not fulfill the linguistic needs of all their users around the world. In order to diminish the problems that Brazilian practitioners may encounter in the adoption of materials that demand a great level of adaptation to meet their students’ needs, a checklist was thought to evaluate textbooks. The aim of this paper is to propose a checklist that evaluates textbooks used in English language training of Brazilian air traffic controllers. The criteria used to compound the checklist are based on materials development literature, as well as on linguistic requirements established by ICAO on its publications, on English for Specific Purposes (ESP) principles, and on Brazilian aviation English language proficiency test format. The checklist has as main indicators the language learning tenets under which the book was written, graphical features, lexical, grammatical and functional competencies required for minimum proficiency, similarities to official testing format, and support materials, totaling 117 items marked as YES, NO or PARTIALLY. In order to verify if the use of the checklist is effective, an aviation English textbook was evaluated. From this evaluation, it is possible to measure quantitatively how much the material meets the students’ needs and to offer a tool to help professionals engaged in aviation English teaching around the world to choose the most appropriate textbook according to their audience. From the results, practitioners are able to verify which items the material does not fulfill and to make proper adaptations since the perfect material will be difficult to find.

Keywords: aviation English, ICAO, materials development, English language proficiency

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Authors: P. Ghosh, S. B. Sharma

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The growing problem of food waste is causing unacceptable economic, environmental and social impacts across the globe. In Australia, food waste is estimated at about AU$8 billion per year; however, information on the extent of wastage at different stages of the food value chain from farm to fork is very limited. This study aims to identify causes for and extent of food waste at wholesaler stage of the food value chain in the state of Western Australia. It also explores approaches applied to reduce and utilize food waste by the wholesalers. The study was carried out at Perth city market in Caning Vale, the main wholesale distribution centre for fruits and vegetables in Western Australia. A survey questionnaire was prepared and shared with 51 wholesalers and their responses to 10 targeted questions on quantity of produce (fruits and vegetables) delivery received and further supplied, reasons for waste generation and innovations applied or being considered to reduce and utilize food waste. Data were computed using the Statistical Package for the Social Sciences (SPSS version 21). Among the wholesalers 52% were primary wholesalers (buy produce directly from growers) and 48% were secondary wholesalers (buy produce in bulk from major wholesalers and supply to the local retail market, caterers, and customers with specific requirements). Average fruit and vegetable waste was 180 Kilogram per week per primary wholesaler and 30 Kilogram per secondary wholesaler. Based on this survey, the fruit and vegetable waste at wholesaler stage was estimated at about 286 tonnes per year. The secondary wholesalers distributed pre-ordered commodities, which minimized the potential to cause waste. Non-parametric test (Mann Whitney test) was carried out to assess contributions of wholesalers to waste generation. Over 56% of secondary wholesalers generally had nothing to bin as waste. Pearson’s correlation coefficient analysis showed positive correlation (r = 0.425; P=0.01) between the quantity of produce received and waste generated. Low market demand was the predominant reason identified by the wholesalers for waste generation. About a third of the wholesalers suggested that high cosmetic standards for fruits and vegetables - appearance, shape, and size - should be relaxed to reduce waste. Donation of unutilized fruits and vegetables to charity was overwhelmingly (95%) considered as one of the best options for utilization of discarded produce. The extent of waste at other stages of fruit and vegetable supply chain is currently being studied.

Keywords: food waste, fruits and vegetables, supply chain, waste generation

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Authors: Raymond K. Jonkers

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The present study investigated approaches and techniques to enhance strategic management governance and decision making within the framework of a performance-based balanced scorecard. The review of best practices from strategic, program, process, and systems engineering management provided for a holistic approach toward effective outcome-based capability management. One technique, based on factorial experimental design methods, was used to develop an empirical model. This model predicted the degree of capability effectiveness and is dependent on controlled system input variables and their weightings. These variables represent business performance measures, captured within a strategic balanced scorecard. The weighting of these measures enhances the ability to quantify causal relationships within balanced scorecard strategy maps. The focus in this study was on the performance of tangible assets within the scorecard rather than the traditional approach of assessing performance of intangible assets such as knowledge and technology. Tangible assets are represented in this study as physical systems, which may be thought of as being aboard a ship or within a production facility. The measures assigned to these systems include project funding for upgrades against demand, system certifications achieved against those required, preventive maintenance to corrective maintenance ratios, and material support personnel capacity against that required for supporting respective systems. The resultant scorecard is viewed as complimentary to the traditional balanced scorecard for program and performance management. The benefits from these scorecards are realized through the quantified state of operational capabilities or outcomes. These capabilities are also weighted in terms of priority for each distinct system measure and aggregated and visualized in terms of overall state of capabilities achieved. This study proposes the use of interactive controls within the scorecard as a technique to enhance development of alternative solutions in decision making. These interactive controls include those for assigning capability priorities and for adjusting system performance measures, thus providing for what-if scenarios and options in strategic decision-making. In this holistic approach to capability management, several cross functional processes were highlighted as relevant amongst the different management disciplines. In terms of assessing an organization’s ability to adopt this approach, consideration was given to the P3M3 management maturity model.

Keywords: management, systems, performance, scorecard

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Authors: Daniel J. Patricio Jiménez

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The term 'total compensation’ refers to salary, training, innovation, and development, and of course, motivation; total compensation is an open and flexible system which must facilitate personal and family conciliation and therefore cannot be isolated from social reality. Today, the challenge for any company that wants to have a future is to be sustainable, and women play a ‘special’ role in this. Spain, in its statutory and conventional development, has not given sufficient response to new phenomena such as ‘bonuses’, ‘stock options’ or ‘fringe benefits’ (constructed dogmatically and by court decisions), the new digital reality, where cryptocurrency, new collaborative models and service provision -such as remote work-, are always ahead of the law. To talk about compensation is to talk about the gender gap, and with the entry into force of RD.902 /2020 on 14 April 2021, certain measures are necessary under the principle of salary transparency; the valuation of jobs, the pay register (Rd. 6/2019) and the pay audit, are an example of this. Analyzing the methodologies, and in particular the determination and weight of the factors -so that the system itself is not discriminatory- is essential. The wage gap in Spain is smaller than in Europe, but the sources do not reflect the reality, and since the beginning of the pandemic, there has been a clear stagnation. A living wage is not the minimum wage; it is identified with rights and needs; it is that which, based on internal equity, reflects the competitiveness of the company in terms of human capital. Spain has lost and has not recovered the relative weight of its wages; this is having a direct impact on our competitiveness, consequently on the precariousness of employment and undoubtedly on the levels of extreme poverty. Training is becoming more than ever a strategic factor; the new digital reality requires that each component of the system is connected, the transversality is imposed on us, this forces us to redefine content, to give answers to the new demands that the new normality requires because technology and robotization are changing the concept of employability. The presence of women in this context is necessary, and there is a long way to go. The so-called emotional compensation becomes particularly relevant at a time when pandemics, silence, and disruption, are leaving after-effects; technostress (in all its manifestations) is just one of them. Talking about motivation today makes no sense without first being aware that mental health is a priority, that it must be treated and communicated in an inclusive way because it increases satisfaction, productivity, and engagement. There is a clear conclusion to all this: compensation systems do not respond to the ‘new normality’: diversity, and in particular women, cannot be invisible in human resources policies if the company wants to be sustainable.

Keywords: diversity, gender gap, human resources, sustainability.

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Authors: Şule Yanık, Emel Ertürk-Mustul, Zerrin Turan, Hasan Gürgür

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It is known that there are policies that will support the early special education (ESE) for children requiring special care including the children with hearing loss (CHL) in many countries that give importance to early childhood (0-6 years) education, accordingly ESE services have been gradually increasing and these services provide positive contributions to the child and family. These services begin with medical diagnostics, provision of the use of assistive technologies for hearing and the orientation of children towards early education program (EEP) for the CHL. In 0-3 years of age EEP, education and support services are provided to the children and their families. In 3-6 years of age, children are supported in a pre-school education program (PSE) in which their peers and teachers are present. Therefore, the children with hearing loss and their families are going through a series of medical, educational and social transition process after diagnosed with hearing loss. Depending on their age and development, CHL also go through a transition period from hospital to home, from home to EEP and from EEP to PSE. It is seen that there is no legal regulation regarding the transition process in Turkey and hence different processes have been carried out in the transition process from EEP to PSE. The aim of this study is to reveal the problems confronted by the CHL during the transition period from EEP to PSE and the solution proposals for these problems. In this study, a document review was made by reviewing the national and international studies about transition processes of the CHL in Turkey from EEP to PSE. Accordingly, in the study carried out in two stages, firstly, a review of the body of literature was performed by creating key words related to the subject. Secondly, the problems confronted by the CHL in Turkey during the transition period from EEP to PSE and the solution proposals for these problems were demonstrated by analyzing the obtained data. According to the body of literature, it is seen that there are no laws concerning the transition processes of the children who require special care including the CHL in Turkey from EEP (sending) to PSE (receiving), and correspondingly numerous problems have been experienced during the transition period. It seems that the EEP adopts family-centered approaches for strengthening the families of the CHL. However, PSE program aims to prepare the children to school life by focusing on their social and academical development rather with the adoption of children-centered approaches. Therefore, while the families feel an inseparable part of the team in EEP, they indicated that they felt like a stranger in the school team after their children have started to PSE. Therefore, families find the transition processes worrisome and state that they are not satisfied with the process. We discovered that in the process of transition from EEP to PSE, families are not informed, there is a limited number of PSE options available, children cannot adapt to the new educational environment and cannot benefit from the existing PSE.

Keywords: early education program, early special education, children with hearing loss, transition

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Authors: Marta Fernández Batalla, José María Santamaría García, Maria Lourdes Jiménez Rodríguez, Roberto Barchino Plata, Adriana Cercas Duque, Enrique Monsalvo San Macario

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Background: Primary Care Nursing is taking more autonomy in clinical decisions. One of the most frequent therapies to solve is related to the problems of maintaining a sufficient supply of food. Nursing diagnoses related to food are addressed by the nurse-family and community as the first responsible. Objectives and interventions are set according to each patient. To improve the goal setting and the treatment of these care problems, a technological tool is developed to help nurses. Objective: To evaluate the computational tool developed to support the clinical decision in feeding problems. Material and methods: A cross-sectional descriptive study was carried out at the Meco Health Center, Madrid, Spain. The study population consisted of four specialist nurses in primary care. These nurses tested the tool on 30 people with ‘need for nutritional therapy’. Subsequently, the usability of the tool and the satisfaction of the professional were sought. Results: A simple and convenient computational tool is designed for use. It has 3 main entrance fields: age, size, sex. The tool returns the following information: BMI (Body Mass Index) and caloric consumed by the person. The next step is the caloric calculation depending on the activity. It is possible to propose a goal of BMI or weight to achieve. With this, the amount of calories to be consumed is proposed. After using the tool, it was determined that the tool calculated the BMI and calories correctly (in 100% of clinical cases). satisfaction on nutritional assessment was ‘satisfactory’ or ‘very satisfactory’, linked to the speed of operations. As a point of improvement, the options of ‘stress factor’ linked to weekly physical activity. Conclusion: Based on the results, it is clear that the computational tools of decision support are useful in the clinic. Nurses are not only consumers of computational tools, but can develop their own tools. These technological solutions improve the effectiveness of nutrition assessment and intervention. We are currently working on improvements such as the calculation of protein percentages as a function of protein percentages as a function of stress parameters.

Keywords: feeding behavior health, nutrition therapy, primary care nursing, technology assessment

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Authors: Philippa Saunders, Claire Fletcher

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INTRODUCTION: Prostate cancer is the most prevalent malignancy affecting Western males. It is initially an androgen-dependent disease: androgens bind to the androgen receptor and drive the expression of genes that promote proliferation and evasion of apoptosis. Despite reduced androgen dependence in advanced prostate cancer, androgen receptor signaling remains a key driver of growth. Androgen deprivation therapy (ADT) is, therefore, a first-line treatment approach and works well initially, but resistance inevitably develops. Abiraterone and Enzalutamide are drugs widely used in ADT and are androgen synthesis and androgen receptor signaling inhibitors, respectively. The shortage of other treatment options means acquired resistance to these drugs is a major clinical problem. MicroRNAs (miRs) are important mediators of post-transcriptional gene regulation and show altered expression in cancer. Several have been linked to the development of resistance to ADT. Manipulation of such miRs may be a pathway to breakthrough treatments for advanced prostate cancer. This study aimed to validate ADT resistance-implicated miRs and their clinically relevant targets. MATERIAL AND METHOD: Small RNA-sequencing of Abiraterone- and Enzalutamide-resistant C42 prostate cancer cells identified subsets of miRs dysregulated as compared to parental cells. Real-Time Quantitative Reverse Transcription PCR (qRT-PCR) was used to validate altered expression of candidate ADT resistance-implicated miRs 195-5p, 497-5p and 29a-5p in ADT-resistant and -responsive prostate cancer cell lines, patient-derived xenografts (PDXs) and primary prostate cancer explants. RESULTS AND DISCUSSION: This study suggests a possible role for miR-497-5p in the development of ADT resistance in prostate cancer. MiR-497-5p expression was increased in ADT-resistant versus ADT-responsive prostate cancer cells. Importantly, miR-497-5p expression was also increased in Enzalutamide-treated, castrated (ADT-mimicking) PDXs versus intact PDXs. MiR-195-5p was also elevated in ADT-resistant versus -responsive prostate cancer cells, while there was a drop in miR-29a-5p expression. Candidate clinically relevant targets of miR-497-5p in prostate cancer were identified by mining AGO-PAR-CLIP-seq data sets and may include AVL9 and FZD6. CONCLUSION: In summary, this study identified microRNAs that are implicated in prostate cancer resistance to androgen deprivation therapy and could represent novel therapeutic targets for advanced disease.

Keywords: microRNA, androgen deprivation therapy, Enzalutamide, abiraterone, patient-derived xenograft

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Authors: Torsten Hermanns, Thoufik Al Khawli, Wolfgang Schulz

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In laser cutting as well as in long pulsed laser drilling of metals, it can be demonstrated that the ablation shape (the shape of cut faces respectively the hole shape) that is formed approaches a so-called asymptotic shape such that it changes only slightly or not at all with further irradiation. These findings are already known from the ultrashort pulse (USP) ablation of dielectric and semiconducting materials. The explanation for the occurrence of an asymptotic shape in laser cutting and long pulse drilling of metals is identified, its underlying mechanism numerically implemented, tested and clearly confirmed by comparison with experimental data. In detail, there now is a model that allows the simulation of the temporal (pulse-resolved) evolution of the hole shape in laser drilling as well as the final (asymptotic) shape of the cut faces in laser cutting. This simulation especially requires much less in the way of resources, such that it can even run on common desktop PCs or laptops. Individual parameters can be adjusted using sliders – the simulation result appears in an adjacent window and changes in real time. This is made possible by an application-specific reduction of the underlying ablation model. Because this reduction dramatically decreases the complexity of calculation, it produces a result much more quickly. This means that the simulation can be carried out directly at the laser machine. Time-intensive experiments can be reduced and set-up processes can be completed much faster. The high speed of simulation also opens up a range of entirely different options, such as metamodeling. Suitable for complex applications with many parameters, metamodeling involves generating high-dimensional data sets with the parameters and several evaluation criteria for process and product quality. These sets can then be used to create individual process maps that show the dependency of individual parameter pairs. This advanced simulation makes it possible to find global and local extreme values through mathematical manipulation. Such simultaneous optimization of multiple parameters is scarcely possible by experimental means. This means that new methods in manufacturing such as self-optimization can be executed much faster. However, the software’s potential does not stop there; time-intensive calculations exist in many areas of industry. In laser welding or laser additive manufacturing, for example, the simulation of thermal induced residual stresses still uses up considerable computing capacity or is even not possible. Transferring the principle of reduced models promises substantial savings there, too.

Keywords: asymptotic ablation shape, interactive process simulation, laser drilling, laser cutting, metamodeling, reduced modeling

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Authors: John Hang Leung, Shyh-Yau Wang, Hei-Tung Yip, Fion, Ho Tsung-chin, Agnes LF Chan

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Objectives: Platinum-resistant ovarian cancer has a short overall survival of 9–12 months and limited treatment options. The combination of immunotherapy and targeted therapy appears to be a promising treatment option for patients with ovarian cancer, particularly to patients with platinum-resistant recurrent ovarian cancer (PRrOC). However, there are no direct head-to-head clinical trials comparing their efficacy and toxicity. We, therefore, used a network to directly and indirectly compare seven newer immunotherapies or targeted therapies combined with chemotherapy in platinum-resistant relapsed ovarian cancer, including antibody-drug conjugates, PD-1 (Programmed death-1) and PD-L1 (Programmed death-ligand 1), PARP (Poly ADP-ribose polymerase) inhibitors, TKIs (Tyrosine kinase inhibitors), and antiangiogenic agents. Methods: We searched PubMed (Public/Publisher MEDLINE), EMBASE (Excerpta Medica Database), and the Cochrane Library electronic databases for phase II and III trials involving PRrOC patients treated with immunotherapy or targeted therapy plus chemotherapy. The quality of included trials was assessed using the GRADE method. The primary outcomes compared were progression-free survival, the secondary outcomes were overall survival and safety. Results: Seven randomized controlled trials involving a total of 2058 PRrOC patients were included in this analysis. Bevacizumab plus chemotherapy showed statistically significant differences in PFS (Progression-free survival) but not OS (Overall survival) for all interested targets and immunotherapy regimens; however, according to the heatmap analysis, bevacizumab plus chemotherapy had a statistically significant risk of ≥grade 3 SAEs (Severe adverse effects), particularly hematological severe adverse events (neutropenia, anemia, leukopenia, and thrombocytopenia). Conclusions: Bevacizumab plus chemotherapy resulted in better PFS as compared with all interested regimens for the treatment of PRrOC. However, statistical differences in SAEs as bevacizumab plus chemotherapy is associated with a greater risk for hematological SAE.

Keywords: platinum-resistant recurrent ovarian cancer, network meta-analysis, immune checkpoint inhibitors, target therapy, antiangiogenic agents

Procedia PDF Downloads 52

Authors: Mirka Januszkiewicz

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The Regional Municipality of Durham is the upper level of a two-tier municipal and regional structure comprised of eight lower-tier municipalities. With a population of 655,000 in both urban and rural settings, the Region is approximately 2,537 square kilometers neighboring the City of Toronto, Ontario Canada to the east. The Region has been focused on diverting waste from disposal since the development of its Long Term Waste Management Strategy Plan for 2000-2020. With a 54 percent solid waste diversion rate, the focus now is on achieving 70 percent diversion on the path to zero waste using local waste management options whenever feasible. The Region has an Integrated Waste Management System that consists of a weekly curbside collection of recyclable printed paper and packaging and source separated organics; a seasonal collection of leaf and yard waste; a bi-weekly collection of residual garbage; and twice annual collection of intact, sealed household batteries. The Region also maintains three Waste Management Facilities for residential drop-off of household hazardous waste, polystyrene, construction and demolition debris and electronics. Special collection events are scheduled in the spring, summer and fall months for reusable items, household hazardous waste, and electronics. The Region is in the final commissioning stages of an energy from the waste facility for residual waste disposal that will recover energy from non-recyclable wastes. This facility is state of the art and is equipped for installation of carbon capture technology in the future. Despite all of these diversion programs and efforts, there is still room for improvement. Recent residential waste studies revealed that over 50% of the residual waste placed at the curb that is destined for incineration could be recycled. To move towards a zero waste community, the Region is looking to more advanced technologies for extracting the maximum recycling value from residential waste. Plans are underway to develop a pre-sort facility to remove organics and recyclables from the residual waste stream, including the growing multi-residential sector. Organics would then be treated anaerobically to generate biogas and fertilizer products for beneficial use within the Region. This project could increase the Region’s diversion rate beyond 70 percent and enhance the Region’s climate change mitigation goals. Zero waste is an ambitious goal in a changing regulatory and economic environment. Decision makers must be willing to consider new and emerging technologies and embrace change to succeed.

Keywords: municipal waste, residential, waste diversion, zero waste

Procedia PDF Downloads 205

Authors: Rajendra Chetty

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The paper aims to address two aspects of postgraduate studies: interdisciplinary research and creative models of supervision. Interdisciplinary research can be viewed as a key imperative to solve complex problems. While excellent research requires a context of disciplinary strength, the cutting edge is often found at the intersection between disciplines. Interdisciplinary research foregrounds a team approach and information, methodologies, designs, and theories from different disciplines are integrated to advance fundamental understanding or to solve problems whose solutions are beyond the scope of a single discipline. Our aim should also be to generate research that transcends the original disciplines i.e. transdisciplinary research. Complexity is characteristic of the knowledge economy, hence, postgraduate research and engaged scholarship should be viewed by universities as primary vehicles through which knowledge can be generated to have a meaningful impact on society. There are far too many ‘ordinary’ studies that fall into the realm of credentialism and certification as opposed to significant studies that generate new knowledge and provide a trajectory for further academic discourse. Secondly, the paper will look at models of supervision that are different to the dominant ‘apprentice’ or individual approach. A reflective practitioner approach would be used to discuss a range of supervision models that resonate well with the principles of interdisciplinarity, growth in the postgraduate sector and a commitment to engaged scholarship. The global demand for postgraduate education has resulted in increased intake and new demands to limited supervision capacity at institutions. Team supervision lodged within large-scale research projects, working with a cohort of students within a research theme, the journal article route of doctoral studies and the professional PhD are some of the models that provide an alternative to the traditional approach. International cooperation should be encouraged in the production of high-impact research and institutions should be committed to stimulating international linkages which would result in co-supervision and mobility of postgraduate students and global significance of postgraduate research. International linkages are also valuable in increasing the capacity for supervision at new and developing universities. Innovative co-supervision and joint-degree options with global partners should be explored within strategic planning for innovative postgraduate programmes. Co-supervision of PhD students is probably the strongest driver (besides funding) for collaborative research as it provides the glue of shared interest, advantage and commitment between supervisors. The students’ field serves and informs the co-supervisors own research agendas and helps to shape over-arching research themes through shared research findings.

Keywords: interdisciplinarity, internationalisation, postgraduate, supervision

Procedia PDF Downloads 217

Authors: Oluwaseun Adeleke, Samuel O. Ikani, Fidelis Edet, Anthony Nwala, Mopelola Raji, Simeon Christian Chukwu

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Background: The Delivering Innovations in Selfcare (DISC) project aims to increase access to self-care options for women of reproductive age, starting with self-inject subcutaneous depot medroxyprogesterone acetate (DMPA-SC) contraception services. However, the project has faced challenges in ensuring the continuous availability of the commodity in health facilities. Although most states in the country rely on the federal ministry of Health for supplies, some are gradually funding the procurement of Family Planning (FP) commodities. This attempt is, however, often accompanied by procurement delays and purchases inadequate to meet demand. This dilemma was further exacerbated by the commencement of demand generation activities by the project in supported states which geometrically increased commodity utilization rates and resulted in receding stock and occasional service disruptions. Strategies: The project deployed various strategies were implemented to ensure the continuous availability of commodities. These include facilitating inter-facility transfer, monthly tracking of commodity utilization, and alerting relevant authorities when stock levels reach a minimum. And supporting state-level procurement of DMPA-SC commodities through catalytic interventions. Results: Effective monitoring of commodity inventory at the facility level and strategic engagement with federal and state-level logistics units have proven successful in mitigating stock-out of commodities. It has helped secure up to 13,000 units of DMPA-SC commodities from federal logistics units and enabled state units to prioritize supported sites. This has ensured the continuity of DMPA-SC services and an increasing trend in the practice of self-injection. Conclusion: A functional supply chain is crucial to achieving commodity security, and without it, health programs cannot succeed. Stakeholder engagement, stock management and catalytic interventions have provided both short- and long-term measures to mitigate stock-outs and ensured a consistent supply of commodities to clients.

Keywords: family planning, contraception, DMPA-SC, self-care, self-injection, commodities, stock-out

Procedia PDF Downloads 65

Authors: Shivani Yadav

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The Study of terrorism lends itself to the constructivist framework as constructivism focuses on the importance of ideas and norms in shaping interests and identities. Constructivism is pertinent to understand the phenomenon of a terrorist organization like the Islamic State (IS), which opportunistically utilizes radical ideas and norms to shape its ‘politics of identity’. This ‘identity’, which is at the helm of preferences and interests of actors, in turn, shapes actions. The paper argues that an effective counter-terrorism policy must recognize the importance of ideas in order to counter the threat arising from acts of radicalism and terrorism. Traditional theories of international relations, with an emphasis on state-centric security problematic, exhibit several limitations and problems in interpreting the phenomena of terrorism. With the changing global order, these theories have failed to adapt to the changing dimensions of terrorism, especially ‘newer’ actors like the Islamic State (IS). The paper observes that IS distinguishes itself from other terrorist organizations in the way that it recruits and spreads its propaganda. Not only are its methods different, but also its tools (like social media) are new. Traditionally, too, force alone has rarely been sufficient to counter terrorism, but it seems especially impossible to completely root out an organization like IS. Time is ripe to change the discourse around terrorism and counter-terrorism strategies. The counter-terrorism measures adopted by states, which primarily focus on mitigating threats to the national security of the state, are preoccupied with statist objectives of the continuance of state institutions and maintenance of order. This limitation prevents these theories from addressing the questions of justice and the ‘human’ aspects of ideas and identity. These counter-terrorism strategies adopt a problem-solving approach that attempts to treat the symptoms without diagnosing the disease. Hence, these restrictive strategies fail to look beyond calculated retaliation against violent actions in order to address the underlying causes of discontent pertaining to ‘why’ actors turn violent in the first place. What traditional theories also overlook is that overt acts of violence may have several causal factors behind them, some of which are rooted in the structural state system. Exploring these root causes through the constructivist framework helps to decipher the process of ‘construction of terror’ and to move beyond the ‘what’ in theorization in order to describe ‘why’, ‘how’ and ‘when’ terrorism occurs. Study of terrorism would much benefit from a constructivist analysis in order to explore non-military options while countering the ideology propagated by the IS.

Keywords: constructivism, counter terrorism, Islamic State, politics of identity

Procedia PDF Downloads 164

Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski

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Transient ischaemic attacks (TIAs) are warning signs for future strokes. TIA patients are at increased risk of stroke and cardio-vascular events after a first episode. A majority of studies on TIA focused on the occurrence of these ancillary events after a TIA. Long-term mortality after TIA received only limited attention. We undertook this study to determine the long-term hazards of all-cause mortality following a first episode of a TIA using anonymised electronic health records (EHRs). We used a retrospective case-control study using electronic primary health care records from The Health Improvement Network (THIN) database. Patients born prior to or in year 1960, resident in England, with a first diagnosis of TIA between January 1986 and January 2017 were matched to three controls on age, sex and general medical practice. The primary outcome was all-cause mortality. The hazards of all-cause mortality were estimated using a time-varying Weibull-Cox survival model which included both scale and shape effects and a random frailty effect of GP practice. 20,633 cases and 58,634 controls were included. Cases aged 39 to 60 years at the first TIA event had the highest hazard ratio (HR) of mortality compared to matched controls (HR = 3.04, 95% CI (2.91 - 3.18)). The HRs for cases aged 61-70 years, 71-76 years and 77+ years were 1.98 (1.55 - 2.30), 1.79 (1.20 - 2.07) and 1.52 (1.15 - 1.97) compared to matched controls. Aspirin provided long-term survival benefits to cases. Cases aged 39-60 years on aspirin had HR of 0.93 (0.84 - 1.00), 0.90 (0.82 - 0.98) and 0.88 (0.80 - 0.96) at 5 years, 10 years and 15 years, respectively, compared to cases in the same age group who were not on antiplatelets. Similar beneficial effects of aspirin were observed in other age groups. There were no significant survival benefits with other antiplatelet options. No survival benefits of antiplatelet drugs were observed in controls. Our study highlights the excess long-term risk of death of TIA patients and cautions that TIA should not be treated as a benign condition. The study further recommends aspirin as the better option for secondary prevention for TIA patients compared to clopidogrel recommended by NICE guidelines. Management of risk factors and treatment strategies should be important challenges to reduce the burden of disease.

Keywords: dual antiplatelet therapy (DAPT), General Practice, Multiple Imputation, The Health Improvement Network(THIN), hazard ratio (HR), Weibull-Cox model

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Authors: J. Szpor, K. Witczak, M. Storman, A. Orchel, D. Hodorowicz-Zaniewska, K. Okoń, A. Klimkowska

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Core needle biopsy (CNB) is well established as an important diagnostic tool in diagnosing breast cancer and it is now considered the initial method of choice for diagnosing breast disease. In comparison to fine needle aspiration (FNA), CNB provides more architectural information allowing for the evaluation of prognostic and predictive factors for breast cancer, including histological grade—one of three prognostic factors used to calculate the Nottingham Prognostic Index. Several studies have previously described the concordance rate between CNB and surgical excision specimen in determination of histological grade (HG). The concordance rate previously ascribed to overall grade varies widely across literature, ranging from 59-91%. The aim of this study is to see how the data looks like in material at authors’ institution and are the results as compared to those described in previous literature. The study population included 157 women with a breast tumor who underwent a core needle biopsy for breast carcinoma and a subsequent surgical excision of the tumor. Both materials were evaluated for the determination of histological grade (scale from 1 to 3). HG was assessed only in core needle biopsies containing at least 10 well preserved HPF with invasive tumor. The degree of concordance between CNB and surgical excision specimen for the determination of tumor grade was assessed by Cohen’s kappa coefficient. The level of agreement between core needle biopsy and surgical resection specimen for overall histologic grading was 73% (113 of 155 cases). CNB correctly predicted the grade of the surgical excision specimen in 21 cases for grade 1 tumors (Kappa coefficient κ = 0.525 95% CI (0.3634; 0.6818), 52 cases for grade 2 (Kappa coefficient κ = 0.5652 95% CI (0.458; 0.667) and 40 cases for stage 3 tumors (Kappa coefficient κ = 0.6154 95% CI (0.4862; 0.7309). The highest level of agreement was observed in grade 3 malignancies. In 9 of 42 (21%) discordant cases, the grade was higher in the CNB than in the surgical excision. This composed 6% of the overall discordance. These results correspond to the noted in the literature, showing that underestimation occurs more frequently than overestimation. This study shows that authors’ institution’s histologic grading of CNBs and surgical excisions shows a fairly good correlation and is consistent with findings in previous reports. Despite the inevitable limitations of CNB, CNB is an effective method for diagnosing breast cancer and managing treatment options. Assessment of tumour grade by CNB is useful for the planning of treatment, so in authors’ opinion it is worthy to implement it in daily practice.

Keywords: breast cancer, concordance, core needle biopsy, histological grade

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Authors: Elena Pummer, Holger Schuettrumpf

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By today underground pumped storage plants as an outstanding alternative for classical pumped storage plants do not exist. They are needed to ensure the required balance between production and demand of energy. As a short to medium term storage pumped storage plants have been used economically over a long period of time, but their expansion is limited locally. The reasons are in particular the required topography and the extensive human land use. Through the use of underground reservoirs instead of surface lakes expansion options could be increased. Fulfilling the same functions, several hydrodynamic processes result in the specific design of the underground reservoirs and must be implemented in the planning process of such systems. A combined 3D numerical and experimental approach leads to currently unknown results about the occurring wave types and their behavior in dependence of different design and operating criteria. For the 3D numerical simulations, OpenFOAM was used and combined with an experimental approach in the laboratory of the Institute of Hydraulic Engineering and Water Resources Management at RWTH Aachen University, Germany. Using the finite-volume method and an explicit time discretization, a RANS-Simulation (k-ε) has been run. Convergence analyses for different time discretization, different meshes etc. and clear comparisons between both approaches lead to the result, that the numerical and experimental models can be combined and used as hybrid model. Undular bores partly with secondary waves and breaking bores occurred in the underground reservoir. Different water levels and discharges change the global effects, defined as the time-dependent average of the water level as well as the local processes, defined as the single, local hydrodynamic processes (water waves). Design criteria, like branches, directional changes, changes in cross-section or bottom slope, as well as changes in roughness have a great effect on the local processes, the global effects remain unaffected. Design calculations for underground pumped storage plants were developed on the basis of existing formulae and the results of the hybrid approach. Using the design calculations reservoirs heights as well as oscillation periods can be determined and lead to the knowledge of construction and operation possibilities of the plants. Consequently, future plants can be hydraulically optimized applying the design calculations on the local boundary conditions.

Keywords: energy storage, experimental approach, hybrid approach, undular and breaking Bores, 3D numerical approach

Procedia PDF Downloads 196

Authors: Nigatu Tadesse, Li Juan, Liuhong Ming

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Gastric cancer (GC) is the fifth most common and fourth deadly cancer in the world with limited treatment options at late advanced stage in which surgical therapy is not recommended with chemotherapy remain as the mainstay of treatment. However, the occurrence of chemoresistance as well as intera-tumoral and inter-tumoral heterogeneity of response to targeted and immunotherapy underlined a clear unmet treatment need in gastroenterology. Several molecular and cellular alterations ascribed for chemo resistance in GC including cancer stem cells (CSC) and tumor microenvironment (TME) remodeling. Cancer cells including CSC bears higher metabolic demand and major changes in TME involves alterations of gut microbiota interacting with nutrients metabolism. Metabolic upregulation in lipids, carbohydrates, amino acids, fatty acids biosynthesis pathways identified as a common hall mark in GC. Metabolic addiction to methionine metabolism occurs in many cancer cells to promote the biosynthesis of S-Adenosylmethionine (SAM), a universal methyl donor molecule for high rate of transmethylation in GC and promote cell proliferation. Targeting methionine metabolism found to promotes chemo-sensitivity with treatment non-heterogeneity. Methionine restriction (MR) promoted the arrest of cell cycle at S/G2 phase and enhanced downregulation of GC cells resistance to apoptosis (including ferroptosis), which suggests the potential of synergy with chemotherapies acting at S-phase of the cell cycle as well as inducing cell apoptosis. Accumulated evidences showed both the biogenesis as well as intracellular metabolism of exogenous methionine could be safe and effective target for therapy either alone or in combination with chemotherapies. This review article provides an over view of the upregulation in methionine biosynthesis pathway and the molecular signaling through the PI3K/Akt/mTOR-c-MYC axis to promote metabolic reprograming through activating the expression of L-type aminoacid-1 (LAT1) transporter and overexpression of Methionine adenosyltransferase 2A(MAT2A) for intercellular metabolic conversion of exogenous methionine to SAM in GC, and the potential of targeting with novel therapeutic agents such as methioninase (METase), Methionine adenosyltransferase 2A (MAT2A), c-MYC, methyl like transferase 16 (METTL16) inhibitors that are currently under clinical trial development stages and future perspectives.

Keywords: gastric cancer, methionine metabolism, pi3k/akt/mtorc1-c-myc axis, gut microbiota, MAT2A, c-MYC, METTL16, methioninase

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Authors: Tamphasana Wairokpam

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Inflammatory myopathies (IMs) have long been recognised as a heterogenous family of myopathies with acute, subacute, and sometimes chronic presentation and are potentially treatable. Necrotizing autoimmune myopathies (NAM) are a relatively new subset of myopathies. Patients generally present with subacute onset of proximal myopathy and significantly elevated creatinine kinase (CK) levels. It is being increasingly recognised that there are limitations to the independent diagnostic utility of muscle biopsy. Immunohistochemistry tests may reveal important information in these cases. The traditional classification of IMs failed to recognise NAM as a separate entity and did not adequately emphasize the diversity of IMs. This review and case report on NAM aims to highlight the heterogeneity of this entity and focus on the distinct clinical presentation, biopsy findings, specific auto-antibodies implicated, and available treatment options with prognosis. This article is a meta-analysis of literatures on NAM and a case report illustrating the clinical course, investigation and biopsy findings, antibodies implicated, and management of a patient with NAM. The main databases used for the search were Pubmed, Google Scholar, and Cochrane Library. Altogether, 67 publications have been taken as references. Two biomarkers, anti-signal recognition protein (SRP) and anti- hydroxyl methylglutaryl-coenzyme A reductase (HMGCR) Abs, have been found to have an association with NAM in about 2/3rd of cases. Interestingly, anti-SRP associated NAM appears to be more aggressive in its clinical course when compared to its anti-HMGCR associated counterpart. Biopsy shows muscle fibre necrosis without inflammation. There are reports of statin-induced NAM where progression of myopathy has been seen even after discontinuation of statins, pointing towards an underlying immune mechanism. Diagnosisng NAM is essential as it requires more aggressive immunotherapy than other types of IMs. Most cases are refractory to corticosteroid monotherapy. Immunosuppressive therapy with other immunotherapeutic agents such as IVIg, rituximab, mycophenolate mofetil, azathioprine has been explored and found to have a role in the treatment of NAM. In conclusion,given the heterogeneity of NAM, it appears that NAM is not just a single entity but consists of many different forms, despite the similarities in presentation and its classification remains an evolving field. A thorough understanding of underlying mechanism and the clinical correlation with antibodies associated with NAM is essential for efficacious management and disease prognostication.

Keywords: inflammatory myopathies, necrotising autoimmune myopathies, anti-SRP antibody, anti-HMGCR antibody, statin induced myopathy

Procedia PDF Downloads 88

Authors: Esshili Awatef, Manitz Marie-Pierre, Eßlinger Manuela, Gerhardt Alexandra, Plümper Jennifer, Wachholz Simone, Friebe Astrid, Juckel Georg

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Maternal immune activation (MIA) resulting from maternal viral infection during pregnancy is a known risk factor for schizophrenia. The neural mechanisms by which maternal infections increase the risk for schizophrenia remain unknown, although the prevailing hypothesis argues that an activation of the maternal immune system induces changes in the maternal-fetal environment that might interact with fetal brain development. It may lead to an activation of fetal microglia inducing long-lasting functional changes of these cells. Based on post-mortem analysis showing an increased number of activated microglial cells in patients with schizophrenia, it can be hypothesized that these cells contribute to disease pathogenesis and may actively be involved in gray matter loss observed in such patients. In the present study, we hypothesize that prenatal treatment with the inflammatory agent Poly(I:C) during embryogenesis at contributes to microglial activation in the offspring, which may, therefore, represent a contributing factor to the pathogenesis of schizophrenia and underlines the need for new pharmacological treatment options. Pregnant rats were treated with intraperitoneal injections a single dose of Poly(I:C) or saline on gestation day 17. Brains of control and Poly(I:C) offspring, were removed and into 20-μm-thick coronal sections were cut by using a Cryostat. Brain slices were fixed and immunostained with ba1 antibody. Subsequently, Iba1-immunoreactivity was detected using a secondary antibody, goat anti-rabbit. The sections were viewed and photographed under microscope. The immunohistochemical analysis revealed increases in microglia cell number in the prefrontal cortex, in offspring of poly(I:C) treated-rats as compared to the controls injected with NaCl. However, no significant differences were observed in microglia activation in the cerebellum among the groups. Prenatal immune challenge with Poly(I:C) was able to induce long-lasting changes in the offspring brains. This lead to a higher activation of microglia cells in the prefrontal cortex, a brain region critical for many higher brain functions, including working memory and cognitive flexibility. which might be implicated in possible changes in cortical neuropil architecture in schizophrenia. Further studies will be needed to clarify the association between microglial cells activation and schizophrenia-related behavioral alterations.

Keywords: Microglia, neuroinflammation, PolyI:C, schizophrenia

Procedia PDF Downloads 400

Authors: R. M. Shabbir Ahmed, Mohamed Haneef, A. R. Anwar Khan

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Analysis of stresses plays important role in the optimization of structures. Prior stress estimation helps in better design of the products. Composites find wide usage in the industrial and home applications due to its strength to weight ratio. Especially in the air craft industry, the usage of composites is more due to its advantages over the conventional materials. Composites are mainly made of orthotropic materials having unequal strength in the different directions. Composite materials have the drawback of delamination and debonding due to the weaker bond materials compared to the parent materials. So proper analysis should be done to the composite joints before using it in the practical conditions. In the present work, a composite plate with elastic pin is considered for analysis using finite element software Ansys. Basically the geometry is built using Ansys software using top down approach with different Boolean operations. The modelled object is meshed with three dimensional layered element solid46 for composite plate and solid element (Solid45) for pin material. Various combinations are considered to find the strength of the composite joint under uniaxial loading conditions. Due to symmetry of the problem, only quarter geometry is built and results are presented for full model using Ansys expansion options. The results show effect of pin diameter on the joint strength. Here the deflection and load sharing of the pin are increasing and other parameters like overall stress, pin stress and contact pressure are reducing due to lesser load on the plate material. Further material effect shows, higher young modulus material has little deflection, but other parameters are increasing. Interference analysis shows increasing of overall stress, pin stress, contact stress along with pin bearing load. This increase should be understood properly for increasing the load carrying capacity of the joint. Generally every structure is preloaded to increase the compressive stress in the joint to increase the load carrying capacity. But the stress increase should be properly analysed for composite due to its delamination and debonding effects due to failure of the bond materials. When results for an isotropic combination is compared with composite joint, isotropic joint shows uniformity of the results with lesser values for all parameters. This is mainly due to applied layer angle combinations. All the results are represented with necessasary pictorial plots.

Keywords: bearing force, frictional force, finite element analysis, ANSYS

Procedia PDF Downloads 315

Authors: W. Mohammedsaeed, A. J. Mcbain, S. M. Cruickshank, C. A. O’Neill

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Many studies have demonstrated the importance of probiotics and their potential therapeutic effects within the gut. Recently, the possible therapeutic effects of probiotics in other tissues have also begun to be investigated. Comparatively few studies have evaluated the use of topical probiotics in relation to the skin. In this study, we have conducted preliminary investigations into whether a well-known probiotic, Lactobacillus rhamnosus GG (LGG), can increase the rate of re-epithelialization in a model wound. Full-thickness skin was obtained from individuals undergoing elective cosmetic surgery. This skin was wounded using excisional punch and cultured using a serum-free medium, either in the presence or absence of L. rhamnosus GG lysate. Histological staining of the sections was performed with Haematoxylin& Eosin E to quantify “epithelial tongue length”. This is the length of the new epithelial ‘tongue’ that grows and covers the exposed dermis at the inner wound edges. The length of the new epithelial ‘tongue’ was compared in untreated section and section treated with and L. rhamnosus GG made using108CFU/ml bacterial cells. L. rhamnosus GG lysate enhanced significantly the re-epithelialisation of treated wounds compared with that of untreated wounds (P=0.005, n=3). Tongue length, at day 1 was 7.55μm 0.15, at day 3 it was 18.5μm 0.25 and at day 7 was 22.9μm 0.35. These results can be compared with untreated cultures in which tongue length was 3.25μm 0.35, day 3 was 9.65μm 0.25 and day 7 was 13.5μm 0.15 post-wounding. In ex-vivo proliferation and migration cells were measured by determining the expression of nuclear proliferation marker Ki-67 and the expression of Phosphorylated cortactin respectively demonstrated that L. rhamnosus GG significantly increased NHEK proliferation and migration rates relative to controls. However, the dominant mechanism was migration because in ex-vivo skin treated with the L. rhamnosus GG up-regulated the gene expression of the chemokine receptor and ligands CXCR2 and CXCL2 comparing with controls (P=0.02, P=0.03 respectively, n=3). High levels of CXCL2/CXCL2 have already been implicated in multiple aspects of stimulation of wound healing through activation of keratinocyte migration. These data demonstrate that lysates from Lactobacillus rhamnosus GG increase re-epithelialization by stimulation of keratinocyte migration. The current study identifies the partial mechanism that contribute to stimulating the wound-healing process ex vivo in response to L. rhamnosus GG lysate is an increase in the production of CXCL2/ CXCR2 in ex vivo models. The use of probiotic lysates potentially offers new options to develop treatments that could improve wound healing.

Keywords: Lactobacillus rhamnosus GG, wounds, migration, lysate

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Authors: U. Isyaku, C. Upton, J. Dickinson

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Critical institutional approach for understanding pathways to shared prosperity among forest communities enabled questioning the underlying rational choice assumptions that have dominated traditional institutional thinking in natural resources management. Common pool resources framing assumes that communities as social groups share collective interests and values towards achieving greater development. Hence, policies related to natural resources management in the global South prioritise economic prosperity by focusing on how to maximise material benefits and improve the livelihood options of resource dependent communities. Recent trends in commodification and marketization of ecosystem goods and services into tradable natural capital and incentivising conservation are structured in this paradigm. Several researchers however, have problematized this emerging market-based model because it undermines cultural basis for protecting natural ecosystems. By exploring how forest people’s motivations for conservation differ within the context of reducing emissions from deforestation and forest degradation (REDD+) project in Nigeria, we aim to provide an alternative approach to conceptualising prosperity beyond the traditional economic thinking. Through in depth empirical work over seven months with five communities in Nigeria’s Cross River State, Q methodology was used to uncover communities’ perspectives and meanings of forest values that underpin contemporary and historic conservation practices, expected benefits, and willingness to participate in the REDD+ process. Our study finds six discourses about forest and conservation values that transcend wealth creation, poverty reduction and livelihoods. We argue that communities’ decisions about forest conservation consist of a complex mixture of economic, emotional, moral, and ecological justice concerns that constitute new meanings and dimensions of prosperity. Prosperity is thus reconfigured as having socio-cultural and psychological pathways that could be derived through place identity and attachment, connectedness to nature, family ties, and ability to participate in everyday social life. We therefore suggest that natural resources policy making and development interventions should consider institutional arrangements that also include the psycho-cultural dimensions of prosperity among diverse community groups.

Keywords: critical institutionalism, Q methodology, REDD+, shared prosperity

Procedia PDF Downloads 318

Authors: Alberto Mínguez-Martínez, Jesús de Vicente y Oliva

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Modern manufacturing processes have led to the miniaturization of systems and, as a result, parts at the micro-and nanoscale are produced. This trend seems to become increasingly important in the near future. Besides, as a requirement of Industry 4.0, the digitalization of the models of production and processes makes it very important to ensure that the dimensions of newly manufactured parts meet the specifications of the models. Therefore, it is possible to reduce the scrap and the cost of non-conformities, ensuring the stability of the production at the same time. To ensure the quality of manufactured parts, it becomes necessary to carry out traceable measurements at scales lower than one millimeter. Providing adequate traceability to the SI unit of length (the meter) to 2D and 3D measurements at this scale is a problem that does not have a unique solution in industrial environments. Researchers in the field of dimensional metrology all around the world are working on this issue. A solution for industrial environments, even if it is not complete, will enable working with some traceability. At this point, we believe that the study of the surfaces could provide us with a first approximation to a solution. Among the different options proposed in the literature, the areal topography methods may be the most relevant because they could be compared to those measurements performed using Coordinate Measuring Machines (CMM’s). These measuring methods give (x, y, z) coordinates for each point, expressing it in two different ways, either expressing the z coordinate as a function of x, denoting it as z(x), for each Y-axis coordinate, or as a function of the x and y coordinates, denoting it as z (x, y). Between others, optical measuring instruments, mainly microscopes, are extensively used to carry out measurements at scales lower than one millimeter because it is a non-destructive measuring method. In this paper, the authors propose a calibration procedure for the scales of optical measuring instruments, particularizing for a confocal microscope, using material standards easy to find and calibrate in metrology and quality laboratories in industrial environments. Confocal microscopes are measuring instruments capable of filtering the out-of-focus reflected light so that when it reaches the detector, it is possible to take pictures of the part of the surface that is focused. Varying and taking pictures at different Z levels of the focus, a specialized software interpolates between the different planes, and it could reconstruct the surface geometry into a 3D model. As it is easy to deduce, it is necessary to give traceability to each axis. As a complementary result, the roughness Ra parameter will be traced to the reference. Although the solution is designed for a confocal microscope, it may be used for the calibration of other optical measuring instruments by applying minor changes.

Keywords: industrial environment, confocal microscope, optical measuring instrument, traceability

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