Search results for: long term care facility

Authors: Fernandez liporace, Mercedes Uriel Fabiana

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Academic achievement in high school and college students is currently a matter of concern. National and international assessments show high schoolers as low achievers, and local statistics indicate alarming dropout percentages in this educational level. Even so, 80% of those students intend attending higher education. On the other hand, applications to Public National Universities are free and non-selective by examination procedures. Though initial registrations are massive (307.894 students), only 50% of freshmen pass their first year classes, and 23% achieves a degree. Low performances use to be a common problem. Hence, freshmen adaptation, their adjustment, dropout and low academic achievement arise as topics of agenda. Besides, the hinge between high school and college must be examined in depth, in order to get an integrated and successful path from one educational stratum to the other. Psychology aims at developing two main research lines to analyse the situation. One regarding psychometric scales, designing and/or adapting tests, examining their technical properties and their theoretical validity (e.g., academic motivation, learning strategies, learning styles, coping, perceived social support, parenting styles and parental consistency, paradoxical personality as correlated to creative skills, psychopathological symptomatology). The second research line emphasizes relationships within the variables measured by the former scales, facing the formulation and testing of predictive models of academic achievement, establishing differences by sex, age, educational level (high school vs college), and career. Pursuing these goals, several studies were carried out in recent years, reporting findings and producing assessment technology useful to detect students academically at risk as well as good achievers. Multiple samples were analysed totalizing more than 3500 participants (2500 from college and 1000 from high school), including descriptive, correlational, group differences and explicative designs. A brief on the most relevant results is presented. Providing information to design specific interventions according to every learner’s features and his/her educational environment comes up as a mid-term accomplishment. Furthermore, that information might be helpful to adapt curricula by career, as well as for implementing special didactic strategies differentiated by sex and personal characteristics.

Keywords: academic achievement, higher education, high school, psychological assessment

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Authors: Mehrdad Abkenari, Mehmet Kunt, Mahdi Nourollahi

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Evaluating the environmental risk factors is a combination of analysis of transportation effects. Various definitions for risk can be found in different scientific sources. Each definition depends on a specific and particular perspective or dimension. The effects of potential risks present along the new proposed routes and existing infrastructures of large transportation projects like railways should be studied under comprehensive engineering frameworks. Despite various definitions provided for ‘risk’, all include a uniform concept. Two obvious aspects, loss and unreliability, have always been pointed in all definitions of this term. But, selection as the third aspect is usually implied and means how one notices it. Currently, conducting engineering studies on the environmental effects of railway projects have become obligatory according to the Environmental Assessment Act in developing countries. Considering the longitudinal nature of these projects and probable passage of railways through various ecosystems, scientific research on the environmental risk of these projects have become of great interest. Although many areas of expertise such as road construction in developing countries have not seriously committed to these studies yet, attention to these subjects in establishment or implementation of different systems have become an inseparable part of this wave of research. The present study used environmental risks identified and existing in previous studies and stations to use in next step. The second step proposes a new hybrid approach of analytical network process (ANP) and DEMATEL in fuzzy conditions for assessment of determined risks. Since evaluation of identified risks was not an easy touch, mesh structure was an appropriate approach for analyzing complex systems which were accordingly employed for problem description and modeling. Researchers faced the shortage of real space data and also due to the ambiguity of experts’ opinions and judgments, they were declared in language variables instead of numerical ones. Since fuzzy logic is appropriate for ambiguity and uncertainty, formulation of experts’ opinions in the form of fuzzy numbers seemed an appropriate approach. Fuzzy DEMATEL method was used to extract the relations between major and minor risk factors. Considering the internal relations of risk major factors and its sub-factors in the analysis of fuzzy network, the weight of risk’s main factors and sub-factors were determined. In general, findings of the present study, in which effective railway environmental risk indicators were theoretically identified and rated through the first usage of combined model of DEMATEL and fuzzy network analysis, indicate that environmental risks can be evaluated more accurately and also employed in railway projects.

Keywords: DEMATEL, ANP, fuzzy, risk

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Authors: Vithya Veeramani, Karunanidhi Subbaiah

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Emotional problems were found to be the predominant cause of suicide and second leading cause of death among adolescents in India. Emotional problems seem to be the underlying cause for various other severe psycho-social problems experienced in adolescence and also in later years of life. The Corporation schools in Chennai city are named as Chennai High School or Chennai Higher Secondary School run by the Corporation of Chennai. These schools fulfill the educational needs of students who hail from lower socio-economic status living in slums of the Chennai city. Adolescent students of Chennai schools tend to lack basic needs like food, clothes, shelter, etc. Some of the other significant problems faced by them are broken family, lack of parental support, frequent quarrel between parents, alcoholic parents, drug abuse and substance abuse among parents and neighbors, extended family, illiterate parents, deprivation of love and care, and lack of sense of belongingness. This prevailing condition may affect them emotionally and could lead to maladaptive behaviour, aggressiveness, poor interpersonal relationship with others, school refusal behaviour, school drop-out, suicide, etc. Therefore, it is very important to investigate the emotional problems faced by the adolescent students studying in Chennai schools, Chennai. A cross-sectional survey design was used to find the prevalence of emotional problems among adolescent students. Cluster sampling technique was used to select the schools for the present study considering the school as a cluster. In total, there are 15 zones, under the control of Chennai Corporation, of which only 7 zones have Corporation Schools in Chennai city, comprising of 32 Chennai Higher Secondary Schools and 38 Chennai High Schools. Out of these 70 schools, 29 schools comprising of 17 high schools and 12 higher secondary schools were selected randomly using lottery method. A sample of 2594 adolescent students from 9th standard and 11th standard was chosen for the study. Percentage analysis was done to find out the prevalence rate of emotional problems among adolescents students studying in Chennai Schools. Results of the study revealed that, out of 2594 students surveyed, 21.04% adolescent students were found to have academic problems (n = 546), 15.99% adolescent students had social problems (n = 415), behaviour problems was found to be prevalent among 12.87% adolescent students (n = 334), depression was prevalent among 15.88% adolescent students (n = 412) and anxiety was prevalent among 14.42% adolescent students (n = 374). Prevalence of emotional problems among male and female revealed that academic problems were more prevalent compared to other problems. Behaviour problems were least prevalent among boys and anxiety was least prevalent among girls than other problems. The overall prevalence rate of emotional problems was found to be on an increasing trend among adolescent students of low socio-economic status in Chennai city. The findings indicated the need for intervention to prevent and rehabilitate these adolescent students.

Keywords: adolescents, corporation schools, emotional problems, prevalence

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Authors: K. J. Keerthi, Vasundhara Kamineni, A. Ravi Shanker, T. Rammurthy, A. Vijaya Lakshmi, Q. Hasan

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Pancreatic β-cells are the predominant insulin-producing cell types within the Islets of Langerhans and insulin is the primary hormone which regulates carbohydrate and fat metabolism. Apoptosis of β-cells or insufficient insulin production leads to Diabetes Mellitus (DM). Current therapy for diabetes includes either medical management or insulin replacement and regular monitoring. Replacement of β- cells is an attractive treatment option for both Type-1 and Type-2 DM in view of the recent paper which indicates that β-cells apoptosis is the common underlying cause for both the Types of DM. With the development of Edmonton protocol, pancreatic β-cells allo-transplantation became possible, but this is still not considered as standard of care due to subsequent requirement of lifelong immunosuppression and the scarcity of suitable healthy organs to retrieve pancreatic β-cell. Fetal pancreatic cells from abortuses were developed as a possible therapeutic option for Diabetes, however, this posed several ethical issues. Hence, in the present study Mesenchymal stem cells (MSCs) were differentiated into insulin producing cells which were isolated from Human Umbilical cord (HUC) tissue. MSCs have already made their mark in the growing field of regenerative medicine, and their therapeutic worth has already been validated for a number of conditions. HUC samples were collected with prior informed consent as approved by the Institutional ethical committee. HUC (n=26) were processed using a combination of both mechanical and enzymatic (collagenase-II, 100 U/ml, Gibco ) methods to obtain MSCs which were cultured in-vitro in L-DMEM (Low glucose Dulbecco's Modified Eagle's Medium, Sigma, 4.5 mM glucose/L), 10% FBS in 5% CO2 incubator at 37°C. After reaching 80-90% confluency, MSCs were characterized with Flowcytometry and Immunocytochemistry for specific cell surface antigens. Cells expressed CD90+, CD73+, CD105+, CD34-, CD45-, HLA-DR-/Low and Vimentin+. These cells were differentiated to β-cells by using H-DMEM (High glucose Dulbecco's Modified Eagle's Medium,25 mM glucose/L, Gibco), β-Mercaptoethanol (0.1mM, Hi-Media), basic Fibroblast growth factor (10 µg /L,Gibco), and Nicotinamide (10 mmol/L, Hi-Media). Pancreatic β-cells were confirmed by positive Dithizone staining and were found to be functionally active as they released 8 IU/ml insulin on glucose stimulation. Isolating MSCs from usually discarded, abundantly available HUC tissue, expanding and differentiating to β-cells may be the most feasible cell therapy option for the millions of people suffering from DM globally.

Keywords: diabetes mellitus, human umbilical cord, mesenchymal stem cells, differentiation

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Authors: Fernando Araujo, Sandra Cardoso, Fátima Fonseca, Sandra Cavaca

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A debureaucratization strategy for the Portuguese Health Service was assumed by the Executive Board of the SNS, in deep articulation with the Shared Services of the Ministry of Health. Two of the main dimensions were focused on sick leaves (SL), that transform primary health care (PHC) in administrative institutions, limiting access to patients. The self-declaration of illness (SDI) project, through the National Health Service Contact Centre (SNS24), began on May 1, 2023, and has already resulted in the issuance of more than 300,000 SDI without the need to allocate resources from the National Health Service (NHS). This political decision allows each citizen, in a maximum 2 times/year, and 3 days each time, if ill, through their own responsibility, report their health condition in a dematerialized way, and by this way justified the absence to work, although by Portuguese law in these first three days, there is no payment of salary. Using a digital approach, it is now feasible without the need to go to the PHC and occupy the time of the PHC only to obtain an SL. Through this measure, bureaucracy has been reduced, and the system has been focused on users, improving the lives of citizens and reducing the administrative burden on PHC, which now has more consultation times for users who need it. The second initiative, which began on March 1, 2024, allows the SL to be issued in emergency departments (ED) of public hospitals and in the health institutions of the social and private sectors. This project is intended to allow the user who has suffered a situation of acute urgent illness and who has been observed in an ED of a public hospital or in a private or social entity no longer need to go to PHC only to apply for the respective SL. Since March 1, 54,453 SLs have been issued, 242 in private or social sector institutions and 6,918 in public hospitals, of which 134 were in ED and 47,292 in PHC. This approach has proven to be technically robust, allows immediate resolution of problems and differentiates the performance of doctors. However, it is important to continue to qualify the proper functioning of the ED, preventing non-urgent users from going there only to obtain SL. Thus, in order to make better use of existing resources, it was operationalizing this extension of its issuance in a balanced way, allowing SL to be issued in the ED of hospitals only to critically ill patients or patients referred by INEM, SNS24, or PHC. In both cases, an intense public campaign was implemented to explain the way it works and the benefits for patients. In satisfaction surveys, more than 95% of patients and doctors were satisfied with the solutions, asking for extensions to other areas. The administrative simplification agenda of the NHS continues its effective development. For the success of this debureaucratization agenda, the key factors are effective communication and the ability to reach patients and health professionals in order to increase health literacy and the correct use of NHS.

Keywords: debureaucratization strategy, self-declaration of illness, sick leaves, SNS24

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Authors: Anders Troedsson

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For us humans, risks are intimately linked to human vulnerabilities - where there is vulnerability, there is potentially insecurity, and risk. Reducing vulnerability through compensatory measures means increasing security and decreasing risk. The paper suggests that a meaningful way to approach the study of risks (including threats, assaults, crisis etc.), is to understand the vulnerabilities these external phenomena evoke in humans. As is argued, the basis of risk evaluation, as well as responses, is the more or less subjective perception by the individual person, or a group of persons, exposed to the external event or phenomena in question. This will be determined primarily by the vulnerability or vulnerabilities that the external factor are perceived to evoke. In this way, risk perception is primarily an inward dynamic, rather than an outward one. Therefore, a route towards an understanding of the perception of risks, is a closer scrutiny of the vulnerabilities which they can evoke, thereby approaching an understanding of what in the paper is called the essence of risk (including threat, assault etc.), or that which a certain perceived risk means to an individual or group of individuals. As a necessary basis for gauging the wide spectrum of potential risks and their meaning, the paper proposes a model of human vulnerabilities, drawing from i.a. a long tradition of needs theory. In order to account for the subjectivity factor, which mediates between the innate vulnerabilities on the one hand, and the event or phenomenon out there on the other hand, an ensuing ontological discussion about the timespace characteristics of risk/threat/assault as perceived by humans leads to the positing of two dimensions. These two dimensions are applied on the vulnerabilities, resulting in a modelling effort featuring four realms of vulnerabilities which are related to each other and together represent a dynamic whole. In approaching the problem of risk perception, the paper thus defines the relevant realms of vulnerabilities, depicting them as a dynamic whole. With reference to a substantial body of literature and a growing international policy trend since the 1990s, this model is put in the language of human security - a concept relevant not only for international security studies and policy, but also for other academic disciplines and spheres of human endeavor.

Keywords: human security, timespace, vulnerabilities, risk perception

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Authors: Ayelet Hersch, Corrine Serfaty, Sigal Portnoy

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Stroke survivors commonly report persistent fatigue and sleep disruptions during rehabilitation and post-recovery. While limited research has explored the impact of stroke on a patient's chronotype, there is a gap in understanding the differences in cognitive performance based on treatment timing. Study objectives: (a) To characterize the sleep chronotype in sub-acute post-stroke individuals. (b) Explore cognitive task performance differences during preferred and non-preferred hours. (c) Examine the relationships between sleep quality and cognitive performance. For this intra-subject study, twenty participants (mean age 60.2±8.6) post-first stroke (6-12 weeks post stroke) underwent assessments at preferred and non-preferred chronotypic times. The assessment included demographic surveys, the Munich Chronotype Questionnaire, Montreal Cognitive Assessment (MoCA), Rivermead Behavioral Memory Test (RBMT), a fatigue questionnaire, and 4-5 days of actigraphy (wrist-worn wGT3X-BT, ActiGraph) to record sleep characteristics. Four sleep quality indices were extracted from actigraphy wristwatch recordings: The average of total sleep time per day (minutes), the average number of awakenings during the sleep period per day, the efficiency of sleep (total hours of sleep per day divided by hours spent in bed per day, averaged across the days and presented as percentage), and the Wake after Sleep Onset (WASO) index, indicating the average number of minutes elapsed from the onset of sleep to the first awakening. Stroke survivors exhibited an earlier sleep chronotype post-injury compared to pre-injury. Enhanced attention, as indicated by higher RBMT scores, occurred during preferred hours. Specifically, 30% of the study participants demonstrated an elevation in their final scores during their preferred hours, transitioning from the category of "mild memory impairment" to "normal memory." However, no significant differences emerged in executive functions, attention tasks, and MoCA scores between preferred and non-preferred hours. The Wake After Sleep Onset (WASO) index correlated with MoCA/RBMT scores during preferred hours (r=0.53/0.51, p=0.021/0.027, respectively). The number of awakenings correlated with MoCA letter task performance during non-preferred hours (r=0.45, p=0.044). Enhanced attention during preferred hours suggests a potential relationship between chronotype and cognitive performance, highlighting the importance of personalized rehabilitation strategies in stroke care. Further exploration of these relationships could contribute to optimizing the timing of cognitive interventions for stroke survivors.

Keywords: sleep chronotype, chronobiology, circadian rhythm, rehabilitation timing

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Authors: Esther Ekundayo

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The nature of AI-generated works makes it difficult to identify an author. Although, some scholars have suggested that all the players involved in its creation should be allocated authorship according to their respective contribution. From the programmer who creates and designs the AI to the investor who finances the AI and to the user of the AI who most likely ends up creating the work in question. While others suggested that this issue may be resolved by the UK computer-generated works (CGW) provision under Section 9(3) of the Copyright Designs and Patents Act 1988. However, under the UK and Nigerian copyright law, only human-created works are recognised. This is usually assessed based on their originality. This simply means that the work must have been created as a result of its author’s creative and intellectual abilities and not copied. Such works are literary, dramatic, musical and artistic works and are those that have recently been a topic of discussion with regards to generative artificial intelligence (Generative AI). Unlike Nigeria, the UK CDPA recognises computer-generated works and vests its authorship with the human who made the necessary arrangement for its creation . However, making necessary arrangement in the case of Nova Productions Ltd v Mazooma Games Ltd was interpreted similarly to the traditional authorship principle, which requires the skills of the creator to prove originality. Although, some recommend that computer-generated works complicates this issue, and AI-generated works should enter the public domain as authorship cannot be allocated to AI itself. Additionally, the UKIPO recognising these issues in line with the growing AI trend in a public consultation launched in the year 2022, considered whether computer-generated works should be protected at all and why. If not, whether a new right with a different scope and term of protection should be introduced. However, it concluded that the issue of computer-generated works would be revisited as AI was still in its early stages. Conversely, due to the recent developments in this area with regards to Generative AI systems such as ChatGPT, Midjourney, DALL-E and AIVA, amongst others, which can produce human-like copyright creations, it is therefore important to examine the relevant issues which have the possibility of altering traditional copyright principles as we know it. Considering that the UK and Nigeria are both common law jurisdictions but with slightly differing approaches to this area, this research, therefore, seeks to answer the following questions by comparative analysis: 1)Who is the author of an AI-generated work? 2)Is the UK’s CGW provision worthy of emulation by the Nigerian law? 3) Would a sui generis law be capable of protecting AI-generated works and its author under both jurisdictions? This research further examines the possible barriers to the implementation of the new law in Nigeria, such as limited technical expertise and lack of awareness by the policymakers, amongst others.

Keywords: authorship, artificial intelligence (AI), generative ai, computer-generated works, copyright, technology

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Authors: Vakhtang Charaia, Mariam Lashkhi

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Foreign direct investment (FDI) plays a vital role in global business. It provides firms with new markets and advertising channels, cheaper production facilities, admission to new technology, products, skills and financing. FDI can provide a recipient country/company with a source of new technologies, capital, practice, products, management skills, and as such can be a powerful drive for economic development. It is one of the key elements of stable economic development in many countries, especially in developing ones. Therefore the size of FDI inflow is one of the most crustal factors for economic perfection in small economy countries (like, Georgia), while most of developed ones are net exporters of FDI. Since, FDI provides firms with new markets; admission to new technologies, products and management skills; marketing channels; cheaper production facilities, and financing opportunities. It plays a significant role in Georgian economic development. Increasing FDI inflows from all over the world to Georgia in last decade was achieved with the outstanding reforms managed by the Georgian government. However, such important phenomenon as world financial crisis and Georgian-Russian war put its consequence on the over amount of FDI inflow in Georgia in the last years. It is important to mention that the biggest investor region for Georgia is EU, which is interested in Georgia not only from the economic points of view but from political. The case studies from main EU investor countries show that Georgia has a big potential of investment in different areas, such as; financial sector, energy, construction, tourism industry, transport and communications. Moreover, signing of Association Agreement between Georgia and EU will further boost all the fields of economy in Georgia in both short and long terms. It will attract more investments from different countries and especially from EU. The last, but not least important issue is the calculation of annual FDI inflow to Georgia, which it is calculated differently by different organizations, based on different methodologies, but what is more important is that all of them show significant increase of FDI in last decade, which gives a positive signal to investors and underlines necessity of further improvement of investment climate in the same direction.

Keywords: foreign direct investment (FDI), Georgia, investment development path, investment climate

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Authors: Cristina Fernandez, Felix Amparano, John Tumberger, Stephani Stancil, Sarah Hampl, Brooke Sweeney, Amy R. Beck, Helena H Laroche, Jared Tucker, Eileen Chaves, Sara Gould, Matthew Lindquist, Lora Edwards, Renee Arensberg, Meredith Dreyer, Jazmine Cedeno, Alleen Cummins, Jennifer Lisondra, Katie Cox, Kelsey Dean, Rachel Perera, Nicholas A. Clark

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Background: Adolescents with obesity are at higher risk of disordered eating than the general population. Detection of eating disorders (ED) is difficult. Screening questionnaires may aid in early detection of ED. Our team’s prior efforts focused on increasing ED screening rates to ≥90% using a validated 10-question adolescent binge eating disorder screening questionnaire (ADO-BED). This aim was achieved. We then aimed to improve treatment plan initiation of patients ≥12 years of age who screen positive for BED within our WMC from 33% to 70% within 12 months. Methods: Our WMC is within a tertiary-care, free-standing children’s hospital. A3, an improvement framework, was used. A multidisciplinary team (physicians, nurses, registered dietitians, psychologists, and exercise physiologists) was created. The outcome measure was documentation of treatment plan initiation of those who screen positive (goal 70%). The process measure was ADO-BED screening rate of WMC patients (goal ≥90%). Plan-Do-Study-Act (PDSA) cycle 1 included provider education on current literature and treatment plan initiation based upon ADO-BED responses. PDSA 2 involved increasing documentation of treatment plan and retrain process to providers. Pre-defined treatment plans were: 1) repeat screen in 3-6 months, 2) resources provided only, or 3) comprehensive multidisciplinary weight management team evaluation. Run charts monitored impact over time. Results: Within 9 months, 166 patients were seen in WMC. Process measure showed sustained performance above goal (mean 98%). Outcome measure showed special cause improvement from mean of 33% to 100% (n=31). Of treatment plans provided, 45% received Plan 1, 4% Plan 2, and 46% Plan 3. Conclusion: Through a multidisciplinary improvement team approach, we maintained sustained ADO-BED screening performance, and, prior to our 12-month timeline, achieved our project aim. Our efforts may serve as a model for other multidisciplinary WMCs. Next steps may include expanding project scope to other WM programs.

Keywords: obesity, pediatrics, clinic, eating disorder

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Authors: Christine Lassen, Elizabeth Leonard, Matthew Oliver

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The management of trauma is often complex and outcomes dependent on clinical expertise, effective teamwork, and a supported trauma system. The implementation of a statewide trauma education program should be accessible to all clinicians who manage trauma, but this can be challenging due to diverse individual needs, trauma service needs and geography. The NSW Institute of Trauma and Injury Management (ITIM) is a government funded body, responsible for coordinating and supporting the NSW Trauma System. The aim of this presentation is to describe how education initiatives have been implemented across the state. Simulation: In 2006, ITIM developed a Trauma Team Training Course - aimed to educate clinicians on the technical and non-technical skills required to manage trauma. The course is now independently coordinated by trauma services across the state at major trauma centres as well as in regional and rural hospitals. ITIM is currently in the process of re-evaluating and updating the Trauma Team Training Course to allow for the development of new resources and simulation scenarios. Trauma Education Evenings: In 2013, ITIM supported major trauma services to develop trauma education evenings which allowed the provision of free education to staff within the area health service and local area. The success of these local events expanded to regional hospitals. A total of 75 trauma education evenings have been conducted within NSW, with over 10,000 attendees. Wed-Based Resources: Recently, ITIM commenced free live streaming of the trauma education evenings which have now had over 3000 live views. The Trauma App developed in 2015 provides trauma clinicians with a centralised portal for trauma information and works on smartphones and tablets that integrate with the ITIM website. This supports pre-hospital and bedside clinical decisions and allows for trauma care to be more standardised, evidence-based, timely, and appropriate. Online e-Learning modules have been developed to assist clinicians, reduce unwarranted clinical variation and provide up to date evidence based education. The modules incorporate clinically focused education content with summative and formative assessments. Conclusion: Since 2005, ITIM has helped to facilitate the development of trauma education programs for doctors, nurses, pre-hospital and allied health clinicians. ITIM has been actively involved in more than 100 specialized trauma education programs, seminars and clinical workshops - attended by over 12,000 staff. The provision of state-wide trauma education is a challenging task requiring collaboration amongst numerous agencies working towards a common goal – to provide easily accessible trauma education.

Keywords: education, simulation, team-training, trauma

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Authors: M. Miljkovic, A. Urakpo, M. Simic-Koumoutsaris

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Benefit-risk assessment (BRA) is a valuable tool that takes place in multiple stages during a medicine's lifecycle, and this assessment can be conducted in a variety of ways. The aim was to summarize current BRA methods used during approval decisions and in post-approval settings and to see possible future directions. Relevant reviews, recommendations, and guidelines published in medical literature and through regulatory agencies over the past five years have been examined. BRA implies the review of two dimensions: the dimension of benefits (determined mainly by the therapeutic efficacy) and the dimension of risks (comprises the safety profile of a drug). Regulators, industry, and academia have developed various approaches, ranging from descriptive textual (qualitative) to decision-analytic (quantitative) models, to facilitate the BRA of medicines during the product lifecycle (from Phase I trials, to authorization procedure, post-marketing surveillance and health technology assessment for inclusion in public formularies). These approaches can be classified into the following categories: stepwise structured approaches (frameworks); measures for benefits and risks that are usually endpoint specific (metrics), simulation techniques and meta-analysis (estimation techniques), and utility survey techniques to elicit stakeholders’ preferences (utilities). All these approaches share the following two common goals: to assist this analysis and to improve the communication of decisions, but each is subject to its own specific strengths and limitations. Before using any method, its utility, complexity, the extent to which it is established, and the ease of results interpretation should be considered. Despite widespread and long-time use, BRA is subject to debate, suffers from a number of limitations, and currently is still under development. The use of formal, systematic structured approaches to BRA for regulatory decision-making and quantitative methods to support BRA during the product lifecycle is a standard practice in medicine that is subject to continuous improvement and modernization, not only in methodology but also in cooperation between organizations.

Keywords: benefit-risk assessment, benefit-risk profile, product lifecycle, quantitative methods, structured approaches

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Authors: Ivette Gonzalez-Rivera, Diana B. Paz-Trejo, Oscar Galicia-Castillo, David N. Velazquez-Martinez, Hugo Sanchez-Castillo

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Prolonged exposure to stress can cause disorders related with dysfunction in the prefrontal cortex such as generalized anxiety and depression. These disorders involve alterations in neurotransmitter systems; the serotonergic system—a target of the drugs that are commonly used as a treatment to these disorders—is one of them. Recent studies suggest that 5-HT1A receptors play a pivotal role in the serotonergic system regulation and in stress responses. In the same way, there is increasing evidence that astrocytes are involved in the pathophysiology of stress. The aim of this study was to examine the effects of 8-OH-DPAT, a selective agonist of 5-HT1A receptors, in the behavioral signs of anxiety and anhedonia as well as in the number of astrocytes in the medial prefrontal cortex (mPFC) after exposure to chronic stress. They used 50 male Wistar rats of 250-350 grams housed in standard laboratory conditions and treated in accordance with the ethical standards of use and care of laboratory animals. A protocol of chronic unpredictable stress was used for 10 consecutive days during which the presentation of stressors such as motion restriction, water deprivation, wet bed, among others, were used. 40 rats were subjected to the stress protocol and then were divided into 4 groups of 10 rats each, which were administered 8-OH-DPAT (Tocris, USA) intraperitoneally with saline as vehicle in doses 0.0, 0.3, 1.0 and 2.0 mg/kg respectively. Another 10 rats were not subjected to the stress protocol or the drug. Subsequently, all the rats were measured in an open field test, a forced swimming test, sucrose consume, and a cero maze test. At the end of this procedure, the animals were sacrificed, the brain was removed and the tissue of the mPFC (Bregma: 4.20, 3.70, 2.70, 2.20) was processed in immunofluorescence staining for astrocytes (Anti-GFAP antibody - astrocyte maker, ABCAM). Statistically significant differences were found in the behavioral tests of all groups, showing that the stress group with saline administration had more indicators of anxiety and anhedonia than the control group and the groups with administration of 8-OH-DPAT. Also, a dose dependent effect of 8-OH-DPAT was found on the number of astrocytes in the mPFC. The results show that 8-OH-DPAT can modulate the effect of stress in both behavioral and anatomical level. Also they indicate that 5-HT1A receptors and astrocytes play an important role in the stress response and may modulate the therapeutic effect of serotonergic drugs, so they should be explored as a fundamental part in the treatment of symptoms of stress and in the understanding of the mechanisms of stress responses.

Keywords: anxiety, prefrontal cortex, serotonergic system, stress

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Authors: Abdul Ganiyu Iddrisu

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Digitization is the process of transforming analog material into digital form, especially for storage and use in a computer. Significant development of information and communication technology (ICT) over the past years has encouraged many researchers to investigate its contribution to promoting economic growth, and reducing poverty. Yet compelling empirical evidence on the effects of digitization on economic growth remains weak, particularly in Africa. This is because extant studies that explicitly evaluate digitization and economic growth nexus are mostly reports and desk reviews. This points out an empirical knowledge gap in the literature. Hypothetically, digitization influences financial sector development which in turn influences economic growth. Digitization has changed the financial sector and its operating environment. Obstacles to access to financing, for instance, physical distance, minimum balance requirements, low-income flows among others can be circumvented. Savings have increased, micro-savers have opened bank accounts, and banks are now able to price short-term loans. This has the potential to develop the financial sector, however, empirical evidence on digitization-financial development nexus is dearth. On the other hand, a number of studies maintained that financial sector development greatly influences growth of economies. We therefore argue that financial sector development is one of the transmission mechanisms through which digitization affects economic growth. Employing macro-country-level data from African countries and using fixed effects, random effects and Hausman-Taylor estimation approaches, this paper contributes to the literature by analysing economic growth in Africa focusing on the role of digitization, and financial sector development. First, we assess how digitization influence financial sector development in Africa. From an economic policy perspective, it is important to identify digitization determinants of financial sector development so that action can be taken to reduce the economic shocks associated with financial sector distortions. This nexus is rarely examined empirically in the literature. Secondly, we examine the effect of domestic credit to private sector and stock market capitalization as a percentage of GDP as used to proxy for financial sector development on 2 economic growth. Digitization is represented by the volume of digital/ICT equipment imported and GDP growth is used to proxy economic growth. Finally, we examine the effect of digitization on economic growth in the light of financial sector development. The following key results were found; first, digitalization propels financial sector development in Africa. Second, financial sector development enhances economic growth. Finally, contrary to our expectation, the results also indicate that digitalization conditioned on financial sector development tends to reduce economic growth in Africa. However, results of the net effects suggest that digitalization, overall, improves economic growth in Africa. We, therefore, conclude that, digitalization in Africa does not only develop the financial sector but unconditionally contributes the growth of the continent’s economies.

Keywords: digitalization, economic growth, financial sector development, Africa

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Authors: Vanlounni Sibounheuang, Wanarat Anusornsangiam, Pattarin Kittiboonyakun, Chanthanom Manithip

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In worldwide, one of the most common use of oral anticoagulant is warfarin. Its margin between therapeutic inhibition of clot formation and bleeding complications is narrow. Mahosot Hospital, warfarin clinic had not been established yet. The descriptive study was conducted by investigating drug-related problems of outpatients using warfarin, the value of the international normalized ratio (INR) higher than normal ranges (25.40 % of the total 272 outpatients) were mostly identified at Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. This result led to the present study conducting qualitative interviews in order to help establish a warfarin clinic at Mahosot Hospital for the better outcomes of patients using warfarin. The purpose of this study was to explore perspectives of healthcare professional providing services for outpatients using warfarin. The face to face, in-depth interviews were undertaken among nine healthcare professionals (doctor=3, nurse=3, pharmacist=3) working at out-patient clinic, Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. The interview guides were developed, and they were validated by the experts in the fields of qualitative research. Each interview lasted approximately 20 minutes. Three major themes emerged; healthcare professional’s experiences of current practice problems with warfarin therapy, healthcare professionals’ views of medical problems related to patients using warfarin, and healthcare professionals’ perspectives on ways of service improvement. All healthcare professionals had the same views that it’s difficult to achieve INR goal for individual patients because of some important patient barriers especially lack of knowledge about to use warfarin properly and safety, patients not regularly follow-up due to problems with transportations and financial support. Doctors and nurses agreed to have a pharmacist running a routine warfarin clinic and provided counselling to individual patients on the following points: how to take drug properly and safety, drug-drug and food-drug interactions, common side effects and how to manage them, lifestyle modifications. From the interviews, some important components of the establishment of a warfarin clinic included financial support, increased human resources, improved the system of keeping patients’ medical records, short course training for pharmacists. This study indicated the acceptance of healthcare professionals on the important roles of pharmacists and the feasibility of setting up warfarin clinic by working together with the multidisciplinary health care team in order to help improve health outcomes of patients using warfarin at Mahosot Hospital, Lao PDR.

Keywords: perspectives, healthcare professional, warfarin therapy, Mahosot Hospital

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Authors: Pichaya Poonlarp, Danai Boonyakiat, C. Chuamuangphan, M. Chanta

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Current consumers’ behavior trends have changed towards more health awareness, the well-being of society and interest of nature and environment. The Royal Project Foundation is, therefore, well aware of organic agriculture. The project only focused on using natural products and utilizing its highland biological merits to increase resistance to diseases and insects for the produce grown. The project also brought in basic knowledge from a variety of available research information, including, but not limited to, improvement of soil fertility and a control of plant insects with biological methods in order to lay a foundation in developing and promoting farmers to grow quality produce with a high health safety. This will finally lead to sustainability for future highland agriculture and a decrease of chemical use on the highland area which is a source of natural watershed. However, there are still shortcomings of the postharvest management in term of quality and losses, such as bruising, rottenness, wilting and yellowish leaves. These losses negatively affect the maintenance and a shelf life of organic vegetables. Therefore, it is important that a research study of the appropriate and effective postharvest management is conducted for an individual organic vegetable to minimize product loss and find root causes of postharvest losses which would contribute to future postharvest management best practices. This can be achieved through surveys and data collection from postharvest processes in order to conduct analysis for causes of postharvest losses of organic pak-choi, baby pak-choi, and choy sum. Consequently, postharvest losses reduction strategies of organic vegetables can be achieved. In this study, postharvest losses of organic pak choi, baby pak-choi, and choy sum were determined at each stage of the supply chain starting from the field after harvesting, at the Development Center packinghouse, at Chiang Mai packinghouse, at Bangkok packing house and at the Royal Project retail shop in Chiang Mai. The results showed that postharvest losses of organic pak-choi, baby pak-choi, and choy sum were 86.05, 89.05 and 59.03 percent, respectively. The main factors contributing to losses of organic vegetables were due to mechanical damage and underutilized parts and/or short of minimum quality standard. Good practices had been developed after causes of losses were identified. Appropriate postharvest handling and management, for example, temperature control, hygienic cleaning, and reducing the duration of the supply chain, postharvest losses of all organic vegetables should be able to remarkably reduced postharvest losses in the supply chain.

Keywords: postharvest losses, organic vegetables, handling improvement, shelf life, supply chain

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Authors: Rahul Jain, Jagdish Chander, Anish Gupta

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Introduction: Laparoscopic common bile duct exploration (LCBDE) allows cholecystectomy and the removal of common bile duct (CBD) stones to be performed during the same sitting, thereby decreasing hospital stay. CBD exploration through choledochotomy can be closed primarily with an absorbable suture material, but can lead to biliary leakage postoperatively. In this study we tried to find a solution to further lower the incidence of bile leakage by using fibrin glue to reinforce the sutures put on choledochotomy suture line. It has haemostatic and sealing action, through strengthening the last step of the physiological coagulation and biostimulation, which favours the formation of new tissue matrix. Methodology: This study was conducted at a tertiary care teaching hospital in New Delhi, India, from 2011 to 2013. 20 patients with CBD stones documented on MRCP with CBD diameter of 9 mm or more were included in this study. Patients were randomized into two groups namely Group A in which choledochotomy was closed with polyglactin 4-0 suture and suture line reinforced with fibrin glue, and Group ‘B’ in which choledochotomy was closed with polyglactin 4-0 suture alone. Both the groups were evaluated and compared on clinical parameters such as operative time, drain content, drain output, no. of days drain was required, blood loss & transfusion requirements, length of postoperative hospital stay and conversion to open surgery. Results: The operative time for Group A ranged from 60 to 210 min (mean 131.50 min) and Group B 65 to 300 min (mean 140 minutes). The blood loss in group A ranged from 10 to 120 ml (mean 51.50 ml), in group B it ranged from 10 to 200 ml (mean 53.50 ml). In Group A, there was no case of bile leak but there was bile leak in 2 cases in Group B, minimum 0 and maximum 900 ml with a mean of 97 ml and p value of 0.147 with no statistically significant difference in bile leak in test and control groups. The minimum and maximum serous drainage in Group A was nil & 80 ml (mean 11 ml) and in Group B was nil & 270 ml (mean 72.50 ml). The p value came as 0.028 which is statistically significant. Thus serous leakage in Group A was significantly less than in Group B. The drains in Group A were removed from 2 to 4 days (mean: 3 days) while in Group B from 2 to 9 days (mean: 3.9 days). The patients in Group A stayed in hospital post operatively from 3 to 8 days (mean: 5.30) while in Group B it ranged from 3 to 10 days with a mean of 5 days. Conclusion: Fibrin glue application on CBD decreases bile leakage but in statistically insignificant manner. Fibrin glue application on CBD can significantly decrease post operative serous drainage after LCBDE. Fibrin glue application on CBD is safe and easy technique without any significant adverse effects and can help less experienced surgeons performing LCBDE.

Keywords: bile leak, fibrin glue, LCBDE, serous leak

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Authors: Irene Kretchy, Frances Owusu-Daaku, Samuel Danquah

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Hypertension is the leading risk factor for cardiovascular diseases, and a major cause of death and disability worldwide. This study examined whether psychosocial variables influenced patients’ perception and experience of side effects of their medicines, how they coped with these experiences and the impact on mental health and medication adherence to conventional hypertension therapies. Methods: A hospital-based mixed methods study, using quantitative and qualitative approaches was conducted on hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms, and coping mechanisms with the aid of standard questionnaires. Information from the quantitative phase was analyzed with the Statistical Package for Social Sciences (SPSS) version 20. The interviews from the qualitative study were audio-taped with a digital audio recorder, manually transcribed and analyzed using thematic content analysis. The themes originated from participant interviews a posteriori. Results: The experiences of side effects – such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion - were categorized as no/low (39.75%), moderate (53.0%) and high (7.25%). Significant relationships between depression (x 2 = 24.21, P < 0.0001), anxiety (x 2 = 42.33, P < 0.0001), stress (x 2 = 39.73, P < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association are reported – depression [OR = 1.9 (1.03 – 3.57), p = 0.04], anxiety [OR = 1.5 (1.22 – 1.77), p = < 0.001], and stress [OR = 1.3 (1.02 – 1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95% CI 1.07 – 1.85), p = 0.04] with social factors, media influences and attitudes of primary caregivers further explaining this relationship. The personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments, and interventions made by clinicians were the main forms of coping with side effects. Conclusions: Results from this study show that contrary to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The result offers more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care. Additionally, medication side effects should be considered as a possible cause of non-adherence among hypertensive patients, thus addressing this problem from a Biopsychosocial perspective in any intervention may improve adherence and invariably control blood pressure.

Keywords: biopsychosocial, hypertension, medication adherence, psychological disorders

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Authors: Phusit Phukamchanoad, Bua Srikos

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Research aimed to study the characteristics of a community in the social, economical and cultural context. This research used interviews and surveys members in Patthana Soi Ranongklang community, Dusit District, Bangkok. The results are as follows: In terms of overall conditions and characteristics, Patthana Soi Ranongklang community is located on the property of Treasury Department. 50 years ago the location of this community consisted of paddy fields with limited convenience in terms of transportation. Rama V Road was only a small narrow road with only three-wheelers and no buses. The majority of community members moved in from Makkhawan Rangsan Bridge. Thus, most community members were either workers or government officials as they were not the owners of the land. Therefore, there were no primary occupations within this 7 acres of the community. The development of the community started in 1981. At present, the community is continuously being developed and modernization is rapidly flowing in. One of the reasons was because main roads were amended, especially Rama V Road that allows more convenient transportation, leading to heightened citizens’ convenience. In terms of the economy and society, the research found out that the development and expansion of Rama V Road cause a change in the conditions of the area and buildings. Some building were improved and changed along the time, as well as the development of new facilities that cause the community members to continually become more materialistic. Jobs within the community started to appear, and areas were improved to allow for new building and housing businesses. The trend of jobs become more in variety, in terms of both jobs at home, such as workers, merchandizing, and small own businesses, and jobs outside the community, which became much more convenient as car drivers are used to the narrow roads inside the community. The location of the community next to Rama V Road also allows helo from government agencies to reach the community with ease. Moreover, the welfare of the community was well taken care of by the community committee. In terms of education, the research found that there are two schools: Wat Pracharabuedham School and Wat Noi Noppakun School, that are providing education within the community. The majority of the community received Bachelor degrees. In areas of culture, the research found that the culture, traditions, and beliefs of people in the community were mainly transferred from the old community, especially beliefs in Buddhism as the majority are Bhuddists. The main reason is because the old community was situated near Wat Makut Kasattriyaram. Therefore, the community members have always had Buddhist temples as the center of the community. In later years, more citizens moved in and bring along culture, traditions, and beliefs with them. The community members also took part in building a Dharma hall named Wat Duang Jai 72 Years Ranong Klang. Traditions that community members adhere to since the establishment of the community are the New Year merit making and Songkran Tradition.

Keywords: social capital, culture, Patthana Soi Ranongklang community, way of life

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Authors: Cristian Cazacu, Bela Kobulniczky

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Even though nowadays the median area of the Bucharest’s Sector 1 owns one of the best reputations in terms of quality of life level, the problems in urban planning from the last twenty years, as well as those related to the urban environment, became more and more obvious and shrill. And all this happened as long as non-compliance with urban and spatial planning laws, corroborated with uncontrolled territorial expansion on certain areas and faulty management of public and private spaces were more acute. The action of all these factors has been felt more and more strongly in the territory in the last twenty years, generating the degradation of the quality of the urban environment and affecting in parallel the general level of the inhabitants¬’ quality of life. Our methodology is based on analyzing a wide range of environmental parameters and it is also based on using advanced resources and skills for mapping planning and environmental dysfunctions as well as the possibility of integrating information into GIS programs, all data sets corroborated with problems related to spatial planning management and inaccuracies of the urbanistic sector. In the end, we managed to obtain a calculated and realistic image of the dysfunctions and a quantitative view of their magnitude in the territory. We also succeeded to create a full general map of the degree of degradation of the urban environment by typologies of urban tissues. Moreover, the methods applied by us can also be used globally to calculate and create realistic images and intelligent maps over the quality of the environment in areas larger than this one. Our study shows that environmental degradation occurred differently in the urban tissues from our study area, depending on several factors, reviewing the faulty way in which the processes of recovery / urban regeneration of the gap in recent years have led to the creation of new territorial dysfunctions. The general, centralized results show that the analyzed space has a much wider range of problems than initially thought, although notoriety and social etiquette place them far above other spaces from the same city of study.

Keywords: environment, GIS, planning, urban tissues

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Authors: Esmat Kamel

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This paper aims to shed light on the extent to which the Agadir Association agreement has fostered inter regional trade between the E.U_26 and the Agadir_4 countries; once that we control for the evolution of Agadir agreement’s exports to the rest of the world. The next valid question will be regarding any remarkable variation in the spatial/sectoral structure of exports, and to what extent has it been induced by the Agadir agreement itself and precisely after the adoption of rules of origin and the PANEURO diagonal cumulative scheme? The paper’s empirical dataset covering a timeframe from [2000 -2009] was designed to account for sector specific export and intermediate flows and the bilateral structured gravity model was custom tailored to capture sector and regime specific rules of origin and the Poisson Pseudo Maximum Likelihood Estimator was used to calculate the gravity equation. The methodological approach of this work is considered to be a threefold one which starts first by conducting a ‘Hierarchal Cluster Analysis’ to classify final export flows showing a certain degree of linkage between each other. The analysis resulted in three main sectoral clusters of exports between Agadir_4 and E.U_26: cluster 1 for Petrochemical related sectors, cluster 2 durable goods and finally cluster 3 for heavy duty machinery and spare parts sectors. Second step continues by taking export flows resulting from the 3 clusters to be subject to treatment with diagonal Rules of origin through ‘The Double Differences Approach’, versus an equally comparable untreated control group. Third step is to verify results through a robustness check applied by ‘Propensity Score Matching’ to validate that the same sectoral final export and intermediate flows increased when rules of origin were relaxed. Through all the previous analysis, a remarkable and partial significance of the interaction term combining both treatment effects and time for the coefficients of 13 out of the 17 covered sectors turned out to be partially significant and it further asserted that treatment with diagonal rules of origin contributed in increasing Agadir’s_4 final and intermediate exports to the E.U._26 on average by 335% and in changing Agadir_4 exports structure and composition to the E.U._26 countries.

Keywords: agadir association agreement, structured gravity model, hierarchal cluster analysis, double differences estimation, propensity score matching, diagonal and relaxed rules of origin

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Authors: Anders Schou Simonsen, Kim Sorensen, Thomas Condra

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Wet scrubbers are used for flue gas desulfurization by injecting water directly into the flue gas stream from a set of sprayers. The water droplets will flow freely inside the scrubber, and flow down along the scrubber walls as a thin wall film while reacting with the gas phase to remove SO₂. This complex multiphase phenomenon can be divided into three main contributions: the continuous gas phase, the liquid droplet phase, and the liquid wall film phase. This study proposes a complete model, where all three main contributions are taken into account and resolved using OpenFOAM for the continuous gas phase, and MATLAB for the liquid droplet and wall film phases. The 3D continuous gas phase is composed of five species: CO₂, H₂O, O₂, SO₂, and N₂, which are resolved along with momentum, energy, and turbulence. Source terms are present for four species, energy and momentum, which are affecting the steady-state solution. The liquid droplet phase experiences breakup, collisions, dynamics, internal chemistry, evaporation and condensation, species mass transfer, energy transfer and wall film interactions. Numerous sub-models have been implemented and coupled to realise the above-mentioned phenomena. The liquid wall film experiences impingement, acceleration, atomization, separation, internal chemistry, evaporation and condensation, species mass transfer, and energy transfer, which have all been resolved using numerous sub-models as well. The continuous gas phase has been coupled with the liquid phases using source terms by an approach, where the two software packages are couples using a link-structure. The complete CFD model has been verified using 16 experimental tests from an existing scrubber installation, where a gradient-based pattern search optimization algorithm has been used to tune numerous model parameters to match the experimental results. The CFD model needed to be fast for evaluation in order to apply this optimization routine, where approximately 1000 simulations were needed. The results show that the complex multiphase phenomena governing wet scrubbers can be resolved in a single model. The optimization routine was able to tune the model to accurately predict the performance of an existing installation. Furthermore, the study shows that a coupling between OpenFOAM and MATLAB is realizable, where the data and source term exchange increases the computational requirements by approximately 5%. This allows for exploiting the benefits of both software programs.

Keywords: desulfurization, discrete phase, scrubber, wall film

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Authors: Mahnaz Jafari, Parisa Izadpanahi, Francesco Mancini, Muhammad Qureshi

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The advancement in Information Technology (IT) has been an intrinsic element in the developments of the 21st century bringing benefits such as increased economic productivity. However, its widespread application has also been associated with inadvertent negative impacts on society and the environment necessitating selective interventions to mitigate these impacts. This study responded to this need by developing a Green IT Rating Tool (GIRT) for higher education institutions (HEI) in Australia to evaluate the sustainability of IT-related practices from an environmental, social, and economic perspective. Each dimension must be considered equally to achieve sustainability. The development of the GIRT was informed by the views of interviewed IT professionals whose opinions formed the basis of a framework listing Green IT initiatives in order of their importance as perceived by the interviewed professionals. This framework formed the base of the GIRT, which identified Green IT initiatives (such as videoconferencing as a substitute for long-distance travel) and the associated weighting of each practice. The proposed sustainable Green IT model could be integrated into existing IT systems, leading to significant reductions in carbon emissions and e-waste and improvements in energy efficiency. The development of the GIRT and the findings of this study have the potential to inspire other organizations to adopt sustainable IT practices, positively impact the environment, and be used as a reference by IT professionals and decision-makers to evaluate IT-related sustainability practices. The GIRT could also serve as a benchmark for HEIs to compare their performance with other institutions and to track their progress over time. Additionally, the study's results suggest that virtual and cloud-based technologies could reduce e-waste and energy consumption in the higher education sector. Overall, this study highlights the importance of incorporating Green IT practices into the IT systems of HEI to contribute to a more sustainable future.

Keywords: green information technology, international higher-educational institution, sustainable solutions, environmentally friendly IT systems

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Authors: P. Uma Devi, S. Sujith, K. Rahul, T. S. Dipu, V. Anil Kumar , Vidya Menon

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Introduction: Candida is an important cause of bloodstream infections (BSIs), causing significant mortality and morbidity. The epidemiology of Candida infection is also changing, mainly in relation to the number of episodes caused by species Candida non-albicans. However, in India, the true burden of candidemia is not clear. Thus, this study was conducted to evaluate the clinical characteristics, species distribution, antifungal susceptibility and outcome of candidemia at our hospital. Methodology: Between January 2012 and April 2014, adult patients with at least one positive blood culture for Candida species were identified through the microbiology laboratory database (for each patient only the first episode of candidemia was recorded). Patient data was collected by retrospective chart review of clinical characteristics including demographic data, risk factors; species distribution, resistance to antifungals and survival. Results: A total of 165 episodes of Candida BSI were identified, with 115 episodes occurring in adult patients. Most of the episodes occurred in males (69.6%). Nearly 82.6% patients were between 41 to 80 years and majority of the patients were in the intensive care unit (65.2%) at the time of diagnosis. On admission, 26.1% and 18.3% patients had pneumonia and urinary tract infection, respectively. Majority of the candidemia episodes were found in the general medicine department (23.5%) followed by gastrointestinal surgery (13.9%) and medical oncology & haematology (13%). Risk factors identified were prior hospitalization within one year (83.5%), antibiotic therapy within the last one month (64.3%), indwelling urinary catheter (63.5%), central venous catheter use (59.1%), diabetes mellitus (53%), severe sepsis (45.2%), mechanical ventilation (43.5%) and surgery (36.5%). C. tropicalis (30.4%) was the leading cause of infection followed by C. parapsilosis (28.7%) and C. albicans (13%). Other non-albicans species isolated included C. haemulonii (7.8%), C. glabrata (7%), C. famata (4.3%) and C. krusei (1.7%). Antifungal susceptibility to fluconazole was 87.9% (C. parapsilosis), 100% (C. tropicalis) and 93.3% (C. albicans). Mortality was noted in 51 patients (44.3%). Early mortality (within 7 days) was noted in 32 patients while late mortality (between 7 and 30 days) was noted in 19 patients. Conclusion: In recent years, candidemia has been flourishing in critically ill patients. Comparison of data from our own hospital from 2005 shows a doubling of the incidence. Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious BSI. High index of suspicion and sensitive diagnostics are essential to improve outcomes in resource limited settings with emergence of non-albicans Candida.

Keywords: antifungal susceptibility, candida albicans, candidemia, non-albicans candida

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Authors: Sobia Shafqat, Saeed Ahmad Qaisrani

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MicroRNAs play an essential role in the regulation and development of all processes in most eukaryotes because of their prospective part as mediators controlling cell growth and differentiation towards the exact position of RNAs response in plants under biotic and abiotic factors or stressors. In a few cases, Zn is oblivious poisonous for plants due to its heavy metal status. Some other metals are extremely toxic, like Cd, Hg, and Pb, but these elements require in rice for the programming of genes under abiotic stress resembling Zn stress when micro RNAs268 was importantly introduced in rice. The micro RNAs overexpressed in transgenic plants with an accumulation of a large amount of melanin dialdehyde, hydrogen peroxide, and an excessive quantity of Zn in the seedlings stage. Let out results for rice pliability under Zn stress micro RNAs act as negative controllers. But the role of micro RNA268 act as a modulator in different ecological condition. It has been explained clearly with a long understanding of the role of micro RNA268 under stress conditions; pliability and practically showed outcome to increase plant sufferance under Zn stress because micro RNAs is an intervention technique for gene regulation in gene expression. The proposed study was experimented with by using genetic factors of Zn stress and toxicity effect on rice plants done at District Vehari, Pakistan. The trial was performed randomly with three replications in a complete block design (RCBD). These blocks were controlled with different concentrations of genetic factors. By overexpression of micro RNA268 rice, seedling growth was not stopped under Zn deficiency due to the accumulation of a large amount of melanin dialdehyde, hydrogen peroxide, and an excessive quantity of Zn in their seedlings. Results showed that micro RNA268 act as a negative controller under Zn stress. In the end, under stress conditions, micro RNA268 showed the necessary function in the tolerance of rice plants. The directorial work sketch gave out high agronomic applications and yield outcomes in rice with a specific amount of Zn application.

Keywords: micro RNA268, zinc, rice, agronomic approach

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Authors: Fortune Mangara

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The world is undergoing the largest wave of urban growth in history due to rapid urbanization. Africa’s fast rate of urbanization is being driven by several factors such as population growth and migration. Urbanization results in development pressure on existing infrastructure, and numerous existing buildings are being destroyed in the process. Many of these buildings are built by environmental heritage resources which are part of the city's heritage and are therefore valuable. Many built environment heritage resources are currently being destroyed due to development pressure, while others are facing the risk of destruction or abandonment. There are different approaches that inform urban development and urban conservation. The modernist and post-modernist dichotomy has played an influencing role on how development or conservation of built environment heritage resources are approached. The fragmented nature of historical urban conservation paradigms and theories are also reflected in the evolution of policy and legislation that guide urban development and conservation of built heritage resources. Urban development and conservation have a long history of being guided by separated policies and legislation. However, recent international and South African policy and legislation had started to acknowledge the importance of integrating urban development and urban conservation. Spatial planning guides urban development and can be used as an integrative tool. With the aforementioned in mind, the main research question that guides this study is: What role does spatial planning play in the coexistence of urban development and urban conservation in a city in transition? The main purpose of this research is to use spatial planning as a tool for integrating urban conservation and urban development with reference to built environmental heritage resources. A qualitative research methodology is going to be employed in which a singular case study will be used as the research design. A qualitative document analysis will be used to collect data. Potchefstroom is going to be used as a case study as it is the oldest town in the North West province therefore is rich in built environmental heritage resources.

Keywords: built environmental heritage resources, document analysis, spatial planning, urban conservation, urban development

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Authors: Aparecida De Fatima Dutra, Freddie Avant, Wilma Cordova

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People living with HIV/AIDS (PLWHA) have benefited from advances in treatment. Medical costs are a challenge for some, but the real challenge is the stigma and discrimination PLWHA continue to face, even though the disease has festered for the last four decades. Few studies regarding stigma and discrimination give voice to those affected by these practices. This study provides a voice to PLWHA in Brazil and in the US as to how they perceive stigma and discrimination, as well as services they access. The methodology of this study was designed based on phenomenological research, which is a research that aims to identify what individuals facing the same situation have to share about their experiences. Qualitative research using in- depth interviews was used in order to gather participants’ perceptions about services they access, and stigma and discrimination they experience as PLWHA (hypothesis). The target population was a minority group of 13 Afro-descendant men, mean age of 48.3, residents in East Texas, United States and Salvador, Brazil. Our findings indicate that in both countries, overall, participants have reasonable access to medication and qualified services, except for some specialties, such as dentistry. With regard to stigma and discrimination the majority of participants have not disclosed their diagnosis. They state they prefer not to disclose for fear of being ostracized and rejected. Participants who did reveal their status indicate that stigma and discrimination is a daily occurrence. These experiences tend to occur within their own families, neighborhoods, and in public health agencies where HIV/AIDS is not the focus. Participants who did offer suggestions for social change indicated they would have to reveal their status even if it means being stigmatized and discriminated against. Other factors contributing to this discrimination include skin color and poverty. This study concludes that even after decades since the spread of this epidemic, nothing has changed regarding stigma and discrimination towards PLWHA. Lack of awareness, empathy and education continue to be a major challenge, not only at a local level but across the globe. In conclusion, as documented in previous studies while stigma and discrimination towards this population prevail, negative attitudes will continue to jeopardize all individuals from receiving equal access to prevention, treatment and care. It is crucial to face stigma and discrimination not only as individual experiences, but as social practices that violate and restrict human rights and that as a result, reinforce inequality and social exclusion. Policies should be at the forefront to eliminate the stigma and discrimination PLWHA experience. Health professionals and societies must take a stand in order to promote mindfulness about the negative effect of oppression towards individuals living with HIV/AIDS and the potential global impact of these practices.

Keywords: discrimination, HIV/AIDS, human rights, stigma

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Authors: Kirsten Wilson, Patrick M. Brauer, Sandra Babic, Diana Golubeva, Jessica Van Eyk, Tinya Wang, Avanti Karkhanis, Tim A. Le Fevre, Andy I. Kokaji, Allen C. Eaves, Sharon A. Louis, , Nooshin Tabatabaei-Zavareh

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Long-lived plasma cells are rare, non-proliferative B cells generated from antibody-secreting cells (ASCs) following an immune response to protect the host against pathogen re-exposure. Despite their therapeutic potential, the lack of in vitro protocols in the field makes it challenging to use B cells as a cellular therapeutic tool. As a result, there is a need to establish robust and reproducible methods for the generation of B cells. To address this, we have developed a culture system for generating B cells from hematopoietic stem and/or progenitor cells (HSPCs) derived from human umbilical cord blood (CB) or pluripotent stem cells (PSCs). HSPCs isolated from CB were cultured using the StemSpan™ B Cell Generation Kit and produced CD19+ B cells at a frequency of 23.2 ± 1.5% and 59.6 ± 2.3%, with a yield of 91 ± 11 and 196 ± 37 CD19+ cells per input CD34+ cell on culture days 28 and 35, respectively (n = 50 - 59). CD19+IgM+ cells were detected at a frequency of 31.2 ± 2.6% and were produced at a yield of 113 ± 26 cells per input CD34+ cell on culture day 35 (n = 50 - 59). The B cell receptor loci of CB-derived B cells were sequenced to confirm V(D)J gene rearrangement. ELISpot analysis revealed that ASCs were generated at a frequency of 570 ± 57 per 10,000 day 35 cells, with an average IgM+ ASC yield of 16 ± 2 cells per input CD34+ cell (n = 33 - 42). PSC-derived HSPCs were generated using the STEMdiff™ Hematopoietic - EB reagents and differentiated to CD10+CD19+ B cells with a frequency of 4 ± 0.8% after 28 days of culture (n = 37, 1 embryonic and 3 induced pluripotent stem cell lines tested). Subsequent culture of PSC-derived HSPCs increased CD19+ frequency and generated ASCs from 1 - 2 iPSC lines. This method is the first report of a serum- and feeder-free system for the generation of B cells from CB and PSCs, enabling further B lineage-specific research for potential future clinical applications.

Keywords: stem cells, B cells, immunology, hematopoiesis, PSC, differentiation

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Authors: Violina Angelova, Krasimir Ivanov, Stefan Krustev, Dimitar Dimitrov

Abstract:

Availability of a metal is characterised by its quantity transgressing from soil into different extractants or by its content in plants. In literature, the terms 'available forms of compounds' and 'mobile' are often considered as equivalents of the term 'accessible' to plants. Rapid and a sufficiently reliable method for defining the accessible for plants forms turns out to be their extraction through different extractants, imitating the functioning of the root system. As a criterion for the pertinence of the extractant to this purpose usually serves the significant statistic correlation between the extracted quantities of the element from soil and its content in plants. The aim of this work was to evaluate the effectiveness of various extractions (DTPA-TEA, AB-DTPA, Mehlich 3, 0.01 M CaCl₂, 1M NH₄NO₃) for the determination of bioavailability of heavy metals in industrially polluted soils from the metallurgical activity near Plovdiv and Kardjali, Bulgaria. Quantity measurements for contents of heavy metals were performed with ICP-OES. The results showed that extraction capacity was as follows: Mehlich 3>ABDTPA>DTPA-TEA>CaCl₂>NaNO₃. The content of the mobile form of heavy metals depends on the nature of metal ion, the nature of extractant and pH. The obtained results show that CaCl₂ extracts a greater quantity of mobile forms of heavy metals than NH₄NO₃. DTPA-TEA and AB-DTPA are capable of extracting from the soil not only the heavy metals participating in the exchange processes but also the heavy metals bound in carbonates and organic complexes, as well as bound and occluded in oxide and secondary clay minerals. AB-DTPA extracts a bit more heavy metals than DTPA-TEA. The darker color of the solutions obtained with AB-DTPA indicates that considerable quantities organic matter are being destructed. A comparison of the mobile forms of heavy metals extracted from clean and highly polluted soils has revealed that in the polluted soils the greater portion of heavy metals exists in a mobile form. High correlation coefficients are obtained between the metals extracted with different extractants and their total content in soil (r=0.9). A positive correlation between the pH, soil organic matter and the extracted quantities of heavy metals has been found. The results of correlation analysis revealed that the heavy metals extracted by DTPA-TEA, AB-DTPA, Mehlich 3, CaCl₂ and NaNO₃ correlated significantly with plant uptake. Significant correlation was found between DTPA-TEA, AB-DTPA, and CaCl₂ with heavy metals concentration in plants. Application of extracting methods contains chelating agents would be recommended in the future research onthe availabilityof heavy metals in polluted soils.

Keywords: availability, chemical extractants, heavy metals, mobile forms

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Authors: E. V. Fakhrutdinova, Y. S. Kolesnikova, E. A. Karasik, V. M. Zagidullina

Abstract:

Poverty as the social and economic phenomenon exists in any society and represents a many-sided problem. In this sense it is universal and for many centuries serves as a research objects for scientists. Special attention to a problem of poverty in Russia is caused, first of all, by the critical growth of inequality and by scales of expansion of poverty, considerable decrease in the level and quality of life of the population, decrease in availability of education during the period of reforming. The expansion of poverty on the working members of society, youth, which has to provide reproduction of the population is alarming. As poverty is the reason of weakening of national security of the country, degradation of the population, decline in the quality of the human capital, complication of a demographic situation, strengthening of social contradictions in society, so far as the reduction of poverty, so, the increase in production. Poverty: the characteristic of an economic situation of the individual or social group at which they can't satisfy certain minimum requirements necessary for life, preservations of working capacity and reproduction. Poverty became one of the critical factors expelling people from the system of the institutional interactions reducing social space in which their relations were building breaking their social identity. Complication of the problem of poverty in modern society happened due to penetration of the related relations into many spheres of life. It is known that negative consequences of poverty display not only at the personal level of the poor person, but also at the level of interpersonal social interactions, decline in the quality and level of development of the human capital, and also at social and economic system in general. We conducted a research on the influence of education on the change of poverty level of the population. We consider education as a resource for an increase of the income and social mobility. Dependence of the income of the population on the level of education, availability of education (level of education and quality of education) on the level of income of families is found. Differentiation of quality and number of educational services for children depending on the level of the income of families is revealed. Influence of a factor of poverty on the availability of education is also studied. We consider expenses on education as the limiter of access to education. We consider education as a factor of fixation and aggravation of a property inequality. In the solution of problems of poverty the defining condition is the state regulation of social and economic development by means of creation of the effective institutional environment. The state has to develop measures for an increase of availability of various services to all categories of citizens, in particular services of health care and education, especially for poor citizens enters. The special attention regarding an increase of availability of education services has to be paid to creation of system of social elevators.

Keywords: poverty, education, human capital, quality of life

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